Neural basis of generation of conclusions in elementary deduction

In everyday life, people untrained in formal logic draw simple deductive inferences from linguistic material (i.e., elementary propositional deductions). Presently, we have limited information on the brain areas implicated when such conclusions are drawn. We used event-related fMRI to identify these brain areas. A set of multiple and independent criteria was derived from the two main theories in the field of reasoning to maximize the reliability of detection of areas in which activity is specifically associated with deductive inferences. Two left lateralized clusters of areas, one in frontal cortex (Brodmann Area 44 and 6) and one in parietal lobe (BA 40), satisfied all criteria; activation was present at the moment of inference, it was shared by both conditional ("if-based") and disjunctive ("or-based") inferences but was greater for disjunctive clauses. Identification of the reasoning network was corroborated by the observation that activity in these areas was greater the longer the reasoning time. Taken together with results from preceding studies, our findings suggest possible theoretically relevant dissociations between elementary propositional deductions and other types of deductive reasoning.     

Efficacy and Safety of Ramipril in Hypertensive Single-Kidney Patients

The effects of medium-term antihypertensive treatment with the ACE inhibitor ramipril were studied on 10 hypertensive single-kidney patients in a double-blind study versus placebo. Patients with renovascular hypertension were excluded. Compared to placebo, ramipril induces a significant reduction of arterial blood pressure (p < 0.02 for systolic, p < 0.01 for diastolic, and p < 0.05 for mean blood pressure), renal vascular resistance (p < 0.005), and microalbuminuria (p < 0.005), but a significant rise of effective renal plasma flow (p < 0.01) and no significant variation of the glomerular filtration rate. The reduction of microalbuminuria was not related to arterial blood pressure variation. Our study shows that ramipril, in appropriately selected-kidney patients, is effective and safe in reducing arterial blood pressure, bringing about an improvement of renal function and reducing microalbuminuria, which is frequently observed in this condition.     

Risk of malignant lymphoma following viral hepatitis infection

We investigated lymphoma risk following hepatitis infection in a case-control study of 274 incident lymphoma cases, defined according to the WHO classification, and 336 population controls in Sardinia, Italy. Part of our study population (198 cases and 219 controls) was included in the EPILYMPH study of Hepatitis C virus (HCV) infection in relation to non-Hodgklin's lymphoma risk. Based on questionnaire information on whether and at what age a diagnosis of hepatitis was posed by a physician, systematic anti-HCV antibodies testing in cases and controls by enzyme-linked immunoassay, and HCV-RNA assessment by PCR analyses in positive samples, we investigated more in detail whether hepatitis non-C is also associated with lymphoma risk, and whether risk varies by clinical form of hepatitis (acute or chronic infection). After adjusting by age, gender, education, and area of birth whether from the study area or elsewhere in Italy, a previous generic diagnosis of hepatitis was associated with a significantly elevated lymphoma risk [odds ratio (OR) = 1.8; 95% CI 1.1, 2.8], which was equally increased for hepatitis B (OR = 1.8; 95% CI 0.9, 3.5), for HCV positive subjects overall (OR = 2.0; 95% CI 0.8, 4.8), and for hepatitis non-B non-C (OR = 1.6; 95% CI 0.7, 3.9). Once concurrent infection from other hepatitis viruses was excluded, acute or chronic hepatitis C was the only one showing a consistent risk increase in all lymphoma subtypes, but follicular lymphoma. Some indications of an excess risk of lymphoma were observed also for acute, but not chronic forms of hepatitis B and hepatitis non-B, non C. Self-limited hepatitis C did not show an association. No significant heterogeneity in the risk of major lymphoma subtype was observed. Our results confirm a role of either acute or chronic active HCV infection in lymphomagenesis. Further studies are warranted to test the hypothesis that acute infection from other hepatitis viruses might also increase lymphoma risk.     

Dynamic Left Ventricular Outflow Tract Obstruction During Myocardial Ischemia in Mitral Valve Prolapse Syndrome

Systolic anterior motion of the mitral valve (MV) with dynamic left ventricular (LV) outflow tract obstruction is a well known phenomenon in hypertrophic cardiomyopathy, or other forms of hyper-dynamic LV function associated with hypovolemic states, or LV hypertrophy. We report three patients with MV prolapse in the absence of the above predisposing factors, who developed an LV outflow dynamic gradient during acute transient myocardial ischemia. An interaction between structural abnormalities of the mitral apparatus and ischemia-dependent LV shape deformity most likely accounted for the outflow gradient.     

Renal artery stenting in patients with chronic ischemic heart disease

Objectives : To investigate the role of renal stenting in selected patients with chronic ischemic heart disease and renal artery stenosis. Methods : Consecutive patients, with chronic ischemic heart disease and severe hypertension and/or impaired renal function undergoing renal stenting, were prospectively enrolled. Mid‐term (at least 2 years) follow‐up was performed to assess both changes in renal function [serum creatinine and estimated glomerular filtrate rate (eGFR)] and blood pressure (BP) control (number of required drugs) and to record the incidence of clinical major adverse events. Moreover, in the first consecutive 24 patients, out‐of‐range pressure values at 24‐hr BP monitoring and GFR at renal scintigraphy were measured at baseline and 1 month after stenting. Results : Seventy patients treated by stenting on 86 renal arteries entered the study. Procedural success rate was 99% and no major complication occurred. At 2‐year follow‐up, both mean serum creatinine (?0.1 ± 0.7 mg/dl at follow‐up compared to baseline, P = 0.6) and eGFR (+3.7 ± 23.5 ml/min/1.73m² at follow‐up compared to baseline, P = 0.2) did not significantly change while the number of drugs required to control BP significantly decreased (2.7 ± 0.8 to 2.2 ± 0.7, P < 0.0001). In the subset of 24 patients evaluated at 1 month, GFR significantly increased (62 ± 20 ml/min to 67 ± 21 ml/min; P = 0.008) and the rate of the out‐of‐range systolic pressure values at 24‐hr monitoring significantly decreased (51–33%, P = 0.005). Elevated baseline creatinine values and the presence of global renal ischemia were identified as predictors of poor outcome at the multivariate analysis. Conclusions : In selected patients with chronic ischemic heart disease and hypertension and/or renal insufficiency, renal stenting may be performed with very low periprocedural complications and results in unchanged renal function and improved BP control. © 2010 Wiley‐Liss, Inc.