Development of a self-report screening instrument for emotional dysregulation: the Reactivity, Intensity, Polarity and Stability questionnaire, screening version (RIPoSt-SV)

BACKGROUND

Emotional dysregulation (ED) refers to the inability to manage emotional experiences or expressions hindering goal-oriented behavior. Moderate impairment on at least two domains among temper control, affective lability, and emotional over-reactivity has been proposed to identify ED in adults with attention-deficit/hyperactivity disorder (ADHD). No screening measure designed for use in diverse psychiatric samples exists. We aimed to develop a self-report screening tool for ED based on the 40-item version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40).

METHODS

150 adult outpatients with non-psychotic conditions were enrolled between February and July 2023 at the Second Psychiatry Unit of Pisa University Hospital. Clinically significant ED (CSED) was defined based on the previously suggested approach for ADHD. Differences between patients with and without CSED were tested. To develop our screening instrument, a decision tree algorithm was trained by hyperparameter tuning through 5-fold cross-validation in 120 subjects and tested on the remaining 30.

RESULTS

75 subjects met criteria for CSED (50 %). CSED was associated with lower age and higher prevalence of psychiatric conditions, including minor mood disorders, ADHD, cannabis use disorders, and eating disorders. We identified a decision tree consisting of six items from RIPoSt-40 that effectively detected CSED, with accuracy, sensitivity, specificity, positive and negative predictive values of 80 % or higher in both the training and testing sets.

LIMITATIONS

Tertiary-level; no consensus on criteria; sample size.

CONCLUSION

The screening version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-SV) demonstrates promise as a valuable tool for ED screening in clinical settings.

Early experience with the new DORA daridorexant in patients with insomnia disorder and comorbid mental disturbances: Results of a naturalistic study with 3 months follow-up

Insomnia disorder may affect mental health, increasing suicidal risk. Targeting insomnia is crucial in the clinical practice. Sixty-six consecutive patients with insomnia disorder according with the DSM-5-TR criteria were treated with the dual orexin receptor antagonist, daridorexant 50 mg. Baseline (T0), 1 month (T1) and 3 month (T2) evaluations were performed. Insomnia severity (Insomnia Severity Index), mood, anxiety symptoms and suicidal risk (Beck Depression Inventory-II, Young Mania Rating Scale, Self-Reported Anxiety Scale, Suicidal Ideation Scale), dysfunctional insomnia-cognitive factors and pre-sleep arousal (Dysfunctional Beliefs About Sleep, Pre-Sleep Arousal Scale) were evaluated. The final sample included 66 patients (n = 36, 54% females, mean age 60 ± 13.6 years). Most of them, 64%, suffered from insomnia disorder comorbid with unipolar/bipolar depression, anxiety disorders and substance use disorders. Repeated ANOVA analyses showed that Insomnia Severity Index, Dysfunctional Beliefs About Sleep and Pre-Sleep Arousal Scale total score decreased across time (F = 68.818, p < 0.001; F = 47.561, p < 0.001; F = 28.142, p < 0.001, respectively). Similarly, Beck Depression Inventory-II, Self-Reported Anxiety Scale, Young Mania Rating Scale, and Suicidal Ideation Scale significantly decreased over time (p < 0.001). Predictors of insomnia remission (Insomnia Severity Index < 8) at T1 were improvement of Insomnia Severity Index at T1 (F = 60.205, p < 0.001), and improvement of Dysfunctional Beliefs About Sleep at T1 (F = 4.432, p = 0.041). Insomnia remission at T2 was best predicted by improvement of Dysfunctional Beliefs About Sleep at T2 (F = 3.993, p = 0.023). Multiple-regression models showed that clinical improvement of Beck Depression Inventory-II was best predicted by improvement in Dysfunctional Beliefs About Sleep at T1 and T2, manic symptoms by Insomnia Severity Index at T2, anxiety symptoms by Dysfunctional Beliefs About Sleep, Insomnia Severity Index and somatic Pre-Sleep Arousal Scale at T1 and T2. With the caution of a naturalistic design, early experience with daridorexant showed that by targeting insomnia it may be possible to improve not only insomnia symptoms but also comorbid symptoms.

The Role of Vortioxetine in the Treatment of Depressive Symptoms in General Hospital Psychiatry: A Case-Series and PRISMA-Compliant Systematic Review of the Literature

Depressive symptoms are a customary finding in hospitalized patients, particularly those who are undergoing long hospitalizations, underwent major surgical procedures or suffer from high levels of multimorbidity and frailty. The patients included in this case series shared high degrees of frailty-complexity and were evaluated within the ordinary consultation and liaison psychiatry service of the University Hospital in Pisa, Italy, from September 2021 to June 2023. Patients were administered at least one follow-up evaluation after a week and before discharge. To relate this case series to the extant literature, a comprehensive systematic review of vortioxetine safety and efficacy was performed. None of the six patients included developed serious safety issues, but one patient complained of mild-to-moderate nausea for some days after the vortioxetine introduction. Five out of six patients exhibited at least a slight clinical benefit as measured by the clinical global impression scale. Of the 858 entries screened via Scopus and Medline/PubMed, a total of 134 papers were included in our review. The present case series provides preliminary evidence for vortioxetine's safety in this healthcare domain. The literature reviewed in this paper seems to endorse a promising safety profile and a very peculiar efficacy niche for vortioxetine in consultation and liaison psychiatry.

The role of NMDA receptors in bipolar disorder: A systematic review

OBJECTIVES

Glutamatergic transmission and N-methyl-D-aspartate receptors (NMDARs) have been implicated in the pathophysiology schizophrenic spectrum and major depressive disorders. Less is known about the role of NMDARs in bipolar disorder (BD). The present systematic review aimed to investigate the role of NMDARs in BD, along with its possible neurobiological and clinical implications.

METHODS

We performed a computerized literature research on PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, using the following string: (("Bipolar Disorder"[Mesh]) OR (manic-depressive disorder[Mesh]) OR ("BD") OR ("MDD")) AND ((NMDA [Mesh]) OR (N-methyl-D-aspartate) OR (NMDAR[Mesh]) OR (N-methyl-D-aspartate receptor)).

RESULTS

Genetic studies yield conflicting results, and the most studied candidate for an association with BD is the GRIN2B gene. Postmortem expression studies (in situ hybridization and autoradiographic and immunological studies) are also contradictory but suggest a reduced activity of NMDARs in the prefrontal, superior temporal cortex, anterior cingulate cortex, and hippocampus.

CONCLUSIONS

Glutamatergic transmission and NMDARs do not appear to be primarily involved in the pathophysiology of BD, but they might be linked to the severity and chronicity of the disorder. Disease progression could be associated with a long phase of enhanced glutamatergic transmission, with ensuing excitotoxicity and neuronal damage, resulting into a reduced density of functional NMDARs.

Sodium valproate: cacosmia and dysgeusia as uncommon side effects

Smell and taste disturbances are potential adverse reactions of many drugs used in Psychiatry, such as antidepressants, anti-Parkinson agents, lithium, minor and major tranquilizers. To our knowledge, only one clinical case regarding valproate and cacosmia has been reported so far. However, several anticonvulsants are reported to cause taste and smell disturbances, although the underlying etiology is currently unclear. Our patient developed cacosmia and dysgeusia when taking valproic acid, both effects quickly disappeared upon drug discontinuation. In this article we not only report this uncommon side effect, but we discuss the plausible mechanisms behind such an adverse reaction. Our case is to date the second similar case in the literature. The aim of the present article is to make clinicians informed about this very uncommon and unpleasant side effect.

Insomnia During the Perinatal Period and its Association with Maternal and Infant Psychopathology: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

While sleep serves important regulatory functions for mental health, sleep disturbances, in particular insomnia, may contribute to mental disorders. Since insomnia symptoms are frequent during the perinatal period, the aim of this work is to systematically review the potential association between perinatal insomnia and maternal and infant psychopathology.

RECENT FINDINGS

A systematic search was conducted according with PRISMA guidelines, and meta-analytic calculations were conducted. Totally, 34 studies were included and involved 835,021 perinatal women. Four meta-analysis yielded four statistically significant random-effect models. All models show that women with perinatal symptoms of insomnia possess increased odds of developing clinically relevant symptoms of depression OR = 3.69, p = 0.001 and anxiety OR = 2.81; p < 0.001, as well as increased suicidal risk OR = 3.28; p < 0.001, and distress in the newborn OR = 2.80 (P = 0.007). These findings emphasize the role of assessing and addressing insomnia during the perinatal period to mitigate its negative effect on maternal and infant mental health via sleep regulation.

Valproate-induced burning mouth syndrome in a male with fibromyalgia and bipolar spectrum disorder

Burning mouth syndrome is a chronic painful condition characterized by a subjective intraoral pain and burning sensations in the absence of an identifiable medical, dental, or psychiatric cause. Although the underlying etiology is currently unclear, an idiopathic (or primary) form and a secondary form to other conditions are formally recognized. However, as several authors have suggested, it might be of clinical utility to consider the existence of a third clinical entity, namely Drug-Induced Burning mouth syndrome, for its therapeutic implications. The latter has been reported with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, antiretrovirals, anticoagulants, chemotherapy, and drugs commonly used in the treatment of neuropsychiatric disorders such as antidepressants, benzodiazepines, and antipsychotics. Regarding anticonvulsants a literature search found a previous case of Topiramate-Induced Burning mouth syndrome but no previous report of valproate-induced Burning mouth syndrome. Our case is, to date, the first case in the literature of Burning mouth syndrome onset following the administration of valproate to a patient suffering from fibromyalgia and bipolar spectrum disorder. Symptoms resolved completely when the drug was stopped, and the association between symptoms and drug was replicated after drug re-administration.

Ultrastructural Evidence of Eosinophil Clustering and ETosis in Association with Damage to Single Tumour Cells in a Case of Poorly Cohesive NOS Gastric Carcinoma

A case of poorly cohesive NOS gastric carcinoma, characterised by high-grade tumour-associated tissue eosinophilia (TATE), is studied by transmission electron microscopy. Eosinophil clustering around single tumour cells constituted a recurrent ultrastructural hallmark. Some eosinophils were in intimate contact with tumour cells and exhibited extracellular trap cell death (ETosis): a non-apoptotic cell death process, recently described in non-neoplastic, eosinophil-associated diseases. Discharge of chromatin material and specific granules, due to eosinophil ETosis, was polarised towards single tumour cells that showed various degrees of cytopathogenic changes. Our data suggest that eosinophil ETosis may exert an antitumoural activity in gastric cancer.

LEARNING POINTS

A recent meta-analysis reported that TATE is a histopathological marker of favourable prognosis, particularly in patients with gastrointestinal cancer.Experimental studies have shown that eosinophils may exert antitumour activity through discharge of their highly cytotoxic granular proteins.Our ultrastructural findings add novel mechanism insights for eosinophil antitumoural activity, providing morphologic evidence of eosinophil ETosis in association with single tumour cell injury.

Poor Sleep Quality May Independently Predict Suicidal Risk in Covid-19 Survivors: A 2-Year Longitudinal Study

Objective

Multiple symptoms of psychiatric, neurological, and physical illnesses may be part of Post-COVID conditions and may pose COVID-19 survivors a high suicidal risk. Accordingly, we aimed to study factors contributing to suicidal risk in Post COVID-19 patients.

Method

Consecutive patients with post COVID-19 conditions were followed for 2 years at the University Hospital of Ferrara at baseline (T0), 6 (T1), 12 (T2), and 24 (T3) months. Demographics, and clinical data for all patients included: disease severity, hospital length of stay, comorbidity, clinical complications, sleep quality, cognitive complaints, anxiety and stress-related symptoms, depressive symptoms, and suicidal ideation.

Results

The final sample included 81 patients with post COVID survivors. The mean age was 64 + 10,6 years, 35,8% were females, 65,4% had medical comorbidities, and 69,1% had WHO severe form of COVID forms. At T0 more than 90% of patients showed poor sleep quality, 59.3% reported moderate/severe depressive symptoms, and 51.% experienced anxiety, 25.9% experienced post-traumatic stress symptoms. At T0 suicidal ideation, interested 6.1% and at T3 it increased to 7.4%. In the regression analysis, suicidal ideation at baseline was best predicted by poor sleep quality (O.R. 1.71, p=0.044) and, after 2 years, suicidal ideation was best predicted by poor sleep quality experienced at baseline (OR 67.3, p=0.001).

Conclusions

Poor sleep quality may play as an independent predictor of suicidal risk in post-COVID survivors. Evaluating and targeting sleep disturbances in COVID survivors is important to prevent the consequences of disrupted sleep in mental health.

Lithium-induced parkinsonism associated with vocal cord paralysis: an atypical presentation

Drug-induced parkinsonism has been commonly studied and discussed regarding antipsychotic agents, but lithium-induced parkinsonism should also be considered when patients present with parkinsonian symptoms and chronic lithium use. There are several reports of parkinsonism arising during lithium administration and regressing following its reduction or discontinuation. Our case is, to date, the first case in the literature in which vocal cord paralysis occurred as the first symptom of lithium-induced parkinsonism, contributing to confuse doctors and patients and to delay diagnosis and treatment. In our clinical case prompt withdrawal of lithium and its reintroduction at lower doses led to complete resolution of this disabling clinical presentation. This report emphasizes the importance of careful monitoring of lithium levels, especially in elderly subjects, and the need to consider lithium-induced parkinsonism even when unusual motor symptoms appear in chronic lithium users.

Binge eating disorder, impulsivity and bipolar spectrum features in a sample of obese candidates for bariatric surgery

AIMS

Candidates for bariatric surgery are routinely screened for psychiatric disorders because abnormal eating behaviors are considered common among these patients. This study aimed to evaluate the frequency and persistence, in terms of one month-to-lifetime prevalence ratio, of binge eating disorder (BED) and the potential association with impulsivity features and bipolar spectrum comorbidity in a sample of obese patients undergoing a psychiatric evaluation for bariatric intervention.

METHODS

Overall, 80 candidates to bariatric surgery were assessed consecutively over 12 months within the framework of a collaboration between the University of Pisa Psychiatry and Internal Medicine Departments. Patients were evaluated through structured clinical interviews and self-report questionnaires.

RESULTS

The lifetime and last-month frequencies of BED according to DSM-5 criteria were 46.3% and 17.5%, respectively, with a prevalence ratio of 37.8%. Rates of formal bipolar disorder diagnoses were extremely low in patients with or without BED. However, patients with BED showed more severe dyscontrol, attentional impulsivity and bipolar spectrum features than patients with no BED.

CONCLUSIONS

The relationship of BED, impulsivity, and mood disorders in bariatric patients is more complex than usually reported in the literature. In particular, the presence of bipolar spectrum features should be systematically investigated in these patients because of their essential clinical and therapeutical implications.

An Atypical Case of Late-Onset Wolfram Syndrome 1 without Diabetes Insipidus

Wolfram syndrome 1, a rare autosomal recessive neurodegenerative disease, is caused by mutations in the WFS1 gene. It is characterized by diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD), and other clinical manifestations such as urological and neurological disorders. Here we described the case of a patient with an atypical late-onset Wolfram syndrome 1 without DI. Our WS1 patient was a c.1620_1622delGTG (p.Trp540del)/c.124 C > T (p.Arg42*) heterozygous compound. The p.Arg42* nonsense mutation was also found in heterozygosity in his sister and niece, both suffering from psychiatric disorders. The p.Arg42* nonsense mutation has never been found in WS1 and its pathogenicity is unclear so far. Our study underlined the need to study a greater number of WS1 cases in order to better understand the clinical significance of many WFS1 variants.

Impact of urbanization on predator and parasitoid insects at multiple spatial scales

Landscapes are becoming increasingly urbanized, causing loss and fragmentation of natural habitats, with potentially negative effects on biodiversity. Insects are among the organisms with the largest diversity in urbanized environments. Here, we sampled predator (Ampulicidae, Sphecidae and Crabronidae) and parasitoid (Tachinidae) flower-visiting insects in 36 sites in the city of Rome (Italy). Although the diversity of herbivorous insects in urban areas mostly depends on the availability of flowering plants and nesting sites, predators and parasitoids generally require a larger number of resources during their life cycle, and are expected to be particularly influenced by urbanization. As flower-visitors can easily move between habitat patches, the effect of urbanization was tested at multiple spatial scales (local, landscape and sub-regional). We found that urbanization influenced predator and parasitoid flower-visitors at all three spatial scales. At the local scale, streets and buildings negatively influenced evenness of predators and species richness and abundance of parasitoids probably acting as dispersal barrier. At the landscape scale, higher percentage of urban decreased predator abundance, while increasing their evenness, suggesting an increase in generalist and highly mobile species. Area and compactness (i.e. Contiguity index) of urban green interactively influenced predator communities, whereas evenness of parasitoids increased with increasing Contiguity index. At the sub-regional scale, species richness and abundance of predators increased with increasing distance from the city center. Compared to previous studies testing the effect of urbanization, we found little variation in species richness, abundance and evenness along our urbanization gradient. The current insect fauna has been probably selected for its tolerance to habitat loss and fragmentation, being the result of the intensive anthropogenic alteration occurred in the area in the last centuries. Conservation strategies aimed at predator and parasitoid flying insects have to take in account variables at multiple spatial-scales, as well as the complementarity of resources across the landscape.

Randomised clinical trial: sofosbuvir and ledipasvir in patients with transfusion-dependent thalassaemia and HCV genotype 1 or 4 infection

BACKGROUND

Patients with thalassaemia major depend on blood transfusions. In Italy, up to 80% of thalassaemia patients bear HCV antibodies due to HCV contaminated transfusions before 1990. Thalassaemia patients with HCV infection have high risk of developing HCC. Treatment based on Pegylated-IFN (Peg-IFN) and Ribavirin (RBV) was limited by relevant side effects.

AIM

To evaluate the impact of Sofosbuvir/Ledipasvir (SOF/LDV) fixed dose combination for 12 weeks without RBV, in patients with thalassaemia major and HCV Genotype 1 or 4 (GT1/4).

METHODS

Open label, historically-controlled, nationwide multicentre study in thalassaemia patients including naïve with cirrhosis and prior treatment failure without cirrhosis. SOF/LDV single pill was administered for 12 weeks to 100 patients of whom 16% had cirrhosis. The control group included 96 patients with comparable baseline characteristics treated with Peg-IFN/RBV. The primary end point was sustained virologic response at follow-up week 12 or 24 after IFN-free or Peg-IFN/RBV, respectively.

RESULTS

In the study group, sustained virological response (SVR) was reported in 98% of patients (95% CI 95.3%-100%). Cirrhotic as well as prior treatment failure achieved 100% SVR. In the control group, SVR was 47.9% (95% CI 37.9%-57.9%). Adverse events including fatigue, headache, nausea, decrease in haemoglobin or increase in ferritin levels were rare and significantly less common in the study than in the historical control group.

CONCLUSIONS

In conclusion, SOF/LDV for 12 weeks provides simple, highly effective and safe Peg-IFN/RBV-free treatment for HCV GT1/4 thalassaemia patients. EUDRACT number 2015-002401-1.

Shorter myotomy on the gastric site (≤2.5 cm) provides adequate relief of dysphagia in achalasia patients

The right length of the myotomy on the gastric side for esophageal achalasia is still a debated issue. We aimed to investigate the final outcome after classic myotomy (CM) as compared with a longer myotomy on the gastric side (LM) in two cohorts of achalasia patients. Forty-four achalasia patients who underwent laparoscopic Heller-Dor were considered; patients with a sigmoid-shaped esophagus were excluded. Symptoms were scored using a detailed questionnaire for dysphagia, regurgitation, and chest pain. Barium swallow, endoscopy, and esophageal manometry were performed before and 6 months after the surgical treatment; 24-hour pH-monitoring was also performed 6 months after the procedure. CM was defined as a gastric myotomy length in the range of 1.5-2.0 cm, while LM was 2.5-3 cm in length. The surgical treatment (CM or LM) was adopted in two consecutive cohorts. Treatment failure was defined as a postoperative symptom score >10th percentile of the preoperative score (i.e. >8). Of the 44 patients representing the study population, 20 had CM and 24 had LM. The patients' demographic and clinical parameters (age, sex, symptom score, duration of symptoms, esophageal diameter, and manometric pattern) were similar in the two groups. The median follow up was 24 months (interquartile range 12-39). One patient in each group was classified as a treatment failure. After the treatment, there was a significant decrease in both groups' symptom score, and resting and residual pressure (P < 0.01), with no statistically significant differences between the two groups in terms of postoperative symptom score, resting and residual pressure, or total and abdominal lower esophageal sphincter length and esophageal diameter. Extending the length of the myotomy on the gastric side does not seem to change the final outcome of the laparoscopic Heller-Dor procedure.

The beneficial effects of early short-term exercise in the offspring of obese mothers are accompanied by alterations in the hypothalamic gene expression of appetite regulators and FTO (fat mass and obesity associated) gene

Maternal overnutrition is implicated in the development of adult metabolic disease, and has been shown to alter the expression of genes involved in energy homeostasis. In the present study, we aimed to test whether a short period of voluntary exercise, followed by a sedentary period, would regulate hypothalamic markers involved in appetite. Adult female Sprague-Dawley rats were fed either normal chow or high-fat diet (HFD) ad lib. for 5 weeks, mated and continued on their assigned diet during gestation/lactation. At weaning males, were separated into chow or HFD groups; half were exercised (running wheels), whereas the remainder were sedentary. At week 10, wheels were removed and rats remained sedentary for 5 weeks, prior to tissue collection. Maternal obesity increased offspring adiposity at 15 weeks and this was exacerbated by postnatal HFD (P < 0.05). Body weight and fat mass were reduced in offspring of obese mothers if they exercised, and this was maintained even after 5 weeks without exercise. At 15 weeks, fasting plasma insulin, leptin and triglyceride concentrations were significantly reduced by exercise in offspring of lean and obese mothers consuming chow, with little benefit in those consuming HFD. Hypothalamic mRNA expression of pro-opiomelanocortin was increased by exercise but only in offspring of lean mothers. Exercise reduced hypothalamic FTO (fat mass and obesity associated) mRNA in offspring of lean dams regardless of diet. A short period of exercise early in life had lasting beneficial effects on body weight, adiposity and hormone profile of male offspring from obese and lean dams, despite being followed by a period of inactivity. The effects of exercise on hypothalamic appetite regulators were more marked in offspring of lean dams.

Endocrine Effects on Heart Function

Among the factors associated with thalassemic heart disease, endocrine disturbance is also a contributing factor. We present a retrospective, cross sectional study, which aims to establish the prevalence of cardiac complications in thalassaemia major (TM) patients with endocrine complications and to evaluate the influence of endocrine disease on cardiac complications. Endocrinological and cardiological parameters were considered on 957 TM patients who are enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network in 68 sites in Italy. Patients with pubertal hypogonadism (163 males and 175 females), hypothyroidism (192), diabetes mellitus (87) and hypoparathyroidism (61), were compared according to cardiac complications: global heart T2*, cardiac dysfunction, heart failure, arrythmias, pulmonary hypertension and myocardial fibrosis. Control groups were made up according to the age range of patients with the corresponding endocrinopathy. The prevalence of cardiac dysfunction, arrhythmias and heart failure was significantly increased in patients with endocrinopathies. Cardiac complications tended to increase according to the number of endocrinologies affecting the patient. Aim of our retrospective and cross sectional study was to establish the prevalence of cardiac complications in thalassemia major (TM) patients with endocrine diseases and to evaluate the influence of endocrine diseases on cardiac complications.与地中海贫血心脏疾病相关的因素中，内分泌失调也是一个促进因素。 我们进行了回顾和断面研究，旨在患有内分泌并发症的重型地中海贫血患者中建立心脏并发症的患病率，以及评估内分泌疾病对心脏并发症的影响。 曾考虑到意大利地中海贫血心肌铁过载（MIOT）网络的68个站点上注册的957名重型地中海贫血患者的内分泌和心脏病学参数。 根据以下心脏并发症对青春期性腺机能减退的患者（男性163名、女性175名）、甲状腺机能减退患者（192名）、糖尿病患者（87名）和甲状旁腺机能减退患者（61名）进行了比较： 心脏 T2*、心功能障碍、心脏衰竭、心率不齐、肺动脉高血压以及心肌纤维化。 根据相应内分泌病患者的年龄范围建立了对照组。 心功能障碍、心率不齐和心脏衰竭的患病率在内分泌病患者中明显增加。 根据影响患者的内分泌病的数量，心脏并发症倾向于增加。

Thromboembolic events in beta thalassemia major: an Italian multicenter study

Thromboembolic (TE) events have been frequently reported in beta-thalassemic patients in association with known risk factors such as diabetes, complex cardiopulmonary abnormalities, hypothyroidism, liver function anomalies, and postsplenectomy thrombocytosis. In a recent survey involving 9 Italian thalassemic centers, we identified 32 patients with TE episodes in a total of 735 subjects, of whom 683 had thalassemia major and 52 thalassemia intermedia, corresponding to 3.95 and 9.61%, respectively. There was a great variation in localization: the main one (16/32) was CNS, with a clinical picture of headache, seizures and hemiparesis. Other localizations were the pulmonary (3 patients), mesenteric (1 patient) and portal (2 patients) sites. There were 6 cases of deep venous thrombosis (2 in the upper limbs, 4 in the lower ones). Intracardiac thrombosis was found in 2 subjects and clinical and laboratory signs of DIC were observed in 2 others during pregnancy. Since our patients with TE events present a statistically significantly higher incidence of associated dysfunction (cardiomyopathy, diabetes, liver function anomalies, hypothyroidism) than those without TE events (50 vs. 13.8%), we suggest close monitoring of those patients who are at higher risk of developing TE events because of the presence of one or more of these predisposing factors.

Scrapie strain-specific interactions with endogenous murine leukaemia virus

The finding that a senescence-accelerated mouse (SAMP8) shows early brain ageing, with histopathological changes resembling those seen in scrapie, combined with the discovery of high levels of endogenous murine leukaemia virus (MuLV) in brains of SAMP8 mice prompted us to examine the effect of scrapie infection on MuLV titres in this strain and in one of its progenitors, the AKR strain. Three scrapie strains (ME7, 22L and 139A) that had a comparatively short incubation period in SAMP8 and AKR mice caused an increase in brain MuLV titres that was scrapie strain-specific: in each mouse strain, the greatest effect was with 1 39A, and the least with ME7. The 22A scrapie strain, which has a long incubation period in SAMP8 mice, did not affect MuLV titres in brains of this mouse strain. Previous analyses of scrapie incubation periods in AKR, SAMP8 and another strain derived from an AKR cross (SAMR1) showed an inverse relationship between brain MuLV titres and scrapie incubation periods. This finding, combined with the effect of scrapie on MuLV titres, suggests an interaction between the scrapie infectious process and MuLV replication.

Clonal chromosome changes in non-neoplastic ureters

Cytogenetic analysis was performed on 23 samples from non-neoplastic ureters. Clonal chromosome abnormalities were found in eight. They were: loss of Y chromosome, as a single abnormality (five cases) or associated with trisomy 10 and 20 (one case) or with trisomy 2 (one case); and duplication of Y chromosome (one case). Different numerical and structural sporadic abnormalities were found in nine cases. Immunohistochemical analysis and direct observation using the inverted microscope showed that the cells were mainly of the fibroblastic type. FISH analysis with chromosome 7 alpha-satellite probes failed to detect the presence of trisomy 7 in three epithelial cases tested.

[Maps of somatosensory evoked potentials from the arm in patients with neoplasms and post-traumatic brain lesions]

Short-latency somatosensory evoked potentials by the stimulation of the median nerve at the wrist, were recorded in six patients (four with cerebral tumors and two with post-trauma lesions). The electrodes were placed on the scalp following the 10-20 International System. A reference electrode was placed on earlobe contralateral to the site of the stimulation. Eleven normal subjects were used as control (mean age 64.4 +/- 12.05). We used the Brain-Surveyor-Basis Trade system which allowed us to elaborate the results by coloured mapping through linear interpolation of signal amplitudes. The following parameters were investigated: peak latencies of the N13, N20, P22, N30 waves; amplitudes of the post-rolandic P14-N20, N20-P25, pre-rolandic P22-N30 components and the central conduction time N13-N20 (CCT). The evaluation of latencies was not significant in determining the lesion site. On the contrary, the evaluation of amplitudes revealed expressive asymmetry, though it did not define the nature of alteration (increase or decrease due to lesion), and the correlation between these variations and the site of the lesion. The authors discussed the possibility that amplitude abnormalities in patients with tumors were related either to the tumors and/or drug effects.

[Antibiotic therapy in infertile subjects with chronic gonococcal infections: measurement of sperm output]

Several antibiotics of choice for the treatment of Gonorrhoea have proved to be effective in the acute forms of this disease. Men infected with gonococci may not develop or may not notice any symptoms at all: thus, complications of gonococcal infection can cause semen inadequacy and infertility. We are not aware of any previous paper on the treatment of chronic asymptomatic gonorrhoea (IUGC) and the cytotoxic effects in sperm maturation (so called "stress pattern tubular syndrome") and/or motility possibly mediated by some antigonococcal agents after prolonged period of administration. In IUGC the aims of therapy should be both the bactericidal activity and the improvement in the seminal quality. One-hundred eleven out of 785 male partners of infertile marriages were studied. They had negative post coital test and culture positive for N. Gonorrhoea in their semen. They were subdivided in six random groups and were treated with Ceftazidime (CFZ = 20 cases), Cefonicid (CFN = 20 cases) Spectinomycin (SPM = 15 cases), Aztreonam (AZT = 20 cases), Piperacillin (PP = 18 cases) and Doxycycline (DXC = 18 cases) respectively. After 7 days of treatment (C1) seminal cultures became negative in 25 cases (22.5%) and no seminal parameter showed significant variation among groups. When the treatment was repeated other twice (C3. = 1 week every month for 3 months) the antigonococcal efficacy was complete (100%), but various effects on seminal quality (Density, D; Motility, M, Oval forms, O; Sperm precursors, Sp; nemaspermic penetration depth in bovine cervical mucus PN; rate of pregnancies) were observed.

[Radiology of thalassemic syndrome in the transition from the old to the new therapeutic transfusion regimen]

The authors have evaluated the skull, thorax, wrist and hand standard radiographs of 29 patients affected by Cooley's disease who were treated up to 1983 with a low transfusion regimen, rather with a high transfusion regimen (Hb level greater than 9.5 g/dl). The patients have been divided into two groups, according to the prevalence of the first or the second transfusion regimen. Almost all the changes described in the literature have been found in the radiographs, but completely modified; some of these, like rib notchings, in higher percentage than known. In the youngest patients the most significant appearances were ribs and hand changes, that can be considered the most important feature in their radiological monitoring. However this new transitional radiological syndrome will rapidly modify with the establishment "ab initio" of the high transfusional regimen.

[The endocrine complications in thalassemia major]

Based on a review of the literature and personal observation, the authors discuss the most frequent endocrine complication that occur in patients with thalassemia major given blood transfusion and chelating therapy. All the complication are attributed to iron overload in the endocrine glands. The authors conclude that an adequate chelating therapy protects against hemosiderosis and thus against endocrine pathologies.

[Memory changes in herpes virus encephalitis: report of a case]

A case of Herpes Simplex Encephalitis with a benign course was present in a 66-year-old patient. A year after the acute phase of the illness, the patient continued to suffer from inability to fix verbal material in memory. During the acute phase, cerebral NMR revealed a large evolving lesion in the right temporal region, and an old lesion located in the same region of the opposite hemisphere. From the medical history, we learned that the patient, 35 years earlier, suffered a similar episode, including a short-term memory deficit. In the following study, we will discuss this case report in relation to data found in the literature dealing with memory deficit, caused by mono and bilateral, temporal lesions.

Effects of ADP and epinephrine on macaque and human platelets. Implications for studies on human atherosclerosis

The ranges for near-threshold ADP concentrations for the aggregation of macaque and human citrated platelets overlapped. The minimum concentrations of epinephrine, 0.05 microM to 1.0 microM, that at least doubled the aggregation response at threshold ADP concentrations were comparable for macaque and human citrated platelets. Epinephrine (1.0 microM to 10 mM) alone never aggregated macaque citrated platelets. Biphasic aggregation occurred with both macaque and human citrated platelets. The addition of heparin to a final concentration of 2.2 units/ml had no effect on the threshold ADP concentrations or the sensitivity of macaque or human citrated platelets to epinephrine. One microM phentolamine eliminated the potentiating effect of 1 microM epinephrine on ADP-induced aggregation of macaque and human citrated platelets. The threshold concentrations of ADP for macaque platelets were sharply reduced when heparin was used as an anticoagulant rather than citrate. However, epinephrine induced a similar increase in aggregability with both citrated and heparinized platelets, 0.55 +/- 0.09 SEM% and 0.44 +/- 0.09 SEM%, respectively. These data indicate that macaque and human platelets behave in a similar manner in response to ADP and that epinephrine potentiates the ADP-induced aggregation of macaque and human platelets equally well.

Potentiation with epinephrine of macaque platelet aggregation by other agonists: implications for studies on human atherosclerosis

The effects of low concentrations of epinephrine on the aggregation of macaque and human platelets by arachidonic acid (AA), collagen, and thrombin were studied. When epinephrine (0.05 to 1 microM) was added to macaque or human citrated or macaque heparinized platelets, either before or after the addition of near-threshold concentrations of AA, significant increases in aggregability were always seen. Epinephrine alone did not aggregate macaque platelets from citrated blood. When near-threshold concentrations of collagen or thrombin were present in the medium, low concentrations of epinephrine (0.05 to 0.50 microM) potentiated the aggregation of macaque and human citrated platelets and macaque heparinized platelets. The P values for the addition of epinephrine were less than 0.01 in all series. The ability of low epinephrine concentrations to potentiate aggregation of macaque platelets by other agonists is of particular significance because in humans the most important effect of epinephrine on platelets in vivo is probably the potentiation, by low concentrations, of aggregation induced by other aggregatory agents normally present in the blood in low concentrations.