Treatment options for PNET liver metastases. a systematic review

Pancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms. About 40-80% of patients with PNET are metastatic at presentation, usually involving the liver (40-93%). Liver metastasis represents the most significant prognostic factor. The aim of this study is to present an up-to-date review of treatment options for patients with liver metastases from PNETs

Quality data assessment and improvement in pre-processing pipeline to minimize impact of spurious signals in functional magnetic imaging (fMRI)

In the recent years, the field of quality data assessment and signal denoising in functional magnetic resonance imaging (fMRI) is rapidly evolving and the identification and reduction of spurious signal with pre-processing pipeline is one of the most discussed topic. In particular, subject motion or physiological signals, such as respiratory or/and cardiac pulsatility, were showed to introduce false-positive activations in subsequent statistical analyses. Different measures for the evaluation of the impact of motion related artefacts, such as frame-wise displacement and root mean square of movement parameters, and the reduction of these artefacts with different approaches, such as linear regression of nuisance signals and scrubbing or censoring procedure, were introduced. However, we identify two main drawbacks: i) the different measures used for the evaluation of motion artefacts were based on user-dependent thresholds, and ii) each study described and applied their own pre-processing pipeline. Few studies analysed the effect of these different pipelines on subsequent analyses methods in task-based fMRI.The first aim of the study is to obtain a tool for motion fMRI data assessment, based on auto-calibrated procedures, to detect outlier subjects and outliers volumes, targeted on each investigated sample to ensure homogeneity of data for motion. The second aim is to compare the impact of different pre-processing pipelines on task-based fMRI using GLM based on recent advances in resting state fMRI preprocessing pipelines. Different output measures based on signal variability and task strength were used for the assessment

Detection rate of FNA cytology in medullary thyroid carcinoma. a meta-analysis

Background: The early detection of medullary thyroid carcinoma (MTC) can improve patient prognosis, because histological stage and patient age at diagnosis are highly relevant prognostic factors. As a consequence, delay in the diagnosis and/or incomplete surgical treatment should correlate with a poorer prognosis for patients. Few papers have evaluated the specific capability of fine-needle aspiration cytology (FNAC) to detect MTC, and small series have been reported. This study conducts a meta-analysis of published data on the diagnostic performance of FNAC in MTC to provide more robust estimates. Research Design and Methods: A comprehensive computer literature search of the PubMed/MEDLINE, Embase and Scopus databases was conducted by searching for the terms 'medullary thyroid' AND 'cytology', 'FNA', 'FNAB', 'FNAC', 'fine needle' or 'fine-needle'. The search was updated until 21 March 2014, and no language restrictions were used. Results: Fifteen relevant studies and 641 MTC lesions that had undergone FNAC were included. The detection rate (DR) of FNAC in patients with MTC (diagnosed as 'MTC' or 'suspicious for MTC') on a per lesion-based analysis ranged from 12·5% to 88·2%, with a pooled estimate of 56·4% (95% CI: 52·6-60·1%). The included studies were statistically heterogeneous in their estimates of DR (I-square >50%). Egger's regression intercept for DR pooling was 0·03 (95% CI: -3·1 to 3·2, P = 0·9). The study that reported the largest MTC series had a DR of 45%. Data on immunohistochemistry for calcitonin in diagnosing MTC were inconsistent for the meta-analysis. Conclusions: The presented meta-analysis demonstrates that FNAC is able to detect approximately one-half of MTC lesions. These findings suggest that other techniques may be needed in combination with FNAC to diagnose MTC and avoid false negative results. © 2014 John Wiley & Sons Ltd

Cortico–Cortical Paired Associative Stimulation (ccPAS) in Ageing and Alzheimer’s Disease: A Quali-Quantitative Approach to Potential Therapeutic Mechanisms and Applications

Background/Objectives: Cognitive decline and Alzheimer’s disease (AD) pose a major challenge for the ageing population, with impaired synaptic plasticity playing a central role in their pathophysiology. This article explores the hypothesis that cortico–cortical paired associative stimulation (ccPAS), a non-invasive brain stimulation technique, can restore synaptic function by targeting impaired spike-timing-dependent plasticity (STDP), a key mechanism disrupted in AD. Methods: We reviewed existing studies investigating the effects of ccPAS on neuroplasticity in both ageing and AD populations. Results: Findings suggest age-specific effects, with ccPAS improving motor performance in young adults but showing limited efficacy in older adults, likely due to age-related declines in synaptic plasticity and cortical excitability. In AD, ccPAS studies reveal significant impairments in long-term potentiation (LTP)-like plasticity, while long-term depression (LTD)-like mechanisms appear relatively preserved, emphasising the need for targeted neuromodulation approaches. Conclusions: Despite promising preliminary results, evidence remains limited and largely focused on motor function, with the impact of ccPAS on cognitive domains still underexplored. To bridge this gap, future research should focus on larger and more diverse cohorts to optimise ccPAS protocols for ageing and AD populations and investigate its potential for enhancing cognitive function. By refining stimulation parameters and integrating neuroimageing-based personalisation strategies, ccPAS may represent a novel therapeutic approach for mitigating neuroplasticity deficits in ageing and neurodegenerative conditions

Loneliness as neurobehavioral issue in amyotrophic lateral sclerosis

Objective: In elderly people loneliness represents a risk factor for dementia and may negatively impact on mental and physical health. The specific contribute of loneliness to cognitive and behavioral functioning have not yet been determined in amyotrophic lateral sclerosis (ALS). Our hypothesis was that loneliness may be related to motor dysfunction with a negative impact on cognitive and behavioral decline, possibly related to specific cortical involvement. Methods: In 200 ALS patients (ALSpts) and 50 healthy controls (HCs) we measured loneliness, mood, and quality of life (QoL). ALSpts underwent comprehensive clinical, genetic, and neuropsychological assessment to define phenotypes. Seventy-seven ALSpts performed 3T MRI scans to measure cortical thickness. Between-group, partial correlation and regression analyses were used to examined clinical, neuropsychological, and cortical signatures of loneliness. Results: Feelings of loneliness were documented in 38% of ALSpts (ALS/L+pts) and in 47% of HCs. In both groups loneliness was associated with anxiety (P < 0.001), depression (P ≤ 0.005), and poor QoL (P < 0.001). ALS/L+pts had similar motor dysfunctions and cognitive abilities than non-lonely ALSpts, but distinct behavioral profiles (P ≤ 0.005) and frontoparietal involvement (P < 0.05). Loneliness in ALS is related to behavioral changes, apathy, and emotional dysregulation (P < 0.001). Interpretation: Our cross-sectional study indicates that, in ALS, the satisfaction of social environment is associated with a sense of life well-being that is not limited to the motor status, proving instead that loneliness can impact on disease-related neurobehavioral changes with a possible flashback on brain architecture. This suggests that sociality could promote personal resilience against behavioral and affective decline in ALS

Postoperative Pancreatic Fistula. Is Minimally Invasive Surgery Better than Open? A Systematic Review and Meta-analysis

Background/Aim: Minimally invasive pancreatico-duodenectomy (PD) is gaining popularity. The aim of this study was to compare the incidence of postoperative pancreatic fistula (POPF) after minimally invasive versus open procedures. Materials and Methods: Following the PRISMA statement, literature research was conducted focusing on papers comparing the incidence of POPF after open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD). Results: Twenty-one papers were included in this meta -analysis, for a total of 4,448 patients. A total of 2,456 patients (55.2%) underwent OPD, while 1,992 (44.8%) underwent MIPD. Age, ASA score III patients, incidence of pancreatic ductal adenocarcinoma and duct diameter were significantly lower in the MIPD group. No statistically significant differences were found between the OPD and MIPD regarding the incidence of major complications (15.6% vs. 17.0%, respectively, p=0.55), mortality (3.7% vs. 2.4%, p=0.81), and POPF rate (14.3% vs. 12.9%, p=0.25). Conclusion: MIPD and OPD had comparable rates of postoperative complications, postoperative mortality, and POPF

Detecting rs-fMRI Networks in Disorders of Consciousness: Improving Clinical Interpretability

Background: Preserved resting-state functional MRI (rs-fMRI) networks are typically observed in Disorders of Consciousness (DOC). Despite the widespread use of rs-fMRI in DOC, a systematic assessment of networks is needed to improve the interpretability of data in clinical practice. We investigated functional connectivity of the main networks, combining structural MRI to obtain a description of the most observed networks in DOC, their diagnostic ability, and whether they can be related to clinical assessment. Methods: A group of 109 chronic patients [65 vegetative state/unresponsive wakefulness state (VS/UWS), 34 minimally conscious state (MCS), and 10 emerged from MCS (eMCS)], with different etiologies, and 34 control subjects underwent multimodal assessment. Rs-fMRI data were analyzed with a semi-automatic pipeline to assess residual functional activity in terms of number, type, mean intensity, and structural preservation of networks. Results: The more networks observed, the better the patient's clinical condition is likely to be. VS/UWS patients display 0-9, MCS 5-9, and eMCS 8-10 networks. Both the presence and intensity of 5 networks (visual networks, temporal, left fronto-parietal and default mode network) are relevant to distinguish VS/UWS from MCS, with AUCs of 0.64-0.69 (95% confidence interval). Etiology and disease duration have an impact on the number and type of preserved networks. High residual functional connectivity observed in VS/UWS patients, as in MCS, is in agreement with neurophysiological and metabolic evaluations. Conclusions: This systematic assessment of the main rs-fMRI networks in DOC provides basic measures of functional connectivity that can enhance their interpretability in clinical practice

Terapia cognitivo-comportamental: A preparação do paciente com transtorno de pânico para as exposições agorafóbicas interoceptivas e in vivo

Objetivo: O estudo com terapia cognitivo-comportamental (TCC) procurou demonstrar a preparaçãodo paciente com transtorno do pânico para exposições agorafóbicas. Foram usadas as técnicas dasexposições interoceptivas, às próprias sensações corporais, e in vivo, a locais ou situações temidas.Metodologia: 50 indivíduos, divididos em dois grupos de 25 participantes cada um. O grupo 1 realizou 10 sessões de TCC semanais e individuais com uma hora de duração e fez uso de medicamentos e o grupo 2, controle, usou apenas medicação sem TCC. A medicação prescrita consistiu em antidepressivos tricíclicos e inibidores seletivos de recaptação da serotonina. Foram aplicados instrumentos de avaliação no início e ao fim das intervenções médica e psicológica. Resultados: Observamos uma diferença significativa entre a avaliação inicial e final no grupo 1, como: redução nos ataques de pânico, ansiedade antecipatória, esquiva agorafobia e medo das sensações corporais. Na escala de avaliação global do funcionamento, um aumento do bem-estar global de 60.8% a 72.5% entre pacientes do grupo 1 com terapia, diferentemente do grupo 2 sem terapia. Conclusões: As técnicas de TCC para as exposições foram consideradas essenciais na preparação dos pacientes com transtorno de pânico, para enfrentarem os ataques de pânico e as situações agorafóbicas subsequentes

Dysregulated anterior insula reactivity as robust functional biomarker for chronic pain—Meta-analytic evidence from neuroimaging studies

Neurobiological pain models propose that chronic pain is accompanied by neurofunctional changes that mediate pain processing dysfunctions. In contrast, meta-analyses of neuroimaging studies in chronic pain conditions have not revealed convergent evidence for robust alterations during experimental pain induction. Against this background, the present neuroimaging meta-analysis combined three different meta-analytic approaches with stringent study selection criteria for case–control functional magnetic resonance imaging experiments during acute pain processing with a focus on chronic pain disorders. Convergent neurofunctional dysregulations in chronic pain patients were observed in the left anterior insula cortex. Seed-based resting-state functional connectivity based on a large publicly available dataset combined with a meta-analytic task-based approach identified the anterior insular region as a key node of an extended bilateral insula-fronto-cingular network, resembling the salience network. Moreover, the meta-analytic decoding showed that this region presents a high probability to be specifically activated during pain-related processes, although we cannot exclude an involvement in autonomic processes. Together, the present findings indicate that dysregulated left anterior insular activity represents a robust neurofunctional maladaptation and potential treatment target in chronic pain disorders