Establishment of two forensic medicine OSCE stations on the subject of external post-mortem examination.

An improvement in quality of medical external post-mortem examinations among others can be achieved by more intensive training of medical students. Modern learning and teaching methods such as e-learning modules and SkillsLab stations should be used for this. The introduction of corresponding methods of assessment such as the OSCE procedure is necessary to test the success of learning. In Halle (Germany), two OSCE stations on the subject of external post-mortem examinations were introduced in 2016. The 'practical external post-mortem examination' station test skills and abilities students have learned during practical external post-mortem examination in small group classes on a simulation doll. At the 'death certificate' station, an original death certificate must be filled in, testing the knowledge, skills and abilities learned in the SkillsLab station and during e-learning. A total of 148 students took part in the test. At both stations, at least two thirds of the students (69.5 and 81.7%) were able to show good or very good test results. In addition to the strengths, a detailed evaluation of the test results showed that there were still deficits in terms of the corresponding courses (e.g. inspection of the neck region in the small group classes), which will have to be remedied in the future. When analysing the test concept and the test implementation, objectivity was nearly perfect. There was a satisfactory internal consistency and stability over 8 months. Ultimately, in addition to several strengths (such as good understanding and transparency of the checklists) the evaluation of the examiners also showed further potential areas for improvement (e.g. harmonisation of the degree of difficulty for the individual rotations) when designing the OSCE stations. Overall, it was possible to determine that the OSCE testing format is a suitable tool to test external post-mortem examination skills and that conclusions about improvements in teaching can also be drawn from this.

[Legal medicine specialists within the framework of acute care : Analysis of legal medicine consultations in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt]. / Der Rechtsmediziner im Rahmen der Akutversorgung : Analyse rechtsmedizinischer Konsile in Relation zur Opferstatistik des Landeskriminalamtes Sachsen-Anhalt.

BACKGROUND: In acute medical care, there are patients who have been injured by the influence of others. The aim of this study was to analyze all cases which were presented to the Institute for Legal Medicine of the University Halle (Saale). The cases where analyzed in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt. MATERIALS AND METHODS: The consultations of the Institute for Legal Medicine Halle-Wittenberg for 2012-2015 were evaluated with regard to the age and gender distribution, the reasons for the consultation and time until the request for consultations. These cases were statistically compared to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt 2014-2015. RESULTS: A total of 536 cases (55.6% male and 44.4% female patients) were evaluated. In all, 62.1% of patients were under 18 years of age; 43.5% of all consultations were requested by pediatric (surgery) clinics. The most common reasons for consultation were sexual child abuse or violence against children (50.7%). Compared to the victims' statistics, significantly more children were examined by legal medicine specialists than could have been expected (p < 0.001). In adult patients, the most common causes for consultation were acts of violence (20.4%) and domestic violence (10.1%). Among adults, significantly more women and fewer men were presented than expected (p = 0.001). CONCLUSION: There were only a small number of consultations of legal medicine specialists in relation to the victims' statistics. Most of them were children and women. The temporal latency between the act of violence and the consultations was one day and more. The latency and the renunciation of the consultation of the legal medicine specialists can lead to loss of evidence.

Injury pattern and the biomechanical assessment of skull fracture risk in blows with a rubber mallet.

Acts of violence often result in blunt force trauma. On behalf of the court, forensic experts not only have to assess injuries in terms of morphology or severity, but they also have to give statements regarding the risk of potential fatal injuries. We describe a case of domestic violence where a man hit the head of his wife using a rubber mallet. His wife sustained extensive and multiple parietal scalp lacerations and avulsions with exposure of the cranial bone. A CCT revealed neither skull fractures nor intracranial injuries. Biomechanical measurements were performed using a bowling ball and an animal head representing head surrogates. In comparison to steel hammer impacts we hypothesized longer contact durations and lower maximum contact forces in blows with a rubber mallet. However, contact durations in the magnitude of 3ms do not confirm our hypothesis. The contact forces calculated based on mallet and animal head accelerations were between 2.97kN and 4.68kN. These force values are rather below the parietal fracture thresholds, explaining the absence of parietal skull fractures in the case presented. Moreover, the relatively low Young's modulus comes along with a deformation of the rubber mallet and a decrease in contact pressure. In summary, contact times could be reliably estimated, while contact forces remained largely uncertain.

Munich Oktoberfest experience: remarkable impact of sex and age in ethanol intoxication.

Approximately 5,000 of 6 million annual visitors of the Oktoberfest in Munich have to undergo medical treatment. Patients with alcohol intoxication without trauma or further complications are all treated in a specialized medical camp. We studied these patients in order to identify risk factors and to assess the relevance of the Glasgow Coma Score (GCS) and of ethanol blood concentrations for patient management. In 2004 totally 405 patients suffering from ethanol intoxication without trauma were treated in the medical camp. A complete set of the following data was obtained from all 405 patients: GCS, ethanol blood concentration, age, sex, blood pressure (mean, systolic and diastolic), body temperature, heart rate, blood sugar, GOT, gamma-GT, and CK. A multivariate logistic regression model was applied to identify risk factors predicting patients at increased risk of hospitalization. Low GCS (< or =8 vs. >8, OR: 4.18, CI: 1.96-8.65) low age (20-29 vs. > or =30 years, OR: 2.35, CI: 1.05-5.65) and male gender (male vs. female, OR: 3.58, CI: 1.36-9.34) independently predicted patients that had to be hospitalized. All other parameters including ethanol blood concentrations were not explanatory. Patients with GCS < or = 8 (n = 66) had a lower median blood pressure (P = 0.0312) and showed a smaller increase in blood pressure during the observation period compared to patients with GCS > 8 (P < 0.001), suggesting that this subgroup may require longer recovery periods. Men aged 20-29 years were at highest risk for hospital admission. Increased risk could not be explained by higher ethanol blood concentrations in this subgroup. Importantly, GCS < 6 does not justify endotracheal intubation in ethanol intoxicated patients, when further complications, such as trauma, can be excluded.

Objective structured clinical examination "Death Certificate" station - Computer-based versus conventional exam format.

One option for improving the quality of medical post mortem examinations is through intensified training of medical students, especially in countries where such a requirement exists regardless of the area of specialisation. For this reason, new teaching and learning methods on this topic have recently been introduced. These new approaches include e-learning modules or SkillsLab stations; one way to objectify the resultant learning outcomes is by means of the OSCE process. However, despite offering several advantages, this examination format also requires considerable resources, in particular in regards to medical examiners. For this reason, many clinical disciplines have already implemented computer-based OSCE examination formats. This study investigates whether the conventional exam format for the OSCE forensic "Death Certificate" station could be replaced with a computer-based approach in future. For this study, 123 students completed the OSCE "Death Certificate" station, using both a computer-based and conventional format, half starting with the Computer the other starting with the conventional approach in their OSCE rotation. Assignment of examination cases was random. The examination results for the two stations were compared and both overall results and the individual items of the exam checklist were analysed by means of inferential statistics. Following statistical analysis of examination cases of varying difficulty levels and correction of the repeated measures effect, the results of both examination formats appear to be comparable. Thus, in the descriptive item analysis, while there were some significant differences between the computer-based and conventional OSCE stations, these differences were not reflected in the overall results after a correction factor was applied (e.g. point deductions for assistance from the medical examiner was possible only at the conventional station). Thus, we demonstrate that the computer-based OSCE "Death Certificate" station is a cost-efficient and standardised format for examination that yields results comparable to those from a conventional format exam. Moreover, the examination results also indicate the need to optimize both the test itself (adjusting the degree of difficulty of the case vignettes) and the corresponding instructional and learning methods (including, for example, the use of computer programmes to complete the death certificate in small group formats in the SkillsLab).

Y-SNP-genotyping - a new approach in forensic analysis.

Y-chromosomal DNA polymorphisms, especially Y-STRs are well established in forensic routine case work. The STRs are used for identification in paternity deficiency cases and stain analysis with complicate mixtures of male and female DNA. In contrast, Y-chromosomal SNPs are a new tool in forensic investigations. At present, Y-SNPs are mainly used in molecular anthropology for evolutionary studies. Nevertheless, these markers could also provide very useful information for the analysis of forensic cases. The aim of the presented study was to test Y-SNP-typing for stain analyses using different methods-SNaPshot and MALDI-TOF MS. Both methods are based on the principle of minisequencing. The selected Y-SNP markers are suited to define the most important European haplogroups.

Population data of Y-chromosomal STRs in Lithuanian, Latvian and Estonian males.

Data of nine Y-chromosomal STRs, the so called "extended core set", were obtained from 152 unrelated males from Lithuania, 145 from Latvia and 133 from Estonia. The haplotype data reported here have been included into the Y-STR database maintained at the Institute of Legal Medicine, Humboldt-University, Berlin.

Child neglect and forensic entomology.

Close co-operation between forensic scientists, medico-legal doctors, and police forces made it possible to estimate not only the post-mortem interval but also the time since a child was neglected. On the skin surface under the diaper (anal-genital area), third instar larvae of the false stable fly Muscina stabulans FALLEN, and the lesser house fly Fannia canicularis L. were found. F. canicularis adults are attracted to both feces and urine. From the face, larvae of the bluebottle fly Calliphora vomitoria L. were collected. C. vomitoria maggots are typical early inhabitants of corpses. From the developmental times of the flies, it was estimated that the anal-genital area of the child had not been cleaned for about 14 days (7-21 day range), and that death occurred only 6-8 days prior to discovery of the body. This is the first report where an examination of the maggot fauna on a person illustrated neglect that had occurred prior to death.

Population genetics of ACTBP2 (SE33) in Western Saxony (Germany).

In order to apply a useful STR system we performed a population study in Western Saxony (Germany). The allele distribution was investigated in a sample of 431 unrelated adults. In addition, 170 families from routine paternity cases were examined for the presence of meiotic mutations, and two mutations were observed.

Population genetics of Y-chromosomal microsatellites in Baltic males.

Y-chromosomal microsatellites (STRs) are potentially useful in forensic practice but, in contrast to autosomal systems, large and diverse population databases are required in order to facilitate the statistical evaluation of donor-stain matches. Since appropriate data from the Baltic region have so far been lacking, blood samples were obtained from 430 males originating from one of the three Baltic states and these samples were genotyped using a previously described "extended core set" of nine Y-STR marker systems. Allele frequency distributions and discrimination indices were calculated, and the three populations were tested for genetic differences by means of analysis of molecular variance (AMOVA). A larger genetic difference became apparent between Estonian and both Lithuanian and Latvian males than between the latter two, non-Finno-Ugric speaking populations. The haplotype data reported here have been included into the Y-STR database maintained at the Institute of Legal Medicine, Humboldt University, Berlin.

16 X-chromosome STR loci frequency data from a German population.

Allele frequencies for 16 X-linked STRs, suitable for forensic purposes, were obtained from a sample of unrelated German individuals (male and female). The presented data show also repeat sequence structures and statistic parameters describing there information content.

A new method for the evaluation of matches in non-recombining genomes: application to Y-chromosomal short tandem repeat (STR) haplotypes in European males.

A 9-locus microsatellite framework (minimal haplotype), previously developed for forensic purposes so as to facilitate stain analysis, personal identification and kinship testing, has been adopted for the establishment of a large reference database of male European Y-chromosomal haplotypes. The extent of population stratification pertaining to this database, an issue crucial for its practical forensic application, was assessed through analysis of molecular variance (AMOVA) of the 20 regional samples included. Despite the notion of some significant haplotype frequency differences, which were found to correlate with known demographic and historic features of Europeans, AMOVA generally revealed a high level of genetic homogeneity among the populations analyzed. Owing to their high diversity, however, accurate frequency estimation is difficult for Y-STR haplotypes when realistic (i.e. moderately sized) datasets are being used. As expected, strong pair-wise and higher order allelic associations were found to exist between all markers studied, implying that haplotype frequencies cannot be estimated as products of allele frequencies. A new extrapolation method was therefore developed which treats haplotype frequencies as random variables and generates estimates of the underlying distribution functions on the basis of closely related haplotypes. This approach, termed frequency 'surveying', is based upon standard population genetics theory and can in principle be applied to any combination of markers located on the Y-chromosome or in the mitochondrial genome. Application of the method to the quality assured reference Y-STR haplotype database described herein will prove very useful for the evaluation of positive trace-donor matches in forensic casework.

Online reference database of European Y-chromosomal short tandem repeat (STR) haplotypes.

The reference database of highly informative Y-chromosomal short tandem repeat (STR) haplotypes (YHRD), available online at http://ystr.charite.de, represents the largest collection of male-specific genetic profiles currently available for European populations. By September 2000, YHRD contained 4688 9-locus (so-called "minimal") haplotypes, 40% of which have been extended further to include two additional loci. Establishment of YHRD has been facilitated by the joint efforts of 31 forensic and anthropological institutions. All contributing laboratories have agreed to standardize their Y-STR haplotyping protocols and to participate in a quality assurance exercise prior to the inclusion of any data. In view of its collaborative character, and in order to put YHRD to its intended use, viz. the support of forensic caseworkers in their routine decision-making process, the database has been made publicly available via the Internet in February 2000. Online searches for complete or partial Y-STR haplotypes from evidentiary or non-probative material can be performed on a non-commercial basis, and yield observed haplotype counts as well as extrapolated population frequency estimates. In addition, the YHRD website provides information about the quality control test, genotyping protocols, haplotype formats and informativity, population genetic analysis, literature references, and a list of contact addresses of the contributing laboratories.

Individualisation of dental tissue--an aid for odontological identification?

The introduction of new methods in forensic diagnostics, especially serological techniques, including the use of individual markers for identification is becoming increasingly important. The DNA techniques are particularly promising and dental tissue, especially dental pulp, is a good source of DNA because it is well protected against autolysis. Gc-subtyping and application of DNA techniques for identification were reported in 1992 and show the efficacy of PCR systems for the individualisation of dental tissues. In cases of optimal conditions-room temperature and dry air-the analysis was successful after 6 or 12 months and the results could be used for identification. Under the influence of high temperature autolysis occurs and the pulp degrades making DNA typing almost impossible. The experiments show that the system HLA-DQ alpha is more reliable than the system MCT 118 and the results confirm that these techniques can be used for identification of unknown persons in some cases. The methods are only usable if comparative material belonging to the subject, such as hair, is available.

[Suicidal chloroform poisoning]. / Suizidale Chloroformintoxikation.

The results of the autopsy and of the toxicological analysis of a suicidal poisoning case by chloroform inhalation of a man (28) are described. The cause of death was acute cardiac failure, accompanied by centrolobular liver necroses. Quantitative analytical results (e.g. blood 47, liver 188, kidney 144, brain 74, urine 2 ug/ml, determined by head space GC were in agreement with literature data. The low concentration in stomach content indicated inhalation in accordance to the findings on site.

Does the quality of dental images depend on patient's age and sex ?- Explanations from the forensic sciences.

The objective of this analysis was to investigate the dependency of image quality of dental panoramic radiographs on patient's age and sex, and to demonstrate that forensic science can explain these relationships. The image qualities of 100 dental panoramic radiographs obtained from 50 patients with two devices were assessed by ten independent observers of different specialisations. Image quality decreased with increasing age of the patients (P=0.003). One of the devices turned out to be superior to the other; however, this difference between the devices was present only in older patients but not in young ones (P=0.03). Image quality was higher in women than in men (P=0.01). The observed influences of age and sex are explained by results of forensic investigations concerning age-related changes of the dental pulp and sex differences of the skull geometry. Thus forensic science can elucidate effects relevant for everyday clinical practice. Studies on dental image quality must consider age and sex of the patients.

Oncogene-blocking therapies: new insights from conditional mouse tumor models.

Identification of oncogene dependent signaling pathways controlling aggressive tumor growth has led to the emergence of a new era of oncogene-blocking therapies, including Herceptin and Gleevec. In the recent years conditional mouse tumor models have been established that allow switching-off the expression of specific oncogenes controlling tumor growth. The results may have two important implications for oncogene-blocking therapies: (i) downregulation of oncogenes, for instance HER2, MYC, RAS, RAF, BCR-ABL or WNT1, usually leads to a rapid tumor remission. However, it was observed that the initial remission was followed by recurrent tumor growth in most studies. Interestingly, different oncogenes controlled tumor growth in the recurrent than in the primary tumors. This could explain the astonishing clinical observation that inhibitors of a broader spectrum of protein kinases (so-called: "dirty inhibitors") may be superior over highly specific substances. Due to their additional "unspecific" inhibition of a broader spectrum of kinases, they may hamper the escape mechanisms by antagonizing also the pathways controlling recurrent tumor growth. (ii) Experiments with cell systems that allow switching-on oncogene expression point to a so far possibly underestimated cancer drug target: the dormant tumor cell. Oncogene expression (for instance: NeuT or RAS) led to a phenomenon named oncogene-induced senescence or dormancy. Dormant cells are unresponsive to mitogenic stimuli. Importantly, such cells are not at all ready to die, but can remain viable for extended periods of time. Recently, dormant tumor cells have been shown to be more resistant to stresses such as hypoxia or exposure to cytostatic drugs. It still is a matter of debate if and under which conditions dormant tumor cells can be "kissed to life". If these cells contribute to carcinogenesis, it will be important to identify substances specifically killing senescent cells. This review will focus on the possible relevance of senescence both as a pre-oncogenic condition and also for therapy.

Forensic Applications of Y-Short Tandem Repeats.

Y-short tandem repeats (STRs) are located in the nonrecombining part of the Y-chromosome. Its genetic characteristics are helpful to paternity testing. The male lineage can be pursued over several generations. Since an overwhelming majority of rape or sexual assault cases involve male suspects, these markers proved to be very useful with mixed stains. Routine casework performed in our laboratory has demonstrated that Y-STRs analysis can detect minimal amounts of male DNA in a stain. Analysis of Y-STRs should be conducted even when preliminary tests for the presence of sperms are negative or when the analysis of autosomal STRs shows no male component in the mixed stains.

Y chromosome polymorphisms and haplotypes in west Saxony (Germany).

In order to apply a set of useful and high polymorphic Y-STRs in paternity testing, we performed a population genetic study from Saxony. The allele distributions of the systems DYS19, DYS385, DYS389I/II and DYS390 were investigated in a sample of 250 unrelated males from the area of Leipzig. PCR products were detected using native polyacrylamide gel electrophoresis as well as capillary electrophoresis and GenScan Software on the ABI Prism 310 DNA sequencer. Haplotype frequency data of 164 different types were obtained which show that these four systems are very useful for special cases of paternity and forensic stain analysis. In addition several confirmed father-son pairs were examined using the paternity cases of the institute. One mutation was found in the system DYS390 and sequencing data are presented.

[Disasters in former East Germany--experiences and problems of the Leipzig "Identification" Task Group]. / Untersuchungen bei Massenunfällen in der ehemaligen DDR--Erfahrungen und Probleme der Leipziger Arbeitsgruppe "Identifikation".

Mass-disasters with high numbers of victims are a real challenge to the specialists. The role of forensic experts is generally emphasized. The missions of the Leipzig Taskgroup for identification and the experience gained during them confirm, that special training necessary staff members is. Compared with the general signs of identity, like clothing, jewelry and accessories, scars etc., the marks of ears and observations of forensic odonto-stomatology provide good chances for identification. For forensic odonto-stomatology, we developed computer programs.