Fat embolism after intraosseous catheters in pediatric forensic autopsies.

In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data

Can the size of the contact area body-ground influence the presence of acute pulmonary emphysema in cases of incomplete hanging?

In a recently published study, we showed that acute pulmonary emphysema (APE) was present in cases of death by incomplete hanging and absent in cases of complete hanging. This result suggested a possible role of the hanging position on the respiratory distress of these victims. To further investigate this hypothesis, in the present study, we compared cases of incomplete hanging with a small contact area between body and ground (group A) to cases of incomplete hanging with a large contact area (group B). As positive and negative control group, we investigated cases of freshwater drowning (group C) and acute external bleeding (group D) respectively. Pulmonary samples were histologically examined, and the mean alveolar area (MAA) for each group was measured by digital morphometric analysis. MAA was 23,485 μm <sup>2</sup> for group A and 31,426 μm <sup>2</sup> for group B (p < 0.05). MAA of group B was similar to MAA of positive control group (33,135 μm <sup>2</sup> ) and MAA of group A was similar to MAA of negative control group (21,991 μm <sup>2</sup> ). These results seem to confirm our hypothesis and suggest that the size of the contact area between body and ground influences the presence of APE. Furthermore, the present study showed that APE can be proposed as a vitality sign in incomplete hanging, but only in cases with a large contact area between body and ground

Practical application of synthetic head models in real ballistic cases.

In shooting crimes, ballistics tests are often recommended in order to reproduce the wound characteristics of the involved persons. For this purpose, several "simulants" can be used. However, despite the efforts in the research of "surrogates" in the field of forensic ballistic, the development of synthetic models needs still to be improved through a validation process based on specific real caseworks. This study has been triggered by the findings observed during the autopsy performed on two victims killed in the same shooting incident, with similar wounding characteristics; namely two retained head shots with ricochet against the interior wall of the skull; both projectiles have been recovered during the autopsies after migration in the brain parenchyma. The thickness of the different tissues and structures along the bullets trajectories as well as the incident angles between the bullets paths and the skull walls have been measured and reproduced during the assemblage of the synthetic head models. Two different types of models ("open shape" and "spherical") have been assembled using leather, polyurethane and gelatine to simulate respectively skin, bone and soft tissues. Six shots have been performed in total. The results of the models have been compared to the findings of post-mortem computed tomography (PMCT) and the autopsy findings.Out of the six shots, two perforated the models and four were retained. When the projectile was retained, the use of both models allowed reproducing the wounds characteristics observed on both victims in terms of penetration and ricochet behaviour. However, the projectiles recovered from the models showed less deformation than the bullets collected during the autopsies. The "open shape" model allowed a better controlling on the shooting parameters than the "spherical" model. Finally, the difference in bullet deformation could be caused by the choice of the bone simulant, which might under-represent either the strength or the density of the human bone. In our opinion, it would be worth to develop a new, more representative material for ballistic which simulates the human bone

From Deutsche Zeitschrift to International journal of legal medicine-100 years of legal medicine through the lens of journal articles, Part 4: International journal of legal medicine from 1990 to 2022.

This is the fourth and final paper in a series related to the analysis of articles published in this journal during its first 100 years of activity. This article covers the time span from 1990 to 2022. It is important to note that, given the period covered by this analysis, it does not aim to provide a historical overview but rather an examination of the most recent trends in our discipline compared to the past. Between 1990 (Volume 104) and 2022 (Volume 136), 4004 articles were published in the International Journal of Legal Medicine (IJLM) across 33 volumes. This corresponds to 53% of all the articles published since the launch of the journal. When compared to the period from 1970 to 1990, some categories no longer appear to be as relevant (e.g., sexual medicine, 1 article; social medicine, 0 articles; biography, 3 articles; history, 4 articles). Conversely, the most recent period has shown an increasing importance in forensic genetics (1388 articles) and the emergence of new significant topics that merit their own classification, such as age estimation (286 articles), forensic anthropology (189 articles), forensic imaging (150 articles), and forensic entomology (90 articles)

From Deutsche Zeitschrift to International Journal of Legal Medicine-100 years of legal medicine through the lens of journal articles : Part 3: Zeitschrift für Rechtsmedizin-Journal of Legal Medicine from 1970 to 1990.

From volume 67 (1970) onwards, the journal appeared under the new bilingual title Zeitschrift für Rechtsmedizin-Journal of Legal Medicine. The editorial board was expanded and internationalised. From 1970 to 1990, 1416 articles were published in 36 volumes. 1036 articles were in German and 380 in English. The authors of 411 articles came from non-German-speaking countries. Compared to the periods under review in the first two parts of our article series, the proportion of papers on forensic genetics increased significantly between 1970 and 1990, with a small increase in publications on the identification of unknown dead bodies. An opposite trend was observed in the articles on forensic psychiatry and psychology, sexual medicine and social medicine. This development reflects a further sharpening of the discipline's profile

From Deutsche Zeitschrift to International Journal of Legal Medicine-100 years of legal medicine through the lens of journal articles : Part 2: Deutsche Zeitschrift für die gesamte gerichtliche Medizin from 1948 to 1969.

The interruption of the publication of the Deutsche Zeitschrift für die gesamte gerichtliche Medizin due to the war ended with volume 39 for the years 1948/1949. Until volume 66/1969, the journal appeared unchanged under the historical title. The 912 publications contained in the 28 volumes of these two decades cover topics from the main fields of forensic medicine, but also from related and unrelated disciplines. The topic-specific analysis of the publications shows a shift of the research focus in the German institutes since the post-war period. This is most evident in the decline in the number of publications from the fields of scientific and technical criminalistics as well as forensic psychiatry and psychology. An opposite trend with a significant increase in scientific papers was observed in alcohology, forensic genetics and traffic medicine. While the evaluated publications on most topics contain new findings that are still valid today, the use of blood group characteristics for forensic purposes came to an end as a result of the introduction of DNA analysis

Immunohistochemical expression of P-selectin, SP-A, HSP70, aquaporin 5, and fibronectin in saltwater drowning and freshwater drowning.

The diagnosis of drowning is one of the most difficult in forensic medicine. The aim of this study was to analyze pulmonary tissue reactions in death by drowning. In particular, we focused on the immunohistochemical expression of P-selectin, SP-A, HSP70, AQP-5, and fibronectin to investigate our expression in drowning and to understand whether there are differences between saltwater drowning (SWD) and freshwater drowning (FWD), which may indicate a different pathophysiology. We retrospectively investigated 10 cases of SWD (Mediterranean Sea) from the Institute of Legal Medicine of Genoa (Italy), and 10 cases of FWD (Lake of Geneva) from the University Center of Legal Medicine of Geneva (Switzerland). As control group, we examined 10 cases of death by acute external bleeding, characterized by minimal respiratory distress. As compared with controls, in SWD cases, the results showed a decrease of SP-A expression with membrane patterns. Furthermore, we observed a greater SP-A expression with granular pattern in drowning cases without statistically significant difference between SWD and FWD. For the markers AQP-5, HSP70, fibronectin, and P-selectin, no statistically significant differences were found between SWD, FWD, and controls

A forensic case of hydranencephaly in a preterm neonate fully documented by postmortem imaging techniques.

The authors present a medico-legal autopsy case of hydranencephaly in a male preterm newborn, fully documented by postmortem unenhanced and enhanced imaging techniques (postmortem computed tomography and postmortem magnetic resonance imaging). Hydranencephaly is a congenital anomaly of the central nervous system, consisting in almost complete absence of the cerebral hemispheres and replacement of the cerebral parenchyma by cerebrospinal fluid, rarely encountered in forensic medical practice. A premature baby was born during the supposed 22nd and 24th week of pregnancy in the context of a denial of pregnancy without any follow-up. The newborn died a few hours after birth and medico-legal investigations were requested to determine the cause of death and exclude the intervention of a third person in the lethal process. The external examination revealed neither traumatic nor malformative lesions. Postmortem imaging investigations were typical of hydranencephaly, and conventional medico-legal autopsy, neuropathological examination, and histological examination confirmed a massive necrotic-haemorrhagic hydranencephaly. This case represents in itself an association of out-of-the-ordinary elements making it worthy of interest. Postmortem unenhanced and enhanced imaging techniques (computed tomography and magnetic resonance imaging) were performed as complementary examination to conventional medico-legal investigations.Postmortem angiography of a preterm newborn is possible with catheterization of the umbilical blood vessels.Hydranencephaly is a congenital anomaly of the central nervous system, consisting in almost complete absence of the cerebral hemispheres and replacement of the brain by cerebrospinal fluid, for which several aetiologies have been postulated

The unrestricted Skyrme-tensor time-dependent Hartree-Fock and its application to the nuclear response from spherical to triaxial nuclei

The nuclear time-dependent Hartree-Fock model formulated in the three-dimensional space,based on the full Skyrme energy density functional and complemented with the tensor force,is presented for the first time. Full self-consistency is achieved by the model. The application to the isovector giant dipole resonance is discussed in the linear limit, ranging from spherical nuclei (16O, 120Sn) to systems displaying axial or triaxial deformation (24Mg, 28Si, 178Os, 190W, 238U). Particular attention is paid to the spin-dependent terms from the central sector of the functional, recently included together with the tensor. They turn out to be capable of producing a qualitative change on the strength distribution in this channel. The effect on the deformation properties is also discussed. The quantitative effects on the linear response are small and, overall, the giant dipole energy remains unaffected. Calculations are compared to predictions from the (quasi)-particle random phase approximation and experimental data where available, finding good agreement

Postmortem coronary artery calcium score in cases of myocardial infarction.

Sudden cardiac death (SCD) related to atherosclerotic coronary artery disease (ACAD) resulting in myocardial infarction is the most prevalent cause of death in western countries. In clinical practice, coronary artery calcium score (CACS) is considered an independent predictor of coronary events, closely related to atherosclerotic burden and is quantified radiologically by the Agatston score being calculated through computed tomography. Postmortem computed tomography (PMCT) allows the visualization and quantification of coronary calcifications before the autopsy. However, it was reported that some patients who died from severe ACAD had a zero CACS in PMCT. In this study, a retrospective evaluation of CACS in adult's myocardial infarction cases related to ACAD, with available CACS and histological slides of coronary arteries, was performed in order to gain a deeper understanding of coronary calcifications and their role in myocardial infarction cases. The CACS was calculated by using the software Smartscore 4.0 after the radiological examination on a 64-row CT unit using a specific cardiac protocol. Thirty-six cases were identified out of 582 autopsies, recorded during a 2-year study period (29 men, 7 women; age 56.3 ± 11.7). CACS was 0-10 in 5 cases (5 men, 44.8 ± 13.7), 11-100 in 8 cases (6 men, 2 women, 53.1 ± 7.7), 101-400 in 13 cases (11 men, 2 women, 57.4 ± 9.6), and > 400 in 10 cases (9 men, 1 woman, 63.1 ± 11.9). Coronary thrombosis was found in 28 cases, histologically identified as plaque erosions in 6 cases and as plaque ruptures in 22 cases. Statistical analyses showed that CACS increases significantly with age (p-value < 0.05) and does not show significant correlation with gender, body weight, body mass index, and heart weight. CACS was significantly higher in plaque ruptures than in plaque erosions (p-value < 0.01). Zero or low CACS on unenhanced PMCT cannot exclude the presence of myocardial infarction related to ACAD. This paradoxical discrepancy between imaging and autopsy findings can be explained considering the histological aspect of fatal coronary plaques