Search

Background: The standardization of outcome measures is needed for comparing studies and using common measures in clinical practice. We aimed to identify cognitive and patient-reported outcomes and timing of assessment for glioma, meningioma, and vascular surgery. Method: A consensus study was conducted. Participants selected cognitive and patient-reported measures among a list of instruments identified through a literature search. Results: Seventeen cognitive tests for the glioma and meningioma’s evaluation, 8 for the vascular diseases, and one questionnaire on quality of life and one on emotional distress were identified. The timing of outcome assessment selected was before surgery, at discharge, and after 3 and 12 months for glioma; before surgery and after 3 months for meningioma; before surgery, at discharge, and after 6 months for vascular diseases. Conclusion: The identification of common outcome measures is the first step toward a shared data collection improving the quality and comparability of future studies.

Background: The aim of this study was to achieve a consensus on the minimum set of outcome measures and predictors to be used in the neurosurgical practice and on the timing of outcome assessment. Methods: A consensus building approach was employed. All neurosurgical departments in Lombardy (Italy) were invited to participate by the Carlo Besta Neurologic Institute IRCCS Foundation. Three workshops were organized during which a multidisciplinary group called Neurosurgical Outcome Network (NEON) was created and the methodology to select outcome measures, predictors, and timing of outcome assessment was established. Eight working groups were created for the different neurosurgical diseases (neuro-oncological, skull base, vascular, traumatic, spinal, peripheral nervous system, malformation, functional) and 8 workshops were organized to identify the outcome measures and predictors specific for each of the neurosurgical diseases based on the experts' clinical practice and the existing literature. Results: A total of 20 neurosurgical departments participated in this study. Specific outcome measures, predictors and the timing of outcome assessment were identified for each of the 8 neurosurgical diseases. Moreover, a list of variables common to all pathologies were identified by the NEON group as further data to be collected. Conclusions: A consensus on the minimum set of outcome measures and predictors and the timing of outcome assessments for 8 neurosurgical diseases was achieved by a group of neurosurgeons of the Lombardy region, called NEON. These sets could be used in future studies for a more homogeneous data collection and as a starting point to reach further agreement also at national and international level.

Gliomas are brain tumors that are treated with surgical resection. Prognosis is influenced by the extent of resection and postoperative neurological status. As consequence, given the extreme interindividual and interhemispheric variability of subcortical white matter (WM) surgical planning requires to be patient's tailored. According to the “connectionist model,” there is a huge variability among both cortical areas and subcortical WM in all human beings, and it is known that brain is able to reorganize itself and to adapt to WM lesions. Brain magnetic resonance imaging diffusion tensor imaging (DTI) tractography allows visualization of WM bundles. Nowadays DTI tractography is widely available in the clinical setting for presurgical planning. Arcuate fasciculus (AF) is a long WM bundle that connects the Broca's and Wernicke's regions with a complex anatomical architecture and important role in language functions. Thus, its preservation is important for the postoperative outcome, and DTI tractography is usually performed for planning surgery within the language-dominant hemisphere. High variability among individuals and an asymmetrical pattern has been reported for this WM bundle. However, the functional relevance of AF in the contralateral non-dominant hemisphere in case of tumoral or surgical lesion of the language-dominant AF is unclear. This review focuses on AF anatomy with special attention to its asymmetry in both normal and pathological conditions and how it may be explored with preoperative tools for planning surgery on gliomas in language areas. Based on the findings available in literature, we finally speculate about the potential role of preoperative evaluation of the WM contralateral to the surgical site.

Conceptual knowledge is supported by multiple semantic systems that are specialized for the analysis of different properties associated with object concepts. Various types of semantic association between concrete concepts-categorical (CA), encyclopedic (EA), functional (FA), and visual-encyclopedic (VEA) associations-were tested through a new picture-to-picture matching task (semantic association task, SAT). Forty individuals with Alzheimer's disease (AD), 13 with behavioral variant of frontotemporal dementia (bv-FTD), 6 with primary progressive aphasia (PPA), and 37 healthy participants were tested with the SAT. Within-group comparisons highlighted a global impairment of all types of semantic association in bv-FTD individuals but a disproportionate impairment of EA and FA, with relative sparing of CA and VEA, in AD individuals. Single-case analyses detected dissociations in all dementia groups. Conceptual knowledge can be selectively impaired in various types of neurodegenerative disease on the basis of the specific cognitive process that is disrupted.

Background: The standardization of outcome measures is needed for comparing studies and using common measures in clinical practice. We aimed to identify cognitive and patient-reported outcomes and timing of assessment for glioma, meningioma, and vascular surgery. Method: A consensus study was conducted. Participants selected cognitive and patient-reported measures among a list of instruments identifed through a literature search. Results: Seventeen cognitive tests for the glioma and meningioma’s evaluation, 8 for the vascular diseases, and one questionnaire on quality of life and one on emotional distress were identifed. The timing of outcome assessment selected was before surgery, at discharge, and after 3 and 12 months for glioma; before surgery and after 3 months for meningioma; before surgery, at discharge, and after 6 months for vascular diseases. Conclusion: The identifcation of common outcome measures is the frst step toward a shared data collection improving the quality and comparability of future studies

The dual-route models of action distinguish between a semantic and a non-semantic visuo-motor route to execute different types of gestures. Despite the large amount of evidence in support to the model, some aspects are debated. One issue concerns the recruitment of the visuo-motor route to correctly execute meaningful gestures when the semantic route is damaged. Debated predictions of the dual-route model were investigated in a sample of 32 patients with left hemisphere stroke lesions compared to 27 healthy controls. Group analysis showed that patients were equally impaired on meaningful and meaningless gestures. Single-case analysis demonstrated that most cases were more impaired on meaningful than on meaningless gestures both when they are given in separate lists and when they are intermingled. Impaired performance on the imitation of meaningful gestures in both the separate and mixed list but spared performance on meaningless gestures in the separate list is against the hypothesis that the intact visuo-motor route compensates for damage to the semantic route. These results suggest that the damaged semantic route interferes with the visuo-motor route and prevents the processing of meaningful gestures along the visuo-motor route. Furthermore, an explorative analysis was conducted to investigate the relationship between gestures imitation and pantomime of object use on verbal command and between gestures imitation and performance on linguistic tasks. Although no significant correlation emerged, patients with moderate/severe impairment on the AAT performed significantly worse on MF, but not on ML gestures than patients with mild/minimal language impairment, suggesting that praxis and language systems are independent but dynamically interact.

Disturbi del linguaggio e aprassia si associano frequentemente, sia in pazienti con lesioni cerebrali dovute a ictus emisferico e sinistro, sia in pazienti con malattie degenerative, in particolare nei soggetti affetti da Demenza Semantica. Numerosi studi comportamentali e di neuro immagine, effettuati su soggetti sani e pazienti, mostrano che queste due abilità cognitive sono in parte supportate dalle stesse vie neurali, ma la natura dell’interazione tra linguaggio e prassia dipende dagli specifici aspetti cognitivi che vengono presi in esame. Per questo motivo, sono stati condotti tre studi con l’obiettivo di investigare la relazione tra diversi compiti prassici e linguistici. Anzitutto, i meccanismi cognitivi che permettono l’imitazione di gesti con e senza significato sono stati studiati in pazienti con lesioni cerebrali sinistre, conseguenti a ictus, in relazione alla prestazione ottenuta in una batteria per l’afasia, in un compito di denominazione e comprensione di verbi, e in un compito di associazione semantica (il quale richiedeva di associare oggetti in base a caratteristiche diverse, come ad esempio associare due oggetti che possono essere usati insieme per completare un’azione). La prestazione dei pazienti nell’imitazione di gesti con significato, rispetto a quelli senza significato, è risultata essere significativamente inferiore rispetto ai soggetti di controllo. Inoltre, i pazienti che ottenevano un punteggio migliore nel compito di associazione di oggetti, quando era richiesto di scegliere i due oggetti che potevano essere usati insieme nella stessa azione, avevano una prestazione significativamente migliore nel compito di imitazione di gesti significativi. Il secondo studio è stato condotto in un gruppo di pazienti con malattie degenerative, con l’obiettivo di indagare i correlati neurali di tre diversi tipi di conoscenze semantiche sugli oggetti (ovvero manipolazione, funzione e contesto d’uso). Prestazioni dissociate nei tre tipi di conoscenze, Linguistic and praxis deficits often co-occur in patients with stroke-related left hemisphere lesions and in those with neurodegenerative diseases, especially Semantic Dementia. Many behavioral and neuroimaging studies involving both patients and healthy participants revealed that these two cognitive abilities are at least partially supported by common neural pathways, but the interpretation of the interaction between language and praxis depends on which cognitive aspects are examined. For this reason, three studies involving different praxis and linguistic tasks were conducted. First, cognitive processes that enable imitation of meaningless and meaningful gestures were studied in left hemisphere stroke patients through performance obtained in a general standardized battery for aphasia, in verb naming and comprehension tasks, and in a semantic association task (which included various types of semantic association, e.g. matching objects that could be used together in the same action). Patients were significantly more affected in the imitation of meaningful, as opposed to meaningless, gestures. Higher scores in imitation of meaningful gestures were significantly predicted by better performance on the semantic association task when participants were required to associate objects that could be used together to perform a familiar, meaningful action. A second study investigated neural correlates of three distinct types of conceptual object knowledge (i.e. manipulation, purpose and context of use), in a group of neurodegenerative patients. In association with disproportionate behavioral responses on each type of object knowledge, three distinct patterns of hypometabolism emerged. Specifically, manipulation knowledge significantly correlated with the left angular gyrus, and left posterior middle and inferior temporal areas, whereas purpose and context of use significantly correlated with the left temporal pole, the left fusiform gyrus and left anterior temporal areas. Final

On the one hand, apraxic patients are often reported as being impaired in tool manipulation knowledge, suggesting that integrity of motor production processes is necessary for action recognition. On the other hand, evidence from patients with Semantic Dementia indicates that semantic knowledge is necessary for correct use of objects. Our study explores the role of praxis and general semantics in action knowledge for object use. Performance of 10 apraxic patients with Posterior Cortical Atrophy (n= 7), Corticobasal Syndrome (n= 2) or Alzheimer’s Disease (n= 1) was compared with that of six patients with Semantic Dementia in two experimental tasks requiring the matching of objects (Picture-to-Picture matching, PtP; name-to-name matching, NtN) according to how they are manipulated or to their context of use. We also correlated the two tasks with tests addressing semantic memory and limb apraxia. Repeated measures ANOVA showed a significant group x condition interaction in the PtP matching task, due to similar performance in the two conditions for Semantic Dementia patients, and a significantly worse performance in manipulation than context of use for the apraxic patients; a similar trend also occurred for the NtN matching task. Significant direct correlations emerged for the PtP context condition with measures of semantic memory, and for both NtN conditions with verbal tasks; no correlation emerged with the apraxia measures. Altogether, these findings confirm that apraxic patients are critically impaired in knowledge of tool manipulation, and support a crucial role of semantic memory deficits rather than apraxia.

BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice. METHODS: Multicenter, randomized, before and after study. The eight participating centers were randomized in two groups, and received training at different times. The use of validated tools (Verbal Numeric Rating or Behavioral Pain Scale for pain; Richmond Agitation-Sedation Scale for agitation; Confusion Assessment Method for the ICU for delirium) was evaluated from clinical data recorded in medical charts during a week, with follow-up up to six months after the training. All the operators were invited to complete a questionnaire, at baseline and after the training. RESULTS : Among the 374 nurses and physicians involved, 140 (37.4%) completed at least one of the three courses. The assessment of pain (38.1 vs. 92.9%, P<0.01) and delirium (0 vs. 78.6%, P<0.01) using validated tools significantly increased after training. Observation in the follow-up showed further improvement in delirium monitoring, with no signs of extinction for pain and sedation/agitation measurements. CONCLUSIONS: This e-learning program shows encouraging effectiveness, and the increase in the use of validated tools for neurological monitoring in critically ill patients lasts over time.

Objectives: Apraxic patients with left-hemisphere lesions are impaired in semantic tasks tapping knowledge of objects manipulation, but the specific locus of actions representations is still debated: the same brain regions involved in action production, according to the sensory-motor theory, or the left posterior middle/superior temporal gyrus (MTG/STG), according to a more recent hypothesis. To address this issue, we investigated brain FDG-PET correlates of action knowledge in three neurodegenerative cases with left-hemisphere damage. Materials and methods: We included one patient with Cortico-basal Syndrome (CBS), limb apraxia and parietal-occipital hypometabolism, one patient with Alzheimer's Disease (AD), mild apraxia and aphasia and extensive posterior temporal hypometabolism including MTG/STG, and one patient with Semantic Dementia (SD) showing anterior temporal hypometabolism. Their knowledge of actions vs context of use was assessed with a visual object-to-object association task and a verbal categorical decision task. Results: The CBS case showed no impairment of action knowledge, the AD patient had a worse performance in the gesture condition, with a strong dissociation in the verbal task, and the SD case was equally impaired in gesture and context in the verbal task but had a normal performance with gestures in the visual task. Discussion and conclusions: Contrary to the sensory-motor prediction, in the CBS patient parietal damage causing apraxia dissociated from loss of action knowledge. In the SD case, general semantic impairment affected action representations, sparing access to affordances. Finally, the AD patients' performance supports a specific role for the left posterior MTG/STG in storing/processing action semantics. References: Binkowski, F., & Buxbaum, L. J. (2012). Two action system in the human brain. Brain and Language, 127, 222-229. Buxbaum, L. J., et al. (2014). Critical brain regions for tool-related and imitative actions: a componential

The human tissue plasminogen activator (h-tPA) cDNA was fused either with the leader sequence of the killer toxin of Kluyveromyces lactis or with the Saccharomyces diastaticus glucoamylase leader peptide and cloned in the yeast expression vector under the control of the inducible UASgal/CYC1 promoter. The recombinant tPA is produced in yeast as a single-chain glycosylated polypeptide of 66-72 kDa, which accumulates intracellularly associated with a membrane fraction. Using two-step fed-batch fermentation, a productivity up to 100 mg/l of active intracellular tPA was obtained

This article presents the results of further investigation: the analysis of the presence of young people in the highest rated media in Catalonia and how this media made their discourse about this collective on the basis of journalistic sources used, the analysis of the headlines, and the narrator's attitude from a methodology that applies qualitative and quantitative techniques. The article also includes the journalists thinking about press coverage of young people, on the one hand, and professionals working with young people, on the other, through the answers obtained with qualit, En este artículo se presentan parte de los resultados de una investigación más amplia: el análisis de la presencia de los jóvenes en los medios informativos de más audiencia en Cataluña y cómo estos medios elaboran el discurso sobre este colectivo atendiendo a las fuentes periodísticas usadas, las formas de titular o la propia actitud del narrador a partir de una metodología que aplica técnicas cualitativas y cuantitativas. El artículo contempla también la reflexión que existe sobre el tratamiento periodístico de las personas jóvenes entre los propios periodistas, por un lado, y los agentes de juventud, por otro a través de las respuestas obtenidas con técnicas cualitativas.

Thesis (M.S.) Massachusetts Institute of Technology. Dept. of Mechanical Engineering, 1952., Bibliography: leaves 54-55., by O. Mauri I. Kurki-Suonio., M.S.

Descripció del recurs: 8 abril 2003, Consultable des del TDX, Títol obtingut de la portada digitalitzada, Objectiu: Estudi del lupus eritematós sistèmic (LES) com un estat d'hipercoagulabilitat. Material i Mètodes: Es varen estudiar 239 pacients amb lupus eritematós sistèmic controlats al servei de Medicina Interna de l'Hospital Vall d'Hebrón. S'han descrit els diferents episodis trombòtics apareguts al llarg de l'evolució de la malaltia i s'han valorat una sèrie de factors de risc clínics i immunològics tant per la trombosi arterial (TA) com per la venosa (TV). Els factors de risc clínic avaluats han estat el sexe, els anys d'evolució de la malaltia, la hipertensió arterial, la dislipèmia, la diabetis, la obesitat, l'hàbit tabàquic, l'activitat de la malaltia ( SLEDAI >5), la nefropatia, l'ús d'anticonceptius orals, el tractament amb corticoterapia, l'embaràs-puerperi i l'hiperhomocisteinèmia. Els factors de risc immunes avaluats han estat per mètodes coagulomètrics l'anticoagulant lúpic i per mètodes d'ELISA ( isotipus IgG i IgM) els anticossos anticardiolipina, antiB2glicoproteïna, antiprotrombina, antifosfatidiletanolamina, antiproteïna S, antiproteïna C, antitrombina III i antifactor XII. Es va establir una anàlisi estadística amb un test de Chi-quadrat i un test de Mann- Whitney. Es va acceptar com significació estadística una p<0,05. Resultats: Un 25% de la nostra sèrie va presentar un o més episodis trombòtics. La majoria d'ells varen ser en el territori venós (55%). Un 28% del grup de pacients amb trombosi va presentar una retrombosi. La majoria dels episodis venosos varen ser en forma de trombosi venosa profunda i els arterials en forma d'accidents vasculars cerebrals. L'edat mitjana de presentació de la trombosi va ser als 36 anys, el temps mitja d'evolució de la malaltia pel grup amb TA va ser de 5,6 anys i pel grup TV de 3,5 anys. La majoria de pacients amb trombosi varen presentar un o més de factors de risc clínics o immunològics en el moment de la trombosi. Els factors de risc clínic més prevalents en el grup amb TA varen ser la corticoterapia (63%), l'h, Objective: To evaluate systemic lupus erythematosus disease (SLE) as an hypercoagulable state. Material and Methods: Two hundred thirty-nine patients with SLE meeting the ACR criteria were evaluated. Clinical and immune risk factors for arterial (AT) and venous thrombosis (VT) were assessed. Clinical risk factors studied were gender, duration of lupus disease, hypertension, hyperlipidaemia, diabetes, obesity, smoking, disease activity (SLEDAI >5), renal disease, oral contraceptives use, steroids use, pregnancy-puerperium and homocysteine levels. Lupus anticoagulant (LA) was tested by coagulation test. Antibodies (IgG and IgM isotypes) against cardiolipin (aCL), B2glycoprotein (aB2GPI), prothrombin (aPT), phosphatidylethanolamine (aPE), protein (aPC), protein (aPS), antithrombin III (aATIII) and factor XII (aFXII) were carried out by independent ELISAs. Chi-Square and Mann-Withney test were applied as the statiscal analysis. A p value less then 0,05 was considered significant. Results: Sixty patients (25%) developed thrombotic events. Thirty (55%) of these patients had a venous thrombotic event. Seventeen (28%) of the patients with thrombosis had more than one thrombotic events. The most frequent site of venous thrombosis was deep vein thrombosis and of arterial thrombosis was brain ischemic attack. The mean age for the thrombotic event was 36 years and the mean disease duration was 5,6 years for AT and 3,5 years for VT. Arterial or venous thrombosis are exceptional in the absence of risk factors. Among the patients with AT the more frequently risk factors associated were steroids use (63%), smoking (51%), disease activity (48%), hyperhomocysteine (44%), hypertension (41%) and hyperlipidaemia (22%) and with VT steroids use (61%), smoking (51%), disease activity (43%), hyperlipidaemia (39%), hyperhomocysteine (27%), pregnancy-puerperium (15%). The immune risk factors for AT were LA (52%), aCL (66%), aB2GPI (59%), aPT (37%), aPE (66%), aPC (7%), aPS (33%), aATIII (11%)

We used yeast "two-hybrid" screening to isolate cDNA-encoding proteins interacting with the N-terminal domain of the Ras nucleotide exchange factor CDC25(Mm). Three independent overlapping clones were isolated from a mouse embryo cDNA library. The full-length cDNA was cloned by RACE-polymerase chain reaction. It encodes a large protein (1080 amino acids) highly homologous to the human deubiquitinating enzyme hUBPy and contains a well conserved domain typical of ubiquitin isopeptidases. Therefore we called this new protein mouse UBPy (mUBPy). Northern blot analysis revealed a 4-kilobase mRNA present in several mouse tissues and highly expressed in testis; a good level of expression was also found in brain, where CDC25(Mm) is exclusively expressed. Using a glutathione S-transferase fusion protein, we demonstrated an "in vitro" interaction between mUBPy and the N-terminal half (amino acids 1-625) of CDC25(Mm). In addition "in vivo" interaction was demonstrated after cotransfection in mammalian cells. We also showed that CDC25Mm, expressed in HEK293 cells, is ubiquitinated and that the coexpression of mUBPy decreases its ubiquitination. In addition the half-life of CDC25Mm protein was considerably increased in the presence of mUBPy. The specific function of the human homolog hUBPy is not defined, although its expression was correlated with cell proliferation. Our results suggest that mUBPy may play a role in controlling degradation of CDC25(Mm), thus regulating the level of this Ras-guanine nucleotide exchange factor

The CDC25 gene product is an exchange factor for Ras proteins and it activates the Ras/cAMP pathway in the yeast Saccharomyces cerevisiae. The overexpression of the CDC25 gene in S. cerevisiae cells causes a partial glucose-derepressed phenotype which is particularly evident for expression of invertase. To define domains of Cdc25 protein relevant for this derepression and to test another glucose repressed system, different to invertase, we have overexpressed different regions of the CDC25 gene under the control of a GAL-promoter. We found that a derepression of both GAL-regulated promoters and invertase was related to the overexpression of CDC25 regions that contain a functional guanine nucleotide exchange (GEF) domain. The effect on GAL-promoters was particular evident when the CDC25 gene was under the control of a UAS(gal) element and operates at transcriptional level, although a moderate derepression was found also for UAS(gal)/lacZ reporter gene. Finally, the overexpression of the GEF domain of CDC25 also caused an increase in the expression of the GAL4 regulatory gene, while a constitutive activation of the Ras/cAMP pathway did not produce any increase in GAL4 expression. These findings indicate that the overexpression of the catalytic domain of CDC25 gene is necessary and sufficient to give a glucose-derepression of GAL promoters and of invertase. They also suggest that the derepression of GAL promoters occurs through an increase of GAL4 expression in a Ras/cAMP independent way