The aim of the present study was to establish whether the size (diameter and area) of bullet entrance holes in skin varies between distant shots to the anterior and posterior trunk, respectively, ...when using the same ammunition (in concreto pistol cartridges 9 mm Luger). For that purpose, specimens of porcine skin from the belly region and the back were taken (10 samples each) and shot at from a distance of 1.6 m. The entrance holes were photo-documented under standardised conditions. After image processing for contrast enhancement, the maximum diameter and the area of each skin defect were measured automatically by means of an image analysis system. Both size parameters differed significantly depending on the body region affected. On the back with its comparatively thick dermis, the skin defects were considerably smaller than those on the ventral trunk where the corium is less thick. This difference can be explained by the fact that the elastic properties of skin are strongly determined by the connective tissue which is especially rich in fibres. The study results were consistent with the authors’ casework experience and support the assumption that the entrance site of gunshot wounds has a major influence on the size of the bullet hole in skin.
In contrast to gunshot wounds in skin and bone, the medico-legal literature pays little attention to the appearance of bullet penetration sites in abdominal organs. It was only in 1983 that Metter ...and Schulz published an article entitled “Morphological features of gunshot wounds in the liver and spleen.” According to their observations, the organs in question showed stellate tears at the bullet penetration sites resembling skin wounds from contact shots to body regions having a bony support. The study presented simulated the real conditions by means of test shots to composite models consisting of porcine organs embedded in ballistic gelatin. The ammunition used was pistol cartridges 9 mm Luger with full metal jacket round nose bullets. The shots were video-documented with a high-speed camera in order to record the bullet’s travel through the target. In addition, the composite models fired at underwent CT examinations followed by a macroscopic assessment of the organs. The study confirmed the findings of Metter and Schulz with regard to the star-like appearance of gunshot wounds in the liver and spleen. Likewise, the kidney showed radiating tears originating from the bullet path, whereas the wound track in pulmonary tissue was tube-shaped and lacked additional cracks. The varying wound patterns in parenchymatous organs can reasonably be explained as a consequence of the respective viscoelastic tissue properties.
The Target Absorbers for Neutrals (TANs) represent one of the most radioactive regions in the Large Hadron Collider. Seven 40cm long fused silica rods with different dopant specifications, ...manufactured by Heraeus, were irradiated in one of the TANs located around the ATLAS experiment by the Beam RAte of Neutrals (BRAN) detector group. This campaign took place during Run 2 p＋p data taking, which occurred between 2016 and 2018. This paper reports a complete characterization of optical transmission per unit length of irradiated fused silica materials as a function of wavelength (240 nm–1500 nm), dose (up to 18 MGy), and level of OH and H2 dopants introduced in the manufacturing process. The dose delivered to the rods was estimated using Monte Carlo simulations performed by the CERN FLUKA team.
Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) have a significantly increased risk of breast cancer, which can be substantially reduced with antiestrogen therapy for ...chemoprevention. However, antiestrogen therapy for breast cancer risk reduction remains underutilized. Improving knowledge about breast cancer risk and chemoprevention among high-risk patients and their healthcare providers may enhance informed decision-making about this critical breast cancer risk reduction strategy.
We are conducting a cluster randomized controlled trial to evaluate the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. We have cluster randomized 26 sites across the U.S. through the SWOG Cancer Research Network. A total of 415 patients and 200 healthcare providers are being recruited. They are assigned to standard educational materials alone or combined with the web-based decision support tools. Patient-reported and clinical outcomes are assessed at baseline, after a follow-up visit at 6 months, and yearly for 5 years. The primary outcome is chemoprevention informed choice after the follow-up visit. Secondary endpoints include other patient-reported outcomes, such as chemoprevention knowledge, decision conflict and regret, and self-reported chemoprevention usage. Barriers and facilitators to implementing decision support into clinic workflow are assessed through patient and provider interviews at baseline and mid-implementation.
With this hybrid effectiveness/implementation study, we seek to evaluate if a multi-level intervention effectively promotes informed decision-making about chemoprevention and provide valuable insights on how the intervention is implemented in U.S. clinical settings.
NCT04496739
Abstract An 88-year-old woman committed suicide by drinking a toxic amount of highly concentrated alcohol and setting two rooms of her flat on fire. As there was not enough oxygen, the fire went out, ...however. At autopsy, no thermal lesions were found on the body, but soot depositions in the airways and a COHb value of 14% pointed to the inhalation of fire fumes. The ethanol concentration in femoral blood was 6.62 per mille. The gastric mucosa was fixed by the ingested alcohol and showed hardly any autolytic changes despite a post-mortem interval of five days. Congener analysis of the gastric contents and the femoral blood indicated the uptake of a fruit distillate or its foreshot.
Highlights • In drug addicts, infective endocarditis is a possible cause of unexpected death. • Septic embolism may be followed by brain infarctions and/or intracranial hemorrhage. • A non-traumatic ...subdural hematoma due to septic embolism is described.
Abstract Pistols, revolvers and blank guns are not only used to discharge cartridges, but also for hits to the victim. In such cases, the blows preferably affect the head and/or the interposed hands ...protecting the body. The impact is mostly exerted either by the grip of a pistol or the butt of a revolver. In vigorous thrusts inflicted with the muzzle end of the weapon, the edge of the barrel may produce circular punch lesions with central skin flaps roughly corresponding to the bore. As in other kinds of pistol-whipping, the scalp wounds may be associated with fractures of the skull and even with brain contusions. Using the example of a homicide committed by pistol-whipping, the morphological features of blunt injuries from a handgun's muzzle are presented. The characteristic wound pattern found on the victim's head could be reproduced experimentally by forceful blows to the forehead of a slaughtered pig. In the case presented, the dominant hand of the perpetrator showed friction blisters due to prolonged striking with an unhandy tool in the form of a pistol.
Abstract The muzzle imprint mark in contact shots is usually regarded as a patterned pressure abrasion depicting the barrel end as well as adjacent constructional components of the weapon. Due to ...parching after exposure to air, the affected skin assumes a brown color, especially along the contours of the impacting structures. Apart from this well-known type of epidermal damage, the imprint mark may also be formed by intradermal hemorrhages. In some cases, these intracutaneous bleedings manifest themselves as circular, curved or straight reddish lines mirroring the surface relief of the weapon's muzzle end. To estimate the frequency of skin hematomas in muzzle imprints, 35 consecutive contact shots to the head (temple, forehead, submental and occipital region) were evaluated. In 3 cases, the muzzle imprint mark exclusively consisted of intracutaneous bruises surrounding the bullet entrance hole. In 14 cases, the muzzle imprint was composed of both excoriations and intradermal hematomas.
Acquired estrogen receptor alpha (ER/ESR1) mutations commonly cause endocrine resistance in ER+ metastatic breast cancer (mBC). Lasofoxifene, a novel selective ER modulator, stabilizes an antagonist ...conformation of wild-type and ESR1-mutated ER-ligand binding domains, and has antitumor activity in ESR1-mutated xenografts.
In this open-label, randomized, phase II, multicenter, ELAINE 1 study (NCT03781063), we randomized women with ESR1-mutated, ER+/human epidermal growth factor receptor 2 negative (HER2−) mBC that had progressed on an aromatase inhibitor (AI) plus a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) to oral lasofoxifene 5 mg daily or IM fulvestrant 500 mg (days 1, 15, and 29, and then every 4 weeks) until disease progression/toxicity. The primary endpoint was progression-free survival (PFS); secondary endpoints were safety/tolerability.
A total of 103 patients received lasofoxifene (n = 52) or fulvestrant (n = 51). The most current efficacy analysis showed that lasofoxifene did not significantly prolong median PFS compared with fulvestrant: 24.2 weeks (∼5.6 months) versus 16.2 weeks (∼3.7 months; P = 0.138); hazard ratio 0.699 (95% confidence interval 0.434-1.125). However, PFS and other clinical endpoints numerically favored lasofoxifene: clinical benefit rate (36.5% versus 21.6%; P = 0.117), objective response rate 13.2% (including a complete response in one lasofoxifene-treated patient) versus 2.9%; P = 0.124, and 6-month (53.4% versus 37.9%) and 12-month (30.7% versus 14.1%) PFS rates. Most common treatment-emergent adverse events with lasofoxifene were nausea, fatigue, arthralgia, and hot flushes. One death occurred in the fulvestrant arm. Circulating tumor DNA ESR1 mutant allele fraction (MAF) decreased from baseline to week 8 in 82.9% of evaluable lasofoxifene-treated versus 61.5% of fulvestrant-treated patients.
Lasofoxifene demonstrated encouraging antitumor activity versus fulvestrant and was well tolerated in patients with ESR1-mutated, endocrine-resistant mBC following progression on AI plus CDK4/6i. Consistent with target engagement, lasofoxifene reduced ESR1 MAF, and to a greater extent than fulvestrant. Lasofoxifene may be a promising targeted treatment for patients with ESR1-mutated mBC and warrants further investigation.
•Lasofoxifene showed antitumor activity in patients with ESR1-mutated mBC that progressed on an AI plus a CDK4/6i.•Lasofoxifene numerically improved PFS (5.6 versus 3.7 months) and clinical benefit rate (37% versus 22%) versus fulvestrant.•Lasofoxifene was well-tolerated with no unexpected safety signals.•Lasofoxifene reduced ESR1 MAF, including Y537S MAF, in more patients than fulvestrant, exhibiting target engagement.•Lasofoxifene may be a promising endocrine therapy backbone for ESR1-mutated mBC in a post-CDK4/6i setting.
Abstract In some fatalities from intense blunt trauma, the victims’ clothes show strikingly yellow discoloration being in topographic correspondence with lacerated skin and crush damage to the ...underlying fatty tissue. This phenomenon is especially pronounced in light-colored textiles such as underwear made of cotton and in the absence of concomitant blood-staining. The constellation of findings seems to indicate that the fabric has been soaked with liquid body fat deriving from the contused adipose tissue. To check this hypothesis, textiles suspected to be contaminated with fat were investigated in 6 relevant cases. GC–MS-analysis proved the presence of 11 fatty acids. The fatty acid composition was similar to that of human adipose tissue with a high proportion of oleic acid (18:1). In total, the morphological and chemical findings demonstrated that the yellow discoloration of the victims’ clothes was caused by fat from traumatized adipose tissue.
