Objective and self-reported cognitive dysfunction in breast cancer women treated with chemotherapy: a prospective study.

The objective of this study is to investigate if changes in cognitive functions can be recognised in patients undergoing chemotherapy for breast cancer. Forty women with breast cancer and without depression underwent cognitive evaluation before and after 6 months of chemotherapy; emotional evaluation was performed before and after 1, 3 and 6 months of chemotherapy. Self-reported cognitive deficit evaluation was included. Global cognitive functioning before starting chemotherapy was good. After 6 months of treatment there was a significant decline in some cognitive functions, particularly involving the attention subdomain. Objective cognitive deficit resulted independent from the emotional status. On the contrary, self-perceived mental dysfunction was unrelated to the objective cognitive decline, but it was associated with depression and anxiety. Breast cancer chemotherapy can induce domain-specific cognitive dysfunction. Patients' self-perception of mental decline is unrelated to objective cognitive deficit. Breast cancer patients negatively judge their cognitive performances if they have a negative emotional functioning.

Development and Validation of a Novel Calibration Methodology and Control Approach for Robot-Aided Transcranial Magnetic Stimulation (TMS).

OBJECTIVE: This article presents the development and validation of a new robotic system for Transcranial Magnetic Stimulation (TMS), characterized by a new control approach, and an ad-hoc calibration methodology, specifically devised for the TMS application. METHODS: The robotic TMS platform is composed of a 7 dof manipulator, controlled by an impedance control, and a camera-based neuronavigation system. The proposed calibration method was optimized on the workspace useful for the specific TMS application (spherical shell around the subject's head), and tested on three different hand-eye and robot-world calibration algorithms. The platform functionality was tested on six healthy subjects during a real TMS procedure, over the left primary motor cortex. RESULTS: employing our method significantly decreases ( ) the calibration error by 34% for the position and 19% for the orientation. The robotic TMS platform achieved greater orientation accuracy than the expert operators, significantly reducing orientation errors by 46% ( ). No significant differences were found in the position errors and in the amplitude of the motor evoked potentials (MEPs) between the robot-aided TMS and the expert operators. CONCLUSION: The proposed calibration represents a valid method to significantly reduce the calibration errors in robot-aided TMS applications. Results showed the efficacy of the proposed platform (including the control algorithm) in administering a real TMS procedure, achieving better coil positioning than expert operators, and similar results in terms of MEPs. SIGNIFICANCE: This article spotlights how to improve the performance of a robotic TMS platform, providing a reproducible and low-cost alternative to the few devices commercially available.

'Doublecheck: a sensory confirmation is required to own a robotic hand, sending a command to feel in charge of it'.

Over a lifetime of experience, the representation of the body is built upon congruent integration of multiple elements constituting the sensorimotor loop. To investigate its robustness against the rupture of congruency between senses and with motor command, we selectively manipulated in healthy subjects the binds between sight, proprioception, and efferent motor command. Two experiments based on the Moving Hand Illusion were designed employing Tendon Vibration Illusion to modulate proprioception and generate illusory altered feedback of movement. In Experiment A, visuomotor congruency was modulated by introducing adelay between complex multifingered movements performed by arobotic hand and real movement of each participant's hand. In the presence of the motor command, visuomotor congruency enhanced ownership, agency, and skin conductance, while proprioceptive-motor congruency was not effective, confirming the prevalence of vision upon proprioception. In Experiment B, the impact of visuo-proprioceptive congruency was tested in the absence of motor command because the robotic hand moved autonomously. Intersensory congruency compensated for the absence of motor command only for ownership. Skin conductance in Exp Band Proprioceptive Drift in both experiments did not change. Results suggest that ownership and agency are independently processed, and presence of the efferent component modulates sensory feedbacks salience. The brain seems to require the integration of at least two streams of congruent information. Bodily awareness can be generated from sensory information alone, but to feel in charge of the body, senses must be double-checked with the prediction generated from efference copy, which is treated as an additional sensory modality.

Different level of virtualization of sight and touch produces the uncanny valley of avatar's hand embodiment.

Humans increasingly often act through virtual and robotic avatars, which can feed back to their user only virtual sensory information. Since avatar is user's embodiment and body image is mostly based on senses, how virtualization of sensory inputs affects avatar self-attribution is a key question for understanding nowadays human behavior. By manipulating visual and tactile inputs in a series of experiments fashioned after the rubber hand illusion, we assessed the relative weight of the virtualization of sight (Real, Robotic, Virtual) and of touch (Real, Virtual) on artificial hand embodiment. Virtualization decreased embodiment, but unexpectedly lowest embodiment was found when only one sense was virtual. Discordant levels of virtualization of sight and touch elicited revulsion, extending the concept of the uncanny valley to avatar embodiment. Besides timing, spatial constraints and realism of feedback, a matched degree of virtualization of seen and felt stimuli is a further constraint in building the representation of the body.

Electro-cutaneous stimulation on the palm elicits referred sensations on intact but not on amputated digits.

OBJECTIVE: Grasping and manipulation control critically depends on tactile feedback. Without this feedback, the ability for fine control of a prosthesis is limited in upper limb amputees. Early studies have shown that non-invasive electro-cutaneous stimulation (ES) can induce referred sensations that are spread to a wider and/or more distant area, with respect to the electrodes. Building on this, we sought to exploit this effect to provide somatotopically matched sensory feedback to people with partial hand (digital) amputations. APPROACH: For the first time, this work investigated the possibility of inducing referred sensations in the digits by activating the palmar nerves. Specifically, we electrically stimulated 18 sites on the palm of non-amputees to evaluate the effects of sites and stimulation parameters on modality, magnitude, and location of the evoked sensations. We performed similar tests with partial hand amputees by testing those sites that had most consistently elicited referred sensations in non-amputees. MAIN RESULTS: We demonstrated referred sensations in non-amputees from all stimulation sites in one form or another. Specifically, the stimulation of 16 of the 18 sites gave rise to reliable referred sensations. Amputees experienced referred sensations to unimpaired digits, just like non-amputees, but we were unable to evoke referred sensations in their missing digits: none of them reported sensations that extended beyond the tip of the stump. SIGNIFICANCE: The possibility of eliciting referred sensations on the digits may be exploited in haptic systems for providing touch sensations without obstructing the fingertips or their movements. The study also suggests that the phenomenon of referred sensations through ES may not be exploited for partial hand prostheses, and it invites researchers to explore alternative approaches. Finally, the results seem to confirm previous studies suggesting that the stumps in partial hand amputees partially acquire the role of the missing fingertips, physiologically and cognitively.

Clinical-pathologic features, long term-outcome and surgical treatment in a large series of patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC).

PURPOSE OF THE STUDY: A retrospective analysis on 1407 patients with invasive ductal carcinoma (IDC) and 243 invasive lobular carcinoma (ILC) was performed in order to compare the histological features, the immunohistochemical characteristics, the surgical treatment and the clinical outcome in the two groups. RESULTS: ILC seems to be more likely multifocal, estrogen receptor positive, HER-2 negative and to have a lower proliferative index compared to IDC. ILC, when treated with conservative surgery, required more frequently re-excision and/or mastectomy because of positive resection margins. No difference was observed in terms of 5-year disease free survival and local relapse free survival between the two groups, in the whole series and in the subgroup of patients treated with breast-conserving treatment. CONCLUSION: ILC can be safely treated with conservative surgery but a more accurate preoperative evaluation of tumor size and multifocality could be advocated, in order to reduce the re-excision rate.