The lost ability to distinguish between self and other voice following a brain lesion.

Mechanisms underlying the self/other distinction have been mainly investigated focusing on visual, tactile or proprioceptive cues, whereas very little is known about the contribution of acoustical information. Here the ability to distinguish between self and others' voice is investigated by using a neuropsychological approach. Right (RBD) and left brain damaged (LBD) patients and healthy controls were submitted to a voice discrimination and a voice recognition task. Stimuli were paired words/pseudowords pronounced by the participant, by a familiar or unfamiliar person. In the voice discrimination task, participants had to judge whether two voices were same or different, whereas in the voice recognition task participants had to judge whether their own voice was or was not present. Crucially, differences between patient groups were found. In the discrimination task, only RBD patients were selectively impaired when their own voice was present. By contrast, in the recognition task, both RBD and LBD patients were impaired and showed two different biases: RBD patients misattributed the other's voice to themselves, while LBD patients denied the ownership of their own voice. Thus, two kinds of bias can affect self-voice recognition: we can refuse self-stimuli (voice disownership), or we can misidentify others' stimuli as our own (embodiment of others' voice). Overall, these findings reflect different impairments in self/other distinction both at behavioral and anatomical level, the right hemisphere being involved in voice discrimination and both hemispheres in the voice identity explicit recognition. The finding of selective brain networks dedicated to processing one's own voice demonstrates the relevance of self-related acoustic information in bodily self-representation.

Short term analgesia based sedation in the Intensive Care Unit: morphine vs remifentanil + morphine.

AIM: The aim of the study was the evaluation of postoperative short term analgesia-based sedation provided by a continuous i.v. morphine vs morphine+remifentanil infusion in the ICU. METHODS: A prospective, randomized, controlled study was carried out. INCLUSION CRITERIA: patients aged > 18 years undergoing major surgery (abdominal, vascular, thoracic). A total of 100 patients undergoing balanced anaesthesia, were enrolled; at the end of surgery an i.v. loading morphine dose (0.1 mg/kg) was administered and a continuous ground i.v. infusion (0.24 microg/kg/min) was started. When the patient was admitted to the ICU, a second i.v. continuous infusion was started and patients were allocated into 2 groups with regard to the second opioid: MM = morphine + morphine, MR = morphine + remifentanil. The second continuous infusion (boluses allowed) was titrated to obtain a numerical rate score (NRS) < 3 and Ramsay Scale =or>2. If Ramsay =or< 2 rescue sedation was administered (diazepam). RESULTS: The groups were homogeneous with regard to gender, age, weight, duration of surgery, intraoperative opioids, SAPS II. The second infusion rate in the first 24 postoperative hours was 0.73+/-0.55 microg/kg/min morphine in MM and 0.06+/-0.05 microg/kg/min remifentanil in RM. Hemodynamic parameters and SpO(2) were similar. Hypnotic consumption and NRS were significantly lower in RM, while Ramsay Scale was higher. Postextubation respiratory rate and minute volume were lower in group MM, while PaCO(2), postoperative nausea and vomiting (PONV) incidence and frequency of diazepam administration were higher. In both groups more than 70% of the patients were very satisfied. CONCLUSION: The combination of morphine + remifentanil provided better analgesia and sedation than morphine alone, with a lower incidence of side effects and a similar hemodynamic profile and patient satisfaction. The adherence to a clear analgesia based sedation protocol probably represents the most important issue carrying out analgosedation; however, the continuous infusion of a short acting drug, although more expensive, allows better titration and adjustment of the desired level of analgesia and sedation, avoiding the risk of undersedation as well as oversedation with a potential reduction of otherwise unnecessary ICU stays and, consequently, a decrease in comprehensive costs.

Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site.

AIM: The purpose of this prospective, randomized, controlled study was the comparison of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, large drape) vs control precautions (mask, cap, sterile gloves, small drape) and of transparent polyurethan film vs gauze dressing for use on central venous (CVC) nontunneled catheters, inserted via the jugular vein. Skin colonization at the insertion site (defined by quantitative skin cultures performed at the time of insertion and in days 2 and 5) was used as a primary endpoint. Catheter tip colonization was also assessed through qualitative culture and CVC related sepsis was defined by the isolation of the same organism from the catheter tip and the blood, with clinical sepsis of no other apparent source. METHODS: Eighty-two consecutive patients were enrolled, admitted to a mixed medical-surgical ICU, aged 72+/-12 years, 58% male, SAPS II 42+/-13. One-hundred and seven CVCs were studied (presenting 750 catheter in situ days); CVCs were in place for a mean period of 6.9+/-4.7 days and 5 episodes of central catheter-related bloodstream infection were detected (6.6 per 1000 catheter days). RESULTS: A multiple logistic regression detected an increased risk of skin colonization in male gender (OR=2.5) and control precautions (OR=3.4) and no difference with regard to age, dressing and diagnostic group. CONCLUSIONS: Maximal sterile barrier proved to be an effective and recommended practice. However surveillance skin cultures revealed the common and changing nature of colonization of skin at the insertion site.

[Changes in pancreatic arginase activity in pubertal and adult rats induced by castration]. / Cambios en la actividad de arginasa pancreática en ratas púberes y adultas inducidos por la castración.

Arginase activity in kidney, and small intestine in several mammalian species is sensitive to castration, a finding that could suggest their dependence on testosterone. However, as far as we know, information on regulation of pancreatic arginase activity is scarce. In this paper, the effect of orchidectomy on pancreatic arginase activity in pubescent and adult rats was studied. Male pubescent and adult rats, 21 days old and 4 months old, respectively, were orquidectomizades and sacrificed at various times post-surgery. Groups of intact rats served as controls. Arginase activity and proteins were measured in pancreatic tissue. The activity of this enzyme was measured in serum in addition to glucose, triglycerides and total proteins. In pubescent rats pancreatic and serum arginase activities peaked at day 5 post-surgery, increased arginase activity in adult rats was seen at day 20. Changes in serum and pancreatic proteins in pubescent, but not in adult, castrated rats were observed. Taken together, these results suggest that pancreatic arginase activity is androgen-dependent and that there is age-difference, probably due lo distinct patterns of hormone secretion in pubescent and adult rats.