Rossana Cecchi

Estimating wound age: looking into the future

A critical review is made of the studies on wound healing used for forensic purposes, focusing on the problem of which characteristics indicate that a parameter could be used as evidence in court. A panel analysing the more important information obtained by each marker is given, and a perspective of what might be expected from future research is discussed.

Bio-medicolegal scientific research in Europe: a comprehensive bibliometric overview.

In times of globalisation, the future of bio-medicolegal sciences in Europe depends on the scientific community’s ability to develop new strategies for research, to introduce new and generally accepted standards, to develop new analytical methods, all in order to draw up inter-site, multidisciplinary and interdisciplinary long-term research projects, eligible for European Union (EU) funding. To analyse the scientific output and to identify the topics of greatest interest and appeal in these sciences, an innovative method has been developed to select and analyse publications. This method has been applied to analyse a total of 21,176 records from PubMed out of which 5,826 papers were suitable for further analysis because they were published in national and international journals in the time between January 1, 2005 and June 1, 2010 by European authors in the field of interest. In 69% of all manuscripts, authors presented results of systematic research (original articles); 84% of the papers were written in English language. The cumulative impact factor increased from 1,670 points in 2005 to 1,878 in 2009, and extrapolated 2,812 points in 2010. The most frequent topics were the description of new analytical methods in forensic toxicology (5.7% of all papers), the analysis of short tandem repeat systems (STR, 5.6%) as well as the analysis of injury mechanisms in forensic pathology and clinical forensic medicine (4.9%). If the impact factor related potential of different topics is calculated (ratio of frequency of papers and frequency of impact points achieved), SIDS research reaches 1.64 points, followed by studies on mtDNA (1.59) and the development of new analytical methods in forensic toxicology (1.49). The findings made in the present bibliometric analysis reveal a clear and interesting overall picture of the European scientific production and productivity and could be used to identify the most innovative research lines.

Bio-medicolegal guidelines and protocols: survey and future perspectives in Europe

The preservation of uniqueness and the enhancement of the value of evidence in legal medicine is based on the implementation and development of a “quality management system,” which includes a continuous education of specialists, the introduction and application of guidelines and protocols, as well as mechanisms of internal quality control. This ongoing process shows differences with regard to various fields of knowledge such as forensic genetics, toxicology, forensic pathology or forensic psychiatry, especially if different European countries are compared. To get an overview on the development of legal medicine in different European countries, a questionnaire was developed and sent to representatives of 42 European countries to verify the existence of bio-medicolegal guidelines and protocols. A National Society of Legal Medicine is established in 27 out of 32 countries (84%) which could be included in the final analyses. In 25 countries (78%), a specialisation is necessary as a prerequisite of inclusion in a national register, and 30 of the countries (94%) have guidelines in at least one field of legal medicine. The most common guidelines concern forensic pathology (in the fields of professional qualification and sudden death), forensic toxicology (driving under the influence of drugs and substance testing) and forensic genetics (paternity testing and personal identification). The findings of this study show that comparison is possible and can be a basis for further consensus in the European medicolegal community. The process of harmonisation of the medicolegal autopsy rules in Europe initiated in 1990 was a first step on this way. Further consensus is necessary and might be gained by developing European guidelines for each field within the subdisciplines, based on a standard European Guideline Format.

Journals publishing bio-medicolegal research in Europe.

Fragmentation of bio-medicolegal knowledge has led to a proliferation of ultra-specialised sub-disciplines and branches, often published in ‘field-oriented’ scientific journals.The aim of this work is to provide an in-depth analytical picture of bio-medicolegal sources of publication, within and outside the traditional conception of legal medicine. An extensive search of bio-medicolegal articles published in the last five and a half years was performed on the MEDLINE database according to MeSH terms combined with free-text protocols. We performed a systematic analysis of targeted journals after merging, selecting and categorising all retrieved records, taking into account data from the 2009 JCR Science Edition (released on June 2010); 1,037 different journals were identified, of which only 48 (4.6%) focus specifically on bio-medicolegal matters, and of which only seven (14.6%) have an impact factor (IF). Despite this apparent dispersion, 47% of articles were published in bio-medicolegal journals (BML), of which 70.2% were in journals with IF (BML-IF). Articles published in BML-IF journals (33% of total papers) reach almost 50%, mainly in “Forensic Science International”, “International Journal of Legal Medicine” and “Journal of Forensic Sciences”. Instead, publications in not specifically bio-medicolegal journals (Not BML-IF) are greatly scattered and even fragmented in about 650 journals.The sub-disciplines that appear most frequently in Not BML-IF rather than BML-IF journals are Forensic Psychiatry (48.2% vs. 5.1%), Criminology (37.1% vs. 8.3%), Malpractice (50.7% vs. 4.0%), Medical Law and Ethics (46.4% vs. 6.9%) and Clinical Forensic Medicine (39.5% vs. 21.3%). The proposed bibliometric analysis revealed the preference of Forensic Pathology, Criminalistics (Biological), Forensic Genetics, Forensic Anthropology and Forensic Entomology for journals traditionally considered pertinent to the medico-legal discipline, with a considerable dispersion involving Toxicology, Psychiatry, Criminology and Malpractice, which were published in less well-known journals. This dispersion could be reduced adapting specialised forensic sections and increasing the IF of forensic journals, in order to respond suitably to the present demand for visibility by bio-medicolegal scientists, clearly oriented towards enhancing the objective impact of their curricula and attempting to attract funding to their research projects.

Development of Micro-Grippers for Tissue and Cell Manipulation with Direct Morphological Comparison

Although tissue and cell manipulation nowadays is a common task in biomedical analysis, there are still many different ways to accomplish it, most of which are still not sufficiently general, inexpensive, accurate, efficient or effective. Several problems arise both for in vivo or in vitro analysis, such as the maximum overall size of the device and the gripper jaws (like in minimally-invasive open biopsy) or very limited manipulating capability, degrees of freedom or dexterity (like in tissues or cell-handling operations). This paper presents a new approach to tissue and cell manipulation, which employs a conceptually new conjugate surfaces flexure hinge (CSFH) silicon MEMS-based technology micro-gripper that solves most of the above-mentioned problems. The article describes all of the phases of the development, including topology conception, structural design, simulation, construction, actuation testing and in vitro observation. The latter phase deals with the assessment of the function capability, which consists of taking a series of in vitro images by optical microscopy. They offer a direct morphological comparison between the gripper and a variety of tissues.

Fatal thromboembolism following physical restraint in a patient with schizophrenia

Fatal thromboembolism during physical restraint in patients suffering from psychotic disorders is a very rare occurrence. In the case we present here, the criteria used in forensic pathology for the age determination of venous thrombi are applied to a case of pulmonary embolism in a patient suffering from schizophrenia who died after physical restraint. The possible association between conventional antipsychotic drugs and deep venous thrombosis, followed by pulmonary embolism, in a man with no predisposing risk factors, as well as the question concerning the appropriateness of medical care, are discussed.

The diagnosis of fatal pulmonary fat embolism using quantitative morphometry and confocal laser scanning microscopy

The postmortem diagnosis of fat embolism syndrome (FES), traditionally based on the histological demonstration of fat globules, needs a quantitative analysis of both the size and localization of the fat emboli, which is essential for a reliable grading of the pulmonary fat embolism. The clinical data and the autopsy records of 2738 autopsies were retrospectively evaluated, and 21 cases in which FES was pointed out as cause of death were selected and compared with 21 fatal cases referred to as major trauma in which the cause of death was not attributed to fat embolism, and with 47 fatal cases as control group, respectively. The following parameters were investigated: the total area of the embolized tissue; the total number of emboli; the mean area of the emboli; the mean percentage of the embolized tissue area as compared with the total tissue area of each sample; the total percentage of the embolized tissue area as compared with the total tissue area of all slides. The most reliable parameters seem to be the ratio between embolized tissue areas as compared with the total tissue area of each sample. These parameters showed a good correlation with the clinical data.

Markers of mechanical asphyxia: immunohistochemical study on autoptic lung tissues

Forensic pathologists are often asked to provide evidence of asphyxia death in the trial and a histological marker of asphyxiation would be of great help. Data from the literature indicate that the reaction of lung tissue cells to asphyxia may be of more interest for forensic purposes than migrating cells. The lungs of 62 medico-legal autopsy cases, 34 acute mechanical asphyxia (AMA), and 28 control cases (CC), were immunostained with anti-P-selectin, anti-E-selectin, anti-SP-A, and anti-HIF1-α antibodies, in order to verify if some of them may be used as markers of asphyxia death. Results show that P- and E-selectins expression in lung vessels, being activated by several types of trigger stimuli not specific to hypoxia, cannot be used as indicator of asphyxia. Intra-alveolar granular deposits of SP-A seem to be related to an intense hypoxic stimulus, and when massively present, they can suggest, together with other elements, a severe hypoxia as the mechanism of death. HIF1-α was expressed in small-, medium-, and large-caliber lung vessels of the vast majority of mechanical asphyxia deaths and CO intoxications, with the number and intensity of positive-stained vessels increasing with the duration of the hypoxia. Although further confirmation studies are required, these preliminary data indicate an interesting potential utility of HIF1-α as a screening test for asphyxia deaths.

Death due to crush injuries in a compactor truck: vitality assessment by immunohistochemistry

We present a case in which the timing of injuries was requested to determine whether the death of a man found in a landfill was due to homicide or accident. The use of immunohistochemistry to detect P-selectin and E-selectin on endothelial cells of vessels in damaged skin samples, and compare them with intact skin samples, as well as the presence of lung adipose embolism provide information on the timing of the injury, thereby helping substantially to identify the dynamics of death.

Pulmonary embolisation of bone fragments from penetrating cranial gunshot wounds

Bone embolism is a very rare event that usually occurs in trauma-induced septic bone lesions, after bone surgery or after bone marrow transplantation, and normally remains silent. To our knowledge, there are no previous reports of bone embolism after a gunshot to the head. We describe a case of pulmonary embolism associated with bone fragments after a gunshot to the head in which bone fragments surrounded by leukocytes, interstitial and intra-alveolar oedema and haemorrhage around the embolised vessels, leukostasis and fat and bone marrow embolism suggest that the survival time from the gunshot was sufficiently long to allow changes in lung microcirculation and lung tissue.