The brain tissue reaction to blunt trauma: a field of possible cooperation between neuroanatomists and forensic pathologists

The goal of this presentation is to describe, through the histological examination, the evolution over time of the biological processes, at the cellular and molecular level, in the neurological tissue after a blunt trauma. The origin of the secondary ischemia, that often occurs after a brain trauma, leading to death the patient, is almost studied on animal models and is not well known yet. It is presumed that hemorrhages and contusions result in brain ischemia, and that also brain edema arises intra-cranial pressure producing ischemia. Forensic pathology deals everyday with cases of traumatic deaths, and is therefore able to study the inflammatory reaction to trauma in a human casuistry giving information to other disciplines like neuroanatomy. The time-dependent appearance of different leucocyte subtypes can contribute to a forensic wound age estimation but, in contrast to peripheral tissue, the cellular reaction in the CNS is characterized by a minimal neutrophil exsudation and a delayed increase in mononuclear cell numbers. 62 deaths due to head injury with a survival time from few minutes till 30 days were studied. Samples of brain tissue were stained with immunohistochemistry using selectin P and E, GFAP, HIF1-α, CD 117 (c-kit), LCA. The schematic information about chronology of head trauma are given as follows: survival of a few minutes, of 1 hour, of 2-4 hours, of 4-12 horus, of 12-24 hours, 24-48 hours, 2-6 days, 6-14 days, 15-30 days. The number of platelets microthrombi increases with TBI age up to 3 days, afterward leukocytes start to take their place. Platelets aggregates may impair cerebral circulation causing ischemia. Cerebral ischemia plays an important role in SBD. There is also an involvement of CD 117+ cells and HIF-1 α in the modulation and progression of the brain injury. After brain injury a cascade of events occurs leading sometime to a brain secondary ischemic injury. Thanks to the availability of injured human brain tissues, forensic histopathologists might work together with neuroanatomists in order to help in the identification of glial cells and leukocytes communication with endothelial cells, and on the post-traumatic ischemic process that causes the death in prolonged survival time after brain injury

Planned and unplanned complex suicides: Casuistry of the Institute of Legal Medicine of Parma (Italy)

Complex suicide is performed using more harmful methods, simultaneously or consecutively. In these cases, the distinction between suicide and homicide represents a challenge for forensic pathologists. In literature, complex suicide is divided in two subgroups: â\u80\u9cplanned complex suicideâ\u80\u9d or â\u80\u9cunplanned complex suicideâ\u80\u9d depending from forensic features and often related to psychiatric variables. Aim of this study was to show the casuistry of complex suicide in Parma's Forensic service analyzing, for each case, the forensic medical problems (type and site of lesions on the body), and the supplementary data [Police's inspection report, toxicological analysis and psychiatric anamnesis (when available)], trying, through a multidisciplinary approach, to determine a possible correlation between the victim's mood and suicide's method chosen, whether planned or unplanned. Our results showed the importance of all the elements collected on the crime scene to distinguish suicide from homicide, and the correlation between bipolar disorder, borderline personality disorder and schizophrenia with unplanned complex suicide (because of the impulsiveness), and major depression disorder and anxiety disorder with planned complex suicide. Being able to understand the causes behind this extreme gesture may become important not only for forensic pathologists and judicial authority, but also, and above all, for the family as well

Suicide in the elderly: a 37-years retrospective study

The rates of suicide increase with age and reach their highest levels in the oldest age groupings and are sufficiently large for them to constitute a public health concern. The number of deaths due to suicides after the age of 60 years in Italy is 1,775 (41.36%) in 2013; there is a constant increase of elder population over the last ten years and elderly are almost twice of young. It is in this context that suicide arises, a risk factor during old age

Femicide and forensic pathology: Proposal for a shared medico-legal methodology

In a previous work, authors have proposed a medico-legal definition of femicide as the murder due to the failure to recognize the right of self-determination of women. The aim of this paper was to apply the proposed definition to a cohort of cases to characterise femicides and female homicides and assess whether femicides can be considered a distinct entity or not. A comparison between female and male homicides was performed to assess common and distinctive features. Femicides were identified and compared to the cohort of non-femicide female murder. Results were compared to those reported in published forensic studies. Significant associations between female and male homicides were found for sex and partner/ex-partner offender, sex and indoor homicide and sex and asphyxia as dynamic of death emerged. A higher prevalence of indoor homicides and asphyxiation and of partner relationships were documented in female homicides. Gunshot, blunt injuries and cut wounds are well represented in both types of homicides. Most affected sites are back and chest in male homicides, and head, breasts, pubis, and limbs in female homicides. When comparing femicides and female homicides, a positive association between strangulation as harmful mean and a negative one between femicides and indoor homicides were found. Male and female homicides can be considered as two distinct victimological phenomena. Focusing on femicide allows to establish injuries and circumstantial patterns, that could represent evidence of a specific murder. More studies with a standardized data collection are needed to corroborate the theory of this paper

Femicide and forensic pathology: Proposal for a shared medico-legal methodology

In a previous work, authors have proposed a medico-legal definition of femicide as the murder due to the failure to recognize the right of self-determination of women. The aim of this paper was to apply the proposed definition to a cohort of cases to characterise femicides and female homicides and assess whether femicides can be considered a distinct entity or not. A comparison between female and male homicides was performed to assess common and distinctive features. Femicides were identified and compared to the cohort of non-femicide female murder. Results were compared to those reported in published forensic studies. Significant associations between female and male homicides were found for sex and partner/ex-partner offender, sex and indoor homicide and sex and asphyxia as dynamic of death emerged. A higher prevalence of indoor homicides and asphyxiation and of partner relationships were documented in female homicides. Gunshot, blunt injuries and cut wounds are well represented in both types of homicides. Most affected sites are back and chest in male homicides, and head, breasts, pubis, and limbs in female homicides. When comparing femicides and female homicides, a positive association between strangulation as harmful mean and a negative one between femicides and indoor homicides were found. Male and female homicides can be considered as two distinct victimological phenomena. Focusing on femicide allows to establish injuries and circumstantial patterns, that could represent evidence of a specific murder. More studies with a standardized data collection are needed to corroborate the theory of this paper

Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs

Background &amp; Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006–2020) in Italy. Methods: Data from the Italian Liver Cancer (ITA.LI.CA) registry were used: 1,391 patients were allocated to three groups based on the year of HCC diagnosis (2006–2010; 2011–2015; 2016–2020). Patient characteristics, HCC treatment, and overall survival were compared among groups. Survival predictors were also investigated. Results: Approximately 80% of alcohol-related HCCs were classified as cases of metabolic dysfunction-associated fatty liver disease. Throughout the quinquennia, <50% of HCCs were detected by surveillance programmes. The tumour burden at diagnosis was slightly reduced but not enough to change the distribution of the ITA.LI.CA cancer stages. Intra-arterial and targeted systemic therapies increased across quinquennia. A modest improvement in survival was observed in the last quinquennia, particularly after 12 months of patient observation. Cancer stage, HCC treatment, and presence of oesophageal varices were independent predictors of survival. Conclusions: In the past 15 years, modest improvements have been obtained in outcomes of alcohol-related HCC, attributed mainly to underuse of surveillance programmes and the consequent low amenability to curative treatments. Metabolic dysfunction-associated fatty liver disease is a widespread condition in alcohol abusers, but its presence did not show a pivotal prognostic role once HCC had developed. Instead, the presence of oesophageal varices, an independent poor prognosticator, should be considered in patient management and refining of prognostic systems. Impact and Implications: Alcohol abuse is a leading and growing cause of hepatocellular carcinoma (HCC) worldwide and is associated with a worse prognosis compared with other aetiologies. We assessed the evolutionary landscape of alcohol-related HCC over 15 years in Italy. A high cumulative prevalence (78%) of metabolic dysfunction-associated fatty liver disease, with signs of metabolic dysfunction, was observed in HCC patients with unhealthy excessive alcohol consumption. The alcohol + metabolic dysfunction-associated fatty liver disease condition tended to progressively increase over time. A modest improvement in survival occurred over the study period, likely because of the persistent underuse of surveillance programmes and, consequently, the lack of improvement in the cancer stage at diagnosis and the patients’ eligibility for curative treatments. Alongside the known prognostic factors for HCC (cancer stage and treatment), the presence of oesophageal varices was an independent predictor of poor survival, suggesting that this clinical feature should be carefully considered in patient management and should be included in prognostic systems/scores for HCC to improve their performance