Detrimental effects of scene manipulations on temperature-based time since death estimation.

In forensic casework, time since death (TSD) estimations may play a crucial role to establish chains of events as well as for alibi assessment in homicide cases. Classical TSD estimation relies on reasonably stable ambient temperatures and a correct documentation of ambient and rectal temperatures. This constancy is in some cases disturbed by post-discovery alterations of the crime scene, e.g. opening a window. In order to develop a better understanding of this alteration-based detrimental impact on TSD estimation as well as to identify feasible recommendations for casework, the present pilot study examined ambient temperature effects of different window opening scenarios regarding various time intervals (5 to 360 min) in a furnished 10 m2 apartment during winter. In this context, in addition to the ambient temperature and thus the cooling rate of the room, re-approximation to initial room temperature, potential influences on a nomogram-based time since death estimation using a fictitious case, and the impact of the measurement height above the ground were investigated. Our data indicate a significant reduction of the mean temperature decrease rate after 15 min regardless of the remaining opening time and a correlation with the size of the respective opening surfaces. Re-approximation to initial room temperatures was observed with up to three times longer than the initial opening time. There was no evidence of a substantial advantage of temperature measurements above the level of the corpse (> 0.1 m). The limitations of the study and its applicability for forensic casework are critically reviewed.

Atypical wound trajectory after a tangential pistol shot.

Three intermediate-range shots from a Browning, model 1955, 7.65 mm caliber, pistol were fired from the driver's seat of a car at a woman in the passenger seat. She sustained three wounds: An, ultimately fatal, penetrating head wound, a graze wound across her forehead, and a tangential, perforating, wound, with bullet entry over the medial sternum and exit through the right flank. Neither postmortem CT nor forensic autopsy discovered bony thoracic injuries or perforations of the thoracoabdominal cavities. There was pulmonary contusion in the medial lobe of the right lung and hemorrhage in the adipose tissue around the right kidney. The tangential bullet had left an almost 40-cm-long wound channel through a pronounced layer of subcutaneous fat. Based on 3D reconstructed CT-data determinations, a straight bullet trajectory between entry and exit wounds would have traversed the abdominothoracic cavities, right lung, and liver. The actual trajectory, however, described a prominent curve, without signs of deflection by bone. Postulated explanations for this unusual bullet track are that the woman was twisting her body in a dynamic scene when the bullet struck; further, due to its shallow angle of incidence on the skin, the bullet was deflected to an intracutaneous path. Additionally, soft tissue resistance may have caused the bullet to yaw. Caution should, thus, be exercised when reconstructing bullet trajectories solely from entry and exist wounds, also for bullet wounds through basically homogenous soft tissues.

Gunshots through laminated glass: expelled compounded fragments as a function of bullet type.

In the frame of an experimental setting, the formation of round-shaped compounded glass fragments on the exit site after gunshots through a windshield was examined. For that purpose, a 9 × 19 mm pistol (HK P30) and two different cartridges containing (a) a full metal jacketed round-nosed projectile and (b) a deformation projectile were used. On the basis of 52 gunshots, the morphology, impact angles and terminal ballistics of occurring compounded glass fragments were examined. The results showed that the compounded glass fragments' morphology allowed for the differentiation of two used projectiles. Fragments were able to cause round-shaped defects in a single cotton layer (T-shirt) with subsequent penetration of up to 2.4 cm into ballistic gelatin (10%, 4 °C). As a function of the projectile type, the compounded glass fragments showed different reproducible impact angles that differed notably from the known conical pattern of expelled glass fragments after bullet penetration. These findings might help to explain the atypical morphology of gunshot wounds with laminated glass as an intermediate target and prevent possible misinterpretations when reconstructing the sequence of events.

Postmortem fluorescence angiography of the explanted human heart.

Within the scope of this technical report, the feasibility of indocyanine green (ICG) as a fluorescent agent for postmortem angiography of the heart is tested. The study included 4 deceased persons with no respective medical history of heart diseases. The basic patterns of findings in ICG fluorescence angiography associated with healthy hearts are presented. The method can easily be integrated into a workflow without restricting the macroscopic or histologic diagnostics. This paper represents the fundamental technical and analytical basis for upcoming studies concerning the possibilities and limitations of fluorescence angiography in the diagnosis of heart pathology.

Application of the "bubbling" procedure to dead body portraits in forensic identification.

PURPOSE: A procedure is needed for bodies with disfiguring injuries to the face and the use of their portrait for visual identification. METHOD: We present the application of a simple image processing procedure, otherwise known as "bubbling," which is based on the concept of "perceptual filling-in," to images for visual identification in the forensic context. The method is straight forward and can be performed using readily available software and hardware.. RESULTS: The method is demonstrated and examples are shown. The visual recognition of known persons using "bubbled" images was successfully tested. CONCLUSION: The "bubbling" procedure for visual identification enhancement is quick and straightforward and may be attempted before escalating to more involved identification methods and procedures.

Relative blood loss in forensic medicine-do we need a change in doctrine?

In forensic medicine, blood loss is encountered frequently, either as a cause of death or as a contributing factor. Here, risk to life and lethality assessment is based on the concept of relative blood loss (absolute loss out of total volume). In emergency medicine, the Advanced Trauma Life Support (ATLSⓇ) classification also refers to relative blood loss. We tested the validity of relative blood loss benchmarks with reference to lethality. Depending on the quality of the total blood volume (TBV) estimation formula, relative blood loss rates should be reflected in the case cohort as significantly higher absolute blood loss in heavier individuals since all TBV estimation formulas positively correlate body weight with TBV. METHOD: 80 autopsy cases with sudden, quantifiable, exclusively internal blood loss were retrospectively analyzed and a total of 8 different formulas for TBV estimation were applied. RESULTS: No statistical correlation between body weight and absolute blood loss was found for any of the tested TBV estimation algorithms. All cases showed a wide spread of both absolute and relative blood loss. DISCUSSION: The principle of relative blood loss is of very limited use in casework. It opens the forensic expert opinion to unnecessary criticism and possible negative legal implications. CONCLUSION: We challenge the use of relative blood loss benchmarks in textbooks and practical casework and advocate for its elimination from the ATLSⓇ 's grading system. If necessary, we recommend the use of BMI-adjusted algorithms for TBV estimation.

Mongolian spots as a finding in forensic examinations of possible child abuse-implications for case work.

Mongolian spots (MS) are congenital dermal conditions resulting from neural crest-derived melanocytes migration to the skin during embryogenesis. MS incidences are highly variable in different populations. Morphologically, MS present as hyperpigmented maculae of varying size and form, ranging from round spots of 1 cm in diameter to extensive discolorations covering predominantly the lower back and buttocks. Due to their coloring, which is also dependent on the skin type, MS may mimic hematoma thus posing a challenge on the physician conducting examinations of children in cases of suspected child abuse. In the present study, MS incidences and distribution, as well as skin types, were documented in a collective of 253 children examined on the basis of suspected child abuse. From these data, a classification scheme was derived to document MS and to help identify cases with a need for recurrent examination for unambiguous interpretation of initial findings alongside the main decisive factors for re-examination such as general circumstances of the initial examination (e. g., experience of the examiner, lighting conditions) and given dermatological conditions of the patient (e. g., diaper rash).

Feasibility of an accelerated PVAL method for the collection of GSR and biological traces.

The polyvinyl alcohol method (PVAL) is known as an effective technique to thoroughly collect traces of gunshot residue (GSR) from different surfaces, e.g., from hands or gunshot wounds. Despite obvious advantages over other methods using adhesive tapes, PVAL is still not widely accepted and applied in routine case work due to a required acquisition time of at least 15 to 20 min for a single shooting hand. In this study, the feasibility of a modified procedure taking 6 to 8 min per sample is tested within the frame of an experimental setting including (1) the collection of GSR from experimental gunshots with a semi-automatic pistol and lead-containing primer ammunition and (2) a simple experimental setting involving dry and moist artificial blood traces. In a third step, samples of four gun-associated suicide cases and one attempted suicide case were taken and analyzed. Furthermore, an exemplary implementation into a work flow of modern instrumental techniques of GSR analysis is presented.

Time since death nomographs implementing the nomogram, body weight adjusted correction factors, metric and imperial measurements.

The concept of nomography was developed around 1880 as a means to compute formulas graphically. Regular use has decreased over time in most fields, mainly owing to progress in electronic computation devices. In forensic pathology, nomography is still used in the so-called "nomogram method" for the estimation of time since death. It is the graphical representation of the formula by Marshall and Hoare with the parameters of Henssge. Here, two nomograms exist (for ambient temperatures below and above 23 °C, no imperial measurements). Rounding for body weight input and result reading introduces errors. In addition, correction factors, applied to body weight, allow to adapt for certain conditions on the crime scene and are essential to the method. They are not directly integrated into the nomograms but must be applied in advance. A formula, scaling correction factors for different body weights, was later added by Henssge, along with a simplified table for case work. In this publication, we present newly designed time since death nomographs as representations of Henssge's parameters with the addition of both metric and imperial measurements, integration of weight adjusted scaling of correction factors, and a geometrically consistent framework for body weight and result reading, which eliminates some rounding steps and reduces the overall rounding-related estimation errors.

Detectability, visualization, and DNA analysis of bloodstains after repainting the walls.

A recurrent observation in forensic casework is that culprits and/or their abettors attempt to remove or mask bloodstain patterns, e.g., by painting the walls. The present study was designed to elucidate whether luminol treatment of bloodstains on (a) plastered and (b) wallpapered walls may help with the visualization of respective patterns after being repainted beyond macroscopic recognition. Furthermore, wallpaper punches of luminol-positive spots were analyzed for DNA. The experiments showed that the prospects for visualization after a four- to sixfold paint application declined considerably as the drying time of the paint increased. A compelling explanation for this observation is that paint becomes increasingly resistant to water during the drying process after paint application. In these cases, moistening the surface in question with distilled water for 15 min has been proven to be a promising pretreatment before luminol application. DNA analysis revealed full STR profiles in 74% of luminol-positive wallpaper punches, whereas rubs of the aforementioned positively tested regions (luminol and human blood pretests) demonstrated negative results.

Effect of anticoagulation therapy on drying times in bloodstain pattern analysis.

In forensic case work, blood stain pattern analysis frequently aids in deducing the chain of actions or parts thereof taking place during an event leading to blood loss. Wiped single blood stains and/or groups of blood stains are seen at a majority of complex crime scenes. The appearance of wiped blood stains depends on droplet volume and stain age (as a function of blood viscosity and the degree of stain skeletonization) and characteristics of the stained surface (i.e., texture, temperature). Furthermore, based on the biochemical and biophysical properties of blood, not only the drying processes, but also complex coagulation cascades are relevant to the assessment of wiped blood stains. This study was designed to determine if anticoagulation therapies markedly affect the wipeability of blood stains over times elapsed since deposition and the overall drying process. A total of 813 blood stains, originating from donors being treated with acetylsalicylic acid (ASA), clopidogrel + ASA, low-molecular-weight heparin, or rivaroxaban, were dropped on common household tiles. Wipeability at an ambient temperature of 20 °C was tested for 22 time periods (1, 2, 3, 5, 10, 15…105 min since deposition). Whereas stains consisting of untreated blood were dried within 55 min, wipeability of all droplets originating from donors with prior anticoagulation treatment showed pronounced delays compared with the control, ranging from 20 min (ASA and clopidogrel + ASA) to 45 min (rivaroxaban). This pronounced effect was not seen in earlier studies, which might be explained by the higher volume of droplets used in this study, which resulted in a shift in relevance from drying to clotting processes. Significant differences between the drying times of the various anticoagulation regimes might be attributed to anticoagulant activity against different targets in the coagulation cascades. In conclusion, anticoagulation treatment prior to blood loss significantly affected the wipeability of blood stains. Anticoagulation therapy should therefore be taken into account in the analysis of blood stain patterns.

Interdisciplinary teaching and training - A medicolegal specialty.

The Frankfurt model is described to exemplify the teaching and training concepts implemented at the Institute of Legal Medicine in Frankfurt am Main up to 2015. The Frankfurt model describes a comprehensive, networked teaching system aiming at an interdisciplinary training. Interdisciplinarity is a domain of forensic medicine as a broadly diversified subject related to various scientific disciplines. The importance of the medicolegal triad (research, teaching, services) rooted in the university setting, on which the success of this interdisciplinary teaching and training concept is based, is illustrated. Sufficient funding is required to maintain this medicolegal triad, and the consequences of potential reductions due to fiscal reasons are outlined.

Bony injuries in homicide cases (1994-2014). A retrospective study.

Even when human skeletal remains are found in contexts indicative of body disposal after homicide, none of the bones may manifest injuries. When skeletons are incomplete, there are two possibilities, the injured bones are missing or none were injured. This leads to the question how frequently bones are injured during homicide, where the injuries tend to be placed, and whether the frequency of injury is related to the type of homicide. To answer these questions, the postmortem reports from all autopsies performed for homicide victims at the Institute of Legal Medicine at the University Hospital in Frankfurt am Main, Germany, between 1994 and 2014, were retrospectively evaluated for bony injuries discovered during autopsy. In 90 cases, a preliminary postmortem computed tomography (pmCT) examination had been performed. The cases were categorized into the following five groups by type of fatal trauma: blunt force, sharp force, gunshot injury, strangulation, or other. In total, the postmortem reports for 897 homicides (527 male, 370 female) were evaluated. The number of victims per trauma category were sharp force, 309; blunt force, 179; gunshot injury, 242; strangulation, 92; and other, 75. Bony injuries had been reported in 70.9 % of the homicides. The "gunshot" category contained the highest proportion of victims with bony injuries (92.6 %). With 80.4 %, the second-highest proportion of victims with bony injuries was in the "blunt force" category, followed by 66.3 % of victims in the "sharp force" group. In contrast, with 53.3 %, the second-lowest proportion of victims with bony injuries was in the "strangulation" category, which contained a preponderance of female victims, followed by 17.3 % of victims with bony injuries in the "other" category. Bony injuries thus occurred in the majority of homicides. Forensic osteological analysis should, therefore, always be performed on badly decomposed human remains. Where necessary, the additional use of visualization techniques, in particular, pmCT, or maceration may be considered. The absence of bony injuries does not rule out homicide; e.g., in strangulations, bony injuries are manifest in only half the victims, even when the skeleton is intact. The relevant structures are also easily lost to decomposition, scavenging, or scattering.

[Suicide and suicide tendencies in adolescent detainees]. / Suizid und Suizidalität unter adoleszenten Häftlingen.

Following accidents, suicide is the second leading cause of death in adolescence. This stage of life has the most suicide attempts of all age groups. In addition to mentally ill juveniles, adolescent delinquents represent a high-risk group for suicidal behavior and completed suicide. In particular, the population of detainees, an extreme form of juvenile delinquency, have a 16- to 18-fold higher risk of suicidal behavior and suicide compared to the general population. Because the composition of juvenile detainees differs greatly from that of detained adults, age-specific scientific approaches and prevention programs are needed. This task cannot be addressed by juvenile detention staff alone, but rather demands close cooperation between adolescent psychiatrists, psychologists, prison medical staff, legal experts and prison officers to use the opportunity for suicide prevention in juvenile detention facilities.

A literature study on the definition and history of the term "kidney shrinkage".

The term "kidney shrinkage", which is used in both pathological anatomy and clinical contexts, is not uniformly defined. In medicolegal practice, it is particularly important whether or not a cause of death can be inferred from this diagnosis. If this were the case, a shrunken kidney determined in a forensic autopsy would obtain the same significance as a competing cause of death. International medical journals and German-language textbooks were searched for definitions of the various terms used to denote this condition, and the definitions were reassessed. The term "kidney shrinkage" was found to have historical roots and has further evolved since the 19th century. Although the first use of the term could not be determined with certainty, Bright (1789-1858) appears to be one of the first to use it in describing kidney disease. Definitions given in modern textbooks are based on kidney function, size, or macromorphology. However, these definitions lack uniformity and are often unsubstantiated. Because of its evocative power, the use of the historically coined term "kidney shrinkage" appears justified, at least as part of the medicolegal practitioner's jargon, to describe kidneys that have an uneven surface, decreased renal parenchyma, and a weight of less than 80 g, even if the term does not allow deductions about the degree of renal insufficiency and, thus, the significance of kidney shrinkage as the cause of death. The evaluation of such aspects requires histological analysis or referral to the results of clinical chemistry analyses that may have been performed while the individual was still alive.

[True color accuracy in digital forensic photography]. / Über die Farbdetailtreue in der digitalen forensischen Fotografie.

Forensic photographs not only need to be unaltered and authentic and capture context-relevant images, along with certain minimum requirements for image sharpness and information density, but color accuracy also plays an important role, for instance, in the assessment of injuries or taphonomic stages, or in the identification and evaluation of traces from photos. The perception of color not only varies subjectively from person to person, but as a discrete property of an image, color in digital photos is also to a considerable extent influenced by technical factors such as lighting, acquisition settings, camera, and output medium (print, monitor). For these reasons, consistent color accuracy has so far been limited in digital photography. Because images usually contain a wealth of color information, especially for complex or composite colors or shades of color, and the wavelength-dependent sensitivity to factors such as light and shadow may vary between cameras, the usefulness of issuing general recommendations for camera capture settings is limited. Our results indicate that true image colors can best and most realistically be captured with the SpyderCheckr technical calibration tool for digital cameras tested in this study. Apart from aspects such as the simplicity and quickness of the calibration procedure, a further advantage of the tool is that the results are independent of the camera used and can also be used for the color management of output devices such as monitors and printers. The SpyderCheckr color-code patches allow true colors to be captured more realistically than with a manual white balance tool or an automatic flash. We therefore recommend that the use of a color management tool should be considered for the acquisition of all images that demand high true color accuracy (in particular in the setting of injury documentation).

So-called skin signs in acute pancreatitis.

Skin signs in acute necrotizing pancreatitis (e. g., Cullen's and Grey-Turner's sign) have been described in clinical medicine. The aim of the present study was to evaluate if, and how often, skin signs were noted in autopsy-confirmed cases of necrotizing pancreatitis. In a first step, the literature was extensively reviewed to establish which skin signs have so far been described in acute pancreatitis cases. As a second step, the reports of 16,000 autopsies performed at the Institutes of Legal Medicine in Frankfurt am Main and Giessen, Germany, were retrospectively evaluated. Twenty cases with necrotizing pancreatitis were found. In almost all of these, necrotizing pancreatitis was - either solely or in combination with other factors - the cause of death. In three cases, discolorations of the skin were found that were considered to be skin signs due to their location. At least in the evaluated medicolegal autopsy pool, skin signs in necrotizing pancreatitis thus appear to be a rare occurrence. Nevertheless, in cases of unexpected death, particularly of individuals with a history of alcohol abuse, necrotizing pancreatitis should be considered in the differential diagnosis of hematomas possibly attributed to trauma.

Simultaneous LC-MS/MS determination of JWH-210, RCS-4, ∆(9)-tetrahydrocannabinol, and their main metabolites in pig and human serum, whole blood, and urine for comparing pharmacokinetic data.

A series of new synthetic cannabinoids (SC) has been consumed without any toxicological testing. For example, pharmacokinetic data have to be collected from forensic toxicological case work and/or animal studies. To develop a corresponding model for assessing such data, samples of controlled pig studies with two selected SC (JWH-210, RCS-4) and, as reference, ∆(9)-tetrahydrocannabinol (THC) should be analyzed as well as those of human cases. Therefore, a method for determination of JWH-210, RCS-4, THC, and their main metabolites in pig and human serum, whole blood, and urine samples is presented. Specimens were analyzed by liquid-chromatography tandem mass spectrometry and multiple-reaction monitoring with three transitions per compound. Full validation was carried out for the pig specimens and cross-validation for the human specimens concerning precision and bias. For the pig studies, the limits of detection were between 0.05 and 0.50 ng/mL in serum and whole blood and between 0.05 and 1.0 ng/mL in urine, the lower limits of quantification between 0.25 and 1.0 ng/mL in serum and 0.50 and 2.0 ng/mL in whole blood and urine, and the intra- and interday precision values lower than 15% and bias values within ±15%. The applicability was tested with samples taken from a pharmacokinetic pilot study with pigs following intravenous administration of a mixture of 200 µg/kg body mass dose each of JWH-210, RCS-4, and THC. The cross-validation data for human serum, whole blood, and urine showed that this approach should also be suitable for human specimens, e.g., of clinical or forensic cases.

[Sauna deaths in Hesse, Germany, between 1994 and 2014]. / Saunatodesfälle in Hessen 1994-2014.

Due to the high ambient temperature, sauna deaths show a few confounding particularities, such as an accelerated onset of the postmortem changes, that can make correct assessment of the manner of death difficult and severely constrain the accuracy of post- mortem interval estimates. This retrospective study, performed at the medicolegal institutes in Hesse, Germany, reviewed all autopsy reports from the years 1994-2014 for sauna-related deaths. 9 relevant cases were found involving one woman and eight men aged between 52 and 80 years (mean and median value: 67 years). Of the individuals who had died of a natural cause, four were found to have had coronary heart disease, which, in the setting of heart hypertrophy and exposure to high temperatures, ultimately led to cardiac failure. In three other cases, a non-natural cause of death had been diagnosed; however, all were attributable to accidents. In two of these, blood alcohol concentrations (BAC) of over two per mil were found. In our opinion, the manner of death should be classified as undetermined in sauna-related fatalities. Such cases require a court-ordered autopsy to reliably identify the actual cause of death.

Genetic-epigenetic interaction modulates µ-opioid receptor regulation.

Genetic and epigenetic mechanisms play important roles in protein expression, although at different levels. Genetic variations can alter CpG sites and thus influence the epigenetic regulation of mRNA expression, providing an increasingly recognized mechanism of functional consequences of genetic polymorphisms. One of those genetic effects is the association of reduced µ-opioid receptor expression with the functional genetic variant N40D (OPRM1 118A>G, rs1799971) that causes an amino acid exchange in the extracellular terminal of the µ-opioid receptor. We report that the nucleotide exchange at gene position +118 introduces a new CpG-methylation site into the OPRM1 DNA at position +117. This leads to an enhanced methylation of the OPRM1 DNA at this site and downstream. This epigenetic mechanism impedes µ-opioid receptor upregulation in brain tissue of Caucasian chronic opiate addicts, assessed postmortem. While in wild-type subjects, a reduced signalling efficiency associated with chronic heroin exposure was compensated by an increased receptor density, this upregulation was absent in carriers of the 118G receptor variant due to a diminished OPRM1 mRNA transcription. Thus, the OPRM1 118A>G SNP variant not only reduces µ-opioid receptor signalling efficiency, but, by a genetic-epigenetic interaction, reduces opioid receptor expression and therefore, depletes the opioid system of a compensatory reaction to chronic exposure. This demonstrates that a change in the genotype can cause a change in the epigenotype with major functional consequences.