Topological map of the body in post-stroke patients: lesional and hodological aspects

Objective: It has been repeatedly hypothesized that at least 3 distinct types of body representations do exist: body schema, a representation derived from multiple sensory and motor inputs; topological map of the body, a structural description of spatial relations among the body parts; and body semantics, a lexical-semantic representation. Although several studies have assessed neural correlates of the topological map of the body in healthy participants, a systematic investigation of neural underpinnings of the topological map of the body in brain-damaged patients is still lacking. Method: Here we investigated the neural substrates of topological map of the body in 23 brain-damaged patients, both from a topological and an hodological perspectives, using Voxel Lesion Symptom Mapping and atlas-based track-wise statistical analysis. Besides neuroimaging investigation, consisting of T1-weighted and FLAIR sequences, patients underwent the frontal body-evocation subtest (FBE) to assess the topological map of the body. Results: The present results reveal a large-scale brain network involved in the topological map of the body assessed with FBE, encompassing both regions of primary elaboration and multisensory associative areas, in the temporal, parietal, frontal, and insular cortices. Hodological analysis revealed significant association between processing of the body topological map and the disconnection of the frontomarginal tract. Conclusions: These findings suggest that the topological map of the body is built up basing on both external and internal information that comes from the body and are constantly updated and integrated. The theoretical and clinical relevance of these results is discussed

Travel Planning Ability in Right Brain-Damaged Patients: Two Case Reports

Planning ability is fundamental for goal-directed spatial navigation. Preliminary findings from patients and healthy individuals suggest that travel planning (TP)—namely, navigational planning—can be considered a distinct process from visuospatial planning (VP) ability. To shed light on this distinction, two right brain-damaged patients without hemineglect were compared with a control group on two tasks aimed at testing VP (i.e., Tower of London-16, ToL-16) and TP (i.e., Minefield Task, MFT). The former requires planning the moves to reach the right configuration of three colored beads on three pegs, whereas the latter was opportunely developed to assess TP in the navigational environment when obstacles are present. Specifically, the MFT requires participants to plan a route on a large carpet avoiding some hidden obstacles previously observed. Patient 1 showed lesions encompassing the temporoparietal region and the insula; she performed poorer than the control group on the ToL-16 but showed no deficit on the MFT. Conversely, Patient 2 showed lesions mainly located in the occipitoparietal network of spatial navigation; she performed worse than the control group on the MFT but not on the ToL-16. In both cases performances satisfied the criteria for a classical dissociation, meeting criteria for a double dissociation. These results support the idea that TP is a distinct ability and that it is dissociated from VP skills

Lifelong impairment in episodic re-experiencing: Neuropsychological and neuroimaging examination of a new case of Severely Deficient Autobiographical Memory

: Autobiographical memory (AM) represents a complex and multimodal cognitive function, that allows an individual to collect and retrieve personal events and facts, enabling to develop and maintain the continuity of the self over time. Here we describe the case of DR (acronym of the fictional name Doriana Rossi), a 53-year-old woman, who complains of a specific and lifelong deficit in recalling autobiographical episodes. Along with an extensive neuropsychological assessment, DR underwent a structural and functional MRI examination to further define this impairment. The neuropsychological assessment revealed a deficit in episodic re-experiencing of her own personal life events. DR showed reduced cortical thickness in the Retrosplenial Complex in the left hemisphere, and in the Lateral Occipital Cortex, in the Prostriate Cortex and the Angular Gyrus in the right hemisphere. An altered pattern of activity in the calcarine cortex was detected during ordering of autobiographical events according to her own personal timeline. The present study provides further evidence about the existence of a severely deficient autobiographical memory condition in neurologically healthy people, with otherwise preserved cognitive functioning. Furthermore, the present data provide new important insights into neurocognitive mechanisms underpinning such a developmental condition

Action and non-action oriented body representations. insight from behavioural and grey matter modifications in individuals with lower limb amputation

Following current model of body representations, we aimed to systematically investigate the association between brain modifications, in terms of grey matter loss, and body representation deficits, in terms of alterations of the body schema (BS) and of non-action oriented body representations (NA), in individuals with lower limb amputation (LLA)

Improvement of Fatty Acid Profile in Durum Wheat Breads Supplemented with Portulaca oleracea L. Quality Traits of Purslane-Fortified Bread

The addition of functional ingredients to breads could have effects on preventing cardiovascular diseases, cancers and inflammation. The incorporation of 0–5–10–15% of three populations of dried purslane flour on the rheological, sensorial and nutritional quality of fortified durum wheat breads were evaluated. The increase in dried purslane (up to 15%) caused an increase in the resistance to the mixture and a consequent reduction in its extensibility. The “panel test” gave a largely positive evaluation in 10% of enrichment. The fatty acids in breads resulted higher with the 5% substitution. Contrary to what has been imagined, the increase in percentage of substitution to 10 and 15% did not lead to an increase in linoleic (omega-3) and α-linolenic (omega-6) acid and probably the cause is in the cooking. The total phenols content and the antioxidant potential, evaluated by ferric reducing antioxidant potential (FRAP) and 2,20 -azinobis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays of the enriched breads increased with the percentage of the dry purslane substitution. The enrichment of the durum wheat flour with 5% purslane resulted in a good compromise to obtain good rheological characteristics of loaves and breads with decreased omega-6/omega-3 ratio and good antioxidant properties

Transient Waterhouse-Friderichsen Syndrome in a Child: A Case Report

Waterhouse-Friderichsen syndrome (WFS) is a rare but usually fatal disease characterized by adrenal insufficiency associated to bilateral adrenal hemorrhage. It can be associated both to non-infection and a variety of infectious diseases, among which sepsis from Neisseria meningitidis accounts for more than 80% of cases. We report the case of an otherwise healthy 2-year-old child who had a WFS as a consequence of Neisseria meningitidis infection and in which we witnessed a complete recovery of adrenal function a few months after the event. The case highlights not only the difficulty of diagnosing this syndrome but also, at the same time, the extreme importance of high suspicion, early treatment, a multidisciplinary approach and, most of all, the importance of verifying the restoration of adrenal function in order to achieve a better quality of life. Int J Clin Pediatr. 2021;10(1):28-33 doi: https://doi.org/10.14740/ijcp42

Hydrogeological and hydrogeochemical monitoring in the Cumae archaeological site (Phlegraean Fields, southern Italy)

Phlegraean Fields, hydrogeological model, hydrochemical facie

Monitoring of blood serum amyloid (SAA) to predict outcome of first-line pembrolizumab (P) in patients (pts) with advanced non-small cell lung cancer (ANSCLC).

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Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis.

ABSTRACTObjectives:To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer's disease (AD), and healthy comparisons (HCs).Design:A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases.Setting:The United States, France, Japan, and China.Participants:Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included.Measurements:The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC).Results:We identified 109 potentially eligible studies from 1672 records, and 7 papers were included in the meta-analysis. The meta-analysis showed that there was significant impairment in a decision-making capacity in MCI patients compared to the HCs group in terms of Understanding (SMD = −1.04, 95% CI: −1.31 to −0.77, P < 0.001; I2 = 52%, P = 0.07), Appreciation (SMD = −0.51, 95% CI: −0.66 to −0.36, P < 0.001; I2 = 0%, P = 0.97), and Reasoning (SMD = −0.62, 95% CI: −0.77, −0.47, P < 0.001; I2=0%, P =0.46). MCI patients scored significantly higher in Understanding (SMD = 1.50, 95% CI: 0.91, 2.09, P = 0.01, I2 = 78%, P = 0.00001) compared to patients affected by AD.Conclusions:Patients affected by MCI are at higher risk of impaired capacity to consent to treatment and research compared to HCs, despite being at lower risk compared to patients affected by AD. Clinicians and researchers need to carefully evaluate decisional capacity in MCI patients providing informed consent

Blood serum amyloid A as potential biomarker of pembrolizumab efficacy for patients affected by advanced non-small cell lung cancer overexpressing PD-L1: results of the exploratory "FoRECATT" study

Background: Identifying the patients who may benefit the most from immune checkpoints inhibitors remains a great challenge for clinicians. Here we investigate on blood serum amyloid A (SAA) as biomarker of response to upfront pembrolizumab in patients with advanced non-small-cell lung cancer (NSCLC). Methods: Patients with PD-L1 ≥ 50% receiving upfront pembrolizumab (P cohort) and with PD-L1 0-49% treated with chemotherapy (CT cohort) were evaluated for blood SAA and radiological response at baseline and every 9&nbsp;weeks. Endpoints were response rate (RR) according to RECIST1.1, progression-free (PFS) and overall survival (OS). The most accurate SAA cut-off to predict response was established with ROC analysis in the P cohort. Results: In the P Cohort (n = 42), the overall RR was 38%. After a median follow-up of 18.5&nbsp;months (mo), baseline SAA ≤ the ROC-derived cut-off (29.9&nbsp;mg/L; n = 28/42.67%) was significantly associated with higher RR (53.6 versus 7.1%; OR15, 95% CI 1.72-130.7, p = 0.009), longer PFS (17.4 versus 2.1 mo; p &lt; 0.0001) and OS (not reached versus 7.2mo; p &lt; 0.0001) compared with SAA &gt; 29.9&nbsp;mg/L. In multivariate analysis, low SAA positively affects PFS (p = 0.001) and OS (p = 0.048) irrespective of ECOG PS, number of metastatic sites and pleural effusion. SAA monitoring (n = 40) was also significantly associated with survival endpoints: median PFS 17.4 versus 2.1 mo and median OS not reached versus 7.2 mo when SAA remained low (n = 14) and high (n = 12), respectively. In the CT Cohort (n = 30), RR was not affected by SAA level (p &gt; 0.05) while low SAA at baseline (n = 17) was associated with better PFS (HR 0.38, 95% CI 0.16-0.90, p = 0.006) and OS (HR 0.25, 95% CI 0.09-0.67, p &lt; 0.001). Conclusion: Low SAA predicts good survival outcomes irrespective of treatment for advanced NSCLC patients and higher likelihood of response to upfront pembrolizumab only. The strong prognostic value might be exploited to easily identify patients most likely to benefit from immunotherapy. A further study (FoRECATT-2) is ongoing to confirm results in a larger sample size and to investigate the effect of SAA on immune response in vitro assays