Neuropathological Variability within a Spectrum of NMDAR-Encephalitis.

OBJECTIVE: To describe the neuropathological features of N-methyl-D-aspartate receptor (NMDAR)-encephalitis in an archival autopsy cohort. METHODS: We examined four autopsies from patients with NMDAR-encephalitis; two patients were untreated, three had comorbidities: small cell lung cancer, brain post-transplant lymphoproliferative disease (PTLD), and overlapping demyelination. RESULTS: The two untreated patients had inflammatory infiltrates predominantly composed of perivascular and parenchymal CD3+ /CD8- T cells and CD79a+ B cells/plasma cells in basal ganglia, amygdala, and hippocampus with surrounding white matter. The hippocampi showed a significant decrease of NMDAR-immunoreactivity that correlated with disease severity. The patient with NMDAR-encephalitis and immunosuppression for kidney transplantation developed a brain monomorphic PTLD. Inflammatory changes were compatible with NMDAR-encephalitis. Additionally, plasma cells accumulated in the vicinity of the necrotic tumor along with macrophages and activated microglia that strongly expressed pro-inflammatory activation markers HLA-DR, CD68, and IL18. The fourth patient developed demyelinating lesions in the setting of a relapse 4 years after NMDAR-encephalitis. These lesions exhibited the hallmarks of classic multiple sclerosis with radially expanding lesions and remyelinated shadow plaques without complement or immunoglobulin deposition, compatible with a pattern I demyelination. INTERPRETATION: The topographic distribution of inflammation in patients with NMDAR-encephalitis reflects the clinical symptoms of movement disorders, abnormal behavior, and memory dysfunction with inflammation dominantly observed in basal ganglia, amygdala, and hippocampus, and loss of NMDAR-immunoreactivity correlates with disease severity. Co-occurring pathologies influence the spatial distribution, composition, and intensity of inflammation, which may modify patients' clinical presentation and outcome. ANN NEUROL 2021;90:725-737.

Stable isotope and trace element studies on gladiators and contemporary Romans from Ephesus (Turkey, 2nd and 3rd Ct. AD)--mplications for differences in diet.

The gladiator cemetery discovered in Ephesus (Turkey) in 1993 dates to the 2nd and 3rd century AD. The aim of this study is to reconstruct diverse diet, social stratification, and migration of the inhabitants of Roman Ephesus and the distinct group of gladiators. Stable carbon, nitrogen, and sulphur isotope analysis were applied, and inorganic bone elements (strontium, calcium) were determined. In total, 53 individuals, including 22 gladiators, were analysed. All individuals consumed C3 plants like wheat and barley as staple food. A few individuals show indication of consumption of C4 plants. The δ13C values of one female from the gladiator cemetery and one gladiator differ from all other individuals. Their δ34S values indicate that they probably migrated from another geographical region or consumed different foods. The δ15N values are relatively low in comparison to other sites from Roman times. A probable cause for the depletion of 15N in Ephesus could be the frequent consumption of legumes. The Sr/Ca-ratios of the gladiators were significantly higher than the values of the contemporary Roman inhabitants. Since the Sr/Ca-ratio reflects the main Ca-supplier in the diet, the elevated values of the gladiators might suggest a frequent use of a plant ash beverage, as mentioned in ancient texts.

Does the prior application of the field kit bullet hole testing kit 3 on a suspected bullet hole bias the analysis of atomic absorption spectrophotometry?

Forensic ballistics is the study of bullet trajectory and consists of determining gunshot residue (GSR) to identify bullet holes. Among several highly sensitive methods, atomic absorption spectrophotometry (AAS) is employed to analyze GSR in the laboratory. However, it is sometimes necessary to identify bullet holes immediately at a crime scene. The purpose of this examination was to determine whether the use of the field test Bullet Hole Testing Kit 3 (BTK3) on a suspected bullet hole would influence the outcome of AAS-analysis: Three commonly encountered firearms (Glock17, Tokarev, and Colt) were fired at skin, wood, and cloth. AAS-analysis was performed with and without previous BTK3 application. The results clearly indicate that there is no significant interaction on the grounds of BTK3 use (BTK3 vs. no-BTK3 [kit_nokit] [Pb: p = 0.1309; Sb: p = 0.9111], material*kit_nokit [Pb: p = 0.5960; Sb: p = 0.9930], distance*kit_nokit [Pb: p = 0.4014; Sb: p = 0.9184], and firearm type*kit_nokit [Pb: p = 0.9662; Sb: p = 0.9885]); hence, applying this field kit does not falsify later AAS outcomes.

Citrate content of bone for time since death estimation: results from burials with different physical characteristics and known PMI.

A recently introduced method to determine the postmortem interval (PMI) based on quantification of the citrate content in bone was applied on the temporal bones and femora of 20 individuals buried in wooden coffins (WO) and body bags (BB), respectively. Concerning known vs. calculated PMI, a significant difference between the temporal and the femur bone samples of the same individuals was observed in the BB group (p = 0.012). In contrast, differences were insignificant for the WO group (p = 0.400). Moreover, similar levels of underestimation of PMIs resulted from the analysis of the femora for both burial groups (p = 0.247). Also, there was consistently less citrate preserved in the flat temporal bones as compared to the femora, indicating that the cortical layer of the long bones should be preferentially employed for citrate-based PMI estimations. The results call for additional research on subsurface-buried and surface-deposited remains to enhance the accuracy of the published PMI equation.

Investigations on human and animal remains from a medieval shaft well in Ayasuluk/Ephesos (Turkey).

In course of the archaeological survey of Ayasuluk/Ephesos region (Turkey), a shaft well situated at the area of an extensive medieval bathing complex was excavated. In the stratum corresponding to the reign Mehmed II the well-preserved skeletons of two humans, an equine and a canine were recovered. Anthropological analysis of the human skeletons indentified two males aged 22 (± 3) and 36 (± 5) years. The skeleton of the younger individual showed signs of various antemortal conditions, including a well-healed fraction of right arc of the fifth lumbar vertebra, and a marked asymmetry of the shoulder joints. The older individual exhibited significant peri/postmortem injuries at the elbows, with evident signs of peeling and external burning. Also, the few elements of the cranium recovered showed also indications of burning. Archaeozoological characterization of the complete skeletons of the equine and canine established evidence of well cared-for animals of high value. The time of disposal of this group coincides with uprising of the formerly ruling Aydnoullar clan against the Ottomans in power. The human individuals recovered from the well may have been members of Aydnoullar tribe or men in service of the latter, suffering severe torture and/or mutilation for siding with the rebels after defeat.

Micromorphological changes in cardiac tissue of drug-related deaths with emphasis on chronic illicit opioid abuse.

AIMS: The main intention of this retrospective study was to investigate whether chronic illicit drug abuse, especially the intravenous use of opioids (heroin), could potentially trigger the development of myocardial fibrosis in drug addicts. DESIGN: A retrospective case-control study was performed using myocardial tissue samples from both drug-related deaths (DRD) with verifiable opioid abuse and non-drug-related deaths in the same age group. SETTING: Department of Forensic Medicine, Medical University of Vienna, Austria (1993-94). PARTICIPANTS: Myocardial specimens were retrieved from 76 deceased intravenous opioid users and compared to those of 23 deceased non-drug users. MEASUREMENTS: Drug quantification was carried out using the enzyme-multiplied immunoassay technique (EMIT), followed by [gas chromatography-mass spectrometry (GC-MS), MAT 112(®) ], and analysed using the Integrator 3390A by Hewlett Packard(®) and LABCOM.1 computer (MSS-G.G.). The amount of fibrous connective tissue (FCT) in the myocardium was determined by using the morphometric software LUCIA Net version 1.16.2(©) , Laboratory Imaging, with NIS Elements 3.0(®) . FINDINGS: Drug analysis revealed that 67.11% were polydrug users and the same proportion was classified as heroin addicts (6-monoacetylmorphine, 6-MAM)-32.89% were users of pure heroin. In 76.32% of DRD cases, codeine was detected. Only 2.63% consumed cocaine. The mean morphine concentrations were 389.03 ng/g in the cerebellum and 275.52 ng/g in the medulla oblongata, respectively. Morphometric analysis exhibited a strong correlation between DRD and myocardial fibrosis. The mean proportion of FCT content in the drug group was 7.6 ± 2.9% (females: 6.30 ± 2.19%; males: 7.91 ± 3.01%) in contrast to 5.2 ± 1.7% (females: 4.45 ± 1.23%; males: 5.50 ± 1.78%) in the control group, indicating a significant difference (P = 0.0012), and a significant difference in the amount of FCT between females and males (P = 0.0383). There was no significant interaction of age and FCT (P = 0.8472). CONCLUSIONS: There is a long-term risk of cardiac dysfunction following chronic illicit drug abuse with opioids as a principal component. Regular cardiological examination of patients receiving substitution treatment with morphine is strongly recommended.

Iatrogenic death: A review of cases from 1990-2000 investigated at the Department of Forensic Medicine, Vienna.

Medical malpractice is a global problem which can have considerable financial and legal consequences for the community as well as personal consequences for those involved. Austria does not record any statistical and epidemiological data concerning medical malpractice cases. Data from 7,211 autopsy cases from the Department of Forensic Medicine in Vienna covering the period from 1990 to 2000 were analyzed. Fifty-five autopsy reports that were filed as suspected medical malpractice were recorded and analyzed. Thirty cases were classified as surgical incidents, 19 cases as negligence, and 6 cases as medication incidents. Out of a total of 40 cases from available court files, 36 cases were dropped, there were 2 acquittals and only two resulted in convictions. The number of instances of medical malpractice leading to iatrogenic deaths in Austria seems to be very low in comparison to other countries. The possibility that many cases go unnoticed needs to be taken into consideration.