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A partir de campos medios mensuales obtenidos de los reanálisis del NCEP/NCAR se identifica a la corriente en chorro subtropical sobre América del Sur durante el período 1978-1999. Para determinar su intensidad y posición se construyeron cortes verticales del viento zonal medio mensual. Luego, se identifica al núcleo de la corriente en chorro mediante el empleo de campos medios mensuales de la intensidad del viento en 200 hPa. Los resultados obtenidos en este estudio y su comparación con aquellos obtenidos por otros autores muestran la eficiencia de los reanálisis en detectar a la corriente en chorro subtropical (JST) media mensual. La intensidad y la posición latitudinal del JST están relacionados de manera tal que al desplazarse hacia el polo, el JST se debilita. Sin embargo, en octubre este comportamiento no se observa, lo cual representa una particularidad del JST en América del Sur. El análisis de la ubicación del núcleo de la corriente en chorro subtropical muestra que éste tiende a posicionarse sobre el este de Argentina y Uruguay. También se halla una segunda ubicación preferida sobre el Océano Pacífico frente a la costa de América del Sur. En verano, los núcleos tienden a permanecer sobre el continente y no sobre el mar, en cambio durante el invierno su localización presenta una gran dispersión zonal.The subtropical jet stream over South America is identified from monthly mean wind fields obtained from NCEP/NCAR reanalysis during the period 1978-1999. Zonal wind vertical cross-sections are used to determine its intensity and latitudinal position. Then, 200-hPa wind intensity fields are used to identify the subtropical jet stream core. The results obtained in this study and the comparison with those obtained by other authors show the efficiency of the reanalysis in detecting the monthly mean subtropical jet stream (STJ). The intensity and latitudinal position of the STJ are related in such a way that the STJ weakens as it moves poleward. However, this behavior is not observed in October, which defines a particular feature of the STJ in South America. The analysis of the subtropical jet stream core position shows a preferred location over eastern Argentina and Uruguay. Also, a secondary preferred location is found during winter over the tropical Pacific Ocean off the South America coast. Whereas the cores prefer to remain over the continent instead of the ocean during summer, they are considerably more zonally widespread in winter.

The article presents a study that examines El Niño event classification in the tropical Pacific Ocean. Two sets of events were made, one in which the warming core moves eastward along the tropical Pacific until April-June of the following year and another one in which it moves westward until November-January. The first type has linked positive precipitation anomalies over southeastern South America during April-June. The second type of event shows slight negative or near-normal precipitation anomalies over the same region.

The series of 16 Climate Outlook Forums' (COFs') seasonal precipitation forecasts for southeast South America since December 1997 are verified. The COFs' forecasts consist of a probabilistic tercile distribution of precipitation for the upcoming 3 months period, over a domain in South America between 20 and 40°S, to the east of the Andes Mountains. The COFs' forecast is the result of the consensus agreement between atmosphere model predictions, physically based statistical model predictions, results of diagnostic analysis and published research on climate variability over the region, and expert interpretation of this information in the context of the current situation. The validation is conducted by means of the hit score (HS), which expresses the percentage of forecasts verified in the dominant predicted category, and the ranked probability skill Score (RPSS), which measures the difference between the probability distribution of the forecasts and the observed categories. The HS reveals that over most of the region the categorical agreement is low and close to 33%, which is the result that would be obtained by a three‐category random forecast, and only sparse regions achieve a categorical agreement between 40 and 50%. The regions with positive RPSS (i.e. forecasts better than climatology and potentially useful for applications) represent 30% of the total area considered by the COFs. There are significantly large regions with negative RPSS, i.e. forecasts worse than climatology. The result of the COFs' forecasts is compared with that of the IRI Net Assessment forecasts, the only source of physically based seasonal forecasts regularly available at the COFs' discussions. There is general coincidence in the regions with positive and negative skill. Although one might expect the consensus of the COFs' forecasts to improve upon the skill of the IRI forecast, this was not the case during this period. Copyright © 2005 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

Background: Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules., Objective: This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians., Methods: Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up., Results: Both studies showed that MT decreased cynicism (posttreatment: 33% reduction; P≤.04; r≥0.41 and follow-up: 33% reduction; P≤.04; r≥0.45), while improvements in emotional exhaustion were observed solely in the first study (25% reduction, P=.02, r=.50 at posttreatment; 25% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P≤.01, r≥0.49 at posttreatment; P≤.01, r≥0.54 at follow-up), intolerance of uncertainty (P≤.03, r≥.57 at posttreatment; P<.001, r≥0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P≤.02, r≥0.50 at posttreatment; P≤.006, r≥0.59 at follow-up) and mindfulness (nonreactivity: P≤.001, r≥0.69 at posttreatment; P≤.004, r≥0.58 at follow-up; nonjudgment: P≤.009, r≥0.50 at posttreatment; P≤.03, r≥0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r≥0.38; P≤.04; emotional exhaustion: r≥0.58; P≤.001)., Conclusions: To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians., Trial Registration: ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425., (©Lia Antico, Judson Brewer. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.01.2025.)

Physician burnout is a pressing issue in healthcare that demands effective wellness interventions. Enhancing wellness resources is challenging and this article highlights key insights for successful initiatives. It emphasizes the importance of evidence-based and user-centered design, which involves engaging physicians in the development and implementation of wellness programs. For example, mindfulness training programs designed with clinician input were tailored to fit their busy schedules and addressed their specific needs, resulting in significant reductions in cynicism and emotional exhaustion among participants. Additionally, the article advocates for a dual approach that targets both organizational and individual factors to effectively combat burnout. By fostering a culture of self-care and resilience in both education and the workplace, healthcare systems can improve well-being and engagement among current and future employees. Ultimately, collaborative and sustained efforts to implement validated interventions are essential for achieving lasting improvements in healthcare environments.

Background: Carotid near-occlusion (CNO) represents an anatomical-functional condition characterized by severe (more than 90%) internal carotid artery stenosis which can lead to a distal lumen diameter greater or less than 2 mm. CNO can be divided into a less severe subgroup (without lumen full collapse: diameter >2 mm) and a more severe subgroup (with lumen full collapse: diameter <2 mm). The decision for revascularization is still highly debated in Literature. The aim of the present multicenter retrospective study is to analyze the incidence of perioperative (30 days) and follow-up complications in 2 groups of patients with or without distal internal carotid lumen full collapse., Methods: Between January 2011 and March 2023, in 5 Vascular Surgery Units, 67 patients (49 male, 73% and 18 females, 27%) with CNO underwent carotid endarterectomy: 28 (41.7%) with lumen diameter <2 mm and 39 (58.3%) with diameter >2 mm. 19 patients were symptomatic and 48 asymptomatic. The outcomes considered for comparative analysis were: perioperative neurological and cardiac complications, carotid restenosis or occlusion at follow-up. Both groups were homogeneous in terms of risk factors, morphological features and pharmacological treatments., Results: In the group with lumen <2 mm, 3 perioperative major events (10.7%) occurred (1 ischemic stroke, 1 hemorrhagic stroke, 1 myocardial infarction) and 2 (7.1%) at follow-up (average 11 ± 14.5 months; 1 asymptomatic carotid occlusion, 1 hemodynamic restenosis treated with stenting). No event was recorded in the group with lumen >2 mm., Conclusions: According to our results CNO patients show different complication risk according to the presence or not of distal lumen collapse. The later seems to play a significant role in perioperative and follow-up complication rate. These results therefore support a surgical treatment only in patients with CNO without lumen full collapse., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In the last 2 years, governments of many countries imposed heavy social restrictions to contain the spread of the COVID-19 virus, with consequent increase of bad mood, distress, or depression for the people involved. Few studies investigated the impact of these restrictive measures on individual social proficiency, and specifically the processing of emotional facial information, leading to mixed results. The present research aimed at investigating systematically whether, and to which extent, social isolation influences the processing of facial expressions. To this end, we manipulated the social exclusion experimentally through the well-known Cyberball game (within-subject factor), and we exploited the occurrence of the lockdown for the Swiss COVID-19 first wave by recruiting participants before and after being restricted at home (grouping factor). We then tested whether either form of social segregation influenced the processing of pain, disgust, or neutral expressions, across multiple tasks probing access to different components of affective facial responses (state-specific, shared across states). We found that the lockdown (but not game-induced exclusion) affected negatively the processing of pain-specific information, without influencing other components of the affective facial response related to disgust or broad unpleasantness. In addition, participants recruited after the confinement reported lower scores in empathy questionnaires. These results suggest that social isolation affected negatively individual sensitivity to other people's affect and, with specific reference to the processing of facial expressions, the processing of pain-diagnostic information.

Action video game players (AVGPs) display superior performance in various aspects of cognition, especially in perception and top-down attention. The existing literature has examined these performance almost exclusively with stimuli and tasks devoid of any emotional content. Thus, whether the superior performance documented in the cognitive domain extend to the emotional domain remains unknown. We present 2 cross-sectional studies contrasting AVGPs and nonvideo game players (NVGPs) in their ability to perceive facial emotions. Under an enhanced perception account, AVGPs should outperform NVGPs when processing facial emotion. Yet, alternative accounts exist. For instance, under some social accounts, exposure to action video games, which often contain violence, may lower sensitivity for empathy-related expressions such as sadness, happiness, and pain while increasing sensitivity to aggression signals. Finally, under the view that AVGPs excel at learning new tasks (in contrast to the view that they are immediately better at all new tasks), the use of stimuli that participants are already experts at predicts little to no group differences. Study 1 uses drift-diffusion modeling and establishes that AVGPs are comparable to NVGPs in every decision-making stage mediating the discrimination of facial emotions, despite showing group difference in aggressive behavior. Study 2 uses the reverse inference technique to assess the mental representation of facial emotion expressions, and again documents no group differences. These results indicate that the perceptual benefits associated with action video game play do not extend to overlearned stimuli such as facial emotion, and rather indicate equivalent facial emotion skills in AVGPs and NVGPs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nicotinic acetylcholine receptors (nAChRs) are widely distributed in the human brain and play an important role in the neuromodulation of brain networks implicated in attentional processes. Previous work in humans showed that heteromeric α4β2 nAChRs are abundant in the cingulo-insular network underlying attentional control. It has been proposed that cholinergic neuromodulation by α4β2 nAChRs is involved in attentional control during demanding tasks, when additional resources are needed to minimize interference from task-irrelevant stimuli and focus on task-relevant stimuli. Here we investigate the link between the availability of α4β2 nAChRs in the cingulo-insular network and behavioral measures of interference control using two versions of the Stroop paradigm, a task known to recruit cingulo-insular areas. We used a previously published PET dataset acquired in 24 non-smoking male subjects in the context of a larger study which investigated the brain distribution of nAChRs in two clinical groups using 2-[(18)F]F-A-85380 PET. We found that higher availability of α4β2 nAChRs in the dorsal anterior cingulate cortex (ACC) predicted better interference control independently of group and age. In line with animal models, our results support the view that the availability of α4β2 nAChRs in the dorsal ACC is linked with more efficient attentional control., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Embodied models of social cognition argue that others' affective states are processed by re-enacting a sensory-specific representation of the same state in the observer. However, neuroimaging studies suggest that a reliable part of the representation shared between self and others is supramodal and relates to dimensions such as Unpleasantness or arousal, common to qualitatively different experiences. Here we investigated whether representations of first-hand pain and disgust influenced the subsequent evaluation of facial expressions in Modality-specific fashion, or in terms of Unpleasantness or arousal., Methods: Thirty volunteers were subjected to thermal painful and olfactory disgusting events, and subsequently were asked to classify computer-generated faces expressing pain (characterized by high Unpleasantness and arousal), disgust (high Unpleasantness and low arousal), surprise (low Unpleasantness and high arousal) and hybrid combinations thereof., Results: Thermal and olfactory events were associated with comparable Unpleasantness ratings and heart rate (but stronger galvanic response was found for painful temperatures). Furthermore, we found that the appraisal of facial expressions was biased by the prior stimulus, with more frequent pain classifications following thermal stimuli, and more frequent disgust classifications following olfactory stimuli. Critically, this modulation was cross-modal in nature, as each first-hand stimulation influenced in comparable fashion facial traits diagnostic of both pain and disgust, without instead generalizing to features of surprise., Conclusion: Overall, these data support the presence of shared coding between one's aversive experiences and the appraisal of others' facial responses, which is best describable as supramodal representation of the Unpleasantness of the experience., Significance: These results extend previous findings about common representational coding between the experience of first-hand and others' pain. In particular, they highlight that reliable part of the information shared is supramodal in nature and relates to a broad dimension of Unpleasantness common also to painless aversive states such as disgust., (© 2019 European Pain Federation - EFIC®.)

Seminal theories posit that social and physical suffering underlie partly-common representational code. It is unclear, however, if this shared information reflects a modality-specific component of pain, or alternatively a supramodal code for properties common to many aversive experiences (unpleasantness, salience, etc.). To address this issue, we engaged participants in a gaming experience in which they were excluded or included by virtual players. After each game session, participants were subjected to comparably-unpleasant painful or disgusting stimuli. Subjective reports and cardiac responses revealed a reduced sensitivity to pain following exclusion relative to inclusion, an effect which was more pronounced in those participants who declared to feel more affected by the gaming manipulation. Such modulation was not observed for disgust. These findings indicate that the relationship between social and physical suffering does not generalize to disgust, thus suggesting a shared representational code at the level of modality-specific components of pain., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Both affective states and personality traits shape how we perceive the social world and interpret emotions. The literature on affective priming has mostly focused on brief influences of emotional stimuli and emotional states on perceptual and cognitive processes. Yet this approach does not fully capture more dynamic processes at the root of emotional states, with such states lingering beyond the duration of the inducing external stimuli. Our goal was to put in perspective three different types of affective states (induced affective states, more sustained mood states and affective traits such as depression and anxiety) and investigate how they may interact and influence emotion perception. Here, we hypothesized that absorption into positive and negative emotional episodes generate sustained affective states that outlast the episode period and bias the interpretation of facial expressions in a perceptual decision-making task. We also investigated how such effects are influenced by more sustained mood states and by individual affect traits (depression and anxiety) and whether they interact. Transient emotional states were induced using movie-clips, after which participants performed a forced-choice emotion classification task with morphed facial expressions ranging from fear to happiness. Using a psychometric approach, we show that negative (vs. neutral) clips increased participants' propensity to classify ambiguous faces as fearful during several minutes. In contrast, positive movies biased classification toward happiness only for those clips perceived as most absorbing. Negative mood, anxiety and depression had a stronger effect than transient states and increased the propensity to classify ambiguous faces as fearful. These results provide the first evidence that absorption and different temporal dimensions of emotions have a significant effect on how we perceive facial expressions., Competing Interests: The authors have declared that no competing interests exist.

Patients with schizophrenia can sometimes report strange face illusions when staring at themselves in the mirror; such experiences have been conceptualized as anomalous self-experiences that can be experienced with a varying degree of depersonalization. During adolescence, anomalous self-experiences can also be indicative of increased risk to develop schizophrenia-spectrum disorders. To date however, the Mirror-Gazing test (MGT), an experimentally validated experiment to evaluate the propensity of strange face illusions in nonclinical and clinical adults, has yet to be investigated in an adolescent sample. The first goal of the present study was to examine experimentally induced self-face illusions in a nonclinical sample of adolescents, using the MGT. The second goal was to investigate whether dimensions of adolescent trait schizotypy were differentially related to phenomena arising during the MGT. One hundred and ten community adolescents (59 male) aged from 12 to 19 years (mean age = 16.31, SD age = 1.77) completed the MGT and Schizotypal Personality Questionnaire. The results yielded 4 types of strange face illusions; 2 types of illusions (slight change of light/color [20%] and own face deformation [45.5%]) lacked depersonalization-like phenomena (no identity change), while 2 other types (vision of other identity [27.3%], and vision of non-human identity [7.3%]) contained clear depersonalization-like phenomena. Furthermore, the disorganization dimension of schizotypy associated negatively with time of first illusion (first press), and positively with frequency of illusions during the MGT. Statistically significant differences on positive and disorganized schizotypy were found when comparing groups on the basis of degree of depersonalization-like phenomena (from slight color changes to non-human visions). Similarly to experimentally induced self-face illusions in patients with schizophrenia, such illusions in a group of nonclinical adolescents present significant associations to schizotypy dimensions., (© The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This contribution deals with the issue of the professional autonomy of the medical doctor. Worldwide, the physician's autonomy is guaranteed and limited, first of all, by Codes of Medical Ethics. In Italy, the latest version of the national Code of Medical Ethics (Code 1998) was published in 1998 by the Federation of provincial Medical Associations (FnomCeO). The Code 1998 acknowledges the physician's autonomy regarding the scheduling, the choice and application of diagnostic and therapeutic means, within the principles of professional responsibility. This responsibility has to make reference to the following fundamental ethical principles: (1) the protection of human life; (2) the protection of the physical and psychological health of the human being; (3) the relief from pain: (4) the respect for the freedom and the dignity of the human person, without discrimination; (5) an up-to-date scientific qualification (Art. 5). The authors underline that autonomy is an anthropological--and consequently ethical-- characteristic of the human person. Different positions on autonomy in bioethics (individualistic, evolutionistic, utilitarian and personalistic models) are explained. The relation between the professional autonomy of the physician and the autonomy of the patient and of colleagues is discussed. In fact, the medical doctor is obliged: (1) to respect the fundamental rights of the person, first of all his/her life; (2) to ensure the continuity of the care, even if he can only relieve the patient's suffering; (3) to maintain, except under certain circumstances, professional secrecy and confidentiality regarding patients and their medical records. Moreover, the physician cannot deny the patient correct and appropriate information. He/she should not perform any diagnostic or therapeutic activity without the informed consent of the patient and the medical doctor must give up medical treatment in case of documented refusal of the individual. Furthermore, the medical doctor has the right to raise conscientious objections if he/she is requested to perform medical actions that are contrary to his/her conscience or medical opinion, unless this attitude would seriously and immediately harm the patient. Regarding the relationships with colleagues, the physician is obliged to solidarity, mutual respect, and care of sick colleagues. Finally, the authors discuss the Italian legislation affecting the physician's professional autonomy: (1) the SSN health care Acts; (2) the so-called Charter for Public Health Care Services; (3) the Acts on privacy; (4) Good Clinical Practice.

Academic stress is a good model of psychological stress in humans for studying psychoneuroimmune correlations. We looked for correlations between psychological scores, immune tests and plasma levels of cortisol and neuropeptide Y (NPY). A group of medical students were evaluated at the beginning of the academic year (Baseline) and the day before an examination (Stress). They underwent evaluation by The Profile of Mood States (POMS), The Malaise Inventory, The Self Efficacy Scale and A Global Assessment of Recent Stress (GARS). The lymphocyte subsets, the lymphocyte proliferative response and the cytokine production were also evaluated. We detected modifications of some psychological test scores between the Baseline and Stress evaluation, a significant reduction of lymphocyte proliferation, IL-2 production and percentage of the lymphocyte CD19, and an increase in plasma cortisol levels during stress. The lymphocyte proliferation negatively correlated with the POMS score as well as the percentage of CD16+ cells with NPY plasma levels. NPY levels were not different from Baseline. The emotional and mood states seem to influence immunity. Copyrightz1999S.KargerAG,Basel

The effects of aging on the activation of the cytoplasmic tyrosine protein kinase p56(lck) have been investigated in PBL from adult and elderly subjects upon activation with mitogens or different co-stimuli. Results show that the amount and phosphorylation of p56(lck) are reduced in PBL from elderly as compared to adult subjects. This finding suggests that alterations in p56(lck) may contribute to the age-associated loss of some T cell functions, such as proliferation and IL-2 production, which are found decreased in PBL from old individuals. However, p56(lck) seems irrelevant to the production of IFN-gamma and IL-4 which were both found increased in the PBL from old subjects, as expected from the relative expansion of memory versus naive T cell subpopulations in aging.

Previous studies on DNA repair in ageing have demonstrated increased frequencies of single and double strand breaks in lymphocytes from elderly subjects and, as a consequence, decreased efficiency in DNA replication. We have investigated the relationship between cell proliferation and the nuclear expression of ku protein in a human population of 43 subjects of different ages. Ku is an heterodimeric protein composed of two subunits of 70 and 80 kDa, which is involved in the early steps of DNA damage recognition. In the present study, PBL from subjects of different ages were PHA-activated to evaluate the stimulation index and the production of Th1- and Th2-type cytokines. Moreover, nuclear extracts were obtained from activated lymphocytes to evaluate by a gel retardation assay the presence and the functional activity of the heterodimer ku 70/80. Our results indicate that ageing affects the mitotic responsiveness and cytokine production to a significant extent, but only marginally the expression of ku 70/80. These findings suggest that the age-related impairment in DNA repair mechanisms are only in part related to the reduced expression of ku protein able to recognize DNA damage.

In recent years the relationships among immune, endocrine and nervous systems have been extensively studied, and grouped in a new research field: psychoneuro-immunoendocrinology. Since ancient times its has been known that, in humans, mood as well as environmental influences could affect health. In the late '70s, only, evidence of bi-directional pathways has been achieved, first in animal models and, later on, in humans. We reviewed current knowledge on neuroimmunomodulation, concerning the influence of stress and psychological status on immunity as well as neuroendocrine modulation by the immune system, reporting some data obtained from our studies. Particularly, having detected a relevant impairment concerning most of the parameters studied, we emphasized the effects of depressive disorders on immune function in the elderly.

Lymphocyte activities were determined in a population of 26 institutionalized aged subjects, selected as healthy according to the SENIEUR protocol and previously reported to display immunological and endocrinological abnormalities correlated with depressive disorders. The lymphocyte mitotic response to PHA, which was reduced in aged as compared to adult subjects, was found to be significantly lower and negatively correlated with the depression score in the elderly subjects. In supernatants of PHA-stimulated lymphocyte culture from aged subjects, IL-2, IL-4 and gamma-IFN levels were very low and more severely affected in the depressed aged group. Each cytokine production was negatively correlated with age and depression score. NK activity was lower in the aged and it could be augmented by the addition of IL-2 or alpha-IFN, even though to a lesser extent than in the adult subjects. The nondepressed aged displayed higher levels of IL-2 inducible NK activity than the depressed aged subjects. IL-2 and alpha-IFN stimulated NK activities were negatively correlated with depression score. The present work indicates that the psychological status could affect lymphocyte reactivity in the aged. Given the relatively high frequency of affective disorders in these subjects, the psychological status should be considered in studies of immune senescence.

Twenty-six institutionalized elderly subjects, selected as healthy according to the SENIEUR protocol, were compared to adult controls to establish correlations between affective disorders and immune abnormalities and to investigate underlying neuroendocrine mechanisms. After an extensive psychodiagnostic examination, 35% of the aged subjects were classified as depressed. Cutaneous delayed hypersensitivity tests showed reduced responses in the aged, but no correlation was found with the psychological status. Examination of the peripheral blood lymphocyte subsets revealed no imbalance in the percentages of CD3+, CD4+, CD8+ cells in the aged. A slight reduction in the CD4+/CD8+ cell ratio could however be detected in the non-depressed aged, as compared to adult controls. The CD4+/CD45R+ cell subset was reduced in non-depressed aged. The percentage of B lymphocytes was reduced in the aged, mostly in the non-depressed subjects. No changes were detected in the percent of OKDR+ cells. The percentage of CD16+ cells was found unchanged, while that of Leu7+ cells was significantly higher in the aged than in the adults and in the non-depressed than in the depressed aged. Leu7+ cell levels were negatively correlated with the depression score. On double labelling, the percent of CD16+/Leu7+ cells appears increased in the subgroup of depressed aged and positively correlated with age. Plasmatic and urinary cortisol levels were both positively correlated with depression score. Urinary cortisol level was higher in the depressed aged. These parameters, as well as plasmatic ACTH, beta-endorphin and urinary catecholamines, were not correlated with immune responses. Based on these findings, we recommend that the neuroendocrinological conditions should be taken into account when healthy subjects are examined in studies of immune senescence.

In the elderly, an impairment of the immune system could lead to increased incidence of infectious, neoplastic and autoimmune diseases; on the other hand, depression, which is the most common psychiatric problem in aged people, seems to be linked with alterations in immunological function. Thirteen institutionalized elderly subjects were studied to investigate the relationship between depression and immunological parameters. These subjects were selected as "healthy" according to the SENIEUR-EURAGE protocol and they belonged to a population already evaluated by our group--one year before--for psychological, endocrinological and immunological parameters. The lymphocyte mitotic response to PHA was greatly diminished in aged subjects, when compared to the adult controls. Depressed elderly showed impaired immunological function as compared with nondepressed ones, either "in vitro" or "in vivo". Lymphocyte stimulation with phytohemagglutinin (PHA), T cell growth factor (TCGF) production (induced by stimulation with PHA) and cutaneous delayed hypersensitivity (CDH) were reduced in depressed aged subjects. As far as lymphocyte proliferation with PHA in the whole group were concerned, no differences were found comparing the present results with those obtained in a former study. Although it is difficult to understand the significance of the immune imbalance associated with depression in the elderly, our results suggest that psychological status could influence the immunological functions in old people.

The use of psychoactive drugs in geriatric nursing homes has to be considered within the peculiar frame work of the elderly condition. The present study was aimed at verifying the prevalence and characteristics of prolonged benzodiazepine use (greater than 1 month) in the entire elderly institutionalized population of an Italian region (Molise). In the 31 benzodiazepine consumers identified, psychosocial and clinical data were recorded by means of a specific scale and of a semistructured interview for the assessment of drug effects. The dependence potential was evaluated in a smaller sample of 18 patients, recording with a scale the onset of withdrawal and/or rebound symptoms following discontinuation of drug treatment. The characteristics of prescription appeared to be generally correct and no appreciable tendency toward abuse was evidenced. In only one patient, discontinuation of benzodiazepines precipitated a confusional state. In other 5 patients significant but not severe withdrawal symptoms were recorded. Duration of treatment was the only variable moderately correlated with the onset of withdrawal/rebound symptomatology (p less than 0.1). In conclusion, the results of our study are reassuring but they should not induce to disregard important clinical aspects of psychopharmacotherapy in the elderly, such as: psychopathological diagnosis, drug associations and interactions, duration of treatment and dosage of prescribed benzodiazepines.

The scimitar syndrome groups a combination of several congenital anomalies in the right lung with an abnormal right pulmonary venous drainage in the inferior vena cava or the right atrium. After a survey of 130 cases in the literature, clinical, angiografic and hemodynimac features of the syndrome are defined. The Authors report two new cases diagnosed in adults, characterised by a clean discordance between the clinical features and the angiographic ones. The former case is completely asymptomatic and the radiographic feature is typical, while the latter shows a characteristic symptomatology but there isn't a clean "scimitar image". But notwithstanding the absence of this "scimitar image", the Authors think that the anomalous pulmonary drainage in the right atrium and the several anomalies in the right lung can be attributed to the scimitar syndrome, physiopatologically.