Epidemiological, clinical and endoscopic features of epistaxis severity and quality of life in Hereditary haemorrhagic telangiectasia: a cross-sectional study.

BACKGROUND: Epistaxis is the main complaint in patients with Hereditary haemorrhagic telangiectasia (HHT). Even though the role of epistaxis in affecting the quality of life (QoL) is well-known, little is known about epidemiological and clinical factors contributing to epistaxis severity and QoL. METHODOLOGY: This is a cross-sectional study, including adult patients with HHT with epistaxis. All patients underwent an otolaryngological evaluation with nasal endoscopy. Epistaxis severity was graded using the FID score, and QoL was evaluated with the Short-Form Health Survey (SF-36). Descriptive statistics were produced for demographic characteristics; the Shapiro-Wilk test was used to test the normal distribution of quantitative variables. Correlation between the quantitative variables was evaluated with Pearson's correlation coefficient. Both univariate and multivariate linear regression models were fitted to find associations between demographic or clinical factors and the FID score or SF-36. RESULTS: A total of 234 patients with HHT were included in the study. The univariate analysis highlighted the association between high blood pressure, septal perforation, nocturnal epistaxis, surgery, blood transfusion, hormonal therapy and both FID score and QoL. Sex, allergic rhinitis and nasal polyposis were neither related to epistaxis severity nor perceived health. CONCLUSIONS: Epistaxis severity and QoL in patients with HHT are influenced by several clinical factors both dependent and independent from HHT. Some of the results are consistent with those already published, but for the first time, we extended the analysis to different clinical parameters, such as endoscopic findings, never assessed before.

FID Score: an effective tool in Hereditary Haemorrhagic Telangiectasia - related epistaxis.

BACKGROUND: Hereditary haemorrhagic telangiectasia (HHT) is a rare disease characterized by a multisystemic vascular dysplasia and epistaxis, that is the most common cause of disability and social impairment. Patient management strictly depends on the severity of this symptom; therefore, it is of paramount importance for the clinicians to effectively grade epistaxis severity. The aim of this report was to validate the Frequency, Intensity and Duration score (FID) for grading epistaxis severity in patients with HHT; we studied repeatability and external validity comparing FID score with Epistaxis Severity Score (ESS). METHODS: This is a descriptive, observational study that included 264 adult HHT patients with epistaxis. Diagnosis of HHT was established with Curacao criteria or positivity at genetic testing. Nosebleed severity was evaluated according to the FID score and the ESS. The first 30 patients were included in the validation of the FID score, which was graded on days 0, 1, 3 and 7. In the remaining 234 patients, a comparison between the ESS and FID score was performed. RESULTS: The statistical analysis performed in order to validate the FID score showed very good agreement between scores calculated on different days; analysis comparing the FID score with the ESS revealed a high correlation between the two grading systems. CONCLUSIONS: The FID score is a quick, easy and precise tool for evaluating HHT-related epistaxis and could be a possible alternative to the ESS. The FID score meets the need for an intuitive and smart grading system that is easy to manage in clinicians’ hands.

Hand use by tufted capuchins (Cebus apella) to extract a small food item from a tube: digit movements, hand preference, and performance.

The aim of this study was to analyze the manual patterns used by tufted capuchin monkeys (Cebus apella) to retrieve a small food item from a narrow tube, with special attention focused on the independent use of single fingers, fine digit movements, hand preference, and intermanual differences in the time it took the monkeys to obtain the food. The capuchins (n = 20) mainly used their forefinger to extract the food from the tube. The simultaneous use of the index and middle fingers occurred less frequently, and the use of the forefinger in combination with other digits occurred rarely. The capuchins demonstrated a capacity to move single digits independently when the fingers were locating the food inside the tube, and displayed a high mobility of the distal phalanx joints. However, they possessed only a limited capacity to coordinate single fingers in space, and displayed only a slight degree of manual preshaping when they approached the tube. A hand-preference analysis failed to reveal any significant lateral bias for the group, since both adults (> or = 5 years) and immature individuals (<5 years) of both sexes used either hand with the same frequency. Conversely, a latency analysis showed a significant interaction between the subject's age and performance difference between hands: in adults, but not in immature individuals, the left hand was faster than the right hand in retrieving food.

Manual laterality in haptic and visual reaching tasks by tufted capuchin monkeys (Cebus apella). An association between hand preference and hand accuracy for food discrimination.

Manual laterality was examined in 26 tufted capuchins (Cebus apella) in three tasks differing in their sensorimotor demands and the availability of visual cues. The Haptic discrimination task required the monkeys to discriminate haptically between two pumpkin seeds and two tinfoil items stuck into a tray inside an opaque box. The other two tasks required the monkeys to reach for two pumpkin seeds stuck into the tray within a transparent box with vision (Visually guided reaching task) or without vision (Visual-Tactual reaching task) during reaching. A significant group-level left hand bias was found for food retrieval in both the Haptic discrimination and Visual-Tactual tasks, and a significant group-level right hand bias in the Visually guided reaching task. The strength of hand preferences did not differ among the tasks. It was found that the accuracy of food recognition in the Haptic discrimination task was greater for the left than the right hand. The results suggest that the differences in the manipulo-spatial requirements of the tasks and in the availability of visual cues can variously affect manual laterality in capuchins. The left-hand preferences for the Haptic discrimination and Visual-Tactual tasks as well as the left-hand advantage for food discrimination may reflect a greater involvement of the right hemisphere in processing haptic information.

Spontaneous classification in action by a human-enculturated and language-reared bonobo (Pan paniscus) and common chimpanzees (Pan troglodytes).

The authors investigated the formal features of spontaneous manipulations used by 1 bonobo (Pan paniscus) and 2 common chimpanzees (Pan troglodytes) to classify objects in action. Chimpanzees' manipulations were evenly split between serial, one-at-a-time acts on 1 object and parallel, two-at-a-time acts on 2 or 3 objects. Chimpanzees systematically combined their manipulations into routines to generate class-consistent categories of objects. Their routines featured much reproduction of the same manipulations, planful acts that anticipated follow-up manipulations, and manipulations that were reciprocal to each other to accomplish an end. In all these respects, chimpanzees' manipulations were similar to those of 2-year-old human infants. In others they differed. Chimpanzees' routines were mainly based on a linear integration of manipulations. Classifying in action was only infrequently produced by hierarchically integrated routines.

Categorization in monkeys and chimpanzees.

Studies on the classificatory ability of non-human primates are reviewed. The evidence suggests that there are important differences in the degree to which monkeys and chimpanzees detect same/different relations and construct classes that embody these relations. Data on matching to sample performance suggest that monkeys have a limited capacity for abstract representation of identity relations between individual objects. Chimpanzees, by contrast, not only detect similarities and differences between individual objects at a more abstract level than monkeys, but can also perceive same/different relations between pairs of objects. Further evidence for such cognitive differences between monkeys and chimpanzees comes from data on the development of spontaneous classificatory behavior. Monkeys develop first-order classifying. Their spontaneous spatial groupings are restricted to elements from one class. Chimpanzees progress from first-order to elementary second-order classifying. At 5 years of age they are capable of composing two contemporaneous sets in which objects are identical or similar within each set and different between sets.

Early sensorimotor development in chimpanzees (Pan troglodytes).

The cognitive and locomotor development of 4 chimpanzees (Pan troglodytes) during their 1st year of life was examined with Piagetian theory and method as paradigm. The infant chimpanzees progressed through the same 4 stages of development as babies do. However, the chimpanzees seemed less developed than babies in object exploration and in object-object combination. When chimpanzee early cognition is compared with that of other nonhuman primates, chimpanzees appear more advanced than gorillas, capuchins, and macaques in these same areas of cognition and similar to orangutans. A unitary explantation of the relative advances and delays in chimpanzee early cognition, which refers to the relation between rates of locomotor and cognitive development, is proposed.

Development of spontaneous classificatory behavior in chimpanzees (Pan troglodytes).

I investigated the development of spontaneous classificatory behavior in 5 chimpanzees (Pan troglodytes) tested at different ages and analyzed subjects' spontaneous constructive interactions with sets of logically structured objects. The results show that chimpanzees possess a natural capacity to react to similarities and differences among test stimuli and construct classes. The general progression of their classificatory development is very similar to that reported for human infants from 6 to 24 months. In both species, classification progresses from constructing single classes by different properties of objects to constructing single classes by similar or identical properties of objects. In addition, like humans, older chimpanzees spontaneously coordinate relations of similarities between sets and construct 2 class-consistent groupings. Chimpanzees' results are compared with those from a similar study with capuchins and macaques.

[Conditioning of active type avoidance in the rat : effect of the interval between conditioned stimulus and unconditioned stimulus]. / Condizionamento di evitamento di tipo attivo nel ratto: effetto dell-intervallo fra stimolo condizionato e stimolo incondizionato

Lengthening the time interval between the conditioned stimulus and the unconditioned stimulus increases the number of active avoidance conditioned responses in subjects that have been trained to a stable level of performance in many previous conditioning sessions. In the present research, rats chosen from a population specially selected for low rates of avoidance conditioning have been used. In addition to this characteristic, subjects were chosen for the exhibition of an apparent absence of retention from one day to another. The dependency of the number of conditioned responses on the time interval between conditioned stimulus and unconditioned stimulus may lead to wrong evaluation of the subjects' conditioning level. In fact, the level of conditioning may be attributed to either learning or memory processes when in many cases it is determined only by the latency time of the conditioned response. The conditioned response has no possibility of manifesting itself when its latency time exceeds in length the time interval between conditioned stimulus and unconditioned stimulus.

[Methods for grading the strength of passive conditioned avoidance reaction]. / Metodi per graduare la forza della reazione condizionata di evitamento di tipo passivo

Three methods for obtaining passive avoidance conditioned responses of different strength are described. The first method consists of delayed reinforcement, constituted by a foot-shock, in the conditioning trial. The second method corresponds to the "detention" procedure, through which the animal is kept in one part of the apparatus for some time, after the conditioning trial. The third method consists of using foot-shocks of different strength in the conditioning trial. This method, however, is not advisable in most cases, since it produces strong differences in the subjects' level of arousal after conditioning and therefore a different reactivity to the various treatments.