Language in autism: domains, profiles and co-occurring conditions.

This article reviews the current knowledge state on pragmatic and structural language abilities in autism and their potential relation to extralinguistic abilities and autistic traits. The focus is on questions regarding autism language profiles with varying degrees of (selective) impairment and with respect to potential comorbidity of autism and language impairment: Is language impairment in autism the co-occurrence of two distinct conditions (comorbidity), a consequence of autism itself (no comorbidity), or one possible combination from a series of neurodevelopmental properties (dimensional approach)? As for language profiles in autism, three main groups are identified, namely, (i) verbal autistic individuals without structural language impairment, (ii) verbal autistic individuals with structural language impairment, and (iii) minimally verbal autistic individuals. However, this tripartite distinction hides enormous linguistic heterogeneity. Regarding the nature of language impairment in autism, there is currently no model of how language difficulties may interact with autism characteristics and with various extralinguistic cognitive abilities. Building such a model requires carefully designed explorations that address specific aspects of language and extralinguistic cognition. This should lead to a fundamental increase in our understanding of language impairment in autism, thereby paving the way for a substantial contribution to the question of how to best characterize neurodevelopmental disorders.

Draw a Star and Make it Perfect: Incremental Processing of Telicity.

Predicates like "coloring-the-star" denote events that have a temporal duration and a culmination point (telos). When combined with perfective aspect (e.g., "Valeria has colored the star"), a culmination inference arises implying that the action has stopped, and the star is fully colored. While the perfective aspect is known to constrain the conceptualization of the event as telic, many reading studies have demonstrated that readers do not make early commitments as to whether the event is bounded or unbounded. A few visual-world studies tested the processing of telic predicates during online sentence processing, demonstrating an early integration of aspectual and temporal cues. By employing the visual-world paradigm, we tested the incremental processing of the perfective aspect in Italian in two eye-tracking studies in which listeners heard durative predicates in the perfective form in a scenario showing a completed and a non-completed event. Differently from previous studies, we compared telic durative predicates such as "coloring-the-star" to punctual predicates such as "lighting-the-candle." While for punctual predicates, the inferences of telicity (the event has a telos) and of culmination (the telos is reached) are lexically encoded in the perfective verb, for durative predicates, the degree of event completion (visually encoded) needs to be integrated with perfective aspect (linguistically encoded) for the culmination inference derivation. By modulating the interaction of visual and linguistic stimuli across the two experiments, we show that the verb's perfective aspect triggers the culmination inference incrementally during sentence processing, offering novel evidence for the continuous integration of linguistic processing with real-world visual information.

Irony Comprehension in Children With Cochlear Implants: The Role of Language Competence, Theory of Mind, and Prosody Recognition.

Purpose Aims of this research were (a) to investigate higher order linguistic and cognitive skills of Italian children with cochlear implants (CIs); (b) to correlate them with the comprehension of irony, which has never been systematically studied in this population; and (c) to identify the factors that facilitate the development of this competence. Method We tested 28 Italian children with CI (mean chronological age = 101 [SD = 25.60] months, age range: 60-144 months), and two control groups of normal-hearing (NH) peers matched for chronological age and for hearing age, on a series of tests assessing their cognitive abilities (nonverbal intelligence and theory of mind), linguistic skills (morphosyntax and prosody recognition), and irony comprehension. Results Despite having grammatical abilities in line with the group of NH children matched for hearing age, children with CI lag behind both groups of NH peers on the recognition of emotions through prosody and on the comprehension of ironic stories, even if these two abilities were not related. Conclusions This is the first study that targeted irony comprehension in children with CI, and we found that this competence, which is crucial for maintaining good social relationships with peers, is impaired in this population. In line with other studies, we found a correlation between this ability and advanced theory of mind skills, but at the same time, a deeper investigation is needed, to account for the high variability of performance in children with CI.

Narrative and prosodic skills in children and adolescents with Down syndrome and typically developing children.

PURPOSE: Children with Down Syndrome (DS) show difficulties in language development, in both basic and complex abilities, as narratives. Less is known about the prosodic competence in DS, but the few available studies highlighted the presence of some deficits. Considering the importance of narratives and prosody in communication, the main aim of this study is to investigate these two competencies in participants with DS. METHOD: 13 children with DS participated (Mean age: 13;04, years; months). Their narrative and prosodic abilities, collected through a storytelling task, were compared with those of two control groups of typically developing (TD) children, one matched for nonverbal mental age (MA, Mean age: 5;03) and the other matched for the mean length of utterance (MLU, Mean age: 5;05). For the narrative competence, we considered both the macrostructural (i.e. quantity of information and story structure) and the microstructural level (i.e. verbal productivity, lexical diversity, syntactic complexity). For the prosodic competence, we took into account acoustic measures linked to intonation (i.e. mean fundamental frequency (f0), pitch range, final speech profile, and speed of speech). RESULT: The results of the Mann-Whitney test showed that participants with DS produced stories comparable to those of TD children in nearly all the variables considered, except for the syntactic complexity when compared with children of the same MA. Differences between participants with DS and TD children were found in the f0 and the final pitch profile used. CONCLUSION: Considering the small size of the samples, these preliminary results should be taken with caution. Nonetheless, this study confirms the presence of difficulties in the prosody of speech and in the syntactic competence of children with DS. These difficulties could have consequences on the possibility to communicate efficiently and should be taken into account in rehabilitation programmes.

Does the COVID-19 war metaphor influence reasoning?

In recent times, many alarm bells have begun to sound: the metaphorical presentation of the COVID-19 emergency as a war might be dangerous, because it could affect the way people conceptualize the pandemic and react to it, leading citizens to endorse authoritarianism and limitations to civil liberties. The idea that conceptual metaphors actually influence reasoning has been corroborated by Thibodeau and Boroditsky, who showed that, when crime is metaphorically presented as a beast, readers become more enforcement-oriented than when crime is metaphorically framed as a virus. Recently, Steen, Reijnierse and Burgers replied that this metaphorical framing effect does not seem to occur and suggested that the question should be rephrased about the conditions under which metaphors do or do not influence reasoning. In this paper, we investigate whether presenting the COVID-19 pandemic as a war affects people's reasoning about the pandemic. Data collected suggest that the metaphorical framing effect does not occur by default. Rather, socio-political individual variables such as speakers' political orientation and source of information favor the acceptance of metaphor congruent entailments: right-wing participants and participants relying on independent sources of information are those more conditioned by the COVID-19 war metaphor, thus more inclined to prefer bellicose options.

Children's and Adults' Sensitivity to Gricean Maxims and to the Maximize Presupposition Principle.

Up to age 5, children are known to experience difficulties in the derivation of implicitly conveyed content, sticking to literally true, even if underinformative, interpretation of sentences. The computation of implicated meanings is connected to the (apparent or manifest) violation of Gricean conversational maxims. We present a study that tests unmotivated violations of the maxims of Quantity, Relevance, and Manner and of the Maximize Presupposition principle, with a Truth Value Judgment task with three options of response. We tested pre-schoolers and school-aged children, with adults as controls, to verify at which age these pragmatic rules are recognized and to see whether there is a difference among these tenets. We found an evolutionary trend and that, in all age groups, violations of the maxims of Quantity and of Relation are sanctioned to a higher degree compared to infringements of the Maim of Manner and of the Maximize Presupposition principle. We conjecture that this relates to the effects that the violation of a certain maxim or principle has on the goals of the exchange: listeners are less tolerant with statements that transmit inaccurate or incomplete information, while being more tolerant with those that still permit to understand what has happened.

Scalar and ad-hoc pragmatic inferences in children: guess which one is easier.

Several studies investigated preschoolers' ability to compute scalar and ad-hoc implicatures, but only one compared children's performance with both kinds of implicature with the same task, a picture selection task. In Experiment 1 (N = 58, age: 4;2-6;0), we first show that the truth value judgment task, traditionally employed to investigate children's pragmatic ability, prompts a rate of pragmatic responses comparable to the picture selection task. In Experiment 2 (N = 141, age: 3;8-9;2) we used the picture selection task to compare scalar and ad-hoc implicatures and linked the ability to derive these implicatures to some cognitive and linguistic measures. We found that four- and five-year-olds children performed better on ad-hoc than on scalar implicatures. Furthermore, we found that morphosyntactic competence was associated with success in both kinds of implicatures, while performance on mental state reasoning was positively associated with success on scalar but not ad-hoc implicatures.

Drain fluid's pH predicts anastomotic leak in colorectal surgery: results of a prospective analysis of 173 patients.

BACKGROUND: The early risk assessment of anastomotic leak (AL) after colorectal surgery is crucial. Several markers have been proposed, including peritoneal fluid's pH. Aim of the present study is to evaluate the role of drain fluid pH as predictor of AL. METHODS: All patients undergoing colorectal surgery from January 2015 to December 2017 were considered eligible. Hartmann procedures, procedures including temporary ileostomy and emergency surgery were excluded. Drain fluid was submitted for pH and chemical-physical assessment on postoperative day 1 (POD1) and postoperative day 3 (POD3). RESULTS: Out of 173 patients, those who developed AL showed a lower drain fluid's pH on POD1 and on POD3 compared to patients who did not (P<0.05). The plotted ROC curves identified 7.53 as pH cut-off on POD1 (AUC 0.80) and 7.21 on POD3 (AUC 0.86). With both the cut-offs, pH was an independent predictor of AL at multivariable analysis (P<0.001). pH<7.53 on POD1 and pH<7.21 on POD3 showed 93.75% sensitivity and 97% specificity respectively. CONCLUSIONS: Drain fluid's pH on POD1 is useful to select patients who will not develop AL while on POD3 it might identify those requiring a more careful management.

Hospital readmission after distal pancreatectomy is predicted by specific intra- and post-operative factors.

BACKGROUND: Distal pancreatectomy (DP) continues to carry a significant risk of morbidity resulting in hospital readmissions and increased costs. Prognostic factors predicting 30-day readmission after DP were evaluated. METHODS: Data were collected from 946 patients undergoing DP at the University of Verona Hospital Trust and the Massachusetts General Hospital between 2004 and 2014. Patients were divided into a derivation and a validation cohort. RESULTS: The 30-day readmission rate was 13.9%. Predictors of readmission were age over 60 years (OR 1.8), intraoperative transfusions (OR 2.02), CR-POPF (OR 2.4), abdominal abscesses (OR 3.9), and urinary tract infections (OR 5.9). The score generated by the derivation cohort was validated identifying three different categories with a progressively increased risk for readmission. CONCLUSION: One out of seven patients undergoing DP will be readmitted within 30 days of discharge. Comorbidities seems not to affect the risk. A 10-point score predicts the risk of 30-days readmission.

Distal pancreatectomy associated with multivisceral resection: results from a single centre experience.

PURPOSE: Tumors arising in the body/tail of the pancreas tend to be diagnosed at a more advanced stage, with a lower rate of resectability compared to disease of the head. Distal pancreatectomy (DP) associated to multivisceral resections (MVR) can represent a surgical option for selected patients with advanced tumors. METHODS: We retrospectively analyzed data of patients who underwent DP associated with MVR at our Institution over a 9-year period, and compared them to standard DP. MVR was defined as resection of at least one additional organ or vascular structure because of neoplastic involvement. RESULTS: Out of 508 DP, in 59 cases MVR was performed. The absolute incidence of complications was comparable between the two groups (69.5 % in MVR arm vs. 57.2 % in control arm, p = 0.072) but more patients in the study group had a Clavien-Dindo class ≥3 (18.6 vs. 9.8 %, p = 0.04). A longer operative time (291 ± 91 vs. 227 ± 67, p < 0.001), an increased need for intraoperative transfusions (21.4 vs. 3.3 %, p < 0.001) and a slightly longer hospitalization (9 [7-16] days vs. 8 [7-10]; p < 0.001) were observed in the MVR group. In patients with ductal adenocarcinoma (n = 118), mortality was comparable between groups (p = 0.44) over a median follow up of 26 [16-41] months. In contrast, among patients with neuroendocrine neoplasms, mortality was higher in the study group (p = 0.002). CONCLUSION: Multivisceral resection for cancer of body and tail of the pancreas is feasible in selected cases, with an acceptable surgical complication rate compared to standard procedures and a favorable long-term survival in ductal cancer.

Management of ampullary neoplasms: A tailored approach between endoscopy and surgery.

Ampullary neoplasms, although rare, present distinctive clinical and pathological features from other neoplastic lesions of the periampullary region. No specific guidelines about their management are available, and they are often assimilated either to biliary tract or to pancreatic carcinomas. Due to their location, they tend to become symptomatic at an earlier stage compared to pancreatic malignancies. This behaviour results in a higher resectability rate at diagnosis. From a pathological point of view they arise in a zone of transition between two different epithelia, and, according to their origin, may be divided into pancreatobiliary or intestinal type. This classification has a substantial impact on prognosis. In most cases, pancreaticoduodenectomy represents the treatment of choice when there is an overt or highly suspicious malignant behaviour. The rate of potentially curative resection is as high as 90% and in high-volume centres an acceptable rate of complications is reported. In selected situations less invasive approaches, such as ampullectomy, have been advocated, although there are some concerns mainly because of a higher recurrence rate associated with limited resections for invasive carcinomas. Importantly, these methods have the drawback of not including an appropriate lymphadenectomy, while nodal involvement has been shown to be frequently present also in apparently low-risk carcinomas. Endoscopic ampullectomy is now the procedure of choice in case of low up to high-grade dysplasia providing a proper assessment of the T status by endoscopic ultrasound. In the present paper the evidence currently available is reviewed, with the aim of offering an updated framework for diagnosis and management of this specific type of disease.