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La rehabilitación vestibular se utiliza mucho en el tratamiento del vértigo crónico. Consta de dos aspectos específicos muy distintos: por una parte, las maniobras posicionales en el vértigo posicional paroxístico benigno, que se describirán como tratamiento físico, aunque no se trata en sentido estricto de una rehabilitación: se ha demostrado la eficacia del procedimiento terapéutico en estas situaciones, aunque precisan una gran vigilancia durante la exploración clínica debido a los diagnósticos diferenciales, sobre todo centrales; por otra parte, las técnicas de rehabilitación vestibular dirigidas a favorecer nuevas estrategias de equilibración tras un déficit vestibular. Los datos fisiológicos respecto a la plasticidad cerebral, las estrategias de equilibración, el sistema vestibular, la compensación y sus factores desfavorables, así como la evaluación de los resultados de la rehabilitación vestibular han permitido su desarrollo en unas indicaciones más amplias (cinetosis, presbivestibulia, intolerancia al movimiento, dependencia visual, etc.). El acceso a nuevas herramientas lúdicas, como la realidad virtual, facilita la adhesión del paciente a los ejercicios dirigidos a favorecer una información sensorial (al suprimir o falsear las otras) o a mantener una habituación (disminución de la reactividad a un estímulo preciso). Su utilización requiere dominar las consecuencias fisiológicas de las situaciones creadas: el establecimiento de un programa de rehabilitación vestibular debe seguir a un diagnóstico médico tan preciso como sea posible, que determina los objetivos deseados, adaptados a cada paciente (refuerzo propioceptivo, vestibular, sustitución, habituación, etc.). Por tanto, la rehabilitación vestibular implica una buena colaboración entre el otorrinolaringólogo (ORL) y el kinesiterapeuta, con una situación de partida y de los objetivos precisados por el ORL, y un programa de rehabilitación establecido por el kinesiterapeuta que indica a su vez las modificaciones obtenidas, lo que lleva a sopesar una posible indicación de renovación de la rehabilitación (después del programa inicial de 2-3 meses) si aún es posible lograr progresos.

La rieducazione vestibolare è ampiamente utilizzata nel trattamento delle vertigini croniche. Ha due specificità ben distinte: da un lato, le manovre posizionali nella vertigine parossistica posizionale benigna, che presenteremo come trattamento fisico anche se, a rigor di termini, non si tratta di rieducazione: si è dimostrata l’efficacia del gesto terapeutico in queste situazioni che richiedono tuttavia una grande vigilanza in sede di esame clinico a causa delle diagnosi differenziali, in particolare centrali; dall’altro, le tecniche di rieducazione vestibolare volte a favorire nuove strategie di equilibrio dopo un deficit vestibolare. I dati fisiologici riguardanti la plasticità cerebrale, le strategie di equilibrio, il sistema vestibolare, la compensazione e i suoi fattori peggiorativi, nonché la valutazione dei risultati della rieducazione vestibolare ne hanno permesso lo sviluppo in indicazioni più ampie (cinetosi, presbivestibulia, intolleranza al movimento, dipendenza visiva, ecc.). L’accesso a nuovi strumenti ludici come la realtà virtuale facilita l’adesione del paziente a esercizi volti a promuovere input sensoriali (sopprimendo o distorcendo gli altri) o a indurre un’assuefazione (riduzione della reattività a uno specifico stimolo). Il loro utilizzo richiede la padronanza delle conseguenze fisiologiche delle situazioni create: l’impostazione di un programma di rieducazione vestibolare deve fare seguito a una diagnosi medica quanto più precisa possibile che determini gli obiettivi mirati adattati a ciascun paziente (rinforzo propriocettivo, vestibolare, sostituzione, assuefazione, ecc.). La rieducazione vestibolare prevede quindi una buona collaborazione tra l’oto-rino-laringoiatra (ORL) e il fisioterapista, con una situazione di partenza e obiettivi precisati dall’ORL e un programma rieducativo stabilito dal fisioterapista che indica in cambio le modificazioni ottenute, che portano a valutare un’eventuale indicazione di ripetizione della rieducazione (dopo il programma iniziale di 2-3 mesi) se sono ancora possibili dei progressi.

Il velo, vero e proprio setto muscolomucoso appartenente all’orofaringe, separa il rinofaringe dall’orofaringe in basso e indietro e dalla cavità orale in basso e in avanti. Le lesioni maligne del velo palatino sono dominate dai carcinomi malpighiani, il cui principale fattore di rischio è il consumo cronico di alcol e tabacco. Tuttavia, negli ultimi anni, è stato visto emergere un nuovo fattore di rischio: lo human papilloma virus(HPV). Le lesioni maligne del velo possono essere scoperte accidentalmente o rivelarsi tramite disfagia, dolore faringeo o adenopatia cervicale. La valutazione richiede un esame obiettivo di tutte le vie aerodigestive superiori (VADS), al fine di definire la localizzazione, la dimensione e la presenza di adenopatie e di ricercare una lesione sincrona. Una nasofibroscopia deve valutare il versante nasale del velo. Vengono eseguiti un’endoscopia in anestesia generale, una biopsia della lesione, una TC con contrasto dalla base del cranio al torace e un esame radiologico mediante risonanza magnetica (RM) per determinare lo stadio tumor-node-metastasis(TNM). Per le lesioni estese, può essere necessaria una tomografia a emissione di positroni associata a una TC (PET-TC) per escludere delle localizzazioni secondarie. Il trattamento deve tenere conto della grande linfofilia dei carcinomi epidermoidi orofaringei e della necessità di mantenere o ripristinare un velo funzionale. I tumori classificati T1 o T2 vengono prontamente trattati chirurgicamente. La perdita di sostanza viene ricostruita tramite lembi locali, regionali o liberi. È legittimo realizzare una radiochemioterapia per trattare le lesioni il cui asse maggiore è superiore a 4 cm, per le quali l’escissione con margini sani sarebbe troppo demolitiva per proporre una ricostruzione con risultati funzionali soddisfacenti.

El velo del paladar es un auténtico tabique miomucoso perteneciente a la orofaringe y separa la rinofaringe de la orofaringe hacia abajo y hacia adelante y de la cavidad bucal hacia abajo y hacia adelante. Las lesiones malignas del velo más frecuentes son los carcinomas epidermoides, cuyo principal factor de riesgo lo constituyen el etilismo y el tabaquismo crónicos. Sin embargo, en los últimos años ha surgido un nuevo factor de riesgo: el virus del papiloma humano (VPH). Las lesiones malignas del velo pueden descubrirse de forma fortuita, o manifestarse por disfagia, dolor faríngeo o adenopatías cervicales. Su evaluación requiere una exploración física de todas las vías aerodigestivas superiores (VADS) para definir la localización, el tamaño y la presencia de adenopatías, así como para buscar una lesión sincrónica. La cara nasal del velo debe evaluarse mediante una nasofibroendoscopia. Se realizan una endoscopia bajo anestesia general, una biopsia de la lesión, una tomografía computarizada (TC) con contraste de la base del cráneo hasta el tórax, así como una resonancia magnética (RM) para determinar el estadio TNM (tumor, ganglios [nodes],metástasis). Para las lesiones extensas, puede ser necesaria una tomografía por emisión de positrones acoplada a una tomografía computarizada (PET-TC) para descartar las localizaciones secundarias. El tratamiento debe tener en cuenta la gran linfofilia de los carcinomas epidermoides orofaríngeos y la necesidad de conservar o de restaurar un velo funcional. Los tumores clasificados como T1 o T2 se tratan en ocasiones con cirugía. La pérdida de sustancia debe reconstruirse con colgajos locales, regionales o libres. Está justificado recurrir a la radioquimioterapia para tratar las lesiones cuyo eje mayor sea superior a 4 cm, en los que la resección con márgenes sanos sería demasiado destructiva para proponer una reconstrucción con resultados funcionales satisfactorios.

The α1β1 collagen receptor is only present in a few epithelial cell types. In the intestine, it is specifically expressed in proliferating crypt cells. This integrin has been reported to be involved in various cancers where it mediates the downstream activation of the Ras/ERK proliferative pathway. We have recently shown that integrin α1β1 is present in two-thirds of colon adenocarcinomas, but the mechanism by which ITGA1 expression is regulated is not known. DNA methylation, involved in ITGA1 repression during megakaryocyte differentiation, is not the mechanism of ITGA1 regulation in colorectal cancer cells. Our in silico analysis of the ITGA1 promoter revealed two response elements for MYC, an oncogenic factor known to regulate cancer cell proliferation, invasion and migration. In situ, the expressions of both MYC and ITGA1 are localized in the lower crypt of the normal colon and correlate in 72% of the 65 analyzed colorectal cancers. MYC pharmacological inhibition or downregulation of expression with short hairpin RNA in HT29, T84 and SW480 cells resulted in reduced ITGA1 expression at both the transcript and protein levels. Chromatin immunoprecipitation assays revealed that MYC was bound to the chromatin region of the ITGA1 proximal promoter, whereas MYC overexpression enhanced ITGA1 promoter activity that was reduced with MAD co-transfection or by the disruption of the response elements. We concluded that MYC is a key regulating factor for the control of ITGA1 expression.

This paper briefly discusses the general subject of motivation in the workplace, and it reviews motivating factors that apply on any job or project. These motivating factors, applicable anywhere, include salary increases or promotions, dealing honestly and fairly with everyone, being sensitive to employees' needs as people, setting the proper example, possibly visiting the site of the work, and the proper use of humor. It then describes the motivating factors that are especially critical on a joint venturetype project. Foremost among the motivating factors especially necessary for joint venture projects is the need to develop a team spirit, and a sense of a common goal, among the employees of the several companies working together on the project. The paper gives examples of management actions designed to achieve the team spirit required of the employees of the various companies, along with several other means of properly motivating the joint venture employees.

We report that by using 800 nm femtosecond pulses and the phase-mask technique, first-order fiber Bragg gratings with refractive index modulation in excess of 1×10^−3 can be written through both the acrylate and polyimide coatings of unloaded standard silica fibers without noticeable degradation of mechanical strength. We also demonstrate that the same experimental conditions can be applied for efficient FBG writing through the polyimide coating of pure silica core fibers, opening significant opportunities in the field of fiber sensors.

Idiopathic REM sleep behavior disorder (iRBD) might be a stage in the development of neurodegenerative disorders, especially Parkinson disease and dementia with Lewy bodies. Recent studies showing a slowing of waking EEG in iRBD suggest that iRBD is associated with cognitive impairment.

To compare nondemented patients with Parkinson’s disease (PD) with and without REM sleep behavior disorder (RBD) to healthy controls on quantitative EEG characteristics for both wakefulness and REM sleep.

De la puberté à la ménopause, les femmes sont soumises à d'importantes fluctuations hormonales. Les femmes rapportent en général plus de plaintes de fatigue et plus de difficultés reliées au sommeil que les hommes et elles consomment également plus de somnifères. Il est probable que la ménopause, le cycle menstruel, l'utilisation de contraceptifs hormonaux et l'hormonothérapie seraient des facteurs influençant la qualité du sommeil chez les femmes. Les études chez l'animal et l'être humain montrent que l'administration de progestérone et d'estrogène influence la qualité et l'architecture du sommeil. Les effets du cycle menstruel sur le sommeil demeure encore une question en litige dans la littérature alors que vraiment peu d'études se sont intéressées jusqu' à maintenant aux effets des contraceptifs hormonaux sur la qualité du sommeil. Les difficultés à dormir et la fatigue s'avèrent des plaintes importantes chez les femmes ménopausées. Il semble que les bouffées de chaleur jouent un rôle important dans la détérioration de la qualité du sommeil chez les femmes ménopausées. Il existe encore très peu d'études portant sur les effets de l'hormonothérapie sur les paramètres polysomnographiques du sommeil. La plupart des ces études ont rapporté de faibles améliorations sur différents paramètres de sommeil. Une meilleure compréhension des mécanismes qui sous-tendent les modulations hormonales du cycle éveil-sommeil, nous permettra de mieux développer des mesures préventives et thérapeutiques adaptées au sommeil des femmes à travers toutes les étapes de leur vie reproductive.

To determine the frequency of REM sleep behavior disorder (RBD) among patients with PD using both history and polysomnography (PSG) recordings and to further study REM sleep muscle atonia in PD.

To determine the effects of a 90-minute afternoon nap regimen on nocturnal sleep, circadian rhythms, and evening alertness and performance levels in the healthy elderly.

Our understanding of the mechanisms by which sleep deteriorates with age almost exclusively stems from comparisons of young and elderly subjects. The present study investigated the different effects of a 25-h sleep deprivation on the recovery sleep initiated in the morning (when circadian sleep propensity decreases) of young (20–39 y) and middle-aged subjects (40–60 y). Middle-aged subjects showed a steeper increase in the duration of wakefulness during daytime recovery sleep than the young subjects. Slow-wave sleep (SWS) and EEG slow-wave activity (SWA: spectral power between 0.5–4.5 Hz) were potentiated in both groups following sleep deprivation. However, the rebound of SWS and SWA was significantly less pronounced in the middle-aged than in the young. This reduction in homeostatic recuperative drive in middle-aged subjects might account for the decrease in their ability to maintain sleep when they have to recuperate at an abnormal circadian phase. These results helps to understand the increase in complaints related to shift work and jet lag in the middle years of life.

Summary Culture medium conditioned with human hemangioma promotes the growth of endothelial cells from isolated adult porcine brain capillaries in primary culture and represents an improvement in culture conditions for such cells. It is the first enriched medium that is not supplied with purified growth factors or conditioned with cultured tumoral cells. Porcine brain microvascular endothelial cells grown in this manner display a typical capillary endothelial morphology, synthesize von Willebrand Factor, and express angiotensin converting enzyme activity.

Previous observations on the heterogeneous distribution of von Willebrand factor in the vascular endothelium led us to examine the expression of angiotensin I-converting enzyme (ACE) in function of the vascular origin of endothelial cells (EC). EC from pig thoracic aorta, pulmonary artery, inferior vena cava and brain capillaries were cultured and assayed for ACE by enzymatic radiochemical determination and by western-blot and immunofluorescence using an antiACE polyclonal antibody. EC from the various vascular levels secreted ACE in the culture medium; western-blot analysis showed its presence at cellular level and immunofluorescence confirmed its location on the plasma membrane. But quantification revealed that EC from pulmonary artery contain more ACE than EC from the other vessels, especially from brain capillaries; immunofluorescence correlated well with the functional data. In contrast, secretion of ACE by brain capillaries EC was faster than that of arteries and of vena cava, the latter being the less effective. This differential ACE expression along the vascular tree could have a pharmacological implication since ACE inhibitors, used in the treatment of arterial hypertension, may act more at the vascular level than on the plasma renin-angiotensin system. On the other hand, endothelial distribution of ACE was different from that of von Willebrand factor; in particular we showed that EC cultured from vessels of pigs homozygous for the von Willebrand disease, in which von Willebrand factor synthesis was completely abolished, normally express ACE.

The effects of anaphylaxis on vascular protein extravasation in selected tissues and on the release of prostaglandins in the peritoneal cavity were studied in sensitized rats. Extravasation of Evans blue dye was used as a measure of vascular permeability. Specific antigen challenge increased by 279, 297, 328, 250, and 192% the protein extravasation in the trachea, upper and lower bronchi, pancreas, and duodenum, respectively, but did not modify significantly the vascular permeability of the lung parenchyma, heart, liver, and kidney. Extravasation of Evans blue dye also was increased by 43-fold in the peritoneal cavity. Pretreatment of the animals with indomethacin (10 mg/kg) did not modify significantly the protein extravasation of the trachea, upper and lower bronchi, pancreas, and duodenum induced by anaphylaxis. Pretreatment with a mixture of mepyramine (3 mg/kg) and methysergide (2.5 mg/kg) reduced by 62, 66, and 40% the protein extravasation in the trachea, upper bronchi, and peritoneal cavity, respectively, in similar conditions. The PAF antagonist BN-52021 (5 mg/kg) very strongly reduced the protein extravasation elicited by anaphylaxis in the trachea, upper and lower bronchi, pancreas, and duodenum by 72, 87, 82, 67, and 85%, respectively, and by 53% in the peritoneal cavity. Anaphylaxis also increased the concentrations of thromboxane B2 and leukotriene B4 in the peritoneal exudates, but prostaglandin E2 levels were not affected. Pretreatment with BN-52021 reduced by 29 and 75 % the level of thromboxane B2 and leukotriene B4 in the exudates. These results suggest that PAF, histamine, and serotonin mediate the protein extravasation associated with anaphylaxis, whereas prostaglandins are likely to play a minor role in this reaction.

The interprofessional agenda in the health and welfare field has come increasingly strongly into focus in Britain over the past few years in both the public and private sector, as witnessed by the growing emphasis on primary health care and inter-agency work. It has begun to affect the whole range of professional groups in this area, from general practitioners, nurses and speech therapists, at one end of the spectrum, to social workers, probation officers and care managers, at the other. Many factors have contributed towards the move in this direction, including escalating specialisation, shifts in government policy, changes in legislation, the desire for more efficient and more cost effective provision and, perhaps most fundamentally, the desire to enhance the quality of care by establishing more integrated and responsive services. Unsurprisingly, this trend has also been expressed in the growth in the number of publications on this subject especially since the 1980s, not least of which are the three interrelated collections of papers reviewed here.

Moderate circadian phase shifts were induced by 3 days of bright light exposure, without changing the habitual sleep schedule. Daytime sleep propensity was evaluated with multiple sleep latency tests (MSLT) conducted before and after the light treatment. Phase shifts were estimated using the core body temperature rhythm recorded during constant routines. The subjects were divided into three groups according to the timing of the bright light exposure. Morning bright light exposure (Morning group) advanced the circadian phase by about 1.2 hours, evening bright light (Evening group) delayed the circadian phase by 1.6 hours on average; whereas, bright light administered in the afternoon (Afternoon group) did not change the circadian phase. After the light treatment, daytime sleep latencies decreased in the Evening and Afternoon groups, but did not change in the Morning group. Reduced sleep latencies in the Afternoon group probably reflect an increase in the manifest sleep tendency induced by the protocol itself. It is suggested that, in the presence of a high physiological sleep tendency, a moderate circadian phase delay may increase further daytime sleep propensity, whereas a moderate circadian phase advance may help to maintain daytime sleep propensity at a lower level.

Tobacco leaves (Nicotiana tabacum var. Wisconsin 38) submitted to anaerobic conditions behave in a manner similar to that of maize, sugarcane, or sorghum leaves (C4-plants); more precisely, a lag time in O2 release is exhibited when the leaves are exposed to light after treatment in the dark under pure nitrogen. Although the conditions for the appearance of this phenomenon in tobacco are somewhat different, the main features are identical to those observed with maize: abolition of the lag time upon immediate exposure to light, release of CO2 under light (illumination burst of CO2), photochemical nature of the reactions involved in the abolition of the lag time, activation of oxygen release by far-red light, and the antagonistic effect of red and far-red light on the lag time. The high CO2 compensation point of tobacco leaves permits the classification of this plant among the C3 group. A comparison of these experimental results with others from the literature suggests than the distinguishing features between C3- and C4-plants are not as sharp as generally thought.

This paper briefly discusses the general subject of motivation in the workplace, and it reviews motivating factors that apply on any job or project. These motivating factors, applicable anywhere, include salary increases or promotions, dealing honestly and fairly with everyone, being sensitive to employees' needs as people, setting the proper example, possibly visiting the site of the work, and the proper use of humor. It then describes the motivating factors that are especially critical on a joint venture‐type project. Foremost among the motivating factors especially necessary for joint venture projects is the need to develop a team spirit, and a sense of a common goal, among the employees of the several companies working together on the project. The paper gives examples of management actions designed to achieve the team spirit required of the employees of the various companies, along with several other means of properly motivating the joint venture employees.

Preliminary data are presented on 53 urban Mexican males interviewed during 1970–1971 in a study of homosexual encounters in a large Mexican city. These data are compared with data from recent studies in the United States and England of male homosexual behavior. Although preliminary and limited, the Mexican data indicate that cultural factors are important determinants of life styles and sex practices of homosexual males. Forty-eight of the 53 (90%) preferred and usually practiced anal intercourse, four preferred oral contacts, and one preferred mutual masturbation. Interviewees were also grouped according to major type of sex activity during the first sustained year of homosexual activity after puberty. One intragroup comparison indicates significant differences between anal active and anal passive interviewees. For example, as children anal passive subjects had significantly more homosexual contacts with adults; they also considered themselves more effeminate and as children were more involved with female sex-typed activities. Comparison of data from the English and United States studies with the present data suggests that preference for a particular sexual technique is not as developed in the former two countries; when there is a preference, it is not usually for anal intercourse.

Les troubles du sommeil sont fréquents chez les patients avec un trouble neurocognitif. Leur diagnostic et prise en charge chez ces patients peut s’avérer complexe en pratique clinique.

This study aimed to determine whether human mental processing actually slows down during the night hours, separately from the previously documented microsleeps, lapses in attention, and general slowing of motor responses. Eighteen healthy young adults were studied during 36 hours of constant wakeful bedrest. Every 2 hours, they performed a logical reasoning task. Items phrased in the negative voice took reliably longer to respond to than items phrased in the positive voice, indicating the need for more mental processing in those items. By subtracting "negative" from "positive" reaction times at each time of day, we were able to plot a circadian rhythm in the time taken for this extra mental processing to be done separately from microsleeps, psychomotor slowing, and inattention. The extra mental processing took longer at night and on the day following sleep loss than it did during the day before the sleep loss, suggesting that human mental processing slows down during the night under sleep deprivation.