Immunohistochemistry (IHC) is widely applied in post-mortem forensic investigations. Its evidentiary value depends critically on methodological standardization. Following PRISMA guidelines and PROSPERO registration (CRD420251063965), we systematically searched PubMed, Scopus, and Web of Science for original IHC studies on human autopsy material. A total of 144 studies were included and evaluated against six predefined methodological criteria (M1-M6) addressing slide interpretation metrics, multi-reader assessment, observer blinding, concordance reporting, quality control, and predefined positivity thresholds. IHC was applied across diverse forensic domains, most frequently in traumatic brain injury (16%), sudden cardiac death (14%), COVID-19-related death (13%), and wound vitality/wound dating (11%). Quantitative or semi-quantitative slide reading (M1) was adopted in 75.7% of studies, and quality control measures (M5) in 52.8%. By contrast, blinded reading (M3) was implemented in only 40% of applicable studies, inter-observer concordance (M4) in 10%, and predefined positivity thresholds (M6) in only 4.2% of studies. Only 38.9% of studies met three or more methodological criteria, and a single study satisfied all six criteria. Forensic IHC demonstrates broad application and considerable inferential ambition, but its methodological foundations remain inconsistently consolidated. We propose that future forensic IHC studies place greater emphasis on analytical validation, standardized interpretation criteria, assessment of observer agreement, and systematic reporting of relevant pre-analytical variables in order to improve reproducibility and comparability.

The Italian Ministry of Justice and that of Health have established two strategies to limit the spread of COVID-19 in prisons: progressive isolation from the external world and adoption of practices to identify possible cases and to treat infected subjects. After the announcement of regulations revolts erupted in numerous Italian prisons. The motivations and effects of these strategy are discussed critically into the search for a balance between the right to health and other rights of prisoners in Italian prisons with the problem of an occupancy level of 121.75%.

Radiocarbon analysis is used in forensic anthropology, and its application to dental tissues has become increasingly adopted. This systematic review aimed to assess the current state of knowledge on radiocarbon dating of dental tissues, focusing on methodological approaches, interpretative frameworks, and forensic applicability of enamel, dentin, and cementum. PubMed, Scopus, and Web of Science databases were searched up to March 2024, and original studies involving radiocarbon analysis of dental tissues for forensic or anthropological purposes were included. Nine studies were found eligible and reviewed in detail. The selected studies encompassed over 270 individual teeth, primarily molars, and were conducted using accelerator mass spectrometry combined with calibration curves. Enamel yielded the most accurate results, with a mean absolute error of ± 1.3–1.9 years for post-1963 formation. Dentin and cementum, although metabolically active and subject to appositional changes, contributed useful complementary information but introduced potential chronological discrepancies. Key limitations included small sample sizes, practical constraints in separating dental tissues, and the impact of geographic and dietary variability on radiocarbon interpretation. Radiocarbon dating of dental tissues, particularly enamel, offers a reliable means of estimating time-related biological parameters in forensics. Nonetheless, its effectiveness is influenced by sample integrity, the specific dental component analyzed, and the availability of contextual data, such as geographic origin. Integration with stable isotopes and genetic analyses is recommended to enhance the robustness of forensic identification. Future studies should prioritize larger sample sizes and focus on whole-tooth analyses to reflect real-world forensic constraints.

PURPOSE:Chronic postherniorrhaphy inguinal pain (CPIP) is a recognized postoperative complication and a potential trigger for malpractice litigation. This case series presents a descriptive medicolegal analysis of civil verdicts involving CPIP following inguinal hernia repair in Italy. METHODS:A retrospective review was performed using the Italian Ministry of Justice's Banca Dati di Merito, examining malpractice verdicts from 2015 to 2025 related to CPIP after hernioplasty. Seventeen cases met the inclusion criteria. Variables collected included type of nerve injury, surgical technique, fixation method, informed consent, reinterventions, and symptom profile. Data were summarized using descriptive statistics. RESULTS:Compensation was awarded in 4 of 17 cases (23.5%). Nerve injury was documented in 13 cases (76.5%), with genitofemoral nerve involvement in 6 of these (46.2%). Among the six cases with genitofemoral injury, four received compensation (66.7%), while no compensation occurred in cases without such injury. Neurectomy was performed in 5 cases, three of which resulted in compensation (60.0%) compared with 1 of the 12 cases without neurectomy (8.3%). Informed consent forms were available in 5 cases; in three of these, the risk of nerve injury was omitted, with one case leading to compensation. CONCLUSION:This descriptive case series highlights a potential association between genitofemoral nerve injury and compensation outcomes in CPIP-related litigation. In most cases involving genitofemoral injury, compensation was awarded. Neurectomy also appeared to show a trend toward legal relevance. These findings reinforce the medico-legal importance of accurate nerve identification, thorough intraoperative documentation, and attentive postoperative management in hernia surgery. Further prospective studies are warranted to confirm these preliminary observations and inform both surgical and legal best practices.

BACKGROUND:Post-mortem microbial communities (microbiota and microbiome) have emerged as promising tools for forensic investigations, particularly in estimating the post-mortem interval (PMI). However, experimental variability in sampling protocols, analytical methods, and reporting standards has limited the comparability and reproducibility of findings across studies. METHODS:A systematic review was conducted in accordance with PRISMA guidelines to evaluate the current literature on human post-mortem microbiota and microbiome. Inclusion criteria focused on studies that examined microbial communities in human cadavers using culture-based techniques, next-generation sequencing (NGS), or both. Data were extracted regarding sample types, microbial targets, analytical methods, decomposition stages, insect activity, and study objectives. RESULTS:A total of 24 studies were included, revealing substantial heterogeneity in methodological approaches. NGS techniques dominated recent literature, targeting bacterial 16S rRNA gene sequences to characterize microbial succession during decomposition. While some studies have shown promising correlations between microbial taxa and PMI, the inconsistent use of controls and variable decomposition conditions impeded cross-study comparisons. Culture-based approaches were generally limited to early investigations and provided narrower taxonomic resolution. CONCLUSIONS:Despite encouraging results, the forensic application of post-mortem microbiome and microbiota remains hindered by methodological inconsistencies and a lack of standardization. Establishing unified protocols and adopting interdisciplinary approaches will be essential for validating microbial signatures as reliable forensic tools.

Radiocarbon analysis in bones, particularly through Bomb Pulse dating, is an essential tool in forensic investigations for estimating the postmortem interval of human remains. However, there are some limitations related to the interpretation of laboratory data, since this can differ from the Post Mortem Interval by many years, depending on the anatomical district and the bone part sampled, as well as the age of the individual and other parameters, since these elements influence bone turnover. In recent years, many studies have been conducted, but with non-standardized data and on limited samples. Therefore there is a need (experienced by the authors themselves in daily forensic practice when only bones are available) to summarize in a single work the data spread in the literature and try to standardize data, as much as possible, with limitation to forensic case only, in a review that is not only critical, but also systematic, in order to have specific and ready to use information for the interpretation of laboratory results. This work, therefore, not only aims to highlight the complexity and the need for standardized methodologies on multiple types of tissue for future research, but also to be an immediate help to refine the interpretation of the results provided by radiocorabion in order to have a Post Mortem Interval as reliable as possible.

INTRODUCTION:In forensic pathology, estimating the postmortem interval (PMI) is crucial for legal investigations, particularly in homicide cases. Traditional methods for determining the time since death offer only estimations, and formulas related to solute concentrations in vitreous humor vary, complicating the process. To present a novel software solution that integrates body temperature data and solute concentrations in the vitreous humor (potassium, albumin, hypoxanthine, and urea). METHODS:The software combines the Henssge method with current knowledge of solute concentration evolution in the vitreous humor post-death. Formulas derived from the scientific literature were implemented in a Java-based program. The program features a intuitive interface and is compatible with Windows and MacOS. Functional and non-functional requirements were addressed, ensuring quick data input, low resource consumption, and easy interpretation of results. RESULTS:The software provides more precise PMI estimations by unifying the Henssge method with regression equations from existing literature. This integration enhances usability for practical applications and academic research. CONCLUSION:This study introduces a cohesive software solution that integrates traditional and modern methodologies for PMI estimation. The program's comprehensive approach and intuitive design promise to improve accuracy and facilitate broader application in forensic investigations.

Background: Chronic postoperative inguinal pain [CPIP] is a prevalent and often debilitating complication following inguinal hernia repair. With the widespread adoption of mesh-based techniques, recurrence rates have significantly declined, shifting clinical focus toward postoperative pain management. Methods: This narrative review synthesizes international literature on CPIP incidence, surgical technique, geographic variation, and the distinction between neuropathic and nociceptive pain. Studies were selected based on relevance, sample size, and inclusion of pain subclassification. Results: CPIP incidence varies markedly across studies (6–64.3%), influenced by follow-up duration, surgical approach, and regional healthcare practices. The risk of CPIP varies significantly, depending on the surgical technique employed, with open repairs generally associated with higher rates than laparoscopic approaches. Neuropathic pain predominates in specific cohorts, particularly following open repairs with limited nerve preservation. Few studies differentiate pain types, revealing a critical gap in diagnostic precision. Conclusions: CPIP is a multifactorial and under-recognized problem in clinical practice. The adoption of standardized diagnostic tools and long-term follow-up protocols is essential to improve pain classification and management. A structured diagnostic algorithm may assist clinicians in distinguishing pain types and tailoring treatment strategies to individual patient profiles.

The diagnosis of hyperthermia-related death presents a significant challenge in the field of forensic medicine due to the lack of pathognomonic signs and the complexity of the variables involved. This systematic review analyzes research on the role of immunohistochemistry (IHC) in postmortem diagnosis of hyperthermia, considering studies related to environmental hyperthermia, fire-related fatalities, and substance-induced hyperthermia. A total of 36 studies were included, selected according to PRISMA guidelines and critically evaluated using JBI tools. The results highlighted significant methodological heterogeneity, with differences in the tissues studied, the immunohistochemical markers used, and the analytical techniques employed. Some markers showed diagnostic potential in cases of fire exposure, but in deaths due to environmental or substance-induced hyperthermia, the markers examined were neither specific nor reliable. Common methodological weaknesses included small sample sizes, biases, and insufficient statistical analysis, which influenced the interpretation of the results. Considering these issues, IHC cannot be considered a valid diagnostic technique for hyperthermia-related deaths. Future studies with greater methodological rigor, validation of specific markers, and standardization of procedures are necessary.

The postmortem diagnosis of anaphylaxis remains a forensic challenge due to the lack of specific external signs. Tryptase, a mast cell-derived protease, has emerged as a potential biomarker for fatal anaphylaxis. This systematic review critically examined 40 studies published between 2014 and 2024, including both biochemical and immunohistochemical analyses. Literature was identified through comprehensive searches of PubMed, Scopus, and Web of Science, following PRISMA guidelines. Biochemical studies consistently reported elevated postmortem β-tryptase levels in anaphylaxis-related deaths, with proposed diagnostic thresholds ranging from 30.4 to 64 μg/L. A diagnostic threshold of 53.8 μg/L demonstrated particularly strong discriminative capacity (AUC = 0.98; p < 0.001). Immunohistochemical analyses revealed an increased number of tryptase-positive mast cells in lung, pharynx, and skin tissues, but standardized protocols or quantification criteria were lacking. Notably, mast cell localization around bronchioles or vascular structures was more frequent in anaphylaxis cases. Despite promising findings, substantial heterogeneity in postmortem interval, sampling site, and analytical methodology limits the generalizability of current evidence. Elevated tryptase levels were also documented in non-anaphylactic deaths, underscoring its limited specificity. Overall, tryptase can support the postmortem diagnosis of anaphylaxis when interpreted in the context of autopsy findings, scene investigation, and clinical history. However, it should not be used as a standalone marker. Standardized protocols and combined biomarker panels are urgently needed to enhance diagnostic reliability in forensic settings.

BACKGROUND:Laparoscopic cholecystectomy is the gold standard in the treatment of symptomatic gallstones. The large number of gallbladders removed every year is not fully consistent with the excessively high incidence of iatrogenic bile duct injury (IBDI). Several strategies have been suggested to reduce this risk. Among them, the use of extra biliary anatomic structures, such as the Rouvière's sulcus, as a landmark to guide the surgeon during dissection has been proposed as a means to prevent IBDI. The main aim of the present paper is the evaluation of the prevalence of Rouvière's sulcus (RS) and its anatomic variants in a given population. MATERIALS AND METHODS:This observational, cross-sectional, and multicenter study has been conducted at the Department of Digestive and Emergency Surgery of the "Azienda Ospedaliera Santa Maria," Terni (Italy), at the Department of Surgical Sciences of the "Azienda Ospedaliera Perugia," Perugia (Italy) and at the Department of Emergency and Trauma Surgery of the "Policlinico Umberto I," Rome (Italy). Intraoperative images of 111 patients undergoing laparoscopic cholecystectomy were analyzed to identify the presence and type of RS, according to the Singh-Prasad classification and the Dahmane classification. RESULTS:RS was present in 93 (83.8%) patients. Singh-Prasad type 1A is present in 48.4% of patients, type 1B in 25.8%, type 2 in 12.9% and type 3 in 12.9%. Dahmane's open type is present in 48.4% of patients and fused type in 51.6%. CONCLUSION:Due to its high prevalence, RS can be used as an anatomic landmark and probably reduces the incidence of IBDI during laparoscopic cholecystectomy.

Introduction: Suicidal hanging resulting in decapitation is rarely documented. This discussion involves a case of a 35-year-old man found decapitated in his residence's garden. A systematic literature review on hanging-induced decapitation was conducted to comprehensively investigate and compare the case to existing literature. The study aims to identify frequently described post-mortem findings in cases of suicidal hanging leading to decapitation. Case report: A 35-year-old man was found decapitated in his garden, with a jute strap and chimney debris nearby. The cervical region was completely severed along the dorsoventral and craniocaudal plane, exposing internal structures. A ligature mark was present, along with Amussat's sign and Simon's bleeding. Methods: The systematic review of the literature followed PRISMA standards, analyzing 3622 publications from Google Scholar, PubMed, and Scopus databases up to 2023. Inclusion criteria comprised cases of complete or incomplete decapitation resulting from hanging, available in full-text and written in English. Results: 16 articles on hanging-induced decapitation met the selection criteria; 22 cases were analyzed. Studies, mostly from Europe, showed a mean victim age of 44.3, all male. Fall height ranged from 1 m to 18 m, with various suspension media. Most cases displayed complete decapitation, primarily between cervical vertebrae C1 and C3. Some cases noted collateral findings. Conclusions: Complete crime scene investigation and thorough post-mortem examination are crucial for reconstructing events, especially with confounding elements. Precise evidence collection and literature comparison are essential to understand the case and substantiate the forensic pathologist's hypothesis in court.

Reflecting on the inappropriateness (medical overuse) and on defensive medicine, the Authors wonder whether the new Italian reform of professional guilt, desired at all institutional levels, will actually contain the high economic costs produced by these large and widespread phenomena. After having characterized the medical overuse and the defensive medicine indicating the common traits and main differences, the reflection is conducted by exploring the many scientific evidence that does not document any causal link between the decriminalization of professional conduct and the containment of the costs produced by the prescriptive inappropriateness. They conclude by stating that, for their containment, a third reform of professional liability will not be helpful. Instead, it must focus on other issues, mainly addressing the excessive reliance on judicial recourse. It should provide for mandatory out-of-court conciliatory mechanisms and clarifying the protective umbrella of the doctor's non-criminality.

Introduction. Sexually transmitted infections (STIs) can be caused by a number of microorganisms that vary greatly in size, life cycle, clinical manifestations, and sensitivity to available treatments. Transmission of STIs can occur during unprotected (or condomless) sexual contact and through the exchange of body fluids during any type of activity. The prevalence of sexually transmitted diseases remains high in the world, despite diagnostic and therapeutic improvements for these infectious diseases that rapidly eliminate the contagiousness of patients. Our study determines the prevalence of STI pathogens in adolescents and young adults in the population of the Province of Macerata (Italy). We will analyze data in correspondence to age and gender, and we will compare our results to international studies. Materials and Method. We analyzed STI test results from the entire database of a Provincial Health Authority for the period 2021–2022. The samples came from the following age groups: 0–12, 13–18, 19–25, and 26–35 from 2021 to 2022. The results came from vaginal and cervical swabs (for females); urethral, rectal, and pharyngeal swabs (for males and females); and seminal fluid (for males) for the following infections: HPV, Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasmas, Gardnerella, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum. The results also came from blood tests for HIV, hepatitis C, hepatitis B, and Treponema pallidum (TPHA, VDRL). In addition, we examined results from urine tests for chlamydia, Neisseria gonorrhoeae, trichomonas, and Treponema pallidum. Conclusions. The literature for other countries reports the need for comprehensive, culturally and developmentally sensitive care to address sexuality-related issues in adolescents and young adults, a need that also applies to Italy. These data will be of great importance in adopting evidence-based STI control programs in Marche Region. This study could, indeed, represent a landmark for public health officials and professionals, with the aim of promoting adolescents’ access to sexual health services to receive useful information, strengthening preventive measures in younger age groups, and designing sexual education programs.

Sudden unexpected deaths often remain unresolved despite forensic examination, posing challenges for pathologists. Molecular autopsy, through genetic testing, can reveal hidden causes undetectable by standard methods. This review assesses the role of molecular autopsy in clarifying SUD cases, examining its methodology, utility, and effectiveness in autopsy practice. This systematic review followed PRISMA guidelines and was registered with PROSPERO (registration number: CRD42024499832). Searches on PubMed, Scopus, and Web of Science identified English studies (2018–2023) on molecular autopsy in sudden death cases. Data from selected studies were recorded and filtered based on inclusion/exclusion criteria. Descriptive statistics analyzed the study scope, tissue usage, publication countries, and journals. A total of 1759 publications from the past 5 years were found, with 30 duplicates excluded. After detailed consideration, 1645 publications were also excluded, leaving 84 full-text articles for selection. Out of these, 37 full-text articles were chosen for analysis. Different study types were analyzed. Mutations were identified in 17 studies, totaling 47 mutations. Molecular investigations are essential when standard exams fall short in determining sudden death causes. Expertise in molecular biology is crucial due to diverse genetic conditions. Discrepancies in post-mortem protocols affect the validity of results, making standardization necessary. Multidisciplinary approaches and the analysis of different tissue types are vital.

Background: Knowledge of vascular anatomy and its possible variations is essential for performing embolization or revascularization procedures and complex surgery in the pelvis. The obturator artery (OA) is a branch of the anterior division of the internal iliac artery (IIA), and it has the highest frequency of variation among branches of the internal iliac artery. Possible anomalies of the origin of the obturator artery (OA) should be known when performing pelvic and groin surgery, where its control or ligation may be required. The purpose of this systematic review and meta-analysis, based on Sanudo’s classification, is to analyze the origin of the obturator artery (OA) and its variants. Methods: Thirteen articles published between 1952 and 2020 were included. Results: The obturator artery (OA) was present in almost all cases (99.8%): the pooled prevalence estimate for the origin from the IIA axis was 77.7% (95% CI 71.8–83.1%) vs. 22.3% (95% CI 16.9–28.2%) for the origin from EIA axis. In most cases, the obturator artery (OA) originated from the anterior division trunk of the internal iliac artery (IIA) (61.6%). Conclusions: Performing preoperative radiological examination to determine the pelvic vascular pattern and having the awareness to evaluate possible changes in the obturator artery can reduce the risk of iatrogenic injury and complications.

Home healthcare in the Italian health system has proven to be an essential factor in adequately responding to the health needs of an increasingly aging population. The opportunities offered by digitization and new technologies, such as artificial intelligence (AI) and robotics, are a lever for making home care services more effective and efficient on the one hand, and on the other for improving remote patient monitoring. Telemedicine devices have enormous potential for telemonitoring and telerehabilitation of patients suffering from chronic disabling diseases; in particular, AI systems can now provide very useful managerial and decision-making support in numerous clinical areas. AI combined with digitalization, could also allow for the remote monitoring of patients' health conditions. In this paper authors describe some digital and healthcare tools or system of AI, such as the Connected Care model, the Home Care Premium (HCP) project, The Resilia App and some professional service robotics. In this context, to optimize potential and concrete healthcare improvements, some limits need to be overcome: gaps in health information systems and digital tools at all levels of the Italian National Health Service, the slow dissemination of the computerized medical record, issues of digital literacy, the high cost of devices, the poor protection of data privacy. The danger of over-reliance on such systems should also be examined. Therefore the legal systems of the various countries, including Italy, should indicate clear decision-making paths for the patient.

Background: This systematic umbrella review aims to investigate and provide an analysis of guidelines regarding the treatment of diverticular abscesses. Material and methods: A systematic literature search was performed using the Cochrane Overviews of Reviews model and the ‘Clinical Practice Guidelines’; at the end of initial search, only 12 guidelines were included in this analysis. The quality of the guidelines was assessed by adopting the “Appraisal of Guidelines for Research and Evaluation II” (AGREE II). The comparative analysis of these guidelines has highlighted the presence of some differences regarding the recommendations on the treatment of diverticular abscesses. In particular, there are some controversies about the diameter of abscess to be used in order to decide between medical treatment and percutaneous drainage. Different guidelines propose different abscess diameter cutoffs, such as 3 cm, 4–5 cm, or 4 cm, for distinguishing between small and large abscesses. Conclusions: Currently, different scientific societies recommend that diverticular abscesses with diameters larger than 3 cm should be considered for percutaneous drainage whereas abscesses with diameters smaller than 3 cm could be appropriately treated by medical therapy with antibiotics; only a few guidelines suggest the use of percutaneous drainage for abscesses with a diameter greater than 4 cm. The differences among guidelines are the consequence of the different selection of scientific evidence. In conclusion, our evaluation has revealed the importance of seeking new scientific evidence with higher quality to either confirm, reinforce or potentially weaken the existing recommendations from different societies.

IntroductionThe most frequent sterilization procedures include postpartum tubal ligation, laparoscopic tubal disruption or salpingectomy, and hysteroscopic tubal occlusion. It may be performed via laparoscopy, mini-laparotomy, or hysteroscopy. Safety, efficacy, short-term complications, long-term complications, and non-contraceptive benefits of sterilization are different for each procedure. Female sterilization has become an important professional liability problem in obstetrics and gynecology. Materials and methodsWe analyzed 6 cases of surgical sterilization that have been the subject of civil proceedings. We review indications, contraindications, and complications associated with each sterilization procedure. ResultsIn our small number of cases, women who have undergone sterilization performed negligently are entitled to recover damages for wrongful conception, negligence, and wrongful birth. We also consider the issue of female sterilization of minors. DiscussionTubal sterilization can be performed with different techniques, chosen in light of the various situations involved, with the goal of reducing as many as possible any failures. Thorough and complete communication of information is of primary importance. ConclusionSterilization is the most widely used birth control method around the world. The procedure is generally safe and highly effective. As reported in the literature, the decision concerning method depends on the setting, the surgeon's experience, the country's economic development, and the woman's preference, but we think that some techniques present a greater risk of failure and expose the surgeon to malpractice litigation.

BACKGROUND:Fredet's fascia represents a crucial landmark for vascular surgical anatomy, especially in minimally invasive complete mesocolic excision (CME) for right-sided colon adenocarcinoma. Fredet's fascia allows access to the gastrocolic trunk of Henle (GCTH), the most critical step in both open and minimally invasive right-sided CME techniques. Despite this, a recent workshop of expert surgeons on the standardization of the laparoscopic right hemicolectomy with CME did not recognize or include the term of Fredet's fascia or area. Hence, we undertook a systematic review of articles that include the terms "Fredet's fascia or area", or synonyms thereof, with special emphasis on the types of articles published, the nationality, and the relevance of this area to surgical treatments.METHODS:We conducted a systematic review up to 15 July 2022 on PubMed, WOS, SCOPUS, and Google Scholar.RESULTS:The results of the study revealed that the term "Fredet's fascia" is poorly used in the English language medical literature. In addition, the study found controversial and conflicting data among authors regarding the definition of "Fredet's fascia" and its topographical limits.CONCLUSIONS:Knowledge of Fredet's fascia's surgical relevance is essential for colorectal surgeons to avoid accidental injuries to the superior mesenteric vascular pedicle during minimally invasive right hemicolectomies with CME. In order to avoid confusion and clarify this fascia for future use, we suggest moving beyond the use of the eponymous term by using a "descriptive term" instead, based on the fascia's anatomic structure. Fredet's fascia could, therefore, be more appropriately renamed "sub-mesocolic pre-duodenopancreatic fascia".