1,721,086 research outputs found
QUANTITATIVE PROFILING OF PHOSPHATIDYLETHANOL MOLECULAR SPECIES IN BLOOD OF HEAVY AND SOCIAL DRINKERS
No full textL’abuso alcolico cronico costituisce un problema di salute pubblica mondiale, di estensione e portata assai vaste.
Vi sono diversi metaboliti attivi dell’etanolo in grado di provocare alterazioni tissutali e danni d’organo in vari distretti dell’organismo. Il fosfatidiletanolo (PEth) è un fosfolipide di membrana atipico che si forma nella cellula soltanto in presenza di etanolo. Tale molecola ha recentemente attratto l’attenzione di alcuni gruppi di studio, in qualità di promettente marcatore di abuso alcolico cronico. Il PEth non è una singola molecola, bensì un gruppo di fosfolipidi caratterizzati da una testa polare comune e da differenti catene laterali di acidi grassi in posizione sn-1 e sn-2.
Lo scopo della presente tesi è stata l’analisi della distribuzione quantitativa delle specie molecolari del fosfatidiletanolo in sangue prelevato da bevitori occasionali (social drinkers) ed abusatori cronici di etanolo (heavy drinkers) mediante due differenti tecniche analitiche: l’elettroforesi capillare e la cromatografia liquida ad alte prestazioni accoppiate alla spettrometria di massa.
I suddetti metodi analitici sono stati sviluppati e validati secondo le linee guida internazionali in ambito tossicologico-forense e, successivamente, applicati all'analisi di campioni di sangue reali, raccolti in ambito clinico. L’analisi quantitativa della distribuzione degli omologhi del fosfatidiletanolo ha dimostrato che le specie 16:0/18:1 e 16:0/18:2 sono predominanti negli abusatori cronici, costituendo mediamente il 46% e 28% del PEth totale. Variazioni inter-individuali fanno sì che il PEth 16:0/18:2 sia talvolta più abbondante rispetto alla forma 16:0/18:1; il PEth 18:1/18:1 ed il 18:0/18:2 rappresentano di norma l’11% del totale mentre il PEth 18:1/18:2 e 16:0/20:3 costituiscono il 6% circa.
L’elevata sensibilità del metodo sviluppato in cromatografia liquida accoppiata alla spettrometria di massa ad alta risoluzione ha consentito la quantificazione delle due specie molecolari più abbondanti (PEth 16:0/18:1 e 16:0/18:2) anche nel sangue di alcuni bevitori sociali.
I risultati ottenuti sottolineano la necessità di ulteriori studi volti alla caratterizzazione della velocità di formazione e di degradazione delle singole specie molecolari del PEth, al fine ultimo di identificare idonei cut-off per ciascun omologo ed evidenziare eventuali possibili vantaggi clinici nell’utilizzo di singoli omologhi o combinazioni di omologhi (invece della concentrazione totale del fosfatidiletanolo) per poter discriminare un consumo sociale, da un binge drinking o da un abuso alcolico cronico.Heavy alcohol consumption places a substantial burden on health all over the world. Metabolites of alcohol evoke alterations that lead to tissue damage in many organs. Phosphatidylethanol (PEth) is a unique phospholipid formed in the cellular membranes during the metabolism of ethanol after alcohol consumption. PEth has attracted special attention as it is postulated to be a reliable marker of long-term heavy alcohol consumption. Recent experiments have demonstrated the presence of different homologues of PEth in blood, revealing that it is not a single molecular species but a group of phospholipids with a common nonpolar phosphoethanol head group onto which 2 fatty acid moieties are attached at positions sn-1 and sn-2.
The aim of the present study was to investigate the distribution of PEth molecular species in blood collected from heavy and social drinkers by means of two different analytical techniques: capillary electrophoresis and high-performance liquid chromatography, both coupled to a mass spectrometric detector. The above-mentioned methods were developed and validated according to international forensic toxicology guidelines, and applied to the analysis of real blood samples collected in a clinical setting. The quantitative profiling of PEth homologues in heavy drinkers showed that PEth 16:0/18:1 and 16:0/18:2 are the predominant species accounting on average for 46% and 28%, respectively, of total PEth. Due to inter-individual variations, PEth 16:0/18:2 was sometimes the major molecular species, whereas PEth 18:1/18:1 and 18:0/18:2 made up 11% of total PEth, and PEth 18:1/18:2 and 16:0/20:3 about 6%.
Due to the high sensitivity of the liquid-chromatography high-resolution mass spectrometry method, it was possible to detect the two most abundant PEth homologues (PEth 16:0/18:1 and 16:0/18:2) also in blood of social drinkers.
These results underline the importance of further research in order to characterize the formation and degradation rates of singular PEth molecular species, determine the most appropriate cut-off for each species, highlight the possible clinical advantages of focusing on distinct homologues instead of on total PEth, and to determine whether this marker of chronic alcohol abuse could also be utilized for detecting single episodes of heavy drinking (“binge drinking”)
Functional '-omics' in intrauterine growth restriction: Novel insights into child development
No full textPersonalized medicine and medical malpractice [Medicina personalizzata e mala praxis sanitaria]
No full textThe manuscript deals with personalized medicine and medical liability in Europe and Italy, addressing the importance of synergistic collaboration between clinical and medico-legal professionals in order to appropriately investigate medical errors and prevent any future adverse event. Following a rapid epidemiological overview of mala praxis in Europe, the manuscript presents and discusses the International Guidelines developed and adopted by the International Academy of Legal Medicine (IALM), which guide the work of the medical experts under both criminal and/or civil law. Finally, the manuscript proposes the indispensability of a quality assurance and accreditation system for clinical and medico-legal reports along with a shared and integrated methodology for managing health claims in order to prevent adverse events. © PI-ME, Pavia 2017
Avulsion of the left internal mammary artery graft after minimally invasive coronary surgery: fatal complication or medical error? A case report
No full textMinimally invasive direct coronary artery bypass (MIDCAB) is performed through a left anterior mini-thoracotomy without the use of a cardiopulmonary bypass and offers greater potential for more rapid recovery, reduced pain and a decreased need for blood transfusion than conventional coronary artery bypass grafting. Few major complications of the MIDCAB procedure have been reported in the literature since the first intervention was performed in 1995, but the most serious one is avulsion of the left internal mammary artery (LIMA) graft near the site of anastomosis with the left anterior descending coronary artery. Forensic issues regarding the role of the surgeon in causing this life-threatening emergency condition have not been discussed. We report here the case of a 48-year-old man who died 18 days after a MIDCAB of massive thoracic bleeding due to the avulsion of the LIMA graft. We discuss the probable etiopathogenesis of this fatal complication from a forensic point of view
Avulsion of the left internal mammary artery graft after minimally invasive coronary surgery: fatal complication or medical error? A case report
No full textMinimally invasive direct coronary artery bypass (MIDCAB) is performed through a left anterior mini-thoracotomy without the use of a cardiopulmonary bypass and offers greater potential for more rapid recovery, reduced pain and a decreased need for blood transfusion than conventional coronary artery bypass grafting. Few major complications of the MIDCAB procedure have been reported in the literature since the first intervention was performed in 1995, but the most serious one is avulsion of the left internal mammary artery (LIMA) graft near the site of anastomosis with the left; anterior descending coronary artery. Forensic issues regarding the role of the surgeon in causing this life-threatening emergency condition have not been discussed. We report here the case of a 48-year-old man who died 18 days after a MIDCAB of massive thoracic bleeding due to the avulsion of the LIMA graft. We discuss the probable etiopathogenesis of this fatal complication from a forensic point of view
Caveats against an improper use of hair testing to support the diagnosis of chronic excessive alcohol consumption, following the "Consensus" of the Society of Hair Testing 2009 [Forensic Science International 196 (2010) 2]
No full textUrethral catheterization in men with artificial urinary sphincter: clinical and legal implications.
No full textSex differences and driving impairment related to psychoactive substances
No full textObjective: The first aim of the study was to identify sex differences in the use of psychoactive substances among subjects with a previous driving under the influence (DUI) episode. The secondary objective was to propose specific strategies for medico-legal improvements. Methods: This was a retrospective observational study that took place between June 1, 2019, and August 31, 2023. It was conducted on DUI subjects examined for reinstatement of their driver's license using an integrated medico-legal and toxicological approach. Ethyl glucuronide (EtG) and illicit psychoactive substances were determined from hair samples. We performed descriptive statistical analyses for the entire sample as well as separately by sex. Additionally, we conducted binary logistic regression analyses separately for males and females to identify protective/risk factors associated with previous road accidents and judgments of unfitness to drive due to excessive alcohol consumption (EtG ≥ 30 pg/mg). Results: The study included 2,221 subjects, comprising 1,970 men and 251 women. Men exhibited a higher prevalence of tobacco, alcohol, and illicit psychoactive substance use. Women were more frequently co-users of alcohol and psychoactive substances and involved in road accidents at the time of DUI. Among the men, being married or having a partner was found to be a protective factor concerning past traffic accidents. For both sexes, a DUI episode with a blood alcohol concentration (BAC) exceeding 1.5 g/L or the co-ingestion of alcohol and drugs was identified as a risk factor for road accident involvement. For men, smoking more than 20 cigarettes per day and, for women, having a DUI episode with a BAC over 1.5 g/L were the main factors indicating unfitness to drive, as determined through high hair EtG levels (> 30 pg/mg). Women with a previous history of road accidents were less likely to have EtG levels of 30 pg/mg or more. Conclusions: The study confirmed sex differences in subjects with a previous DUI episode. A BAC exceeding 1.5 g/L or the simultaneous use of alcohol and drugs at the time of DUI necessitate careful assessment of both men and women seeking driver's license reinstatement. In women, a BAC exceeding 1.5 g/L is considered a risk factor for a subsequent judgment of unfitness to drive. The medico-legal assessment should also involve a thorough investigation of smoking habits in men, as these habits could be related to an increased risk of excessive alcohol consumption
Planned complex suicide by penetrating captive-bolt gunshot and hanging: Case study and review of the literature
No full textCaptive-bolt guns or slaughterer's guns are devices widely used in meat industry and private farmer households for slaughtering animal stocks. They consist of a simple cylindrical metal tube (barrel) with a metal bolt placed in their centre (around 9-15cm long and 1-1.5cm wide). The bolt is actuated by a trigger pull and is propelled forward by compressed air or by the discharge of a blank powder gun cartridge. Violent deaths inflicted by captive-bolt guns are rarely encountered in forensic practice and are predominantly suicidal events. We report an unusual complex suicide by hanging and self-shooting with a slaughterer's gun in a 21-year-old boy. The victim after putting a ceiling fixed rope around his neck shot himself in the head (occipital region) with a Kerner captive-bolt gun. He used two mirrors (a cosmetic mirror and a man-sized one) in order to properly visualize his back and to target the occipital region of his head. Radiological data (computed tomography with three dimensional reconstruction) and autopsy findings are discussed according to the clinical and forensic literature. A brief review on planned complex suicides is also given
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