Histologic dating of bruises in moribund infants and young children

It is generally held that leukocytes are found within bruised subcutaneous tissues within 4–12 h of injury as part of a standard cellular response to trauma. As a corollary, the absence of leukocytes is often cited as evidence of more recent injury. To investigate how long after injury it may be before a leukocyte response occurs selected bruises from three children aged 27, 11, and 3 months, respectively, were examined microscopically. All of the children had sustained lethal head trauma, with survival on life-support equipment for some time in hospital, and with bruises of at least 24-h duration confirmed by medical evaluation (at 30, 44, and 79 h from the time of initial medical evaluation to death). Histologic examination of selected lesions in all three cases revealed extravasation of red blood cells within subcutaneous tissues, but no leukocyte infiltration or other cellular reaction. Other bruises in these children exhibited a standard inflammatory response. This study has shown that selected bruises in three children were present for at least 30 h without a leukocyte infiltrate. Caution should, therefore, be exercised in assigning too rigid a time course to bruising in infants and young children based on a lack of a vital reaction, as the absence of leukocytes within soft tissues of bruised skin in these cases may not necessarily indicate that the injuries are recent. Variability in tissue response may also occur in different bruises in the same individual. Whether severe craniocerebral trauma played a role in delaying the cellular response in these particular injuries is unclear.     

Characterization of bruises using ultrasonography for potential application in diagnosis of child abuse

To protect children from abuse, it is important to identify victims at an early date, but diagnosis is often difficult. We used ultrasonography for objective examination of bruises arising from subcutaneous hemorrhages, and determined whether we could precisely measure the depth and thickness of a subcutaneous hemorrhage. We compared macroscopic findings, microscopic findings and ultrasonographic images of 10 bruises in forensic autopsy cases. In addition, we measured chronologic changes in subcutaneous hemorrhages using ultrasonography of 16 bruises in healthy volunteer children. Mild or moderate subcutaneous hemorrhages spreading along the fibrous partition in subcutaneous fatty tissue were observed by histological examination. There was a thickened fibrous partition or an isoechoic or hyperechoic area in the ultrasonographic images. A good correlation between the thickness of the subcutaneous hemorrhages by macroscopic examination and by ultrasonographic imaging was found in postmortem cases. We were also able to confirm objectively that the thickness of the subcutaneous hemorrhage of healthy children decreased with time. It is possible to measure the depth from the skin surface to the subcutaneous hemorrhage, and the thickness of the subcutaneous hemorrhage accurately using ultrasonography. Thus, the age of a bruise can be estimated more precisely using information on the subcutaneous hemorrhage from ultrasonography in addition to established evaluations by the naked eye and by spectrophotometry.     

Bruising caused by traditional Chinese massage therapy (ba sha) complicating the assessment of a case of fatal child abuse

Precise evaluation of bruises and patterned skin lesions in infants and children is an essential requirement in cases of potential abuse. Such injuries may be markers of more significant internal injuries and/or may be supportive of an assault rather than an accident. On occasion, however, unusual patterned skin lesions may be identified that have been inflicted as part of traditional therapeutic techniques. A five-year-old boy from a rural Chinese community is reported who died from ligature strangulation. In addition to bruises from abusive trauma he had a series of unusual patterned, often-paired, bruises over the anterior and posterior aspects of both shoulders, unrelated to the ligature mark. Upon further police inquiries it transpired that his grandmother and mother had been using traditional Chinese therapeutic massage or “ba sha” to treat an episode of vomiting. The term means “to pull out fever” and involves firm pinching of the skin between the thumb and index finger, often on the neck, chest or back. An awareness of the potential manifestations of traditional therapies is important in contemporary forensic practice so that injuries caused by these treatments are not confused with non-therapeutic inflicted injury.     

Cut or burnt? – Categorizing morphological characteristics of heat-induced fractures and sharp force trauma

Distinguishing trauma from heat-induced fractures is a challenge faced by forensic anthropologists and pathologists during medicolegal investigations in which fire has been used by the perpetrators to destroy evidence. This paper aims to validate the provided identification features to distinguish between fire induced alterations and sharp force trauma.A total of 80 cremated adult individuals were used in this paper: 3 recently deceased embalmed cadavers from Cementerio Sur de Madrid for the sharp force trauma experiment in which 55 pre-burning injuries were inflicted using a machete and a serrated knife in different anatomical regions. And 77 cremated individuals from the Forensic Anthropology and Odontology Laboratory osteological collection. Five cremated long bones from this collection were selected, and 10 cuts were manually inflicted using a serrated knife to analyse post-burning trauma. Heat-induced changes and trauma morphologic characteristics were thus documented and analysed. The examination and documentation of morphological traits enabled the production of a heat-induced changes visual guide and a flow-chart. Two intraclass correlation tests were performed to validate the capacity of the observer to distinguish between fire related alterations and toolmarks.The results obtained in the statistical analysis indicate that, even if the toolmarks are visible and recognizable upon macroscopic observation by the observers, some features, such as the step and the transverse fractures can be mistaken with inflicted trauma. The use of the proposed features coupled with careful anthropological examination is recommended and has been found functional for participants with no prior knowledge in the analysis of cremated remains.     

Studies on mRNA expression of tissue-type plasminogen activator in bruises for wound age estimation

We investigated mRNA expression of tissue-type plasminogen activator (tPA) and inflammatory cell dynamics for wound age estimation of bruises in mice. Neutrophils were detected from 1 h post-injury. Up to 8 h, they accumulated in subcutaneous tissue and the lower part of the dermis, and thereafter they extended to all the layers. Macrophages became detectable 3 h post-injury, and moderate infiltration of lymphocytes was seen from 144 h. In addition, epidermal thickening was also seen from 72 h. tPA mRNA expression peaked at 1 h, and increased slightly at 72 h post-injury. tPA mRNA was detected in epidermal cells, fibroblasts, and endothelial cells before and after injury, from 3 h in neutrophils and from 72 h in macrophages, respectively. This study presents the time-dependent expression of tPA mRNA in bruises in relation to temporal histologic characteristics during wound healing, which was considered to be useful for wound age estimation. Furthermore, it is suggested that tPA plays an important role in the first step of tissue remodeling.     

Identification and differential diagnosis of perimortem blunt force trauma in tubular long bones

The identification of perimortem injuries from human remains is crucial in the forensic evaluation of skeletal trauma. The purpose of this article is to review the criteria currently used by forensic experts for the identification and differential diagnosis of perimortem blunt force trauma in long bones. The mechanism of injury and the associated fracture pattern in long bones is discussed because it is fundamental in the forensic interpretation. The distinction between postmortem and perimortem fractures is based on the evidence of an osteogenic reaction. The first signs of healing can be detected macroscopically, radiographically, or histologically. Perimortem injuries may be distinguished from postmortem damage by examining certain attributes such as fracture angle and fracture margins. Additionally, the most commonly encountered taphonomic factors leading to postmorterm damage are described in order to alert the workers of the existence of such pitfalls that may perplex the forensic interpretation of skeletal trauma. Although the distinction of bone damage that occurred long after death from perimortem trauma is relatively easy, the differentiation of fractures inflicted shortly before death or soon after death may be difficult or even impossible.     

Spectrophotometric and tristimulus analysis of the colors of subcutaneous bleeding in living persons

In forensic activities the estimation of the age of subcutaneous bleeding is very important. The evaluation of color, however, will vary according to differences of light-source, observer, size, background and so forth. The colorimetric methods using a spectrophotometer can effectively evaluate skin discoloration. In this study, the tristimulus and spectrophotometric patterns of color changes of skin bruises were examined among eight Japanese adult men volunteers wounded by a sharp pinch on the inside of the upper arm and forearm. From a series of color changes among the subjects, the tristimulus data and the spectral reflectance graphs showed variable patterns that made a comparison of absolute numerical values by a single measurement meaningless. Therefore, if we use colorimetric methods in a practical case, we should measure bruises in the same lesion twice or more at intervals of 1 or 2 days.     

Determination of age-related changes in structure and function of skin, adipose tissue, and skeletal muscle with computed tomography, magnetic resonance imaging, and positron emission tomography

In this article, we report quantitative preliminary data obtained from retrospective analysis of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and combined PET-computed tomography (PET/CT) examinations in subjects ages 3 to 84 years pertaining to changes in the metabolism of skin, subcutaneous adipose tissue, visceral adipose tissue, and skeletal muscle with age, as well as age-related changes in skeletal muscle attenuation. We also propose a new method for identifying hypermetabolic brown fat on FDG-PET. Finally, we present a review of the literature regarding reported age-related structural and functional changes that occur in skin, fat, and skeletal muscle. Using FDG-PET, We evaluated 213 subjects for changes in the metabolism of skin, adipose tissue, and skeletal muscle with aging. Thirty-two separate subjects were chosen to measure maximum standardized uptake value (SUV) of hypermetabolic brown fat on dual-time point PET imaging. Finally, 15 subjects evaluated by PET/CT were selected to measure changes in metabolism and attenuation of skeletal muscle, and changes in metabolism of adipose tissue with aging. We found that skin, fat, and skeletal muscle all demonstrate significant (P < 0.05) increases in SUV with increasing age on PET imaging. Dual-time point PET imaging demonstrates increasing FDG uptake of hypermetabolic brown fat in various regions studied. Finally, our PET/CT studies revealed statistically insignificant (P > 0.05) decreases in SUV of adipose tissue with aging and the opposite trend in skeletal muscles (P > 0.05). Skeletal muscle attenuation in the various regions studied was found to significantly decrease with age (P < 0.05). Our study shows notable trends in metabolism and attenuation of skeletal muscle and metabolism of skin and adipose tissue that occur with normal aging. We hope that the methodologies and data we present here will serve as a useful starting point for those interested in conducting future prospective research on age-related changes in these structures.     

Evaluating change in bruise colorimetry and the effect of subject characteristics over time

Forensic clinicians are routinely asked to estimate the age of cutaneous bruises. Unfortunately, existing research on noninvasive methods to date bruises has been mostly limited to relatively small, homogeneous samples or cross-sectional designs. Purpose: The purpose of this prospective, foundational study was to examine change in bruise colorimetry over time and evaluate the effects of bruise size, skin color, gender, and local subcutaneous fat on that change. Method: Bruises were created by a controlled application of a paintball pellet to 103 adult, healthy volunteers. Daily colorimetry measures were obtained for four consecutive days using the Minolta Chroma-meter^®. The sample was nearly equal by gender and skin color (light, medium, dark). Analysis included general linear mixed modeling (GLMM). Results: Change in bruise colorimetry over time was significant for all three color parameters (L*a*b*), the most notable changes being the decrease in red (a*) and increase in yellow (b*) starting at 24 h. Skin color was a significant predictor for all three colorimetry values but sex or subcutaneous fat levels were not. Bruise size was a significant predictor and moderator and may have accounted for the lack of effect of gender or subcutaneous fat. Conclusion: Study results demonstrated the ability to model the change in bruise colorimetry over time in a diverse sample of healthy adults. Multiple factors, including skin color and bruise size must be considered when assessing bruise color in relation to its age. This study supports the need for further research that could build the science to allow more accurate bruise age estimations.     

Blunt force impact to the head using a teeball bat: systematic comparison of physical and finite element modeling

Blunt head trauma secondary to violent actions with various weapons is frequently a cause of injury in forensic casework; differing striking tools have varying degrees of injury capacity. The systematic approach used to examine a 19-year-old student who was beaten with a wooden teeball bat will be described. The assailant stopped beating the student when the teeball bat broke into two pieces. The surviving victim sustained bruises and a forehead laceration. The State’s Attorney assigned a forensic expert to examine whether the forces exerted on the victim’s head (leading to the fracture of the bat) were potentially life threatening (e.g. causing cranial bone fractures). Physical modeling was conducted using a pigskin-covered polyethylene end cap cushioned by cellulose that was connected to a piezoelectric force gauge. Experiments with teeball bats weighing 295–485 g demonstrated that 12–20 kN forces were necessary to cause a comparable bat fracture. In addition to physical testing, a computer-aided simulation was conducted, utilizing a finite-element (FE) method. In the FE approach, after selecting for wood properties, a virtual bat was swung against a hemisphere comprising two layers that represented bone and soft tissue. Employing this model, a 17.6 kN force was calculated, with the highest fracture probability points resembling the fracture patterns of the physically tested bats.     

Genome-wide mRNA profiling and multiplex quantitative RT-PCR for forensic body fluid identification

In forensic science, identifying a tissue where a forensic specimen was originated is one of the principal challenges. Messenger RNA (mRNA) profile clearly reveals tissue-specific gene expression patterns that many attempts have been made to use RNA for forensic tissue identification. To systematically investigate the body-fluid-specific expression of mRNAs and find novel mRNA markers for forensic body fluid identification, we performed DNA microarray experiment with 24 Korean body fluid samples. Shannon entropy and Q-values were calculated for each gene, and 137 body-fluid-specific candidate genes were selected. By applying more stringent criteria, we further selected 28 candidate genes and validated them by RT-PCR and qRT-PCR. As a result, we suggest a novel combination of four body-fluid-specific mRNA makers: PPBP for blood, FDCSP for saliva, MSMB for semen and MSLN for vaginal secretion. Multiplex qRT-PCR assay was designed using the four mRNA markers and DNA/RNA co-extraction method was tested for forensic use. This study will provide a thorough examination of body-fluid-specifically expressed mRNAs, which will enlarge the possibility of practical use of RNA for forensic purpose.     

Abdominal stab wounds: Self-inflicted wounds versus assault wounds

Intentional penetrating wounds, self inflicted or inflicted by others, are increasingly common. As a result, it can be difficult for the forensic examiner to determine whether the cause is self-inflicted or not. This type of trauma has been studied from a psychological perspective and from a surgical perspective but the literature concerning the forensic perspective is poorer. The objective of this study was to compare the epidemiology of abdominal stab wounds so as to distinguish specific features of each type. This could help the forensic scientist to determine the manner of infliction of the wound.We proposed a retrospective monocentric study that included all patients with an abdominal wound who were managed by the visceral surgery department at Angers University Hospital. Demographic criteria, patient history, circumstances and location of the wound were noted and compared. A comparison was drawn between group 1 (self inflicted wound) and group 2 (assault).This study showed that the only significant differences are represented by the patient's prior history and the circumstances surrounding the wound, i.e. the scene and time of day. In our study, neither the site, nor the injuries sustained reveal significant clues as to the origin of the wound. According to our findings, in order to determine the cause, the forensic examiner should thus carefully study the circumstances and any associated injuries.     

Visual assessment of the timing of bruising by forensic experts

IntroductionForensic experts are frequently asked to comment on the age of injuries and interpretation may have significant medico-legal consequences. The purpose of this study is to determine the accuracy with which forensic experts can visually age a bruise from photographs produced under standard conditions.MethodsBruises were produced on the upper arms of 11 subjects by a suction pump. Sequential photographs were taken daily until they were no longer visible to the naked eye. Fifteen forensic experts who did not know the age of the bruises were asked to estimate their ages and also to place them in chronological order.ResultsHundred and thirty-two images of 25 bruises were produced, ranging from 0 to 209 h in age. There was considerable inter- and intra-observer variability in accuracy (median difference between the estimated age and the real age = 26.0 h (95% C.I. 24.0–31.0 h). There was greatest accuracy for bruises photographed between 0 and 12 h. No significant differences were seen between male and female observers (p = 0.553) and performance was also unaffected by the age of the observer (p = 0.160). Of the bruise images placed in chronological order >80% of the observers made between 0 and 2 errors.ConclusionBruise age estimates by forensic experts, from photographs, are unreliable. However, it appears that the vast majority of observers are better able to place bruises from the same subjects in their chronological order.     

Role of inducible nitric oxide synthase and interleukin-6 expression in estimation of skin burn age and vitality

Estimation of age and vitality of burn injury both in the living and dead is essential in forensic practice. Nitric oxide and interleukin-6 (IL-6) play an important role in skin burn healing. In this study, the expression of inducible nitric oxide synthase (iNOS) and IL-6 proteins during skin burn healing in rats was studied for purposes of burn dating and to differentiate between ante-mortem and post-mortem burn. Ante-mortem skin burns were created on forty five rats. Normal and burnt skin samples were taken at 1, 3, 5, 7, 9, 11, 13, 15 and 21 days following burn induction (5 rats for each stage). Post-mortem burn was inflicted 6 h after scarification in another five rats. There was a statistically significant difference in both iNOS and IL-6 expression between the different time intervals of the ante-mortem burn. Expression of both iNOS and IL-6 decreased remarkably in the post-mortem burn with a statistically significant difference from ante-mortem intervals. A statistically significant positive association between the two markers was found. These results indicate that both iNOS and IL-6 expression in ante-mortem burnt skin was time dependent and significantly differed from post-mortem burn. Further research on humans is recommended.     

Validation of alternate light sources for detection of bruises in non-embalmed and embalmed cadavers

Bruising is frequently documented in cases of violence for use as forensic evidence. However, bruises can be overlooked if they are not visible to the naked eye. Alternate light sources such as ultraviolet, narrow band, and infrared have been used in an attempt to reveal the presence of bruising that is not otherwise apparent. However, there is a significant gap in knowledge surrounding this technique as it has not been validated against histology to confirm that bruising is genuinely being enhanced. A recent study evaluated the ability of alternate light sources to enhance visibility of bruises using a pigskin model. However, histological confirmation of bruising in humans using these light sources has not yet been performed. In this study, embalmed and non-embalmed human cadavers were used. Bodies were surveyed with alternate light sources, and enhanced regions that were unapparent under white light were photographed with the alternate light sources and sampled for histological assessment. Immunohistochemical staining for the red blood cell surface protein glycophorin was used determine if the enhanced area was a bruise (defined by the presence of extravasated erythrocytes). Photographs of areas confirmed to be bruises were analyzed using the program Fiji to measure enhancement, which was defined as an increase in the measured transverse diameter. In the non-embalmed and the embalmed cadavers violet alternate light produced the greatest enhancement of histologically confirmed bruises, followed by blue (both p < 0.0001). Regions that were not confirmed as bruises also enhanced, indicating that light sources may not be specific. This suggests that the use of light sources to enhance the visibility of bruising should be undertaken with caution and further studies are required.     

An assessment of abdominal fatty tissue distribution in obese children. A comparison between echography and computed tomography

PURPOSE: Computed tomography (CT) and, more recently, ultrasound (US), have proved excellent tools for quantifying adipose tissue distribution. Body fat distribution is an important factor in the treatment of obesity and its complications. We investigated the correlation between CT and US measurements in pediatric obesity. MATERIAL AND METHODS: Forty obese children and adolescents aged 4.1-14.8 years were submitted to CT and US. Intra-abdominal, subcutaneous and total body fat were calculated (in cm2), with the CT image analysis software. The rectus muscle-spine and rectus muscle-aorta distances, as indicative of visceral fat thickness, were measured on US images with(out) compression. The distance between skin-fat and fat-rectus muscle interfaces was measured as subcutaneous fat thickness. We also compared US-CT findings with other morphometric variables--i.e., patient's (ideal) body weight and skin fold measures. RESULTS: At US, the rectus muscle-aorta and rectus muscle-spine distances ranged 2.4-7.5 cm (mean: 4.47 cm) and 3.6-8.9 cm (mean: 5.79 cm), respectively. The skin-rectus muscle distance ranged 1.2-7.5 cm (mean: 3.14 cm). A statistically significant correlation was found between the CT measurement of visceral fat and the aorta-rectus muscle and rectus muscle-spine distances (r = 0.80 and 0.74, respectively). The US measurements of subcutaneous fat were correlated with CT subcutaneous fat area (r = 0.82). No correlation was found between overweight, as calculated by body mass index, and CT or US fat. CONCLUSION: Our findings indicate that US is as useful as CT in evaluating body fat distribution in pediatric obesity.     

Spectrophotometric evaluation of the colour of intra- and subcutaneous bruises

Spectrophotometric measurements were performed on intra- and/or subcutaneous bruises occurring in direct temporal connection with peracute fatal trauma. The purpose of these measurements was to determine whether the visual colour impression of a fresh traumatic extravasation can give information on the localisation of the haemorrhage in a certain tissue layer. After visual assessment of the colour of the bruise, the spectral reflectance curves and the CIE-L*a*b* colour values were determined with the help of a diode array spectrophotometer. The localisation and size of the haemorrhages in the cutis and/or subcutis were evaluated morphologically after incision of the skin. It was confirmed that there is a relationship between the colour impression and the localisation of the bruise. Bruises localised near the surface have a more reddish appearance while bruises in deeper layers give a more bluish colour impression. An explanation may be found in the optical characteristics of skin. Blood localised in the subcutis appears blue on the surface due to scattering processes in the dermis (Rayleigh scattering), as the blue wavelengths of the light are scattered (and thus reflected) to a greater extent than the red wavelengths. Received: 4 March 1999 / Accepted: 9 September 1999     

An autopsy case report of tramline bruises with various shapes –histological and mechanistic considerations–

An autopsy case involving a child showing various shapes of tramline bruises caused by a single weapon is described. On autopsy, multiple tramline bruises in different orientations were found, mainly on the back. Shapes of the tramline bruises were variable, including linear, arcuate, nodular, hook-like, and hook-like with a knot at the end. Due to the presence of severe subcutaneous hemorrhages and the absence of other potentially fatal injuries or diseases, we determined the cause of death to be traumatic shock. Microscopically, of the many tramline bruises, characteristic hemorrhages were observed on the right abdominal and left lumbar regions. Those hemorrhages were observed in the dermis, corresponding to macroscopic tramline bruises. Hemorrhage was also observed in the subcutis, corresponding to the pallor of the outer surface. The mechanisms by which tramline bruises occurred in the dermis and subcutis in this case are discussed with reference to the literature. We also propose subcutaneous and intradermal hemorrhagic types of tramline bruising.     

代谢综合征大鼠模型的建立及其相关基因表达变化的研究

目的建立与人类代谢综合征(MS)相似的大鼠模型,并分析其相关基因的表达变化。方法雄性8周龄Wistar大鼠30只随机分为普通膳食对照组(NC组)和高脂高盐膳食组(MS组)。喂养期间对大鼠体重、血压、空腹血糖(FPG)、血脂、胰岛素水平等进行连续监测;24周喂养结束进行高胰岛素-正常血糖钳夹试验和腹腔注射糖耐量试验,检测颈动脉血压,测量内脏脂肪重量;取其白色脂肪(肠系膜)、棕色脂肪和骨骼肌组织,以RT-PCR法检测胰岛素敏感组织基因表达变化。结果MS组体重、内脏脂肪、血压、血浆甘油三酯(TG)、游离脂肪酸(FFA)与NC组比较显著增加(P<0·05或P<0·01),且存在严重的胰岛素抵抗[GIR:1·26±0·82mg/(kg·min)vs7·03±1·68mg/(kg·min),P<0·01]和糖耐量减退,表现为典型的MS特征;胰岛素敏感组织基因检测结果显示,与NC组比较,MS组与糖脂代谢和能量代谢相关的23种基因的mRNA表达水平在白色脂肪(肠系膜)、棕色脂肪和骨骼肌组织中多数变化显著。结论长期高脂和高盐饮食喂养可诱导类似于人类MS的基本临床特征大鼠模型,其机制可能与高脂摄入导致大鼠胰岛素敏感组织的糖脂代谢和能量代谢相关基因的变化有关。