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Ischemic heart disease is one of the leading causes of morbidity and death worldwide. Consequently, myocardial infarctions are often encountered in clinical and forensic autopsies, and diagnosis can be challenging, especially in the absence of an acute coronary occlusion. Precise histopathological identification and timing of myocardial infarction in humans often remains uncertain while it can be of crucial importance, especially in a forensic setting when third person involvement or medical responsibilities are in question. A proper post-mortem diagnosis requires not only up-to-date knowledge of the ischemic coronary and myocardial pathology, but also a correct interpretation of such findings in relation to the clinical scenario of the deceased. For these reasons, it is important for pathologists to be familiar with the different clinically defined types of myocardial infarction and to discriminate myocardial infarction from other forms of myocardial injury. This article reviews present knowledge and post-mortem diagnostic methods, including post-mortem imaging, to reveal the different types of myocardial injury and the clinical-pathological correlations with currently defined types of myocardial infarction.

Forensic pathology plays a vital role in determining the cause and manner of death through macroscopic and microscopic post-mortem examinations. However, the field faces challenges such as variability in outcomes, labor-intensive processes, and a shortage of skilled professionals. This paper introduces SongCi, a visual-language model tailored for forensic pathology. Leveraging advanced prototypical cross-modal self-supervised contrastive learning, SongCi improves the accuracy, efficiency, and generalizability of forensic analyses. Pre-trained and validated on a large multi-center dataset comprising over 16 million high-resolution image patches, 2, 228 vision-language pairs from post-mortem whole slide images, gross key findings, and 471 unique diagnostic outcomes, SongCi demonstrates superior performance over existing multi-modal models and computational pathology foundation models in forensic tasks. It matches experienced forensic pathologists’ capabilities, significantly outperforms less experienced practitioners, and offers robust multi-modal explainability. To overcome various challenges in forensic pathology, the authors present SongCi, a visual-language AI trained on multi-modal autopsy cases of various cohorts. SongCi detects diverse post-mortem diseases and injuries and gives clear image-text explanations for forensic analysis, rivaling senior pathologists.

Estimating the postmortem interval (PMI) is one of the major tasks and a continuous challenge in forensic pathology. It is often an exclusion process of available methods, which ultimately can lead to an unsatisfactory outcome due to poor reliability. This problem is most acute in the late PMI, when decomposition proceeds and some methods (such as rigor, livor, and algor mortis) are no longer applicable. Several methods, such as forensic entomology, skeletal muscle protein degradation, and the study of body decomposition by application of a morphological scoring, are expected to provide further information; however, all have certain limitations and weaknesses. Availability of a tool-box of methods allows a case-specific selection of the most appropriate one(s), or eventually provides improvements in the overall accuracy and precision of the PMI estimation by merging and combining methods. To investigate practical (field) application, eventual interferences, and/or synergetic effects, as well as the robustness of these methods towards specific influencing factors, a field study was conducted, using eight pig cadavers of different body weights and physical coverage, left to decompose under natural conditions for 16 days. Morphological changes during decomposition were assessed using the total body score (TBS), muscle samples were collected to analyze protein degradation, and insect colonization was evaluated. The results reveal strengths and current limitations of all tested methods, as well as promising synergistic effects, and thus, provide a baseline for targeted future research.

Estimation of the postmortem interval in advanced postmortem stages is a challenging task. Although there are several approaches available for addressing postmortem changes of a (human) body or its environment (ecologically and/or biochemically), most are restricted to specific timeframes and/or individual and environmental conditions. It is well known, for instance, that buried bodies decompose in a remarkably different manner than on the ground surface. However, data on how established methods for PMI estimation perform under these conditions are scarce. It is important to understand whether and how postmortem changes are affected under burial conditions, if corrective factors could be conceived, or if methods have to be excluded for respective cases. We present the first multi-methodological assessment of human postmortem decomposition carried out on buried body donors in Europe, at the Amsterdam Research Initiative for Sub-surface Taphonomy and Anthropology (ARISTA) in the Netherlands. We used a multidisciplinary approach to investigate postmortem changes of morphology, skeletal muscle protein decomposition, presence of insects and other necrophilous animals as well as microbial communities (i.e., microbiomes) from August to November 2018 associated with two complete body exhumations and eight partial exhumations. Our results clearly display the current possibilities and limitations of methods for PMI estimation in buried remains and provide a baseline for future research and application.

Computed tomography (CT) and other advanced diagnostic imaging techniques are gaining popularity in forensic pathology. This paper aims to define and offer complete and easily accessible “state of the art” for post-mortem computed tomography (PMCT), by reviewing the latest international literature. The proposed format answers the “five Ws” that follows: (1) What: We report the different kinds of CT scan and settings generally used in post-mortem imaging. The machine most employed is a 8/16-slice spiral CT, usually without contrast enhancement. The introduction of some variables, such as CT-guided biopsies, post-mortem ventilation, and PMCT angiography is becoming increasingly useful. (2) Why: Literature highlights the many advantages of PMCT. Limitations can be partly overcome by modern imaging techniques and combined evaluation with traditional autopsy. (3) Who: Most authors agree that collaboration between different specialists, i.e., radiologists and pathologists, is the best scenario, since radiologic, anatomic, and forensic skills are needed simultaneously. The most important human factor is “teamwork”. (4) When: Literature provides no absolute limits for performing PMCT. Some authors have tested PMCT as a replacement for conventional autopsy but found some limitations. Others evaluated PMCT as a guide or screening tool for traditional autopsy. (5) Where: Many research groups around the world have performed studies on the use of PMCT. Although few countries adopt PMCT in routine practice, its use is rapidly spreading.

Pathology has benefited from the rapid progress of image-digitizing technology during the last decade. However, the application of digital whole slide images (WSI) in forensic pathology still needs to be improved. WSI validation is crucial to ensure diagnostic performance, at least equivalent to glass slides and light microscopy. The College of American Pathologists Pathology and Laboratory Quality Center recently updated internal digital pathology system validation recommendations. Following these guidelines, this pilot study aimed to validate the performance of a digital approach for forensic histopathological diagnosis. Six independent skilled forensic pathologists from different forensic medicine institutes evaluated 100 glass slides of forensic interest (80 stained with standard hematoxylin and eosin, 20 with special staining), including different organs and tissues, with light microscopy (Olympus BX51, Tokyo, Japan). Glass slides were scanned using the Aperio GT 450 DX Digital Slides Scanner (Leica Biosystems, Nussloch, Germany). After two wash-out weeks, forensic pathologists evaluated WSIs in front of a widescreen using computer devices with dedicated software (O3 viewer, O3 Enterprise, Zucchetti, Trieste, Italy). Side-by-side comparisons between diagnoses performed on tissue glass slides versus WSIs were above the threshold stated in the validation guidelines (mean concordance of 97.8%). CSUQ Version 3 questionnaire showed high satisfaction for all pathologists (mean result: 6.6/7). Our institutional digital forensic pathology system has been validated for practical casework application. This approach opens new scenarios in practical forensic casework investigations, such as sharing live histological ex-glass slides online, as well as educational and research perspectives, with improving impacts on the whole daily workflow.

Five simple methods for diatom drowning analysis, including three newly developed ones, were compared for diatom yield and species composition consistency. Saponification of fats using sodium hydroxide solution significantly improved the yield of the extraction step, as well as the use of filtration instead of centrifugation. The combination of nitric acid digestion, vacuum filtration, and polycarbonate filter melting led to the development of the lossless light microscopy diatom forensic method (HNO3-PCF), with no detectable alteration in diatom community composition. When applied to 4-week submerged pig cadavers and six confirmed drowned human cases, the method exhibited unprecedented sensitivity. Among eight tissue types, lung diatom concentration was found to be the only reliable indicator for distinguishing between non-drowned and drowned cases. To minimize false positives from systematic contamination of the thoracic cavity, subtraction of heart diatom concentration from lung values was recommended. Provisional diatom concentration thresholds for drowning determination were set. The method’s low equipment requirements (simple vacuum filtration, light microscope, hot plate) and high efficiency make it a promising tool for widespread use in forensic practice. •New HNO3-PCF method enhances diatom yield and species consistency for forensic drowning analysis.•Saponification and filtration improve diatom extraction from tissues.•Diatom analysis using HNO3-PCF method provides reliable drowning determination with minimal equipment.

Sudden unexplained death (SUD) is not uncommon in forensic pathology. Yet, diagnosis of SUD remains challenging due to lack of specific biomarkers. This study aimed to screen differentially expressed proteins (DEPs) and validate their usefulness as diagnostic biomarkers for SUD cases. We designed a three-phase investigation, where in the discovery phase, formalin-fixed paraffin-embedded (FFPE) heart specimens were screened through label-free proteomic analysis of cases dying from SUD, mechanical injury and carbon monoxide (CO) intoxication. A total of 26 proteins were identified to be DEPs for the SUD cases after rigorous criterion. Bioinformatics and Adaboost-recursive feature elimination (RFE) analysis further revealed that three of the 26 proteins (MYH6, COX5B and TNNT2) were potential discriminative biomarkers. In the training phase, MYH6 and COX5B were verified to be true DEPs in cardiac tissues from 29 independent SUD cases as compared with a serial of control cases (n = 42). Receiver operating characteristic (ROC) analysis illustrated that combination of MYH6 and COX5B achieved optimal diagnostic sensitivity (89.7 %) and specificity (84.4 %), with area under the curve (AUC) being 0.91. A diagnostic software based on the logistic regression formula derived from the training phase was then constructed. In the validation phase, the diagnostic software was applied to eight authentic SUD cases, seven (87.5 %) of which were accurately recognized. Our study provides a valid strategy towards practical diagnosis of SUD by integrating cardiac MYH6 and COX5B as dual diagnostic biomarkers. •Label-free proteomic profiling discovers 26 potential biomarkers for SUD.•MYH6 and COX5B were verified as true biomarkers for SUD.•The two biomarkers-based diagnostic model and software was developed for SUD.•The developed software was successfully validated in authentic human cases.

•ADD-based PMI estimation models cannot be validated experimentally.•TBS and TBSsurf models significantly over-estimated the PMI.•There was no relationship between known ADD and accumulated decay.•Temperature differences had a negligible effect on decomposition expression.•Seasonal variation in humidity is an important factor in decomposition. This study investigated the effect of seasonal variables on decomposition in the early post-mortem period using 26 donated human cadavers at the University of Tennessee’s Anthropology Research Facility (ARF), USA. The rate and pattern of decomposition in human cadavers (as measured by TBS and the revised TBSsurf methods) did not vary significantly between all seasons. Summer and autumn cadavers had comparable rates of accelerated decomposition despite significant differences in both ADD and temperature (p<0.05). Spring cadavers had the slowest onset of decomposition characteristics, even compared to the few decomposition characteristics expressed in winter. Seasonal variation in humidity, rather than temperature, may be the overarching driving force for decomposition progression in the early post-mortem period. Both TBS and TBSsurf methods were poor predictors of the PMI (R2=0.4) and significantly over-estimated the PMI across all seasons, although to a lesser extent in spring. This study also demonstrated no relationship between known ADD and TBS/TBSsurf (R2=0.025). TBS and TBSsurf are ADD-based PMI estimation models that cannot be validated under experimental conditions. Accounting for seasonal expression of individual decomposition characteristics is needed for improvement of PMI predictability in forensic practice.

ObjectivesFire deaths are challenging fatalities for forensic pathologists, as the main question of whether death was due to the fire or not needs to be answered. In this retrospective study, we assessed whether post-mortem computed tomography (PMCT) has an added value prior to a forensic autopsy of burned victims.MethodsFrom 2008 to 2016, a PMCT was performed in 50 burned corpses prior to a complete forensic autopsy. In retrospect, all 50 PMCT scans were systematically assessed by a forensically experienced radiologist, masked from the autopsy reports. Subsequently, the PMCT findings were compared with the autopsy reports.ResultsHeat fractures, contractions and destruction of extremities, subcutaneous emphysema and post-mortem gas collections were easier to detect by PMCT compared to autopsy. Alterations by penetrating and blunt trauma and the presence of foreign bodies were easy to detect by PMCT as well by autopsy. PMCT was, however, not successful in detecting signs of vitality during the fire, detection of superficial thermal injuries and to answer the main question of the forensic autopsy, which is to investigate the cause of death.ConclusionsPMCT prior to autopsy is a valuable add-on in the post-mortem forensic investigation of burned victims for detection of hidden signs of trauma, gas collections and foreign bodies. However, since PMCT cannot answer the two main questions in forensic examination—determining the cause of death and detecting signs of vitality during the fire—it cannot replace an autopsy.Key Points• Post-mortem CT (PMCT) in burned victims shows hidden signs of trauma.• Foreign bodies and gas collections can easily be detected.• Cause of death and vitality signs cannot be assessed by PMCT.