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Rossana CECCHI

Professore Ordinario
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze,sede Istituti Anatomici (area Policlinico)

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Pubblicazioni

2024 - Applications of forensic anthropology methodology: accuracy of virtual face reproductions performed on the Tenchini collection [Articolo su rivista]
Donato, L.; Ubelaker, D. H.; Marsella, L. T.; Bugelli, V.; Camatti, J.; Treglia, M.; Cecchi, R.
abstract

Facial reproduction validation uses the methodology typical of forensic anthropology to confirm the accuracy of three-dimensional reproductions of faces. Achieving high accuracy in virtual facial reproductions is still under study. In the present paper, the Tenchini collection, which contains wax reproductions of prisoners’ faces and their skulls, was used. By creating facial reproductions on skulls from this collection, the result was compared with the real face of the person to whom the skull belongs. The three-dimensional volume of each examined skull of Tenchini collection was acquired via CT scan and photogrammetry. Subsequently, the virtual reproduction of each skull was processed using three-dimensional graphics software (ZBrush, Pixologic®). The morphological comparison parameters used in the field of personal identification by forensic anthropology were used. The blind procedure required the operator to see the mask subsequent to the facial reproduction phase, so that the facial reproduction cannot exploit the information that knowledge of the mask would have produced. The parameters used in the study of facial reproductions have shown discrepancies between the characteristics of the masks and the facial reproductions, partly expected because due to the lack of soft tissue on the skull. However, a high degree of accuracy in the facial reproductions performed due to the applied methodology was documented. The present study allowed us to observe how these parameters can be useful to study the accuracy of facial reproduction and identify what difficulties are encountered in producing a result close to the real appearance.

2024 - Artificial intelligence in healthcare: why not apply the medico-legal method starting with the Collingridge dilemma? [Articolo su rivista]
Cecchi, R.; Haja, T. M.; Calabro, F.; Fasterholdt, I.; Rasmussen, B. S. B.
abstract

Technology has greatly influenced and radically changed human life, from communication to creativity and from productivity to entertainment. The authors, starting from considerations concerning the implementation of new technologies with a strong impact on people’s everyday lives, take up Collingridge’s dilemma and relate it to the application of AI in healthcare. Collingridge’s dilemma is an ethical and epistemological problem concerning the relationship between technology and society which involves two approaches. The proactive approach and socio-technological experimentation taken into account in the dilemma are discussed, the former taking health technology assessment (HTA) processes as a reference and the latter the AI studies conducted so far. As a possible prevention of the critical issues raised, the use of the medico-legal method is proposed, which classically lies between the prevention of possible adverse events and the reconstruction of how these occurred. The authors believe that this methodology, adopted as a European guideline in the medico-legal field for the assessment of medical liability, can be adapted to AI applied to the healthcare scenario and used for the assessment of liability issues. The topic deserves further investigation and will certainly be taken into consideration as a possible key to future scenarios.

2024 - Current status of undergraduate teaching in forensic & legal medicine in Europe [Articolo su rivista]
Payne-James, J.; Payne-James, G.; Cecchi, R.; Cusack, D.; Keller, E.; Ludes, B.; Madea, B.; Väli, M.; Vieira, D. N.; Sajantila, A.
abstract

: The European Council of Legal Medicine (ECLM) is the body established in 1992 to represent practitioners forensic & legal medicine and is composed of delegates of the countries of the European Union (EU) and from other countries which form part of Europe to a current total of 34 member countries. The aims of this study were to determine the current status of undergraduate forensic & legal medicine teaching in the curriculum of medical studies in ECLM countries and to use the results of this study to determine whether it would be appropriate to develop new guidelines and standards for harmonising the content of undergraduate forensic medicine training across ECLM member countries. A detailed questionnaire was sent to all individuals or organisations listed on the ECLM contact database. Responses were received from 21 of 33 countries on the database. These responses showed considerable emphasis on undergraduate teaching of forensic medicine in all countries with the exception of Belgium and the United Kingdom. There was great general consistency in the subjects taught. The data from this survey provide a baseline which should assist in developing a strategy to harmonise forensic & legal medicine undergraduate training in member countries of the ECLM. The ECLM is now in a good position to establish a pan-European working group to coordinate a consensus document identifying an appropriate and modern core undergraduate forensic medicine curriculum that can be presented to the medical education authorities in each country, and which can be adapted for local requirements, based on available personnel, the forensic medicine structure in the country, and most importantly, the needs of the local population.

2024 - Drug-facilitated sexual assault followed by femicidal chloroform poisoning and suffocation: A case-report of criminal responsibility [Articolo su rivista]
Camatti, J.; Galliani, I.; Cirnelli, A.; Cecchi, R.
abstract

Introduction: Criminal responsibility evaluation represents one of the most controversial and debated issues in forensic psychiatry. Although clear procedures have been recommended, little research exists on decision-making process by forensic psychiatrists. We present a case assessing the criminal responsibility of a murderer who committed femicide as a result of chloroform poisoning and suffocation after a drug-facilitated sexual assault. Materials and methods: A.S., a 30-year-old female, was found dead in the home of S.P., a 50-year-old male. S.P. recounted killing A.S. by forced inhalation of chloroform, when the woman had experienced sensory clouding following unintentional ingestion of Zolpidem, a hypnotic agent. A multidisciplinary approach was taken to resolve the case. Autopsy, histological, genetic, and toxicological examinations were performed by a forensic pathologist, while a digital forensic examiner analysed electronic devices. A pool of three forensic psychiatrists and two psychologists was asked to assess the mental state of S.P. at the time of the crime. Results and conclusions: The cause of death of A.S. was identified as a lethal chloroform intoxication in altered consciousness caused by Zolpidem, while homicidal suffocation was also described. Mobile forensics demonstrated that S.P. had videotaped the crime scene, clearly revealing that A.S. had been sexually assaulted by S.P. before dying. Criminal responsibility of S.P. was evaluated through various psychological tests and seven interviews with the accused, each lasting an average of 180 min. Specialists concluded that S.P. could not be exempted from being responsible for the homicide.

2024 - Epigenetic analyses in forensic medicine: future and challenges [Articolo su rivista]
Gerra, M. C.; Dallabona, C.; Cecchi, R.
abstract

The possibility of using epigenetics in forensic investigation has gradually risen over the last few years. Epigenetic changes with their dynamic nature can either be inherited or accumulated throughout a lifetime and be reversible, prompting investigation of their use across various fields. In forensic sciences, multiple applications have been proposed, such as the discrimination of monozygotic twins, identifying the source of a biological trace left at a crime scene, age prediction, determination of body fluids and tissues, human behavior association, wound healing progression, and determination of the post-mortem interval (PMI). Despite all these applications, not all the studies considered the impact of PMI and post-sampling effects on the epigenetic modifications and the tissue-specificity of the epigenetic marks. This review aims to highlight the substantial forensic significance that epigenetics could support in various forensic investigations. First, basic concepts in epigenetics, describing the main epigenetic modifications and their functions, in particular, DNA methylation, histone modifications, and non-coding RNA, with a particular focus on forensic applications, were covered. For each epigenetic marker, post-mortem stability and tissue-specificity, factors that should be carefully considered in the study of epigenetic biomarkers in the forensic context, have been discussed. The advantages and limitations of using post-mortem tissues have been also addressed, proposing directions for these innovative strategies to analyze forensic specimens.

2024 - Expression of matrix metalloproteinase-9 (MMP-9) in human skin within 1 hour after injury through immunohistochemical staining: a pilot study [Articolo su rivista]
Cecchi, R.; Tomoya, I.; Camatti, J.; Mizuho, N.; Yuko, I.; Toshikazu, K.
abstract

Matrix metalloproteinase-9 (MMP-9) is involved in tissue remodeling and in skin wound healing. The present study focuses on the MMP-9 expression in epidermal wound healing within 1 h after injury, to test whether MMP-9 can be used to estimate the time of injury in forensic practice. A sample consisting of 5 individuals undergoing surgery was analyzed. With the consent of the patients, sections of skin were removed from the surgical wound at predefined time intervals. For each subject, 8 sections were taken, one for each time interval defined at 0 ‘- 1’ − 3 ‘- 5’ − 10 ‘- 15’ − 30 ‘- 60’ minutes. The specimens were immunostained with MMP-9, and the number of positively stained cells was examined. The number of positively stained cells showed an increasing trend as a function of time. Less than 30 positively stained cells were found in all cases within 3 min. At the post-infliction time of 5 min, the number of positively stained cells exceeded 30 in 3 out of 5 cases. The number of MMP-positive cells exceeded 40 in all cases in over 10 min. In the light of these results, the count of MMP-9 positive cells might be a useful marker in the wound-age estimation within 1 h in forensic setting. More research is required to collect more samples and to compare samples from the hyperacute phase with those from several days after injury.

2024 - Father figure: Study of the age progression process from old pictures and its value in forensic sciences [Articolo su rivista]
Donato, Laura; Ubelaker, Douglas H; Marsella, Luigi; Camatti, Jessika; Treglia, Michele; Cecchi, Rossana
abstract

The application of age progression to the search for missing persons demonstrates its usefulness in being able to reconstruct the aged face based on the current age of a person who has been missing for many years. Age progression takes into account facial physiognomic elements and their changes over time. Based on these premises, the present study aims to investigate the evolution of somatic features, from childhood to adulthood, of one of the authors' father using photos at different ages of him. Sixteen photos were collected depicting an individual of Italian origin between the age of 1 and 72. The photos were processed in Adobe (c) Photoshop software to graphically highlight the shape development of individual physiognomic elements. The shape of the face, eyebrows, eyes, nose, mouth, and cheeks were analysed in detail using a morphological approach. The ageing processes that occurred in this case were discussed on the basis of the literature. The present study demonstrates the in-depth analysis of the dynamics of facial growth in a single case. Nonetheless, aging is different for each individual, so further studies are necessary to observe facial development on as many subjects as possible.

2024 - Forensic species identification: practical guide for animal and plant DNA analysis [Articolo su rivista]
Corradini, Beatrice; Gianfreda, Denise; Ferri, Gianmarco; Ferrari, Francesca; Borciani, Ilaria; Santunione, Anna Laura; Cecchi, Rossana
abstract

: The importance of non-human DNA in the forensic field has increased greatly in recent years, together with the type of applications. The molecular species identification of animal and botanical material may be crucial both for wildlife trafficking and crime scene investigation. However, especially for forensic botany, several challenges slow down the implementation of the discipline in the routine.Although the importance of molecular analysis of animal origin samples is widely recognized and the same value is acknowledged to the botanical counterpart, the latter does not find the same degree of application.The availability of molecular methods, especially useful in cases where the material is fragmented, scarce or spoiled preventing the morphological identification, is not well known. This work is intended to reaffirm the relevance of non-human forensic genetics (NHFG), highlighting differences, benefits and pitfalls of the current most common molecular analysis workflow for animal and botanical samples, giving a practical guide. A flowchart describing the analysis paths, divided in three major working areas (inspection and sampling, molecular analysis, data processing and interpretation), is provided. More real casework examples of the utility of non-human evidence in forensic investigations should be shared by the scientific community, especially for plants. Moreover, concrete efforts to encourage initiatives in order to promote quality and standardization in the NHFG field are also needed.

2024 - Medically assisted suicide in Italy: Recent legal developments on a controversial topic [Articolo su rivista]
Cecchi, Rossana; Sassani, Matilde; Romolo, Francesco Saverio; Rovito, Alfredo; Montisci, Massimo; Masotti, Vittoria; Sannella, Alessandra
abstract

: On 16th June 2022, the first case of lawful 'medically assisted suicide' took place on Italian soil. This event is a result of decade-long debates on informed consent and end-of-life care stimulated by medical jurisprudence. The authors first retrace the crucial moments that allowed this to happen and underline the problems still to be solved. The cases of DJ Fabo, Davide Trentin, Mario and Fabio Ridolfi are discussed, signalling how they influenced the path implemented by Italian jurisprudence.

2024 - Taxonomic and metabolic development of the human gut microbiome across life stages: a worldwide metagenomic investigation [Articolo su rivista]
Mancabelli, L.; Milani, C.; De Biase, R.; Bocchio, F.; Fontana, F.; Lugli, G. A.; Alessandri, G.; Tarracchini, C.; Viappiani, A.; De Conto, F.; Nouvenne, A.; Ticinesi, A.; Bussolati, O.; Meschi, T.; Cecchi, R.; Turroni, F.; Ventura, M.
abstract

The human gut microbiota is a dynamic community of microorganisms that undergo variable changes over the entire life span. To thoroughly investigate the possible fluctuations of the microbiota throughout human life, we performed a pooled analysis of healthy fecal samples across different age groups covering the entire human life span. Our study integrated data from 79 publicly available studies and new stool samples from an Italian cohort, i.e., the Parma Microbiota project, resulting in 6,653 samples processed through the shotgun metagenomic approach. This approach has allowed species-level taxonomic reconstruction of the gut microbiota and investigation of its metabolic potential across the human life span. From a taxonomic point of view, our findings confirmed and detailed at species-level accuracy that the microbial richness of the gut microbiota gradually increases in the first stage of life, becoming relatively stable during adolescence. Moreover, the analysis identified the potential core microbiota representative of distinct age groups, revealing age-related bacterial patterns and the continuous rearrangement of the microbiota in terms of relative abundances across the life span rather than the acquisition and loss of taxa. Furthermore, the shotgun approach provided insights into the functional contribution of the human gut microbiome. The metagenomic analysis revealed functional age-related differences, particularly in carbohydrate and fiber metabolism, suggesting a co-evolution of the microbiome assembly with diet. Additionally, we identified correlations between vitamin synthesis, such as thiamine and niacin, and early life, suggesting a potential role of the microbiome in human physiology, in particular in the functions of the host’s nervous and immune systems. IMPORTANCE In this study, we provided comprehensive insights into the dynamic nature of the human gut microbiota across the human life span. In detail, we analyzed a large data set based on a shotgun metagenomic approach, combining public data sets and new samples from the Parma Microbiota project and obtaining a detailed overview of the possible relationship between gut microbiota development and aging. Our findings confirmed the main stages in microbial richness development and revealed specific core microbiota associated with different age stages. Moreover, the shotgun metagenomic approach allowed the disentangling of the functional changes in the microbiome across the human life span, particularly in diet-related metabolism, which is probably correlated to bacterial co-evolution with dietary habits. Notably, our study also uncovered positive correlations with vitamin synthesis in early life, suggesting a possible impact of the microbiota on human physiology.

2024 - The forensic imaging technique of age progression used within missing people cases: The Italian Missing Children association realizing age progression for Missing Child Kenya [Articolo su rivista]
Donato, L.; Ubelaker, D. H.; Marsella, L.; Munyendo, M.; Treglia, M.; Camatti, J.; Dagoli, S.; Cecchi, R.
abstract

The age progression technique allows to update identification photos of individuals who have been missing for years. This method is based on the study of the facial variation and on the dynamics of facial growth. Knowledge about changes in the distribution of facial fat and the tone of the cartilage allows realistic predictions of the facial appearance after many years. Beside these elements, age progression is also supported by similar characters between family members. This is why photos of the missing and family members are used to create an age progression, making the new identikit accurate. Non-profit associations are crucial for the dissemination of information on the problem of missing persons. In Italy, the Italian Missing Children association provides for free an age progression service with the support of forensic anthropology. With the activation of a protocol, consisting of guidelines, and a form for the request for age progression by family members, the Italian Missing Children has started a collaboration with Missing Child Kenya. It allowed to disseminate up-to-date photos of the presumed current appearance of the missing children in Kenya. Thus, in the present study some cases are reported, in which age progression technique was applied. The photos provided by Italian Missing Children were shown in video documentaries made by Missing Child Kenya, allowing to continue the dissemination of age progression photo during the Covid quarantines and to keep the population active in the search for the missing.

2024 - Unveiling the Dark Nexus: A systematic review on the interplay of mental health, substance abuse, and socio-cultural factors in femicide [Articolo su rivista]
Caroppo, E.; Sapienza, M.; Mazza, M.; Sannella, A.; Cecchi, R.; Marano, G.; Kondo, T.; Calabrese, C.; De Lellis, P.
abstract

A shared definition of femicide would help to distinguish it from the murder of a woman and understand its root causes favoring prevention. We conducted a Systematic Literature Review (SLR) to assess how (and if) femicide cases were related to mental disorders. Articles papers that explicitly define or discuss femicides or articles that, albeit not expressly mention femicides, thoroughly compare generic homicides and homicides with female victims. We analyse 3546 articles were retrieved from the databases, and 75 studies fulfilled the eligibility criteria and were included in the SLR. Many forms of femicide emerge worldwide as people's values, beliefs, attitudes, and behaviours evolve (intimate partner femicide, femicide-suicide, religious femicide, honour, revolt femicide) and state of vulnerability. A tiny percentage of femicides occur at the hands of subjects with diagnosed mental disorders, and controversies exist regarding the possible link between femicide and the use of drugs and/or alcohol and other factors. The complex problem of violence against women must be addressed with a transdisciplinary approach and targeted interventions for both the victims and the perpetrators. The present SLR shows that it is not possible to link femicides to mental disorders and that socio and cultural factors appear to be more relevant. Further quantitative research is warranted to disentangle the root causes of this heinous phenomenon plaguing our times. Our studies show that using the proposed definition of feminicide would help to delimit and adequately recognise violence in courtrooms, promote the culture of equality, and identify adequate policy strategies for prevention.

2023 - Compliant Microgripper for In-Vitro Biological Manipulation [Relazione in Atti di Convegno]
Buzzin, A.; Cecchi, R.; Vurchio, F.; Veroli, A.; Scorza, A.; Sciuto, S. A.; de Cesare, G.; Belfiore, N. P.
abstract

We present a feasibility study on biological tissue and cell manipulation by a novel, multi-hinge microgripper characterized by high dexterity and complex in-plane tips displacement, while being at the same time highly compact and easy to manufacture via MEMS technology. The device was obtained by combining selective flexibility with planar fabrication technology and has been developed to propose new solutions for miniaturized, inexpensive, energy-efficient, effective and accurate manipulation at the micro-scale. The presented study consists of a direct morphological comparison with real-life cardiac and lung tissue samples, and was accomplished via in-vitro microscope observation. The results highlight the function capability of manipulating, grasping and clamping objects having a size of 50 to 150 µm, including muscle fibers, blood vessels and cells, encouraging further developments toward an in-vivo scenario with actual biological material.

2023 - Editorial: Toxicological profiles and pharmacological properties of synthetic cannabinoids: From chemical and analytical issues to fatal and non-fatal intoxications [Articolo su rivista]
Giorgetti, Arianna; Cecchi, Rossana; Auwärter, Volker
abstract

2023 - Education nursing students' in Palliative Care and Pain Therapy: an observational study [Articolo su rivista]
La Sala, Rachele; Cazzato, Serena; Cecchi, Rossana; Marletta, Giuseppe; Martelli, Michele; Coppola, Debora; Lo Coco, Alessandro; Cavalli, Lisa
abstract

Background and aim: University education plays an important role in the preparation of future nurses, especially in the care of dying patients, which is one of the most emotionally engaging aspects. The objectives of the study were to describe the attitudes of students in end-of-life care and to analyze the possible relationship with some socio-demographic variables, through an observational study. Methods: Preliminarily, an analysis of the educational context of the Nursing Course  of the University of Parma was started, through a comparison of the university course with the recommendations of the MIUR concerning the teaching and learning of Palliative Care and Pain Therapy. Subsequently, a questionnaire containing the Frommelt Attitude Toward Care of the Dying Scale Form B and some socio-demographic context variables was administered to a sample of 109 students belonging to the CoS of Nursing in Parma. Results: From the data collected, it emerged that university planning partly reflects the recommendations of the MIUR and how, on average, nursing students have described positive attitudes in all the dimensions investigated. Interesting is the presence of a positive relationship between the personal experiences of bereavement and the attitudes of the students. Conclusions: Nurses are essential in ensuring the quality of care provided to patients at the end of life; Nursing training in Palliative Care and Pain Therapy should include a complete and varied program (frontal activity, simulation, internship paths...) in order to develop positive student attitudes associated with high levels of satisfaction and improvement of the quality of care provided.

2023 - Facial age progression: Review of scientific literature and value for missing person identification in forensic medicine [Articolo su rivista]
Donato, L.; Cecchi, R.; Dagoli, S.; Treglia, M.; Pallocci, M.; Zanovello, C.; Ubelaker, D. H.; Marsella, L. T.
abstract

2023 - Femicide and forensic pathology: Proposal for a shared medico-legal methodology [Articolo su rivista]
Cecchi, Rossana; Masotti, Vittoria; Sassani, Matilde; Sannella, Alessandra; Agugiaro, Giulia; Ikeda, Tomoya; Pressanto, Davide Maria; Caroppo, Emanuele; Schirripa, Maria Laura; Mazza, Marianna; Kondo, Toshikazu; De Lellis, Pietro
abstract

In a previous work, authors have proposed a medico-legal definition of femicide as the murder due to the failure to recognize the right of self-determination of women. The aim of this paper was to apply the proposed definition to a cohort of cases to characterise femicides and female homicides and assess whether femicides can be considered a distinct entity or not. A comparison between female and male homicides was performed to assess common and distinctive features. Femicides were identified and compared to the cohort of non-femicide female murder. Results were compared to those reported in published forensic studies. Significant associations between female and male homicides were found for sex and partner/ex-partner offender, sex and indoor homicide and sex and asphyxia as dynamic of death emerged. A higher prevalence of indoor homicides and asphyxiation and of partner relationships were documented in female homicides. Gunshot, blunt injuries and cut wounds are well represented in both types of homicides. Most affected sites are back and chest in male homicides, and head, breasts, pubis, and limbs in female homicides. When comparing femicides and female homicides, a positive association between strangulation as harmful mean and a negative one between femicides and indoor homicides were found. Male and female homicides can be considered as two distinct victimological phenomena. Focusing on femicide allows to establish injuries and circumstantial patterns, that could represent evidence of a specific murder. More studies with a standardized data collection are needed to corroborate the theory of this paper.

2023 - Malpratice claims in cardiology and cardiac surgery: A medico-legal issue [Articolo su rivista]
Montisci, R.; Licciardi, M.; Cecchi, R.; Kondo, T.; Gerosa, G.; Casula, R.; Cecchetto, G.; Montisci, M.
abstract

Medical liability has become a challenge in every physician's modern practice with the consequent loss of the physician's autonomy and an increase in “defensive medicine”. From this perspective, the role of Legal Medicine in assessing medical liability has become increasingly specific and a homogenization of the methods of ascertainment is increasingly necessary, since such a process can contribute to strengthening the guarantees in professional liability procedures. Focusing on malpractice claims in the field of cardiology, the complexity of the management of cardiac pathologies and the frequency of severe adverse events implies the importance of a multi-disciplinary approach, together with the application of a shared ascertainment methodology. In particular, it is essential for the forensic pathologist to collaborate with experts in cardio-pathology, cardiology and/or cardiac surgery in cases of alleged medical liability in the cardiologic field and to follow the guidelines which have been produced to assist the expert dealing with deaths reflecting cardiac disease, in order to prevent criticism of case analysis in medico-legal environments and to promote the standardization of the structure of the juridical-legislative medical malpractice lawsuits.

2023 - On-Site Inspection Form in Veterinary Cases: The Parma Veterinary Form [Articolo su rivista]
Marchetti, Cristina; Mastrogiuseppe, Luigi; Vanin, Stefano; Cecchi, Rossana; Gherardi, Mirella
abstract

Simple Summary In veterinary practice, the on-site inspection of the scene of an animal dead body is crucial for a correct interpretation of the autopsy results, in particular to determine the manner, mechanism and cause of death, as an important role in the control of public health including the prevention of zoonoses. It is also fundamental for the recognition and the contrast of crimes against animals and to animal abuse phenomena, considered an alert sign of an anti-social or violent behavior of humans, theory known as "The Link". A good practice is the presence of a veterinary pathologist on the scene. Although photographs and information made available by the police officers on the place of discovery of the animal cadaver can be useful, the information that can be achieved by a direct examination of the scene is irreplaceable. Today the best veterinary procedure requires an accurate collection of evidence at the scene that can be then handed to experts belonging to other forensic sciences for further evaluation and data interpretation. In this paper authors suggest a form aiming to facilitate either the on-site and the autopsy activities. The suggested form can contribute to guarantee the quality of the forensic process from the discovery site up to the court. Particular attention is paid to the training of non-medical personnel who often represent the first, and sometimes, the only figure to be present on the scene. The form proposed is inspired by the interdisciplinary form developed by the European Council of Legal Medicine. This form represents an initial tool to improve a multidisciplinary activity in close synergy with other forensic experts. The on-site inspection of the scene of an animal cadaver is crucial for a correct interpretation of the autopsy results, to determine the manner, method, and cause of death. This information plays a crucial role in the control of public health including the prevention of zoonoses. It is also fundamental for the recognition and the contrast of crimes against animals and to animal abuse phenomena, considered an alert sign of an anti-social or violent behavior of humans. Today the best veterinary procedure requires an accurate collection of the evidence at the scene that can be then handed to experts belonging to other forensic disciplines for further evaluation and data interpretation. In this paper authors suggest a form aiming to facilitate either the on-site and the autopsy activities, as a guarantee of the quality of the forensic process starting from the discovery scene up to the reconstruction of the case. Essential is training of non-medical personnel who often represent the first responder to be present on the scene. The form is inspired by the interdisciplinary form developed by the European Council of Legal Medicine and represents an initial tool to stimulate a multidisciplinary activity in close synergy with other forensic experts.

2022 - A medico-legal definition of femicide [Articolo su rivista]
Cecchi, R; Sassani, M; Agugiaro, G; Caroppo, E; De Lellis, P; Sannella, A; Mazza, M; Ikeda, T; Kondo, T; Masotti, V
abstract

Femicide refers to the extreme form of violence against someone belonging to the female gender, i.e. the killing of a woman. Research shows that, to date, gender-based violence remains largely a hidden phenomenon with prevalence often being underestimated by official statistics and data missing in numerous countries. It can be argued that the under-reporting may be suggestive of a legislative gap that needs addressing. This work aims to reach a shared medico-legal definition of femicide stemming from a comprehensive review of the current legislation of countries around the world. In addition, it appraises forensic pathology studies focusing on the murder of women as well as the most relevant documents published by prominent international organizations fighting violence against women. Review of the literature shows a scarcity of national legislations concerning specifically femicide, despite the attention given to this phenomenon by international organizations fighting violence against women. Additionally, a non-homogeneous framing of the term femicide arises from the forensic pathology literature and national laws. Starting from one of the funding principle of medical ethics - autonomy - authors propose to define femicide as a murder perpetrated because of a failure to recognize the victim's right to self-determination. This definition would give the forensic pathologist a central role in identifying femicide cases among the murders of women. A shared forensic approach is needed, ideally employing standardized methodology to compare international data and to standardize scientific research in the field.

2022 - End-of-life: let's talk about communication [Articolo su rivista]
Cecchi, Rossana; Sassani, Matilde; Romolo, Francesco S.; Teston, Nicole; Sannella, Alessandra
abstract

INTRODUCTION: The aim of the present work was to analyse the role played by communication in the medical-health intervention and how to transform it in a practical support for the health professions and the patient’s outcome. EVIDENCE ACQUISITION: Through a review of the literature the meaning of bad news is analyzed and the main models aimed at helping doctors and health care teams communicate the bad news (the NURSE protocol, the PERCS protocol and the SPIKES protocol) are described. EVIDENCE SYNTHESIS: Starting from the meaning of bad news and the communication models available, authors discuss the impact of bad news on the patient, on the doctor and underline the need for the teaching of communication for doctors and degree students, as well as the need for training in communication with the patient. CONCLUSIONS: The complexity of the doctor-patient relationship implies communicative exchanges, in which the effectiveness of the information provided by the doctor depends on the emotions felt in communicating it, and the understanding of what is communicated depends on the patient’s emotional state. It appears urgent, therefore, to create a training path that stems from the standardization of the results obtained from sector studies and that aims to replicate the socio-health practices considered to be of excellence. The communication effectiveness is indispensable for an adaptation process that expresses the citizen’s ability to adapt to changes in the environment, to grow and age, to heal after a sickness, and to suffer and wait, more possible serenely, the death.

2022 - European Council of Legal Medicine (ECLM) on-site inspection forms for forensic pathology, anthropology, odontology, genetics, entomology and toxicology for forensic and medico-legal scene and corpse investigation: the Parma form [Articolo su rivista]
Cecchi, R.; Cusack, D.; Ludes, B.; Madea, B.; Vieira, D. N.; Keller, E.; Payne-James, J.; Sajantila, A.; Vali, M.; Zoia, R.; Cucurachi, N.; Schirripa, M. L.; Marezza, F.; Anzillotti, L.; Donato, L.; Cattaneo, C.; Favretto, D.; Pelotti, S.; Pinchi, V.; Vanin, S.; Gherardi, M.
abstract

Further to a previous publication by the European Council of Legal Medicine (ECLM) concerning on-site forensic and medico-legal scene and corpse investigation, this publication provides guidance for forensic medical specialists, pathologists and, where present, coroners’ activity at a scene of death inspection and to harmonize the procedures for a correct search, detection, collection, sampling and storage of all elements which may be useful as evidence, and ensure documentation of all these steps. This ECLM’s inspection form provides a checklist to be used on-site for the investigation of a corpse present at a crime or suspicious death scene. It permits the collection of all relevant data not only for the pathologist, but also for forensic anthropologists, odontologists, geneticists, entomologists and toxicologists, thus supporting a collaborative work approach. Detailed instructions for the completion of forms are provided.

2022 - Oral status of a noble European couple from the 16th century: A morphologic analysis of the teeth of Alessandro Farnese and of his wife Maria D'Aviz [Articolo su rivista]
Peracchia, Marianna; Meleti, Marco; Armocida, Emanuele; Toffoli, Andrea; Cucurachi, Nicola; Bussolati, Ovidio; Cecchi, Rossana
abstract

Objective. To report the results of dental morphological analysis performed on the remains of two European nobles (Duke Alessandro Farnese and his wife Maria D’Aviz) who lived in the 16th century, together with hypotheses on their nutrition and oral hygiene habits. Design and results. The remains of Alessandro Farnese (1545–1592) and Princess Maria D'Aviz (1538–1577) were exhumed in Parma, Italy, in the context of an historical investigation into their possible causes of death. The skulls were examined and analysed through direct inspection, high-detailed photographs and radiographs. Ante mortem tooth loss (AMTL), postmortem tooth loss (PMTL), Scott and Smith dental wear indexes and the Kerr periodontal index were used to assess the dental and periodontal status of the couple. Alessandro Farnese suffered from severe dental wear while it was presumed that Maria D’Aviz was affected by periodontal disease and tooth decay. Conclusions. Based on the findings of the present analysis, we hypothesise that Alessandro Farnese’s diet was mainly based on hard and unrefined foods, also suggested by limited historical reports. It is likely that Maria D’Aviz’s nutrition was based on sugar-enriched foods.

2022 - Oral fluid analysis to monitor recent exposure to synthetic cannabinoids in a high-risk subpopulation [Articolo su rivista]
Pascali, J. P.; Dagoli, S.; Antonioni, M.; Facetti, O.; Anzillotti, L.; Calo, L.; Affini, G.; Cantarelli, B.; Cecchi, R.
abstract

Among novel psychoactive substances, synthetic cannabinoid receptor agonists (SCRA) seem to have the widest diffusion in the population with no limitation to any particular demographic group. Information on drug consumption relies mostly on anonymized surveys and less on clinical or analytical data; notwithstanding, the huge efforts constantly made to enroll subjects to gather epidemiological data. In the present study, we collected 66 oral fluid samples from volunteers in a drug rehabilitation center in 2019 and early 2020. A liquid chromatography–mass spectrometry method previously developed and validated by our Unit was applied to detect SCRA (n = 10) in oral fluid. Results proved the presence of synthetic cannabinoids at a positivity rate of almost 20%, with detection frequency HU211(5/13) > UR144/JWH122 (3/13) > JWH019/JWH081/AM2201 (1/13). Concentrations were in the range < LOQ −0.36 ng/ml. Synthetic cannabinoids consumption had not been declared by any volunteer. This study enabled for the unprecedent detection of synthetic cannabinoids use in the territory of Parma (Italy) in a high-risk subpopulation. The identified SCRA proved the persistence into the market of the “first-generation” JWH family into the Italian territory and the marketing of relatively new ones (AM-2201). Public health consequences represented by NPS consumption are still scarce; therefore, further studies are needed to understand the real diffusion in the population.

2022 - Over 30-year retrospective analyses of moped-motorcycle fatal road accidents in the northern area of the Italian region of Emilia Romagna and review of the literature: Aiming for further preventive measures in the future [Articolo su rivista]
Lusetti, A.; Dagoli, S.; Banchini, A.; Gentile, M.; Lezzi, P.; Cecchi, R.
abstract

Road traffic injuries are a major cause of morbidity and mortality worldwide, with pedestrians and riders of two-wheeled motor vehicles being the most vulnerable. The present study aims to determine the epidemiological characteristics of fatal motorcycle crashes in a portion of the Italian region of Emilia Romagna, and to compare them with the data available in literature. Data were retrieved from autopsy reports on 350 subjects who died following road accidents involving moped or motorcycle in the cities of Parma, Piacenza, and Reggio Emilia. Two types of data were extrapolated: circumstantial and traumatological. The population was divided into subgroups according to gender, crash time, alcohol positivity, presence or absence of the helmet, and the period elapsed between the accident and death. Most of the considered road accidents occurred during the day and on weekends. 25.5 % of the victims tested positive for alcohol. As far as traumas are concerned, the limbs resulted to be the most affected body segment, followed by the head (87.4 %), the thorax (85.7 %), the abdomen (65.7 %), and lastly the neck (50.3 %). According to similar studies, the sample victim of a moped/ motorcycle accident is a young male subject. The results obtained allow us to demonstrate that the mandatory use of the helmet has reduced skull and brain injury over the years. At present, no law regulates the use of protections for other body parts. Regulatory interventions in this sense would be desirable given the ever more rapid technical evolutions in the field of motorcycles.

2022 - Road traffic deaths: A retrospective analysis (2009-2019) in the north of the Italian region Emilia Romagna [Articolo su rivista]
Anzillotti, L; Dagoli, S; Calò, L; Maglietta, G; Cecchi, R
abstract

Objective: International literature and several national studies demonstrate that alcohol and illicit drugs impair driving abilities, diminishing the level of attention, and cause traffic accidents. In Italy, driving under the influence of alcohol or drugs is regulated by Articles 186 and 187 of the National Street Code, which defines penalties and fines for the convicted. The aim of this study was the collection of all available data from 2009 to 2019 focusing on deaths related to road accidents in the Unit of Legal Medicine of Department of Medicine and Surgery at the University of Parma, in order to assess any consumption of alcohol, illicit drugs, and medicinal drugs among drivers. Methods: Data were retrieved from autopsy reports found at the Unit of Legal Medicine of Parma University related to 327 subjects who died following road accidents in the Italian areas of Parma, Reggio-Emilia, and Piacenza. The population was divided into subgroups according to age, gender, crash time, and drug positivity. Results: Those in the age group 46 to 65 years old were involved in the most accidents, whereas the category with fewest members included subjects under 26 years old. The majority of road accidents occurred during the daytime and on weekends. Among the toxicological investigations carried out (only for drivers), the highest prevalence was found for alcohol (43.1%), followed by illicit drugs (14.4%) and medicinal drugs (7.8%). The prevalence of alcohol and illicit drugs in combination was 11.8%. Regarding subjects positive for alcohol and illicit drugs in combination, 44.4% had a blood alcohol concentration (BAC) > 1.5 g/L and overall, in 61.1% of the total cases a BAC > 0.81 g/L was detected. Conclusions: Our results are in line with national and international studies highlighting the prevalence of high BAC levels in most of the cases. Confirmation analyses on blood collected from people who died following road accidents showed levels of BAC above 0.8 g/L (threshold for penal sanctions) in the majority of the subjects who tested positive for alcohol. They also revealed cocaine, cannabis, and benzodiazepines as the most common illicit drugs and medicinal drugs used, respectively, as demonstrated in several international studies.

2022 - Tenchini’s legacy as a starting point for the reconstruction of the history of a criminal in the 19th century|L’eredità del Tenchini come punto di partenza per la ricostruzione della storia di un criminale del XIX secolo [Articolo su rivista]
Lusetti, A.; Dagoli, S.; Donato, L.; Cecchi, R.
abstract

Late in the 19th century, physician Lorenzo Tenchini undertook a study of criminal subjects and psychiatric patients. One of these was B.A., a 22-year-old soldier who committed suicide after attempting to kill his lover, a prostitute named G.I. The starting points of this study were the analysis of the subject's biography – data which resulted from the autopsy – and several observations on his brain and skull in accordance with the phrenological doctrine of that time. The goal of this work was to shed new light on an Italian criminal of the late 19th century and on Tenchini's work, combining the material collected by the doctor himself with sources of the period and modern medical knowledge.

2022 - Third trimester intrauterine fetal death: proposal for the assessment of the chronology of umbilical cord and placental thrombosis [Articolo su rivista]
Bonasoni, Maria Paola; Muciaccia, Barbara; Pelligra, Caterina B; Goldoni, Matteo; Cecchi, Rossana
abstract

: The timing of umbilical cord and placental thrombosis in the third trimester intrauterine fetal death (TT-IUFD) may be fundamental for medico-legal purposes, when it undergoes medical litigation due to the absence of risk factors. Authors apply to human TT-IUFD cases a protocol, which includes histochemistry and immunohistochemistry (IHC) for the assessment of thrombi's chronology. A total of 35 thrombi of umbilical cord and/or placenta were assessed: 2 in umbilical artery, 6 in umbilical vein, 15 in insertion, 10 in chorionic vessels, 1 in fetal renal vein, 1 in fetal brachiocephalic vein. Thrombi's features were evaluated with hematoxylin-eosin, Picro-Mallory, Von Kossa, Perls, and immunohistochemistry for CD15, CD68, CD31, CD61, and Smooth Muscle Actin. The estimation of the age of the thrombi was established by applying neutrophils/macrophages ratio taking into consideration, according to literature, the presence of hemosiderophagi, calcium deposition, and angiogenesis. To estimate an approximate age of fresh thrombi (< 1 day), a non-linear regression model was tested. Results were compared to maternal risk factors, fetal time of death estimated at autopsy, mechanism, and cause of death. Our study confirms that the maternal risk factors for fetal intrauterine death and the pathologies of the cord, followed by those of the placental parenchyma, are the conditions that are most frequently associated with the presence of thrombi. Results obtained with histological stainings document that the neutrophile/macrophage ratio is a useful tool for determining placental thrombi's age. Age estimation of thrombi on the first day is very challenging; therefore, the study presented suggests the N/M ratio as a parameter to be used, together with others, i.e., hemosiderophagi, calcium deposition, and angiogenesis, for thrombi's age determination, and hypothesizes that its usefulness regards particularly the first days when all other parameters are negative.

2021 - Diatom extraction: A new technique with heated H2O2. A technical note [Articolo su rivista]
Marezza, F.; Marchetti, C.; Lanzi, G.; Lusetti, A.; Bertani, A.; Cecchi, R.
abstract

The best method of diatom identification in animal and human tissues is still an important discussion topic, in terms of effectiveness and reliability. In this technical note, authors propose a new method of extraction of diatoms using heated hydrogen peroxide from animal and human tissue samples. This method has been compared with the traditional method of digestion with acids. The results of the comparison show that heated hydrogen peroxide extraction is more efficient in terms of reduction of sediment, extraction of the material and preservation of diatoms proving to be a viable alternative to conventional approaches with acids in terms of costs and operator safety.

2021 - Legal scenarios in the coronavirus time: Medico legal implications in the aspects of governance [Articolo su rivista]
Bonvicini, Barbara; Cecchi, Rossana; Parisi, Saverio G.; Masotti, Vittoria; Viero, Alessia; Cecchetto, Giovanni; Terranova, Claudio; Viel, Guido; Montisci, Massimo
abstract

Along with rising levels of the infection around the world, the state of emergency prompted by the COVID-19 pandemic has also been having a heavy legal impact. The situation is posing important criminal challenges, as well as an ocean of social and public health issues around the world. It has not only directly affected constitutionally-guaranteed rights and individual freedoms, but also brought to the fore certain types of criminal offence that had previously been of little practical importance, such as the crime of ‘maliciously or unintentionally causing an epidemic’. Different countries and states have introduced policies to manage the emergency at different times and in different ways. The measures adopted have been the object of much criticism, also raising questions of constitutional legitimacy in countries like Italy. The present contribution begins with a brief outline of the different international scenarios. Then we examine some of the medicolegal aspects of criminal offences previously envisaged and newly introduced since the arrival of the pandemic. We suggest the need for a sort of ‘code of public health laws for the time of coronavirus’, that could also be applied to other public health emergencies, pandemic or otherwise. The idea is to give operators in the sector and the general population the opportunity to identify clear and simple rules to follow in the current complex global situation. We need a new, appropriate interpretation of the ‘boundaries’ of our individual rights in relation to the need to safeguard the wider community and its more vulnerable members.

2021 - Management of infants with brief resolved unexplained events (Brue) and apparent life-threatening events (alte): A rand/ucla appropriateness approach [Articolo su rivista]
Prezioso, G.; Perrone, S.; Biasucci, G.; Pisi, G.; Fainardi, V.; Strisciuglio, C.; Nonnis Marzano, F.; Moretti, S.; Pisani, F.; Tchana, B.; Argentiero, A.; Neglia, C.; Caffarelli, C.; Bertolini, P.; Bersini, M. T.; Canali, A.; Voccia, E.; Squarcia, A.; Ghi, T.; Verrotti, C.; Frusca, T.; Cecchi, R.; Giordano, G.; Colasanti, F.; Roccia, I.; Palanza, P.; Esposito, S.
abstract

Unexpected events of breath, tone, and skin color change in infants are a cause of consider-able distress to the caregiver and there is still debate on their appropriate management. The aim of this study is to survey the trend in prevention, decision-making, and management of brief resolved unexplained events (BRUE)/apparent life-threatening events (ALTE) and to develop a shared proto-col among hospitals and primary care pediatricians regarding hospital admission criteria, work-up and post-discharge monitoring of patients with BRUE/ALTE. For the study purpose, a panel of 54 experts was selected to achieve consensus using the RAND/UCLA appropriateness method. Twelve scenarios were developed: one addressed to primary prevention of ALTE and BRUE, and 11 focused on hospital management of BRUE and ALTE. For each scenario, participants were asked to rank each option from ‘1’ (extremely inappropriate) to ‘9’ (extremely appropriate). Results derived from panel meeting and discussion showed several points of agreement but also disagreement with different opinion emerged and the need of focused education on some areas. However, by combining previous recommendations with expert opinion, the application of the RAND/UCLA appropriateness permit-ted us to drive pediatricians to reasoned and informed decisions in term of evaluation, treatment and follow-up of infants with BRUE/ALTE, reducing inappropriate exams and hospitalisation and highlighting priorities for educational interventions.

2021 - The global health community must stand for health and democracy in Myanmar [Articolo su rivista]
Sarli, L.; D'Apice, C.; Cecchi, R.
abstract

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2020 - ASPETTI MEDICO-LEGALI NELLA PANDEMIA DA SARS-COV-2 [Articolo su rivista]
Cecchi, Rossana; Masotti, Vittoria; Mezzadri, Fabio
abstract

La situazione di emergenza che il Governo, e con esso i Governi di tutto il mondo, sebbene con scelte parzialmente differenti, ha dovuto affrontare per contenere la diffusione del virus SARS-CoV-2 ha comportato la necessità di operare delle scelte in ordine alle misure di contenimento dello stesso. Tali misure, attuate nel pieno dell’emergenza sanitaria e ospedaliera, hanno dovuto necessariamente comprimere alcuni diritti fondamentali dei cittadini che, più o meno improvvisamente, hanno dovuto accettare rinunce importanti. Sulla necessità di attuare simili misure non vi è dubbio mentre sulla legittimità delle misure, da più parti definite draconiane, il dibattito è aperto. Il presente lavoro, lungi da voler proporre una soluzione, si propone di offrire alcuni spunti di riflessione sul tema.

2020 - BUONE PRATICHE PER L'AUTOPSIA MEDICO-LEGALE NEI CADAVERI CON SOSPETTA INFEZIONE DA SARS-COV-2. UN AGGIORNAMENTO DALLA TASK FORCE DEL GRUPPO ITALIANO DI PATOLOGIA FORENSE [Articolo su rivista]
Fais, Paolo; Gavelli, Simone; Bolino, Giorgio; Pietro Campobasso, Carlo; Cecchetto, Giovanni; Cecchi, Rossana; Demontis, Roberto; D’Ovidio, Cristian; Moretti, Matteo; Neri, Margherita; Oliva, Antonio; Pierucci, Giovanni; Ventura Spagnolo, Elvira; Ventura, Francesco; Di Vella, Giancarlo
abstract

In light of the global spread of the new human coronavirus SARS-CoV-2, identified for the first time during an outbreak of pneumonia cases in Wuhan, China, a number of forensic autopsies will be performed on potentially infected corpses. The main aim of this document is to provide safety recommendations to perform forensic autopsies. Moreover, the forensic pathologist sometimes is the first physician facing to the death of a SARSCOV- 2 infected subject. In this case, a comprehensive knowledge of SARS-COV-2 clinical and pathological features, may be of the utmost importance not only to timely pose the suspect of infection but also to timely provide safety measures and adequatepost-mortem sampling. After summarizing clinical and pathological features of SARSCOV- 2 infection, information about the related health and safety issues will be provided. The autopsy facility must be Biosafety Level 3 and negative pressure with 6-12 air changes per hour should be provided in the autopsy room. Moreover, personal protective equipment for individual protection must guarantee protection both from direct contact and aerosol transmission. Furthermore, clinical information, relevant to pose the suspect of infection before and during the autopsy, will be focused in a dedicated section. Finally, the autopsy procedure will be illustrated together with the microbiological and histopathological sampling activity, recommended not only for diagnostic purposes but also for scientific studies. SARS-CoV-2 recommendations dedicated to the forensic setting seem of the utmost importance. Indeed, the forensic pathologist might be claimed not only to establish the cause of death, but also to solve a number of further issues, such as: the assessment of malpractice and medical liability, complicated by the rapid evolution of the state of the art; the potential contributory role of SARS-CoV-2 infection in the manner of death, for example, cases of suicide have been reported in infected patients; to reconstruct retrospectively the time and transmission modality of the infection in a specific subject, aimed for example to evaluate the liability to third parties especially for infections occurred in fragile patients living in nursing homes for elderly or disabled people.

2020 - COVID-19: The wrong target for healthcare liability claims [Articolo su rivista]
Parisi, S. G.; Viel, G.; Cecchi, R.; Montisci, M.
abstract

Regrettably, after a first moment of appreciation and praise of the citizens for healthcare personnel facing COVID 19 pandemia, numerous episodes of actions taken against them on the issue of their legal liability followed. Impelling is to start an argumentation on this problem that aims to establish a shared conduct in dealing with them. The authors propose a basis for discussion on which to begin a constructive debate.

2020 - IL SUICIDIO MEDICALMENTE ASSISTITO: QUALI PROSPETTIVE FUTURE PER IL MEDICO? [Articolo su rivista]
Cecchi, Rossana; Masotti, Vittoria
abstract

Il tema del suicidio medicalmente assistito è da tempo intensamente dibattuto. Sebbene la materia sia ancora oggetto dell’inerzia legislativa, il cui intervento è atteso da più parti, oggi, finalmente, possiamo dire che la stessa ha subito una svolta ad opera della Corte costituzionale. La Consulta già nel 2018 con l’ordinanza n. 207 aveva formulato rilievi e conclusioni sul thema decidendum poi confermati con la sentenza n. 242 del 2019. Temi, questi, trattati nel presente lavoro che desidera offrire alcuni spunti di riflessione sulla materia da differenti prospettive. Numerose le conseguenze seguite alla decisione della Consulta, dall’assoluzione dell’imputato Marco Cappato, all’introduzione di indirizzi applicativi all’art. 17 del Codice Deontologico ad opera della FNOMCeO.

2020 - Implicazioni medico legali nella governance della pandemia da Covid-19 [Articolo su rivista]
Bonvicini, Barbara; Cecchi, Rossana; Parisi, Saverio G.; Masotti, Vittoria; Viero, Alessia; Terranova, Claudio; Cecchetto, Giovanni; Viel, Guido; Montisci, Massimo
abstract

The state of emergency due to the Covid-19 pandemic has led, together with the increase in infections worldwide, an important judicial impact with relevant criminal matters which, in the mare magnum of the current global socio-health situation, in addition to having directly affected constitutionally guaranteed rights and assets, such as individual freedom, have brought back into vogue offenses that until now have had little practical relevance, such as the willful and negligent epidemic. With a view to limiting and containing viral spread, in a scenario still today characterized by numerous knowledge gaps with completely insufficient scientific evidence in tracing the best operative practices, the various countries and states, in different times and ways, have introduced policies of emergency governance which have been the subject of numerous criticisms, as well as having raised issues of constitutionality where, as in Italy, the health laws introduced in the fascist era have been recalled and the Responsabilità Medica 2020, n. 3 330 Osservatorio medico-legale Introduzione Il virus della sindrome respiratoria acuta grave (SARS-CoV-2), agente eziologico responsabile della malattia nota come COrona VIrus Disease 19 (Covid-19), segnalato per la prima volta a metà dicembre 2019 dalla Commissione Municipale della città cinese di Wuhan, si è rapidamente diffuso su scala planetaria coinvolgendo gran parte della popolazione mondiale. Stando ai dati dell’OMS1 al 1° dicembre 2020 sono oltre 62 milioni i casi confermati e quasi un milione e mezzo di decessi segnalati in tutto il mondo, con tassi di mortalità tra i vari Paesi variabili in relazione alla diversa composizione demografica, ai sistemi sanitari in vigore e alle differenti politiche di intervento, volte ad arginare il contagio virale2. In Europa, ad esempio, gli stati membri hanno adottato misure di contenimento della diffusione virale con differenti tempistiche; mentre nel 1 Who, Weekly epidemiological update, 1 December 2020, consultabile all’indirizzo: www.who.int/publications/m/item/ weekly-epidemiological-update---1-december-2020. 2 Mercatelli, Giorgi, Geographic and Genomic Distribution of SARS-CoV-2 Mutations, in Front. Microbiol., 22 July 2020. Regno Unito veniva approvato il Coronavirus Act 2020, una legge parlamentare che in data 25 marzo 2020 riceveva l’assenso reale3 e conferiva allo Stato poteri straordinari per dare una risposta efficace alla condizione di emergenza, anche mediante provvedimenti limitativi delle libertà individuali, in altri Paesi si assisteva a politiche “attendiste”, oltre al dilagare di correnti di “negazionisti” che, non credendo all’esistenza della pandemia, assumevano un atteggiamento di ostruzionismo e contestavano le misure restrittive. In Italia, una frangia folkloristica ha addirittura avanzato l’ipotesi di una “dittatura sanitaria”, affermando che lo stato di emergenza é “una menzogna usata per fini politici – per prolungare la vita del governo”4. Mentre si assiste ad “una seconda ondata pandemica”, per la quale sono state introdotte nuove misure restrittive, i vari governi si trovano alle prese con il dilagare di un crescente malcontento per gli effetti sui diritti umani indotti dalle differenti strategie di governance. Discussione Dall’inizio della pandemia, numerose sono state le iniziative volte non solo al contenimento e contrasto della diffusione epidemica, ma anche alla definizione di specifiche funzioni assistenziali con riorganizzazione dell’architettura ospedaliera e identificazione di nuove misure di gestione del rischio clinico ad opera delle strutture sanitarie, sempre più impegnate in uno scenario catastrofico che ha seriamente minato la tenuta dei Sistemi Sanitari5, colti impreparati sotto molteplici aspetti, tra i quali probabilmente anche quello giuridico e che comunque è stato affrontato con il fine as- 3 Coronavirus Act 2020 receives Royal Assent - Cambridge Network,

2020 - Mephedrone and chemsex: a case report [Articolo su rivista]
Anzillotti, L.; Calo, L.; Banchini, A.; Schirripa, M. L.; Marezza, F.; Cecchi, R.
abstract

The chemsex or slamsex phenomenon has attracted attention worldwide, with concerns also expressed by health professionals for the spread of sexually transmitted diseases. Mephedrone or 4-methylmethcathinone, a substituted cathinone homolog of ephedrine, is one of the most popular substances used as a cheaper alternative to other traditional drugs. Fatal cases of chemsex are still rare. We present here the first case-report to the best of our knowledge of a mephedrone-related acute toxicity case in Parma (Italy) detected and quantitated in biological specimens (2.0 mg/L in urine sample, 1.1 mg/L in bile and 1.0 mg/L in central blood while 0.8 mg/L in peripheral blood). None of the other most common drugs of abuse could be detected. Autopsy findings such as facies edematosa, oedema and polyvisceral congestion, interstitial petechiae are compatible elements with a death from acute cardio-respiratory failure, with peri-mortem agony of few minutes in which the cardiac hypertrophy, the moderate aortocoronary sclerosis and mephedrone injection have played a substantial role in the evaluation of the final cause due to an accidental acute intoxication with mephedrone.

2020 - Photogrammetry vs CT Scan: Evaluation of Accuracy of a Low-Cost Three-Dimensional Acquisition Method for Forensic Facial Approximation [Articolo su rivista]
Donato, Laura; Cecchi, Rossana; Goldoni, Matteo; Ubelaker, Douglas H.
abstract

Photogrammetry is a three-dimensional acquisition method potentially applicable to the forensic field. This possibility requires the verification of its accuracy. In this study, 3D volumes of skulls are generated to compare the photogrammetry versus the CT scan. In order to provide eligible material to the photogrammetric software, photographs were captured at a distance of 30 cm from the skull placed on a support 1 m in height and illuminated with diffused laboratory ceiling artificial light. A Nikon Coolpix P7100 camera was used. Photographs capture common elements with the previous and the next photograph so as to allow the photogrammetric software to recognize these common points between photographs and create a 3D puzzle. The Zephyr Lite (3DFlow©) software was employed to register the 3D volume. CT-based skulls are taken as a metric reference. The photogrammetry-based skulls are then enlarged according to the measurements of some landmarks or Zygion and Zygion, the distance between end of nasal and base of nasal pyramid for frontal projection, and minimum breadth of the mandibular ramus for the right lateral projection. The accuracy of the photogrammetry is compared to that of the CT scan by measuring the 3D volumes of the skulls studied. Specific landmarks are used as reference points for the measures in both frontal and lateral views. Bland–Altman graph shows homogeneity. The mean difference (1.28 mm) indicates that the measurements taken on the photogrammetry-based skull tend to slightly overestimate compared with the measurements taken on the CT-based skull.

2020 - SCHEDE DI SOPRALLUOGO INTERGRUPPI: IL PROTOCOLLO DI PARMA [Articolo su rivista]
Cecchi, R; Cucurachi, N; Schirripa, Ml; Marezza, F; Anzillotti, L; Banchini, A; Donato, L; Gherardi, M
abstract

Il costante evolversi delle scienze forensi rappresenta una continua sfida per il medico legale, al quale sono richieste competenze sempre più ampie ed approfondite per la migliore interpretazione possibile del caso di interesse giudiziario, anche a fronte dell’impossibilità concreta di essere sempre affiancati da altri esperti forensi (antropologo, odontologo, genetista, entomologo e tossicologo). Per venir incontro a questa esigenza, partendo dall’attenta disamina dei protocolli operativi delle differenti discipline specialistiche, congiunta all’osservazione critica della pratica quotidiana del Servizio di Medicina Legale dell’Università di Parma, è stato elaborato un corpus di schede suddiviso in sei sezioni (Patologia forense, Antropologia, Odontologia, Genetica, Entomologia e Tossicologia) dal titolo “Protocollo di raccolta informazioni in sede di sopralluogo”. Sono state inoltre discusse le opportune procedure di conservazione dei campioni, nonché le modalità di compilazione delle schede specialistiche di accompagnamento da trasmettere all’esperto di riferimento. Le schede proposte sono state condivise dai Presidenti dei gruppi scientifici GIPF, GeFI, GTFI, GIEF e GIAOF e con i rispettivi direttivi. Successivamente, le schede approvate in via definitiva sono state presentate al I Convegno Intergruppi (Villasimius Settembre 2017) e, quindi, adottate dalla SIMLA che le ha condivise con i propri associati. La Consulta dei Giovani Medici Legali ha utilizzato le schede e i risultati sono stati presentati al II Convegno Intergruppi (Chia Maggio 2018). Le Schede che vengono presentate costituiscono il prodotto finale del confronto con tutti gli attori coinvolti.

2020 - Validation of a bioanalytical method for the determination of synthetic and natural cannabinoids (New psychoactive substances) in oral fluid samples by means of hplc-ms/ms [Articolo su rivista]
Calo, L.; Anzillotti, L.; Maccari, C.; Cecchi, R.; Andreoli, R.
abstract

New psychoactive substances (NPS) represent an important focus nowadays and are continually produced with minimal structural modifications in order to circumvent the law and increase the difficulty of identifying them. Moreover, since there are a high number of different compounds, it is arduous to develop analytical screening and/or confirmation methods that allow the identification and quantification of these compounds. The aim of this work is to develop and validate a bioanalytical method for detecting new synthetic drugs in biological samples, specifically oral fluid, using high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS/MS) with minimal sample pretreatment. Oral fluid samples were simply centrifuged and denaturized with different rapid procedures before injection into the LC-MS/MS system. Calibration curves covered a linear concentration range from LOQ to 100 ng/mL. Validation parameters such as linearity, precision, accuracy, selectivity, matrix effect and thermal stability were evaluated and showed satisfactory results, in accordance with US Food & Drug Administration guidelines. The inter-day analytical bias and imprecision at two levels of quality control (QC) were within ±15% for most compounds. This method was able to identify and calculate the concentration of 10 NPS validated in this biological sample, even in the presence of matrix effect.

2019 - A case report positive for synthetic cannabinoids: are cardiovascular effects related to their protracted use? [Articolo su rivista]
Anzillotti, L.; Marezza, F.; Calo, L.; Banchini, A.; Cecchi, R.
abstract

The use of synthetic cannabinoids is being increasingly recognised worldwide, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. New substances are constantly being added to the content of synthetic cannabinoids and they are rarely identified on toxicological screening tests. Due to their structures synthetic cannabinoids and their effects have been compared to the psychoactive compound, Δ-9-tetrahydrocannabinol (THC), found in marijuana. On the molecular level, they are potent cannabinoid receptor agonists that also may have affinity for other types of receptors such as those on platelets. Reported symptoms of toxicity include anxiety, agitation, paranoia, hallucinations, tachycardia, hypertension, excessive sweating, nausea, and vomiting. They can also be linked to serious adverse cardiovascular events and can affect the cardiovascular system causing hypotension and bradycardia, myocardial infarction, atrial fibrillation, prolonged QTc, and Mobitz type II atrioventricular block, as well as interfere with the aggregation of platelets. We present a case report of a cardiac tamponade with toxicological findings positive for synthetic cannabinoids. This case highlights the importance of testing routinely for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.

2019 - Determination of synthetic and natural cannabinoids in oral fluid by solid-phase microextraction coupled to gas chromatography/mass spectrometry: A pilot study [Articolo su rivista]
Anzillotti, Luca; Marezza, Francesca; Calò, Luca; Andreoli, Roberta; Agazzi, Silvia; Bianchi, Federica; Careri, Maria; Cecchi, Rossana
abstract

In 2008, several synthetic cannabinoids were detected in herbal smoking blends sold on websites and in the so-called “smart shops”. These compounds, as well as new psychoactive substances, flooded the market of illicit drugs and are sold at street level. Development and validation of rapid analytical methods for the detection and quantification of synthetic cannabinoids in biological matrices are essential for the investigation of pharmacokinetic, pharmacodynamic and toxicological properties. In this pilot study, the potential of direct immersion solid-phase microextraction coupledto GC/MS for the determination of synthetic and natural cannabinoids in oral fluid was proved. Validation proved the suitability of the developed method for the determination of the analytes at trace levels in oral fluid: linearity was assessed in the LOQ – 1000 ng/mL range, whereas a good precision was observed with CV below 20%. The method was then applied to more than 100 real oral fluid samples collected from a population of young students, showing a positivity rate of 3.8%

2019 - LE LINEE GUIDA NELLA PATOLOGIA FORENSE TRA PASSATO E FUTURO; QUALI INDICAZIONI PER L’ATTIVITÀ AUTOPTICA? [Articolo su rivista]
Cecchi, Rossana; Cucurachi, Nicola; Milone, Livio
abstract

The Gelli-Bianco law, anticipated by the Balduzzi law and even before by constant jurisprudence of the Supreme Court, has placed particular emphasis on the relevance ofGuidelines as a tool to obtain from health professionals behaviors adhering to the dictates of international scientific literature and Evidence Based Medicine. The topic, of specific interest for health professionals directly involved in diagnostic- therapeutic-assistance activities, is important also for medico-legal professionals, explicitly referred to in the art. 5 of the aforementioned law. Even those who practice forensic pathology and in particular post-mortem activities as autopsies must therefore refer to the recommendations provided for by the guidelines, whose development is the duty of scientific societies. The application and regulatory references to autopsy practice date back in the past, but new contributions, in the form of guidelines, have also recently been developed; they require adequate knowledge by the operators in the autopsy field and by the Judicial Authority.

2019 - Novel sample-substrates for the determination of new psychoactive substances in oral fluid by desorption electrospray ionization-high resolution mass spectrometry [Articolo su rivista]
Bianchi, Federica; Agazzi, Silvia; Riboni, Nicolò; Erdal, Nejla; Hakkarainen, Minna; Ilag, Leopold L.; Anzillotti, Luca; Andreoli, Roberta; Marezza, Francesca; Moroni, Fabrizio; Cecchi, Rossana; Careri, Maria
abstract

A reliable screening and non invasive method based on the use of microextraction by packed sorbent coupled with desorption electrospray ionization-high resolution mass spectrometry was developed and validated for the detection of new psychoactive substances in oral fluid. The role of different sample substrates in enhancing signal intensity and stability was evaluated by testing the performances of two polylactide-based materials, i.e. non-functionalized and functionalized with carbon nanoparticles, and a silica-based material compared to commercially available polytetrafluorethylene supports. The best results were achieved by using the nonfunctionalized polylactide substrates to efficiently ionize compounds in positive ionization mode, whereas the silica coating proved to be the best choice for operating in negative ionization mode. LLOQs in the low μg/L, a good precision with CV% always lower than 16% and RR% in the 83(±4)-120(±2)% range, proved the suitability of the developed method for the determination of the analytes in oral fluid. Finally, the method was applied for screening oral fluid samples for the presence of psychoactive substances during private parties, revealing mephedrone in only one sample out of 40 submitted to analysis.

2019 - Suicide in the elderly: a 37-years retrospective study [Articolo su rivista]
Crestani, Carlo; Masotti, Vittoria; Corradi, Natalia; Schirripa, Maria Laura; Cecchi, Rossana
abstract

The rates of suicide increase with age and reach their highest levels in the oldest age groupings and are sufficiently large for them to constitute a public health concern. The number of deaths due to suicides after the age of 60 years in Italy is 1,775 (41.36%) in 2013; there is a constant increase of elder population over the last ten years and elderly are almost twice of young. It is in this context that suicide arises, a risk factor during old age.

2019 - The Tenchini’s collection: a forensic anthropometric legacy of 19th century Parma, Italy [Articolo su rivista]
Donato, Laura; Toni, Roberto; Porro, Alessandro; Vitale, Marco; Barbaro, Fulvio; Cecchi, Rossana
abstract

A group of 19th century inmates dead in the prison of Parma are the protagonist of an incredible scientific collection. Lorenzo Tenchini started the creation of this collection and dedicated his work and his studies to its completeness. Anatomist and academic, Lorenzo Tenchini (1852–1906) dedicated his scientific studies to macroscopic anatomy, particularly about central nervous system and its correlation with psychic function. In 1881 he became ordinary professor in Normal Human Anatomy at the University of Parma dedicating himself to the study of the anatomical organization of the brain and psychic and social disturbs. During the study of the skulls and brains of psychotic patients and the deformations of skulls belonging to patients admitted in the Hospital of Brescia, he started a collaboration with Alessandro Cugini (1829–1913), founder of the Institute of Legal Medicine at the University of Parma. Tenchini realized an anatomical collection, preserved today in the Museum of Biomedicine of the University of Parma. This collection represents the masterpiece of his research carried out during his academic activity and still a unicum in the western world, as there are no similar collection assembling such a multidisciplinary information. The peculiarity of this collection is due not only to the scientific interest of the anatomic samples and their full clinical documentation, but also to the methods employed in order to realize it. At the end of the 19th century, as a student of Cesare Lombroso (1835–1909), Tenchini based his work on the study of the face, the skull and brain of each dead inmate of Parma’s prison or Colorno’s mental hospital. These individuals as protagonists of Tenchini’s collection, leave a legacy identifiable as scientific heritage. Their skulls and brains, the reproduction of their faces through ceroplastic and other anatomical samples treated with other techniques, are accompanied by an autoptic and psychiatric full documentation, allowing the collection to be complete with every aspect related to the inmates studied. Through his work, a comparison between different kind of studies, such as psychiatry, psychology, neurology, legal medicine and anthropology, is suitable in scientific research to be realized. Moreover, data come from a forensic context: this allows a comparison with different methodologies employed in modern age by forensic expertise such as the comparison between modern and ancient medical diagnostic technique. This masterpiece represents Tenchini’s neuroanatomical research on behaviour and set a pioneering step in the history of biomedical science allowing further multidisciplinary studies.

2019 - “Toxicological findings: a retrospective overview of medico-legal investigations in Parma (Italy)” [Articolo su rivista]
Anzillotti, Luca; Marezza, Francesca; Calò, Luca; Cucurachi, Nicola; Veronesi, Licia; Cecchi, Rossana
abstract

The aim of this study was to collect all available data from 2009 to 2016 focusing on the epidemiological, clinical and pharmacological issues only related to acute intoxication fatalities in the Unit of Legal Medicine of the Department of Medicine and Surgery at the University of Parma. All death certificates and autopsy reports were retrieved from the archives and evaluated to identify cases in which only acute intoxication from xenobiotics could be defined as the cause of death, however statistical and descriptive analyses were applied to all the data. A more comprehensive analysis on all causes of death showed that out of 1005 total cases the most common is haemorrhagic shock/traumatic shock (36.5%), followed by cardiogenic shock with 27.4%; asphyxia ranks as the third cause of death (11.8%); concerning encephalic injuries, our data show 10.9% of cases, while acute intoxication by xenobiotics accounts for 5.7%. Data show that the majority of subjects are poly-abuser (75.4%); people not enrolled within a preventive treatment (59.4%) were more likely to commit suicide (28.1%), whereas only 6.2% in the sub-population in treatment (40.6%) committed suicide: therefore, data strongly suggest the evidence that joining a preventive programme can decrease the probability of extreme action. Access to a full case history may indeed save considerable time and expense in carrying out tests, but also valuable targeted samplings. The investigating officer should, therefore, submit as much information as possible about the case, as this may influence the type and extent of analysis undertaken, as well as the interpretation of analytical results.

2018 - Determination of methadone and eight new psychoactive substances in hair samples by gas chromatography/mass spectrometry [Articolo su rivista]
Anzillotti, Luca; Calo', Luca; Giacalone, Marianna; Banchini, Antonio; Cecchi, Rossana
abstract

Many new psychoactive substances (NPSs) with different chemical structures have emerged in the illicit drug market in the last decade. The present work was aimed at the development of a simple method in gas chromatography/mass spectrometry (MS) for the determination of NPS of different classes, the use of cannabinoids, and, at the same time, the evaluation of methadone therapy in hair matrix, within our routine analysis control for methadone treatment or from autopsy cases. The determination of synthetic cannabinoids and methadone therapy used an extraction method based on incubation in concentrated sodium hydroxide (NaOH) solution, providing a dissolution of the keratin matrix. The described method was applied on 15 authentic specimens from our cases: five showed the presence of methadone and 2‑ethylidene‑1,5‑dimethyl‑3,3‑diphenylpyrrolidine (EDDP). The described method can be useful not only in the forensic investigation of NPS‑related addiction histories but also in epidemiological and retrospective studies on the spread of NPS among specific safety‑sensitive social workers. The GC instrument was an Agilent 7820A (Agilent Technologies, Santa Clara, CA, USA), and the detection system was an Agilent 5977B single quadrupole MS operating in selective ion monitoring mode. Validation parameters such as limit of detections (LODs), limit of quantifications (LOQs), repeatability, accuracy, and linearity were satisfactory for its application on real specimens. LODs, LOQs, R2, %CV, standard deviation, and the mean concentration for the analyzed compounds are reported in Table 1b. Accuracy and repeatability were acceptable for all the analytes at their respective LOQs. Recovery experiments varied from 58.3% to 103.0%, thus allowing the application on authentic specimens. The described method can be useful not only in the forensic investigation of NPS‑related addiction histories but also in epidemiological and retrospective studies on the spread of NPS among specific safety‑sensitive social workers, such as drivers.

2018 - Hypochlorite accident during endodontic therapy with nerve damage – A case report [Articolo su rivista]
Perotti, Silvia; Bin, Paola; Cecchi, Rossana
abstract

Endodontic therapy is a routinely practised clinical procedure with few reported complications but, as a bleaching agent, inadvertent spillage of sodium hypochlorite beyond the root canal system may result in extensive soft tissue or nerve damage, and even airway compromise. Although very rare, complications arising from hypochlorite extrusion beyond the root apex are described. NaOCl causes oxidation of protein and lipid membrane and causes necrosis, hemolysis and dermal ulcerations (2-4). Neurological complication are very rare. Paraesthesia and anaesthesia may affect the mental, inferior dental and infra-orbital branches of the trigeminal nerve and normal sensation may take many months to completely resolve (6, 7). Nerve damage (the buccal branch) was described in 2005 by Witton et al. (8) and patients exhibited a loss of the naso-labial groove and a down turning of the angle of the mouth and the motor function was regained after several months. We present a case in which the extrusion of NaOCl solution during endodontic therapy led to important destructive effects on soft tissues and nerves. The arisen medico legal issues are discussed. (www.actabiomedica.it).

2017 - Back to the Future - Part 1. The medico-legal autopsy from ancient civilization to the post-genomic era [Articolo su rivista]
Cecchetto, Giovanni; Bajanowski, Thomas; Cecchi, Rossana; Favretto, Donata; Grabherr, Silke; Ishikawa, Takaki; Kondo, Toshikazu; Montisci, Massimo; Pfeiffer, Heidi; Bonati, Maurizio Rippa; Shokry, Dina; Vennemann, Marielle; Ferrara, Santo Davide
abstract

Part 1 of the review â Back to the Futureâ examines the historical evolution of the medico-legal autopsy and microscopy techniques, from Ancient Civilization to the Post-Genomic Era. In the section focusing on â The Pastâ , the study of historical sources concerning the origins and development of the medico-legal autopsy, from the Bronze Age until the Middle Ages, shows how, as early as 2000 BC, the performance of autopsies for medico-legal purposes was a known and widespread practice in some ancient civilizations in Egypt, the Far East and later in Europe. In the section focusing on â The Presentâ , the improvement of autopsy techniques by Friedrich Albert Zenker and Rudolf Virchow and the contemporary development of optical microscopy techniques for forensic purposes during the 19th and 20th centuries are reported, emphasizing, the regulation of medico-legal autopsies in diverse nations around the world and the publication of international guidelines or best practices elaborated by International Scientific Societies. Finally, in â The Futureâ section, innovative robotized and advanced microscopy systems and techniques, including their possible use in the bio-medicolegal field, are reported, which should lead to the improvement and standardization of the autopsy methodology, thereby achieving a more precise identification of natural and traumatic pathologies.

2017 - Back to the Future - Part 2. Post-mortem assessment and evolutionary role of the bio-medicolegal sciences [Articolo su rivista]
Ferrara, Santo Davide; Cecchetto, Giovanni; Cecchi, Rossana; Favretto, Donata; Grabherr, Silke; Ishikawa, Takaki; Kondo, Toshikazu; Montisci, Massimo; Pfeiffer, Heidi; Bonati, Maurizio Rippa; Shokry, Dina; Vennemann, Marielle; Bajanowski, Thomas
abstract

Part 2 of the review â Back to the Futureâ is dedicated to the evolutionary role of the bio-medicolegal sciences, reporting the historical profiles, the state of the art, and prospects for future development of the main related techniques and methods of the ancillary disciplines that have risen to the role of â autonomousâ sciences, namely, Genetics and Genomics, Toxicology, Radiology, and Imaging, involved in historic synergy in the â post-mortem assessment,â together with the mother discipline Legal Medicine, by way of its primary fundament, universally denominated as Forensic Pathology. The evolution of the scientific research and the increased accuracy of the various disciplines will be oriented towards the elaboration of an â algorithm,â able to weigh the value of â evidenceâ placed at the disposal of the â justice systemâ as real truth and proof.

2017 - Italian law on the vehicular homicide: Medical legal issues and comparative analysis [Articolo su rivista]
Montanari Vergallo, Gianluca; Marinelli, E.; Di Luca, N. M.; Masotti, Vittoria; Cecchi, Rossana; Zaami, S.
abstract

Law no. 41/2016, enacted after a parliamentary debate characterized by a strong media pressure, intends to give a strong response to the growing social alarm caused by road accidents causing deaths. In this perspective, it introduced the categories of road homicide and road injuries within the Penal Code and the new hypotheses of mandatory and facultative arrest in flagrante delicto. This paper aims at comparing the rules by which the United Kingdom, France, Spain, Germany and Italy protect people's lives and safety of vehicular traffic in order to highlight strengths and weaknesses with a view to future reforms. A survey on the European legislature highlights that, while other countries tend to criminally sanction several dangerous driving conducts, Italy has preferred, on the one hand, to punish only with administrative sanctions some violations related to reckless driving (with the exception of driving under the influence of alcohol and drugs) and, on the other, to provide for particularly harsh prison sentences in the case of vehicular homicide. The authors criticize this approach and other aspects of the new law. Moreover, it seems that the legislator's aim has not been achieved because traffic accidents have not decreased. They also believe that better results could be obtained by increasing controls on the roads and developing a policy of economical investments which improves road safety.

2017 - Laboratory management and professional liability: molecular diagnostics [Gestione di laboratorio e responsabilità professionale: la diagnostica molecolare] [Articolo su rivista]
Leone, Barbara; Panebianco, Noemi; Cecchi, Rossana
abstract

Le implicazioni medico-legali connesse all’attività professionale nel Laboratorio clinico discendono necessariamente dall’eventualità di comportamenti inadeguati e forieri di danno per il paziente, connessi all’esercizio della professione. Attualmente, gli studi più recenti utilizzano un approccio che si basa sulla necessità di investigare ogni possibile difetto che si verifichi nel processo analitico nel suo complesso, che spazia dal momento della richiesta degli esami alla loro interpretazione e refertazione, e la corretta utilizzazione dell’informazione prodotta. Il presente lavoro prende in considerazione un Laboratorio di Diagnosi Molecolare come esempio di possibili errori che potenzialmente possono verificarsi. Partendo da quanto contenuto nelle normative di riferimento, attraverso rappresentazioni schematiche (schemi e flow-charts) viene effettuata un’analisi pratica, immediata e visiva della problematica. L’aspetto medico-legale della questione viene affrontato partendo dal presupposto che, essendo coinvolte più figure professionali, l’identificazione del responsabile di un errato dato laboratoristico andrà ricercata tenendo conto delle competenze di ciascuno. Di conseguenza, in caso di contenzioso per responsabilità professionale in cui sia coinvolto l’operato di un tecnico sanitario di laboratorio biomedico (TSLB) l’organismo giudicante (giudice di tribunale penale, civile o amministrativo) prenderà come riferimento la normativa da cui si evincono le competenze che, per legge, il TSLB deve possedere e, nello specifico, la legge 10 agosto 2000, n. 251, recante la disciplina delle professioni sanitarie infermieristiche, tecniche, della riabilitazione, della prevenzione, nonché della professione ostetrica e il codice deontologico dei Tecnici di laboratorio biomedico.

2017 - Planned and unplanned complex suicides: Casuistry of the Institute of Legal Medicine of Parma (Italy) [Articolo su rivista]
Banchini, Antonio; Schirripa, Maria Laura; Anzillotti, Luca; Cecchi, Rossana
abstract

Complex suicide is performed using more harmful methods, simultaneously or consecutively. In these cases, the distinction between suicide and homicide represents a challenge for forensic pathologists. In literature, complex suicide is divided in two subgroups: â planned complex suicideâ or â unplanned complex suicideâ depending from forensic features and often related to psychiatric variables. Aim of this study was to show the casuistry of complex suicide in Parma's Forensic service analyzing, for each case, the forensic medical problems (type and site of lesions on the body), and the supplementary data [Police's inspection report, toxicological analysis and psychiatric anamnesis (when available)], trying, through a multidisciplinary approach, to determine a possible correlation between the victim's mood and suicide's method chosen, whether planned or unplanned. Our results showed the importance of all the elements collected on the crime scene to distinguish suicide from homicide, and the correlation between bipolar disorder, borderline personality disorder and schizophrenia with unplanned complex suicide (because of the impulsiveness), and major depression disorder and anxiety disorder with planned complex suicide. Being able to understand the causes behind this extreme gesture may become important not only for forensic pathologists and judicial authority, but also, and above all, for the family as well.

2017 - The law on artificial insemination: an italian anomaly [Articolo su rivista]
Cecchi, Rossana; Masotti, Vittoria; Meo, Arturo Umberto; Rinaldi, Raffaella
abstract

The law on medically assisted procreation in Italy, from its entering into force, has undergone numerous amendments. This has been due to the fact that those citizens, directly affected by its imposed prohibitions, have not given in, bringing their requests before the courts, both nationally and internationally. Over the years, the courts through numerous rulings have significantly changed a law clearly incapable of protecting the rights of those involved. Currently Italy has an acceptable law on M.A.P. which is the result of the strong willing of citizens affected by problems of sterility or infertility. The aim of this paper is to present an historical summary of the troubled path which the issue, from every perspective, has faced and is still facing today. As well, it will document how, in Italy, the case-law and, therefore, the law's interpretation and application by the judges have contributed, in the end, to shaping a positive legislation.

2017 - Use of corneas for transplant after self-inflicted eyeballs enucleation in the Italian law [Articolo su rivista]
Montanari Vergallo, Gianluca; Pacella, E.; di Luca, A.; di Luca, N. M.; Cecchi, R.; Marinelli, E.
abstract

The authors analyze from an ethical and legal point of view the case of a 37 year old man, hospitalized for four days because of a "dissociative syndrome", who had introduced in both his orbits a portable radio antenna. Most likely, he completed the self-enuclation using his own hands. He was brought to the Ophtalmic Hospital by nurses who handed the two eyeballs to the physicians who ascertained that the corneas were intact. Then, they performed the conservative extraction. In the following days those corneas were transplanted (keratoplasty) on two subjects on the waiting list at that hospital. The case raises the question of whether it is lawful and ethically acceptable to take, for transplant use, the corneas of a mentally incapable patient who has excised his own eyeballs. The authors analyze the case from the angle of the Italian law and Oviedo Convention. Neither of them has a specific regulation on this topic. It is therefore necessary to apply general principles that holdvalidfor Italy and a variety of countries worldwide. Particularly, the choice to use the corneas for transplant did not prejudice the physical integrity of the patient, who could no longer utilize his own eyeballs. His self-determination has not been affected; in fact, he was not in the position to make a conscious decision. Additionally, the so-called "implied consent" could be applied. Therefore, the principle of human solidarity, which is the moral duty to benefit others, seems to prevail in the case at hand.

2017 - Ventricular androgenic-anabolic steroid-related remodeling: an immunohistochemical study [Articolo su rivista]
Cecchi, Rossana; Muciaccia, Barbara; Ciallella, Costantino; Di Luca, Natale Mario; Kimura, Akihiko; Sestili, Cristina; Nosaka, Mizuho; Kondo, Toshikazu
abstract

Background: Several fatal cases of bodybuilders, following a myocardial infarction after long exposure to androgenic-anabolic steroids (AAS), are reported. In recent years, evidence has emerged of cases of heart failure related to AAS consumption, with no signs of coronary or aorta atherosclerosis. This study aims to further investigate the pathogenesis of the ventricular AAS-related remodeling performing immunohistochemistry (IHC). Method: In order to examine innate immunity activity and myocytes and endothelial cell apoptosis, IHC analyses were performed on heart tissue of two cases of bodybuilders who died after years of supratherapeutic use of metelonone and nandrolone and where no atherosclerosis or thrombosis were found, using the following antibodies: anti-CD68, anti-iNOS, anti-CD163, anti-CD 15, anti-CD8, anti-CD4, anti-HIF1 α, and in situ TUNEL staining. Results: Results confirm the experimental findings of recent research that, in the absence of other pathological factors, if intensive training is combined with AAS abuse, myocytes and endothelial cells undergo apoptotic alterations. The absence of inflammatory reactions and the presence of an increased number of M2 macrophages in the areas of fibrotic remodeling confirm that the fibrotic changes in the heart are apoptosis-related and not necrosis-related. Conclusions: In conclusion, the study indicates that, in very young subjects with chronic hypoxia-related alterations of the heart, signs of a heart failure in the other organs and a history of AAS abuse, death can be ascribed to progressive heart failure due to the direct apoptotic cardiac and endothelial changes produced by AAS.

2016 - Are mast cells implicated in asphyxia? [Articolo su rivista]
Cecchi, Rossana; C., Ciallella; L., Cipolloni; C., Sestili; C., Terranova; B., Muciaccia
abstract

In a previous immunohistochemical (IHC) study, we documented the reaction of lung tissue vessels to hypoxia through the immunodetection of HIF1-α protein, a key regulator of cellular response to hypoxic conditions. Findings showing that asphyxia deaths are associated with an increase in the number of mast cell (MC)-derived tryptase enzymes in the blood suggests that HIF1-α production may be correlated with MC activation in hypoxic conditions. This hypothesis prompted us to investigate the possible role of pulmonary MC in acute asphyxia deaths. Lung of 47 medico-legal autopsy cases (35 asphyxia/hypoxia deaths, 11 controls, and 1 anaphylactic death) were processed by IHC analysis using anti-CD117 (c-Kit) antibody to investigate peri-airway and perivascular MC together with their counts and features. Results showed a significant increase in peri-vascular c-kit+ MC in some asphyxia deaths, such as hanging, strangulation, and aspiration deaths. A strong activation of MC in peri-airway and peri-vascular areas was also observed in lung samples from the anaphylaxis case, which was used as a positive control. Our study points to the potential role of MC in hypoxia and suggests that an evaluation of MC in the lungs may be a useful parameter when forensic pathologists are required to make a differential diagnosis between acute asphyxia deaths and other kinds of death.

2016 - Comment on “The static evolution of the new Italian code of medical ethics” [Articolo su rivista]
Cecchi, R.
abstract

2016 - Diagnosis of anaphylactic death in forensics: Review and future perspectives [Articolo su rivista]
Cecchi, Rossana
abstract

The diagnosis of anaphylaxis in a pre- or post-mortal phase involves the formulation of problems not yet solved by the international scientific literature, due to the complexity of pathogenic factors and pathophysiological processes that characterizes it. For forensic autopsies, further problems of differential diagnosis arise and often leave the forensic pathologist unable to express an opinion of certainty, as a result of lack of case history, circumstantial and autoptical-histopathological data. Nevertheless, in routine cases the postmortem diagnosis of anaphylactic death continues to be based on exclusion and circumstantial evidence. The author, after an extensive review of the literature relating to deaths from anaphylaxis of forensic pathological interest, and a discussion of the microscopical and biochemical findings, proposes a diagnostic protocol for forensic purposes and evaluates the diagnostic perspectives enabled by the newly available analytic techniques and markers. Maybe, the application of omics methodologies could help in the future for anaphylaxis diagnosis.

2016 - Il consenso informato in Terapia Occupazionale: proposta di una modulistica [Articolo su rivista]
Giovanni, Galeoto; Rita De, Santis; Alessandra, Marcolin; Alfonso, Cinelli; Cecchi, Rossana
abstract

L’evoluzione normativa che ha portato all’istituzione delle Lauree Triennali delle Professioni Sanitarie pone tutti i professionisti sanitari nella condizione di dover assolvere al compito deontologico e giuridico di ottenere un consenso informato valido da parte del paziente prima di procedere al trattamento. Nel presente lavoro l’attenzione si è incentrata sulla figura del terapista occupazionale. Materiali e metodi. Sono stati sviluppati moduli di consenso informato orientati secondo la patologia specifica della quale è affetto il paziente sottoposto a terapia occupazionale; identificando le seguenti categorie di malato: amputato, età evolutiva, ortopedico, mieloleso, neurologico, psichiatrico, oncologico e geriatrico. Risultati e conclusione. I moduli di consenso da noi proposti appaiono particolarmente adatti all’ottenimento di un consenso valido da parte del paziente e, nel contempo, permettono al terapista occupazionale di ottenere tutte le informazioni di cui necessita per l’espletamento in sicurezza del trattamento. Ne deriva una maggior compliance del paziente alla terapia favorita da un miglior rapporto empatico con il terapista.

2016 - Mass disasters observed at the Sapienza University of Rome: A retrospective study between 1964 and 2005 [Articolo su rivista]
Cecchi, Rossana; Bottoni, Edoardo; Cappelletti, Simone; Fiore, Paola Antonella; Straccamore, Marco; Bolino, Giorgio; Marinelli, Enrico; Di Luca, Natale Mario Ario; Romolo, Francesco Saverio; Ciallella, Costantino
abstract

The specialists of the Department of Legal Medicine of the Sapienza University of Rome (Italy) were involved in the investigation of ten mass disasters over fifty years (1964-2005). The victims examined were 230. The cases, distributed both in Italy and abroad, included four terrorist attacks, three airplane accidents, two collapsed buildings, and one shipwreck in a river. One of the most important tasks in mass disasters is the identification of victims. Another key issue is the determination of the cause of death and the contribution to the reconstruction of the events. In all cases the training and the capability of our specialists to interact with all the entities involved in the mass disaster management played a critical role. For all cases the timeline of operations is provided, beginning with the collection of the antemortem information. Specialists of our Department took part to the antemortem teams, due to their particular experience. For postmortem collection of information our Institute historically played a central role, especially because all the Italian victims of any accidents happened abroad are examined in â Sapienzaâ smorgue. The aim of this contribution is to highlight the changes that have occurred over the years in the management of mass disaster investigations in Rome and to present the latest developed organisation of specialists involved and their procedures, stressing the necessity of a multidisciplinary approach in mass disaster management.

2016 - The brain tissue reaction to blunt trauma: a field of possible cooperation between neuroanatomists and forensic pathologists [Abstract in Rivista]
Cecchi, Rossana; Laura Schirripa, Maria; Banchini, Antonio; Vitale, Marco
abstract

The goal of this presentation is to describe, through the histological examination, the evolution over time of the biological processes, at the cellular and molecular level, in the neurological tissue after a blunt trauma. The origin of the secondary ischemia, that often occurs after a brain trauma, leading to death the patient, is almost studied on animal models and is not well known yet. It is presumed that hemorrhages and contusions result in brain ischemia, and that also brain edema arises intra-cranial pressure producing ischemia. Forensic pathology deals everyday with cases of traumatic deaths, and is therefore able to study the inflammatory reaction to trauma in a human casuistry giving information to other disciplines like neuroanatomy. The time-dependent appearance of different leucocyte subtypes can contribute to a forensic wound age estimation but, in contrast to peripheral tissue, the cellular reaction in the CNS is characterized by a minimal neutrophil exsudation and a delayed increase in mononuclear cell numbers. 62 deaths due to head injury with a survival time from few minutes till 30 days were studied. Samples of brain tissue were stained with immunohistochemistry using selectin P and E, GFAP, HIF1-α, CD 117 (c-kit), LCA. The schematic information about chronology of head trauma are given as follows: survival of a few minutes, of 1 hour, of 2-4 hours, of 4-12 horus, of 12-24 hours, 24-48 hours, 2-6 days, 6-14 days, 15-30 days. The number of platelets microthrombi increases with TBI age up to 3 days, afterward leukocytes start to take their place. Platelets aggregates may impair cerebral circulation causing ischemia. Cerebral ischemia plays an important role in SBD. There is also an involvement of CD 117+ cells and HIF-1 α in the modulation and progression of the brain injury. After brain injury a cascade of events occurs leading sometime to a brain secondary ischemic injury. Thanks to the availability of injured human brain tissues, forensic histopathologists might work together with neuroanatomists in order to help in the identification of glial cells and leukocytes communication with endothelial cells, and on the post-traumatic ischemic process that causes the death in prolonged survival time after brain injury.

2015 - Development of Micro-Grippers for Tissue and Cell Manipulation with Direct Morphological Comparison [Articolo su rivista]
Cecchi, Rossana; Verotti, Matteo; Capata, Roberto; Dochshanov, Alden; Broggiato Giovanni, Battista; Crescenzi, Rocco; Balucani, Marco; Natali, Stefano; Razzano, Giovanna; Lucchese, Franco; Bagolini, Alvise; Bellutti, Pierluigi; Sciubba, Enrico; Belfiore Nicola, P.
abstract

Although tissue and cell manipulation nowadays is a common task in biomedical analysis, there are still many different ways to accomplish it, most of which are still not sufficiently general, inexpensive, accurate, efficient or effective. Several problems arise both for in vivo or in vitro analysis, such as the maximum overall size of the device and the gripper jaws (like in minimally-invasive open biopsy) or very limited manipulating capability, degrees of freedom or dexterity (like in tissues or cell-handling operations). This paper presents a new approach to tissue and cell manipulation, which employs a conceptually new conjugate surfaces flexure hinge (CSFH) silicon MEMS-based technology micro-gripper that solves most of the above-mentioned problems. The article describes all of the phases of the development, including topology conception, structural design, simulation, construction, actuation testing and in vitro observation. The latter phase deals with the assessment of the function capability, which consists of taking a series of in vitro images by optical microscopy. They offer a direct morphological comparison between the gripper and a variety of tissues.

2015 - Healing and Repair of Wounds and Bones [Voce in Dizionario o Enciclopedia]
Cecchi, R.
abstract

In the field of forensic medicine, it is often of paramount importance to estimate accurately the time at which an injury was inflicted. This chapter illustrates what a forensic histopathologist needs to know in order to assess wound age. Knowledge of wound healing (WH) processes and of cellular-extracellular matrix (ECM) mediators is required to estimate wound age. In this chapter, in which studies conducted over the last decade are reviewed, the WH features that are most relevant to forensic studies and the most reliable markers of wound age assessment are described. Lastly, the new perspectives provided by omics sciences that pave the way for future interdisciplinary research are discussed.

2015 - Il consenso informato in fisioterapia: proposta di una modulistica [Articolo su rivista]
Giovanni, Galeoto; Roberta, Mollica; Orazio, Astorino1; Cecchi, Rossana
abstract

Obiettivi: Scopo del lavoro è evidenziare l’esigenza, il dovere e l’obbligo anche per il fisioterapista di ottenere un consenso informato valido del paziente. Materiali e metodi: Gli autori, partendo dai moduli di consenso informato già esistenti per i medici, propongono moduli adattati alle esigenze del fisioterapista, specifici per ogni campo di riabilitazione. Risultati: Siffatte schede di consenso informato possono risultare molto utili ai fisioterapisti per ottemperare agli obblighi di informazione e di ottenimento del consenso e ai pazienti per comprendere appieno il trattamento proposto e aderirvi. Conclusioni: Ne deriva l’importanza di conservarli quale prova al fine di dirimere contenziosi relativi alla non riuscita delle cure ovvero rivendicazioni da parte del paziente.

2015 - Molecular analysis of different classes of RNA molecules from formalin-fixed paraffin-embedded autoptic tissues: a pilot study [Articolo su rivista]
Muciaccia, B; Vico, C; Aromatario, M; Fazi, F; Cecchi, Rossana
abstract

For a long time, it has been thought that fresh and frozen tissues are the only possible source of biological material useful to extract nucleic acids suitable for downstream molecular analysis. Recently, for forensic purpose such as personal identification, also fixed tissues have been used to recover DNA molecules, whereas RNA extracted from such material is still considered too degraded for gene expression studies. In the present pilot study, we evaluated the possibility to use forensic formalin-fixed paraffin-embedded (FFPE) samples, collected at autopsy at different postmortem intervals (PMI) from four individuals, to perform advanced molecular analyses. In particular, we performed qualitative and quantitative analyses of total RNAs extracted from different FFPE tissues and put expression profiles in relation with the organ type and the duration of PMI. Different classes of RNA molecular targets were studied by real-time quantitative RT-PCR. We report molecular evidence that small RNAs are the only RNA molecules still detectable in all the FFPE autoptic tissues. In particular, microRNAs (miRNAs) represent a consistent, stable, and well-preserved molecular target detectable even from tissue sources displaying signs of ongoing putrefaction at autopsy. In this pilot study, we show that miRNAs could represent a highly sensitive and potentially useful forensic marker. Amplification of specific miRNAs using paraffin-embedded blocks could facilitate retrospective molecular analysis using specific forensic-archived tissues chosen as most suitable according to PMI, and this approach would address molecular evidence in forensic cases in which fresh or frozen material is no longer available.

2014 - Assisted suicide in the care of mentally ill patients: The Lucio Magri's case [Articolo su rivista]
Paola, Frati; Matteo, Gulino; Paola, Mancarella; Cecchi, Rossana; Stefano, Ferracuti
abstract

A year after Mario Monicelli's suicide, the death of another famous person in Italy, Lucio Magri, reawakened the Italian debate on social, ethical and juridical issues in end-of-life decisions. Unlike Monicelli, Lucio Magri decided to end his own life in Switzerland with the help of a physician because his mental illness rendered his life unbearable. Both Monicelli and Magri suffered from a severe depression. The authors analyze the ethical issues regarding the right to die for mentally ill patients and neurological disabled patients, discussing the decision-making autonomy in persons suffering from severe depression. The role of the psychiatry in the management of end-of-life decision requests is considered along with pros and cons of suicide prevention and rationale suicide. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

2014 - Markers of mechanical asphyxia: immunohistochemical study on autoptic lung tissues [Articolo su rivista]
Cecchi, Rossana; C., Sestili; G., Prosperini; G., Cecchetto; E., Vicini; G., Viel; B., Muciaccia
abstract

Forensic pathologists are often asked to provide evidence of asphyxia death in the trial and a histological marker of asphyxiation would be of great help. Data from the literature indicate that the reaction of lung tissue cells to asphyxia may be of more interest for forensic purposes than migrating cells. The lungs of 62 medico-legal autopsy cases, 34 acute mechanical asphyxia (AMA), and 28 control cases (CC), were immunostained with anti-P-selectin, anti-E-selectin, anti-SP-A, and anti-HIF1-α antibodies, in order to verify if some of them may be used as markers of asphyxia death. Results show that P- and E-selectins expression in lung vessels, being activated by several types of trigger stimuli not specific to hypoxia, cannot be used as indicator of asphyxia. Intra-alveolar granular deposits of SP-A seem to be related to an intense hypoxic stimulus, and when massively present, they can suggest, together with other elements, a severe hypoxia as the mechanism of death. HIF1-α was expressed in small-, medium-, and largecaliber lung vessels of the vast majority of mechanical asphyxia deaths and CO intoxications, with the number and intensity of positive-stained vessels increasing with the duration of the hypoxia. Although further confirmation studies are required, these preliminary data indicate an interesting potential utility of HIF1-α as a screening test for asphyxia deaths.

2014 - Migrating Granulomatous Chronic Reaction from Hyaluronic Acid Skin Filler (Restylane): Review and Histopathological Study with Histochemical Stainings [Articolo su rivista]
Cecchi, Rossana; Andrea, Spota; Paola, Frati; Barbara, Muciaccia
abstract

Background: A unique case is presented in whom an allergic reaction to Restylane filler, associated with migrating granulomas, persisted despite medical interventions. A histopathological study was requested for evidence at court. Methods: Hematoxylin-eosin, alcian blue and colloidal iron staining were applied to skin sample biopsies obtained 5 months and 3 years after the hyaluronic acid (HA) injection. Results: The histological staining highlighted the presence of the filler inside the foreign body granuloma and in the derma of a biopsy obtained after 5 months; a small amount of filler was discovered within a granulomatous reaction 3 years after the injection. Conclusions: Smaller fragments of HA display inflammatory, angiogenic and immune-stimulatory activities. Intradermal skin testing before the start of HA filler therapy, and before each subsequent injection, may prevent legal implications for the plastic surgeon. Informed consent to skin tests should be obtained. (C) 2013 S. Karger AG, Basel

2013 - A Rare Case of Sudden Death Due to Hypotension during Cesarean Section in a Woman Suffering from Pheochromocytoma and Neurofibromatosis [Articolo su rivista]
Cecchi, Rossana; Paola, Frati; Oriana, Capri; Luigi, Cipolloni
abstract

Sudden death following acute hypotension due to an undiagnosed pheochromocytoma (PHEO) is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37-year-old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra-operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death. The autopsy revealed the presence of a PHEO, confirmed immunohistochemically with chromogranin-A (CgA), CD20 antibody (L26), anti-Keratocan antibody (KER-1) and neuron-specific enolase (NSE), and a PHEO-induced cardiomyopathy. The physiopathology of both stress-induced cardiomyopathy and PHEO-induced cardiomyopathy, as well as the role of anesthesia in provoking the death, are discussed. The association of an undiagnosed PHEO with neurofibromatosis as the cause of sudden death in pregnancy is an obstetric urgency that raises forensic pathology issues. © 2013 American Academy of Forensic Sciences.

2013 - Analisi etica nell’ambito dell’HTA circa l’uso del Boceprevir nel trattamento dell’epatite C [Capitolo/Saggio]
Cecchi, Rossana; R., Saulle; G., La Torre
abstract

health technology assessment, ethics, Boceprevir

2013 - Organizational and Economic Issues Related to the Introduction of Boceprevir in the Treatment of Patients with Genotype 1 Chronic Hepatitis C in Italy [Relazione in Atti di Convegno]
La Torre, G.; Miele, L.; Mannocci, A.; Saulle, R.; Giraldi, G.; Unim, B.; Ursillo, P.; Semyonov, L.; Colamesta, V.; Melcarne, R.; Biolato, M.; Cecchi, Rossana; Villari, P.; De Giusti, M.
abstract

Objectives: To present the critical points concerning organizational and economic issues of the introduction of boceprevir in the treatment of patients with genotype 1 chronic hepatitis C in Italy. Methods: A budget impact analysis was conducted adapting the NICE (UK) scheme for this drug, using the Italian epidemiological context and the perspective of the National Health Service. The cost-utility analysis (CUA) was carried out using a Markov model comparing the triple therapy (TT) with peginterferon alfa, ribavirin and boceprevir to the double therapy (DT) with peginterferon alfa and ribavirin. Available Italian published scientific literature provided data source. The main outcome of the CUA was the incremental cost-effectiveness ratio (ICER). The organizational aspects considered were: clinical management of patient with HCV chronic infection, access modalities, outpatient visit, planned and unplanned visits, hospital admission, role of the general practitioner (GP). Results: The budget impact analysis shows that, considering both naïve and previously treated patients, the treatment with boceprevir has an impact on the National Health Service of almost €66 million for the first year. Compared to treatment with DT, the cost-utility analysis shows for the boceprevir-based treatment strategy an ICER of €8.622,00. The management of TT for its intrinsic complexity requires monthly outpatients visits, at least at the beginning of treatment, for monitoring the compliance to treatment, efficacy and side effects. A critical organizational point is potentially the request for boceprevir for each single patient by the medical prescriptor, who needs to fill in detailed form from the Italian Agency of Drug (AIFA). Conclusions:The impact of the introduction of boceprevir on the budget is high, even if the ICER is favourable. Patients’ management is particularly complex and there is the need for an alliance between the patients, their relatives, GPs and specialized centers.

2012 - Contributo della tecnica immunoistochimica per le Selectine per la soluzione di casi giudiziari [Articolo su rivista]
Aromatario, M.; Bottoni, E.; Ciallella, C.; D'Annibale, C.; Sestili, C.; Cecchi, Rossana
abstract

L’indagine patologico-forense rappresenta una fase di criticità nella risoluzione di casi criminalistici; i quesiti relativi alle cause, ma soprattutto ai mezzi e all’epoca del decesso, ne rappresentano un nodo cruciale, che sempre di piú oggigiorno necessita dell’integrazione dell’esame autoptico con le piú moderne tecniche diagnostiche e di laboratorio quali, ad esempio, l’immunoistochimica, che stanno offrendo un contributo sempre maggiore ai fini di una concreta risposta ai quesiti posti dall’Autorità Giudiziaria. Il contributo analizza la tecnica immunoistochimica per la ricerca delle Selectine, molecole di adesione coinvolte nell’interazione leucociti-endotelio, ed in particolar modo la sua applicazione pratica per la risoluzione di casi sottoposti ad indagine peritale.

2012 - Death due to crush injuries in a compactor truck: vitality assessment by immunohistochemistry [Articolo su rivista]
Cecchi, Rossana; M., Aromatario; P., Frati; D., Lucidi; C., Ciallella
abstract

We present a case in which the timing of injuries was requested to determine whether the death of a man found in a landfill was due to homicide or accident. The use of immunohistochemistry to detect P-selectin and Eselectin on endothelial cells of vessels in damaged skin samples, and compare them with intact skin samples, as well as the presence of lung adipose embolism provide information on the timing of the injury, thereby helping substantially to identify the dynamics of death.

2012 - Fatal thromboembolism following physical restraint in a patient with schizophrenia [Articolo su rivista]
Cecchi, Rossana; Antonella, Lazzaro; Miriam, Catanese; Gabriele, Mandarelli; Stefano, Ferracuti
abstract

Fatal thromboembolism during physical restraint in patients suffering from psychotic disorders is a very rare occurrence. In the case we present here, the criteria used in forensic pathology for the age determination of venous thrombi are applied to a case of pulmonary embolism in a patient suffering from schizophrenia who died after physical restraint. The possible association between conventional antipsychotic drugs and deep venous thrombosis, followed by pulmonary embolism, in a man with no predisposing risk factors, as well as the question concerning the appropriateness of medical care, are discussed.

2012 - Journal publishing bio-medicolegal research in Europe [Articolo su rivista]
Boscolo, R.; Viel, G.; Cecchi, Rossana; Terranova, C.; Vogliardi, S.; Bajanowski, T.; Ferrara, S. D.
abstract

Fragmentation of bio-medicolegal knowledge has led to a proliferation of ultra-specialised sub-disciplines and branches, often published in 'field-oriented' scientific journals.The aim of this work is to provide an in-depth analytical picture of bio-medicolegal sources of publication, within and outside the traditional conception of legal medicine. An extensive search of bio-medicolegal articles published in the last five and a half years was performed on the MEDLINE database according to MeSH terms combined with free-text protocols. We performed a systematic analysis of targeted journals after merging, selecting and categorising all retrieved records, taking into account data from the 2009 JCR Science Edition (released on June 2010); 1,037 different journals were identified, of which only 48 (4.6%) focus specifically on bio-medicolegal matters, and of which only seven (14.6%) have an impact factor (IF). Despite this apparent dispersion, 47% of articles were published in bio-medicolegal journals (BML), of which 70.2% were in journals with IF (BML-IF). Articles published in BML-IF journals (33% of total papers) reach almost 50%, mainly in "Forensic Science International", "International Journal of Legal Medicine" and "Journal of Forensic Sciences". Instead, publications in not specifically bio-medicolegal journals (Not BML-IF) are greatly scattered and even fragmented in about 650 journals.The sub-disciplines that appear most frequently in Not BML-IF rather than BML-IF journals are Forensic Psychiatry (48.2% vs. 5.1%), Criminology (37.1% vs. 8.3%), Malpractice (50.7% vs. 4.0%), Medical Law and Ethics (46.4% vs. 6.9%) and Clinical Forensic Medicine (39.5% vs. 21.3%). The proposed bibliometric analysis revealed the preference of Forensic Pathology, Criminalistics (Biological), Forensic Genetics, Forensic Anthropology and Forensic Entomology for journals traditionally considered pertinent to the medico-legal discipline, with a considerable dispersion involving Toxicology, Psychiatry, Criminology and Malpractice, which were published in less well-known journals. This dispersion could be reduced adapting specialised forensic sections and increasing the IF of forensic journals, in order to respond suitably to the present demand for visibility by bio-medicolegal scientists, clearly oriented towards enhancing the objective impact of their curricula and attempting to attract funding to their research projects.

2012 - Markers di cronologia delle lesioni e rilevanza di prova [Articolo su rivista]
Cecchi, Rossana; D'Annibale, C; Valente, S; Boccardelli, G; Caruso, S; Mariani, A; Catanese, M; Sestili, C.
abstract

Gli Autori effettuano una revisione critica degli studi, eseguiti sino ad oggi, concernenti la cronologia delle lesioni di interesse della patologia forense, focalizzando l'attenzione sulle caratteristiche che dovrebbe avere un parametro per assumere il valore di prova in giudizio. Le informazioni piú affidabili di ciascun marker sono sintetizzate in tabelle secondo la cronologia che evidenziano e le prospettive di ricerca future sono discusse.

2012 - Morte anafilattica. Stato dell'arte e proposta di sistematica diagnostica medico-legale [Articolo su rivista]
Cecchi, Rossana; Muciaccia, B.
abstract

Gli Autori dopo un’ampia revisione della letteratura relativa alle morti per anafilassi, di interesse patologico forense, propongono un protocollo diagnostico a fini forensi e analizzano le nuove prospettive diagnostiche rese possibili dalle nuove tecniche analitiche e dai nuovi markers disponibili.

2012 - Pulmonary embolisation of bone fragments from penetrating cranial gun shot wounds [Articolo su rivista]
Cecchi, Rossana; Cipolloni, L.; Sestili, C.; Aromatario, M.; Ciallella, C.
abstract

Bone embolism is very rare event that only occurs in trauma-induced septic bone lesions, after bone surgery or after bone marrow transplantation, and normally remains silent. To our knowledge, there are no previous reports of bone embolism after a gunshot to the head. We describe a case of pulmonary embolism associated with bone fragments after a gunshot to the head in which bone fragments surrounded by leukocytes, interstitial and intra-alveolar oedema and haemorrhage around the embolised vessels, leukostasis, fat and bone marrow embolism suggest that the survival time from the gunshot was sufficiently long to allow changes in lung microcirculation and lung tissue.

2011 - Bio-medicolegal scientific research in Europe. A country-based analysis [Articolo su rivista]
Guido, Viel; Rafael Boscolo, Berto; Cecchi, Rossana; Thomas, Bajanowski; Nuno Duarte, Vieira; Santo Davide, Ferrara
abstract

The European mosaic of socio-cultural, economic and legal realities is reflected in forensic and legal medicine, in which a great variety of operational modes of forensic medical services, organisational systems, structures, functional competences and scientific research strategies can be observed. The present work analyses the European bio-medicolegal scientific output of the last 5.5 years (exact time window, January 1, 2005-June 1, 2010), categorising papers by nationality of the corresponding author and forensic sub-discipline in question, in order to identify the peculiarities of national sub-specialised competences and to build up international research projects. This country-based bibliometric analysis, based on the number of articles and the impact factor produced by each European country, also considering its economic profile (gross domestic product and per capita gross domestic product), highlights the prevailing productive role of Western and Southern Europe (Germany, Great Britain, Italy, Switzerland, Spain and France). Categorising scientific output by forensic sub-discipline and branch, significant in terms of impact factor are contributions from Germany (coming first in Pathology, Toxicology, Genetics, Anthropology and Biological Criminalistics), Great Britain (first in Clinical Forensic Medicine, Malpractice and Invalidity-Social Insurance), Switzerland (first in Criminology), Italy (second in Toxicology, Anthropology and Invalidity-Social Insurance), The Netherlands (third in Clinical Forensic Medicine and Medical Law and Ethics), Spain (third in Genetics, Criminalistics and Invalidity-Social Insurance) and France (third in Toxicology and Malpractice). Interestingly, several countries with low gross domestic product, such as Poland, Turkey and other Eastern European nations, show notable scientific production in specific sub-disciplines such as Pathology, Toxicology and Forensic Genetics, suggesting that fruitful international cooperation could be planned and be of interest to funding sources within the European Community, also taking into account funds reserved for depressed areas undergoing development.

2011 - Bio-medicolegal scientific research in Europe: a comprehensive bibliometric overview [Articolo su rivista]
Santo Davide, Ferrara; Thomas, Bajanowski; Cecchi, Rossana; Rafael Boscolo, Berto; Guido, Viel
abstract

In times of globalisation, the future of bio-medicolegal sciences in Europe depends on the scientific community's ability to develop new strategies for research, to introduce new and generally accepted standards, to develop new analytical methods, all in order to draw up inter-site, multidisciplinary and interdisciplinary long-term research projects, eligible for European Union (EU) funding. To analyse the scientific output and to identify the topics of greatest interest and appeal in these sciences, an innovative method has been developed to select and analyse publications. This method has been applied to analyse a total of 21,176 records from PubMed out of which 5,826 papers were suitable for further analysis because they were published in national and international journals in the time between January 1, 2005 and June 1, 2010 by European authors in the field of interest. In 69% of all manuscripts, authors presented results of systematic research (original articles); 84% of the papers were written in English language. The cumulative impact factor increased from 1,670 points in 2005 to 1,878 in 2009, and extrapolated 2,812 points in 2010. The most frequent topics were the description of new analytical methods in forensic toxicology (5.7% of all papers), the analysis of short tandem repeat systems (STR, 5.6%) as well as the analysis of injury mechanisms in forensic pathology and clinical forensic medicine (4.9%). If the impact factor related potential of different topics is calculated (ratio of frequency of papers and frequency of impact points achieved), SIDS research reaches 1.64 points, followed by studies on mtDNA (1.59) and the development of new analytical methods in forensic toxicology (1.49). The findings made in the present bibliometric analysis reveal a clear and interesting overall picture of the European scientific production and productivity and could be used to identify the most innovative research lines.

2011 - Iatrogenic damage to the mandibular nerves as assessed by the masseter inhibitory reflex [Articolo su rivista]
Antonella, Biasiotta; Piero, Cascone; Cecchi, Rossana; Giorgio, Cruccu; Giorgio, Iannetti; Alessandro, Mariani; Andrea, Spota; Andrea, Truini
abstract

Iatrogenic injury of the inferior alveolar or lingual nerves frequently leads to legal actions for damage and compensation for personal suffering. The masseter inhibitory reflex (MIR) is the most used neurophysiological tool for the functional assessment of the trigeminal mandibular division. Aiming at measuring the MIR sensitivity and specificity, we recorded this reflex after mental and tongue stimulations in a controlled, blinded study in 160 consecutive patients with sensory disturbances following dental procedures. The MIR latency was longer on the affected than the contralateral side (P < 0.0001). The overall specificity and sensitivity were 99 and 51%. Our findings indicate that MIR testing, showing an almost absolute specificity, reliably demonstrates nerve damage beyond doubt, whereas the relatively low sensitivity makes the finding of a normal MIR by no means sufficient to exclude nerve damage. Probably, the dysfunction of a small number of nerve fibres, insufficient to produce a MIR abnormality, may still engender important sensory disturbances. We propose that MIR testing, when used for legal purposes, be considered reliable in one direction only, i.e. abnormality does prove nerve damage, normality does not disprove it.

2011 - Tecnologia, etica e medicina legale [Capitolo/Saggio]
Cecchi, Rossana; Procaccianti, P.
abstract

Analisi degli elementi psicologici, sociologici, antropologici, filosofici, teologici, giuridico-legislativi, oltre che scientifici su cui si fonda la bioetica. Aspetti etici relativi all'interruzione volontaria di gravidanza, obiezione di coscienza, procreazione medicalmente assistita. Problemi relativi ai diritti del malato terminale; informazione, cure palliative, trattamento del dolore ed eutanasia.

2010 - Bio-medicolegal guidelines and protocols: survey and future perspectives in Europe [Articolo su rivista]
Santo Davide, Ferrara; T., Bajanovski; Cecchi, Rossana; Rossella, Snenghi; Colette, Case; Guido, Viel
abstract

The preservation of uniqueness and the enhancement of the value of evidence in legal medicine is based on the implementation and development of a "quality management system," which includes a continuous education of specialists, the introduction and application of guidelines and protocols, as well as mechanisms of internal quality control. This ongoing process shows differences with regard to various fields of knowledge such as forensic genetics, toxicology, forensic pathology or forensic psychiatry, especially if different European countries are compared. To get an overview on the development of legal medicine in different European countries, a questionnaire was developed and sent to representatives of 42 European countries to verify the existence of bio-medicolegal guidelines and protocols. A National Society of Legal Medicine is established in 27 out of 32 countries (84%) which could be included in the final analyses. In 25 countries (78%), a specialisation is necessary as a prerequisite of inclusion in a national register, and 30 of the countries (94%) have guidelines in at least one field of legal medicine. The most common guidelines concern forensic pathology (in the fields of professional qualification and sudden death), forensic toxicology (driving under the influence of drugs and substance testing) and forensic genetics (paternity testing and personal identification). The findings of this study show that comparison is possible and can be a basis for further consensus in the European medicolegal community. The process of harmonisation of the medicolegal autopsy rules in Europe initiated in 1990 was a first step on this way. Further consensus is necessary and might be gained by developing European guidelines for each field within the subdisciplines, based on a standard European Guideline Format.

2010 - Erratum: Bio-medicolegal guidelines and protocols: Survey and future perspectives in Europe (International Journal of Legal Medicine DOI: 10.1007/s00414-010-0475-z) [Articolo su rivista]
Ferrara, S. D.; Bajanowski, T.; Cecchi, R.; Snenghi, R.; Case, C.; Viel, G.
abstract

2010 - Estimating wound age: looking into the future [Articolo su rivista]
Cecchi, Rossana
abstract

A critical review is made of the studies on wound healing used for forensic purposes, focusing on the problem of which characteristics indicate that a parameter could be used as evidence in court. A panel analysing the more important information obtained by each marker is given, and a perspective of what might be expected from future research is discussed.

2010 - Il consenso informato in igiene dentale: proposta di una modulistica [Articolo su rivista]
Cecchi, Rossana; A., Grillo
abstract

Scopo del lavoro è evidenziare l’esigenza, il dovere e l’obbligo anche per l’igienista di ottenere un consenso informato valido del paziente. Gli autori, partendo dai moduli di consenso informato già esistenti per gli odontoiatri, propongono moduli adattati alle esigenze dell’igienista dentale, specifici per ogni trattamento di prevenzione. Essi constano di 4 parti: 1) dati anagrafici; 2) anamnesi; 3) informazione sul tipo di intervento indicato dal medico/odontoiatra, sulle tecniche e/o materiali impiegati nel trattamento, sulle loro controindicazioni, sul risultato ottenibile e sui comportamenti da seguire per evitare complicanze successive all’intervento; 4) una dichiarazione del paziente di aver ricevuto le informazioni sopra elencate e del rispettivo consenso o diniego all’effettuazione degli interventi di prevenzione con la rispettiva firma dello stesso e dell’igienista dentale. Siffatte schede di consenso informato possono risultare molto utili agli igienisti dentali per ottemperare agli obblighi di informazione e di ottenimento del consenso. Ne deriva l’importanza di conservarli quale prova al fine di dirimere contenziosi relativi alla non riuscita delle cure ovvero rivendicazioni da parte del paziente.

2009 - Affidabilità medico-legale del riflesso inibitore del massetere per la valutazione delle lesioni iatrogene del nervo mandibolare [Articolo su rivista]
Cecchi, Rossana; Mariani, A; Truini, A; Cruccu, G.
abstract

Ottenere una stima medico-legale precisa della frequenza e della gravità del danno a carico della terza branca del trigemino è difficile in assenza di una standardizzazione e di un metodo di indagine obiettivo. Il presente studio si pone il fine di verificare la sensibilità e la specificità del test del riflesso inibitore del massetere (MIR) atto ad obiettivare le lesioni iatrogene a carico del nervo alveolare inferiore e del nervo linguale allo scopo di valutarne l'applicabilità a fini medico-legali.

2009 - Diritti dei soggetti trapiantati nell’ambito del SSN ed in ambito lavorativo [Capitolo/Saggio]
Cecchi, Rossana; Caruso, S.
abstract

1. Riconoscimento o conferma della condizione di invalido civile e diritto alle prestazioni sulla base della percentuale di invalidità tabellata (L.118/71 e DM del 5 febbraio 1992). 2. Benefici in caso di sussistenza della condizione di handicap (L.104/92). 3. Riconoscimento o conferma della pensione di inabilità o dell’assegno ordinario di invalidità INPS (artt. 1 e 2 L. 222/84). 4. Diritto all’esenzione dalla partecipazione al costo per le prestazioni di assistenza sanitaria (DM 329/99 aggiornato dal DM 296/01). 5. Rimborsi spese di carattere non sanitario (spese di viaggio e di soggiorno) le cui modalità sono indicate specificatamente nelle varie leggi regionali.

2009 - Istopatologia forense [Capitolo/Saggio]
Cecchi, Rossana; Marchetti, D.
abstract

Sommario: 1. Il laboratorio di istopatologia forense. – 1.1. M.O. e sue finalità. – 1.2. Immunoistochimica. – 1.3. Ibridizzazione in situ. – 1.4. Estrazione del DNA dai tessuti.– 1.5. Metodi di conservazione degli organi. – 1.6. Il Microscopio elettronico e sue finalità. – 2. Processi patologici: generalità. – 3. Il Sistema Nervoso. – 3.1. Alterazioni microscopiche del Sistema Nervoso Centrale nelle lesioni traumatiche. –3.1.1. Danno cerebrale primitivo (Contusione cerebrale, Danno assonale). – 3.1.2. Complicanze secondarie al trauma (Edema cerebrale, Danno ipossico, Infarto cerebrale).– 3.1.3. Emorragie intracraniche (Subdurale, Subaracnoidea, Intraparenchimale). – 3.2. Aspetti microscopici degli emboli cerebrali (Embolia adiposa, Embolia gassosa, Microemboli settici). – 3.3. Microtrombi. – 3.4. Lesioni dei vasi cerebrali (Aneurismi, Necrosi acidofila, Del sistema vertebro-basilare, Vasculiti). – 3.5. Alterazioni post-traumatiche dell’ipofisi. – 4. Il sistema scheletrico. – 4.1. L’identificazione dell’età attraverso l’esame microscopico. – 4.2. L’esame istologico di frammenti di osso allo scopo di valutarne l’origine o meno umana. – 5. La cute. – 5.1. Le lesioni d’arma da fuoco. – 5.1.1. Foro d’entrata. – 5.1.2. Foro d’uscita. – 5.1.3. Problemi di diagnosi differenziale. – 5.2. Alterazioni cutanee da calore e da passaggio di elettricità. – 5.2.1. Le lesioni da calore. – 5.2.2. Le lesioni da elettricità. – 5.3. Lesioni termiche da freddo. – 5.4. Lesioni cutanee da laccio nell’impiccamento.– 5.5. I segni di agopuntura. – 6. Il cuore. – 6.1. Alterazioni ischemiche della cellula miocardica. – 6.2. Modificazioni del sistema di conduzione e di innervazione cardiaca. – 6.3. Complicanze cardiovascolari dei traumi chiusi del torace. – 6.4.Miocarditi. – 6.5. Aspetti microscopici delle cardiomiopatie (Cocaina-correlate, Alcool- etilico associate, Aritmogena del ventricolo destro, Ipertrofica). – 6.6. Alterazioni microscopiche correlate a farmaci, sostanze stupefacenti ed a sostanze tossiche inorganiche. – 7. Il Polmone. – 7.1. Alterazioni istologiche nelle asfissie meccaniche violente. – 7.2. Le embolie polmonari. – 7.3. Il polmone nello shock allergico. – 7.4. Il polmone fetale e del prematuro. – 7.5. Alterazioni correlate a farmaci, a sostanze stupefacenti ed all’assunzione di sostanze tossiche inorganiche. – 7.6. Le modificazioni post-mortali. – 8. Il fegato. – 8.1. Alterazioni correlate a farmaci, a sostanze stupefacenti ed all’assunzione di sostanze tossiche. – 8.2. Le modificazioni postmortali. – 9. Il tratto gastrointestinale. – 9.1. Le lesioni da calore. – 9.2. Le alterazioni microscopiche correlate a farmaci ed a sostanze tossiche. – 9.3. Lesioni della mucosa gastrica nei casi di annegamento. – 10. Utero, Ovaio, Placenta. – 11.Il rene. – Fonti bibliografiche.

2009 - Le asfissie meccaniche [Capitolo/Saggio]
Merli, S; Cecchi, Rossana
abstract

SOMMARIO: 1. Definizione. –2. Il decorso del processo asfittico. —3. Reviviscenza. —4. Quadri generici di asfissia. —5. Reperti istologici. — 6. Reperti ultrastrutturali. — 7. Reperti biochimici. — 8. Soffocamento. — 8.1. Definizione. — 8.2. Meccanismo asfittico. — 8.3. Esame necroscopico. — 8.4. Dinamica. —9. Strozzamento. — 9.1. Definizione. — 9.2. Meccanismo asfittico. — 9.3. Esame necroscopico. — 9.4. Dinamica. — 10. Strangolamento. — 10.1. Definizione. — 10.2. Meccanismo asfittico. — 10.3. Esame necroscopico. — 10.4. Dinamica. — 10.5. Diagnosi differenziale. — 11. Impiccamento. — 11.1. Definizione. — 11.2. Meccanismo asfittico. — 11.3. Esame necroscopico (segni esterni). — 11.4. Esame necroscopico (segni interni). — 11.5. Dinamica. — 11.6. Diagnosi differenziale. — 12. Le asfissie da aspirazione: il problema definitorio. — 12.1. Sommersione interna. — 12.1.1. Defmizione. — 12.1.2. Meccanismo asfittico. — 12.1.3. Esame necroscopco. — 12.1.4. Dinamica. — 12.2. Intasamento. — 12.2.1. Definizione. — 12.2.2. Meccanismo asfittico. — 12.2.3. Dinamica. — 12.2.4. Esame necroscopico e diagnosi differenziale. — 13. Compressione del torace: — 131. Definizione. — 13.2. Meccanismo asfittico. — 13.3. Esame necroscopico. — 13.4. Dinamica. — 14. Asfissia da spazio confinato. — 14.1. Definizione. — 14.2. Dinamica.

2009 - Stati intersessuali e quesitoni medico-legali [Articolo su rivista]
Cecchi, Rossana; Morrocco, G.
abstract

La diagnosi degli stati intersessuali, l’attribuzione del sesso e la correlata terapia farmaco-chirurgica pongono questioni medico-legali la cui rilevante complessità è accentuata dalla molteplicità di soluzioni adottabili, nonché dalla diversità di figure professionali e parentali in esse coinvolte. Ipotesi di colpa professionale scaturiscono da errori di attribuzioni del sesso, da misinterpretazione di dati clinici o da prematuro ed errato intervento chirurgico. La diagnosi ed il trattamento degli stati intersessuali richiedono una buona raccolta anamnestica ed un attento esame obiettivo, nonché esami di laboratorio e radiografici, terapie chirurgiche e farmacologiche che devono essere attuate in equipe di esperti. Per tale motivo viene enfatizzata l’importanza di linee-guida di riferimento così come centrale diviene il consenso informato del minore. Gli autori propongono una possibile soluzione del problema giudico connesso a questa problematica.

2008 - Deontologia medica. Dalla deontologia ippocratica alla bioetica [Monografia/Trattato scientifico]
Calcagni, C; Cecchi, Rossana
abstract

PARTE A FILOSOFIA, ETICA E BIOETICA NELLE DISCIPLINE SANITARIE 1) La deontologia medica 2) Riflessioni storico-filosofiche tra etica e professione medica 3) Rapporto tra etica e deontologia medica 4) Dicotomia tra etica e morale nel pensiero filosofico 5) Origine e sviluppo storico e filosofico del pensiero deontologico 6) Il codice deontologico medico PARTE B ANALISI IN CHIAVE BIOETICA E DEONTOLOGICA DEI PRINCIPALI TEMI DI INTERESSE SANITARIO 7) Segreto professionale 8) Atto medico, facoltà di compierlo, informazione al cittadino e consenso del malato alle cure 9) Cartella clinica 10) Tutela dei dati personali dell’assistito 11) Sperimentazione e Comitati etici 12) Accanimento terapeutico ed il cosiddetto testamento biologico 13) Diritti del malato terminale: informazione, cure palliative, eutanasia 14) Obblighi del medico nell’esercizio professionale - Certificazione medica - Ricetta - Denunce - La prescrizione di sostanze stupefacenti, psicotrope e antidolorifiche 15) Doveri del medico in sede penale - Referto - Omissione di soccorso - Responsabilità professionale - Perizia e Consulenza Tecnica 16) Accertamento di morte cerebrale, prelievi e trapianti di organo, idratazione ed alimentazione artificiale e stato vegetativo permanente 17) Aspetti medico-legali e deontologici in ginecologia ed ostetricia - Interruzione volontaria di gravidanza - Fecondazione assistita - Contraccezione, etica prenatale - Nuove frontiere della responsabilità professionale in ostetricia 18) Irrinunciabilità del valore deontologico dell’incontro medico-paziente

2008 - Lo stato vegetativo permanente: una questione bioetica aperta [Articolo su rivista]
Cecchi, Rossana
abstract

L’Autrice esamina il problema dello stato vegetativo permanente in ambito bioetico-giurisprudenziale, suggerendo una metodologia di approccio che parte dall’aspetto strettamente medico-diagnostico, sulla base del quale inquadrare la prognosi che, cosı`, diviene il terreno di discussione delle misure assistenziali da attuare, tenendo in debito conto le volonta` eventualmente espresse in precedenza dal paziente, ovvero il suo consenso/dissenso, come desunto dagli elementi a disposizione per valutare la sussistenza della fattispecie di accanimento terapeutico.

2008 - The diagnosis of fatal pulmonary fat embolism using quantitative morphometry and confocal laser scanning microscopy [Articolo su rivista]
Emanuela, Turillazzi; Irene, Riezzo; Margherita, Neri; Cristoforo, Pomara; Cecchi, Rossana; Vittorio, Fineschi
abstract

The postmortem diagnosis of fat embolism syndrome (FES), traditionally based on the histological demonstration of fat globules, needs a quantitative analysis of both the size and localization of the fat emboli, which is essential for a reliable grading of the pulmonary fat embolism. The clinical data and the autopsy records of 2738 autopsies were retrospectively evaluated, and 21 cases in which FES was pointed out as cause of death were selected and compared with 21 fatal cases referred to as major trauma in which the cause of death was not attributed to fat embolism, and with 47 fatal cases as control group, respectively. The following parameters were investigated: the total area of the embolized tissue; the total number of emboli; the mean area of the emboli; the mean percentage of the embolized tissue area as compared with the total tissue area of each sample; the total percentage of the embolized tissue area as compared with the total tissue area of all slides. The most reliable parameters seem to be the ratio between embolized tissue areas as compared with the total tissue area of each sample. These parameters showed a good correlation with the clinical data. (c) 2008 Elsevier GmbH. All rights reserved.

2008 - VERIFICA DELLA CONCORDANZA TRA DIAGNOSI CLINICA E AUTOPTICA IN CASI DI LESIONI MORTALI DA INCIDENTI STRADALI [Articolo su rivista]
Cecchi, Rossana; Selleri, I; Boccardelli, G; Caruso, S; Valente, S.
abstract

Il pronto soccorso rappresenta un momento critico al fine di evitare i decessi nei casi di incidenti stradali. L'individuazione di eventuali errori commessi in tali strutture diventa, quindi, fondamentale. In collaborazione con l'Agenzia di Sanità Pubblica della Regione Lazio, sono stati confrontati i referti autoptici del settorato dell'istituto di medicina legale dell'Università "Sapienza" di Roma, riguardanti i decessi per incidente stradale, verificatisi negli anni 2000-2001 e le corrispondenti diagnosi cliniche di pronto soccorso. Lo studio dimostra che esiste un'elevata percentuale di discordanze tra la diagnosi medica in sede di pronto soccorso e la diagnosi autoptica, donde la necessità di promuovere indagini analoghe su più larga scala.

2007 - IL CONTRIBUTO DELL’ISTOPATOLOGIA NELLO STUDIO DEL CADAVERE PUTREFATTO [Articolo su rivista]
Fornes, P; Tovaglia, P; Cecchi, Rossana
abstract

La diagnosi della causa di morte nel cadavere in putrefazione rappresenta da sempre un problema importante per il medico legale, ciò è legato agli artefatti che tale processo di modificazione postmortale può determinare. L’obiettivo del presente lavoro è quello di valutare il contributo dell’istopatologia nello studio del tessuto in decomposizione ed il suo metodo di applicazione. Sono stati prelevati da cadavere in vari stadi di putrefazione frammenti di organi successivamente colorati con tecniche standard (Ematossilina-Eosina-Safran) e speciali (Tricromica di Masson, Gordon-Sweet, Perls) che evidenziano le componenti tessutali maggiormente resistenti: tessuto connettivale ed elastico. La persistenza di queste componenti anche a distanza di tempo dalla morte, in diversi casi, ha consentito la valutazione morfologica di : cuore, polmoni, vasi, fegato, milza, pancreas, meningi, cute. L’analisi dei risultati ottenuti consente di definire una proposta di protocollo relativo al tipo di prelievo da effettuare nel cadavere e quali tecniche istologiche specifiche utilizzare. Tale metodologia può essere applicata sia ai casi di morte naturale che violenta.

2007 - Medicina Legale [Capitolo/Saggio]
Merli, S; Cecchi, Rossana
abstract

Inquadramento giuridico del problema, la responsabilità professionale del medico in ambito penale, la condotta colposa , il danno, il nesso di causalità materiale, il problema dell'eziologia e della patogenesi, il problema delle concause, il metodo medico-legale. La responsabilità professionale del medico in ambito civile, la responsaiblità contrattuale ed extracontrattuale, applicazione dell'art. 2236 c.c. nel diritto penale. Lo stato di necessità. La valutazione della responsabilità professionale del chirurgo, l'errore chirurgico. La cartella clinica, il consenso informato. Il metodo medico-legale per la valutazione dell'errore chirurgico, fase pre-operatoria, fase intraoperatoria, fase post-operatoria. Errori legati al cihirurgo.

2007 - Su di un caso di morte asfittica per distrofia muscolare [Articolo su rivista]
Moriani, S; Caruso, S; D'Alessandro, V; Cecchi, Rossana
abstract

Gli Autori presentano un caso peritale, giunto all’osservazione del settorato medico legale di Roma, di un soggetto affetto da distrofia muscolare facio-scapolo-omerale (FSH) e deceduto a seguito dell’interruzione della ventilazione meccanica a cui era soggetto a causa di una progressiva paralisi della muscolatura toracica. Essendo nota con esattezza la durata del processo asfittico terminale, che dal momento dell’interruzione della ventilazione meccanica ha condotto al decesso il paziente, abbiamo ritenuto interessante verificare, oltre ai segni classici della patologia a carico dei vari organi, l’esistenza di reperti nel tessuto nervoso che potessero dare indicazione del tempo di sofferenza asfittica e valutarne la correlazione con il dato temporale a nostra disposizione. Campioni di cuore, encefalo, polmoni, fegato e pancreas sono stati prelevati e trattati con ematossilina-eosina. I dati ottenuti a carico del tessuto cardiaco hanno evidenziato reperti morfologici compatibli con quelli comunemente osservati nell’involuzione della muscolatura volontaria e involontaria nei pazienti affetti da distrofia muscolare. Per quanto concerne il meccanismo che ha portato a morte il soggetto, i dati anatomo-patologici a carico dei polmoni hanno documentato un chiaro quadro di sofferenza asfittica prolungata a cui corrisponde il quadro ipossico rilevato a livello del tessuto cerebrale.

2007 - “Opzioni e propensioni di un campione di medici “intensivisti” riguardo all’interruzione e la sospensione delle cure nei malati terminali in casi eticamente problematici (il questionario Ethicatt).” [Articolo su rivista]
Cecchi, Rossana; DI VELLA, G; Sannella, A; Valente, S; Boccardelli, G; Longo, E.
abstract

Gli Autori riferiscono i risultati ottenuti dalla somministrazione ai medici dei reparti di terapia intensiva dell’Ethicatt Questionnaire-Doctor realizzato nel contesto del più ampio studio approvato dalla Commissione Europea nell’ambito del V Programma quadro per il finanziamento alla ricerca, condotto dalla Facoltà di Sociologia dell’Università di Roma La Sapienza, sul tema “Life and death in intensive care units in Europe. The ethics of decision-making about end of life”. Sono state estrapolate le risposte date ai quesiti relativi alla decisione di sospendere o rifiutare trattamenti ai malati terminali ed i risultati dimostrano l’affermazione del principio di equivalenza morale fra il non intraprendere ed il sospendere una terapia, pur permanendo, tuttavia, una profonda differenza sul piano psicologico, per cui molti medici hanno più difficoltà a sospendere piuttosto che a rifiutare un trattamento.

2006 - Il Testamento biologico: perchè? [Capitolo/Saggio]
Cecchi, Rossana
abstract

L'Autore, attraverso l'analisi dell'evoluzione del concetto di consenso informato realizzatasi nei codici deontologici medici che si sono susseguiti dal 1978 ad oggi, dimostra come in Italia i tempi siano maturi per una legislazione in tema di direttive anticipate di trattamento (cd. testamento biologico).

2006 - Medico Legal and Forensic Psychiaric Aspects of Gender Assignment. [Abstract in Atti di Convegno]
Cecchi, R.; Ferracuti, S.
abstract

2006 - Opzioni e propensioni di un campione di medici “intensivisti” riguardo al consenso dei malati terminali circa l’attuazione e la sospensione delle cure in casi eticamente problematici (il questionario Ethicatt) [Articolo su rivista]
Cecchi, Rossana; DI VELLA, G; Sannella, A; Valente, S; Boccardelli, G; Longo, E.
abstract

Gli Autori riferiscono i rsiultati ottenuti dalla somministrazione ai medici di terapia intensiva dell'Ethicatt Questionnaire-Doctor realizzato nel contesto del più ampio studio approvto dalla Commissione Europea nell'ambito del 5° programma quadro per il finanziamento alla ricerca , condotto dalla Facoltà di Sociologia dell'Università La Sapienza di Roma dal tema "Life and death in intensive care in Europe. The Ethics of decision-making about end of life". Sono state estrapolate le risposte date ai quesiti relativi al consenso informato del paziente del paziente terminale, i cui risultati documentano un cambiamento dell'atteggiamento del medico nei confronti del paziente e della sua famiglia, mostrando l'influsso positivo che potrebbe avere l'eventuale presenza di un testamento biologico.

2005 - Cure palliative e sedazione terminale tra legittimità ed eticità [Articolo su rivista]
Cecchi, Rossana; Boccardelli, G; Caruso, S; Celeste, G.
abstract

Gli Autori esaminano le principali caratteristiche delle cure palliative e della sedazione terminale, descrivendo il contesto socio-sanitario in cui si sono affermate. Discutono, quindi, la loro collocazione, tra qualità della vita, accanimento terapeutico ed eutanasia, in un dibattito bioetico che pone al centro il malato terminale ed i problemi di fine vita.

2005 - La procreazione medicalmente assistita: à la recherche di un difficile equilibrio tra scienza e diritto [Articolo su rivista]
Manna, A; Cecchi, Rossana; Agnello, G; Sannella, A; Resta, F.
abstract

Gli Autori osservano come la legge 40/2004 rappresenti un caso di riproposizione dei paradigmi tipici della legislazione penale "emergenziale", caratterizzata dalla prevalente utilizzazione del precetto penale in chiave simbolico-espressiva e in funzione preformativa di un ethos sociale, che rinviene una forte copertura ideologica nella tutela incondizionata e assoluta dell'embrione. Un corretto bilanciamento dei valori in conflitto avrebbe, invece, imposto l'adozione di un modello di tutela "gradualistica" del diritto alla vita del concepito, che si fondi sul riconoscimento della distinzione tra tutela della vita e della dignità del soggetto e attribuzione, allo stesso, dello statuto giuridico di "persona".

2005 - Quale impostazione al dibattito sulla legge 40/2004? [Articolo su rivista]
Cecchi, Rossana; Boccardelli, G; Caruso, S; Agnello, G; Sannella, A.
abstract

Il dibattito seguito alla legge 40/2004, che regola la prassi della fecondazione assistita in Italia, ha dato vita alla necessità di una conferma referendaria della stessa. Gli Autori esaminano i quesiti ammessi dalla Corte Costituzionale , partendo dalle motivazioni tecnico-pratiche che ne sono alla base, e propongono soluzioni possibili alla discussione attualmente in corso.

2004 - Atti V Convegno Nazionale del Gruppo Italiano di Patologia Forense. Tirrenia, 11-13 Novembre 2004 [Curatela]
G. M., Mazzei; Cecchi, Rossana
abstract

2004 - La vitalità delle lesioni da arma bianca: studio sperimentale [Articolo su rivista]
Cecchi, Rossana; D'Annibale, C; Valente, S; Ferrera, V.
abstract

Gli Autori applicano la tecnica immunoistochimica con anticorpo anti-selectina P a campioni di cute prelevati nel corso di interventi chirurgici a 0', 1', 3', 5', 10', 15', 30', 60' al fine di verificare l'attivazione degli endoteli dei vasi tempo-dipendente. I risultati dimostrano che già a 1 minuto il numero dei vasi attivati aumenta, con un picco a 15' e 30'. Si tratta, pertanto, di un buon marker per la vitalità delle lesioni.

2003 - La morte da shock psico-emotivo nel settorato dell'Istituto di Medicina Legale e delle Assicurazioni dell'Università di Roma "La Sapienza". Revisione casistica di un ventennio (1979-1999) [Articolo su rivista]
Cipolloni, L; Tiburzi, P; Cecchi, Rossana
abstract

Gli Autori riportano ed esaminano la casistica (12 casi) relativa alle morti da shock psico-emotivo osservata nel settorato medico-legale dell'Università di Roma La Sapienza nel ventennio 1979-1999. I risultati emersi dall'analisi dei dati a disposizione appaiono in accordo con la letteratura sull'argomento per quanto attiene alla esiguità della casistica, all'importanza dell'età e dell'intervallo tra esposizone allo stimolo emozionale e decesso, e, infine, alle alterazioni istologiche osservate a carico dell'apparato cardiocircolatorio , che rappresenta il target elettivo di detta reazione, e confermano l'effettivo ruolo concausale dello stress emotivo nell'exitus dei soggetti.

2002 - L’applicazione della metodica istologica in istopatologia forense [Relazione in Atti di Convegno]
CAVE BONDI, G; Cecchi, Rossana
abstract

Gli autori descrivono le più frequenti applicazioni delle metodiche istochimiche ed immunoistochimiche nell'ambito della patologia forense come ad es. la vitalità e cronologia delle lesioni cutanee, le ferite d'arma da fuoco, il marchio elettrico.

2001 - A review of suicides by burning in Rome between 1947-1997 examined by Pathology Department of the Istitute of Forensic Medicine, University of Rome "La Sapienza" [Articolo su rivista]
CAVE BONDI, G; Cipolloni, L.; Parroni, E; Cecchi, Rossana
abstract

The 34 cases of suicide by self-immolation admitted to the Institute of Forensic Medicine, University of Rome ‘La Sapienza’, during a 50-year period (1947–1997) were investigated. The nature of this phenomenon in relation to sex, age of the victims, location of the suicides and combination of methods used is discussed. Finally the distribution and extent and characteristics of the lesions are considered from a forensic point of view.

2001 - Immunohistochemical quantification of pulmonary mast-cells and post mortem bood dosages of tryptase and eosinophil cationic protein in 48 heroin-related deaths [Articolo su rivista]
Fineschi, V; Cecchi, Rossana; Centini, F; Reattelli, Lp; Turillazzi, E.
abstract

Recent studies suggest that many fatal heroin overdoses are caused by anaphylactoid reaction. In the present study we measured tryptase and eosinophil cationic protein in post-mortem blood of 48 deaths after heroin injection. We also investigated the presence and pulmonary distribution of mast-cells using specific immunohistochemical antibody for tryptase and morphometric evaluation in those cases of heroin-related deaths. The data were compared with 44 subjects who died following head trauma and to 32 cases of fatal anaphylactic shock. In the heroin-related death cases, the measurements of serum tryptase levels and eosinophil cationic protein dosages resulted in particularly elevated concentrations compared with the trauma cases. Nevertheless, the data that our study supplies by immunohistochemical techniques indicate that when mast-cells count in the lung was determined, no definite pattern was obtained between fatal heroin overdose cases and the control groups. Furthermore, the wide range of morphine concentrations found in post-mortem blood samples suggest that the term 'overdose' is relative and does not sufficiently characterize death associated with heroin addiction. Our study confirms that elevated concentrations of serum tryptase are associated with many heroin-related deaths. At this moment to attribute the cause of these deaths to 'heroin overdose' ignores the likely causal contribution of other possible systemic reactions to the mechanism of death.

2001 - L’applicazione del metodo di Dahl sulle lesioni cutanee da arma da fuoco per lo studio della distanza di sparo [Articolo su rivista]
Cecchi, Rossana; Cecchetti, F; Ciallella, C.
abstract

La dimostrazione della presenza dei residui dell'innesco (Pb, Sb, Ba, Zn, Ti) sulla cute attinta da un colpo d'arma da fuoco, indica che il colpo è stato sparato da breve distanza. Nel presente lavoro gli Autori hanno applicato il metodo di Dahl che sfrutta la capacità dell'Alizarina Red S (ARS) di produrre precipitati di colore rosso rubino con il bario, su 105 lesioni cutanee da arma da fuoco con distanza dello sparo da 0 cm a più di un metro. I risultati ottenuti hanno dimostrato sia la specificità di questa tecnica, in quanto solo i colpi a contatto ed a breve distanza hanno reagito positivamente, sia la sua sensibilità, in quanto la reazione si è verificata anche in corrispondenza di isolati residui di innesco frammisti a singoli precipitati della carica di lancio.

2001 - Medical liability in organ transplantation procedures [Articolo su rivista]
Merli, S; Piccinato, A; Cecchi, Rossana
abstract

In February 2000, a sentence of the Supreme Court of Justice ratified that being the transplantation surgery procedures close dependent, they have to be co-ordinate. Therefore, this kind of surgery presupposes a "multidisciplinary co-operation", where different specialists work at the same time or one after another. For this reason, in the sentence not only the doctor who committed the mistake was held responsible, but also other colleagues that have undervalued his action. Strarting from this sentence, Authors describe the procedure of transplantation in all phases (donor's and receiver's clinical condition, donor-receiver compatibility, surgical treatment, receiver short or long time post- surgical assistance) isolating the cases of receiver damage and analysing in which of these hypothesis of professional liability can be recognised.

2000 - Aspetti fisiopatologici della morte da shock psico-emotivo [Articolo su rivista]
Cipolloni, L; Tiburzi, P; Cecchi, Rossana
abstract

La morte da shock psico-emotivo è argomento di notevole interesse in ambito medico-legale in ragione della evidente sproporzione che spesso emerge tra stimolo stressante ed entità della risposta che ad esso segue. In tale ottica gli Autori approfondiscono i meccanismi fisio-patologici conosciuti, implicati nella reazione di stress, alla luce delle più recenti acquisizioni scientifiche, descrivendo le principali vie anatomo-funzionali coinvolte e i sistemi effettori di detta reazione; infine, puntualizzano gli effetti che eventi stressanti acuti hanno sull'apparato cardiocircolatorio, che rappresenta il target elettivo della reazione di stress come dimostrano le morti inattese che si verificano a seguito di forti emozioni.

2000 - La morte improvvisa nel settorato dell’Istituto di Medicina Legale di Roma nel decennio 1985-1995 [Articolo su rivista]
Cecchi, Rossana; Picca, D; Cipolloni, L.
abstract

Gli Autori esaminano una casistica di 2.401 morti improvvise estrapolate da un totale di 13.478 autopsie eseguite presso il settorato dell'Istituto di Medicina Legale dell'Università La Sapienza di Roma dal 1985 al 1995, confrontandole con indagini simili eseguite in Italia e all'estero. Le patologie più rappresentate concernono l'apparato cardiocircolatorio, seguite da patologie del sistema nervoso centrale. Il sesso maschile è risultato il più rappresesntato, mentre l'avvento della menopausa aumenta l'incidenza nel sesso femminile. Le età maggiormente colpite sono state il terzo, il quarto e il quinto decennio di vita.

2000 - L’omicidio da asfissia meccanica nell’esperienza del settorato dell’Istituto di medicina legale e delle assicurazioni della Università di Roma La Sapienza (1985-1994) [Articolo su rivista]
CAVE BONDI, G; Cecchi, Rossana; Picca, D; Cipolloni, L.
abstract

Gli Autori hanno operato una revisione casistica degli omicidi attuati mediante asfissia meccanica violenta estrapolati da un cospicuo numero di casi giunti all'osservazione del settorato dell'Istituto di medicina legale dell'Università di Roma La Sapienza nel decennio 1985-1994. Valendosi anche dei dati riportati in letteratura, sono state formulate considerazioni di ordine statistico ed epidemiologico, nonché analisi dei reperti autoptici e microscopici, al fine di poter apportare un contributo nella diagnosi differenziale tra omicidio, suicidio ed accidentalità, posti in essere mediante un fenomeno asfittico violento.

2000 - L’omicidio volontario nella casistica del settorato medico-legale romano negli anni 1985-1997 [Articolo su rivista]
Cipolloni, L; Mortati, L; D'Annibale, C; Cecchi, Rossana
abstract

Gli Autori riportano i dati relativi ad una ricerca condotta sui casi di omicidio volontario pervenuti alla Sezione anatomopatologica dell'Istituto medico-legale dell'Università La Sapienza negli anni 1985-1997. Lo studio si propone di verificare se il fenomeno dell'omicidio volontario abbia subito modificazioni in rapporto al mutamento delle condizioni economiche, sociali e demografiche. Di ciascun caso sono stati studiati il sesso, l'età, le caratteristiche predisponenti alla vittimizzazione, la nazionalità, i precedenti penali, gli stati di intossicazione, le malattie mentali. Quindi sono stati esaminati i mezzi lesivi utilizzati, i tempi di sopravvivenza, i rapporti tra utori e vittime e, infine, i moventi. Le analisi condotte sull'ampia casistica hanno permesso di ricostruire la dinamica del reato in oggetto in modo sufficientemente analitico.

1999 - Il rifiuto della terapia trasfusionale in pazienti testimoni di Geova: considerazioni medico-legali su di un caso peritale [Articolo su rivista]
Cipolloni, L; Cecchi, Rossana
abstract

Gli Autori, prendendo spunto da un caso peritale, pongono in risalto il contrasto esistente tra norme deontologiche e giuridiche, laddove queste ultime imporrebbero al sanitario di astenersi sempre da qualsiasi azione clinico-terapeutica in assenza di esplicito consenso valido del paziente. Cionostante rimane obbligo del medico di attenersi in primo luogo alle indicazioni etiche della professione che orientano l'applicazione delle norme giuridiche e di invocare lo stato di necessità soltanto qualora il soggetto versi in uno stato di incoscienza.

1999 - Informed consent form for the hormonal replacement therapy in a menopausal center: A proposal [Articolo su rivista]
Oriana, Capri; Giuseppina, Perrone; Cecchi, Rossana; Pier Luigi, Palazzetti; Lucio, Zichella; Silvio, Merli
abstract

Hormonal Replacement Therapy (HRT) represents a valid therapeutic approach for menopausal symptoms and for the prevention of cardiovascular disease and osteoporosis. Nevertheless, an informed consent, after a complete information, must be obtained from the patient. This procedure is generally adopted in any medical activity, but the modality of the consent in the HRT administration is not well established (verbal or written?, timing of administration?). The authors propose an informed written consent model to be utilized in menopausal centers; this model synthetically informs about HRT benefits and risks and must be red and signed by the patient. The written consent should be explained through a verbal detailed discussion about it, during which the patient's comprehension must be assured. The informed consent procedure should be renewed every year in long term-users. The influence of the HRT informed consent in menopausal centers must be analyzed in particular as far as women compliance is concerned.

1999 - Istopatologia forense [Capitolo/Saggio]
Cecchi, Rossana; Marchetti, D.
abstract

Vengono descritti e discussi gli aspetti istologici delle patologie dei vari organi (cervello, cuore, polmoni, cute, rene, fegato, apparato gastrointestinale, cute, utero, ovaia, placenta) di interesse del patologo forense, con particolare attenzione al tipo di colorazioni da privilegiare, nonchè i problemi legati alla diagnosi differenziale.

1999 - L’apoptosi nella guarigione delle ferite cutanee [Articolo su rivista]
Cecchi, Rossana; Rosati, R; CAVE BONDI, G.
abstract

Gli Autori applicano la tecnica ISEL (in situ end labelling DNA strands) per la rivelazione dell'apoptosi su prelievi cutanei di soggetti deceduti con lesioni cutanee prodottesi in epoche differenti prima delal morte. I risultati mostrano un inizio dell'apoptosi delle cellule infiammatorie già a due giorni dalla lesione e un picco all'ottavo giorno, mentre i fibroblasti in apoptosi sono evidenziabili dopo due-tre settimane. Ciò rende tale marker utile ai fini della valutazione della cronologia delle lesioni.

1998 - L’ibridizzazione in situ (ISH) nella identificazione di sesso su tessuti umani [Articolo su rivista]
Cecchi, Rossana; Cipolloni, L; CAVE BONDI, G.
abstract

Gli Autori hanno applicato la tecnica dell'ibridizzazione in situ, utilizzando markers per il centromero dei cromosomi X e Y, a campioni di cute, cuore, denti e ossa al fine di verificare il tessuto più idoneo per l'identificazione di sesso. Nonostante le difficoltà tecniche che comporta, il tessuto dentale, e, in particolare, la polpa, è apparso quello in grado di fornire risultati più affidabili, seguito dall'endotelio dei vasi, mentre l'osso è del tutto inadeguato.

1997 - A case of Moschcowitz disease diagnosed histologically [Articolo su rivista]
Moriani, S.; Cecchi, R.; Piervitali, F.
abstract

1997 - Incorrect identification of a military pilot with international implications [Articolo su rivista]
Cecchi, Rossana; Luigi, Cipolloni; M., Nobile
abstract

The case is reported of a military pilot shot down in 1986 during a mission whose body was recovered in an advanced state of decomposition and delivered to Italian police in 1989. The first autopsy led to an incorrect identification of the corpse. Because of the advanced decomposed state of the corpse, a correct identification was made only through evaluation of the dental status and radiological examination. The correct evaluation of the specific shape of the amalgam restorations, particularly of those of the first and second inferior right molars, showed agreement with those of the pilot of the plane and not of the co-pilot as was initially stated.

1997 - La plastinazione degli organi: dalle origini ad oggi [Articolo su rivista]
Cecchi, Rossana; Piervitali, F.
abstract

Gli Autori riportano i dati di una ricerca inerente la plastinazione degli organi (tecnica reversibile che, salvaguardando le caratteristiche proprie del materiale esaminato, lo rende modificailbe nel tempo). Lo studio si propone di accertare la possibilità di utilizzare reperti prima lesi e poi plastinati a fini didattici e quale elemento di prova immutabile nelle sue caratteristiche peculiari, sempre disponibile, anche a distanza di anni, a fini penali, civili e assicurativi. Vengono presentati i risultati ottenuti in un viscere sottoposto preliminarmente a lesioni da mezzo tagliente, valutando l'attendibilità delle caratteristiche morfologiche delle lesioni stesse dopo plastinazione.

1996 - L'idoneita al servizio di leva presso il reparto di osservazione dell'O.M. di medicina legale di Roma nel 1994 [Articolo su rivista]
Aratari, G; Basso, A; Cecchi, Rossana; Cipolloni, L.
abstract

1996 - Macrophage subtype patterns in protracted asphyxiation [Articolo su rivista]
A., Du Chesne; Cecchi, Rossana; K., Pueschel; B., Brinkmann
abstract

The question was examined whether protracted asphyxiation is associated with a distinct macrophage subtype pattern in lung tissue. Immunohistochemical preparations of lung specimens were tested with the antibodies MRP8, MRP14, 27E10 and 25F9 in cases of protracted asphyxiation (n = 8) and in ''control'' groups (hanging: n = 6; peracute deaths: n = 9). MRP8 and MRP14 interstitial cell counts showed a doubling in protracted asphyxiation. Furthermore, clear increases of 27E10 and 25F9 cells (intravascular and interstitial) were found in protracted asphyxiation, both in the intravascular and interstitial compartments. At present the results look promising as to an additional diagnostic criterion for the differential diagnosis between acute and protracted asphyxiation.

1996 - Proposte di armonizzazione di protocolli internazionali: il protocollo del Minnesota e quelo approvato dall’ECLM [Articolo su rivista]
Colesanti, C; Cecchi, Rossana
abstract

Gli Autori ripercorrono l'iter che ha indotto il Consiglio d'Europa a richiedere agli Stati membri di impegnarsi nella creazione di linee-guida per l'esecuzione delle autopsie giudiziarie ed illustrano e comparano il protocollo approvato dall'European Council of Legal Medicine con il Minnesota protocol. Ne emerge la necessità che le autopsie forensi vengano sempre eseguite da specialisti in patologia forense esperti.

1996 - Suicide by sharp instruments: A case of harakiri [Articolo su rivista]
Stefano, Moriani; Cecchi, Rossana; Luigi, Cipolloni
abstract

A case of suicide by harakiri is described. The position of the subject, the absence of the shirt and the abdominal L-shaped cut agreed well with the formal procedure of harakiri. The characteristics of the stab wounds present on the right-hand side of the neck confirmed the assumption of self-infliction and excluded, from a legal point of view, murder by consent.

1996 - The laboratory for forensic histopathology of the Institute of Legal Medicine of the La Sapienza University of Rome [Articolo su rivista]
Bondi, G. C.; Cecchi, R.
abstract

1996 - “Detection and significance of adenoviruses in cases of sudden infant death” [Articolo su rivista]
Bajanowski, T.; Wiegand, P.; Cecchi, Rossana; PRING AKERBLOM, P.; Adrian, T.; Jorch, G.; Brinkmann, B.
abstract

Respiratory tract infections have been thought to act as a trigger mechanism in sudden infant death. In 118 autopsy cases of infant death, paraffin-embedded or frozen lung tissues were investigated by means of a nested polymerase chain reaction (PCR) to detect adenovirus (AV) DNA. The primers used are general primers and allow the detection of most pathogenic adenoviruses with high specificity and sensitivity and independently of devitalization of viruses or degradation of viral DNA. For the investigation three groups were established: there were 13 cases of unnatural death, 78 cases of natural death without histological signs of interstitial pneumonia, and 27 cases with interstitial pneumonia. The first group was AV negative. In the group without interstitial pneumonia AV was detected in 10.2% of the cases. In the group with interstitial pneumonia the frequency of AV detection was almost 26%. The results obtained demonstrate an association between interstitial pneumonia and detection of AV DNA, indicating that AV may play an important part in pulmonary infection in infants. Histological evidence of interstitial pneumonia was not observed in all AV-positive cases, perhaps because nonspecific virus-related changes occurred only in early stages of viral infection. Comparison of the AV frequency in SIDS (15%) and non-SIDS cases (4%) indicates an association between pulmonary AV infections and sudden death. These results support the working hypothesis of respiratory infections acting as a trigger mechanism in sudden infant death.

1995 - APPLICAZIONE SU TESSUTI PUTREFATTI DI UNA COLORAZIONE ISTOLOGICA PER IL CONNETTIVO MODIFICATA [Articolo su rivista]
Aratari, G; Cipolloni, L; Cecchi, Rossana
abstract

1995 - Aspetti neurologici e psichiatrico-forensi delle infezioni HIV in una popolazione carceraria [Articolo su rivista]
Marasco, M; Cecchi, Rossana; Colesanti, C; Rinaldi, R; Merli, S.
abstract

Relazione presentata al 5th World Conference on Prison Health Care, Brisbane, 6-11 giugno 1993.

1995 - CMV-DNA DETECTION IN PARENCHYMATOUS ORGANS IN CASES OF SIDS [Articolo su rivista]
Cecchi, Rossana; Thomas, Bajanowski; Barbara, Kahl; Peter, Wiegand
abstract

A nested PCR approach has been developed especially for the detection of small amounts of cytomegalovirus (CMV) DNA in autopsy samples. Lung tissue and submandibular glands in 118 cases of infant death (92 SIDS cases, 13 natural deaths due to other defined causes and 13 unnatural deaths) were investigated by this technique and compared to the results obtained by other CMV detection methods (histology, immunohistochemistry, in situ hybridization and PCR). CMV-DNA could be detected in the lung tissue in 7 cases of SIDS using nested PCR. Compared to conventional PCR (3 positive cases in lung tissue) the nested approach always gave glear results and showed less additional bands. In all cases where CMV could be detected in the lungs, positive results were also obtained in the submandibular glands. The nested PCR method proved to be a more sensitive technique than the other detection methods including PCR and hot start, and even minimal amounts of target DNA could be detected in the presence of human and bacterial background DNA.

1995 - Comparative analysis on european legislations on doping [Articolo su rivista]
Cecchi, Rossana; Cipolloni, L.
abstract

The Authors analyse legislation and regulations concerning doping in force in Belgium, Italy, Great Britain, Greece, Switzerland, France, Spain, Finland, Norway, Portugal, Luxemburg, Sweden, Germany, Austria and Denmark and examine the causes and the definition of doping as well as problems sorrounding education and information, the tracing forbidden substances, the determination of their use, and the controls and the sanctions provided. Prominence is given to those provisions which, according to the authors, have to be adopted from each law or regulation in order to form a homogeneous European regulation.

1995 - Diagnosis of brain death in anencephalic infants: medico-legal and ethical aspect [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S.
abstract

Medical science needs to regulate the transplantation of organs, including the adoption of new guidelines concerning the diagnosis of brain death in patient less than five years old. In fact in the case of anencephalic infants the specific criteria are not the same as those used in subjects with normal development. The authors indicate the international medical point of view on what constitutes the diagnosis of brain death in anencephalic infants and discuss medicolegal and ethical aspects.

1995 - La tutela della vita umana ed i diritti del malato terminale: implicazioni etico-giuridiche [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S.
abstract

Gli Autori ritengono che fondamentale diritto del malato terminale sia quello di morire con dignità. Ma sotto il profilo etico-giuridico non poche difficoltà affiorano nella definizione del concetto stesso di dignità umana. Il malato terminale può considerare la qualità della propria vita con criteri diversi da quelli generali, proprio in virtu del fatto che si trova in una condizione sfavorevole dal punto di vista sia fisico che psichico. Di qui la problematica dell'autodeterminazione del malato e del consenso informato, del miglioramento dell'assistenza, dell'accanimento terpeutico e dei suoi limiti, dell'eutanasia.

1995 - Une nouvelle technique pour le laboratoire de médecine légale: la plastination [Articolo su rivista]
Cave Bondi, G.; Cecchi, R.; Cipolloni, L.; Aratari, G.
abstract

1995 - Vergleich der HIV-1-Prävalenz bei Drogentodesfällen in Deutschland sowie in verschiedenen europäischen Groβstädten. (Stand: 31.12.1993) [Articolo su rivista]
Lockemann, U; Wischhusen, F; Pueschel, K; Cecchi, Rossana
abstract

In an international multicenter study of the year 1993 the HIV-1 status of 1171 drug abuse-related fatalities in Germany was evaluated. In Germany it seems to be stabilizing at a level of about 10%. In Europe there was an obvious south-north decline of HIV prevalence.

1994 - Attualità di una medicina legale comparata: i codici deontologici tedesco ed italiano a confronto [Relazione in Atti di Convegno]
CAVE BONDI, G; Cecchi, Rossana
abstract

1994 - La plastinazione degli organi: applicabilità in medicina legale [Articolo su rivista]
CAVE BONDI, G; Ripani, M; Cecchi, Rossana; Cipolloni, L; Aratari, G; Marinozzi, G.
abstract

Gli autori riportano i risultati ottenuti dalla plastinazione di un fegato di maiale sottoposto a lesioni da taglio, al fine di documentare la possibilità di utilizzare reperti interessati da lesioni e, successivamente, sottoposti a plastinazione, a fini didattici e quale elemento di prova immutabile nelle sue caratteristiche peculiari, sempre disponibile, anche a distanza di anni, a fini penali, civili e assicurativi.

1994 - Legal Medicine in Europe - Quo vadis? [Articolo su rivista]
Brinkmann, B.; Cecchi, Rossana; Du Chesne, A.
abstract

1994 - Trapiantologia pediatrica: stato dell’arte e problemi di sviluppo [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S; Moriani, S.
abstract

Lo studio delle casistiche ufficiali nazionali ed internazionali e dei numerosi contributi americani ed europei, permettono di dare sistematicità alla dinamica che investe il problema donazione-trapianto d'organo in età pediatrica e neonatale. L'esperienza maturata sino ad oggi fornisce elementi utili ad indirizzare, verso un approccio concreto al problema, il dibattito sociale, culturale e religioso attualmente esistente, da cui si attende una soluzione normativa adeguata.

1994 - [Moist autoclaving. A simplified method for antigen unmasking] [Articolo su rivista]
A., Bankfalvi; K., Riehemann; D., Oeffner; Cecchi, Rossana; J. M., Morgan; J., Piffko; W., Boecker; B., Jasani; K. W., Schmid
abstract

Wet autoclaving is a simple, reliable and time-effective method for antigen retrieval in routinely processed archival material. Both routine diagnostic (e.g., oestrogen and progesterone receptors, cytoskeletal proteins) and research antibodies (e.g. various p53 antibodies, mdm-2, bcl-2, MIB-1) are reported to demonstrate its application. We autoclaving may allow successful application of antibodies in paraffin-embedded tissues designed for use on frozen sections. The technique has the potential to reliably handle up to 200 sections at a time, without evidence of any significant damage to the sections or nuclear morphology.

1993 - Considerazioni in tema di doping [Articolo su rivista]
Cecchi, Rossana; Cipolloni, L.
abstract

Il doping si è sempre più diffuso nell'ambiente sportivo professionistico e dilettantistico sino ad assurgere a fenomeno di massa. L'esame della normativa nazionale e sovranazionale in materia documenta l'importanza di un corretto inquadramento nosologico del fenomeno al fine di poter definiìre i limiti di liceità in cui può agire il medico nel somministrare farmaci ad uno sportivo.

1993 - Il paziente psichiatrico vittima di violenza carnale: risultati di un’indagine statistica condotta presso i dipartimenti di salute mentale di Roma [Articolo su rivista]
Cecchi, Rossana; Cipolloni, L; DEL VECCHIO, S.
abstract

Gli Autori , attraverso un questionario somministrato ai Dipartimenti di Salute Mentale della città di Roma, hanno cercato di evidenziare l'incidenza di un reato, la violenza carnale sui malati di mente, che in gran parte non giunge all'osservazione delle autorità competenti. Lo studio ha messo in evidenza una alta percentuale di vittime di età inferiore ai trenta anni, in condizioni di dipendenza sia fisica che psichica da terze persone, che con l'autore del reato avevano un rapporto di parentela più o meno stretto, da cui la conseguente scarsità di denunce del reato.

1993 - Il trapianto d’organo in Germania [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S.
abstract

Gli Autori prendono spunto dalla Dichiarazione del Consiglio Scientifico dell'Ordine dei Medici tedesco del 29 giugno 1991, che stabilisce i "Criteri per l'accertamento della morte cerebrale", per discutere l'organizzazione dei trapianti d'organo in Germania, ove, sino ad oggi, non esiste una legge che regoli sotto il profilo giuridico questo atto medico. In particolare viene discussa la possibilità in Germania di accertare la morte cerebrale senza esami sturmentali quali l'EEG; allo stesso tempo appare sufficiente un tracciato EEgrafico silente per trenta minuti per poter definire un soggetto morto, oppure potenziali evocati negativi o un arresto della circolazione cerebrale documentata attraverso metodiche doppler, scintigrafiche o angiografiche. Vengono discusse le differenze e le affinità con il nostro ordinamento.

1993 - La regolamentazione dei trattamenti trasfusionali in Germania ed in Italia: aspetti deontologi e giuridici [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S; Durso, S.
abstract

Gli Autori esaminano la normativa e le direttive deontologiche che regolano i trattamenti trasfusionali in Italia e Germania, ponendo particolare attenzione alla prevenzione della trasmissione dell'HIV. Le differenze sono riferibili sia alla diversa organizzazione dei sistemi sanitari che alle variabili epidemiologiche nei due campioni di popolazione. Direttive comunitarie consentiranno di ridurre sensibilmente i rischi di trasmissione di malattie infettive.

1992 - Criteri per la valutazione del danno biologico nel trapianto di rene [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S.
abstract

1992 - La responsabilità professionale nell’utilizzo delle novità in ostetricia e ginecologia tra l’etica e il diritto [Articolo su rivista]
Oriana, Capri; Cecchi, Rossana; Lucio, Zichella
abstract

1992 - La vittima di violenza carnale in un’indagine presso i servizi consultoriali delle città di Roma : primi risultati [Relazione in Atti di Convegno]
Cecchi, Rossana; DEL VECCHIO, S; DI CROCE, W.
abstract

1992 - Legislazione deontologica comparata in tema di sperimentazione umana nell’ambito dei Paesi CEE [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S; Cipolloni, L.
abstract

In vista della propsttiva europea del 1992, gli Autori avvertono la necessità di un'armonizzazione delle legislazioni sanitarie che favorisca ulteriormente il progresso scientifico, attraverso una realizzata intesa sulla realtà interpretativa dei grandi temi che hanno impegnato la medicina finoa oggi. In quest'ottica analizzano comparativamente i diversi codici deontologici europei in tema di sperimentazione umana al fine di poter meglio analizzare e comprendere le differenze e sottolineare le uniformità di pensiero.

1992 - Meeting of the North German Society of Legal Medicine [Articolo su rivista]
Cecchi, R.
abstract

1992 - On the utility of standardising European legislation concerning health sector advertising [Articolo su rivista]
Cecchi, R.; Del Vecchio, S.; Cippoloni, L.
abstract

The authors here analyse health sector advertising regulations in member states of the European Community. With reference to ethical codes and laws applying specifically to this problem, they underline the uniformities that already exist within the various countries of the EEC. The latest Italian regulations (law 175/92) point to a high degree of awareness within the health sector and draw their inspiration from ethical guidelines which now appear to be a common European heritage.

1992 - Sull’utilità di un’uniforme legislazione europea in tema di pubblicità sanitaria [Articolo su rivista]
Cecchi, Rossana; DEL VECCHIO, S; Cipolloni, L.
abstract

Gli Autori analizzano le normative degli Stati membri della Comunità europea in tema di pubblicità sanitaria. In particolare, facendo riferimento a quanto emerge dai vari codici deontologici e dalle legislazioni specifiche vigenti in materia, evidenziando le uniformità esistenti nei vari Paesi della CEE. La più recente normativa italiana (legge 175/92) ha dimostrato una particolare sensibilità nel settore, ispirandosi a quegli orientamenti deontolgici che ormai appaiono essere comune patrimonio europeo.

1991 - Euthanasia and organ transplantation [Articolo su rivista]
Iapichino, F.; Cecchi, R.
abstract

1991 - L’eutanasia nel nuovo codice di deontologia medica [Articolo su rivista]
Cecchi, Rossana
abstract

L'Autore esamina gli articoli del codice deontologico medico del 1989 riguardanti l'assitenza ai morenti e sottolinea come da questi si evinca un netto rifiuto verso qualsiasi forma di eutanasia attiva, mentre risulti deontologicamente corretto il non accanirsi terapeuticamente e il rispettare la volontà del malato che, giunto alla fase terminale ed irreversibile della vita, richieda la cessazione delle cure e il mantenimento della sola terapia di sostegno e della terapiua antidolorifica.

1991 - Unicità del concetto di morte: orientamenti etici, deontologici e legislativi [Articolo su rivista]
Cecchi, Rossana
abstract

Attraverso l'analisi dell'evoluzione legislativa e deontologica si dimostra come il concetto di morte debba essere unico, ovvero quello di morte cerebrale, mentre le varie aggettivazioni utilizzate -cardiaca, neurologica, biologica, etc.-rappresentano i criteri attraverso i quali accertare lo stato, appunto, di morte cerebrale.

1990 - Il significato della obiettivazione del dolore nella prospettiva medico-legale [Capitolo/Saggio]
Cecchi, Rossana; S., Ferracuti; M., Marchetti
abstract

Cellule T, dimensione affettiva, cognitiva, discriminativa, motivazionale, sensoriale, valutativa; dolore: asimbolia del, assenza congenita del, basi neurofisiologiche del, dimensioni psicologiche del, fisiopatologia del, obiettivazione del; fattori, economici di rischio, socio-culturali; fibre, A delta, C; gate control theory; iperalgesia; iperpatia; McGill Pain Questionnaire (MPQ); MBHI; nocicettori, meccanici, polimodali, termici; pain behaviour; paziente con dolore, profilo psicologico del, valutazione del; scala nalogica visiva (VAS); scale di descrizione verbale; sintomo dolore, misure di valutazione del; target areas, teoria del controllo a cancello; trigger points; West Haven Yale Multidimensional Pain Inventory (WHYMPI)

1990 - The fragile X-syndrome: Clinical and medicolegal aspects relating to case surveys [Articolo su rivista]
Marasco, M.; D'Agostino, L.; De Luca, P.; Cecchi, R.
abstract

The Authors provide an account of the case of two brothers subjected to medicolegal observation for the purpose of ascertaining civil disability. The two persons in question were affected by the fragile X-chromosome syndrome (S.M.B.X.), a rare hereditary disease producing mental retardation and etiologically due to a cytogenetic anomaly, the presence of a chromosomic break at the level of the interface between Xq 27 and Xq 28. After examining thoroughly the cytogenetic and clinical aspects of the syndromes with X-linked mental retardation, the Authors take advantage of the case in question to make a series of observations on the disabling aspects of mental deficiencies and in particular on the medicolegal criteria to be applied in assessing civil disability.

1990 - Una recente proposta di intervento normativo in tema di bioetica: l’avant-project francese sulle scienze della vita e sui diritti dell’uomo [Articolo su rivista]
Merli, S; Ciallella, C; Cecchi, Rossana
abstract

Gli Autori riportano il contenuto di un recente progetto di legge francese sulle "scienze della e vita e i dirtti dell'uomo", concernente temi di rilevante interesse etico e deontologico quali la ricerca in campo biomedico, le tecniche di procreazione artificiale, la sperimentazione ed i trapianti sull'uomo, la diagnostica prenatale e l'attività dei Comitati etici. L'interesse dell'argomento si desume anche nella prospettiva ormai imminente dell'Europa Comunitaria che, in campi così importanti, non potrà prescindere da una armonizzazione delle diverse normative nazionali. I contenuti del progetto di legge vengono, pertanto, analizzati anche con riferimento alla normativa italiana, peraltro, del tutto carente riguardo alle problematiche ora ricordate.

1989 - Circonvenzione di persone incapaci [Capitolo/Saggio]
Cecchi, Rossana
abstract

L'Autore analizza il contenuto dell'art. 643 c.p. e delinea il compito del perito chiamato ad identificare la circonvenzione di persona incapace, che deve limitarsi alla sola rilevazione dello stato di infermità o deficienza psichica che deve sussistere al momento in cui il fatto è avvenuto, per cui divengono di importanza primaria i rapporti intercorsi tra la vittima e l'autore collocati in un preciso momento storico dal quale non si può prescindere.

1989 - I problemi dell’accertamento dell’identità sessuale [Capitolo/Saggio]
Cecchi, Rossana
abstract

1989 - L'uso dell'EEG Computerizzato in Medicina Legale, [Articolo su rivista]
S., Ferracuti; Cecchi, Rossana
abstract

1989 - La Consulenza Tecnica nel Diritto Civile: dell’affidamento del minore [Capitolo/Saggio]
Marasco, M; Cecchi, Rossana
abstract

1989 - La perizia psichiatrica sulla vittima: I delitti contro la libertà sessuale [Capitolo/Saggio]
Cecchi, Rossana
abstract

L'Autore esamina il disegno di legge approvato dal Senato il 30 giugno 1988 che che raggruppa gli atti di libidine violenta e la congiunzione carnale nella più vasta nozione di violenza sessuale e discute il cambiamento che la legge, qualora approvata in via definitiva, apporterebbe all'attuale processo in materia di violenza carnale. Vengono descritti gli aspetti di natura vittimologica e psichiatrica che devono essere tenuti in debita considerazione da parte del perito nel momento in cui deve stilare una perizia richiesta dal Giudice.

1989 - La perizia psichiatrica sulla vittima: La vittimologia [Capitolo/Saggio]
Cecchi, Rossana
abstract

1989 - La perizia psichiatrica sulla vittima: il maltrattamento dei minori [Capitolo/Saggio]
Cecchi, Rossana
abstract

1989 - La valutazione medico-legale del danno fisiognomico in responsabilità civile [Articolo su rivista]
Ciallella, C; Cecchi, Rossana
abstract

Gli Autori sottolineano l'importanza dell'autonoma valutazione delle menomazioni fisiognomiche. Considerano la necessità di un inquadramento del danno al patrimonio estetico individuale nell'ambito dei pregiudizi alla salute, tenendo presente l'opportunità di una differenziata valutazione in riferimento alla specifica capacità lucrativa del leso. Auspicano la necessità di riconsiderare i parametri valutativi ai fini di una maggior aderenza al mutato inquadramento dottrinario e giurisprudenziale del danno alla persona in responsabilità civile.

1989 - Ruolo ed attendibilità del testimone [Capitolo/Saggio]
Cecchi, Rossana
abstract

Vengono discusse le tre fasi del processo testimoniale (fissazione percettiva, conservazione mnestica, rievocazione epsressiva del fatto) ed i fattori che le influenzan di ordine psicologico, fisiologico o patologico, compresa la suggestionabilità, particolarmente importante nel caso dei minori.