Empatia materna per il dolore e depressione post partum:uno studio delle basi cerebrali mediante topografia ottica

2008/2009EMPATIA MATERNA PER IL DOLORE E DEPRESSIONE POST PARTUM: UNO STUDIO DELLE BASI CEREBRALI MEDIANTE TOPOGRAFIA OTTICA Introduzione. Per empatia intendiamo quella particolare competenza psichica che facilita la risonanza affettiva interindividuale ottimizzando le relazioni interpersonali. La maggior parte dei lavori che hanno indagato le basi neurali dell’empatia hanno fatto riferimento all’empatia nei confronti del dolore vissuto da un’altra persona. Recenti scoperte suggeriscono l’utilizzo di rappresentazioni che riflettono reazioni emozionali personali al dolore per comprendere e sintonizzarsi con il dolore altrui. Meccanismi empatici di risonanza affettiva facilitano il precoce “attuning” materno – infantile ed in particolare la responsività materna alle necessità psicofisiche del proprio bambino. La Depressione Post – Partum (DPP), stato emotivo di vulnerabile fragilità, può ostacolare la ricettività materna ed indebolire lo scambio relazionale all’interno della diade. Obiettivo del presente studio consiste nell’indagare, attraverso la topografia ottica, i meccanismi neurali di risonanza affettiva alla base del vissuto empatico materno implicati nella percezione del dolore altrui ed identificare eventuali pattern di attivazione corticale diversificati in madri con fattori di rischio per la DPP. Materiali e metodi. La topografia ottica rappresenta un sistema di imaging funzionale cerebrale non invasivo che consente delle misurazioni funzionali dei cambiamenti emodinamici a livello della corteccia cerebrale. I cambiamenti emodinamici nel flusso sanguigno cerebrale (Cerebral Blood Flow) sono stati rilevati bilateralmente nelle aree fronto/temporo/parietali di 18 madri durante l’osservazione di una procedura dolorosa minore (prelievo al tallone), effettuata al proprio bambino a scopo diagnostico. La Edinburgh Postnatal Depression Scale è stata somministrata ad ogni madre per rilevare l’eventuale occorrenza di fattori di rischio per lo sviluppo di una condizione depressiva (Depression Post – Partum). Risultati. Nelle madri senza fattori di rischio per lo sviluppo di una condizione depressiva è stato individuato un aumento del flusso sanguigno cerebrale (CBF) nell’area perinsulare (parte posteriore del giro frontale inferiore), mentre nelle madri con presenza di questi fattori di rischio si è rilevato un decremento significativo di attivazione nella stessa area. Conclusioni. Nella condizione “empatia per il dolore”, questo studio ha evidenziato dei pattern di attivazione corticale differenziati a livello peri-insulare a seconda della presenza (decremento CBF) o assenza (incremento CBF) della sintomatologia depressiva post – partum. Facendo riferimento a quanto osservato in questo studio, sono stati evidenziati dei pattern di attivazione corticale differenziati a seconda della presenza o meno di fattori di rischio per una sintomatologia depressiva post partum. Questi risultati potrebbero rappresentare un passo nella comprensione dei processi cerebrali potenzialmente implicati nella riduzione delle abilità materne empatiche in condizioni di rischio depressivo.XXII Cicl

Validation of the italian translation of the affective neuroscience personality scales

Summary.-The theoretical perspective on affective neuroscience advanced by Panksepp, identified six basic innate affective systems: the SEEK, FEAR, ANGER, SADNESS, PLAY, and CARE systems. (3) It has been proposed that the fundamental elements of human personality and its variants may be based on the different expressions of these basic emotional systems and their combinations. A self-report inventory, the Affective Neuroscience Personality Scales (ANPS), has been devised with the aim of studying and evaluating personality from this perspective. This study reports data on the initial validation of ANPS Italian translation on a sample of 418 adult participants. Descriptive statistics for each scale were calculated, assessing also their internal consistency, as a measure of reliability and factorial validity. Acceptable internal consistency was found in all but one scale (SADNESS), and a second-order factor analysis identified a more general affective feature of personality hinging on relational characteristics, independent of the dimensions of general positive and negative affect

Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability

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 domain‐1 interacts with cellular proteins inducing pro‐oncogenic pathways. Thus, we explore genetic variations in NS5A domain‐1 and their association with HCC, by analyzing 188 NS5A sequences from HCV genotype‐1b infected DAA‐naïve 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 (5.7–82.3); p < 0.001). Focusing on HCC‐group, the presence of these mutations correlates with higher viremia (median (IQR): 5.7 (5.4–6.2) log IU/mL vs. 5.3 (4.4–5.6) log IU/mL, p = 0.02) and lower ALT (35 (30–71) vs. 83 (48–108) 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 cell‐cycle regulation (p53, p85‐PIK3, and β‐ 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 HCV‐mediated oncogenesis. The role of these NS5A domain‐1 mutations in triggering pro‐oncogenic stimuli that can persist also despite achievement of sustained virological response deserves further investigation

Differences in time course activation of dorsolateral prefrontal cortex associated with low or high risk choices in a gambling task

Prefrontal cortex plays an important role in decision making (DM), supporting choices in the ordinary uncertainty of everyday life. To assess DM in an unpredictable situation, a playing card task, such as the Iowa Gambling Task (IGT), has been proposed. This task is supposed to specifically test emotion-based learning, linked to the integrity of the ventromedial prefrontal cortex (VMPFC). However, the dorsolateral prefrontal cortex (DLPFC) has demonstrated a role in IGT performance too. Our aim was to study, by multichannel near-infrared spectroscopy, the contribution of DLPFC to the IGT execution over time. We tested the hypothesis that low and high risk choices would differentially activate DLPFC, as IGT execution progressed. We enrolled 11 healthy adults. To identify DLPFC activation associated with IGT choices, we compared regional differences in oxy-hemoglobin variation, from baseline to the event. The time course of task execution was divided in four periods, each one consisting of 25 choices, and DLPFC activation was distinctly analyzed for low and high risk choices in each period. We found different time courses in DLPFC activation, associated with low or high risk choices. During the first period, a significant DLPFC activation emerged with low risk choices, whereas, during the second period, we found a cortical activation with high risk choices. Then, DLPFC activation decreased to non-significant levels during the third and fourth period. This study shows that DLPFC involvement in IGT execution is differentiated over time and according to choice risk level. DLPFC is activated only in the first half of the task, earlier by low risk and later by high risk choices. We speculate that DLPFC may sustain initial and more cognitive functions, such as attention shifting and response inhibition. The lack of DLPFC activation, as the task progresses, may be due to VMPFC activation, not detectable by fNIRS, which takes over the IGT execution in its second half