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Agents who pursue optimal portfolio choice by optimizing a univariate objective (e.g., an expected utility) obtain optimal payoffs that are increasing with each other (situation of no diversification). This situation may lead to an undesirable level of systemic risk for society. A regulator may consider a global perspective and aim to enforce diversification among the various portfolios by optimizing a suitable multivariate objective. We explain that optimal solutions satisfy a notion of multivariate cost-efficiency and provide an algorithm to obtain multivariate cost-efficient payoffs. We also assess the cost of diversification and provide the strategy that the regulator should pursue for obtaining the desired level of diversification.

Background The DAPA–HF and the EMPEROR reduced trials showed that sodium–glucose cotransporter type 2 inhibitors (SGLT2i) dapagliflozin and empagliflozin, on best medical therapy, resulted in a reduced incidence of the combined primary outcome cardiovascular death and worsening heart failure (–26%) and a preventive effect on renal function decline. Based on this evidence, the 2021 ESC guidelines have included SGLT2i in class I recommendations in combination with angiotensin and neprilysin receptor inhibitors (ARNI) or ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB), beta–blockers (BB), and mineral corticoid receptor antagonists (MRA). However, the effect of adding SGLT2i in real–life patients is just partly known. The aim of the study was therefore to evaluate the impact of SGLT2i in a real world population of patients with heart failure and reduced left ventricular ejection fraction (HFrEF). Methods 220 consecutive patients with HFrEF, treated with SGLT2i and with 6 months of follow–up already enrolled in the PONTE (BRIDGE) HF project (PDTA FOR THE INTEGRATED FOLLOW–UP IN THE HOSPITAL TERRITORY OF THE PATIENT WITH HEART FAILURE), a care model implemented in Puglia region (Italy) based on hospital–territory integration aimed at the optimized management of patient with HF after hospitalization, were considered for the study. Demographic, clinical, laboratory and instrumental characteristics and changes in NYHA class, creatinine, NT proBNP, loop diuretic dose, LVEF after initiation of therapy with SGLT2i were evaluated. Results The 220 enrolled patients (mean age of 62 years, 72% hypertensive, 38% diabetic, 67% with ischemic heart disease, 50% with ICD/CRT, 44% with atrial fibrillation, 5.6% in NYHA class I, 61% class II, 33% class III, mean LVEF 30±11%) were in treatment with BB in 93% of cases, with MRA in 94%, with ACE/ARB in 24% and with ARNI in 80%. At 6–month follow–up of, a reduction of patients in NYHA class III from 33 to 20%, an increase in patients in NYHA class II from 61 to 70%, and in NYHA class I from 5.6 to 10% were observed; the LVEF (30 vs 37.2%) and creatinine values (1.3 vs 1.5) increased significantly, while loop diuretic doses decreased (35 vs 97.5). Conclusions Data from patients treated with SGLT2i from real world seem to confirm the efficacy of this class of drugs already in a short term follow–up, with a positive effect on NYHA class, LVEF, and renal function.

There are numerous clinical conditions in which symptoms and signs may overlap, among these myocardial Ischemia in the absence of obstructive coronaropathy (INOCA/MINOCA), gets into differential diagnosis with a plethora of clinical pictures such as Takotsubo syndrome, myocarditis and cardiomyopathies. In this setting, cardiac magnetic resonance has a critical discriminating role. Herein we report the clinical case of a 52–year old patient suffering from hypertension and dyslipidaemia, with a history of chest pain episodes and recent intense psychophysical stress. After symptoms exacerbation, ambulance was called, loss of conscience was witnessed, observing ventricular fibrillation, subjected to prompt DC shock. Once in Emergency room, ECG showed ST–elevation in V1, V2 and AVR for which urgent coronary angiography was performed. It surprisingly resulted negative for epicardial coronary artery disease. Moderate left ventricular dysfunction (LVEF 45%) was found on 2D ultrasound along with apex akinesia, while mild elevation myocardial necrosis enzymes was seen at blood tests. The clinical picture characterized by female sex, history of psychophysical stress, by association of chest pain, ischemic type alterations of repolarization at ECG, akinesia of the apex and the concomitant slight elevation of myocardial necrosis enzymes in the absence of epicardial coronary lesions, highly suggested Tako–Tsubo Syndrome. In order to confirm the diagnosis, cardiac MRI was performed which, unexpectedly, showed the presence of oedema on T2–weighted STIR sequences at the level of the left ventricular apex, associated to same site transmural fibrosis at post–contrast imaging sequences, thus eliciting the hypothesis of a MINOCA. After a new retrosternal pain with transient ST–elevation in V1, a IVUS – guided new coronary angiography examination was performed, resulting intoIVA diffuse coronary spasm, reduced after intravenous nitrate administration. Final diagnosis was “MINOCA complicated by primary VF‘‘ and a subcutaneous AICD implant CMR imaging by virtue of its ability to provide information about cardiac structure and function and simultaneously, to define the characterization of tissues, together with the data of dynamic coronary spasm, proved to be essential in this case to establish the diagnosis, often misunderstood, of MINOCA, hence allowing to define the best therapeutic strategy. ​

Background Drug therapy of patients with chronic heart failure (HF) with mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF) remains a challenge. We aimed to assess whether escalating neuro–humoral–modulation (NHM) (renin–angiotensin system inhibitors (RASI), betablockers (BB), mineralocorticoid receptor antagonists (MRA)) was differentially associated with outcome according to phenotype and age groups. Methods and Results Between 1999 and 2018 we recruited in a nationwide cardiology registry 4707 patients (HFmrEF n=2298, HFpEF n=2409) and classified them into 3 age groups: young ( Conclusions In a cardiology setting, among HF outpatient with EF>40%, prescription rates of triple NHM increased over time and were associated with better patient outcome.

Background A careful and integrated follow up after hospitalization for heart failure (HF) may represent a feasible strategy to optimize the adherence to ESC guidelines and reduce the occurrence of adverse events (mortality, re–hospitalizations). Methods A strict integration between hospital and local health district proximity office cardiologist through an integrated clinical data sharing software has been implemented in Apulia region, Italy, in order to optimize the management of the HF patient after an hospitalization: the PONTE (PDTA FOR INTEGRATED FOLLOW–UP TERRITORY HOSPITAL OF THE PATIENT WITH CARDIAC HEART FAILURE) (bridge) project. As until December 2021, 1200 patients with HF have been enrolled in the project, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). Adherence to ESC HF guidelines in HFrEF patients before vs after December 2020 was compared. Results In the HFrEF population (56%) the mean age was 63 years, 38% were hypertensive, 15% diabetic, 40% had ischemic heart disease, 42% were previously treated with coronary angioplasty, 56% had an ICD/CRT, 22% had atrial fibrillation. Mean NYHA class was 2.2, mean LVEF 30%, mean NT–proBNP values 4027 pg/mL, mean serum creatinine 1 mg/dL, 91% were taking beta–blockers (BB), 86% mineral corticoid receptor antagonists (MRA), 98% ACE–inhibitors/angiotensin–receptor–antagonists/neprilysin and angiotensin receptor antagonists (ACE/ARB/ARNI), and 13% ARNI. Compared to patients enrolled before 2020, ARNI prescription increased in 2021 (60% vs 13%, p Conclusions The implementation the PONTE project shows an improved adherence to ESC HF guidelines.

Background Heart rate is able to impact on the prognosis if patients with cardiovascular diseases. The aim of this study was to evaluate the impact of heart rate at discharge of patients with ACS and/or coronary revascularization on long–term follow–up Methods This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause mortality at one–year follow–up. Results We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. Heart rate at discharge was 65.5 ± 11.3 bpm. At univariate regression analysis, age, systolic and diastolic arterial pressure, body mass index, smoke habit, diabetes, hypertension, high–density lipoprotein and total cholesterol, creatinine, haemoglobin, fasting glycemia, left ventricle ejection fraction, heart rate, use of ACEi/sartans, statins, dual/triple anti–thrombotics were all related to all–cause mortality. Nevertheless, at multivariate Cox regression analysis, age (β coefficient: 0.07117 ± 0.01942, p = 0.0002), history of hypertension (1.4823 ± 0.7476, p = 0.0474), and heart rate (0.04409 ± 0.01278, p = 0.0006) remained related to the primary endpoint. Conclusions Heart rate confirmed to act as a long–term predictor of all–cause death in patients with ACS.

Wastewater treatment plants (WWTPs) are known sources of contaminants of emerging concern (CECs) spreading into the environment, as well as, of unpleasant odors. CECs represent a potential hazard for human health and the environment being pharmaceutical or biologically active compounds and they are acquiring relevance in European directives. Similarly, the public concern about odour emissions from WWTPs is also increasing due to the decreasing distance between WWTP and residential areas. This study focuses on the effectiveness of the recently developed MULESL technology (MUch LEss SLudge; WO2019097463) in removing CECs and limiting odour emissions from WWTPs. MULESL technology has been developed for its ability to reduce up to 80% the sludge production from WWTPs. However, it is ought to evaluate if the benefits coming from sludge production reduction do not invalidate CECs removal or negatively affect odour emissions. Thus, the performances of a MULESL and a conventional WWTP (flow rate of 375 m3/d and 3600 m3/d, respectively) were compared while treating the same municipal sewage. Whereas both plants succeeded in removing the traditional gross parameters characterizing wastewaters (e.g. chemical oxygen demand, nitrogen), the MULESL was much more effective than the conventional one in terms of CECs removal for about 60% of the identified compounds showing, however, the same or lower effectiveness for about 30% and 10% of them, respectively. This result was attributed to the high sludge retention time and biomass concentration in the MULESL (enabling enrichment of slow growing microorganisms and forcing biomass to use unusual substrates, respectively), and to the biomass feature to grow in the form of biofilm and granules (favoring micropollutants absorption on biomass). Furthermore, odour impact analysis has shown that the MULESL was characterized by a much lower impact, i.e. 45% lower than that of primary and secondary treatments of the conventional WWTP.

Our aim was to enhance the spontaneous slow-frequency EEG activity during the resting state using oscillating transcranial direct currents (tDCS) with a stimulation frequency that resembles the spontaneous oscillations of sleep onset. Accordingly, in this preliminary study, we assessed EEG after-effects of a frontal oscillatory tDCS with different frequency (0.8 vs. 5 Hz) and polarity (anodal, cathodal, and sham). Two single-blind experiments compared the after effects on the resting EEG of oscillatory tDCS [Exp. 1=0.8 Hz, 10 subjects (26.2 ± 2.5 years); Exp. 2=5 Hz, 10 subjects (27.4 ± 2.4 years)] by manipulating its polarity. EEG signals recorded (28 scalp derivations) before and after stimulation [slow oscillations (0.5-1 Hz), delta (1-4 Hz), theta (5-7 Hz), alpha (8-12 Hz), beta 1 (13-15 Hz) and beta 2 (16-24 Hz)] were compared between conditions as a function of polarity (anodal vs. cathodal vs. sham) and frequency of stimulation (0.8 vs. 5 Hz). We found a significant relative enhancement of the delta activity after the anodal tDCS at 5 Hz compared to that at 0.8 Hz. This increase, even though not reaching the statistical significance compared to sham, is concomitant to a significant increase of subjective sleepiness, as assessed by a visual analog scale. These two phenomena are linearly related with a regional specificity, correlations being restricted to cortical areas perifocal to the stimulation site. We have shown that a frontal oscillating anodal tDCS at 5 Hz results in an effective change of both subjective sleepiness and spontaneous slow-frequency EEG activity. These changes are critically associated to both stimulation polarity (anodal) and frequency (5 Hz). However, evidence of frequency-dependence seems more unequivocal than evidence of polarity-dependence.

Summary Introduction Medical assistance for detainees is often hampered by logistic and procedural limitations. Telemedicine may represent the solution by which such limitations can be overcome. We therefore report an update on an experience of remote telemedicine support by pre-hospital electrocardiograms and remote tele-consultation with a cardiologist implemented in a group of Italian penitentiaries. Methods Eleven State penitentiaries situated in Apulia (South-Eastern Italy) were provided with a pocket electrocardiogram recorder. The electrocardiograms were interpreted by a remote cardiologist available 24/7, which also gave a brief consultation. Results A total 3213 pre-hospital electrocardiograms were performed from January 2008 to October 2014. In 1.1% of pre-hospital electrocardiograms a supra-ventricular tachycardia was found: pre-hospital electrocardiogram showed in 7.2% anomalies suggestive for acute myocardial ischemia, in 0.8% an ST-elevation requiring immediate transfer for primary PCI. Clinical indications after pre-hospital electrocardiogram were hospitalization in 29 cases, primary PCI in 26; direct cardiologist referral in 162, a cardiac troponin assay in 142; in 252 cases outdoor further medical examinations were suggested. By converse, thanks to pre-hospital telemedicine screening, immediate hospitalization was avoided in 99% of tele-consultations; in 2961 cases with suspected acute cardiovascular disease detainees were examined with an electrocardiogram without leaving the penitentiary. Conclusions Pre-hospital electrocardiogram telemedicine screening strategy in the case of suspected acute cardiovascular disease in detainees is feasible. A single regional telemedicine ‘hub’ may provide support to a region-wide network with 11 penitentiaries and about 3500 detainees.

Summary Background Pre-hospital triage supported by electrocardiogram assessment and telemedicine was used to shorten time to reperfusion in subjects with acute myocardial infarction (AMI). Timely treatment of AMI presupposes huge geographical areas covered by one primary angioplasty network, one emergency medical service (EMS), and that pre-hospital electrocardiograms are interpreted by a physician, preferably a cardiologist. Methods We report preliminary data on a telemedicine network which provides remote interpretation of pre-hospital triage EMS electrocardiograms for Apulia, Southern Italy (4 million inhabitants): the region is served by one public health care service, one public EMS, one hospital network and one telemedicine service provider. Results From October 2004 to September 2013, 598,140 electrocardiograms were read by the telemedicine hub. Fifty percent of subjects triaged via the pre-hospital telemedicine electrocardiogram network were male, 50% were aged over 70 years, 36% were triaged during night shift. Fifteen percent of electrocardiograms in subjects with chest pain were abnormal, therefore requiring direct access to the cath-lab or hospitalization. Frontline diagnosis was ST-elevation in 6178 subjects, while 40,106 electrocardiograms showed arrhythmias other than premature contraction or sinus rhythm. Typical chest pain was found in less than 50% of subjects diagnosed with ST-elevation AMI. Conclusions The region of Apulia (4 million inhabitants, Southern Italy) is served by a unique combination of one telemedicine hub that reads pre-hospital electrocardiograms and provides cardiology consultations, one EMS, one hospital network for primary angioplasty in ST-elevation AMI. More than half a million electrocardiograms have been interpreted since 2004.

In order to assess indoor air quality (IAQ), two 1-week monitoring campaigns of volatile organic compounds (VOC) were performed in different areas of a multistorey shopping mall. High-spatial-resolution monitoring was conducted at 32 indoor sites located in two storehouses and in different departments of a supermarket. At the same time, VOC concentrations were monitored in the mall and parking lot area as well as outdoors. VOC were sampled at 48-h periods using diffusive samplers suitable for thermal desorption. The samples were then analyzed with gas chromatography-mass spectrometry (GC-MS). The data analysis and chromatic maps indicated that the two storehouses had the highest VOC concentrations consisting principally of terpenes. These higher TVOC concentrations could be a result of the low efficiency of the air exchange and intake systems, as well as the large quantity of articles stored in these small spaces. Instead, inside the supermarket, the food department was the most critical area for VOC concentrations. To identify potential emission sources in this department, a continuous VOC analyzer was used. The findings indicated that the highest total VOC concentrations were present during cleaning activities and that these activities were carried out frequently in the food department. The study highlights the importance of conducting both high-spatial-resolution monitoring and high-temporal-resolution monitoring. The former was able to identify critical issues in environments with a complex emission scenario while the latter was useful in interpreting the dynamics of each emission source.

Sleep onset is characterized by specific and orchestrated patterns of frequency and topographical EEG changes. Power analyses and computational assessments of network dynamics have described an earlier synchronization of the centrofrontal areas rhythms and a spread of synchronizing signals from associative prefrontal to posterior areas. We assess how “small world” characteristics of brain networks, as reflected in EEG rhythms, are modified in the wakefulness-sleep transition comparing pre- and post-sleep onset epochs. 40 healthy subjects (20 males;age range 18–29 years) were analyzed. EEG functional connectivity was evaluated in the cortical sources’ networks during the wake-to-sleep transition by graph theory application for the evaluation of small-world characteristics. Sleep onset is characterized by a less ordered brain network (as reflected by small world higher values) in sigma band for the frontal lobes indicating stronger connectivity, and a more ordered brain network in low frequency delta and theta bands indicating disconnection on the remaining brain areas. Results depict the timing and topography of the specific mechanisms for the maintenance of functional connectivity of frontal brain regions at the sleep onset, also providing a possible explanation for the prevalence of the frontal-to-posterior information flow directionality previously observed after sleep onset.

Summary We present a model of telecardiology ECG triage in cases of acute chest pain. A 61-year-old man with recurrent chest pain, radiating to the neck, was referred to the emergency room (ER) at Foggia University Hospital, Italy, with a red triage code. Due to a large number of red code patients present at the ER all immediately requiring medical examination for suspected acute myocardial infarction (AMI), the patient first underwent ECG triage evaluation with the Cardio Vox P12 telecardiology recorder device by a nurse. The ECG was transmitted to the regional telecardiology hub, where the ECG was immediately read by a cardiologist; signs of an inferior ST-elevation acute myocardial infarction (STEMI) were present. The catheterisation lab was therefore immediately alerted and the patient underwent primary percutaneous coronary intervention (PCI) within thirty minutes of hospitalisation. Therefore, in emergency settings with high-volume work-loads, telecardiology screening may “speed up” STEMI diagnosis and treatment.

Objective The increase of elderly population prompted growing research for the understanding of cerebral phenomena sustaining learning abilities, with inclusion of long-term potentiation (LTP)-like plasticity phenomena. Aim of the present study was to characterize LTP-like plasticity dependence on age and gender. Methods A LTP-like primary motor cortex plasticity inducing a potentiation of the motor evoked potential (MEP) to focal transcranial magnetic stimulation as a consequence of a paired associative stimulation (PAS) was induced in a 50 healthy subject cohort, equally distributed for gender and age groups (25 young subjects, mean age ± SD = 29.8 ± 4.5 years; elderly 61.1 ± 4.1 years). Results Resting motor thresholds’ excitability level increased in the elderly group, the basal MEP did not depend on gender or age. The PAS-induced primary motor cortex (M1) plastic excitability modulation was similar in young females and males, while it decreased with age in females only. Conclusions A reduction of the PAS-induced M1 plasticity in females after menopause was documented, possibly due to an impairment of intracortical excitatory network activity. Significance A LTP-like plasticity dependence on age was found in female only, suggesting caution in interpreting behavioural studies on learning abilities in dependence on age.

Odour annoyance represents one of the most emerging aspects related to odour emissions, produced by industrial plants and constitutes an indicator of an unhealthy environment, strongly felt by population. Odour emission is considered as one of the most important causes of population complaints and its evaluation represents a matter characterized by great complexity. The management of the complaints of the citizens, living in the surroundings of odour sources, represents a very hard topic to face for public authorities. Taranto city, located in the South of Italy, is seriously afflicted by a strong environmental pollution produced by the different plants in the industrial area. In this area a project of citizen science has been applied by means of an experimental methodology for the detection and evaluation of olfactory annoyance, called Odortel®; it is able to integrate automatic remote systems in order to record the olfactory perception of human receptors and to collect odour samples in real time. In this project citizens play a key role to alert the public authority by means of a phone switchboard, communicating in real time the perception of odor events and their intensity. The application of Odortel® in the area of Taranto has permitted, for the first time, to manage the population complaints in a systematic way, to prove the refinery as the source and, at the same time, to perform improvements in sampling-analysis process.

Atmospheric concentrations of benzene and toluene were assessed during three different seasons in the city of Taranto, using Radiello® diffusive samplers, in order to detect the most critical areas and to point out the sources contributing to pollution (vehicular traffic or industrial activities). High spatial resolution maps were built using a grid of 30 meshes drawn on the urban area of the city. For each mesh a monitoring site as representative as possible was chosen. Besides, in order to describe the highest levels of pollutants to which people is exposed, other 10 sampling sites were detected near high vehicular traffic crossroads or in particular critical zones of the city. The measurements of the concentration of these pollutants were carried out with Radiello® diffusive samplers for thermal desorption. The analysis of the results and the comparison between the map of vehicular traffic flows and the map of the concentrations of benzene suggested that in urban area the main benzene source is the traffic and the most significant pollution phenomena happens in zones characterized by narrow roads. Moreover it was possible to observe that high concentrations of benzene found in the NE zone of Taranto could be assigned to the industrial activities. This hypothesis was confirmed considering the diagnostic ratio between the toluene and benzene concentrations.

We recorded the resting electroencephalogram of 20 healthy subjects in order to investigate the effect of electromagnetic field (EMF) exposure on EEG waking activity and its temporal development. The subjects were randomly assigned to two groups and exposed, in double-blind conditions, to a typical mobile phone signal (902.40 MHz, modulated at 217 Hz, with an average power of 0.25 W) before or during the EEG recording session. The results show that, under real exposure as compared to baseline and sham conditions, EEG spectral power was influenced in some bins of the alpha band. This effect was greater when the EMF was on during the EEG recording session than before it. The present data lend further support to the idea that pulsed high-frequency electromagnetic fields can affect normal brain functioning, also if no conclusions can be drawn about the possible health effects.

The study aimed to investigate the time-course of electromagnetic field (EMF)-induced effects on human cognitive and behavioral performance and on tympanic temperature. Subjects were randomly assigned to two groups, exposed to a 902.40 MHz EMF before the testing session, or to the same signal during the data collecting session. Following a double-blind paradigm, subjects were tested on four performance tasks: an acoustic simple-reaction time task, a visual search task, an arithmetic descending subtraction task and an acoustic choice-reaction time task. Moreover, tympanic temperature was collected five times during each session. Results indicated an improvement of both simple- and choice-reaction times and an increase of local temperature on the exposed region under the active exposure. There was a clear time-course of the reaction time and temperature data, indicating that performance and physiological measures need a minimum of 25 min of EMF exposure to show appreciable changes.

The coexistence of regionally dissociated brain activity patterns -with some brain areas being active while other already showing sleep signs- may occur throughout all vigilance states including the transition from wakefulness to sleep and may account for both physiological as well as pathological events. These dissociated electrophysiological states are often characterized by multi-domain cognitive and behavioral impairment such as amnesia for events immediately preceding sleep. By performing simultaneous intracerebral electroencephalographic recordings from hippocampal as well as from distributed neocortical sites in neurosurgical patients, we observed that sleep spindles consistently occurred in the hippocampus several minutes before sleep onset. In addition, hippocampal spindle detections consistently preceded neocortical events, with increasing delays along the cortical antero-posterior axis. Our results support the notion that wakefulness and sleep are not mutually exclusive states, but rather part of a continuum resulting from the complex interaction between diffuse neuromodulatory systems and intrinsic properties of the different thalamocortical modules. This interaction may account for the occurrence of dissociated activity across different brain structures characterizing both physiological and pathological conditions.

Previous studies have shown a decrease in rapid eye movement (REM) frequency during desynchronized sleep in recovery nights following total or partial sleep deprivation. This effect has been ascribed to an increase in sleep need or sleep depth consequent to sleep length manipulations. The aims of this study were to assess REM frequency variations in the recovery night after two consecutive nights of selective slow-wave sleep (SWS) deprivation, and to evaluate the relationships between REM frequency and SWS amount and auditory arousal thresholds (AAT), as an independent index of sleep depth. Ten normal males slept for six consecutive nights in the laboratory: one adaptation, two baseline, two selective SWS deprivation and one recovery night. SWS deprivation allowed us to set the SWS amount during both deprivation nights close to zero, without any shortening of total sleep time. In the ensuing recovery night a significant SWS rebound was found, accompanied by an increase in AAT. In addition, REM frequency decreased significantly compared with baseline. This effect cannot be attributed to a variation in prior sleep duration, since there was no sleep loss during the selective SWS deprivation nights. Stepwise regression also showed that the decrease in REM frequency is not correlated with the increase in AAT, the traditional index of sleep depth, but is correlated with SWS rebound.

C-reactive protein (CRP) plasmatic levels might increase in patients with acute coronary syndrome (ACS) or atherosclerosis and evaluation of CRP is relevant for prognosis in case of ischemic heart disease. This clear role played by CRP in risk stratification of cardiovascular diseases is however biased by non-cardiac determinants: genetic heritable factors, seasonal or daily variability, and gender differences probably based on hormonal differences. Also non-steroidal hormones seem to be involved in CRP determinism, in a complicated interaction not easy to extricate. Nevertheless, CRP determination in patients with ACS should be considered as crucial for its prognostic relevance, even after a careful consideration of all these bias factors.

Several findings confirm the assumption that neurophysiological mechanisms of encoding and recall of episodic memories are homogeneous across wake and sleep. Brain lesion and neuroimaging approaches converged to identify the crucial role of the temporoparieto-occipital junction and ventromesial regions of the prefrontal cortex in dream generation. Morphoanatomical measurements indicated some direct relations between volumetric and ultrastructural measures of the hippocampus–amygdala on the one hand, and some specific qualitative features of dreaming on the other. Finally, regional electroencephalographic (EEG) studies showed that sleep cortical oscillations associated to a successful dream recall were the same involved in encoding and recall of episodic memories across wakefulness.

Lateral eye movers are subjects who consistently shift their gaze either leftward or rightward while reflecting on visuospatial or verbal questions. When reliably assessed, prevalent direction of gaze can be assumed as a valid index of hemispheric asymmetry. The present study evaluated discrimination of heartbeat (HB) and of spontaneous changes of finger temperature in 24 right-handed females reliably selected as lateral movers. Results replicate and extend previous findings by showing that left movers' superiority in HB discrimination is present also in females and concerns the perception of a different vascular function, that is, peripheral finger temperature. Differences between right movers and left movers were not due to activation level during the test or to body composition.

Background The aim was to investigate prognostic relevance of history of allergy in subjects with unstable angina treated with coronary angioplasty. Methods Fifty-seven consecutive patients with unstable angina who underwent coronary angioplasty were enrolled in the study and were divided into two groups: those with a history of allergy (Group A, N=15); and controls (Group C, N=42). Major adverse cardiac events were recorded over a six-month follow-up period. Patients with primary or unsuccessful angioplasty and patients treated with drug eluting stent were excluded from the study. Results Group A patients (history of allergy) showed a 46.67% incidence of major adverse cardiac events at six-month follow-up (vs. 9.52% Group C, p

Posttraumatic stress disorder (PTSD) is characterized by the presence of anatomo-functional hippocampal alterations. To date, the ability to orient within the environment, which relies on hippocampal integrity, has never been investigated in PTSD. We hypothesized that the ability to form a cognitive map of the environment would be impaired in PTSD. Moreover, spatial memory consolidation benefits from postlearning sleep. Because PTSD individuals often complain about sleep disturbances, we hypothesized that any sleep effect on memory performance would be hampered in these subjects. Twenty-two subjects, all survivors of the L'Aquila 2009 earthquake, were divided into a PTSD and a control group, based on clinical evaluation. After an acquisition phase, they were tested twice ("test" and "retest") on a virtual navigation task. In addition, participants were administered the Digit Span and Task Switching. Subjective sleep quality and sleep disturbances were also assessed. The two testing sessions were on consecutive mornings, interspersed with a night of sleep. During the acquisition phase, the PTSD group took more than twice as long to form a cognitive map of the environment compared to the control group. However, once this phase was successfully completed, the two groups did not differ at test, but they tendentially differed at postsleep retest. Additional analyses comparing performances between groups on test-retest difference scores confirm that sleep-dependent consolidation may be differentially affected in the two groups. Our findings are strictly confined to the navigation performance, excluding a generalized cognitive deficit. PTSD also reported more subjective sleep disturbances and shorter sleep time than controls, which were correlated to worse performance at retest. The specific deficit in the formation of a cognitive map reported in PTSD may be related to hippocampal dysfunctions as well as to the sleep disturbances experienced by these patients. The possible deficiency of sleep-dependent spatial performance improvement should however be confirmed by further studies comprising a wake control group.

Sleep inertia (SI) denotes a period of hypovigilance, confusion and impaired cognitive and behavioral performance that immediately follows awakening. Based on the observation that the reactivation of some cortical areas is faster than other upon awakening, here we examined regional differences between presleep and postsleep waking period. Moreover, we also compared rapid eye movements (REM) and stage 2 non-rapid eye movements (NREM) awakenings in a within-subject design. Presleep and postsleep waking electroencephalogram (EEG; 5 min with eyes-closed and 5 min with eyes-open) of 18 healthy subjects (12 males, mean age=23.8±2.3 years) were recorded from 19 derivations. Participants slept for two consecutive nights in the laboratory. In one night they were awakened from stage 2 NREM, while in the other from REM sleep. EEG power spectra were calculated across the following bands: delta (1-4 Hz), theta (5-7 Hz), alpha (8-12 Hz), beta-1 (13-16 Hz) and beta-2 (17-24 Hz). Moreover, a detailed hertz-by-hertz analysis has been repeated in the 2-4 Hz frequency range. Postsleep wakefulness, compared to presleep, is characterized by a generalized decrease of higher beta-1 and beta-2 EEG power over almost all scalp locations. A detailed analysis of topographical modifications in the low-frequency range showed that postsleep wakefulness is characterized by an increased delta activity in the posterior scalp locations, and by a concomitant frontal decrease compared to presleep. Moreover, it was found a prevalence of EEG power in the high frequency ranges (beta-1 and beta-2) upon awakening from stage 2 compared to REM awakenings over the left anterior derivations. Altogether these findings support the hypothesis that a generalized reduction in beta activity and increased delta activity in more posterior areas upon awakening may represent the EEG substratum of the sleep inertia phenomenon.

A 25-item handedness performance test was administered twice, at a one-month interval, to 85 elementary school children (60 right handers and 25 left handers in two different age groups). The laterality quotient distribution for right handers was more skewed and significantly different in central tendency and shape than the left handers' distribution. Mean point-biserial item-test correlation was 0.85. The test-retest correlation coefficient for the whole group was 0.79.

Quantitative analysis of EEG during wakefulness in AD/MCI patients shows a slowing of EEG rhytms, in terms of increase of delta activity and decrease of alpha activity. Some studies show differences in AD/MCI patients even in EEG sleep: an increase in stage 1, number and length of intra-night awakenings, a decrease of Slow Wave Sleep (SWS) and REM sleep. Given the strong relation (bidirectional) between EEG sleep and wakefullness rhythms, the objective of the study is to assess EEG topography during sleep (REM and NREM) and wakefulness, and to assess relationship between sleep EEG modifications and subsequent variations in wakefulness EEG. 8 patients AD, 13 MCI and 9 elderly healthy people performed one-night sleep PSG recordings (19 cortical electrods, EOG, EMG) and wakefulness EEG recordings (5 min with eyes open and 5 min with eyes closed). Analyses of EEG topography of wakefulness, REM and NREM sleep suggest significant differences between MCI groups vs. controls within the alpha band, in terms of lower EEG activity within this frequency range in patients in occipital and temporal derivations compared to controls. Although preliminary, data of EEG topography seems showing the same functional variations both in sleep and wakefulness. Hence, the observed slowing may be an electrophysiological evidence of neurodegenerative processes at a cortical level.

A fundamental feature of the human cortex is the capability to express plastic changes that seem to be present even during physiological aging. The paired associative stimulation (PAS) protocol is a paradigm capable of inducing neuroplastic changes, possibly by mechanisms related to spike timing-dependent associative neuronal activity, and represents a suitable tool for investigating age-dependent neuroplastic modulations of the primary somatosensory cortex (S1). To examine age dependency of S1 plasticity, the amplitude changes of median nerve somatosensory evoked potential (SEP) before and after PAS intervention were investigated in young and elderly subjects. The main finding of our study is that low-frequency medial nerve stimulation paired with transcranial magnetic stimulation over the contralateral cortex enhances S1 excitability. Moreover, the S1 long term potentiation–like plasticity changes as a function of aging, with a significant increase of N20–P25 complex in the elderly compared to young subjects. These results are congruent with the hypothesis that some elderly subjects retain a high level of plasticity in specific neuronal circuits. Such plasticity could represent a compensatory mechanism, in terms of functional reserve of somatosensory cortex, used by the aging brain to counterbalance the cortical degeneration associated with aging.

The present study investigated the presence of a cumulative effect of brief and repeated exposures to a GSM mobile phone (902.40 MHz, 217 Hz modulated; peak power of 2 W; average power of 0.25 W; SAR = 0.5 W/kg) on psychomotor functions. To this end, after each of 3 15-min exposures, both an acoustic simple reaction time task (SRTT) and a sequential finger tapping task (SFTT) were administered to 24 subjects. The present study was unable to detect the cumulative effects of brief and repeated EMF exposure on human psychomotor performance, although there was a non-statistical trend to shorter reaction times. In summary, these data show an absence of effects with these particular exposure conditions; however, possible cognitive effects induced by different signal characteristics cannot be excluded. Bioelectromagnetics 29:237–241, 2008. © 2007 Wiley-Liss, Inc.

In recent years a growing number of people have begun to use mobile phone technology. This phenomenon has raised questions and doubts about possible effects on users' brains. This literature review focuses on the human electrophysiological and neuro-metabolic effects of mobile phone (MP)-related electromagnetic fields (EMFs) published in the last 10 years. To this end, all relevant papers have been reported and, subsequently, a literature selection has been carried out by taking several criteria into account, such as: blind techniques, randomization or counter-balancing of conditions and subjects, detail of exposure characteristics and the statistical analyses used. As a result, only the studies meeting the selection criteria have been described, evaluated and discussed further. The main goal of this review is to provide a clear scenario of the most reliable experiments carried out over the last decade and to offer a critical point of view in their evaluation. It is concluded that MP-EMFs may influence normal physiology through changes in cortical excitability and that in future research particular care should be dedicated to both methodological and statistical control, the most relevant criteria in this research field.

Human adaptation to unknown and extreme environments requires changes in the psychological and physical homeostasis. We previously reported a significant decrease of anterior pituitary and adrenal hormonal levels and a significant modification of psychophysiological correlates of stress, such as galvanic skin response, after exposure to Antarctica, suggesting a possible decrease of individual arousal. The latter was hypothesized to be correlated with a modification of autonomic balance, mainly represented by a possible reduction of adrenergic output. The aim of the present study was to assess the patterns of hormonal circadian rhythms and the autonomic nervous system balance by means of spectral analysis of heart rate variability (HRV). These parameters were evaluated during 3 sessions (baseline, session 1 and session 2), before, at the beginning and after a 40-day stay in Antarctica (Station of Terra Nova Bay; average temperature in the study period: −11 °C, 24 h of light, sea level). In each of the sessions, 6 healthy male subjects underwent a 24-h electrocardiogram and blood sampling (08.00, 12.00, 16.00, 20.00, 24.00 and 08.00 h) for hormonal determinations. The data showed a remarkable decrease of hormonal levels without significant changes in circadian rhythms. Spectral analysis of HRV showed an imbalance of the autonomic nervous system with a relative significant decrease of the low frequency band (0.1 Hz) in session 1 and 2 compared to baseline, which can be functionally interpreted as a relative decrement of the sympathetic component. In conclusion, the exposure to a cold and extreme environment seems to affect autonomic balance over a 40-day period. This is followed by a significant reduction of the anterior pituitary and adrenal hormonal secretory patterns with preserved hormonal circadian rhythms (within the same time period of 40 days). This pattern is suggestive of a trophotropic neurovegetative adaptive process.

The design and development of new bioactive surfaces on titanium-based materials employed in orthopedic implants is described. The new biosurfaces consist of thin polypyrrole films, directly grown on implant materials and modified by the inclusion of hydroxyapatite and/or collagen during the polymer electrodeposition step. The experimental procedure has been optimized in terms of loading and distribution of the bioactive components. X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) investigations have been performed in order to control the effectiveness of film modifications. In particular, XPS has been used to check the presence of biocompounds in the surface and sub-surface region of the polymer film, which is a critical requisite for a positive interface interaction between the biomaterial and the surrounding tissue.

Microstructural electroencephalographic changes during the wakefulness-sleep transition have been investigated by comparing two definitions of sleep onset: the first occurrence of stage 1 and of stage 2. Power values were calculated across a 1-28-Hz frequency range in a 1-Hz bin resolution in the sleep recordings of 26 normal subjects. Quantitative changes were assessed after averaging individual time series, aligned with respect to the first occurrence of stage 1 or of stage 2. The time course of the single-Hz activity revealed a linear increase of power in the 1-6-Hz range and a linear decrease in the 9-12- and 16-28-Hz ranges during the stage 1 transition. During the stage 2 transition, electroencephalogram power linearly increased in the 1-7- and 14-15-Hz ranges and decreased in the 18-28-Hz range, while the 8-12-Hz range fitted a second-order polynomial curve. The two 'switch' points were also compared in their ability to differentiate Hz by Hz wakefulness from sleep: a lower mean power was found after stage 1 onset in the 9-11-Hz and 20-28-Hz bins and a higher one in the 1-5-Hz bins, while a higher power was found in the 1-8-Hz and 12-16-Hz bins and a lower one in 18-28-Hz bins after stage 2 onset. The time course of three electroencephalographic frequency ranges [delta/theta/sigma (1-7 and 12-16 Hz); beta (17-28 Hz); alpha (8-11 Hz)], grouped on the basis of a principal component analysis, fitted a first-order polynomial curve for the first two ranges, and a second-order polynomial curve for the last, with a progressive decrease during wakefulness, a minimum point during stage 1, and a subsequent increase during stage 2. The uniformly increasing electroencephalographic power across the 1-16-Hz frequency range during stage 2 and the shift of functional meaning for the alpha power during stage 1 point to the start of stage 2 as a more reliable boundary between wakefulness and sleep.