Sleep changes during a spontaneous manic episode: PSG assessment in a clinical context.

Sleep plays a key role in the pathogenesis and clinical presentation of mood disorders. However, only a few studies have investigated sleep architecture during the manic episodes of Bipolar Disorder (BD) and changes in sleep parameters that follow clinical variations. Twenty-one patients (8 males, 13 females) affected by BD, manic phase, underwent polysomnographic recordings (PSG) at the beginning of the admission in our ward (T0) and after three weeks of hospital treatment (T1). All participants were clinically evaluated using Young Mania Rating Scale (YMRS), Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ). During the admission, we observed an increase in both quantity (Total Sleep Time - TST) and quality (Sleep Efficiency - SE) of sleep. In addition, clinical improvement, evaluated with YMRS and PSQI scales, was accompanied by a significant increase in the percentage of REM sleep. According to our findings, the improvement of manic symptoms is accompanied by an increase in "REM pressure" (increase in REM% and REM density, reduction of REM latency). Overall, changes in sleep architecture appear to be markers sensitive to clinical variations during manic phases of Bipolar Disorder.

An objective method to assess the improvements of skin texture roughness after botulinum toxin type a treatment of crow's feet.

BACKGROUND: Photo-numeric scales could lack precision and objectivity on evaluating the improvements on wrinkles after a treatment with botulinum toxin type A. The authors suggest a new digital evaluation method to analyze its effectiveness. OBJECTIVES: This study aims to investigate retrospectively the effect of intramuscular injection of botulinum toxin type A on skin texture in the lateral peri-orbital region with a new objective method. METHODS: Skin texture roughness (STR) in the lateral peri-orbital region is evaluated with a multi-directional light beam by light emitting diodes of different wavelengths (Antera 3D® ), before and after injections of 12 units of botulinum toxin type A. The wrinkles and lines deeper than 0.5 mm are filtered to measure accurately skin texture. RESULTS: We observed an improvement of STR in all cases treated with botulinum toxin type A. A significant decrease of STR was recorded as follows: 17.08% (P < .0001) at 4 weeks and 12.14% at 4 months (P = .001). CONCLUSION: Botulinum toxin type A treatment of crow's feet was able to improve STR. The Antera® device and software are a valuable, objective, easy and reproducible method to assess the effects of the toxin.

Presence of cancer cells in gastric lavage of gastric cancer patients as an indicator of advanced disease, predictor of tumour aggressive phenotype and independent prognostic factor for poor survival: The endoluminal metastatic pathway of gastric cancer and GL0/GL1 classification.

OBJECTIVE: As of 2017, the pathobiology of gastric cancer (GC) is far from fully understood; consequently, new methods of basic and advanced research have been proposed and tested. The presence (GL1) vs absence (GL0) of malignant cells exfoliated in gastric lavage (GL) of GC patients was formerly evaluated with diagnostic intent but not for staging or prognostic assessment. We investigated this hitherto unreported application of cytopathology. METHODS: GL was preoperatively and prospectively collected from 80 GC patients and cytologically analysed. The results were compared with the classic clinicopathological features of GC and related to survival. The prognostic value of GL1 was assessed through univariate and multivariate analyses. RESULTS: GL1 was detected in 36 samples (45%) and correlated with advanced tumour depth (T3-T4), lymphatic metastasis (N+), distant metastasis (M1) and lymphovascular invasion (LVI1; P=.0317, .0024, .003 and .0028, respectively). Overall survival (OS) was significantly shorter for GL1 (23 months) vs GL0 patients (42 months; P=.005) and GL1 vs GL0 T1 subjects (12.6 vs 47.8 months, P=.0029). Univariate analysis revealed that GL1, N+, M1, LVI1 and advanced stage were significantly associated with OS. Multivariate analysis assessed GL1 as the only independent prognostic factor for worse OS and progression-free survival (P=.0013 and .0107). CONCLUSIONS: In the present study, GL1 was correlated with advanced disease, aggressive tumour behaviour and poor prognosis. Although additional studies are needed to confirm these findings, the GL0/GL1 classification can be applied to GC patients to achieve higher accuracy in staging, prognostic stratification and treatment selection.

Quantifying the critical thickness of electron hybridization in spintronics materials.

In the rapidly growing field of spintronics, simultaneous control of electronic and magnetic properties is essential, and the perspective of building novel phases is directly linked to the control of tuning parameters, for example, thickness and doping. Looking at the relevant effects in interface-driven spintronics, the reduced symmetry at a surface and interface corresponds to a severe modification of the overlap of electron orbitals, that is, to a change of electron hybridization. Here we report a chemically and magnetically sensitive depth-dependent analysis of two paradigmatic systems, namely La1-xSrxMnO3 and (Ga,Mn)As. Supported by cluster calculations, we find a crossover between surface and bulk in the electron hybridization/correlation and we identify a spectroscopic fingerprint of bulk metallic character and ferromagnetism versus depth. The critical thickness and the gradient of hybridization are measured, setting an intrinsic limit of 3 and 10 unit cells from the surface, respectively, for (Ga,Mn)As and La1-xSrxMnO3, for fully restoring bulk properties.

Magnetic hydroxyapatite coatings as a new tool in medicine: A scanning probe investigation.

Hydroxyapatite films enriched with magnetite have been fabricated via a Pulsed Plasma Deposition (PPD) system with the final aim of representing a new platform able to disincentivate bacterial adhesion and biofilm formation. The chemical composition and magnetic properties of films were respectively examined by X-ray photoelectron spectroscopy (XPS) and Superconducting Quantum Interference Device (SQUID) measurements. The morphology and conductive properties of the magnetic films were investigated via a combination of scanning probe technologies including atomic force microscopy (AFM), electrostatic force microscopy (EFM), and scanning tunneling microscopy (STM). Interestingly, the range of adopted techniques allowed determining the preservation of the chemical composition and magnetic properties of the deposition target material while STM analysis provided new insights on the presence of surface inhomogeneities, revealing the presence of magnetite-rich islands over length scales compatible with the applications. Finally, preliminary results of bacterial adhesion tests, indicated a higher ability of magnetic hydroxyapatite films to reduce Escherichia coli adhesion at 4h from seeding compared to control hydroxyapatite films.

Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs.

IMPORTANCE: The prognostic role of high blood pressure and the aggressiveness of blood pressure lowering in dementia are not well characterized. OBJECTIVE: To assess whether office blood pressure, ambulatory blood pressure monitoring, or the use of antihypertensive drugs (AHDs) predict the progression of cognitive decline in patients with overt dementia and mild cognitive impairment (MCI). DESIGN, SETTING, AND PARTICIPANTS: Cohort study between June 1, 2009, and December 31, 2012, with a median 9-month follow-up of patients with dementia and MCI in 2 outpatient memory clinics. MAIN OUTCOMES AND MEASURES: Cognitive decline, defined as a Mini-Mental State Examination (MMSE) score change between baseline and follow-up. RESULTS: We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4). Among them, 68.0% had dementia, 32.0% had MCI, and 69.8% were being treated with AHDs. Patients in the lowest tertile of daytime systolic blood pressure (SBP) (≤ 128 mm Hg) showed a greater MMSE score change (mean [SD], -2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], -0.7 [2.5]; P = .002) and patients in the highest tertile (≥ 145 mm Hg) (mean [SD], -0.7 [3.7]; P = .003). The association was significant in the dementia and MCI subgroups only among patients treated with AHDs. In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups. The association between office SBP and MMSE score change was weaker. Other ambulatory blood pressure monitoring variables were not associated with MMSE score change. CONCLUSIONS AND RELEVANCE: Low daytime SBP was independently associated with a greater progression of cognitive decline in older patients with dementia and MCI among those treated with AHDs. Excessive SBP lowering may be harmful for older patients with cognitive impairment. Ambulatory blood pressure monitoring can be useful to help avoid high blood pressure overtreatment in this population.

Relationship between primary headache and nutrition: a questionnaire about dietary habits of patients with headache.

The role of food associated with the headache has been the subject of scientific research since 1900, especially for migraine patients. A substantial proportion of patients (ranging from 12 to 60 %) report that their migraine attacks may be precipitated by dietary elements, certain eating habits (fasting) and abuse (caffeine and alcoholic beverages abuse and withdrawal). The biological mechanism by means of triggers in general and food in particular precipitate migraine attacks remains obscure. Based on the data in the literature, we performed an osservational study searching for possible correlations between nutrition and primary headaches. We enrolled 50 consecutive patients from the Headache Center of the Neurology Department of Hospital "Cardinal Massaia" of Asti and submitted them a 14-item questionnaire for the assessment of relationship between primary headache and food. Our preliminary data, although the follow up is still in progress, show that there are strong associations between the onset of the headache and dietary habits. It will be necessary to analyze a larger sample in order to draw more precise conclusions on this topic.

Ulcer piercing: cleansing of complicated diabetic neuropathic foot ulcers by positive pressure irrigation.

OBJECTIVE: To demonstrate the efficacy of the ulcer piercing procedure, which allows constant cleansing of the ulcer and facilitates a positive pressure irrigation of any pierced hidden tracts, in order to reduce the negative impact of stasis on wound healing. METHOD: We designed a surgical procedure of ulcer piercing and drainage with a silastic tube, which allows positive pressure irrigation of any pierced tracts. This procedure was performed in a continuous series of 25 selected diabetic patients affected by a Wagner stage 3 ulcer of the toe (n=16), metatarsal midfoot (n=5) and plantar Charcot foot (n=4), and with adequate foot arterial blood supply. RESULTS: Within 6 months of the ulcer piercing procedure, 23/25 of ulcers had completely healed. In two further cases, the ulcer piercing ring was still in place after 3 and 5 months, progressively healing with no active signs of infection. CONCLUSION: Taking into consideration the advantages and the lack of side effects afforded by this procedure, ulcer piercing represents a small but effective step towards an easier and safer approach to treating complicated diabetic neuropathic foot ulcers with adequate arterial blood supply. DECLARATION OF INTEREST: There were no external sources of funding for this study. The author has no conflicts of interest to declare with regard to the manuscript or its content.

Sensitization and pain.

Migraine is often accompanied with signs of increased intracranial and extracranial mechanical sensitivities. The prevailing view today is that migraine headache is a neurovascular disorder with intracranial origin and involvement of meningeal blood vessels and their pain nerve fibers. Allodynia, defined as perception of pain following not painful stimulation, is a common clinical feature in various pain syndromes, and as part of migraine pain, it can be considered an indicator of trigeminal neural network sensitization. The cutaneous allodynia that accompanies the migraine headache in a large percentage of patients may be considered the clinical expression of central nervous system sensitization and is characterized by pain provoked by stimulation of the skin that would ordinarily not produce pain. An altered codification process of sensory impulses in the brainstem, in particular by the nucleus caudalis trigeminalis, may justify the temporal aspects and symptoms in the course of migraine attack.

Genome-wide association study of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a common, debilitating neuropsychiatric illness with complex genetic etiology. The International OCD Foundation Genetics Collaborative (IOCDF-GC) is a multi-national collaboration established to discover the genetic variation predisposing to OCD. A set of individuals affected with DSM-IV OCD, a subset of their parents, and unselected controls, were genotyped with several different Illumina SNP microarrays. After extensive data cleaning, 1465 cases, 5557 ancestry-matched controls and 400 complete trios remained, with a common set of 469,410 autosomal and 9657 X-chromosome single nucleotide polymorphisms (SNPs). Ancestry-stratified case-control association analyses were conducted for three genetically-defined subpopulations and combined in two meta-analyses, with and without the trio-based analysis. In the case-control analysis, the lowest two P-values were located within DLGAP1 (P=2.49 × 10(-6) and P=3.44 × 10(-6)), a member of the neuronal postsynaptic density complex. In the trio analysis, rs6131295, near BTBD3, exceeded the genome-wide significance threshold with a P-value=3.84 × 10(-8). However, when trios were meta-analyzed with the case-control samples, the P-value for this variant was 3.62 × 10(-5), losing genome-wide significance. Although no SNPs were identified to be associated with OCD at a genome-wide significant level in the combined trio-case-control sample, a significant enrichment of methylation QTLs (P<0.001) and frontal lobe expression quantitative trait loci (eQTLs) (P=0.001) was observed within the top-ranked SNPs (P<0.01) from the trio-case-control analysis, suggesting these top signals may have a broad role in gene expression in the brain, and possibly in the etiology of OCD.

Safety of a new biological adhesive after pancreatic resection.

AIM: Pancreatic fistula (PF) represents the main complication (10%-29%) after pancreatic surgery. Soft pancreatic texture with a not dilated pancreatic duct represent the major risk factors for PF. Mortality after pancreaticoduodenectomy (PD) is reported in several large series to be <5%. PF and local sepsis are the main causes of delayed arterial hemorrage with a high mortality rate (14-38%). Therefore, any effort should be implemented in order to reduce the incidence of PF. METHODS: In the present study we have extended the use of the biological adhesive Bioglue® to coat pancreatic resection surface after distal pancreasectomy (DP, N.=5) and pancreatico-jejunostomy (PJ) after PD (N.=18) in a RESULTS: Operative mortality was observed in 2 instances: one case after PJ leakage (1/18, 5.5%) and one case after DP not related to PF (1/5, 20%). PF has been documented in 7/23 (30,4%) after pancreatic resection, and in all cases after PD. In 3 cases PF has been successfully treated conservatively by NPO and octreotide. 2 patients required radiological percutaneous transhepatic biliary drainage and 2 patients required surgical drainage of multiple intrabdominal collections and radiological PTBD. CONCLUSION: On the basis of these observations Bioglue® can be safely utilized to coat pancreatic surface after DP and pancreatico-jejunostomy after PD. This experience warrants further larger controlled studies of the potential value of Bioglue® in reducing the incidence of PF after major pancreatic surgery.

One-step substrate nanofabrication and patterning of nanoparticles by lithographically controlled etching.

We propose an integrated top-down and bottom-up approach to single-step nanofabrication of complex nanostructures made of different materials. The process, termed lithographically controlled etching (LCE), starts with a drop of an etching solution cast on the surface to be patterned. By placing a polymeric mold on the substrate, the stamp protrusions come into contact with the surface, thus protecting it, whereas the surface beneath the mold recesses is exposed to a thin layer of etching solution, allowing the surface to be etched. By dispersing nanoparticles into the etching solution, these can be deposited and self-organize in the recesses on the substrate as these are excavated. We demonstrate here the fabrication of complex structures and nanowires 30 nm wide. Moreover, by exploiting capillary forces, it is possible to deposit nanoparticles at precise positions with respect to optically addressable microstructures, thus realizing a multiscale functional pattern.

Sleep and primary headaches.

The relationship between sleep and primary headaches has been known for over a century, particularly for headaches occurring during the night or early morning. Migraine, tension-tyre headache, and cluster headache may cause sleep fragmentation, insomnia, and hypersomnia, causing considerable social and economical costs and several familial problems. By contrast, sleep disorders may themselves trigger headache attacks. Finally, headaches and sleep disorders can also be symptoms of other underlying pathologies. Despite this background, there is still no clarity about the mechanism that links these two entities and their interdependence remains to be defined. Patients with primary headache should undergo a careful assessment of sleep habits.

In situ scanning tunneling microscopy investigation of sulfur oxidative underpotential deposition on Ag(100) and Ag(110).

Underpotential (UPD) deposition of sulfur from Na(2)S solution in 0.1 M NaOH was studied on Ag(100) and Ag(110) using in situ scanning tunneling microscopy (STM). The cyclic voltammogram on Ag(100) presents two broad peaks, whereas three partial overlapping peaks and a sharper one are observed on Ag(110). STM measurements carried out during the whole UPD process show that progressively more compact structures are formed as the applied potential is scanned toward more positive potentials. More precisely, p(2×2), c(2×6), and c(2×2) were found on Ag(100) at E = -1.25, -1.0, and -0.9 V, respectively. Less definite conclusions can be drawn for the structures of S overlayers on Ag(110). However, the experimental findings are consistent with an incomplete p(2×1) at potentials preceding the sharp peak, and with a c(2×2) structure at E = -0.9 V vs Ag/AgCl, KCl(sat). The coverage values calculated on the basis of the hypothesized structures have been compared with the values obtained from chronocoulometric measurements at the most positive potentials investigated. Thus, the experimental coverage θ = 0.5 coincides with the coverage calculated for the c(2×2) structure found on Ag(110) at E = -0.9 V by STM, whereas the experimental coverage θ = 0.42 suggests that a mixture of structures c(2×6) and c(2×2) is formed on Ag(100).

Greater occipital nerve block in chronic migraine.

Headache syndromes often involve occipital and neck symptoms suggesting a functional connectivity between nociceptive trigeminal and cervical afferents. Several studies have suggested that pain relief in migraine and other types of headache can be achieved by local injections of steroids, local anaesthetics or a mixture of both in the area of greater occipital nerve (GON). Usually greater occipital nerve block (GONB) is performed by using local anaesthetics alone or with steroid. The rationale of performing a GONB for the treatment of chronic headache states is on the anatomical connections between trigeminal and upper cervical sensory fibres at the level of the trigeminal nucleus caudalis. However, the reason for the improvement after GONB in primary headache is unknown. The objective of this study is to determine whether adding triamcinolone to local anaesthetics increased the efficacy of GONB and trigger point injections (TPIs) for chronic migraine (TM). Patients with TM were randomized to receive GONB and TPIs using lidocaine 2% and bupivacaine 0.5% + either saline or triamcinolone 40 mg. Particularly, a 10-ml syringe containing 4.5 ml of lidocaine 2%, 4.5 ml of bupivacaine 0.5% and 1 ml of either saline (group A) or triamcinolone 40 mg/ml (group B) was prepared for each patients. Patients were given bilateral GONB and TPIs in the cervical paraspinal and trapezius muscles bilaterally. 2 ml were injected into each GON at the medial third of the distance between the occipital protuberance and the mastoid process. In addition, 0.5 ml was injected into each of the 12 trigger points. The total injected volume was 10 ml. The primary outcome measure was the change in mean headache severity from before injection to 20 min after in the two groups. Secondary outcome measures were the change in mean neck pain, photophobia and phonofobia severity from before injection to 20 min after in the two groups. Patients documented headache and severity of associated symptoms for 4 weeks after injection. Changes in symptom severity were compared between the two groups. Thirty-seven patients were included. Twenty minutes after injection, mean headache severity decreased by 3.2 points in group A (p < 0.01) and by 3.1 points in group B (p < 0.01). Mean neck pain severity decreased by 1.5 points in group A (p < 0.01) and by 1.7 points in group B (p < 0.01). Mean duration of being headache-free was 2.7 +/- 3.8 days in group A and 1.0 +/- 1.1 days in group B (p = 0.67). None of the outcome measures differed significantly between the two groups. Both treatments were full tolerated. In our study, adding triamcinolone to local anaesthetic when performing GONB and TPIs was not associated with improved outcome in the sample of patients with TM. In both groups, the procedure resulted in significant and rapid relief of headache, neck pain, photophobia and phonofobia.

[Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head and papilla of Vater]. / Duodenocefalopancreatectomia per adenocarcinoma della testa del pancreas e della papilla di Vater.

AIM: The authors report their consecutive experience in the surgical management of adenocarcinoma (ADC) of head of pancreas and papilla of Vater, in order to review the available literature. METHODS: One hundred and seventy cases (131 in the head of pancreas and 39 in the papilla of Vater) were operated upon for ADC by radical pancreaticoduodenectomy in the period 1972-2005. The stomach was resected in 81 patients (47.7%) and the pylorus was preserved in 89 (52.3%). Follow-up was completed in all patients. RESULTS: Postoperative morbidity was reported in 66 patients (38.8%) and pancreatic fistulae were observed in 39 patients (22.9%). Postoperative mortality was 9.4% (16 patients), but in the last 10 years it was reduced to 4.1% (4/97 patients). Five-year survival for pancreatic ADC was 75% in stage IA, 43.9% in stage IB and IIA, 3.2% in stage IIB. In ADC of the papilla of Vater, for the same stages, the 5-year survival rates were 54.4%, 51.4%, 0% and 37.5%, respectively. None of the III-staged patients survived at a 5-year follow-up in both groups. CONCLUSIONS: Preoperative studies should include laparoscopy with cytological examination of peritoneal lavage, while preoperative biliary drainage is rarely indicated in case of obstructive jaundice. The Wirsung duct has to be anastomosed directly to the jejunum and the pancreatic section needs to be checked. Extended lymphadenectomy, in addition to the standard peripancreatic excision, is seldom indicated, there is no controindication to pylorus preservation and Wirsung drainage is not necessary. This operation should be performed in Centres with substantial experience.

True mediastinal ectopic goitre. Case report.

Heterotopic thyroid tissue is described to usually lie at the tongue base, while the 10% at the hyoid bone. We report a case of incidental diagnosis of a true mediastinal goitre with preoperative chest X-ray in a 35-year old woman with a multinodular cervical goitre.