Has GBL replaced GHB in recreational settings?

Has GBL replaced GHB in recreational setting

Liability arising from restraint use in psychiatry [Responsabilità professionale derivante dall’uso della contenzione in psichiatria]

Lo scopo del presente articolo è quello di valutare se e quando l'uso della contenzione può essere giustificato in psichiatria. Gli autori espongono i vari tipi di costrizione e i rischi che tali mezzi comportano per il benessere psicofisico del paziente, soffermandosi ad analizzare se tali pratiche costituiscano realmente forme di cura sanitaria. Infatti, una risposta negativa a tale domanda comporterebbe che la contenzione non è mai obbligatoria e può essere eseguita solo in stato di necessità. Una risposta affermativa, invece, significherebbe che condizioni straordinarie potrebbero rendere obbligatoria la contenzione. Di conseguenza, i medici possono essere ritenuti legalmente responsabili se non usano la contenzione quando necessario per impedire ai pazienti di compiere atti di autolesionismo o danni ad altri. Poiché la contenzione di per sé comporta pesanti limitazioni alla libertà personale (art. 13 Cost.) e gravi rischi per la salute (art. 32 Cost.) essa può considerarsi obbligatoria solo se sono rispettati i criteri dello stato di assoluta necessità (ex art. 54 Cost. della legge penale italiana). Tali parametri dovrebbero essere fissati a livello nazionale e non locale.This article aims to lay out an assessment of whether and when restraint use may be warranted in psychiatry. The authors lay out various types of restraints and the risks posed by such means for the patient’s psychophysical well-being, wondering whether such practices really constitute forms of health care treatment. A negative response to that question would entail that restraint is never compulsory and can only be performed under the state of necessity. An affirmative answer, on the other hand, would mean that extraordinary conditions could make restraint mandatory. As a consequence of that, doctors may be held legally liable whether they fail to use restraint when necessary to keep patients from engaging in self-harm or harm against others. Since restraint per se entails heavy limitations to personal freedom (art. 13 Cost.) and serious risks for health (art. 32 Cost.) it can only be considered compulsory if the standards of an absolute state of necessity are met (under article 54 of Italian criminal statutes). Such parameters should be set on a national, rather than local, level. © 2021 Author(s)

Hierarchical Multi-Agent Reinforcement Learning for Air Combat Maneuvering

The application of artificial intelligence to simulate air-to-air combat scenarios is attracting increasing attention. To date the high-dimensional state and action spaces, the high complexity of situation information (such as imperfect and filtered information, stochasticity, incomplete knowledge about mission targets) and the nonlinear flight dynamics pose significant challenges for accurate air combat decision-making. These challenges are exacerbated when multiple heterogeneous agents are involved. We propose a hierarchical multi-agent reinforcement learning framework for air-to-air combat with multiple heterogeneous agents. In our framework, the decision-making process is divided into two stages of abstraction, where heterogeneous low-level policies control the action of individual units, and a high-level commander policy issues macro commands given the overall mission targets. Low-level policies are trained for accurate unit combat control. Their training is organized in a learning curriculum with increasingly complex training scenarios and league-based self-play. The commander policy is trained on mission targets given pre-trained low-level policies. The empirical validation advocates the advantages of our design choices.Comment: 22nd International Conference on Machine Learning and Applications (ICMLA 23

CRISPR-Cas and its wide-ranging applications: from human genome editing to environmental implications, technical limitations, hazards and bioethical issues

The CRISPR-Cas system is a powerful tool for in vivo editing the genome of most organisms, including man. During the years this technique has been applied in several fields, such as agriculture for crop upgrade and breeding including the creation of allergy-free foods, for eradicating pests, for the improvement of animal breeds, in the industry of bio-fuels and it can even be used as a basis for a cell-based recording apparatus. Possible applications in human health include the making of new medicines through the creation of genetically modified organisms, the treatment of viral infections, the control of pathogens, applications in clinical diagnostics and the cure of human genetic diseases, either caused by somatic (e.g., cancer) or inherited (mendelian disorders) mutations. One of the most divisive, possible uses of this system is the modification of human embryos, for the purpose of preventing or curing a human being before birth. However, the technology in this field is evolving faster than regulations and several concerns are raised by its enormous yet controversial potential. In this scenario, appropriate laws need to be issued and ethical guidelines must be developed, in order to properly assess advantages as well as risks of this approach. In this review, we summarize the potential of these genome editing techniques and their applications in human embryo treatment. We will analyze CRISPR-Cas limitations and the possible genome damage caused in the treated embryo. Finally, we will discuss how all this impacts the law, ethics and common sense

Smart drugs and synthetic androgens for cognitive and physical enhancement: revolving doors of cosmetic neurology

Cognitive enhancement can be defined as the use of drugs and/or other means with the aim to improve the cognitive functions of healthy subjects in particular memory, attention, creativity and intelligence in the absence of any medical indication. Currently, it represents one of the most debated topics in the neuroscience community. Human beings always wanted to use substances to improve their cognitive functions, from the use of hallucinogens in ancient civilizations in an attempt to allow them to better communicate with their gods, to the widespread use of caffeine under various forms (energy drinks, tablets, etc.), to the more recent development of drugs such as stimulants and glutamate activators. In the last ten years, increasing attention has been given to the use of cognitive enhancers, but up to now there is still only a limited amount of information concerning the use, effect and functioning of cognitive enhancement in daily life on healthy subjects. The first aim of this paper was to review current trends in the misuse of smart drugs (also known as Nootropics) presently available on the market focusing in detail on methylphenidate, trying to evaluate the potential risk in healthy individuals, especially teenagers and young adults. Moreover, the authors have explored the issue of cognitive enhancement compared to the use of Anabolic Androgenic Steroids (AAS) in sports. Finally, a brief overview of the ethical considerations surrounding human enhancement has been examined

Functional reconstitution of HBV-specific CD8 T cells by in vitro polyphenol treatment in chronic hepatitis B.

Background & aims In chronic HBV infection, mitochondrial functions and proteostasis are dysregulated in exhausted HBV-specific CD8 T cells. To better characterise the potential involvement of deregulated protein degradation mechanisms in T cell exhaustion, we analysed lysosome-mediated autophagy in HBV-specific CD8 T cells. Bioactive compounds able to simultaneously target both mitochondrial functions and proteostasis were tested to identify optimal combination strategies to reconstitute efficient antiviral CD8 T cell responses in patients with chronic HBV infection. Methods Lysosome-mediated degradation pathways were analysed by flow cytometry in virus-specific CD8 T cells from patients with chronic HBV infection. Mitochondrial function, intracellular proteostasis, and cytokine production were evaluated in HBV-peptide-stimulated T cell cultures, in the presence or absence of the polyphenols resveratrol (RSV) and oleuropein (OLE) and their metabolites, either alone or in combination with other bioactive compounds. Results HBV-specific CD8 T cells from patients with CHB showed impaired autophagic flux. RSV and OLE elicited a significant improvement in mitochondrial, proteostasis and antiviral functions in CD8 T cells. Cytokine production was also enhanced by synthetic metabolites, which correspond to those generated by RSV and OLE metabolism in vivo, suggesting that these polyphenols may also display an effect after transformation in vivo. Moreover, polyphenolic compounds improved the T cell revitalising effect of mitochondria-targeted antioxidants and of programmed cell death protein 1/programmed cell death ligand 1 blockade. Conclusions Simultaneously targeting multiple altered intracellular pathways with the combination of mitochondria-targeted antioxidants and natural polyphenols may represent a promising immune reconstitution strategy for the treatment of chronic HBV infection. Lay summary In chronic hepatitis B, antiviral T lymphocytes are deeply impaired, with many altered intracellular functions. In vitro exposure to polyphenols, such as resveratrol and oleuropein, can correct some of the deregulated intracellular pathways and improve antiviral T cell function. This effect can be further strengthened by the association of polyphenols with antioxidant compounds in a significant proportion of patients. Thus, the combination of antioxidants and natural polyphenols represents a promising strategy for chronic hepatitis B therapy

CVD-graphene/graphene flakes dual-films as advanced DSSC counter electrodes

The use of graphene-based electrodes is burgeoning in a wide range of applications, including solar cells, light emitting diodes, touch screens, field-effect transistors, photodetectors, sensors and energy storage systems. The success of such electrodes strongly depends on the implementation of effective production and processing methods for graphene. In this work, we take advantage of two different graphene production methods to design an advanced, conductive oxide- and platinum-free, graphene-based counter electrode for dye-sensitized solar cells (DSSCs). In particular, we exploit the combination of a graphene film, produced by chemical vapor deposition (CVD) (CVD-graphene), with few-layer graphene (FLG) flakes, produced by liquid phase exfoliation. The CVD-graphene is used as charge collector, while the FLG flakes, deposited atop by spray coating, act as catalyst for the reduction of the electrolyte redox couple (i.e., I3-/I-- and Co+2/+3). The as-produced counter electrodes are tested in both I3-/I-- and Co+2/+3-based semitransparent DSSCs, showing power conversion efficiencies of 2.1% and 5.09%, respectively, under 1 SUN illumination. At 0.1 SUN, Co+2/+3-based DSSCs achieve a power conversion efficiency as high as 6.87%. Our results demonstrate that the electrical, optical, chemical and catalytic properties of graphene-based dual films, designed by combining CVD-graphene and FLG flakes, are effective alternatives to FTO/Pt counter electrodes for DSSCs for both outdoor and indoor applications

Binding of myomesin to obscurin-like-1 to the muscle M-band provides a strategy for isoform-specific mechanical protection

The sarcomeric cytoskeleton is a network of modular proteins that integrate mechanical and signalling roles. Obscurin, or its homolog obscurin-like-1, bridges the giant ruler titin and the myosin crosslinker myomesin at the M-band. Yet, the molecular mechanisms underlying the physical obscurin(-like-1):myomesin connection, important for mechanical integrity of the M-band, remained elusive. Here, using a combination of structural, cellular, and single-molecule force spectroscopy techniques, we decode the architectural and functional determinants defining the obscurin(-like-1): myomesin complex. The crystal structure reveals a trans-complementation mechanism whereby an incomplete immunoglobulin-like domain assimilates an isoform-specific myomesin interdomain sequence. Crucially, this unconventional architecture provides mechanical stability up to forces of 135 pN. A cellular competition assay in neonatal rat cardiomyocytes validates the complex and provides the rationale for the isoform specificity of the interaction. Altogether, our results reveal a novel binding strategy in sarcomere assembly, which might have implications on muscle nanomechanics and overall M-band organization.We thank the Diamond Light Source and the European Synchrotron Radiation Laboratory for access to MX and SAXS beamlines, respectively. This work was supported by a British Heart Foundation grant (PG/10/67/28527) awarded to R.A.S. and M.G. as well as MRC grant MR/J010456/1 to M.G. and a British Heart Foundation grant (PG/13/50/30426) and EPSRC Fellowship (K00641X/1) to S.G.-M

Parathyroid Retrospective Analysis of Neoplasms Incidence (pTRANI Study): An Italian Multicenter Study on Parathyroid Carcinoma and Atypical Parathyroid Tumour

Background: Parathyroid cancer (PC) is a rare sporadic or hereditary malignancy whose histologic features were redefined with the 2022 WHO classification. A total of 24 Italian institutions designed this multicenter study to specify PC incidence, describe its clinical, functional, and imaging characteristics and improve its differentiation from the atypical parathyroid tumour (APT). Methods: All relevant information was collected about PC and APT patients treated between 2009 and 2021. Results: Among 8361 parathyroidectomies, 351 patients (mean age 59.0 ± 14.5; F = 210, 59.8%) were divided into the APT (n = 226, 2.8%) and PC group (n = 125, 1.5%). PC showed significantly higher rates (p < 0.05) of bone involvement, abdominal, and neurological symptoms than APT (48.8% vs. 35.0%, 17.6% vs. 7.1%, 13.6% vs. 5.3%, respectively). Ultrasound (US) diameter >3 cm (30.9% vs. 19.3%, p = 0.049) was significantly more common in the PC. A significantly higher frequency of local recurrences was observed in the PC (8.0% vs. 2.7%, p = 0.022). Mortality due to consequences of cancer or uncontrolled hyperparathyroidism was 3.3%. Conclusions: Symptomatic hyperparathyroidism, high PTH and albumin-corrected serum calcium values, and a US diameter >3 cm may be considered features differentiating PC from APT. 2022 WHO criteria did not impact the diagnosis

Analysis of immunization time, amplitude, and adverse events of seven different vaccines against SARS-CoV-2 across four different countries

BackgroundScarce information exists in relation to the comparison of seroconversion and adverse events following immunization (AEFI) with different SARS-CoV-2 vaccines. Our aim was to correlate the magnitude of the antibody response to vaccination with previous clinical conditions and AEFI.MethodsA multicentric comparative study where SARS-CoV-2 spike 1-2 IgG antibodies IgG titers were measured at baseline, 21-28 days after the first and second dose (when applicable) of the following vaccines: BNT162b2 mRNA, mRNA-1273, Gam-COVID-Vac, Coronavac, ChAdOx1-S, Ad5-nCoV and Ad26.COV2. Mixed model and Poisson generalized linear models were performed.ResultsWe recruited 1867 individuals [52 (SD 16.8) years old, 52% men]. All vaccines enhanced anti-S1 and anti-S2 IgG antibodies over time (p<0.01). The highest increase after the first and second dose was observed in mRNA-1273 (p<0.001). There was an effect of previous SARS-CoV-2 infection; and an interaction of age with previous SARS-CoV-2 infection, Gam-COVID-Vac and ChAdOx1-S (p<0.01). There was a negative correlation of Severe or Systemic AEFI (AEs) of naïve SARS-CoV-2 subjects with age and sex (p<0.001); a positive interaction between the delta of antibodies with Gam-COVID-Vac (p=0.002). Coronavac, Gam-COVID-Vac and ChAdOx1-S had less AEs compared to BNT162b (p<0.01). mRNA-1273 had the highest number of AEFIs. The delta of the antibodies showed an association with AEFIs in previously infected individuals (p<0.001).ConclusionsThe magnitude of seroconversion is predicted by age, vaccine type and SARS-CoV-2 exposure. AEs are correlated with age, sex, and vaccine type. The delta of the antibody response only correlates with AEs in patients previously exposed to SARS-CoV-2.Registration numberClinicalTrials.gov, identifier NCT05228912