To reconstruct the etiology of a perimortem injury observed on a Neolithic - Chalcolithic cranium (5060 - 4400 yrs cal. BP).
A cranium of an old adult male individual belonging to a collective burial from Cova Foradada site (Calafell, Tarragona, Spain).
The cranium was analyzed macroscopically and microscopically using micro-CT scan.
The fracture on the right parietal bone presents characteristics of perimortem trauma. The morphology of the point of impact allows for the interpretation of this fracture as a result of impact by an object with a straight and sharp edge. In addition, the same cranium presents two healed antemortem injuries.
The object that most likely caused the cranial fracture was a stone adze. The blow occurred from behind the individual, possibly by a right-handed attacker.
The potential to link cranial fractures with specific tools increases our understanding of interpersonal violence during the Neolithic.
It is not possible to infer if this cranial injury was related to a large-scale intergroup confrontation or an intragroup violent event.
To investigate additional similar sites in the northeastern Iberian Peninsula to better characterize the fracture pattern caused by stone axes and adzes as well as other objects used as weapons during the Neolithic - Chalcolithic ages.

This case study describes a perimortem hip fracture in a documented individual from the Robert J. Terry Skeletal Collection. The purpose of this paper is to comprehend how co-occurring conditions contributed to fracture risk and to understand the effect of the injury on this individual.
A 73-year-old female from the Terry Collection with a fracture of the left proximal femur was assessed macroscopically, and images were taken with a Keyence VHX-2000 digital microscope. Documentation concerning the individual\'s history and contemporary treatment of hip fractures was explored.
Assessment demonstrated impaction of fractured elements occurred as a result of the inferior displacement of the femoral head into the femoral neck. Eburnation and hinge fractures are present on the fracture margins. Bending deformities of the sacrum, sternum, and ribs indicate underlying osteomalacia. No evidence of surgical intervention was observed.
Both osteomalacia and osteoporosis contributed to overall fracture risk in this case, which demonstrates how complex underlying factors can interact to increase the probability of fracture, and influence post-fracture mortality.
This report is the first case study, to date, of a healing hip fracture in which the circumstances of the fracture and the medical history of the individual are known.
To fully investigate osteoporosis, bone mineral density for this individual should be compared with others in the collection.
The effect of co-occurring conditions on fracture risk should be explored in the wider Terry Collection, and in other skeletal collections.

Differentiating traumatic injuries in bone from taphonomic damage in the postmortem period is a complex process requiring a systematic approach. Trauma by definition occurs while the individual is still living, but bone characteristics usually do not allow delineation of the moment of death. Thus, the anthropologist seeks characteristics that will associate a skeletal defect with the perimortem period, at or about the time of death. However, the anthropological designation of perimortem time period does not have precise boundaries. It refers to remains that lack any sign of remodeling or healing on the one hand, and which have not lost biomechanical elasticity and plasticity on the other hand, i.e., it refers to the condition of skeletal remains when they sustained the suspected injury. Fracture patterns that reflect biomechanical plasticity are lost gradually as the time since death increases, and this pace will depend on the environmental context. There are additional clues to identify postmortem status, including when the damaged feature fits a taphonomic pattern of scavenger modification or weathering, or physically overlies obvious postmortem modifications, or when the feature fits a known pattern of sharp force instruments or weapons. Damage due to recovery or the examination process must be ruled out. The timing of occurrence of a suspected perimortem injury can therefore extend for days or weeks into the time before the actual death, and it can extend for days to months after death. The anthropologist responds to the challenge of differentiating trauma and taphonomic modification by knowing the characteristics of healing bone, the features of biomechanical plasticity reflected in fracture morphology, the taphonomic patterns of scavenging and weathering, the environmental context of discovery and recovery, and the characteristics of the relevant regional taphonomy.

Postmortem changes can both mask and mimic trauma, impairing interpretation of the injuries. Bones, while capable of surviving the postmortem period relatively intact, are not immune from these effects. Without attached soft tissue to aid an examiner, it can be difficult to determine the time frame of a fracture\'s occurrence (i.e., before death, at death, or after death). Bones are composed of both organic and inorganic material, each of which contribute to the biomechanical properties of the bones. With the loss of organic material, the biomechanical response of bones to trauma changes; however, the organic material can remain a part of the bone for an extended period after death. Bone with intact organic material is wet bone, and bone without the organic material is dry bone, and because of this difference, fractures of wet bone can appear different than fractures of dry bone. Important in distinguishing the two are differential coloration, various features of the fracture itself (e.g., angle, surface, outline), surrounding flaking of the cortex, and incomplete separation of bone fragments from the fracture. However, the changes are not absolute, and determination of the two types of fractures can be problematic. Although the terms antemortem, perimortem, and postmortem have been used to describe the general time frame of fractures in relation to the time of death of the individual, because of confusion among specialties regarding the definition of \"perimortem,\" its use may best be discontinued in favor of a descriptive approach when fractures are identified in skeletal remains.

Burnt human remains present a difficult interpretative dilemma to forensic pathologists and anthropologists. Distinguishing postmortem damage in long bones as a result of fire damage from perimortem fractures is an important challenge in trauma analysis. During our case investigation of a burnt body from a fiery car crash, distinct perimortem traits on long bone fractures were still distinguishable along the charred areas. Next to timing of fractures and shortening the perimortem time gap suggesting that the fractures occurred when soft tissue was still present, the traits make it possible to distinguish blunt trauma caused by the accident from heat-induced bone damage. Applying this specific perimortem pattern could be an additional macroscopic tool to interpret blunt force trauma more accurately in the analysis of burnt remains.

Long-term hospitalized patients have a higher risk of adverse outcomes and mortality rate. These patients often rapidly deteriorate, leading to death. We aim to evaluate end-of-life laboratory values time trends among deceased long-term inpatients.
Time-stamped laboratory data for adult inpatients who had died in the hospital were extracted. The data were normalized and time-series analysis was performed. The patients were also clustered based on the laboratory result trends.
Laboratory results from 257 patients were evaluated. Significant time trends were observed: serum urea nitrogen, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and potassium increased while platelets and albumin decreased. Most patients showed significant shifts in at least four major laboratory indices within the last week of life.
In the last week of life in chronically hospitalized patients, an alteration of the physiologic state of the patient occurs that manifests as subtle changes in metabolite levels compared with the patient\'s baseline.

Literature on timing of rib trauma is scarce but remains challenging during forensic cases. This study analysed the macroscopic fracture patterns of perimortem rib fractures and compared them to experimentally reproduced rib fractures on fresh and dry ribs. Six distinctive macroscopic traits were found in ribs that might provide information about the timing of trauma, fracture mechanism and/or trauma circumstances. These traits are peels, folds, differential fracture edges, incomplete fractures, plastic deformation and longitudinal lines. Peels, folds and plastic deformation might provide information about trauma timing. Folds and different fracture edges might provide information about the fracture mechanism. Statistical analyses showed that longitudinal lines, folds and incomplete fractures might provide information about the trauma circumstances and that age might have an influence on the occurrence of complete fractures, longitudinal lines and peels (p ≤ 0.05). The new insights presented in this study might be valuable for forensic anthropologists in rib trauma analysis.

Peri-mortem limb amputations are rarely reported in the paleopathological literature. The cases reported here concern severing of both hands and feet observed in three adult male skeletons, exhumed from the medieval Portuguese necropolis of Rossio do Marquês de Pombal, Estremoz, Portugal. The fact that they were found in the same site, in graves placed side by side, that all are young males, and that the three skeletons show similar perimortem injuries, make this a unique case meriting detailed analysis. Considering the lesions\' location and pattern, as well as historical data, we hypothesize that this is a case of amputation as a consequence of judicial punishment. Estremoz was an important city in sustaining the Royal power at a regional scale during the medieval period.

During the investigation of fresh bone fractures, it might be difficult to visualize all the fracture lines that could contribute to the interpretation of the biomechanics behind a fracture. To optimize the examination of the fracture, the bones should first be defleshed to expose the osseous surface. To reveal small fracture lines more clearly, we developed two easy, fast, cheap and non-destructive methods to enhance fracture lines and bone defects by coloring the fracture lines with ink. One method consists of cooking the bone in ink, and the second method uses capillary action for ink penetration. We strongly recommend the use of the latter method with Talens® Black Indian Ink for the clearest results.

Differentiating between medical procedures performed antemortem, perimortem or postmortem in skeletal remains can be a major challenge. This work aims to present evidence of procedures to treat rhinosinusitis (RS) and mastoiditis, suggest criteria for the diagnosis of frontal sinus disease, and frame the individuals described in their medical historical context. In the International Exchange collection, the skull (878) of a 24-year-old male, who died in 1933 due to frontal sinusitis and meningitis, presents evidence of a trepanation above the right frontonasal suture, and micro/macroporosity on the superciliary arches. The available Coimbra University Hospitals archives (1913-1939) reported that 46 females and 59 males (aged 15 months-84 y.o., x̄=35.33) underwent surgery to treat RS, primarily by trepanation (94.3%). In a search for similar evidence in the collection, the skull of a 42-year-old female (85), who died in 1927 due to sarcoma in the abdomen, shows four quadrangular holes located above the right supraorbital notch, right and left maxilla, and left mastoid process. The number/location of the holes and cut marks point to postmortem medical training (possible dissection). This paper discusses the value of information from historical contexts to differentiate between surgery and medical training in the paleopathological record.