Memory in time: electrophysiological comparison between reality filtering and temporal order judgment.

Orbitofrontal reality filtering (ORF) denotes a little known but vital memory control mechanism, expressed at 200-300ms after stimulus presentation, that allows one to sense whether evoked memories (thoughts) refer to present reality and can be acted upon, or not. Its failure induces reality confusion evident in confabulations that patients act upon and disorientation. In what way ORF differs from temporal order judgment (TOJ), that is, the conscious knowledge about when something happened in the past, has never been explored. Here we used evoked potential analysis to compare ORF and TOJ within a combined experimental task and within a comparable time frame, close to the experienced present. Seventeen healthy human subjects performed an experiment using continuous recognition tasks that combined the challenges of ORF and TOJ. We found that the two mechanisms dissociated behaviorally: subjects were markedly slower and less accurate in TOJ than ORF. Both mechanisms evoked similar potentials at 240-280ms, when ORF normally occurs. However, they rapidly dissociated in terms of amplitude differences and electrical source from 310 to 360ms and again from 530 to 560ms. We conclude that the task of consciously ordering memories in the immediate past (TOJ) is effortful and slow in contrast to sensing memories' relation with the present (ORF). Both functions invoke similar early electrocortical processes which then rapidly dissociate and engage different brain areas. The results are consistent with the different consequences of the two mechanisms' dysfunction: while failure of ORF has a known clinical manifestation (reality confusion as evident in confabulation and disorientation), the failure of TOJ, as tested here, has no such known clinical correlate.

[Applicative aspects of liquid-based cytology in cervical cancer screening]. / Aspetti applicativi della citologia in fase liquida nello screening del cervico-carcinoma.

The quality of cytological services is the very heart of the prevention of cervical pathologies. Indeed, various studies have demonstrated that inadequate sampling, mistakes made in the organisational and management methods of the screening programme, and incorrect diagnoses result in unnecessarily high incidence and mortality rates. The aim of this work is to compare the effectiveness of two different methods, i.e. a conventional smear test and a liquid based ThinPrep (TP) test. Said methods were tested on a sample 453 cases diagnosed as being "Atypical Squamous Cells of Undetermined Significance"/"Atypical Glandular Cells of Undetermined Significance" according to the 1991 Bethesda System. All the women with an "Atypical Squamous Cells of Undetermined Significance "/"Atypical Glandular Cells of Undetermined Significance" cytological diagnosis were called back within 3 months for a ThinPrep test, as part of the Level 2 diagnostic controls of a cervical cancer screening programme. Of the initial diagnoses of "Atypical Squamous Cells of Undetermined Significance"/"Atypical Glandular Cells of Undetermined Significance" with a conventional smear test, 124 cases (27.4%) were classified as being adequate, while 329 (72.6%) were satisfactory, although they did have limited indicators of quality. Upon repetition of the cytology with a ThinPrep test, 322 cases (71.1%) were found to be adequate, 129 (28.4%) "suboptimal" and 2 inadequate (p < 0.0001). The main reasons for insufficient results in conventional smear tests are: bad preservation (40.2%), the presence of granulocytes (36.4%), intense phlogosis (12.1%) and erythrocytes (5.5%). In liquid based smear tests, the main indicator of quality is the absence of endocervical glandular cells (56.7%). As for the cytological diagnosis, the use of ThinPrep supplied the following results: of the 453 cases diagnosed initially as being "Atypical Squamous Cells of Undetermined Significance"/"Atypical Glandular Cells of Undetermined Significance", 371 (84.1%) were negative, 54 (11.9%) "Atypical Squamous Cells of Undetermined Significance "/"Atypical Glandular Cells of Undetermined Significance" and 18 (4%) L-SIL (p < 0.0001). Histological follow-up of the 18 cases with L-SIL confirmed the presence of a dysplastic lesion in 8 out of 12 cases (66.7%); in 4 cases there was no consistency between the cytological and histological diagnoses, and in 6 patients no biopsy had been taken. The preliminary experience of this study, although indeed carried out on a limited number of cases, appears to show that suitable training for the collection of samples in a liquid solution could improve the adequacy of the sample and thus the precision of the cytological diagnosis.

[Sex chromosome abnormality: report of three clinical cases of X pentasomy]. / Anormalità dei cromosomi sessuali: segnalazione di tre casi con pentasomia X.

Pentasomy X cases are very few. In this study we describe three clinical cases (two newborn children and a girl in puberal age) of females showing a 49, XXXXX cariotype. The salient phenotypic characteristics of these cases (heart defects, growth deficiency, craniofacial and hand abnormalities) are compared to the clinico-pathological data described in literature.

Glucose or sucrose as an analgesic for newborns: a randomised controlled blind trial.

BACKGROUND: To evaluate the effect of different oral glucose or sucrose solutions on the pain response to heelstick in newborns. DESIGN: randomised double blind placebo controlled trial of water (control) versus one of three solutions of glucose - namely 5, 33 and 50% - or one of two solutions of sucrose (33% and 50%) or nothing. SETTING: postnatal ward. PATIENTS: seven groups of 20 healthy newborns (gestational age 38-41, weighing over 2500 g) were randomised to receive 2 ml of one of the six solutions on the tongue inmediately before heelstick procedure. MAIN OUTCOME MEASURE: heart rate before, during and three minutes after the procedure. RESULTS: Even if the trend of the cardiac rates did not reach statistic significance, glucose solution 33 and 50% proved to be the most effective in reducing pain response. CONCLUSIONS: Sweet solutions may be an easy, useful, safe and cheap analgesic for minor invasive procedures in newborns.

Gastric cancer: epidemiologic and biological aspects.

Although temporal trends and regional-racial variations in gastric cancer incidence have led to the formulation of different hypotheses, no definite association has been seen between this disease and any behavioural or genetic determinant. In fact, several aetiological factors have been associated with risk of gastric cancer, but not without controversy. Various studies have suggested that genetic factors might be of importance in the pathogenesis of gastric tumours. In fact, stomach carcinoma occurs more frequently among close relatives of affected individuals than in the general population and some of the most common pre-cancerous lesions seem to be genetically determined. In the light of this circumstantial evidence, we decided to investigate the role of various genetic alterations in gastric cancer in order to study their relationship with aetiopathogenesis and disease progression and their value as indicators of risk and prognosis. Our main areas of interest were: i. c-Ha-ras locus polymorphism; ii, truncated c-myc gene variant; iii. loss of heterozygosity, iv. p53 gene mutations; v. oncogene amplification; vi. oncogene amplification proliferative activity and their relation to prognosis in gastric cancer.

A few remarks on the morphogenesis of the larynx.

After having reviewed the principal theories regarding the development of the larynx the authors performed a study on the morphogenesis of the above structure using four horizontally- and sagitally-sectioned human embryos. The conclusion of a study of these sections is that the LC constitutes the primordium of the laryngeal vestibule. From its lateral margin, caudally (Stage 19, Carnegie System), the primitive ventricles begin to form, while in the final stages the EL extends caudally enclosing a small cephalic infraglottic area and therefore completely separating the IG from the LC. Such findings in our opinion would confirm a different embryological derivation of the laryngeal cavity above and below the glottis.

[Hypophosphatasia: a family study]. / Ipofosfatasia: studio di una famiglia.

Diagnostic pathway and 5-years follow-up of a case of childhood-form hypophosphatasia (a severe form of vitamin D resistant rickets) are described. Family study led to the identification of five affected relatives (father, sister, paternal uncle, first-cousins), two with severe clinical evidence. Inheritance pattern in this family is compatible with autosomal dominant transmission.

The relationship between parotid and superficial fasciae.

The paper reports a study conducted on serial sections of subcutaneous neck and facial tissues taken from ten human fetuses with a craniocaudal distance of between 7 and 30 cms for the purpose of establishing the age at which various anatomical structures develop and interact. In particular, the study was aimed at investigating the relationship between the parotid and superficial fasciae. Findings, supported also by direct observations on humans, demonstrated that a parotid fascia proper does not exist. The study was also aimed at confirming or invalidating the contrasting opinions reported in recent literature. On the basis of our observations on the parotid gland, no parotid fascia as such seems to be present, but rather a superficial thickening of the connective tissue with muscle fibres which can be identified with the superficial fascia of the region and as a continuation of the platysma m., and with the septa subdividing the gland. Moreover, only a thin connective layer was detected in the deep surface of the fascia. These findings are in line with those reported by Jost who, like ourselves, conducted his research on both primates and humans. The anatomical and surgical implications of these findings are considerable as they entail a redefinition of the existence of a parotid fascia. In particular, this implies abandoning the expression introduced by Mitz who defines this structure as representing a "superficial muscular and aponeurotic system (SMAS)" which in fact can be considered to correspond to the superficial fascia as correctly described by Sterzi and subsequently confirmed by Bertelli.(ABSTRACT TRUNCATED AT 250 WORDS)

[Resumption of breast feeding in low-birth-weight newborn infants]. / Recupero dell'allattamento al seno nei nati di basso peso.

It has been inquired into the possibility of the resumption of breast feeding in low birth weight babies, in the 101 survivors of the 128 infants weighing less than 2000 g at birth, who were born at St. Andrea Hospital in Vercelli between 1974-82. 86% of the mothers accepted to attempt breast feeding after the separation period for intensive care and the attempt the successful in 85% of the cases (73 infants). The resumption was successful with more than 90% of the infants weighting more than 1250 g at birth and 68.6% of these infants were exclusively breast-fed. 57% of those infants weighting less than 1250 g at birth resumed breast feeding. No infant developed an infectious disease nor necrotizing enterocolitis. Almost all of the mothers succeeded in maintaining breast feeding for a mean period of 5 months and all of them considered the experience extremely positive. The study demonstrated that it is possible to resume breast feeding in low birth weight babies with suitable encouragement and care on the part of the family, the doctors and the nurses.

[Usefulness of multicenter evaluation of the reliability of a program for automatic analysis in clinical electrocardiography]. / Utilità della valutazione policentrica dell'affidabilità di un programma per l'analisi automatica in elettrocardiografia clinica.

The HP-5 program for computer analysis of the ECG has been evaluated as far as sensibility and specificity in a multicenter study. A consistent number of tracings were sampled according to a statistical formula and all measurements and statements given by the computer were checked in a standardized manner. The collected data were classified and computerized. The HP-5 program has shown a very high specificity for tracings classified as normal (0.7% of false negatives) and for those classified abnormal (no false positive), while the level of agreement between manual and computer readings of the tracings classified atypical or borderline, was fair (75%). It is concluded that the new program represents a significant step forward in the practical use of computerized ECG.

N-nitroso compound precursors and gastric cancer: preliminary data of a study on a group of farm workers.

An epidemiological research on gstric cancer mortality rates carried out in the town of Forì is reported. The results are significant as regards the relation between the urban and rural areas, and show a higher risk for gastric cancer in the rural area. Salivary nitrite measurement in 92 farm workers showed particularly high values (over 30 ppm in 4 individuals). Analysis of histological findings in biopsies performed during endoscopy in 46 persons of the group studied showed a great number of CAG and CAG + IM in asymptomatic individuals.

[Multicenter study and clinical use of HP-5 program (author's transl)]. / Valutazione policentrica e impiego clinico di un programma per l'analisi automatica dell'ECG (HP-5].

The HP-5 program for computer analysis of the ECG has been evaluated as far as sensibility and specificity in a multicenter study. A consistent number of tracings (850) were sampled according to a statistical formula and all measurements and statements given by the computer were checked in a standardized manner. The collected data were classified and computerized. The HP-5 program has shown a very high specificity for tracings classified as normal (0.7% of false negatives) and for those classified abnormal (no false positive), while the level of agreement between manual and computer readings of the tracings classified atypical or borderline, was practical of computerized ECG.

[Results of the automatic analysis of a group of 2,250 electrocardiograms examined with the HP4 system and supplied by 13 hospitals associated with a single computer center]. / Risultati dell'analisi automatica di un gruppo di 2250 elettrocardiogrammi esaminati con il sistema HP4 e provenienti da 13 ospedali consorziati con un unico Centro di calcolo

The reliability of the HP4 programme for automatic ECG reading has been studied. 13 Lombardy Hospitals together with the Italian Diagnostic Centre took part in the experiments. In each hospital, 170 ECG's were simultaneously recorded on paper and magnetic tape, a total of 2.252 examinations. The tapes were sent to the Italian Diagnostic Centre for processing. The ECG's were also examined by hospital cardiologists using their own criteria and by a cardiologist of the I.D.C. according to the HP4 programme criteria. The evaluation criteria were of two types: 1) according to a final synthetic judgment (normal, atypical, at the limit of the normal, abnormal); 2) according to the type of pathology (arrythmia, left ventricular hypertrophy, infarction, repolarization alterations, intraventricular conduction disturbances). The data obtained in this study showed the reliability of the HP4 programme for screening the population, for use in Cardiology Departments (hospital or out-clinics) and in Social Cardiology centres. Its practical use is excluded (as are most of the programmes on the market) where a specific diagnosis in particular types of pathology is required (e.g. coronary units, cardiology division, etc.) The cardiologist is irreplaceable although this equipment provides him with a considerable aid for the performance of his work.