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Accurate dating of bone fractures can be crucial in the context of forensic trauma analysis since it may provide essential information for the corroboration or contradiction of statements by victims or suspects in cases of domestic abuse or torture. The different stages of bone healing have been well described in the existing literature, and some previous studies attempted to define related timelines particularly in the paediatric population. However, the bone healing process can be very variable and despite the importance of the topic in the forensic field, so far little is known about the radiological appearance of bone fractures at different healing stages, and how this correlates with time, especially in an adult population. The aim of this retrospective observational study was to describe the temporal aspect of pre-defined healing stages as they appear on radiographs of tubular bone fractures in adults, and explore the effect of potential cofounding variables. A dynamic nomogram was developed as a user-friendly tool to be eventually applied in clinical or medico-legal settings. This study showed that the posttraumatic time interval (PTTI) increased progressively with the pre-defined healing stages. However, confounding factors, such as patients' age, sex, and location of the fracture need to be accounted for in the final estimation model. Further studies are needed to explore more potentially confounding variables to refine the presented outcomes. Better knowledge of the effect of different confounding variables in the dating of fracture healing will contribute to greater accuracy of PTTI estimation of bone fractures in adults., Competing Interests: Conflict of interest The authors wish to declare that they have no affiliation or involvement with any organization/financial interest regarding the subject matter and content in this manuscript., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Death scene investigation (DSI) is critically important for the identification of the manner of death. The present study aims to present a scoring system for the correct framing of a case as a suicide starting from the DSI and its preliminary application. The method is based on five items: (1) statistical frequency of the method adopted; (2) victim's history of mental illness; (3) circumstantial data; (4) number of means; (5) compatibility of means and injuries with suicidal dynamics; and the application of a correction factor if suicide risk indicators are present. We blindly analyzed 180 cases of violent deaths equally divided into suicides, homicides and accidental deaths and the results obtained were compared with the established dynamics of death. The proposed method has proven to be efficient in the identification of suicide at the DSI, but further on-site studies making use of a wider number of cases is necessary., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Major interplaying causes of heat stroke (HS) and fatal hyperthermia are climate, physical activity, artificial extreme ambient temperatures, confinement in a small compartment, and effects of drugs and chemicals, combined with predispositions and complications. A common and unfortunate cause of HS is vehicular hyperthermia (VH) death. Hyperthermia in a vehicle is a type of environmental thermal disorder, involving victim's susceptibility, confinement with restraint, and possible influences of drugs and poisons, including exhaust gas containing complex fumes, carbon dioxide and monoxide. Whereas VH typically occurs when babies or young children are being left unattended in parked vehicles in direct sunlight, it has been reported only anecdotally for adult subjects. Three cases of adult fatal VH will be herein presented. In each presented case the corpse was found enclosed in a vehicle on spring/summer days. During crime scene investigation (CSI) psychoactive substances were found near to the corpses leading to the suspect of a suicidal fatal drug intoxication. Basing on this misleading suspect in Case 2 and 3 a forensic expert was not charged for the CSI and a fatal VH was not suspected nor properly investigated. Later, a comprehensive autopsy, including biochemical and toxicological analyses, excluded a death related to natural causes, fatal intoxications, ketoacidosis and traumas. On the other hand, the reconstruction of the temperature, the humidity, the heat index and the related risk of HS allowed the diagnosis of fatal VH in all the reported cases. In particular, death occurred because of the long-lasting stay into a hot parked vehicle which was facilitated from self-administration of psychoactive drugs with related neuro-depression. This case series confirms that a comprehensive CSI followed by an autopsy including histology, biochemical and toxicological analysis remains mandatory in cases of forensic interest, as well as when a corpse is found enclosed in a vehicle. Anyway, sometimes the diagnosis of heat-related fatalities remains a medley of investigative and medicolegal observations., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Traumatic fatal aortic rupture (FAR) is a common finding in victims of motor vehicle crashes (MVC), but its aetiology and mechanisms of production remain an issue of major concern, above all in motorcyclists. This study reports a series of cases obtained from a retrospective analysis of traumatic FARs occurring in motorcycle drivers, with the aim of defining the injury patterns and correlating them with the mechanisms of FAR production. Circumstantial, autopsy and histology data were collected through a retrospective analysis of post mortem examinations performed at the Institute of Legal Medicine of the University of Padova between 2014 and 2016. Among 151 traffic related victims, 8 were motorcycle drivers and displayed traumatic FAR and were thus included in the study. In 7 cases, the presence of abdominal/thoracic injuries suggested that the external compression due to the accident was at least a concurrent cause of FAR, being the predominant mechanism of aortic injury in 4 cases, through the "osseous pinch" or the "waterhammer effect" mechanisms. Our study highlights the well-known role of "preventative forensic pathology", which has become routinary in traffic medicine since many years, also for defining the points of impact and the injury patterns of motorcyclists sustaining traumatic FAR, thereby facilitating the development of new prevention strategies and devices. Further studies, however, are needed in order to widen the investigated population and to estimate the real number of victims for which traumatic FAR might hypothetically be prevented with specific countermeasures., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Death due to mechanical or chemical intoxication of heroin body packers, thanks to the continuous improvement in packaging techniques, are increasingly rare, and almost all the cases reported in the literature refer to drug swallowers. A case of fatal acute heroin intoxication in a body pusher with an unreported packaging technique is presented, and previous deaths due to heroin body packing are reviewed, taking into consideration imaging techniques performed, cause of death, toxicological analysis on biological and non-biological samples, as well as number, position and type of drug packages identified at the dissection of the body. The innovative packaging technique found in the present case, constituted by an external multilayer cellophane casing containing 16 smaller packages of hardened heroin powder, each one covered with cigarette paper and multiple layers of heat-sealed cellophane, was probably used to avoid both chemical complications of package rupture and to create a package with morphological and radiological features different from those reported by previous studies. Drug dealers, in fact, are continually looking for packaging methods that, besides being safer, minimize the risk of detection at the radiological examinations performed, thus increasing the number of false negative findings. The identification of new types of package is therefore important, in order to identify packages that do not have the typical radiological signs, both in order to protect the patient's health and to avoid the non-recognition of a drug carrier. Despite the presence of multilayer composition of both the smaller and the bigger external coverage, these new types of package did not guarantee the greater safety of the drug dealer., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Many studies have focused on the importance of post-mortem computed tomography (PMCT) prior to or in substitution of standard forensic autopsies in case of firearm death. However, due to the fact that PMCT is not routinely performed in all countries, in cases of death abroad it can happen that a CT scan is performed only after a first autopsy. A case of post-mortem re-examination, including the external examination and a post-autopsy computed tomography (PACT), of a gunshot victim of homicide in a foreign country is presented, and the pros and cons of imaging in post-autopsy setting are discussed. PACT could be a tool for carrying out more complete investigations and for obtaining information on bone injuries and foreign bodies trapped within peripheral soft tissues that can be re-analyzed after the arrival of the first autopsy report. Given that the value of information derived may be strongly influenced by the previously performed autopsy, in order to process the definitive considerations it is necessary to compare and interpret the data obtained through PACT with the results of the first autopsy, and to continue the international cooperation effort and the application of international guidelines in order to share information at the repatriation of the corpse., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Anabolic androgenic steroids (AAS) are the main class of doping agents and their consumption produces adverse effects involving several organs and systems. Three cases of sudden cardiac death (SCD) and one of death due to congestive heart failure of previously healthy athletes who were AAS users are herein reported. Concentric cardiac hypertrophy with focal fibrosis (one case), dilated cardiomyopathy with patchy myocyte death (two cases) and eosinophilic myocarditis (one case) were observed and most probably relate to the final event. Molecular investigation for viral genomes was positive in one case (Ebstein virus). Our data confirm previous findings, showing that the most typical cardiac abnormality in AAS abusers is left ventricular hypertrophy, associated with fibrosis and myocytolysis. An exceptional cardiovascular substrate was represented by the case with drug induced eosinophilic myocarditis. These features are at risk of ventricular arrhythmias as well as congestive heart failure. The cause-effect relationship between AAS abuse and cardiac death can be established only by a rigorous methodology with the use of standardized protocols, including precise morphological studies of all target organs to search for chronic toxic effects. Laboratory investigations should focus on AAS searching on a wide range of biological matrices to demonstrate type, magnitude and time of exposure., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Embalming and formalin fixation are common, and yet they can create problems for the forensic scientist if a drug has been the cause of death and if the only available specimens to be analyzed are formalin-fixed tissues. Previous studies have demonstrated that during fixation xenobiotics are extracted into formalin according to tissue and fixing solution characteristics. In some cases formalin can react with the analyte resulting in the production of new chemical entities. Regarding cocaine and its metabolites, Cingolani et al. have reported that formalin-fixation extracts benzoylecgonine (BE) from tissues and that BE is stable in the fixing solution. However, the stability and kinetic properties of cocaine remain so far unexplored. Our data show that in buffered formalin (pH 7.4) cocaine is hydrolyzed to BE in agreement with a pseudo first-order reaction kinetic (half-life time approximately 7 days), whereas in unbuffered formalin (pH approximately 3.5) it is relatively stable over a period of 30 days. The analysis of brain and liver samples at different fixation times indicates that during fixation an extraction process occurs for both analytes and that the extraction is more efficient in the liver than in the brain, probably because of a greater lipophilicity of the brain tissue. In conclusion, our study demonstrates that formalin-fixed tissues and their fixing solutions can be used for cocaine analysis only if a short time period has passed since the fixation beginning. The rapid extraction process of cocaine into formalin and the concomitant hydrolysis to BE occurring in buffered formalin may prevent the identification of cocaine in both tissues and formalin solution already at 15-30 days after fixation. Moreover, the unpredictable extraction rate of both analytes, along with the hydrolysis of cocaine into BE significantly affects tissue concentrations, thus complicating the interpretation of quantitative results.

A 43-year-old woman was found dead inside the bathtub in a sitting position with a knife embedded in chest. Multiple sharp force wounds were present: 4 stab wounds in the sternal region, 2 cut wounds in the neck, several longitudinal and transverse cuts in the arms. Scene circumstances and autopsy findings pointed toward a suicidal etiology. The case presented some particular aspects that allowed us to identify the mechanism of production of the lethal thoracic wound and to partially reconstruct the time-sequence of injuries.