[Exposure to low doses of CS2 and cardiovascular risk factors]

The effects were studied on cardiovascular risk factors of occupational exposure to carbon disulfide (CS2) concentrations ranging from 0.05 to 1.60 mg/m3, 74 workers exposed (E) to CS2 and 79 non-exposed (NE) workers were examined. Information was obtained on age, working age and life habits (alcohol, smoke, etc.) through a questionnaire and height and weight were measured to assess body mass index (BMI). All the workers underwent blood collection for the assessment of total cholesterol, HDL cholesterol and triglyceride levels and electrocardiogram. No clinically evident heart disease were detected in the workers examined and the prevalences of obesity and hypertension resulted to be similar among workers of the two groups. Mean triglyceride levels and frequencies of hypertriglyceridemia and of HDL cholesterol values < 40 mg/dl were significantly higher in exposed workers than non-exposed. The triglyceride levels resulted to be significantly and directly influenced by BMI and exposure to CS2. Occupational exposure to low environmental CS2 concentrations seems to interacts with other factors to determine alterations of lipid metabolism.

A fMRI study of word retrieval in aphasia

The neural mechanisms underlying recovery of cognitive functions are incompletely understood. Aim of this study was to assess, using functional magnetic resonance (fMRI), the pattern of brain activity during covert word retrieval to letter and semantic cues in five aphasic patients after stroke, in order to assess the modifications of brain function which may be related to recovery. Four out of five patients had undergone language recovery, according to standard testing, after at least 6 months of rehabilitation. The cerebral activation of each patient was evaluated and compared with the activation pattern of normal controls studied with the same fMRI paradigm. In the patients, the pattern of brain activation was influenced by the site and extent of the lesion, by the degree of recovery of language, as reflected by task performance outside the scanner, and by task requirements. In the case of word retrieval to letter cues, a good performance was directly related to the activation in Broca's area, or in the right-sided homologue. On the other hand, in the case of semantic fluency, the relationship between performance level and activation was less clear-cut, because of extensive recruitment of frontal areas in patients with defective performance. These findings suggest that the performance in letter fluency is dependent on the integrity of the left inferior frontal cortex, with the participation of the homologous right hemispheric region when the left inferior frontal cortex is entirely of partially damaged. Semantic fluency, which engages the distributed network of semantic memory, is also associated with more extensive patterns of cerebral activation, which however appear to reflect retrieval effort rather than retrieval success.

Quality of life in patients with traumatic brain injury-basic issues, assessment and recommendations

INTRODUCTION

Traumatic brain injuries (TBI) are one of the most common consequences of traffic accidents. Patients with mild, moderate or severe brain injuries suffer from physical, cognitive, behavioral, emotional and social problems. Most of these problems have been a long standing focus amongst practitioners and researchers. Only recently a development has started that took interest in the quality of life outcome of TBI patients. The international members of this consensus meeting reviewed the literature on Quality of Life assessment after TBI and discussed the applicability of different measurements to this specific patient group.

TIME POINTS

During the acute phase (T1; < 3 month after trauma) QoL it is difficult to assess due to the reduced consciousness of TBI patients. In the phase of rehabilitation (T2; < one year after trauma) and in the post-rehabilitation phase (T3) repeated assessment of QoL is recommended.

INSTRUMENTS

Several generic and disease-specific instruments possibly relevant to TBI patients or specifically developed for this group were assessed according to the existing evidence in the literature. Criteria for the evaluation of these instruments were: feasibility, specificity, validity, comprehensiveness, international availability, existence of norms, and psychometric quality. The cognitive impairment and the existential dimension were not sufficiently considered in most of the reviewed instruments.

GROUP CONSENSUS

The family's and relatives' view of the patient's QoL should not be used as a proxy but provides an additional source of information in the acute phase. At T2 and T3, assessment of the patient's quality of life should include a generic as well as a disease specific instrument. Among the generic instruments the SF-36, the EuroQol and the WHO-QoL should be considered. The literature about specific instruments for patients with TBI like the EBIC is scarce. Therefore, the group could hardly give an empirically based recommendation. The need for further investigation on QoL instruments in TBI patients is strongly emphasized.

Assessment of calculation and number processing using the EC301 battery: cross-cultural normative data and application to left- and right-brain damaged patients

To provide referential normative data on simple tasks dealing with number processing and calculation which could be used in clinical investigations, 551 normal volunteers aged between 18 and 69 years from France and Belgium (n = 180). Italy (n = 212) and Germany (n = 159). performed the 31 tasks which constitute the EC301 calculation and number processing battery. Differences between countries were significant for 16 tasks and a Gender x Education interaction was observed for some tasks, with men performing better than women among subjects with low education only. To present an overview of preserved and impaired calculation and number processing abilities in left-brain damaged (LBD) aphasic patients and right-brain damaged (RBD) nonaphasic patients, the 31 subtests of the EC301 battery were proposed to 80 patients with cerebrovascular accident, 56 left and 24 right, for most cases in the territory of the middle cerebral artery. LBD aphasic patients showed low performance on oral and alphabetical spoken verbal and written verbal counting, transcoding when a written code was involved, and mental or written calculation; but relatively good performance at finding the number of elements in small sets, comparing numbers written in the Arabic digital code and placing correctly numbers on an analogue number line. The lowest performances of RBD patients were observed for estimation tasks and for placing a number on a scale. Results and their implications for further research are discussed according to the present information processing and anatomofunctional models of calculation and number processing.

Bromocriptine and the expression of c-myc and c-fos in human prolactinomas

Prolactinomas are one of the most frequent tumors of the human anterior pituitary. Dopamine agonists are the choice in the medical treatment of this disease. Bromocriptine (BC) is a well known anti-neoplasic agent in human PRL secreting adenomas although its effect on PRL cells is far from clear. We decided to investigate its influence on cell proliferation parameters: (3H)thymidine incorporation, expression of c-myc and c-fos, and number of estrogen receptors present in the samples. A total of 28 patients were included in this protocol. They were treated with BC (5-7.5mg day(-1) patient(-1)) or with vehicle orally 15 days before surgery. We found that in BC treated patients (3H)thymidine incorporation was lower than in vehicle treated patients. The oncogenes expression were diminished in BC comparing with vehicle-treated patients. No difference in the number of estrogen receptors was observed in the samples from BC or vehicle-treated patients. These results clearly demonstrate that one mechanism to reduce the size of human PRL secreting adenomas by BC is the inhibition of DNA duplication.

The tyrosine kinase inhibitor ZD1839 ("Iressa") inhibits HER2-driven signaling and suppresses the growth of HER2-overexpressing tumor cells

The epidermal growth factor receptor (EGFR) is commonly overexpressed in many human tumors and provides a new target for anticancer drug development. ZD1839 ("Iressa"), a quinazoline tyrosine kinase inhibitor selective for the EGFR, has shown good activity in preclinical studies and in the early phase of clinical trials. However, because it remains unclear which tumor types are the best targets for treatment with this agent, the molecular characteristics that correlate with tumor sensitivity to ZD1839 have been studied. In a panel of human breast cancer and other epithelial tumor cell lines, HER2-overexpressing tumors were particularly sensitive to ZD1839. Growth inhibition of these tumor cell lines was associated with the dephosphorylation of EGFR, HER2, and HER3, accompanied by the loss of association of HER3 with phosphatidylinositol 3-kinase, and down-regulation of Akt activity. These studies suggest that HER2-overexpressing tumors are particularly susceptible to the inhibition of HER family tyrosine kinase signaling and suggest novel strategies to treat these particularly aggressive tumors.

Use of mathematical models of survivorship in the study of biomarkers of aging: the role of heterogeneity

An ever increasing number of people have been engaging in aging research using various interventions aimed to modify aging processes, and/or life span, of experimental animals. Since this type of studies needs outcome parameters for assessing the efficacy of such interventions, research on biomarkers of aging (ABs) has received new stimuli. In the present paper, the problem of the occurrence of a vicious circle any time we study ABs and determinants of aging is addressed. In fact, while ABs would represent the standard reference to be used in the study of the main causes of processes of aging, these very determinants should already be known in order to get reliable ABs. A feasible way to overcome this impasse is proposed, using mathematical models of survivorship or mortality based on biological hypotheses and accounting for inter-individual heterogeneity, a necessary ingredient for a correct interpretation of survival results. Specific kinetics of experimental parameters that are candidates as ABs can be compared to the kinetics hypothesized for general biological functions entering the model. We have built a model of this type that can also be used to perform a reliable overall gross estimate of the rate of aging, R(a), in the population, a parameter useful when judging the success of interventions aimed to act on determinants of aging. The perspective that theory of complex systems can be of help in the search for ABs is also discussed.

Advances in management of neurosurgical trauma in different continents

Neurotrauma is a major public health problem. The incidence varies from 67 to 317 per 100,000 and mortality rates are in the range of near 1% for minor injury, 18% for mild injury, and 48% for severe head injury. It is the main cause of death and disability in people under 40 years old. Several problems appear when outcome measurements, rehabilitation programs and treatment options are considered. In order to solve these problems a worldwide campaign is outlined. It focuses on epidemiology, prevention, education, treatment, rehabilitation, social re-insertion, and outcome measurements. The goals of such a program are to take into account realities in both developed and developing countries, to develop worldwide acceptable programs and guidelines, and to test those guidelines and programs and diminish mortality and morbidity, improving quality of life. We describe the concept of Centers of Excellence and an educational program, Advanced Brain Life Support. Such a program is a moral obligation because mortality and morbidity tend to decrease in Centers of Excellence.

Modulation of Hsp90 function by ansamycins sensitizes breast cancer cells to chemotherapy-induced apoptosis in an RB- and schedule-dependent manner. See: E. A. Sausville, Combining cytotoxics and 17-allylamino, 17-demethoxygeldanamycin: sequence and tumor biology matters, Clin. Cancer Res., 7: 2155-2158, 2001

17-allyl-aminogeldanamycin (17-AAG) is an ansamycin antibiotic that binds to a highly conserved pocket in the Hsp90 chaperone protein and inhibits its function. Hsp90 is required for the refolding of proteins during cellular stress and the conformational maturation of certain signaling proteins. 17-AAG has antitumor activity in cell culture and animal xenograft models and is currently in clinical trial. It causes an RB-dependent G(1) arrest, differentiation, and apoptosis. RB-negative cells arrest in mitosis and undergo apoptosis. Hsp90 plays an important role in the cellular response to environmental stress. Therefore, we tested whether the regulation of Hsp90 function by 17-AAG could sensitize cells to cytotoxic agents. 17-AAG sensitized tumor cells to Taxol and doxorubicin. Taxanes cause growth arrest in mitosis and apoptosis. The addition of 17-AAG to cells after exposure to Taxol significantly increased both the activation of caspases 9 and 3 and apoptosis. In cells with intact RB, exposure to 17-AAG before Taxol resulted in G(1) arrest and abrogated apoptosis. Schedule dependence was not seen in cells with mutated RB, because both agents blocked cells in mitosis. Schedule- or RB-dependence was also not observed when cells were treated with 17-AAG and doxorubicin, a DNA-intercalating agent that acts on different phases of the cell cycle. These findings suggest that inhibition of Hsp90 function by 17-AAG enhances the apoptotic effects of cytotoxic agents. The sequence of drug administration and the RB status significantly influence efficacy.

Long-live euthymic BALB/c-nu mice. I. Survival study suggests body weight as a life span predictor

This paper is the first of a series aimed to show the main physiological and pathological characteristics of male euthymic BALB/c-nu mice, a long-live strain of BALB/c mice bred in our own Institute. In particular, the first two paired papers are respectively devoted to general survival information and disease characteristics, also taking into account very old animals that are of high interest for studies on successful aging. In this paper we report the analysis of survival kinetics, the time course of body weight and the correlation between body weight and time-at-death. The longitudinal study has been performed on 88 male mice, checking individually their body weight and date of death and analyzing survival data by a model built by our own. Survival analysis shows quite higher longevity (median age: about 29 months) in this population when compared with other BALB/c strains. The most relevant finding on body weight is its correlation with longevity until the age of 22 months: thinner subjects live longer and lose weight at a lower rate than their heavier mates. Results have formed the basis on which to plan the cross-sectional experiment to study pathologies and biological parameters at different ages, including a group of mice at very advanced ages (34 months).

Long-live euthymic BALB/c-nu mice. II: spontaneous tumors and other pathologies

This paper is the second of a series aimed to show the main physiological and pathological characteristics of male euthymic BALB/c-nu mice, a long-live strain of BALB/c mice bred in our own Institute. The previous paired paper Piantanelli (Mech. Ageing Dev. (2001)) has been devoted to a survival study up to advanced ages highly interesting for studies on successful aging. In the present paper we report first data of a cross-sectional study on 4,15,22,28 and 34 months-old mice, dealing with tumors and other relevant pathologies. Results have shown that tumors or other pathologies can hardly be detected up to the age of 22 months. At 34 months of age about 40% of mice revealed a variety of neoplasia and other diseases are clearly detectable. These results suggest that a significant increase in longevity could be a factor increasing the risk of tumor development; thus, caution has to be paid in studies on mice utilized for long term carcinogenicity assay, where animals are sacrificed at the age of 18 months, according to the International Program. Finally, animals of the same chronological age have been subdivided in clusters according to their presumptive longevity, estimated taking advantage of the relationship between body weight and age-at-death found in the paired longitudinal study. This subdivision will be helpful in interpreting inter-individual variability of the biological parameters checked in these animals.

Acquisition of new "words" in normal subjects: a suggestion for the treatment of anomia

The study explores the efficacy of three learning methods in normal controls. Thirty subjects, randomly assigned to the repetition, reading aloud, or orthographic cueing method, were asked to learn 30 new "words" (legal nonwords arbitrarily assigned to 30 different pictures); 30 further new "words" were used as controls. Number of trials to criterion was significantly lower, and number of words remembered at follow-up was significantly higher for the orthographic cueing method. Two aphasic patients with damage to the output lexicons were also rehabilitated with the same three methods. In both patients the orthographic cueing method was significantly more efficacious. The differences in learning efficacy of the three methods are discussed.

[Fatiguing work, aging and health: a cross-sectional study of a group of anesthesiologists]

A cross-sectional study was carried out to verify if work as an anaesthetician-reanimator can be considered as a fatiguing job. An anonymous self-administered questionnaire was utilized to obtain information about the general characteristics of the subjects, job organization, human relations, perceived risks and previous diseases; 1438 questionnaires were examined. The results of the study showed that in anaesthetist-reanimator: organic diseases do not occur earlier than expected; perception of the emotional aspects related to the particular occupation is low; the group relationships are difficult, on both horizontal and vertical levels, and these difficulties increase work-stress and hinder its management; age influences the occurrence of both arthritic and stress-related diseases; there is an association between jobs dissatisfaction and stress disorders; all the causal variables considered, evaluated as a group, constitute a heavy physical load, that leads to risk of stress related diseases.

The natural course of acalculia in left-brain-damaged patients

Acalculia is a frequent disorder in left-brain-damaged patients but nothing is known about its natural course. We report a study on 51 vascular acalculic patients examined at least twice. Our results indicate that recovery from acalculia is possible in the first months post-stroke, that initial severity does not significantly influence recovery, and that it correlates with recovery of auditory comprehension.

Perceiving left and imagining right: dissociation in neglect

Signor Piazza, a patient with a left parieto-occipital haemorrhage and a right thalamic stroke, showed severe right personal neglect (e.g. touching own body parts) and right perceptual neglect in tasks with (e.g. cancelling tasks) or without (e.g. description of a complex picture) motor response. He had also right-sided neglect dyslexia (including single words), without language impairments. However, the patient also presented with a clear left-sided deficit in the representational domain (e.g. imagery tasks). Signor Piazza's pattern of performance suggests dissociation between imagery and perception within the neglect syndrome.

Acalculia, aphasia and spatial disorders in left and right brain-damaged patients

The paper reports the performance of 50 left- and 26 vascular right-brain-damaged (LBD, RBD) patients in the EC301 Calculation Battery, which explores different aspects of number and calculation processing. All patients underwent a comprehensive neuropsychological testing that also included evaluation for the presence and type of aphasia in LBD patients, and of spatial disorders in RBD patients. LBD were subdivided in three groups: non-aphasic (NA), Broca and Wernicke aphasics. Results indicate that language and calculation disorders can dissociate. The relationship between spatial and calculation disorders in RBD patients is less clear. No significant difference was found between Broca and Wernicke aphasics, nor between NA and RBD patients. In the transcoding tasks (reading or writing to dictation numbers and number words, for instance) syntactic errors were the most frequent type of errors in all groups. They were also present when neither the input nor the required response was in the Arabic code, and a word-by-word strategy could have been used to read the number word or write a spoken number in the orthographic code.

Acquisition of output irregular orthographic representations in normal adults: an experimental study

Twenty normal controls without previous knowledge of French were asked to learn 12 French words that could not be written by Italian correspondence rules. After acquisition of the phonological representations, participants were presented the pictures and asked to write the corresponding words (baseline). They were then presented 3 times with the pictures and the corresponding written words. After a filled delay of 10 min, they were re-presented the pictures and asked to write the corresponding words (testing). A week later, participants were again requested to write the words (follow-up). Number of words correctly written at testing and at follow-up significantly differs from baseline, as well as number of words correctly written at testing and at follow-up. These results are discussed and it is suggested that acquisition of irregular output orthographic representations can be supported by knowledge of orthographic representations for reading and that rehabilitation of patients with damage to output orthographic representations can utilize input orthographic representations.

Alpha subunit of glycoprotein hormones in the sera of acromegalic patients and its mRNA in the tumors

Within a population of 16 pituitary adenomas we found high levels of glycoprotein alpha subunits in the sera of patients with somatotrophic tumors. This finding was correlated with the presence of mRNA alpha subunit in these tumors indicating the adenomas themselves as the origin of the circulating alpha-subunit. Synthesis of these two hormones, which are chemically very different, by the same tumor cells indicates a high degree of differentiation of these cells. We are unable at this time to conclusively correlate differentiation of these tumors aggressively.

Phonetically cued word-fluency, gender differences and aging: a reappraisal

Five-hundred and three normal subjects were given a phonetically cued word-fluency task in order to investigate the controversial issue of the influence of gender and aging on this task. Subjects were requested to say in one minute all the words that occurred to them, beginning with a given letter (F, P and L). Besides the expected significance of education, we observed a female advantage, but not a significant decline in the performance with aging. However, the slope of the line expressing word fluency as a function of age was different between females and males, indicating a greater sensitivity to aging for males. We provide inner and outer tolerance limits for this test in the normal population and give a formula useful for adjusting the raw scores on the basis of gender and education. The results are discussed with reference to previous findings and some hypotheses about the origins of the female advantage in PWF.

Current surgical treatment for sphenoorbital meningiomas

BACKGROUND

Originally, the authors used a combined transcranial-transmalar approach for removal of sphenoorbital tumors.

METHODS

More recently, when computed tomography (CT) scanning became available, surgical management of sphenoorbital meningiomas included resection of the hyperostosis in the pterional region, orbital roof and lateral wall, and middle fossa floor. Thereafter, intradural and intraorbital components are removed, as well as infiltrated dura mater. Finally, a periosteal flap is placed over the dural defect and bone reconstructed with methylmethacrylate.

RESULTS

Of 25 patients, there was only one death and all but one showed very good to moderate response to treatment. Four recurrences were observed.

CONCLUSIONS

Surgical management cannot be uniform in all cases, but must be adapted to each form of presentation. On the basis of the satisfactory results achieved, we feel justified in advising the technique described above with its current modifications.

Expression of c-myc and c-fos and binding sites for estradiol and progesterone in human pituitary tumors

We studied the concentration of mRNA from the oncogenes c-myc and c-fos in human pituitary adenomas by Northern blot hybridization (35 somatotrophinomas, 9 prolactinomas, 21 nonsecreting and 3 adrenocorticotrophinomas). The concentration of estrogens and progesterone receptors was also investigated. The levels of c-myc and c-fos mRNA was higher in nonsecreting tumors which were generally the largest and had a higher percentage of recurrence after surgery than the other groups. High concentration of estrogen receptors was observed in tumors derived from cells which are normally the target of this hormone, mainly prolactinomas. They were also present in somatotrophic and nonsecreting adenomas, related to the presence of prolactin or gonadotrophin cells in these tumors. The presence of estrogen receptors indicates that the tumor cells maintain their differentiation and a good prognosis as is the case for prolactinomas. We did not find any relationship between estrogen receptors and the concentration of c-myc and c-fos oncogenes. Larger adenomas (mainly nonsecreting) had higher levels of c-myc and c-fos mRNA than the other tumors and they had an important percentage of recurrence after surgery. It is clear that tumor size is related to the outcome after surgery and that nonsecreting adenomas are usually large because of the late diagnosis. However two large somatotrophinomas with extrasellar expansion also had overexpression of both oncogenes and both relapsed after surgery.

[The heterogeneity of myocardial sympathetic innervation in normal subjects: an assessment by iodine-123 metaiodobenzylguanidine scintigraphy]

123I-radiolabeled metaiodobenzylguanidine (123I-MIBG) cardiac imaging has been used to evaluate the distribution of sympathetic nervous system (SNS) in the heart. Different heart diseases have shown impaired cardiac SNS distribution as reflected by MIBG activity. The aim of this study was to assess the cardiac distribution of SNS in normal subjects, using MIBG imaging. Ten normal subjects (1 male and 9 females, mean age 46 +/- 9 years) with no cardiac abnormalities underwent myocardial 123I-MIBG scintigraphy, Tc-99m methoxyisobutylisonitrile (MIBI) cardiac perfusion imaging and equilibrium radionuclide angiography (RNA). Regional myocardial MIBG and MIBI activities were quantitatively evaluated using a region of interest analysis. For this purpose, the left ventricle was divided into 6 myocardial regions as anterior, apical, inferior, septum, lateral and posterolateral. In particular, myocardial MIBG and MIBI activities were measured as myocardium to mediastinum ratio. Regional left ventricular function was assessed by RNA. Myocardial MIBG uptake was homogeneous in anterior (2.2 +/- 0.5), inferior (2.5 +/- 0.7), septal (2.4 +/- 0.4), lateral (2.3 +/- 0.4), and posterolateral (2.3 +/- 0.4) regions. Conversely, MIBG uptake was significantly lower in the apical region (1.9 +/- 0.3) compared to all other left ventricular segments (p < 0.05). Regional myocardial perfusion, as measured by MIBI uptake, was homogeneous in all regions. No regional left ventricular wall motion abnormalities were observed by RNA. In conclusion, our data suggest that a decreased MIBG uptake may be observed in the left ventricular apical region of normal subjects reflecting reduced sympathetic innervation of the apex. This finding is not related to myocardial perfusion or wall motion abnormalities. The knowledge of cardiac sympathetic innervation in normal subjects may be helpful to assess SNS abnormalities in heart disease.

Aphasia therapy

From the point of view of rehabilitation, two groups of aphasic patients can be recognized. They differ in the severity of the aphasic disorder, in the type of evaluation that can and should be utilized to plan and monitor therapy, and in the therapeutic intervention itself. The therapeutic intervention obviously differs not only between the two groups of patients but also from patient to patient, since no two patients show exactly the same disorder. What I refer to here is a deeper difference, a difference that lies in the rationale underlying the choice of the different implementations. In the first group, the rationale originates in identification of the functional damage, based on an explicit model of the normal function and the choice of coherent and theoretically based exercises; in the second group, no cognitive analysis of the disorder is possible, the theoretical rationale (analysis of conversation) is coarse, and the therapeutic intervention is grossly similar from patient to patient.