[Features of coarse calico damage by hollow-point bullets of ammunitions to a 12-gauge fire smoothbore weapon (12×70) under the conditions of remote shooting distance]. / Osobennosti povrezhdeniya byazevoi tkani ekspansivnymi pulyami patronov k ognestrel'nomu gladkostvol'nomu oruzhiyu 12-go kalibra (12×70) v usloviyakh neblizkoi distantsii vystrela.

The article presents the experimental study results of damaged clothes imitators' (coarse calico) features in consequence of shot by ammunitions with hollow-point bullet from a 12-gauge fire smoothbore weapon (12×70). The generation mechanism of coarse calico damage during wound of underlying biological human body's imitator by bullet and the factors influencing on mentioned process have been clarified using high-speed video recording.

[Variability of input gunshot injuries of clothing fabrics]. / Variabel'nost' vkhodnykh ognestrel'nykh povrezhdenii tkanei odezhdy.

One of the main components of a gunshot injury is the entrance hole. Its characteristic features: round shape, size, the presence of a central tissue defect, abrasion collar (contamination, metallization), are differential diagnostic signs of an entrance gunshot injury. Under the conditions of the conducted experiments, the peculiarities of the variability of the described signs of the entrance holes on the clothing fabrics were studied, depending on the nature of the objects to be subjected and the contact velocity of the firearm projectile. The identified features must be taken into account when examining gunshot injuries, as well as planning and conducting experimental studies with firearms.

[Impact of projectile incidence angle with obstacle during ricochet on the damage characteristics formed in smoothbore weapon shot]. / Vliyanie ugla vstrechi puli s pregradoi pri rikoshete na kharakteristiku povrezhdenii, obrazuyushchikhsya pri vystrele iz gladkostvol'nogo oruzhiya.

The aim of this study was to establish the degree of projectile incidence angle with obstacle on forensic medical characteristic of gunshot injuries arising from smoothbore weapon fire and bullet ricochet. Based on the comprehensive forensic study results of experimental entry gunshot injuries, statistically significant differences in the following morphological signs were found for two ranges of incidence angle values (10-20° and 30-50°): «Number of MD¼, «Length 1 MD¼, «Length 2 MD¼, «Width 1 MD¼, «Orientation of AD to the conventional clock face relative to MD 1 or to the group of largest MD (max. value)¼. The medians and limits of 99% confidence intervals of these features values were observed depending on the range of incidence angle values. The revealed patterns can be used in expert practice during forensic medical examination of gunshot injuries formed as a result of a projectile ricochet after smoothbore weapon fire, as well as to develop a methodology for conducting a forensic study of this gunshot injury type.

[Morphology features of gunshot injuries in occupants of a car]. / Osobennosti morfologii ognestrel'nykh povrezhdenii u lyudei, nakhodyashchikhsya v salone avtomobilya.

The article presents a case of fatal gunshot wounds in occupants of a car. The wounds occurred after the passage of gunfire projectiles through a vehicle's triplex glass barrier and had certain features that distinguished them from the common wounds due to the characteristics of the barrier. As part of the solution of the expert questions, the following up-to-date research methods were applied: scanning electron microscopy, energy-dispersive analysis, and computerized three-dimensional reconstruction of the incident circumstances. These research methods provided a clear-cut solution for the situational tasks set by the investigator and served as tools for assessment of the mechanism of bodies injury.

[Characteristics of the trajectory of projectiles after penetration of biological and non-biological obstacles in shots fired from various types of firearms]. / Kharakteristika traektorii dvizheniya snaryadov posle probitiya biologicheskikh i nebiologicheskikh pregrad pri vystrelakh iz razlichnykh obraztsov ognestrel'nogo oruzhiya.

The purpose of the work was to study the movement trajectory of the projectile after breaking through an obstacle made of various materials installed at various angles to the aiming line when firing from rifled and traumatic weapons. As a result of a series of experimental shots by shells fired from a traumatic pistol «Jorge¼ (9×22 mm RA cartridge with an initial velocity of 300±20 m/s and a bullet weight of 0.7 g) and the Blaser R93 carbine (Norma Jaktmatch 9.3×62 mm hunting cartridge with an initial speed of 765 m/s and a bullet weight of 11 g) it has been found that, when punching both biological simulators and triplex glass located at the angles of 40-60° with respect to the aiming line, a deflection of the firearm from the aiming line is observed.

[Effect of the target type on the characteristics of gunshot injuries resulting from bullet and shrapnel ricochet]. / Vliyanie vida misheni na kharakteristiku ognestrel'nykh povrezhdenii, obrazuyushchikhsya v rezul'tate rikosheta puli i kartechi.

The study objective is to establish the effect of the type of experimental target (biological, non-biological) on the forensic medical characteristics of gunshot injuries resulting from bullet and shrapnel ricochet when fired from a smooth-bore weapon. Differences in the skin and clothing or their imitators render different morphological patterns of the input gunshot injuries. Based on the results of the ballistic experiment, a list of statistically significant differences in the qualitative and quantitative characteristics of the input gunshot injuries to biological and non-biological targets as a result of a ricochet when a bullet is fired from a smooth-bore weapon was compiled. In addition, the characteristics of the input gunshot injuries were established, demonstrating statistically significant differences only in certain combinations of the specified types of bullet and experimental target. The results obtained can be used in medical forensic examinations of gunshot injuries.

Selective Nonoperative Management of Abdominal Shotgun Wounds.

BACKGROUND: Selective nonoperative management (SNOM) of abdominal gunshot wounds (GSWs) has not been specifically examined after shotgun injuries. Because of the unpredictable nature of shotgun pellets, it is unclear if SNOM after shotgun wounds is safe. The study objective was to examine outcomes after SNOM for shotgun wounds to the abdomen. METHODS: Patients with isolated abdominal shotgun wounds were identified from the National Trauma Data Bank (2007-2017). Transfers, arrival without signs of life, death in the emergency department, severe (Abbreviated Injury Scale ≥3) extra-abdominal injuries, abdominal Abbreviated Injury Scale = 6, and missing data were exclusion criteria. Patients with abdominal handgun wounds (GSWs) were used for comparison. Study groups of shotgun-injured patients were defined by management strategy: operative management (OM) (exploratory laparotomy ≤4h) versus SNOM (no exploratory laparotomy ≤4h). Outcomes were compared by mechanism of injury (shotgun versus GSW) and management strategy (OM versus SNOM) using univariate and multivariate analyses. RESULTS: After exclusions, 1425 patients injured by abdominal shotgun wounds were included. Shotgun-injured patients underwent SNOM more frequently than GSW patients (42% versus 34%, P < 0.001). On multivariate analysis, injury by shotgun was independently associated with SNOM (OR 1.443, P = 0.040). Shotgun injuries were significantly more likely to fail SNOM (OR 2.401, P = 0.018). Failure of SNOM occurred earlier among shotgun-than GSW-injured patients (15 versus 24h, P = 0.011). SNOM after shotgun injury was associated with lower mortality than OM, even when patients failed SNOM (P < 0.001). Complications were uniformly higher after OM than SNOM, even when SNOM failed (P < 0.05). CONCLUSIONS: SNOM was utilized more commonly after shotgun wounds than GSWs. However, SNOM was more likely to fail after shotgun injury and tended to occur earlier after admission. SNOM after shotgun injury was associated with improved mortality and decreased complication rates when compared with OM, even when patients failed SNOM. SNOM appears to be a safe and beneficial management strategy after shotgun wounds to the abdomen.

The Influence of the Opioid Epidemic on Firearm Violence in Kentucky Counties.

BACKGROUND: The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively). METHODS: For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate. RESULTS: ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (-0.28, P = 0.012), and percentage high school graduates (-0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and -0.32, P < 0.001, respectively) but were not significant in the multivariable model. CONCLUSIONS: In addition to recognized nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties. Firearm injury prevention efforts should consider the contribution of opioid use and abuse.

Treatment of Peripheral Nerve Injuries in Syria's War Victims: Experience from a Northern Israeli Hospital.

BACKGROUND: The collapse of the Syrian healthcare system during the civil war led numerous citizens to cross the Syrian-Israeli border to seek medical care. OBJECTIVES: To describe the epidemiology of peripheral nerve injuries (PNIs) sustained in war, their management, and short-term outcomes. METHODS: A retrospective case series study was conducted on 45 consecutive patients aged 25.7 ± 9.3 years. These patients were referred to the hand surgery unit of the department of orthopedic surgery and traumatology at Galilee Medical Center between December 2014 and June 2018. Median time between injury and presentation was 60 days. Injury pattern, additional injuries, surgical findings and management, complications, and length of hospital stay were extracted from medical records. RESULTS: Most injuries were blast (55.6%) followed by gunshot injuries (37.8%). There were 9 brachial plexus injuries, 9 sciatic nerve injuries, and 38 PNIs distal to the plexus: specifically 20 ulnar, 11 median, and 7 radial nerve injuries. In the latter group, neurotmesis or axonotmesis was found in 29 nerves. Coaptation was possible in 21 nerves necessitating cable grafting in 19. A tendon transfer was performed for 13 peripheral nerves, occasionally supplementing the nerve repair. The patients returned to their country after discharge, average follow-up was 53.6 ± 49.6 days. CONCLUSIONS: For nerve injuries sustained in war, early surgical treatment and providing adequate soft tissue conditions is recommended. Tendon transfers are useful to regain early function.

Trends in Firearm Injuries Among Children and Teenagers in the United States.

BACKGROUND: Gun violence among children and teenagers in the United States occurs at a magnitude many times that of other industrialized countries. The trends of injury in this age group relative to the adult population are not well studied. This study seeks to measure trends in pediatric firearm injuries in the United States. METHODS: Data from the National Trauma Data Bank (2010-2016) were used in selecting patients evaluated for firearm injury. Patients were classified as children and teenagers (<20 y) or adults (≥20 y). Changes in the proportion of firearm injuries among children and teenagers relative to the overall population (pediatric component) were determined using trend analyses. RESULTS: There were 240,510 firearm injuries with children and teenagers accounting for 45,075 of these injuries (pediatric component of 18.7%). Pediatric firearm injury was mostly among males (87.4%), Blacks (60.7%), and victims of assault (76.0%). The pediatric component of firearm injuries decreased from 21.7% in 2010 to 18.2% in 2016 (P-trend < 0.001). Although there was a decrease from 22.7% to 17.6% in the pediatric component of assault (P-trend < 0.001), there was an increase from 8.7% to 10.1% in the pediatric component of self-inflicted injuries (P-trend = 0.028). Substratification by race/ethnicity showed decrease in the pediatric component of firearm injuries among all groups (P-trend < 0.001) except Whites (P-trend = 0.847). CONCLUSIONS: Despite reductions in the pediatric component of firearm injuries, there remains a significant burden of injury in this group. Continued public health efforts are necessary to ensure safety and reduce firearm injuries among children and teenagers in the United States.

A 1810 skull of Napoleon army's soldier: a clinical-anatomical correlation of steam gun trauma.

INTRODUCTION: In the following article, we are presenting a clinical observation of Baron Larrey. In 1804, Larrey was the inspector general of health, as well as the chief surgeon of the imperial Napoleonic Guard. He participated in all of Napoleon's campaigns. A paleopathological study was performed on a skull from Dupuytren's Museum (Paris) with a long metal stick in the head. We report here a clinical case as well as the autopsy description of this soldier's skull following his death. We propose a different anatomical analysis of the skull, which allowed us to rectify what we believe to be an anatomical error and to propose varying hypotheses regarding the death of soldier Cros. MATERIALS AND METHODS: The skull was examined, observed and described by standard paleopathology methods. Measurements of the lesion were performed with metric tools and expressed in centimeters. Historical research was made possible through the collaboration with the Museum of Medicine History-Paris Descartes University. RESULTS: Following the above detailed anatomical analysis of the path of the metal rod, we propose various possible lesions in soldier Cros due to the accident. At the inlet, the frontal sinuses could have been damaged. At the level of the second portion of the intracranial path, all of the anatomical elements present in the cavernous sinus could have been injured (cranial nerves III, IV, V1 and V2, VI, internal carotid artery and cavernous sinus). The exit orifice of the foreign body passes through the left condylar fossa of the occipital bone, points to a highly probable lesion of the left hypoglossal nerve (12th cranial nerve). CONCLUSION: The paleopathological study of human remains, when combined with anatomical and clinical knowledge of the pathologies of the head and neck, can rectify diagnoses of the past.

[Thoracic and abdominal injuries caused by air weapons]. / Pulevye raneniia grudi i zhivota iz pnevmaticheskogo oruzhiia.

Thoracic and abdominal injuries caused air weapons are rarer compared with gunshot wounds. Nevertheless, pneumatic weapons are able to inflict potentially fatal lesions despite small mass and dimension of projectile. Three clinical cases of patients with various internal injuries are presented in the article. Differentiated diagnostic and surgical approach is suggested.

The Association Between Urban Tree Cover and Gun Assault: A Case-Control and Case-Crossover Study.

Green space and vegetation may play a protective role against urban violence. We investigated whether being near urban tree cover during outdoor activities was related to being assaulted with a gun. We conducted geographic information systems-assisted interviews with boys and men aged 10-24 years in Philadelphia, Pennsylvania, including 135 patients who had been shot with a firearm and 274 community controls, during 2008-2011. Each subject reported a step-by-step mapped account of where and with whom they traveled over a full day from waking until being assaulted or going to bed. Geocoded path points were overlaid on mapped layers representing tree locations and place-specific characteristics. Conditional logistic regressions were used to compare case subjects versus controls (case-control) and case subjects at the time of injury versus times earlier that day (case-crossover). When comparing cases at the time of assault to controls matched at the same time of day, being under tree cover was inversely associated with gunshot assault (odds ratio (OR) = 0.70, 95% confidence interval (CI): 0.55, 0.88), especially in low-income areas (OR = 0.69, 95% CI: 0.54, 0.87). Case-crossover models confirmed this inverse association overall (OR = 0.55, 95% CI: 0.34, 0.89) and in low-income areas (OR = 0.54, 95% CI: 0.33, 0.88). Urban greening and tree cover may hold promise as proactive strategies to decrease urban violence.

Firearm injuries due to legal intervention in children and adolescents: a national analysis.

BACKGROUND: Firearm injuries related to legal intervention have come under scrutiny because of recent events. METHODS: The Kids' Inpatient Database (1997-2012) was searched for firearm injuries due to legal interventions (International Classification of Diseases, ninth revision, Clinical Modification E970) requiring inpatient admission in children aged <20 y. Cases were weighted to provide national estimates. The Brady Campaign criteria were used to identify lenient versus strict gun law states. RESULTS: Overall, 275 cases were identified, with a 7.5% mortality rate. Incidence peaked at 1.0 per 100,000 admissions in 2006, significantly increased from a low 0.2 per 100,000 admissions in 1997, P < 0.001. Patients were predominantly male (97%). African Americans (44%) represented the largest racial group, followed by Hispanics (30%) and Caucasians (20%). Mean age was 17.5 ± 2.08 y. Patients were insured by Medicaid (33%) or a private payer (24%); the remainder (43%) was uninsured. Admissions most frequently occurred at urban teaching hospitals (81%). Cases occurred most frequently in the Southern United States (44%), followed by the Western United States (35%). Most patients presented to non-children's hospitals (97%). Mean hospital admission cost was 27,507 ± 40,197 USD, whereas mean charges amounted to 75,905 ± 116,622 USD. Cases mostly occurred in lenient (56%) gun law states, whereas the remainder occurred in strict (41%) and neutral (3%) states. When analyzed by race, Caucasians (16%) had a significantly higher mortality rate when compared with African Americans (5%), P = 0.03. CONCLUSIONS: An analysis of this very specific injury mechanism demonstrates important findings, which are difficult to collect from conventional data sources. Future research will contribute to the objective analysis of this politically charged subject.

Trends in analysis of gunshot residue for forensic purposes.

Detection and identification of organic and inorganic components of gunshot residue are well established within forensic chemistry because of highly characteristic and uncommon features of the products of ammunition discharge at the time and place of a shooting incident in comparison to other materials present in daily life of people. Both types of residue play an important role in establishing various circumstances of a shooting crime, though the most vital one concerns the possibility of relating a suspect with the activity of shooting. In this aspect, solid, inorganic particles, nowadays called characteristic, have been utilized. Their specific features result from the primer mixture composition, including compounds of heavy metals, lead, antimony, and barium, and from the extraordinarily dynamic conditions of their formation, taking place at the moment of the primer detonation. Scanning electron microscopy and X-ray microanalysis techniques proved to be necessary and sufficient to reveal the content and the spherical morphology of the particles for this purpose. Recently, the recommendation that the potential for lead exposure be minimized was followed in the production of ammunition cal. 9 mm Luger, 0.40 S&W, 0.380 Auto, and 0.38 Special. These modern types of ammunition expel less characteristic particles, the identification of which can be a challenge for the examiners. At least two solutions to strengthen the residue identity are taken into account: additional insights into the internal structure of inorganic particles, e.g., by means of electron backscattered diffraction and focused ion beam, as well as complementary examinations of organic residues with sensitive mass spectrometric techniques.

Violence Perpetration Among Patients Hospitalized for Unintentional and Assault-Related Firearm Injury: A Case-Control Study and a Cohort Study.

BACKGROUND: Hospital-based violence intervention programs typically focus on patients whose firearm injury occurred through interpersonal violence (assault). Knowledge of violence perpetration by victims of unintentional (accidental) firearm injury is limited. OBJECTIVE: To examine violence perpetration before and after a patient becomes hospitalized for firearm injury according to injury intent (intentional [assault] or unintentional [accidental]). DESIGN: A case-control study and a retrospective cohort study. SETTING: Hospitals in Washington. PATIENTS: Persons aged 15 years or older hospitalized for a firearm injury, other injuries, or a noninjury reason from 2006 to 2007. MEASUREMENTS: In the case-control study, the odds of violence-related arrest from 2001 through hospitalization by injury intent among 3 groups were compared. In the cohort study, the rates of violence-related arrest from hospitalization through 2011 by injury intent among 3 groups were compared. RESULTS: Patients with unintentional firearm injuries (n = 180) were more likely than those with other unintentional injuries (n = 62 795; odds ratio [OR], 2.01 [95% CI, 1.31 to 3.09]) and no injuries (n = 172 830; OR, 3.43 [CI, 2.22 to 5.32]) to have been arrested for a violent crime before hospitalization. Prior violence-related arrest did not differ between patients with assault-related firearm injuries (n = 339) and those with other assault-related injuries (n = 2342; OR, 1.10 [CI, 0.84 to 1.46]). During follow-up, the cumulative incidence of violence-related arrest for patients with unintentional and assault-related firearm injuries was 10% and 15% (subhazard ratio, 1.88 [CI, 1.11 to 3.17] and 1.61 [CI, 1.08 to 2.44]), respectively, compared with 1% for those without injuries. LIMITATION: Exclusion of self-inflicted injuries, misclassification of intent, and ascertainment bias. CONCLUSION: Some firearm injuries classified as accidental may indicate involvement in the cycle of violence and present an opportunity for intervention. PRIMARY FUNDING SOURCE: City of Seattle and the University of Washington Royalty Research Fund.

[The possibilities for the expert diagnostics of the influence of the glance of a bullet on the character of the injuries inflicted by shooting a hunting weapon]. / Vozmozhnosti ékspertnoi otsenki vliianiia rikosheta pul' na kharakter povrezhdenii ot vystrelov iz okhotnich'ego oruzhiia.

The objective of the present work was to study and analyze the available data concerning the influence of the glance of a bullet on the character of the injuries inflicted by shooting certain types of hunting weapons. This review gives evidence of the possibility of the objective diagnostics of the injuries inflicted by gunshots using the rifle-bore weapons. However, we have failed to find information about the diagnostic criteria for the evaluation of the wounds inflicted by the bullets shot from smooth-bore hunting rifles after their glance from various surfaces in the available special literature publications. Such situation creates the prerequisites for the erroneous conclusions from the results of forensic medical expertise of the after-penetration blunt wounds.

[The forensic medical significance of the igniting primer for the 18×45T cartridges of the 'Osa' pistol]. / Sudebno-meditsinskoe znachenie kapsiulia-vosplamenitelia u patronov 18×45T k pistoletu 'Osa'.

The objective of the present study was to obtain the ballistic characteristics of the igniting primer (electrical ignitor) for the 18×45T cartridges of the 'Osa' pistol produced by different manufacturers. The experiments included a series of shots fired from the 'Osa' pistol with the use of cartridges having an energy of 85 Joules ('Novye oruzheinye tekhnologii', Ltd., Sergiev Posad) and 88 Joules ('A+A', Ltd, Tula). The shooting distance varied from the point blank range to 5, 10, 20, 30, 40, and 50 cm. The targets were either the femoral soft tissue of the cut-off human lower extremity, white cotton fabric, and the 1-5 cm high gelatin cylinder 25 cm in diameter. The experiments have demonstrated that the igniting primer (electrical ignitor) for the cartridges manufactured by the 'Novye oruzheinye tekhnologii', Ltd., Sergiev Posad, served as an additional factor of the shot responsible for the penetrating power of the ammunition at a distance of 50 cm. The data on the composition of metals used for the manufacturing of the igniting primers under consideration are presented.