Evaluation de la réorganisation cérébrale du langage chez les patients épileptiques. Apport de la psychologie cognitive

National audienceL'objectif de cet article est de rappeler les exigences spécifiques nécessaires à la mise en place d'un paradigme d'activation en IRMf dans le cadre de l'évaluation fonctionnelle du langage lors du bilan pré- et post-chirurgical de l'épilepsie

Dynamic causal modeling of spatiotemporal integration of phonological and semantic processes: an electroencephalographic study.: DCM of phonology and semantics

International audienceIntegration of phonological and lexicosemantic processes is essential for visual word recognition. Here we used dynamic causal modeling of event-related potentials, combined with group source reconstruction, to estimate how those processes translate into context-dependent modulation of effective connectivity within the temporal-frontal language network. Fifteen healthy human subjects performed a phoneme detection task in pseudo-words and a semantic categorization task in words. Cortical current densities revealed the sequential activation of temporal regions, from the occipital-temporal junction toward the anterior temporal lobe, before reaching the inferior frontal gyrus. A difference of activation between phonology and semantics was identified in the anterior temporal lobe within the 240-300 ms peristimulus time window. Dynamic causal modeling indicated this increase of activation of the anterior temporal lobe in the semantic condition as a consequence of an increase of forward connectivity from the posterior inferior temporal lobe to the anterior temporal lobe. In addition, fast activation of the inferior frontal region, which allowed a feedback control of frontal regions on the superior temporal and posterior inferior temporal cortices, was found to be likely. Our results precisely describe spatiotemporal network mechanisms occurring during integration of phonological and semantic processes. In particular, they support the hypothesis of multiple pathways within the temporal lobe for language processing, where frontal regions would exert a top-down control on temporal regions in the recruitment of the anterior temporal lobe for semantic processing

Deregulation of LIMD1-VHL-HIF-1α-VEGF pathway is associated with different stages of cervical cancer.

To understand the mechanism of cellular stress in basal-parabasal layers of normal cervical epithelium and during different stages of cervical carcinoma, we analyzed the alterations (expression/methylation/copy number variation/mutation) of HIF-1α and its associated genes LIMD1, VHL and VEGF in disease-free normal cervix (n = 9), adjacent normal cervix of tumors (n = 70), cervical intraepithelial neoplasia (CIN; n = 32), cancer of uterine cervix (CACX; n = 174) samples and two CACX cell lines. In basal-parabasal layers of normal cervical epithelium, LIMD1 showed high protein expression, while low protein expression of VHL was concordant with high expression of HIF-1α and VEGF irrespective of HPV-16 (human papillomavirus 16) infection. This was in concordance with the low promoter methylation of LIMD1 and high in VHL in the basal-parabasal layers of normal cervix. LIMD1 expression was significantly reduced while VHL expression was unchanged during different stages of cervical carcinoma. This was in concordance with their frequent methylation during different stages of this tumor. In different stages of cervical carcinoma, the expression pattern of HIF-1α and VEGF was high as seen in basal-parabasal layers and inversely correlated with the expression of LIMD1 and VHL. This was validated by demethylation experiments using 5-aza-2'-deoxycytidine in CACX cell lines. Additional deletion of LIMD1 and VHL in CIN/CACX provided an additional growth advantage during cervical carcinogenesis through reduced expression of genes and associated with poor prognosis of patients. Our data showed that overexpression of HIF-1α and its target gene VEGF in the basal-parabasal layers of normal cervix was due to frequent inactivation of VHL by its promoter methylation. This profile was maintained during different stages of cervical carcinoma with additional methylation/deletion of VHL and LIMD1.This work was supported by CSIR (Council of Scientific and Industrial Research, Government of India)-JRF/NET grant [File No.09/030(0059)/2010-EMR-I] to Mr. C.Chakraborty, grant [Sr. No. 2121130723] from UGC (University Grants Commission, Government of India) to Mr. Sudip Samadder, grant [SR/SO/HS-116/2007] from DST (Department of Science and Technology, Government of India) to Dr. C. K. Panda and grant [ No. 60(0111)/14/EMR-II of dt.03/11/2014] from CSIR (Council of Scientific and Industrial Research, Government of India) to Dr. C. K. Pand

Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild-moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild-moderate IC were reported such malignancy (753-100%), diabetes (103-13.7%), malnutrition (26-3.5%) and uremia (1-0.1%), while severe IC causes were steroids treatment (14-16.3%); neutropenia (7-8.1%), malignancy on chemotherapy (71-82.6%). Preoperative risk classification were reported as follow: mild-moderate: ASA 1-14 (1.9%); ASA 2-202 (26.8%); ASA 3-341 (45.3%); ASA 4-84 (11.2%); ASA 5-7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2-16 patients (18.6%); ASA 3-41 patients (47.7%); ASA 4-19 patients (22.1%); ASA 5-3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild-moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild-moderate and severe groups. Long-term survival data: in mild-moderate disease-free survival (median, IQR) is 28 (10-91) and in severe IC, it is 21 (10-94). Overall survival (median, IQR) is 44 (18-99) and 26 (20-90) in mild-moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16-81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild-moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients

Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Background: Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods: We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results: Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann’s procedure is mainly performed in grades 1–2 (p < 0.0001). Major complications increased significantly after a Hartmann’s procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). Conclusions: Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann’s procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay

Marcela Perrone-Bertolotti's Quick Files

The Quick Files feature was discontinued and it’s files were migrated into this Project on March 11, 2022. The file URL’s will still resolve properly, and the Quick Files logs are available in the Project’s Recent Activity

Spécialisation hémisphérique et cartographie du langage chez le sujet sain et les patients épileptiques : effet des variables inter- et intra-individuelles. Evaluation comportementale, neuropsychologique et neurophysiologique (IRM fonctionnelle)

The purpose of this PhD research was to identify the effect of several individual and experimental variables on hemispheric specialization and cortical mapping of language in healthy subjects and epileptic patients. The question was addressed by means of a multidisciplinary approach including behavioral, neuropsychological and neurophysiological (fMRI) testing. The main goal of this work was to corroborate data provided from all these methods and to build a model of the representation and reorganization (plasticity) of language according to the considered factors. Moreover, we aimed to provide several practical tools to clinicians for presurgical evaluation of hemispheric specialization in patients with drug-resistant epilepsy. Overall, our results reflect the necessity to use a multidimensional approach composed of complementary techniques and methods, in order to assess cerebral representations in normal and pathological conditions. Key words: language, specialization, hemisphere, divided visual field, fMRI, phonology, semantics, prosody, gender, healthy, epilepsy, plasticity, reorganization.Le but de ce travail est d'identifier l'effet de certaines caractéristiques liée aux individus et aux paradigmes expérimentaux sur l'organisation inter-hémisphérique (spécialisation hémisphérique) et intra-hémisphérique (cartographie fonctionnelle) du langage, (a) en condition physiologique chez les sujets sains et (b) en condition pathologique chez des patients présentant une épilepsie focale et pharmaco-résistante. Pour aborder cette question, une approche méthodologique expérimentale pluridisciplinaire a été utilisée. Plus spécifiquement nous avons évalué l'effet des variables inter-individuelles (sexe, préférence manuelle, et caractéristiques pathologiques) et intra-individuelles (opération linguistique, tâche, type de stimuli) sur l'organisation cérébrale du langage. L'un des objectifs de ce travail est de corroborer les données issues de différentes méthodes pour mettre en place un modèle de représentation et de réorganisation langagière, en fonction des facteurs considérés. Un second objectif de ce travail est de proposer aux cliniciens des outils permettant de quantifier la spécialisation hémisphérique chez les patients épileptiques. Nos résultats chez les sujets sains mettent en évidence une interaction entre les variables inter- et intra-individuelles sur le degré de spécialisation hémisphérique et sur la cartographie fonctionnelle du langage. Chez les patients épileptiques, nos résultats préliminaires permettent de mettre en relation les patterns de réorganisation cérébrale et les variables évaluées. L'ensemble de nos résultats montre que la neuropsychologie cognitive et la neuroimagerie fonctionnelle apportent des informations complémentaires nous permettant une meilleure compréhension des mécanismes d'organisation et réorganisation cérébrale. Mots clés : langage, spécialisation, hémisphère, champ visuel divisé, IRMf, phonologie, sémantique, prosodie, sexe, sain, épileptique, plasticité, réorganisation

Hemispheric specialization and mapping of language in healthy subjects and epileptic patients : effect of inter-and intra-individual variable. Behavioral neuropsychological and neurophysiological (fMRI) assessment.

Le but de ce travail est d'identifier l'effet de certaines caractéristiques liée aux individus et aux paradigmes expérimentaux sur l'organisation inter-hémisphérique (spécialisation hémisphérique) et intra-hémisphérique (cartographie fonctionnelle) du langage, (a) en condition physiologique chez les sujets sains et (b) en condition pathologique chez des patients présentant une épilepsie focale et pharmaco-résistante. Pour aborder cette question, une approche méthodologique expérimentale pluridisciplinaire a été utilisée. Plus spécifiquement nous avons évalué l'effet des variables inter-individuelles (sexe, préférence manuelle, et caractéristiques pathologiques) et intra-individuelles (opération linguistique, tâche, type de stimuli) sur l'organisation cérébrale du langage. L'un des objectifs de ce travail est de corroborer les données issues de différentes méthodes pour mettre en place un modèle de représentation et de réorganisation langagière, en fonction des facteurs considérés. Un second objectif de ce travail est de proposer aux cliniciens des outils permettant de quantifier la spécialisation hémisphérique chez les patients épileptiques. Nos résultats chez les sujets sains mettent en évidence une interaction entre les variables inter- et intra-individuelles sur le degré de spécialisation hémisphérique et sur la cartographie fonctionnelle du langage. Chez les patients épileptiques, nos résultats préliminaires permettent de mettre en relation les patterns de réorganisation cérébrale et les variables évaluées. L'ensemble de nos résultats montre que la neuropsychologie cognitive et la neuroimagerie fonctionnelle apportent des informations complémentaires nous permettant une meilleure compréhension des mécanismes d'organisation et réorganisation cérébrale. Mots clés : langage, spécialisation, hémisphère, champ visuel divisé, IRMf, phonologie, sémantique, prosodie, sexe, sain, épileptique, plasticité, réorganisation.The purpose of this PhD research was to identify the effect of several individual and experimental variables on hemispheric specialization and cortical mapping of language in healthy subjects and epileptic patients. The question was addressed by means of a multidisciplinary approach including behavioral, neuropsychological and neurophysiological (fMRI) testing. The main goal of this work was to corroborate data provided from all these methods and to build a model of the representation and reorganization (plasticity) of language according to the considered factors. Moreover, we aimed to provide several practical tools to clinicians for presurgical evaluation of hemispheric specialization in patients with drug-resistant epilepsy. Overall, our results reflect the necessity to use a multidimensional approach composed of complementary techniques and methods, in order to assess cerebral representations in normal and pathological conditions. Key words: language, specialization, hemisphere, divided visual field, fMRI, phonology, semantics, prosody, gender, healthy, epilepsy, plasticity, reorganization