Further investigations into the speed of cerebral swelling following blunt cranial trauma

An anesthetized sheep model of traumatic brain injury (TBI) has been developed to assess early changes in intracranial pressure (ICP) following closed head injury. Immediately after TBI, a transient (<10 min) hypertensive response occurred, followed by significant and prolonged systemic hypotension. ICP demonstrated a biphasic response, being seven times baseline values of 8 ± 2 mm Hg 10 min after injury, decreasing to 25 ± 2 mm Hg by 30 min, and then increasing to values exceeding 30 mm Hg by 4 h postinjury. ICP was always significantly higher than baseline values, which combined with hypotension, reduced cerebral perfusion pressure to less than 60% of normal. This early and sustained increase in ICP after craniocerebral trauma acutely alters cerebral perfusion pressure and brain oxygenation and provides a potential pathophysiological explanation for immediate clinical manifestations in humans following significant TBI.     

Do bone elasticity and postmortem interval affect forensic fractographic analyses?

Forensic fractographic features of bone reliably establish crack propagation in perimortem injuries. We investigated if similar fracture surface features characterize postmortem fractures. Experimentally induced peri- and postmortem fractures were used to assess if fractographic features vary as bone elasticity decreases during the postmortem interval (PMI). Thirty-seven unembalmed, defleshed human femoral shafts from males and females aged 33–81 years were fractured at varying PMIs with a drop test frame using a three-point bending setup and recorded with a high-speed camera. Vital statistics, cause of death, PMI length, temperature, humidity, collagen percentage, water loss, fracture energy, and fractography scores were recorded for each sample. Results showed that fractographic features associated with perimortem fractures were expressed in PMIs up to 40,600 accumulated degree hours (ADH), or 60 warm weather days. Hackle was the most consistently expressed feature, occurring in all fractures regardless of ADH. The most variable characteristics were wake features (78.4%) and arrest ridges (70.3%). Collagen percentage did not correlate strongly with ADH (r = −0.04, p = 0.81); however, there was a strong significant correlation between ADH and water loss (r = 0.74, p < 0.001). Multinomial logistic regression showed no association between fractographic feature expression and ADH or collagen percentage. In conclusion, forensic fractographic features reliably determine initiation and directionality of crack propagation in experimentally induced PMIs up to 40,600 ADH, demonstrating the utility of this method into the recent postmortem interval. This expression of reliable fractographic features throughout the early PMI intimates these characteristics may not be useful standalone features for discerning peri- versus postmortem fractures.     

Ballistic impact of hollow-point ammunition on porcine bone

Identifying failure mechanisms in skeletal tissue allows a deeper understanding of the effects of specific projectile impacts on bone. While ballistic trauma in flat bones is largely researched, knowledge of how long bones react to gunshot impacts is limited in the literature. The impacts of deforming ammunition appear to produce higher levels of fragmentation; however, these have not been studied in depth. This study compares the damage to femora bone by HP 0.357 and 9 mm projectiles constructed with both full and semi-metal jackets. Impact experiments were undertaken on a single-stage light gas gun involving the use of a high-speed video camera and full reconstruction of the bones to ascertain fracture patterns occurring in the femora. Higher degrees of fragmentation are likened to the presence of semi-jacketed HP projectiles than jacketed HP projectiles. The observations of external facing beveled edges are believed to be associated with the increased separation of the jacket and lead core of projectiles. Additionally, experimentation has shown that the amount of kinetic energy lost postimpact is likely related to the presence or the absence of a metal jacket on an HP projectile. The observed data, therefore, suggest that the composition, rather than the configuration, of a projectile affects the type and extent of the damage.     

Skeletal evidence of the ethnic cleansing actions in the Free City of Danzig (1939-1942) based on the KL Stutthof victims analysis

In the early days of World War II, many of the prominent and influential people of Polish nationality from the Free City of Danzig were arrested by the Germans and sent to the nearby concentration camp KL Stutthof. Nearly a hundred of them died within the next seven months upon their arrival, and were buried in a clandestine mass grave in a nearby forest. However, the exact nature of their death is unknown, as it is unclear what the attitude of the aggressors was toward the victims. We do not know whether there was only one executioner or there were several assassins, nor if the killing methodology was consistent with the other state-regulated executions.The studied material represents the commingled remains of a minimum thirty-four people, possibly all male, aged from under eighteen to over sixty at the time of death. Perimortem traumatic lesions are shown mainly on the skull bones. We asked whether the perimortem trauma lesions visible on the victims’ skeletons could be informative on the cause and manner of their death.Our results show the prevalence of the perimortem trauma inflicted by a blunt object are on the parietal bones above the Hat Brim Line (HBL), which is commonly associated with a violent attack. The gunshot trauma was usually localized on the occipital bone or posterior parietal, which could indicate a shot to the back of the head, and this was commonly encountered during executions. No signs of defensive injuries can be explained either by restraining of the hands or by a surprise attack. The abundance and variability of the trauma type can be evident of multiple assailants. Moreover, the multiple impact points detected on several crania prove unnecessary overkill and brutality, which reflects the personal attitudes of the executioners towards the victims.     

Specific Characteristics of Injuries Inflicted by Claw Hammer

Claw hammers have the specific characteristic of having two distinct ends: one a flat head of variable form, the other bifurcated. So the use of this tool as a blunt instrument will cause varying injuries. The authors present two clinical cases of assault with a claw hammer. Examinations revealed two types of wound. A first injury composed of integumentary lacerations and underlying bone injuries in terms of “shape” suggested the use of a blunt instrument. A second injury made up of damage showing two parallel wounds or two wounds located one in the extension of the other suggested the use of an object with a bifurcated end. The combination of both types of injury should alert examiners to the possibility of the use of a claw hammer in causing the injuries in order to help direct investigators in their investigations and in the search for the weapon used.     

外伤性癫痫及其法医学评定进展

外伤性癫痫(post traumatic epilepsy,PTE)是指颅脑损伤后的癫痫性发作,影像学检查可见器质性病变,脑电图检查可见异常脑电波与颅脑损伤部位一致。外伤后癫痫发生率低,案例报道较少,患者易夸大病情,给法医学鉴定增加难度。本文就外伤性癫痫流行病学、发病机制、临床治疗、法医学鉴定等方面的现状进行综述。     

Vicarious Trauma in Child Welfare Workers: A Study of Organizational Responses

Child welfare is provided within an organizational context that both supports and thwarts the efforts of workers and administrators to meet the myriad of goals established by federal, state, and local regulation and professional bodies. As the field moves toward trauma-informed services for children and families (Ko et al., 2008 Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., Brymer, M. J., &; Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, healthcare, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396–404.[Crossref], [Web of Science ®] , [Google Scholar]), the effect of trauma on workers has received less agency attention (Middleton &; Potter, 2015 Middleton, J. S., &; Potter, C. C. (2015). Relationship between vicarious traumatization and turnover among child welfare professionals. Journal of Public Child Welfare, 9(2), 195–216.[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]). This exploratory, qualitative study examines the level of knowledge administrators have regarding vicarious trauma and probes the organizational responses of public child welfare agencies to the vicarious trauma experienced by workers.     

当代文学女性创伤叙事的三个维度

女性创伤叙事具有独特而重要的价值。作为文化记忆的创伤、作为认同困境的创伤和作为个体体验的创伤是当代女性创伤叙事的基本图景。那些具有大事件性质的“缠绕式”的创伤是历史的骨架和关节;历史演进中各种新的创伤是具有时代症候的特质呈现;历史和时代之外的个人创伤构成历史骨架之外的血肉和脉络。当代文学的女性创伤叙事呈现出三个可能的维度,从女性创伤出发,又超脱出性别的界限,将女性创伤叙事的视野和层次提升到两性、国民甚至人类的高度,形成一种现实主义的人文情怀,显现出更为广阔的形态。     

The Corpus Callosum and Forensic Issues—An Overview

The corpus callosum is a large central white matter tract that connects the right and left cerebral hemispheres. It permits placental mammals to have a more sophisticated interhemispheric integration of sensory cortices and allows communication between cortical and subcortical neurons. Search of the literature and the pathology archives at The University of Adelaide was undertaken to identify lesions and injuries within the corpus callosum that may have forensic significance. These include developmental/congenital lesions with agenesis/dysgenesis, vascular malformations, and lipomas; inherited syndromes such as neurofibromatosis; and acquired lesions involving trauma, neoplasia, demyelination, vascular conditions, infections, fat embolism, aging/dementia, and the effects of toxins. The finding of lesions within the corpus callosum should initiate careful examination of the adjacent brain and other organ systems for related phenomena as this may shed some light on the nature of the underlying condition, and also help to determine whether there are any forensic implications.     

血府逐瘀汤辅助治疗重症闭合性胸外伤临床观察

目的 观察血府逐瘀汤辅助治疗重症闭合性胸外伤的疗效。方法 将60例重症闭合性胸外伤患者随机分为治疗组和对照组,每组30例。对照组在西医常规对症治疗的基础上进行纤维气管镜肺泡灌洗,治疗组在对照组疗法的基础上加服血府逐瘀汤。采用视觉模拟量表(visual analogue scale,VAS)评价患者的胸痛程度,通过检测外周血白细胞(white blood cell, WBC)及血清C-反应蛋白(C-reactive protein, CRP)水平评价炎症程度,采用血气分析评价肺通气和换气功能。结果 治疗组患者治疗后VAS评分降低程度显著大于对照组（P<0.05）。治疗组患者住院时间较对照组明显缩短（P<0.05）。治疗第3、7、12天末,治疗组患者血pH值、动脉血氧分压、血氧饱和度均显著高于对照组（P<0.05）,动脉血二氧化碳分压、外周血WBC计数、血清CRP水平均显著低于对照组（P<0.05）。治疗组临床疗效明显优于对照组（P<0.05）。结论 血府逐瘀汤能提高重症闭合性胸外伤患者肺泡的通透性,改善肺组织的通气及换气功能,降低炎症反应。