[Exposure to low levels of solvents and noise, ear canal volume and audiometric pattern]

We described a case of a male worker, 62 years old, with a combined exposure to low noise levels (80-85 dB Leq,A) and organic solvents mixture for more than 30 years in the automobile industry as a painter. His ear canal has a diameter of more than 1.3 cm. and determine a peculiar pattern of hearing loss, similar to the noise induced one, but chiefly in the speech frequencies. According to experimental and human studies we speculate that in this patient the peculiar morphology of the audiogram, with the low or mean frequencies maximally affected, may been explained by a synergistic effect of solvents mixture in conjunction with noise exposure and a high ear canal volume.

The boundary between wakefulness and sleep: quantitative electroencephalographic changes during the sleep onset period

Microstructural electroencephalographic changes during the wakefulness-sleep transition have been investigated by comparing two definitions of sleep onset: the first occurrence of stage 1 and of stage 2. Power values were calculated across a 1-28-Hz frequency range in a 1-Hz bin resolution in the sleep recordings of 26 normal subjects. Quantitative changes were assessed after averaging individual time series, aligned with respect to the first occurrence of stage 1 or of stage 2. The time course of the single-Hz activity revealed a linear increase of power in the 1-6-Hz range and a linear decrease in the 9-12- and 16-28-Hz ranges during the stage 1 transition. During the stage 2 transition, electroencephalogram power linearly increased in the 1-7- and 14-15-Hz ranges and decreased in the 18-28-Hz range, while the 8-12-Hz range fitted a second-order polynomial curve. The two 'switch' points were also compared in their ability to differentiate Hz by Hz wakefulness from sleep: a lower mean power was found after stage 1 onset in the 9-11-Hz and 20-28-Hz bins and a higher one in the 1-5-Hz bins, while a higher power was found in the 1-8-Hz and 12-16-Hz bins and a lower one in 18-28-Hz bins after stage 2 onset. The time course of three electroencephalographic frequency ranges [delta/theta/sigma (1-7 and 12-16 Hz); beta (17-28 Hz); alpha (8-11 Hz)], grouped on the basis of a principal component analysis, fitted a first-order polynomial curve for the first two ranges, and a second-order polynomial curve for the last, with a progressive decrease during wakefulness, a minimum point during stage 1, and a subsequent increase during stage 2. The uniformly increasing electroencephalographic power across the 1-16-Hz frequency range during stage 2 and the shift of functional meaning for the alpha power during stage 1 point to the start of stage 2 as a more reliable boundary between wakefulness and sleep.

Optical Sensor for real-time Monitoring of CO(2) Laser Welding Process

An optical sensor for real-time monitoring of laser welding based on a spectroscopic study of the optical emission of plasma plumes has been developed. The welding plasma's electron temperature was contemporarily monitored for three of the chemical species that constitute the plasma plume by use of related emission lines. The evolution of electron temperature was recorded and analyzed during several welding procedures carried out under various operating conditions. A clear correlation between the mean value and the standard deviation of the plasma's electron temperature and the quality of the welded joint has been found. We used this information to find optimal welding parameters and for real-time detection of weld defects such as crater formation, lack of penetration, weld disruptions, and seam oxidation.

Identification of cathepsin L as a differentially expressed message associated with skeletal muscle wasting

Alteration of skeletal muscle protein breakdown is a hallmark of a set of pathologies, including sepsis, with negative consequences for recovery. The aim of the present study was to search for muscle markers associated with protein loss, which could help in predicting and understanding pathological wasting. With the use of differential display reverse transcription-PCR, we screened differentially expressed genes in muscle from septic rats in a long-lasting catabolic state. One clone was isolated, confirmed as being overexpressed in septic skeletal muscle and identified as encoding the lysosomal cysteine endopeptidase cathepsin L. Northern- and Western-blot analysis of cathepsin L in gastrocnemius or tibialis anterior muscles of septic rats confirmed an elevation (up to 3-fold) of both mRNA and protein levels as early as 2 days post-infection, and a further increase 6 days post-infection (up to 13-fold). At the same time, the increase in mRNAs encoding other lysosomal endopeptidases or components of the ubiquitin-proteasome pathway did not exceed 4-fold. Cathepsin L mRNA was also increased in tibialis anterior muscle of rats treated with the glucocorticoid analogue, dexamethasone, or rats bearing the Yoshida Sarcoma. The increase in cathepsin L mRNA was reduced by 40% when the tumour-bearing animals were treated with pentoxifylline, an inhibitor of tumour necrosis factor-alpha production. In conclusion, these results demonstrate a positive and direct correlation between cathepsin L mRNA and protein level and the intensity of proteolysis, and identify cathepsin L as an appropriate early marker of muscle wasting. Cathepsin L presumably participates in the pathological response leading to muscle loss, with glucocorticoids and tumour necrosis factor-alpha potentially being involved in the up-regulation of cathepsin L.

Inhibition of CHOP translation by a peptide encoded by an open reading frame localized in the chop 5'UTR

Chop is a ubiquitously expressed mammalian gene encoding a small nuclear protein related to the CCAAT/enhancer-binding protein (C/EBP) family of transcription factors. CHOP protein plays an important role in various cellular processes such as growth, differentiation and programmed cell death. CHOP expression is strongly increased in response to a large variety of stresses including perturbation of the endoplasmic reticulum function, DNA damage and nutrient deprivation. Multiple mechanisms including transcriptional and post-transcriptional controls are involved in the regulation of CHOP expression. We show here that the 5'UTR of the Chop transcript plays an important role in controlling the synthesis of CHOP protein. In particular, the 5'UTR contains a conserved uORF which encodes a 31 amino acid peptide that inhibits the expression of the downstream ORF. Mutational analysis of the 5' leader region and peptide coding sequences suggests that the peptide itself inhibits expression of the downstream ORF. Such results suggest a role for uORF in limiting ribosomal access to downstream initiation sites. With respect to the importance of CHOP protein in the regulation of cellular functions, the mechanisms that regulate its basal level are of considerable interest.

Topographical distribution of spindles: variations between and within nrem sleep cycles

Spindle density, visually scored in the 12-15 Hz range over antero-posterior midline derivations, was assessed during a baseline night in ten normal subjects. Sleep spindles were found to be highly variable between subjects and more abundant during Stage 2. Topographical distribution of spindle density showed a centroparietal prevalence, stable between NREM sleep stages. Intra-night variations of spindle density exhibited a linear increase across consecutive NREM episodes, suggesting an inverse relation with the time course of slow wave sleep. Except for occipital leads reaching a maximum during the third NREM cycle and then decreasing, changes in spindle density across sleep cycles were similar over different derivations. Intra-cycle variations fit a fourth-order polynomial curve with a minimum in the middle part of each sleep episode (when most slow wave sleep is expressed); this intra-cycle trend also seems stable between derivations and consecutive sleep cycles. These results confirm and extend, to the level of macroscopic EEG, the reciprocal relationship between sigma and delta waves previously shown by spectral analysis of EEG frequencies and, at a neuronal level in the thalamocortical network, by changes of membrane potentials that oscillate in the frequency range of spindles or delta at different levels of hyperpolarization.

Selective slow-wave sleep (SWS) deprivation and SWS rebound: do we need a fixed SWS amount per night?

Visually scored delta activity (stages 3 and 4, SWS) as well as computerized delta activity measures increase after total and selective sleep deprivation. It is, however, still controversial if SWS amount is only a function of prior waking duration, or if it is related to the structure of the previous sleep period (i.e., to the time spent in SWS). In order to clarify if the amount of SWS is crucial in determining SWS recovery, we selectively deprived SWS during two nights to assess the presence of a compensatory SWS rebound in the following recovery night. Ten normal males slept for 6 consecutive nights in the laboratory. After an adaptation and two baseline nights (BSL; BSL-A), selective SWS deprivation was accomplished for two consecutive nights (DEP-1; DEP-2), by means of an acoustic stimulation technique. A recovery (REC) night then followed. An almost complete selective SWS suppression during both deprivation nights was achieved. A significant increase of S4 and SWS in the REC as compared to the BSL-A paralleled a significant shortening of S3 and S4 latencies. S2 percentage significantly increased during both DEP nights with respect to the other experimental nights. There was no significant difference among nights with regard to total sleep time, percentage of REM sleep, stage 1, movement time, number of awakenings and number of movement arousals, indicating that the acoustic stimulation technique did not dramatically disrupt normal sleep continuity and architecture. These results indicate that SWS rebound after selective SWS deprivation can be ascribed to the loss of SWS accumulated during two consecutive nights, further supporting the idea that the delta sleep amount is more linked to SWS in the previous sleep periods than to the total sleep duration.

Inhibition of BRCA1 leads to increased chemoresistance to microtubule-interfering agents, an effect that involves the JNK pathway

We have developed ribozymes (Rz) that inhibit BRCA1 expression in order to study the role of this gene in chemosensitivity. Two Rz, targeting positions 358 or 5282 of the BRCA1 mRNA, were cloned into the retroviral vector LXSN and lipofected into the breast cancer cell-line HBL100. We obtained 79-99% inhibition of BRCA1 expression, as determined by real-time quantitative PCR and by Western blotting. Decreased expression of BRCA1 led to sensitivity to the DNA damaging agents cisplatin and etoposide, resistance to the microtubule-interfering agents (MIA) taxol and vincristine. The molecular mechanism of resistance to MIA was investigated further by determining the status of the JNK pathway. We found that JNK1 expression was elevated, while JNK2 expression was decreased in Rz-expressing clones compared to controls. We have quantified the mRNA levels of BRCA1, JNK1, 2, MEK-4, -7 and c-jun after treatment with MIA. Vincristine treatment of control cells resulted in transcriptional repression of BRCA1, while the JNK1, 2, MEK-4, -7 and c-jun genes were induced. In Rz-treated cells, only JNK1 and MEK-4 were expressed and none was induced after MIA treatment. We then studied the phosphorylation of c-jun, a downstream effector of the JNK pathway. We observed a strong increase in phosphorylated c-jun after MIA treatment of the control cells but not in BRCA1-Rz treated cells, suggesting inhibition of the JNK pathway. These results show that the BRCA1-JNK pathway is involved in the cytotoxic response to MIA treatment, and inhibition of BRCA1 leads to transcriptional modifications of the JNK pathway.

Antero-posterior EEG changes during the wakefulness-sleep transition

OBJECTIVES

To investigate the brain topography of the human sleep EEG along the antero-posterior axis during the wakefulness-sleep transition, by means of both a single Hz analysis and a grouped-frequency analysis of EEG changes.

METHODS

EEG power values were calculated across a 1-28 Hz frequency range in a 1 Hz resolution during the wakefulness-sleep transition of 7 normal subjects. Topographical changes were assessed from C3-A2, C4-A1, Fpz-A1, Fz-A1, Cz-A1, Pz-A1, Oz-A1 recordings, after averaging individual time series, aligned with respect to the onset of stage 2.

RESULTS

The single Hz analysis showed that before sleep onset (SO), the <7 Hz slow frequencies were more prominent at the more anterior scalp locations; this anterior prominence was counterbalanced by a reciprocal prevalence across the >8 Hz frequencies of EEG activity from the occipital areas; while the >13 Hz fast frequencies were not characterized by significant antero-posterior differences. After SO, more EEG power was found in the range of slow frequencies at the centro-frontal scalp locations and a second peak of EEG activity was also revealed within the range of the sigma frequency, higher at the centro-parietal scalp locations. No consistent topographical changes were observed within the range of faster EEG frequencies. Grouped-frequency analysis confirmed these results, also pointing to different changes in the alpha frequency as a function of the SO point.

CONCLUSIONS

The results suggest that: (a) the alpha rhythm spreads anteriorly as the transition progresses; (b) several anterior areas first synchronize EEG activity; (c) the functional meaning of the EEG bands during the SO period should be partially revised with regard at least to alpha rhythm; (d) SO coincides with the start of stage 2.

EEG arousals in normal sleep: variations induced by total and selective slow-wave sleep deprivation

STUDY OBJECTIVES

Aim of the present study was to assess changes in arousal rates after selective slow-wave (SWS) and total sleep deprivations.

DESIGN

Two-way mixed design comparing the arousal index (Al), as expressed by the number of EEG arousals divided by sleep duration, in totally or selectively sleep deprived subjects.

SETTING

Sleep laboratory.

PATIENTS OR PARTICIPANTS

Nineteen normal male subjects [mean age=23.3 years (S.E.M.=0.55)].

INTERVENTIONS

Al was measured in baseline nights and after selective SWS (N=10) and total sleep deprivation (N=9).

MEASUREMENTS AND RESULTS

During the baseline nights AI values changed across sleep stages as follows: stage 1 > stage 2 and REM > SWS, but did not present any significant variations as a function of time elapsed from sleep onset. The recovery after deprivation showed a reduction in EEG arousals, more pronounced after total sleep deprivation; this decrease affected NREM but not REM sleep. During the baseline nights Al showed a close-to-significance negative correlation with REM duration, while during the recovery nights a significant positive relation with stage 1 duration was found.

CONCLUSIONS

The present results suggest that recuperative processes after sleep deprivation are also associated with a higher sleep continuity as defined by the reduction of EEG arousals.

Auditory evoked responses upon awakening from sleep in human subjects

The hypothesis that a state of hypoarousal upon awakening should lead to a decrease in amplitude and an increase in latency of the N1-P2 components of the Auditory Evoked Potentials (AEPs) as compared to presleep wakefulness levels, was evaluated after two nocturnal awakenings and after the final morning awakening from a 7.5-h night of sleep. The amplitude of the N1-P2 complex was reduced upon awakening as compared to presleep wakefulness levels, but only following the first nocturnal awakening, scheduled after the first 2 h of sleep. This result is interpreted as indicating a link between slow wave sleep amount, mainly present during the first part of the night, and lowered levels of brain activation upon awakening. The reaction times, recorded concomitantly to AEPs, were more sensitive to the negative effects of sleep inertia.

Visual search performance across 40 h of continuous wakefulness: Measures of speed and accuracy and relation with oculomotor performance

The aim of the study was to estimate the sensitivity of a brief self-paced visual search task to increased levels of sleepiness as a consequence of 40 h of sleep deprivation. Time-of-day effects on this task, on subjective sleepiness and on oculomotor performance changes, were also assessed. Eight normal subjects slept for three nights in the laboratory (adaptation, baseline, recovery). Baseline and recovery nights were separated by a period of 40 h of continuous wakefulness, during which subjects were tested every 2 h from 10:00 to 22:00 h on both days preceding and following the sleep deprivation night, as well as from 24:00 to 08:00 h during the deprivation period. At the same time, subjects filled in a visual analogue sleepiness scale and the Stanford Sleepiness Scale (SSS). As regards cognitive performance, significant effects were found on speed measures, while accuracy was not affected. The number of explored rows was higher after the baseline night than after the sleepless night, and showed a consistent time-of-day trend. Omissions ratio (OR), false positives ratio (FPR) and hits ratio (HR) did not show any significant effect. Subjective ratings of sleepiness varied according to speed measures, being affected by sleep deprivation and time of day. Since similar effects were found with an oculomotor task, detrended functions for all variables across the 40 h of continuous wakefulness were calculated. A circadian effect was found, in which speed measures seem to be more affected than accuracy ones in both visual search and oculomotor tasks. It is concluded that 40 h of prolonged wakefulness significantly impairs performance in a brief cognitive visual search task. Such a performance worsening is evident on speed, but not on accuracy indices, and is strictly related to the deterioration of oculomotor performance, indicating a clear circadian effect.

Bleeding from cavernous angiomatosis of the rectum in Klippel-Trenaunay syndrome: report of three cases and literature review

Klippel-Trenaunay syndrome (KTS) is a congenital vascular anomaly characterized by limb hypertrophy, cutaneous hemangiomas, and varicosities. GI hemorrhage is a potentially serious complication secondary to diffuse hemangiomatous involvement of the gut. We report on three patients with KTS who presented with transfusion-dependent anemia and life-threatening bleeding due to extensive cavernous hemangiomas involving the rectum. Two patients were treated by proctocolectomy and coloanal anastomosis, which preserved anal function while controlling bleeding. The third patient required an abdominoperineal resection because of extensive rectal, perianal, and perineal angiomatosis. The literature on the evaluation and management of GI hemorrhage in KTS, particularly of colorectal origin, is reviewed.

Glucose regulates protein catabolism in ras-transformed fibroblasts through a lysosomal-dependent proteolytic pathway

Transformed cells are exposed to heterogeneous microenvironments, including low D-glucose (Glc) concentrations inside tumours. The regulation of protein turnover is commonly impaired in many types of transformed cells, but the role of Glc in this regulation is unknown. In the present study we demonstrate that Glc controls protein turnover in ras-transformed fibroblasts (KBALB). The regulation by Glc of protein breakdown was correlated with modifications in the levels of lysosomal cathepsins B, L and D, while autophagic sequestration and non-lysosomal proteolytic systems (m- and mu-calpains and the zeta-subunit of the proteasome) remained unaffected. Lactacystin, a selective inhibitor of the proteasome, depressed proteolysis, but did not prevent its regulation by Glc. The sole inhibition of the cysteine endopeptidases (cathepsins B and L, and calpains) by E-64d [(2S,3S)-trans-epoxysuccinyl-L-leucylamido-3-methylbutane ethyl ester] was also not sufficient to alter the effect of Glc on proteolysis. The Glc-dependent increase in proteolysis was, however, prevented after optimal inhibition of lysosomal cysteine and aspartic endopeptidases by methylamine. We conclude that, in transformed cells, Glc plays a critical role in the regulation of protein turnover and that the lysosomal proteolytic capacity is mainly responsible for the control of intracellular proteolysis by Glc.

Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques

To facilitate mini-access for cardiac surgery, two different methods of active venous drainage are used: vacuum assisted drainage and centrifugal pump aspiration on the venous line. The aim of this study was to compare the haemolysis produced using these two techniques. From June to December 1999, 50 consecutive patients were operated on using a ministernotomy. All of these patients had valvular surgery for either valve repair or valve replacement (9 MVRepair, 11 MVR, 29 AVR, 1 AVR + MVR). They were randomized into two groups: Group A, 25 patients who underwent surgery where vacuum assisted drainage was used, and Group B, 25 patients where kinetic asssisted venous drainage with centrifugal pump venous aspiration was used. Patient characteristics of both groups were similar for age, gender, body weight, body surface area, height, cardiopulmonary bypass (CPB) time, aortic crossclamp time, priming volume, cardioplegia volume, haemoglobin concentration, haematocrit, serum creatinine, bilirubin, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (sGOT), serum glutamic pyruvic transaminase (sGPT), aptoglobin, reticulocytes, and platelet count. We checked all these laboratory parameters preoperatively, at the end of CPB, and 2 and 24 h after operation. We also checked haemoglobinuria at these same time points. We assessed blood loss at 6, 12, and 24 h after the operation and calculated total postoperative bleeding. There was a tendency towards a greater increase in LDH, sGOT and sGPT in Group A more than in Group B, but these data did not reach statistical significance. Platelet count was always lower in Group A and aptoglobin increased in Group A more than in Group B. More patients in Group A had haemoglobinuria. These findings indicate that haemolysis is increased more in patients treated with vacuum assisted drainage, when compared to the rise in haemolysis in those treated with centrifugal pump venous drainage. Total bleeding is also greater in Group A.

Activation of c-Jun N-terminal kinase 1 (JNK-1) after amino acid deficiency in HeLa cells

Long-term amino acid starvation represents a form of metabolic stress which stimulates gene expression. Here we report that depriving HeLa cells for any one of a series of amino acids activates c-Jun N-terminal kinase-1 (JNK-1). In contrast, the other mitogen-activated protein kinases (MAPKs) ERK-1 and, to a lesser extent, p38 activities decreased under such conditions. In methionine- or leucine-deprived cells, JNK-1 activation occurred after 4 or 6 h, respectively, and reached a steady maximum of 5- to 7-fold over control cells afterwards. This activation was dependent on the amino acid concentration and it could be reversed by resupplying the complete medium. Limitation for all amino acids also augmented JNK-1 activity, whereas increased amino acid concentrations had an opposite effect. The free radical scavenging thiol antioxidant N-acetylcysteine (NAC) alleviated partially JNK-1 activation in amino acid-deprived cells. The data indicate that activation of JNK-1 by long-term amino acid deprivation may be mediated in part by oxidative stress.

Sexual behaviour of heterosexual individuals with HIV infection naive for antiretroviral therapy in Italy

BACKGROUND

Specific information about determinants of sexual behaviour of HIV infected heterosexuals, like injecting drug use (IDU), are essential to design interventions aimed at promoting safer sex practices.

METHODS

We analysed data on sexual behaviour collected, between March 1997 and March 1999, through a self administered questionnaire among 1050 IDUs and 642 non-IDU heterosexuals enrolled in a prospective multicentre cohort study on the natural history of HIV infection.

RESULTS

Among non-IDU heterosexuals, more women (48.5%) than men (25.1%) (p<0.001) reported that they were infected by HIV positive regular partners whose HIV status they were not aware of. Among the 1119 heterosexual males, one fifth reported having had more than 25 sexual partners during their lifetime. Condom use in the last sexual intercourse was more common among heterosexual IDUs (64.9%) than among non-IDU heterosexual males (58.3%) (p=0.05). Heterosexual IDU males were more likely (66.7%) than non-IDU heterosexuals (50.6%) to have an HIV negative partner (p<0.001). Of the 573 heterosexual females studied, 10.2% reported having had more than 25 lifetime sex partners. This proportion was higher among heterosexual IDUs (18.8%) than among non-IDU heterosexuals (4.3%) (p<0.001). Nearly 50% of the women in both groups reported having used a condom in the last intercourse. Almost 57% of heterosexual IDUs had a current HIV negative partner, compared with 34.9% non-IDU heterosexuals (p<0.001). In both sexes, the findings from univariate analysis were confirmed by multiple logistic regression analysis.

CONCLUSIONS

This study identified some important differences, in both males and females, in sexual lifestyles according to injecting drug use (for example, in terms of HIV negative partners). This observation indicates the need to tailor HIV prevention messages according to history of injecting drug use.

Hematological and molecular analysis of beta-thalassemia and Hb Lepore in Campania, Italy

This epidemiological study was based on a hematological and a molecular analysis of 310 heterozygous beta thalassemic and 75 carriers of Hb Lepore out of 3,000 microcythemic subjects from the Campania region of Italy. The molecular analysis of beta chains and the deltabeta hybrid gene has shown different beta chain defects, but only the Hb Lepore-Boston-Washington type in association with haplotypes I and V. The prevalence and distribution of these molecular defects in Campania show that they are linked to historical events and to the geographical characteristics of this region.

Slow eye movements and EEG power spectra during wake-sleep transition

OBJECTIVE

The aim of the present study was to assess the relationship between slow eye movements (SEMs) and quantitative EEG measures during the wake-sleep transition.

METHODS

Individual distributions were aligned with respect to the onset of stage 2 to provide an unequivocal hallmark of the beginning of sleep and to reduce the sources of variability in this transition. The relationship between EEG spectral powers and EOG changes was assessed by means of product-moment correlations and bootstrap analyses for individual time series, and by means of a multiple regression analysis for the entire sample.

RESULTS

Results on the individual distributions as well as on averaged data showed a tight relationship between SEMs and EEG changes, negative across the 1-14 Hz frequency range and positive across the 15-30 Hz one. Spectral power in the sigma EEG band, that corresponds to the frequency at the phasic sleep spindles, resulted as the best predictor of SEM variations, being negatively correlated to the EOG changes. With respect to the other EEG frequency bands, the split half of the distributions with respect to stage 2 onset indicated a positive correlation of delta power with the increase of SEM activity before sleep onset, and of beta power with the decrease of SEMs after sleep onset.

CONCLUSIONS

These results seem to suggest that sleep spindles could trigger the reduction and the final disappearance of slow eye movements in the late part of the wake-sleep transition.

Effect of slow-wave sleep deprivation on topographical distribution of spindles

Spindle activity, visually scored in the 12-15 Hz range over antero-posterior midline derivations, has been assessed in ten normal subjects during a baseline and a recovery sleep after 2 nights of selective slow-wave sleep (SWS) deprivation. The recovery sleep, characterized by a significant increase of stage 4 and SWS as compared to the baseline, revealed that sleep spindles are reduced in the first NREM sleep cycle. The size of this reduction in spindle density progressively decreased in the course of the night, paralleling the depletion of SWS rebound. Topographical distribution of spindle activity showed a global linear increase over consecutive NREM-REM sleep cycles, regarding to the whole antero-posterior midline EEG derivations except the occipital one. It is concluded that the SWS rebound after 2 nights of selective SWS deprivation is associated with a reduction of spindles during stage 2.

Oculomotor impairment after 1 night of total sleep deprivation: a dissociation between measures of speed and accuracy

OBJECTIVES

The present study examined the effects of 40 h of sleep deprivation and of time-of-day on saccadic and smooth pursuit oculomotor performance.

METHODS

Nine normal subjects slept for 3 consecutive nights in the laboratory (one adaptation, one baseline, one recovery). Baseline and recovery were separated by a period of 40 h of continuous wakefulness, during which subjects were tested every 2 h. Oculomotor performance assessed at the following hours: 10:00, 12:00, 14:00, 16:00, 18:00, 20:00, 22:00, of both the days preceding and following the sleep deprivation night, as well as at 24:00, 02:00, 04:00, 06:00 and 08:00 h during the deprivation period.

RESULTS

Saccade latency increased and peak velocity decreased significantly during the post-deprivation day; saccadic accuracy was unaffected. As regards smooth pursuit performance, phase (a measure of accuracy) was not affected by sleep loss, while velocity gain significantly decreased during the day that followed the sleep deprivation night. Significant time-of-day effects on the considered oculomotor variables except saccadic accuracy were also found, indicating an overall performance impairment during the night.

CONCLUSIONS

It is concluded that 40 h of sleep deprivation significantly impaired diurnal performance in pursuit and saccadic tasks. This performance worsening is limited to the measures of speed, while accuracy is not affected by sleep loss. A significant operational relevance of these results is suggested, since saccadic velocity has recently been found to be negatively correlated with simulator vehicle crash rates.

Amino acids control mammalian gene transcription: activating transcription factor 2 is essential for the amino acid responsiveness of the CHOP promoter

In mammals, plasma concentration of amino acids is affected by nutritional or pathological conditions. It has been well established that nutrients, and particularly amino acids, are involved in the control of gene expression. Here we examined the molecular mechanisms involved in the regulation of CHOP (a CCAAT/enhancer-binding protein [C/EBP]-related gene) expression upon amino acid limitation. We have previously shown that regulation of CHOP mRNA expression by amino acid concentration has both transcriptional and posttranscriptional components. We report the analysis of cis- and trans-acting elements involved in the transcriptional activation of the human CHOP gene by leucine starvation. Using a transient expression assay, we show that a cis-positive element is essential for amino acid regulation of the CHOP promoter. This sequence is the first described that can regulate a basal promoter in response to starvation for several individual amino acids and therefore can be called an amino acid response element (AARE). In addition, we show that the CHOP AARE is related to C/EBP and ATF/CRE binding sites and binds in vitro the activating transcription factor 2 (ATF-2) in starved and unstarved conditions. Using ATF-2-deficient mouse embryonic fibroblasts and an ATF-2-dominant negative mutant, we demonstrate that expression of this transcription factor is essential for the transcriptional activation of CHOP by leucine starvation. Altogether, these results suggest that ATF-2 may be a member of a cascade of molecular events by which the cellular concentration of amino acids can regulate mammalian gene expression.

Leucine limitation induces autophagy and activation of lysosome-dependent proteolysis in C2C12 myotubes through a mammalian target of rapamycin-independent signaling pathway

Loss of muscle mass usually characterizes different pathologies (sepsis, cancer, trauma) and also occurs during normal aging. One reason for muscle wasting relates to a decrease in food intake. This study addressed the role of leucine as a regulator of protein breakdown in mouse C2C12 myotubes and aimed to determine which cellular responses regulate the process. Determination of the rate of protein breakdown indicated that leucine is one key regulator of this process in myotubes because starvation for this amino acid is responsible for 30-40% of the total increase generated by total amino acid starvation. Leucine restriction rapidly accelerates the rate of protein breakdown (+11 to 15% (p < 0.001) after 1 h of starvation) in a dose-dependent manner. By using various inhibitors, evidence is provided that acceleration of protein catabolism results mainly from an induction of autophagy, activation of lysosome-dependent proteolysis, without modification of mRNA levels encoding the lysosomal cathepsins B, L, or D. Those results suggest that autophagy is an essential cellular response for increasing protein breakdown in muscle following food deprivation. Induction of autophagy precedes a decrease in global protein synthesis (-20% to -30% (p < 0.001)) that occurs after 3 h of leucine starvation. Inhibition of the mammalian target of rapamycin (mTOR) activity does not abolish the effect of leucine starvation and the level of phosphorylated ribosomal S6 protein is not affected by leucine withdrawal. These latter data provide clear evidence that the mTOR signaling pathway is not involved in the mediation of leucine effects on both protein synthesis and degradation in C2C12 myotubes.

The spontaneous K-complex during stage 2 sleep: is it the 'forerunner' of delta waves?

The hypothesis that K-complexes (KCs) contribute to the process of synchronization leading to Slow-Wave Sleep (SWS) was evaluated by measuring their dynamic evolution across sleep cycles and before transitions to rapid eye movement (REM) or to SWS. KC density and inter-KC intervals respectively decreased and increased across the sleep cycles, revealing linear trends. Comparisons among transitions from stage 2 to SWS or to REM sleep showed a prevalence of KCs before the shift to SWS as compared to REM. Changes in KC density before the shift to SWS were fitted by a linear regression, at variance with the transition to REM sleep. Intra-night variations of KCs, paralleling the well-known decrease of slow waves across sleep cycles, and intracycle variations before shifting to SWS, both converge to indicate that KCs can be considered as the forerunner of delta waves.

Primary diffuse malignant peritoneal mesothelioma: case report and update of therapy

BACKGROUND AND OBJECTIVES

Primary Diffuse Malignant Peritoneal Mesothelioma is a rare disease, with an incidence of 2.2 cases in 1. 000.000 in the USA. It occupies 10% of all mesotheliomas referred in literature.

METHODS

We describe a case of diffuse malignant peritoneal mesothelioma arising in a 54-year-old woman who presented a small bowel occlusion. A middle line laparotomy was done; multiple biopsies and an ileostomy were performed. There was not a history of exposure to asbestos. Histologic diagnosis was based on light microscopy, histochemistry, and immunohistochemistry.

RESULTS

Patient had no further treatment because of her poor general conditions. She died 4 months later.

CONCLUSIONS

Update of treatment is briefly described with particular attention to multimodality approach (surgery, chemotherapy, radiotherapy) and other new therapeutic options (iperthermochemotherapy, immunotherapy, gene therapy), currently in clinical trials.

The sleep inertia phenomenon during the sleep-wake transition: theoretical and operational issues

Sleep inertia (SI) defines a period of transitory hypovigilance, confusion, disorientation of behavior and impaired cognitive and sensory-motor performance that immediately follows awakening. SI, the cognitive and behavioral correlate of the transition from sleep to wakefulness, has been incorporated in several models of sleep and vigilance regulation. Monitoring of several physiological parameters during the awakening period clearly indicate that this transition process is very slow. On the cognitive and behavioral side, SI has relevant operational implications. SI is one of the most serious contraindications to the use of napping during quasi-continuous operations if the individual may be required to perform complex tasks immediately after sudden awakening at unpredictable times. The studies on SI modulating factors showed that SI is strongly affected by slow wave sleep amount and sleep depth, while the outcomes concerning the modulation of SI by circadian factors are not consistent. Cognitive tasks involving high attentional load seem to be much more affected by SI than simple motor ones, performance accuracy being more impaired than speed. Finally, some possible countermeasures against the detrimental effects of SI to be applied in operational settings have been provided.

The 1396del A mutation and a missense mutation or a rare polymorphism of the WRN gene detected in a French Werner family with a severe phenotype and a case of an unusual vulvar cancer. Mutations in brief no. 136. Online

The Werner's syndrome (WS) is a rare recessive disease characterized by an early onset of geriatric disorders. The Werner's syndrome gene (WRN) recently cloned, encodes for an helicase and therefore plays a role in DNA metabolism and DNA repair. Here, we report the study of a French family with two affected members and numerous cancers. Using the protein truncation test and sequencing, we identified a homozygous mutation in the WRN gene. This mutation generates a frame shift leading to a very short 391 amino acids truncated protein without the helicase motif. A particularly severe phenotype of the affected patient was associated with an unusual vulvar cancer traditionaly observed in elderly patients and therefore likely to be related to the Werner's syndrome. An additional substitution of G for A at nucleotidic position 1392 was also described. We suggest that a relation between genotype and phenotype could exist in the studied family.

Increased translation efficiency and antizyme-dependent stabilization of ornithine decarboxylase in amino acid-supplemented human colon adenocarcinoma cells, Caco-2

The mechanisms of the response of ornithine decarboxylase(ODC), the rate-limiting enzyme in polyamine biosynthesis, to amino acid supplementation were studied in the human colon adenocarcinoma cell line, Caco-2. Supplementation of serum-deprived, subconfluent Caco-2 cells with any one of a series of amino acids (10 mM) resultedin increased ODC activity, reaching a maximum of approx. 12.5-fold after approx. 4 h, over control cells either not supplemented or supplemented with iso-osmolar D-mannitol. Glycine, L-asparagine and L-serine, as well as their D-enantiomers, were the strongest effectors and acted in a concentration-dependent manner; millimolar concentrations of most of these amino acids being sufficient to significantly increase ODC activity. In contrast, supplementation with D-methionine, L-lysine, L-aspartate or L-glutamate had little or no effect on ODC activity, whereas supplemental L-methionine, L-arginine, L-ornithine or L-cysteine was inhibitory. Polyamine assays showed that the putrescine content of cells varied in accordance with the changes in ODC activity. Western-blot and Northern-blot analyses revealed specifically increased levels of ODC protein but not mRNA,respectively, in response to supplementation with an ODC-inducing amino acid. Suppression of the increase in cycloheximide-treated cellsconfirmed a requirement for protein synthesis. Pulse-labelling of cellswith [(35)S]methionine showed a 3-fold increase in thesynthesis of ODC protein after 4 h of supplementation with glycineor L-serine. Supplemental glycine also augmented, reversibly, the half-life of ODC by almost 4-fold and simultaneously decreased the activity of putrescine-induced free antizyme. These results suggest that translational, but not transcriptional, regulation of ODC takes part in ODC induction by amino acids in Caco-2 cells. However, it also appears to occur in concert with decreased enzyme in activation and/or degradation.

Effect of a presleep optokinetic stimulation on rapid eye movements during REM sleep

Some evidence supports the view point that phasic motor events of REM sleep show a complementary relation with the corresponding wake motor activities: (a) an inverse relationship between waking saccades and REM sleep eye movements (REMs) has been found with respect to frequency, amplitude, and direction; (b) an increase of middle-ear muscle activity (MEMA) in the 2 h before sleep causes a complementary decrease of MEMA during REM sleep. The present study evaluated this relation with respect to the optokinetic (OKN) system, assessing the role of automatically induced eye movements in affecting direction and frequency of REMs during sleep. Ten subjects were recorded following standard rules in 3 consecutive nights (one adaptation, one baseline, one experimental). In the experimental night subjects underwent 2 h presleep OKN stimulation at 15 degrees /s. The actual mean number of quick phases of nystagmus induced by the OKN stimulation was 12461.4 +/- 1.7 quick phases/s). No significant effect was found with regard to direction or frequency of REMs; the hypothesis that differences in REM direction and frequency could be modulated by the rank order of REM episodes (i.e., as a function of time elapsed from presleep stimulation) also failed to show any effect of a complementary relation between OKN and REMs. The results suggest that the complementary relation between wake and sleep eye movements is specific for the saccadic system, allowing us to exclude a peripheral mechanism, that is, an effect due to fatigue of extraocular muscles.

The relationship between frequency of rapid eye movements in REM sleep and SWS rebound

Previous studies have shown a decrease in rapid eye movement (REM) frequency during desynchronized sleep in recovery nights following total or partial sleep deprivation. This effect has been ascribed to an increase in sleep need or sleep depth consequent to sleep length manipulations. The aims of this study were to assess REM frequency variations in the recovery night after two consecutive nights of selective slow-wave sleep (SWS) deprivation, and to evaluate the relationships between REM frequency and SWS amount and auditory arousal thresholds (AAT), as an independent index of sleep depth. Ten normal males slept for six consecutive nights in the laboratory: one adaptation, two baseline, two selective SWS deprivation and one recovery night. SWS deprivation allowed us to set the SWS amount during both deprivation nights close to zero, without any shortening of total sleep time. In the ensuing recovery night a significant SWS rebound was found, accompanied by an increase in AAT. In addition, REM frequency decreased significantly compared with baseline. This effect cannot be attributed to a variation in prior sleep duration, since there was no sleep loss during the selective SWS deprivation nights. Stepwise regression also showed that the decrease in REM frequency is not correlated with the increase in AAT, the traditional index of sleep depth, but is correlated with SWS rebound.

Evidence for multiple signaling pathways in the regulation of gene expression by amino acids in human cell lines

In mammals, plasma concentrations of amino acids (AA) are affected by nutritional or pathologic conditions. Alterations in AA profiles have been reported as a result of a deficiency of any one of the essential AA, a dietary imbalance of AA or an insufficient intake of protein. In recent years, evidence has accumulated that AA availability regulates the expression of several genes involved in the regulation of a number of cellular functions or AA metabolism. Nevertheless, the molecular mechanisms involved in the AA regulation of mammalian gene expression are limited, particularly the signaling pathways mediating the AA response. This work provides a better understanding of the signaling pathways involved in the AA control of gene expression. We studied the expression of C/EBP homologous protein (CHOP) and asparagine synthetase (AS) in response to deprivation of a single AA and investigated the possible link between protein synthesis inhibition due to amino acid limitation and gene expression. We have shown the following: 1) several mechanisms are involved in the AA control of gene expression. When omitted from the culture medium, each AA can activate one (or several) specific signaling pathways leading to the regulation of one specific pattern of genes. 2) AA limitation by itself can induce gene expression independently of a cellular stress due to protein synthesis inhibition. Together, these results suggest that AA control of gene expression involves several specific mechanisms by which one AA (or one group of AA) can activate one signaling pathway and thus alter one specific pattern of gene expression.

Psychosocial factors and male seminal parameters

The relationships between (a) alexithymia, (b) extroversion (E), neuroticism (N), psychoticism (P), (c) coping style towards stressors, and seminal parameters, were assessed in 132 males on their first seminal fluid examination by means of a multivariate approach. They were given the TAS-20, the EPQ, and the Coping Inventory for Stressful Situations (CISS). Seminal parameters were: (1) sperm concentration; (2) total sperm count; (3) forward motility; (4) atypical forms. Multiple regressions considering quantitative parameters of seminal status as criterion showed a negative relationship with P, difficulty describing feelings (DDF), while a positive relationship was found for N, and emotion-oriented coping. A discriminant analysis also showed that P, N and DDF distinguished between two groups of normozoospermic and oligozoospermic subjects with a high probability of correct classifications. Results confirm the hypothesis that biological and psychological variables are not completely independent or randomly related in people with an impaired seminal status, although the correlations between psychosocial and biological data are not very strong.

[Gastric MALT lymphoma and Helicobacter pylori]

Aim of this paper is to evaluate the effects of eradicating Helicobacter pylori (Hp) on the course of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. A total of 13 consecutive patients, 7 males and 6 females (median age 54 years) Hp-positive were included, all affected by low-grade B-cell gastric MALT lymphoma, stage I using established criteria; histologic assessment by gastric biopsies was performed. Each patient received anti-Hp therapy with standard protocol for 7 days and underwent endoscopy and histology every 3-6 months. Complete eradication was obtained in all patients (100%); on histology 9 patients showed complete regression, but in one of these lymphoma relapsing after 12 months was observed. Our findings confirm recent cooperative reports of Hp eradication rate and regression of gastric tumour (about 70%). In conclusion, the indolent clinical course of the disease justifies a first-line conservative approach with Hp eradication therapy.

Time-course of sleep inertia upon awakening from nighttime sleep with different sleep homeostasis conditions

BACKGROUND

We assessed the time-course of sleep inertia during the first 75 min after morning awakening from regular nocturnal sleep, as well as from nighttime sleep episodes with altered sleep homeostasis conditions.

METHODS

Ten normal males slept for 6 nights in the laboratory: 1 adaptation (AD), 2 baseline (BSL, BSL-A), 2 selective Slow-Wave Sleep (SWS) deprivation (DEP-1, DEP-2), and 1 recovery night (REC). On morning awakening, performance was assessed by means of: a) Descending Subtraction Task (DST); b) Auditory Reaction Time task (ART); and c) Finger Tapping Task (FTT). The test battery, lasting about 13 min, was repeated for 5 times.

RESULTS

In regard to DST, the Correct Response ratio (CR/NR) showed a great increase of sleep inertia on the first testing session of REC. Regarding sleep inertia time-course, a significant linear decrease across the testing sessions during the BSL-A and the DEP-2 was present, whereas a significant quadratic trend during the AD, the DEP-1 and the REC was found. On the other hand, ART performance showed a significant quadratic trend across testing sessions, while FTT performance did not show any significant variation.

CONCLUSIONS

A uniform pattern of variation of time-course of sleep inertia as a function of the different sleep homeostasis conditions was not recognized. Performance accuracy (CR/NR) on the DST showed the hypothesized increasing linear trend across testing sessions only during 2 out of 6 nights, while the unexpected quadratic trend of ART performance is probably due to a fatigue effect. During sleep inertia, cognitive performance reached the baseline level about 30 min after awakening, while motor performance was still below the baseline levels 75 min after awakening. The finding that cognitive performance recovery is greater and more rapid than motor performance recovery could be very important for operational settings and in sustained operations.

Sleep deprivation and phasic activity of REM sleep: independence of middle-ear muscle activity from rapid eye movements

In the recovery nights after total and partial sleep deprivation there is a reduction of rapid eye movements during REM sleep as compared to baseline nights; recent evidence provided by a selective SWS deprivation study also shows that the highest percentage of variance of this reduction is explained by SWS rebound. The present study assesses whether the reduction of rapid eye movements (REMs) during the recovery night after total sleep deprivation is paralleled by a decrease of middle-ear muscle activity (MEMA), another phasic muscle activity of REM sleep. Standard polysomnography, MEMA and REMs of nine subjects were recorded for three nights (one adaptation, one baseline, one recovery); baseline and recovery night were separated by a period of 40 hours of continuous wake. Results show that, in the recovery night, sleep deprivation was effective in determining an increase of SWS amount and of the sleep efficiency index, and a decrease of stage 1, stage 2, intra-sleep wake, and NREM latencies, without affecting REM duration and latency. However, MEMA frequency during REM sleep did not diminish during these nights as compared to baseline ones, while there was a clear effect of REM frequency reduction. Results indicate an independence of phasic events of REM sleep, suggesting that the inverse relation between recovery sleep after sleep deprivation and REM frequency is not paralleled by a concomitant variation in MEMA frequency.

A complementary relationship between wake and REM sleep in the auditory system: a pre-sleep increase of middle-ear muscle activity (MEMA) causes a decrease of MEMA during sleep

Since some evidence has supported a complementary relationship between waking and REM-sleep eye movement (variations in frequency, amplitude, or direction of waking saccades have been found to inversely affect the corresponding parameters of rapid eye movements), the present study assessed whether this relationship can also be shown for other phasic components of REM sleep, such as middle-ear muscle activity (MEMA), as a consequence of an increase of middle-ear reflex frequency during pre-sleep wake. Ten subjects were studied in three consecutive nights (one adaptation, one baseline, one experimental). In the experimental night, subjects underwent a 2-h pure-tone (1000 Hz, 90 dB SPL) auditory stimulation and MEMA was monitored every 15 min; noise exposure during daytime was also controlled. Results show that MEMA frequency during REM sleep significantly decreased during the experimental nights compared with baseline nights, while each sleep variable as well as mean daily auditory input did not present any significant difference between baseline and experimental nights. Results suggest that the complementary relationship between wake and REM sleep is not bounded to oculomotor activity, but it may also be extended at least to middle-ear muscle phasic activity.

Auditory arousal thresholds after selective slow-wave sleep deprivation

OBJECTIVES

The aim of this study is to assess Auditory Arousal Thresholds (AATs) three times during an undisturbed baseline night and to compare them to AATs during the recovery night that follows two consecutive nights of selective SWS deprivation. The presence of a time-of-night effect on AATs will also be assessed.

METHODS

Ten male Ss slept in the laboratory for 6 consecutive nights. The first two nights were undisturbed. The 3rd night was considered as baseline. During the 4th and 5th nights, selective SWS deprivation was obtained by means of acoustic stimulation. The 6th night was a recovery. In the last 4 nights Ss were awakened three times, after 2, 5 and 7.5 h of sleep, respectively. All the awakenings were carried out from stage 2 (after at least 5 consecutive min of stage 2), by means of 1000 Hz ascending tone series. The AAT determination was based on EEG-EMG criteria: at least 10-s of clear alpha rhythm and/or a 10 s movement arousal.

RESULTS

During both deprivation nights, SWS amount was close to zero. In the ensuing recovery night a significant SWS rebound was found, accompanied by a significant increase of AATs with respect to the baseline. Furthermore, there was a significant linear decrease of AATs during the night. Finally, the individual correlations between AATs and SWS amount were significant in 4 out of 10 Ss.

CONCLUSIONS

These results confirm that AATs are a reliable index of sleep depth by showing that the SWS rebound following selective SWS deprivation is paralleled by a significant AAT enhancement. The experimental paradigm also allows us to claim that AATs show a decreasing linear trend during the night, having excluded any procedural bias. Finally, AATs can be directly related to SWS amount that preceded the awakening, although the individual correlations between AATs and SWS have to be considered with caution, given the high inter-subject variability and the small number of observations.

The effects of slow-wave sleep (SWS) deprivation and time of night on behavioral performance upon awakening

The aim of the present study is to evaluate the effects of selective SWS deprivation on the motor and sensory motor performance impairment immediately after awakening from nocturnal sleep at different times of the night. Ten normal males slept for 6 consecutive nights in the laboratory: one adaptation, two baseline, two selective SWS deprivation, and one recovery night. During the last 4 nights performance was assessed four times: (a) before sleep, as a baseline measure; (b) within 30 s from the first nighttime awakening, after 2 h of sleep; (c) within 30 s from the second nighttime awakening, after 5 h of sleep; (d) within 30 s from the final morning awakening. After each awakening, following a 3-min cognitive test, a simple Auditory Reaction Time task (ART, about 5 min) and a Finger Tapping Task (FTT, 3 min) were administered. Median of Reaction Times (RT) and of Intertapping Intervals (ITI), 10% fastest RT, 10% slowest RT, and number of misses were considered as dependent variables. The selective SWS deprivation was very effective: SWS percentage during both the deprivation nights was close to zero. This strong manipulation of SWS amount interacted with time-of-night factors in influencing sleep inertia. The SWS deprivation procedure caused a worsening of behavioral performance during the deprivation nights. as well as upon the final awakening of the recovery night. Behavioral performance slowing upon awakening is accounted for by: (1) a general decrement in overall response speed (median of RT); (2) an "optimum response shift", i.e., a decrease in speed of the fastest responses; (3) an increase of lapsing, with more marked response delays resulting in a further decrease in response speed in the "lapse domain". Finally, our results do not support the existence of a circadian rhythm of sleep inertia linked to body temperature rhythm.

Assessing nighttime vigilance through a three-letter cancellation task (3-LCT): effects of daytime sleep with temazepam or placebo

Nocturnal sleepiness is a common complaint suffered by night-shift workers, especially in conditions of an abrupt shift of the wake-sleep cycle. Alertness management strategies can minimize the adverse effects of sleep loss and circadian rhythm desynchronization and promote optimal vigilance in operational settings. Within these strategies. one possibility is to use short periods of "prophylactic sleep" (before long periods of work), which can be facilitated by hypnotics. Vigilance can be evaluated by means of several tests which, sometimes, imply procedures and devices not easily employable in operational settings. In such conditions pencil and paper tests of vigilance can be very useful in the assessment of attentional performance degradation due to sleep loss and/or inversion of the sleep-wake cycle. In this study we evaluated the sensitivity of a three-Letter Cancellation Task (3-LCT) in revealing nighttime variations of vigilance in a laboratory simulation of acute night shift, after a diurnal sleep with placebo (PLC) or temazepam (TMZ). Nocturnal levels of vigilance were also assessed using the Maintenance of Wakefulness Test (MWT) and the Multiple Sleep Latency Test (MSLT). All tests were administered four times at 2-h intervals during nighttime after a daytime sleep. Results show that the 3-LCT is sensitive to variations of vigilance occurring during a laboratory simulation of acute night shift. We also found some effects of TMZ, which in the first nocturnal session caused a slowing down of visuoattentive performance. Nocturnal variations of vigilance detected through the 3-LCT were similar to those revealed by means of MSLT, while the ability to maintain wakefulness was substantially spared during the night.

[Dermatofibrosarcoma protuberans: authors' experience]

Dermatofibrosarcoma protuberans is an uncommon slow-growing cutaneous neoplasm. Surgical excision is an effective therapeutic approach although a significant number of local recurrences has been documented in the literature. In the present paper the Authors report 3 cases of dermatofibrosarcoma protuberans. All cases have been surgically treated with a wide local excision extended up to 3 cm from the tumor borders. No local recurrence has been reported. The Authors conclude that the surgical technique employed could reduce the local recurrence rate of dermatofibrosarcoma protuberans.

Treatment of refractory metastatic breast cancer with 5-fluorouracil plus levofolinic acid as continuous venous infusion: a phase II study

Effective palliation of metastatic breast carcinoma (MBC) after the failure of front-line chemotherapy for advanced disease, often based on the use of anthracyclines and taxanes, is quite difficult to achieve due to the development of dominant neoplastic cellular clones highly resistant to further therapy. Therefore the therapeutic index of second and third line chemotherapeutic treatments is usually quite low. Thirty patients with MBC with progressive disease after anthracycline-based chemotherapy as first line therapy were treated with l-FA 100 mg/m2/day and 5FU 1000 mg/m2/day ad continuous venous infusion for 96 hours every 4 weeks. Most patients (60%) had multiple sites of disease at entry and had visceral lesions as the dominant site of disease. Twenty-eight patients were evaluated for objective response: two patients had clinically progressive disease before restaging after the third cycle of chemotherapy. These patients were considered progressive disease since all patients were included in an intent-to-treat analysis. Nine patients achieved partial response for an overall response rate of 30% (intent-to-treat analysis) with a median duration of 9.5+ months (range 4.0/14.0 months), and disease stability was obtained in 10 cases (33%) with a median duration of 5.5 months (5-11). Progressive disease was recorded in 9 patients. After a median follow-up of 11 months, the overall median survival time of the whole series of patients was 14.0+ months. Objective responses were recorded both at visceral and bone sites. Chemotherapeutic treatment was generally quite well tolerated. No toxic deaths were recorded. Among gastrointestinal side-effects grade 3 stomatitis was noted in 30% of patients, and grade 3 diarrhea in 10% of cases. Grade 3-4 leukopenia was observed in 23% of patients, but significant episodes of febrile neutropenia were limited (2 patients). Grade 3 thrombocytopenia was seen only occasionally in 1 patient. Grade 1 anemia was recorded in 10% of patients. Hand-foot syndrome was noted in 2 patients (7%). Cardiotoxicity was minimal. The combination of 5FU and high-dose I-FA given as 96 hour continuous venous infusion was active, at least in terms of the overall response rate, against anthracycline refractory metastatic breast carcinoma. These results compare favourably with bolus 5FU/FA or other salvage regimens in terms of antineoplastic activity, and is well tolerated both subjectively and objectively by most patients.

Treatment of refractory metastatic breast cancer with 5-fluorouracil and levofolinic acid as 48 hours continuous venous infusion

Twenty-four consecutive patients with metastatic breast carcinoma (MBC) refractory to first line chemotherapy were treated with high-dose folinic acid (FA) 100 mg/m2 diluted in 250 cc of normal saline as 2 hour infusion followed by 5-fluorouracil (5FU) 400 mg/m2 bolus then 5FU 600 mg/m2 as continuous infusion for 22 hours. This therapy was repeated for 2 consecutive days. Chemotherapy was repeated every 15 days. All enrolled patients were evaluable for objective response. A complete response was achieved in 1 patient (4%) and a partial response in 6 cases (25%) for an overall response rate of 29% (confidence limits 18%-39%). The median duration of objective responses was 8.4+ months (range 3.0+/12.8). Six patients showed no change (25%) with a median duration of 4.0 months 11 patients progressed (46%). A subjective improvement in tumor-related symptoms was reported by all responding patients and in 3 patients with no change. Most patients (7/10) with symptomatic bone lesions had a subjective improvement with reduction in analgesic drugs consumption. Objective responses were observed at all sites of disease. In fact, responses were seen in the skin liver lung bore and rodal metastases. The median overall survival was 13.0+ months (range 4.0/16.2+). Over a total of 160 cycles (a mean of 6.6 cycles/patient) grade 1-2 leukopenia was seen in 9 patients (37%) grade 1 thrombocytopenia in 4 patients (17%) and grade 1 anemia in only 2 cases (8%). Grade 3-4 leukopenia or thrombocytopenia were not seen. Phlebitis at the injection vein occurred in 3/10 patients (30%) which refused to implant a central line. In patients with a central line or a port-a-cath no cases of vascular, toxicity were seen. Gastrointestinal toxicity was very mild with 9 patients (37%) suffering from grade 1-2 nausea/vomiting 6 patients (25%) complaining of grade 1-2 diarrhea and 6 patients with grade 1-2 stomatitis. Hand-foot syndrome was observed in only 1 patient. No cases of grade 3-4 gastrointestinal toxicities have been, observed. No cases of cardiotoxicity and/or neurotoxicity were recorded. The combination of high-dose FA and 5FU given as 48 hour continuous venous infusion every 2 weeks is active, at least in terms of objective response rate and tumor-related symptoms palliation against anthracycline-refractory MBC. These results compare favorably with bolus administration of FA and 5FU or other salvage regimens.

The Edinburgh Postnatal Depression Scale: validation for an Italian sample

A sample of 113 women has been recruited for the Italian validation of Edinburgh Post Natal Depression Scale (EPDS). These women, between the eighth and the twelfth week after delivery, were admnistered the EPDS and diagnosed according the DSM-III-R criteria using the MINI Interview. At the 8/9 cut-off score the sensitivity is 94.4%, specificity 87.4% and PPV 58.6%. The internal consistency of the EPDS Italian version was tested using Chronbach's alpha coefficient (0.7894) and Guttman split-half coefficient (0.8191). Finally a receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale: the area under ROC curve AUC is 0.7470 and the logistic estimate for the threshold score of 11/12 fitted the model sensitivity at 75% and model specificity at 67%. Our data confirm the validity of EPDS in identifying postnatal depression also in its Italian version and the scale could be used as an useful instrument in the clinical practice.

Amino acid limitation regulates CHOP expression through a specific pathway independent of the unfolded protein response

The gene encoding CHOP (C/EBP-homologous protein) is transcriptionally activated by many stimuli and by amino acid deprivation. CHOP induction was considered to be due to an accumulation of unfolded protein into the ER (unfolded protein response (UPR)). We investigate the role of the UPR in the induction of CHOP by amino acid deprivation and show that this induction is not correlated with BiP expression (an UPR marker). Moreover, amino acid deprivation and UPR inducers regulate the CHOP promoter activity using distinct cis elements. We conclude that amino acid deprivation does not activate the UPR and regulates CHOP expression through a pathway that is independent of the UPR.

Antizyme-dependent and -independent mechanisms are responsible for increased spermidine transport in amino acid-restricted human cancer cells

Amino acid deprivation can inhibit tumour cell proliferation. Since polyamines are required for cell growth, we hypothesised that their regulatory pathways can respond to amino acid restriction. We report here that exposure of human colon adenocarcinoma Caco-2 cells to a medium restricted for a single amino acid, but not for D-glucose, activates spermidine transport. The increase was rapid and seemed transient with a maximum 4-6 hr after amino acid removal. Kinetics showed that the maximal velocity of transport was solely increased in L-methionine- or L-leucine-deprived cells, indicating increased number of transporters. The intracellular level of complex of ornithine decarboxylase (ODC) with antizyme, a negative regulator of polyamine transport, was decreased by 16-29% in amino acid-deprived cells. However, exposure to limited amounts of amino acid increased transport without altering the ODC-antizyme complex level. We propose that antizyme-independent mechanisms, sensitive to the amino acid concentration, also participate to the control of spermidine transport.