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The effect of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) on psychopathological symptoms and resting state brain activity was assessed in a patient with obsessive-compulsive disorder (OCD). tDCS and rTMS had no effect on OC symptoms. tDCS, however, improved depression and anxiety. Functional magnetic resonance imaging at baseline showed an interhemispheric asymmetry with hyperactivation of the left and hypoactivation of the right anterior neural circuits. A reduction of interhemispheric imbalance was detected after tDCS but not after rTMS. tDCS seems to be more effective than rTMS in restoring interhemispheric imbalance and improving anxiety and depression in OCD. [ABSTRACT FROM AUTHOR]

The effect of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) on psychopathological symptoms and resting state brain activity was assessed in a patient with obsessive–compulsive disorder (OCD). tDCS and rTMS had no effect on OC symptoms. tDCS, however, improved depression and anxiety. Functional magnetic resonance imaging at baseline showed an interhemispheric asymmetry with hyperactivation of the left and hypoactivation of the right anterior neural circuits. A reduction of interhemispheric imbalance was detected after tDCS but not after rTMS. tDCS seems to be more effective than rTMS in restoring interhemispheric imbalance and improving anxiety and depression in OCD. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: Studies on brain computer interfaces (BCIs) have been mainly concerned with algorithm improvement for better signal classification. Fewer studies, however, have addressed to date the role of cognitive mechanisms underlying the elicitation of brain-signals in BCIs. We tested the effect of visuospatial attention orienting on a P300-guided BCI, by comparing the effectiveness of three visual interfaces, which elicited different modalities of visuospatial attention orienting (exogenous vs. endogenous). Methods: Twelve healthy participants performed 20 sessions, using the abovementioned P300-guided BCI interfaces to control a cursor. Brain waves were recorded on each trial and were subsequently classified on-line using an ad hoc algorithm. Each time the P300 was correctly classified, the cursor moved towards the target position. Results: The “endogenous” interface was associated with significantly higher performance than the other two interfaces during the testing sessions, but not in the follow-up sessions. Conclusions: Endogenous visuospatial attention orienting can be effectively implemented to increase the performance of P300-guided BCIs. Significance: The study of visuospatial attention underlying participants’ performance is essential for implementing efficient visual BCIs. [Copyright &y& Elsevier]

Abstract: Objective: This study aimed to describe the use of the P300 event-related potential as a control signal in a brain computer interface (BCI) for healthy and paralysed participants. Methods: The experimental device used the P300 wave to control the movement of an object on a graphical interface. Visual stimuli, consisting of four arrows (up, right, down, left) were randomly presented in peripheral positions on the screen. Participants were instructed to recognize only the arrow indicating a specific direction for an object to move. P300 epochs, synchronized with the stimulus, were analyzed on-line via Independent Component Analysis (ICA) with subsequent feature extraction and classification by using a neural network. Results: We tested the reliability and the performance of the system in real-time. The system needed a short training period to allow task completion and reached good performance. Nonetheless, severely impaired patients had lower performance than healthy participants. Conclusions: The proposed system is effective for use with healthy participants, whereas further research is needed before it can be used with locked-in syndrome patients. Significance: The P300-based BCI described can reliably control, in ‘real time’, the motion of a cursor on a graphical interface, and no time-consuming training is needed in order to test possible applications for motor-impaired patients. [Copyright &y& Elsevier]

Despite decades of studies, it is still an open question on how and where simple multiplications are solved by the brain. This fragmented picture is mostly related to the different tasks employed. While in neuropsychological studies patients are asked to perform and report simple oral calculations, neuroimaging and neurophysiological studies often use verification tasks, in which the result is shown, and the participant must verify the correctness. This MEG study aims to unify the sources of evidence, investigating how brain activation unfolds in time using a single-digit multiplication production task. We compared the participants' brain activity—focusing on the parietal lobes—based on response efficiency, dividing their responses in fast and slow. Results showed higher activation for fast, as compared to slow, responses in the left angular gyrus starting after the first operand, and in the right supramarginal gyrus only after the second operand. A whole-brain analysis showed that fast responses had higher activation in the right dorsolateral prefrontal cortex. We show a timing difference of both hemispheres during simple multiplications. Results suggest that while the left parietal lobe may allow an initial retrieval of several possible solutions, the right one may be engaged later, helping to identify the solution based on magnitude checking. [ABSTRACT FROM AUTHOR]

Introduction: The stapled hemorrhoidopexy (SH) and the Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) are minimally invasive procedures for the surgical treatment of hemorrhoids. This study aims to verify the efficacy of the DG-THD versus the SH in the treatment of third-degree hemorrhoids.Method: One hundred consecutive patients were causally allocated to either procedure, obtaining two groups of 50 pts. A clinical examination was performed at 3, 7, 15, and 30 days after the operation. Quality of life, anal symptoms, recurrence of hemorrhoids, and reoperation were assessed by means of a questionnaire and of a clinical examination at long-term follow-up (7.0 year average).Results: At short-term follow-up, the median postoperative pain score was significantly lower in DG-THD group compared to SH group, (V.A.S 2 vs 6; t = 2.65, p < 0.01). The morbidity rate and the return to normal life and work were similar after the two procedures. At long-term follow-up, the incidence of piles was not statistically different between the two groups (DG-THD 10.0 %; SH 14.0 %). No differences were reported by patients in terms of satisfaction for surgery.Conclusion: SH and DG-THD procedures do not show significantly different results with regard to the patients outcome. However, considering the lower p. o. pain, the DG-THD might be proposed as the first line treatment in third-degree hemorrhoids. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess the effect of transcranial direct current stimulation (TDCS) applied to the dorso-lateral prefrontal cortex (DLPF) on the behavioral responses and brain oscillations in 15 patients in vegetative (VS) and minimally conscious state (MCS). 10 daily sessions of anodal tcds were applied to the left dlpf. A sham stimulation was used as a control condition. 19-channels EEG was recorded before and after stimulation. The EEG coherence and spectral pattern differences before and after each treatment were analyzed. EEG data analysis showed a significant increase of coherence over the frontal and fronto-parietal areas in beta and gamma frequencies after tdcs. No significant effects were observed after sham stimulation. Clinical assessment of patients showed no significant changes. However all caregivers reported a reduction of oscillations of arousal level. Our study suggests that tdcs could influence the EEG coherence of rapid frequencies allowing the interaction between frontal and parietal areas. This interaction represents a fundamental prerequisite for all conscious perception mechanisms. TDCS may represent an useful new tool for cognitive rehabilitation. [Copyright &y& Elsevier]

Background: The role of supplemental oxygen therapy in the healing of colorectal anastomosis is still very much at an experimental stage. The aim of the present study, prospective randomized, was to assess the effect of administration of perioperative supplemental oxygen therapy on infraperitoneal anastomosis, where the risk of leakage is higher.Methods: We enrolled 72 patients between February, 2008 and February, 2011, who underwent elective open infraperitoneal anastomosis for rectal cancer (middle and low). Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 37) or 80% (n = 35). Administration was commenced after induction of anesthesia and maintained for 6 h after surgery.Results: The overall anastomotic leak rate was 16.6% (12 out of 72); 8 patients (21.6%) had an anastomotic dehiscence in the 30% FiO2 group and 4 (11.4%) in the 80% FiO2 group (p < 0.05). The risk of anastomotic leak was 46% lower in the 80% FiO2 group (RR, 0.63; 95% confidence interval, 0.42–0.98) vs. the 30% FiO2.Conclusion: Therefore, supplemental 80% FiO2 during and for 6 h after major rectal cancer surgery, reducing postoperative anastomotic dehiscence, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost. [ABSTRACT FROM AUTHOR]

We hypothesized that nandrolone (ND)-abuse induces cardiac hypertrophy, increases myocardial susceptibility to ischemia/reperfusion (I/R) injury, and reduces responsiveness to postconditioning (PostC) cardioprotection. Wistar-rats were ND treated for 2 weeks (short_ND) or 10 weeks (long_ND). Vehicle-treated rats served as controls. Hearts were retrogradely perfused and left ventricular pressure (LVP) was measured before and after 30-min global ischemia. In subgroups of hearts, to induce cardioprotection a PostC protocol (five cycles of 10-s reperfusion and 10-s ischemia) was performed. β-adrenoreceptors, kinases (Akt and GSK-3β) and phosphatases (PP2A sub A and PP2A sub B) were examined by Western blot before and after ischemia. After 120-min reperfusion, infarct size was measured. Short_ND slightly increased cardiac/body weight ratio, but did not affect cardiac baseline nor post-ischemic contractile function or infarct size when compared to vehicle hearts. However, PostC limited cardiac dysfunction much more in short_ND hearts than the other groups. Although cardiac/body weight ratio markedly increased after long_ND, baseline LVP was not affected. Yet, post-ischemic contracture and infarct size were exacerbated and PostC was unable to reduce infarct size and ventricular dysfunction. While short_ND increased phosphatases, non-phosphorylated and phosphorylated Akt, long_ND reduced phosphatase-expression and Akt phosphorylation. Both short_ND and long_ND had no effect on the GSK-3β-phosphorylation but increased the expression of β-adrenoreceptors. In reperfusion, PostC increased Akt phosphorylation regardless of protective effects, but reduced phosphatase-expression in protected hearts only. In conclusion, short_ND improves post-ischemic myocardial performance in postconditioned hearts. However, long_ND increases myocardial susceptibility to I/R injury and abolishes cardioprotection by PostC. This increased susceptibility might be related to steroid-induced hypertrophy and/or to altered enzyme expression/phosphorylation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The limited evidence and inconsistency of purposeful behaviors in patients in a minimally conscious state (MCS) asks for objective electrophysiological marker of the level of consciousness. Here, a comparison between event-related potentials (ERPs) was investigated using different level of stimulus complexity. Methods: ERPs were recorded in seventeen patients, 6 of which in vegetative state (VS), 11 in MCS, and 10 controls. Three oddball paradigms with different level of complexity were applied: sine tones, the subject’s own name versus sine tones and other first names. Latencies and amplitudes of N1 and P3 waves were compared. Results: Cortical responses were found in all MCS patients, and in 6 of 11 patients in VS. Healthy controls and MCS patients showed a progressive increase of P3 latency in relation to the level of stimulus complexity. No modulation of P3 latency was observed in the vegetative patients. Conclusions: These results suggest that the modulation of P3 latency related to stimulus complexity may represent an objective index of higher-order processing integration that predicts the recovery of consciousness from VS to MCS when clinical manifestations are inconsistent. Significance: Modulation of P3 latency related to stimulus complexity could provide valuable information about the cognitive capabilities of unresponsive patients. [Copyright &y& Elsevier]

Passive and imagined limb movements induce changes in cerebral oscillatory activity. Central modulatory effects play a role in plastic changes, and are of uttermost importance in rehabilitation. This has extensively been studied for upper limb (UL), but less is known for lower limb (LL). The aim of this study is to investigate the topographical distribution of event-related desynchronization/synchronization (ERD/ERS) and task-related coherence during a robot-assisted and a motor imagery task of lower limb in healthy subjects. 32-channels electroencephalogram (EEG) was recorded in twenty-one healthy right handed subjects during a robot-assisted single-joint cyclic right ankle movement performed by the BTS ANYMOV robotic hospital bed. Data were acquired with a block protocol for passive and imagined movement at a frequency of 0.2 Hz. ERD/ERS and task related coherence were calculated in alpha1 (8–12 Hz), alpha2 (10.5–12.5 Hz) and beta (13–30 Hz) frequency ranges. During passive movement, alpha2 rhythm desynchronized over the contralateral sensori-motor area and ipsilateral prefrontal cortex, and beta over the bilateral SM. During motor imagery, a significant desynchronization was evident for alpha1 over contralateral SM, for alpha2 over bilateral SM, and for beta over central scalp areas. No statistically significant difference emerged from the two conditions. Task-related coherence decreased in alpha2 band between left central - right frontal and left central – left parietal areas; beta band coherence decreased between C3–C4 electrodes, and increased between C3–Cz. These data contribute to the understanding of oscillatory activity during lower limb robot-assisted motor performance, and point to the advantages of this analysis to evaluate cortical oscillations changes. [ABSTRACT FROM AUTHOR]

The limited evidence and inconsistency of purposeful behaviors in patients in a minimally conscious state (MCS) asks for objective electrophysiological marker of the level of consciousness. Here, a comparison between event-related potentials (ERPs) was investigated using different level of stimulus complexity. ERPs were recorded in 17 patients, 11 of which in vegetative state (VS), 6 in MCS, and 10 controls. Three oddball paradigms with different level of complexity were applied: sine tones, the subject’s own name vs. sine tones and other first names. Latencies and amplitudes of N1 and P3 waves were compared using a semi-automated peak detection algorithm. Cortical responses were found in all MCS patients, and in 6 of 11 patients in VS. Healthy controls and MCS patients showed a progressive increase of P3 latency in relation to the level of stimulus complexity. No modulation of P3 latency was observed in the vegetative patients. These results suggest that the modulation of P3 latency related to stimulus complexity may represent an objective index of higher-order processing integration that predicts the recovery of consciousness from VS to MCS when clinical manifestations are inconsistent. P3 latency modulation may help differentiate between different states of consciousness. [Copyright &y& Elsevier]