Long lasting musical training modifies language processing: a Dichotic Fused Word Test study.

Musical training modifies neural areas associated with both music and language and enhances speech perception and discrimination by engaging the right hemisphere regions classically associated with music processing. On these bases we hypothesized that participants with extended musical training could have reduced left-hemisphere dominance for speech. In order to verify this hypothesis, two groups of right-handed individuals, one with long-term musical training and one with no musical training, participated to a Dichotic Fused Word Test consisting in the simultaneous presentation of different pairs of rhyming words and pseudo-words, one to the left ear and one to the right one. Participants typically show a greater number of reports of the right ear input than of the left one. This effect, called right ear advantage (REA), reflects left-hemisphere dominance for speech processing. In our study, we expected that musicians had a reduced dichotic listening REA for linguistic stimuli. The main result of this study was the attenuation, and in some cases the complete suppression, of the dichotic effect in musicians, since most of them perceived both words, simultaneously. This finding suggests that both hemispheres may have similar verbal competence and contribute to speech processing in parallel. This contrasts with the normal brain organization in which hemispheres cooperate but are engaged in different analysis of speech. The "two words" perception also extended to pseudo-words. Thus, musical training, by shaping the language circuits, could produce the enhancement of bilateral processing of stimuli with linguistic characteristics (i.e. phonetics) independently of semantics.

Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review.

Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.

Hypnotizability and haptics: visual recognition of unimanually explored 'nonmeaningful' objects.

The cognitive trait of hypnotizability modulates sensorimotor integration and mental imagery. In particular, earlier results show that visual recognition of 'nonmeaningful', unfamiliar objects bimanually explored is faster and more accurate in subjects with high (Highs) than with low hypnotizability (Lows). The present study was aimed at investigating whether Highs exhibit a similar advantage after unimanual exploration. Recognition frequency (RF) and Recognition time (RT) of correct recognitions of the explored objects were recorded. The results showed the absence of any hypnotizability-related difference in recognition frequencies. In addition, RF of the right and left hand was comparable in Highs as in Lows, while slight differences were found in RT. We suggest that hemispheric co-operation played a key role in the better performance of Highs in the bimanual task previously studied. In the unimanual exploration, the task's characteristics (favoring the left hand), hypnotizability-related cerebral asymmetry (favoring the right hand in Highs) and the possible preferential verbal style of recognition in Lows (favoring the right hand in this group) antagonize each other and prevent the occurrence of major differences between the performance of Highs and Lows.

Fear-object perception: does it entail the involuntary capture of attention?

The idea that fearful stimuli are automatically detected i.e. without attention, is challenged by the hypothesis that detection of threatening stimuli is facilitated by the involuntary, stimulus-driven recruitment of attentional resources. In order to clarify this question, we studied spiders detection in arachnophobic individuals by means of an iconic version of the Attentional Blink Task (AB). The experiment consisted of two tasks: 1) Probe detection within a rapid sequence of distractors, including a Critical Distractor (CD); 2) Probe detection and identification of the CD (Target). In this case, the close temporal proximity of CD-Target and Probe typically produces the so-called AB effect, that is the decrease of Probe visibility, due to competition for limited attentional resources. In both tasks, CD-Target was either a spider (50%) or an innocuous animal shape (50%), and Probe (a rabbit icon) was presented at one out of 3 possible lags from the CD-Target. At lag I (100 ms), arachnophobics, at difference with controls, exhibited an AB effect also when the spider was the CD to be ignored. Moreover, Probe detection scores were inversely correlated with spider recalls at lag I. In conclusion, our findings contrast the automatic view of threat detection, and support an attention capturing mechanism automatically driven by the fearful connotation of the stimulus.

HIV bio-behavioural survey among men who have sex with men in Barcelona, Bratislava, Bucharest, Ljubljana, Prague and Verona, 2008-2009.

Data from 23 European countries show that the annual number of HIV diagnoses in men who have sex with men (MSM) increased by 86% between 2000 and 2006. This paper reports the main preliminary results of a bio-behavioural survey in MSM with a specific focus on HIV prevalence and use of United Nations General Assembly Special Session (UNGASS) indicators in six cities in Southern and Eastern Europe. Time-location sampling (TLS) was used. A total number of 2,356 questionnaires and 2,241 oral fluid samples were collected (invalid samples 4.1%). The data show different socio-demographic patterns across countries regarding age, level of education, living conditions, living area and self-identity. Southern European cities had the highest percentage of people who had tested for HIV and collected the result. More than 50% of respondents in the sample from Barcelona reported having used a condom last time they had anal sex (57.2%), whilst in all other cities this proportion was below 50%. The cities with the highest HIV prevalence in MSM were Barcelona (17.0%) and Verona (11.8%) whilst lower percentages were reported in Bratislava (6.1%), Bucharest (4.6%), Ljubljana (5.1%) and Prague (2.6%). The low prevalence in Eastern European cities is encouraging. However, with the level of high-risk sexual behaviour documented and the lower frequency of HIV test seeking behaviour, there is a clear risk of an increase in HIV transmission.

Be(a)ware of spider! An attentional blink study on fear detection.

We investigated whether detection of fearful stimuli is independent from attention by using an iconic version of the Attentional Blink Task in arachnophobic individuals. A colored animal icon (Target) and a black spider or butterfly icon (Probe) appeared in close temporal proximity within a stream of distractors, at one of 4 possible time lags. In one task, Probe detection was required; in another one, Target identification was also requested. In this case, competition for attentional resources produces the so-called AB effect, that is the decrease of Probe perception as a function of lag. During spider-Probe detection, arachnophobics showed a reduced AB effect with respect to the butterfly-Probe session. Their spider detection scores were also greater than ratings obtained by non-phobic controls with both Probe types. Thus, fear appears to enhance the probability of consciously perceiving the stimulus even when attention is engaged by a previous demanding event. One may assume that spider-Probe is scarcely attention demanding because detection of threat in arachnophobics is increased by rapid amygdala activation of visual areas and/or facilitated by a strong arousal-induced noradrenergic cortical input. Alternatively, an attention capturing mechanism involuntary triggered by the phobic meaning of the stimulus could be hypothesized.

Manipulation of attention in highly and low hypnotizable individuals: a study on verbal priming.

This study investigated the effects of manipulation of attention on verbal priming in highly (Highs) and low (Lows) hypnotizable individuals. Priming was evaluated via the word-stem completion task (WSCT). The experimental paradigm consisted of one condition in full-attention and in two conditions with colored words in which attention was directed, respectively, only to the color and to both color and word. No significant differences between Highs and Lows were found in none of the three attentional conditions. However, during encoding in full-attention, Highs showed shorter reaction times (RTs) than Lows. This is in accord with previous evidence of faster simple and choice RTs in Highs than in Lows, and suggests hypnotizability-related differences in arousal, likely driven by a different cognitive control activity. Also, Highs' self-report of interference of color-naming on word-reading suggests possible differences between Highs and Lows in cognitive activity related to mental effort.

Hypnotizability and spatial attentional functions.

Many theories of hypnotic responding have proposed that differences in hypnotic trait rely on differences in frontal attentional functions. Evidence of hypnotizability-related attentional abilities are, however, very scant. This study was designed to investigate the relationship between hypnotizability and executive control components of attention in the spatial domain. We chose the Attention Network Test that enables to analyze alerting, orienting and executive control functions by measuring reaction times (RTs) to targets cued for different locations in space. According to Posner theory, alerting, orienting and executive control effects were found in both groups. No differences between highly susceptible (Highs) and low susceptible individuals (Lows) on executive control functions were found. However, in Highs alerting was significantly smaller than in Lows and Highs were significantly faster than Lows in the no and central cue conditions. These findings suggest that Highs would be endowed with a basal higher efficiency in achieving and maintaining their readiness to respond to incoming stimuli. This relation between hypnotizability and alerting, is discussed in terms of a possible more efficient noradrenergic activity driven by frontal attentional systems.

Efficacy and tolerability of a very low molecular weight heparin compared with standard heparin in patients with unstable angina: a pilot study.

BACKGROUND: Unstable angina is an active thrombotic process that involves thrombus formation and platelets. It requires a rapid and intensive treatment with anticoagulants and antiplatelets. HYPOTHESIS: The aim of the present study was to compare the efficacy of a very low molecular weight heparin, OP 2000, with standard heparin in the treatment of unstable angina. Tolerance and safety were also assessed. METHODS: The study population included 120 consecutive hospitalized patients with unstable angina randomized for treatment with very low molecular weight heparin or with standard heparin. The dosage of the study drug was 200 mg intramuscular (i.m.) the first day followed by 150 mg IM/day. The control drug was standard heparin starting at a dosage of 5,000 UI/ml intravenously (i.v.) and followed by continuous infusion at an activated partial thromboplastin time-adjusted dosage. The primary end points were death, acute myocardial infarction, urgent revascularization, and recurrence of angina. Tolerability was assessed using bleeding parameters, thrombocytopenia, and allergic reactions. RESULTS: Fourteen clinical events were reported in the study group compared with 25 events in the control group (p < 0.05). No adverse events were reported in either group. CONCLUSION: During the acute phase of unstable angina, treatment with a very low molecular weight heparin plus aspirin was more effective than treatment with standard heparin plus aspirin.

Prevalence of atrial fibrillation and stroke in paced patients without prior atrial fibrillation: a prospective study.

BACKGROUND: Several reports suggest that the incidence of stroke and atrial fibrillation is reduced in patients receiving physiologic pacemakers, compared with patients receiving a ventricular pacemaker. HYPOTHESIS: The study was undertaken to address the impact of different pacing modalities on the incidence of stroke and atrial fibrillation. METHODS: We prospectively analyzed 210 consecutive patients. Those with previous episodes of cerebral ischemia and/or atrial fibrillation were excluded from the study. The study population included 100 patients paced for total atrioventricular (AV) block or second-degree AV block (type II Mobitz) and 110 patients paced for sick sinus syndrome (SSS). The pacing mode was randomized. All patients underwent a brain computed tomography (CT) scan at the date of enrollment and after 1 and 2 years. Patients were followed for 2 years, and the incidence of atrial fibrillation and stroke was evaluated. RESULTS: The incidence of atrial fibrillation was 10% at 1 year and 11% at 2 years. Comparing the different pacing modalities, we reported an increase in the incidence of atrial fibrillation in patients receiving ventricular pacing (p < 0.05). On the other hand, no difference was found between patients paced for AV block and those paced for SSS. At the end of follow-up, we reported 29 cases of cerebral ischemia: 9 patients had AV block while 20 had SSS (p < 0.05). Comparing the different pacing modalities, there was an increase in the incidence of stroke in patients receiving ventricular pacing (p < 0.05). CONCLUSION: There was an increase in the incidence of stroke and atrial fibrillation in patients with ventricular pacing.

Sentinel lymph node biopsy under local anaesthesia versus general anaesthesia: reliability and cost-effectiveness analysis in 153 patients with malignant melanoma.

AIM: The aim of our study was to evaluate feasibility, reliability and cost-benefit balance of sentinel node (SN) biopsies conducted under local anaesthesia (LA) in patients affected by stage I-B or II cutaneous melanoma. PATIENTS AND METHODS: A retrospective analysis was carried out in 153 patients, evaluating the number of harvested lymph nodes, perioperative and postoperative complications, operating time and operating room costs, comparing interventions under LA and general anaesthesia (GA). Operations were carried out under LA in 112 cases (73%) and under GA in the remaining 41(27%). RESULTS: The mean number of removed SN was overall higher in the GA group but was not significantly different under LA with respect to the subgroups of axillary biopsies. No difference was noted in the number of complications. Operating time was significantly shorter under LA, with significantly lower costs. CONCLUSION: LA for groin and axillary SN biopsies can be a reliable and effective alternative to GA in melanoma patients, with shorter operating time, lower costs and without the side-effects and risks associated with GA.

[Transesophageal echocardiography in the assessment of patients with atrial fibrillation and stroke]. / L'ecocardiografia transesofagea nella valutazione dei pazienti con fibrillazione atriale e stroke.

Cardiac evaluation of stroke or transient ischemic attack (TIA) patients includes transthoracic and transesophageal echocardiography to identify potential cardiac source of embolism. In the present study transesophageal echocardiography was performed in 53 consecutive patients with non valvular atrial fibrillation and a previous embolic stroke. All patients were referred to our department because of an episode of atrial fibrillation. They all underwent computed tomography (CT) scan: 31 patients had a positive scan whereas 22 had a negative scan with a positive history of TIA diagnosed from a neurologist during hospitalization. In the group of 31 patients with a positive scan 9 patients with no history of a previous ischemic attack were found. The transesophageal echocardiography was performed in all the study subjects: 7 patients had a thrombus in the left atrial appendage, 2 patients had a thrombus in the right atrium. Spontaneous echo contrast was reported in 15 patients. Evaluating the interatrial septum we observed a patent foramen ovale in 4 patients, a defect in 2 patients and a fossa ovalis aneurysm in 3 patients. The mitral valve analysis showed a leaflet prolapse in 3 patients. The entire thoracic aorta was imaged in each patient: in 12 an abnormal atherosclerotic plaque was found. Transesophageal echocardiography is an important component of the comprehensive evaluation of potential sources of embolism in patients with ischemic cerebral attack and nonrheumatic atrial fibrillation.

Stroke in paced patients with sick sinus syndrome: influence of left atrial function and size.

Patients with sick sinus syndrome have a high prevalence of cerebral ischemia. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome and the role of atrial size and function. This prospective study analyzed 100 consecutive patients with sick sinus syndrome without atrial fibrillation who received either dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. Endpoint of the study was cerebral ischemia. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 18 patients. Univariate predictors for embolism were age >65 years (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.

[Development of the steady-state cortical visual evoked response in children]. / Le développement de la réponse stationnaire corticale évoquée visuelle chez l'enfant.

Steady-state VEPs responses (pattern reversal stimulation) have been studied by the application of frequency analysis with Fourier methods. Authors examined with this method a group of children aged from 4 to 12 years, without ophthalmological or neurological pathologies. Responses evaluation is based on the number of harmonic frequency components and also on the power spectra of the first two components. Frequency analysis shows a well proportioned responses development that can be considered as a good index of visual function growth.

[Recovery of mechanical atrial function following atrial fibrillation]. / Il ripristino della funzione meccanica atriale dopo fibrillazione atriale.

To evaluated the recovery of atrial function following atrial fibrillation, we followed 66 patients with atrial fibrillation cardioverted to sinus rhythm. Over 3 months of follow-up we performed transmitral pulsed Doppler echocardiography. The results were evaluated according to the etiology, duration of atrial fibrillation, left atrial dimension and modality of cardioversion. We observed a significant increase in both peak A wave velocity and percent atrial contribution to total left ventricular filling after 1 month in hypertensive patients and after 3 months in ischemic patients. The recovery of atrial mechanical function was earlier in patients with recent atrial fibrillation (< 24 hours) and in patients with normal left atrium. These results may have implications in guiding the duration of anticoagulant therapy after cardioversion.

Symptomatic achievements with diuretics in congestive heart failure.

The short-term clinical efficacies of furosemide, 25 mg/day, and torasemide, 10 mg/day, have been compared in 2 groups of 12 patients with severe heart failure. In each group there were similar numbers of patients in whom heart failure was due to coronary heart disease, high blood pressure, or idiopathic dilated cardiac myopathy. The design of the study was open and the diuretics were added to baseline treatment with digoxin. Treatment for 8 days with the 2 loop diuretics resulted in similar substantial and significant improvements in symptoms and exercise tolerance as judged by the increase in total body oxygen consumption, and reductions in radiographic evidence of pulmonary congestion and in right heart filling pressure as judged from the jugular venous pressure wave. The results of this short-term comparative study confirm that furosemide and torasemide are equally efficacious in inducing substantial improvements in the clinical status of patients in severe heart failure.

Stroke in paced patients with sick sinus syndrome: relevance of atrial mechanical function, pacing mode and clinical characteristics.

Patients with sick sinus syndrome have a high prevalence of cerebral ischemia and emboli of the viscera and extremities. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome, with specific attention to pacing mode, atrial function (evaluated using Doppler echocardiography) and the clinical condition of the patients. The prospective study analyzed 80 consecutive patients with sick sinus syndrome who received either atrial, dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. End points of the study were cerebral ischemia or emboli of the viscera or extremities. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 13 patients and emboli of the viscera or extremities were observed in 2 patients. Univariate predictors for embolism consisted of a prior history of cerebrovascular disease (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). Independent risk factors for stroke included a history of previous cerebral ischemia, age > 65 years, left atrial echo contrast on an echocardiogram and a depressed atrial ejection force. These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.

[Atrial ejection force. Findings in healthy subjects]. / La forza di eiezione atriale. Rapporti correlativi in soggetti normali.

Atrial ejection force was measured by Doppler echocardiography from the A-wave of the transmitral inflow pattern. Atrial ejection force was measured in 72 normal subjects, 36 males and 36 females aged 20 to 80 years, 12 patients for each decade. Using bivariate correlation we analyzed the relationship between atrial ejection force and biological parameters: age, height, weight, body surface; clinical parameters: heart rate, systolic, diastolic and mean blood pressure; echocardiographic measures: left atrial dimensions. A significant correlation between atrial ejection force and age (r = 0.9, p < 0.001) was found. The atrial ejection force was also correlated with left atrial dimensions (p < 0.01). No relations between atrial ejection force and other clinical parameters were found. The atrial ejection force is a potentially useful parameter for assessing the atrial contribution to diastolic performance, the age-corrected normogram is essential when assessing atrial ejection force in individual patients.