Use of Cardiac Injury Markers in the Postmortem Diagnosis of Sudden Cardiac Death

In the daily practice of forensic pathology, sudden cardiac death (SCD) is a diagnostic challenge. Our aim was to determine the usefulness of blood biomarkers [creatine kinase CK‐MB, myoglobin, troponins I and T (cTn‐I and T), and lactate dehydrogenase] measured by immunoassay technique, in the postmortem diagnosis of SCD. Two groups were compared, 20 corpses with SCD and 8 controls. Statistical significance was determined by variance analysis procedures, with a post hoc Tukey multiple range test for comparison of means (p < 0.05). SCD cases showed significantly higher levels (p < 0.05) of cTn‐T and cTn‐I compared to the control group. Although only cases within the first 8 h of postmortem interval were included, and the control group consisted mainly of violent death cases, our results suggest that blood troponin levels may be useful to support a diagnosis of SCD.     

The Erratic Behavior of Lesions in Burnt Bone

This study analyses depressed fractures (by blunt force trauma) and circular full‐thickness injuries (drill injuries and gunshot wounds) in charred bones. Fifty bovine ribs (total 104 lesions) were divided into three groups. The first group consisted in 20 depressed hammer‐produced fractures; in the second one, 60 round drill‐holes were produced (30 circular, 30 semicircular); in the third group, 12 fleshed and 12 skeletonized ribs were hit by 9‐mm bullets. Each specimen was carbonized in an electric oven up to 800°C. Morphological and metric analyses were performed before and after: morphological features were preserved, but depressed fractures showed an increase in their dimensions (p‐value < 0.05); the drilled holes shrunk (p‐value < 0.01); the charring cycle increased the number of fractures in samples with gunshot wounds differently in fleshed and defleshed ribs. This study showed the complex behavior of charred bone, for what concerns the interpretation of trauma and how caution should be applied.     

Quantifying the Temperature of Maggot Masses and its Relationship to Decomposition

Numerous Calliphoridae species have been observed to form larval aggregations during the feeding stage of development, resulting in localized increases in temperature. This study investigates the relationship between maggot numbers in a mass and heat generation. Single‐species aggregations (Lucilia sericata) of various sizes (50–2500 individuals) were reared in the laboratory at a constant ambient temperature of 22°C. Internal mass temperatures were recorded every 5 min throughout the feeding stage of development. Results showed that mass temperatures increased with mass numbers (p‐value < 0.001), ranging from 2.5 to 14°C above ambient. A minimum mass size of 1200 produced overall temperatures that were significantly warmer than ambient, diverging away from 22°C after c. 26 h. These results indicate that the microclimate of a mass has the potential to differ significantly from ambient, which may be influencing larval development rates and should therefore be factored into mPMI estimates to increase accuracy.     

Viability of Human Articular Chondrocytes Harvested Postmortem: Changes with Time and Temperature of In Vitro Culture Conditions

Different studies of long‐term chondrocytes viability have shown a gradual reduction as a function of time and ambient temperature. The aim of our in vitro study was to establish chondrocyte postmortem viability curves for 4°C, 11°C, 23°C, 35°C during 63 days after the donors' death. Osteochondral cylinders were procured from the knees of 16 male donors (20–47 years), stored in preservation media that was not changed, and analyzed in 3‐day intervals using a confocal laser scanning microscope. A significant influence of time on viability was found from Day 9 (p = 0.0029) and onwards (p < 0.0001). The lowest overall chondrocyte viability was at 35°C, followed by 4°C (p < 0.0001). The conditions used in this in vitro analysis suggest that similar viabilities may occur while in situ in the decedent. Further studies of chondrocyte viability from individuals with known postmortem intervals may show premise to help evaluate time since death in the late postmortem interval.     

The Use of CT Scans in Estimating Age at Death by Examining the Extent of Ectocranial Suture Closure

We examined the utility of CT scans in the evaluation of degree of ectocranial suture closure. Five cranial points (left and right midcoronal positions, left and right midlambdoidal positions, and the lambda) were evaluated in 231 CT scans using a three‐point scoring system (open, partial closed, and closed). The slice increment and thickness varied between three groups of the scans. The results showed a good correlation between degree of suture closure and increasing age in each group. Young individuals (<40 years) and old individuals (>60 years) could be clearly distinguished from the middle‐aged individuals. ANOVA test revealed no difference between two groups of scans and between left and right sides (p > 0.05). Interobserver agreement was good, especially considering the score by sides. The results of this study create the base for developing a robust and simple method to estimate the age at death using CT scans.     

Dynamics of Ninhydrin‐Reactive Nitrogen and pH in Gravesoil During the Extended Postmortem Interval

Estimating the postmortem interval of skeletal remains is difficult, as few tools exist to do so. To address this problem, we conducted a field experiment to measure the chemistry of swine (Sus scrofa domesticus Linnaeus) gravesoil after 1 year and 3 years postmortem. Carcasses were placed on the soil surface of a pasture during June in a cold (Dfa) climate. Significant (p < 0.05) increases in ninhydrin‐reactive nitrogen, pH, total nitrogen, and nitrate in gravesoil were detected 1 year postmortem. Significant differences in gravesoil chemistry were not detected 3 years postmortem. These observations coincided with gaps in plant growth 1 year postmortem and the development of lush vegetation 3 years postmortem. We conclude that these phenomena can be used to assist the decision‐making process regarding the allocation of resources during the early stages of a death investigation.     

The Role of Postmortem Cardiac Markers in the Diagnosis of Acute Myocardial Infarction*

Abstract: Sudden cardiac deaths because of acute myocardial infarction (MI) constitute a significant percentage of the caseload for death investigators, coroners, and forensic pathologists. Clinicians use cardiac markers, highly sensitive and specific for myocardial damage, to screen living patients for acute MI; however, to this point, the utility of these markers in the autopsy setting has not been fully established. The current study included 10 decedents, five who died of acute MI, and five subjects who died of noncardiac disease. Samples of pericardial fluid and blood from multiple sites were tested for creatine kinase, creatinine kinase MB, and troponin‐I. Three main conclusions were drawn: the levels of cardiac markers from all patients are significantly higher than the reference range for living patients, there are significant differences in cardiac marker levels between samples from different anatomic locations, and only three cardiac marker/anatomic site combinations were significantly different between the control and study groups.     

Validation of an LC–MS Method for the Detection and Quantification of BZP and TFMPP and their Hydroxylated Metabolites in Human Plasma and its Application to the Pharmacokinetic Study of TFMPP in Humans*

Abstract: An LC–MS method was developed for benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP), constituents of “party pills” or “legal herbal highs,” and their metabolites in human blood plasma. Compounds were resolved using a mixture of ammonium formate (pH 4.5, 0.01 M) and acetonitrile (flow rate of 1.0 mL/min) with a C18 column. Calibration curves were linear from 1 to 50 ng/mL (R² > 0.99); the lower limit of quantification (LLOQ) was 5 ng/mL; the accuracy was >90%; the intra‐ and interday relative standard deviations (R.S.D) were <5% and <10%, respectively. Human plasma concentrations of TFMPP were measured in blood samples taken from healthy adults (n = 6) over 24 h following a 60‐mg oral dose of TFMPP: these peaked at 24.10 ng/mL (±1.8 ng/mL) (C_max) after 90 min (T_max). Plasma concentrations of 1‐(3‐trifluoromethyl‐4‐hydroxyphenyl) piperazine peaked at 20.2 ng/mL (±4.6 ng/mL) after 90 min. TFMPP had two disposition phases (t_½ = 2.04 h (±0.19 h) and 5.95 h (±1.63 h). Apparent clearance (Cl/F) was 384 L/h (±45 L/h).     

Comparison Among Manual Facial Approximations Conducted by Two Methodological Approaches of Face Prediction

This study verified the difference between two methods of forensic facial approximation (FFA) regarding recognition and resemblance rates. Three‐dimensional models of skulls were obtained from computerized tomography (CT) scans of two subjects (targets). Two manual FFAs were performed for each target, by applying two different guidelines for the facial structures (what we called “American method” (AM) and “Combined method” (CM)). Unfamiliar assessors evaluated the sculptures by recognition and resemblance tests. The AM was that which allowed more correct responses of recognition and higher resemblance's scores for the male target (p < 0.001). Regarding guidelines for modeling characteristics of the face, the ones that are practical and easily performed for sculptures, such as the length of the anterior nasal spine multiplied by 3 for nose prediction, may offer better results in terms of resemblance.     

Comparative Evaluation of Potentially Radiolucent Projectile Components by Radiographs and Computed Tomography

Projectile components that are traditionally radiolucent can be of considerable importance in determination of weapon type and caliber, but they are often missed on evaluation of postmortem radiographs. We hypothesized that these components would be significantly better visualized by evaluation of computed tomography (CT) scans compared to the practice standard of radiography alone. In this project, potentially radiolucent projectile components were both pulled apart and fired, and the radiolucent components were recovered. These components were embedded in blocks of ballistics gelatin and were imaged using both radiography and CT. The scans were evaluated by three blinded, board‐certified radiologists for the presence/absence of projectile components and true‐negative regions in each block. If a radiologist indicated visualization of a projectile component, they were further requested to describe their observation. It was found that traditionally radiolucent projectile components are not significantly more often identified on CT scans than radiography (p < 0.05).     

Experimental Study on the Postmortem Redistribution of the Substituted Phenethylamine, 25B‐NBOMe

2‐(4‐Bromo‐2,5‐dimethoxyphenyl)‐N‐(2‐methoxybenzyl)ethanamine (25B‐NBOMe) is a substituted phenethylamine, which has become highly prevalent worldwide since 2014. Recently, in an autopsy case involving fatal 25B‐NBOMe intoxication, we found the postmortem increase of 25B‐NBOMe concentration in the cardiac blood approximately 2 days after death. The aim of this study was to investigate the distribution of 25B‐NBOMe and reproduce the postmortem redistribution using a rat model. Sprague‐Dawley rats were killed 30 min after intraperitoneal injection of 25B‐NBOMe (0.5 mg/kg) and left for 0, 3, 6, 9, 15, or 24 h (six rats at each time point). Postmortem 25B‐NBOMe concentrations in the cardiac blood increased by more than 10‐fold at 6‐h postmortem. 25B‐NBOMe accumulated primarily in the lung. Moreover, this postmortem redistribution occurred even in rats that had died 1 week following the 25B‐NBOMe administration. These findings indicate that attention should be paid to sample collection and data interpretation in the toxicological analysis of 25B‐NBOMe.     

心肌早期缺血再灌流损伤免疫组化观察

探询原癌基因c fos蛋白产物在心肌早期缺血再灌流损伤中的病理形态学改变。用SD大白鼠建立心肌早期缺血再灌流损伤模型 ,3 2只大鼠分为正常、缺血对照组与缺血再灌流组。心脏标本经HE染色及免疫组化观察。结果发现 :在缺血 3 0min再灌流 3 0min后 ,再灌流区心肌细胞有部分细胞核 ( 3 7 76%± 9 66% )呈弱阳性着色 ,而在缺血 60min再灌流 3 0min后 ,心肌细胞核 ( 4 0 3 4 %± 3 3 2 % )呈棕褐色阳性染色 ,但正常和单纯缺血组心肌细胞核未见有阳性反应 ;HE染色无明显改变。提示c fos蛋白免疫组化对显示实验性心肌早期缺血再灌流损伤有重要的价值     

Identification Using Frontal Sinus by Three‐Dimensional Reconstruction from Computed Tomography*

Abstract: Radiographs and computed tomography (CT) images have been increasingly applied and accepted in forensic sciences. Along with radiographs and CT images, the frontal sinus is often used for the individual identification because of its unique and unchangeable characteristics. The purpose of this study is to define the usefulness of three‐dimensional (3‐D) images of the frontal sinus for identification. CT images from 119 Korean cadavers were built up for 3‐D reconstruction and surveyed with 15 measurements. The total volume of the sinus, some nonmetric characteristics, and the bilateral asymmetry index in men differed significantly from those in women (p < 0.05). The digit codes, six sections and 10‐digit number, were almost able to accurately identify individuals (98%). This study showed a statistical difference between the sexes and classified the fused and prominent middle sinuses for the first time. This proposed method for identification is more accurate than those used in other studies.     

Cathepsin-L在缺血心肌中的表达

目的检测cathepsin-L(CTSL)在大鼠早期缺血心肌中的表达变化,并探讨其法医学意义。方法建立大鼠早期心肌缺血模型,设置早期缺血组(early ischemic myocardium,EIM)、非缺血组(non-ischemic myocardium,NIM)、假手术组以及空白对照组,采用real-time PCR方法检测大鼠缺血后15min,30min,1h和2h CTSL mRNA的表达量,并进行组内和组间比较。收集心源性猝死者缺血心肌和机械性损伤致死者正常心肌样本,采用免疫组化染色方法观察心肌组织中CTSL蛋白表达。结果 EIM组CTSL mRNA表达量与NIM组、假手术组及空白组相比,在15min时无统计学意义(P>0.05),在30min、1h和2h时分别升高1.4、3.1和4.5倍(P<0.05);其余3组间差异无统计学意义(P>0.05)。观察10例冠脉狭窄程度Ⅲ～Ⅳ级的心源性猝死(SCD)者缺血心肌,CTSL表达增强。结论大鼠心肌缺血后早期即可检测到CTSL mRNA的升高,并在SCD冠脉狭窄死者缺血心肌中高表达,提示CTSL可作为心肌缺血与SCD的参考指标。     

Effect of Head Position on Facial Soft Tissue Depth Measurements Obtained Using Computed Tomography

Facial soft tissue depth (FSTD) studies employing clinical computed tomography (CT) data frequently rely on depth measurements from raw 2D orthoslices. However, the position of each patient's head was not standardized in this method, potentially decreasing measurement reliability and accuracy. This study measured FSTDs along the original orthoslice plane and compared these measurements to those standardized by the Frankfurt horizontal (FH). Subadult cranial CT scans (n = 115) were used to measure FSTDs at 18 landmarks. Significant differences were observed between the methods at eight of these landmarks (p < 0.05), demonstrating that high‐quality data are not generated simply by employing modern imaging modalities such as CT. Proper technique is crucial to useful results, and maintaining control over head position during FSTD data collection is important. This is easily and most readily achieved in CT techniques by rotating the head to the FH plane after constructing a 3D rendering of the data.     

早期心肌缺血猝死心肌Ⅰ型胶原的表达

目的探讨Ⅰ型胶原蛋白在心肌早期缺血死后诊断中的法医学价值。方法将收集的案例心肌蜡块分为3组：正常对照组、早期心肌缺血组、心肌梗死组,用免疫组织化学技术（S-P法）,观察猝死心肌内Ⅰ型胶原的表达情况,对其结果进行半定量分析。结果早期心肌缺血组和心肌梗死组心肌细胞质以及细胞核染色阳性,且早期心肌缺血组与心肌梗死组表达强度相近,说明早期心肌缺血组在胶原网结构方面已经发生与心肌梗死相同的改变。结论Ⅰ型胶原可以作为早期心肌缺血的一个诊断指标。     

肌红蛋白诊断早期心肌梗死的特异性研究

目的　探讨肌红蛋白在早期心肌梗死死后诊断的特异性。方法　应用免疫组织化学S -P法检测梗死心肌和其它非梗死性的直接或间接心肌损害的心肌肌红蛋白染色的变化。结果　梗死心肌均可见不同程度的肌红蛋白缺染 ,其它非梗死性的直接或间接心肌损害的心肌中 ,如心脏挫伤、心肌炎、出血性休克、电击死、机械性窒息、有机磷中毒等 ,也有不同程度的肌红蛋白缺染。结论　应用肌红蛋白免疫组织化学方法诊断早期心肌梗死需慎重     

The Effect of Soft Tissue on Temperature Estimation from Burnt Bone Using Fourier Transform Infrared Spectroscopy

This study investigated the effect of soft tissue and different exposure times on the prediction of burning temperatures of bone when using Fourier transform infrared spectroscopy (FTIR). Ovis aries rib bones were burnt at different temperatures and for varying time intervals. Results of a linear regression analysis indicated that burn temperatures can be predicted with a standard error of ±70°C from defleshed bone spectra. Exposure time does not have a significant impact on prediction accuracy. The presence of soft tissue has a significant impact on heat‐induced changes of the bone matrix in low (<300°C) as well as high temperatures (>800°C), slowing down combustion in the former and accelerating it in the latter (p < 0.05). At medium temperatures, no significant difference was noted. These results provide forensic investigators a new perspective with which to interpret the results of crystallinity measures derived from burnt bone.     

结蛋白诊断早期心肌梗死的特异性研究

目的　探讨结蛋白在早期心肌梗死死后诊断的特异性。方法　应用免疫组织化学S -P法检测梗死心肌和其他非梗死性的直接或间接心肌损害的心肌结蛋白染色的变化。结果梗死心肌均可见不同程度的结蛋白缺染 ,其他非梗死性的直接或间接心肌损害的心肌中 ,如心脏挫伤、心肌炎、出血性休克、电击死、机械性窒息、有机磷中毒等 ,也有不同程度的结蛋白缺染。结论　应用结蛋白免疫组织化学方法诊断早期心肌梗死需慎重     

Preliminary Observations of Arthropods Associated with Buried Carrion on Oahu

Several studies in Hawaii have focused on arthropod succession and decomposition patterns of surface remains, but the current research presents the first study to focus on shallow burials in this context. Three domestic pig carcasses (Sus scrofa L.) were buried at the depths of 20–40 cm in silty clay loam soil on an exposed ridge on the leeward side of the volcanically formed Koolau Mountain Range. One carcass was exhumed after 3 weeks, another after 6 weeks, and the last carcass was exhumed after 9 weeks. An inventory of arthropod taxa present on the carrion and in the surrounding soil and observations pertaining to decomposition were recorded at each exhumation. The longer the carrion was buried, the greater the diversity of arthropod species that were recovered from the remains. Biomass loss was calculated to be 49% at the 3‐week interval, 56% at the 6‐week interval, and 59% at the 9‐week interval.