Gambling and the need for new responses in Public Health with an addiction "sine substantia"

BACKGROUND

The Gambling Disorder (GD) was recently defined as a behavioral addiction by the "The Diagnostic and Statistical Manual of Mental Disorders IV"( DSM-V) since the clinical, neurobiological and psychopathological similarities led it to be defined it as an addiction "sine substantia". The aim of this study is to formulate an "identikit" of the gambler, to evaluate a possible association between GD / emotional specific factors and the correlation between GD / substance abuse, GD / suicide.

METHOD

In the study, 41 subjects were included (31 males and 10 females) and all were diagnosed with GD. A questionnaire was distributed containing 24 questions deriving from South Oaks Gambling Screen and the DSM-IVTR.

RESULTS

The study showed that 51% of the respondents makes use of alcohol and / or drugs; that 73% of the patients started playing in order to relieve feelings of dysphoria and suffering consequences on work as well as family life (51%). A great deal of the respondents were indebted (39%) to the extent of needing to ask for loans from usurer (17%). Furthermore, 41% of the respondents in the sample showed that GD could be transformed into an alarming risk of suicide.

DISCUSSION

The correlation between GD and drug abuse may depend on the brain function and the neural circuits that support impulsive behavior and the gratification mechanisms. Emotional experiences (stress, low level of education, divorce, poor social support) could constitute a possible risk factor that increases the GD. The committed offenses related to gambling could be explained by "loss of control".

CONCLUSIONS

The results of the present study contributes to the body of knowledge regarding the size of phenomenon from a statistical and epidemiological point of view, suggesting the necessity for targeted information on the risks connected to GD in order to capture early warning signs which enables the intervention with suitable strategies.

Prediction and prevention of early-onset pre-eclampsia: impact of aspirin after first-trimester screening

OBJECTIVE

To examine the effect of a combination of screening and treatment with low-dose aspirin on the prevalence of early-onset pre-eclampsia (PE).

METHODS

This was a retrospective analysis of two consecutive cohorts of women screened for early PE. The first cohort was observed to determine whether algorithms developed to screen for PE at 11 to 13 + 6 weeks' gestation could be applied to our population. High-risk women in the second cohort were advised on their risk and offered aspirin (150 mg at night), with treatment starting immediately after screening. The prevalence of early PE and the proportion of women with PE delivering at 34-37 weeks' gestation were compared between the cohorts.

RESULTS

In the observational and interventional cohorts, 3066 and 2717 women, respectively, were screened. There were 12 (0.4%) cases of early PE in the observational cohort and one (0.04%) in the interventional cohort (P < 0.01). Among all women with PE delivering before 37 weeks, 25 (0.83%) were in the observational cohort and 10 (0.37%) in the interventional cohort (P = 0.03).

CONCLUSIONS

A strategy of first-trimester screening for early PE coupled with prescription of aspirin to the high-risk group appears to be effective in reducing the prevalence of early PE.

Coronary artery disease in thrombotic aneurysm of the abdominal aorta

Even if the rupture is the most common cause of death of patients with Abdominal Aortic Aneurysm (AAA) and the risk increases with the presence and the size of IntraLuminal Thrombosis (ILT), there are cases in which death occurs for other causes. The Authors present an autoptic report of considerable size AAA with ILT in a patient who died by heart failure due to CAD thrombotic and ischemic heart disease. A protective role of approved in the literature and the role of products resulting from the thrombotic formation could explain the death event.

Perinatal testicular torsion and medicolegal considerations

Perinatal testicular torsion (PTT) is a very complex condition because of rarity of presentation and diagnostic and therapeutic difficulties. In presence of perinatal testicular torsion, the involvement of contralateral testis can be present also in absence of other indications which suggest the bilateral involvement; therefore, occurrences supported by literature do not exclude the use of surgery to avoid the risk of omitted or delayed diagnosis. The data on possible recovery of these testicles are not satisfactory, and treatment consists of an observational approach ("wait-and-see") or an interventional approach. The hypothesis of randomized clinical trials seems impracticable because of rarity of disease. The authors present a case of PTT, analyzing injuries due to clinical and surgical management of these patients, according to medicolegal profile. The delayed diagnosis and the choice of an incorrect therapeutic approach can compromise the position of healthcare professionals, defective in terms of skill, prudence and diligence. Endocrine insufficiency is an unfortunate event. The analysis of literature seems to support, because of high risk, a surgical approach aimed not only at resolution of unilateral pathology or prevention of a relapse, but also at prevention of contralateral testicular torsion.

[Environmental quality of the operating theatres in Campania: long lasting monitoring results]

In this study the microbiological, physical and chemical results of an investigation concerning the environmental conditions of operating theatres in 38 public hospitals of the Campania Government are presented. The analysis of the results has been made by considering specific standards suggested by national and international regulations. The results showed that 84% of the operating theatres presented normal microbiological values, in relation to the total bacterial load, while 16% did not. By considering the microclimatic monitoring 55% of the operating theatres showed normal values while 45% at least a microclimatic index did not. In relation to the concentrations of anaesthetics gases the survey pointed out that the nitrous oxides was within non prescribed environmental limits (50 ppm for N2O); while 15% of the halogenated was not in normal values.

The Akt signaling pathway determines the different proliferative capacity of chronic lymphocytic leukemia B-cells from patients with progressive and stable disease

Chronic lymphocytic leukemia (CLL) B-cells are hyporesponsive to many proliferative signals that induce activation of normal B-lymphocytes. However, a heterogeneous response has recently been observed with immunostimulatory CpG-oligodeoxynucleotides (CpG ODN). We now show that CpG ODN induce proliferation mainly in CLL B-cells from patients with progressive disease and unmutated immunoglobulin V(H) genes, whereas G(1)/S cell cycle arrest and apoptosis are induced in leukemic B-cells from stable/V(H) mutated CLL. Examination of early signaling events demonstrated that all CLL B-cells respond to CpG ODN stimulation by degradation of the NF-kappaB inhibitor IkappaB and activation of the Akt, ERK, JNK and p38 MAPK kinases, but the magnitude and duration of the signaling response was greater in the proliferating cases. Pharmacological inhibition of these pathways showed that simultaneous activation of Akt, ERK and JNK is required for cell cycle progression and proliferation. Conversely, introduction of constitutively active Akt in nonproliferating CLL B-cells resulted in induction of cyclin A following CpG ODN stimulation, indicating that increased Akt activation is sufficient to overcome the hyporesponsiveness of these cells to proliferative signals. Thus, the magnitude of Akt signaling may determine the distinct responses observed in leukemic B-cells belonging to the different prognostic subgroups.

Vertebral hemi-resection for bone tumor with wide invasion of the vertebral canal: modified surgical method

The authors describe a variation in the method of vertebral hemi-resection used for the treatment of neoplasms that present a wide invasion of the vertebral canal. This is followed by a review of the literature on the subject.

A potential role for protein tyrosine kinase p56(lck) in rheumatoid arthritis synovial fluid T lymphocyte hyporesponsiveness

Rheumatoid arthritis (RA) synovial fluid (SF)-T lymphocytes appear relatively inactive in situ and respond only weakly to diverse stimuli ex vivo. To characterize the molecular defects underlying this hyporesponsiveness we analyzed the expression level of several proteins involved in TCR-proximal signal transduction. As compared to peripheral blood (PB)-T lymphocytes, SF-T cells from some (but not all) of the patients analyzed expressed lower levels of TCRalphabeta, CD3epsilon, TCRzeta, p56(lck) and LAT, while p59(fyn), phospholipase C-gamma1 and ZAP-70 expression was unaltered. Semi-quantitative analysis of T cells from several patients revealed that the degree of TCRzeta chain and p56(lck) modulation correlated statistically significantly with the level of SF-T cell hyporesponsiveness. The differential reactivity of p56(lck) specific monoclonal and polyclonal antibodies in SF-T but not PB-T lymphocytes indicated that p56(lck) modulation consists of a conformational change rather than loss of expression. Our results indicate that multiple signaling molecules can be modulated in RA SF-T cells and show for the first time a direct quantitative correlation between T cell hyporesponsiveness and modulation of TCRzeta and of p56(lck), a critical protein tyrosine kinase required for T cell activation.

Localization, purification, and characterization of the rabbit sarcoplasmic reticulum associated calmodulin-dependent protein kinase

The Ca2+/calmodulin dependent protein kinase associated with the sarcoplasmic reticulum membranes (SR CaM kinase) plays a specific and important role in the modulation of both Ca2+ uptake and release functions of the sarcoplasmic reticulum itself. In this work we have localized a 60 kD SR CaM kinase in slow and fast twitch rabbit skeletal muscle fractions; the kinase was present in both the longitudinal and the junctional sarcoplasmic reticulum. We then developed a procedure for the purification of the active kinase from the longitudinal sarcoplasmic reticulum and performed biochemical and functional characterization of the enzyme. Differently from what was previously suggested, our analysis shows that the biochemical properties of the purified SR CaM kinase (Ca2+ sensitivity, K0.5 for calmodulin, Km for ATP, IC50 for the specific inhibitory peptide (290-309), autophosphorylation properties) are not significantly different from those of the soluble multifunctional CaM kinase II. Moreover, we show that the purified SR CaM kinase retains the ability to autophosphorylate in a Ca2+/calmodulin-dependent manner, becoming a Ca2+-independent enzyme. In the light of the knowledge of the rabbit SR CaM kinase biochemical properties, we propose and discuss the possibility that, under physiological conditions, the activity of the autophosphorylated kinase persists when the Ca2+ transient is over.

MRI appearance of cervical incompetence in a pregnant patient

Ultrasonography is currently the principal imaging modality for diagnosing cervical incompetence during pregnancy. Various technical factors, both patient and technologist/transducer related, may limit its evaluation for cervical incompetence. MRI is not dependent on these technical considerations. MRI may demonstrate a higher degree of soft tissue contrast than ultrasonography for depicting uterine anatomy. MRI may, in some instances, be more accurate in depicting cervical incompetence in the gravid patient. We present the first case of cervical incompetence in a pregnant patient diagnosed by MRI, in which ultrasonography failed to provide conclusive evidence of extra-uterine herniation of the amniotic sac.

MRI appearance of placenta percreta and placenta accreta

The purpose of this paper is to describe the magnetic resonance imaging (MR) features of placenta accreta and percreta. We retrospectively reviewed MRI findings in four cases of placenta accreta/percreta to determine features which assist in identifying the presence and extent of placental implantation abnormality. All patients had ultrasound (US) examinations. Pathologic correlation was available in all cases. There were two cases of placenta percreta and two cases of placenta accreta. All cases were treated by hysterectomy. In the two cases of placenta percreta, the placenta demonstrated transmural extension through the uterus (percreta) on MRI. In the two cases of placenta accreta, the location of thinning in the uterine wall correlated with the location of placental invagination into the myometrium at pathology. US correlation was available in all four cases. Gray scale US did not demonstrate placental invasion in any of the four cases of placenta accreta/percreta, however, in two of three cases in which color Doppler was performed, there was flow at the uterine margin suspicious for implantation abnormality. In conclusion, MRI is useful for identifying the presence and extent of placenta accreta/percreta.

Tyrosine 319 in the interdomain B of ZAP-70 is a binding site for the Src homology 2 domain of Lck

T-cell antigen receptor-induced signaling requires both ZAP-70 and Lck protein-tyrosine kinases. One essential function of Lck in this process is to phosphorylate ZAP-70 and up-regulate its catalytic activity. We have previously shown that after T-cell antigen receptor stimulation, Lck binds to ZAP-70 via its Src homology 2 (SH2) domain (LckSH2) and, more recently, that Tyr319 of ZAP-70 is phosphorylated in vivo and plays a positive regulatory role. Here, we investigated the possibility that Tyr319 mediates the SH2-dependent interaction between Lck and ZAP-70. We show that a phosphopeptide encompassing the motif harboring Tyr319, YSDP, interacted with LckSH2, although with a lower affinity compared with a phosphopeptide containing the optimal binding motif, YEEI. Moreover, mutation of Tyr319 to phenylalanine prevented the interaction of ZAP-70 with LckSH2. Based on these results, a gain-of-function mutant of ZAP-70 was generated by changing the sequence Y319SDP into Y319EEI. As a result of its increased ability to bind LckSH2, this mutant induced a dramatic increase in NFAT activity in Jurkat T-cells, was hyperphosphorylated, and displayed a higher catalytic activity compared with wild-type ZAP-70. Collectively, our findings indicate that Tyr319-mediated binding of the SH2 domain of Lck is crucial for ZAP-70 activation and consequently for the propagation of the signaling cascade leading to T-cell activation.

Tyrosine 319, a newly identified phosphorylation site of ZAP-70, plays a critical role in T cell antigen receptor signaling

Following T cell antigen receptor (TCR) engagement, the protein tyrosine kinase (PTK) ZAP-70 is rapidly phosphorylated on several tyrosine residues, presumably by two mechanisms: an autophosphorylation and a trans-phosphorylation by the Src-family PTK Lck. These events have been implicated in both positive and negative regulation of ZAP-70 activity and in coupling this PTK to downstream signaling pathways in T cells. We show here that Tyr315 and Tyr319 in the interdomain B of ZAP-70 are autophosphorylated in vitro and become phosphorylated in vivo upon TCR triggering. Moreover, by mutational analysis, we demonstrate that phosphorylation of Tyr319 is required for the positive regulation of ZAP-70 function. Indeed, overexpression in Jurkat cells and in a murine T cell hybridoma of a ZAP-70 mutant in which Tyr319 was replaced by phenylalanine (ZAP-70-Y319F) dramatically impaired anti-TCR-induced activation of the nuclear factor of activated T cells and interleukin-2 production, respectively. Surprisingly, an analogous mutation of Tyr315 had little or no effect. The inhibitory effect of ZAP-70-Y319F correlated with a substantial loss of its activation-induced tyrosine phosphorylation and up-regulation of catalytic activity, as well as with a decreased in vivo capacity to phosphorylate known ZAP-70 substrates, such as SLP-76 and LAT. Collectively, our data reveal the pivotal role of Tyr319 phosphorylation in the positive regulation of ZAP-70 and in TCR-mediated signaling.

Colocalization of the dihydropyridine receptor, the plasma-membrane calcium ATPase isoform 1 and the sodium/calcium exchanger to the junctional-membrane domain of transverse tubules of rabbit skeletal muscle

The subcellular distribution of the calmodulin-stimulated plasma-membrane Ca(2+)-ATPase (PMCA) has been studied in rat and rabbit skeletal muscle cells by indirect (calmodulin gel overlays) and direct (Western blotting with specific antibodies) methods. It has also been studied in situ in immunocytochemistry experiments. The distribution of PMCA has been compared with that of the NA+/Ca2+ exchanger and of the dihydropyridine receptor, which has been studied by Western blotting with specific antibodies. Both PMCA and the Na+/Ca2+ exchanger had a dual localization, i.e., they were found in the plasma membrane and in the transverse-tubule fractions of the two main types of skeletal muscles studied. The pump and the exchanger were not diffusely distributed in the transverse-tubule-membrane system, but specifically confined to the membrane domain where the dihydropyridine receptor was also localized, i.e., the junctional membrane. Experiments with isoform-specific antibodies have shown that the pump isoform expressed in skeletal muscle is PMCA 1.

Skeletal muscle sarcoplasmic reticulum phenotype in myotonic dystrophy

In this study we investigated the sarcoplasmic reticulum (SR), alongside myofibrillar phenotype, in muscle samples from five Myotonic Dystrophy (DM) patients and five control individuals. DM muscles exhibited as a common feature, a decrease in the slow isoform of myosin heavy chain (MHC) and of troponin C in myofibrils. We observed a match between myofibrillar changes and changes in SR membrane markers specific to fiber type, i.e. the fast (SERCA1) Ca(2+)-ATPase isoform increased concomitantly with a decrease of protein phospholamban (PLB), which in native SR membranes colocalizes with the slow (SERCA2a) SR Ca(2+)-ATPase, and regulates its activity depending on phosphorylation by protein kinases. Our results outline a cellular process selectively affecting slow-twitch fibers, and non-degenerative in nature, since neither the total number of Ca(2+)-pumps or of ryanodine receptor/Ca(2+)-release channels, or their ratio to the dihydropyridine receptor/voltage sensor in junctional transverse tubules, were found to be significantly changed in DM muscle. The only documented, apparently specific molecular changes associated with this process in the SR of DM muscle, are the defective expression of the slow/cardiac isoform of Ca(2+)-binding protein calsequestrin, together with an increased phosphorylation activity of membrane-bound 60 kDa Ca(2+)-calmodulin (CaM) dependent protein kinase. Enhanced phosphorylation of PLB by membrane-bound Ca(2+)-CaM protein kinase also appeared to be most pronounced in biopsy from a patient with a very high CTG expansion, as was the overall 'slow-to-fast' transformation of the same muscle biopsy. Animal studies showed that endogenous Ca(2+)-CaM protein kinase exerts a dual activatory role on SERCA2a SR Ca(2+)-ATPase, i.e. either by direct phosphorylation of the Ca(2+)-ATPase protein, or mediated by phosphorylation of PLB. Our results seem to be consistent with a maturational-related abnormality and/or with altered modulatory mechanisms of SR Ca(2+)-transport in DM slow-twitch muscle fibers.

Bacterial colonization of amniotic fluid in patients with intact membranes during labor

Amniotic fluid from gravidas with intact membranes was obtained for bacteriologic culture at the time of cesarean section. The incidence of positive cultures from patients not in labor was 8%. When the length of labor was eight hours or less (mean 6.1 hours) and the membranes were intact, the incidence of positive cultures was 37%; in patients whose length of labor was 12 hours or less (mean 9.7 hours) with intact membranes, 55% of cultures were positive. The incidence of endomyometritis in patients with bacterial growth from the amniotic fluid cultures in each group was 33%, 33%, and 45%, respectively.

Prophylactic antibiotics for cesarean section: comparison of high- and low-risk patients for endomyometritis

The efficacy of ticarcillin in the prevention of post-cesarean section endomyometritis was studied in 259 women randomly given either the antibiotic or a placebo. The ticarcillin group received 6 g intravenously immediately after delivery. Then 22 of those patients were also given a second 3-g dose 6 to 8 hours after delivery. Among the 139 patients who received ticarcillin, endomyometritis developed in 44 (32%), as it did in 66 of 120 patients (55%) in the placebo group. These differences are highly significant (P = .002). Of the 259 patients in the study, 238 could be classified as to risk for endomyometritis developing. Among the 124 high-risk patients, 52 received a placebo and endomyometritis developed in 71%. Only 26 of the 72 high-risk patients who received ticarcillin (36%) were so infected. Among the low-risk patients, endomyometritis developed in 10 of 54 patients (18.5%) who received prophylaxis and in 24 of 60 patients who received placebo (40%). Ticarcillin appears to be effective in reducing the incidence of post-cesarean section endomyometritis in patients at high risk and in those at low risk. The number of pelvic examinations during labor was the most important single factor in the development of endomyometritis.

Renal carcinoma in pregnancy

A gravid patient presented with gross hematuria in the last trimester of pregnancy but did not permit diagnostic measures. After delivery a large abdominal mass, which proved to be renal cell carcinoma, was found. Previously reported cases are reviewed, and the importance of adequate workup of hematuria during pregnancy is emphasized.

Comparison of sterilization by tubal ligation and hysterectomy

A comparison was made between sterilization by hysterectomy and by tubal ligation at the time of cesarean section and as an interval procedure. All operations were done at one institution and, essentially, by the same physician population, allowing for promotion within the residency program. The major deterrent to hysterectomy was the associated high incidence of necessary blood transfusion. However, a hysterectomy does offer the benefits of a permanent and completely effective procedure and the removal of an organ which ultimately may be the source of other problems. If another pathologic condition exists, making ultimate hysterectomy likely, it is the procedure of choice for sterilization, avoiding risks, costs, and the inconvenience of another operation. Methods of elective sterilization must be individualized. If the patient is appraised of the increased risk of hysterectomy and desires this more definitive procedure on the basis of informed consent, the incidence of complications is not prohibitive. These should not deter the well trained surgeon but should mandate use of all available skills, intensive evaluation of the patient, and concerned recognition of the potential adverse consequences.

Prophylactic internal iliac artery ligation at cesarean hysterectomy

One hundred and eight preplanned cesarean hysterectomies have been evaluated in an effort to determine that advisability of prophylactic bilateral hypogastric artery ligation when there is anticipated heavy bleeding associated with surgery. The data indicates that prophylactic bilateral internal iliac artery ligation is of questionable value in reducing operative bleeding, which can be controlled by more conventional means. However, when used therapeutically, it may be a lifesaving operation. Familiarity with the procedure is necessary for all those performing operative obstetrics and gynecology.