How do we treat the broad spectrum of patients with serious mental illness who have committed crimes? The Law 81/2014: limits and problems

In Italia è in corso un processo di deistituzionalizzazione che non ha precedenti al mondo. Si stanno progressivamente svuotando gli Ospedali Psichiatrici Giudiziari che non sono mai stati riformati negli ultimi 80 anni. Questo processo sta venendo attuato tramite una stratificazione di norme senza una progettualità diversa dalla rapida chiusura di queste fatiscenti strutture. Ai Dipartimenti di Salute Mentale (DSM) sono richieste una molteplicità di compiti nuovi e fortemente specialistici, e una estensione del loro potere di controllo, senza che queste strutture siano organizzate in tale senso. Alcune delle norme recentemente varate, come la Legge 81 del 2014, per risolvere alcuni problemi derivanti dalle difficoltà di deistituzionalizzazione complicano, a nostro parere, diversi aspetti gestionali di questa popolazione di gravi pazienti psichiatrici, che comunque non è assimilabile alla normale utenza dei DSM.Vi è necessità di un intervento legislativo coordinato e pensato su una prospettiva a lungo termineIn Italy an ongoing process of deinstitutionalization unprecedented in the world is been enacted.The Judicial Psychiatric Hospitals, that were never reformed in the past 80 years, are now on the edge of their closure.This process is being implemented through a layering of rules that had no purpose other than the rapid closure of these structures.The Mental Health Departments have now the responsibility of a multiplicity of new and highly specialized tasks, and an extension of their power to control.There is no previous organization for these tasks in the Mental Health System. Some of the recently enacted laws,such as the Law 81 of 2014, are intented to solve some problems, althought issues of deinstitutionalization are getting worse.In our opinion several management aspects of this population of severe psychiatric patients are unfit with the present organization of the Mental Health Services.There is need for legislative action coordinated and based on a long-term perspective

Divergent behavior of hydrogen sulfide pools and of the sulfur metabolite lanthionine, a novel uremic toxin, in dialysis patients.

Dialysis patients display a high cardiovascular mortality, the causes of which are still not completely explained, but are related to uremic toxicity. Among uremic toxins, homocysteine and cysteine are both substrates of cystathionine β-synthase and cystathionine γ-lyase in hydrogen sulfide biosynthesis, leading to the formation of two sulfur metabolites, lanthionine and homolanthionine, considered stable indirect biomarkers of its production. Hydrogen sulfide is involved in the modulation of multiple pathophysiological responses. In uremia, we have demonstrated low plasma total hydrogen sulfide levels, due to reduced cystathionine γ-lyase expression. Plasma hydrogen sulfide levels were measured in hemodialysis patients and healthy controls with three different techniques in comparison, allowing to discern the different pools of this gas. The protein-bound (the one thought to be the most active) and acid-labile forms are significantly decreased, while homolanthionine, but especially lanthionine, accumulate in the blood of uremic patients. The hemodialysis regimen plays a role in determining sulfur compounds levels, and lanthionine is partially removed by a single dialysis session. Lanthionine inhibits hydrogen sulfide production in cell cultures under conditions comparable to in vivo ones. We therefore propose that lanthionine is a novel uremic toxin. The possible role of high lanthionine as a contributor to the genesis of hyperhomocysteinemia in uremia is discusse

High Frequency Inductive Power Transfer Through Soil for Agricultural Applications

This work was supported by the UK Research and Innovation (UKRI), reference numbers: NE/ T011467/1 and NE/T011068/1, and the National Science Foundation (NSF), award no. 1935632: SitS NSF-UKRI: Wireless In-Situ Soil Sensing Network for Future Sustainable Agriculture’. (Corresponding author: Juan M. Arteaga.)Peer reviewedPublisher PD

Post-operative acute urinary retention after greenlight laser. Analysis of risk factors from a multicentric database

Purpose: Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP. Materials and methods: In a multicenter experience, we retrospectively analyzed the onset of early and late post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention. Results: The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89-0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19- 10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors for pAUR. Conclusion: In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal

Calibration curves obtained for the three analytes.

<p>Calibration curves obtained for the three analytes.</p

Quantitative determination of l-Asp, d-Asp and NMDA in samples from mouse prefrontal cortex by MRM LC-MSMS analysis.

<p>Samples were obtained from brain of three individual animals from each group (<i>DDO</i>^+/+, wild type mouse; <i>DDO</i>^-/-, D-aspartate oxidase (DDO) knockout mouse). Each measurement represents the average of three technical replicates.</p

Quantitative determination of free D-Asp, L-Asp and N-methyl-D-aspartate in mouse brain tissues by chiral separation and Multiple Reaction Monitoring tandem mass spectrometry

<div><p>Several studies have suggested that free d-Asp has a crucial role in N-methyl d-Asp receptor-mediated neurotransmission playing very important functions in physiological and pathological processes. This paper describes the development of an analytical procedure for the direct and simultaneous determination of free d-Asp, l-Asp and N-methyl d-Asp in specimens of different mouse brain tissues using chiral LC-MS/MS in Multiple Reaction Monitoring scan mode. After comparing three procedures and different buffers and extraction solvents, a simple preparation procedure was selected the analytes of extraction. The method was validated by analyzing l-Asp, d-Asp and N-methyl d-Asp recovery at different spiked concentrations (50, 100 and 200 pg/μl) yielding satisfactory recoveries (75–110%), and good repeatability. Limits of detection (LOD) resulted to be 0.52 pg/μl for d-Asp, 0.46 pg/μl for l-Asp and 0.54 pg/μl for NMDA, respectively. Limits of quantification (LOQ) were 1.57 pg/μl for d-Asp, 1.41 pg/μl for l-Asp and 1.64 pg/μl for NMDA, respectively. Different concentration levels were used for constructing the calibration curves which showed good linearity. The validated method was then successfully applied to the simultaneous detection of d-Asp, l-Asp and NMDA in mouse brain tissues. The concurrent, sensitive, fast, and reproducible measurement of these metabolites in brain tissues will be useful to correlate the amount of free d-Asp with relevant neurological processes, making the LC-MS/MS MRM method well suited, not only for research work but also for clinical analyses.</p></div

TIC and MRM chromatograms recorded for the three analytes in a sample from prefrontal cortex of wild type mouse.

<p>The specific MRM transitions for each analyte are indicated.</p

Quantitative analysis of d-Asp (left panel) and d-Asp versus l-Asp ratio (right panel) in samples from mouse prefrontal cortex using the developed LC-MS/MS MRM procedure.

<p><i>DDO</i>^+/+, wild type mouse; <i>DDO</i>^-/-, d-aspartate oxidase (DDO) knockout mouse.</p

LCMSMS analyses in MRM mode of test samples from mouse brain tissues to optimise the sample treatment procedure.

<p>Some experimental conditions for sample extraction and precipitation are reported in the figure. Peaks corresponding to each analyte are labelled.</p