Sleep as a window for evaluating neurodevelopmental outcome: which impact on the brain of preterm infants? A prospective study on prematurity from a biological neuropsychiatry perspective

Background. Newborns and infants spend most of their time sleeping an immature sleep, which allows brain maturation a good neurodevelopment. Preterm birth is associated with abnormal brain development and alterations in later-in-life sleep patterns, carrying a high social burden, even when not accompanied by major neurological damages. Which impact prematurity itself can have on early sleep architecture, which influence it can have on well- known adverse outcomes, and which role brain lesions play in determining sleep patterns in preterm infants are still matter of debate. This exploratory pilot study aimed to describe the distribution of sleep states among very low birth weight (VLBW) infants, and to correlate it with neurobehavioral assessment at 35 weeks of post-menstrual age (PMA), and to observe if these persisted at term equivalent age (TEA) and at 6 months of corrected age (CA). Secondly, it aimed to assess if the presence of a major or minor brain lesion detected at MRI can affect sleep duration, distribution and quality. Methods. 10 VLBW were assessed at 34±2 weeks PMA with a 24-hours video- polysomnographic recording and received a neurobehavioral examination at the moment of the recording and at TEA (with Neonatal Behavior Assessment Scale; Hammersmith Neurological Neonatal Examination, and the neonatal visual battery). They were followed- up at 6 months CA with Griffiths’ Mental Development Scale III edition. Analysis of sleep stages distribution and spectra was conducted. Results. Total sleep time and total amount of transitional sleep (TS) significantly positively correlated with neurological, and neurobehavioral assessment at 34 weeks PMA, at TEA and with neurodevelopment at 6 months CA, while Sleep Onset Active Sleep (SOAS) had a negative association. Infants carrying severe-moderate brain lesions showed lower Total Sleep time (66.9% ± 7.39 vs 72.2% ± 3.52, p = 0.047) accompanied by a higher prevalence of SOAS (23.9% ± 10.2 vs 12.26% ± 5.5 p = 0.048), and showed a gradient for higher power of posterior slow activity (slow δ and δ) during SOAS from the posterior cerebral regions. Conclusions. Understanding sleep mechanism among preterm infants might provide future therapeutic/management strategies, which need to encompass sleep care. Further analyses with larger samples and more complex methods are claimed

Ressenyes

Index de les obres ressenyades: Carlo GINZBURG, El queso y los gusanos. El cosmos según un molinero del siglo XV

Cristo si è fermato a Eboli Gagliano e il parco letterario di Aliano : metamorfosi di una memoria

La relazione fra Carlo Levi, la sua opera Cristo si é fermato a Eboli ed il paese di Aliano ha subito dei cambiamenti dal momento della pubblicazione del libro (1945) fino all'istituzione del Parco Letterario Carlo Levi (2001). L'esperienza e il ricordo del confino influenzarono molto la formazione dell'intellettuale antifascista e marcarono profondamente le sue successive scelte letterarie e politiche. Di pari intensità fu la reazione che il libro suscitò nel piccolo centro lucano. Passati ormai più di cinquanta anni, l'iniziale posizione critica e distante degli alianesi si é via via modificata fino a permettere, grazie al patrimonio letterario lasciato da Levi, una valorizzione culturale del territorio.The relationship between Carlo Levi, his work Christ Stopped at Eboli and the village of Aliano, has changed a great deal between the first publication of the book in 1945 and the establishment of the Parco Letterario Carlo Levi in 2001. The experience and the memory of Levi's exile in Aliano profoundly affected his intellectual development and deeply influenced both his subsequent literary and political choices. When the book first appeared, it provoked an intense reaction, but fifty years later the initial response from the critics had changed to the extent that an easier and more constructive relationship between people from Aliano, the author and his masterpiece was possible. This process culminated in a cultural endowment called the Parco Letterario Carlo Levi, which aims to improve links between the region territory and its literary heritage

Classification of neuroendocrine neoplasms: lights and shadows.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of neoplastic proliferations showing different morphological features, immunophenotype, molecular background, clinical presentation, and outcome. They can virtually originate in every organ of the human body and their classification is not uniform among different sites. Indeed, as they have historically been classified according to the organ in which they primarily arise, the different nomenclature that has resulted have created some confusion among pathologists and clinicians. Although a uniform terminology to classify neuroendocrine neoplasms arising in different systems has recently been proposed by WHO/IARC, some issues remain unsolved or need to be clarified. In this review, we discuss the lights and shadows of the current WHO classifications used to define and characterize NENs of the pituitary gland, lung, breast and those of the head and neck region, and digestive and urogenital systems

Localization of inhibin-activin subunits in normal pituitary and pituitary adenomas

The localization of inhibin/activin (I/A) subunits was investigated in human normal adenohypophysial cells and in 87 pituitary adenomas of different types, using immunohistochemistry. Monoclonal antibodies directed against alpha, beta A and beta B subunits of I/A were employed. In normal pituitary, alpha subunit of inhibin was detected only in FSH-positive gonadotrophs, while beta A subunit of I/A was expressed in FSH-positive gonadotrophs, GH-cells and in a few PRL-cells. beta B subunit was found in FSH-positive gonadotrophs, TSH-cells and a few LH-positive gonadotrophs. The three subunits of I/A were detected in the majority of nonfunctioning tumors, while functioning adenomas showed a significantly lower expression. This study shows that alpha, beta A and beta B subunits of I/A are expressed by specific adenohypophysial cell types and that they are characteristically present in nonfunctioning adenomas. These results suggest that inhibins and activins may play a role in the local regulation of pituitary hormonal secretion both in normal adenohypophysial cells and in pituitary adenoma