Anorexia-Induced Hypoleptinemia Drives Adaptations in the JAK2/STAT3 Pathway in the Ventral and Dorsal Hippocampus of Female Rats

Leptin is an appetite-regulating adipokine that is reduced in patients with anorexia nervosa (AN), a psychiatric disorder characterized by self-imposed starvation, and has been linked to hyperactivity, a hallmark of AN. However, it remains unknown how leptin receptor (LepR) and its JAK2-STAT3 downstream pathway in extrahypothalamic brain areas, such as the dorsal (dHip) and ventral (vHip) hippocampus, crucial for spatial memory and emotion regulation, may contribute to the maintenance of AN behaviors. Taking advantage of the activity-based anorexia (ABA) model (i.e., the combination of food restriction and physical activity), we observed reduced leptin plasma levels in adolescent female ABA rats at the acute phase of the disorder [post-natal day (PND) 42], while the levels increased over control levels following a 7-day recovery period (PND49). The analysis of the intracellular leptin pathway revealed that ABA rats showed an overall decrease of the LepR/JAK2/STAT3 signaling in dHip at both time points, while in vHip we observed a transition from hypo- (PND42) to hyperactivation (PND49) of the pathway. These changes might add knowledge on starvation-induced fluctuations in leptin levels and in hippocampal leptin signaling as initial drivers of the transition from adaptative mechanisms to starvation toward the maintenance of aberrant behaviors typical of AN patients, such as perpetuating restraint over eating.

Temporal dynamics of BDNF signaling recruitment in the rat prefrontal cortex and hippocampus following a single infusion of a translational dose of ketamine

Despite several decades of investigations, the mechanisms underlying the rapid action of ketamine as antidepressant are still far from being completely understood. Several studies indicated Brain-Derived Neurotrophic Factor (BDNF) as critical for the fast antidepressant action of ketamine, due to its contribution in early and rapid synaptic adaptations. However, previous reports have been essentially based on ketamine dosing modes that differ from the clinical route of administration (slow intravenous infusion). In this report, we investigated the effects of a ketamine dosing mode in male Sprague-Dawley rats showed to be translational to the clinically effective mode in patients. We focused on the first 24 h after infusion to finely dissect potential differences in the contribution of BDNF signaling pathway in prefrontal cortex and hippocampus, two brain regions involved in the antidepressant effects of ketamine. Our data show that the slow ketamine infusion activates the BDNF-mTOR-S6 pathway in prefrontal cortex as early as 2 h and remains on until at least 6 h after the infusion. At the 12 h timepoint, this pathway is turned off in prefrontal cortex while it becomes activated in hippocampus. Interestingly, this pathway appears to be activated in both brain regions at 24 h through a BDNF-independent mechanism adding complexity to the early action of ketamine. We have captured previously unknown dynamics of the early effects of ketamine showing rapid activation/deactivation of BDNF and its downstream signaling in prefrontal cortex and hippocampus, following a precise temporal profile.

Recency memory is altered in cocaine-withdrawn adolescent rats: Implication of cortical mTOR signaling

In humans, cocaine abuse during adolescence poses a significant risk for developing cognitive deficits later in life. Among the regions responsible for cognitive processes, the medial prefrontal cortex (mPFC) modulates temporal order information via mechanisms involving the mammalian-target of rapamycin (mTOR)-mediated pathway and protein synthesis regulation. Accordingly, our goal was to study the effect of repeated cocaine exposure during both adolescence and adulthood on temporal memory by studying the mTOR pathway in the mPFC. Adolescent or adult rats underwent repeated cocaine injections for 15 days and, after two weeks of withdrawal, engaged in the temporal order object recognition (TOOR) test. We found that repeated cocaine exposure during adolescence impaired TOOR performance, while control or adult-treated animals showed no impairments. Moreover, activation of the mTOR-S6-eEF2 pathway following the TOOR test was diminished only in the adolescent cocaine-treated group. Notably, inhibition of the mTOR-mediated pathway by rapamycin injection impaired TOOR performance in naïve adolescent and adult animals, revealing this pathway to be a critical component in regulating recency memory. Our data indicate that withdrawal from cocaine exposure impairs recency memory via the dysregulation of protein translation mechanisms, but only when cocaine is administered during adolescence.

Chronic Lithium Treatment Alters NMDA and AMPA Receptor Synaptic Availability and Dendritic Spine Organization in the Rat Hippocampus

BACKGROUND

The mechanisms underlying the action of lithium (LiCl) in bipolar disorder(BD) are still far from being completely understood. Previous evidence has revealed that BD is characterized by glutamate hyperexcitability, suggesting that LiCl may act, at least partially, by toning down glutamatergic signaling abnormalities.

OBJECTIVE

In this study, taking advantage of western blot and confocal microscopy, we used a combination of integrative molecular and morphological approaches in rats exposed to repeated administration of LiCl at a therapeutic dose (between 0.6 and 1.2 mmol/l) and sacrificed at two different time points, i.e., 24 hours and 7 days after the last exposure.

RESULTS

We report that repeated LiCl treatment activates multiple, parallel, but also converging forms of compensatory neuroplasticity related to glutamatergic signaling. More specifically, LiCl promoted a wave of neuroplasticity in the hippocampus, involving the synaptic recruitment of GluN2A-containing NMDA receptors, GluA1-containing AMPA receptors, and the neurotrophin BDNF that are indicative of a more plastic spine. The latter is evidenced by morphological analyses showing changes in dendritic spine morphology, such as increased length and head diameter of such spines. These changes may counteract the potentially negative extra-synaptic movements of GluN2B-containing NMDA receptors as well as the increase in the formation of GluA2-lacking Ca2+-permeable AMPA receptors.

CONCLUSION

Our findings highlight a previously unknown cohesive picture of the glutamatergic implications of LiCl action that persist long after the end of its administration, revealing for the first time a profound and persistent reorganization of the glutamatergic postsynaptic density receptor composition and structure.

Effects of Multidisciplinary Rehabilitation Enhanced with Neuropsychological Treatment on Post-Acute SARS-CoV-2 Cognitive Impairment (Brain Fog): An Observational Study

Concentration and memory impairment (named "brain fog") represents a frequent and disabling neuropsychological sequela in post-acute COVID-19 syndrome (PACS) patients. The aim of this study was to assess whether neurocognitive function could improve after a multidisciplinary rehabilitation program enhanced with individualized neuropsychological treatment. A prospective monocentric registry of PACS patients consecutively admitted to our Rehabilitation Unit was created. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive impairment at admission and discharge. A total of sixty-four (64) PACS patients, fifty-six (56) of them with brain fog, were treated with a day-by-day individualized psychological intervention of cognitive stimulation (45 min) on top of a standard in-hospital rehabilitation program. The mean duration of the acute-phase hospitalization was 55.8 ± 25.8 days and the mean in-hospital rehabilitation duration was 30 ± 10 days. The mean age of the patients was 67.3 ± 10.4 years, 66% of them were male, none had a previous diagnosis of dementia, and 66% of the entire sample had experienced severe COVID-19. At admission, only 12% of the patients had normal cognitive function, while 57% showed mild, 28% moderate, and 3% severe cognitive impairment. After psychological treatment, a significant improvement in the MoCA score was found (20.4 ± 5 vs. 24.7 ± 3.7; p < 0.0001) as a result of significant amelioration in the following domains: attention task (p = 0.014), abstract reasoning (p = 0.003), language repetition (p = 0.002), memory recall (p < 0.0001), orientation (p < 0.0001), and visuospatial abilities (p < 0.0001). Moreover, the improvement remained significant after multivariate analysis adjusted for several confounding factors. Finally, at discharge, 43% of the patients with cognitive impairment normalized their cognitive function, while 4.7% were discharged with residual moderate cognitive impairment. In conclusion, our study provides evidence of the effects of multidisciplinary rehabilitation enhanced with neuropsychological treatment on improvement in the cognitive function of post-acute COVID-19 patients.

Long-lasting BDNF signaling alterations in the amygdala of adolescent female rats exposed to the activity-based anorexia model

Introduction: Anorexia nervosa (AN) is a severe psychiatric disorder characterized by a pathological fear of gaining weight, excessive physical exercise, and emotional instability. Since the amygdala is a key region for emotion processing and BDNF has been shown to play a critical role in this process, we hypothesized that alteration in the amygdalar BDNF system might underline vulnerability traits typical of AN patients. Methods: To this end, adolescent female rats have been exposed to the Activity-Based Anorexia (ABA) protocol, characterized by the combination of caloric restriction and intense physical exercise. Results: The induction of the anorexic phenotype caused hyperactivity and body weight loss in ABA animals. These changes were paralleled by amygdalar hyperactivation, as measured by the up-regulation of cfos mRNA levels. In the acute phase of the pathology, we observed reduced Bdnf exon IX, exon IV, and exon VI gene expression, while mBDNF protein levels were enhanced, an increase that was, instead, uncoupled from its downstream signaling as the phosphorylation of TrkB, Akt, and S6 in ABA rats were reduced. Despite the body weight recovery observed 7 days later, the BDNF-mediated signaling was still downregulated at this time point. Discussion: Our findings indicate that the BDNF system is downregulated in the amygdala of adolescent female rats under these experimental conditions, which mimic the anorexic phenotype in humans, pointing to such dysregulation as a potential contributor to the altered emotional processing observed in AN patients. In addition, since the modulation of BDNF levels is observed in other psychiatric conditions, the persistent AN-induced changes of the BDNF system in the amygdala might contribute to explaining the onset of comorbid psychiatric disorders that persist in patients even beyond recovery from AN.

Motor imagery and action-observation in neurorehabilitation: A study protocol in Parkinson's disease patients

Introduction

Action Observation Treatment (AOT) and Motor Imagery (MI) represent very promising cognitive strategies in neuro-rehabilitation. This study aims to compare the effectiveness of the two cognitive strategies, taken alone or combined, in Parkinson's disease patients.

Material and methods

This study is designed as a prospective randomized controlled trial, with four arms. We estimated a sample size of 64 patients (16 in each treatment group) to be able to detect an effect size of F = 0.4 with a statistical significance of 0.05. Primary outcomes will be functional gains in the FIM and UPDRS scales. Secondary outcome measure will be functional gain as revealed by kinematic parameters measured at Gait Analysis.

Discussion

The results of this trial will provide insights into the use of AOT and MI, taken alone or combined, in the rehabilitation of Parkinson's disease patients.

Ethics and dissemination

The study protocol was approved by the Ethics Committee of the Don Gnocchi Foundation. The study will be conducted in accordance with the 1996 World Medical Association guidelines and according to good clinical practice. The study has been registered on clinicaltrial.gov under the following code: AOTPRFDG. Dissemination will include both submission of the study to peer-reviewed journals and discussion of the study protocol at conferences.

3D early embryogenesis image filtering by nonlinear partial differential equations

We present nonlinear diffusion equations, numerical schemes to solve them and their application for filtering 3D images obtained from laser scanning microscopy (LSM) of living zebrafish embryos, with a goal to identify the optimal filtering method and its parameters. In the large scale applications dealing with analysis of 3D+time embryogenesis images, an important objective is a correct detection of the number and position of cell nuclei yielding the spatio-temporal cell lineage tree of embryogenesis. The filtering is the first and necessary step of the image analysis chain and must lead to correct results, removing the noise, sharpening the nuclei edges and correcting the acquisition errors related to spuriously connected subregions. In this paper we study such properties for the regularized Perona-Malik model and for the generalized mean curvature flow equations in the level-set formulation. A comparison with other nonlinear diffusion filters, like tensor anisotropic diffusion and Beltrami flow, is also included. All numerical schemes are based on the same discretization principles, i.e. finite volume method in space and semi-implicit scheme in time, for solving nonlinear partial differential equations. These numerical schemes are unconditionally stable, fast and naturally parallelizable. The filtering results are evaluated and compared first using the Mean Hausdorff distance between a gold standard and different isosurfaces of original and filtered data. Then, the number of isosurface connected components in a region of interest (ROI) detected in original and after the filtering is compared with the corresponding correct number of nuclei in the gold standard. Such analysis proves the robustness and reliability of the edge preserving nonlinear diffusion filtering for this type of data and lead to finding the optimal filtering parameters for the studied models and numerical schemes. Further comparisons consist in ability of splitting the very close objects which are artificially connected due to acquisition error intrinsically linked to physics of LSM. In all studied aspects it turned out that the nonlinear diffusion filter which is called geodesic mean curvature flow (GMCF) has the best performance.

Stroke rehabilitation pathways and procedures in Italy

AIM

Rehabilitation pathways and procedures after first stroke vary widely. We wanted to determine in what ways first stroke rehabilitation in Italian rehabilitation centers are similar and in line with the Italian Ministry of Health guidelines and international reports.

METHODS

Data from the study, Cerebral Ictus and Rehabilitation: Clinical Indicators and Outcomes, of the Italian Cooperative Research (ICR(2)), on 997 inpatients in 18 rehabilitation centers were analyzed and the rehabilitation procedures were compared. To do this, we compared the variables: onset admission interval, length of stay, intensity of treatment and discharge destination. Statistical analyses were performed using the Kruskal-Wallis test, the post hoc Mann-Whitney U test and the chi squared test.

RESULTS

Major differences among the centers were found for onset of admission, length of stay, intensity of treatment and discharge destination, whereas the clinical characteristics and the functional outcomes of the study population were similar.

CONCLUSIONS

Our results emphasize the importance of better integration between the acute treatment phase and the rehabilitation teams in reducing the onset admission interval of first acute stroke patients. To define optimal intensity of treatment and length of stay, randomized multicenter studies will be needed.

Complications of internal jugular vein retrograde catheterization

We report on the incidence of complications of 172 internal jugular vein retrograde catheterizations (IJVRCs) performed on 126 patients. Standard cannulation and X-ray control of the catheter tip placement were performed. Difficulties encountered during the manouvre were registered. Patients with a jugular catheter in place for more than one day had neck echography on catheter removal and one week later. Carotid artery puncture occurred in 20 (12%) cases and lymphatic vessel puncture in one. In 13 (8%) cases IJVRC failed due to difficulties in advancing the guide. X-ray films documented catheter misplacement in 39 (23%) cases: loop into the internal jugular vein in 11 (6%); paravertebral venous plexus cannulated in one; other extracranial jugular afferent cannulated in 4 (2%); catheter tip into the jugular lumen in 10 (6%); catheter tip beyond the jugular bulb in 13 (8%). First neck echography documented: one perivascular hematoma (absent one week later); 3 (4%) jugular vein thrombosis (2 asymptomatic and absent one week later; one symptomatic and still evident one week later). Positive neck echography was not associated with difficulties, length of catheterization, diameter of the catheter. IJVRC is a simple and safe procedure with a low incidence of serious complications.

The utility and cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis

BACKGROUND AND OBJECTIVE

The potential utility of D-dimer measurements for the diagnosis of deep vein thrombosis became evident soon after the development of reliable commercial assays. The purpose of this review is to outline some critical aspects affecting cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis (DVT).

METHODS

The authors have been working in this field contributing original papers whose data have been used for this study. In addition, the material analyzed in this article includes papers published in the journals covered by the Science Citation Index and Medline.

RESULTS

D-dimer levels are very sensitive to the process of fibrin formation/dissolution occurring with ongoing thrombosis. However, they may not be highly specific for venous thromboembolism as they are influenced by the presence of comorbid conditions potentially elevating plasma D-dimer (cancer, surgery, infectious diseases). In addition, commercially available ELISA assays, although quantitative and reproducible, cannot be used under emergency conditions because they are time-consuming and suited for batch-processing of plasma samples. Recently, new assays have been introduced which permit fast and quantitative D-dimer estimations in individual patients. We have evaluated the utility of two new rapid assays (LPIA D-dimer. Mitsubishi, and VIDAS D-DIMER, bio-Merieux) in combination with compression real-time-B-mode ultrasonography for the detection of deep vein thrombosis in asymptomatic patients following elective hip replacement and in patients with clinically suspected deep vein thrombosis. In both settings, we identified cut-off values with optimal sensitivity which allow exclusion of deep vein thrombosis in a considerable percentage of patients, with substantial sparing of economic resources. In fact, based on a cost-effectiveness analysis, a diagnostic algorithm combining D-dimers measurement and compression ultrasonography would result in cost-savings ranging from 5% to 55% in patients with high or low clinical pretest probability respectively. However, the specificity of D-dimer measurements for deep vein thrombosis was much higher in symptomatic than in asymptomatic patients. Choice of the cut-off value proved to be dependent on the method as well as on the patient populations studied.

CONCLUSIONS

The cost-effectiveness of D-dimers measurement in the diagnosis of asymptomatic DVT remains questionable. Conversely, our data strongly support the utility of D-dimers determinations in the diagnosis of symptomatic DVT. In terms of sparing economic resources, the introduction in the clinical laboratory of the rapid quantitative assays would be highly convenient, because they avoid a source of bias in the interpretation of D-dimers results, are easy to perform and do not require dedicated personnel or instrumentation. Prospective management studies validating the utility of D-dimer measurement in the diagnosis of deep vein thrombosis are urgently needed.

[Unusual case of reappearing biliary ileus in a cholecystectomized patient with late stenosis of ileo-ileal anastomosis]

An unusual case of alternating jejunal obstruction, caused by a former latero-lateral anastomosis stenosis, complicated by two stones into the afferent jejunal tract bottom, is described. The anamnestic data of previous cholecystectomy and operative finding of no one biliary fistula clue, make the authors doubtful about a hypothetic calculi migration: it is likely calculi are formed into the bowel.

[Predictive value of ultrasonography in the study of aortic abdominal aneurysms]

Several authors have collected a great deal of data in the study of abdominal aorta aneurysm through the swift diffusion of ultrasonography in the abdominal diagnostics. The authors illustrate their experience confirming the excellent reliability of ultrasonography in the diagnosis of abdominal aorta aneurysms with respect to other methods of imaging (Angiography, CAT, etc) not with a view to replacing them but as a useful means of screening.

[Invaginating colonic lipoma as a cause of intestinal occlusion]

The authors describe three cases of single invaginating colon lipoma, causing ileus. They review the literature and make some remarks.

[Use of the computer in total parenteral nutrition. Our experience]

The Authors show their method to set up and to plan a T.P.N. for surgical patients. They emphasize how the introduction of the computer in the intensive therapy practice, not only helps the work of the medical corps and the hospital attendants, but it marks and plans again every day the components' dosages on the blood-metabolical alterations, daily checked on the patients. They are here showing their experiences since 1977, appraising in a critical way the directions and the results.

[Lead arsenate as an underestimated cause of polyneuropathy in rural environment: description of two cases]

Two cases of lead arsenate polyneuropathy are described in two farmers from the same rural area; the etiology of the neurologic al disorder was ascertained only after repeated hospital admissions. It was a neuropathy of the radial nerve associated with signs of peripheral impairment of the lower limbs with pains and paresthesias. Abdominal colies, arterial hipertension, anaemia and signs of renal impairment were also present. Specific therapy was undertaken which was soon followed by nearly full recovery. Lead and arsenic toxicology are discussed with particular focusing on the necessity emphasis on commun occupational hazards both in terms of diagnostic and therapeutic procedures. The differential diagnosis is considered between the observed clinical picture and other polyneuropathies of different etiology i.e. dysmetabolic (porphyria) or toxic (insecticides, T.O.C.P., etc).

[Gastric acid secretion in the rat following end-to-side porto-caval and mesenteric-caval anastomosis]

Marked gastric acid hypersecretion by comparison with a control group was noted following the collection of samples 2 hr after ligation of the pylorus in rats 20 days after subjection to total portosystemic deviation or deviation of the mesenteric flow only into the vena cava.

[Free aminoacids and cerebral lipids in the rat following porto-cava anastomosis]

Free aminoacids and cerebral lipids were studied in rats following porto-cava anastomosis with total deviation of the portal flow. No difference in lipid pattern with respect to the controls was noted after 1 month. Changes in free aminoacids, however, were observed, including a significant increase in gamma-aminobutyric acid (GABA) and a significant decrease in glutamic acid. The meaning of these results with respect to the pathogenesis of porto-cava encephalopathy is discussed.

[Encephalopathy in the rat following partial portosystemic anastomosis]

Gamma-aminobutyric acid (GABA) values were determined in 4 groups of Sprague-Dawley rats 45-50 days after end-to-side porto-cava (PC), mesentericosplenic-cava (MSC) and mesenteric-cava (MC) anastomosis, and a false operation (FO) respectively. Values were significantly increased in the anastomosed animals. If, as may be supposed, this finding points to altered cerebral metabolism, its observation in the MSC and MC groups militates against the general view that encephalopathy in the experimental animal only occurs as a result of total deviation of the portal flow.