Search Results (164)

Drowning remains the third leading cause of accidental injury-related deaths worldwide, disproportionately affecting low- and middle-income countries where lifeguard coverage is limited or absent. To address this critical gap, we present Robobuoy, an intelligent real-time rescue system that integrates deep learning-based object detection with an unmanned surface vehicle (USV) for autonomous intervention. The system employs a monitoring station equipped with two specialized object detection models: YOLO12m for recognizing drowning individuals and YOLOv5m for tracking the USV. These models were selected for their balance of accuracy, efficiency, and compatibility with resource-constrained edge devices. A geometric navigation algorithm calculates heading directions from visual detections and guides the USV toward the victim. Experimental evaluations on a combined open-source and custom dataset demonstrated strong performance, with YOLO12m achieving an mAP@0.5 of 0.9284 for drowning detection and YOLOv5m achieving an mAP@0.5 of 0.9848 for USV detection. Hardware validation in a controlled water pool confirmed successful target-reaching behavior in all nine trials, achieving a positioning error within 1 m, with traversal times ranging from 11 to 23 s. By combining state-of-the-art computer vision and low-cost autonomous robotics, Robobuoy offers an affordable and low-latency prototype to enhance water safety in unsupervised aquatic environments, particularly in regions where conventional lifeguard surveillance is impractical. Full article

Background: Although orbital fractures are common in trauma care, age-specific mechanisms and admission physiology-based risk stratification have not been systematically characterized. This study aimed to identify age–mechanism interaction patterns and develop an admission-based physiological risk score for orbital fracture patients. Methods: This retrospective cohort study analyzed 41,464 adult orbital fracture patients from the National Trauma Data Bank (2018–2020). A three-component physiological risk score was developed using admission vital signs: severe hypotension (<90 mmHg, 2 points), tachycardia (>100 bpm, 1 point), and severe traumatic brain injury (GCS ≤ 8, 1 point). Risk stratification performance was validated against composite adverse outcomes. Results: Distinct age–mechanism patterns emerged: 74.0% of elderly patients (≥65 years) sustained falls, while young adults demonstrated a bimodal distribution with motor vehicle crashes (31.2%) and violence (28.4%). Violence-related injuries occurred in younger patients (40.3 vs. 55.0 years) but had lower injury severity scores (10.0 vs. 14.4) and mortality (2.8% vs. 5.2%) than accidental mechanisms. High-/critical-risk patients (8.4% of the cohort) had 16.2% mortality versus 2.1% in stable patients. Complex facial injuries demonstrated 11-fold higher mortality (7.7% vs. 0.7%). The physiologic risk score achieved AUC 0.79 (95% CI: 0.78–0.80). Conclusions: Age–mechanism interactions revealed distinct bimodal injury patterns in young adults. Admission physiologic parameters effectively identify 8.4% of patients requiring intensive resources, while violence-related injuries paradoxically demonstrate better outcomes than accidental mechanisms. Full article

Although the accidental or intentional explosions produced in industrial facilities or in urban areas are events with low probability, they have a high destructive potential and potential for human injuries and/or fatalities. One of the types of such events is given by detonation of improvised explosive devices (IEDs)—dirty bombs for terrorist purposes—which may produce a high number of metallic fragments. Studying mass and spatial distributions of these fragments is useful for evaluating their lethality and destructive potential and may help to implement adequate protective measures. This work brings a closer insight into the fragment dispersion around the detonation of a steel-enclosed C4 charge with cylindrical symmetry. In this respect a specific approach involving both detonation experiments and numerical simulations performed by home-made and commercial software packages for investigation of the fragmentation process and accompanying angular scattering of the fragments was proposed. Special algorithms, which allow the estimation of the spatial distributions of fragments from the numerical analysis of perforations made by the metallic fragments generated by such IEDs on surrounding material walls, are developed. Further, numerical simulations of a similar IED device provided output parameters related to the statistical distributions of mass, kinetic energy and position of the fragments. Experimental fragmentation generated a recovered mass distribution (94 fragments of 67.5 g) that was compared with that extracted from simulation, revealing a reasonable agreement on the 0.3–1 g range. In the case of simulations, 300 fragments from a total number of 374 showed a mass ranging from 0.004 to 0.3 g. The simulations showed that the middle part of the steel case generated fragments of kinetic energy over 4 kJ and its ends generated fragments of kinetic energy under 1 kJ. Experimental fragment scattering distributions were investigated with specific home-made numerical algorithms, which, based on a set of images, analysed the correlations between spatial coordinates of perforations made by fragments on surrounding special panels and provided histograms that are discussed in relation with the fragment-induced lethality degree. Full article

Introduction: Charred bodies represents a significant challenge for forensic pathologists due to the destructive effects of fire on human remains. Although most fire-related deaths are accidental, cases of suicide and homicide are not uncommon. Case Report: We report a peculiar case of a severely burned body discovered inside a torched vehicle. Under judicial investigation, a full autopsy was performed, including macroscopic and microscopic examination of key anatomical structures: the inspection of oral cavity revealed no soot deposits; a foreign object (a chestnut) was found anterior to the epiglottis, though not lodged within the glottis; no thermal injuries or soot were observed in the upper or lower airways. Histological analysis excluded thermal damage at the alveolar–capillary interface. Alveolar spaces appeared both hyperinflated and ectatic, likely due to septal rupture, suggestive of acute pulmonary emphysema and multiorgan congestion. Carboxyhemoglobin levels were below 5%, indicating a low level which did not support intravital inhalation of combustion gases. Based on the comprehensive medico-legal findings, the cause of death was attributed to an asphyxial mechanism. It was further demonstrated that the burning of the body occurred post-mortem. DNA extraction from two dental specimens enabled positive identification of the victim. Subsequent investigations confirmed the case to be a femicide. The perpetrator, following a domestic altercation over jealousy, suffocated his young wife and attempted to simulate accidental choking by placing a chestnut in her mouth. He then staged a vehicular fire to mimic a fatal accident. Conclusions: The case underlines that a multidisciplinary forensic approach is essential, and must integrate different methodologies and the analysis of both circumstantial evidence and scene investigation. Full article

Objective: The insertion of venous catheters into supra-aortic vessels is a standard procedure in the treatment of a large number of diseases. Incorrect placement of venous catheters into and accidental perforation of arterial vessels is a rare but serious complication that can lead to severe bleeding, dissections, and strokes. Materials and Methods: We present a case of iatrogenic malposition of a Broviac catheter into the right vertebral artery and its successful treatment through stenting of the perforation site using a Walrus balloon catheter to achieve a secure treatment position and eventually cover the perforation site. Additionally, we conducted a systematic literature review on endovascular rescue procedures in inadvertent injuries of the supra-aortic arteries related to venous catheter placement. Results: A balloon guide catheter was used to achieve a secure treatment position for the deployment of a stent graft covering the perforation site, ensuring no significant arterial hemorrhage occurred during the removal of the incorrectly placed Broviac catheter. The review of the literature on endovascular rescue procedures for supra-aortic arterial vessel damage caused by venous catheter placement revealed that endovascular treatment has been successful in all reported cases of catheter-related supra-aortic arterial injury. Primary stent graft placement without additional actions was the most common treatment approach. Conclusions: In the treatment of iatrogenic injuries to the supra-aortic vessels, endovascular treatment strategies represent a safe, reliable, and generally recognized option and thus are used much more frequently than surgical procedures. Key point: In rare cases of accidental malposition of venous catheters into supra-aortic arterial vessels, endovascular insertion of a stent graft covering the perforation site using a balloon guide catheter can be a safe treatment option. Full article

Background/Objectives: Corrosive substance intake remains a significant public health concern due to its potential for severe gastrointestinal (GI) injury and associated morbidity. Early risk stratification is crucial for appropriate management, yet there is a lack of reliable non-invasive predictors of injury severity. This study aimed to evaluate the clinical characteristics of adult patients with corrosive ingestion and to investigate the correlation between inflammatory markers and endoscopic injury severity. Methods: In this retrospective study, 83 adult patients who underwent esophagogastroduodenoscopy (EGD) following corrosive ingestion between January 2017 and January 2021 were analyzed. Endoscopic injuries were graded using the Zargar classification and categorized as mild (grades 0–2a) or severe (grades 2b–4). Demographic, clinical, endoscopic, and laboratory data, including neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels, were recorded. The correlation between inflammatory markers and injury severity was assessed, and receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy. Results: Among the patients, 55.4% were female with a mean age of 41.5 ± 17.3 years. Most ingestions were accidental (74.7%), with bleach being the most common agent (41%). Endoscopic injury was detected in 55.4% of patients, predominantly in the stomach and esophagus. Severe injuries were associated with longer intensive care and hospital stays, increased complication rates, and more frequent organ involvement (p < 0.001). A weak but statistically significant correlation was found between injury severity and both NLR (r = 0.357, p = 0.001) and CRP (r = 0.247, p = 0.024). ROC analysis revealed an NLR cut-off of 2.95 (AUC = 0.804) and CRP cut-off of 2.5 (AUC = 0.706) for predicting severe injury. Conclusions: Early endoscopic evaluation remains essential for assessing corrosive injury severity. However, NLR and CRP may serve as useful, non-invasive indicators in predicting injury severity, potentially aiding clinical decision-making, especially in settings where endoscopy is not readily available or is contraindicated. Full article

Background: Free fatal falls (FFF) represent a distinct form of blunt force trauma (BFT) that is frequently encountered in forensic practice. Distinguishing FFF injuries from other forms of BFT, such as motor vehicle accidents (MVAs), can pose challenges. Despite its growing usage, the role of postmortem computed tomography (PMCT) in diagnosing FFF and its comparison with autopsy remains underexplored. Purpose: This review synthesizes fracture patterns in FFF, examining both extrinsic and intrinsic variables that influence skeletal injuries. It also compares PMCT and autopsy findings to establish a replicable database for forensic analysis. Methods: PubMed and Google Scholar were systematically searched by three independent reviewers. The inclusion criteria required studies to be published in English, report at least 10 cases, focus on fatal falls, and provide precise data on skeletal injuries. Studies lacking detailed descriptions, focusing on survivors, or involving non-free falls were excluded. Data extraction tables facilitated synthesis and analysis. Key Findings: FFF are characterized mainly by axial skeletal fractures, particularly of the chest, skull, and pelvis. A history of intoxication and psychiatric disorders often correlates with the manner of death. Fracture patterns vary by fall height, impact surface, and cause: accidental falls show greater chest and skull involvement, whereas suicidal falls present more pelvic and skull fractures. PMCT detects fractures more frequently than traditional autopsy. Conclusions: Distinct fracture patterns aid in differentiating suicidal from accidental FFF, shaped by extrinsic and intrinsic factors. Given its superior fracture detection capabilities, PMCT should be integrated into forensic protocols for FFF investigations. Full article

Background: The incidence of chemical ocular trauma after accidentally instilling the “wrong” eyedrops is still frequent, but cases resulting from stamper ink refills are rare. Case Presentation: A 73-year-old man presented to our emergency department with a history of inadvertently instilling stamper ink refill into both eyes (BEs) instead of artificial tears. Immediate irrigation and evaluation were performed. The initial visual acuity (VA) was 0.4 in the right eye (RE) and 0.8 in the left eye (LE). Slit lamp examination showed edema palpebra with periocular blue staining in BEs, chemotic conjunctiva with a much darker color in the RE than the LE, and epithelial defects with a positive fluorescein test in BEs. A diagnosis of bilateral corneal abrasion and chemotic conjunctiva was established. Ten hours after the emergency visit, RE VA decreased to 0.2, and corneal edema was found during the follow-up examination. Medications including levofloxacin antibiotic, sodium hyaluronate, sodium chloride, combined polymyxin sulfate–neomycin sulfate and dexamethasone eyedrops, mefenamic acid, and ascorbic acid tablets were prescribed. The RE corneal edema still occurred, and the endothelial cell count was 1952 and 987 cells/mm² in the RE and LE at the one-week follow-up. After three weeks, corneal edema had fully resolved, and the VA was 0.4 and 0.8 in the RE and LE, respectively. Conclusions: This case report adds to the spectrum of the continuing problem of chemical ocular trauma after mistakenly instilling the eyedrops. Promoting and changing to different packages for non-ophthalmic products in plastic bottles mimicking eyedroppers is essential to minimize these injuries. Full article

Imidazole dipeptides (IDPs), including anserine, carnosine, and balenine, are predominantly found in the skeletal muscles of vertebrates. Balenine is the major IDP in cetaceans. Serum amyloid A (SAA) is an acute phase protein released in response to damage or injury in various tissues, including skeletal muscles. A captive bottlenose dolphin (Tursiops truncatus) died due to rhabdomyolysis and subsequent acute kidney injury that probably originated from accidental muscle trauma. In this study, concentrations of IDPs and SAA were measured using stored serum collected from the affected dolphin with intermittent continuous damage of skeletal muscles to demonstrate the pathological relevance of these parameters and their usefulness as biomarkers for muscle damage in dolphins. The IDP concentration was measured using the high-performance liquid chromatography-ultraviolet method. The SAA concentration was measured using an enzyme-linked immunosorbent assay (ELISA) specific to dolphin SAA and a latex turbidimetric immunoassay (LTI) specific to human SAA. Herein, the IDP concentration was altered similarly to serum muscular enzymes, including creatinine kinase (CK) and aspartate aminotransferase (AST). However, IDP concentrations were elevated one day earlier than CK and AST levels at disease onset. Furthermore, IDP concentrations were similarly altered when assessed using both ELISA- and LTI-SAAs, and the change in IDP concentration coincided with that in LTI-SAA based on the statistical analysis. These data suggest that IDP concentration could detect muscle damage and injury, including necrosis and inflammation, in dolphins. Full article

Background/Objectives: Orbital fractures are common facial injuries that require precise reconstruction to restore both function and esthetics. Heterologous cortical lamina and titanium preformed meshes are widely used for orbital wall reconstruction; however, comparative data on their outcomes remain limited. Methods: This retrospective observational study analyzed 67 patients treated for orbital fractures at Santa Maria Hospital, Terni, between January 2021 and November 2024. Patients underwent orbital reconstruction using either a heterologous cortical lamina or titanium mesh. Clinical data, including demographics, trauma etiology, fracture characteristics, surgical approach, and postoperative complications were collected. Outcomes such as diplopia, enophthalmos, ocular motility, and sensory impairment were assessed preoperatively and postoperatively and compared between groups. Statistical analyses included Chi-square and Mann–Whitney U tests, with logistic regression to identify risk factors for complications. Results: Accidental falls were the leading cause of injury (46.3%), with the orbital floor being the most commonly affected site (83.6%). Postoperative complications occurred in 15% of patients, with diplopia significantly reduced from 47.8% preoperatively to 10.4% postoperatively (p < 0.05). Sensory impairment and motility restrictions also improved significantly. Patients reconstructed using heterologous cortical lamina experienced significantly fewer postoperative complications compared to those treated with titanium mesh (OR = 0.171, 95% CI: 0.023–0.799, p = 0.040). Conclusions: Both heterologous cortical lamina and titanium mesh provide effective orbital reconstruction; however, the heterologous cortical lamina was associated with fewer postoperative complications, particularly diplopia and sensory impairment. Material selection should consider the fracture complexity, patient characteristics, and potential long-term outcomes. Full article

Background/Objectives: Traditional diagnostic criteria for SBS include subdural, subarachnoid, and retinal hemorrhages. While intentional shaking is a known cause, the potential for similar forces acting on the head resulting from accidental trauma has not been fully explored. This study investigated the biomechanical forces on a model infant’s head during improper handling to determine if such forces could contribute to SBS without malicious intent. Methods: A realistic silicone infant model was equipped with an inertial measurement unit (IMU) to quantify head accelerations during two conditions: (1) placement of the infant model on a table with the head unsupported, and (2) manual shaking at maximum effort by 2 participants holding the model by the torso. Peak head accelerations were recorded for both conditions, and the results were analyzed for comparative assessment of the forces involved. Results: The average peak head acceleration when placing the infant model on a table with the head unsupported was +31,000 ± 7000 mg, with a range of +19,000.00 to +43,000 mg across trials. The average peak head accelerations during maximum effort shaking were significantly lower than placing the infant on the table, averaging 11,000 ± 10,000 vs. 31,000 ± 7000 mg, p < 0.0001). There were no significant differences in head accelerations between participants when placing the infant model on the table with the head unsupported (p = 0.89) nor with shaking the baby with maximum effort (p = 0.96). Conclusions: The study highlights that even accidental non-recommended handling of infants can result in high G-forces to the head, potentially leading to injuries similar to those observed in SBS. These findings highlight the necessity of supporting an infant’s head during handling and warrants caution against prematurely attributing physical abuse in SBS cases without considering unintentional causes. Full article

Spiral fractures are a frequent clinical manifestation of child abuse, particularly in non-ambulatory infants. Approximately 50% of fractures in children under one year of age are non-accidental, yet differentiating between accidental and abusive injuries remains challenging, as no single fracture type is diagnostic in isolation. The objective of this study is to investigate the biomechanics of spiral fractures in immature long bones and the role of the periosteum in modulating fracture behavior under torsional loading. Methods: Paired metatarsal bone specimens from immature sheep were tested using controlled torsional loading at two angular velocities (90°/s and 180°/s). Specimens were prepared through potting, application of a base coat, and painting of a speckle pattern suitable for high-speed digital image correlation (HS-DIC) analysis. Both periosteum-intact and periosteum-removed groups were included. Results: Spiral fractures were successfully induced in over 85% of specimens. Digital image correlation revealed localized diagonal tensile strain at the fracture initiation site, with opposing compressive zones. Notably, bones with intact periosteum exhibited broader tensile stress regions before and after failure, suggesting a biomechanical role in constraining deformation. Conclusion: This study presents a novel integration of high-speed digital image correlation (DIC) with paired biomechanical testing to evaluate the periosteum’s role in spiral fracture formation—an area that remains underexplored. The findings offer new insight into the strain distribution dynamics in immature long bones and highlight the periosteum’s potential protective contribution under torsional stress. Full article

Background: Forensic investigation of child homicides presents unique challenges due to the vulnerability of children and the complexity of distinguishing between natural, accidental, and intentional manner of death. A multidisciplinary approach integrating traditional forensic methods with emerging technologies is crucial to ensure accurate diagnosis and effective legal outcomes. Methods: This review examines current and emerging forensic techniques used in neonate, infant, and older child homicide investigations. It highlights advancements in postmortem imaging, histological examination, microbiological analysis, toxicology, and molecular autopsy. Results: Traditional forensic autopsy remains the cornerstone of child homicide investigations, providing critical insights into external and internal injuries. Histological examination enhances diagnostic accuracy by detecting microscopic evidence of trauma and infectious diseases. Postmortem imaging techniques are complementary for better identifying fractures, soft tissue injuries, and vascular abnormalities. Forensic toxicology plays a key role in detecting poisoning, while postmortem microbiology aids in identifying infectious causes of death. Furthermore, advancements in molecular autopsy and genetic testing have significantly enhanced the identification of hereditary conditions linked to sudden unexplained deaths in children, especially in cases involving multiple child fatalities within the same family, where forensic investigations are needed to accurately differentiate between natural causes and potential criminal involvement. Conclusions: A multidisciplinary approach incorporating traditional autopsy with postmortem imaging, histological examination, toxicology, postmortem microbiology, and molecular autopsy is essential for comprehensive forensic analysis, promoting both justice and prevention of fatal child abuse/homicide. Future research should focus on standardizing forensic protocols and exploring the potential of artificial intelligence (AI) in forensic investigations. Full article

Bone diseases lead to an increasing demand for implants to treat long bone defects and for load-bearing applications. Osteoporosis care and accidental injuries are major contributors to this rising need. Our research aims to demonstrate innovative material systems and methods for preparing implants that can be used in regenerative medicine. We hypothesize that by combining titanium alloys (Ti6Al4V) with hydroxyapatite (Hap), we can enhance biocompatibility and tribo-mechanical performance, which are critical for the longevity of Ti-based surgical implants. Additionally, we investigate the application of laser surface treatments to expose the underlying porosity, thereby enhancing cell transport and promoting cell growth. In this study, we investigate the effects of two fabrication techniques—Spark Plasma Sintering (SPS) and powder metallurgy (PM)—on the properties of laser-textured Ti64/Hap biocomposites. Our findings demonstrate that the selected processing route significantly influences the microstructure, tribological performance, and surface properties of these materials. An X-ray diffraction (XRD) analysis corroborates our results from incubation studies in simulated body fluids, highlighting the impact of phase transformations during sintering on the chemical properties of Ti-Hap composites. Additionally, while laser surface texturing was found to slightly increase the friction coefficient, it markedly enhanced the wear resistance, particularly for the PM and SPS Ti + 5%Hap composites. Full article

In human medicine, neurological diseases have been associated with transient cardiac abnormalities. In horses, myocardial disease is rarely diagnosed and has been associated with a wide variety of causes. The aim of this article is to describe three horses with no previous cardiac disease, which all developed severe cardiomyopathy following neurological disease. A 5-year-old Shetland pony stallion was diagnosed with cardiomyopathy with arrhythmias following an episode of seizures caused by an accidental intra-arterial xylazine injection. A 20-year-old crossbred mare was hospitalised for an open fracture of the left maxillary bone with copious epistaxis from both nostrils and developed acute cardiomyopathy with arrhythmias following a venous air embolism. Both had elevated troponin concentrations. Multifocal areas of haemorrhages and coagulative necrosis within the myocardium were found at the post-mortem examination of a 4-year-old thoroughbred gelding who died shortly after suffering acute brain injury following a backward fall. Based on this report, we suggest that myocardial injury can also occur in horses following neurological disease. Equine patients with acute neurological disease may benefit from cardiac monitoring; otherwise, patients with unspecific or mild symptoms of cardiomyopathy are likely to remain unidentified. The prognosis associated with this type of cardiac disease remains to be defined. Full article