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Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting.
This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate.
There were 12 patients from 2013 to 2020, aged 0.07–50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed.
The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis.
Self-disorders (SDs) have been described as a core feature of schizophrenia-spectrum disorders. Previous studies conducted on heterogeneous clinical adult and adolescents samples demonstrated that SDs aggregate selectively in the schizophrenia spectrum disorders compared to other disorders.
To examine the specificity of SDs for schizophrenia spectrum disorders in adolescent inpatient sample.
Fifty-five adolescent inpatients admitted to the Child Psychiatry Unit at the Sapienza University in Rome were assessed for psychopathology using Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), Structured Interview for Prodromal Syndromes (SIPS/SOPS),Examination of Anomalous Self-Experiences (EASE), Multidimensional Anxiety Scale for Children (MASC), Calgary depression scale for schizophrenia (CDSS)
Patients, aged 14-18 years, were divided in four diagnostic groups: schizophrenia spectrum disorders (5 pts.), mood disorders (19 pts.), anxiety disorders (27 pts.) and other disorders (4 pts.). Frequency of self-disorders was different among the 4 groups. Including patients schizotypal personality disorder in the schizophrenia-spectrum disorder group, the difference is still significant. Mann-Whitney U test shows no differences between EOP and UHR patients in SD. Furthermore, correlations between EASE total score and Calgary and MASC total scores were significant.
Our results confirm the specificity of SDs for schizophrenia spectrum disorders and also the belonging of schizotypal personality disorder to schizophrenia-spectrum.
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.
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.
Definitions of therapeutic outcome in schizophrenia include both maintained symptomatic remission and appropriate functioning. In schizophrenic patients insight is associated with positive (better compliance and recovery) and negative outcomes (depression, low self-esteem and quality of life).
To evaluate the correlation between insight and recovery in schizophrenic patients according to criteria for both symptomatic and functional remission.
To demonstrate how high levels of insight are positively correlated with recovery.
70 schizophrenic patients who switched or started a new pharmacological treatment were tested using Schedule for the Assessment of Insight, Positive and Negative Syndrome Scale, Short Form questionnaire, Psychological General Well-Being Index and Global Assessment of Functioning scale at baseline, 12 and 24 months.
After 2 years, 50% of the subjects achieved symptom remission and 25.5% had adequate social functioning for 2 years or more. Only 12% of subjects met full recovery criteria for 2 years or longer. Patients in remission showed a better outcome on all PANSS subscales, an improvement in social functioning and in subjective well-being. No differences in terms of Quality of life between groups. All patients in recovery showed an improvement of insight, especially those treated with SGA. Recovery after 2 years was predicted by female sex, higher age, pre-morbid social adaptation and low level of negative symptoms at baseline.
The results indicate that only 12% of patients achieve recovery and suggest that social functioning, compliance, type of antipsychotic and improvement in insight levels represent important predictors for recovery.
Comorbidity between depression and diabetes is a particularly common condition as underdiagnosed. Individuals with diabetes have about a 2-fold increased risk for major depression, affecting one of every 10 diabetic patients. Biological and psychosocial variables represent risk factors. Comorbidity with depressive disorders led to a worsening of diabetic symptoms, greater functional impairment and worse quality of life.
To evaluate the relationship between depression and HbA1c levels, biological and socio-demographic factors, quality of life and diabetes distress.
To demonstrate how depression in diabetic patients results in a worsening of clinical, treatment and social outcome.
72 patients with diabetes were recruited and matched into two groups (depressed, non-depressed). Socio-demographic data and HbA1c levels were collected. Diabetics patients were tested using Hamilton Depression Scale, Quality of Life Index and Diabetes Distress Scale (DDS).
Depressed diabetic patients had about a 4-fold increased risk for higher HbA1c levels (≥ 8%) (OD= 4.375). Depression was more prevalent in women than men (p< 0.05) and in retired (p < 0.05). Lower education level was significantly correlated with depression in comorbidity with diabetes (p < 0.05). Quality of life in depressive diabetic patients was poorer than patients without depression (p < 0.01). Depressed group showed higher levels in DDS particularly in Emotional Burden (p < 0.01), Regimen Distress (p < 0.01) and Interpersonal Distress (p < 0.05).
Depression in diabetic patients is significantly related to biological and socio-demographic factors and worse quality of life. Depressed demonstrates higher distress due to diabetes.
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.
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.
This research work deals with chlorite-vermiculite mixed-layer stability under hydrothermal and metamorphic conditions. We used as a case study a clayey flysch unit cropping out in an active geothermal area near to a Recent volcano (Mt. Amiata) in central Italy. The geothermal gradient is higher than the world average and temperatures over 100°C can occur at less than 1 km depth. The mineralogical data, obtained from X-Ray Power Diffraction (XRPD) analysis of clay samples from the same geologic unit, show that the primary anchimetamorphic mineral assemblage (illite, chlorite, illite-smectite mixed layers) is accompanied by secondary phases, such as chlorite-vermiculite mixed-layers and calcite. Reactive flow modelling was used to outline a realistic water-rock (W/R) interaction process able to generate the new minerals. In the numerical simulation, the pristine shale was made to react with a local thermal spring, at an estimated but realistic carbonate reservoir temperature. The simulation predicts that, at a temperature of 120°C, clinochlore dissolves and vermiculite crystallizes, a good proxy of the chlorite-vermiculite crystallization process. Under low water/rock conditions the proportions of the clay minerals (illite, chlorite, smectite and vermiculite) are comparable with the analytical results. The simulation also shows that temperatures higher than 120°C enhance the vermiculite formation. We conclude that the chlorite-vermiculite mixed-layers formed in the recent past due to the upflow of thermal water which permeated the flysch unit. This result indicates that the alteration of the clayey cap-rocks of geothermal reservoirs is enhanced by the interaction with geothermal fluids, and can be used as a prospecting tool.
This study characterizes the effects of fluid migration into a predominantly shale cover which seals the active geothermal system of Mt. Amiata (Tuscany, Italy). During Alpine orogenesis the shale unit was affected by regional metamorphism at the limit of the diagenesis-anchizone. Subsequently, the phyllosilicate clay minerals of the shales underwent significant alteration at diagenetic temperatures (175±25ºC as determined by the geochemical model) by the pervasive circulation of fluids activated by the geothermal field. The overall mineralogical assemblages indicate that the main transformations consisted mostly of destabilization of illite and formation of kaolinite together with large amounts of I-S mixed layers, with higher smectite content and decreased Reichweite I-S ordering (from R3 to R1) with respect to the original, unaltered phases. Application of computer modelling indicates that the circulation of CO2-rich geothermal fluids into the shale unit was responsible for the observed phyllosilicate clay mineral transformations.
We agree with Lake and colleagues on their list of “key ingredients” for building human-like intelligence, including the idea that model-based reasoning is essential. However, we favor an approach that centers on one additional ingredient: autonomy. In particular, we aim toward agents that can both build and exploit their own internal models, with minimal human hand engineering. We believe an approach centered on autonomous learning has the greatest chance of success as we scale toward real-world complexity, tackling domains for which ready-made formal models are not available. Here, we survey several important examples of the progress that has been made toward building autonomous agents with human-like abilities, and highlight some outstanding challenges.
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.
Acute agitation is a nonspecific term applied to an array of syndromes and behaviors. It is frequently defined as an increase in psychomotor activity, aggression, disinhibition/impulsivity, and irritable or labile mood. Etiologies of acute agitation include medical disorders, delirium, substance intoxication or withdrawal, psychiatric disorders, and medication side effects. Treatment of acute agitation requires both environmental and pharmacologic intervention. Patients should be calmed with sedating agents early in the course of treatment, allowing for diagnostic tests to take place. Failure to correctly diagnose causes of agitation may lead to delayed treatment for serious conditions, and can even exacerbate agitation.The most common cause of agitation in patients with schizophrenia is psychotic relapse due to medication nonadherence. Pharmacologic treatment options for these patients include lorazepam and antipsychotic agents. Lorazepam causes nonspecific sedation and treats some substance withdrawal, but has little effect on psychosis. First-generation antipsychotics treat psychosis and, at high enough doses, cause sedation, but may induce extrapyramidal side effects (EPS). Some second-generation antipsychotics have been approved for the treatment of agitation in schizophrenia. These agents treat psychosis with a favorable EPS profile, but are comparatively expensive and cause risks such as hypotension. However, avoiding EPS may reduce patients' resistance to antipsychotic treatment.
In this expert roundtable supplement, Joseph Battaglia, MD, provides an overview of the definition of acute agitation. Next, Delbert, G. Robinson, MD, outlines evaluation methods for actue agitation. Finally, Leslie Citrome, MD, MPH, reviews interventions for acute and ongoing management of agitation.
A study was conducted to evaluate the excretion pattern of melamine from feed into eggs, plasma, kidney, liver and muscle of laying hens. In particular, 90 laying hens were randomly allocated to three dietary treatments and fed diets contaminated with melamine at a level of 2.5, 25 and 250 mg of melamine/kg of diet for T1, T2 and T3 groups, respectively. The diets were offered in six replicate boxes (five hens each) for 13 days. Eggs were collected from each group for melamine quantification on days 0, 1, 3, 6, 9 and 13. At the end of the experimental period, one hen per box was randomly selected and slaughtered to collect plasma, liver, kidney and muscle samples. During the experiment, feeding diets with increasing levels of melamine had no effect (P > 0.05) on weight gain, feed intake, egg production, egg weight and mortality of laying hens. The melamine in eggs increased from day 1 after melamine ingestion and reached a plateau between days 6 and 13 of melamine ingestion. At steady-state condition, the melamine egg concentrations increased (P < 0.01) with treatments, being 0.026, 0.352 and 4.631 mg/kg for T1, T2 and T3, respectively. Similarly, the carryover of melamine from feed to egg increased (P < 0.05) with the levels of melamine in the diets, varying from 0.50 to 0.70 and 0.84 for T1, T2 and T3, respectively. The melamine was detected in plasma of all tested groups, increasing (P < 0.01) with levels of melamine in the diets (0.030, 0.266 and 4.102 mg/l in T1, T2 and T3, respectively). Melamine was not detected in kidney, liver and muscle of hens fed T1. Except for kidney sampled in the T3, no melamine concentration higher than 2.5 mg/kg, representing the maximum allowable limit set by the US Food and Drug Administration and European Union for food and feeds, was measured. The melamine resulted higher in plasma and kidneys than in the liver and muscle both in T2 and T3. The results confirmed the presence of an excretion pattern of melamine from feed to eggs and tissues in laying hens.
We studied the stellar populations of Fornax dwarf spheroidal galaxy using HST/WFPC2 imaging of 7 galaxy fields. Our observations reach the oldest main-sequence turn-off, revealing distinct stars formation episodes and allowing us to address the evolution of this prototype dwarf spheroidal galaxy known to have experienced an extended history of star formation. From our HST data, spatial gradients in the stellar content of Fornax emerge with greater clarity. The outermost fields show only stars with ages between 7–12Gyr, while the intermediate region hosts a stellar population between 4–10Gyr, and stars younger of 2 Gyr are found in the innermost fields. A clearly visible gap in the subgiant branch points to bimodality in the main star formation episode. Our observations also indicate that the inner clump detected by Coleman et al. (2004) is characterized by the presence of young stars with age about 1.8 Gyr.
The NIR Ca II triplet has proven to be an important tool for quantitative spectroscopy. Here we present results of synthetic spectral analysis for the Ca II triplet for low-metallicity red giant stars, combined with observational data. Our results start to deviate strongly from the widely-used and linear empirical calibrations below [Fe/H] = −2. We provide a new calibration for Ca II triplet studies which is valid down until [Fe/H] = −4 and apply this new calibration to current data sets. We suggest that the classical dwarf galaxies are not so devoid of extremely low-metallicity stars as was previously thought and discuss preliminary results and possibilities for follow-up observations of these extremely low-metallicity candidates.
Samples of line-of-sight velocities and metallicities for hundreds individual red giant branch stars in Milky Way satellite galaxies have been obtained in the recent past thanks to wide-area multi-object spectrographs on 8 m–10 m class telescopes. These samples have greatly improved our knowledge of the large scale metallicity properties and the internal kinematics of the Milky Way satellites, uncovering in several of these systems the presence of multiple stellar components, velocity gradients and allowing more accurate mass determinations.
With the current instrumentation this kind of studies are already challenging at the outskirts of the Local Group, limiting the variety of galaxy types and environments that we can explore at a similar degree of detail.
With its 42 m diameter, the European Extremely Large Telescope (E-ELT) represents the project for the largest ground-based optical-infrared telescope in the world. In this contribution I discuss results from simulations I have carried out on the feasibility of intermediate resolution spectroscopic surveys in the near-infrared CaII triplet region for large samples of individual red giant branch stars in galaxies at the outskirts of the Local Group and beyond.
Iodine and selenium are essential trace elements involved in the regulation of thyroid metabolism and antioxidant status. Two experiments were undertaken on lactating cows to determine the milk concentrations of iodine and selenium, carry over (CO) in milk, the fraction in curdle portion and how milk yield affects the milk iodine and selenium concentrations and CO. Sources of elements were potassium iodide and sodium selenite. In Experiment 1, 12 cows were randomly allotted to three diet groups in a completely randomized design: control group (CTR) – total mixed ration (TMR) containing 1.71 and 0.08 mg/kg dry matter (DM); Group 1 (T1) – TMR plus 23.8 and 2.2 mg; Group 2 (T2) – TMR plus 45.5 and 4.3 mg, respectively, for iodine and selenium. In Experiment 2, 30 cows were allotted to three groups according to milk yield: high (H), average (A) and low (L). Within each group, cows were randomly assigned two levels of iodine and selenium: Level 1: TMR containing 1.55 and 0.15 mg/kg DM; Level 2: TMR plus 47.2 mg and 8.0 mg, respectively, iodine and selenium. In both experiments, individual milk samples were collected and analyzed for iodine and selenium contents. In Experiment 1, Grana Padano cheese was obtained at lab scale and the iodine and selenium fractions in the curd were measured. In Experiment 1, the iodine intake increased (P < 0.001) the concentration and total excretion in milk. The CO increased (P < 0.05) from 16 (CTR) to 27 (T1) and 26% (T2); the sampling time was significant (P < 0.05) with no interaction with treatments. Concentration of selenium in milk was increased (P < 0.05) by treatment and CO decreased (P < 0.01) from 26 (CTR) to 12 (T1) and 9% (T2). The iodine showed a mild enrichment factor in the curdle (about 1.7-fold), whereas selenium enriched five- to sevenfold. In Experiment 2, the level of iodine supplementation affected (P < 0.05) the concentration and total excretion in milk. No effects on milk iodine concentration were related to milk yield or milk yield × treatment interaction; however, the iodine excretion in milk was major (P < 0.05) in higher yielding groups. The iodine CO was affected (P < 0.05) by the milk yield in supplemented groups. The selenium milk concentration and excretion were affected (P < 0.01) by the milk yield, whereas the CO was affected (P < 0.05) by the milk yield and selenium supplementation. Results highlight the possibility of fortification with iodine in milk and selenium in cheese through animal feeding.