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Background Conscious perception of external stimuli has been related to recurrent activity in distributed cortical networks, although brain mechanisms controlling unconscious processing and stimuli access to conscious report need to be clarified. Objective This study aims at investigating modulations in cortical excitability related to conscious perception and unconscious processing of face stimuli with different visibility levels. Methods We used TMS-EEG over the right occipital face area (rOFA), or the right premotor cortex (rPMC) as control site, to measure cortical excitability during a backward masking paradigm with individually defined stimuli visibility. Results Event related potentials showed significant differences for faces compared to houses, and detected faces compared to missed ones, 200 ms post target onset. TMS over rOFA, but not over rPMC, triggered a relative positivity starting 150 ms post target when faces with high visibility were consciously reported. Moreover, rOFA TMS evoked differential responses for high versus low visible faces in conscious and unconscious processing at 290–390 and 180–240 ms, respectively. Conclusion Results unveiled a causal link between rOFA excitability and late responses related to access to conscious perception, suggesting a critical role of recurrent activity, but distinct components, for consciously perceived stimuli and unconscious face processing.

According to embodied cognition, language processing relies on the same neural structures involved when individuals experience the content of language material. If so, processing nouns expressing a motor content presented in a second language should modulate the motor system as if presented in the mother tongue. We tested this hypothesis using a go-no go paradigm. Stimuli included English nouns and pictures depicting either graspable or non-graspable objects. Pseudo-words and scrambled images served as controls. Italian participants, fluent speakers of English as a second language, had to respond when the stimulus was sensitive and refrain from responding when it was not. As foreseen by embodiment, motor responses were selectively modulated by graspable items (images or nouns) as in a previous experiment where nouns in the same category were presented in the native language.

Two experiments were carried out to investigate whether and how one important characteristic of the motor system, that is its goal-directed organization in motor chains, is reflected in language processing. This possibility stems from the embodied theory of language, according to which the linguistic system re-uses the structures of the motor system. The participants were presented with nouns of common tools preceded by a pair of verbs expressing grasping or observational motor chains (i.e., grasp-to-move, grasp-to-use, look-at-to-grasp, and look-at-to-stare). They decided whether the tool mentioned in the sentence was the same as that displayed in a picture presented shortly after. A primacy of the grasp-to-use motor chain over the other motor chains in priming the participants' performance was observed in both the experiments. More interestingly, we found that the motor information evoked by the noun was modulated by the specific motor-chain expressed by the preceding verbs. Specifically, with the grasping chain aimed at using the tool, the functional motor information prevailed over the volumetric information, and vice versa with the grasping chain aimed at moving the tool (Experiment 2). Instead, the functional and volumetric information were balanced for those motor chains that comprise at least an observational act (Experiment 1). Overall our results are in keeping with the embodied theory of language and suggest that understanding sentences expressing an action directed toward a tool drives a chained activation of the motor system.

Breakfast consumption can entail nutritional advantages positively affecting food choices. This study investigated the effect of minor changes in breakfast composition on the perceived attributes of foods, both at breakfast and at lunchtime. Four breakfasts were defined considering nutritional and perceptual factors. Three breakfasts varied just for a single cereal-based chocolate-containing food item, while a control breakfast mimicked fasting conditions. Breakfast perception was assessed before and after consumption. Subjects rated breakfast energy content on the basis of single items, while judged breakfast healthiness as a whole, suggesting that the combination of different ingredients can modify the perceived health value of foods. Additionally, 4 h after breakfast, a perceptual evaluation of lunch-related food images was performed, without differences among breakfasts. This study extends current knowledge on the relationship between subjective perceptual attributes and objective energy value and food composition, as well as on breakfast impact on food perception at lunchtime.

The activation of the mirror-neuron circuit during the observation of motor acts is thought to be the basis of human capacity to read the intentions behind the behavior of others. Growing empirical evidence shows a different activation of the mirror-neuron resonance mechanism depending on how much the observer and the observed agent share their motor repertoires. Here, the possible modulatory effect of physical similarity between the observer and the agent was investigated in three studies. We used a visuo-motor priming task in which participants were asked to categorize manipulable and non-manipulable objects into natural or man-made kinds after having watched precision and power reach-to-grasp movements. Physical similarity was manipulated by presenting reach-to-grasp movements performed by the hands of actors of three different age ranges that are adults of the same age as the participants, children, and elderly. Faster responses were observed in trials where power grip movements were performed by the adults and precision grip movements were performed by the elderly (Main Study). This finding is not in keeping with the idea that physical similarity shapes the mirror-neuron resonance. Instead, it suggests an effect of the kinematic organization of the reach-to-grasp movements, which systematically changed with the actor age as revealed by a kinematic analysis. The differential effect played by adult and elderly actor primes was lost when static grasping hands (Control Study 1) and reach-to-grasp movements with uniform kinematic profiles (Control Study 2) were used. Therefore, we found preliminary evidence that mirror-neuron resonance is not shaped by physical similarity but by the kinematics of the observed action. This finding is novel as it suggests that human ability to read the intentions behind the behavior of others may benefit from a mere visual processing of spatiotemporal patterns.

Embodied approaches to language understanding hold that comprehension of linguistic material entails a situated simulation of the situation described. Some recent studies have shown that implicit, explicit, and relational properties of objects implied in a sentence are part of this simulation. However, the issue concerning the extent to which language sensorimotor specificity expressed by linguistic constituents of a sentence, contributes to situating the simulation process has not yet been adequately addressed. To fill this gap, we combined a concrete action verb with a noun denoting a graspable or non-graspable object, to form a sensible or non-sensible sentence. Verbs could express a specific action with low degrees of freedom (DoF) or an action with high DoF. Participants were asked to respond indicating whether the sentences were sensible or not. We found that simulation was active in understanding both sensible and non-sensible sentences. Moreover, the simulation was more situated with sentences containing a verb referring to an action with low DoF. Language sensorimotor specificity expressed by the noun, played a role in situating the simulation, only when the noun was preceded by a verb denoting an action with high DoF in sensible sentences. The simulation process in understanding non-sensible sentences evoked both the representations related to the verb and to the noun, these remaining separated rather than being integrated as in sensible sentences. Overall our findings are in keeping with embodied approaches to language understanding and suggest that the language sensorimotor specificity of sentence constituents affects the extent to which the simulation is situated. © 2011 Elsevier Srl.

Vision of the body is known to affect somatosensory perception (e.g. proprioception or tactile discrimination). However, it is unknown whether visual information about one's own body size can influence bodily action. We tested this by measuring the maximum grip aperture (MGA) parameter of grasping while eight subjects viewed a real size, enlarged or shrunken image of their hand reaching to grasp a cylinder. In the enlarged view condition, the MGA decreased relative to real size view, as if the grasping movement was actually executed with a physically larger hand, thus requiring a smaller grip aperture to grasp the cylinder. Interestingly, MGA remained smaller even after visual feedback was removed. In contrast, no effect was found for the reduced view condition. This asymmetry may reflect the fact that enlargement of body parts is experienced more frequently than shrinkage, notably during normal growth. In conclusion, vision of the body can significantly and persistently affect the internal model of the body used for motor programming.

Objective: The aim of our study was to investigate which text-background (TB) color combinations improve legibility and pleasantness of texts either presented on a computer screen or projected on a wider surface. Background: Our work stems from the observation that multimedia presentations, even those by professionals in visual disciplines, are often spoiled by illegibility, which affects readability and the pleasantness of attending to such presentations. Methods: We investigated this problem through three experiments. Experiment 1 assessed the best TB color combinations in slides presented on a laptop. Experiment 2 verified the correlation between legibility and pleasantness for TB presentations. Experiment 3 investigated the legibility of a slide projected on a wide screen in different room lighting conditions. In all experiments participants expressed a rating score for stimulus legibility or pleasantness. Results: Experiments I and 3 showed that it is best to have a dark text on a light background for both displayed and projected texts. Experiment 2 showed that pleasantness is tightly correlated with legibility, though legibility depends on contrast between text and background. Conclusions: Our findings are not in complete agreement with the literature concerning legibility of text displayed on a computer screen, and they are in contrast with the common belief that for projection purposes it is best to have a light text on a dark background. Applications: Some practical rules on combining TB colors are given to enhance the legibility of presentations, especially important for the legibility of projected texts.

Abstract. Recently, the Simon effect (SE) has been observed in social contexts when two individuals share a two-choice task. This joint SE (JSE) has been interpreted as evidence that people co-represent their actions. However, it is still not clear if the JSE is driven by social factors or low-level mechanisms. To address this question, we applied a common paradigm to a joint Simon task (Experiments 1 and 4), a standard Simon task (Experiment 2), and a go/no-go task (Experiment 3). The results showed that both the JSE and the SE were modulated by the repetition/non-repetition of task features. Moreover, the JSE was differently modulated by the gender composition of the two individuals involved in the shared task and by their interpersonal relationship. Taken together, our results do not support a pure social explanation of the JSE, nevertheless, they show the independent role of different social factors in modulating the effect.

In two behavioral experiments, Marino et al. (2014) investigated the modulation of the motor cortex during the semantic processing of graspable and non-graspable objects, presented either as photos or written nouns. They used scrambled images and pseudowords as control stimuli. At 150 ms after stimulus presentation, participants had to respond when the stimulus referred to a real object with their right (experiment 1) or left (experiment 2) index finger, and refrain from responding when a scrambled image or a pseudoword was presented. Participants' responses related to photos or nouns of graspable objects were slower than those related to non-graspable ones, independent of the responding hand. According to the authors, these findings support the notion that the semantic processing of photos and written nouns referring to graspable objects, is due to common neural substrates, crucially involving the motor system. Specifically, they forward that, to solve the requested semantic task, participants relied on the motor representations of potential hand interactions with the object depicted in the photo (affordance as described by Gibson, 1977) or expressed by the verbal label. In this way, the motor system was engaged in two tasks, that is processing stimuli and performing a motor response (pressing the button), at the same time. Participants therefore paid a cost as revealed by the slowing down of their motor responses. Some previous papers (Tucker and Ellis, 2004; Makris et al., 2011) support the notion that the recruitment of the motor system (affordance effect) during the visual presentation of objects appears later than 150 ms after stimulus presentation. Based on that, in his commentary Makris (2015) proposes an alternative explanation of the experimental findings reported by Marino et al. (2014), namely as due to an attentional effect. The author proposes that graspable objects suddenly appearing on screen can automatically grab exogenous attention (Yantis and Jonides, 1984) and then for a rapid period after stimulus onset (~100–150 ms) a withdrawal of attention from the objects in display occurs, leading to a rebalance of the affordance-driven motor plans. According to Makris, it could be that 150 ms after the presentation of the stimuli, exogenous-like attention was withdrawn only from the graspable, but not the non-graspable, objects. This way, participants would have to re-direct their attention to the graspable objects in order to resolve the semantic task and this process would have some cost in the timing of their responses. According to the author, this account would fit with a theoretical model known as the affordance competition hypothesis proposed by Cisek (2007). In principle, one cannot rule out the attentional hypothesis, as an alternative explanation to the findings of Marino et al. (2014). However, even admitting a specific role of attention in explaining the data, in the commentary by Makris it is not clear why, at difference with non-graspable objects, the processing of graspable ones would require the withdrawal of attention at about 150 ms after stimulus presentation and the subsequent reallocation of attention to solve the semantic task. It is worth keeping in mind that also non-graspable objects were presented abruptly and therefore they could potentially grab exogenous attention as graspable objects did. Moreover, the affordance competition hypothesis does not seem to support this time course of attention allocation since in this account action selection and specification are parallel and not serial processes. That said, it is worth stressing as Makris himself admits, that it is difficult to disentangle between attentional and motor processes. Based on several studies, one may argue that there is no need to postulate two control mechanisms, one for action and one for attention. Rather, attention derives from the activity of the sensorimotor circuits devoted to interact with objects (e.g., Corbetta et al., 1998; Craighero et al., 1999). The time course of the recruitment of the motor system during semantic processing of objects and nouns is still a matter of debate. However, there is increasing evidence of an early involvement of the motor system during semantic tasks involving language material. Neurophysiological studies (for review see Pulvermueller et al., 2009) support a recruitment of the motor system during language processing of words related to action within the first 200 ms after stimulus onset. In the same time window, behavioral studies have shown that participants give slower hand motor responses when they have to process language material expressing hand actions or hand related objects (as for nouns, see Marino et al., 2013). In a very recent paper (Klepp et al., 2015), by means of magnetoencephalography, it has been assessed that this early slowing down of motor responses is due to a suppression of beta rhythm weaker than that found during the preparation and execution of actual movements. Taken together, these findings may lead to the conclusion that the modulation of the motor system during language processing may change over time, moving from an early interference, operating between 100 and 200 ms after stimulus onset, to a subsequently facilitation, operating later than 200 ms after stimulus presentation (Chersi et al., 2010). As for seen objects, the recruitment of the motor system (affordance effect), has been clearly shown at 200 ms after stimulus presentation (Buccino et al., 2009), that is quite earlier than 300 ms found by Makris et al. (2011). In addition, the findings of Marino et al. (2014) strongly suggest that there is a specific modulation of motor responses during the processing of photos depicting graspable objects already 150 ms after stimulus presentation. This modulation parallels the one occurring during the processing of language material expressing the same object category. Hence the proposal that the neural substrates devoted to processing photos depicting graspable objects and nouns referring to the same object category may be shared and crucially involve the motor system. Future studies should assess at what extent the semantic processing of seen objects and nouns overlap.

Adaptive adjustments of strategies are needed to optimize behavior in a dynamic and uncertain world. A key function in implementing flexible behavior and exerting self-control is represented by the ability to stop the execution of an action when it is no longer appropriate for the environmental requests. Importantly, stimuli in our environment are not equally relevant and some are more valuable than others. One example is the gaze of other people, which is known to convey important social information about their direction of attention and their emotional and mental states. Indeed, gaze direction has a significant impact on the execution of voluntary saccades of an observer since it is capable of inducing in the observer an automatic gaze-following behavior: a phenomenon named social or joint attention. Nevertheless, people can exert volitional inhibitory control on saccadic eye movements during their planning. Little is known about the interaction between gaze direction signals and volitional inhibition of saccades. To fill this gap, we administered a countermanding task to 15 healthy participants in which they were asked to observe the eye region of a face with the eyes shut appearing at central fixation. In one condition, participants were required to suppress a saccade, that was previously instructed by a gaze shift toward one of two peripheral targets, when the eyes were suddenly shut down (social condition, SC). In a second condition, participants were asked to inhibit a saccade, that was previously instructed by a change in color of one of the two same targets, when a change of color of a central picture occurred (non-social condition, N-SC). We found that inhibitory control was more impaired in the SC, suggesting that actions initiated and stopped by social cues conveyed by the eyes are more difficult to withhold. This is probably due to the social value intrinsically linked to these cues and the many uses we make of them.

Stimulus position is coded even if it is task-irrelevant, leading to faster response times when the stimulus and the response locations are compatible (spatial Stimulus–Response Compatibility–spatial SRC). Faster responses are also found when the handle of a visual object and the response hand are located on the same side; this is known as affordance effect (AE). Two contrasting accounts for AE have been classically proposed. One is focused on the recruitment of appropriate grasping actions on the object handle, and the other on the asymmetry in the object shape, which in turn would cause a handle-hand correspondence effect (CE). In order to disentangle these two accounts, we investigated the possible transfer of practice in a spatial SRC task executed with a S–R incompatible mapping to a subsequent affordance task in which objects with either their intact handle or a broken one were used. The idea was that using objects with broken handles should prevent the recruitment of motor information relative to object grasping, whereas practice transfer should prevent object asymmetry in driving handle-hand CE. A total of three experiments were carried out. In Experiment 1 participants underwent an affordance task in which common graspable objects with their intact or broken handle were used. In Experiments 2 and 3, the affordance task was preceded by a spatial SRC task in which an incompatible S–R mapping was used. Inter-task delays of 5 or 30 min were employed to assess the duration of transfer effect. In Experiment 2 objects with their intact handle were presented, whereas in Experiment 3 the same objects had their handle broken. Although objects with intact and broken handles elicited a handle-hand CE in Experiment 1, practice transfer from an incompatible spatial SRC to the affordance task was found in Experiment 3 (broken-handle objects), but not in Experiment 2 (intact-handle objects). Overall, this pattern of results indicate that both object asymmetry and the activation of motor information contribute to the generation of the handle-hand CE effect, and that the handle AE cannot be reduced to a SRC effect.

Patients with irritable bowel syndrome (IBS) report an increased frequency of sensations during rectal distension in comparison with healthy subjects. This alteration might be due to a psychological response bias leading patients to over report their sensations. The aim of this study was to measure perceptual sensitivity and response bias during rectal distension in healthy subjects and IBS patients using the sensory decision theory (SDT). Thirteen healthy subjects and 22 IBS patients underwent five rectal distensions up to 100 mL, five up to 200 mL and five sham distensions. They were asked to identify the distension by means of an electronic marker. Perceptual sensitivity and response bias were calculated according to the SDT. The patients identified a more 100 mL distensions than the healthy subjects (P = 0.02), whereas there was no difference in the number of identified 200 mL and sham distensions between the two groups. The perceptual sensitivity of IBS patients was significantly greater during 100 mL (P = 0.01), but not during 200 mL distensions. The response bias was not significantly different between the two groups. These data suggest that the increased frequency of sensations reported by IBS patients is not due to a psychological response bias.

Colonic lactulose fermentation induces bloating, but whether it also causes abdominal distension is not known. The aim of this study was to assess the effect of colonic lactulose fermentation on abdominal girth using a new extensometer. We recorded abdominal girth in 24 healthy subjects by means of an extensometer that measures the phase shift of an ultrasound wave propagating in a tube encircling the abdomen. The recordings were continuously made for 3 h after the ingestion of 100 mL of tap water with (16 subjects) or without (eight subjects) 10 g of lactulose. Every 10 min, H2 in the breath was analysed and the intensity of bloating was recorded. Bloating was never reported after water ingestion, whereas it was reported by 10 subjects after lactulose ingestion (P = 0.002). The mean +/- SD changes in abdominal girth in comparison with resting conditions were statistically significant after lactulose ingestion (3 +/- 2.9 mm; P = 0.002) but not after water ingestion (-0.2 +/- 2.7 mm; P = 0.82). The area under the curve of the changes in abdominal girth after lactulose were significantly greater than after water ingestion (P = 0.03). In conclusion, colonic lactulose fermentation induces bloating and abdominal distension. The new extensometer is useful for continuously recording changes in abdominal girth.

To determine the accuracy of various ultrasonographic (US) signs for assessment of the degree of liver fibrosis, with histologic results as reference standard.Three hundred consecutive asymptomatic patients with at least 6 months of increased levels of aspartate aminotransferase and/or alanine aminotransferase underwent liver US and biopsy. The estimated pretest probability of severe fibrosis or cirrhosis was 35%. Three US parameters were investigated: liver surface nodularity, caudate lobe hypertrophy, and pattern of hepatic venous blood flow. US results were compared with histologic results obtained after liver biopsy, which constituted the reference standard for diagnosis of severe fibrosis or cirrhosis. The degree of fibrosis was graded according to METAVIR criteria, with stages 3 and 4 considered together. Data were analyzed with kappa and chi2 statistics. Sensitivity, specificity, positive and negative likelihood ratios, and posttest probability were calculated for each US sign.In 107 (36%) patients with severe fibrosis (n = 34) or cirrhosis (n = 73), liver surface nodularity had the highest diagnostic accuracy, with specificity of 95% and positive and negative likelihood ratios 11.6 and 0.51, respectively. When liver surface nodularity was considered alone, posttest probability of severe fibrosis or cirrhosis increased from 35% to 86%. When caudate lobe hypertrophy and hepatic venous blood flow were also taken into account, posttest probability increased by only 2% (ie, to 88%).US determination of liver surface nodularity is an accurate method for identifying the subset of asymptomatic patients with severe liver fibrosis or cirrhosis, which indicates a worse prognosis.

Gaze-following behaviour is considered crucial for social interactions which are influenced by social similarity. We investigated whether the degree of similarity, as indicated by the perceived age of another person, can modulate gaze following. Participants of three different age-groups (18–25; 35–45; over 65) performed an eye movement (a saccade) towards an instructed target while ignoring the gaze-shift of distracters of different age-ranges (6–10; 18–25; 35–45; over 70). The results show that gaze following was modulated by the distracter face age only for young adults. Particularly, the over 70 year-old distracters exerted the least interference effect. The distracters of a similar age-range as the young adults (18–25; 35–45) had the most effect, indicating a blurred own-age bias (OAB) only for the young age group. These findings suggest that face age can modulate gaze following, but this modulation could be due to factors other than just OAB (e.g., familiarity).

It is an open question whether the motor system is involved during understanding of concrete nouns, as it is for concrete verbs. To clarify this issue, we carried out a behavioral experiment using a go-no go paradigm with an early and delayed go-signal delivery. Italian nouns referring to concrete objects (hand-related or foot-related) and abstract entities served as stimuli. Right-handed participants read the stimuli and responded when the presented word was concrete using the left or right hand. At the early go-signal, slower right-hand responses were found for hand-related nouns compared to foot-related nouns. The opposite pattern was found for the left hand. These findings demonstrate an early lateralized modulation of the motor system during noun processing, most likely crucial for noun comprehension. © 2011 Springer-Verlag.

Wertheimer's (1923, Psychologische Forschung 4 301-350) idea that the perceptual world is articulated according to factors of organisation is widely acknowledged as one of the most original contributions of Gestalt psychology and stands as a milestone in the history of vision research. An inquiry focused on the forerunners of some of Wertheimer's factors of perceptual organisation is documented here. In fact, in 1900 Schumann described grouping by proximity and by vertical symmetry, and in 1903 G E Muller identified the factors of sameness/ similarity and contour. Other authors contributed to the early description of these factors, such as Rubin, who in 1922 originally illustrated grouping by similarity. Even though Wertheimer himself granted these authors due recognition, later psychologists have paid little attention to their contributions. Some possible reasons for this negligence are briefly discussed. © 2012 a Pion publication.

Can viewing our own body modified in size reshape the bodily representation employed for interacting with the environment? This question was addressed here by exposing participants to either an enlarged, a shrunken, or an unmodified view of their own hand in a reach-to-grasp task toward a target of fixed dimensions. When presented with a visually larger hand, participants modified the kinematics of their grasping movement by reducing maximum grip aperture. This adjustment was carried over even when the hand was rendered invisible in subsequent trials, suggesting a stable modification of the bodily representation employed for the action. The effect was specific for the size of the grip aperture, leaving the other features of the reach-to-grasp movement unaffected. Reducing the visual size of the hand did not induce the opposite effect, although individual differences were found, which possibly depended on the degree of subject's reliance on visual input. A control experiment suggested that the effect exerted by the vision of the enlarged hand could not be merely explained by simple global visual rescaling. Overall, our results suggest that visual information pertaining to the size of the body is accessed by the body schema and is prioritized over the proprioceptive input for motor control. © 2013 Springer-Verlag Berlin Heidelberg.

Colonoscopy workload for endoscopy services in Western countries is increasing markedly because of the implementation of faecal occult blood-based mass screening programmes against colorectal cancer (CRC). We therefore explored the possibility of using a combination of faecal tests to prioritize the access to colonoscopy with criteria other than symptoms and/or time of referral.We tested a combination of faecal tests [immunochemical faecal occult blood test (i-FOBT), M2-PK, calprotectin] as markers for advanced neoplasia in a selected series of patients requiring colonoscopy for the suspicion of CRC. All the tests were performed in a 1-day stool sample of patients aged 50-80 years, without any dietary restriction, before colonoscopy.A total of 280 patients' stool single samples were analysed. Forty-seven patients had CRC and 85 patients had one or more advanced adenoma(s) at colonoscopy/histology. CRCs were associated with a highly significant increase (P0.001) in faecal tumour M2-PK (mean 24.2 kU/l), which correlated with Dukes' staging. For CRC detection, i-FOBT was the test with the highest specificity and positive predictive value (0.89 and 0.53), whereas M2-PK had the highest sensitivity and negative predictive value (0.87 and 0.96). Calprotectin showed performance similar to M2-PK in terms of sensitivity and negative predictive value (0.93), but had lower specificity (0.39). The best combination of tests to predict the risk of CRC in this series was i-FOBT+M2-PK, as in patients showing positivity to both markers, the risk of cancer was as high as 79%.The combination of i-FOBT and M2-PK is a sensitive tool in clinical practice for the appropriate management of waiting lists for colonoscopy, as it allows the classification of patients into different degrees of priority for investigation, according to their foreseeable risk of CRC.

In 2005, the National Health Service recommended a population-based colorectal cancer (CRC) screening program using biennial fecal occult blood testing (FOBT), followed by total colonoscopy in positive patients. So far, no studies have been performed to evaluate the impact of a mass-screening CRC campaign on the health system services at the community level in Italy. We have therefore assessed the workload generated by the first two biennial rounds of screening program on the activity of hospital services involved in CRC diagnosis in the Lecco province.Routine data from all hospital services of our province were collected on activity levels related to CRC diagnosis from January 2003 to December 2009. This time span covered the 2 years prior to, as well as the two biennial rounds of the CRC screening program. In particular, we focused on the volume of outpatient FOBTs and colonoscopies (both diagnostic and interventional) performed among subjects outside the screening program. Joinpoint models were used to test whether an apparent change in trend of examination over time was statistically significant in different age cohorts of the population (50 years, 50-69 years, and ≥70 years).The volume of "extra-screening" per-patient/FOBTs and colonoscopies increased significantly over the evaluated periods in all ages, until year 2008, when a steady trend was beginning; the AAPCs (average of the annual percent changes) values were 5.7, 3.1, and 8.4 for FOBT and 14.6, 13.4, and 16.7 for colonoscopy in the three age cohorts, respectively. However, the increase in both FOBT and colonoscopy demand was maximal in the cohort ≥70 years, where three statistically significant annual percent changes (APCs) were identified (in 2003-2005, 2005-2006, and 2006-2007 APCs were 12.3, 14.9, and 15.9 for FOBT, and 18.7, 36.8, and 25.4 for colonoscopy, respectively).After the implementation of a FOBT-based mass-screening program for CRC, careful consideration must be given to the significant increase in the workload of hospital services involved in CRC diagnosis, outside the screening campaign. The extra-work mainly involves gastroenterologists performing colonoscopy, whose activity increased over the 5-year period by 118%, as well as laboratory services, where the demand of FOBTs rose by 40%. This phenomenon, mainly attributable to a profound change in the attitude toward CRC screening by those age cohorts outside the program, covers a time span of two full rounds of screening, whereupon a steady trend for colonoscopy is apparent.

Mucosal healing has been proposed as an important sign of the efficacy of medical treatment of inflammatory bowel disease; however, direct evidence in ulcerative colitis (UC) is scarce. We evaluated the usefulness of colonoscopy and bowel ultrasound (US) as indexes of response to short-term therapy and as predictors of subsequent outcome in UC.A total of 83 patients with moderate-to-severe UC were recruited; endoscopic and US severity was graded 0-3 at entry according to validated scores. Of the recruited patients, 74, who were clinically responsive to steroids, were followed up with repeated colonoscopy and bowel US at 3, 9, and 15 months from recruitment. Concordance between clinical, endoscopic, and US scores at various visits was determined by kappa statistics. Multiple unconditional logistic regression models were used to assess the predictivity of clinical, endoscopic, and US scores measured at 3 and 9 months on the development of endoscopic UC relapse within 15 months.A variable concordance was found over time between endoscopic and clinical score (weighted kappa between 0.38 and 0.95), with high and consistent concordance between endoscopic and US scores (weighted kappa between 0.76 and 0.90). On logistic regression analysis, moderate-to-severe endoscopic and US scores at 3 months were associated with a high risk of endoscopic activity at 15 months (odds ratio (OR): 5.2; 95% confidence interval (CI): 1.6-17.6 and OR: 9.1; 95% CI: 2.5-33.5, respectively).Bowel US may be used as a surrogate of colonoscopy in assessing the short-term response of severe forms of UC to therapy. Both US score and endoscopic score after 3 months of steroid therapy predict outcome of disease at 15 months.

Background and Aim: Mucosal healing (MH) after short-term medical treatment is being considered as an important step in the therapeutic work-up of inflammatory bowel disorder (IBD) patients due to the potential prognostic role of MH in predicting disease outcome. However, IBD patients are reluctant to be re-endoscoped during follow-up; therefore, there is a need for non-invasive alternative index of MH which can replace endoscopy in clinical practice. We evaluated bowel ultrasound (US) as a surrogate of colonoscopy in a series of consecutive patients with active ulcerative colitis (UC). Patients and Methods: 83 patients with moderate to severe UC requiring high-dose steroids were initially recruited; endoscopic severity of UC was graded 0–3 according to Baron score, and US severity was also graded 0–3 according to the colonic wall thickening and the presence of vascular signal at power Doppler. 74 patients responsive to steroids and then maintained on 5-ASA compounds were followed up with repeated colonoscopy and bowel US at 3, 9 and 15 months from entry. Concordance between clinical, endoscopic and US scores at various visits was determined by kappa statistics. Multiple unconditional logistic regression models were used to assess the predictivity of Truelove, Baron and US scores measured at 3 and 9 months on the development of a UC relapse (Baron score 2–3) at 15 months. Results: An inconsistent concordance was found over time between 0 and I Baron scores and Truelove score (weighted κ between 0.38 and 0.94), with high and consistent concordance between 0 and I Baron scores and US scores (weighted κ between 0.76 and 0.90). On logistic regression analysis, a moderate/severe Baron score, regardless of their Truelove score, at 3 months was associated with a high risk of endoscopic activity at 15 months (OR 5.2; 95% CI: 1.6–17.6); similarly, patients with severe US scores (2–3) at 3 months had a high risk of severe endoscopic activity at 15 months (OR 9.1; 95% CI: 2.5–33.5). Discussion: In expert hands bowel US may be used as a surrogate of colonoscopy in evaluating the response to high-dose steroids in severe forms of UC. US score after 3 months of steroid therapy accurately predicts clinical outcome of disease at 15 months.

It is widely accepted that illusory contours have been first displayed and discussed by Schumann (1900, Zeitschrift für Psychologie und Physiologie der Sinnesorgane23 1–32). Here we show that, before him, Jastrow (1899, Popular Science Monthly54 299–312) produced illusory contours consisting of a shadow word. A brief history of shadow writing in psychological literature from Jastrow to Brunswik is presented, in which the contributions of Pillsbury, Warren, Koffka, and Benussi are examined.

Colonoscopy constitutes the principal investigation for colo-rectal neoplasms due to its ability to detect and remove most of precancerous lesions; due to the ongoing or planned colon cancer screening programs in many European countries we should expect an enormous increase in colonoscopic demand over the next few years. Diagnostic accuracy and therapeutic safety of colonoscopy strictly depends upon the quality of bowel cleansing which is often perceived as the most unpleasant part of the procedure in individuals undergoing this examination. The ideal preparation for colonoscopy should reliably empty the colon from all faecal material allowing the optimal visualization of the entire colonic mucosa without causing great patient's discomfort nor significant shifts in fluids or electrolytes. Standard PEG solutions and sodium phoshate (NaP) compounds are the most frequently used preparations; both are accepted and relatively well tolerated by the majority of patients undergoing colonoscopy; however, NaP compounds should be avoided in elderly subjects as well as in those with congestive heart failure, renal and hepatic insufficiency or taking diuretics, ACE inhibitors or angiotensin receptor blockers, since they can induce severe electrolyte and/or fluid disturbances. Standard PEG solutions are often taken incompletely due to the low palatability and the high volume of liquids required which induce nausea and vomiting with negative consequences in terms of colon cleansing. Reduced volume and better palatability of PEG solutions, such as those obtained with the newest PEG formulations, as well as improved patient education concerning the importance of bowel cleansing could undoubtedly increase compliance with oral bowel preparations and promote adherence to colo-rectal cancer screening programs.

It has been postulated that a viscerosomatic reflex activated by gut distension and inhibiting abdominal wall muscle tone may be one of the mechanisms underlying functional abdominal distension. Any demonstration of such a reflex has to take into account the fact that gut distension may increase abdominal girth as a result of volume displacement. As biomechanical and sensory rectal responses vary at different rates of rectal distension, we hypothesized that different rates of rectal distension might reveal different changes in abdominal girth. Abdominal girth was continuously recorded in 14 healthy subjects using a previously validated extensometer. The rectal distensions were made in a randomized order at rates of 100 mL min(-1) or 10 mL min(-1) up to 150 mL, and sham distensions were used as controls. An increase in abdominal girth was observed at the end of both distensions (P

1580 Background: Mass screening programs for colorectal cancer are based on fecal occult blood test (FOBT). To improve its low sensitivity other fecal tests such as tumor M2-PK or fecal calprotecti...