Reconstruction of the columella with interposition of nasogenian flaps: A case report.

INTRODUCTION: Reconstructing large defects of the columella and upper lip is an interesting challenge in facial reconstruction due to the high visibility of this aesthetic subunit and the difficulties posed by the unique characteristics of the skin in these areas, which differs from that of the surrounding regions. Among the various techniques proposed, the use of local flaps remains the most commonly used and effective method in this type of reconstruction. PRESENTATION OF THE CASE: A 47-year-old man in good clinical condition presented with a nodular lesion on the columella and upper lip. The lesion was excised (revealing it to be a squamous cell carcinoma) and reconstructed using two opposing nasogenian flaps, resulting in an optimal aesthetic and functional restoration. DISCUSSION: The use of local flaps remains the most effective technique for columella defect reconstruction. However, many described techniques require multiple surgical stages or result in visible scarring. Additionally, they do not guarantee effective reconstruction in cases involving the upper lip. On the other hand, the use of free flaps, while more expensive and requiring expert teams, may not ensure optimal color and skin texture matching. CONCLUSIONS: The use of opposing nasogenian flaps allows for a rapid and effective reconstruction of defects involving the columella and upper lip, leading to a swift return to normal life for the patient.

Surgical approach to a rare case of Beckwith Wiedemann syndrome with left thigh hyperplasia.

Thigh lift surgery is generally performed in patients with severe weight loss outcomes, particularly those undergoing bariatric surgery. However, there are other congenital malformation conditions that may require the same treatment, such as Beckwith Wideman syndrome.

New-onset vitiligo following COVID-19 disease.

Background: Coronavirus disease 2019 (COVID-19) disease and vaccines have been associated to various skin reactions, which are mostly similar amongst them. New onset of vitiligo and hypopigmentations have been described following COVID-19 vaccination, but never after COVID-19 infection. Objectives: We present the case of a 45-year-old woman, who developed vitiligo 2 weeks after COVID-19 disease. Skin lesions stabilized after 1 month of initial spreading. Results: Vitiligo is a relatively common acquired pigmentary disorder, possibly caused by a T CD8+ cell-mediated autoimmune process, which may be enhanced after the immune activation of COVID-19 disease. Molecular mimicry and bystander activation have been advocated as possible pathogenic mechanisms of vitiligo after COVID-19 vaccination. The same mechanisms may also be involved as possible vitiligo triggers during COVID-19 disease. Conclusions: Clinicians should be aware of this possible autoimmune cutaneous reaction to COVID-19 disease.

Greater efficacy of episodic than continuous growth hormone-releasing hormone (GHRH) administration in promoting slow-wave sleep (SWS).

It has been suggested that growth hormone (GH)-releasing hormone (GHRH) stimulates the surge in GH and enhances slow-wave sleep (SWS), two phenomena that characterize the beginning of nocturnal sleep. However, in human studies the effects of systemic GHRH administration on sleep were not consistent. This may reflect the differential influence of administration procedures being episodic in one of the above studies, but either a continuous infusion or a single bolus in the others. The present study in healthy volunteers compared changes in nocturnal sleep following 200 micrograms GHRH administered iv either episodically (4 boluses of 50 micrograms each at 2200, 2300, 2400, and 0100 h) or as a continuous infusion (57 micrograms/h between 2130 and 0100 h). Time spent in stage 4 of SWS on nights of episodic GHRH administration significantly exceeded that on nights of continuous GHRH administration (P < 0.01). Compared with a placebo condition, episodic administration of GHRH enhanced SWS (P < 0.01) and rapid eye movement (REM) sleep (P < 0.05) and diminished time spent in wakefulness and sleep stage 1 (P < 0.05). Effects of continuous GHRH infusion on sleep generally remained insignificant compared with placebo. Plasma GH concentrations were enhanced during both conditions of GHRH administration (P < 0.01), with the increase following episodic administration slightly exceeding that during continuous infusion (P < 0.05). The results support a greater physiological efficacy of episodic GHRH stimulation in promoting sleep.

Brain potential changes after intranasal vs. intravenous administration of vasopressin: evidence for a direct nose-brain pathway for peptide effects in humans.

There is evidence that intranasal application of peptides is a way to circumvent the blood-brain barrier. This led us to compare the effects of arginine-vasopressin (AVP) on event-related potentials (ERPs) in healthy men (n = 15) after intranasal and after intravenous (i.v.) administration. In a double-blind, crossover study, subjects received on three different occasions 20 IU of AVP intranasally (IN), 1.5 IU of AVP i.v., and saline solution. ERPs were recorded during the subject's performance on a auditory attention task. Plasma concentrations of vasopressin during task performance were enhanced after AVP, with the increase after i.v. administration of AVP exceeding that after AVP (p < 0.05). Intranasal administration of AVP substantially increased the P3 component of the ERP (p < 0.05). Intranasal administration of AVP substantially increased the P3 component of the ERP (< 0.01). By contrast, i.v. administration of AVP had no consistent effects on the ERP responses. In supplementary experiments as well, i.v. administration of lower doses of AVP (0.1 and 0.025 IU) did not affect the ERP. Plasma vasopressin concentrations after the 0.025 IU dose in these experiments were comparable to those after intranasal administration of 20 IU AVP. The results provide functional evidence that in the human brain effects of peptides like AVP may be facilitated after IN as compared to i.v. administration.

The angiotensin converting enzyme inhibitors fosinopril and enalapril differ in their central nervous effects in humans.

BACKGROUND: Although the antihypertensive actions of different angiotensin converting enzyme (ACE) inhibitors are comparable, they may affect central nervous activity, mood and well-being differently. Thus, central nervous actions of ACE inhibitors may represent an essential factor determining compliance with antihypertensive therapy. OBJECTIVE: To compare central nervous effects of the biochemically different ACE inhibitors fosinopril and enalapril in healthy men. METHODS: In a double-blind cross-over study, auditory event-related brain potentials and heart rate variability were assessed 6 h after oral intake of placebo, enalapril (10 mg) and fosinopril (20 mg) with the doses being equipotent with regard to systemic ACE inhibition. Plasma concentrations of noradrenaline, adrenaline, vasopressin and cortisol were determined 3 and 6 h after drug intake. Central nervous effects mediated via direct systemic hypotensive actions were avoided (although not completely ruled out) by including only subjects (n = 14) who displayed no substantial drop in blood pressure following intake of the ACE inhibitors. RESULTS: Enalapril, but not fosinopril, enhanced the N1 component and the N1-P2 amplitude of the event-related brain potential (P < 0.05). In addition, enalapril enhanced plasma noradrenaline concentrations (P < 0.05). A similar effect of fosinopril failed to reach significance. There was no clear-cut effect of ACE inhibition on heart rate variability, and also plasma concentrations of adrenaline, vasopressin and cortisol remained unaffected. CONCLUSION: The results suggest an enhancing effect of enalapril on mechanisms regulating stimulus-induced cortical arousal and central nervous sympathetic outflow. The effects diverging between enalapril and fosinopril indicate that access to human brain functions differs among the various types of ACE inhibitors.

Spindle and slow wave rhythms at slow wave sleep transitions are linked to strong shifts in the cortical direct current potential.

Electroencephalographic activity at the transition from wakefulness to sleep is characterized by the appearance of spindles (12-15 Hz) and slow wave rhythms including delta activity (1-4 Hz) and slow oscillations (0.2-1 Hz). While these rhythms originate within neocortico-thalamic circuitry, their emergence during the passage into slow wave sleep (SWS) critically depends on the activity of neuromodulatory systems. Here, we examined the temporal relationships between these electroencephalogram rhythms and the direct current (DC) potential recorded from the scalp in healthy men (n=10) using cross-correlation analyses. Analyses focused on transitions from wakefulness to SWS in the beginning of the sleep period, and from SWS to lighter sleep and rapid eye movement (REM) sleep at the end of the first sleep cycle. For spindle, delta and slow oscillatory activity strong negative correlations with the DC potential were found at the transition into SWS with peak correlation coefficients (at zero time lag) averaging r=-0.81, -0.88 and -0.88, respectively (P<0.001). Though slightly lower, distinct negative correlations between these measures were also found at the transition from SWS to REM sleep (-0.78, -0.77 and -0.77, respectively, P<0.001). Fast oscillatory activity in the beta frequency band (15-25 Hz) was correlated positively with the DC potential (r=+0.75, P<0.05, at the passage to SWS). Data indicate close links between increasing spindle, delta and slow oscillatory activity and the occurrence of a steep surface negative cortical DC potential shift during the transition from wake to SWS. Likewise, a DC potential shift toward surface positivity accompanies the disappearance of these oscillatory phenomena at the end of the non-REM sleep period. The DC potential shifts may reflect gradual changes in extracellular ionic (Ca2+) concentration resulting from the generation of spindle and slow wave rhythms, or influences of neuromodulating systems on cortical excitability thereby controlling the emergence of cortical spindle and slow wave rhythms at SWS transitions.

Slow potential shifts at sleep--wake transitions and shifts between NREM and REM sleep.

Scalp-recorded direct current (DC) potentials and their topographical distribution (F3, F4, C3, C4 and Pz) were investigated at the transition from wakefulness to sleep, and during NREM-REM sleep and REM-NREM sleep transitions in 11 healthy men during normal sleep. Changes in endexpiratory CO2 partial pressure (ETCO2), scalp temperature and polysomnographic data were simultaneously measured. The transition to sleep was associated with a negative potential shift reaching significance bilaterally at frontal and central sites 5 to 10 minutes after sleep onset (p < 0.05). Largest shifts were found at frontal locations 10 to 15 minutes after sleep onset averaging (mean +/- SEM) -512 +/- 103 mu V. Negative DC potential shifts also occurred at the transitions from NREM to REM sleep and from REM to NREM sleep, but were, however, less pronounced. The negative DC shift at NREM-REM sleep transitions preceded the REM sleep onset (assessed conventionally by polysomnographic criteria) by about 1.5 minutes. Changes in temperature, ETCO2 and eye movements were ruled out as factors significantly contributing to the generation of these shifts. Assuming a neuronal origin of the DC potential, the negative shifts at the wake--sleep transition and between NREM and REM sleep suggest a temporary phase of increased cortical excitability.

The incidence of DNA aneuploidy in multiple myeloma does not correlate with stage of disease.

The bone marrow of 47 patients with multiple myeloma (MM), 2 patients with plasma cell leukemia, and 11 patients with monoclonal gammopathy of undetermined significance (MGUS) was analyzed by flow cytometry for the detection of DNA aneuploidy. The question to be addressed was whether a correlation exists between the incidence of DNA aneuploidy and the stage of disease. With one-parameter analysis of DNA staining, a DNA aneuploidy was detectable in 17 of 60 patients. The detection rate for DNA aneuploidies could be increased to 37 of 60 patients with the second method, the simultaneous measurement of DNA content in additional immunophenotyped cells (CD38 or B-B4). In MGUS and the early stages of MM, the discrepancy between both methods was higher than in stage III MM. There were no statistical differences in the incidence of DNA aneuploidy between MGUS or the early stages of MM and stage III MM (21/32 patients vs 16/26 patients). The CD56 expression in plasma cells was significantly higher in cases of DNA aneuploidy (mean +/- SD, 64.7% +/- 33.65% vs 39.3% +/- 36.69%; P = .028). Comparing the ratio of diploid to DNA aneuploid with that of CD56+ to CD56- plasma cells, a correlation was found in MGUS (r = 0.7320) in the early stages of MM, I and II (r = 0.8023), but not in stage III MM. Based on these data, the dual-staining method for DNA content in immunophenotyped cells is preferred for the detection of DNA aneuploidy, especially in the early stages of MM and in MGUS. The clinical importance of a classification of DNA aneuploidy and CD56 antigen expression together is proposed for testing.

Event-related gamma band activity during passive and active oddball tasks.

The EEG was recorded during passive listening and active attending to tone pips of an oddball stimulus sequence, and the time course of event-related gamma band activity (30-60 Hz) was compared with event-related potential (ERP) components. In the conventional frequency range (0.1-4.3 Hz) mismatch negativity (MMN) was produced in the passive listening condition. Concurrent with MMN, the power of event-related gamma activity to the deviant stimulus was higher than gamma activity elicited by the preceding standard stimulus. The transition from the N2b to the P3 wave, produced during active attention, was associated with a decrease in gamma band power upon the deviant tone. The results show the differential generation of gamma band power depending on preattentive and attentive stimulus processing.

Regulation of human thought by neuropeptide ACTH 4-10: an analysis of the EEG's dimensional complexity.

The neuroactive 4-10 fragment of adrenocorticotropin (ACTH 4-10) has been found to impair electroencephalographic (EEG) signs of selective attention in previous studies. It was hypothesized that this effect reflects a more general influence of the peptide weakening the mutual inhibition among frontocortical neuronal networks. Therefore, ACTH 4-10 was expected to loosen attentional control not only over external input but also over internal thoughts. This study examined the effects of ACTH 4-10 on the dimensional complexity of the EEG recorded while subjects solved tasks of convergent analytical thinking and of divergent creative thinking and during mental relaxation. Subjects were tested 30 min after i.v. administration of placebo or ACTH 4-10 (2 mg). ACTH 4-10 enhanced dimensional complexity of the EEG. The effect primarily concerned frontocortical recordings during convergent thinking, which, following placebo, was associated with the lowest EEG dimension. ACTH 4-10 also impaired behavioral performance on tasks of convergent thought, when presented verbally. Results suggest that ACTH 4-10 counteracts the inhibitory control among cortical neuronal networks necessary for orderly analytical thinking.

Sleep and signs of attention during 3 months of intranasal vasopressin: a pilot study in two elderly subjects.

Prominent features of aging include a decrease of attention abilities and loss of sleep. Although acute effects of vasopressin (VP) on these functions in the elderly remained inconsistent, beneficial effects of the peptide may develop only with subchronic treatment, which so far has not been tested. This pilot study examined the changes in: i) event-related brain potentials (ERPs) during an attention task, ii) mood, and iii) nocturnal sleep in two healthy elderly subjects during a 3-month period of VP treatment (40 IU/day). The period of VP treatment was preceded and followed by 4-week periods of placebo treatment. ERPs and mood were not consistently affected by VP. However, unexpectedly, VP improved sleep by markedly enhancing nocturnal slow-wave sleep (SWS, p < 0.05). These findings indicate that effects of subchronic treatment with VP involve mechanisms different from those mediating acute effects.

Scalp recorded direct current (DC) potential shifts associated with food intake in hungry humans.

In humans, eating is assumed to be regulated within a neuronal circuitry integrating hypothalamic "feeding centers" with neocortical regions. Here, DC potentials were recorded in food deprived men to demonstrate a graded tuning of neocortical excitability in conjunction with meal ingestion. In the beginning of food ingestion a pronounced negative DC potential shift developed (P<0.01) which was replaced by a gradual positive potential shift reaching a maximum within 5 min after cessation of food intake (P<0.05). Both negative and positive shifts showed a widespread cortical distribution. The initial negative DC potential presumably reflecting increased depolarisation of apical cortical dendrites, may serve to facilitate eating behavior. The succeeding positivity points to a growing inhibitory influence on cortical processing with increasing satiety that may support termination of meal intake.

EEG synchronization upon reward in man.

OBJECTIVES: It was tested whether reward in humans is associated with EEG synchronization similar to that seen in animals. METHODS: In two experiments (I and II) the EEG was recorded from frontal, central, and parietal positions before, during, and after drinking or oral stimulation. In Experiment I, subjects (n=11) who had either been thirsty for 16h or had quenched thirst before recordings, drank 400ml of water. In Experiment II, thirsty subjects (n=11) either drank 400ml of water or sucked on a soother. The recording epochs included a 3min baseline, an interval of about 5min during which subjects drank or sucked on the soother, and a 7min post-drinking interval. RESULTS: During the drinking epoch, beta band-power (12-30Hz) was enhanced in both conditions of Experiment I and II, respectively. In Experiment I, after drinking, lower alpha power (8-10Hz) was higher when subjects were thirsty than when they were not. Lower alpha was also enhanced in the post-drinking interval of both conditions of Experiment II, and after sucking, lower alpha synchronization was in addition accompanied by increased theta activity (4-8Hz). CONCLUSIONS: Increased beta activity during drinking and sucking in thirsty subjects presumably reflects non-specific activation related to the motivational strength of sensorimotor regulation during consumatory behavior. The thirst dependent lower alpha synchronization after drinking, generated not only by water consumption but also by surrogate oral stimuli, can be considered a reflection of the drive reducing and rewarding qualities of oral stimulation and consumatory behavior.

Drinking related direct current positive potential shift in the human EEG depends on thirst.

Scalp recorded direct current (DC)-potential shifts were examined in 11 human subjects who had either thirsted for 16 h or had quenched thirst before recordings. The recording epoch included a 3-min baseline, an interval of about 5 min during which subjects drank 400 ml of water, and a 7-min post-drinking interval. Consistent with previous data, when thirsty, subjects displayed a widespread negative DC-potential shift during drinking which was replaced by a positive DC shift at the transition to the post-drinking interval. The positivity after drinking lasted for about 2 min and averaged 146 microV at frontal recording sites. Quenching thirst before recordings reduced the positive DC-potential shift upon drinking, whereas changes in preceding drinking related DC negativity appeared to be secondary. The post-drinking positive DC-potential shift depending on the subject's motivational state can be considered an indicator of reward associated with quenching thirst, pointing to a lowered frontocortical excitability during reward.

Enhanced dynamic complexity in the human EEG during creative thinking.

This study shows that divergent thinking, considered the general process underlying creative production, can be distinguished from convergent, analytical thought based on the dimensional complexity of ongoing electroencephalographic (EEG) activity. EEG complexity over the central and posterior cortex was higher while subjects solved tasks of divergent than convergent thinking, and also higher than during mental relaxation. Over the frontal cortex, EEG complexity was comparable during divergent thinking and mental relaxation, but reduced during convergent thinking. Results indicate that the basic process underlying the generation of novel ideas expresses itself in a strong increase in the EEG's complexity, reflecting higher degrees of freedom in the competitive interactions among cortical neuron assemblies. Frontocortical EEG complexity being comparable with that during mental relaxation, speaks for a loosened attentional control during creative thinking.

Rhythms of pituitary-adrenal activity during sleep in patients with Cushing's disease.

Previous studies have indicated a dependence of nocturnal pituitary-adrenal secretory activity on central nervous sleep processes in healthy humans: Under normal physiological conditions the release of ACTH/cortisol is inhibited during early sleep and becomes entrained to periods of NonREM sleep during late sleep. Here, we compared nocturnal dynamics in plasma concentrations of ACTH/cortisol in 7 patients with Cushing's disease with those of 7 healthy controls matched in age and sex with the patients. The patients in part were repeatedly tested. The total of 13 nights is composed of 7 nights of hyperpulsatile secretion pattern (5 patients) and 6 nights from hypopulsatile secretion pattern (4 patients). After an adaptation night polysomnographic sleep recordings were obtained and blood was sampled every 15 min between 23.00 and 7.00 h. Controls displayed the typical minimum in ACTH/cortisol concentrations during the early part of the night and maximum concentrations during the late part of the night, whereas ACTH/cortisol levels of Cushing patients indicated a relatively constant elevated pituitary-adrenal activity throughout the night, lacking any circadian variation. Autocorrelation functions revealed the presence of cortisol secretory rhythms with a similar period length in healthy controls (155.6+/-17.4 min) and patients with a hyperpulsatile pattern (142.4+/-6.6 min). In patients displaying hypopulsatility, no significant rhythmicity was observed. However, regardless of the type of secretory pulsatility, adrenal secretory activity started predominantly during periods of NonREM sleep (p<0.01) in healthy controls as well as in patients with Cushing's disease. This data indicates that the normal nocturnal circadian oscillation of pituitary-adrenal activity is absent in Cushing patients, whereas a link between pituitary-adrenal activity and ultradian rhythms of sleep appears to be preserved.

Orthopantomography and the determination of majority age.

The problem of determining a subject's age to ascertain whether he can be criminally charged brings to prominence all the methods of investigation which can be used to define a person's biological age. The methodologies used to determine dental age still represent today the most sensitive means of arriving at this end. Researchers in Turin in 1980 elaborated an equational formula to determine a subject's presumable age by means of orthopantomography, basing the examination on the mineralization times of 4.5, 4.7, 4.8. After thorough checks carried out on sample groups of urban inhabitants, it was noted that the phases of mineralization of the 3rd molar can provide an answer to the judicial authorities' query as to whether the subject in question has come of age. The phase of mineralization of the 3rd molar is evaluated according to the table we have proposed during a previous conference and in another paper, which establishes 12 phases of mineralization. Focusing our attention on the final 12th phase, corresponding to the complete mineralization of the tooth roots, it was noted that this was present in 93 subjects, of whom 43 male and 50 female. A check of the personal data of these subjects revealed that for the male group age was between 6875 and 9396 days (between 18 years 10 months and 25 years 9 months), whereas for the female group age was between 6711 and 9275 days (between 18 years 4 months and 25 years 5 months). In other words, none of the subjects was found to be under 18 years of age.

Mental comparison of visually presented two-digit numbers: a P300 study.

Comparison processes were investigated in a multiple-stimulus paradigm with a pseudo-random sequence of visually presented numbers 11 to 20. The subjects' task was to compare each current number with the preceding one and to indicate whether it was larger or smaller. ERPs were selectively averaged for the 10 number stimuli, for three functional conditions according to the information the numbers provide about the ensuing response and for the differences between consecutive numbers. P300 amplitude averaged for each number stimulus showed a U-shaped trend with largest amplitudes for the numbers 11 and 20. It was found that P300 amplitudes change with the amount of information the current number is delivering for the ensuing response. This information delivery is related to the processing in the subsequent trial, as revealed by a negative correlation between P300 in the current trial and RT in the ensuing trial. Reaction times decreased significantly with increasing difference between the current number and the preceding one. This symbolic distance effect was not found for P300 parameters. The dissociation between RT and P300 data provides evidence for the assumption that under the present experimental conditions informational transaction leading to the distance effect occur after the elicitation of P300.