L'influenza del sonno sull'andamento temporale della consolidazione delle abilità procedurali

Background: It is well known, since the pioneristic observation by Jenkins and Dallenbach (Am J Psychol 1924;35:605-12), that a period of sleep provides a specific advantage for the consolidation of newly acquired informations. Recent research about the possible enhancing effect of sleep on memory consolidation has focused on procedural memory (part of non-declarative memory system, according to Squire’s taxonomy), as it appears the memory sub-system for which the available data are more consistent. The acquisition of a procedural skill follows a typical time course, consisting in a substantial practice-dependent learning followed by a slow, off-line improvement. Sleep seems to play a critical role in promoting the process of slow learning, by consolidating memory traces and making them more stable and resistant to interferences. If sleep is critical for the consolidation of a procedural skill, then an alteration of the organization of sleep should result in a less effective consolidation, and therefore in a reduced memory performance. Such alteration can be experimentally induced, as in a deprivation protocol, or it can be naturally observed in some sleep disorders as, for example, in narcolepsy. In this research, a group of narcoleptic patients, and a group of matched healthy controls, were tested in two different procedural abilities, in order to better define the size and time course of sleep contribution to memory consolidation. Experimental Procedure: A Texture Discrimination Task (Karni & Sagi, Nature 1993;365:250-2) and a Finger Tapping Task (Walker et al., Neuron 2002;35:205-11) were administered to two indipendent samples of drug-naive patients with first-diagnosed narcolepsy with cataplexy (International Classification of Sleep Disorder 2nd ed., 2005), and two samples of matched healthy controls. In the Texture Discrimination task, subjects (n=22) had to learn to recognize a complex visual array on the screen of a personal computer, while in the Finger Tapping task (n=14) they had to press a numeric sequence on a standard keyboard, as quickly and accurately as possible. Three subsequent experimental sessions were scheduled for each partecipant, namely a training session, a first retrieval session the next day, and a second retrieval session one week later. To test for possible circadian effects on learning, half of the subjects performed the training session at 11 a.m. and half at 17 p.m. Performance at training session was taken as a measure of the practice-dependent learning, while performance of subsequent sessions were taken as a measure of the consolidation level achieved respectively after one and seven nights of sleep. Between training and first retrieval session, all participants spent a night in a sleep laboratory and underwent a polygraphic recording. Results and Discussion: In both experimental tasks, while healthy controls improved their performance after one night of undisturbed sleep, narcoleptic patients showed a non statistically significant learning. Despite this, at the second retrieval session either healthy controls and narcoleptics improved their skills. Narcoleptics improved relatively more than controls between first and second retrieval session in the texture discrimination ability, while their performance remained largely lower in the motor (FTT) ability. Sleep parameters showed a grater fragmentation in the sleep of the pathological group, and a different distribution of Stage 1 and 2 NREM sleep in the two groups, being thus consistent with the hypothesis of a lower consolidation power of sleep in narcoleptic patients. Moreover, REM density of the first part of the night of healthy subjects showed a significant correlation with the amount of improvement achieved at the first retrieval session in TDT task, supporting the hypothesis that REM sleep plays an important role in the consolidation of visuo-perceptual skills. Taken together, these results speak in favor of a slower, rather than lower consolidation of procedural skills in narcoleptic patients. Finally, an explanation of the results, based on the possible role of sleep in contrasting the interference provided by task repetition is proposed.

Relazione gestante-feto, modalità del parto e sviluppo fisico del bambino

Extensive literature outlined that the quality of the mother-foetus relationship is considered the main feature with regard to the quality of postnatal mother-infant interaction and also to the child’s psychical development. Nowadays the relationship between the pregnant woman and her foetus is viewed as the central factor of the somatic dialogue between the functioning of the maternal and the foetal organisms. This dialogue is responsible for the physic development of the child, as well as of its psychosomatic structure. Therefore the research area has necessarily had to extend to the analysis of psychological processes concerning: the pregnancy, the couple that is bound by parenthood, the influence of intergenerational dynamics. In fact, the formation of maternal identity, as well as that of the relationship between the woman and the foetus, refers to the pregnant woman’s relationship with her parents, especially with her mother. The same pregnancy, considered as a psychosomatic event, is directly influenced by relational, affective and social factors, particularly by the quality of the interiorized parental relations and the quality of the current relationships (such as that with her partner and with her family of origin). Some studies have begun to investigate the relationship between the pregnant woman and the foetus in term of “prenatal attachment” and its relationship with socio-demographic, psychological e psychopathological aspects (such as pre and post partum depression), but the research area is still largely unexplored. The present longitudinal research aimed to investigate the quality of the pregnant womanfoetus relationship by the prenatal attachment index, the quality of the interiorized relationship with woman’s parents, the level of alexithymic features and maternity social support, in relation with the modulation of the physiology of delivery and of postpartum, as well as of the physical development of the child. A consecutive sample of 62 Italian primipara women without any kind of pathologies, participated in the longitudinal study. In the first phase of this study (third trimester of the pregnancy), it has investigated the psychological processes connected to the affective investment of the pregnant women towards the unborn baby (by Prenatal Attachment Inventory), the mothers’ interiorized relationship with their own parents (by Parental Bonding Instrument), the social and affective support from their partner and their family of origin are able to supply (by Maternity Social Support Scale), and the level of alexithymia (by 20-Toronto Alexithymia Scale). In the second phase of this study, some data concerning the childbirth course carried out from a “deliverygram” (such as labour, induction durations and modalities of delivery) and data relative to the newborns state of well-being (such as Apgar and pH indexes). Finally, in the third phase of the study women have been telephoned a month after the childbirth. The semistructured interview investigated the following areas: the memory concerning the delivery, the return to home, the first interactions between the mother and the newborn, the breastfeeding, the biological rhythms achieved from newborns. From the data analysis a sample with a good level of prenatal attachment and of support social and a good capability to mental functioning emerged. An interesting result is that the most of the women have a great percentage of “affectionless control style” with both parents, but data is not sufficient to interpret this result. Moreover, considering the data relative to the delivery, medical and welfare procedures, that have been necessary, are coherent with the Italian mean, while the percentage of the caesarean section (12.9%) is inferior to the national percentage (30%). The 29% of vaginal partum has got epidural analgesia, which explains the high number (37%) of obstetrician operations (such as Kristeller). The data relative to the newborn (22 male, 40 female) indicates a good state of well-being because Apgar and pH indexes are superior to 7 at first and fifth minutes. Concerning the prenatal phase, correlation analysis showed that: the prenatal attachment scores positively correlated with the expected social support and negatively correlated with the “externally oriented thinking” dimension of alexithymia; the maternity social support negatively correlated with total alexithymia score, particularly with the “externally oriented thinking” dimension, and negatively correlated with maternal control of parental bonding. Concerning the delivery data, there are many correlations (after all obvious) among themselves. The most important are that the labour duration negatively correlated with the newborn’s index state of well-being. Finally, concerning the data from the postpartum phase the women’ assessments relative to the partum negatively correlated with the duration of the delivery and positively correlated with the assessment relative to the return to home and the interaction with the newborn. Moreover the length of permanence in the hospital negatively correlated with women’s assessments relative to the return to home that, in turn, positively correlated with the quality of breastfeeding, the interaction between the mother and the newborn and the biological regulation of the child. Finally, the women’ assessments relative to breastfeeding positively correlated with the mother-child interactions and the biological rhythms of children. From the correlation analysis between the variables of the prenatal phase and the data relative to the delivery, emerged that the prenatal attachment scores positively correlated with the dilatation stage scores and with the newborn’s Apgar index at first minute, the paternal care dimension of parental bonding positively correlated with the lengths of the various periods of childbirth like so the paternal control dimension with placental stage. Moreover, emerged that the expected social support positively correlated with the lengths of the various periods of childbirth and that the global alexithymia scores, particularly “difficulty to describe emotions” dimension, negatively correlated with total childbirth scores. From the correlation analysis between the variables of the prenatal phase and variable of the postpartum phase emerged that the total alexithymia scores positively correlated with the time elapsed from the childbirth to the breastfeeding of the child, the difficulty to describe emotions dimension of the alexithymia negatively correlated with the quality of the breastfeeding, the “externally oriented thinking” dimension of the alexithymia negatively correlated with mother-child interactions, and finally the paternal control dimension of the parental bonding negatively correlated with the time elapsed from the child to the breastfeeding of the child. Finally, from the analysis of the correlation between the data of the partum and the women’s assessments of the postpartum phase, emerged the negative correlation between the woman’s assessment relative to the delivery and the quantitative of obstetrician operations and the lengths of the various periods of childbirth, the positive correlation between the women’s assessment about the length of delivery periods and the real lengths of the same ones, the positive relation between woman’s assessment relative to the delivery and the Apgar index of children. In conclusion, there is a remarkable relation between the quality of the relationship the woman establishes with the foetus that influences the course of the pregnancy and the delivery that, in turn, influences the postpartum outcome, particularly relative to the mother-children relationship. Such data should be confirmed by heterogeneous populations in order to identify vulnerable women and to project focused intervention.

Presa di decisione in situazioni rischiose: effetto della rabbia

The current studies assessed the role of trait anger and anger expression styles on risk decision-making in adulthood, adolescence and childhood. In the first experiment 158 adults completed the STAXI-2 and an inventory consisting of a battery of hypothetical everyday decision-making scenarios. Participants were also asked to evaluate the perception of risk for each chosen option and some contextual characteristics, that are familiarity and salience for each scenario. The study provides evidence for a relationship between individual differences in the tendency to feel and express anger and risky decisions and for mediation effects of familiarity and salience appraisals. Moreover, results indicated that trait anger was predictive of risk perception and they provide evidence for a positive relationship between risk decision-making and risk perception. In the second study, we examined the relationship between specific components of anger (i.e., cognitive, affective and behavioural) and risk decision-making in adolescents. 101 subjects completed specific tasks, measuring risk decision-making, assessed using hypothetical choice scenarios, and anger, evaluated through the STAXI-CA and the MSAI-R. Results showed that adolescents higher on hostility, anger experience and destructive expression, make more risky decisions in everyday life situations. Moreover, regression analyses indicated that destructive expression of anger and hostility were predictive of adolescents’ risky decisions. In the third experiment, 104 children completed three tasks: the STAXI-CA, the MSAI-R and a task measuring risk decision-making in everyday situations. Subjects were also asked to evaluate the degree of danger, benefit, fun and fear perceived for each risky choice. Analyses indicated that: (a) risk decision-making was predicted by both trait anger and outward expression of anger; (b) destructive expression o anger was predictive of children’s risky decisions; (c) appraisal of danger fully mediated the relation between trait anger and risk; (d) perceptions of benefit, scare and fun partially mediated the relationship between trait anger and risk; and (e) appraisal of danger partially mediated the relationship between outward expression of anger and risk decision-making. The results provide evidence for a relationship between dispositional anger and risk decision-making during childhood, suggesting a possible explanation of the mechanisms below. In particular, risk decision-making can be viewed as the output of cognitive and emotive processes, linked to dispositional anger that leads children to be amused, optimistic and fearless in potentially risky situations. These findings substantiate the importance of incorporating cognitive and emotive factors in theories that seek to explain the relationship between personality traits and risk decision making across a broad range of age.

Seizure prediction and control in epilepsy

The first part of my thesis presents an overview of the different approaches used in the past two decades in the attempt to forecast epileptic seizure on the basis of intracranial and scalp EEG. Past research could reveal some value of linear and nonlinear algorithms to detect EEG features changing over different phases of the epileptic cycle. However, their exact value for seizure prediction, in terms of sensitivity and specificity, is still discussed and has to be evaluated. In particular, the monitored EEG features may fluctuate with the vigilance state and lead to false alarms. Recently, such a dependency on vigilance states has been reported for some seizure prediction methods, suggesting a reduced reliability. An additional factor limiting application and validation of most seizure-prediction techniques is their computational load. For the first time, the reliability of permutation entropy [PE] was verified in seizure prediction on scalp EEG data, contemporarily controlling for its dependency on different vigilance states. PE was recently introduced as an extremely fast and robust complexity measure for chaotic time series and thus suitable for online application even in portable systems. The capability of PE to distinguish between preictal and interictal state has been demonstrated using Receiver Operating Characteristics (ROC) analysis. Correlation analysis was used to assess dependency of PE on vigilance states. Scalp EEG-Data from two right temporal epileptic lobe (RTLE) patients and from one patient with right frontal lobe epilepsy were analysed. The last patient was included only in the correlation analysis, since no datasets including seizures have been available for him. The ROC analysis showed a good separability of interictal and preictal phases for both RTLE patients, suggesting that PE could be sensitive to EEG modifications, not visible on visual inspection, that might occur well in advance respect to the EEG and clinical onset of seizures. However, the simultaneous assessment of the changes in vigilance showed that: a) all seizures occurred in association with the transition of vigilance states; b) PE was sensitive in detecting different vigilance states, independently of seizure occurrences. Due to the limitations of the datasets, these results cannot rule out the capability of PE to detect preictal states. However, the good separability between pre- and interictal phases might depend exclusively on the coincidence of epileptic seizure onset with a transition from a state of low vigilance to a state of increased vigilance. The finding of a dependency of PE on vigilance state is an original finding, not reported in literature, and suggesting the possibility to classify vigilance states by means of PE in an authomatic and objectic way. The second part of my thesis provides the description of a novel behavioral task based on motor imagery skills, firstly introduced (Bruzzo et al. 2007), in order to study mental simulation of biological and non-biological movement in paranoid schizophrenics (PS). Immediately after the presentation of a real movement, participants had to imagine or re-enact the very same movement. By key release and key press respectively, participants had to indicate when they started and ended the mental simulation or the re-enactment, making it feasible to measure the duration of the simulated or re-enacted movements. The proportional error between duration of the re-enacted/simulated movement and the template movement were compared between different conditions, as well as between PS and healthy subjects. Results revealed a double dissociation between the mechanisms of mental simulation involved in biological and non-biologial movement simulation. While for PS were found large errors for simulation of biological movements, while being more acurate than healthy subjects during simulation of non-biological movements. Healthy subjects showed the opposite relationship, making errors during simulation of non-biological movements, but being most accurate during simulation of non-biological movements. However, the good timing precision during re-enactment of the movements in all conditions and in both groups of participants suggests that perception, memory and attention, as well as motor control processes were not affected. Based upon a long history of literature reporting the existence of psychotic episodes in epileptic patients, a longitudinal study, using a slightly modified behavioral paradigm, was carried out with two RTLE patients, one patient with idiopathic generalized epilepsy and one patient with extratemporal lobe epilepsy. Results provide strong evidence for a possibility to predict upcoming seizures in RTLE patients behaviorally. In the last part of the thesis it has been validated a behavioural strategy based on neurobiofeedback training, to voluntarily control seizures and to reduce there frequency. Three epileptic patients were included in this study. The biofeedback was based on monitoring of slow cortical potentials (SCPs) extracted online from scalp EEG. Patients were trained to produce positive shifts of SCPs. After a training phase patients were monitored for 6 months in order to validate the ability of the learned strategy to reduce seizure frequency. Two of the three refractory epileptic patients recruited for this study showed improvements in self-management and reduction of ictal episodes, even six months after the last training session.

Effetto crowding e dislessia evolutiva: un confronto inter e intra-linguistico

Crowding is defined as the negative effect obtained by adding visual distractors around a central target which has to be identified. Some studies have suggested the presence of a marked crowding effect in developmental dyslexia (e.g. Atkinson, 1991; Spinelli et al., 2002). Inspired by Spinelli’s (2002) experimental design, we explored the hypothesis that the crowding effect may affect dyslexics’ response times (RTs) and accuracy in identification tasks dealing with words, pseudowords, illegal non-words and symbolstrings. Moreover, our study aimed to clarify the relationship between the crowding phenomenon and the word-reading process, in an inter-language comparison perspective. For this purpose we studied twenty-two French dyslexics and twenty-two Italian dyslexics (total forty-four dyslexics), compared to forty-four subjects matched for reading level (22 French and 22 Italians) and forty-four chronological age-matched subjects (22 French and 22 Italians). Children were all tested on reading and cognitive abilities. Results showed no differences between French and Italian participants suggesting that performances were homogenous. Dyslexic children were all significantly impaired in words and pseudowords reading compared to their normal reading controls. Regarding the identification task with which we assessed crowding effect, both accuracy and RTs showed a lexicality effect which meant that the recognition of words was more accurate and faster in words than pseudowords, non-words and symbolstrings. Moreover, compared to normal readers, dyslexics’ RTs and accuracy were impaired only for verbal materials but not for non-verbal material; these results are in line with the phonological hypothesis (Griffiths & Snowling, 2002; Snowling, 2000; 2006) . RTs revealed a general crowding effect (RTs in the crowding condition were slower than those recorded in the isolated condition) affecting all the subjects’ performances. This effect, however, emerged to be not specific for dyslexics. Data didn’t reveal a significant effect of language, allowing the generalization of the obtained results. We also analyzed the performance of two subgroups of dyslexics, categorized according to their reading abilities. The two subgroups produced different results regarding the crowding effect and type of material, suggesting that it is meaningful to take into account also the heterogeneity of the dyslexia disorder. Finally, we also analyzed the relationship of the identification task with both reading and cognitive abilities. In conclusion, this study points out the importance of comparing visual tasks performances of dyslexic participants with those of their reading level-matched controls. This approach may improve our comprehension of the potential causal link between crowding and reading (Goswami, 2003).

Scene di violenza, esperienze emotive e condotte aggressive

The aim of this research is to estimate the impact of violent film excerpts on university students (30 f, 30 m) in two different sequences, a “justified” violent scene followed by an “unjustified” one, or vice versa, as follows: 1) before-after sequences, using Aggressive behaviour I-R Questionnaire, Self Depression Scale and ASQ-IPAT Anxiety SCALE; 2) after every excerpt, using a self-report to evaluate the intensity and hedonic tone of emotions and the violence justification level. Emotion regulation processes (suppression, reappraisal, self-efficacy) were considered. In contrast with the “unjustified” violent scene, during the “justified” one, the justification level was higher; intensity and unpleasantness of negative emotions were lower. Anxiety (total and latent) and rumination diminished after both types of sequences. Rumination decreases less after the JV-UV sequence than after the UV-JV sequence. Self-efficacy in controlling negative emotions reduced rumination, whereas suppression reduced irritability. Reappraisal, self-efficacy in positive emotion expression and perceived emphatic selfefficacy did not have any effects.

Componenti spaziali della rappresentazione cognitiva della grandezza del numero

The humans process the numbers in a similar way to animals. There are countless studies in which similar performance between animals and humans (adults and/or children) are reported. Three models have been developed to explain the cognitive mechanisms underlying the number processing. The triple-code model (Dehaene, 1992) posits an mental number line as preferred way to represent magnitude. The mental number line has three particular effects: the distance, the magnitude and the SNARC effects. The SNARC effect shows a spatial association between number and space representations. In other words, the small numbers are related to left space while large numbers are related to right space. Recently a vertical SNARC effect has been found (Ito & Hatta, 2004; Schwarz & Keus, 2004), reflecting a space-related bottom-to-up representation of numbers. The magnitude representations horizontally and vertically could influence the subject performance in explicit and implicit digit tasks. The goal of this research project aimed to investigate the spatial components of number representation using different experimental designs and tasks. The experiment 1 focused on horizontal and vertical number representations in a within- and between-subjects designs in a parity and magnitude comparative tasks, presenting positive or negative Arabic digits (1-9 without 5). The experiment 1A replied the SNARC and distance effects in both spatial arrangements. The experiment 1B showed an horizontal reversed SNARC effect in both tasks while a vertical reversed SNARC effect was found only in comparative task. In the experiment 1C two groups of subjects performed both tasks in two different instruction-responding hand assignments with positive numbers. The results did not show any significant differences between two assignments, even if the vertical number line seemed to be more flexible respect to horizontal one. On the whole the experiment 1 seemed to demonstrate a contextual (i.e. task set) influences of the nature of the SNARC effect. The experiment 2 focused on the effect of horizontal and vertical number representations on spatial biases in a paper-and-pencil bisecting tasks. In the experiment 2A the participants were requested to bisect physical and number (2 or 9) lines horizontally and vertically. The findings demonstrated that digit 9 strings tended to generate a more rightward bias comparing with digit 2 strings horizontally. However in vertical condition the digit 2 strings generated a more upperward bias respect to digit 9 strings, suggesting a top-to-bottom number line. In the experiment 2B the participants were asked to bisect lines flanked by numbers (i.e. 1 or 7) in four spatial arrangements: horizontal, vertical, right-diagonal and left-diagonal lines. Four number conditions were created according to congruent or incongruent number line representation: 1-1, 1-7, 7-1 and 7-7. The main results showed a more reliable rightward bias in horizontal congruent condition (1-7) respect to incongruent condition (7-1). Vertically the incongruent condition (1-7) determined a significant bias towards bottom side of line respect to congruent condition (7-1). The experiment 2 suggested a more rigid horizontal number line while in vertical condition the number representation could be more flexible. In the experiment 3 we adopted the materials of experiment 2B in order to find a number line effect on temporal (motor) performance. The participants were presented horizontal, vertical, rightdiagonal and left-diagonal lines flanked by the same digits (i.e. 1-1 or 7-7) or by different digits (i.e. 1-7 or 7-1). The digits were spatially congruent or incongruent with their respective hypothesized mental representations. Participants were instructed to touch the lines either close to the large digit, or close to the small digit, or to bisected the lines. Number processing influenced movement execution more than movement planning. Number congruency influenced spatial biases mostly along the horizontal but also along the vertical dimension. These results support a two-dimensional magnitude representation. Finally, the experiment 4 addressed the visuo-spatial manipulation of number representations for accessing and retrieval arithmetic facts. The participants were requested to perform a number-matching and an addition verification tasks. The findings showed an interference effect between sum-nodes and neutral-nodes only with an horizontal presentation of digit-cues, in number-matching tasks. In the addition verification task, the performance was similar for horizontal and vertical presentations of arithmetic problems. In conclusion the data seemed to show an automatic activation of horizontal number line also used to retrieval arithmetic facts. The horizontal number line seemed to be more rigid and the preferred way to order number from left-to-right. A possible explanation could be the left-to-right direction for reading and writing. The vertical number line seemed to be more flexible and more dependent from the tasks, reflecting perhaps several example in the environment representing numbers either from bottom-to-top or from top-to-bottom. However the bottom-to-top number line seemed to be activated by explicit task demands.

La sorpresa come fattore critico indicatore di sintonizzazione emotiva in bambini normali e con disturbi pervasivi dello sviluppo

The topic of this study is surprise, re gard as an evolutionary complex process, with manifold implication in different fields, from neurological, since aspecific correlate of surprise exist more or less at every level of neuronal processes (e.g. Rao e Ballard, 1999.), to behavioral , inasmuch a s our ability to quickly valuate(assess), recognize and learn from surprising events, are be regarded as pivotal for survival (e.g. Ranganath e Rainer, 2003). In particular this work, going from belief that surprise is really a psychoevolutive mechanism of primary relevance, has the objective to investigate if there may be a substantial connection between development of surprise' emotion and specific developmental problems, or, if in subjects with pervasive developmental disorders surprise may embody (represent) a essential mechanism of emotional tuning, and consequently if abnormalities in such process may be at the base of at least a part of cognitive and behavioural problems that determine (describe) this pathology. Theoretical reasons lead us to conside r this particular pathologic condition, recall to a broad area of research concern the comprehension of belief as marker of ability to reasons about mental states of others (i.e. Theory of Mind), and in addition, at the detection of specific subjects' diff iculty in this field. On the experimental side, as well as limited of this work, we have to compare comprehension and expression of surprise in a sample of 21 children with pervasive developmental disorders (PDD), with a sample of 35 children without deve lopmental problems, in a range of age 3-12. Method After the customary approach to become friendly with the child, an experimenter and an accomplice showed three boxes of nuts, easily to distinguish one from the other because of their different colours an d , working together with the child, the contents of one of the boxes were replaced and a different material (macaroni, pebbles) was put in the box. for the purpose of preparing a surprise for someone. At this stage, the accomplice excused himself/herself and left and the experimenter suggested to the child that he prepare another surprise, replacing the contents in the second box. When the accomplice came back, the child was asked to prepare a surprise for him by picking out the box that he thought was the right one for the purpose. After, and the child doesn't know it, the accomplice change the content of one of the boxes with candies and asked out to the children to open the box, in order to see if he show surprise. Result Date have obtain a significant difference between autistic and normal group, in all four tests. The expression of surprise too, is present in significantly lower degree in autistic group than in control group. Moreover, autistic children do not provide appropriate metarappresentative explanations. Conclusion Our outcome, with knowledge of the limit of our investigation at an experimental level (low number of the champions, no possibility of video registration to firm the expressions ) orient to consider eventuality that surprise, may be seen as relevant component, or indicative, in autistic spectrum disorders.

Liver transplantation for transthyretin amyloidosis: experience of a single center in Italy

Liver transplantation is the only definitive treatment for transthyretin amyloidosis, with an excellent 5-year survival in endemic countries where the Met30 mutation is predominant. We report our experience of liver transplantation for transthyretin amyloidosis. We reviewed the clinical records of 17 transplanted patients (11 males, 6 females; age at liver transplant: 45.7±11.7 years). We had a wide spectrum of non-Met30 mutations (52.9%), with a predominance of Gln89 (23.5%). Five-year survival after transplantation was 43.8%; at multivariate analysis, both non-Met30 mutations (HR 17.3, 95% CI 1.03-291.7) and modified BMI (HR 0.50, 95% CI 0.29-0.87) showed significant and independent prognostic roles (P=0.048 and P=0.015, respectively). Five out of the 9 non-Met30 carriers received combined heart transplantation because of severe cardiomyopathy; they showed a trend towards a better prognosis vs. the 4 patients who did not receive combined heart transplantation (although not statistically significant; P=0.095). At follow-up, no significant improvement of transthyretin amyloidosis manifestations was observed. The results of liver transplantation for transthyretin amyloidosis in our population are poorer than those reported in the literature probably because of the high prevalence of non-Met30 mutations.

Valutazione del rapporto urinario proteine totali/creatinina e albumina/creatinina in cani affetti da iperadrenocorticismo e da diabete mellito

INTRODUCTION – In human medicine, diabetes mellitus (DM), hypertension, proteinuria and nephropathy are often associated although it is still not clear whether hypertension is the consequence or the cause of nephropathy and albuminuria. Microalbuminuria, in humans, is an early and sensitive marker which permits timely and effective therapy in the early phase of renal damage. Conversely, in dogs, these relationships were not fully investigated, even though hypertension has been associated with many diseases (Bodey and Michell, 1996). In a previous study, 20% of diabetic dogs were found proteinuric based on a U:P/C > 1 and 46% were hypertensive; this latter finding is similar to the prevalence of hypertension in diabetic people (40-80%) (Struble et al., 1998). In the same canine study, hypertension was also positively correlated with the duration of the disease, as is the case in human beings. Hypertension was also found to be a common complication of hypercortisolism (HC) in dogs, with a prevalence which varies from 50 (Goy-Thollot et al., 2002) to 80% (Danese and Aron, 1994).The aim of our study was to evaluate the urinary albumin to creatinine ratio (U:A/C) in dogs affected by Diabetes Mellitus and HC in order to ascertain if, as in human beings, it could represent an early and more sensitive marker of renal damage than U:P/C. Furthermore, the relationship between proteinuria and hypertension in DM and HC was also investigated. MATERIALS AND METHODS – Twenty dogs with DM, 14 with HC and 21 healthy dogs (control group) were included in the prospective case-control study. Inclusion criteria were hyperglycaemia, glicosuria and serum fructosamine above the reference range for DM dogs and a positive ACTH stimulation test and/or low-dose dexamethasone test and consistent findings of HC on abdominal ultrasonography in HC dogs. Dogs were excluded if affected by urinary tract infections and if the serum creatinine or urea values were above the reference range. At the moment of inclusion, an appropriate therapy had already been instituted less than 1 month earlier in 12 diabetic dogs. The control dogs were considered healthy based on clinical exam and clinicopathological findings. All dogs underwent urine sample collection by cystocentesis and systemic blood pressure measurement by means of either an oscillometric device (BP-88 Next, Colin Corporation, Japan) or by Doppler ultrasonic traducer (Minidop ES-100VX, Hadeco, Japan). The choice of method depended on the dog’s body weight: Doppler ultrasonography was employed in dogs < 20 kg of body weight and the oscillometric method in the other subjects. Dogs were considered hypertensive whenever systemic blood pressure was found ≥ 160 mmHg. The urine was assayed for U:P/C and U:A/C (Gentilini et al., 2005). The data between groups were compared using the Mann-Whitney U test. The reference ranges for U:P/C and U:A/C had already been established by our laboratory as 0.6 and 0.05, respectively. U:P/C and U:A/C findings were correlated to systemic blood pressure and Spearman R correlation coefficients were calculated. In all cases, p < 0.05 was considered statistically significant. RESULTS – The mean ± sd urinary albumin concentration in the three groups was 1.79 mg/dl ± 2.18; 20.02 mg/dl ± 43.25; 52.02 mg/dl ± 98.27, in healthy, diabetic and hypercortisolemic dogs, respectively. The urine albumin concentration differed significantly between healthy and diabetic dogs (p = 0.008) and between healthy and HC dogs (p = 0.011). U:A/C values ranged from 0.00 to 0.34 (mean ± sd 0.02 ± 0.07), 0.00 to 6.72 (mean ± sd 0.62 ± 1.52) and 0.00 to 5.52 (mean ± sd 1.27 ± 1.70) in the control, DM and HC groups, respectively; U:P/C values ranged from 0.1 to 0.6 (mean ± sd 0.17 ± 0.15) 0.1 to 6.6 (mean ± sd 0.93 ± 1.15) and 0.2 to 7.1 (mean ± sd 1.90 ± 2.11) in the control, DM and HC groups, respectively. In diabetic dogs, U:A/C was above the reference range in 11 out of 20 dogs (55%). Among these, 5/20 (25%) showed an increase only in the U:A/C ratio while, in 6/20 (30%), both the U:P/C and the U:A/C were abnormal. Among the latter, 4 dogs had already undergone therapy. In subjects affected with HC, U:P/C and U:A/C were both increased in 10/14 (71%) while in 2/14 (14%) only U:A/C was above the reference range. Overall, by comparing U:P/C and U:A/C in the various groups, a significant increase in protein excretion in disease-affected animals compared to healthy dogs was found. Blood pressure (BP) in diabetic subjects ranged from 88 to 203 mmHg (mean ± sd 143 ± 33 mmHg) and 7/20 (35%) dogs were found to be hypertensive. In HC dogs, BP ranged from 116 to 200 mmHg (mean ± sd 167 ± 26 mmHg) and 9/14 (64%) dogs were hypertensive. Blood pressure and proteinuria were not significantly correlated. Furthermore, in the DM group, U:P/C and U:A/C were both increased in 3 hypertensive dogs and 2 normotensive dogs while the only increase of U:A/C was observed in 2 hypertensive and 3 normotensive dogs. In the HC group, the U:P/C and the U:A/C were both increased in 6 hypertensive and 2 normotensive dogs; the U:A/C was the sole increased parameter in 1 hypertensive dog and in 1 dog with normal pressure. DISCUSSION AND CONCLUSION- The findings of this study suggest that, in dogs affected by DM and HC, an increase in U:P/C, U:A/C and systemic hypertension is frequently present. Remarkably, some dogs affected by both DM and HC showed an U:A/C but not U:P/C above the reference range. In diabetic dogs, albuminuria was observed in 25% of the subjects, suggesting the possibility that this parameter could be employed for detecting renal damage at an early phase when common semiquantiative tests and even U:P/C fall inside the reference range. In HC dogs, a higher number of subjects with overt proteinuria was found while only 14% presented an increase only in the U:A/C. This fact, associated with a greater number of hypertensive dogs having HC rather than DM, could suggest a greater influence on renal function by the mechanisms involved in hypertension secondary to hypercortisolemia. Furthermore, it is possible that, in HC dogs, the diagnosis was more delayed than in DM dogs. However, the lack of a statistically significant correlation between hypertension and increased protein excretion as well as the apparently random distribution of proteinuric subjects in normotensive and hypertensive cases, imply that other factors besides hypertension are involved in causing proteinuria. Longitudinal studies are needed to further investigate the relationship between hypertension and proteinuria.

Profilo molecolare dei linfomi post-trapianto

Fifty-two cases of monomorphic post-transplant lymphoproliferative disorders (M-PTLD), developed in patients undergone solid organ or bone marrow transplantation, were studied by the application of the tissue micro-array (TMA) technology. They included 50 cases of diffuse large B-cell lymphomas (DLBCL) and 2 Burkitt lymphomas (BL). In order to evaluate the immune-profile a large panel of antibodies was applied including several new markers (Cyclin D2, Cyclin D3, p27, PKC-β, FOXP-1 and Survivin) identified as negative prognostic factors in DLBCL of the immunocompetent patient. Out of 50 DLBCL, 23 cases (46%) had an Activated B Cell (ABC) phenotype, 8 (16%) a Germinal Centre B-cell (GCB) phenotype, and 11 (22%) an Unclassified (UC) phenotype. In 8 cases (16%) the subtype was not demonstrable due to sub-optimal preservation or loss of the tissue core. FISH analysis detected BCL2 gene amplification and MYC rearrangement. EBV was identified in 32 cases (64%) performing immunohistochemistry (LMP-1) and in situ hybridization (EBER). Clinical data and follow-up were available in all cases of malignant lymphomas but one. Thirty-two patients died for progression of disease or complications related to transplant (bleeding, bacterial infections, and multi-organ failure); 17 patients are actually alive and disease-free. M-PTLD are aggressive lymphomas characterized by very poor outcome. The neoplastic process is stimulated by a prolonged immunosuppressive status which is capable to induce alterations of the immune system and allow EBV reactivation in previously infected patients. Indeed EBV infection seems to be the most significant risk factor to predict the development of a PTLD while age, sex, site of involvement and type of transplant do not have significant correlation. Furthermore DLBCL arisen in a setting of immunodeficiency share phenotypic and molecular features with DLBCL of the immunocompetent patient. In particular, the former shows a high incidence of BCL2 gene amplification and this aberration typically correlates with “non-GCB” phenotype. Also M-PTLD do express prognostic markers (PKC-β, cyclin D2, FOXP-1, and Survivin): notably, in our study, PKC-β and FOXP-1 were frequently expressed and they were predictive of a shorter overall survival even in lymphomas recognized to have a good prognosis (GCB-type). Given the fact that such molecules are detectable at the time of the diagnosis, we postulate whether a “tailored” or more specific therapy might be applied in the management of the immune-compromised patient.

L'attrazione sessuale: processi psichici e strumenti di indagine. L'adattamento italiano del Cuestionario de Atraccion sexual

The sexual attraction is a complex emotional event, with somatic modifications, that like all the emotions, belongs to the psychic dimension and that, too much simply, can be led back, from a explicative point of view, to biological and psychical causes. The sexual attraction represents a personal experience, that is difficult to record, but of which every adult is able to delineate a correspondence with own “lived”. In the within of biological sciences, many experimental studies were been conducted with the aim to know which chemistries substances and cerebral zones are involved in front of a stimulus assessed like sexually attractive. Contrarily, there are little researches conducted in psychological field, aimed to the understanding the psychical factors, often unconscious, tinged to the subjective processes of sexual attraction: the sexual attraction remains an unexplored psychological event and unprovided of adapted instruments of assessment. The present thesis is oriented in primis to examine the existing scientific literature, in order to provide an exhaustive picture of the sexual attraction and to analyze the instruments of survey available for the empirical assessment of it. Secondly, the thesis is oriented to introduce two studies: the first study is aimed to adapt the Cuestionario de Atracción Sexual - CAS (Fernández ET to, 2006a; 2006b; 2006c) to the Italian language; the second study is aimed to assess the attitudes towards the sexual attraction in a sample of university students, in order to establish if some differences or association with some psychological dimensions (attachment stiles and alexithymia) exist.