Sleep electroencephalography and brain maturation: developmental trajectories and the relation with cognitive functioning.

Sleep has a crucial role in brain functioning and cognition, and several sleep electroencephalography (EEG) hallmarks are associated with intellectual abilities, neural plasticity, and learning processes. Starting from this evidence, a growing interest has been raised regarding the involvement of the sleep EEG in brain maturation and cognitive functioning during typical development (TD). The aim of this review is to provide a general framework about the maturational changes and the functional role of the human sleep EEG during TD from birth to late adolescence (≤22 years). The reviewed findings show large developmental modifications in several sleep EEG hallmarks (slow wave activity, sleep spindles, theta activity, and cyclic alternating pattern) during TD, and many studies support the notion of an active role of sleep slow wave activity in supporting brain maturation. Moreover, we focus on the possible relation between sleep microstructure, intelligence, and several memory domains (declarative, emotional, procedural), showing that sleep EEG oscillations seem involved in intellectual abilities and learning processes during TD, although results are often conflicting and divergent from findings in adults. Starting from the present literature, we propose that larger methodological uniformity, greater attention to the topographical and maturational aspects of the sleep EEG oscillations and their mutual interactions, and a higher number of longitudinal studies will be essential to clarify the role of the sleep EEG in cognitive functioning during TD.

Narcolepsy and emotional experience: a review of the literature.

Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. This disease affects significantly the overall patient functioning, interfering with social, work, and affective life. Some symptoms of narcolepsy depend on emotional stimuli; for instance, cataplectic attacks can be triggered by emotional inputs such as laughing, joking, a pleasant surprise, and also anger. Neurophysiological and neurochemical findings suggest the involvement of emotional brain circuits in the physiopathology of cataplexy, which seems to depending on the dysfunctional interplay between the hypothalamus and the amygdala associated with an alteration of hypocretin levels. Furthermore, behavioral studies suggest an impairment of emotions processing in narcolepsy-cataplexy (NC), like a probable coping strategy to avoid or reduce the frequency of cataplexy attacks. Consistently, NC patients seem to use coping strategies even during their sleep, avoiding unpleasant mental sleep activity through lucid dreaming. Interestingly, NC patients, even during sleep, have a different emotional experience than healthy subjects, with more vivid, bizarre, and frightening dreams. Notwithstanding this evidence, the relationship between emotion and narcolepsy is poorly investigated. This review aims to provide a synthesis of behavioral, neurophysiological, and neurochemical evidence to discuss the complex relationship between NC and emotional experience and to direct future research.

Electrical stimulation of the frontal cortex enhances slow-frequency EEG activity and sleepiness.

Our aim was to enhance the spontaneous slow-frequency EEG activity during the resting state using oscillating transcranial direct currents (tDCS) with a stimulation frequency that resembles the spontaneous oscillations of sleep onset. Accordingly, in this preliminary study, we assessed EEG after-effects of a frontal oscillatory tDCS with different frequency (0.8 vs. 5 Hz) and polarity (anodal, cathodal, and sham). Two single-blind experiments compared the after effects on the resting EEG of oscillatory tDCS [Exp. 1=0.8 Hz, 10 subjects (26.2 ± 2.5 years); Exp. 2=5 Hz, 10 subjects (27.4 ± 2.4 years)] by manipulating its polarity. EEG signals recorded (28 scalp derivations) before and after stimulation [slow oscillations (0.5-1 Hz), delta (1-4 Hz), theta (5-7 Hz), alpha (8-12 Hz), beta 1 (13-15 Hz) and beta 2 (16-24 Hz)] were compared between conditions as a function of polarity (anodal vs. cathodal vs. sham) and frequency of stimulation (0.8 vs. 5 Hz). We found a significant relative enhancement of the delta activity after the anodal tDCS at 5 Hz compared to that at 0.8 Hz. This increase, even though not reaching the statistical significance compared to sham, is concomitant to a significant increase of subjective sleepiness, as assessed by a visual analog scale. These two phenomena are linearly related with a regional specificity, correlations being restricted to cortical areas perifocal to the stimulation site. We have shown that a frontal oscillating anodal tDCS at 5 Hz results in an effective change of both subjective sleepiness and spontaneous slow-frequency EEG activity. These changes are critically associated to both stimulation polarity (anodal) and frequency (5 Hz). However, evidence of frequency-dependence seems more unequivocal than evidence of polarity-dependence.

MILORD: Multi-media Interaction with Large Object-oriented Radiological and clinical Databases.

The MILORD project concerns the storage, communication, and processing of large multi-media clinical information in an integrated environment. Advanced information technologies are exploited: new knowledge representation languages and tools, friendly human-computer interaction, 3D graphical processing and displaying of medical images, high performance parallel architectures, large-scale distributed data storage, federated environments for clinical cooperation. The project is developing an environment for designing and handling medical workstations. New turn-key marketable systems are expected after the end of the project. From its first version, the system is installed and under evaluation in large hospitals.

[Computerized prototype of a screening test for the assessment of psychomotor development in childhood]. / Prototipo automatizzato di un test di screening per la valutazione dello sviluppo psicomotorio dell'infanzia.

The aim of Denver's screening test is to study the psychomotor development of normal or supposed normal children aged from 0 to 6 years and to suggest further investigation when an abnormal development is noticed. The test is divided into 4 sections: social behavior, fine motility, language, gross motility. The results are valid only if the test is done in a standardized manner. The aim of this paper is to describe the computerized prototype of the Denver test in use at the Divisional Pediatric Ambulatory of "A. Gemelli" University Policlinic in Rome. This test is used in the context of an automatized ambulatory management system called ARPIA, capable of interacting and guiding "non expert" user. The program performs the following functions: 1) General instructions for the execution and interpretation of the test. The original instructions of the test (1975 version) have been used. 2) Input, modification, exclusion of questions. The archive is organized in the following manner: questions are divided in the above four sections, according to the child, undergoing the test, age limit; the questions regarding information that can be asked directly to the parents or the display of a picture that better explains the test are marked. During the test the questions may be modified using a menu with a certain number of options to facilitate the use of the system. The questions to eliminate from the test may be appropriately marked and removed. The text is not physically deleted from the archive. The inverse operation of inclusion of a formerly removed question may be performed too.(ABSTRACT TRUNCATED AT 250 WORDS)

[Implementation of a computerized pharmacological database for pediatric use]. / Realizzazione di un archivio farmacologico computerizzato ad uso pediatrico.

The authors present a pharmacological database to support teaching and care activity carried out in the Divisional Paediatric Ambulatory of the Catholic University of Rome. This database is included in a integrated system, ARPIA (Ambulatory and Research in Pediatric by Information Assistance), devoted to manage ambulatory paediatric data. ARPIA has been implemented by using a relational DBMS, very cheap and highly diffused on personal computers. The database specifies: active ingredient and code number related to it, clinical uses, doses, contra-indications and precautions, adverse effects, besides the possible wrapping available on the market. All this is showed on a single for that appears on the screen and allows a fast reading of the most important elements characterizing every drug. The search of the included drugs can be made on the basis of three different detailed lists: active ingredient, proprietary preparation and clinical use. It is, besides, possible to have a complete report about the drugs requested by the user. This system allows the user, without modifying the program, to interact with the included data modifying each element of the form. In the system there is also a fast consultation handbook containing for every active ingredient, the complete list of italian proprietary medicines. This system aims to give a better knowledge of the most commonly used drugs, not only limited to the paediatrician but also to the ambulatory health staff; an improvement of the therapy furthering, a more effective use of several pharmacological agents and first of all a training device not only to specialists but also to students.

Functionality of the ARPIA ambulatory information system.

Although database-based medical information systems are becoming popular, experiments done by researchers tell us that physicians still do not fully accept them. Key factors for changing physicians' practice habits are the availability of more powerful methods and tools for interactive data acquisition and retrieval. Problems involving human engineering usually require the identification of and experimentation with many novel approaches before the most suitable answer is discovered. ARPIA is an ambulatory information system experimenting on the effectiveness and acceptability (by medical users) of new intelligent and friendly interaction techniques and tools. In particular, it tests a novel flexible dialogue-based man-machine interface offering physical and logical data 'independence' during retrieval operations. Other features of the system are: a fast and robust data acquisition environment; a text- and picture-based data presentation and report generation facility; finally, a set of modules offering the ambulatory staff effective assistance in some extra complex interactive tasks. A user-oriented description of the main functionality of ARPIA is given; users' feedback summarizing almost 2 years of usage of the system is also reported.

[The laboratory in monitoring high-risk pregnancy]. / Il laboratorio nel monitoraggio della gravidanza a rischio.

108 cases of high-risk pregnancy are object of our investigation (gestosis, feto-placental insufficiency, chronic nephropathy, rhesus immunization). HCG, plasma estriol, HPL and beta1-SP1-glycoprotein have been studied. The simultaneous determination of the four hormones makes it possible to establish the degree of the pregnancy risk, eventual fetal suffering and the hormonal course of pregnancy.