ADRIS: The new open-source accessible driving simulator for training and evaluation of driving abilities

BACKGROUND AND OBJECTIVE

Independent living and transportation are crucial aspects for people living with a disability. After an injury, it is important to assess driving ability, in terms of physical and psychological conditions, and to test the effects of prescribed drugs. Within this framework, driving simulators are suitable tools for training driving skills; however, available tools are expensive or lack appropriate sets of behavioral measures to fully characterize the drivers' ability.

METHODS

This work presents the first step toward the development of ADRIS, a new open-source, accessible, realistic virtual reality simulator for training and testing driving skills of people with sensory-motor disability. This includes a prototype based on an open-source simulator for autonomous driving research (CARLA), with the addition of customized features such as adaptable driving controllers, a virtual reality headset, and the possibility to collect behavioral and physiological data. Also, the new system allows to set different environmental conditions, to include and control the timing of potentially dangerous situations, and to set scenarios with various difficulty levels.

RESULTS

Tests on 17 healthy participants demonstrated that the simulator is well tolerated in terms of discomfort, physical fatigue, and mental effort. Also, the system is easy to use and is capable of providing a realistic driving experience, allowing the extraction of reliable behavioral parameters.

CONCLUSIONS

ADRIS combines a high-fidelity virtual world, with customizable features specifically designed for the training and testing of people living with a disability, thus making it usable in many contexts such as home training, rehabilitation, education, and research.

Phase and amplitude EEG correlations change with disease progression in people with idiopathic rapid eye-movement sleep behavior disorder

Study Objectives

Increased phase synchronization in electroencephalography (EEG) bands might reflect the activation of compensatory mechanisms of cognitive decline in people with neurodegenerative diseases. Here, we investigated whether altered large-scale couplings of brain oscillations could be linked to the balancing of cognitive decline in a longitudinal cohort of people with idiopathic rapid eye-movement sleep behavior disorder (iRBD).

Methods

We analyzed 18 patients (17 males, 69.7 ± 7.5 years) with iRBD undergoing high-density EEG (HD-EEG), presynaptic dopaminergic imaging, and clinical and neuropsychological (NPS) assessments at two time points (time interval 24.2 ± 5.9 months). We thus quantified the HD-EEG power distribution, orthogonalized amplitude correlation, and weighted phase-lag index at both time points and correlated them with clinical, NPS, and imaging data.

Results

Four patients phenoconverted at follow-up (three cases of parkinsonism and one of dementia). At the group level, NPS scores decreased over time, without reaching statistical significance. However, alpha phase synchronization increased and delta amplitude correlations decreased significantly at follow-up compared to baseline. Both large-scale network connectivity metrics were significantly correlated with NPS scores but not with sleep quality indices or presynaptic dopaminergic imaging data.

Conclusions

These results suggest that increased alpha phase synchronization and reduced delta amplitude correlation may be considered electrophysiological signs of an active compensatory mechanism of cognitive impairment in people with iRBD. Large-scale functional modifications may be helpful biomarkers in the characterization of prodromal stages of alpha-synucleinopathies.

Recognition of antigenic clusters of Candida albicans by T lymphocytes from human immunodeficiency virus-infected persons

The fine specificity of the cellular immune response to Candida albicans (i.e., recognition of different antigenic components) between normal controls and human immunodeficiency virus-infected patients in various stages of disease was compared. C. albicans-specific T cells, enriched by antigen stimulation and interleukin-2 expansion, were challenged with antigenic fractions of different molecular weight obtained by SDS-gel fractionation of C. albicans extracts in the presence of autologous mononuclear cells as antigen-presenting cells. Proliferative responses showed similar patterns of reactivity between controls and category A and B seropositive subjects. Category C patients with concurrent C. albicans infections did not give rise to C. albicans-specific T cell lines, confirming the T cell defect. Patients without clinically evident C. albicans infection had a low but broad reactivity pattern of C. albicans-specific T cells. These results suggest that depletion of C. albicans-specific T cells, independent of their fine specificity, occurs along with disease progression.

Anti-V3 loop spectrotype in HIV-infected individuals during zidovudine therapy

In order to investigate the role played by zidovudine (ZDV) as immune modulator, particularly on B-cell response, the anti-V3 loop spectrotype in 115 sera from 26 HIV-infected individuals was evaluated, prior to and during treatment with ZDV, by isoelectric focusing and reverse blotting (IEF-RB), a technique useful for indirectly measuring the activity and the number of B-cell clones. All 18 patients showing seroreactivity by IEFRB displayed a clear oligoclonal banding pattern, with no change in the spectrotype (i.e. new bands), in sequential analysis over the course of therapy. Only minor changes in band intensity were found, without any correlation with ZDV treatment or CD4+ cell count. In addition, among the sera reactive in spectrotypic analysis, the percentage of those with p24 antigen positivity was significantly lower than those with no detectable p24 antigen (19.8% vs 80.2%, respectively, p = < 0.0001, Fisher's exact test). In conclusion, it could not be demonstrated by IEFRB that there was any effect of ZDV on the activity and the number of anti-V3 specific B-cell clones. This data is in line with previous studies showing the constancy of anti-gp120 antibody spectrotype over the long course of the disease.

T cell blastogenic responses to Toxoplasma gondii trophozoites among HIV-infected patients

OBJECTIVE

To evaluate the cell-mediated immune response to Toxoplasma gondii (T. gondii) among HIV-infected patients.

METHODS

Forty HIV-infected patients were studied. Of them, 35 had antibodies to T. gondii and 5 had not. Nine of 35 patients with detectable serum Toxoplasma antibodies were classified as group A1 (CDC 1993), 10 as group B2, 6 as group B3, and 10 as group C3. Peripheral blood mononuclear cells (PBMCs) were obtained by Ficoll-Hypaque gradient centrifugation. Living Toxoplasma gondii trophozoites, herpes simplex virus (HSV), tetanus toxoid, and phytohemoagglutinin (PHA) were used in standard proliferation assays. Toxoplasma-responding blasts were expanded and assayed for antigen specificity and HLA restriction by proliferation assays. T cell subsets were analyzed using two-color flow cytometry.

RESULTS

Among patients with detectable Toxoplasma serum antibodies, significant PBMC proliferation in response to T. gondii trophozoites was observed in those classified in group A1 or B2 but not in those in groups B3 and C3. Toxoplasma-induced blasts from five of six patients after 7 days of culture and from five patients after 15 days of culture proliferated in response to T. gondii in the presence of either autologous or allogeneic PBMCs as antigen-presenting cells (APCs) and/or also proliferated in response to HSV. The surface markers of T. gondii-induced blasts showed a variable percentage of CD4 and CD8 activated cells.

CONCLUSIONS

T cell proliferative response to living trophozoites of T. gondii is lost only in patients with severe depletion of CD4 cells. PBMC proliferation was observed only in patients with previous T. gondii infection, but the T cell blasts generated showed a strong alloreactivity (proliferating in response to allogeneic irradiated PBMCs) and were apparently not antigen specific (proliferating also in response to HSV).

Sublingual immunotherapy in Parietaria pollen-induced rhinitis: a double-blind study

A double-blind, placebo-controlled study of immunotherapy was conducted in 31 patients with allergic rhinitis due to Parietaria pollen to evaluate the efficacy and safety of high doses of allergen via the sublingual route. The patients were assessed before and after a 10-month period of treatment by clinical (symptom-medication scores and specific nasal reactivity) and immunological (total IgE, specific IgE, IgG and IgG4 antibodies) parameters. High doses of Parietaria extract corresponding to a cumulative dose of 105 BU for each patient were administered with negligible side effects. The actively treated patients had significantly lower medication scores than those on placebo (p < 0.05) when the maximum pollen count was recorded, and at the end of the trial they showed a significant decrease in nasal reactivity (p < 0.02) and a significant increase in serum specific IgG4 (p = 0.02). No differences were detected in any of these parameters in the placebo group. Possible explanations for the mechanisms of sublingual immunotherapy are proposed.

Herpes simplex virus and oral mucositis in children with cancer

The relationship between herpes simplex virus (HSV) and oral mucositis was investigated in children undergoing antineoplastic chemotherapy. HSV culture was performed in 20 children with stomatitis developing after antineoplastic chemotherapy. Viral isolates were typed and susceptibility to acyclovir was investigated. The virus was isolated from oral lesions in 10 of 20 children with severe oral mucositis. Viral reactivation was the most likely explanation in most cases, since HSV was isolated in 9 of 13 seropositive patients (and in 1 patient with unknown anti-HSV serology), but in no seronegative patient. HSV type 1 was isolated more frequently than HSV type 2 (8 versus 2). Acyclovir showed standard in vitro activity against all isolates. Our results suggest that oral mucositis in children receiving antineoplastic treatment is probably multifactorial in origin and that HSV can be an important cofactor, especially in children who are seropositive for HSV. In our Centre, acyclovir remains active in vitro against this opportunistic pathogen and could be employed in prophylaxis and therapy.

In vitro activity of a Combretum micranthum extract against herpes simplex virus types 1 and 2

The authors demonstrate in vitro antiviral activity of a methanolic extract of Combretum micranthum leaves against HSV-1 and HSV-2. This activity is present only in the extract dissolved 7 days before the assay, but not in the freshly prepared extract, thus indicating the presence of inactive precursors which undergo spontaneous transformations into active compounds. The alkaline autooxidation of the methanolic extract promotes this rapid transformation. The precursors have been identified as condensed catechinic tannins, which, under alkaline conditions, suffer rapid cleavage, intramolecular rearrangement to catechinic acid and autooxidation. The alkaline autooxidation products of the methanolic extract of C. micranthum and those of the synthetic catechinic acid show similar I.R. and U.V. absorption curves, as well as similar anti-HSV-1 and -HSV-2 activities. EC50s of catechinic acid autooxidation products against HSV-1 and HSV-2 replication were 2 micrograms/ml and 4 micrograms/ml, respectively, when cell cultures were treated with the compound during virus infection.

Zidovudine therapy of HIV-1 infection during pregnancy: assessment of the effect on the newborns

Zidovudine (ZDV) administration during pregnancy has been suggested for the prevention of mother-to-child HIV-1 transmission. Reliable levels of the drug have been observed in the fetus and in the newborn. Seven HIV-1-infected pregnant women who declined to have abortions and whose immunological status required antiretroviral treatment were administered oral ZDV 18 mg/kg in four daily doses, the initial dose being administered anytime from the 16th to the 30th week of gestation up until the time of delivery. Follow-up of the seven infants from birth with a mean duration of 22 months (range 16-32 months) revealed mild drug-related toxicity: anemia in two infants and macrocytosis in all seven, both conditions resolved by the second month of life. All infants remained HIV-1 seronegative, according to the 1987 CDC classification, and all stayed clinically well. Other virological parameters including virus culture, in vitro antibody production, and polymerase chain reaction, repeatedly performed in the infants, remained negative. Although none of the mothers transmitted HIV-1 infection to the offspring, the size of this study and the relatively low transmission rate (13%) in Europe do not permit us to draw a definite conclusion about treatment efficacy in preventing maternal-fetal transmission. However, the drug caused only limited toxicity among the infants, and its administration to large numbers of mothers in treatment trials should be considered relatively safe for both mother and child.

Cotrimoxazole therapy of Toxoplasma gondii encephalitis in AIDS patients

Twenty-four consecutive HIV-positive patients affected by Toxoplasma gondii encephalitis received trimethoprim-sulfamethoxazole (cotrimoxazole) as acute-phase treatment. Two dosage regimens of cotrimoxazole were used: 40 mg/kg/day (12 patients) or 120 mg/kg/day (12 patients) of total compound (trimethoprim plus sulfamethoxazole). Clinical and radiological responses to treatment were evaluated, and the product-limit method for survival data analysis was used. Eighteen of 24 patients showed both a clinical and radiological response (75% response rate). There were no differences in response rates between patients receiving the two dosage regimens of cotrimoxazole. Adverse reaction consisted of leukopenia (two cases) and skin rash (three cases) which led to the discontinuation of the drug in one case. These results suggest that a randomized, controlled clinical trial should be carried out comparing cotrimoxazole versus sulfadiazine-pyrimethamine in AIDS patients with Toxoplasma gondii encephalitis.

Neurological complications in HIV infection. Personal experience

The personal experience on neurological disturbances associated with early HIV infection and AIDS is reported. Central nervous system (CNS) involvement occurred during the early stages in 3 cases: 2 patients with HIV-seroconversion (CDC category III) and one patient with persistent generalized lymphadenopathy (PGL, III group CDC, 1986). The patients had HIV acute meningitis. The neurological manifestations in AIDS had high incidence (49 of 83 cases), often with multiple aetiology in single patients. We remark the necessity of an early aetiological diagnosis to address the treatment.

Individual NK cell clones lyse both tumor cell targets and herpes simplex virus-infected fibroblasts in the absence of interferon

The target specificity of natural killer (NK) cells for either tumor cells or virus-infected cells has been investigated. Lymphocyte clones with the surface phenotype of NK cells (CD3-, CD16+) were obtained by limiting dilution of peripheral blood mononuclear cells stimulated with PHA, Herpes simplex virus type 1 (HSV-1), or Varicella-Zoster antigens. Clones were maintained in media with recombinant interleukin 2 (IL-2). Both NK-sensitive (K562 cells) and NK-resistant (Raji cells) targets were lysed by three cloned lines of NK cells. The ability to lyse NK-resistant target cells was largely lost when the cloned lymphocytes were cultured overnight in the absence of IL-2. Effector cells from all three clones were also capable of specifically lysing HSV-1 infected human fibroblasts in comparison with uninfected fibroblasts. We also showed that lysis of HSV-1 infected targets by NK cloned cells was independent of interferons in the culture system.

Immunoreactive lactoferrin in resting, activated, and neoplastic lymphocytes

Lactoferrin (Lf) in lymphocytes was assessed with immunofluorescence/flow cytometric technique. Surface Lf was detected primarily among B-cell-enriched preparations. Tonsillar B-cells of different densities expressed surface Lf similarly. Very small percentages of CALLA+ ALL, HCL, or EBV-transformed B-cells expressed surface Lf, whereas B-CLL lymphocytes had the highest percentages of surface Lf positivity. Few resting, cultured, or neoplastic T-lymphocytes expressed Lf. The pattern of immunofluorescence and analyses of surface and total cellular immunoreactive Lf indicated that Lf is associated primarily with the lymphocyte surface. The percentage and/or intensity of surface Lf-specific fluorescence were not significantly altered in B- or T-cells by incubation with physiologic concentrations of differric Lf, and the percentages of Lf-positive cells detected in respective subjects remained stable over time. Surface Lf positivity was unrelated to the expression of other surface antigens (except those marking B- or T-cell lineage) or cell cycle. Expression and/or binding of Lf in B-lymphocytes may become increased during certain stages of cell maturation.

Significance of specific immunoglobulin M in the chronological diagnosis of 38 cases of toxoplasmic lymphadenopathy

The persistence of immunoglobulin M (IgM) antibody to Toxoplasma gondii in sera from 38 patients after toxoplasmic lymphadenopathy was investigated by using an indirect immunofluorescence assay, a double-sandwich enzyme-linked immunosorbent assay, and an immunosorbent agglutination assay. Positive predictive values at 3 and 6 months after lymphadenopathy were, respectively, 45 and 73% for the indirect immunofluorescence assay, 25 and 45% for the double-sandwich enzyme-linked immunosorbent assay, and 22 and 43% for the immunosorbent agglutination assay.

[Combined fetal alcohol and hydantoin syndromes]

Ethanol and hydantoin are both teratogenic drugs of common usage and are associated with specific syndromes. This is a report on two children born to different heavy drinking, mentally abnormal epileptic women, that were also under treatment with 300 mg/day of hydantoin (mother of case 1 on a regular basis and that of case 2 sporadically) during pregnancy. Both infants displayed the syndrome due to both of these drugs. Particularly relevant were failure to thrive, severe mental retardation, microcephaly, blepharophimosis, hypertelorism, and long philtrum. Additional findings in case 1 included nail hypoplasia and in case 2 palatine fissure. Case 1 died unexpectedly at age three months. Case 2 is still alive and he is severely mentally retarded at age four years.

An in vitro model for Toxoplasma infection in man. Interaction between CD4+ monoclonal T cells and macrophages results in killing of trophozoites

The cell interactions that take place between Toxoplasma gondii trophozoites and the human immune system have been investigated by using an in vitro model of infection. PBMC were co-cultured with live, appropriately attenuated, trophozoites. When cells from immune (seropositive) donors were used, a proliferative response was observed. At the same time, the proliferating T cells proved capable of controlling the growth of live trophozoites. By contrast, cells from seronegative donors failed to mount a proliferative response and intracellular overgrowth of trophozoites with subsequent cell injury occurred. Actively proliferating T cells were expanded in continuous cell lines with IL-2 and periodical restimulation with Ag in the presence of autologous irradiated mononuclear cells. From some of the lines obtained, clones were also derived. Ten clones were selected for further studies. They proliferated in response to trophozoites but not to unrelated Ag. Their response required the presence of autologous monocytes-macrophages isolated from peripheral blood on Percoll density gradients. B cells that were obtained from the same donors and immortalized by EBV infection proved inefficient as APC. These data suggest that live trophozoites have to be processed by macrophages in order to be presented to T cells. Upon appropriate antigen stimulation, all of the clones produced IL-2 and IFN-gamma, a finding that was consistent with both their CD4+ surface phenotype and their helper capacity on B cell proliferation and differentiation in vitro. The supernatants of all of the stimulated clones released a factor that activated macrophages to kill intracellular trophozoites as well as an unrelated pathogen, Listeria monocytogenes. This factor was identified as IFN-gamma because it was neutralized by specific anti-IFN-gamma antibodies. The present in vitro model of response to live protozoa may prove suitable to assess the role of both T lymphocytes and macrophages in intracellular parasite infections in man. Furthermore, this experimental system may be applied to detect specific lesions of cell mediated immunity in a number of immunodeficiency syndromes.

An in vitro model for Toxoplasma infection in man. Interaction between CD4+ monoclonal T cells and macrophages results in killing of trophozoites

The cell interactions that take place between Toxoplasma gondii trophozoites and the human immune system have been investigated by using an in vitro model of infection. PBMC were co-cultured with live, appropriately attenuated, trophozoites. When cells from immune (seropositive) donors were used, a proliferative response was observed. At the same time, the proliferating T cells proved capable of controlling the growth of live trophozoites. By contrast, cells from seronegative donors failed to mount a proliferative response and intracellular overgrowth of trophozoites with subsequent cell injury occurred. Actively proliferating T cells were expanded in continuous cell lines with IL-2 and periodical restimulation with Ag in the presence of autologous irradiated mononuclear cells. From some of the lines obtained, clones were also derived. Ten clones were selected for further studies. They proliferated in response to trophozoites but not to unrelated Ag. Their response required the presence of autologous monocytes-macrophages isolated from peripheral blood on Percoll density gradients. B cells that were obtained from the same donors and immortalized by EBV infection proved inefficient as APC. These data suggest that live trophozoites have to be processed by macrophages in order to be presented to T cells. Upon appropriate antigen stimulation, all of the clones produced IL-2 and IFN-gamma, a finding that was consistent with both their CD4+ surface phenotype and their helper capacity on B cell proliferation and differentiation in vitro. The supernatants of all of the stimulated clones released a factor that activated macrophages to kill intracellular trophozoites as well as an unrelated pathogen, Listeria monocytogenes. This factor was identified as IFN-gamma because it was neutralized by specific anti-IFN-gamma antibodies. The present in vitro model of response to live protozoa may prove suitable to assess the role of both T lymphocytes and macrophages in intracellular parasite infections in man. Furthermore, this experimental system may be applied to detect specific lesions of cell mediated immunity in a number of immunodeficiency syndromes.

Enzyme immunoassay for evaluation of Toxoplasma gondii growth in tissue culture

An enzyme-linked immunosorbent assay (ELISA) for the evaluation of growth kinetics of Toxoplasma gondii in tissue cultures was developed. Tissue culture microplates (96 wells) were seeded with Vero cells, infected with a virulent strain of T. gondii, and incubated for different time periods. The ELISA was performed with anti-T. gondii antibodies on the infected cells. The method was simple, rapid, and accurate, and very good correlations between the ELISA results and the percentage of T. gondii rosettes in infected cells, the number of free T. gondii in the supernatant, and the amount of T. gondii antigen in the supernatant were observed.

[Effects of clindamycin and josamycin in experimental Toxoplasma gondii infections]

The effects of clindamycin and josamycin on experimental toxoplasmosis of mice (RH strain) are studied. Oral administration of clindamycin 800 mg/kg daily for 14 days cured 80% of Toxoplasma-infected mice at 60 days after infection. Josamycin, administered subcutaneously at 100, 200, 500, 1000 mg/kg daily for 14 days did not prevent death due to acute infection, and no difference was demonstrated with untreated infected mice.

The occurrence of toxoplasma gondii in saliva

The role of saliva in transmission of experimental toxoplasmosis has been evaluated. Three groups of rabbits were infected with 6 X 10(6), 24 X 10(9) 96 X 10(9) toxoplasmic trophozoites. The saliva was drawn with a sterile aspirator on different days from infection and it was intraperitoneally injected in mice. Mice so injected with saliva were examined for intraperitoneal trophozoites or toxoplasmic cysts in brain. Toxoplasma gondii was demonstrated in saliva in 33% of toxoplasma infected rabbits. The possible role of saliva in natural transmission of acquired toxoplasmic infection is considered.

Effects of the H2 receptor antagonist ranitidine on anterior pituitary hormone secretion in man

The effect of an i.v. bolus of the H2-receptor antagonist ranitidine 50, 100, 200 and 300 mg on serum levels of prolactin, TSH, GH, LH, FSH and cortisol was studied in 12 normal males. Ranitidine 200 and 300 mg significantly stimulated prolactin release without affecting any of the other hormones. Ranitidine 300 mg caused a rise in prolactin comparable to that observed following cimetidine 200 mg. The results show that ranitidine releases prolactin in man, but only when a large intravenous injection is given.

On the role of dopamine receptors in the central regulation of human TSH

The effects of acute administration of haloperidol (4 mg im) and pimozide (4 mg orally) on TSH and Prl secretion were studied in normal and hypothyroid man. The TRH-induced TSH secretion before and after pre-medication with pimozide and domperidone, a peripheral dopamine (DA) blocker, was also evaluated in a group of normal subjects. Haloperidol and pimozide induced a marked increment in serum Prl; mean Prl levels were still significantly elevated 12 h following pimozide administration. A small but significant TSH increase was observed following haloperidol and pimozide in normal as well as hypothyroid subjects. Both domperidone and pimozide significantly enhanced TRH-induced TSH release. In another experiment 3 women with primary thyroid failure received an infusion of DA (4 micrograms/kg/min for 4 h) with and without domperidone administration. TSH and Prl levels were suppressed by DA, but the effect was completely abolished by domperidone. The results suggest that psychotrophic drugs, such as haloperidol and pimozide, can, like substituted benzamides, stimulate TSH release in man. Since domperidone and DA do not cross the blood-brain-barrier and domperidone significantly enhanced the TSH response to TRH, the data also support the hypothesis that human TSH is regulated by DA at the hypothalamus (median eminence) and/or pituitary level.

[Agglutinating antibodies against Listeria monocytogenes in healthy adult subjects]

The prevalence of antibodies to L. monocytogenes, type 1 and type 4b, in 334 healthy adults of Liguria land was determined by serological agglutination test. Agglutinins at low titer to L. monocytogenes are present in 22.45% of cases; in 88% of these the titer is 1:40. On the whole, the incidence of antibodies to L. monocytogenes type 1 increases with age and is higher (53.33%) than to 4b (22.66%). The incidence of agglutinins to O-antigens of L. monocytogenes is higher than to H-antigens.

[Listeria monocytogenes agglutinating antibodies in children]

The AA. relate the results of a serological study on the spreading of listeria infection over the pediatric population of Liguria. The research of agglutinating antibodies for types 1 and 4b of L. monocytogenes in 367 sera gave the following results: -- 195 sera (53,13%) resulted positive, although at low titer (1/40) as a general rule; -- on the whole, agglutinins toward type 1 had considerably higher incidence than toward type 4b ones (57,43% and 5,12% respectively); -- O - antibodies had higher incidence (44,95%) than H - antibodies (22,34%).