Listening to music during intranasal (es)ketamine therapy in patients with treatment-resistant depression correlates with better tolerability and reduced anxiety.

Background: Although the effectiveness of (es)ketamine for therapy-resistant depression (TRD) has been established, potential treatment-limiting factors include side effects like dissociation, anxiety, or elevated blood pressure. Music can reduce stress and negative emotions as anxiety. This study aimed to investigate the impact of listening to music during intranasal (es)ketamine administration on both tolerability and efficacy. Methods: Records of 494 sessions (of 37 patients) with intranasal (es)ketamine administration, each containing data of blood pressure measurements, DSS-IV (dissociation symptoms scale-IV), anxiety and euphoria analogue scale, MADRS (Montgomery-Åsberg Depression Rating Scale) and BDI (Beck's Depression Inventory) were evaluated. Results: The between-group analysis, comparing participants who listened to music with those who did not, revealed significant differences in the administered dose (p-value: 0.003, mean: 131.5 mg with music vs. 116.7 mg without music), scores on the DSS Item 1 (p-value: 0.005, mean: 3 points vs. 2.4 points), levels of anxiety (p-value: <0.001, mean: 0.4 points vs. 1.4 points), and measurements of maximal systolic blood pressure after administration (p-value: 0.017, mean: 137.9 mmHg vs. 140.3 mmHg). Listening to music had no impact on the MARDS-change score between the sessions. Limitations: Key limitations include a non-randomized naturalistic design and the non-standardized selection of music, which was based on individual patient preferences. Conclusion: Listening to music during intranasal (es)ketamine therapy appears to be linked to reduced anxiety and lower blood pressure, stable or increased dissociation levels, and improved tolerance for higher doses. These findings could potentially contribute to the optimization of (es)ketamine therapy, both in terms of treatment efficacy and managing side effects.

Distributed attention beats the down-side of statistical context learning in visual search.

Spatial attention can be deployed with a narrower focus to process individual items or distributed relatively broadly to process larger parts of a scene. This study investigated how focused- versus distributed-attention modes contribute to the adaptation of context-based memories that guide visual search. In two experiments, participants were either required to fixate the screen center and use peripheral vision for search ("distributed attention"), or they could freely move their eyes, enabling serial scanning of the search array ("focused attention"). Both experiments consisted of an initial learning phase and a subsequent test phase. During learning, participants searched for targets presented either among repeated (invariant) or nonrepeated (randomly generated) spatial layouts of distractor items. Prior research showed that repeated encounters of invariant display arrangements lead to long-term context memory about these arrays, which can then come to guide search (contextual-cueing effect). The crucial manipulation in the test phase was a change of the target location within an otherwise constant distractor layout, which has previously been shown to abolish the cueing effect. The current results replicated these findings, although importantly only when attention was focused. By contrast, with distributed attention, the cueing effect recovered rapidly and attained a level comparable to the initial effect (before the target location change). This indicates that contextual cueing can adapt more easily when attention is distributed, likely because a broad attentional set facilitates the flexible updating of global (distractor-distractor), as compared to more local (distractor-target), context representations-allowing local changes to be incorporated more readily.

[An innovative laser for the minimally invasive treatment of benign prostatic hyperplasia]. / Nouvelle génération de laser pour le traitement de l'hyperplasie bénigne de la prostate.

In an aging population, the number of patients suffering from benign prostatic hyperplasia is increasing. Furthermore, this older part of the population often bears multiple co-morbidities requiring permanent anticoagulation or antiaggregration medication. This has led to encourage the development of new surgical techniques. Photovaporization of the prostate (PVP) in particular provides improved hemostasis, and allow to operate patients without interrupting anticoagulation therapy. Functional results of PVP with a medium-term followup are similar to the current standards of transurethral resection of the prostate (TURP). Finally, PVP allows a significantly shorter hospital stay than TURP.

Intestinal obstruction following use of laparoscopic barbed suture: a new complication with new material?

Small bowel obstruction is a common pathology. Among the various etiologies, foreign material has been incriminated as a possible but uncommon cause. Recently, barbed suture has been successfully introduced in various surgical fields and has been reported as safe as standard suture. We report herein a case of intestinal obstruction due to the laparoscopic use of barbed suture during a promontofixation. Barbed suture has the risk of entrapping the small bowel. The surgeon should keep in mind this hypothetical problem and a high index of suspicion is needed to diagnose and treat quickly this potentially severe complication.

[Medical therapy for ureteral stones: high versus low fluid intake]. / Traitement médical de la tithiase urétérale: restriction versus chasse hydrique?

The mainstays of renal colic medical treatment are first to provide efficient pain relief, and second to facilitate migration of the ureteral stone or dissolve it. In the ambulatory setting, non steroidal anti-inflammatory drugs are the treatment of choice of pain relief. To facilitate stone migration, the debate between hydric restriction and hyperhydration remains somewhat open. Besides that, alpha-blockers and anti-calcic agents appear to speed up stone explusion, whereas stone chemolysis acts on a longer time scale.

Urothelial carcinoma "nested variant" of renal pelvis and ureter.

The nested variant of urothelial carcinoma is a rare type of urothelial invasive carcinoma. It is characterized by islands of discrete to moderate atypical urothelial cells that strongly simulate von Brunn nests and invade to the lamina propria or deeper. Almost all described cases have been located in the bladder. We report a case of nested variant of urothelial carcinoma of the renal pelvis and ureter, synchronous with high-grade urothelial papillary carcinoma.