Platelet number is negatively and independently associated with carotid intima-media thickness in apparently healthy overweight/obese subjects.

BACKGROUND AND AIM: A significant change of platelet number may be a risk factor for atherosclerotic cardiovascular disease. The aim of this study was to investigate the association between platelet number and early signs of atherosclerosis, evaluated by carotid intima-media thickness (c-IMT), in a apparently healthy population mainly represented by obese subjects. METHODS AND RESULTS: As many as 961 subjects, 686 women and 275 men, aged between 18 and 74 years, were enrolled in the study. Of these, 54 individuals (5.6% of all subjects) were normal weight, 259 individuals (27.0% of all subjects) were overweight, and 648 individuals (67.4% of all subjects) were obese. Waist circumference (WC) and blood glucose, insulin, total cholesterol, high and low density lipoprotein cholesterol, triglycerides and platelet count were also detected in all subjects, who underwent carotid echo color doppler ultrasound to measure c-IMT. c-IMT was significantly and positively associated to age (r = 0.204, P < 0.0001), fasting glucose (r = 0.073, P < 0.0240), total cholesterol (r = 0.096, P = 0.0031), and systolic and diastolic blood pressure (r = 0.140, P < 0.0001 and r = 0.119, P < 0.0003 respectively); c-IMT was significantly and negatively correlated with platelet count (r = -0.165, P < 0.0001). Only age (P < 0.0001) and systolic blood pressure (P = 0.0393), positively, and platelet number (P < 0.0001), negatively, were significantly and independently associated to c-IMT in a final multiple regression analysis. CONCLUSION: Lower platelet number represented an independent determinant of c-IMT in a population, mainly represented by obese patients. These results suggest that a decrease of platelet number may well be an early defensive mechanism in subjects developing the thickening of carotid artery.

Cerebral blood flow changes associated with attribution of emotional valence to pleasant, unpleasant, and neutral visual stimuli in a PET study of normal subjects.

OBJECTIVE: To assist in the development of a model for the psychopathology of emotions, the present study sought to identify the neural circuits associated with the evaluation of visual stimuli for emotional valence. METHOD: Seventeen healthy individuals were shown three sets of emotionally laden pictures carrying pleasant, unpleasant, and neutral content. While subjects evaluated the picture set for emotional valence, regional cerebral blood flow was measured with the use of [15O] water positron emission tomography. Subjective ratings of the emotional valence of the picture sets were recorded. Data were analyzed by comparing the images acquired during the neutral condition with the unpleasant and pleasant image sets and the unpleasant and pleasant conditions with each other. RESULTS: Processing of pleasant stimuli was associated with increased blood flow in the dorsal-lateral, orbital, and medial frontal cortex relative to the unpleasant condition and in the cingulate, precuneus, and visual cortex relative to the neutral condition. Evaluation of unpleasant stimuli activated the amygdala, visual cortex, and cerebellum relative to the pleasant condition and the nucleus accumbens, precuneus, and visual cortex relative to the neutral condition. CONCLUSIONS: Observing and assigning emotional value to unpleasant stimuli produced activations in subcortical limbic regions, whereas evaluation of pleasant stimuli produced activations in cortical limbic areas. These findings are consistent with the notion of a subcortical and archaic danger recognition system and a system detecting pleasantness in events and situations that is phylogenetically younger, involving primarily the prefrontal cortex.

Recalling word lists reveals "cognitive dysmetria" in schizophrenia: a positron emission tomography study.

OBJECTIVE: This study explored the neural circuitry used during recall of unstructured verbal material in schizophrenic patients and healthy volunteer subjects. METHOD: The subjects were 13 healthy volunteers and 14 schizophrenic patients. All patients were free of medication, and all subjects were right-handed. Two experimental cognitive conditions were used: recall of novel and practiced word lists (two 15-item lists from the Rey Auditory Verbal Learning Test). Both active recall tasks were compared with an eyes-closed resting baseline condition. A nonparametric randomization test was used to determine within- and between-group differences in regional cerebral blood flow. RESULTS: Performance on both the practiced and novel memory tasks was nonsignificantly different in the patients and control subjects. During the novel memory task, the patients showed decreased flow in the right anterior cingulate, right thalamus, and bilateral cerebellum (left greater than right) relative to the control subjects. When recalling the practiced word lists, the patients showed decreased flow in the left dorsolateral prefrontal cortex, bilateral medial frontal cortex, left supplementary motor area, left thalamus, left cerebellar regions, anterior vermis, and right cuneus. CONCLUSIONS: Patients with schizophrenia fail to activate cortical-cerebellar-thalamic-cortical circuitry during recall of both well-learned and novel word lists.

Emotional activation of limbic circuitry in elderly normal subjects in a PET study.

OBJECTIVE: This study was undertaken to identify brain structures associated with emotion in normal elderly subjects. METHOD: Eight normal subjects aged 55-78 years were shown film clips intended to provoke the emotions of happiness, fear, or disgust as well as a neutral state. During emotional activation, regional cerebral blood flow was measured with the use of [15O]H2O positron emission tomography imaging, and subjective emotional responses were recorded. Data were analyzed by subtracting the values during the neutral condition from the values in the various emotional activations. RESULTS: The stimuli produced a general activation in visual pathways that included the primary and secondary visual cortex, involving regions associated with object and spatial recognition. In addition, the specific emotions produced different regional limbic activations, which suggests that different pathways may be used for different types of emotional stimuli. CONCLUSIONS: Emotional activation in normal elderly subjects was associated with increases in blood flow in limbic and paralimbic brain structures. Brain activation may be specific to the emotion being elicited but probably involves complex sensory, association, and memory circuitry. Further studies are needed to identify activations that are specific for emotion.

Improved executive functioning following repetitive transcranial magnetic stimulation.

The cognitive effects of active and sham repetitive transcranial magnetic stimulation (rTMS) were examined in 19 middle-aged and elderly patients with refractory depression. Patients received either active (n = 9) or sham (n = 10) rTMS targeted at the anterior portion of the left middle frontal gyrus. Patients in the active rTMS group improved significantly on a test of cognitive flexibility and conceptual tracking (Trail Making Test-B).

Brain activity assessed with PET during recall of word lists and narratives.

This study investigated the functional neuroanatomy involved in retrieval of structured versus unstructured verbal information. We compared cerebral blood flow using PET with the [15O]water method while subjects engaged in recall of novel and practised narratives and lists of unrelated words. Left orbital frontal cortex was activated during recall of both novel and practised unrelated words. Right parietal cortex was relatively more active during recall of the novel word list. Right orbital frontal cortex and anterior cingulate were relatively more active during recall of the practised but not the novel word list. These results are consistent with the role of left orbital frontal cortex in retrieval of unstructured verbal information. Right orbital frontal activity suggests that cognitive strategies may be involved in retrieval of well-practised words.

"Cognitive dysmetria" as an integrative theory of schizophrenia: a dysfunction in cortical-subcortical-cerebellar circuitry?

Earlier efforts to localize the symptoms of schizophrenia in a single brain region have been replaced by models that postulate a disruption in parallel distributed or dynamic circuits. Based on empirical data derived from both magnetic resonance and positron emission tomography, we have developed a model that implicates connectivity among nodes located in prefrontal regions, the thalamic nuclei, and the cerebellum. A disruption in this circuitry produces "cognitive dysmetria," difficulty in prioritizing, processing, coordinating, and responding to information. This "poor mental coordination" is a fundamental cognitive deficit in schizophrenia and can account for its broad diversity of symptoms.

Patterns of academic competence in adults with epilepsy: a cluster analytic study.

Cluster analysis was used in the attempt to derive a meaningful taxonomy of academic competence in 117 adults with temporal lobe epilepsy. Reading, spelling and arithmetic achievement scores from the Wide Range Achievement Test-Revised were subjected to hierarchical complete linkage cluster analysis, and the stability of the obtained solution was examined by the application of two additional clustering procedures. A six cluster solution was obtained, and tests of internal validity showed membership in four of the clusters to be extremely stable (Moderate and Marked Reading/Spelling Underachievement, Above Average Achievement, Reading/Arithmetic Underachievement), while the remaining two clusters showed some exchange of cases (Arithmetic Underachievement, Average Achievement). Modest evidence of external validity was found through the comparison of specific clusters to the Average Achievement group on measures of neuropsychological function, neurological and demographic characteristics. It is concluded that cluster analysis may be helpful in developing taxonomies of psychosocial impairment in epilepsy, and may facilitate an understanding of the determinants of variable quality of life outcomes associated with epilepsy.

[Research on the psychological view of maternity in women in the puerperium]. / Indagine sul vissuto psicologico della maternità in donne in puerperio.

The aim of our research was to observe the ways in which the hospital and the social environment react towards delivery and birth and how pregnant women experience this event from the psychological point of view. A questionnaire was submitted to 58 puerperas at their third-fifth day. From the analysis of the results we can observe that the hospital structure tends to treat this experience as a mechanical and routinary event; this particularly jouful moment which should be a time of celebration is often undervalued. As a matter of fact the hospital does not create an atmosphere of joy which should accompany any event connected with birth and which should be transmitted to the child offering him a sense of confidence from the very first moment of his life. Women are generally the victims of a culture of terror, originated by an ideology of "institutionalism" which tends to regard the process of birth as a medical phenomenon and not as a natural one, and so they prefer to hand over all responsibility to the specialist, instead of taking charge of it themselves. We have also noticed that women very rarely undertake psycho-physical training before the delivery; the reasons may be the culture of terror or also because the training techniques are considered inadequate for the psychological aspects. We have observed that most of all, women are frightened by the delivery itself and of giving birth to a deformed child. Women lack an experience of psychological growth which would help them to reach an emotional maturity. This is necessary to help the child to develop his infinite potential and abilities which he already possesses from the moment he is born and which will help him to face whole heartedly the fascinating albeit painful adventure that is life.

[Early ultrasonic amniocentesis. 147 cases]. / Amniocentesi precoce ecoguidata. 147 casi.

The results of 147 amniocenteses are analysed. The authors found chromosome abnormalities in 1.4% of the cases (two Down's syndromes were diagnosed) and no short and/or long-term materno-foetal complications were encountered.

[High resolution electrophoresis of serum aand amniotic fluid]. / Elettroforesi ad alta risoluzione del siero e del liquido amniotico.

In a sample group of 92 women undergoing prenatal echo-guided transabdominal amniocentesis between the 12th and 23rd week of pregnancy the Authors analysed amniotic fluid and maternal serum using the recently developed method of high resolution protein electrophoresis in order to identify the presence of particular proteins in the amniotic fluid which are pathognomonic for a number of maternofetal pathologies. The results obtained in normal and pathological pregnancies or in the case of twins showed a marked dispersion in amniotic fluid of total protein concentrations depending on the period of gestation; in addition, albumin, alpha 1-antitrypsin, alpha 2-glycoprotein acid, alpha 2-macroglobulin and beta 2-protein were also found. Plasma levels of prealbumin, albumin, alpha 1-glycoprotein acid and IgG were slightly reduced, whereas there was a marked increase in ceruloplasmin, transferrin and fibrinogen; C3 and haptoglobin levels were normal. It is therefore possible to ascertain that amniotic fluid proteins analysed by high-resolution 15-band electrophoresis did not vary qualitatively or quantitatively until the 23rd week of gestation and in those cases of twin or pathological pregnancies examined no anomalous band was found in the protein electrophoresis of maternal serum or amniotic fluid which might prove useful in prenatal diagnosis.

Proposal of new gradual dilation metal dilators.

The Authors suggest a new conceived line of metal cervical dilators, testing them on a group, made up of 69 patients, who will undergo Voluntary Pregnancy Interruption (VPI). Comparing the results with those obtained within a further test-group, made up of 69 women who have undergone a cervical dilation, performed by traditional Hegar dilators, it has been noticed that the new dilators are less traumatic on the cervical canal of the uterus; they can be used more easily and a wider employment is foreseen.

PIP: A set of 5 newly cervical dilators was tested on a group of 69 patients having abortion before the 3rd month of gestation, in comparison with 69 on which Hegar dilators were used. The new dilators are cone shaped, 190 mm in length, with a working length of 50 mm corresponding to the length of uterus from the os to the fundus. The minimum and maximum diameters were calculated as a function of the vertex angle, with each instrument's diameter larger than the preceding one. Calculations of design parameters, drawings and photographs are shown. cervical dilation of the subjects was assessed with Hegar dilators before the procedure began and at follow up 1 month later. Among both multiparas, and nulliparas and women with only cesarean deliveries, the cervical dilation as follow up was increased in a higher proportion of the group that had been dilated with Hegar dilators than in those dilated with the new dilators. There were no complications or fevers in these subjects. These new dilators caused less trauma as shown by cervical dilation at follow up, allowed less operative and anesthesia time, and fewer instruments, 5 instead of 20 Hegar dilators.

Electrical activity of the human uterus in vivo in the phases of the menstrual cycle.

The Authors established a method for detecting the electrical activity in the human uterus in vivo in order to observe possible variations in the two phases of the menstrual cycle. The results of surveys on six women, both in the follicular and in the luteal phase, as well as the spectral analysis, indicated an increase of frequency and intensity in the follicular phase.

[Uterine malformations and pregnancy: differential diagnosis (description of a case)]. / Malformazioni uterine e gravidanza: diagnostica differenziale (descrizione di un caso).

The authors describe a case of near-term pregnancy in a bicornuate uterus, discussing the differential diagnosis with the amniotic band syndrome and amnio-chorionic separation and discussing the distinctive characteristics of each of them.

Minor depression after stroke: an initial validation of the DSM-IV construct.

Using 141 patients with a single left- or right-hemisphere stroke, the authors investigated the distinction between major and minor depression after stroke. Major- and minor-depression patients and nondepressed control patients were compared, and a logistic-regression model suggested that major and minor depressions may be cross-sectionally distinguishable disorders. Minor depression was associated with younger age, left-hemisphere lesion location, and more caudal hemisphere lesions. There was an association between minor depression and pathoanatomical variables, with results generally consistent with the categorical vs. the continuum hypothesis of mood disorders in stroke victims. Authors discuss the significance of damage in left-hemisphere posterior portions of the brain for the development of minor depression after stroke.

Gender differences in poststroke depression.

In stroke and other medical illnesses, secondary depression may be associated with different factors in women than in men. The authors examined 301 consecutive admissions for acute treatment of cerebrovascular accident for gender differences in depression, psychosocial factors, physical impairment, and lesion location. Women were twice as frequently diagnosed with major depression as men. Women with major depression had a greater frequency of left hemisphere lesions than men. In men, major depression was associated with greater impairment in activities of daily living, and greater severity of depression was associated with greater impairment in daily activities and social functioning. In women, greater severity of depression was associated with prior diagnosis of psychiatric disorder and cognitive impairment. These findings suggest a different nature of poststroke depression in men and women and may have implications for its treatment.