Postmortem genetic testing in sudden unexplained death: A public health laboratory experience

Sudden unexplained death in the young poses a diagnostically challenging situation for practicing autopsy pathologists, especially in the absence of anatomic and toxicological findings. Postmortem genetic testing may identify pathogenic variants in the deceased of such cases, including those associated with arrhythmogenic channelopathies and cardiomyopathies. The Wisconsin State Laboratory of Hygiene (WSLH) is a state-run public health laboratory which performs postmortem genetic testing at no cost to Wisconsin medical examiners and coroners. The current study examines sequencing data from 18 deceased patients (ages 2 months to 49 years, 5 females) submitted to WSLH, from 2016 to 2021. Panel-based analysis was performed on 10 cases, and whole exome sequencing was performed on the most recent 8 cases. Genetic variants were identified in 14 of 18 decedents (77.8%), including 7 with pathogenic or likely pathogenic variants (38.9%). Whole exome sequencing was more likely to yield a positive result, more variants per decedent, and a larger number of variants of uncertain significance. While panel-based testing may offer definitive pathogenic variants in some cases, less frequent variants may be excluded. Whole exome testing may identify rare variants missed by panels, but increased yield of variants of uncertain significance may be difficult to interpret. Postmortem genetic testing in young decedents of sudden unexplained death can provide invaluable information to autopsy pathologists to establish accurate cause and manner of death and to decedent's relatives to allow appropriate management. A public health laboratory model may be a financially advisable alternative to commercial laboratories for medical examiner's/coroner's offices.     

An unusual blunt force trauma pattern and mechanism to the cranial vault: Investigation of an atypical infant homicide

This case report presents an unusual fracture pattern in the cranium of a four-month-old infant indicative of child abuse. Upon postmortem examination, the infant presented with numerous bilateral linear cranial fractures running perpendicular to the sagittal suture with depressed and curvilinear fractures apparent on the supra-auricular surfaces of the cranium. Histological evidence indicates multiple traumatic events to the cranium. In addition, the stair-step pattern of a parietal fracture may represent multiple contiguous fractures from repeated loading of the head at different times with variation of the focal points of compressive force. Additionally, the left humerus, left radius, and left ulna have healing metaphyseal fractures, and the left ulna also has an antemortem diaphyseal fracture which resulted in the distal metaphysis being rotated 45 degrees medially. Integration of autopsy, anthropological, and neuropathological reports for this case suggest multiple inflicted injury episodes with a repeated atypical mechanism(s) to the cranial vault of the infant. During investigative interviews, the caretaker admitted to squeezing the infant's head and neck on multiple occasions to quiet the child. This reported abusive mechanism is consistent with the pattern of symmetric cranial fractures and soft tissue injuries indicating asphyxiation. This case report provides forensic investigators with a potential trauma mechanism to explore in cases when a similar pattern of cranial trauma is observed and highlights the need for greater research on fracture propagation and fracture healing in the infant cranium.     

A forensic examination of four popular cross‐platform file‐sharing apps with Wi‐Fi P2P

File‐sharing apps with Wi‐Fi hotspot or Wi‐Fi Direct functions become more popular. They can work on multiple platforms and allow users to transfer files in a concealed manner. However, when criminals use these apps in illegal activities, it becomes an important issue for investigators to find digital evidence on multiple platforms. At present, there are few studies on this topic, and most of them are limited to the single platform problem. In this paper, we propose a forensic examination method for four popular cross‐platform file‐sharing apps with Wi‐Fi hotspot and Wi‐Fi Direct functions: Zapya, SHAREit, Xender, and Feem. We use 22 static and live forensic tools for 11 platforms to acquire, analyze, and classify the forensic artifacts. In our experiments, we find many useful forensic artifacts and classify them into six categories. The experimental results can support law enforcement investigations of digital evidence and provide information for future studies on other cross‐platform file‐sharing apps.     

Validation of the 4‐aminophenol color test for the differentiation of marijuana‐type and hemp‐type cannabis

The analysis of cannabis plant material submitted to seized‐drug laboratories was significantly affected by the signing of the Agricultural Improvement Act of 2018, which defined hemp and removed it from the definition of marijuana in the Controlled Substances Act. As a result, field law enforcement personnel and forensic laboratories now are in need of implementing new protocols that can distinguish between marijuana‐type and hemp‐type cannabis. Colorimetric tests provide a cost‐effective and efficient manner to presumptively identify materials prior to submission to a laboratory for analysis. This work presents the validation of the 4‐aminophenol (4‐AP) color test and demonstrates its utility for discriminating between marijuana‐type and hemp‐type cannabis (i.e., typification). Validation studies included the testing of numerous cannabinoid reference materials, household herbs, previously characterized cannabis plant samples, and real‐case samples. The 4‐AP test reliably produces a pink result when the level of Δ⁹‐tetrahydrocannabinol (THC) is approximately three times lower than the level of cannabidiol (CBD). A blue result is generated when the level of THC is approximately three times higher than that of CBD. Inconclusive results are observed when the levels of THC and CBD are within a factor of three from each other, demonstrating the limitations of the test under those scenarios.     

The effect of household corrosive substances on latent fingermark development in the context of deliberate corrosive substance attacks

Corrosive substance attacks (CSA) are a prevalent issue in the UK with 525 offenses involving a corrosive substance reported to the police in the year ending March 2022. Easy availability, low cost, and concealability in public are common reasons for choosing a corrosive substance as a weapon. The Metropolitan Police revealed that 68% of 1849 CSA cases resulted in no suspect identified or evidential difficulties. There is limited research into the effect of corrosive substances on latent fingermarks. This study aimed to determine the potential for fingermarks to be recovered from surfaces exposed to a household corrosive substance within the context of a deliberate CSA. Natural and sebaceous-loaded fingermarks were exposed to Domestos bleach, Harpic limescale remover (hydrochloric acid-based) and lemon juice. Harpic limescale remover had the most detrimental effect, with only 7.1% of fingermarks (n = 378) exposed being identifiable (defined as sufficient clear ridge detail for identification) after enhancement, followed by bleach with only 10.3% of fingermarks (n = 378) identifiable. Lemon juice had the least detrimental effect on fingermarks, with 40.5% fingermarks (n = 378) identifiable compared to 53.4% for the controls (not exposed to any substance; n = 378). Throughout the study, fewer natural fingermarks were identifiable after exposure to corrosive substances compared to sebaceous fingermarks which was as expected. Overall, this study demonstrated that there is potential to recover latent fingermarks, depending on their composition, following exposure to a household corrosive substance. This area warrants further research to establish best practice to maximize the potential to recover identifiable fingermarks.     

我国近年来反腐败问题研究综述

本文从腐败本质问题界定、腐败行为特征及其成因、腐败测度、反腐败策略四个方面,对我国反腐败问题进行了文献综述。本文提出,腐败是滥用公共权力谋取特殊权利的一切行为。当前我国腐败行为呈现出绝对权力腐败猖獗、从滥用公共权力向滥用公共资源转变、腐败手段更加复杂和隐蔽、灰色腐败倾向明显等新特征。滥用权力的欲望、官员的经济理性、公共权力寻租、行政监督缺位、行政道德失范是腐败产生的主要原因。中国应创新腐败测度方法,科学测度腐败程度,推进反腐国际化。客观权衡腐败零容忍、全面反腐、权力反腐的利弊,综合使用经济处罚、道德教育与法律惩处手段,加强对腐败行为的行政监督。     

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

Determined to Die! Ability to Act Following Multiple Self‐inflicted Gunshot Wounds to the Head. The Cook County Office of Medical Examiner Experience (2005–2012) and Review of Literature

Cases of multiple (considered 2+) self‐inflicted gunshot wounds are a rarity and require careful examination of the scene of occurrence; thorough consideration of the decedent's psychiatric, medical, and social histories; and accurate postmortem documentation of the gunshot wounds. We present a series of four cases of multiple self‐inflicted gunshot wounds to the head from the Cook County Medical Examiner's Office between 2005 and 2012 including the first case report of suicide involving eight gunshot wounds to the head. In addition, a review of the literature concerning multiple self‐inflicted gunshot wounds to the head is performed. The majority of reported cases document two gunshot entrance wound defects. Temporal regions are the most common affected regions (especially the right and left temples). Determining the capability to act following a gunshot wound to the head is necessary in crime scene reconstruction and in differentiation between homicide and suicide.