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Zwirner J, Ondruschka B, Scholze M, Thambyah A, Workman J, Hammer N, Niestrawska JA. Dynamic load response of human dura mater at different velocities. J Mech Behav Biomed Mater 2023; 138:105617. [PMID: 36543085 DOI: 10.1016/j.jmbbm.2022.105617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Despite of its assumed role to mitigate brain tissue response under dynamic loading conditions, the human dura mater is frequently neglected in computational and physical human head models. A reason for this is the lack of load-deformation data when the dura mater is loaded dynamically. To date, the biomechanical characterization of the human dura mater predominantly involved quasi-static testing setups. This study aimed to investigate the strain rate-dependent mechanical properties of the human dura mater comparing three different velocities of 0.3, 0.5 and 0.7 m/s. Samples were chosen in a perpendicular orientation to the visible main fiber direction on the samples' surface, which was mostly neglected in previous studies. The elastic modulus of dura mater significantly increased at higher velocities (5.16 [3.38; 7.27] MPa at 0.3 m/s versus 44.38 [35.30; 74.94] MPa at 0.7 m/s). Both the stretch at yield point λf (1.148 [1.137; 1.188] for 0.3 m/s, 1.062 [1.054; 1.066] for 0.5 m/s and 1.015 [1.012; 1.021] for 0.7 m/s) and stress at yield point σf of dura mater (519.14 [366.74; 707.99] kPa for 0.3 m/s versus 300.52 [245.31; 354.89] kPa at 0.7 m/s) significantly decreased with increasing velocities. Conclusively, increasing the load application velocity increases stiffness and decreases tensile strength as well as straining potential of human dura mater between 0.3 and 0.7 m/s. The elastic modulus of human dura mater should be adapted to the respective velocities in computational head impact simulations.
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Affiliation(s)
- J Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Oral Sciences, University of Otago, Dunedin, New Zealand.
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Scholze
- Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany
| | - A Thambyah
- Department of Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
| | - J Workman
- Department of Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
| | - N Hammer
- Department of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria; Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Fraunhofer IWU, Dresden, Germany
| | - J A Niestrawska
- Department of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria.
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Bertram F, Hajek A, König HH, Wulff B, Ondruschka B, Püschel K, Heinrich F. Psychiatric and somatic health of homeless individuals in the context of their migration history. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Descriptions of homeless individuals’ somatic and psychiatric health status remain scarce. The heterogenicity of the population is increasing, with more people migrating within the European Union. Migration history has been described as a determinant of health and healthcare access.
Methods
A multicenter cross-sectional study design included homeless individuals in Germany. Using interview-based questionnaires, the prevalence of mental and somatic illnesses, as well as healthcare use and access, were determined. Multinominal logistic regression analysis was performed to examine the influence of the homeless migration history on health status.
Results
306/635 (48.2%) of the homeless individuals were born outside Germany; 213/306 (69.6%) came from another EU country. Homeless people from EU countries frequently reported economic reasons for leaving their home country (51.0%) and entering Germany (64.4%). Compared to homeless individuals of German origin and homeless non-EU migrants, they stated to live rough (48.2% p = 0,03), not hold health insurance (62.4% p < 0,0001), and not receive state funds (82.6% p < 0,0001) more often. Prevalences of psychiatric and somatic illnesses among homeless people were high compared to the general German population. There were no differences observed between the prevalence of chronic diseases if stratified by the origin of the homeless individuals.
Conclusions
Homeless individuals report higher prevalences of psychiatric and somatic illnesses than the general population. Compared to homeless people of other origins, homeless EU migrants may be disadvantaged in their housing situation and integration into the German social security system.
Key messages
• Programs aiming to integrate homeless people into mainstream health care should focus on homeless EU migrants.
• Our data underline the need for specific care services for homeless individuals.
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Affiliation(s)
- F Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - A Hajek
- Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - H-H König
- Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - B Wulff
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - K Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - F Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
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Lohner L, Nigbur L, Klasen C, Witzel I, Garland J, Ondruschka B, Anders S. Vaginal injuries after consensual sexual intercourse - a survey among office-based gynecologists in Hamburg, Germany. Forensic Sci Med Pathol 2022; 18:352-358. [PMID: 35716294 PMCID: PMC9587115 DOI: 10.1007/s12024-022-00488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
Studies on the occurrence of injuries following consensual sexual intercourse (CSI) among patients treated by office-based gynecologists are lacking. This survey aimed to assess the presence and medical relevance of vaginal injuries after CSI in gynecological office-based practice, associated risk factors, and their significance for forensic medical assessment practice. All office-based gynecologists in Hamburg, Germany (n = 316), were asked to fill in a one-page questionnaire via a fax survey. The questionnaire covered various aspects such as having observed CSI-related injuries, injury severity, risk factors, and concomitant factors (bleeding, need for surgical care, hospitalization). Response rate was 43.2% (n = 115). Overall, 83.5% of office-based gynecologists reported having observed vaginal injuries after CSI at least once and 59.1% repeatedly. Regarding maximum injury severity, 52.1% observed mucosal erosions, 32.3% mucosa penetrating injuries, and 14.6% injuries penetrating the vagina. Having observed bleeding was reported by 56.3%, 28.1% had to perform surgical suture care, and hospital admission was initiated by 20.8%. Menopause (37.5%), use of objects (19.8%), alcohol, and/or drug use (16.7%) were reported as the most frequently observed associated risk factors. Vaginal injuries after CSI have been observed by the majority of office-based gynecologists in Hamburg involving a wide spectrum of severity, including the necessity of surgical care and hospital admission. Complementing published work in clinical and emergency medicine, these findings are highly relevant to the forensic evaluation of injuries in an allegation of sexual assault, as the severity of a vaginal injury in this setting does not necessarily support a conclusion on the issue of consent.
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Affiliation(s)
- L. Lohner
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - L. Nigbur
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - C. Klasen
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I. Witzel
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Garland
- Forensic and Scientific Services, Coopers Plains, Brisbane, Australia
| | - B. Ondruschka
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - S. Anders
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
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von Stillfried S, Freeborn B, Windeck S, Boor P, Böcker J, Schmidt J, Tholen P, Röhrig R, Majeed R, Wienströer J, Bremer J, Weis J, Knüchel R, Breitbach A, Bülow RD, Cacchi C, Wucherpfennig S, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Spring O, Braun G, Römmele C, Kling E, Kröncke T, Wittmann M, Hirschbühl K, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Friemann J, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Esposito I, Crudele G, Seidl M, Mahlke N, Hartmann A, Haller F, Eichhorn P, Lange F, Amann KU, Coras R, Ingenwerth M, Rawitzer J, Schmid KW, Theegarten D, Gradhand E, Smith K, Wild P, Birngruber CG, Schilling O, Werner M, Acker T, Gattenlöhner S, Franz J, Metz I, Stadelmann C, Stork L, Thomas C, Zechel S, Ströbel P, Fathke C, Harder A, Wickenhauser C, Glatzel M, Matschke J, Krasemann S, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Ondruschka B, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Jonigk D, Werlein C, Domke LM, Hartmann L, Klein I, Schirmacher P, Schwab C, Röcken C, Langer D, Roth W, Strobl S, Rudelius M, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weichert W, Weirich G, Stock K, Barth P, Schnepper A, Wardelmann E, Evert K, Evert M, Büttner A, Manhart J, Nigbur S, Bösmüller H, Fend F, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Vogt N, Kurz F. [Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]. Pathologie (Heidelb) 2022; 43:101-105. [PMID: 36114379 PMCID: PMC9483541 DOI: 10.1007/s00292-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autopsies are a valuable tool for understanding disease, including COVID-19. MATERIALS AND METHODS The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs. RESULTS The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy. CONCLUSIONS Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.
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Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Benita Freeborn
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Svenja Windeck
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Elektronenmikroskopische Einrichtung, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
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Zwirner J, Ondruschka B, Pregartner G, Berghold A, Scholze M, Hammer N. On the correlations of biomechanical properties of super-imposed temporal tissue layers and their age-, sex-, side- and post-mortem interval dependence. J Biomech 2021; 130:110847. [PMID: 34753030 DOI: 10.1016/j.jbiomech.2021.110847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
Obtaining biomechanical properties of biological tissues for simulation purposes or graft developments is time and resource consuming. The number of samples required for biomechanical tests could be reduced if the load-deformation properties of a given tissue layer could be estimated from adjacent layers or if the biomechanical parameters were unaffected by age, bodyside, sex or post-mortem interval. This study investigates for the first time potential correlations of multiple super-imposed tissue layers using the temporal region of the human head as an area of broad interest in biomechanical modelling. Spearman correlations between biomechanical properties of the scalp, muscle fascia, muscle, bone and dura mater from up to 83 chemically unfixed cadavers were investigated. The association with age, sex and post-mortem interval was assessed. The results revealed sporadic correlations between the corresponding layers, such as the maximum force (r = 0.43) and ultimate tensile strength (r = 0.33) between scalp and muscle. Side- and age-dependence of the biomechanical properties were different between the tissue types. Strain at maximum force of fascia (r = -0.37) and elastic modulus of temporal muscle (r = 0.26) weakly correlated with post-mortem interval. Only strain at maximum force of scalp differed significantly between sexes. Uniaxial biomechanical properties of individual head tissue layers can thus not be estimated solely based on adjacent layers. Therefore, correlations between the tissues' biomechanical properties, anthropometric data and post-mortem interval need to be established independently for each layer. Sex seems not to be a relevant influencing factor for the passive tissue mechanics of the here investigated temporal head tissue layers.
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Affiliation(s)
- J Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Legal Medicine, University of Leipzig, Leipzig, Germany.
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - A Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - M Scholze
- Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany; Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - N Hammer
- Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria; Department of Orthopedic and Trauma Surgery, University of Leipzig, Germany; Fraunhofer IWU, Dresden, Germany.
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Dietz E, Schädler J, Püschel K, Ondruschka B. Auftragsmord und Anstiftung zum Mord als Varianten des Intimizids. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungDargestellt wird der Fall eines Intimizids, bei dem sich ein Ehemann durch Anstiftung zum Mord seiner Ehefrau entledigen wollte. Auftragsmorde bzw. Anstiftungen zum Mord innerhalb von Paarbeziehungen stellen ein Ausnahmegeschehen dar. Hier sollen die Facetten einer umfangreichen kriminalistischen Fallbearbeitung dargestellt werden, die neben rechtsmedizinischen Erkenntnissen auch wesentliche psychiatrische, psychologische und kriminalistische Aspekte der Tatbegehung bzw. -anstiftung beleuchtet.
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Duffy M, Garland J, Hu M, Kesha K, Glenn C, Morrow P, Stables S, Ondruschka B, Da Broi U, Tse R. Convolutional neural networks on postmodern histology organ recognition. Pathology 2021. [DOI: 10.1016/j.pathol.2021.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lohner L, Fröb D, Edler C, Schröder AS, Dietz E, Ondruschka B. [SARS-CoV-2-associated deaths in adult persons up to 50 years of age]. Rechtsmedizin (Berl) 2021; 31:418-426. [PMID: 33867689 PMCID: PMC8042458 DOI: 10.1007/s00194-021-00483-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Several evaluations of deaths in persons of advanced age associated with SARS-CoV‑2 can be found in the international literature. The aim of this work was the evaluation of deaths associated with SARS-CoV‑2 of persons of younger or middle age (up to 50 years) at the Institute of Legal Medicine in Hamburg, Germany, with presentation of frequency, comorbidities and disease courses. MATERIAL AND METHODS A total of 735 SARS-CoV-2-associated cases of decedents with registered addresses in Hamburg were evaluated in 2020 at the Institute of Legal Medicine in Hamburg, Germany, using various examination methods. The selection and performance of the respective methods was based on the consent given by the relatives. In addition, more autopsies of decedents with a registered address outside Hamburg and positive SARS-CoV‑2 detection were performed. RESULTS AND CONCLUSION Of the 735 decedents 9 with a registered Hamburg address and 3 of the deaths studied with an external registered address (n = 12; 7 men and 5 women) were aged 50 years or younger, with an average age of 39.8 years. Essentially, there were cardiovascular, neurological, and malignant pre-existing diseases, as well as obesity. The SARS-CoV‑2 was detected post-mortem for the first time in two cases; these were found to have a virus-independent cause of death. Of the individuals 7 died from COVID-19 pneumonia, 3 individuals from the consequences of the necessary intensive medical treatment.Several studies have demonstrated an association between obesity and severe SARS-CoV-2-related disease progression, particularly in younger patients and this was confirmed in the legal medicine study population.
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Affiliation(s)
- L. Lohner
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - D. Fröb
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - C. Edler
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - A. S. Schröder
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - E. Dietz
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
| | - B. Ondruschka
- Institut für Rechtsmedizin Hamburg, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland
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van Rüth V, König HH, Bertram F, Schmiedel P, Ondruschka B, Püschel K, Heinrich F, Hajek A. Determinants of health-related quality of life among homeless individuals during the COVID-19 pandemic. Public Health 2021; 194:60-66. [PMID: 33865148 DOI: 10.1016/j.puhe.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To clarify which variables are associated with the health-related quality of life (HRQoL) among homeless individuals during the COVID-19 pandemic. STUDY DESIGN Cross-sectional research. METHODS Data were taken from the Hamburg survey of homeless individuals (n = 151). HRQoL was assessed using the EQ-5D tool. More precisely, the EQ-5D-5L questionnaire was used to quantify problems in five health dimensions (i.e. mobility, self-care, usually activities, pain/discomfort, anxiety/depression), and its visual analog scale (EQ-VAS) was used to record the according self-rated health status. Explanatory variables include sex, age, education, marital status, country of origin, health insurance, and chronic alcohol consumption. RESULTS With regard to HRQoL, most frequently, problems were reported as pain/discomfort (47.3%), followed by anxiety/depression (32.4%), mobility (29.7%), usual activities (20.7%) and self-care (4.6%). The mean EQ-VAS score was 75.34 (SD 22.23; range 1-100), and the mean EQ-5D-5L index was 0.84 (SD 0.23; range 0.32-1). Regressions showed increasing problems in mobility and self-care with higher age, whereas EQ-VAS was positively associated with younger age. Furthermore, EQ-5D-5L index was positively associated with younger age and higher education. Summarized, among this cohort, a higher age is associated with a lower HRQoL. CONCLUSION Remarkably high EQ-VAS values and rather few problems in the five dimensions investigated here were reported among the homeless individuals during the COVID-19 pandemic particularly compared with the general population. Moreover, study findings particularly stress the link between higher age and lower HRQoL among homeless individuals. This knowledge is important to address homeless individuals at risk of poor HRQoL. Longitudinal studies are required to confirm the given findings.
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Affiliation(s)
- V van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Schmiedel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zwirner J, Koutp A, Vidakovic H, Ondruschka B, Kieser DC, Hammer N. Assessment of plantaris and peroneus tertius tendons as graft materials for ankle ligament reconstructions - A cadaveric biomechanical study. J Mech Behav Biomed Mater 2020; 115:104244. [PMID: 33310268 DOI: 10.1016/j.jmbbm.2020.104244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/14/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Both the plantaris tendon and the peroneus tertius tendon are used as auto- and allogenous graft materials to reconstruct the ankle ligament complex. However, it is unclear to what extent these graft materials resemble the load-deformation behavior of the ankle ligaments. A total of 34 human ankle ligaments and 35 tendons were assessed mechanically deploying a quasi-static tensile testing setup. Tendons were significantly stiffer (median elastic moduli: plantaris tendon = 465.7 MPa, peroneus tertius tendon = 338.5 MPa, medial ligament = 61.4 MPa, lateral ligament = 49.3 MPa; p ≤ 0.035), but more distensible (median strain at maximum force: plantaris tendon = 15.1%, peroneus tertius tendon = 15.3%, medial ligament = 9.3%, lateral ligament = 9.6%; p ≤ 0.008) and mechanically tougher (median ultimate tensile strength: plantaris tendon = 51.0 MPa, peroneus tertius tendon = 40.5 MPa, medial ligament = 4.1 MPa, lateral ligament = 3.5 MPa; p ≤ 0.033) when compared to medial and lateral ankle ligaments. The lateral ligaments of the right ankle were significantly tougher compared to the left side (p = 0.015). The elastic modulus of the medial ligament (r = 0.489, p = 0.045) and the peroneus tertius tendon (r = 0.517, p = 0.014) yielded an age-dependent increase. Both tendons seem biomechanically suitable graft materials to replace the medial and lateral ankle ligaments during physiological loading. The age-dependent increase in tissue elastic properties of the medial vs. lateral ankle ligaments, and differences in ultimate tensile strength between the lateral ligaments left vs. right, may reflect the complex asymmetric loading behavior of both ankle ligaments.
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Affiliation(s)
- J Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand.
| | - A Koutp
- Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - H Vidakovic
- Department of Orthopedics and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D C Kieser
- Department of Orthopedics and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - N Hammer
- Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria; Department of Orthopedic and Trauma Surgery, University of Leipzig, Germany; Fraunhofer IWU, Dresden, Germany
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Taylor SC, Hammer N, Zwirner J, Ondruschka B, Kieser DC. Morphometric and density comparisons of Bos taurus scapulae as a proxy to human frontal crania. Egypt J Forensic Sci 2020. [DOI: 10.1186/s41935-020-00191-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In the absence of cadaveric tissues, forensic simulation, trauma modelling, and cranial surgical training necessitates a surrogate for the human calvaria. This study investigates the validity of Bos taurus scapulae as a proxy for human frontal bones by comparing the laminar and cancellous bone thickness, as well as the bone mineral density (BMD) of cadaveric frontal bones and adult Bos taurus scapulae.
Results
This study aimed to validate the bovine scapulae as a valid proxy for forensic experiments, which benefit researchers and investigators who need to recreate forensic scenarios where synthetic proxies are found unsuitable due to their non-viscoelastic nature and cadaveric human models are unavailable due to ethical restrictions. Our results identified different total thicknesses of the relative bones, but non-different cortical measurements between human frontal bone and bovine scapulae. The bone mineral density is similar between both groups.
Conclusion
This study has found Bos taurus scapulae to be a suitable proxy for human frontal bones as it has a similar morphology with regard to thickness and structure as well as a comparable density. However, there is a significant difference between the cancellous bone, and therefore, the overall thickness.
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Zwirner J, Ondruschka B, Scholze M, Schulze-Tanzil G, Hammer N. Mechanical properties of native and acellular temporal muscle fascia for surgical reconstruction and computational modelling purposes. J Mech Behav Biomed Mater 2020; 108:103833. [DOI: 10.1016/j.jmbbm.2020.103833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023]
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Zwirner J, Ondruschka B, Scholze M, Hammer N. Passive load-deformation properties of human temporal muscle. J Biomech 2020; 106:109829. [DOI: 10.1016/j.jbiomech.2020.109829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
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Taylor SC, Kieser DC, Hammer N, Ondruschka B, Kranioti E, Pullen A, Hooper G. Viability of Bos taurus scapulae as a flat bone proxy for ballistic testing. BMJ Mil Health 2020; 168:196-199. [PMID: 32393517 DOI: 10.1136/bmjmilitary-2019-001369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Handguns and rifles are often involved in violent deaths such as homicide and suicide. Consequently, forensic investigations are important to clarify the nature of ballistic trauma. METHODS This study investigated the differences in entrance and exit wound morphology with Bos taurus (bovine) scapulae that have two cortical layers surrounding a central cancellous bone section which are comparable with human flat bones, with a series of experiments using six different calibres (0.22 Long Rifle, 9×19 mm North Atlantic Treaty Organization, 0.40 Smith & Wesson, 0.45 Automatic Colt Pistol, 5.56×45 mm and 7.62×51 mm). B. taurus (bovine) scapulae were used for closed range 30 cm simulated executions. RESULTS The ballistic experiments presented similarities in entrance wound morphology and exit wound bevelling with that of recognised forensic cases. As muzzle velocity increased, bevelling increased. Circumferential delamination is clearly visible with full metal jacket rounds, yielding similar bone damage morphology as human crania. CONCLUSION Bovine scapulae seem appropriate for ballistic simulations of flat bone injuries on the macroscopic level, if the correct portion of the scapulae is deployed. More research is needed to further substantiate these interpretations.
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Affiliation(s)
- Seth C Taylor
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - D C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - N Hammer
- Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
| | - B Ondruschka
- Universität Leipzig Medizinische Fakultät, Leipzig, Germany
| | - E Kranioti
- Department of Forensic Sciences, University of Crete Faculty of Medicine, Heraklion, Greece
| | - A Pullen
- Balllistics and Personnel Protection, New Zealand Defence Force, Devonport, New Zealand
| | - G Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Ondruschka B, Dreßler J, Gräwert S, Hammer N, Hossfeld B, Bernhard M. Der „offene Patient“. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-00365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ondruschka B, Heil K, Schulz S, Dreßler J, Morgenthal S. Suizid oder Homizid? Eine rechtsmedizinische Auswertung letaler Bolzenschussverletzungen. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0256-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ondruschka B, Baier C, Dreßler J, Höch A, Bernhard M, Kleber C, Buschmann C. [Additional emergency medical measures in trauma-associated cardiac arrest]. Anaesthesist 2017; 66:924-935. [PMID: 29143074 DOI: 10.1007/s00101-017-0383-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases. MATERIAL AND METHODS All autopsy protocols from the Institutes of Legal Medicine in Leipzig and Chemnitz, Germany within the years 2011-2017 were retrospectively examined and all trauma deaths with professional prehospital tCPR at the scene, during transport or shortly after arriving at the emergency room were analyzed. In addition to epidemiological parameters all forms of medical procedure performed by emergency physicians and the injury patterns were recorded. Thus, the questions whether any of the trauma deaths were preventable and if failures in work-flow management were evident could be retrospectively answered through a structured Delphi method. RESULTS Overall, 3795 autopsy protocols were listed containing 154 trauma cases (4.1%) with various preclinical tCPR attempts (male patients 70.1%; mean age 48 ± 21 years). Most of them died at the accident site (84.4%), some during transport (2.6%) or directly after admission to a hospital (13.0%). Only 23 patients (14.9%) received 25 additional interventions exceeding the normal scope (pleural decompression 80.0%, pericardiocentesis 8.0% and external stabilization of the pelvis 12.0%). A relevant number of potentially reversible causes for trauma-associated cardiac arrest was determined. There were deficits in the performance of pleural decompression in cases of tension pneumothorax. Even if isolated traumatic hemopericardium was a rare occurrence in the examined cases, the rate of pericardiocentesis was still too low. Also, more focus needs to be placed on provisional external pelvic stabilization of trauma patients which was performed too rarely even though an instable pelvic ring was apparent during the postmortem external examination. None of the cases received a rescue thoracotomy even if a few patients might have derived benefit from this and none of the cases showed injury patterns with tourniquet indications. Furthermore, no single case of death due to incorrect or missing airway management was determined. Errors in work-flow management were found in 37.0% and potentially preventable deaths occurred cumulatively in 12.3% of the cases. The potentially preventable deaths were particularly related to penetrating chest injuries caused by a sharp force. DISCUSSION The percentage of patients who might benefit from additive treatment implemented in tCPR efforts was shown to be equal between the local situations in Leipzig and Chemnitz compared to previous reports in Berlin. A need for optimizing the professional resuscitation process still remains as not all reversible causes were appropriately addressed. Further training and education should intensively address the mentioned deficits and continuous awareness of necessary additional medical procedures in the preclinical setting in cases of traumatic cardiac arrest is inevitable. Cooperation with forensic institutes can help to impart particular issues and treatment options of emergency medicine in cases of potentially reversible causes of traumatic cardiac arrest.
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Affiliation(s)
- B Ondruschka
- Institut für Rechtsmedizin, Universität Leipzig, Medizinische Fakultät, Johannisallee 28, 04103, Leipzig, Deutschland.
| | - C Baier
- Institut für Rechtsmedizin, Universität Leipzig, Medizinische Fakultät, Johannisallee 28, 04103, Leipzig, Deutschland
| | - J Dreßler
- Institut für Rechtsmedizin, Universität Leipzig, Medizinische Fakultät, Johannisallee 28, 04103, Leipzig, Deutschland
| | - A Höch
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - C Kleber
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - C Buschmann
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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Ondruschka B, Baier C, Siekmeyer M, Buschmann C, Dreßler J, Bernhard M. Cardiopulmonary resuscitation-associated injuries in still-/newborns, infants and toddlers in a German forensic collective. Forensic Sci Int 2017; 279:235-240. [PMID: 28926779 DOI: 10.1016/j.forsciint.2017.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) may lead to injuries. Forensic experts are sometimes confronted with claims that fatal injuries were caused by chest compressions during CPR rather than by assaults. We want to answer, how often CPR-associated injuries are present in younger children and if they may mimic injuries caused by abuse. MATERIAL AND METHODS All autopsy records of the Institute of Legal Medicine in Leipzig, Germany in a 6-year study period were used (2011-2016). There were 3664 forensic autopsies in total, comprising 97 autopsies of children ≤4 years. After exclusion criteria we were able to include 51 cases in the study. Following this, all CPR-related variables were collected according to the 'Utstein style'. Standard procedures were used for statistical evaluation of the data. RESULTS The most common cause of cardiac arrest was SIDS. The mean duration of CPR was 50min. Bystander CPR was performed in 43.1%. In no single case death was declared without at least partly professional CPR. Most of the children were first resuscitated out-of-hospital (41.2%). 27.5% of the children had at least one CPR injury without preference to an age group. None of the recorded CPR-associated injuries were considered significant or life-threatening. The duration of CPR or presence of bystander CPR did not correlate to the presence of any detected injury. CONCLUSION Skeletal injuries and relevant injuries to the soft tissue and organs seem to occur only very rarely after pediatric CPR. Whenever such injuries are diagnosed, the children should be examined thoroughly for potential abuse.
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Affiliation(s)
- B Ondruschka
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
| | - C Baier
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - M Siekmeyer
- University Clinic of Leipzig, Department of Pediatrics Hospital for Children and Adolescents, Leipzig, Germany
| | - C Buschmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Legal Medicine and Forensic Sciences, Berlin, Germany
| | - J Dreßler
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - M Bernhard
- University of Leipzig, Emergency Department, Leipzig, Germany
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Zwirner J, Bayer R, Japes A, Eplinius F, Dreßler J, Ondruschka B. Suicide by the intraoral blast of firecrackers - experimental simulation using a skull simulant model. Int J Legal Med 2017; 131:1581-1587. [PMID: 28478532 DOI: 10.1007/s00414-017-1580-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
Suicides committed by intraorally placed firecrackers are rare events. Given to the use of more powerful components such as flash powder recently, some firecrackers may cause massive life-threatening injuries in case of such misuse. Innocuous black powder firecrackers are subject to national explosives legislation and only have the potential to cause harmless injuries restricted to the soft tissue. We here report two cases of suicide committed by an intraoral placement of firecrackers, resulting in similar patterns of skull injury. As it was first unknown whether black powder firecrackers can potentially cause serious skull injury, we compared the potential of destruction using black powder and flash powder firecrackers in a standardized skull simulant model (Synbone, Malans, Switzerland). This was the first experiment to date simulating the impacts resulting from an intraoral burst in a skull simulant model. The intraoral burst of a "D-Böller" (an example of one of the most powerful black powder firecrackers in Germany) did not lead to any injuries of the osseous skull. In contrast, the "La Bomba" (an example of the weakest known flash powder firecrackers) caused complex fractures of both the viscero- and neurocranium. The results obtained from this experimental study indicate that black powder firecrackers are less likely to cause severe injuries as a consequence of intraoral explosions, whereas flash powder-based crackers may lead to massive life-threatening craniofacial destructions and potentially death.
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Affiliation(s)
- J Zwirner
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - R Bayer
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - A Japes
- Criminal Investigation Department, Saxony State Police, Dresden, Germany
| | - F Eplinius
- Department of Diagnostic and Interventional Radiology, Heart Center, University Leipzig, Leipzig, Germany
| | - J Dreßler
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - B Ondruschka
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany.
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Ondruschka B, Edelmann J, Harder R, Dreßler J, Babian C. Forensische Untersuchungen an den Gebeinen von Karl May. Rechtsmedizin (Berl) 2016. [DOI: 10.1007/s00194-016-0135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zwirner J, Bayer R, Hädrich C, Bollmann A, Klein N, Dreßler J, Ondruschka B. Pulmonary artery perforation and coronary air embolism-two fatal outcomes in percutaneous left atrial appendage occlusion. Int J Legal Med 2016; 131:191-197. [PMID: 27815629 DOI: 10.1007/s00414-016-1486-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
Percutaneous left atrial appendage (LAA) closure is a routinely performed method to reduce the risk of stroke in patients suffering from atrial fibrillation, when an oral anticoagulation is no longer indicated due to relevant bleeding complications. Currently, the Amplatzer Amulet and the Watchman system are two equally used systems. While there is an acute success rate of more than 95 per cent for this intervention, several minor and major complications such as pericardial effusions, air embolism, vascular lesions in proximity to the heart or even death can occur. Here, we report two cases of very rare fatal outcomes in percutaneous LAA occlusion. Eight hours after deployment of an Amplatzer Amulet a patient died, after the pulmonary trunk was perforated by a hook of the occluder device causing pericardial tamponade. In the second case during final radiological position control of the deployed Watchman occluder air was injected accidentally. The patient immediately died due to coronary air embolism. Forensic autopsies are necessary to solve the cause and manner of death, to evaluate and develop medical devices and to rule out medical malpractice. Thus, a close collaboration of legal medicine and the various cardiologic departments is proposed.
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Affiliation(s)
- J Zwirner
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - R Bayer
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - C Hädrich
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - A Bollmann
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - N Klein
- Hospital St. Georg Leipzig, Clinic for Cardiology, Angiology and Intensive Care, Leipzig, Germany
| | - J Dreßler
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - B Ondruschka
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
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Morgenthal S, Bayer R, Schneider E, Zachäus M, Röcken C, Dreßler J, Ondruschka B. Nodular pulmonary amyloidosis with spontaneous fatal blood aspiration. Forensic Sci Int 2016; 262:e1-4. [DOI: 10.1016/j.forsciint.2016.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/22/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
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Ondruschka B, Habeck JO, Hädrich C, Dreßler J, Bayer R. Rare cause of natural death in forensic setting: hemophagocytic syndrome. Int J Legal Med 2015; 130:777-81. [PMID: 26718840 DOI: 10.1007/s00414-015-1305-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
We report about the case of a sudden unexpected death of a 25-year-old male suffering from infectious disease. An autopsy was ordered with no final premortem diagnosis. Microscopic and microbiological examination revealed a pneumococcal bronchopneumonia and hemophagocytic lesions in the bone marrow. After integrating clinical and autopsy reports as well as additional postmortem investigations, the cause of death was found to be infectious-triggered hemophagocytic syndrome (HPS) with a final cytokine storm. This seems to be the first reported fatal case of a reactive form of HPS associated to Streptococcus pneumoniae to the best of our knowledge. HPS is a dangerous hyperinflammation with highly characteristic, but nonspecific, laboratory findings and symptoms. Autopsies in such cases must be carefully performed and include systematic tissue sampling done by an experienced pathologist.
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Affiliation(s)
- B Ondruschka
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
| | - J-O Habeck
- Centre of Histopathology, Chemnitz, Unritzstraße 21, 09117, Chemnitz, Germany
| | - C Hädrich
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
| | - J Dreßler
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
| | - R Bayer
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
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Glauche J, Ondruschka B, Wenzel V, Dreßler J, Hädrich C. Examination of invisible injuries. Rechtsmedizin (Berl) 2015. [DOI: 10.1007/s00194-015-0053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schober K, Ondruschka B, Dreßler J, Abend M. Detection of hypoxia markers in the cerebellum after a traumatic frontal cortex injury: a human postmortem gene expression analysis. Int J Legal Med 2014; 129:701-7. [PMID: 25432860 PMCID: PMC4475240 DOI: 10.1007/s00414-014-1129-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/14/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE The response to traumatic brain injury (TBI) is complex and induces various biological pathways in all brain regions that contribute to bad outcomes. The cerebellar hypoxia after a frontal cortex injury may potentiate the pathophysiological impacts of TBI. Therefore, a gene expression analysis was conducted to determine the influence of hypoxia on TBIs. MATERIAL AND METHODS Total RNA, including microRNAs, was isolated from the cerebellum of individuals who had died from severe frontal cortex injuries or due to natural causes of death (reference group). RESULTS From a total of 19,596 genes, an average of 59.56% messenger RNAs (mRNAs) appeared expressed with 42 of them showing significant >2-fold differences of upregulated (n = 18) and downregulated (n = 24) genes. The validity of 14 candidate genes (with low p values and high fold differences or based on cited literature) was confirmed using qRT-PCR (Spearman correlation r(2) = 0.93). Only four genes appeared to be either upregulated (FOSB and IL6) or downregulated (HSD11B1 and HSPA12B). From a total of 667 microRNAs, altogether, 248 microRNAs appeared expressed with 13 of them showing significant differences in the mean gene expression. The combination of two mRNAs (HSPA12B/FOSB or IL6/HSD11B1) or two microRNAs (either miR-138/miR-744 or miR-195/miR-324-5p) completely discriminated both groups, a finding unaltered by potential confounders such as age at biosampling, survival time, and the postmortem interval. CONCLUSIONS Cerebellar hypoxia markers are important to understand the pathophysiology of TBIs and could be used for therapeutic strategies or forensic purposes, e.g., to assess the severity of a brain injury.
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Affiliation(s)
- K Schober
- German Air Force Center for Aerospace Medicine, Postfach 1264/KFL, 82242, Fürstenfeldbruck, Germany,
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Qui NV, Scholz P, Keller TF, Pollok K, Ondruschka B. Ozonated Multiwalled Carbon Nanotubes as Highly Active and Selective Catalyst in the Oxidative Dehydrogenation of Ethyl Benzene to Styrene. Chem Eng Technol 2013. [DOI: 10.1002/ceat.201200354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ren Y, Wu Z, Ondruschka B, Braeutigam P, Franke M, Nehring H, Hampel U. Oxidation of Phenol by Microbubble-Assisted Microelectrolysis. Chem Eng Technol 2011. [DOI: 10.1002/ceat.201000534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schmöger C, Gallert T, Stolle A, Ondruschka B, Bonrath W. Microwave-Assisted Chemoselective Hydrogenation Reactions Incorporating Hydrogen as Reducing Agent. Chem Eng Technol 2011. [DOI: 10.1002/ceat.201000312] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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35
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Stark A, Hofmann C, Wirker R, Ondruschka B, Hübschmann S, Kralisch D. Dimcarb als Reaktivlösungsmittel in der Kolbe-Schmitt-Synthese. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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36
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37
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38
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Stark A, Huebschmann S, Sellin M, Kralisch D, Trotzki R, Ondruschka B. Microwave-Assisted Kolbe-Schmitt Synthesis Using Ionic Liquids or Dimcarb as Reactive Solvents. Chem Eng Technol 2009. [DOI: 10.1002/ceat.200900331] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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39
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Nigrovski B, Scholz P, Krech T, Qui N, Pollok K, Keller T, Ondruschka B. The influence of microwave heating on the texture and catalytic properties of oxidized multi-walled carbon nanotubes. CATAL COMMUN 2009. [DOI: 10.1016/j.catcom.2009.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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40
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41
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Ondruschka B, Klemm W, Scholz P, Stark A, Zimmermann EL, Strümpel M, Hegner D. Der Einsatz von Mikroreaktoren im chemisch-technischen Praktikum. CHEM-ING-TECH 2008. [DOI: 10.1002/cite.200800078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Krech T, Möser C, Emmerich R, Scholz P, Ondruschka B, Cihlar J. Catalytic and Heating Behavior of Nanoscaled Perovskites under Microwave Radiation. Chem Eng Technol 2008. [DOI: 10.1002/ceat.200700502] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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43
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44
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45
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Nigrovski B, Scholz P, Ondruschka B, Tsend-Ayush T, Hoffmann J, Rost M, Wegner R. Katalysatoren zur Totaloxidation von flüchtigen organischen Komponenten. CHEM-ING-TECH 2007. [DOI: 10.1002/cite.200700099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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46
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Zavyalova U, Pollok K, Langenhorst F, Scholz P, Ondruschka B. Combustion Synthesized Nanocrystalline Mixed Oxide Catalysts for Elimination of Volatile Organic Compounds. CHEM-ING-TECH 2007. [DOI: 10.1002/cite.200750337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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47
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48
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Lifka J, Ondruschka B, Stark A. Herstellung von 5-Hydroxymethylfurfural aus D-Fructose. CHEM-ING-TECH 2006. [DOI: 10.1002/cite.200650169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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49
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50
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Taubert T, Scholz P, Ondruschka B. Dehydrodimerization of Isobutene to 2,5-Dimethyl-1,5-Hexadiene over Bismuth-(III)-Oxide and Various Additives. Chem Eng Technol 2006. [DOI: 10.1002/ceat.200500320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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