The representation of child-parent relation: validation of the Italian version of the child-parent relationship scale (CPRS-I)

This study proposes a psychometric validation of the Italian version of the Child-Parent Relationship Scale (CPRS) developed by Pianta in 1992. Based on attachment theory, the scale assesses parents' relationship perceptions with their own child and comprises three scales: Closeness, Conflict, and Dependency. A sample of 501 parents (188 fathers and 313 mothers) completed 30 items of the Italian version of the Child-Parent Relationship Scale (CPRS-I) online, but only 437 answered 85% of the entire protocol; hence, the analyses only focused on 437 participants. The first analysis of the original theoretical model revealed poor fit, item loadings, and internal consistency. Therefore, a follow-up analysis was conducted. Exploratory and confirmatory analyses with a split sample (EFA = 218; CFA = 219) confirmed the original three-factor structure of the Italian sample, although some items were eliminated. The validity and reliability of the Italian version of the CPRS-I were also verified by correlating the above three factors with measures of adult attachment styles and children's internalizing and externalizing behaviors. The CPRS-I showed significant correlations with all tested constructs, in line with those found by Driscoll and Pianta for the short form of the scale. Our results confirm that the CPRS-I has the same structure as the original scale; therefore, it can be a useful tool for assessing parents' perceptions of their relationship with their children. The implications for educational and clinical settings are also discussed.

Internalizing and externalizing symptoms in children during the COVID-19 pandemic: a systematic mixed studies review

Introduction

Given the vulnerability of children during the COVID-19 pandemic, paying close attention to their wellbeing at the time is warranted. The present protocol-based systematic mixed-studies review examines papers published during 2020-2022, focusing on the impact of the COVID-19 pandemic on children's internalizing/externalizing symptoms and the determinants thereof.

Method

PROSPERO: CRD42022385284. Five databases were searched and the PRISMA diagram was applied. The inclusion criteria were: papers published in English in peer-reviewed journals; papers published between January 2020 and October 2022 involving children aged 5-13 years; qualitative, quantitative, and mixed studies. The standardized Mixed Method Appraisal Tool protocol was used to appraise the quality of the studies.

Results

Thirty-four studies involving 40,976 participants in total were analyzed. Their principal characteristics were tabulated. The results showed that children's internalizing/externalizing symptoms increased during the pandemic, largely as a result of disengagement from play activities and excessive use of the internet. Girls showed more internalizing symptoms and boys more externalizing symptoms. Distress was the strongest parental factor mediating children's internalizing/externalizing symptoms. The quality of the studies was appraised as low (n = 12), medium (n = 12), and high (n = 10).

Conclusion

Gender-based interventions should be designed for children and parents. The studies reviewed were cross-sectional, so long-term patterns and outcomes could not be predicted. Future researchers might consider a longitudinal approach to determine the long-term effects of the pandemic on children's internalizing and externalizing symptoms.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022385284, identifier: CRD42022385284.

The promotion of mature theory of mind skills in educational settings: a mini-review

After formal school entry, theory of mind development encounters a blooming period of growth intertwined with social and academic achievements and challenges. Within this framework, in last years researchers have proposed training programs to foster mature ToM skills, but also, to test causal pathways for the role that ToM development may have in broader cognitive and social outcomes. In the current mini-review we examine which training programs have been developed so far to enhance three key aspects of mature ToM skills: second-order false belief reasoning, the ability to put one's own ToM knowledge into use, and the mentalization of thoughts and emotions. We also illustrate effects of these activities on intra- and inter- personal competence. In its conclusion the paper provides considerations of both first achievements of research in this area and gaps to be addressed in future works.

Prognostic Relevance of Multi-Antigenic Myeloma-Specific T-Cell Assay in Patients with Monoclonal Gammopathies

Multiple Myeloma (MM) typically originates from underlying precursor conditions, known as Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM). Validated risk factors, related to the main features of the clonal plasma cells, are employed in the current prognostic models to assess long-term probabilities of progression to MM. In addition, new prognostic immunologic parameters, measuring protective MM-specific T-cell responses, could help to identify patients with shorter time-to-progression. In this report, we described a novel Multi-antigenic Myeloma-specific (MaMs) T-cell assay, based on ELISpot technology, providing simultaneous evaluation of T-cell responses towards ten different MM-associated antigens. When performed during long-term follow-up (mean 28 months) of 33 patients with either MGUS or SMM, such deca-antigenic myeloma-specific immunoassay allowed to significantly distinguish between stable vs. progressive disease (p < 0.001), independently from the Mayo Clinic risk category. Here, we report the first clinical experience showing that a wide (multi-antigen), standardized (irrespective to patients' HLA), MM-specific T-cell assay may routinely be applied, as a promising prognostic tool, during the follow-up of MGUS/SMM patients. Larger studies are needed to improve the antigenic panel and further explore the prognostic value of MaMs test in the risk assessment of patients with monoclonal gammopathies.

Teachers during the COVID-19 Era: The Mediation Role Played by Mentalizing Ability on the Relationship between Depressive Symptoms, Anxious Trait, and Job Burnout

BACKGROUND

The COVID-19 outbreak caused severe changes in school activities over the past two years. Teachers underwent a re-planning of their teaching approaches, shifting from face-to-face teaching formats to remote ones. These challenges resulted in high levels of burnout. The identification of risk/protective factors contributing to burnout is crucial in order to inform intervention programs. Thus, we hypothesized a mediation role of teachers' mentalizing ability (processing of emotions, a component of mentalized affectivity) on the relationship between depression, anxiety, and depersonalization (burnout dimension). Two reverse models were computed. Job satisfaction, teachers' age and gender, school grade, and length of teaching experience served as covariates.

METHODS

466 (M(sd) = 46.2 (10.4) years) online questionnaires were completed by Italian teachers of primary (n = 204) and middle (n = 242) schools. Measures of burnout, depression, anxiety, and mentalization were administered.

RESULTS

The findings corroborated our hypotheses: in all models, processing emotions served as a mediator on the relationship between depression, anxiety, and depersonalization, and on the reciprocal one. Job satisfaction positively impacted processing emotion, and negatively impacted depression and depersonalization; women teachers reported high levels of the anxious trait.

CONCLUSIONS

Overall, it can be concluded that the ability to mentalize has a beneficial impact on teachers' well-being. Policymaking, clinical, and research implications were discussed.

Children’s representations of the COVID-19 lockdown and pandemic through drawings

The COVID-19 pandemic and the measures to face it have placed children and their caregivers in front of many challenges that could represent sources of stress. This work aims to explore the point of view of children through drawing, as a spontaneous means of expression, relating it to parents’ perceptions of children’s difficulties, strengths, and mentalization skills. The sample consists of 18 children (mean age = 8.22, SD = 1.79). Parents were asked to complete: a socio-demographic questionnaire with information on the impact of COVID-19 on the family, the Strengths and Difficulties Questionnaire, and the Everyday Mindreading Scale. Children were asked to draw three moments: “Before” the pandemic, “During” the lockdown, and “After,” when the COVID-19 will be passed. The drawings were coded by constructing a content and expressive analysis grid, adapting coding systems found in the literature. Data were collected at the beginning of the summer of 2020, just after the first lockdown period (from March to May 2020 in Italy). The results of the present work are in line with previous studies that reported experiences of wellbeing and tranquility of children in time spent at home with family during the pandemic. From the drawings emerges that children feel sufficiently able to master the situation, as reflected by including themselves in drawings and providing many details of the house in “During” drawings. The literature also reports a feeling of sadness/loneliness caused by the lack of friends, an element that we also find in the tendency to represent friends significantly more in the drawings concerning the future. Some contents of drawings (inclusion of friends, relatives, and parents) appeared associated with emotional, interpersonal, and mentalizing abilities of children, as perceived by parents. Exploring children’s representations of a stressful event like the pandemic through drawings allows to focus both on their difficulties and on their resources, with useful implications for the educational support.

Measuring cognitive and affective Theory of Mind with the Italian Yoni task: normative data and short versions

Theory of Mind (ToM), a high-order human social cognition skill, is relevant for mental health and wellbeing and frequently impaired in many clinical conditions. To detect ToM difficulties, validated and standardized measures need to be adopted in clinical practice. The Yoni task provides a comprehensive evaluation of first-order, second-order, affective and cognitive mentalistic inferences. However, the Yoni task remains a time-demanding tool without normative data. To fill this gap, we explored the convergent and discriminant validity, the inter-item reliability and provided normative data of the Italian version of the Yoni task (98 items), and developed two short versions (48 and 36 items). For the validation, internal consistency and convergent/discriminant validity have been considered. Then, the effects of demographical variables on 98 item Yoni were explored, and normative data were provided. Our data demonstrated high reliability and a good convergent validity in all the Yoni versions. Then, two composite scores were proposed to obtain: 1) a global ToM level and 2) the balance between affective and cognitive ToM components, whose alteration represents a signature of several clinical conditions. The future standardization of the short versions of Yoni will allow a comprehensive and quick examination of ToM abilities, suitable for both research and clinical settings.

Supporting mentalizing in primary school children: the effects of thoughts in mind project for children (TiM-C) on metacognition, emotion regulation and theory of mind

Mentalization is a useful ability for social functioning and a crucial aspect of mentalizing is emotion regulation. Literature suggests programmes for children and adults to increase mentalizing abilities useful both for emotional and social competences. For this reason, the issue of how to prompt children's mentalization has started to attract researchers' attention, supporting the importance of the interpersonal dimension for the individual differences in the developmental of mentalization. The TiM (Thoughts in Mind) Project, a training programme based on the explanation of mentalization mechanisms and designed for adults, deals with emotion regulation. Starting from the TiM Project, this study tests the effects of the TiM Child (TiM-C) training programme, over a control training programme, a conversational training designed for the school context, in children attending Year 2 of primary school. We designed a training based on narratives, followed by multiple-choice questions and conversations about mental states. Our results revealed significant improvements over the training period only in the TiM-C Project group for Metacognition, Emotion Regulation Strategies and a Theory of Mind task. As far as the educational implications, our findings suggest that it is possible to enhance mentalization through activities at school by promoting not only the understanding of the relations between mind and emotion, but also metacognitive skills.

Maternal Psychological Distress and Children's Internalizing/Externalizing Problems during the COVID-19 Pandemic: The Moderating Role Played by Hypermentalization

In order to explore the psychological impact of the COVID-19 outbreak on the caregiver–child relationship, we investigated the interplay among COVID-19 exposure and children’s internalizing/externalizing problems during the Italian lockdown, hypothesizing a mediation effect played by maternal distress. Additionally, we included maternal reflective functioning (i.e., hypermentalization) as a moderator factor among this interplay. A total of 305 Italian mothers of children aged 6–13 years (M = 10.3; SD = 2.4) filled in an online survey. Findings revealed an indirect effect of maternal COVID-19 exposure on children’s anxious/depressed (k² = 0.46) and attention problems (k² = 0.32) via maternal distress. Hypermentalization moderated the impact of maternal COVID-19 exposure on children’s anxious/depressed problems (β = −1.08, p = 0.04). Hypermentalization moderated both the relation between maternal distress and children’s aggressive behaviors (β = 12.226; p < 0.001) and between maternal distress and children’s attention problems (β = 5.617, p < 0.001). We found pivotal significant effects of maternal hypermentalization on children’s anxious/depressed and attention problems, indicating that the higher the mother’s hypermentalization was, the higher the children’s problems were. Our results broaden what we knew on the role of maternal reflective and emotional functioning on children’s emotional/behavioral adjustment during stressful situations.

Psychological Impact of COVID-19 Outbreak on Families of Children with Autism Spectrum Disorder and Typically Developing Peers: An Online Survey

BACKGROUND

When COVID-19 was declared as a pandemic, many countries imposed severe lockdowns that changed families' routines and negatively impacted on parents' and children's mental health. Several studies on families with children with autism spectrum disorder (ASD) revealed that lockdown increased the difficulties faced by individuals with ASD, as well as parental distress. No studies have analyzed the interplay between parental distress, children's emotional responses, and adaptive behaviors in children with ASD considering the period of the mandatory lockdown. Furthermore, we compared families with children on the spectrum and families with typically developing (TD) children in terms of their distress, children's emotional responses, and behavioral adaptation.

METHODS

In this study, 120 parents of children aged 5-10 years (53 with ASD) participated.

RESULTS

In the four tested models, children's positive and negative emotional responses mediated the impact of parental distress on children's playing activities. In the ASD group, parents reported that their children expressed more positive emotions, but fewer playing activities, than TD children. Families with children on the spectrum reported greater behavioral problems during the lockdown and more parental distress.

CONCLUSIONS

Our findings inform the interventions designed for parents to reduce distress and to develop coping strategies to better manage the caregiver-child relationship.

The Mentalized Affectivity Scale (MAS): Development and validation of the Italian version

This study proposes a psychometric validation of the Italian version of the Mentalized Affectivity Scale (MAS) developed by Greenberg and colleagues in 2017. The mentalized affectivity construct integrates mentalization ability in the process of emotional regulation. An adult sample (N = 506) completed the 60-items MAS online version. In contrast to the three-factor structure of the original version, the Italian context confirmatory and exploratory factor analyses with splitted sample (CFA = 258; EFA = 248) revealed a five-factor structure. The hierarchically structured MAS factors are: Emotional Processing (being able to process emotion in situations); Expressing Emotions (talking and knowing emotions); Identifying Emotions (awareness of emotions); Control Processing (to control emotional reactions and expression), and Autobiographical Memory (related to childhood experiences). We also verified the convergent validity and reliability of the Italian version of the MAS by correlating the above five factors with measures of emotion regulation and reflective functioning. Moreover, we analyzed the relationships among the factors of the MAS, personality measures and well-being indexes, such as life satisfaction and self-efficacy: The new 35-item MAS scale showed robust correlations with all the tested constructs. Our results confirm that the MAS is a useful measure to assess mentalized affectivity, with the Italian version showing a more complex structure than the original English one, thus enriching the literature about mentalization.

Maternal Distress/Coping and Children's Adaptive Behaviors During the COVID-19 Lockdown: Mediation Through Children's Emotional Experience

The present study focused on the psychological impact that the lockdown due to coronavirus disease-19 (COVID-19) had on families in Italy. During the COVID-19 pandemic, the Italian government imposed a strict lockdown for all citizens. People were forced to stay at home, and the length of the lockdown was uncertain. Previous studies analyzed the impact of social distance measures on individuals' mental health, whereas few studies have examined the interplay between the adults' functioning, as parents, during this period and the association with the child's adjustment. The present study tested if maternal distress/coping predicts children's behaviors during the COVID-19 lockdown, hypothesizing a mediation effect via children's emotional experience. Participants were 144 mothers (M age = 39.3, 25-52, SD = 5.6) with children aged 5-10 years (M age = 7.54, SD = 1.6, 82 boys); mothers answered to an online survey. Results indicated that mothers with higher exposure to COVID-19 showed higher levels of distress and higher display of coping attitudes, even if in the structural equation modeling model, the COVID-19 exposure was not a predictor of mothers' distress. Compared with mothers with good coping skills, mothers with higher stress levels were more likely to attribute negative emotions to their children at the expense of their positive emotions. Moreover, children's emotions acted as mediators between maternal distress/coping and children's adaptive/maladaptive behaviors. In conclusion, it is important to support parents during pandemic emergence, by providing them with adequate information to manage the relationship with their children, to reduce their level of distress and to enhance their coping abilities.

Neurophthalmologic and Orthoptic Ambulatory Assessments Reveal Ocular and Visual Changes in Patients With Early Alzheimer and Parkinson's Disease

Patients with Alzheimer's disease (AD) and Parkinson's disease (PD) develop a progressive decline of visual function. This condition aggravates overall cognitive and motor abilities, is a risk factor for developing hallucinations, and can have a significant influence on general quality of life. Visual problems are common complaints of patients with PD and AD in the early stages of the disease, but they also occur during normal aging, making it difficult to differentiate between normal and pathological conditions. In this respect, their real incidence has remained largely underestimated, and no rehabilitative approaches have been standardized. With the aim to increase awareness for ocular and visual disorders, we collected the main neurophthalmologic and orthoptic parameters, including optical coherence tomography (OCT), in six patients with a diagnosis of PD, six patients with a diagnosis of early AD, and eight control subjects in an easily assessable outpatient setting. We also evaluated the patient's ability to recognize changes in facial expression. Our study demonstrates that visual problems, including blurred vision, diplopia, reading discomfort, photophobia, and glare, are commonly reported in patients with PD and AD. Moreover, abnormal eye alignment and vergence insufficiency were documented in all patients during examination. Despite the small size of the sample, we demonstrated greater ganglion cell and retinal nerve fibers layer (RNFL) damage and a defect of facial emotion recognition in AD/PD patients with respect to a comparable group of normal elderly persons, with peculiarities depending upon the disease. Ocular defects or visual discomfort could be correctly evaluated in these patients and possibly corrected by means of lens, orthoptic exercises, and visual rehabilitation. Such a practical approach may help to ameliorate motor autonomy, reading ability, and may also reduce the risk of falls, with a positive impact in daily living activities.

Can we optimise doxorubicin treatment regimens for children with cancer? Pharmacokinetic simulations and a Delphi consensus procedure

BACKGROUND

Despite its cardiotoxicity doxorubicin is widely used for the treatment of paediatric malignancies. Current treatment regimens appear to be suboptimal as treatment strategies vary and do not follow a clear pharmacological rationale. Standardisation of dosing strategies in particular for infants and younger children is required but is hampered by scarcely defined exposure-response relationships. The aim is to provide a rational dosing concept allowing for a reduction of variability in systemic therapy intensity and subsequently unforeseen side effects.

METHODS

Doxorubicin plasma concentrations in paediatric cancer patients were simulated for different treatment schedules using a population pharmacokinetic model which considers age-dependent differences in doxorubicin clearance. Overall drug exposure and peak concentrations were assessed. Simulation results were used to support a three round Delphi consensus procedure with the aim to clarify the pharmacological goals of doxorubicin dosing in young children. A group of 28 experts representing paediatric trial groups and clinical centres were invited to participate in this process.

RESULTS

Pharmacokinetic simulations illustrated the substantial differences in therapy intensity associated with current dosing strategies. Consensus among the panel members was obtained on a standardised a priori dose adaptation that individualises doxorubicin doses based on age and body surface area targeting uniform drug exposure across children treated with the same protocol. Further, a reduction of peak concentrations in very young children by prolonged infusion was recommended.

CONCLUSIONS

An approach to standardise current dose modification schemes in young children is proposed. The consented concept takes individual pharmacokinetic characteristics into account and involves adaptation of both the dose and the infusion duration potentially improving the safety of doxorubicin administration.

The Black Pedagogy Scale: A New Task to Explore Educational Practices for Children's Well-Being

The present contribute focuses on the concept of "Black Pedagogy" (Rutschky, 1977; ISBN: 3548356702), meant as a set of educational practices assimilable into those that nowadays are included in the frame of physical and psychological maltreatment (e.g., corporal punishment, frightening children, etc.). The purpose of this work is to present our operationalization proposal of the concept and the results deriving from a first validation of the "Black Pedagogy Scale". The questionnaire was administered to 374 Italian university students in their university classrooms (pilot study with double administration) and to 830 Italian adults, parents of primary school-aged children, through an online survey platform (main study). In the pilot study, explorative analyses, paired-samples t-test and ML EFA (with Varimax rotation) were performed. In the main study, proprieties of the refined instrument and relations between the construct of Black Pedagogy and demographics were explored. The Black Pedagogy Scale (α > .8) resulted composed by three factors, consistently with what was initially hypothesized: "Values of Black Pedagogy" (var. 18.7%), "Education of children over time" (var. 10.6%) "Methods of Black Pedagogy" (var. 8.6%). Participants resulted more in agreement with Black Pedagogy's values rather than with its methods, and those with higher educational qualification showed less agreement with the construct, F(2, 813) = 28.22, p < .001, η² = .065. The possible legacy of a Black Pedagogy's forma mentis can contribute to explain why some detrimental disciplinary practices are culturally deemed as acceptable. Results suggest designing interventions focused on educational values to discourage such practices.

Identification and RNAi Profile of a Novel Iflavirus Infecting Senegalese Aedes vexans arabiensis Mosquitoes

The inland floodwater mosquito Aedes vexans (Meigen, 1830) is a competent vector of numerous arthropod-borne viruses such as Rift Valley fever virus (Phenuiviridae) and Zika virus (Flaviviridae). Aedes vexans spp. have widespread Afrotropical distribution and are common European cosmopolitan mosquitoes. We examined the virome of Ae. vexans arabiensis samples from Barkédji village, Senegal, with small RNA sequencing, bioinformatic analysis, and RT-PCR screening. We identified a novel 9494 nt iflavirus (Picornaviridae) designated here as Aedes vexans iflavirus (AvIFV). Annotation of the AvIFV genome reveals a 2782 amino acid polyprotein with iflavirus protein domain architecture and typical iflavirus 5' internal ribosomal entry site and 3' poly-A tail. Aedes vexans iflavirus is most closely related to a partial virus sequence from Venturia canescens (a parasitoid wasp) with 56.77% pairwise amino acid identity. Analysis of AvIFV-derived small RNAs suggests that AvIFV is targeted by the exogenous RNA interference pathway but not the PIWI-interacting RNA response, as ~60% of AvIFV reads corresponded to 21 nt Dicer-2 virus-derived small RNAs and the 24-29 nt AvIFV read population did not exhibit a "ping-pong" signature. The RT-PCR screens of archival and current (circa 2011-2020) Ae. vexans arabiensis laboratory samples and wild-caught mosquitoes from Barkédji suggest that AvIFV is ubiquitous in these mosquitoes. Further, we screened wild-caught European Ae. vexans samples from Germany, the United Kingdom, Italy, and Sweden, all of which tested negative for AvIFV RNA. This report provides insight into the diversity of commensal Aedes viruses and the host RNAi response towards iflaviruses.

Adolescents' Beliefs About Peers' Engagement in an Online Self-Harm Challenge: Exploring the Role of Individual Characteristics Through a Latent Class Analysis

In the last decade considerable attention has been devoted to the possible contribution of social media, and the Internet generally, to instigating adolescents' engagement in self-harm activities, which are considered the result of a combination of multidimensional variables, such as depression and anxiety. This study aimed to identify, using latent class analysis (LCA), classes homogeneous for adolescents' beliefs about peers' motivations in taking part in the recent Blue Whale Challenge Game, and to analyze the individual predictors (gender, mental health problems, self-harm and risk-taking behaviors, and problematic Internet use) of the adolescent's latent class membership. We performed an LCA using "perceived attraction" and "perceived constraint" as nominal indicators. Relative fit indices suggested the two class solution as the best measurement model: the first class was mostly composed of adolescents who attributed a central role to the adolescent (internal causality), while the second class mostly composed of adolescents who attributed a central role to the recruiters (external causality). In addition, we explored some individual characteristics to test whether they could predict adolescents' class membership. Results suggests that it is significantly more likely for adolescents with higher level of stress and risk-taking to attribute a central role to their peers' internal motivation, rather than to the recruiter, in deciding to take part in the online self-harm challenge game. Implications for preventive interventions are discussed.

Cognitive and Affective Theory of Mind in Mild Cognitive Impairment and Parkinson's Disease: Preliminary Evidence from the Italian Version of the Yoni Task

The aim of the study was to explore cognitive and affective dimensions of ToM using the computerized Yoni task in participants with amnestic Mild Cognitive Impairment (aMCI=16), early stage of Parkinson's Disease (PD=14), and healthy controls (HC=18) Results demonstrated that the Yoni task was effective in discriminating between groups in 1^th order cognitive dimension (MCI<PD=HC, p_corr<.05), and in 2^nd order cognitive and affective dimensions (MCI<HC, p_corr <.05), highlighting a reduced ToM performance also in people with PD (MCI<PD<HC, p_corr <.05). Thus, the Yoni task represents a sensitive tool for detecting different dimensions of ToM impairment, across different clinical conditions.

Genomic complexity and dynamics of clonal evolution in childhood acute myeloid leukemia studied with whole-exome sequencing

Despite significant improvement in treatment of childhood acute myeloid leukemia (AML), 30% of patients experience disease recurrence, which is still the major cause of treatment failure and death in these patients. To investigate molecular mechanisms underlying relapse, we performed whole-exome sequencing of diagnosis-relapse pairs and matched remission samples from 4 pediatric AML patients without recurrent cytogenetic alterations. Candidate driver mutations were selected for targeted deep sequencing at high coverage, suitable to detect small subclones (0.12%). BiCEBPα mutation was found to be stable and highly penetrant, representing a separate biological and clinical entity, unlike WT1 mutations, which were extremely unstable. Among the mutational patterns underlying relapse, we detected the acquisition of proliferative advantage by signaling activation (PTPN11 and FLT3-TKD mutations) and the increased resistance to apoptosis (hyperactivation of TYK2). We also found a previously undescribed feature of AML, consisting of a hypermutator phenotype caused by SETD2 inactivation. The consequent accumulation of new mutations promotes the adaptability of the leukemia, contributing to clonal selection. We report a novel ASXL3 mutation characterizing a very small subclone (<1%) present at diagnosis and undergoing expansion (60%) at relapse. Taken together, these findings provide molecular clues for designing optimal therapeutic strategies, in terms of target selection, adequate schedule design and reliable response-monitoring techniques.

Social Decision Making in Adolescents and Young Adults: Evidence From the Ultimatum Game and Cognitive Biases

During adolescence and early adulthood, individuals deal with important developmental changes, especially in the context of complex social interactions. Previous studies demonstrated that those changes have a significant impact on the social decision making process, in terms of a progressive increase of intentionality comprehension of others, of the sensitivity to fairness, and of the impermeability to decisional biases. However, neither adolescents nor adults reach the ideal level of maximization and of rationality of the homo economicus proposed by classical economics theory, thus remaining more close to the model of the “bounded rationality” proposed by cognitive psychology. In the present study, we analyzed two aspects of decision making in 110 participants from early adolescence to young adulthood: the sensitivity to fairness and the permeability to decisional biases (Outcome Bias and Hindsight Bias). To address these questions, we adopted a modified version of the Ultimatum Game task, where participants faced fair, unfair, and hyperfair offers from proposers described as generous, selfish, or neutral. We also administered two behavioral tasks testing the influence of the Outcome Bias and of the Hindsight Bias in the evaluation of the decision. Our behavioral results highlighted that the participants are still partially consequentialist, as the decisional process is influenced by a complex balance between the outcome and the psychological description of the proposer. As regards cognitive biases, the Outcome Bias and the Hindsight Bias are present in the whole sample, with no relevant age differences.

Prospective thinking and decision making in primary school age children

In this study, we seek to widen our understanding of the developmental processes underlying bargaining behaviour in children addressing the concept of prospective thinking. We argue that the emergence of the capacity to think prospectively about future outcomes or behaviours in response to current actions is a required precedent to strategic decision making. To test this idea, we compared 6, 8 and 10 years old children's performance on three tasks: the ultimatum game assessing fairness/inequality aversion, the marshmallow task, an intertemporal choice task evaluating the ability to delay gratification, and the dictator game assessing altruism. The children's socio-demographic and cognitive variables were also evaluated. We hypothesized that development of strategic thinking in the ultimatum game is related to an increased ability to delay gratification - given that both tasks require looking at prospective benefits - and, crucially, not to altruism, which benefits from immediate selfless reward. Our results confirmed our hypothesis suggesting that increased strategic planning with age would also stem from the development of competencies like prospective thinking.

Adolescents' and Young Adults' Naïve Understandings of the Economic Crisis

Over the last decade, Financial Literacy (FL) and interventions aimed at improving it, that is Financial Education (FE), have been the focus of increased attention from economists, governments, and international organizations such as the world Bank and OECD, but much less by scholars in the fields of Learning and Instruction. We examined open-ended written answers on the causes of the economic crisis that started in 2007-2008, as given by 381 Italian secondary school and university students, and 268 Swiss Italian-speaking secondary school students. Most Italian students mentioned internal political causes (i.e., corrupt politicians or inefficiency of the government), whereas Swiss students mentioned banks more often. International factors were rarely mentioned by either group, and explanations were generally very poor, listing a few causes without making connections between them. These findings indicate the need for economics education aimed at making people more knowledgeable of the workings of the economic system and the effects of financial systems on the real economy.

Central Nervous System Complications in Children Receiving Chemotherapy or Hematopoietic Stem Cell Transplantation

Therapy-related neurotoxicity greatly affects possibility of survival and quality of life of pediatric patients treated for cancer. Central nervous system (CNS) involvement is heterogeneous, varying from very mild and transient symptoms to extremely severe and debilitating, or even lethal syndromes. In this review, we will discuss the broad scenario of CNS complications and toxicities occurring during the treatment of pediatric patients receiving both chemotherapies and hematopoietic stem cell transplantation. Different types of complications are reviewed ranging from therapy related to cerebrovascular with a specific focus on neuroradiologic and clinical features.

Social Competence in Children with Borderline Intellectual Functioning: Delayed Development of Theory of Mind Across All Complexity Levels

Borderline intellectual functioning (BIF) is characterized by heterogeneous cognitive difficulties, with an intelligence quotient (IQ) between 70 and 85 points, and a failure to meet the developmental and sociocultural standards for personal independence and social responsibility required in daily life. The fact that this population still remain a marginal clinical category, with no ad hoc diagnostic and therapeutic approaches, has stimulated the present research. Our goal was to study children with BIF investigating the development of Theory of Mind (ToM) as a pillar of social competence. Children with BIF (N = 28, 16 male/12 female, and mean age 9.46 ± 1.26 years) and children with typical development (TD; N = 31, 17 male/14 female; mean age 8.94 years ± 0.99) underwent a neurocognitive assessment and a ToM assessment. Children with BIF showed a significant lower performance across all the levels of ToM development investigated compared to the control group, and a correlation between executive functions and the advanced levels of ToM reasoning. These results constitute a first step in the direction of defining the clinical profile of children with BIF concerning ToM development, opening the way to future interventions in order to support the developmental evolution of this population in an adaptive direction.

Promoting Mentalizing in Pupils by Acting on Teachers: Preliminary Italian Evidence of the "Thought in Mind" Project

Mentalization research focuses on different aspects of this topic, highlighting individual differences in mentalizing and proposing programs of intervention for children and adults to increase this ability. The “Thought in Mind Project” (TiM Project) provides training targeted to adults—teachers or parents—to increase their mentalization and, consequently, to obtain mentalization improvement in children. The present research aimed to explore for the first time ever the potential of training for teachers based on the TiM Project, regarding the enhancement of mentalizing of an adult who would have interacted as a teacher with children. For this reason, two teachers – similar for meta-cognitive and meta-emotional skills - and their classes (N = 46) were randomly assigned to the training or control condition. In the first case, the teacher participated in training on the implementation of promotion of mentalizing in everyday school teaching strategies; in the second case the teacher participated in a control activity, similar to training for scheduling and methods, but without promoting the implementation of mentalization (in both conditions two meetings lasting about 3 h at the beginning of the school year and two supervisions during the school year were conducted). The children were tested by tasks assessing several aspects of mentalization (second and third-order false belief understanding, Strange Stories, Reading the mind in the Eyes, Mentalizing Task) both before and after the teacher participate in the TiM or control training (i.e., at the beginning and at the end of the school year). The results showed that, although some measured components of mentalization progressed over time, only the TiM Project training group significantly improved in third order false belief understanding and changed - in a greater way compared to the control group – in two of the three components of the Mentalizing Task. These evidences are promising about the idea that the creation of a mentalizing community promotes the mentalization abilities of its members.

Theory of Mind and the Whole Brain Functional Connectivity: Behavioral and Neural Evidences with the Amsterdam Resting State Questionnaire

A topic of common interest to psychologists and philosophers is the spontaneous flow of thoughts when the individual is awake but not involved in cognitive demands. This argument, classically referred to as the "stream of consciousness" of James, is now known in the psychological literature as "Mind-Wandering." Although of great interest, this construct has been scarcely investigated so far. Diaz et al. (2013) created the Amsterdam Resting State Questionnaire (ARSQ), composed of 27 items, distributed in seven factors: discontinuity of mind, theory of mind (ToM), self, planning, sleepiness, comfort, and somatic awareness. The present study aims at: testing psychometric properties of the ARSQ in a sample of 670 Italian subjects; exploring the neural correlates of a subsample of participants (N = 28) divided into two groups on the basis of the scores obtained in the ToM factor. Results show a satisfactory reliability of the original factional structure in the Italian sample. In the subjects with a high mean in the ToM factor compared to low mean subjects, functional MRI revealed: a network (48 nodes) with higher functional connectivity (FC) with a dominance of the left hemisphere; an increased within-lobe FC in frontal and insular lobes. In both neural and behavioral terms, our results support the idea that the mind, which does not rest even when explicitly asked to do so, has various and interesting mentalistic-like contents.

Mind-Reading Ability and Structural Connectivity Changes in Aging

The Mind-Reading ability through the eyes is an important component of the affective Theory of Mind (ToM), which allows people to infer the other’s mental state from the eye gaze. The aim of the present study was to investigate to which extent age-associated structural brain changes impact this ability and to determine if this association is related to executive functions in elderly subjects. For this purpose, Magnetic Resonance Imaging was used to determine both gray matter and white matter (WM) areas associated with aging. The resulting areas have been included in a subsequent correlation analysis to detect the brain regions whose structure was associated with the Mind-Reading ability through the eyes, assessed with the Italian version of the “Reading the Mind in the Eyes” (RME) test, in a sample of 36 healthy subjects ranging from 24 to 79 years of age. The analysis resulted in three important findings: (1) the performance to the RME test is relatively stable across the decades 20–70 (despite a slight decrease of this ability with aging) and independent from executive functions; (2) structural brain imaging demonstrated the involvement of a great number of cortical ToM areas for the execution of the RME test: the bilateral precentral gyrus, the bilateral posterior insula, the left superior temporal gyrus and the left inferior frontal gyrus, which also showed a significant volume decrease with age; (3) an age and task-related decline in WM connectivity on left fronto-temporal portion of the brain. Our results confirm the age-related structural modifications of the brain and show that these changes have an influence on the Mind-Reading ability through the eyes.

Theory of Mind Development in Adolescence and Early Adulthood: The Growing Complexity of Recursive Thinking Ability

This study explores the development of theory of mind, operationalized as recursive thinking ability, from adolescence to early adulthood (N = 110; young adolescents = 47; adolescents = 43; young adults = 20). The construct of theory of mind has been operationalized in two different ways: as the ability to recognize the correct mental state of a character, and as the ability to attribute the correct mental state in order to predict the character’s behaviour. The Imposing Memory Task, with five recursive thinking levels, and a third-order false-belief task with three recursive thinking levels (devised for this study) have been used. The relationship among working memory, executive functions, and linguistic skills are also analysed. Results show that subjects exhibit less understanding of elevated recursive thinking levels (third, fourth, and fifth) compared to the first and second levels. Working memory is correlated with total recursive thinking, whereas performance on the linguistic comprehension task is related to third level recursive thinking in both theory of mind tasks. An effect of age on third-order false-belief task performance was also found. A key finding of the present study is that the third-order false-belief task shows significant age differences in the application of recursive thinking that involves the prediction of others’ behaviour. In contrast, such an age effect is not observed in the Imposing Memory Task. These results may support the extension of the investigation of the third order false belief after childhood.

Is a bird in the hand worth two in the future? Intertemporal choice, attachment and theory of mind in school-aged children

Intertemporal choice is a decision-making dilemma related to outcomes of different entity located at different time points. Economic and psychological literature on this topic showed the phenomen of temporal discounting, i.e., the proclivity to devalue the outcome distant in time on the basis of the time delay necessary to obtain it. The goals of this research are to investigate two different components of intertemporal choice separately, namely time and outcome, in school-age children, and the possible link among such components and the security of attachment style and theory of mind. Ninety one children aged between 6 and 10 years performed two intertemporal choice tasks, first and second order false belief tasks and the Separation Anxiety Task in the Family and School versions. Results showed that the two components of intertemporal choice (waiting tolerance and sensitivity to delayed outcome) are stately interrelated; the quality of the attachment to the family caregiver affects the tolerance to waiting time and first order false belief understanding affects both the components of intertemporal choice.

Endothelin-1 promotes survival and chemoresistance in chronic lymphocytic leukemia B cells through ETA receptor

The endothelin axis, comprising endothelins (ET-1, ET-2 and ET-3) and their receptors (ET(A)R and ETBR), has emerged as relevant player in tumor growth and metastasis. Here, we investigated the involvement of ET-1/ET(A)R axis in chronic lymphocytic leukemia (CLL). CLL cells expressed higher levels of ET-1 and ETA receptor as compared to normal B cells. ET-1 peptide stimulated phosphoinositide-3-kinase and mitogen-activated protein kinase signaling pathways, improved survival and promoted proliferation of leukemic cells throughout ET(A)R triggering. Moreover, the blockade of ET(A)R by the selective antagonist BQ-123 inhibited the survival advantage acquired by CLL cells in contact with endothelial layers. We also found that blocking ET(A)R via BQ-123 interferes with ERK phosphorylation and CLL pro-survival effect mediated by B-cell receptor (BCR) activation. The pro-apoptotic effect of phosphoinositide-3-kinase δ inhibitor idelalisib and mitogen-activated protein kinase inhibitor PD98059 was decreased by the addition of ET-1 peptide. Then, ET-1 also reduced the cytotoxic effect of fludarabine on CLL cells cultured alone or co-cultured on endothelial layers. ET(A)R blockade by BQ-123 inhibited the ET-1-mediated protection against drug-induced apoptosis. Lastly, higher plasma levels of big ET-1 were detected in patients (n = 151) with unfavourable prognostic factors and shorter time to first treatment. In conclusion, our data describe for the first time a role of ET-1/ET(A)R signaling in CLL pathobiology. ET-1 mediates survival, drug-resistance, and growth signals in CLL cells that can be blocked by ET(A)R inhibition.

Training communication abilities in Rett Syndrome through reading and writing

The goal of this clinical case study is to investigate the possibility of training communication abilities in people with Rett Syndrome (RS). Usually, girls with RS never exceed the sensorimotor stage of development, but the inter-individual variability typical of RS may lead us to doubt the irrevocability of that developmental limit, especially for those girls who are engaged in cognitive rehabilitation. The case study reported here concerns a 21-year-old girl with RS who was engaged in cognitive rehabilitation training based upon the principles of Feuerstein's modificability and mediated learning theory. The training aimed to teach her basic concepts and enhance reading-writing abilities. Statistical analyses showed that the girl reached adequate reading-writing abilities, proving the validity of the cognitive intervention which allowed her to communicate by composing words with her forefinger on an alphabetic table. Although these results need to be cautiously considered as they derive from a single case study, they have implications for future cognitive rehabilitation for deeply impaired clinical conditions as in the case of RS.

The monocytic population in chronic lymphocytic leukemia shows altered composition and deregulation of genes involved in phagocytosis and inflammation

Macrophages reside in tissues infiltrated by chronic lymphocytic leukemia B cells and the extent of infiltration is associated with adverse prognostic factors. We studied blood monocyte population by flow cytometry and whole-genome microarrays. A mixed lymphocyte reaction was performed to evaluate proliferation of T cells in contact with monocytes from patients and normal donors. Migration and gene modulation in normal monocytes cultured with CLL cells were also evaluated. The absolute number of monocytes increased in chronic lymphocytic leukemia patients compared to the number in normal controls (792 ± 86 cells/μL versus 485 ± 46 cells/μL, P=0.003). Higher numbers of non-classical CD14(+)CD16(++) and Tie-2-expressing monocytes were also detected in patients. Furthermore, we performed a gene expression analysis of monocytes in chronic lymphocytic leukemia patients, showing up-regulation of RAP1GAP and down-regulation of tubulins and CDC42EP3, which would be expected to result in impairment of phagocytosis. We also detected gene alterations such as down-regulation of PTGR2, a reductase able to inactivate prostaglandin E2, indicating immunosuppressive activity. Accordingly, the proliferation of T cells in contact with monocytes from patients was inhibited compared to that of cells in contact with monocytes from normal controls. Finally, normal monocytes in vitro increased migration and up-regulated CD16, RAP1GAP, IL-10, IL-8, MMP9 and down-regulated PTGR2 in response to leukemic cells or conditioned media. In conclusion, altered composition and deregulation of genes involved in phagocytosis and inflammation were found in blood monocytes obtained from chronic lymphocytic leukemia patients, suggesting that leukemia-mediated "education" of immune elements may also include the establishment of a skewed phenotype in the monocyte/macrophage population.

Theory of mind in amnestic mild cognitive impairment: an FMRI study

Theory of Mind (ToM) undergoes changes at the behavioral level in pathological aging (Alzheimer's disease (AD)) and at the neural level in physiological aging. The aim was to determine if there are changes in ToM in the behavioral and neural domains in old subjects with high risk of switching from successful to unsuccessful neurocognitive aging. Patients with amnestic mild cognitive impairment (aMCI) syndrome were studied, since aMCI was proposed to fill the gap between normal aging and dementia. Sixteen aMCI patients (mean age 71 years) and fifteen healthy controls (mean age 67 years) with no differences in age or education were subjected to increasingly complex ToM tasks and to fMRI scanning while performing the Reading the Mind in the Eyes test (RME), which attributes mental states by focusing on eye-gaze. aMCI subjects had worse performances in two second order false belief tasks, confirming the decay of ToM on the behavioral level. Despite a minor activation of some components (posterior end of the superior temporal sulcus and temporal pole) of the ToM neural circuit, no significant differences in the behavioral performances to the RME was found in aMCI compared to controls. Probably the preservation of the mirror neuron system (precentral gyrus-BA 6; Broca area - BA 44) and the stronger involvement of frontal areas (middle and medial frontal cortex and anterior cingulate cortex) supplemented the decay of part of the mentalizing neural circuit, preserving task performance.

Physical contact with endothelial cells through β1- and β2- integrins rescues chronic lymphocytic leukemia cells from spontaneous and drug-induced apoptosis and induces a peculiar gene expression profile in leukemic cells

BACKGROUND

Chronic lymphocytic leukemia B cells display prolonged survival in vivo, but when cultured in vitro rapidly undergo spontaneous apoptosis. We hypothesize that interactions with endothelial cells in infiltrated tissues and during recirculation may have a pathogenic role in chronic lymphocytic leukemia.

DESIGN AND METHODS

We evaluated apoptosis of leukemic cells after co-culture on a monolayer of human umbilical vein endothelial cells with addition of fludarabine and antibodies that block adhesion. Then, we compared microarray-based gene expression profiles between leukemic cells at baseline and after co-culture.

RESULTS

We found that the endothelial layer protected leukemic cells from apoptosis inducing a 2-fold mean decrement in apoptotic cells after 2 days of co-culture. Moreover, the endothelial layer decreased the sensitivity of chronic lymphocytic leukemia B cells to fludarabine-induced apoptosis. Physical contact with endothelium mediated by both β(1)- and β(2)- integrins is essential for the survival advantage of leukemic cells. In particular, blocking CD106 on endothelial cells or CD18 on leukemic B cells led to the almost complete abrogation of the survival advantage (>70% inhibition of viability). However, a reduction of apoptosis was also measured in leukemic cells cultured in conditioned medium collected after 2 days of co-culture, implying that survival is partially mediated by soluble factors. Overall, the contact with endothelial cells modulated 1,944 genes in chronic lymphocytic leukemia B cells, establishing a peculiar gene expression profile: up-regulation of angiogenesis-related genes, an increase of genes involved in TGFβ and Wnt signaling pathways, secretion of cytokines recruiting stromal cells and macrophages and up-regulation of anti-apoptotic molecules such as Bcl2 and Survivin.

CONCLUSIONS

Our study supports the notion that endothelial cells are major players in the chronic lymphocytic leukemia microenvironment. Adhesion to endothelium strongly supports survival, protects from drug-induced apoptosis and extensively modifies the gene expression profile of leukemic cells.

The CPP Tat enhances eGFP cell internalization and transepithelial transport by the larval midgut of Bombyx mori (Lepidoptera, Bombycidae)

Cell-Penetrating Peptides (CPPs) are short peptides that are able to translocate across the cell membrane a wide range of cargoes. In the past decade, different mammalian cell lines have been used to clarify the mechanism of CPPs penetration and to characterize the internalization process, which has been described either as an energy-independent direct penetration through the plasma membrane, or as endocytic uptake. Whatever the mechanism involved, the cell penetration properties of these peptides make their use very attractive as vector for promoting the cellular uptake of coupled bioactive macromolecules, such as peptides, proteins and oligonucleotides. Here we demonstrate, for the first time in insect, that cultured columnar cells from the larval midgut of Bombyx mori more readily internalize eGFP (enhanced Green Fluorescent Protein) when fused to CPP Tat. Tat-eGFP translocates across the plasma membrane of absorptive cells in an energy-independent and non-endocytic manner, since no inhibition of the fusion protein uptake is exerted by metabolic inhibitors and by drugs that interfere with the endocytic uptake. Moreover, the CPP Tat enhances the internalization of eGFP in the columnar cells of intact midgut tissue, mounted in a suitable perfusion apparatus, and the transepithelial flux of the protein. These results open new perspectives for effective delivery of insecticidal macromolecules targeting receptors located both within the insect gut epithelium and behind the gut barrier, in the hemocoel compartment.

Mapping levels of theory of mind in Alzheimer's disease: a preliminary study

BACKGROUND

Research on Theory of Mind (ToM), the ability to understand behaviour based on mental state representation, has shifted towards a life span perspective in typical and atypical conditions (dementia).

OBJECTIVES

The aim of this study is to investigate the presence and the features of ToM decay in early Alzheimer's disease (AD) patients compared to healthy controls adopting a neurodevelopmental stance.

METHOD

Sixteen AD patients and 16 healthy controls were submitted to an increasing complexity ToM battery, tapping ToM precursors, standard first- and second-order false beliefs and advanced ToM tasks (Eyes Test and strange stories).

RESULTS

The results underline a similar pattern of increasing difficulty of the tasks that explore ToM abilities in both the groups. They also confirm the presence of a strong gap in performance between the CTR and the AD groups, especially in the more complex ToM tasks, whereas there is no significant difference between the two groups in the first level of reasoning about beliefs (first-order false belief). The impairment in specific cognitive functions (i.e. memory and executive functions) seems to correlate with the decline in the most complex mentalistic abilities.

CONCLUSION

This study identifies a specific pattern of deterioration in ToM abilities in AD patients, following backwards developmental steps typical of the acquisition of mentalizing abilities, where the most complex ToM levels are impaired, whereas the intermediate and the simplest ones are preserved.

Gene expression profiling of acute promyelocytic leukaemia identifies two subtypes mainly associated with Flt3 mutational status

Acute promyelocytic leukaemia (APL) is a well-defined disease characterized by a typical morphology of leukaemic cells, the presence of t(15;17) translocation and the unique sensitivity to the differentiating effect of all-trans retinoic acid. Nevertheless, some aspects are variable among APL patients, with differences substantially related to morphological variants, peripheral leukocytes count, the presence of a disseminated intravascular coagulopathy, different PML/RARalpha isoforms (long, variable or short) and Fms-like tyrosine kinase 3 (Flt3) mutations. In order to better define this variability, we investigated the gene expression profiles of 18 APL cases revealing, besides a high uniformity in gene expression pattern, the presence of few robust differences among patients able to identify, by an unsupervised analysis, two major clusters of patients characterized by different phenotypes (hypogranular M3v vs classical M3) and by the presence or absence of Flt3 internal tandem duplications (ITDs). Further supervised analysis confirmed that Flt3 status was the APL parameter best associated with these two subgroups. We identified, between Flt3 wild-type and Flt3-ITDs subsets, 147 differentially expressed genes that were involved in the cytoskeleton organization, in the cell adhesion and migration, in the proliferation and the coagulation/inflammation pathways as well as in differentiation and myeloid granules constitution suggesting a role of Flt3 mutations in the pathogenesis and clinical manifestations of APL.

Immunoglobulin mutational status detected through single-round amplification of partial V(H) region represents a good prognostic marker for clinical outcome in chronic lymphocytic leukemia

The immunoglobulin (Ig) mutational status in B-cell chronic lymphocytic leukemia (CLL) distinguishes two subsets of patients with different prognosis. Ig status detection is commonly performed with a panel of V(H) family-specific primers. Although this method detects clonal VDJ rearrangement in virtually all cases, it is technically cumbersome and therefore not widely used clinically. Here, we describe a simple and rapid method to establish the mutational status of IgV(H) in CLL. The method is based on a consensus V(H) FR2 primer, used in both polymerase chain reaction (PCR) and sequencing reactions. Overall, monoclonal B-cell populations were detected in 163 of 189 CLL patients (86%). The prognostic value of IgV(H) mutational status was then evaluated by analyzing survival in 146 CLL cases using different V(H) homology cutoffs. CLL prognostic groups were best separated by the classical 98% cutoff: median survival was 127 and 206 months in unmutated and mutated CLL cases, respectively (P = 0.0023). V(H) FR2 consensus and V(H) family PCR were compared in 41 cases, correctly assigning all cases by both methods. Therefore, we suggest a sequential strategy to detect immunoglobulin mutational status in CLL patients by first using the approach described in this study followed by alternative V(H) family-specific PCRs for negative cases.