Frontal GABA Levels Change during Working Memory

Functional neuroimaging metrics are thought to reflect changes in neurotransmitter flux, but changes in neurotransmitter levels have not been demonstrated in humans during a cognitive task, and the relationship between neurotransmitter dynamics and hemodynamic activity during cognition has not yet been established. We evaluate the concentration of the major inhibitory (GABA) and excitatory (glutamate + glutamine: Glx) neurotransmitters and the cerebral perfusion at rest and during a prolonged delayed match-to-sample working memory task. Resting GABA levels in the dorsolateral prefrontal cortex correlated positively with the resting perfusion and inversely with the change in perfusion during the task. Further, only GABA increased significantly during the first working memory run and then decreased continuously across subsequent task runs. The decrease of GABA over time was paralleled by a trend towards decreased reaction times and higher task accuracy. These results demonstrate a link between neurotransmitter dynamics and hemodynamic activity during working memory, indicating that functional neuroimaging metrics depend on the balance of excitation and inhibition required for cognitive processing

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Male offspring born to mildly ZIKV-infected mice are at risk of developing neurocognitive disorders in adulthood

Congenital Zika virus (ZIKV) syndrome may cause fetal microcephaly in -1% of affected newborns. Here, we investigate whether the majority of clinically inapparent newborns might suffer from long-term health impairments not readily visible at birth. Infection of immunocompetent pregnant mice with high-dose ZIKV caused severe offspring phenotypes, such as fetal death, as expected. By contrast, low-dose (LD) maternal ZIKV infection resulted in reduced fetal birth weight but no other obvious phenotypes. Male offspring born to LD ZIKV-infected mothers had increased testosterone (TST) levels and were less likely to survive in utero infection compared to their female littermates. Males also presented an increased number of immature neurons in apical and basal hippocampal dendrites, while female offspring had immature neurons in basal dendrites only. Moreover, male offspring with high but not very high (storm) TST levels were more likely to suffer from learning and memory impairments compared to females. Future studies are required to understand the impact of TST on neuropathological and neurocognitive impairments in later life. In summary, increased sex-specific vigilance is required in countries with high ZIKV prevalence, where impaired neurodevelopment may be camouflaged by a healthy appearance at birth.Peer reviewe

Breast reshaping in gynecomastia by the \u201cpull-through technique\u201d: considerations after 15 years

Gynecomastia corresponds to abnormal and excessive development of breast tissue in male patients. It may be unilateral or bilateral and, depending on breast volume and skin redundancy, it can be classified, according to Simon, in four different groups. Standard therapy is surgery and different techniques have been described so far, including different type of incisions in the periareolar or intrareolar skin. In 1996 in this journal we described our personal technique, called "pull-through." Our technique combines liposuction that is performed on two planes, subcutaneous and subglandular, and sharp parenchymal excision, performed through the small liposuction incisions. These incisions are short (1-1.5 cm) and hidden in the inframammary fold and behind the anterior axillary pillar. Furthermore the operation can be performed under local anesthesia and with a short recovery period. Since then we have operated on 260 patients. We now present our 15 years experience and our review of literature, focused on authors who used and criticized our technique. Results, in terms of breast volume reduction, skin retraction, and minimal visibility of scars, were very good, even in cases more severe than in our first series (Simon's type IIb and female-to-male transsexuals). Patients' satisfaction rate was high as well and the incidence of complications was low. The results we observed in our series and the ones presented by different authors confirmed the validity and feasibility of the "pull-through" technique in terms of esthetic and functional results, patient satisfaction, and a low incidence of complications

[HLA and hypo-responsivity to anti-HBV vaccination (genetic study of non-responder subjects to anti-hepatitis B viral vaccine)].

The control of the immunization due to hepatitis B vaccines (HB-VAX and HEVAC B) showed that a low percentage of healthy adults vaccinated develop a non protective title of HBsAb or do not produce antibodies. The correlation between immunity and HLA has already been demonstrated: HLA is at the base of individual immunological response; this correlation directed our genetic study of low-responders or non-responders patients to anti-HBV vaccine. In our study 11 out of 97 subjects vaccinated (11.34%) with HB VAX or HEVAC B resulted hyporesponsive and underwent complete HLA typing to verify the relation between immune deficiency response and genetic system. There was an increase in phenotype HLA-DR7 incidence, with respect to a non-selective population and a decrease of HLA-DR1, as it has already been mentioned in the literature, the variations were not statistically significant taking into account the exiguity of the samples considered

Expanding the middle third of the face by distraction osteogenesis in apert patients

Cranial deformities often require major surgical procedures to be corrected. Plastic surgeon Paul Tessier, a pioneer in the evolution of craniofacial surgery, insists that the guiding principle in the treatment of craniosinostoses is to separate the splancocranium from the neurocranium and move the splancocranium into a more anatomically correct position. This is still the main procedure of today, but the recent use of bone distraction devices has significantly changed surgical techniques. Two children affected by Apert's syndrome were operated on by performing a Lefort III osteotomy and applying Molina's bone distractors in order to obtain the "push" technique. The activation period lasted six weeks at which time the patient was required to wear a modified facial mask in order to control the amount of "pull" forward distraction. The distractors were removed after the 8-week consolidation period had expired. Postoperative clinical and instrumental (CT-scan) evalution showed a remarkable improvement of midfacial hypoplasia with correction of the exophtalmus, advancement of the nasal pyramid and an increase in facial length. CT scans also showed the formation of new good quality bone. Gradual advancement of the facial skeleton by distraction avoids the need for bone grafting and rigid fixation. Results are safer and aesthetic appearance is improved due to a guided bone expansion which gradually pushes and stretches soft tissues resulting in the entire midface to be expanded in a more harmonious manner

Upper eyelid myocutaneous flap for the repair of lower eyelid skin defects

Lesions leading to a skin defect of the lower eyelid are quite frequent. The most frequent cause of eyelid defects is skin cancer resection. Other causes are traumatic avulsion, burn injuries or sequelae of erred cosmetic procedures. Skin defects, if not adequately treated, lead to mild to severe lid retraction or ectropion. There are many surgical options and the choice depends on the amount of eyelid skin missing. The upper eyelid, especially in senior patients, is a good donor area for defects of the lower eyelid. The skin can be harvested and transposed as a free graft as well as a flap. A myocutaneous flap harvested from the upper eyelid is frequently used for the repair of lower eyelid defects. The anatomical and clinical bases of this flap are reported, its main applications are discussed and its reliability is confirmed. The flap is thin and pliable, its rotation is easy and it can easily reach and seal defects of the skin and muscle layers of the lower eyelid by a single-step procedure. The first step is a wide, oncologically radical resection of the cancer; after that, the flap is harvested from the upper lid using a blepharoplasty-like incision. The orbicularis muscle flap with the skin island is then elevated; its pedicle is on the lateral side. After that the flap is passed through a tunnel undermined at the lateral canthal area, thus being able to reach the lower lid defect. The described technique was applied on 23 patients after resection of skin cancers of the lower eyelid. Complete repair of the skin defect with excellent wound healing was obtained in all cases. All the patients had good results both from the functional and from the aesthetic point of view