Traumatic fractures in an early 19th century museum skeleton suggest the homicide of an old Munich character: the history of "Finessensepperl" (Finesse Joseph)

The well preserved skeleton of Joseph Huber, a very well-known historical character of the 19th century Munich, also nicknamed "Finessen-Sepperl", is the starting point of the reconstruction of life and death of this historical individual. He was known as a postilion d´amour (love's messenger) of the Royal Bavarian capital with numerous comments and anecdotes and a few biographical sketches that indicate he remained well until the last few years of his life where requests for his duties lessened. The skeleton shows a small-sized male individual with almost complete loss of teeth, but otherwise very well-mineralized bone, having suffered from three episodes of trauma - an old-healed incomplete femoral neck fracture leading to severe osteoarthrosis, a clavicle fracture of the medial third with a few weeks old callus formation, and fresh serial rib fractures along with severe skull trauma with fractures of the os temporale and petrosum, presumably leading to intracranial bleeding and finally death. The type and distribution of these latter two injuries are in agreement with a murderous attack - which was retrospectively reported several years after his death, while the old-healed femoral neck fracture may have caused reduction in Joseph´s walking activities but not reduced requests for his services. Paleopathology not only identifies the terminal decline, but also previous diseases of this Old Bavarian character and thereby completes his story.

Isotopic analysis of formula milk reveals potential challenges in geolocating bottle-fed babies

In forensic investigations involving the identification of unknown deceased individuals, isotope analysis can provide valuable provenance information. This is especially pertinent when primary identifiers (i.e., DNA, dactyloscopy, etc.) fail to yield matches. The isotopic composition of human tissues is linked to that of the food consumed, potentially allowing the identification of regions of origin. However, the isotopic composition of deceased newborns and infants fed with milk formula may be influenced by that of the prepared milk. The findings contribute towards the possibility to isotopically identify bottle-fed infants. More importantly, the data convincingly show that the Sr isotope composition of the prepared milk is determined by that of the formula and not the (local) tap water, thereby limiting the potential of Sr isotope analysis for determining the geological or geographical origin in formula-fed babies in medico-legal cases.

Holiday trip to Norway - a stable isotope project on hair strands of individuals of a travel group from Bavaria

Hair strands were taken from individuals of a travel group from Bavaria that stayed on the Lofoten Islands/Norway for 3 weeks. By means of serial stable isotope analyses of carbon, nitrogen, sulphur and hydrogen along the hair strands, food-specific changes during travel could be detected. The higher consumption of marine fish led to significant changes of the stable isotope values of nitrogen, sulphur and hydrogen. The highest differences for the values were found in the most proximal part of hair strands which were taken shortly after the trip. The basic values for the isotope distribution of the elements in the hair also indicate specific diets of some individuals that could be confirmed upon request.

Identification of a female murder victim found in Burgenland, Austria in 1993

In 1993, the skeletal remains of a female corpse were found in Burgenland, Austria. Initial identification of the approximately 25–35-year-old female appeared impossible, but the case was reopened 23 years later. By applying biogeochemical isotope methods to her body tissues, the geographical origin of the unknown corpse could be predicted. The results of the C, N, S, H, Sr, and Pb isotope analyses suggested that the female did not originate from Europe and most likely spent her youth in the northern Caribbean. Using these findings, the police were able to identify the woman within 2 weeks. The female came from the Dominican Republic and resided in Austria for only a short period before she was murdered. This case shows that isotope biogeochemistry investigations can provide the police with crucial information that enables unknown persons to be identified.

Keypoints

C-N-S-H and Sr-Pb isotope analyses were applied to human remains associated with a cold case.

It was possible to determine the region of origin of the unknown deceased individual as the northern Caribbean.

After 23 years, the murder victim was successfully identified.

Chronic active non-lethal human-type tuberculosis in a high royal Bavarian officer of Napoleonic times-a mummy study

In paleopathology, morphological and molecular evidence for infection by mycobacteria of the M. tuberculosis complex (MTC) is frequently associated with early death. In the present report, we describe a multidisciplinary study of a well-preserved mummy from Napoleonic times with a long-standing tuberculous infection by M. tuberculosis senso stricto who died at the age of 88 years of focal and non-MTB related bronchopneumonia. The well-preserved natural mummy of the Royal Bavarian General, Count Heinrich LII Reuss-Köstritz (1763–1851 CE), was extensively investigated by macro- and histomorphology, whole body CT scans and organ radiography, various molecular tissue analyses, including stable isotope analysis and molecular genetic tests. We identified signs for a long-standing, but terminally inactive pulmonary tuberculosis, tuberculous destruction of the second lumbar vertebral body, and a large tuberculous abscess in the right (retroperitoneal) psoas region (a cold abscess). This cold abscess harboured an active tuberculous infection as evidenced by histological and molecular tests. Radiological and histological analysis further revealed extensive arteriosclerosis with (non-obliterating) coronary and significant carotid arteriosclerosis, healthy bone tissue without evidence of age-related osteopenia, evidence for diffuse idiopathic skeletal hyperostosis and mild osteoarthrosis of few joints. This suggests excellent living conditions correlating well with his diet indicated by stable isotope results and literary evidence. Despite the clear evidence of a tuberculous cold abscess with bacterioscopic and molecular proof for a persisting MTC infection of a human-type M. tuberculosis strain, we can exclude the chronic MTC infection as cause of death. The detection of MTC in historic individuals should therefore be interpreted with great caution and include further data, such as their nutritional status.

Stable isotope relationships between apatite phosphate (δ18 O), structural carbonate (δ18 O, δ13 C), and collagen (δ2 H, δ13 C, δ15 N, δ34 S) in modern human dentine

RATIONALE

The use of multi-isotopic analysis (δ² H, δ¹³ C, δ¹⁵ N, δ¹⁸ O, and δ³⁴ S values) of modern human body tissues for provenancing of unknown individuals in forensics is increasing. Tooth dentine develops during childhood and adolescence, therefore providing geographical information from that period of life. Tooth apatite δ¹⁸ O values are commonly used for the reconstruction of drinking water values, and H-C-N-S isotope ratios in collagen supply additional information about the composition of diet. We tested if dentine collagen δ² H values provide similar information to apatite δ¹⁸ O values with a proof-of-concept study.

METHODS

Tooth samples were taken from modern-day individuals born in different regions of the world. Apatite and collagen were prepared from dentine. Stable isotope analyses were performed on apatite phosphate oxygen (δ¹⁸ O_phos ); oxygen and carbon of the structural carbonate (δ¹⁸ O_carb , δ¹³ C_carb ); and hydrogen, carbon, nitrogen, and sulfur of the collagen (δ² H_coll, δ¹³ C_coll , δ¹⁵ N, δ³⁴ S).

RESULTS

δ¹⁸ O_phos , δ¹⁸ O_carb , and δ² H_coll values are highly correlated in modern human dentine. There are significant relationships of δ¹⁸ O values in the apatite fraction and δ² H values in the collagen fraction with local δ¹⁸ O and δ² H precipitation values, respectively. Pearson correlation coefficients indicate no direct relationship between δ¹⁵ N values and the isotope ratios of any other element. Weak relationships exist between collagen δ³⁴ S values and δ¹⁸ O_carb or δ¹⁸ O_phos values.

CONCLUSIONS

The highly significant correlation of δ¹⁸ O_phos , δ¹⁸ O_carb , and δ² H_coll values in the modern human dentine implies that measurement of δ² H values in collagen or δ¹⁸ O values in bioapatite will provide reliable information about the climate at the person's whereabouts.

Abstract P4-10-06: Influence of older age on triple negative breast cancer (TNBC) clinical-pathological characteristics and outcomes

Background: The impact of age at diagnosis on clinical presentation and treatment delivery for triple negative breast cancer (TNBC) is unclear. Utilizing data from a prospective registry, the aim of this study was to further elucidate the age-dependent correlation between TNBC clinical-pathological features, and the implications of age-bias on treatment delivery and prognosis.

Methods: 480 subjects with stage I-III TNBC were enrolled in an IRB approved multisite prospective registry between 2011 and 2016. Clinical, demographic, treatment information was collected and patients were followed for recurrence and survival. Patients were categorized as older (>60 years) or younger groups (<60 years). Recurrence free survival (RFS) and overall survival (OS) were estimated according to the Kaplan-Meier method and compared among groups by log-rank test.

Results: 145 (30%) of 480 TNBC patients were older (> 60 years) at time of diagnosis. Compared to younger patients, older patients were more likely to present with screen detected vs symptomatic cancer (47% vs 25% p=<0.001), more likely to have node negative cancer (71% vs 61% p=0.030), stage I disease (42% vs 28% p=0.003), and low level (1-10%) ER or PR positivity (19% vs 12% p=0.046). Compared to the younger patients, older patients were less likely to have a BRCA1/2 mutation (6% vs 23% p=0.0002) but more likely to have a prior history of hormone positive breast cancer (7% vs 1% p=0.0002). Compared to younger counterparts, older patients were less likely to receive neo/adjuvant chemotherapy (93% vs 99% p=0.0006), and less likely to receive > 4 cycles of neo/adjuvant chemotherapy (61% vs 78%, p=0.0003). Three year RFS for the entire cohort was 80% and was identical for older and younger patients at 80%. Three year OS for the entire cohort was 87% and was similar for older and younger patients. On multivariable analysis only tumor size and nodal status significantly impacted RFS.

Conclusions: A significant fraction (30%) of TNBC patients are older (> 60 years) at time of diagnosis. Despite presenting a with more favorable disease stage, older TNBC patients did not demonstrate better outcomes compared to the higher risk younger patients. The underlying reasons for this observation may be tumor biology differences between older and younger TNBC patients or perhaps could be related to underutilization of appropriate systemic chemotherapy (39% of older patients received < 4 cycles of chemotherapy). Further studies are warranted on this subject.

Citation Format: Mina A, Lehn C, Wang YY, Klemp JR, O'Dea AP, Elia M, Hoffmann M, Crane G, Sheehan M, Madhusudhana S, Jensen RA, Godwin AK, Khan QJ, Kimler BF, Sharma P. Influence of older age on triple negative breast cancer (TNBC) clinical-pathological characteristics and outcomes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-06.

Abstract P6-11-08: Safety and efficacy results from phase I study of BYL 719 plus nab-paclitaxel in HER 2 negative metastatic breast cancer

Introduction

Mutations/deregulations in the phosphatidylinositol-3-kinase (PI3K) pathway are common in breast cancer, Inhibition of the PI3K pathway is recognized as a promising target for the treatment of breast cancer. Although taxanes are effective early on in advanced stage breast cancer, resistance often develops. It has been demonstrated that activation of the PI3K/AKT pathway confers resistance to paclitaxel, and in preclinical models, concomitant inhibition of the PI3K pathway enhances the efficacy of taxanes. BYL719 is a potent oral, class I PI3K inhibitor which strongly inhibits the PI3K alpha isoforms and is significantly less active against the other class I isoforms. Targeting the alpha isoform of PI3K is expected to improve the therapeutic window over inhibitors with less isoform specificity. Nab-Paclitaxel is a solvent-free, nanoparticle, albumin-based paclitaxel which takes advantage of the antitumor activity of paclitaxel while decreasing the toxicities typically associated with the solvent (Cremophor) used to administer the most common formulation of paclitaxel.

Methods

A 3+3 dose-escalation design evaluated three dose levels of BYL719 (250mg, 300mg, and 350mg) administered PO once daily (D1-28) with nab-Paclitaxel (100 mg/m2 intravenously D 1, 8, 15) every 28 days in patients with metastatic HER 2 negative breast cancer. The aims of the study were to 1) determine the recommended phase II dose (RPTD) of BYL719 + nab-Paclitaxel, 2) assess pharmacokinetics of BYL and nab-paclitaxel, and 3) assess preliminary efficacy.

Results

10 patients were enrolled at 3 dose levels of BYL719 and 3 patients were enrolled in expansion cohort at the RPTD of BYL719 of 350 mg PO daily plus nab-paclitaxel 100mg/m2 (D 1, 8, 15). Median age was 61years; 54% (7/13) of patients were hormone receptor positive and 46% (6/13) triple negative. 85% (11/13) had visceral disease, 69% (9/13) had received prior chemotherapy for metastatic disease and 85% (11/13) had received prior taxane in adjuvant/metastatic setting. There were no DLTs in the three cohorts and the MTD of BYL was not reached. Hyperglycemia (G3:31%, G4:0%) and neutropenia (G3:15%, G4:8%), were the most common grade 3/4 adverse events. There were no Grade 3/4 diarrhea or rash. Best overall response for 12 patients was 58% (7/12) (complete response=1, partial response=6), and an additional 33% (4/12) demonstrated stable disease. Objective responses were noted in both hormone positive and triple negative disease. Median duration of response is 6.5 months (range 2-14 months). No pharmacokinetic interactions were detected when BYL and nab-paclitaxel were co-administered.

Discussion:

This phase I study demonstrates that combination of BYL719 and nab-paclitaxel was well tolerated and shows encouraging efficacy in metastatic HER2 negative breast cancer. Enrollment in the phase II portion of the trial at the RPTD (BYL719 350mg PO daily plus nab-paclitaxel 100mg/m2 D1,8,15 every 28 days) continues. Ongoing analysis of PI3K pathway alterations in tumor and cfDNA will be correlated with clinical response.

Citation Format: Sharma P, Abramson VG, O'Dea A, Lewis S, Scott JN, Ward J, De Jong JA, Lehn C, Brown AR, Williamson SK, Perez RP, Komiya T, Godwin AK, Reed GA, Khan QJ. Safety and efficacy results from phase I study of BYL 719 plus nab-paclitaxel in HER 2 negative metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-11-08.

Abstract P5-16-02: Pathological complete response is associated with excellent outcomes in BRCA mutation associated triple negative breast cancer

Introduction: Pathological complete response (pCR) in unselected triple negative breast cancer (TNBC) is associated with excellent long-term survival. However, controversy remains as to whether pCR in BRCA mutation associated (BRCA[+]) TNBC is predictive of improved long-term outcome. A recent study suggests that pCR was not a surrogate for outcomes in BRCA1 associated TNBC. All of the patients in this study harbored an Ashkenazi Jewish founder BRCA1 mutation and the majority of mutation carriers underwent lumpectomy. Impact of pCR as it relates to BRCA status in a larger, heterogeneous TNBC cohort treated in a contemporary time frame is not known.

Aim: Evaluate and compare the prognostic impact of pCR as it relates to the BRCA mutation status in patients enrolled in a prospective multisite TNBC registry.

Methods: 453 patients with stage I-III TNBC were enrolled within a multisite registry between 2011- 2015, out of which 173 received neoadjuvant chemotherapy (NAC) and also underwent germline BRCA testing. pCR in the breast and axilla was evaluated and patients were followed for reoccurrence and survival. Recurrence free survival (RFS) was estimated according to the Kaplan-Meier method and compared among groups with log-rank statistic.

Results: For the 173 eligible patients the median age was 49 years; African-American:14%; median tumor size:3 cm; 42%:Lymph node positive; and 18% (32/173) demonstrated BRCA mutation (BRCA1=28, BRCA2=4). All patients received anthracycline and/or taxane based NAC. pCR rates for BRCA[+] and wild type (BRCA[-]) patients was 72% and 46% respectively (p=0.01). 97% of BRCA[+] and 42% of BRCA[-] patients underwent bilateral mastectomy (p=0.001). The three year RFS was 92% and 81% in BRCA[+] and BRCA[-] patients, respectively (p=0.18). Attainment of pCR was associated with excellent 3 year RFS of 95% and 97% in BRCA[+] and BRCA[-] patients, respectively (p=0.85). Among BRCA[-] patients lack of pCR was associated with significantly worse 3 year RFS (70% RFS in patients without pCR, compared to 97% in patients with pCR; p=0.001). Among BRCA[+] patients lack of pCR was associated with numerically lower but not statistically significant worse 3 year RFS (83% RFS in patients without pCR, compared to 95% in patients with pCR; p=0.41). On multivariable Cox regression analysis, only stage III disease was associated with higher risk of relapse (p<0.001).

Conclusions: Our observation of higher pCR in BRCA-carriers compared to wild-type TNBC patients is consistent with previously published literature. In this contemporary cohort of TNBC patients for whom the majority of BRCA[+] patients underwent bilateral mastectomy, attainment of pCR carried an excellent prognosis in both BRCA[+] and BRCA[-] patients. On the other hand, BRCA[+] patients who do not attain pCR may have better outcomes compared to BRCA[-] patients without pCR. Further research to explore the underlying biological mechanisms involved in tumor response and relapse in BRCA[+] and BRCA[-] TNBC patients is needed. Furthermore, given these observations, germline BRCA mutation status should be used as a stratification variable in studies evaluating pCR and long term outcomes with investigational therapies in TNBC.

Citation Format: Prochaska LH, Godwin AK, Kimler BF, Lehn C, Klemp JR, O'Dea A, Elia M, Hoffmann MS, Crane G, McKittrick R, Sheehan M, Graff SL, Madhusudhana S, Khan QJ, Jensen RA, Sharma P. Pathological complete response is associated with excellent outcomes in BRCA mutation associated triple negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-02.

Global spatial distributions of nitrogen and carbon stable isotope ratios of modern human hair

RATIONALE

Natural stable carbon (δ(13)C) and nitrogen isotope ratios (δ(15)N) of humans are related to individual dietary habits and environmental and physiological factors. In forensic science the stable isotope ratios of human remains such as hair and nail are used for geographical allocation. Thus, knowledge of the global spatial distribution of human δ(13)C and δ(15)N values is an essential component in the interpretation of stable isotope analytical results.

METHODS

No substantial global datasets of human stable isotope ratios are currently available, although the amount of available (published) data has increased within recent years. We have herein summarised the published data on human global δ(13)C andδ(15)N values (around 3600 samples) and added experimental values of more than 400 additional worldwide human hair and nail samples. In order to summarise isotope ratios for hair and nail samples correction factors were determined.

RESULTS

The current available dataset of human stable isotope ratios is biased towards Europe and North America with only limited data for countries in Africa, Central and South America and Southeast Asia. The global spatial distribution of carbon isotopes is related to latitude and supports the fact that human δ(13)C values are dominated by the amount of C4 plants in the diet, either due to direct ingestion as plant food, or by its use as animal feed. In contrast, the global spatial distribution of human δ(15)N values is apparently not exclusively related to the amount of fish or meat ingested, but also to environmental factors that influence agricultural production.

CONCLUSIONS

There are still a large proportion of countries, especially in Africa, where there are no available data for human carbon and nitrogen isotope ratios. Although the interpretation of modern human carbon isotope ratios at the global scale is quite possible, and correlates with the latitude, the potential influences of extrinsic and/or intrinsic factors on human nitrogen isotope ratios have to be taken into consideration.

Change of geographical location from Germany (Bavaria) to USA (Arizona) and its effect on H-C-N-S stable isotopes in human hair

To receive information about the duration of a person's stay abroad related to those questions in forensics, stable isotopes of H-C-N-S were analysed in beard hair samples from four young soldiers, who went from Fürstenfeldbruck (Bavaria, Germany) to Phoenix (Arizona, USA) on the same date for their pilot training over a time period of 3 months. All study subjects were almost of the same age, had similar physical constitutions and stayed at the same military bases for the whole study period. However, the results showed considerable individual variabilities. In Arizona, hair δ(13)C increased by 2.3‰ (±0.6) and δ(34)S decreased by 1.8‰ (±1.2). No remarkable shifts of hair δ(15)N and δ(2)H were observed. Significant shifts of δ(13)C or δ(34)S in the shaved beard hair samples occurred 8 or 9 days after arrival in Arizona, respectively. The time lag to receive the isotope signals in hair due to US diet correspond to the growth period that hair needs to cover the distance of 2-3 mm from its root to the surface of the skin. This implies that isotopic changes due to the consumption of food and drinks were incorporated almost immediately into the hair protein. Consequently, if connected with an isotopic change of the diet, short-term stays for only a few days might be clearly recognizable within the first millimetres of a scalp hair strand which includes the hair roots.

Origin assignment of unidentified corpses by use of stable isotope ratios of light (bio-) and heavy (geo-) elements—A case report

An unknown male body was found near an expressway in Germany. As different criminalistic and forensic methods (e.g. tooth status, fingerprint or DNA-analysis) could not help to identify the person, multielement stable isotope investigations were applied. The combined analysis of stable isotope ratios of light (H, C, N) and heavy elements (Pb, Sr) on the man's body tissues supported to assign him to Romania. The case report demonstrates an application of multielement-isotope analysis in the forensic fields and its potential.

[Ergosterol as a measure of fungus growth in fodder. I. Ergosterol content of grain]

Ergosterol was determined as a chemical indicator of fungal biomass in wheat (w), barley (b), oats (o), and grain corn (c). In samples selected by microscopy and odour as an indicator of good mycological quality the following contents (mg/kg dry matter) were found: 1.96 +/- 0.72 (w), 2.43 +/- 0.82 (b), 2.42 +/- 1.4 (o), 0.61 +/- 0.37 (c). In cereals from farms in Baden-Württemberg (FRG) which were not selected by microscopy and odour 5.8 +/- 3.8 (w), 5.8 +/- 2.0 (b), 15.8 +/- 9.0 (o) mg/kg (year of harvest: 1984); and 3.5 +/- 1.9 (w), 3.9 +/- 1.4 (b), 9.9 +/- 3.6 (o) mg/kg (year of harvest: 1985) were found. Differences between years of harvest, between samples without and with selection, and between oats and the two other types of cereal are significant. Elevated ergosterol contents (as compared to those of selected samples) were found in 66 and 22% (w), 70 and 15% (b), 95 and 86% (o) of farm samples from 1984 and 1985, respectively. The more prolific mold growth in 1984 was mainly due to readier development of field fungi and can be explained by heavier rainfall. Almost all of the ergosterol contents described in literature for wheat and grain corn are in the range found in the present study.