key: cord-0890542-ngk2vysp
authors: nan
title: 99. Jahrestagung der Deutschen Gesellschaft für Rechtsmedizin: Luzern (Schweiz), 1.–4. September 2020
date: 2020-08-27
journal: Rechtsmedizin (Berl)
DOI: 10.1007/s00194-020-00424-x
sha: 7b829d27c26a64c41ac584d2b57a317a48bf9a34
doc_id: 890542
cord_uid: ngk2vysp

nan

Terroristische Anschläge mit dem Ziel möglichst zahlreiche Opfer in der Zivilbevölkerung zu verursachen sind Szenarien, mit denen sich das Gesundheitswesen und die Sicherheitsbehörden auseinandersetzen müssen. Die Versorgung und der Umgang mit den überlebenden und verstorbenen Opfern und Tatverdächtigen, die mit hochpathogenen Erregern oder biologischen Toxinen in Kontakt gekommen sind, stellt eine erhebliche, menschliche, logistische und infrastrukturelle Herausforderung dar, deren Bewältigung eine interdisziplinäre Zusammenarbeit der unterschiedlichen Kompetenzen im Gesundheitswesen, der Sicherheitsorgane und der Kriminaltechnik fordert. Die Rechtsmedizin ist hiervon nicht ausgenommen. Die Aktualität der Bedrohung durch solche Szenarien zeigte sich im Juni 2018 in Köln-Chorweiler, wo ein Anschlag mit einem Rizin-haltigen unkonventionellen Brand-und Sprengsatz verhindert werden konnte. In Berlin wurde 2017 eine Großübung (MEBBI/Management kontaminierter Anschlagsorte -Erkennen, Bewerten und Beseitigen von Infektionsrisiken) der Gesundheits-und Sicherheitsbehörden durchgeführt. Die Übungsziele reichten von den polizeilichen Zugriffsmaßnahmen am Ereignisort, den Spurensicherungsmaßnahmen im kontaminierten Umfeld, der Dekontamination von Einsatzkräften, Zivilbevölkerung und Tatverdächtigen, der Versorgung von Verletzten bis zur rechtsmedizinischen Obduktion eines potentiell an Lungenpest verstorbenen Tatverdächtigen. Dargestellt werden die Voraussetzungen für eine rechtsmedizinische Obduktion von Verstorbenen mit Erkrankungen durch hochpathogene Erreger sowie die Möglichkeiten und Limitationen der rechtsmedizinischen und kriminaltechnischen Arbeit im Gebläseschutzanzug unter Sonderisolierbedingungen.

Der Hamburger Weg: Die Behörde für Gesundheit und Verbraucherschutz (BGV) und die Gesundheitsämter in Hamburg sind von Anfang an den Weg der Anordnung von Sektionen als Maßnahme zur Bekämpfung von COVID-19 gegangen. Zwischen Mitte März und Juni wurden mehr als 230 COVID-19-Sterbefälle in der Rechtsmedizin registriert und dokumentiert; die Sektionen wurden überwiegend im Institut für Rechtsmedizin (IfR) des Universitätsklinikum Hamburg-Eppendorf, zum Teil auch in Instituten für Pathologie durchgeführt. Durch eine sehr intensive interdisziplinäre Kooperation umfasst das Untersuchungsspektrum neben sehr umfangreichen Sektionsmaßnahmen unter anderem spezielle (mikro-)morphologische, virologische, immunologische, gerinnungsanalytische, genetische, molekularbiologische, chemische Untersuchungen, usw. Die meisten Todesfälle ereigneten sich Ende April. Der Gipfel lag etwa 2 bis 3 Wochen nach dem Höhepunkt der täglich registrierten Neuinfektionen. Seit der zweiten Junihälfte sterben nur noch höchst vereinzelt COVID-19-Patienten. -Neben dem Aspekt des Infektionsschutzes haben zahlreiche Wissenschaftler des UKE und anderer Krankenhäuser sowie die Mitarbeiter des öffentlichen Gesundheitsdienstes in Hamburg bereits Hirnblutungen, sowie Fälle mit Kopfdurchschüssen an zwei MRI Systemen untersucht. 7 T MRI ermöglichte eine detailliertere Darstellung von anatomischen Strukturen, eine höhere Kontrastauflösung und eine höhere Ortsauflösung gegenüber 3 T MRI. Mittels 7 T MRI konnten zerebrale Mikroblutungen (microbleeds) in Zusammenhang mit Coup und Contrecoup Verletzungen bei Traumafällen, sowie Weichteilverletzungen ausserhalb des permanenten Wundkanals bei Schussfällen dargestellt werden. 7 T MRI bietet eine präzise nicht-invasive Darstellung von zerebralen Verletzungen, und könnte somit eine wichtige Rolle in der zukünftigen Forschung auf dem Gebiet der virtuellen Autopsie und Wundballistik einnehmen. Forensics currently stand in a front of a new era of data analysis as Massively Parallel Sequencing becomes more common tool. It allows to study the art and the number of markers in a way that was not possible using forensic golden standard, namely capillary electrophoresis. What follows are legal changes obligatory for new cases arising. Certainly, the biggest modifications deal with the issue of legalization of phenotyping, as this analysis concerns coding DNA and goes beyond the methods used so far. In Germany, a change in legislation was introduced in the end of 2019. According to the new law, forensic specialist can be asked to analyze a casework sample for phenotype and biological age of the unknown individual who contributed to the trace. A special situation occurs in the federal state of Bavaria where, since mid-2018, the law exists in an expanded form and it includes also the predictions of one's ancestry but the testing can be done only in particular cases. In response to those changes, minding the current state of commercially available solutions, we decided to design a custom Ion AmpliSeq Panel which could shed light on an unknown perpetrator or a victim. Panel comprises 202 autosomal hotspots, correlated with ancestry and phenotype (for eye, hair and skin color prediction). The Y-SNPs cover 20 major haplogroups from the basic Y-chromosome phylotree and additionally the list includes 100 subhaplogroups for a better phylogenetic resolution. Panel was validated on 140 diverse reference samples collected from volunteers who self-declared their ancestry (down to 3rd generation) and phenotype (photos for comparison were taken). We also performed a sensitivity study in triplicate, using a known male sample, diluted from 1 ng to 7 pg of DNA input. The above experiments were a basis for setting interpretation guidelines for the unknown casework samples. We sequenced various biological samples collected during the autopsies and additionally we analyzed actual traces collected at crime scenes. Our results suggest that we were able to establish a reliable interpretation pipeline eligible for forensic investigations.

Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel disease and its course. Furthermore, autopsies are essential for the correct statistical recording of the coronavirus disease 2019 (COV-ID-19) deaths. However, worldwide COVID-19 autopsy activity seems to be very low. In the northern German Federal State of Hamburg, all deaths of Hamburg citizens with ante-or postmortem PCR-confirmed SARS-CoV-2 infection have been systematically examined by forensic specialists since the outbreak of the pandemic in Germany. Additionally, a categorization has been suggested to correctly record the deaths. As of June 22nd, 2020, a total of 251 deceased with a PCR-confirmed SARS-CoV-2 infection have been evaluated at the DLM to determine the exact cause of death. The majority of these i. e. 164 (65.3 %) have undergone full autopsies. In the remaining cases (n = 87, 34.7 %), the cause of death has only been determined through a combined analysis of the deceased's medical files, post-mortem computer tomography findings and external corpse examination. An initial analysis of the first consecutive 80 autopsies performed between March 20th and April 18th, 2020 revealed that in six cases, SARS-CoV-2 infection was diagnosed postmortem by a positive PCR test in a nasopharyngeal or lung tissue swab while in the other 74 cases, SARS-CoV-2 infection had already been known antemortem. The deceased were aged between 52 and 96 years (average 79.2 years, median 82.4 years). In the study cohort, 34 deceased were female (38 %) and 46 male (62 %). Overall, 38 % of the deceased were overweight or obese. All deceased, except for two women, in whom no significant pre-existing conditions were found autoptically, had relevant comorbidities (in descending order of frequency): (1) diseases of the cardiovascular system, (2) lung diseases, (3) central nervous system diseases, (4) kidney diseases, and (5) diabetes mellitus. A total of 76 cases (95 %) were classified as COVID-19 deaths, corresponding to categories 1-3. Four deaths (5 %) were defined as non-COVID-19 deaths with virus-independent causes of death. In eight cases, pneumonia was combined with a fulminant pulmonary artery embolism. Peripheral pulmonary artery embolisms were found in nine other cases. Overall, deep vein thrombosis was found in 40 % of the cases (1). In the present evaluation therefore, we present an expanded systematic analysis of all SARS-CoV-2-related deaths examined at the Department of Legal Medicine in Hamburg between March 20th and August 15th, 2020. Keywords: Coronavirus, SARS-CoV-2, COVID-19, Autopsy, Pulmonary embolism, Venous thromboembolic disease Mann wurde 8 Tage nach positiver Testung auf SARS-CoV-2 und häuslicher Quarantäne ohne Therapie leblos gefunden. Alle Männer hatten einen BMI >27. Zwei Patienten waren zuletzt SARS-CoV-2-negativ getestet worden. Obduktionsergebnisse: 2 × extrem, 1 × mäßig erhöhte Lungengewichte, 2 × war das kritische Herzgewicht deutlich überschritten. Das Lungengewebe jeweils fokal grau-glasig bis rotbraun, 1 × vermehrt brüchig, 1 × periphere Pulmonalarterienthromben. Die Lungenperipherie jeweils leicht überbläht. 1 × ein präzirrhotisches Lebergewebe, 1 × eine Cholezystolithiasis, 2 × eine Hepatosplenomegalie. Jeweils eine nicht stenosierende Koronarsklerose. Keine tiefen Beinvenenthrombosen. 1 × auffällig "mürbe" Skelettmuskulatur. Histopathologie: Leber und Myokard jeweils mit Zeichen einer hypoxischen Schädigung. Das Lungengewebe beim nicht-therapierten Patienten mit frischeren hyalinen Membranen, diese ansonsten in Organisation begriffen bei ausgedehnter interstitieller, perivaskulär betonter lymphozytärer Pneumonie, Alveolitis, Emphysem und Lungenödem. Die beatmeten Patienten mit fokaler granulozytärer Bronchitis und Pneumonie (massenhaft Enterococcus faecicum, E. coli und/oder Proteus mirabilis). 2 × eine Cholestase im Lebergewebe, 1 × eine interstitielle Nephritis, eher ballonierte Glomerulumschlingen. 1 × weniger gravierende Lungenveränderungen, jedoch eine ausgedehnte lymphozytäre Myokarditis. Ergebnisse: SARS-CoV-2 kann zu einer massiven Schädigung nicht nur des Lungengewebes führen und zu einer Hypoxie in den inneren Organen. Im Einzelfall müssen die Lungenveränderungen für sich nicht Todesursache sein. Die histopathologischen Befunde stützen die Annahme, dass im Überlebensfall persistierende Organschäden und Funktionseinschränkungen bleiben, auch eine erhöhte Disposition für Pneumonien. Nach primär viraler SARS-CoV-2-Pneumonie droht zumindest zeitnah eine sekundär bakterielle Pneumonie.

Klinische Beobachtungen legen nahe, dass COVID-19 eine systemische Erkrankung ist. Eine Untersuchung der viralen Verteilung innerhalb des menschlichen Organismus und eine gleichzeitige Korrelation dieser Verteilung mit der sichtbaren Gewebeschädigung könnte das Verständnis zur Pathophysiologie einer SARS-CoV-2-Infektion erhöhen. Die vorliegende Untersuchung präsentiert im Ergebnis ein detailliertes Verteilungsmuster der viralen RNA an 61 Geweben und Organen von 11 verstorbenen Patienten mit der Diagnose COVID-19. Die Obduktionen wurden alle im (sehr) früh-postmortalen Intervall durchgeführt (Mittelwert: 5,6 h), um eine systematische Beeinträchtigung durch Degradation von viraler RNA und Gewebe möglichst zu verhindern. Viruslasten und Blutspiegel von Zytokinen und prothrombotischen Faktoren wurden mit der Makro-und Mikromorphologie der gewonnenen Gewebe und Organe korreliert. Die Covid-19-Pandemie hält die Welt seit Anfang 2020 in Atem und hat nicht nur zu bisher 13.299.163 Infizierten und 578.319Todesfällen weltweit (Stand: 15.07.2020), sondern auch zu bisher nicht bekannten globalen Restriktionen in allen Bereichen des öffentlichen Lebens geführt. Aus diesem Grund ist auch für die meisten osteuropäischen Kolleginnen und Kollegen die Teilnahme an der 99. Jahrestagung der Deutschen Gesellschaft für Rechtsmedizin nicht möglich. In diesem Vortrag sollen die Auswirkungen der Corona-Pandemie in den verschiedenen osteuropäischen Ländern von Rechtsmedizinern aus den Ländern Slowakei, Polen, Russland, Ukraine, Belorussland, Moldawien, Rumänien, Bulgarien, Nordmazedonien, und Albanien kumulativ dargestellt und mit der Situation in Deutschland verglichen werden. Dabei wird auf die Entwicklung der Zahlen der Infizierten, der Patienten mit intensivmedizinischer Behandlung, und der Todesfälle sowie der Übersterblichkeit in den jeweiligen Ländern eingegangen. Fragen nach Behandlungsmethoden und -strategien werden behandelt sowie Erfahrungen und Ergebnisse vorgestellt. Darüber hinaus werden insbesondere die Maßnahmen des Lockdowns und die damit verbundenen Einschränkungen in den aufgeführten Ländern und die unterschiedlichen staatlichen Vorgaben bezüglich einer Obduktion der Covid-Toten dargestellt und verglichen.. . Das Lungengewebe wurde lichtmikroskopisch anhand eines Befunderhebungsbogens standardisiert untersucht. Dabei wurde insbesondere auf freie Alveolarseptenenden ("Dead-ends") geachtet, die dann elektronenmikroskopisch genauer beschrieben wurden. Weiter wurden mit Aquaporin-5 sowie Surfactant-Protein-A zwei immunhistochemische Marker untersucht, die die Diagnose "Erstickung" stützen sollen, aber noch nicht in Bezug auf das CE untersucht wurden. Sämtliche erhobenen Parameter wurden sowohl einzeln auf ihre Tauglichkeit als "AE Marker" geprüft als auch gemeinsam in einem multivariaten Modell (machine learning). Ergebnisse und Diskussion: Sämtliche erhobenen Befunde waren jeweils in allen vier Gruppen zu finden. In der multivariaten Analyse der Gesamtheit der makroskopischen und lichtmikroskopischen Befunde war es jedoch möglich, jeweils 86 % der AE und der CE-Fälle sowie 50 % der AC + CE-Fälle richtig zu diagnostizieren. Lichtmikroskopisch konnten drei Varianten von "Dead-ends" differenziert werden, die elektronenmikroskopisch eine starke Variabilität zeigten. Die Variante "fransig" wurde signifikant häufiger bei AE-Fällen gesehen als bei den anderen Fällen. Die untersuchten immunhistochemischen Parameter ergaben keine Befunde, die zur Differenzierbarkeit zwischen AE und CE genutzt werden könnten. Zusammenfassend war festzustellen, dass eine sichere Identifikation von AE-Anteilen in einem CE allein aufgrund der untersuchten einzelnen Parameter nicht möglich ist. Eine differenziertere Beurteilung von "dead ends" sowie die Berücksichtigung sämtlicher Befunde in einem multivariaten Ansatz über machine learning eröffnen hier möglicherweise neue Perspektiven.

im September 2019 an 436 rechtsmedizinisch tätige Ärzt*innen verschickt. Die psychosoziale Arbeitsbelastung wurde anhand des Modells der beruflichen Gratifikationskrisen (Effort-Reward-Imbalance) überprüft. Daten von 181 Teilnehmer*innen konnten ausgewertet werden. 63,0 % davon hatten einen Facharzttitel. 58,0 % waren weiblich; je jünger die Befragten waren, desto größer war der Frauenanteil. 89,0 % waren universitär angestellt und die Mehrheit arbeitete in Deutschland (84,0 %). Der Großteil der Befragten war zufrieden mit der eigenen rechtsmedizinischen Routinetätigkeit, nur etwas mehr als ein Drittel war zufrieden mit der wissenschaftlichen Tätigkeit. Die psychosoziale Arbeitsbelastung und Verausgabungsneigung war insgesamt eher hoch. Es zeigten sich keine Unterschiede bezüglich Arbeitsbelastung und -zufriedenheit zwischen Assistenz-und Fachärzt*innen. Eine hohe Zufriedenheit mit Routine/Forschung und die Möglichkeit, autonom zu arbeiten, waren mit einer geringeren psychosozialen Arbeitsbelastung assoziiert. 54,1 % der befragten Ärzt*innen betrieb aktiv Forschung, wobei der Anteil der forschenden Fachärzt*innen etwas größer war. Die meisten Assistenzärzt*innen würden gerne mehr forschen. Fast die Hälfte der Assistenzärzt*innen war unzufrieden mit den institutsinternen Weiterbildungsbedingungen. Among injuries mechanical injuries take the leading place and brain injuries are the most common among them. Differentiation of the cause of death from ischemic cerebral infarction (ICI), hemorrhages of traumatic (HTG) and non-traumatic (HNG) genesis eliminates the violent nature of the onset of death. Materials and methods: For the study were used native histological sections of human brain substance (HBS) from 85 corpses in the case of: death from coronary heart disease-25 native sections (group 1-control); HTG-20 sections (group 2), ICI-20 sections (group 3), HNG-20 sections (group 4). Measuring the coordinate allocation of Muller-matrix invariants (MMI) of microscopic images was carried out at the location of the standard stokes-polarimeter. Results: Müller-matrix mapping of polarization manifestations of linear birefringence (LB) of fibrillar networks of brain samples revealed: 1) significant coordinate heterogeneity of MMI maps of HBS histologic sections of deceased from all groups; 2) for histograms that characterize MMI distributions of LB samples from all groups, individual and significant variations in the values of dispersion, asymmetry and peak acuity are characteristic; 3) the difference in the statistical structure of the coordinate distributions of the Muller-matrix magnitude invariant sections of HBS between group 1 and all experimental groups 2-4, as well as between groups 2 and 4 and also between groups 2 and 3. 

The efficacy between group differentiation of specimens of deaths from traumatic hemorrhage and ischemic cerebral infarction reaches a satisfactory level of 77-81 %, and between hemorrhagic and ischemic cerebral infarction -75-79 %. For the control group and experimental group 3 (ischemic cerebral infarction), the azimuthal-invariant Muller-matrix mapping of the polarized manifestations of linear birefringence of fibrillar nerve tissue networks of the brain of the dead was ineffective-the strength of the method lies within 60-70 %. Time of hemorrhages formation (THF) estimation in case of death from hemorrhages of traumatic genesis (HTG) in brain is very important for futher determination of the circumstances of the injury and identification of the potential perpetrator of the injury. Materials and methods: For the study were used native histological sections of human brain substance (HBS) from 80 corpses with a previously known THF from 6 to 96 h in the case of: death from coronary heart disease-20 native sections (group 1-control); HTG-30 sections (group 2), hemorrhages of non-traumatic genesis (HNG)-30 sections (group 3). Measuring the coordinate allocation of orientation parameter (OP) of microscopic images was carried out at the location of the standard stokespolarimeter. The calculation of the statistical moments of the 1st-4th orders, which characterize the OP maps for different THF was perfomed and the length of linear sections of the time dependencies of the THF was determined. Results: Comparative analysis of the polarization mapping data of OP distributions of histological sections microscopic images of the HBS from dead in 2 and 3 groups revealed the destruction of the polycrystalline structure formed by optically active protein complexes of HBS. This fact is indicated by the decrease in the absolute values and the range of OP scatter with the increase of the THF. Due to this the mean and dyspersion decreases over time with the increase of the THF. Asymmetry and excess are increasing. Conclusion: The range of temporal linear changes in the values of the statistical moments of 1-4 orders, which characterize the maps of OP microscopic images of brain samples of the dead with hemorrhage reaches 12 h. The accuracy of the THF is 1.5 h ± 15 min. 

Examinations were set up as a randomized, double blind, placebo-controlled, 2-way crossover study. After smoking a joint containing either CBD-rich marijuana or a placebo, different psychomotor and neurocognitive tests, were performed to determine any influence on driving ability. Dried blood spot samples were taken before and after the tests to determine the cannabinoid profile in capillary blood. Results and Discussion: The traffic psychological assessment showed that there are no significant differences between the consumption of CBD-rich marijuana and placebo, neither in reaction time, nor in motor time, nor in behaviour under stress, nor in concentration. The tests for balance and coordination also indicated no major differences. These results are somewhat surprising in the sense that high THC concentrations were detected in capillary blood after smoking CBD-rich marijuana. Mean values were 28.7 ng/mL after smoking and 6.5 ng/mL after performing the tests. According to literature on similar studies with THCrich marijuana, such values should have led to symptoms of deficiency. It is assumed that the much higher CBD concentrations cause a negative allosteric effect in the endocannabinoid system, preventing the formation of such symptoms. Conclusions: To the best of our knowledge, this is one of the first studies investigating the potential impact of smoking CBD-rich marijuana on road safety. Although no symptoms of deficiency have occurred, we recommend consumers to refrain from driving for several hours after smoking CBD-rich marijuana. In Switzerland, CBD-cannabis with <1 % ∆9-tetrahydrocannabinol (THC) can be legally purchased as tobacco substitutes. These cannabis varieties typically contain high amounts of cannabidiol (CBD), a non-intoxicating cannabinoid with anticonvulsive, sedative, and anti-inflammatory effects. Regarding driving, Switzerland pursues a zero tolerance for THC, which is implemented by a legal limit of 1.5 µg/L in whole blood. Single case studies demonstrated that this limit can be exceeded after smoking of CBDcannabis. CBDrive, a placebo-controlled, double-blind, cross-over study assesses cannabinoid levels in blood and urine, and the effect on mental performance capabilities after inhalation of CBD-cannabis in a larger study population. The currently on-going study was co-initiated and co-financed by the Swiss Federal Office of Public Health. Preliminary data on pharmacokinetic profiles of CBD, THC and further cannabinoids in blood of ten participants will be presented. Study participants inhaled two types of CBD-cannabis using a medically approved vaporizer. The products differed in the THC amount (both <1 % THC), while containing similar amounts of CBD (11-14 %). Blood samples were collected at t 0 and up to 5 h post-consumption. Over 500 samples were prepared by automated solid-phase extraction and analyzed by gas chromatography tandem mass spectrometry for: CBD, cannabinol (CBN), THC, 11-hydroxy-THC (OH-THC) and 11-nor-9-carboxy-THC (THC-COOH). Limits of detections were 0.15 µg/L for CBD, THC, and OH-THC; 0.10 µg/L for CBN; and 1.5 µg/L for THC-COOH. Limit of quantifications were 0.5 µg/L for CBD, THC, and OH-THC; 0.3 µg/L for CBN; and 5 µg/L for THC-COOH. Peak CBD and THC blood concentrations were reached immediately after inhalation and ranged 46-260 µg/L for CBD and 1.2-14 µg/L for THC, respectively. THC exceeded the legal limit up to 50 min after inhalation and could be detected up to 5 h post exposure (maximum observation time). The ratio of mean CBD to mean THC levels was >9 at all sampling points. CBN, OH-THC and THC-COOH were usually only detectable when associated with higher THC-levels.

E. Goldberg Introduction and Aims: Since 2017, tobacco substitute products with low ∆9-tetrahydrocannabinol (< 1 % total THC) and high cannabidiol (CBD) contents can be legally acquired and consumed in Switzerland. However, the consumption of CBD-rich marijuana can lead to detectable THC blood concentrations. A first pilot study showed that THC concentrations of up to 6.8 ng/mL can occur after smoking CBD-rich marijuana, rendering the consumer unable to drive from a legal point of view (cut-off 1.5 ng/mL). However, psychological effects (e. g. psychomotor, cognition, attention) of CBD-rich marijuana concerning driving ability have not been investigated before. In view of the legal availability of CBD-rich marijuana, a pilot study with 33 participants to investigate different psychomotor and neurocognitive skills with regard to driving ability after smoking CBD-rich marijuana was conducted. Results from the study will support interpretation of forensic-toxicological cases relating to cannabis and driving, by e. g. distinguishing the inhalative use of CBD-rich cannabis from THC-rich products. The data are equally important for consumer protection and development of future guidelines regarding CBD-cannabis and driving. Drug Checking is a low-threshold harm reduction tool, allowing drug consumers to get their drugs analyzed while attending a counseling interview. Despite the limited number of such services, due to local drug policies, Drug Checking services are gaining interest. For instance, the number of stationary Drug Checking services in Switzerland has more than doubled within one year. Beginning in July 2019, a stationary Drug Checking service in the city of Basel (Switzerland) was implemented. The collected samples are analyzed at the Institute of Forensic Medicine, University of Basel, offering a unique insight into the drug market at consumer level. Following a two-week interval, adult drug consumers are able to hand in drug samples for analysis. Sample analysis is directly linked to professional counseling as well as to a survey, including questions about the means of purchase, stated dosage, and price. The samples are analyzed using high-performance liquid chromatography (HPLC) with a diode-array detector (DAD). In cases of unidentified substances and uncertainty of the substances identified (particularly in case of new psychoactive substances, NPS), additional techniques such as high-resolution mass spectrometry (HRMS) are applied. For quantification, an HPLC-DAD method was validated for over 30 analytes, including common drugs of abuse and adulterants. The majority of the service users were male (80 %), with median age of 29 (18-69), of which 17 % were classified as exhibiting signs of drug addiction. The main drugs analyzed were cocaine (51 %), MDMA (37 %), amphetamine (26 %), and LSD (17 %). Several NPS have been detected, with LSD-derivatives (2 %) and synthetic cannabinoids (1 %) being the most prominent drug classes within the group of NPS. Even though the majority of drugs have been purchased through private encounters (68 %), a considerable amount was purchased via the darknet (10 %). False declarations and deception of consumers have been observed in 5 %, e. g. in samples of cannabis of the chemotype III that were laced with synthetic cannabinoids and sold as marijuana. Global trends reported by the UNODC and EMCDDA, which have been observed in other Drug Checking services, were also observed during the reported period. Our observations not only contribute to minimizing risks for consumers, but will allow direct comparison of the analyzed drugs to seized material and, as a result, will give valuable insight into the drug market. 

Wolf Schweitzer, Stephan Bolliger, Michael Thali Institut für Rechtsmedizin, Universität Zürich, Switzerland Case: A 50-year old man was found dead at home, days after he had gone home from work after telling coworkers he was feeling unwell, around the time when we had a maximum number of daily COVID-19 case registrations. A naso-pharyngeal swab had yielded a negative PCR-test for SARS-CoV-2. Post mortem CT (PMCT) showed lung changes that achieved a median value of CORADS-4 when reviewed by seven readers. There was a low degree of coronary artery calcification. Further investigation revealed that the man was a chain smoker and that he had avoided to consult medical doctors generally. External examination and PMCT did not yield any findings suspicious of a violent death, and no further examinations were requested. Circumstances and findings were judged as consistent with the assumption of Natural Death. After discussion, the public health office did not request us to submit the case as COVID-19 death, as it did not fulfill their formal criteria. Discussion: In our forensic setting, unascertained deaths (German: "AGT" Aussergewöhnlicher Todesfall, see Art. 253, Swiss Criminal Code/StPO) are typically screened for possible third-party involvement (which includes third-party responsibilities, such as death in care or recent medical consultation) under the auspices of a state attorney. If there are no indications or clues pointing towards such, the body is usually released as required by Art. 253. Then, a deeper investigation into natural causes may not be routinely performed at that level. After the body is released, relatives or the public health office may request a further examination if they so wish. As COVID-19 is new and with its significant socioeconomic impact, legislation surrounding deaths and suspicious cases may change. The rupture of the Middle Meningeal Artery (MMA) is reported as a main cause of bleeding during an epidural hematoma. The axial stretching is the dominant loading for blood vessels according to studies found in the literature. In our pre-study, we have proposed a computer model to investigate a possible injury mechanism of the MMA due to the axial stretching under bending-like deformation. To properly understand the injury mechanism of the MMA, the mechanical responses including the failure loads/stresses of the underlying tissues are required. We, therefore, designed an experimental study to analyze the mechanical failure behavior of the MMA through uniaxial extension tests using the human dura mater obtained from forensic autopsy. Specimens are immediately frozen at -20 °C after dissection to be able to perform several tests over a longer period. Two types of samples, isolated arteries and arteries attached to the dura mater are prepared. Initial observations in pre-testing indicated a considerably higher failure force, namely three to four times, for the arteries attached to the dura mater. This may suggest a strong protection of the MMA by the dura mater in the longitudinal direction, which might prevent local damage in this direction. As a conclusion, this observation could help us to develop a hypothesis, that the axial failure of the MMA may not be a main injury mechanism in epidural hematoma, at least as long as the connection to the dura mater is intact.

In order to verify this hypothesis, testing should include peeling off the artery from the dura mater. We are going to complement our study on axial failure experiments accordingly. On the other hand, some other mechanisms could cause the injury of the MMA during epidural hematoma, such as arterial failure in the circumferential direction, which also needs to be included in future studies to draw more accurate conclusions on these mechanisms. 

A. Tsiatsiuyeu, V. Semyonov Belarussian State Medical University, Minsk, Belarus

In cases of penetrating bullet injuries of the head buttonhole entrance fractures scull bones are the target for identifying examinations. We describe a case when medico-criminalistic examination of an exit bullet perforating fracture allowed us to determine not only the caliber of the bullet but also its type by the side profile. During a forensic anthropological examination of skeletonized remains perforating fracture of the left parietal bone was revealed. The shape and size of the hole defect in the left parietal bone looked like the lateral profile of the jacketed bullet of a standard 9 mm cartridge for the Makarov pistol or Stechkin automatic pistol. On the left parietal bone, a buttonhole fracture with a defect 12,79 × 10,5 mm was present. This defect had a quadrangular shape with a rounded back end.

The edges of the defect on the inner surface of the parietal bone were regular and without chipping of the compact layer. On the external surface the margins of the defect were serrated, with external bevel of compact layer. Three perpendicular linear fissures of 29 mm, 25 mm and 11 mm extended respectively from the left, front and right segments of the of the defect edge.

To perform the photoalignment procedure a reference bullet was selected from the ballistic collection-a full-jacketed bullet of a standard 9 mm cartridge for Makarov pistol or Stechkin automatic pistol. Then digital photo images of the buttonhole fracture of the left parietal bone from the side of the internal bone plate were obtained as well as digital images of reference bullet from the side of its head and the side profile using the same focal length and angle of photography. Using the Adobe Photoshop photo editor, the reference bullet images were inverted to mirror images and were subsequently superimposed on the image of the buttonhole fracture. The largest lateral contours of the mirror-imaged reference bullet were slightly less than the boundaries of the hole fracture. The contours of the side profile of the mirror-imaged reference bullet almost completely correspond to the boundaries of the hole fracture. Thus, the exit bullet perforating fractures of the skull bones have identifying significance when entrance bullet injuries of the skull are either absent or not suitable for identification purpose. Dead bodies exhibit a variable range of changes with advancing decomposition. Seasonal changes might influence the state of decomposition and social isolation might influence the post-mortem interval. To estimate the post-mortem interval, several methods with approximate accuracy have been established. One of the few methods that actually quantifies the state of decomposition with a clearly defined value is the recently developed radiological alteration index in post-mortem whole-body computed tomography. In this retrospective study we (I) investigated the correlation between the state of decomposition and the season of body discovery, and (II) evaluated the correlation between socio-demographic factors (age, gender) and the state of decomposition. We analysed the demographic data from all autopsy reports from January 2017 to July 2019 and evaluated for each case the radiological alteration index in post-mortem wholebody computed tomography. Bodies showed more advanced states of decomposition in older males. Seasonal effects had no significant influence on the decomposition state. Autopsy reports contain valuable data that allow for interpretation beyond purely forensic purposes, such as for sociopolitical observations. Imaging techniques are widely used for medical diagnostics. In some cases it can lead to a real bottleneck when there is a lack of medical practitioners and the images have to be manually processed. In such a situation there is a need to reduce the amount of manual work by automating part of the analysis. In this article, we present a custom-made convolutional neural network to classify postmortem computed tomography images of rib fractures (RiFNet). To test our model, first, we select retrospectively from our database of postmortem computed tomography images of rib fractures. The images are prepared by applying an existing rib unfolding tool that flattens the rib cage to form a two-dimensional projection. Then, we use transfer learning on an independent convolutional neural network architecture (MobileNet) and compare the results with our network. We obtain an F_1 Score of 0.72 using MobileNet and an average F_1 Score of 0.91 ± 0.04 with RiFNet. We conclude that RiFNet is efficient in detecting rib fractures on postmortem computed tomography images. The temperature effect on the magnetic resonance imaging (MRI) parameters T 1 , T 2 and T 2 * represents a major issue in in-situ post mortem MRI (PMMRI) due to the passive cooling of the cadaver [1, 2] . A few journal articles published MRI parameters of the brain corrected for the body core temperature [3] [4] [5] [6] . However, it could be shown that the core temperature decreased at a slower cooling rate than the brain temperature after death [7-8]. In this study, the effect of the brain and rectal temperature, respectively, on the brain's relaxation parameters were investigated to lay the foundation for future projects on post mortem validation of in vivo MRI techniques. 9 deceased underwent PMMRI brain examination on a 3T scanner. The temperatures were measured in-situ in the rectum and the brain. The temperature effect was computed by fitting a linear model to the MRI parameters of eight different regions of interest and the corresponding brain and rectal temperature, respectively. The brain and the core temperature revealed no linear correlation with each other. Significant linear relations between the brain temperature and the relaxation parameters T 1 of the gray matter were observed. While T 2 did not reveal a significant temperature dependence, T 2 * revealed a linear dependence on the brain temperature in deep gray matter. The linear correlations assessed with the body core temperature yielded inferior fit results. The preliminary data size was insufficient for retrieving significant results in white matter. The results highlight the importance of performing accurate post mortem temperature correction of brain MRI parameters based on the brain temperature instead of the core temperature, particularly of T 1 and T 2 * in gray matter. This will be crucial for future in vivo MRI validation projects in order to avoid misleading quantification caused by post mortem temperature decreases. For the record, interpretation and preservation of forensic evidence, a standardized documentation process is fundamental. The most conclusive method for the documentation of superficial wounds is a combination of two modalities: two-dimensional (2D) photography for evidence preservation, and live examination for wound analysis. As forensic science technologies improve, 2D photography is being outdated by realistic reproductions of forensic data, such as the depiction of threedimensional structures. In our study, we compared four different technical examination methods of superficial wounds with the direct visual examination carried out by two board-certified forensic pathologists as gold standard: 2D forensic photography, 2D photography with the multi-camera system Botscan©, 3D photogrammetry reconstruction on screen and a VR visualisation using HMD. We used a mannequin equipped with 42 artificial injury stickers and documented orientation, form, colour, size, wound borders, wound corners and suspected type of violence. The results showed that the two forensic pathologists had an inter-reader agreement ranging from 69 % for the orientation and 12 % for the size of the wounds. A substantial part of the direct visual documentation showed only a partial overlap, especially for the items size and colour, prohibiting statistical comparison of these two items with the technical display methods. A Forest plot analysis of the remaining six items in the four technical display methods compared with the direct visual examination showed no statistical difference. We found that amongst the forensic pathologists there was a high variability in the vocabulary used for the description of wound morphology, complicating an exact comparison between the two documentations of the same wound.

A main drawback in this study is that the documentation of injuries was performed solely on injury stickers on a mannequin, disregarding amongst other diascopic information or depth of a real injury. However, there was Fig. 1 8 Ausschnitt des Blender-Addons zur Bestimmung der "Area of Origin". Zu sehen ist die räumliche Erfassung eines Bluttropfens in Blender und das zugehörige Userinterface nails such as treatment with nail polish or nail diseases must be considered. The slower growth rate of the nails and thus higher concentrations in contrast to hair must be taken into account. In addition, nails show high inter-individual differences (thickness, texture, porosity) hence powdered samples are best for a good homogenization and for easy extraction with highest yields.

The new extraction and analysis protocol for EtG in nails has been validated. In Switzerland, the grinding of hair for abstinence control is an accepted procedure for extraction of EtG from hair. When using nails instead of hair, a standardization of sample extraction should also be considered. For interpretation of results, more investigations have to be performed with comparison with hair EtG and other alcohol markers or self-reports, to finally decide on decision limits for EtG analysis in nails.

Cheating on forensic hair testing? Detection of potential endogenous biomarkers for cosmetic hair treatment using an untargeted metabolomics approach (33) Aims: As hair provides a retrospective and long detection window of drugs of abuse or alcohol, it has gained great importance in forensic toxicology. Yet, the application of oxidative hair treatments (e. g. bleaching) can cause significant analyte loss and might lead to false negative hair testing results. Therefore, objective markers to detect oxidative hair treatments are required for improved analysis interpretation. As a global approach, untargeted metabolomics should be able to identify endogenous metabolites altered after oxidative hair treatment possibly serving as biomarkers to differentiate untreated from manipulated hair samples. The aim was to apply an untargeted metabolomics workflow to identify a variety of markers for oxidative hair treatment. Methods: For an initial biomarker search, cosmetically untreated hair samples (n = 21) were either left untreated or bleached in vitro with 9 % hydrogen peroxide (H2O2) during 30 min. All hair samples were decontaminated (dichloromethane, H2O) and extracted with acetonitrile (ACN)/H2O (2:8 v/v). Hair extracts were analyzed by liquid chromatography high-resolution (HR) MS and MS/MS in negative and positive electrospray ionization mode using reversed-phase and normal phase chromatography. Untargeted data processing and identification was performed using Progenesis Qi and PeakView. Results and discussion: Over 60 metabolites could be identified as significantly (p < 0.05, Student's t-test) altered after bleaching. Metabolites predominantly identified belonged to compound classes of carnitines, amino acids and derivatives, purines and nucleosides. The majority of metabolites decreased after bleaching. Yet, single, totally degraded metabolites after bleaching seemed the most promising as well as the (non)detectability of a metabolite selection. Ratios formed of the combination of decreasing and increasing markers (e. g. adenosine/inosine) furthermore improved the discrimination of untreated and treated hair samples.

The applied untargeted metabolomics workflow allowed the initial detection of a variety of endogenous biomarkers for bleaching. As sample preparation and analysis methods differ widely among laboratories, the identified markers and marker ratios now offer the possibility to individually apply and evaluate a selection of markers suited for a specific routine method. 

Introduction and Aims: Ethyl glucuronide (EtG) as a direct alcohol biomarker is suitable for abstinence controls, short-term in urine and longterm in keratinous matrices. Due to accumulation, it is detectable for weeks or months depending on the length of hair or nails. Since hair sampling is not always possible, nails can be used as a possible alternative matrix. The aim of this study is to validate the quantitative determination of EtG in nails. Methods: Nails were washed with 3 mL each of water, acetone and dichloromethane, dried for about 1 h and grounded. After addition of 10 µL internal standard, 10 mg powdered sample were extracted with 1 mL deionized water for 2 h in an ultrasonic bath. After centrifugation the aqueous phase was applied onto a Evolute Express AX SPE column (Biotage) without preconditioning. After washing with 2 mL 1 % ammonia solution and 1 mL methanol, analytes were eluted with 1 mL methanol (2 % formic acid). The evaporated and reconstituted samples were analysed using a previously published on-line SPE-LC-MS/MS method. Results and Discussion: Good linearity and accuracy was achieved between 10 to 2500 pg/mg (R = 0.999, accuracy of QCs 88-110 %). No carry over was detected. The limit of quantification (LOQ) was 10 pg/mg. Only 10 mg of nails are needed to perform this method. It is therefore also suitable for small sample quantities. positive for fentanyl in blood. For one case a 30 cm long hair strand (representing a time frame of two and a half years) was segmented in six five cm segments and fentanyl, fentanyl-metabolites, acetylfentanyl and methoxyacetylfentanyl were found in all six segments.

The current study proves that hair analysis is an excellent tool to study the prevalence of (designer)drugs in different populations of drug consumers. Even though the total number of Swiss hair samples was low, the results demonstrate that synthetic opioids are present in Switzerland. The segmented analysis of five post mortem hair samples from New York City provided additional information about past drug consumption behavior of the deceased persons which can be a helpful information for interpretation of toxicological (post mortem) results. 

The comparison of the obtained results with the results of the studies that focused on hospitalized children has shown that mean concentrations of ethanol in the blood of hospitalized children are significantly higher than the lethal concentrations for some children that died before hospitalization or for any other cause.

Background: Drug addiction has become a worldwide problem and the leading cause of death. Information on drug users in the three Southern Caucasus countries is entered into the database collected from two sources: records on individuals detained by the police for being in the state of drug intoxication and individuals receiving treatment in the corresponding treatment. The information related to this indicator is rather inadequate in the countries. In Azerbaijan, death cases related to drug use are more or less recorded, but in Georgia and Armenia mortality or death cases related to drug use are not recorded at all. The statistics of positive cases due to use of drug and psychotropic substances were separated on the following principle: 1. Drug availability 2. Availability of psychotropic substances 3. Chronic poisoning 4. Drug overdose It is noteworthy that when we consider the presence of drugs and psychotropic substances, we find both the presence of pure drugs and psychotropic substances, as well as cases of mixed use, when the use of drugs combined with psychotropic substances. Statistical analysis of toxicological studies has shown that we also have positive cases due to the use of petroleum products. We encounter not only the presence of petroleum products, but also the combination of the later with drugs and psychotropic substances.

Research is especially interesting in the case of deaths caused by chronic poisoning and drug overdose, where most of the cases are accompanied by the presence of petroleum products. Conclusion: According to the analysis of statistical data, due to the chemotoxicological analysis, there is an increase not only in the number of examinations, but also in the number of deaths due to the use of drugs and psychotropic substances. 

Department of Forensic Medicine, Faculty of Medicine, Fukuoka University Fukuoka, Japan

We are studying the analysis of urinary markers from liquor components that can prove alcohol drinking by GC-MS measurement. So far, we have been focusing on the analysis of ethyl glucoside produced during brewing. It was found that liquor components such as phenols were also detected by sample processing using a weak ion exchange cartridge. Using this method, we analyzed the profile of urine after drinking. Materials and methods: Urine specimens: Urine from volunteers was collected 2 h after drinking. Sample preparation: After urease treatment of 0.1 ml of urine with 0.3 ml of deionized water, 2 ml of acetonitrile (ACN) and 0.05 ml of acetic acid were added and mixed, and the solution was passed through an ISOLUTE CBA (500 mg/3 mL, Biotage) cartridge, which had been washed with 2 ml of ACN. Next, 2 ml of ACN and 0.1 ml of ammonia water was additionally passed through the cartridge and collected together in a glass test tube containing 0.4 ml of acetic acid. The filtrate was evaporated to dryness under a nitrogen stream. GC-MS conditions: Apparatus = Shimadzu GCMS-QP 2010Ultra. Column = a tandem column consisting of ZB-SemiVoltiles (0.18 mm i. d.) and BPX5 (0.15 mm i. d.). Oven Temperature program = 90ºC initially for 0.5 min, then increased to 200ºC at a rate of 70ºC/min, finally to 320ºC at 50ºC/min. Ionization mode = electron ionization. Results: By this method, 2-phenethylalcohol, tyrosol, mono-ethyl succinate, and several other phenolic compounds related to alcoholic beverage components, as well as ethyl glucoside, were detected in the volunteers' urine. Discussion: By this sample preparation method, phenolic compounds and organic acids were clearly detected. By adding additional acetic acid, the dissociation of organic acids was suppressed, and clean peaks were detected by GC-MS. Basic organic compounds have also been recovered, but the peak shapes by GC-MS were not ideal. Phenolic compounds derived from plant lignin are present in brewed liquors, but these are also abundant in general foods, and therefore it is difficult to know their origin. The detection of tyrosol and mono-ethyl succinate, also generated during brewing along with ethyl glucoside, may have important implications in the certification of alcohol consumption.

Cannabinoids Cumyl-5F-P7AICA (12) biopsy tool, 37 human cases involving ADNs were systematically studied for time-dependent PMR. Postmortem biopsy samples of the femoral (pB) and heart blood (HB) (right ventricle), lungs, kidneys, liver, spleen, adipose and muscle tissue were collected from the deceased at admission to the institute (t1). At time of autopsy, approx. 24 h later (t2), samples from the same body regions were collected manually; additionally urine, brain tissue and left ventricleheart blood were collected. For quantification, a two-step liquid-liquid extraction was performed with subsequent LC-MS/MS (5500 QTrap) analysis using a previously validated method. Target analytes were citalopram, mirtazapine, quetiapine, risperidone, venlafaxine and the two metabolites OH-risperidone and O-desmethylvenlafaxine (ODMV). For quetiapine (n = 11), risperidone (n = 5) and OH-risperidone (n = 8), pB concentration increases and decreases over time were observed. Quetiapine cases demonstrated a correlating behavior with the postmortem interval (PMI) (concentration decreases in the early PMI, increases at later PMI), indicating multiple stages of time-dependent PMR. Most citalopram cases (n = 10), showed time-dependent concentration decreases in pB (mean -10 %); for mirtazapine (n = 7) a trend for concentration increases was observed (mean +12 %). HB concentrations for both analytes increased and might be caused by passive diffusion processes along the lungto-HB/liver-to-HB concentration gradient (corresponding changes in lung and liver tissue were observed). Only minimal concentration changes in pB were observed for venlafaxine (n = 7) and ODMV (n = 5) (mean -1 % and +3 %), which contradicts previous studies, but could be caused by inter-individual variability within the limited sample set. Overall, the observed concentration changes in pB indicate the occurrence of PMR processes for most investigated ADNs. No forensic case interpretation had to be adjusted in the course of this study, but the very early postmortem period (before t1) could not be analyzed and bodies were stored in a temperature-controlled environment between sampling procedures. Keywords: postmortem redistribution, CT-guided biopsy, time-dependent investigation 

the asphyxiation death group. In the culture experiments, neurons were cultured in a hypoxic state, and 4-AP and caffeine were added. The results showed increases in the neuronal death rate that were dependent on the concentration of each drug and on the time that had elapsed after the addition of the drugs. In a simple comparison of the neuronal death rate with 4-AP and caffeine, the cell death rate with 4-AP was slightly higher. Discussion: From the experimental results, it is clear that the administration of CNS stimulants in a hypoxic state hastens neuronal death. Together with the autopsy results, this may indicate that the use of CNS stimulants facilitates neuronal death based on hypoxia from brain edema.

Kei Ikeda 1 *, Tomoya Ikeda 1,2 , Naoto Tani Background: Ingestion of stimulant drugs and other central nervous system stimulants (CNS stimulants) is known to cause cerebral edema and lead to neuronal death from hypoxia in the central nervous system. However, no detailed investigations have been reported on the effects of CNS stimulants on neurons based on hypoxia. We report an investigation of the changes in cultured neurons after the addition of 4-aminopyridine (4-AP) as a CNS stimulant to raise the action potentials of nerves in human neurons cultured in a hypoxic environment, together with an investigation of autopsy cases. Methods: Together with histopathological findings, we compared the extent of edema corrected for brain weight in three groups of drug overdose deaths autopsied in our laboratory (Group A: stimulant drug only detected, 11 cases; Group B: stimulant drug and psychotropic drug detected, 13 cases; Group C: psychotropic drug only detected, 9 cases) with 5 asphyxiation deaths and 16 deaths in which caffeine only was detected as control groups. In a culture experiment, we added 0-40 µM 4-AP and 0-40 ng/ml caffeine to human neurons placed in a hypoxic environment and measured the cell death rate from 10 to 180 min using trypan blue. Results: In the autopsy cases, brain weight was the heaviest in Group A, followed in order by Group B, the caffeine detection group, Group C, and Zusätzlich konnte aufgrund der fortgeschrittenen Verwesung kein Blut und Urin asserviert werden. Auftragsgemäß wurden chemisch-toxikologische Untersuchungen durchgeführt, wobei die Untersuchung auf LSD und iso-LSD mittels LC-MS/MS und unter der Verwendung von alternativen Asservaten erfolgte. Im Lebergewebe ergaben sich positive Befunde für LSD (ca. 5,7 ng/g) und iso-LSD (ca. 8,5 ng/g); zudem konnten beide Stoffe im Mageninhalt nachgewiesen werden. Hinweise auf die Aufnahme ers sized 12 cm x 3 cm that were closed off at both ends. They were restrained for 1 h daily followed recovery, and this procedure were repeated the following 2 days. Subsequently, the thymus was taken and subjected to the following analyses. Results and discussion: There was no significant difference in thymus weight between unrestrained WT and Cx3cr1-/-mice. When WT mice were restrained, the thymuses significantly involuted. However, in Cx-3cr1-/-mice treated with the same manner, the decrease of thymus weight was significantly suppressed. In the next series, we examined apoptotic cells in the thymus of WT and Cx3cr1-/-mice. Restrain stress significantly induced the apoptosis in the thymic cells of WT mice. On the contrary, the absence of Cx3cr1 significantly suppressed apoptosis of thymic cells. These observations implied that the absence of CX3CR1 resisted stress-induced thymic atrophy. Thus, CX3CR1-mdiated signals would promote thymic involution induced by restrain stress. From the forensic aspects, CX3CR1 would be a key molecule for diagnosing abuse in infants and children.

Etablierung einer SNP-Analyse Methode und deren Anwendung in der forensischen DNA-Analyse (146) During sexual assaults, there is close physical contact or even an exchange of body fluids, and small to large amounts of DNA-containing material remain on the victim or the perpetrator. When examining victims and case relevant materials (e. g. clothing), these DNA traces can be recovered and analyzed, potentially providing incriminating evidence that helps investigators clarify case circumstances and may ultimately lead to the conviction of the offender. The applied DNA collecting method should be efficient and practicable for medical staff and should cause as little further stress to the victim as possible with procedures that do not take a long time.

For the sampling of the genital area, the most common method is the use of forensic swabs. There are various swab types commercially available with a range of different materials for swab heads, swab handles as well as packaging.

In this study, we compared the currently used swab type Prionics ForensiX Evidence Collection Swab with the two alternative models Prionics Foren-siX Evidence Collection SafeDry and Sarstedt Forensic Swab XL, which differ both in swab materials and packaging. To represent typical sexual assault samples, 15 couples provided vaginal swabs taken with each model at specific time points after unprotected sexual intercourse (approved by ethics committee of north and central Switzerland, Project-ID 2019-00508).

In addition to the evaluation of quantifiable DNA and the detectability of seminal fluid and sperm cells, the swab types and their packaging were rated regarding handling practicality by the test couples. Statistical evaluation showed significant differences in quantifiable DNA between Prionics and Sarstedt swabs but no significant differences between the two Prionics models. These results, combined with the results of other parameters and handling scores, provide arguments for changing the swab model used in routine examinations, which will benefit victims, medical staff and investigators likewise. Virtual anthropology is fast becoming a major subdiscipline of forensic anthropology, aiming to translate the methods used on actual bones to the virtual environment, using 3D models of human remains. While great advances have been made in this endeavour in the past decade, several interrogations concerning how reliable these models are and what their proper use within the forensic context should be remain unanswered. The research presented shows the results of the investigations into a fundamental principle of virtual anthropology: whether the way we perceive and apply an anthropological method is truly similar when looking at bones macroscopically and through various 3D media. In total, ten craniums of known age and sex were scanned using a CT scanner and a 3D surface scanner. Two observers applied a defined staging method to eight suture sites, first looking at the bone macroscopically, then on the 3D surface scan, and finally on the CT scan. These observations were repeated twice, with an interval of two weeks. Intra-and inter-observer error were evaluated, and statistical analyses using two sample t-tests were performed. The results show a high degree of inter-observer error. Furthermore, the data obtained from 3D surface scans differ from macroscopic observation for both observers, suggesting that the kind of structures under consideration (sutures) might be problematic when using the chosen configuration of this visualization medium. Indeed, the chosen 3D scan resolution led to larger differences in the interpretation of the appearance of the sutures resulting in some structures appearing different to macroscopic observations. In the same settings however, CT scans yielded results comparable to those obtained through macroscopic observations. These results offer many possibilities for future research, including indications on the kind of anthropological methods and anatomical landmarks that might be reliably transferable to the virtual environment. A common cause of post-mortem indoor injuries is animal scavenging. In our case the body of a 38-year-old woman was found in her living room. The death scene indicated a drug addiction. The regions of the face and neck were almost completely skeletonized and showed a large tissue defect with bite wounds on the edges. A German shepherd and two cats lived at the scene. Animal faeces were distributed in the apartment. A complete forensic examination inclusive of Computer tomography (CT) and histology was performed. The autopsy provided no morphological cause of death but indications of intoxication. The missing parts were: tongue, pharyngeal ring, soft tissues of the neck, thyroid gland, larynx, trachea, oesophagus and cervical vertebrae 3-6. Furthermore some piercings were lacked. Therefore, the animal faeces were scanned using a multi-slice CT in order to look for the missing parts. CT is particularly useful for the localization, detection, and identification of foreign objects. Hounsfield Unit (HU) measurements can improve this. The CT examination of the body showed the absence of several vertebrae and some piercings. In the CT reconstruction of one of the dog's faeces xray dense objects could be detected. Some of these structures had an osseous shape (HU: 500-1300) and two had the shape of a jewel (HU: 2900-3200). Two metal jewels as seen in CT and several bone fragments were found manually. We assume that the bone fragments found in the faeces are most likely from the corpse. Furthermore, the two pieces of jewellery could be distinguished due to the comparatively higher density than human tissue based on HU measurements. HU measurements are important for material and object identification and can be useful to distinguish between forensically more or less relevant objects. Due to the CT scan we were able to identify the forensically relevant animal faeces efficiently prior to their manual investigation. Authors contributed equally. Introduction: Minimally invasive autopsies (MIA) with a robot are a promising alternative when conventional autopsies (CA) are not feasible due to time, cost or ethical objections. Moreover, in the case of a pandemic, a robotic MIA can reduce the risk of infections for the examiner. We present first results of a CT-guided robotic system with force sensing. Material and Methods: A CT-scan is acquired of the corpse and the medical staff can define targets as well as the needle trajectory. We insert biopsy needles with a light-weight robot that can be placed freely next to the corps and offers high flexibility in defining targets and trajectories. A tracking camera relates the robot's position to the CT imaging frame. Forces at the needle shaft are recorded while the robot performs a fully automated needle insertion. Our system can be further extended by sensing elastic tissue properties in front of the needle for sample verification. For this purpose, we employ optical coherence tomography imaging for tracing excited shear waves inside the tissue. First in lab results have shown that elastic properties of tissue can be estimated through the needle [2] . Results: We realized our setup and evaluated needle placement. Quantitative evaluation without additional sensing resulted in a mean distance between the needle tip and a target in wax phantoms of 4.32 ± 1.27 mm and in corpses 10.81 ± 4.44 mm [1] . We report maximum forces of 6.16 ± 1.55N ble for the patient. The orthosis has a life time, and experience shows that it is not possible to reproduce an identical splint. The present work consisted in the creation of protective splints by 3D print. The size, shape and texture of the limb were first digitalised painless and contactless by our forensic 3D surface scanner team (a fortuitous collaboration). The data was then used to digitally design the splint, in a specific 3D printer format. The pro and cons of 3D orthosis versus standard molded orthosis from the point of view of the patient and the practitioner and time/cost comparison are discussed. We conclude with the evaluation of a larger scale application and related indications of this technology. Allodynia is a pain of neuropathic origin, triggered by a stimulus that is normally painless. For example, a slight touch of the skin or a slight sensation of hot or cold is extremely painful. Rehabilitation of allodynia is long and uncertain. Protecting the pain area from stimuli is a priority of care. The pain caused when manufacturing a classic molded orthosis is unbeara-Autoptisch präsentierte sich ein generalisiertes Hirnödem mit Zeichen einer oberen und unteren Einklemmung sowie eine perlmuttfarbene Raumforderung (Durchmesser 6 × 5 × 4 cm) mit unregelmässiger Oberfläche im Bereich der basalen Zisternen, dem Mittelhirn und der Pons, durch welche der dritte Ventrikel vollständig verlegt war. In den histologischen Untersuchungen zeigten sich hauptsächlich kernlose Keratinlamellen und im Randbereich flaches, dysplasiefreies Plattenepithel. Insgesamt wurde neuropathologisch die Diagnose einer Epidermoidzyste im Bereich der basalen Zisternen mit vollständiger Verlegung des dritten Ventrikels und Dilatation der Seitenventrikel diagnostiziert. Epidermoidzysten zählen zu den monodermalen Geschwulsten (Teratome) und treten an verschiedenen Stellen des Körpers auf, häufig im Gesichts-, Hals-und Rumpfbereich. Im Hirn sind sie sehr selten, machen etwa 0,3-1 % aller Hirntumore aus und treten meist zwischen dem 25. und 50. Lebensjahr auf. Klinisch manifestieren sich Epidermoidzysten vor allem durch lokale Verdrängungserscheinungen. So führte im konkreten Fall die Epidermoidzyte zu einem Hydrozephalus welcher akut exazerbierte und als todesursächlich anzusehen ist. Differentialdiagnostisch kam zunächst die ZNS-Manifestation einer Tuberkulose in Frage, welche sich bevorzugt in den basalen Hirnbereichen ausbreitet. Dies konnte jedoch mittels infektiologischer Untersuchung ausgeschlossen werden.

Complete decapitation by self-constructed guillotine in a burned body-complex suicide or postmortem burning? (50) We report a suicidal case of complete decapitation using a self-constructed guillotine. A 45-year-old man whose body was severely burned was found dead. The head was completely separated from the middle level of the neck, and a sharp blade with a steel frame was placed between the head and neck. The severance plane passed between the C4 and C5 vertebrae. Vital reactions, such as hemorrhage, could not be confirmed at the decapitated skin edge because the body was severely burned. Both common carotid arteries were sharply transected. Subendocardial hemorrhage was detected in the left ventricle. Only a little blood but not soot was detected in the respiratory tract, such as the trachea and bilateral bronchi. Subarachnoid hemorrhage was noted at the edge of the cervical spinal cord. The saturation level of CO-Hb was 5.7 % in the left cardiac blood, 5.9 % in the right cardiac blood, and 5.8 % in the peripheral blood from the femoral vein. Cervical transection was diagnosed as the cause of death. We believe that he was unintentionally burned by spread fire from the automobile after decapitation by self-constructed guillotine. Institute of forensic medicine, Faculty of medicine Skopje, Nordmazedonien; 2 Institute of forensic medicine, Faculty of medicine Ljubljana, Slovenia

Diffuse hypoxic-ischemic brain lesion (DHIL) is a typical diffuse brain damage of secondary type, that occurs secondary to almost every closed head injury with a time of survival. According to the pathogenesis, the ischemia of the brain and its consequences-the DHIL, are the result of the decreased cerebral perfusion pressure (CPP). It has been considered that the macroscopic changes of global ischemia are becoming visible 12 to 24 h after the head trauma. The fact is, that ischemia occurs earlier, when it can be perceived only by microscopic examination. The aim of this study has been to examine a case material of a total of 80 cases with closed head injury, which have been post mortally submitted to forensic neuropathological examination in a purpose to find out the occurrence of the DHIL, with its macroscopic and microscopic appearance in the function of time, and also to perceive its correlation with the raised intracranial pressure. According to the results, the incidence of the DHIL has been 52,5 % of all examined cases, 85 % of all cases survived more than three hours, and also 80 % of cases which have been submitted to some surgery intervention. The ischemia could has been seen macroscopically most earlier at a survival of 7 h post injury. In the group of cases with confirmed DHIL and with the survival of up to 6 h-6 cases in total, the ischemia couldn't be seen by macroscopic examination and has been perceived by microscopic examination employing the β-APP immunohistochemistry. Also, the positive correlation has been statistically proved of the DHIL and the intravitally raised ICP i. e. the signs of herniation. Conclusion: Hence, the proved presence of the DHIL and the signs for the herniation on the pathologic feature, are indication that intravitally there existed a state of the raised intracranial pressure and also can give important information about the age of injury, which is certainly of medico-legal importance. 

We studied 30 criminal cases related to the adverse outcome of medical care. In each criminal case, there was a forensic medical examination. In 12 (40 %) cases, the victims did not agree with the conclusions of the examination and demanded the appointment of a repeated or additional commission forensic examination. At the same time, they argued their position by mistrusting the experts of the regional forensic bureaus because of their affiliation with the local public health au-protein (MBP) in left heart blood and cerebrospinal fluid were measured, focusing on cases of stimulant drug use and heatstroke. As a histopathological test, immunostaining of the parietal lobe of the cerebrum was done with these markers, and the neuron positivity rate was measured. In addition, neurons were cultured at 40 °C as a model of a high temperature environment, and the CNS stimulant 4-aminopyridine (4-AP) was added to cultured cells as a model of stimulant drug use. The differences in the various markers were then investigated. Results and Discussion: IL-6 in both blood and cerebrospinal fluid showed a significantly higher value in cases of stimulant drug use than in cases of heatstroke. IL-8 in both blood and cerebrospinal fluid showed higher values with stimulant drugs, heatstroke, and psychotropic drug poisoning. NSE in blood tended to show higher values with stimulant drugs and heatstroke, whereas NSE in cerebrospinal fluid was significantly higher with heatstroke. MBP in blood was significantly higher with stimulant drugs and heatstroke, whereas in cerebrospinal fluid, no difference was seen among causes of death. In the results of immunohistological examinations using the various markers, only IL-6 did not show a clear difference depending on the cause of death. In experiments with cultured human neurons, higher values were seen for all markers in the heatstroke model compared to the stimulant drug model. The test results in these autopsy cases and the results of the culture cell experiments indicate that structural damage to neurons plays a key role in CNS disorders associated with heatstroke. In contrast, CNS disorders due to stimulant drugs and other CNS stimulants were shown to have changes in mainly IL-6 as an immune response. This suggests that in both heatstroke and stimulant drug use cases, IL-8 may act to protect nervous tissue. Keywords: Central nervous system disorders, heatstroke, stimulant drug, cytokine, structural protein

Tomoya Ikeda 1,2* , Naoto Tani Background: Respiratory syncytial virus (RSV) infection can be fatal in infants younger than 1 year old. However, morphological findings associated with infant death are insufficient, and screening procedures are problematic. The present study aimed to establish a postmortem diagnosis of RSV infection. Material and Methods: Serial forensic autopsies of 55 infants who died suddenly within one year of birth due to viral pneumonia (n = 18), bacterial pneumonia (n = 12), and other diseases and trauma (n = 25), were assessed. Causes of viral pneumonia determined by immunochemical screening and histological staining of airway effusions included RSV (n = 8) and other viruses (n = 10). Results: Bronchial epithelial and inflammatory cells in the interstitium surrounding the bronchioles and alveoli were immunopositive for RSV. Bronchial epithelium was frequently more positive for RSV in patients with viral pneumonia (5/8, 62.5 %) than bacterial pneumonia and other causes of death (7/47, 14.9 %) and intra-alveolar sites were also frequently more positive for viral pneumonia caused by RSV (3/8, 37.5 %) than bacterial pneumonia and other causes of death (4/47, 8.5 %). On the other hand, peribronchiolar interstitial RSV positivity was similar between viral pneumonia caused by RSV (7/8, 87.5 %) and other causes of death (34/47, 72.3 %). Conclusions: The present autopsy study of pulmonary tissue from infants who died suddenly showed that the characteristic distribution of RSV immunopositivity in the bronchial epithelium and intra-alveolar cells, as well P2-39 Zwei Jahre Opferambulanz in Luxemburg -eine erste Bilanz über "umedo" (72) T Seit Juli 2018 steht die Opferambulanz umedo (unité médico-légale de documentation des violences) a an der luxemburgischen Institution für Rechtsmedizin (Département Médecine Légale des LNS) erwachsenen Opfern physischer und/oder sexualisierter Gewalt für niedrigschwellige rechtsmedizinische Untersuchungen und die gerichtsfeste Verletzungsdokumentation und Spurensicherung zur Verfügung. Dass es einen Bedarf für diese staatlich finanzierte Einrichtung gibt, zeigen die aktuellen Zahlen zur häuslichen Gewalt in Luxemburg, wonach 2018 insgesamt 869 Fälle polizeilich bekannt wurden -bei vermutlich deutlich höherer Dunkelziffer. Die Anzahl der tatsächlich durchgeführten Untersuchungen lag gleichmäßig verteilt in den zwei Jahren bei insgesamt 41 (bis einschließlich Juni 2020) und ist somit, jedenfalls bisher, trotz recht hoher medialer Präsenz hinter der Prognose von 50 bis 100 Fällen im Jahr zurückgeblieben. Opfer sexualisierter Gewalt waren gegenüber Opfern physischer Gewalt in der Minderzahl, Männer wurden bisher keine untersucht. Während der Covid-19-bedingten Ausgangssperre war indes eher eine Abnahme als eine Zunahme der Inanspruchnahme von umedo zu beobachten. Grundlage für die Etablierung der Opferambulanz war die Einführung eines eigens für umedo geschaffenen Gesetzes im November 2017. Die hierin festgeschriebenen, insbesondere datenschutzrechtlichen Vorgaben stellen hohe Ansprüche an das Handling der Fälle und die damit verbundene Datenverarbeitung, die sich in den letzten zwei Jahren teilweise als herausfordernd darstellten. In dem Beitrag soll einerseits ein Überblick über die bisherige Inanspruchnahme von umedo gegeben und andererseits auf Probleme und Fallstricke im Zusammenhang mit der Etablierung der Opferambulanz sowie der Umsetzung der rechtlichen Vorgaben eingegangen werden.

215 Fälle im Zeitraum 2005-2018, davon 96 in der Gruppe "Gynäkologie allein" und 119 in der Gruppe "Gynäkologie mit Rechtsmedizin". Studienteilnehmer waren weibliche Personen mit einem Mindestalter von 16 Jahren, welche sich innerhalb einer Woche nach angegebener sexueller Gewalt an eine der oben genannten, erstversorgenden Instanzen wandten. Ergebnisse: Es konnten statistisch signifikante Unterschiede zwischen den zwei Gruppen bei der Untersuchungsdurchführung und -dokumentation aufgezeigt werden. Beispielsweise geht aus den Untersuchungsprotokollen der "Gynäkologie allein" mehrheitlich nicht hervor, welche extragenitalen Körperpartien genau untersucht wurden. So wurde in dieser Gruppe die Untersuchung der oberen Extremitäten in 44 % der Fälle dokumentiert, hingegen in der Gruppe "Gynäkologie mit Rechtsmedizin" in 95 % (p<.001). Weitere Ergebnisse werden vorgestellt. Schlussfolgerung: Die Unterschiede in der nachvollziehbaren Dokumentation und Beweissicherung verdeutlichen den Bedarf einer rechtsmedizinischen Unterstützung, einer weiteren Standardisierung und der Einführung qualitätssichernder Maßnahmen bei der Untersuchung von Vergewaltigungsopfern. Einleitung: Die Versorgung von Gewaltbetroffenen ist in Deutschland nicht einheitlich geregelt. Erfolgt unmittelbar nach dem Übergriff eine Strafanzeige, wird fallabhängig eine rechtsmedizinische Untersuchung der betroffenen Person mit nachfolgender Gutachtenerstattung seitens der Ermittlungsbehörden beauftragt. Viele rechtsmedizinische Institute haben Versorgungsstrukturen geschaffen, um in Fällen körperlicher und sexualisierter Gewalt von Erwachsenen und Kindern auch ohne Strafanzeige eine gerichtsverwertbare Befunderhebung anzubieten. Methoden: Um den aktuellen Stand rechtsmedizinsicher Modelle der Gewaltopferversorgung zu erfassen, wurde durch die AG Klinische Rechtsmedizin eine onlinebasierte Umfrage mittels "SoSci Survey" an rechtsmedizinischen Instituten in Deutschland durchgeführt. Die Befragung umfasste Angaben zur Projektstruktur, zum Leistungsangebot und Versorgungsgebiet, zur Finanzierung sowie zu Vor-und Nachteilen der Projekte bzw. Verbesserungsvorschläge. Ergebnisse: Wir erhielten Rückmeldung von 16 Projekten aus 14 Bundesländern, die federführend unter der Leitung der Rechtsmedizin stehen. Nahezu alle Projekte bieten ein umfassendes Angebot an körperlichen Untersuchungen im rechtsmedizinischen Institut, an eigenen und peripheren Standorten, Lagerung von Asservaten, Beratungen sowie ein umfassendes Fortbildungsangebot. Etwa die Hälfte der Projekte hat zusätzlich koordinierende Funktion, wobei die Untersuchungen durch Kooperationspartner durchgeführt werden. Der Großteil der Projekte wird über öffentliche Mittel finanziert, dennoch erfolgt die Finanzierung in 9 Projekten ausschließlich oder zusätzlich aus eigenen oder sonstigen Mitteln. 10 Projekte sind zudem befristet oder Modellprojekte. Diskussion: Rechtsmedizinische Institute bieten in nahezu allen Bundesländern ein umfassendes niederschwelliges Angebot auf einem hohen fachlichen Qualitätsniveau. Die Finanzierungsmodelle sind allerdings sehr heterogen, häufig befristet und nicht auskömmlich. Die rechtsmedizinische Expertise wird auf Wunsch der Geldgeber häufig leichtfertig ausgelagert, wodurch ein gerichtsverwertbarer Standard oft nicht gegeben ist. Um die Versorgung von Gewaltopfern entsprechend der neuen Bestimmungen des Bundestages langfristig auf hohem Niveau zu gewährleisten, ist eine bundesweite Stärkung der Rolle der Rechtsmedizin in der Versorgung von Gewaltopfern, politische Unterstützung sowie auskömmliche Finanzierung dringend zu fordern.

Age, and Educational Level Attribute to Blood Alcohol Concentration in Hospitalized Intoxicated Adolescents

Changing Pattern of Acute Alcohol Intoxications in Children

Alcohol intoxication in hospitalized young teenagers

Needle placement accuracy in CT-guided robotic post mortem biopsy

An approach for needle based optical coherence elastography measurements

Aim: Phenylacetylglutamine is known as uremic materials produced by the enterobacillus. We are researching the meaning of urinary PAG in forensic autopsy cases. It reports on the assay method of urinary PAG and the analyzing forensic autopsy cases. Materials and Methods: Sample preparation; Urine 0.1 mL and deionized water 0.3 ML, Internal standard solution (PAG-d5 and caffeine-d3), and urease solution 0.04 mL were mixed. After 30 minutes, acetonitrile 2 mL and acetate 0.05 ML were mixed, and the extraction column was passed. Continuously, acetonitrile 2 mL and sal volatile 0.1 mL (CBA) or 2M hydrochloric acid 0.1 mL (SAX) mixture was thrown. The passage liquid was collected to the glass test tube that put acetate 0.3 mL. Samples were concentrated and dewatered under the nitrogen stream. The residue was dissolved to methanol/propyl acetate (5/1), and was analyzed with GC-MS. Assay condition: Column; ZB-SemiVoltiles/BPX5 tandem column. Urinary PAG and Cr concentration were measured from forensic autopsy (64 cases) within 48 hours of postmortem interval (PMI), and the healthy adults (6 cases). Results and discussion: A stable result was obtained by our urinary PAG analysis method. Urinary PAG in the healthy adult was 204.5 ± 128.8mi-croG/mL (mean±standard deviation). In forensic autopsy cases, urinary PAG, Cr, and PAG/Cr concentration was 95-436maicroG/mL, 92-185 mg/ dL, and 0.063-0.236 mg, respectively. Relation among urine PAG concentration, age, sex, PMI, and duration from failure to death was statistically analyzed by using the comparison between the correlation coefficient and the crowd. The significant difference was not admitted in the sex though a weak positive correlation was admitted between urine PAG and the age. Urinary PAG, 333.3microG/mL (mean+ SD) or more was classified as abnormal group, and 462.1microG/mL (mean+ 2SD) or more classified as advanced abnormal group. Urinary PAG abnormal groups were 5 among 64 cases made a research object, and all were an advanced abnormal groups (477-863microG/mL). In basic data and 1) sex, 2) age, 3) PMI, 4) duration from failure to death, and 5) cause of death, a clear feature was not admitted. It will work on the clarification of the factor that urine PAG/Cr and urinary PAG concentration show abnormality in the future. Abstracts tersuchung verstarb der Suizident an einem akuten Herzpumpversagen bei Herzdurchschuss. Ein beruflicher oder ein privater Bezug zu Schusswaffen konnte nicht hergestellt werden, so dass die Herkunft der Patronen unklar blieb.

Y. Kolev 1 , P. Petrov 2 , I. Kavaldzhiev 3 1 Department of Forensic medicine, District Hospital MBAL, Gabrovo, Bulgaria; 2 Cardiac Surgery, Acibadem City Clinic Cardiac Surgery Hospital Burgas, Burgas, Bulgaria; 3 Vascular Surgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria Survival after heart penetration by a gunshot bullet is a rare incident. The clinical presentation of a penetrating cardiac injury depends on several factors, such as the type of the object, size of the wound, structures damaged, the presence of hemopericardium, and associated noncardiac injuries. The case presented is about an accident during hunting where a 45-years old man sustained one gunshot wound to the thorax. After the transportation to the nearest district hospital, CT evaluation revealed a bullet embedded in the heart, patient being stable. In a state of emergency, cardiac surgery was performed and a 9 mm gunshot pellet was found penetrating the left ventricle wall, which entered the ventricle in the beginning of surgery. The cardiac wall was successfully repaired and the patient was moved in a good condition to another hospital for further vascular surgery-to remove the migrated pellet, causing embolization of abdominal aorta at the level of Th10. After the surgery the patient recovered and was asymptomatic. The chest and abdomen CT scan and CT angiography were very helpful for forensic reconstruction of the ballistics of the accident, for the needs of the legal investigation of the case. Keywords: gunshot wound, cardiac penetration, arterial bullet embolization, CT-reconstruction, ballistics, forensic imaging Die Abbremsung eines Geschosses in Gelatineblocks von 12 cm Länge liess sich mithilfe einer Hochgeschwindigkeitskamera von Bild zu Bild darstellen [1] . Dabei zeigten sich jedoch Grenzen der örtlichen Auflösbarkeit, so dass lediglich eine quasi konstante Abbremsung von formstabilen Geschossen festgestellt werden konnte. Um die tatsächliche Abbremsung genauer darstellen zu können, wurde ein Scheibenmodell erprobt. Gelatineblöcke von 1 bis 12 cm Länge wurden mit Vollmantelmunition (n = 62) und mit Deformationsgeschossen Action-4 (n = 43) aus einer Pistole Glock 17 im Kaliber 9 mm Luger beschossen und mit einer SA-X2 Hochgeschwindigkeitskamera (Photron), 40.000 Bildern pro Sekunde und 2,5 µs Belichtungszeit, dokumentiert. Anhand der skalierten Bilder wurden mit AxioVision SE 64 Rel. 4.9 (Zeiss) die Geschossgeschwindigkeit vor und hinter dem Block berechnet. Die Blöcke wurden nach Beschuss längs aufgeschnitten und die Schusskanallänge auf ±1 mm vermessen. Die 8 g schweren Vollmantelgeschosse (n = 32) wiesen Geschwindigkeiten von 318-343 m/s und eine lineare Abbremsung sowie eine entsprechende Energieabgabe auf. 30 Schuss 10,2 g schwere subsonic Vollmantelmunition hatten einen Geschwindigkeitsmedian von 268 m/s und zeigten eine ähnliche Charakteristik. Die Anfangsgeschwindigkeiten der Action-4 Deformationsgeschosse (6,1 g) variierten zwischen 389 und 435 m/ s. Die Geschwindigkeitsabnahme zeigte einen linearen Zusammenhang mit der Durchdringungsstrecke, während sich die absolute Energieabgabe am besten durch einen logarithmischen Verlauf darstellen liess. Die vorgestellte Vorgehensweise ist zwar aufwändig, verspricht jedoch genauere Referenzkurven der Abbremsung resp. Energieabgabe für das jeweilige Geschoss. Lethal ketoacidosis is observed in chronic alcohol abuse, derailed diabetes mellitus or lethal hypothermia. In cases of ketoacidosis, vacuole changes in the epithelium of the proximal renal tubules can be observed. Meanwhile it has been proven that subnuclear vacuolization is found not only in alcoholics but also in diabetic coma and hypothermia.

In this study measurements of the ketone body betahydroxybutyrate were performed in a collective of deaths related to chronic alcoholics, diabetics, hypothermia, combinations of them as well as controls. Beta-hydroxybutyrate was mainly analyzed in vitreous humor, partly in cerebrospinal fluid or femoral venous blood. Histological examinations of the kidneys were carried out using HE-, Sudan-, and PAS-Staining to allow differentiation between lipids and glycogens. Measured ketone body concentrations were then correlated with the degree of Sudan-stainability in the renal tissue.Results: Comparing the concentrations of beta-hydroxybutyrate with the degree of Sudan-stainability, a clear correlation was found: the higher the degree of subnuclear, lipid-containing vacuolization, the higher the detected ketone body concentration. In the control group, in most cases ketone bodies were measured in physiological concentrations and no or only a low degree of vacuolization was observed.

The results show a close correlation between the ketone body concentration and the degree of subnuclear vacuolization. However, there was also one person in the study who, despite the presence of a pathological ketone body value, did not show any vacuolization and, vice versa, there was one person who, despite a low ketone body concentration, showed moderate vacuolization. Therefore, histological examination alone does not seem to be reliable. In the case of a morphologically unexplainable cause of death, still, this finding could be the reason for a specific determination of ketone bodies to clarify the cause of death. The purpose of this study was to investigate, from the perspective of cytokines and structural proteins, differences in the pathology of central nervous system (CNS) disorders associated with hyperthermia in abnormal temperature environments and those due to CNS stimulants, mainly stimulant drugs. Materials and methods: Using 87 autopsy cases, the concentrations of interleukin (IL)-6, IL-8, neuron-specific enolase (NSE), and myelin basic The victims most often referred to the Federal Forensic Medical Center or those Non-state without jurisdiction with the Ministry of Health as the venue for the repeated examination. In the first case, the examination is free, and the execution time is from two to three years. In the second, the deadlines are several months, with an average cost of 150,000 Russian rubles.

The increase in the total number of forensic medical examination commissions is associated with several systemic problems in conducting examinations in-state expert institutions, such as refusal to examine by an investigator from other regions, long production periods, the need to pay for the work of involved specialists, and the lack of uniform approaches to organizing the examination such examinations, the variability of conclusions in assessing the presence of defects in the provision of medical care and their causal relationship with an adverse outcome.