Anterior Visual Pathway (aVP) damage may be linked to diverse inflammatory, degenerative and/or vascular conditions. Currently however, a standardized methodological framework for extracting MRI biomarkers of the aVP is not available. We used high-resolution, 3-D MRI data to generate a probabilistic anatomical atlas of the normal aVP and its intraorbital (iOrb), intracanalicular (iCan), intracranial (iCran), optic chiasm (OC), and tract (OT) subdivisions. We acquired 0.6 mm3 steady-state free-precession images from 24 healthy participants using a 3 T scanner. aVP masks were obtained by manual segmentation of each aVP subdivision. Mask straightening and normalization with cross-sectional area (CSA) preservation were obtained using scripts developed in-house. A probabilistic atlas (“aVP-24”) was generated by averaging left and right sides of all subjects. Leave-one-out cross-validation with respect to interindividual variability was performed employing the Dice Similarity Index (DSI). Spatially normalized representations of the aVP subdivisions were generated. Overlapping CSA values before and after normalization demonstrate preservation of the aVP cross-section. Volume, length, CSA, and ellipticity index (ε) biometrics were extracted. The aVP-24 morphology followed previous descriptions from the gross anatomy. Atlas spatial validation DSI scores of 0.85 in 50% and 0.77 in 95% of participants indicated good generalizability across the subjects. The proposed MRI standardization framework allows for previously unavailable, geometrically unbiased biometric data of the entire aVP and provides the base for future spatial-resolved, group-level investigations.

Objective Bilingualism has been associated with cognitive benefits and a potential protective effect against neurodegenerative conditions. Previous research has shown that bilingual individuals exhibit greater white matter integrity compared to monolinguals of the same age. However, the impact of foreign-language learning on brain structure in older adults during the initial stages of language acquisition remains uncertain. This study aimed to investigate the cognitive and structural effects of a four-month-long foreign language learning program in a group of healthy monolinguals older adult. Materials and Methods Thirteen Italian-speaking participants (aged 59-78) underwent a four-month intensive English course for beginners. Pre- and post-assessments were conducted to evaluate executive cognitive functions, as well as diffusion tensor imaging (DTI) to examine brain structural changes. Results The study findings showed substantial increases in axial, radial, and mean diffusivity during the four-month language learning period. The most prominent variations were observed in key brain regions, namely the fronto-occipital fasciculus, the superior longitudinal fasciculus, and the corpus callosum areas. Notably, brain-behaviour correlations indicated a robust positive relationship between changes in axial diffusivity and performance on the Stroop task, a well-established measure of cognitive interference inhibition. Conclusions These findings suggest that a four-month foreign language learning program can lead to structural changes in the brain, particularly affecting white matter integrity and that these structural changes are associated with improvements in executive functions. The study underscores the potential of brief language learning interventions to influence brain structure and enhance cognitive abilities in older adults. Highlights ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement GB acknowledges partial funding from the project Departments of Excellence of the Italian Ministry of Education University and Research MIUR. This work was also partially supported by the Departments of Excellence 2018 2022 initiative of the Italian Ministry of Education University and Research for the Department of Neuroscience Imaging and Clinical Sciences DNISC of the University of Chieti Pescara, and the NRRP Mission 4 Education and Research Component 2 From Research to Business Investment 1 2 Funding projects presented by young researchers Seal of Excellence Next Generation EU SOE0000062 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Informed consent was obtained from all participants, and the study was approved by the Institutional and Ethical Committee of the University "G. d'Annunzio" of Chieti-Pescara. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

BACKGROUND AND PURPOSE: Surgical resection of cerebral cavernous malformations close to eloquent regions frequently uses fMRI and DTI for surgical planning to best preserve neurologic function. This study investigates the reliability of fMRI and DTI near cerebral cavernous malformations. MATERIALS AND METHODS: Consecutive patients with cerebral cavernous malformations undergoing presurgical fMRI and DTI mapping were identified. Each cerebral cavernous malformation was hand-contoured; 2 sequential 4-mm expansion shells (S1 and S2) were created, generating 2 ROIs and 2 contralateral controls. Fractional anisotropy and regional homogeneity measurements were then extracted from each ROI and compared with the contralateral controls. Reliability, accuracy, and precision were compared as appropriate. RESULTS: Fifty-four patients were identified and included. Errors of fractional anisotropy were significantly lower than those of regional homogeneity in S1 and S2 (P < .001), suggesting that fractional anisotropy is more reliable than regional homogeneity near cerebral cavernous malformations. Proximity to cerebral cavernous malformations worsened the reliability of regional homogeneity (S1 versus S2, P < .001), but not fractional anisotropy (P = .24). While fractional anisotropy was not significantly biased in any ROI (P > .05), regional homogeneity was biased toward lower signals in S1 and S2 (P < .05), an effect that was attenuated with distance from cerebral cavernous malformations (P < .05). Fractional anisotropy measurements were also more precise than regional homogeneity in S1 and S2 (P < .001 for both). CONCLUSIONS: Our findings suggest that hemosiderin-rich lesions such as cerebral cavernous malformations may lead to artifactual depression of fMRI signals and that clinicians and surgeons should interpret fMRI studies near cerebral cavernous malformations with caution. While fMRI is considerably affected by cerebral cavernous malformation–related artifacts, DTI appears to be relatively unaffected and remains a reliable imaging technique near cerebral cavernous malformations.

Committeri Giorgia, Danilo Bondi, Carlo Sestieri, Ginevra Di Matteo, Claudia Piervincenzi, Christian Doria, Roberto Ruffini, Antonello Baldassarre, Tiziana Pietrangelo, Rosamaria Sepe, Riccardo Navarra, Piero Chiacchiaretta, Antonio Ferretti, and Vittore Verratti. Neuropsychological and neuroimaging correlates of high-altitude hypoxia trekking during the "Gokyo Khumbu/Ama Dablam" expedition. High Alt Med Biol 00:000-000, 2021.Background: Altitude hypoxia exposure may produce cognitive detrimental adaptations and damage to the brain. We aimed at investigating the effects of trekking and hypoxia on neuropsychological and neuroimaging measures.Methods: We recruited two balanced groups of healthy adults, trekkers (n = 12, 6 F and 6 M, trekking in altitude hypoxia) and controls (gender- and age-matched), who were tested before (baseline), during (5,000 m, after 9 days of trekking), and after the expedition for state anxiety, depression, verbal fluency, verbal short-term memory, and working memory. Personality and trait anxiety were also assessed at a baseline level. Neuroimaging measures of cerebral perfusion (arterial spin labeling), white-matter microstructural integrity (diffusion tensor imaging), and resting-state functional connectivity (functional magnetic resonance imaging) were assessed before and after the expedition in the group of trekkers.Results: At baseline, the trekkers showed lower trait anxiety (p = 0.003) and conscientiousness (p = 0.03) than the control group. State anxiety was lower in the trekkers throughout the study (p < 0.001), and state anxiety and depression decreased at the end of the study in both groups (p = 0.043 and p = 0.007, respectively). Verbal fluency increased at the end of the study in both groups (p < 0.001), whereas verbal short-term memory and working memory performance did not change. No significant differences between before and after the expedition were found for neuroimaging measures.Conclusions: We argue that the observed differences in the neuropsychological measures mainly reflect aspecific familiarity and learning effects due to the repeated execution of the same questionnaires and task. The present results thus suggest that detrimental effects on neuropsychological and neuroimaging measures do not necessarily occur as a consequence of short-term exposure to altitude hypoxia up to 5,000 m, especially in the absence of altitude sickness.

Purpose To investigate the diagnostic efficacy of MRI diagnostic algorithms with an ascending automatization, in distinguishing between high-grade glioma (HGG) and solitary brain metastases (SBM). Methods 36 patients with histologically proven HGG (n = 18) or SBM (n = 18), matched by size and location were enrolled from a database containing 655 patients. Four different diagnostic algorithms were performed serially to mimic the clinical setting where a radiologist would typically seek out further findings to reach a decision: pure qualitative, analytic qualitative (based on standardized evaluation of tumor features), semi-quantitative (based on perfusion and diffusion cutoffs included in the literature) and a quantitative data-driven algorithm of the perfusion and diffusion parameters. The diagnostic yields of the four algorithms were tested with ROC analysis and Kendall coefficient of concordance. Results Qualitative algorithm yielded sensitivity of 72.2%, specificity of 78.8%, and AUC of 0.75. Analytic qualitative algorithm distinguished HGG from SBM with a sensitivity of 100%, specificity of 77.7%, and an AUC of 0.889. The semi-quantitative algorithm yielded sensitivity of 94.4%, specificity of 83.3%, and AUC = 0.889. The data-driven algorithm yielded sensitivity = 94.4%, specificity = 100%, and AUC = 0.948. The concordance analysis between the four algorithms and the histologic findings showed moderate concordance for the first algorithm, (k = 0.501, P < 0.01), good concordance for the second (k = 0.798, P < 0.01), and third (k = 0.783, P < 0.01), and excellent concordance for fourth (k = 0.901, p < 0.0001). Conclusion When differentiating HGG from SBM, an analytical qualitative algorithm outperformed qualitative algorithm, and obtained similar results compared to the semi-quantitative approach. However, the use of data-driven quantitative algorithm yielded an excellent differentiation.

Background: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic small-vessel disease that is characterized by a wide range of neurologic and neuropsychological impairments. Constructional impairments have been reported in some cases but have never been assessed systematically. Objective: To evaluate constructional abilities and their cognitive and neural correlates in nondemented individuals with CADASIL. Method: Thirty individuals with CADASIL who were not affected by clinically relevant cognitive deterioration and 30 healthy controls (HC) underwent an extensive cognitive assessment and paper-and-pencil visuoconstructional tasks in order to detect constructional impairments. Performance on the visuoconstructional tasks was correlated with the cognitive assessment scores and with quantitative indices of regional gray matter atrophy (obtained via FreeSurfer image analysis) and white matter involvement. Results: The individuals with CADASIL achieved significantly lower scores on the cognitive assessment compared with the HC. Poor visuoconstructional abilities were observed in seven (23.3%) of the individuals with CADASIL when performing the copy drawing task and in nine (30%) when performing the Rey Complex Figure Test. Logistic regression revealed that visuoconstructional impairments were significantly associated with scores on the Frontal Assessment Battery and the Attentional Matrices Test. Morphometric results revealed that scores on the visuoconstructional tasks were related to gray matter atrophy of the left frontal lobe and right parietal lobe. Conclusion: Impairments on visuoconstructional tasks are quite common in individuals with CADASIL, even in the lack of clinically relevant cognitive deterioration, and are critically related to frontal and parietal atrophy.

Brain tumor surgery requires a delicate tradeoff between complete removal of neoplastic tissue while minimizing loss of brain function. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) have emerged as valuable tools for non-invasive assessment of human brain function and are now used to determine brain regions that should be spared to prevent functional impairment after surgery. However, image analysis requires different software packages, mainly developed for research purposes and often difficult to use in a clinical setting, preventing large-scale diffusion of presurgical mapping. We developed a specialized software able to implement an automatic analysis of multimodal MRI presurgical mapping in a single application and to transfer the results to the neuronavigator. Moreover, the imaging results are integrated in a commercially available wearable device using an optimized mixed-reality approach, automatically anchoring 3-dimensional holograms obtained from MRI with the physical head of the patient. This will allow the surgeon to virtually explore deeper tissue layers highlighting critical brain structures that need to be preserved, while retaining the natural oculo-manual coordination. The enhanced ergonomics of this procedure will significantly improve accuracy and safety of the surgery, with large expected benefits for health care systems and related industrial investors.

Myofascial pain in the masticatory region, generally referred to as headache, is a common temporomandibular disorder (TMD) characterized by the hypersensitive regions of the contracted skeletal muscle fibers. A correct clinical treatment of myofascial pain has the potential to modify the functional activation of cerebral networks associated with pain and unconscious teeth clenching, specifically the pain network (PN) and default mode network (DMN). In this study, research is presented as a case series of five patients with myofascial pain: three were diagnosed with intra- and extra-articular disorders, and two were diagnosed with only extra-articular disorders. All five patients received gnathological therapy consisting of passive splints and biofeedback exercises for tongue–palatal vault coordination. Before and after treatment, patients underwent pain assessments (through measures of visual analog scales and muscular palpation tests), nuclear magnetic resonance of the temporomandibular joint, and functional nuclear magnetic resonance of the brain. In each patient, temporomandibular joint nuclear magnetic resonance results were similar before and after the gnathological treatment. However, the treatment resulted in a considerable reduction in pain for all patients, according to the visual analog scales and the palpation test. Furthermore, functional nuclear magnetic resonance of the brain clearly showed a homogeneous modification in cerebral networks associated with pain (i.e., PN and DMN), in all patients. In conclusion, gnathological therapy consisting of passive aligners and biofeedback exercises improved myofascial pain in all five patients. Most importantly, this study showed that all five patients had a homogeneous functional modification of pain and default mode networks. Using passive splints in combination with jaw exercises may be an effective treatment option for patients with TMD. This research could be a starting point for future investigations and for clinicians who want to approach similar situations.

Premature birth affects the developmental trajectory of the brain during a period of intense maturation with possible lifelong consequences. To better understand the effect of prematurity on brain structure and function, we performed blood-oxygen-level dependent (BOLD) and anatomical magnetic resonance imaging (MRI) at 40 weeks of postmenstrual age on 88 newborns with variable gestational age (GA) at birth and no evident radiological alterations. We extracted measures of resting-state functional connectivity and activity in a set of 90 cortical and subcortical brain regions through the evaluation of BOLD correlations between regions and of fractional amplitude of low-frequency fluctuation (fALFF) within regions, respectively. Anatomical information was acquired through the assessment of regional volumes. We performed univariate analyses on each metric to examine the association with GA at birth, the spatial distribution of the effects, and the consistency across metrics. Moreover, a data-driven multivariate analysis (i.e., Machine Learning) framework exploited the high dimensionality of the data to assess the sensitivity of each metric to the effect of premature birth. Prematurity was associated with bidirectional alterations of functional connectivity and regional volume and, to a lesser extent, of fALFF. Notably, the effects of prematurity on functional connectivity were spatially diffuse, mainly within cortical regions, whereas effects on regional volume and fALFF were more focal, involving subcortical structures. While the two analytical approaches delivered consistent results, the multivariate analysis was more sensitive in capturing the complex pattern of prematurity effects. Future studies might apply multivariate frameworks to identify premature infants at risk of a negative neurodevelopmental outcome.

Left ventricular assist device (LVAD) is considered a standard care for patients with advanced heart failure. The aim of this work was to study in vitro the effects of direct exposure of the Jarvik 2000 LVAD to 10-MV photon beams. Jarvik 2000 pump was immersed in a siliconized box filled with deionized water. A 30 × 30 × 15 cm RW3 slabs were added forth and back to the box. A treatment plan consisting of a single direct 10 × 10 cm2 field size beam was used to deliver 1000 MU at the center of the pump. During irradiation, the external Flow Maker controller and the lithium battery were positioned away from the beam. Pump parameter data (included voltage, current and frequency) were measured, recorded and analyzed for changes in pump function among baseline, pre-irradiation, during irradiation, post-irradiation and after 6 months. The whole session lasted 6 months. The Mann–Whitney U test was used to compare the repeated measurements. X-ray radiation attenuation was also studied. The parameters investigated remained stable over the 6 months; that is, no pump stops, alarms, events, operational changes or abnormalities during the discharge rate of the connected power sources, were encountered, confirmed by the Mann–Whitney U test applied to all sessions (p > 0.1). The measured X-ray attenuation differed from the calculated one by TPS by 34%. The Jarvik 2000 resulted stable under direct X-ray beam of 10-MV energy. Its strong attenuation, however, can affect dose deposition in the pump in TPS, and it must be taken into account.

AbstractAlthough aging is considered to be an unavoidable event, recent experimental evidence suggests that the process can be delayed, counteracted, if not completely interrupted. Aging is the primary risk factor for the onset and development of neurodegenerative conditions like Alzheimer’s disease, Parkinson’s disease, and Amyotrophic Lateral Sclerosis. Intracellular calcium (Ca2+i) dyshomeostasis, mitochondrial dysfunction, oxidative stress, and lipid dysregulation are critical factors that contribute to senescence-related processes. Ceramides, a class of sphingolipids involved in a wide array of biological functions, are important mediators of cellular senescence, but their role in neuronal aging is still largely unexplored.In this study, we investigated the effects of L-cycloserine (L-CS), an inhibitor ofde novoceramide biosynthesis, on the aging phenotype of cortical neurons that have been maintained in culture for 22 days, a setting employed as anin vitromodel of cellular senescence. Our findings indicate that ‘aged’ neurons display, when compared to control cultures, overt dysregulation of cytosolic and subcellular [Ca2+]ilevels, mitochondrial dysfunction, increased reactive oxygen species generation, altered synaptic activity as well as the activation of neuronal death-related molecules. Treatment with L-CS (30 µM) positively affected the senescent phenotype, a result accompanied by recovery of neuronal [Ca2+]isignaling, and reduction of mitochondrial dysfunction and reactive oxygen species generation.The results suggest that thede novoceramide biosynthesis may represent a critical intermediate in the molecular and functional cascade leading to neuronal senescence. Our findings also identify ceramide biosynthesis inhibitors as promising pharmacological tools to decrease age-related neuronal dysfunctions.

Decline in fluid abilities in normal aging is associated with increased white matter lesions, measured on T1-weighted images as white matter signal abnormalities (WMSAs). WMSAs are particularly evident in hypertensive older adults, suggesting vascular involvement. However, because hypertension is assessed systemically, the specific role of cerebral arterial stiffening in WMSAs has yet to be demonstrated. In 93 cognitively normal adults (aged 18–87 years), we used a novel method to measure cerebral arterial elasticity (pulse relaxation function [PReFx]) with diffuse optical tomography (pulse-DOT) and investigated its association with WMSAs, age, and cognition. PReFx was associated with WMSAs, with older adults with low PReFx showing the greatest WMSA burden. PReFx in brain regions perfused by the middle cerebral artery showed the largest associations with WMSAs and partially mediated the relationship between age and WMSAs. Finally, WMSAs partially mediated the relationship between PReFx and fluid but not crystallized abilities scores. Taken together, these findings suggest that loss of cerebral arterial elasticity is associated with cerebral white matter lesions and age-related cognitive decline.

Background and objective. - Application parameters of transcranial direct current stimulation (tDCS) for therapeutic purposes are relatively restricted. The aim of this study was to assess safety and effects on motor cortex excitability of an intensive anodal-tDCS protocol. Methods. - In 26 healthy subjects, five 15-minute anodal-tDCS sessions were delivered, at increasing time intervals, over 24 hours. Safety was defined as absence of serious adverse events including brain tissue alterations on magnetic resonance imaging. Effect on motor cortex excitability was evaluated by motor evoked potential (MEP) amplitude, measured eight times. Results. - No serious adverse events occurred. Mild adverse events, such as reversible scalp erythema or transient metallic taste, were observed in 27% of subjects. MEP amplitudes did not change in any of the recording periods. When inter-individual variability was taken into account and threshold values defined, 50% of subjects were classified as responders, 15% were inverse responders, and 35% non-responders. In the responders, normalized MEP was increased by 57% 1 hour after the first anodal-tDCS and increased by 50% three hours after two stimulations delivered 1 hour apart. Intra-individual, inter-sessional consistency of MEP response over four measurements was 61-77%. Discussion. - Five anodal-tDCS delivered in 24 hours are safe and well tolerated, expanding the safety standard of tDCS. However, only half of subjects respond to anodal-tDCS with a robust and durable MEP augmentation. On the other hand, the response to a single anodal-tDCS predicts fairly well the response to other sessions in the same subject. Conclusions. -These findings should be considered in clinical trials utilizing repeated anodal-tDCS. (C) 2018 Elsevier Masson SAS. All rights reserved.

Although aging is considered to be an unavoidable event, recent experimental evidence suggests that the process can be counteracted. Intracellular calcium (Ca2+i) dyshomeostasis, mitochondrial dysfunction, oxidative stress, and lipid dysregulation are critical factors that contribute to senescence-related processes. Ceramides, a pleiotropic class of sphingolipids, are important mediators of cellular senescence, but their role in neuronal aging is still largely unexplored. In this study, we investigated the effects of L-cycloserine (L-CS), an inhibitor of thede novoceramide biosynthesis, on the aging phenotype of cortical neurons cultured for 22 days, a setting employed as anin vitromodel of senescence. Our findings indicate that, compared to control cultures, 'aged' neurons display dysregulation of [Ca2+]ilevels, mitochondrial dysfunction, increased generation of reactive oxygen species (ROS), altered synaptic activity as well as the activation of neuronal death-related molecules. Treatment with L-CS positively affected the senescent phenotype, a result associated with recovery of neuronal [Ca2+]isignaling and reduction of mitochondrial dysfunction and ROS generation. The results suggest that thede novoceramide biosynthesis represents a critical intermediate in the molecular and functional cascade leading to neuronal senescence and identify ceramide biosynthesis inhibitors as promising pharmacological tools to decrease age-related neuronal dysfunctions.

Background: MRI plays a crucial role to identify men with a high likelihood of clinically significant prostate cancer who require immediate biopsy. The added value of DCE MRI in combination with T2-weighted imaging and DWI is controversial (risks related to gadolinium administration, duration of MR exam, financial burden, effects on diagnostic performance). A comparison of a biparametric and a standard multiparametric MR imaging protocol, taking into account the different experience of the readers, may help to choose the best MR approach regarding diagnostic performance. Purpose: To determine the added value of dynamic contrasted-enhanced imaging (DCE) over T2-weighted imaging (T2-WI) and diffusion weighted imaging (DWI) for the detection of clinically significant prostate cancer, and to evaluate how it affects the diagnostic performance of three readers with different grade of experience in prostate imaging. Materials and methods: Eighty-five patients underwent prostate MR examination at 1.5 T MR scanner performed because of elevated prostate-specific antigen level and/or suspicion of prostate cancer at digital rectal examination. Two MR images sets (Set 1 = biparametric, Set 2 = multiparametric) were retrospectively and independently scored by three radiologists with 7, 3 and 1 years of experience in prostate MR imaging respectively, according to PI-RADS v2. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated by dichotomizing reader scores. Receiver operating characteristic (ROC) analysis was performed and areas under the curve (AUCs) were calculated for each reader and image set. A comparison of ROC curves was performed to test the difference between the areas under the ROC curves among the three readers. Results: There was no significant difference regarding the detection of clinically significant tumor among the three readers between the two image sets. The AUC for the bi-parametric and multi-parametric MR imaging protocol was respectively 0.68-0.72 (Reader 1), 0.72-0.70 (Reader 2) and 0.60-0.54 (Reader 3). ROC curve comparison revealed no statistically significant differences for each protocol among the most experienced (Reader 1) and the other readers (Readers 2-3). Conclusion: The diagnostic accuracy of a bi-parametric MR imaging protocol consisting of T2-weighted imaging and DWI is comparable with that of a standard multi-parametric imaging protocol for the detection of clinically significant prostate cancer. The experience of the reader does not significantly modify the diagnostic performance of both MR protocols.

Purpose Ventricular Assist Device (VAD) improves quality of life, but in patients requiring also radiotherapy its performance might be conditioned. We attempted measurements of basic operating parameters in vitro setting under high-energy photon beams with Jarvik2000 VAD. Methods Jarvik2000 was a turbine pump (diameter = 2.5 cm, length = 5.5 cm, weight = 85 g) with neodymium-iron-boron magnet impeller supported by ceramic bearings and housed inside a titanium-welded shell. Implanted in left ventricle, the VAD made blood flow into the descending thoracic aorta and ensured perfusion of the organs by alternating two operating states: S1 (high-speed in 64 sec.) and S2 (low-speed in 8 sec). The device was connected to an external FlowMaker controller delivering power via a tunnelled driveline from a lithium ion battery. The in vitro setting consisted of a RW3 phantom with Plexiglas siliconized box filled with deionized water containing the pump. This was located and irradiated at the isocenter of a Synergy Agility (Elekta, Crawley) using 10MV photon beam, 1000 M.U. and a 20 × 20 cm2 field. Voltage, current and frequency parameters of VAD alternating power supply were first measured to establish reference values in the BaseLine session. Then they were compared to those obtained immediately before, during and after irradiation (“PreRad”, “Irradiation” and “PostRad” sessions respectively) and finally two months later (“Final Verification” session). Results No changes were recorded in the registered parameters after each session. The VAD system worked stably. Figure shows both behaviour of voltage(mV), current(mA) and frequency(Hz) in S1 and S2 operating states during BaseLine session(a) and voltage(b), current(c) and frequency(d) of the five sessions during S1 state. Conclusions Ventricular Assist Device (VAD) improves quality of life, but in patients requiring also radiotherapy its performance might be conditioned. We attempted measurements of basic operating parameters in vitro setting under high-energy photon beams with Jarvik2000 VAD. Jarvik2000 was a turbine pump (diameter = 2.5 cm, length = 5.5 cm, weight = 85 g) with neodymium-iron-boron magnet impeller supported by ceramic bearings and housed inside a titanium-welded shell. Implanted in left ventricle, the VAD made blood flow into the descending thoracic aorta and ensured perfusion of the organs by alternating two operating states: S1 (high-speed in 64 sec.) and S2 (low-speed in 8 sec). The device was connected to an external FlowMaker controller delivering power via a tunnelled driveline from a lithium ion battery. The in vitro setting consisted of a RW3 phantom with Plexiglas siliconized box filled with deionized water containing the pump. This was located and irradiated at the isocenter of a Synergy Agility (Elekta, Crawley) using 10MV photon beam, 1000 M.U. and a 20 × 20 cm2 field. Voltage, current and frequency parameters of VAD alternating power supply were first measured to establish reference values in the BaseLine session. Then they were compared to those obtained immediately before, during and after irradiation (“PreRad”, “Irradiation” and “PostRad” sessions respectively) and finally two months later (“Final Verification” session). No changes were recorded in the registered parameters after each session. The VAD system worked stably. Figure shows both behaviour of voltage(mV), current(mA) and frequency(Hz) in S1 and S2 operating states during BaseLine session(a) and voltage(b), current(c) and frequency(d) of the five sessions during S1 state.

To investigate modifications of Magnetic Resonance Diffusion Tensor Imaging (DTI) and Diffusion Kurtosis Imaging (DKI) metrics in lateral white matter (WM) bundles of the cervical spinal cord in patients with previous stroke in the vascular territory of the middle cerebral artery (MCA).

To assess safety and effects of five C-tDCS (charge density 342,857 C/m2) delivered at increasing time intervals in 25 h. Safety was defined as absence of serious adverse events and by magnetic resonance imaging and spectroscopy. Effects on motor cortex excitability were evaluated by motor evoked potential (MEP) amplitudes. Inter-individual MEP variability was calculated by the SEM at baseline and subjects were classified on the basis of the ratio between normalized MEPs after the first stimulation compared to baseline. Thirty-two healthy subjects were enrolled. No serious adverse events occurred. Magnetic resonance imaging and spectroscopy did not show structural and biochemical alterations. Only 56% of subjects responded to cathodal-tDCS with the expected reduction of MEP amplitude, 25% were non-responders and 19% opposite responders. In responders, MEP suppression was 32% one hour after the first cathodal-tDC, 21% three hours after the second, no longer present four hours after the third and 12 h after the fourth cathodal-tDCS. Loss of effect was due to the increasing interval between C-tDCS and not to intervening homeostatic plasticity. Five C-tDCS in 25 h are safe. Interindividual variability on motor cortex excitability and effect duration limited to three hours should be considered in planning therapeutic trials utilizing repeated C-tDCS.

The Trauma Symptom Inventory-2 (TSI-2) is a broad-spectrum assessment instrument designed to identify symptoms that can appear in the aftermath of potentially traumatic experiences.This study aimed to evaluate the external and internal validity of this newly reconstructed instrument.In total, 696 individuals participated in the study, including 83 psychiatric outpatients. Participants answered the TSI-2, together with a trauma history questionnaire, and other questionnaires assumed to correlate with the different scales included in the TSI-2.Validity was evaluated by correlations between the TSI-2 and the other instruments and by the differences between clinical and non-clinical populations. Reliability was calculated by testing internal consistency and test-re-test reliability. A confirmatory factor analysis (CFA) was computed to test the postulated four-factor structure. Cronbach's alpha was found to be good and ranged from α = .77 to .91 and test-retest reliability was strong. Strong to satisfactory correlations were found between the TSI-2 and the other instruments. The student sample scored significantly lower than the clinical group on all clinical scales. Sensitivity and specificity were calculated with different cut-off scores.Despite the CFA demonstrating a questionably good model of fit, most of the scales proved to be sound and the TSI-2 could be recommended as a broad-spectrum assessment instrument.