Radiological detection of gunshot redisue in firearm wounds

Introduzione La valutazione della distanza di sparo assume frequente e rilevante importanza. Ad oggi, le procedure impiegate nella determinazione del firing range sono basate sull\u2019analisi della distribuzione dei residui di sparo (gunshot residue \u2013 GSR). Fenomeni fisici e chimici agenti nel post-mortem possono alterare le caratteristiche delle ferite d\u2019arma da fuoco, complicando la ricostruzione della dinamica delittuosa. Scopo dello studio Il presente studio si propone di identificare, quantificare e comparare il GSR su diverse tipologie di ferite d\u2019arma da fuoco, mediante analisi radiologiche di ultima generazione (micro-TC). Materiali e metodi Il campione casistico \ue8 costituito da 110 segmenti di gambe umane amputate chirurgicamente e sottoposte a prove di sparo da differenti distanze (5, 15, 23, 30 e 40 cm). Come controlli sono state usate 30 ferite da punta prodotte su gambe umane. Sessanta campioni (10 per ogni distanza testata e 10 ferite da punta) sono stati immediatamente fissati in formalina. Quaranta campioni (10 ferite prodotte da 5 cm, da 15 cm e da 30 cm e 10 ferite da punta) sono stati lasciati esposti all\u2019aria aperta per 15 giorni prima di essere fissati in formalina. Quaranta campioni (10 ferite prodotte da 5 cm, da 15 cm e da 30 cm e 10 ferite da punta) sono stati posti all\u2019interno di una stufa a legna ed esposti alle fiamme per 4 minuti a 400\ub0C prima di essere fissati in formalina. Ciascun segmento \ue8 stato quindi analizzato con micro-TC. Risultati L\u2019analisi con micro-TC ha rilevato GSR su tutte le ferite d\u2019entrata d\u2019arma da fuoco. Nei campioni freschi, i residui inorganici di sparo erano concentrati sulla cute attorno al foro e negli strati sottocutanei attorno al tramite. Nei campioni putrefatti il GSR era localizzato prevalentemente nel sottocute. Nei campioni carbonizzati i residui erano in parte costituiti da aggregati di particelle metalliche fuse tra loro. Nei fori di uscita e nelle ferite da punta non sono state rilevate particelle metalliche. L\u2019analisi statistica ha rilevato un decremento non lineare tra la quantit\ue0 di GSR e la distanza di sparo. Conclusioni Il presente studio rappresenta la prima applicazione della micro-TC in ambito di balistica forense. Nei campioni freschi, la metodica utilizzata, rapida e oggettiva, permette di discriminare chiaramente i colpi sparati alle diverse distanze testate. Nei campioni putrefatti e carbonizzati, l\u2019analisi con micro-TC fornisce utili informazioni per discriminare ferite d\u2019entrata d\u2019arma da fuoco da ferite con caratteristiche morfometriche simili (fori d\u2019uscita e/o ferite da punta). La stima della sensibilit\ue0 e specificit\ue0 del metodo testato sar\ue0 verificata mediante analisi di ferite derivanti da casi forensi e dalla verifica dei risultati ottenuti con tecniche \u201cgold standard\u201d, quali la microscopia elettronica a scansione ambientale accoppiata ad un rilevatore a dispersione di energia, che confermino la reale composizione chimica dei residui rilevati sul bersaglio.Introduction Estimation of the firing range is often critical for reconstructing gunshot fatalities, where the main measurable evidence is the gunshot residue (GSR). After-death events, such as putrefaction, autolysis, incineration or extensive burning of the body, can alter the typical macroscopic and microscopic characteristics of firearm wounds, hampering or at least complicating the reconstruction of gunshot fatalities. Aim of the research project The present study aimed at evaluating and comparing the amount and differential distribution of GSR on fresh, decomposed, and charred gunshot wounds, utilizing a micro-computed tomography (micro-CT) analysis. Materials and methods A total of 110 experimental shootings at different firing distances (5, 15, 23, 30, and 40 cm) were performed on human calves surgically amputated for medical reasons. As controls we used 30 stab wounds, produced with an ice pick on calf sections. Sixty specimens (10 for each tested distance and 10 stab wounds) were immediately formalin-fixed. Forty specimens (10 gunshot wounds from 5, 15, and 30 cm, and 10 stab wounds) were enclosed in a cowshed for 15 days, before formalin-fixation. Forty specimens (10 gunshot wounds from 5, 15, and 30 cm, and 10 stab wounds) were placed inside a wood-burning stove for 4 minutes at a temperature of 400\ub0C. All the samples were analysed by a micro-CT coupled to an imaging analysis software. Results Micro-CT analysis with three-dimensional image reconstruction detected GSR particles in all the investigated entrance wounds. In fresh specimens, GSR was concentrated on the skin surface around the entrance hole, and in the epidermis and dermis layers around the cavity. In decomposed specimens the high-density particles were detected only in the dermis layer. Regarding the charred wounds, the GSR deposits of the firearm lesions inflicted at very close distance (5 cm) were mainly constituted of huge particles with an irregular shape and well-delineated edges; at greater distances, agglomerates of tiny radiopaque particles scattered in the epidermis and dermis layers were evident. No GSR was detected in exit holes and stab wounds. Statistical analysis showed a nonlinear relationship between the amount of GSR deposits and the firing range. Conclusions Our study, which is the first application of micro-CT analysis in the field of forensic ballistics, demonstrates that micro-CT could be an objective and rapid tool for the analysis of gunshot wounds in firearm fatalities. On fresh samples, this method may be of practical use for estimating the firing range given a known percentage of the GSR deposit, while in bodies in advanced decomposition or extremely damaged by fire, it might furnish precious information on the nature and means of productions of an injury, playing an important role for reconstructing the shooting incident. For estimating the sensitivity and specificity of the proposed method, it will be necessary to test the micro-CT, analysing specimens of forensic caseworks and confirming the positive results with a \u201cgold-standard\u201d method

Algorithm and software to automatically identify latency and amplitude features of local field potentials recorded in electrophysiological investigation

A function that is called by main_script.m to compute the onset and the maximum latencies and amplitudes from the signal time-derivative. Also the functions that guarantee the correct running of main_script.m. To test the algorithm, invoking only main_script.m is necessary (all the other functions must be contained in the same folder). (M 1 kb

Post-Mortem Assessment and Evolutionary Role of the Autopsy

The Chapter is dedicated to the evolutionary role of autopsy, reporting the historical profiles, the state of the art, and prospects for future development of the main related techniques and methods of the ancillary disciplines (like Radiology), involved in historic synergy in the post-mortem assessment, together with the mother discipline Forensic Pathology. A task sustainable through the utilization of the so-called advanced molecular autopsy, a convergence of different skills jointly makes use of the high dimensionality of data generated by new technologies requiring a data mining approach governed by improved bioinformatics and computational biology tools. The evolution of the scientific research and the increased accuracy of the various disciplines will be able to weigh the value of evidence, placed at the disposal of the justice system as truth and proof

Hyperbaric oxygen treatment of superficial soft tissue lesions in children with oncologic disease

This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5–16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill

DAX-1 Expression in Pediatric Rhabdomyosarcomas: Another Immunohistochemical Marker Useful in the Diagnosis of Translocation Positive Alveolar Rhabdomyosarcoma

OBJECTIVES: The aim of this study was to investigate the expression of DAX-1 in a series of pediatric rhabdomyosarcomas (RMS) with known translocation and compare it to Ap2\u3b2, known to be selectively expressed in ARMS. DESIGN: We revised a series of 71 alveolar rhabdomyosarcomas (ARMS), enrolled in the Italian Protocols RMS 79 and 96, and 23 embryonal rhabdomyosarcomas (ERMS) as controls. Before investigating Ap2\u3b2 and DAX-1, ARMS were reviewed and reclassified as 48 ARMS and 23 non-ARMS. RESULTS: Translocation positive ARMS showed a characteristic Ap2\u3b2/DAX-1+ staining pattern in 78% of cases, while 76% of classic ERMS were negative for both. Ap2\u3b2 alone was positive in 3.9% of RMS lacking translocation, whereas DAX-1 alone was positive in 25.4%. Conversely, 9% and 6% of translocation positive ARMS were positive only for DAX-1 or Ap2\u3b2, respectively. The 23 non-ARMS shared the same phenotype as ERMS but had a higher frequency of DAX-1 expression. CONCLUSIONS: DAX-1 is less specific than Ap2\u3b2, however it is a sensitive marker for translocation positive ARMS and can be helpful in their diagnosis if used in combination with Ap2\u3b2

Castleman's disease in childhood: report of three cases and review of the literature

Castleman's disease (CD) is a rare, localized or generalized, lymphoproliferative disorder with a frequent mediastinal location, but possible in any lymph node or extra nodal site. It usually appears in young adults whilst it rarely occurs in childhood. There are only about 100 pediatric cases published, five of them in Italy. We report 3 cases of localized Castleman's disease, investigated in our Department in a 3 years period and reviewed the literature

Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review

Background: Cannabis is the most consumed drug worldwide and number of users is increasing, particularly among youth. Moreover, cannabis potential therapeutic properties have renewed interest to make it available as a treatment for a variety of conditions. Albeit rarely, cannabis consumption has been associated with cardiovascular diseases such as arrhythmias, myocardial infarction (MI) and potentially sudden death. Case presentation: A 24-year-old woman presented to the emergency department sent by her cardiologist because of a recent finding of a 16 seconds asystole on the implantable loop recorder (ILR) she implanted 7 months before for recurrent syncopes. She declared that she is a heavy cannabis user (at least 5 cannabis-cigarette per day, not mixed up with tobacco, for no less than 12 years) and all syncopes occurred shortly after cannabis consumption. After a collective discussion with the heart team, syncope unit, electrophysiologists and toxicologist, we decided to implant a dual chamber pacemaker with a rate response algorithm due to the high risk of trauma of the syncopal episodes. 24 months follow-up period was uneventful. Conclusions: Cannabis cardiovascular effects are not well known and, although rare, among these we find ischemic episodes, tachyarrhythmias, symptomatic sinus bradycardia, sinus arrest, ventricular asystole and possibly death. Because of cannabis growing consumption both for medical and recreational purpose, cardiovascular diseases associated with cannabis use may become more and more frequent. In the light of the poor literature, we believe that cannabis may produce opposite adverse effects depending on the duration of the habit. Acute administration increases sympathetic tone and reduces parasympathetic tone; conversely, with chronic intake an opposite effect is observed: repetitive dosing decreases sympathetic activity and increases parasympathetic activity. Clinicians should be aware of the increased risk of cardiovascular complications associated with cannabis use and should investigate its consumption especially in young patients presenting with cardiac dysrhythmias

Per- and polyfluoroalkyl substances (PFAS) presence in food: Comparison among fresh, frozen and ready-to-eat vegetables

There is a worldwide discussion to provide safety limits in food for per-and polyfluoroalkyl substances (PFAS), a group of persistent contaminants associated to human disease. Processed food is more at risk of containing increased amounts of PFAS as a consequence of intentionally or non-intentionally contamination during manipulation and packaging. Among food products, also vegetables can be submitted to industrial manipulation; therefore, a different PFAS content correlated to the level of vegetables processing is conceivable. This study assessed the amount and type of PFAS present in fresh, frozen and ready-to-eat vegetables. Differences have been observed between the three groups of samples in the average PFAS content; the difference between ready-to eat and frozen vegetables resulted statistically significative. Organic vegetables displayed a lower total amount of PFAS respect to the traditional counterpart. The impact of industrial manipulation remains to be cleared, but pesticides use during cultivation could be considered a source of PFAS contamination

Bowel parasitosis and neuroendocrine tumours of the appendix. A report from the Italian TREP project

Five children with a neuroendocrine tumour (NET) of the appendix associated with a parasitic bowel infection are described, and the possibility of inflammation-triggered carcinogenesis is discussed. Schistosoma haematobium is linked primarily to bladder cancer but it has been reported in association with several other histotypes, including NETs of the gastrointestinal tract. Conversely, Enterobius vermicularis has not yet been claimed to participate in the onset of pre-cancerous conditions or tumours. The rare occurrence of contemporary appendiceal NETs and parasitic infection, raises the intriguing hypothesis of an inflammation-related carcinogenesis, although a cause-effect relationship cannot be established. Larger international series of childhood appendiceal NETs, which also include countries with higher prevalence of parasitic bowel infections, are needed to further clarify this possible cause-effect relationshi

Epithelial thymic tumours in paediatric age: a report from the TREP project

<p>Abstract</p> <p>Background</p> <p>Thymic epithelial tumours (thymoma and carcinoma) are exceptionally rare in children. We describe a national multicentre series with a view to illustrating their clinical behaviour and the results of treatment.</p> <p>Methods</p> <p>From January 2000 all patients under 18 years of age diagnosed with "<it>rare paediatric tumours</it>" were centrally registered by the Italian centres participating in the TREP project (<b>T</b>umori <b>R</b>ari in <b>E</b>tà <b>P</b>ediatrica [Rare Tumours in Paediatric Age]). The clinical data of children with a thymic epithelial tumour registered as at December 2009 were analyzed for the purposes of the present study.</p> <p>Results</p> <p>Our series comprised 4 patients with thymoma and 5 with carcinoma (4 males, 5 females; median age 12.4 years). The tumour masses were mainly large, exceeding 5 cm in largest diameter. Based on the Masaoka staging system, 3 patients were stage I, 1 was stage III, 1 was stage IVa and 4 were stage IVb.</p> <p>All 3 patients with stage I thymoma underwent complete tumour resection at diagnosis and were alive 22, 35 and 93 months after surgery. One patient with a thymoma metastasizing to the kidneys died rapidly due to respiratory failure.</p> <p>Thymic carcinomas were much more aggressive, infiltrating nearby organs (in 4 cases) and regional nodes (in 5), and spreading to the bone (in 3) and liver (in 1). All patients received multidrug chemotherapy (platinum derivatives + etoposide or other drugs) with evidence of tumour reduction in 3 cases. Two patients underwent partial tumour resection (after chemo-radiotherapy in one case) and 4 patients were given radiotherapy (45-54 Gy). All patients died of their disease.</p> <p>Conclusions</p> <p>Children with thymomas completely resected at diagnosis have an excellent prognosis while thymic carcinomas behave aggressively and carry a poor prognosis despite multimodal treatment.</p