Frontal and cerebellar contributions to pitch and rhythm processing: a TMS study.

Music represents a salient stimulus for the brain with two key features: pitch and rhythm. Few data are available on cognitive analysis of music listening in musically naïve healthy participants. Beyond auditory cortices, neuroimaging data showed the involvement of prefrontal cortex in pitch and of cerebellum in rhythm. The present study is aimed at investigating the role of prefrontal and cerebellar cortices in both pitch and rhythm processing. The performance of fifteen participants without musical expertise was investigated in a listening discrimination task. The task required to decide whether two eight-element melodic sequences were equal or different according to pitch or rhythm characteristics. Before the task, we applied a protocol of continuous theta burst transcranial magnetic stimulation interfering with the activity of the left cerebellar hemisphere (lCb), right inferior frontal gyrus (rIFG), or vertex (Cz-control site), in a within cross-over design. Our results showed that participants were more accurate in pitch than rhythm tasks. Importantly, the reaction times were slower following rIFG or lCb stimulations in both tasks. Notably, frontal and cerebellar stimulations did not induce any motor effect in right and left hand. The present findings point to the role of the fronto-cerebellar network in music processing with a single mechanism for both pitch and rhythm patterns.

Right-deviating prismatic adaptation reduces obsessions in a community sample.

Background and aims: Patients with obsessive-compulsive (OC) disorder are impaired in disengaging attention from negative valence stimuli and show an attentional bias toward the right space. This pattern in OC disorder is similar to the impaired disengagement of attention from stimuli in the ipsilesional space as a consequence of a right-hemispheric cerebral lesion in patients with neglect, suggesting a right hemispheric dysfunction in patients with OC disorder. The attentional impairment in patients with neglect is reduced by a visuomotor procedure, such as prismatic adaptation (PA) with right-deviating lenses. Thus, here, we explored whether right-deviating PA is also effective in reducing OC psychological symptoms. Methods: Participants with a high rate of OC symptoms completed self-report measures of such symptoms before and after right- or left-deviating PA. Results: Right-deviating PA, and not left-deviating PA, reduced OC symptoms more prominently on obsessions than compulsions. Conclusion: Results support the idea that right-deviating PA might be considered an effective technique to modulate OC symptoms. This has implications for theories about the underlying mechanisms of OC symptoms and the consideration of PA as a complementary procedure to psychological treatments.

Neglect in temporal domain: Amelioration following a prismatic adaptation treatment and implications in everyday life. A single case study.

As in line bisection, in time bisection, neglect patients fail to process the first/left part of time representation (Mental-Time-Line-MTL) resulting in a rightward shift of the interval midpoint. A leftward shift of spatial attention after one session of prismatic-adaptation (PA) reduces this deficit. The impact on daily life of time deficit is little investigated in neglect. Here we study the time deficit and its ecological impact in an outpatient with neglect (LL) and the effects of a PA-treatment (ten sessions) on the deficit and its impact. Before and after PA-treatment, LL completed a: time-bisection-task assessing the MTL in the milliseconds-seconds range; lifespan-task assessing the MTL in the lifespan range; qualitative interview assessing the impact on daily routines. Patient's performance on the tasks was compared with the performance of non-neurological controls. Before PA-treatment, LL showed a rightward shift in the time-bisection-task and a compression of life events distribution in the lifespan-task. The feeling "to be forward in time" emerged in the interview. The PA-treatment reduced the deficits in the tasks and the feeling "to be forward in time" in the interview. PA-treatment is suggested as a powerful instrument for the reduction of time deficit and its ecological impact in neglect patients.

Spatial attention and representation of time intervals in childhood.

Spatial attention and spatial representation of time are strictly linked in the human brain. In young adults, a leftward shift of spatial attention by prismatic adaptation (PA), is associated with an underestimation whereas a rightward shift is associated with an overestimation of time both for visual and auditory stimuli. These results suggest a supra-modal representation of time left-to-right oriented that is modulated by a bilateral attentional shift. However, there is evidence of unilateral, instead of bilateral, effects of PA on time in elderly adults suggesting an influence of age on these effects. Here we studied the effects of spatial attention on time representation focusing on childhood. Fifty-four children aged from 5 to 11 years-old performed a temporal bisection task with visual and auditory stimuli before and after PA inducing a leftward or a rightward attentional shift. Results showed that children underestimated time after a leftward attentional shift either for visual or auditory stimuli, whereas a rightward attentional shift had null effect on time. Our results are discussed as a partial maturation of the link between spatial attention and time representation in childhood, due to immaturity of interhemispheric interactions or of executive functions necessary for the attentional complete influence on time representation.

Keeping secrets from friends: Exploring the effects of friendship quality, loneliness and self-esteem on secrecy.

The tendency to keep secrets in adolescents has been studied in particular in their relationships with their parents and associated with psychosocial disadvantages. The current study focused on peer relationships and investigated the effects of friendship quality, loneliness in a multidimensional perspective, and self-esteem on secrecy from friends. Italian adolescents (N = 457; 47% male; 100% white) aged between 13 and 19 years (M = 16.11; SD = 1.53) reported their secrecy from friends, peer and parent-related loneliness, aversion and affinity for aloneness, their self-esteem and the quality of their relationships with their friends. The results showed that peer-related loneliness, affinity for aloneness and self-esteem in particular affect keeping secrets from friends, independent of the participant's gender. Moreover, peer-related loneliness and affinity for aloneness mediated the relationship between self-esteem and secrecy. The data were discussed in the light of adolescence developmental tasks.

Innate and Cultural Spatial Time: A Developmental Perspective.

We reviewed literature to understand when a spatial map for time is available in the brain. We carefully defined the concepts of metrical map of time and of conceptual representation of time as the mental time line (MTL) in order to formulate our position. It is that both metrical map and conceptual representation of time are spatial in nature. The former should be innate, related to motor/implicit timing, it should represent all magnitudes with an analogic and bi-dimensional structure. The latter MTL should be learned, available at about 8-10 years-old and related to cognitive/explicit time. It should have uni-dimensional, linear and directional structure (left-to-right in Western culture). We bear the centrality of the development of number cognition, of time semantic concepts and of reading/writing habits for the development of ordinality and linearity of the MTL.

Exploring the Link among State of Mind Concerning Childhood Attachment, Attachment in Close Relationships, Parental Bonding, and Psychopathological Symptoms in Substance Users.

BACKGROUND: In the present study, we have explored the link among styles of attachment and psychopathology in drug users. We know that insecure attachment predisposes the individuals the development of drug-addiction and psychopathological symptoms. However, we do not know which attachment is more frequent in drug users and which is related to particular psychopathological symptoms. The aim of the present work is to explore the relationship between childhood attachment state of mind, attachment in close relationships, parental bonding and psychopathology in sample of Italian substance users. METHODS: We explored, in a sample of 70 drug users and drug-addicted patients, the childhood attachment state of mind measured by the Adult Attachment Interview, the attachment in close relationships by the Relationship Questionnaire and parental bonding measured by the Parental Bonding Instrument. The Symptom Check-List-90-R (SCL-90-R) measured psychopathological symptoms. RESULTS: We found that parental bonding, rather than state of mind concerning childhood attachment or attachment in close relationships, is related to the psychopathological manifestation of anxiety, hostility, depression, and paranoid ideation in the sample. The latter occurs frequently in our sample, independent of state of mind concerning child attachment, attachment in close relationships, and parental bonding, suggesting its role either as a factor that favors a bad image of the participants' own relationships or as a direct effect of consuming drugs. CONCLUSION: These results have clinical implications on suggesting ways of interventions that prevent drug-addiction, which should include the evaluation of attachment in the prodromic phases of substance use onset or rehabilitation programs to prevent and manage psychotic-like symptoms.

Prismatic adaptation as a novel tool to directionally modulate motor cortex excitability: evidence from paired-pulse TMS.

BACKGROUND: The prismatic adaptation (PA) is a visuo-motor procedure that has captured the attention of neuroscientists in the last decades, hence it seems to affect high-order cognition. However, the basic neural processes related to PA and its effects on cortical plasticity are not clear yet. OBJECTIVE/HYPOTHESIS: The aim of the present study is to explore whether PA induces a direct effect on the motor cortices (M1) excitability. METHODS: Fourteen healthy participants were submitted to paired-pulse TMS to measure short-intracortical-inhibition (SICI) and intracortical-facilitation (ICF) on both the left and the right M1, before and after PA, that could induce a leftward or rightward after-effect. RESULTS: An increase of intracortical-facilitation was found in the M1 contralateral to the after-effect direction. Moreover the extent of facilitation and of the after-effect were correlated to each others. CONCLUSION: This finding reveals that PA influences M1 cortices directly, raising their excitability. The present investigation represents an innovative step for the understanding of neurophysiological processes by which PA affects brain functions.

Exploring the reciprocal modulation of time and space in dancers and non-dancers.

We explored whether time and space representations modulate each other in subjects that are trained to integrate time and space dimensions, i.e., professional dancers. A group of dancers, and one of non-dancers, underwent two different tasks employing identical stimuli. A first static central line could last one of three possible durations and could have one of three possible lengths. A second growing line appeared from the left or right of the screen and grew up toward the opposite direction at constant velocity. In the Spatial task, subjects encoded the length of the static line and stopped the growing line when it had reached half the length of the static one, regardless of time travel. In the Temporal task, subjects encoded the duration of the static line and stopped the growing line when it had lasted half the duration of the static one, regardless of space traveled. Dancers, differently from non-dancers, anticipated time in the Temporal task. However, both dancers and non-dancers were biased by the stimulus length when performing the Temporal task, while they were not biased by the stimulus duration when performing the Spatial task. Concluding, this study underlines the plasticity of time dimension that can be influenced by spatial information and by sensorimotor training for the synchronization in space and time.

Left insular cortex and left SFG underlie prismatic adaptation effects on time perception: evidence from fMRI.

Prismatic adaptation (PA) has been shown to affect left-to-right spatial representations of temporal durations. A leftward aftereffect usually distorts time representation toward an underestimation, while rightward aftereffect usually results in an overestimation of temporal durations. Here, we used functional magnetic resonance imaging (fMRI) to study the neural mechanisms that underlie PA effects on time perception. Additionally, we investigated whether the effect of PA on time is transient or stable and, in the case of stability, which cortical areas are responsible of its maintenance. Functional brain images were acquired while participants (n=17) performed a time reproduction task and a control-task before, immediately after and 30 min after PA inducing a leftward aftereffect, administered outside the scanner. The leftward aftereffect induced an underestimation of time intervals that lasted for at least 30 min. The left anterior insula and the left superior frontal gyrus showed increased functional activation immediately after versus before PA in the time versus the control-task, suggesting these brain areas to be involved in the executive spatial manipulation of the representation of time. The left middle frontal gyrus showed an increase of activation after 30 min with respect to before PA. This suggests that this brain region may play a key role in the maintenance of the PA effect over time.

The role of posterior parietal cortices on prismatic adaptation effects on the representation of time intervals.

Previous studies provided evidence of an ascending left-to-right spatial representation of time durations by using a technique affecting high levels of spatial cognition, i.e. prismatic adaptation (PA). Indeed, PA that induced a leftward aftereffect distorted time representation toward an underestimation, while PA that induced a rightward aftereffect distorted time representation toward an overestimation. The present study advances previous findings on the effects of PA on time by investigating the neural basis subtending these effects. We focused on the posterior parietal cortex (PPC) since it is involved in the PA procedure and also in the formulation of the spatial representation of time. We conducted two experiments where right-handed healthy adults were submitted to a time task, before and after PA, that could induce a leftward or rightward aftereffect. Repetitive TMS (rTMS) was used to inhibit the left or right PPC before PA administration. In a first experiment the time task consisted of reproducing an half duration (time bisection task) by pressing a key and the participants responded and adapted to prisms with their right hand. In a second experiment the time task consisted of reproducing a whole duration (time reproduction task) by pressing a key and the participants responded and adapted to prisms with their left hand. We found an abolition of the effects of PA on time when rTMS was delivered on the left and not on the right PPC, regardless of the task and moreover, when the participants responded and adapted with the right hand and also with the left hand. This result suggests a direct involvement of the left PPC in the interactive process, between spatial modulations induced by PA and the spatial representation of time, that does not depend on motor processes. This study provides useful results for future investigations on the neural mechanisms subtending the effects of PA on spatial representations.

Prismatic adaptation effects on spatial representation of time in neglect patients.

Processing of temporal information may require the use of spatial attention to represent time along a mental time line. We used prismatic adaptation (PA) to explore the contribution of spatial attention to the spatial representation of time in right brain damaged patients with and without neglect of left space and in age-matched healthy controls. Right brain damaged patients presented time underestimation deficits, that were significantly greater in patients with neglect than in patients without neglect. PA inducing leftward attentional deviation reduced time underestimation deficit in patients with neglect. The results support the hypothesis that a right hemispheric network has a role, per se, in time perception. Moreover, they suggest that right hemisphere is important in time perception for its control of spatial attention, engaged in spatial representation of time. Procedures that ameliorate left spatial deficits could also be useful for modulating temporal deficits in right brain damaged patients with neglect.

Changing auditory time with prismatic goggles.

The aim of the present study was to explore the spatial organization of auditory time and the effects of the manipulation of spatial attention on such a representation. In two experiments, we asked 28 adults to classify the duration of auditory stimuli as "short" or "long". Stimuli were tones of high or low pitch, delivered left or right of the participant. The time bisection task was performed either on right or left stimuli regardless of their pitch (Spatial experiment), or on high or low tones regardless of their location (Tonal experiment). Duration of left stimuli was underestimated relative to that of right stimuli, in the Spatial but not in the Tonal experiment, suggesting that a spatial representation of auditory time emerges selectively when spatial-encoding is enforced. Further, when we introduced spatial-attention shifts using the prismatic adaptation procedure, we found modulations of auditory time processing as a function of prismatic deviation, which correlated with the interparticipant adaptation effect. These novel findings reveal a spatial representation of auditory time, modulated by spatial attention.

Body knowledge in brain-damaged children: a double-dissociation in self and other's body processing.

Bodies are important element for self-recognition. In this respect, in adults it has been recently shown a self vs other advantage when small parts of the subjects' body are visible. This advantage is lost following a right brain lesion underlying a role of the right hemisphere in self body-parts processing. In order to investigate the bodily-self processing in children and the development of its neuronal bases, 57 typically developing healthy subjects and 17 subjects with unilateral brain damage (5 right and 12 left sided), aged 4-17 years, were submitted to a matching-to-sample task. In this task, three stimuli vertically aligned were simultaneously presented at the centre of the computer screen. Subjects were required which of two stimuli (the upper or the lower one) matched the central target stimulus, half stimuli representing self and half stimuli representing other people's body-parts and face-parts. The results showed that corporeal self recognition is present since at least 4 years of age and that self and others' body parts processing are different and sustained by separate cerebral substrates. Indeed, a double dissociation was found: right brain damaged patients were impaired in self but not in other people's body parts, showing a self-disadvantage, whereas left brain damaged patients were impaired in others' but not in self body parts processing. Finally, since the double dissociation self/other was found for body-parts but not for face parts, the corporal self seems to be dissociated for body and face-parts. This opens the possibility of independent and lateralized functional modules for the processing of self and other body parts during development.

Time and spatial attention: effects of prism adaptation on temporal deficits in brain damaged patients.

Growing evidence indicates that the representations of space and time interact in the brain but the exact neural correlates of such interaction remain unknown. Neuroimaging and neuropsychological studies show that processing of temporal information engages a distributed network in the right hemisphere and suggest a link between deficits in spatial attention and deficits in time perception. In the present study we used the procedure of prismatic adaptation (PA) to directionally manipulate spatial attention in order to explore the effect of attentional deviation on time perception in patients with right (RBD) vs. left (LBD) brain damage. In a first experiment, two groups of RBD and LBD patients and two groups of age-matched healthy subjects were submitted to a time reproduction task before and after rightward or leftward PA (between-group design). In a second experiment RBD and LBD patients were submitted to the same task, before and after rightward and leftward PA (within-group design). RBD but not LBD patients presented a time deficit with a clear tendency to underestimate the real time. PA inducing leftward attentional deviation biased time perception toward an underestimation in RBD patients and controls, while it was ineffective in LBD patients. PA inducing a rightward attentional deviation failed to affect time perception in either group. These results underline the effects of PA on temporal deficits in brain damaged patients. The novel finding is that, while a right hemispheric network is critical for explicit timing, a left hemispheric network is necessary for mediating the effects of prismatic adaptation on spatial and temporal perception.

Prismatic lenses shift time perception.

Previous studies have demonstrated the involvement of spatial codes in the representation of time and numbers. We took advantage of a well-known spatial modulation (prismatic adaptation) to test the hypothesis that the representation of time is spatially oriented from left to right, with smaller time intervals being represented to the left of larger time intervals. Healthy subjects performed a time-reproduction task and a time-bisection task, before and after leftward and rightward prismatic adaptation. Results showed that prismatic adaptation inducing a rightward orientation of spatial attention produced an overestimation of time intervals, whereas prismatic adaptation inducing a leftward shift of spatial attention produced an underestimation of time intervals. These findings not only confirm that temporal intervals are represented as horizontally arranged in space, but also reveal that spatial modulation of time processing most likely occurs via cuing of spatial attention, and that spatial attention can influence the spatial coding of quantity in different dimensions.

Antiepileptic drug use and epileptic seizures in elderly nursing home residents: a survey in the province of Pavia, Northern Italy.

Some surveys indicate that elderly nursing home residents are extensively prescribed antiepileptic drugs (AEDs). Few studies have evaluated the prevalence of seizure-related diagnoses as a risk factor for AED administration in nursing homes. To assess the prevalence of AED use and of epileptic seizures in the elderly nursing home residents in our country, we considered age and gender data, functional status (measured by the Barthel's Index), drugs currently administered on a scheduled basis, clinical diagnoses from the patient's chart including possible history of epileptic seizures, of all subjects aged 60 years and over living in 21 federated nursing homes in the province of Pavia, Northern Italy. Data relating to 2.001 subjects (77.5 % females) were collected over a 4-month period (September-December 2000). Eighty-seven of the 2.001 residents (4.3%; 5.3% of all the males and 4.0% of all the females) were taking AEDs and 58 (3.5% of all the males and 2.7% of all the females), all of them under treatment with at least one AED, had epileptic seizures in their history. Both these subgroups had a mean modified Barthel's Index score significantly lower than that of the population as a whole. Phenobarbitone was the most frequently prescribed AED, and the penetration of newer AEDs was minimal. Subjects in early old age (60-74 years) were more likely than older subjects to take an AED. Logistic regression indicated a significant association between seizures reports, a younger age and a history of cerebrovascular events, alcohol abuse and meningiomas. The prevalence of AED use in this study was lower than that found by previous U.S. studies: nevertheless, our data confirm male gender and early old age as factors associated with AED taking in elderly nursing home residents. In our series AED users showed a lower level of autonomy. Taken together, our data suggest that an earlier institutionalization of seizure subjects could be facilitated by the clustering of various conditions, such as seizures, cerebrovascular events, other clinical disorders and a possibly inappropriate anticonvulsant treatment.

Chemical pleurodesis to improve patients' quality of life in the management of malignant pleural effusions: the 15 year experience of the National Cancer Institute of Milan.

We analyzed chemical pleurodesis role in recurrent neoplastic pleural effusions management, performed by two different techniques: VATS and minimal lateral thoracotomy. We compared the results obtained using the two different procedures, and we also evaluated the two sclerosing agents used (talc and alcohol). From January 1987 to March 2002, we treated 565 patients with malignant pleural effusion: 355 (63%) by VATS and 210 (37%) through mini-thoracotomy all of them underwent chemical pleurodesis: 442 (78%) by means of talc and 123 (22%) by alcohol. Chemical pleurodesis therapeutic success was globally obtained in 436 patients (77%). Dealing with surgical approaches, VATS reduced operating time (33 versus 44 minutes: P < 0.001), mean drainage time (3 versus 5 days: P < 0.001), complications (2% versus 7%: P = 0.006) and mean postoperative course (5 versus 7 days: P < 0.001). Therapeutic success of VATS-treated patients was 81% versus 65% of those undergoing thoracotomy (P < 0.001). We obtained a significantly lower relapse rate in the patients of all the two groups treated with talc versus alcohol (12% versus 35% in VATS group and 25% versus 59% in thoracotomic group). Our data indicate that chemical pleurodesis represents a good palliative treatment of neoplastic pleural effusion. Talc was superior to alcohol as sclerosant agent regardless of the surgical procedure. Comparing the two techniques, VATS should be preferred to minimal thoracotomy. We can suggest talc pleurodesis by VATS as the choice treatment in case of recurrent pleural effusions.

The real impact and usefulness of video-assisted thoracoscopic surgery in the diagnosis and therapy of clinical lymphadenopathies of the mediastinum.

BACKGROUND: The aim of this study was to evaluate the impact of video-assisted thoracoscopic surgery (VATS) in the diagnosis and therapy of clinical mediastinal lymphadenopathies. METHODS: In our Institute, from 1995 to 2001, 85 patients underwent VATS biopsy: 55 subjects (group 1) for suspected lung cancer (65%) and 30 (group 2) for unknown nodes enlargement (35%). Lymphonodes were considered suspected if > 1 cm by radiological imaging. We performed 83 thoracoscopic biopsies: 33 in level 5 (39%), 24 in level 6 (29%), 19 in level 7 (22%), and 7 in level 8 (8%). RESULTS: A histological analysis of frozen sections was made in every case. Twenty subjects underwent lung resection in one-time (24%). Histology in group 1 was adenocarcinoma in 28 cases, epidermoid carcinoma in 14, microcytoma in 9, and giant-cell carcinoma in 4. Ten patients were at stage I, 10 at stage II, 33 at stage III, and two at stage IV. Histology of group 2 was lymphoma in 18 cases, sarcoidosis in eight, and focal aspecific hyperplasia in four. CONCLUSION: The usefulness of VATS allowed the pathological assessment of the presumed involved mediastinal lymph nodes in every patient and thus permitted to assure in all the cases the indicated therapeutic treatment.