Psychopathological characteristics in ultra-high risk for psychosis with and without comorbid ADHD.

AIM: This study investigates the psychopathological characteristics of a sample of individuals at ultra-high risk for psychosis with and without comorbid attention-deficit hyperactivity disorder (ADHD). METHODS: Twenty-eight subjects (aged 13-21 years; 13 females) with attenuated psychosis syndrome (APS) were recruited in a cross-sectional study and divided into two groups, each with 14 patients, according to the presence or absence of ADHD. RESULTS: The APS group showed a significantly higher prevalence of negative symptoms than the APS + ADHD group. Other characteristics investigated (positive symptoms, aberrant salience, psychotic-like experiences and prodromal symptoms) did not differ between groups. CONCLUSIONS: The different profiles of negative symptoms in the APS with or without ADHD might suggest the presence of a specific subtype among individuals at ultra-high risk for psychosis. Longitudinal studies with larger samples will provide information about the role of negative symptoms in determining conversion to full psychosis in those people with 'pure' APS and those with APS + ADHD.

The rights of migrants to the identification of their dead: an attempt at an identification strategy from Italy.

Europe is turning a blind eye on a humanitarian disaster unfolding at its doorsteps, with thousands of migrants dying unidentified in Mediterranean waters. Since 2014, Italy has been struggling in an almost indifferent international scenario to identify its dead migrants. Despite the lack of sufficient resources, of the difficulties in collecting post mortem data from the disseminated bodies, and of the problems of contacting and collecting ante mortem information from relatives, it has been proven, with a series of pilot studies, that not only can these bodies be identified but that relatives are also looking for their loved ones and need death certificates. This article focuses on the administrative limbo and lack of regulations obliging single states to engage in appropriate procedures to maximise identification.

Twenty-five years of unidentified bodies: an account from Milano, Italy.

The identification of decedents has always been a central issue in forensic pathology, for ethical, criminal, and administrative reasons, but today, it needs more attention due to issues related not only to migration but also to the weakening of family ties. This article presents a descriptive study discussing the Italian regulatory situation developed in the last decade to face the many identification issues, with all its improvements and flaws. Hence, data gathered in 25 years of at the Institute of Legal Medicine of Milan and the epidemiology of unidentified decedents are illustrated. Briefly, from 1995 to 2019, the number of unidentified human remains with no identity or requesting verification of identity amounts to 726, i.e., 3% circa of all autopsies performed at the Institute, with an average of 29 individuals per year. In total, 528 (72.7%) individuals were successfully identified, 100 (13.8%) remained without an identity, and 98 (13.5%) individuals remained with suspected yet unconfirmed identities. Percentages for each identification technique are displayed, with insight into the role of forensic anthropology and odontology compared to genetics, and into the misuse of non-scientific methods allowed by Public Prosecutors. All the data is compared, as much as possible, with the very few recent studies concerning the problem worldwide. Finally, the article aims to show the Italian experience in dealing with unidentified bodies, in order to provide food for thought for other countries toward a discussion regarding a global issue which is sometimes taken for granted and underestimated.

Assessment of the Effects Exerted by Acid and Alkaline Solutions on Bone: Is Chemistry the Answer?

The treatment of corpses with extremely acid or basic liquids is sometimes performed in criminal contexts. A thorough characterization by chemical analysis may provide further help to macroscopic and microscopic analysis; 63 porcine bone samples were treated with solutions at different pH (1-14) for immersion periods up to 70 days, as well as in extremely acidic sulfuric acid solutions (9 M/18 M) and extremely basic sodium hydroxide. Inductively coupled optical emission spectrometry (ICP-OES)/plasma mass spectrometry (ICP-MS), Fourier transform infrared spectroscopy (FT-IR), energy dispersive X-ray analysis (EDX), X-ray powder diffraction (XRPD), and scanning electron microscopy (SEM) showed that only the sulfuric acid solution 18 M was able to completely dissolve the sample. In addition, chemical analysis allowed to recognize the contact between bone and substances. Hydrated calcium sulfate arose from extreme pH. The possibility of detecting the presence of human material within the residual solution was demonstrated, especially with FT-IR, ICP-OES, and EDX.

Variations of midfacial soft-tissue thickness in subjects aged between 6 and 18years for the reconstruction of the profile: A study on an Italian sample.

Facial approximation techniques used in forensic anthropology are based on soft-tissue thickness databases. However most of articles deal with adult populations, and very few studies were conducted on minors. This study aims at providing data concerning facial thickness for George reconstruction, preliminary to the 3D facial approximation. Diagnostic cephalometric X-ray films were obtained from 222 healthy Caucasoid children (91 boys and 131 girls), aged between 6 and 18years, treated in a Department of Orthodontics of Northern Italy. After setting the Frankfurt plane horizontal, 14 measurements were taken at the mid-facial landmarks: supraglabella, glabella, nasion, nasale, subnasale, superior labial sulcus, labrale superius, stomion, labrale inferius, inferior labial sulcus, suprapogonion, pogonion, gnathion, menton. Mean and standard deviation of soft-tissues thickness at each point were calculated. A two-way analysis of variance (ANOVA) was performed to test the modifications of facial parameters with age and sex (p<0.01). The results demonstrated that there is an increase in tissue thickness as individuals grow; in most occasions, males showed thicker soft tissues than females of the same age, especially after the adolescent growth spurt. Facial thicknesses at subnasale, superior labial sulcus, labrale superius, labrale inferius, inferior labial sulcus, suprapogonion, pogonion and gnathion significantly modified with age, whereas the same parameters at subnasale, superior labial sulcus, labrale superius, labrale inferius, stomion and suprapogonion were significantly sexually dimorphic. In addition, a database for soft-tissue thicknesses in children aged between 6 and 18years was created, which may be of interest in cases of facial approximation of Italian minors.

Characteristics and time-dependence of cut marks and blunt force fractures on costal cartilages: an experimental study.

PURPOSE: The distinction between cut marks and blunt force injuries on costal cartilages is a crucial issue in the forensic field. Moreover, a correct distinction may further be complicated by decomposition, so the need arises to investigate the distinctive features of lesions on cartilage and their changes over time. METHODS: This study aimed to assess the stereomicroscopic features of cut marks (performed with six different knives) and blunt fractures (performed with a hammer and by means of manual bending) on 48 fragments of human costal cartilages. Moreover, in order to simulate decomposition, the cut and fractured surfaces were checked with stereomicroscopy and through casts after 1 and 2 days, 1 week, and 1, 2 and 4 months of drying in ambient air. RESULTS: In fresh samples, for single and unique cuts, striations were observed in between 44 and 88% of cases when non-serrated blades were used, and between 77 and 88% for serrated blades; in the case of "repeated" (back and forth movement) cuts, striations were detected in between 56 and 89% of cases for non-serrated blades, and between 66 and 100% for serrated blades. After only 1 week of decomposition the detection rates fell to percentages of between 28 and 39% for serrated blades and between 17 and 33% for non-serrated blades. Blunt force injuries showed non-specific characteristics, which, if properly assessed, may lead to a reliable distinction between different cut marks in fresh samples. The most evident alterations of the structure of the cartilage occurred in the first week of decomposition in ambient air. After one week of drying, the characteristics of cut marks were almost undetectable, thereby making it extremely challenging to distinguish between cut marks, blunt force fractures and taphonomic effects. CONCLUSION: The study represents a contribution to the correct assessment and distinction of cut marks and blunt force injuries on cartilages, providing a glimpse on the modifications such lesions may undergo with decomposition.

Histological determination of the human origin from dry bone: a cautionary note for subadults.

Anthropologists are frequently required to confirm or exclude the human origin of skeletal remains; DNA and protein radioimmunoassays are useful in confirming the human origin of bone fragments but are not always successful. Histology may be the solution, but the young subadult structure could create misinterpretation. Histological tests were conducted on femur and skull of 31 human subjects. Each sample was observed focusing on presence or absence of fibrous bone, lamellar bone, radial lamellar bone, plexiform bone, reticular pattern, osteon banding, Haversian bone, primary osteons, secondary osteon and osteon fragments. Samples were divided into five age classes; 1 (<1 year), 2 (1-5 years), 3 (6-10 years), 4 (11-15 years) and 5 (16-20 years). Regarding femurs, class 1 presented the following: 87.5% fibrous bone, 37.5% plexiform bone, 12.5% reticular pattern and 12.5% lamellar bone radially oriented. Class 2 showed 37.5% of fibrous bone, 12.5% of reticular pattern and 37.5% of osteon banding. In the higher age classes, the classical human structures, lamellar bone and osteons were frequently visible, except for one case of reticular pattern, generally considered a distinctive non-human structure. The situation appeared different for the skull, where there was a lack of similar information, both in human and non-human. An analysis of the percentage of lamellar bone and osteons was conducted on femur and skull fragments. A trend of increase of primary osteon number and a decrease of the lamellar bone area has been detected in the femur. The present study has therefore shed some light on further pitfalls in species determination of subadult bone.

Dismemberment and disarticulation: A forensic anthropological approach.

The dismemberment of a corpse is fairly rare in forensic medicine. It is usually performed with different types of sharp tools and used as a method of concealing the body and thus erasing proof of murder. In this context, the disarticulation of body parts is an even rarer event. The authors present the analysis of six dismemberment cases (well-preserved corpses or skeletonized remains with clear signs of dismemberment), arising from different contexts and in which different types of sharp tools were used. Two cases in particular showed peculiar features where separation of the forearms and limbs from the rest of the body was performed not by cutting through bones but through a meticulous disarticulation. The importance of a thorough anthropological investigation is thus highlighted, since it provides crucial information on the manner of dismemberment/disarticulation, the types of tools used and the general context in which the crime was perpetrated.

The effects of acid and alkaline solutions on cut marks and on the structure of bone: An experimental study on porcine ribs.

Among taphonomical modifications during decomposition processes, little is known about the action of high or low pH to human tissues and bones. Moreover, acid or basic solutions are seldom used to ease decomposition and wrecking of the body. In this study a total of 60 samples of porcine bones on which two cut marks were produced before the beginning of the experiment, were put in six different solutions with different pH (1, 3, 5, 9, 12, 14) and analyzed every five days over a period of 70 days. Surveys were carried out macroscopically, with stereomicroscopy and with light microscopy on thin sections. Only the specimens exposed to extremely acid (<1) or basic (>12) pH showed evident modifications of the bone's structure, as witnessed by the analyses with stereomicroscopy as well. Many samples showed a detachment of the periosteum; cut marks became soon unrecognizable with pH 14 but still detectable in all the other samples. The information gained from the present study can be of great help in detecting the exposure of human tissues to high or low environmental pH and in understanding the effects that these solutions can exert on human bones.

The Erratic Behavior of Lesions in Burnt Bone.

This study analyses depressed fractures (by blunt force trauma) and circular full-thickness injuries (drill injuries and gunshot wounds) in charred bones. Fifty bovine ribs (total 104 lesions) were divided into three groups. The first group consisted in 20 depressed hammer-produced fractures; in the second one, 60 round drill-holes were produced (30 circular, 30 semicircular); in the third group, 12 fleshed and 12 skeletonized ribs were hit by 9-mm bullets. Each specimen was carbonized in an electric oven up to 800°C. Morphological and metric analyses were performed before and after: morphological features were preserved, but depressed fractures showed an increase in their dimensions (p-value<0.05); the drilled holes shrunk (p-value<0.01); the charring cycle increased the number of fractures in samples with gunshot wounds differently in fleshed and defleshed ribs. This study showed the complex behavior of charred bone, for what concerns the interpretation of trauma and how caution should be applied.

The utility of ground-penetrating radar and its time-dependence in the discovery of clandestine burials.

In the field of forensic investigation burial is a relatively common method of hiding a corpse. The location of clandestine graves is, however, a particularly difficult task in which multiple forensic disciplines such as anthropology, botany or archaeology can provide valuable assistance. The use of GPR (ground-penetrating radar) has recently been introduced as a method in the detection of these graves, but what is the true potential of this tool in an operative search scenario? In this study a total of 11 pig carcasses were buried in two wooded areas, each presenting a similar soil composition. The animals were subsequently exhumed at regular intervals, ranging from 2 to 111 weeks, using systematic GPR analysis of the burial sites and archaeological recovery of the subjects that were then autopsied. GPR proved to be useful in recognizing anomalies at the chosen depths of burial and appeared to be dependent on the state of decay of the samples, producing only slight anomalous readings in the presence of skeletal remains: at 92 weeks from burial the difference in signal was weak and at 111 weeks GPR survey offered no helpful information as to burial location. The experiment, in this particular context, determined the technique as being successful in the presence of recent burials, highlighting the need for a multidisciplinary approach in the operative search for buried human remains.

Assets and pitfalls of chemical and microscopic analyses on gunshot residues in skeletonized bodies: a report of five cases.

In case of gunshot wounds, forensic anthropologists and pathologists have many tools at hand, and the assistance that chemical and microscopic investigations can provide in such scenarios is often valuable and crucial. However, the results of such analyses in the search of gunshot residues (GSR) ought not to be acritically considered. We report five cases where chemical (sodium rhodizonate) and microscopic (scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX)) analyses were performed for the search of GSR. Four cases concerned the forensic field and analyses on buried, charred, or submerged remains, whereas one case concerned the historical remains of a soldier of the First World War. In every case, the search for GSR with these techniques showed their persistence even after long periods and preservation in peculiar environments. However, chemical analyses provided their contribution, but in two cases, anthropological analyses provided crucial and solving results. The five cases show the indisputable usefulness of chemical and microscopic analyses in the search of GSR in gunshot wounds and especially how such residues may survive in time and in adverse environmental conditions. However, experts should always be dubious about some pitfalls (such as contamination) one can frequently find in these scenarios.

Splitting hairs: differentiating between entomological activity, taphonomy, and sharp force trauma on hair.

PURPOSE: The analysis of hair can provide useful information for the correct evaluation of forensic cases, but studies of trauma on hair are extremely rare. Hair may present lesions caused by traumatic events or by animals: in fact, signs of sharp force weapons on hair may provide important information for the reconstruction of the manner of death, and, for example, may suggest fetishist practice. This study stemmed from a judicial case where it was fundamental to distinguish between sharp force lesions and insect activity on hair. METHODS: In order to highlight differences between sharp force lesions and insect feeding activity, different experiments were performed with high power microscopy: hair samples were subjected to several lesions by blunt and sharp force trauma; then samples were used as pabulum for two taxa of insects: the common clothes moth (Tineola bisselliella Lepidoptera, Tineidae) and the carpet beetle (Anthrenus sp., Coleoptera, Dermestidae). Hairs were examined from a macroscopic and microscopic point of view by stereomicroscopy and scanning electron microscopy (SEM): the morphological characteristics of the lesions obtained from the different experimental samples were compared. RESULTS: Results show that sharp force trauma produces lesions with regular edges, whereas insects leave concave lesions caused by their "gnawing" activity. These two types of lesions are easily distinguishable from breaking and tearing using SEM. CONCLUSIONS: This study demonstrates that insect activity leaves very specific indications on hair and sheds some light on different hair lesions that may be found in forensic cases.

Temperature measurement from the brain and rectum in charred corpses: a pilot study on an animal model.

Measurement of body temperature provides relevant data on postmortem interval, and different studies have been so far attempted to apply temperature assessment methods also under extreme environmental conditions; however, none of them has been performed yet on charred or heated bodies, where temperature measurement is presumed to be unreliable because of the possible influence of heating. This study aimed at verifying any possible early-stage alterations of rectal and endocranial temperature due to fire on an animal model during the charring process. Three pigs, 2 adults (pigs 1 and 2) whose weight was about 50 kg each and 1 piglet weighing 3 kg, were heated and burnt on a natural fire lit on top of a wooden stack, without the use of accelerants; 2 thermocouples were positioned in the rectum and in the cranium to record second-by-second rectal and endocranial temperature values. Results demonstrate that the rectal temperature does not seem to increase in adult pigs for 40 to 50 minutes after the body has been exposed to fire, probably because of the thermal insulating characteristics of the adipose tissue. Therefore, temperature may still be of some help for estimating postmortem interval on heated or burnt cadavers.

Applicability of cranial models in urethane resin and foam as a substitute for bone: are synthetic materials reliable?

As literature is poor in functional synthetic cranial models, in this study, synthetic handmade models of cranial vaults were produced in two different materials (a urethane resin and a self-hardening foam), from multiple bone specimens (eight original cranial vaults: four human and four swine), in order to test their resemblance to bone structure in behavior, during fracture formation. All the vaults were mechanically tested with a 2-kg impact weight and filmed with a high-speed camera. Fracture patterns were homogeneous in all swine vaults and heterogeneous in human vaults, with resin fractures more similar to bone fractures. Mean fracture latency time extrapolated by videos were of 0.75 msec (bone), 1.5 msec (resin), 5.12 msec (foam) for human vaults and of 0.625 msec (bone), 1.87 msec (resin), 3.75 msec (foam) for swine vaults. These data showed that resin models are more similar to bone than foam reproductions, but that synthetic material may behave quite differently from bone as concerns fracture latency times.

The importance of an anthropological scene of crime investigation in the case of burnt remains in vehicles: 3 case studies.

Inspection of a crime scene is a crucial step in forensic medicine, and even the methods taught by forensic anthropology are essential. Whereas a thorough inspection can provide crucial information, an approximate inspection can be useless or even harmful. This study reports 3 cases of burnt bodies found inside vehicles between 2006 and 2009 in the outskirts of Milan (Italy). In all 3 cases, the victim was killed by gunshot, and the body was burnt in the vehicle to destroy signs of skeletal injury and prevent identification. In every case, the assistance of forensic anthropologists was requested, but only after the inspection of the body at autopsy showed that the remains were incomplete, thus making it more difficult to determine the identity, cause, and manner of death. A second scene of crime inspection was therefore performed with strict anthropological and adapted archeological methods by forensic anthropologists to perform a more complete recovery, proving how much material had been left behind. These cases clearly show the importance of a proper recovery and of the application of forensic anthropology methods on badly charred bodies and the importance of recovering every fragment of bone: even the smallest fragment can provide essential information. Thus, a precise coordination, a correct and thorough recovery of bone fragments, and an anthropological approach are crucial for many issues: analysis of the scene of crime, reconstruction of the corpse, and reconstruction of the perimortem events.

Burial of piglet carcasses in cement: a study of macroscopic and microscopic alterations on an animal model.

Scarce experimental data exist describing postmortem effects of burial in cement. The scanty literature presents several case reports, but no experimental study. To perform a pilot study, the following experimental system was designed: 4 piglet corpses, who died of natural causes, were encased in concrete. After 1, 2, 3, and 6 months, a block was opened, and autopsy and microscopic analyses were performed. At the first month, initial putrefaction had started, and hindlegs were partly skeletonized. At the second month, both forelegs and hindlegs were partly skeletonized, and the abdomen and back showed advanced putrefaction. At the third month, the samples showed areas of mummification at the abdomen within a general context of initial putrefaction. At the sixth month, the sample showed wide adipocere formation. Histological findings revealed in some analyzed tissues (epithelium, dermis, adipose, and subcutaneous muscular tissues) a well-defined histological pattern even at 3 months after encasement in concrete: this means that microscopic changes may be delayed in concrete and that it may be worth performing histological analyses even in such kind of decomposed material.

Detection of metal residues on bone using SEM-EDS. Part I: Blunt force injury.

Previous studies have indicated that metal particles remain on bone after sharp force injury or gunshot and that their detection by scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDS) could greatly help in tool identification. However, the presence of metal particles on bone surfaces in the context of blunt force trauma has never been assessed experimentally. For this reason the present paper represents an experimental study of the behaviour of metal residues on bone following blunt force injury. Ten fresh sub-adult bovine metatarsal bones were manually cleaned of soft tissues. They were then struck by metal bars (copper, iron or aluminium) on the external surface of the mid-diaphysis. All blunt metal instruments used in this study left a sign in the form of single particles, a smear or a powder-like deposit on the bone surface. The residues of all three metal implements were detected on the bone surface, 0.3-10 mm from the fracture border. The presence of metal particles was confirmed in all samples struck with iron and copper and in two of six aluminium samples; no particles were detected on the negative control. Chemical composition of residues highly corresponded with the composition of applied bars.