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The medical response to terrorist attacks does not just involve saving lives, but it also serves as a message to our people: we shall never surrender to terrorism. In this Viewpoint, we present a synopsis of the measures taken in France to improve our medical capacity to face the unexpected (table).8

In an effort to characterize the people who composed the groups known as the Xiongnu, nuclear and whole mitochondrial DNA data were generated from the skeletal remains of 52 individuals excavated from the Tamir Ulaan Khoshuu (TUK) cemetery in Central Mongolia. This burial site, attributed to the Xiongnu period, was used from the first century BC to the first century AD. Kinship analyses were conducted using autosomal and Y-chromosomal DNA markers along with complete sequences of the mitochondrial genome. These analyses suggested close kin relationships between many individuals. Nineteen such individuals composed a large family spanning five generations. Within this family, we determined that a woman was of especially high status; this is a novel insight into the structure and hierarchy of societies from the Xiongnu period. Moreover, our findings confirmed that the Xiongnu had a strongly admixed mitochondrial and Y-chromosome gene pools and revealed a significant western component in the Xiongnu group studied. Using a fine-scale approach (haplotype instead of haplogroup-level information), we propose Scytho-Siberians as ancestors of the Xiongnu and Huns as their descendants.

The post-mortem interval (PMI) is the time elapsed between the death of an individual and its forensic examination. It is a crucial information for judicial authorities, but current techniques still cannot establish a precise time interval. Novel approaches are therefore required. Recently, gingival tissue has emerged as interesting for forensic analysis thanks to the protection offered by lips to this tissue, limiting the influence of environmental factors. It is also easily accessible, and its sampling is minimally invasive even in the presence of rigor mortis . Moreover, the expression of HIF-1α, a master mediator of the hypoxic environment, has been described in gingival samples at different post-mortem (PM) times. We have hypothesized that the time-dependent post-mortem expression of HIF-1α could serve as a biomarker to more accurately predict the PMI. Our analyses were performed in an animal model, the mouse, where environment can be precisely controlled. Therewith, gingival tissue morphology was evaluated through histochemical staining and HIF-1α expression was analyzed by qPCR, western blots and immunofluorescence at different post-mortem times (0h to 100h). Our results showed (a) a global post-mortem stability of gingival tissue (b) a rapid increase in HIF-1α mRNA expression in the short post-mortem times followed by a slow decrease in transcript expression until 100h PM (c) an expression of the HIF- 1α protein and its degradation products, that follows the mRNA pattern (d) the presence of HIF-1α protein in the epithelial and connective layers of the tissue, with signal accumulation in both gingival strata until at least 32h post-mortem. This pilot study thus validated the mouse and the gingival tissue as models for post-mortem analyses, as well as for studying the fate of proteins such as HIF-1α. Transferring these approaches to human subjects may provide a more accurate estimate of PMI.

The challenges and methodologies associated with reporting missing persons and identifying unidentified bodies, including migrants and domestic deaths, widely vary worldwide. This comparative study delves into the medico-legal practices and legislative frameworks in Italy and France, specifically focusing on the cities of Milan and Paris and highlights the disparities and similarities in the processes and legislative environments of both countries. The ultimate aim is to propose improvements to existing methods and advocate for a more unified approach within Europe, recognizing the shared challenges and the need for concerted efforts in upholding the dignity of the deceased and providing closure for affected families. This study uses Milan and Paris as case examples to highlight the need for improved interconnectivity and procedural alignment in forensic identification across national and European jurisdictions, potentially anchored in internationally recognized frameworks, such as INTERPOL’s Disaster Victim Identification protocol. This work indeed reveals that, while national and regional systems are in place for managing these cases, there are significant limitations in terms of interconnectivity, resource allocation, and management of data. The effectiveness of these systems, considering the high number of cases in large cities and the different scientific, administrative and legal variables involved is then discussed. The paper also provides a detailed analysis of the medico-legal procedures and the involvement of multiple professional disciplines in the identification process, emphasizing the multi-faceted nature of this work. The importance of collaborative strategies and shared practices at a supranational level to address the complex challenges in identifying missing persons and unknown bodies is underlined. The findings from Milan and Paris serve as a microcosm to understand broader patterns, offering insights that could inform global practices.

The Neolithic is a key period in the history of the European settlement. Although archaeological and present-day genetic data suggest several hypotheses regarding the human migration patterns at this period, validation of these hypotheses with the use of ancient genetic data has been limited. In this context, we studied DNA extracted from 53 individuals buried in a necropolis used by a French local community 5,000 y ago. The relatively good DNA preservation of the samples allowed us to obtain autosomal, Y-chromosomal, and/or mtDNA data for 29 of the 53 samples studied. From these datasets, we established close parental relationships within the necropolis and determined maternal and paternal lineages as well as the absence of an allele associated with lactase persistence, probably carried by Neolithic cultures of central Europe. Our study provides an integrative view of the genetic past in southern France at the end of the Neolithic period. Furthermore, the Y-haplotype lineages characterized and the study of their current repartition in European populations confirm a greater influence of the Mediterranean than the Central European route in the peopling of southern Europe during the Neolithic transition.

Variola Virus in a 300-Year-Old Mummy This letter describes a distant lineage of the variola virus (the agent of smallpox) that was identified in a mummy found buried in the Siberian permafrost. To the Editor: Smallpox, which is caused by the variola virus of the Poxviridae family and the orthopoxvirus genus, is among the most devastating human diseases. It may have originated and spread from Egypt, the Near East, or the Indus Valley 3000 to 4000 years ago, and historical reports indicate epidemics in China as early as the first century A.D. and in Europe during the 6th century. By the mid-18th century, smallpox was a worldwide endemic disease. It was eradicated after vaccination campaigns began more than 200 years ago. 1 Variola DNA is about 186 kbp, with genes distributed across conserved . . .

Purpose The majority of terrorist acts are carried out by explosion or shooting. The objective of this study was first, to describe the management implemented to treat a large number of casualties and their flow together with the injuries observed, and second, to compare these resources according to the mechanism of trauma. Methods This retrospective cohort study collected medical data from all casualties of the attacks on November 13th 2015 in Paris, France, with physical injuries, who arrived alive at any hospital within the first 24 h after the events. Casualties were divided into two groups: explosion injuries and gunshot wounds. Results 337 casualties were admitted to hospital, 286 (85%) from gunshot wounds and 51 (15%) from explosions. Gunshot casualties had more severe injuries and required more in-hospital resources than explosion casualties. Emergency surgery was required in 181 (54%) casualties and was more frequent for gunshot wounds than explosion injuries (57% vs. 35%, p  < 0·01). The types of main surgery needed and their delay following hospital admission were as follows: orthopedic [ n  = 107 (57%); median 744 min]; general [ n  = 27 (15%); 90 min]; vascular [ n  = 19 (10%); median 53 min]; thoracic [ n  = 19 (10%); 646 min]; and neurosurgery [n = 4 (2%); 198 min]. Conclusion The resources required to deal with a terrorist attack vary according to the mechanism of trauma. Our study provides a template to estimate the proportion of various types of surgical resources needed overall, as well as their time frame in a terrorist multisite and multitype attack. Funding Assistance Publique–Hôpitaux de Paris.

Age estimation is a key factor for identification procedure in forensic context. Based on anthropological findings, degenerative changes of the sternal extremity of the 4th rib are currently used for age estimation. These have been adapted to post-mortem computed tomography (PMCT). The aim of this study was to validate a post-mortem computed tomography method based on a revision of the Iscan’s method on a French sample. A total of 250 PMCT (aged from 18–98 years (IQR 36–68 years, median 51 years); 68 (27%) females) from the Medicolegal Institute of Paris (MLIP) were analyzed by two radiologists. The sternal extremity of 4th right rib was scored using method adapted from Iscan et al. Weighted κ was used to evaluate intra- and inter-observer reliability and Spearman correlation was performed to evaluate relationship between age and score. Confidence intervals for individual prediction of age based on 4th rib score and sex were computed with bootstrapping. The intra-observer reliability and inter-observer reliability were almost perfect (weighted κ = 0.85 [95%CI: 0.78–0.93] and 0.82 [95%CI 0.70–0.96] respectively). We confirmed a high correlation between the 4th rib score and subject age (rho = 0.72, p < 0.001), although the confidence intervals for individual age prediction were large, spanning over several decades. This study confirms the high reliability of Iscan method applied to PMCT for age estimation, although future multimodal age prediction techniques may help reducing the span of confidence intervals for individual age estimation.Trial registration: INDS 0,509,211,020, October 2020, retrospectively registered.