Isolated cerebellar stroke in a paediatric patient with typical haemolytic uraemic syndrome: a case report and literature review.

Haemolytic Uraemic Syndrome (HUS) is a rare medical condition characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. Neurological complications are documented but rarely involve the cerebellum. We present a unique case of a 23-month-old male with HUS triggered by Escherichia coli-O157 (E.coli-O157) infection leading to an isolated cerebellar stroke.The patient initially presented with fever, bloody stools, and seizures. Confirmation of E.coli-O157 infection was obtained, and MRI revealed an isolated cerebellar stroke. Treatment included supportive care, anticoagulation for a right atrial thrombus, with gradual improvement observed.This case highlights the unusual occurrence of isolated cerebellar stroke in HUS patients, emphasising the importance of promptly recognizing manifestations of the central nervous system and the necessity for a multidisciplinary approach. Finally, a comprehensive literature review was conducted to identify cases of HUS patients with cerebellar involvement.

Motor imagery for paediatric neurorehabilitation: how much do we know? Perspectives from a systematic review.

Background: Motor Imagery (MI) is a cognitive process consisting in mental simulation of body movements without executing physical actions: its clinical use has been investigated prevalently in adults with neurological disorders. Objectives: Review of the best-available evidence on the use and efficacy of MI interventions for neurorehabilitation purposes in common and rare childhood neurological disorders. Methods: systematic literature search conducted according to PRISMA by using the Scopus, PsycArticles, Cinahl, PUBMED, Web of Science (Clarivate), EMBASE, PsychINFO, and COCHRANE databases, with levels of evidence scored by OCEBM and PEDro Scales. Results: Twenty-two original studies were retrieved and included for the analysis; MI was the unique or complementary rehabilitative treatment in 476 individuals (aged 5 to 18 years) with 10 different neurological conditions including, cerebral palsies, stroke, coordination disorders, intellectual disabilities, brain and/or spinal cord injuries, autism, pain syndromes, and hyperactivity. The sample size ranged from single case reports to cohorts and control groups. Treatment lasted 2 days to 6 months with 1 to 24 sessions. MI tasks were conventional, graded or ad-hoc. MI measurement tools included movement assessment batteries, mental chronometry tests, scales, and questionnaires, EEG, and EMG. Overall, the use of MI was stated as effective in 19/22, and uncertain in the remnant studies. Conclusion: MI could be a reliable supportive/add-on (home-based) rehabilitative tool for pediatric neurorehabilitation; its clinical use, in children, is highly dependent on the complexity of MI mechanisms, which are related to the underlying neurodevelopmental disorder.

Self-Efficacy and the Digit Ratio in a Group of Sports University Students.

Self-efficacy is one's awareness of being able to cope optimally with different situations. Perceived self-efficacy is a belief that closely involves emotional and personological functioning. In fact, when one perceives oneself as capable, the likelihood of success increases significantly. The aim of this research was to verify a possible correlation between self-efficacy and the Digit Ratio (2D:4D), referred to as prenatal androgen levels, and whether these correlate with some psychological variables, considering possible gender differences. This study involved 56 sports university students, whose 2D:4D ratio was calculated. Moreover, self-assessment questionnaires: the Self-efficacy Scale (SES), the Big Five Questionnaire-2 (BFQ-2), the Profile of Mood State (POMS), the State-Trait Anxiety Inventory Form Y (STAI-Y) and the Emotional Regulation Questionnaire (ERQ) were administered. The data show that the perceived levels of self-efficacy seem to be influenced by an innate predisposition linked to prenatal androgen values to which the subjects were exposed during uterine life (2D:4D). This negative correlation indicates that the higher the value of the digit ratio, the more likely it is that the level of perceived self-efficacy will be lower. Finally, the degree of perceived self-efficacy also seems to depend on the levels of subjective anxiety, understood both as a personological disposition and a contingent condition, and the latter also seems to be influenced by prenatal androgen levels, particularly in women.

Efficacy of videogames and exergames in pediatric neurorehabilitation: a systematic review.

INTRODUCTION: In recent years, the rehabilitation of children with neurological disorders has taken into account the possibility of using videogaming consoles and virtual reality systems to make children's therapy more enjoyable, motivating, participated and effective. This study aims at conducting a systematic review about the use and the efficacy of digital games in pediatric neurorehabilitation. EVIDENCE ACQUISITION: In accordance with the PRISMA approach, a rather wide-ranging search was conducted on PubMed, Scopus, and Web of Science databases by using different combinations of keywords based on MeSH terms. EVIDENCE SYNTHESIS: Fifty-five papers have been included into this review, namely, 38 original studies and 17 reviews. The total number of children and adolescents is 573, with 58% of them being affected by cerebral palsy. Despite a wide variability in the adopted protocols, devices, assessment tools, and a more frequent focus on motor aspects than on cognitive ones, the results of the majority of the analyzed studies support the safety (i.e., absence of severe adverse effects) and efficacy of the videogame-based therapy. CONCLUSIONS: Videogames, when administered by means of commercial consoles or ad-hoc digital systems, seem to be a valid support for physical therapy. Further researchers are needed to deeply investigate the role of this approach in cognitive therapy and cognitive outcomes.

Classification of Drivers' Mental Workload Levels: Comparison of Machine Learning Methods Based on ECG and Infrared Thermal Signals.

Mental workload (MW) represents the amount of brain resources required to perform concurrent tasks. The evaluation of MW is of paramount importance for Advanced Driver-Assistance Systems, given its correlation with traffic accidents risk. In the present research, two cognitive tests (Digit Span Test-DST and Ray Auditory Verbal Learning Test-RAVLT) were administered to participants while driving in a simulated environment. The tests were chosen to investigate the drivers' response to predefined levels of cognitive load to categorize the classes of MW. Infrared (IR) thermal imaging concurrently with heart rate variability (HRV) were used to obtain features related to the psychophysiology of the subjects, in order to feed machine learning (ML) classifiers. Six categories of models have been compared basing on unimodal IR/unimodal HRV/multimodal IR + HRV features. The best classifier performances were reached by the multimodal IR + HRV features-based classifiers (DST: accuracy = 73.1%, sensitivity = 0.71, specificity = 0.69; RAVLT: accuracy = 75.0%, average sensitivity = 0.75, average specificity = 0.87). The unimodal IR features based classifiers revealed high performances as well (DST: accuracy = 73.1%, sensitivity = 0.73, specificity = 0.73; RAVLT: accuracy = 71.1%, average sensitivity = 0.71, average specificity = 0.85). These results demonstrated the possibility to assess drivers' MW levels with high accuracy, also using a completely non-contact and non-invasive technique alone, representing a key advancement with respect to the state of the art in traffic accident prevention.

Emotion Recognition: Photoplethysmography and Electrocardiography in Comparison.

Automatically recognizing negative emotions, such as anger or stress, and also positive ones, such as euphoria, can contribute to improving well-being. In real-life, emotion recognition is a difficult task since many of the technologies used for this purpose in both laboratory and clinic environments, such as electroencephalography (EEG) and electrocardiography (ECG), cannot realistically be used. Photoplethysmography (PPG) is a non-invasive technology that can be easily integrated into wearable sensors. This paper focuses on the comparison between PPG and ECG concerning their efficacy in detecting the psychophysical and affective states of the subjects. It has been confirmed that the levels of accuracy in the recognition of affective variables obtained by PPG technology are comparable to those achievable with the more traditional ECG technology. Moreover, the affective psychological condition of the participants (anxiety and mood levels) may influence the psychophysiological responses recorded during the experimental tests.

Cognitive Performances: The Role of Digit Ratio (D2:D4) With a Protective Factor for Anxiety.

This study aimed to identify a possible correlation between the D2:D4 ratio and state and/or trait anxiety in adult healthy subjects and, if so, whether it exists any difference between men and women. In addition, we also wanted to observe whether there is a relationship between participants' age and state and/or trait anxiety. The research involved 125 subjects of both sexes, who were calculated the D2:D4 ratio and were administered the self-assessment questionnaire State-Trait Anxiety Inventory (STAI-Y). Results show that there are positive significant correlations between the D2:D4 ratio and score at state anxiety and trait anxiety, in the total sample. However, if men are examined separately from women, it can be observed that only men have a statistically significant relationship between D2:D4 ratios and state anxiety and trait anxiety. Moreover, about possible relations between the age of participants and state and trait anxiety, a significant negative relationship was observed, without differences between men and women. However, only subjects with a D2:D4 ratio ≥ 1, without differences between men and women, showed a statistically significant negative linear correlation between their age and their state and trait anxiety. The present data allow us to conclude that a low D2:D4 ratio (<1) represents a protective factor against anxiety in both men and women and that this protection seems likely to act throughout life.

Prediction of state anxiety by machine learning applied to photoplethysmography data.

BACKGROUND: As the human behavior is influenced by both cognition and emotion, affective computing plays a central role in human-machine interaction. Algorithms for emotions recognition are usually based on behavioral analysis or on physiological measurements (e.g., heart rate, blood pressure). Among these physiological signals, pulse wave propagation in the circulatory tree can be assessed through photoplethysmography (PPG), a non-invasive optical technique. Since pulse wave characteristics are influenced by the cardiovascular status, which is affected by the autonomic nervous activity and hence by the psychophysiological state, PPG might encode information about emotional conditions. The capability of a multivariate data-driven approach to estimate state anxiety (SA) of healthy participants from PPG features acquired on the brachial and radial artery was investigated. METHODS: The machine learning method was based on General Linear Model and supervised learning. PPG was measured employing a custom-made system and SA of the participants was assessed through the State-Trait Anxiety Inventory (STAI-Y) test. RESULTS: A leave-one-out cross-validation framework showed a good correlation between STAI-Y score and the SA predicted by the machine learning algorithm (r = 0.81; p = 1.87∙10-9). The preliminary results suggested that PPG can be a promising tool for emotions recognition, convenient for human-machine interaction applications.

Executive Functions During Submaximal Exercises in Male Athletes: Role of Blood Lactate.

The present study was carried out among 20 healthy young male athletes to determine whether aerobic exercise performed at two different intensities is able to affect executive functions. For this purpose, we used the Stroop Color Word Test (SCWT) to evaluate the ability to inhibit cognitive interference and the Trail Making Test (TMT) to assess organized visual search, set shifting, and cognitive flexibility. Simple Reaction Time (RT), as a measure of perception and response execution, was also evaluated. The experimental protocol included the measure of blood lactate levels with the aim of assessing possible relations between lactate blood values and selected executive functions after a 30-min steady-state test performed at 60% and at 80% of VO2max. The results showed that a 30-min aerobic exercise is not associated with a worsening of executive functions as long as the blood lactate levels stay within the 4 mmol/l threshold.

Multi-Site Photoplethysmographic and Electrocardiographic System for Arterial Stiffness and Cardiovascular Status Assessment.

The development and validation of a system for multi-site photoplethysmography (PPG) and electrocardiography (ECG) is presented. The system could acquire signals from 8 PPG probes and 10 ECG leads. Each PPG probe was constituted of a light-emitting diode (LED) source at a wavelength of 940 nm and a silicon photomultiplier (SiPM) detector, located in a back-reflection recording configuration. In order to ensure proper optode-to-skin coupling, the probe was equipped with insufflating cuffs. The high number of PPG probes allowed us to simultaneously acquire signals from multiple body locations. The ECG provided a reference for single-pulse PPG evaluation and averaging, allowing the extraction of indices of cardiovascular status with a high signal-to-noise ratio. Firstly, the system was characterized on optical phantoms. Furthermore, in vivo validation was performed by estimating the brachial-ankle pulse wave velocity (baPWV), a metric associated with cardiovascular status. The validation was performed on healthy volunteers to assess the baPWV intra- and extra-operator repeatability and its association with age. Finally, the baPWV, evaluated via the developed instrumentation, was compared to that estimated with a commercial system used in clinical practice (Enverdis Vascular Explorer). The validation demonstrated the system's reliability and its effectiveness in assessing the cardiovascular status in arterial ageing.

Risk-taking behavior, the second-to-fourth digit ratio and psychological features in a sample of cavers.

BACKGROUND: The risk-taking behavior is largely modulated by the subject's history, its lifestyles, by the characteristics of the situations with which it is compared, and also by the effects of prenatal androgens. Thus, the personality of the single person is a significant predictor of such way of acting. METHODS: The present study aimed to explore the relationship between Digit Ratio Measurement (2D:4D) and personality factors capable to be good predictors for choosing highly risky activities, such as caving. Furthermore, our purpose was to investigate whether 2D:4D ratio is related to cavers' affective states and to assess the personological and emotional features of 34 healthy cavers, aged between 24 and 71 years (M = 39.70, SD = 9.81). RESULTS: Data analysis showed several significant correlations between 2D:4D and Deliberate Risk Taking (RTI) and Precautionary Behavior (RTI), confirming that 2D:4D is a reliable index able to predict risk-taking behaviors. Furthermore, data analysis showed that Conscientiousness and its sub-dimension Scrupulousness (BFQ-2) are recurrent among significant correlations; in particular, the latter reports negative correlations with many factors of POMS. Moreover, all participants seemed to have a good attitude to collaboration, in terms of goal-direct strategy, and an adequate management of negative affective states, useful to maintaining a good level of stress within the group. Finally, the BFQ-2 factor Openness to culture seemed to be a predominant feature in the cavers, and this feature could be considered as predictive in the choice of an activity, such as caving, which requires curiosity, perseverance and a great planning of cave exploration.

Digit ratio, personality and emotions in skydivers.

The aim of the present study was investigate if there is an association between second-to-fourth digit length (2D:4D) ratio and personality factors capable of serving as predictors of individual choice towards high-risk activities in a group of experts skydivers; Furthermore, their skills in regulating anxiety and emotions were assessed. The 2D:4D ratio of the right hand of 41 expert skydivers was measured and each of them completed four questionnaires: Big Five Questionnaire-2 (BFQ-2), Profile of Mood States (POMS), State-Trait Anxiety Inventory Form Y (STAI-Y) and Risk-Taking Inventory. Lower 2D:4D ratios did not appear associated with a greater propensity for taking risks but rather with a lower aptitude to assume precautions in unsafe conditions. In fact, the only sub-dimensions of personality, analyzed by the BFQ-2, correlated with the 2D:4D ratio were conscientiousness and agreeableness. Furthermore, prior to launch, the skydiver's level of stress, measured by the POMS, or state anxiety, measured by the STAI-Y, was not significantly correlated with 2D:4D ratio; whereas there was significant positive correlation between 2D:4D values and trait anxiety. Data analysis further revealed that social desirability correlated negatively with state anxiety and total mood disturbance index, and positively with emotion control. The present results suggest that lower 2D:4D ratio may represent a significant predictor of less attentive precautionary behavior when risk-taking.