Involvement of superior temporal areas in audiovisual and audiomotor speech integration

Perception of speech sounds is affected by observing facial motion. Incongruence between speech sounds and watching somebody articulating may influence the perception of auditory syllable, referred to as the McGurk effect. We tested the degree to which silent articulation of a syllable also affects speech perception and searched for its neural correlates. Listeners were instructed to identify the auditory syllables /pa/ and /ta/ while silently articulating congruent/incongruent syllables or observing videos of a speaker's face articulating them. As a baseline, we included an auditory-only condition without competing visual or sensorimotor input. As expected, perception of sounds degraded when incongruent syllables were observed, and also when they were silently articulated, albeit to a lesser extent. This degrading was accompanied by significant amplitude modulations in the beta frequency band in right superior temporal areas. In these areas, the event-related beta activity during congruent conditions was phase-locked to responses evoked during the auditory-only condition. We conclude that proper temporal alignment of different input streams in right superior temporal areas is mandatory for both audiovisual and audiomotor speech integration.

Motor imagery beyond the joint limits: a transcranial magnetic stimulation study

The processes and neural bases used for motor imagery are also used for the actual execution of correspondent movements. Humans, however, can imagine movements they cannot perform. Here we explored whether plausibility of movements is mapped on the corticospinal motor system and whether the process is influenced by visuomotor vs. kinesthetic-motor first person imagery strategy. Healthy subjects imagined performing possible or biomechanically impossible right index finger movements during single pulse TMS of the left motor cortex. We found an increase of corticospinal excitability during motor imagery which was higher for impossible than possible movements and specific for the muscle involved in the actual execution of the imagined movement. We expand our previous action observation studies, suggesting that the plausibility of a movement is computed in regions upstream the primary motor cortex, and that motor imagery is a higher-order process not fully constrained by the rules that govern motor execution.

Oral beclometasone dipropionate in the treatment of extensive and left-sided active ulcerative colitis: a multicentre randomised study

AIM

To explore the efficacy and safety of the topically acting steroid beclometasone dipropionate (BDP) in an oral controlled release formulation in the treatment of extensive or left-sided ulcerative colitis.

METHODS

In a multicentre, randomised, parallel-group, single-blind study, patients with active mild to moderate ulcerative colitis were randomised to a 4-week treatment with BDP 5 mg/day o.d. vs. 5-ASA 0.8 g t.d.s. The primary efficacy variable was the decrease of Disease Activity Index (DAI) (clinical symptoms and endoscopic appearance of mucosa). Safety was evaluated by monitoring adverse events, vital signs, haematochemical parameters and adrenal function.

RESULTS

One hundred and seventy-seven patients were enrolled and randomly treated with BDP (n = 90) or 5-ASA (n = 87). Mean DAI score decreased in both treatments groups (P < 0.0001 vs. baseline for both groups). Clinical remission was achieved in 63.0% of patients in the BDP group vs. 62.5% in the 5-ASA group. A significant DAI score improvement (P < 0.05) in favour of BDP was observed in patients with extensive disease. Both treatments were well tolerated. Mean plasma cortisol levels were significantly reduced vs. baseline in BDP recipients, but without signs of pituitary-adrenal function depletion.

CONCLUSION

Oral BDP gave an overall treatment result in patients with active ulcerative colitis without signs of systemic side-effects.

A common perceptual parameter for stair climbing for children, young and old adults

In this paper we examine whether a common perceptual parameter is available for guiding old adults, young adults and children in climbing the highest stair mountable in a bipedal fashion. Previous works have shown that the ratio between the height of the stair and the hip height was the body-scaled invariance adopted as information for selecting the highest stair by young adults [Journal of Experimental Psychology: Human Perception and Performance 10 (1984) 683-703] but not by older adults [Journal of Experimental Psychology: Human Perception and Performance 3 (1992) 691-697]. Indeed, for older adults additional bio-mechanical parameters needed to be added to the model due to their decrease in leg strength and flexibility.Up to now, no perceptual invariant has been identified yet for determining the relevant information used for guiding the stair climbing action for normal healthy people. We propose a new parameter as the angle defined by the ratio between the height of the stair and the distance taken from the feet to the top edge of the stair before the initiation of the movement. We show that this angle is the same for children, young adults and older adults despite the different kinematics of the motion, the anthropometrics and the skill ability exhibit by the participants. In summary we show that even when the climbability judgments, based on the simple ratio leg length-stair height, are influenced by differences in age, participants use a common perceptual variable when they are coordinating their stair climbing action.

Mortality in patients with coeliac disease and their relatives: a cohort study

BACKGROUND

Although previous studies have shown increased mortality in patients with coeliac disease and their relatives, no data are available in relation to different patterns of clinical presentation. We assessed mortality in patients with coeliac disease and their first-degree relatives.

METHODS

We enrolled, in a prospective cohort study, 1072 adult patients with coeliac disease consecutively diagnosed in 11 gastroenterology units between 1962 and 1994, and their 3384 first-degree relatives. We compared the number of deaths up to 1998 with expected deaths and expressed the comparison as standardised mortality ratio (SMR) and relative survival ratio.

FINDINGS

53 coeliac patients died compared with 25.9 expected deaths (SMR 2.0 [95% CI 1.5-2.7]). A significant excess of mortality was evident during the first 3 years after diagnosis of coeliac disease and in patients who presented with malabsorption symptoms (2.5 [1.8-3.4]), but not in those diagnosed because of minor symptoms (1.1 [0.5-2.2]) or because of antibody screening (1.2 [0.1-7.0]). SMR increased with increasing delay in diagnosis and for patients with poor compliance with gluten-free diet. Non-Hodgkin lymphoma was the main cause of death. No excess of deaths was recorded in relatives with coeliac disease.

INTERPRETATION

Prompt and strict dietary treatment decreases mortality in coeliac patients. Prospective studies are needed to clarify the progression of mild or symptomless coeliac disease and its relation to intestinal lymphoma.

Analysis of kinematically redundant reaching movements using the equilibrium-point hypothesis

Six subjects performed a planar reaching arm movement to a target while unpredictable perturbations were applied to the endpoint; the perturbations consisted of pulling springs having different stiffness. Two conditions were applied; in the first, subjects had to reach for the target despite the perturbation, in the second condition, the subjects were asked to not correct the motion as a perturbation was applied. We analyzed the kinematics profiles of the three arm segments and, by means of inverse dynamics, calculated the joint torques. The framework of the equilibrium-point (EP) hypothesis, the lambda model, allowed the reconstruction of the control variables, the "equilibrium trajectories", in the "do not correct" condition for the wrist and the elbow joints as well as for the end point final position, while for the other condition, the reconstruction was less reliable. The findings support and extend to a multiple-joint planar movement, the paradigm of the EP hypothesis along with the "do not correct" instruction.

Effects of different carbohydrate sources on the growth of Tuber borchii Vittad. mycelium strains in pure culture

The influence of carbohydrate utilisation on the growth of three strains of Tuber borchii Vittad. mycelium (1BO, 17BO and 10RA) in culture was assessed using culture media containing glucose (control), mannose or mannitol. Mannose was the best substrate for growth of the strains and this was particularly evident for strain 17BO. Mannitol instead was metabolized only by 10RA and 1BO. In order to explain the different growth trends, analyses of enzyme levels, kinetic parameters, protein patterns and the morphology of the three strains were carried out. Our results show that these strains of T. borchii mycelium were affected by the substrates used in the media. The aim of the present work was to optimise the in vitro production of T. borchii mycelium for use in experiments which require the fungus in precise and reproducible conditions, such as mycorrhizal synthesis or protein and nucleic acid extractions.

Peptic ulcer bleeding: comparison of two hemostatic procedures

OBJECTIVE

Bleeding is a serious complication of peptic ulcer. Endoscopic injection therapy is accepted as a homeostatic endoscopic treatment in acute nonvariceal of upper GI hemorrhages, particularly in bleeding peptic ulcers. The risk of rebleeding is predicted by the endoscopic appearance of ulcer features classified according to Forrest's criteria.

METHODS

Two hundred twenty-three patients were selected from 1,003 emergency upper endoscopies for GI bleeding. According to Forrest's criteria, 99 well-matched patients with ulcers F1 and F2 were considered at risk of rebleeding; 54 patients (group A) received local ulcer injection of epinephrine solution 1:10,000, whereas (group B) patients were treated with local epinephrine injection and then with endoscopic Hemoclips. (1) We considered the control of bleeding, the number of rebleeding episodes, the need for emergency surgery, and mortality.

RESULTS

Bleeding ulcers stopped completely in 83.3% group A patients, and in 95.6% group B patients (p = not significant). In a subset of F1b patients the rebleeding rate was 31 % for group A and 0% for group B (p < 0.05). There was no mortality as a result of the procedure. There was a trend toward reducing surgery in favor of the combined therapy (0% vs 7.4%). No differences were found in transfusion requirements or mean hospitalization days.

CONCLUSIONS

We conclude that endoscopic injection of l:10,000 epinephrine solution alone and epinephrine solution plus application of Hemoclips are equivalent therapies in treating bleeding and rebleeding from peptic ulcers. There was no difference between therapies in terms of need for surgery or mortality. Possibly combination therapy is more effective in treating ulcers that are actively oozing.

Body-scaled transitions in human grip configurations

This article reports two experiments that were set up to examine the preferred human grip configuration used to displace cubes that varied in length (Lc), mass (Mc), and density (ML3). In particular, the authors sought to provide a more precise test of a dimensional relation between the object and the hand that had previously been shown to predict the grip configuration used to transport an object from one location to another. The experiments examined 2 grip transitions (from 3 digits to 4 digits and from 1 hand to 2 hands) within 2 sets of object conditions. In Experiment 1, cubes with a low density and a small increment in size (1 mm) were used, whereas in Experiment 2, cubes with 2 fixed sizes and small increments in mass were used. The results showed that the body-scaled equation K = logLc + (logMc/a + bMh + cLh), where Mh and Lh are the anthropometric measures of the hand mass and length and a, b, and c are empirical constants, is the body-scaled information that predicts the grip configurations used to displace objects.

Relapse of low-grade gastric MALT lymphoma after Helicobacter pylori eradication: true relapse or persistence? Long-term post-treatment follow-up of a multicenter trial in the north-east of Italy and evaluation of the diagnostic protocol's adequacy

The effect of eradication of Helicobacter pylori on early stage gastric low-grade MALT lymphoma in 76 patients with follow-up of at least 1 year (12-63 months, mean 28) is reported. No regression was found in five cases after 12-48 months. In one case surgical resection detected the involvement of perigastric lymph nodes overlooked by endoscopic ultrasonography (EUS). Neither progression of the disease nor a high-grade component was documented by repeated gastric mappings, EUS and complete stagings in the other four cases. After histological remission five relapses of low-grade and one relapse of high-grade MALT lymphoma were found 12-48 months after eradication. Subsequent histological remission, without any additional therapy, was found in three relapsed cases. A rapid and persistent histological remission was obtained in 56 patients (73%). A late remission was observed in six cases. Monoclonal remission was found in half of the patients and was frequently delayed. Persistent monoclonality was associated with histological remission in the vast majority of patients. Our data confirm H. pylori eradication as the first choice therapy for early stage gastric low-grade MALT lymphoma and recommend extensive bioptic mapping and endoscopic sonography both in the local staging and in the regression evaluation. The rare cases of late remission encourage us to wait for at least 1 year after eradication of H. pylori. Longer follow-up studies will clarify the meaning of histological relapse/persistence and late remission. The study of non-responder cases could show us a step in lymphomagenesis.

Body scaling of grip configurations in children aged 6-12 years

This study examined the influence of body scale on the grip configurations used by young children (6-12 years old) to displace cubes that varied systematically in size (L) and mass (M). It was determined if the scaling relation we had developed for adults K = log Lc + ((log Mc)/(a + bLh + cMh)) where L(c) and M(c) is the length side and mass of the cubes, respectively, and L(h) and M(h) are the length and mass of the hand, respectively, it would also predict the change in grip configurations across this age range in a fashion consistent with the principle of similitude. The statistical and scaling analyses revealed that the invariant body-scaled relation that specified the adult grip transitions also held for the 6- to 12-year-old children.

The natural history of ulcerative proctitis: a multicenter, retrospective study. Gruppo di Studio per le Malattie Infiammatorie Intestinali (GSMII)

OBJECTIVE

The aim of this study was to evaluate the clinical features and the long term evolution of patients with a well defined initial diagnosis of ulcerative proctitis.

METHODS

Patients with an original diagnosis of ulcerative proctitis who had been seen at any of 13 institutions from 1989 to 1994 were identified. Data on disease onset and subsequent evolution were recorded. In addition, 575 patients with more extensive disease, treated in the same centers, were used as controls.

RESULTS

A total of 341 patients satisfied the inclusion criteria. The percentage of smokers in these patients was slightly lower than in controls; no differences were found in the other clinical/demographic variables evaluated. A total of 273 patients entered long term follow-up (mean, 52 months). Proximal extension of the disease occurred in 74 of them (27.1%). The cumulative rate of proximal extension and of extension beyond the splenic flexure was 20% and 4% at 5 yr and 54% and 10% at 10 yr, respectively. The risk of proximal extension was higher in nonsmokers, in patients with >3 relapses/yr, and in patients needing systemic steroid or immunosuppressive treatment. Refractory disease was confirmed as an independent prognostic factor at multivariate analysis.

CONCLUSIONS

Proximal extension of ulcerative proctitis is frequent and may occur even late after the original diagnosis. However, the risk of extension beyond the splenic flexure appears to be quite low. Smoking seems to be a protective factor against proximal extension, whereas refractoriness is a risk factor for proximal extension of the disease.

The scaling of human grip configurations

The many degrees of freedom of the hand and arm afford the wide range and rich adaptability of human grip configurations in action. Several classification schemes of human grip configurations have been proposed, but none is based on scaling laws of physical biology, which are well established for other categorizations of fundamental physical activities such as locomotion. This study examined the preferred human grip configurations used to displace to a new location cubes that varied systematically in length (L), mass (M), and density (ML-3). The body-scaled equation K = log L + (log M)/h (where h refers to anthropometric measures of the hand) predicted the grip configurations used to displace objects. The findings suggest that information about the dynamic scaling relation is picked up visually and organizes the many degrees of freedom of the hand-arm complex in the coordination of prehensile grip configurations.

The scaling of human grip configurations

The many degrees of freedom of the hand and arm afford the wide range and rich adaptability of human grip configurations in action. Several classification schemes of human grip configurations have been proposed, but none is based on scaling laws of physical biology, which are well established for other categorizations of fundamental physical activities such as locomotion. This study examined the preferred human grip configurations used to displace to a new location cubes that varied systematically in length (L), mass (M), and density (ML-3). The body-scaled equation K = log L + (log M)/h (where h refers to anthropometric measures of the hand) predicted the grip configurations used to displace objects. The findings suggest that information about the dynamic scaling relation is picked up visually and organizes the many degrees of freedom of the hand-arm complex in the coordination of prehensile grip configurations.

On taking the grasping out of prehension

Smeets and Brenner provide a very clear and useful statement of the work that has been stimulated by Jeannerod's 1984 paper but seem more concerned about the viability of model fitting than model assumptions. The theoretical and practical limitations of viewing "grasping as nothing more than pointing" are noted. We reemphasize the importance in prehension of the union of the hand with the object in the act of realizing a task goal.

A new mesalazine gel enema in the treatment of left-sided ulcerative colitis: a randomized controlled multicentre trial

BACKGROUND

A new mesalazine rectal gel preparation (without propellant gas) has been recently developed to improve topical treatment in distal ulcerative colitis.

AIM

To evaluate the efficacy, safety and patient tolerability of mesalazine gel enema compared with mesalazine foam enema in the treatment of patients with acute left-sided ulcerative colitis.

METHODS

In a randomized multicentre investigator-blind parallel group trial, 103 patients with mild to moderate left-sided colitis or proctosigmoiditis were randomly allocated to mesalazine 2 g gel enema (n = 50 evaluable patients) and mesalazine 2 g foam enema (n = 53 evaluable patients) for 4 weeks. Clinical symptoms, endoscopic and histological findings were assessed at entry, 2 and 4 weeks. Patients' evaluation of treatment tolerability and acceptability was assessed at 2 and 4 weeks.

RESULTS

After 4 weeks of treatment, clinical remission was achieved by 76% of mesalazine gel enema-treated patients and 69% of patients treated with mesalazine foam enema (P = 0.608). Endoscopic remission rates at week 4 were 51 and 52% for the mesalazine gel and foam enemas, respectively (P = 0.925). Histological remission was achieved by 30% of patients in both groups. Patients reported that the new mesalazine gel preparation was significantly better tolerated than the foam enema. Patients in the foam group had significantly more difficulty in retention (25% vs. 6%, P < 0.05), abdominal bloating (50% vs. 26%, P < 0.005) and discomfort during administration (48% vs. 26%, P < 0.05).

CONCLUSION

The new mesalazine gel enema is efficacious and significantly better tolerated than the mesalazine foam enema.

Antigenic mimicry between Helicobacter pylori and gastric mucosa in the pathogenesis of body atrophic gastritis

BACKGROUND & AIMS

The majority of patients with Helicobacter pylori infection have autoantibodies cross-reacting with gastric antigens. In this study, the relation between autoantibody status, histopathology of body mucosa, and antigenic profile of H. pylori was investigated.

METHODS

One hundred patients were examined for H. pylori infection, body gastritis, and gastric autoantibodies. Balb/c mice were analyzed for serum autoantibodies after immunization with H. pylori from patients with and without atrophic gastritis.

RESULTS

Immunoglobulin G autoantibodies were detected in 57 of the 87 infected patients (65.5%) but in none of the 13 patients without infection and gastritis. The autoreaction involved mainly the luminal surface of glandular cells and secretory canaliculi of parietal cells. The autoantibody status correlated with the presence and degree of inflammation and atrophy of the glands. H. pylori from patients with atrophic gastritis showed a higher capacity to induce autoantibodies than H. pylori from patients with a minimal superficial gastritis. Monoclonal antibodies showed differences in the bacterial expression of cross-reacting determinants.

CONCLUSIONS

H. pylori-mediated autoimmunity is involved in the pathogenesis of chronic atrophic gastritis. The grade of antigenic mimicry of the infecting H. pylori strain plays a role in the progression of chronic gastritis to atrophy.

Survival after endoscopic sclerotherapy for esophageal varices in cirrhotics

OBJECTIVES

Gastroesophageal bleeding from varices is the most life-threatening complication in liver cirrhosis with portal hypertension. Since its first application, endoscopic sclerotherapy seems to be the most widely applicable procedure to stop the bleeding and to prevent recurrences. The aim of this study was to ascertain the role of some factors as predictors of survival in different groups of cirrhotic patients.

METHODS

At the time of their first hemorrhage from esophageal varices, 184 patients with portal hypertension from cirrhosis were treated by endoscopic sclerotherapy using a combined intraparavariceal procedure and Polidocanol 1% as sclerosing agent.

RESULTS

The follow-up range was 1-106 months (mean, 28.2 months), and 84 patients were still alive (45.7%), 97 had died (52.7%), and three had withdrawn (1.6%) at the end of the period. The major cause of death was bleeding, and 35 patients died in the first 6 wk after sclerotherapy. Using Cox proportional hazard models, Child's grading was the most important prognostic factor of both short-term (first 6 wk) and medium/long-term survival (after the first 6 wk up to 5 years). Complete eradication of varices, too, was associated with both short- and long-term survival, whereas age, sex, etiology of cirrhosis, and the presence of esophageal stenosis as a side effect of sclerotherapy were not. The type of sclerotherapy (elective vs emergent) was associated with survival, but it was not independent from Child's grade, because only patients in Child C treated electively showed a better prognosis than those treated in emergency.

CONCLUSIONS

We can conclude that patients with severe liver disease (Class C) have poor prognosis, and complete eradication represents an aim because it seems to be protective against the risk of dying.

Gastrointestinal transit in hyperthyroid patients before and after propranolol treatment

Mean mouth to cecum transit time determined by the hydrogen breath test after oral lactulose in a group of 10 hyperthyroid patients (nine with regular bowel habit and one with diarrhea) was significantly lower than that observed in 10 euthyroid controls [53 min (SD 15) versus 123 min (SD 12.2), p less than 0.01]. After 5 days of propranolol treatment the patients showed a significant reduction of the heart rate but no modification of transit time [51 min (SD 7.3)].