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Background: Answering legal questions is everyday routine in forensic medicine. The reconstruction of violent crimes following attacks with sharp and/or pointed instruments is usually complex and can hardly be adequately answered using traditional forensic methods such as autopsies. For this reason, clinical and postmortem radiology has become the ideal complement to forensic medicine., Methods: While classic X‑ray is unsuitable to image soft tissue injuries, and magnetic resonance imaging is too expensive, too complex and also not available everywhere, multislice computed tomography (MSCT) has now emerged as the method of choice in forensic imaging for the assessment of the consequences of sharp force injuries., Achievements: Forensic imaging, especially MSCT, offers an indispensable addition to reconstruction, particularly after stab wounds. In many cases, it is at least equal to, and in some cases superior to, the classic autopsy in the assessment of stab wounds, the reconstruction of the sequence of events or the assessment of (life-threatening) injuries., Conclusions: The forensic radiological assessment after sharp violence requires experience in both the field of radiology and forensic medicine. Provided that both disciplines work closely together, forensic radiology can be an essential tool in the care for victims of violence., (© 2024. The Author(s).)

In tool mark identification, there is still a lack of characteristics and methodologies standardization used to analyze and describe sharp force trauma marks on skeletal remains. This study presents a classification method for cut marks on human bones, providing an applicable methodology for their examination and the relevant terminology for describing cases of sharp force trauma. A total of 350 cut marks were produced by stabbing pig ribs (Sus scrofa) with seven knives. The samples were analyzed under a stereomicroscope with a tangential light source. Through the analysis of cut marks, eleven traits were identified as significantly associated with the type of knife used. These traits included the general morphology of the kerf shape, the entrance and exit cross-profile shapes, the location of the rising on the entrance and exit cross-profile, the presence or absence of feathering, the presence or absence of shards and the location and the general morphology of the mounding. Binary logistic regression models were later trained and tested using nine out of the eleven traits. The first model categorized the cut mark as either produced by a serrated or non-serrated blade, while the second, as either produced by a single- or double-beveled blade. Classification scores of those models ranged between 63%-85% for the serration class and 63%-89% for the blade bevel class. This study proposes a new set of traits and the use of machine learning models to standardize and facilitate the analysis of stab wounds., (© 2024 The Author(s). Journal of Forensic Sciences published by Wiley Periodicals LLC on behalf of American Academy of Forensic Sciences.)

Evaluating sharp force trauma (SFT) injuries to bone inflicted by a larger class of chopping/hacking tools (i.e., swords, axes, hatchets, machetes, and cleavers) is a growing area within the field of forensics. Previous studies have demonstrated promise regarding tool differentiation through the utilization of microscopic cut mark characteristics. However, this is an area that warrants additional investigation as there has yet to be a comprehensive study that incorporates the majority of these microscopic chopping/hacking cut mark characteristics into one analysis. The purpose of the current research was to analyze a large sample of microscopic cut mark characteristics derived from the current chopping/hacking literature to determine if differentiation of tool type could be made based on the microscopic cut mark characteristics. An additional goal of the current research is to develop standardization guidelines for the assessment of cut marks, focusing on a comprehensive suite of microscopic cut mark characteristics commonly observed in the existing literature. The skeletal sample for the current research was derived from a previous macroscopic cut mark characteristic experiment where trauma was inflicted to 20 partially fleshed domestic pig (Sus scrofa domesticus) limbs utilizing four chopping/hacking tools (i.e., axe, hatchet, machete, and cleaver) as well as a large carving knife for comparison. Cut marks were evaluated for 15 microscopic cut mark characteristics to assess statistical significance. Utilizing a chi-square analysis, nine of the 15 microscopic cut mark characteristics demonstrated statistically significant differences in relation to the tool utilized, indicating moderate to relatively strong effect sizes. For example, it should be possible to use a combination of microscopic cut mark characteristics to potentially indicate which chopping/hacking tool inflicted trauma when analyzing bones. In particular, examining the characteristics such as regularity of the cut mark edges along with the occurrence of uprising, fossae/depressions, and microscopic fractures can suggest or exclude tool class within forensic contexts., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Several studies have been performed to recognize the main features in homicide and suicide sharp wound-related death, revealing that a single cutting wound to the neck is an infrequent event in suicide cases, and several hesitation marks near the fatal injury are usually present. We report a case of an atypical self-inflicted cutthroat injury without tentative marks involving a 79-year-old female. The weapon used, a kitchen knife, was found at the crime scene. The wound had clean margins, and no other incisions were found. Scene circumstances, namely the absence of signs of a break-in, the victim found on the bed, the knife located near the body, the vital wound in an accessible site, and the absence of defense injuries, collectively support a likely suicide. A literature review was also performed to compare forensic data of the case presented with the other 6 cases reported regarding atypical suicide characterized by a single incising cut to the throat without hesitation marks. Given the few cases reported and the lack of gross descriptions and histopathological data available in the literature, additional knowledge of such a case may help forensic pathologists in the identification of suicidal events when a single neck injury is observed. In this frame, suicide by a unique single incising cut to the throat without hesitation marks near the lethal injury may be observed as an atypical presentation, and the crime scene investigation, together with additional background information of the deceased, aid in the identification of the manner of the death., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Knife cut marks have been extensively studied in forensic literature, and the results have been beneficial in identifying both the cut mark and implement type on bone. For this study, an assessment in differentiating knife cut marks has been attempted by using sword cut mark characteristics. In addition, a flowchart was created to assist in interpreting such marks. Knives of different serrations (non-serrated, macro- and micro-serrated) were used to inflict cut marks on pig ribs with a forward and backward stab thrust. The analysis revealed that some traits adapted from previous studies applied to knife cut marks and that non-serrated and serrated marks could be distinguished accurately using the flowchart. The distinction between different types of serrated blades was not as successful. However, results show that further research and development of the flowchart can be invaluable in similar analyses., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Differentiating homicidal or suicidal deaths in presence of a singular stab wound to the anterior or lateral trunk is still a challenge in forensic practice. There are numerous criteria in the literature and in current forensic textbooks to distinguish between self-inflicted injuries and homicide. The applicability of these criteria in single stab injuries was examined by elucidating 12 suicides and 33 homicides, each with a single stab injury to the anterior or lateral trunk and were largely confirmed. An instrumentality still stuck in the corpse was always associated with a suicide in the given cohort. In summary, the final evaluation should always be based on an interpretation of the post mortem findings together with the circumstances on site of discovery as well as the results of the police investigation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Two men were wrongfully convicted of murder in 2017 and sentenced to life imprisonment. After a physical altercation inside a flat, the victim (A) was found dead approximately 60 m away outside a residential address. He had sustained a number of injuries including a stab wound to the left side of his neck which was found to have divided the right carotid artery. The location where A was found was not regarded as a crime scene and not subjected to a specialist forensic examination by scientists as it was assumed that the fatal injury was sustained in the flat. The pathologist, who subsequently carried out the autopsy on A, was not asked to attend the scene. A review of the blood distribution at the scene in conjunction with the pathology findings indicated however that the fatal neck wound had been inflicted outside the flat, near to where the victim was found. An appeal against the convictions for murder was upheld in 2021 and a re-trial ordered. Following this second trial, both accused were acquitted of murder and released from custody. The new pathology and blood pattern evidence introduced at the second trial was a major part of the defense strategy which led to the acquittal of the accused. The case illustrates that a more inclusive and detailed crime scene strategy had been undertaken, including an assessment of the bloodstains present, in conjunction with discussion with the pathologist, then the likelihood is that the two men subsequently charged with murder would have been eliminated as suspects and a miscarriage of justice would have been avoided., (© 2022. The Author(s).)

Astrogliosis after brain trauma can have a significant impact on functional recovery. However, little is known about the mechanisms underlying astrocyte proliferation and subsequent astrogliosis. In this study, we established a cortical stab wound injury mouse model and observed dramatic astrocyte activation and nerve growth factor receptor (p75NTR) upregulation near the lesion. We also found profound alterations in the cell cycle of astrocytes near the lesion, with a switch from a mitotically quiescent (G0) phase to the G2/M and S phases. However, no changes in the level of astrocyte apoptosis were observed. Cell cycle progression to the G2/M and S phases and CDK2 protein levels in response to cortical stab wound was inhibited after p75NTR knockdown in mouse astrocytes. Conversely, p75NTR overexpression in mouse astrocytes was sufficient in promoting cell cycle progression. In conclusion, our results suggested that p75NTR upregulation in astrocytes after brain injury induces cell cycle entry by promoting CDK2 expression and promoting astrocyte proliferation. Our findings provided a better understanding of astrocytic responses after cortical stab wound injury in mice., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

While zebrafish have a superior capacity to regenerate their central nervous system (CNS), medaka has a lower CNS regenerative capacity. A brain injury model was developed in the adult optic tectum of zebrafish and medaka and comparative histological and molecular analyses were performed to elucidate the molecular mechanisms regulating the high regenerative capacity of this tissue across these fish species. Here a stab wound injury model is presented for the adult optic tectum using a needle and histological analyses for proliferation and differentiation of the neural stem cells (NSCs). A needle was manually inserted into the central region of the optic tectum, and then the fish were intracardially perfused, and their brains were dissected. These tissues were then cryosectioned and evaluated using immunostaining against the appropriate NSC proliferation and differentiation markers. This tectum injury model provides robust and reproducible results in both zebrafish and medaka, allowing for comparing NSC responses after injury. This method is available for small teleosts, including zebrafish, medaka, and African killifish, and enables us to compare their regenerative capacity and investigate unique molecular mechanisms.

Reactive astrocytes manifest molecular, structural, and functional alterations under various pathological conditions. We have previously demonstrated that the reactive astrocytes of the stab wound injury model (STAB) display aberrant cellular gamma-aminobutyric acid (GABA) content and tonic GABA release, whereas the active astrocytes under enriched environment (EE) express high levels of proBDNF. However, the role of monoamine oxidase B (MAO-B) in reactive astrogliosis and hypertrophy still remains unknown. Here, we investigate the role of MAO-B, a GABA-producing enzyme, in reactive astrogliosis in STAB. We observed that the genetic removal of MAO-B significantly reduced the hypertrophy, scar formation, and GABA production of reactive astrocytes, whereas the MAO-B overexpression under glial fibrillary acidic protein (GFAP) promoter enhanced the levels of GFAP and GABA. Furthermore, we found that one of the by-products of the MAO-B action, H 2 O 2 , but not GABA, was sufficient and necessary for the hypertrophy of reactive astrocytes. Notably, we identified two potent pharmacological tools to attenuate scar-forming astrogliosis-the recently developed reversible MAO-B inhibitor, KDS2010, and an H 2 O 2 scavenger, crisdesalazine (AAD-2004). Our results implicate that inhibiting MAO-B activity has dual beneficial effects in preventing astrogliosis and scar-formation under brain injury, and that the MAO-B/H 2 O 2 pathway can be a useful therapeutic target with a high clinical potential., (© 2021 Wiley Periodicals LLC.)

This work deals with the examination of tool marks in human cartilage. We compared the effectiveness of several cleaning methods on cut marks in porcine cartilage. The method cleaning by multiple casts achieved the significantly highest scores (P = 0.02). Furthermore, we examined the grain-like elevations (dots) located on casts of cut cartilage. The results of this study suggest that the casting material forms these dots when penetrating cartilage cavities, which are areas where the strong collagen fibres leave space for the chondrocytes. We performed fixation experiments to avoid this, without success. In addition, 31 casting materials were compared regarding contrast under light-microscope and 3D tool marks scanner. Under the light-microscope, brown materials achieved significantly higher values than grey (P = 0.02) or black (P = 0.00) whereas under the 3D scanner, black materials reached higher contrast values than grey (P = 0.04) or brown (P = 0.047). To compare the accuracy and reproducibility of 6 test materials for cartilage, we used 10 knives to create cut marks that were subsequently scanned. During the alignment of the individual signals of each mark, the cross-correlation coefficients (X max ) and lags (L Xmax ) were calculated. The signals of the marks in agarose were aligned with significantly fewer lags and achieved significantly higher cross-correlation coefficients compared to all tested materials (both P = 0.00). Moreover, we determined the cross-correlation coefficients (X C ) for known-matches (KM) per material. Agarose achieved significantly higher values than AccuTrans®, Clear Ballistics™, and gelatine (all P = 0.00). The results of this work provide valuable insights for the forensic investigation of marks in human costal cartilage., (© 2021. The Author(s).)

Background: Estimation of postmortem interval (PMI) is a critical component of forensic death investigations. C5b-9 and cardiac Troponin C (cTnC) have the potential as markers for myocardial damage and can be suitable markers for determination of PMI. The aim of current study was to estimate different postmortem intervals using C5b-9 and cTnC detected by immunohistochemical technique in stab wounds and firearm injuries of the heart., Materials and Methods: Cardiac tissue samples from 70 forensic autopsy cadavers were obtained from XXXXXXX morgue, processed, for histopathological examination as well as immunohistochemical detection of C5b-9 and cTnC expression. The surface area of the positive C5b-9 and troponin C immune reactive cardiac tissue was measured morphometrically then the data were used to construct multiple regression equations for the estimation of PMI., Results: Histopathological autolytic changes occurred in all groups and increased in intensity with the increase in the PMI in stab wound and firearm injury groups. These findings were supported by immunohistochemical morphometric analysis. Constructed equations to estimate PMI were highly accurate especially those combining both markers., Conclusion: C5b-9 and cTnC can be considered reliable indicators of myocardial damage and can be used either separately or in combination for accurate estimation of PMI., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Cut marks provide essential knowledge to interpret which and how tools were used, both in archaeological and forensic context. Lots of studies focused on experimentally produced cut marks on animal models to develop methods for stabbing incidents. However, animal models are criticized to be morphologically different in comparison to human bones. This study analyzed the bone composition and experimentally obtained cut marks done on ribs from humans, pigs and goats. Methods included a qualitative description of differences between the species and a quantitative analysis of the cut mark proportions in histological thin sections and micro CT scans. The results indicated that especially the cortical bone of non-human ribs was different in comparison to human bone tissue as they were more robust and usually juvenile. Plexiform bone dominates and remodeled lamellar bone is rarely visible. The knife impact tends to create debris inside the cut mark and stress fractures along lamellae and cement lines perpendicular to the cut mark. Moreover, entheses of the intercostal muscles are always affected by the incision. Pig ribs were shown to be better suited as a model for sharp force trauma than goat ribs in comparison to humans. Though, plexiform bone and non-remodeled bone made it not quite ideal. We suggested to use bone material from animals used for breeding instead of meat production as they are slaughtered at higher ages., Competing Interests: Declarations of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This paper describes the variety of information that a tool mark analysis on human tissue can provide based on a case of multiple sharp violence. The perpetrator attacked the victim with a sharp-edged weapon against the head, leaving several deep wounds on the back of the skull bone. Three of those marks on the skull bone could be used for a forensic tool mark examination. Silicone casts of the marks were compared by light microscopy with casts of test marks of Japanese katana swords found at the crime scene. One of the swords could be identified as the one responsible for the marks. In addition, the marks and the test marks were scanned in 3D and examined in a visual on-screen comparison confirming the results from the light microscopic examination. Furthermore, a mathematical approach in which the signatures of the marks from the skull bone and the test marks from the sword were compared by cross correlation confirms those findings. In addition, the aforementioned results were used to determine the orientation of the sword in relation to the cranial bone at the time of the respective impact.

The present study proves that rapid and demarcating astroglial reactions are confined to birds and mammals. To understand the function of post-lesion astroglial reaction, the phylogenetical aspects are also to be investigated. Considering the regenerative capabilities, reptiles represent an intermediate position between the brain regeneration-permissive fishes and amphibians and the almost non-permissive birds and mammals. Damage is followed by a rapid astroglial reaction in the mammalian and avian brain, which is held as an impediment of regeneration. In other vertebrates the reactions were usually observed following long survival periods together with signs of regeneration, therefore they can be regarded as concomitant phenomena of regeneration. The present study applies short post-lesion periods comparable to those seen in mammals and birds for astroglial reactions. Two species of lizards were used: gecko (leopard gecko, Eublepharis macularius, Blyth, 1854) and agama (bearded dragon, Pogona vitticeps, Ahl, 1926). The gecko brain is rich in GFAP whereas the agama brain is quite poor in this. Crocodilia, the closest extant relatives of birds were represented in this study by Cuvier's dwarf caiman (Paleosuchus palpebrosus, Cuvier, 1807). The post-lesion astroglial reactions of crocodilians have never been investigated. The injuries were stab wounds in the telencephalon. The survival periods lasted 3, 7, 10 or 14 days. Immunoperoxidase reactions were performed applying anti-GFAP, anti-vimentin and anti-nestin reagents. No rapid and demarcating astroglial reaction resembling that of mammalian or avian brains was found. Alterations of the perivascular immunoreactivities of laminin and β-dystroglycan as indicators of glio-vascular decoupling proved that the lesions were effective on astroglia. The capability of rapid and demarcating astroglial reaction seems to be confined to mammals and birds and to appear by separate, parallel evolution in them.

High-quality digital three-dimensional (3D) reconstructions of microscopic findings have been used in anatomical and histopathologic research, but their use in forensic pathology may also be of interest. This paper presents an application of these methods to better characterize the pathway of a stab wound of the anterior surface of the heart in a case of suicide. A portion of the heart wall including the stab wound was serially sectioned for microscopic analysis along the full extent of the wound. Histologic sections were digitally acquired, and a 3D reconstruction was created with ImageJ software for 3D computer graphics. This showed a full-thickness wound path extending to the endocardial surface of the left ventricle, curvilinear in appearance. After correction for shrinkage, 3D reconstruction allowed estimation of the dimensions of the myocardial injury and comparison of the appearance of the wound with the suspected knife used. The curvilinear appearance was considered to reflect injury during myocardial contraction. Complete microscopic sectioning and 3D reconstruction may allow virtual sectioning through various orientations and also provide useful forensic information for selected injuries., (© 2020 American Academy of Forensic Sciences.)

Forensic anthropologists have traditionally relied on a qualitative scale (mild, moderate, severe) for describing the forces required to generate a bony injury; however, recently efforts have focused on providing more quantitative data. The current study considers the effects of blade angle on the peak force, average force, and work measured during an instrumented sharp force impact. Sixty-two porcine side ribs were stabbed with the long axis of the blade perpendicular to the convex surface and the blade edge in one of three orientations (0°, 45°, 90°). Peak force was highest when the cutting edge was perpendicular to the long axis of the rib (90°) and lowest when it was aligned (0°). Conversely, work was highest when the blade was at an oblique angle (45°) to the rib. These results confirm that the orientation of a sharp force event must be considered when estimating the mechanical loading required to generate an injury., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Hacking trauma is prevalent in forensic cases involving genocide and dismemberment, but research into the identification of this type of trauma is lacking. The present study examines characteristics of hacking and blunt force skeletal trauma in order to determine if there is a point at which blunt force trauma becomes distinguishable from hacking trauma. Ten implements with a range of blade angles (i.e., the striking surface of the implement) were used in conjunction with a controlled-force hacking device to impact 100 limb bones of white-tailed deer (Odocoileus virginianus). Observations of the trauma included the occurrence and degree of fragmentation, the entrance widths of the impacts, and composite scores of six hacking characteristics, especially the distinctive V-shaped kerf. ANOVA tests and regression analyses were used to assess the relationships between these characteristics and the blade angles. A significant relationship (p-value = 0.011) was found between the composite hacking scores and the blade angles, indicating that blunt force and hacking trauma can be distinguished. The entrance widths of the impacts exhibited a significant relationship with the blade angles (p-value = 0.037). There was also a significant relationship between the visibility of a V-shaped kerf in the bones (p-value = 0.003), with visibility decreasing around the 60° blade angle. These data should assist in establishing guidelines to differentiate hacking and blunt force skeletal trauma in cases where the implement is on a spectrum between sharp and blunt., (© 2020 American Academy of Forensic Sciences.)

The interpretation of sharp force fatality dynamics may be difficult in some cases, but a contribution to analysis of the phenomenon may be provided by case studies. Therefore, the purpose of our study is focused on identifying, in observed sharp force fatalities, reliable parameters that can differentiate a homicidal and suicidal manner of death, with particular reference to criminological parameters. Data derived from sharp force fatality cases in Padua and Venice from 1997 to 2019, anonymized and collected in Excel, included personal, circumstantial, clinical, and psychopathological-criminological data, as well as crime scene investigation, necroscopic, and toxicological data. Statistical analyses were performed using chi-square and Wilcoxon rank-sum tests. Possible predictors of homicide were analyzed by logistic regression. Six parameters (bloodstains distant from the body, clothing lacerations, hesitation/defense wounds, number of injuries, and potential motives) were significantly different in the two groups (p < 0.05). An independent statistical association between potential motives explaining the crime (p < 0.001; OR 27.533) and homicide on multiple logistic regression analysis was highlighted. The absence of clothing lacerations was inversely related to homicide (p = 0.002, OR 0.092). To the best of our knowledge, this is one of very few Italian studies concerning the differential diagnosis between homicidal and suicidal sharp force fatalities. The dynamics of the event is established in most cases by the integrated evaluation of data from crime scene investigation and the autopsy. Nevertheless, in an atypical scenario, a psychopathological-criminological analysis may provide essential elements, and particular attention should be given to the identification of potential explanatory motives., (© 2020 American Academy of Forensic Sciences.)

Background: There are few reported cases in the literature of spinal injuries from the past, and all of them resulted in the death of the individual or led to severe health consequences. From the historical record, it is well known there were no cures or treatments for spinal lesions in the past. Given the paucity of historical documents focused on this topic, anthropological research on spinal injuries can contribute with important information regarding the medical history of this kind of trauma. Moreover, skeletal trauma and occupational markers may be crucial for the reconstruction of habitual behaviors and the identification of causes and timing of death. We report results of an anthropological study of a case of vertebral injury discovered in an individual from the Italian Iron Age that highlights this important topic. The aim of this study was to assess the habitual activity pattern and manner of death of an ancient inhabitant of Spina in Padanian Etruria (northeastern Italy)., Methods: We performed a detailed anthropological and paleopathological analysis of skeletal remains., Results: The unknown individual was identified as a middle-aged man characterized by a particular trauma to the spine. Lesion analysis revealed a perimortem injury at the L2-L3 level. Characteristic markers on the bones indicated intense physical activity carried out during his life., Conclusions: This Etruscan, in all likelihood a sailor according to the occupational markers, did not survive a stabbing attack with a bladed weapon., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992-2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide., (© 2019 American Academy of Forensic Sciences.)

Investigation of a complex suicide is a challenging task, particularly when the combination of modalities adopted is rare and unplanned. There is often a significant likelihood of labeling the case as a homicide. We present an interesting case of unplanned complex suicide with self-stabbing and head injury resulting from intentionally being struck by a train. There were also hesitation cuts evident over the neck and left wrist. This case highlights the importance of studying the nature and characterization of the wounds, examination of clothes, and examination of the scene to safely conclude the cause and the manner of death.

A 29-year-old man died at the scene of an altercation from a stab wound to the left side of the neck. At autopsy, careful in situ examination of the common carotid artery did not reveal any evidence of hemorrhage or apparent vascular injury. However, applying pressure to the chest wall and underlying thoracic viscera (lungs and heart) resulted in filling of the collapsed vessel with blood causing hemorrhage from a small incision on the medial aspect of the common carotid artery. Release of pressure and drying of the dissection field enabled the artery to be opened and the small defect to be identified. This technique may be used to temporarily restore blood to a vessel to help identify a small bleeding point that may otherwise be difficult to detect., (© 2019 American Academy of Forensic Sciences.)

Introduction: Fights, domestic violence and street crimes are the major causes of stab wounds in the Kingdom of Saudi Arabia (KSA). The objective of the study was to describe the nature and severity of stab wounds at a tertiary care hospital in KSA., Methods: A cross-sectional study, which included 106 patients, was conducted at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. The patients that fulfilled the inclusion criteria were recruited for the study after having confirmed their consent. The authors procured and analysed the patients' clinical notes to obtain information that was pertinent to the study. The authors recorded all data within a Microsoft Excel document. SPSS 22.0 was utilized for statistical analysis., Results: Of 106 patients, the majority were adolescents and young adults under the age of 40 (n = 77). Eighty-seven point seven percent of patients were male and 84.0% were Saudis. Demographic details were tabulated. The top three causes were fights (20.8%) followed by domestic violence (18.9%) and street crime (17.0%). Degree of shock, stabbing zones, injury to vessels, nerves and bones, injury severity score (ISS) and Glasgow Coma Scale (GCS) were tabulated., Conclusion: The nature and severity of stab wounds should be carefully evaluated and properly managed, as these may lead to serious complications., Competing Interests: The authors declare no competing interests., (© Abdulmohsen Khlaif Alenazi et al.)

Crime scene reconstruction plays a significant role in crime solving by helping to determine the course of events. Non-invasive, high-resolution measurement and increased insight are always the goal of forensic crime scene documentation. However, entire crime scenes cannot be effectively reconstructed with traditional methods. In this study, we present a portable system that consists of a laser scanner, two hand-held structured light scanners and a low-cost virtual reality (VR) headset with a mobile power supply to conduct multi-angle and omnidirectional three-dimensional spatial data collection of crime scenes. To demonstrate practical use, a real case has been analysed to verify the feasibility and effectiveness of the system. The system accurately obtains information on decedent injuries, possible injury-inflicting tools and on-site traces. Various types of evidence from the crime scene can be jointly studied by three-dimensional visualization to develop a cohesive story. The data are presented via immersive VR rather than displayed on computer screens. The relationship between evidence chains enables us to achieve a complete crime scene reconstruction, using the specialized knowledge of experts and computer-aided forensic tools to analyse the causes of damage and identify suspects. The use of three- dimensional imaging techniques allows a more insightful survey and several useful analyses, such as accurate measurement, relative blood source location determination and injury-inflicting tool comparison., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Direct penetrating trauma to the spinal cord as a result of stabbing is rare. The vertebral column is strongly suited to protecting the vital neural structures underneath, especially in the midline., Case Description: A 25-year-old woman experienced a direct stabbing injury to her spinal cord, through the midline structures, resulting in bilateral dorsal column injury. She remained intact with regard to motor function despite bilateral sensory and proprioception loss., Conclusions: Owing to the strength of the protective elements of the osseous structures surrounding the spinal cord, direct stabbing injuries usually result in incomplete neurologic deficits. This is generally manifested as a Brown-Sequard syndrome because of the midline ligamentous structures and spinous processes deflecting injuries laterally. Our patient experienced a direct midline puncture, resulting in a unique case of bilateral dorsal column injury. These injuries are generally treated conservatively, in the absence of a retained foreign body. Spinal cord stabbing injuries are a rare entity with interesting clinical and anatomic correlations., (Published by Elsevier Inc.)

Chop or slash wounds are produced by sharp-edged tools such as an axe, or a machete. This paper presents a case of a violent death of a 57 year-old-man. Autopsy revealed deformation of the right side of the head. A total of 23 slash, stab and cut wounds as well as contused lacerations were identified on the scalp as well as the face and the neck. In addition, superficial abrasions and bruises were identified on the skin. The immediate cause of death was due to extensive brain contusion following fragmentation of the neurocranium. The injuries resulting in the death of the victim were sustained during an assault on the head with an axe, which was used both as a slashing tool and a blunt instrument.

Non-missile penetrating spinal injury (NMPSI) is a rare form of traumatic spinal injury. Cases with neurological deficit on presentation are treated surgically. In the extremely rare circumstance of NMPSI presenting with no neurological deficit the management is contentious. We report a case of a 43-year-old male presenting with a penetrating stab injury through the thoracolumbar spinal canal. On presentation he had no neurological deficits and subsequently the knife was removed in theatre without deep surgical exploration. In this report we review the literature of non-missile penetrating spinal injuries as well as their management and conclude that exploratory surgery for NMPSI without neurological deficit may not be necessary as previously thought., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Penetrating abdominal trauma is uncommon in Australia. There are multiple potential approaches to the patient without an indication for immediate laparotomy. This study examined the management of patients with a penetrating anterior abdominal injury in a Level 1 trauma centre, and in particular investigated the outcomes of those patients who underwent diagnostic laparoscopy., Methods: A retrospective review was undertaken of all patients presenting to a Level 1 trauma centre with an anterior abdominal stab wound over a 15-year period. Patient demographic, injury, examination, treatment and outcome data were extracted. These data were analysed using SPSS PASW version 20., Results: A total of 318 patients were identified. Immediate laparotomy was performed in 121 of those patients. Of the remaining 197 patients, 146 underwent diagnostic laparoscopy. Peritoneal breach was identified in 87 patients, 79 of whom then had exploratory laparotomy. The laparotomy was therapeutic in 36 of 79 patients (45.6%). Multiple stab wounds were an independent predictor of therapeutic laparotomy (hazard ratio 2.39, 95% CI 1.16-4.93). Diagnostic laparoscopy was 100% sensitive, 60.9% specific and had a negative predictive value of 100% and a positive predictive value of 40%. Non-therapeutic laparotomy was associated with a median length of stay of 5.5 days and a complication rate of 9.3%., Conclusion: Diagnostic laparoscopy to detect peritoneal breach is a safe approach in the management of anterior abdominal stab wounds. However, utilizing peritoneal breach as an indication for laparotomy is associated with a moderate incidence of non-therapeutic laparotomy. Measures to decrease the negative laparotomy rate should be considered., (© 2019 Royal Australasian College of Surgeons.)

Identifying tool mark and involved weapon in sharp force trauma is essential to understanding the circumstances of death. But accuracy and reliability of such expert testimony remains unknown, and validation studies are rare in forensic literature. That is why, we conducted an experiment in order to determine error rates and predictive values on identifying the right implement through different types of knife-inflicted trauma. Human bone cut marks were analysed through epifluorescence microscopy. The samples were examined through a randomised, blinded, controlled study by three researchers with varying degrees of experience with direct and indirect observation of cut marks (photography). Our results showed that identifying the weapon involved is possible thanks to numerous criteria analysis. Correct classification rates were high and misclassifications rare. Asymmetric blades obtained better results than symmetric blades. Predictive values were also calculated, and the negative one reached very high levels, near 100% with regard to all the implements. Positive predictive values were more variable. But even if individual diagnoses remain in doubt, triage can be done and tools not implicated in injury can be eliminated with certainty. Moreover, our work clearly highlighted the importance of experience in such activities. A high level of experience is fundamental to obtain the best values, especially in such a context where evidence reliability is extremely important for forensic admissibility testimony in the court.

Killings of human beings involving animals have rarely been described in the forensic literature. In the present case, the decapitated corpse of a woman as well as the decapitated, castrated and partially disemboweled corpse of a dog were found together. Both bodies also exhibited analogous, distributed massive sharp-force traumas. The approximately same pattern of actions as well as findings consistent with an exaggerated killing are particularly noteworthy. The perpetrator was found to be the son of the victim and had long exhibited psychological abnormalities. He was acquitted of the charge of manslaughter due to mental incapacity and was subsequently placed in a psychiatric hospital., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Animal inflicted fatal or near fatal injuries are well described in the forensic literature, with the most frequently described cases involving dogs, large cats and bears. To our knowledge, a deer inflicted fatality has not been described in the forensic literature previously. This article reports a case of a 64-year-old male, who was found lying in a pool of blood near an enclosure for stags and hinds at the end of October. There were mechanical defects on his jacket and trousers, which appeared to be torn or penetrated, as well as multiple lacerations and stab wounds in different parts of his body. The type and location of the injuries the man had sustained strongly suggested that another person had been involved in the incident that had led to his death. The cause of death was deemed as external exsanguination due to multiple stab wounds to large vessels. After evaluating all of the information regarding the circumstances around the death, the case was classified as a deer attack related fatality, and the manner of death was determined to be accidental. The man was most probably attacked by one of the deer while he was refilling the animal feeder. A substantial increase in the levels of selected hormones, especially testosterone, during the rutting season explains the increased levels of aggression shown by the deer that led to a fatal outcome for the decedent.

An investigation into the arm and body position required to obtain the blood pattern visible in the image of the Shroud of Turin was performed using a living volunteer. The two short rivulets on the back of the left hand of the Shroud are only consistent with a standing subject with arms at a ca 45° angle. This angle is different from that necessary for the forearm stains, which require nearly vertical arms for a standing subject. The BPA of blood visible on the frontal side of the chest (the lance wound) shows that the Shroud represents the bleeding in a realistic manner for a standing position while the stains at the back-of a supposed postmortem bleeding from the same wound for a supine corpse-are totally unrealistic. Simulation of bleeding from the nail wounds contacting wood surfaces yielded unclear results., (© 2018 American Academy of Forensic Sciences.)

Forensic examination of human remains is a complex process that relies on the contribution of multidisciplinary forensic medicine specialties. Here we present a complex forensic case regarding a double murder whose victims were found almost completely skeletonized. Post-mortem investigations allowed us to define the biological profile of the two bodies (ancestry, sex, age and stature), to discover their identity through forensic DNA analysis, and to detect peri-mortem injuries caused by firearms and stabbing weapons. Three men were recognized as involved in the crime and two of them were condemned to life imprisonment for homicide. The judges accepted the reconstruction of the crime promoted by the Prosecutor (double firearm murder).

Sharp force injuries are uncommon in routine forensic practice. While the majority of these cases are homicides or suicides, a significant minority of accidental deaths means that a careful investigation of the circumstances of the death is necessary. We present the case of a young man who presented with stab and cut injuries due to a duralumin rod embedded in his chest. Examination of the body revealed that death was due to penetration of the thoracic aorta by a duralumin rod. Careful investigation of the circumstances surrounding the death was able to confim a case of accidental death due to falling from a ladder onto tomato seedlings that were supported by duralumin rods.

Previous studies have shown that estradiol reduces reactive gliosis after a stab wound injury in the cerebral cortex. Since the therapeutic use of estradiol is limited by its peripheral hormonal effects, it is of interest to determine whether synthetic estrogenic compounds with tissue-specific actions regulate reactive gliosis. Tibolone is a synthetic steroid that is widely used for the treatment of climacteric symptoms and/or the prevention of osteoporosis. In this study, we have assessed the effect of tibolone on reactive gliosis in the cerebral cortex after a stab wound brain injury in ovariectomized adult female mice. By 7 days after brain injury, tibolone reduced the number of glial fibrillary acidic protein (GFAP) immunoreactive astrocytes, the number of ionized calcium binding adaptor molecule 1 (Iba1) immunoreactive microglia, and the number of microglial cells with a reactive phenotype in comparison to vehicle-injected animals. These effects on gliosis were associated with a reduction in neuronal loss in the proximity to the wound, suggesting that tibolone exerts beneficial homeostatic actions in the cerebral cortex after an acute brain injury.

Unlike humans and other mammals, adult zebrafish have the superior capability to recover from central nervous system (CNS) injury. We previously found that proliferation of radial glia (RG) is induced in response to stab injury in optic tectum and that new neurons are generated from RG after stab injury. However, molecular mechanisms which regulate proliferation and differentiation of RG are not well known. In the present study, we investigated Shh and Notch signaling as potential mechanisms regulating regeneration in the optic tectum of adult zebrafish. We used Shh reporter fish and confirmed that canonical Shh signaling is activated specifically in RG after stab injury. Moreover, we have shown that Shh signaling promotes RG proliferation and suppresses their differentiation into neurons after stab injury. In contrast, Notch signaling was down-regulated after stab injury, indicated by the decrease in the expression level of her4 and her6, a target gene of Notch signaling. We also found that inhibition of Notch signaling after stab injury induced more proliferative RG, but that inhibition of Notch signaling inhibited generation of newborn neurons from RG after stab injury. These results suggest that high level of Notch signaling keeps RG quiescent and that appropriate level of Notch signaling is required for generation of newborn neurons from RG. Under physiological condition, activation of Shh signaling or inhibition of Notch signaling also induced RG proliferation. In adult optic tectum of zebrafish, canonical Shh signaling and Notch signaling play important roles in proliferation and differentiation of RG in physiological and regenerative conditions., (© 2018 Wiley Periodicals, Inc.)

Microglia and blood-borne macrophages in injured or diseased brains are difficult to distinguish because they share many common characteristics. However, the identification of microglia-specific markers and the use of flow cytometry have recently made it easy to discriminate these types of cells. In this study, we analyzed the features of blood-borne macrophages, and activated and resting microglia in a rat traumatic brain injury (TBI) model. Oxidative injury was indicated in macrophages and neurons in TBI lesions by the presence of 8-hydroxy-2'-deoxyguanosine (8-OHdG). Generation of mitochondrial reactive oxygen species (ROS) was markedly observed in granulocytes and macrophages, but not in activated or resting microglia. Dihydroethidium staining supported microglia not being the major source of ROS in TBI lesions. Furthermore, macrophages expressed NADPH oxidase 2, interleukin-1β (IL-1β), and CD68 at higher levels than microglia. In contrast, microglia expressed transforming growth factor β1 (TGFβ1), interleukin-6 (IL-6), and tumor necrosis factor α at higher levels than macrophages. A hypnotic, bromovalerylurea (BU), which has anti-inflammatory effects, reduced both glycolysis and mitochondrial oxygen consumption. BU administration inhibited chemokine CCL2 expression, accumulation of monocytes/macrophages, 8-OHdG generation, mitochondrial ROS generation, and proinflammatory cytokine expression, and markedly ameliorated the outcome of the TBI model. Yet, BU did not inhibit microglial activation or expression of TGFβ1 and insulin-like growth factor 1 (IGF-1). These results indicate that macrophages are the major aggravating cell type in TBI lesions, in particular during the acute phase. Activated microglia may even play favorable roles. Reduction of cellular energy metabolism in macrophages and suppression of CCL2 expression in injured tissue may lead to amelioration of TBI., (© 2018 Wiley Periodicals, Inc.)

Complex suicides are rare and consist in the use of more than one method to induce death, representing a challenging investigation for forensic pathologists. According to the several combinations reported in literature, they have been classified into "typical" (where two common suicide methods are associated) and "atypical" (where more than two methods, or infrequent combinations of suicide methods are involved). In the case discussed here, an elderly man suffering of depression was found dead inside the tool shed of his house with a knife embedded in the abdomen and two plastic bags fastened around the neck using a twine. Three other superficial stab wounds were clustered close to the penetrating lesion. Internal examination revealed haemorrhagic infiltration at the mesentery and haemoperitoneum. No evident signs of asphyxia were highlighted and the cause of death was attributed to haemorrhagic shock. This association of suicide methods has turned out to be unusual. A review of the literature concerning complex suicides, abdominal self-stabbing and plastic bag suffocation has been managed. Crime scene and details of the used tools, medical and psychiatric history of the victim and features of the internal and external lesions have been examined and compared to previous studies. Toxicological analyses were not performed., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Determining the manner of death in cases involving multiple stab injuries from a knife is generally straightforward. The medico-legal investigation of a stabbing death caused by a single stab injury from a knife comprises a smaller but potentially more problematic subset of forensic cases. We reviewed our institute's experience with single stab injuries and endeavored to identify features identified at the post-mortem examination which may aid in the differentiation between cases of homicide, suicide and accidental death. The single stab injury was to the left chest in the majority of deaths from homicide and from suicide. Clothing was nearly always involved in cases of homicide, but was also seen in cases of suicide. The knife was found in situ in 9 of the 11 cases of suicide involving a chest injury, but was not seen in any of the cases of homicide. There were no cases of an accidental single stab death from a knife in our records. Clinical data on accidental stab injuries was sought via a search of the medical records of a major tertiary referral hospital. A single non-fatal case of an accidental single stab injury from a knife was identified after the conclusion of our study period. Accidental stab injuries from a knife causing injury or death are rare.

"Defense" type wounds are sustained when a victim is attempting to ward off an attacker, or a weapon. A 39-year-old woman is reported who was found deceased with incised wounds to the dorsa of both hands that resembled defense wounds. Examination of the flexor surfaces of both wrists, however, revealed horizontal incised wounds typical of self-infliction. Perfusion of the subclavian arteries produced leakage of water from peripheral veins within wounds on both hands and the right wrist. Death was due to exsanguination from incised wounds of the hands and right wrist; manner suicide. This case demonstrates the difficulties that may arise in differentiating self-inflicted from assaultive wounds. On occasion suicidal sharp force injuries may be multiple and in atypical locations. In these circumstances a high index of suspicion for homicide must be maintained.

Penetrating cardiac trauma is a medical emergency that commonly affects young men throughout the world. A retrospective review of the records of all patients presenting with cardiac injury was done from January 2000 to December 2015 at our institute. There were 10 cases of such trauma, all of whom were males, 17 to 48 years of age. The most common mechanism of injury was gunshot wounds followed by stab wounds. The Mean Revised Trauma Score was 7.23±0.855. Only 2 out of the total 10 patients died (20% mortality). The Right Ventricle followed by the Left Ventricle was the most common site of injury. Median Sternotomy was the surgical procedure of choice in managing these patients. Pericardial tamponade and Haemothorax were common intra-operative findings. Patients having penetrating cardiac injury presenting with detectable signs of life on arrival to the hospital can be rescued by early surgical intervention.