Efficacy of multivitamin support following bariatric surgery in patients with obesity: a prospective observational study.

PURPOSE: Bariatric surgery (BS), an effective treatment for severe obesity and its comorbidities, may result in micronutrient and vitamin deficiencies. This monocentric prospective observational study aimed at evaluating the efficacy of a specifically designed vitamin/mineral formula (Bariatrifast, BIOITALIA S.r.l., Italy) for preventing and treating micronutrient deficiencies in patients submitted to BS. METHODS: Twenty patients with severe obesity (mean weight and BMI: 123.5 kg (range 88-174) and 43.3 kg/m2 (range 37-54) respectively) underwent BS (10 vertical sleeve gastrectomy VSG, 10 Roux-en-Y gastric bypass, RYGB). The mean age was 49.9 years (range 27-68). After a presurgical visit (V0), follow-up visits were performed at 1, 3, 6 and 12 months after surgery (V1-V4). Recorded data included weight, height and BMI. A complete blood count, measurement of ferritin, folic acid, vitamin B12, ionized calcium, 25 OH vitamin D, parathyroid hormone (PTH) were obtained. Following BS, patients started the daily oral multivitamin and mineral supplement. RESULTS: All patients achieved a significant weight loss (mean - 34.7 ± 11.8 kg). No deficiencies of various vitamins/micronutrients were detected during the entire study period. The serum concentrations of vitamin B12, 25-OH Vitamin D and folic acid increased over the follow-up period compared with V0 (mean increase 243 ng/L, 23 µg /L, 8 µg/L, respectively). Compared to RYGB, patients who underwent sleeve gastrectomy showed higher levels of 25-OH vitamin D at V2, V3 and V4 (all p < 0.05), and higher levels of Vitamin B12 and folic acid at V4 (p < 0.05 and p < 0.005, respectively). No adverse events were reported. CONCLUSION: Following VSG or RYGB, Bariatrifast administration was associated with normal values of essential micronutrients, and it was well-tolerated without evidence of gastrointestinal side effects. Clinical Trial Registration ClinicalTrials.gov, identifiers NCT06152965.

Evaluation of Upper Body and Lower Limbs Kinematics through an IMU-Based Medical System: A Comparative Study with the Optoelectronic System.

In recent years, the use of inertial-based systems has been applied to remote rehabilitation, opening new perspectives for outpatient assessment. In this study, we assessed the accuracy and the concurrent validity of the angular measurements provided by an inertial-based device for rehabilitation with respect to the state-of-the-art system for motion tracking. Data were simultaneously collected with the two systems across a set of exercises for trunk and lower limbs, performed by 21 healthy participants. Additionally, the sensitivity of the inertial measurement unit (IMU)-based system to its malpositioning was assessed. Root mean square error (RMSE) was used to explore the differences in the outputs of the two systems in terms of range of motion (ROM), and their agreement was assessed via Pearson's correlation coefficient (PCC) and Lin's concordance correlation coefficient (CCC). The results showed that the IMU-based system was able to assess upper-body and lower-limb kinematics with a mean error in general lower than 5° and that its measurements were moderately biased by its mispositioning. Although the system does not seem to be suitable for analysis requiring a high level of detail, the findings of this study support the application of the device in rehabilitation programs in unsupervised settings, providing reliable data to remotely monitor the progress of the rehabilitation pathway and change in patient's motor function.

The discrimination of expressions in facial movements by infants: A study with point-light displays.

Perceiving facial expressions is an essential ability for infants. Although previous studies indicated that infants could perceive emotion from expressive facial movements, the developmental change of this ability remains largely unknown. To exclusively examine infants' processing of facial movements, we used point-light displays (PLDs) to present emotionally expressive facial movements. Specifically, we used a habituation and visual paired comparison (VPC) paradigm to investigate whether 3-, 6-, and 9-month-olds could discriminate between happy and fear PLDs after being habituated with a happy PLD (happy-habituation condition) or a fear PLD (fear-habituation condition). The 3-month-olds discriminated between the happy and fear PLDs in both the happy- and fear-habituation conditions. The 6- and 9-month-olds showed discrimination only in the happy-habituation condition but not in the fear-habituation condition. These results indicated a developmental change in processing expressive facial movements. Younger infants tended to process low-level motion signals regardless of the depicted emotions, and older infants tended to process expressions, which emerged in familiar facial expressions (e.g., happy). Additional analyses of individual difference and eye movement patterns supported this conclusion. In Experiment 2, we concluded that the findings of Experiment 1 were not due to a spontaneous preference for fear PLDs. Using inverted PLDs, Experiment 3 further suggested that 3-month-olds have already perceived PLDs as face-like stimuli.

Nutrition in Advanced Thyroid Cancer Patients.

In the last decade, multikinase inhibitors (MKIs) have changed the paradigm of treatment of advanced and progressive thyroid cancer. Compared with the traditional treatment with chemotherapy and radiotherapy, these new drugs have shown a good efficacy in controlling the neoplastic disease, and also a different toxicity profile compared to traditional chemotherapy, milder but still present and involving mainly the nutritional profile. Weight loss, nausea, anorexia, stomatitis, diarrhea may be associated with malnutrition and cancer-related cachexia. The latter is characteristic of the advanced cancer stage and may be present before starting MKIs, or may develop afterwards. Adverse events with nutritional impact may cause a significant impairment of quality of life, often requiring dose reduction and sometimes drug discontinuation, but with a lower efficacy on the neoplastic disease. The aim of this paper was to discuss the role of nutritional therapy in advanced thyroid cancer and the importance of prevention, early recognition and careful management of malnutrition and cachexia during systemic therapy with MKIs.

Preparing for the Maximum Emergency with a Simulation: A Table-Top Test to Evaluate Bed Surge Capacity and Staff Compliance with Training.

INTRODUCTION: The sudden increase in the number of critically ill patients following a disaster can be overwhelming. STUDY OBJECTIVE: The main objective of this study was to assess the real number of available and readily freeable beds ("bed surge capacity") and the availability of emergency operating rooms (OR) in a maximum emergency using a theoretical simulation. PATIENTS AND METHODS: The proportion of dismissible patients in four areas (Medical Area, Surgical Area, Sub-intensive Care Units, Intensive Care Units) and three emergency OR was assessed at 2 and 24 hours after a simulated maximum emergency. Four scenarios were modeled. Hospitalization and surgical capacities were assessed on weekdays and holidays. The creation of new beds was presumed by the possibility of moving patients to a lower level of care than that provided at the time of detection, of dislocation of patients to a discharge room, with care transferred to lower-intensity hospitals, rehabilitation, or discharge facilities. The Phase 1 table-top simulations were conducted during the weekday morning hours. In particular, the 24-hour table-top simulations of a hypothetical event lasted about 150 minutes compared to those conducted at 2 hours, which were found to be longer (about 195 minutes). Phase 2 was conducted on two public holidays and a quick response time was observed within the first 40 minutes of the start of the test (about 45% of departments). RESULTS: The availability of simulated beds was greater than that indicated in the maximum emergency plans (which was based solely on the census of beds). Patients admitted to Intensive Care and The Sub-Intensive Area may be more difficult to move than those in low-intensity care. The availability of emergency OR was not problematic. Age influenced the possibility of remitting/transferring patients. CONCLUSION: Simulation in advance of a maximum emergency is helpful in designing an efficient response plan.

Estimation of pelvis kinematics in level walking based on a single inertial sensor positioned close to the sacrum: validation on healthy subjects with stereophotogrammetric system.

BACKGROUND: Kinematics measures from inertial sensors have a value in the clinical assessment of pathological gait, to track quantitatively the outcome of interventions and rehabilitation programs. To become a standard tool for clinicians, it is necessary to evaluate their capability to provide reliable and comprehensible information, possibly by comparing this with that provided by the traditional gait analysis. The aim of this study was to assess by state-of-the-art gait analysis the reliability of a single inertial device attached to the sacrum to measure pelvis kinematics during level walking. METHODS: The output signals of the three-axis gyroscope were processed to estimate the spatial orientation of the pelvis in the sagittal (tilt angle), frontal (obliquity) and transverse (rotation) anatomical planes These estimated angles were compared with those provided by a 8 TV-cameras stereophotogrammetric system utilizing a standard experimental protocol, with four markers on the pelvis. This was observed in a group of sixteen healthy subjects while performing three repetitions of level walking along a 10 meter walkway at slow, normal and fast speeds. The determination coefficient, the scale factor and the bias of a linear regression model were calculated to represent the differences between the angular patterns from the two measurement systems. For the intra-subject variability, one volunteer was asked to repeat walking at normal speed 10 times. RESULTS: A good match was observed for obliquity and rotation angles. For the tilt angle, the pattern and range of motion was similar, but a bias was observed, due to the different initial inclination angle in the sagittal plane of the inertial sensor with respect to the pelvis anatomical frame. A good intra-subject consistency has also been shown by the small variability of the pelvic angles as estimated by the new system, confirmed by very small values of standard deviation for all three angles. CONCLUSIONS: These results suggest that this inertial device is a reliable alternative to stereophotogrammetric systems for pelvis kinematics measurements, in addition to being easier to use and cheaper. The device can provide to the patient and to the examiner reliable feedback in real-time during routine clinical tests.

A new protocol from real joint motion data for wear simulation in total knee arthroplasty: stair climbing.

In its normal lifespan, a knee prosthesis must bear highly demanding loading conditions, going beyond the sole activity of level walking required by ISO standard 14243. We have developed a protocol for in vitro wear simulation of stair climbing on a displacement controlled knee simulator. The flexion/extension angle, intra/extra rotation angle, and antero/posterior translation were obtained in patients by three-dimensional video-fluoroscopy. Axial load data were collected by gait analysis. Kinematics and load data revealed a good consistence across patients, in spite of the different prosthesis size. The protocol was then implemented and tested on a displacement controlled knee wear simulator, showing an accurate reproduction of stair climbing waveforms with a relative error lower than 5%.

Three-dimensional implant position and orientation after total knee replacement performed with patient-specific instrumentation systems.

Patient-specific instrumentation systems are entering into clinical practice in total knee replacement, but validation tests have yet to determine the accuracy of replicating computer-based plans during surgery. We performed a fluoroscopic analysis to assess the final implant location with respect to the corresponding preoperative plan. Forty-four patients were analyzed after using a patient-specific system based on CT and MRI. Computer aided design implant models and models of the femur and tibia bone portions, as for the preoperative plans, were provided by the manufacturers. Two orthogonal fluoroscopic images of each knee were taken after surgery for pseudo-biplane imaging; 3D component locations with respect to the corresponding bones were estimated by a shape-matching technique. Assuming that the corresponding values at the preoperative plan were equal to zero, discrepancies were taken as an indication of accuracy for the systems. A repeatability test revealed that the technique was reliable within 1 mm and 1°. The maximum discrepancies for all the patients for the femoral component were 5.9 mm in a proximo-distal direction and 4.2° in flexion. Good matching was found between final implantations and preoperative plans with mean discrepancies smaller than 3.1 mm and 1.9°.

Primary progressive aphasia in a bilingual speaker: a single-case study.

We report on the case of an elderly bilingual woman presenting with a diagnosis of primary progressive aphasia. The participant's native language was Friulian (L1), a predominantly oral Romance language, and her second language was Italian (L2), formally learned at primary school in oral and written forms. We investigated her linguistic abilities by means of the Bilingual Aphasia Test ( Paradis, M., & Libben, G. (1987). The assessment of bilingual aphasia. Hillsdale, NJ: Lawrence Erlbaum Associates), which is specifically devised for studying language levels and skills in bilingual/polyglot individuals with aphasia. Specifically, we focused on different tasks extracted from the Bilingual Aphasia Test, targeting phonology, morphology, syntax and lexical semantics. Results show that both languages were affected to a clinically significant degree, but with different profiles in terms of linguistic levels, suggesting the presence of greater phonological, morphological, grammatical and syntactic impairments in L2. Results are discussed in terms of possible dissociations both within the language system of each language and between languages, within the Procedural/Declarative theoretical framework of language acquisition in bilinguals.

Mechanisms underlying neglect recovery after prism adaptation.

Prism adaptation (PA) has been demonstrated to be effective in improving hemispatial neglect. However not all patients seem to benefit from this procedure. Thus, the objective of the present work is to provide behavioural and neuroanatomical predictors of recovery by exploring the reorganization of low-order visuo-motor behaviour and high-order visuo-spatial representation induced by PA. To this end, 16 neglect patients (experimental group) were submitted to a PA treatment for 10 daily sessions. Neglect and oculo-motor responses were assessed before the treatment, 1 week, 1 and 3 months after the treatment. Eight control patients, who received general cognitive stimulation, were submitted to the same tests at the same time interval. The results showed that experimental patients obtained, as a consequence of PA, a long lasting neglect recovery, a reorganization of low-order visuo-motor behaviour during and after prism exposure (error reduction and after-effect, respectively) and a leftward deviation of oculo-motor responses. Importantly, the level of error reduction obtained in the first week of treatment was predictive of neglect recovery and the amelioration of oculo-motor responses, and the degree of eye movement deviation was positively related to neglect amelioration. Finally, the study of patients' neuroanatomical data showed that severe occipital lesions were associated with a lack of error reduction, poor neglect recovery and reduced oculo-motor system amelioration. In conclusion, the present results suggest that low-order visuo-motor reorganization induced by PA promotes a resetting of the oculo-motor system leading to an improvement in high-order visuo-spatial representation able to ameliorate neglect.

Recovery of oculo-motor bias in neglect patients after prism adaptation.

Patients with "neglect dyslexia" usually make errors in reading the left part of words and non-words. It has been shown that "neglect dyslexia" can improve following a short period of adaptation to wedge prisms [Neuropsychologia 40 (2002) 718], however the mechanisms underlying this amelioration are still unknown. The present study evaluated the effect of prism adaptation (PA) on ocular scanning behaviour of neglect dyslexia patients by investigating: (a) the first saccade landing position during reading a letter string and (b) the distribution of fixation time as a function of the side of oculo-motor exploration of words and non-words. This in order to assess whether possible changes (in reading performance) after the adaptation might be attributed to a resetting of the oculo-motor system. Eye movements' performances were recorded before and after a single prismatic exposure on right brain-damaged patients with left hemispatial neglect and "neglect dyslexia". The results obtained in Experimental neglect patients before and after PA were then compared to that of control neglect patients, who were wearing goggles with neutral lenses. Moreover, in order to provide normative data on ocular scanning behaviour during letter string reading, neurologically healthy subjects were also studied. Following a single session of prism adaptation, the results showed, in the Experimental neglect patients, an improvement of neglect dyslexia, an increased left-sided exploration of the letter string and an increased amplitude of the first left-sided saccade. In contrast, in the Control neglect patients, neglect dyslexia as well as the oculo-motor system behaviour, remained the same after the use of goggles with neutral lenses. These findings demonstrate that the beneficial effect induced by a single prismatic adaptation may be conceived as a complex interaction between sensory stimulation and a resetting of oculo-motor system.

Long-lasting amelioration of visuospatial neglect by prism adaptation.

It has been shown that unilateral left neglect can be significantly improved for a short time after a short period of adaptation to a prismatic shift of the visual field to the right. In neuropsychological studies, however, there is no evidence demonstrating long-lasting effects following treatment by prism adaptation (PA). The first aim of the present study was to find out whether the short-term amelioration found after prismatic adaptation could be converted into long-term therapeutic improvement. Secondly, we investigated whether the improvement of neglect in standard tests could be generalized to ecological visuospatial tests. Thirdly, the effects of prism adaptation on different spatial domains (far, near and personal space) were evaluated. Fourthly, the influence of PA on high-order visuospatial functions, such as spatial representation, and on a low-order factor, i.e. sensory--motor bias, was investigated. Finally, we investigated the possible correlation between neglect amelioration, the adaptation effect and the visuomotor after-effect, as assessed by a pointing task during and after PA. Seven patients with right hemisphere lesion and left visuospatial neglect were treated with prismatic lenses in twice-daily sessions over a period of 2 weeks. In each training session, patients were required to perform a pointing task wearing base-left wedge prisms inducing a shift of the visual field to the right by 10. The presence of visual neglect and the duration of the amelioration achieved were assessed before the treatment and 2 days, 1 week and 5 weeks after treatment by using a standardized battery that included a series of behavioural and ecological visuospatial tests. Six control, untreated patients, matched to the experimental group for gravity and duration of illness, were submitted to the same tests at the same intervals as the experimental patients. The results showed an improvement in the experimental patients' performance after PA, which was maintained during the 5-week period after treatment. The amelioration of neglect was found in standard as well as in behavioural tests and in all spatial domains. In contrast, control patients did not show any improvement in neglect. The amelioration of neglect occurred only in patients who showed the adaptation effect and the after-effect in the pointing task. Neglect amelioration did not occur in one patient who did not show the adaptation effect and had an unstable after-effect. In conclusion, these findings show that prism adaptation is a productive way of achieving long-lasting improvements in neglect treatment.