Biphasic effect of abstinence duration following cocaine self-administration on spine morphology and plasticity-related proteins in prelimbic cortical neurons projecting to the nucleus accumbens core.

Cocaine self-administration (SA) in rats dysregulates glutamatergic signaling in the prelimbic (PrL) cortex and glutamate release in the nucleus accumbens (NA) core, promoting cocaine seeking. PrL adaptations that affect relapse to drug seeking emerge during the first week of abstinence, switching from an early (2 h) hypoglutamatergic state to a later (7 days) hyperglutamatergic state. Different interventions that normalize glutamatergic signaling in PrL cortex at each timepoint are necessary to suppress relapse. We hypothesized that plasticity-related proteins that regulate glutamatergic neurotransmission as well as dendritic spine morphology would be biphasically regulated during these two phases of abstinence in PrL cortical neurons projecting to the NA core (PrL-NA core). A combinatorial viral approach was used to selectively label PrL-NA core neurons with an mCherry fluorescent reporter. Male rats underwent 2 weeks of cocaine SA or received yoked-saline infusions and were perfused either 2 h or 7 days after the final SA session. Confocal microscopy and 3D reconstruction analyses were performed for Fos and pCREB immunoreactivity (IR) in the nucleus of layer V PrL-NA core neurons and GluA1-IR and GluA2-IR in apical dendritic spines of the same neurons. Here, we show that cocaine SA decreased PrL-NA core spine head diameter, nuclear Fos-IR and pCREB-IR, and GluA1-IR and GluA2-IR in putative mushroom-type spines 2 h after the end of cocaine SA, whereas the opposite occurred following 1 week of abstinence. Our findings reveal biphasic, abstinence duration-dependent alterations in structural plasticity and relapse-related proteins in the PrL-NA core pathway after cocaine SA.

Tumor suppressor Nf2/merlin drives Schwann cell changes following electromagnetic field exposure through Hippo-dependent mechanisms.

Previous evidence showed mutations of the neurofibromin type 2 gene (Nf2), encoding the tumor suppressor protein merlin, in sporadic and vestibular schwannomas affecting Schwann cells (SCs). Accordingly, efforts have been addressed to identify possible factors, even environmental, that may regulate neurofibromas growth. In this context, we investigated the exposure of SC to an electromagnetic field (EMF), which is an environmental issue modulating biological processes. Here, we show that SC exposed to 50 Hz EMFs changes their morphology, proliferation, migration and myelinating capability. In these cells, merlin is downregulated, leading to activation of two intracellular signaling pathways, ERK/AKT and Hippo. Interestingly, SC changes their phenotype toward a proliferative/migrating state, which in principle may be pathologically relevant for schwannoma development.

Colistin, meropenem and rifampin in a combination therapy for multi-drug-resistant Acinetobacter baumannii multifocal infection. A case report.

A 16 year-old girl underwent a multifocal (lungs, skin, soft tissues) infection due to multiresistant Acinetobacter baumannii after a car crash. To treat such a severe disease we used a combination therapy of colistin (2 millions Units twice/day), rifampicin (600 mg/day), meropenem (1 g 3 times a day) after a synergistic activity test was performed (checkerboard method on Mueller-Hinton broth and 5x10(5) cfu/mL inoculum). After 24 days, when a significant clinical improvement was gained, the 3-drugs combination therapy was replaced with i.v. levofloxacin 500 mg twice/day but, after 10 days of quinolones therapy, fever started again and the same multidrug resistant (MDR) A. baumannii was isolated from the skin grafts, central venous catheter tip and bronchial alveolar lavage. A combination therapy with colistin and meropenem was therefore started and definitive defervescence was obtained after 10 days. This therapy was continued for 70 days even if the patient was apyretic because A. baumannii was still present in the skin secretions. After 109 days of hospitalization in our intensive care unit, the patient was transferred to a rehabilitative unit. This case shows how useful is, in selected cases, rediscovering old antibiotic drugs, specially when they are adopted as a combination therapy, and highlights the importance of the clinical microbiological laboratory as it may help clinicians in choosing the best drugs combination.

[School performance: a question that divides. Analysis of learning difficulty]. / Il rendimento scolastico: una questione che divide. Analisi delle difficoltà di apprendimento.

The difficulty of learning is getting always more important, also in relation of a better knowledge of these problems. One factor which has to be taken in consideration as the behaviour of the school.

[They way adolescents live at home]. / Come l'adolescente vive la casa.

The kids, observing the relationship of their parents, are learning from them. Today the home is less home for everyone. At home you are eating, you are learning, especially you are watching a lot of TV. Often there is non a lot of trust between each other. Because of this the conversation is necessary and not the control of the adolescent secretly.

[Adolescence and family life cycle. Role of the pediatrician]. / L'adolescenza e il ciclo di vita della famiglia. Il ruolo del pediatra.

Adolescence observed as one of the step of the life cycle from the point of view of changes in the family. The role of paediatricians in the conversation with the adolescent and his parents is to pay attention to the influence that the whole family system could have on producing symptoms.

[Eating disorders in adolescence: anorexia in children]. / I disturbi alimentari in adolescenza: l'anoressia nel bambino.

When doctor visits adolescents have to pay attention to the massage of body like a mirror of difficulty about growth. Adolescents change their eating habits because they need to distinguish to the family. The doctor have to see first signals of more serious behaviour join to eating: anorexia nervosa.

[Advanced adolescence]. / L'adolescenza avanzata.

The advanced adolescence is the one after the eighteenth birthday. The adolescent tries to accomplish 3 engagements: 1. social and economic stability, 2. the research of a system of values, 3. record of concepts.

[Adolescence and alcohol abuse. Relevance of information given by the pediatrician]. / Gli adolescenti e l'abuso di alcol. L'importanza dell'informazione per il pediatra.

Often we don't see alcohol abuse among adolescents, but this kind of drug, easy to find, could be used to trying their limits. Contemporary group has an important role in the habit of drinking. Often family don't think that it's real problem and it's important that paediatrician grasp this dangerous signals.

[Children are born twice: at birth and in adolescence. The adolescent, his/her parents, and the pediatrician]. / Il bambino nasce due volte: quando viene alla luce e all'adolescenza. L'adolescente, i suoi genitori ed il pediatra.

We know the young's problem often depended to family and to society. In these years we have seen important changes of the family, that is no more a "patriarchal family" but is a "nuclear family". In general we can say that there is a change of the social levels of the family; in particular the Mass-media (especially television-set) are the most important factors responsible of these changes in fact they block the dialogue between family's members. In Italy we can found about 4.500.000 of adolescents (with age between 14 and 20 years). If we observe recent epidemiological data, we can suppose that: about 500.000 of young men have or will have problems that block them to live serenely their adolescence about 70.000 of young men have had a so important problem than they have a psychiatric personality in the future about 4.000 of young men will die for suicide, drugs or for road's incidences. For adolescents is necessary a doctor with multiple competence. We think that this doctor can be pediatrician because he is the doctor that visit children from neonatal age and, for this reason, ha can identify the "family with problems". In conclusion we can say that the pediatrician could say to adolescent's patents that "it is born a new child" with personal idea and with different attitudes, for these reason they must change the rules that they used before puberty because now the same rules are no more valid!

Splanchnic perfusion evaluation during hemorrhage and resuscitation with gastric near-infrared spectroscopy.

OBJECTIVE: The purpose of this study was to use a prototype side-illuminating near-infrared spectroscopy (NIRS) nasogastric probe to continuously measure changes in gastric tissue oxygen saturation (Sto2) in a pig hemorrhage model. METHODS: Swine (n = 12; 6 per group) underwent laparotomy and placement of a gastric NIRS probe, jejunal tonometer, superior mesenteric artery (SMA) flow probe, and a portal vein catheter. Animals underwent hemorrhage (28 mL/kg) t = 0 to 20 minutes (where t = time). Pigs in group I were resuscitated (t = 20-40 minutes) with lactated Ringer's solution (84 mL/kg), whereas group II had no resuscitation. RESULTS: A significant decrease in mean arterial pressure and SMA flow was observed after hemorrhage. SMA flow significantly correlated in group I with both NIRS Sto2 (r = 0.58, p = 0.0001) and regional CO2 (r = -0.54, p = 0.0001). In group II, superior mesenteric flow correlated with NIRS Sto2 (r = 0.30, p = 0.03), but not regional CO2 (r = -0.23, p = 0.09). CONCLUSION: Direct measurement of tissue oxygen saturation with a prototype side-illuminating near-infrared spectroscopy gastric probe appeared to rapidly reflect changes in splanchnic perfusion.

Near-infrared spectroscopy reflects changes in mesenteric and systemic perfusion during abdominal compartment syndrome.

BACKGROUND: Continuous and minimally invasive near-infrared spectroscopy (NIRS)-derived gastric tissue oxygen saturation (GStO(2)) and muscle tissue oxygen saturation (MStO(2)) were evaluated in a clinically relevant porcine model of hemorrhagic shock and abdominal compartment syndrome (ACS). METHODS: Phenobarbital-anesthetized swine underwent pulmonary artery catheter insertion for mixed venous oxygen saturation (SvO(2)) measurement and midline laparotomy to permit placement of a gastric NIRS probe, a jejunal (regional carbon dioxide [PrCO(2)]) tonometer, superior mesenteric artery (SMA) flow probe, and a portal vein oxygen saturation (SpvO(2)) catheter. A muscle NIRS probe was placed on the front limb. After randomization, Group 1 underwent hemorrhage and resuscitation. Group 2 had no hemorrhage or resuscitation. ACS was induced by peritoneal fluid infusion in both groups. A significant decrease in SMA flow, SpvO(2), GStO(2), SvO(2), and MStO(2) was observed after hemorrhage in Group 1 and with abdominal hypertension in both groups. RESULTS: GStO(2) significantly correlated with SMA flow (Group 1: r(2) = 0.90; Group 2: r(2) = 0.83) and mesenteric oxygen delivery (mesenteric oxygen delivery, Group 1: r(2) = 0.73; Group 2: r(2) = 0.89). MStO(2) significantly correlated with SvO(2) (Group 1: r(2) = 0.99; Group 2: r(2) = 0.65) and systemic oxygen delivery (SDO2, Group 1: r(2) = 0.60; Group 2: r(2) = 0.88). Tonometer-derived PrCO(2) values did not change at any time point in either group. CONCLUSIONS: NIRS measurement of GStO(2) and MStO(2) reflected changes in mesenteric and systemic perfusion respectively during hemorrhage and ACS.

Prospective randomized trial of two wound management strategies for dirty abdominal wounds.

OBJECTIVE: To determine the optimal method of wound closure for dirty abdominal wounds. SUMMARY BACKGROUND DATA: The rate of wound infection for dirty abdominal wounds is approximately 40%, but the optimal method of wound closure remains controversial. Three randomized studies comparing delayed primary closure (DPC) with primary closure (PC) have not conclusively shown any advantage of one method over the other in terms of wound infection. METHODS: Fifty-one patients with dirty abdominal wounds related to perforated appendicitis, other perforated viscus, traumatic injuries more than 4 hours old, or intraabdominal abscesses were enrolled. Patients were stratified by cause (appendicitis vs. all other causes) and prospectively randomized to one of two wound management strategies: E/DPC (wound packed with saline-soaked gauze, evaluated 3 days after surgery for closure the next day if appropriate) or PC. In the E/DPC group, wounds that were not pristine when examined on postoperative day 3 were not closed and daily dressing changes were instituted. Wounds were considered infected if purulence discharged from the wound, or possibly infected if signs of inflammation or a serous discharge developed. RESULTS: Two patients were withdrawn because they died less than 72 hours after surgery. The wound infection rate was greater in the PC group than in the E/DPC group. Lengths of hospital stay and hospital charges were similar between the two groups. CONCLUSION: A strategy of DPC for appropriate dirty abdominal wounds 4 days after surgery produced a decreased wound infection rate compared with PC without increasing the length of stay or cost.

Utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome.

OBJECTIVE: To determine the utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome (CS). METHODS: Nine patients with CS confirmed by physical examination and elevated compartment pressures (64 +/- 17 mm Hg) were evaluated before and after fasciotomy. Control readings were also performed on 33 surgical patients who had no evidence of CS. The deltoid muscle was used as a reference value. RESULTS: The deltoid muscle oxygen saturation (StO2) readings revealed a mean = 84 +/- 17% prefasciotomy and mean = 83 +/- 12% postfasciotomy in the CS group. The control group had a mean StO2 of 83 +/- 11%. In the CS group, the leg compartment with the highest pressure had a StO2 mean = 56 +/- 27% before fasciotomy. This value was statistically significantly lower (p < 0.05) than either the postfasciotomy mean StO2 in that compartment (82 +/- 16%) or the values found in matched control patients with no evidence of CS (87 +/- 7%). CONCLUSION: Near-infrared spectroscopy-derived StO2 values in the lower extremities of trauma patients with CS were diminished relative to the control patients and usually normalized after fasciotomy. Near-infrared spectroscopy evaluation may offer a rapid, noninvasive method of assessing extremities at risk for CS.

[Quantitative study of the "T" subpopulations in subjects with bronchiolitis]. / Studio quantitativo delle sottopopolazioni "T" nei soggetti affetti da brochiolite.

T-lymphocyte subsets were determined by monoclonal antibodies in eighty children with acute bronchiolitis, eighty healthy controls and 37 patients with respiratory tract infections other than bronchiolitis, all matched by age and sex. T3 and T8-positive cells, but not T3-positive cells, were significantly decreased in the bronchiolitis patients (p less than 0.001), with a subsequent increase in the T-helper/suppressor ratio (p less than 0.001). The decrease in T-suppressor lymphocytes could play a role in the pathogenesis of acute bronchiolitis, allowing IgE hyperproduction and alveolar mast cell activation, due to the imbalance in helper/suppressor activity.

A combination of cefuroxime and N-acetyl-cysteine for the treatment of lower respiratory tract infections in children.

One hundred and three children with lower respiratory tract infections were treated with a combination of cefuroxime and N-acetyl-cysteine. Positive clinical results were obtained in 100 patients, symptoms being completely relieved in 58 and distinct improvement produced in 42. Chest x-rays provided objective evidence of recovery or improvement in these 100 patients. Of the 72 pathogenic strains isolated before treatment in the trial population as a whole, none were still detectable at the end of treatment. No side effects or adverse reactions of any kind were observed.