Objective interpretation of ultraviolet-induced luminescence for characterizing pictorial materials.

Ultraviolet-induced Luminescence (UVL) is the property of some materials of emitting light once illuminated by a source of UV radiation. This feature is characteristic of some mediums and pigments, such as some red lakes, widely used for the realisation of works of art. On the one hand, UVL represents a like strike for a researcher in the cultural heritage field: in fact, UVL allows to characterise the state of conservation of the paintings and, in some cases, to recognize at glance some of the materials used by the artists. On the other hand, the contribution of UVL to the study of the artefacts is almost always limited to qualitative observation, while any speculation about the cause of the luminescence emission relies on the observer's expertise. The aim of this paper is to overcome this paradigm, moving a step toward a more quantitative interpretation of the luminescence signal. The obtained results concern the case study of pictorial materials by Giuseppe Pellizza da Volpedo (1868-1907, Volpedo, AL, Italy) including his iconic masterpiece Quarto Stato (1889-1901), but the method has general validity and can be applied whenever the appropriate experimental conditions occur. Once designed an appropriate set-up, the statistical comparison between the acquisitions performed on Quarto Stato, on a palette belonged to the master, on drafts made by the author himself and on a set of ad hoc prepared samples both with commercial contemporary pigments and prepared with the traditional recipe, shed some light on which materials have been employed by the artist, where they have been applied and support some intriguing speculations on the use of the industrial lakes in the Quarto Stato painting.

Ceramic-metal composites for heat exchangers in concentrated solar power plants.

The efficiency of generating electricity from heat using concentrated solar power plants (which use mirrors or lenses to concentrate sunlight in order to drive heat engines, usually involving turbines) may be appreciably increased by operating with higher turbine inlet temperatures, but this would require improved heat exchanger materials. By operating turbines with inlet temperatures above 1,023 kelvin using closed-cycle high-pressure supercritical carbon dioxide (sCO2) recompression cycles, instead of using conventional (such as subcritical steam Rankine) cycles with inlet temperatures below 823 kelvin1-3, the relative heat-to-electricity conversion efficiency may be increased by more than 20 per cent. The resulting reduction in the cost of dispatchable electricity from concentrated solar power plants (coupled with thermal energy storage4-6) would be an important step towards direct competition with fossil-fuel-based plants and a large reduction in greenhouse gas emissions7. However, the inlet temperatures of closed-cycle high-pressure sCO2 turbine systems are limited8 by the thermomechanical performance of the compact, metal-alloy-based, printed-circuit-type heat exchangers used to transfer heat to sCO2. Here we present a robust composite of ceramic (zirconium carbide, ZrC) and the refractory metal tungsten (W) for use in printed-circuit-type heat exchangers at temperatures above 1,023 kelvin9. This composite has attractive high-temperature thermal, mechanical and chemical properties and can be processed in a cost-effective manner. We fabricated ZrC/W-based heat exchanger plates with tunable channel patterns by the shape-and-size-preserving chemical conversion of porous tungsten carbide plates. The dense ZrC/W-based composites exhibited failure strengths of over 350 megapascals at 1,073 kelvin, and thermal conductivity values two to three times greater than those of iron- or nickel-based alloys at this temperature. Corrosion resistance to sCO2 at 1,023 kelvin and 20 megapascals was achieved10 by bonding a copper layer to the composite surface and adding 50 parts per million carbon monoxide to sCO2. Techno-economic analyses indicate that ZrC/W-based heat exchangers can strongly outperform nickel-superalloy-based printed-circuit heat exchangers at lower cost.

AEgIS at ELENA: outlook for physics with a pulsed cold antihydrogen beam.

The efficient production of cold antihydrogen atoms in particle traps at CERN's Antiproton Decelerator has opened up the possibility of performing direct measurements of the Earth's gravitational acceleration on purely antimatter bodies. The goal of the AEgIS collaboration is to measure the value of g for antimatter using a pulsed source of cold antihydrogen and a Moiré deflectometer/Talbot-Lau interferometer. The same antihydrogen beam is also very well suited to measuring precisely the ground-state hyperfine splitting of the anti-atom. The antihydrogen formation mechanism chosen by AEgIS is resonant charge exchange between cold antiprotons and Rydberg positronium. A series of technical developments regarding positrons and positronium (Ps formation in a dedicated room-temperature target, spectroscopy of the n=1-3 and n=3-15 transitions in Ps, Ps formation in a target at 10 K inside the 1 T magnetic field of the experiment) as well as antiprotons (high-efficiency trapping of [Formula: see text], radial compression to sub-millimetre radii of mixed [Formula: see text] plasmas in 1 T field, high-efficiency transfer of [Formula: see text] to the antihydrogen production trap using an in-flight launch and recapture procedure) were successfully implemented. Two further critical steps that are germane mainly to charge exchange formation of antihydrogen-cooling of antiprotons and formation of a beam of antihydrogen-are being addressed in parallel. The coming of ELENA will allow, in the very near future, the number of trappable antiprotons to be increased by more than a factor of 50. For the antihydrogen production scheme chosen by AEgIS, this will be reflected in a corresponding increase of produced antihydrogen atoms, leading to a significant reduction of measurement times and providing a path towards high-precision measurements.This article is part of the Theo Murphy meeting issue 'Antiproton physics in the ELENA era'.

SILICON PHOTOMULTIPLIERS FOR MEDICAL IMAGING AND DOSIMETRY-AN OVERVIEW.

Silicon photomultipliers (SiPMs) are an enabling solid-state technology for low light sensing, with single photon sensitivity and photon number resolving capability. They feature an extremely high internal gain at the 10(6) level, comparable to photomultiplier tubes (PMTs), with the advantage of low operating voltage (~50 V compared to ~1000 V for PMT) and low energy consumption. The solid-state technology makes SiPMs compact, insensitive to magnetic fields and with an extreme flexibility in the design to cope with different applications. The fast development of the multiplication avalanche opens up the possibility to achieve time resolution at the 30 ps level. Dynamic range is however limited compared to PMT and the dark count rate relatively high, yet today at the level of 50 kHz/mm(2) at room temperature. Interfaced with scintillation material, SiPMs provide a powerful platform for medical imaging applications (in positron emission tomography/computed tomography and in positron emission tomography/magnetic resonance), for X-ray quality control as well as for novel compact radiation protection instruments. This article gives an overview of SiPMs for medical imaging and dosimetry. In addition, a learning and training program targeted to graduate students is described.

A simple approach to measure the radon equilibrium factor F from air filter gross beta counting.

The internal alpha dose assessment (ICRP 65, 1994) depends on the value of the equilibrium factor F. This parameter is generally not measured and a mean conventional value ranging between 0.4 and 0.6 is assumed, possibly leading to a significant bias in the dose assessments. In this paper, a method for the measurement of F is reported, based on the total aerosol sampling on filters and immediate gross beta counting of 214Pb and 214Bi activities. Measurements are interpreted according to a Raabe-Wrenn and Jacobi simplified room model, leading to an estimate of the individual airborne activities of short-lived radon daughters, the removal parameter and the equilibrium factor. The method was laboratory tested and validated and it is being qualified by field surveys in different indoor environmental conditions.

Fertilization rates and in vitro embryo production using sexed or non-sexed semen selected with a silane-coated silica colloid or Percoll.

The aim of this study was to evaluate sperm fertilization rates and in vitro embryo development rates for sexed and non-sexed semen selected using a silane-coated silica colloid method (Isolate) or Percoll. Frozen/thawed, sexed and unsexed semen samples from four Holstein bulls were randomly allocated to one of two different density gradient selection methods. Sperm quality (motility, concentration, morphology and membrane integrity) were evaluated and compared before and after sperm selection. Sperm motility and morphology improved (P < 0.005) after the sperm selection process with no differences between the two methods. For non-sexed semen, Percoll gradient increased the mean (± SEM) percentage of sperm recovered (57.3 ± 2.8) compared to Isolate (46.0 ± 1.8; P < 0.01). However, membrane integrity was higher after Isolate than Percoll (sexed semen: 41.0 ± 0.6 vs. 38.8 ± 0.8 and non-sexed semen 60.8 ± 1.6 vs. 58.8 ± 0.5; P < 0.05). The percentage of blastocysts produced was higher when either sexed or non-sexed semen was selected by Isolate (14.0 ± 1.0; 22.0 ± 1.1) than by Percoll (10.5 ± 1.5; 17.0 ± 2.1, respectively; P < 0.05). In summary, Isolate was a more effective method for the recovery of high quality sperm for in vitro fertilization embryo production.

Effects of oestradiol and some of its esters on gonadotrophin release and ovarian follicular dynamics in CIDR-treated beef cattle.

Three experiments were conducted to: (1) compare the effect of three oestradiol formulations on gonadotrophin release in ovariectomised cows; (2) compare the effects of either oestradiol-17beta (E-17beta) or oestradiol benzoate (EB), given at two doses, on the synchrony of ovarian follicular wave emergence in CIDR-treated beef cattle; and (3) determine the timing of ovulation of the dominant follicle of a synchronised follicular wave following administration of E-17beta or EB 24h after progesterone withdrawal. In Experiment 1, ovariectomised cows (n = 16) received a once-used CIDR on Day 0 (beginning of the experiment) and were allocated randomly to receive 5mg of E-17beta, EB or oestradiol valerate (EV) plus 100mg progesterone i.m. The CIDR inserts were removed on Day 7. There were effects of time, and a treatment-by-time interaction (P < 0.0001) for plasma concentrations of both oestradiol and FSH. Plasma oestradiol concentrations peaked 12h after treatment, with highest (P < 0.01) peak concentrations in cows given E-17beta; estradiol concentrations subsequently returned to baseline by 36 h in E-17beta-treated cows and by 96 h in EB- and EV-treated cows. Plasma FSH concentrations decreased by 12h after oestradiol treatment in all groups (P < 0.0001), reached a nadir at 24h, and increased by 60 h in all groups; plasma FSH reached higher (P < 0.02) concentrations in E-17beta-treated than in EB- or EV-treated cows. In Experiment 2, non-lactating Hereford cows (n = 29) received a new CIDR on Day 0 (beginning of the experiment), and were assigned randomly to receive 1 or 5mg of E-17beta or EB i.m. on Day 1. On Day 8, CIDR were removed and PGF was given. Transrectal ultrasonography was done once daily from 2 days before CIDR insertion to 2 days after CIDR removal, and then twice-daily to ovulation. Although there was no difference among groups in the interval from oestradiol treatment to follicular wave emergence (4.2 +/- 0.3 days; P = 0.5), 5mg of E-17beta resulted in the least variable interval to wave emergence (P < 0.005), compared with the other treatment groups which were not different (P = 0.1). For the interval from CIDR removal to ovulation, there were no differences among groups for either means (P = 0.5) or variances (P = 0.1). In Experiment 3, beef heifers (n = 32) received a once-used CIDR on Day 0 (beginning of the experiment) plus 100mg progesterone i.m. and were assigned randomly to receive 5mg E-17beta or 1mg EB i.m. On Day 7, CIDR were removed and all heifers received PGF. On Day 8 (24h after CIDR removal), each group was subdivided randomly to receive 1mg of either E-17beta or EB i.m. There was no effect of oestradiol formulation on interval from treatment to follicular wave emergence (4.1 +/- 0.2 days; P = 0.7) or on the median interval (76.6h; P = 0.7) or range (72-120 h; P = 0.08) from CIDR removal to ovulation. In summary, oestradiol treatments suppressed FSH in ovariectomised cows, with the duration of suppression dependent on the oestradiol formulation. Both E-17beta and EB effectively synchronised ovarian follicular wave emergence and ovulation in CIDR-treated cattle, and the interval from CIDR removal to ovulation did not differ in heifers given either E-17beta or EB 24h after CIDR removal.

The control of follicular wave development for self-appointed embryo transfer programs in cattle.

Our expanding knowledge of the control of follicular wave dynamics during the bovine estrous cycle has resulted in renewed enthusiasm for the prospects of precisely controlling the follicular and luteal dynamics and finely controlling the time of ovulation. Follicular wave development can be controlled mechanically by ultrasound-guided follicle ablation or hormonally by treatments with GnRH or estradiol and progestogen/progesterone in combination. Treatment of cattle with GnRH in combination with prostaglandin F2 alpha (PGF) 7 d later and a second GnRH 48 h after PGF (known as Ovsynch) has resulted in acceptable pregnancy rates after fixed-time AI in lactating dairy cows and in recipients in which embryos were transferred without estrus detection. Alternatively, treatments with estradiol and progestogen/progesterone-releasing devices resulted in synchronous emergence of a new follicular wave and, when a second estradiol treatment was given 24 h after device removal, synchronous ovulation and high pregnancy rates to fixed-time AI. Self-appointed embryo transfer (without estrus detection) using estradiol and progesterone treatments have resulted in pregnancy rates comparable with those obtained with recipients transferred 7 d after estrus. Furthermore, estradiol and progesterone treatments combined with PGF and eCG (given 1 d after the expected time of wave emergence) have resulted in high rates of recipients selected for transfer (84.6%) and an overall pregnancy rate of 48.7% (recipients pregnant/recipients treated). Estradiol and progestogen/progesterone treatments have also been widely used for self-appointed superstimulation protocols with equivalent embryo production to that of donor cows superstimulated using the traditional approach beginning 8 to 12 d after estrus. In summary, exogenous control of luteal and follicular development facilitates the application of assisted reproductive technologies in cattle by offering the possibility of planning the superstimulation of donors and synchronization of recipients at a self-appointed time, without the necessity of estrus detection and without sacrificing results.

Descending and ascending spinal cord evoked potentials from oesophago-vertebral electrical stimulation in normal awake man.

Electrical stimulation of the spinal cord at C7D1 evoked triphasic descending spinal cord evoked potentials (DSCEP) from an oesophago-vertebral recording at D8D8 or D1OD1O. Ascending SCEPs (ASCEP) larger and similar in shape were also observed when the orientation of the stimulating and recording dipoles was reversed. Both SCEPs are in part generated by descending and ascending synchronous excitation of neuronal volume-conducted spinal cord dipoles.

Muscle compound motor action potentials from esophago-vertebral electrical stimulation of the spinal cord in the normal awake man.

In 15 normal alert subjects, electrical stimulation of the spinal cord at various levels by a nasopharyngeal probe (cathode) and a vertebral surface electrode (anode) was performed with different orientation of the stimulating dipole. Maximum spinal cord compound motor action potentials (SCCMAPmax) simultaneously recorded from homologous muscles of the upper arm of both sides were not significantly different in amplitude and latency. By stimulating the spinal cord at the cervico-dorsal level it was possible to obtain simultaneous recordings of SCCMAP from muscles of the upper and lower limbs and trunk at a stimulus intensity of 50-70 mA. Stimulating the spinal cord and the peripheral nerve at Erb's point it was also possible to calculate motor propagation velocity of the peripheral nerve of limb-girdle muscles. Central latency of the F wave exceeded by 0.5 to 0.7 ms that of the SCCMAP, suggesting that esophago-vertebral stimulation is able to directly excite the motor neurons. By threshold current intensity, it is possible to obtain a threshold SCCMAP (SCCMAPth) of the same latency as SCCMAPmax and different in shape, duration and amplitude from the CMAP obtained by cortical stimulation with threshold magnetic stimuli. SCCMAPth was different in shape from the motor unit action potential activated at weak voluntary effort, SCCMAPth latency and amplitude were unchanged after voluntary homo- and contralateral activation.

Prevalence of subclinical neuropathy in diabetic patients: assessment by study of conduction velocity distribution within motor and sensory nerve fibres.

Nerve conduction velocity distribution (CVD) study is a newly-developed electrodiagnostic method for detecting alterations in the composition of nerve fibres according to their conduction velocity. The presence of subclinical neuropathy was evaluated in 138 diabetic patients by CVD study of four motor nerves (external popliteal and ulnar nerves bilaterally) and two sensory nerves (median nerve bilaterally), and the data obtained were compared with standard electrophysiological parameters in the same nerve segments. CVD studies revealed an altered distribution pattern in 106 of 129 evaluable patients for motor nerves (82%) and in 67 of 115 evaluable patients for sensory nerves (58%), while standard examination gave abnormal findings in 92 of 137 patients (67%) and in 33 of 118 patients (11%), respectively. Of the patients adequately evaluated by both techniques, 21 of 129 patients (16%) revealed altered CVD data unaccompanied by slowing of maximum nerve conduction velocity, and 37 patients of 101 (37%) showed similar findings for sensory nerves. Subclinical alterations of motor and sensory nerve CVD were not significantly related to age or to metabolic control expressed as glycated haemoglobin levels; a significantly longer duration of disease was found in patients with motor and mixed subclinical neuropathy with respect to non-neuropathic patients. The CVD study allowed us to detect subclinical abnormalities of motor and sensory nerve fibres; often this is a more sensitive method than the standard electrodiagnostic study. This method can be very useful as a diagnostic tool and in research in the study of the progression of diabetic neuropathy.

Short and long latency cortical potentials evoked by electrical stimulation of the oesophageal mucosa in normal alert humans.

Cerebral responses from the oesophagus were investigated in 16 normal male and female volunteers ranging in age from 20 to 54 years. The stimulus was applied by a naso-oesophageal probe equipped with bipolar ring electrodes. Short and long latency EP (SLEP and LLEP) were observed in all the subjects examined. SLEP consisted in a low threshold potential of 30 to 70 microV amplitude, biphasic or triphasic in shape and of approximately 5 to 10 ms duration; mean latency at the largest peak was 4.5 +/- 1.7 at 25 cm from the nostrils. Early components at about 2.5-3.5 ms and of small amplitude are also present. Recording from the neck at C7 with a common non-cephalic reference, SLEP components occurred from 2 to 6 ms earlier than that from the scalp, suggesting an oligo-synaptic transmission of the excitement via ganglion and lemniscal pathways to the cortex. SLEP was always followed by a complex potential formed of a succession of negative and positive waves with latencies ranging from 20 to 300 ms: the LLEP. This LLEP was usually not very stable and reproducible during the course of successive recordings and in the same subject because it tended to adjust. Preliminary observations concerning the topographical cortical distribution of oesophageal evoked potentials show a circumscribed localization of the SLEP in the parieto-temporal region of the hemisphere whereas LLEP was more widespread. It is the authors' opinion that oesophageal evoked potentials are generated both by the excitation of myelinic fibres with a wide range of conduction speed and of amyelinic fibres from the oesophageal mucosa and the paraoesophageal peripheral nerves of vagal origin.

[Hypokinetic arrhythmia, paradoxical chronotropic reaction and hypotension during dobutamine stress test]. / Aritmie ipocinetiche, risposte cronotrope paradosse ed ipotensione in corso di test eco-dobutamina.

AIM: The aim of this study was to evaluate the incidence of hypokinetic arrhythmias, bradycardiac (BR) and hypotensive reactions in a population of 775 patients during dobutamine stress test (DST): 281 patients (36.2%, group I) were symptomatic for thoracic pain without any history of coronary artery disease (CAD); 494 patients (63.8%, group II) were evaluated 3-4 weeks after an acute myocardial infarction (AMI) to stratify ischemic risk. None of these patients was receiving coronarodilating therapy. MATERIALS AND METHODS: DST was performed using an infusion of 5, 10, 20, 40 micrograms/kg/min for 5 minutes during the first two stages and for 3 minutes during subsequent stages, and was accompanied by EKG and echocardiographic monitoring. BR was defined as severe when heart rate diminished more than 40 b/min, moderate when the decrease ranged between 20 and 39 b/min, and mild when the decrease was less than 20 b/min. RESULTS: A total of 34 (4.38%) BR were observed, 19 (55%) in group I and 15 (45%) in group II. BR were severe in 12 patients (35.9%), 3 with recent AMI (2 inferior and 1 anterior) and 9 without a history of CAD. Fifteen (45%) presented moderate BR, 8 with recent AMI (6 inferior and 2 anterior); 7 cases were in group I. Mild BR was observed in 7 patients (20%), 2 with recent AMI (1 inferior, 1 anterior), of which 5 were in group I. Episodes of junctional rhythm were also observed in 10 patients (29.4%) and 1 patient (2.9%) presented 2nd degree AV block during DST positive for ischemia. The mean duration of bradycardic episodes was 89.6 seconds (+/- 29.8) and only 3 patients (8.8%) presented significant hypotension. In 13 patients (38.2%) arrhythmia was observed during dobutamine-induced ischemia. In spite of the often severely diminished heart rate, no significant hypotension was evident during the bradycardiac episode in 19 patients (55%). Only one patient (2.9%) showed a decrease of more than 40 mmHg. CONCLUSIONS: In conclusion, we found that the incidence of BR during DST (4.38%) is higher than that reported in the literature; moreover, patients with recent inferior AMI showed a higher incidence of BR compared to patients with AMI in other sites (9 vs 4, p = n.s.). We feel that ischemia alone may not be responsible for hypokinetic arrhythmia during DST, but that dobutamine-induced neurovegetative reflexes may also contribute to the pathophysiological mechanisms underlying the phenomenon.

Electrophysiology of the palmomental reflex in normal and parkinsonian subjects.

The palmomental reflex (PMR), obtained by mechanical stimulation of the skin of the thenar and hypothenar eminences of the hand and recording the surface EMG response from the chin muscles homolateral and contralateral to the side of stimulation, was studied in normal subjects and in a group of akinetic parkinsonians, both de novo and treated. PMR was present in most subjects of both groups. No differences regarding the incidence of the PMR homolateral to stimulation of the thenar eminence was found between controls and patients, and it was non-habituating in both groups. When the hypothenar eminence was stimulated, the PMR was present in about half of the subjects of both groups. PMR was present contralaterally in both normal and patients, whereas bilateral PMR prevailed in parkinsonians. Latency and duration of the reflex were significantly shorter in parkinsonians than in controls. The data are discussed in the light of the pathophysiology of the PMR putative pathways in normal subjects and in Parkinson's disease.

[Primary antiphospholipid syndrome and cardiac involvement. Description of a clinical case of right atrial thrombosis]. / Sindrome antifosfolipidica primitiva e coinvolgimento cardiaco. Descrizione di un caso clinico di trombosi atriale destra.

Antiphospholipid syndrome is a well-defined clinical and serological entity characterized by venous and arterial thrombosis, recurrent abortion and thrombocytopenia. The immunological feature shows the presence of anticardiolipin antibodies and lupus anticoagulant. Cardiac involvement includes pericardial effusion, myocardial dysfunction, valvular disease, coronary artery occlusion. The literature reports only a few cases of intracardiac thrombosis associated with primary antiphospholipid syndrome. Here we describe a case of a 54 year-old woman with thrombocytopenia and history of recurrent abortions. When she was 51 she presented a left deep iliac venous thrombosis, followed by recurrent pulmonary embolism; a caval filter was placed in the inferior vena cava. Transthoracic and transoesophageal echocardiogram showed 3 masses in the right atrium: the first one was connected with the atrial wall, hyperechogenic and extending to the right ventricle in diastole: th second was connected with the interatrial septum and less echogenic; the third was in connection with septum-tricuspid valve junction and it was floating in the atrium. The immunological feature showed the presence of lupus anticoagulant and antiphospholipid antibodies; the histological examination of the masses, surgically removed, proved they were thrombi coated by endothelial cells. The case reported is very uncommon and offers the opportunity to emphasize the difficulty of diagnostic differentiation of intracardiac masses using echocardiographic imaging: thrombotic masses may present similar characteristics of seat, morphology and echogenicity of other cardiac masses. For these reasons it can be useful to look for antiphospholipid antibodies and lupus anticoagulant in such clinical conditions.

[Infectious endocarditis following artificial insemination. A clinical case report and review of the literature]. / Endocardite infettiva seguita ad inseminazione artificiale. Descrizione di un caso clinico e revisione della letteratura.

We describe a case of infective endocarditis in a 33 year old patient, with mitral valve prolapse (MVP), who underwent nine attempts of artificial insemination with semen by donor. Several blood cultures demonstrated the presence of Enterococcus faecalis; the same agent was identified in some vaginal cultures. Despite antibiotic therapy, infective endocarditis was complicated by severe mitral regurgitation, followed by the rupture of a chorda tendinea. The patient underwent cardiac surgery: valvuloplasty of posterior mitral cusp, chordae tendineae in Goretex and anulus reinforcement with autologous pericardium. MVP is the most common heart disease associated with infective endocarditis in non-drug addict patients (32-54%). The review of the literature did not show any other case of infective endocarditis after artificial insemination procedures. Because of the large spread of these procedures, we think antibiotic prophylaxis of infective endocarditis should be considered in patients with MVP.

Myotonia induced by potassium repletion in a diabetic patient with secondary hypokalemic paralysis.

In a woman suffering from insulin-dependent diabetes mellitus, hypokalemic paralysis developed acutely following an episode of diabetes decompensation. During the treatment of this episode, as soon as serum potassium levels were restored to normal values, a marked increase in muscular excitability with an electromyographic picture of myotonia was observed. The patient showed signs of chronic muscle denervation that accounted for an increased sensitivity to potassium-induced depolarization and contraction and that might have been responsible for the appearance of myotonia during potassium repletion.

Peripheral autonomic involvement in the carpal tunnel syndrome.

The sympathetic skin response (SSR), evoked from the middle finger of both hands by electrical stimuli to the median nerve (MN) at the wrist, was studied in 21 patients with bilateral carpal tunnel syndrome (CTS) and in 16 patients with monolateral CTS (14 at the right and 2 at the left side) without clinical signs of autonomic involvement. In monolateral and bilateral CTS there was a decrease in the SSR areas of both sides. In monolateral CTS the decrease was greater contralaterally to the lesion. A decrease in the SSR in CTS generally indicates a local blockade of sympathetic nerve excitability due to MN entrapment. Contralateral reduction of the sympathetic response suggests an involvement of the efferent pathway of the autonomic reflex far from the lesion at the wrist. However, dispersion of the excitement over a long distance and throughout numerous synaptic connections may affect contralateral more than homolateral SSR excitability. Finally, sympathetic damage in CTS is in accord with the anatomo-functional correlation (in the peripheral nerve and ganglia) between somatic sensory, which were most markedly involved in our patients, and sympathetic afferent nerve fibers.

An electrophysiological method to assess the distribution of the sensory propagation velocity of the digital nerve in normal and diabetic subjects.

We report a new computer-assisted collision method to evaluate sensory conduction velocity (SCV) distribution in the digital nerve of the middle finger in normal subjects and in insulin-dependent diabetic subjects without any neurological impairment. Distribution curves were monomodally shaped in controls, indicating a greater proportion of fibers with relatively slow conduction velocity and a lesser proportion of fibers with faster velocity. In most diabetic nerves, a monomodal trend of the SCV distribution indicated a definite reduction in high and intermediate SCV. In a small proportion of nerves, the SCV distribution tended to be bimodal, with an absolute maximum corresponding to lower velocities and a relative maximum to intermediate-fast velocities. Slowing of the intermediate velocity, or loss of fibers of intermediate velocity, can be hypothesized to represent the early electrical evidence of a subclinical polyneuropathy in insulin-dependent diabetic subjects.

Indobufen in the prevention of thromboembolic complications in patients with heart disease. A randomized, placebo-controlled, double-blind study.

BACKGROUND: The purpose of this randomized, double-blind study was to evaluate the efficacy of indobufen, a reversible inhibitor of platelet cyclooxygenase, in the prevention of embolic events of cardiac origin. METHODS AND RESULTS: One hundred ninety-six patients with heart disease and at risk for cardiogenic embolism (90 with atrial fibrillation and 106 in sinus rhythm) were randomly assigned to receive indobufen (100 mg b.i.d.) or placebo. All patients were reexamined every 3 months for the duration of the study. The primary study end points were cerebral ischemic attack (stroke and transient ischemic attack), systemic embolism, pulmonary embolism, and fatal myocardial infarction. The median duration of treatment was 854 days in the indobufen group and 865 days in the placebo group. The frequencies of primary end points (fatal and nonfatal) were 6.1% and 17.3%, respectively, in the indobufen and placebo groups (p < 0.05) for a reduction of 65% in the risk of a primary event (indobufen/placebo relative risk, 0.35; 95% confidence limits, 0.14-0.89). Adverse drug reactions, mostly gastrointestinal or hemostasis disorders, occurred in 9.2% of indobufen-treated patients. CONCLUSIONS: The results of the study indicate that indobufen may reduce the risk of ischemic events in patients with heart disease associated with an increased risk of embolism.