Recent advances in the surgical care of breast cancer patients

A tremendous improvement in every aspect of breast cancer management has occurred in the last two decades. Surgeons, once solely interested in the extipartion of the primary tumor, are now faced with the need to incorporate a great deal of information, and to manage increasingly complex tasks

Topological network properties of resting-state functional connectivity patterns are associated with metal mixture exposure in adolescents

IntroductionAdolescent exposure to neurotoxic metals adversely impacts cognitive, motor, and behavioral development. Few studies have addressed the underlying brain mechanisms of these metal-associated developmental outcomes. Furthermore, metal exposure occurs as a mixture, yet previous studies most often consider impacts of each metal individually. In this cross-sectional study, we investigated the relationship between exposure to neurotoxic metals and topological brain metrics in adolescents. MethodsIn 193 participants (53% females, ages: 15-25 years) enrolled in the Public Health Impact of Metals Exposure (PHIME) study, we measured concentrations of four metals (manganese, lead, copper, and chromium) in multiple biological media (blood, urine, hair, and saliva) and acquired resting-state functional magnetic resonance imaging scans. Using graph theory metrics, we computed global and local efficiency (global:GE; local:LE) in 111 brain areas (Harvard Oxford Atlas). We used weighted quantile sum (WQS) regression models to examine association between metal mixtures and each graph metric (GE or LE), adjusted for sex and age. ResultsWe observed significant negative associations between the metal mixture and GE and LE [beta GE = -0.076, 95% CI (-0.122, -0.031); beta LE= -0.051, 95% CI (-0.095, -0.006)]. Lead and chromium measured in blood contributed most to this association for GE, while chromium measured in hair contributed the most for LE. DiscussionOur results suggest that exposure to this metal mixture during adolescence reduces the efficiency of integrating information in brain networks at both local and global levels, informing potential neural mechanisms underlying the developmental toxicity of metals. Results further suggest these associations are due to combined joint effects to different metals, rather than to a single metal

The minimally invasive open video-assisted approach in surgical thyroid diseases

BACKGROUND: The targets of minimally invasive surgery (MIVA) could be summarised by: achievement of the same results as those obtained with traditional surgery, less trauma, better post-operative course, early discharge from hospital and improved cosmetic results. The minimally invasive techniques in thyroid surgery can be described as either endoscopic "pure" approach (completely closed approach with or without CO(2 )insufflation), or "open approach" with central neck mini-incision or "open video-assisted approach". Traditionally, open thyroidectomy requires a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is much shorter (1.5 cm for small nodules, up to 2–3 cm for the largest ones, in respect of the exclusion criteria) upon the suprasternal notch. Patients also experience much less pain after MIVA surgery than after conventional thyroidectomy. This is due to less dissection and destruction of tissues. Pathologies treated are mainly nodular goiter; the only kind of thyroid cancer which may be approached with endoscopic surgery is a small differentiated carcinoma without lymph node involvement. The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria, such as gland volume and the kind of disease. In our experience we have chosen the minimally invasive open video-assisted approach of Miccoli et al. (2002). The aim of this work was to verify the suitability of the technique and the applicability in clinical practice. METHODS: A completely gasless procedure was carried out through a 15–30 mm central incision about 20 mm above the sternal notch. Dissection was mainly performed under endoscopic vision using conventional endoscopic instruments. The video aided group included 11 patients. All patients were women with a average age of 54. RESULTS: We performed thyroidectomy in 8 cases and hemithyroidectomy in 3 cases. The operative average time has been 170 minutes. CONCLUSION: Nowadays this minimally invasive surgery, in selected patients, clearly demonstrates excellent results regarding patient cure rate and comfort, with shorter hospital stay, reduced postoperative pain and most attractive cosmetic results

Giving and taking: representational building blocks of active resource-transfer events in human infants

Active resource transfer is a pervasive and distinctive feature of human sociality. We hypothesized that humans possess an action schema of giving specific for representing social interactions based on material exchange, and specified the set of necessary assumptions about giving events that this action schema should be equipped with. We tested this proposal by investigating how 12-month-old infants interpret abstract resource-transfer events. Across eight looking-time studies using a violation-of-expectation paradigm we found that infants were able to distinguish between kinematically identical giving and taking actions. Despite the surface similarity between these two actions, only giving was represented as an object-mediated social interaction. While we found no evidence that infants expected the target of a giving or taking action to reciprocate, the present results suggest that infants interpret giving as an inherently social action, which they can possibly use to map social relations via observing resource-transfer episodes

Temporal evolution and strength of neural activity in parietal cortex during eye and hand movements

The role of area 7a in eye-hand movement was studied by recording from individual neurons while monkeys performed 7 different tasks, aimed at assessing the relative influence of retinal, eye, and hand information on neural activity. Parietal cell activity was modulated by visuospatial signals about target location, as well as by information concerning eye and/or hand movement, and position. The highest activity was elicited when the hand moved to the fixation point. The population activities across different memory tasks showed common temporal peaks when aligned to the visual instruction (visuospatial peak) or Go signal (motor peak) for eye, hand, and coordinated eye-hand movement. The motor peak was higher for coordinated eye-hand movement, and it was absent in a No-Go task. Two activation maxima were also observed during visual reaching. They had the same latency of the visuospatial and motor peaks seen in the memory tasks. Therefore, area 7a seems to operate through a common neural mechanism underlying eye, hand, or combined eye-hand movement. This mechanism is revealed by invariant temporal activity profiles and is independent from the effector selected and from the presence or absence of a visible target during movement. For comparative purposes, we have studied the temporal evolution of the population activity in the superior parietal lobule (SPL) during the same reaching tasks and during a saccade task. In SPL, the population activity was characterized by a single peak, time locked to the Go signal for eye, hand, or combined eye-hand movement. As in IPL, the time of occurrence of this peak was effector independent. The population activity remained unchanged when the position of the eye changed, suggesting that SPL is mostly devoted to the hand motor behavior

Application of insects to wounds of self and others in chimpanzees in the wild

Medical practices characterize human societies and have been suggested to originate from observing the behavior of other animals. Mascaro and colleagues report that chimpanzees apply insects to their own and the open wounds of other conspecifics, thereby adding to the current debate on self-medicative and prosocial behaviours in nonhuman animals

The over-representation of contralateral space in parietal cortex: A positive image of directional motor components of neglect?

The activity of single cells was recorded in behaving monkeys while they performed several eye-hand directional motor tasks. The results revealed that in parietal area 7a there exists a directional representation of eye and hand motor space that, contrary to that of superior parietal, premotor and motor cortex, is highly skewed toward the contralateral workspace. In man, the loss of this representation after parietal lesions might explain the emergence of the directional movement disorders of neglect. In fact, although unilateral neglect is consequence of damage to different brain structures, it is more common and enduring after right inferior parietal cortex lesions. Neglect patients ignore and avoid interacting with events occurring in the contralesional part of their physical and mental space. Current theories distinguish perceptual from motor components of neglect. One key feature of the latter is directional hypokinesia, an impaired representation of space for action, evident as difficulty to plan hand movements toward the contralesional part of egocentric space. An impairment of a similar nature is also observed for eye movements. In this study, we offer an interpretation of directional movement disorders of neglect from a physiological perspective, i.e. by focusing on the mechanisms underlying the representation of visuomotor space in parietal cortex

The Eye And The Hand: Neural Mechanisms And Network Model For Oculomanual Coordination

The coordinated action of the eye and the hand is necessary for the successful performance of a large variety of motor tasks based on visual information. Although at the output level the neural control systems for the eye and the hand are largely segregated, in the parietal cortex of the macaque monkey there exist populations of neurons able to combine ocular and manual signals on the basis of their spatial congruence. An expression of this congruence is the clustering of eye- and hand-related preferred directions of these neurons into a restricted region of the workspace, defined as field of global tuning. This domain may represent a neural substrate for the early composition of commands for coordinated oculo-manual actions. Here we study two different prototypical network models integrating inputs about retinal target location, eye position and hand position. In the first one, we model the interaction of these different signals, as it occurs at the afferent level, in a feed-forward fashion. In the second model, we assume that recurrent interactions are responsible for their combination. Both models account surprisingly well for the experimentally observed global tuning fields of parietal neurons. When we compare them with the experimental findings, no significant difference emerges between the two. Experiments potentially able to discriminate between these models could be performed