Visibility of inflicted bruises by alternate light: Results of a randomized controlled trial.

Difficulty visualizing bruises resulting from interpersonal violence, especially in individuals with dark skin, contributes to disparities in access to justice. The purpose of this analysis was to compare bruise visibility of detected injuries using white light versus alternate light sources (ALS). Visibility was assessed using the 5-point Bruise Visibility Scale (BVS) for white light and the ALS Visibility Scale (AVS) for ALS. Bruises were induced using controlled application of a paintball to the upper arm on 157 healthy adults across six skin color categories. Using a crossover design, the light source used first to assess the bruise (white light or ALS) was randomized. Each bruise was examined up to 21 times over 4 weeks using white light and 10 combinations of wavelengths (350 nanometer [nm] - 535 nm) and colored filters (yellow, orange, and red). Multilevel modeling was used to analyze the repeated measures data with a total 20,103 bruise assessments. Results revealed 415 nm with yellow filter resulted in an almost 0.5-point increase in BVS/AVS score across all skin colors (Estimate = 0.46; 95% CI: 0.43, 0.49; p < 0.001), a clinically significant improvement in ability to visualize bruises. Conversely, 515 nm (Estimate = -0.80; 95% CI: -0.84, -0.76; p < 0.001) and 535 nm (Estimate = -0.64, 95% CI: -0.67, -0.60; p < 0.001) with red filter resulted in more than 0.5-point decrease in BVS/AVS score. The use of ALS is supported by the data and results in improved bruise visibility during medical forensic examinations.

Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis.

BACKGROUND/AIMS: Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. METHODS: The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. RESULTS: Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). CONCLUSION: The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).

Prevalence and Site of Concomitant Osteochondral Injuries in Patients With Acute Lateral Patellar Dislocation: A Systematic Review and Meta-analysis.

Background: Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the pattern of these injuries warrants further analysis, especially in relation to patient age. Purpose: To determine the overall prevalence of concomitant OCIs as well as the prevalence differences based on location and age after acute lateral patellar dislocations. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to July 20, 2022. All articles reporting the prevalence of OCI were included. The sample characteristics such as age, study design, magnetic resonance imaging diagnostic data, and the number of patients with OCI were extracted. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. The overall and per-;site injury rates were calculated, and the prevalence was stratified by age-;group (≤16 and >16 years) and compared. Results: The systematic review included 39 studies involving 3354 patients. MINORS scores were 11.94 ± 1.98 and 16 ± 3.46 in the noncomparative and comparative studies, respectively. The overall prevalence of bone bruises and OCI was 89.6% (95% CI, 77.4%-97.7%) and 48.8% (95% CI, 39.0%-58.7%), respectively. In both overall and >16-year-old patients, the lateral femoral condyle (LFC) was the most common site of bone bruise (90.5% [95% CI, 84.0%-95.6%] and 91.5% [95% CI, 84.3%-96.9%], respectively); however, the medial patellar bruise was more common in patients ≤16 years (89.2% [95% CI, 82.9%-94.4%]). Among the pooled sites of OCI, the medial patella accounted for the largest proportion (36.9% [95% CI, 28.0%-46.3%]). OCIs were more common in patients >16 years (52.6% [95% CI, 39.4%-65.6%]) than in patients ≤16 years (46.6% [95% CI, 33.2%-60.3%]). Conclusion: Bone bruises on the LFC were most prevalent overall and in patients >16 years, whereas bone bruises on the medial patella were more prevalent in patients ≤16 years. OCIs were frequently seen in patients >16 years, with the most common site being the medial patella.

Concurrent Deficiency of Factor V and Factor VIII in a Pediatric Patient: A Case Report.

This case report delves into an uncommon coagulopathy recognized as factor V and VIII deficiency (F5F8D), which follows an autosomal recessive inheritance pattern. The focal point of this study is a five-year-old Asian female who was initially presented with complaints of hematuria, epistaxis, and bruises all over the body. Comprehensive haematological and coagulation profiling unveiled indicators such as diminished haemoglobin levels and prolonged activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR). Subsequent factor assays demonstrated noteworthy reductions in both factor V and factor VIII activities, unequivocally confirming the existence of a concurrent deficiency in these crucial factors. Notably, patients exhibiting elongated INR, PT, and aPTT values necessitate a comprehensive assessment for potential combined deficits in factors V and VIII when formulating a differential diagnosis. In cases where substantial bleeding manifestations are evident during the patient's presentation, it is prudent to exercise judicious medical management strategies.

The role of dental professionals in identifying, reporting, and supporting domestic violence victims.

Domestic violence is a pervasive social issue affecting individuals across all demographics and has severe consequences for both the victims and society. Domestic violence is commonly defined as the exertion of power by one individual over another within a relationship, aiming to establish a sense of fear, control, and authority. The connection between domestic violence and oral health is established, with common oral health issues associated with domestic violence, such as dental trauma, head and neck bruises and injuries as well as facial fractures. Dental professionals play a crucial role in detecting signs of domestic violence by closely examining the head and neck region and the oral cavity during routine examinations. The significance of approaching patients suspected of experiencing domestic violence with sensitivity and empathy is of utmost importance. Recommendations include establishing trust, maintaining confidentiality, using open-ended questions, and providing information about local resources. Legal and ethical considerations are paramount, highlighting the obligations of dental professionals in cases of suspected domestic violence, including mandatory reporting laws and the balance between patient autonomy and safety. Challenges faced by dental professionals in reporting and intervening are discussed as well in this narrative review, emphasizing the importance of collaboration with other healthcare professionals and support services. This review underscores the vital role of dental care providers in recognizing signs of domestic violence, promoting intervention and support, and contributing to the well-being and safety of individuals impacted by domestic violence.

Child Abuse, Misdiagnosed by an Expertise Center: Part I-Medico-Social Aspects.

Child abuse is a dangerous situation for an infant. Professionals need to weigh the risk of failing to act when children are seriously harmed against the serious harm done by carrying out safeguarding interventions. In severe cases, foster care might be advisable. The negative effects for the child's psychosocial development requires that such placement must be based on very solid evidence. Our aim is to identify why Dutch parents whose child may have a medical condition that could mimic symptoms of child abuse have a significant chance of being erroneously convicted and losing custody of their child. As a method, we describe and analyze the following case. An Armenian-Dutch newborn (uncomplicated term vaginal delivery), starting at two weeks after birth, developed small bruises on varying body locations. At two months, a Well-Baby Clinic physician referred the girl to a university hospital, mentioning that there were no reasons to suspect child abuse and that her Armenian grandmother easily bruised as well. However, before consultation by a pediatrician of the hospital-located Expertise Center for Child Abuse, the parents were suspected of child abuse. Based on the expertise center's protocols, skeletal X-rays were made, which showed three healed, asymptomatic rib fractures, while invalid statistics suggested, incorrectly, a 10-100 times more likely non-accidental than accidental cause of the symptoms (discussed in Part II of this series). The expertise enter physician ignored any argument that could show parental innocence, including the positive parent-child relationship reported by the Well-Baby Clinic and the general practitioner. The girl and her older brother were placed in a family foster home and then in a secret home. The case radically resolved when a large bruise also developed there, and an independent tissue disease specialist diagnosed a hereditary connective tissue disorder in the mother, implying that the girl's bruises and rib fractures could well be disease-related. In conclusion, if child abuse is suspected, and foster care placement considered, the patient and the parents should be thoroughly investigated by an independent experienced pediatrician together with an experienced pediatric clinical psychologist or psychotherapist to produce an independent opinion. Children deserve this extra safeguard before being separated from their parents.

Effects of certain risk factors on presence and severity of carcass bruising in cattle: A study in Turkey.

The aim of the study was to examine the effects of some pre-slaughter factors on the total carcass bruise severity score and the presence of carcass bruises. Bruises on 1027 cattle carcasses were evaluated with the "The Australian Carcass Bruise Scoring System," and at least one bruise score was determined in 92.7% of the carcasses. The total carcass bruise severity score increased as the animal's age, transport time, and AWACT (the Welfare Impact Score of Stockperson Actions) score increased (P < 0.001). The probability of the presence of carcass bruising increased 2.751 times in the autumn (P = 0.031) and 2.200 times in the summer (P = 0.072) compared to the winter. Carcass bruises tended to be 1.747 times more common in females than males (P = 0.065), and 65.9% less in the Simmental than Brown Swiss breed (P = 0.060). Human contact (OR = 1.685; P = 0.079) and electric goad using (OR = 1.762; P = 0.069) on the slaughter corridor tended to increase the probability of the presence of carcass bruises. In conclusion, to reduce the presence and severity of carcass bruises, it may be beneficial to focus on the improvement of handling and coercion practices applied by the stock person, to slaughter the cattle in the nearest slaughterhouse, and to pay more care to the handling of culled cattle.

Child Abuse, Misdiagnosed by an Expertise Center-Part II-Misuse of Bayes' Theorem.

A newborn girl had, from two weeks on, small bruises on varying body locations, but not on her chest. Her Armenian grandmother easily bruised, too. Her mother was diagnosed with hypermobility-type Ehlers-Danlos-Syndrome (hEDS), an autosomal dominant connective tissue disorder, with a 50% inheritance probability. Referral to a University Medical Center located "Dutch Expertise Center for Child Abuse" resulted (prior to consultation) in physical abuse suspicion. Protocol-based skeletal X-rays showed three healed, asymptomatic rib fractures. A protocol-based Bayesian likelihood ratio guesstimation gave 10-100, erroneously used to suggest a 10-100 times likelier non-accidental-than-accidental cause. Foster care placement followed, even in a secret home, where she also bruised, suggesting hEDS inheritance. Correct non-accidental/accidental Bayes' probability of symptoms is (likelihood ratio) × (physical abuse incidence). From the literature, we derived an infant abuse incidence between about ≈0.0009 and ≈0.0026 and a likelihood ratio of <5 for bruises. For rib fractures, we used a zero likelihood ratio, arguing their cause was birth trauma from the extra delivery pressure on the chest, combined with fragile bones as the daughter of an hEDS-mother. We thus derived a negligible abuse/accidental probability between <5 × 0.0009 <0.005 and <5 × 0.0026 <0.013. The small abuse incidence implies that correctly using Bayes' theorem will also miss true infant physical abuse cases. Curiously, because likelihood ratios assess how more often symptoms develop if abuse did occur versus non-abuse, Bayes' theorem then implies a 100% infant abuse incidence (unwittingly) used by LECK. In conclusion, probabilities should never replace differential diagnostic procedures, the accepted medical method of care. Well-known from literature, supported by the present case, is that (child abuse pediatrics) physicians, child protection workers, and judges were unlikely to understand Bayesian statistics. Its use without statistics consultation should therefore not have occurred. Thus, Bayesian statistics, and certainly (misused) likelihood ratios, should never be applied in cases of physical child abuse suspicion. Finally, parental innocence follows from clarifying what could have caused the girl's bruises (inherited hEDS), and rib fractures (birth trauma from fragile bones).

Higher Sedentary Behaviors and Lower Levels of Specific Knowledge Are Risk Factors for Physical Activity-Related Injuries in Saudi Adolescents.

Encouraging physical activity (PA) for adolescents is necessary to achieve and maintain optimal health, but it may increase the risk of PA-related injuries. This study sought to assess the frequency, location, type, and severity of PA-related injuries in Saudi students aged 13 to 18 years and to identify associated risk factors. A total of 402 students, including 206 boys aged 15.87 ± 1.69 years and 196 girls aged 15.83 ± 1.70 years, were randomly assigned to participate in this study. For each participant, height, weight, body mass index, and fat percentage were measured. Responses to a specially designed four-part self-administered questionnaire were also collected. Results revealed that better specific knowledge was associated with a lower likelihood of sustaining injuries (ß = -0.136; p = 0.001) but increased sedentary behaviors were associated with a greater likelihood of sustaining a PA-related injury (ß = 0.358; p = 0.023). Gender, knowledge, and sedentary behaviors were the factors overall associated with a greater likelihood of suffering 1, 2, and 3 or more PA-related injuries. However, gender, fat-free mass, knowledge, and sedentary behaviors were associated overall with a greater likelihood of bruises, strains, fractures, sprains, concussions, and at least two types of PA-related injuries. Collectively, we should pay attention to the PA-related injury problem among middle and high school students, particularly when promoting a physically active lifestyle.

Delayed adverse reaction in donors after whole blood donation: Is it a matter of concern?

BACKGROUND: Blood donation has a remarkable safety record and most of the donors have a good experience or only mild symptoms after blood donation were noted. Although even a very low rate of reactions may have gloomy effect diminishing their fondness to donate again. The main aim of our study was to determine the incidence and to analyze how various donor demographic factors tend to be associated with delayed adverse donor reactions (ADR). MATERIAL AND METHODS: The prospective observational study was conducted in Department of Immuno-hematology and Blood Transfusion of tertiary care hospital. All the whole blood donors, who gave consent to participate in the study were contacted telephonically after 24 hours and day 7 after donation. The donor who couldn't be contacted telephonically, was tried again at an interval of four hours in a day for two consecutive days before declaring the participant to be non-responder. RESULTS: A total of 2495 (92.4%) blood donors experienced delayed ADRs. The commonest delayed ADRs reported were generalized weakness (24.6%), bruises (24.2%) followed by painful arm (14.5%). Females, first-time blood donors, donors with low BMI and donors engaged in manual labor were more vulnerable to develop any adverse reactions. CONCLUSION: Blood donors can experience delayed ADRs. It is important to prevent these reactions especially in susceptible donors. Proper awareness and training to the staff was provided to minimize the incidence of ADR.

Relationship between Bruises on Carcasses of Beef Cattle and Transport-Related Factors.

The assessment of bruises on carcasses at the slaughterhouse has been lately indicated as a valid method to evaluate cattle welfare. However, little is known about the prevalence and the causes of bruises of cattle slaughtered in Italy. The aim of this study was to collect information concerning the prevalence of bruises on the carcasses of beef cattle slaughtered in an Italian abattoir and to determine a relationship between fresh bruises and transport-related factors. In total, 1265 animals were included in this study, with 21.6% of them being positive for at least one bruise, either fresh or old. In most cases, the bruising was mild, with lesions exclusively located in one area of the carcass. Most of the bruised animals (63%) showed at least one red lesion. Occurrence of such red, fresh bruises varied significantly depending on the body parts (p < 0.0001), with the flank being the most affected area (39.5%), followed by the butt (36.0%) and the front (23.8%). The probability of fresh bruising varied significantly depending on the category of each animal (p < 0.0001), with steers showing fewer red bruises than both heifers and veal. Finally, animals transported in conditions of a high density had a lower probability of bruising (p = 0.0003). These findings support the use of a monitoring scheme based on the presence of bruises to assess cattle welfare at the abattoir level in order to provide feedback to farmers and to implement procedures carried out during transport.

Convolutional neural network for apple bruise detection based on hyperspectral.

The timely detection of apple bruises caused by collision and squeeze is of great significance to reduce the economic losses of the apple industry. This study proposed a spectral analysis model (SpectralCNN) based on a one-dimensional convolutional neural network to detect apple bruises. The influences of six spectral preprocessing methods on the SpectralCNN model were firstly analyzed in this paper. Compared with traditional chemometric models, the SpectralCNN model had a better accuracy, which was demonstrated not depend on the spectral preprocessing method by experiment results. Then, 20 characteristic wavelengths could be extracted by successive projection algorithm. The SpectralCNN model could achieve an accuracy of 95.79% on the test set of characteristic wavelengths, indicating that the extracted characteristic wavelengths contain most of the features of bruised and healthy pixels.

Social isolation impairs feed intake, growth and behavioural patterns of catfish under culture conditions.

Globally, the culture of fishes is important for food production. There is a growing interest in understanding and improving the welfare of cultured fish from both ethical and production perspectives. Social isolation is a common practice in catfish farming. This study assessed how social interactions affect the feeding behaviour, growth performance, and behavioural pattern of Clarias gariepinus under different social conditions. Juveniles of African catfish with a mean weight of 23.6 ± 1.09 g were stocked in 20L-aquaria (1.7 m × 1.2 m × 1.0 m) and fed twice daily in isolated (one fish/tank; N = 6 replicates) and non-isolated (six fish/tank; N = 6 replicates) conditions for a 36-day experimental period. Feed intake and growth response were monitored, while behavioural patterns were observed twice per week using focal sampling techniques for a total of 40 minutes per day. Wilcoxon two-sample tests and GLMs were used to analyse the data. Social context significantly (P < 0.001) affected the feed intake, feeding duration, and other observed behavioural patterns. However, the time of feeding (P > 0.001) did not affect the feed intake or the duration of feeding. Fish cultured in non-isolated conditions consumed more pellets (63 ± 2.36). The duration of feeding was longer in isolated conditions (431 s) while the latency to feed increased significantly (P < 0.001) from the first and fifth day of the experiment for the non-isolated and isolated, respectively. Behaviourally, isolated groups were inactive (Ws = 446.34, z = 5.397; P < 0.01) and displayed fewer aggressive acts (Ws = 0.95, z = 1.19; P < 0.01), while non-isolated groups were more active (Ws = 564.39, z = -5.397; P < 0.01) and displayed more escape attempts (Ws = 11.56, z =  -5.47; P < 0.01). Non-isolated groups had higher (Ws = 23.41, z = 1.06; P < 0.01) number of scars and bruises. Furthermore, non-isolated fish had a higher specific growth rate (2.36 ± 0.12), feed conversion ratio (1.27 ± 0.01) and a better condition factor (1.01 ± 0.08). Conclusively, these findings are relevant to African catfish welfare as social isolation changes the behavioural attributes, feeding pattern and growth rate of C. gariepinus. However, social context should be monitored since it resulted in more scars and bruises, which might affect the acceptability and welfare of this aquatic fish species.

Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review : Awareness and recognition of injury patterns.

PURPOSE: Elder abuse is a worldwide problem with serious consequences for individuals and society. The recognition of elder abuse is complex due to a lack of awareness and knowledge. In this systematic review, types, characteristics and anatomic location of physical signs in elder abuse were identified. METHODS: Databases of MEDLINE, COCHRANE, EMBASE and CINAHL were searched. The publication dates ranged from March 2005 to July 2020. In addition to the electronic searches, the reference lists and citing of included articles were hand-searched to identify additional relevant studies. The quality of descriptive and mixed-methods studies was assessed. RESULTS: The most commonly described physical signs in elder abuse were bruises. The characteristics of physical signs can be categorized into size, shape and distribution. Physical signs were anatomically predominantly located on the head, face/maxillofacial area (including eyes, ears and dental area), neck, upper extremities and torso (especially posterior). Physical signs related to sexual elder abuse were mostly located in the genital and perianal area and often accompanied by a significant amount of injury to non-genital parts of the body, especially the area of the head, arms and medial aspect of the thigh. CONCLUSIONS: Most common types, characteristics and anatomic location of physical signs in elder abuse were identified. To enhance (early) detection of physical signs in elder abuse, it is necessary to invest in (more) in-depth education and to include expertise from a forensic physician or forensic nurse in multidisciplinary team consultations.

Mongolian Spots - A challenging clinical sign.

Mongolian Spots (MS) are the most common birthmarks in newborn children. The condition presents as greenish-bluish to greyish macules, particularly in the lumbosacral area. The incidents of MS can vary in different ethnic groups and normally fade in early childhood. MS can be misinterpreted as hematomas because of the color and the predilection site. This paper discusses the case of a two-month old female admitted to hospital under suspicion of child abuse. The clinical forensic examination of the infant and her two older sisters found the children were in good health and did not show signs of abuse, despite the infant presenting with multiple and extensive greyish-blue macules. Thirteen months later, a welfare officer requested another forensic examination on the now 15-month-old child after noticing greyish-blue macules. Following a second examination, no evidence of abuse was found. This case illustrates the issue of MS as a differential diagnosis of hematomas.

Q-switch nanosecond laser as innovative and instant management for bruises discoloration, a case report.

Bruises is one of the most common side effects of injectable cosmetic procedures, which leads to stress to clients and health care providers. Conventional treatments such as vitamin K preparation, cold compresses, and Arnica cream have been used to treat bruises, yet these treatments do not provide instant results. The purpose of this report is to present a case in which different wavelengths of Q-switch nanosecond laser was used to treat cosmetic injection-related bruises.Four different laser wavelengths were used to treat injection-related bruises. Pictures were taken before and after the treatment and analyzed using the RGB color histogram and the Image color analyzer from http://mkweb.bcgsc.ca/. Pictures showed a close to complete resolution of the bruises and discoloration. The results of this report suggest that using multiple selective wavelengths, in shorter pulse width but higher fluence would be more effective in resolving bruise-related discoloration compared to using one wavelength with longer pulse width.

The frequently dismissed importance of properly sampling skin bruises.

The correct interpretation of skin lesions is a crucial issue in forensic medicine. Many macroscopic and microscopic vital reaction markers and molecules have been studied in the past years in order to estimate the timing of injuries. However, literature lacks information regarding how to perform sampling to obtain a more reliable and accurate response. The present study investigates 25 bruises and analyses the different histological asset in different areas (central or marginal) and the different layers (epidermis, dermis, hypodermis and muscle) of the wound. All wounds were sampled in several areas and analysed under a 200× magnification optical microscope, simply counting the degree of haemorrhaging (i.e hematic infiltration) visible in each optical field (0 = 0%-5%; 1 = 6%-25%; 2 = 26%-50%; 3 = 51%-75%; 4 = 76%-100%). All the injuries presented some kind of infiltration in at least one area, nonetheless only 56% of the wounds were infiltrated in the entirety of the areas. Finally, in 28% the dermal layer did not show any trace of infiltration. Therefore, considering such results it seems that depth or area of sampling of a bruise may largely influence the evaluation of vitality and hence of age of a wound. Though this may seem intuitive, no studies have examined this issue in depth.

Horse welfare at slaughter: A novel approach to analyse bruised carcasses based on severity, damage patterns and their association with pre-slaughter risk factors.

The study presents a novel veterinary forensic approach to analyse the bruising of horse carcasses, based on the nature of the bruises and how they are grouped in certain anatomical areas. Data on pre-slaughter logistics was obtained for 113 journeys with horses that travelled from Mexico and the USA to a Mexican abattoir. We found that carcass bruising was a highly prevalent problem (79% of carcasses had bruising) and was especially problematic in journeys lasting longer than 12 h, independently of the animal's country of origin, sex, age, lairage time or vehicle type. Multivariable logistic regression showed that the most severe bruises were not dispersed randomly on the carcass and that their distribution was associated with the presence of medium-sized bruises on the abdominal wall, front and rear limb. Cluster analysis suggested four damage patterns based on bruise location: severe and concentrated bruising, as well as non-severe bruises on the rear limb, thoracic-wall or more dispersed throughout the carcass.

Letter to the Editor on "Prediction of Knee Kinematics at Time of Noncontact Anterior Cruciate Ligament Injuries Based on Bone Bruises".

The aim of the present Letter was to comment on the paper "Prediction of Knee Kinematics at Time of Noncontact Anterior Cruciate Ligament Injuries Based on Bone Bruises" from Shi et al. (Ann Biomed Eng, 2020, https://doi.org/10.1007/s10439-020-02523-y ). Though the authors provided an extremely interesting paper on a debated topic in Sport Medicine, with a strong methodology and consistent results, caution should be used when drawing conclusions on Anterior Cruciate Ligament injury mechanism through the interpretation of such data.

From unloading to trimming: studying bruising in individual slaughter cattle.

Livestock bruising is both an animal welfare concern and a detriment to the economic value of carcasses. Understanding the causes of bruising is challenging due to the numerous factors that have been shown to be related to bruise prevalence. While most cattle bruising studies collect and analyze data on truckload lots of cattle, this study followed a large number (n = 585) of individual animals from unloading through postmortem processing at five different slaughter plants. Both visual bruise presence and location was recorded postmortem prior to carcass trimming. By linking postmortem data to animal sex, breed, trailer compartment, and traumatic events at unloading, a rich analysis of a number of factors related to bruise prevalence was developed. Results showed varying levels of agreement with other published bruising studies, underscoring the complexity of assessing the factors that affect bruising. Bruising prevalence varied across different sex class types (P < 0.001); 36.5% of steers [95% confidence interval (CI): 31.7, 41.6; n = 378], 52.8% of cows (45.6, 60.0; 193), and 64.3% of bulls (no CI calculated due to sample size; 14) were bruised. There was a difference in bruise prevalence by trailer compartment (P = 0.035) in potbelly trailers, indicating that cattle transported in the top deck were less likely to be bruised (95% CI: 26.6, 40.4; n = 63) compared to cattle that were transported in the bottom deck (95% CI: 39.6, 54.2; n = 89). Results indicated that visual assessment of bruising underestimated carcass bruise trimming. While 42.6% of the carcasses were visibly bruised, 57.9% of carcasses were trimmed due to bruising, suggesting that visual assessment is not able to capture all of the carcass loss associated with bruising. Furthermore, bruises that appeared small visually were often indicators of larger, subsurface bruising, creating an "iceberg effect" of trim loss due to bruising.