94 results on '"Paolo Fais"'
Search Results
2. The Precision, Inter-Rater Reliability, and Accuracy of a Handheld Scanner Equipped with a Light Detection and Ranging Sensor in Measuring Parts of the Body—A Preliminary Validation Study
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Enrica Callegari, Jacopo Agnolucci, Francesco Angiola, Paolo Fais, Arianna Giorgetti, Chiara Giraudo, Guido Viel, and Giovanni Cecchetto
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handheld scanner ,LiDAR ,anthropometric measurements ,3D model reconstruction ,Chemical technology ,TP1-1185 - Abstract
Background: Anthropometric measurements play a crucial role in medico-legal practices. Actually, several scanning technologies are employed in post-mortem investigations for forensic anthropological measurements. This study aims to evaluate the precision, inter-rater reliability, and accuracy of a handheld scanner in measuring various body parts. Methods: Three independent raters measured seven longitudinal distances using an iPad Pro equipped with a LiDAR sensor and specific software. These measurements were statistically compared to manual measurements conducted by an operator using a laser level and a meterstick (considered the gold standard). Results: The Friedman test revealed minimal intra-rater variability in digital measurements. Inter-rater variability analysis yielded an ICC = 1, signifying high agreement among the three independent raters. Additionally, the accuracy of digital measurements displayed errors below 1.5%. Conclusions: Preliminary findings demonstrate that the pairing of LiDAR technology with the Polycam app (ver. 3.2.11) and subsequent digital measurements with the MeshLab software (ver. 2022.02) exhibits high precision, inter-rater agreement, and accuracy. Handheld scanners show potential in forensic anthropology due to their simplicity, affordability, and portability. However, further validation studies under real-world conditions are essential to establish the reliability and effectiveness of handheld scanners in medico-legal settings.
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- 2024
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3. Assessment of the structural and functional characteristics of human mesenchymal stem cells associated with a prolonged exposure of morphine
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Francesco Carano, Gabriella Teti, Alessandra Ruggeri, Francesca Chiarini, Arianna Giorgetti, Maria C. Mazzotti, Paolo Fais, and Mirella Falconi
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Medicine ,Science - Abstract
Abstract The discovery of the expression of opioid receptors in the skin and their role in orchestrating the process of tissue repair gave rise to questions regarding the potential effects of clinical morphine treatment in wound healing. Although short term treatment was reported to improve tissue regeneration, in vivo chronic administration was associated to an impairment of the physiological healing process and systemic fibrosis. Human mesenchymal stem cells (hMSCs) play a fundamental role in tissue regeneration. In this regard, acute morphine exposition was recently reported to impact negatively on the functional characteristics of hMSCs, but little is currently known about its long-term effects. To determine how a prolonged treatment could impair their functional characteristics, we exposed hMSCs to increasing morphine concentrations respectively for nine and eighteen days, evaluating in particular the fibrogenic potential exerted by the long-term exposition. Our results showed a time dependent cell viability decline, and conditions compatible with a cellular senescent state. Ultrastructural and protein expression analysis were indicative of increased autophagy, suggesting a relation to a detoxification activity. In addition, the enhanced transcription observed for the genes involved in the synthesis and regulation of type I collagen suggested the possibility that a prolonged morphine treatment might exert its fibrotic potential risk, even involving the hMSCs.
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- 2021
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4. Pembrolizumab-Induced Fatal Myasthenia, Myocarditis, and Myositis in a Patient with Metastatic Melanoma: Autopsy, Histological, and Immunohistochemical Findings—A Case Report and Literature Review
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Elena Giovannini, Maria Paola Bonasoni, Michele D’Aleo, Ione Tamagnini, Matteo Tudini, Paolo Fais, and Susi Pelotti
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pembrolizumab ,myasthenia ,myocarditis ,myositis ,autopsy ,immunohistochemistry ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Immune checkpoint inhibitors (ICIs) represent a major advance in cancer treatment. The lowered immune tolerance induced by ICIs brought to light a series of immune-related adverse events (irAEs). Pembrolizumab belongs to the ICI class and is a humanized IgG4 anti-PD-1 antibody that blocks the interaction between PD-1 and PD-L1. The ICI-related irAEs involving various organ systems and myocarditis are uncommon (incidence of 0.04% to 1.14%), but they are associated with a high reported mortality. Unlike idiopathic inflammatory myositis, ICI-related myositis has been reported to frequently co-occur with myocarditis. The triad of myasthenia, myositis, and myocarditis must not be underestimated as they can rapidly deteriorate, leading to death. Herein we report a case of a patient with metastatic melanoma who fatally developed myasthenia gravis, myocarditis, and myositis, after a single cycle of pembrolizumab. Considering evidence from the literature review, autopsy, histological, and immunohistochemical investigations on heart and skeletal muscle are presented and discussed, also from a medical–legal perspective.
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- 2023
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5. Infection Induced Fetal Inflammatory Response Syndrome (FIRS): State-of- the-Art and Medico-Legal Implications—A Narrative Review
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Elena Giovannini, Maria Paola Bonasoni, Jennifer Paola Pascali, Arianna Giorgetti, Guido Pelletti, Giancarlo Gargano, Susi Pelotti, and Paolo Fais
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fetal inflammatory response syndrome ,placental pathology ,causal link ,medical liability ,medico-legal compensation ,Biology (General) ,QH301-705.5 - Abstract
Fetal inflammatory response syndrome (FIRS) represents the fetal inflammatory reaction to intrauterine infection or injury, potentially leading to multiorgan impairment, neonatal mortality, and morbidity. Infections induce FIRS after chorioamnionitis (CA), defined as acute maternal inflammatory response to amniotic fluid infection, acute funisitis and chorionic vasculitis. FIRS involves many molecules, i.e., cytokines and/or chemokines, able to directly or indirectly damage fetal organs. Therefore, due to FIRS being a condition with a complex etiopathogenesis and multiple organ dysfunction, especially brain injury, medical liability is frequently claimed. In medical malpractice, reconstruction of the pathological pathways is paramount. However, in cases of FIRS, ideal medical conduct is hard to delineate, due to uncertainty in diagnosis, treatment, and prognosis of this highly complex condition. This narrative review revises the current knowledge of FIRS caused by infections, maternal and neonatal diagnosis and treatments, the main consequences of the disease and their prognoses, and discusses the medico-legal implications.
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- 2023
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6. Validation of a HS–GC–FID Method for the Quantification of Sevoflurane in the Blood, Urine, Brain and Lungs for Forensic Purposes
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Guido Pelletti, Rossella Barone, Susan Mohamed, Francesca Rossi, Marco Garagnani, Arianna Giorgetti, Paolo Fais, and Susi Pelotti
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sevoflurane ,gas chromatography ,flame ionization detector ,biological matrices ,forensic toxicology ,Biochemistry ,QD415-436 - Abstract
Background: Sevoflurane is a polyfluorinated compound extensively used as an inhalation anesthetic in patients undergoing surgery. If administered outside the operating room, sevoflurane is dangerous and potentially lethal, and toxicologists may be asked to investigate its presence in biological matrices for forensic purposes. The aim of the present study is to develop and validate a method for the detection and the quantification of sevoflurane in biological fluids and organs through gas chromatography coupled to flame ionization detection (GC–FID). Methods: The method was optimized based on the maximization of the signal-to-noise ratio. The GC–FID instrument was equipped with a Zebron capillary column ZB-624 (30 m, 0.32 mm ID, 1.80 µm film thickness). Results: The method was validated over a concentration range of 1.0–304.0 µg/mL (blood and urine) and µg/g (brain, lungs). The lower limit of quantitation was 1.0 µg/mL or µg/g. Both the intra- and interassay imprecision and inaccuracy were ≤15% at all quality control concentrations in all the matrices. The method was successfully applied to measure the sevoflurane concentrations for 20 negative controls and for a real forensic case. Conclusions: The present method is suitable for the identification and quantification of sevoflurane in fluids and organs and can be a reliable tool in forensic casework.
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- 2023
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7. Is old stuff back? A fatal case of ethyl chloride sniffing
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Jennifer P. Pascali, Paolo Fais, Guido Viel, Giovanni Cecchetto, and Massimo Montisci
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Forensic science ,Forensic toxicology ,Ethyl chloride ,Chloroethane ,Sudden sniffing deaths ,Gas chromatography ,Law in general. Comparative and uniform law. Jurisprudence ,K1-7720 ,Medicine (General) ,R5-920 - Abstract
Abstract Background Ethyl chloride (EC) or chloroethane is a colourless halogenated hydrocarbon gas regularly employed as a topical anaesthetic spray for pain-related injuries and muscle spasm in athletes. However, EC became also popular as a street drug in the 1980s. Brief inhalations of EC vapour can result in dizziness, euphoria, confusion, incoordination, hallucinosis, impairment of short-term memory and narcosis. Inhalation of higher doses, usually employed to “get high”, may be related to severe depression of the central nervous system. Indeed, toxicity and deaths have been reported so far. Case presentation A 40-year-old man was found unresponsive after EC inhalation. EC determination was performed by dynamic headspace gas chromatography coupled to mass spectrometry. EC was detected in the peripheral blood (0.156 g/L), central blood concentration (0.203 g/L) and the lung and brain (19 and 25 mg/kg). EC in the vitreous humour showed a sensitively lower respect to blood (0.018 vs 0.203 g/L). Conclusions Considering the results of toxicological analyses of investigations on the death scene besides the absence of any signs of trauma, death was attributed to inhalation of ethyl chloride.
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- 2019
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8. Molecular Mechanisms of Action of Novel Psychoactive Substances (NPS). A New Threat for Young Drug Users with Forensic-Toxicological Implications
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Arianna Giorgetti, Jennifer P. Pascali, Paolo Fais, Guido Pelletti, Andrea Gabbin, Giorgia Franchetti, Giovanni Cecchetto, and Guido Viel
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forensic toxicology ,new psychoactive substances (NPS) ,mass spectrometry ,toxicodynamic ,mechanism of action ,Science - Abstract
Novel psychoactive substances (NPS) represent a severe health risk for drug users. Even though the phenomenon has been growing since the early 2000s, the mechanisms of action of NPS at the receptors and beyond them are still scarcely understood. The aim of the present study was to provide a systematic review of the updated knowledge regarding the molecular mechanisms underlying the toxicity of synthetic opioids, cannabinoids, cathinones, and stimulants. The study was conducted on the PubMed database. Study eligibility criteria included relevance to the topic, English language, and time of publication (2010–2020). A combined Mesh and free-text protocols search was performed. Study selection was performed on the title/abstract and, in doubtful cases, on the full texts of papers. Of the 580 records identified through PubMed searching and reference checking, 307 were excluded by title/abstract and 78 additional papers were excluded after full-text reading, leaving a total of 155 included papers. Molecular mechanisms of synthetic opioids, synthetic cannabinoids, stimulants, psychedelics, and hallucinogens were reviewed and mostly involved both a receptor-mediated and non-receptor mediated cellular modulation with multiple neurotransmitters interactions. The molecular mechanisms underlying the action of NPS are more complex than expected, with a wide range of overlap among activated receptors and neurotransmitter systems. The peculiar action profile of single compounds does not necessarily reflect that of the structural class to which they belong, accounting for possible unexpected toxic reactions.
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- 2021
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9. The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis
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Arianna Giorgetti, Jennifer Pascali, Massimo Montisci, Irene Amico, Barbara Bonvicini, Paolo Fais, Alessia Viero, Raffaele Giorgetti, Giovanni Cecchetto, and Guido Viel
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methadone ,drug-related death ,post-mortem examination ,forensic toxicology ,Microbiology ,QR1-502 - Abstract
Methadone-related deaths are characterized by a wide range of post-mortem blood concentrations, due to the high pharmacokinetic/dynamic inter-individual variability, the potential subjective tolerance state and to other risk factors or comorbidities, which might enhance methadone acute toxicity. In the present study, the association among pre-existing and external conditions and diseases and the resultant methadone death capacity have been investigated. Beside a systematic literature review, a retrospective case-control study was done, dividing cases in which methadone was the only cause of death (controls), and those with associated clinical-circumstantial (naive/non-tolerant state), pathological (pulmonary or cardiovascular diseases) or toxicological (other drugs detected) conditions. Methadone concentrations were compared between the two groups and the association with conditions/diseases was assessed by multiple linear and binomial logistic regressions. Literature cases were 139, in house 35, consisting of 22 controls and 152 cases with associated conditions/diseases. Mean methadone concentrations were 2122 ng/mL and 715 ng/mL in controls and cases respectively, with a statistically significant difference (p < 0.05). Lower methadone concentrations (by 24, 19 and 33% respectively) were detected in association with naive/non-tolerant state, pulmonary diseases and presence of other drugs, and low levels of methadone (
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- 2021
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10. Correction to: Is old stuff back? A fatal case of ethyl chloride sniffing
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Jennifer P. Pascali, Paolo Fais, Guido Viel, Giovanni Cecchetto, and Massimo Montisci
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Law in general. Comparative and uniform law. Jurisprudence ,K1-7720 ,Medicine (General) ,R5-920 - Abstract
An amendment to this paper has been published and can be accessed via the original article.
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- 2020
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11. Phosphatidylethanol in Blood as a Marker of Chronic Alcohol Use: A Systematic Review and Meta-Analysis
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Santo Davide Ferrara, Paolo Fais, Alessandro Nalesso, Giovanni Cecchetto, Rafael Boscolo-Berto, and Guido Viel
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alcohol abuse ,chronic excessive drinking ,biological markers ,phospholipids ,phosphatidylethanol ,mass spectrometry ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
The present paper aims at a systematic review of the current knowledge on phosphatidylethanol (PEth) in blood as a direct marker of chronic alcohol use and abuse. In March 2012, the search through “MeSH” and “free-text” protocols in the databases Medline/PubMed, SCOPUS, Web of Science, and Ovid/Embase, combining the terms phosphatidylethanol and alcohol, provided 444 records, 58 of which fulfilled the inclusion criteria and were used to summarize the current evidence on the formation, distribution and degradation of PEth in human blood: (1), the presence and distribution of different PEth molecular species (2), the most diffused analytical methods devoted to PEth identification and quantization (3), the clinical efficiency of total PEth quantification as a marker of chronic excessive drinking (4), and the potential utility of this marker for identifying binge drinking behaviors (5). Twelve papers were included in the meta-analysis and the mean (M) and 95% confidence interval (CI) of total PEth concentrations in social drinkers (DAI ≤ 60 g/die; M = 0.288 µM; CI 0.208–0.367 µM) and heavy drinkers (DAI > 60 g/die; M = 3.897 µM; CI 2.404–5.391 µM) were calculated. The present analysis demonstrates a good clinical efficiency of PEth for detecting chronic heavy drinking.
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- 2012
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12. Routine Photography of Injuries
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Arianna Giorgetti, Jennifer Paola Pascali, Guido Pelletti, Annamaria Silvestri, Elena Giovannini, Susi Pelotti, and Paolo Fais
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Pathology and Forensic Medicine - Published
- 2023
13. Forensic applications of micro-computed tomography: a systematic review
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Giorgia Franchetti, Guido Viel, Paolo Fais, Giulia Fichera, Diego Cecchin, Giovanni Cecchetto, and Chiara Giraudo
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Radiology, Nuclear Medicine and imaging - Abstract
Purpose The aim of this systematic review was to provide a comprehensive overview of micro-CT current applications in forensic pathology, anthropology, odontology, and neonatology. Methods A bibliographic research on the electronic databases Pubmed and Scopus was conducted in the time frame 01/01/2001–31/12/2021 without any language restrictions and applying the following free-text search strategy: “(micro-computed tomography OR micro-CT) AND (forensic OR legal)”. The following inclusion criteria were used: (A) English language; (B) Application of micro-CT to biological and/or non-biological materials to address at least one forensic issue (e.g., age estimation, identification of post-mortem interval). The papers selected by three independent investigators have been then classified according to the investigated materials. Results The bibliographic search provided 651 records, duplicates excluded. After screening for title and/or abstracts, according to criteria A and B, 157 full-text papers were evaluated for eligibility. Ninety-three papers, mostly (64) published between 2017 and 2021, were included; considering that two papers investigated several materials, an overall amount of 99 classifiable items was counted when referring to the materials investigated. It emerged that bones and cartilages (54.55%), followed by teeth (13.13%), were the most frequently analyzed materials. Moreover, micro-CT allowed the collection of structural, qualitative and/or quantitative information also for soft tissues, fetuses, insects, and foreign materials. Conclusion Forensic applications of micro-CT progressively increased in the last 5 years with very promising results. According to this evidence, we might expect in the near future a shift of its use from research purposes to clinical forensic cases.
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- 2022
14. Human DNA contamination of postmortem examination facilities: Impact of COVID‐19 cleaning procedure
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Carla Bini, Arianna Giorgetti, Elena Giovannini, Guido Pelletti, Paolo Fais, and Susi Pelotti
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Genetics ,COVID-19 ,Equipment Contamination ,Humans ,Autopsy ,DNA ,DNA Contamination ,Pandemics ,Pathology and Forensic Medicine - Abstract
The DNA contamination of evidentiary trace samples, included those collected in the autopsy room, has significant detrimental consequences for forensic genetics investigation. After the COVID-19 pandemic, methods to prevent environmental contamination in the autopsy room have been developed and intensified. This study aimed to evaluate the level of human DNA contamination of a postmortem examination facility before and after the introduction of COVID-19-related disinfection and cleaning procedures. Ninety-one swabs were collected from the surfaces and the dissecting instruments, analyzed by real-time quantitative PCR (q-PCR) and typed for 21 autosomal STRs. Sixty-seven out of 91 samples resulted in quantifiable human DNA, ranging from 1 pg/μl to 12.4 ng/μl, including all the samples collected before the implementation of COVID-19 cleaning procedures (n = 38) and 29 out of 53 (54.7%) samples taken afterward. All samples containing human DNA were amplified, resulting in mixed (83.6%), single (13.4%), and incomplete (3%) profiles. A statistically significant decrease in DNA contamination was found for dissecting instruments after treatment with chlorhexidine and autoclave (p 0.05). Environmental decontamination strategies adopted during COVID-19 pandemic only partially solved the long-standing issue of DNA contamination of postmortem examination facilities. The pandemic represents an opportunity to further stress the need for standardized evidence-based protocols targeted to overcome the problem of DNA contamination in the autopsy room.
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- 2022
15. Insights in opiates toxicity: impairment of human vascular mesenchymal stromal cells
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Maria Carla Mazzotti, Gabriella Teti, Arianna Giorgetti, Francesco Carano, Guido Pelletti, Jennifer Paola Pascali, Mirella Falconi, Susi Pelotti, Paolo Fais, Mazzotti, Maria Carla, Teti, Gabriella, Giorgetti, Arianna, Carano, Francesco, Pelletti, Guido, Pascali, Jennifer Paola, Falconi, Mirella, Pelotti, Susi, and Fais, Paolo
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Morphine sulphate ,In vitro ,Human vascular mesenchymal stromal cell ,Opiate-related fatalities ,Pathology and Forensic Medicine ,Forensic toxicology - Abstract
The most common pulmonary findings in opiate-related fatalities are congestion and oedema, as well as acute and/or chronic alveolar haemorrhage, the cause of which is thought to be a damage to the capillary endothelium related to ischemia. Human vascular mesenchymal stromal cells (vMSCs) play a fundamental role in tissue regeneration and repair after endothelial cell injury, and they express opioid receptors. The aim of this study was to assess the effect of in vitro morphine exposure on the physiological activity and maintenance of human vMSCs. vMSCs were obtained from abdominal aorta fragments collected during surgery repair and were exposed to incremental doses (0.1 mM, 0.4 mM, 0.8 mM and 1 mM) of morphine sulphate for 7 days. The effect was investigated through cell viability assessment, proliferation assay, reactive oxygen species (ROS) detection assay, senescence-associated β-galactosidase assay, senescent-related markers (p21WAF1/CIP1 and p16INK4) and the apoptosis-related marker caspase 3. Moreover, an ultrastructural analysis by transmission electron microscopy and in vitro vascular differentiation were evaluated. Results showed a decrease of the cellular metabolic activity, a pro-oxidant and pro-senescence effect, an increase in intracellular ROS and the activation of the apoptosis signalling, as well as ultrastructural modifications and impairment of vascular differentiation after morphine treatment of vMSC. Although confirmation studies are required on real fatal opiate intoxications, the approach based on morphological and immunofluorescence methodologies may have a high potential also as a useful tool or as a complementary method in forensic pathology. The application of these techniques in the future may lead to the identification of new markers and morphological parameters useful as complementary investigations for drug-related deaths.
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- 2023
16. Sudden cardiac death related to left coronary artery anomalies including hypoplasia and anomalous origin with retro-aortic course
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Clara Fiorentini, Ornella Leone, Gabriele Bronzetti, Jennifer Paola Pascali, Maddalena Graziosi, Susi Pelotti, and Paolo Fais
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Issues, ethics and legal aspects ,Pathology and Forensic Medicine - Published
- 2023
17. Analysis and distribution of per- and polyfluoroalkyl substances in decidua and villi placenta explants
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Jennifer P. Pascali, Elena Piva, Maria Paola Bonasoni, Costanza Migliavacca, Anna Seidenari, and Paolo Fais
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Biochemistry ,General Environmental Science - Published
- 2023
18. Multiple prohibited ingredients detected in nutritional supplements in a case of adverse analytical finding (AAF)
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Jennifer P. Pascali, Elena Piva, Pasquale Ioime, Mattia Forcato, Rafael Boscolo‐Berto, Roberto Rondinelli, and Paolo Fais
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Doping in Sports ,Anabolic Agents ,cardarine ,methasterone ,Dietary Supplements ,dietary supplements ,doping ,ligandrol ,nutritional supplements ,Pharmaceutical Science ,Environmental Chemistry ,Spectroscopy ,Analytical Chemistry - Published
- 2022
19. [Sudden cardiac death in young people and in adults: primary and contributing causes. The experience of the multidisciplinary network in Emilia-Romagna]
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Ornella, Leone, Valentina, Agostini, Maddalena, Graziosi, Cesare, Rossi, Guido, Pelletti, Alberto, Foà, Gianni, Guadagnini, Mattia, Riefolo, Matteo, Ziacchi, Paolo, Fais, Susi, Pelotti, Claudio, Rapezzi, and Marco, Seri
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Adult ,Male ,Adolescent ,Heart Diseases ,Infant ,Middle Aged ,Young Adult ,Death, Sudden, Cardiac ,Child, Preschool ,Humans ,Female ,Autopsy ,Genetic Testing ,Child ,Brugada Syndrome - Abstract
The multidisciplinary network of Emilia-Romagna for the study of juvenile sudden cardiac death (SCD) was started in Bologna in June 2018 in order to: (1) define the spectrum of etiologies and mechanisms of SCD in young people; (ii) standardize diagnostic terminology and categories; (iii) identify potentially hereditary genetic heart diseases and define the contribution of post-mortem genetic analysis (so-called molecular autopsy) to the overall diagnostic process; (iv) identify preclinical forms of the pathologies in the first-degree relatives of the deceased subject using both phenotypic and genotypic evaluation and, where possible, undertake therapeutic/prophylactic measures (primary prevention).In the first 2 years of activity (01/06/2018-27/08/2020) 50 cases of SCD came to the attention of the Cardiovascular Pathology Unit of the S. Orsola-Malpighi Polyclinic in Bologna, from Centres of Forensic Medicine and Pathological Anatomy in most of the region.Sixty-two percent of cases were sent by forensic pathologists, 36% by clinical pathologists and 2% by the family of the deceased. Medico-legal cases were prompted by autopsies requested by the Judicial Authority in 70% of cases; 55.5% of patients referred by pathologists came from the Cardiovascular Tissue Bank, as part of the regional program for the quality and safety control of organs and tissues from multiorgan-multitissue donors. The average age of the subjects was 35 ± 13.6 years (70% male, range: 1-55 years; median: 38 years). The spectrum of the final diagnoses includes: structurally normal hearts 14%, cardiomyopathies 40%, coronary heart disease 23%, Brugada syndrome 6%, aortic dissection 4%, substance abuse 6%, valvular heart disease 2%, mixed causes 2%.The network is necessarily centered on post-mortem pathological activities, but it does not end with these. If in 60% of cases the pathological autopsy examination was decisive in identifying the cause of death, in the other cases a detailed final diagnosis was reached only with more complex pathways involving molecular genetics, clinical genetics, and toxicology.
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- 2022
20. Valproic acid determination by liquid chromatography coupled to mass spectrometry (LC-MS/MS) in whole blood for forensic purposes
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Jennifer P. Pascali, Arianna Giorgetti, Rossella Barone, Guido Pelletti, and Paolo Fais
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Pharmaceutical Science ,Environmental Chemistry ,Spectroscopy ,Analytical Chemistry - Abstract
Valproic acid (VPA) is a well-known drug prescribed as anti-epileptic. It has a narrow therapeutic range and shows great individual differences in pharmacodynamics and pharmacokinetics. Consequently, the therapeutical drug monitoring (TDM) in patient's plasma is of crucial importance. Liquid chromatography coupled to mass spectrometry (LC-MS/MS) has gained importance in TDM applications for its features of sensitivity, selectivity and rapidity. However, in case of VPA, the LC-MS/MS selectivity could be hampered by the lack of a sufficient number of multiple reaction monitoring (MRM) transitions describing the molecule. In fact, the product ion scan of deprotonated molecules of VPA does not produce any ion and thus most LC-MS/MS methods are based on the detection of the unique MRM transition m/z 143➔143. In this way, the advantages of selectivity in LC-MS cannot be effectively exploited. In the present method, stable analyte adducts were exploited for the determination of VPA in blood. An Acquity HSS C18 column and mobile phases consisting of 5-mM ammonium formate and acetonitrile both added 0.1% formic acid were used. Source worked in negative acquisition mode and parameters were optimized to increase the adduct (m/z 189) and dimer (m/z 287) stability, and their fragmentation were used to increase the selectivity of MRM detection. The method has been validated according to the toxicological forensic guidelines and successfully applied to 10 real blood samples. Finally, the present method showed suitable for the rapid LC-MS/MS detection of VPA in whole blood, demonstrating the possibility to increase specificity by exploiting stable in-source adducts. This should be considered of utmost importance in the case of forensic applications.
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- 2022
21. Gender differences in driving under the influence of psychoactive drugs: Evidence mapping of real case studies and meta-analysis
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Guido Pelletti, Rafael Boscolo-Berto, Rossella Barone, Arianna Giorgetti, Clara Fiorentini, Jennifer P. Pascali, Paolo Fais, and Susi Pelotti
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Male ,Automobile Driving ,Psychotropic Drugs ,GenderDrugs of abuseMedicationForensic ToxicologyDriving Under the Influence ,Substance-Related Disorders ,Cannabinoids ,Amphetamines ,Pathology and Forensic Medicine ,Substance Abuse Detection ,Analgesics, Opioid ,Sex Factors ,Cocaine ,Humans ,Female ,Driving Under the Influence ,Law - Abstract
Very few studies have examined predictors of Driving Under the Influence (DUI) as a function of gender. This oversight is relevant, because analyzing gender differences prevents generalization of results observed in men, who still currently account for the majority of drivers worldwide, to women. The aim of this study is to analyze the prevalence of DUI of drugs in men and women reported in real case studies published in the last two decades, and to assess gender differences in risky DUI behaviour.PubMed, Scopus, Web of Science were searched for eligible studies in May 2021; a follow-up literature search was conducted in August 2021. Real-case studies of drivers convicted for DUI of psychoactive drugs with positive toxicological confirmatory analysis were included. The extracted outcome was the prevalence of positive findings of men and women for cocaine, cannabinoids, amphetamine-like drugs, opioids, and psychoactive prescription drugs. A meta-analysis of random effects estimates was performed to investigate the change in the size of the overall effect (by Cohen d standardized mean difference test). A Mann Whitney U test was performed to test for differences between genders.Of the 2877 studies screened, 439 were retrieved in full-text and 26 were included. The meta-analysis showed a significant higher prevalence among men for cocaine (1.8% vs 0.9%; p 0.001), cannabinoids (3.5% vs 1.6%; p = 0.01) and amphetamine-like drugs (1.2% vs 0.6%; p 0.01). Surprisingly, no differences were observed in the use of opioids (2.3% vs 2.2%; p = 0.45) and benzodiazepines/Z-drugs (2.9% vs 3.7%; p = 0.52).Contrary to the extraordinary number of real-case studies reported in literature, only a few papers differentiate the prevalence of DUI between men and women. This can lead to an underestimation of the influence of gender in DUI phenomenon or complicate the evaluation of the results for some classes of substances, as observed for medications and opioids. The primary goal in the future will be to collect the data concerning DUI drivers following shared and homogeneous methodologies, in order to allow the analysis of data disaggregated by gender, which can be used for monitoring evolving trends and developing gender-specific targeted prevention and enforcement efforts.
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- 2022
22. Forensic applications of micro‐computed tomography: a systematic review
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Franchetti, Giorgia, Viel, Guido, Paolo, Fais, Fichera, Giulia, Cecchin, Diego, Cecchetto, Giovanni, and Giraudo, Chiara
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- 2022
23. Per- and polyfluoroalkyl substances (PFAS) determination in shellfish by liquid chromatography coupled to accurate mass spectrometry
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Elena Piva, Pasquale Ioime, Sonia Dall'Ara, Paolo Fais, and Jennifer P. Pascali
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Fluorocarbons ,Pharmaceutical Science ,Environmental Chemistry ,Mass Spectrometry ,Water Pollutants, Chemical ,Spectroscopy ,Chromatography, Liquid ,Shellfish ,Analytical Chemistry - Published
- 2022
24. Morphological characterization using scanning electron microscopy of fly artifacts deposited by Calliphora vomitoria (Diptera: Calliphoridae) on household materials
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Desiree Martini, Laura Ingrà, Paolo Fais, Arianna Giorgetti, Maria Carla Mazzotti, Mirella Falconi, Guido Pelletti, Pelletti G., Martini D., Ingra L., Mazzotti M.C., Giorgetti A., Falconi M., and Fais P.
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Morphology (linguistics) ,Scanning electron microscope ,Analytical chemistry ,01 natural sciences ,Calliphora ,Pathology and Forensic Medicine ,Forensic pathology ,03 medical and health sciences ,0302 clinical medicine ,Calliphoridae ,Animals ,Humans ,030216 legal & forensic medicine ,Texture (crystalline) ,biology ,Chemistry ,Diptera ,010401 analytical chemistry ,Bloodstain pattern analysi ,biology.organism_classification ,0104 chemical sciences ,Amorphous solid ,Fly artifact ,Polyester ,Blood Stains ,Ultrastructure ,Microscopy, Electron, Scanning ,Artifacts ,Bloodstain pattern analysis ,Scanning electron microscopy ,Crime scene - Abstract
Insects found at a crime scene can produce traces referred to as fly artifacts (FA) due to their movement over the corpse and the manner in which they feed upon it. These can be detrimental for carrying out criminal investigations. Confusing a FA with a genuine bloodspot can lead to misinterpretations, also taking into consideration that FA may contain a human DNA profile. The aim of the present study was to employ scanning electron microscopy (SEM) for the analysis of FA produced by Calliphora vomitoria on hard surfaces and fabrics that are commonly present at crime scenes. FA and control bloodstains were produced under experimental conditions on metal, glass, plaster, cotton, and polyester. After macroscopic analysis, FA were examined at standard low (20–40 ×), medium low (300–600 ×), and high ultrastructural (1200 ×) magnification through a SEM Stereoscan 360, Leica, Cambridge. SEM analysis enabled the identification of distinctive features of FA on hard surfaces, namely, amorphous crystals, micro-crystals with a morphology similar to those of uric or micro-crystals with a comparable morphology to cholesterol, absent in controls. Moreover, red blood cells (RBC) were absent in FA but were always present in controls. On cotton, for both FA and controls, the drop was almost completely absorbed and thus indistinguishable from the underlying fabric texture. On polyester, FA showed amorphous/crystal-like deposits and no RBC, as observed on hard surfaces, except for those showing a completely flat surface. SEM analysis appeared to be suitable for differential diagnosis between FA and genuine bloodstains on hard surfaces, although the results may be inconclusive on tested fabrics.
- Published
- 2022
25. Who killed my dog? Use of forensic genetics to investigate an enigmatic case
- Author
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Susi Pelotti, Paolo Fais, Giuseppe Merialdi, Carla Bini, Mariana Roccaro, Angelo Peli, Roccaro M., Bini C., Fais P., Merialdi G., Pelotti S., and Peli A.
- Subjects
Forensic Genetics ,Mitochondrial DNA ,Cytochrome b ,Case Report ,Biology ,Genetic analysis ,DNA, Mitochondrial ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Dogs ,Species Specificity ,medicine ,Dog ,Animals ,030216 legal & forensic medicine ,Bites and Stings ,Animal attack ,Gene ,030304 developmental biology ,Genetic testing ,Genetics ,0303 health sciences ,medicine.diagnostic_test ,mtDNA ,Forensic genetic ,Cytochromes b ,Nuclear DNA ,DNA profiling ,Animal attacks ,Autopsy ,Forensic genetics ,Hair - Abstract
Genetic testing of animal biological material has become a valuable tool in forensic investigations, and it is successfully used to identify unknown crime perpetrators, to unmask food frauds, or to clarify cases of animal attacks on humans or other animals. When DNA profiling is not possible due to inadequate amounts of nuclear DNA, mitochondrial DNA (mtDNA) testing is the only viable alternative, as in the case of shed hair samples. In this case, a dog was allegedly killed by wild animals while being hosted in a boarding house. Extraneous hair fragments recovered from the dog’s mouth and paws were subjected to genetic analysis: the cytochrome b gene located on mtDNA was amplified and sequenced in order to determine the species responsible for the killing. The mtDNA analysis provided evidence that the dog was killed by other dogs, thus unmasking a false wild animal attack and putting the case in an entirely different perspective. Electronic supplementary material The online version of this article (10.1007/s00414-020-02388-9) contains supplementary material, which is available to authorized users.
- Published
- 2020
26. Detection of multiple prohibited ingredients in nutritional supplements in a case of doping
- Author
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Jennifer Pascali, Elena Piva, Mattia Forcato, Rafael Boscolo-Berto, Roberto Rondinelli, and Paolo Fais
- Subjects
Health, Toxicology and Mutagenesis ,Toxicology - Published
- 2022
27. Urine versus hair analysis: when hair analysis supports the diagnosis
- Author
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Jennifer P. Pascali, Massimo Montisci, Paolo Fais, Giovanni Cecchetto, and Guido Viel
- Subjects
business.industry ,Hair analysis ,Physiology ,Medicine ,Urine ,business - Published
- 2021
28. A 70-year study of femicides at the Forensic Medicine department, University of Bologna (Italy)
- Author
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Arianna Giorgetti, Paolo Fais, Elena Giovannini, Chiara Palazzo, Ilenia Filipuzzi, Guido Pelletti, and Susi Pelotti
- Subjects
Humans ,Female ,Autopsy ,Violence ,Homicide ,Forensic Pathology ,Law ,Crime Victims ,Pathology and Forensic Medicine - Abstract
Femicide is defined as the gender-related killings of women and girls or as an any intentional murder of women and it represents a worldwide health issue. Although it has gained a growing attention across the public and the media, true data on its prevalence and a characterization of the phenomenon are still scarce. The aim of the present study was to evaluate the characteristics of female homicides and femicides, which are necessary to design and monitor effective preventive efforts. Post-mortem examination reports of female homicides occurred in the judicial district of Bologna over a period of 70 years were revised. Characteristics of victims and perpetrators, circumstantial and post-mortem data were extracted. Overall, 172 female homicides were observed, including 103 femicides, with no significant changes over time. The mean age of victims increased over time and showed a statistically significant association with the victim-perpetrator relationship. Homicides committed by non-intimate partner family members increased. Our study unveiled that, in the past decades, femicide was a hidden but constant social phenomenon, despite the social, cultural and juridical changes. The research in forensic pathology could help bring to light trends, characteristics and risk factors to be considered for strategies to counteract violence against women.
- Published
- 2022
29. Determination of perfluoroalkyl substances (PFAS) in human hair by liquid chromatography-high accurate mass spectrometry (LC-QTOF)
- Author
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Elena Piva, Massimo Montisci, Jennifer P. Pascali, Giovanni Cecchetto, Paolo Fais, Guido Viel, Piva E., Fais P., Cecchetto G., Montisci M., Viel G., and Pascali J.P.
- Subjects
Fluorocarbon ,Clinical Biochemistry ,PFAS ,LC-QTOF ,Liquid chromatography ,Mass spectrometry ,Biochemistry ,Perfluoroalkyl acids ,Analytical Chemistry ,Tandem Mass Spectrometry ,Biomonitoring ,Humans ,Environmental Pollutant ,Chromatography, High Pressure Liquid ,Fluorocarbons ,Chromatography ,Chemistry ,Extraction (chemistry) ,Perfluoroalkyl acid ,Cell Biology ,General Medicine ,Mass measurement ,Hair ,Perfluorinated compounds ,Perfluorinated compound ,Alkanesulfonic Acids ,Alkanesulfonic Acid ,Environmental Pollutants ,Environmental Monitoring ,Human - Abstract
Biomonitoring of perfluoroalkyl substances (PFASs) in hair is conventionally achieved by SPE extraction and liquid chromatography-triple quadrupole analysis, with sensitivities in the range of ng/g. The aim of this study was to develop and validate a rapid method to detect 20 perfluoroalkyl substances (PFASs) in human hair from general populations by SPE purification and liquid-chromatography coupled to accurate mass measurement (LC-QTOF). The obtained sensitivities (LOQ), linearity and RSD accuracies were respectively in the range of 0.07-0.5 ng/g, 0.1 (or 0.2 or 0.5)-10 ng/g, 1-16%. To verify the applicability of the method, 11 hair samples from volunteers were tested. The detected PFAS were PFBA (range 0.24-14.6 ng/g), PFBS (0.496 ng/g), PFOA (range 0.08-0.178 ng/g) and PFOS (LOQ-0.239 ng/g). The results were compared in terms of detection frequency and abundance with previously published studies. The method proved useful for the determination of the tested PFAS in the hair matrix.
- Published
- 2021
30. The use of fly artifacts in a crime scene: Is there any application for forensic toxicology?
- Author
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Elena Giovannini, Arianna Giorgetti, Paolo Fais, Guido Pelletti, Rossella Barone, Susi Pelotti, Jennifer P. Pascali, Giorgetti A., Pelletti G., Fais P., Giovannini E., Barone R., Pelotti S., and Pascali J.P.
- Subjects
6-MAM ,human bloodstains ,Pathology and Forensic Medicine ,Heroin ,chemistry.chemical_compound ,Trace evidence ,Tandem Mass Spectrometry ,Genetics ,Crime scene ,Medicine ,Heroin users ,forensic toxicology ,Putrefaction ,liquid chromatography-mass spectrometry ,codeine ,Morphine Derivatives ,fly artifacts ,business.industry ,Codeine ,human bloodstain ,Forensic toxicology ,Pattern recognition ,chemistry ,benzoylecgonine ,fly artifact ,Benzoylecgonine ,crime scene investigation ,Crime ,Artificial intelligence ,Artifacts ,business ,Chromatography, Liquid ,medicine.drug - Abstract
Fly artifacts (FA) are bloodstains resulting from insect activity at a crime scene, usually by feeding on human blood. Whether these artifactual stains might be useful for forensic toxicological investigations in cases of absence of conventional and unconventional matrices, for example, in cases concealment of the body or of extensive putrefaction, has not yet been investigated. The purpose of this study is to understand if FA trace evidence permits toxicological analysis when traditional matrices are not available. To this aim, FA experimentally produced by Calliphora vomitoria feeding on human blood of a cocaine and heroin user were collected from absorptive and non-absorptive material. FA material was analyzed by a new simple and fast LC-MS/MS method. Results were evaluated in terms of presence of the drug and relative amount of the detected molecules. From a qualitative point of view, the analysis of FA revealed all the substances originally detected in post-mortem blood in both cases. The ratios of cocaine/benzoylecgonine, codeine/morphine, and 6-monoacetylmorphine/morphine recovered in FA from cotton-textile materials and from non-absorptive surfaces were consistent with data resulted from original post-mortem blood. The preliminary study herein reported demonstrated that FA are extremely informative in case of cocaine and heroin users and merit further research in order to be applied in real caseworks.
- Published
- 2021
31. Homicide and concealment of the corpse. Autopsy case series and review of the literature
- Author
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Arianna Giorgetti, Maria De Matteis, Paolo Fais, Chiara Giraudo, Amalia Lupi, Guido Viel, Massimo Montisci, Giovanni Cecchetto, Claudio Terranova, Alessandra Puggioni, De Matteis M., Giorgetti A., Viel G., Giraudo C., Terranova C., Lupi A., Fais P., Puggioni A., Cecchetto G., and Montisci M.
- Subjects
Body disposal ,medicine.medical_specialty ,Forensic radiology and toxicology ,Omics sciences ,Post-mortem examination ,Burial ,Poison control ,Omics science ,Multiple methods ,01 natural sciences ,Fires ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Age Distribution ,Homicide ,Epidemiology ,Freezing ,Immersion ,Cadaver ,Medicine ,Humans ,030216 legal & forensic medicine ,Corpse Dismemberment ,Sex Distribution ,Crime Victims ,Retrospective Studies ,Motivation ,business.industry ,010401 analytical chemistry ,Medical jurisprudence ,Retrospective cohort study ,Autopsy case ,Criminals ,Forensic Medicine ,0104 chemical sciences ,Forensic science ,Family medicine ,business - Abstract
Introduction: The concealment of the body following a homicide undermines different moments of the forensic and medico-legal investigations. The aim of the present study is to provide an overview of the literature and the forensic casuistry of the Institute of Legal Medicine of Padova for analyzing and discussing diverse methodological approaches for the forensic pathologist dealing with covered-up homicides. Material and methods: A literature review, updated until September 2019, was performed, and a literature pool of forensic cases was built. In-house cases were included by conducting a retrospective analysis of the forensic caseworks of Padova of the last 20years. Data regarding epidemiology, methodology of assessment, methods of concealment, and answers to medico-legal issues were extracted for both data sets. Results and discussion: Seventy-eight papers were included in the literature review (78.2% being case reports or case series, 17% retrospective studies, and 6% experimental studies or reviews). Literature and in-house data sets consisted of 145 and 13 cases, respectively. Death scene investigation, radiology, toxicology, and additional analyses were performed in 20–54% of literature and 62–77% of in-house cases. Cover-up by multiple methods prevailed. Death was caused by head trauma in about 40% of cases (both data sets), strangulation in 21% of literature, and 7% of in-house cases, and was undetermined in 17% of literature and 7% of in-house cases. Conclusions: The methodology of ascertainment should be case-specific and based on a multidisciplinary and multimodal evaluation of all data, including those gained through novel radiological and/or analytical techniques.
- Published
- 2021
32. Importance of dashboard camera (Dash Cam) analysis in fatal vehicle–pedestrian crash reconstruction
- Author
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Arianna Giorgetti, Alessio Giusti, Marco Garagnani, Elena Giovannini, Guido Pelletti, Paolo Fais, Susi Pelotti, Jennifer P. Pascali, Giovannini E., Giorgetti A., Pelletti G., Giusti A., Garagnani M., Pascali J.P., Pelotti S., and Fais P.
- Subjects
Computer science ,Vehicle pedestrian crash ,Video Recording ,Case Report ,Dash Cam ,Pedestrian ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Aeronautics ,Traffic crash ,0502 economics and business ,Dash ,Humans ,030216 legal & forensic medicine ,Articulated vehicle ,Forensic Pathology ,Pedestrians ,050210 logistics & transportation ,Privacy right ,05 social sciences ,Digital video ,Accidents, Traffic ,General Medicine ,Manner of death ,Motor Vehicles ,Dashboard ,Motor Vehicle ,Forensic pathology ,Human - Abstract
The reconstruction of dynamic of traffic injuries remains a challenge in forensic pathology and is often based on circumstantial data. Dash Cams are digital video recorders which can be located inside a vehicle and continuously record the view through the windscreen, thus providing objective evidence. Here we present the case of a traffic crash in which a pedestrian was hit by an articulated lorry. The analysis of a video recorded from a Dash Cam retrieved inside the vehicle during the death scene investigation (DSI) was crucial in the reconstruction of the manner of death. Indeed, the death, which was initially assumed to be accidental, was finally deemed as a suicide on the basis of the video recording, which showed an intentional and sudden rush of the victim to the middle of the roadway. Advantages and disadvantages of the use of Dash Cams will be discussed, focusing on the profound differences in the related national and international regulations. Based on the present case, in traffic crashes, the search for Dash Cams during the DSI may be recommended and the video recordings should be analyzed in the setting of a multidisciplinary and multimodal evaluation of the case, for a proper reconstruction of the facts. Supplementary Information The online version contains supplementary material available at 10.1007/s12024-021-00382-0.
- Published
- 2021
33. Hair determination of per- and polyfluoroalkyl substances (PFAS) in the Italian population
- Author
-
Massimo Montisci, E. Piva, F. Lo Faro, P. Ioime, F. Pirani, Francesca Freni, Luca Morini, Paolo Fais, Jennifer P. Pascali, Arianna Giorgetti, Piva E., Giorgetti A., Ioime P., Morini L., Freni F., Faro F.L., Pirani F., Montisci M., Fais P., and Pascali J.P.
- Subjects
0301 basic medicine ,Adult ,Fluorocarbon ,Male ,Aging ,Adolescent ,Population ,Toxicology ,LC–MS ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Biomonitoring ,Hair ,Perfluoroalkyl substances ,PFOA ,PFOS ,Aged ,Chromatography, High Pressure Liquid ,Environmental Monitoring ,Environmental Pollutants ,Female ,Fluorocarbons ,Geography ,Humans ,Italy ,Limit of Detection ,Middle Aged ,Prevalence ,Tandem Mass Spectrometry ,education ,Environmental Pollutant ,Chromatography ,education.field_of_study ,Chemistry ,Italian population ,030104 developmental biology ,Internal dose ,High Pressure Liquid ,Bioaccumulation ,Environmental chemistry ,Perfluoroalkyl substance ,030217 neurology & neurosurgery ,Human - Abstract
Per- and polyfluoroalkyl substances (PFAS) are anthropogenic chemicals present in the environment and defined as persistent organic pollutants (POPs). The interest in these forms of contaminants is related to the toxic consequences for health derived from exposures and bioaccumulation processes. The present research aims at assessing differences in the exposure of PFAS in the Italian population by hair analyses. To this aim, 20 compounds of the PFAS family were investigated in hair of 86 Italian subjects distributed across the regions of Veneto, Emilia-Romagna, Lombardy and Marche. The applied method was ad hoc developed in a previous research and included SPE extraction and LC-QTOF analysis. In the analyzed population, 66.4 % had quantifiable amounts of one or more PFAS molecules (up to 4 compounds); mean PFAS content, expressed as sum of PFAS, was 0.1457 ng/g, ranging from “not detected” to 0.85 ng/g (SD 0.1867). PFOA and PFOS were the chemicals most frequently detected, with mean concentrations of 0.1402 ng/g and 0.1155 ng/g, respectively. PFBA was detected in 9.3 % of subjects with a mean concentration of 0.3760 ng/g; PFNA in 3.5 % of subjects with mean concentration 0.12 ng/g; PFDA was found in one subject at the concentration of 0.541 ng/g. PFUnA and PFHxS were detected below the limit of quantification. The overall results displayed differences in the presence and prevalence of PFAS in hair of the Italian population on a geographical base. On the contrary, no significatively differences in the amount of PFAS were observed when considering gender or age classes. On this base, hair can be considered a good diagnostic tool to assess PFAS exposure on a regional-scaled base. Of course, more studies are required to infer PFAS internal dose from hair results due to its peculiar detection window and to interpretative issues derived from external contamination.
- Published
- 2021
34. The role of risk or contributory death factors in methadone-related fatalities: A review and pooled analysis
- Author
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Giovanni Cecchetto, Alessia Viero, Raffaele Giorgetti, Barbara Bonvicini, Guido Viel, Paolo Fais, Jennifer P. Pascali, Massimo Montisci, Irene Amico, Arianna Giorgetti, Giorgetti A., Pascali J., Montisci M., Amico I., Bonvicini B., Fais P., Viero A., Giorgetti R., Cecchetto G., and Viel G.
- Subjects
medicine.medical_specialty ,Drug-related death ,Forensic toxicology ,Methadone ,Post-mortem examination ,Endocrinology, Diabetes and Metabolism ,lcsh:QR1-502 ,Logistic regression ,Biochemistry ,Article ,lcsh:Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Pharmacokinetics ,Internal medicine ,Medicine ,030216 legal & forensic medicine ,030212 general & internal medicine ,Molecular Biology ,Pathological ,Cause of death ,business.industry ,Acute toxicity ,Pooled analysis ,business ,medicine.drug - Abstract
Methadone-related deaths are characterized by a wide range of post-mortem blood concentrations, due to the high pharmacokinetic/dynamic inter-individual variability, the potential subjective tolerance state and to other risk factors or comorbidities, which might enhance methadone acute toxicity. In the present study, the association among pre-existing and external conditions and diseases and the resultant methadone death capacity have been investigated. Beside a systematic literature review, a retrospective case-control study was done, dividing cases in which methadone was the only cause of death (controls), and those with associated clinical-circumstantial (naive/non-tolerant state), pathological (pulmonary or cardiovascular diseases) or toxicological (other drugs detected) conditions. Methadone concentrations were compared between the two groups and the association with conditions/diseases was assessed by multiple linear and binomial logistic regressions. Literature cases were 139, in house 35, consisting of 22 controls and 152 cases with associated conditions/diseases. Mean methadone concentrations were 2122 ng/mL and 715 ng/mL in controls and cases respectively, with a statistically significant difference (p <, 0.05). Lower methadone concentrations (by 24, 19 and 33% respectively) were detected in association with naive/non-tolerant state, pulmonary diseases and presence of other drugs, and low levels of methadone (<, 600 ng/mL) might lead to death in the presence of the above conditions/diseases.
- Published
- 2021
35. Molecular mechanisms of action of novel psychoactive substances (Nps). A new threat for young drug users with forensic-toxicological implications
- Author
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Giorgia Franchetti, Giovanni Cecchetto, Guido Pelletti, Paolo Fais, Andrea Gabbin, Arianna Giorgetti, Jennifer P. Pascali, Guido Viel, Giorgetti A., Pascali J.P., Fais P., Pelletti G., Gabbin A., Franchetti G., Cecchetto G., and Viel G.
- Subjects
0301 basic medicine ,Hallucinogen ,Drug ,media_common.quotation_subject ,Science ,Neurotransmitter systems ,toxicodynamic ,Review ,Mechanism of action ,Bioinformatics ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Study Eligibility Criteria ,Synthetic cannabinoids ,Medicine ,Health risk ,Ecology, Evolution, Behavior and Systematics ,media_common ,Mass spectrometry ,business.industry ,Toxicody-namic ,Forensic toxicology ,Paleontology ,030104 developmental biology ,Action (philosophy) ,Space and Planetary Science ,New psychoactive substances (NPS) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Novel psychoactive substances (NPS) represent a severe health risk for drug users. Even though the phenomenon has been growing since the early 2000s, the mechanisms of action of NPS at the receptors and beyond them are still scarcely understood. The aim of the present study was to provide a systematic review of the updated knowledge regarding the molecular mechanisms underlying the toxicity of synthetic opioids, cannabinoids, cathinones, and stimulants. The study was conducted on the PubMed database. Study eligibility criteria included relevance to the topic, English language, and time of publication (2010–2020). A combined Mesh and free-text protocols search was performed. Study selection was performed on the title/abstract and, in doubtful cases, on the full texts of papers. Of the 580 records identified through PubMed searching and reference checking, 307 were excluded by title/abstract and 78 additional papers were excluded after full-text reading, leaving a total of 155 included papers. Molecular mechanisms of synthetic opioids, synthetic cannabinoids, stimulants, psychedelics, and hallucinogens were reviewed and mostly involved both a receptor-mediated and non-receptor mediated cellular modulation with multiple neurotransmitters interactions. The molecular mechanisms underlying the action of NPS are more complex than expected, with a wide range of overlap among activated receptors and neurotransmitter systems. The peculiar action profile of single compounds does not necessarily reflect that of the structural class to which they belong, accounting for possible unexpected toxic reactions.
- Published
- 2021
36. Correction to: Homicide and concealment of the corpse. Autopsy case series and review of the literature
- Author
-
Claudio Terranova, Chiara Giraudo, Giovanni Cecchetto, Paolo Fais, Maria De Matteis, Arianna Giorgetti, Guido Viel, Massimo Montisci, Alessandra Puggioni, and Amalia Lupi
- Subjects
History ,Homicide ,Published Erratum ,MEDLINE ,Medical law ,Autopsy case ,Genealogy ,Pathology and Forensic Medicine - Abstract
This article was published online with an error. Given names and family names of the authors were interchanged. The correct author names are presented above. The original article has been corrected.
- Published
- 2021
37. The Red Swamp Crayfish Procambarus Clarkii (the Louisiana Crayfish) as a Particular Scavenger on a Human Corpse
- Author
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Jennifer P. Pascali, Paolo Fais, Nicola Pigaiani, Guido Viel, Stefano Vanin, Massimo Montisci, Giovanni Cecchetto, Pascali J.P., Viel G., Cecchetto G., Pigaiani N., Vanin S., Montisci M., and Fais P.
- Subjects
Male ,forensic science ,education ,Zoology ,Astacoidea ,crayfish ,forensic pathology ,postmortem interval ,Procambarus clarkii ,scavenging ,Swamp ,Scavenger ,Postmortem Changes ,Pathology and Forensic Medicine ,Feeding behavior ,Immersion ,Genetics ,80 and over ,Animals ,Humans ,Postmortem Change ,Aged ,Aged, 80 and over ,geography ,geography.geographical_feature_category ,Drowning ,Feeding Behavior ,biology ,Animal ,forensic science, forensic pathology, Procambarus clarkii, scavenging, crayfish, postmortem interval ,biology.organism_classification ,Crayfish ,Crustacean ,Human - Abstract
An 85-year-old man was found deceased floating in an irrigation ditch 18days after his disappearance. During crime scene investigation, specimens of the red swamp crayfish Procambarus clarkii were found in proximity of the body. The feeding activity of these nonendemic crayfishes contributed to the formation of specific injuries on the body and in the production of a large substance defects inside the corpse. The aim of this paper was to illustrate the scavenging activity of P.clarkii on a human body and highlight the potential postmortem artefacts caused by this species. This is the first report on a real case of postmortem injuries produced by P.clarkii crayfishes on a submerged human body. So far, crustaceans are not considered useful for the estimation of the minimum postmortem interval. However, the important modifications on the corpses deriving from the activity of these animals should be kept in consideration.
- Published
- 2020
38. Integrated multidisciplinary approach in a case of occupation related planned complex suicide-peticide
- Author
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Chiara Palazzo, Paolo Fais, Guido Pelletti, Susi Pelotti, Jennifer P. Pascali, Federica Fersini, Maria Carla Mazzotti, Palazzo C., Pascali J.P., Pelletti G., Mazzotti M.C., Fersini F., Pelotti S., and Fais P.
- Subjects
Forensic pathology ,medicine.medical_specialty ,01 natural sciences ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Dogs ,Multidisciplinary approach ,Dog ,Medicine ,Animals ,Humans ,Psychiatric drugs ,030216 legal & forensic medicine ,Occupations ,Psychiatry ,business.industry ,Illicit Drugs ,Mentally ill ,Mental Disorders ,010401 analytical chemistry ,Forensic toxicology ,Pets ,Middle Aged ,0104 chemical sciences ,Pet ,Suicide ,Issues, ethics and legal aspects ,Licit drug ,Female ,business ,Homicide - Abstract
The combined event of a suicide and the killing of a pet has been hardly explored in forensic literature, but it is not rare at all. In the reported case the dead corpse of a 60-year old mentally ill woman and the carcass of a dog were found on the bed of a private apartment. In light of death scene investigation, necroscopic examination and toxicological analyses death was attributed to licit drug intoxication and self-strangulation after lethal poisoning of the dog. Due to the presence of two lethal means (cervical noose and drugs), acting in chronological order, the event was classified as a secondary complex suicide. Moreover, the woman, although mentally ill, was a psychiatrist. Thus, her professional background, namely the easy access to psychiatric drugs together with her knowledge of drug composition and properties lead to suppose an occupation related suicide. The comprehensive analysis of all the available information, including death scene investigation, occupational, necroscopic and toxicological data, resulted of the utmost importance for a proper reconstruction of the events and are recommended in complex cases such as occupation related planned complex suicides combined to the killing of pets.
- Published
- 2020
39. Post-mortem thermal angiography: a pilot study on swine coronary circulation
- Author
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Maria Carla Mazzotti, Susi Pelotti, Guido Viel, Giovanni Cecchetto, Ornella Leone, Paolo Fais, Chiara Palazzo, Massimo Montisci, Fais P., Mazzotti M.C., Montisci M., Palazzo C., Leone O., Cecchetto G., Viel G., and Pelotti S.
- Subjects
medicine.medical_specialty ,Thermal imaging ,Swine ,Post-mortem imaging ,Cardiopathology ,Pilot Projects ,Coronary Angiography ,Ex situ coronarography ,Pathology and Forensic Medicine ,Coronary circulation ,Left coronary artery ,Coronary Circulation ,Internal medicine ,medicine.artery ,medicine ,Animals ,Pilot Project ,Circumflex ,Post-mortem coronarography ,Coronary Vessel ,medicine.diagnostic_test ,Animal ,business.industry ,Heart ,Organ Size ,Coronary Vessels ,Coronary arteries ,Contrast medium ,medicine.anatomical_structure ,Thermography ,Right coronary artery ,Angiography ,Coronary vessel ,Cardiology ,Autopsy ,business - Abstract
Thermal imaging (TI) allows the detection of thermal patterns emitted from objects as a function of their temperature in the long-infrared spectrum and produces visible images displaying temperature differences. The aim of this pilot study was to test TI to visualize the coronary circulation of swine hearts. Thirty swine hearts were prepared for ex situ coronarography, and thermal images were acquired through a FlirOne thermal camera (FLIR Systems®) paired with a Google Android Smartphone. Coronary arteries were cannulated, namely the anterior interventricular artery, the circumflex branch of the left coronary artery, and the right coronary artery. The heart was cooled, and contrast medium (CM) consisting of distilled water heated to 40°C was injected in a coronary vessel, while thermal images were captured. These steps were repeated for each coronary vessel and under experimentally simulated coronary heart disease. Thermal imaging coronarography (TIC) allowed a clear representation of the morphology and course of the coronary vessels and of experimentally simulated coronary heart disease, moreover, demonstrated to be easy to perform during or after autopsies on ex situ hearts, non-destructive, reproducible, and cheap. On the basis of these preliminary results, TIC might allow a subsequent more focused and comprehensive cardiopathological examination of the heart, which remains mandatory for the definitive diagnosis of coronary heart disease. Although these preliminary results seem encouraging, further systematic studies on human hearts, both normal and pathological, are necessary for estimating the sensitivity and specificity of the proposed method and to draw any definitive conclusion.
- Published
- 2018
40. Fatal varicella in immigrants from tropical countries: Case reports and forensic perspectives
- Author
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Sveva Borin, Susi Pelotti, Annamaria Govi, F. Poli, Paolo Fais, Gianni Guadagnini, Simone Lo Baido, Guadagnini, Gianni, Lo Baido, Simone, Poli, Francesca, Govi, Annamaria, Borin, Sveva, Fais, Paolo, and Pelotti, Susi
- Subjects
Adult ,Male ,Herpesvirus 3, Human ,Pediatrics ,medicine.medical_specialty ,Asia ,South asia ,viruses ,media_common.quotation_subject ,Immigration ,Emigrants and Immigrants ,Disease ,medicine.disease_cause ,Pathology and Forensic Medicine ,Immunocompromised Host ,03 medical and health sciences ,Chickenpox ,0302 clinical medicine ,030225 pediatrics ,Humans ,Medicine ,030212 general & internal medicine ,Varicella Ancestry Geographical provenance Immunization ,Forensic Pathology ,Pathological ,media_common ,Tropical Climate ,business.industry ,Varicella zoster virus ,virus diseases ,medicine.disease ,Comorbidity ,Death ,Issues, ethics and legal aspects ,Italy ,Immunization ,Immunization program ,Female ,business - Abstract
The primary Varicella Zoster Virus (VZV) infection results in varicella, a generally benign, self-limiting disease in immunocompetent children. Despite the usual course a possible fatal evolution of the primary infection is observed predominantly in immunocompromised subjects and in adults, especially emigrating from tropical regions. Two cases of fatal varicella have been investigated and discussed. Death occurred in two patients over 40 years of age, coming from South Asia and receiving chronic immunosuppressive therapy. The forensic expert must be cautious and consider all clinical records in managing fatal varicella cases, bearing in mind risk factors and pre-existing conditions such as age, geographical provenance and pathological comorbidity, which may lead to a bad prognosis irrespective of therapies. Based on the severe and fatal course observed in the reported cases, an extension of the immunization program appears advisable for immigrants from tropical countries, especially before scheduled immunotherapy.
- Published
- 2018
41. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges
- Author
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Renzo Giordano, Alessia Viero, Giovanni Cecchetto, Dario Raniero, Paolo Fais, Guido Viel, Stefano Kusstatscher, Massimo Montisci, Chiara Giraudo, and Paolo Fais, Alessia Viero, Guido Viel, Renzo Giordano, Dario Raniero, Stefano Kusstatscher, Giraudo Chiara, Giovanni Cecchetto, Massimo Montisci
- Subjects
Adult ,Male ,medicine.medical_specialty ,Forensic pathology ,Necrotizing fasciitis ,Medical malpractice ,Medical law ,Clinical forensic medicine ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,LRINEC score ,Diagnosis ,Medicine ,Humans ,030216 legal & forensic medicine ,Fasciitis, Necrotizing ,Intensive care medicine ,Fasciitis ,Forensic pathology, clinical forensic medicine, necrotizing fasciitis, medical malpractice, LRINEC score ,Cause of death ,Retrospective Studies ,business.industry ,Septic shock ,Soft Tissue Infections ,Soft tissue ,Middle Aged ,medicine.disease ,Italy ,030220 oncology & carcinogenesis ,Female ,business ,Medical literature - Abstract
Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.
- Published
- 2018
42. 'Light cannabis' consumption in a sample of young adults: Preliminary pharmacokinetic data and psychomotor impairment evaluation
- Author
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Rossella Barone, Arianna Giorgetti, Francesca Rossi, Susi Pelotti, Marco Garagnani, Guido Pelletti, Paolo Fais, Pelletti G., Barone R., Giorgetti A., Garagnani M., Rossi F., Fais P., and Pelotti S.
- Subjects
media_common.quotation_subject ,Pharmacokinetic ,Cannabidiol (CBD) ,01 natural sciences ,Pathology and Forensic Medicine ,03 medical and health sciences ,Psychomotor Performances ,0302 clinical medicine ,Human use ,Pharmacokinetics ,Δ9-tetrahydrocannabinol (Δ9-THC) ,Medicine ,030216 legal & forensic medicine ,Young adult ,media_common ,Psychomotor learning ,biology ,Light cannabi ,business.industry ,010401 analytical chemistry ,Psychomotor impairment ,biology.organism_classification ,0104 chemical sciences ,Blood ,Cannabis ,business ,Law ,Cannabidiol ,Vigilance (psychology) ,Demography ,medicine.drug - Abstract
Introduction: In 2019, the Italian Supreme Court established that hemp cannot be commercialized for human use, when the “psychotropic effect” of the product or its “offensiveness” can be demonstrated. The aim of the present study is to assess Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) blood concentrations after smoking cannabis with a low percentage of Δ9-THC, also referred as “light cannabis”, and its effects on young adults’ vigilance, cognitive and motor skills. Materials and methods: Eighteen young adults consumed three light cannabis cigarettes containing 400 mg of inflorescences each, with a percentage of 0.41% of Δ9-THC and of 12.41% of CBD. Blood samples were collected before the experiment (t0), after each light cannabis cigarette (t1→t3), 60 (t4) and 120 (t5) minutes after the beginning of the experiment. Five performance tasks and a subjective scale were employed for measuring cognitive and psychomotor performances the day before the experiment (TT0) and after the third cigarette (TT1). Results: Mean (SD) concentrations (ng/ml) were 1.0 (0.8) in t1, 1.2 (0.9) in t2, 1.0 (0.8) in t3, 0.6 (0.4) in t4 and 0.3 (0.3) in t5 for Δ9-THC; 10.5 (10.3) in t1, 10.3 (13.2) in t2, 15.1 (14.8) in t3, 9.9 (9.2) in t4 and 5.7 (5.7) in t5 for CBD. No significant differences were observed between TT0 and TT1 for all performed psychomotor performance task. None of the subjects declared to feel “high” after the experiment. Discussion: All study participants reported that a higher number of cigarettes, corresponding in this study to 1200 mg of herbal product, could hardly be consumed by smoking in a recreational setting. Δ9-THC and CBD concentrations showed a high inter-subject variability, and the average concentrations were lower than those previously reported. Toxicological results showed a decrease of Δ9-THC and CBD after the third light cannabis cigarette, and a Δ9-THC /CBD ratio always
- Published
- 2021
43. Micro-computed tomography of false starts produced on bone by different hand-saws
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Diego Miotto, Alessia Viero, Guido Viel, Giovanni Cecchetto, Sindi Visentin, Massimo Montisci, Chiara Giraudo, Paolo Fais, Guido Pelletti, Pelletti, Guido, Viel, Guido, Fais, Paolo, Viero, Alessia, Visentin, Sindi, Miotto, Diego, Montisci, Massimo, Cecchetto, Giovanni, and Giraudo, Chiara
- Subjects
Micro-CT ,Engineering ,Saw marks ,False start ,Human bone ,High resolution ,01 natural sciences ,Bone and Bones ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Tool marks ,Humans ,Orthopedic Procedures ,030216 legal & forensic medicine ,Micro ct ,Micro-computed tomography ,business.industry ,False starts ,Micro computed tomography ,010401 analytical chemistry ,nutritional and metabolic diseases ,Pattern recognition ,X-Ray Microtomography ,Surgical Instruments ,0104 chemical sciences ,Issues, ethics and legal aspects ,Saw mark ,Forensic Anthropology ,Artificial intelligence ,Tomography ,business ,Biomedical engineering - Abstract
The analysis of macro- and microscopic characteristics of saw marks on bones can provide useful information about the class of the tool utilized to produce the injury. The aim of the present study was to test micro-computed tomography (micro-CT) for the analysis of false starts experimentally produced on 32 human bone sections using 4 different hand-saws in order to verify the potential utility of micro-CT for distinguishing false starts produced by different saws and to correlate the morphology of the tool with that of the bone mark. Each sample was analysed through stereomicroscopy and micro-CT. Stereomicroscopic analysis allowed the identification of the false starts and the detection of the number of tool marks left by each saw. Micro-CT scans, through the integration of 3D renders and multiplanar reconstructions (MPR), allowed the identification of the shape of each false start correlating it to the injuring tool. Our results suggest that micro-CT could be a useful technique for assessing false starts produced by different classes of saws, providing accurate morphological profiles of the bone marks with all the advantages of high resolution 3D imaging (e.g., high accuracy, non-destructive analysis, preservation and documentation of evidence). However, further studies are necessary to integrate qualitative data with quantitative metrical analysis in order to further characterize the false start and the related injuring tool.
- Published
- 2017
44. Intra-class and inter-class tool discrimination through micro-CT analysis of false starts on bone
- Author
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Lisa Martinuzzo, Chiara Giraudo, Marco Bisceglia, Emilio Quaia, Michael Weber, Giovanni Cecchetto, Paolo Fais, Sofia Moschi, Arianna Giorgetti, Massimo Montisci, Guido Viel, Giraudo, Chiara, Montisci, Massimo, Giorgetti, Arianna, Martinuzzo, Lisa, Bisceglia, Marco, Moschi, Sofia, Fais, Paolo, Weber, Michael, Quaia, Emilio, Viel, Guido, and Cecchetto, Giovanni
- Subjects
Forensic anthropology ,Saw marks ,False start ,Diagnostic accuracy ,Wounds, Penetrating ,01 natural sciences ,Sensitivity and Specificity ,Bone and Bones ,Pathology and Forensic Medicine ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Statistical analyses ,Humans ,030216 legal & forensic medicine ,Micro ct ,Forensic Pathology ,Mathematics ,Micro-computed tomography ,business.industry ,False starts ,010401 analytical chemistry ,Pattern recognition ,X-Ray Microtomography ,Predictive value ,Class (biology) ,Forensic pathology ,0104 chemical sciences ,Morphometric analysis ,ROC Curve ,Artificial intelligence ,Weapons ,business ,Validation cohort - Abstract
Micro-CT has successfully been applied to the characterization of false starts (FSs) and, among several parameters, kerf width seems to correlate to the tool blade. The aim of the present study was to evaluate the diagnostic value of micro-CT for the differentiation of saw marks produced by different classes of saws and by saws belonging to the same class and differing only in number of teeth per inches (TPI). A morphological and morphometric analysis of 84 marks, produced by 6 saws belonging to 3 morphological classes, was performed. In the experimental cohort, for each parameter, statistically significant differences in intra- and inter-class analysis were searched for and cut-offs were established. The diagnostic accuracy of cut-offs was assessed through statistical analyses on the validation cohort. The morphological assessment did not allow to differentiate saws differing only in TPI. Angle 1 and top kerf width, respectively for cross-cut and rip-cut saws with alternating set, allowed a good discrimination between FSs produced by tools belonging to the same morphological class. High positive predictive values were found in intra-class analyses, while results in inter-class analyses were less encouraging. In cases of dismemberment, a micro-CT-based analysis of FSs is strongly suggested as a part of a multistep and multimodal methodology of assessment, which includes scanning electron microscopy and stereomicroscopy. A morphological assessment should be followed by an experimental trial and by a morphometric analysis. Further studies are needed to evaluate hampering factors, such as damage by physico-chemical agents.
- Published
- 2019
45. Determining the time of death by morphological and immunohistochemical evaluation of collagen fibers in postmortem gingival tissues
- Author
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Susi Pelotti, Chiara Palazzo, Maria Carla Mazzotti, Federica Fersini, Gabriella Teti, Mirella Falconi, Paolo Fais, Alessandra Ruggeri, Mazzotti M.C., Fais P., Palazzo C., Fersini F., Ruggeri A., Falconi M., Pelotti S., and Teti G.
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Time Factors ,Time Factor ,Gingiva ,Connective tissue ,Post mortem interval ,Biology ,01 natural sciences ,Postmortem Changes ,Pathology and Forensic Medicine ,Time ,Extracellular matrix ,03 medical and health sciences ,Collagen Type III ,0302 clinical medicine ,Collagen fiber ,medicine ,Humans ,030216 legal & forensic medicine ,Postmortem Change ,Post-mortem interval ,010401 analytical chemistry ,Biomarker ,Forensic Medicine ,Immunohistochemistry ,0104 chemical sciences ,Time of death ,Ultrastructural morphological change ,Issues, ethics and legal aspects ,medicine.anatomical_structure ,Ultrastructure ,Female ,Collagen ,Gingival tissue ,Biomarkers ,Human - Abstract
The estimation of the post mortem interval (PMI) is still one of the most challenging variables to determine and the different approaches currently used in its estimation generally yield to large post mortem windows. In the present study we combined morphological and immunohistochemical analysis in order to reach a more detailed knowledge on tissue organization and degradation after death. Ultrastructural cellular changes and the extracellular matrix of gingival tissues, collected at different post mortem intervals, were observed by a Transmission Electron Microscopy (TEM), in combination with the immunohistochemical detection of extracellular matrix proteins (i.e. collagen type I and collagen type III) as potential post mortem biochemical markers. The final goal was to find a correlation between morphological modifications, biomarkers expression and the time of death. Samples of gingival tissues obtained from 10 cadavers at different post mortem intervals (short post mortem interval, 1–3 days; mid post mortem interval, 4–6 days; long post mortem interval, 7–9 days) were processed for light microscopy and TEM and they were also immunostained with anti-collagen type I and type III antibodies. Results showed gradual degradation of extracellular matrix in the suboral connective tissue in relation to the different time of death. Moreover PMI was related to an increase of nuclear chromatin condensation and cytoplasmic vacuolization both in epithelial and connective tissues. In conclusion, in addition to traditional forensic approaches to estimate PMI, the combined analyses of cellular morphology, ultrastructure and immunohistochemical expression of collagen proteins allow to better infer the PMI.
- Published
- 2019
46. Shared Decision-Making for Delivery Mode: An OPTION Scale Observer-Based Evaluation
- Author
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Federica Fersini, Paolo Fais, Nicola Rizzo, Maria Livia Rizzo, Francesca Ingravallo, Annamaria Govi, Susi Pelotti, Kim de Nooijer, Fersini F, Govi A, Rizzo ML, De Nooijer K, Ingravallo F, Fais P, Rizzo N, Pelotti S., Public Health, Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, and End-of-life Care Research Group
- Subjects
Adult ,medicine.medical_specialty ,Shared decision making ,Psychological intervention ,Skill level ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Decision aids ,Humans ,Medicine ,030212 general & internal medicine ,Observer based ,Cesarean delivery ,Patient involvement ,Cesarean Section ,business.industry ,Vaginal delivery ,Medical liability ,030503 health policy & services ,OPTION(12) score ,General Medicine ,Delivery, Obstetric ,Delivery mode ,Italy ,Scale (social sciences) ,Physical therapy ,Mode of delivery ,Female ,Pregnant Women ,Patient Participation ,0305 other medical science ,business ,Decision Making, Shared - Abstract
Objective Shared decision-making (SDM) may help to reduce the rate of Cesarean Delivery (CD). The aim of the study was to evaluate the extent to which pregnant women are involved in SDM about the mode of delivery, applying the Italian version of the OPTION 12 scale to obstetric consultations. Methods Fifty-eight outpatient consultations were rated; statistical associations between OPTION 12 scores and sociodemographic data of both patient and physicians were determined. Results The OPTION 12 total scores showed a skewed distribution in the lower range of total scores. Total scores in a percentage basis ranged from 0 to 69, with a mean of 21.2 (±19.84) and a median of 13.5. Mean and median scores for all the 12 OPTION 12 items never reached the minimum skill level. Conclusion A low level of patient involvement in deciding between a CD and a Vaginal Delivery (VD) was demonstrated. Interventions aiming at educating obstetricians as well as the adoption of decision aids are requested. Practice implications The OPTION 12 scale may prove useful for testing the extent of pregnant women’s involvement in deciding between CD and VD. The awareness of a low patient involvement seems mandatory to improve SDM and may lead to medico-legal protection.
- Published
- 2019
47. Zwitterionic HILIC stationary phase as a valuable alternative in separative techniques: Application to the analysis of gamma-hydroxybutyric acid and its metabolite in hair
- Author
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Paolo Fais, Elisabetta Bertol, Alice Ciolini, Fabio Vaiano, Jennifer P. Pascali, Pascali J.P., Fais P., Vaiano F., Ciolini A., and Bertol E.
- Subjects
Male ,Metabolite ,Clinical Biochemistry ,Hydroxybutyrates ,Liquid chromatography–mass spectrometry ,030226 pharmacology & pharmacy ,01 natural sciences ,Biochemistry ,Mass Spectrometry ,Analytical Chemistry ,Hydroxybutyrate ,chemistry.chemical_compound ,0302 clinical medicine ,Ethyl glucuronide ,Limit of Detection ,Glucuronide ,Chromatography ,Liquid ,Drug-facilitate sexual assault ,Hydrophilic interaction chromatography ,General Medicine ,Forensic toxicology ,drug-facilitate sexual assault ,forensic toxicology ,ghb ,ghb-glucuronide ,liquid chromatography–mass spectrometry ,Linear Model ,Female ,Hydrophobic and Hydrophilic Interactions ,medicine.drug ,Human ,Adult ,Reproducibility of Result ,03 medical and health sciences ,Hydrophobic and Hydrophilic Interaction ,Glucuronides ,medicine ,GHB ,GHB-glucuronide ,Chromatography, Liquid ,Forensic Toxicology ,Hair ,Humans ,Infant ,Linear Models ,Reproducibility of Results ,Sex Offenses ,Detection limit ,010401 analytical chemistry ,gamma-Hydroxybutyric acid ,Cell Biology ,0104 chemical sciences ,chemistry ,Sex offense - Abstract
In this work, the physical and chemical properties of a novel zwitterionic LC stationary phase are applied to the development, validation and application of a new fast and reliable method devoted to the analysis of GHB (gamma-hydroxybutyric acid) and its relatively new discovered glucuronide metabolite in hair. The obtained sensitivity, expressed as limit of detection (LOD) and quantification (LOQ), were 0.033 and 0.10 ng/mg for GHB and 0.11 and 0.37 ng/mg, for GHB-glucuronide respectively. Linearity was assessed between LOQ and 50 ng/mg for both compounds. GHB and GHB-glucuronide extraction from hair matrix was maintained simple and consisted in an acidified-solvent incubation. No samples purification was required before LC–MS/MS analysis. The method was finally applied to 65 real hair sample, 60 adults and 5 children below 2 years old. The obtained results highlighted that GHB concentrations were in the range 0.11–0.96 ng/mg (average 0.38 ± 0.25 ng/mg) in 44 cases (68%) while in 21 samples GHB concentrations were in the range between LOD and LOQ (0.033–0.1 ng/mg). GHB-glucuronide was detected in few samples (n. 3) at levels below LOQ. The interest on these molecules relies on the fact that GHB is both a naturally occurring inhibitory neurotransmitter in the central nervous system and an illicit drug often experienced by victims of drug-facilitated sexual assault. GHB-glucuronide was firstly identified in urine by the group of Petersen in 2013 and, as per analogy to ethyl glucuronide, it was proposed as a longer biomarker for GHB intoxication.
- Published
- 2019
48. Is old stuff back? A fatal case of ethyl chloride sniffing
- Author
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Paolo Fais, Jennifer P. Pascali, Massimo Montisci, Giovanni Cecchetto, Guido Viel, Pascali J.P., Fais P., Viel G., Cecchetto G., and Montisci M.
- Subjects
Health (social science) ,Ethyl chloride ,Ethyl Chloride ,Chloroethane ,01 natural sciences ,Sudden sniffing deaths ,Pathology and Forensic Medicine ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Sniffing ,Medicine ,lcsh:Law in general. Comparative and uniform law. Jurisprudence ,030216 legal & forensic medicine ,Forensic science ,Forensic toxicology ,Gas chromatography ,lcsh:R5-920 ,Vitreous humour ,Inhalation ,business.industry ,010401 analytical chemistry ,0104 chemical sciences ,chemistry ,Anesthesia ,lcsh:K1-7720 ,Toxicity ,medicine.symptom ,business ,lcsh:Medicine (General) ,Law ,muscle spasm - Abstract
Background Ethyl chloride (EC) or chloroethane is a colourless halogenated hydrocarbon gas regularly employed as a topical anaesthetic spray for pain-related injuries and muscle spasm in athletes. However, EC became also popular as a street drug in the 1980s. Brief inhalations of EC vapour can result in dizziness, euphoria, confusion, incoordination, hallucinosis, impairment of short-term memory and narcosis. Inhalation of higher doses, usually employed to “get high”, may be related to severe depression of the central nervous system. Indeed, toxicity and deaths have been reported so far. Case presentation A 40-year-old man was found unresponsive after EC inhalation. EC determination was performed by dynamic headspace gas chromatography coupled to mass spectrometry. EC was detected in the peripheral blood (0.156 g/L), central blood concentration (0.203 g/L) and the lung and brain (19 and 25 mg/kg). EC in the vitreous humour showed a sensitively lower respect to blood (0.018 vs 0.203 g/L). Conclusions Considering the results of toxicological analyses of investigations on the death scene besides the absence of any signs of trauma, death was attributed to inhalation of ethyl chloride.
- Published
- 2019
49. Scanning electron microscopy in the identification of fly artifacts
- Author
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Desiree Martini, Alberto Amadasi, Laura Ingrà, Mirella Falconi, Susi Pelotti, Maria Carla Mazzotti, Guido Pelletti, Paolo Fais, Chiara Palazzo, Pelletti G., Mazzotti M.C., Fais P., Martini D., Ingra L., Amadasi A., Palazzo C., Falconi M., and Pelotti S.
- Subjects
Scanning electron microscope ,Sarcophagidae ,Sarcophaga carnaria ,01 natural sciences ,Pathology and Forensic Medicine ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Animals ,Humans ,030216 legal & forensic medicine ,biology ,Chemistry ,010401 analytical chemistry ,Bloodstain pattern analysi ,Sem analysis ,biology.organism_classification ,Blood Physiological Phenomena ,0104 chemical sciences ,Fly artifact ,Blood Stains ,Microscopy, Electron, Scanning ,Artifacts ,Bloodstain pattern analysis ,Scanning electron microscopy ,Biomedical engineering ,Crime scene - Abstract
Bloodstain pattern analysis has a key role in crime scene reconstruction; however, it can be hampered by diverse confounding factors, such as insect activity which may lead to the production of small artifactual bloodstains, commonly referred to as fly artifacts (FA). Although several techniques aimed at distinguishing human bloodstains and FA have been developed, actually, no standardized and reproducible methodology is available. The aim of our study was to test the use of scanning electron microscopy (SEM) to distinguish human bloodstains from FA produced by Sarcophaga carnaria. FA and bloodstains have been produced on five different deposition surfaces under experimental conditions. After visual analysis, bloodstains and FA were analyzed at standard low (× 40–× 300) and high (× 600–× 1200) magnification through a Philips SEM 515. Although differential diagnosis between bloodstains and FA resulted often inconclusive at visual analysis, SEM analysis allowed the identification of additional key distinctive morphological features. In particular, on the surface of FA, small crystal-like and/or amorphous material deposits were observed. Such deposits were absent on bloodstains which, on the other hand, displayed red blood cells stacked in “rouleaux.” Basing on these results and under our experimental conditions, SEM analysis resulted suitable to perform a differential diagnosis between bloodstains and FA produced from the insect activity of Sarcophaga carnaria.
- Published
- 2018
50. Validation and preliminary application of a GC-MS method for the determination of putrescine and cadaverine in the human brain: a promising technique for PMI estimation
- Author
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Susi Pelotti, Paolo Fais, Rafael Boscolo-Berto, Marco Garagnani, Annalisa Morotti, Francesca Rossi, Guido Pelletti, Rossella Barone, Raffaella Roffi, and Pelletti G, Garagnani M, Barone R, Boscolo-Berto R, Rossi F, Morotti A, Roffi R, Fais P, Pelotti S.
- Subjects
Accuracy and precision ,Correlation coefficient ,Gas chromatography mass spectrometry ,Liquid-Liquid Extraction ,CAD ,Post mortem interval ,01 natural sciences ,Gas Chromatography-Mass Spectrometry ,Pathology and Forensic Medicine ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Limit of Detection ,Cadaverine ,medicine ,Putrescine ,Humans ,030216 legal & forensic medicine ,Forensic Pathology ,Mathematics ,Post-mortem interval ,Biogenic polyamine ,Forensic biochemistry and toxicology ,business.industry ,010401 analytical chemistry ,Forensic toxicology ,Brain ,Reproducibility of Results ,Pattern recognition ,Human brain ,Biogenic polyamines ,2734 ,0104 chemical sciences ,medicine.anatomical_structure ,chemistry ,Postmortem Changes ,Artificial intelligence ,Gas chromatography–mass spectrometry ,business ,Law ,Biomarkers - Abstract
Introduction Among the several techniques proposed for the estimation of the Post Mortem Interval (PMI), the analysis of odorous amines has been applied in the past, with conflicting results. The aims of this study are: (i) to develop and validate a GC–MS method for the determination of putrescine (PUT) and cadaverine (CAD) in the human brain (validation study) and (ii) to study the relation of PUT and CAD concentration in the human brain and the PMI (decomposition study). Materials and methods Validation study. Analysis has been performed through GC–MS after a liquid-liquid extraction and a single step-derivatization for the identification and quantification of odorous amines in brain cortex samples. The standard protocol used in forensic toxicology, slightly modified for endogenous compounds according to recent guidelines, was used for validation. Decomposition study. Three uninjured human brains were sampled during the autopsy of three fatal traumatic cases. Along a 120-hour period of decomposition under experimental conditions, each brain was sampled along predetermined time intervals. Results Validation study. Both PUT and CAD validation parameters were within the acceptable values defined by the Scientific Working Group for Forensic Toxicology (SWGTOX), with better selectivity, linearity, accuracy and precision values for PUT. Decomposition study. A significant relationship between PUT and CAD levels and PMI has been demonstrated through statistical analysis with a correlation coefficient of 0.98 for PUT and 0.93 for CAD (p Conclusion Although further experimental studies on a wider number of samples are necessary, the results of this study suggest a possible role of polyamine levels in brain cortex for the estimation of PMI.
- Published
- 2018
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