1,721,009 research outputs found
Direttive Anticipate di Trattamento nei pazienti oncologici: una prospettiva internazionale
Full text linkAbstract
La presente tesi vuole fornire spunti di riflessione su tematiche etiche e bioetiche la cui rilevanza è attuale e indiscussa, quello delle Direttive Anticipate di Trattamento, con particolare riferimento nei pazienti oncologici, e delle tematiche bioetiche ad esse connesse.
Essa nasce da una ricerca effettuata nella banche dati mediche, giuridiche e bioetiche, con un approccio multidisciplinare e internazionale.
Tale ricerca delinea un quadro della situazione attuale dal punto giuridico-normativo e bioeticistico, sulla base delle più aggiornate fonti bio-giuridiche, in primis nel nostro Paese e successivamente una veduta ed un confronto europeo, un confronto oltreoceano con l’analisi della situazione Statunitense e parallelamente un confronto con il resto del mondo.
Il lavoro parte da un inquadramento delle stesse Direttive Anticipate nel contesto etico e bioetico, poiché un approccio medico-legale alle dinamiche delle Direttive Anticipate di Trattamento nei pazienti oncologici non può prescindere da una visuale “bioetica” della relazione medico-paziente e da un raccordo con i diritti inviolabili dell’uomo sanciti dalla nostra Costituzione.
Si procederà poi ad un esame dei fondamenti legislativi che sono alla base delle stesse Direttive Anticipate e della rinuncia ad un trattamento medico, partendo dalla tutela della dignità umana sancita nella Convenzione di Oviedo, e proseguendo poi con i principi sanciti dal Comitato Nazionale per la Bioetica nel 2003 e proclamati dal nostro stesso Codice di Deontologia Medica, ultimo aggiornamento del 2014
A rare and lethal case of right common carotid pseudoaneurysm following whiplash trauma
Full text linkWhiplash trauma from a car crash is one of the most common causes of neck injury, resulting in pain and dysfunction. We report on an unusual case of post-whiplash
pseudoaneurysm of the right common carotid artery, which led to acute massive hemorrhage and death days after the initial trauma. A post-mortem computed tomography
angiography showed rupture of the pseudoaneurysm of the right common carotid artery with the contrast agent leaking out into the mouth. The subsequent autopsy confirmed
a large hemorrhagic clot extending to the right side of the neck and mediastinum. A rupture of the right wall of the oropharynx was identified with massive bronchial hemoaspiration.
The case demonstrates a rare but lethal clinical entity, and is important in providing a better understanding of the potentially fatal consequences of minor trauma, such as whiplash injury, and its physiopathological mechanisms. Thus, changing symptoms after a whiplash injury should be carefully evaluated since they can be related to the underlying severe consequences of a
rapid hyperextension–hyperflexion of the neck, as in the reported case
Multi-phase post-mortem CT-angiography (MPMCTA) is a very significant tool to explain cardiovascular pathologies. A sudden cardiac death case
No full textMulti-Phase Post-Mortem CT-Angiography (MPMCTA) is a standardized technique performed by a protocol that increases the radiological interpretation by decreasing artifacts due to the perfusion and by reaching a complete filling of the vascular system. The quality of the CT angiographies was evaluated radiologically by observing the opacification of the vascular system and assessing the interpretability of the resulting images, and by comparing radiological diagnoses to conventional autopsy conclusions. Here we describe a sudden death case in which Multi-Phase Post-Mortem CT-Angiography was helpful to define the diagnosis. A 72 year-old man that during a violent quarrel with his wife he complained of thoracic pain, and he suddenly died. Multi-Phase Post-Mortem Computed Tomography Angiography was carried out using the standardized protocol and it visualized the blood in pericardial sac and the ruptured wall situated in the posterior part of the left ventricle, as the contrast agent leaked through the rupture. The following autopsy confirmed the hemopericardium; the inspection of the left ventricle showed on the lateral and posterior wall a darkish and stiff area. Axial slices from the apex to the atrioventricular valves revealed a large area of pale myocardium diffused to the lateral and posterior free wall of the left ventricle, and in the forth section the rupture of the ventricular wall was visible. In all sections the marginal and the posterior branches of the left circumflex artery were totally occluded by darkish thrombosis. This catastrophic complication of the extensive myocardial infarction often remains undiagnosed and constitutes an autopsy finding. In this way the post-mortem imaging, in particular the CT-Angiography, is an useful tool to investigate all the vascular system and it enables better visualization of the ruptured ventricular wall
Touch DNA: “Touch” time and resiliency
No full textWith every touch of the skin on a surface, cells are left behind; with every cell, the genetic code can be found. People touch doors, tables, and so many other surfaces every day, often with multiple people touching the same object through the course of a day1. New research has found that Touch DNA analysis can erroneously implicate a person who never even laid eyes on the crime scene as the main contributor of the DNA on its handle.
When a swab is used for evidence collection from a surface, the investigator may not know how many people may have touched this evidence in the past or what level of persistence DNA may have on touched objects over time. Though every touch leaves cells containing DNA, most contact leaves only a few cells if minimal pressure is used. These trace levels of DNA may remain undetected or, if detected, may be at such low levels that only stochastic effects and low levels of allele drop-in are seen 2.
The goals of this work are:- to evaluate how much time (in term of seconds) is necessary to leave "Touch DNA" on dress; - what kind of the technique maximizes the DNA recovery, evaluating among swabs, cut or adhesive tape to sample an area of interest.
To acquire a greater knowledge of the rate of detectable wearer, touch and background DNA, 30 females wore their brassiere for 12 h. The lateral regions were handled by one of 5 male volunteers with a different timing: for 60 s, 45 s, 30 s, 20 s, 10 s.
Every experiment was carried out in triplicate: in the first case collecting sample was done by the swab, the second by cut of area if interest and the third sample by adhesive tape. The quantity of recovered DNA was determined using real-time Polymerase Chain Reaction (PCR) with Alu-based targets and SYBR green detection. The samples were also analyzed using capillary electrophoresis-based Short Tandem Repeat (STR) typing to determine the percentage of recoverable alleles. Touch DNA is an emulation of the Locard exchange principle, in that any time a person is in a location, that person may leave evidence of their presence.
The evidences showed that the best technique to recovery of "Touch DNA" is the cut of the interest area. The toucher was detected as a single profile in samples beetween 60s and 45 s. The wearer was present in a mixture from 30s to 10s; the toucher was always observed as the major contributor.
Greater knowledge of the frequency of detection of reportable wearer DNA and/or toucher allows scientists to evaluate the likelihood of observing a matching profile if an individual wore a garment rather than touched it in disputed case scenarios. Everyone in the medico-legal community — forensic scientists and technicians, DNA analysts, potential jurors, judges and lawyers for both the prosecution and defence— must know and understand the potential for mistakes
Italian law on medically assisted reproduction: Do women's autonomy and health matter?
No full textBackground: In Italy in 2004, a very restrictive law was passed on medically assisted reproduction (MAR) (Law 40/2004) that placed Italy at the most conservative end of the European spectrum. The law was widely criticized and many couples seeking MAR brought their cases before the Italian Civil Courts with regard to pre-implantation genetic diagnosis (PGD), donor insemination and the issue of consent. Ten years on, having suffered the blows of the Italian Constitutional Court, little remains of law 40/2004. Discussion: In 2009, the Constitutional Court declared the maximum limit of the number of embryos to be produced and transferred for each cycle (i.e. three), as stated in the original version of the law, to be constitutionally illegitimate. In 2014, the same Court declared as unconstitutional the ban on donor insemination, thus opening the way to heterologous assisted reproduction. Heterologous MAR is therefore perfectly legitimate in Italy. Finally, in 2015 a further ruling by the Constitutional Court granted the right to access MAR to couples who are fertile but carriers of genetic diseases. However, there is still much room for criticism. Many couples and groups are still, in fact, excluded from MAR. Same-sex couples, single women and those of advanced reproductive age are, at the present time, discriminated against in that Italian law denies these subjects access to MAR. Summary: The history of Law 40/2004 has been a particularly troubled one. Numerous rulings have, over the years, dismantled much of a law constructed in violation of the rights and autonomy of women and couples. However, a number of troubling issues still exist from what is left of the law and the debate is still open at national and transnational level regarding some of the contradictions and gaps in the law highlighted in this article. Only by abolishing the final prohibitions and adopting more liberal views on these controversial yet crucial issues will Law 40/2004 become what it should have been from the start, i.e. a law which outlines the 'rules of use' of MAR and not, as it has been until now, a law of bans which sets limits to the freedom to reproduce
Drugs of abuse in pregnancy, poor neonatal development, and future neurodegeneration. Is oxidative stress the culprit?
No full textThe abuse of licit and illicit drugs is a worldwide issue that is a cause for concern in pregnant women. It may lead to complications in pregnancy that may affect the mother, fetus, and /or neonate. The effects of any substance on the developing embryo and fetus are dependent upon dosing, timing, duration of drug exposure, and the extent of drug distribution. Teratogenic effects have been described when exposure takes place during the embryonic stage; however drugs have subtle effects, including abnormal growth and/or maturation, alterations in neurotransmitters and their receptors, and brain organization. The mechanisms by which intrauterine exposure to many substances may result in neuronal injury have not been completely elucidated. Oxidative stress and epigenetic changes have been recently implicated in the pathogenesis of long - term adverse health sequelae, and neuro-developmental impairment in the offspring of addicted mothers. Transgenerational epigenetics may also explain the alarming datum that developmental abnormalities, impairment in learning and memory, and attention deficit can occur even in the absence of direct fetal exposure, when drugs are consumed prior to conception. There is a growing body of evidence demonstrating a link between redox state unbalance, epigenetic markers, developmental anomalies, and neurodegeneration. The reviewed literature data uphold redox homeostasis disruption as an important factor in the pathogenesis of drug of abuse- induced neurodegeneration, and highlight the potential for new therapies that could prevent neurodegeneration through antioxidant and epigenetic modulatory mechanisms. This therefore reveals important targets for novel neuroprotective strategies
Drugs of Abuse in Pregnancy, Poor Neonatal Development, and Future Neurodegeneration. Is Oxidative Stress the Culprit?
No full textThe abuse of licit and illicit drugs is a worldwide issue that is a cause for concern in pregnant women. It may lead to complications in pregnancy that may affect the mother, fetus, and /or neonate. The effects of any substance on the developing embryo and fetus are dependent upon dosing, timing, duration of drug exposure, and the extent of drug distribution. Teratogenic effects have been described when exposure takes place during the embryonic stage; however drugs have subtle effects, including abnormal growth and/or maturation, alterations in neurotransmitters and their receptors, and brain organization. The mechanisms by which intrauterine exposure to many substances may result in neuronal injury have not been completely elucidated. Oxidative stress and epigenetic changes have been recently implicated in the pathogenesis of long - term adverse health sequelae, and neuro-developmental impairment in the offspring of addicted mothers. Transgenerational epigenetics may also explain the alarming datum that developmental abnormalities, impairment in learning and memory, and attention deficit can occur even in the absence of direct fetal exposure, when drugs are consumed prior to conception. There is a growing body of evidence demonstrating a link between redox state unbalance, epigenetic markers, developmental anomalies, and neurodegeneration. The reviewed literature data uphold redox homeostasis disruption as an important factor in the pathogenesis of drug of abuse- induced neurodegeneration, and highlight the potential for new therapies that could prevent neurodegeneration through antioxidant and epigenetic modulatory mechanisms. This therefore reveals important targets for novel neuroprotective strategies.The abuse of licit and illicit drugs is a worldwide issue that is a cause for concern in pregnant women. It may lead to complications in pregnancy that may affect the mother, fetus, and /or neonate. The effects of any substance on the developing embryo and fetus are dependent upon dosing, timing, duration of drug exposure, and the extent of drug distribution. Teratogenic effects have been described when exposure takes place during the embryonic stage; however drugs have subtle effects, including abnormal growth and/or maturation, alterations in neurotransmitters and their receptors, and brain organization. The mechanisms by which intrauterine exposure to many substances may result in neuronal injury have not been completely elucidated. Oxidative stress and epigenetic changes have been recently implicated in the pathogenesis of long - term adverse health sequelae, and neuro-developmental impairment in the offspring of addicted mothers. Transgenerational epigenetics may also explain the alarming datum that developmental abnormalities, impairment in learning and memory, and attention deficit can occur even in the absence of direct fetal exposure, when drugs are consumed prior to conception. There is a growing body of evidence demonstrating a link between redox state unbalance, epigenetic markers, developmental anomalies, and neurodegeneration.The reviewed literature data uphold redox homeostasis disruption as an important factor in the pathogenesis of drug of abuse- induced neurodegeneration, and highlight the potential for new therapies that could prevent neurodegeneration through antioxidant and epigenetic modulatory mechanisms. This therefore reveals important targets for novel neuroprotective strategies
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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