Population structure of invasive Streptococcus pneumoniae isolates in Italy prior to the implementation of the 7-valent conjugate vaccine (1999-2003).

A total of 773 pneumococcal isolates were collected from a nationwide surveillance of invasive pneumococcal diseases during 1999-2003 prior to the implementation of the 7-valent conjugate vaccine (PCV7) in Italy. The isolates included vaccine serotypes (VS, 393 isolates), vaccine-related serotypes (VRS, 93), and nonvaccine serotypes (NVS, 279). The ten most prevalent serotypes were: 14 (16.4%), 3 (8.4%), 23F (8%), 19F (7.4%), 4 (5.9%), 7F (5.8%), 9V (5.3%), 6B (4.9%), 19A (4.7%), and 1 (3.7%). VRS or NVS isolates showed a lower rate of penicillin or drug resistance than VS. Representative isolates of the major VS, VRS, and NVS were genotyped by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The isolates examined were found to belong to 18 international clones and to eight newly described clones. VS isolates sharing clonal groups with VRS or NVS were also detected. Evidence of a past history of capsular switching events was observed in five clones.

LTD-like plasticity induced by paired associative stimulation: direct evidence in humans.

Paired associative stimulation (PAS), in which peripheral nerve stimuli are followed by transcranial magnetic stimulation (TMS) of the motor cortex, may produce a long lasting change in cortical excitability. At an interstimulus interval slightly shorter than the time needed for the afferent inputs to reach cerebral cortex (10 ms), motor cortex excitability decreases. Indirect data support the hypothesis that PAS at this interval (PAS10) involves LTD like-changes in cortical synapses. The aim of present paper was to investigate more directly PAS10 effects. We recorded corticospinal descending volleys evoked by single pulse TMS before and after PAS10 in two conscious subjects who had a high cervical epidural electrode implanted for pain control. These synchronous volleys provide a measure of cortical synaptic activity. PAS10 significantly reduced the amplitude of later descending waves while the earliest descending wave was not modified. Present results confirm the cortical origin of the effect of PAS10.

BDNF plasma levels in acute stroke.

The transport of brain derived neurotrophic factor (BDNF) across the blood-brain barrier (BBB) is negligible in normal conditions. However, BDNF might pass through the BBB when BBB is disrupted by a pathological condition such as stroke. This migration of BDNF through the BBB might be important during post-ischemic phase since BDNF can exert a protective action in the site of lesion. This study aimed to investigate plasma levels of BDNF in the acute phase of stroke in humans. Serial venous blood samples were taken in ten patients with acute stroke at the admission to the Stroke Unit and on the following 4 days. In the same samples we also evaluated the plasma levels of S100beta protein, a marker of BBB disruption. There was no significant change in BDNF plasma levels in our patients, even in the presence of a pronounced BBB dysfunction, as demonstrated by a significant increase of S100beta protein concentrations at days 2 and 3 after stroke. Our data, though indirectly, suggest that there is no significant increase in endogenous extracellular BDNF after a stroke in humans.

Neurobiological after-effects of non-invasive brain stimulation.

BACKGROUND: In recent years, many studies have evaluated the effects of noninvasive brain stimulation (NIBS) techniques for the treatment of several neurological and psychiatric disorders. Positive results led to approval of NIBS for some of these conditions by the Food and Drug Administration in the USA. The therapeutic effects of NIBS have been related to bi-directional changes in cortical excitability with the direction of change depending on the choice of stimulation protocol. Although after-effects are mostly short lived, complex neurobiological mechanisms related to changes in synaptic excitability bear the potential to further induce therapy-relevant lasting changes. OBJECTIVE: To review recent neurobiological findings obtained from in vitro and in vivo studies that highlight molecular and cellular mechanisms of short- and long-term changes of synaptic plasticity after NIBS. FINDINGS: Long-term potentiation (LTP) and depression (LTD) phenomena by itself are insufficient in explaining the early and long term changes taking place after short episodes of NIBS. Preliminary experimental studies indicate a complex scenario potentially relevant to the therapeutic effects of NIBS, including gene activation/regulation, de novo protein expression, morphological changes, changes in intrinsic firing properties and modified network properties resulting from changed inhibition, homeostatic processes and glial function. CONCLUSIONS: This review brings into focus the neurobiological mechanisms underlying long-term after-effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) recently obtained from in vitro and in vivo studies, both in animals and humans.

Factors associated with 1-year outcome of major depression in the community.

Evidence from outcome studies of major depression indicates a high rate of relapse and chronicity, and that prior chronicity, recurrent episodes, and the presence of psychosocial stressors are associated with a poor outcome. However, the generalizability of these findings is limited because most studies have focused on treated samples; thus, these studies may have been biased toward more chronic or severe illnesses. In prospectively surveying a large probability sample of the general population, the Epidemiologic Catchment Area program offers the opportunity to investigate prognosis without selection bias. In this study, the Epidemiologic Catchment Area subjects with a diagnosis of Major Depressive Disorder at first interview (n = 423) were categorized according to their diagnostic status 1 year later. The results confirmed a high rate of nonrecovery, with clinical features associated with a poor outcome that resembled those identified in previous clinical studies. Overall, clinical factors were more important prognostically than were sociodemographic characteristics. However, there was some evidence that a poorer outcome in older women may partially explain the greater female prevalence of depression in the community.

Rational use of antibiotics in acute uncomplicated cystitis: a pharmaco-epidemiological study.

Uncomplicated community-acquired urinary tract infections are among those most commonly found in clinical practice, resulting in significant morbidity and health care costs. Current management is usually empirical because of the narrow and predictable spectrum of etiologic agents that cause acute cystitis and their susceptibility patterns. However, since antimicrobial resistance is increasing, the use narrow-spectrum, inexpensive antimicrobial agents becomes less feasible. In our study we have evaluated the effectiveness of amoxicillin, a narrow-spectrum, inexpensive and non toxic drug, against non-complicated acute cystitis in 34 patients, and compared the results with the antibiotic therapy previously employed by the physicians of the Health Care Unit of Paola (CS), Italy. Amoxicillin was found to be effective for the treatment of community-acquired cystitis, thus suggesting that the development of bacterial resistance does not represent a limit to its use. Furthermore, our study demonstrates that besides providing an effective alternative to broad-spectrum antibiotics, the use of amoxicillin significantly reduced health care costs.

The epidemiology of dysthymia in five communities: rates, risks, comorbidity, and treatment.

Data from a survey of five U.S. communities showed that dysthymia affected approximately 3% of the adult population. It was more common in women under age 65, unmarried persons, and young persons with low income and was associated with greater use of general health and psychiatric services and psychotropic drugs. Dysthymia had a high comorbidity with other psychiatric disorders, particularly major depression; only about 25%-30% of cases occur over a lifetime in the absence of other psychiatric disorders. The findings suggest that although the onset and highest risk periods of major depression and bipolar disorder are in young adulthood, a residual state of dysthymia occurs in middle and old age.

Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study.

OBJECTIVE: This study examined the effects of nine axis I psychiatric disorders, as assessed by the Diagnostic Interview Schedule, on the risk of mortality over a 9-year period among a community sample of 3,560 men and women aged 40 and older. METHOD: The study identified the vital status as of Oct. 1, 1989, of respondents who were first interviewed in 1980 by the New Haven Epidemiologic Catchment Area study. Mortality risk by psychiatric status was estimated by using Cox proportional hazards models. RESULTS: Nine years after the baseline interview, it was confirmed that 1,194 (33.5%) of the respondents were deceased and 2,344 (65.8%) survived; the vital status of 22 (0.6%) remained unknown. When the relative risk of mortality was adjusted for age, several disorders--major depression, alcohol abuse or dependence, and schizophrenia--increased the likelihood of mortality. CONCLUSIONS: These data are further evidence of the negative outcome of some psychiatric problems even when assessed in community samples. The relatively high prevalence of depression and alcohol disorders indicates the far-reaching impact that these problems have on community health in general.

Reliability of self-reported age at onset of major depression.

Reliability of self-reported age at onset of major depressive disorder was studied in a sample of 335 subjects who were ascertained from a large epidemiologic survey conducted in several U.S. communities and who were interviewed blindly at two different times. Reliability was generally good for these subjects who met DSM-III criteria for depression at two interviews. A large proportion of the variability in the difference of test-retest values can be accounted for by recency of last episode of depression and interactions of age with duration of illness, having been treated for a mental health problem, and comorbidity of other mental disorders. Interactions between duration and comorbidity and between geographic region and treatment were also significant. Contrary to previous studies which do not consider the interval between current age and age at onset and which suggest that reliability diminishes with age, our findings show that older respondents tend to systematically decrease and not increase age at onset across the two interviews. These findings do not support the hypothesis that recently reported secular changes in major depression, including a decreased age at onset and higher rates in younger as compared to older cohorts, can be explained by a differential reporting effect. Furthermore, the findings suggest that factors which contribute to variability in an individual's age at onset should be incorporated in genetic and clinical studies of major depression.

Assessing the value of a short-term residential drug treatment program for homeless men.

Cocaine and other substance abuse has been found to be a contributing or primary cause of homelessness in urban men. This project evaluated the effectiveness of the Grant Street Partnership (GSP), a shelter-based treatment program for homeless, cocaine-abusing men, consisting of 90 days of residential treatment and 6 months of aftercare. We tested the hypothesis that the 182 men randomized to the GSP group, as compared to the 112 men randomized to a "usual services" group, would show significantly greater improvement over time in the areas of drug use and residential and economic stability. An 80% response rate was achieved overall for the five follow-up points. Cocaine use, defined as use of cocaine at least once in the prior 30 days, declined from about 90% at baseline for both groups to 11% in the GSP group and 55% in the control group at 21 months. The GSP group was also more likely than the usual services group to have achieved residential stability by the time of the 9 month follow-up. Neither group experienced an improvement over time in employment status.

A new phosphate-selective sorbent for the Rem Nut process. Laboratory investigation and field experience at a medium size wastewater treatment plant.

P-control technologies for municipal wastewater are essentially based on "destructive" methods, that lead to formation of concentrated solid-phases (sludge), usually disposed-off in controlled landfills. Ion exchange, as a "non-destructive" technology, allows for selective removal and simultaneous recovery of pollutants, which can be recycled to the same and/or related productive lines. In this context, the REM NUT process removes nutrient species (HPO4 = , NH4+, K+) present in biologically oxidised municipal effluents and recovers them in the form of struvites (MgNH4PO4; MgKPO4), premium quality slow release fertilisers. The main limitation to the extensive application of this ion exchange based process is the non-availability of selective exchangers for specific removal of nutrient species. This paper illustrates laboratory investigation and pilot scale development of a so-called "P-driven" modified REM NUT scheme based on a new phosphate-selective sorbent developed at Lehigh University, PA, USA.

Rem nut ion exchange plus struvite precipitation process.

Nutrients control technologies from wastewater are based on destructive technologies which defer the problem fromthe diluted liquid-phase (effluent) to a more concentrated waste (sludge) in the case of phosphates, or to nitrogen gas and/or volatile compounds in the case of ammonia. The REM NUT process allows for simultaneous removal of phosphate and ammonium ions by selective ion exchange and recovery by chemical precipitation in the form of struvite (magnesium ammonium phosphate) from the spent exchangers regeneration eluates. In the paper revised versions of the REM NUT process, i.e., P-driven layouts, are presented and cost effectiveness is compared to chemical precipitation based on the use of ferric chloride.

[Dentinogenesis imperfecta. Scanning electron microscopic study and microanalysis]. / Dentinogenesi imperfetta. Studio al microscopio elettronico a scansione e microanalisi.

BACKGROUND: Dentinogenesis imperfecta (DI) is an inherited dentine defect which affects both the primary and secondary dentitions. Shields et al. in 1973 suggested a classification of DI within three types: type I, associated with osteogenesis imperfecta (OI), type II and type III. Although the varying clinical, radiographic and histological findings in DI have been described in detail, an available method for closer examination of the abnormal dentine matrix, electron microscopy, has seldom been used. Scanning and transmission electron microscopy studies can help to understand the pathogenesis of the different types of heritable dentine defects and the diagnosis and classification of these diseases. The aim of the present study was to evaluate a case of DI using scanning electron microscopy and microanalysis. METHODS: Dentine was obtained from tooth samples from a fourteen-year-old boy affected by DI and from third molars extracted for therapeutic reasons used as controls. Samples were observed with a scanning electron microscope, scanning electron micrographs were evaluated with an image analysis program and specimens were finally observed with a scanning electron microscope equipped for micro-analysis. RESULTS AND CONCLUSIONS: The results obtained showed that the total number of dentinal tubules was significantly reduced and the presence of a dentine mineralization defect in the patient affected by DI, in comparison to the controls.

Synaptic plasticity in neurodegenerative diseases evaluated and modulated by in vivo neurophysiological techniques.

Several studies demonstrated in experimental models and in humans synaptic plasticity impairment in some neurodegenerative and neuropsychiatric diseases such as Parkinson's disease, Alzheimer's disease, Huntington's disease, and schizophrenia. Recently new neurophysiological tools, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been introduced in experimental and clinical settings for studying physiology of the brain and modulating cortical activity. These techniques use noninvasive transcranial electrical or magnetic stimulation to modulate neurons activity in the human brain. Cortical stimulation might enhance or inhibit the activity of cortico-subcortical networks, depending on stimulus frequency and intensity, current polarity, and other stimulation parameters such as the configuration of the induced electric field and stimulation protocols. On this basis, in the last two decades, these techniques have rapidly become valuable tools to investigate physiology of the human brain and have been applied to treat drug-resistant neurological and psychiatric diseases. Here we describe these techniques and discuss the mechanisms that may explain these effects.

Repetitive transcranial magnetic stimulation for ALS.

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease affecting upper and lower motor neurons characterized by progressive weakness, respiratory failure and death within 3-5 years. It has been proposed that glutamate-related excitotoxicity may promote motor neuron death in ALS. Glutamatergic circuits of the human motor cortex can be activated noninvasively using transcranial magnetic stimulation (TMS) of the brain, and repetitive TMS (rTMS) can produce changes in neurotransmission that outlast the period of stimulation. In recent years a remarkable number of papers about the potential effects of rTMS in several neurological disorders including ALS has been published. Preliminary studies have shown that rTMS of the motor cortex, at frequencies that decrease cortical excitability, causes a slight slowing in the progression rate of ALS, suggesting that these effects might be related to a diminution of glutamate-driven excitotoxicity. RTMS could also interfere with motor neuron death through different mechanisms: rTMS could modulate the production of brain-derived neurotrophic factor (BDNF), a potent survival factor for neurons, that in turn might represent a promoter of motor neuron sparing in ALS. Despite some promising preliminary data, recent studies have demonstrated a lack of significant long-term beneficial effects of rTMS on neurological deterioration in ALS. However, further studies are warranted to evaluate the potential efficacy of different protocols of motor cortex stimulation (in terms of technique, duration and frequency of stimulation), particularly during the early stages of the disease when the progression rate is more pronounced.