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Manta AM, Petrasso PEY, Tomassini L, Piras GN, De Maio A, Cappelletti S, Straccamore M, Siodambro C, De Simone S, Peonim V, Cipolloni L, Fulginiti L, Oliva A, Worasuwannarak W, Fineschi V, Ciallella C. The wounding potential of assault rifles: analysis of the dimensions of entrance and exit wounds and comparison with conventional handguns. A multicentric study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00767-3. [PMID: 38146043 DOI: 10.1007/s12024-023-00767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
The appearance of a gunshot wound (GSW) is greatly influenced by the velocity of the projectile, where high-velocity projectiles (HVPs) are defined as ballistic agents reaching a muzzle velocity of > 600 m/s fired from assault rifles. The aim of the study is to present and explain the differences in the dimensions of entrance and exit wounds between the most used handguns and assault rifles and to propose a predictor of HVP, i.e., the ratio of exit and entrance wounds (EX/ENR). The surface area of entrance and exit GSWs and the EX/ENR were calculated. 66 perforating GSWs produced by NATO FMJ 7.62 × 52 mm and 5.56 × 42 mm fired from assault rifles were assigned to the HVP, while 64 lesions produced by conventional projectiles fired from revolvers and semi-automatic pistols were assigned to the low-velocity projectile (LVP) group. The dimensions of the exit wounds of the HVP group were significantly higher when compared to the LVP group (95% CI 0.9886-2.423, p < 0.05). The HVP group showed significantly higher values for the EX/ENR when compared to the LVP group (95% CI 2.617-7.173, p < 0.05). The evaluation of the EX/ENR can be considered an adequate tool to assess the type of weapon involved and to roughly estimate the associated wounding mechanisms, which can guide both the physician in the management and treatment of the patients affected by GSW, and the forensic pathologist in crime investigation.
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Affiliation(s)
- Anna Maria Manta
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy.
| | - Pia Eugenia Ylenia Petrasso
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Tomassini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Niccolò Piras
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro De Maio
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Simone Cappelletti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Straccamore
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Siodambro
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania De Simone
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Vichan Peonim
- Department of Pathology, Division of Forensic Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Laura Fulginiti
- Department of Pathology, College of Medicine, University of Arizona, Tucson, USA
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Wisarn Worasuwannarak
- Department of Pathology, Division of Forensic Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vittorio Fineschi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
| | - Costantino Ciallella
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Section of Legal Medicine, Sapienza University of Rome, Rome, Italy
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Di Fazio N, Scopetti M, Delogu G, Morena D, Santurro A, Cipolloni L, Serviddio G, Papi L, Frati P, Turillazzi E, Fineschi V. Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital. Diagnostics (Basel) 2023; 13:3361. [PMID: 37958256 PMCID: PMC10650777 DOI: 10.3390/diagnostics13213361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Healthcare-related homicidal cases are not novel within the medical-legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy;
| | - Luigi Papi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
| | - Emanuela Turillazzi
- Department of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (E.T.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, Italy; (N.D.F.); (M.S.); (G.D.); (D.M.); (A.S.); (P.F.)
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Morena D, Di Fazio N, Scognamiglio P, Delogu G, Baldari B, Cipolloni L, Frati P, Fineschi V. Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey. Medicina (Kaunas) 2023; 59:1928. [PMID: 38003977 PMCID: PMC10673589 DOI: 10.3390/medicina59111928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75-7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50-3.46, p < 0.001). Prioritizing protection from professional liability over patients' actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a 'risk management culture' and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine.
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Affiliation(s)
- Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | | | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
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Morena D, Di Fazio N, Scognamiglio P, Delogu G, Baldari B, Cipolloni L, Frati P, Fineschi V. Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey. Medicina (B Aires) 2023; 59:1928. [DOI: https:/doi.org/10.3390/medicina59111928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine.
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Affiliation(s)
- Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
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Cioffi A, Cecannecchia C, David MC, Cipolloni L, Santurro A. Cannabis regulatory system in European Union countries, forensic concept of "doping dose" and medico-legal implications. Med Leg J 2023; 91:128-135. [PMID: 37293768 DOI: 10.1177/00258172231166272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cannabis is the most widely used illicit psychoactive substance in the world. In recent years, in many European Union countries, there has been a decriminalisation of the use and personal possession of cannabis for recreational purposes. There has been a spread of medical cannabis, as well as marketing of cannabis products at low concentrations of delta-9-tetrahydrocannabinol (Delta-9-THC), the major chemical to which cannabis owes its psychotropic effect. The percentage limit of this substance, only recently set by the European Court of Justice, must be distinguished from the "doping dose" of Delta-9-THC, namely, the dose which causes psychotropic effect in the consumer. Our study analyses and summarises the regulations in the countries of the European Union on the penalisation of recreational cannabis, the legalisation of medical cannabis and limits on percentage of THC imposed locally. Based on the analysis of a recent judgment of the Italian Supreme Court of Cassation, we discuss the importance of the role of the forensic toxicologist in the scientific definition of "doping dose". The distinction between the doping dose of THC and the percentage of THC contained in the marketed cannabis product is vital when establishing fair punishment in the event of a crime.
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Affiliation(s)
- Andrea Cioffi
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Italy
| | - Camilla Cecannecchia
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Maria C David
- Department of Public Security, Health Central Directorate, Research Center and Forensic Toxicology Laboratory, Ministry of the Interior, Rome, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry - Scuola Medica Salernitana, University of Salerno, Italy
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Baldari B, De Simone S, Cipolloni L, Frisoni P, Alfieri L, D’Errico S, Fineschi V, Turillazzi E, Greco P, Vitagliano A, Scutiero G, Neri M. Oxidative Stress Markers in Human Brain and Placenta May Reveal the Timing of Hypoxic-Ischemic Injury: Evidence from an Immunohistochemical Study. Int J Mol Sci 2023; 24:12221. [PMID: 37569597 PMCID: PMC10418753 DOI: 10.3390/ijms241512221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
During pregnancy, reactive oxygen species (ROS) serve as crucial signaling molecules for fetoplacental circulatory physiology. Oxidative stress is thought to sustain the pathogenesis and progression of hypoxic-ischemic encephalopathy (HIE). A retrospective study was performed on the brains and placentas of fetuses and newborns between 36-42 weeks of gestation (Group_1: Fetal intrauterine deaths, Group_2: Intrapartum deaths, Group_3: Post-partum deaths, Control group sudden neonatal death); all groups were further divided into two subgroups (Subgroup_B [brain] and Subgroup_P [placenta]), and the study was conducted through the immunohistochemical investigations of markers of oxidative stress (NOX2, 8-OHdG, NT, iNOS), IL-6, and only on the brain samples, AQP4. The results for the brain samples suggest that NOX2, 8-OHdG, NT, iNOS, and IL-6 were statistically significantly expressed above the controls. iNOS was more expressed in the fetal intrauterine death (Group_1) and less expressed in post-partum death (Group_3), while in intrapartum death (Group_2), the immunoreactivity was very low. IL-6 showed the highest expression in the brain cortex of the fetal intrauterine death (Group_1), while intrapartum death (Group_2) and post-partum death (Group_3) showed weak immunoreactivity. Post-partum death (Group_3) placentas showed the highest immunoreactivity to NOX2, which was almost double that of the fetal intrauterine death (Group_1) and intrapartum death (Group_2) placentas. Placental tissues of fetal intrauterine death (Group_1) and intrapartum death (Group_2) showed higher expression of iNOS than post-partum death (Group_3), while the IL-6 expression was higher in the fetal intrauterine death (Group_1) than the post-partum death (Group_3). The AQP4 was discarded as a possible marker because the immunohistochemical reaction in the three groups of cases and the control group was negative. The goal of this study, from the point of view of forensic pathology, is to provide scientific evidence in cases of medical liability in the Obstetric field to support the clinical data of the timing of HIE.
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Affiliation(s)
- Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (B.B.); (V.F.)
| | - Stefania De Simone
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Viale Europa 12, 71122 Foggia, Italy; (S.D.S.); (L.C.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Viale Europa 12, 71122 Foggia, Italy; (S.D.S.); (L.C.)
| | - Paolo Frisoni
- Unit of Legal Medicine, Azienda USL di Ferrara, Via Arturo Cassoli 30, 44121 Ferrara, Italy;
| | - Letizia Alfieri
- Department of Medical Sciences, Section of Legal Medicine University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy;
| | - Stefano D’Errico
- Department of Medicine, Surgery and Health, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (B.B.); (V.F.)
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Via Roma, 55/57, 56126 Pisa, Italy;
| | - Pantaleo Greco
- Department of Medical Sciences, Section of Obstetrics and Gynecology, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (P.G.); (G.S.)
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy;
| | - Gennaro Scutiero
- Department of Medical Sciences, Section of Obstetrics and Gynecology, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (P.G.); (G.S.)
| | - Margherita Neri
- Department of Medical Sciences, Section of Legal Medicine University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy;
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Di Fazio N, Delogu G, Morena D, Cipolloni L, Scopetti M, Mazzilli S, Frati P, Fineschi V. New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review. Diagnostics (Basel) 2023; 13:1722. [PMID: 37238204 PMCID: PMC10217069 DOI: 10.3390/diagnostics13101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Head trauma represents the first cause of death in abused children, but diagnostic knowledge is still limited. The characteristic findings of abusive head trauma (AHT) are retinal hemorrhages (RH) and additional ocular findings, including optic nerve hemorrhages (ONH). However, etiological diagnosis must be cautious. (2) Methods: The Preferred Reporting Items for Systematic Review (PRISMA) standards were employed, and the research focus was the current gold standard in the diagnosis and timing of abusive RH. (3) Results: Sixteen articles were included for qualitative synthesis. The importance of an early instrumental ophthalmological assessment emerged in subjects with a high suspicion of AHT, with attention to the localization, laterality, and morphology of the findings. Sometimes it is possible to observe the fundus even in deceased subjects, but the current techniques of choice consist of Magnetic Resonance Imaging and Computed Tomography, also useful for the timing of the lesion, the autopsy, and the histological investigation, especially if performed with the use of immunohistochemical reactants against erythrocytes, leukocytes, and ischemic nerve cells. (4) Conclusions: The present review has made it possible to build an operational framework for the diagnosis and timing of cases of abusive retinal damage, but further research in the field is needed.
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Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, 00185 Rome, Italy; (N.D.F.); (G.D.); (D.M.); (S.M.); (P.F.)
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, 00185 Rome, Italy; (N.D.F.); (G.D.); (D.M.); (S.M.); (P.F.)
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, 00185 Rome, Italy; (N.D.F.); (G.D.); (D.M.); (S.M.); (P.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Sara Mazzilli
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, 00185 Rome, Italy; (N.D.F.); (G.D.); (D.M.); (S.M.); (P.F.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, 00185 Rome, Italy; (N.D.F.); (G.D.); (D.M.); (S.M.); (P.F.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, 00185 Rome, Italy; (N.D.F.); (G.D.); (D.M.); (S.M.); (P.F.)
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Cioffi A, Cecannecchia C, Santurro A, Cipolloni L, Cioffi F. Attitudes of Italian Infertile Women Toward Ethical and Regulatory Limits of Medically Assisted Procreation (MAP). Clin Ter 2023; 174:251-256. [PMID: 37199360 DOI: 10.7417/ct.2023.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Objective Outline the views of Italian women, with fertility problems, on Medically Assisted Procreation. Methods We have collected the opinions of 448 infertile women. The items used in the questionnaire were created with a qualitative method based on the Medically Assisted Procreation's most important bioethics issues and on the basis of the limits imposed by Law. The questions of the first part of the questionnaire were open; in the second part was closed ("Yes/No"); for each method they were asked whether they would introduce a legal limit to prohibit it. The tests have been standardized with test-retest method. Results We found that much of the disputes that have, over time, been made to Law 40 of 2004 by Italian Courts, are shared by patients with infertility problems. Italian women do not share the legal limit for Medically Assisted Procreation in over 43 women, heterologous in-semination with seed donation and egg donation. Moreover, our sample show that Italian women do not share legal limit to pre-implantation genetic diagnosis and cryopreservation of embryos. Moreover, it emerges that many Italian infertile patients disagree with the Medically Assisted Procreation for homosexual couples. Conclusion It will be important, in the event of a legislative reform in Italy on the Medically Assisted Procreation, also consider the point of view of women with infertility problems.
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Affiliation(s)
- A Cioffi
- Department of Clinical and Experimental Medicine, Section of Legal Medicine. University of Foggia, Italy
| | - C Cecannecchia
- Department of Ana-tomical, Histological, Forensic and Orthopedic Sciences. Sapienza University of Rome, Italy
| | - A Santurro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - L Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine. University of Foggia, Italy
| | - F Cioffi
- Fertilitas Day Surgery Reproductive Medicine, Salerno, Italy
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9
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Prati F, Gurguglione G, Biccire F, Cipolloni L, Ferrari M, Di Toro A, Arbustini E. Sudden cardiac death in ischaemic heart disease: coronary thrombosis or myocardial fibrosis? Eur Heart J Suppl 2023; 25:B136-B139. [PMID: 37091636 PMCID: PMC10120974 DOI: 10.1093/eurheartjsupp/suad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The mechanisms underlying sudden cardiac death (SCD) in patients with ischaemic heart disease (IHD) caused by coronary atherosclerosis are not yet clarified. For decades, acute coronary causes have been sought as the main triggers of SCD in these patients. In fact, angiographic and pathological studies in cardiac arrest survivors and SCD victims, respectively, consistently show that acute plaque events occur in ∼50% of SCD of patients with IHD. Among the acute events, plaque rupture and erosion triggering acute coronary thrombosis remain the main substrates; however, a significant percentage of plaque haemorrhage (20%) is identified by pathological studies. Its role in acute coronary thrombosis is unknown and deserves future intravascular imaging developments. In the remaining 50% of SCD, the atherosclerotic coronary disease shows the characteristics of structural stability. More recent studies have focused attention not only on the coronary tree and on the search for acute complications of atherosclerotic plaques but also on myocardial tissue, identifying replacement and patchy fibrosis as the most frequent findings in the post-mortem hearts of these patients, a feature followed by cardiac hypertrophy, as assessed by the heart weight, usually associated with fibrosis. The possibility of characterizing myocardial fibrosis in vivo, besides confirming the pathological data, now offers new risk stratification perspectives to prevent SCD in IHD, alongside the consolidated secondary prevention criteria based on left ventricular dysfunction.
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Affiliation(s)
| | - Giovanni Gurguglione
- Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Foggia, Italy
| | - Flavio Biccire
- CLI Foundation Onlus, Cli Foundation, Rome, Italy
- UniCamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Luigi Cipolloni
- Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Foggia, Italy
| | - Michela Ferrari
- Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Di Toro
- Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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10
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Delogu C, Fineschi B, La Russa R, Cipolloni L, Morena D, Frati P. A Close Insight into Medical Assisted Procreation (MAP) and related Informed Consent: A Recent Case from Italy. Clin Ter 2022; 173:507-511. [PMID: 36373444 DOI: 10.7417/ct.2022.2471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Law n. 40/2004 regulated Medically Assisted Procreation (MAP) in Italy. The case described in this article is part of the many judicial cases that have affected this legislation. Following the marital separation process, the former husband withdrew consent to the implantation of already formed embryos in the uterus of his former wife who turned to the judiciary to obtain permission to initiate such a procedure. This paper consists of an analysis of this judicial process and deals with medical-legal and bioethical issues. In contrast to what is stated in Law n. 40/2004, the subsequent Law n. 219/2017 about informed consent, establishes the general principle of the withdrawal of consent until the healthcare procedure is carried out. Another issue concerns the difficult balance between the guarantee of personal freedom and the embryo's life protection, considering that although the embryo is already formed, it is not a person yet. In light of the existence of previous conflicting judicial sentences, the careful and separate assessment of the case under discussion, together with potential future events, is essential to reach a balanced conclusion, that can resolve disputes in the Italian constantly changing society.
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Affiliation(s)
- C Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
| | - B Fineschi
- University of Siena, AGI medica, Siena, Italy
| | - R La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Medicine, University of Foggia, Foggia, Italy
| | - L Cipolloni
- Department of Clinical and Experimental Medicine, Section of Forensic Medicine, University of Foggia, Foggia, Italy
| | - D Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
| | - P Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
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11
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Frisoni P, Diani L, De Simone S, Bosco MA, Cipolloni L, Neri M. Forensic Diagnosis of Freshwater or Saltwater Drowning Using the Marker Aquaporin 5: An Immunohistochemical Study. Medicina (B Aires) 2022; 58:medicina58101458. [PMID: 36295616 PMCID: PMC9610618 DOI: 10.3390/medicina58101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Aquaporins are a family of water channel proteins. In this study, the renal and intrapulmonary expression of aquaporin-5 (AQP5) was examined in forensic autopsy cases to evaluate it as a drowning marker and to differentiate between freshwater drowning and saltwater drowning. Materials and Methods: Cases were classified into three groups: freshwater drowning (FWD), saltwater drowning (SWD), and controls (CTR). Samples were obtained from forensic autopsies at less than 72 h postmortem (15 FWD cases, 15 SWD cases, and 17 other cases) and were subjected to histological and immunohistochemical investigations. Results: In FWD group, intrapulmonary AQP5 expression was significantly suppressed compared with SWD and CTR; there was no significant difference in AQP5 expression among the other two groups. The same differences in expression were also observed in the kidney. Conclusions: These observations suggest that AQP5 expression in alveolar cells was suppressed by hypotonic water to prevent hemodilution. Moreover, it is possible to hypothesize that in the kidney, with the appearance of hypo-osmotic plasma, AQP5 is hypo-expressed, as a vital reaction, to regulate the renal reabsorption of water. In conclusion, the analysis of renal and intrapulmonary AQP5 expression would be forensically useful for differentiation between FWD and SWD, or between FWD and death due to other causes.
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Affiliation(s)
- Paolo Frisoni
- Unit of Legal Medicine, Azienda USL di Ferrara, Via Arturo Cassoli 30, 44121 Ferrara, Italy
| | - Luca Diani
- Department of Biomedical, Metabolic and Neural Sciences, Institute of Legal Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Stefania De Simone
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Maria Antonella Bosco
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy
- Correspondence:
| | - Margherita Neri
- Department of Medical Sciences, Section of Legal Medicine University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
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Abstract
Binge eating is characterised by the ingestion of large quantities of food in a short time. Cases in the literature deal exclusively with gastric perforation in people with a history of anorexia nervosa, binge eating disorder or bulimia nervosa.We report the case of a young woman with no previous diagnosis of mental illness and a history of only two binge-eating episodes that occurred a few years earlier. She died suddenly during a binge-eating episode from stomach rupture resulting from a single perforation of the stomach with leakage of food material within the abdominal cavity. There was no sign of gastric necrosis or peritonitis. The deceased died quickly.Our case, which appears unique in the literature, shows that there is a risk of death even in people with no diagnosis of eating disorders and a history of only few and isolated binge-eating episodes. Physicians should carefully investigate a patient's history to assess any risks.
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Affiliation(s)
- Andrea Cioffi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Stefania De Simone
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
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13
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Ferrara M, Bertozzi G, Volonnino G, Di Fazio N, Frati P, Cipolloni L, La Russa R, Fineschi V. Glymphatic System a Window on TBI Pathophysiology: A Systematic Review. Int J Mol Sci 2022; 23:ijms23169138. [PMID: 36012401 PMCID: PMC9408940 DOI: 10.3390/ijms23169138] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In recent years, the attention of the scientific world has focused on a clearance system of brain waste metabolites, called the glymphatic system, based on its similarity to the lymphatic system in peripheral tissue and the relevant role of the AQP4 glial channels and described for the first time in 2012. Consequently, numerous studies focused on its role in organ damage in cases of neuropathologies, including TBI. Methods: To evaluate the role that the glymphatic system has in the pathogenesis of TBI, on 23 March 2022, a systematic review of the literature according to PRISMA guidelines was carried out using the SCOPUS and Medline (via PubMed) databases, resulting in 12 articles after the selection process. Discussion and conclusion: The present review demonstrated that an alteration of AQP4 is associated with the accumulation of substances S100b, GFAP, and NSE, known markers of TBI in the forensic field. In addition, the alteration of the functionality of AQP4 favors edema, which, as already described, constitutes alterations of secondary brain injuries. Moreover, specific areas of the brain were demonstrated to be prone to alterations of the glymphatic pathway, suggesting their involvement in post-TBI damage. Therefore, further studies are mandatory. In this regard, a study protocol on cadavers is also proposed, based on the analyzed evidence.
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Affiliation(s)
- Michela Ferrara
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
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14
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De Simone S, Pollice G, Carpano F, Cipolloni L, Bosco MA, Giacani E, La Russa R. Suicide in the Province of Foggia: Retrospective Study and Analysis of the Difference between Men and Women. J Mens Health 2022. [DOI: 10.31083/j.jomh1808166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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Simone SD, Vittorio S, Cipolloni L, Bibbò R, Gurgoglione G, Fazio ND, Bosco MA. Men’s Suicide by Self-abdominal Cut and Disembowelment: A Literature Review and Analysis of Three Cases. J Mens Health 2022. [DOI: 10.31083/j.jomh1807158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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16
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Cioffi A, Cecannecchia C, Bertozzi G, Cipolloni L, Baldari B. Unusual suicide with an electric Jigsaw: A case report and literature review. J Forensic Leg Med 2022; 89:102372. [DOI: 10.1016/j.jflm.2022.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
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17
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Mariottini F, De Simone S, Cipolloni L, Bosco MA, La Russa R. Proximal Femoral Fractures in the Elderly, Mortality at 30 days and Fast Track: Does It Always Worth It? Clin Ter 2022; 173:149-154. [PMID: 35385038 DOI: 10.7417/ct.2022.2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Proximal femur fractures (PFF) usually occur in ge-riatric patients and lead to high mortality and disability. This study aims to analyze the mortality rate at 30 days in over-65 -years hospitalized patients with proximal femur fractures, comparing the data collected from three public hospitals in Lazio Region, focusing on early surgery outcomes. MATERIALS AND METHODS They were gathered data from the Regional Program for the Evaluation of the Outcomes of Health Interventions (P.Re.Val.E.) dated 2019, managed by the Department of Epidemiology of the Regional Health Service of Lazio (DEP), concerning femur fractures' treatment and outcome in elderly patients. Three hospitals were selected (called A, B, or C), belonging to a specific Local He-alth Authority in Rome, and for each of them were identified some indicators (total number of hospitalizations, origin of the admissions, destination of patients, surgery within 48 hours or two days, 30-day mortality, number of hospitalizations). RESULTS In Hospital A, the mortality rate at 30 days (305 registe-red patients) was 2.6%, the lowest among the hospitals considered. In Hospital B, the total mortality at 30 days (254 registered patients) was 7.48%, above the regional average of 5.95%. In Hospital C, the mortality rate at 30 days (71 registered patients) was 4.23%, below the regional average. CONCLUSIONS P.Re.Val.E. represents a fundamental tool to evaluate the work of the Local Health Authorities and the structures that are part of it. In particular, about proximal femoral fractures in over-65-years patients, the results of surgical treatment in 48 hours and the morta-lity rate at 30 days represent a reproducible index of quality of the healthcare system. However, other variables need to be considered in future studies, taking into account different features of various hospitals, even if they belong to the same Local Health Authority. v.
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Affiliation(s)
- F Mariottini
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - S De Simone
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - L Cipolloni
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - M A Bosco
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - R La Russa
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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18
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La Russa R, Maiese A, Cipolloni L, Di Fazio N, Delogu G, De Matteis A, Del Fante Z, Manetti F, Frati P, Fineschi V. Diagnostic assessment of traumatic brain injury by vacuum extraction in newborns: overview on forensic perspectives and proposal of operating procedures. FRONT BIOSCI-LANDMRK 2022; 27:79. [PMID: 35345311 DOI: 10.31083/j.fbl2703079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 10/18/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) during birth constitutes one of the most relevant causes of mortality and morbidity in newborns worldwide. Although improvements in obstetrical management and better indications for caesarean section have led to a consistent decrease in the incidence of perinatal mechanical injury, vacuum extraction is still associated with a high complications rate leading to several forensic issues in the evaluation of healthcare professional management. METHODS Vacuum-associated lesions may be topographically distinguished as extracranial or intracranial injuries. In order to achieve a correct assessment, diagnostic procedure should include post-mortem computed tomography and magnetic resonance imaging, autopsy examination, brain sampling and histological/immunohistochemical examination. RESULTS Post-mortem imaging represents a valid aid to guarantee preliminary evidence and direct subsequent investigations. An appropriate autopsy sampling must include several areas of cortex and underlying white matter; moreover, any visceral hemorrhages or other lesions should be sampled for the histological and immunohistochemical assessment of vitality and timing. CONCLUSIONS This study aimed to promote a validated step-by-step procedure to be adopted in order to standardize and to make easier the post-mortem framing and timing of vacuum-associated pediatric brain injuries.
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Affiliation(s)
- Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Zoe Del Fante
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Di Fazio N, Baldari B, Del Fante Z, De Simone S, Aromatario M, Cipolloni L. Gas gangrene, not a common infection: case report of post-traumatic fulminant death. Clin Ter 2022; 173:1-5. [PMID: 35147638 DOI: 10.7417/ct.2022.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Post-traumatic gas gangrene is a rare but potentially life-threa-tening condition due to soft tissues infection by Clostridium species. These anaerobic microaerophile bacteria are highly resistant to external insults related to their ability to produce spores, which can survive on any surface for long periods. Under certain conditions suitable for proliferation (such as in ischemic tissues), bacteria produce many to-xins. In particular, Clostridium perfringens type A represents the most frequent cause of traumatic gas gangrene nowadays. It produces toxins responsible for thrombotic and necrotic phenomena in soft tissues and rapid disease diffusion to muscles. Clinical manifestations usually start as local edema and emphysema but rapidly evolve into a septic state. Prognosis is poor in 20-30% of cases, and death occurs due to multiorgan failure. Because of its rapid evolution, clinical diagnosis is not always obtained, thus determining the need for post-mortem investigation. This case report presents a rare case of fulminant gas gangrene due to Clostridium Perfrigens infection developed after trau-matic injury. Despite the prompt antibiotic administration and surgical intervention on the site of trauma, gas gangrene rapidly evolved into septic shock, leading to the patient's death. Post-mortem investigations were conducted and confirmed multiorgan failure as the cause of death. Cultural analysis was also performed but showed no bacterial growth. Negativity on culture tests should be related to antibiotic administration before blood sampling and bacterial characteristics. In such cases, the correct identification of the cause of death was only possible following a careful and detailed forensic methodological approach.
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Affiliation(s)
- N Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
| | - B Baldari
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
| | - Z Del Fante
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
| | - S De Simone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - M Aromatario
- Legal Medicine Division, Sant'Andrea University Hospital, Rome, Italy
| | - L Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Ferrara M, Baldari B, Vittorio S, Bertozzi G, Cipolloni L, De Simone S. Penetrating cardiac injuries: literature review and analysis of the forensic approach. Front Biosci (Landmark Ed) 2022; 27:29. [DOI: 10.31083/j.fbl2701029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022]
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21
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Bertozzi G, Cafarelli FP, Ferrara M, Di Fazio N, Guglielmi G, Cipolloni L, Manetti F, La Russa R, Fineschi V. Sudden Cardiac Death and Ex-Situ Post-Mortem Cardiac Magnetic Resonance Imaging: A Morphological Study Based on Diagnostic Correlation Methodology. Diagnostics (Basel) 2022; 12:diagnostics12010218. [PMID: 35054385 PMCID: PMC8774558 DOI: 10.3390/diagnostics12010218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
During the last years, post-mortem imaging has gradually been assumed within research in the field of forensic pathology. This role appears to be clearly and simply applied in the trauma field with the use of conventional radiography or Post Mortem Computed Tomography (PMCT). Recently, particular attention was paid to cardiovascular imaging using Post Mortem Magnetic Resonance Imaging (PMMRI). The present experimental study aims to: (i) confirm the efficacy of a Post Mortem Cardiac Resonance Imaging (PMCRI) study protocol for the study of human hearts collected during the autopsy; (ii) apply the defined protocol on subjects who died of “SCD (sudden cardiac death)”, to identify alterations that could guide subsequent sampling. Two hearts of healthy subjects (A: male 22 years; B: female 26 years), who died from causes other than SCD were collected and compared to hearts that belonged to SCD individuals (C: male, 47 years old; D: female, 44 years old; E: male; 72 years old). The exams were performed on a 1.5 T scanner (Philips Intera Achieva, Best, the Netherlands) on hearts collected during autopsy and after a 30-day formalin fixation. Two readers analyzed the obtained images blindly and after randomization. From the comparison between the data from imaging and the macroscopic and histological investigations carried out, the present study proved the effectiveness of a PMMRI protocol to study ex-situ hearts. Moreover, it suggested the following semeiology in post-mortem SCD cases: the hyperintense area with indistinct margins in the Short Tau Inversion Recovery (STIR) sequence was linked to edema or area of pathological fibers, whereas the hypointense area in the T2-FFE sequences was linked to fibrosis. PMMRI can provide a valuable benefit to post-mortem investigations, helping to distinctly improve the success rate of histological sampling and investigations, which remains the gold standard in the diagnosis of sudden death.
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Affiliation(s)
- Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Francesco Pio Cafarelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Michela Ferrara
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
- Correspondence: ; Tel.: +39-06-4991-2722
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22
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De Simone S, Giacani E, Bosco MA, Vittorio S, Ferrara M, Bertozzi G, Cipolloni L, La Russa R. The Role of miRNAs as New Molecular Biomarkers for Dating the Age of Wound Production: A Systematic Review. Front Med (Lausanne) 2022; 8:803067. [PMID: 35096893 PMCID: PMC8795691 DOI: 10.3389/fmed.2021.803067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The timing of wounds production is a significant issue in forensic pathology. Although various methods have been evaluated, obtaining an accurate dating of lesions is still a challenge. The pathologist uses many parameters to value wound age, such as histological and immunohistochemical. In recent years, there have been many studies regarding the use of miRNAs in wound-age estimation; indeed, miRNAs have multiple potential uses in forensic pathology. SCOPE This review aims to verify the efficacy and feasibility of miRNAs as a tool for determining the timing of lesions. MATERIALS AND METHODS The authors conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed was used as a search engine to find articles published between January, 1st 2016 and October, 1st 2021, to evaluate the current state of the art regarding wound-age estimation. RESULTS A total of 256 articles were collected; after screening according to PRISMA guidelines, the systematic review included 8 articles. The studies included in this review were all Original articles evaluating the use of biomarkers for wound-age determination. DISCUSSION AND CONCLUSION The literature review showed that analysis of miRNA is an innovative field of study with significant potentiality in forensic pathology. There are few studies, and almost all of them are at an early stage. The challenge is to understand how to standardize the samples' selection to obtain reliable experimental data. This observation represents a necessary prerequisite to planning further clinical trials.
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Affiliation(s)
- Stefania De Simone
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Elena Giacani
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Maria Antonella Bosco
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Simona Vittorio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Michela Ferrara
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
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23
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Bertozzi G, Ferrara M, La Russa R, Pollice G, Gurgoglione G, Frisoni P, Alfieri L, De Simone S, Neri M, Cipolloni L. Wound Vitality in Decomposed Bodies: New Frontiers Through Immunohistochemistry. Front Med (Lausanne) 2022; 8:802841. [PMID: 35004780 PMCID: PMC8739223 DOI: 10.3389/fmed.2021.802841] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The question about wound vitality and the estimation of wound age of production are two of the classic investigation fields of forensic sciences. To answer this, the techniques most frequently used in research studies are immunohistochemistry (IHC), molecular biology, and biochemistry. Despite the great data on the literature about the usefulness of IHC in forensic pathology, there is always a request for further studies, especially on tissues altered by putrefactive phenomena. In fact, the degradation of the tissues is intended as the main limiting factor to the use of this technique. Scope: The aim of this pilot study was to evaluate the immunohistochemical behavior of samples collected from decomposed bodies (in different putrefaction phases) and to relate these findings to wound vitality and postmortem interval. Materials and Methods: Samples of skin and soft tissues were collected during autopsies, which were executed on decomposed bodies, whose cause of death was concluded to be traumatic. An immunohistochemical study was performed using antibodies against CD15, CD45, IL-15, tryptase, and glycophorin-A MMPs (endopeptidases involved in degrading extracellular matrix proteins: MMP-9 and MMP-2). An immunohistochemistry (IHC) reaction was evaluated according to a qualitative method as the following legend: (0): not expressed, (+): isolated and disseminated expression, (++): expression in groups or widespread foci, and (+++): widespread expression. Results: Most of the tested markers (tryptase, glycophorin, IL15, CD 15, CD 45, and MMP9) showed to be highly expressed in the tissue of putrefied skin for 15 days. Discussion and Conclusion: Although certainly inconclusive, this experimental application demonstrated that a nonexclusive but combined use of multiple antibodies is appropriate to verify wound vitality in decomposed bodies. Among them, GPA exhibited major reliability.
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Affiliation(s)
- Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Michela Ferrara
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Giovanni Pollice
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Giovanni Gurgoglione
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Paolo Frisoni
- Department of Medical Sciences, Section of Legal Medicine, University of Ferrara, Ferrara, Italy
| | - Letizia Alfieri
- Department of Medical Sciences, Section of Legal Medicine, University of Ferrara, Ferrara, Italy
| | - Stefania De Simone
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Margherita Neri
- Department of Medical Sciences, Section of Legal Medicine, University of Ferrara, Ferrara, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
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24
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Radaelli D, Zanon M, Concato M, Fattorini P, Alfieri L, Marino R, Neri M, Cipolloni L, D'Errico S. Spine surgery and fat embolism syndrome. Defining the boundaries of medical accountability by hospital autopsy. FRONT BIOSCI-LANDMRK 2021; 26:1760-1768. [PMID: 34994188 DOI: 10.52586/5067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fat Embolism Syndrome (FES) is a clinical condition characterized by neurological, respiratory, hematological and cutaneous manifestations. Fatal FES has been described as a rare complication during or after spinal elective surgery. The investigation of the cause of death in fatalities related with spine surgery should be mandatory to exclude or confirm fat embolism; a detailed methodological approach to the body in these cases suggests to provide a cautious dissection of surgical site and collection of samples to detect embolized fat globules in vessels. METHODS Two fatal cases of fat embolism syndrome after posterior spinal fusion are presented. CONCLUSIONS A complete post mortem examination by means of histochemical and immunohistochemical analysis explained the cause of death and prevented medical malpractice litigation.
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Affiliation(s)
- Davide Radaelli
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Martina Zanon
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Monica Concato
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Paolo Fattorini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Letizia Alfieri
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Raffaella Marino
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Margherita Neri
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
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25
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Abstract
Peritoneal encapsulation is a rare congenital pathological condition. Typical of this pathology is the presence of an accessory peritoneal flap that encloses the entire mass of the small intestine. Subjects with this condition often do not show symptoms and, in most cases, finding of it is accidental. We report a case of peritoneal encapsulation, not previously identified and found during an autopsy; the deceased, positive for HIV and affected by a Kaposi's sarcoma, died following a road accident. Unlike other cases in the literature, the peritoneum encapsulated all abdominal organs and not only small intestines. Notwithstanding, there were no signs of intestinal ischaemia or intestinal obstruction.
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Affiliation(s)
- Andrea Cioffi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefania de Simone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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26
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Bertozzi G, Maiese A, Passaro G, Tosoni A, Mirijello A, Simone SD, Baldari B, Cipolloni L, La Russa R. Neutropenic Enterocolitis and Sepsis: Towards the Definition of a Pathologic Profile. ACTA ACUST UNITED AC 2021; 57:medicina57060638. [PMID: 34203105 PMCID: PMC8234962 DOI: 10.3390/medicina57060638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022]
Abstract
Background: Neutropenic enterocolitis (NE), which in the past was also known as typhlitis or ileocecal syndrome for the segment of the gastrointestinal tract most affected, is a nosological entity that is difficult to diagnose and whose pathogenesis is not fully known to date. Initially described in pediatric patients with leukemic diseases, it has been gradually reported in adults with hematological malignancies and non-hematological conditions, such as leukemia, lymphoma, multiple myeloma, aplastic anemia, and also myelodysplastic syndromes, as well as being associated with other immunosuppressive causes such as AIDS treatment, therapy for solid tumors, and organ transplantation. Therefore, it is associated with high mortality due to the rapid evolution in worse clinical pictures: rapid progression to ischemia, necrosis, hemorrhage, perforation, multisystem organ failure, and sepsis. Case report: A case report is included to exemplify the clinical profile of patients with NE who develop sepsis. Literature Review: To identify a specific profile of subjects affected by neutropenic enterocolitis and the entity of the clinical condition most frequently associated with septic evolution, a systematic review of the literature was conducted. The inclusion criteria were as follows: English language, full-text availability, human subjects, and adult subjects. Finally, the papers were selected after the evaluation of the title and abstract to evaluate their congruity with the subject of this manuscript. Following these procedures, 19 eligible empirical studies were included in the present review. Conclusions: Despite the recent interest and the growing number of publications targeting sepsis and intending to identify biomarkers useful for its diagnosis, prognosis, and for the understanding of its pathogenesis, and especially for multi-organ dysfunction, and despite the extensive research period of the literature review, the number of publications on the topic “neutropenic enterocolitis and sepsis” appears to be very small. In any case, the extrapolated data allowed us to conclude that the integration of medical history, clinical and laboratory data, radiological imaging, and macroscopic and histological investigations can allow us to identify a specific pathological profile.
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Affiliation(s)
- Giuseppe Bertozzi
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Viale Europa 12, 71100 Foggia, Italy; (G.B.); (S.D.S.); (L.C.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Giovanna Passaro
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Alberto Tosoni
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Stefania De Simone
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Viale Europa 12, 71100 Foggia, Italy; (G.B.); (S.D.S.); (L.C.)
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00186 Rome, Italy;
| | - Luigi Cipolloni
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Viale Europa 12, 71100 Foggia, Italy; (G.B.); (S.D.S.); (L.C.)
| | - Raffaele La Russa
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Viale Europa 12, 71100 Foggia, Italy; (G.B.); (S.D.S.); (L.C.)
- Correspondence:
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27
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Aromatario M, Torsello A, D’Errico S, Bertozzi G, Sessa F, Cipolloni L, Baldari B. Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating. Medicina (Kaunas) 2021; 57:medicina57020125. [PMID: 33535407 PMCID: PMC7912597 DOI: 10.3390/medicina57020125] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 04/09/2023]
Abstract
Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, and even in a medical responsibility scenario. The aim of this review is to give an overview of the published data in the medical literature, useful to forensic pathologists. We mainly focused on the data from the last 15 years, and considered the most updated protocols and diagnostic-therapeutic tools. This study reviews the epidemiology, outcome, and dating of extra-axial hematomas in the adult population; studies on the controversial interdural hematoma are also included.
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Affiliation(s)
| | - Alessandra Torsello
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Stefano D’Errico
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Giuseppe Bertozzi
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
- Correspondence:
| | - Francesco Sessa
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Luigi Cipolloni
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00186 Rome, Italy;
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Sessa F, Salerno M, Bertozzi G, Cipolloni L, Messina G, Aromatario M, Polo L, Turillazzi E, Pomara C. miRNAs as Novel Biomarkers of Chronic Kidney Injury in Anabolic-Androgenic Steroid Users: An Experimental Study. Front Pharmacol 2020; 11:563756. [PMID: 33041804 PMCID: PMC7525215 DOI: 10.3389/fphar.2020.563756] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
miRNAs are a family of 20–22 non-coding nucleotides that control gene expression by inhibiting the translation of their target messenger RNAs (mRNAs). Two models have been proposed to elucidate the mechanism of action: they act either hindering mRNA translation or enhancing mRNA degradation. Anabolic-Androgenic Steroids (AASs) represent a class of drugs used to treat several diseases. In the last few years, AASs have frequently been used for aesthetic purposes, indeed, they form part of the larger group called image- and performance-enhancing drugs (IPEDs). Long-term AAS use can lead to serious health consequences. In this regard, the present study aimed to analyze the role of several microRNAs (miRNAs) in renal damage after AAS use, to better understand the underlying mechanisms. For this purpose, two miRNAs (miR-21 and miR-205) were tested in two groups: AAS group (seven males, mean age 33.28 ± 4.68 years; mean body mass index (BMI) 27.04 ± 1.07), and chronic kidney disease (CKD) group (seven males, mean age 66.2 ± 5.4 years; mean BMI 24.75 ± 1.35). Finally, the same miRNAs were tested in the “Control” group (seven males, mean age 44.85 ± 5.75 years; mean BMI 26.5 ± 1.88). Kolmogorov-Smirnov Test was used to determine the normality of data distribution. All variables were normally distributed. Student’s t-test was used for comparisons between two groups. Analyzing the results of the present study, the two tested miRNAs (miR-21 and miR-205) were significantly higher in the CKD group compared to the AAS group, with mir-21 being much more expressed than miR-205. This study represents a pilot study to define if these expression patterns could be studied in other biological samples (plasma, urine) in subjects with different kidney injury linked to chronic kidney diseases and AAS use, to identify reliable biomarkers that could be applied in clinical and forensic diagnostics, as well as a target for toxicological investigations or therapeutic treatments.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Polo
- Brain srl, Services and Consultancy in Health, Pavia, Italy
| | - Emanuela Turillazzi
- Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
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Sessa F, Salerno M, Cipolloni L, Bertozzi G, Messina G, Mizio GD, Asmundo A, Pomara C. Anabolic-androgenic steroids and brain injury: miRNA evaluation in users compared to cocaine abusers and elderly people. Aging (Albany NY) 2020; 12:15314-15327. [PMID: 32756006 PMCID: PMC7467388 DOI: 10.18632/aging.103512] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022]
Abstract
Anabolic-androgenic steroids (AASs) can be used to treat both hormonal diseases and other pathologies characterized by muscle loss (aging, cancer, and AIDS). Even if the adverse effects related to the misuse of AASs have been well studied in different systems and apparatuses, knowledge about brain damage is poor.In this scenario, this experimental study aimed to analyze the role of several microRNAs (miRNAs) in brain damage after AAS misuse, to better comprehend the underlying mechanisms. The research hypothesis at the base of this experimental study is that the chronic use of AASs may be associated to brain damage with a dysregulation of these miRNAs. Moreover, miRNA expression values were compared among three different groups, "AAS" group, "Cocaine" group and "Aging" group, in order to define if AAS brain damage can be compared with the brain impairment linked to aging and/or cocaine assumption.This experimental study revealed that the tested miRNAs (hsa-miR-21-5p, hsa-miR-34a-5p, hsa-miR-124-5p, hsa-miR-132-3p, and hsa-miR-144-3p) were overexpressed in all enrolled groups. In the light of the presented results, the identification of specific circulating and/or tissue biomarkers is challenging for the scientific community. Further studies with larger samples are needed to confirm these interesting findings.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania 95121, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Giulio Di Mizio
- Department of Legal, Historical, Economic and Social Sciences, University of Catanzaro, Catanzaro 88100, Italy
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, Messina 98121, Italy
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania 95121, Italy
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30
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Sessa F, Bertozzi G, Cipolloni L, Baldari B, Cantatore S, D’Errico S, Di Mizio G, Asmundo A, Castorina S, Salerno M, Pomara C. Clinical-Forensic Autopsy Findings to Defeat COVID-19 Disease: A Literature Review. J Clin Med 2020; 9:E2026. [PMID: 32605192 PMCID: PMC7409028 DOI: 10.3390/jcm9072026] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
The severe acute respiratory syndrome (SARS)-CoV-2 was identified for the first time in China, in December 2019. Confirmed cases of COVID-19 have been reported around the world; indeed, this infection has been declared a pandemic. Consequently, the scientific community is working hard to gain useful information about the history of this virus, its transmission, diagnosis, clinical features, radiological findings, research and development of candidate therapeutics as well as vaccines. This review aims to analyze the diagnostic techniques used to ascertain the COVID-19 infection, critically reviewing positive points and criticism for forensic implications, obviously including autopsy. Finally, this review proposes a practical workflow to be applied in the management of corpses during this outbreak of the COVID-19 infection, which could be useful in cases of future infectious disease emergencies. Analyzing the diagnostic methods, to date, virus nucleic acid RT-PCR represents the standard method used to ascertain the COVID-19 infection in living subjects and corpses, even if this technique has several criticisms: mainly, the staff should be highly specialized, working in high-throughput settings, able to handle high workloads and aware of health risks and the importance of the results. Thus, IgG/IgM serological tests have been developed, overcoming RT-qPCR duration, costs, and management, not requiring highly trained personnel. Nevertheless, serological tests present problems; the WHO recommends the use of these new point-of-care immunodiagnostic tests only in research settings. Furthermore, nothing has yet been published regarding the possibility of applying these methods during post-mortem investigations. In light of this scenario, in this review, we suggest a flow chart for the pathologist called on to ascertain the cause of death of a subject with historical and clinical findings of COVID-19 status or without any anamnestic, diagnostic, or exposure information. Indeed, the literature data confirmed the analytical vulnerabilities of the kits used for laboratory diagnosis of COVID-19, particularly during postmortem examinations. For these reasons, autopsy remains the gold standard method to ascertain the exact cause of death (from or with COVID-19 infection, or other causes), to consequently provide real data for statistical evaluations and to take necessary measures to contain the risks of the infection. Moreover, performing autopsies could provide information on the pathogenesis of the COVID-19 infection with obvious therapeutic implications.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (G.B.); (S.C.)
| | - Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (G.B.); (S.C.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (G.B.); (S.C.)
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00186 Rome, Italy;
| | - Santina Cantatore
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (G.B.); (S.C.)
| | - Stefano D’Errico
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Giulio Di Mizio
- Department of Law, Forensic Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Alessio Asmundo
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Sezione di Medicina Legale, Università di Messina, 98122 Messina, Italy;
| | - Sergio Castorina
- Anatomy, Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95121 Catania, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy;
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy;
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Fineschi V, Aprile A, Aquila I, Arcangeli M, Asmundo A, Bacci M, Cingolani M, Cipolloni L, D’Errico S, De Casamassimi I, Di Mizio G, Di Paolo M, Focardi M, Frati P, Gabbrielli M, La Russa R, Maiese A, Manetti F, Martelloni M, Mazzeo E, Montana A, Neri M, Padovano M, Pinchi V, Pomara C, Ricci P, Salerno M, Santurro A, Scopetti M, Testi R, Turillazzi E, Vacchiano G, Crivelli F, Bonoldi E, Facchetti F, Nebuloni M, Sapino A. Management of the corpse with suspect, probable or confirmed COVID-19 respiratory infection - Italian interim recommendations for personnel potentially exposed to material from corpses, including body fluids, in morgue structures and during autopsy practice. Pathologica 2020; 112:64-77. [PMID: 32324727 PMCID: PMC7931563 DOI: 10.32074/1591-951x-13-20] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Anna Aprile
- Department of Molecular Medicine, Legal Medicine, University of Padua, Italy
| | - Isabella Aquila
- Institute of Legal Medicine, University “Magna Graecia” of Catanzaro, Italy
| | - Mauro Arcangeli
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, Italy
| | - Alessio Asmundo
- Departmental section of Legal Medicine “G. Martino”, University of Messina, Italy
| | - Mauro Bacci
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Italy
| | | | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, Ospedale Colonnello D’Avanzo, Foggia, Italy
| | | | - Ilaria De Casamassimi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Giulio Di Mizio
- Institute of Legal Medicine, University “Magna Graecia” of Catanzaro, Italy
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Italy
| | - Martina Focardi
- Department of Health Sciences, Section of Forensic Medicine, University of Florence, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Mario Gabbrielli
- Department of Medicine, Surgery and Neuroscience, Santa Maria alle Scotte University Hospital of Siena, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Massimo Martelloni
- Department of Legal Medicine, Azienda USL Toscana Nordovest, Lucca, Italy
| | - Elena Mazzeo
- Department of Biomedical Sciences, Legal Medicine, University of Sassari, Italy
| | - Angelo Montana
- Department of Medical Science, Surgical Science and advanced Technologies “G.F, Ingrassia”, University of Catania, Italy
| | - Margherita Neri
- Department of Morphology, Surgery and Experimental Medicine, Section of Legal Medicine and LTTA Centre, University of Ferrara, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Vilma Pinchi
- Department of Health Sciences, University of Florence, Italy
| | - Cristoforo Pomara
- Department of Medical Science, Surgical Science and advanced Technologies “G.F, Ingrassia”, University of Catania, Italy
| | - Pietrantonio Ricci
- Institute of Legal Medicine, University “Magna Graecia” of Catanzaro, Italy
| | - Monica Salerno
- Department of Medical Science, Surgical Science and advanced Technologies “G.F, Ingrassia”, University of Catania, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Roberto Testi
- ASL “Città di Torino”, Regional Center for Prion Diseases (DOMP), Turin, Italy
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Italy
| | - Giuseppe Vacchiano
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
| | | | - Emanuela Bonoldi
- SC Anatomia Istologia Patologica e Citogenetica, Grande Ospedale Metropolitano Niguarda Milan, Italy
| | - Fabio Facchetti
- UOC di Anatomia Patologica, ASST Spedali Civili di Brescia, Italy
| | | | - Anna Sapino
- SC Anatomia Patologica FPO-IRCCS, Candiolo (Turin), Italy
- Department of Medical Sciences, University of Turin, Italy
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32
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Gatto V, Scopetti M, La Russa R, Santurro A, Cipolloni L, Viola RV, Di Sanzo M, Frati P, Fineschi V. Advanced Loss Eventuality Assessment and Technical Estimates: An Integrated Approach for Management of Healthcare-Associated Infections. Curr Pharm Biotechnol 2020; 20:625-634. [PMID: 30961487 DOI: 10.2174/1389201020666190408095050] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/15/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Healthcare Associated Infections (HAIs) represent a crucial issue in health and patient safety management due to the persistent nature, economic impact and possible preventability of the phenomenon. Compensation claims for damages resulting from HAI could provide insights that can improve the understanding of suboptimal steps in the therapeutic process, enable an estimate of costs related to infectious complications, and guide the development of planning tools for implementation of the quality of care. OBJECTIVE This paper analyzes all the HAI claims received at the Umberto I General Hospital of Rome across a five-year period with the aim of outlining a methodological approach to the litigation management and of characterizing the economic impact of infections on health facilities resources. METHODS All claims received during the study period have been classified according to the International Classification for Patient Safety (ICPS) system. Subsequently, claims related to Healthcare Associated Infections were evaluated through an innovative tool for determination of the risk of loss, the Advanced Loss Eventuality Assessment (ALEA) score. RESULTS The results obtained demonstrate the relevance of a correct management of HAI claims in the administration of a health care system. Specifically, the cases examined during the study highlighted the significant impact of infectious diseases of a nosocomial nature in terms of frequency and economic exposure. CONCLUSION The proposed methodological approach allows a productive analysis of the internal processes, providing fundamental data for the refinement of the preventive strategies and for the rationalization of the resources through the expenditure forecasts. Article Highlights Box: Healthcare-Associated Infections represent an essential element to consider in the management of health facilities. • Many studies highlight the economic burden of Healthcare-Associated Infections in health policies. • Litigation management represents a useful resource in the prevention of Healthcare Associated Infections. • Appropriate clinical risk management policies in the field of Healthcare-Associated Infections allow the implementation of preventive measures, the reduction of the incidence of the phenomenon and the quality of care. • The costs of Healthcare-Associated Infections can be limited through a systematic methodological approach based on Advanced Loss Eventuality Assessment and technical estimate of the value of each case. • The application of a standardized system would be desirable in any health facility despite the potential methodological, technical, behavioral and financial issues.
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Affiliation(s)
- Vittorio Gatto
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Rocco V Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Mariantonia Di Sanzo
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
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Bertozzi G, Maglietta F, Sessa F, Scoto E, Cipolloni L, Di Mizio G, Salerno M, Pomara C. Traumatic Brain Injury: A Forensic Approach: A Literature Review. Curr Neuropharmacol 2020; 18:538-550. [PMID: 31686630 PMCID: PMC7457403 DOI: 10.2174/1570159x17666191101123145] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/27/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is the principal cause of invalidity and death in the population under 45 years of age worldwide. This mini-review aims to systematize the forensic approach in neuropathological studies, highlighting the proper elements to be noted during external, radiological, autoptical, and histological examinations with particular attention paid to immunohistochemistry and molecular biology. In the light of the results of this mini-review, an accurate forensic approach can be considered mandatory in the examination of suspected TBI with medico-legal importance, in order to gather all the possible evidence to corroborate the diagnosis of a lesion that may have caused, or contributed to, death. From this point of view, only the use of an evidence-based protocol can reach a suitable diagnosis, especially in those cases in which there are other neuropathological conditions (ischemia, neurodegeneration, neuro-inflammation, dementia) that may have played a role in death. This is even more relevant when corpses, in an advanced state of decomposition, are studied, where the radiological, macroscopic and histological analyses fail to give meaningful answers. In these cases, immune-histochemical and molecular biology diagnostics are of fundamental importance and a forensic neuropathologist has to know them. Particularly, MiRNAs are promising biomarkers for TBI both for brain damage identification and for medico-legal aspects, even if further investigations are required to validate the first experimental studies. In the same way, the genetic substrate should be examined during any forensic examination, considering its importance in the outcome of TBI.
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Affiliation(s)
| | | | | | | | | | | | | | - Cristoforo Pomara
- Address correspondence to this author at the Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy; Via S. Sofia 78, 95123 Catania, Italy; Tel: (39) 095.3782153; E-mail:
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Bertozzi G, Maglietta F, Baldari B, Besi L, Torsello A, Di Gioia CRT, Sessa F, Aromatario M, Cipolloni L. Mistrial or Misdiagnosis: The Importance of Autopsy and Histopathological Examination in Cases of Sudden Infant Bronchiolitis-Related Death. Front Pediatr 2020; 8:229. [PMID: 32537440 PMCID: PMC7266995 DOI: 10.3389/fped.2020.00229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/15/2020] [Indexed: 11/13/2022] Open
Abstract
Pediatrics, among all the branches of medicine, is a sector not particularly affected by a high number of claims. Nevertheless, the economic value of the compensation is significantly high, for example, in cases of children who suffered multiple disabilities following perinatal lesions with a long life expectancy. In Italy, most of the claims for compensation concern surgical pathologies and infections. Among these latter, the dominant role is taken by respiratory tract infections. In this context, the purpose of this manuscript is to present a case series of infant deaths in different emergency-related facilities (ambulances, emergency rooms) denounced by relatives. Following these complaints, the autopsy was performed, and subsequent histological examinations revealed the presence of typical and pathognomonic histological findings of acute viral bronchiolitis, whose morphological appearance is poorly reported in the literature. The analysis of these cases made it possible to highlight the following conclusions: the main problems in diagnosing sudden death causes, especially in childhood, are the rapidity of death and the scarce correlation between the preexistent diseases and of the cause of death itself. For all these reasons, the autopsy, either clinical or medicolegal, is mandatory in cases of sudden unexpected infant death to manage claim requests because only the histological examinations performed on samples collected during the autopsy can reveal the real cause of death.
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Affiliation(s)
- Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Francesca Maglietta
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Livia Besi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Torsello
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Sessa
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Foggia, Italy
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35
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Cipolloni L, Besi L, Baldari B, La Russa R, Frati P, Fineschi V. Intentional Homicide: A Fifteen-Year Study (2000-2014) at the Department of Forensic Medicine, University of Rome "Sapienza". J Forensic Sci 2019; 65:103-111. [PMID: 31404476 DOI: 10.1111/1556-4029.14162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Abstract
This study analyzes postmortem records from 260 homicide cases autopsied by the Department of Forensic Medicine in Rome from 2000 to 2014. The victims were mainly males (74%) and young (61% aged from 21 to 50 years). Although the victims were mostly Italians, the number of foreign victims (33%) has increased since 1990, primarily due to immigration. The offenders frequently used firearms (39%), particularly in multiple murders. An increase in blunt (20%) and sharp force (32%) weapons was also seen. The primary crime scene was residential (42%), and the head was the most frequently injured body region. Male victims occurred frequently in the context of organized crime (7.6%). In family or intimate-sexual relationships, women were the majority of victims (8%). Forensic pathologists play an important role during investigation. They should consider all the information available to them, including autopsy information, crime scene information, and crime investigation data.
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Affiliation(s)
- Luigi Cipolloni
- Department of Anatomic, Histological, Forensic and Orthopedic Science, University of Rome "Sapienza", viale Regina Elena 336, 00161, Rome, Italy
| | - Livia Besi
- Department of Anatomic, Histological, Forensic and Orthopedic Science, University of Rome "Sapienza", viale Regina Elena 336, 00161, Rome, Italy
| | - Benedetta Baldari
- Department of Anatomic, Histological, Forensic and Orthopedic Science, University of Rome "Sapienza", viale Regina Elena 336, 00161, Rome, Italy
| | - Raffaele La Russa
- Department of Anatomic, Histological, Forensic and Orthopedic Science, University of Rome "Sapienza", viale Regina Elena 336, 00161, Rome, Italy
| | - Paola Frati
- Department of Anatomic, Histological, Forensic and Orthopedic Science, University of Rome "Sapienza", viale Regina Elena 336, 00161, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomic, Histological, Forensic and Orthopedic Science, University of Rome "Sapienza", viale Regina Elena 336, 00161, Rome, Italy
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36
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Pinchi E, Frati P, Aromatario M, Cipolloni L, Fabbri M, La Russa R, Maiese A, Neri M, Santurro A, Scopetti M, Viola RV, Turillazzi E, Fineschi V. miR-1, miR-499 and miR-208 are sensitive markers to diagnose sudden death due to early acute myocardial infarction. J Cell Mol Med 2019; 23:6005-6016. [PMID: 31240830 PMCID: PMC6714215 DOI: 10.1111/jcmm.14463] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022] Open
Abstract
MicroRNAs (miRNAs) are strongly up-regulated under pathological stress and in a wide range of diseases. In recent years, miRNAs are under investigation for their potential use as biomarkers in cardiovascular diseases. We investigate whether specific cardio-miRNAs are overexpressed in heart samples from subjects deceased for acute myocardial infarction (AMI) or sudden cardiac death (SCD), and whether miRNA could help differentiate between them. Forty four cases of death due to cardiovascular disease were selected, respectively, 19 cases categorized as AMI and 25 as SCD. Eighteen cases of traumatic death without pathological cardiac involvement were selected as control. Immunohistochemical investigation was performed for CD15, IL-15, Cx43, MCP-1, tryptase, troponin C and troponin I. Reverse transcription and quantitative real-time PCR were performed for miR-1, miR-133, miR-208 and miR-499. In AMI group, stronger immunoreaction for the CD15, IL-15 and MCP-1 antibodies was detectable compared with SCD and control. Cx43 showed a negative reaction with respect to the other groups. Real-time PCR results showed a down-regulation of all miRNAs in the AMI group compared with SCD and control. The selected miRNAs presented high accuracy in discriminating SCD from AMI (miR-1 and miR-499) and AMI from control (miR-208) representing a potential aid for both clinicians and pathologists for differential diagnosis.
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Affiliation(s)
- Enrica Pinchi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Fabbri
- Department of Morphology, Experimental Medicine and Surgery, University of Ferrara, Ferrara, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Margherita Neri
- Department of Morphology, Experimental Medicine and Surgery, University of Ferrara, Ferrara, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuela Turillazzi
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
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37
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Cipolloni L, Baldari B, Besi L, Scopetti M, Di Sanzo M, Ursu S, Fineschi V. Management of victims occurred in mass disaster: The experience of center Italy earthquake 2016. J Forensic Leg Med 2019; 62:19-24. [PMID: 30634072 DOI: 10.1016/j.jflm.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/10/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Luigi Cipolloni
- Department of Anatomic, Hystologic, Orthopedic and Forensic Science, Sapienza University of Rome, Viale Regina Elena 336, 00161, Roma, Italy.
| | - Benedetta Baldari
- Department of Anatomic, Hystologic, Orthopedic and Forensic Science, Sapienza University of Rome, Viale Regina Elena 336, 00161, Roma, Italy
| | - Livia Besi
- Department of Anatomic, Hystologic, Orthopedic and Forensic Science, Sapienza University of Rome, Viale Regina Elena 336, 00161, Roma, Italy
| | - Matteo Scopetti
- Department of Anatomic, Hystologic, Orthopedic and Forensic Science, Sapienza University of Rome, Viale Regina Elena 336, 00161, Roma, Italy
| | - Mariantonia Di Sanzo
- Department of Anatomic, Hystologic, Orthopedic and Forensic Science, Sapienza University of Rome, Viale Regina Elena 336, 00161, Roma, Italy
| | - Simona Ursu
- Department of Planning, Evaluation and Control, Umberto I University Hospital, Viale del Policlinico, 00161, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomic, Hystologic, Orthopedic and Forensic Science, Sapienza University of Rome, Viale Regina Elena 336, 00161, Roma, Italy
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38
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Salerno M, Cascio O, Bertozzi G, Sessa F, Messina A, Monda V, Cipolloni L, Biondi A, Daniele A, Pomara C. Anabolic androgenic steroids and carcinogenicity focusing on Leydig cell: a literature review. Oncotarget 2018; 9:19415-19426. [PMID: 29721213 PMCID: PMC5922407 DOI: 10.18632/oncotarget.24767] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/27/2018] [Indexed: 01/25/2023] Open
Abstract
Anabolic androgenic steroids (AAS) are some of the most common drugs used among athletes, frequently in combination with resistance training, to improve physical performance or for aesthetic purpose. A great number of scientific reports showed the detrimental effects of anabolic androgenic steroids on different organs and tissues. In this literature review, we analyzed the AAS-mediated carcinogenicity, focusing on Leydig cell tumor. AAS-induced carcinogenicity can affect DNA transcription through two pathways. It can act directly via the androgen receptor, by means of dihydrotestosterone (DHT) produced by the action of 5-a-reductase. It can also work through the estrogen receptor, by means of estradiol produced by CYP19 aromatase. In addition, nandrolone and stanazolol can activate the PI3K/AKT and PLC/PKC pathways via IGF-1. This would result in cell proliferation in Leydig cell cancer, or magnify cyclin D1 concentration inducing breast cell proliferation. AAS abuse is becoming a serious public health concern in view of the severe health consequences secondary to AAS abuse. The negative role of AAS in supraphysiological dosage impairs the expression of enzymes involved in testosterone biosynthesis. Abnormal synthesis of testosterone plays has a negative effect on the hormonal changes/regulation, and might be involved in certain carcinogenic mechanisms. At the light of this review, it could become very interesting to perform an information campaign more strengthened in gyms and schools in order to prevent male fertility impairment and other tissues damage.
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Affiliation(s)
- Monica Salerno
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Orazio Cascio
- University of Catania, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia", Catania, Italy
| | - Giuseppe Bertozzi
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Francesco Sessa
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Antonietta Messina
- University of Campania "L. Vanvitelli", Department of Experimental Medicine, Naples, Italy
| | - Vincenzo Monda
- University of Campania "L. Vanvitelli", Department of Experimental Medicine, Naples, Italy
| | - Luigi Cipolloni
- Università degli Studi di Roma "La Sapienza", Department of Public Health, Roma, Italy
| | - Antonio Biondi
- University of Catania, Department of Surgery, Catania, Italy
| | - Aurora Daniele
- University of Campania "L. Vanvitelli", CEINGE Biotecnologie Avanzate S.C. a r.l., Naples, Italy
| | - Cristoforo Pomara
- University of Catania, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia", Catania, Italy
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39
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Pinchi E, Frati A, Cipolloni L, Aromatario M, Gatto V, La Russa R, Pesce A, Santurro A, Fraschetti F, Frati P, Fineschi V. Clinical-pathological study on β-APP, IL-1β, GFAP, NFL, Spectrin II, 8OHdG, TUNEL, miR-21, miR-16, miR-92 expressions to verify DAI-diagnosis, grade and prognosis. Sci Rep 2018; 8:2387. [PMID: 29402984 PMCID: PMC5799407 DOI: 10.1038/s41598-018-20699-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/23/2018] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the most important death and disability cause, involving substantial costs, also in economic terms, when considering the young age of the involved subject. Aim of this paper is to report a series of patients treated at our institutions, to verify neurological results at six months or survival; in fatal cases we searched for βAPP, GFAP, IL-1β, NFL, Spectrin II, TUNEL and miR-21, miR-16, and miR-92 expressions in brain samples, to verify DAI diagnosis and grade as strong predictor of survival and inflammatory response. Concentrations of 8OHdG as measurement of oxidative stress was performed. Immunoreaction of β-APP, IL-1β, GFAP, NFL, Spectrin II and 8OHdG were significantly increased in the TBI group with respect to control group subjects. Cell apoptosis, measured by TUNEL assay, were significantly higher in the study group than control cases. Results indicated that miR-21, miR-92 and miR-16 have a high predictive power in discriminating trauma brain cases from controls and could represent promising biomarkers as strong predictor of survival, and for the diagnosis of postmortem traumatic brain injury.
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Affiliation(s)
- Enrica Pinchi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Alessandro Frati
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Vittorio Gatto
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Alessandro Pesce
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Flavia Fraschetti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy. .,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy.
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Di Sanzo M, Cipolloni L, Borro M, La Russa R, Santurro A, Scopetti M, Simmaco M, Frati P. Clinical Applications of Personalized Medicine: A New Paradigm and Challenge. Curr Pharm Biotechnol 2017; 18:194-203. [PMID: 28240172 DOI: 10.2174/1389201018666170224105600] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/25/2016] [Accepted: 12/29/2016] [Indexed: 12/14/2022]
Abstract
The personalized medicine is an emergent and rapidly developing method of clinical practice that uses new technologies to provide decisions in regard to the prediction, prevention, diagnosis and treatment of disease. A continuous evolution of technology and the developments in molecular diagnostics and genomic analysis increased the possibility of an even more understanding and interpretation of the human genome and exome, allowing a "personalized" approach to clinical care, so that the concepts of "Systems Medicine" and "System Biology" are actually increasing. The purpose of this study is to evaluate the personalized medicine about its indications and benefits, actual clinical applications and future perspectives as well as its issues and health care implications. A careful review of the scientific literature on this field that highlighted the applicability and usefulness of this new medical approach as well as the fact that personalized medicine strategy is even more increasing in numerous fields of applications.
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Affiliation(s)
- Mariantonia Di Sanzo
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | | | - Marina Borro
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome. Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome. Italy
| | - Paola Frati
- Malzoni Clinical-Scientific Institute (MaCSI), Via Carmelo Errico 2, 83100 Avellino, Italy
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Borro M, Gentile G, Cipolloni L, Foldes-Papp Z, Frati P, Santurro A, Lionetto L, Simmaco M. Personalised Healthcare: The DiMA Clinical Model. Curr Pharm Biotechnol 2017; 18:242-252. [PMID: 28183244 DOI: 10.2174/1389201018666170208125131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/29/2016] [Accepted: 12/24/2016] [Indexed: 12/14/2022]
Abstract
Large-scale application of Personalized Medicine requires a multi-disciplinal environment allowing synergic cooperation among different competences. Strict collaboration between medical and medical sciences, as informatics, ethics, politics, are needed to face the challenges of one-sized healthcare. In spite of the increasing interest, how this system can be globally realized remains tentative. Yet, a relatively small, Personalised Healthcare Service is providing a proof-of principle organizational model to guide implementation into clinical practice.
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Affiliation(s)
- Marina Borro
- DiMA (Advanced Molecular Diagnosis), Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital - Sapienza University of Rome, Via di Grottarossa, 00189 Rome. Italy
| | - Giovanna Gentile
- DiMA (Advanced Molecular Diagnosis), Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital - Sapienza University of Rome, Via di Grottarossa, 00189 Rome. Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome. Italy
| | - Zeno Foldes-Papp
- Medizinische Klinik, Heidekreis-Klinikum, 29614 Soltau - Hamburg Area. Germany
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome. Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome. Italy
| | - Luana Lionetto
- DiMA (Advanced Molecular Diagnosis), Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital - Sapienza University of Rome, Via di Grottarossa, 00189 Rome. Italy
| | - Maurizio Simmaco
- DiMA (Advanced Molecular Diagnosis), Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital - Sapienza University of Rome, Via di Grottarossa, 00189 Rome. Italy
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Monda V, Valenzano A, Moscatelli F, Salerno M, Sessa F, Triggiani AI, Viggiano A, Capranica L, Marsala G, De Luca V, Cipolloni L, Ruberto M, Precenzano F, Carotenuto M, Zammit C, Gelzo M, Monda M, Cibelli G, Messina G, Messina A. Primary Motor Cortex Excitability in Karate Athletes: A Transcranial Magnetic Stimulation Study. Front Physiol 2017; 8:695. [PMID: 28955250 PMCID: PMC5600924 DOI: 10.3389/fphys.2017.00695] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/29/2017] [Indexed: 12/03/2022] Open
Abstract
Purpose: The mechanisms involved in the coordination of muscle activity are not completely known: to investigate adaptive changes in human motor cortex Transcranial magnetic stimulation (TMS) was often used. The sport models are frequently used to study how the training may affect the corticospinal system excitability: Karate represents a valuable sport model for this kind of investigations for its high levels of coordination required to athletes. This study was aimed at examining possible changes in the resting motor threshold (rMT) and in the corticospinal response in karate athletes, and at determining whether athletes are characterized by a specific value of rMT. Methods: We recruited 25 right-handed young karate athletes and 25 matched non-athletes. TMS was applied to primary motor cortex (M1). Motor evoked potential (MEP) were recorded by two electrodes placed above the first dorsal interosseous (FDI) muscle. We considered MEP latencies and amplitudes at rMT, 110% of rMT, and 120% of rMT. Results: The two groups were similar for age (p > 0.05), height (p > 0.05) and body mass (p > 0.05). The TMS had a 70-mm figure-of-eight coil and a maximum output of 2.2 T, placed over the left motor cortex. During the stimulation, a mechanical arm kept the coil tangential to the scalp, with the handle at 45° respect to the midline. The SofTaxic navigator system (E.M.S. Italy, www.emsmedical.net) was used in order to correctly identifying and repeating the stimulation for every subject. Compared to non-athletes, athletes showed a lower resting motor threshold (p < 0.001). Furthermore, athletes had a lower MEP latency (p < 0.001) and a higher MEP amplitude (p < 0.001) compared to non-athletes. Moreover, a ROC curve for rMT was found significant (area: 0.907; sensitivity 84%, specificity 76%). Conclusions: As the main finding, the present study showed significant differences in cortical excitability between athletes and non-athletes. The training can improve cortical excitability inducing athletes' modifications, as demonstrated in rMT and MEP values. These finding support the hypothesis that the sport practice determines specific brain organizations in relationship with the sport challenges.
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Affiliation(s)
- Vincenzo Monda
- Department of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Fiorenzo Moscatelli
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Monica Salerno
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Antonio I Triggiani
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Andrea Viggiano
- Department of Medicine and Surgery, University of SalernoSalerno, Italy
| | - Laura Capranica
- Department of Motor, Human and Health Science, University of Rome, "Foro Italico"Rome, Italy
| | - Gabriella Marsala
- Struttura Complessa di Farmacia, Azienda Ospedaliero-UniversitariaFoggia, Italy
| | - Vincenzo De Luca
- Department of Psychiatry, University of TorontoToronto, ON, Canada
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Università degli Studi di Roma La SapienzaRome, Italy
| | - Maria Ruberto
- Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Francesco Precenzano
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Marco Carotenuto
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Christian Zammit
- Anatomy Department, Faculty of Medicine and Surgery, University of MaltaMsida, Malta
| | - Monica Gelzo
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico IINaples, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
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Monda V, Lupoli GA, Messina G, Peluso R, Panico A, Villano I, Salerno M, Sessa F, Marciello F, Moscatelli F, Valenzano A, Molino L, Lupoli R, Fonderico F, Tortora A, Pisano A, Ruberto M, Gabriella M, Cavaliere G, Trinchese G, Mollica MP, Cipolloni L, Cibelli G, Monda M, Lupoli G, Messina A. Improvement of Bone Physiology and Life Quality Due to Association of Risedronate and Anastrozole. Front Pharmacol 2017; 8:632. [PMID: 28955236 PMCID: PMC5601069 DOI: 10.3389/fphar.2017.00632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/28/2017] [Indexed: 12/16/2022] Open
Abstract
The endocrine therapy is the new frontiers of many breast cancers hormone sensitive. Hormone therapy for treating women with hormone receptor-positive cancer suppresses breast cancer growth either by reducing estrogen synthesis or by interfering with the action of estrogen within tumor cells. In this prospective randomized observational study we investigate the effect of adjuvant anastrozole in monotherapy or associated with risedronate on bone physiology and quality of life in postmenopausal, hormone-sensitive early breast cancer women at mild to moderate risk of fragility fractures. Methods : 84 women were randomly assigned to receive anastrozole alone (group A) or anastrozole plus oral risedronate (group A+R). At baseline and after 24 months lumbar spine (LS) and femoral neck (FN) BMD were evaluated with dual-energy x-ray absorptiometry and health-related quality of life (HRQoL) was examined using the short-form healthy survey. Results : After 24 months, the group A+R has showed a significant increase in T-score for LS (p < 0.05) and for FN (p < 0.05) whereas women of group A had a statistically significant rate of bone loss both in LS T-score (p < 0.05) and in FN (p < 0.05). A significant change in T-score BMD was seen for group A+R compared with group A at the LS (p = 0.04) and at FN (p = 0.04). Finally, group A+R showed an overall significant improvement of health profile (SF-36) in group A (p = 0.03). Conclusion : Postmenopausal breast cancer women with osteopenia during treatment with anastrozole have considerable risk of developing osteoporosis during the first 2 years; preventive measures such as healthy lifestyle and daily supplements of calcium and vitamin D alone seem to be insufficient in holding their bones healthy. Our findings suggest the usefulness of addition of risedronate in order to prevent aromatase inhibitors-related bone loss, not only in case of high-risk of fractures, but also for women at mild-moderate risk. This determines a significant improvement in bone health and a positive impact on HRQoL.
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Affiliation(s)
- Vincenzo Monda
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy
| | - Gelsy A Lupoli
- Department of Clinical Medicine and Surgery, University of Naples Federico IINaples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Rosario Peluso
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy.,Rheumatology Research Unit, University of Naples Federico IINaples, Italy
| | - Annalisa Panico
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy
| | - Ines Villano
- Department of Clinical Medicine and Surgery, University of Naples Federico IINaples, Italy
| | - Monica Salerno
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Francesca Marciello
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy
| | - Fiorenzo Moscatelli
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Leonardo Molino
- Rheumatology Research Unit, University of Naples Federico IINaples, Italy
| | - Roberta Lupoli
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy
| | - Francesco Fonderico
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy
| | - Anna Tortora
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy
| | - Agata Pisano
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy.,Department of Oncohematology, Santa Maria delle Grazie HospitalPozzuoli, Italy
| | - Maria Ruberto
- Department of Medical-Surgical and Dental Specialties, University of Campania "L.Vanvitelli"Naples, Italy
| | - Marsala Gabriella
- Struttura Complessa di Farmacia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di FoggiaFoggia, Italy
| | - Gina Cavaliere
- Department of Biology, University of Naples Federico IINaples, Italy
| | | | - Maria P Mollica
- Department of Biology, University of Naples Federico IINaples, Italy
| | | | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Marcellino Monda
- Department of Clinical Medicine and Surgery, University of Naples Federico IINaples, Italy
| | - Giovanni Lupoli
- Section of Human Physiology and Unit of Dietetic and Sport Medicine, Department of Experimental Medicine, University of Campania "L. Vanvitelli"Naples, Italy
| | - Antonietta Messina
- Department of Clinical Medicine and Surgery, University of Naples Federico IINaples, Italy
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Chieffi S, Messina A, Villano I, Valenzano AA, Nigro E, La Marra M, Cibelli G, Monda V, Salerno M, Tafuri D, Carotenuto M, Cipolloni L, Mollica MP, Monda M, Messina G. The Use of Velocity Information in Movement Reproduction. Front Psychol 2017; 8:983. [PMID: 28659849 PMCID: PMC5466998 DOI: 10.3389/fpsyg.2017.00983] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/29/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Previous studies suggested that movement velocity influence space perception. Aim and Objectives: We examined whether healthy participants used velocity information when they were asked to reproduce a previously performed movement. Two experiments were carried out. Methods: In Experiment 1, blindfolded participants actively performed an arm movement (criterion movement, CM) at a natural velocity, or quickly, or slowly. After a brief delay, participants were asked to reproduce (reproduction movement, RM) CM-amplitude. No velocity constraints were imposed in making RM. In Experiment 2, CM was performed quickly or slowly. After a brief delay, the participants were asked to reproduce not only CM-amplitude but also CM-velocity. Results: Experiment 1: in Natural condition, RM-velocity did not differ from CM-velocity and the participants accurately reproduced CM-amplitude. Conversely, in Fast and Slow condition, RM-velocities differed from CM-velocities and in Slow condition RM-amplitude was greater than CM-amplitude. Experiment 2: both RM-amplitude and -velocity did not differ from CM-amplitude and -velocity. Conclusion: The present study confirms the view that movement velocity influences selectively space perception and suggests that this influence is stronger for slow than fast movements. Furthermore, although velocity information is crucial in accurately reproducing CM-amplitude, it was not used spontaneously when movements were performed at unnatural velocities.
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Affiliation(s)
- Sergio Chieffi
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Anna A Valenzano
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | | | - Marco La Marra
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Monica Salerno
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Domenico Tafuri
- Department of Motor Sciences and Wellness, University of Naples "Parthenope"Naples, Italy
| | - Marco Carotenuto
- Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | | | - Maria P Mollica
- Department of Biology, Università degli Studi di Napoli Federico IINaples, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
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45
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Chieffi S, Carotenuto M, Monda V, Valenzano A, Villano I, Precenzano F, Tafuri D, Salerno M, Filippi N, Nuccio F, Ruberto M, De Luca V, Cipolloni L, Cibelli G, Mollica MP, Iacono D, Nigro E, Monda M, Messina G, Messina A. Orexin System: The Key for a Healthy Life. Front Physiol 2017; 8:357. [PMID: 28620314 PMCID: PMC5450021 DOI: 10.3389/fphys.2017.00357] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022] Open
Abstract
The orexin-A/hypocretin-1 and orexin-B/hypocretin-2 are neuropeptides synthesized by a cluster of neurons in the lateral hypothalamus and perifornical area. Orexin neurons receive a variety of signals related to environmental, physiological and emotional stimuli, and project broadly to the entire CNS. Orexin neurons are “multi-tasking” neurons regulating a set of vital body functions, including sleep/wake states, feeding behavior, energy homeostasis, reward systems, cognition and mood. Furthermore, a dysfunction of orexinergic system may underlie different pathological conditions. A selective loss orexin neurons was found in narcolepsia, supporting the crucial role of orexins in maintaining wakefulness. In animal models, orexin deficiency lead to obesity even if the consume of calories is lower than wildtype counterpart. Reduced physical activity appears the main cause of weight gain in these models resulting in energy imbalance. Orexin signaling promotes obesity resistance via enhanced spontaneous physical activity and energy expenditure regulation and the deficiency/dysfunction in orexins system lead to obesity in animal models despite of lower calories intake than wildtype associated with reduced physical activity. Interestingly, orexinergic neurons show connections to regions involved in cognition and mood regulation, including hippocampus. Orexins enhance hippocampal neurogenesis and improve spatial learning and memory abilities, and mood. Conversely, orexin deficiency results in learning and memory deficits, and depression.
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Affiliation(s)
- Sergio Chieffi
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Marco Carotenuto
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Ines Villano
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Francesco Precenzano
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Domenico Tafuri
- Department of Motor Sciences and Wellness, University of Naples "Parthenope"Naples, Italy
| | - Monica Salerno
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Nicola Filippi
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Francesco Nuccio
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Maria Ruberto
- Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Vincenzo De Luca
- Department of Psychiatry, University of TorontoToronto, ON, Canada
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Università degli Studi di Roma La SapienzaRome, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Maria P Mollica
- Department of Biology Università degli Studi di Napoli Federico IINaples, Italy
| | - Diego Iacono
- Neurodevelopmental Research Lab, Biomedical Research Institute of New JerseyMorristown, NJ, United States.,Neuroscience Research, MidAtlantic Neonatology Associates, Atlantic Health SystemMorristown, NJ, United States.,Neuropathology Research, MANA/Biomedical Research Institute of New JerseyMorristown, NJ, United States
| | | | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
| | - Giovanni Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy.,Department of Clinical and Experimental Medicine, University of FoggiaFoggia, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli"Naples, Italy
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Barone R, Pitruzzella A, Marino Gammazza A, Rappa F, Salerno M, Barone F, Sangiorgi C, D'Amico D, Locorotondo N, Di Gaudio F, Cipolloni L, Di Felice V, Schiavone S, Rapisarda V, Sani G, Tambo A, Cappello F, Turillazzi E, Pomara C. Nandrolone decanoate interferes with testosterone biosynthesis altering blood-testis barrier components. J Cell Mol Med 2017; 21:1636-1647. [PMID: 28244681 PMCID: PMC5542904 DOI: 10.1111/jcmm.13092] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/15/2016] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to investigate whether nandrolone decanoate (ND) use affects testosterone production and testicular morphology in a model of trained and sedentary mice. A group of mice underwent endurance training while another set led a sedentary lifestyle and were freely mobile within cages. All experimental groups were treated with either ND or peanut oil at different doses for 6 weeks. Testosterone serum levels were measured via liquid chromatography–mass spectrometry. Western blot analysis and quantitative real‐time PCR were utilized to determine gene and protein expression levels of the primary enzymes implicated in testosterone biosynthesis and gene expression levels of the blood–testis barrier (BTB) components. Immunohistochemistry and immunofluorescence were conducted for testicular morphological evaluation. The study demonstrated that moderate to high doses of ND induced a diminished serum testosterone level and altered the expression level of the key steroidogenic enzymes involved in testosterone biosynthesis. At the morphological level, ND induced degradation of the BTB by targeting the tight junction protein‐1 (TJP1). ND stimulation deregulated metalloproteinase‐9, metalloproteinase‐2 (MMP‐2) and the tissue inhibitor of MMP‐2. Moreover, ND administration resulted in a mislocalization of mucin‐1. In conclusion, ND abuse induces a decline in testosterone production that is unable to regulate the internalization and redistribution of TJP1 and may induce the deregulation of other BTB constituents via the inhibition of MMP‐2. ND may well be considered as both a potential inducer of male infertility and a potential risk factor to a low endogenous bioavailable testosterone.
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Affiliation(s)
- Rosario Barone
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC)University of PalermoPalermoItaly
- Euro‐Mediterranean Institute of Science and Technology (IEMEST)PalermoItaly
| | - Alessandro Pitruzzella
- Euro‐Mediterranean Institute of Science and Technology (IEMEST)PalermoItaly
- Department of NeuroscienceMental Health and Sense Organs (Nesmos)Sapienza University of RomeRomeItaly
| | - Antonella Marino Gammazza
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC)University of PalermoPalermoItaly
- Euro‐Mediterranean Institute of Science and Technology (IEMEST)PalermoItaly
| | - Francesca Rappa
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC)University of PalermoPalermoItaly
- Euro‐Mediterranean Institute of Science and Technology (IEMEST)PalermoItaly
| | - Monica Salerno
- Department of Clinical and Experimental MedicineForensic PathologyUniversity of FoggiaFoggiaItaly
| | - Fulvio Barone
- Department of Clinical and Experimental MedicineForensic PathologyUniversity of FoggiaFoggiaItaly
- Department of RadiologyScientific Institute Hospital “Casa Sollievo della Sofferenza”San Giovanni Rotondo (FG)Italy
| | - Claudia Sangiorgi
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC)University of PalermoPalermoItaly
| | - Daniela D'Amico
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC)University of PalermoPalermoItaly
| | | | - Francesca Di Gaudio
- Locorotondo Labs srlPalermoItaly
- Department of Pathobiology and Medical BiotechnologyUniversity of PalermoPalermoItaly
| | - Luigi Cipolloni
- Department of Forensic PathologySapienza University of RomeRomeItaly
| | - Valentina Di Felice
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC)University of PalermoPalermoItaly
- Euro‐Mediterranean Institute of Science and Technology (IEMEST)PalermoItaly
| | - Stefania Schiavone
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItlay
| | - Venerando Rapisarda
- Occupational MedicineDepartment of Clinical and Experimental MedicineUniversity of CataniaCataniaItaly
| | - Gabriele Sani
- Department of NeuroscienceMental Health and Sense Organs (Nesmos)Sapienza University of RomeRomeItaly
| | - Amos Tambo
- Department of Clinical and Experimental MedicineForensic PathologyUniversity of FoggiaFoggiaItaly
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItlay
| | - Francesco Cappello
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC)University of PalermoPalermoItaly
- Euro‐Mediterranean Institute of Science and Technology (IEMEST)PalermoItaly
| | - Emanuela Turillazzi
- Department of Clinical and Experimental MedicineForensic PathologyUniversity of FoggiaFoggiaItaly
| | - Cristoforo Pomara
- Department of Clinical and Experimental MedicineForensic PathologyUniversity of FoggiaFoggiaItaly
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItlay
- Department of AnatomyUniversity of MaltaMsidaMalta
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Busardò FP, Kyriakou C, Cipolloni L, Zaami S, Frati P. From Clinical Application to Cognitive Enhancement: The Example of Methylphenidate. Curr Neuropharmacol 2016; 14:17-27. [PMID: 26813119 PMCID: PMC4787280 DOI: 10.2174/1570159x13666150407225902] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/17/2015] [Accepted: 04/03/2015] [Indexed: 12/20/2022] Open
Abstract
Methylphenidate (MPD) is a central nervous system (CNS) stimulant, which belongs to the phenethylamine group and is mainly used in the treatment of attention deficit hyperactive disorder (ADHD). However, a growing number of young individuals misuse or abuse MPD to sustain attention, enhance intellectual capacity and increase memory. Recently, the use of MPD as a cognitive enhancement substance has received much attention and raised concerns in the literature and academic circles worldwide. The prescribing frequency of the drug has increased sharply as consequence of the more accurate diagnosis of the ADHD and the popularity of the drug itself due to its beneficial short-term effect. However, careful monitoring is required, because of possible abuse. In this review different aspects concerning the use of MPD have been approached. Data showing its abuse among college students are given, when the drug is prescribed short term beneficial effects and side effects are provided; moreover studies on animal-models suggesting long lasting negative effects on healthy brains are discussed. Finally, emphasis is given to the available formulations and pharmacology.
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Affiliation(s)
- Francesco Paolo Busardò
- Department of Anatomical, Histological, Medico-legal and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336 (00185) Rome, IT.
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Donato L, Cipolloni L, Ozonoff A, di Luca A. A Preliminary Study of the Relationship between Obliteration of Cranial Sutures and Age at Time of Death. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2329-6577.1000163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Frati P, Busardò FP, Cipolloni L, Dominicis ED, Fineschi V. Anabolic Androgenic Steroid (AAS) related deaths: autoptic, histopathological and toxicological findings. Curr Neuropharmacol 2015; 13:146-59. [PMID: 26074749 PMCID: PMC4462039 DOI: 10.2174/1570159x13666141210225414] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/01/2014] [Accepted: 10/25/2014] [Indexed: 12/22/2022] Open
Abstract
Anabolic androgenic steroids (AASs) represent a large group of synthetic derivatives of testosterone, produced to maximize anabolic effects and minimize the androgenic ones. AAS can be administered orally, parenterally by intramuscular injection and transdermally. Androgens act by binding to the nuclear androgen receptor (AR) in the cytoplasm and then translocate into the nucleus. This binding results in sequential conformational changes of the receptor affecting the interaction between receptor and protein, and receptor and DNA. Skeletal muscle can be considered as the main target tissue for the anabolic effects of AAS, which are mediated by ARs which after exposure to AASs are up-regulated and their number increases with body building. Therefore, AASs determine an increase in muscle size as a consequence of a dose-dependent hypertrophy resulting in an increase of the cross-sectional areas of both type I and type II muscle fibers and myonuclear domains. Moreover, it has been reported that AASs can increase tolerance to exercise by making the muscles more capable to overload therefore shielding them from muscle fiber damage and improving the level of protein synthesis during recovery. Despite some therapeutic use of AASs, there is also wide abuse among athletes especially bodybuilders in order to improve their performances and to increase muscle growth and lean body mass, taking into account the significant anabolic effects of these drugs. The prolonged misuse and abuse of AASs can determine several adverse effects, some of which may be even fatal especially on the cardiovascular system because they may increase the risk of sudden cardiac death (SCD), myocardial infarction, altered serum lipoproteins, and cardiac hypertrophy. The aim of this review is to focus on deaths related to AAS abuse, trying to evaluate the autoptic, histopathological and toxicological findings in order to investigate the pathophysiological mechanism that underlines this type of death, which is still obscure in several aspects. The review of the literature allowed us to identify 19 fatal cases between 1990 and 2012, in which the autopsy excluded in all cases, extracardiac causes of death.
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Affiliation(s)
- Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
- Neuromed, Istituto Mediterraneo Neurologico (IRCCS), Via Atinense 18, Pozzilli, 86077 Isernia, Italy
| | - Francesco P. Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
| | | | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy
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Cecchi R, Frati P, Capri O, Cipolloni L. A rare case of sudden death due to hypotension during cesarean section in a woman suffering from pheochromocytoma and neurofibromatosis. J Forensic Sci 2013; 58:1636-9. [PMID: 24117722 DOI: 10.1111/1556-4029.12279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/12/2012] [Accepted: 12/01/2012] [Indexed: 11/29/2022]
Abstract
Sudden death following acute hypotension due to an undiagnosed pheochromocytoma (PHEO) is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37-year-old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra-operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death. The autopsy revealed the presence of a PHEO, confirmed immunohistochemically with chromogranin-A (CgA), CD20 antibody (L26), anti-Keratocan antibody (KER-1) and neuron-specific enolase (NSE), and a PHEO-induced cardiomyopathy. The physiopathology of both stress-induced cardiomyopathy and PHEO-induced cardiomyopathy, as well as the role of anesthesia in provoking the death, are discussed. The association of an undiagnosed PHEO with neurofibromatosis as the cause of sudden death in pregnancy is an obstetric urgency that raises forensic pathology issues.
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Affiliation(s)
- Rossana Cecchi
- Department of Anatomical Histological Legal Medical and Orthopaedic Sciences, Faculty of Medicine and Pharmacology, Sapienza University of Rome, Rome, Italy
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