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Background: Even though most of the systematic reviews suggest that depression and anxiety are related to poor neonatal outcomes, it is not yet clear whether a dose-response effect exists., Aim: The aim of the present study is to evaluate the amount of depressive and anxiety symptoms in a cohort of pregnant women and its effect on their newborns., Methods: Two hundred ninety-nine women were assessed for anxiety and depressive disorders and anxious and depressive symptoms at near monthly intervals throughout pregnancy. At the time of delivery, we collected the newborns' gestational age, birth weight and the Apgar score at 1 and 5 min., Results: Sixty-seven women were diagnosed as depressed and 43 had an anxious disorder. After controlling for confounding variables only the overall levels of anxiety during pregnancy were negatively associated with birth weight ( B = -5.76; 95% CI = -10.96, -2.81), suggesting the existence of a "dose-response" effect. The birth outcomes in mildly depressed pregnant women were similar to those of nondepressed women., Conclusion: Anxiety symptoms, beyond a categorical diagnosis, are associated with low birth weight and should be recognized and properly treated during pregnancy.

The national expenditure limits set by the spending review has required reorganization and streamlining measures. The present study was conducted in 2015, among 2,020 nurses and 861 doctors in the autonomous province of Trento (Italy), to describe their perceptions of the containment measures introduced in healthcare spending, following the spending review. Results show that nurses and doctors were most affected by the measures regarding staff management (staff turnover rate, reducing overtime and changes in training). These measures, however, cannot be adopted for a long period of time without leading to negative effects on organization and quality of care.

Background: Down syndrome (DS) shows neuropathology similar to Alzheimer disease, which presents olfactory impairment. Previous work showed olfactory impairment in DS, but a comprehensive evaluation of olfactory function in DS is lacking., Methods: We investigated a large number (n = 56; M = 31, F = 25) DS participants (age range18-57y) using the "Sniffin' Sticks" Extended test. This comprises three subtests (threshold, discrimination, and identification) yielding a global score (TDI) defining normosmia, hyposmia, and functional anosmia. To the best of our knowledge, this is the second largest group of DS people investigated for olfactory function ever. Age- and sex matched euploid individuals (n = 53) were the control., Results: In DS, TDI was lower (16.7±5.13 vs. 35.4±3.74; P<0.001), with DS people performing worse in any subtests (P<0.001 for all); 27 DS participants showed functional anosmia (i.e., TDI<16). In DS, age was weakly and negatively correlated with TDI (r = -0.28, P = 0.036) and identification (r = -0.34, P = 0.012). When participants were stratified in young adults (18-29y) and older adults (30-61y), a significant effect of age was found for identification in both DS (young adults, 8.3±2.58; older adults, 6.9±2.99; P = 0.031) and control (young-adult, 14.3±1.18, older adult, 13.0±1.54; P = 0.016)., Conclusion: Olfactory function is overall severely impaired in DS people and may be globally impaired at relatively young age, despite of reportedly normal smell. However, specificity of this olfactory profile to DS should be considered with some caution because cognition was not evaluated in all DS participants and comparison with a control group of non-DS individuals having cognitive disabilities was lacking. Further study is required to longitudinally assess olfactory dysfunction in DS and to correlate it with brain pathology.

Rationale: Avoidance of contexts directly associated with fearful experiences represents an adaptive behavioral survival strategy. Over-interpretation of contextual cues leading to generalized avoidance of situations that are only remotely similar to the original fear context represents a pathologic process that contributes to anxiety disorders. Orexin neuropeptides modulate anxiety-like behavioral and physiological responses., Objective: The objective of this paper was to investigate the impact of pharmacological orexin receptor blockade on generalized avoidance behavior., Methods: Rats received a single electric foot-shock in the dark side of a two-compartment shuttle box followed by situational context reminders. After shock, rats were treated chronically (3 weeks) with the orexin receptor antagonist almorexant or with the selective serotonin reuptake inhibitor sertraline, used as positive anxiolytic control. In week 3, avoidance behavior was measured under conditions of high (dark-light (DL)-box) and low (elevated plus maze (EPM)) similarity to the original shock context. Avoidance behavior was re-assessed 5 and 17 weeks after treatment termination., Results: Avoidance in the DL box (contextual fear memory) remained unaffected by any treatment and lasted 20 weeks post-shock exposure. Avoidance in the EPM (neophobic fear generalization) was partially attenuated during treatment with almorexant and sertraline at week 3. Following 5 and 17 weeks of drug washout, avoidance in the EPM was significantly reduced in almorexant- but not in sertraline-treated rats. Almorexant also reduced persistent avoidance in the EPM upon treatment initiation 3 weeks after shock exposure., Conclusion: Chronic orexin receptor blockade in rats reduces both the development and persistence of generalized avoidance in situations with low similarity to the initial shock context.

Background: The study investigates the prevalence of Panic Disorder (PD) with or without comorbid Major (MD) or Minor Depressive (md) disorder during pregnancy and focuses its attention on the different pattern of risk factors in these two subgroups in a sample of women attending two Centres for Prenatal Care of the Public Health Service., Methods: Two-hundred and seventy-seven pregnant women were assessed monthly throughout the whole pregnancy period using the Primary Care Evaluation of Mental Disorders (PRIME-MD) for the screening of PD and the Hospital Anxiety and Depression Scale (HADS) for the evaluation of severity of anxious and depressive symptoms., Results: Twenty-one women (7.5%) were diagnosed as affected by PD, of whom 12 (57.1%) showed MD or md comorbidity. The development of PD without depressive comorbidity is predicted by a history of previous episodes of Anxiety Disorders while the development of PD plus depressive comorbidity is predicted by a history of previous depressive episodes and by the lack of familiar support., Limitations: Given the small sample size of our anxious and depressed women, the present data need to be verified by using larger samples., Conclusions: The frequent association between PD and MD or md, the analysis of risk factors and of temporal relationship strongly suggests that the panic-depressive comorbidity might represent in fact depressive disorders with intense anxiety symptoms. These findings raise the question if the PD-depressive association is a true comorbidity or reveals the anxious symptomatology of a depressive disorder (MD or md)., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Neurohumoral, immunologic and metabolic alteration characterize surgical procedures in relation with the intensity of injury, the total operating time and the anesthetic technique. We, therefore, compared the effects of desflurane versus sevoflurane anesthesia on intra and postoperative release of the stress hormones and inflammatory cytokines., Methods: Fifty Caucasian women undergoing laparoscopic surgery for benign ovarian cysts were randomized to receive inhaled anesthesia with desflurane (DES group; N.=25) or sevoflurane (SEVO group; N.=25), with fentanyl bolus and remifentanil infusion. Plasma levels of noradrenaline, adrenaline, ACTH and cortisol were measured preoperatively (T1), 30 minutes after the beginning of surgery (T2), and 30 minutes, 2 and 4 hours after the end of surgery (T3, T4, T5 respectively). Interleukin 6 (IL-6), glucose and C-reactive protein (CRP) were measured at T1, T2,T3, T4, T5 and 12 hours after the end of surgery (T6)., Results: An increase of catecholamines during (T2) and immediately after surgery (T3) was observed in both groups. However, adrenaline and noradrenaline levels were significantly higher in the DES group compared to the SEVO group. Despite a drop of cortisol concentration was observed in both groups, only in the DES group there was a significant difference intraoperatively as compared to the baseline levels and to the SEVO group. While, the consequent increase of ACTH was significantly higher in the SEVO group at T2-T4. The preoperatory levels were restored at T5. Glucose, IL-6, CRP levels and postoperative pain did not show significant differences in timing within the same group and comparing DES vs SEVO group., Conclusion: In the present study we demonstrated that desflurane and sevoflurane produced a different stress response in the setting of laparoscopic surgery. The greater release of catecholamines during desflurane anesthesia could have adverse effects in patients with pre-existing cardiovascular disease. In low stress surgery desflurane, as compared to sevoflurane, was associated with a better control of intraoperative cortisol and ACTH response (T2). Moreover, the ACTH secretion resulted attenuated also postoperatively (T3-T4). Both gases did not influence the plasmatic levels of Il-6, CRP and glucose.

Enhanced female vulnerability and symptom severity are described in post-traumatic stress disorder (PTSD). It remains largely unknown whether females present with more pronounced PTSD-like symptoms than males in rodent models of PTSD. A model of single electric foot-shock followed by situational reminders was used to investigate in rats the impact of sex on potential long-lasting changes in anxiety-like behavior, and in endocrine and physiological responses to stress and fearful situations. Three weeks after single shock exposure (in the dark side of a shuttle box) both male and female rats spent less time in the dark compartment of a dark-light box and in the closed arms of an elevated plus maze than non-shocked controls. Both behaviors were likely due to avoidance of places reminiscent of the initial shock context. The shock exposure had no long-term impact on social interaction behavior or on basal and restraint stress-induced increases in plasma corticosterone. Shock exposure increased sudden silence-induced freezing responses and hyperthermia during novelty stress and fear to a similar extent in both males and females and left heart rate responses unaffected. Non-shocked females generally showed a reduced response or faster recovery to baseline under stress- or fearful test conditions as compared to non-shocked males, which was likely due to differential sex-specific coping strategies. Taken together, our results suggest that, despite some baseline sex differences, both male and female rats are similarly affected in the long-term by the initial foot-shock exposure used in this particular simulation of PTSD., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Central amygdala (CeA) projections to hypothalamic and brain stem nuclei regulate the behavioral and physiological expression of fear, but it is unknown whether these different aspects of the fear response can be separately regulated by the CeA. We combined fluorescent retrograde tracing of CeA projections to nuclei that modulate fear-related freezing or cardiovascular responses with in vitro electrophysiological recordings and with in vivo monitoring of related behavioral and physiological parameters. CeA projections emerged from separate neuronal populations with different electrophysiological characteristics and different response properties to oxytocin. In vivo, oxytocin decreased freezing responses in fear-conditioned rats without affecting the cardiovascular response. Thus, neuropeptidergic signaling can modulate the CeA outputs through separate neuronal circuits and thereby individually steer the various aspects of the fear response.

Background: The cardiac left ventricle responds to pressure overloads with mechanisms culminating in irreversible structural/functional cardiac alterations (left ventricular hypertrophy and/or diastolic dysfunction), inducing myocardial cells to secrete natriuretic peptides (NT-proBNP) antagonists of the renin-angiotensin-aldosterone system. The aim of this study was to evaluate the diagnostic accuracy of serum NT-proBNP levels in order to detect structural/functional cardiac diseases assessed by echocardiography., Methods: A total of 126 consecutive newly diagnosed, never before treated, hypertensive patients (30-67 years) were enrolled, and clinical, echocardiography parameters and biochemical data were collected. Our reference was the presence of structural/functional cardiac disease (CSFD) and our index text was the serum NT-proBNP levels., Results: NT-proBNP levels in CSFD patients were ~2 times higher than in non-CSFD subjects (median 61 vs 29 ng/L, n=50 and 76, respectively); in addition, 60% of CSFD subjects (only 14% of which with pathological levels, >125 ng/L), and 30% without CSFD showed NT-proBNP concentrations higher than 50 ng/L. However, ROC curves demonstrated a low specificity (38%) (calculated at 90% sensitivity at a cut-off of 22.5 ng/L)., Discussion: NT-proBNP levels, as a screening tool for cardiac structural/functional disease, appear to be limited, because of the low specificity. However, the strong association between its concentration and the establishment of irreversible cardiac hypertrophy prompts successive studies aimed to ascertain the use of its serum levels as an early alert indicator of disease severity., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Context: Teaching strategies and methodology used in clinical training are varied and have different levels of outcome., Methods: A descriptive study was carried out in Italy on a convenience sample of third year students at four campuses of the Verona University, using a questionnaire divided into four sections: trainees' perception of the levels of usefulness of various teaching strategies, the levels of effectiveness, the level of supervision and the perceived complexity., Results: 308 students compiled the questionnaire. All the tutorial strategies included were perceived as having medium to high levels of usefulness, ten out of the eleven learning strategies were found to be very useful. A medium-high level of usefulness was perceived for supervision (M 2.9±1). The two skills recorded as needing the most supervision were the management of therapy (M 3.8±1.03; Me 4) and performing nursing techniques (M 3.7±0.95; Me 4). The most complex activities were considered to be confronting an emergency situation (M 3.8±1.03) and the planning of care for a group of patients (M 3.3±0.941), and these two activities had had the least amount of supervision., Conclusions: A tutoring model emerged that was centred on learning by experience and with guidance., (Copyright © 2010. Published by Elsevier Ltd.)

Mucormycosis is a relatively rare, opportunistic, invasive infection caused by various members of the Phycomycetes class [from Greek phyko- seaweed; having a plant body], an extensive taxonomy introduced in 1956 to enlarge the class of Zygomycetes. These filamentous fungi have a worldwide distribution and are capable of rapid growth and thermotolerance of human body temperature. Infection typically occurs in seriously compromised patients (i.e. diabetic ketoacidosis, hematologic malignancies, immunosuppressive disorders, end-stage renal disease, solid-organ or bone-marrow transplantation) and can be acute or fulminant, as well as indolent and chronic. In this paper we describe a case of cutaneous mucormycosis that occurred in a 54-year-old diabetic woman and evolved into a disseminated form, leading to an uncommon spinal cord infarction and consequent paraparesis. Our case suggests the importance of suspecting a mucormycosis infection in patients with decompensated diabetes mellitus, even without ketoacidosis.

Oxytocin is a neuropeptide that can reduce neophobia and improve social affiliation. In vitro, oxytocin induces a massive release of GABA from neurons in the lateral division of the central amygdala which results in inhibition of a subpopulation of peripherally projecting neurons in the medial division of the central amygdala (CeM). Common anxiolytics, such as diazepam, act as allosteric modulators of GABA(A) receptors. Because oxytocin and diazepam act on GABAergic transmission, it is possible that oxytocin can potentiate the inhibitory effects of diazepam if both exert their pre, - respectively postsynaptic effects on the same inhibitory circuit in the central amygdala. We found that in CeM neurons in which diazepam increased the inhibitory postsynaptic current (IPSC) decay time, TGOT (a specific oxytocin receptor agonist) increased IPSC frequency. Combined application of diazepam and TGOT resulted in generation of IPSCs with increased frequency, decay times as well as amplitudes. While individual saturating concentrations of TGOT and diazepam each decreased spontaneous spiking frequency of CeM neurons to similar extent, co-application of the two was still able to cause a significantly larger decrease. These findings show that oxytocin and diazepam act on different components of the same GABAergic circuit in the central amygdala and that oxytocin can facilitate diazepam effects when used in combination. This raises the possibility that neuropeptides could be clinically used in combination with currently used anxiolytic treatments to improve their therapeutic efficacy.

Background and Objective: Several reports concerning the haemodynamic changes during gynaecologic laparoscopy have been published so far, and the effects of head-down tilt and pneumoperitoneum have not been clearly separated. However, its main effect seems to be an increase in systemic vascular resistance. We investigated how the augmented afterload can affect diastolic function., Methods: : Our study involved 20 healthy women, classified as having ASA status I: 10 undergoing laparoscopic hysterectomy and 10 undergoing conventional open hysterectomy. Measurements were made in awake patients and after induction of anaesthesia and then repeated after carbon dioxide insufflation and head-down positioning and at the end of surgery. Diastolic function was primarily studied by transthoracic echocardiography., Results: We observed that pneumoperitoneum caused a significant reduction in stroke volume, cardiac output and left ventricular end-diastolic volume; the diastolic filling times showed a progressive reduction in the E-velocity (the velocity of early mitral inflow, corresponding to the ventricular passive filling phase, measured by pulsed-wave Doppler), a prolonged deceleration time and an augmented isovolumetric relaxation time. After head-down tilting, stroke volume, cardiac output and left ventricular end-diastolic volume increased in both laparoscopic hysterectomy and conventional open hysterectomy groups., Conclusion: We have found that pneumoperitoneum has important effects on left ventricular volumes, causing a drop in left ventricular end-diastolic volume; it also affects diastolic function with a delay in deceleration time and isovolumetric relaxation time without any effects on intracavitary pressures.

Aims: The aim of this study was to discover whether problems experienced by older people with multiple chronic diseases were considered to be avoidable from the perspective of nurses., Background: The concept of avoidability is defined as 'that which can be avoided'; when something is perceived as avoidable, action is taken 'to prevent the occurrence'. It is possible that the nurses' perception on the avoidability of problems in chronically-ill older people, could have a role in the decisions they make about the most suitable type of care (e.g. therapeutic, preventive) while if they perceive a problem to be unavoidable they adopt palliative interventions. No literature is available on the factors that nurses take into account when judging whether a patient's problem could be avoided or not, and no nursing diagnosis title includes the concept of an 'unavoidable' problem (e.g. unavoidable depression related to nursing home institutionalisation)., Design: A phenomenological method was used to identify and understand the meaning of a human being's experience by means of direct reporting and interviews., Method: Participants were forty 40 nurses working in homecare services and nursing homes in Northern Italy., Findings: Various factors were assumed to make certain problems inescapable, such as the interaction of multiple diseases, older people refusing care and inadequate surveillance. Other problems were judged to be completely or partially avoidable such as aspects relating to families' reactions (the burden of providing care, family members' inability to provide adequate care), and to healthcare management dysfunctions (poor exchange of information, limited resources)., Conclusion: The nurses perceived they could only marginally modify the older person's problems however, they could take action instead to improve the organisational processes, the involvement of family members, and their own skills and sense of purpose., Relevance to Clinical Practice: To reflect on unavoidable nursing problems and related factors is important for the potential consequences of clinical judgment on patients and on nursing care and for ethical implications. The factors affecting avoidable or unavoidable problems need strategic and individualised action to develop healthcare plans including the older people themselves, their families, and members of a multidisciplinary team and to provide adequate resources and educational programmes., (© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.)

Introduction: Planned discharge guarantees continuity of care. The process starts with the identification of patients at risk of post-discharge problems. In Italy no validated screening instruments are available. One of the UK discharge screening instruments is the Blaylock Risk Assessment Screening Score (BRASS), applicable from admission, for the identification of patients that need a discharge plan., Aims: To assess the validity (sensitivity and specificity) of the BRASS scale on a sample of adult patients admitted to medical wards., Methods: Patients admitted to medical wards of Trento Hospital from January to March 2006 were screened at admission and discharge and interviewed by phone 45 days after discharge to assess where they had been discharged., Results: One hundred eighty nine patients were assessed at admission and discharge and 145 were available at follow-up after 3 months; 7.5% were at risk for difficult discharge. Sensibility and specificity of the scale were respectively 73.1 and 83.2%. No major differences were observed for risk scores obtained at admission and discharge., Conclusions: The BRASS scale collects a limited number of information, predictive on the need to organize discharge services. It can therefore be an useful instrument to help health care workers to plan appropriate and timely interventions for guaranteeing continuity of care.

Oxytocin and vasopressin are two neuropeptides that have been extensively studied for their systemic and physiological roles. Studies in rodents show that oxytocin and vasopressin play an opposite role in several behavioural and physiological tests for anxiety and fear. Their effects on single cell activity in the central amygdala (CeA) triggered a number of electrophysiological studies that allowed us to develop a model of their opposing effects. In our model, GABAergic neurons in the lateral part of the central amygdala are excited by oxytocin and project to the medial part where they inhibit neurons that can be excited by vasopressin. Besides oxytocin and vasopressin, the CeA expresses a large number of other neuropeptide receptors and the question arises if a similar model can apply to their actions. We here develop a hypothesis in which neuropeptides, through their effects on distinct populations in the CeA, affect specific projections and specific physiological expressions of the fear response. Our hypothesis may be of importance for the current interest in neuropeptide receptors as therapeutic targets for neuropsychiatric disorders.

The short- and long-range structure of a series of single and mixed aluminophosphate glasses with the general composition [xNa(2)O (46 - x)Li(2)O], [yAl(2)O(3) (54 - y)P(2)O(5)] is analyzed using (31)P and (27)Al magic-angle spinning (MAS) NMR as well as small-angle X-ray scattering. These series of glasses allow analyzing both the effect of alumina incorporation in these glasses, for small alumina content (y = 0, 4, 8), and the structural changes associated with the so-called mixed alkali effect (x = 0, 11.5, 23, 34.5, 46). Our results indicate that aluminum is mainly octahedrally coordinated in these glasses and that there is most likely some segregation of the Al(OP)(6) species. In the pure phosphate glasses, we observe a "classical" continuous variation of the structural properties with the relative alkali content, but in the aluminophosphate, both local and long-range structural results reveal for the first time some nonlinear change as a function of the relative alkali content.

Carbon dioxide (CO2) is considered the largest contributor to the greenhouse gas effect. Most attempts to manage the flow of CO2 or carbon into our environment involve reducing net emissions or sequestering the gas into long-lived sinks. Using CO2 as a chemical feedstock has a long history, but using it on scales that might impact the net emissions of CO2 into the atmosphere has not generally been considered seriously. There is also a growing interest in employing our natural biomes of carbon such as trees, vegetation, and soils as storage media. Some amelioration of the net carbon emissions into the atmosphere could be achieved by concomitant large withdrawals of carbon. This report surveys the potential and limitations in employing carbon as a resource for organic chemicals, fuels, inorganic materials, and in using the biome to manage carbon. The outlook for each of these opportunities is also described.

The authors report two cases of inguinal lymphocele and phlogistic cysts of the abdominal wall treated with fibrin glue. The complete resolution of both cases after one injection, the simplicity of the technique and the low cost suggest a wider experimentation.

The Authors examined to SEM modifications induced by two different bending procedures on orthodontic wires. Changes observed in the group made by orthodontic pliers lacked in the group bended by the machine. Further dinamometric checks will be made to assure that improvements in the mechanical properties of II order bends correspond to phenomena described.