Reconstruction and 3D visualisation based on objective real 3D based documentation

Reconstructions based directly upon forensic evidence alone are called primary information. Historically this consists of documentation of findings by verbal protocols, photographs and other visual means. Currently modern imaging techniques such as 3D surface scanning and radiological methods (Computer Tomography, Magnetic Resonance Imaging) are also applied. Secondary interpretation is based on facts and the examiner's experience. Usually such reconstructive expertises are given in written form, and are often enhanced by sketches. However, narrative interpretations can, especially in complex courses of action, be difficult to present and can be misunderstood. In this report we demonstrate the use of graphic reconstruction of secondary interpretation with supporting pictorial evidence, applying digital visualisation (using 'Poser') or scientific animation (using '3D Studio Max', 'Maya') and present methods of clearly distinguishing between factual documentation and examiners' interpretation based on three cases. The first case involved a pedestrian who was initially struck by a car on a motorway and was then run over by a second car. The second case involved a suicidal gunshot to the head with a rifle, in which the trigger was pushed with a rod. The third case dealt with a collision between two motorcycles. Pictorial reconstruction of the secondary interpretation of these cases has several advantages. The images enable an immediate overview, give rise to enhanced clarity, and compel the examiner to look at all details if he or she is to create a complete image.

Effect of shortening the barrel in contact shots from rifles and shotguns

In a suicidal gunshot fired to the chest from a carbine, the barrel of which had been shortened to half its original length, an unexpectedly large degree of destruction of the anterior thoracic wall with extensive undermining of the subcutis was found. This phenomenon was investigated for reconstructive purposes by firing test shots from two different long guns (caliber 7.92 x 57 repeating rifle with full-jacketed pointed bullet and caliber 12/70 single-barreled shotgun with shotgun slug) into blocks of soap (38 x 25 x 25 cm). The contact shots were fired before and after shortening the barrels (repeating rifle from 60 to 30 cm and single-barreled shotgun from 72 to 36 cm). The volume of the cavities in the simulant was visualized three-dimensionally with the help of a multislice computed tomography (CT) scanner and calculated sectionally. With the repeating rifle and the single-barreled shotgun, the shots from the sawed-off barrels produced significantly larger cavity diameters in the first section of the bullet track. This effect is attributable to the fact that, with a shortened barrel, the gas pressure at the muzzle is higher, thus, leading to increased expansion in the initial part of the wound track in contact shots.

Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement

BACKGROUND: Transcatheter aortic valve implantation (TAVI) for high-risk and inoperable patients with severe aortic stenosis is an emerging procedure in cardiovascular medicine. Little is known of the impact of TAVI on renal function. METHODS: We analysed retrospectively renal baseline characteristics and outcome in 58 patients including 2 patients on chronic haemodialysis undergoing TAVI at our institution. Acute kidney injury (AKI) was defined according to the RIFLE classification. RESULTS: Fifty-eight patients with severe symptomatic aortic stenosis not considered suitable for conventional surgical valve replacement with a mean age of 83 +/- 5 years underwent TAVI. Two patients died during transfemoral valve implantation and two patients in the first month after TAVI resulting in a 30-day mortality of 6.9%. Vascular access was transfemoral in 46 patients and transapical in 12. Estimated glomerular filtration rate (eGFR) increased in 30 patients (56%). Fifteen patients (28%) developed AKI, of which four patients had to be dialyzed temporarily and one remained on chronic renal replacement therapy. Risk factors for AKI comprised, among others, transapical access, number of blood transfusions, postinterventional thrombocytopaenia and severe inflammatory response syndrome (SIRS). CONCLUSIONS: TAVI is feasible in patients with a high burden of comorbidities and in patients with pre-existing end-stage renal disease who would be otherwise not considered as candidates for conventional aortic valve replacement. Although GFR improved in more than half of the patients, this benefit was associated with a risk of postinterventional AKI. Future investigations should define preventive measures of peri-procedural kidney injury.

Perioperative use of crystalloids in patients undergoing open radical cystectomy: balanced Ringer's maleate versus a glucose 5%/potassium-based balanced solution: study protocol for a randomized controlled trial

BACKGROUND The optimal crystalloid solution to use perioperatively in patients undergoing open radical cystectomy remains unclear. Many of the fluids used for intravenous hydration contain supraphysiologic concentrations of chloride, which can induce hyperchloremia and metabolic acidosis, resulting in renal vasoconstriction and decreased renal function. In addition, patients receiving less fluid and less sodium show faster recovery of gastrointestinal (GI) function after colonic surgery. METHODS AND DESIGN This is an investigator-initiated, single-center, randomized, controlled, parallel group trial with assessor-blinded outcome assessment, in the Department of Urology, University Hospital Bern, Switzerland. The study will involve 44 patients with bladder cancer scheduled for radical cystectomy and urinary diversion. The primary outcome is the duration between the end of surgery and the return of the GI function (first defecation). Secondary outcomes are fluid balance (body weight difference postoperatively versus preoperatively) and the incidence of kidney function disorders according to the Risk-Injury-Failure-Loss-End Stage Renal Disease (RIFLE classification). An equal number of patients are allocated to receive Ringerfundin® solution or a glucose/potassium-based balanced crystalloid solution as baseline infusion during the entire time that intravenous administration of fluid is necessary during the perioperative period. The randomized crystalloid solution is infused at a rate of 1 ml/kg/h until the bladder has been removed, followed by 3 ml/kg/h until the end of surgery. Postoperative hydration is identical in both groups and consists of 1,500 ml of the randomized crystalloid solution per 24 hours. Postoperative patient care is identical in both groups; patients are allowed to drink clear fluids immediately after surgery, and liquid diet is started on postoperative day 1, as well as active mobilization and the use of chewing gum. Body weight is measured daily in the morning. Time of first flatus and first defecation are recorded. DISCUSSION This trial assesses the benefits and harms of two different balanced crystalloid solutions for perioperative fluid management in patients undergoing open radical cystectomy with urinary diversion, with regard to return of GI function and effects on postoperative renal function. TRIAL REGISTRATION Current Controlled Trials ISRCTN32976792 (registered on November 21 2013).

Optimal lange Fixationen? Eine experimentelle Studie zu überlangen "QuietEye"-Dauern

Einleitung: Im Zusammenhang mit der Leistungsdienlichkeit langer finaler Fixation (quiet eye, QE) wird vermutet, dass Leistungsverbesserungen nur für eine optimale Dauer zu beobachten sein sollten, also auch bei „überlangen“ QE-Dauern die Leistung wieder abnimmt (u.a. Janelle et al., 2000; Klostermann, 2014). Jedoch liegen zu dieser Vermutung bislang keine empirischen Befunde vor, so dass in der hier präsentierten Studie Präzisionsleistung in einer Wurfaufgabe in Abhängigkeit von (auch) sehr langen experimentell kontrollierten QE-Dauern untersucht wurde. Methode: In einem Within-subject-Design hatten 20 Sportstudierende unter acht verschiedenen QE-Bedingungen (Onset in 400-ms-Schritten von -3200 ms bis -400 ms vor Bewegungsbeginn; 16 Versuche pro Bedingung in randomisierter Abfolge) mit retro-reflektierenden Bällen auf eine Großleinwand projizierte Zielscheiben möglichst mittig zu treffen. Die QE-Manipulation erfolgte über eine an den Bewegungsbeginn gebundene Zielscheibeneinblendung samt Wurfrhythmisierung durch Tonvorgaben. Aus den mit einem Vicon-T20-System (200 Hz) sowie einem integrierten mobilen Eyetracker (EyeSeeCam, 220 Hz) erhobenen Daten wurden die QE-Dauer (ms) und die Wurfleistung (radialer Fehler, mm) als abhängige Variablen berechnet und varianzanalytisch auf Unterschiede untersucht. Resultate und Diskussion: Für die QE-Dauer wurde ein signifikanter Haupteffekt gefunden, F(7, 133) = 38.4, p < .01, ηp2 = .67, mit zumindest tendenziellen (-2000 ms vs. -2400 ms, -2800 ms vs. -3200 ms), größtenteils aber signifikanten QE-Anstiegen gemäß der experimentellen Manipulation (alle ps < .01), obgleich die jeweils angezielten QE-Dauern nicht erreicht und zum Teil deutlich unterschritten wurden (tatsächliche relativ zur angezielten Dauer im Mittel 59.95 %). Für den radialen Fehler ergab sich ein signifikanter Haupteffekt, F(7, 133) = 8.5, p < .01, ηp2 = .31, welcher durch signifikant schlechtere Leistungen bei den Onsets -400 ms und -800 ms gegenüber allen anderen Onsets erklärt wird (alle ps < .05; ausgenommen -400 ms vs. -800 ms und -800 ms vs. -2400 ms). Somit wurde der „klassische“ QE-Effekt schlechterer Leistungen infolge kurzer QE-Dauern repliziert; die Vermutung einer Leistungsverschlechterung bei überlangen QE-Dauern konnte jedoch – zumindest unter den infolge der Manipulation tatsächlich erzielten Werten – nicht untermauert werden. Literatur: Klostermann, A. (2014). Finale Fixationen, sportmotorische Leistung und eine Inhibitionshypothese: Mechanismen des „Quiet Eye“, Sportwissenschaft, 44, 49-59. Janelle, C. M., Hillman, C. H., Apparies, R. J., Murray, N. P., Meili, L., Fallon, E. A. & Hatfield, B. D. (2000). Expertise differences in cortical activation and gaze behavior during rifle shooting. Journal of Sport & Exercise Psychology, 22, 167-182.