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In this study, hydrogels were produced using a Schiff base reaction between two hyaluronic acid derivatives: one containing aldehyde groups (HA-Ald) and the other holding a diethylenetriamine with terminal amino groups (HA-DETA). The DETA portion promotes the in situ growth, complexation, and stabilization of silver nanoparticles (AgNPs), eliminating the need for external reducing agents. The reaction between HA-DETA and HA-Ald leads to the formation of imine bonds, which results in dynamically pH-responsive cross-linking. While the DETA capping ability helped in embedding the AgNPs, the on/off pH environmental responsivity of the hydrogel allows for a controlled and on-demand release of the drug, mainly when bacterial infections cause pH variation of the wound bed. The injectable hydrogels resulted in being highly compatible in contact with blood red cells, fibroblasts, and keratinocytes and capable of having a proliferative effect on an in vitro wound scratch model. The pH-responsive hydrogels showed proper antibacterial activity againstPseudomonas aeruginosaandStaphylococcus aureus, common bacterial strains presented in wound infections. Finally, in vivo wound model studies demonstrated an overall speeding up in the wound healing rate and advanced wound conditions in the experimental group treated with the hydrogels compared to control samples.

Leonardo da Vinci per migliorare la qualità dell’espressività dei volti e dei corpi ritratti e scolpiti nelle sue opere ha approfondito, in sala settoria insieme ad anatomisti del tempo (Padova 1510, Marcantonio della Torre), la sua conoscenza del corpo umano, peraltro l’anatomia del Rinascimento non disponeva di raffigurazioni, ma utilizzava schemi di strutture corporee molto stilizzati e scarsamente rappresentativi della realtà anatomica dell’uomo e della donna. Il suo metodo di studio comprendeva l’osservazione sistematica del corpo umano, accompagnata da appunti e disegni frutto anche di sperimentazioni matematiche e meccaniche, che rispecchia il moderno metodo scientifico. L’approccio rinascimentale, applicato da Leonardo da Vinci allo studio del corpo umano, metteva in relazione diversi fenomeni e ne interpretava i meccanismi, mostrandoli graficamente in termini esemplificativi e modificandoli nel tempo a seguito di nuove conoscenze.

L'arrivo in Italia di migranti stranieri che dichiarano la minore età e sono privi di documenti d'identificazione validi sono in aumento negli ultimi anni. La tutela dei diritti del minore migrante richiede quindi prestazioni nell'ambito della medicina legale e nello specifico la stima dell'età biologica attraverso diversi accertamenti di tipo non medico e di tipo medico (con priorità per quelli non invasivi). La relazione al corso di perfezionamento (organizzatori F4CRnetwork, Croce Rossa Italiana, La Cordata (Impresa valore sociale, Chiamamilano) introduce i concetti base dell'accertamento dell'età del presunto minore migrante facendo riferimento alla recente normativa (L. 47/2017 "Disposizioni in materia di misure di protezione dei minori stranieri non accompagnati"), che ha lo scopo anche di uniformare le procedure di identificazione dell'età biologica del minore. I risultati dell'accertamento clinico e degli eventuali esami strumentali deve essere interpretato tenendo in considerazione l'etnia di provenienza ed i margini di errore insite nella variabile biologica analizzata e della metodica utilizzata

In occasione della settimana in cui ricorre la giornata mondiale contro la violenza sulle donne (25 novembre) si è presentato in sintesi al convegno il ruolo dei sanitari nell'ambito dei casi in cui sussiste un sospetto di violenza nelle relazioni di intimità, che comprende l'assistenza sanitaria immediata e nel medio-lungo termine, l'identificazione di situazioni a rischio immediato e svariate attività medico-legali (documentare, fotografare, repertare, eventuale segnalazione all'autorità giudiziaria). Si sono ricordati gli obblighi di segnalazione da parte del personale sanitario all'autorità giudiziaria in caso di reati procedibili d'ufficio (referto e denuncia di reato) e si sono evidenziate le caratteristiche delle vittime di violenza domestica (condizione fisica, autonomia, capacità di comunicazione) e l'approccio medico-legale in tali casi per distinguere lesioni accidentali da lesioni non accidentali .

Presentazione delle normative italiane in tema di Donazione di Organi da cadavere per la finalità del trapianto terapeutico.

The most frequent homicide in the family is uxoricide, but in older couples the high frequency of homicide-suicide reduces the judicial investigations, including autopsy which is very rarely performed. Uxoricide represents the most extreme form of violence against women in the couple in later life and social isolation makes it very difficult to perceive and identify the existence of risk factors for uxoricide and prevent the crime. To better understand the characteristic of uxoricide in older intimate partners in Italy - with at least one member aged ≥ 60 yr - we have decided to select the casuistry not only from published official data, but from the media and newspapers reports in a five year period. The results have shown 91 cases of uxoricides in the five year period 2005-2009. The study indicates that uxoricide in later life involves mostly married Italian couples, aged 60-74ys, living in cities of the northern regions. The wife is killed mostly in spring-summer, by her husband in their marital home by shooting. Rage/jealousy is the most frequent trigger event and in 55% of the cases there is recurrence of suicide or attempted suicide of the offender.

Introduction: Penetrating neck injuries are nowadays frequent civilian trauma and the spectrum of injury ranges from minor to life-threatening. This type of injury is particularly challenging to treat because of the complex anatomy of the neck, with vital structures in close proximity to one another and in the lateral part of the head and neck the major blood vessels and nerves are relatively close to the skin surface and incised wounds in this region can be frequently fatal. Stab wounds to the neck account for 40% of all penetrating neck injuries and are usually low velocity injuries and can be produced with minimal force. Glass can be considered sometimes a sharp, pointed, knife-like tool and glass injuries can cause severe penetrating injuries to skin and underlying nerves and vessels, as well as tendons, and result in significant long term disability or death by exsanguinations due to injury of a major vessel, most often the carotid artery. In bars and disco pub beer is normally served in Italy in glass bottle (33cl) that can become formidable impulsive weapons, due to the sharpness of the edges especially on breaking on somebody’s head or face during altercations. Case report: During a dispute between a group of young people outside a disco pub in an early December morning (07:00 AM) a 33-year-old man (190cm, 99Kg) received a blow with a glass bottle in his head by a 32 years-old man, hit shortly before with a fist in the face, as testified by other persons present at the dispute. Immediately after the fact a passer-by found the young man prone on the sidewalks and alerted the emergency medical service that found the man in hemorrhagic shock. At the Emergency Department (07:22 AM) the clinical-instrumental investigation detected an active heavy bleeding injury complex in the left temporal region (auricle helix lacerations, deep laceration of the parotid gland, injury of the internal jugular vein (level mouth floor); bleeding spots in ramification vessels of the

Venous malformations are errors of morphogenesis and consist of abnormal channels linked by normal endothelium and represent the most common congenital vascular anomalies. Injection sclerotherapy has been identified as an effective alternative to surgery and is considered nowadays as the less invasive option with good midterm results, especially with detergent sclerosing foam. Sclerotherapy acts as an irritant on the endothelius of dysplastic vessels triggering immediate thrombosis. As result of a sclerotherapy treatment a young woman experienced a scalp necrosis and a scalp scar as negative longterm outcome, associated with a depressed mood with anxious substrate. The less diluted sclerofoam, a slightly excessive total amount of foam (8cc) administered in a unique session in general anesthesia, had prolonged vessel wall contact with a more concentrated foam. The visible scalp scar is a non-facial scarring following a sclerotherapy and the anatomic location is in a usually visible area. The scar is patent in sitting position, half visible in the right lateral and occipital view, barely visible in the front view and not perceptible in the left lateral view. The alopecic scalp scar determines a functional damage, by decreasing the thickness of the scalp, associated with a significant aesthetic impairment. Size, location and surface of the scar can beside arouse unpleasantness or distaste in the observer, resulting in strong feeling of discomfort and mortification, with negative incidence on femininity and on the individual personal image. The presence of a scalp scar is not only an aesthetic impairment, with elements of gravity like gender, age and single status, but affects also the individual emotional-affective sphere in private, social and work context

Overseas holidays are nowadays very frequent, especially in the Caribbean with tempting splendid natural environment. Outside the own country persons are less likely to be familiar with a different health system and the legal framework; political and insurance policies can make sometimes problems insurmountable. Support which one can freely get in the home country may not be available or may be very expensive and the foreign office support sometimes provide interpreters, doctors and funeral assistance. The author present a case of a suspect death abroad far away from the own country, with poor health assistance in the emergency situations and the presentation focuses on the reconstruction of all medical activities arranged on place before death.

La violence est un phénomène complexe, ancré aux différents facteurs de risque: individuels, sociaux, culturels, économiques et familiale. Chaque phase du développement, de la naissance à l’âge adulte, amène de nouveaux besoins et de nouvelles exigences. L’origine de la violence envers les enfants au sein de la famille dépend toujours de la combinaison des différents facteurs. Selon l’OMS sont les petits enfants qui subissent plus fréquemment la maltraitance physique et un des problèmes pour la lutte contre les maltraitances des petits enfants est la fréquente absence de visibilité. Les répercussions de la maltraitance sur la santé e le développement de l’enfant sont des atteintes à court et à long terme. Le cas concerne un nourrisson né à terme sans problèmes par une grossesse normale par une couple marié depuis cinq ans, occupé et vivant dans une maison de leur propriété en une petite ville du Nord d’Italie. Trois semaines après la naissance, la petite a présenté des manifestations dermatologiques avec des fissurations et exfoliation cutanée, traitée avec des antibiotiques locaux, avec un avantage temporaire et suspicion d'une maladie héréditaire due aux récidives ingravescente. A l’âge d’un moins et demie le père l’accompagne aux Urgences par immobilité du membre inférieur gauche; par les radiographies ont été détectés une fracture spiroïdal récente de la diaphyse du fémur gauche et un hématome calcifié à la diaphyse du tibia gauche. L’étude orthopédique et radiographique a conduit à l'exclusion des fractures pathologiques (syndrome de fragilité osseuse constitutionelle), mais suspicion d’un syndrome héréditaire tenue compte de la double occurrence des affections dermatologiques et orthopédiques sans cause apparente. Le service sociale du district furent avertis du suspect des maltraitement, mais ils ne furent pas prises mesures spéciales à part quelque entretien avec les parents. A l’âge des trois mois la petite a présenté un arrêt cardio-respiratoire et hyperto

L’évaluation médico-légale pour permettre la réparation du dommage corporel en responsabilité civile est souvent routinière en cas de coup de fouet cervical, mais peut être aussi un défi d’évaluation dans des cas particuliers. Le coup de fouet cervical est défini comme un mécanisme d’accélération-décélération de l’énergie transférée au cou généralement dû à un accident de la route. L’impact peut entraîner des lésions squelettiques ou des tissus mous et la présence d’une problématique du rachis cervical, marqué par une malformation congénitale peut modifiée la réponse physiologique au traumatisme en déterminant des séquelles plus graves. Un homme (né en 1965, prothésiste dentaire) en Juillet 2010 au volant d'une voiture sur l'autoroute a été frappé par derrière par une autre voiture. Le dispositif électronique a enregistrée une accélération pendant l'impact de 9.76g. A la fin de la projection en avant de la tête, le sujet (hauteur 192cm) est resté avec la tête fixé sous le pare-soleil, avec une perte de conscience temporaire; immédiat les douleurs au cou, au bas du dos, avec une sensation de lourdeur et paresthésie au membre supérieur droit. Les malformations congénitales du rachis cervical ont été détectées à la charnière C1-C3, sans fractures. Le diagnostic définitif a été un traumatisme cervical, confirmé par un contrôle de neurochirurgie avec prescription d’un collier cervical et thérapie analgésique. Dans les trois mois suivants des séquelles sensitivo-motrices d’origine médullaire étaient devenu évident aux quatre membres, traités avec des séances de rééducation. Un an après l'accident, les symptômes étaient caractérisés par des troubles visuels et tétraplégie incomplète par un syndrome bulbaire dans une malformation cervicale. Une IRM cervicale dynamique a démontré dans l'hyperextension maximale une annulation de la distance C1-C2 pour un mouvement vers le bas et vers l'avant de la dent et avec flexion forcée de la tête l'apex de la dent entre en contact avec

The author present a private helicopter crash case happened in Northern Italy in January 2008. The pilot (43 y.o.) had a 15 years of non professional aviation experience, as passenger the pilot’s wife (46 y.o). Around 15 minutes after departure, the helicopter crashed on the ground and then set in flames. The pilot and his wife were killed on impact with the ground and were found outside the helicopter cabin, completely destroyed and reduced in wreckages. The pilot sustained severe external carbonization, mutilation of the lower trunk and pelvis area, with laceration of the abdominal wall and complete avulsion of the bowel; severe blunt force trauma with multiple fractures of face/skull, multiple rib and sternal fractures, multiple thoracic organs lacerations (lung; tracheal wall; pericardial myocardial; aorta), T5-T6 vertebro-medullary fractures, bilateral diaphragm lacerations, multiple lacerations of stomach, liver and bowel. The passenger-wife presented a skull crash, multiple thoracic organs lacerations (lung; tracheal wall; pericardial myocardial; aorta), T5-T6 vertebro-medullary fractures, bilateral diaphragm lacerations with partial liver herniation, multiple lacerations of liver and spleen, pubic fracture and multiple pelvic and upper and lower limbs fractures. Soot was not present in the upper airways and in the esophageal-gastric tract of both bodies. Pilot’s toxicological analysis: blood alcohol 0.35g/L; brain alcohol: 0.15g/Kg, carboxyhemoglobin: undetectable; metahaemoglobin: 10.5%. Engine/mechanical failure was excluded and a pilot error/inexperience in difficult weather conditions (fog with high reduced visibility) was considered the primary cause of this aviation fatality.

This paper present a dramatic farm tractor rail crash disaster happened at a rail crossing in Romania in 2012. A 78 y.o. farm tractor driver was going to the fields with 17 daily workers in the trailer and the train struck directly on the trailer and the passengers were thrown out and fall on the ground in a ray of 30m. As consequence of this traffic accident 7 young adults died on site, one victim died during the helicopter transfer and another nine person were injured; the farm tractor driver, the train driver and all the train passengers remained uninjured. The autopsies revealed different types of body injuries: 2 victims presented massive blunt trauma injuries of head, thorax and abdomen; 3 other victims presented crash of the head, vertebro-medullary trauma (cervical and thoracic level), multiple lacerations of thoracic and abdominal organs and multiple limb’s fractures as results of a combination of a direct high velocity impact, the consequent projection of the bodies on the ground and also the compression under the trailer was contributing; 2 victims presented extensive mutilations of body parts as result of the train wheels action. During investigation the farm tractor driver affirmed he was passing the rail crossing without checking the rail line. The most relevant contributory factor in this farm tractor train crash was the negligence of an elderly driver. In rural areas the regulations to farm tractors and equipment on public roads are not always clear to drivers because of their general lack of awareness of road regulations. Important to prevent such dramatic fatal accidents is information and safety in farmer’s vehicle mobility.

A 45 y.o. man died of sepsis secondary to quadriplegia due to complex multiple fractures of the lower cervical column (C4-C7) after a 3-weeks hospitalization in the intensive care unit. The family interviewed before performing autopsy declared that he was arrested for an alleged fight with a neighbor of the day before. They told that during the statement taken in the police station the police officer noticed a strange, irascible behavior and a neuropsychiatric consultation was requested. The medical documentation shows that the man was hospitalized in the psychiatric unit and suddenly some neurological signs appeared. Then the patient was moved to the orthopedic unit and checked radiologically with positive result – instable C5 fracture – and a Philadelphia collar stabilizer was applied. His condition was rapidly worsen and he was transferred to the intensive care unit with respiratory arrest, peripheral and central cyanosis, fixed and unreactive pupils (GCS=3). The blood pressure and oxygen’s saturation were undetectable and the pulse was 40 bpm. He was reanimated, intubated and a cardiotonic was administered; the patient recovered cardio-respiratory function (pulse 120-130bpm). It follows a complex monitoring, sedation and algotherapy with morphine. After some days an extensive CT scan of the head and neck was performed and no pathological or traumatic signs were found in the head, but multiple fractures from C4 to C7 (fractures of the spinous process of C4 and C5; fractures of the vertebral bodies of C5 (type III), C6 (type I), C7 (type I) were detected. After ten days of admission in intensive care unit the patient presented convulsion and fever (BT: 38.7 °C). During hospitalization the patient received fluid supply, human albumin 20%, mannitol 20%, antibiotic therapy according to antibiogram, antiaggregant, barbituric, analgesics, sedatives, antiacid and vitamins. Despite of this intensive treatment his hemodynamic state was instable and the fever rose up till

The authors describe an unusual case of suicide by detonating a hand-grenade happened in March 2012 in the Mitrovice/Mitrovica District of Kosovo (Western Balkans). A 55 y.o. man was found in the cellar of his house with an ample left sided laceration of the trunk with exposure of the thoracic and abdominal cavities, associated with partial evisceration of the abdominal content and the complete destruction of the left hand. Burns and black residues were visible on the wound's margins and on the clothes' remains. On scene, near the body, parts of an explosive device were discovered. After medico-legal autopsy the cause of death was identified in the destruction of several vital organs (heart explosion; thoracic aorta laceration). The medical history revealed a stroke attack in 2008, with residual right-sided neurological deficits - hemiparesis. In this case the forensic evaluation was centred on the manner of death - especially suicide versus bad handling of some explosive materials, and the concrete possibility to activate a hand grenade with suicide intent, by a person with right hand impairment, neurological deficit subsequent to an old stroke.

The paper present a multiple non-passengers/non-pedestrians car accident with 4 dead and 2 injured victims happened in June 2009 in Transilvania (Romania). In front of a fenced-in courtyard, some persons were sitting on a bench beside an urban road and suddenly were run over by a car. At the end of the crash the car remained in the footpath with a wracked wheel and moderate damages in the left front part; the driver was uninjured. The four autopsies revealed in the male 63y.o.: relevant fracture of vault and skull basis with meningeal hemorrhage and frontal lobe contusions, thoracic and pelvic ring injuries (blood alcohol: 0.155g/L); in the female 46y.o.: thoracic aorta laceration and multiple, bilteral lower limb fractures (blood alcohol: 0.2g/L); in male child 4y.o.: blunt trauma of face and skull with a complex comminute fracture in the left temporal region irradiated to the cranial base; thoracic vertebral fractures (T2-T3) and an abdominal trauma with liver, spleen and right kidney ruptures; female child 3y.o.: complex vault and cranial basis fracture, brain mengeal hemorrhages; multiple, bilateral rib fractures and left clavicle fracture. In this run-off-road collision relevant contributory factors were the loss of control and mis-judging a curve while driving at high speed and the lethal injuries were the result of a combination of a direct high velocity impact and projection of the bodies on the ground. Important to prevent such dramatic fatal road accidents is the improvement of road safety, creating a clear zone, or separating with guard rails the footpath and the road in residential areas.