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Organ procurement and transplantation have grown steadily, and the need for organs will only rise in the future. Increasing the number of potential donors is therefore paramount. However, transplant coordination teams face refusals that can be linked to the contexts of the deaths, especially when they involve legal issues. In France, deaths involving legal proceedings are not uncommon (7-10%). In these cases, the prosecutor is immediately contacted, and makes the decision of whether to remove the involved organs. Refusals of this type represent 4% (approximately 30 cases per year) of obstacles to organ removals, and are governed by specific legislation. Thus, the prosecutor must arrange contact with a forensic pathologist and with the organ transplant teams to assemble all of the necessary elements for him to take the decision. To assist prosecutors in their decision making and to ensure them scientific rigour, the French Society of Forensic Medicine sought to develop a national recommendation to harmonise practices; it emerged in early 2013. The guideline makes practical recommendations, including among others: nominating local referents; writing regional protocols between judicial authorities, forensic pathologists and transplant teams; establishing terms for the forensic pathologist's intervention on the donor's body before and after a procurement. This recommendation by the French Society of Forensic Medicine aimed to combine two interests: addressing the shortage of organs, and fulfilling the requisites of a criminal investigation by standardising practices and encouraging communication., (© The Author(s) 2014.)

Reducing the capacity of a victim to react against sexual assault, coupled with a possible abrupt unconsciousness-inducing effect and ease of administration in spiked drinks, have resulted in the use of sedative agents in cases of drug-facilitated offence. Among these compounds, tetrazepam may impair an individual rapidly. The chances of detecting this substance increase if the most sensitive methods are used and if the biologic matrix that allows the longest possible detection time is available. To document the window of detection of tetrazepam, 50 mg of the drug was administered orally to 2 volunteers, and the following samples were collected: oral fluid (n = 1) over 515 minutes, urine (n = 2) over 236-240 hours, hair (n = 2) 4 weeks after exposure, and beard (n = 1) over 34 days. Tetrazepam was analyzed by LC-MS/MS (Micromass Quattro Micro) after alkalinization and extraction by dichloromethane/diethyl ether in the presence of diazepam-d5, used as internal standard. Reversed-phase separation on an XTerra MS C18 column was achieved in 12 minutes, under gradient conditions. Pseudo-molecular ions selected were m/z 289.2 and 290.2 for tetrazepam and the internal standard (IS), respectively, and the corresponding daughter ions selected were m/z 225.2 and 253.2 for tetrazepam and m/z 154.1 and 198.3 for the IS. Urine tested positive for tetrazepam over 236-240 hours (14-13 ng/mL). Oral fluid tested positive for tetrazepam over 515 minutes (2.5 ng/mL). Tetrazepam was detected in beard over 27 days (6.5 pg/mg). A single tetrazepam dose was detected in hair 4 weeks after intake (123-175 pg/mg). Tetrazepam tested positive over the studied time intervals but would be expected to be detectable for a considerably longer time. Therefore, in cases of drug-facilitated crimes in which tetrazepam is involved, hair and beard analyses can be an important complement to urine analyses to document exposure, particularly if LC-MS/MS is used.

Whereas the analysis of ancient DNA (aDNA) has become an increasingly popular mode of investigation in both archaeological and evolutionary studies, this approach is complicated by the degraded nature of ancient nucleic acids, the presence of enzymatic inhibitors in aDNA extracts, as well as the risk of contamination during either excavation or manipulation of samples. Despite these difficulties, numerous methods have been developed to optimize the recovery, study, and authentication of aDNA. In this article, we describe the procedures used in our laboratory to extract and amplify informative DNA segments from prehistoric or protohistoric human samples, as well as the precautions and strategies implemented to avoid or at least detect contaminations.

The purported lowering of sex opposition, coupled with a possible abrupt unconsciousness-inducing effect and ease of administration in spiked drinks have resulted in the use of hypnotics in cases of drug-facilitated offense. Among these compounds, lorazepam possesses amnesic properties and can impair an individual rapidly. The chances to detect this substance increase if the most sensitive methods are used and if the biological fluid which allows the longest possible detection time is available. In order to document the window of detection of lorazepam, we have orally administered 2.5 mg of the drug to three volunteers and collected oral fluid (n = l) over 8 h, urine (n = 2) over 144 h and hair (n = 3) 4 weeks after exposure. Lorazepam was analyzed by LC-MS/MS after alkalinisation (to pH 8.4 with phosphate buffer) and extraction by dichloromethane/diethyl ether in presence of diazepam-d5, used as internal standard. Reversed-phase separation on a XTerra C18 column was achieved in 12 min, under gradient conditions. Molecular ions (m/z 321 and 290 for lorazepam and the IS, respectively) were selected in Ql and the corresponding daughter ions (m/z 303 and 275 for lorazepam and m/z 154 and 198 for the IS) were detected in Q3 after collision with argon. Urine tested positive for lorazepam over 144 h (2-4 ng/ml), with a peak detected after 24 h exposure (411-880 ng/ml). Oral fluid tested positive for lorazepam over 8 h (0.7 ng/ml). Despite a limit of quantitation at 1 pg/mg, we were unable to detect a single lorazepam dose in hair, contrarily to most other benzodiazepines that are detectable. Therefore, in case of drug-facilitated crimes involving lorazepam, urine appears as the best specimen to document exposure, particularly if LC-MS/MS is used.

Since gamma-hydroxybutyrate (GHB) is present in both blood and urine of the general population as an endogenous compound, toxicologists must be able to discriminate between these endogenous levels and a concentration resulting from exogenous exposure. The implementation of a cut-off concentration must be done cautiously, due to the wide distribution of endogenous concentrations. To verify the accuracy of a proposed 50 mg/l postmortem blood cut-off, we tested 71 autopsy cases of subjects where the cause of death could exclude GHB exposure. The delay between death and autopsy ranged from 12 to 72 h. GHB was tested by gas chromatography-mass spectrometry (GC-MS) after precipitation. Briefly, 20 microl of blood, bile, or vitreous humor was pipetted in a glass tube, followed by 20 microl of GHB-d6 and 45 microl of acetonitrile. After vortexing and centrifugation, the supernatant was collected and evaporated to dryness. The residue was derivatized with bis(trimethylsilyl)trifluoroacetamide (BSTFA) with 1% trimethylchlorosilane (TMCS) for 20 min at 70 degrees C. After injection on a 30 m HP5 MS capillary column, GHB (m/z 233, 204, and 147) and GHB-d6 (m/z 239) were identified by MS. GHB tested positive in all the 71 whole blood (cardiac) specimens, with concentrations in the range 0.4-409 mg/l, with a major distribution in the range 10-40 mg/l. A concentration >50 mg/l was observed in 14 cases. As there was no data to support GHB exposure, this was considered as postmortem formation. In order to discriminate this contamination, when available, femoral blood, bile or/and, vitreous humor were tested. The following results were obtained: cardiac blood (55-409 mg/l) versus bile (6.1-238 mg/l) in seven cases; cardiac blood (51-409 mg/l) versus femoral blood (17-44 mg/l) in five cases, and cardiac blood (51-409 mg/l) versus vitreous humor (3.9-2 mg/l) in six cases. It is obvious that bile does not fit the requirements for discrimination and that femoral blood and mostly vitreous humor can be of particular interest. These results demonstrate that a positive (>50 mg/l) postmortem blood GHB concentration cannot support alone drug exposure and that it is essential to document the case with other specimens, including peripheral blood and vitreous humor.

The use of Japanese swords for homicidal attempts is rare. A Japanese samurai sword is a sharp and cutting object. When faced with the use of this weapon, one must distinguish between stabs and incised wounds. Incised wounds can rarely lead to death, but because of the size of the weapon, stabs usually cause much more serious injuries. Stabs also imply a penetrating movement, whereas incised wounds can be the consequence of protective circular blows. Therefore, it is important to distinguish clinically between these two kinds of wounds. We report a case where the perpetrator argued he had given a circular blow, unfortunately hitting the victim. The pieces of evidence are discussed.

Terrorist attacks have been on the rise. During the recent terrorist attacks in France, terrorists perpetrated their acts using weapons of war, as well as explosive charges. These two modes of action, when combined, can create skin lesions with similar macroscopic appearances, which can sometimes go unnoticed because of body fragmentation. A total of 68 autopsies, 83 external examinations, 140 standard radiographic examinations, and 49 computed tomography (CT) scans were performed over 7 days during the 2015 terrorist attacks in France. Bodies were injured by firearms and shrapnel-like projectiles. We analysed the clinical findings for the secondary blast cutaneous lesions from the explosive devices and compared these lesions with ballistic-related lesions to highlight that patterns can be macroscopically similar on external examination. Secondary blast injuries are characterised by penetrating trauma associated with materials added to explosive systems that are propelled by explosive air movement. These injuries are caused most often by small, shrapnel-like metallic objects, such as nails and bolts. Propulsion causes ballistic-type injuries that must be recognised and distinguished from those caused by firearm projectiles. Differentiating between these lesions is very difficult when using conventional criteria (size, shape, number and distribution on the body) with only external examination of corpses. This is why the particularities of these lesions must be further illustrated and then confirmed by complete autopsies and radiological and anatomopathological examinations. When occurring simultaneously in terrorist attacks, injuries caused by secondary blasts appear as cutaneous wound patterns that can be macroscopically very similar to those caused by firearm projectiles. The criteria usually found in the literature for distinguishing these two types of projectiles may be difficult to use. It is important in these difficult situations to benefit from systematic postmortem imaging. Systematic autopsy and then anatomopathological analyses of the orifices also help determine the cause of the wounds. [ABSTRACT FROM AUTHOR]

The terrorist attacks of November 2015 led to the immediate death of 129 victims admitted to the Legal and Forensic Medicine Institute of Paris, including 41 unidentified. During the Disaster Victim Identification (DVI) operations, 22 bodies were examined by the postmortem (PM) dental team with the aim of establishing PM odontograms. At the same time, the dental expert in the antemortem (AM) unit collected a large number of dental files, progressively filtered as the list of missing persons became reduced. Feedback from these events has highlighted the difficulties of implementing the DVI chain principles in a legal framework, published the day before the attacks, and also the technical complexity of collecting dental data on a week end of terror. The return on experience after this event has represented a paradigm shift on previous methods of DVI in Paris and even more in France. Indeed, the victim identification procedure was redesigned, integrating new technical means such as a CT scan directly on spot, allowing the extraction of maxillofacial data as soon as possible in order to support the PM dental examination team. Moreover, the National Dental Council proceeded to the overall remodeling of the dental identification unit, which is composed of trained members, from local, regional and national aspects. These forensic experts are dedicated, at the request of the legal authorities, to DVI operations and deployed throughout the country capable of managing AM and PM data. This unit aims also to share experiences and awareness-raising among health professionals and investigators in order to optimize a better submission of AM elements and also to enhance the major interest of odontology as a primary identifier in disaster. [ABSTRACT FROM AUTHOR]

In cases of terrorist bomb attacks, the issue of victim identification is the principal aim. For investigators and justice, terrorists must also be identified in a timely manner. The fragmentation of bodies caused by explosive devices however makes this operation difficult. The cases presented correspond to six autopsies of perpetrators carrying explosives. Their explosive belts produced different body sections on areas correlated with the location on the body of carrying explosive charges. Indeed, cross-sectional areas are the signature of the level of explosive devices on the body, and some fracture features through the damage of certain areas of constitutional weaknesses are specific elements to consider. These elements can allow a quick distinction between victims and terrorists, in order to assist in the medico-legal process of identification. [ABSTRACT FROM AUTHOR]

Estimation of age at death from human bones in legal medicine or in anthropology and archaeology is hampered by controversial results from the various macroscopic and histological techniques. This study attempted an estimation of age at death by histomorphometric analysis, from the fourth left rib adjacent to the costochondral joint in 80 forensic cases. Use of the picrosirius dye provided a reliable staining of the decalcified paraffin-embedded ribs. The total bone cortical area, the major and minor diameter as well as the area of the Haversian canals, the osteon areas of intact and remodelled secondary osteons, the area of non-Haversian canals were evaluated by means of image analysis, and derived parameters were calculated on both the internal and external sides of the rib. Most of the variables exhibited consistency between three different observers. Noteworthy, morphometric measurements in the internal cortex of the rib showed less variability than in the external cortex. Finally, discriminant statistical analysis from the 80 cases in this study indicated that the osteon population density was virtually sufficient to significantly discriminate between three groups of age: 20-39 (adulthood), 40-59 (middle age) and a group superior to 60. A subsequent blind evaluation of ten new subjects satisfactorily classified seven subjects out of ten within the three age groups. These results make feasible a larger study aimed at characterization of the practical relationships between bone tissue histomorphometry in ribs and chronological age in forensic cases. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated the age-related accumulation of duplications in the D-loop of mitochondrial DNA (mtDNA) extracted from skeletal muscle. This kind of mutation had not yet been studied in bone. The detection of age-related mutations in bone tissue could help to estimate age at death within the context of legal medicine or/and anthropological identification procedures, when traditional osteological markers studied are absent or inefficient. As we detected an accumulation of a point mutation in mtDNA from an older individual's bones in a previous study, we tried here to identify if three reported duplications (150, 190, 260 bp) accumulate in this type of tissue. We developed a sensitive method which consists in the use of back-to-back primers during amplification followed by an electrophoresis capillary analysis. The aim of this study was to confirm that at least one duplication appears systematically in muscle tissue after the age of 20 and to evaluate the duplication age appearance in bones extracted from the same individuals. We found that the number of duplications increase from 38 years and that at least one duplicated fragment is present in 50% of cases after 70 years in this tissue. These results confirm that several age-related mutations can be detected in the D-loop of mtDNA and open the way for the use of molecular markers for age estimation in forensic and/or anthropological identification. [ABSTRACT FROM AUTHOR]

Ricochet of a bullet in the spinal canal is well known by neurosurgeons but relatively not a common event in usual medico-legal autopsy practice. This article presents a homicide case of a penetrating gunshot injury of the lumbar spine through the T12-L1 intervertebral foramen with active movement of the projectile within the spinal canal to the L5-S1 level. This case illustrates a bullet intradural and intramedullary active movement because of a ricochet of the body of T12 with active redirection of the path. In the current literature, different types of migration in caudal or cranial direction, intradural, or intramedullary are reported. If spontaneous migration of T10 to S1 seems to be more frequent, some authors reported a C1 to S2 migration. Such migration could be asymptomatic or induce neurological impairment. The medico-legal consequences of these migrations within the spinal canal are described. [ABSTRACT FROM AUTHOR]

The article about the "Overview of clinical forensic services in various countries of European Union" [[1]] is an important milestone in the field of clinical forensic medicine in so far that one of the main proposals would be to set up a Clinical Forensic Network for Europe. Were to discuss a future Clinical Forensic Network for Europe (CFN Europe) and a European-wide minimum standard for clinical forensic examinations. Furthermore, the CFN Europe could be a network proposing training for medical staff and other occupational groups who are in close contact with victims of physical and/or sexual violence in order to secure and adequately store forensic findings. [Extracted from the article]

Mutation analysis in the mitochondrial DNA (mtDNA) control region is widely used in population genetic studies as well as in forensic medicine. Among the difficulties linked to the mtDNA analysis, one can find the detection of heteroplasmy, which can be inherited or somatic. Recently, age-related point mutation A189G was described in mtDNA and shown to accumulate with age in muscles. We carried out the detection of this 189 heteroplasmic point mutation using three technologies: automated DNA sequencing, Southern blot hybridization using a digoxigenin-labeled oligonucleotide probe, and peptide nucleic acid (PNA)/real-time PCR combined method on different biological samples. Our results give additional information on the increase in mutation frequency with age in muscle tissue and revealed that the PNA/real-time PCR is a largely more sensitive method than DNA sequencing for heteroplasmy detection. These investigations could be of interest in the detection and interpretation of mtDNA heteroplasmy in anthropological and forensic studies. [ABSTRACT FROM AUTHOR]

• The protective shell around the otic capsule preserves it from degradation. • The absence of vascularisation prevents exogenous contamination in petrous bones. • Degradation in petrous bones varies depending on environmental factors. • STR genotyping is more reliable using DNA extracted from petrous bones. Over the last few years, palaeogenomic studies of the petrous bone (the densest part of the temporal bone) have shown that it is a source of DNA in both larger quantities and of better quality than other bones. This dense bone around the otic capsule has therefore been called the choice substrate in palaeogenomics. Because the practice of forensic genetics responds to different imperatives, we implemented a study aimed at (i) understanding how and why the petrous bone is an advantageous substrate in ancient DNA studies and (ii) establishing whether it is advantageous in forensic STR typing. We selected 50 individual skeletal remains and extracted DNA from one tooth and one petrous bone from each. We then amplified 24 STR markers commonly used in forensic identification and compared the quality of that amplification using the RFU intensities of the signal as read on the STR profiles. We also performed histological analyses to compare (i) the microscopic structure of a petrous bone and of a tooth and (ii) the microscopic structure of fresh petrous bone and of an archaeological or forensic sample. We show that the RFU intensities read on STR profiles are systematically higher in experiments using DNA extracted from petrous bones rather than teeth. For this reason, we were more likely to obtain a complete STR profile from petrous bone material, increasing the chance of identification in a forensic setting. Histological analyses revealed peculiar microstructural characteristics (tissue organization), unique to the petrous bone, that might explain the good preservation of DNA in that substrate. Therefore, it appears that despite the necessity of analysing longer fragments in forensic STR typing compared to NGS palaeogenomics, the use of petrous bones in forensic genetics could prove valuable, especially in cases involving infants, toothless individuals or very degraded skeletal remains. [ABSTRACT FROM AUTHOR]