Bile analysis in heroin overdose.

Following its metabolism in the liver, morphine and its metabolites can be directly eliminated in bile. Then, they undergo the enterohepatic cycle (EHC) and mostly reappear in the circulation. We report a case showing the presence of morphine in bile (21.3 lg \u2044 mL) and hair (4.8 ng \u2044mg) but not in blood, urine or the liver of an addict who survived in hospital for about 144 h (6 days). These data would indicate that the EHC does not play any role about 144 h after the last injection, and directly confirms that gall bladder is a storage depot for morphine. They constitute the first report of a demonstration of the effect of the EHC on morphine bioavailability in an addict, and could be considered as indication, without supporting circumstantial evidence, that the morphine level in bile is related to chronic opiate use

Analisi del fenomeno della guida in stato di ebbrezza da alcool nella provincia di Macerata negli anni 2008-2009 sulla base della attivit\ue0 di controllo delle Forze dell'ordine

This study analyzes the phenomenon of driving under the influence of alcohol, based on police control data in the province of Macerata during the years 2008 and 2009. The study was carried out following the introduction of Law 160/2007 that envisages higher levels of sanctioning for drunk driving. Data utilized have concerned the alcohol concentrations found in drivers who have been subject to breathalyzer and have been sanctioned. Data analysis show differences not only between sexes but also between different age groups, with the youngest people being more sanctioned. Average alcohol levels were higher in older age groups

Use of 3D rotational angiography to perform computational fluid dynamics and virtual interventions in aortic coarctation

Computational fluid dynamics (CFD) can be used to analyze blood flow and to predict hemodynamic outcomes after interventions for coarctation of the aorta and other cardiovascular diseases. We report the first use of cardiac 3‐dimensional rotational angiography for CFD and show not only feasibility but also validation of its hemodynamic computations with catheter‐based measurements in three patients.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154333/1/ccd28507.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154333/2/ccd28507_am.pd

Comprehensive comparative outcomes in children with congenital heart disease: The rationale for the Congenital Catheterization Research Collaborative

Clinical research in the treatment of patients with congenital heart disease (CHD) is limited by the wide variety of CHD manifestations and therapeutic options as well as the generally low incidence of CHD. The availability of comprehensive, contemporary outcomes studies is therefore limited. This inadequacy may result in a lack of data‐driven medical decision making. In 2013, clinician scientists at two centers began a research collaboration, the Congenital Catheterization Research Collaborative (CCRC). Over time, the CCRC has grown to include nine cardiac centers from across the United States, with a common data coordinating center. The CCRC seeks to generate high‐quality, contemporary, statistically robust, and generalizable outcomes research which can help address important clinical questions in the treatment of CHD. To date, the CCRC has reported on multicenter outcomes in: neonates with congenital aortic stenosis, infants undergoing right ventricular decompression for pulmonary atresia and intact ventricular septum, and infants with ductal‐dependent pulmonary blood flow. The CCRC has been successful at leveraging large multicenter cohorts of patients in a contemporary period to perform comparative studies. In the future, the CCRC plans to continue to perform hypothesis‐driven retrospective and prospective observational studies of CHD populations where controversy exists or where novel interventions or therapies have emerged. Quality improvement efforts including lesion‐specific registry development may be an additional potential future target.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149494/1/chd12737.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149494/2/chd12737_am.pd

I tossicodipendenti.

In tutte le epoche e in tutte le civilt\ue0 si sono assunte determinate sostanze esclusivamente per gli effetti derivanti dal loro uso, essendo esse capaci di provocare stati psichici particolari, insoliti, ed elettivamente ricercati a vari fini (culti, ritualit\ue0 sociali o mero piacere). Tuttavia la diffusione dei consumi di droghe, a livello di massa e specialmente tra i pi\uf9 giovani, \ue8 un fenomeno che ha interessato il mondo occidentale solo da una trentina d\u2019anni, creando una gravissima serie di problemi, non solo sociali, che hanno determinato una rivoluzione nell\u2019analisi del fenomeno. \uc8 ormai assodato che il concetto di droga, o meglio di stupefacente, non pu\uf2 essere definito in senso assoluto, essendo impossibile un\u2019esatta definizione sotto il profilo chimico, come anche riguardo agli effetti sull\u2019organismo. La terminologia tecnica e scientifica delle sostanze stupefacenti non sempre combacia con quello che \ue8 il lessico giuridico, infatti, sarebbe opportuno che vi fosse coincidenza tra questi due ambiti anche in considerazione del fatto che le incongruenze terminologiche e definitorie, potrebbero incidere sulla concreta applicazione o esatta interpretazione di alcune specifiche norme. Il continuo modificarsi del quadro storico sulle tossicodipendenze si accompagna ai veloci mutamenti riguardanti il tipo e le modalit\ue0 del consumo, difatti, ci\uf2 che da diversi anni gli operatori del settore sostengono \ue8 che \ue8 cambiata la fenomenologia della tossicodipendenza