Publications by authors named "Chiara Ferrari"

57 Publications

Severe oropharyngeal dysphagia following COVID-19: a case report.

Clin Case Rep 2021 Mar 28;9(3):1539-1543. Epub 2021 Jan 28.

Rehabilitation Unit ASST Bergamo Est Briolini Hospital Bergamo Italy.

Dysphagia may occur after a prolonged intubation due to COVID-19 but it is usually mild. Case reports on severe dysphagia following COVID-19 are infrequent. Diagnosis can be difficult because international indications recommend avoiding instrumental assessments as far as possible because of the infection risk. An early rehabilitation treatment is recommended.
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http://dx.doi.org/10.1002/ccr3.3819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981729PMC
March 2021

Quality of life, gastrointestinal symptoms, sleep problems, social support, and social functioning in adults with autism spectrum disorder.

Res Dev Disabil 2021 May 4;112:103915. Epub 2021 Mar 4.

Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland.

Background: The purpose of this study was to investigate the relationship between sleep problems, gastrointestinal symptoms, social functioning, autism traits, and social support on quality of life (QoL) in 107 adults with autism spectrum disorder (ASD).

Method: Questionnaires included the Autism Spectrum Quotient-10 (Adult), Multidimensional Scale of Perceived Social Support, Social Functioning Questionnaire, Pittsburgh Sleep Quality Index, Gastrointestinal Symptom Inventory, and World Health Organization Quality of Life-BREF.

Results: GI symptoms were a common comorbidity with 86 % of participants presenting with them. Sleep problems were also frequent issues with 89 % of participants being classified as poor sleepers. Greater sleep problems were correlated with poorer QoL in the physical health and environment domains. Specifically, the sleep problem of daytime dysfunction was correlated with poorer QoL in physical health. Daytime dysfunction and sleep duration were correlated with poorer QoL in the environment domain. Better social support was correlated with greater QoL in the psychological, social and environment domains. Poorer social functioning was correlated with poorer QoL in each of the four domains.

Conclusion: This research indicated that GI symptoms and sleep problems are common comorbid conditions in the adult ASD population. This paper expanded upon the existing literature by highlighting unexplored factors influencing QoL in adults with ASD.
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http://dx.doi.org/10.1016/j.ridd.2021.103915DOI Listing
May 2021

Facemasks and face recognition: Potential impact on synaptic plasticity.

Neurobiol Dis 2021 06 26;153:105319. Epub 2021 Feb 26.

Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Visual recognition of facial expression modulates our social interactions. Compelling experimental evidence indicates that face conveys plenty of information that are fundamental for humans to interact. These are encoded at neural level in specific cortical and subcortical brain regions through activity- and experience-dependent synaptic plasticity processes. The current pandemic, due to the spread of SARS-CoV-2 infection, is causing relevant social and psychological detrimental effects. The institutional recommendations on physical distancing, namely social distancing and wearing of facemasks are effective in reducing the rate of viral spread. However, by impacting social interaction, facemasks might impair the neural responses to recognition of facial cues that are overall critical to our behaviors. In this survey, we briefly review the current knowledge on the neurobiological substrate of facial recognition and discuss how the lack of salient stimuli might impact the ability to retain and consolidate learning and memory phenomena underlying face recognition. Such an "abnormal" visual experience raises the intriguing possibility of a "reset" mechanism, a renewed ability of adult brain to undergo synaptic plasticity adaptations.
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http://dx.doi.org/10.1016/j.nbd.2021.105319DOI Listing
June 2021

Viewing of figurative paintings affects pseudoneglect as measured by line bisection.

Atten Percept Psychophys 2020 Nov 6;82(8):3795-3803. Epub 2020 Oct 6.

IRCCS Mondino Foundation, Pavia, Italy.

Neurologically intact individuals usually show a leftward bias in spatial attention, known as pseudoneglect, likely reflecting a right-hemisphere dominance in the control of spatial attention. A leftward bias also seems to manifest when individuals are asked to provide aesthetic judgments about visual stimuli, like artworks. However, whether artwork perception affects the allocation of spatial attention has never been directly investigated. Here, we assessed whether viewing figurative paintings affects hemispheric imbalance in the control of spatial attention by asking participants to bisect a series of lines presented on a grey background, on figurative paintings or on non-artistic photographs of real-world scenes, while either simply observing or explicitly evaluating each image. In line with previous evidence, participants showed a leftward bisection bias in the baseline condition, reflecting pseudoneglect. Critically, the presence of a painting in the background (irrespective of whether an aesthetic evaluation was required or not) significantly shifted the bias further to the left compared to when lines were bisected over a grey background (baseline) or a photographed scene. This finding suggests that perception of visual art may affect the control of spatial attention, possibly tapping on right-hemisphere resources related to visuospatial exploration, regardless of reward apprehension mechanisms (at least when images do not evoke strong emotional reactions leading to polarized like/dislike judgements).
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http://dx.doi.org/10.3758/s13414-020-02138-4DOI Listing
November 2020

TMS over the posterior cerebellum modulates motor cortical excitability in response to facial emotional expressions.

Eur J Neurosci 2021 Feb 14;53(4):1029-1039. Epub 2020 Sep 14.

Department of Psychology, University of Milano-Bicocca, Milan, Italy.

Evidence suggests that the posterior cerebellum is involved in emotional processing. Specific mechanisms by which the cerebellum contributes to the perception of and reaction to the emotional state of others are not well-known. It is likely that perceived emotions trigger anticipatory/preparatory motor changes. However, the extent to which the cerebellum modulates the activity of the motor cortex to contribute to emotional processing has not been directly investigated. In this study, we assessed whether the activity of the posterior cerebellum influences the modulation of motor cortical excitability in response to emotional stimuli. To this end, we transiently disrupted the neural activity of the left posterior cerebellum using 1 Hz repetitive transcranial magnetic stimulation (rTMS) and examined its effect on motor cortical excitability witnessed during emotional face processing (in comparison to the effects of sham rTMS). Motor excitability was measured as TMS-based motor evoked potentials (MEPs) recorded from bilateral first dorsal interosseous (FDI) muscles during the viewing of negative emotional (i.e. fearful) and neutral facial expressions. In line with previous evidence, we found that MEP amplitude was increased during the viewing of fearful compared to neutral faces. Critically, when left posterior cerebellar activity was transiently inhibited with 1 Hz rTMS, we observed a reduction in amplitude of MEPs recorded from the contralateral (right) motor cortex during the viewing of emotional (but not neutral) faces. In turn, inhibition of the left posterior cerebellum did not affect the amplitude of MEPs recorded from the ipsilateral motor cortex. Our findings suggest that the posterolateral (left) cerebellum modulates motor cortical response to negative emotional stimuli and may serve as an interface between limbic, cognitive, and motor systems.
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http://dx.doi.org/10.1111/ejn.14953DOI Listing
February 2021

Consensus Paper: Cerebellum and Social Cognition.

Cerebellum 2020 Dec;19(6):833-868

Ataxia Laboratory, IRCCS Fondazione Santa Lucia, 00179, Rome, Italy.

The traditional view on the cerebellum is that it controls motor behavior. Although recent work has revealed that the cerebellum supports also nonmotor functions such as cognition and affect, only during the last 5 years it has become evident that the cerebellum also plays an important social role. This role is evident in social cognition based on interpreting goal-directed actions through the movements of individuals (social "mirroring") which is very close to its original role in motor learning, as well as in social understanding of other individuals' mental state, such as their intentions, beliefs, past behaviors, future aspirations, and personality traits (social "mentalizing"). Most of this mentalizing role is supported by the posterior cerebellum (e.g., Crus I and II). The most dominant hypothesis is that the cerebellum assists in learning and understanding social action sequences, and so facilitates social cognition by supporting optimal predictions about imminent or future social interaction and cooperation. This consensus paper brings together experts from different fields to discuss recent efforts in understanding the role of the cerebellum in social cognition, and the understanding of social behaviors and mental states by others, its effect on clinical impairments such as cerebellar ataxia and autism spectrum disorder, and how the cerebellum can become a potential target for noninvasive brain stimulation as a therapeutic intervention. We report on the most recent empirical findings and techniques for understanding and manipulating cerebellar circuits in humans. Cerebellar circuitry appears now as a key structure to elucidate social interactions.
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http://dx.doi.org/10.1007/s12311-020-01155-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588399PMC
December 2020

A novel local impedance algorithm to guide effective pulmonary vein isolation in atrial fibrillation patients: Preliminary experience across different ablation sites from the CHARISMA pilot study.

J Cardiovasc Electrophysiol 2020 09 9;31(9):2319-2327. Epub 2020 Jul 9.

Laboratorio di Elettrofisiologia, Clinica Montevergine, Mercogliano, Avellino, Italy.

Introduction: Recently, a novel technology able to measure local impedance (LI) and tissue characteristics has been made available for clinical use. This analysis explores the relationships among LI and generator impedance (GI) parameters in atrial fibrillation (AF) patients. Characterization of LI among different ablation spots and procedural success were also evaluated.

Methods And Results: Consecutive patients undergoing AF ablation from the CHARISMA registry at five Italian centers were included. A novel radiofrequency (RF) ablation catheter with a dedicated algorithm (DIRECTSENSE™) was used to measure LI and to guide ablation. The ablation endpoint was pulmonary vein (PV) isolation. We analyzed 2219 ablation spots created around PVs in 46 patients for AF ablation. The mean baseline tissue impedance was 105.8 ± 14 Ω for LI versus 91.8 ± 10 Ω for GI (p < .0001). Baseline impedance was homogenous across the PV sites and proved higher in high-voltage areas than in intermediate- and low-voltage areas and the blood pool (p < .001). Both LI and GI displayed a significant drop after RF delivery, and absolute LI drop values were significantly larger than GI drop values (14 ± 8 vs. 3.7 ± 5 Ω, p < .0001). Every 5-point increment in LI drop was associated with successful ablation (odds ratio = 3.05, 95% confidence interval: 2.3-4.1, p < .0001). Conversely, GI drops were not significantly different comparing successful versus unsuccessful sites (3.7 ± 5 vs. 2.8 ± 4 Ω, p = .1099). No steam pops or major complications occurred during or after the procedures. By the end of the procedures, all PVs had been successfully isolated in all patients.

Conclusions: The magnitude of the LI drop was more closely associated with effective lesion formation than the GI drop.
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http://dx.doi.org/10.1111/jce.14647DOI Listing
September 2020

Comorbid Feeding and Gastrointestinal Symptoms, Challenging Behavior, Sensory Issues, Adaptive Functioning and Quality of Life in Children and Adolescents with Autism Spectrum Disorder.

Dev Neurorehabil 2021 Jan 4;24(1):35-44. Epub 2020 Jun 4.

National University of Ireland , Galway, Ireland.

Aim: Children and adolescents diagnosed with an autism spectrum disorder (ASD) often demonstrate difficulties with feeding. The goal of the current study was to investigate co-occurring issues that often accompany feeding problems in 120 children and adolescents with ASD. : This study investigated the relationship between feeding problems and gastrointestinal symptoms, challenging behavior and sensory issues, quality of life, adaptive functioning and use of complementary and alternative medicine (CAM). : High rates of feeding problems, gastrointestinal symptoms, challenging behavior and sensory issues were endorsed by caregivers. Considerable differences were observed in the levels of gastrointestinal symptoms, challenging behavior, sensory issues, quality of life and CAM practices.: The results of this study extend the present literature by highlighting comorbid conditions related to feeding problems and how feeding problems impact quality of life and adaptive behavior.
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http://dx.doi.org/10.1080/17518423.2020.1770354DOI Listing
January 2021

The left posterior cerebellum is involved in orienting attention along the mental number line: An online-TMS study.

Neuropsychologia 2020 06 12;143:107497. Epub 2020 May 12.

IRCCS Mondino Foundation, Pavia, Italy; Department of Psychology, University of Milano-Bicocca, Milan, Italy. Electronic address:

Although converging evidence suggests that the posterior cerebellum is involved in visuospatial functions and in the orienting of attention, a clear topography of cerebellar regions causally involved in the control of spatial attention is still missing. In this study, we aimed to shed light on this issue by using online neuronavigated transcranial magnetic stimulation (TMS) to temporarily interfere with posterior medial (Vermis lobule VII) and left lateral (Crus I/II) cerebellar activity during a task measuring visuospatial (landmark task, Experiment 1 and 2) and representational (number bisection task, Experiment 2) asymmetries in the orienting of attention. At baseline, participants showed attentional biases consistent with the literature, that is a leftward and upward bias with horizontal and vertical lines, respectively, and a leftward bias in number bisection. Critically, TMS over the left cerebellar hemisphere significantly counteracted pseudoneglect in the number bisection task, whilst not affecting attentional biases in the landmark task. In turn, TMS over the posterior vermis did not affect performance in either task. Taken together, our findings suggest that the left posterior cerebellar hemisphere (but not the posterior vermis) is a critical node of an extended brain network subtending the control of spatial attention, at least when attention needs to be allocated to an internal representational space and a certain degree of mental manipulation is required (as in the number bisection task).
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http://dx.doi.org/10.1016/j.neuropsychologia.2020.107497DOI Listing
June 2020

Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy.

Obes Surg 2020 Jul;30(7):2519-2527

Anesthesia, Humanitas Clinical and Research Center -IRCCS, via Manzoni, 56 20089, Rozzano, MI, Italy.

Background: Bariatric surgery is the most effective treatment for patients affected by morbid obesity. The Enhanced Recovery After Surgery (ERAS) protocol increases clinical outcomes, but the most recent literature shows incomplete patients' adherence. This study aims to demonstrate the feasibility of applying a Value-Based Healthcare (VBHC) strategy associated with ERAS to increase patients' engagement and outcomes.

Method: A multiprofessional team redesigned the process considering ERAS recommendations and patients' feedbacks. Outcomes that matter to patients were defined with structured patients' interviews and collected in the electronic clinical record. Adherence to the pathway and the cost of the cycle of care were measured to demonstrate sustainability. A model was developed to grant its replicability.

Results: A total of 2.122 patients were included. The lowest adherence to the protocol for a single item was 82%. 74% of excess weight loss; 90% better comorbidities control; 77.5% had no pain after surgery; 61% no postoperative nausea and vomiting. Zero mortality; 1.8% overall morbidity; 0.4% readmission and reoperation rate within 30 days. The average length of stay is 2.1 days. Patient-Reported Outcome Measures (PROMs) documented increased productivity and quality of life.

Conclusion: Building a caring relationship by a multidisciplinary team, adding patient wellness in a VBHC framework on top of ERAS as a patient-centered approach, increases patients' engagement and adherence to the pathway of care, resulting in better health outcomes (clinical and PROMs). The Value-Based Model is sustainable and replicable; it represents the prototype for redesigning other pathways and may become a model for other organizations.
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http://dx.doi.org/10.1007/s11695-020-04464-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260281PMC
July 2020

The MICELI (MICrofluidic, ELectrical, Impedance): Prototyping a Point-of-Care Impedance Platelet Aggregometer.

Int J Mol Sci 2020 Feb 11;21(4). Epub 2020 Feb 11.

Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy.

As key cellular elements of hemostasis, platelets represent a primary target for thrombosis and bleeding management. Currently, therapeutic manipulations of platelet function (antithrombotic drugs) and count (platelet transfusion) are performed with limited or no real-time monitoring of the desired outcome at the point-of-care. To address the need, we have designed and fabricated an easy-to-use, accurate, and portable impedance aggregometer called "MICELI" (MICrofluidic, ELectrical, Impedance). It improves on current platelet aggregation technology by decreasing footprint, assay complexity, and time to obtain results. The current study aimed to optimize the MICELI protocol; validate sensitivity to aggregation agonists and key blood parameters, i.e., platelet count and hematocrit; and verify the MICELI operational performance as compared to commercial impedance aggregometry. We demonstrated that the MICELI aggregometer could detect platelet aggregation in 250 μL of whole blood or platelet-rich plasma, stimulated by ADP, TRAP-6, collagen, epinephrine, and calcium ionophore. Using hirudin as blood anticoagulant allowed higher aggregation values. Aggregation values obtained by the MICELI strongly correlated with platelet count and were not affected by hematocrit. The operational performance comparison of the MICELI and the Multiplate Analyzer demonstrated strong correlation and similar interdonor distribution of aggregation values obtained between these devices. With the proven reliability of the data obtained by the MICELI aggregometer, it can be further translated into a point-of-care diagnostic device aimed at monitoring platelet function in order to guide pharmacological hemostasis management and platelet transfusions.
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http://dx.doi.org/10.3390/ijms21041174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072796PMC
February 2020

Learning the affective value of people: More than affect-based mechanisms.

Acta Psychol (Amst) 2020 Feb 22;203:103011. Epub 2020 Jan 22.

Department of Psychology, Princeton University, Princeton, USA.

People's ability to learn about the affective value of others is impressive. However, it is unclear whether this learning solely reflects general affect-based processes or a mixture of affect-based and person-attribution processes. Consistent with the former possibility, people's ability to learn the affective value of people and places have been shown to be comparable (Falvello, Vinson, Ferrari, & Todorov, 2015). To investigate whether general affect-based processes are sufficient to account for this kind of learning, we presented participants with images paired with valenced statements that were either relevant (e.g., a person statement with a person image) or irrelevant (e.g., a person statement with a non-person image). After this presentation, participants evaluated the goodness or badness of the images. In Experiment 1, we found that the learning effects for faces and places were comparable and occurred only when the statements were relevant. However, when we presented the images with multiple statements of the same valence (Experiments 2-4), we found that places acquired affective value from both relevant and irrelevant statements. In contrast, faces were less likely to acquire affective value from irrelevant statements. Our findings suggest that although general affect-based processes might be sufficient to account for affective learning of places, affective learning of faces might involve both affect-based and person-attribution processes.
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http://dx.doi.org/10.1016/j.actpsy.2020.103011DOI Listing
February 2020

Distinct Cerebellar regions for Body Motion Discrimination.

Soc Cogn Affect Neurosci 2019 Dec 10. Epub 2019 Dec 10.

Department of Psychology, University of Milano-Bicocca, Milan 20126, Italy.

Visual processing of human movements is critical for adaptive social behavior. Cerebellar activations have been observed during biological motion discrimination in prior neuroimaging studies and cerebellar lesions may be detrimental for this task. However, whether the cerebellum plays a causal role in biological motion discrimination has never been tested. Here, we addressed this issue in three different experiments by interfering with the posterior cerebellar lobe using transcranial magnetic stimulation (TMS) during a biological discrimination task. In Experiment 1 and 2 we found that TMS delivered at onset of the visual stimuli over the vermis (vermal lobule VI), but not over the left cerebellar hemisphere (left lobule VI/Crus I), interfered with participants' ability to distinguish biological from scrambled motion compared to stimulation of a control site (vertex). Interestingly, when stimulation was delivered at a later time point (300 ms after stimulus onset), participants performed worse when TMS was delivered over the left cerebellar hemisphere compared to the vermis and the vertex (Experiment 3). Our data show that the posterior cerebellum is causally involved in biological motion discrimination, and suggest that different sectors of the posterior cerebellar lobe may contribute to the task at different time points.
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http://dx.doi.org/10.1093/scan/nsz088DOI Listing
December 2019

Medial prefrontal cortex involvement in aesthetic appreciation of paintings: a tDCS study.

Cogn Process 2020 Feb 21;21(1):65-76. Epub 2019 Oct 21.

Human Evolution and Cognition Group (EvoCog), University of the Balearic Islands, Palma de Mallorca, Spain.

Among the brain regions involved in the aesthetic evaluation of paintings, the prefrontal cortex seems to play a pivotal role. In particular, consistent neuroimaging evidence indicates that activity in the dorsolateral prefrontal cortex (mainly in the left hemisphere) and in medial and orbital sectors of the prefrontal cortex is linked to viewing aesthetically pleasing images. In this study, we focused on the contribution of the medial prefrontal cortex (mPFC) in mediating aesthetic decisions about paintings. We found that enhancing excitability in this region via anodal tDCS led participants to judge paintings as more beautiful. Although significant, the effects were moderate, possibly due to the neutral affective value of the artworks we used, suggesting that activity in mPFC may be critically dependent on the affective impact of the paintings.
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http://dx.doi.org/10.1007/s10339-019-00936-9DOI Listing
February 2020

Cerebellar contribution to emotional body language perception: a TMS study.

Soc Cogn Affect Neurosci 2019 Oct 7. Epub 2019 Oct 7.

Department of Psychology, University of Milano-Bicocca, Milan 20126, Italy.

Consistent evidence suggests that the cerebellum contributes to the processing of emotional facial expressions. However, it is not yet known whether the cerebellum is recruited when emotions are expressed by body postures or movements, or whether it is recruited differently for positive and negative emotions. In this study, we asked healthy participants to discriminate between body postures (with masked face) expressing emotions of opposite valence (happiness vs. anger, Experiment 1), or of the same valence (negative: anger vs. sadness; positive: happiness vs. surprise, Experiment 2). Whilst performing the task, participants received online TMS over a region of the posterior left cerebellum and over two control sites (early visual cortex and vertex). We found that TMS over the cerebellum affected participants' ability to discriminate emotional body postures, but only when one of the emotions was negatively valenced (i.e., anger). These findings suggest that the cerebellar region we stimulated is involved in processing the emotional content conveyed by body postures and gestures. Our findings complement prior evidence on the role of the cerebellum in emotional face processing and have important implications from a clinical perspective, where non-invasive cerebellar stimulation is a promising tool in the treatment of motor, cognitive and affective deficits.
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http://dx.doi.org/10.1093/scan/nsz074DOI Listing
October 2019

Enhanced recovery after bariatric surgery (ERABS) in a high-volume bariatric center.

Surg Obes Relat Dis 2019 Oct 9;15(10):1785-1792. Epub 2019 Jul 9.

Bariatric Surgery Unit, Humanitas Research Hospital, Milan, Italy.

Background: The growing demand for bariatric surgery has been accompanied by an expensive technological evolution and the need to contain healthcare costs and to increase the quality of care. The enhanced recovery after surgery (ERAS) protocols applied to the bariatric setting can be the answer to all these different issues.

Objectives: Feasibility and safety of ERAS protocol in a single, high-volume bariatric center.

Setting: Humanitas Research Hospital, Rozzano MI, Italy.

Methods: Our ERAS bariatric protocol is based on the following 3 steps: (1) preoperative: optimization of all co-morbidities, counseling patients and family with information and education, and shortening fasting times (clear fluids up to 2 hr and solids up to 4 hr before induction of anesthesia); (2) intraoperative: premedication, parallel team work, awake patient positioning, standardized multimodal anesthesia and analgesia, noninvasive monitoring, video-laryngoscopy in reverse Trendelenburg position, short-acting anesthetic agents, and standardized laparoscopic surgery avoiding the nasogastric tube, catheter, and drain; and (3) postoperative: analgesia, early mobilization, early oral fluid, thromboprophylaxis, discharge planning, and follow-up telephone call. Clinical pathways were established and outcomes were retrospectively collected.

Results: Comparison between conventional care and ERAS protocol reveals a reduction of the length of hospital stay (from 4.7 to 2.1 d) and a low morbidity rate. From July 2015 to July 2018, a total of 2400 consecutive patients underwent primary or revisional bariatric surgery (2122 sleeve gastrectomies and 278 Roux-en-Y gastric bypasses [RYGB]). Mean body mass index was 44.9 kg/m, mean age was 41.9 years, and the male to female ratio was 1:2.5. Total mean operative time was 85 minutes, with a surgical time of 65 minutes and an anesthesiologic/patient induction time of 4 minutes. Early complication rate was 3.5% with no perioperative mortality. Mean hospital stay was 2.1 days and the rate of readmission was .9%.

Conclusions: This study demonstrates that our ERAS protocol is safe, feasible, and efficient. Patient preparation and multidisciplinary/parallel team work are crucial points.
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http://dx.doi.org/10.1016/j.soard.2019.06.038DOI Listing
October 2019

A kinematic analysis of water ski jumping in male and female elite athletes.

Sports Biomech 2019 Jun 21:1-16. Epub 2019 Jun 21.

a Department of Neuroscience, Biomedicine and Movement Sciences , University of Verona , Verona , Italy.

The aim of this study was to perform a kinematic analysis of the in-run, take-off and early flight phases in water ski jumping and to analyse the differences in linear/angular parameters between males and females. Forty-two elite skiers participated in this study (27 males; 15 females); their jumps were video recorded during competitions: the time course of absolute (trunk, thigh, ski) and relative (hip, knee, ankle) angles was calculated, as well as the (trochanter) resultant speed. Males were able to reach faster in-run speeds than females (25.4 ± 1.9 and 21.8 ± 1.2 m/s, respectively) and jumped further (56.2 ± 8.6 and 40.4 ± 6.3 m). Longer jumps were correlated with faster speeds in all phases (r range: 0.87-0.91, < 0.001, = 42). From take-off to early flight skiers extend their hip (86-109°) and knee (136-171°) angles, lean their trunk forward (49-41°) and raise their skis (20-51°); no major sex differences were observed in the body position (or ski incline) in these phases and none of the angular parameters was correlated with jump distance. Our results suggest that skiers should focus on achieving a larger in-run speed to maximise performance in this discipline.
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http://dx.doi.org/10.1080/14763141.2019.1624813DOI Listing
June 2019

Differences in Emotion Recognition From Body and Face Cues Between Deaf and Hearing Individuals.

Multisens Res 2019 01 1;32(6):499-519. Epub 2019 Jan 1.

1Department of Psychology, University of Milano-Bicocca, Milan 20126, Italy.

Deaf individuals may compensate for the lack of the auditory input by showing enhanced capacities in certain visual tasks. Here we assessed whether this also applies to recognition of emotions expressed by bodily and facial cues. In Experiment 1, we compared deaf participants and hearing controls in a task measuring recognition of the six basic emotions expressed by actors in a series of video-clips in which either the face, the body, or both the face and body were visible. In Experiment 2, we measured the weight of body and face cues in conveying emotional information when intense genuine emotions are expressed, a situation in which face expressions alone may have ambiguous valence. We found that deaf individuals were better at identifying disgust and fear from body cues (Experiment 1) and in integrating face and body cues in case of intense negative genuine emotions (Experiment 2). Our findings support the capacity of deaf individuals to compensate for the lack of the auditory input enhancing perceptual and attentional capacities in the spared modalities, showing that this capacity extends to the affective domain.
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http://dx.doi.org/10.1163/22134808-20191353DOI Listing
January 2019

Differences in Emotion Recognition From Body and Face Cues Between Deaf and Hearing Individuals.

Multisens Res 2019 01 1;32(6):499-519. Epub 2019 Jan 1.

1Department of Psychology, University of Milano-Bicocca, Milan 20126, Italy.

Deaf individuals may compensate for the lack of the auditory input by showing enhanced capacities in certain visual tasks. Here we assessed whether this also applies to recognition of emotions expressed by bodily and facial cues. In Experiment 1, we compared deaf participants and hearing controls in a task measuring recognition of the six basic emotions expressed by actors in a series of video-clips in which either the face, the body, or both the face and body were visible. In Experiment 2, we measured the weight of body and face cues in conveying emotional information when intense genuine emotions are expressed, a situation in which face expressions alone may have ambiguous valence. We found that deaf individuals were better at identifying disgust and fear from body cues (Experiment 1) and in integrating face and body cues in case of intense negative genuine emotions (Experiment 2). Our findings support the capacity of deaf individuals to compensate for the lack of the auditory input enhancing perceptual and attentional capacities in the spared modalities, showing that this capacity extends to the affective domain.
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http://dx.doi.org/10.1163/22134808-20191353DOI Listing
January 2019

TMS over the superior temporal sulcus affects expressivity evaluation of portraits.

Cogn Affect Behav Neurosci 2018 12;18(6):1188-1197

Department of Psychology, University of Milano-Bicocca, Piazza dell' Ateneo Nuovo,1, 20126, Milano, Italy.

When viewing a portrait, we are often captured by its expressivity, even if the emotion depicted is not immediately identifiable. If the neural mechanisms underlying emotion processing of real faces have been largely clarified, we still know little about the neural basis of evaluation of (emotional) expressivity in portraits. In this study, we aimed at assessing-by means of transcranial magnetic stimulation (TMS)-whether the right superior temporal sulcus (STS) and the right somatosensory cortex (SC), that are important in discriminating facial emotion expressions, are also causally involved in the evaluation of expressivity of portraits. We found that interfering via TMS with activity in (the face region of) right STS significantly reduced the extent to which portraits (but not other paintings depicting human figures with faces only in the background) were perceived as expressive, without, though, affecting their liking. In turn, interfering with activity of the right SC had no impact on evaluating either expressivity or liking of either paintings' category. Our findings suggest that evaluation of emotional cues in artworks recruit (at least partially) the same neural mechanisms involved in processing genuine biological others. Moreover, they shed light on the neural basis of liking decisions in art by art-naïve people, supporting the view that aesthetic appreciation relies on a multitude of factors beyond emotional evaluation.
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http://dx.doi.org/10.3758/s13415-018-0630-4DOI Listing
December 2018

Applying Lean-Six-Sigma Methodology in radiotherapy: Lessons learned by the breast daily repositioning case.

Radiother Oncol 2018 May 6;127(2):326-331. Epub 2018 Mar 6.

Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.

Background & Purpose: Lean Six Sigma Methodology (LSSM) was introduced in industry to provide near-perfect services to large processes, by reducing improbable occurrence. LSSM has been applied to redesign the 2D-2D breast repositioning process (Lean) by the retrospective analysis of the database (Six Sigma).

Materials & Methods: Breast patients with daily 2D-2D matching before RT were considered. The five DMAIC (define, measure, analyze, improve, and control) LSSM steps were applied. The process was retrospectively measured over 30 months (7/2014-12/2016) by querying the RT Record&Verify database. Two Lean instruments (Poka-Yoke and Visual Management) were considered for advancing the process. The new procedure was checked over 6 months (1-6/2017).

Results: 14,931 consecutive shifts from 1342 patients were analyzed. Only 0.8% of patients presented median shifts >1 cm. The major observed discrepancy was the monthly percentage of fractions with almost zero shifts (AZS = 13.2% ± 6.1%). Ishikawa fishbone diagram helped in defining the main discrepancy con-causes. Procedure harmonization involving a multidisciplinary team to increase confidence in matching procedure was defined. AZS was reduced to 4.8% ± 0.6%. Furthermore, distribution symmetry improvement (Skewness moved from 1.4 to 1.1) and outlier reduction, verified by Kurtosis diminution, demonstrated a better "normalization" of the procedure after the LSSM application.

Conclusions: LSSM was implemented in a RT department, allowing to redesign the breast repositioning matching procedure.
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http://dx.doi.org/10.1016/j.radonc.2018.02.019DOI Listing
May 2018

The Spatial Musical Association of Response Codes does not depend on a normal visual experience: A study with early blind individuals.

Atten Percept Psychophys 2018 May;80(4):813-821

Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy.

Converging evidence suggests that the perception of auditory pitch exhibits a characteristic spatial organization. This pitch-space association can be demonstrated experimentally by the Spatial Musical Association of Response Codes (SMARC) effect. This is characterized by faster response times when a low-positioned key is pressed in response to a low-pitched tone, and a high-positioned key is pressed in response to a high-pitched tone. To investigate whether the development of this pitch-space association is mediated by normal visual experience, we tested a group of early blind individuals on a task that required them to discriminate the timbre of different instrument sounds with varying pitch. Results revealed a comparable pattern in the SMARC effect in both blind participants and sighted controls, suggesting that the lack of prior visual experience does not prevent the development of an association between pitch height and vertical space.
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http://dx.doi.org/10.3758/s13414-018-1495-xDOI Listing
May 2018

The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents.

PLoS One 2018 3;13(1):e0190426. Epub 2018 Jan 3.

Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy.

A Body Shape Index (ABSI) and normalized hip circumference (Hip Index, HI) have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2-18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass % detected by bioelectrical impedance analysis) and obesity-related conditions (including hepatic steatosis and metabolic syndrome). We recruited 217 patients (114 males), mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190426PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752028PMC
February 2018

The role of the cerebellum in explicit and incidental processing of facial emotional expressions: A study with transcranial magnetic stimulation.

Neuroimage 2018 04 12;169:256-264. Epub 2017 Dec 12.

Department of Psychology, University of Milano-Bicocca, Milan 20126, Italy; Brain Connectivity Center, National Neurological Institute C. Mondino, Pavia 27100, Italy. Electronic address:

Growing evidence suggests that the cerebellum plays a critical role in non-motor functions, contributing to cognitive and affective processing. In particular, the cerebellum might represent an important node of the "limbic" network, underlying not only emotion regulation but also emotion perception and recognition. Here, we used transcranial magnetic stimulation (TMS) to shed further light on the role of the cerebellum in emotional perception by specifically testing cerebellar contribution to explicit and incidental emotional processing. In particular, in three different experiments, we found that TMS over the (left) cerebellum impaired participants' ability to categorize facial emotional expressions (explicit task) and to classify the gender of emotional faces (incidental emotional processing task), but not the gender of neutral faces. Overall, our results indicate that the cerebellum is involved in perceiving the emotional content of facial stimuli, even when this is task irrelevant.
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http://dx.doi.org/10.1016/j.neuroimage.2017.12.026DOI Listing
April 2018

An Exploratory TMS Study on Prefrontal Lateralization in Valence Categorization of Facial Expressions.

Exp Psychol 2017 Jul;64(4):282-289

1 Department of Psychology, University of Milano-Bicocca, Italy.

Converging neuroimaging and patient data suggest that the dorsolateral prefrontal cortex (DLPFC) is involved in emotional processing. However, it is still not clear whether the DLPFC in the left and right hemisphere is differentially involved in emotion recognition depending on the emotion considered. Here we used transcranial magnetic stimulation (TMS) to shed light on the possible causal role of the left and right DLPFC in encoding valence of positive and negative emotional facial expressions. Participants were required to indicate whether a series of faces displayed a positive or negative expression, while TMS was delivered over the right DLPFC, the left DLPFC, and a control site (vertex). Interfering with activity in both the left and right DLPFC delayed valence categorization (compared to control stimulation) to a similar extent irrespective of emotion type. Overall, we failed to demonstrate any valence-related lateralization in the DLPFC by using TMS. Possible methodological limitations are discussed.
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http://dx.doi.org/10.1027/1618-3169/a000363DOI Listing
July 2017

Polymer ultrapermeability from the inefficient packing of 2D chains.

Nat Mater 2017 09 31;16(9):932-937. Epub 2017 Jul 31.

EastChem, School of Chemistry, University of Edinburgh, David Brewster Road, Edinburgh EH9 3FJ, UK.

The promise of ultrapermeable polymers, such as poly(trimethylsilylpropyne) (PTMSP), for reducing the size and increasing the efficiency of membranes for gas separations remains unfulfilled due to their poor selectivity. We report an ultrapermeable polymer of intrinsic microporosity (PIM-TMN-Trip) that is substantially more selective than PTMSP. From molecular simulations and experimental measurement we find that the inefficient packing of the two-dimensional (2D) chains of PIM-TMN-Trip generates a high concentration of both small (<0.7 nm) and large (0.7-1.0 nm) micropores, the former enhancing selectivity and the latter permeability. Gas permeability data for PIM-TMN-Trip surpass the 2008 Robeson upper bounds for O/N, H/N, CO/N, H/CH and CO/CH, with the potential for biogas purification and carbon capture demonstrated for relevant gas mixtures. Comparisons between PIM-TMN-Trip and structurally similar polymers with three-dimensional (3D) contorted chains confirm that its additional intrinsic microporosity is generated from the awkward packing of its 2D polymer chains in a 3D amorphous solid. This strategy of shape-directed packing of chains of microporous polymers may be applied to other rigid polymers for gas separations.
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http://dx.doi.org/10.1038/nmat4939DOI Listing
September 2017

Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience.

PLoS One 2017 13;12(7):e0181095. Epub 2017 Jul 13.

Department of Pediatrics, V.Buzzi Childrens' Hospital, University of Milan, Milan, Italy.

Aims: To evaluate the effects of an outpatient multidisciplinary weight loss intervention in reducing body mass index (BMI) in children and adolescents suffering overweight and obesity, changes in A Body Shape Index (ABSI, waist circumference normalized to height and weight) and Hip Index (HI, normalized hip circumference) during treatment and correlation between the ABSI and HI with change in BMI z score.

Methods: We analyze anthropometric data from pediatric patients affected by overweight and obesity aged 2 to 18 years old who entered our multidisciplinary weight loss intervention, which included medical, psychological and nutritional sessions, from January 1st 2006 to December 31st 2016. Lifestyle modification counselling was delivered. Follow-up visits were planned every month for 3 months and subsequently every 2-4 months. BMI, ABSI, and HI were converted to z scores using age and sex specific population normals.

Results: 864 patients entered our intervention. 453 patients (208 males), mean age 11.2 ±3.1 years, 392 with obesity (86%, z-BMI 2.90 ±0.80 SD) and 61 patients with overweight (z-BMI 1.73±0.21 SD) attended at least 1 follow-up visit. The mean number of visits was 3.5 (± 1.8 SD) in overweight subjects and 3.9 (±2.2 SD) in ones with obesity. At the last attended follow-up visit (at 16 ± 12 months SD) we observed a reduction in mean z-BMI in patients with obesity (to 2.52 ±0.71 SD) and patients with overweight (to 1.46 ±0.5 SD). Most patients (80.8%) reduced their BMI z scores. Mean ABSI and HI z scores showed no significant change. 78/392 patients (19.8%) recovered from obese to overweight, 5/392 (1.2%) from obese to normal weight. The recovery rate from overweight to normal weight was 13.1%. In a multivariate model, initial BMI z score and number of follow-up visits were significant predictors of weight change, while age, sex, ABSI, and HI were not significant predictors.

Conclusions: Patients affected by overweight and obesity involved in a multidisciplinary weight loss intervention reduced their mean BMI z score, while ABSI and HI were stable. Weight loss was not predicted by initial ABSI or HI. More visits predict more weight loss, but dropout rates are high. The great majority of patients leave the weight management program before having normalized their BMI.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181095PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509286PMC
September 2017

Emotion processing in early blind and sighted individuals.

Neuropsychology 2017 Jul 13;31(5):516-524. Epub 2017 Mar 13.

Department of Psychology, University of Milano-Bicocca.

Objective: Emotion processing is known to be mediated by a complex network of cortical and subcortical regions with evidence of specialized hemispheric lateralization within the brain. In light of prior evidence indicating that lateralization of cognitive functions (such as language) may depend on normal visual development, we investigated whether the lack of prior visual experience would have an impact on the development of specialized hemispheric lateralization in emotional processing.

Method: We addressed this issue by comparing performance in early blind and sighted controls on a dichotic listening task requiring the detection of specific emotional vocalizations (i.e., suggestive of happiness or sadness) presented independently to either ear.

Results: Consistent with previous studies, we found that sighted individuals showed enhanced detection of positive vocalizations when presented in the right ear (i.e., processed within the left hemisphere) and negative vocalizations when presented in the left ear (i.e., right hemisphere). It is interesting to note that although blind individuals were as accurate as sighted controls in detecting the valance of the vocalization, performance was not consistent with any pattern of specialized hemispheric lateralization.

Conclusions: Overall, these results suggest that although the lack of prior visual experience may not lead to impaired emotion processing performance, the underlying neurophysiological substrate (i.e., degree of special hemispheric lateralization) may depend on normal visual development. (PsycINFO Database Record
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http://dx.doi.org/10.1037/neu0000360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757241PMC
July 2017

The dorsomedial prefrontal cortex mediates the interaction between moral and aesthetic valuation: a TMS study on the beauty-is-good stereotype.

Soc Cogn Affect Neurosci 2017 05;12(5):707-717

Department of Psychology, University of Milano-Bicocca, Milan, Italy.

Attractive individuals are perceived as possessing more positive personal traits than unattractive individuals. This reliance on aesthetic features to infer moral character suggests a close link between aesthetic and moral valuation. Here we aimed to investigate the neural underpinnings of the interaction between aesthetic and moral valuation by combining transcranial magnetic stimulation (TMS) with a priming paradigm designed to assess the Beauty-is-Good stereotype. Participants evaluated the trustworthiness of a series of faces (targets), each of which was preceded by an adjective describing desirable, undesirable, or neutral aesthetic qualities (primes). TMS was applied between prime and target to interfere with activity in two regions known to be involved in aesthetic and moral valuation: the dorsomedial prefrontal cortex (dmPFC, a core region in social cognition) and the dorsolateral prefrontal cortex (dlPFC, critical in decision making). Our results showed that when TMS was applied over vertex (control) and over the dlPFC, participants judged faces as more trustworthy when preceded by positive than by negative aesthetic primes (as also shown in two behavioral experiments). However, when TMS was applied over the dmPFC, primes had no effect on trustworthiness judgments. A second Experiment corroborated this finding. Our results suggest that mPFC plays a causal role linking moral and aesthetic valuation.
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http://dx.doi.org/10.1093/scan/nsx002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460046PMC
May 2017