IRIS UniSR (’Università Vita-Salute San Raffaele)
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Biological signatures of cognitive impairment in mood disorders
Get PDFThe role of the kynurenine pathway in mood disorders: genetic and neurovascular mechanisms underlying connectivity and cognitionIl ruolo del pathway della chinurenina nei disturbi dell'umore: i meccanismi genetici e neurovascolari sottostanti la connettività e la cognizion
Understanding Grandiose and Vulnerable Narcissism in Adult Outpatients: A Head-to-Head Comparison Between DSM-5 Section II Personality Disorders and DSM-5 Alternative Model for Personality Disorders
Get PDFTo compare the effectiveness of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Section II personality disorder (PD) model, and of the Alternative Model for Personality Disorders (AMPD) model in characterizing vulnerable (VN) and grandiose (GN) narcissism, a sample of clinical psychotherapy participants (N = 369) was administered the Schedule for Nonadaptive and Adaptive Personality-2, the Levels of Personality Functioning Scale-Self Report (LPFS-SR), the Personality Inventory for DSM-5, the Five-Factor Narcissism InventoryShort Form (FFNI-SF), and the Pathological Narcissism Inventory (PNI). In multiple regression models, the LPFS-SR scales and the Personality Inventory for DSM-5 (PID-5) domain scales explained 34.6% and 23.7% more variance than the self-reports of the 10 Section II PD symptom counts in the FFNI-SF and PNI GN scores, respectively. Similarly, AMPD measures outperformed self-reported symptom counts of the 10 Section II PDs, accounting for 28.8% and 22.6% more variance in the FFNI-SF and PNI VN scale scores, respectively
How to Do Echo in Septic Cardiomyopathy: A Consensus Statement of the Italian Society of Echocardiography and Cardiovascular Imaging
Get PDFSeptic cardiomyopathy (SCM) is an acute, reversible myocardial dysfunction occurring in the context of sepsis, independent of ischemic heart disease. Despite its frequent occurrence in critically ill patients, SCM remains poorly defined and underdiagnosed. This article provides clinicians with a practical guide for the recognition and management of SCM, with particular attention to the role of bedside echocardiography. Echocardiography is emphasized as both a diagnostic and hemodynamic monitoring tool to optimize treatment strategies in patients with sepsis and septic shock. Advanced techniques such as speckle-tracking echocardiography enhance sensitivity for detecting subclinical myocardial impairment and support differential diagnosis. Real-time echocardiographic assessment allows tailored therapy and may improve patient outcomes. Key elements include the recognition of characteristic echocardiographic patterns, integration of global longitudinal strain analysis, and the use of echocardiographic findings to guide hemodynamic management decisions
Book Review: Beaver, David, and Stanley, Jason. The Politics of Language. Princeton, NJ: Princeton University Press, 2023. Pp. 520. $39.95 (cloth)
No full textfMRI of Memory
No full textNumerous fMRI studies have investigated the network of brain regions critical for memory. While neuropsychological techniques can delineate brain regions that are necessary for intact memory function, neuroimaging techniques can be used to investigate which regions are recruited during healthy memory formation, storage, and retrieval. For example, fMRI studies have shown that lateral prefrontal cortex (PFC) supports some components of working memory function. However, working memory is not localized to a single brain region but is likely a property of the functional interaction between the PFC and posterior brain regions. The medial temporal lobe (MTL) and its connections with neocortical, prefrontal, and limbic structures are implicated in episodic memory. Semantic memory is mediated by a network of neocortical structures, including lateral and anterior temporal lobes, and inferior frontal cortex, possibly to a greater extent in the left hemisphere. Memory for semantic information benefits from the MTL for only a limited time, and can be acquired, albeit slowly and with difficulty, without it. To date, most of the emphasis has been on exploring the unique aspects of these different types of memory. Some evidence, however, of functional overlap in general retrieval processes does exist
Validation of the six-minute walking test as a measure of postoperative recovery after pancreatic surgery
No full textThe six-minute walking test (6MWT) is a measure of functional capacity, but there is limited evidence supporting its use as a postoperative recovery outcome. This study aims to contribute evidence for the validity of 6MWT as a measure of recovery after pancreatic surgery. Following the COSMIN checklist, we analyzed data from patients enrolled in a prospective cohort study at San Raffaele Hospital (2020-2022). Construct validity was tested by hypothesizing that the distance walked in 6 min (6MWD) at 30 days after surgery would be greater in patients known to recover better: (1) younger vs. older, (2) with higher physical status vs. lower, (3) undergoing distal vs. proximal pancreatectomy, (4) laparoscopic vs. open resection, (5) with a shorter vs. longer length of stay, and (6) without severe complications vs. with. Additionally, 6MWD with patient-reported outcomes, including Duke Activity Status Index (DASI) and PROMIS-29 Physical Health Summary Score (PHS), were assessed. Patients (n=151) who completed the 6MWT preoperatively and at 30 days after surgery were analyzed. Data supported construct validity of the 6MWT, showing significantly higher 6MWD in 5 of 6 (83%) groups known to recover better. Only the hypothesis that 6MWT would be higher in younger patients was not confirmed. The 6MWT also showed a moderate positive correlation with DASI (r = 0.41) and PHS (r = 0.47). This is the first study to contribute evidence for the validity of the 6MWT as a measure of recovery after pancreatic resection. Results support the use of the 6MWT as an outcome measure in studies evaluating interventions aimed at improving recovery after pancreatectomy
Stool Glial Fibrillary Acidic Protein Is Elevated in Progressive Multiple Sclerosis
Get PDFObjectives: The gut microbiota and altered intestinal physiology have been implicated in multiple sclerosis (MS). Enteric glial cells regulate enteric nervous and immune function and express glial fibrillary acidic protein (GFAP) and S100β. Serum GFAP and neurofilament light chain can predict disease worsening; however, no clear markers differentiate relapsing from progressive disease. Methods: To investigate enteric glial function in MS, we measured stool GFAP (st-GFAP) using an enzyme-linked immunosorbent assay in 31 healthy controls (HCs), 77 patients with relapsing remitting MS (RRMS), and 53 patients with progressive MS (ProgMS). Participants underwent clinical follow-up at 2 and 5 years after stool donation. Results: We found higher st-GFAP levels in patients with ProgMS compared with those with RRMS and HCs. St-GFAP was positively correlated with baseline Expanded Disability Status Scale (EDSS) score, 25-foot walk time, and an increased EDSS score at 2 and 5 years. We found enteric glial hyperplasia in the colonic mucosa of a patient with primary progressive MS, as indicated by GFAP and S100β immunoreactivity, an effect not observed in duodenum tissue in patients with RRMS from our Milan cohort. St-GFAP in patients with ProgMS was negatively associated with Eubacterium hallii. Discussion: These exploratory data indicate an altered enteric glial phenotype in patients with ProgMS and suggest that st-GFAP may be a prognostic biomarker
Early Stroke Volume Variation After Transcatheter or Surgical Aortic Valve Replacement Predicts Clinical Outcomes in Low-Flow Aortic Stenosis
No full textBackground Little is known about stroke volume index (SVi) change and its prognostic implication in patients with low-flow aortic stenosis (AS) undergoing aortic valve replacement (AVR) and conflicting results are present in literature. The aim of this study was to evaluate the postoperative change in SVi and its impact on outcomes in patients with low-flow severe AS undergoing AVR. Methods Retrospective observational study of a high-volume tertiary care center including consecutive patients with low-flow (SVi <= 35 mL/m2) severe AS who underwent AVR (either surgical or transcatheter) with available comprehensive pre- and post-AVR echocardiographic assessment. Post-AVR SVi improvement was defined as an increase >= 15% from baseline, while SVi normalization was defined as post-AVR SVi > 35 mL/m2. A up to 36-month follow-up was conducted and the study primary endpoint was the composite of all cause-mortality and hospitalizations for heart failure. Results One-hundred-fifty-one patients (mean age 80 +/- 8 years, 53.6% female) were included. After AVR, SVi improved by > 15% in 51 (33.8%) and normalized in 51 (33.8%) patients. At a median follow-up of 17 (7-32) months, 62 (52.6%) patients reached the primary composite endpoint. SVi improvement, but not SVi normalization, was associated with better survival free from the primary endpoint (log rank p = 0.02 and 0.056, respectively). Multivariate analysis confirmed that both SVi improvement and its absolute change per mL/m2 unit carried a better prognosis (adj. HR 0.51 [0.28-0.91, p = 0.02] and 0.97 (0.94-0.99), p = 0.016, respectively). Conclusions In patients with low-flow AS undergoing AVR, early post-procedural SVi increase has beneficial prognostic significance. These findings highlight the importance of post-AVR hemodynamic assessment and may help refine risk stratification in this vulnerable population
Maintenance Treatment for Type 1 Autoimmune Pancreatitis: Effectiveness and Development of the PrescrAIP Relapse Prediction Model
No full textBackground & aims: Type 1 autoimmune pancreatitis (AIP) is a relapsing remitting disorder that often requires multiple treatment courses. Our aims were to assess the efficacy of maintenance treatment in preventing relapse and to develop the PrescrAIP risk score predicting relapse risk and the benefit of maintenance treatment. Methods: We retrospectively analyzed patients meeting international diagnostic criteria for type 1 AIP who reached partial or complete remission after initial treatment. The primary outcome was disease relapse, defined as recurrence of symptoms and/or radiologic findings. We developed a multivariable prediction model using Cox proportional hazards regression, performed internal and internal-external validation, and built a predictive nomogram. Results: We included 577 patients (68% male). During a median follow-up of 34 months (interquartile range, 13-69 months), we observed 154 relapses. The overall 3-year relapse risk was 28% (95% confidence interval [CI], 24%-32%), lower in patients receiving maintenance treatment than in those without (22% vs 35%; P < .001). The final PrescrAIP model incorporated protective factors (maintenance treatment, prior surgery, focal mass, female sex) and risk factors (biliary involvement, other organ involvement, IgG4 elevation, allergy, jaundice, acute pancreatitis). The model showed moderate discrimination (Concordance index, 0.69) and good calibration. Internal-external validation yielded Concordance index values ranging from 0.64 to 0.71. Maintenance treatment significantly reduced relapse in patients with a PrescrAIP score >155, but not in those with lower scores. Conclusion: Maintenance therapy reduced relapse only in patients at high relapse risk. Once externally validated, the PrescrAIP score may guide personalized maintenance treatment decisions