Distribution of bone fragments in angled shots: an experimental study conducted on composite models containing artificial bone plates.

In conventional gunshot injuries to targets containing bone the resulting osseous fragments do not precede but follow the bullet on its further way through adjacent soft tissues. The term "secondary projectiles" for the particles does not appear to be appropriate since they are not believed to have enough energy necessary for creating their own wound channels away from the temporary cavity. Former studies have shown that in angled shots to glass panes the bulk of splinters does not follow the bullet's trajectory: The majority of the glass fragments, especially the larger ones, move at right angles to the pane shot through. The aim of the presented study was to examine whether osseous fragments behave like glass splinters in angled shots to flat synthetic bone. In this context, it should also be assessed, whether the bone fragments might act as secondary projectiles in rare cases. To answer these questions, test shots were fired to composite models consisting of flat synthetic bone and ballistic gelatin. Pistol cartridges 9 mm Luger were used to fire the shots which were video-documented with a high-speed camera. Afterwards, the composite models underwent CT examination and macroscopic inspection. Video-documentation revealed that the larger bone particles from the perforation site move at a roughly right angle from the osseous sheet into the gelatin, causing an eccentric bulge of the temporary cavity. The smaller bone fragments were also lodged along the bullet's path, predominantly in the cracks radiating from the permanent wound channel.

Ethanol Kinetics in the Human Brain Determined by Magnetic Resonance Spectroscopy.

In many parts of the world, ethanol is a widely consumed substance that displays its effect in the brain, the target organ for desired, but also negative impact. In a previous study, the ethanol concentrations were analyzed in different regions of the brain by magnetic resonance spectroscopy (MRS). In this study, the same method is used to demonstrate the kinetics of the ethanol concentration in the human brain after oral ethanol uptake. A drinking study was performed with 10 healthy participants. After the uptake of ethanol in a calculated amount leading to a plasma ethanol concentration of 0.92 g/L (19.95 mM corresponding to a blood ethanol concentration of 0.7 g/kg), brain ethanol concentrations were continuously measured by means of MRS on a 3 Tesla human magnetic resonance imaging (MRI) system. For the data acquisition a single-voxel sLASER sequence was used, with the volume of interest located in the occipital cortex. Intermittently, blood samples were taken and plasma was analyzed for ethanol using headspace gas chromatography with flame ionization detection (HS-GC-FID). The obtained MRS brain ethanol curves showed distinct inter-individual differences; however, a good intra-individual correlation of plasma and brain ethanol concentrations was observed. The results suggest a rapid equilibration between blood and brain. The ethanol concentrations measured in the brain were substantially lower than the measured plasma ethanol results, suggesting an MRS visibility of about 63% for ethanol in brain tissue. The maximum individual ethanol concentrations in the brain (normalized to water content) ranged between 7.1 and 14.1 mM across the cohort, while the highest measured plasma concentrations were in the range between 0.35 g/L (9.41 mM) and 0.95 g/L (20.52 mM).

Comparison of ethanol concentrations in the human brain determined by magnetic resonance spectroscopy and serum ethanol concentrations.

AIMS: Ethanol is a widespread substance that inherits desired effects, but also negative consequences with regard to DUI or battery. Where required, the ethanol concentration is usually determined in peripheral venous blood samples, while the brain is the target organ of the ethanol effects. The aim of this study with three participants was the determination of the ethanol concentration in functionally relevant regions of the brain and the comparison with serum ethanol concentrations. DESIGN: After the uptake of ethanol in a calculated amount, leading to a serum ethanol concentration of 0.99 g/L, the ethanol concentrations in the brain were directly analyzed by means of magnetic resonance spectroscopy on a 3 Tesla human MRI system and normalized to the water content. The measurement voxels were located in the occipital cortex, the cerebellum, the frontal cortex, and the putamen and successively examined. Intermittently blood samples were taken, and serum was analyzed for ethanol using HS-GC-FID. FINDINGS AND CONCLUSIONS: Ethanol concentrations in brain regions normalized to the water content were lower than the measured serum ethanol results and rather homogenous within the three participants and the various regions of the brain. The maximum ethanol concentration in the brain (normalized to water content) was 0.68 g/L. It was measured in the frontal cortex, in which the highest results were gained. The maximum serum concentration was 1.19 g/L. The course of the brain ethanol curve seems to be flatter than the one of the serum ethanol concentrations.

A moving human body causes fatal blunt trauma: an unusual traffic accident.

In urban traffic accidents, mainly pedestrians and cyclists are at risk of being injured and killed. Lethal injuries are usually caused by the immediate impact of a car or a tram. This paper presents a fatal accident without any direct contact with a motor vehicle. A 63-year-old woman sitting on a chair in a pavement cafe was killed by the impact of a 60-year-old male cyclist, who was flung in her direction after colliding with a car. Autopsy yielded intracutaneous haemorrhages on the impact sites of the female victim (left cheek, left shoulder and left upper arm). The woman sustained a ring fracture of the skull base encircling the foramen magnum with subtotal severance of the brain stem and massive chest trauma. All the injuries were caused by the blunt impact of the moving human body. The head was forcibly bent towards the contralateral shoulder resulting in a depression fracture of the skull. Reconstruction of the accident at the scene was challenging, as the fatally injured victim remained sitting on the chair and did not show any striking external signs of traumatisation. According to the assessment of the technical expert, the collision velocity of the moving body amounted to 6-8 m/s.

Bullet wipe on the uppermost textile layer of gunshot entrance sites: may it be absent due to pre-existing blood staining?

Most gunshot entrance sites on human victims are localized in clothed body regions. Except for the use of lead-free ammunition, a positive color reaction of the sodium rhodizonate test indicates a primary target hit by the bullet. Any lead residue pattern in the area around the entrance hole allows approximate conclusions as to the firing distance in close and intermediate range shots, whereas the presence of a bullet wipe denotes an entrance site. A criminal case gave rise to an experimental study to clarify whether a blood-soaked garment being shot at as a primary target may lack a bullet wipe around the entrance hole. Distant-range shots were fired with a semi-automatic pistol (Heckler & Koch, Mod. USP Compact, cal. 9-mm Luger) using cartridges with jacketed round-nose bullets and a Sinoxid primer containing lead styphnate. In fabrics saturated with fluid blood, a wide area around the bullet entrance was densely covered with rhodizonate-positive microparticles simulating gunshot residues (GSR) from a close-range shot. In shots to fabrics oversaturated with blood, a typical bullet wipe was lacking, whereas lead-containing particles were spotted in the periphery. The results are discussed with respect to the aberrant appearance of bullet entrance sites in blood-soaked fabrics.

Phosphatidylethanol (PEth) detected in blood for 3 to 12 days after single consumption of alcohol-a drinking study with 16 volunteers.

In most studies, the alcohol marker phosphatidylethanol (PEth) was used to differentiate social drinking from alcohol abuse. This study investigates PEth's potential in abstinence monitoring by performing a drinking study to assess the detection window of PEth after ingesting a defined amount of alcohol. After 2 weeks of abstinence, 16 volunteers ingested a single dose of alcohol, leading to an estimated blood alcohol concentration (BAC) of 1 g/kg. In the week after drinking, blood and urine samples were taken daily; in the second week, samples were taken every other day. PEth 16:0/18:1 and 16:0/18:2 were analyzed in blood by online-SPE-LC-MS/MS. Ethyl glucuronide and ethyl sulfate were determined in urine for abstinence monitoring. Prior to start of drinking, PEth 16:0/18:1 exceeded 30 ng/mL in blood samples of five volunteers despite the requested abstinence period. Positive PEth values resulted from drinking events prior to this abstinence period. After the start of drinking, maximum BACs were reached after 2 h with a mean of 0.80 ± 0.13 g/kg (range: 0.61-1.11 g/kg). PEth 16:0/18:1 increased within 8 h to maximum concentrations (mean: 88.8 ± 47.0 ng/mL, range: 37.2-208 ng/mL). After this event, PEth was detectable for 3 to 12 days with a mean half-life time of approximately 3 days. PEth has a potential in abstinence monitoring, since PEth could be detected for up to 12 days after a single drinking event. Further investigations are necessary, to establish cut-off levels for PEth as diagnostic marker for the determination of drinking habits like abstinence, social drinking, or risky alcohol consumption.

Wound morphology in contact shots from blank cartridge handguns: a study on composite models.

It is a well-known fact that blank cartridge guns can cause penetrating and even fatal injuries when discharged in contact or at very close ranges. In these cases, the gas jet perforates the skin leaving an entrance wound similar to that from a conventional gun. In order to investigate the wound morphology in contact shots from blank firearms, test shots were fired at composite models of pig skin and gelatin blocks using three different calibre 9-mm blank cartridge handguns (two pistols and one revolver) and two types of ammunition. It turned out that the penetrating gas jet produced roundish skin defects resembling bullet entrance holes. Small skin particles from the perforation site were dispersed in the underlying simulant where radiating cracks containing greyish gunshot residues indicated the original expansion of the inrushing combustion gases. Apart from the size of the permanent entrance hole in the skin and the final position of the displaced tissue particles, the penetration depth of the gas jet was determined. Under the specified conditions of the test shots, the zone of mechanical destruction within the simulant was 2.2 to 6.1 cm in length, which illustrates the injuring potential of contact shots inflicted with blank cartridge handguns.

The influence of the bullet shape on the width of abrasion collars and the size of gunshot entrance holes.

To investigate if there is any correlation between the bullet design and the respective dimensions of the abrasion collar and the skin defect in gunshot entrance wounds, experimental studies were performed on dyed pig skin. For the test shots, .38 Special revolver cartridges with three different bullet designs (round nose, wadcutter, and truncated cone) were used. With the help of an image editing program in combination with an image analyzing system, the area size of the abrasion rings and the skin defects was calculated automatically. The measured values differed significantly depending on the bullet type: the abrasion ring areas were largest in shots with round nose bullets and smallest with wadcutter projectiles. With regard to the entrance hole size, the relationship was inverse. The results are discussed with reference to the pertinent literature concerning the dynamic interaction between bullet and skin.

Suicide with two makes of captive-bolt guns (livestock stunners) fired simultaneously to the forehead.

In humans, most fatalities from slaughterer's guns are suicides committed by persons familiar with stunning devices. The great majority of cases accounts for shots to the head, especially the frontal region. Only a small number of two subsequent cranial shots from captive-bolt humane killers have been reported up to now. In the case presented by the authors, a suicide by simultaneous shots to the head fired from two different makes of captive-bolt guns (one of them having two separate outlets for the combustion gases in the muzzle plane, the other type having no additional openings) is described for the first time. One of the shooting devices remained in firm contact with the left hand and produced patterned staining from rust corresponding to the surface relief of the gun. The medicolegal and criminalistic aspects of this unique case are discussed with reference to the pertinent literature.

Detection of the ethanol consumption markers ethyl glucuronide and ethyl sulfate in urine samples from inmates of two German prisons.

INTRODUCTION: Abstinence from ethanol is necessary in various situations. Among these are jail terms. Nevertheless, it is a matter of fact that ethanol is illegally produced and ingested in prisons. So far, data regarding drug prevalence in jail have mainly been collected by questionnaires. To get an objective database for the prevalence of ethanol consumption in jail, a cross-sectional study was performed. METHODS: Inmates of two German prisons (Offenburg and Freiburg) were asked to give a urine sample at an unknown and random point of time. Participation was voluntary and did lead to neither negative consequences nor benefits. All samples were anonymized. Using the consumption markers ethyl glucuronide (EtG) and ethyl sulfate (EtS), the urine samples were tested for previous ethanol consumption. Analyses were performed by a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. RESULTS: In total 676 male inmates participated in this study. The participation rate was 70-75% of all permanent inmates in Offenburg and 30.6% in Freiburg. Ten of the 555 (1.8%) samples from Offenburg and 1 of the 121 (0.8%) samples from Freiburg were positive for ethanol consumption markers with concentrations ranging from trace amounts to 1400 ng/mL for EtG and up to 510 ng/mL for EtS, respectively. CONCLUSIONS: The number of participants in this study was rather high, so that the results represent a good cross section, at least for Offenburg, the jail with the higher number of positive samples.

Influence of Gilbert's syndrome on the formation of ethyl glucuronide.

A drinking experiment with participants suffering from Gilbert's syndrome was performed to study the possible influence of this glucuronidation disorder on the formation of ethyl glucuronide (EtG). Gilbert's syndrome is a rather common and, in most cases, asymptomatic congenital metabolic aberration with a prevalence of about 5 %. It is characterized by a reduction of the enzyme activity of the uridine diphosphate glucuronosyltransferase (UGT) isoform 1A1 up to 80 %. One of the glucuronidation products is EtG, which is formed in the organism following exposure to ethanol. EtG is used as a short-term marker for ethyl alcohol consumption to prove abstinence in various settings. After 2 days of abstinence from ethanol and giving a void urine sample, 30 study participants drank 0.1 L of sparkling wine (9 g ethanol). 3, 6, 12, and 24 h after drinking, urine samples were collected. 3 hours after drinking, an additional blood sample was taken, in which liver enzyme activities, ethanol, hematological parameters, and bilirubin were measured. EtG and ethyl sulfate (EtS), another short-term marker of ethanol consumption, were determined in the urine samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS); creatinine was measured photometrically. In all participants, EtG and EtS were detected in concentrations showing a wide range (EtG: 3 h sample 0.5-18.43 mg/L and 6 h sample 0.67-13.8 mg/L; EtS: 3 h sample 0.87-6.87 mg/L and 6 h sample 0.29-4.48 mg/L). No evidence of impaired EtG formation was found. Thus, EtG seems to be a suitable marker for ethanol consumption even in individuals with Gilbert's syndrome.

[Fire disaster due to deflagration of a propane gas-air mixture]. / Folgenschwerer Brand durch Entzündung eines Propangas-Luft-Gemisches.

On 26 Nov 2012, a serious fire occurred at Neustadt/Black Forest in which 14 persons in a sheltered workshop died and 10 other individuals were injured. The fire was caused by the unbridled escape of propane gas due to accidental disconnection of the screw fixing between a gas bottle and a catalytic heater. Deflagration of the propane gas-air mixture set the workshop facilities on fire. In spite of partly extensive burns the fatally injured victims could be rapidly identified. The results of the fire investigations at the scene and the autopsy findings are presented. Carboxyhemoglobin concentrations ranged between 8 and 56 % and signs of fire fume inhalation were present in all cases. Three victims had eardrum ruptures due to the sudden increase in air pressure during the deflagration.

Non-Fatal accidental strangulation in a stroke patient.

Non-fatal strangulation poses a significant concern in clinical forensic medicine. Indeed, surviving victims often present a diverse array of signs and symptoms. In rare instances, acute pathological events that manifest with symptoms similar to those secondary to neck compression (e.g., stroke with subsequent neurological symptoms, etc.) can lead to loss of consciousness, inadvertently resulting in strangulation. Therefore, in this context, forensic investigation plays a crucial role in interpreting the signs and symptoms presented by the victim and determining whether they are the cause or consequence of neck compression. This report presents a case of a middle-aged previously healthy woman who was found by her husband on the bathroom floor and then brought to the medical attention exhibiting signs of neck compression in combination with neurological symptoms. Since a previous episode of domestic violence involving the husband has been recorded in the hospital database, a medico-legal investigation was initiated at the behest of the prosecutor. The integration of all clinical, radiological, forensic pathological findings and circumstantial data allowed the exclusion of homicidal strangulation by ligature perpetrated by the husband, as well as suicidal hanging; instead, it classified the case as an accidental hanging, with a stroke being the underlying cause of the accident. The case provides valuable insights into the complexity of interpreting injuries associated with neck compression and emphasizes the need for comprehensive investigative approach in such cases.

Intimate partner femicide (IPF): Medico-legal investigation at the Institutes of Legal Medicine of Freiburg (Germany) and Padova (Italy).

Violence against women is a significant public health concern, with femicide as its most extreme manifestation. This crime is often perpetrated by current or former intimate partners, thus taking the name of intimate partner femicide (IPF). Although international comparisons are essential for prevention policies, cross-country comparative studies are scarce in this context. The aim of this study was to evaluate and compare clinical, epidemiological and medico-legal characteristics of IPF autopsy cases investigated at the Institutes of Legal Medicine of two Western European cities, in order to identify a potential medico-legal pattern of IPF. Autopsy and police reports of IPF cases occurred in the judicial district of Freiburg (Germany) and Padova (Italy) from 2000 to 2022 were analyzed. Data relating to victims, perpetrators, relationship context, and circumstantial and pathological-forensic characteristics of the homicide were collected. Statistical analyses were performed to explore potential relationships between the data collected. Additionally, a review of the literature dealing with autopsy-based studies on IPF was performed. Overall, 82 cases of IPF were analyzed, 39 from Freiburg and 43 from Padova. A total of 6 papers fulfilled the review inclusion criteria. Our study identified a medico-legal pattern of IPF and demonstrated that it did not vary substantially between the two European Countries considered, suggesting that certain IPF characteristics are shared at the European level. However, a significant finding emerged regarding the higher prevalence of firearm-related IPFs in Italy compared to Germany. Forensic pathology research might contribute to developing targeted prevention policies to protect women from this lethal form of violence.

In Search for a Pathogenesis of Major Depression and Suicide-A Joint Investigation of Dopamine and Fiber Tract Anatomy Focusing on the Human Ventral Mesencephalic Tegmentum: Description of a Workflow.

Major depressive disorder (MDD) is prevalent with a high subjective and socio-economic burden. Despite the effectiveness of classical treatment methods, 20-30% of patients stay treatment-resistant. Deep Brain Stimulation of the superolateral branch of the medial forebrain bundle is emerging as a clinical treatment. The stimulation region (ventral tegmental area, VTA), supported by experimental data, points to the role of dopaminergic (DA) transmission in disease pathology. This work sets out to develop a workflow that will allow the performance of analyses on midbrain DA-ergic neurons and projections in subjects who have committed suicide. Human midbrains were retrieved during autopsy, formalin-fixed, and scanned in a Bruker MRI scanner (7T). Sections were sliced, stained for tyrosine hydroxylase (TH), digitized, and integrated into the Montreal Neurological Institute (MNI) brain space together with a high-resolution fiber tract atlas. Subnuclei of the VTA region were identified. TH-positive neurons and fibers were semi-quantitatively evaluated. The study established a rigorous protocol allowing for parallel histological assessments and fiber tractographic analysis in a common space. Semi-quantitative readings are feasible and allow the detection of cell loss in VTA subnuclei. This work describes the intricate workflow and first results of an investigation of DA anatomy in VTA subnuclei in a growing naturalistic database.

Can PEth be Detected with a Cutoff of 20 ng/mL after Single Alcohol Consumption?

Phosphatidylethanol (PEth) can be determined in capillary blood collected as dried blood spots (DBS) and is a promising direct alcohol biomarker for the determination of drinking habits. Its use for abstinence monitoring needs to be evaluated. Studies with patients undergoing alcohol withdrawal have shown that the elimination of PEth can take up to 2 months. For the determination of PEth 16:0/18:1, a cutoff of 20 ng/mL has been agreed upon in the major US laboratories. However, it is not yet clear what minimum blood alcohol concentrations (BACs) have to be achieved by a single drinking episode to result in PEth concentrations above this cutoff after previous long-term abstinence. To determine whether low drinking amounts can result in a positive PEth concentration above 20 ng/mL, we recruited 12 participants ('social' drinkers). After 4 weeks of abstinence, alcohol was consumed at two separate drinking events with target BACs of 0.5 and 0.3 g/kg, resulting in maximum BACs in the ranges of 0.30-0.63 g/kg and 0.10-0.28 g/kg, respectively. Capillary blood was collected at different time points of the drinking experiment, and PEth was extracted from DBS and analyzed by liquid chromatography-tandem mass spectrometry. Despite drinking doses up to 0.58 g ethanol per kg body weight and reaching BACs of up to 0.63 g/kg, PEth 16:0/18:1 and PEth 16:0/18:2 could not be detected at or above the 20 ng/mL cutoff in any participant at any time after the drinking events. We conclude that after long-term abstinence the cutoff of 20 ng/mL for single alcohol consumption leading to BACs up to 0.63 g/kg is not exceeded.

Detection of methadone and buprenorphine in urine samples from inmates of German prisons.

The use of non-prescribed opioid substitution drugs is a serious public health problem, involving general population as well as vulnerable populations such as prisoners. The estimation of the prevalence of opioid substitution drug misuse in prisoners is crucial to suggest strategies to contrast this phenomenon and reduce the associated morbidity and mortality. The present study aimed to provide an objective estimation of the prevalence of illicit use of methadone and buprenorphine in two German prisons. Urine samples were collected from inmates of Freiburg and Offenburg prisons at random times and tested for the detection of methadone, buprenorphine and their metabolites. Analyses were performed by a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. In total 678 inmates participated in this study. The participation rate was about 60% of all permanent inmates. Of the 675 samples suitable for the analysis, 70 samples (10.4%) tested positive for methadone, 70 samples (10.4%) for buprenorphine, and 4 samples (0.6%) for both drugs. At least 100 samples (14.8%) were not associated with reported prescribed-opioid substitution treatment (OST). Buprenorphine was the most common illicitly used drug. In one of the prisons, buprenorphine was brought in from the outside. The present cross-sectional experimental study was able to provide reliable information regarding the illicit use of opioid substitution drugs in prisons.

Incomplete decapitation with exenteration of the brain in a motorcyclist run over by a semitrailer.

Although decapitation is a well-known traumatic mechanism in road traffic deaths, incomplete decapitation of a motorcyclist with exenteration of the brain has not yet been reported in the forensic literature in a victim run over by a vehicle. This paper deals with an autopsy case of a 69-year-old motorcyclist, who had been run over by a semitrailer, as a result of which flattening of the head with extrusion of the brain and incomplete decapitation occurred at the level of the fourth cervical vertebra. This constellation allows to define a special mechanism of accident-related decapitation. Moreover, the case underlines the importance of a multidisciplinary approach for the reconstruction of the accident as well as for the assessment of its judicial consequences. On the suspicion of a hit-and-run accident, simulation tests were performed by technical experts. These tests revealed that the motorcycle may not have been conspicuous for the truck driver prior to and during the accident. Consequently, the charge of manslaughter and failure to render assistance against the truck driver was dropped.

Diverging prefrontal cortex fiber connection routes to the subthalamic nucleus and the mesencephalic ventral tegmentum investigated with long range (normative) and short range (ex-vivo high resolution) 7T DTI.

Uncertainties concerning anatomy and function of cortico-subcortical projections have arisen during the recent years. A clear distinction between cortico-subthalamic (hyperdirect) and cortico-tegmental projections (superolateral medial forebrain bundle, slMFB) so far is elusive. Deep Brain Stimulation (DBS) of the slMFB (for major depression, MD and obsessive compulsive disorders, OCD) has on the one hand been interpreted as actually involving limbic (prefrontal) hyperdirect pathways. On the other hand slMFB's stimulation region in the mesencephalic ventral tegmentum is said to impact on other structures too, going beyond the antidepressant (or anti OCD) efficacy of sole modulation of the cortico-tegmental reward-associated pathways. We have here used a normative diffusion MRT template (HCP, n = 80) for long-range tractography and augmented this dataset with ex-vivo high resolution data (n = 1) in a stochastic brain space. We compared this data with histological information and used the high resolution ex-vivo data set to scrutinize the mesencephalic tegmentum for small fiber pathways present. Our work resolves an existing ambiguity between slMFB and prefrontal hyperdirect pathways which-for the first time-are described as co-existent. DBS of the slMFB does not appear to modulate prefrontal hyperdirect cortico-subthalamic but rather cortico-tegmental projections. Smaller fiber structures in the target region-as far as they can be discerned-appear not to be involved in slMFB DBS. Our work enfeebles previous anatomical criticism and strengthens the position of the slMFB DBS target for its use in MD and OCD.