Heart Rate Variability and Respiratory Sinus Arrhythmia Assessment of Affective States by Bivariate Autoregressive Spectral Analysis

The study of emotions elicited by human-computer interactions is a promising field that could lead to the identification of specific patterns of affective states. We present a heart rate variability (HRV) assessment of the autonomic nervous system (ANS) response and respiratory sinus arrhythmia during PC-mediated stimuli by means of standard and multivariate autoregressive spectral methods. 35 healthy volunteers were exposed to computer-mediated tasks during data collection. The stimuli were designed to elicit: relaxation (R), engagement (E) and stress (S); half of the subjects were exposed to E before S (RES) while the other to S before E (RSE). HRV measures clearly separate the ANS response among R, S and E. Less significant differences are found between E and S in RSE, suggesting that S stimuli may cause a lasting response affecting the E period. Results from the bivariate analysis indicate a disruption of the cardio-respiratory coupling during non-relax conditions.

Feto-placental atherosclerotic lesions in intrauterine fetal demise: role of parental cigarette smoking

The atherogenic effect of cigarette smoking is already recognizable in coronary arteries of fetuses in the last gestational weeks. In this study we analyzed the atherogenic effect of mother's and father's smoking habit on coronary arteries and even on adnexa of 30 human fresh fetuses died from 32 to 41 gestational weeks. In 12 cases only the mothers of the victims were cigarette smokers, in 7 cases only the fathers were smokers, whereas in 11 cases nobody smoked.We observed pre-atherosclerotic and initial atherosclerotic lesions of the adnexa in 21 cases, of which 11 cases had only mother smokers and 6 cases only father smokers. The atherogenic effect is statistically significant in both smoker groups, but stronger in maternal one. The atherosclerotic lesions found in umbilical and placental arteries are similar to those described in fetal coronary arteries: thickening of the arterial walls caused by proliferation and migration of the smooth muscle cells of the tunica media with loss of polarity and infiltration of the subendothelial connective tissue.

The Predictive Role of Anxiety Disorders on Depressive Phenomenology During Post-partum Period

Aims:

To investigate the predictive role of any specific (DSM-IV) Anxiety Disorders (AD) on depressive symptoms and Major or Minor Depressive Disorder (MDD, mDD) during early postpartum period.

Method:

Women (at the 12th-15th gestational week, N=1066) were recruited in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)". Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), and Axis-I disorders (AD, MDD, mDD) were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I).

Results:

Any current AD at baseline (3rd month of pregnancy) was detected in 231 (21.7%). Having at least one current AD, was associated with a greater likelihood of having MDD or mDD during the early postpartum period, even after the adjustment for the confounding factor of having a lifetime history of MDD (RR=3.86 95%CI 1.58-9.42).

In particular, women affected by Obsessive Compulsive Disorder (N=17; 1.6%) or Panic Disorder (N=43; 4%) had at higher risk to develop depressive symptoms (EPDS≥13) during the postpartum period than women without these AD (RR=6.9 and 6.7 respectively). As for the risk of developing PPD, the strongest association was found for women with Panic Disorder (RR=7.6 95% CI 2.62-22.0).

Conclusions:

AD are associated with a greater likelihood to develop depressive symptoms and MDD or mDD during the early postpartum period. Women with current PD have the strongest risk to develop both MDD or mDD and depressive symptoms during early postpartum period compared to other anxiety disorders.

The structure of lifetime panic-agoraphobic spectrum

The heterogeneity of the clinical presentation of panic disorder (PD) has prompted researchers to describe different subtypes of PD, on the basis of the observed predominant symptoms constellation. Starting from a dimensional approach to panic disorder, an instrument to assess lifetime panic-agoraphobic spectrum (PAS) available in interview or self-report form (SCI-PAS, PAS-SR) was developed which proved to have sound psychometric properties and the ability to predict delayed response to treatment in patients with mood disorders. However, the structure of the instrument was defined a priori and an examination of its empirical structure is still lacking. Aim of the present report is to analyse the factor structure of the PAS taking advantage of a large database of subjects with panic disorders (N=630) assessed in the framework of different studies. Using a classical exploratory factor analysis based on a tetrachoric correlation matrix and oblique rotation, 10 factors were extracted, accounting overall for 66.3% of the variance of the questionnaire: panic symptoms, agoraphobia, claustrophobia, separation anxiety, fear of losing control, drug sensitivity and phobia, medical reassurance, rescue object, loss sensitivity, reassurance from family members. The first two factors comprise the DSM-IV criteria for panic disorder and agoraphobia. The other factors had received limited empirical support to date. We submit that these symptoms profiles might be clinically relevant for tailoring drug treatments or psychotherapeutic approaches to specific needs. Future perspectives might include the use of these factors to select homogeneous subgroups of patients for brain-imaging studies and to contribute to elucidating the causes and pathophysiology of panic disorder at molecular level.

The predictive Role of Anxiety Disorders on Depressive Phenomenology During Post-partum Period

Aims:

To investigate the predictive role of any specific (DSM-IV) Anxiety Disorders (AD) on depressive symptoms and Major or Minor Depressive Disorder (MDD, mDD) during early postpartum period.

Method:

Women (at the 12th-15th gestational week, N=1066) were recruited in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)’. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), and Axis-I disorders (AD, MDD, mDD) were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I).

Results:

Any current AD at baseline (3rd month of pregnancy) was detected in 231 (21.7%). Having at least one current AD, was associated with a greater likelihood of having MDD or mDD during the early postpartum period, even after the adjustment for the confounding factor of having a lifetime history of MDD (RR=3.86 95%CI 1.58-9.42).

In particular, women affected by Obsessive Compulsive Disorder (N=17; 1.6%) or Panic Disorder (N=43; 4%) had at higher risk to develop depressive symptoms (EPDS≥13) during the postpartum period than women without these AD (RR=6.9 and 6.7 respectively). As for the risk of developing PPD, the strongest association was found for women with Panic Disorder (RR=7.6 95% CI 2.62-22.0).

Conclusions:

AD are associated with a greater likelihood to develop depressive symptoms and MDD or mDD during the early postpartum period. Women with current PD have the strongest risk to develop both MDD or mDD and depressive symptoms during early postpartum period compared to other anxiety disorders.

Hormone assays: some aspects that endocrinologists should know

Since the pioneering works of Yalow and Berson that introduced radioimmunoassays (RIA), hormone assays have been developed gradually, with improvements in all aspects of their design, from immunoradiometric assays to automatization. Examples of this evolution are the thyrotropin (TSH) and parathyroid (PTH) assays. Despite the strong accuracy and reliability of currently used hormone assays, some limitations should be reviewed, such as interference by autoantibodies, heterophile antibodies or macroprolactin and the hook effect.

Spin-diffusion NMR at low field for the study of multiphase solids

The use of spin-diffusion NMR for the measurement of domain sizes in multiphase materials is becoming increasingly popular, in particular for the study of heterogeneous polymers. Under conditions where T(1) relaxation can be neglected, which is mostly the case at high field, analytical and approximate solutions to the evolution of spin diffusion are available. In order to extend the technique to more general conditions, we performed a comprehensive study of the diffusion of magnetization in a model copolymer at low field, where T(1) tends to be of the same order of magnitude as the typical spin-diffusion time. In order to study the effects of T(1) and to delineate the optimal T(1) values for back correction prior to applying the initial-rate approximation, we developed a numerical simulation based on the diffusion equation and including longitudinal relaxation. We present and discuss the limits of simple correction strategies for initial-slope analysis based on apparent relaxation times from saturation-recovery experiments or the spin-diffusion experiments themselves. Our best strategy faithfully reproduces domain sizes obtained by both TEM investigations and full simultaneous fitting of spin-diffusion and saturation-recovery curves. Full fitting of such independent data sets not only yields correct domain sizes, but also the true longitudinal relaxation times, as well as spin-diffusion coefficients. Effects of interphases with distinct mobility on spin-diffusion curves, as well as practical hints concerning the reliable component decomposition of the detected low-resolution FID signal by help of different magnetization filters are also discussed in detail.

Quality of life and clinical characteristics of patients with generalized and performance-focused social anxiety disorder: An Italian study

Introduction. The aim of this study is to investigate quality of life (QoL) and clinical characteristics of generalized (GSAD) and performance-focused social anxiety disorder (PFSAD). Method. Our sample includes 41 outpatients with social anxiety disorder and 100 control subjects. QoL was assessed using the Quality of Life and Enjoyment questionnaire. Assessments included the MINI Neuropsychiatric Interview, the Symptom Checklist, the Work and Social Adjustment Scale and the Clinical Global Impression Scale (CGI). Using the Liebowitz social anxiety scale, patients were divided into GSAD and PFSAD. Results. QoL of subjects with GSAD was lower than in controls in most areas, while only the areas of physical health and leisure time were impaired in patients with PFSAD. Patients with GSAD were more likely to be depressed, to meet criteria for substance abuse, to have higher severity scores on the CGI and the SCL-90 compared to PFSAD. Conclusions. GSAD is associated with widespread worsening of QoL, while patients with PFSAD had a poorer QoL than controls only in the areas of physical health and leisure time.

Recolonization and recovery dynamics of the macrozoobenthos after sand extraction in relict sand bottoms of the Northern Adriatic Sea

The long-term effects of sand extraction on macrozoobenthic communities were investigated in an offshore area in the Northern Adriatic Sea characterised by relict sands formed during the last Adriatic post-glacial transgression. Surveys were carried out before, during and 1, 6, 12, 18, 24 and 30 months after extraction at three impacted and seven reference stations. The operations did not influence the physical characteristics of the sediment, but they caused almost complete defaunation at dredged sites. Univariate and multivariate analyses highlighted that the macrozoobenthic community responses to the dredging operations were (1) a rapid initial recolonisation phase by the dominant taxa present before dredging, which took place 6-12 months after sand extraction; (2) a slower recovery phase, that ended 30 months after the operations, when the composition and structure of the communities were similar in the dredged and reference areas. This pattern of recolonisation-recovery fits well with the commonly encountered scenario where the substratum merely remains unchanged after marine aggregate extraction.

[Occupational relevance of alcohol related neurological involvement]

BACKGROUND AND OBJECTIVES

Accidents and various degrees of impairment in working performances and abilities are strongly correlated to alcohol consumption, either of moderate or of severe degree. Accidents, in particular, have been investigated in population studies that strongly suggest a direct effect of alcohol on attention and executive functions as well as a relevant interference of drinking with the neurological functioning and with eventual subclinical dysfunction of individuals: epilepsy threshold, cardiovascular risk and previous events, sleep disorders; post-traumatic sequelae.

DISCUSSION AND CONCLUSIONS

Impairment of cognitive function (and concomitant functional/structural brain damage) is characterized, in particular, by difficulties in abstract problem solving, visuo-spatial and verbal learning, memory function, perceptual and motor skills, related to disruption of frontal, pontocerebellar and cerebellothalamocortical systems. These abilities should therefore be monitored in at-risk working populations in order to prevent work accidents and to address appropriate therapeutic and rehabilitative interventions.

[Tetanus treated with continuous baclofen intrathecal perfusion]

After making a bibliographic search in our country and demonstrating the lack of original articles or communications on treatment with intrathecal baclofen for the generalized forms of tetanus, our objective is to present this treatment based on the successful experience of one clinical case. In relationship to the case, we review baclofen pharmacokinetic and pharmacodynamic effects and its possible utility in the treatment of tetanus.

Bioaccumulation and biomarker responses of trace metals and micro-organic pollutants in mussels and fish from the Lagoon of Venice, Italy

The aims of this study were to evaluate levels and effects of trace metals (Cd, Cr, Cu, Fe, Mn, Pb, Zn), PAHs and PCBs in mussels and fish native to the Lagoon of Venice. To this end, bioaccumulation and various biomarkers of generic stress and exposure (malondialdehyde, MDA and metallothioneins, MT; ethoxyresorufin O-deethylase activity, EROD; fluorescent bile metabolites and somatic indices in fish; lysosomal membrane stability, LMS; lipofuscins, LF; neutral lipids, NL and survival-in-air, SOS in mussels) were measured in organisms seasonally collected from two differently influenced areas. In mussels, metal bioaccumulation levels at the two sites were low and fluctuated similarly, exhibiting decreasing levels in summer, like MDA and MT. Micro-organic pollutants and the probably related biological response of LMS did not show either significant site differences or seasonal trends. LF and NL revealed inconclusive patterns. The results of the survival-in-air test were quite erratic, showing that they were associated with the high variability of both natural and physiological parameters temperature, food, reproduction, and body reserve cycle. In fish, both inorganic and organic micropollutant levels were low, and differences were detected between sites only for PCBs. The pattern exhibited by micro-organic contaminants was clearly related to the reproductive cycle at both sites; a relationship with PCBs, EROD and MDA was established at the site where their levels were generally higher. Bile metabolites (3-OH benzo(a)pyrene, 1-OH pyrene) were associated with PAH contents.

Outcome of pregnancy in a hypothyroid woman with resistance to thyroid hormone treated with triiodothyronine

Epidemiological and research data have shown the significant role of maternal thyroid hormone in fetal neurologic development. It has been suggested that maternal hypothyroxinemia is potentially damaging for the neurodevelopment of the fetus, independently of T3 levels. We present a pregnant woman with resistance to thyroid hormone and iatrogenic hypothyroidism who was treated with triiodothyronine during the whole pregnancy. Even though maternal hypothyroxinemia was severe the children showed a normal neuropsychological development.

Amisulpride in the treatment of behavioural disturbances among patients with moderate to severe Alzheimer's disease

OBJECTIVE

The aim of this article was to evaluate the effects of amisulpride on the behavioural and psychiatric symptoms of patients with Alzheimer's disease (AD).

MATERIALS AND METHODS

In this open-label study, we observed 18 outpatients affected by moderate to severe AD, complicated with agitation and disruptive behaviours. Behavioural, cognitive and motor effects of amisulpride at baseline and after 12 weeks were rated by the Neuropsychiatric Inventory (NPI), Mini Mental State Examination, Clinical Dementia Rating Scale, activities of daily living, and the motor score of the Unified Parkinson's Disease Rating Scale.

RESULTS

After treatment with amisulpride (200 mg/day), the patients showed a significant decrease in NPI total scores, particularly for the subitem 'agitation'. Cognitive and motor variables did not worsen significantly over the 12-week period.

CONCLUSIONS

This preliminary observation suggests that amisulpride can be useful to control agitation and disruptive behaviours in AD patients without significantly effecting vigilance and motor activity.

The management of headaches in the emergency department: critical issues

Typical cases of the most common kinds of headache can be diagnosed and treated by general practitioners (GPs). Non-traumatic patients with de novo acute sudden-onset disabling headaches as well as significant worsening of pre-existing headaches seek care at emergency departments (EDs) and represent a diagnostic challenge for the consultant neurologist, who is the specialist of reference for the entire diagnostic process. Explicit diagnostic criteria for the classification of headache disorders (ICHD-II) are fundamental for verifying the final diagnosis, but in the emergency setting diagnostic and therapeutic guidelines and recommendations, coupled with lists of diagnostic alarms and warnings, may further contribute to the preliminary identification of secondary headaches.

Acute encephalopathies

In daily hospital activity a frequent observation is that of patients in conditions of acute global suffering of the central nervous system due to a primary cause or symptomatic of other diseases. This condition shows an alteration of the state of consciousness, which involves three possible semeiologic manifestations: delirium (acute confusional state), acute confusional state associated with psychomotor underactivity and coma. The possible causes of an acute encephalopathy (AE) are: metabolic, iatrogenic and toxic, infective, primary neurologic, surgery-related and others. Diagnostic-therapeutic routes to be followed by emergency room doctors and neurologists dealing with AE are defined.

Determinación de cortisol salival en el diagnóstico de la enfermedad de Cushing pediátrico

Endogenous Cushing's syndrome in children is a very rare entity. Diagnosis is complex due to the wide variety of tests available. Recently, the utility of salivary cortisol has been proposed for the diagnosis of this entity, although greater evidence is required, especially in pediatric patients. We report a 14-year-old girl with Cushing's disease due to a pituitary microadenoma in whom salivary cortisol determination was very useful for the diagnosis.