23 research outputs found
Non-Functional Jaw Muscular Activity in Patients with Disorders of Consciousness Revealed by A Long-Lasting Polygraphy
The presence of involuntary, non-functional jaw muscle activity (NFJMA) has not yet been assessed in patients with disorders of consciousness (DOC), although the presence of bruxism and other forms of movement disorders involving facial muscles is probably more frequent than believed. In this work, we evaluated twenty-two prolonged or chronic DOC patients with a long-lasting polygraphic recording to verify NFJMA occurrence and assess its neurophysiological patterns in this group of patients. A total of 5 out of 22 patients showed the presence of significant NFJMA with electromyographic patterns similar to what can be observed in non-DOC patients with bruxism, thus suggesting a disinhibition of masticatory motor nuclei from the cortical control. On the other hand, in two DOC patients, electromyographic patterns advised for the presence of myorhythmia, thus suggesting a brainstem/diencephalic involvement. Functional, non-invasive tools such as long-lasting polygraphic recordings should be extended to a larger sample of patients, since they are increasingly important in revealing disorders potentially severe and impacting the quality of life of DOC patients
Genetic determinants in a critical domain of ns5a correlate with hepatocellular carcinoma in cirrhotic patients infected with hcv genotype 1b
HCV is an important cause of hepatocellular carcinoma (HCC). HCV NS5A domainâ1 interacts with cellular proteins inducing proâoncogenic pathways. Thus, we explore genetic variations in NS5A domainâ1 and their association with HCC, by analyzing 188 NS5A sequences from HCV genotypeâ1b infected DAAânaĂŻve cirrhotic patients: 34 with HCC and 154 without HCC. Specific NS5A mutations significantly correlate with HCC: S3T (8.8% vs. 1.3%, p = 0.01), T122M (8.8% vs. 0.0%, p < 0.001), M133I (20.6% vs. 3.9%, p < 0.001), and Q181E (11.8% vs. 0.6%, p < 0.001). By multivariable analysis, the presence of >1 of them independently correlates with HCC (OR (95%CI): 21.8 (5.7â82.3); p < 0.001). Focusing on HCCâgroup, the presence of these mutations correlates with higher viremia (median (IQR): 5.7 (5.4â6.2) log IU/mL vs. 5.3 (4.4â5.6) log IU/mL, p = 0.02) and lower ALT (35 (30â71) vs. 83 (48â108) U/L, p = 0.004), suggesting a role in enhancing viral fitness without affecting necroinflammation. Notably, these mutations reside in NS5A regions known to interact with cellular proteins crucial for cellâcycle regulation (p53, p85âPIK3, and ÎČâ catenin), and introduce additional phosphorylation sites, a phenomenon known to ameliorate NS5A interaction with cellular proteins. Overall, these results provide a focus for further investigations on molecular bases of HCVâmediated oncogenesis. The role of these NS5A domainâ1 mutations in triggering proâoncogenic stimuli that can persist also despite achievement of sustained virological response deserves further investigation
The cerebellum and the Mirror Neuron System : a study of functional connectivity and probabilistic tractography
Un' importante scoperta nel campo delle neuroscienze Ăš quella dei neuroni mirror. Negli ultimi anni diversi studi hanno osservato il coinvolgimento di ulteriori aree rispetto a quelle che classicamente lo definivano, suggerendo lâipotesi dellâesistenza di un sistema mirror esteso. In particolare, studi recenti hanno dimostrato il coinvolgimento del cervelletto sia durante lâesecuzione di unâazione sia durante la sua osservazione. Su tali premesse, lâobiettivo di questa tesi Ăš quello di indagare le connessioni tra il cervelletto e le aree mirror corticali, mediante analisi di connettivitĂ funzionale (fcMRI) e della trattografia probabilistica. âAn important discovery in the field of neuroscience is the mirror neuron system. Recently, several studies suggested the involvement of additional areas in this system compared to those that classically defined it, leading to a hypothesis of an extended mirror system. In particular, recent studies have shown the involvement of the cerebellum during both action execution and the observation of the same action. On these bases, the aim of this thesis is to investigate the connectivity between the cerebellum and the cortical mirror areas, using functional connectivity analysis (fcMRI) and probabilistic tractography.
Non-Functional Jaw Muscular Activity in Patients with Disorders of Consciousness Revealed by A Long-Lasting Polygraphy
The presence of involuntary, non-functional jaw muscle activity (NFJMA) has not yet been assessed in patients with disorders of consciousness (DOC), although the presence of bruxism and other forms of movement disorders involving facial muscles is probably more frequent than believed. In this work, we evaluated twenty-two prolonged or chronic DOC patients with a long-lasting polygraphic recording to verify NFJMA occurrence and assess its neurophysiological patterns in this group of patients. A total of 5 out of 22 patients showed the presence of significant NFJMA with electromyographic patterns similar to what can be observed in non-DOC patients with bruxism, thus suggesting a disinhibition of masticatory motor nuclei from the cortical control. On the other hand, in two DOC patients, electromyographic patterns advised for the presence of myorhythmia, thus suggesting a brainstem/diencephalic involvement. Functional, non-invasive tools such as long-lasting polygraphic recordings should be extended to a larger sample of patients, since they are increasingly important in revealing disorders potentially severe and impacting the quality of life of DOC patients
Towards a New Assessment Tool for Caregivers of Patients with Disorders of Consciousness: The Social and Family Evaluation Scale (SAFE)
Monitoring the level of responsiveness of patients with Disorders of Consciousness (DoCs) represents an issue in all the settings where there is not the daily presence of clinicians, such as long-term and domestic settings. The involvement of patients’ informal caregivers (i.e., patients’ family) in such a monitoring process is thus fundamental. However, to date, no standardized tailored-made instruments exist that informal caregivers can use without the presence of clinicians, despite evidence illustrating the good accuracy of caregivers when expressing their opinions about the level of responsiveness of DoC patients. The present work aims to set the foundational knowledge, to create a standardized instrument that is able to assess the level of responsiveness of patients with DoCs by their informal caregivers. After selecting and modifying the items to be included in the new scale from the gold standard to diagnose DoCs (i.e., the Coma Recovery Scale-revised), and following a consensus process, we created the Social and Family Evaluation (SAFE) scale for caregivers of patients with DoCs. Although the SAFE needs a validation process, with the present work we provided its preliminary description along with insights into its clinical utility
Sleep Treatments in Disorders of Consciousness: A Systematic Review
Sleep disorders are among the main comorbidities in patients with a Disorder of Consciousness (DOC). Given the key role of sleep in neural and cognitive functioning, detecting and treating sleep disorders in DOCs might be an effective therapeutic strategy to boost consciousness recovery and levels of awareness. To date, no systematic reviews have been conducted that explore the effect of sleep treatments in DOCs; thus, we systematically reviewed the existing studies on both pharmacological and non-pharmacological treatments for sleep disorders in DOCs. Among 2267 assessed articles, only 7 were included in the systematic review. The studies focused on two sleep disorder categories (sleep-related breathing disorders and circadian rhythm dysregulation) treated with both pharmacological (Modafinil and Intrathecal Baclofen) and non-pharmacological (positive airway pressure, bright light stimulation, and central thalamic deep brain stimulation) interventions. Although the limited number of studies and their heterogeneity do not allow generalized conclusions, all the studies highlighted the effectiveness of treatments on both sleep disorders and levels of awareness. For this reason, clinical and diagnostic evaluations able to detect sleep disorders in DOC patients should be adopted in the clinical routine for the purpose of intervening promptly with the most appropriate treatment
Anesthetic management of pregnant patients with cardiovascular disease: a commentary on the 2023 American Heart Association (AHA) scientific statement
The American Heart Association (AHA) has recently released a statement on cardiovascular management of pregnant women from an anesthesiological point of view. Although managing such situation is extremely frequent in clinical practice, poor attention is paid to the topic and many cardiologists and anesthesiologists in small centers have to cope with cardiovascular complications during pregnancy, being at the forefront as consultants. Consequently, we deem appropriate to dwell on this statement. The aim of the present commentary is to summarize the main practical indications provided by the AHA from a strictly cardiological point of view
Theoretical Models of Consciousness: A Scoping Review
The amount of knowledge on human consciousness has created a multitude of viewpoints and it is difficult to compare and synthesize all the recent scientific perspectives. Indeed, there are many definitions of consciousness and multiple approaches to study the neural correlates of consciousness (NCC). Therefore, the main aim of this article is to collect data on the various theories of consciousness published between 2007â2017 and to synthesize them to provide a general overview of this topic. To describe each theory, we developed a thematic grid called the dimensional model, which qualitatively and quantitatively analyzes how each article, related to one specific theory, debates/analyzes a specific issue. Among the 1130 articles assessed, 85 full texts were included in the prefinal step. Finally, this scoping review analyzed 68 articles that described 29 theories of consciousness. We found heterogeneous perspectives in the theories analyzed. Those with the highest grade of variability are as follows: subjectivity, NCC, and the consciousness/cognitive function. Among sub-cortical structures, thalamus, basal ganglia, and the hippocampus were the most indicated, whereas the cingulate, prefrontal, and temporal areas were the most reported for cortical ones also including the thalamo-cortical system. Moreover, we found several definitions of consciousness and 21 new sub-classifications
The EMPOWER Occupational eâMental Health Intervention Implementation Checklist to Foster eâMental Health Interventions in the Workplace:Development Study
Background: Occupational eâmental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. Objective: The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. Methods: Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing âelements that positively affect implementationâ and 17 barriers presented as statements addressing âconcerns toward implementation.â If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from âvery difficult to implementâ to âvery easy to implement.â In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholdersâ responses to the open surveyâs questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. Results: In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. Conclusions: Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.</p
La comunit\ue0 che cura: una ricerca azione partecipata per promuovere salute nella zona di Pescarola.
Ricerca-azione partecipata e promozione della salute nella zona di Pescarola (Bologna)