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Toi T, Tsuneya S, Inokuchi G, Chiba F, Hoshioka Y, Nagasawa S, Yoshida M, Yamaguchi R, Torimitsu S, Inoue H, Motomura A, Yajima D, Makino Y, Iwase H. Characteristics of indoor and outdoor fatal hypothermia cases in Chiba, Japan. Leg Med (Tokyo) 2024; 71:102494. [PMID: 39067244 DOI: 10.1016/j.legalmed.2024.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/29/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
In forensic medicine, hypothermia is a frequently encountered cause of death, and this characteristic provides public health information to prevent similar deaths in the future. Previous studies revealed regional differences in hypothermia occurrence (indoors or outdoors). However, to our knowledge, no recent studies in Japan have directly compared the characteristics of indoor- and outdoor-onset cases based on forensic autopsy reports. Hence, this study aimed to determine the characteristics and risks of unexpected hypothermia-related death. It included 218 cases from the Chiba Prefecture, Japan, wherein forensic autopsies were performed and hypothermia was diagnosed; these cases were categorized into indoor- and outdoor-onset cases, and their characteristics were examined. The results showed no significant differences between the two groups in relation to the age of onset or residential environment (i.e., the presence or absence of cohabitants). The outdoor-onset group tended to have a higher incidence of dementia. Regarding the causes of hypothermia, the indoor group had more internal causes (p < 0.0001), whereas the outdoor group had more primary and external causes (p < 0.0001 and p = 0.0029, respectively). The indoor group was more undressed than the outdoor group. Atypical antipsychotic components were predominantly detected in the blood in the outdoor group (p = 0.0077). The body mass index tended to be lower in the indoor group than in the outdoor group. Broadening public awareness of the present study findings may aid in developing preventative strategies for hypothermia based on the location of onset.
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Affiliation(s)
- Toki Toi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Shigeki Tsuneya
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Sayaka Nagasawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroyuki Inoue
- Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, Kozunomori 4-3, Narita City, Chiba 286-8686, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, Kozunomori 4-3, Narita City, Chiba 286-8686, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, Kozunomori 4-3, Narita City, Chiba 286-8686, Japan
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Tsuneya S, Nakajima M, Yoshida M, Hoshioka Y, Chiba F, Inokuchi G, Torimitsu S, Iwase H. Detection of diatoms in a case of mud aspiration at a coastal area. Leg Med (Tokyo) 2024; 66:102354. [PMID: 37988879 DOI: 10.1016/j.legalmed.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
The source of diatoms detected in non-drowned bodies have been attributed to postmortem invasion, contamination during autopsy or diatom testing, or "natural load." However, sand aspiration has not been reported as a source. Herein, we report an autopsy case in which diatoms were detected in a non-drowned human who had aspirated mud. A man in his 60 s was found dead at a harbor park in Japan. His whole body was covered with sand, including his face. A situational investigation suggested that he may have entered the sea. Autopsy revealed intratracheal mud, with no obvious findings indicating drowning, suggesting that he died from mud aspiration probably due to hypothermia or non-lethal ethanol intoxication. In the diatom test, 10-100 diatoms/g were detected in bilateral lung samples, which were similar to those found in the intraoral and intratracheal mud and the sand samples from around the discovery site and not similar to those found in the seawater samples. The diatoms in the stomach content exhibited an intermediate trend between those found in the sand and seawater. Therefore, careful qualitative and quantitative analyses are required to differentiate between true drowning and false-positives in non-drowning cases to determine the cause of death.
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Affiliation(s)
- Shigeki Tsuneya
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Makoto Nakajima
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Objective evaluation of chest findings in infants by postmortem computed tomography. Leg Med (Tokyo) 2023; 60:102178. [PMID: 36495780 DOI: 10.1016/j.legalmed.2022.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/31/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to review the findings of computed tomography (CT) performed early postmortem on infants and to clarify the postmortem CT lung findings that occur in the absence of abnormal histopathological findings. MATERIALS AND METHODS From July 2016 to March 2022, 72 infants were autopsied with postmortem CT (41 boys 31 girls, aged 0-36 (mean 8.2) months). Autopsy and postmortem CT lung findings were compared with the causes of death identified by the autopsies, namely sudden infant death syndrome (n = 37), acute circulatory system disease (18), drowning (7), asphyxia (5), and dehydration/undernutrition (5). RESULTS The %aerated lung volume (-700 HU or less) ranged from 0 % to 33 % (mean 1.5 %, median 0 %), being <1 % in 61 cases (84.7 %) and >3 % in 3/5 (60 %) of the dehydration/undernutrition group. The dehydration/undernutrition group showed significant preservation of lung field air content compared with the other causes of death groups (p < 0.05). Receiver characteristic curve analysis showed a cut off value of 0.8 % and area under the curve of 0.88806. The drowning group had significantly greater pleural cavity fluid retention than the other causes of death groups (p < 0.05). No correlation was found between postmortem interval and pleural cavity fluid retention. However, resuscitation time and pleural cavity fluid retention were correlated. CONCLUSION Evaluation of CT values on postmortem lung fields of infants usually reveals a marked decrease in air content. When air content exceeds 0.8% on infant postmortem CT, dehydration/undernutrition should be considered in the differential diagnosis.
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Tokue H, Sano R, Takahashi Y, Hayakawa A, Fukuda H, Tokue A, Kominato Y, Tsushima Y. Hypothermic death resulting from extreme freezing with characteristic postmortem computed tomography findings: A case report and review of the literature. Radiol Case Rep 2023; 18:1423-1426. [PMID: 36798068 PMCID: PMC9925835 DOI: 10.1016/j.radcr.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023] Open
Abstract
We report a case of hypothermic death that resulted from extreme freezing, with characteristic postmortem computed tomography (PMCT) findings. A 75-year-old man died in a deeply frozen state. In PMCT, there was a lack of increase in the bilateral lung-field attenuation. Urinary retention, with a hypodense area of frozen urine, was observed in the bladder. Changes that appeared to involve the crystallization of serum in frozen blood were observed in the aorta. Based on the scene and his circumstances, it was speculated that he died of hypothermia. Present case and our review revealed that although PMCT findings from hypothermic death that resulted from deep freezing are very rare, the characteristic PMCT findings may help determine the cause of death.
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Affiliation(s)
- Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511 Japan
- Corresponding author.
| | - Rie Sano
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Haruki Fukuda
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Azusa Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511 Japan
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Ikeda-Murakami K, Ikeda T, Tani N, Aoki Y, Ishikawa T. Sudden child death with acute encephalitis due to human herpesvirus 7: A case report and review of the literature. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2022. [DOI: 10.1016/j.fsir.2021.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kasagawa A, Usui A, Kawasumi Y, Funayama M, Saito H. Block-like and cast-like hyperdense areas in the right heart cavities on post-mortem CT strongly suggest the presence of intracardiac blood clots at autopsy. Eur Radiol 2021; 31:8879-8886. [PMID: 34100997 DOI: 10.1007/s00330-021-08052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/25/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To classify the types of hyperdense areas in the heart cavities on post-mortem CT (PMCT) and compare them according to the presence of blood clots in the heart cavities at forensic autopsy. METHODS One hundred and twelve cases with CT images taken before forensic autopsy were evaluated. The presence and shape of hyperdense areas in the right or left heart cavities were retrospectively evaluated on PMCT images and were classified into four types (block-like, cast-like, fluid level-like, and unclear). The presence of blood clots was confirmed when there were clots in the heart cavities at forensic autopsy. RESULTS Of the 112 cases, 57 exhibited blood clots in the heart cavities at forensic autopsy. The hyperdense areas in the right heart cavities on PMCT in 57 cases exhibiting blood clots at forensic autopsy were classified as follows: block-like, 32; fluid level-like, 4; cast-like, 17; and unclear, 4. The sensitivity of block-like and cast-like hyperdense areas in the right heart cavities on PMCT for the presence of clots in the heart cavities at forensic autopsy was 86% (95% confidence interval [CI]: 74-94%); the corresponding specificity, PPV, and NPV were 95% (95% CI: 85-99%), 94% (95% CI: 84-99%), and 87% (95% CI: 75-94%), respectively. CONCLUSION Block-like and cast-like hyperdense areas in the right heart cavities on PMCT predicted the presence of intracardiac blood clots at forensic autopsy. KEY POINTS • Clinical radiologists likely have no experience of interpreting findings of blood clots on post-mortem CT (PMCT). • The appearance of blood clots on PMCT provides important clues for diagnosing the cause and process of death. • The shapes of the hyperdense areas in the heart cavities were classified into four types, and two of these types could be used to predict the presence of blood clots in the heart cavities at forensic autopsy.
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Affiliation(s)
- Akito Kasagawa
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Akihito Usui
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Yusuke Kawasumi
- Department of Clinical Imaging, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masato Funayama
- Department of Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Haruo Saito
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Kniep I, Heinemann A, Edler C, Sperhake JP, Püschel K, Ondruschka B, Schröder AS. COVID-19 lungs in post-mortem computed tomography. Rechtsmedizin (Berl) 2021; 31:145-147. [PMID: 33612977 PMCID: PMC7884063 DOI: 10.1007/s00194-021-00462-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/24/2022]
Abstract
Post-mortem computed tomography (PMCT) is a rapid and noninvasive diagnostic tool for important contributions to the identification of pulmonary findings in the deceased with pneumonia, including cases of coronavirus disease 2019 (COVID-19). Although computed tomography (CT) shows a high sensitivity for pneumonia in living persons, it is relatively unspecific for COVID-19 pneumonia clinically. Typical CT findings for viral pneumonia therefore require confirmation by PCR tests (polymerase chain reaction tests), even if lung infections with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) show characteristic patterns, most frequently ground glass opacities (GGO) and a combination of GGO and air space consolidations. In the consecutive autopsy series of SARS-CoV‑2 deaths from Hamburg, Germany, the most frequent cause of death was and still is COVID-19 pneumonia. Typical findings were frequently found in the PMCT in SARS-CoV-2-associated deaths, which were taken into account when classifying the death as COVID-19.
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Affiliation(s)
- I Kniep
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - A Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - C Edler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - J P Sperhake
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - K Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - A S Schröder
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
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Kondou H, Tsuboi H, Takazakura R, Nakamura M, Bandou R, Ichioka H, Idota N, Ikegaya H. Diagnosis of sudden death using postmortem CT. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Homma N, Zhang X, Qureshi A, Konno T, Kawasumi Y, Usui A, Funayama M, Bukovsky I, Ichiji K, Sugita N, Yoshizawa M. A Deep Learning Aided Drowning Diagnosis for Forensic Investigations using Post-Mortem Lung CT Images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1262-1265. [PMID: 33018217 DOI: 10.1109/embc44109.2020.9175731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Feasibility of computer-aided diagnosis (CAD) systems has been demonstrated in the field of medical image diagnosis. Especially, deep learning based CAD systems showed high performance thanks to its capability of image recognition. However, there is no CAD system developed for post-mortem imaging diagnosis and thus it is still unclear if the CAD system is effective for this purpose. Particulally, the drowning diagnosis is one of the most difficult tasks in the field of forensic medicine because findings of the post-mortem image diagnosis are not specific. To address this issue, we develop a CAD system consisting of a deep convolution neural network (DCNN) to classify post-mortem lung computed tomography (CT) images into two categories of drowning and non-drowning cases. The DCNN was trained by means of transfer learning and performance evaluation was conducted by 10-fold cross validation using 140 drowning cases and 140 non-drowning cases of the CT images. The area under the receiver operating characteristic curve (AUC-ROC) for the DCNN was achieved 0.88 in average. This high performance clearly demonstrated that the proposed DCNN based CAD system has a potential for post-mortem image diagnosis of drowning.
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Giorgetti A, Mogler L, Halter S, Haschimi B, Alt A, Rentsch D, Schmidt B, Thoma V, Vogt S, Auwärter V. Four cases of death involving the novel synthetic cannabinoid 5F-Cumyl-PEGACLONE. Forensic Toxicol 2019. [DOI: 10.1007/s11419-019-00514-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
Purpose
Cumyl-PEGACLONE was the first synthetic cannabinoid (SC) with a γ-carbolinone core structure detected in forensic casework and, since then, it has dominated the German SC-market. Here the first four cases of death involving its fluorinated analog, 5F-Cumyl-PEGACLONE, a recently emerged γ-carbolinone derived SC, are reported.
Methods
Complete postmortem examinations were performed. Postmortem samples were screened by immunoassay, gas chromatography mass spectrometry (GC–MS) or liquid chromatography tandem mass spectrometry. For quantification of SCs, the standard addition method was employed. Herbal blends were analyzed by GC–MS. In each case of death, the Toxicological Significance Score (TSS) was assigned to the compound.
Results
5F-Cumyl-PEGACLONE was identified at concentrations ranging 0.09–0.45 ng/mL in postmortem femoral blood. In case 1, signs of hypothermia and kidney bleedings were noted. Despite a possible tolerance due to long term SC use, a TSS of 3 was assigned. In case 2, an acute heroin intoxication occurred and a contributory role (TSS = 1) of 5F-Cumyl-PEGACLONE was suggested. In case 3, a prisoner was found dead. GC–MS analysis of herbal blends, retrieved in his cell together with paraphernalia, confirmed the presence of 5F-Cumyl-PEGACLONE and a causative role was deemed probable (TSS = 2). In case 4, the aspiration of gastric content due to a SC-induced coma was observed (TSS = 3).
Conclusions
5F-Cumyl-PEGACLONE is an emerging and extremely potent SC which raises serious public health concerns. A comprehensive analysis of circumstantial, clinical, and postmortem findings, as well as an in-depth toxicological analysis is necessary for a valid interpretation and for the assessment of the toxicological significance.
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Lin H, Guo X, Luo Y, Chen Y, Zhao R, Guan D, Wang Z, Huang P. Postmortem Diagnosis of Fatal Hypothermia by Fourier Transform Infrared Spectroscopic Analysis of Edema Fluid in Formalin-Fixed, Paraffin-Embedded Lung Tissues. J Forensic Sci 2019; 65:846-854. [PMID: 31868923 DOI: 10.1111/1556-4029.14260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 12/29/2022]
Abstract
The goal of this study was to investigate whether pulmonary edema could become a specific diagnostic marker for fatal hypothermia using Fourier transform infrared (FTIR) spectroscopy in combination with chemometrics. The spectral profile analysis indicated that hypothermia fatalities associated with pulmonary edema fluid contained more β-sheet protein conformational structures than the control causes of death, which included sudden cardiac death, brain injury, cerebrovascular disease, mechanical asphyxiation, intoxication, and drowning. Subsequently, the results of principal component analysis (PCA) further revealed that the content of β-sheet protein conformational structures in the pulmonary edema fluid was the main discriminatory marker between fatal hypothermia and the other causes of death. Ultimately, a robust postmortem diagnostic model for fatal hypothermia using a partial least-squares discriminant analysis (PLS-DA) algorithm was constructed. Pulmonary edema fluid spectra collected from eight new forensic autopsy cases that did not participate in the construction of the diagnostic model were predicted using the model. The results showed the causes of death of all these eight cases were correctly classified. In conclusion, this preliminary study demonstrates that FTIR spectroscopy in combination with chemometrics could be a promising approach for the postmortem diagnosis of fatal hypothermia.
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Affiliation(s)
- Hancheng Lin
- Department of Forensic Pathology, Xi'an Jiaotong University, Xi'an, 710061, China.,Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China
| | - Xiangshen Guo
- Forensic Medicine School, China Medical University, Shenyang, 110122, China
| | - Yiwen Luo
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China
| | - Yijiu Chen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China
| | - Rui Zhao
- Forensic Medicine School, China Medical University, Shenyang, 110122, China
| | - Dawei Guan
- Forensic Medicine School, China Medical University, Shenyang, 110122, China
| | - Zhenyuan Wang
- Department of Forensic Pathology, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China
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Fatal obstructive asphyxia: Trans-pulmonary density gradient characteristic as relevant identifier in postmortem CT. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jofri.2019.100337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Morikawa K, Hyodoh H, Matoba K, Mizuo K, Okazaki S, Watanabe S. Time-related change evaluation of the cerebrospinal fluid using postmortem CT. Leg Med (Tokyo) 2016; 22:30-5. [DOI: 10.1016/j.legalmed.2016.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
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Hyodoh H, Ogura K, Sugimoto M, Suzuki Y, Kanazawa A, Murakami R, Shimizu J, Rokukawa M, Okazaki S, Mizuo K, Watanabe S. Frozen (iced) effect on postmortem CT – Experimental evaluation. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jofri.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Palmiere C, Teresiński G, Hejna P. Postmortem diagnosis of hypothermia. Int J Legal Med 2014; 128:607-14. [DOI: 10.1007/s00414-014-0977-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/04/2014] [Indexed: 11/24/2022]
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17
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Assisted suicide and killing of a household pet: pre-autopsy post-mortem imaging of a victim and a dog. Forensic Sci Med Pathol 2013; 10:122-5. [DOI: 10.1007/s12024-013-9498-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
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