[Does a short telemedicine-based CBT programme for insomnia lead to changes in dysfunctional beliefs about sleep?] / Un programme court de TCCi en groupe par visioconférence dans l'insomnie modifie-t-il les croyances erronées ?

INTRODUCTION: The Morphee Sleep network runs a short group CBT programme. During the pandemic, the programme was administered by videoconference. The programme focuses on behavioral modification. The objective of our study was to evaluate whether the videoconference programme produced changes in dysfunctional beliefs about sleep and whether these changes were linked to improvements in insomnia. METHODS: Observational study of 3×90minute sessions of group CBT by videoconference over one month delivered by experienced psychologists. The outcome measures : insomnia severity scale (ISI), dysfunctional beliefs and attitudes about sleep short version (DBAS 16), hospital anxiety and depression scale (subscales depression HADD and anxiety HADA), and epworth sleepiness scale (ESS) completed before session 1 and at the end of session 3. The effectiveness of the programme on insomnia was evaluated by the decrease in the ISI score : full response R+ (>7 points), partial response, R- (4 - 6 points) non response, NR (<3 points). The effect on dysfunctional beliefs and attitudes about sleep were measured by the decrease in the DBAS 16 with response CR (>9 points) and no response CNR (<9 points). RESULTS: There were fifty-five participants, 64 % women with a mean age of 49.1±16.1 years. The DBAS 16 was reduced by 6.12±1.29 to 5.09±1.57 (P< 0.0001) with 67 % of participants showing a response CR. The ISI score reduced from 17.7±3.6 to 14.0±4.9 (P< 0.0001) with 49 % showing at least a partial response (R+ and R-). A significant correlation (0.327, P=0.015) between the CBT response and dysfunctional beliefs about sleep was observed with a significant reduction in the DBAS 16 between responders R+ and non-responders (R+ vs. NR 1.67±1.3 vs. 0.57±1.28 P=0.012). Seventy-nine of R+ showed improvements in the DBAS 16 vs. 69 % of R- and 61 % of non-responders NR. CONCLUSION: A short group CBT programme by videoconference focused on behavioral modification can reduce dysfunctional beliefs about sleep.

French Sleepiness Scale for Adolescents-8 items: A discriminant and diagnostic validation.

The objective of the present study was to validate the Short Version of French Sleepiness Scale for Adolescents (FSSA) with eight items (FSSA8). METHODS: A total of 384 adolescents, aged between 12 and 18 years, completed the FSSA8. These included 269 nonclinical adolescents and 115 adolescents admitted for overnight polysomnography and Multiple Sleep Latency Test (MSLT) because of suspected hypersomnia (85 patients with narcolepsy and 30 with other sleep disorders). Item response theory (IRT) assumptions were tested and psychometric properties were analysed. Matching on sex ratio and age was conducted to estimate concurrent criterion, diagnostic validity and cut-offs. RESULTS: IRT assumptions were validated confirming the one-dimensionality of the FSSA8. The latent continuum sleepiness for which the scale and its items are reliable encompassed most of the clinical subjects. FSSA8 is weakly correlated with MSLT. Distribution of scores for the nonclinical group and the clinical group differed significantly; the FSSA8 had very good screening validity in sleep disorders. The cut-off was seven points. CONCLUSION: The FSSA8 appeared to be more reliable for patients than for nonclinical participants and to be a good tool for screening excessive daytime sleepiness in sleep disorders.

T-DM1 versus pertuzumab, trastuzumab and a taxane as first-line therapy of early-relapsed HER2-positive metastatic breast cancer: an Italian multicenter observational study.

BACKGROUND: The current standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive (+) metastatic breast cancer is the combination of pertuzumab, trastuzumab and a taxane (P + T + taxane), while standard second-line is ado-trastuzumab-emtansine (T-DM1). The registration trial of pertuzumab, however, did not include early-relapsing patients, defined as patients experiencing tumor relapse ≤12 months from the end of (neo)adjuvant anti-HER2 therapy. Conversely, the pivotal trial of T-DM1 included some patients relapsing ≤6 months after the end of (neo)adjuvant trastuzumab. Thus, a proportion of early-relapsing patients are currently eligible to receive T-DM1 as first-line treatment. Nevertheless, no direct comparison exists between the two regimens in this clinical setting. PATIENTS AND METHODS: We retrospectively compared T-DM1 versus P + T + taxane as first-line treatment in two cohorts of early-relapsing patients in an Italian 'real-world' setting, involving 14 public health care institutions. The primary endpoint was progression-free survival. Secondary endpoints included patients' characterization, overall survival and post-progression survival. Univariate and multivariate analyses were carried out. All tests were two-sided and a P ≤ 0.05 was considered statistically significant. RESULTS: Among 1252 screened patients, 75 met the inclusion criteria. Forty-four (58.7%) received P + T + taxane and 31 (41.3%) received T-DM1. The two cohorts showed similar characteristics of aggressiveness and no significant differences in treatment history. T-DM1, compared with P + T + taxane was associated with worse progression-free survival (adjusted hazard ratio: 2.26, 95% confidence interval: 1.13-4.52, P = 0.021) and overall survival (adjusted hazard ratio: 3.95, 95% confidence interval: 1.38-11.32, P = 0.010), irrespective of previous (neo)adjuvant treatment, age, hormone receptors status, time-to-relapse (≤6 months or within 6-12 months) and presence of visceral/brain metastases. No differences were observed in post-progression survival (P = 0.095). CONCLUSIONS: Our study suggests superiority for P + T + taxane over T-DM1 as up-front treatment of early-relapsing HER2+ metastatic breast cancer, which merits further assessment in larger and prospective trials.

[The effects of quarantine for SARS-CoV-2 on sleep: An online survey]. / Les effets de confinement SARS-CoV-2 sur le sommeil : enquête en ligne au cours de la quatrième semaine de confinement.

OBJECTIVES: Explore the evolution of sleep during the SARS-CoV-2 quarantine period and define associated factors. METHODS: An online survey of patients in quarantine. Questions targeted the conditions of quarantine, sleep related behaviours and exposure to factors known to affect sleep and circadian rhythms (light exposure and sport). RESULTS: In all, 1777 participants were included: 77% women and 72% aged 25-54 years. Quarantine conditions were most frequently in couples with children (36%) and in a house with a garden (51%). Forty-seven percent of participants reported a decrease in sleep quality during quarantine. Factors associated with a reduction in sleep quality by logistic regression were sleep reduction (OR 15.52 P<0.001), going to bed later (OR 1.72 P<0.001), getting up earlier (2.18 P=0.01), an increase in sleep-wake irregularity (OR 2.29 P<0.001), reduced exposure to daylight (OR 1.46 P=0.01) and increased screen use in the evenings (OR 1.33 P=0.04). CONCLUSION: Sleep quality tended to reduce during quarantine and this was associated with changes in sleep behaviours and light exposure, especially in the evening. In order to optimise sleep during quarantine, regular sleep and wake times, at least 1hour exposure to daylight and a reduction of screen use in the evenings are suggested.

[The use of social media modifies teenagers' sleep-related behavior]. / Nouveaux médias sociaux, nouveaux comportements de sommeil chez les adolescents.

OBJECTIVE: Modification of sleep behaviors in teenagers has been observed over the past 30years with a reduction in overall sleep time and an increasing number of teenagers suffering from sleep deprivation. Sleep deprivation is linked to physical problems such as obesity but also to change in performance at school and mood disorders. Changes have been associated with the use of screens, cell phones, Internet and social media. Use of screens has been shown to delay sleep onset and melatonin secretion and stimulation of wake systems by interaction with social media may exacerbate these effects. The links between the use of social media and sleep patterns have not been fully explored. Our study aimed to evaluate the effects of social media on teenagers' sleep and the impact of sleep deprivation. METHODOLOGY: As part of a sleep education program conducted in middle schools, teenagers from 6th to 9th grade were invited to complete an online questionnaire on sleep habits with teacher supervision and after parental consent. Outcome measures were sleep and wake times with estimated sleep duration in school (SP) and rest periods (RP), use of screens (computers, tablets, smartphones and video game consoles), the use of social media and impact on visual analogue scales of sleep quality, mood and daytime functioning. Students were divided into those with clear sleep deprivation (sleep time<6hours in SP) and those whose sleep time was in line with the National Sleep Foundations recommended sleep needs for teenagers (9hours or more). RESULTS: A total of 786 questionnaires were completed and 776 were exploitable. Four schools took part with 408/786 girls (64.2 %) and a mean age of 12.4±1.24. Internet access was almost universal (98.3 %), 85.2 % had cell phones and 42.7 % had a personal computer in their bedroom. Social media was used by 64.6 %. After dinner, 52.6 % spent more than an hour and 14.7 % spent more than 2hours in front of a screen. After bedtime, 51.7 % regularly used electronic devices of which 25.6 % had a screen-based activity (e.g. texts, social media, video games or television). During the night, some teens woke up to continue screen-based activities: 6.1 % in order to play online video games, 15.3 % to send texts and 11 % to use social media. Bedtimes were later in PR compared with PS (22h06±132 vs. 23h54±02; P<0.0001) as were wake times (7h06±36 vs. 10h06±102; P<0.0001). Sleep time was clearly longer in PR (10h12±126 P<0.0001) compared to PS. For students in 6th grade compared to 9th grade in sleep duration in SP decreased (8:55±90 vs. 7:25±93; P<0.0001), whereas sleep duration during RP was stable (10h08±118 vs. 10h08±90 P<0.029). No significant difference was found between girls and boys for sleep duration, sleep quality, performance during the day or mood. Sleep deprivation during the week (6hours or less) was less common in 6th graders 5 % vs. 15 % (P<0.0001). In sleep deprived teens compared to teens sleeping, the recommended ≥9hours, difficulties falling asleep were reported with 33 % vs. 9 % taking over an hour to fall asleep (P<0.0001) and difficulties getting up in the morning were more common (7.05±3.27 vs. 5.74±2.97; P=0.0003). Sleep deprivation had an effect on daytime performance: teenagers deprived of sleep were more likely to report a need to fight sleepiness, (5.93±3.24 vs. 2.84±2.44 P<0.0001) and had reduced energy during the day (6.21±2.86 vs. 7.77±2.07 P<0.0001). A negative effect on mood was evident: in sleep, deprived teenagers irritability (5.28±3.12 vs. 3.30±2.34; P<0.0001) and feelings of sadness (3.97±2.99 vs. 2.59±2.15; P=0.003) were more common. There was a clear association between sleep deprivation and access to screens and social media: sleep deprived teens were at more risk of nocturnal disruption with a higher prevalence of computers (67 % vs. 33 %; P<0.0001), cell phones (99 % vs. 80 %; P=0.0001) and smart phones (85 % vs. 66 %; P=0.0001) in their bedrooms. CONCLUSIONS: Access to social media and especially a cell phone in teenagers' bedrooms is associated with a reduction in sleep time during the school week with negative effects on daily functioning and mood which increases with increasing age. Education about use of social media and sleep for teenagers needs to start early as modifications in sleep and evening use of screens was present on our population from 11years on and to involve parents as setting parent controlled bedtimes has been shown to increase teenage sleep time.

[How to characterize and treat sleep complaints in bipolar disorders?] / Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?

OBJECTIVES: Sleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD. METHODS: We examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: "bipolar disorder" and ("sleep" or "insomnia" or "hypersomnia" or "circadian" or "apnoea" or "apnea" or "restless legs"). RESULTS: Patients with BD suffer from sleep and circadian rhythm abnormalities during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal and/or early awakenings, non-restorative sleep) and manic episodes (insomnia, decreased need for sleep without fatigue), but also some of these abnormalities may persist during remission. These remission phases are characterized by a reduced quality and quantity of sleep, with a longer sleep duration, increased sleep latency, a lengthening of the wake time after sleep onset (WASO), a decrease of sleep efficiency, and greater variability in sleep/wake rhythms. Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness, sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS), and restless legs syndrome (RLS). These disorders are insufficiently diagnosed and treated whereas they are associated with mood relapses, treatment resistance, affect cognitive global functioning, reduce the quality of life, and contribute to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities have been also associated with suicidal behaviors. Therefore, a clinical exploration with characterization of these abnormalities and disorders is essential. This exploration should be helped by questionnaires and documented on sleep diaries or even actimetric objective measures. Explorations such as ventilatory polygraphy, polysomnography or a more comprehensive assessment in a sleep laboratory may be required to complete the diagnostic assessment. Treatments obviously depend on the cause identified through assessment procedures. Treatment of chronic insomnia is primarily based on non-drug techniques (by restructuring behavior and sleep patterns), on psychotherapy (cognitive behavioral therapy for insomnia [CBT-I]; relaxation; interpersonal and social rhythm therapy [IPSRT]; etc.), and if necessary with hypnotics during less than four weeks. Specific treatments are needed in phase delay syndrome, OSAHS, or other more rare sleep disorders. CONCLUSIONS: BD are defined by several sleep and circadian rhythm abnormalities during all phases of the disorder. These abnormalities and disorders, especially during remitted phases, should be characterized and diagnosed to reduce mood relapses, treatment resistance and improve BD outcomes.

Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?

OBJECTIVES: To evaluate the effectiveness of a short (3 session) programme of group cognitive behavioural therapy (CBT) on insomnia, sleepiness and symptoms of anxiety and depression. METHODS: Prospective observational study of group CBT with follow-up at 3 months. Participants were self-referred patients with chronic insomnia. Outcome measures were the insomnia severity scale (ISI), the Epworth sleepiness scale (ESS), depression (Pichot scale), and the number of anxiety symptoms. RESULTS: Participation in CBT was offered to 489 patients of whom 474 completed the programme and 154 were followed up at 3 months. Significant improvements in insomnia were seen: ISI score (17.74-14.27, P<0.0001) after CBT and at follow-up (13.78, P<0.0001). At the end of CBT, 76% (59/78) with initial severe insomnia and 52% (132/255) with moderate insomnia were improved, maintained at 3 months in 71% (15/21) with severe insomnia and 56% (50/90) with moderate insomnia. Depression and anxiety symptoms were significantly improved: mean depression symptoms (4.15-3.35, P<0.0001) and anxiety symptoms (4.52-3.95, P<0.0001), maintained at 3 months with mean depression symptoms (3.17, P<0.0001) and mean anxiety symptoms (3.62, P<0.0001). Sleepiness increased between baseline and the end of the group (6.67-7.24, P=0.015) followed by a reduction at 3 months (7.19-6.34 at 3 months, P=0.001). Initial ISI score but neither sex nor age were predictive of outcome. CONCLUSIONS: A short programme of CBT can improve sleep, depression and anxiety symptoms in self-referred patients suffering from chronic insomnia with good adherence and maximum benefit in patients with severe insomnia.

From gold nanobipyramids to nanojavelins for a precise tuning of the plasmon resonance to the infrared wavelengths: experimental and theoretical aspects.

Anisotropic gold nanoparticles and in particular with shapes exhibiting tips are known to present an extremely strong localized electromagnetic field. This field is mostly located at the top of the tips and can be used in various optical applications. Moreover, as a consequence of their anisotropy, they present two plasmon resonance bands corresponding to the transverse and longitudinal resonance modes. Tuning the aspect ratio it becomes possible to display SPR bands near the near infrared region. This was particularly investigated in the case of nanorods and also for bipyramids. In this paper we report a high yield synthesis approach that allows one to precisely control the aspect ratio of bipyramids and to elongate the structure until they adopt a javelin-like aspect. We were able to prepare nano-javelins with surface plasmon resonances up to 1850 nm, opening important perspectives in terms of optical applications in the NIR and IR regions. The synthetic methods are fully reported and the optical properties were correlated with the theoretical approach, taking into consideration not only the aspect ratio but also the truncation of the nano-objects.

Plasmonic bipyramids for fluorescence enhancement and protection against photobleaching.

A great number of studies focus their interest on the photophysical properties of fluorescent hybrid gold nanoparticles for potential applications in biotechnologies such as imaging and/or treatment. Spherical gold nanoparticles are known to quench a chromophore fluorescent signal, when moieties are located in their close vicinity. The use of a polymer spacer on such a system allowed only partial recovery of the dye emission by controlling the surface to dye distance. Gold-based anisotropic sharp nanostructures appear to exhibit more interesting features due to the strong electric field generated at their edges and tips. In this paper, a complete study of hybrid fluorescent bipyramidal-like gold nanostructures is presented. We describe the chemical synthesis of gold bipyramids functionalized with fluorescent water-soluble polymers and their photophysics both in solution and on a single object. We show that the use of a bipyramidal shape instead of a spherical one leads to total recovery of the fluorescence and even to an enhancement of the emission of the dyes by a factor of 1.4.

[Role of a health network dedicated to patient care for sleep disorders]. / Rôle d'un réseau de santé dans la prise en charge des troubles du sommeil.

The Réseau Morphée is a health network funded by the Regional Health Commission (Mission Régionale de Santé d'Ile-de-France). Its mission is to improve the management of sleep disorders via actions for the public, patients and health professionals. For patients suffering from sleep apnea, the network improves access to care and organises education and support groups for patients treated by Continuous Positive Airway Pressure (CPAP) in order to improve compliance. Health professionals can optimise patient care using an Internet based computerised consultation system which automatically incorporates sleep recording and CPAP reports. The expertise of the Morphée medical team is on hand at all times to help in the management of complex patients and expert advice from other members of the network is shared during regular patient management meetings. The réseau Morphée is certified as a continuing medical education (FMC) and clinical practice accreditation (EPP) organisation and so active members can validate both their FMC and EPP.

Oxidative stress and eicosanoids in the kidneys of hyperglycemic rats treated with dehydroepiandrosterone.

Oxidative stress plays a crucial role in the pathogenesis of chronic diabetic complications. Normoglycemic and streptozotocin-diabetic rats were treated with dehydroepiandrosterone (DHEA) (4 mg/d per rat) for 3 weeks. At the end of treatment, hydroxynonenal, hydroperoxyeicosatetraenoic acids and antioxidant levels, as well as Na/K-ATPase activity and membrane fatty acids composition were evaluated in kidney homogenates. Chronic hyperglycemia caused a marked increase of both hydroxynonenal and lipoxygenase pathway products and a drop in both GSH levels and membrane Na/K-ATPase activity. DHEA treatment restored the antioxidant levels to close to the control value and considerably reduced hydroxynonenal and hydroperoxyeicosatetraenoic acid levels. Moreover, DHEA counteracted the detrimental effect of hyperglycemia on membrane function: the drop of Na/K-ATPase activity in diabetic animals was significantly inhibited by DHEA treatment. These results show that DHEA reduces oxidative stress and the consequent increase of lipoxygenase pathway products induced by experimental diabetes in rat kidney; they also suggest that, by reducing the inflammatory response to oxidative stress, DHEA treatment might delay the progression of diabetic kidney disease.

Dehydroepiandrosterone prevents oxidative injury induced by transient ischemia/reperfusion in the brain of diabetic rats.

Both chronic hyperglycemia and ischemia/reperfusion (IR) cause an imbalance in the oxidative state of tissues. Normoglycemic and streptozotocin (STZ)-diabetic rats were subjected to bilateral carotid artery occlusion for 30 min followed by reperfusion for 60 min. Rats had either been treated with dehydroepiandrosterone (DHEA) for 7, 14, or 21 days (2 or 4 mg/day per rat) or left untreated. Oxidative state, antioxidant balance, and membrane integrity were evaluated in isolated synaptosomes. IR increased the levels of reactive species and worsened the synaptic function, affecting membrane Na/K-ATPase activity and lactate dehydrogenase release in all rats. The oxidative imbalance was much severer when transient IR was induced in STZ-diabetic rats. DHEA treatment restored H2O2, hydroxyl radical, and reactive oxygen species to close to control levels in normoglycemic rats and significantly reduced the level of all reactive species in STZ-diabetic rats. Moreover, DHEA treatment counteracted the detrimental effect of IR on membrane integrity and function: the increase of lactate dehydrogenase release and the drop in Na/K-ATPase activity were significantly prevented in both normoglycemic and STZ-diabetic rats. The results confirm that DHEA, an adrenal steroid that is synthesized de novo by brain neurons and astrocytes, possesses a multitargeted antioxidant effect. They also show that DHEA treatment is effective in preventing both derangement of the oxidative state and neuronal damage induced by IR in experimental diabetes.

NT2 neurons, a classical model for Alzheimer's disease, are highly susceptible to oxidative stress.

We have tested undifferentiated NT2 cells as well as differentiated NT2 neurons (NT2N) for vulnerability to oxidative stress, lipid composition and antioxidant pattern. NT2N, but not NT2 cells, are highly susceptible to oxidative stress elicited by different classic pro-oxidant stimuli. In particular, NT2N cells undergo a high level of oxidative decomposition of omega-3 and omega-6 polyunsaturated fatty acids (PUFA) of membrane phospholipids, as evaluated by monitoring generation of thiobarbituric reactive substances, 4-hydroxynonenal (HNE) and chromolipid fluorescent adducts. NT2N cells exhibit low levels of natural antioxidants such as glutathione (GSH) and alpha-tocopherol and of antioxidant enzymatic activities such as Se-dependent GSH peroxidase and catalase. Accordingly, a direct correlation between lipid peroxidation and irreversible cell damage is suggested by prevention of NT2N cell death by alpha-tocopherol.

Oxidative derangement in rat synaptosomes induced by hyperglycaemia: restorative effect of dehydroepiandrosterone treatment.

Central nervous system damage in diabetes is caused by both cerebral atherosclerosis and the detrimental effect of chronic hyperglycaemia on nervous tissue. Hyperglycaemia is the primer of a series of cascade reactions causing overproduction of free radicals. There is increasing evidence that these reactive molecules contribute to neuronal tissue damage. Dehydroepiandrosterone (DHEA) has been reported to possess antioxidant properties. This study evaluates the oxidative status in the synaptosomal fraction isolated from the brain of streptozotocin-treated rats and the antioxidant effect of DHEA treatment on diabetic rats. Hydroxyl radical generation, hydrogen peroxide content, and the level of the reactive oxygen species was increased (P<0.05) in synaptosomes isolated from streptozotocin-treated rats. The derangement of the oxidative status was confirmed by a low level of reduced glutathione and alpha-tocopherol. DHEA treatment (4 mg per day for 3 weeks, per os) protected the synaptosomes against oxidative damage: synaptosomes from diabetic DHEA-treated rats showed a significant decrease in reactive species (P<0.05) and in the formation of end products of lipid peroxidation, evaluated in terms of fluorescent chromolipid (P<0.01). Moreover, DHEA treatment restored the unsaturated fatty acid content of the membrane and the reduced glutathione and alpha-tocopherol levels to normal levels and restored membrane NaK-ATPase activity close to control levels. The results demonstrate that DHEA supplementation greatly reduces oxidative damage in synaptosomes isolated from diabetic rats and suggest that this neurosteroid may participate in protecting the integrity of synaptic membranes against hyperglycaemia-induced damage.

Olfaction in Parkinson's disease: methods of assessment and clinical relevance.

Several neurological conditions have been reported to be associated with peripheral or central deficits of olfactory system. In recent years particular emphasis has been placed on the early and severe olfactory impairment in Parkinson's disease (PD), in which limited neuropathological studies have revealed a marked dopaminergic deficit in the olfactory tubercles. Moreover, indirect evidence suggests that dysfunction of the dopaminergic pathways from mesencephalon to the piriform cortex may play a role in olfactory impairment in PD. A large number of clinical studies have reported that olfactory loss in idiopathic PD is bilateral, present in hemiparkinsonism, unrelated to the stage or clinical subtype of the disease, and independent of antiparkinsonian medication. In addition, major olfactory alterations have been reported in familial PD and dementia with Lewy bodies but not in progressive supranuclear palsy and essential tremor. These findings might stimulate further research targeted to determine the biological substrate of dissimilar olfactory performances in these movement disorders. The present review summarizes standardized procedures for the assessment of olfactory acuity (detection threshold), identification (multiple choice odor naming), discrimination (differentiation between similar/dissimilar odorants), and memory (recognition of a substance previously smelled). Specific suggestions concerning the psychometric and neuropsychological evaluation of PD patients are provided.

Dehydroepiandrosterone protects tissues of streptozotocin-treated rats against oxidative stress.

Chronic hyperglycemia in diabetes determines the overproduction of free radicals, and evidence is increasing that these contribute to the development of diabetic complications. It has recently been reported that dehydroepiandrosterone possesses antioxidant properties; this study evaluates whether, administered daily for three weeks per os, it may provide antioxidant protection in tissues of rats with streptozotocin-induced diabetes. Lipid peroxidation was evaluated on liver, brain and kidney homogenates from diabetic animals, measuring both steady-state concentrations of thiobarbituric acid reactive substances and fluorescent chromolipids. Hyperglycemic rats had higher thiobarbituric acid reactive substances formation and fluorescent chromolipids levels than controls. Dehydroepiandrosterone-treatment (4 mg/day for 3 weeks) protected tissues against lipid peroxidation: liver, kidney and brain homogenates from dehydroepiandrosterone-treated animals showed a significant decrease of both thiobarbituric acid reactive substances and fluorescent chromolipids formation. The effect of dehydroepiandrosterone on the cellular antioxidant defenses was also investigated, as impaired antioxidant enzyme activities were considered proof of oxygen-dependent toxicity. In kidney and liver homogenates, dehydroepiandrosterone treatment restored to near-control values the cytosolic level of reduced glutathione, as well as the enzymatic activities of superoxide-dismutase, glutathione-peroxidase, catalase. In the brain, only an increase of catalase activity was evident (p < .05), which reverted with dehydroepiandrosterone treatment. The results demonstrate that DHEA treatment clearly reduces oxidative stress products in the tissues of streptozotocin-treated rats.

Assessing olfaction in the Italian population: methodology and clinical application.

Disorders of the sense of smell are receiving growing clinical as well as experimental attention. Indeed, several neurological conditions have been associated with peripheral or central deficits of the olfactory system. In recent years, particular emphasis has been attributed to the early and severe olfactory impairment in neurodegenerative diseases, such as Alzheimer's dementia and Parkinson's disease. Olfactory assessment has also been included in comprehensive pre- and post-surgical evaluations of temporal lobe epilepsy. Moreover, the request for standardized methods of olfactory evaluation by forensic and occupational medicine is greatly increasing. Despite this requirement, there is no agreement in the Italian neurological community on olfactory assessment. This lack prompted us to generate a battery of standardized tests capable of bypassing cross-cultural differences in olfactory assessment and to be potentially useful in the clinical as well as experimental settings. Procedures of assessment of olfactory acuity (detection threshold), identification (multiple choice odor naming), discrimination (differentiation between similar/dissimilar odorants) and memory (recognition of a substance previously smelled) are fully described. In order to control bias factors depending upon the nature of the investigated disorder and the applied olfactory tasks, a minimal complementary neuropsychological assessment is recommended.

Oxygen free radical scavenger properties of dehydroepiandrosterone.

The microsomes from dehydroepiandrosterone (DHEA)-supplemented animals are good hydroxyl radical scavengers, as demonstrated through electron spin resonance and deoxyribose degradation. The ability of DHEA-supplemented microsomes to react with superoxide radical was also demonstrated through the inhibition of nitroblue-tetrazolium reduction determined by superoxide radicals produced in a hypoxanthine-xanthine oxidase system. DHEA-enriched microsomes, obtained from acutely DHEA-treated rats, become resistant to iron-dependent lipid peroxidation triggered by H2O2/FeSO4 and ascorbate/FeSO4. The direct addition of DHEA to microsomes from untreated rats failed to prevent iron-dependent lipid peroxidation, even if the microsomes were preincubated with DHEA for up to 15 min, indicating that in vivo transformation is required before antioxidant action can be exerted.

[Narcolepsy and the psychiatric tableau. A specific form of narcolepsy?]. / Narcolepsie et tableau psychiatrique. Une forme de narcolepsie particulière?

Narcolepsy is a well-known hypersomnia. Nevertheless narcolepsy in which the hallucinatory component is unusually prominent may lead to a false diagnosis of schizophrenia syndrome. This aspect is illustrated by the case of Miss B. who appears like a psychotic patient without dissociation syndrome and with a hysterical personality. Are the narcoleptics with psychiatric disorders a peculiar sub-type of narcolepsy? Fourty-five percent of our eleven narcoleptics patients have an associated psychiatric disorder. Most of them are depressive. Surprisingly fourty percent of our patients are non-DR2 at the Human Leucocyte Antigen typing. Furthermore seventy five percent of them have an associated psychiatric disorder. This would mean a peculiar sub-type of narcolepsy.