Association between esophageal motor disorders and pulmonary involvement in patients affected by systemic sclerosis: a retrospective study.

Systemic sclerosis (SSc) is a rare autoimmune disease of the connective tissue that can affect multiple organs. The esophagus is the most affected gastrointestinal tract, while interstitial lung disease (ILD) is a main feature associated with SSc. The aim of the present study was to evaluate the association and prognostic implication between motor esophageal disorders and pulmonary involvement in SSc patients. We retrospectively assessed patients with SSc who underwent both the HRM with the new Chicago Classification 4.0 and pulmonary evaluation comprehensive of function tests and high-resolution computer tomography (HrCT) with the use of Warrick score. A total score ≥ 7 was considered predictive of ILD, while a score ≥ 10 in a HrCT acquired prospectively from baseline evaluation was considered to establish significant interstitial involvement. Forty-two patients were included. We found a score ≥ 7 in 11 patients with aperistalsis, in 6 subjects with IEM and in 6 patients with a normal manometry. Otherwise, a score < 7 was observed in 3 patients with aperistalsis, and in 2 and 14 patients with IEM and with a normal contractility, respectively. Higher scores were observed in subjects with absent contractility or ineffective esophageal motility than subjects with normal motility, indeed DCI and HrCT score were inversely correlated in linear and logarithmic regression analysis. Prospectively, lower baseline LESP and greater HrCT scores at follow-up evaluation were significantly correlated. This study shows an association between motor esophageal disorder and pulmonary involvement in SSc patients: more severe is the esophageal involvement, more critical is the pulmonary disease.

Endoscopic fluorescent lymphography for gastric cancer.

Lymphography by radioisotope or dye is a well-known technique for visualizing the lymphatic drainage pattern in a neoplastic lesion and it is in use in gastric cancer. Indocyanine green (ICG) more recently has been validated in fluorescent lymphography studies and is under evaluation as a novel tracer agent in gastric cancer. The amount and dilution of ICG injected as well as the site and the time of the injection are not standardized. In our unit, endoscopic submucosal injections of ICG are made as 0.5 mg in 0.5 mL at four peritumoral sites the day before surgery (for a total of 2.0 mg in 2.0 mL). Detection instruments for ICG fluorescence are evolving. Near-infrared systems integrated into laparoscopic or robotic instruments (near-infrared fluorescence imaging) have shown the most promising results. ICG fluorescence recognizes the node that receives lymphatic flow directly from a primary tumor. This is defined as the sentinel lymph node, and it has a high predictive negative value at the cT1 stage, able to reduce the extent of gastrectomy and lymph node dissection. ICG also enhances the number of lymph nodes detected during extended lymphadenectomy for advanced gastric cancer. Nevertheless, the practical effects of ICG use in a single patient are not yet clear. Standardization of the technique and further studies are needed before fluorescent lymphography can be used extensively worldwide. Until then, current guidelines recommend an extensive lymphadenectomy as the standard approach for gastric cancer with suspected metastasis.

Is empathy necessary to comprehend the emotional faces? The empathic effect on attentional mechanisms (eye movements), cortical correlates (N200 event-related potentials) and facial behaviour (electromyography) in face processing.

The present research explored the effect of social empathy on processing emotional facial expressions. Previous evidence suggested a close relationship between emotional empathy and both the ability to detect facial emotions and the attentional mechanisms involved. A multi-measure approach was adopted: we investigated the association between trait empathy (Balanced Emotional Empathy Scale) and individuals' performance (response times; RTs), attentional mechanisms (eye movements; number and duration of fixations), correlates of cortical activation (event-related potential (ERP) N200 component), and facial responsiveness (facial zygomatic and corrugator activity). Trait empathy was found to affect face detection performance (reduced RTs), attentional processes (more scanning eye movements in specific areas of interest), ERP salience effect (increased N200 amplitude), and electromyographic activity (more facial responses). A second important result was the demonstration of strong, direct correlations among these measures. We suggest that empathy may function as a social facilitator of the processes underlying the detection of facial emotion, and a general "facial response effect" is proposed to explain these results. We assumed that empathy influences cognitive and the facial responsiveness, such that empathic individuals are more skilful in processing facial emotion.

Reward Sensitivity (Behavioral Activation System), Cognitive, and Metacognitive Control in Gambling Behavior: Evidences From Behavioral, Feedback-Related Negativity, and P300 Effect.

The present research explored the main factors able to influence the subjects' choices in the case of decisions and distinguish between high- and low-risk decisions. Behavioral responses (Iowa Gambling Task [IGT]), meta-cognitive strategy, and event-related potential (feedback-related negativity [FRN] and P300) effects were used as predictive markers of gambling behavior. Behavioral activation system (BAS)-reward measure was applied to distinguish between high-BAS and low-BAS. It was found that higher-BAS opted in favor of the immediate reward, with a concomitant dysfunctional metacognition of their strategy. Finally, a consistent "reward bias" affected the high-BAS performance reducing the P300 and FRN in response to unexpected (loss) events. The cortical localization (sLORETA) of ERPs showed the contribution by distinct anterior and posterior areas.

Left Hemispheric Imbalance and Reward Mechanisms Affect Gambling Behavior: The Contribution of the Metacognition and Cortical Brain Oscillations.

The present research used the Iowa Gambling Task to test the effect of the reward-sensitivity Behavioral Activation System-Reward (BAS-Reward) construct on the ability to distinguish between high- and low-risk decisions. To elucidate the individual differences that influence the decisional processes, making the strategies more or less advantageous, we considered the impact of the BAS motivational system and the frontal left and right cortical activity on subjects' decisions. More specifically, the lateralization effect, which is related to the increased activation of the left (BAS-Reward-related) hemisphere, was explored by using frequency band analysis. Specifically, behavioral responses (gain/loss options), metacognition, and delta, theta, alpha, and beta band modulation (asymmetry index) were considered. Thirty subjects were divided into high-BAS and low-BAS groups. In comparison with low-BAS, the high-BAS group showed an increased tendency to opt in favor of the immediate reward (losing strategy) instead of the long-term option (winning strategy), and members of this group were more impaired in metacognitive monitoring of their strategies and showed an increased left hemisphere activation when they responded to losing choices. A "reward bias" effect was hypothesized to act for high BAS, based on a left-hemisphere hyperactivation.

Reward bias and lateralization in gambling behavior: behavioral activation system and alpha band analysis.

The present research explored the main factors that can influence subjects' choices in the case of decisions. In order to elucidate the individual differences that influence the decisional processes, making their strategies more or less advantageous, we tested the effect of a reward sensitivity in the behavioral activation system (BAS-Reward) constructed on the ability to distinguish between high- and low-risk decisions. Secondly, the lateralization effect, related to increased activation of the left (BAS-related) hemisphere, was explored. Thirty-one subjects were tested using the Iowa Gambling Task, and the BAS-Reward measure was applied to distinguish between high-BAS and low-BAS groups. Behavioral responses (gain/loss options) and alpha-band modulation were considered. It was found that high-BAS group increased their tendency to opt in favor of the immediate reward (loss strategy) rather than the long-term option (win strategy). Secondly, high-BAS subjects showed an increased left-hemisphere activation in response to losing (with immediate reward) choices in comparison with low-BAS subjects. A "reward bias" effect was supposed to explain both the bad strategy and the unbalanced hemispheric activation for high-BAS and more risk-taking subjects.

The contribution of dorsolateral prefrontal cortex and temporoparietal areas in processing instrumental versus functional semantic violations in action representation.

In the present study, we explored the contribution of different cortical areas in processing different semantic violations in action representation--that is, instrumental or functional violations. The cortical contribution in object-related action comprehension was verified by measuring changes in event-related potential (N400 effect), error rates (ERs), and response times (RTs), by applying an inhibitory transcranial direct current stimulation (tDCS) on the dorsolateral prefrontal cortex (DLPFC). Thirty-three subjects performed the detection task (action frames ending with a congruous vs. incongruous action). The tDCS effect was analyzed by comparing the N400, ERs, and RTs before and after stimulation. A significant reduction of the N400 and increased RTs were observed for incongruous stimuli in the case of inhibitory stimulation of the DLPFC. These results highlighted that DLPFC inhibition may limit the ability to analyze a semantically incongruous action, with a reduced N400 ERP effect and increased "cognitive costs" (higher RTs). Moreover, functional violation showed also the contribution of the temporoparietal areas to modulate the N400 amplitude. Therefore the existence of different cortical generators was supposed for the instrumental (more frontal) and the functional (more frontal and temporoparietal) semantic anomaly processing.

Reward-system effect (BAS rating), left hemispheric "unbalance" (alpha band oscillations) and decisional impairments in drug addiction.

The current research explored the impact of cortical frontal asymmetry (left-lateralization effect) and Behavioral Activation System (BAS) on Substance Use Disorder (SUD) in decisional processes using the Iowa Gambling Task (IGT). Forty SUD participants and forty-two controls (CG) were tested using the IGT. Behavioral responses (gain/loss options), BIS/BAS scores and lateralized alpha band modulation (LTA) were considered. The SUD group increased the tendency to opt in favor of the immediate reward (loss strategy) more than the long-term option (win strategy) compared to the CG. Secondly, higher reward-subscale scores were observed in SUD. Thirdly, SUD showed an increase in left-hemisphere activation in response to losing (with immediate reward) choices in comparison with the CG. An imbalanced left hemispheric effect related to higher BAS trait could explain this "reward bias," because these components were found to explain (through the regression analysis) the main behavioral deficits.

Activation of the prefrontal cortex and posterior parietal cortex increases the recognition of semantic violations in action representation.

BACKGROUND: The correct outcome of transitive actions depends on an object's use, considering both the instrumental and functional features. Indeed, the representation of transitive action includes the correct/incorrect instrumental use and the congruous/incongruous functional use of the object. OBJECTIVES: The contribution of frontal (experiment 1) and posterior parietal (experiment 2) areas to process semantic violations in instrumental vs. functional action representation was explored. METHODS: These cortical areas were appositely modulated by anodal tDCS (transcranial direct current stimulation) or sham tDCS when 43 healthy subjects processed semantic violations (congruous/incongruous pairs) and they had to perform an error detection task (measuring ERs - error rates; and RTs - response times). RESULTS: Decreased RTs were observed for incongruous pairs in the case of prefrontal stimulation compared to the sham condition. This effect was related to both the instrumental and functional conditions, suggesting that the activation of the prefrontal area may increase the ability to analyze the semantic incongruence independently from the anomaly type, which would limit the cognitive costs. In contrast, posterior parietal stimulation reduced RTs only in response to functional action in the case of semantic incongruence. CONCLUSIONS: Thus, different cortical contributions by anterior vs. posterior areas occurred in response to semantic incongruences respectively for generic expectancy violations (more frontally distributed) and specific functional violations (more parietally distributed).

High-frequency rTMS on DLPFC increases prosocial attitude in case of decision to support people.

Engaging in prosocial behavior was explored in the present research, by investigating the role of dorsolateral prefrontal cortex (DLPFC) in modulation of intention to support other people and of emotional attuning as it was expressed by facial feedback (electromiography, EMG). High-frequency rTMS was applied on DLPFC to 25 subjects when they were required to choose to directly intervene or not to support other people in emotionally valenced social situations (cooperative, noncooperative, conflictual, neutral contexts). Two control conditions were included in the experimental design to control the simple stimulation effect (sham condition with absence of TMS stimulation) and the location effect (control site condition with Pz stimulation). In comparison with sham and control condition, rTMS stimulation induced increased prosocial behavior in all the emotional situations. Moreover, as a function of valence, zygomatic (for positive situations) and corrugators (for negative situations) muscle activity was increased, with significant effect by DLPFC stimulation which induced a "facilitation effect". In addition, negative situations showed a higher rTMS impact for both behavioral and EMG responsiveness. Finally, prosocial behavior was found to be predicted (regression analysis) by EMG variations, as a function of the negative versus positive valence. The prefrontal circuit was suggested to support emotional responsiveness and facial feedback in order to facilitate the prosocial behavior.

Prosocial attitudes and empathic behavior in emotional positive versus negative situations: brain response (ERPs) and source localization (LORETA) analysis.

The present research firstly investigated the neural correlates (ERPs, event-related potentials) of attitudes to engage in prosocial-helping behaviors, and secondly, it analyzed the relation between these brain-based potentials and personal profile (high vs. low empathic profile). It was considered the subjects' behavior in response to specific emotional situations (positive vs. negative) in case it was required a possible prosocial intervention. Thirty-one subjects were invited to empathize with the emotional contexts (videotapes that reproduced two person's exchanges) and to decide whether to intervene or not to support these persons. BEES questionnaire for empathic behavior was submitted to the subjects after the experimental session. ERP acquisition and LORETA source analysis revealed a negative ongoing deflection (N200 effect) more prefrontally distributed (dorsolateral prefrontal cortex) in response to prosocial intervention options mainly for negative and positive contexts. Moreover, a significant positive correlation was found between high-empathic profiles, intervention behaviors (higher frequency of interventions) and N200 amplitude (higher peak). These results highlight the role of emotions in prosocial behavior, since the N200 effect was considered a marker of the emotional significance of the interpersonal situation. Secondly, the empathic trait may explain the prosocial decisional processes: Higher empathic trait contributes to induce subject's intervention behavior which in turn appears to be directly related to the cortical responsiveness within the prefrontal areas.

Emotional contagion and trait empathy in prosocial behavior in young people: the contribution of autonomic (facial feedback) and balanced emotional empathy scale (BEES) measures.

The present research investigated first the facial feedback measured by EMG (electromyography) during decisions to engage in prosocial-helping behaviors and secondly the relation between this psychophysiological correlate and emotional empathy trait in young people. Thirty young subjects were invited to choose to adopt or not a prosocial behavior in response to social interactions. An increased zygomatic and corrugator muscle activity was found in response to prosocial interventions. Moreover, a significant positive correlation was found between empathic profile and the EMG modulation. These results highlight the role of emotions and empathy in prosocial behavior, induced by an "emotional contagion effect."