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Objectives: REM sleep is known to reduce epileptic activity. Here we test the hypothesis that phasic REM (P-REM) sleep has a higher suppressive effect on IEDs than tonic REM (T-REM), investigating the distribution of IEDs with intracerebral implanted electrodes (stereo-EEG), in drug resistant epileptic patients, across REM sleep. IEDs distribution was analyzed in two patient groups: a) with hippocampal sclerosis (HS) b) with focal cortical dysplasia (FCD). Methods: Night combining scalp-stereoEEG recordings were chosen. Sleep scoring was performed from scalp-EEG; P-REM and T-REM epochs were distinguished on the basis of eye movements-bursts (at least three in a 30 seconds epoch); moreover, eye-movements bursts (EM) were marked. Spikes were recognized with a semi-automated system on contacts recording from the HS and the FCD. Statistical analyses compared spike density in P-REM and T-REM and during EM and out of EM. Results: Nine recordings were analyzed (5FCD, 4MTS); 83.36 minutes of REM sleep were scored (66.53% P-REM, 34.47% T-REM; 50.1% time spent with EM). Spike rate (IEDs/min) was calculated for each condition. A signi fi cant reduction of IEDS was in found in P-REM with respect to T-REM (P < 0.05), with a percentage change of 33.35%. This variation resulted much higher, 74.16%, when comparing IEDs during EM and out of EM (P < 0.01). This behavior was confirmed also in the single groups (HS and FCD). Conclusion: Our data show that, independently from the histopathological substrate, REM sleep with EM exerts a stronger suppression effect on IEDs with respect to REM sleep without EM.

E Nettis1, G F Calogiuri2, E Di Leo1, F Cardinale3, L Macchia1, A Ferrannini1, A Vacca1,41Section of Allergology and Clinical Immunology, Department of Internal Medicine and Infectious Diseases; 24th Pneumology Department, Pneumologic Hospital A Galateo, San Cesario di Lecce, Italy; 3Department of Biomedicina dell’Età Evolutiva, Pediatrics Unit “S Maggiore”; 4Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, ItalyAbstract: Levocetirizine is the pharmacologically active enantiomer of cetirizine. It is a potent histamine H-1 receptor antagonist with anti-inflammatory and antiallergic properties. The review analyses the levocetirizine’s properties in terms of safety and efficacy both in allergic rhinitis and urticarioid syndromes.Keywords: allergic rhinitis, chronic idiopatic urticaria, levocetirizine

We tested middle-ear functioning in humans following intense exposure to noise. Noise generated by small caliber firearms was thought to have no effect on the middle-ear.A cross-over design. We measured middle-ear impedance, acoustic reflex, distortion product otoacoustic emissions (DPOAEs), and transient evoked otoacoustic emissions (TEOAEs) before and after practice rounds performed twice per day.Fifty-nine soldiers equipped with earplugs undergoing regular training for a special mission. The mean noise exposure (LAeq8h) was estimated to be 106 ±1 dB SPL.Impedancemetry revealed a significant increase in the compliance and gradient of the tympano-ossicular chain after impulse noise exposure in the right and left ears. Acoustic reflex reactivity did not show a significant change. DPOAEs and TEOAEs were slightly decreased at 2 kHz, and showed a marked asymmetry in disfavor of the left ear. In soldiers with initial high reactivity of acoustic reflex, increased compliance was associated with a significant decrease in left TEOAEs at 1.5 and 2 kHz.Our results suggest that the use of small-caliber firearms, even while wearing earplugs, affects middle-ear function and may play a role in the early stage of auditory fatigue encompassing tinnitus.

Using anisotropic elasticity theory, we analyze the relative thermodynamic stabilities of strained graphitic (hexagonal) BN and cubic BN (cBN) single-crystal structures for all orientations of biaxial stress and strain fields relative to the crystallographic directions. In hBN, the most thermodynamically stable orientation has the graphitic basal planes oriented roughly 45° relative to either the plane of stress or strain. For cBN, the lowest-energy configuration differs for the constant stress or constant strain assumptions. Importantly, these most-stable orientations of hBN and cBN differ from those found experimentally for graphitic BN and cBN in polycrystalline BN films produced by energetic deposition processes. Therefore, the observed textures are not those that minimize elastic strain energy. We discuss possible origins other than elastic strain–energy effects for the observed textures.

We have examined the effect of the substrate in cubic boron nitride (c‐BN) film synthesis by depositing BN films on a variety of materials using ion‐assisted pulsed laser deposition. Using optical modeling, we estimated the c‐BN content of the films from the measured infrared reflectance spectra. We find less c‐BN in films grown on metal substrates than in films grown on Si and SiC/Si substrates. The c‐BN content of the films decreased with decreasing substrate microhardness. This result is qualitatively consistent with the model of stress‐induced c‐BN film formation.

The influence of environmental conditions on cubic boron nitride (cBN) film adhesion to silicon substrated was investigated. cBN films were deposited on (100)-oriented silicon substrates by ion-assisted pulsed laser deposition. The irradiating ions were mixtures of nitrogen with (i) argon, (ii) krypton and (iii) xenon. Under room-ambient conditions, the films delaminated in the following time order: N/Xe, N/Kr and N/Ar. cBN films deposited using N/Xe ion-assisted deposition were exposed to four environmental conditions for several weeks: a 1 mTorr vacuum, high humidity, dry oxygen and dry nitrogen. Films exposed to the humid environment delaminated whereas those stored under vacuum or in dry gases did not. Films stored in dry nitrogen were removed after nearly 2 weeks and placed in the high-humidity chamber; these films subsequently delaminated with 14 h. It is concluded that the presence of a humid environment facilitates the delamination of BN thin films from silicon substrates. A model of the interaction between water and the interfacial material is also presented.

We have investigated how ion irradiation can selectively promote the formation of dense sp3-bonded cubic boron nitride (cBN) over the graphite-like sp2-bonded phases. We have conducted a series of experiments using ion-assisted pulsed laser deposition in which either the ion mass (mion) or ion energy (E) was varied in conjunction with the ratio of ion flux to depositing atom flux (J/a). For a fixed ion energy and mass, there is a critical J/a above which cBN formation is initiated, a window of J/a values in which large cBN percentages are obtained, and a point at which J/a is so large that the resputter and deposition rates balance and there is no net film deposition, in agreement with Kester and Messier. As do Kester and Messier, we find that cBN formation is controlled by a combination of experimental parameters that scale with the momentum of the ions. However, unlike Kester and Messier, we do not find that cBN formation scales with the maximum momentum that can be transferred in a single binary collision, as either incorrectly formulated by Targove and Macleod and used by Kester and Messier, or as correctly formulated. Instead we observe that cBN formation best scales with the total momentum of the incident ions, (mionE)1/2. We also consider the mechanistic origins of this (mionE)1/2 dependence. Computer simulations of the interaction of ions with BN show that cBN formation cannot be simply scaled to parameters such as the number of atomic displacements or the number of vacancies produced by the ion irradiation. A critical examination of the literature shows that none of the proposed models satisfactorily accounts for the observed (mionE)1/2 dependence. We present a quantitative model that describes the generation of stress during ion-assisted film growth. The model invokes a kinetic approach to defect production and loss. We apply a simplified version of the model to cBN synthesis, and find that it predicts an approximate (mionE)1/2 dependence for cBN formation.

Background: The cytokinesis-block micronucleus test (MNT), as a marker of chromosomal mutagen sensitivity, was applied in a number of studies enrolling breast cancer (BC) patients and subjects with known or putative genetic predisposition to BC. The large majority of them involve the evaluation of induced micronuclei (MN) frequency in peripheral lymphocytes, after the in vitro challenge with ionising radiations. Methods: The aim of the present systematic review and meta-analysis is to investigate the role of MN assay in the identification of individuals at increased risk of BC and its potential use as prescreening test in women with a family history (FH) of BC. Results: Twelve studies were included in the meta-analysis, covering a time interval 1998–2007, and including 752 cases and 593 controls. Among the cases, 629 are cancer patients and 123 are cancer-free subjects, including 32 first-degree relatives of the susceptible subjects and 91 BRCA1/2 mutation carriers. Our meta-analysis reveals a significant increase of baseline MN frequency related to cancer status, but the association with FH of BC and specifically with BRCA mutations is not clear. A larger difference in MN frequency between cases and controls was observed after in vitro challenge, but response to radiation exposure doesn't appear to better discriminate cancer-susceptible subjects. Conclusion: Our study suggests the presence of some bias affecting many of these studies, reinforcing the suggestion that a more rigorous study design is needed in this area.

Thin films of iridium and gold were deposited using the saddle‐field source with argon as the sputtering gas. The purpose of this investigation was to determine the effects of deposition parameters on the grain size and composition of the films with thicknesses of 1.0, 2.5, and 5.0 nm, which are typical of the coatings used for high resolution electron microscopy. The films were deposited onto amorphous carbon films using ion beam sputtering, and as expected, the grain size of the films increased with the thickness, and the average grain size showed a dependence on the ion source energy. No oxides were formed in either the iridium or gold films.

The structure and composition of thin, conductive metallic films of chromium and iridium that are typical of the coatings used for electron microscopy is described. The purpose of this study was to determine the grain size and composition of the films deposited, with thicknesses of 1 nm, 2.5 nm, and 5 nm, onto amorphous carbon films using ion beam sputtering with argon as the sputtering gas. A comparison between chromium films deposited under conditions of liquid nitrogen (LN) trapping or of no trapping revealed slight differences in their microstructure. As expected, the grain size of the films increased with the thickness, and the average grain sizes varied between 10 and 25 nm. Grain size was also found to depend on the source of ion beam energy; the correlation between grain size and beam energy was more pronounced in the iridium films than in the chromium films. This effect was greater when the deposition chamber was not LN trapped. As the ion beam energy increased from 18 W to 24 W, there was a corresponding increase in grain size in some of the films. Although transmission electron diffraction analysis indicated the presence of about 5% chromium oxide in the chromium films, no oxide was detected in the iridium films.

The biaxial modulus of polycrystalline diamond (PCD) films deposited by microwave plasma assisted chemical vapor deposition on silicon substrates has been investigated. The amount of hydrogen incorporated in the PCD films is determined using Fourier transform infrared spectroscopy. Additional characterization of the PCD films is performed using x‐ray diffraction, Raman spectroscopy, and scanning electron microscope analysis. Biaxial moduli of PCD films containing 0.9% and 0.3% hydrogen have been found to be 960 and 1177 GPa, respectively. Comparison with the biaxial modulus of 1228 GPa for a randomly oriented aggregate of bulk diamond is discussed.

Background SAVI syndrome is a recently identified condition associated to mutations of TMEM173. Up to know only few cases of this disease have been described. Objectives To describe the clinical manifestation of an Italian patient affected by SAVI syndrome Results The girl, first born from healthy, not relatives parents, at the age of 8 months started to present erythematosus-infiltrated skin lesions with pustular evolution and finally hesitating in scars in 15-20 days. From the age of three years chilblains and severe nail dystrophy appeared. At the age of 8 years the girl presented a severe pneumonia, requiring prolonged antibiotic therapy. The chest CT performed showed, in addition to the lung infiltrate, the presence of diffuse interstitial thickening with ground-glass appearance. A restrictive framework was detected at spirometry (FVC 51%). The autoantibodies detection revealed positive ANA (1: 160), ANCA (1:80) and Coombs test; rheumatoid factor was slightly increased. Anti-DNA and ENA were negative. The skin biopsy revealed a predominantly granulomatous nodular dermatitis, with aspects of deep granulomatous folliculitis and secondary fibrosis. The lung biopsy revealed focal hemorrhage, edema and predominantly lymphocytic inflammatory aggregates in the peribronchial interstitial areas with aspects of capillaritis and contiguous focal subatelettasia with alveolar cavity filled of macrophages. In the following months, in light of the progression of the disease, steroidal treatment (prednisone 1 mg/kg/day) was started with improvement of clinical manifestation, anemia and normalization of inflammatory markers. However attempts to reduce such therapy were followed by an exacerbation of the clinical picture. In the attempt to reduce steroidal treatment, the child was treated wit both immunosuppressive (azathioprine) and biologic (etanercept) drugs, without clear improvement. Unsatisfactory growth was also detected. In the following months the child started to present a mild renal involvement with microscopic hematuria and hypertension, requiring anti-hypertensive treatment. Given the evocative framework, interferon gene signature was performed, revealing a significant activation; the molecular analysis of TMEM173 gene showed the presence of the de novo Val155Met mutation, already described as causative of SAVI syndrome. The child continued to present persistent severe microcytic anemia, requiring erythrocytes9 transfusions, despite high levels of erythropoietin. Bone marrow aspiration was therefore performed, that revealed dysmaturative signs in the in erythroid progenitors. Conclusions This report of the first Italian patient with SAVI syndrome confirms the presence of the previously described clinical manifestations. Persistent hematuria and hypertension are reasonably signs of an underlying renal involvement, not previously described in this condition. Thus a renal biopsy is needed for confirmation. The origin of severe anemia is still unclear. Thus a possible deregulatory effect of mutated STING protein on bone marrow progenitors has to be investigated and is actually under study in our patient. Disclosure of Interest None declared

A study of antibody levels (in saliva and blood) against common vaccine antigens was performed in a population of 32 children suffering from recurrent upper respiratory tract infections (URTI). None of the patients had primary or secondary immunodeficiency syndromes or other known predisposing factors for respiratory diseases. Titres of the isotype-specific antibodies immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) against two vaccine antigens--poliovirus type 3 (P3) and tetanus toxoid (TT), a viral antigen and a bacterial antigen, respectively--were measured in unstimulated saliva and serum, both in patients and in 24 healthy children (controls), by using a standard enzyme-linked immunosorbent assay (ELISA). In addition, levels of total IgA and avidity of IgA antibodies to both P3 and TT in saliva were evaluated. No difference was found between patients and controls as to levels of total IgA, or specific IgA and IgM antibodies against both P3 and TT in saliva. Furthermore, the avidity of salivary IgA antibodies against the two antigens did not differ between the two populations. However, the average concentrations of saliva-specific IgG antibodies to both the viral and the bacterial antigen were significantly lower (p0.01 for P3 and p0.05 for TT, respectively) in saliva of children with recurrent URTI, whereas no difference was found in serum for any immunoglobulin isotype determined compared with healthy individuals. The results of the present study provide suggestive evidence for the existence of subtle IgG-restricted defects in antibody responses at the mucosal level, but not at the serum level, in some children with undue susceptibility to URTI.

Our understanding of cortical alterations and related epilepsies has grown enormously in the last decade thanks to the explosion of basic information from laboratory neuroscience combined with advances in diagnostic tools, therapeutic approaches and surgical techniques. In the present paper, we briefly review the most important advances in these fields from the point of view of the clinician concerned with cortical malformation-related epilepsies. We propose that a highly effective way forward, expected not only to widen knowledge of the basic mechanisms of seizure generation, but also to improved the management of patients, would be to promote interdisciplinary research programmes on resected human cortex that involve neurosurgeons, neurologists and laboratory neuroscientists.

We give a description of stereotaxic methodology as originally elaborated by the S.te Anne Hospital School in Paris, and successively modified and utilised in Niguarda Hospital in Milan. Performing a stereotactic arteriography and ventriculography should allow the appreciation of minimal modification of vascular anatomy, identification of sulci and gyri by utilising stereoscopic technique and the proportional grid, based on bicommissural line, evaluation of the morphological abnormalities and their precise reconstruction in the intracranial space. Anatomical information obtained by this kind of examinations are essential for intracerebral stereo-EEG investigation and for planning surgical procedure.

We make an overview of the most significant historical steps of the temporal lobe epilepsies surgical treatment, from the first description, at the end of 19th century, to recent times. We also describe the history of neuropsichological testing (mainly Wada test), extra- and intra-cranial EEG-recordings, synchronised electro-clinical monitoring, structural and functional neuroimaging. We mainly tried to point out that the selection of candidates to surgical treatment should be based, despite any technological development, on a synoptical anatomo-electroclinical reasoning.

This paper reports the first demonstration of MOS device fabrication using extreme ultraviolet lithography. The alignment strategy, mask layout, mask fabrication, and device characteristics will be reported.

To determine the safety and efficacy of intravenous adenosine as used in the emergency department (ED) for the treatment of presumed supraventricular tachycardia, the investigators performed a retrospective chart review in an urban, university-affiliated ED. Seventy-two consecutive patients were treated with intravenous adenosine for presumed supraventricular tachycardia. Of the 72 patients who were treated with adenosine, 46 patients had a confirmed diagnosis of supraventricular tachycardia. Of these, 39 or 46 (84.8%) converted to sinus rhythm after treatment. Of patients who successfully converted to sinus rhythm, none had recurrent tachycardia or required additional pharmacotherapy. Arrhythmias not successfully treated among the initially misdiagnosed patients were atrial fibrillation (n = 11), atrial flutter (n = 7), tachycardia of other origin (n = 5), and ventricular tachycardia (n = 2). No clinically significant adverse effects were noted among the stydy population. Intravenous adenosine is a safe and efficacious treatment for the emergent treatment of supraventricular tachycardia, including unstable patients (with hypotension and/or chest pain). It is also safe among patients initially presumed to have supraventricular tachycardia, who are later diagnosed with other arrhythmias.

The antibody levels and relative avidity of serum IgM and IgG aniibodies against E. coli O antigens, poliovirus type 1 and /J-lactoglobulin were determined with enzyme-linked immunosor-bent techniques in IgA deficient (IgAd) patients with frequent respiratory tract infections an d healthy IgAd individuals. Heallhy individuals with normal tmmunoglobulin levels served as controls. The IgM antibody levels against the bacterial, viral and food antigens and the IgG antibody levels against the bacterial antigens were significantly higher in the IgAd group with recurrent infections than in the group of healthy IgAd individuals. The symptomatic IgAd group had significantly higher levels of the IgG antibodies against the bacterial antigen, also when eompared with controls. In contrast the healthy IgAd individuals had the highesi avidities of IgM antibodies to the viral and food antigens. The high avidities of aniibodies could be a compensatory host defence mechanism in IgAd. These aberrations may appear as a consequence of increased mucosal exposure in IgAd to antigens such as E. coti or/f-lactoglobulin. but presumably not to poliovirus which is only exceptionally present in the milieux. They could also be a result of the previously suggested dysregulation of antibody responses in IgAd.

Dose response curves were established for local control of the rat rhabdomyosarcoma BA1112 for radiation alone and for radiation following a cytoreductive operation. Removal of one-half of the tumor prior to irradiation did not significantly alter the dose of radiation necessary to cure 50 per cent of the tumors. This experimental result confirms the theoretic predictions and suggests that, to be useful in combination with radiation, surgical treatment must remove in excess of 90 per cent of the tumor.

The results of treatment with radiation therapy of 65 cases of epidermoid carcinoma of the palatine tonsil have been reviewed. The major determinant of prognosis is the stage of the primary lesion. Failure usually results from the inability to control local grossly detectable tumor. Thirteen of thirteen T1 lesions but only two of sixteen T3 lesions were locally cured with external beam radiation therapy. No difference in survival was noted between patients with no clinical adenopathy vs those with clinically involved movable ipsilateral adenopathy.

Vitamin D plays a pivotal role in the regulation of calcium-phosphorus metabolism, particularly during pediatric age when nutritional rickets and impaired bone mass acquisition may occur. Besides its historical skeletal functions, in the last years it has been demonstrated that vitamin D directly or indirectly regulates up to 1250 genes, playing so-called extraskeletal actions. Indeed, recent data suggest a possible role of vitamin D in the pathogenesis of several pathological conditions, including infectious, allergic and autoimmune diseases. Thus, vitamin D deficiency may affect not only musculoskeletal health but also a potentially wide range of acute and chronic conditions. At present, the prevalence of vitamin D deficiency is high in Italian children and adolescents, and national recommendations on vitamin D supplementation during pediatric age are lacking. An expert panel of the Italian Society of Preventive and Social Pediatrics reviewed available literature focusing on randomized controlled trials of vitamin D supplementation to provide a practical approach to vitamin D supplementation for infants, children and adolescents.