Pamidronate for the treatment of osteoporosis secondary to chronic cholestatic liver disease in Wistar rats

Osteoporosis is a major complication of chronic cholestatic liver disease (CCLD). We evaluated the efficacy of using disodium pamidronate (1.0 mg/kg body weight) for the prevention (Pr) or treatment (Tr) of cholestasis-induced osteoporosis in male Wistar rats: sham-operated (Sham = 12); bile duct-ligated (Bi = 15); bile duct-ligated animals previously treated with pamidronate before and 1 month after surgery (Pr = 9); bile duct-ligated animals treated with pamidronate 1 month after surgery (Tr = 9). Rats were sacrificed 8 weeks after surgery. Immunohistochemical expression of IGF-I and GH receptor was determined in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia and the right femur was used for biomechanical analysis. Bone material volume over tissue volume (BV/TV) was significantly affected by CCLD (Sham = 18.1 ± 3.2 vs Bi = 10.6 ± 2.2%) and pamidronate successfully increased bone volume. However, pamidronate administered in a preventive regimen presented no additional benefit on bone volume compared to secondary treatment (BV/TV: Pr = 39.4 ± 12.0; Tr = 41.2 ± 12.7%). Moreover, the force on the momentum of fracture was significantly reduced in Pr rats (Sham = 116.6 ± 23.0; Bi = 94.6 ± 33.8; Pr = 82.9 ± 22.8; Tr = 92.5 ± 29.5 N; P < 0.05, Sham vs Pr). Thus, CCLD had a significant impact on bone histomorphometric parameters and pamidronate was highly effective in increasing bone mass in CCLD; however, preventive therapy with pamidronate has no advantage regarding bone fragility.

Women's subjective and objective health over time : the role of psychosocial conditions and physiological stress responses

Today, health problems are likely to have a complex and multifactorial etiology, whereby psychosocial factors interact with behaviour and bodily responses. Women generally report more health problems than men. The present thesis concerns the development of women’s health from a subjective and objective perspective, as related to psychosocial living conditions and physiological stress responses. Both cross-sectional and longitudinal studies were carried out on a representative sample of women. Data analysis was based on a holistic person-oriented approach as well as a variable approach. In Study I, the women’s self-reported symptoms and diseases as well as self-rated general health status were compared to physician-rated health problems and ratings of the general health of the women, based on medical examinations. The findings showed that physicians rated twice as many women as having poor health compared to the ratings of the women themselves. Moreover, the symptom ”a sense of powerlessness” had the highest predictive power for self-rated general health. Study II investigated individual and structural stability in symptom profiles between adolescence and middle-age as related to pubertal timing. There was individual stability in symptom reporting for nearly thirty years, although the effect of pubertal timing on symptom reporting did not extend into middle-age. Study III explored the longitudinal and current influence of socioeconomic and psychosocial factors on women’s self-reported health. Contemporary factors such as job strain, low income, financial worries, and double exposure in terms of high job strain and heavy domestic responsibilities increased the risk for poor self-reported health in middle-aged women. In Study IV, the association between self-reported symptoms and physiological stress responses was investigated. Results revealed that higher levels of medically unexplained symptoms were related to higher levels of cortisol, cholesterol, and heart rate. The empirical findings are discussed in relation to existing models of stress and health, such as the demand-control model, the allostatic load model, the biopsychosocial model, and the multiple role hypothesis. It was concluded that women’s health problems could be reduced if their overall life circumstances were improved. The practical implications of this might include a redesign of the labour market giving women more influence and control over their lives, both at and away from work.

Maximal muscular vascular conductances during whole body upright exercise in humans

[EN] That muscular blood flow may reach 2.5 l kg(-1) min(-1) in the quadriceps muscle has led to the suggestion that muscular vascular conductance must be restrained during whole body exercise to avoid hypotension. The main aim of this study was to determine the maximal arm and leg muscle vascular conductances (VC) during leg and arm exercise, to find out if the maximal muscular vasodilatory response is restrained during maximal combined arm and leg exercise. Six Swedish elite cross-country skiers, age (mean +/-s.e.m.) 24 +/- 2 years, height 180 +/- 2 cm, weight 74 +/- 2 kg, and maximal oxygen uptake (VO(2,max)) 5.1 +/- 0.1 l min(-1) participated in the study. Femoral and subclavian vein blood flows, intra-arterial blood pressure, cardiac output, as well as blood gases in the femoral and subclavian vein, right atrium and femoral artery were determined during skiing (roller skis) at approximately 76% of VO(2,max) and at VO(2,max) with different techniques: diagonal stride (combined arm and leg exercise), double poling (predominantly arm exercise) and leg skiing (predominantly leg exercise). During submaximal exercise cardiac output (26-27 l min(-1)), mean blood pressure (MAP) (approximately 87 mmHg), systemic VC, systemic oxygen delivery and pulmonary VO2(approximately 4 l min(-1)) attained similar values regardless of exercise mode. The distribution of cardiac output was modified depending on the musculature engaged in the exercise. There was a close relationship between VC and VO2 in arms (r= 0.99, P < 0.001) and legs (r= 0.98, P < 0.05). Peak arm VC (63.7 +/- 5.6 ml min(-1) mmHg(-1)) was attained during double poling, while peak leg VC was reached at maximal exercise with the diagonal technique (109.8 +/- 11.5 ml min(-1) mmHg(-1)) when arm VC was 38.8 +/- 5.7 ml min(-1) mmHg(-1). If during maximal exercise arms and legs had been vasodilated to the observed maximal levels then mean arterial pressure would have dropped at least to 75-77 mmHg in our experimental conditions. It is concluded that skeletal muscle vascular conductance is restrained during whole body exercise in the upright position to avoid hypotension.

Effect of different live prey, Grapsus grapsus Linnaeus 1758 and Plagusia depressa Fabricius, 1775 zoeas,over histology and biochemical composition of common octopus, octopus vulgaris Cuvier, 1797 paralarvae

[EN] Since paralarval rearing is still the main bottleneck for the development of octopus culture, the aim of the present study was to obtain some information on the feeding strategy and nutritional requirements during paralarval stage. For that purpose just hatched out octopus paralarvae were fed with live preys in three different combinations, trying to match their natural food: Enriched Artemia metanauplii, Grapsus grapsus zoeas supplemented with enriched Artemia, and Plagusia depressa zoeas supplemented with enriched Artemia. Paralarval treatments were carried out during 28 days in triplicates; fibre glass 120 l tanks in flow through system were used. Growth, in terms of dry body weight, mantle length and width, was determined each seven days. A histological study of the paralarval development was carried out. Biochemical composition of preys and paralarvae were determined. Growth was significantly better in paralarvae fed with zoeas and Artemia than in those fed only with Artemia, from day 8 after hatching. Besides a clear effect on the digestive gland histology morphology was observed.

Biomeccanica del servizio e del diritto nel tennis: confronto fra atleti di livello di gioco differente

Il tennis è uno sport molto diffuso che negli ultimi trent’anni ha subito molti cambiamenti. Con l’avvento di nuovi materiali più leggeri e maneggevoli la velocità della palla è aumentata notevolmente, rendendo così necessario una modifica a livello tecnico dei colpi fondamentali. Dalla ricerca bibliografica sono emerse interessanti indicazioni su angoli e posizioni corporee ideali da mantenere durante le varie fasi dei colpi, confrontando i giocatori di altissimo livello. Non vi sono invece indicazioni per i maestri di tennis su quali siano i parametri più importanti da allenare a seconda del livello di gioco del proprio atleta. Lo scopo di questa tesi è quello di individuare quali siano le variabili tecniche che influenzano i colpi del diritto e del servizio confrontando atleti di genere differente, giocatori di livello di gioco diverso (esperti, intermedi, principianti) e dopo un anno di attività programmata. Confrontando giocatori adulti di genere diverso, è emerso che le principali differenze sono legate alle variabili di prestazione (velocità della palla e della racchetta) per entrambi i colpi. Questi dati sono simili a quelli riscontrati nel test del lancio della palla, un gesto non influenzato dalla tecnica del colpo. Le differenze tecniche di genere sono poco rilevanti ed attribuibili alla diversa interpretazione dei soggetti. Nel confronto di atleti di vario livello di gioco le variabili di prestazione presentano evidenti differenze, che possono essere messe in relazione con alcune differenze tecniche rilevate nei gesti specifici. Nel servizio i principianti tendono a direzionare l’arto superiore dominante verso la zona bersaglio, abducendo maggiormente la spalla ed avendo il centro della racchetta più a destra rispetto al polso. Inoltre, effettuano un caricamento minore degli arti inferiori, del tronco e del gomito. Per quanto riguarda il diritto si possono evidenziare queste differenze: l’arto superiore è sempre maggiormente esteso per il gruppo dei principianti; il tronco, nei giocatori più abili viene utilizzato in maniera più marcata, durante la fase di caricamento, in movimenti di torsione e di inclinazione laterale. Gli altri due gruppi hanno maggior difficoltà nell’eseguire queste azioni preparatorie, in particolare gli atleti principianti. Dopo un anno di attività programmata sono stati evidenziati miglioramenti prestativi. Anche dal punto di vista tecnico sono state notate delle differenze che possono spiegare il miglioramento della performance nei colpi. Nel servizio l’arto superiore si estende maggiormente per colpire la palla più in alto possibile. Nel diritto sono da sottolineare soprattutto i miglioramenti dei movimenti del tronco in torsione ed in inclinazione laterale. Quindi l’atleta si avvicina progressivamente ad un’esecuzione tecnica corretta. In conclusione, dal punto di vista tecnico non sono state rilevate grosse differenze tra i due generi che possano spiegare le differenze di performance. Perciò questa è legata più ad un fattore di forza che dovrà essere allenata con un programma specifico. Nel confronto fra i vari livelli di gioco e gli effetti di un anno di pratica si possono individuare variabili tecniche che mostrano differenze significative tra i gruppi sperimentali. Gli evoluti utilizzano tutto il corpo per effettuare dei colpi più potenti, utilizzando in maniera tecnicamente più valida gli arti inferiori, il tronco e l’arto superiore. I principianti utilizzano prevalentemente l’arto superiore con contributi meno evidenti degli altri segmenti. Dopo un anno di attività i soggetti esaminati hanno dimostrato di saper utilizzare meglio il tronco e l’arto superiore e ciò può spiegare il miglioramento della performance. Si può ipotizzare che, per il corretto utilizzo degli arti inferiori, sia necessario un tempo più lungo di apprendimento oppure un allenamento più specifico.

Letteratura postmoderna e comunicazione pubblicitaria, problemi teorici e analisi testuali

Premise: In the literary works of our anthropological and cultural imagination, the various languages and the different discursive practices are not necessarily quoted, expressly alluded to or declared through clear expressive mechanisms; instead, they rather constitute a substratum, a background, now consolidated, which with irony and intertextuality shines through the thematic and formal elements of each text. The various contaminations, hybridizations and promptings that we find in the expressive forms, the rhetorical procedures and the linguistic and thematic choices of post-modern literary texts are shaped as fluid and familiar categories. Exchanges and passages are no longer only allowed but also inevitable; the post-modern imagination is made up of an agglomeration of discourses that are no longer really separable, built up from texts that blend and quote one another, composing, each with its own specificities, the great family of the cultural products of our social scenario. A literary work, therefore, is not only a whole phenomenon, delimited hic et nunc by a beginning and an ending, but is a fragment of that complex, dense and boundless network that is given by the continual interrelations between human forms of communication and symbolization. The research hypothesis: A vision is delineated of comparative literature as a discipline attentive to the social contexts in which texts take shape and move and to the media-type consistency that literary phenomena inevitably take on. Hence literature is seen as an open systematicity that chooses to be contaminated by other languages and other discursive practices of an imagination that is more than ever polymorphic and irregular. Inside this interpretative framework the aim is to focus the analysis on the relationship that postmodern literature establishes with advertising discourse. On one side post-modern literature is inserted in the world of communication, loudly asserting the blending and reciprocal contamination of literary modes with media ones, absorbing their languages and signification practices, translating them now into thematic nuclei, motifs and sub-motifs and now into formal expedients and new narrative choices; on the other side advertising is chosen as a signification practice of the media universe, which since the 1960s has actively contributed to shaping the dynamics of our socio-cultural scenarios, in terms which are just as important as those of other discursive practices. Advertising has always been a form of communication and symbolization that draws on the collective imagination – myths, actors and values – turning them into specific narrative programs for its own texts. Hence the aim is to interpret and analyze this relationship both from a strictly thematic perspective – and therefore trying to understand what literature speaks about when it speaks about advertising, and seeking advertising quotations in post-modern fiction – and from a formal perspective, with a search for parallels and discordances between the rhetorical procedures, the languages and the verifiable stylistic choices in the texts of the two different signification practices. The analysis method chosen, for the purpose of constructive multiplication of the perspectives, aims to approach the analytical processes of semiotics, applying, when possible, the instruments of the latter, in order to highlight the thematic and formal relationships between literature and advertising. The corpus: The corpus of the literary texts is made up of various novels and, although attention is focused on the post-modern period, there will also be ineludible quotations from essential authors that with their works prompted various reflections: H. De Balzac, Zola, Fitzgerald, Joyce, Calvino, etc… However, the analysis focuses the corpus on three authors: Don DeLillo, Martin Amis and Aldo Nove, and in particular the followings novels: “Americana” (1971) and “Underworld” (1999) by Don DeLillo, “Money” (1984) by Martin Amis and “Woobinda and other stories without a happy ending” (1996) and “Superwoobinda” (1998) by Aldo Nove. The corpus selection is restricted to these novels for two fundamental reasons: 1. assuming parameters of spatio-temporal evaluation, the texts are representative of different socio-cultural contexts and collective imaginations (from the masterly glimpses of American life by DeLillo, to the examples of contemporary Italian life by Nove, down to the English imagination of Amis) and of different historical moments (the 1970s of DeLillo’s Americana, the 1980s of Amis, down to the 1990s of Nove, decades often used as criteria of division of postmodernism into phases); 2. adopting a perspective of strictly thematic analysis, as mentioned in the research hypothesis, the variations and the constants in the novels (thematic nuclei, topoi, images and narrative developments) frequently speak of advertising and inside the narrative plot they affirm various expressions and realizations of it: value ones, thematic ones, textual ones, urban ones, etc… In these novels the themes and the processes of signification of advertising discourse pervade time, space and the relationships that the narrator character builds around him. We are looking at “particle-characters” whose endless facets attest the influence and contamination of advertising in a large part of the narrative developments of the plot: on everyday life, on the processes of acquisition and encoding of the reality, on ideological and cultural baggage, on the relationships and interchanges with the other characters, etc… Often the characters are victims of the implacable consequentiality of the advertising mechanism, since the latter gets the upper hand over the usual processes of communication, which are overwhelmed by it, wittingly or unwittingly (for example: disturbing openings in which the protagonist kills his or her parents on the basis of a spot, former advertisers that live life codifying it through the commercial mechanisms of products, sons and daughters of advertisers that as children instead of playing outside for whole nights saw tapes of spots.) Hence the analysis arises from the text and aims to show how much the developments and the narrative plots of the novels encode, elaborate and recount the myths, the values and the narrative programs of advertising discourse, transforming them into novel components in their own right. And also starting from the text a socio-cultural reference context is delineated, a collective imagination that is different, now geographically, now historically, and from comparison between them the aim is to deduce the constants, the similarities and the variations in the relationship between literature and advertising.

Konditionale Expression von HER-2, H-Ras oder BXB-Raf1 in einem Maustumormodell

Es ist bekannt, dass die Überexpression eines einzigen Onkogens im Tumorgewebe einen maligneren Phänotyp zur Folge haben kann. Ein Beispiel hierfür ist die Rezeptortyrosinkinase HER-2. Besonders in Mamma- und Ovarialkarzinomen tritt häufig eine HER-2 Überexpression auf, die mit einer schlechteren Prognose für die Patientinnen einhergeht. Die HER-2 blockierende Therapie mit Trastuzumab (Herceptin®) konnte zu einer signifikanten Verbesserung der Überlebenszeit bei Patientinnen mit metastasierendem Mammakarzinom führen. Es ist deshalb von großem Interesse herauszufinden, ob ein Tumor durch gezielte Blockade eines bestimmten Onkogens sein tumorigenes Potential verlieren kann, und dadurch das Tumorwachstum zumindest zeitweise unterbunden wird. Die Frage ist also, ob ein Tumor reversibel sein kann, wenn die Expression seiner Onkogene blockiert wird. Frühere Arbeiten meiner Arbeitsgruppe haben gezeigt, dass Tumore, die konditional humanes HER-2 exprimierten, nach Ausschalten von HER-2 tatsächlich in Remission gingen, d.h. reversibel waren. Tumorgrößenabhängig konnte sogar eine vollständige Tumorremission beobachtet werden. Die vorliegende Arbeit soll nun helfen, die beobachtete Remission nach Ausschalten von HER-2 besser verstehen zu können. Von Interesse sind dabei vor allem die molekularen Mechanismen, die in dem Tumor nach Ausschalten der HER-2 Expression ablaufen. Die konditionale Expression von HER-2 wurde mit Hilfe des TET-OFF Systems in NIH3T3 Mausfibroblasten erreicht. Mit dieser Technik wurde ein Maustumormodell etabliert, das ermöglichte, die Veränderungen in den Tumoren nach Ausschalten von HER-2 zu untersuchen. Ein besonderes Augenmerk wurde dabei auf zwei der durch HER-2 vermittelten Signalwege gerichtet, den Ras-MAP Kinase Signalweg und die Aktivierung von Akt über die Phosphoinositol-3 Kinase. Beide wurden nach Ausschalten der HER-2 Expression deaktiviert. Um herausfinden zu können, welcher der beiden Wege eine wichtigere Rolle bei der Tumorremission spielt, wurden in der vorliegenden Arbeit zwei weitere Maustumormodelle zur konditionalen Expression von humanem H-Ras bzw. einer Form des humanen c-Raf-1 (BXB-Raf1) etabliert. Die Modelle funktionierten auf dieselbe Weise wie das HER-2 Maustumormodell und es wurden auch dieselben Faktoren untersucht. Ras und Raf sind Mitglieder des Ras-MAP Kinase Signalweges. Raf ist aber im Gegensatz zu HER-2 und Ras nicht in der Lage, Akt zu aktivieren. Durch Vergleich der Ergebnisse der drei Maustumormodelle war es deshalb möglich zu differenzieren, ob Einflüsse auf die Tumorentwicklung über denn Ras-MAP Kinase oder den PI3K/Akt Signalweg vermittelt wurden. Auch Ausschalten von H-Ras oder BXB-Raf1 führte zu einer raschen Tumorremission. Damit wurde erneut die Frage nach der Reversibilität eines Tumors beantwortet. Ob die Remission auf einer Induktion von Apoptose beruhte, konnte nicht endgültig geklärt werden, da es zwar nach Ausschalten von HER-2 zu einer Erhöhung der Apoptoserate kam, nicht jedoch nach Ausschalten von H-Ras oder BXB-Raf1. Aufgrund der vorhandenen Ergebnisse wird vermutet, dass es zu einer Störung des Gleichgewichtes zwischen proliferationsfördernden und apoptotischen Faktoren nach Ausschalten der Onkogene kam. Die in den Tumoren vorhandene Spontanapoptose könnte dann ausreichen, den Prozess der Tumorremission auszulösen. Die Untersuchungen haben gezeigt, dass ERK bzw. der Ras-MAP Kinase Signalweg die bedeutendere Rolle bei der Tumorremission spielte. Zum einen wurde dies belegt durch die Beobachtung, dass die Tumorverläufe von HER-2 und BXB-Raf1 nahezu identisch waren. Zum anderen kam es in allen drei Modellen zu einer Dephosphorylierung von ERK, die der Tumorremission vorausging. Akt schien dagegen keine Rolle zu spielen, da das Ausschalten der HER-2, H-Ras oder BXB-Raf1 Expression zu keiner einheitlichen Veränderung des Posphorylierungsgrades von Akt führte. Demnach ist die Blockade des Ras-MAP Kinase Signalweges, der hauptsächlich proliferationsfördernde Eigenschaften besitzt, wichtiger für die Tumorremission als die Blockade des PI3K/Akt Signalweges, der hauptsächlich anti-apoptotische Eigenschaften vermittelt.

A LES study of a modified Ahmed body geometry

A numerical study using Large Eddy Simulation Coherent Structure Model (LES-CSM), of the flow around a simplified Ahmed body, has been done in this work of thesis. The models used are two salient geometries from the experimental investigation performed in [1], and consist, in particular, in two notch-back body geometries. Six simulation are carried out in total, changing Reynolds number and back-light angle of the model’s rear part. The Reynolds numbers used, based on the height of the models and the free stream velocity, are Re = 10000, Re = 30000 and Re = 50000. The back-light angles of the slanted surface with respect to the horizontal roof surface, that characterizes the vehicle, are taken as B = 31.8◦ and B = 42◦ respectively. The experimental results in [1] have shown that, depending on the parameter B, asymmetric and symmetric averaged flow over the back-light and in the wake for a symmetric geometry can be observed. The aims of the present work of master thesis are principally two. The first aim is to investigate and confirm the influence of the parameter B on the presence of the asymmetry of the averaged flow, and confirm the features described in the experimental results. The second important aspect is to investigate and observe the influence of the second variable, the Reynolds number, in the developing of the asymmetric flow itself. The results have shown the presence of the mentioned asymmetry as well as an influence of the Reynolds number on it.

L'azione di classe

La ricerca conduce un’indagine sull’azione di classe, introdotta nell’ordinamento italiano in epoca recente e foriera di numerose incertezze ed ambiguità interpretative, con riferimento sia allo specifico contenuto delle singole disposizioni normative che si sono alternate nel corso del tempo (determinate, sovente, dalla necessità di elidere le- di volta in volta riscontrate- anomalie e contraddizioni del tessuto normativo), sia alle possibili incongruenze tra taluni profili della disciplina oggi prevista dall’art. 140-bis del Codice del consumo e taluni principi generali dell’ordinamento, anche in materia di risarcimento del danno. Viene esaminato, anzitutto, il tema della legittimazione ad agire e del rapporto tra consumatore e l’ente rappresentativo cui questi, eventualmente, si rivolga, tentando la riconduzione di tale relazione alle ordinarie categorie privatistiche. Parimenti, è in termini di qualificazione secondo le tradizionali categorie del diritto civile che si tenta di apprezzare la natura dell’atto di adesione del soggetto che si vanti detentore di un diritto omogeneo a quello della classe cui pretende di appartenere. Vengono, quindi, esaminate le condizioni di ammissibilità dell’azione di classe e le caratteristiche peculiari della fase preliminare del giudizio di ammissibilità dell’azione. La ricerca indaga, quindi, la natura ed i possibili contenuti della sentenza che definisce il processo di classe, e conduce, nell’ultimo capitolo, una disamina relativa alle situazioni giuridiche tutelate.

Beatrice Potter e la signora Webb. La politica come amministrazione del carattere

La tesi affronta la vita e la riflessione politica di Beatrice Potter collocandola all’interno del pensiero politico britannico ed europeo della fine dell’Ottocento e dei primi decenni del Novecento. Rispetto alla maggior parte della bibliografia disponibile, risulta un’autonomia e un’originalità anche rispetto alla riflessione del marito Sidney Webb. La riflessione politica di Potter è caratterizzata in primo luogo dalla ricerca del significato immediatamente politico di quella scienza sociale, che si sta affermando come approccio scientifico dominante nell’intero panorama europeo. Il lavoro è diviso in tre ampi capitoli così suddivisi: il primo ricostruisce l’eredità intellettuale di Potter, con particolare attenzione al rapporto con la filosofia evoluzionista di Herbert Spencer, suo mentore e amico. In questo capitolo vengono anche discussi i contributi di John Stuart Mill, Joseph Chamberlain, Alfred Marshall e Karl Marx e la loro influenza sull’opera di Potter. Il secondo capitolo prende in esame la sua opera prima dell’incontro con il marito e mostra come lo studio della povertà, del lavoro, della metropoli, della cooperazione e delle condizioni delle donne getti le basi di tutta la produzione successiva della partnership. Lo studio politico della povertà, cioè la messa a punto di una scienza amministrativa del carattere sociale del lavoro, rappresenta uno degli elementi principali di quella che viene qui definita un’epistemologia della democrazia. Il terzo capitolo riprende il tema cruciale della democrazia nella sua accezione «industriale» e indaga il ruolo funzionale dello Stato, anche in relazione alla teoria pluralista di Harold Laski, al socialismo guildista di George D. H. Cole e all’idealismo di Bernard Bosanquet. Centrale in questo confronto del pensiero di Potter con il più ampio dibattito degli anni venti e trenta sulla sovranità è la concezione della decadenza della civiltà capitalista e dell’emergere di una new civilisation, dopo la conversione al comunismo sovietico.

Older Breast Cancer Survivors: Geriatric Assessment Domains Are Associated With Poor Tolerance of Treatment Adverse Effects and Predict Mortality Over 7 Years of Follow-Up

Purpose To evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. Methods Six hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age ≥ 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, χ2 tests, and regression analyses. Results In multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI ≥ 1 (odds ratio [OR] = 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR = 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR = 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] = 1.89; 95% CI, 1.24 to 2.88; CCI ≥ 1 (HR = 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR = 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR = 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. Conclusion This study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.

[Body-packer ; body-stuffer - a medical challenge]

Since the seventies, the practice of drug smuggling in the form of body packing has increased in the Western world. The goal of our study was to present an algorithm for the safe management of intracorporal drug transport based on clinical experience and current evidence. The retrospective study, conducted over the past four years in our hospital prison, analyzes and discusses the diagnostic and therapeutic concepts. Thirty-four patients hospitalized 37 times in a 48-month period were included. In 28 patients drug packages were identified. Only two patients suffered from serious complications. The study demonstrates that following a specifically designed management algorithm based on clinical experience and principles of evidence-based medicine can optimize risk management, improve quality assurance and patient safety.

[Chronic right-sided pain-associated nondermatomal somatosensory deficit following an accident]

We present the case of a 48-year old man who, eight years after an industrial accident, presents with chronic right-sided nondermatomal pain and hypaesthesia to heat and touch. During symmetric peripheral touch functional magnetic resonance imaging revealed hypometabolism in the left thalamus, somatosensory cortex, and anterior cingulate cortex. Pain-associated nondermatomal somatosensory deficits (NDSDs) localizing to one side of the body are a frequent clinical entity, which are often triggered by an accident. The tendency of NDSDs to extend to adjunct ipsilateral body parts and to become chronic points to maladaptive adjustment of pain-processing areas in the central nervous system. Psychological stress prior to or around the triggering event seems an important risk factor for NDSDs.

Personal neglect-a disorder of body representation?

The cognitive mechanisms underlying personal neglect are not well known. One theory postulates that personal neglect is due to a disorder of contralesional body representation. In the present study, we have investigated whether personal neglect is best explained by impairments in the representation of the contralesional side of the body, in particular, or a dysfunction of the mental representation of the contralesional space in general. For this, 22 patients with right hemisphere cerebral lesions (7 with personal neglect, 15 without personal neglect) and 13 healthy controls have been studied using two experimental tasks measuring representation of the body and extrapersonal space. In the tasks, photographs of left and right hands as well as left and right rear-view mirrors presented from the front and the back had to be judged as left or right. Our results show that patients with personal neglect made more errors when asked to judge stimuli of left hands and left rear-view mirrors than either patients without personal neglect or healthy controls. Furthermore, regression analyses indicated that errors in interpreting left hands were the best predictor of personal neglect, while other variables such as extrapersonal neglect, somatosensory or motor impairments, or deficits in left extrapersonal space representation had no predictive value of personal neglect. These findings suggest that deficient body representation is the major mechanism underlying personal neglect.

Early bursts of body size and shape evolution are rare in comparative data

George Gaylord Simpson famously postulated that much of life's diversity originated as adaptive radiations-more or less simultaneous divergences of numerous lines from a single ancestral adaptive type. However, identifying adaptive radiations has proven difficult due to a lack of broad-scale comparative datasets. Here, we use phylogenetic comparative data on body size and shape in a diversity of animal clades to test a key model of adaptive radiation, in which initially rapid morphological evolution is followed by relative stasis. We compared the fit of this model to both single selective peak and random walk models. We found little support for the early-burst model of adaptive radiation, whereas both other models, particularly that of selective peaks, were commonly supported. In addition, we found that the net rate of morphological evolution varied inversely with clade age. The youngest clades appear to evolve most rapidly because long-term change typically does not attain the amount of divergence predicted from rates measured over short time scales. Across our entire analysis, the dominant pattern was one of constraints shaping evolution continually through time rather than rapid evolution followed by stasis. We suggest that the classical model of adaptive radiation, where morphological evolution is initially rapid and slows through time, may be rare in comparative data.