Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality. Reperfusion strategies are the current standard therapy for AMI. However, they may result in paradoxical cardiomyocyte dysfunction, known as ischemic reperfusion injury (IRI). Different forms of IRI are recognized, of which only the first two are reversible: reperfusion-induced arrhythmias, myocardial stunning, microvascular obstruction, and lethal myocardial reperfusion injury. Sudden death is the most common pattern for ischemia-induced lethal ventricular arrhythmias during AMI. The exact mechanisms of IRI are not fully known. Molecular, cellular, and tissue alterations such as cell death, inflammation, neurohumoral activation, and oxidative stress are considered to be of paramount importance in IRI. However, comprehension of the exact pathophysiological mechanisms remains a challenge for clinicians. Furthermore, myocardial IRI is a critical issue also for forensic pathologists since sudden death may occur despite timely reperfusion following AMI, that is one of the most frequently litigated areas of cardiology practice. In this paper we explore the literature regarding the pathophysiology of myocardial IRI, focusing on the possible role of the calpain system, oxidative-nitrosative stress, and matrix metalloproteinases and aiming to foster knowledge of IRI pathophysiology also in terms of medicolegal understanding of sudden deaths following AMI.

Contrast media (CM) are used in imaging techniques to enhance the differences between body tissues on images. The ideal contrast medium should achieve very high concentration in the tissues without producing any adverse effects. Unfortunately, this has not been possible so far and all CM have adverse effects. The increasing use of CM is likely to give rise to a wide range of pitfalls, including compliance with and appropriateness of indications for the use of CM themselves, the choice of the ‘best’ contrast agent, off-label use, evaluation of special populations of patients, and competence to tackle emergency scenarios following the administration of CM. Even more prominent, and potentially more important, is the issue of informed consent which brings with it a duty to inform patients awaiting the administration of CM with regard to the nature of the procedure, the existence of alternative procedures, the extent of the risks relating to the use of CM and, finally, the risks relating to refusal of the procedure. All these issues may give rise to concerns about liability for failure to offer adequate information to patients or to carefully evaluate and balance the potential risks and benefits of the procedure or, finally, for being unprepared in the event of adverse reactions to CM, especially when these are severe and life-threatening. Educational and training programmes for radiologists are likely to shape change in the medical liability environment in the coming years.

Allogenic hematopoietic progenitor cell transplantation (allo-HSCT) is an established treatment for many diseases. Stem cells may be obtained from different sources: mobilized peripheral blood stem cells, bone marrow, and umbilical cord blood. The progress in transplantation procedures, the establishment of experienced transplant centres, and the creation of unrelated adult donor registries and cord blood banks gave those without an human leucocyte antigen- (HLA-) identical sibling donor the opportunity to find a donor and cord blood units worldwide. HSCT imposes operative cautions so that the entire donation/transplantation procedure is safe for both donors and recipients; it carries with it significant clinical, moral, and ethical concerns, mostly when donors are minors. The following points have been stressed: the donation should be excluded when excessive risks for the donor are reasonable, donors must receive an accurate information regarding eventual adverse events and health burden for the donors themselves, a valid consent is required, and the recipient's risks must be outweighed by the expected benefits. The issue of conflict of interest, when the same physician has the responsibility for both donor selection and recipient care, is highlighted as well as the need of an adequate insurance protection for all the parties involved.

Background: Self-defense is legitimate both in common law and in civil law systems. Nevertheless, there remains the age-old question for the prosecutor to identify the limit between the righteous self-defense and the self-defense with excessive force. In these cases, the gathering of all evidence by a forensic multidisciplinary team is essential to provide the necessary data for the prosecutor's evaluation. Case presentation: The case of a 55-year-old man who was killed in front of his neighbor's house is described. The prosecutor alerted the forensic team, classifying the crime as a gunshot homicide. The neighbor immediately admitted his responsibility as self-defense. Moreover, the relatives of the victim told a different version of the story, assuring that the neighbor had killed him for futile motivations. For these reasons, the prosecutor established further investigations, such as autopsy, the K-9 unit exploration, and alerting the forensic biologist for analysis. Conclusions: This case aims to highlight the teamwork of multidisciplinary forensic expertise to solve complex cases; moreover, combining ultra-specialist forensic activities, such as the K-9 unit, it is possible to collect all the evidence to submit to the prosecutor for the formulation of judgment.

Cocaine is one of the principal drugs of abuse, it is an illegal psychostimulant, and the chronic consumption of cocaine causes damage in a range of body organs. Cocaine is known to undergo metabolism through multiple enzymatic pathways leading to the formation of several highly reactive species, which have been proposed to exert a direct toxic effect in the organs. All its metabolites may be involved in the activation of redox cycles, the depletion or decrease of antioxidant enzymes and the consequent generation of reactive oxygen species (ROS) leading to oxidative stress (OS) events, the lipid peroxidation and disruption of cellular activity, and consequently cocaine-induced organs damage. However, the exact mechanisms of cocaine-mediated toxicity in all the organs are not fully understood. \ud This review provides extensive evidence in support of the hypothesis that oxidative metabolites play important roles comprising oxidative stress, defined as a disturbance of redox signaling and control that can cause malfunction in organs such as the brain, heart, liver, kidney and skin