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The aim of our ongoing study is to investigate the effectiveness of Zonisamide augmentation to Duloxetine in partial and non-responder patients in course of Unipolar Major Depressive Episode.
35 outpatients will be enrolled in a 12-weeks open-label study including both genders, 18 to 65 years old subjects. Unipolar Major Depressive Episode diagnosis will be performed at screening time using “Structured Clinical Interview for DSM-IV-Axis-I Disorders- Italian 1996 version” (SCID-I, First et al., 1996) and by a ≥14 total score for the “Quick Inventory of Depressive Symptomathology-Self Rated” (QIDS-SR, Rush et al., 2003). Patients will be repeatedly evaluated during the course of the study using a wide range of mood and anxiety rating scales and monitoring biomarkers such as electroretinogram b-wave amplitude, interleukins, flogosis and BDNF factors etc. At week 6, Duloxetine partial/non responders will be augmetated to Zonisamide and further evaluations of mentioned markers will be repeated. A “Fisher-test” or χ² analysis will be performed at the end of the study. Expected p will be ≤ 0,005.
We expect Zonisamide augmentation to be an effective treatment for SNRI-resistant Major Depression.
The aim of this preliminary study is to assess, in a sample of patients with Coronary Heart Disease (CHD), the specific association between depressive symptoms and systemic inflammation.
Sixty-One inpatients with CHD, 31 Unstable Angina and 28 Myocardial Infarction, participated in the study. The plasma levels of C Reactive Protein were measured using Dade Behring’s High Sensitivity CRP assay (hs-CRP) at T0, T30 and T90.
At the same timings, they were tested by an examiner, unaware of their diagnosis, with a psychometric battery (SCL90-R, HDRS, MADRS, BDI, QlesQ).
The elevation of hs-CRP occurs during the whole observation period, with maximum significance at T90 (p = 0,031).
A multivariate analysis at T0 indicates a statistical correlation between SCL90-R scores and hs-CRP levels (p = 0.02).
The SCL90-R is also associated with the risk of further cardiac events (p = 0.013).
Also the BDI could be useful as a prognostic factor (p = 0.026).
We found a trend towards correlation between CRP values and depressive symptoms, but it never reaches statistical significance for the other scales.
The feelings of loss and the fear of death, related to the environmental and emotional situation of the hospitalization, may prevail in the acute phase of CHDs.
Some patients may overcome this reactive depression, while others may exhibit a biological depression, related to the high level of CRP and thus to an increased risk of re-infarction and other coronary events.
The aim of this study was to evaluate some Children’s Depression Inventory (CDI) psychometric properties and the prevalence of depressive symptoms in an unselected Italian sample of two hundred and eighty-four children aged 8 years. The CDI internal consistency was adequate (Cronbach’s alpha: .80). The mean and standard deviation of CDI and the percentage of children at risk of depression (10.6%) in this sample are consistent with the figures reported by other studies carried out in northern Europe and North America. There were differences in gender and socioeconomic level in that boys scored higher than girls, and in the lower socioeconomic level there were more children at risk of depression. Ten items best discriminated children at risk for depression with 94% of correct classification. Most of these items consisted of observable signs. It is suggested that the CDI has noteworthy consistency across samples of relatively different cultures, that it can reliably be employed in the assessment of young children, and that observable signs outnumber internalizing symptoms of depression among children at risk.
We assessed the lifetime prevalence of major depression in a sample of 145 patients with a current diagnosis of panic disorder and/or social phobia. The prevalenee tended to be higher in patients with both diagnoses. Patients with panic disorder and social phobia had an earlier onset of the former condition. Familial rates of panic were higher in patients with pure panic disorder, and the rate of depression was increased in relatives of probands who had a lifetime diagnosis of depression.
it is well established that adversities and GRIN2B genetic variants (encoding NMDAR GluN2B subunit) are independently associated with behavioral and cognitive impairments in childhood. However, a high proportion of children exposed to risk have good, long-term outcomes.
for the first time, we explored how environmental adversities and GRIN2B genetic variants influence children's cognitive abilities and behavioral problems.
we adopted a gene-by-environment interaction (GxE) approach, to identify children with an unfavorable developmental outcome with the potential of better informing the understanding of susceptibility to developmental disorders.
6 SNPs of GRIN2B were genotyped in 625 children aged 6-11 years from an Italian community-based sample. The interactive effect of GRIN2B variants with 4 measures of adversities (low socioeconomic status - SES, preterm delivery, maternal smoking, absence of breastfeeding) was investigated upon cognitive abilities (vocabulary, block design, forward/backward digit spans of Wechsler's Intelligence Scale, and Rey Figure test) and parents-rated behavioral problems (Child Behavior Checklist/6-18).
rs5796555 x gestational age interaction (p= .00145) influenced cognition, with lower IQ memory among children in the ‘A/A genotype and ≤ 36 gestational age’ group, compared to all other groups. Rs2268119 x SES interaction (p= .00008) influenced behavior, with more attention problems among children in the ‘either A/T or T/T genotype and low SES’ group, compared to all other groups.
GRIN2B targets children with the worst outcome in memory and attention functioning among children exposed to environmental adversities. Identification of children with the highest risk may prompt cost-effective preventive/treatment strategies.
Valerian officinalis roots extract is a popular medication for insomnia and anxiety treatment. Sedative effect of Valerian is mainly attributed to the modulation of gabaergic transmission, but its pharmacodynamics has not been fully elucidated.
To investigate the acute effects of Valerian Officinalis extracts intake on corticoexcitability as measured by TMS.
To obtain further data on Valerian pharmacodynamics.
Twelve healthy volunteers participated in a double-blind randomized crossover placebo-controlled study. They were required to take either 900 mg of Valerian officinalis extract (valerenic acid 0.8%) or placebo. Focal TMS of the hand area of left motor cortex was used to test Resting motor threshold (RMT), Motor evoked potentials (MEPs) amplitude and silent period duration (SP). We also tested Short-interval Intracortical Inhibition (SICI), Intracortical facilitation (ICF), Short and Long afferent Inhibition (SAI and LAI). All parameters were investigated at baseline, 1 hour and 6 hours after drug intake. After a 3-week washout period the subjects switched to the alternate arm of the study.
A mixed RMANOVA revealed a significant main effect of “time” [F(1,22) = 4.03, P = 0.02] and a significant “treatment × time” interaction [F(1,22) = 6.3, P = 0.003]. Post-hoc analysis indicated that the amount of ICF was significantly reduced 1 hour after Valerian intake (P = 0.01) returning to baseline values after 6 hours. No significant changes between the Valerian and placebo groups were observed for the other parameters investigated.
The modulation of ICF induced by Valerian officinalis is likely due to glutamatergic antagonism and might underlie the anti-anxiety therapeutic effects.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Pediatric bipolar disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders, with high levels of morbidity and disability and with a great risk of suicide.
While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified.
To assess the prevalence, demographics, clinical correlates and course of these euphoric versus irritable pediatric mania.
Systematic review of the available studies assessing the phenomenology, course and outcome of pediatric mania.
Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age.
Severe irritability is the most common presentation of abnormal mood described in children with bipolar disorder. Longitudinal studies of samples with irritable versus elated mood presentation and chronic versus episodic course may help clarify whether these are factors predicting different long-term course, treatment-response and outcome of pediatric onset bipolar disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Methane contributes substantially to global warming as the second most important anthropogenic greenhouse gas. Radiocarbon (14C) measurements of atmospheric methane can be used as a source apportionment tool, as they allow distinction between thermogenic and biogenic methane sources. However, these measurements remain scarce due to labor-intensive methods required. A new setup for the preparation of atmospheric methane samples for radiocarbon analysis is presented. The system combines a methane preconcentration line with a preparative gas chromatography technique to isolate pure methane samples for a compound-specific radiocarbon analysis. In order to minimize sample preparation time, we designed a simplified preconcentration line for the extraction of methane from 50 L atmospheric air, which corresponds to 50 µg C as required for a reliable 14C analysis of methane-derived CO2 gas measurement with accelerator mass spectrometry (AMS). The system guarantees a quantitative extraction of methane from atmospheric air samples for 14C analysis, with a good repeatability and a low processing blank. The setup was originally designed for the measurement of samples with low methane concentrations, but it can also be adapted to apportion sources from environmental compartments with high methane levels such as freshwaters or wetlands.
Introduction: Procedural skills training varies significantly across Canadian medical schools, and there is currently no standardized assessment tool to evaluate its benefits. This project aims to develop a curriculum that teaches 2nd-year medical students to perform and evaluate procedural skills. The goals of this program include decreasing anxiety, increasing confidence, and achieving competence for students and also allowing staff to judge the appropriate level of supervision when delegating learners to perform basic procedures in the team setting. Our curriculum incorporates, near-peer teaching as well as near peer formative assessment. Methods: Each of the twelve 2nd year participants completed a State Trait Anxiety Inventory and self-reported confidence questionnaire related to procedural skills. Students participated in four sessions taught by expert physicians over a five month period. A new skill was taught at each monthly workshop and an opportunity to practice previously taught skills was provided. Skills were assessed in a skills integration simulation OSCE, and the anxiety and confidence questionnaire was repeated. Results: Students who completed this pilot program showed a significant decrease in mean anxiety state (2.48 vs 1.74, p-value <0.001), while the control group did not (p-value = 0.408). When assessing confidence, students who completed this program showed increased self-assessed knowledge and confidence in each of the program's assessed skills. An increased level of competency was achieved in each skill by each student as assessed by the expert physicians. Conclusion: There is evidence to suggest that implementation of this procedural skills training model within the Canadian medical school curriculum may improve student anxiety, confidence, and competency for success in clerkship and could be the foundation for developing milestones for EPAs.
Introduction: In order to better characterize procedural skills curricula in Canada, a national survey was conducted. The objectives of the survey were: (i) to characterize procedural skills education currently employed in pre-clerkship and clerkship curricula; (ii) to determine what skills physician-educators think medical students should know upon graduation; and (iii) to identify physician-educator perceptions regarding the development of pre-clerkship procedural curriculum. Methods: A web-based survey was distributed to 201 clinician-educators across Canada's 17 medical schools. Respondents were directed to an individualized survey based on their self-identified roles at their institution. Respondents were asked demographic questions, what procedural skills are being taught and in what setting at their institution, and their opinions on the value of a pre-clerkship procedural curriculum. Results: From the 17 school's surveyed, 12 schools responded, with 8 schools responding “yes” that they had a clerkship procedural curriculum. For a pre-clerkship procedural curriculum, only 4 schools responded “yes”. The 5 of the top 10 procedurals skills identified that medical students should know upon graduation, in order, are: IV Access, Airway Management/Ventilator Management, Local anesthesia/field block, Casting, Spontaneous Vaginal Delivery. On a Likert scale, clinician-educators strongly supported a pre-clerkship procedural curriculum (median = 4.00/5.00, mode = 5.00/5.00), and they believed it would decrease anxiety (median = 4.00/5.00), increase confidence (median = 4.00/5.00), and increase technical ability (median = 3.00/5.00) in incoming clerks. Conclusion: Across Canada, the state of undergraduate medical education procedural skills education is inconsistent. With the identification of the Top 10 procedural skills medical students should know upon graduation, the learning objectives of a formal curriculum can be developed. With overwhelming support from physician-educators, a formal pre-clerkship procedural curriculum is poised to redefine the landscape of procedural care for a whole new generation of physicians.
The study of dwarf spheroidal galaxies (dSph) is of great importance to understand galaxy evolution at the low-mass end. In the Local Group the majority of them are found to be satellites of the Milky Way or M31. The closest ones have been studied in great detail, however it is hard to constrain if their present-day observed properties are mainly caused by internal or environmental mechanisms. In order to minimize these effects and gain an insight into their intrinsic properties, we are studying two of the three isolated dSph galaxies in the Local Group, i.e. Cetus and Tucana, located far beyond the virial radius of the Milky Way and M31. We present here results from our recently published analysis of Cetus (Taibi2018) and preliminary results for Tucana (Taibi et al. in prep.).
Understanding the peculiar properties of Ultra Diffuse Galaxies (UDGs) via spectroscopic analysis is a challenging task that is now becoming feasible. The advent of 10m-class telescopes and high sensitivity instruments is enabling the gathering of high quality spectra even for the faintest systems. In addition, advances in the modelling of stellar populations, stellar libraries, and full-spectral fitting codes are allowing the recovery of the stellar content shaping those spectra with unprecedented reliability. In this contribution we report on the extensive tests we have carried out using the inversion code STECKMAP. The similarities between the Star Formation Histories (SFH) recovered from STECKMAP (applied to high-quality spectra) and deep Colour-Magnitude diagrams fitting (resolved stars) in two Local Group dwarf galaxies (LMC and LeoA) are remarkable, demonstrating the impressive performance of STECKMAP. We exploit the capabilities of STECKMAP and perform one of the most complete and reliable characterisations of the stellar component of UDGs to date using deep spectroscopic data. We measure radial and rotation velocities, SFHs and mean population parameters, such as ages and metallicities, for a sample of five UDG candidates in the Coma cluster. From the radial velocities, we confirm the Coma membership of these galaxies. We find that their rotation properties, if detected at all, are compatible with dwarf-like galaxies. The SFHs of the UDG are dominated by old (∼ 7 Gyr), metal-poor ([M/H] ∼ -1.1) and alpha-enhanced ([Mg/Fe]∼ 0.4) populations followed by a smooth or episodic decline which halted ∼ 2 Gyr ago, possibly a sign of cluster-induced quenching. We find no obvious correlation between individual SFH shapes and any UDG morphological properties. The recovered stellar properties for UDGs are similar to those found for DDO 44, a local UDG analogue resolved into stars. We conclude that the UDGs in our sample are extended dwarfs whose properties are likely the outcome of both internal processes, such as bursty SFHs and/or high-spin haloes, as well as environmental effects within the Coma cluster.
Palatal reconstruction following maxillectomy is a surgical challenge, and a nasoseptal flap is a feasible approach. This paper reports the first known successful clinical case of a nasoseptal pedicle flap applied for the reconstruction of maxillary bone following hemi-maxillectomy.
This report describes hemi-maxillectomy in a 60-year-old Italian male diagnosed with stage IV squamous cell carcinoma of the left maxilla. Endoscopic transnasal extended medial maxillectomy was performed, followed by a transoral modified midfacial degloving technique for removal of the maxillary bone. The contralateral nasoseptal pedicle flap was used to reconstruct the defect. The case was followed up prospectively for the assessment of flap reception and healing.
The locally accessible nasoseptal flap is a viable alternative for palatal reconstruction; therefore, a second surgical procedure with its associated donor site morbidity can be avoided. Large-scale studies may help in establishing the cosmetic and functional outcomes.
Understanding the properties of dwarf galaxies is important not only to put them in their proper cosmological context, but also to understand the formation and evolution of the most common type of galaxies. Dwarf galaxies are divided into two main classes, dwarf irregulars (dIrrs) and dwarf spheroidals (dSphs), which differ from each other mainly because the former are gas-rich objects currently forming stars, while the latter are gas-deficient with no on-going star formation. Transition types (dT) are thought to represent dIs in the process of losing their gas, and can therefore shed light into the possible process of dwarf irregulars (dIrrs) becoming gas-deficient, passively evolving galaxies. Here we present preliminary results from our wide-area VLT/FORS2 MXU spectroscopic survey of the Phoenix dT, from which we obtained line-of-sight velocities and metallicities from the nIR Ca II triplet lines for a large sample of individual Red Giant Branch stars.
In this review I will discuss the current status on determinations of the dark matter content and distribution in Milky Way dwarf spheroidals, for which the available data-sets allow the application of sophisticated mass modeling techniques.
This paper provides for the first time data on age and growth of Remora osteochir, also describing its sagittal otolith together with other biological and ecological aspects. Overall, 236 individuals of marlin sucker were collected in the southern-central Mediterranean Sea, from 2008 to 2009. All samples were hosted by the Mediterranean spearfish, Tetrapturus belone, caught by surface longline and harpoon. Analysis of gonads identified a reproductive peak during June and July. The estimated growth parameters according to the von Bertalanffy equation were: L∞ = 27.37 cm TL, k = 0.248 year−1, t0 = −1.36 year. The length-weight relationship, computed by using eviscerate weight, highlighted an isometric growth for both sexes, as supported by the other results: similar sizes, growth curves and disc length-total length relationship.
We improve the efficiency of a bottom-emitting red phosphorescent organic light emitting diode (OLED) by the suppression of wave-guided modes in the bottom contact. ITO as bottom contact layer has been substituted by a thin Ti/Au layer. Electromagnetic simulation results of both devices predict the absence of TE polarized guided contact modes by the use of 10 nm Au as bottom electrode. We measured an improved outcoupling of light which overcompensates absorption losses of the Ti/Au layer in the measured emission cone. By the use of 1 nm Ti as undercoat, a continuous Au film of 8 nm thickness could be realized with an improved transmittance for long wavelengths (λ > 550 nm). As a consequence of fewer lateral guided modes, the external quantum efficiency (EQE) has been enhanced from 11.5 % of the standard device to 14 % of the device with the Ti/Au electrode.
We present results of theoretical and experimental studies of whispering-gallery modes in optical microdisk resonators interacting with subwavelength dielectric particles. We predict theoretically and confirm by direct observations that, contrary to the generally accepted models, both peaks of the particle-induced doublet of resonances are red shifted with respect to the position of the initial resonance.