Emotional susceptibility trait modulates insula responses and functional connectivity in flavor processing

The present study aimed at investigating the relationship between Emotional Susceptibility (ES), an aspect of the personality trait Neuroticism, and individual differences in the neural responses in anterior insula to primary sensory stimuli colored by affective valence, i.e., distasting or pleasantly tasting oral stimuli. In addition, it was studied whether intrinsic functional connectivity patterns of brain regions characterized by such differential responses could be related to ES. To this purpose 25 female participants underwent functional magnetic resonance imaging scanning, while being involved in a flavor experiment. During the experiment, flavor stimuli were administered consisting of small amounts of liquid with a different affective valence: neutral, pleasant, unpleasant. The results showed that individual differences in ES trait predicted distinct neural activity patterns to the different stimulus conditions in a region of left anterior insula that a previous meta-analysis revealed to be linked with olfacto-gustatory processing. Specifically, low ES was associated with enhanced neural responses to both pleasant and unpleasant stimuli, compared to neutral stimuli. By contrast, high ES participants showed equally strong neural responses to all types of stimuli without differentiating between the neutral and affective stimuli. Finally, during a task-free state, high ES trait appeared also to be related to decreased intrinsic functional connectivity between left anterior insula and left cerebellum. Our findings show that individual differences in ES are associated with differential anterior insula responses to primary sensory (flavor) stimuli as well as to intrinsic functional cortico-cerebellar connectivity, the latter suggesting a basis in the brain intrinsic functional architecture of the regulation of emotional experiences

Effect of a quality improvement program on compliance to the sepsis bundle in non-ICU patients: a multicenter prospective before and after cohort study

ObjectiveSepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes. We aimed to evaluate the impact of a multi-faceted quality implementing program (QIP) on the compliance of a “simplified 1-h bundle” (Sepsis 6) and hospital mortality of severe sepsis and septic shock patients out of the intensive care unit (ICU).MethodsEmergency departments (EDs) and medical wards (MWs) of 12 academic and non-academic hospitals in the Lombardy region (Northern Italy) were involved in a multi-faceted QIP, which included educational and organizational interventions. Patients with a clinical diagnosis of severe sepsis or septic shock according to the Sepsis-2 criteria were enrolled in two different periods: from May 2011 to November 2011 (before-QIP cohort) and from August 2012 to June 2013 (after-QIP cohort).Measurements and main resultsThe effect of QIP on bundle compliance and hospital mortality was evaluated in a before–after analysis. We enrolled 467 patients in the before-QIP group and 656 in the after-QIP group. At the time of enrollment, septic shock was diagnosed in 50% of patients, similarly between the two periods. In the after-QIP group, we observed increased compliance to the “simplified rapid (1 h) intervention bundle” (the Sepsis 6 bundle – S6) at three time-points evaluated (1 h, 13.7 to 18.7%, p = 0.018, 3 h, 37.1 to 48.0%, p = 0.013, overall study period, 46.2 to 57.9%, p < 0.001). We then analyzed compliance with S6 and hospital mortality in the before- and after-QIP periods, stratifying the two patients’ cohorts by admission characteristics. Adherence to the S6 bundle was increased in patients with severe sepsis in the absence of shock, in patients with serum lactate <4.0 mmol/L, and in patients with hypotension at the time of enrollment, regardless of the type of admission (from EDs or MWs). Subsequently, in an observational analysis, we also investigated the relation between bundle compliance and hospital mortality by logistic regression. In the after-QIP cohort, we observed a lower in-hospital mortality than that observed in the before-QIP cohort. This finding was reported in subgroups where a higher adherence to the S6 bundle in the after-QIP period was found. After adjustment for confounders, the QIP appeared to be independently associated with a significant improvement in hospital mortality. Among the single S6 procedures applied within the first hour of sepsis diagnosis, compliance with blood culture and antibiotic therapy appeared significantly associated with reduced in-hospital mortality.ConclusionA multi-faceted QIP aimed at promoting an early simplified bundle of care for the management of septic patients out of the ICU was associated with improved compliance with sepsis bundles and lower in-hospital mortality

Is TIB – Test Breve d’Intelligenza – a good measure of IQ’s?

SUMMARY. The Test d’Intelligenza Breve (TIB) is an Italian test modelled on the well-known NART test. The aim of the study was to investigate whether performances on TIB, correlate with general intellectual skills in Italian participants. A large group (N = 840) of healthy young adults was given the TIB and the Italian full scale version of the WAIS-R. Analyses focused on the comparison between TIB and each of the subtests of the WAIS-R in classifying the predicted and the actual IQ. Over- all, results showed that TIB moderately predicts Verbal IQ and Full Scale IQ but it dramatically fails in the case of the Per- formance IQ. Therefore, the results undermine the usefulness of TIB in estimating IQ. Results also brought up arguments on the use of the short test in the assessment of IQ in traumatic brain injury patients

Impaired visual processing of contralesional stimuli in neglect patients: a visual-evoked potential study

Transient visual-evoked potentials (VEPs) were recorded in II patients with right brain damage and spatial neglect. High-resolution EEG was recorded using focal stimuli located in the four visual quadrants. VEPs to left stimuli, i.e. located in the neglected side, were compared to VEPs to right stimuli. Results showed that bottom-up processing of a visual stimulus located in the neglected hemifield was intact up to 130 ms from stimulus onset. Hemispheric differences were not significant for either CI or PI components representing the activity of striate and extrastriate areas, respectively. In contrast, visual processing in more dorsal areas adjacent to the superior parietal lobe was changed from normal. We failed to record the NIa component for left visual field stimuli expected in the 130-160 ms time range. Furthermore, the NIp (140-180 ms) and P2 (180-220) components were delayed and/or reduced in amplitude for stimuli located on the neglected side. The source of the NIa was previously localized in the intraparietal sulcus in the dorsal occipital cortex; NIp may represent a reactivation of area V3A and P2 reactivation of occipital visual areas including VI due to top-down feedbacks. Six patients with left brain damage (LBD) and no neglect and 2I healthy subjects were also tested in the same experimental conditions used for patients with neglect. In LBD patients, all components evoked by contralesional stimuli were comparable to ipsilesional components. Overall, data allow localizing in time and space the processing deficit specific for patients with neglect. The first takes place around 130 ms in the bottom-up processing at the level of the anatomically intact dorsal parietal areas; the second is located at the level of the reactivation of the striate and extrastriate areas via feedback connections from higher visual areas. The two functional impairments were limited to left-field stimuli

A first step to assess different components of executive processes

Venezia, 2-6 Aprile, 200

Resting heart rate variability predicts inhibitory control above and beyond impulsivity

Heart rate variability (HRV) has been linked to effective functioning of prefrontal-subcortical inhibitory circuits. Despite the recognized role of the prefrontal cortex (PFC) in executive functions linked to inhibitory capacity, studies linking HRV to executive functions are inconsistent, likely due to potential confounders. The present study sought to examine this relation in a sample of 50 healthy participants (31 females; Mage = 24.2 years) who underwent assessment of resting HRV and two executive tasks assessing inhibitory control, namely the Rule Shift Cards and the Hayling Sentence Completion Test. Hierarchical multiple regressions showed that HRV predicted performance on both tasks (i.e., time taken to inhibit a strongly activated response) above and beyond the role of sex, body mass index, and impulsivity. Present results disconfirm that the HRV-executive function association is only due to confounders, and corroborate such relationship with the use of two ecological tasks assessing inhibitory control. Current findings support the Neurovisceral Integration Model and provide plausible explanation for previous inconsistent result