Dental pattern diversity in a military population and its usefulness for assessing the degree of certainty in dental identification.

In forensic dentistry, the analysis of dental diversity forms the basis of probability calculations in dental identification. The present study aimed to contribute to the knowledge of dental diversity in a Spanish military population (considering isolated teeth, sets of different numbers of teeth, and combinations of teeth of forensic interest) and its implications for dental identification. A further aim was to compare the performance of three coding systems (detailed, generic, and binary) to assess dental pattern diversity. Dental diversity of a representative sample of the Spanish military population (3920 individuals aged between 18 and 55 years) was calculated according to a genetic (mitochondrial DNA) model in which diversity was defined as the likelihood that two randomly selected individuals in a sample would exhibit different patterns. By performing all pairwise comparisons of dental patterns in the dataset, the total number of matches was generated, and the diversity of dental patterns was then derived. First and third molars were the teeth that showed the highest levels of diversity, and a high diversity value (>0.99) was obtained with only 5 teeth (16, 36, 38, 46, and 48) when detailed coding was used. In addition, dental diversity in the full dentition and posterior teeth exceeded the threshold of 0.99 in all three coding systems. Although a very high diversity value (≥0.999) was only achieved with detailed coding, it should be noted that the generic coding system requires less time and skill to use, and can also provide high diversity values. Our findings show that further efforts should be made to establish large, periodically updated dental datasets of different populations in order to assess dental pattern diversity (without excluding third molars) based on empirical comparison, and to substantiate the certainty of dental identification.

Technical note: A mobile collaborative workspace to assist forensic experts in disaster victim identification scenarios.

Integrated approaches to disaster victim identification (DVI) management have led to a need for technologies to improve interaction among parties involved in post-mortem (PM) and ante-mortem (AM) data collection through better communication and coordination. Mobile Forensic Workspace© (MFW) is a collaborative mobile system that not only facilitates the systematic collection of high-quality data, but also allows DVI professionals to coordinate activities and exchange data through secure real-time communication at major disaster scenarios in accordance with security, privacy and legal protocols. MFW is adaptable to any communication format (text, voice calls, photographs, etc.) and is dynamically self-reconfigurable when connectivity problems arise. It also allows data integration and backup through secure communication channels between local and remote servers. The feasibility of the system has been demonstrated through implementation of MFW on the iOS platform for iPhone, iPod Touch and iPad terminals. A further strength of MFW is that it provides out-of-the-box support for INTERPOL DVI forms. The application of information and communication technologies for DVI was shown to be useful in improving DVI management by enhancing the quality of data collection and enabling non-Internet dependent real-time data sharing and communication.

Diferencias según el género en el perfil clínico de riesgo del paciente amputado de miembro inferior.

OBJETIVO: Analizar las diferencias según el sexo en el perfil clínico de riesgo de los pacientes amputados de miembro inferior por causa no traumática. MÉTODO: Estudio retrospectivo descriptivo con 697 pacientes amputados de miembro inferior por causa no traumática, en un Servicio de Angiología y Cirugía Vascular, durante un periodo de 5 años y divididos en función del sexo. Se analizaron variables demográficas (edad) y clínicas (causa, comorbilidad, factores de riesgo cardiovascular y nivel de amputación). RESULTADOS: La edad media (± desviación estándar) de las mujeres fue mayor (75.3 ± 12 frente a 68.9 ± 11 años; p < 0.001) y ellas presentaron mayor frecuencia de factores de riesgo cardiovascular concomitantes, tales como diabetes, hipertensión y obesidad, que los varones, mientras que ellos presentaron mayor frecuencia de tabaquismo. No hubo diferencia significativa entre sexos respecto a la distribución de las causas de amputación, siendo la principal causa la isquémica, destacando la arteriosclerosis. Las mujeres presentaron mayor frecuencia y predisposición para un nivel de amputación mayor. CONCLUSIONES: En nuestro estudio, las mujeres presentaron un perfil de riesgo cardiovascular más desfavorable y el sexo femenino fue un predictor independiente de amputación mayor de miembro inferior por causa no traumática. OBJECTIVES: To analyse the possible gender differences within the clinical risk profile of lower-limb amputee patients who had a non-traumatic amputation. METHOD: A retrospective study with 697 lower-limb amputee patients, classified according to their gender, has been conducted at the Angiology and Vascular Surgery Department for 5 years. The variables considered were demographic variables (age and gender) and clinic variables (cause of the amputation, comorbidity, cardiovascular risk factors and the amputation level). RESULTS: Regarding to the results, the average of women was older than men (75.3 ± 12 vs. 68.9 ± 11 years; p < 0.001), showing an increasing frequency to concomitant cardiovascular risk factors, such as diabetes, hypertension, and obesity. However, men present a higher frequency to smoking. There were no gender differences in the main cause of the amputation, the ischemic cause, being notably into this cause the subgroup of arteriosclerosis cause. Women showed a higher frequency and predisposition for major amputation. CONCLUSIONS: This study showed that women had a more unfavorable cardiovascular risk profile than men, being the female gender an independent predictor to a major lower-limb amputation with non-traumatic amputation.

Impacto del nivel socioeconómico sobre el perfil del paciente amputado de miembro inferior por causa no traumática / Impact of socioeconomic status on the clinical profile of patients with non-traumatic lower-limb amputation

INTRODUCCIÓN: Analizar la influencia del nivel socioeconómico (NSE) sobre el perfil clínico del paciente amputado de miembro inferior por causa no traumática. MÉTODOS: Estudio retrospectivo con 697 pacientes amputados de miembro inferior, en un Servicio de Angiología y Cirugía Vascular, durante un periodo de 5 años. Los pacientes fueron divididos según NSE (bajo, medio y alto). Se analizaron variables demográficas (edad y género) y clínicas (causa, comorbilidad, factores de riesgo cardiovascular y nivel de amputación). RESULTADOS: La edad media fue 70,5 ± DE 11,9 años y la mediana 72 años. El NSE bajo presentó mayor frecuencia de hombres amputados. Todos los factores de riesgo cardiovascular fueron más frecuentes en este nivel, aunque solo fue estadísticamente significativo en diabetes (85,8% bajo, 69,3% medio, 65% alto; p < 0,01) y obesidad (31,4% bajo, 22,6% medio, 12,5% alto, p < 0,01). La retinopatía diabética fue la única comorbilidad que mostró asociación significativa con el NSE bajo (21,1% bajo, 15,3% medio, 12,5% alto, p < 0,03). No existió diferencia entre los NSE respecto de la causa de amputación. Se observó mayor frecuencia de amputación mayor en el NSE bajo, siendo esta diferencia estadísticamente significativa (63,6% bajo, 41,2% medio, 55% alto, p < 0,04) y una mayor predisposición a este nivel de amputación. CONCLUSIONES: El NSE bajo determina un perfil de riesgo vascular más desfavorable en los pacientes amputados de miembro inferior por causa no traumático y una mayor predisposición a sufrir amputación mayor. Este NSE muestra una influencia negativa sobre diabetes, obesidad y retinopatía diabética en estos pacientes

INTRODUCTION: To analyse the influence of socioeconomic status on the clinical profile of patients undergoing non-traumatic lower-limb amputation. METHODS: Retrospective study of 697 lower-limb amputee patients in an Angiology and Vascular Surgery Department during a 5-year period. Patients were classified according to their socioeconomic status (low, medium and high). We analysed demographic (age and gender) and clinical variables (cause of amputation, comorbidity, cardiovascular risk factors and amputation level). RESULTS: Mean age was 70.5 ± 11.9 years, and the median was 72 years. The low socioeconomic status group presented a higher frequency of amputations in men. Cardiovascular risks factors were more frequent in this socioeconomic group, and the difference was statistically significant for diabetes (85.8% low, 69.3% medium, 65% high; P < .01) and obesity (31.4% low, 22.6% medium, 12.5% high, P < .01). Diabetic retinopathy was the only comorbidity with a significant association with low socioeconomic status (21.1% low, 15.3% medium, 12.5% high, P < .03). Regarding the cause for amputation, there was no difference in terms of socioeconomic status. The low socioeconomic level showed a higher frequency of major amputation, which was a significant difference (63.6% low, 41.2% medium, 55% high, P < .04) and a higher predisposition for this amputation level. CONCLUSIONS: The low socioeconomic status has been shown to determine an unfavourable vascular risk profile in lower-limb non-traumatic amputees and a higher predisposition of a major amputation. This socioeconomic level demonstrates a negative influence on these patients' diabetes, obesity and diabetic retinopathy

Impact of socioeconomic status on the clinical profile of patients with non-traumatic lower-limb amputation. / Impacto del nivel socioeconómico sobre el perfil del paciente amputado de miembro inferior por causa no traumática.

INTRODUCTION: To analyse the influence of socioeconomic status on the clinical profile of patients undergoing non-traumatic lower-limb amputation. METHODS: Retrospective study of 697 lower-limb amputee patients in an Angiology and Vascular Surgery Department during a 5-year period. Patients were classified according to their socioeconomic status (low, medium and high). We analysed demographic (age and gender) and clinical variables (cause of amputation, comorbidity, cardiovascular risk factors and amputation level). RESULTS: Mean age was 70.5 ± 11.9 years, and the median was 72 years. The low socioeconomic status group presented a higher frequency of amputations in men. Cardiovascular risks factors were more frequent in this socioeconomic group, and the difference was statistically significant for diabetes (85.8% low, 69.3% medium, 65% high; P<.01) and obesity (31.4% low, 22.6% medium, 12.5% high, P<.01). Diabetic retinopathy was the only comorbidity with a significant association with low socioeconomic status (21.1% low, 15.3% medium, 12.5% high, P<.03). Regarding the cause for amputation, there was no difference in terms of socioeconomic status. The low socioeconomic level showed a higher frequency of major amputation, which was a significant difference (63.6% low, 41.2% medium, 55% high, P<.04) and a higher predisposition for this amputation level. CONCLUSIONS: The low socioeconomic status has been shown to determine an unfavourable vascular risk profile in lower-limb non-traumatic amputees and a higher predisposition of a major amputation. This socioeconomic level demonstrates a negative influence on these patients' diabetes, obesity and diabetic retinopathy.

A Legal and Forensic Medicine Approach to Police Physical Intervention Techniques in High-Risk Situations.

Background: The physical intervention techniques (PITs) typically used by the police in troublesome situations are examined in terms of injuring potential depending on whether they target a body zone of high, medium or low vulnerability. Based on legal and forensic considerations, and principles of congruence, opportunity and proportionality, a need exists to favor opponent locking and arrest techniques targeting non-vulnerable zones to minimize the risk of severe damage. Methods: A search of the training manuals for the different kind of law of enforcement officers was carried out. Revision of injuries was available from electronic databases of academic o medical journals. Results: Three different locking and arrest PITs based on operational tactical procedures (OTP) that avoid zones of high or medium vulnerability are proposed. The new techniques use blocking, diverting and grabbing of the upper and lower limbs, followed by dislocation and locking of the same targets. Conclusions: The damaging potential of such PITs was assessed in terms of anatomical region and most were found to have a high risk of severe damage. The alternative PITs proposed here, which rely on OTP, improve in legal and forensic medical terms on existing choices and dramatically reduce the risk of injuring arrestees.

DNA methylation levels and telomere length in human teeth: usefulness for age estimation.

In the last decade, increasing knowledge of epigenetics has led to the development of DNA methylation-based models to predict age, which have shown high predictive accuracy. However, despite the value of teeth as forensic samples, few studies have focused on this source of DNA. This study used bisulfite pyrosequencing to measure the methylation levels of specific CpG sites located in the ELOVL2, ASPA, and PDE4C genes, with the aim of selecting the most age-informative genes and determining their associations with age, in 65 tooth samples from individuals 15 to 85 years old. As a second aim, methylation data and measurements of relative telomere length in the same set of samples were used to develop preliminary age prediction models to evaluate the accuracy of both biomarkers together and separately in estimating age from teeth for forensic purposes. In our sample, several CpG sites from ELOVL2 and PDE4C genes, as well as telomere length, were significantly associated with chronological age. We developed age prediction quantile regression models based on DNA methylation levels, with and without telomere length as an additional variable, and adjusted for type of tooth and sex. Our results suggest that telomere length may have limited usefulness as a supplementary marker for DNA methylation-based age estimation in tooth samples, given that it contributed little improvement in the prediction errors of the models. In addition, even at older ages, DNA methylation appeared to be more informative in predicting age than telomere length when both biomarkers were evaluated separately.

mRNA expression patterns in human myocardial tissue, pericardial fluid and blood, and its contribution to the diagnosis of cause of death.

Gene expression has become an interesting research area in forensic pathology to investigate the process of death at the molecular level. The aims of this study were to analyze changes in gene expression patterns in relation to the cause of death, and to propose new molecular markers of myocardial ischemia of potential use for the postmortem diagnosis of early ischemic heart damage in cases of sudden cardiac death (SCD). We determined mRNA levels of five proteins related with ischemic myocardial damage and repair - TNNI3, MYL3, TGFB1, MMP9 and VEGFA - in specific sites of the myocardium, blood and pericardial fluid in samples from 30 cadavers with different causes of death (SCD, multiple trauma, mechanical asphyxia, and other natural deaths). TNNI3 expression in blood, and MMP9 expression in pericardial fluid, were significantly higher when the cause of death was mechanical asphyxia, probably because of the more sensitive response of these proteins to acute systemic hypoxia/ischemia. Specifically, among SCD cases, increased MYL3, VEGFA and MMP9 values in the anterior wall of the right ventricle were found when the confirmed cause of death was acute myocardial infarction (AMI). Higher TGFB1 expression was found in the interventricular septum when AMI was not the cause of death, most likely as a reflection of the short duration of ischemia. Molecular biology techniques can provide complementary tools for the forensic diagnosis of early ischemic myocardial damage and AMI, and may make it possible to determine the duration and severity of myocardial ischemia.

Usefulness of telomere length in DNA from human teeth for age estimation.

Age estimation is widely used to identify individuals in forensic medicine. However, the accuracy of the most commonly used procedures is markedly reduced in adulthood, and these methods cannot be applied in practice when morphological information is limited. Molecular methods for age estimation have been extensively developed in the last few years. The fact that telomeres shorten at each round of cell division has led to the hypothesis that telomere length can be used as a tool to predict age. The present study thus aimed to assess the correlation between telomere length measured in dental DNA and age, and the effect of sex and tooth type on telomere length; a further aim was to propose a statistical regression model to estimate the biological age based on telomere length. DNA was extracted from 91 tooth samples belonging to 77 individuals of both sexes and 15 to 85 years old and was used to determine telomere length by quantitative real-time PCR. Our results suggested that telomere length was not affected by sex and was greater in molar teeth. We found a significant correlation between age and telomere length measured in DNA from teeth. However, the equation proposed to predict age was not accurate enough for forensic age estimation on its own. Age estimation based on telomere length in DNA from tooth samples may be useful as a complementary method which provides an approximate estimate of age, especially when human skeletal remains are the only forensic sample available.

Three-dimensional analysis of third molar development to estimate age of majority.

Third molars are one of the few biological markers available for age estimation in undocumented juveniles close the legal age of majority, assuming an age of 18years as the most frequent legal demarcation between child and adult status. To obtain more accurate visualization and evaluation of third molar mineralization patterns from computed tomography images, a new software application, DentaVol©, was developed. Third molar mineralization according to qualitative (Demirjian's maturational stage) and quantitative parameters (third molar volume) of dental development was assessed in multi-slice helical computed tomography images of both maxillary arches displayed by DentaVol© from 135 individuals (62 females and 73 males) aged between 14 and 23years. Intra- and inter-observer agreement values were remarkably high for both evaluation procedures and for all third molars. A linear correlation between third molar mineralization and chronological age was found, with third molar maturity occurring earlier in males than in females. Assessment of dental development with both procedures, by using DentaVol© software, can be considered a good indicator of age of majority (18years or older) in all third molars. Our results indicated that virtual computed tomography imaging can be considered a valid alternative to orthopantomography for evaluations of third molar mineralization, and therefore a complementary tool for determining the age of majority.

Significance of EGFR Expression in Circulating Tumor Cells.

This chapter focuses on a deep description of the epidermal growth factor receptor (EGFR) expression in circulating tumor cells (CTCs) and its main role in cancer progression, genetic changes related to metastasis , and resistance to treatment. The aberrant behavior of cancer cells is caused by genetic mutations and altered patterns of gene expression. These changes can be responsible for an increase in cell motility but also an ability of CTCs to survival in different microenvironments, as well as developing therapy-resistant clones. Finally, CTCs can acquire the ability to invade distant organs, where metastatic foci can develop.

Cardiac troponin T determination by a highly sensitive assay in postmortem serum and pericardial fluid.

PURPOSE: The main objective of this study was to test, for the first time, a highly sensitive cardiac troponin T (cTnThs) assay in postmortem serum and pericardial fluid and to evaluate cardiac troponin T (cTnT) levels and their stability after death at different postmortem intervals, in an attempt to determine the viability of the cTnThs assay in the postmortem diagnosis of the cause of death. METHODS: cTnT levels were determined in serum and pericardial fluid samples taken from 58 cadavers at known postmortem intervals, whose causes of death were categorized into the following groups: (1) sudden cardiac deaths, (2) multiple trauma, (3) mechanical asphyxia, and (4) other natural deaths. cTnT was determined by inmunoassay, using the Troponin T highly sensitive STAT assay (Roche(®)). RESULTS: Average cTnT levels measured by a highly sensitive assay in postmortem serum were markedly higher than clinical serum levels. Moreover, similar results, higher cTnT levels in postmortem pericardial fluid, were obtained when compared to levels found in pericardial fluid taken from two living patients during coronary artery bypass surgery. cTnT levels in both postmortem fluids remained stable for up to 34 h after death. No differences in cTnT levels in either postmortem fluid by sex and age were detected. Levels of cTnT found in pericardial fluid in the other natural deaths group were significantly lower than the cTnT levels found in that postmortem fluid from any of the other causes of death groups. CONCLUSION: It is therefore reasonable to conclude that determination of cTnT by a highly sensitive assay in pericardial fluid can provide forensic pathologists with a complementary test to the diagnosis of cause of death.

Cellular extracts from post-mortem human cardiac tissue direct cardiomyogenic differentiation of human adipose tissue-derived stem cells.

BACKGROUND AIMS: Human adipose tissue-derived stem cells (hASCs) can be easily (and inexpensively) expanded in culture, and their high plasticity allows their conversion to different cell types. We study the potential capacity of postmortem cardiac tissue to direct cardiac differentiation of hASCs in vitro. METHODS: Cardiac tissue collected from autopsies was used to obtain cell extracts and conditioned medium, and both approaches were tested for cardiac induction. RESULTS: Gene expression analyses proved that post-mortem human cardiac tissue maintains genetic integrity. hASCs exposed to the cell extracts or conditioned medium for 2 weeks achieved the appearance of myotube-like structures and were positive for cardiac markers such as sarcomeric α-actinin, cardiac troponin I and T and desmin as proved by immunofluorescence. In addition, differentiated cells showed increased expression of cardiomyocyte-related genes analyzed by reverse transcriptase polymerase chain reaction (GATA-4, myocyte-enhancer factor-2c, α-cardiac actin and cardiac troponin I). CONCLUSIONS: For the first time, post-mortem human cardiac tissue was used to induce hASC differentiation into myocardial-like cells. The methodology described here would serve as a useful model to obtain cardiomyocyte-like cells in vitro.

Studies on RNA integrity and gene expression in human myocardial tissue, pericardial fluid and blood, and its postmortem stability.

Analyses of gene expression of ischemic myocardial injury and repair related proteins has been carried out for the first time in samples from five specific sites of the myocardium, pericardial fluid and blood from thirty cadavers in relation to post-mortem interval (PMI). RNA integrity was evaluated by RNA integrity number (RIN), with values ranging from 6.57 to 8.11; sufficiently high levels of integrity to permit further gene amplification. No significant correlations between RIN and PMI in any samples were detected. Prior to target gene expression analysis, a normalization strategy was carried out to assess candidate reference gene stability, involving the analysis and comparison of four common housekeeping genes (Glyceraldehide-3-phosphate dehydrogenase, beta-actin, TATA box binding protein and Cyclophilin A). Gene expression of cardiac troponin I (TNNI3), myosin light chain 3 (MYL3), matrix metalloprotease 9 (MMP9), transforming growth factor beta 1 (TGFB1), and vascular endothelial growth factor A (VEGFA) in myocardial zones and body fluids were subsequently studied by real-time quantitative PCR. Expression levels of all the proteins studied in cardiac zone samples were similar. No statistical differences for expression were detected among proteins taken from any myocardial area. No significant differences were detected for TNNI3 and TGFB1 gene expressions when compared with samples at or under 12h-PMI or over 12h-PMI. However, differences in MYL3, MMP9, and VEGFA gene expression in body fluids were found at PMI periods of over 12h. These interesting results may contribute to the refinement of current knowledge regarding cardiac metabolism and improve understanding of the underlying mechanisms involved in myocardium ischemia and its repair.

Evaluación práctica de las alteraciones postmortem debidas a la actividad de los artrópodos / Alterations practice postmortem evaluation of activity due to arthropods

Tras la muerte de un organismo vivo, la actividad de los insectos es el principal mecanismo por el que la materia orgánica en descomposición se reintegra en la cadena alimenticia. No obstante, hay que tener en cuenta que dicha actividad puede implicar modificaciones de gran interés tafonómico y forense. Si no se conoce bien su magnitud, pueden inducir al error en el posterior análisis del patólogo forense. En este artículo, damos una clasificación organizada de los diferentes fenómenos tafonómicos inducidos por insectos (adición, eliminación y modificación del cadáver) y enunciamos los caracteres diferenciales que permiten separarlos de procesos patológicos similares, centrando nuestra atención en los órdenes Coleoptera, Diptera y Lepidoptera como principales causantes de estas modificaciones...

After death of a living organism, the activity of insects is the main mechanism by which decomposing organic matter returns to the nutritional chain. However, it is necessary to consider that this activity can imply modifications of great taphonomic and forensic interest. If its magnitude is not known well, it can induce to error in the later analysis of the forensic pathologist. In this article, we give an organized classification of the different taphonomic phenomena induced by insects (addition, elimination and modification of the corpse) and enunciate the differential features that allow to separate them from similar pathological processes, focusing our attention on the orders Coleoptera, Diptera and Lepidoptera as the main responsibles of these modifications...

Occurrence of Poecilochirus austroasiaticus (Acari: Parasitidae) in forensic autopsies and its application on postmortem interval estimation.

Despite the fact that mites were used at the dawn of forensic entomology to elucidate the postmortem interval, their use in current cases remains quite low for procedural reasons such as inadequate taxonomic knowledge. A special interest is focused on the phoretic stages of some mite species, because the phoront-host specificity allows us to deduce in many occasions the presence of the carrier (usually Diptera or Coleoptera) although it has not been seen in the sampling performed in situ or in the autopsy room. In this article, we describe two cases where Poecilochirus austroasiaticus Vitzthum (Acari: Parasitidae) was sampled in the autopsy room. In the first case, we could sample the host, Thanatophilus ruficornis (Küster) (Coleoptera: Silphidae), which was still carrying phoretic stages of the mite on the body. That attachment allowed, by observing starvation/feeding periods as a function of the digestive tract filling, the establishment of chronological cycles of phoretic behavior, showing maximum peaks of phoronts during arrival and departure from the corpse and the lowest values in the phase of host feeding. From the sarcosaprophagous fauna, we were able to determine in this case a minimum postmortem interval of 10 days. In the second case, we found no Silphidae at the place where the corpse was found or at the autopsy, but a postmortem interval of 13 days could be established by the high specificity of this interspecific relationship and the departure from the corpse of this family of Coleoptera.