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The authors present a case involving a 37-year-old woman discovered in an operating freezer. Suicide hypothesis has been considered from the beginning. Due to the exceptional scene circumstances, a forensic autopsy was performed. Apart from some non-specific hypothermia and asphyxia signs, the autopsy revealed several skull fractures, prompting extensive anatomopathological and histological analyses. These analyses confirmed the fractures origin and determined whether they were ante-mortem or post-mortem, thus ruling out the possibility of a criminal act disguised as suicide. The authors also describe the challenges in determining the cause of death, particularly the issues related to the post-mortem diagnosis of lethal hypothermia and asphyxia. This case is the first in the literature to describe suicide by exposure to cold in a confined environment. It highlights the importance of close collaboration between forensic pathologists, histologists, toxicologists, and police investigators to answer judicial inquiries. [ABSTRACT FROM AUTHOR]

In July 2023, an in-house forensic neuropathology consultation pilot was established at the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare. This offered an alternative to the previous practice of full outsourcing to a hospital neuropathology department. This paper aims to introduce the first year experiences of the pilot. The in-house consultant team comprised two forensic pathologists with special training in neuropathology. In-house consultations were offered for medico-legal autopsy cases with traumatic brain injury (TBI) and hypoxic-ischaemic encephalopathy. The in-house histology laboratory participated in the pilot, implementing beta-amyloid precursor protein (β-APP) stain at the end of the pilot year. An electronic database was also developed for data collection and reporting. The characteristics, costs, and duration of the first 25 consultation cases were reviewed. The cases involved mostly male decedents (84.0%) with TBI (84.0%). The median total cost of a pilot case was €624, which was substantially lower compared to the previous outsourced practice (€1013 per case + €38/84 for each microscope slide with special/immunohistochemical stain, respectively). After the implementation of β-APP stain into the in-house laboratory service, the median total cost of a pilot case was reduced further to €94. The median duration of an in-house consultation was 2.3 months. Thanks to a favourable in-house atmosphere, the first year experiences are encouraging. While the costs of the in-house consultation practice appear to be markedly lower than those of an external provider, both alternatives should be available for cases where sufficient expertise cannot be found in-house. [ABSTRACT FROM AUTHOR]

Research on suicide has always been an area of particular interest in the forensic field. Over time, classifications have been proposed to define different types of suicide. A category is represented by complex suicides (CS) defined using two or more suicide methods simultaneously or consecutively. Considering the victim's intentions, CS can be distinguished into planned, in which the victim plans the methods to ensure the fatal outcome, and unplanned, in which the methods are implemented in the mid-course because the first proves too painful or prolonged. The sometimes-varied dynamics with which such suicides are carried out can pose a diagnostic challenge for forensic pathologists and investigators. This paper aims to report the case history of complex suicides analysed during a year at the University of Rome 'Tor Vergata'. For each case, the data from the on-site investigation (presence of suicide note and anamnestic information from the medical records of the deceased or family members' reports) and autopsy investigations were analysed and discussed, with particular reference to the suicide methods used. For each case, a classification into planned and unplanned was proposed based on an integrated analytical approach. [ABSTRACT FROM AUTHOR]

Postmortem analysis of C-reactive protein (CRP) in autopsies has been extensively researched for its potential utility. This analysis could aid forensic pathologists in screening for and investigating the potential infectious or inflammatory causes of death, thereby guiding appropriate autopsy procedures. To assess the diagnostic accuracy of postmortem CRP analysis in autopsy settings, a thorough electronic literature search was conducted across databases such as PubMed, Scopus, Web of Science, and Cochrane Library. Two independent reviewers screened eligible studies, followed by a methodological quality assessment using the QUADAS-2 checklist. Utilising a random-effects model, hierarchical summary receiver operating characteristic (HSROC) curve analysis and bivariate model meta-analysis were performed to evaluate heterogeneity across studies. Of the 1286 studies initially identified, nine met the eligibility criteria for the final analysis. The pooled sensitivity of postmortem CRP analysis was 0.93 (95% CI, 0.76, 0.98), with a pooled specificity of 0.80 (95% CI, 0.71, 0.87). The prevalence across studies ranged from 0.23 to 0.68, with a median of 0.5. Moderate variability was observed in the heterogeneity assessment across the primary studies. In summary, the study findings indicate that postmortem serum CRP analysis demonstrates high diagnostic accuracy with moderate heterogeneity. Additionally, postmortem CRP testing may be useful as a screening tool in autopsy practice to rule out the likelihood of sepsis. [ABSTRACT FROM AUTHOR]

Suicide is one of the leading causes of death today, and among all mental illness, mood disorders account for one of the main risk factors. It is well known and proven that suicides are very common among people undergoing treatment and prescribed psychiatric medication. So far, however, there have only been a few studies dealing with this particular phenomenon. For this reason, autopsy patients who died by suicide, suffered from a mood disorder, and were known to be taking psychiatric medication at the time of death were selected for this study. The blood and urine samples taken during the autopsy underwent toxicological analysis and the results were compared with the prescribed therapy. A total of 22 people were included in the study: 12 presenting with depression and 10 with bipolar disorder. The toxicological analysis revealed that only 6 cases (27%) showed a qualitative match with the prescribed medication. In 5 cases (22.7%) the medication was only partially complied with and in 11 cases (50%) it was not complied with at all. Furthermore, even when medication was present, the value was often below the therapeutic range. Overall, more than 70% of the test subjects adhered to their medication only partially or not at all. Since treatment adherence is considered as a key factor in reducing the risk of suicide, this inevitably raises relevant clinical and forensic questions. Against this background, prospective monitoring of post-mortem medication levels in suicidal individuals and synergistic collaboration between clinicians and forensic pathologists could help to evaluate the effectiveness of specific medical interventions, highlight existing critical problems and develop new approaches to suicide prevention. [ABSTRACT FROM AUTHOR]

Active euthanasia is legally permissible in only eight jurisdictions worldwide and may only be administered by qualified personnel following specific selection criteria. Mercy killing refers to the deliberate termination of the life of an individual suffering from a terminal chronic medical condition. Detecting both illegally performed active euthanasia and instances of mercy killing presents challenges for forensic pathologists. The presented case describes a mercy killing involving a 72‐year‐old woman with multiple chronic conditions who was killed by her grandson via heroin intoxication after administration of the anxiolytic alprazolam. Key findings from the external postmortem examination included a single fresh injection site on the inside of the elbow and a superficial T‐shaped cut on the flexor side of the left forearm. Toxicological analyses revealed elevated blood levels of heroin metabolites, including 6‐monoacetylmorphine and absence of hydroxyalprazolam, indicating an only short survival time following heroin injection. A cocaine concentration in blood was comparatively low but rather high in hair samples. Elderly individuals with multiple chronic conditions are at increased risk of becoming homicide victims. Comprehensive forensic documentation of injection sites is essential to avoid overlooking deaths caused by injection and to differentiate them from medical measures during resuscitation attempts. [ABSTRACT FROM AUTHOR]

Background: Firearm wounds tend to have a precise pattern. Despite this, real-world case presentations can present uncertain elements, sometimes deviating from what is considered standard, and present uncommon features that are difficult for forensic pathologists and ballistic experts to explain. Methods: A retrospective analysis of autopsy reports from the Institute of Legal Medicine, University of Catania, covering 2019–2023, included 348 judicial inspections and 378 autopsies performed as part of the institute's overall activities. Among these, seventeen cases of firearm deaths were identified, with three atypical cases selected for detailed analysis. An interdisciplinary approach involving forensic pathology, radiology, and ballistics was used. Results: The selected cases included: (1) A 56-year-old female with a thoracic gunshot wound involving three 7.65 caliber bullets, displaying complex trajectories and retained bullets; (2) A 48-year-old male with two cranial gunshot injuries, where initial evaluation suggested homicide staged as a suicide, later confirmed to be a single self-inflicted shot; and (3) A 51-year-old male was found in a car with two gunshot wounds to the head, involving complex forensic evaluation to distinguish between entrance and exit wounds and determine trajectory. The findings showed significant deviations from standard patterns, underscoring the critical role of radiological imaging and ballistic analysis in understanding wound morphology and projectile trajectories. Conclusions: This case series highlights the necessity for standardized yet adaptable protocols and cooperation among forensic specialists. A flexible approach allows forensic investigations to be tailored to the specific circumstances of each case, ensuring that essential examinations are conducted while unnecessary procedures are avoided. Comprehensive data collection from autopsies, gross organ examinations, and, when needed, radiological and histological analysis is essential to accurately diagnose injuries, trace bullet trajectories, retrieve retained projectiles, and determine the fatal wound, particularly in complex cases or those involving multiple shooters. [ABSTRACT FROM AUTHOR]

The workload of forensic pathologists involves performing autopsies for a coroner. In this study of Australia, it was hypothesized that autopsy numbers would increase over time owing to increasing numbers of deaths, but this potential trend could be influenced by changes in Coroners Acts. The five largest coronial jurisdictions of Australia were studied between 2006 to 2017. Regression analysis was used to compare autopsy numbers (from the National Coronial Information System) to the number of deaths (from the Australian Bureau of Statistics). The number of deaths increased over time in all jurisdictions. Two jurisdictions had changes to their Coroners Acts that appeared related to decreasing numbers of autopsies. Two jurisdictions had no changes to their Coroners Acts: one showed a greater increase in autopsy numbers than the increase in deaths, but the other's trend was significantly different to the increasing number of deaths. The fifth jurisdiction had a change in Coroners Act with a following, non-sustained decrease in autopsy numbers. The findings support the hypothesis that forensic pathology workload can be influenced by changes in Coroners Acts, but the finding also suggests that other factors may influence the number of autopsies that are performed by forensic pathologists. [ABSTRACT FROM AUTHOR]

Thrombus age determination in fatal venous thromboembolism cases is an important task for forensic pathologists. In this study, we investigated the time-dependent expressions of formyl peptide receptor 2 (FPR2) and Annexin A1 (ANXA1) in a stasis-induced deep vein thrombosis (DVT) murine model, with the aim of obtaining useful information for thrombus age timing. A total of 75 ICR mice were randomly classified into thrombosis group and control group. In thrombosis group, a DVT model was established by ligating the inferior vena cava (IVC) of mice, and thrombosed IVCs were harvested at 1, 3, 5, 7, 10, 14, and 21 days after modeling. In control group, IVCs without thrombosis were taken as control samples. The expressions of FPR2 and ANXA1 during thrombosis were detected using immunohistochemistry and double immunofluorescence staining. Their protein and mRNA levels in the samples were determined by Western blotting and quantitative real-time PCR. The results reveal that FPR2 was predominantly expressed by intrathrombotic neutrophils and macrophages. ANXA1 expression in the thrombi was mainly distributed in neutrophils, endothelial cells of neovessels, and fibroblastic cells. After thrombosis, the expressions of FPR2 and ANXA1 were time-dependently up-regulated. The percentage of FPR2-positive cells and the level of FPR2 protein significantly elevated at 1, 3, 5 and 7 days after IVC ligation as compared to those at 10, 14 and 21 days after ligation (p < 0.05). Moreover, the mRNA level of FPR2 were significantly higher at 5 days than that at the other post-ligation intervals (p < 0.05). Besides, the levels of ANXA1 mRNA and protein peaked at 10 and 14 days after ligation, respectively. A significant increase in the mRNA level of ANXA1 was found at 10 and 14 days as compared with that at the other post-ligation intervals (p < 0.01). Our findings suggest that FPR2 and ANXA1 are promising as useful markers for age estimation of venous thrombi. [ABSTRACT FROM AUTHOR]

In forensic practice, spinal cord injury (SCI) resulting in death has rarely been reported. Here, we present the case of a 65-year-old woman who on admission was conscious without dyspnea or dysphagia. Physical examination revealed two sharp objects penetrating the neck: a pair of scissors lodged in the neck on the right side of the thyroid cartilage and a knife embedded in the nuchal region accompanied by minor seepage of bloody exudate. Radiography showed that the scissors and knife were retained in the cervical spine. Despite a series of medical interventions, the patient died 26 days later. Method: A systematic forensic autopsy was performed. Results: The cause of death was confirmed to be respiratory failure associated with SCI, which was caused by the combination of scissors and a knife. Conclusion: Based on this case, we believe that when there are multiple causes of death, forensic pathologists should determine the primary, immediate, contributory, and other causes of death to ascertain criminal responsibility. [ABSTRACT FROM AUTHOR]

Human or time resources can sometimes fall short in medical image diagnostics, and analyzing images in full detail can be a challenging task. With recent advances in artificial intelligence, an increasing number of systems have been developed to assist clinicians in their work. In this study, the objective was to train a model that can distinguish between various fracture types on different levels of hierarchical taxonomy and detect them on 2D-image representations of volumetric postmortem computed tomography (PMCT) data. We used a deep learning model based on the ResNet50 architecture that was pretrained on ImageNet data, and we used transfer learning to fine-tune it to our specific task. We trained our model to distinguish between "displaced," "nondisplaced," "ad latus," "ad longitudinem cum contractione," and "ad longitudinem cum distractione" fractures. Radiographs with no fractures were correctly predicted in 95–99% of cases. Nondisplaced fractures were correctly predicted in 80–86% of cases. Displaced fractures of the "ad latus" type were correctly predicted in 17–18% of cases. The other two displaced types of fractures, "ad longitudinem cum contractione" and "ad longitudinem cum distractione," were correctly predicted in 70–75% and 64–75% of cases, respectively. The model achieved the best performance when the level of hierarchical taxonomy was high, while it had more difficulties when the level of hierarchical taxonomy was lower. Overall, deep learning techniques constitute a reliable solution for forensic pathologists and medical practitioners seeking to reduce workload. [ABSTRACT FROM AUTHOR]

Background: Autopsy, being the precise and detailed study of a person's corpse following death is of different types. Medicolegal autopsy plays the pivotal role to the forensic pathologist. Regular weighing of different types of human viscera plays a significant role in medical sciences as any detection of dereliction in weight from the normal range is suggestive of some pathological changes in the organ. Recording of organ weights is regularly being done by the forensic pathologists during an autopsy. The findings are meant to be compared to what is standard or average of a specific organ for a specific age range and particular sex. The determination of weight of spleen in particular has significant clinical value. Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 570 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria. Results: Total 570 cases had been selected after following the inclusion and exclusion criteria out of which 362 were males and 208 were females. Among the studied 570 cases, 362 (63.5 %) were male and rest (36.5 %) were female. In this study the discussion was mainly on relation of age, sex, body weight, and body length upon the weight of spleen. Conclusion: A database may be deduced from this study regarding normal range of the weight of various organs and their relation with external parameters of the subjects which can be applicable on the population of this region for future reference. In severely mutilated bodies found in mass disasters or in homicidal killing, weights of isolated organs may give an idea about the stature, built and age of the victims helping in identification. [ABSTRACT FROM AUTHOR]

Background: Even in this modern era of advanced knowledge in medical science, still the human skeleton holds its medicolegal importance in forensic anthropology as before. The forensic pathologists still face the dilemma to identify and opine whether the skeletal remains are of human or not along with estimation of the relatively correct age, sex, and height of the specimen available. Innumerable scientific literature is not unavailable in forensic anthropometry for the identification of human skeletons. The examination of the human skeleton is an integral part to serve medico-legal purpose. The pivotal step of forensic investigation usually starts with the sexual differentiation of the adult human bone. The whole skeleton helps to identify the sex of bone (male/female) with almost 100% accuracy. This current pilot study is an attempt of finding morphometric relationship between sex and predefined transverse linear measurements of adult sternum. Materials And Methods: Following the approval of the institutional ethical committee, the research was carried out on 64 adult human sternums that were selected based on specific inclusion and exclusion criteria. Results: In the current study, the study population comprises 38 (59.4%) males and 26 (40.6%) females, selected through the complete enumeration method. Among total 64 cases of the present study 28(43.8%) cases are from 18-39 years age group and 22 (34.4%) cases are from 40-59years age group 14(21.9%) cases are from 60-90years. Predefined transverse linear parameters i.e. Manubrium Width and Mesothermal Width_ both found to be greater in Male sex. Independent t -test also suggested that the sex-wise differences also found to be statistically significant (<0.001) Conclusion: Transitioning from a morphological approach to a morphometric analysis for sex determination based on the sternum is expected to minimize subjective variability, allowing for subsequent refinement and enhancement through more detailed methodologies. [ABSTRACT FROM AUTHOR]

Forensic pathologists need to have comprehensive knowledge of a large variety of causes of sudden natural death. We describe a case of sudden and unexpected death in woman in her sixties due to rupture of a large paraesophageal hematoma. The post-mortem examination and differential diagnosis are discussed. The combined findings of whole-body post-mortem CT imaging (PMCT), targeted PMCT angiography, autopsy, and histology are most in keeping with 'esophageal apoplexy'; a rare cause of hemorrhage in the esophageal wall. A review of the literature indicates that most cases of esophageal apoplexy are self-limiting and that fatal complications are exceedingly rare. Our case demonstrates that esophageal apoplexy can present as sudden unexpected death. [ABSTRACT FROM AUTHOR]

Fatalities caused by sharp and pointed instruments, especially screwdrivers, are not frequently observed in the United States. The shape of the screwdriver tip generally determines the resulting wounds that can range from linear, to rectangular or cross‐shaped, often reflecting common screwdriver head shapes. Recognizing such patterns is crucial, as they can aid in identifying the potential weapon used in the crime. In the reported case, an adult male was found dead in his living room surrounded by a pool of blood, with multiple injuries. At autopsy, the pattern of penetration was consistent with that of a six‐point star (Torx) screwdriver, which has never been reported as a deadly weapon in the literature before. A Torx screwdriver has a blunt head, resulting in hybrid injuries with both penetrating and blunt force features. Because of its rigid structure and narrow tip, a Torx screwdriver may forcefully penetrate the skin, soft tissues, and bone, causing severe injuries to the deep organs. The case highlights the importance for the forensic pathologist to examine and recognize atypical penetrating wounds for the identification and location of rare weapons. High‐definition graphic documentation of the injuries allows thorough examination and comparison of injuries with potential weapons. When the weapon is not retrieved, detailed injury descriptions guide investigations toward searching for a screwdriver, improving the chances of identifying the weapon used to commit the crime. [ABSTRACT FROM AUTHOR]

Novel benzodiazepine (NBz) detections in Victorian coronial cases started early in 2018 and have continued to increase in number and type up to December 2022. The 11 different NBz detections included etizolam (n  = 82), flualprazolam (n  = 43), clonazolam or 8-aminoclonazolam (n  = 30), bromazolam (n  = 15), clobromazolam (n  = 13), phenazepam (n  = 13), flubromazolam (n  = 12), flubromazepam (n  = 8), desalkylflurazepam (n  = 6), diclazepam (n  = 2), and estazolam (n  = 1). The pattern of detections varied over the 5-year period, with different compounds appearing over different time frames. The most recent NBz to appear were bromazolam, clobromazolam, flubromazepam, and phenazepam, whereas etizolam had been seen regularly in case work since 2018. Of the total 133 deaths, 95 were considered drug-related deaths by forensic pathologists with at least one additional CNS depressant also present capable of contributing to death. All deaths involved other (non-benzodiazepine) CNS active drugs, although many involved multiple NBz, with five or more different benzodiazepines detected in eight cases. [ABSTRACT FROM AUTHOR]

Fat embolism (FE) is a historically recognised but still actively researched topic in forensic pathology. Several aspects remain not fully elucidated, such as its aetiopathogenesis, its causal role in death determination, the impact of interfering factors (e.g. cardiopulmonary resuscitation or other medical procedures) and both qualitative and quantitative diagnostic methodologies in clinical and forensic contexts. These issues are further underscored by the potential involvement of FE in the causal determination of non‐traumatic deaths, which often raises questions of professional liability. The present study aims to provide a comprehensive and up‐to‐date overview of the most recent scientific evidence relevant to forensic pathology. Our systematic research has included 58 articles from 1990 to the present on the topic of FE and fat embolism syndrome (FES). From these articles, we identified 45 case reports, from which the authors’ descriptions were extracted to provide information on individual cases and the operational methods of forensic pathologists. Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non‐traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest‐risk specialities. Experimental studies have re‐evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy–histological evaluation. The major critical points that emerged include the lack of complete and detailed information on premortem clinical conditions, the underutilisation of grading systems and the methodological heterogeneity applied, resulting in considerable variability regarding the organs studied histologically and the diagnostic techniques used. Despite the limitations associated with the analysis of case reports and the heterogeneity of included experimental studies, we believe that this study can provide a comprehensive overview of the FE topic. It furnishes pathologists with an updated overview useful for clinical practice and guiding future research trends, as well as facilitating the development of standardised procedures. [ABSTRACT FROM AUTHOR]

Introduction: In a demographically diverse, vast, and highly densely populated developing country like India, the establishment of the identity of a deceased poses great medico-legal importance. It also poses a great challenge to the forensic pathologist working in an environment where decomposition and taphonomic processes are rapid. Structurally bones resist common degradation and putrefactive changes and remain longer as material for evidential value. Human skeletal remains, which are found under suspicious circumstances and doctors examining them need to give an opinion in the court of law. Forensic experts are often consulted regarding the identification of skeletal remains. One of the important bones that helps to determine sex is the Sternum Bone. For this purpose, a technique will be highly appreciated for the determination of sex from the morphometry of the sternum. This current pilot investigation was designed to determine the sex from the adult human sternum from predefined vertical linear measurements. Materials And Methods: After getting institutional ethical committee clearance, the study was conducted over the 64 adult human sternums screened through the inclusion and exclusion criteria. Results: In the current study, the study population comprises 38 (59.4%) males and 26 (40.6%) females, selected through the complete enumeration method. Among total 64 cases of the present study 28(43.8%) cases are from 18-39 years age group and 22 (34.4%) cases are from 40-59years age group 14(21.9%) cases are from 60-90years. On considering sex, it is found that the mean length of manubrium in male(52.44mm) is greater than that of female (45.19mm). The mean length of body in male(98.44cm) is greater than that of female (83..20cm). Most importantly unstandardized canonical discriminant function was estimated using two pre-defined vertical linear measurements as independent variables (Manubrium Length-ML and Mesosternum Length-SL) as :- D= (0.211* ML) + (0.37* SL) -13.845. CONCLUSION: A paradigm shift from morphological to morphometrical determination of sex from sternum will help to reduce the subjective variation to an extent that can be modified and sophisticated later through more thorough detailing. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between the cause of death stated on a post-mortem (medical) examination report and the subsequent cause of death given in a finding by a legal or judicial coroner (non-medical). A review of causes of death provided by forensic pathologists in their reports found the majority of cases (89%) were given in the traditional death certificate format, but were transformed to a sentence format in just over two thirds of coronial findings (68.5%). There was no evidence that converting the format of the cause of death statements caused a delay in finalizing the case. Of note, the post-mortem examination report provided an indefinite cause of death in 3.8% of cases and around a quarter (25.3%) of these were converted to a definite cause of death in the coronial finding (for example, by removing the word 'probable'). Where the post-mortem examination did not determine a cause of death (5.2% of cases), most remained undetermined in the coronial finding. It is suggested that pathologists could work with coroners to ensure the cause of death provided on post-mortem examination reports are in the preferred style for their jurisdiction. [ABSTRACT FROM AUTHOR]

Non-prescription use of anabolic androgenic steroids (AAS) is associated with an increased risk of premature death. However, these substances are seldom screened in connection with forensic cause-of-death investigation, unless the forensic pathologist specifically suspects use, often based on a positive AAS use history. Since AAS use is often concealed from others, this practice may lead to mistargeting of these analyses and significant underestimation of the true number of AAS positive cases undergoing forensic autopsy. Thus, more accurate diagnostic tools are needed to identify these cases. The main objective of this study was to determine, whether a multivariable model could predict AAS urine assay positivity in forensic autopsies. We analyzed retrospectively the autopsy reports of all cases that had been screened for AAS during forensic cause-of-death investigation between 2016–2019 at the Finnish Institute for Health and Welfare forensic units (n = 46). Binary logistic regression with penalized maximum likelihood estimation was used to generate a nine-variable model combining circumferential and macroscopic autopsy-derived variables. The multivariable model predicted AAS assay positivity significantly better than a "conventional" model with anamnestic information about AAS use only (area under the receiver operating characteristic curve [AUC] = 0.968 vs. 0.802, p = 0.005). Temporal validation was conducted in an independent sample of AAS screened cases between 2020–2022 (n = 31), where the superiority of the multivariable model was replicated (AUC = 0.856 vs. 0.644, p = 0.004). Based on the model, a calculator predicting AAS assay positivity is released as a decision-aiding tool for forensic pathologists working in the autopsy room. [ABSTRACT FROM AUTHOR]

When faced with increasing drug‐related deaths and decline in practicing forensic pathologists, the need to quickly identify toxicology‐related deaths is evident in order to appropriately triage cases and expedite turnaround times. Lateral flow immunoassays conducted pre‐autopsy offer quick urine drug screen (UDS) results in minutes and are used to inform the need for autopsy. Over 1000 medicolegal cases were reviewed to compare UDS results to laboratory enzyme‐linked immunosorbent assay (ELISA) blood results to evaluate how well autopsy UDS predicted laboratory findings. Mass spectral analysis was performed on ELISA‐positive specimens and these data were used to investigate UDS false‐negative (FN) results when possible. Five different UDS devices (STAT One Step Drug of Abuse dip card and cassette, Premiere Biotech multi‐drug and fentanyl dip cards and ATTEST 6‐acetylmorphine (6‐AM) dip card) were tested encompassing 11 drug classes: 6‐AM, amphetamine/methamphetamine, benzodiazepines, benzoylecgonine, fentanyl, methadone, opioids, phencyclidine, and delta‐9‐tetrahydrocannabinol. Sensitivity, specificity, efficiency, and positive and negative predictive values >80% indicated that UDS was useful for predicting cases involving benzoylecgonine, methadone, methamphetamine, and phencyclidine. UDS was unreliable in predicting amphetamine, benzodiazepines, fentanyl, and opiates‐related cases due to a high percentage of FN (up to 11.2%, 8.0%, 12.4%, and 5.5%, respectively) when compared to ELISA blood results. For the later analytes, sensitivities were as low as 57.5%, 60.0%, 72.2%, and 66.7%, respectively. Overall results support that UDS cannot replace laboratory testing. Because UDS is subject to false‐positive and FN results users must understand the limitations of using UDS for triage or decision‐making purposes. [ABSTRACT FROM AUTHOR]

The appearance of a gunshot wound (GSW) is greatly influenced by the velocity of the projectile, where high-velocity projectiles (HVPs) are defined as ballistic agents reaching a muzzle velocity of > 600 m/s fired from assault rifles. The aim of the study is to present and explain the differences in the dimensions of entrance and exit wounds between the most used handguns and assault rifles and to propose a predictor of HVP, i.e., the ratio of exit and entrance wounds (EX/ENR). The surface area of entrance and exit GSWs and the EX/ENR were calculated. 66 perforating GSWs produced by NATO FMJ 7.62 × 52 mm and 5.56 × 42 mm fired from assault rifles were assigned to the HVP, while 64 lesions produced by conventional projectiles fired from revolvers and semi-automatic pistols were assigned to the low-velocity projectile (LVP) group. The dimensions of the exit wounds of the HVP group were significantly higher when compared to the LVP group (95% CI 0.9886–2.423, p < 0.05). The HVP group showed significantly higher values for the EX/ENR when compared to the LVP group (95% CI 2.617–7.173, p < 0.05). The evaluation of the EX/ENR can be considered an adequate tool to assess the type of weapon involved and to roughly estimate the associated wounding mechanisms, which can guide both the physician in the management and treatment of the patients affected by GSW, and the forensic pathologist in crime investigation. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy worldwide. It results in characteristic acute and chronic findings on postmortem computed tomography (PMCT), macroscopic and microscopic examinations. While the diagnostic imaging and macroscopic features are not specific for SCD on their own, when coupled with microscopic features such as sickled erythrocytes and evidence of chronic venous congestion (i.e., Gamna-Gandy bodies), these clues can help alert forensic pathologists to the presence of SCD. Despite the prevalence of the disease and the constellation of findings alluded to above, SCD is not often explored in forensic pathology literature. This case demonstrates classic acute and chronic features of SCD on PMCT, macroscopic and microscopic examinations. It explores the pathophysiology leading to sudden and unexpected death in a person with SCD and possible pitfalls in attribution of cause of death. [ABSTRACT FROM AUTHOR]

The article responds to a study on the role of restraint in fatal excited delirium syndrome, highlighting flaws in the original study's methodology and conclusions. The authors argue that the study's scope goes beyond its stated aims and that the interpretation of the literature is flawed. They question the exclusion of cases and the subjective nature of diagnoses, ultimately concluding that the study fails to provide a balanced and accurate interpretation of the subject matter. The authors emphasize the need for a comprehensive post-mortem examination by a qualified forensic pathologist in cases involving restraint-related deaths. [Extracted from the article]

Water intoxication is rarely seen in forensic practice and is typically associated with excessive water consumption, amphetamine intake, and child abuse. Iatrogenic water intoxication is rare but usually related to medical disputes. Here, we report a 44-year-old female was admitted to the hospital due to a 3-month history of excessive menstrual bleeding. B-ultrasound revealed multiple substantial intrauterine masses, leading to a diagnosis of multiple uterine fibroids. After admission, she underwent submucous myomectomy, endometrial resection, and transcervical resection of endometrial polyps. During the procedure, the patient suffered dizziness and chest tightness, her blood pressure decreased to 89/52 mmHg, and moist rales were heard in her both lungs; she died despite medical efforts. A forensic autopsy was performed and revealed severe pulmonary edema. Considering the patient's clinical history, acute water intoxication was considered to be the cause of death. This highlights the need for forensic pathologists to be vigilant of postoperative water intoxication, a rare complication in obstetrics, to ensure accurate assessments. [ABSTRACT FROM AUTHOR]

Sodium nitrite (NaNO2) is an inorganic compound that is commonly used as a preservative (E250) in the fish and meat industry. When ingested, sodium nitrite will lead to methemoglobinemia, hypotension, and arrhythmias. An increasing trend in the use of sodium nitrite as a suicide agent has been reported. In Belgium however it remains a rare phenomenon. The ingestion of sodium nitrite is not always apparent from the death scene investigation, especially in cases of covert administration or accidental ingestion. Hence, the forensic pathologist must be aware of this trend and the postmortem changes related to the ingestion of sodium nitrite to effectively identify these cases and determine the cause and manner of death. We describe a case of fatal self-poisoning following the oral ingestion of sodium nitrite with suicidal intent. Postmortem investigations showed signs of methemoglobinemia, such as a gray-brown discoloration of lividity and a chocolate brown discoloration of the blood. Postmortem toxicological investigation revealed methemoglobinemia (35%) in cardiac blood, hypernatremia (159.6 mmol/L) in vitreous humor, and the presence of nitrite in gastric contents (1.15 g/L) and, for the first time in a forensic case, in serum (38 µg/mL). A review of the existing literature regarding cases of sodium nitrite intoxications was performed to correlate these findings. [ABSTRACT FROM AUTHOR]

Background: Although forensic pathology age estimation of a wound is difficult, it can help reconstruct murder scenes and identify potential culprits. Forensic specialists usually focus on two aspects when evaluating wound life and determining how long ago the wound occurred. Recent developments in forensic techniques, particularly in high-throughput analyses, have allowed for the simultaneous evaluation of several markers and molecular and cellular levels of material analysis. Aim: To evaluate valuable additional information offered by each marker, summarize recent literature, and offer an update on wound-age estimation in forensic pathology. With the intention of providingsome insight for future research, prospects for evaluating wound age in forensic practice are finally examined. Conclusions: Although forensic pathologists find it difficult to determine the age of wounds, doing so can help reconstruct crime scenes and help apprehend suspects. In circumstances where several traumas are sustained by various offenders, forensic pathologists must determine the chronology and sequence of injuries because the severity of an injury usually determines the severity of punishment. Wound tracing, photographic recording (including image analysis), biophysical approaches, and/or invasive protocols requiring wound biopsies are examples of protocols that can be used to do the assessment. We give a summary of some of the most frequently required and utilized methods in this article: (a) Preclinical and animal models, such as those involving incisions, excisions, burns, and damaged wounds; (b) techniques for assessing the rate of healing, image-based wound analysis, biophysical evaluation, histological, immunological, and biochemical assays; and techniques for assessing the healing progression. [ABSTRACT FROM AUTHOR]

Background: Intrauterine fetal death and perinatal death represent one of the most relevant medical scientific problems since, in many cases, even after extensive investigation, the causes remain unknown. The considerable increase in medical legal litigation in the obstetrical field that has witnessed in recent years, especially in cases of stillborn births, has simultaneously involved the figure of the forensic pathologist in scientific research aimed at clarifying the pathophysiological processes underlying stillbirth. Methods: our study aims to analyze cases of sudden intrauterine unexplained death syndrome (SIUD) to evaluate the role of oxidative stress in the complex pathogenetic process of stillbirth. In particular, the immunohistochemical expression of specific oxidative stress markers (NOX2, NT, iNOS, 8-HODG, IL-6) was evaluated in tissue samples of placentas of SIUDs belonging to the extensive case series (20 cases), collected from autopsy cases of the University of Ferrara and Politecnica delle Marche between 2017 and 2023. Results: The study demonstrated the involvement of oxidative stress in intrauterine fetal deaths in the placenta of the cases examined. In SIUD, the most expressed oxidative stress markers were NOX2 and 8-HODG. Conclusions: The study contributes to investigating the role of oxidative stress in modulating different pathways in unexplained intrauterine fetal death (SIUD) tissues. [ABSTRACT FROM AUTHOR]

The border river of the Evros/Meriç/Maritsa has been shaped during the century since its demarcation by the Lausanne peace treaty. Over this period, a dense overlap of environmental, geopolitical, legal and cultural actors has turned it into both a riverised border and a borderised river. The border regime appropriates the riverine characteristics of flow, erosion, mud, turbulence and fog as much as it is founded on military technology, international law, agricultural and conservation practices, resource logistics, border crossing and the denial thereof. Here, the river's movement of sand and alluvium has become an agent in the policing of the river border. Drawing on interviews with asylum seekers, locals, forensic pathologists, legal scholars and fish scientists, this paper weaves field research, primarily undertaken on the Greek side, with a historic and ecosystemic perspective of a century‐old border that has become a hotspot for violent practices. These practices themselves harness the uncertain physical conditions that the riverscape affords. In this article we argue that the disjunctures of the river's dynamic geomorphology and the history of demarcation of the median line frame the contemporary politics of mobility of those illegalised by the border regime. In the ambiguous territorial pockets produced by the movement of the river away from the median line of 1926, islands of hyperlegality have been produced where state violence takes place with impunity. [ABSTRACT FROM AUTHOR]

Background: Any portion of the body that has sustained damage due to mechanical force is referred to as an injury or wound. Weapon use, blunt force, and sharp force can all cause mechanical injuries. In many nations, the most common method of homicide is the use of sharp objects, particularly knives. One of a forensic pathologist's main responsibilities in the realm of forensics is wound examination. By identifying prospective criminal suspects and tracking the origin and progression of violent occurrences, wound assessment supports criminal investigations. Aim: The current review provides a view on wounds/injuries, their classifications, incised wounds, how to differentiate them from lacerations, and the importance of wound examination in the field of forensics. Conclusion: In summary, researchers have classified wounds/injuries according to many factors, and they frequently emphasize the significance of wound examination in the field of forensics. [ABSTRACT FROM AUTHOR]

While forensic pathologists have always played a pivotal role in victim identification after mass casualties, new developments in forensic methods have given forensic anthropologists more agency in positively identifying individuals who were previously unidentifiable. This review aims to contribute to the refinement of diagnostic tools, ensure optimal utilization of remnants and information available, and emphasize the contributions of forensic pathologists and forensic odontologist to victim identification and the importance of forensic pathologists and forensic odontologist in the criminal justice system. Considering the Interpol DVI Guide's emphasis on fingerprints, dental examinations, and DNA as primary identifiers, the forensic pathologist's role as the leader of a multidisciplinary team of experts in a disaster situation has taken on new significance. This is due to the forensic pathologist's and forensic odontologist training and experience leading similar teams during routine operations at a forensics institute. This thorough examination highlights the utmost significance of the job carried out by forensic pathologists and forensic odontologist. They play an important role in the judicial process by providing expert views in criminal investigations. Their expertise ensures accurate identification of victims and provides critical evidence that is necessary for holding offenders responsible. Their contributions are fundamental to the administration of justice, highlighting the great importance of their function in the overall structure of the criminal judicial system. [ABSTRACT FROM AUTHOR]

Multiple gunshot suicides are relatively rare and present significant challenges for investigators and forensic pathologists. In such cases, assessing the possibility of more than one shot being fired can be crucial in distinguishing homicide from suicide. We present a rare case of multiple self‐inflicted gunshot wounds to the chest with severe injury to the heart and left lung. Both the sudden, unexpected death of the man, the unknown source of the firearm, and the number and nature of the injuries sustained seemed quite unusual. The investigation revealed that the wounds were self‐inflicted at close range, and the interval between successive shots (estimated by witnesses at up to 2 min) suggests that even multiple gunshot wounds perforating the heart and lungs may not necessarily cause immediate incapacitation. Forensic investigations in such cases should be multi‐faceted and include full autopsy and ballistics expertise, as well as witness testimony and medical history. [ABSTRACT FROM AUTHOR]

Introduction: Zopiclone, a controlled substance prescribed for insomnia, has become a common toxicological finding in forensic autopsy cases. This study investigated the role and extent of zopiclone use in fatal intoxications in Sweden. Methods: All forensic autopsy cases positive for zopiclone in femoral blood during 2012–2020 were selected. Among these cases, fatalities caused by intoxication according to the cause of death certificates issued by the forensic pathologist were identified. Intoxications where zopiclone contributed to the cause of death were included in the study. The Swedish Prescribed Drug Register was utilized to examine whether the included cases were prescribed zopiclone or not. Results: In total 7320 fatal intoxications underwent a forensic autopsy during the study period, 573 of them were caused by zopiclone. Among the zopiclone fatalities, 87% (n = 494) had a prescription for zopiclone, and 8% (n = 43) were monointoxications. Most fatalities, 62% (n = 354) were suicides, and zopiclone was involved in about 17% (n = 354) of all intoxication suicides in Sweden. Women were significantly (p < 0.01) overrepresented in suicides with zopiclone, comprising 56% (n = 291) of fatalities. The median age was 55 years among zopiclone intoxications compared with 44 years amongst all fatal intoxications. Conclusion: This study demonstrates that the toxicity of zopiclone can be lethal both in combination with other substances and on its own. Most individuals dying in fatal zopiclone intoxications were prescribed zopiclone, which potentially indicates that a more restrictive prescribing rate could prevent future intoxication deaths, especially when caring for patients with an increased suicide risk. [ABSTRACT FROM AUTHOR]

Forensic medicine is a thriving application field for artificial intelligence (AI). Indeed, AI applications intended to forensic pathologists or forensic physicians have emerged since the last decade. For example, AI models were developed to help estimate the biological age of migrants or human remains. However, the uses of AI applications by forensic pathologists or physicians and their levels of integration in medicolegal practices are not well described yet. Therefore, a scoping review was conducted on PubMed, ScienceDirect, and Scopus databases. This review included articles that mention any AI application used by forensic pathologists or physicians in practice or any AI model applied in one expertise field of the forensic pathologist or physician. Articles in other languages than English or French or dealing mainly with complementary analyses handled by experts who are not forensic pathologists or physicians or with AI to analyze data for research purposes in forensic medicine were excluded from this review. All the relevant information was retrieved in each article from a grid analysis derived and adapted from the TRIPOD checklist. This review included 35 articles and revealed that AI applications are developed in thanatology and in clinical forensic medicine. However, those applications seem to mainly remain in research and development stages. Indeed, the use of AI applications by forensic pathologists or physicians is not actual due to issues discussed in this article. Finally, the integration of AI in daily medicolegal practice involves not only forensic pathologists or physicians but also legal professionals. [ABSTRACT FROM AUTHOR]

Forensic anthropology (FA) as a specialized discipline has been practised in multi-lingual Switzerland for over a decade. A variety of expertise regarding osteological assessments as well as facial image comparison (FIC) is provided by different centres. Nevertheless, information is lacking about the awareness of FA and its benefits for forensic investigations among forensic stakeholders. Therefore, a survey was sent to Swiss anthropologists (AN) and related professions (police officers, prosecutors, and forensic pathologists) to assess three main aspects: (1) the experience of working (biological/forensic) anthropologists within FA; (2) how FA is perceived by other professions within the legal system; and (3) identify gaps (if any) in understanding of FA with the aim to suggest avenues for improvement if necessary. The results show that awareness of FA varies by occupation and cantonal regions. In areas where close collaborations between forensic anthropologists (FAs) and other stakeholders have been formally established, be it with focus on osteological analyses or FIC, the awareness of FA competencies was superior to areas where this was not the case. An overwhelming majority of forensic actors expressed interest in continuing education related to the role of FA. These findings indicate that facilitation of communication and collaboration leads to improvement in the awareness of the competencies of FAs and their contribution to forensic investigations. [ABSTRACT FROM AUTHOR]

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by the progressive fibro-fatty replacement of the right ventricular myocardium, leading to myocardial atrophy. Although the structural changes usually affect the right ventricle, the pathology may also manifest with either isolated left ventricular myocardium or biventricular involvement. As ARVC shows an autosomal dominant pattern of inheritance with variable penetrance, the clinical presentation of the disease is highly heterogeneous, with different degrees of severity and patterns of myocardial involvement even in patients of the same familiar group with the same gene mutation: the pathology spectrum ranges from the absence of symptoms to sudden cardiac death (SCD) sustained by ventricular arrhythmias, which may, in some cases, be the first manifestation of an otherwise silent pathology. An evidence-based systematic review of the literature was conducted to evaluate the state of the art of the diagnostic techniques for the correct post-mortem identification of ARVC. The research was performed using the electronic databases PubMed and Scopus. A methodological approach to reach a correct post-mortem diagnosis of ARVC was described, analyzing the main post-mortem peculiar macroscopic, microscopic and radiological alterations. In addition, the importance of performing post-mortem genetic tests has been underlined, which may lead to the correct identification and characterization of the disease, especially in those ARVC forms where anatomopathological investigation does not show evident morphostructural damage. Furthermore, the usefulness of genetic testing is not exclusively limited to the correct diagnosis of the pathology, but is essential for promoting targeted screening programs to the deceased's family members. Nowadays, the post-mortem diagnosis of ARVC performed by forensic pathologist remains very challenging: therefore, the identification of a clear methodological approach may lead to both a reduction in under-diagnoses and to the improvement of knowledge on the disease. [ABSTRACT FROM AUTHOR]

The diagnosis of drowning is one of the most difficult tasks in forensic medicine. The diatom test is a complementary analysis method that may help the forensic pathologist in the diagnosis of drowning and the localization of the drowning site. This test consists in detecting or identifying diatoms, unicellular algae, in tissue and water samples. In order to observe diatoms under light microscopy, those samples may be digested by enzymes such as proteinase K. However, this digestion method may leave high amounts of debris, leading thus to a difficult detection and identification of diatoms. To the best of our knowledge, no model is proved to detect and identify accurately diatom species observed in highly complex backgrounds under light microscopy. Therefore, a novel method of model development for diatom detection and identification in a forensic context, based on sequential transfer learning of object detection models, is proposed in this article. The best resulting models are able to detect and identify up to 50 species of forensically relevant diatoms with an average precision and an average recall ranging from 0.7 to 1 depending on the concerned species. The models were developed by sequential transfer learning and globally outperformed those developed by traditional transfer learning. The best model of diatom species identification is expected to be used in routine at the Medicolegal Institute of Paris. [ABSTRACT FROM AUTHOR]

In examining deaths resulting from gunshot wounds, it is important to describe the wound pathway created by the projectile. Forensic pathologists must identify all entrance and exit wounds and account for all projectiles. Occasionally, confusion arises as to whether a skin defect represents an entrance wound or not, an exit wound, or some other type of wound. Herein, we propose the descriptor "bullet track skin defect" as a formal description for a superficial skin defect created along the pathway of a projectile within the body. Specifically, we define the "bullet track skin defect" as a partial‐ or full‐thickness skin defect produced by a projectile traveling beneath the skin in a relatively tangential fashion as part of a wound pathway within the body. It is somewhat analogous to a traditional graze or superficial tangential wound, wherein the projectile traveling outside the body strikes the skin tangentially from above, without entering the body. However, the projectile is already traveling within the body with the bullet track skin defect, disrupting the skin tangentially from below rather than from above, without exiting the body. Although these defects are not a common presentation of gunshot wounds, they are certainly not rare. With this case series, we suggest that such defects may be referred to as "bullet track skin defects." Alternative language that can substitute for "bullet track skin defects" includes "bullet track skin wounds" or "bullet track cutaneous defects." [ABSTRACT FROM AUTHOR]

Wound age estimation is a crucial medicolegal task for forensic pathologists. The main objective of the current study was to evaluate the ability of the histopathological profile and immunohistochemical markers (CD14 and IL-8) to predict the age of abrasion and, furthermore, identify the relationship between the histopathological profile and immunohistochemical markers in abrasion aging. The study involved postmortem cases (n = 246) of abrasion injuries in which the injury infliction time was known. The test skin samples were taken from the abrasion site, and an adjacent area of uninjured skin was sampled for control. Hematoxylin and eosin stain was applied to tissue sections for the histopathological analysis. The semi-quantitative evaluation was made for expressing immunohistochemical markers CD14 and IL-8 on the infiltrating inflammatory cells. The study showed that the age of abrasion was significantly higher (p < 0.05) among the cases with positive staining than those with negative staining for both CD14 and IL-8. Additionally, the study found a significant association between the age of the abrasion and the IHC staining for IL-8. However, no significant association was seen between the age of abrasion and the CD-14 IHC staining. The odds ratio (95% confidence interval) for more than 72 h of the age of abrasion was compared to 0 to 72 h of the age of abrasion. The odds ratios were 39.00 (4.177–364.13) for the predominant mononuclear cell infiltration and 84.50 (9.287–768.814) for cases with the appearance of fibroblast, granulation tissue, and collagen deposition when compared to an unremarkable change on histopathological examination. Positive staining of immunohistochemical markers CD14 and IL-8 for the age of abrasion of more than 72 h showed a sensitivity of 40% and 80.95%, respectively, and specificity of 71.6% and 52.5%, respectively. The quantification of the histopathological changes of predominant mononuclear cell infiltration and the appearance of fibroblast, granulation tissue formation, and collagen deposition showed a significant correlation for the age of abrasion of more than 72 h. The immunohistochemical analysis revealed IL-8 as a more accurate marker than CD14 in identifying abrasions older than 72 h. [ABSTRACT FROM AUTHOR]

We present the case of a 23-month-old child who died less than 24 h after the onset of cardiac symptoms, despite being admitted to the hospital 72 h earlier. Autopsy revealed no significant macroscopic changes, and histologic examination revealed focal lymphocytic myocarditis with myocyte disruption, diffuse alveolar damage in the exudative phase, and generalized lymphocytic immune activation in other organs. Ante-mortem and post-mortem microbiological exams did not clearly prove a causative role of infectious agents. The peculiarity of this case was characterized by the contrast between the severe clinical features and the mild cardiac histological findings. This discrepancy, coupled with the suspicion of a viral causative role based on both ante-mortem and post-mortem microbiological examinations, presented significant challenges in reaching an etiological diagnosis. This case also confirms that the diagnosis of myocarditis in children cannot be made solely on the basis of histological cut-offs or microbiological results. Using abductive reasoning, various diagnostic hypotheses were formulated and evaluated to arrive at the final diagnosis of fatal myocarditis of viral or post-viral origin. Data from post-mortem examination are often the only source of information that is available to the experts, especially in cases of sudden infant death syndrome. In such cases, the forensic pathologists should accurately evaluate findings that may appear to indicate a different etiology, and, in the absence of clinical or radiological data, interpret post-mortem data in a logically correct manner. The autopsy is the first essential step to evaluate the cause of death and must be integrated with the results of ante- and post-mortem diagnostic tests in a holistic approach, which is crucial to allow forensic pathologists to provide an appropriate and relevant opinion. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic utility of multiphase postmortem CT angiography (PMCTA) to detect plaque enhancement as a surrogate marker of inflammation, using fatal coronary plaques obtained from autopsies following sudden cardiac death. Methods: In this retrospective study, we included 35 cases (12 women, 34%; median [IQR] age, 52 [11] years), with autopsy-proven coronary thrombosis, histological examination, and multiphase PMCTA. Two radiologists blinded towards histological findings assessed PMCTA for plaque enhancement of the culprit lesion in consensus. Two forensic pathologists determined the culprit lesion and assessed histological samples in consensus. Cases with concomitant vasa vasorum density increase and intraplaque and periadventital inflammation were considered positive for plaque inflammation. Finally, we correlated radiology and pathology findings. Results: All 35 cases had histological evidence of atherosclerotic plaque disruption and thrombosis; 30 (85.7%) had plaque inflammation. Plaque enhancement at multiphase PMCTA was reported in 21 (60%) and resulted in a PPV of 95.2% (77.3–99.2%) and an NPV of 28.6% (17–43.9%). Median histological ratings indicated higher intraplaque inflammation (p =.024) and vasa vasorum density (p =.032) in plaques with enhancement. We found no evidence of a difference in adventitial inflammation between CT-negative and CT-positive plaques (p =.211). Conclusions: Plaque enhancement was found in 2/3 of fatal atherothrombotic occlusions at coronary postmortem CT angiography. Furthermore, plaque enhancement correlated with histopathological plaque inflammation and increased vasa vasorum density. Plaque enhancement on multiphase CT angiography could potentially serve as a noninvasive marker of inflammation in high-risk populations. Clinical relevance statement: Phenotyping coronary plaque more comprehensively is one of the principal challenges cardiac imaging is facing. Translating our ex vivo findings of CT-based plaque inflammation assessment into clinical studies might help pave the way in defining high-risk plaque better. Key Points: • Most thrombosed coronary plaques leading to fatality in our series had histological signs of inflammation. • Multiphase postmortem CT angiography can provide a noninvasive interrogation of plaque inflammation through contrast enhancement. • Atherosclerotic plaque enhancement at multiphase postmortem CT angiography correlated with histopathological signs of plaque inflammation and could potentially serve as an imaging biological marker of plaque vulnerability. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiovascular diseases, and it shows an autosomal dominant pattern of inheritance. HCM can be clinically silent, and sudden unexpected death due to malignant arrhythmias may be the first manifestation. Thus, the HCM diagnosis could be performed at a clinical and judicial autopsy and offer useful findings on morphological features; moreover, it could integrate the knowledge on the genetic aspect of the disease. This review aims to systematically analyze the literature on the main post-mortem investigations and the related findings of HCM to reach a well-characterized and stringent diagnosis; the review was performed using PubMed and Scopus databases. The articles on the post-mortem evaluation of HCM by gross and microscopic evaluation, imaging, and genetic test were selected; a total of 36 studies were included. HCM was described with a wide range of gross findings, and there were cases without morphological alterations. Myocyte hypertrophy, disarray, fibrosis, and small vessel disease were the main histological findings. The post-mortem genetic tests allowed the diagnosis to be reached in cases without morpho-structural abnormalities; clinical and forensic pathologists have a pivotal role in HCM diagnosis; they contribute to a better definition of the disease and also provide data on the genotype–phenotype correlation, which is useful for clinical research. [ABSTRACT FROM AUTHOR]

The analysis of charred bodies represents a serious challenge for forensic pathologists, and an interdisciplinary approach is often the only way to determine the cause and manner of death. We present an unusual case in which the charred body of a 61‐year‐old man was found inside his burning vehicle. In order to determine cause and manner of death, an interdisciplinary team was employed, with experts in forensic pathology, forensic radiology, toxicology and fire investigations. Post‐mortem computed tomography, autopsy and toxicology ruled out the presence of trauma injury and detected signs of vital exposure to fire and blood alcohol levels. On the other hand, according to fire investigations, the fire started inside the car and partially burned fragments of a garden hose were found along the right side of the car. A suicide could therefore be hypothesized, with the man having attempted to poison himself with the car's exhaust fumes and having set the car on fire. The death was consistent with a complicated suicide in which the victim, in a state of reduced capability, accidentally set his car on fire and was unable to escape. The hypothesis of a complex suicide, with the car having been set deliberately on fire, could not, however, be ruled out. [ABSTRACT FROM AUTHOR]

Introduction: Murder is an odious crime. Identifying such crime requires precision and cooperation between the various agencies, including the police and forensic pathologist. Both need to keep an open mind, and consider each crime through all the possible perspectives. We present a case of hanging associated with a long drop which resulted in a complete decapitation, but was alleged to be the result of a sharp force injury by unknown assailants. The preparators of this crime, dumbfounded by the unexpected outcome, tried to conceal the crime. However, on meticulous examination and review of past literature we are of the considered opinion that decapitation in this case was caused by hanging. However, the manner of death was not clear and the police ruled it as murder based on their investigation. [ABSTRACT FROM AUTHOR]

Traffic accident injuries are relevant causes of mortality in industrialized countries. Among traffic accidents, the most destructive effect on the victim's body is produced by trains, which in a very short time provoke a complete distortion of the normal anatomical profiles and extensive amputations of the body. Deaths by severe body mutilation and/or decapitation require complex forensic investigation, as the victims' identification and the recognition of their body are not often feasible. In this study, a retrospective analysis of a series of cases of railway accidents is presented, with the aim of showing potential identification strategies, including a systematic physical re-assembling of the body. Among the railway fatalities assessed at the University Institute of Legal Medicine of Milan from 2016 until 2020, 61 cases were analyzed, focusing on the collection of postmortem data to improve accuracy for the identification of the victims. The results showed that the identification could be based on elements traditionally called "secondary identifiers" which, however, are becoming more and more important for positive identification, especially when dealing with migrants, vagrants, and homeless people. However, several issues need to be considered such as the limitations of the public prosecutors to perform expensive analyses (i.e., genetic testing), and the lack of antemortem data to be compared with postmortem findings, both odontological and fingerprint. In cases where it is not possible to proceed with identification or formal recognition of victims of railroad accidents with severe mutilations, a systematic physical re-assembling of the body is critical to reaching positive identification. [ABSTRACT FROM AUTHOR]

This paper discusses the introduction, development and utility of post-mortem imaging relating specifically to conflict-related and terrorist-related deaths and considers the use of computed tomography (CT) in the investigations. We demonstrate how a multi-disciplinary approach involving direct communication between forensic pathologist and radiologist can maximise evidential yield, reduce the need for unnecessary dissection and further our understanding of such injuries. This summarises our shared experience of hundreds of cases, each having been individually discussed and reviewed, and has helped shape our understanding of conflict injury as well as contributing to the development of mitigation strategies and adaptations to protective equipment. A series of clinical cases are presented to demonstrate some of the strengths and weaknesses of the process. • Development of post-mortem CT in forensic radiology by UK military. • Collaborative learning and working between radiology, pathology and police. • What the forensic pathologist and police want from CT. • What radiology can answer from a pragmatic PMCT study. • Strengths and weaknesses of the technique through case scenarios. [ABSTRACT FROM AUTHOR]

Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed benefits. In this qualitative study, the effects of using a 3D print, demonstrating a blunt force skull fracture, in court were explored by thematic analysis of interviews with judges, prosecutors, defence counsels, and forensic pathologists with the aim of improving the expert testimony. Five semi-structured focus groups and eight one-to-one interviews with a total of 29 stakeholders were transcribed ad verbatim and analysed using thematic analysis. The study found that a highly accurate 3D print of a skull demonstrated autopsy findings in detail and provided a quick overview, but sense of touch was of little benefit as the 3D print had different material characteristics than the human skull. Virtual 3D models were expected to provide all the benefits of 3D prints, be less emotionally confronting, and be logistically feasible. Both 3D prints and virtual 3D models were expected to be less emotionally confronting than autopsy photos. Regardless of fidelity, an expert witness was necessary to translate technical language and explain autopsy findings, and low-fidelity models may be equally suited as demonstrative aids. The court infrequently challenged the expert witnesses' conclusions and, therefore, rarely had a need for viewing autopsy findings in detail, therefore rarely needing a 3D print. [ABSTRACT FROM AUTHOR]

Crime scene investigation (CSI) is the complex act of reconstructing the dynamics that led to a crime and the circumstances of its perpetration. Crystallizing the CSI is a difficult task for the forensic pathologist; however, it is often requested by the public prosecutor and many judicial cases remain unsolved precisely for this reason. Recent years have seen an improvement in the ability of 3D scanning technology to obtain dense surface scans of large-scale spaces, for surveying, engineering, archaeology, and medical purposes such as forensics. The applications of this new technology are growing every day: forensic measurement of wounds in clinical reports, for example, reconstruction of traffic accidents, bullet trajectory studies in gunshot wounds, and 3D bloodstain pattern analysis. A retrospective analysis was conducted across all crime scene investigations performed by the forensic staff of the Department of Forensic Pathology of the University of Catania from January 2019 to June 2022. Inclusion criteria were the use of a laser scanner (LS), the use of a camera, a full investigative scene, and collection of circumstantial data thanks to the help of the judicial police. Cases in which the LS was not used were excluded. Out of 200 CSIs, 5 were included in the present study. In case number 1, the use of the LS made it possible to create a complete scale plan of the crime scene in a few hours, allowing a ship to be quickly returned to the judicial police officer. In case 2 (fall from a height), the LS clarified the suicidal intent of the deceased. In case number 3 it was possible to reconstruct a crime scene after many years. In case 4, the LS provided a great contribution in making a differential diagnosis between suicide and homicide. In case 5, the LS was fundamental for the COVID team in planning the study of COVID-19 pathways and areas within a hospital with the aim of reduction of nosocomial transmission. In conclusion, the use of the LS allowed the forensic staff to crystallize the investigative scene, making it a useful tool. [ABSTRACT FROM AUTHOR]