MRI Segmentation of Cervical Muscle Volumes in Survived Strangulation: Is There an Association between Side Differences in Muscle Volume and the Handedness of the Perpetrator? A Retrospective Study

We evaluate the potential value of magnetic resonance imaging (MRI) in the examination of survivors of manual strangulation. Our hypothesis was that trauma-induced edema of the cervical muscles might lead to a side difference in the muscle volumes, associated with the handedness of the perpetrator. In 50 individuals who survived strangulation, we performed MRI-based segmentation of the cervical muscle volumes. As a control group, the neck MRIs of 10 clinical patients without prior trauma were used. The ratio of the right to left muscle volume was calculated for each muscle group of the control and strangulation groups. Cutoff values for the assumed physiological muscle volume ratios between the right and left sides were identified from our control group. There was no significant difference among the individuals in the pathological muscle volume ratio between right-handed versus both-handed strangulation for the sternocleidomastoid, pretracheal, anterior deep, or trapezoid muscle groups. Only the posterior deep muscle group showed a statistically significant difference in the pathological muscle volume ratio for both-handed strangulations (p = 0.011). Measurement of side differences in cervical muscle volume does not allow for a conclusion concerning the probable handedness of the perpetrator

In situ temperature determination using magnetic resonance spectroscopy thermometry for noninvasive postmortem examinations

Magnetic resonance spectroscopy (MRS) thermometry offers a noninvasive, localized method for estimating temperature by leveraging the temperature‐dependent chemical shift of water relative to a temperature‐stable reference metabolite under suitable calibration. Consequentially, this technique has significant potential as a tool for postmortem MR examinations in forensic medicine and pathology. In these examinations, the deceased are examined at a wide range of body temperatures, and MRS thermometry may be used for the temperature adjustment of magnetic resonance imaging (MRI) protocols or for corrections in the analysis of MRI or MRS data. However, it is not yet clear to what extent postmortem changes may influence temperature estimation with MRS thermometry. In addition, N‐acetylaspartate, which is commonly used as an in vivo reference metabolite, is known to decrease with increasing postmortem interval (PMI). This study shows that lactate, which is not only present in significant amounts postmortem but also has a temperature‐stable chemical shift, can serve as a suitable reference metabolite for postmortem MRS thermometry. Using lactate, temperature estimation in postmortem brain tissue of severed sheep heads was accurate up to 60 h after death, with a mean absolute error of less than 0.5°C. For this purpose, published calibrations intended for in vivo measurements were used. Although postmortem decomposition resulted in severe metabolic changes, no consistent deviations were observed between measurements with an MR‐compatible temperature probe and MRS thermometry with lactate as a reference metabolite. In addition, MRS thermometry was applied to 84 deceased who underwent a MR examination as part of the legal examination. MRS thermometry provided plausible results of brain temperature in comparison with rectal temperature. Even for deceased with a PMI well above 60 h, MRS thermometry still provided reliable readings. The results show a good suitability of MRS thermometry for postmortem examinations in forensic medicine

Evaluation des Nationalen Aktionsplans der Bundesregierung zur Umsetzung der UN-Behindertenrechtskonvention: Abschlussbericht

Mit dem im Juni 2011 vom Bundeskabinett beschlossenen Nationalen Aktionsplan (NAP) zur Umsetzung der UN-Behindertenrechtskonvention (UN-BRK) wurde erstmals eine behindertenpolitische Gesamtstrategie verabschiedet, die politikfeldübergreifend die Ziele und Maßnahmen zur Umsetzung der Konvention auf Bundesebene zusammenführt. Im vorliegenden Gutachten werden sowohl die inhaltliche Ausgestaltung des NAP - d.h. sein konzeptioneller Aufbau und die enthaltenen Maßnahmen - als auch die Rolle der verschiedenen Akteure sowie die Prozesse während der Entwicklung und bisherigen Umsetzung des NAP im Kontext der Anforderungen der UN-BRK untersucht. Das Gutachten beschäftigt sich zudem mit der Frage, inwiefern das Thema Wirkungsanalyse im gegenwärtigen NAP bereits verankert ist und umgesetzt wird

Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT.

OBJECTIVE To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS. MATERIAL AND METHODS The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre. RESULTS The study included 116 patients (71% women, p < .001, χ2), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ2) or assault by unknown offender (88% of men, p < 0.002 χ2). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT. CONCLUSIONS The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations. CLINICAL RELEVANCE STATEMENT MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation. KEY POINTS • Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. • Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients. • MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation

Can We Predict Skeletal Lesion on Bone Scan Based on Quantitative PSMA PET/CT Features?

Objective: The increasing use of PSMA-PET/CT for restaging prostate cancer (PCa) leads to a patient shift from a non-metastatic situation based on conventional imaging (CI) to a metastatic situation. Since established therapeutic pathways have been designed according to CI, it is unclear how this should be translated to the PSMA-PET/CT results. This study aimed to investigate whether PSMA-PET/CT and clinical parameters could predict the visibility of PSMA-positive lesions on a bone scan (BS). Methods: In four different centers, all PCa patients with BS and PSMA-PET/CT within 6 months without any change in therapy or significant disease progression were retrospectively selected. Up to 10 non-confluent clear bone metastases were selected per PSMA-PET/CT and SUVmax, SUVmean, PSMAtot, PSMAvol, density, diameter on CT, and presence of cortical erosion were collected. Clinical variables (age, PSA, Gleason Score) were also considered. Two experienced double-board physicians decided whether a bone metastasis was visible on the BS, with a consensus readout for discordant findings. For predictive performance, a random forest was fit on all available predictors, and its accuracy was assessed using 10-fold cross-validation performed 10 times. Results: A total of 43 patients were identified with 222 bone lesions on PSMA-PET/CT. A total of 129 (58.1%) lesions were visible on the BS. In the univariate analysis, all PSMA-PET/CT parameters were significantly associated with the visibility on the BS (p < 0.001). The random forest reached a mean accuracy of 77.6% in a 10-fold cross-validation. Conclusions: These preliminary results indicate that there might be a way to predict the BS results based on PSMA-PET/CT, potentially improving the comparability between both examinations and supporting decisions for therapy selection

Evaluation der Ergänzenden unabhängigen Teilhabeberatung

Im Jahr 2018 startete die modellhafte Einführung der Ergänzenden unabhängigen Teilhabeberatung (EUTB®) nach § 32 Neuntes Buch Sozialgesetzbuch (SGB IX). Mit ihr wurden rund 500 Angebote in ganz Deutschland gefördert, in denen Menschen mit Behinderungen und ihre Angehörigen über Fragen der Rehabilitation und Teilhabe informiert und beraten werden. Die wissenschaftliche Begleitung der EUTB® adressiert grundsätzliche Fragen zu den Umsetzungs- und Wirkungsbedingungen der EUTB®. Ihre Ergebnisse zeigen, dass es der EUTB® auftragsgemäß gelungen ist, ein breit akzeptiertes Informations- und Beratungsangebot zu entwickeln, das die vorhandene Beratungsinfrastruktur im Bereich Rehabilitation und Teilhabe ergänzt. Im Zuge ihrer Etablierung konnte für die EUTB® - in der Regie der Fachstelle Teilhabeberatung - ein umfassendes System der Qualifizierung und Qualitätssicherung entwickelt werden, so dass zum Ende der Förderphase einheitliche Qualitätsstandards für die Beratung vorliegen und weiterentwickelt werden können. Die Zufriedenheit der Ratsuchenden mit der Beratung durch die EUTB® ist hoch. Die Klärung ihrer Anliegen und die Erreichung der wichtigsten Ziele gelingen nach ihrer Selbsteinschätzung häufig. Damit kann die EUTB® nachweislich zur Stärkung der Selbstbestimmung und gesellschaftlichen Teilhabe der Ratsuchenden beitragen. Die Beratung von Betroffenen für Betroffen als "Peer-Beratung" trägt zu einer wesentlichen Unterstützung des Angebots bei

Altersabhängiger Rückgang der Infektion mit G. duodenalis sowie Assoziation mit verringerter Körpergröße bei Schulkindern im Huye Distrikt, Ruanda

Giardia duodenalis infection is highly prevalent and a cause of underweight in pre-school children in rural Rwanda. The present study aimed at assessing the age-pattern of Giardia infection and its manifestation in older children, i.e., during school age. Stool samples were collected from 622 schoolchildren at two schools in the Huye district of southern Rwanda (rural, 301; urban, 321) and subjected to G. duodenalis specific PCR assays. Clinical and anthropometric data, socio-economic status and factors potentially associated with G. duodenalis infection were assessed. Of the 622 children (mean age, 10.4 years), 35.7% were infected with G. duodenalis (rural, 43.9%; urban, 28.0%; P<0.0001). Only few indicators of low socio-economic status were found to be associated with infection. In rural but not urban schoolchildren, infection prevalence declined significantly with age. G. duodenalis infection more than doubled the odds of stunting in both rural (adjusted OR, 2.35 (95%CI, 1.25-4.41)) and urban children (adjusted OR, 2.27 (95%CI, 1.01-5.09)). In the study area of rural southern Rwanda, G. duodenalis prevalence among children declined throughout school-age. The data suggest that while lacking overt clinical manifestation at high endemicity, G. duodenalis infection is a common cause of stunting in schoolchildren.Die Infektion mit Giardia duodenalis ist bei Kleinkindern im ländlichen Ruanda häufig und eine Ursache für Untergewicht. Die vorliegende Studie zielte darauf ab, bei älteren Kindern im Schulalter die Giardia-Infektion hinsichtlich Altersabhängigkeit und Manifestation zu untersuchen. Stuhlproben von 622 Kindern aus zwei Schulen im Huye-Distrikt im südlichen Ruanda (ländlich: 302; urban: 321) wurden mit Hilfe eines PCR-Verfahrens auf G. duodenalis untersucht. Des Weiteren wurden anthropometrische Daten, das klinische Erscheinungsbild und der sozio-ökonomische Status auf eine mögliche Assoziation mit der G. duodenalis Infektion hin untersucht. Von den 622 Kindern (durchschnittliches Alter: 10,4 Jahre) waren 35,7% mit G. duodenalis infiziert (ländlich: 43,9%; städtisch: 28,0%; p<0.0001). Von den sozio- ökonomischen Faktoren zeigten nur wenige eine Assoziation mit der G. duodenalis-Infektion. Die Prävalenz der Infektion nahm bei Kindern aus dem ländlichen Gebiet mit zunehmendem Alter signifikant ab. Die Wahrscheinlichkeit für ein verzögertes Wachstum verdoppelte sich bei Vorliegen einer Infektion bei beiden Gruppen (ländlich; adjustierte OR, 2.35 (95% KI, 1.25-4.41); städtisch; adjustierte OR, 2.27 (95% KI, 1.01-5.09)). Die Daten führen zu der Annahme, dass die Infektion mit G. duodenalis auch ohne ein offenkundiges klinisches Erscheinungsbild ein häufiger Grund für verzögertes Wachstum bei Schulkindern ist

Effects of blood loss on organ attenuation on postmortem CT and organ weight at autopsy.

BACKGROUND Cases of external hemorrhage are difficult to recognize on postmortem computed tomography (PMCT). PURPOSE To investigate the effects of blood loss on CT attenuation of the spleen, liver, kidneys, and lungs on PMCT and to assess the relationship between blood loss and organ weight. METHODS A total of 125 cases with blood loss were sex- and age-matched to 125 control cases without blood loss. Individual organ attenuation was measured on transverse CT images. Organ weights of the liver, spleen, kidneys, and lung were extracted from the autopsy protocols. RESULTS Organ weight was significantly lower in cases with blood loss (lung 30%, spleen 28%, kidneys 14%, liver 18%) than in controls. CT attenuation of the lungs was significantly lower (30%) in cases with blood loss than in controls. CT attenuation of the spleen and kidneys did not significantly differ between cases and controls. CT attenuation of the liver was significantly higher (25%) in cases with blood loss than in controls. CONCLUSION Blood loss decreases organ weight and CT attenuation of the lungs but appears to have no significant effect on CT attenuation of the spleen and kidneys. The increased liver attenuation in cases with blood loss compared to controls was an unexpected finding and remains challenging to explain. One probable interpretation refers to different levels of hepatic glycogen; however, further work is warranted to substantiate this hypothesis