Stimulus-driven actions are preceded by preparatory brain activity that can be expressed by event-related potentials (ERP). Literature on this topic has mainly focused on simple actions, such as the finger keypress, finding activity in frontal, parietal, and occipital areas detectable up to two seconds before the stimulus onset. However, little is known about the preparatory brain activity when the action complexity increases, and specific brain areas designated to achieve movement integration intervene. The main aim of this paper is to identify the time course of preparatory brain activity associated with actions of increasing complexity using ERP analysis and a visuomotor discrimination task. Motor complexity was manipulated by asking nineteen volunteers to provide their response by simply pressing a key or by adding to the keypress arm extensions (reaching) alone, or in combination with a standing step (involving the whole body). Results showed that these actions of increasing levels of complexity appear to be associated with different patterns of preparatory brain activity. Specifically, the simple keypress was characterized by the largest motor excitatory preparation in premotor areas paralleled by the largest prefrontal inhibitory/attentional control. Reaching presented a dominant parietal preparation confirming the role of these integration areas in reaching actions toward a goal. Stepping was characterized by localized activity in the bilateral dorsomedial parieto-occipital areas attributable to sensory readiness, for the approaching stimulus. In conclusion, the brain is able to optimally anticipate any stimulus-driven action modulating the activity in the brain areas specialized in the preparation of that action type.

Abstract Background: Binge eating (BE) is associated with a range of cognitive control deficits related to impulsivity, including lower response inhibition, preference for immediate gratification, and maladaptive decision-making. The aim was to investigate whether impulsivity and BE may interact with the decision process and underlying brain activity in obese or overweight outpatients who are starting a treatment to achieve weight loss. Methods: A sample of 26 treatment-seeking obese and overweight outpatients with and without BE was evaluated for impulsivity, binge eating, and temporal discounting rates. Impulsivity was measured with the Barratt Impulsiveness Scale (BIS-11), binge eating with the Binge Eating Scale (BES), and changes in subjective value of rewards with the Temporal Discounting Task (TDt). Brain activity was recorded through high-density electroencephalogram (hd-EEG) during the TDt. Results: Patients with BE reported more impulsive tendencies and perceived sooner rewards as more gratifying when both options were delayed (p=0.02). The reward choice in the TDt was accompanied by an EEG alpha rhythm desynchronization in parietal areas. Conclusions: The tendency to favor immediate rewards may constitute an obstacle for obtaining adherence to treatment plans and to achieve weight loss goals for obese or overweight outpatients. Clinicians are therefore encouraged to include psychological outcomes such as impulsivity and dysfunctional eating behaviors when designing a weight loss program. Trial registration: This study was approved by the Ethics Committee of the Department of Psychological, Health, and Territorial Sciences of the University G. d’Annunzio of Chieti-Pescara (Prot. n. 254 of 03/14/2017)

Abstract Background Dupuytren's disease, a chronic thickening and retraction of the palmar aponeurosis of the hands, may result in permanent and progressive flexion of one or more fingers. Percutaneous needle fasciotomy is a simple method that uses a hypodermic needle usually performed under local anaesthesia. The study aim was to report the postoperative results and complications using a percutaneous approach to treat Dupuytren's contracture in a consecutive series of patients with advanced Dupuytren’s disease, also considering the relevant medico-legal implications. Methods Retrospective multicentre study of all patients with Tubiana stage 3–4 Dupuytren's contracture treated with percutaneous needle aponeurotomy from 2012 to 2022. Patient demographics, disease severity, treatment-related complications, and the incidence of recurrence were identified. An overview of therapeutic treatment options has accounted for 52 relevant sources spanning the 2007–2023 time period. Results Overall, 41.7% (N = 200 ) of patients were females, the mean age was 72 years (60–89), the right hand was treated in 54.2% (N = 260 ) of patients. The little finger was involved in 50% of the patients. The 12 months mean PED was 9°, the mean quickDASH was 8, the mean URAM 6. Minor complications were reported in 18.7% (N = 90) of patients, typically skin lacerations (83.3%) with no clinical sequelae, and no major complications were reported. Recurrence occurred in 30% (N = 144) of patients. Conclusions Percutaneous needle fasciotomy is safe and reliable even in patients with advanced Dupuytren's disease, resulting in predictably acceptable outcome with low risk of complications.

Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating, degenerative disease of the central nervous system and the second most frequent cause of permanent disability in young adults. One of the most common issues concerns the ability to perform postural and gait tasks while simultaneously completing a cognitive task (namely, dual-task DT). Assessing cognitive-motor dual-task training effectiveness in patients with Multiple Sclerosis (PwMS) for dynamic gait quality when walking on straight, curved, and blindfolded paths. Two-arm single-blind randomized controlled trial. Follow-up at 8 weeks. Neurorehabilitation Hospital. A sample of 42 PwMS aged 28-71, with a score of 4.00±1.52 on the Expanded Disability Status Scale were recruited. Participants were randomized in conventional (CTg) neurorehabilitation and dual-task training (DTg) groups and received 12 sessions, 3 days/week/4 weeks. They were assessed at baseline (T0), after the treatment (T1), and 8 weeks after the end of the treatment (T2) through Mini-BESTest, Tinetti Performance Oriented Mobility Assessment, Modified Barthel Index, and a set of spatiotemporal parameters and gait quality indices related to stability, symmetry, and smoothness of gait extracted from initial measurement units (IMUs) data during the execution of the 10-meter Walk Test (10mWT), the Figure-of-8 Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). Thirty-one PwMS completed the trial at T2. Significant improvement within subjects was found in Mini-BESTest scores for DTg from T0 to T1. The IMU-based assessment indicated significant differences in stability (P<0.01) and smoothness (P<0.05) measures between CTg and DTg during 10mWT and Fo8WT. Substantial improvements (P<0.017) were also found in the inter-session comparison, primarily for DTg, particularly for stability, symmetry, and smoothness measures. This study supports the effectiveness of DT in promoting dynamic motor abilities in PwMS. Cognitive-motor DT implemented into the neurorehabilitation conventional program could be a useful strategy for gait and balance rehabilitation.

Subjects with a fragility fracture have an increased risk of a new fracture and should receive effective strategies to prevent new events. The medium-term to long-term strategy should be scheduled by considering the mechanisms of action in therapy and the estimated fracture risk. A systematic review was conducted to evaluate the sequential strategy in patients with or at risk of a fragility fracture in the context of the development of the Italian Guidelines. Systematic review and meta-analysis. PubMed, Embase, and the Cochrane Library were investigated up to February 2021 to update the search of a recent systematic review. Randomized clinical trials (RCTs) that analyzed the sequential therapy of antiresorptive, anabolic treatment, or placebo in patients with or at risk of a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using fixed-effects models. The primary outcome was the risk of refracture, while the secondary outcome was the bone mineral density (BMD) change. In all, 17 RCTs, ranging from low to high quality, met our inclusion criteria. A significantly reduced risk of fracture was detected at (i) 12 or 24 months after the switch from romosozumab to denosumab versus placebo to denosumab; (ii) 30 months from teriparatide to bisphosphonates versus placebo to bisphosphonates; and (iii) 12 months from romosozumab to alendronate versus the only alendronate therapy (specifically for vertebral fractures). In general, at 2 years after the switch from anabolic to antiresorptive drugs, a weighted BMD was increased at the lumbar spine, total hip, and femoral neck site. The Task Force formulated recommendations on sequential therapy, which is the first treatment with anabolic drugs or 'bone builders' in patients with very high or imminent risk of fracture.

Gender-related methodology in biomedical sciences receives considerable attention, with numerous studies highlighting biological differences between cisgender males and females. These differences influence the clinical symptoms of various diseases and impact therapeutic approaches. In this in vitro study, we investigate the potential role of sex-chromosome-related dimorphism on steroidogenic enzymes, androgen receptor (AR) expression, and cellular translocation in primary human skeletal muscle cells before and after exposure to testosterone. We analyzed 46XY and 46XX cells for 17β-hydroxysteroid dehydrogenase (17β-HSD), 5α-reductase (5α-R2), aromatase (Cyp-19), and AR gene expression. We also compared AR expression and intracellular translocation after increasing exposure to testosterone. At baseline, we observed higher mRNA expression for 5α-R2 and AR in 46XY cells and higher Cyp-19 mRNA expression in 46XX cells. Following testosterone exposure, we observed an increase in AR expression and translocation in 46XX cells, even at the lowest dose of 0.5 nM, while significant changes in 46XY cells were observed only from 10 nM. Our in vitro results demonstrate that the diverse sex chromosome assets reflect important differences in muscle steroidogenesis. They support the concept that chromosomal disparities between males and females, even in vitro, lead to pivotal variations in cellular physiology and response. This understanding represents a crucial starting point in gender medicine, ensuring a precise approach in clinical practice, sports, and exercise settings and facilitating the translation of in vitro data to in vivo applicability.

Fragile X syndrome (FXS) is the leading cause of genetic intellectual disability. Among the neurobehavioral dysfunctions in FXS individuals, language development and literacy are compromised. Recent evidence hypothesized that the disruption of excitatory glutamatergic and GABAergic inhibitory neurotransmission balance might be responsible for impairment in cognitive function. In this study, we evaluated for the first time, the safety, tolerability, and efficacy of anodal prefrontal transcranial direct current stimulation (tDCS) combined with standard speech therapy to enhance language function in FXS patients. In total, 16 adult FXS patients were enrolled. Participants underwent 45 min of anodic tDCS combined with speech therapy for 5 weeks (3 times per week). Language function was evaluated using the Test for Reception of Grammar-Version 2 (TROG-2) and subtests of the Italian Language Examination (Esame del Linguaggio - II, EDL-II). Right and left dorsolateral prefrontal cortex transcranial magnetic stimulation and concurrent electroencephalography (TMS-EEG) recordings were collected at baseline and after the treatment to evaluate cortical reactivity and connectivity changes. After 5 weeks of combined therapy, we observed a significant improvement in the writing (7.5%), reading (20.3%), repetition (13.3%), and TROG-2 (10.2%) tests. Parallelly with clinical change, TMS-EEG results showed a significant difference in TMS-evoked potential amplitude over the left frontal cortex after treatment (-0.73 ± 0.87 μV) compared to baseline (0.18 ± 0.84 μV). Our study provides novel evidence that left anodal prefrontal tDCS combined with standard speech therapy could be effective in enhancing language function in FXS patients, mainly by inducing a rebalance of the dysfunctional prefrontal cortical excitability.

The objective of this study was to analyze the perceived barriers to dual career success and athletic identity of student-athletes according to disability type and level of professionalization. The final sample consisted of 203 student-athletes with disabilities from five European countries. The questionnaires used were ESTPORT, EBBS and AIMS. Depending on disability type, it was found that student-athletes with hearing and physical impairment showed the highest difficulty in reconciling sports and studies (p = 0.001); that student-athletes with a hearing impairment showed the highest score in the barrier ‘the cost of education is high’ (p = 0.023); that student-athletes with a physical impairment had the highest scores in the barrier ‘Exercise tires me’ (p = 0.013); that student-athletes with cerebral palsy showed the highest scores in the barrier ‘I do not have enough university/educational institution support’ (p = 0.014) and ‘Exercise facilities do not have convenient timetables for me’ (p = 0.001). Depending on sports professionalization level, semi-professional student-athletes showed the highest values in the barrier ‘the university/educational institution is far from my training center’ (p = 0.040); while professional student-athletes had the highest score in the barrier ‘exercise takes too much time from family responsibilities’ (p = 0.034). In most of the variables related to identity as athletes, professional student-athletes showed the highest values, followed by semi-professional athletes (p = 0.043- < 0.001). In conclusion, the self-perception of barriers is quite relevant, with differences arising from disability type and level of professionalization, whereas the identity as an athlete is only different according to the level of professionalization.

Abstract Flexible goal-directed human cognition is supported by many forms of self-directed manipulation of representations. Among them, Inner-Speech (IS; covert self-directed speech) acts on second-order representations (e.g., goals/sub-goals), empowering attention and feedback processing. Interestingly, patients with Schizophrenia Spectrum Disorders (SSD) show impaired Executive Functions (EF; e.g., cognitive flexibility) and, probably, a related IS alteration. However, fragmentary evidence and no computational modeling prevent a clear assessment of these processes and focused therapeutic interventions. Here, we address these issues by exploiting a translational approach that integrates experimental clinical data, machine learning, and computational modeling. First, we administered the Wisconsin Cards Sorting Test (WCST; a neuropsychological test probing cognitive flexibility) to SSD patients and computed the behavioural data with a data-driven clustering algorithm. Second, we extracted the cluster neuropsychological profiles with our theory-based validated computational model of the WCST. Finally, we exploited our model to emulate an IS-based psychotherapeutic intervention for SSD subpopulations. We identified different SSD sub-populations and global trends (e.g., a descending feedback sensitivity); however, extremely different neuropsychological profiles emerged. In particular, `Relatively Intact' patients showed an unexpected profile (distraction/reasoning failures), quite divergent from the perseverative/rigid profile of the others. Importantly, the former showed no impact of Interfering-IS, while the others showed increased Interfering-IS strongly affecting their cognition. These differences highlight that SSD populations require a cluster-dependent individualisation of the intervention to achieve adequate cognitive performance. Overall, these results support a clear definition of neuropsychological profiles and the related Interfering-IS impact in SSD subpopulations, thus showing important implications for basic research (e.g., cognitive neuroscience) and clinical fields (clinical psychology and psychiatry).