German Air Force Centre of Aerospace Medicine Molecular pathology - - PowerPoint PPT Presentation

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German Air Force Centre of Aerospace Medicine Molecular pathology - - PowerPoint PPT Presentation

Oct 09, 2022 343 likes •608 views

German Air Force Centre of Aerospace Medicine Molecular pathology in aircraft accident investigations In co-operation with: Dr. Michael J. Schwerer, Lt. Col. Anatomic Pathologist, Forensic Pathologist, Institute of Forensic Medicine

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German Air Force Centre of Aerospace Medicine

Molecular pathology in aircraft accident investigations

  • Dr. Michael J. Schwerer, Lt. Col.

Anatomic Pathologist, Forensic Pathologist, Aeromedical Examiner (class 1, military), Branch I 4 – Aircraft Accident Investigation, Fuerstenfeldbruck, Germany

In co-operation with:

Institute of Forensic Medicine Ludwig-Maximilians-University, Munich, Germany Head: Prof. Dr. M. Graw

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Disclosure statement

  • I have no financial relationships to disclose.
  • I will not discuss any off-label use and/or

investigational use in my presentation.

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Background

Otto Lilienthal † 1896 Actual Airliner Crash - No fatalities

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Background

International Civil Aviation Organization Founded on 7th December 1944 ICAO Annex 13: Aircraft Accident and Incident Investigation

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Background

The ICAO Annex 13 „Aircraft accident and incident investigation“ requires the assessment

  • f aircraft mishaps to increase flight safety and to prevent future accidents.
  • Included in European law:

VOEU996/2010.

  • Included in German national law:

Flugunfalluntersuchungsgesetz; FlUUG 1998. Technical investigation carried out by the „Bundesstelle für Flugunfalluntersuchung“ as an independent federal agency. Medical investigation carried out in institutes for forensic pathology by order of public prosecutors.

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Background

German Air Force F104G „Starfighter“

  • 900 aircraft ordered
  • 292 aircraft accidents
  • 116 pilots killed
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Aircraft accident investigation

  • Crash site

investigation

  • External

inspection and forensic autopsy

  • Identification

using DNA-analysis

  • Toxicology to

confirm or exclude illicit substances Forensic medical examination includes: The basic questions in the reconstruction of the mishap are:

  • Was the pilot alive

at the moment of loss of control?

  • Occured a sudden

incapacitation of the pilot?

  • Did any kind of

pre-existing disease cause the loss of control?

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(Forensic) Pathology in mishap investigation

The basic questions in the reconstruction of the mishap are:

  • Was the pilot alive

at the moment of loss of control?

  • Occured a sudden

incapacitation of the pilot?

  • Did any kind of

pre-existing disease cause the loss of control? These questions remain unanswered in autopsy alone in the majority of cases.

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(Forensic) Pathology in mishap investigation

Additional techniques usually involve microscopy/histology. However, these methods require sufficient qualitiy of available tissues.

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(Molecular) Pathology in mishap investigation

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(Molecular) Pathology in mishap investigation

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Aims and methods

A literature review was carried out to look for new techniques in clinical pathology, which can also be used in the investigation of aircraft accidents. Own results from the implementation of these new techniques in forensic pathology practice are demonstrated.

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Diagnosis of pathogens

Demonstration of the presence of Aeromonas species in skin wounds in clinical pathology and in veterinary medicine. Identification of the same bacteria in the peripheral blood/ deep muscles of the lower limbs is diagnostic for drowning.

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Diagnosis of pathogens

Identification of the same bacteria in the peripheral blood/ deep muscles of the lower limbs is diagnostic for drowning.

„Cold case“ – Aircraft accident in the Lake Constance with 7 persons killed in 1994. No macroscopic

  • r histologic

signs of drowning.

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Diagnosis of manifest heart disease

Hypertrophic heart with penetrating injury from rib fracture. White scar tissue from infarction (formalin- fixed organ).

Hematoxylin-eosin - staining Fibronectin - IHC C5b-9 - IHC

CD 56 - IHC

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Diagnosis of latent heart disease

DNA degrades into short fragments. When the fragments are too short, primer annealing to the target sequence and strand elongation is impossible.

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Diagnosis of latent heart disease

Detection of the epigenetic regulation of gene expression investigating CpG-methylation in short sequences in the promotor region of genes as well as short microRNAs.

One solution investigating material with degraded DNA:

Methylation analysis using pyrosequencing. MicroRNA analysis employing SybrGreen-based real-time PCR.

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Diagnosis of latent Heart Disease

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Diagnosis of latent heart disease

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Diagnosis of latent heart disease

Hypertrophic heart with penetrating injury from rib racture. White scar tissue from infarction (formalin- fixed organ).

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Diagnosis of latent heart disease

„Liquid biopsy technique“ Applicable in living patients to detect e.g. tumor markers or

  • ther disease-related spill of DNA
  • r microRNA in the bloodstream.

Applicable also in blood samples from deceased persons. Informative e.g. of disease related markers present prior to an accident event.

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Further applications

Markers for lung damage, e.g. in fighter pilots using positive pressure breathing. Markers for vascular damage, e.g. in flyers wearing anti-G-suits. Markers for other aeromedical flieds of interest including

  • Circadian rhythm and

performance

  • Fatigue
  • Mood disorders
  • White matter lesions
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CpG-methylation in SFTP-promotor

Methylation in lung tissue:

  • 71%
  • 46%
  • 54%
  • 53%

Methylation in muscle tissue:

  • 93%
  • 70%
  • 85%
  • 67%
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CpG-methylation in SFTP-promotor

Methylation in liquid biopsy:

  • 79%
  • 59%
  • 69%
  • 66%
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Summary

With these recently developed techniques molecular pathology made ist way into (scientific) aerospace medicine.

?

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Thank you very much for your attention.