Dr-MUSIC: An Effective Device for Investigating Multisensory Mechanisms during Development with EEG recordings.

From birth, we are continuously exposed to multisensory stimuli that we learn to select and integrate during development to perceive a coherent world. To date, there are no optimal solutions to investigate how auditory, visual and tactile signals are integrated during EEG recording in infants and children. The present work aims to introduce Dr-MUSIC, a novel multisensory device with EEG-compatible timing and an attractive design for children. It is composed of audio, visual, and tactile stimulators arranged in the form of a couple of chubby dragons that can simultaneously provide selectable uni-, bi-, or tri-modal information. We first validated the system's EEG compatibility in 8 adults by implementing an audio-tactile oddball task during a high-density EEG recording. Then, we replicated the same task in a couple of toddlers to validate the device's usability for young children. The results suggest that the system can be effectively used for setting new experimental protocols to understand the neural basis of multisensory integration in the first years of life.Clinical Relevance- The amusing design and the possibility of changing the stimulation's characteristics (i.e., light, sound, and vibrotactile features) make it attractive in children with and without sensory impairments. Therefore, Dr-MUSIC could be used to investigate multisensory development and related neural correlates in typical and atypical children to design new early rehabilitation protocols.

MultiTab: A Novel Portable Device to Evaluate Multisensory Skills.

To infer spatial-temporal features of an external event we are guided by multisensory cues, with intensive research showing an enhancement in the perception when information coming from different sensory modalities are integrated. In this scenario, the motor system seems to also have an important role in boosting perception. With the present work, we introduce and validate a novel portable technology, named MultiTab, which is able to provide auditory and visual stimulation, as well as to measure the user's manual responses. Our preliminary results indicate that MultiTab reliably induces multisensory integration in a spatial localization task, shown by significantly reduced manual response times in the localization of audiovisual stimuli compared to unisensory stimuliClinical relevance- The current work presents a novel portable device that could contribute to the clinical evaluation of multisensory processing as well as spatial perception. In addition, by promoting and recording manual actions, MultiTab could be especially suitable for the design of rehabilitative protocols using multisensory motor training.

A novel multisensory device for the assessment and rehabilitation of perceptual and attentional competencies.

The present study aims to assess a novel technological device suitable for investigating perceptual and attentional competencies in people with or without sensory impairment. The TechPAD is a cabled system including embedded sensors and actuators to enable visual, auditory, and tactile interactions and a capacitive surface receiving inputs from the user. The system is conceived to create multisensory environments, using multiple units controlled separately and simultaneously. We assessed the device by adapting a spatial attention task comparing performances in different cognitive load conditions (high or low) and stimulation (unimodal, bimodal, or trimodal). 28 sighted adults were asked to monitor both the central and peripheral parts of the device and to tap a target stimulus (either visual, auditory, haptic, or multimodal) as fast as they could. Our results suggest that this new device can provide congruent and incongruent multimodal stimuli and quantitatively measure parameters such as reaction time and accuracy, allowing to investigate perceptual mechanisms in multisensory environments.Clinical Relevance-The TechPad is a reliable tool for the assessment of spatial attention during interactive tasks. its application in clinical trials will pave the way to its role in multisensory rehabilitation.

Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes.

PURPOSE: To evaluate in men with type 2 diabetes the association of cardiometabolic indices [Visceral Adiposity Index (VAI), Triglyceride Glucose Index (TyG), and lipid accumulation product (LAP)] with total testosterone (TT) levels, and their predictive cut-off values in identifying hypogonadism. METHODS: 265 consecutive men aged 40-70 years with type 2 diabetes performed an andrological evaluation; metabolic parameters and TT were determined. Receiver operating characteristic (ROC) curves were used to identify cut-off values of cardiometabolic indices in predicting low testosterone (TT < 12 nmol/l). RESULTS: VAI, TyG, and LAP were negatively associated with TT levels. The prevalence of hypogonadism in men in the fourth quartiles of VAI, TyG, and LAP was ~ 70.0-75.0% compared to ~ 10.0-17.0% in men in the first quartiles (p < 0.001). The sensitivity and specificity of the three cardiometabolic indices in predicting TT < 12 nmol/l were significantly higher concerning BMI, waist circumference, lipid profile and HbA1c. Cut off values of VAI ≥ 3.985, TyG ≥ 4.925, and LAP ≥ 51.645 predict hypogonadism with good sensitivity and specificity. CONCLUSION: This is the first study evaluating the association of VAI, TyG, and LAP with hypogonadism in men with type 2 diabetes. Alterations in these indices should direct the patients to andrological evaluation.

Waves of Change: Brain Sensitivity to Differential, not Absolute, Stimulus Intensity is Conserved Across Humans and Rats.

Living in rapidly changing environments has shaped the mammalian brain toward high sensitivity to abrupt and intense sensory events-often signaling threats or affordances requiring swift reactions. Unsurprisingly, such events elicit a widespread electrocortical response (the vertex potential, VP), likely related to the preparation of appropriate behavioral reactions. Although the VP magnitude is largely determined by stimulus intensity, the relative contribution of the differential and absolute components of intensity remains unknown. Here, we dissociated the effects of these two components. We systematically varied the size of abrupt intensity increases embedded within continuous stimulation at different absolute intensities, while recording brain activity in humans (with scalp electroencephalography) and rats (with epidural electrocorticography). We obtained three main results. 1) VP magnitude largely depends on differential, and not absolute, stimulus intensity. This result held true, 2) for both auditory and somatosensory stimuli, indicating that sensitivity to differential intensity is supramodal, and 3) in both humans and rats, suggesting that sensitivity to abrupt intensity differentials is phylogenetically well-conserved. Altogether, the current results show that these large electrocortical responses are most sensitive to the detection of sensory changes that more likely signal the sudden appearance of novel objects or events in the environment.

A Novel Wearable and Wireless Device to Investigate Perception in Interactive Scenarios.

The aim of the present work is to introduce a novel wearable device suitable to be used to investigate perception in interactive tasks, on individuals with and without sensory disabilities. The system is composed by small units embedded with sensors and actuators that allows emitting different kind of stimuli (light, haptic, sound) and to record the user response, thanks to a capacitive sensor. We validated the system by implementing an interception task in three different sensory modalities: visual, tactile and auditory. Six subjects with normal sight were asked to tap either a static or a moving stimulus generated by 6 units placed on their forearm. Results suggest that the system can effectively provide new insights in characterizing how perception principles vary when perceptual judgement occurs through different senses. This confirms the device potential in contributing to the design of rehabilitation protocols rooted on neuroscientific findings, for people with sensory impairments.

Simultaneous measurement of peritoneal glucose and free water osmotic conductances.

Ultrafiltration (UF) failure is one of the most important causes of long-term peritoneal dialysis (PD) failure in patients. Osmotic forces acting across small and ultra-small pores generate a UF with solutes through the small pore and free water transport (FWT) through the ultra-small pore. The ability of glucose to exert an osmotic pressure sufficient to cause UF is the so-called 'osmotic conductance to glucose' (OCG) of the peritoneal membrane. Our study proposes a simple method to determine both the OCG and FWT. In 50 patients on PD, a Double Mini-Peritoneal Equilibration Test (Double Mini-PET), consisting of two Mini-PET, was performed consecutively. A solution of 1.36% glucose was used for the first test, whereas a solution of 3.86% glucose was used for the second test. The sodium removal values and the differences in UF between the two tests were used to calculate FWT and the OCG. Patients with UF failure showed significant reductions not only in the OCG and the FWT but also of UF of small pores. The Double Mini-PET is simple, fast, and could become useful to evaluate patients on PD in everyday clinical practice.

Peritoneal transport assessment by peritoneal equilibration test with 3.86% glucose: a long-term prospective evaluation.

The peritoneal equilibration test (PET) with 3.86% glucose concentration (3.86%-PET) has been suggested to be more useful than the standard 2.27%-PET in peritoneal dialysis (PD), but no longitudinal data for 3.86%-PET are currently available. A total of 242 3.86%-PETs were performed in 95 incident PD patients, who underwent the first test during the first year of treatment and then once a year. The classical parameters of peritoneal transport, such as peritoneal ultrafiltration (UF), D/D(0), and D/P(Creat), were analyzed. In addition, the absolute dip of dialysate sodium concentration (DeltaD(Na)), as an expression of sodium sieving, was studied. D/D(0) was stable, and a progressive decrease in UF was observed after the second PET, whereas D/P(Creat) firstly increased and then stabilized. DeltaD(Na) was the only parameter showing a progressive decrease over time. On univariate analysis, D/D(0) and DeltaD(Na) were found to be significantly associated with the risk of developing UF failure (risk ratio (RR) 0.987 (0.973-0.999), P=0.04, and RR 0.768 (0.624-0.933), P=0.007, respectively), but on multivariate analysis only DeltaD(Na) showed an independent association with the risk of developing UF failure (RR 0.797 (0.649-0.965), P=0.020). UF, D/D(0), and D/P(Creat) changed only in those patients developing UF failure, reflecting increased membrane permeability, whereas DeltaD(Na) significantly decreased in all patients. The 3.86%-PET allows a more complete study of peritoneal membrane transport than the standard 2.27%-PET. DeltaD(Na) shows a constant and significant reduction over time and is the only factor independently predicting the risk of developing UF failure in PD patients.

Acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections in community-acquired pneumonia and exacerbations of COPD or asthma: therapeutic considerations.

Rates of acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections were determined in 115 adults hospitalized for community-acquired pneumonia (CAP), purulent exacerbations of COPD and acute exacerbations of bronchial asthma, by means of serology and molecular methods. Results were compared with those obtained in a matched control group. Common respiratory pathogens were isolated by cultures in 22.5% and 22.2% of CAP and exacerbated COPD patients, respectively. Cultures from exacerbated asthma patients were always negative. Serological and molecular evidence of current C. pneumoniae infection was obtained in 10.0%, 8.9% and 3.3% of CAP, COPD and asthma cases. The corresponding rates of acute M. pneumoniae infection were 17.5%, 6.7% and 3.3%, respectively. Finally, no difference was found between typical and atypical pathogen rates. These findings highlight the importance of taking into account C. pneumoniae and M. pneumoniae infections in guiding the choice of empirical antibacterial treatment for CAP and purulent exacerbations of COPD.

How to determine ionic dialysance for the online assessment of delivered dialysis dose.

BACKGROUND: Ionic dialysance may be equivalent to blood-water urea clearance corrected for recirculation (effective urea clearance); however, this is controversial. The aims of our study were (1) to verify in vivo whether the value of ionic dialysance is affected by the method of determination, given the effect of cardiopulmonary recirculation on inlet plasma water conductivity when the inlet dialysate conductivity is changed; and (2) to define the operative modalities for determining ionic dialysance to obtain an adequate estimate of effective urea clearance. METHODS: Thirty-three hemodialysis patients were studied during 186 dialysis sessions with low-flux polysulfone dialyzers using a modified Fresenius Medical Care 4008 B machine equipped with meters to measure inlet and outlet dialysate conductivities. This machine varied inlet dialysate conductivity (Cdi) according to the following pattern: starting from baseline (step 0), Cdi was increased by 8% (step 1). After Cdi had reached the target value, which took 8 to 10 minutes, it was lowered to 8% below the baseline value (step 2). After 8 to 10 minutes, when Cdi had reached the new target, it was returned to its starting value (step 3). Four values of conventional ionic dialysance (using the standard formula) and actual ionic dialysance (taking into account cardiopulmonary recirculation) were obtained for each cycle and were compared among them and with effective urea clearance (Kde). RESULTS: Mean conventional dialysance values at steps 0 to 2 and 2 to 3 (190 and 189 mL/min) were similar and higher than those at steps 0 to 1 and 1 to 2 (171 and 181 mL/min). Mean conventional ionic dialysance values underestimated Kde, particularly at steps 0 to 1 (-22.2 mL/min, P < 0.001) and 1 to 2 (-12.6 mL/min, P < 0.001). The actual dialysance values underestimated Kde by no more than 4.3 mL/min (P < 0.001). In steps 0 to 1 and 1 to 2, the underestimate of Kde by conventional dialysance increased at higher values of Kde, but this relationship did not exist when considering actual dialysance. CONCLUSIONS: The value of ionic dialysance is affected by the method of determination, given the effect of cardiopulmonary recirculation on inlet plasma water conductivity when inlet dialysate conductivity is changed. As a consequence, to provide a correct and direct estimate of effective urea clearance, ionic dialysance must be determined by changing inlet dialysate conductivity in such a way as to keep inlet plasma water conductivity constant by means of two symmetrical high and low dialysate conductivity steps.

Spurious estimations of sodium removal during CAPD when [Na](+) is measured by Na electrode methodology.

BACKGROUND: The aim of this study was to investigate the effect of pH and glucose concentration on sodium removal and the dialysate and plasma sodium ratio (D/PNa) as measured by means of a flame photometer (NaF) or direct ion-selective electrode (NaE) in continuous ambulatory peritoneal dialysis (CAPD). METHODS: In vitro, glucose concentration, pH, NaF, and NaE were measured in fresh peritoneal dialysis solutions (PDSs) before and after the addition of glucose or KOH. In vivo, 66 four-hour peritoneal equilibration tests were performed in 35 patients on CAPD using a low pH PDS with a glucose concentration of 3.86%. RESULTS: In vitro, NaF and NaE were significantly influenced by the glucose concentration and pH of the PDS. In vivo, in fresh PDS, there was a significant difference between the NaF and NaE results; the respective median values were 132.1 (interquartile range 129.3 to 137.5) versus 138.0 (134.4 to 141.5) mmol/L (P < 0.0001). The D/PNa ratio calculated by NaE was significantly lower than that calculated by NaF (0.88 +/- 0.03 vs. 0.91 +/- 0.04 and 0. 90 +/- 0.03 vs. 0.94 +/- 0.04 at 60 and 240 min, respectively, P < 0.0001), whereas there was no significant difference between the NaE and NaF values after correction for plasma water and a Donnan factor of 0.96 (0.88 +/- 0.03 vs. 0.88 +/- 0.04 and 0.90 +/- 0.03 vs. 0.91 +/- 0.04, P < 0.3473). Sodium removal was significantly lower when calculated as NaE than when calculated as NaF (43.9 +/- 32.7 vs. 61.0 +/- 32.2 mmol, P < 0.0001). CONCLUSIONS: The fresh PDS sodium concentration can be corrected using a glucose concentration-related factor. The D/PNa ratio calculated as NaE or NaF is not different after correction for plasma water and a Donnan factor of 0.96. Sodium removal must be measured by means of NaF rather than NaE. This could have an important clinical impact.

Recombinant hepatitis B vaccine use in chronic hemodialysis patients. Long-term evaluation and cost-effectiveness analysis.

The prevalence of hepatitis B virus (HBV) infection in our unit was 45% (86/190); there were 77 (40.5%) and 9 (4.7%) patients with previous and persistent HBV infection, respectively. Recombinant hepatitis B vaccine was given to 118 chronic HD patients with a regimen of 3 double doses administered intramuscularly at 0, 1 and 2 months, obtaining a seroprotection rate of 67% (79/118), 57% (45/79) being high responders. At month 24, 78% (40/51) maintained protective levels of anti-HBs, 45% (18/40) of them being high responders. There was a statistically significant difference between responder and non-responder patients with regard to nutritional parameters such as serum total proteins and mean levels of transferrinemia. The number of diabetic patients was significantly increased in the nonresponder group. Patients with persistent antibodies ('persistent responders') were younger and had a shorter duration of HD treatment compared to those responders who rapidly lost anti-HBs ('transient responders'). Serological positivity for antibodies against hepatitis B core antigen significantly facilitates the decrease of anti-HBs antibodies over time. We detected seven episodes of HBV infection among HD patients at our unit before the beginning of the vaccination program. On the contrary, there were no episodes of HBV infection among responder vaccinees during the 24-month follow-up period. After the initial cost of vaccination, a savings of US$ 3,272 per year was realized by the elimination of frequent serologic screening of vaccine responders.

Incidence of seroconversion for hepatitis C virus in chronic haemodialysis patients: a prospective study.

We conducted a prospective study in HD patients of our unit to evaluate the incidence of seroconversion for HCV in this high-risk group. Two hundred and thirty-five patients were observed during the average follow-up of 29.4 months: 183 were seronegative and 52 seropositive for anti-HCV antibodies at the start of the study. During the observation period two of 183 patients developed anti-HCV antibodies late in the study, while the other 181 patients remained seronegative throughout the observation period; anti-HCV antibodies persisted through the follow-up in the 52 HCV-positive patients at the beginning of the study. Our results showed a very low incidence of HCV seropositivity (0.44% per year) after implementation of our operative protocol including 'universal precautions' and other infection control procedures. Once infected, there is no disappearance rate of anti-HCV. The 4-RIBA results did not change during the follow-up period. Prevalence of HCV RNA by PCR technique was 41% (22 of 54) among anti-HCV-positive patients. Future investigations are warranted to clarify the exact route of transmission of HCV among HD patients and to reduce the rate of HCV transmission in this clinical setting.

[Application of the urea kinetic model to evaluate the adequacy of hemodialysis]. / Applicazione del modello cinetico dell'urea per la valutazione dell'adeguatezza emodialitica.

The evaluation of dialysis adequacy still remains an unsolved problem. The mathematical model proposed by Gotch and Sargent is now currently used to quantify the dialysis need in urysiemic patients. In this study we evaluated the reliability of this kinetic model in 9 patients admitted to high efficiency hemodialysis. Only 5 out of the 9 patients showed a Protein Catabolic Rate normalized (PCRn) within 0.8-1.6 gr/kg/die a range considered optimal for hemodialysis patients. The other patients showed a PCRn higher than 1.6 gr/kg/die and were therefore excluded from this study. The volume of urea distribution (V) measurements deduced from urea kinetic model showed a great variability with a very high mean value (more than 78.3 +/- 6.3%). We therefore suggest that for the evaluation of dialysis adequacy in patients submitted to high efficiency hemodialysis an arbitrary value of urea distribution equal to 60% of the body weight should be used. However further clinical and biochemical evaluations are needed to confirm whether this model might be considered as a reliable parameter of dialysis adequacy.

Haemodialysis efficiency after long-term treatment with recombinant human erythropoietin.

In 11 chronic haemodialysis patients we investigated whether the increase in haematocrit during recombinant human erythropoietin (rHuEPO) treatment might alter the long-term efficiency of haemodialysis. After correction of anaemia with rHuEPO (mean Ht 35 +/- 2% vs 19 +/- 2% at baseline) (p 0.001), mean predialysis creatinine and urea did not change, while predialysis phosphate (1.77 +/- 0.38 vs 1.51 +/- 0.29 mmol/l) were significantly increased (p 0.01). In six of the 11 rHuEPO treated patients a post- versus pre-dialysis haemoconcentration (haematocrit 44% vs 35%) not attributable to different ultrafiltration regimes, was observed. In these 6 patients mean predialysis phosphate, creatinine and urea tended to be higher, but not significantly, in comparison to he remaining 5 patients who did not haemoconcentrate. Dialyser clearances and total extractions for urea, creatinine, phosphate and inulin were compared to those of 11 matched haemodialysis patients with anaemia. No differences were observed either for small and middle molecule clearances or their extractions between rHuEPO and anaemic patients. In conclusion, dialysis efficiency is not affected if haematocrit values are kept about 35%.