The still under-investigated role of cognitive deficits in PML diagnosis

Background: Despite cognitive deficits frequently represent the first clinical manifestations of Progressive Multifocal Leukoencephalopathy (PML) in Natalizumab-treated MS patients, the importance of cognitive deficits in PML diagnosis is still under-investigated. The aim of the current study is to investigate the cognitive deficits at PML diagnosis in a group of Italian patients with PML. Methods: Thirty-four PML patients were included in the study. The demographic and clinical data, the lesion load and localization, and the longitudinal clinical course was compared between patients with (n = 13) and without (n = 15) cognitive deficit upon PML suspicion (the remaining six patients were asymptomatic). Clinical presentation of cognitive symptoms was described in detail. Result: After symptoms detection, the time to diagnosis resulted to be shorter for patients presenting with cognitive than for patients with non cognitive onset (p = 0.03). Within patients with cognitive onset, six patients were presenting with language and/or reading difficulties (46.15%); five patients with memory difficulties (38.4%); three patients with apraxia (23.1%); two patients with disorientation (15.3%); two patients with neglect (15.3%); one patients with object agnosia (7.7%), one patient with perseveration (7.7%) and one patient with dementia (7.7%). Frontal lesions were less frequent (p = 0.03), whereas temporal lesions were slightly more frequent (p = 0.06) in patients with cognitive deficits. The longitudinal PML course seemed to be more severe in cognitive than in non cognitive patients (F = 2.73, p = 0.03), but differences disappeared (F = 1.24, p = 0.29) when balancing for the incidence of immune reconstitution syndrome and for other treatments for PML (steroids, plasma exchange (PLEX) and other therapies (Mefloquine, Mirtazapine, Maraviroc). Conclusion: Cognitive deficits at PML onset manifest with symptoms which are absolutely rare in MS. Their appearance in MS patients should strongly suggest PML. Clinicians should be sensitive to the importance of formal neuropsychological evaluation, with particular focus on executive function, which are not easily detected without a formal assessment

Markerless Analysis of Articulatory Movements in Patients With Parkinson's Disease

Objectives: A large percentage of patients with Parkinson's disease have hypokinetic dysarthria, exhibiting reduced peak velocities of jaw and lips during speech. This limitation implies a reduction of speech intelligibility for such patients. This work aims at testing a cost-effective markerless approach for assessing kinematic parameters of hypokinetic dysarthria. Study design: Kinematic parameters of the lips are calculated during a syllable repetition task from 14 Parkinsonian patients and 14 age-matched control subjects. Methods: Combining color and depth frames provided by a depth sensor (Microsoft Kinect), we computed the three-dimensional coordinates of main facial points. The peak velocities and accelerations of the lower lip during a syllable repetition task are considered to compare the two groups. Results: Results show that Parkinsonian patients exhibit reduced peak velocities of the lower lip, both during the opening and the closing phase of the mouth. In addition, peak values of acceleration are reduced in Parkinsonian patients, although with significant differences only in the opening phase with respect to healthy control subjects. Conclusions: The novel contribution of this work is the implementation of an entirely markerless technique capable to detect signs of hypokinetic dysarthria for the analysis of articulatory movements during speech. Although a large number of Parkinsonian patients have hypokinetic dysarthria, only a small percentage of them undergoes speech therapy to increase their articulatory movements. The system proposed here could be easily implemented in a home environment, thus, increasing the percentage of patients who can perform speech rehabilitation at home

Ten relevant questions for applying biodiversity offsetting in the Pantanal wetland

In Brazil, biodiversity offsetting operates in an ad hoc manner while biodiversity equivalence has mainly been overlooked by public policies. Despite being mandatory since 1965s Forest Code (Law 4.771), we fail to have a robust offsetting framework. The revision of the forest code in 2012 (i.e., Native Vegetation Protection Law—NVPL—Law n° 12,651/2012), maintained the obligation for landowners to set aside a biome-specific percentage of their native vegetation for preservation. Known as Legal Reserves, these set-asides are a precondition for compliance with NVPL's regularization procedure called CAR (Rural Environmental Cadaster). Despite enthusiasm about biodiversity offsetting opportunities following the NVPL enactment in 2012, uncertainties around its implementation remains. Here, we formulated 10 questions that discuss and illustrate how offsetting can be applied to maintain wetland integrity, economic fairness and biodiversity conservation in the Pantanal and Upper Paraguay River basin (UPRB). The aim is to stimulate robust public policies and stimulate wetland offsetting research opportunities. We provided examples of implementation opportunities of the NVPL in integrating the floodplain and highland in Pantanal at UPRB, analyze spatial compliance deficits, and illustrate opportunities that require harmonized legislation and policies between Mato Grosso and Mato Grosso do Sul states in Brazil

Eight basic principles for the elaboration of public policies and development projects for the Pantanal

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Author(s). Conservation Science and Practice published by Wiley Periodicals LLC on behalf of Society for Conservation Biology. The Pantanal is considered the largest continuous freshwater wetland in the world, and its sustainable use requires a unified conceptual framework. The lengthy process to establish public policies has contributed to the increasing vulnerability of the Pantanal. Given the need for a conceptual basis to help this process, we elaborate a list of eight basic principles based on the accumulated scientific evidence: (i) Consider the Paraguay River Basin a management unity; (ii) Establish rules that follow the concept of restricted use approach; (iii) Ensure the ecologically sustainable use of the Pantanal; (iv) Maintain the environmental heterogeneity and functionality in the Pantanal landscapes; (v) Maintain the hydrological integrity and connectivity; (vi) Ensure the environmental representativeness of the protected areas network; (vii) Provide economic incentives for conservationist use of the land; and (viii) Recognize and protect traditional people, their values, resources, and way of living. However, the elaboration of public policies should be a participatory and inclusive decision‐making process towards a more just and sustainable future

Ten relevant questions for applying biodiversity offsetting in the Pantanal wetland

In Brazil, biodiversity offsetting operates in an ad hoc manner while biodiversity equivalence has mainly been overlooked by public policies. Despite being mandatory since 1965s Forest Code (Law 4.771), we fail to have a robust offsetting framework. The revision of the forest code in 2012 (i.e., Native Vegetation Protection Law—NVPL—Law n° 12,651/2012), maintained the obligation for landowners to set aside a biome-specific percentage of their native vegetation for preservation. Known as Legal Reserves, these set-asides are a precondition for compliance with NVPL's regularization procedure called CAR (Rural Environmental Cadaster). Despite enthusiasm about biodiversity offsetting opportunities following the NVPL enactment in 2012, uncertainties around its implementation remains. Here, we formulated 10 questions that discuss and illustrate how offsetting can be applied to maintain wetland integrity, economic fairness and biodiversity conservation in the Pantanal and Upper Paraguay River basin (UPRB). The aim is to stimulate robust public policies and stimulate wetland offsetting research opportunities. We provided examples of implementation opportunities of the NVPL in integrating the floodplain and highland in Pantanal at UPRB, analyze spatial compliance deficits, and illustrate opportunities that require harmonized legislation and policies between Mato Grosso and Mato Grosso do Sul states in Brazil