Patient's proprioceptive remnants in nipple reconstruction planning

OBJECTIVE

The aim of this study is to demonstrate that for patients undergoing mastectomy the use of the proprioceptive memory represents a valid method to identify the perfect position of the nipple, which will be reconstructed on an operated breast.

PATIENTS AND METHODS

Fifty-one patients undergoing breast reconstruction after unilateral Modified Radical Mastectomy or unilateral Skin Sparing Mastectomy were included in the study. All patients were asked to identify, while keeping their eyes closed, the mammary segment where they perceived their nipples, both on the reconstructed breast mound and on the contralateral breast. Sternal Notch-to-nipple distance (SN), Nipple-to-inframammary Fold distance (NF), Midclavicular line-to-nipple distance (CN), the distance from the nipple to the chest Midline (NM), Anterior Axillary line-to-nipple distance (ZN) were measured on both breasts. The ideal position of the nipple to be reconstructed was evaluated using a geometric method based on the Pythagorean Theorem.

RESULTS

A statistically significant correlation emerges between the distances measured from the anatomical landmarks of the chest to the point coinciding with the patient's perception of the nipple on the reconstructed breast, and the distances measured from the same chest landmarks to the nipple on the contralateral native breast and to the nipple placed in the ideal position assessed with the geometric method.

CONCLUSIONS

The patient's proprioceptive memory of the nipple position can be useful to identify the exact place to reconstruct the nipple in breast reconstruction.

Investigation of WO3 Electrodeposition Leading to Nanostructured Thin Films

Nanostructured WO₃ represents a promising material for electrochromic and sensing devices. In this scenario, electrodeposition is a promising low-cost approach for careful production. The electrodeposition of tungsten oxide film from a peroxo-tungstic-acid (PTA) solution is investigated. WO₃ is synthetized onto Indium doped Tin Oxide (ITO) substrates, in a variety of shapes, from a fragmentary, thin layer up to a thick continuous film. Samples were investigated by scanning electron (SEM) and atomic force microscopy (AFM), Rutherford backscattering spectrometry (RBS), X-ray Diffraction analysis (XRD), energy gap measurement. Electrodeposition current curves are compared with characterization results to model the growth process. Early stages of electrodeposition are characterized by a transient cathodic current revealing an instantaneous nucleation followed by a diffusion limited process. A quantitative analysis of W deposition rate and current at working electrode validates a microscopic model for WO₃ electrodeposition driving the process towards nanostructured versus continuous WO₃ film.

Rest-activity rhythm in breast cancer survivors: an update based on non-parametric indices

Recently we evaluated by actigraphy the rest-activity circadian rhythm (RAR) in breast cancer (BC) survivors at 5 years from primary diagnosis, as well as in a control group with similar age and body mass index (BMI). RAR, analyzed by Cosinor method, resulted significantly different in BC survivors compared to healthy subjects: BC survivors showed lower values of MESOR and Amplitude (A), while acrophase (φ) was similar in the two groups. Now, using non-parametric methods we have detected Interdaily Stability (IS), Intradaily Variability (IV), nocturnal activity (L5), and daily activity (M10) on the same sample of previous study: 15 BC survivors at 5 years from the primary diagnosis (mean age = 56.7 ± 6.6 yrs; mean BMI = 24.5 ± 3.8 Kg/m²) and 13 healthy controls (mean age = 54.4 ± 7.2 yrs; mean BMI = 25.2 ± 2.8 Kg/m²). The non-parametric indices showed that in BC-group IV was significantly higher than in Ctrl-group (0.86 vs. 0.65 a.u. in BC and Ctrl, respectively; p <.01), while L5 (11.27 vs. 34.41 a.c. in BC and Ctrl, respectively; p <.0001) and M10 (326.82 vs. 428.07 a.c. in BC and Ctrl, respectively; p <.01) were significantly lower compared to Ctrl-group. The data suggest that BC patients need constant clinical assessment of RAR characteristics along the years following the primary diagnosis. The analysis of RAR in all its components, parametric and non-parametric, is important to detect alterations in the sleep-wake cycle and can be useful for developing new strategies for health protection, such as structured and tailored physical activity programs, to improve circadian activity level in order to raise the quality of life in BC survivors.

[Mobile seizure monitoring in epilepsy patients]

Wearables are receiving much attention from both epilepsy patients and treating physicians, for monitoring of seizure frequency and warning of seizures. They are also of interest for the detection of seizure-associated risks of patients, for differential diagnosis of rare seizure types and prediction of seizure-prone periods. Accelerometry, electromyography (EMG), heart rate and further autonomic parameters are recorded to capture clinical seizure manifestations. Currently, a clinical use to document nocturnal motor seizures is feasible. In this review the available devices, data on the performance in the documentation of seizures, current options for clinical use and developments in data analysis are presented and critically discussed.

Effect of chronotype on academic achievement in a sample of Italian University students

Circadian rhythms play an important role in biological function; their expression differs across individuals; three chronotypes are distinguished: Morning- [MT], Evening- [ET], and Neither- [NT] type. MT achieve peak activation in the first part of the day and are generally more conscientious and achievement-oriented than ET, which reach their best during the second half of the day and express a higher intelligence. University class schedules can sometimes conflict with ET circadian preferences, compromising their academic performance compared with their MT classmates. Conversely, MT students, being more aligned with their daily schedule, might be more advantaged in their mental performance. The attitudes and performance of NT students are little considered. No studies to date have investigated academic achievement in relation to chronotype in an Italian student population. To fill this gap, this study examined the relationship between chronotype and academic performance in a population of Motor Science Faculty in Milan, differentiating achievement in theoretical and practical subjects by chronotype. The study population was 423 university students (290 males and 133 females) and categorized by chronotype according to Morningness-Eveningness Questionnaire (MEQ) scores. Student transcripts were reviewed to obtain exam grades on three practical and three theoretical subjects. The interaction between MEQ score or chronotypes and mean exam grade was evaluated using one-way ANOVA. The mean grades on the theoretical and practical exams were higher for the MT than for either the ET or the NT students. The NT students (24.8 ± 0.1) had lower mean grades for the theoretical subjects than either the MT (26.3 ± 0.4) or the ET (25.3 ± 0.2) students, while the ET (26.6 ± 0.2) performed worse than either the MT (27.8 ± 0.2) or the NT students (26.9 ± 0.1) on the practical exams. The same trend was observed for the total sample and when subdivided by sex. In the total sample, significant differences in theoretical and practical exam grades were noted between chronotypes: MT vs ET (p < .002, p < .0006) and MT vs NT (p < .04, p < .003). The differences between the males were significant for the theoretical (p < .006, MT vs NT, p < .002) and the practical subjects (MT vs ET p < .004, MT vs NT, p < .01), but no significant differences were noted between the females. Our findings indicate overall better academic achievement by the MT students, whereas the NT had lower exam grades for the theoretical subjects and the ET performed worse on the practical exams. We speculate that the higher intelligence expressed by the ET students might have helped them compensate the disadvantage on the theoretical but not on practical exams, in which the effect of misalignment between circadian preferences and university class schedule was more evident.

Extracellular enzymatic activities of 32 fungal species

Se investigó en 32 especies fúngicas, la producción de enzimas extracelulares y ms determinaciones cualitativas (amilasa, celulosa, caseinasa, fosfatasa, lipasa, pectinasa y ureasa). La detección de los enzimas en los cultivos fúngicos en agar varió ampliamente.En la mayoría de los cultivos fúngicos se detectaron: amilasas, ureasas, y fosfatasas. Las celulosas se pesquizaron particularmente en cultivo de Aspergillus flavus, A. fumigatus, Cladosporium cladosporioides Penicillium brevicompactum, Rhizopus stolonifer, Scopulariopsis flava y Trichothecium roseum. Penicillium digitatum y P.duclauxi fueron productores de caseinasa en un alto grado. La actividad lipolítica se detectó en cultivos con grasas sintéticas tweens 20, 40, 60, y 80 como sustrato para lipasa. Indicaron actividad lipolítico para estos sustratos A. flavus, Aureobasidium pullulans, C. cladosporioides, Gliocladium roseum, Mycothypha microspora, Microsporum gypseum, P. brevicompactum y Scopulariopsis brumptii. Productores de pectinasas fueron las cepas de A. flavus, C. cladosporioides y Fusarium oxysporum, P. brevicompoctum y Ulocladium atrum

Nasal cytology as a screening tool in formaldehyde-exposed workers

Background

Workers in pathology and anatomy laboratories may be exposed to formaldehyde. An evaluation of the early effects of this substance is, therefore, paramount. This preliminary study was conducted to evaluate if nasal cytology could be used as a tool to detect changes in nasal mucosa in workers exposed to formaldehyde.

Aims

To assess whether nasal cytology was able to reveal any alteration of nasal mucosa in workers exposed to formaldehyde compared to unexposed subjects, and to ascertain whether a specific pattern of alterations correlated with years of exposure in order to evaluate long-term occupational exposure effects.

Methods

The study included a group of workers exposed to formaldehyde and a group of non-exposed workers. All subjects underwent clinical examination, followed by nasal cytology. Pathological indices from each rhinocytograms were compared between the two groups.

Results

Nasal cytology revealed a chronic inflammatory non-allergic condition in the exposed group. Qualitative analysis of data distribution of neutrophils and mucous-secreting/ciliated cells ratio showed data clustering with a cut-off set at 15 years of exposure. The mean formaldehyde concentrations ranged from <0.04 to 0.15 parts per million (ppm). The maximum levels of formaldehyde concentrations ranged from 0.2 to 0.67 ppm.

Conclusions

Our data indicate that nasal cytology may be a promising tool for the health surveillance of workers exposed to formaldehyde and may also represent a useful research tool for the study of the health effects of other chemicals irritants for the upper airways.

Role of the TAp63 Isoform in Recurrent Nasal Polyps

The pathogenic molecular mechanisms underlying the insurgence of nasal polyps has not been completely defined. In some patients, these lesions can have a recurrence after surgery removal, and the difference between recurrent and not recurrent patients is still unclear. To molecularly characterize and distinguish between these two classes, a cohort of patients affected by nasal polyposis was analysed. In all patients we analysed the p63 isoform expression using fresh tissues taken after surgery. Moreover, confocal immunofluorescence analysis of fixed sections was performed. The results show high ΔNp63 expression in samples from the nasal polyps of patients compared to the normal epithelia. Analysis of the expression level of the TAp63 isoform shows differential expression between the patients with recurrence compared to those not recurring. The data, considered as the ΔN/TAp63 ratio, really discriminate the two groups. In fact, even though ΔNp63 is expressed in non-recurrent patients, the resulting ratio ΔN/TAp63 is significantly lower in these patients. This clearly indicates that the status of TAp63 expression, represented by the ΔN/TAp63 ratio, could be considered a prognostic marker of low recurrence probability. In these samples we also investigated the expression of OTX2 transcription factor, known to be a selective activator of TAp63, detecting a significant correlation. Database analysis of HNSCC patients showed increased survival for the patients presenting OTX2 amplification and/or overexpression. These results, together with the fact that TAp63 can be selectively upregulated by HDAC inhibitors, open the possibility to consider local treatment of recurrent nasal polyps with these molecules.

Peripheral neuropathy in diabetes: it's not always what it looks like

BACKGROUND

Hereditary Neuropathy with liability to Pressure Palsies (HNPP) is an autosomal dominant neuropathy, associated with deletion of the Peripheral Myelin Protein-22 (PMP-22) gene, causing recurrent painless palsies with age of onset between 10 and 30 years old. Only a few cases of Type 2 Diabetes and HNPP have been described and the coexistence of HNPP and Type 1 diabetes has never been reported.

CASE REPORT

A 54-year old man with a history of Type 1 diabetes, managed with continuous subcutaneous insulin infusion (CSII), presented with deterioration of long-standing motor and sensory symptoms, previously attributed to golfer's elbow, diabetic neuropathy and spinal degenerative disease. He had multilevel severe spine degenerative changes and L4/L5 and L5/S1 root impingements with a L4/L5 discectomy performed when he was 25 years old. On physical examination he had normal power and distal hypoaesthesia of the digits and plantar aspect of the feet. Investigations revealed normal full blood count, liver and renal function, electrolytes, vitamin B12 and serum folate. He suffered from primary hypothyroidism and thyroid function tests indicated adequate levothyroxine replacement. Nerve conduction studies revealed a generalized demyelinating sensorimotor neuropathy, with more severe involvement of nerves over entrapment sites. Further history that his father suffered from episodes of weakness and numbness was elicited. Genetic analysis revealed one copy of the PMP22 gene at 17p11.2 confirming the diagnosis of HNPP.

CONCLUSION

In people with diabetes the evaluation of peripheral neuropathy should include a careful history, a comprehensive physical examination, blood tests and in some cases nerve conduction studies and genetic testing.

Enhanced sensitivity in non-enzymatic glucose detection by improved growth kinetics of Ni-based nanostructures

Ni-based nanostructures are attractive catalytic materials for many electrochemical applications, among which are non-enzymatic sensing, charge storage, and water splitting. In this work, we clarify the synthesis kinetics of Ni(OH)₂/NiOOH nanowalls grown by chemical bath deposition at room temperature and at 50 °C. We applied the results to non-enzymatic glucose sensing, reaching a highest sensitivity of 31 mA cm^-2mM^-1. Using scanning electron microscopy, x-ray diffraction analysis and Rutherford backscattering spectrometry we found that the growth occurs through two regimes: first, a quick random growth leading to disordered sheets of Ni oxy-hydroxide, followed by a slower growth of well-aligned sheets of Ni hydroxide. A high growth temperature (50 °C), leading mainly to well-aligned sheets, offers superior electrochemical properties in terms of charge storage, charge carrier transport and catalytic action, as confirmed by cyclic voltammetry and electrochemical impedance spectroscopy analyses. The reported results on the optimization and application of low-cost synthesis of these Ni-based nanostructures have a large potential for application in catalysis, (bio)sensing, and supercapacitors areas.

Rest-activity circadian rhythm and sleep quality in patients with binge eating disorder

Recent findings suggest that altered rest-activity circadian rhythms (RARs) are associated with a compromised health status. RARs abnormalities have been observed also in several pathological conditions, such as cardiovascular, neurological, and cancer diseases. Binge eating disorder (BED) is the most common eating disorder, with a prevalence of 3.5% in women and 2% in men. BED and its associate obesity and motor inactivity could induce RARs disruption and have negative consequences on health-related quality of life. However, the circadian RARs and sleep behavior in patients with BED has been so far assessed only by questionnaires. Therefore, the purpose of this study was to determine RARs and sleep parameters by actigraphy in patients with BED compared to a body mass index-matched control group (Ctrl). Sixteen participants (eight obese women with and eight obese women without BED diagnosis) were recruited to undergo 5-day monitoring period by actigraphy (MotionWatch 8®, CamNtech, Cambridge, UK) to evaluate RARs and sleep parameters. In order to determine the RARs, the actigraphic data were analyzed using the single cosinor method. The rhythmometric parameters of activity levels (MESOR, amplitude and acrophase) were then processed with the population mean cosinor. The Actiwatch Sleep Analysis Software (Cambridge Neurotecnology, Cambridge, UK) evaluated the sleep patterns. In each participant, we considered seven sleep parameters (sleep onset: S-on; sleep offset: S-off; sleep duration: SD; sleep latency: SL; movement and fragmentation index: MFI; immobility time: IT; sleep efficiency: SE) calculated over a period of five nights. The population mean cosinor applied to BED and Ctrl revealed the presence of a significant circadian rhythm in both groups (p < 0.001). The MESOR (170.0 vs 301.6 a.c., in BED and Ctrl, respectively; p < 0.01) and amplitude (157.66 vs 238.19 a.c., in BED and Ctrl, respectively p < 0.05) differed significantly between the two groups. Acrophase was not different between BED and Ctrl, as well as all sleep parameters. Both groups displayed a low level of sleep quality (SE 80.7% and 75.7% in BED and Ctrl, respectively). These data provided the first actigraphy-based evidence of RARs disruption and sleep behavior disorder in patients with BED. However, while sleep disorders could be reasonably ascribed to overweight/obesity and the related lower daily physical activity, RARs disruption in this pathology should be ascribed to factors other than reduced physical activity. The circadian timing approach can represent a novel potential tool in the treatment of patients with eating disorders. These data provide exploratory evidence of behavioral association in a small population of patients that, if confirmed in a wider number of subjects and across different populations, may lead to a revision and enhancement of interventions in BED patients.

Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study

BACKGROUND

Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common.

METHODS

A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation.

RESULTS

In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate.

CONCLUSION

In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.

GTest: a software tool for graphical assessment of empirical distributions' Gaussianity

In the present paper, the novel software GTest is introduced, designed for testing the normality of a user-specified empirical distribution. It has been implemented with two unusual characteristics; the first is the user option of selecting four different versions of the normality test, each of them suited to be applied to a specific dataset or goal, and the second is the inferential paradigm that informs the output of such tests: it is basically graphical and intrinsically self-explanatory. The concept of inference-by-eye is an emerging inferential approach which will find a successful application in the near future due to the growing need of widening the audience of users of statistical methods to people with informal statistical skills. For instance, the latest European regulation concerning environmental issues introduced strict protocols for data handling (data quality assurance, outliers detection, etc.) and information exchange (areal statistics, trend detection, etc.) between regional and central environmental agencies. Therefore, more and more frequently, laboratory and field technicians will be requested to utilize complex software applications for subjecting data coming from monitoring, surveying or laboratory activities to specific statistical analyses. Unfortunately, inferential statistics, which actually influence the decisional processes for the correct managing of environmental resources, are often implemented in a way which expresses its outcomes in a numerical form with brief comments in a strict statistical jargon (degrees of freedom, level of significance, accepted/rejected H0, etc.). Therefore, often, the interpretation of such outcomes is really difficult for people with poor statistical knowledge. In such framework, the paradigm of the visual inference can contribute to fill in such gap, providing outcomes in self-explanatory graphical forms with a brief comment in the common language. Actually, the difficulties experienced by colleagues and their request for an effective tool for addressing such difficulties motivated us in adopting the inference-by-eye paradigm and implementing an easy-to-use, quick and reliable statistical tool. GTest visualizes its outcomes as a modified version of the Q-Q plot. The application has been developed in Visual Basic for Applications (VBA) within MS Excel 2010, which demonstrated to have all the characteristics of robustness and reliability needed. GTest provides true graphical normality tests which are as reliable as any statistical quantitative approach but much easier to understand. The Q-Q plots have been integrated with the outlining of an acceptance region around the representation of the theoretical distribution, defined in accordance with the alpha level of significance and the data sample size. The test decision rule is the following: if the empirical scatterplot falls completely within the acceptance region, then it can be concluded that the empirical distribution fits the theoretical one at the given alpha level. A comprehensive case study has been carried out with simulated and real-world data in order to check the robustness and reliability of the software.

Nonvolatile memory effects in an orthoconic smectic liquid crystal mixture doped with polymer-capped gold nanoparticles

Promising applications of liquid crystal nanocomposites have driven extensive efforts to achieve non-volatile memory effects for the realization of electronic storage devices. In this context, non-volatile memory effects in an orthoconic smectic liquid crystal mixture, with and without polymer capped gold nanoparticles, were investigated. The dielectric spectroscopy technique was performed by applying a d.c. bias during the measurement or a d.c. potential before the start of the measurement in order to obtain pre-conditioning of the sample. Both techniques showed the presence of non-volatile memory effects in the pure orthoconic smectic liquid crystal mixture similar to the doped one. The results demonstrate that the addition of gold nanoparticles enhances the memory effect making it permanent. Our experimental evidence underlines the importance of the structure of the host liquid crystal and clearly suggests that the prolonged time memory effect, observed in the doped liquid crystal, is due to the electric field inducing charge transfer from the liquid crystal molecules to the gold nanoparticles, thanks to the polymer-capping which acts as an ionic charge trapper. Such an ionic trap effect is also responsible for strong reduction of total conductivity of the doped system.

Pathophysiology of neurally-mediated syncope

INTRODUCTION

Neurally-mediated syncope (NMS) is defined as a transient loss of consciousness due to an abrupt and intermittent drop in blood pressure (BP).

OBJECTIVES

This study describes the putative pathophysiological mechanisms giving rise to NMS, the role of baroreflex (BR), and the interaction of its main haemodynamic variables: heart rate (HR) and BP.

DEVELOPMENT

Episodic dysregulation affects control over the haemodynamic variables (HR and BP) mediated by baroreflex mechanisms. During active standing, individuals experience a profound transient drop in systolic BP due to the effect of gravity on the column of blood and probably also because of reflex vasodilation. Abnormalities in the BR in NMS could be due to a more profound drop in BP upon standing, or to delayed or incomplete vasoconstriction resulting from inhibited or delayed sympathetic activity.

CONCLUSIONS

Sympathetic hyperactivity is present in patients with NMS at rest and before syncope. During active standing or passive tilting, excessive tachycardia may be followed by bradycardia and profound hypotension. Recovery of systolic BP is delayed or incomplete.

Intranasal Administration of Hyaluronan as a Further Resource in Olfactory Performance in Multiple Chemical Sensitivity Syndrome

Multiple chemical sensitivity (MCS) is a relatively common clinical diagnosis in western populations and its symptoms (i.e. dysosmia) are mainly triggered by chemical compounds, such as common odorants. The aim of this study was to test the effect of intranasal administration of hyaluronic acid (HA) on odour threshold and related quality of life in MCS syndrome. Two randomized groups of MCS patients received 30 days' administration of either a nasal spray (Ialumar®) containing HA [HA group (HAG); n=29] or only physiological solution [PS group (PG); n=30]. Both groups were investigated using the “Sniffin' Sticks” test (SST) battery, Questionnaire of Olfactory Disorder (QOD) and Zung Anxiety Scale (SAS) before randomization and after treatment. Paired t-test analysis found a statistically significant reduction in odour threshold (OT) and an improvement in QOD and SAS between pre- and post-treatment results only in the HAG. Furthermore, positive correlations were found between the OT reduction, SAS and QOD improvement. Thus, intranasal administration of HA could be suggested as a further well-tolerated resource in alleviating MCS olfactory discomfort.

Extended point defects in crystalline materials: Ge and Si

B diffusion measurements are used to probe the basic nature of self-interstitial point defects in Ge. We find two distinct self-interstitial forms--a simple one with low entropy and a complex one with entropy ∼30  k at the migration saddle point. The latter dominates diffusion at high temperature. We propose that its structure is similar to that of an amorphous pocket--we name it a morph. Computational modeling suggests that morphs exist in both self-interstitial and vacancylike forms, and are crucial for diffusion and defect dynamics in Ge, Si, and probably many other crystalline solids.

Preventing weight gain during adjuvant chemotherapy for breast cancer: a dietary intervention study

Adjuvant chemotherapy significantly decreases recurrences and improves survival in women with early breast cancer (BC). However, the side effects of chemotherapy include weight gain, which is associated with poorer prognosis. We have previously demonstrated that by means of a comprehensive dietary modification which aims at lowering insulin levels it is possible to reduce body weight and decrease the bioavailability of insulin, sex hormones and the growth factors linked to BC risk and prognosis. We are now going to present a randomized controlled study of adjuvant diet in BC patients undergoing chemotherapy. The diet was designed to prevent weight gain during chemotherapy treatment. Women of any age, operated for invasive BC, scheduled for adjuvant chemotherapy and without evidence of distant metastases, were randomized into a dietary intervention group and a control group. The intervention implied changing their usual diet for the whole duration of chemotherapy, following cooking classes and having lunch or dinner at the study centre at least twice per week. 96 BC patients were included in the study. The women in the intervention group showed a significant reduction in their body weight (2.9 kg on average), compared with the controls. They also significantly reduced body fat mass, waist and hip circumferences, biceps, underscapular and suprailiac skinfolds, compared with the women in the control group. Our results support the hypothesis that dietary intervention during adjuvant chemotherapy for BC is feasible and may prevent weight gain.

Post-irradiation malignant fibrous histiocytoma of the larynx: A case report with an unusual metastatic spread pattern

We report a case of a laryngeal malignant fibrous histiocytoma (MFH) that showed an uncommon clinical behavior. This tumor occurred in a 70-year-old male patient 5 years after radiation treatment for laryngeal squamous cell carcinoma, and unusual metastases were spread unusually to the pleural cavity. The interval between the end of radiotherapy and the onset of MFH can be justified by the development of laryngeal stenosis by fibrotic tissue as a late complication of radiotherapy. Laryngeal fibrosis after radiotherapy probably triggered the MFH. Neither computed tomography nor magnetic resonance imaging differentiate between fibrotic tissue and MFH, and only repeated biopsy was definitive to give us the correct diagnosis.

Can the electronic nose diagnose chronic rhinosinusitis? A new experimental study

In otorhinolaryngologist's experience the nasal out-breath of people affected by chronic nasal or paranasal infections may be characterized by peculiar odours. In a previous study we showed that an electronic nose (EN), examining nasal out breath was able to distinguish subjects affected by chronic rhinosinusitis from healthy subjects. The present study is aimed at analysing the intensity and the quality of the odorous components present in the air expired by patients affected by rhinosinusitis, using a new EN based on gas-chromatography and surface acoustic wave analysis. In the gas-chromatographic tracings of the pathologic subjects there were six peaks, which were not present in control group cases. These peaks correspond to odorous components, whose chemical composition ranges from C6 to C14. Peaks obtained were compared with other tracings revealed from specific bacterial and fungal cultures analyses and we appreciated some analogies.

Experimental and clinical aspects of the efferent auditory system

The discovery of active mechanisms in the cochlea and the efferent auditory pathways from the brain to the cochlea demonstrated the existence of a modulation of the auditory input in the central nervous system (CNS). Otoacoustic emissions (OAEs) are weak signals that can be recorded in the ear canal and are considered a byproduct of an active process from the outer hair cells (OHCs) to the basilar membrane. The efferent auditory system plays an inhibitory role on the activity of OHCs; its stimulation reduces auditory nerve response, basilar membrane motility and OAEs amplitude. Indirect stimulation by contralateral sound is also inhibitory; a reduction of OAEs amplitude can be recorded and such an effect disappears after olivocochlear bundle section. The efferent system seems to play a role in detection of signals in noise, protection in noise-induced cochlear damage, development of hearing and processing of complex auditory signals. With respect to clinical application, OAEs suppression after contralateral auditory stimulation seems to be the only objective and non-invasive method for evaluation of the functional integrity of the medial efferent system, and, therefore, for evaluation of the structures lying along its course, at least up to the level of inferior colliculi.

Variations of Neck Structures after Supracricoid Partial Laryngectomy: A Multislice Computed Tomography Evaluation

BACKGROUND

Surgery of laryngeal cancer used to profoundly alter the anatomy of the cervical region. Accurate anatomo-embryologic studies and repeated surgical trials allowed recognition of the cricoarytenoid complex as the smallest anatomofunctional unit able to maintain all the laryngeal functions.

OBJECTIVES

The aim of this study was to determine whether significant variations of neck anatomical parameters exist after partial laryngectomy, and to analyze whether some of these parameters are associated with a positive functional outcome.

METHODS

Out of 48 patients treated with a surgical technique according to Mayer-Piquet (cricohyoidoepiglottopexy, CHEP) over a 6-year period, 18 patients were enrolled in the study. Patients were all males with a mean age of 60 years. Cervical structures and their relationships were measured by computed tomography, and the measurements before and after surgery were compared.

RESULTS

Our data showed that hyoid bone is modified, both in morphology and position during CHEP. More specifically the relation of the hyoid bone to other neck structures (identified by the alpha-angle) is modified. The neolarynx and trachea undergo a caudocranial shift. All diameters of the cricoid cartilage remain unchanged after surgery. The position of the epiglottis after CHEP, in particular its relation with the arytenoid cartilage, is closely related to swallowing function outcome and recovery time.

CONCLUSIONS

Our study showed that these structures, and more specifically the relations among them, undergo significant variations after CHEP. Our results identify some parameters, i.e. the alpha-angle, width of the hyoid bone and position of the epiglottis, that may predispose to a positive functional outcome after surgery.

Cellular labeling with Gd(III) chelates: only high thermodynamic stabilities prevent the cells acting as 'sponges' of Gd3+ ions

MR-labeling of cells may be carried out by adding a Gd-based contrast agent to the incubation media. The amount of gadolinium internalized in HTC and C6 cells upon incubation with Gd-DTPA-BMA is circa one order of magnitude higher than those found with Gd-DTPA, Gd-DOTA and Gd-HPDO3A, respectively. The comparison of relaxometric and mass spectrometry determinations allows us to establish that only a minor fraction of intact Gd-DTPA-BMA is internalized into the cells. Moreover the binding/uptake behavior shown by Gd-DTPA-BMA resembles that found when GdCl(3) is added to the incubation medium. We suggest that the lower stability of Gd-DTPA-BMA is responsible for a shift in the dissociation equilibrium that results in the net transfer of Gd(3+) ions on the cell membrane followed by a slower internalization process. The transmetallation process is mediated by components of the incubation media, among which a dominant role is represented by phosphate anions. The uptake of Gd(3+) ions is clearly reflected in the drastic decrease of cell viability observed for cells labeled with Gd-DTPA-BMA.

Experimental use of a new surface acoustic wave sensor for the rapid identification of bacteria and yeasts

AIMS

Use of an electronic nose (zNose(TM)) to discriminate between volatile organic molecules delivered during bacterial/fungal growth on agar and in broth media.

METHODS AND RESULTS

Cultures of bacteria (Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli) and yeasts (two Candida albicans strains) were grown on agar and in broth media and incubated for 24 h at 37 degrees C. Headspace samples from microbial cultures were analysed by the zNose(TM), a fast gas chromatography-surface acoustic wave detector. Olfactory images of volatile production patterns were observed to be different for the various species tested after 24 h. Moreover, some strains (two K. pneumoniae, two C. albicans) did not show changes in volatile production patterns within our species.

CONCLUSIONS

Our experiments demonstrate that the electronic nose system can recognize volatile production patterns of pathogens at species level.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results, although preliminary, promise exciting challenges for microbial diagnostics.

Woolly hair and palmoplantar hyperkeratosis may present with hypertrophic cardiomyopathy

Woolly hair and palmoplantar hyperkeratosis is an infrequent autosomal recessive ectodermal disorder that may be associated with arrhythmogenic right ventricular dysplasia (Naxos disease) or dilated cardiomyopathy. We report the sporadic occurrence of the aforementioned skin-hair anomalies in a patient with physical findings compatible with Noonan's syndrome and hypertrophic cardiomyopathy-an association heretofore not described.

Functional and structural characterization of two populations of human monocyte-derived dendritic cells

BACKGROUND

The characterization of human monocyte-derived dendritic cells (HM-DC) subsets have been a very difficult and elusive task because of the lack of appropriate reagents. We, therefore utilized several diverse approaches to evaluate two populations of HM-DC including flow cytometry, ultra-structural evaluation by electron microscopy, and functional assays. In addition, we studied the kinetics of the expression of antigens on HM-DC at diverse intervals of time and identify surface markers and functional differences of these two HM-DC subsets.

RESULTS

This study identified that a phenotype of HM-DC as defined by CD11c+, CD86+, and CD40+ could be separated in the presence or absence of TGF-beta1 into two different subsets of DC: (i) HM-DC without Birbeck granuli (Mo-DC) and (ii) HM-DC with Birbeck granuli (Mo-LC). Furthermore, the functional studies showed that the HM-DC treated with TGF-beta1 (Mo-LC) exhibited the presence of Birbeck granuli and could actively divide. In addition, after undergoing more than four cell divisions, these cells split into at least two additional subsets of Mo-LC: (iia) Mo-LC with high forward scatter (FSC) and (iib) Mo-LC with normal FSC. In contrast, the Mo-DC cultured in absence of TGF-beta1 did not exhibit Birbeck granuli, showed reduced ability to divide, and kept the normal FSC when analyzed.

CONCLUSIONS

This study enabled us to determine in HM-DC: (i) the existence of antigenic and functional differences between various subpopulations of Mo-DC and Mo-LC; (ii) the existence of differences in the kinetics of antigens expression among the subsets of Mo-DC and Mo-LC; (iii) the existence of specific markers for each of the subpopulations of HM-DC.

Nicergoline in the treatment of dizziness in elderly patients. A review

In elderly patients, dizziness occurs very frequently with significant effects on the patient's life. Its frequency increases with age, and may arise from a variety of causes. Chronic dysequilibrium in elderly patients is most probably related to disturbances within the central nervous system, due either to altered neuronal functions or to an underlying vascular disease. Nicergoline, a drug used in the treatment of cognitive disturbances in geriatric patients, improves dizziness in elderly demented and non-demented patients. In a double blind,placebo controlled trial the drug improved (i) the severity of symptoms, measured by the dizziness assessment rating scale (DARS), (ii) the overall clinical conditions revealed by global impression scale, and (iii) the perceived quality of life estimated by the dizziness handicap inventory (DHI). These results indicate a possible positive effect also on posturographic measures. Moreover, the improvement occurred at no expense of the established strategy of postural control suggesting that the effect is mediated by a substitute compensatory mechanism allowing the patient to preserve consolidated postural strategies. The results of previous open clinical studies in about 3000 patients are in agreement with those findings. Overall, severity of symptoms decreased by 68 % (57 % in the control study). Globally, the results indicate a beneficial effect of nicergoline on symptoms related to balance disorders of central origin. Animal studies show that the drug displays a broad spectrum of actions on cellular and molecular mechanisms. Moreover, animal research specifically aimed at vestibular pathophysiology has revealed that nicergoline improves vestibular compensation in models of vestibular lesion. Chronic treatment with nicergoline improved the time-course of behavioral recovery in old rats after hemi-labyrinthectomy and counteracted the regulation of cholinergic receptors observed after lesion in old rats. Nicergoline interacts at several levels by various mechanisms, from the molecular level to cognitive function, probably enhancing spontaneous plasticity phenomena underlying the central vestibular compensation. This effect is not dependent from the interaction with a single-transmitter-identified neural pathway, but from anatomical, functional and neurochemical synergistic adjustments in several brain areas.

Direct observation of the multisheet Fermi surface in the strongly correlated transition metal compound ZrZn2

The existence of flat areas of a Fermi surface (FS), predicted by electronic structure calculations and used in models of both magnetically mediated and phonon-mediated Fulde-Ferrell-Larkin-Ovchinnikov superconducting states, is reported in the paramagnetic phase of the ferromagnetic superconductor ZrZn2 using positron annihilation. The strongly mass-renormalized FS sheet, dominating the Fermi level density of states, is seen for the first time. The delocalization of the magnetization is studied using measured and calculated magnetic Compton profiles.

Nose: aesthetics and function. Rhinoplasty and functional problems related to anterior ethmoid

Aesthetic nasal surgery has progressed in the last years, as concerning both surgical techniques and surgical instruments, which allowed the finding of new and more sophisticated surgical solutions. Clinical practice led to observe sometimes functional surgical failures, due rather than an inaccurate surgical technique, to an incomplete diagnostic approach to the patient. It has been observed that modifying the external conformation of nasal pyramidis inner-nose volumes and spaces will be subsequently reduced, giving as a result a condition which is only aesthetically but not functionally valid. 32 subjects, selected for a rhinoplasty and presenting nasal respiratory obstruction and anterior ethmoid abnormalities, confirmed by nasal endoscopy and nasal CT, were evaluated and subdivided into two groups: the first (A) group underwent only to an aesthetic rhinoplasty, the second group (B) was operated of a rhinoplasty combined with functional endoscopic sinus surgery (FESS) in order to correct the above mentioned anatomical abnormalities. The nasal airflow, and though the nasal cavities patency, was evaluated pre- and post-operatively in the two groups of patients, referring to rhinomanometric conductance values. Patients of group A reported decreased post-operative conductance values, patients of group B reported increased post-operative conductance values, showing though the functional involvement of anterior ethmoid in nasal obstruction and the necessity of correcting its anatomical abnormalities, in order to reach not only a new nasal profile, but also a better respiratory performance.