Pub Date : 2025-10-01DOI: 10.1016/j.legalmed.2025.102721
Greta Seveso, Federica Bagini, Giacomo Belli, Luca Morini, Silvia Damiana Visonà, Giovanni Cecchetto, Luca Tajana
Analyzing suicidal behavior and methods is crucial to gain a deeper understanding of this complex phenomenon, which affects over 700,000 individuals annually and ranks among the leading causes of death worldwide. The global scope of this issue explains why suicide represents a significant public health concern and why it is so important to unveil the complex mechanisms behind its occurrence.
We report a case of a fatal thermal injury to the left femoral artery, self-inflicted with a hot glue gun. The uniqueness of this case lies primarily in the instrument used, which, to the best of our knowledge, has never been reported in the literature as a means of suicide. In fact, the only previously documented case involving a hot glue gun resulted in non-fatal injuries inflicted in a context of maltreatment. Furthermore, the anatomical region involved is unusual, as self-inflicted injuries typically target specific “elective sites” based on the chosen method.
Forensic experts may occasionally encounter atypical suicide cases involving unusual methods or tools, as well as morphologically peculiar injuries. Reporting such cases is essential for expanding our knowledge of the subject, providing valuable references for medico-legal practice, and improving preventive strategies.
{"title":"Atypical suicide by thermal injury to the femoral artery caused by a hot glue gun: A case report and review of the literature","authors":"Greta Seveso, Federica Bagini, Giacomo Belli, Luca Morini, Silvia Damiana Visonà, Giovanni Cecchetto, Luca Tajana","doi":"10.1016/j.legalmed.2025.102721","DOIUrl":"10.1016/j.legalmed.2025.102721","url":null,"abstract":"<div><div>Analyzing suicidal behavior and methods is crucial to gain a deeper understanding of this complex phenomenon, which affects over 700,000 individuals annually and ranks among the leading causes of death worldwide. The global scope of this issue explains why suicide represents a significant public health concern and why it is so important to unveil the complex mechanisms behind its occurrence.</div><div>We report a case of a fatal thermal injury to the left femoral artery, self-inflicted with a hot glue gun. The uniqueness of this case lies primarily in the instrument used, which, to the best of our knowledge, has never been reported in the literature as a means of suicide. In fact, the only previously documented case involving a hot glue gun resulted in non-fatal injuries inflicted in a context of maltreatment. Furthermore, the anatomical region involved is unusual, as self-inflicted injuries typically target specific “elective sites” based on the chosen method.</div><div>Forensic experts may occasionally encounter atypical suicide cases involving unusual methods or tools, as well as morphologically peculiar injuries. Reporting such cases is essential for expanding our knowledge of the subject, providing valuable references for medico-legal practice, and improving preventive strategies.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102721"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.legalmed.2025.102720
Jae-Bong Jung , Kyung Min Lee , Seong Hwan Park , Sang-Hyun Park
Medicolegal entomology, once primarily utilized for estimating the post-mortem interval (PMI), now serves an expanding role in evaluating abuse and neglect in vulnerable populations. This case study examines a pivotal 2022 ruling by the Busan District Court, where forensic entomological evidence led to a conviction for negligent homicide by abandonment. The victim, an 82-year-old woman with dementia and multiple chronic conditions, was discovered in a severely unsanitary environment. Numerous third-instar larvae of Lucilia sericata were retrieved from necrotic pressure ulcers, and developmental analysis indicated colonization had begun at least 72 h before death. These findings underscore the need for routine integration of entomological expertise into medicolegal protocols, particularly in jurisdictions where the discipline is still underutilized.
{"title":"Medicolegal entomology in an elder neglect investigation: A case study from South Korea","authors":"Jae-Bong Jung , Kyung Min Lee , Seong Hwan Park , Sang-Hyun Park","doi":"10.1016/j.legalmed.2025.102720","DOIUrl":"10.1016/j.legalmed.2025.102720","url":null,"abstract":"<div><div>Medicolegal entomology, once primarily utilized for estimating the post-mortem interval (PMI), now serves an expanding role in evaluating abuse and neglect in vulnerable populations. This case study examines a pivotal 2022 ruling by the Busan District Court, where forensic entomological evidence led to a conviction for negligent homicide by abandonment. The victim, an 82-year-old woman with dementia and multiple chronic conditions, was discovered in a severely unsanitary environment. Numerous third-instar larvae of <em>Lucilia sericata</em> were retrieved from necrotic pressure ulcers, and developmental analysis indicated colonization had begun at least 72 h before death. These findings underscore the need for routine integration of entomological expertise into medicolegal protocols, particularly in jurisdictions where the discipline is still underutilized.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102720"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.legalmed.2025.102717
Jessika Camatti , Anna Laura Santunione , Monica Bolognini , Denis Cusack , Stefania Zerbo , Antonina Argo , Maria Puntarello , Giovanni Scalzo , Fattorini Paolo , Tommaso Bruscagin , Lorenzo Desinan , Laura Battistig , Fabrizio Tosku , Guido Viel , Giorgia Franchetti , Biagio Solarino , Laura Ambrosi , Giovanni Cecchetto , Silvia Damiana Visonà , Emanuele Sala , Rossana Cecchi
The European Council of Legal Medicine (ECLM) on-site inspection form allows the collection of data relevant to the identification, collection, sampling and preservation of all elements that, during the on-site inspection, may be useful as forensic evidence. The aim of this study is to assess the completeness of the information collected in a large number of on-site inspections, the records of which were drawn up without the use of the ECLM on-site inspection form, in order to verify the usefulness and the application of this form.
The authors present a multicentre study involving 20 Italian forensic medicine institutes. For each institute, the reports of on-site inspections carried out without the use of the ECLM on-site inspection form were collected and a forensic pathologist was asked to analyse the individual cases and to identify, for each case, the presence or absence of information regarding all the points examined by the ECLM on-site inspection form. A practical database was prepared and sent to each institute for this analysis.
Data were collected and analysed from a total of 1721 on-site inspection reports. Our results document that certain items on the ECLM on-site inspection form are not always investigated in reports written without the use of this tool.
The use of the ECLM on-site inspection form proves to be a valid tool to assist the forensic pathologist during the on-site inspection. We therefore hope that the forms developed by the ECLM will be systematically adopted in the forensic practice of the forensic pathologist.
{"title":"Towards a standard of scientific evidence in on-site inspection: compilation of the ECLM on-site inspection form in a broad case history","authors":"Jessika Camatti , Anna Laura Santunione , Monica Bolognini , Denis Cusack , Stefania Zerbo , Antonina Argo , Maria Puntarello , Giovanni Scalzo , Fattorini Paolo , Tommaso Bruscagin , Lorenzo Desinan , Laura Battistig , Fabrizio Tosku , Guido Viel , Giorgia Franchetti , Biagio Solarino , Laura Ambrosi , Giovanni Cecchetto , Silvia Damiana Visonà , Emanuele Sala , Rossana Cecchi","doi":"10.1016/j.legalmed.2025.102717","DOIUrl":"10.1016/j.legalmed.2025.102717","url":null,"abstract":"<div><div>The <em>European Council of Legal Medicine (ECLM) on-site inspection</em> form allows the collection of data relevant to the identification, collection, sampling and preservation of all elements that, during the on-site inspection, may be useful as forensic evidence. The aim of this study is to assess the completeness of the information collected in a large number of on-site inspections, the records of which were drawn up without the use of the <em>ECLM on-site inspection form</em>, in order to verify the usefulness and the application of this form.</div><div>The authors present a multicentre study involving 20 Italian forensic medicine institutes. For each institute, the reports of on-site inspections carried out without the use of the <em>ECLM on-site inspection form</em> were collected and a forensic pathologist was asked to analyse the individual cases and to identify, for each case, the presence or absence of information regarding all the points examined by the <em>ECLM on-site inspection form</em>. A practical database was prepared and sent to each institute for this analysis.</div><div>Data were collected and analysed from a total of 1721 on-site inspection reports. Our results document that certain items on the <em>ECLM on-site inspection form</em> are not always investigated in reports written without the use of this tool.</div><div>The use of the <em>ECLM on-site inspection form</em> proves to be a valid tool to assist the forensic pathologist during the on-site inspection. We therefore hope that the forms developed by the ECLM will be systematically adopted in the forensic practice of the forensic pathologist.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102717"},"PeriodicalIF":1.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-21DOI: 10.1016/j.legalmed.2025.102718
Marco Piraino , Bianca Beltrame , Salvatore Nigliaccio , Davide Fontana , Antonina Argo , Tommaso D’Anna , Stefania Zerbo , Giuseppe Davide Albano , Pietro Messina , Giuseppe Alessandro Scardina
The use of three-dimensional (3D) reconstruction technologies in forensic science is gaining increasing relevance for the documentation and analysis of traumatic injuries. This approach provides an innovative, non-invasive, precise, and reproducible method that is particularly well-suited for evidentiary purposes in judicial contexts.
This study presents two forensic cases of suspected death from dog attacks, in which 3D models were reconstructed to analyze bite-related injuries identified on the victims’ bodies, with the aim of distinguishing them from bite marks caused by other species. Specifically, the Dexis 3600 intraoral scanner was used for data acquisition, Agisoft Metashape software was employed for photogrammetric processing and Geomagic Control X was utilized for 3D analysis. In the first case, five bite wounds were analyzed; in the second case, ten lesions were examined.
The findings demonstrate that the integration of 3D scanning and photogrammetry in forensic and forensic odontology practice can significantly enhance the accuracy of animal bite mark assessment. This integration provides objective support in both identifying the lesion typology and attributing the injuries to a specific animal species, as well as reconstructing the overall dynamics of the attack − an essential aspect of forensic expert analysis.
在法医科学中，三维（3D）重建技术的使用与创伤性损伤的记录和分析越来越相关。这种方法提供了一种创新的、非侵入性的、精确的和可重复的方法，特别适合于司法环境中的证据目的。本研究提出了两起疑似因狗袭击而死亡的法医案例，其中重建了3D模型，以分析受害者身上发现的咬伤，目的是将它们与其他物种造成的咬痕区分开来。具体而言，使用Dexis 3600口腔内扫描仪进行数据采集，使用Agisoft Metashape软件进行摄影测量处理，使用Geomagic Control X进行三维分析。在第一例病例中，分析了5个咬伤；在第二个病例中，检查了十个病变。结果表明，在法医和法医牙科学实践中，三维扫描与摄影测量相结合可以显著提高动物咬痕评估的准确性。这种整合为识别病变类型和将损伤归因于特定动物物种以及重建攻击的整体动态提供了客观支持-这是法医专家分析的重要方面。
{"title":"From evidence to proof: case series application of 3d reconstructions in forensic analysis of dog bite injuries","authors":"Marco Piraino , Bianca Beltrame , Salvatore Nigliaccio , Davide Fontana , Antonina Argo , Tommaso D’Anna , Stefania Zerbo , Giuseppe Davide Albano , Pietro Messina , Giuseppe Alessandro Scardina","doi":"10.1016/j.legalmed.2025.102718","DOIUrl":"10.1016/j.legalmed.2025.102718","url":null,"abstract":"<div><div>The use of three-dimensional (3D) reconstruction technologies in forensic science is gaining increasing relevance for the documentation and analysis of traumatic injuries. This approach provides an innovative, non-invasive, precise, and reproducible method that is particularly well-suited for evidentiary purposes in judicial contexts.</div><div>This study presents two forensic cases of suspected death from dog attacks, in which 3D models were reconstructed to analyze bite-related injuries identified on the victims’ bodies, with the aim of distinguishing them from bite marks caused by other species. Specifically, the Dexis 3600 intraoral scanner was used for data acquisition, Agisoft Metashape software was employed for photogrammetric processing and Geomagic Control X was utilized for 3D analysis. In the first case, five bite wounds were analyzed; in the second case, ten lesions were examined.</div><div>The findings demonstrate that the integration of 3D scanning and photogrammetry in forensic and forensic odontology practice can significantly enhance the accuracy of animal bite mark assessment. This integration provides objective support in both identifying the lesion typology and attributing the injuries to a specific animal species, as well as reconstructing the overall dynamics of the attack − an essential aspect of forensic expert analysis.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102718"},"PeriodicalIF":1.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This retrospective study evaluated 637 forensic autopsy cases of solitary deaths (kodoku-shi in Japanese) and clarified the current status of solitary deaths from the viewpoint of forensic medicine. Of the 637 cases of solitary death, 471 were men and 166 were women, indicating that solitary death predominantly occurred in men. This tendency increased from the age of 40 years in men to 60 years in women. Among these, 349 and 199 were natural and external deaths, respectively. Ischemic heart disease and fire-related fatalities were the most common causes of natural and external death, respectively. Suicidal deaths were more frequent among women than men. We found two peaks of postmortem interval until finding (PMI-f): <1 day (182 cases, 28.6 %) and 7 days to < 1 month (164 cases, 25.7 %). The PMI-f was significantly shorter in women than in men. The PMI-f of external death cases was significantly shorter than that of natural death cases. Kushimoto and Shingu, located in Southern Japan (Kinan region), had a high solitary death rate in forensic autopsy cases because of the high aging rate and high rate of individuals in single-person households aged ≥ 65 years. Few cases of solitary deaths in the Kinan region (non-urban area) were welfare recipients, and 23 of the 36 welfare recipients lived in Wakayama City, indicating that the economic state contributed more to the occurrence of solitary deaths in Wakayama City (urban area). We identified several risk factors and regional characteristics of solitary deaths. Our observations could contribute to administrative welfare measures for the prevention of solitary deaths.
{"title":"Retrospective study on solitary deaths (kodoku-shi) from the aspects of forensic and social medicine","authors":"Yumiko Hashizume, Akiko Ishigami, Yuko Ishida, Mizuho Nosaka, Yumi Kuninaka, Hiroki Yamamoto, Satoshi Hata, Jumpei Matsuki, Haruki Yasuda, Tatsunori Takayasu, Fukumi Furukawa, Akihiko Kimura, Toshikazu Kondo","doi":"10.1016/j.legalmed.2025.102712","DOIUrl":"10.1016/j.legalmed.2025.102712","url":null,"abstract":"<div><div>This retrospective study evaluated 637 forensic autopsy cases of solitary deaths (<em>kodoku-shi</em> in Japanese) and clarified the current status of solitary deaths from the viewpoint of forensic medicine. Of the 637 cases of solitary death, 471 were men and 166 were women, indicating that solitary death predominantly occurred in men. This tendency increased from the age of 40 years in men to 60 years in women. Among these, 349 and 199 were natural and external deaths, respectively. Ischemic heart disease and fire-related fatalities were the most common causes of natural and external death, respectively. Suicidal deaths were more frequent among women than men. We found two peaks of postmortem interval until finding (PMI-f): <1 day (182 cases, 28.6 %) and 7 days to < 1 month (164 cases, 25.7 %). The PMI-f was significantly shorter in women than in men. The PMI-f of external death cases was significantly shorter than that of natural death cases. Kushimoto and Shingu, located in Southern Japan (Kinan region), had a high solitary death rate in forensic autopsy cases because of the high aging rate and high rate of individuals in single-person households aged ≥ 65 years. Few cases of solitary deaths in the Kinan region (non-urban area) were welfare recipients, and 23 of the 36 welfare recipients lived in Wakayama City, indicating that the economic state contributed more to the occurrence of solitary deaths in Wakayama City (urban area). We identified several risk factors and regional characteristics of solitary deaths. Our observations could contribute to administrative welfare measures for the prevention of solitary deaths.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102712"},"PeriodicalIF":1.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Accurate detection and quantification of human nuclear DNA (nDNA), named the human accelerated region 1 (HAR1) assay, was developed to simultaneously prove the human origin of forensic biological samples and optimize nDNA input for PCR in human DNA profiling. The HAR1 assay, a TaqMan probe-based real-time PCR assay targeting HAR1 in nDNA, was exclusively specific to human DNA samples with no cross-reactivity across 23 vertebrate species (mammals including non-human primates, birds, reptiles, amphibians, and fishes). This assay is capable of proving the human origin of the samples from as little as the DNA content of a single somatic cell. Moreover, accurate quantification of human nDNA was achieved down to the minimum input concentration (33 pg/μL) recommended by commercial DNA profiling kits. Furthermore, it was confirmed that the presence of non-human DNA mixed with human DNA did not interfere with the accuracy of human nDNA quantification. Therefore, the HAR1 assay represents a valuable and practical tool for improving both the accuracy and efficiency of human DNA profiling, particularly in forensic casework where sample quantity and quality may be limited and the presence of non-human DNA can complicate analysis.
{"title":"Accurate Detection and Quantification of Human Nuclear DNA","authors":"Toshifumi Nakagawa , Masanori Doi , Kosuke Nishi , Takuya Sugahara","doi":"10.1016/j.legalmed.2025.102715","DOIUrl":"10.1016/j.legalmed.2025.102715","url":null,"abstract":"<div><div>Accurate detection and quantification of human nuclear DNA (nDNA), named the human accelerated region 1 (HAR1) assay, was developed to simultaneously prove the human origin of forensic biological samples and optimize nDNA input for PCR in human DNA profiling. The HAR1 assay, a TaqMan probe-based real-time PCR assay targeting HAR1 in nDNA, was exclusively specific to human DNA samples with no cross-reactivity across 23 vertebrate species (mammals including non-human primates, birds, reptiles, amphibians, and fishes). This assay is capable of proving the human origin of the samples from as little as the DNA content of a single somatic cell. Moreover, accurate quantification of human nDNA was achieved down to the minimum input concentration (33 pg/μL) recommended by commercial DNA profiling kits. Furthermore, it was confirmed that the presence of non-human DNA mixed with human DNA did not interfere with the accuracy of human nDNA quantification. Therefore, the HAR1 assay represents a valuable and practical tool for improving both the accuracy and efficiency of human DNA profiling, particularly in forensic casework where sample quantity and quality may be limited and the presence of non-human DNA can complicate analysis.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"79 ","pages":"Article 102715"},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-19DOI: 10.1016/j.legalmed.2025.102716
Enrico Pilia , Andrea Mastrostefano , Tommaso Germanò , Giuseppe Amato , Gozzelino Camilla , Corrado Ciccu , Ernesto d’Aloja , Emanuela Locci , Alberto Chighine
Objective
The post-mortem diagnosis of fatal anaphylaxis presents significant challenges due to the absence of pathognomonic findings. Serum tryptase has been proposed as a potential biomarker to support forensic diagnosis, but optimal post-mortem thresholds remain undefined. This systematic review investigates the sensitivity and specificity of post-mortem blood tryptase in diagnosing fatal anaphylaxis.
Methods
We conducted a systematic literature review adhering to the PRISMA guidelines, with searches across major databases. Studies published between 1990 and 2024 were screened to identify those addressing fatal anaphylactic shock, applying strict inclusion criteria to ensure relevance. A total of 20 studies met our criteria, representing 1033 individuals, including 221 anaphylactic deaths. Sensitivity and specificity of tryptase were analyzed using various thresholds, with data synthesis conducted using the Mann–Whitney–Wilcoxon test and ROC analysis to identify optimal diagnostic cut-offs.
Results
Our findings demonstrated that the cut-off of 30.4 ng/mL proposed by the most recent meta-analysis offers a balanced sensitivity (88.20 %) and specificity (87.00 %). Sensitivity remains stable across tryptase values ranging from 30 to 60 ng/mL, while specificity tends to increase. Youden’s J index was applied to identify the cut-off with the optimal combination of sensitivity and specificity, namely 74.2 ng/mL. Additionally, Negative Likelihood Ratio allowed to identify 12.00 ng/mL as the cut-off at which the possibility of an anaphylactic death can be ruled out.
Conclusion
This review highlights the optimal balance of sensitivity and specificity of post-mortem blood tryptase enhancing forensic diagnostic accuracy for fatal anaphylaxis cases.
{"title":"A systematic review of the diagnostic value of post-mortem blood tryptase in fatal anaphylaxis: assessment of sensitivity and specificity","authors":"Enrico Pilia , Andrea Mastrostefano , Tommaso Germanò , Giuseppe Amato , Gozzelino Camilla , Corrado Ciccu , Ernesto d’Aloja , Emanuela Locci , Alberto Chighine","doi":"10.1016/j.legalmed.2025.102716","DOIUrl":"10.1016/j.legalmed.2025.102716","url":null,"abstract":"<div><h3>Objective</h3><div>The post-mortem diagnosis of fatal anaphylaxis presents significant challenges due to the absence of pathognomonic findings. Serum tryptase has been proposed as a potential biomarker to support forensic diagnosis, but optimal post-mortem thresholds remain undefined. This systematic review investigates the sensitivity and specificity of post-mortem blood tryptase in diagnosing fatal anaphylaxis.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review adhering to the PRISMA guidelines, with searches across major databases. Studies published between 1990 and 2024 were screened to identify those addressing fatal anaphylactic shock, applying strict inclusion criteria to ensure relevance. A total of 20 studies met our criteria, representing 1033 individuals, including 221 anaphylactic deaths. Sensitivity and specificity of tryptase were analyzed using various thresholds, with data synthesis conducted using the Mann–Whitney–Wilcoxon test and ROC analysis to identify optimal diagnostic cut-offs.</div></div><div><h3>Results</h3><div>Our findings demonstrated that the cut-off of 30.4 ng/mL proposed by the most recent <em>meta</em>-analysis offers a balanced sensitivity (88.20 %) and specificity (87.00 %). Sensitivity remains stable across tryptase values ranging from 30 to 60 ng/mL, while specificity tends to increase. Youden’s J index was applied to identify the cut-off with the optimal combination of sensitivity and specificity, namely 74.2 ng/mL. Additionally, Negative Likelihood Ratio allowed to identify 12.00 ng/mL as the cut-off at which the possibility of an anaphylactic death can be ruled out.</div></div><div><h3>Conclusion</h3><div>This review highlights the optimal balance of sensitivity and specificity of post-mortem blood tryptase enhancing forensic diagnostic accuracy for fatal anaphylaxis cases.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102716"},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.legalmed.2025.102708
Rossana Cecchi , Jessika Camatti , Anna Laura Santunione , Marco Vinceti , Tommaso Filippini , Riccardo Mazzoli , Alice Buzzelli , Alessandra De Martina , Graziamaria Corbi , Carlo Pietro Campobasso , Alessandra Sannella , Paolo Fais , Susi Pelotti , Arianna Giorgetti , Elena Lacchè , Andrea Verzeletti , Bianca Beltrame , Riccardo Zoia , Lorenzo Franceschetti , Giulia Vignali , Raffaella Marino
Femicides are grievous, but little is known about risk factors and preventive measures. We present the results of a study conducted across 27 Italian Forensic Institutes. We analyzed 1,238 cases of female homicide and, adopting the definition of femicide as the murder due to the failure to recognize women’s right to self-determination, we identified 410 cases as femicides and 395 as non-femicides Current partners were identified as aggressors in a much larger proportion of femicide cases (241 femicides vs. 145 non-femicides; odds ratio (OR) of femicide 2.46, 95 % CI 1.85–3.27), such association being more pronounced for ex-partners (102 vs. 11; OR 11.56, 95 % CI 6.10–21.92). Sharp weapons showed a higher frequency in femicides (168 vs. 140; OR 1.26, 95 % CI 0.95–1.68). Femicides were more often associated with bodies found in vehicles (31 vs. 9; OR 3.50, 95 % CI 1.64–7.45) and outdoor (68 vs. 43; OR 1.62, 95 % CI 1.08–2.45).
There was an indication of femicides being more frequently associated with overkilling (87/323 vs. 71/324; OR 1.24, 95 % CI 0.88–1.76) and even more with lesions located in erogenous zones (94/316 vs. 70/325; OR 1.38, 95 % CI: 0.97–1.95). However, the strongest (though statistically imprecise) association emerged for overkilling in erogenous zones (12/398 vs. 6/389; OR 1.95, 95 % CI: 0.72–5.25). The number of lesions showed a nonlinear association with femicide likelihood.
These findings offer forensic indicators that could contribute in predicting and potentially prevent femicide occurrence in a Western population such as the Italian one.
杀害妇女是令人痛心的，但人们对危险因素和预防措施知之甚少。我们提出了在27个意大利法医研究所进行的一项研究的结果。我们分析了1238起女性杀人案，并将杀害女性定义为未承认妇女自决权的谋杀，我们将410起案件确定为杀害女性，395起案件确定为非杀害女性。在杀害女性的案件中，目前的伴侣被确定为侵犯者的比例要大得多（杀害女性的241人对非杀害女性的145人；杀害女性的比值比（OR）为2.46,95% CI为1.85-3.27），这种关联在前伴侣中更为明显(102对11；（11.56, 95% ci 6.10-21.92）。锐利武器在杀害女性中的使用频率更高（168比140；OR 1.26, 95% CI 0.95-1.68）。杀女性者通常与在车辆（31对9；OR 3.50, 95%可信区间1.64-7.45）和户外（68对43；OR 1.62, 95%可信区间1.08-2.45）中发现的尸体有关。有迹象表明，杀女性剂更频繁地与过度杀戮相关（87/323 vs. 71/324; OR 1.24, 95% CI 0.88-1.76），甚至与位于性敏感区的病变相关（94/316 vs. 70/325; OR 1.38, 95% CI: 0.97-1.95）。然而，最强烈的关联（尽管统计上不精确）出现在性敏感区的过度杀戮（12/398比6/389；OR 1.95, 95% CI: 0.72-5.25）。病变的数量与杀害女性的可能性呈非线性关系。这些发现提供了法医指标，可以有助于预测和潜在地防止杀害妇女事件在西方人口中发生，如意大利人。
{"title":"A nationwide forensic case-series of femicides in Italy – Part 2: Clues to its epidemiology, prediction and prevention","authors":"Rossana Cecchi , Jessika Camatti , Anna Laura Santunione , Marco Vinceti , Tommaso Filippini , Riccardo Mazzoli , Alice Buzzelli , Alessandra De Martina , Graziamaria Corbi , Carlo Pietro Campobasso , Alessandra Sannella , Paolo Fais , Susi Pelotti , Arianna Giorgetti , Elena Lacchè , Andrea Verzeletti , Bianca Beltrame , Riccardo Zoia , Lorenzo Franceschetti , Giulia Vignali , Raffaella Marino","doi":"10.1016/j.legalmed.2025.102708","DOIUrl":"10.1016/j.legalmed.2025.102708","url":null,"abstract":"<div><div>Femicides are grievous, but little is known about risk factors and preventive measures. We present the results of a study conducted across 27 Italian Forensic Institutes. We analyzed 1,238 cases of female homicide and, adopting the definition of femicide as the murder due to the failure to recognize women’s right to self-determination, we identified 410 cases as femicides and 395 as non-femicides Current partners were identified as aggressors in a much larger proportion of femicide cases (241 femicides vs. 145 non-femicides; odds ratio (OR) of femicide 2.46, 95 % CI 1.85–3.27), such association being more pronounced for ex-partners (102 vs. 11; OR 11.56, 95 % CI 6.10–21.92). Sharp weapons showed a higher frequency in femicides (168 vs. 140; OR 1.26, 95 % CI 0.95–1.68). Femicides were more often associated with bodies found in vehicles (31 vs. 9; OR 3.50, 95 % CI 1.64–7.45) and outdoor (68 vs. 43; OR 1.62, 95 % CI 1.08–2.45).</div><div>There was an indication of femicides being more frequently associated with overkilling (87/323 vs. 71/324; OR 1.24, 95 % CI 0.88–1.76) and even more with lesions located in erogenous zones (94/316 vs. 70/325; OR 1.38, 95 % CI: 0.97–1.95). However, the strongest (though statistically imprecise) association emerged for overkilling in erogenous zones (12/398 vs. 6/389; OR 1.95, 95 % CI: 0.72–5.25). The number of lesions showed a nonlinear association with femicide likelihood.</div><div>These findings offer forensic indicators that could contribute in predicting and potentially prevent femicide occurrence in a Western population such as the Italian one.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102708"},"PeriodicalIF":1.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.legalmed.2025.102709
Jun Yoshida, Kazuya Mori, Akane Nishi, Fumiya Morioka, Kei Okino, Munehiro Katagi, Takako Sato
In the field of forensic toxicology, deaths related to carbon monoxide (CO) inhalation is one of the most relevant concerns. A common method for measuring CO-hemoglobin (Hb) saturation in blood is to measure the absorbance with a spectrophotometer. We recently encountered a fire case in which there appeared a large discrepancy between the autopsy findings and CO-Hb saturation, where the coagulated blood clots filling the heart and large blood vessels showed CO-Hb saturation of about 80% (CO poisoning level), but no soot was found in the bronchial tubes of the remaining body. We suspected this discrepancy to be caused by the application of spectrophotometry, which normally is applied to liquid blood sample, but in this case was applied to thermally coagulated blood. In this study, firstly we heated blood at various temperatures and times to investigate whether thermally coagulated blood clots were formed or not. Furthermore, CO-Hb saturation was measured in the coagulated blood clots using spectrophotometry to verify the discrepancy between the autopsy findings and CO-Hb saturation in the present case. The results show that CO-Hb saturation in coagulated blood clots that had undergone thermal denaturation and coagulation did not reflect the original values, in particular, blood samples with low CO-Hb saturation can show high CO-Hb saturation that may indicate CO poisoning. When determining cause of death, therefore, CO-Hb saturation value determined by spectrophotometer should be used with caution.
{"title":"Analytical pit-holes in the determination of carboxyhemoglobin saturation in thermally denatured coagulated blood samples","authors":"Jun Yoshida, Kazuya Mori, Akane Nishi, Fumiya Morioka, Kei Okino, Munehiro Katagi, Takako Sato","doi":"10.1016/j.legalmed.2025.102709","DOIUrl":"10.1016/j.legalmed.2025.102709","url":null,"abstract":"<div><div>In the field of forensic toxicology, deaths related to carbon monoxide (CO) inhalation is one of the most relevant concerns. A common method for measuring CO-hemoglobin (Hb) saturation in blood is to measure the absorbance with a spectrophotometer. We recently encountered a fire case in which there appeared a large discrepancy between the autopsy findings and CO-Hb saturation, where the coagulated blood clots filling the heart and large blood vessels showed CO-Hb saturation of about 80% (CO poisoning level), but no soot was found in the bronchial tubes of the remaining body. We suspected this discrepancy to be caused by the application of spectrophotometry, which normally is applied to liquid blood sample, but in this case was applied to thermally coagulated blood. In this study, firstly we heated blood at various temperatures and times to investigate whether thermally coagulated blood clots were formed or not. Furthermore, CO-Hb saturation was measured in the coagulated blood clots using spectrophotometry to verify the discrepancy between the autopsy findings and CO-Hb saturation in the present case. The results show that CO-Hb saturation in coagulated blood clots that had undergone thermal denaturation and coagulation did not reflect the original values, in particular, blood samples with low CO-Hb saturation can show high CO-Hb saturation that may indicate CO poisoning. When determining cause of death, therefore, CO-Hb saturation value determined by spectrophotometer should be used with caution.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"78 ","pages":"Article 102709"},"PeriodicalIF":1.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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