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Although the recent years have witnessed a growing interest in functional connectivity (FC) through brain sources, the FC in extreme situations has not been completely elucidated. This paper is aimed at investigating whether the expertise acquired during the deep-sea diving is reflected in FC in a group of professional divers (PDs) compared to a group of new divers (NDs), and how it could affect the concentration and stress levels. The sources of brain frequency rhythms, derived by the electroencephalography acquisition in a hyperbaric chamber, were extracted in different frequency bands and the corresponding FC was estimated in order to compare the two groups. The results highlighted a significant decrease of the alpha source in PDs during air breathing and a significant increase of the upper beta source over central areas at the beginning of post-oxygen air, as well as an increase of beta FC between fronto-temporal regions in the last minutes of oxygen breathing and in the early minutes of post-oxygen air. This provides evidence in support of the hypothesis that experience and expertise differences would modulate brain networks. These experiments provided the unique opportunity of investigating the impact of the neurophysiological activity in simulated critical scenarios in view of the investigation in real sea-water experiments.

Objective The aim was to investigate and define possible alterations in cerebral activity during prolonged hyperbaric oxygen exposure and decompression as compared to baseline activity. Methods Thirty-two channel electroencephalography (EEG) was recorded with a Bluetooth EEG system in 11 subjects. A 20-min EEG recording was carried out under three different conditions: breathing air inside a hyperbaric chamber at sea level; breathing oxygen at a simulated depth of 18 msw; breathing air at sea level after decompression. Relative EEG power was estimated in frequency ranges. Results During oxygen breathing, brain activity showed an early fast delta decrease in the posterior regions, with a synchronous and significant increase in alpha in the same regions. After decompression, the delta relative power decrease was uniformly distributed over the cerebral cortex until minute 8, and the alpha relative power was maximal in the posterior regions during the first 2 min. Conclusions These results may be relevant for establishing a reference point in future studies on oxygen-sensitive subjects who reported problems during oxygen diving. Significance Significant changes in EEG relative power suggest that it may be possible to define and recognize landmarks of oxygen-induced brain activity, which would be useful in the medical treatment of subjects reporting “oxygen-toxicity diving-related problems”.

Recording biological signals inside a hyperbaric chamber poses technical challenges (the steel walls enclosing it greatly attenuate or completely block the signals as in a Faraday cage), practical (lengthy cables creating eddy currents), and safety (sparks hazard from power supply to the electronic apparatus inside the chamber) which can be overcome with new wireless technologies. In this technical report we present the design and implementation of a Bluetooth system for electroencephalographic (EEG) recording inside a hyperbaric chamber and describe the feasibility of EEG signal transmission outside the chamber. Differently from older systems, this technology allows the online recording of amplified signals, without interference from eddy currents. In an application of this technology, we measured EEG activity in professional divers under three experimental conditions in a hyperbaric chamber to determine how oxygen, assumed at a constant hyperbaric pressure of 2.8 ATA , affects the bioelectrical activity. The EEG spectral power estimated by fast Fourier transform and the cortical sources of the EEG rhythms estimated by low-resolution brain electromagnetic analysis were analyzed in three different EEG acquisitions: breathing air at sea level; breathing oxygen at a simulated depth of 18 msw, and breathing air at sea level after decompression.

Study objective – The aim was to assess the changes in sympatho-vagal balance which occur with exercise. Design – The power spectnun of RR interval fluctuations (low frequency [LF] and high frequency components [HF]) was determined before, during, and after graded work load exercise on a cycle ergometer. The power spectrum of the respiratory signal, oxygen consumption, and respiratory volumes were also evaluated. In all subjects HF was considered to be an index of respiratory sinus arrhythmia. In normal subjects HF and LF were considered to be indices of relative vagal and sympathetic activity, respectively, whereas in heart transplant subjects HF was considered as a respiratory modulation of the intrinsic heart rate, and not dependent on autonomic tone. Heart rate variability was evaluated as RR interval variance. Subjects – 15 normal subjects (six trained cyclists and nine healthy sedentary subjects) and six orthotopic heart transplant recipients took part in the study. Measurements and main results – During the fust part of exercise, heart rate increased, RR interval variance decreased, HF decreased, and the relative amount of LF increased both in sedentary and athletic subjects, suggesting a relative increase in sympathetic tone. However, when approaching peak exercise, while heart rate further increased and the variance slightly decreased, the relative proportion of LF decreased and HF proportionally increased. At peak exercise HF accounted for 99.9% of heart rate variability in athletic subjects and for 88.9% in sedentary subjects (p

The Infectious Diseases Unit of Lucca Hospital conducted a multicentric retrospective study to evaluate the epidemiological and clinical features of adult patients affected by bacterial meningitis attending all the Infectious Diseases Units of Tuscany (Italy) from July 1999 to June 2004. A specific questionnaire was sent to all the units to collect information about each case of bacterial meningitis occurring in patients older than sixteen. Patients with meningitis by Mycobacterium tuberculosis were excluded from the analysis. Nine out of 12 Infectious Diseases Units of Tuscany took part in the study and 197 cases were identified. Most cases of meningitis occurred during 2002 with a slight reduction in cases in subsequent years. Streptococcus pneumoniae and Neisseria meningitidis were the most frequently isolated pathogens with an increase in diagnosis from 1999 to 2004; in 23.8% of patients no pathogens were isolated, with a reduction in meningitis from unknown aetiology from 1999 to 2004. Most patients were treated with a combination of two antibiotics, and corticosteroid drugs were added to the therapy; in the group of patients treated with corticosteroid drugs invalidating complications occurred in 23% of cases and 5% of patients died. In all, 27 out of 197 subjects (13.7%) developed invalidating complications and 20 out of 197 patients (10.2%) died.

OBJECTIVE: To investigate thiamin and its phosphoester content in plasma and erythrocytes for a complete picture of thiamin status in obese individuals. DESIGN: Comparative study of the thiamin status of obese vs normal individuals. SUBJECTS: In all, 10 healthy, overweight, fertile age women (age: 33.1±5.1 y; BMI: 47.0±0.2 kg/m2) and 10 normal women (age: 30.1±3.5 y; BMI: 22.8±0.2 kg/m2). METHODS: a high-pressure liquid chromatography (HPLC) method for the determination of thiamin and its phosphoesters in the plasma and erythrocytes of the subjects. RESULTS: The major findings were: (1) significant decrease of plasma thiamin, its monophosphate and total thiamin contents in obese vs normal women; (2) significant decrease of thiamin pyrophosphate ester and total thiamin content in obese vs normal women; (3) significant increase in plasma thiamin/thiamin monophosphate ratio (in practice, it was inverted) and corresponding decrease of the plasma thiamin monophosphate/erythrocytes thiamin pyrophosphate ratio in obese vs normal women, where plasma thiamin monophosphate and erythrocytes thiamin pyrophosphate contents are an index of thiamin status. CONCLUSIONS: This study advances the hypothesis that obese women maintain higher levels of thiamin compared to normal weight subjects by storing greater amounts of thiamin in cells through preferential intracellular thiamin recycling to compensate for relatively lower levels of thiamin.

Specific immunotherapy is the only currently available allergen-orientated treatment able to modify the natural history of respiratory allergic diseases. Safety and clinical efficacy of this treatment are well documented, but evidence about the ability to reduce new sensitizations is still poor.We report a retrospective study conducted in order to assess the prevention of new sensitizations in monosensitized subjects treated with specific immunotherapy vs. monosensitized patients treated with anti-allergic drugs.8396 monosensitized patients with respiratory symptoms were selected according to an open, retrospective design. Group A included 7182 patients submitted to specific immunotherapy (and anti-allergic drugs when needed) for 4 years and then treated with drugs for at least 3 years. Group B included 1214 patients treated only with drugs for at least 7 years. All patients underwent prick test with a standard panel of allergens and total and specific IgE determination before and after 4 years of treatment and again 3 years later.Groups were well balanced. Polysensitized subjects were 23.75% in Group A and 68.03% in Group B after 4 years (P0.0001) and 26.95% and 76.77%, respectively, after 7 years (P0.0001). Asthmatic subjects were more prone to develop polysensitization in comparison to subjects suffering only from rhinitis (32.14% instead of 27.29% after 4 years, 36.5% instead of 31.33% after 7 years; P0.0001). Specific IgE decreased by 24.11% in Group A and increased by 23.87% in Group B (P0.0001). Total IgE decreased by 17.53% in Group A and increased by 13.71% in Group B (P0.0001).Specific immunotherapy was observed retrospectively to reduce new sensitizations in monosensitized subjects suffering from respiratory allergic diseases.

Fluticasone propionate is a very effective topical treatment for asthma. Interleukin-12, which is produced by monocyte-macrophage and B lymphocytic cell lines, plays an important role in the induction of Th1 cells; whereas interferon-gamma (IFN-gamma), mainly produced by Th1 cells, exhibits a crucial effect on macrophage and natural killer cell activation. Since previous studies have demonstrated a reduced production of IL-12 and IFN-gamma in patients with allergic asthma, we examined whether fluticasone propionate therapy could influence the release of these cytokines in asthma. We selected two groups of subjects (15 per group): nonatopic healthy donors (group A) and asthmatic patients (group B). Cytokine release was assessed in sera as well as in supernatants of whole blood cultures after IFN-gamma priming and lipopolysaccharide stimulation. Venous blood and spirometric tests from patients in group B were obtained before and after treatment. Fluticasone propionate therapy significantly increased interleukin-12 levels in both supernatants of blood cultures (1,152.12 +/- 225.57 vs. 540.87 +/- 130.07 pg/ml; p0.05) or in sera (72.24 +/- 15.76 vs. 10.83 +/- 2.70 pg/ml; p0.05). Patients treated with fluticasone propionate also displayed increased levels of IFN-gamma in either blood culture supernatants (59.12 +/- 16.88 vs. 18.87 +/- 7.53 IU/ml; p0.05) or in sera (5.60 +/- 2.87 vs.1 IU/ml; p0.05). In addition, we observed a significant increase in FEV1 values in asthmatic patients after fluticasone propionate therapy (51.86 +/- 5.31 vs. 71.46 +/- 10.37% predicted). We propose that fluticasone propionate may exert at least in part of its antiinflammatory activity through the modulation of the cytokine output.

Nonallergic rhinitis with eosinophilia (NARES), accounting for some 15% of perennial rhinitis, is a nasal disorder whose main features are eosinophil counts in nasal smear higher than 10% and negative IgE tests. The mainstay of treatment is topical corticosteroids.To evaluate the adjunctive effect of loratadine, a non-sedating antihistamine with anti-allergic activity, on nasal symptoms and eosinophil counts in nasal secretions in patients with NARES.Thirty patients with NARES were divided in two groups, half receiving flunisolide two 25 microg puffs per nostril morning and night plus loratadine 10 mg u.i.d. and half the same doses of flunisolide plus placebo, according to a double-blind fashion, for 3 weeks. The effectiveness of the treatment in the two groups was evaluated by comparing symptom scores and eosinophil counts, and safety was assessed by comparing the adverse effects.The loratadine treated group had better results both in nasal symptoms, with a decrease in sneezing (P0.000001) and rhinorrhoea (P0.006), respectively, corresponding with 73.4% and 66.7% with respect to 46.6% and 26.7% in the control group, and in eosinophil counts which decreased by 20% compared with 14.3% in patients treated with placebo and flunisolide. As to safety, only nasal irritation in two patients, one in each group, was reported.Loratadine improves the effectiveness of flunisolide in treatment of NARES with no change in safety, and with no sedation.

We report the case of a 32-year-old woman who had pruritic urticarial skin lesions associated with episodes of arthralgia. The first site affected by the eruption was the inside surface of the thighs; the patient also reported the presence of leukorrhea. The woman had previously been treated with H1 antagonist with moderate and transitory results; skin lesions reappeared just after the interruption of the treatment. Her biochemical data showed increased levels of erythrocyte sedimentation rate, blood eosinophilia and hypocomplementemia. Antinuclear antibodies, rheumatoid factor, cryoglobulins and serological diagnosis for hepatitis or mononucleosis viruses resulted negative. Considering the initial site of the cutaneous features and the presence of leukorrhea, we requested a vaginal smear and a culture of the cervical secretion, which revealed the presence of a Trichomonas infection. Furthermore, the SDS-PAGE revealed the presence of a molecular mass of 230,000 Da (230-kDa) in the serum, which indicated a Trichomonas surface protein. The following treatment with oral metronidazole caused the eradication of the Trichomonas infection after 3 weeks and subsequently the resolution of the urticarial clinical features. We wish to underline that in the presence of a case of urticaria vasculitis syndrome which seems to be without cause, it is important to investigate every diagnostic suspicion scrupulously.

We present a case of urticaria in a tattooed patient due to hypersensitivity to the cobalt chloride contained in the blue ink used for tattoo. The patch test with the series of International Contact Dermatitis Research Group was positive only for chloride cobalt. Cobalt is believed to be responsible for contact urticaria through a non-immunological mechanism. On reviewing the literature we have found no report of contact urticaria to cobalt in tattooed patients.

The aim of our study was to evaluate the efficiency and safety of mivacurium, comparing two dose-induction in patients undergone a minor orthopaedic surgery. 30 patients were divided into two groups and mivacurium were administered at the dose of 0.15 mg Kg-1 and 0.20 mg Kg-1 respectively. The results confirmed its efficiency in short surgery. Mioresolution was excellent only in the second group (0.20 mg Kg-1) despite an histamine-related blood pressure reduction.

The aim of the study was to evaluate the efficiency and safety of ropivacaine, in comparison with bupivacaine, in axillary brachial plexus block. 24 patients, undergoing upper limb surgery, was divided into 2 homogeneous groups and the local anaesthetics was administered: A (ropivacaine 0.75%, 25 ml; total dose 187.5 mg) and B (bupivacaine 0.5%, 25 ml; total dose 125 mg). The axillary plexus block was executed with the help of an electrostimulator. The results show that using ropivacaine the onset-time is lower and the duration of sensory and motor block is higher than using bupivacaine. In conclusion we can affirm that ropivacaine is a new step in local anaesthetic field.

Forty patients, monosensitized to Parietaria judaica with a clinical history of at least two years of rhinoconjunctivitis with or without asthma, were selected and randomly allocated in two groups. According to an open controlled experimental plan, twenty patients were submitted to sublingual immunotherapy (SLIT) with a solution of purified and biologically standardized extract of Parietaria judaica, following a preseasonal rush schedule. All patients, twenty belonging to the SLIT group and twenty belonging to the control group, were allowed to take authorized rescue drugs at need. At the end of the Parietaria pollen season. 15 patients for each group resulted to have complied with the criteria of the study. SLIT tolerance turned out to be excellent as no side effects were noticed in the group under treatment. No change could be detected in specific IgE and IgG4 in either group. According to the daily symptom and drug scores registered by each patient in a diary card, the SLIT group showed a statistically significant lower symptom score (p = 0.032) and lower drug plus symptom score (p = 0.037) during the peak pollen period (May-June 1994) in comparison to the group treated only with symptomatic drugs. Moreover, 13 out of 15 patients submitted to SLIT expressed a very favourable subjective opinion about the therapy and asked to continue the same treatment the following season. According to our results, the rush SLIT schedule, followed by maintenance during the pollen season, is simple, safe and effective for Parietaria pollen allergy and showed an excellent compliance.

In a group of 80 patients (50 male and 30 female) aged between 44 and 65, affected by alcoholic liver disease (46 with steatosis and 34 with liver cirrhosis) the Authors examined the relationship between the plasma lipid, in particular of Lp(a), and the incidence of vascular atherosclerotic plaques. The results were compared with those found in the controls (50 subjects of similar age, social and working status to that of the above patients but nondrinkers without liver or other metabolic disease). In the patients with steatosis we found a moderate increase in plasma lipid fractions including total, HDL and LDL cholesterol, but low levels of Lp(a), with an incidence of arterial plaques of 10.86%. In those with liver cirrhosis the findings were characterized by low levels of lipids and in particular of Lp(a), with an incidence of arterial plaques of 8.82%, decidedly less marked than in the controls (16%). In both cases the low incidence of vascular involvement appears to be in some way linked with low levels of Lp(a) and the severity of liver disease and not with the behaviour of HDL cholesterol.

In evaluating the significance of arrhythmias and ECG changes during exercise, 42 consecutive patients (pts) with mitral valve prolapse (MVP) underwent a symptom-limited cycloergometer Exercise Stress Test (EST) with load increase of 25 watts every 3 minutes. Eight patients (19%) were positive for anamnestic cardiopalm. The patients were divided in 2 groups, according to echocardiographic evidence of the MPV: group A (12 patients, mean age 32 +/- 13) with prolapse of one mitral leaflet and group B (30 patients, mean age 30 +/- 13) with prolapse of both mitral leaflets. Exercise duration doesn't differ significantly in the two groups. No arrhythmias during EST were found in group A, while arrhythmias were present in 6 patients (20%) in group B. A strong correlation was found between anamnestic cardiopalm and arrhythmias during EST (6/8 = 75%). Three of four patients (75%) with ST impairment during EST, showed at thallium myocardial scintigraphy a non reversible perfusion defect after exercise. These data showed a higher incidence of arrhythmias during EST in patients with MVP of both leaflets and good relationship with symptomatology of cardiopalm.

In this study relationships between local venous lactate concentrations and power spectrum changes in surface EMG due to fatiguing isometric contractions were investigated. Two different isometric efforts of the opponents pollicis muscle, 25% and 50% of maximum voluntary contraction, were examined. In 25% of maximum voluntary contraction no changes in local venous lactate were observed, whereas mean power frequency values of surface EMG shifted significantly towards lower frequencies. On the contrary, in 50% of maximum voluntary contraction lactate significantly increased and was related to the mean power frequency shifts of the surface EMG. These data suggest that lactate plays a role in muscle fatigue only in a limited intensity range of isometric muscle contractions.

The authors verified the hypothesis regarding an unawareness of possible febrile alterations during night sleep in patients with Hodgkin's disease who complain of night sweats as their only symptom. In these patients, body temperature was monitored by means of a 0.01 degrees C-sensitive linear transducer coupled with a digital multimeter. The palm of the hand (after it was passively closed in a fist by a full bandage) was the body site where temperature measurement was found to be most comfortable for a sleeping patient and independent of movements during sleep. A good correlation was found between the hand temperature taken with this technique and oral temperature. Of six patients with sweating as their only symptom, sweating recurred during the night in four and during the afternoon in the other two. In all patients sweating was preceded by a critical 0.5 to 1.5 degrees C increase in hand temperature, which took place no more than 30 minutes before sweating. Those with nocturnal sweats awakened during the subsequent sweating-related, rapid temperature decrease. These results are consistent with the occurrence of slight unperceived febrile pulses that precede sweating. The only peculiarity of night sweats consists in the higher probability that a preceding slight temperature rise may not be perceived by a sleeping patient, who is more likely to be awakened by the discomfort of the subsequent sweating. This would also explain the small prognostic significance of these sweats, which is the same as that of the preceding fever. These results are discussed in light of the increasing clinical evidence that patients with Hodgkin's disease are often affected by an instability of the thermoregulatory hypothalamic centers.

A coprological survey was carried out in 1982-1983 in East Boè and in Canhabaque Island, (Bijagòs Islands), where 289 and 288 specimens of stools, respectively, have been collected. The samples were taken from apparently healthy subjects, of both sexes and of different age groups. The tests were made according to the modified Ritchie technique. The following results were obtained: A) East Boè: 1) Protozoa: E. coli 68.9%, E. nana 24.6%, G. intestinalis 8.7%, I. buetschlii 5.9%, E. histolytica 1.7%, E. hartmanni 0.7%, T. intestinalis 0.7%. b) Helminths: Ancylostomatidae 69.2%, T. trichiura 38.4%, S. stercoralis 6.2%, Taenia sp. 1.7%, H. nana 0.7%, S. haematobium 0.7%, S. mansoni 0.7%, S. fuelleborni 0.7%. B) Canhabaque: a) Protozoa: E. coli 85.1%, I. buetschlii 14.9%, E. nana 12.5%, G. intestinalis 8.3%, C. mesnili 7.3%, E. hartmanni 1.4%, E. histolytica 1.0%, T. intestinalis 0.4%. b) Helminths: Ancylostomatidae 87.9%, T. trichiura 9.4%, S. stercoralis 7.9%, S. fuelleborni 2.8%, Trichostrongylus sp. 1.4%, A. lumbricoides 0.7%, H. nana 0.4%. Eggs of Capillaria sp. probably pseudoparasites, were found in 8.7% of samples. The high prevalence of Ancylostomatidae infections appears to be related to the heavy fecal pollution all over the examined territory. The utilization of antihelminthic drug of popular medicine, which has a specific action on A. lumbricoides, could explain the lack and the low prevalence, respectively, of A. lumbricoides infections in both examined areas. In the past, other authors emphasized the low prevalence of this parasite for other Guinea Bissau regions which have a different geomorfological constitution. The cases of S. fuelleborni and H. nana are the first reported for Guinea Bissau.

A new uncemented prosthetic stem based on a screw system is presented. The biomechanical, metallurgic and technical principles on which this innovation is based are discussed. The indication and surgical technique are described and 73 cases are reported. The new stem is easy to apply and makes it possible to regulate anteversion precisely, and above all, to satisfy the preconceived biomechanical requirements. Some cases with a shorter follow-up are included because we allowed a suitable time lapse after our earlier cases before extending our indication. However, there is considerable documentation of screw stems in the literature on the long term toleration of screw stems.