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Crossed aphasia has been reported mainly as post-stroke aphasia resulting from brain damage ipsilateral to the dominant right hand. Here, we described a case of a crossed nonfluent/agrammatic primary progressive aphasia (nfvPPA), who developed a corticobasal syndrome (CBS). We collected clinical, cognitive, and neuroimaging data for four consecutive years from a 55-year-old right-handed lady (JV) presenting with speech disturbances. 18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) and DaT-scan with (123)I-Ioflupane were obtained. Functional MRI (fMRI) during a verb naming task was acquired to characterize patterns of language lateralization. Diffusion tensor MRI was used to evaluate white matter damage within the language network. At onset, JV presented with prominent speech output impairment and right frontal atrophy. After 3 years, language deficits worsened, with the occurrence of a mild agrammatism. The patient also developed a left-sided mild extrapyramidal bradykinetic-rigid syndrome. The clinical picture was suggestive of nfvPPA with mild left-sided extrapyramidal syndrome. At this time, voxel-wise SPM analyses of (18)F-FDG PET and structural MRI showed right greater than left frontal hypometabolism and damage, which included the Broca's area. DaT-scan showed a reduced uptake in the right striatum. FMRI during naming task demonstrated bilateral language activations, and tractography showed right superior longitudinal fasciculus (SLF) involvement. Over the following year, JV became mute and developed frank left-sided motor signs and symptoms, evolving into a CBS clinical picture. Brain atrophy worsened in frontal areas bilaterally, and extended to temporo-parietal regions, still with a right-sided asymmetry. Tractography showed an extension of damage to the left SLF and right inferior longitudinal fasciculus. We report a case of crossed nfvPPA followed longitudinally and studied with advanced neuroimaging techniques. The results highlight a complex interaction between individual premorbid developmental differences and the clinical phenotype.

An increasing number of MRI investigations suggest that patients with Alzheimer's disease (AD) show not only gray matter decreases but also white matter (WM) abnormalities, including WM volume (WMV) deficits and integrity disruption of WM pathways. In this study, we applied multimodal voxel-wise meta-analytical methods to study WMV and fractional anisotropy in AD. Fourteen studies including 723 participants (340 with AD and 383 controls) were involved. The meta-analysis was performed using effect size signed differential mapping. Significant WMV reductions were observed in bilateral inferior temporal gyrus, splenium of corpus callosum, right parahippocampal gyrus, and hippocampus. Decreased fractional anisotropy was identified mainly in left posterior limb of internal capsule, left anterior corona radiata, left thalamus, and left caudate nucleus. Significant decreases of both WMV and fractional anisotropy were found in left caudate nucleus, left superior corona radiata, and right inferior temporal gyrus. Most findings showed to be highly replicable in the jackknife sensitivity analyses. In conclusion, AD patients show widespread WM abnormalities mainly in bilateral structures related to advanced mental and nervous activities.

The term early-onset Alzheimer's disease (EOAD) identifies patients who meet criteria for AD, but show onset of symptoms before the age of 65. We map progression of gray matter atrophy in EOAD patients compared to late-onset AD (LOAD). T1-weighted MRI scans were obtained at diagnosis and one-year follow-up from 15 EOAD, 10 LOAD, and 38 age-matched controls. Voxel-based and tensor-based morphometry were used, respectively, to assess the baseline and progression of atrophy. At baseline, EOAD patients already showed a widespread atrophy in temporal, parietal, occipital, and frontal cortices. After one year, EOAD had atrophy progression in medial temporal and medial parietal cortices. At baseline, LOAD patients showed atrophy in the medial temporal regions only, and, after one year, an extensive pattern of atrophy progression in the same neocortical cortices of EOAD. Although atrophy mainly involved different lateral neocortical or medial temporal hubs at baseline, it eventually progressed along the same brain default-network regions in both groups. The cortical region showing a significant progression in both groups was the medial precuneus/posterior cingulate.

Background: Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, which extent is known to be associated with a higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI) [PA-TDI] has been introduced to assess the total atrial activation time, as a noninvasive surrogate of fibrosis and remodeling. The aim of the study is to investigate the role of PA-TDI interval as a predictor of AF ablation efficacy. Methods: We retrospectively included patients with paroxysmal symptomatic drug-refractory AF referred to our institution for CA procedure, who presented sinus rhythm at admission. A complete transthoracic echocardiogram was performed before the ablation procedure, including the assessment of PA-TDI interval. Results: From January 2015 to April 2018, 128 patients (mean age: 61.86 ± 9.08 years, 68% male, body surface area: 1.97 ± 0.21 mq, body mass index: 26.98 ± 3.86 kg/mq, and ejection fraction: 59% ±6.06%) with symptomatic drug-refractory AF who received radiofrequency CA were enrolled. During the follow-up of 15.80 ± 6.7 months, 30 patients (23%) developed AF recurrence out of the blanking period. Compared with those without recurrence (group 1), patients with recurrence (group 2) had a larger left atrium (LA) size (Group 1 vs. Group 2: mean LA area: 22.2 ± 4.6 cmq vs. 25 ± 6.6 cmq, P = 0.015; mean indexed LA volume: 35 ± 10 mL/mq vs. 40 ± 12 mL/mq, P = 0.04) and longer PA-TDI interval (Group 1 vs. Group 2: 162 ± 33 ms vs. 133 ± 26 ms, P < 0.0001). A cutoff of PA-TDI > 150 ms identified patients with recurrence after ablation with a sensibility of 82% and specificity of 83% (area under the curve 0.879). Conclusions: The total activation time assessed by PA-TDI is an independent predictor of AF recurrence and can be used to predict the efficacy of transcatheter ablation. [ABSTRACT FROM AUTHOR]

Epicardial access is often crucial for successful ventricular tachycardia (VT) ablation, but it is often burdened by significant procedural risk. Intentional coronary vein exit and intrapericardial CO 2 insufflation (EpiCO 2) can facilitate subxiphoid pericardial access. This prospective study aimed to assess procedural feasibility, safety, and impact of the introduction of intrapericardial CO 2 insufflation for epicardial access in a referral center for VT ablation. All consecutive patients treated with epicardial VT ablation between November 2022 and January 2024 with the EpiCO 2 technique at Pisa University Hospital were prospectively enrolled and compared in terms of feasibility, efficiency, and safety with a local retrospective cohort of patients treated with subxiphoid dry puncture between July 2018 and October 2022. Twenty-two consecutive patients (90.9% male; mean age, 54.3 years) underwent VT ablation with EpiCO 2 during the study period. Epicardial access was achieved in all patients; median time from coronary sinus (CS) cannulation to epicardial access was 33 minutes. Intentional vein exit was successful in all cases, whereas CO 2 insufflation was not feasible in 1 patient. There were no major complications and no significant bleeding. Since EpiCO 2 introduction, epicardial approach utilization increased from 17.8% to 40% of all VT procedures. Comparison with 20 standard dry approach epicardial ablations showed no significant differences in terms of total procedural duration (322.5 [interquartile range, 296.75–363.75] minutes vs 359 [interquartile range, 323–409] minutes; P =.08). In our single-center experience, EpiCO 2 was feasible and safe and led to significant increase in procedural volume without affecting total procedural time compared with standard dry puncture. [ABSTRACT FROM AUTHOR]

The plasmid-borne mph(A) gene that confers resistance to azithromycin and has recently emerged in Shigella sonnei is present in multidrug- and non-multidrug-resistant Escherichia coli isolates from 4 continents. Further spread of mph(A) to Shigella and Salmonella spp. may be expected.

The plasmid-borne mph(A) gene that confers resistance to azithromycin and has recently emerged in Shigella sonnei is present in multidrug- and non-multidrug-resistant Escherichia coli isolates from 4 continents. Further spread of mph(A) to Shigella and Salmonella spp. may be expected.

Engineering students on control courses lack a deep understanding of equilibrium and stability that are crucial concepts in this discipline. Several studies have shown that students find it difficult to understand simple familiar or academic static equilibrium cases as well as dynamic ones from mechanics even if they know the discipline's criteria and formulae. Our aim is to study the impact of a specific and innovative classroom session, containing well-chosen situations that address students' misconceptions. We propose an example of Active Learning experiment based both on the Didactical Engineering methodology and the Conceptual Fields Theory that aims at promoting a conceptual change in students. The chosen methodology allows, at the same time, a proper design of the student learning activities, an accurate monitoring of the students' rational use during the tasks and provides an internal tool for the evaluation of the session's efficiency. Although the expected starting conceptual change was detected, it would require another activity in order to be reinforced.

Ceruloplasmin (Cp) is a ferroxidase that plays a role in cellular iron homeostasis and is mainly expressed in the liver and secreted into the blood. Cp is also produced by adipose tissue, which releases it as an adipokine. Although a dysfunctional interaction of iron with the metabolism of lipids has been associated with several metabolic diseases, the role of Cp in adipose tissue metabolism and in the interplay between hepatocytes and adipocytes has been poorly investigated. We previously found that Cp‐deficient (CpKO) mice become overweight and demonstrate adipose tissue accumulation together with liver steatosis during aging, suggestive of lipid dysmetabolism. In the present study, we investigated the lipid alterations which occur during aging in adipose tissue and liver of CpKO and wild‐type mice both in vivo and ex vivo. During aging of CpKO mice, we observed adipose tissue accumulation and liver lipid deposition, both of which are associated with macrophage infiltration. Liver lipid deposition was characterized by accumulation of triglycerides, fatty acids and ω‐3 fatty acids, as well as by a switch from unsaturated to saturated fatty acids, which is characteristic of lipid storage. Liver steatosis was preceded by iron deposition and macrophage infiltration, and this was observed to be already occurring in younger CpKO mice. The accumulation of ω‐3 fatty acids, which can only be acquired through diet, was associated with body weight increase in CpKO mice despite food intake being equal to that of wild‐type mice, thus underlining the alterations in lipid metabolism/catabolism in Cp‐deficient animals. [ABSTRACT FROM AUTHOR]

Engineering students in control courses have been observed to lack an understanding of equilibrium and stability, both of which are crucial concepts in this discipline. The introduction of these concepts is generally based on the study of classical examples from Newtonian mechanics supplemented with a control system. Equilibrium and stability are approached in different ways at the various stages of a typical engineering syllabus: at the beginning, they are mostly dealt with a static point of view, for example in mechanics, and are subsequently handled through dynamic analysis in control courses. In general, there is a little clarification of the differences between these concepts or the ways in which they are linked. We believe that this leads to much confusion and incomprehension among engineering students. Several studies have shown that students encounter difficulties when presented with simple familiar or academic static equilibrium cases in mechanics. Our study investigates students' conceptions and misconceptions about equilibrium and stability through a series of questions about several innovative non-static situations. It reveals that the understanding of these notions is shaken when the systems being studied are placed in inertial or non-inertial moving reference frames. The students in our study were particularly uncertain about the existence of unstable equilibrium positions and had difficulty in differentiating between the two concepts. The results suggest that students use a velocity-based approach to explain such situations. A poor grasp of the above fundamental concepts may result from previous learning experiences. More specifically, certain difficulties seem to be directly linked to a lack of understanding of these concepts, while others are related to misconceptions arising from everyday experiences and the inappropriate use of physical examples in primary school.