Using TMS-EEG to assess the effects of neuromodulation techniques: a narrative review

Over the past decades, among all the non-invasive brain stimulation (NIBS) techniques, those aiming for neuromodulatory protocols have gained special attention. The traditional neurophysiological outcome to estimate the neuromodulatory effect is the motor evoked potential (MEP), the impact of NIBS techniques is commonly estimated as the change in MEP amplitude. This approach has several limitations: first, the use of MEP limits the evaluation of stimulation to the motor cortex excluding all the other brain areas. Second, MEP is an indirect measure of brain activity and is influenced by several factors. To overcome these limitations several studies have used new outcomes to measure brain changes after neuromodulation techniques with the concurrent use of transcranial magnetic stimulation (TMS) and electroencephalogram (EEG). In the present review, we examine studies that use TMS-EEG before and after a single session of neuromodulatory TMS. Then, we focused our literature research on the description of the different metrics derived from TMS-EEG to measure the effect of neuromodulation

Comunicare è difficile se non c’è la rete. Il caso “Telecom-Comune di Aggius”

Il volume espone i risultati di una ricerca dell’Istituto di Ricerche sulla Pubblica Amministrazione (IRPA), che ha impegnato 25 ricercatori nell’arco temporale di un anno con l’obiettivo di cogliere ed analizzare i nodi della pubblica amministrazione, che ostacolano o complicano l’attività quotidiana di cittadini ed imprese. La ricerca è stata condotta con un approccio empirico – utilizzando anche interviste e visite sul campo – di analisi di alcuni casi concreti, esemplificativi di rilevanti nodi che caratterizzano l’attività amministrativa italiana. La maggior parte dei procedimenti esaminati riguarda lo svolgimento di attività produttive, concentrandosi nei settori delle comunicazioni (il caso delle infrastrutture TLC nel Comune di Aggius), dell’industria mineraria (la vicenda della Solvay in Toscana), dell’industria petrolifera (il caso del petrolio in Basilicata) e dell’energia. Per quest’ultimo settore sono state individuate, in particolare, due coppie di casi, ciascuna basata sullo stesso procedimento, ma concluse con esiti opposti: di successo in un caso (gli impianti di Porto Levante e di Torre Valdaliga), di insuccesso nell’altro (gli impianti di Brindisi e di Porto Tolle). Due capitoli sono, inoltre, dedicati alla difficoltà di gestione del territorio e di esercizio efficace dei poteri di emergenza (la vicenda dei lavori sul torrente Bisagno a Genova) e dei poteri sostitutivi attribuiti alla Presidenza del Consiglio per risolvere il disaccordo tra le amministrazioni competenti coinvolte in “micro procedimenti”. Per ogni procedimento amministrativo si è cercato di ricostruire la storia, lo svolgimento e l’esito, con l’analisi di ogni passaggio e interazione, mettendo in evidenza per ciascuna fase il comportamento dei diversi soggetti – pubblici e privati – coinvolti e il quadro di incentivi e disincentivi in cui l’azione amministrativa si muove e, spesso, si arresta. In ogni capitolo è stato esaminato il contesto di riferimento, le condizioni – storiche, normative, istituzionali, economiche – i nodi burocratici, spesso ricostruiti grazie a interviste e colloqui con i diretti interessati e i possibili rimedi, riepilogando, in un dossier finale, la cronologia dei fatti, le fonti e l’elenco dei materiali utilizzati. Dai casi esaminati emerge un processo decisionale spesso imprevedibile, costellato di ritardi, silenzi e ripensamenti e frequentemente doppiato dall’intervento del legislatore, con leggi provvedimento e dall’intervento del giudice, con ordinanze e sentenze, che sospendono o conformano l’azione amministrativa. Nella pubblica amministrazione italiana l’impostazione legalista prevale, ma la certezza del diritto è ancora oggi un miraggio: le possibili soluzioni devono essere disegnate sui problemi e gli ostacoli concreti, per una semplificazione effettiva e non solo dichiarata nelle norme

Comunicare è difficile se non c'è la rete. Il caso "Telecom-Comune di Aggius"

Il volume espone i risultati di una ricerca dell’Istituto di Ricerche sulla Pubblica Amministrazione (IRPA), che ha impegnato 25 ricercatori nell’arco temporale di un anno con l’obiettivo di cogliere ed analizzare i nodi della pubblica amministrazione, che ostacolano o complicano l’attività quotidiana di cittadini ed imprese. La ricerca è stata condotta con un approccio empirico – utilizzando anche interviste e visite sul campo – di analisi di alcuni casi concreti, esemplificativi di rilevanti nodi che caratterizzano l’attività amministrativa italiana. La maggior parte dei procedimenti esaminati riguarda lo svolgimento di attività produttive, concentrandosi nei settori delle comunicazioni (il caso delle infrastrutture TLC nel Comune di Aggius), dell’industria mineraria (la vicenda della Solvay in Toscana), dell’industria petrolifera (il caso del petrolio in Basilicata) e dell’energia. Per quest’ultimo settore sono state individuate, in particolare, due coppie di casi, ciascuna basata sullo stesso procedimento, ma concluse con esiti opposti: di successo in un caso (gli impianti di Porto Levante e di Torre Valdaliga), di insuccesso nell’altro (gli impianti di Brindisi e di Porto Tolle). Due capitoli sono, inoltre, dedicati alla difficoltà di gestione del territorio e di esercizio efficace dei poteri di emergenza (la vicenda dei lavori sul torrente Bisagno a Genova) e dei poteri sostitutivi attribuiti alla Presidenza del Consiglio per risolvere il disaccordo tra le amministrazioni competenti coinvolte in “micro procedimenti”. Per ogni procedimento amministrativo si è cercato di ricostruire la storia, lo svolgimento e l’esito, con l’analisi di ogni passaggio e interazione, mettendo in evidenza per ciascuna fase il comportamento dei diversi soggetti – pubblici e privati – coinvolti e il quadro di incentivi e disincentivi in cui l’azione amministrativa si muove e, spesso, si arresta. In ogni capitolo è stato esaminato il contesto di riferimento, le condizioni – storiche, normative, istituzionali, economiche – i nodi burocratici, spesso ricostruiti grazie a interviste e colloqui con i diretti interessati e i possibili rimedi, riepilogando, in un dossier finale, la cronologia dei fatti, le fonti e l’elenco dei materiali utilizzati. Dai casi esaminati emerge un processo decisionale spesso imprevedibile, costellato di ritardi, silenzi e ripensamenti e frequentemente doppiato dall’intervento del legislatore, con leggi provvedimento e dall’intervento del giudice, con ordinanze e sentenze, che sospendono o conformano l’azione amministrativa. Nella pubblica amministrazione italiana l’impostazione legalista prevale, ma la certezza del diritto è ancora oggi un miraggio: le possibili soluzioni devono essere disegnate sui problemi e gli ostacoli concreti, per una semplificazione effettiva e non solo dichiarata nelle norme

Detecting the stepwise propagation of the Eastern Sicily thrust belt (Italy): insight from thermal and thermochronological constraints

An extensive dataset of vitrinite reflectance, FTIR parameters on organic matter, illite content in mixed layers illite-smectite, apatite fission tracks and U-Th/He dating has been used to reconstruct the stepwise propagation of the Eastern Sicily fold-and-thrust belt during Late Palaeogene and Neogene times. The results indicate that the fold-and-thrust belt is divisible into two levels of thermal maturity. These levels consist of a less evolved level of thermal maturity that records limited sedimentary burial and minor heating, and a more evolved level of thermal maturity that indicates tectonic burial and exhumation at different times. Deformation and exhumation of shallowly buried units are linked to wedge forward propagation by low-angle thrusts, whereas the evolution of deeply buried units is associated with tectonic imbrications by duplex formation and steep thrusts. The two tectonic styles alternate during evolution of the fold-and-thrust belt under low erosion rates

Enhancing gamma oscillations restores primary motor cortex plasticity in Parkinson's disease

In humans, gamma (γ) oscillations in cortical motor areas reflect asynchronous synaptic activity and contribute to plasticity processes. In Parkinson's disease (PD), γ oscillatory activity in the basal ganglia-thalamo-cortical network is altered and the long-term potentiation (LTP)-like plasticity elicited by intermittent theta burst stimulation (iTBS) is reduced in the primary motor cortex (M1). In this study, we tested whether transcranial alternating current stimulation (tACS) delivered at γ frequency promotes iTBS-induced LTP-like plasticity in M1 in PD patients. Sixteen patients ('OFF' condition) and 16 healthy subjects (HS) underwent iTBS during γ-tACS (iTBS-γ tACS) and during sham-tACS (iTBS-sham tACS) in two sessions. Motor-evoked potentials (MEPs) evoked by single-pulse TMS and short-interval intracortical inhibition (SICI) were recorded before and after the co-stimulation. A subgroup of patients also underwent iTBS during β tACS. iTBS-sham tACS facilitated single-pulse MEPs in HS, but not in patients. iTBS-γ tACS induced a larger MEPs facilitation than iTBS-sham tACS in both groups, with similar values in patients and HS. In patients, SICI improved after iTBS-γ tACS. The effect produced by iTBS-γ tACS on single-pulse MEPs correlated with disease duration, while changes in SICI correlated with UPDRS-III scores. The effect of iTBS-β tACS on both single-pulse MEPs and SICI was similar to that obtained in the iTBS-sham tACS session. Our data suggest that γ oscillations have a role in the pathophysiology of the abnormal LTP-like plasticity in PD. Entraining M1 neurons at the γ rhythm through tACS may be an effective method to restore impaired plasticity.SIGNIFICANCE STATEMENTIn Parkinson's disease, the LTP-like plasticity of the primary motor cortex is impaired, and gamma oscillations are altered in the basal ganglia-thalamo-cortical network. Using a combined TMS-tACS approach (iTBS-γ tACS co-stimulation), we demonstrate that driving gamma oscillations restores the LTP-like plasticity in patients with Parkinson's disease. The effects correlate with clinical characteristics of patients, being more evident in less affected patients and weaker in patients with longer disease duration. These findings suggest that cortical gamma oscillations play a beneficial role in modulating the LTP-like plasticity of M1 in Parkinson's disease. The iTBS-γ tACS approach may be potentially useful in rehabilitative settings in patients

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review

Ultrasound-guided perineural hydrodissection (HD) is a novel technique that has been found to be effective in providing mechanical release of perineural adhesions and decompression of the nerve, reducing inflammation and edema and restoring its physiological function. It has a significant impact on chronic neuropathic pain (20 ± 4 weeks with VAS < 5 or VAS diminished by 2 points after the procedure). Carpal tunnel syndrome (CTS) is a common entrapment mononeuropathy, and its distribution is typically innervated by the median nerve. Patients with mild or moderate CTS may benefit from nonsurgical treatments or conservative therapies. This review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Four investigators assessed each title, abstract, and full-text article for eligibility, with disagreements being resolved by consensus with two experienced investigators. The qualitative assessment of the studies was carried out using the modified Oxford quality scoring system, also known as the modified Jadad score. Furthermore, risk of possible biases was assessed using the Cochrane collaboration tool. The results of this review suggest that US-guided HD is an innovative, effective, well-tolerated, and safe technique (11 out of 923 patients had collateral or side effects after the procedure). However, further studies comparing all drugs and with a larger sample population are required to determine the most effective substance

Plazomicin against Multidrug-Resistant Bacteria: A Scoping Review

Plazomicin is a next-generation semisynthetic aminoglycoside antibiotic that can be used to treat infections by multi-resistant bacteria. It is effective against many bacteria-producing carbapenemases or other specific hydrolases. This scoping review aims to define the role acquired by plazomicin from its approval by the FDA (US Food and Drug Administration) in 2018 to the present day. Furthermore, we aim to provide a base for a future meta-analysis. This project was conducted following the recommendations presented in the PRISMA extension for scoping reviews and the JBI Manual for Evidence Synthesis. Among 901 potentially engaging citations, 345 duplicates were removed, and only 81 articles were selected for the analysis. According to the data analysis, plazomicin has been used to treat urinary tract infections, bloodstream infections, and ventilation-associated pneumonia. The pathogens killed included multi-resistant E. coli, K. pneumoniae, A. baumannii, P. aeruginosa, and S. aureus. Plazomicin can be a manageable, valid non-beta-lactam alternative for treating multi-resistant bacteria infections

Transcranial evoked potentials can be reliably recorded with active electrodes

Electroencephalographic (EEG) signals evoked by transcranial magnetic stimulation (TMS) are usually recorded with passive electrodes (PE). Active electrode (AE) systems have recently become widely available; compared to PE, they allow for easier electrode preparation and a higher-quality signal, due to the preamplification at the electrode stage, which reduces electrical line noise. The performance between the AE and PE can differ, especially with fast EEG voltage changes, which can easily occur with TMS-EEG; however, a systematic comparison in the TMS-EEG setting has not been made. Therefore, we recorded TMS-evoked EEG potentials (TEPs) in a group of healthy subjects in two sessions, one using PE and the other using AE. We stimulated the left primary motor cortex and right medial prefrontal cortex and used two different approaches to remove early TMS artefacts, Independent Component Analysis and Signal Space Projection—Source Informed Recovery. We assessed statistical differences in amplitude and topography of TEPs, and their similarity, by means of the concordance correlation coefficient (CCC). We also tested the capability of each system to approximate the final TEP waveform with a reduced number of trials. The results showed that TEPs recorded with AE and PE do not differ in amplitude and topography, and only few electrodes showed a lower-than-expected CCC between the two methods of amplification. We conclude that AE are a viable solution for TMS-EEG recording

Plazomicin against Multidrug-Resistant Bacteria: A Scoping Review

Plazomicin is a next-generation semisynthetic aminoglycoside antibiotic that can be used to treat infections by multi-resistant bacteria. It is effective against many bacteria-producing carbapenemases or other specific hydrolases. This scoping review aims to define the role acquired by plazomicin from its approval by the FDA (US Food and Drug Administration) in 2018 to the present day. Furthermore, we aim to provide a base for a future meta-analysis. This project was conducted following the recommendations presented in the PRISMA extension for scoping reviews and the JBI Manual for Evidence Synthesis. Among 901 potentially engaging citations, 345 duplicates were removed, and only 81 articles were selected for the analysis. According to the data analysis, plazomicin has been used to treat urinary tract infections, bloodstream infections, and ventilation-associated pneumonia. The pathogens killed included multi-resistant E. coli, K. pneumoniae, A. baumannii, P. aeruginosa, and S. aureus. Plazomicin can be a manageable, valid non-beta-lactam alternative for treating multi-resistant bacteria infections