Biological factors and self-perception of stress in relation to freeze-like response in humans.

Many animals react to threatening stimuli such as a predator attacks by freezing. However, little experimental research investigated freeze response in humans. Here, we have employed practices commonly used in self-defense training to create two unique scenarios simulating armed physical threat. Sixty healthy men volunteers divided into three groups of twenty (untrained, trained but unexperienced, trained and experienced) underwent these scenarios accompanied by measurement of biochemical, physiological, and psychological markers of stress. Our results show that untrained individuals exhibit stronger freezing reactions, while highly skilled participants display the lowest propensity for freezing, especially in high-intensity scenarios. Moreover, the study shows variations in anxiety levels and selected biomarkers, with cortisol and osteocalcin showing different patterns in low and high-intensity scenarios, and suggests a complex interplay between these factors, electrodermal activity, and stress perception.

Standard autopsy and diagnostic procedure in forensic departments in cases of sudden cardiac death (SCD) in individuals under 40 years of age.

Sudden cardiac death (SCD) in individuals younger than 40 years has a heritable cause in a significant part of the cases. Identification of SCD, post mortem genetic analysis, and the cardiological screening examination in victim´s relatives represent an important diagnostic tool for the primary prevention of cardiac arrest. Based on global and European recommendations, cases of sudden cardiac death in individuals under the age of 40 with negative or ambiguous autopsy findings, or findings suspicious for hereditary cardiovascular disease, should be investigated using molecular genetic methods. Based on European guidelines, the Czech Society of Forensic Medicine and Forensic Toxicology has developed its own recommended procedure, which summarizes the identification of these cases, the optimal autopsy procedure, including the collection of material, and a summary of other necessary actions for performing a post mortem genetic examination in a person who has died suddenly. Complex examination of these cases requires multicentric and multidisciplinary collaboration.

Substantial decrease in SARS-CoV-2 RNA after fixation of cadavers intended for anatomical dissection.

With the onset of the COVID-19 pandemic, a problem arose with classic body donation programmes for obtaining cadavers for anatomical dissections, science and research. The question has emerged whether bodies of individuals who died of COVID-19 or were infected by SARS-CoV-2 could be admitted to Departments of Anatomy. To determine the risk of SARS-CoV-2 transmission to employees or students, the presence and stability of SARS-CoV-2 RNA in cadavers after fixation agents' application and subsequent post-fixation baths over time were examined. The presence of viral RNA in swabs from selected tissues was assessed by the standardized routine RNA isolation protocol and subsequent real-time PCR analysis. To support the results obtained from the tissue swabs, samples of RNA were exposed in vitro to short and long-term exposure to the components of the injection and fixation solutions used for the bodies' conservation. Substantial removal of SARS-CoV-2 RNA was observed in post-mortem tissue following perfusion with 3.5% phenol, 2.2% formaldehyde, 11.8% glycerol and 55% ethanol, and subsequent post-fixation in an ethanol bath. In vitro experiments showed significant effects of formaldehyde on SARS-CoV-2 RNA, while phenol and ethanol showed only negligible effects. We conclude that cadavers subjected to fixation protocols as described here should not pose a considerable risk of SARS-CoV-2 infection while being handled by students and staff and are, therefore, suitable for routine anatomical dissections and teaching.

The importance of molecular autopsy in forensic medicine.

Standard autopsy does not always detect a cause of individuals death. It occurs often in cases of sudden death. The reason for decease, at least in a part of unsolved cases, can be revealed using methods of molecular biology and genetics. This approach is called molecular autopsy. First application dates to the end of 20th century when cause of sudden unexplained death of a young woman was provided only after execution of molecular autopsy. Molecular autopsy (also known as post-mortem genetic testing) finds its application particularly in cases of sudden death of young people or infants as their decease is more frequently associated with hereditary diseases linked for example to heart or metabolic conditions. In terms of methodical development, the form of molecular testing has been improved until now. Originally, targeted analysis of small number of genes was used. Nowadays, whole-exome and whole-genome sequencing slowly becomes a new standard for molecular autopsy. Although molecular autopsy has a potential to be integrated into an autopsy as a standard part of it, for now it has not become a standardised routine part of forensic autopsy.

Gender differences in the effect of a 0.11% breath alcohol concentration on forward and backward gait.

Alcohol contributes to a large number of diseases and health conditions related to injuries. The aim of our study was to evaluate gender differences in forward and backward gait when sober and at a breath alcohol concentration (BrAC) of 0.11%. Fifty females and fifty males participated in our study. The gait analysis was performed twice, when sober and after drinking a given amount of vodka mixed with orange juice. Under both conditions, participants were asked to walk forward and then backward on a Zebris platform. Multivariate analysis and the Mann-Whitney U test were used to compare the differences between genders when walking forward and backward. The Wilcoxon Signed Ranks test was used to compare the differences between 0.00% BrAC and 0.11% BrAC. Spearman's Rho was used to analyze the relationship between the AUDIT score, anthropometrical characteristics and the subjective score of drunkenness and gait parameters. The results show different strategies to improve stability during gait in women and men when intoxicated with alcohol. When intoxicated, males in forward gait increase their stability by increasing their foot rotation, while females increase their step width. A decrease in balance-related variables was observed in females when walking backward with a BrAC of 0.11%. Additionally, females tended to perform an increase in balance-related gait variables when subjectively feeling more drunk in both forward and backward gait. Different strategies to maintain stability during gait were observed in women and men. The results of our study show that alcohol intoxication has a greater impact on gait in females who tended to perform an increase in balance-related variables with an increase in their subjective score of drunkenness.

Current issues of body donation for teaching and research purposes and their use in the Czech Republic.

Since time immemorial, bodies of deceased have been an integral part of teaching anatomy, and therefore the study of medicine. Without them, the teaching of anatomy, clinical anatomy and many research projects could not be realized. Nowadays, the European countries allow to use exclusively bodies of the deceased donors. Recently, we have registered a growing trend in the needs of the bodies not only for the purposes of medical education, but also for those of clinical anatomy. The question also arose of the suitability of using COVID-19 positive donors or the legislative possibility of obtaining bodies in the absence of donors in the donor program. Our communication addresses current issues of body donation for teaching and research purposes and their use in the Czech Republic.

Various fatal complications of urolithiasis.

This article describes two cases of fatal complications of urolithiasis. The first case discusses the development of fatal urosepsis in a patient with a known mental health issue. The patient had self-introduced a thermometer into her bladder, which led to stone formation around the thermometer and consequently to fatal urosepsis. The second case deals with a motor vehicle accident in which a passenger with pre-existing hydronephrosis suffered a kidney injury leading to fatal bleeding into the surrounding adipose tissue. To provide a wider context, the paper also discusses the fatal complications and origin of urolithiasis.

Traumatic Decapitation of the Fetus During Birth: Criminalistic and Forensic Aspects.

Serious intrapartum fetal injuries are unfortunate events that confer severe consequences on medical personnel. Most birth traumas are noncritical and resolve for a few days. Permanent effects or fatal outcomes occur infrequently. We report an unusual case of intrapartum complete fetal decapitation. The labor was complicated by shoulder dystocia, with resultant repeated mechanical trauma to the fetal neck and, finally, decapitation. The tragic results of biological processes in human organisms do not automatically confirm medical malpractice. However, there may be grave ethical and forensic outcomes.

An Unplanned Complex Suicide by Multiple Blank Cartridge Gunshots and Cutting.

Blank firing guns are readily accessible in most countries due to an absence of legal regulations. These weapons are capable of causing lethal injuries. We report a rare case of secondary (unplanned) complex suicide committed with a knife and blank cartridge pistol. A 59-year-old man was found dead with three superficial incisions in his neck and a gunshot wound to the chest. The external examination revealed an entrance wound in the left chest region consistent with contact shooting. The appearance of a muzzle imprint suggested two discharges. The autopsy showed a slightly hemorrhaged but otherwise intact pericardium, blood in the pericardial sac, and a channel-like defect in the anterior wall of the left cardiac ventricle. The cause of death was attributed to cardiac tamponade. To the best of our knowledge, this is the first reported case of unplanned complex suicide involving an unmodified blank firing gun.

Applying 3D prints to reconstructing postmortem craniofacial features damaged by devastating head injuries.

Postmortem facial identification is one of the most common techniques for establishing a deceased person's identity. In victims suffering from devastating cranial injuries, the feasibility of facial identification tasks can be compromised by damage to or disfigurement of the identifying cranial features. Although there are several reconstructive approaches, which help experts to restore the essence of person's physical appearance, thus enhancing the chances of recognition, only a few of them involve restoring the fractured cranial bones as the foundation for the reconstructed soft tissues. Here, we propose a technique based on replacement of heavily damaged hard tissues with generic prosthetics manufactured by 3D printing. Our approach does not require medical imaging technologies or other costly lab equipment. It is simple, affordable and relatively labor-efficient. The deceased's reconstructed craniofacial features can be subsequently assessed, photographed, drawn or otherwise reproduced in order to help determine his or her identity. In addition, the imagery can be displayed, published or broadcasted in media without concerns of being overly graphic.

Using drone-mounted cameras for on-site body documentation: 3D mapping and active survey.

Recent advances in unmanned aerial technology have substantially lowered the cost associated with aerial imagery. As a result, forensic practitioners are today presented with easy low-cost access to aerial photographs at remote locations. The present paper aims to explore boundaries in which the low-end drone technology can operate as professional crime scene equipment, and to test the prospects of aerial 3D modeling in the forensic context. The study was based on recent forensic cases of falls from height admitted for postmortem examinations. Three mock outdoor forensic scenes featuring a dummy, skeletal remains and artificial blood were constructed at an abandoned quarry and subsequently documented using a commercial DJI Phantom 2 drone equipped with a GoPro HERO 4 digital camera. In two of the experiments, the purpose was to conduct aerial and ground-view photography and to process the acquired images with a photogrammetry protocol (using Agisoft PhotoScan® 1.2.6) in order to generate 3D textured models. The third experiment tested the employment of drone-based video recordings in mapping scattered body parts. The results show that drone-based aerial photography is capable of producing high-quality images, which are appropriate for building accurate large-scale 3D models of a forensic scene. If, however, high-resolution top-down three-dimensional scene documentation featuring details on a corpse or other physical evidence is required, we recommend building a multi-resolution model by processing aerial and ground-view imagery separately. The video survey showed that using an overview recording for seeking out scattered body parts was efficient. In contrast, the less easy-to-spot evidence, such as bloodstains, was detected only after having been marked properly with crime scene equipment.

[Oncology secrets of suddenly deceased individuals]. / Onkologická tajemství zemrelých.

Malignant neoplasms represent the second most common cause of death in men and women in the Czech Republic after cardiovascular diseases. The incidence, prevalence and mortality is recorded in the Czech National Cancer Registry. The most recent data available is from 2013, in this year there were 81 541 patients newly diagnosed with cancer and 26 944 people died of cancer. From a long-term perspective, the incidence of neoplasms is increasing and the mortality is decreasing. In the Institute of Forensic Medicine in Brno there were 480 cases of newly reported malignant tumors during the period 2010-2015, which were not known before the autopsy. 71.4 % of these cases were men and 28.6 % were women. In 212 cases the tumor was advanced and was the immediate cause of death. The total number of deadly cases in men was 149, the age average was 66.2 years. The most common malignant tumor leading to death was of bronchi and lungs (39.6 %), large intestine (9.4 %), pancreas (6.7 %), liver (4.7 %), stomach (4 %) and prostatic gland (4 %). In women the total number of deaths resulting from malignant tumor was 63, the age average was 72.6 years. The most common malignant tumor leading to death was of bronchi and lungs (33.3%), ovary (11.1 %), large intestine (9.5 %), gall bladder (6.3 %) and kidney (6.3 %). Some of the autopsy findings are shown on the photographs at the end of the article.

Postmortem Increase in Body Core Temperature: How Inaccurate We Can Be in Time Since Death Calculations.

Postmortem increase in body core temperature is a well-known phenomenon in forensic practice. Despite this, cases of reliably documented postmortem hyperthermia are rarely reported in the forensic literature, and it is still not clear how frequently postmortem hyperthermia occurs and in which cases we may it predict. In routine forensic practice, the standard course of body cooling is expected, and the prediction of normal body core temperature in the time of death is used for back-calculating the time of death by Henssge method. The unexpected rising in body core temperature may considerably misguide the estimation of time since death in the early postmortem period. We present a rare case of nonviolent death in the hospital with exactly recorded unusual elevation of body core temperature after death, although the body temperature shortly before the death was normal. In the presented case, the "standard" cooling of the body began up to 4 hours after death.

[Current macro-diagnostic trends of forensic medicine in the Czech Republic]. / Makrodiagnostické trendy soucasné soudnelékarské praxe v Ceské republice.

Over the last few years, advanced diagnostic methods have penetrated in the realm of forensic medicine in addition to standard autopsy techniques supported by traditional X-ray examination and macro-diagnostic laboratory tests. Despite the progress of imaging methods, the conventional autopsy has remained basic and essential diagnostic tool in forensic medicine. Postmortem computed tomography and magnetic resonance imaging are far the most progressive modern radio diagnostic methods setting the current trend of virtual autopsies all over the world. Up to now, only two institutes of forensic medicine have available postmortem computed tomography for routine diagnostic purposes in the Czech Republic. Postmortem magnetic resonance is currently unattainable for routine diagnostic use and was employed only for experimental purposes. Photogrammetry is digital method focused primarily on body surface imaging. Recently, the most fruitful results have been yielded from the interdisciplinary cooperation between forensic medicine and forensic anthropology with the implementation of body scanning techniques and 3D printing. Non-invasive and mini-invasive investigative methods such as postmortem sonography and postmortem endoscopy was unsystematically tested for diagnostic performance with good outcomes despite of limitations of these methods in postmortem application. Other futuristic methods, such as the use of a drone to inspect the crime scene are still experimental tools. The authors of the article present a basic overview of the both routinely and experimentally used investigative methods and current macro-diagnostic trends of the forensic medicine in the Czech Republic.

[Correct indications and performing of autopsies in the Czech republic]. / Správný postup pri indikaci a provádení pitev v Ceské republice.

Since July 1st 2016 Czech law, after more than two years after the new Civil code came into force, in turn, permits performing the clinician indicated pathological-anatomical autopsies with regard to their basic purpose, which is to identify the cause of death, other diseases, complications of diseases and to verify the clinical diagnosis and medical treatment of patient.For physicians requesting an autopsy it is important to know the rules for their indication and implementation. These rules respect the public interest in performing the autopsies as well as the possibility to decide about post-mortem treatment of the own body and bodies of close relatives.Clinical autopsies can be divided into three groups: absolutely obligatory (carried always), relatively obligatory for professional reasons (with possibility of cancellation after additional professional assessment by a provider performing the autopsy) and relatively mandatory after the disapproval of the autopsy (by the deceased during his life or on the request of close relatives after death).The paper presents a review of medical practice regarding autopsies indicated by clinicians according to generally binding legal regulations in the Czech Republic.

Atypical stab injury suggesting ritual suicide.

Sharp weapons have been one of the most common deadly tools in cases of homicide and suicide for a long time. Tentative incisions accompany the majority of suicides by sharp force and the absence of hesitation marks provokes questions about the manner of death. We present the bizarre fatality of a 41-year-old male with an isolated circumscribed incision on the right neck, where the body was found lying in a pool of blood in the shower of his apartment. The internal examination revealed a 4-cm-long channel-like defect running inwardly and downwardly along the right sternocleidomastoid region. The cause of death was external bleeding from an injured right carotid artery and internal jugular vein. The wound had clean non-contused margins without any conspicuous hesitation injuries. A fragment of a razor blade, found in blood splatters, was identified as the only potential injuring tool. The case was classified as a suicide.

[The criteria for appointing experts in forensic medicine]. / Kritéria pro jmenování znalcu pro obor zdravotnictví odvetví soudní lékarství

UNLABELLED: In the Czech Republic, forensic medicine is an independent medical field, in which physicians with the appropriate attestation perform expert activities, especially in criminal proceedings, after being formally appointed by a regional court. In order to improve the quality of the activities provided by these experts, the Ministry of Justice is endeavouring to tighten up the general conditions for the appointment of new forensic experts. The individual criteria do not, however, take into account the special nature of forensic medicine as a medical field, the very essence of which involves the specialist qualifications which are necessary for the provision of expert opinions, most frequently to the police. In particular, the introduction of a strict requirement for ten-years of work experience after leaving medical school has hindered and stalled the entrance of young physicians with completed post-graduate studies into the area of forensic medicine. An inquiry sent to the regional courts has discovered that the average length of work experience for newly appointed experts in the period from 2004 to 2013 was 8.2 years, that half of them had work experience of seven years or less and that 75 percent of the newly appointed experts did not meet any set requirements for the length of their work experience at the time of their appointment. The new conditions may have a negative impact on attracting qualified graduates to forensic medicine after the completion of their medical studies and in the long term it may endanger the ability of the field of forensic medicine to provide expert opinions in criminal proceedings. In conclusion, it is the authors opinion that the appointment conditions should be set in cooperation with the professional medical associations and that they should take into account the specific characteristics of the individual medical fields, especially if they are to be set directly by means of a legal regulation within the framework of the recodification of the standing of forensic experts in the Czech Republic. KEYWORDS: forensic medicine - expertises - criminal procedure.

Retroperitoneal Liposarcoma: an Autopsy Case.

Liposarcoma is very rare mesenchymal tumor that occurs in deep soft tissue and mostly seen in limbs and retroperitoneum, accounts for 24% of extremity and 45% of retroperitoneal soft tissue sarcomas. Retroperitoneal liposarcomas are typically present with advanced disease and often carry a poor prognosis. Retroperitoneal liposarcomas grow slowly in the very expandable retroperitoneal space in the deeply hidden and clinically silent therefore diagnosis is usually made late. Liposarcomas have five histological subtypes; well-differentiated liposarcoma (WDLS), dedifferentiated liposarcoma (DDLS), pleomorphic, myxoid and round cell liposarcoma. Our case is 81-year-old male who was found dead in the village homeless shelter. This was classified as a suspicious death and transferred to our service for autopsy. The external examination revealed rectal prolapse, abdominal distension and scrotal swelling. The internal autopsy showed green membrane on the peritoneum, brown smelly contents in the abdominal space, a perforation area 1.5x1 cm in size that in the first part of the duodenum and the dimension of tumor was 48x30x6 cm in the retroperitoneal space. The pathological report was dedifferentiated liposarcoma. We present a rare case of a dedifferentiated retroperitoneal liposarcoma with duodenal ulcer perforation.

Death Due to Myocardial Bridging.

Myocardial bridging is a congenital coronary pathology described as a segment of coronary artery which courses through the myocardial wall beneath the muscle bridge. Although the myocardial bridging prognosis is benign, have been also reported sudden death in medical literature. ¬A 30-year-old married woman was found dead at her home. After local prosecutors' investigation the death was declared as suspicious and forensic autopsy was obliged. The left anterior descending coronary artery was detected embedded deeply in the myocardium 2 cm from its coronary ostial origin. There were no other pathology to explain death. We analyzed sudden death case occurred because of myocardial bridging and the pathophysiological mechanisms in the light of medico-legal literature.