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Willacker L, Raiser TM, Bassi M, Bender A, Comanducci A, Rosanova M, Sobel N, Arzi A, Belloli L, Casarotto S, Colombo M, Derchi CC, Fló Rama E, Grill E, Hohl M, Kuehlmeyer K, Manasova D, Rosenfelder MJ, Valota C, Sitt JD. PerBrain: a multimodal approach to personalized tracking of evolving state-of-consciousness in brain-injured patients: protocol of an international, multicentric, observational study. BMC Neurol 2022; 22:468. [PMID: 36494776 PMCID: PMC9733076 DOI: 10.1186/s12883-022-02958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Disorders of consciousness (DoC) are severe neurological conditions in which consciousness is impaired to various degrees. They are caused by injury or malfunction of neural systems regulating arousal and awareness. Over the last decades, major efforts in improving and individualizing diagnostic and prognostic accuracy for patients affected by DoC have been made, mainly focusing on introducing multimodal assessments to complement behavioral examination. The present EU-funded multicentric research project "PerBrain" is aimed at developing an individualized diagnostic hierarchical pathway guided by both behavior and multimodal neurodiagnostics for DoC patients. METHODS In this project, each enrolled patient undergoes repetitive behavioral, clinical, and neurodiagnostic assessments according to a patient-tailored multi-layer workflow. Multimodal diagnostic acquisitions using state-of-the-art techniques at different stages of the patients' clinical evolution are performed. The techniques applied comprise well-established behavioral scales, innovative neurophysiological techniques (such as quantitative electroencephalography and transcranial magnetic stimulation combined with electroencephalography), structural and resting-state functional magnetic resonance imaging, and measurements of physiological activity (i.e. nasal airflow respiration). In addition, the well-being and treatment decision attitudes of patients' informal caregivers (primarily family members) are investigated. Patient and caregiver assessments are performed at multiple time points within one year after acquired brain injury, starting at the acute disease phase. DISCUSSION Accurate classification and outcome prediction of DoC are of crucial importance for affected patients as well as their caregivers, as individual rehabilitation strategies and treatment decisions are critically dependent on the latter. The PerBrain project aims at optimizing individual DoC diagnosis and accuracy of outcome prediction by integrating data from the suggested multimodal examination methods into a personalized hierarchical diagnosis and prognosis procedure. Using the parallel tracking of both patients' neurological status and their caregivers' mental situation, well-being, and treatment decision attitudes from the acute to the chronic phase of the disease and across different countries, this project aims at significantly contributing to the current clinical routine of DoC patients and their family members. TRIAL REGISTRATION ClinicalTrials.gov, NCT04798456 . Registered 15 March 2021 - Retrospectively registered.
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Affiliation(s)
- L. Willacker
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
| | - T. M. Raiser
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
| | - M. Bassi
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy
| | - A. Bender
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany ,grid.478057.90000 0004 0381 347XTherapiezentrum Burgau, Hospital for Neurological Rehabilitation, Burgau, Germany
| | - A. Comanducci
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - M. Rosanova
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy
| | - N. Sobel
- grid.13992.300000 0004 0604 7563Department of Brain Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - A. Arzi
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France ,grid.9619.70000 0004 1937 0538Department of Medical Neurobiology and Department of Cognitive and Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - L. Belloli
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France ,grid.7345.50000 0001 0056 1981Laboratorio de Inteligencia Artificial Aplicada, Instituto de Ciencias de la Computación, Universidad de Buenos Aires, Buenos Aires, Argentina ,grid.423606.50000 0001 1945 2152Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ministry of Science, Technology and Innovation, Buenos Aires, Argentina
| | - S. Casarotto
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy ,grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - M. Colombo
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy
| | - C. C. Derchi
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - E. Fló Rama
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France
| | - E. Grill
- grid.5252.00000 0004 1936 973XInstitute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany ,grid.411095.80000 0004 0477 2585German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany
| | - M. Hohl
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
| | - K. Kuehlmeyer
- grid.5252.00000 0004 1936 973XInstitute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - D. Manasova
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France
| | - M. J. Rosenfelder
- grid.478057.90000 0004 0381 347XTherapiezentrum Burgau, Hospital for Neurological Rehabilitation, Burgau, Germany ,grid.6582.90000 0004 1936 9748Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - C. Valota
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy ,grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - J. D. Sitt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France
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Russo S, Sarasso S, Puglisi G, Dal Palù D, Pigorini A, Casarotto S, D’Ambrosio S, Astolfi A, Massimini M, Rosanova M, Fecchio M. TAAC - TMS Adaptable Auditory Control: a universal tool to mask TMS click. J Neurosci Methods 2022; 370:109491. [DOI: 10.1016/j.jneumeth.2022.109491] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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Comanducci A, Boly M, Claassen J, De Lucia M, Gibson RM, Juan E, Laureys S, Naccache L, Owen AM, Rosanova M, Rossetti AO, Schnakers C, Sitt JD, Schiff ND, Massimini M. Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group. Clin Neurophysiol 2020; 131:2736-2765. [PMID: 32917521 DOI: 10.1016/j.clinph.2020.07.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022]
Abstract
The analysis of spontaneous EEG activity and evoked potentialsis a cornerstone of the instrumental evaluation of patients with disorders of consciousness (DoC). Thepast few years have witnessed an unprecedented surge in EEG-related research applied to the prediction and detection of recovery of consciousness after severe brain injury,opening up the prospect that new concepts and tools may be available at the bedside. This paper provides a comprehensive, critical overview of bothconsolidated and investigational electrophysiological techniquesfor the prognostic and diagnostic assessment of DoC.We describe conventional clinical EEG approaches, then focus on evoked and event-related potentials, and finally we analyze the potential of novel research findings. In doing so, we (i) draw a distinction between acute, prolonged and chronic phases of DoC, (ii) attempt to relate both clinical and research findings to the underlying neuronal processes and (iii) discuss technical and conceptual caveats.The primary aim of this narrative review is to bridge the gap between standard and emerging electrophysiological measures for the detection and prediction of recovery of consciousness. The ultimate scope is to provide a reference and common ground for academic researchers active in the field of neurophysiology and clinicians engaged in intensive care unit and rehabilitation.
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Affiliation(s)
- A Comanducci
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Boly
- Department of Neurology and Department of Psychiatry, University of Wisconsin, Madison, USA; Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA
| | - J Claassen
- Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - M De Lucia
- Laboratoire de Recherche en Neuroimagerie, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - R M Gibson
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - E Juan
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA; Amsterdam Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - S Laureys
- Coma Science Group, Centre du Cerveau, GIGA-Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - L Naccache
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Sorbonne Université, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - A M Owen
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - M Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - A O Rossetti
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - J D Sitt
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - N D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - M Massimini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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Rossini P, Di Iorio R, Bentivoglio M, Bertini G, Ferreri F, Gerloff C, Ilmoniemi R, Miraglia F, Nitsche M, Pestilli F, Rosanova M, Shirota Y, Tesoriero C, Ugawa Y, Vecchio F, Ziemann U, Hallett M. Methods for analysis of brain connectivity: An IFCN-sponsored review. Clin Neurophysiol 2019; 130:1833-1858. [DOI: 10.1016/j.clinph.2019.06.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 05/08/2019] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
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Parmigiani S, Casarotto S, Fecchio M, Rosanova M. How to collect genuine TEPs: a Graphical User Interface to control data quality in real-time. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mattavelli G, Pisoni A, Lauro LR, Marino B, Bonomi M, Rosanova M, Papagno C. TMS-EEG approach unveils brain mechanisms underlying conscious and unconscious face perception. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rosanova M, Fecchio M, Casarotto S, Sarasso S, Casali AG, Pigorini A, Comanducci A, Seregni F, Devalle G, Citerio G, Bodart O, Boly M, Gosseries O, Laureys S, Massimini M. Sleep-like cortical OFF-periods disrupt causality and complexity in the brain of unresponsive wakefulness syndrome patients. Nat Commun 2018; 9:4427. [PMID: 30356042 PMCID: PMC6200777 DOI: 10.1038/s41467-018-06871-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Unresponsive wakefulness syndrome (UWS) patients may retain intact portions of the thalamocortical system that are spontaneously active and reactive to sensory stimuli but fail to engage in complex causal interactions, resulting in loss of consciousness. Here, we show that loss of brain complexity after severe injuries is due to a pathological tendency of cortical circuits to fall into silence (OFF-period) upon receiving an input, a behavior typically observed during sleep. Spectral and phase domain analysis of EEG responses to transcranial magnetic stimulation reveals the occurrence of OFF-periods in the cortex of UWS patients (N = 16); these events never occur in healthy awake individuals (N = 20) but are similar to those detected in healthy sleeping subjects (N = 8). Crucially, OFF-periods impair local causal interactions, and prevent the build-up of global complexity in UWS. Our findings link potentially reversible local events to global brain dynamics that are relevant for pathological loss and recovery of consciousness. Many brain-injured patients retain large cortical islands that are intact, active and reactive but blocked in a state of low complexity, leading to unconsciousness. Here, the authors show that this loss of complexity is due to the pathological engagement of sleep-like neuronal mechanisms.
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Affiliation(s)
- M Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy.,Fondazione Europea per la Ricerca Biomedica Onlus, Milan, 20063, Italy.,Neurointensive Care Unit, ASTT Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy
| | - M Fecchio
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - S Casarotto
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy.,IRCCS Fondazione Don Gnocchi, Milan, 20149, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - A G Casali
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, Sao Jose dos Campos, 12231-280, Brazil
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - A Comanducci
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - F Seregni
- Department of Paediatrics, Cambridge University Hospital NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Devalle
- IRCCS Fondazione Don Gnocchi, Milan, 20149, Italy
| | - G Citerio
- Scuola di Medicina e Chirurgia, University of Milan Bicocca, Milan, 20126, Italy
| | - O Bodart
- GIGA-consciousness, Coma Science Group, University and University Hospital of Liège, Liège, 4000, Belgium
| | - M Boly
- Department of Neurology, University of Wisconsin, Madison, WI, 53705, USA.,Department of Psychiatry, University of Wisconsin, Madison, WI, 53719, USA
| | - O Gosseries
- GIGA-consciousness, Coma Science Group, University and University Hospital of Liège, Liège, 4000, Belgium
| | - S Laureys
- GIGA-consciousness, Coma Science Group, University and University Hospital of Liège, Liège, 4000, Belgium
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy. .,IRCCS Fondazione Don Gnocchi, Milan, 20149, Italy.
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Casarotto S, Comanducci A, Casali A, Rosanova M, Massimini M. A non-invasive perturbation approach to disorders of consciousness. Int J Psychophysiol 2018. [DOI: 10.1016/j.ijpsycho.2018.07.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sanders RD, Banks MI, Darracq M, Moran R, Sleigh J, Gosseries O, Bonhomme V, Brichant JF, Rosanova M, Raz A, Tononi G, Massimini M, Laureys S, Boly M. Propofol-induced unresponsiveness is associated with impaired feedforward connectivity in cortical hierarchy. Br J Anaesth 2018; 121:1084-1096. [PMID: 30336853 DOI: 10.1016/j.bja.2018.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Impaired consciousness has been associated with impaired cortical signal propagation after transcranial magnetic stimulation (TMS). We hypothesised that the reduced current propagation under propofol-induced unresponsiveness is associated with changes in both feedforward and feedback connectivity across the cortical hierarchy. METHODS Eight subjects underwent left occipital TMS coupled with high-density EEG recordings during wakefulness and propofol-induced unconsciousness. Spectral analysis was applied to responses recorded from sensors overlying six hierarchical cortical sources involved in visual processing. Dynamic causal modelling (DCM) of induced time-frequency responses and evoked response potentials were used to investigate propofol's effects on connectivity between regions. RESULTS Sensor space analysis demonstrated that propofol reduced both induced and evoked power after TMS in occipital, parietal, and frontal electrodes. Bayesian model selection supported a DCM with hierarchical feedforward and feedback connections. DCM of induced EEG responses revealed that the primary effect of propofol was impaired feedforward responses in cross-frequency theta/alpha-gamma coupling and within frequency theta coupling (F contrast, family-wise error corrected P<0.05). An exploratory analysis (thresholded at uncorrected P<0.001) also suggested that propofol impaired feedforward and feedback beta band coupling. Post hoc analyses showed impairments in all feedforward connections and one feedback connection from parietal to occipital cortex. DCM of the evoked response potential showed impaired feedforward connectivity between left-sided occipital and parietal cortex (T contrast P=0.004, Bonferroni corrected). CONCLUSIONS Propofol-induced loss of consciousness is associated with impaired hierarchical feedforward connectivity assessed by EEG after occipital TMS.
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Affiliation(s)
- R D Sanders
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
| | - M I Banks
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - M Darracq
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - R Moran
- Faculty of Engineering, University of Bristol, Bristol, UK
| | - J Sleigh
- Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
| | - O Gosseries
- Coma Science Group, GIGA-consciousness, University of Liège, Liège, Belgium
| | - V Bonhomme
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anestheisa and ICM, CHU Liège, Liège, Belgium; University Department of Anesthesia and ICM, CHR Citadelle, Liège, Belgium
| | - J F Brichant
- Department of Anestheisa and ICM, CHU Liège, Liège, Belgium
| | - M Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - A Raz
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; Rambam Healthcare Campus, Haifa, Israel
| | - G Tononi
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - M Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - S Laureys
- Coma Science Group, GIGA-consciousness, University of Liège, Liège, Belgium; Department of Neurology, CHU Liège, Liège, Belgium
| | - M Boly
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA; Department of Neurology, University of Wisconsin, Madison, WI, USA
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Rosanova M, Brizuela M, Carnovale S, Caracciolo B, Caravallo N, Gomez S, Sarkis C. Candidemia in children: Epidemiology and risk factors for mortality. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rosanova M, De Falco S, Attademo L, Fiore G, De Stefano A, Maddalena C, De Placido S, Carlomagno C. Multiple treatment lines and prognosis for metastatic colorectal (mCRC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pisoni A, Mattavelli G, Vergallito A, Rosanova M, Fecchio M, Romero Lauro L. P087 Impact of coil waveform and orientation on TMS evoked potentials. A TMS-EEG study. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bodart O, Amico E, Wannez S, Gomez F, Casarotto S, Rosanova M, Casali A, Gosseries O, Laureys S, Massimini M, Martens G. Global structural and effective connectivity in patients with chronic disorders of consciousness. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Romero Lauro L, Pisoni A, Rosanova M, Mattavelli G, Bolognini N, Vallar G. Tracking the effects of tDCS on cortical plasticity by means of TMS-EEG. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fecchio M, Casarotto S, Trimarchi P, Casali A, Landi C, Pigorini A, Saia L, Napolitani M, Sarasso S, Rosanova M, Devalle G, Massimini M. 4. Reliability of the perturbational complexity index in discriminating chronic patients with disorders of consciousness. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Seregni F, Fecchio M, Rosanova M, Sarasso S, Pigorini A, Napolitani M, Casarotto S, Gosseries O, Massimini M. 100. Cortical bistability in pathological loss of consciousness after brain injury: A TMS/EEG study. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Casali AG, Gosseries O, Rosanova M, Boly M, Sarasso S, Casali KR, Casarotto S, Bruno MA, Laureys S, Tononi G, Massimini M. A Theoretically Based Index of Consciousness Independent of Sensory Processing and Behavior. Sci Transl Med 2013; 5:198ra105. [DOI: 10.1126/scitranslmed.3006294] [Citation(s) in RCA: 645] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Casarotto S, Casali AG, Rosanova M, Mariotti M, Massimini M. A data-driven procedure to characterize the electrophysiology of any cortical area using TMS/hd-EEG. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
AIM To describe two children with hypertrophic osteoarthropathy associated with cholestatic hepatic disease. Both patients suffered from chronic progressive cholestatic liver disease and developed digital clubbing, polyarthritis and periosteal reaction. In one of them, clinical and radiological features normalized after liver transplant. CONCLUSION Hepatic hypertrophic osteoarthropathy is a rare disabling condition that responds poorly to conservative management, while liver transplantation appears to be the only effective therapeutic intervention.
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Affiliation(s)
- M Katsicas
- Department of Immunology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
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Paganini H, Bologna R, Debbag R, Casimir L, Gomez S, Rosanova M, Scopinaro M. Fever and neutropenia in children with cancer in one pediatric hospital in Argentina. Pediatr Hematol Oncol 1998; 15:405-13. [PMID: 9783306 DOI: 10.3109/08880019809016568] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors retrospectively analyzed 863 episodes of neutropenia and fever in 635 children with cancer or hematological disease hospitalized between October 1988 and November 1994. The most frequent underlying diseases were solid tumors (45%) and acute lymphoblastic leukemia (29%). Clinical site of infection could be determined in 454 (53%) episodes. Bacteremia was documented in 114 (13%) cases. Gram-positive cocci were the microorganisms most frequently isolated (47% of the cases). Noninfectious complications could be determined in 140 (16%) episodes, and were mainly severe bleeding and metabolic impairment. The episodes were divided in two groups for comparative evaluation: group A, 404 episodes, study period 1988-1991, and group B, 459 episodes, 1992-1994. According to the results, more patients in group A than group B were younger than 1 year old and had profound neutropenia; fewer patients in group A than group B had an endovascular catheter, a higher frequency of manifest clinical site of infection at admission, and a prevalence of isolation of gram-negative bacilli. A higher percentage of patients in group B had neutropenia of more than 14 days, gram-positive cocci in culture, and lower mortality. Multivariate analysis by logistic regression in 340 patients revealed that the presence of a severe noninfectious complication, severe neutropenia, and positive blood culture correlated with high mortality rate (p < or = 0.001).
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Affiliation(s)
- H Paganini
- Department of Infectious Diseases, Hospital de Pediatría, Buenos Aires, Argentina.
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