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The Doppelgänger phenomenon and death:a peculiar case of homicide by a subject with first-episode psychosis

Forensic Sciences Research 2022年第4期7卷 798-802页

作者： Cristiano Barbieri Gabriele Rocca Caterina Bosco Lucia Tattoli Ignazio Grattagliano Giancarlo Di Vella Section of Forensic Medicine and Forensic Sciences University of PaviaPaviaItaly Department of Health Sciences University of GenoaGenoaItaly S.C.Medicina Legale U A.O.U.Cittàdella Salute e della Scienza di TorinoTurinItaly Department of Education PsychologyCommunication University Aldo Moro of BariBariItaly Department of Public Health and Pediatric Sciences Legal Medicine UnitUniversity of TurinTurinItaly

The Doppelgänger phenomenon refers to the experience of a direct encounter with one’s self,characteriswed by:(i)the perception of a figure with one’s own identical physical features;or(ii)the apprehension that the perceived figure shares the same personality and identity.The Doppelgänger does not only look like the same person,it is his/her double.The perceptual element is usually a hallucination,although occasionally a false perception of an actual figure may be involved.This phenomenon has been described in individuals suffering from overwhelming fear,severe anxiety or intoxication,epilepsy,as well as in the sleep-wakefulness transition.It has also been reported in major psychoses.The fear of imminent death often precedes the Doppelgänger experience.This report presents the case of a 30-year-old man,Mr.Y,who was stabbed to death by Mr.X,his“double”.The aggressor and his victim,although not related,were truly doubles;remarkably,they shared the same name and surname,age,professional activity and place of work.Moreover,they attended the same sports center but barely knew each other.The forensic psychiatric evaluations in Mr.X,subsequent to the crime committed,were suggestive of a psychotic condition.This case is unique in the scientific literature.In the most serious psychotic forms,the issue of the“double”calls into question not only the dissociative processes involved in the etiopathogenesis of the disorder,but also bio-psycho-social elements,as well as personal data in this case,which made the victim and the aggressor“identical”.In the context of psychopathological functioning,the delusional mood(Wahnstimmung)that precedes the development of delirium is a sort of gateway to an impending psychotic illness,involving delusional awareness or mood(atmosphere).In psychosis,splitting is the main issue and this influence is seen as an evil,foreign,apocalyptic and unknown side no longer recognised as belonging to the self even in a physical sense.In such a situation,it is felt that the only way to survive is by suppress

关键词： Forensic sciences forensic psychiatry homicide first-episode psychosis Doppelgänger delusional disorder criminal responsibility

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Dynamic carbon 13 breath tests for the study of liver function and gastric emptying

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Gastroenterology Report 2015年第1期3卷 12-21页

作者： Leonilde Bonfrate Ignazio Grattagliano Giuseppe Palasciano Piero Portincasa Department of Biomedical Sciences and Human Oncology Clinica Medica‘A.Murri’University of Bari Medical SchoolBariItaly Italian College of General Practitioners Florence and BariItaly

In gastroenterological practice,breath tests(BTs)are diagnostic tools used for indirect,non-invasive assessment of several pathophysiological metabolic processes,by monitoring the appearance in breath of a metabolite of a specific substrate.Labelled substrates originally employed radioactive carbon 14(^(14)C)and,more recently,the stable carbon 13 isotope(^(13)C)has been introduced to label specific substrates.The ingested^(13)C-substrate is metabolized,and exhaled^(13)CO_(2)is measured by mass spectrometry or infrared spectroscopy.Some^(13)C-BTs evaluate specific(microsomal,cytosolic,and mitochondrial)hepatic metabolic pathways and can be employed in liver diseases(i.***.simple liver steatosis,non-alcoholic steato-hepatitis,liver fibrosis,cirrhosis,hepatocellular carcinoma,drug and alcohol effects).Another field of clinical application for^(13)C-BTs is the assessment of gastric emptying kinetics in response to liquids(^(13)C-acetate)or solids(^(13)C-octanoic acid in egg yolk or in a pre-packed muffin or the^(13)C-Spirulina platensis given with a meal or a biscuit).Studies have shown that^(13)C-BTs,used for gastric emptying studies,yield results that are comparable to scintigraphy and can be useful in detecting either delayed-(gastroparesis)or accelerated gastric emptying or changes of gastric kinetics due to pharmacological effects.Thus,^(13)C-BTs represent an indirect,cost-effective and easy method of evaluating dynamic liver function and gastric kinetics in health and disease,and several other potential applications are being studied.

关键词： breath tests stable isotope hepatic metabolism gastric motility scintigraphy

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Management of liver cirrhosis between primary care and specialists

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World Journal of Gastroenterology 2011年第18期17卷 2273-2282页

作者： Ignazio Grattagliano Enzo Ubaldi Leonilde Bonfrate Piero Portincasa Italian College of General Practitioners (SIMG) Via del Pignoncino 9-11 50142 Firenze Italy Clinica Medica "A. Murri" Department of Internal and Public Medicine University Medical School of Bari

This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: "ascites", "liver fibrosis", "cirrhosis", "chronic hepatitis", "chronic liver disease", "decompensated cirrhosis", "hepatic encephalopathy", "hypertransaminasemia", "liver transplantation" and "portal hypertension". Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology, Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications. Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis.

关键词：卫生保健肝硬化管理专家随机对照试验研究论文慢性肝炎家庭护理

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Biochemical mechanisms in drug-induced liver injury:Certainties and doubts

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World Journal of Gastroenterology 2009年第39期15卷 4865-4876页

作者： Ignazio Grattagliano Leonilde Bonfrate Catia V Diogo Helen H Wang David QH Wang Piero Portincasa Clinica Medica "A.Murri" Dipartimento di Medicina Interna e Medicina PubblicaUniversity of Bari Medical School Department of Zoology Center for Neurosciences and Cell BiologyUniversity of Coimbra Department of Medicine Liver Center and Gastroenterology DivisionBeth Israel Deaconess Medical CenterHarvard Medical School and Harvard Digestive Diseases Center

Drug-induced liver injury is a significant and still unresolved clinical problem.Limitations to knowledge about the mechanisms of toxicity render incomplete the detection of hepatotoxic potential during preclinical development.Several xenobiotics are lipophilic substances and their transformation into hydrophilic compounds by the cytochrome P-450 system results in production of toxic metabolites.Aging,preexisting liver disease,enzyme induction or inhibition,genetic variances,local O2 supply and,above all,the intrinsic molecular properties of the drug may affect this process.Necrotic death follows antioxidant consumption and oxidation of intracellular proteins,which determine increased permeability of mitochondrial membranes,loss of potential,decreased ATP synthesis,inhibition of Ca2+-dependent ATPase,reduced capability to sequester Ca2+ within mitochondria,and membrane bleb formation.Conversely,activation of nucleases and energetic participation of mitochondria are the main intracellular mechanisms that lead to apoptosis.Non-parenchymal hepatic cells are inducers of hepatocellular injury and targets for damage.Activation of the immune system promotes idiosyncratic reactions that result in hepatic necrosis or cholestasis,in which different HLA genotypes might play a major role.This review focuses on current knowledge of the mechanisms of drug-induced liver injury and recent advances on newly discovered mechanisms of liver damage.Future perspectives including new frontiers for research are discussed.

关键词：生化机制肝损伤药物性免疫系统激活肝细胞损伤毒性机制肝脏疾病抗氧化剂

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Pathogenic role of oxidative and nitrosative stress in primary biliary cirrhosis

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World Journal of Gastroenterology 2014年第19期20卷 5746-5759页

作者： Ignazio Grattagliano Giuseppe Calamita Tiziana Cocco David Q-H Wang Piero Portincasa Italian College of General Practitioners 50100 FlorenceBari 70124Italy Department of Bioscience Biotechnologyand Biopharmaceutics"Aldo Moro" University Medical SchoolBari 70124Italy Department of Basic Medical Science Neurosciencesand Sense Organs"Aldo Moro" University Medical SchoolBari 70124Italy Department of Internal Medicine Division of Gastroenterology and HepatologySaint Louis University School of MedicineSt.LouisMO 63104United States Clinica Medica "A.Murri" Department of Biomedical Sciences and Human Oncology"Aldo Moro" University Medical SchoolBari 70124Italy

Primary biliary cirrhosis is a multifactor autoimmune disease characterized by hepatic and systemic manifestations,with immune system dysregulation and abnormalities in the hepatic metabolism of bile salts,lipids,and nutrients,as well as destruction of membrane lipids and mitochondrial dysfunction.Both oxidative and nitrosative stress are associated with ongoing manifestations of the disease.In particular,abnormalities in nitric oxide metabolism and thiol oxidation already occur at early stages,thus leading to the hypothesis that these biochemical events play a pathogenic role in primary biliary cirrhosis.Moreover,the association of these metabolic abnormalities with the progression of the disease may indicate some biochemical parameters as early diagnostic markers of disease evolution,and may open up the potential for pharmacological intervention to inhibit intra-and extra-cellular stress events for resuming hepatocellular functions.The following paragraphs summarize the current knowledge by outlining molecular mechanisms of the disease related to these stress events.

关键词： Aquaporins Bile salts Chronic cholestasis Glutathi

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Silybin counteracts lipid excess and oxidative stress in cultured steatotic hepatic cells

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World Journal of Gastroenterology 2016年第26期22卷 6016-6026页

作者： Giulia Vecchione Elena Grasselli Adriana Voci Francesca Baldini Ignazio Grattagliano David QH Wang Piero Portincasa Laura Vergani DISTAV Department of Earth Environment and Life Sciences University of Genova Department of Biomedical Sciences and Human Oncology University School of Medicine Department of Internal Medicine Division of Gastroenterology and Hepatology Saint Louis University School of Medicine

AIM: To investigate in vitro the therapeutic effect and mechanisms of silybin in a cellular model of hepatic steatosis.METHODS: Rat hepatoma Fa O cells were loaded with lipids by exposure to 0.75 mmol/L oleate/palmitate for 3 h to mimic liver steatosis. Then, the steatotic cells were incubated for 24 h with different concentrations(25 to 100 μmol/L) of silybin as phytosome complex with vitamin E. The effects of silybin on lipid accumulation and metabolism, and on indices of oxidative stress were evaluated by absorption and fluorescence microscopy, quantitative real-time PCR, Western blot, spectrophotometric and fluorimetric assays.RESULTS: Lipid-loading resulted in intracellular triglyceride(TG) accumulation inside lipid droplets, whose number and size increased. TG accumulation was mediated by increased levels of peroxisome proliferator-activated receptors(PPARs) and sterol regulatory element-binding protein-1c(SREBP-1c). The lipid imbalance was associated with higher production of reactive oxygen species(ROS) resulting in increased lipid peroxidation, stimulation of catalase activity and activation of nuclear factor kappa-B(NF-κB). Incubation of steatotic cells with silybin 50 μmol/L significantly reduced TG accumulation likely by promoting lipid catabolism and by inhibiting lipogenic pathways, as suggested by the changes in carnitine palmitoyltransferase 1(CPT-1), PPAR and SREBP-1c levels. The reduction in fat accumulation exerted by silybin in the steatotic cells was associated with the improvement of the oxidative imbalance caused by lipid excess as demonstrated by the reduction in ROS content, lipid peroxidation, catalase activity and NF-κB activation.CONCLUSION: We demonstrated the direct antisteatotic and anti-oxidant effects of silybin in steatotic cells, thus elucidating at a cellular level the encouraging results demonstrated in clinical and animal studies.

关键词： Non-alcoholic fatty liver disease Steatotic hepatocytes Silybin Lipid metabolism Oxidative stress Li

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A silybin-phospholipids complex counteracts rat fatty liver degeneration and mitochondrial oxidative changes

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World Journal of Gastroenterology 2013年第20期19卷 3007-3017页

作者： Ignazio Grattagliano Catia V Diogo Maria Mastrodonato Ornella de Bari Michele Persichella David QH Wang Adriana Liquori Domenico Ferri Maria Rosaria Carratù Paulo J Oliveira Piero Portincasa Section of Internal Medicine Department of Interdisciplinary MedicineUniversity of Bari70124 BariItaly Center for Neuroscience and Cell Biology Largo Marques de PombalUniversity of CoimbraP-3004-517 CoimbraPortugal Laboratory of Histology and Comparative Anatomy Department of Animal and Environmental BiologyUniversity of Bari70125 BariItaly Division of Gastroenterology and Hepatology Department of Internal MedicineEdward Doisy Research CenterSaint Louis University School of MedicineSaint LouisMO 63104United States Department of Pharmacology and Human Physiology University of Bari70124 BariItaly

AIM:To investigate the effectiveness of antioxidant compounds in modulating mitochondrial oxidative alterations and lipids accumulation in fatty hepatocytes.METHODS:Silybin-phospholipid complex containing vitamin E(Realsil) was daily administered by gavage(one pouch diluted in 3 mL of water and containing 15 mg vitamin E and 47 mg silybin complexed with phospholipids) to rats fed a choline-deprived(CD) or a high fat diet [20% fat,containing 71% total calories as fat,11% as carbohydrate,and 18% as protein,high fat diet(HFD)] for 30 d and 60 d,respectively.The control group was fed a normal semi-purified diet containing adequate levels of choline(35% total calories as fat,47% as carbohydrate,and 18% as protein).Circulating and hepatic redox active and nitrogen regulating molecules(thioredoxin,glutathione,glutathione peroxidase),NO metabolites(nitrosothiols,nitrotyrosine),lipid peroxides [malondialdehyde-thiobarbituric(MDA-TBA)],and pro-inflammatory keratins(K-18) were measured on days 0,7,14,30,and 60.Mitochondrial respiratory chain proteins and the extent of hepatic fatty infiltration were evaluated.RESULTS:Both diet regimens produced liver steatosis(50% and 25% of liver slices with CD and HFD,respectively) with no signs of necro-inflammation:fat infiltration ranged from large droplets at day 14 to disseminated and confluent vacuoles resulting in microvesicular steatosis at day 30(CD) and day 60(HFD).In plasma,thioredoxin and nitrosothiols were not significantly changed,while MDA-TBA,nitrotyrosine(from 6 ± 1 nmol/L to 14 ± 3 nmol/L day 30 CD,P < 0.001,and 12 ± 2 nmol/L day 60 HFD,P < 0.001),and K-18(from 198 ± 20 to 289 ± 21 U/L day 30 CD,P < 0.001,and 242 ± 23 U/L day 60 HFD,P < 0.001) levels increased significantly with ongoing steatosis.In the liver,glutathione was decreased(from 34.0 ± 1.3 to 25.3 ± 1.2 nmol/mg prot day 30 CD,P < 0.001,and 22.4 ± 2.4 nmol/mg prot day 60 HFD,P < 0.001),while thioredoxin and glutathione peroxidase were initially increased and then decreased.Nitrosothiols were constantly increas

关键词： Fatty liver Glutathione Lipid peroxidation Nitrosothiols Nitrotyrosine Thioredoxin

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End-life Prediction of Commercial PLA Used for Food Packaging through Short Term TGA Experiments: Real Chance or Low Reliability?

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Chinese Journal of Polymer Science 2014年第6期32卷 681-689页

作者： ignazio Blanco Department of Industrial Engineering University of Catania

A long-term （about nine months） isothermal degradation experiment of two different commercial polylactide （PLA） samples used for food packaging was carried out at a relatively low temperature （423 K）. Thermooxidative degradations of the same polymers were carried out in a thermogravimetric （TG） analyser, at higher temperatures （453 K 〈 T 〈 523 K）, under isothermal heating conditions. The obtained set of experimental TG data was used to determine the apparent activation energy （Ea） of degradation through two isothermal kinetic methods. The results from long-term experiment evidenced considerable mass loss for both PLA samples in the investigated period, but the experimental data were not in agreement with those from the short-term degradations at higher temperatures, thus suggesting a different degradation kinetics, and, then a low reliability of the lifetime predictions for polymers in service or degradation forecasts for the end of their life based on experiments at higher temperatures.

关键词： Lifetime prediction Degradation activation energy Kinetics of polymer degradation Thermogravimetry.

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Operative management of a shear fracture of the bilateral capitellum： A case report and review of the literature

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Chinese Journal of Traumatology 2016年第4期19卷 231-234页

作者： Alessandro Are ignazio Tornatore Emmanouil Theodorakis Department of Orthopedics Policlinico Casilino Hospital Rome Italy Department of Orthopedics Aurelia Hospital Rome Italy

Fracture of bilateral capitulum humeri is a very rare injury. We present a case of a 38-year-old woman, affected by a shear fracture of bilateral capitellum after a motorcycle accident. Intervention was carried out through a lateral approach on both sides and direct fixation of the fragment with headless screws. Consolidation was achieved and no signs of avascular necrosis occurred at 24months of follow-up. The patient returned to her previous activities with no functional limitations. To the best of our knowledge, only four cases are reported describing different types of treatment and postoperative period of cast immobilization. According to our review of the literature regarding capitellar fractures, we preferred an immediate postoperative rehabilitation of the elbow, following the stable osteosynthesis.

关键词： Elbow joint Fracture of capitulum humeri Fracture fixation Internal Recovery of functional

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REVIEW ON JOHN W. HEAD＇S WORKS： GREAT LEGAL TRADITIONS -- CIVIL LAW, COMMON LAW AND CHINESE LAW IN HISTORICAL AND OPERATIONAL PERSPECTIVE

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Frontiers of Law in China-Selected Publications from Chinese Universities 2012年第4期7卷 702-706页

作者： ignazio Castellucci at School of Law University of Trento Trento Italy

John W. Head is a Robert W. Wagstaff Distinguished Professor at School of Law, University of Kansas, USA; his involvement in comparative and historical legal research dates back decades, with specific experiences in China and Asia as a researcher, teacher and legal consultant. This handbook on comparative legal traditions follows other books of his on Chinese law and legal history, published by Carolina Academic Press in 2009 （China＇s Legal Soul -- the Modern Chinese Legal Identity in Historical Context） and 2005 （Law Codes in Dynastic China, co-authored with Yanping Wang）.

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