Partially Overlapping Brain Networks for Singing and Cello Playing.

This research uses an MR-Compatible cello to compare functional brain activation during singing and cello playing within the same individuals to determine the extent to which arbitrary auditory-motor associations, like those required to play the cello, co-opt functional brain networks that evolved for singing. Musical instrument playing and singing both require highly specific associations between sounds and movements. Because these are both used to produce musical sounds, it is often assumed in the literature that their neural underpinnings are highly similar. However, singing is an evolutionarily old human trait, and the auditory-motor associations used for singing are also used for speech and non-speech vocalizations. This sets it apart from the arbitrary auditory-motor associations required to play musical instruments. The pitch range of the cello is similar to that of the human voice, but cello playing is completely independent of the vocal apparatus, and can therefore be used to dissociate the auditory-vocal network from that of the auditory-motor network. While in the MR-Scanner, 11 expert cellists listened to and subsequently produced individual tones either by singing or cello playing. All participants were able to sing and play the target tones in tune (<50C deviation from target). We found that brain activity during cello playing directly overlaps with brain activity during singing in many areas within the auditory-vocal network. These include primary motor, dorsal pre-motor, and supplementary motor cortices (M1, dPMC, SMA),the primary and periprimary auditory cortices within the superior temporal gyrus (STG) including Heschl's gyrus, anterior insula (aINS), anterior cingulate cortex (ACC), and intraparietal sulcus (IPS), and Cerebellum but, notably, exclude the periaqueductal gray (PAG) and basal ganglia (Putamen). Second, we found that activity within the overlapping areas is positively correlated with, and therefore likely contributing to, both singing and playing in tune determined with performance measures. Third, we found that activity in auditory areas is functionally connected with activity in dorsal motor and pre-motor areas, and that the connectivity between them is positively correlated with good performance on this task. This functional connectivity suggests that the brain areas are working together to contribute to task performance and not just coincidently active. Last, our findings showed that cello playing may directly co-opt vocal areas (including larynx area of motor cortex), especially if musical training begins before age 7.

The Impact of Instrument-Specific Musical Training on Rhythm Perception and Production.

Studies comparing musicians and non-musicians have shown that musical training can improve rhythmic perception and production. These findings tell us that training can result in rhythm processing advantages, but they do not tell us whether practicing a particular instrument could lead to specific effects on rhythm perception or production. The current study used a battery of four rhythm perception and production tasks that were designed to test both higher- and lower-level aspects of rhythm processing. Four groups of musicians (drummers, singers, pianists, string players) and a control group of non-musicians were tested. Within-task differences in performance showed that factors such as meter, metrical complexity, tempo, and beat phase significantly affected the ability to perceive and synchronize taps to a rhythm or beat. Musicians showed better performance on all rhythm tasks compared to non-musicians. Interestingly, our results revealed no significant differences between musician groups for the vast majority of task measures. This was despite the fact that all musicians were selected to have the majority of their training on the target instrument, had on average more than 10 years of experience on their instrument, and were currently practicing. These results suggest that general musical experience is more important than specialized musical experience with regards to perception and production of rhythms.

Mortality rates and clinical predictors of reduced survival after cardioverter defibrillator implantation.

We aimed to identify mortality rates and clinical predictors of reduced survival in a large cohort of patients after implantation of an implantable cardioverter-defibrillator (ICD). Although existing data from clinical trials report annual mortality after ICD implantation from 2% to 9%, there are few data available on mortality rates or predictors of reduced survival in this patient population in clinical practice. In this single-center, retrospective analysis of 286 patients who underwent ICD implantation between June 1, 2000 and December 30, 2003, candidate predictors of mortality were assessed and subjected to multivariable analysis. Outcomes were documented using the Social Security Death Master File and hospital medical records. Overall annualized mortality was 11.3% after ICD implantation. Mortality rates in patients with left ventricular ejection fraction (LVEF) <25% were 27.2% at 1 year and 50.5% at 3 years. Digoxin (hazard ratio 1.86, 95% confidence interval [CI] 1.21 to 2.86, p = 0.0046) and loop diuretics (hazard ratio 1.59, 95% CI 1.06 to 2.38, p = 0.024) were associated with reduced survival. Angiotensin-converting enzyme inhibitor or aldosterone receptor blocker use was associated with reduced mortality (hazard ratio 0.50, 95% CI 0.31 to 0.80, p = 0.0038). In conclusion, mortality after ICD implantation is higher than demonstrated in primary or secondary prevention ICD trials; LVEF remains a potent predictor of mortality after ICD implantation, particularly in patients with an LVEF <25%; loop diuretic and digoxin use is associated with an approximate twofold increase in mortality in this population; and angiotensin-converting enzyme inhibitor or aldosterone receptor blocker use is associated with improved survival after ICD implantation.

Transesophageal echocardiographic diagnosis of left atrial appendage occluder device infection.

The safety and efficacy of a left atrial appendage closure device is currently under evaluation in a large-scale multi-center clinical trial. We report an initial case of left atrial appendage occluder device infection with Staphylococcus aureus; transesophageal echocardiography played a pivotal role in diagnosis and treatment.