Intentional child and adolescent homicides in Milan (Italy): A 30-year interdisciplinary study.

This study aims to discuss the forensic and criminological implications of child homicides in the territory of Milan, Italy. The authors present a retrospective study on all the cases of child and adolescent homicides, that were observed at the Institute of Legal Medicine of Milan (Italy) in the last 30 years (from January 1991 to December 2020). A total of 46 child homicides were collected, focusing on the sociological features, by highlighting peculiar cases, risk factors, potential changing social trends, and comparing our cases with the current literature. The analysis revealed a statistically significant relationship (p < 0.05) for male adolescents and indicated that adolescent homicides were more frequently perpetrated in extrafamilial contexts. In contrast, neonaticides and infanticides were mainly committed at home. Furthermore, the Fisher's Exact test revealed that child murders were mainly committed by immigrants in the Milan district after 2005 (p < 0.05). The two main causes of death were due to sharp and firearm injuries. While the relationship between homicide clusters and homicides committed by sharp objects was not significant, adolescent homicides were mainly committed using firearms (p < 0.05). The present study may help to identify risk factors for homicides against child and adolescent. Consequently, policies that identify, prevent, and minimize this extreme violence should be designed to interrupt the vicious circle of such dreadful murderous events. Child and adolescent homicides deserve additional focus and better education for healthcare professionals and further research should be carried out to develop therapeutic and caring strategies.

Applications of artificial intelligence in forensic sciences: Current potential benefits, limitations and perspectives.

In recent years, new studies based on artificial intelligence (AI) have been conducted in the forensic field, posing new challenges and demonstrating the advantages and disadvantages of using AI methodologies to solve forensic well-known problems. Specifically, AI technology has tried to overcome the human subjective bias limitations of the traditional approach of the forensic sciences, which include sex prediction and age estimation from morphometric measurements in forensic anthropology or evaluating the third molar stage of development in forensic odontology. Likewise, AI has been studied as an assisting tool in forensic pathology for a quick and easy identification of the taxonomy of diatoms. The present systematic review follows the PRISMA 2020 statements and aims to explore an emerging topic that has been poorly analyzed in the forensic literature. Benefits, limitations, and forensic implications concerning AI are therefore highlighted, by providing an extensive critical review of its current applications on forensic sciences as well as its future directions. Results are divided into 5 subsections which included forensic anthropology, forensic odontology, forensic pathology, forensic genetics, and other forensic branches. The discussion offers a useful instrument to investigate the potential benefits of AI in the forensic fields as well as to point out the existing open questions and issues concerning its application on real-life scenarios. Procedural notes and technical aspects are also provided to the readers.

Environment, Environmental Crimes, Environmental Forensic Medicine, Environmental Risk Management and Environmental Criminology.

Forensic medicine has always held the human environment, either seen as a source for pathological agents or the background of judicial events, in great consideration. The concept of the environment has evolved through time, expanding itself to include all the physical and virtual sub-spaces in which we exist. We can nowadays talk of technoenvironmental reality; virtual spaces exploded because of the COVID-19 pandemic making us come to terms with the fact that those are the places where we work, where we socialize and, even, where we meet our doctors and can be cured. Artificial Intelligence (AI) has contributed to shaping new virtual realities that have got their own rules yet to be discovered, carved and respected. We already fight a daily battle to save our natural environment: along with the danger of green crimes, comes the need for environmental justice and environmental forensic medicine that will probably develop a forensic branch and an experimental branch, to implement our technical culture leading to definition of the real dimension of the risk itself to improve the role of legal medicine in the Environmental Risk Management. While green criminology addresses widespread green crimes, a virtual environment criminology will also develop, maybe with a contribution of AI in the justice field. For a sustainable life, the environmental revolution must rapidly take place, and there is the need for a new justice, a new forensic medicine and a new criminology too.

Explosion-related deaths: An overview on forensic evaluation and implications.

PURPOSE: Explosion-related deaths are uncommon events which require expertise and confidence so that an appropriate death investigation can be performed. The present study aims to provide a detailed forensic analysis of the issues and implications arising in the event of an explosion. METHODS: A retrospective review of casualty data was conducted on electronic literature databases. Cases concerning deadly explosions registered at the Milan Institute of Legal Medicine were examined and analyzed altogether. RESULTS: Explosions may involve closed or open systems. A security assessment of the site is always necessary. Alterations of the site due to rescue procedures can occur; thus, on-site forensic investigation should be adapted to the environment. Then, a study protocol based on autopsy procedures is presented. Application of the postmortem radiology enforces forensic procedures both for the analysis of blast injuries and skeleton fractures, and for identification purposes. Blast injuries typically cause lacerations of the lungs, intestine and major vessels; moreover, hyoid fractures can be documented. Histopathology may help to define blast injuries effectively. Forensic chemistry, toxicology and ballistics provide useful investigative evidence as well as anthropology and genetics. Different forensic topics regarding explosions are discussed through five possible scenarios that forensic pathologists may come across. Scenarios include self-inflicted explosion deaths, domestic explosions, work-related explosions, terrorist events, and explosions caused by accidents involving heavy vehicles. CONCLUSION: The scenarios presented offer a useful instrument to avoid misinterpretations and evaluation errors. Procedural notes and technical aspects are provided to the readers, with an insight on collaboration with other forensic experts.

Forensic considerations on the two major civilian terrorist events occurred in Milan: A retrospective autopsy-based study.

Explosion-related deaths are a disregarded topic of forensic sciences, despite the pivotal role of the forensic pathologist in such investigations. In fact, very few scientific articles have been published up to now, even if there is a considerable increase of terrorist attacks worldwide due to the use of improvised explosive devices (IEDs). In this paper, the authors show a retrospective autopsy-based study on the two major civilian terrorist events which occurred in Milan (Italy). The first one took place in a closed system, where a gelignite bomb was set inside the National Agriculture Bank in December 1969. 17 people were killed, and all of them underwent forensic autopsies, which were performed at the Milan Institute of Legal Medicine. The second event took place in an open system, where a car bomb exploded in Palestro Street in July 1993. 5 people were killed, forensic autopsies were performed as well. A total of 22 explosion-related deaths were assessed in this study. For each victim, the analysis of clothes, external and internal examinations were reported; furthermore, a statistical analysis using Fisher's exact test was carried out in order to show differences among blast injuries that occurred in a closed system versus an open system. The analysis of the autopsy reports, which included the descriptions of clothes, and the injury patterns allowed a possible reconstruction of the bodily exposure side of the victims in relation to the origin site of the explosive devices.

Prediction model for autopsy diagnosis of driver and front passenger in fatal road traffic collisions.

Road traffic collisions (RTC) analysis is almost a daily activity in many autopsy room. Especially when analyzing an RTC with multiple occupants in the car, it can be necessary to distinguish driver from front seat passenger in order to provide the judicial authority with elements useful to understand and to prove who was driving, considering the criminal and civil responsabilities that may derive from it. Despite this, it is beyond doubt that there is enormous difficulty in providing such information. The aim of this paper is then to evaluate whether it is possible to differentiate driver and front seat passenger in case of fatal collisions using a mathematical model based on injury pattern alone. Autopsy reports concerning 90 drivers and 60 front-seat passengers were analyzed. Statistical analysis was used to detect injuries capable of discriminating between driver and passenger, considering skin, skeletal and visceral injuries. Results show that certain skin injuries, fractures and internal organ lesions are possibly associated with drivers and front seat passenger status and the overall injury pattern seems to be able to provide useful information. A mathematical model is presented. The process to distinguishing driver from front seat passenger following fatal motor vehicle collision may use multiple sources of information, including autopsy injury pattern analysis.

The pathological diagnosis of the height of fatal falls: A mathematical approach.

The authors analyzed the injury pattern of 385 victims of fall from a height which underwent a complete autopsy, with the objective to investigate whether it was possible to construct a mathematical model to be used for height of the fall diagnosis. The cases were selected and enrolled according to a balanced stratification of the heights of the fall, allowing a subdivision into seven classes consisting of 55 subjects each: 6m or less, 9m, 12m, 15m, 18m, 21m, 24m or more (maximum 36m). For each case anthropologic and necroscopic data was collected and analyzed to obtain a standardized description of the injury pattern was obtained, dividing the body into 4 major anatomical areas (Head, Thorax, Abdomen, Skeleton), each of them further divided in 5 major organs. Every organ was finally divided into 5 objective degrees of injury. Statistical analysis was performed on all the available data using IBM SPSS Statistics 20, to test the performance of the "injury pattern assessment table" in the diagnosis of the height of the fall and to develop a related mathematical model. Our findings confirm that the height of the fall is significantly associated with age, weight of the body and the injury pattern. An Injury Pattern Assessment Table and two mathematical models which correlates the height of the fall with analyzed variables are presented.

The Adult Male Rape Victim: Forensic Description of a Series of 57 Cases.

A retrospective analysis on 57 adult male victims of sexual violence has been performed. Age, nationality and anamnesis of the victims, location of the assault, type of violence, number and identity of the assailants, presence of physical injuries, lapse of time between the assault and the request of medical assistance, and toxicological and semen detection tests were analyzed. Victims were mostly in the 31- to 40-year age group. Ten victims referred themselves as either active homosexuals or bisexuals. Forced oral and/or anal penetration was registered in 86.8% of cases, mostly performed by a single assailant. Anogenital injuries were recorded in 61.4% of cases, whereas extragenital injuries in 35.1%: abrasions and perianal reddening were the most frequent acute anogenital marks, whereas the head and lower limbs were the body parts most commonly affected by blunt trauma. No clinically severe injuries were found. Anal and perianal swabs for semen detection tested positive in less than 20% cases, whereas oral swabs always tested negative. When performed, nearly 50% of cases tested positive in drug tests, above all for psychoactive substances. No definite forensic diagnosis in terms of confirmation of rape was possible on the basis of type and topography of injuries.

How reliable are parenchymal tissues for the evaluation of carbon monoxide poisoning? A pilot study.

Dealing with burnt bodies, the forensic pathologist must first of all answer the question whether the victim was alive at the moment of the fire. This study aims at clarifying whether some human solid tissues may be reliably used for the forensic diagnosis of Co poisoning on burnt bodies providing no collectable blood during the autopsy. From 34 selected cases, both cardiac blood and parenchymal samples were collected to perform CO-oxymeter, spectrophotometry, and gas chromatography tests: blood CO estimations (blood COHb% and blood[CO]) and parenchymal[CO] values have been compared with special focus on R values. The solid tissues having the best correlations with blood CO amount turned out to be the lung (R 0.84), the liver (R 0.83), the kidney (R 0.79), and the spleen (R 0.92).

The injury pattern in fatal suicidal falls from a height: an examination of 307 cases.

Falls from a height are a common cause of suicidal death in urban settings. The aim of the present work is to describe and discuss a specific set of 307 autopsies performed in a metropolitan city such as Milan, Italy from 2006 to 2011, with a special focus on the relationship between the injury pattern and height of the fall, age at death and weight at death. The rib cage (92%), the lungs (76%), the heart (53%) and the liver (58%) turned out to be the most injured structures in the whole population. Age resulted statistically significant for heart, thoracic aorta, mesentery, kidney hilus, hip bones and right forearm injuries. Weight resulted statistically significant for subtentorial brain, facial skull, rib cage, lungs and liver injuries. Height was significant for the facial skull (including the jaw), lungs, heart, thoracic aorta, diaphragm, liver, cervical spine, sacroiliac joints, pubic symphysis, right arm and left leg. A simple Injury Extension Score was also calculated which showed a correlation with height. A great variability does exist across all the available forensic literature concerning falls from a height. As a strong common denominator for the injury pattern across all the available literature there is however the very low prevalence of neck injuries, the very high prevalence of rib cage fractures and a definite thorax and upper abdomen injury.

The medical malpractice in Milan-Italy. A retrospective survey on 14 years of judicial autopsies.

The medical malpractice is a rising and central topic for the forensic pathologist and forensic autopsies are a mandatory step in the judicial evaluation of the suspected medical malpractice. Reliable national and international registers about the medical malpractice are still missing and nowadays the necroscopic archives are therefore one of the best sources of data about such a complex phenomenon. We analyzed the archive of the Institute of Forensic Medicine of the Milan University from 1996 to 2009 and selected 317 lethal cases of suspected medical malpractice. The mean age of our cases was 60±18 years for males and 58±19 years for the females. In 70% of such cases the patient death occurred in a hospital setting. The first 24h of hospitalization turned out to be the hottest period for deaths followed by malpractice claims. The surgical branches were obviously the most involved, with abdominal surgery, orthopedics, neurosurgery and gynecology as the main contributors. Just 12% of the total amount of cases came from all the internistic branches put together. Non-hospital malpractice was typically caused by misdiagnosed myocardial infarctions and aortic ruptures. A full forensic report was present in 71 cases (all belonging to the 2007-2009 period): in 69% of cases the judicial autopsy revealed as a sufficient tool for diagnosing the cause of death; medical malpractice was confirmed in only 17% of the whole cases and a causal link between the ascertained malpractice and the patient death was recognized in only 12.7% cases.

Forensic grading of myocarditis: an experimental contribution to the distinction between lethal myocarditis and incidental myocarditis.

Myocarditis can be either the cause of the death of a person or just an incidental finding during the autopsy and the following histological examinations. To establish whether a single myocarditis is a lethal or just an incidental pathology a very careful grading is always mandatory. The aim of the present work is thus to test the hypothesis about the reliability of an evidence-based distinction between the lethal myocarditis and the incidental myocarditis. The present work compares clinical and histological features from two different groups of myocarditis. Group A is composed of patients having myocarditis at the time of death, who certainly died from other reasons (i.e.: death by head gunshot with no survival time). Group B is composed of patients who died having a myocarditis as the only pathological evidence at the autopsy and the following histological and toxicological examinations and then who died because of the myocarditis. The lethal myocarditis and the incidental myocarditis differ statistically about last days' anamnesis, acute findings in the macroscopic analysis of the heart, neutrophilic infiltration, myocite necrosis, multiple sites interstitial oedema and perivascular cuffs. Such variables can be summarized in a scoring system able to quantitatively separate the lethal myocarditis from the incidental myocarditis. Such a reliable scoring system develops far behind the isolated grading of the myocite necrosis, even though the myocite necrosis should always be considered as a pivot variable for distinguishing lethal myocarditis from incidental myocarditis. The proposed scoring system is very easy to use and it is also appreciably money-sparing with its foundations in the simple combination of clinical anamnesis, autopsy and basic histology. Its routinary application could implement the objectivity in the forensic grading of myocarditis.