Skeletal idiopathic osteosclerosis helps to perform personal identification of unknown decedents: A novel contribution from anatomical variants through CT scan.

Personal identification consists of the comparison of ante-mortem information from a missing person with post-mortem data obtained from an unidentified corpse. Such procedure is based on the assessment of individualizing features which may help in providing a conclusive identification between ante-mortem and post-mortem material. Anatomical variants may provide important clues to correctly identify human remains. Areas of idiopathic osteosclerosis (IO), or dense bone islands (DBIs) characterized by radiopaque areas of dense, trabeculated, non-inflamed vital bone represent one of these, potentially individualizing, anatomical features. This study presents a case where the finding of DBI was crucial for a positive identification through CT-scan. A decomposed body was found in an apartment in June 2014 in advanced decomposition and no dental records were available to perform a comparison for positive identification. Genetic tests were not applicable because of the lack of relatives in a direct line. The analysis of the only ante-mortem documentation, a CT-scan to the deceased dating back to August 2009, showed the presence of three DBIs within the trabecular bone of the proximal portion of the right femur. The same bony district was removed from the corpse during the autopsy and analysed by CT-scan, which verified the presence of the same features. Forensic practitioners should therefore be aware of the great importance of anatomical bone variants, such as dense bone islands for identification purposes, and the importance of advanced radiological technique for addressing the individualizing potential of such variants. We propose that anatomical variants of the human skeleton should be considered as being "primary identification characteristics" similar to dental status, fingerprints and DNA.

The identification of living persons on images: A literature review.

Personal identification in the forensic context commonly concerns unknown decedents. However, recently there has been an increase in cases which require identification of living persons, especially from surveillance systems. These cases bring about a relatively new challenge for forensic anthropologists and pathologists concerning the selection of the most suitable methodological approaches with regard to the limitations of the photographic representation of a given person for individualization and identity. Facial features are instinctively the primary focus for identification approaches. However, other body parts (e.g. hands), and body height and gait (on videos) have been considered in cases of personal identification. This review aims at summarizing the state-of-the-art concerning the identification of the living on images and videos, including a critical evaluation of the advantages and limitations of different methods. Recommendations are given in order to aid forensic practitioners who face cases of identification of living persons.

Differences in survival between Maori and New Zealand Europeans with prostate cancer.

This study aims to examine the survival disparity between Maori men and New Zealand (NZ) Europeans diagnosed with prostate cancer. We identified men aged 40+ years in the Midland Cancer Network region registered with prostate cancer in 2007-2010 in the Cancer Registry. Data were extracted from patient notes of all Maori men and a sample of NZ Europeans. The survival disparity between Maori men and Europeans was estimated by the Kaplan-Meier method and Cox proportional-hazards regression models after adjusting for other factors. This study included 535 men with prostate cancer (135 Maori men and 400 Europeans). The 5-year cancer-specific survival was 98.6% for men diagnosed with localised cancer, 88.8% for locally advanced disease and 19.1% for metastatic cancer. The all-cause survival and the cancer-specific survival were both significantly poorer for Maori men than for NZ Europeans (log rank test: P = 0.004, 0.006 respectively). The hazard ratio of cancer-specific survival for Maori men was 2.01 (95% CI: 1.21-3.36) compared with NZ Europeans. Maori men with prostate cancer had poorer all-cause survival and cancer-specific survival than NZ Europeans. Maori men were at risk of having more advanced disease at diagnosis, which explains most of the survival inequity between Maori men and NZ Europeans.

Towards a method for determining age ranges from faces of juveniles on photographs.

The steady increase in the distribution of juvenile pornographic material in recent years strongly required valid methods for estimating the age of the victims. At the present in fact forensic experts still commonly use the assessment of sexual characteristics by Tanner staging, although they have proven to be too subjective and deceiving for age estimation. The objective of this study, inspired by a previous EU project involving Italy, Germany and Lithuania, is to verify the applicability of certain anthropometric indices of faces in order to determine age and to create a database of facial measurements on a population of children in order to improve face ageing techniques. In this study, 1924 standardized facial images in frontal view and 1921 in lateral view of individuals from 7 age groups (3-5 years, 6-8 years, 9-11 years, 12-14 years, 15-17 years, 18-20 years, 21-24 years) underwent metric analysis. Individuals were all of Caucasoid ancestry and Italian nationality. Eighteen anthropometric indices in the frontal view and five in the lateral view were then calculated from the obtained measurements. Indices showing a correlation with age were ch-ch/ex-ex, ch-ch/pu-pu, en-en/ch-ch and se-sto/ex-ex in the frontal view, se-prn/se-sn, se-prn/se-sto and se-sn/se-sto in the lateral view. All the indices increased with age except for en-en/ch-ch, without relevant differences between males and females. These results provide an interesting starting point not only for placing a photographed face in an age range but also for refining the techniques of face ageing and personal identification.

The juvenile face as a suitable age indicator in child pornography cases: a pilot study on the reliability of automated and visual estimation approaches.

OBJECTIVE: In cases of suspected child pornography, the age of the victim represents a crucial factor for legal prosecution. The conventional methods for age estimation provide unreliable age estimates, particularly if teenage victims are concerned. In this pilot study, the potential of age estimation for screening purposes is explored for juvenile faces. In addition to a visual approach, an automated procedure is introduced, which has the ability to rapidly scan through large numbers of suspicious image data in order to trace juvenile faces. METHODS: Age estimations were performed by experts, non-experts and the Demonstrator of a developed software on frontal facial images of 50 females aged 10-19 years from Germany, Italy, and Lithuania. To test the accuracy, the mean absolute error (MAE) between the estimates and the real ages was calculated for each examiner and the Demonstrator. RESULTS: The Demonstrator achieved the lowest MAE (1.47 years) for the 50 test images. Decreased image quality had no significant impact on the performance and classification results. The experts delivered slightly less accurate MAE (1.63 years). Throughout the tested age range, both the manual and the automated approach led to reliable age estimates within the limits of natural biological variability. CONCLUSIONS: The visual analysis of the face produces reasonably accurate age estimates up to the age of 18 years, which is the legally relevant age threshold for victims in cases of pedo-pornography. This approach can be applied in conjunction with the conventional methods for a preliminary age estimation of juveniles depicted on images.

Pitfalls at the root of facial assessment on photographs: a quantitative study of accuracy in positioning facial landmarks.

In the last years, facial analysis has gained great interest also for forensic anthropology. The application of facial landmarks may bring about relevant advantages for the analysis of 2D images by measuring distances and extracting quantitative indices. However, this is a complex task which depends upon the variability in positioning facial landmarks. In addition, literature provides only general indications concerning the reliability in positioning facial landmarks on photographic material, and no study is available concerning the specific errors which may be encountered in such an operation. The aim of this study is to analyze the inter- and intra-observer error in defining facial landmarks on photographs by using a software specifically developed for this purpose. Twenty-four operators were requested to define 22 facial landmarks on frontal view photographs and 11 on lateral view images; in addition, three operators repeated the procedure on the same photographs 20 times (at distance of 24 h). In the frontal view, the landmarks with less dispersion were the pupil, cheilion, endocanthion, and stomion (sto), and the landmarks with the highest dispersion were gonion, zygion, frontotemporale, tragion, and selion (se). In the lateral view, the landmarks with the least dispersion were se, pronasale, subnasale, and sto, whereas landmarks with the highest dispersion were gnathion, pogonion, and tragion. Results confirm that few anatomical points can be defined with the highest accuracy and show the importance of the preliminary investigation of reliability in positioning facial landmarks.

Age changes of facial measurements in European young adult males: implications for the identification of the living.

Metric and morphological analyses of facial features are currently applied in cases of personal identification of the living on images acquired from video surveillance systems. However, facial assessment in the forensic context needs to be based on reliable comparative data for facial measurements. Facial changes in the age range of early adulthood (20-30 years) have been rarely described so far, although such knowledge would be beneficial for comparative personal identification on images. This study investigates changes in facial measurements in European males aged between 20 and 30 years in order to identify metric characters that can be used for personal identification in young adults. A sample of 404 males of European ancestry, aged between 20 and 30 years from Germany, Italy and Lithuania were recruited for this project. Fourteen facial measurements were taken and correlation coefficients were calculated for each cranial measurement with age. Only two measurements - labial width and physiognomic ear length - seem to change between 20 and 30 years with a positive statistically significant correlation (p<0.05). These results suggest caution for what may concern personal identification by assessment of ear and mouth morphology.

Prostate cancer incidence and mortality in rural men--a systematic review of the literature.

INTRODUCTION: Prostate cancer is a common health problem in men worldwide. This systematic review has been undertaken to determine if there are differences in incidence of and mortality from prostate cancer between rural and urban men. The understanding of geographical patterns of prostate cancer incidence and mortality is necessary in order to identify and assess any disparities between rural and urban residents in gaining access to healthcare services, such as screening, diagnosis and treatment. METHODS: Medline, CINAHL and Embase were searched using relevant mesh phrases, such as 'prostate cancer incidence rural' or 'prostatic neoplasms mortality rural'. Secondary literature and reports not published in peer-reviewed journals were included if inclusion criteria had been met. The following inclusion criteria were applied: cohort (population-based study) of adult men, diagnosis of prostate cancer, comparing rural and urban groups, and incidence or mortality with available statistical parameters as outcome. RESULTS: In total, 25 studies were found to fit the inclusion criteria. Sixteen cohort studies were identified that examined incidence of prostate cancer in rural and urban populations, while 18 studies focused on mortality. Nine of these publications discussed both aspects. Twenty of these studies were published in scientific journals, while five were reports identified through secondary literature search. Prostate cancer incidence was found to be higher in urban men, while mortality patterns seemed to vary to some degree depending on different definitions of rural/urban groups, as well as on variations in demographic factors and study periods. There is evidence, however, that after prostate-specific antigen testing was introduced death rates tended to be higher in rural men with prostate cancer. CONCLUSIONS: The review of the literature showed that in spite of inconsistent definitions of rural/urban categories among studies the majority reported higher incidence rates in urban men. This finding suggests that rural men are less likely to be screened and less likely to be subsequently diagnosed with prostate cancer. Although mortality patterns tended to be heterogeneous, there was some evidence that rural residents with prostate cancer experience higher death rates. It would be beneficial if future studies take into consideration factors such as stage at initial diagnosis, ethnicity, and socioeconomic and health status when assessing differences in cancer outcomes. Few studies in this review accounted for one or more of these variables, although there are indications that they contribute to differences in prostate cancer incidence and mortality between rural and urban populations.

Metric and morphological assessment of facial features: a study on three European populations.

Identification from video surveillance systems is becoming more and more frequent in the forensic practice. In this field, different techniques have been improved such as height estimation and gait analysis. However, the most natural approach for identifying a person in everyday life is based on facial characteristics. Scientifically, faces can be described using morphological and metric assessment of facial features. The morphological approach is largely affected by the subjective opinion of the observer, which can be mitigated by the application of descriptive atlases. In addition, this approach requires one to investigate which are the most common and rare facial characteristics in different populations. For the metric approach further studies are necessary in order to point out possible metric differences within and between different populations. The acquisition of statistically adequate population data may provide useful information for the reconstruction of biological profiles of unidentified individuals, particularly concerning ethnic affiliation, and possibly also for personal identification. This study presents the results of the morphological and metric assessment of the head and face of 900 male subjects between 20 and 31 years from Italy, Germany and Lithuania. The evaluation of the morphological traits was performed using the DMV atlas with 43 pre-defined facial characteristics. The frequencies of the types of facial features were calculated for each population in order to establish the rarest characteristics which may be used for the purpose of a biological profile and consequently for personal identification. Metric analysis performed in vivo included 24 absolute measurements and 24 indices of the head and face, including body height and body weight. The comparison of the frequencies of morphological facial features showed many similarities between the samples from Germany, Italy and Lithuania. However, several characteristics were rare or significantly more or less common in one population compared to the other two. On the other hand, all measurements and indices, except for labial width and intercanthal-mouth index showed significant differences between the three populations. As far as comparisons with other samples are concerned, the three European Caucasian samples differed from North American Caucasian, African and Asian groups as concerns the frequency of the morphological traits and the mean values of the metric analysis. The metric and morphological data collected from three European populations may be useful for forensic purposes in the construction of biological profiles and in screening for personal identification.

Small-cell carcinoma of the ovary with breast metastases: a case report.

BACKGROUNDS: Small cell carcinoma (SCC) is characterised by high metastatic potential and the possibility to metastasize to practically any tissue. Small cell carcinoma of the ovary (SCCO) has a very poor prognosis and patients usually die within one year of the initial diagnosis. Breast metastases from SCCO are extremely rare. CASE: We present a 67-year-old female patient with SCCO who initially presented with bone and bilateral breast metastases. Considering the clinical presentation, the patient's age, the absence of hypercalcemia and histological characteristics, a diagnosis of pulmonary type SCCO was made. There was no tumour present in the lungs at the time of the initial diagnosis and thus we ruled out pulmonary SCC. RESULTS: Initially, the patient was treated with radiotherapy of the bone lesion and systemic chemotherapy (etoposide with carboplatin) with the result of partial remission. Then, radical abdominal surgery was performed. Six months later she was diagnosed with progressive disease in the bone, soft tissue including the breast as well as new lesions in the right kidney, pelvis and lungs. She was treated with 2nd line chemotherapy (topotecan with cisplatin) with the result of progressive disease. Because of mediastinal lymphadenopathy, which was causing tracheobronchial compression, radiotherapy was administered with a good palliative outcome. Nine months later, multiple brain metastases were diagnosed and she was treated with whole brain radiotherapy. Shortly after brain irradiation, her status deteriorated rapidly and she died two years after her initial SCCO diagnosis. CONCLUSION: Extrapulmonary small cell carcinoma is a clinicopathological entity distinct from pulmonary small cell carcinoma. It is very rare and therefore there is very little information available regarding treatment of this disease. In contrast to experience in the treatment of pulmonary small cell cancers, prolonged survival is not common.