Non-invasive prehabilitation to foster widespread fMRI cortical reorganization before brain tumor surgery: lessons from a case series.

PURPOSE: The objective of this prospective, single-centre case series was to investigate feasibility, clinical outcomes, and neural correlates of non-invasive Neuromodulation-Induced Cortical Prehabilitation (NICP) before brain tumor surgery. Previous studies have shown that gross total resection is paramount to increase life expectancy but is counterbalanced by the need of preserving critical functional areas. NICP aims at expanding functional margins for extensive tumor resection without functional sequelae. Invasive NICP (intracranial neuromodulation) was effective but characterized by elevated costs and high rate of adverse events. Non-invasive NICP (transcranial neuromodulation) may represent a more feasible alternative. Nonetheless, up to this point, non-invasive NICP has been examined in only two case reports, yielding inconclusive findings. METHODS: Treatment sessions consisted of non-invasive neuromodulation, to transiently deactivate critical areas adjacent to the lesion, coupled with intensive functional training, to activate alternative nodes within the same functional network. Patients were evaluated pre-NICP, post-NICP, and at follow-up post-surgery. RESULTS: Ten patients performed the intervention. Feasibility criteria were met (retention, adherence, safety, and patient's satisfaction). Clinical outcomes showed overall stability and improvements in motor and executive function from pre- to post-NICP, and at follow-up. Relevant plasticity changes (increase in the distance between tumor and critical area) were observed when the neuromodulation target was guided by functional neuroimaging data. CONCLUSION: This is the first case series demonstrating feasibility of non-invasive NICP. Neural correlates indicate that neuroimaging-guided target selection may represent a valid strategy to leverage neuroplastic changes before neurosurgery. Further investigations are needed to confirm such preliminary findings.

Exploring the neural basis of non-invasive prehabilitation in brain tumour patients: An fMRI-based case report of language network plasticity.

Primary brain neoplasms are associated with elevated mortality and morbidity rates. Brain tumour surgery aims to achieve maximal tumour resection while minimizing damage to healthy brain tissue. Research on Neuromodulation Induced Cortical Prehabilitation (NICP) has highlighted the potential, before neurosurgery, of establishing new brain connections and transfer functional activity from one area of the brain to another. Nonetheless, the neural mechanisms underlying these processes, particularly in the context of space-occupying lesions, remain unclear. A patient with a left frontotemporoinsular tumour underwent a prehabilitation protocol providing 20 sessions of inhibitory non-invasive neuromodulation (rTMS and multichannel tDCS) over a language network coupled with intensive task training. Prehabilitation resulted in an increment of the distance between the tumour and the language network. Furthermore, enhanced functional connectivity within the language circuit was observed. The present innovative case-study exposed that inhibition of the functional network area surrounding the space-occupying lesion promotes a plastic change in the network's spatial organization, presumably through the establishment of novel functional pathways away from the lesion's site. While these outcomes are promising, prudence dictates the need for larger studies to confirm and generalize these findings.

Neuromodulation-induced prehabilitation to leverage neuroplasticity before brain tumor surgery: a single-cohort feasibility trial protocol.

Introduction: Neurosurgery for brain tumors needs to find a complex balance between the effective removal of targeted tissue and the preservation of surrounding brain areas. Neuromodulation-induced cortical prehabilitation (NICP) is a promising strategy that combines temporary inhibition of critical areas (virtual lesion) with intensive behavioral training to foster the activation of alternative brain resources. By progressively reducing the functional relevance of targeted areas, the goal is to facilitate resection with reduced risks of neurological sequelae. However, it is still unclear which modality (invasive vs. non-invasive neuromodulation) and volume of therapy (behavioral training) may be optimal in terms of feasibility and efficacy. Methods and analysis: Patients undertake between 10 and 20 daily sessions consisting of neuromodulation coupled with intensive task training, individualized based on the target site and neurological functions at risk of being compromised. The primary outcome of the proposed pilot, single-cohort trial is to investigate the feasibility and potential effectiveness of a non-invasive NICP protocol on neuroplasticity and post-surgical outcomes. Secondary outcomes investigating longitudinal changes (neuroimaging, neurophysiology, and clinical) are measured pre-NICP, post-NICP, and post-surgery. Ethics and dissemination: Ethics approval was obtained from the Research Ethical Committee of Fundació Unió Catalana d'Hospitals (approval number: CEI 21/65, version 1, 13/07/2021). The results of the study will be submitted to a peer-reviewed journal and presented at scientific congresses. Clinical trial registration: ClinicalTrials.gov, identifier NCT05844605.

Análogos de GLP1 en los pacientes con sobrepeso u obesidad durante el confinamiento / GLP1 analogues among patients with overweight or obesity during lockdown

Antecedentes y objetivosUno de los potenciales efectos negativos de un confinamiento son los cambios en los patrones dietéticos y de estilo de vida, que pueden conllevar a una ganancia de peso. El objetivo fue ver los cambios sobre los hábitos higiénico-dietéticos y de patrones de ingesta en una situación de confinamiento y el impacto sobre el peso. Asimismo, ver si el estar bajo tratamiento con análogos de GLP1 (aGLP1) modificó estos parámetros.Material y métodosSe reclutó, de forma consecutiva, a 100 pacientes con sobrepeso/obesidad que acudieron a revisión al finalizar el confinamiento. Se diseñó una entrevista estructurada para ver los cambios en los hábitos dietéticos, rutinas y ejercicio.ResultadosEl 52% de los pacientes ganaron peso durante el confinamiento. El porcentaje de sujetos con historia activa de depresión o ansiedad fue superior entre el grupo de pacientes que ganó peso. El porcentaje de pacientes que empeoraron su hiperfagia ansiosa fue superior en aquellos que ganaron peso (71,2% vs. 10,6%; p<0,0001); lo mismo ocurrió con los atracones (92% vs. 10,6%; p<0,0001) y los cravings, dulces y salados (69,2% vs. 21,3% y 69,2% vs. 14,9%; p<0,0001 y p<0,0001, respectivamente). De los 48 pacientes que no ganaron peso, 30 estaban en tratamiento con aGLP1 (61,7%). El empeoramiento de los patrones anómalos de ingesta fue inferior entre los pacientes en tratamiento con aGLP-1.ConclusionesUn confinamiento es un período vulnerable para ganar peso, especialmente en aquellos pacientes con antecedentes psicopatológicos. Los aGLP1 consiguen controlar la ingesta emocional convirtiéndolos en una opción terapéutica valiosa.

GLP1 analogues among patients with overweight or obesity during lockdown. / Análogos de GLP1 en los pacientes con sobrepeso u obesidad durante el confinamiento.

BACKGROUND AND OBJECTIVES: One of the potential negative effects of a lockdown are changes in dietary and lifestyle patterns, which can lead to weight gain. Our objective was to assess the changes on dietary habits and eating patterns in a lockdown situation and their impact on weight. We aimed to determine whether the treatment with GLP1 analogues (aGLP1) could impact on these parameters. MATERIAL AND METHODS: 100 overweight/obese patients were consecutively recruited for a review at the end of the lockdown. A structured interview was designed to see changes in dietary habits, routines and exercise. RESULTS: 52% patients gained weight during lockdown. The percentage of subjects with an active history of depression or anxiety was higher among the group of patients who gained weight. The percentage of patients who worsened their hyperphagia was higher in those who gained weight (71.2% vs. 10.6%; P<0.0001); similar results were observed with binge eating (92% vs. 10.6%; p<0.0001) and cravings, both sweet and salty (69.2% vs. 21.3% and 69.2% vs. 14.9%; p<0.0001 and p<0.0001 respectively). Of the 48 patients who did not gain weight, 30 were under aGLP1 treatment (61.7%). The worsening of abnormal eating patterns was lower among patients treated with aGLP-1. CONCLUSIONS: A lockdown is a vulnerable period to gain weight, especially in those patients with a psychopathological history. aGLP1 manage to control emotional eating, making them a valuable therapeutic option.

Sibship Size, Height and Cohort Selection: A Methodological Approach.

This article deals with the historical relationship between the number of siblings in a family or household and height, a proxy for biological living standards. Ideally, this relationship is better assessed when we have evidence on the exact number of siblings in a family from its constitution onwards. However, this generally requires applying family reconstitution techniques, which, unfortunately, is not always possible. In this latter case, scholars must generally settle for considering only particular benchmark years using population censuses, from which family and household structures are derived. These data are then linked to the height data for the young males of the family or household. Height data are generally obtained from military records. In this matching process, several decisions have to be taken, which, in turn, are determined by source availability and the number of available observations. Using data from late 19th-century Catalonia, we explore whether the methodology used in matching population censuses and military records as described above might affect the relationship between sibship size and biological living standards and, if so, to what extent. We conclude that, while contextual factors cannot be neglected, the methodological decisions made in the initial steps of research also play a role in assessing this relationship.

Intelligent Coaching Assistant for the Promotion of Healthy Habits in a Multidomain mHealth-Based Intervention for Brain Health.

Brain Health is defined as the development and preservation of optimal brain integrity and neural network functioning for a given age. Recent studies have related healthy habits with better maintenance of brain health across the lifespan. As a part of the Barcelona Brain Health Initiative (BBHI), a mHealth platform has been developed with the purpose of helping people to improve and monitor their healthy habits, facilitating the delivery of health coaching strategies. A decision support system (DSS), named Intelligent Coaching Assistant (ICA), has been developed to ease the work of professional brain health coaches, helping them design and monitor adherence to multidomain interventions in a more efficient manner. Personalized recommendations are based on users' current healthy habits, individual preferences, and motivational aspects. Taking these inputs, an initial user profile is defined, and the ICA applies an algorithm for determining the most suitable personalized intervention plan. An initial validation has been done focusing on assessing the feasibility and usability of the solution, involving 20 participants for three weeks. We conclude that this kind of technology-based intervention is feasible and implementable in real-world settings. Importantly, the personalized intervention proposal generated by the DSS is feasible and its acceptability and usability are high.

Nutrición y desigualdad en el largo plazo: ¿qué enseña la historia antropométrica sobre España? / Nutrition, growth and inequality in the long term: What does anthropometric history teach about Spain?

Este artículo destaca la importancia de la historia antropométrica entre las ciencias preocupadas por la nutrición y la salud. La evolución del estado nutricional y de la desigualdad en España medida por indicadores antropométricos es el principal objetivo de un conjunto de 18 contribuciones presentadas y discutidas en el IV Workshop de Historia Antropométrica celebrado a comienzos de 2018. Después de mostrar la capacidad de la estatura humana como representación del impacto de los procesos socioeconómicos y de los cambios ambientales en el estado nutricional durante los últimos siglos, se presentan las principales aportaciones y avances realizados en el taller. Las contribuciones abordan distintas facetas de la desigualdad de la salud nutricional y de sus determinantes desde finales del siglo xviii hasta 2015. Además de la talla y del peso a diferentes edades (principalmente adultas), se incluyen otros indicadores antropométricos, como el dimorfismo sexual y el bajo peso al nacimiento. Los resultados reflejan graves problemas de malnutrición y de desigualdad en el pasado que persisten con otra naturaleza en la actualidad: retraso en el crecimiento hasta la década de los sesenta y creciente prevalencia de obesidad desde 1980. Se concluye que los determinantes del estado nutricional y de la desigualdad de la salud requieren un enfoque multidimensional y de diálogo entre las ciencias sociales y las biomédicas. Conocer su dimensión en el pasado y su evolución proporciona un valioso aporte de conocimiento para entender con mayor perspectiva los problemas actuales y poder intervenir con atino en las políticas futuras

This article underlines the relevance of anthropometric history among the disciplines concerned with health and nutrition. The examination of changes on the nutritional status and inequality in Spain focused the 4th Anthropometric History Workshop held at the beginning of 2018 where 18 original contributions were presented and discussed. We first show the ability of human stature to approach the impact of socioeconomic processes and environmental changes on the nutritional status over the last centuries. Then it is proceeded to present the main contents and advances achieved in the workshop. The papers coped with diverse dimensions of inequality regarding nutritional health and its determinants since the end of the 18th century until 2015. Aside of height and weight at different ages, principally adult ones, others anthropometric indicators were analyzed such as sexual dimorphism and low weight at birth. The results illustrate the large prevalence of malnutrition and social inequality in past Spain. These problems persisted over a good part of the 20th century (i.e. stunting) and, they acquired a different nature since the 1980s as the increasing prevalence of overweight and obesity reveals. It is concluded that the determinants of nutritional status and health-related inequalities request multidimensional approaches and the dialogue between social sciences and biomedical sciences. Knowing about their dimensions in the past and their evolution over time provides a valuable basis in order to understand current problems in these areas and to address future public policies more adequately on childhood and adolescence

Biological Standards of Living in Rural Catalonia over the Long Run: A Comparison with Urban Areas (1840-1960) / Niveles de vida biológicos en la Cataluña rural en el largo plazo: una comparación con las áreas urbanas (1840-1960)

Objective: to assess the long-term evolution of biological living standards in rural Catalonia and to compare it with the corresponding figures in urban areas. Methods: using data from military records of conscripts from six towns in western Catalonia, we construct an annual height series. Height is standardised at the age of 21 years. We also construct a body mass index (BMI) for conscripts born in 1891 and 1934-39. The annual height series for western Catalonia is systematically compared to the series for Reus, Catalonia’s second largest city during the second half of the 19th century. Results: comparing the cohorts born in the periods 1840-49 and 1951-60, we find that height increased by 5.7 centimetres over this period. However, the increase was not distributed equally over time. In the second half of the 19th century, rural heights stagnated over the long run and declined relative to urban heights. In the cohorts born in the decades between 1910 and 1950, rural heights rose by more than 5 centimetres, and converged with those of Reus. Conclusion: we provide new evidence for the current debate on the rural-urban height gap. Between the 1840s and the 1950s, heights in rural western Catalonia grew at rates similar to those recorded in certain urban areas, but growth rates differed depending on the period of analysis. This study underlines the importance of adopting long-term perspectives, and stresses that rural-urban height differences tend to be time-and space-specific

Objetivo: analizar la evolución en el largo plazo del nivel de vida biológico en la Cataluña rural y explorar hasta qué punto esta fue diferente a la de las zonas urbanas. Métodos: utilizamos datos de los registros militares de seis localidades rurales del poniente catalán con los que construimos una serie anual de estatura estandarizada a la edad de 21 años con las cohortes nacidas entre 1840 y 1960. También elaboramos un IMC para los reclutas nacidos en 1891 y 1934-1939. La serie rural de estatura se compara sistemáticamente con la de Reus, el segundo mayor centro urbano catalán de la segunda mitad del siglo xix. Resultados: los datos muestran que la estatura aumentó 5,7 centímetros entre las cohortes nacidas entre 1840-1849 y 1951-1960, aunque desigualmente distribuidos a lo largo del tiempo. En la segunda mitad del siglo xix hubo estancamiento en el largo plazo y divergencia con las estaturas urbanas. Entre 1910 y 1950 la talla rural mejoró en más de 5 centímetros y terminó convergiendo con la de Reus. Conclusión: se aporta nueva evidencia al debate sobre la brecha rural-urbana en el nivel de vida biológico. En el periodo analizado, las tasas de crecimiento de la estatura fueron parecidas en ambos ámbitos, aunque con diferencias según el periodo de análisis. Este estudio subraya la importancia de adoptar perspectivas de largo plazo y señala que las diferencias de estatura rural-urbana tienden a ser específicas de tiempo y espacio

[Nutrition, growth and inequality in the long term: What does anthropometric history teach about Spain?] / Nutrición y desigualdad en el largo plazo: ¿qué enseña la historia antropométrica sobre España?

This article underlines the relevance of anthropometric history among the disciplines concerned with health and nutrition. The examination of changes on the nutritional status and inequality in Spain focused the 4th Anthropometric History Workshop held at the beginning of 2018 where 18 original contributions were presented and discussed. We first show the ability of human stature to approach the impact of socioeconomic processes and environmental changes on the nutritional status over the last centuries. Then it is proceeded to present the main contents and advances achieved in the workshop. The papers coped with diverse dimensions of inequality regarding nutritional health and its determinants since the end of the 18th century until 2015. Aside of height and weight at different ages, principally adult ones, others anthropometric indicators were analyzed such as sexual dimorphism and low weight at birth. The results illustrate the large prevalence of malnutrition and social inequality in past Spain. These problems persisted over a good part of the 20th century (i.e. stunting) and, they acquired a different nature since the 1980s as the increasing prevalence of overweight and obesity reveals. It is concluded that the determinants of nutritional status and health-related inequalities request multidimensional approaches and the dialogue between social sciences and biomedical sciences. Knowing about their dimensions in the past and their evolution over time provides a valuable basis in order to understand current problems in these areas and to address future public policies more adequately on childhood and adolescence.

Este artículo destaca la importancia de la historia antropométrica entre las ciencias preocupadas por la nutrición y la salud. La evolución del estado nutricional y de la desigualdad en España medida por indicadores antropométricos es el principal objetivo de un conjunto de 18 contribuciones presentadas y discutidas en el IV Workshop de Historia Antropométrica celebrado a comienzos de 2018.Después de mostrar la capacidad de la estatura humana como representación del impacto de los procesos socioeconómicos y de los cambios ambientales en el estado nutricional durante los últimos siglos, se presentan las principales aportaciones y avances realizados en el taller. Las contribuciones abordan distintas facetas de la desigualdad de la salud nutricional y de sus determinantes desde finales del siglo XVIII hasta 2015. Además de la talla y del peso a diferentes edades (principalmente adultas), se incluyen otros indicadores antropométricos, como el dimorfismo sexual y el bajo peso al nacimiento. Los resultados reflejan graves problemas de malnutrición y de desigualdad en el pasado que persisten con otra naturaleza en la actualidad: retraso en el crecimiento hasta la década de los sesenta y creciente prevalencia de obesidad desde 1980.Se concluye que los determinantes del estado nutricional y de la desigualdad de la salud requieren un enfoque multidimensional y de diálogo entre las ciencias sociales y las biomédicas. Conocer su dimensión en el pasado y su evolución proporciona un valioso aporte de conocimiento para entender con mayor perspectiva los problemas actuales y poder intervenir con atino en las políticas futuras.

[Biological Standards of Living in Rural Catalonia over the Long Run: A Comparison with Urban Areas (1840-1960)]. / Niveles de vida biológicos en la Cataluña rural en el largo plazo: una comparación con las áreas urbanas (1840-1960).

OBJECTIVE: to assess the long-term evolution of biological living standards in rural Catalonia and to compare it with the corresponding figures in urban areas. METHODS: using data from military records of conscripts from six towns in western Catalonia, we construct an annual height series. Height is standardised at the age of 21 years. We also construct a body mass index (BMI) for conscripts born in 1891 and 1934-39. The annual height series for western Catalonia is systematically compared to the series for Reus, Catalonia's second largest city during the second half of the 19th century. RESULTS: comparing the cohorts born in the periods 1840-49 and 1951-60, we find that height increased by 5.7 centimetres over this period. However, the increase was not distributed equally over time. In the second half of the 19th century, rural heights stagnated over the long run and declined relative to urban heights. In the cohorts born in the decades between 1910 and 1950, rural heights rose by more than 5 centimetres, and converged with those of Reus. CONCLUSION: we provide new evidence for the current debate on the rural-urban height gap. Between the 1840s and the 1950s, heights in rural western Catalonia grew at rates similar to those recorded in certain urban areas, but growth rates differed depending on the period of analysis. This study underlines the importance of adopting long-term perspectives, and stresses that rural-urban height differences tend to be time-and space-specific.

Objetivo: analizar la evolución en el largo plazo del nivel de vida biológico en la Cataluña rural y explorar hasta qué punto esta fue diferente a la de las zonas urbanas. Métodos: utilizamos datos de los registros militares de seis localidades rurales del poniente catalán con los que construimos una serie anual de estatura estandarizada a la edad de 21 años con las cohortes nacidas entre 1840 y 1960. También elaboramos un IMC para los reclutas nacidos en 1891 y 1934-1939. La serie rural de estatura se compara sistemáticamente con la de Reus, el segundo mayor centro urbano catalán de la segunda mitad del siglo xix. Resultados: los datos muestran que la estatura aumentó 5,7 centímetros entre las cohortes nacidas entre 1840-1849 y 1951-1960, aunque desigualmente distribuidos a lo largo del tiempo. En la segunda mitad del siglo xix hubo estancamiento en el largo plazo y divergencia con las estaturas urbanas. Entre 1910 y 1950 la talla rural mejoró en más de 5 centímetros y terminó convergiendo con la de Reus. Conclusión: se aporta nueva evidencia al debate sobre la brecha rural-urbana en el nivel de vida biológico. En el periodo analizado, las tasas de crecimiento de la estatura fueron parecidas en ambos ámbitos, aunque con diferencias según el periodo de análisis. Este estudio subraya la importancia de adoptar perspectivas de largo plazo y señala que las diferencias de estatura rural-urbana tienden a ser específicas de tiempo y espacio.