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Bones and teeth represent a common finding in ancient DNA studies and in forensic casework, even after a long burial. Genetic typing is the gold standard for the personal identification of skeletal remains, but there are two main factors involved in the successful DNA typing of such samples: (1) the set-up of an efficient DNA extraction method; (2) the identification of the most suitable skeletal element for the downstream genetic analyses. In this paper, a protocol based on the processing of 0.5 g of bone powder decalcified using Na2EDTA proved to be suitable for a semi-automated DNA extraction workflow using the Maxwell® FSC DNA IQ™ Casework Kit (Promega, Madison, WI, USA). The performance of this method in terms of DNA recovery and quality was compared with a full demineralisation extraction protocol based on Qiagen technology and kits. No statistically significant differences were scored according to the DNA recovery and DNA degradation index (p-values ≥ 0.176; r ≥ 0.907). This new DNA extraction protocol was applied to 88 bone samples (41 femurs, 19 petrous bones, 12 metacarpals and 16 molars) allegedly belonging to 27 World War II Italian soldiers found in a mass grave on the isle of Cres (Croatia). The results of the qPCR performed by the Quantifiler Human DNA Quantification kit showed values above the lowest Limit of Quantification (lLOQ; 23 pg/µL) for all petrous bones, whereas other bone types showed, in most cases, lower amounts of DNA. Replicate STR-CE analyses showed successful typing (that is, >12 markers) in all tests on the petrous bones, followed by the metacarpals (83.3%), femurs (52.2%) and teeth (20.0%). Full profiles (22/22 autosomal markers) were achieved mainly in the petrous bones (84.2%), followed by the metacarpals (41.7%). Stochastic amplification artefacts such as drop-outs or drop-ins occurred with a frequency of 1.9% in the petrous bones, whereas they were higher when the DNA recovered from other bone elements was amplified (up to 13.9% in the femurs). Overall, the results of this study confirm that petrous bone outperforms other bone elements in terms of the quantity and quality of the recovered DNA; for this reason, if available, it should always be preferred for genetic testing. In addition, our results highlight the need for accurate planning of the DVI operation, which should be carried out by a multi-disciplinary team, and the tricky issue of identifying other suitable skeletal elements for genetic testing. Overall, the results presented in this paper support the need to adopt preanalytical strategies positively related to the successful genetic testing of aged skeletal remains in order to reduce costs and the time of analysis. [ABSTRACT FROM AUTHOR]

Nail gun injuries are a forensic problem; it can be difficult to distinguish self-inflicted injuries from accident and homicide instances. This kind of injuries shares some characteristics with both gunshot and puncture wounds. We describe a peculiar case of a man who committed suicide driving nails into his skull using a pneumatic nail gun. Entrance wounds were found on both temporal regions of the head. Reviewing scientific literature, this is the first case in Italy reporting the macroscopic data of bilateral head and brain nail gun injuries during an autopsy. Circumstantial elements were not sufficient to clarify if these lesions were self-inflicted, inflicted by accident, or else. Radiological examination can be helpful to show the exact location of the nails, but it has also its own limitations. We firmly believe that autopsy, especially the head section, is crucial to identify the nature and the extension of these lesions, thus giving us much more information about the mechanism of death and the circumstances in which it occurred. [ABSTRACT FROM AUTHOR]

The study of bite marks provides crucial elements that contribute towards identifying the biter. In many cases, it assumes importance when bite marks are detected on the body of a victim of violence, but it could also be relevant when the bite marks are seen on food substances at the crime scene. In both circumstances, comparing the bite marks with a suspect's dentition can be decisive in confirming or excluding the culpability. In this case report, a bun (bread roll) with the sign of a bite was found at the crime scene. We report a pilot study using 3D reproduction of the bite mark on the bun and dental models of the alleged biter and the victim. A reverse engineering process was used to obtain digital 3D models of the bitten bun and the dental models by taking numerous photographs and stitching them together using a software called Metashape by Agisoft. The last step was to compare the bitemark to the two dental models, evaluating the spatial distance, the degree of overlap, and the degree of interpenetration. The results confirmed the usefulness of reverse engineering in forensic investigations showing the compatibility between the victim's teeth and the bite mark on the bun. [ABSTRACT FROM AUTHOR]

Historically, the law, dental and forensic literature has included numerous articles concerning abused children. The orofacial structures are injured frequently in the maltreated child. Injuries of the neck, head, face, and oral cavity represent the most affected areas of the victim's body that routinely sustain physical trauma in child maltreatment cases. This literature review aimed to report the state of art of child abuse from the point of view of the dentist with focus on studies in dental aspects of child abuse and neglect of the last ten years. Considering the time slot, 20 papers were included with the following inclusion criteria: papers published in English, all keywords included in the title, articles available on PubMed. Many of the injuries are within the scope of dentistry or easily observed by the dental professional during routine dental treatment, and it is essential that the dentist recognizes them. Concerning neglect, it is appropriate to make a distinction between deliberate parental behavior that has the consequence of unavoidable and voluntary neglect towards their children and those conditions of involuntary carelessness determined by socio-economic and cultural factors such as family isolation, lack of finances, parental ignorance, or lack of perceived value of oral health. Therefore, it is relevant that the dentist pays attention to the cases to report and those that only need help. [ABSTRACT FROM AUTHOR]

Background: Child abuse represents an important issue in the medico-legal and social context. In the last few decades, various aspects and mechanisms have been identified in child abuse case studies; however, constant research is needed in the field. With this paper, the authors will present a case of a new entity of Abusive Head Trauma that has come to the attention of medico-legal experts. Discussion: The trauma analysis performed on the cranio-encephalic district of the baby revealed quite peculiar lesions that led the authors to exclude that the injuries had been solely caused by violent shaking of the baby's head, as suggested by Shaken Baby Syndrome. Instead, the authors hypothesised that another lesion mechanism had been added to this one, namely latero-lateral cranial compression. The comprehensive and exhaustive analysis of the case led the authors to present a new possible entity in child abuse trauma, namely 'Compressed Baby Head'. Conclusions: To the best of our knowledge, in the current literature, no similar clinical cases have ever been described. Thus, the case's uniqueness deserves to be brought to the attention of experts and the entire scientific community, as well as medical personnel, paediatricians, and reanimators. These professional figures are the first individuals who may encounter complex clinical cases such as the one presented in this paper; thus, they need to know how to properly manage the case and ensure protection for the abused infants and children. [ABSTRACT FROM AUTHOR]

Introduction: In fatal accidents during scuba diving, it is necessary to differentiate a death from primary drowning from a secondary drowning death that is primarily due to other etiopathogenetic factors. The inhalation of water can only be the end point of a series of events capable of causing the diver’s exitus. This study aims to demonstrate that even low-risk heart disease in daily life become potentially fatal during scuba diving. Methods: In this case series, we describe all cases of deaths in the course of diving that came to the observation of the Forensic Institute of the University Bari over 20 years (2000-2020). A judicial autopsy was performed on all subjects, with ancillary execution of histological and toxicological investigations. Results: The results of the medicolegal investigations carried out in the complex identified heart failure with acute myocardial infarction as the cause of death in four cases characterized by severe myocardiocoronarosclerosis, a primary drowning in a subject without previous pathological substrate in one case, and a terminal atrial fibrillation induced by acute dynamic heart failure due to functional overload of the right ventricle in one case Conclusion: Our study demonstrates that lethal events during diving are often related to the presence of unrecognized or subclinical cardiovascular diseases. Such deaths could be prevented and avoided if a greater regulatory sensitivity to preventing and controlling diving was encouraged, considering both the inherent risks of this activity and the possible unrecognized or underestimated pathologies. [ABSTRACT FROM AUTHOR]

While denial of pregnancy and neonaticide are rare, they are potentially associated and share some risk factors. Neonaticide has been proposed as the extreme outcome of a denial of pregnancy. However, the process leading to such a possible outcome is not yet fully understood. The primary goal of this essay is to examine the various definitions and ambiguities surrounding the denial of pregnancy. The case of a young woman with a history of two denied pregnancies with diverse characteristics and outcomes, the latest of which resulted in neonaticide, is then reported and examined. A forensic psychiatric evaluation was also performed to reconstruct the woman's mental state at the time of the crime. The forensic pathological analysis of the newborn, abandoned near the sea while still alive, is described. The victim's body showed signs of shaken baby syndrome. We contend that differing levels of awareness during a denial of pregnancy might not be predictive of the potential delivery outcome in terms of threat to the newborn's survival, according to the forensic pathological and psychopathological data of the current case. Early identification of women affected by denial of pregnancy who pose a danger of committing infanticide is hampered by both intrinsic traits (dissimulation, unawareness, low propensity to seek assistance) and environmental factors (isolation, low socioeconomic level, poor education.). A previous history of denial of pregnancy should activate health and support services to reduce the potential risks for the mother and the child. [ABSTRACT FROM AUTHOR]

Since the beginning of the COVID-19 public health emergency, we have witnessed an increase in psychiatric problems and pathologies, such as depression, anxiety, isolation, posttraumatic stress disorder, substance abuse, and burnout. The world's collective sentiment finally turned toward optimism after authorization was granted for the COVID-19 vaccines' emergency use by the FDA in December 2020. With the increase in vaccine coverage in Western countries, case counts and deaths gradually plummeted while activity restrictions were progressively lifted. At the same time, however, a new COVID-19-related public health issue has arisen, as a substantial number of eligible individuals refused vaccination. Behaviors assumed by the so-called anti-vax people in manifesting their own opposition towards COVID-19 vaccination are various, and sometimes assume the forms of dramatic gestures with symbolic value, such as suicide. Here, we present the case of a healthy, convinced anti-vax, 58-year-old man, who allowed himself to be run over by a moving train in the presence of eyewitnesses, bringing with him a demonstrative note of his reasons. The present article aims to raise awareness against the social and psychological impact of COVID-19 vaccination refusal and to point out the need of a specific support net to avoid the spread of psychological impairment, social isolation and suicidal behaviors among the "anti-vax community". [ABSTRACT FROM AUTHOR]

In case of thoracoabdominal gunshot wounds (GSW), diaphragmatic lesions are common autopsy findings. In these cases, the bullet's path involves both the thorax and the abdomen, so the diaphragm (the muscle that separates the two cavities) is frequently damaged. In the present report we illustrate a very unusual autopsy finding, came up after a man was shot twice and affected by a lethal thoracoabdominal gunshot wound. In particular, as expected based on CT scans, the corpse exhibited a thoracic-abdominal path and a retained bullet in the abdomen, but no diaphragmatic lesions or hemorrhagic infiltrations of this muscle have been detected during the autopsy. After a scrupulous examination and the section of all the organs, the intracorporeal projectile's path was reconstructed, inferring that the thoracoabdominal transit of the bullet extraordinarily had occurred in correspondence of the diaphragmatic inferior vena cava's ostium, thus exploiting a natural passage without damaging the diaphragmatic muscle. [ABSTRACT FROM AUTHOR]

The aim of this study was to collect soft tissue thickness (STT) values of an Italian population from 12 bone landmarks, to improve the facial approximation process for identification purposes. 100 Italian adults (50 males and 50 females), who had undergone head CT for clinical purposes, were analysed in order to expand the database of the Italian population. Average values, standard deviation and range were collected according to gender and age and the obtained values were statistically analysed in order to evaluate any possible significant difference. Only one landmark was statistically significant associated with sex, females showed significantly higher values for para-zygomaxillary. Two landmarks were statistically significant associated with age, upper incisor and pogonion. The obtained results were compared with the existing literature. Such information can be useful in the forensic craniofacial reconstruction process and can facilitate choosing the most suitable STT values according to osteological analysis of the human remains. [ABSTRACT FROM AUTHOR]

Autoerotic asphyxia is defined as a self-induced cerebral anoxia in an autoerotic context. This practice is used to induce a state of hypoxia to elicit or enhance sexual excitement and orgasm. Autoerotic deaths are very rare events and include different mechanism such as asphyxia by hanging, ligature or electrocution, overdressing wrapping and more. According to the literature, male subjects are reported as the main victims of these events. In this paper we describe an interesting case of a 54-year-old Italian man, who accidentally deceased by placing a hemp rope around his neck during autoerotic asphyxial activities. The rope examination revealed an interesting safety mechanism: a means to adjust its diameter through a supplementary rope. [ABSTRACT FROM AUTHOR]

Since the beginning of March 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been the cause of millions of deaths worldwide. The need to better define the pathogenesis of coronavirus disease 19 (Covid-19) as well as to provide the correct statistical records concerning deaths related to this virus, inevitably involves the role of forensic pathology and routine autopsy practice. Currently, some data on macroscopic and microscopic features in autopsies performed in suspected Covid-19 cases are reported in the literature. The persistence of SARS-CoV-2 in cadavers has not yet been elucidated and only a few reports have emphasized the importance of evaluating the Virus RNA in post-mortem tissues. In this preliminary study, we observed that SARS-CoV-2 survives in multiple cadaver tissues many days after death despite some extreme conditions of post-mortem body preservation. The results of this on-going analysis could help improve the safety of working practices for pathologists as well as understanding the possible interaction between microbiological agents and the cadaver tissue's supravital reactions. [ABSTRACT FROM AUTHOR]

The usefulness of teeth for personal identification lies mainly in their vast individual variability, making them virtually unique for every subject. Odontological identification represents a reliable and important complement to forensic inquiries, in particular in the event of unidentifiable human remains. However, this technique is based on the availability of antemortem records containing significant evidence. In the absence of dental records, the only available ante-mortem elements are often photographs. In the present study, dental profile photographs of selected smiling subjects were compared to the relevant plaster study models through digital image analysis. In order to ascertain the reliability of the technique, the comparison was carried out both in a homologous and heterologous manner with the Facecomp software. The results confirm the ability of Facecomp software to identify even the smallest variations in dental elements to reach a positive identification. The method is useful in forensic practice since a forensic inquiry may obtain plaster models from cadavers for comparison with photographs of missing people's anterior teeth. [ABSTRACT FROM AUTHOR]

Age estimation of nonliving subjects plays a very important role in identifying human remains. When adult remains are in question, this process becomes even more complex. Among the numerous dental methods that exist for adults aging, the evaluation of root translucency is one of the most useful. This study studies the correlation between age and root translucency by investigating monoradicular teeth affected by pathological processes using the equations proposed by Lamendin, Prince & Ubelaker and from Singhal et al. The average age values calculated according to the three methods were compared with the values of known age. Age estimation using the Student's t-test resulted as more accurate in the methods by Singhal et al. and by Prince & Ubelaker, with respect to that of Lamendin. Age estimation based solely on the percentage of radicular dentinal translucency has been found to be more accurate when diseased teeth are involved. [ABSTRACT FROM AUTHOR]

On March 1997, during a naval blockade imposed by Italy to prevent illegal immigration, the motorboat Kater Radez I full of Albanian refugees clashed with an Italian warship with 120 people approximately on board. The boat sank quickly after the collision just in the middle of the Otranto Canal (Mediterranean Sea). Only 34 individuals survived the accident; 58 died, mostly women and children, and dozens were missing. After 7 months spent at depth of 800 m approximately underwater to constant temperature of 4 °C, the motorboat was rescued, and totally, 52 bodies were recovered from the holds. The management of the mass disaster is summarized focusing on the procedures applied in the recovery of the boat and victims, and the identification process. The purpose of the article is to present the unique taphonomic model of decomposition dealing with marine sequestered environments. The postmortem changes have been revised according with a skeletonization scoring system. Surprisingly, most of the victims were in good condition with soft tissues still present except at the head/neck region and the hands resulting in the body parts mostly pre-skeletonized. Closed compartments as well as heavy clothing in multiple layers protected the bodies from animal activity of marine scavengers. Presumptive positive identification was obtained in 49 out of 52 bodies based on the correspondence between ante- and postmortem data. An additional purpose of the article is also to focus on the practice of coercive actions disproportionate to the risk of unauthorized entry criticized by several international organizations for migration and recently condemned by the European Court in Strasbourg. [ABSTRACT FROM AUTHOR]

The authors report an unusual case of suicide of an anesthesiologist, in which the suicide manner and means depend upon the victim's occupation. This is the first case report published in Italy of a death involving propofol and other drugs. The anesthesiologist was found dead with an empty drip still inserted in the hand and another one near his body. Forensic and toxicological findings suggested that the cause of death was a respiratory depression due to a self-administration of a rapidly infused lethal drug mixture. Analytical drug quantification was performed by gas chromatography-mass spectrometry. Blood analysis revealed: zolpidem (0.86 μg/mL), propofol (0.30 μg/mL), midazolam (0.08 μg/mL), thiopental (0.03 μg/mL), and amitriptyline (0.07 μg/mL). Adipose tissue and hair analysis suggested a previous and repeated use of these drugs verifying the fact that in Italy recreational abuse of anesthetic and sedative agents in health care practitioners is becoming an increasing problem. [ABSTRACT FROM AUTHOR]

This study was based on a morphometric analysis of bite marks starting from the quantitative definition of the anterior teeth by the geometric acquisition of the 'injuries,' using bite marks impressed on pig skin and plastic. Each mark was photographed and acquired. A dedicated program automatically supplied the values of the shape factors and the areas of the pattern geometric figures. The values obtained for the homologous samples were compared to the heterologous values. Statistical comparison was made of the sets by linear regression, determining the correlation coefficient and the determination coefficient for each value. Results showed only 4.8% and 2% of overlap between homologous and heterologous values. This study was carried out in attempting to quantitatively define the anterior teeth of the human dentition and the procedure described and the results obtained support the advantage of morphometric studies and computer-aided programs in this study of bite marks. [ABSTRACT FROM AUTHOR]

The aim of this study was to work out a biometric method for personal identification by comparing simulated antemortem and postmortem digital radiographs of unrestored teeth. Intra-oral radiographs of the inferior right first molar, without restorations, were acquired at two different times in 70 subjects using a standardized technique followed by a morphometric analysis. The program automatically supplied values of the absolute distances, relative distances, shape factors, moments, perimeter values, and the areas of the triangles, which were obtained by joining key reference points. The values for the homologous samples were compared with the heterologous samples. Statistical analysis was then carried out, resulting in a section point value of 0.9992. Higher correlation coefficients indicate positive identification, with less than 2% risk of false positives, and approximately 3% of false negatives. We have also tested the method on dental records from 30 patients in order to demonstrate the specificity and sensitivity of the system. [ABSTRACT FROM AUTHOR]

The Apulian (South of Italy) territory saw the birth of a criminal organization called Sacra Corona Unita (SCU, United Holy Crown) which transformed the rules of traditional mafia organizations. This work examined 83 victims of the SCU between 1980 and 2000. The bodies were mainly of SCU members and in some cases, of police and law enforcement officers and other citizens caught in the crossfire. Some of these were discovered; thanks to the collaboration of “repented” SCU members who became police informers. The condition of the bodies varied in relation to the date and manner of killing. In some cases anthropometric research methods were necessary. In 73% of the cases, lesions of the head were the only marks left on the body. In conclusion, the existence of some social aspects connected with the symbolisms and membership rites that characterized the origin, evolution, and decline of the SCU is stressed. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms. [ABSTRACT FROM AUTHOR]

Simple Summary: Forensic anthropology deals with human skeletal remains for law and humanitarian purposes, and it is crucial in determining identity, interpreting traumas, and estimating time since death. Although it adopts a wide array of methods from many disciplines, the macroscopic observation of skeleton morphological characteristics is sometimes exhaustive for differential diagnosis between malformations, degenerative diseases, post-traumatic or iatrogenic lesions. In some cases, as described in this study, skeletal remains show signs of specific surgical techniques, so characteristic as to reconstruct almost faithfully the pathological history of the individual to whom they belonged and the therapeutic procedures the subject underwent. It is of even more interest if considering that, based on the time of death, the subject was among the first individuals who underwent an innovative surgical technique that would have revolutionized the surgical approach to a disease until then incurable. In these rare cases, skeletal remains become the historical testimony of surgery evolution, showing the traces of how men have over time perfected the medical treatment of their fellows. Human skeletal remains are considered as real biological archives of each subject's life. Generally, traumas, wounds, surgical interventions, and many human pathologies suffered in life leave identifiable marks on the skeleton, and their correct interpretation is possible only through a meticulous anthropological investigation of skeletal remains. The study here presented concerns the analysis of a young Slavic soldier's skeleton who died, after his imprisonment, in the concentration camp of Torre Tresca (Bari, Italy), during the Second World War (1946). In particular, the skull exhibited signs of surgical activity on the posterior cranial fossa and the parieto-occipital bones. They could be attributed to surgical procedures performed at different times, showing various degrees of bone edge remodeling. Overall, it was possible to correlate the surgical outcomes highlighted on the skull to the Torkildsen's ventriculocisternostomy (VCS), the first clinically successful shunt for cerebrospinal fluid (CSF) diversion in hydrocephalus, which gained widespread use in the 1940s. For this reason, the skeleton we examined represents a rare, precious, and historical testimony of an emerging and revolutionary neurosurgical technique, which differed from other operations for treating hydrocephalus before the Second World War and was internationally recognized as an efficient procedure before the introduction of extracranial shunts. [ABSTRACT FROM AUTHOR]

The aim of the study was to conduct a morphometric analysis of the root development of the third molar, with the purpose of overcoming the limits of an exclusively morphological analysis. The study was divided in two phases. The first one was the verification of the existence of a constant crown-root (C/R) ratio on a sample of 100 third molars, characterized by a complete root development. The value obtained was used in the second phase to predict the final root's length, knowing the crown height. So we have calculated, on a sample of 322 third molars with developing roots, the final ratios between incomplete roots and complete roots. Statistical analysis was then made with 90%, 95%, and 99% confidence intervals. The results showed a significant difference according to the age of the subject and the limit values, lower and upper, for subjects aged 16 and 17 years versus those aged 18 and 19. For each analysis, the width of the class of tolerance and other statistical indicators were calculated. The results we obtained support the advantage of a morphometric study as opposed to an exclusively morphological study, but all the techniques used to determine the age of a living subject can provide only indications of the biological age, but no certainties as regards chronological age. [ABSTRACT FROM AUTHOR]

Simple Summary: Proper collection and analysis of physical evidence including insects, bloodstains, or any other material can be of probative value in a court of law. This is the first casework where hairs were involved as insect-related evidence. Hairs constitute important categories of trace evidence as they can provide useful information for an association between a suspect and a crime scene or a suspect and a victim. Two "cold cases" occurred in two different European countries in which the trace evidence relating to insects was the last piece of a complex puzzle useful for the conviction of the perpetrator. Insect-related evidence must be considered of probative value just as bloodstains, fingerprints, fibers, or any other materials. Such evidence if properly collected and analyzed can also provide useful details in the reopening of old unsolved murders, also called "cold cases". This paper presents the case of two murders that occurred in two different European countries and remained unsolved for years. The remains of a girl found in Italy 17 years after her disappearance helped to solve a murder that occurred in Britain 8 years prior. The cases were unexpectedly linked together because of the similarities in the ritualistic placing of strands of hair and connections with the suspect. The trace evidence relating to insects and hairs played a relevant role in the conviction of the perpetrator. In Italy, the defense raised the doubt that the strands of hair found nearby the skeletal remains could be the result of insect feeding activity and not the result of a cut by sharp objects. Therefore, it was fundamental to distinguish between sharp force lesions and insect feeding activity on hair. This unusual application of insect-related evidence clearly emphasizes the importance of an appropriate professional collection and analysis of any physical evidence that could be of robust probative value. [ABSTRACT FROM AUTHOR]

An abstract of the article "Comparison of the Validity of Three Dental Methods for Age Estimation Based on Teeth Root Translucency," by Roberta Roca and colleagues is presented.