ERP components associated with an indirect emotional stop signal task in healthy and depressed participants.

Recent research has provided evidence to suggest that emotional stimuli may interfere with response inhibition, due to automatic capture of attention. Whilst previous studies have provided data regarding changes to event-related potentials (ERPs) in emotional Go/NoGo tasks, few studies to-date have utilized an emotional stop signal task (SST). Thirty-five participants were included in the study; 21 healthy controls and 14 depressed. An indirect emotional SST was employed, which consisted of the presentation of neutral, negative or positive visual images. The primary two-choice reaction time task required responding to frame colour (blue or green), whilst in 33% of trials an auditory stop signal was presented, with stop signal delay adjusted according to an adaptive tracking procedure. ERPs associated with both the primary visual task and the auditory SST were analysed using temporal principle components analysis (tPCA). In the primary task, reaction times were found to be slower for negative compared to neutral images. Stop signal reaction time (SSRT) was not found to be affected by image category or depression status. However, the NoGo-N2 component was found to be reduced for positive images, whilst the NoGo-P3 component was reduced for both positive and negative images in comparison to neutral images in the stop signal task. This effect was found to be enhanced for the depressed participants, indicating that inhibitory processing in the presence of positive stimuli may be inhibited to a greater extent in depressed individuals than in healthy controls. These findings provide further evidence for the ability of emotional valence and major depressive disorder to influence inhibitory processing.

Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease.

BACKGROUND/OBJECTIVES: Although loss of fat-free mass (FFM) and reduced muscle strength are highly prevalent in chronic obstructive pulmonary disease (COPD), only few data are available on the relationships of handgrip strength (HGS) and respiratory muscle strength with body composition in such disease. In particular, we aimed to assess whether raw bioelectrical impedance (BIA) variables were independent predictors of muscle strength in COPD patients, possibly more significant than anthropometric variables and BIA-based estimates of FFM. SUBJECTS/METHODS: Two hundred and thirty-seven COPD patients (161 males and 76 females) underwent respiratory, anthropometric, BIA, HGS and respiratory muscle strength (maximum inspiratory or expiratory pressure=MIP and MEP) measurements. Bioimpedance index (BI index=height square/whole-body impedance) and phase angle (PhA) were considered as raw BIA variables. FFM was estimated using three disease-specific BIA equations. RESULTS: In COPD patients a stronger correlation was observed between HGS and PhA compared to the ones with anthropometric variables or FFM estimates. Multiple regression analysis showed that combining BI index and PhA (plus age in male patients) accounted for 50.2% and 42.6% of the variance in HGS in male and female patients, respectively. Similarly, BI index and PhA emerged as predictors of both MIP and MEP in males, while in females MIP was related only to PhA and MEP only to BI index. CONCLUSIONS: Raw BIA variables are independent and valuable predictors of HGS and respiratory muscle strength in COPD patients. BI index and PhA could provide useful information for evaluating body composition and better assessing muscle strength and physical fitness in COPD.

Efficacy of standard rehabilitation in COPD outpatients with comorbidities.

A prospective study was performed to confirm the prevalence pattern of the most frequent co-morbidities and to evaluate whether characteristics of patients, specific comorbidities and increasing number of comorbidities are independently associated with poorer outcomes in a population with complex chronic obstructive pulmonary disease (COPD) submitted for pulmonary rehabilitation (PR). 316 outpatients (mean ± SD age 68 ± 7 yrs) were studied. The outcomes recorded were comorbidities and proportion of patients with a pre-defined minimally significant change in exercise tolerance (6-min walk distance (6MWD) +54 m), breathlessness (Medical Research Council (MRC) score -1 point) and quality of life (St George's Respiratory Questionnaire -4 points). 62% of patients reported comorbidities; systemic hypertension (35%), dyslipidaemia (13%), diabetes (12%) and coronary disease (11%) were the most frequent. Of these patients, >45% improved over the minimum clinically important difference in all the outcomes. In a logistic regression model, baseline 6MWD (OR 0.99, 95% CI 0.98-0.99; p = 0.001), MRC score (OR 12.88, 95% CI 6.89-24.00; p = 0.001) and arterial carbon dioxide tension (OR 1.08, 95% CI 1.00-1.15; p = 0.034) correlated with the proportion of patients who improved 6MWD and MRC, respectively. Presence of osteoporosis reduced the success rate in 6MWD (OR 0.28, 95% CI 0.11-0.70; p = 0.006). A substantial prevalence of comorbidities in COPD outpatients referred for PR was confirmed. Only the individual's disability and the presence of osteoporosis were independently associated with poorer rehabilitation outcomes.

Role of hyperinflation vs. deflation on dyspnoea in severely to extremely obese subjects.

AIM: To test the hypothesis that obese individuals may either hyperinflate or deflate the lung when exercising. In both cases breathlessness is an inescapable consequence. METHODS: Ventilatory variables, end-expiratory lung volume and end-inspiratory lung volume, and dyspnoea score (Borg scale) were studied in 20 class II-III obese subjects and 14 healthy controls during incremental symptom-limited cycle exercise. RESULTS: Ventilation increased with increasing work rate, in obese and in control subjects; most obese subjects had to increase end-expiratory lung volume to escape from flow limitation; in contrast, like controls, a few subjects deflated the lung on heavy-to-peak exercise. Dyspnoea was equal in degree at anaerobic threshold and peak exercise in obese as in control subjects, and in obese who hyperinflated as in those who deflated the lung. In particular, end-expiratory lung volume at baseline (r = -0.84, P = 0.04) was negatively correlated with changes in Borg score in obese who did not hyperinflate: the lower the former the higher the latter. On the other hand, tidal volume (r = 0.54, P = 0.045) and decrease in inspiratory reserve volume (r = 0.59, P = 0.028) were positively correlated with the Borg score in obese subjects who hyperinflated. No other independent variable correlated with the Borg score. CONCLUSIONS: We conclude that not all obese subjects had to increase end-expiratory lung volume on heavy-to-peak exercise. Changes in dyspnoea for unit changes in ventilation were similar in obese who did hyperinflate as well as in those who did not, suggesting that the increase in respiratory neural drive, associated with an increase in ventilation, is an important source of dyspnoea in obese as well as in control subjects.

[Abdominal actinomycosis and retroperitoneal fibrosis. Considerations on a clinical case]. / Actinomicosi addominale e fibrosi retroperitoneale. Considerazioni su di un caso clinico.

Abdominal actinomycosis is a rare disease which often resembles an acute suppurative infection or/and abdominal tumour causing abscesses, fistulas and massive fibrosis. The preoperative diagnosis is difficult and surgical exploration is always needed because of major involvement of visceral and retroperitoneal structures. The disease can be diagnosed with certainty only on the basis of findings of bacterial colonies in histopathologic sections and typical sulphur grains in secretions from fistulas. The authors describe a case of abdominal actinomycosis involving the caecum and right colon, causing extensive retroperitoneal fibrosis and a fistula tract with an external cutaneous orifice at the level of the right iliac crest. These features resembled an acute appendicitis at first, and several surgical explorations were required before a correct diagnosis could be achieved. Abdominal actinomycosis can be treated by simple administration of antibiotics. With a correct diagnosis, medical therapy alone has proved effective in a substantial percentage of patients, thus avoiding the need for surgery, if important visceral or retroperitoneal structures are not involved. Abdominal actinomycosis always requires a careful differential diagnosis and must be considered in patients presenting abdominal tumours associated with abscesses and/or fistulas since early and efficient medical therapy, along with surgical intervention, where necessary, can lead to definitive recovery. Useful diagnostic tools are abdominal CT and selective FNAB.

Diversity and extinction in a lattice model of a population with fluctuating environment.

I study a lattice stochastic model of a mutating population sensitive to the influence of a fluctuating environment. The dynamics of the population stressed by linear and periodic disturbances is investigated. In agreement with previous studies of nonspatial models, I find a critical rate of change in the environmental variable beyond which the population becomes extinct, and I show explicitly that the presence of space in the model can affect the critical rate. Further, I study the diversity defined as the total number of different cell types present in the lattice as a function of intensity and frequency of the environmental disturbance. If the disturbance becomes fast and intense the population becomes extinct. Interestingly, I find that for moderate stresses the diversity increases with the intensity and frequency of disturbance. The transition between large diversity and extinction is sharp, implying that the populations with high diversity are generally the ones closest to the extinction threshold. When subjected to colored noise of increasing intensity the system grows in diversity but at the same time is more likely to become extinct.

Chronic bronchitis: reflex on the pulmonary circulation.

Chronic obstructive pulmonary disease (COPD) is characterized by lower alveolar oxygen content and hypoxia. Hypoxia itself is able to evoke a vascular reflex in a pulmonary vasoconstriction, the explanation of which is, in part, unknown. Pulmonary vasoconstriction leads to different degrees of pulmonary artery pressure (PAP) increase which statistically suggests that the higher the PAP, the poorer the survival rate. Many substances are involved in the vascular homeostasis. An important role is played by cyclooxygenase as well as lipoxygenase pathways metabolites, the antagonists of which have been extensively used in the treatment of pulmonary hypertension in subjects suffering from COPD. An even more important role is played by the endothelium. It is able to modify its metabolism towards the production of substances (e.g., endothelin, EDRF, etc.) which are able to negatively influence the vascular tone. Complete identification of such substances, when possible, would allow us to have a better understanding of the complexity of the mechanism which controls the pulmonary vascular district. In this direction we could hopefully look forward to the detection of specific new drugs able to improve the management of the disease by preventing it from worsening to that extent which statistically and drastically correlates with the worst prognosis.

General vs local anesthesia. Effect on bronchoalveolar lavage findings.

Bronchoalveolar lavage (BAL) can be performed with the patient undergoing either local or general anesthesia (GA). This study investigates whether the type of anesthesia affects BAL fluid and cell recovery. Eighty patients, were selected for study. Fluid recoveries were significantly less in the GA group for both the bronchial and alveolar lavages. The differences were confirmed for BAL fluid recovery in a subsequent group of 120 unselected patients. Bronchoscope size did not appear to affect recovery, nor did anesthesia time; BAL fluid recovery from patients with respiratory failure who were intubated and mechanically ventilated was similar to that in the GA group, suggesting that lower recovery rates may be due to mechanical ventilation. The BAL fluid cell counts were related to fluid recovery, but airway neutrophils represented a higher percentage of BAL lavage fluid cells in the GA lavages, independent of differences in the volume of lavage fluid recovered.

Left ventricular diastolic function with epirubicin therapy: an echodoppler study.

Thirty patients undergoing epirubicin therapy for primary lung cancer were studied by echocardiography and Doppler echocardiography. 2 D ejection fraction (EF) and Doppler left ventricular filling parameters (peak E, peak A, E/A ratio) were calculated before and after the completion of therapy. No differences in the mean values of these parameters were observed. However, 6 out of 30 patients (20%) showed left ventricular filling abnormalities; in 2 of them a slight reduction of EF was also noted. These abnormalities seem to be dose related. A longer term prospective study will be required to evaluate whether these findings are irreversible and to establish the clinical implications of our observations.

[Effects of transdermal nicotine as an adjunct in smoking cessation therapy. A double-blind randomized study controlled with placebo]. / Effetti del rilascio transdermico di nicotina come terapia di supporto per lo svezzamento dal fumo di sigaretta. Uno studio randomizzato in doppio cieco con controlli trattati con placebo.

To assess the smoking cessation efficacy of transdermal nicotine patches an adjunct to low-intervention therapy, we conducted a double-blind, placebo-controlled trial in 158 smokers. Participants were randomly assigned to one of the following three study regimens that required daily application of two 15-cm2 patches: 1) 24-hour nicotine delivery, 2) nicotine delivery during wakeful hours only, and 3) placebo. The impact of the three regimens on smoking cessation rates and tobacco withdrawal symptoms was examined. During the last 2 weeks of the trial, 39% of the 24-hour nicotine regimen delivery group, 35% of those on wakeful hour nicotine regimens, and 13.5% of the placebo treatment group achieved abstinence. Self-reported quit rates for the two nicotine patch-wearing regimens, as compared with that for the placebo group, continued to be significantly higher at 6 months. Moreover, compared with placebo, the transdermal nicotine patches significantly reduced tobacco withdrawal symptoms during the first few weeks of quitting. The differences in quit rates and tobacco withdrawal symptoms between the to active groups were not statistically significant. The patches were well tolerated both topically and systemically. We concluded that transdermal nicotine, when used as an adjunct to low-intervention therapy, significantly reduced tobacco withdrawal symptoms and enhanced smoking cessation rates.

[The use of recombinant interferon alfa-2b in the follow-up of patients laryngectomized for advanced stage carcinoma]. / Utilizzo dell'interferone alfa 2b ricombinante nel follow-up di pazienti laringectomizzati per carcinoma in stadio avanzato.

The AA. report the results of an experimental investigation on 60 subjects who underwent surgery for advanced stage carcinoma of the glottic larynx and treated with alpha 2b recombinant interferon at the dosage of 3,000,000 ul three times a week, before a six-months follow-up. The patients were examined also as to the respiratory functionality and the monitoring of some biological markers of cancers (CEA, TPA, Ca 125, Ca 15.3). The AA. support the satisfactory tolerability of alpha interferon which showed expected side effects; these effects were controlled by the symptomatic treatment, and their metabolic parameters as well as the ones related to the respiratory functionality kept always their valves in the average. The monitoring of biological markers, seems to support a real usefulness in the treatment with alpha interferon, even if a statistically meaningful record couldn't be noticed.

[The usefulness of monoclonal antibodies in the diagnosis of lung carcinoma]. / Utilità degli anticorpi monoclonali nella diagnosi di carcinoma polmonare.

Monoclonal antibodies detection represented a turning point in field of immunological and biological research. Their application has rapidly extended at immunopathology as well as immunodiagnosis and immunotherapy fields. In oncological field monoclonal antibodies has proved a great usefulness in diagnosis of several districts neoplasm. Monoclonal antibodies are utilized in differential diagnosis of different histologic types of lung cancer; in bone marrow metastasis early detection; and, experimentally, in "in vivo" diagnosis of lung cancer via peripheral blood sample examination. Authors relate about more recent literature about this specific topic.

[Bronchoalveolar lavage in the diagnosis of cancer]. / Il lavaggio broncoalveolare nella diagnosi di cancro.

Bronchoalveolar lavage (BAL) is a widely used clinical procedure. To determine if BAL could provide useful information in the detection of cancer, 850 lavages from 421 patients having BAL for a variety of indications, 50 lavages in patients with Hodgkin's disease and 20 patients with breast cancer undergoing bon marrow transplant were reviewed. BALs were performed with the technique established by Rennard and coll. in which 5 successive 20 cc aliquots are infused in a wedge position. The return from the first aliquot was processed separately from the subsequent four aliquots. Diff-Quick stained cytocentrifuge preparations and Papanicolaou stained millipore filter preparations were analyzed. Thirty-five patients had biopsy-proven lung cancer. In 24 (68.6%) of these, BAL revealed cells diagnostic of malignancy. There were no false positives. Six out of 50 Hodgkin's disease patients had Reed Sternberg cells detected on BAL, and 7/20 breast cancer patients had malignant cells on BAL prior to chemotherapy. In summary, the routine performance of BAL, an easily performed and well-tolerated procedure, may prove to be useful in the routine assessment of patients for cancer.

[Thymidine kinase as a biological marker in neoplasms of the lung and mediastinum]. / La timidina-kinasi come marcatore biologico delle neoplasie del polmone e del mediastino.

Thymidine kinase (TK) is a biological marker recently used in diagnosis and monitoring of pulmonary and mediastinal malignant neoplasms. Authors report more recent clinical evidences of literature and, in the meanwhile, they report their personal experiences about a 20 patients group suffering of lung cancer and Hodgkin disease. Their study demonstrates a good sensitivity of TK as biological marker of SCLC and a lower sensitivity in case of NSCLC and Hodgkin disease. It has been possible to contribute to establishment of normal range values, on account of 10 healthy volunteer group blood sample assays.

Doppler echocardiographic assessment of left ventricular diastolic function in patients with primary lung cancer treated with doxorubicin.

Eighteen patients were examined by Doppler echocardiography before and after treatment with doxorubicin (DXR). Early left ventricular filling rate decreased from 66 +/- 15 to 51 +/- 10 cm/sec whereas late filling rate increased from 48 +/- 12 to 61 +/- 9 cm/sec (p less than 0.05) with inversion of the E/A ratio suggesting an impairment of left ventricular diastolic function; conversely no significant changes were found in systolic function indexes. These results suggest that follow-up of patients treated with DXR must include left ventricular diastolic function studies. Doppler echocardiography can be successfully used to detect the presence of diastolic abnormalities.