Early life stress and the anxious brain: evidence for a neural mechanism linking childhood emotional maltreatment to anxiety in adulthood.

BACKGROUND: Childhood emotional maltreatment (CEM) increases the likelihood of developing an anxiety disorder in adulthood, but the neural processes underlying conferment of this risk have not been established. Here, we test the potential for neuroimaging the adult brain to inform understanding of the mechanism linking CEM to adult anxiety symptoms. METHOD: One hundred eighty-two adults (148 females, 34 males) with a normal-to-clinical range of anxiety symptoms underwent structural and functional magnetic resonance imaging while completing an emotion-processing paradigm with facial expressions of fear, anger, and happiness. Participants completed self-report measures of CEM and current anxiety symptoms. Voxelwise mediation analyses on gray-matter volumes and activation to each emotion condition were used to identify candidate brain mechanisms relating CEM to anxiety in adulthood. RESULTS: During processing of fear and anger faces, greater amygdala and less right dorsolateral prefrontal (dlPFC) activation partially mediated the positive relationship between CEM and anxiety symptoms. Greater right posterior insula activation to fear also partially mediated this relationship, as did greater ventral anterior cingulate (ACC) and less dorsal ACC activation to anger. Responses to happy faces in these regions did not mediate the CEM-anxiety relationship. Smaller right dlPFC gray-matter volumes also partially mediated the CEM-anxiety relationship. CONCLUSIONS: Activation patterns of the adult brain demonstrate the potential to inform mechanistic accounts of the CEM conferment of anxiety symptoms. Results support the hypothesis that exaggerated limbic activation to negative valence facial emotions links CEM to anxiety symptoms, which may be consequent to a breakdown of cortical regulatory processes.

Dientamoeba fragilis is more prevalent than Giardia duodenalis in children and adults attending a day care centre in Central Italy.

Giardia duodenalis is a well recognised enteropathogen, while Dientamoeba fragilis is rarely detected and consequently it is not recognised as an important human pathogen. In 2002-2003, a survey has been carried out on enteroparasites in faecal samples of outpatients attending a day care centre in the town of Perugia (Central Italy). To improve the detection level, at least three samples from each patient were collected at different days and within two hours from defecation. The coproparasitological examination has been carried out by direct microscopic examination, faecal concentration, and Giemsa and modified Ziehl-Nielsen stainings of faecal smears. The genotypes of Giardia duodenalis isolates were determined by PCR of the beta-giardin gene. Of 1,989 enrolled people (966 children, 1,023 adults), 165 persons (8.3%; 153 adults, 15.0%; 12 children, 1.2%), were positive for parasites, but only 1 12 adults (73.2% of those infected) and eight children (66.7% of those infected) harboured D. fragilis and G. duodenalis. Both the Assemblages A and B were detected in 18 G. duodenalis isolates examined at the beta-giardin gene. The higher prevalence of D. fragilis infections than that of G. duodenalis is probably related to the method used, a procedure, which is rarely followed in laboratories for the diagnosis of enteric parasites. These epidemiological data suggest that when faecal samples are examined after a period of time and without Giemsa staining, most D. fragilis infections goes undetected.

[Cervico-vaginal pathogens and contraception: microbiological observations]. / Patogeni cervico-vaginali e contraccezione: osservazioni microbiologiche.

The authors relate the results about 172 vaginal and cervical swabs, in women with or without oral/local (IUD) contraception, with or without vaginosis/vaginitis. Gardnerella vaginalis was always prevalent; the authors observed an high correlation between cervical IUD and vaginal Gardnerella, more than IUD and cervical Chlamydia trachomatis. Bacterial associations in Gardnerella vaginalis (Mobiluncus, obligate anaerobes) are related; incidence of Candida and Trichomonas vaginalis are reported; correlation between these microbial agents and contraception are discussed.

PIP: During 1986, 172 female patients aged 17-71 were examined to assess the relationship of contraceptives and pathogens. 18 women used oral contraceptives (OCs), 24 used IUDs, 52 had cervico-vaginal infections, and 78 were healthy and asymptomatic without risk factors (OC use, IUDs, or pregnancies). The ELISA immunoenzymatic system and the immunofluorescence method were utilized. In 50 controls (64% of 78 cases) lactobacillus bacillus was detected in the specimens taken by swabs in 28 cases (36%) other microorganisms were found: Gardnerella vaginalis in 6 cases, 3 different streptococci in 10 cases, staphylococcus and Escherichia coli in 2 cases each, and candida in 10 cases. Among 23 sick women, there were 4 cases of chlamydia, and, in a subgroup of 19 women G. vaginalis was observed in 12 cases (63%) and candida in 4 cases (21%). Another 29 women of the 52 with infections presented 20 cases (69%) of G. vaginalis, 4 cases of mobiluncus, 4 cases of trichomonas vaginalis, and 3 cases of candida. Among the 52 infected women, the most frequent agent was G. vaginalis (67%), followed by mobiluncus (19%), candida (13.5%), trichomonas (13.5%), and chlamydia (17%). Among 24 IUD users, the incidence of pathogens was: lactobacillus 100% of chlamydia in 3 cases, and G. vaginalis in 2 cases. Among 18 OC users, chlamydia was frequent, followed by G. vaginalis, trichomonas, and candida. The association of IUD use to Gardrerella was 70%, IUDs to Chlamydia was 33%, OC use to Gardnerella 33%, and OCs to candida 11%. These results indicate that periodic examinations prior to and after insertion of an IUD are useful to detect pathogens in the cervico- vaginal environment, prevent their spreads and avert infection.

[Urethral infections caused by Chlamydia trachomatis: indirect serological diagnosis]. / Infezioni uretrali da "Chlamydia trachomatis": diagnosi indiretta sierologica.

The authors relate serological inquires (micro-immunofluorescent assay), for valuing the specifical antibody response anti-Chlamydia trachomatis, in acute urethritis. In 53% of cases a immunological response was present and in 18% of the cases was high and significant. Medium title was 1:28. In normal people the medium title was 1:10, and antibodies to Chlamydia were present in 8% of cases. The authors point out the importance and utility of a correct operative protocol for an efficacious diagnosis and for a correct therapy.

[Prevention of reinfarction: a global strategy]. / Prevenzione del reinfarto: strategia globale.

Reinfarction occurs in approximately 10-20% of patients with acute myocardial infarction with an year incidence of about 3% for males and 9% for females. The reinfarction induces a worsen prognosis by producing arrhythmias and a new ventricular "remodelling" with an increase in sudden death and cardiogenic shock. The new event may occur, early or later, in regions either adjacent to or remote from the initial myocardial infarction. Among all the patients admitted to our coronary care unit (1181) during the last 6 years, the overall reinfarction rate was 11.4%; among these, 46% were in the same side (SSMI), while 54% in the distant side (DSMI). The SSMI occurred more often during early months after infarction, while the DSMI occurred significantly later. Cigarettes smoking has been shown to be a common and often the only risk factor in patients with early reinfarction; while arterial hypertension, mostly associated with diabetes and hypercholesterolemia, was found the most important risk factor in later reinfarctions. SSMI was strongly related to one coronary vessel disease or to a double vessel disease (especially with interventricular artery and right coronary artery); while DSMI occurred in presence of triple coronary vessel disease involving secondary branches. The later SSMI is related to serious impairment of left ventricular function in 30% of patients, with cardiogenic shock and death evolution in 25%. The clinical trials for prevention of reinfarction showed that the correction of risk factors and the use of anticoagulation and/or antiaggregation therapy, beta-blockers or Ca(++)-antagonist drugs, must be chosen in relation to the myocardial damage related to previous infarct. In all the patients follow-up during the acute, subacute and chronic phases, must be performed by clinical and instrumental controls able to evidence the developing new cardiovascular events in order to decision making.