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Background In Italy the Law 9/2012 prescribed the total closure of forensic psychiatric hospitals (OPGs) and the conversion to a care model based on residential units in the community employing only clinical personnel (Residenze per l'Esecuzione delle Misure di Sicurezza – REMS) and fully integrated in public mental health services. The aim of this study is to report sociodemographic, clinical and criminological characteristics of patients admitted in Volterra REMS since it opened on 01/12/15 up to 31/12/17. Methods Sociodemographic and clinical information was collected from official documents (clinical files, ward reports) and from patients' personal health records. Psychiatric diagnoses were made by REMS psychiatrists according to the DSM-5 criteria. Criminological information was obtained from patients' criminal records. Results Volterra REMS patients' characteristics are similar to those of samples of OPGs patients (unmarried socially disadvantaged males with an average age of 40, no offsprings, low education, high rates of Schizophrenia Spectrum Disorders and medical comorbidity). However, the REMS model presents a very high turnover rate: during the study period 61 patients were admitted while 32 were discharged. Being assisted by public mental health services before committing the crime increased the probability of discharge. In non-EU patients long acting injectable antipsychotics were used more frequently than in community ones. Substance-Related Disorders are the main psychiatric comorbidity and resulted as being more frequent in bipolar patients than in other patients. Conclusions Due to the high patients' turnover, we expect a progressive change in sociodemographic, clinical and criminological features of the REMS population. The REMS model provides a return for mentally disordered criminals to the care of local public mental health services which are recovering after many years some of their most challenging patients ensuring their deinstitutionalization and reintegration into society.

In the field of sleep disorders, the quality of couple relationship is arousing increasing attention, given its implications for quality of life and treatment adherence. The aim of the present study was to evaluate relationship quality in a sample of treated or untreated patients with Obstructive Sleep Apnoea Syndrome. Eighty-seven patients were recruited in a hospital-based Centre for Sleep Medicine. Subjects were administered the Dyadic Adjustment Scale (DAS) to evaluate relationship quality, and the Epworth Sleepiness Scale (ESS). Apnoea-hypopnoea indexes (AHI) were collected through nocturnal polysomnography or home testing with a portable monitoring device. Although the DAS average scores were similar to local normative values, relationship quality was significantly lower in the untreated patients when compared with the ones treated. The ESS scores showed a negative correlation with many DAS scores, whereas no significant correlation emerged for AHI. Such data suggest a significant impact of perceived sleep apnoea symptoms on marital satisfaction, even though in the absence of striking differences between the whole sample and the general population.

Background: Nevirapine (NVP) is a nonnucleoside reverse transcriptase inhibitor used in HIV patients and recently evaluated as a differentiating and antiproliferative agent in human malignancies. However, while NVP is a safe treatment in immunocompromised patients, NVP-containing regimens have been associated with severe immune-mediated toxicities in non-HIV individuals. Methods and Results: We describe the toxicity profile of single-agent NVP in 6 non-HIV cancer patients treated for a median period of 7.3 months (range 1–24), reporting only a reversible grade III increase in glutamyl transpeptidase and glutamic pyruvic transaminase serum values. Interestingly, NVP treatment correlates with either a decrease in CD8+ T cell counts or a parallel increase in CD4/CD8 ratio, antithyroglobulin and antithyroid peroxidase autoantibody titers. Conclusions: These results, although obtained in a small cohort of patients, suggest that the toxicity profile of single-agent NVP may be worth testing in a phase I/II study in non-HIV cancer patients and that NVP toxicity may depend on its capacity to trigger autoimmune responses in susceptible individuals.

In the literature there are some case reports of hypoxemia due to right to left blood shunting [2–4]. Most causes of right to left shunting through a patent foramen ovale are attributed to right atrial pressure exceeding that of the left, forcing open a potentially patent foramen ovale. A patent foramen ovale is present in 25–30% of healthy subjects [5], and is responsible for a right to left shunt when pulmonary hypertension is present. In the absence of pulmonary hypertension there are three main pathophysiologic mechanisms [6]: extrinsic compression of the right atrium (right hydrothorax or a localized pericardial effusion) causing an increase in the right heart pressure; a decrease in the compliance of the right ventricle (due to right ventricle ischemia or after pneumonectomy); and an abnormal anatomic relationship between the vena cava and the atrial septum or an anatomic distortion of the heart with downward displacement of the right atrium due to the enlargement of the thoracic aorta with distortion of the position of the atrial septum relative to caval inflow and favouring interatrial flow.

In the last few years, not many studies on the use of robot-assisted therapy to recover hand function in acute stroke patients have been carried out. This randomized-controlled observer trial is aimed at evaluating the effects of intensive robot-assisted hand therapy compared with intensive occupational therapy in the early recovery phases after stroke with a 3-month follow-up. Twenty acute stroke patients at their first-ever stroke were enrolled and randomized into two groups. The experimental treatment was performed using the Amadeo Robotic System. Control treatment, instead, was carried out using occupational therapy executed by a trained physiotherapist. All participants received 20 sessions of treatment for 4 consecutive weeks (5 days/week). The following clinical scales, Fugl-Meyer Scale (FM), Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles) (MRC), Motricity Index (MI) and modified Ashworth Scale for wrist and hand muscles (MAS), were performed at baseline (T0), after 20 sessions (end of treatment) (T1) and at the 3-month follow-up (T2). The Barthel Index was assessed only at T0 and T1. Evidence of a significant improvement was shown by the Friedman test for the FM [experimental group (EG): P=0.0039, control group (CG): P

Background. No strongly clinical evidence about the use of hand robot-assisted therapy in stroke patients was demonstrated. This preliminary observer study was aimed at evaluating the efficacy of intensive robot-assisted therapy in hand function recovery, in the early phase after a stroke onset.Methods. Seven acute ischemic stroke patients at their first-ever stroke were enrolled. Treatment was performed using Amadeo robotic system (Tyromotion GmbH Graz, Austria). Each participant received, in addition to inpatients standard rehabilitative treatment, 20 sessions of robotic treatment for 4 consecutive weeks (5 days/week). Each session lasted for 40 minutes. The exercises were carried out as follows: passive modality (5 minutes), passive/plus modality (5 minutes), assisted therapy (10 minutes), and balloon (10 minutes). The following impairment and functional evaluations, Fugl-Meyer Scale (FM), Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles) (MRC), Motricity Index (MI), and modified Ashworth Scale for wrist and hand muscles (AS), were performed at the beginning (T0), after 10 sessions (T1), and at the end of the treatment (T2). The strength hand flexion and extension performed by Robot were assessed at T0 and T2. The Barthel Index and COMP (performance and satisfaction subscale) were assessed at T0 and T2.Results. Clinical improvements were found in all patients. No dropouts were recorded during the treatment and all subjects fulfilled the protocol. Evidence of a significant improvement was demonstrated by the Friedman test for the MRC (P<0.0123). Evidence of an improvement was demonstrated for AS, FM, and MI.Conclusions. This original rehabilitation treatment could contribute to increase the hand motor recovery in acute stroke patients. The simplicity of the treatment, the lack of side effects, and the first positive results in acute stroke patients support the recommendations to extend the clinical trial of this treatment, in association with physiotherapy and/or occupational therapy.

The simultaneous finding of submandibular ectopic thyroid tissue and functional orthotopic thyroid gland is an extremely rare event. The present report describes the case of a woman presenting with a left submandibular mass, distant from a palpable multinodular goitre. Ultrasonography showed an ovoidal solid mass adjacent to the lower margin of the left submandibular gland. Cytological specimens showed colloid material and thyroid follicular cells with no malignant features. A preoperative CT scan demonstrated a very thin connection between the thyroid and the submandibular mass. The patient underwent total thyroidectomy and excision of the submandibular mass. The histopathological diagnosis of the thyroid tissue was multinodular goitre, and the submandibular mass was ectopic thyroid tissue showing a hyperplastic pattern. The main differential diagnosis of the submandibular mass was a metastasis from a well differentiated cancer. This case illustrates that an ectopic thyroid off the midline may not necessarily be a metastasis from a thyroid cancer.

Patients suffering from Alzheimer’s disease, Parkinson disease with dementia, and diffuse cerebrovascular dementia show different features of cortical sources of resting state electroencephalographic (EEG) rhythms (Babiloni et al., 2004, 2011). Here, we tested the hypothesis that stroke patients are characterized by peculiar abnormalities of these rhythms. Resting state eyes-closed EEG data were recorded in 29 acute stroke, 29 Alzheimer’s disease, 29 mild cognitive impairment patients, and 29 cognitively intact elderly subjects. Stroke patients were age matched with the other groups, they showed a mild cognitive decline. EEG recordings were performed from the 20th to 30th days from the first ischemic or hemorrhagic acute event. LORETA was used for source estimation. Compared to the other groups, the stroke patients were characterized by a greater power of widespread cortical sources of delta (1–4 Hz) and theta (4–8 Hz) rhythms (p

TRAP1, a mitochondrial chaperone with antiapoptotic functions, is involved in drug-resistance in human CRC. TRAP1 is a component of the HSP90 mitochondrial survival pathway, which antagonizes the proapoptotic activity of cyclophilin D. Interestingly, novel agents are able to disassemble this pathway and are under clinical evaluation. GST-pulldown experiments and mass spectrometry assays led us to the identification of several TRAP1 ligands and, among others, Sorcin, a Ca2+-binding protein involved in the MDR phenotype of human tumors. We functionally characterized the cooperation between TRAP1 and Sorcin in favoring survival of CRC cells and investigated the expression levels of the two proteins in human CRCs. We demonstrated the mitochondrial localization of a 18kDa isoform of Sorcin that specifically interacts with TRAP1 in human CRC cells. The overexpression or down-regulation of Sorcin and/or TRAP1 allowed us to demonstrate a reciprocal regulation between the two proteins and to show that their interaction is required for Sorcin mitochondrial localization and TRAP1 protein stability. Furthermore, the upregulation of either TRAP1 and/or Sorcin induced resistance to 5-fluoruracil (FU), irinotecan (IRI) and oxaliplatin (l-OHP) in CRC cells. Of note, the knock-down of TRAP1 and/or Sorcin expression by siRNAs as well as the pharmacological inhibition of TRAP1 ATPase re-established a phenotype sensitive to FU, IRI and l-OHP. Consistently with these in vitro observations, gene expression analysis showed that TRAP1 and Sorcin are up-regulated, respectively, in 28/41 and 18/41 CRCs and a significant correlation between the expression of TRAP1 and the p22 isoform of Sorcin was observed (Sperman rank test p = 0.003; Kendal Tau test p = 0.003). Finally, the two proteins are also co-upregulated in CRC cells resistant to FU, IRI and l-OHP. Sorcin and TRAP1 are functionally linked in a survival network responsible for resistance to chemotherapy in CRCs. Thus, TRAP1 pathway deserves to be further evaluated as molecular target to overcome drug resistance in human CRC.