Publications by authors named "Andrea Cherubini"

70 Publications

A Deep Learning Framework for Recognizing Both Static and Dynamic Gestures.

Sensors (Basel) 2021 Mar 23;21(6). Epub 2021 Mar 23.

LIRMM, Université de Montpellier, CNRS, 34392 Montpellier, France.

Intuitive user interfaces are indispensable to interact with the human centric smart environments. In this paper, we propose a unified framework that recognizes both static and dynamic gestures, using simple RGB vision (without depth sensing). This feature makes it suitable for inexpensive human-robot interaction in social or industrial settings. We employ a pose-driven spatial attention strategy, which guides our proposed Static and Dynamic gestures Network-. From the image of the human upper body, we estimate his/her depth, along with the region-of-interest around his/her hands. The Convolutional Neural Network (CNN) in is fine-tuned on a background-substituted hand gestures dataset. It is utilized to detect 10 static gestures for each hand as well as to obtain the hand image-embeddings. These are subsequently fused with the augmented pose vector and then passed to the stacked Long Short-Term Memory blocks. Thus, human-centred frame-wise information from the augmented pose vector and from the left/right hands image-embeddings are aggregated in time to predict the dynamic gestures of the performing person. In a number of experiments, we show that the proposed approach surpasses the state-of-the-art results on the large-scale dataset. Moreover, we transfer the knowledge learned through the proposed methodology to the dataset, and the obtained results also outscore the state-of-the-art on this dataset.
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http://dx.doi.org/10.3390/s21062227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004797PMC
March 2021

Risk of Amyotrophic Lateral Sclerosis and Exposure to Particulate Matter from Vehicular Traffic: A Case-Control Study.

Int J Environ Res Public Health 2021 01 22;18(3). Epub 2021 Jan 22.

Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy.

(1) : Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with still unknown etiology. Some occupational and environmental risk factors have been suggested, including long-term air pollutant exposure. We carried out a pilot case-control study in order to evaluate ALS risk due to particulate matter with a diameter of ≤10 µm (PM) as a proxy of vehicular traffic exposure. (2) : We recruited ALS patients and controls referred to the Modena Neurology ALS Care Center between 1994 and 2015. Using a geographical information system, we modeled PM concentrations due to traffic emissions at the geocoded residence address at the date of case diagnosis. We computed the odds ratio (OR) and 95% confidence interval (CI) of ALS according to increasing PM exposure, using an unconditional logistic regression model adjusted for age and sex. (3) : For the 132 study participants (52 cases and 80 controls), the average of annual median and maximum PM concentrations were 5.2 and 38.6 µg/m, respectively. Using fixed cutpoints at 5, 10, and 20 of the annual median PM levels, and compared with exposure <5 µg/m, we found no excess ALS risk at 5-10 µg/m (OR 0.87, 95% CI 0.39-1.96), 10-20 µg/m (0.94, 95% CI 0.24-3.70), and ≥20 µg/m (0.87, 95% CI 0.05-15.01). Based on maximum PM concentrations, we found a statistically unstable excess ALS risk for subjects exposed at 10-20 µg/m (OR 4.27, 95% CI 0.69-26.51) compared with those exposed <10 µg/m. However, risk decreased at 20-50 µg/m (OR 1.49, 95% CI 0.39-5.75) and ≥50 µg/m (1.16, 95% CI 0.28-4.82). ALS risk in increasing tertiles of exposure showed a similar null association, while comparison between the highest and the three lowest quartiles lumped together showed little evidence for an excess risk at PM concentrations (OR 1.13, 95% CI 0.50-2.55). After restricting the analysis to subjects with stable residence, we found substantially similar results. (4) : In this pilot study, we found limited evidence of an increased ALS risk due to long-term exposure at high PM concentration, though the high statistical imprecision of the risk estimates, due to the small sample size, particularly in some exposure categories, limited our capacity to detect small increases in risk, and further larger studies are needed to assess this relation.
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http://dx.doi.org/10.3390/ijerph18030973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908475PMC
January 2021

Sensor-Based Control for Collaborative Robots: Fundamentals, Challenges, and Opportunities.

Front Neurorobot 2020 7;14:576846. Epub 2021 Jan 7.

Department of Mechanical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.

The objective of this paper is to present a systematic review of existing sensor-based control methodologies for applications that involve direct interaction between humans and robots, in the form of either physical collaboration or safe coexistence. To this end, we first introduce the basic formulation of the sensor-servo problem, and then, present its most common approaches: vision-based, touch-based, audio-based, and distance-based control. Afterwards, we discuss and formalize the methods that integrate heterogeneous sensors at the control level. The surveyed body of literature is classified according to various factors such as: sensor type, sensor integration method, and application domain. Finally, we discuss open problems, potential applications, and future research directions.
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http://dx.doi.org/10.3389/fnbot.2020.576846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817623PMC
January 2021

The Sensor-Based Biomechanical Risk Assessment at the Base of the Need for Revising of Standards for Human Ergonomics.

Sensors (Basel) 2020 Oct 10;20(20). Epub 2020 Oct 10.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy.

Due to the epochal changes introduced by "Industry 4.0", it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human-robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative "direct instrumental evaluations" and "rating of standard methods", allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers' awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities.
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http://dx.doi.org/10.3390/s20205750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599507PMC
October 2020

A Lyapunov-Stable Adaptive Method to Approximate Sensorimotor Models for Sensor-Based Control.

Front Neurorobot 2020 17;14:59. Epub 2020 Sep 17.

Université de Montpellier/LIRMM, Montpellier, France.

In this article, we present a new scheme that approximates unknown sensorimotor models of robots by using feedback signals only. The formulation of the uncalibrated sensor-based regulation problem is first formulated, then, we develop a computational method that distributes the model estimation problem amongst multiple adaptive units that specialize in a local sensorimotor map. Different from traditional estimation algorithms, the proposed method requires little data to train and constrain it (the number of required data points can be analytically determined) and has rigorous stability properties (the conditions to satisfy Lyapunov stability are derived). Numerical simulations and experimental results are presented to validate the proposed method.
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http://dx.doi.org/10.3389/fnbot.2020.00059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527605PMC
September 2020

Patterns and predictors of language representation and the influence of epilepsy surgery on language reorganization in children and young adults with focal lesional epilepsy.

PLoS One 2020 8;15(9):e0238389. Epub 2020 Sep 8.

Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy.

Mapping brain functions is crucial for neurosurgical planning in patients with drug-resistant seizures. However, presurgical language mapping using either functional or structural networks can be challenging, especially in children. In fact, most of the evidence on this topic derives from cross-sectional or retrospective studies in adults submitted to anterior temporal lobectomy. In this prospective study, we used fMRI and DTI to explore patterns of language representation, their predictors and impact on cognitive performances in 29 children and young adults (mean age at surgery: 14.6 ± 4.5 years) with focal lesional epilepsy. In 20 of them, we also assessed the influence of epilepsy surgery on language lateralization. All patients were consecutively enrolled at a single epilepsy surgery center between 2009 and 2015 and assessed with preoperative structural and functional 3T brain MRI during three language tasks: Word Generation (WG), Rhyme Generation (RG) and a comprehension task. We also acquired DTI data on arcuate fasciculus in 24 patients. We first assessed patterns of language representation (relationship of activations with the epileptogenic lesion and Laterality Index (LI)) and then hypothesized a causal model to test whether selected clinical variables would influence the patterns of language representation and the ensuing impact of the latter on cognitive performances. Twenty out of 29 patients also underwent postoperative language fMRI. We analyzed possible changes of fMRI and DTI LIs and their clinical predictors. Preoperatively, we found atypical language lateralization in four patients during WG task, in one patient during RG task and in seven patients during the comprehension task. Diffuse interictal EEG abnormalities predicted a more atypical language representation on fMRI (p = 0.012), which in turn correlated with lower attention (p = 0.036) and IQ/GDQ scores (p = 0.014). Postoperative language reorganization implied shifting towards atypical language representation. Abnormal postoperative EEG (p = 0.003) and surgical failures (p = 0.015) were associated with more atypical language lateralization, in turn correlating with worsened fluency. Neither preoperative asymmetry nor postoperative DTI LI changes in the arcuate fasciculus were observed. Focal lesional epilepsy associated with diffuse EEG abnormalities may favor atypical language lateralization and worse cognitive performances, which are potentially reversible after successful surgery.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238389PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478845PMC
October 2020

Microstructural changes of normal-appearing white matter in Vascular Parkinsonism.

Parkinsonism Relat Disord 2019 06 1;63:60-65. Epub 2019 Mar 1.

Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy; Neuroscience Center, University "Magna Graecia", Catanzaro, Italy. Electronic address:

Objective: Several evidences demonstrated the role of white matter (WM) lesions in the pathogenesis of Vascular Parkinsonism (VP), a clinical entity characterized by parkinsonism, postural instability, marked gait difficulty and poor response to levodopa. However, the involvement of normal appearing white matter (NAWM) in VP still remains unknown. This study aimed to investigate the microstructural integrity of NAWM in VP compared to Parkinson's disease (PD) and controls using neuroimaging approach.

Methods: Magnetic resonance imaging data were acquired from 50 participants (15 VP, 20 PD and 15 controls). Diffusion tensor imaging (DTI) and Tract-based spatial statistics (TBSS) were performed to assess microstructural NAWM changes. In order to evaluate the relationship between specific fiber tract involvement and clinical picture, diffusion alterations were correlated with clinical features.

Results: Compared to PD patients and controls, significantly reduced fractional anisotropy (FA) and increased mean diffusivity (MD) and radial diffusivity (RD) in NAWM of corpus callosum, internal and external capsule, and corona radiata were present in VP. By contrast, DTI metrics were normal in NAWM-PD and controls. A significant correlation was found between FA and MD of anterior third of corpus callosum and clinical variables (postural instability, freezing-of-gait and symmetry of parkinsonism).

Conclusions: This study improves the knowledge on WM pathology in VP, as our results demonstrate that NAWM damage occurs in VP, but not in PD nor in controls. NAWM damage might relate to clinical picture and suggest that non-clearly-visible WM alterations may contribute to the physiopathology of this vascular disease.
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http://dx.doi.org/10.1016/j.parkreldis.2019.02.046DOI Listing
June 2019

Artificial Intelligence for the Objective Evaluation of Acne Investigator Global Assessment.

J Drugs Dermatol 2018 Sep;17(9):1006-1009

Introduction: The evaluation of Acne using ordinal scales reflects the clinical perception of severity but has shown low reproducibility both intra- and inter-rater. In this study, we investigated if Artificial Intelligence trained on images of Acne patients could perform acne grading with high accuracy and reliabilities superior to those of expert physicians.

Methods: 479 patients with acne grading ranging from clear to severe and sampled from three ethnic groups participated in this study. Multi-polarization images of facial skin of each patient were acquired from five different angles using the visible spectrum. An Artificial Intelligence was trained using the acquired images to output automatically a measure of Acne severity in the 0-4 numerical range of the Investigator Global Assessment (IGA).

Results: The Artificial Intelligence recognized the IGA of a patient with an accuracy of 0.854 and a correlation between manual and automatized evaluation of r=0.958 (P less than .001).

Discussion: This is the first work where an Artificial Intelligence was able to directly classify acne patients according to an IGA ordinal scale with high accuracy, no human intervention and no need to count lesions. J Drugs Dermatol. 2018;17(9):1006-1009.
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September 2018

Multimodal assessment of normal-appearing corpus callosum is a useful marker of disability in relapsing-remitting multiple sclerosis: an MRI cluster analysis study.

J Neurol 2018 Oct 26;265(10):2243-2250. Epub 2018 Jul 26.

Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy.

Background And Purpose: Corpus callosum (CC) is frequently involved in relapsing-remitting multiple sclerosis (RRMS). Magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) allow to study CC macrostructural and microstructural tissue integrity. Here, we applied a data-driven approach to MRI and DTI data of normal-appearing CC in RRMS subjects, and subsequently evaluated if differences in tissue integrity corresponded to different levels of physical disability and cognitive impairment.

Methods: 74 RRMS patients and 20 healthy controls (HC) underwent 3 T MRI and DTI. Thickness and fractional anisotropy (FA) along midsagittal CC were extracted, and values from RRMS patients were fed to a hierarchical clustering algorithm. We then used ANOVA to test for differences in clinical and cognitive variables across the imaging-based clusters and HC.

Results: We found three distinct MRI-based subgroups of RRMS patients with increasing severity of CC damage. The first subgroup showed callosal integrity similar to HC (Cluster 1); Cluster 2 had milder callosal damage; a third subgroup showed the most severe callosal damage (Cluster 3). Cluster 3 included patients with longer disease duration and worst scores in Expanded Disability Status Scale. Cognitive domains of verbal memory, executive functions and processing speed were impaired in Cluster 3 and Cluster 2 compared to Cluster 1 and HC.

Conclusions: Within the same homogeneous cohort of patients, we could identify three neuroimaging RRMS clusters characterized by different involvement of normal-appearing CC. Interestingly, these corresponded to three distinct levels of clinical and cognitive disability.
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http://dx.doi.org/10.1007/s00415-018-8980-yDOI Listing
October 2018

Use of Flutemetamol F 18-Labeled Positron Emission Tomography and Other Biomarkers to Assess Risk of Clinical Progression in Patients With Amnestic Mild Cognitive Impairment.

JAMA Neurol 2018 09;75(9):1114-1123

Glasgow Memory Clinic, Glasgow, United Kingdom.

Importance: Patients with amnestic mild cognitive impairment (aMCI) may progress to clinical Alzheimer disease (AD), remain stable, or revert to normal. Earlier progression to AD among patients who were β-amyloid positive vs those who were β-amyloid negative has been previously observed. Current research now accepts that a combination of biomarkers could provide greater refinement in the assessment of risk for clinical progression.

Objective: To evaluate the ability of flutemetamol F 18 and other biomarkers to assess the risk of progression from aMCI to probable AD.

Design, Setting, And Participants: In this multicenter cohort study, from November 11, 2009, to January 16, 2014, patients with aMCI underwent positron emission tomography (PET) at baseline followed by local clinical assessments every 6 months for up to 3 years. Patients with aMCI (365 screened; 232 were eligible) were recruited from 28 clinical centers in Europe and the United States. Physicians remained strictly blinded to the results of PET, and the standard of truth was an independent clinical adjudication committee that confirmed or refuted local assessments. Flutemetamol F 18-labeled PET scans were read centrally as either negative or positive by 5 blinded readers with no knowledge of clinical status. Statistical analysis was conducted from February 19, 2014, to January 26, 2018.

Interventions: Flutemetamol F 18-labeled PET at baseline followed by up to 6 clinical visits every 6 months, as well as magnetic resonance imaging and multiple cognitive measures.

Main Outcomes And Measures: Time from PET to probable AD or last follow-up was plotted as a Kaplan-Meier survival curve; PET scan results, age, hippocampal volume, and aMCI stage were entered into Cox proportional hazards logistic regression analyses to identify variables associated with progression to probable AD.

Results: Of 232 patients with aMCI (118 women and 114 men; mean [SD] age, 71.1 [8.6] years), 98 (42.2%) had positive results detected on PET scan. By 36 months, the rates of progression to probable AD were 36.2% overall (81 of 224 patients), 53.6% (52 of 97) for patients with positive results detected on PET scan, and 22.8% (29 of 127) for patients with negative results detected on PET scan. Hazard ratios for association with progression were 2.51 (95% CI, 1.57-3.99; P < .001) for a positive β-amyloid scan alone (primary outcome measure), 5.60 (95% CI, 3.14-9.98; P < .001) with additional low hippocampal volume, and 8.45 (95% CI, 4.40-16.24; P < .001) when poorer cognitive status was added to the model.

Conclusions And Relevance: A combination of positive results of flutemetamol F 18-labeled PET, low hippocampal volume, and cognitive status corresponded with a high probability of risk of progression from aMCI to probable AD within 36 months.
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http://dx.doi.org/10.1001/jamaneurol.2018.0894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143120PMC
September 2018

Midbrain meningioma causing subacute parkinsonism.

Neurol Clin Pract 2018 Apr;8(2):166-168

Institute of Neurology (AL, AQ), University Magna Græcia, Catanzaro; and Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR) (AL, RN, AC, AQ), Germaneto (CZ), Italy.

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http://dx.doi.org/10.1212/CPJ.0000000000000439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914758PMC
April 2018

Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study.

Brain 2018 02;141(2):391-408

Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, USA.

Progressive functional decline in the epilepsies is largely unexplained. We formed the ENIGMA-Epilepsy consortium to understand factors that influence brain measures in epilepsy, pooling data from 24 research centres in 14 countries across Europe, North and South America, Asia, and Australia. Structural brain measures were extracted from MRI brain scans across 2149 individuals with epilepsy, divided into four epilepsy subgroups including idiopathic generalized epilepsies (n =367), mesial temporal lobe epilepsies with hippocampal sclerosis (MTLE; left, n = 415; right, n = 339), and all other epilepsies in aggregate (n = 1026), and compared to 1727 matched healthy controls. We ranked brain structures in order of greatest differences between patients and controls, by meta-analysing effect sizes across 16 subcortical and 68 cortical brain regions. We also tested effects of duration of disease, age at onset, and age-by-diagnosis interactions on structural measures. We observed widespread patterns of altered subcortical volume and reduced cortical grey matter thickness. Compared to controls, all epilepsy groups showed lower volume in the right thalamus (Cohen's d = -0.24 to -0.73; P < 1.49 × 10-4), and lower thickness in the precentral gyri bilaterally (d = -0.34 to -0.52; P < 4.31 × 10-6). Both MTLE subgroups showed profound volume reduction in the ipsilateral hippocampus (d = -1.73 to -1.91, P < 1.4 × 10-19), and lower thickness in extrahippocampal cortical regions, including the precentral and paracentral gyri, compared to controls (d = -0.36 to -0.52; P < 1.49 × 10-4). Thickness differences of the ipsilateral temporopolar, parahippocampal, entorhinal, and fusiform gyri, contralateral pars triangularis, and bilateral precuneus, superior frontal and caudal middle frontal gyri were observed in left, but not right, MTLE (d = -0.29 to -0.54; P < 1.49 × 10-4). Contrastingly, thickness differences of the ipsilateral pars opercularis, and contralateral transverse temporal gyrus, were observed in right, but not left, MTLE (d = -0.27 to -0.51; P < 1.49 × 10-4). Lower subcortical volume and cortical thickness associated with a longer duration of epilepsy in the all-epilepsies, all-other-epilepsies, and right MTLE groups (beta, b < -0.0018; P < 1.49 × 10-4). In the largest neuroimaging study of epilepsy to date, we provide information on the common epilepsies that could not be realistically acquired in any other way. Our study provides a robust ranking of brain measures that can be further targeted for study in genetic and neuropathological studies. This worldwide initiative identifies patterns of shared grey matter reduction across epilepsy syndromes, and distinctive abnormalities between epilepsy syndromes, which inform our understanding of epilepsy as a network disorder, and indicate that certain epilepsy syndromes involve more widespread structural compromise than previously assumed.
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http://dx.doi.org/10.1093/brain/awx341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837616PMC
February 2018

Increased glutamate + glutamine levels in the thalamus of patients with essential tremor: A preliminary proton MR spectroscopic study.

Parkinsonism Relat Disord 2018 02 28;47:57-63. Epub 2017 Nov 28.

Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neuroimaging Unit, IBFM, National Research Council, Catanzaro, Italy. Electronic address:

Introduction: The aim of this study was to investigate the thalamic biochemical profile in patients with essential tremor (ET), using proton magnetic resonance spectroscopy (H-MRS), and to explore the correlations between clinical and biochemical data.

Methods: Sixteen patients with ET and 14 healthy controls participated in this study. After conventional MR imaging, single-voxel H-MRS (TR = 2000 ms; TE = 28 ms) was performed by using a PROBE-SV system implemented on a 3-T scanner. A voxel of 10 × 10 × 15 mm involving the ventrointermediate (Vim) nucleus was acquired in each thalamus of all subjects. Peak areas of N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (NAA), creatine + phosphocreatine (Cr), glycerophosphocholine + phosphocholine (Cho), and glutamate + glutamine (Glx) were calculated using a version 6.3-1 K of the fitting program LCModel for each voxel. Comparative and correlation analyses were performed on the NAA, Cr, Cho, and Glx concentrations, as well as on the values of the NAA/Cr, a neural density marker, Cho/Cr, a membrane marker, and Glx/Cr, an intracellular neurotransmitter marker.

Results: Patients with ET showed a significant increase in Glx concentration and Glx/Cr ratio values in both thalami, compared to healthy controls, whereas no difference inter-group was found for the other metabolites and NAA/Cr and Cho/Cr ratio values. Of note, the tremor severity was positively related to increased Glx concentrations and Glx/Cr ratio values in ET group.

Conclusions: Our study shows that H-MRS can highlight in vivo metabolic abnormalities in the thalami of ET patients, supporting the evidence that the increase of thalamic glutamatergic transmission can play a role in developing of tremor in ET.
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http://dx.doi.org/10.1016/j.parkreldis.2017.11.345DOI Listing
February 2018

Ictal 18F-FDG PET/MRI in a Patient With Cortical Heterotopia and Focal Epilepsy.

Clin Nucl Med 2017 Oct;42(10):768-769

From the *Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council; †Department of Diagnostic Imaging, Nuclear Medicine Unit, ‡Department of Medical and Surgical Sciences, Institute of Neurology, and §Neuroradiology Unit, Magna Graecia University, Catanzaro, Italy.

A 19-year-old man with epilepsy underwent ictal F-FDG PET/MRI, showing a 5 mm heterotopic nodule in the periventricular white matter, adjacent to the frontal horn of the left lateral ventricle (SUVmax, 5.5; glucidic cerebral metabolic rate, 0.317 μmol/mL). A repeated F-FDG PET/MRI, during seizure freedom, showed, at visual analysis, subtle decrease of the nodule metabolism. SUVmax and glucidic cerebral metabolic rate were clearly reduced to 3.7 and 0.226, respectively. Ictal F-FDG PET/MRI could be useful in epilepsy because of the added value of SUVmax and cerebral metabolic rate of glucose analysis to understand the relationship between heterotopy and epilepsy.
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http://dx.doi.org/10.1097/RLU.0000000000001797DOI Listing
October 2017

Thalamic neurometabolic alterations in tremulous Parkinson's disease: A preliminary proton MR spectroscopy study.

Parkinsonism Relat Disord 2017 Oct 28;43:78-84. Epub 2017 Jul 28.

Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neuroimaging Unit, IBFM, National Research Council, Catanzaro, Italy. Electronic address:

Introduction: The objective of this study was to investigate the thalamic biochemical changes in tremor-dominant Parkinson's disease (tPD) patients in comparison with essential tremor with resting tremor (rET) patients, by using proton MR spectroscopy (H-MRS).

Methods: Fourteen tPD patients, 12 rET patients and 10 controls participated in this study. All patients underwent dopamine transporter single-photon emission computed tomography (DAT-SPECT) with I-ioflupane, and a short-echo single-voxel H-MRS on a 3T scanner. A voxel of 10 × 15 × 10 mm involving the Vim nucleus was acquired in both thalami of all subjects. Peak areas of N-acetyl-aspartate (NAA), creatine (Cr), glycerophosphocholine (Cho), and glutamate (Glu) were measured for each voxel using LCModel. The NAA/Cr, Cho/Cr, and Glu/Cr ratios were then calculated.

Results: DAT-SPECT was abnormal in tPD patients, whereas it was normal in rET patients. Patients with tPD showed a significant reduction of NAA/Cr and Cho/Cr in the thalami compared to rET and healthy controls; whereas there were no significant differences between rET patients and controls. The combination of thalamic NAA/Cr and Cho/Cr ratios showed a 100% accuracy in distinguishing tPD patients from rET patients and controls.

Conclusions: This study provides preliminary evidence that thalamic neurometabolic abnormalities occur in tremor-dominant phenotype of PD, and suggests that H-MRS can help differentiate patients with tPD from those with rET.
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http://dx.doi.org/10.1016/j.parkreldis.2017.07.028DOI Listing
October 2017

Structural connectivity differences in essential tremor with and without resting tremor.

J Neurol 2017 Sep 20;264(9):1865-1874. Epub 2017 Jul 20.

Institute of Molecular Bioimaging and Physiology (IBFM-CNR), National Research Council, Catanzaro, Italy.

In this work, we investigated motor network structure in patients affected by essential tremor (ET) with or without resting tremor, using probabilistic tractography of the cerebello-thalamo-basal ganglia-cortical loop. Twenty-five patients with ET, twenty-two patients with ET associated with resting tremor (rET), and twenty-five age- and sex-matched healthy controls were included in the study. All participants underwent whole-brain 3D T1-weighted and diffusion-weighted MRI, and DAT-SPECT. Probabilistic tractography was performed on diffusion data in network mode, reconstructing connections between the different structures of the cerebello-thalamo-basal ganglia-cortical loop. All patients with ET, regardless of the presence of resting tremor, had normal DAT-SPECT, but showed significantly decreased connectivity in the cerebello-thalamo-precentral cortex network bilaterally, compared to healthy controls. In addition, patients with rET showed reduced connectivity in a pathway connecting globus pallidus, caudate, and supplementary motor area, compared to ET and controls. This latter circuit was significantly damaged in the hemisphere contralateral to the side clinically most affected by resting tremor. These findings provide insights upon structural changes underlying the different clinical presentations of ET. Our study demonstrates that ET and rET share common alterations in the cerebello-thalamo-precentral cortex circuit, while rET patients are characterized by specific damage to additional structures of motor network, such as globus pallidus, caudate nucleus, and supplementary motor area. Our findings suggest that ET and rET are different subtypes of the same neurodegenerative disorder.
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http://dx.doi.org/10.1007/s00415-017-8553-5DOI Listing
September 2017

Structural connectivity differences in motor network between tremor-dominant and nontremor Parkinson's disease.

Hum Brain Mapp 2017 09 20;38(9):4716-4729. Epub 2017 Jun 20.

Institute of Neurology, University "Magna Graecia", Catanzaro, Italy.

Motor phenotypes of Parkinson's disease (PD) are recognized to have different prognosis and therapeutic response, but the neural basis for this clinical heterogeneity remains largely unknown. The main aim of this study was to compare differences in structural connectivity metrics of the main motor network between tremor-dominant and nontremor PD phenotypes (TD-PD and NT-PD, respectively) using probabilistic tractography-based network analysis. A total of 63 PD patients (35 TD-PD patients and 28 NT-PD patients) and 30 healthy controls underwent a 3 T MRI. Next, probabilistic tractography-based network analysis was performed to assess structural connectivity in cerebello-thalamo-basal ganglia-cortical circuits, by measuring the connectivity indices of each tract and the efficiency of each node. Furthermore, dopamine transporter single-photon emission computed tomography (DAT-SPECT) with I-ioflupane was used to assess dopaminergic striatal depletion in all PD patients. Both PD phenotypes showed nodal abnormalities in the substantia nigra, in agreement with DAT-SPECT evaluation. In addition, NT-PD patients displayed connectivity alterations in nigro-pallidal and fronto-striatal pathways, compared with both controls and TD-PD patients, in which the same motor connections seemed to be relatively spared. Of note, in NT-PD group, rigidity-bradykinesia score correlated with fronto-striatal connectivity abnormalities. These findings demonstrate that structural connectivity alterations occur in the cortico-basal ganglia circuit of NT-PD patients, but not in TD-PD patients, suggesting that these anatomical differences may underlie different motor phenotypes of PD. Hum Brain Mapp 38:4716-4729, 2017. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/hbm.23697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866900PMC
September 2017

Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics.

Neuropsychiatr Dis Treat 2017 15;13:1303-1311. Epub 2017 May 15.

Private Inpatient Unit.

In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long-term impairments. In particular, robot-mediated neurorehabilitation is a rapidly advancing field, which uses robotic systems to define new methods for treating neurological injuries, especially stroke. The use of robots in gait training can enhance rehabilitation, but it needs to be used according to well-defined neuroscientific principles. The field of robot-mediated neurorehabilitation brings challenges to both bioengineering and clinical practice. This article reviews the state of the art (including commercially available systems) and perspectives of robotics in poststroke rehabilitation for walking recovery. A critical revision, including the problems at stake regarding robotic clinical use, is also presented.
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http://dx.doi.org/10.2147/NDT.S114102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440028PMC
May 2017

Determinants of serum manganese levels in an Italian population.

Mol Med Rep 2017 May 24;15(5):3340-3349. Epub 2017 Mar 24.

CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, I‑41125 Modena, Italy.

Manganese (Mn) is both essential and toxic for humans, mainly depending on the total levels and its species. Main sources of exposure include food and air pollution, particularly motorized traffic. We sought to determine the potential influence of these sources on serum total levels of Mn and Mn species. We selected a random sample of municipality residents from an Italian urban municipality, from whom we collected detailed personal information, dietary habits and a blood sample for serum Mn determination. We also assessed outdoor air Mn exposure, by modeling levels of particulate matter ≤10 µm (PM10) from motorized traffic at the residence of geocoded subjects. Serum Mn species generally showed higher levels in males and positive correlation with age, while no such differences were found according to smoking habits or use of dietary supplements. Among nutrients, only iron intake showed a relation with Mn [an inverse correlation with Mn‑ferritin (Mn‑Fer) and a direct one with inorganic‑Mn (Inorg‑Mn)]. Meat consumption directly correlated and fish and seafood inversely correlated with total Mn, Mn‑transferrin (Mn‑Tf) and Mn-citrate (Mn-Cit). Fruits and vegetables, including legumes and nuts, generally showed a positive correlation with all Mn species, especially Mn‑Cit, and an inverse one with Inorg‑Mn. Odds ratios (ORs) of having serum Mn levels above median value increased with increasing PM10 tertiles, with an OR for highest‑to‑lowest tertile of 7.40 (1.36‑40.25) in multivariate analysis. Analyses for Mn species did not highlight a clear comparable pattern. In conclusion, our results seem to demonstrate that PM10 exposure positively influences total Mn serum levels, while single Mn species show conflicting results.
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http://dx.doi.org/10.3892/mmr.2017.6379DOI Listing
May 2017

A Novel EMG Interface for Individuals With Tetraplegia to Pilot Robot Hand Grasping.

IEEE Trans Neural Syst Rehabil Eng 2018 02 14;26(2):291-298. Epub 2016 Sep 14.

This paper introduces a new human-machine interface for individuals with tetraplegia. We investigated the feasibility of piloting an assistive device by processing supra-lesional muscle responses online. The ability to voluntarily contract a set of selected muscles was assessed in five spinal cord-injured subjects through electromyographic (EMG) analysis. Two subjects were also asked to use the EMG interface to control palmar and lateral grasping of a robot hand. The use of different muscles and control modalities was also assessed. These preliminary results open the way to new interface solutions for high-level spinal cord-injured patients.
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http://dx.doi.org/10.1109/TNSRE.2016.2609478DOI Listing
February 2018

Determinants of serum cadmium levels in a Northern Italy community: A cross-sectional study.

Environ Res 2016 10 14;150:219-226. Epub 2016 Jun 14.

CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health - Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy. Electronic address:

Introduction: Cadmium (Cd) is a heavy metal and a serious environmental hazard to humans. Some uncertainties still exist about major sources of Cd exposure in non-occupationally exposed subjects in addition to cigarette smoking, such as diet and outdoor air pollution. We sought to determine the influence of these sources on a biomarker of exposure, serum Cd concentration.

Methods: We recruited 51 randomly selected residents from an Italian urban community, from whom we obtained detailed information about dietary habits and smoking habits, and a blood sample for serum Cd determination. We also assessed outdoor air Cd exposure, by modeling outdoor air levels of particulate matter ≤10µm (PM10) from motorized traffic at geocoded subjects' residence.

Results: In crude analysis, regression beta coefficients for dietary Cd, smoking and PM10 on serum Cd levels were 0.03 (95% CI -0.83 to 0.88), 6.96 (95% CI -0.02 to 13.95) and 0.62 (95% CI -0.19 to 1.43), respectively. In the adjusted analysis, regression beta coefficients were -0.34 (95% CI -1-40 to 0.71), 5.81 (95% CI -1.43 to 13.04) and 0.47 (95% CI -0.35 to 1.29), respectively.

Conclusion: Cigarette smoking was the most important factor influencing serum Cd in our non-occupationally exposed population, as expected, while dietary Cd was not associated with this biomarker. Outdoor air pollution, as assessed through exposure to particulate matter generated by motorized traffic, was an additional source of Cd exposure.
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http://dx.doi.org/10.1016/j.envres.2016.06.002DOI Listing
October 2016

Importance of Multimodal MRI in Characterizing Brain Tissue and Its Potential Application for Individual Age Prediction.

IEEE J Biomed Health Inform 2016 09 27;20(5):1232-9. Epub 2016 Apr 27.

This study presents a voxel-based multiple regression analysis of different magnetic resonance image modalities, including anatomical T1-weighted, T2(*) relaxometry, and diffusion tensor imaging. Quantitative parameters sensitive to complementary brain tissue alterations, including morphometric atrophy, mineralization, microstructural damage, and anisotropy loss, were compared in a linear physiological aging model in 140 healthy subjects (range 20-74 years). The performance of different predictors and the identification of the best biomarker of age-induced structural variation were compared without a priori anatomical knowledge. The best quantitative predictors in several brain regions were iron deposition and microstructural damage, rather than macroscopic tissue atrophy. Age variations were best resolved with a combination of markers, suggesting that multiple predictors better capture age-induced tissue alterations. The results of the linear model were used to predict apparent age in different regions of individual brain. This approach pointed to a number of novel applications that could potentially help highlighting areas particularly vulnerable to disease.
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http://dx.doi.org/10.1109/JBHI.2016.2559938DOI Listing
September 2016

The Three Laws of Neurorobotics: A Review on What Neurorehabilitation Robots Should Do for Patients and Clinicians.

J Med Biol Eng 2016;36:1-11. Epub 2016 Feb 9.

Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy.

Most studies and reviews on robots for neurorehabilitation focus on their effectiveness. These studies often report inconsistent results. This and many other reasons limit the credit given to these robots by therapists and patients. Further, neurorehabilitation is often still based on therapists' expertise, with competition among different schools of thought, generating substantial uncertainty about what exactly a neurorehabilitation robot should do. Little attention has been given to ethics. This review adopts a new approach, inspired by Asimov's three laws of robotics and based on the most recent studies in neurorobotics, for proposing new guidelines for designing and using robots for neurorehabilitation. We propose three laws of neurorobotics based on the ethical need for safe and effective robots, the redefinition of their role as therapist helpers, and the need for clear and transparent human-machine interfaces. These laws may allow engineers and clinicians to work closely together on a new generation of neurorobots.
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http://dx.doi.org/10.1007/s40846-016-0115-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791450PMC
February 2016

Cerebellar involvement in essential tremor with and without resting tremor: A Diffusion Tensor Imaging study.

Parkinsonism Relat Disord 2016 06 30;27:61-6. Epub 2016 Mar 30.

Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy; Institute of Neurology, University "Magna Graecia", Catanzaro, Italy. Electronic address:

Objective: Essential Tremor with resting tremor (rET) is a debated and poorly understood clinical phenotype. Converging evidences show that neurodegeneration of the cerebellum underlies the pathophysiology of ET, but it is not known if cerebellar changes also occurs in patients with rET. The aim of our study was to evaluate cerebellar microstructure in patients with ET with- (rET) and without resting tremor (ETwr) in comparison to healthy controls by MR Diffusion Tensor Imaging (DTI).

Methods: We studied 67 patients with ET (rET: 29 and ETwr: 38) and 39 age-matched healthy controls (HC). DTI was performed to measure fractional anisotropy (FA) and mean diffusivity (MD) of white and grey matter (WM, GM) in the entire cerebellum and in right and left cerebellar hemispheres.

Results: MD was significantly higher in the cerebellar GM of ET total group (10.39 ± 0.87) in comparison with HC (9.90 ± 0.71) (p = 0.0027). Interestingly, MD was significantly different when ETwr (10.48 ± 0.77) were compared with HC (p = 0.0017), whereas a trend toward significance were found between rET (10.29 ± 0.99) and HC (p = 0.067). No differences among groups were found in MD of cerebellar WM and in FA values neither in the WM nor in the GM.

Conclusion: Our results demonstrate the presence of microstructural changes in the cerebellum of patients with ET. It is noteworthy that rET showed intermediate values compared to HC and ETwr, suggesting that rET shares part of the pathophysiological mechanisms of ETwr, but cerebellar involvement seems do not fully account for rET. In addition to the cerebellar loops, other networks may play a role in rET pathophysiology.
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http://dx.doi.org/10.1016/j.parkreldis.2016.03.022DOI Listing
June 2016

Integrity of the corpus callosum in patients with benign temporal lobe epilepsy.

Epilepsia 2016 Apr 26;57(4):590-6. Epub 2016 Feb 26.

Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy.

Objective: Corpus callosum (CC) abnormalities are frequently reported in patients with refractory mesial temporal lobe epilepsy (rMTLE). However, whether CC structural alterations are related to the epileptic syndrome itself or to refractoriness is still unknown. Thus, we aimed to compare patterns of CC change in patients with rMTLE and benign MTLE (bMTLE), the latter of which represents a useful resource to better disentangle factors that contribute to refractoriness.

Methods: The study group included 79 patients with bMTLE (mean age 43.2 ± 14. 8 years), 61 with rMTLE (mean age 45.2 ± 12.4 years) and 134 healthy volunteers. Structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) were performed to measure thickness, mean diffusivity (MD), and fractional anisotropy (FA) over 50 regions of interest along the cross-sectional CC profile. Statistical analysis comprised analysis of variance (ANOVA) followed by post hoc Tukey's Honest Significant Difference test.

Results: We found that all imaging metrics of the CC splenium were altered in rMTLE patients compared to bMTLE and controls. We also found significantly reduced thickness and FA of the anterior CC in rMTLE compared to controls and that FA was reduced only in rMTLE compared to bMTLE. Patients with bMTLE did not differ from controls. Differences between disease subgroups were found in the midbody composed of sensorimotor fibers.

Significance: We found altered multimodal imaging metrics of the CC in rMTLE but not in bMTLE. These findings were independent of the radiologic presence of hippocampal sclerosis, suggesting that differences in the distribution of such alterations might be related to refractoriness.
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http://dx.doi.org/10.1111/epi.13339DOI Listing
April 2016

CADA-computer-aided DaTSCAN analysis.

EJNMMI Phys 2016 Dec 16;3(1). Epub 2016 Feb 16.

Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy.

Background: Dopamine transporter (DaT) imaging (DaTSCAN) is useful for the differential diagnosis of parkinsonian syndromes. Visual evaluation of DaTSCAN images represents the generally accepted diagnostic method, but it is strongly dependent on the observer's experience and shows inter- and intra-observer variability. A reliable and automatic method for DaTSCAN evaluation can provide objective quantification; it is desirable for longitudinal studies, and it allows for a better follow-up control. Moreover, it is crucial for an automated method to produce coherent measures related to the severity of motor symptoms.

Methods: In this work, we propose a novel fully automated technique for DaTSCAN analysis that generates quantitative measures based on striatal intensity, shape, symmetry and extent. We tested these measures using a support vector machine (SVM) classifier.

Results: The proposed measures reached 100 % accuracy in distinguishing between patients with Parkinson's disease (PD) and control subjects. We also demonstrate the existence of a linear relationship and an exponential trend between pooled structural and functional striatal characteristics and the Unified Parkinson's disease Rating Scale (UPDRS) motor score.

Conclusions: We present a novel, highly reproducible, user-independent technique for DaTSCAN analysis producing quantitative measures directly connected to striatum uptake and shape. In our method, no a priori assumption is required on the spatial conformation and localization of striatum, and both uptake and symmetry contribute to the index quantification. These measures can reliably support a computer-assisted decision system.
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http://dx.doi.org/10.1186/s40658-016-0140-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754234PMC
December 2016

Alterations of putaminal shape in de novo Parkinson's disease.

Mov Disord 2016 05 16;31(5):676-83. Epub 2016 Feb 16.

Neuroimaging Unit, Institute of Bioimaging and Molecular Physiology (CNR-IBFM), National Research Council, Catanzaro, Italy.

Introduction: Several neuroimaging studies have been carried out to gain insight on the pathological processes that cause PD, but literature findings are inconsistent. The aim of this study was to combine information carried by functional imaging with DA transporter ligands and structural MRI.

Methods: Forty-two untreated, de novo-PD patients and 30 control subjects were involved in this study. Patients were divided in subgroups according to the presence of uni- or bilateral reduction of ligand uptake in the putamen, as observed on DA transporter single-photon emission tomography: 12 patients had abnormal uptake in the right putamen and 11 in the left, whereas 19 had bilateral abnormal uptake. Voxel-based morphometry and shape analysis were used to compare healthy subjects to all de novo-PD or to patients with either right or left abnormal uptake.

Results: Shape analysis identified significant differences between de novo-PD and controls in putaminal regions. In patients with unilateral abnormal uptake, only the medial surface of the structure was involved. When patients with bilateral uptake reduction were also considered, changes extended from the medial to the lateral surface of putamina. Voxel-based morphometry showed similar results to those detected with shape analysis, but it failed to identify the putaminal subfield involved in patients with asymmetric or symmetric damage on DA transporter single-photon emission tomography.

Conclusions: Shape analysis in de novo-PD patients suggested a progressive medial-to-lateral involvement of the putamina that paralleled an asymmetric-to-bilateral distribution of DA transporter depletion. © 2016 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.26550DOI Listing
May 2016

Brain tissues atrophy is not always the best structural biomarker of physiological aging: A multimodal cross-sectional study.

Annu Int Conf IEEE Eng Med Biol Soc 2015 ;2015:5436-40

This study presents a voxel-based multiple regression analysis of different magnetic resonance image modalities, including anatomical T1-weighted, T2* relaxometry, and diffusion tensor imaging. Quantitative parameters sensitive to complementary brain tissue alterations, including morphometric atrophy, mineralization, microstructural damage, and anisotropy loss, were compared in a linear physiological aging model in 140 healthy subjects (range 20-74 years). The performance of different predictors and the identification of the best biomarker of age-induced structural variation were compared without a priori anatomical knowledge. The best quantitative predictors in several brain regions were iron deposition and microstructural damage, rather than macroscopic tissue atrophy. Age variations were best resolved with a combination of markers, suggesting that multiple predictors better capture age-induced tissue alterations. These findings highlight the importance of a combined evaluation of multimodal biomarkers for the study of aging and point to a number of novel applications for the method described.
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http://dx.doi.org/10.1109/EMBC.2015.7319621DOI Listing
September 2016

Does maternal exposure to benzene and PM10 during pregnancy increase the risk of congenital anomalies? A population-based case-control study.

Sci Total Environ 2016 Jan 26;541:444-450. Epub 2015 Sep 26.

Local Health Unit of Reggio Emilia, Reggio Emilia, Italy.

A few studies have suggested an association between maternal exposure to ambient air pollution from vehicular traffic and risk of congenital anomalies in the offspring, but epidemiologic evidence is neither strong nor entirely consistent. In a population-based case-control study in a Northern Italy community encompassing 228 cases of birth defects and 228 referent newborns, we investigated if maternal exposure to PM10 and benzene from vehicular traffic during early pregnancy, as estimated through a dispersion model, was associated with excess teratogenic risk. In conditional logistic regression analysis, and with adjustment for the other pollutant, we found that higher exposure to PM10 but not benzene was associated with increased risk of birth defects overall. Anomaly categories showing the strongest dose-response relation with PM10 exposure were musculoskeletal and chromosomal abnormalities but not cardiovascular defects, with Down syndrome being among the specific abnormalities showing the strongest association, though risk estimates particularly for the less frequent defects were statistically very unstable. Further adjustment in the regression model for potential confounders did not considerably alter the results. All the associations were stronger for average levels of PM10 than for their maximal level. Findings of this study give some support for an excess teratogenic risk following maternal exposure during pregnancy to PM10, but not benzene. Such association appears to be limited to some birth defect categories.
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http://dx.doi.org/10.1016/j.scitotenv.2015.09.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4656073PMC
January 2016

White matter abnormalities differentiate severe from benign temporal lobe epilepsy.

Epilepsia 2015 Jul 19;56(7):1109-16. Epub 2015 Jun 19.

Institute of Neurology, University Magna Graecia, Catanzaro, Italy.

Objective: Temporal and extratemporal white matter abnormalities have been identified frequently in patients with refractory mesial temporal lobe epilepsy (rMTLE). However, the identification of potential water diffusion abnormalities in patients with drug-responsive, benign MTLE (bMTLE) is still missing. The aim of this study was to identify markers of refractoriness in MTLE.

Methods: The study group included 48 patients with bMTLE (mean age 42.8 + 13.5 years), 38 with rMTLE (mean age 41.7 + 14.1 years) and 54 healthy volunteers. Diffusion tensor imaging (DTI) was performed to measure mean diffusivity (MD) and fractional anisotropy (FA) in a regions-of-interest analysis comprising hippocampi and temporal lobe gray and white matter regions. The presence of hippocampal sclerosis (Hs) was assessed using automated magnetic resonance imaging (MRI) evaluation. For statistics we used chi-square test; two-tailed, two-sample t-test; and stratified linear regression.

Results: The significant demographic differences between the two patient groups were sex (p = 0.003), duration of epilepsy (p = 0.003) and complex febrile convulsions (p = 0.0001). In rMTLE, temporal white matter MD was higher and FA lower, as compared to bMTLE. The analysis of diagnostic accuracy (area under the receiver operator characteristic [ROC] curve [AUC]) showed that FA had an AUC for discriminating patients affected from those unaffected by refractory MTLE of 74.0% (p < 0.001), a value that was higher than that of temporal MD (64.0%), hippocampus volume (65.0%), and Hs (66.0%).

Significance: We performed DTI measurements in MTLE and found a significant reduction of FA along the white matter of the temporal lobes in rMTLE, suggesting it as a valuable measure of refractoriness in MTLE.
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http://dx.doi.org/10.1111/epi.13027DOI Listing
July 2015