New perspectives of forensic pathology through machine learning approach on autopsy data: a pilot study.

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 autop-sies 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 predic-tion of cause of death.

New methods in psychological autopsy in cases of doubtful suicides.

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 un-treated 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.

Supermarket shopping death: the role of forensic investigations in plastic bag suffocation.

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.

The impact of climate change on the crime scene and forensic sciences.

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.

Development and machine learning-based calibration of low-cost multiparametric stations for the measurement of CO2 and CH4 in air.

The pressing issue of atmospheric pollution has prompted the exploration of affordable methods for measuring and monitoring air contaminants as complementary techniques to standard methods, able to produce high-density data in time and space. The main challenge of this low-cost approach regards the in-field accuracy and reliability of the sensors. This study presents the development of low-cost stations for high-time resolution measurements of CO2 and CH4 concentrations calibrated via an in-field machine learning-based method. The calibration models were built based on measurements parallelly performed with the low-cost sensors and a CRDS analyzer for CO2 and CH4 as reference instrument, accounting for air temperature and relative humidity as external variables. To ensure versatility across locations, diversified datasets were collected, consisting of measurements performed in various environments and seasons. The calibration models, trained with 70 % for modeling, 15 % for validation, and 15 % for testing, demonstrated robustness with CO2 and CH4 predictions achieving R2 values from 0.8781 to 0.9827 and 0.7312 to 0.9410, and mean absolute errors ranging from 3.76 to 1.95 ppm and 0.03 to 0.01 ppm, for CO2 and CH4, respectively. These promising results pave the way for extending these stations to monitor additional air contaminants, like PM, NOx, and CO through the same calibration process, integrating them with remote data transmission modules to facilitate real-time access, control, and processing for end-users.

Multicentric Italian case-control study on 25OH vitamin D levels in children and adolescents with Prader-Willi syndrome.

PURPOSE: 25OHD levels in patients with Prader-Willi Syndrome (PWS), the most frequent cause of genetic obesity with a peculiar fat mass distribution, are still debated. Insulin resistance (IR), Body Mass Index-SDS (BMI-SDS), Growth Hormone Therapy (GHT), and puberty onset seem to interact with 25OHD levels. The objectives of the study are: (1) To analyze 25OHD levels in pediatric PWS patients in comparison with a control group (CNT) (2) To evaluate a possible correlation between BMI-SDS, HOMA-IR, puberty, GHT, and 25OHD levels. METHODS: This is a retrospective case-control, multicenter study. Data were collected among 8 different Italian Hospitals (outpatient clinics), over a period of four years (2016-2020). We included 192 genetically confirmed PWS and 192 CNT patients, aged 3-18 years, matched 1:1 for age, gender, BMI-SDS, Tanner stage, sun exposure, and month of recruitment. RESULTS: No statistically significant differences in 25OHD levels were observed between the PWS population and the CNT (PWS 24.0 ng/mL vs CNT 22.5 ng/mL, p > 0.05), OR = 0.89 (95% CI 0.58-1.35). We observed a slight, although non-significant, reduction in 25OHD levels comparing NW and OB populations. HOMA-IR, puberty onset, genotype and GHT (previous or ongoing) did not show statistically significant correlation with 25OHD levels. CONCLUSIONS: Our findings could be useful for clinicians to optimize the therapeutic management as well as to increase awareness of PWS.

Kambo: Natural drug or potential toxic agent? A literature review of acute poisoning cases.

Kambo is the name of a natural substance derived from the glandular secretions of the amphibian Phyllomedusa bicolor, a species native to regions in South America. The communities living in these areas administer the substance generally transdermally during rituals for religious-purifying purposes, producing small skin burns. The scientific literature has reported some cases of intoxication following the use of Kambo but this aspect is still poorly understood. In fact, no shared therapy protocols exist for these events nor any real legislation on Kambo. The purpose of this work was to examine all cases of acute intoxication resulting from the administration of Kambo and published over the last 10 years, illustrating clinical signs, laboratory findings, instrumental tests, and therapy. The several cases identified in our review confirm that acute Kambo intoxication can occur, with serious and life-threatening effects. We developed a protocol aimed at the early diagnosis of cases of suspected acute intoxication by creating a treatment algorithm. The study aims to investigate the pathophysiology of these events in humans, proposing a protocol for the diagnosis and treatment of these cases that can be used by healthcare professionals.

Virtual reality for COPD rehabilitation: a technological perspective.

Virtual Reality (VR) is a promising technology for implementing personalized, motivating and controlled rehabilitation scenarios. Although its clear potential benefits, VR has been poorly investigated in pulmonary rehabilitation. This review analyses the state of the art, by searching the scientific and grey literature, regarding the use of VR for the rehabilitation of patients with chronic obstructive pulmonary disease, providing a technological perspective. First, the main characteristics of the included systems are presented in terms of visualization devices, way of interaction and type of feedback they provide. Then, results of the selected studies are reported considering feasibility, safety, usability and user experience as outcomes. Finally, the main findings are discussed and future directions for research are outlined.

Lymphadenectomy for gastric cancer at European specialist centres.

BACKGROUND AND AIMS: The aim of this project was to evaluate the current practice of D2 in Europe. MATERIALS AND METHODS: In the first part of the study, 18 European high volume gastric cancer centres completed a questionnaire, designed to evaluate their preferred lymphadenectomy in a series of clinical scenarios. Surgeon compliance with international guidelines for lymphadenectomy was evaluated. In the second part, information on 381 gastrectomies performed for primary gastric cancer by participating surgeons from January to December 2015, was retrospectively collected. RESULTS: Surgical choice in clinical scenarios was affected by tumour stage and to a lesser extent, site and histotype. In particular, in early gastric cancer with diffuse histology D2 was recommended by >70% of surgeons, while this percentage dropped to 44% in intestinal histotypes. When surgeons selected a D2 dissection, the procedure was rarely fully compliant with the Japanese guidelines. In the review of gastrectomy experience an adequate number of nodes (≥15 nodes) was retrieved in 97% after D2. The number of retrieved nodes varied with median values ranging from 17 to 35 (p < 0.001) after D2. D2/D2+ was more frequently performed in mixed (80%) and diffuse (78%) cases than in intestinal cases (69%) (p = 0.016). CONCLUSIONS: Although an adequate lymphadenectomy was achieved in almost all cases in dedicated centres, there is still variation in the number of retrieved nodes. Tumor histology largely affects surgeon's choice as regards the extent of lymphadenectomy; however, the role of histology in planning surgical procedures needs to be verified in prospective trials.

A forensic case of erosive cystitis and septic pulmonary embolism: is there a correlation?

Septic pulmonary embolism (SPE) is an uncommon disease in which a microorganism- containing thrombus causes an inflammatory reaction and a mechanical obstruction in the vascular system of the lungs. Usually it is associated with tricuspid valve vegetation, septic thrombophlebitis or infected venous catheters. We present a rare and fatal case of massive septic pulmonary thromboembolism occurred in a diabetic woman, who complained in previous days dyspnoea, abdominal pain and nausea. Autopsy findings showed evidence of an erosive cystitis, while lungs examination showed total occlusion of pulmonary circulation system due to thrombo-embolic clots. In literature cases report about an association between septic pulmonary thromboembolism and erosive cystitis haven't been reported. So, we here show the first reported fatal case of a septic pulmonary thromboembolism as a lethal evolution of an erosive cystitis.

The use of scanning electron microscopy and energy dispersive X-ray spectroscopy in a case of occupational death.

Scanning electron microscopy is a technique that provides high-resolution images at the micro- and nano-scale. The combination of scanning electron microscopy and energy dispersive X-ray spectroscopy analysis is developing fast for application in forensic science. In this work, we report a case of work-related traumatic death of a 50-year-old man. The autopsy showed cranial fractures with cerebral haemorrhage. It was more difficult to understand the accident dynamics because the body had been shifted from the accident site to mask what had really taken place. Scanning electron microscopy/energy dispersive X-ray spectroscopy was used to identify the material of the impacting tool and to establish the possible legal responsibility of the employer. In this study, we demonstrate that scanning electron microscopy/energy dispersive X-ray spectroscopy is a useful forensic tool for the analysis of biological samples. Further, for studying the lacerations on the corpse from doubtful blunt tools, scanning electron microscopy/energy dispersive X-ray spectroscopy can assist in demonstrating that the scene has been falsified, as it was in this case.

The "Social-mobile autopsy": The evolution of psychological autopsy with new technologies in forensic investigations on suicide.

Suicide is a huge deal in general public health, representing the second cause of mortality in young people worldwide. The suicidal setting analysis is usually performed through psychological autopsy, a method of investigation commonly used to study what leads to suicide. Psychological autopsy, though, requires the involvement of family and friends, or the finding of a diary or a suicide note. Nowadays, this is not always possible, especially during adolescence, the more if we consider new categories of people that are more used to live in a web dimension, than in a real one. So, with the advent of a new kind of social system including the web, psychological autopsy, as we know it, is not enough to determine the setting of an event. We here report the case of a 17-year old girl who committed suicide by hanging down from her house, leaving no suicide note. We propose a new investigation method developed through the analysis of phone messages and Facebook profile in order to better reconstruct the event. Although the standing difficulties in reconsidering the intimate motivations leading to such a decision, psychological autopsy nowadays needs to consider also social networks in order to prevent similar situations and even reconstruct the psychological dimension of the fact. We propose a model of Social-mobile autopsy.

Response to Alpha-Interferon Treatment of the Congenital Dyserythropoietic Anemia type I in Two Sicilian Beta Thalassemia Carriers.

Congenital dyserythropoietic anemia type I (CDAI) is an autosomal recessive inherited haematological disorder associated with moderate-to-severe anemia characterized by ineffective erythropoiesis with distinct morphological abnormalities in erythroid precursors. We present two case of congenital dyserythropoietic anemia type I in two Sicilian patients heterozygous for ß0 39 globin gene cod 39 C > T with marked bone marrow abnormalities, responding to treatment with alpha interferon. The diagnosis was established using routine haematological and biochemical test, light and electron microscopy; molecular analysis of the CDAN1 gene associated to the CDAI disease was performed. The response to the treatment was monitored using the hemoglobin levels, the red cell count, the reticulocyte count and the transfusional requirement. This report points out the usefulness of the treatment with interferon alpha in two Sicilian beta thalassemia carriers, in which the therapy was well tolerated without producing any side effects; in these patients the transfusion requirements after the initiation of interferon therapy decreased.

Comparison Between Rapid Intraoperative and Central Laboratory Parathormone Dosage in 12 Kidney Transplant Candidates.

BACKGROUND: The rapid intraoperative parathormone (PTH) and at central laboratory PTH dosage gives similar results. The central laboratory provides results in longer times and higher costs. Intraoperative measurement can reduce time and costs during parathyroidectomy. METHODS: Twelve patients undergoing parathyroidectomy for hyperparathyroidism renal transplant candidates were included. Diagnosis was made by laboratory tests (serum calcium, PTH) and imaging techniques (ultrasonography and scintigraphy). All patients presented PTH levels of >400 pg/mL (the limit value to be maintained in list for kidney transplantation) and resistant to medical therapy. For each patient, 2 blood samples were collected before surgery at anesthesia induction for PTH testing intraoperative (rapid assay) and central laboratory, and 10 minutes after the removal of each gland. The times from collection-processing to communication to the surgeon of the results were compared for both the methods. It was considered successful the abatement of PTH of ≥70% at rapid intraoperative testing and consequently surgical intervention stopped before communication of central laboratory PTH testing. RESULTS: The average time of reporting the test results of the central laboratory was 41.5 minutes (SD ± 9), whereas with the rapid intraoperative PTH (ioPTH) testing the average time was 9.9 minutes (SD ± 2.02). An average of 33.6 minutes of the duration per intervention (SD ± 10.27) were virtually saved with the use of ioPTH testing. The 2 values of the Pearson correlation (ρ) of 0.99 obtained (for baseline) and 0.975 (for the 10-minute) lead us to conclude that there is an excellent correlation between the series of data. CONCLUSIONS: Rapid ioPTH testing, owing to its accuracy, permits a dramatic reduction of operating time for patients with secondary hyperparathyroidism that need to be treated before inclusion on the waiting list.

Stable isotope ratio analysis for verifying the authenticity of balsamic and wine vinegar.

In this paper, we investigate whether the analysis of stable isotope ratios D/H and ¹³C/¹²C in ethanol and acetic acid and of ¹8O/¹6O in water can be applied to the ingredients of "aceto balsamico di Modena IGP" (ABM) to evaluate their authenticity. We found that impurities in the extraction solution do not affect the ¹³C/¹²C of acetic acid and the D/H values of acetic acid are not affected under a composite NMR experiment. The standard deviation of repeatability and standard deviation of reproducibility are comparable in wine vinegar and ABM and generally lower than those quoted in the official methods. This means that the validation parameters quoted in the official methods can also be applied to the ingredients of ABM. In addition, we found no changes in the isotopic values from wine to vinegar and to ABM, and from the original must to the ABM must, providing experimental evidence that reference data from wine databanks can also be used to evaluate the authenticity of vinegar and ABM.

Chronic pain management in pregnancy and lactation.

During pregnancy most of women will experience some kind of pain, either as a result of a pre-existing condition (low back pain, headache, fibromyalgia, and rheumatoid arthritis) or as a direct consequence of pregnancy (weight gain, postural changes, pelvic floor dysfunction, hormonal factors). However, chronic pain management during pregnancy and lactation remains a challenge for clinicians and pregnant women are at risk of undertreatment for painful conditions, because of fear about use of drugs during pregnancy. Few analgesic drugs have been demonstrated to be absolutely contraindicated during pregnancy and breastfeeding, but studies in pregnant women are not available for most of pain medications. The aim of this paper is to review the safety profile in pregnancy or lactation of the commonly prescribed pain medications and non-pharmacological treatments. In addition to the conventional classifications from the Food and Drug Administration and the American Academy of Paediatrics, authors analyzed the currently available clinical data from literature.

Birth weight, rapid weight gain in infancy and markers of overweight and obesity in childhood.

OBJECTIVE: To evaluate the relationship between birth weight and rapid weight gain in infancy and markers of overweight/obesity in childhood, using different cutoff values for rapid weight gain. SUBJECTS/METHODS: Cross-sectional study involving 98 5-year old pre-school Brazilian children. Rapid weight gain was considered as weight gain in standard deviation score (SDS) above +0.67, +1 and +2 in relation to birth weight, at any time during the first 2 years of life. The nutritional status of the children was determined by anthropometry and electrical bioimpedance. Multiple linear regression analysis was used, considering fat mass percentage, body mass index (BMI), waist and neck circumferences as outcomes. RESULTS: Birth weight, rapid weight gain (assessed by different cutoff values) and maternal obesity were positively associated with increased fat mass percentage, BMI, waist and neck circumferences. Different cutoff values of rapid weight gain did not change the positive associations between rapid weight gain and fat mass percentage (>+0.67 SDS, P=0.007; >+1 SDS, P=0.007; >+2 SDS, P=0.01), BMI (>+0.67 SDS, P=0.002; >+1 SDS, P=0.007; >+2 SDS, P<0.001), waist circumference (>+0.67 SDS, P=0.002; >+1 SDS, P=0.002; >+2 SDS, P<0.001) and neck circumference (>+0.67 SDS, P=0.01; >+1 SDS, P=0.03; >+2 SDS, P<0.001). CONCLUSIONS: The use of different cutoff values for the definition of rapid weight gain did not interfere in the associations between birth weight and rapid weight gain with fat mass percentage, BMI, waist and neck circumferences. Children with the highest birth weight, those who undergo rapid weight gain in infancy and whose mothers were obese, seemed to be more at risk for overweight/obesity.