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Background. Polycystic kidney disease is a cystic genetic disease. There are two forms: an autosomal dominant one, more common and typical of adults, and an autosomal recessive one, rarer and present in childhood. The autosomal dominant form is caused by genetic mutations of the PKD1 gene in 85% of cases and of PKD2 in 10-15% of cases. Case Report. We reported a case of 56-year-old woman with ADPKD, who had a kidney transplant and who was hospitalized for respiratory failure from Covid 19 disease. She was intubated, sedated and dialyzed, treated with antibiotics, immunosuppressants, diuretics and heparin. CT scan of the abdomen showed multiple cysts of various sizes in the liver and multiple cysts in the kidneys. The patient died after 20 days because she was unresponsive to therapy. The autopsy showed milky ascitic fluid in the abdomen, massive gastric haemorrhage, intestinal fungal plaques, hepatic and renal polycystosis. The kidneys measured a total of 27 cm with a total weight of about 9 kg. The liver parenchyma appeared cavernous with multiple cysts. The kidney cysts contained bloody liquid. Conclusions. The case demonstrates how important it is in these subjects to evaluate not only the kidneys but also the liver which could present polycystosis and cause liver failure, affecting the severity of the pathology and death. This data is important to emphasize in the clinical management of these patients a close monitoring of liver function also from a preventative perspective in life. [ABSTRACT FROM AUTHOR]

Background. Fetal death has various causes, among the most common are problems relating to the placenta, such as placental abruption or placental malformations such as placenta accreta. From the literature, it emerges that placental analysis at autopsy can allow for greater resolution of cases compared to clinical history and external examination of the fetus alone. Case Report. We report the case of a woman at the eleventh week of pregnancy who died in hospital. The medical history revealed two further previous pregnancies, both with births by cesarean section. The autopsy identified the cause of maternal death as acute cardiorespiratory arrest secondary to hemorrhagic shock from spontaneous uterine rupture. Hemorrhagic infiltrate was found in the intervillous placental spaces with rupture of the uterus due to placenta previa and accreta. Discussion. Placenta accreta is a condition in which a pathological adherence and/or invasion of the myometrium by the placenta is observed. This condition poses a problem during recovery with potential for severe bleeding. Therefore, we emphasize the macroscopic and histological analysis of the placenta, uterus and the ovaries in all cases of maternal-fetal death, suggesting however that the organs be analyzed both by gross analysis and after permanence in formaldehyde. Furthermore, in these cases, it is important to evaluate the clinical history and data, especially ultrasound scans performed in life, or insertion anomalies during instrumental investigations. For this reason, we recommend to collaborate with a multidisciplinary team in these cases, including the gynecologist and the forensic pathologist. [ABSTRACT FROM AUTHOR]

Background. Sudden infant death syndrome (SIDS) is a tragic and devastating condition whose causes remain largely unknown. Recent studies have shown that the composition of a child's gut flora can play a significant role in the development of SIDS. Methods. This work aims to research those factors that influence the composition of the intestinal flora, the role they have in the development of SIDS and the new strategies for preventing SIDS showing a new interpretation through a detailed review of the literature. The gut in physiological conditions is mainly composed of Bacteroidetes, Firmicutes, Actinobacteria, and Proteobacteria, but when there is the presence of dysbiotic or different microbial communities, the onset of the disease is more likely as an altered microbial community can lead to an interruption of the gut-brain axis and an increased risk of SIDS. Conclusions. All this implies that the composition of the microbiome can be modified to reduce the risk of sudden death in newborns. The results of the literature provide valuable information on the potential role of the intestinal microbiome in SIDS even if not all mechanisms are yet clear, especially in the mechanisms of death. Therefore, it is necessary in cases of SIDS when carrying out an autopsy to also investigate this area; to this end, we suggest a questionnaire to be administered to family members to understand the eating habits of the newborn and the family and integrate with microbiological investigations to explore every possible hypothesis. [ABSTRACT FROM AUTHOR]

Background. In the evolving field of forensic medicine, artificial intelligence (AI) technologies may revolutionize traditional autopsy practices by enhancing the precision and efficiency of postmortem examinations. Methods. A review of the literature was carried out on the Pub-med and Scopus search engines by inserting the keywords "artificial intelligence" AND "forensic" AND ("autopsy" OR "crime scene management" OR "forensic odontology" OR "post mortem interval" OR "forensic anthropology" OR "forensic sciences"). The works that analyzed the applications of artificial intelligence in the forensic and autopsy field were analyzed. Conclusion. The results showed the application of different forms of artificial intelligence such as machine learning, deep learning, robotics, artificial neural networks. Various applications are therefore possible in the autopsy field including forensic identification, analysis of radiological data through Virtopsy, estimation of the weapon used through analysis of firearm damage with ballistics, estimation of the Post-Mortem Interval (PMI), forensic toxicology. Al's potential to aid in the precise identification of causes of death, estimation of postmortem intervals. With forensic pathologists facing the constant challenge of making accurate diagnoses under pressure, AI applications can offer much-needed support by reducing subjective judgment and the inherent human error due to fatigue. Therefore, the integration of AI into autopsies, while promising in terms of efficiency and accuracy, demands a careful balance between technological advancement and ethical responsibility to ensure trust and integrity in forensic practices. [ABSTRACT FROM AUTHOR]

Background. Crime scenes are possible scenario of accidents for operators, despite those risks the are no operative protocols in literature. However, COVID-19 pandemic has affected in a positive manner the management of infectious risk, encouraging use of Personal protective equipment (PPE). The aim of the study is to deepen and examine the occupational risk of all health professionals involved in the analysis of the crime scene and biological material collection to develop an operational protocol that explains in detail all the strategies applicable to reduce it. Materials and Methods. We conducted a review of the Literature researching among the main databases, such as: PUBMED, EMBASE, COCHRANE introducing as keywords: crime scene, medico-legal investigations, occupational risk, infections. Subsequently, we developed an operational protocol that is currently applied during the activity of the Institute of Forensic Medicine "Magna Graecia" of Catanzaro. Conclusion. The crime scene can show numerous dangers for operators, due to the presence of syringes, contaminated biological material or sharps or access to areas with poor hygienic and sanitary conditions. This paper shows various strategies that may be implemented to reduce the risk. The aim of this work is to focus on the occupational risk for operators by proposing an operative protocol showing in detail how to manage a crime scene by reducing the infectious risk for operators until the transfer of the body and the collected evidence to the morgue and to the laboratory. [ABSTRACT FROM AUTHOR]

Background. The subject of this article is the role of forensic toxicology in post-mortem examinations using immunofluorescence methods, its implications and its role in providing conclusive evidence for both criminal and civil proceedings. The aim of the study is to verify the correlation between the mode of death and the ingestion of exogenous substances and, if positive, to identify the category of substances ingested and assess their role in the cause of death. Materials and methods. A laboratory study was carried out, consisting of several phases: pre-analytical phase; analytical phase; post-analytical phase. The variables analyzed were sex, cause of death, age. Abused substances tested: amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine, methadone, opiates, tricyclic antidepressants, delta-9-tetrahydrocannabinol (cannabis), alcohol. Conclusions. Retrospective analysis was performed on a total sample of 55 cases. The most relevant data emerged: cocaine with an incidence of 7.3% (4 cases out of 55), amphetamines with 5.4% (3 cases in total). The results of the screening tests were then subjected to confirmatory tests. There is an association between the use of certain exogenous substances and an increased risk of certain causes of death, such as overdose, traffic accidents, cardiovascular deaths, etc. This paper has highlighted the possibility of using first level immunological tests, such as immunofluorescence, to provide preliminary answers to the judicial authority immediately after autopsy, and a quantitative deepening with further second level tests, such as gas chromatography, as a gold standard to determine the cause of death. [ABSTRACT FROM AUTHOR]

Background. Healthcare-associated infections (HAIs) represent the most frequent adverse event in healthcare systems around the world. From a forensic point of view, HAIs show various legal implications. Therefore, it is essential in cases of death or injury from a suspected nosocomial infection that the infection itself, the source and the method of contamination are correctly diagnosed in order to evaluate any profiles of professional liability. Methods. This study combined a minireview of the scientific literature using the Pubmed search engine, the website of the Higher Institute of Health and the member states information sessions on infection prevention and control (IPC) Discussion. Despite the significant impact that HAIs have on healthcare systems, their severity is often not fully understood by healthcare professionals, leading to insufficient responses. In the autopsy setting, the diagnosis of these infections is not always simple due to the risk of post-mortem contamination determined by the endogenous bacterial flora. In the forensic field, the medical examiner during the autopsy can use various diagnostic techniques and investigative tools to identify the infection. Some usefulpp approaches include: 1) Macroscopic examination of the organs; 2) Histopathological investigations; 3) Microbiological analyzes with the performance of swabs; 4) Immunofluorescence tests for the detection of antigens or antibodies on biological liquids; 5) Molecular tests. The choice of methods will depend on the nature of the suspected infection and the availability of diagnostic resources. [ABSTRACT FROM AUTHOR]

Background. Climate change causes great impact on ambient temperatures. In forensic pathology, temperature has always been an important variable to determine numerous thanatodiagnostic and thanatochronological parameters, as crucial elements to make scientifically valid forensic conclusions. The aim of this work is to describe the impact that climate change is having on the forensic science and crime scene analysis. Materials and methods. A literature review was carried out on the search engines Pubmed, Scopus and Google Scholar. The keywords "climate change" AND "forensic" were used. Conclusion. Climate change is having a significant impact on forensic science in several areas. Among these it is necessary to consider: 1) global warming and crime scenes: high temperature of the planet causes frequent extreme meteorological events in multiple periods of the year; 2) Relationship between climate and PMI (Post Mortem Interval): Temperature influences the rapidity of putrefaction; 3) Relationship between climate and fauna: global warming is influencing the geographical distribution of animal species, with real migrations of species. Fauna has a decisive impact in the forensic field (as in the case of entomology) creating new models of animal-cadaver interaction; 4) Relationship between climate and forensic botany: Climate change influences the flowering and fruiting times of plants, impacting knowledge on botany used in the forensic field. It is essential to adopt prevention measures to address the emerging challenges. [ABSTRACT FROM AUTHOR]

Background. The analysis, interpretation and storage of information is entrusted to the individual expert, who bases his judgments on the knowledge resulting from the experience. The aim of this experimental study is to analyse and introduce a new line of research applicable to forensic pathology, based on the use of artificial intelligence techniques as a possible tool for data collection and analysis. Methods. The sample analysed is represented by judicial autopsies performed at the University of Catanzaro from 01/01/2020 to 31/12/2021. For each case were performed: study of medical records; autopsy; histological examinations; toxicological analysis of blood samples. Continuous variables were presented as means ± standard deviations, and categorical variables were expressed as percentages. A random forest regression model was conducted, as a machine learning approach, to estimate the importance of individual solid organ weight variables in predicting cause of death. Conclusions. This study aimed to evaluate autopsy data to aid in the description and study of forensic cases, using a machine learning approach. To date, this study appears to be the first to evaluate the weight of organs in predicting a cause of death. Artificial intelligence techniques are an optimal solution in solving forensic dilemmas. The results of this study demonstrate that routine data can be submitted using machine learning techniques in order to identify key elements of procedures that provide more information in relation to the prediction of cause of death. [ABSTRACT FROM AUTHOR]

Background. Gender-based violence against women and its lethal outcome, femicide, represent important issues around the world. Although governments have passed specific laws, official data on gender-related violence and femicide are often absent and/or incomplete, difficult to access, rarely updated, contested and underestimated due to stigma, victim blaming or issues of legal interpretation. Femicide is an intentional killing in which a woman is murdered by an individual for misogyny and gender-related reasons. The most common type is in fact intimate femicide, which occurs when the murdered woman and the aggressor have an intimate, family, cohabitation or similar relationship. Case series. We analyzed 15 cases of femicide for which crime scene investigation and autopsy were carried out. For each case, a psychological autopsy was carried out and the means used to determine the individual's death were analysed. The circumstances in which the murder occurred were also examined. Discussion. Overkilling was evidenced in all cases analyzed. Overkilling in forensic medicine is known as a specific type of homicide in which the number of injuries inflicted far exceeds the number of injuries required to kill the victim. Therefore, the medico-legal management of the cases examined is complicated due to the multiple lesions present on the corpse on the victims which make difficult: 1) the reconstruction of the dynamics of the crime 2) the number of blows inflicted 3) the analysis of the fatal blow 4) the imputability of the offender. [ABSTRACT FROM AUTHOR]

Background. Workplace safety is a global public health issue. Reconstructing an accident can prove extremely complicated, especially when the event occurs without direct witnesses or when the scene is altered. In these cases, it is essential to adopt proper investigation protocols in order to ensure the correct reconstruction of the dynamics. Case report. A man was found unconscious on the ground, having fallen from a height of approximately 2 meters, where there was a cabin in which a conveyor belt of raw materials for the production of cement ran. At the end of the path of this belt a scraper was found. An autopsy was carried out and the scraper present at the scene was examined and compared with the injuries on the victim. After the autopsy, the investigators returned to the scene and collected the traces found in the cabin. At the end of collecting the traces, the investigators simulated the dynamics of the event by turning on the conveyor belt and placing a scraper of the same dimensions and characteristics as the one found at the scene inside the cabin. Conclusion. The autopsy showed a maxillofacial trauma with multiple bruises on the face and a serious fracture of the epistropheus tooth. This trauma was therefore incompatible with a simple fall from 2 meters. The investigators created an experimental model that demonstrated a very high energy rebound of the tape when placed in contact with the scraper. This reconstruction made it possible to carry out a single report with the data collected by the medical examiner and the investigators, which was effective and exhaustive, allowing the Authority to be provided with the evidence to continue the investigations about the responsibilities of the worker and the employer. [ABSTRACT FROM AUTHOR]

Background. The blunt injuries may be heterogeneous. Due to the diversity, it is often difficult to establish the type of weapon used. Particular attention must be paid to the circumstantial data and previous diseases because the injuries often could not correspond to the presumed instruments used. Case Report. A man was found dead in his bedroom wearing pajamas. On the bed there was a blanket with visible traces of blood, which had dried. There were around 10 dogs in the house, poor hygienic and sanitary conditions, widespread excrements and unbreathable air. Testimonies from general practitioner, neighbors and the partner were collected. An autopsy, histological and toxicological examination was performed. On external examination the face showed blood smearing down the nose, subconjunctival hemorrhages, and labial cyanosis. Moreover, a hypochromic skin area was present on the right lateral region of the neck. The inguinal region showed large de-epithelized areas with multiple purplish red ecchymoses which were histologically analyzed. These areas showed hemorrhagic infiltration in the superficial and deep dermis up to the adipose tissue due to traumatic action. Conclusion. The reconstruction of the case allowed us to state a strangulation probably attributable to a belt. The discovery of intradermal hemorrhagic infiltrations, supported by histopathological investigations, confirmed the diagnosis of blunt force injuries, excluding other type of non-violent causes of lesions. Therefore, we recommended the use of experimental methods and procedures to evaluate the harmful suitability on biological matrices. [ABSTRACT FROM AUTHOR]

We report on the progress toward a dual-species cadmium and strontium atom interferometer for fundamental physics tests. We have developed and characterized a complete baseline laser system for cadmium, which provides the high power and narrow linewidth necessary for laser cooling and trapping and for performing atom interferometry, with upgraded systems for strontium also implemented. An overview of a design for cooling cadmium is presented, and we outline the basic design of a Cd–Sr atomic fountain, discussing atom launching techniques and the possible role of blackbody radiation. The excellent properties of cadmium and strontium, both individually and as a test pair, are discussed along with the enabled fundamental physics program of tests of the weak equivalence principle and the measurement of relativistic time dilation effects in quantum superpositions of clocks. [ABSTRACT FROM AUTHOR]

Background. Plastic bag suffocation may represent a very complex enigma for the forensic pathologist. The aim of this work is to highlight how the resolution of plastic bag suffocation cases is possible through the use of various forensic investigations, including psychological one (psychological autopsy) and toxicological examinations, in order to be able to define the manner of death. Case report. A 70-year-old man was found by his daughter lying on the bed, with his head inside a plastic bag knotted around his neck. The daughter claimed to have immediately removed the bag, but the father was already dead. An autopsy was performed. The clinical history of the victim was analysed in search of reason that could lead to suicide. The statements of the people on the death scene were examined. Results were compared with the scientific literature: a literature review was performed on the search engine Pubmed, Scopus and Google Scholar using the keywords "plastic bag suffocation" and "death". The autopsy showed no typical signs of asphyxial death. Toxicological examinations revealed benzodiazepines in the urine. Investigations revealed that the victim had been suffering from severe depression. Conclusions. The literature review confirmed that the most used wrapper is the supermarket shopping bag. We emphasize that plastic bag suffocation is a very quick event that does not leave any evident sign: this rapidity does not allow to appreciate the typical elements of asphyxiated death (petechiae, cyanosis). It seems that the fatal mechanism is a cardio-inhibitory, rather than a hypoxic process. [ABSTRACT FROM AUTHOR]

Background. Suicide is considered a global health emergency by the WHO. In suicide, the collection of testimonial data often encounters the refusal of family members to accept the hypothesis of a self-harming event and to provide clear information on the matter. The psychological autopsy is an investigative tool historically known for collecting information on the deceased, although to date there is no standard methodological protocol for conducting interviews with family members/next of kin. Materials and Methods. We present three dubious suicide cases: fuel-related death; hanging during a party; throat cutting with multiple stab wounds. During the interview the operators avoided pressing or direct questions about the event, preferring the interview with free discussion about the deceased (stream of consciousness). Conclusion. Initially, the relatives showed an attitude of clear rejection of the suicidal hypothesis with insistent requests for clarity on what had happened. Subsequently, through the use of free-form interviews, it was still possible to intercept, in the stories, predictive signs of suicidal ideation or psychiatric comorbidities previously untreated and probably not accepted by the relatives, especially through the description of daily acts and household habits and environmental conditions of the deceased. The cases demonstrate the importance of using standardized methods with the use of free interviews with family members in order to indirectly investigate the event. [ABSTRACT FROM AUTHOR]

This article discusses the use of digital single-operator cholangiopancreatoscopy (D-SOC) for the diagnosis and treatment of biliopancreatic diseases, particularly in elderly patients. The study compared the safety and efficacy of D-SOC between older patients (≥75 years) and younger patients (<75 years). The primary endpoints were adverse events (AEs) rate and technical success. The results showed that the success rate and safety profile of D-SOC were comparable between younger and older patients, with cholangitis being the most common adverse event. No deaths related to the procedures were reported. [Extracted from the article]

This article, titled "An unusual case of pancreatic cyst," discusses the case of a 64-year-old man with a history of cirrhosis. The patient underwent abdominal ultrasound and CT scans, which revealed cholelithiasis, two large pancreatic cysts, and thickening of the colon wall with multiple mesenteric lymph nodes. Further investigations, including a colonoscopy and biopsies, confirmed the presence of signet-ring cell colon carcinoma. The patient underwent laparoscopic cholecystectomy, segmental colon resection, and removal of multiple mesenteric lymph nodes, followed by adjuvant chemotherapy. A pEUS with FNA and Micro-forceps was performed to study the pancreatic cysts, and histopathology confirmed the presence of mucus with signet-ring adenocarcinoma cells in the body cyst and amorphous and biliary material with numerous histiocytes in the tail cyst. The diagnosis of pancreatic tail pseudocyst and a rare case of pancreatic body metastasis of signet-ring cell colon carcinoma was established. [Extracted from the article]

This article, published in the journal Endoscopy, presents the findings of a retrospective study on the efficacy and safety of EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) and EUS-FNB (endoscopic ultrasound-guided fine-needle biopsy) for diagnosing gastrointestinal subepithelial lesions. The study included 67 patients who underwent EUS-tissue acquisition between January 2017 and December 2022. The results showed that while EUS-FNB had a higher sample adequacy for immunohistochemistry compared to EUS-FNA, both methods had a high diagnostic capacity for submucosal lesions. The study also found that EUS tissue acquisition was a safe procedure with a low rate of mild adverse events. However, further research with larger sample sizes is needed to confirm these findings. [Extracted from the article]

This article, published in the journal Endoscopy, examines the prevalence and progression of intraductal papillary mucinous neoplasm (IPMN) in patients who have undergone liver transplantation (LT) and are receiving immunosuppressive therapy (IS). The study retrospectively enrolled 20 LT patients with IPMN and found that after a median follow-up of 2.2 years, none of the patients developed high-risk signs or pancreatic malignancy. The authors conclude that low-risk IPMN in LT recipients does not appear to increase the risk of malignancy during IS, suggesting that special management may not be necessary for this type of IPMN before and after transplantation. [Extracted from the article]

This article discusses a study conducted in Italy to evaluate the adherence of Italian endoscopic centers to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines on biliary stenting in malignant distal strictures. The study included 827 patients with distal malignant biliary strictures who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2020 and January 2022. The results showed that while there was full adherence to the guidelines for certain aspects, such as post-ERCP acute pancreatitis prophylaxis and retreatments, there were areas where adherence was poor, such as the excessive use of plastic stents and the routine performance of sphincterotomy. The study concludes that there is a need to improve adherence to the ESGE guidelines in these specific areas. [Extracted from the article]