Photon-counting CT for forensic death investigations-a glance into the future of virtual autopsy.

This article explores the potential of photon-counting computed tomography (CT) in forensic medicine for a range of forensic applications. Photon-counting CT surpasses conventional CT in several key areas. It boasts superior spatial and contrast resolution, enhanced image quality at low x-ray energies, and spectral imaging capabilities that enable more precise material differentiation. These advantages translate to superior visualization of bone structures, foreign bodies, and soft tissues in postmortem examinations. The article discusses the technical principles of photon-counting CT detectors and highlights its potential applications in forensic imaging, including high-resolution virtual autopsies, pediatric forensic CT, trauma analysis, and bone density measurements. Furthermore, advancements in vascular imaging and soft tissue contrast promise to propel CT-based death investigations to an even more prominent role. The article concludes by emphasizing the immense potential of this new technology in forensic medicine and anthropology.

Post-mortem transmission risk of infectious disease: A systematic review.

INTRODUCTION: Autopsies may expose to infectious risks. The objective of this study is to assess the risk of post-mortem transmission of HIV, HBV, HCV, Mycobacterium tuberculosis (MBT), SARS-CoV2 and prion in the workplace and to estimate the duration of their infectiousness. MATERIAL AND METHOD: the PRISMA 2020 guideline was used. Pubmed, Web of Science, Google Scholar and Sciencedirect databases were assessed until February 28, 2023. We searched for articles in any language and any date of publication. Studies involving animals, transmission between two living people or transmission outside the workplace were excluded. Risk of bias was assessed using the appropriate assessment tools for each type of study. A descriptive analysis was performed. RESULTS: A total of 46 studies were included. Cases of post-mortem transmission were certain for HIV (n = 1) and MBT (n = 18). The longest post-mortem interval for positive diagnostic tests was 17 days for HIV, 60 for HBV, 7 for HCV, 36 for MBT and 17 for SARS-CoV2. The longest post-mortem interval for positive cultures was 21 h for HIV, 6 days for HBV, 36 days for MBT, 17 days for SARS-CoV2. The methodology of the studies was heterogeneous, some of them associated with a high risk of bias. CONCLUSION: There is a lack of consistent data in the literature concerning the infectivity of cadavers, except for MBT. Legislation appears to be based on minimizing contact between the biological agent and the professional. In the absence of recent robust scientific data, workers should systematically follow the best practice recommendations.

Fatal road traffic accidents and injuries: a preliminary study.

Road traffic accidents (RTAs) are a major public health problem globally and cause deaths, disability, and significant economic costs. In Italy, there was an increased number of road accidents, deaths, and injuries in 2022 compared to 2021, although still below pre-pandemic levels. A retrospective observational study was performed on a case series of 53 consecutive fatal RTAs examined by the Section of Forensic Medicine of Verona. The case series was divided, according to the type of victims involved, into pedestrians, car drivers, car passengers, and motorcyclists. For each, the times and causes of death, the distribution of external and internal injuries, and toxicological data were analysed, and the results were compared with those in the literature. Although this is a preliminary study on a small case series and lacks statistical validation, so more cases are needed, the preliminary results seem to provide a useful tool for assessing injuries in complex fatal road accidents.

Amyloid PET detects the deposition of brain Aß earlier than CSF fluid biomarkers.

INTRODUCTION: Understanding the relationship between amyloid beta (Aß) positron emission tomography (PET) and Aß cerebrospinal fluid (CSF) biomarkers will define their potential utility in Aß treatment. Few population-based or neuropathologic comparisons have been reported. METHODS: Participants 50+ years with Aß PET and Aß CSF biomarkers (phosphorylated tau [p-tau]181/Aß42, n = 505, and Aß42/40, n = 54) were included from the Mayo Clinic Study on Aging. From these participants, an autopsy subgroup was identified (n = 47). The relationships of Aß PET and Aß CSF biomarkers were assessed cross-sectionally in all participants and longitudinally in autopsy data. RESULTS: Cross-sectionally, more participants were Aß PET+ versus Aß CSF- than Aß PET- versus Aß CSF+ with an incremental effect when using Aß PET regions selected for early Aß deposition. The sensitivity for the first detection of Thal phase ≥ 1 in longitudinal data was higher for Aß PET (89%) than p-tau181/Aß42 (64%). DISCUSSION: Aß PET can detect earlier cortical Aß deposition than Aß CSF biomarkers. Aß PET+ versus Aß CSF- findings are several-fold greater using regional Aß PET analyses and in peri-threshold-standardized uptake value ratio participants. HIGHLIGHTS: Amyloid beta (Aß) positron emission tomography (PET) has greater sensitivity for Aß deposition than Aß cerebrospinal fluid (CSF) in early Aß development. A population-based sample of participants (n = 505) with PET and CSF tests was used. Cortical regions showing early Aß on Aß PET were also used in these analyses. Neuropathology was used to validate detection of Aß by Aß PET and Aß CSF biomarkers.

The under-recognition and significance of frailty syndrome - a geriatric and forensic conundrum.

Frailty syndrome occurs in elderly individuals with declining muscle mass (sarcopenia), unintentional weight loss, decreasing physical strength and activity, exhaustion, and slow ambulation. It significantly increases morbidity and mortality with cardiovascular, renal disease and neurological disorders, osteoporosis and fractures, endocrine and immunological dysfunction and a variety of malignancies. It is increasing in incidence as the population ages. However, unfortunately as identification relies on clinical and not pathological evaluations, its contribution to a wide range of comorbidities and its role in terminal episodes may not be recognized in a forensic context.

Multicystic encephalopathy: an ultimate manifestation of ischemic-hypoxic injury.

Multicystic encephalopathy is a rare neurological finding characterized by the appearance of multiple cystic or cavitary lesions as the result of repetitive episodes of hypoxic-ischemic injury in neonates and infants. We present a rare case of multicystic encephalopathy in a 3-month-old male, born at 34 weeks with Tetralogy of Fallot and multiple comorbidities. Gross examination of the brain during the autopsy revealed multiple irregular cystic lesions and distortion of the brain parenchyma. This case report highlights the uniqueness of multicystic encephalopathy and offers an extensive review of the existing literature, including etiology, clinical presentation, and histopathologic findings.

A Rare Case of Untreated Wilson's Disease in a Teen With Lethal Exit: Morphological Findings From an Autopsy Study.

Wilson's disease (WD) is an autosomal recessive genetic disorder caused by more than 50 different mutations in the APT7B gene. A defect in the gene product results in copper accumulation mainly in the liver, basal ganglia in the brain, cornea, kidneys, and heart, leading to dysfunction and eventually organ failure. We present a case of a 15-year-old male with a minority background who did not receive any form of treatment and ultimately succumbed to the disease. He was previously hospitalized due to suspected autoimmune-mediated acute liver failure (ALF) with positive antinuclear autoantibodies. Abdominal ultrasound revealed uneven contours and diffusely abnormal structure of the liver, interpreted as liver cirrhosis (LC), and splenomegaly. In view of WD as a potential differential diagnosis, a genetic consultation recommended the performance of genetic testing. The patient received symptomatic and corticosteroid therapy and was discharged from the hospital with improved general status. Three days later, the teen experienced deterioration and was readmitted to the hospital in a critical state. Reanimation measures had a temporary effect and ultimately exitus letalis was registered. The autopsy study revealed mixed micronodular and macronodular LC, chronic steatohepatitis, hepatosplenomegaly, ascites, icterus, gynecomastia, telangiectasias, subcutaneous hemorrhages, absence of male pattern body hair, hypogonadism, and chronic calculous cholecystitis as a result of untreated WD. Complications of the main disease appeared to be hepatorenal syndrome, severe bilateral purulent-hemorrhagic pneumonia probably with mixed etiology, acute cardiac failure with congestive changes in all internal organs, pleural and pericardial effusions, pulmonary edema, and cerebral edema with tonsillar herniation. The ATP7B gene sequencing supported the clinical diagnosis and the autopsy suspicion of WD, showing that the boy was homozygous for an H1069Q mutation.

Are multiple coders needed for cause of death assignment: results from telephonic verbal autopsy interviews conducted in 2021 in South Africa.

Introduction: Verbal autopsy (VA) methods have emerged to estimate causes of death in populations lacking robust civil registration and vital statistics (CRVS) systems. Despite World Health Organization endorsement of routine VA use, cost and efficiency concerns persist. Telephonic verbal autopsies (teleVAs) can reduce cost. Physician coding offers a valuable approach, but the expertise required makes it resource-intensive, often involving multiple coders for consensus. Objective: To assess inter-coder agreement for cause of death (CoD) in South African teleVAs using Kappa statistics, evaluating if agreement surpasses a 0.8 cut-off (very high) potentially allowing single coders. Methods: A cross-sectional study employed telephonic VA interviews on non-facility deaths in Cape Town (December 2020-September 2021). Trained fieldworkers administered a standard VA questionnaire. Each case's VA responses were reviewed independently by two physicians, medically certifying the CoD. A panel was used to solve disagreements. Cohen's kappa-statistic (k-statistic) tested agreement levels. Results: Decedents were aged between 18 and 98 years. In total, 228 teleVAs (16.6% response rate) were conducted. Physician coding agreement was good overall (k-statistic: 0.63). Diabetes mellitus (47%) and other non-communicable disease (42%) had initial agreement between physician coders in less than 50% of cases in comparison to consensus totals. COVID-19 (89%) and acute cardiac disease (83%) showed initial agreement in more than 80% of cases compared to consensus totals. A chi-square test revealed a significant difference in the number of causes listed on death notification forms for cases with and without agreement in Part 1 (χ2 = 14.71, p < 0.01), but not in Part 2 (χ2 = 4.97, p = 0.17). Conclusion: CoD agreement might not be high enough to infer that single coders can be used instead of multiple coders. Challenges with co-morbidities and specific CoDs with multiple sequelae highlight the need for further research and refinement of VA methodologies for reliable CoD determination in routine practice.

2,4-dinitrophenol intoxication and its morphological findings as an indication of substance intake.

Lethal intoxications can only very rarely be recognized during an external examination of corpses, as poisoning does not leave any characteristic findings on the deceased. The present study is a retrospective review on 2,4-dinitrophenol (2,4-DNP) intoxications in human subjects from the beginning of the 20th century until today, as well as a case report on a fatal intoxication of a 50-year old obese man in Rostock (Germany) and an introduction for toxicological analysis in post-mortem specimens of the substance ingested in these rare cases. Via selective literature search, the information on occurrence and localization of abnormal pathomorphological external and/or internal findings in cases of 2,4-DNP ingestion/ intoxication was gathered. By 2021, a total of 13 case reports with information on morphological findings due to 2,4-DNP ingestion/intoxication were found. The external findings were dominated by yellowing of the skin, followed by exanthemas/rashes and yellowing of the sclera. The internal findings included yellowing of the internal organs, yellow color of the stomach contents, yellowing of the mucous membranes and an intense yellow color of the urine. Yellowish discoloration of the skin, sclera, mucous membranes, internal organs, sweat and/or an intensive yellow discoloration of the urine are not observed in every 2,4-DNP intoxication. However, when they do occur, they are a characteristic indication of 2,4-DNP ingestion and, if localized to the skin, indicate prolonged consumption. A fatal case from Rostock in 2016 due to prolonged intake of 2,4-DNP for weight loss is exemplified. A simple, fast and cost-effective workup combined with HPLC-DAD for post-mortem toxicology ultimately delivers reliable analysis results.

Whole-body non-forensic fetal virtopsy using postmortem magnetic resonance imaging at 7 Tesla vs classical autopsy.

OBJECTIVE: To determine the diagnostic accuracy of virtual autopsy using whole-body postmortem ultra-high field magnetic resonance imaging (MRI) at 7 Tesla (T), using a short T2-weighted imaging (T2-WI) protocol, compared with classical autopsy, for detecting structural abnormalities in small second-trimester fetuses. METHODS: Thirty consecutive fetuses at 13-19 weeks' gestation (weight, 17-364 g) were included following spontaneous pregnancy loss or termination of pregnancy. After fixation in 10% formaldehyde solution (48 h to 1 week), all fetuses were scanned using a two-dimensional turbo high-resolution T2-WI protocol with multislice relaxation time, followed by an invasive autopsy. The diagnostic accuracy of virtual autopsy vs classical autopsy was calculated for 990 anatomical structures (30 fetuses × 33 items). Sensitivity, specificity, positive and negative predictive values and Cohen's κ coefficient of agreement, with their 95% CIs, as well as the McNemar test, were used to evaluate the accuracy and agreement of the two diagnostic methods. Analysis was stratified by anatomical segment (nervous, pulmonary, cardiovascular, digestive, renal, facial and skeletal) and across three gestational-age intervals (13-14, 15-16 and 17-19 weeks). RESULTS: Considering classical autopsy as the gold standard, virtual autopsy had a sensitivity of 92.04% (95% CI, 85.42-96.29%) and a specificity of 97.87% (95% CI, 94.64-99.42%), with a positive predictive value of 96.30% (95% CI, 90.78-98.56%) and a negative predictive value of 95.34% (95% CI, 91.61-97.45%), achieving a diagnostic accuracy of 95.68% (95% CI, 92.73-97.68%) for detecting structural abnormalities in second-trimester fetuses. Cohen's κ for virtual vs classical autopsy was 0.907. The diagnostic ability of virtual autopsy at 7 T for malformed fetuses was superior to that of classical autopsy for analyzing the nervous system in small fetuses with pronounced autolysis, equivalent to that of classical autopsy when analyzing pulmonary, cardiovascular and renal systems and inferior when evaluating the fetal intestines. The sensitivity of virtual autopsy at 7 T for describing structural abnormalities increased with gestational age. CONCLUSION: Virtual fetal autopsy using 7-T MRI and a turbo high-resolution T2-WI protocol with multislice relaxation time is a feasible postmortem diagnostic tool for the identification of fetal structural anomalies. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Sudden Infant Death Syndrome "Gray Zone" in Newborn with Pneumonia.

Sudden infant death syndrome (SIDS) "gray zone" or borderline cases are those in which it is challenging to define whether the pathological findings are sufficiently severe to lead to death. We report a case of a 17-day old male newborn who came to our attention for unexplained death. A complete autopsy was performed, including close examination of the cardiac conduction system. Lungs presented diffuse alveolar damage and chronic interstitial inflammation, the cardiac conduction system showed fetal dispersion, resorptive degeneration, junctional tissue islands and cartilaginous hypermetaplasia of the central fibrous body. The final cause of death was a "gray zone" SIDS. This case report will highlight the intersection of SIDS and pneumonia in newborns, exploring the challenges and controversies surrounding the diagnosis and management of this complex condition.

Road Fatalities in Children Aged 0-17: Epidemiological Data and Forensic Aspects on a Series of Cases in a Single-Centre in Romania.

INTRODUCTION: Road Traffic Accidents (RTAs) are the leading cause of premature death in young people aged 5-29. Globally, 186,300 children aged 9 years and under die from RTAs each year. Romania had the highest mortality rate in children aged 0 to 14 for 2018-2020. This study aimed to assess the involvement of children aged 0-17 years in fatal RTAs by analyzing medico-legal autopsy records in a 5-year period at Timisoara Institute of Legal Medicine (TILM), Romania. MATERIALS AND METHODS: A retrospective analysis of medico-legal autopsy records of road fatalities in children aged 0-17 years, from TILM in a 5-year period (2017-2021), was conducted. RESULTS: Of all medico-legal autopsies in the 5-year period, 23 cases (5.8%) involved road fatalities in children aged 17 and under. Preschoolers accounted for 10 cases, followed by the age group 15-17 years (n = 9). Most children sustained fatal injuries as passengers (n = 13), followed by child pedestrians (n = 7). This research follows four representative cases, each being a different type of child road fatality regarding the type of road user, the age of the victim, and the involvement of other risk factors. CONCLUSIONS: Our findings emphasize the tragedy of road fatalities in children and the need to determine risk factors and prevention strategies to reduce the enormous global crisis involving these vulnerable victims.

Paraquat Poisoning: Insights from Autopsy, Histology, and Liquid Chromatography with Tandem Mass Spectrometry in Multidisciplinary Forensic Toxicology Practice.

The herbicide paraquat (PQ) is responsible for a significant number of fatalities resulting from self-poisoning. Nevertheless, only a limited number of comprehensive studies focusing on fatal PQ poisoning, which include examination of autopsy findings, histopathology, and quantitative analysis of post-mortem samples, have been published. This study aimed to evaluate autopsy findings, histopathology, and quantitative analysis of PQ in post-mortem human serum samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS), a simple, sensitive, and specific method. Autopsies were performed on all deaths due to PQ poisoning, and serum samples were sent to the toxicology laboratory for chemical analysis. The method was successfully applied to seven human serum samples, and the results indicate its reliability for detecting PQ. The study reports fatal serum PQ levels ranging from 0.5 to 372.0 µg/mL. The comprehensive data presented in this study can be useful for further research and practical applications.

Third Trimester Stillbirth Associated With Hamartoma of Mature Cardiac Myocytes (HMCM).

Fetal primary cardiac tumors (FPCTs) are very rare. The majority of them correspond to cardiac rhabdomyomas, followed by other benign neoplasms or hamartomas. We describe the case of a third trimester female stillborn with an incidental autopsy finding of Hamartoma of Mature Cardiac Myocytes (HMCM), a rare benign cardiac tumor previously unreported in the fetal or neonatal period. The intrauterine demise occurred at 32 + 6 weeks gestation after an uneventful pregnancy. The fetal autopsy revealed a structurally normal heart with a small subendocardial nodule just below the membranous septum. Microscopically, the nodule was well-demarcated from the surrounding penetrating bundle of the conduction axis and the adjacent left ventricular myocardium and consisted of disorganized mature cardiac myocytes in a haphazard arrangement with patchy mild interstitial fibrosis, consistent with HMCM. Awareness that HMCM can occur in the fetus is important in order to consider it among the differential diagnosis of FPCTs.

Fetal Autopsy: Insights Into the Spectrum of Dysraphisms With Associated Anomalies.

Introduction and aim Malformations of the central nervous system (CNS) are one of the most devastating, yet most common congenital anomalies. Congenital CNS anomalies are structural or functional abnormalities of the brain and spinal cord that occur during the intrauterine developmental period and have a high intrauterine mortality. This study aimed to determine the frequency and distribution of neural tube defects (NTDs) in a tertiary care center for a period of 4.5 years. The neural tube defect was analyzed along with the other associated anomalies in the fetus. Its association with maternal risk factors was also analyzed. Materials and methods This retrospective study includes a total of 48 cases of neural tube defects, over a period of 4.5 years from January 2019 to June 2023, retrieved from the archives of the Department of Pathology at Saveetha Medical College. The study population included all fetuses diagnosed with NTDs during the fetal autopsies conducted at Saveetha Medical College during the period of study. The variables studied include maternal age, maternal risk factors, sex of the fetus, other associated anomalies in the fetus, and placental anomalies associated with the NTDs. Results A total of 48 cases of NTDs were included in this study. NTDs were more common among the female fetuses when compared with the male fetuses. The most common NTD observed in our study was anencephaly. The associated anomalies seen with NTDs include dysplastic kidney, unilateral renal agenesis, agenesis of urinary bladder, sacral agenesis, diaphragmatic hernia, bilateral talipes equinovarus deformity in both lower limbs. In the present study, among the placental defects seen in fetuses with NTDs, single umbilical artery was seen in four fetuses with NTDs. Twelve out of the 48 females included in the study did not take folic acid supplements during the antenatal period, and two females had a history of neural tube defects in their previous pregnancies. Conclusion  This study emphasizes that intensive screening and documentation of coexistent abnormalities of NTDs is needed. Either ultrasonography/MRI or fetal autopsy should be conducted in order to exhibit certain diagnoses and to conduct proper prenatal genetic counseling for parents with fetuses having NTDs or having a history of fetuses with NTDs regarding ongoing and future pregnancies.

Death Due to Caffeine and Methamphetamine Toxicity: A Case Report.

Caffeine (1,3,7-trimethylxanthine) is an over-the-counter psychostimulant that, when used in appropriate amounts, is generally considered safe. However, excessive use can cause various symptoms and, in severe cases, can even be life-threatening. A 34-year-old man with a reported history of psychiatric disorders was found unresponsive at his girlfriend's house and transported to an emergency department. He was presumed to have taken several caffeine pills and was pronounced dead approximately six hours later. There was no evidence of trauma or natural diseases at autopsy. Toxicology testing on hospital blood samples revealed toxic levels of caffeine and methamphetamine. After investigation of the circumstances surrounding the death and accounting for the autopsy and toxicology findings, the cause and manner of death were certified as combined caffeine and methamphetamine toxicity and accident, respectively. Lethal levels of caffeine have been reported when blood concentration exceeds 80 mg/L. Caution is needed to avoid excessive caffeine intake, especially when consumed in concentrated forms like tablets or powders. Caffeine should be used with care not only in cases of cardiovascular disease or genetic vulnerability but also for those with psychiatric disorders. Although deaths from caffeine are rare, they are consistently reported, necessitating attention and caution in its use.

Superimposed Imaging of Knife and Stab Wound Relationships Through Pre-autopsy and Intra-autopsy Computed Tomography Integration: A Case Report.

Three-dimensional (3D) reconstruction images using postmortem computed tomography (PMCT) are increasingly used to convey complex information to non-medical professionals, such as police and jurors. This case report demonstrates the effective use of 3D reconstruction images by integrating pre-autopsy, intra-autopsy, and knife CT data to achieve precise visualization of the wound path and associated injuries. The case involved a man in his 40s who was stabbed multiple times and pronounced dead approximately two hours after receiving emergency treatment. Initial PMCT revealed an intraperitoneal hemorrhage; however, no injuries to the abdominal organs or aorta were identified. During the autopsy, a critical abdominal aortic injury was discovered, prompting a further CT scan; however, the aorta remained in situ. By utilizing pre-autopsy, intra-autopsy, and knife CT data, the spatial relationships between the stab wound in the right hypochondriac area, aortic injury, and knife were effectively visualized. This novel approach highlights the potential of intra-autopsy CT for precise forensic visualization, offering a strategy for improvements in the accuracy and clarity of forensic evidence presentation.

Comparison of histopathological and triphenyl tetrazolium chloride test in diagnosing myocardial infarction: An autopsy study.

Background: Sudden and unexpected deaths are increasing drastically. The main cause of sudden death is cardiovascular disease, out of which coronary artery disease predominates forming 80% of the cases. Most of the time, detecting early changes in myocardial infarction during the autopsy is challenging since gross infarct changes do not appear until after 24 to 48 hours of myocardial ischemia injury. So, the aim of this study was to compare two test to detect early changes of Myocardial Infarction one by using Triphenyl Tetrazolium Chloride (TTC) staining of the myocardial tissue, during autopsy and other by histopathological examination. Methods: The sample size of 60 hearts taken from all the sudden deaths cases brought to Mortuary with suspected cause of death due to cardiac origin. The heart was obtained from the deceased by standard post-mortem technique. Serial full-thickness transverse sections of the heart were taken at 2 cm intervals from the apex to the atrioventricular groove. All the serial slices of heart are taken for histochemical staining and TTC staining. Results: In histopathological examination 34 hearts were diagnosed with myocardial infarction and 26 hearts reported non myocardial infarction. With TTC 40 hearts remained unstained suggestive of myocardial infarction and 20 hearts were stained suggestive of non-infarcted hearts. TTC staining in our study shows an accuracy of 88.33%. Conclusion: The result of this study shows that the Triphenyl Tetrazolium Chloride test, a histochemical staining technique of heart, is reliable approach for forensic pathologists to diagnose early myocardial infarction during the post-mortem examination.

Proteomics of severe SARS-COV-2 infection and paraquat poisoning in human lung tissue samples: comparison of microbial infected and toxic pulmonary fibrosis.

Introduction: Pulmonary fibrosis (PF) encompasses a spectrum of lung conditions characterized by the abnormal accumulation of scar tissue in the lungs, leading to impaired respiratory function. Various conditions can result in severe PF, among which viral infections have emerged as significant triggers. In addition to viral infections, exposure to toxic substances such as paraquat represents another significant risk factor for PF. Therefore, this study aimed to explore the dissimilarities and similarities between PF triggered by viral infections and chemical toxicants, using the mechanism of PF in IPF as a reference. Methods: Data-independent acquisition proteomics technology was employed to identify COVID-19 and paraquat-induced PF from the autopsy of lung tissue samples obtained from individuals who died due to PF. Bioinformatics was employed for differential protein analysis, and selected indicators were validated on pathological sections. Results: Our results showed that the differential proteins associated with the two causes of PF were enriched in similar lung fibrosis-related signaling pathways, such as the Wnt signaling pathway. However, differences were observed in proteins such as CACYBP, we verified the consistency of the results with proteomics using the IHC approach. Conclusion: This study illuminates distinct protein-level differences by investigating pulmonary fibrosis pathways in severe COVID-19 and paraquat poisoning. Although both conditions activate lung-protective and repair pathways, COVID-19 shows limited phosphorylation-independent ubiquitination of ß-catenin compared to paraquat toxicity. These findings shed light on potential therapeutic targets for PF induced via diverse factors.

FATAL: A Forensic AuTopsy Annotation tooL for digital recording of autopsy findings.

The findings from forensic autopsies, where cause of death must be established and reported to legal authorities, are reported in paper-based formats. Practitioners are required to map 3D injury findings to 2D space. Here, we design and describe a digital Forensic AuTopsy Annotation tooL (FATAL), that can be used by practitioners to record systematically detailed autopsy findings onto an interactive 3D body model. We employ a user-centred design process involving an expert forensic medicine team. We describe the iteration process and the final functionality determined, based on in-depth analyses of forensic clinical workflows, and feedback on the types of complex cases confronting practitioners. FATAL functions include freehand drawing, a layer system for injury categorisation, trajectory plotting, surface area markings, and point-of-interest marking. Relevant external images, such as investigative report or autopsy photographs, can be loaded into the FATAL tool and assigned to individual annotations. The application streamlines workflows, supports template-driven documentation, and collates all forensic data into a single interface. Findings from the digital tool can be exported to a 2D report (PDF). We highlight the advancements in accuracy, efficiency, and reproducibility afforded by a digital tool for forensic autopsy documentation. Potential applications in forensic medical examinations beyond autopsies are described, along with specific areas for extension, such as supporting touch screen and pen inputs, export for 3D printing models and extending the tool's compatibility with custom 3D body models.