iBalance-ABF: a smartphone-based audio-biofeedback balance system

This paper proposes an implementation of a Kalman filter, using inertial sensors of a smartphone, to estimate 3-D angulation of the trunk. The developed system monitors the trunk angular evolution during bipedal stance and helps the user to improve balance through a configurable and integrated auditory-biofeedback (ABF) loop. A proof-of-concept study was performed to assess the effectiveness of this so-called iBalance-ABF--smartphone-based audio-biofeedback system--in improving balance during bipedal standing. Results showed that young healthy individuals were able to efficiently use ABF on sagittal trunk tilt to improve their balance in the medial-lateral direction. These findings suggest that the iBalance-ABF system as a telerehabilitation system could represent a suitable solution for ambient assisted living technologies.

Can an electro-tactile vestibular substitution system improve balance in patients with unilateral vestibular loss under altered somatosensory conditions from the foot and ankle?

This pilot study aimed at assessing the feasibility and the effectiveness of an electro Electro-tactile Vestibular Substitution System (EVSS) in patients with unilateral vestibular loss under normal and altered somatosensory conditions from the foot and ankle. Four unilateral vestibular-defective patients voluntarily participated in the experiment. They were asked to stand upright as still as possible with their eyes closed in two Normal and Altered foot and ankle sensory conditions. In the Normal condition, the postural task was executed on a firm support surface constituted by the force platform. In the Altered condition, a 2-cm thick foam support surface was placed under the participants' feet. These two foot and ankle sensory conditions were executed under two No EVSS and EVSS experimental conditions. The No EVSS condition served as a control condition. In the EVSS condition, participants executed the postural task using a biofeedback system whose underlying principle consisted of supplying them with additional information about their head orientation/motion with respect to gravitational vertical through electro-tactile stimulation of their tongue. Centre of foot pressure displacements (CoP) were recorded using the force platform. Results showed that, relative to the No EVSS condition, the EVSS condition decreased CoP displacements in both the Normal and the Altered foot and ankle sensory conditions. Interestingly, the stabilizing effect was more pronounced in the Altered than in the Normal foot and ankle sensory condition. These preliminary results suggest that patients with unilateral vestibular loss were able to take advantage to a head position-based electro-tactile tongue biofeedback to mitigate the postural perturbation induced by alteration of somatosensory input from the foot and the ankle.

First measurement of chiral dynamics in π- γ → π- π- π+

The COMPASS Collaboration at CERN has investigated the π- γ → π- π- π+ reaction at center-of-momentum energy below five pion masses, sqrt[s]<5m(π), embedded in the Primakoff reaction of 190 GeV pions impinging on a lead target. Exchange of quasireal photons is selected by isolating the sharp Coulomb peak observed at smallest momentum transfers, t'<0.001  GeV2/c2. Using partial-wave analysis techniques, the scattering intensity of Coulomb production described in terms of chiral dynamics and its dependence on the 3π-invariant mass m(3π)=sqrt[s] were extracted. The absolute cross section was determined in seven bins of sqrt[s] with an overall precision of 20%. At leading order, the result is found to be in good agreement with the prediction of chiral perturbation theory over the whole energy range investigated.

Liposomal amphotericin B does not induce nephrotoxicity or renal function impairment in premature neonates

BACKGROUND

Liposomal amphotericin B (LAMB) is frequently administered in NICU to preterm infants <1500 g at birth (VLBW) for treatment of systemic fungal infections (SFI). Concerns exist on safety and tolerability of such drug in patients who are at risk for renal function impairment due to their prematurity.

AIM

To assess the occurrence of renal function impairment related to LAMB in a 10-year cohort of VLBW neonates treated with this drug.

METHODS

Through database search of clinical charts, all VLBW neonates admitted to a 3(rd) level NICU in the years 1998-2007 and undergoing treatment with LAMB were identified. The occurrence of LAMB-attributable renal toxicity was investigated; infants withdrawn from treatment for development of adverse effects or toxicity were identified.

RESULTS

In the study period, 71 of 792 admitted VLBW neonates (8.9%) underwent antifungal treatment with LAMB administered at the recommended dosages (3-to-5 mg/kg/day). Mean duration of treatment was 14 (±9) days, mean cumulative dose given was 58 (±25) mg/kg per infant. Renal compromise, defined as hypokalaemia, and/or elevated creatinine serum levels, and/or decreased urine output, occurred in 2 of 71 (2.8%) treated patients, by 5 (±3) mean days after treatment initiation. In both patients LAMB was withdrawn; renal function impairment was only mild and transient, and normal renal function was restored at discharge. No other significant adverse effects were recorded in any treated neonate.

CONCLUSIONS

LAMB is generally safe and well tolerated in VLBW neonates. The occurrence of LAMB-related nephrotoxicity appears to be uncommon, mild and transient.

Towards a suitable time-scale representation of cardio-respiratory signals through Empirical Mode Decomposition algorithms: a simulation and validation tool

To what extent is Empirical Mode Decomposition (EMD) able to differentiate the embedded components of a cardio-respiratory (CR) signal? We intend to answer this question by providing a tool which compares the performances of the original EMD algorithm with those of a noise-assisted version (CEEMD) on simulated CR signals, depending on the frequency and amplitude ratios between their respiratory and cardiac components. A statistical Bland & Altman test checks the matching of stroke volumes calculated from the extracted cardiac signal and those from the simulated one. CEEMD turns out to be better than EMD by yielding to reliable multiscale representation of simulated CR signals on a wider domain of frequency and amplitude ratios.

LC analysis of coumestrol incorporated into topical lipid nanoemulsions

A simple, rapid, and sensitive LC method to determine coumestrol incorporated in the lipid nanoemulsions was validated. The analyses were performed at room temperature on a reversed-phase C18 column using a mobile phase composed of methanol/water with 0.1% trifluoracetic acid (70:30, v/v) at 0.8 mL min(-1). The detection was carried out on a UV detector at 343 nm. The linearity, in the range of 0.1-6.0 microg/mL, presented a determination coefficient (r2) of 0.999, calculated by the least square method. No interferences of the oil core or the gelling excipients were detected. The R.S.D. values for intra- and inter-day precision experiments were lower than 2%. The recovery ranged from 99.42% to 100.72%. Finally, the proposed method was successfully applied to determine coumestrol incorporated in the proposed topical formulations.

A regular or an intermittent treatment for asthma: the long-term effect

OBJECTIVES

Many asthmatics take therapy intermittently because of their scarce compliance. It is not known if this is effective in controlling and slowing down the lung function decline in asthma. Our aim was to compare the effect of a regular treatment and an intermittent one on some clinical aspects and on the forced expiratory volume 1 (FEV1) decline in 165 persistent asthmatics with FEV1 > 70% (60 men; age 40.87 +/- 14.05; FEV1 95.03 +/- 13.1%), in a retrospective way over 4 years.

PATIENTS AND METHODS

Eighty-four patients took inhaled corticosteroids (ICSs) plus long-acting bronchodilator agents (LABAs) regularly (regular) and 81 patients took ICSs plus LABAs intermittently for short periods when symptoms appeared (intermittent).

RESULTS

Less patients (p < 0.05) took oral corticosteroids, short-acting bronchodilators as needed in regular compared to intermittent. More patients increased the therapy (step-up) in intermittent (p < 0.01) More patients reported a subjective improvement while fewer reported a worsening in regular (p < 0.05). After 4 years, the variation in maximal mid expiratory flow (FEF25-75) was lower in regular (-159.40 +/- 472.79 ml/sec; CI 95% -261.99, 56.82) than in intermittent (-324.44 +/- 569.97 ml/sec; CI 95% -450.48, -198.41); whereas the FEV1 decline was similar between regular (-276.97 +/- 199.37 ml; CI 95% -316.24, -229.71) and Intermittent (-317.65 +/- 194.05 ml; CI 95% -360.56, -274.74). In males and females, in smokers and non-smokers no differences were found in the FEV1 decline.

CONCLUSIONS

In conclusion, the regular use of ICSs plus LABAs is better than the irregular use of them in controlling asthma over a long period of time. Whereas, after 4 years the regular treatment may not decrease the FEV1 decline more effectively than the intermittent therapy.

[Bipolar disorder, cognitive functioning and hypothalamic-pituitary-thyroid axis]

In psychoneuroendocrinology there's a scarcity of knowledge of hypothalamic-pituitary-thyroid axis (HPT) in relation to bipolar disorder (BD) and neuropsychological functions. The aim of this study is to review the current state of the following issues: (1) neuropsychological dysfunctions in BD, as well as their hypothetic aetiology; (2) response of HPT in each phase of BD, and, finally, (3) connection between alterations in HPT and neuropsychological deficits.

Observation of a J(PC)=1-+ exotic resonance in diffractive dissociation of 190 GeV/c π- into π- π- π+

The COMPASS experiment at the CERN SPS has studied the diffractive dissociation of negative pions into the π- π- π+ final state using a 190  GeV/c pion beam hitting a lead target. A partial wave analysis has been performed on a sample of 420,000 events taken at values of the squared 4-momentum transfer t' between 0.1 and 1  GeV2/c2. The well-known resonances a1(1260), a2(1320), and π2(1670) are clearly observed. In addition, the data show a significant natural-parity exchange production of a resonance with spin-exotic quantum numbers J(PC)=1-+ at 1.66  GeV/c2 decaying to ρπ. The resonant nature of this wave is evident from the mass-dependent phase differences to the J(PC)=2-+ and 1++ waves. From a mass-dependent fit a resonance mass of (1660±10(-64)(+0))  MeV/c2 and a width of (269±21(-64)(+42))  MeV/c2 are deduced, with an intensity of (1.7±0.2)% of the total intensity.

Clinical use of lactoferrin in preterm neonates: an update

Sepsis-related morbidity and mortality is an increasing concern in all neonatal intensive care units, with reported incidences that are dramatically high regardless of the improvements in the quality of neonatal assistance. Antimicrobial resistance is also becoming a global and regional threat to public health. Neonatal sepsis include bloodstream, urine, cerebrospinal, peritoneal infections, and are classified as early-onset (occurring <3 days of life, EOS) and late-onset sepsis (LOS), i.e., infections arising after the perinatal period. Whereas prevention of EOS relies mainly on maternal-perinatal policies, attempts to reduce LOS incidence are a task merely for neonatologists but are hampered by non-specific clinical features, inadequate sensitivity of diagnostic tests, and late recognition. The frequent occurrence of late neurodevelopmental impairment after LOS challenges neonatologists to seek effective preventative strategies rather than more efficacious antibiotics for treatment. In the area of prevention, consistent evidence is accumulating on fluconazole--for prevention of fungal LOS--and, more recently, on bovine lactoferrin for prevention of both bacterial and fungal LOS: this innate immune system glycoprotein plays an important role in "in vivo" host defenses, and has been shown effective in a multicenter RCT recently published on VLBW neonates. Future studies are warranted to better elucidate the extent of the prevention provided by Ictoferrin and to identify the most suitable dosages to be administered.

Acute Subarachnoid Hemorrhage and Cardiac Abnormalities: Takotsubo Cardiomyopathy or Neurogenic Stunned Myocardium? a case report

Introduction

Cardiac abnormalities can be seen with subarachnoid hemorrhage. To date, there have been isolated case reports of transient left ventricular apical ballooning cardiomyopathy, also known as Takotsubo cardiomyopathy in patients suffering from subarachnoid hemorrhage.

Case presentation

An adult female was brought to the emergency department with somnolence. A 3 × 3 mm ruptured basilar aneurysm was found and successfully embolized. Two days after the patient developed acute heart failure. Troponin-I was elevated to 4.2 (normal <0.4). On ECG, new symmetric T wave inversion in V3, V4, V5 with prolonged QT were evident. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20% and akinetic apex along with the distal left ventricular segments, consistent with Takotsubo cardiomyopathy. Myocardial contrast echocardiography showed a decrease in capillary blood flow and volume in the akinetic areas with delayed contrast replenishment, sparing the basal segments. A repeat study 2 weeks later showed near normalization of the perfusion parameters. The patient improved with medical management. A repeat echocardiogram, a month later revealed an ejection fraction of 45% with no identifiable wall motion abnormality.

Conclusion

Our case, as well as others reported previously, supports the diagnosis of Takotsubo cardiomyopathy in patients with Subarachnoid Hemorrhage who fulfill the clinical and imaging description of this syndrome.

Male gamblers have significantly greater salivary cortisol before and after betting on a horse race, than do female gamblers

Prevalence rates of gambling are influenced by gender. Among normative populations, hypothalamic-pituitary-adrenal (HPA) axis response to stress is affected by gender. However, pathological, compared to recreational, gamblers demonstrate perturbations in HPA activation in response to gambling stimuli. We examined whether there were gender differences in HPA response to gambling in a naturalistic setting among horse-race bettors and scratch-off lottery bettors. Salivary cortisol was collected from horse-race gamblers (n=32) and scratch-off lottery ticket players (n=39) before and after (0, 10, or 20 min) betting on a horse race at an off-track betting establishment. Salivary cortisol levels were significantly higher among men than among women, both prior to and following, betting on a horse race. Among women, but not men, there was a decline in salivary cortisol across time in scratch-off bettors, whereas women horse-race bettors maintained consistent low concentrations of salivary cortisol at every time point sampled. Together these data suggest that engaging in gambling may have different effects on stress responses of men, compared to women. Whether these gender differences in HPA activation contribute to gender-related differences in gambling behavior is the subject of ongoing investigation.

First insights into the biochemistry of tube foot adhesive from the sea urchin Paracentrotus lividus (Echinoidea, Echinodermata)

Sea urchins are common inhabitants of wave-swept shores. To withstand the action of waves, they rely on highly specialized independent adhesive organs, the adoral tube feet. The latter are extremely well-designed for temporary adhesion being composed by two functional subunits: (1) an apical disc that produces an adhesive secretion to fasten the sea urchin to the substratum, as well as a deadhesive secretion to allow the animal to move and (2) a stem that bears the tensions placed on the animal by hydrodynamism. Despite their technological potential for the development of new biomimetic underwater adhesives, very little is known about the biochemical composition of sea urchin adhesives. A characterization of sea urchin adhesives is presented using footprints. The latter contain inorganic residues (45.5%), proteins (6.4%), neutral sugars (1.2%), and lipids (2.5%). Moreover, the amino acid composition of the soluble protein fraction revealed a bias toward six amino acids: glycine, alanine, valine, serine, threonine, and asparagine/aspartic acid, which comprise 56.8% of the total residues. In addition, it also presents higher levels of proline (6.8%) and half-cystine (2.6%) than average eukaryotic proteins. Footprint insolubility was partially overcome using strong denaturing and reducing buffers, enabling the visualization of 13 proteins by sodium dodecyl sulfate polyacrylamide gel electrophoresis. The conjugation of mass spectrometry with homology-database search allowed the identification of six proteins: alpha and beta tubulin, actin, and histones H2B, H3, H2A, and H4, whose location and function in the adhesive are discussed but require further investigation. For the remaining unidentified proteins, five de novo-generated peptide sequences were found that were not present in the available protein databases, suggesting that they might be novel or modified proteins.

[Efficacy and safety of long-acting injectable risperidone in maintenance phase of bipolar and schizoaffective disorder]

INTRODUCTION

Our aim was to evaluate treatment safety, tolerability, efficacy and compliance of long-acting injectable risperidone (LAIR) as maintenance treatment in a bipolar and schizoaffective inpatients sample with torpid course due to poor compliance to oral therapy.

METHODS

22 inpatients, 14 with a diagnosis of bipolar disorder and 8 with a diagnosis of schizoaffective disorder, were included in this study. They were treated with LAIR, 1 dose every 14 days, and were evaluated for 40 weeks with the Young Mania Rating Scale (YMRS), Hamilton Scale for Depression (HAM-D), UKU-Side Effect Rating Scale and Clinical Global Impression Severity of Illness scales (CGI).

RESULTS

Average YMRS scores were reduced significantly from 10.5 at baseline interview to 2.5 at week 40 (p < 0.001). HAM-D and UKU scales did not reach a statistically significant reduction. CGI-S scores were reduced from 3.8 at baseline to 1.5 at week 40 (p < 0.001).

CONCLUSIONS

LAIR could be an effective maintenance therapy for bipolar and schizoaffective patients with poor compliance to oral treatment.

Gambling pathology is associated with dampened cortisol response among men and women

Pathological gambling has many similarities to pharmacological addiction. Notably, both pathological gambling and drug addiction are characterized by aberrations in hypothalamic-pituitary-adrenal (HPA) axis responding. As well, there are indications that gender differences may play a role in these processes. Whether gender and/or HPA response are associated with pathological gambling was of interest. Recreational and pathological gamblers (15 men and 6 women per group) had the HPA factor, cortisol, assessed in saliva before and after watching a video of their preferred mode of gambling (slot machines, horse race betting, scratch-off tickets, blackjack, video poker, craps, sports betting, online casino games, or lottery tickets), and a video of neutral stimuli (a rollercoaster ride). Basal levels of salivary cortisol did not significantly differ among recreational and pathological gamblers. However, recreational gamblers demonstrated significantly increased salivary cortisol levels after the gambling and rollercoaster videos, whereas pathological gamblers demonstrated no salivary cortisol increase in response to either video stimulus. There was also a non-significant trend for women to have a greater cortisol response to video stimuli compared to men. These data suggest that pathological gambling is associated with hypoactive HPA response to gambling stimuli, similar to chronic drug exposure, and gender may contribute to this effect.

Clinical Factors as Predictors on Functional Impairment in Bipolar Disorder

Introduction:

Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample.

Methods:

Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time.

Results:

The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001).

Discussion:

In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course.

[Primary allergy prevention: partially or extensively hydrolyzed infant formulas?]

The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders. In infants from ''high-risk'' families (i.e. those with one or two parents and/or a sibling with food allergy, eczema, asthma or allergic rhinitis) food allergen avoidance has been advocated as means of preventing the development of atopic disease. The aim of this review was to evaluate the allergy preventive potential of partially or extensively hydrolyzed formulas. When breast-feeding is not possible or supplemental feeding is needed, infants from atopic families should be given a hydrolyzed infant formula for the first 6 month of life. High-risk infants without a history of eczema in a primary relative will receive the protective effect from the less expensive partial hydrolyzed formula (p-HF); whereas those infants who have first-degree relatives with eczema should receive the extensively hydrolyzed formula (e-HF).

The anatomy of the human thyroid veins and its surgical application

The present study was motivated by the importance of the thyroid veins in surgery in the anterolateral cervical region, particularly in tracheostomies, the need for information on modern diagnostic imaging techniques and the lack of specific publications on the subject. The research was performed on 30 adult human specimens by means of dissection and measurement. The superior thyroid vein was constant, single on both sides (83.3%), with its termination (87.1%) at the internal jugular vein (97.2%), either isolated (29.4%) or with other veins, mostly the lingual vein (52.1%), and was located between 1.0 and 2.5 cm below a plane that passes the upper margin of the hyoid bone. The medial thyroid vein, when present, was not constant (43.3%), was single (96.1%), terminated in the internal jugular vein and was located between 2.0 and 4.0 cm from the mid-sagittal line (84.6%). The inferior thyroid vein was constant (96.7%) and varied in number, with one (62.1%), two (27.6%) or even five occurring, and was formed by the confluence of two primary branches (78.6%) as a result of the abundance of anastomoses coming from the lower and medial parts of the gland. The number of terminations corresponded to the number of veins, at the level of the 5(th) to 8(th) rings in 36.9%, of the 9(th) to 10(th) rings in 34.8% and of the 11(th) to 14(th) rings in 28.3%, and occurred in the right brachiocephalic vein (26.1%), in the left brachiocephalic vein (60.9%) or in both veins (13.0%).

DISTINCT ROLES FOR DISCOIDIN DOMAIN RECEPTOR 1 (DDR1) EXPRESSED ON BONE MARROW DERIVED CELLS AND VESSEL WALL CELLS DURINGATHEROGENESIS

We have recently described a critical role for the discoidin domain receptor 1 (DDR1) collagen receptor tyrosine kinase in the regulation of fibrosis and inflammation during atherosclerotic plaque development. DDR1 isexpressed on both SMCs and macrophages; however the role of DDR1 expressed in these distinct cells during atherogenesis remains unresolved. In the current study, female Ldlr^-/- mice that were either Ddr1^+/+ or Ddr1^-/-were lethally irradiated and reconstituted with bone marrow from male Ddr1^+/+ or Ddr1^-/- donors yielding three groups of chimeric mice: Ddr1^+/+^?^+/+ (control); Ddr1^+/+^?^-/-^ (vessel wall deletion); and Ddr1^-/-^?^+/+ (bone marrow deletion). Chimeric mice were placed on an atherogenic diet for 12 weeks and hadsimilar body weights, total leukocyte counts, levels of Sry chimerism, and fasting plasma triglycerides at sacrifice, although total cholesterol was increased by 42% in Ddr1^+/+^?^-/- mice. Deletion of DDR1 inbone marrow derived cells (Ddr1^-/-^?^+/+) resulted in a 66% reduction in atherosclerotic lesion area in thedescending aorta compared to Ddr1^+/+^?^+/+ mice. Aortic sinus plaquesfrom Ddr1^-/-^?^+/+ mice were 36% smaller than Ddr1^+/+^?^+/+ plaques but the proportion of plaque area occupied by cells and matrix was similar between groups. By contrast, deletion of DDR1 in vessel wall cells (Ddr1^+/+^?^-/-) resulted in a 57% increase in atherosclerosis in the descending aorta. Furthermore, aortic sinus plaques from Ddr1^+/+ ^?^-/- mice had markedly increased fibrillar collagen and elastin accumulation compared to Ddr1^+/+^?^+/+ plaques resulting in a 156% increase in lesion area and reduced SMC and macrophage content. In conclusion, while DDR1 on bone marrow derived cells is required for plaque development, DDR1 expressed on vessel wall cells negatively regulates plaque matrix accumulation and results in the formation of larger lesions with altered cellular composition. Our data suggest a dual role for DDR1 in the regulationof atherogenesis and plaque matrix content.

[Advances in the treatment of mania: aripiprazole]

Aripiprazole is a dopamine partial agonist antipsychotic drug that has just been approved in Europe for its use in the treatment of acute mania and for the prevention of manic episodes in bipolar disorder. Its efficacy in mania is superior to that of placebo, both as monotherapy and as adjunctive therapy, and comparable to that of haloperidol and lithium. From the safety perspective it is remarkable that it is not highly sedative and does not impair the metabolic parameters. The advantages of a non-sedative and metabolically neutral antimanic drug are particularly relevant in the long-term, due to their impact on cognition and quality of life. The experience on its use in routine clinical practice indicates that in order to avoid phenomena such as activation, abrupt worsening or akathisia, it is recommendable to start treatment with low doses and to increase them progressively, especially in those patients who are already receiving other drugs; moreover, it is advisable not to stop abruptly any ongoing treatment, unless there is an emergency, to transiently prescribe a concomitant benzodiazepine, and to maintain the dose that proved efficacious during the short term treatment during maintenance therapy.

Short term effect of a single dose of formoterol or tiotropium on the isolated nocturnal hypoxemia in stable COPD patients: a double blind randomized study

Patients with stable chronic obstructive pulmonary disease (COPD) and diurnal PaO2 > 60 mmHg may have transient oxygen desaturation during sleep. The effect of bronchodilators on nocturnal hypoxemia is not known. The aim of this study was to evaluate if a single dose of Formoterol or Tiotropium, administered in the evening, could improve nocturnal hypoxemia in patients with stable middle/severe COPD. Thirty-seven patients (25 M/12 F; mean age 68.97 +/- 8.57, range 50-78; mean FEV1% of predicted 46.29 +/- 9.2) with PaO2 > 60 mmHg, but with significant oxygen desaturation during sleep and apnea/hypopnea index < or = 10 were selected. They randomly underwent three consecutive nocturnal pulsoxymetry: baseline and after taking placebo and 12 microg of Formoterol (20 pts) or 18 microg of Tiotropium (17 pts) in the evening. FEV1 and IC, measured after 1 h of taking bronchodilators, were significantly higher than placebo. The variation, with regards to baseline values, in mean heart rate and Lowest SpO2% measured after Tiotropium (-1.68 +/- 4.01 and 3.23 +/- 8.58 respectively) was higher (p < 0.05) than placebo (-0.108 +/- 2.85 and 0.29 +/- 7.05 respectively). Moreover, the trend time of SpO2% (measured by pulse-oximeter at each hour of total time registration) after Tiotropium was significantly higher than baseline or placebo (p < 0.01). Instead, the trend time of SpO2% after Formoterol, except for an initial transient hypoxemia fall, was similar to baseline condition and after placebo. Also the trend time of heart rate resulted significantly lower in the Tiotropium group, but higher in the Formoterol group. In conclusion, Formoterol does not seem to influence the nocturnal hypoxemia in stable COPD patients probably for the worsening V/Q ratio. On the contrary, a single dose of tiotropium seems to decrease the severity in the nocturnal desaturations in stable COPD patients probably due to the reduction in the nocturnal bronchial colinergic tone.

Oral corticosteroids can improve nocturnal isolated hypoxemia in stable COPD patients with diurnal PaO2 > 60 mmHg

The aim of this study was to evaluate whether a short therapy cycle of oral methylprednisolone plus conventional therapy might improve isolated nocturnal hypoxemia evidenced through pulse-oxymetry in 28 patients (19 M/9 F; mean age 71 +/- 8.31) with stable moderate to severe COPD (average FEV1 of 43.33 +/- 9.38 of theoretical) and daytime PaO2 > 60 mmHg. All patients showed oxygen desaturation during the night and apnoea/hypoapnoea index < or = 10, measured by means of a nocturnal polysomnography and were successfully on conventional treatment for COPD. The patients were randomly divided into two groups: 14 (steroid group) were administered methylprednisolone for three weeks at progressively decreasing doses (16 mg/die for the first 7 days, then 8 mg die for another 7 days, and finally 4 mg die for another 7 days) plus conventional therapy (bronchodilators and inhaled corticosteroids). The remaining 14 patients (control group) instead were on conventional therapy only. After 3 weeks for the steroid group, but no for the control group, was improved next parameters (p < 0.0001): VC (L) dropped from 2.53 +/- 0.85 measured at baseline to 2.82 +/- 0.84, FEV1 dropped from 1.07 +/- 0.31 L to 1.23 +/- 0.31 L, the IC dropped from 1.71 +/- 0.48 to 2 +/- 0.37 L, the average nocturnal SpO2% from 90.4 +/- 1.79 to 92.3 +/- 1.72 and the Nocturnal Time % of SpO2 < 90% went from 31.19 +/- 18.12 to 10.88 +/- 11.56 after 3 weeks of therapy. Also dyspnoea, sleep duration and mean heart rate significantly improved (p < 0.0001). There was also a significant correlation between average increase in mean nocturnal SpO2% and in Lowest SpO2% and the variation in inspiratory capacity (IC) and in Sleep Duration % in the steroid group (p < 0.0001). In conclusion, methylprednisolone in combination with conventional medical therapy not only improved lung function values but also mean nocturnal oxyhemoglobin saturation and sleep duration in clinically stabilized COPD patients who experience nocturnal oxyhemoglobin desaturation.

Valoración clínico-radiológica de las vertebroplastias

INTRODUCTION

Percutaneous vertebroplasty consists of the injection of acrylic cement into weakened vertebral bodies to achieve pain relief and mechanical stability of the spine.

OBJECTIVE

To evaluate the characteristics and effectiveness of the vertebroplasties performed at the Hospital Universitario Miguel Servet in Zaragoza.

PATIENTS AND METHODS

This is a retrospective study of 147 vertebroplasties performed in 95 patients (60 women and 35 men; age range: 19 to 84 years). The oblique transpedicular approach, which achieves adequate cement injection with a single puncture, is currently used. A visual analogue scale (VAS) was used to evaluate pain before and after the procedure.

RESULTS

The osseous lesion most often treated by vertebroplasty is fracture secondary to osteoporosis, accounting for 65% of the cases in this series, followed by hemangiomas (23%), and osteolytic metastases, traumatic fractures, lymphomas, and myelomas. Prior to vertebroplasty, the mean VAS score was 8.88 versus 2.78 after the treatment. Only 7.3% of the patients had symptomatic complications.

CONCLUSION

Vertebroplasty is safe and efficacious; it is the treatment of choice for vertebral pain refractory to medication. It enables patients to return to their habitual lifestyle quickly and thus helps reduce hospital stays and costs.

Assessing occupational exposure as risk for tuberculous infection at a teaching hospital in São Paulo, Brazil

OBJECTIVE

To determine the risk for TB infection among nurses exposed to TB patients and non-exposed employees, and to evaluate associated aspects to initiate TB prevention in a teaching hospital in Brazil.

DESIGN

A cross-sectional tuberculin skin test (TST) survey and assessment questionnaire of 169 nurses exposed to patients (exposed group [EG]) and 164 administrative employees (comparative group [CG]).

RESULTS

The prevalence of positive TST was 59.7% in the EG and 53.7% in the CG (P = 0.26). Univariate analysis revealed, in the CG, association of TST positivity with BCG scar (P = 0.002), and, in the EG, with male sex (P = 0.02) and working at that hospital for >2 years (P < 0.001). On multivariate analysis, male sex (P = 0.0444), working at the institution for >2 years (P < 0.0001) and BCG scar (P = 0.0004) were associated with positive TST, while occupational exposure was not.

CONCLUSIONS

The results suggest that all health care workers should be evaluated in an institutional TB prevention programme because community exposure to TB and BCG vaccination may have influenced TST positivity in the studied population.

A novel SCN1A mutation associated with severe GEFS+ in a large South American pedigree

Generalized epilepsy with febrile seizures plus (GEFS+) is an inherited epileptic syndrome with a marked clinical and genetic heterogeneity. Here we report the molecular characterization of a large pedigree with a severe clinical form of GEFS+. Genetic linkage analysis implied the involvement of the FEB3 in the disease phenotype of this family (parametric two-point lod-score of 2.2). Sequencing of the SCN1A gene revealed a novel aspartic acid for glycine substitution at position 1742 of this sodium channel subunit. The amino-acid replacement lies in the pore-forming region of domain IV of SCN1A. Our observations are consistent with the genotype-phenotype correlation studies suggesting that mutations in the pore-forming loop of SCN1A can lead to a clinically more severe epileptic syndrome.

[Hypothalamic-infundibular histiocytosis: magnetic resonance findings]

INTRODUCTION

We report the magnetic resonance imaging (MRI) of a case of Langerhans cell histiocytosis in the pituitary. Isolated central nervous system involvement is uncommon.

CASE REPORT

An eighteen-years old female patient who had an acute onset of central diabetes insipidus because of the Langerhans cell histiocytosis. The MRI evidenced a lesion in the hypothalamic-pituitary axis. The hyperintensity in the posterior pituitary lobe, which is seen in normal subjects on T1-weighted images, was absent. The pituitary stalk was thickened and enhanced homogeneously following contrast administration. During the follow-up, the infundibullar lesion extended to the hypothalamic region and other systemic manifestations appeared. Diagnosis of Langerhans cell histiocytosis was confirmed by lung biopsy. After radiotherapy and chemotherapy, MRI showed regression of the hypothalamic-pituitary lesion.

CONCLUSION

The combination of these findings, although nonspecific of Langerhans cell histiocytosis, should nevertheless prompt further studies, including chest films, bone scanning and temporal bone computerized tomography in order to narrow the differential diagnosis.

Mutation at position -132 in the islet amyloid polypeptide ( IAPP) gene promoter enhances basal transcriptional activity through a new CRE-like binding site

AIMS/HYPOTHESIS

Mutations in the islet amyloid polypeptide ( IAPP) gene may play a potential role in the abnormal regulation or expression of the peptide. The aim of this study was to determine the functional role of the -132 G/A mutation reported in the promoter region of the IAPP gene in a population of Spanish Type 2 diabetic patients.

METHODS

We investigated the transcriptional activity using MIN6 cells and luciferase reporter plasmids in several culture conditions. Key regulatory elements of the IAPP promoter region were also analysed by electrophoretic mobility shift assays (EMSA).

RESULTS

The mutant construct doubled IAPP transcriptional activity ( p<0.001). Both constructs showed severely reduced promoter activity (four-fold decrease) in the presence of verapamil and diazoxide. In contrast, IAPP promoter activity was doubled after incubation with forskolin or dexamethasone, regardless of the glucose concentrations in the culture media. EMSA revealed that the -132 G/A mutation increased the binding affinity through two DNA-protein complexes. In addition, a cAMP-responsive element binding protein (CREB) was identified by super-shift EMSA.

CONCLUSIONS/INTERPRETATION

Our studies show that the wild-type and the mutant constructs are regulated in a similar pattern under all conditions, strongly indicating that the -132 G/A mutation increases basal but not inducible transcription. These results may be explained by new binding to the mutant region through CREB and other transcription factors not yet identified.

Pancreatic islets from cyclin-dependent kinase 4/R24C (Cdk4) knockin mice have significantly increased beta cell mass and are physiologically functional, indicating that Cdk4 is a potential target for pancreatic beta cell mass regeneration in Type 1 diabetes

AIMS/HYPOTHESIS

Cyclin-dependent kinase 4 (Cdk4) is crucial for beta cell development. A mutation in the gene encoding for Cdk4, Cdk4R24C, causes this kinase to be insensitive to INK4 cell cycle inhibitors and induces beta cell hyperplasia in Cdk4R24C knockin mice. We aimed to determine whether this Cdk4R24C mutation also affects proper islet function, and whether it promotes proliferation in human islets lentivirally transduced with Cdk4R24C cDNA.

METHODS

Our study was conducted on wild-type and Cdk4R24C knockin mice. Pancreases were morphometrically analysed. Intraperitoneal glucose tolerance tests and intravenous insulin tolerance tests were performed on wild-type and Cdk4R24C mice. We also did in vitro islet perifusion studies and islet metabolic labelling analysis. Human islets were transduced with Cdk4R24C cDNA.

RESULTS

Pancreatic islets from Cdk4R24C knockin mice exhibit a larger insulin-producing beta cell area and a higher insulin content than islets from wild-type littermates. Insulin secretion in response to glucose is faster and reaches a higher peak in Cdk4R24C mice without leading to hypoglycaemia. Conversion of pro-insulin into insulin and its intermediates is similar in Cdk4R24C and wild-type mice. Glucose utilisation and oxidation measured per islet were similar in both experimental groups. Insulin secretion was faster and enhanced in Cdk4R24C islets perifused with 16.7 mmol/l glucose, with slower decay kinetics when glucose returned to 2.8 mmol/l. Moreover, human islets expressing Cdk4R24C cDNA exhibited higher beta cell proliferation.

CONCLUSIONS/INTERPRETATION

Despite their hyperplastic growth, Cdk4R24C insulin-producing islet cells behave like differentiated beta cells with regard to insulin production, insulin secretion in response to glucose, and islet glucose metabolism. Therefore Cdk4 could possibly be used to engineer a source of beta cell mass for islet transplantation.

Anti human papillomavirus vaccine: the checkmate to human papillomavirus?

Cervical cancer is the second most frequently found neoplasia in women worldwide. At least 95% of cervical cancers contain viral DNA which, in 80% of cases, belongs to one of the human papillomavirus (HPV) viral types at high oncogenic risk: 16, 18, 31 and 45. HPV is, at this point, considered the first "necessary cause" of cervical cancer, against which primary prevention with a reduction in the risk of infection can be carried out. Numerous molecular biological studies have been conducted to identify the biological markers of this infection and to refine an effective and well tolerated vaccine capable of preventing HPV infection as well as possibly treating those cases in which the infection has already caused an HPV-related disease of the genital tract. In the near future, the real primary prevention of this disease will be conducted, similar to what occurred for Hepatitis B, using immunoprophylaxis with an anti-cancer vaccine.

Lymph node reticulum cell neoplasm with progression into cytokeratin-positive interstitial reticulum cell (CIRC) sarcoma: a case study

AIMS

To detail on sequential biopsies the morphological and immunohistochemical features of a case of primary lymph nodal fibroblastic reticulum cell (FBRC) tumour which progressed into a clinically aggressive cytokeratin-positive interstitial reticulum cell (CIRC) sarcoma.

METHODS AND RESULTS

A 70-year-old female underwent surgical excision of an enlarged submandibular lymph node. The nodal architecture was effaced by a neoplastic proliferation of medium to large cells, round to oval to spindle in shape, growing in a storiform pattern. The tumour stained for vimentin, CD68, factor XIIIa, alpha1-antitrypsin, fascin and actin. Dendritic and endothelial cell markers were negative. A diagnosis of FBRC tumour was made by combining pathological and clinical data. The patient received no therapy but 5 months later the tumour relapsed, exhibiting a deceptively pleomorphic cytology, phenotypic changes (strong cytokeratin positivity), intense p53 expression and aggressive clinical course with fatal outcome. In-situ hybridization for Epstein-Barr virus was negative.

CONCLUSIONS

We speculate that the morphological changes and p53 expression of the relapsing neoplasm might reflect tumour cell dedifferentiation, in keeping with the aggressive clinical course. The intense p53 expression suggests that this oncoprotein might also play a role in reticulum cell tumorigenesis.

Reproductive outcome after laparoscopic treatment of endometriosis

PURPOSE OF INVESTIGATION

To evaluate the pregnancy rate after laparoscopic treatment of endometriosis.

PATIENTS AND METHODS

47 infertile women undergoing laparoscopic treatment of endometriosis.

RESULTS

rAFS stage was as follows: 11% of patients had Stage I, 11% Stage II, 53.3% Stage III and 24.4% Stage IV. The mean duration of follow-up was 48.5 +/- 18.44 months. The overall pregnancy rate was 64.4%. Eighteen out of 26 women (69%) became pregnant within six months after laparoscopy, 23% at 12 months, 11% within 24 months, and 11% after two years (p < 0.01). Adnexal adhesions and tubal status significantly affected the pregnancy rate. No differences were found regarding the stage of disease and the presence of ovarian endometriomas.

CONCLUSION

Laparoscopic treatment of endometriosis enhances fertility and the pregnancy rate is highest within the first six months after surgery. Adnexal adhesions and tubal conditions influence the reproductive outcome.

Unconverted chars obtained during biomass gasification on a pilot-scale gasifier as a source of activated carbon production

Biomass gasification was used to produce activated carbon on a pilot-scale fluidised-bed gasifier. The feedstock included both biomass alone and biomass mixed with coal and coal/granulated plastic wastes. This paper reports the results obtained from four different runs undertaken under various conditions of fuel supply, different ratios of steam/air for the gasification and temperature. These conditions were selected because they led to a significant amount of unconverted chars produced during gasification (from 0.72 to 1.4 kg) which then served as raw material for the production of activated carbon whilst the amount of gas obtained was also high enough for its potential use for different end-use applications. From the analysis of the results obtained, it can be concluded that a reasonable porosity development (mainly in the area of narrow micropores) was obtained by gasifying unblended pine wastes with steam for 4 h, producing about 1.4 kg of good-quality activated carbon (micropore volume of 0.263 cm(3)/g). In other runs, chars with a reduced microporosity development (i.e. 0.180 cm(3)/g) were obtained, however, they could be used as a proper starting material for the chemically activated carbon production.

Three-dimensional sonography and hysterosalpingosonography in the diagnosis of uterine anomalies

Uterine anomalies implicated in female subfertility, implantation failure and miscarriages can often be detected often by two-dimensional transvaginal (2D TV) ultrasound scanning. When used as a screening test TV ultrasound has provided sensitivity rates of up to 100% about uterine anomalies. Improved depiction has been achieved with the development of hysterosalpingosonography (HSSG). The anechoic interface provided by the saline solution allows the examiner to determine whether an abnormality is intracavitary, endometrial, or submucosal. The aim of this study was to evaluate the role of 2D TV contrast sonography and 3D TV ultrasound in the diagnosis of congenital uterine anomalies in comparison with their appearance of hysterosalpingosonography findings.

Polymorphism in intron 2 of islet amyloid polypeptide gene is associated with lower low-density lipoprotein cholesterol in nondiabetic subjects and in type 2 diabetic patients

The aim of this study was to investigate the presence of mutations in the islet amyloid polypeptide (IAPP) gene in a Spanish population with type 2 diabetes and gestational diabetes mellitus (GDM). Using polymerase chain reaction single-stranded conformation polymorphism, we examined the coding region and the 5'-untranslated region (UTR) of the IAPP gene in 177 unrelated type 2 diabetic patients, 110 healthy control subjects, 38 women with GDM, and 38 gestational control subjects. Mutations were confirmed by DNA sequencing. A heterozygous C-to-A nucleotide substitution at +79 bp in intron 2 of the IAPP gene was detected. The frequencies of the +79-bp polymorphism (A allele) were 6.8% in type 2 diabetic patients, 7.7% in nondiabetic control subjects, 11.8% in women with GDM, and 9.2% in gestational control subjects. No AA genotypes were detected. Nondiabetic subjects and patients with type 2 diabetes bearing the CA genotype had lower low-density lipoprotein (LDL) cholesterol levels than subjects bearing wild genotype. Multivariate logistic regression analysis showed an independent association (p < 0.001; odds ratio: 0.33; 95% confidence interval: 0.17-0.63). We did not detect any sequence variant within exons 1 or 2. One diabetic patient was heterozygous for a silent mutation at codon 31 of exon 3 (Asn31 AAC --> AAT). Our findings indicate that the presence of the +79-bp polymorphism of the IAPP gene in nondiabetic subjects and in patients with type 2 diabetes is associated with lower levels of LDL cholesterol. Furthermore, abnormalities of the coding regions or the 5'-UTR of the IAPP gene are not associated with type 2 diabetes or GDM in the Spanish population.

Eotaxin and CCR3 are up-regulated in exacerbations of chronic bronchitis

BACKGROUND

Eosinophils and T lymphocytes represent constant features in the airways of subjects with exacerbated chronic bronchitis. Eotaxin is the most potent and selective eosinophil chemoattractant which can also attracts lymphocytes. The aim of the study was to evaluate the expression of eotaxin and its receptor, CCR3, in bronchial airways during exacerbation of chronic bronchitis.

METHODS

By immunohistochemistry we studied eotaxin and CCR3 expression in the lamina propria of 14 subjects with acute exacerbation of chronic bronchitis. 20 asthmatics, and 8 healthy subjects. We determined the cell types expressing the CCR3 receptor by colocalization experiments. We finally studied the relationship between eotaxin and CCR3 and eosinophils and T lymphocytes.

RESULTS

The number of eotaxin+ and CCR3+ cells was significantly higher in exacerbated chronic bronchitis (P<0.003 and P<0.002) and asthma (P<0.002 and P<0.0001) when compared to healthy subjects. CCR3 was mainly expressed by eosinophils and to a lesser extent by CD4+ and CD8+ lymphocytes. In exacerbated chronic bronchitis the number of CCR3+ cells was strongly correlated to the number of eosinophils (P<0.0002. r=0.85) and to the number of CD4+ lymphocytes (P<0.05, r=0.57).

CONCLUSION

Our study suggests that eotaxin and CCR3 are up-regulated and could be involved in the eosinophil and CD4+ lymphocyte recruitment into the airways which occur during acute exacerbations of chronic bronchitis.

Molecular typing by pulsed-field gel electrophoresis of Spanish animal and human Listeria monocytogenes isolates

A total of 153 strains of Listeria monocytogenes isolated from different sources (72 from sheep, 12 from cattle, 18 from feedstuffs, and 51 from humans) in Spain from 1989 to 2000 were characterized by pulsed-field gel electrophoresis. The strains of L. monocytogenes displayed 55 pulsotypes. The 84 animal, 51 human, and 18 feedstuff strains displayed 31, 29, and 7 different pulsotypes, respectively, indicating a great genetic diversity among the Spanish L. monocytogenes isolates studied. L. monocytogenes isolates from clinical samples and feedstuffs consumed by the diseased animals were analyzed in 21 flocks. In most cases, clinical strains from different animals of the same flock had identical pulsotypes, confirming the existence of a listeriosis outbreak. L. monocytogenes strains with pulsotypes identical to those of clinical strains were isolated from silage, potatoes, and maize stalks. This is the first study wherein potatoes and maize stalks are epidemiologically linked with clinical listeriosis.

Visceral obesity and the role of the somatotropic axis in the development of metabolic complications

It is well recognized that aberrant fat localization such as visceral obesity rather than total body fat mass is a major risk factor for cardiovascular disease and type 2 diabetes mellitus. During recent decades, several studies have described a range of metabolic disturbances associated with abdominal obesity, including glucose intolerance, hyperinsulinaemia, insulin resistance, hypertension and dyslipoproteinaemia, now widely known as the metabolic syndrome. Several abnormalities in the hypothalamic-pituitary axis have been described associated with visceral obesity, suggesting a central neuroendocrine dysregulation including increased cortisol concentration and impaired gonadotropin and growth hormone (GH) secretion. Some steps in the chain of events in this theory still remain unclear, however, although these findings have introduced new therapeutic possibilities. These include therapy with sex steroids in both viscerally obese men and women, and several attempts to use GH to treat the endocrine abnormalities present in visceral obesity. The results of these studies are promising, but the therapies are still not recommended for general use.

Postchemotherapy late recurrence of non metastatic gestational trophoblastic disease following a partiale mole. A case report

The authors describe a case of a 35-year-old woman who showed elevation of betahCG 13 months after the complete regression of betahCG values following chemotherapy for an incomplete mole. This case outlines the necessity for careful monitoring of betahCG levels in low risk gestational trophoblastic diseases for a period of time longer than one year after achieving the first clinical remission.