Statistical Analysis of Abilities to Give Consent to Health Data Processing

The recent pandemic crisis has highlighted the importance of the availability and management of health data to respond quickly and effectively to health emergencies, while respecting the fundamental rights of every individual. In this context, it is essential to find a balance between the protection of privacy and the safeguarding of public health, using tools that guarantee transparency and consent to the processing of data by the population. This work, starting from a pilot investigation conducted in the Polyclinic of Bari as part of the Horizon Europe Seeds project entitled “Multidisciplinary analysis of technological tracing models of contagion: the protection of rights in the management of health data”, has the objective of promoting greater patient awareness regarding the processing of their health data and the protection of privacy. The methodology used the PHICAT (Personal Health Information Competence Assessment Tool) as a tool and, through the administration of a questionnaire, the aim was to evaluate the patients’ ability to express their consent to the release and processing of health data. The results that emerged were analyzed in relation to the 4 domains in which the process is divided which allows evaluating the patients’ ability to express a conscious choice and, also, in relation to the socio-demographic and clinical characteristics of the patients themselves. This study can contribute to understanding patients’ ability to give their consent and improve information regarding the management of health data by increasing confidence in granting the use of their data for research and clinical management.

Medicolegal autopsies in children: Experience of a department of Legal Medicine in Brazil

Purposes: The purpose of this study was to determine the pattern of mortality in children’s Federal District. Knowledge of the epidemiology of injuries is essential for planning, implementation and evaluation of preventive measures. Methods: We analyzed the forensic examination documents of all children under 12 years sent to the IML-DF, during 2010. The data analyzed included age, gender, cause of death (i.e.natural or external), mechanism of death (traffic accident, asphyxia, firearm injuries, poisoning, heat injuries) and the medical cause of death. Results: A large number of children (n = 123 total;n = 71 males, n = 52 females) were examined in the IML-DF, Brasília, Brazil. Mean age was 37.96 months, with a median of 12 months, and 21% of children were younger than 1 month. There were 62 cases (33 males and 29 female) classified as natural deaths. The average age for natural deaths was 18.72 months. Most cases of natural death occurred in the first year of life (n = 50), being prevalent in the first month of life (n = 24). Among the 62 cases analyzed, six were stillborns, 13 suffered intrauterine fetal distress (e.g. placental insufficiency, prematurity and meconium aspiration), 36 had lung problems (e.g. Acute respiratory distress syndrome (ARDS), bronchopneumonia, pulmonary hemorrhage, interstitial pneumonitis and infant respiratory distress syndrome (IRDS)), five had neurologicalproblems (e.g. hydrocephalus, hydranencephaly,convulsive seizures and meningitis) and two had undetermined cause of death. There were also isolated cases of heart disease, leukemia, diabetic ketoacidosis, peritonitis causedby acute appendicitisand amniotic bandsyndrome. There were 61 cases of deaths from external causes, as a consequence of the following: blunt instrument, firearm, physical agent (i.e.heat), physicochemical agent (i.e.asphyxia) and chemical agent (i.e.poisoning). Conclusions: The profile of deaths from external causesin this developing country follows a trend similar to trends reported in the literature for other developing countries. The majority of deaths are accidental, with traffic accidents being the most frequent cause, followed by asphyxia (i.e.aspiration of gastric contents and drownings). Sporadic cases of poisoning, injuries from firearms, accidents and fires also occur.

Neuroendocrine differentiation:The mysterious fellow of colorectal cancer

Neuroendocrine differentiation in sporadic colorectal cancer has been recognized since decades, but its clinical impact is still controversially discussed. Detailed parameter analyses hint at the possibility that probablynot neuroendocrine differentiation itself, but its association with poor grade of tumor differentiation, lymph node metastases, distant metastases and other unfavorable features contribute to worse clinical outcome. However, other studies deny a relationship between neuroendocrine differentiation and prognosis of colorectal cancer. This review elucidates, whether new insights into the origin of neuroendocrine differentiation in the intestinal epithelium, its regulation by m TOR pathway components and its possible link to the intestinal stem cell compartment could determine a role of neuroendocrine cells as prognostic marker and putative therapeutic target in sporadic colorectal cancer.

The laparoscopic approach in emergency surgery: A review of the literature

The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in abdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

Variation of blood vessels in the cranial-cervical legion

The blood vessels in the head and neck have several main roots for supplying blood to the brain and returning of blood to the heart. It was well known that each artery and vein in the head and neck has its variation. The variation of the vessels some times gives rise to unexpectable findings, which are not described in the textbook. In this study we like to show the morphological variations observed at routine autopsy cases and some forensic pathological findings caused by those variations.

反相高效液相色谱法测定血清中的佐匹克隆

建立了测定血清中佐匹克隆的反相高效液相色谱法 (外标法 )。血样用正丁基氯提取后进行色谱分离。采用的色谱柱为LiChroCART 12 5 4柱 (LiChrospher 6 0RPselectB填料 ,5 μm ,12 5mm× 4mmi d ) ,流动相为乙腈 0 0 2mol/LKH2 PO4缓冲溶液 (体积比为 2 0∶80 ) ,紫外检测波长为 2 5 4nm。当佐匹克隆在血清中的添加质量浓度分别为 4 0 0 μg/L ,16 0 0 μg/L和6 4 0 0 μg/L时 ,血清中佐匹克隆的回收率分别是 (73 4± 3 2 ) % ,(82 2± 4 1) %和(90 3± 4 5 ) %。方法的最低检出限为 15 μg/L。方法适用于法庭毒物分析 ,简便、快速。

Superior mesenteric artery first approach versus standard pancreaticoduodenectomy： a systematic review and meta-analysis

BACKGROUND： The superior mesenteric artery（SMA） first approach was proposed recently as a new modification of the standard pancreaticoduodenectomy. Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenectomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pancreaticoduodenectomy（SMA-PD） with standard pancreaticoduodenectomy（S-PD）.DATA SOURCES： Electronic search of the PubM ed/MEDLINE, EMBASE, Web of Science and Cochrane Library was performed until July 2015. We considered randomized controlled trials（RCTs） and non-randomized comparative studies（NRCSs） comparing SMA-PD with S-PD to be eligible if they included patients with periampullary cancers.RESULTS： A total of one RCT and thirteen NRCSs met the inclusion criteria, involving 640 patients with SMA-PD and 514 patients with S-PD. The SMA-PD was associated with less intraoperative bleeding, less blood transfusions and higher rate of associated venous resections. The pancreatic fistula and delayed gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complication rates and in-hospital mortality. There was no difference regarding R0 resection rate, and one-, two-or three-year over-all survival. The SMA-PD was associated with a lower local, hepatic and extrahepatic metastatic rate.CONCLUSIONS： The SMA-PD is associated with better perioperative outcomes, such as blood loss, transfusion requirements, pancreatic fistula, and delayed gastric emptying. Although the one-, two-or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic recurrence rate.

Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis

AIM To compare the effectiveness of laparoscopic complete mesocolic excision (CME) with central vascular ligation (L-CME) with its open (O-CME) counterpart. METHODS We conducted an electronic search of the PubMed/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, SciELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen (lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individual studies. RESULTS A total of one RCT and eleven CCTs (four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes (MD = -1.06, 95%CI: -3.65 to 1.53, P = 0.42), and tumor to high tie distance (MD = 14.26 cm, 95%CI: -4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group (MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions (OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall (OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I2 = 28%) and disease-free (OR = 1.45, 95% CI: 1.00 to 2.10, P = 0.05, I2 = 0%) survival. CONCLUSION The laparoscopic approach offers the same quality of the resected specimen as the open approach in complete mesocolic excision with central vascular ligation for colon cancer. The laparoscopic complete mesocolic excision with central vascular ligation is superior in all perioperative results and at least non-inferior in long-term oncological outcomes.

Platelet-to-lymphocyte ratio and CA19-9 are simple and informative prognostic factors in patients with resected pancreatic cancer

We read with great interest the paper “Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19-9 level as a prognostic factor in patients with resected pancreatic cancer” published in Hepatobiliary & Pancreatic Diseases International [1].

Basal Cell Carcinoma at Pediatric Age Gorlin-Goltz Syndrome Clinic Experience

The nevoid basal cell carcinoma syndrome is an autosomal dominant inherited disease, associated with PTCH gene mutation. Its presentation is polymorphous, being frequent to appear the clinical triad carcinomas basal cell, odontogenic cysts and skeletal abnormalities. Skin lesions are a very frequent reason for consultation in the paediatric age, being evaluated in most cases in primary care. Sometimes, patients need the intervention of other specialists to deep in a given area. The medical literature shows a fragmented view of the disease, possibly related to the low frequency of appearance of this syndrome, and by the need for intervention of not transversal knowledge specialist, which is why we feel interesting to evaluate the role of specialist who is developing the activity at primary care, with patients who require a multidisciplinary intervention.

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report

BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

COVID-19 pandemic and evolution of telemedicine to TeleIME

The COVID-19 pandemic has been a life altering expe-rience that very few could have predicted.During these unprecedented and uncertain times,with the majority of the world in some type of lockdown and travel restrictions in most places,medicine like many other fields of work has adapted to this challenging new normal.In particular the medical field has encouraged telemedicine and many patient visits have gone virtual.

Pollen Findings in a Presumptive Drowning Case

A medicolegal/botanical collaboration has to lead to an interdisciplinary procedure for developing methods when studying dead bodies found in water with no clear circumstances. Hereby we present a report or a preliminary attempt as a basis for encouraging further work in the field. The body of an unidentified 25 - 35 years old woman was found immersed in a fresh water ditch in state of decomposition. Structural alterations avoid any a priori identification of asphyxia or traumatic cervical lesions. The last cause of death was estimated as a cardio respiratory collapse and a drowning investigation was proposed. Taxonomic species identification was carried out to relate the pollen aspiration with the water medium in lung, spleen, liver and water medium. We presented pollen grains in spleen, as a closed organ, as a clue for death investigation in the absence of diatom findings. Information about where and when pollen grains occur may ascertain that a body or an object was in some place at a certain time. Since the consequences of aspiration depend on many factors, such as the quantity, size and solidity of the material aspirated and whether the aspiration is chronically recurrent or acute, the pollen investigation must be done with precaution. We conclude that in the absence of other microscopic structures, biochemical blood analyses, or histological findings, forensic palynology may be of help to relate the presumptive drowned body with its death scenario.

An Unusual Case of Functional Neurological Disorders and Psychogenic Coma following Physical Assault:Clinical and Medico-Legal Considerations

Functional neurological disorders can have different clinical manifestations,including coma,in the setting of an unknown etiology.In this article,we present a case of a young man affected by intellectual disabilities who,after a physical assault reported serious neurological alterations and a functional coma.This case shows how a stressful psychophysical event can bring acute and variable neurological manifestations of functional significance to a victim with previous intellectual disabilities.Despite the growing interest in this field,research is still very limited and studies in this field could better explain the nature of the psychogenic coma.From a medico-legal point of view,problems of evaluation may emerge for these disorders emerge as a result of acute psycho-physical stress and without any detectable structural alterations.

Sexual Abuse and Mental Disorders:The Dark Side of Violence

Rape and sexual violence occur in all social classes and societies.In most cases,the sexual offenders are known to the victim and the majority of rapes happen in intimate relationships.Children are particularly vulnerable to sexual abuse,in particular,the female sex.The sexual abuse of minors is defined as“any sexual activities that an adult carries on or with a person under the age of consent.”Literature evidence that the prevalence of any type of violence among women with disabilities varies between 26.0%and 90.0%,compared to nondisabled women,showing that people with disabilities have an increased risk of suffering physical and sexual violence.Children with intellectual disabilities(ID)show a high risk of sexual victimization.The World Health Organization presently defines mental retardation as“a significantly reduced ability to understand new or complex information and to learn and apply new skills(impaired intelligence).This results in a reduced ability to cope independently(impaired social functioning),and begins before adulthood,with a lasting effect on development.”The aim of this study is to investigate the correct identification of sexual abuse and severe mental retardation through the collaboration of a team of experts(forensic pathologist,psychiatrist,psychologist,gynecologist,pediatrician,and social worker).We present a case of a 12-year-old female child,who suffers from severe mental retardation and was the victim of rape by a 79-year-old man.The study shows the difficulties in discovering episodes of sexual abuse among children affected by ID by evidencing the importance of adequate analysis through a multidisciplinary approach.The work focuses on the need to improve knowledge about medical and forensic investigations through proper protocols,for early recognition and appropriate management of these complicated cases.

The role of SARS-COV-2 infection in promoting abnormal immune response and sepsis:A comparison between SARS-COV-2-related sepsis and sepsis from other causes

Background:COVID-19 caused by SARS-CoV-2 virus is characterized by respiratory compromise and immune system involvement,even leading to serious disorders,such as cytokine storm.Methods:We then conducted a literature review on the topic of sepsis and covid-19,and in parallel conducted an experimental study on the histological finding of patients who died from SARS-Covid 19 infection and a control group.Results:Sepsis associated with covid-19 infection has some similarities and differences from that from other causes.Conclusion:In this paper the complex interplay between the 2 disorders was discussed,focusing on the similarities and on the effect that one could have on the other.A preliminary experimental section that demonstrates the multisystemic involvement in subjects who die from SARS-CoV-2 is also proposed.

The role of forensic anthropology in disaster victim identification(DVI):recent developments and future prospects

Forensic anthropological knowledge has been used in disaster victim identification(DVI)for over a century,but over the past decades,there have been a number of disaster events which have seen an increasing role for the forensic anthropologist.The experiences gained from some of the latest DVI operations have provided valuable lessons that have had an effect on the role and perceived value of the forensic anthropologist as part of the team managing the DVI process.This paper provides an overview of the ways in which forensic anthropologists may contribute to DVI with emphasis on how recent experiences and developments in forensic anthropology have augmented these contributions.Consequently,this paper reviews the value of forensic anthropological expertise at the disaster scene and in the mortuary,and discusses the way in which forensic anthropologists may use imaging in DVI efforts.Tissue-sampling strategies for DNA analysis,especially in the case of disasters with a large amount of fragmented remains,are also discussed.Additionally,consideration is given to the identification of survivors;the statistical basis of identification;the challenges related to some specific disaster scenarios;and education and training.Although forensic anthropologists can play a valuable role in different phases of a DVI operation,they never practice in isolation.The DVI process requires a multidisciplinary approach and,therefore,has a close collaboration with a range of forensic specialists.

Evaluation of ancestry from human skeletal remains: a concise review

Ancestry assessment represents a major component of forensic anthropological analysis of recovered human remains.Interpretations of ancestry,together with other aspects of the biological profile,can help narrow the search of missing persons and contribute to eventual positive identification.Such information can prove useful to authorities involved in the identification and investigative process since many lists of missing persons have a reference to this parameter.Recent research has strengthened available methodologies involving metric,non-metric morphological as well as chemical and genetic approaches.This review addresses the new anthropological techniques that are now available,as well as the complex historical context related to ancestry evaluation.

Chrysomya chani Kurahashi (Diptera: Calliphoridae), a blow fly species of forensic importance: morphological characters of the third larval instar and a case report from Thailand

Blow flies are worldwide the most important insects from a forensic point of view.In Thailand,aside from the two most common species,Chrysomya megacephala (F.) and Chrysomya rufifacies (Macquart),Chrysomya chani Kurahashi was also found to be of forensic importance.We present a case of a human female cadaver in its bloated stage of decomposition,discovered at Pachangnoi Subdistrict,northern Thailand.Entomological sampling during the autopsy displayed an assemblage of numerous dipteran larvae.Macroscopic observations showed the coexistence of third instar larvae of the three blow flies C.megacephala,Chrysomya villeneuvi Patton,an unknown blow fly species and one muscid,Hydrotaea sp.The minimum post-mortem interval was estimated to be six days,based on the developmental rate of C megacephala.The ID of the unknown larva,which is the focus of this report,was revealed later as C.chani by DNA sequencing,using a 1205 bp of cytochrome c oxidase subunit Ⅰ (COⅠ).The occurrence of C.chani on a human body revealed the need to analyse and describe the morphology of its immature stage,to enable forensic entomologists to identify this fly species in future cases.The morphological examination of the third instar was performed,revealing peculiar characteristics: protuberant tubercles encircling abdominal segments;9-11 lobes on the anterior spiracle;six prominent pairs of tubercles along the peripheral rim of the eighth abdominal segment;a heavily sclerotized complete peritreme of the posterior spiracles.A key to differentiate the third instar of blow flies of forensic importance in Thailand is provided.

Overview of clinical forensic services in various countries of the European Union

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings.In the context of a clinical forensic examination,physical findings are recorded and biological trace material is gathered and secured.Ideally,all forensic findings are documented in a detailed report combined with photographic docu-mentation,which employs a forensic scale to depict the size of the injuries.However,the integrity of such forensic findings depends particularly on two factors.First,the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence.Second,the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time.Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union(EU);in some states,they are not available at all.As part of the JUST_(e)U!(Juridical standards for clinical forensic examinations of victims of violence in Europe)pro-ject,the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz,Austria created(in cooperation with its international partner consortium)a questionnaire:the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU.Our paper pro-vides a summary of the responses and an overview of the current situation concerning pro-vided clinical forensic services.