Forensic Pathology Practice Research Articles

An experimental study to estimate the early postmortem interval based on the degradation of lncRNAs in rat brain tissue

To study the degradation of lncRNAs in EPMI in rat brain tissue, this study provides a new direction for the estimation of EPMI. LncRNA high-throughput sequencing was performed on the brain tissues of hemorrhagic shock model rats at 0 h and 24 h, and the target lncRNAs were screened. Samples at 0, 1, 3, 6, 12, 18 and 24 h after death were collected, and miRNA-9 and miRNA-125b were used as reference genes. The relative expression levels of lncRNAs at each PMI were detected by RT–qPCR, and a functional model involving lncRNAs and EPMI was established. Samples were collected at 6, 9, 15, and 21 h after death for functional model verification. The expression of several lncRNAs decreased with the prolongation of EPMI, and the mathematical model established by several lncRNA indices exhibited good fit. The verification results of the multi-index joint function model are significantly better than those of the single-index function model, and the established model is more practical. There is a linear relationship between lncRNAs and EPMI, and the multi-index function model is significantly better than the single-index function model, which is important for EPMI inference in forensic pathology practice.

Post-blast histological changes to three animal bones exposed to close-range chemical detonation.

A range of investigative practices to aid explosive-related death investigations currently exist, although the use of histopathological bone samples to diagnose blast exposure and the distance of individuals from the blast source has not been previously reported. Forensic histopathology has been used effectively on soft tissue samples to define blast-related injuries effectively, analysing human organs such as the lungs, brain, liver, and skeletal muscles, providing important and useful forensic pathology interpretations. However, no studies currently exist examining the post-blast histological changes in human or animal bones subjected to blasts for forensic pathology practice, despite the opportunity that hard tissue bone samples present, given their significantly lower rate of decomposition over soft tissue. This study presents the first evidence-based findings on the post-blast histological changes in three animal bones when exposed to close-range chemical detonation (C4). The study's qualitative findings highlight critical changes in the tissue architecture of three different animal bone sources due to blast effects with range from the blast source. This emphasises the potential use of histopathological bone sample analysis in future blast-related death investigations, while providing ideas to further explore this work using larger-scale experiments and post-blast case studies in aid of applying this work to human samples and forensic pathology practice.

Breaking the silence: Exploring the emotional and social hazards of forensic pathology practice in India

Breaking the silence: Exploring the emotional and social hazards of forensic pathology practice in India

A statistical study of postmortem heart weight in Chinese adults

IntroductionObjective assessment of cardiac hypertrophy in forensic pathology practice is of great significance for forensic pathologists, for whom reference values for normal heart weights are needed. Developed regions such as Europe, the United States, and Japan recalculate the weight of human organs at regular intervals, but in China, there has been no systematic calculation of the weights of human organs since 2006. AimsTo statistically analyse the heart weight of Chinese adults postmortem and obtain a reference range. Materials and Methods4170 adult autopsy reports were collected from 12 forensic departments in 10 provinces in China. The causes of death were classified by sex, and heart weight and the heart weight/body height ratio reference values were further calculated according to different body mass index and body heights. Finally, the cutoff value of cardiac hypertrophy in Chinese adults was calculated. ResultsIn the group of non-cardiovascular disease causes of death, the cardiac weight of the electric death group was higher, while the heart weight of the prolonged bed-rest group was significantly reduced. After the electric death and prolonged bed-rest groups were excluded, heart weight, the heart weight/body height ratio, and cutoff values for cardiac hypertrophy were further classified and analysed according to body mass index. The mean reference values for heart weight in men and women with normal weight status were 325.82 ± 41.60 g and 286.39 ± 44.84 g, and the heart weight/body height ratios were 1.95 ± 0.23 in men and 1.82 ± 0.27, respectively. The cutoff values for cardiac hypertrophy were 387.35 g for men and 346.80 g for women. ConclusionThe heart weight reference values of both sexes in this study were significantly higher than those in 2006, which is considered related to the development of China's economy and the improvement of people's living standards. This study also suggests the need for a new round of statistical surveys and updated data on the weight of other organs.

Cardiac dimensions measured from post-mortem photographs: are they accurate?

ABSTRACTPeer reviewing post-mortem reports, photographs and histology is a mandatory process in the everyday practice of forensic pathology. In the context of organ measurement/dimensions, comparing the dimensions measured from a post-mortem photograph and what was recorded in the post-mortem report is sometimes necessary. However, there are limited studies validating the accuracy of dimensions measured from a photograph in forensic pathology. This study examined the cardiac dimensions measured from a standard post-mortem photograph of a heart section. It showed that although there was acceptable intra- and inter-rater reliability, the overall accuracy was low compared with gross measurement at post-mortem examination. The results from this study suggest that measurements taken from a post-mortem photograph have limited utility in assessing cardiac dimensions. The reasons for this discrepancy and recommendations on how to improve the accuracy are provided.

Significance of postmortem biomarkers and multimarker strategy in sudden cardiac death

The most common cause in the etiology of sudden cardiac death (SCD) is ischemic heart disease due to atherosclerosis. Postmortem diagnosis can be made by histopathological examinations, but routine histopathological examinations are limited, especially in the early period of postmortem ischemia. For this reason, many methods are being investigated for the postmortem diagnosis of ischemia, and postmortem biochemical studies are promising. In our study, we evaluated the biochemical markers; hs-cTnT, NT-proBNP, H-FABP, pentraxin-3, copeptin, ischemic modified albumin (IMA), and PAPP-A in postmortem serums. In forensic pathology practice, it was investigated whether it would be useful to go to the diagnosis by measuring more than one marker in a single biological fluid in SCD cases. The study included 35 sudden cardiac death cases and 24 control cases and as a result of our study, hs-cTnT, NT-proBNP, and H-FABP values were found to be significantly higher in the SCD group than in the control group. Within the scope of the multi-marker strategy, models were tried to be developed in which the markers were used together, and it was concluded that the model consisting of the myocardial ischemia marker hs-cTnT, the myocardial stress marker NT-proBNP, and the inflammation marker pentraxin 3 was the most accurate combination by correctly classifying the cases at a rate of 94.9%. As a result, it was thought that it would be appropriate to use the multi-marker strategy which is widely used in clinical applications, also in forensic medicine applications.

Ruptured interstitial pregnancy: a case report of a sudden maternal death in the late second trimester from a rare cause

Introduction: Interstitial pregnancy is a rare type of tubal ectopic pregnancy that occurs when implantation takes place in the interstitial segment of the fallopian tube. It remains one of the most difficult gestations to diagnose clinically and sonographically, hence a higher risk of rupture and catastrophic haemorrhage because of delayed diagnosis as the gestation progresses. We report a case of sudden maternal death from a ruptured interstitial pregnancy involving a woman at 27 weeks of pregnancy who was mistakenly thought to have a normal intrauterine pregnancy antenatally. Case description: A 40-year-old woman, normally conceived gravida 7, para 4, abortus 2 at 25 weeks of pregnancy by date, was dead on arrival at the hospital after experiencing sudden abdominal pain. A forensic autopsy revealed more than 2100 ml of hemoperitoneum. The uterine cavity was empty, and the right uterine fundus had an asymmetric cystic bulge found to be a ruptured interstitial pregnancy with a 27-week-old male fetus. Discussion and conclusion: The pathology of interstitial pregnancy and the distinction between this entity and the similar but distinct angular and cornual pregnancies will be described. This case report highlights a type of ectopic pregnancy rarely encountered in forensic pathology practice.

Research Status and Prospects of Non-Traumatic Fat Embolism in Forensic Medicine.

In the practice of forensic pathology, fat embolism is one of the common causes of death, which can be divided into two categories: traumatic and non-traumatic. Non-traumatic fat embolism refers to the blockage of small blood vessels by fat droplets in the circulatory blood flow caused by non-traumatic factors such as underlying diseases, stress, poisoning and lipid metabolism disorders. At present, it is believed that the production of non-traumatic fat embolism is related to the disturbance of lipid metabolism, C-reactive protein-related cascade reaction, the agglutination of chylomicron and very low-density lipoprotein. The forensic identification of the cause of death of non-traumatic fat embolism is mainly based on the case, systematic autopsy, HE staining and fat staining, but it is often missed or misdiagnosed by forensic examiners because of its unknown risk factors, hidden onset, the difficulty of HE staining observation and irregular implementation of fat staining. In view of the lack of attention to non-traumatic fat embolism in forensic identification, this paper reviews the concepts, pathophysiological mechanism, research progress, existing problems and countermeasures of non-traumatic fat embolism, providing reference for forensic scholars.

Válvula aórtica bicúspide y disección de aorta. Valor del estudio genético en patología forense

The present work collects three clinical cases of medicolegal autopsy findings in which some possible circumstances are exemplified in which the bicuspid aortic valve (BAV) can be evidenced in forensic pathology practice. Regarding them, a discussion is developed on the demographic characteristics of BAV, its debated association with the so-called bicuspid aortopathy and its complex heritability. Emphasis is placed on the importance of carrying out a complete autopsy study and having the advice of cardiology and genetics professionals in order to proceed with possible genetic studies of the deceased and preventive medical examinations of their relatives in the first degree.

Double Suicide Due to the Ingestion of Levamisole-Adulterated Cocaine: Case Report and Review of the Literature.

Suicide is a major public health issue and the risk of attempting and committing suicide increases with age. We present the case of an elderly couple who decided to commit suicide together by self-poisoning using levamisole-adulterated cocaine. The choice of committing a double suicide, the method selected (self-poisoning), the drug self-administered (cocaine), and the route of administration (ingestion) are events rarely encountered in the forensic pathology practice, especially not in combination. In this article, we will review the literature regarding the frequency and features of these methods of suicide. An overview of the effects and mechanism of action of levamisole is also provided, highlighting the importance of including this substance and its metabolites in the routine toxicological analyses for cocaine deaths.

Application of Immunohistochemistry and Special Staining Technique in Forensic Traumatic Pathology Identification.

In forensic traumatic pathology practice, immunohistochemistry and special staining technique play an important role in wound age estimation and complications of traumatic complication identification. They even play an important role in the identification of special cases, such as snakebites and insulin killings. This article reviews the application and value of immunohistochemistry and special staining techniques in forensic traumatic pathology based on the cases of forensic practice reported in literature.

Could ante-mortem computed tomography be useful in forensic pathology of traumatic intracranial haemorrhage?

BackgroundImaging techniques have proven valuable in forensic pathology practice, with computed tomography being preferred for forensic use. In the era of virtual autopsy and a low- to middle-income, resource-constrained country, a question arises as to whether ante-mortem computed tomography (ACT) could be cost-effective by reducing the number of invasive autopsies performed.ObjectiveThe objective of this study was to assess the usefulness of ACT in forensic pathology by examining discrepancy rates between ACT scans and autopsy findings in cases of deceased individuals with traumatic intracranial haemorrhages and assess factors associated with discrepancies.MethodsEighty-five cases of ACT and autopsy reports from 01 January 2014 to 31 December 2016 from the Polokwane Forensic Pathology Laboratory, South Africa, were analysed retrospectively. Using Cohen’s kappa statistics, measures of agreement and resultant discrepancy rates were determined. Also, the discrepancy patterns for each identified factor was also analysed.ResultsThe discrepancy rate between ACT and autopsy detection of haemorrhage was 24.71% while diagnostic categorisation of haemorrhage was 55.3%. Classification discrepancy was most observed in subarachnoid haemorrhages and least observed in extradural haemorrhages. A markedly reduced level of consciousness, hospital stay beyond two weeks and three or fewer years of doctors’ experience contributed to classification discrepancies.ConclusionAnte-mortem computed tomography should be used only as an adjunct to autopsy findings. However, the low discrepancy rate seen for extradural haemorrhages implies that ACT may be useful in the forensic diagnosis of extradural haemorrhages.

An overview of artificial intelligence/deep learning

Artificial intelligence (AI) technologies have had increasing use in numerous medical and non-medical applications. Deep learning AI in particular is no longer a matter for research only and has been used in clinical practice applications in radiology and histopathology for years. Whilst radiology, photography and histopathology are large components of modern forensic pathology practice, AI image analysis and recognition technologies have not been used in forensic pathology to the same extent as they have in other medical specialties. This talk aims to provide an introductory explanation of AI and deep learning technologies. Additionally, this talk will discuss published research by the presenters on applications of deep learning technology to post mortem radiology, post mortem histology and macroscopic organ photographs, all conducted using freely available open-source software.

The right to mourn: Post-traumatic stress and the forensic pathologist.

Post-traumatic stress disorder (PTSD) is a condition characterised by recurrent intrusive distressing memories of a traumatic event(s) with recurrent dreams and flashbacks. Given the nature of standard forensic pathology practice which involves on-going assessments of violent crimes and their sequelae with autopsy dissections of victims and in detail study of injuries, it is surprising that more has not been written on this in the literature. Perhaps PTSD should be studied further in a forensic context with a recognition that years of intimate exposure to violence may lead to accumulated, ongoing and unresolved grief in practitioners.

Post-mortem persistence of SARS-CoV-2: a preliminary study

Since the beginning of March 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been the cause of millions of deaths worldwide. The need to better define the pathogenesis of coronavirus disease 19 (Covid-19) as well as to provide the correct statistical records concerning deaths related to this virus, inevitably involves the role of forensic pathology and routine autopsy practice. Currently, some data on macroscopic and microscopic features in autopsies performed in suspected Covid-19 cases are reported in the literature. The persistence of SARS-CoV-2 in cadavers has not yet been elucidated and only a few reports have emphasized the importance of evaluating the Virus RNA in post-mortem tissues. In this preliminary study, we observed that SARS-CoV-2 survives in multiple cadaver tissues many days after death despite some extreme conditions of post-mortem body preservation. The results of this on-going analysis could help improve the safety of working practices for pathologists as well as understanding the possible interaction between microbiological agents and the cadaver tissue’s supravital reactions.

Fatal Motor Vehicle-Pedestrian Collision Injury Patterns-A Systematic Literature Review.

Injury patterns in pedestrians struck by motor vehicles were described in medical literature first published almost a half century ago. "Classical" triads of injury distribution were described for adults (skull-pelvis-extremity) and subsequently applied to children (head-hip or pelvis-distal femur/knee joint). Notably, these classical triads were derived from two publications reporting clinical observations of only 11 patients, all of whom were adults. A systematic literature review was conducted using Medline, CINAHL, EMBASE, and Cochrane to determine the evidence-base for motor vehicle collision (MVC)-pedestrian injury "triads" and other trauma patterns described for pedestrians in the adult and pediatric age groups. Of the 1540 full-text articles identified in the review, 56 articles published in English met the inclusion criteria, that is, motor vehicle-pedestrian collision resulting in specific, fatal injuries determined by postmortem examinations. There were variations in injury patterns that differed from the "classical" triads. These differences likely stem from advances in vehicle design and safety features which have affected the nature and distribution of injuries. Further research on the correlation of specific injuries sustained by pedestrians of different ages with various types of vehicles and impacts are needed to assess the validity of previously observed injury patterns in relation to the current motor vehicle fleet. Delineation of injury patterns can assist health care teams in trauma management. Vehicle manufacturers and government regulators can better assess whether the introduction of advanced driver assistance features designed to protect pedestrians when struck will be effective in reducing severe injuries. In forensic pathology practice, knowledge of pedestrian injury patterns based on data representative of impacts involving modern vehicles can provide MVC death investigators the means to determine MVC dynamics and pedestrian kinematics.

Guide to forensic pathology practice for death cases related to coronavirus disease (COVID-19)

Guide to forensic pathology practice for death cases related to coronavirus disease (COVID-19)

Identifying Fatal Head Injuries on Postmortem Computed Tomography Using Convolutional Neural Network/Deep Learning: A Feasibility Study.

Postmortem computed tomography (PMCT) is a relatively recent advancement in forensic pathology practice that has been increasingly used as an ancillary investigation and screening tool. One area of clinical CT imaging that has garnered a lot of research interest recently is the area of "artificial intelligence" (AI), such as in screening and computer-assisted diagnostics. This feasibility study investigated the application of convolutional neural network, a form of deep learning AI, to PMCT head imaging in differentiating fatal head injury from controls. PMCT images of a transverse section of the head at the level of the frontal sinus from 25 cases of fatal head injury were combined with 25 nonhead-injury controls and divided into training and testing datasets. A convolutional neural network was constructed using Keras and was trained against the training data before being assessed against the testing dataset. The results of this study demonstrated an accuracy of between 70% and 92.5%, with difficulties in recognizing subarachnoid hemorrhage and in distinguishing congested vessels and prominent falx from head injury. These results are promising for potential applications as a screening tool or in computer-assisted diagnostics in the future.

Medico-legal importance of necrotizing fasciitis

Despite the rarity of necrotizing fasciitis (NF), it is a relatively common cause of death in many lawsuits. Families seek financial compensation or legal charges against those they believe to be involved in the death, usually physicians who did not identify the infection soon enough. This paper explores six cases in forensic pathology practice where NF posed a unique medico-legal dilemma.

Assessment of the heart displacement between prone and supine position on post mortem computed tomography (PMCT)

Abstract Stab wounds are commonly encountered in forensic pathology practice and part of their examination and interpretation involves wound-depth measurements, which may provide information about the possible length of the implement. It is suggested that different body positions during life, such as leaning forward or standing up, may cause the internal organs to move relative to each other, and thus the stab wound depth in a non-supine position might be different when measured supine at post mortem examination. Whether internal organs move relatively in different post mortem positions is not well documented yet. This study documented significant post mortem anterior displacement of the heart when the body is prone compared to being supine, up to 32.7 mm. The displacement correlated negatively to weight and body mass index in certain locations, but not with age or height. This study provides evidence that when measuring a stab wound at post mortem examination, the position of the body can be a significant confounding factor affecting the accuracy of measurement and may have significant forensic relevance.