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The head-up tilt test (HUT) and other evidence suggest that the vagal effect on the heart decreases with age.

Identifying the topics addressed in a corpus is one of the primary concerns of automated text analysis. This paper aims to contribute to the comparative analysis of various methodologies. Specifically, a comparison is made of the results obtained by applying the most prevalent topic identification techniques to the same corpus. The analysis is conducted on a large database of original text created from an e-mobility newsletter. To evaluate the outcomes of the methodologies, two criteria are used. First, the semantic coherence and similarities of the various methods are assessed. The second step involves processing the degree of association between the topics identified by the various models.

El acceso con trocar óptico (ATO) es una técnica modificada de laparoscopia cerrada cuyo objetivo es minimizar el riesgo de lesiones vasculares o intestinales y reducir la posible fuga de gas. Se ha analizado el efecto de la curva de aprendizaje (CA) para el ATO, considerando n=30 procedimientos como umbral para definir un nivel aceptable de experticia. Nuestro objetivo es evaluar el impacto de la CA en los primeros 30 casos de ATO realizados por un aprendiz.

After COP 21, the targets for reducing CO2emissions have boosted the commitment of governments and companies to developing alternative technologies for the mobility of people and goods. Electric vehicles are at the heart of this transformation, which is profoundly affecting the characteristics of agents and artefacts. The aim of the paper is to identify the relevant domains of this transformation, and to identify what characterises the space of the agents and artefacts of the electric vehicle and their interactions, as oriented by the public policies promoted by the various countries. The paper presents the results of a multidimensional textual analysis of the news published in English by electrive.com, a daily newsletter covering a wide range of relevant information on developments in electric transport in Europe and beyond. These results are a preliminary step for the analysis of the social, economic, organisational and technological changes related to sustainable mobility.

Cardiovascular diseases, anxiety, and depression are among the most frequent clinical conditions in the Western world, often in comorbidity. Evidence regarding a shared pathophysiology suggests a mediating role by chronic systemic inflammation. The aims of this study were to measure the association between anxiety and depressive symptoms, cardiovascular risk factors, and inflammatory markers. Outpatients aged 40 years or more undergoing colonoscopy after positive fecal occult blood test were enrolled; the following data were collected: body mass index, blood pressure, blood glucose, lipid profile, C-reactive protein (CRP) level, carotid thickness, Hospital Anxiety and Depression Scale, Temperament and Character Inventory, INTERdisciplinary MEDicine Self-Assessment, and 36-Item Short-Form Health Survey scores. Fifty-four patients were enrolled; 30.2% had anxiety symptoms, 18.9% depressive symptoms, and 9.4% concomitant anxiety-depressive symptoms. Anxiety symptoms were associated with low high-density lipoprotein levels. Depressive symptoms were associated with CRP levels, providing supporting evidence for the role of inflammation in the pathophysiology of depression.

Selective serotonin reuptake inhibitors (SSRIs) represent the most common treatment for major depression. However, their efficacy is variable and incomplete. In order to elucidate the cause of such incomplete efficacy, we explored the hypothesis positing that SSRIs may not affect mood per se but, by enhancing neural plasticity, render the individual more susceptible to the influence of the environment. Consequently, SSRI administration in a favorable environment promotes a reduction of symptoms, whereas in a stressful environment leads to a worse prognosis. To test such hypothesis, we exposed C57BL/6 mice to chronic stress in order to induce a depression-like phenotype and, subsequently, to fluoxetine treatment (21 days), while being exposed to either an enriched or a stressful condition. We measured the most commonly investigated molecular, cellular and behavioral endophenotypes of depression and SSRI outcome, including depression-like behavior, neurogenesis, brain-derived neurotrophic factor levels, hypothalamic–pituitary–adrenal axis activity and long-term potentiation. Results showed that, in line with our hypothesis, the endophenotypes investigated were affected by the treatment according to the quality of the living environment. In particular, mice treated with fluoxetine in an enriched condition overall improved their depression-like phenotype compared with controls, whereas those treated in a stressful condition showed a distinct worsening. Our findings suggest that the effects of SSRI on the depression- like phenotype is not determined by the drug per se but is induced by the drug and driven by the environment. These findings may be helpful to explain variable effects of SSRI found in clinical practice and to device strategies aimed at enhancing their efficacy by means of controlling environmental conditions.

The initial evaluation of patients with transient loss of consciousness (LOC) comprises a detailed medical history, physical examination, and 12-lead electrocardiogram. Because there are many causes of syncopal and nonsyncopal LOC, an adequate method of taking the clinical history, which is the cornerstone of diagnosing patients with transient LOC, should be used.

Based on our preclinical data showing a potential accelerating effect of acetylsalicylic acid (ASA) in combination with fluoxetine in an animal model of depression, we examined the effect of ASA augmentation therapy on selective reuptake inhibitors (SSRI) in major depressed non-responder patients. Twenty-four non-responder patients having received at least 4 weeks of an adequate SSRI treatment were included in a pilot open-label study. Participants were treated openly during 4 weeks with 160 mgday ASA in addition to their current antidepressant treatment. The combination SSRI–ASA was associated with a response rate of 52.4. Remission was achieved in 43 of the total sample and 82 of the responder sample. In the responder group, a significant improvement was observed within week 1 (mean Hamilton Depression Rating Scale-21 items at day 029.3±4.5, at day 714.0±4.1; P<0.0001) and remained sustained until day 28. Despite limitations due to the open nature of this study, our preliminary results confirm our preclinical findings and are in favour of an accelerating effect of ASA in combination with SSRIs in the treatment of major depression. Potential physiological and biochemical mechanisms may involve an anti-inflammatory andor neurotrophic effect.

Evidence has accumulated suggesting that major depression is associated with dysfunction of inflammatory mediators. Moreover, antidepressants show an anti-inflammatory action possibly related to their clinical efficacy. An improvement in psychiatric symptoms has been recently reported in patients treated with anti-inflammatory drugs for other indications. These data imply that inflammation may be involved in the pathogenesis of depression and that anti-inflammatory drugs may be used as an adjunctive therapy. The aim of the present study was to evaluate the behavioural effect of the co-administration of acetylsalicylic acid (ASA, 45 mgkg or 22.5 mgkg) and fluoxetine (FLX, 5 mgkg) in the chronic escape deficit model of depression. The chronic escape deficit model is based on the modified reactivity of rats to external stimuli induced by exposure to unavoidable stress and allows evaluation of the capacity of a treatment to revert the condition of escape deficit. In this model, FLX alone needs to be administered for at least 3 weeks to revert this condition. Our results show that combined treatment of fluoxetine and ASA completely reverted the condition of escape deficit by as early as 7 days, the effect being already partially present after 4 days. The effect was maintained after 14 and 21 days of treatment. ASA alone was ineffective at any time tested and the effect of fluoxetine was significant only at 21 days. These results, together with clinical data from preliminary results, suggest that ASA might accelerate the onset of action of selective serotonin reuptake inhibitor antidepressants.

Aims and Background Biological variables linked to genomic instability were examined and related to survival in 52 patients affected by ovarian carcinoma and nine patients with low malignant potential tumors (LMP).Methods DNA ploidy was measured by image cytometry in isolated neoplastic cells; the mitotic index was measured in Feulgen-toluidine blue-stained sections and p53 was investigated by immunohistochemistry.Results Twenty-five tumors (4 LMP) were peridiploid (ploidy <2.25c), 22 tumors (4 LMP) were hyperdiploid (2.25c>ploidy<2.9c) and 14 (1 LMP) had high ploidy (≥2.9c). Ml ranged from 0.3 to 24.2 with a mean of 1.8 for LMP and 6.8 for carcinomas (P <0.001). Widespread p53 overexpression was detected in 49% of carcinomas and in none of the LMP tumors.Conclusions Survival analysis performed in patients with carcinomas indicated that, of the examined biological variables, only Ml was moderately associated with survival in a subgroup of early-stage patients.

Neurohumoral factors may contribute to cardiovascular changes associated with vasovagal syncope (VVS). Galanin (GAL) is a neuropeptide, widely distributed in the central and peripheral nervous systems, that interacts with both sympathetic and vagal systems as well as with neurotransmitters, such as serotonin. We investigated the changes in plasma GAL and catecholamine levels during head-up tilt (HUT) test in patients with recurrent VVS. Twenty-two patients (11 women, aged 33.1 ± 4.2 years) with a history of VVS and 10 healthy subjects (5 women, aged 38.0 ± 5.8 years) underwent HUT test (60°, 45 minutes). GAL and catecholamine plasma levels were measured in the supine position, during HUT and, in patients with positive response, at presyncope, syncope, and after recovery of consciousness. Thirteen patients developed syncope during HUT, whereas no healthy subjects had a positive response. In healthy subjects, GAL did not change during HUT. By contrast, in patients with a history of VVS and a negative response to tilting (no syncope), GAL significantly (P<.001) increased in response to tilting (supine, 10.2 ± 0.6 pmol/L; tilting, 18.1 ± 1.1 pmol/L at 45 minutes) and correlated positively with the increases in blood pressure (BP) and heart rate (HR). In patients with a positive response, GAL did not change either before the loss of consciousness or during syncope. In patients with a positive response, norepinephrine (NE) significantly (P<.001) increased during tilting and then remained practically unchanged during syncope, whereas epinephrine (E) significantly (P<.001) increased during tilting and then showed further significant increases at presyncope and syncope. In conclusion, this study shows that circulating GAL levels progressively increase in correlation with the cardiovascular parameters during a negative HUT in patients with a history of VVS, whereas they remain unchanged in healthy subjects. Moreover, in the patients with tilting-induced syncope GAL does not change either before or during loss of consciousness. These data suggest a role for endogenous GAL in the adaptive responses to acute orthostatic stress preventing syncope in susceptible individuals. Copyright 2003, Elsevier Science (USA). All rights reserved.

OBJECTIVES

Background The routine follow-up of cardioverter defibrillators (CD) is a time-consuming procedure.Aim of the Study and Methods The present study was a prospective randomized cross-over evaluation on the clinical usefulness of a specific semi-automatic software algorithm (Quick Check) for CD follow-up, available in CPI Guidant systems (CD and programmer). Time-saving, while ensuring all the required data and patient safety, was evaluated in a large group of patients (105), recruited in different centers. In the same session and under a physician's supervision all patients underwent a follow-up with the aid of Quick Check or a standard follow-up, in a randomized sequence. Each patient served as his own control.Results In the overall population of 105 patients, the time spent for follow-up was reduced by Quick Check from 186±105 sec to 106±67 sec (p<0.0001) (43% reduction). The reduction in time spent for follow-up with Quick Check was the same (43% reduction) in patients with detected episodes (n=38) (from 241±144 sec to 138±95 sec (p<0.0001)) and in patients without detected episodes (n=67) (from 154±52 sec to 88±34 sec (p<0.0001)). No adverse events or deletion of potentially useful data was detected by the supervising physician.Conclusions Use of a specific software algorithm for routine follow-up of implanted CDs allows a significant shortening of the time spent on routine follow-up, thus reducing costs. The supervision of a physician is a guarantee of patient safety.

OBJECTIVES

In the present study, we have evaluated thyroid function in neonates at delivery and in their mothers who used vaginal povidone-iodine (PVP-I) during the last trimester of pregnancy. Newborns and their mothers without a history of iodine exposure, admitted to the same department and residing in the same geographical area served as controls. Maternal serum thyroxine (T4), triiodothyronine (T3), reverse triiodothyronine (rT3) and thyrotropin (TSH) concentrations at delivery were not significantly different between the two groups of pregnant women. Cord blood thyroid hormone concentrations in the newborns of iodine exposed mothers were not significantly different from those in control newborns. In contrast, cord blood TSH concentrations in the neonates of mothers exposed to PVP-I during the last trimester of pregnancy were significantly higher than values in control neonates (p< 0.05). These data confirm that the fetal thyroid gland, even in the last trimester of pregnancy, does not adapt completely to the inhibitory action of iodine on thyroid hormone synthesis and/or release.

High-resolution vibration-rotation spectra of the stretching fundamentals of 13C2H2and 12C13CH2have been recorded at Doppler- or pressure-limited resolution in the 8-, 4-, and 3-μm spectral regions. Both cold and hot bands involving stretching and stretching-bending combination levels have been analyzed. The complete treatment of the weak quartic anharmonic resonance between the levels ν3and ν2+ ν4+ ν5(Σ+u) in 13C2H2has been performed, yielding the effective anharmonic constant K2345and the unperturbed value of the ν3fundamental for this isotopomer. The analysis of the bands of the 12C13CH2isotopomer provides values for vibrational energies and rotational constants of the first excited states of all stretching vibrations, including the ν2= 1 level, not detected before in IR spectra.

Objectives. This study investigated the hemodynamic effects of oral sotalol during both sinus rhythm and paroxysmal atrial fibrillation.

The possible inhibition exerted by ethanol on the oxytocin response to breast stimulation was tested in normal women. The possible role of endogenous opioids in the control of the oxytocin response to breast stimulation and/or ethanol action was also examined. Sixteen normal women were tested four times on the 22nd day of four consecutive regular menstrual cycles. All women underwent mechanical breast stimulation (for 10 min) with the concomitant administration of normal saline, naloxone (2 or 4 mg in an iv bolus plus 5 or 10 mg over 16 min), ethanol (50 ml in 110ml of whisky po) or the combination of ethanol and naloxone. Plasma oxytocin levels rose about twofold after breast stimulation, with a mean peak response at 10 min. The oxytocin response to breast stimulation was not changed by the treatment with the lower (2 plus 5 mg) or the higher (4 plus 10 mg) dose of naloxone, whereas it was completely abolished by ethanol. However, when ethanol was given together with naloxone, the oxytocin rise induced by breast stimulation was only partially inhibited by ethanol (the mean oxytocin peak was 50% higher than baseline). At both doses naloxone produced similar effects. These data demonstrate that ethanol inhibits the oxytocin response to breast stimulation. Naloxone sensitive endogenous opioids do not appear to be involved in the control of the oxytocin rise induced by breast stimulation. In contrast, since naloxone partially reversed the inhibiting effects of ethanol, a partial involvement of opioid peptides in ethanol action is supposed.

To study the effect of thyrotropin-releasing hormone (TRH) and somatostatin (SRIF) on prolactin (PRL) secretion in at term human fetus these peptides have been administered to at term pregnant women during labor. Evidence has been reported that TRH and SRIF cross the placental barrier and affect the secretion of pituitary hormones. 400 μg TRH were administered to 37 pregnant women. As control 11 women received saline. In cord blood (CB) of neonates whose mothers received TRH CB PRL concentration was not different from those treated with saline, with values ranging between 192 ± 18 and 342 ± 48 ng/ml. 500 μg cyclic SRIF diluted in saline was infused over a period of 30 min in 55 women. Control subjects were infused with saline. At birth CB PRL concentration in SRIF treated neonates ranged between 266 ± 32 and 327 ± 48 ng/ml. In neonates whose mothers were treated with saline, CB PRL was 305 ± 31 ng/ml. This value was not significantly different from that in SRI F-treated groups. Our findings suggest that in at term human fetus TRH does not stimulate PRL secretion probably because fetal pituitary secretes PRL at maximal releasing activity. Furthermore SRIF administration does not have any effect on fetal PRL secretion as consistently observed in adults.

The goal of this study was to validate the quantitative accuracy of a system for 3-dimensional (3D) echocardiographic reconstruction of the left ventricle to assess its volume and function in human beings by using 3 apical views as a simplified technique to promote practical clinical application. End-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (EF) were obtained by 3D echocardiography in 50 patients with dilated or geometrically distorted left ventricles and compared with values from magnetic resonance imaging (20 consecutive patients), angiography (22 consecutive patients), and radionuclide imaging (8 consecutive patients). Three-dimensional results were also compared with 2-dimensional (2D) echocardiographic estimates. Three-dimensional left ventricular reconstruction provided values that correlated and agreed well with pooled data from the other techniques for EDV (y= 0.93x+ 9.1, r= 0.95, standard error of the estimate [SEE] = 15.2 mL, mean difference = –0.5 ± 15.4 mL), ESV (y= 0.94x+ 4.3, r= 0.96, SEE = 11.4 mL, mean difference = 0.4 ± 11.5 mL), and EF (y= 0.90x+ 4.1, r= 0.92, SEE = 6.2%, mean difference = –0.9 ± 6.4%) (all mean differences not significant versus 0), with greater errors by 2D echocardiography. Intraobserver and interobserver variabilities of 3D echocardiography were less than 6% for EDV, ESV, and EF. The overall time for image acquisition and 3D reconstruction was 5 to 8 minutes. Although this 3D method uses only a small number of apical views, it accurately calculates EDV, ESV, and EF in patients with dilated and asymmetric left ventricles and is more accurate than 2D echocardiography. The flexible surface fit used to combine the 3 views provides a convenient visual output as well as quantitation. This simple and rapid 3D method has the potential to facilitate routine clinical applications that assess left ventricular function and changes that occur with remodeling. (J Am Soc Echocardiogr 1998;11:1001-12.)

Abstract. Somatostatin (SRIF) was infused (500 μg over 30 min) into 68 pregnant women during labour. As a control, saline was infused into 26 pregnant women. Maternal blood was obtained prior to the infusion and at delivery and cord blood was obtained at delivery. The subjects were divided into 4 groups based upon the interval of time from the termination of SRIF infusion and delivery. There was a marked decrease in cord blood thyrotrophin (TSH) from 0 to 180 min and in cord blood growth hormone (GH) from 0 to 120 min following SRIF infusion. SRIF infusion did not affect cord blood iodothyronine and thyroglobulin concentrations. SRIF administration induced a small but significant (P< 0.05) decrease in serum GH concentration but had no other effect on maternal hormone values. These studies strongly suggest that SRIF crosses the human placenta and transiently suppresses foetal anterior pituitary TSH and GH secretion.

Objectives. This study evaluates the direct and autonomically mediated effects of oral quinidiee on ventricular repolarization in humans.

Objectives. This study Investigates the rote of an abnormal neural reflex in causing syncope in patients with sinus bradycardia.

Previous studies have suggested that fetal PRL secretion does not respond to stimuli such as TRH, metoclopramide, and cimetidine. It was postulated that the lack of response to TRH could be due to the possibility that, in the term fetus, lactotropes secrete PRL maximally and would be unresponsive to further stimulation. In order to study this hypothesis, 200 μg TRH or saline were administered to preterm pregnant women in labor. Maternal blood was obtained before TRH and saline administration. Maternal and cord blood were obtained at parturition. PRL, TSH, T4and T3concentrations were measured in all sera. TRH administration induced a significant increase in maternal serum PRL, TSH and T3concentrations. In the cord blood of newborns whose mothers received TRH, serum TSH, T4and T3concentrations were significantly higher than in cord blood of newborns whose mothers received saline. Cord blood serum PRL concentrations were unchanged after TRH administration. This latter finding suggests that fetal lactotropes do not respond to TRH in the preterm fetus. Desensitization of fetal PRL secreting cells to TRH stimulation and/or the inhibitory effect of elevated fetal circulating corticosteroids on TRH-induced PRL secretion may explain the absent PRL response to TRH during fetal life.

Abstract. In the adult, dopamine inhibits prolactin (Prl) secretion and less so thyrotropin (TSH) release. Little information is available concerning the role of dopaminergic stimuli in the regulation of TSH and Prl secretion in the term human foetus. The dopamine agonist, bromocriptine (5 mg), or placebo were randomly administered orally to 120 pregnant women during labour. Maternal and foetal cord blood was obtained at parturition and analyzed for Prl, TSH, T4, T3and rT3concentrations. Since the time of parturition is unpredictable, maternal and cord blood hormone values were grouped at intervals of time from the time of bromocriptine or placebo administration to delivery. Hormone values were compared between the bromocriptine and placebo groups by two-way analysis of variance (ANOVA). Bromocriptine markedly inhibited maternal serum Prl conentrations compared to values in the placebo treated women (P< 0.001) and this decrease was more marked as the time interval between bromocriptine administration and delivery increased (P< 0.001, regression analysis). Cord blood Prl was also significantly lower in newborns whose mothers received bromocriptine (P< 0.001). Bromocriptine significantly inhibited maternal serum TSH concentrations as compared to values in women treated with placebo (P< 0.006). In contrast, bromocriptine administration did not affect cord blood TSH concentrations. These findings suggest that bromocriptine crosses the term human placenta and suppresses foetal Prl secretion. In contrast to the small inhibition of TSH secretion in pregnant women, bromocriptine does not affect foetal TSH secretion suggesting that regulation of TSH secretion in the term foetus may not be under dopaminergic control.

This study was undertaken to assess the value of sublingual nitroglycerin administration during upright tilt as a simple practical test for the diagnosis of vasovagal syncope. To this purpose, 235 patients with syncope of unknown origin and no evidence of organic heart disease (110 men, mean age 52 ± 20 years) and 35 asymptomatic control subjects underwent head-up tilt testing with nitroglycerin challenge. Patients and subjects were tilted at 60° for 45 + 20 minutes; the initial 45 minutes were without medication and the final 20 minutes after 300 μg of sublingual nitroglycerin. During the drug-free phase of the test, 59 patients (25%) and no controls had a positive response. After drug administration, a positive response (syncope in association with sudden hypotension and bradycardialoccurred in 60 patients (26%) and in 2 controls (6%), whereas an exaggerated or false-positive response (minor or different symptoms in association with slowly increasing hypotension alone) was observed in 33 patients (14%) and in 5 controls (14%). We conclude that the sublingual nitroglycerin head-up tilt test is a useful tool to unmask the vasovagal origin of unexplained syncope in patients without organic heart disease. The addition of nitroglycerin to upright tilt allows the positive rate of passive tilting to be doubled (51 % vs 25%) while maintaining a high specificity (94% vs 100%).

Correction to: Molecular Psychiatry advance online publication, 15 September 2015; doi:10.1038/mp.2015.142 In Table 1, the marker in the last column of the Stressful condition row should have been a ↑. The publisher regrets the error.

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