Many evidence suggest that recognizing and sharing emotions with others require a first-hand expe... more Many evidence suggest that recognizing and sharing emotions with others require a first-hand experience of those emotions in our own body which, in turn, depends on the adequate perception of our own internal state (interoception) through preserved sensory pathways. Here we explored the contribution of interoception to first-hand emotional experiences and to the recognition of others' emotions. For this aim ten individuals with sensory deafferentation as a consequence of high spinal cord injury (SCI) (5 males and 5 females; mean age: 48±14.8 years) and twenty healthy subjects matched for age, sex and education were included in the study. Recognition of facial expressions and judgment of emotionally evocative scenes were investigated in both groups using the Ekman and Friesen set of Pictures of Facial Affect and the International Affective Picture System. A two-way mixed ANOVA and post-hoc comparisons were used to test differences among emotions and groups. As compared to healthy subjects, individuals with SCI, when asked to judge emotionally evocative scenes, had difficulties in judging their own emotional response to complex scenes eliciting fear and anger, while they were able to recognize the same emotions when conveyed by facial expressions. Our findings endorse a simulative view of emotional processing according to which the proper perception of our own internal state (interoception), through preserved sensory pathways, is crucial for first-hand experiences of the more primordial emotions such as fear and anger.
To validate the Italian version of the Coma Recovery Scale-Revised (CRS-R). Two observers applied... more To validate the Italian version of the Coma Recovery Scale-Revised (CRS-R). Two observers applied the Italian version of the CRS-R to selected patients. On day 1, observer A and B independently scored each patient; the comparison of their observations was used to evaluate inter-observer agreement. On day 2, observer A completed a second evaluation and the comparison of this observation with that obtained on day 1 by the same observer was used to evaluate test-re-test agreement. For each evaluation, also diagnostic impression (vegetative state/minimally conscious state) was reported. Thirty-eight patients were evaluated (mean age ± SD, 58.9 ± 13.8 years). Inter-observer (ρ = 0.81; p < 0.001) as well as test-re-test agreement (ρ = 0.97; p < 0.001) for the total score was high. Inter-observer agreement was excellent for the communication sub-scale, good for the auditory, visual and motor sub-scales and moderate for the oromotor/verbal and arousal sub-scales. Test-re-test agreement was excellent for the visual, motor, oromotor/verbal and communication sub-scales, good for the auditory sub-scale and moderate for the arousal sub-scale. When considering the diagnostic impression, inter-observer agreement was good (κ = 0.75; p < 0.001) and test-re-test agreement was excellent (κ = 0.92; p < 0.001). The Italian version of the CRS-R can be administered reliably and can be also employed to discriminate patients in vegetative and in minimally conscious state.
Abstract Doxycycline inhibits amyloid formation in vitro and its therapeutic efficacy is under ev... more Abstract Doxycycline inhibits amyloid formation in vitro and its therapeutic efficacy is under evaluation in clinical trials for different protein conformational diseases, including prion diseases, Alzheimer's disease and transthyretin amyloidosis. In patients on chronic hemodialysis, a persistently high concentration of β2-microglobulin causes a form of amyloidosis (dialysis-related amyloidosis, DRA) localized in bones and ligaments. Since doxycycline inhibits β2-microglobulin fibrillogenesis in vitro and accumulates in bones, DRA represents an ideal form of amyloidosis where doxycycline may reach a therapeutic concentration at the site of amyloid deposition. Three patients on long-term dialysis with severe articular impairment and uncontrollable pain due to DRA were treated with 100 mg of doxycycline daily. Pharmacokinetics and safety of treatment were conducted. Plasmatic levels of the drug reached a plateau after one week (1.1-2.3 µg/ml). Treatment was well tolerated in two patients for a year, while one was suspended after 5 months due to mild esophagitis. Treatment was associated with a significant reduction in articular pain and with a significant and measurable improvement in passive and active movements in all cases, despite the persistence of unchanged amyloid deposits measured by magnetic resonance imaging.
The objective of this study was to identify the impact of comorbidities on outcomes of patients w... more The objective of this study was to identify the impact of comorbidities on outcomes of patients with vegetative state (VS) or minimally conscious state (MCS). All patients in VS or MCS consecutively admitted to two Post-Acute Care Units within a 1-year period were evaluated at baseline and at 6 months through the Coma Recovery Scale - Revised Version (CRS-R) and the Disability Rating Scale (DRS). Comorbidities were also recorded for each patient along the same period. Six-month outcomes included death, full recovery of consciousness, and functional improvement. One hundred and thirty-nine patients (88 men and 51 women, median age 59 years) were included. Ninety-seven patients were in VS (70%) and 42 in MCS (30%). At 6 months, 33 patients were dead (24%), 39 had a full recovery of consciousness (28%) and 67 remained in VS or MCS (48%). According to DRS scores, 40% of patients (n=55) showed a functional improvement in the level of disability. One hundred and thirty patients (94%) showed at least one comorbidity. Severity of comorbidities (HR=2.8, 95% CI 1.71-4.68; p<0.001) and the presence of ischemic or organic heart diseases (HR 2.6, 95% CI 1.21-5.43; p=0.014) were the strongest predictors of death together with increasing age (HR=1.0, 95% CI 1.0-1.06; p=0.033). Respiratory diseases and arrhythmias without organic heart diseases were negative predictors of full recovery of consciousness (OR=0.3, 95% CI 0.12-0.7, p=0.006; OR=0.2, 95% CI 0.07-0.43, p<0.001) and functional improvement (OR=0.4, 95% CI 0.15-0.85, p=0.020; OR=0.2, CI 0.08-0.45, p<0.001). Our data show that comorbidities are common in these patients and some of them influence recovery of consciousness and outcomes.
There is much evidence to suggest that recognizing and sharing emotions with others require a fir... more There is much evidence to suggest that recognizing and sharing emotions with others require a first-hand experience of those emotions in our own body which, in turn, depends on the adequate perception of our own internal state (inter-oception) through preserved sensory pathways. Here we explored the contribution of interoception to first-hand emotional experiences and to the recognition of others' emotions. For this aim, 10 individuals with sensory deafferentation as a consequence of high spinal cord injury (SCI; five males and five females; mean age, 48 – 14.8 years) and 20 healthy subjects matched for age, sex, and education were included in the study. Recognition of facial expressions and judgment of emotionally evocative scenes were investigated in both groups using the Ekman and Friesen set of Pictures of Facial Affect and the International Affective Picture System. A two-way mixed analysis of variance and post hoc comparisons were used to test differences among emotions and groups. Compared with healthy subjects, individuals with SCI, when asked to judge emotionally evocative scenes, had difficulties in judging their own emotional response to complex scenes eliciting fear and anger, while they were able to recognize the same emotions when conveyed by facial expressions. Our findings endorse a simulative view of emotional processing according to which the proper perception of our own internal state (interoception), through preserved sensory pathways, is crucial for first-hand experiences of the more primordial emotions, such as fear and anger.
Many evidence suggest that recognizing and sharing emotions with others require a first-hand expe... more Many evidence suggest that recognizing and sharing emotions with others require a first-hand experience of those emotions in our own body which, in turn, depends on the adequate perception of our own internal state (interoception) through preserved sensory pathways. Here we explored the contribution of interoception to first-hand emotional experiences and to the recognition of others' emotions. For this aim ten individuals with sensory deafferentation as a consequence of high spinal cord injury (SCI) (5 males and 5 females; mean age: 48±14.8 years) and twenty healthy subjects matched for age, sex and education were included in the study. Recognition of facial expressions and judgment of emotionally evocative scenes were investigated in both groups using the Ekman and Friesen set of Pictures of Facial Affect and the International Affective Picture System. A two-way mixed ANOVA and post-hoc comparisons were used to test differences among emotions and groups. As compared to healthy subjects, individuals with SCI, when asked to judge emotionally evocative scenes, had difficulties in judging their own emotional response to complex scenes eliciting fear and anger, while they were able to recognize the same emotions when conveyed by facial expressions. Our findings endorse a simulative view of emotional processing according to which the proper perception of our own internal state (interoception), through preserved sensory pathways, is crucial for first-hand experiences of the more primordial emotions such as fear and anger.
To validate the Italian version of the Coma Recovery Scale-Revised (CRS-R). Two observers applied... more To validate the Italian version of the Coma Recovery Scale-Revised (CRS-R). Two observers applied the Italian version of the CRS-R to selected patients. On day 1, observer A and B independently scored each patient; the comparison of their observations was used to evaluate inter-observer agreement. On day 2, observer A completed a second evaluation and the comparison of this observation with that obtained on day 1 by the same observer was used to evaluate test-re-test agreement. For each evaluation, also diagnostic impression (vegetative state/minimally conscious state) was reported. Thirty-eight patients were evaluated (mean age ± SD, 58.9 ± 13.8 years). Inter-observer (ρ = 0.81; p < 0.001) as well as test-re-test agreement (ρ = 0.97; p < 0.001) for the total score was high. Inter-observer agreement was excellent for the communication sub-scale, good for the auditory, visual and motor sub-scales and moderate for the oromotor/verbal and arousal sub-scales. Test-re-test agreement was excellent for the visual, motor, oromotor/verbal and communication sub-scales, good for the auditory sub-scale and moderate for the arousal sub-scale. When considering the diagnostic impression, inter-observer agreement was good (κ = 0.75; p < 0.001) and test-re-test agreement was excellent (κ = 0.92; p < 0.001). The Italian version of the CRS-R can be administered reliably and can be also employed to discriminate patients in vegetative and in minimally conscious state.
Abstract Doxycycline inhibits amyloid formation in vitro and its therapeutic efficacy is under ev... more Abstract Doxycycline inhibits amyloid formation in vitro and its therapeutic efficacy is under evaluation in clinical trials for different protein conformational diseases, including prion diseases, Alzheimer's disease and transthyretin amyloidosis. In patients on chronic hemodialysis, a persistently high concentration of β2-microglobulin causes a form of amyloidosis (dialysis-related amyloidosis, DRA) localized in bones and ligaments. Since doxycycline inhibits β2-microglobulin fibrillogenesis in vitro and accumulates in bones, DRA represents an ideal form of amyloidosis where doxycycline may reach a therapeutic concentration at the site of amyloid deposition. Three patients on long-term dialysis with severe articular impairment and uncontrollable pain due to DRA were treated with 100 mg of doxycycline daily. Pharmacokinetics and safety of treatment were conducted. Plasmatic levels of the drug reached a plateau after one week (1.1-2.3 µg/ml). Treatment was well tolerated in two patients for a year, while one was suspended after 5 months due to mild esophagitis. Treatment was associated with a significant reduction in articular pain and with a significant and measurable improvement in passive and active movements in all cases, despite the persistence of unchanged amyloid deposits measured by magnetic resonance imaging.
The objective of this study was to identify the impact of comorbidities on outcomes of patients w... more The objective of this study was to identify the impact of comorbidities on outcomes of patients with vegetative state (VS) or minimally conscious state (MCS). All patients in VS or MCS consecutively admitted to two Post-Acute Care Units within a 1-year period were evaluated at baseline and at 6 months through the Coma Recovery Scale - Revised Version (CRS-R) and the Disability Rating Scale (DRS). Comorbidities were also recorded for each patient along the same period. Six-month outcomes included death, full recovery of consciousness, and functional improvement. One hundred and thirty-nine patients (88 men and 51 women, median age 59 years) were included. Ninety-seven patients were in VS (70%) and 42 in MCS (30%). At 6 months, 33 patients were dead (24%), 39 had a full recovery of consciousness (28%) and 67 remained in VS or MCS (48%). According to DRS scores, 40% of patients (n=55) showed a functional improvement in the level of disability. One hundred and thirty patients (94%) showed at least one comorbidity. Severity of comorbidities (HR=2.8, 95% CI 1.71-4.68; p<0.001) and the presence of ischemic or organic heart diseases (HR 2.6, 95% CI 1.21-5.43; p=0.014) were the strongest predictors of death together with increasing age (HR=1.0, 95% CI 1.0-1.06; p=0.033). Respiratory diseases and arrhythmias without organic heart diseases were negative predictors of full recovery of consciousness (OR=0.3, 95% CI 0.12-0.7, p=0.006; OR=0.2, 95% CI 0.07-0.43, p<0.001) and functional improvement (OR=0.4, 95% CI 0.15-0.85, p=0.020; OR=0.2, CI 0.08-0.45, p<0.001). Our data show that comorbidities are common in these patients and some of them influence recovery of consciousness and outcomes.
There is much evidence to suggest that recognizing and sharing emotions with others require a fir... more There is much evidence to suggest that recognizing and sharing emotions with others require a first-hand experience of those emotions in our own body which, in turn, depends on the adequate perception of our own internal state (inter-oception) through preserved sensory pathways. Here we explored the contribution of interoception to first-hand emotional experiences and to the recognition of others' emotions. For this aim, 10 individuals with sensory deafferentation as a consequence of high spinal cord injury (SCI; five males and five females; mean age, 48 – 14.8 years) and 20 healthy subjects matched for age, sex, and education were included in the study. Recognition of facial expressions and judgment of emotionally evocative scenes were investigated in both groups using the Ekman and Friesen set of Pictures of Facial Affect and the International Affective Picture System. A two-way mixed analysis of variance and post hoc comparisons were used to test differences among emotions and groups. Compared with healthy subjects, individuals with SCI, when asked to judge emotionally evocative scenes, had difficulties in judging their own emotional response to complex scenes eliciting fear and anger, while they were able to recognize the same emotions when conveyed by facial expressions. Our findings endorse a simulative view of emotional processing according to which the proper perception of our own internal state (interoception), through preserved sensory pathways, is crucial for first-hand experiences of the more primordial emotions, such as fear and anger.
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Papers by Benedetta Cazzulani