Medial Temporal Lobe Contributions to Episodic Future Thinking: Scene Construction or Future Projection?

Previous research has shown that the medial temporal lobes (MTL) are more strongly engaged when individuals think about the future than about the present, leading to the suggestion that future projection drives MTL engagement. However, future thinking tasks often involve scene processing, leaving open the alternative possibility that scene-construction demands, rather than future projection, are responsible for the MTL differences observed in prior work. This study explores this alternative account. Using functional magnetic resonance imaging, we directly contrasted MTL activity in 1) high scene-construction and low scene-construction imagination conditions matched in future thinking demands and 2) future-oriented and present-oriented imagination conditions matched in scene-construction demands. Consistent with the alternative account, the MTL was more active for the high versus low scene-construction condition. By contrast, MTL differences were not observed when comparing the future versus present conditions. Moreover, the magnitude of MTL activation was associated with the extent to which participants imagined a scene but was not associated with the extent to which participants thought about the future. These findings help disambiguate which component processes of imagination specifically involve the MTL.

Myostatin mediates abdominal aortic atherosclerosis progression by inducing vascular smooth muscle cell dysfunction and monocyte recruitment.

Myostatin (Mstn) is a skeletal muscle growth inhibitor involved in metabolic disorders and heart fibrosis. In this study we sought to verify whether Mstn is also operative in atherosclerosis of abdominal aorta. In human specimens, Mstn expression was almost absent in normal vessels, became detectable in the media of non-progressive lesions and increased with the severity of the damage. In progressive atherosclerotic lesions, Mstn was present in the media, neointima, plaque shoulder and in infiltrating macrophages. Mstn co-localized with α-smooth muscle actin (α-SMA) staining and with some CD45+ cells, indicating Mstn expression in VSMCs and bloodstream-derived leukocytes. In vitro, Mstn was tested in VSMCs and monocytes. In A7r5 VSMCs, Mstn downregulated proliferation and Smoothelin mRNA, induced cytoskeletal rearrangement, increased migratory rate and MCP-1/CCR2 expression. In monocytes (THP-1 cells and human monocytes), Mstn acted as a chemoattractant and increased the MCP-1-dependent chemotaxis, F-actin, α-SMA, MCP-1 and CCR2 expression; in turn, MCP-1 increased Mstn mRNA. Mstn induced JNK phosphorylation both in VSMCs and monocytes. Our results indicate that Mstn is overexpressed in abdominal aortic wall deterioration, affects VSMCs and monocyte biology and sustains a chronic inflammatory milieu. These findings propose to consider Mstn as a new playmaker in atherosclerosis progression.

Using future thinking to reduce temporal discounting: Under what circumstances are the medial temporal lobes critical?

The capacity to envision the future plays an important role in many aspects of cognition, including our ability to make optimal, adaptive choices. Past work has shown that the medial temporal lobe (MTL) is necessary for decisions that draw on episodic future thinking. By contrast, little is known about the role of the MTL in decisions that draw on semantic future thinking. Accordingly, the present study investigated whether the MTL contributes to one form of decision making, namely intertemporal choice, when such decisions depend on semantic consideration of the future. In an intertemporal choice task, participants must select either a smaller amount of money that is available in the present or a larger amount of money that would be available at a future date. Amnesic individuals with MTL damage and healthy control participants performed such a task in which, prior to making a choice, they engaged in a semantic generation exercise, wherein they generated items that they would purchase with the future reward. In experiment 1, we found that, relative to a baseline condition involving standard intertemporal choice, healthy individuals were more inclined to select a larger, later reward over a smaller, present reward after engaging in semantic future thinking. By contrast, amnesic participants were paradoxically less inclined to wait for a future reward following semantic future thinking. This finding suggests that amnesics may have had difficulty "tagging" the generated item(s) as belonging to the future. Critically, experiment 2 showed that when the generated items were presented alongside the intertemporal choices, both controls and amnesic participants shifted to more patient choices. These findings suggest that the MTL is not needed for making optimal decisions that draw on semantic future thinking as long as scaffolding is provided to support accurate time tagging. Together, these findings stand to better clarify the role of the MTL in decision making.

Does the hippocampus keep track of time?

In the present study, we examined the role of the medial temporal lobe (MTL) in prospective time estimation at short and long timescales using a novel behavioral paradigm adapted from rodent work. Amnesic patients with MTL damage and healthy control participants estimated the duration of nature-based video clips that were either short (≤ 90 s) or long (more than 4 min). Consistent with previous work in rodents, we found that amnesic patients were impaired at making estimations for long, but not for short durations. Critically, these effects were observed in patients who had lesions circumscribed to the hippocampus, suggesting that the pattern observed was not attributable to the involvement of extra-hippocampal structures. That the MTL, and more specifically the hippocampus, is critical for prospective temporal estimation only at long intervals suggests that multiple neurobiological mechanisms support prospective time estimation.

Sinus grafting and simultaneous removal of large antral pseudocysts of the maxillary sinus with a micro-invasive intraoral access.

Large antral pseudocysts of the maxillary sinus (APCs) may hamper the elevation of the Schneiderian membrane during sinus grafting and may impair osteo-meatal complex patency after sinus augmentation. Therefore, these should be removed prior to or at the time of sinus grafting. This study presents a new technique that combines enucleation of large APCs during sinus grafting via a lateral approach with preservation of the Schneiderian membrane periosteal layer. Twelve patients underwent a sinus graft via lateral approach during the years 2004-2012. Simultaneous APC removal was achieved through a small additional bony access, preserving the integrity of the periosteal layer of the Schneiderian membrane. Nineteen implants were inserted at the time of sinus augmentation or during a second stage. Prosthetic rehabilitation was started at 4-6 months after implant placement. No patient developed surgical complications or APC recurrence. The survival rate of implants and related prostheses was 100% over a mean follow-up of 50 months (range 12-96 months) after completion of the prosthetic restorations. This technique may represent an effective procedure to achieve APC removal at the time of sinus grafting, preserving the integrity of the Schneiderian membrane periosteal layer.

Abdominal compartment syndrome: an underrated complication in pediatric kidney transplantation.

The transplantation of a large kidney in small children can lead to many complications, including an underrated complication known as abdominal compartment syndrome (ACS), which is defined as intra-abdominal pressure (IAP)≥20 mm Hg with dysfunction of at least one thoracoabdominal organ. Presenting signs of ACS include firm tense abdomen, increased peak inspiratory pressures, oliguria, and hypotension. Between June 1, 1985, and September 30, 2013, our center performed 420 kidney transplants (deceased/living related donors: 381/39) in 314 pediatric recipients (female/male: 147/167). ACS occurred in 9 pediatric patients (weight<15 kg) who received a large kidney from adult donors. In 1 case, the patient underwent abdominal decompression with re-exploration and closure with mesh in the immediate postoperative period. In a second case, the patient developed a significant respiratory compromise with hemodynamic instability necessitating catecholamines, sedation, and assisted ventilation. For small children transplanted with a large kidney, an early diagnosis of ACS represents a critical step. From 2005 we have measured IAP during transplantation via urinary bladder pressure, and immediately after wound closure we use intraoperative and postoperative duplex sonography to value flow dynamics changes. We recommend that bladder pressure should be routinely checked in small pediatric kidney recipients who are transplanted with a large graft.

Early and long-term outcomes after open or endovascular repair for abdominal aortic aneurysms in high-risk patients.

AIM: The aim of our study was to evaluate the earlier and long term survival as well the postoperative complications in high-risk patients who received endovascular aortic repair (EVAR) as first choice, or open repair when anatomical requirements for EVAR were not met. METHODS: Between January 2005 and January 2010, 593 patients underwent procedures for elective abdominal aortic aneurysm (AAA) repair; 172 of these were considered at high risk according to the American Society of Anesthesiology (ASA) score (ASA III and IV): 150 high-risk patients were males (mean age 72.7, range 53-93 years) and 22 females (mean age 72.9 years, range 60-90 years). The median AAA diameter was 64 (53-75) mm in the open repair group and 62 (55-70) mm in the EVAR group. 121 patients underwent open repair and 51 EVAR, respectively. RESULTS: The 30-day mortality rate was 0% in the EVAR group and 2.4% (3/121) in the open repair group (P=0.26). Long-term results showed: no EVAR-related mortality, no late conversion to open repair in the EVAR group was required during follow-up. No aneurysmal expansion was observed. In the open repair group, no graft-related events were observed during follow-up. The mean follow-up for survival analysis was 1542 days. Overall 5-year survival was 71.7% (SE=4.2%). Survival during follow-up was 92.2%, 86.1%, 76.2%, 65.9% and 61.8% at 12, 24,36,48,60 months respectively in EVAR Group. Open Group present long term survival of 95%, 88.9%, 83.9%, 79.7%, 76% at 12, 24, 36, 48, 60 months respectively. CONCLUSION: Our results in open repair surgery show a perioperative low mortality rate with high survival rate in long term. This result could be successfully achieved even in high-risk patients unsuitable for EVAR.

Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study.

AIM: The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. METHODS: Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. RESULT: FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes' count (P<0.02). Carotid metabolism was directly correlated with monocytes' count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). CONCLUSION: The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.

Deletion variant in the ADRA2B gene increases coupling between emotional responses at encoding and later retrieval of emotional memories.

A deletion variant of the ADRA2B gene that codes for the α2b adrenoceptor has been linked to greater susceptibility to traumatic memory as well as attentional biases in perceptual encoding of negatively valenced stimuli. The goal of the present study was to examine whether emotional enhancements of memory associated with the ADRA2B deletion variant were predicted by encoding, as indexed by the subjectively perceived emotional salience (i.e., arousal) of events at the time of encoding. Genotyping was performed on 186 healthy young adults who rated positive, negative, and neutral scenes for level of emotional arousal and subsequently performed a surprise recognition memory task 1 week later. Experience of childhood trauma was also measured, as well as additional genetic variations associated with emotional biases and episodic memory. Results showed that subjective arousal was linked to memory accuracy and confidence for ADRA2B deletion carriers but not for non-carriers. Our results suggest that carrying the ADRA2B deletion variant enhances the relationship between arousal at encoding and subsequent memory for moderately arousing events.

Stent-graft and multilayer stent for treatment of type II thoracoabdominal aortic aneurysm in a high-risk patient.

The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients.

Pre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study.

Flushing totally implantable venous access devices (TIVADs) with manually filled saline syringes may increase contamination and catheter-related bloodstream infection (CRBSI). We used a retrospective cohort study to assess the impact of changing from manually filled syringes to manufactured pre-filled syringes on the frequency of CRBSI in 718 TIVADs. Manually filled syringes were used in 269 patients and pre-filled syringes in 449. The CRBSI rate was 2.7% in the pre-filled syringe group and 6.3% in the manually filled syringe group (P = 0.016). Sex, tumour type and stage, access site and access body side were not independent risk factors for CRBSI.

Use of health-related quality-of-life measurements to estimate individuals' health on screening.

OBJECTIVES: to investigate the utility of assessing Health-Related Quality of Life (HRQoL) in a large group of subjects participating in a screening program for aneurysm and the relationship between HRQoL, diagnosis of aneurysm and related risk factors. METHODS: subjects involved in this screening program were submitted the EQ-5D questionnaire to report their own HRQoL. HRQoL was reported also a second time by the subjects who were diagnosed with aneurysm during screening and who returned for a monitoring follow up visit a few months later. We evaluated compliance with HRQoL data collection and performed multiple regression analyses in order to investigate the possible relationship between demographic and clinical data with HRQoL. RESULTS: 1,633 subjects screened (6.1% diagnosed with aneurysm) and 125 subjects diagnosed with aneurysm and attending a follow-up visit reported their HRQoL. Completion of the EQ-5D questionnaire was well accepted by both physicians and subjects undergoing screening. HRQoL was not significantly different between the screening and followup visits, on adjusting for age and sex. At the screening visit, HRQoL was associated with ASA class, heart condition, BMI and respiratory diseases. No associations were found at the follow-up visit. CONCLUSION: Assessing HRQoL in screening programs is feasible and well accepted and add useful information on health of large numbers of subjects from general population. This could be considered as a routine approach to optimizing the informative role of screening programs in guiding other investigations or interventions.

International variations in infrainguinal bypass surgery - a VASCUNET report.

OBJECTIVES: To compare practice in lower limb bypass surgery in nine countries. DESIGN: A prospective study amalgamating and analysing data from national and regional vascular registries. METHODS: A table of data fields and definitions was agreed by all member countries of the Vascunet Collaboration. Data from January 2005 to December 2009 was submitted to a central database. RESULTS: 32,084 cases of infrainguinal bypass (IIB) in nine countries were analysed. Procedures per 100,000 population varied between 2.3 in the UK and 24.6 in Finland. The proportion of women varied from 25% to 43.5%. The median age for all countries was 70 for men and 76 for women. Hungary treated the youngest patients. IIB was performed for claudication for between 15.7% and 40.8% of all procedures. Vein grafts were used in patients operated on for claudication (52.9%), for rest pain (66.7%) and tissue loss (74.1%). Italy had the highest use of synthetic grafts. Among claudicants 45% of bypasses were performed to the below knee popliteal artery or more distally. Graft patency at 30 days varied between 86% and 99%. CONCLUSIONS: Significant variations in practice between countries were demonstrated. These results should be interpreted alongside the known limitations of such registry data with respect to quality and completeness of the data. Variation in data completeness and data validation between countries needs to be improved for useful international comparison of outcomes.

Variation in clinical practice in carotid surgery in nine countries 2005-2010. Lessons from VASCUNET and recommendations for the future of national clinical audit.

OBJECTIVES: The aim of the study was to analyse variation in carotid surgical practice, results and effectiveness in nine countries. PATIENTS AND METHODS: A total of 48,185 carotid endarterectomies (CEAs) and 4602 carotid artery stenting (CAS) procedures were included in the comparison. A theoretical effectiveness of CEA provision for each country was estimated. RESULTS: 92.6% of the CEAs were performed according to the inclusion criteria based on the current European recommendations and had a theoretical benefit for the patient. The indication for surgery was symptomatic stenosis in 60.1% and this proportion varied between 31.4% in Italy and 100% in Denmark. The overall combined stroke and death rate in symptomatic patients was 2.3%. This varied between rates of 0.9% in Italy and 3.8% in Norway. The overall combined stroke and death rate in asymptomatic patients was 0.9%. It was lowest in Italy at 0.5%, and highest in Sweden at 2.7%. We estimated that the stroke prevention rate per 1000 CEAs varied from 72.9 in Italy to 130.8 in Denmark. CONCLUSIONS: There is significant variation in clinical practice across the participating countries. The theoretical stroke prevention potential of CEA seems to vary between participating countries due to differences in the inclusion criteria.

Treatment of penetrating aortic ulcer by endoprosthesis: a single center experience.

AIM: This is a retrospective study of a single center experience in the endovascular treatment of penetrating aortic ulcer (PAU). METHODS: Sixteen consecutive patients aged 69.1±9.6 years presenting PAU (in the aortic arch in 2, the descending thoracic aorta in 11, and in the abdominal aorta in 3) undergone therapy. Nine patients presented symptomatic, while 7 were asymptomatic. All patients underwent computer tomography angiography (CTA) of the thoracic and the abdominal aorta. Endovascular therapy alone was carried out in 12 patients, while 4 received hybrid therapy. RESULTS: One patient died of multiorgan failure after hybrid procedure. Complications consisted of type II endoleak from lumbar arteries in 1 case of endovascular procedure, and acute respiratory insufficiency in 1 patient treated by endovascular technique on the emergency basis for aortic rupture. CONCLUSION: PAU involves more frequently the descending thoracic aorta. Endovascular treatment (alone or in hybrid therapy) can give good results in patients with severe concomitant diseases. Prognosis of these patients is not favourable in most cases (48-month survival rate 47.9%) due to severe concomitant diseases.

Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report.

OBJECTIVES: To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries. DESIGN AND METHODS: Data on primary AAA repairs 2005-2009 were amalgamated from national and regional vascular registries in Australia, Denmark, Finland, Hungary, Italy, Norway, Sweden, Switzerland and the UK. Primary outcome was in-hospital or 30-day mortality. Multivariate logistic regression was used to assess case-mix. RESULTS: 31,427 intact AAA repairs were identified, mean age 72.6 years (95% CI 72.5-72.7). The rate of octogenarians and use of endovascular repair (EVAR) increased over time (p < 0.001). EVAR varied between countries from 14.7% (Finland) to 56.0% (Australia). Overall perioperative mortality after intact AAA repair was 2.8% (2.6-3.0) and was stable over time. The perioperative mortality rate varied from 1.6% (1.3-1.8) in Italy to 4.1% (2.4-7.0) in Finland. Increasing age, open repair and presence of comorbidities were associated with outcome. 7040 ruptured AAA repairs were identified, mean age 73.8 (73.6-74.0). The overall perioperative mortality was 31.6% (30.6-32.8), and decreased over time (p = 0.004). CONCLUSIONS: The rate of AAA repair in octogenarians as well as EVAR increased over time. Perioperative outcome after intact AAA repair was stable over time, but improved after ruptured repair. Geographical differences in treatment of AAA remain.

Treatment of penetrating aortic ulcer by endoprosthesis: a single center experience.

AIM: This is a retrospective study of a single center experience in the endovascular treatment of penetrating aortic ulcer (PAU). METHODS:Sixteen consecutive patients aged 69.1±9.6 years presenting PAU (in the aortic arch in 2, the descending thoracic aorta in 11, and in the abdominal aorta in 3) undergone therapy. Nine patients presented symptomatic, while 7 were asymptomatic. All patients underwent computer tomography angiography (CTA) of the thoracic and the abdominal aorta. Endovascular therapy alone was carried out in 12 patients, while 4 received hybrid therapy. RESULTS:One patient died of multiorgan failure after hybrid procedure. Complications consisted of type II endoleak from lumbar arteries in 1 case of endovascular procedure, and acute respiratory insufficiency in 1 patient treated by endovascular technique on the emergency basis for aortic rupture. CONCLUSION:PAU involves more frequently the descending thoracic aorta. Endovascular treatment (alone or in hybrid therapy) can give good results in patients with severe concomitant diseases. Prognosis of these patients is not favourable in most cases (48-month survival rate 47.9%) due to severe concomitant diseases.

Outcome following carotid endarterectomy: lessons learned from a large international vascular registry.

OBJECTIVES: The aim of the study was to assess if technical and patient-related factors are related to outcome after carotid surgery. DESIGN: Vascunet is a collaboration of national and regional registries with 10 contributing countries. PATIENTS AND METHODS: Data from 48,035 carotid endarterectomies (CEAs) performed in 383 centres, during 2003-2007, were merged into a common database. RESULTS: CEA was performed without patch (34%), with patch (40%) or with eversion (26%) in 74% for symptomatic and in 26% for asymptomatic disease. Overall (in-hospital and 30-day) mortality was 0.45%. Type of CEA or anaesthesia did not affect mortality, nor did contralateral occlusion. Mortality was higher in patients above the age of 75 years, for both genders (p < 0.05). The overall (in-hospital) stroke rate was 1.9%, the method of anaesthesia did not affect stroke rate. It was higher in patients with contralateral occlusion (4.6% vs. 2.5%, p = 0.002). Standard CEA without patch had a higher stroke rate than when a patch was used (2.3 vs. 1.7%, p = 0.015). Female patients >75 years had a higher stroke rate than younger women (2.0% vs. 1.6%, p = 0.078); this difference was not observed in men. CONCLUSIONS: Although there are limitations with registry data, the large number of cases involved provides useful information on outcomes, supplementing data from the randomised clinical trials (RCTs).

District-based abdominal aortic aneurysm screening in population aged 65 years and older.

AIM: Screening for abdominal aortic aneurysms (AAAs) has been carried out in an area of Genoa (Italy) for subjects aged 65 years or more to evaluate prevalence of this disease. METHODS: Between March 2007 and September 2009 8234 subjects were screened. Ultrasound examination of the abdominal aorta and the iliac arterial segments was carried out on each subject and all data related to risk factors were collected. RESULTS: Five hundreds-twelve (6.2%) subjects were found to have an AAA: 469 (10.8%) males and 43 (1.1%) females (significant difference, P < 0.01). Based on the aortic diameter, 403 (4.9%), 80 (1.0%) and 29 (0.3%) had an AAA of 3.0-3.9 cm, 4.0-4.9 cm and ≥ 5.0 cm diameter, respectively. With regards to risk factors, family history of cardiovascular disease only resulted more frequent in subjects with AAA than in those without AAA. CONCLUSION: The prevalence of patients with AAA (6.2%) was similar to previously published estimates. Nevertheless, AAA resulted very high in males. This observation is likely due to screening in a city with a very high percentage of elderly subjects. Family predisposition to cardiovascular disease resulted significant risk factor for AAA. Results of our epidemiological study provide evidence of the usefulness of AAA screening thanks to early diagnosis and appropriate treatment of AAA.