Neural dynamics of vicarious physical pain processing reflect impaired empathy toward sexually objectified versus non-sexually objectified women

Sexually objectified women are perceived as dehumanized. This may affect the behavioral and neural responses underlying the observer's empathic reactions for their physical pain, although this hypothesis still lacks empirical support. In the present study, we measured the electrophysiological activity of 30 participants (14 females and 16 males), in an empathy for physical pain paradigm in which pictures of sexualized and non-sexualized women were presented in painful and non-painful situations. The behavioral results revealed that sexualized women were evaluated as experiencing less pain than non-sexualized women. Neural evidence corroborated this finding showing that the perception of vicarious physical pain is lacking for sexualized women in both event-related potentials (ERPs) and brain oscillation domains. Specifically, the P2 component and the event-related synchronization/desynchronization (ERS/ERD) on the mu frequency band differed between painful and non-painful stimulation exclusively when women were not sexualized. Our results provide the first evidence that the neurophysiological responses to the vicarious experience of physical pain are dampened or even absent for sexualized women. These findings expand our understanding of the neurophysiological signatures of empathic processes and highlight the detrimental effect of a sexual-objectification bias in everyday contexts.

Functional connectivity changes in mild cognitive impairment: A meta-analysis of M/EEG studies

OBJECTIVE

Early synchrony alterations have been observed through electrophysiological techniques in Mild Cognitive Impairment (MCI), which is considered the intermediate phase between healthy aging (HC) and Alzheimer's disease (AD). However, the documented direction (hyper/hypo-synchronization), regions and frequency bands affected are inconsistent. This meta-analysis intended to elucidate existing evidence linked to potential neurophysiological biomarkers of AD.

METHODS

We conducted a random-effects meta-analysis that entailed the unbiased inclusion of Non-statistically Significant Unreported Effect Sizes ("MetaNSUE") of electroencephalogram (EEG) and magnetoencephalogram (MEG) studies investigating functional connectivity changes at rest along the healthy-pathological aging continuum, searched through PubMed, Scopus, Web of Science and PsycINFO databases until June 2023.

RESULTS

Of the 3852 articles extracted, we analyzed 12 papers, and we found an alpha synchrony decrease in MCI compared to HC, specifically between temporal-parietal (d = -0.26) and frontal-parietal areas (d = -0.25).

CONCLUSIONS

Alterations of alpha synchrony are present even at MCI stage.

SIGNIFICANCE

Synchrony measures may be promising for the detection of the first hallmarks of connectivity alterations, even at the prodromal stages of the AD, before clinical symptoms occur.

Feasibility of Remote Unsupervised Cognitive Screening With SATURN in Older Adults

Widespread cognitive test screening as part of tele-public health initiatives necessitates a test that is self-administered online and automatically scored, with no clinician effort. The feasibility of unsupervised cognitive screening is unclear. We adapted the Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN) to make it suitable for self-administration and automatic scoring. A sample of 364 healthy older adults completed SATURN via a web browser, in a fully independent manner. SATURN's overall score was not modulated by gender, education, reading speed, the time of day at which the test was taken, or an individual's familiarity with technology. SATURN proved extremely portable across operating systems. Importantly, comments from participants reported satisfaction with the experience and the clarity of the instructions. SATURN represents a fast and easy screening tool that can be used for a first assessment, during a routine test or clinical evaluation, or during periodic health monitoring, in person or remotely.

Age-related effects on online and offline learning in visuo-spatial working memory

Learning results from online (within-session) and offline (between-sessions) changes. Heterogeneity of age-related effects in learning may be ascribed to aging differentially affecting these two processes. We investigated the contribution of online and offline consolidation in visuo-spatial working memory (vWM). Younger and older participants performed a vWM task on day one and after nine days, allowing us to disentangle online and offline learning effects. To test whether offline consolidation needs continuous practice, two additional groups of younger and older adults performed the same vWM task in between the two assessments. Similarly to other cognitive domains, older adults improved vWM through online (during session one) but not through offline learning. Practice was necessary to improve vWM between sessions in older participants. Younger adults instead exhibited only offline improvement, regardless of practice. The findings suggest that while online learning remains efficient in aging, practice is instead required to support more fragile offline mechanisms.

Aging and feature binding in visual working memory

Older adults have reduced performance in visual working memory tasks in comparison to young adults, but the precipitators of the age-related impairment are not fully understood. The most common interpretation of this difference is that older adults are incapable of maintaining the same amount of object representations as young adults over short intervals (in line with the fixed-slot model of working memory). However, it has remained largely unexplored whether the age-related decline is only due to the number of representations that older individuals can retain in visual working memory, or whether the content of the representation(s) may have an effect as well (in line with the flexible-resource model of working memory). Feature binding studies represent an interesting research line to examine the content of older adults' representations. In this mini-review, we present the main results across feature binding studies in aging, as well as highlight the importance of manipulating both the representation content and number to have a stress test of the various models of working memory and their contribution to aging. Overall, feature binding studies, together with the simultaneous manipulation of set size, will allow us to better understand the nature of the age-related decline of visual working memory.

Connectivity alterations underlying the breakdown of pseudoneglect: New insights from healthy and pathological aging

A right-hemisphere dominance for visuospatial attention has been invoked as the most prominent neural feature of pseudoneglect (i.e., the leftward visuospatial bias exhibited in neurologically healthy individuals) but the neurophysiological underpinnings of such advantage are still controversial. Previous studies investigating visuospatial bias in multiple-objects visual enumeration reported that pseudoneglect is maintained in healthy elderly and amnesic mild cognitive impairment (aMCI), but not in Alzheimer’s disease (AD). In this study, we aimed at investigating the neurophysiological correlates sustaining the rearrangements of the visuospatial bias along the progression from normal to pathological aging. To this aim, we recorded EEG activity during an enumeration task and analyzed intra-hemispheric fronto-parietal and inter-hemispheric effective connectivity adopting indexes from graph theory in patients with mild AD, patients with aMCI, and healthy elderly controls (HC). Results revealed that HC showed the leftward bias and stronger fronto-parietal effective connectivity in the right as compared to the left hemisphere. A breakdown of pseudoneglect in patients with AD was associated with both the loss of the fronto-parietal asymmetry and the reduction of inter-hemispheric parietal interactions. In aMCI, initial alterations of the attentional bias were associated with a reduction of parietal inter-hemispheric communication, but not with modulations of the right fronto-parietal connectivity advantage, which remained intact. These data provide support to the involvement of fronto-parietal and inter-parietal pathways in the leftward spatial bias, extending these notions to the complex neurophysiological alterations characterizing pathological aging.

“Classifying-together” phenomenon in fish (Xenotoca eiseni): Simultaneous exposure to visual stimuli impairs subsequent discrimination learning

When animals are previously exposed to two different visual stimuli simultaneously, their learning performance at discriminating those stimuli delays: such a phenomenon is known as “classifying-together” or “Bateson effect”. However, the consistency of this phenomenon has not been wholly endorsed, especially considering the evidence collected in several vertebrates. The current study addressed whether a teleost fish, Xenotoca eiseni, was liable to the Bateson effect. Three experiments were designed, by handling the visual stimuli (i.e., a full red disk, an amputated red disk, a red cross) and the presence of an exposure phase, before performing a discriminative learning task (Exp. 1: full red disk vs. amputated red disk; Exp. 2: full red disk vs. red cross). In the exposure phase, three conditions per pairs of training stimuli were arranged: “congruence”, where fish were exposed and trained to choose the same stimulus; “wide-incongruence”, where fish were exposed to one stimulus and trained to choose the other one; “narrow-incongruence”, where fish were exposed to both the stimuli and trained to choose one of them. In the absence of exposure (Exp. 3), the discrimination learning task was carried out to establish a baseline performance as regards the full red disk vs. amputated red disk, and the full red disk vs. red cross. Results showed that fish ran into retardation effects at learning when trained to choose a novel stimulus with respect to the one experienced during the exposure-phase (wide-incongruence condition), as well as after being simultaneously exposed to both stimuli (narrow-incongruence condition). Furthermore, there were no facilitation effects due to the congruence compared with the baseline: in such a case, familiar stimuli did not ease the performance at learning. The study provides the first evidence about the consistency of the classifying-together effect in a fish species, further highlighting the impact of visual similarities on discrimination processes.

Power shift and connectivity changes in healthy aging during resting-state EEG

The neural activity of human brain changes in healthy individuals during aging. The most frequent variation in patterns of neural activity are a shift from posterior to anterior areas and a reduced asymmetry between hemispheres. These patterns are typically observed during task execution and by using functional magnetic resonance imaging data. In the present study we investigated whether analogous effects can also be detected during rest and by means of source-space time series reconstructed from electroencephalographic recordings. By analyzing oscillatory power distribution across the brain we indeed found a shift from posterior to anterior areas in older adults. We additionally examined this shift by evaluating connectivity and its changes with age. The findings indicated that inter-area connections among frontal, parietal and temporal areas were strengthened in older individuals. A more complex pattern was shown in intra-area connections, where age-related activity was enhanced in parietal and temporal areas, and reduced in frontal areas. Finally, the resulting network exhibits a loss of modularity with age. Overall, the results extend to resting-state condition the evidence of an age-related shift of brain activity from posterior to anterior areas, thus suggesting that this shift is a general feature of the aging brain rather than being task-specific. In addition, the connectivity results provide new information on the reorganization of resting-state brain activity in aging.

Inter- and Intra-Hemispheric Age-Related Remodeling in Visuo-Spatial Working Memory

Electroencephalography (EEG) studies investigating visuo-spatial working memory (vWM) in aging typically adopt an event-related potential (ERP) analysis approach that has shed light on the age-related changes during item retention and retrieval. However, this approach does not fully enable a detailed description of the time course of the neural dynamics related to aging. The most frequent age-related changes in brain activity have been described by two influential models of neurocognitive aging, the Hemispheric Asymmetry Reduction in Older Adults (HAROLD) and the Posterior-Anterior Shift in Aging (PASA). These models posit that older adults tend to recruit additional brain areas (bilateral as predicted by HAROLD and anterior as predicted by PASA) when performing several cognitive tasks. We tested younger (N = 36) and older adults (N = 35) in a typical vWM task (delayed match-to-sample) where participants have to retain items and then compare them to a sample. Through a data-driven whole scalp EEG analysis we aimed at characterizing the temporal dynamics of the age-related activations predicted by the two models, both across and within different stages of stimulus processing. Behaviorally, younger outperformed older adults. The EEG analysis showed that older adults engaged supplementary bilateral posterior and frontal sites when processing different levels of memory load, in line with both HAROLD and PASA-like activations. Interestingly, these age-related supplementary activations dynamically developed over time. Indeed, they varied across different stages of stimulus processing, with HAROLD-like modulations being mainly present during item retention, and PASA-like activity during both retention and retrieval. Overall, the present results suggest that age-related neural changes are not a phenomenon indiscriminately present throughout all levels of cognitive processing.

What Can Neural Activity Tell Us About Cognitive Resources in Aging?

A reduction in cognitive resources has been originally proposed to account for age-related decrements in several cognitive domains. According to this view, aging limits the pool of available cognitive supplies: Compared to younger adults, elderly exhaust the resources more rapidly as task difficulty increases, hence a dramatic performance drop. Neurophysiological indexes (e.g., BOLD response and EEG activity) may be instrumental to quantify the amount of such cognitive resources in the brain and to pinpoint the stage of stimulus processing where the decrement in age-related resources is evident. However, as we discuss in this mini-review, the most recent studies on the neurophysiological markers of age-related changes lack a consistent coupling between neural and behavioral effects, which casts doubt on the advantage of measuring neural indexes to study resource deployment in aging. For instance, in the working memory (WM) domain, recent cross-sectional studies found varying patterns of concurrent age-related brain activity, ranging from equivalent to reduced and increased activations of old with respect to younger adults. In an attempt to reconcile these seemingly inconsistent findings of brain-behavior coupling, we focus on the contribution of confounding sources of variability and propose ways to control for them. Finally, we suggest an alternative perspective to explain age-related effects that implies a qualitative (instead of or along with a quantitative) difference in the deployment of cognitive resources in aging.

Baseline levels of alertness influence tES effects along different age-related directions

Normal aging is usually accompanied by several structural and functional physiological changes of the brain, which are closely related to alterations of cognitive functions (e.g., visual short-term memory). As the average age of the population increases, it has become crucial to identify cognitive-behavioural interventions to maintain a healthy level of cognitive performance. Among a variety of approaches, the targeting of specific intrinsic alertness mechanisms has shown a solid rationale and beneficial effects in both healthy and pathological ageing. In a similar vein, the use of non-invasive transcranial electrical stimulation (tES) represents another promising approach to induce an alerting state that can produce advantages in the information processing in the brain and therefore behaviour. Here, we investigated whether time-locked bursts of tES (i.e., transcranial random noise stimulation) were effective in inducing behavioural and physiological changes, consistently with an alertness increase, in both young and older healthy adults. Namely, we expected to find a beneficial alerting effect on visual short-term memory performance as a function of stimulus perceptual salience and tES. The initial results showed that the performance of younger adults was not affected by tES, while older adults scored lower correct responses for high-salience stimuli during real tES with respect to sham stimulation. However, after including a baseline measure of subjective level of alertness in the analyses, a tES-induced memory improvement did emerge in the less alerted younger adults, while only the more alerted older adults were subject to the worsening effect by tES. We discuss these results in consideration of the evidence on critical age-related differences as well as the interaction between neurostimulation and baseline alerting mechanisms.

Decoding location-specific and location-invariant stages of numerosity processing in subitizing

Extracting the number of objects in perceived scenes is a fundamental cognitive ability. Number processing is proposed to rely on two consecutive stages: an early object location map that captures individuated objects in a location‐specific way and a subsequent location‐invariant representation that captures numerosity at an abstract level. However, it is unclear whether this framework applies to small numerosities that can be individuated at once (“subitized”). Here, we reanalyzed data from two electroencephalography (EEG) experiments using multivariate pattern decoding to identify location‐specific and location‐invariant stages of numerosity processing in the subitizing range. In these experiments, one to three targets were presented in the left or right hemifield, which allowed for decoding target numerosity within each hemifield separately (location specific) or across hemifields (location invariant). Experiment 1 indicated the presence of a location‐specific stage (180–200 ms after stimulus), followed by a location‐invariant stage (300 ms after stimulus). A time‐by‐channel searchlight analysis revealed that the early location‐specific stage is most evident at occipital channels, whereas the late location‐invariant stage is most evident at parietal channels. Experiment 2 showed that both location‐specific and location‐invariant components are engaged only during tasks that explicitly require numerosity processing, ruling out automatic, and passive recording of numerosity. These results suggest that numerosity coding in subitizing is strongly grounded on an attention‐based, location‐specific stage. This stage overlaps with the subsequent activation of a location‐invariant stage, where a full representation of numerosity is finalized. Taken together, our findings provide clear evidence for a temporal and spatial segregation of location‐specific and location‐invariant numerosity coding of small object numerosities.

Relationship between mutual information and cross-correlation time scale of observability as measures of connectivity strength

The task of identifying and characterizing network structures out of experimentally observed time series is tackled by implementing different solutions, ranging from entropy-based techniques to the evaluation of the significance of observed correlation estimators. Among the metrics that belong to the first class, mutual information is of major importance due to the relative simplicity of implementation and its relying on the crucial concept of entropy. With regard to the second class, a method that allows us to assess the connectivity strength of a link in terms of a time scale of its observability via the significance estimate of measured cross correlation was recently shown to provide a reliable tool to study network structures. In this paper, we investigate the relationship between this last metric and mutual information by simultaneously assessing both metrics on large sets of data extracted from three experimental contexts, human brain magnetoencephalography, human brain electroencephalography, and surface wind measurements carried out on a small regional scale, as well as on simulated coupled, auto-regressive processes. We show that the relationship is well described by a power law and provide a theoretical explanation based on a simple noise and signal model. Besides further upholding the reliability of cross-correlation time scale of observability, the results show that the combined use of this metric and mutual information can be used as a valuable tool to identify and characterize connectivity links in a wide range of experimental contexts.

Does numerical similarity alter age-related distractibility in working memory?

Similarity between targets and distracters is a key factor in generating distractibility, and exerts a large detrimental effect on aging. The present EEG study tested the role of a new stimulus dimension in generating distractibility in visual Working Memory (vWM), namely numerical similarity. In a change detection paradigm a varying number of relevant and irrelevant stimuli were presented simultaneously in opposite hemifields. Behavioral results indicated that young participants outperformed older individuals; however, in both groups numerical similarity per se did not modulate performance. At the electrophysiological level, in young participants the Contralateral Delay Activity (CDA, a proxy for item maintenance in vWM) was modulated by the numerosity of the relevant items regardless of numerical similarity. In older participants, the CDA was modulated by target numerosity only in the same numerical condition, where the total number of (relevant and irrelevant) items increased with increasing target numerosities. No effect was present in the dissimilar numerical condition, where the total number of items did not vary substantially across target numerosity. This pattern was suggestive of an age-related effect of the total number of (relevant and irrelevant) items on vWM. The additional analyses on alpha-band lateralization measures support this interpretation by revealing that older adults lacked selective deployment of attentional and vWM resources towards the relevant hemifield. Overall, the results indicate that, while numerical similarity does not modulate distractibility, there is an age-related redistribution of vWM resources across the two visual fields, ultimately leading to a general decrease in task performance of older adults.

Assessing neural responses towards objectified human targets and objects to identify processes of sexual objectification that go beyond the metaphor

Objectification - reducing a someone to a something - represents a powerful and potentially damaging way in which we can see and treat others. Women are often victims of processes of objectification that occur whenever a woman is reduced to her body or certain body parts. What remains unclear is the extent to which a woman becomes an object when objectified. Using the oddball paradigm in three experiments, participants' neural activity was measured while they analyzed frequently presented male and female human stimuli and infrequently presented gender-matched doll-like objects. The infrequent doll-like objects were expected to trigger a late event-related neurophysiological response (P300) the more they were perceived different from the repeated, human stimuli (i.e., the oddball effect). In Experiment 1, the oddball effect was significantly smaller for objectified women compared to objectified men. Results of Experiment 2 confirmed that this effect was confined to objectified depictions of women. In Experiment 3, no semantic references to the human-object divide were provided, but objectified women were still perceived more similar to real objects. Taken together, these results are the first to demonstrate that the perception of women, when objectified, changes in essence beyond the metaphor.

Behavioral Dynamics of Rhythm and Meter Perception: The Effect of Musical Expertise in Deviance Detection

In two behavioral experiments, we explored effects of long-term musical training on the implicit processing of temporal structures (rhythm, non-rhythm and meter), manipulating deviance detection under different conditions. We used a task that did not require an explicit processing of the temporal aspect of stimuli, as this was irrelevant for the task. In Experiment 1, we investigated whether long-term musical training results in a superior processing of auditory rhythm, and thus boosts the detection of auditory deviants inserted within rhythmic compared to non-rhythmic auditory series. In Experiment 2, we focused on the influence of the metrical positions of a rhythmic series, and we compared musicians and non-musicians’ responses to deviant sounds inserted on strong versus weak metrical positions. We hypothesized that musicians would show enhanced rhythmic processing as compared to non-musicians. Furthermore, we hypothesized that musicians’ expectancy level would differ more across metrical positions compared to non-musicians. In both experiments, musicians were faster and more sensitive than non-musicians. Although both groups were overall faster and showed a higher sensitivity for the detection of deviants in rhythmic compared to non-rhythmic series (Experiment 1), only musicians were faster in the detection of deviants on strong positions compared to weak ones (Experiment 2). While rhythm modulates deviance processing also in non-musicians, specific effects of long-term musical training arise when a refined comparison of hierarchical metrical positions is considered. This suggests that long-term musical training enhances sensitivity to the metrical structure and improves temporal prediction mechanisms, even during implicit processing of meter.

Pseudoneglect is maintained in aging but not in mild Alzheimer's disease: new insights from an enumeration task

Neurologically healthy young adults display a behavioral bias, called pseudoneglect, which favors the processing of stimuli appearing in the left visual field. Pseudoneglect arises from the right hemisphere dominance for visuospatial attention. Previous studies investigating the effects of normal aging on pseudoneglect in line bisection and greyscale tasks have produced divergent results. In addition, scarce systematic investigations of visual biases in dementia have been reported. The aim of the present study was to evaluate whether the leftward bias appearing during an enumeration task in young adults would be preserved in normal aging and at different stages of severity of Alzheimer's disease. In Experiment 1, young and older healthy adults showed a comparable pseudoneglect, performing better when targets appeared in the left visual field. In Experiment 2, the leftward bias was maintained in amnesic mild cognitive impairment patients (aMCI), but it vanished in mild Alzheimer's disease patients (AD). The maintenance of pseudoneglect in normal aging and in aMCI patients is consistent with compensatory phenomena involving the right fronto-parietal network, which allow maintaining the right hemisphere dominance. Conversely, the lack of pseudoneglect in the sample of AD patients likely results from a loss of the right hemisphere dominance, caused by the selective degeneration of the right fronto-parietal network. These results highlight the need of further systematic investigations of visuospatial biases along the continuum of normal and pathological aging, both for a better understanding of the changes characterizing cognitive aging and for improvements in the evaluation of neglect in Alzheimer's disease.

Neural Dynamics of Multiple Object Processing in Mild Cognitive Impairment and Alzheimer's Disease: Future Early Diagnostic Biomarkers?

The aim of this study was to investigate the behavioral and electrophysiological dynamics of multiple object processing (MOP) in mild cognitive impairment (MCI) and Alzheimer's disease (AD), and to test whether its neural signatures may represent reliable diagnostic biomarkers. Behavioral performance and event-related potentials [N2pc and contralateral delay activity (CDA)] were measured in AD, MCI, and healthy controls during a MOP task, which consisted in enumerating a variable number of targets presented among distractors. AD patients showed an overall decline in accuracy for both small and large target quantities, whereas in MCI patients, only enumeration of large quantities was impaired. N2pc, a neural marker of attentive individuation, was spared in both AD and MCI patients. In contrast, CDA, which indexes visual short term memory abilities, was altered in both groups of patients, with a non-linear pattern of amplitude modulation along the continuum of the disease: a reduction in AD and an increase in MCI. These results indicate that AD pathology shows a progressive decline in MOP, which is associated to the decay of visual short-term memory mechanisms. Crucially, CDA may be considered as a useful neural signature both to distinguish between healthy and pathological aging and to characterize the different stages along the AD continuum, possibly becoming a reliable candidate for an early diagnostic biomarker of AD pathology.

Simultanagnosia and object individuation

Simultanagnosic patients have difficulty in perceiving multiple objects when presented simultaneously. In this review article, I discuss how neuropsychological research on simultanagnosia has been inspirational for two interconnected lines of research related to the core mechanisms by which the visual system processes cluttered scenes. First, I review previous studies on enumeration tasks indicating that, despite their inability to identify multiple objects, simultanagnosic patients can enumerate up to 2-3 elements as efficiently as healthy individuals (the so-called "subitizing" phenomenon). This intriguing observation is one of the first results to support the existence of an "object individuation" mechanism that can spatially tag a limited set of objects simultaneously, and resonates with recent research on the brain dynamics of enumeration in healthy individuals. Second, I further develop the implications of the dissociation between object identification and object enumeration in simultanagnosia specifically for the distinction between object identification and individuation. The latter distinction has been the subject of recent neuroimaging research that has provided fine-grained information on the spatial as well as temporal aspects of object individuation and recognition. The lessons learned from neuropsychological research on exact enumeration in simultanagnosia can be generalized to the normal functioning of the human mind, and have provided insightful clues for cognitive neuroscience.

The mismatch negativity as an index of cognitive decline for the early detection of Alzheimer's disease

Evidence suggests that Alzheimer's disease (AD) is part of a continuum, characterized by long preclinical phases before the onset of clinical symptoms. In several cases, this continuum starts with a syndrome, defined as mild cognitive impairment (MCI), in which daily activities are preserved despite the presence of cognitive decline. The possibility of having a reliable and sensitive neurophysiological marker that can be used for early detection of AD is extremely valuable because of the incidence of this type of dementia. In this study, we aimed to investigate the reliability of auditory mismatch negativity (aMMN) as a marker of cognitive decline from normal ageing progressing from MCI to AD. We compared aMMN elicited in the frontal and temporal locations by duration deviant sounds in short (400 ms) and long (4000 ms) inter-trial intervals (ITI) in three groups. We found that at a short ITI, MCI showed only the temporal component of aMMN and AD the frontal component compared to healthy elderly who presented both. At a longer ITI, aMMN was elicited only in normal ageing subjects at the temporal locations. Our study provides empirical evidence for the possibility to adopt aMMN as an index for assessing cognitive decline in pathological ageing.

Development of the Fetal Vermis: New Biometry Reference Data and Comparison of 3 Diagnostic Modalities-3D Ultrasound, 2D Ultrasound, and MR Imaging

BACKGROUND AND PURPOSE

Normal biometry of the fetal posterior fossa rules out most major anomalies of the cerebellum and vermis. Our aim was to provide new reference data of the fetal vermis in 4 biometric parameters by using 3 imaging modalities, 2D ultrasound, 3D ultrasound, and MR imaging, and to assess the relation among these modalities.

MATERIALS AND METHODS

A retrospective study was conducted between June 2011 and June 2013. Three different imaging modalities were used to measure vermis biometry: 2D ultrasound, 3D ultrasound, and MR imaging. The vermian parameters evaluated were the maximum superoinferior diameter, maximum anteroposterior diameter, the perimeter, and the surface area. Statistical analysis was performed to calculate centiles for gestational age and to assess the agreement among the 3 imaging modalities.

RESULTS

The number of fetuses in the study group was 193, 172, and 151 for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. The mean and median gestational ages were 29.1 weeks, 29.5 weeks (range, 21-35 weeks); 28.2 weeks, 29.05 weeks (range, 21-35 weeks); and 32.1 weeks, 32.6 weeks (range, 27-35 weeks) for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. In all 3 modalities, the biometric measurements of the vermis have shown a linear growth with gestational age. For all 4 biometric parameters, the lowest results were those measured by MR imaging, while the highest results were measured by 3D ultrasound. The inter- and intraobserver agreement was excellent for all measures and all imaging modalities. Limits of agreement were considered acceptable for clinical purposes for all parameters, with excellent or substantial agreement defined by the intraclass correlation coefficient.

CONCLUSIONS

Imaging technique-specific reference data should be used for the assessment of the fetal vermis in pregnancy.

Object individuation and compensation in healthy aging

Theories on neural compensation suggest that aged participants overactivate the brain areas involved in a task to compensate for the age-related decline. In this electrophysiological study, we investigated the temporal locus of neural overactivation in aging during multiple target processing. We measured performance and three event-related brain potential responses (N1, N2pc, and contralateral delay activity) in young and old adults, while they enumerated a variable number (1-4) of targets presented in an easy (distractor absent) or difficult (distractor present) condition. The main results indicated that although N2pc (∼200 ms) increased in amplitude in the distractor-present condition in the young group, no modulation occurred for the old group. Old participants were associated with larger N2pc amplitudes than young participants in the distractor-absent condition, where both groups had comparable levels of accuracy. These effects were not present for N1 and contralateral delay activity. Overall, the data suggest that in enumeration, aging is associated with compensatory effects that rely on the selection mechanism responsible for target individuation.

Electrophysiological Advances on Multiple Object Processing in Aging

EEG research conducted in the past 5 years on multiple object processing has begun to define how the aging brain tracks the numerosity of the objects presented in the visual field for different goals. We review the recent EEG findings in healthy older individuals (age range: 65-75 years approximately) on perceptual, attentional and memory mechanisms-reflected in the N1, N2pc and contralateral delayed activity (CDA) components of the EEG, respectively-during the execution of a variety of cognitive tasks requiring simultaneous processing of multiple elements. The findings point to multiple loci of neural changes in multi-object analysis, and suggest the involvement of early perceptual mechanisms, attentive individuation and working memory (WM) operations in the neural and cognitive modification due to aging. However, the findings do not simply reflect early impairments with a cascade effect over subsequent stages of stimulus processing, but in fact highlight interesting dissociations between the effects occurring at the various stages of stimulus processing. Finally, the results on older adults indicate the occurrence of neural overactivation in association to good levels of performance in easy perceptual contexts, thus providing some hints on the existence of compensatory phenomena that are associated with the functioning of early perceptual mechanisms.

Individual differences in perceptual abilities predict target visibility during masking

Many studies have shown that the visual system can implicitly process a single stimulus under conditions of low visibility. However, it remains unknown whether this ability extends when viewing conditions become more difficult, and whether differences in early perceptual abilities modulate masking sensitivity. To address these issues, participants enumerated a variable number of target elements among distracters in two electroencephalography experiments. Either one (Experiment 1) or all targets (Experiment 2) were masked through object-substitution. Results showed that an event-related potential measure of selective individuation, the N2pc component, was modulated by target numerosity in both masked and unmasked trials, suggesting that multiple object individuation can operate in conditions of limited visibility. However, this effect was present mainly for participants with low masking effects, who overall showed more pronounced N2pc modulations as a function of target numerosity. Finally, oscillatory activity analyses revealed that early segmentation mechanisms, as reflected by lateralized gamma synchronization, were more active in participants with low sensitivity to masking, suggesting that individual variation in early perceptual functions is associated with susceptibility to masking such that more efficient segmentation and individuation mechanisms reduce the effects of masking. These findings cast doubt on the claim that effectively masked stimuli can be individuated.

Multiple object individuation and subitizing in enumeration: a view from electrophysiology

What are the processes involved in determining that there are exactly n objects in the visual field? The core level of representation for this process is based on a mechanism that iteratively individuates each of the set of relevant objects for exact enumeration. In support of this proposal, we review recent electrophysiological findings on enumeration-at-a-glance and consider three temporally distinct responses of the EEG signal that are modulated by object numerosity, and which have been associated respectively with perceptual modulation, attention selection, and working memory. We argue that the neural response associated with attention selection shows the hallmarks of an object individuation mechanism, including the property of simultaneous individuation of a limited number of objects thought to underlie the behavioral subitizing effect. The findings support the view that the core component of exact enumeration is an attention-based individuation mechanism that binds specific features to locations and provides a stable representation of a limited set of relevant objects. The resulting representation is made available for further cognitive operations for exact enumeration.

Multiple Object Individuation and Exact Enumeration

Exact computation of numerosity requires the selective individuation of the elements to be enumerated so that each element is counted once and only once. Such a mechanism should operate not only when the elements to be enumerated are presented in isolation but also when they are presented in cluttered scenes. To uncover the electrophysiological correlates of the level of object representation necessary for exact enumeration, we examined ERP measures during the execution of a target enumeration task. A variable number (1–4) of lateralized targets were presented with or without distracters on the target side. An early nonlateralized response (N1, 120–180 msec) was modulated by target numerosity only when presented without distracters. By contrast, the amplitudes of a lateralized and later response (N2pc, 180–300 msec) increased as a function of target numerosity both with and without distracters, reaching a plateau at three targets. We propose that the stage of processing reflected in the N2pc corresponds to the component of individuation that binds specific indexes to properties and locations and that this provides the representation type necessary for exact enumeration.

Dual antiplatelet therapy for primary and secondary prevention

The concomitant use of aspirin and an ADP receptor (P2Y12) blocker, also known as dual antiplatelet therapy (DAPT), has been extensively investigated as a primary and secondary prevention strategy in an effort to reduce the risk of cardiovascular events. In this manuscript the authors review the current guideline recommendations for DAPT and discuss the scientific data that supports these recommendations. Reported are also the scientific knowledge gaps and how future studies are likely to delineate these issues. Incremental knowledge is not likely to be an alternative to individualized care provided by the astute clinician to his patient. In consideration for prescribing DAPT (drug, dosage and duration) the clinician will have to weigh the potential benefits (reduction in death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke) and risks (severe or life-threatening bleeding) for each and every patient.

Perceptual grouping and visual enumeration

We used lateralized Event-Related Potential (ERP) measures - the N2pc and CDA/SPCN components - to assess the role of grouping by target similarity during enumeration. Participants saw a variable number (0, 1, 2 or 3) of same- or differently-colored targets presented among homogeneous distracters, and performed an enumeration task. Results showed that the N2pc, but not the CDA, was larger for multiple targets of identical color relative to targets of different colors. The findings are interpreted in terms of the effects of grouping on early versus late stages of multiple object processing. Within this framework, they reveal that grouping has an effect on early individuation mechanisms, while later processing mechanisms are less prone to such an influence.

Fractional flow reserve (FFR): changing the practice of interventional cardiology

Fractional flow reserve (FFR) has become an extremely valuable tool for assessing the hemodynamic significance of intermediate coronary lesions. This manuscript delineates the current guidelines regarding the use of FFR and discusses emerging indications for the use of this diagnostic tool and how they compare with and complement non-invasive or other invasive diagnostic modalities. The manuscript addresses some of the key unanswered questions related to FFR, the potential pitfalls of this tool and discusses future directions of use and research.

Emerging oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation

In patients with atrial fibrillation (AF) warfarin has been the mainstay therapy for stroke prevention. In recent randomized clinical trials (RCTs) oral direct thrombin inhibitor (Dabigatran) and factor Xa inhibitors (Rivaroxaban and Apixaban) challenged the efficacy and safety benchmarks set by warfarin. These drugs boast a rapid onset of action, shorter half-life and fewer drug and dietary interactions. Moreover, these new anticoagulants do not require monitoring, titration or dose adjustments. These agents have already been approved for prevention of stroke or systemic embolism in patients with AF. Uncertainty regarding suitability, efficacy and safety in certain patient subsets and issues related to the ability effectively monitor the pharmacodynamic effects and reverse the therapeutic effects of these drugs should be addressed as we engage in a widespread use of these agents in various patient subsets.

The transvaginal probe as a uterine manipulator: a new technique to simplify transabdominal chorionic villus sampling in cases with difficult access to the trophoblast

OBJECTIVES

To evaluate the efficacy of using the transvaginal probe to manipulate the uterus and change the position of the trophoblast, and to simplify access to the chorionic villus under difficult conditions.

METHODS

One thousand five hundred and thirty-nine procedures were performed in our centre in 1524 pregnant women from September 2006 to September 2009. In 90 of these, a difficult access to the trophoblast was observed and uterine manipulation under continuous ultrasound guidance with a double needle technique, was applied to obtain the sample. Of these, 86 samples were taken from singleton pregnancies and 4 from two bichorionic twin pregnancies

RESULTS

One thousand five hundred and thirty-nine transabdominal chorionic villus sampling (TA-CVS) procedures were conducted on 1524 pregnant women. As many as 1449 were performed without manipulation with the transvaginal probe and in 90 cases the manipulation was carried out. In 89 cases, access to the trophoblast was difficult and the uterus was manipulated, which enabled an adequate TA-CVS to be performed with a single aspiration. In one case, TA-CVS was not performed due to significant pelvic pain in a patient with a fixed, retroflexed uterus and a previous history of endometriosis.

CONCLUSIONS

Uterine manipulation with the transvaginal probe may be a useful solution in cases where TA-CVS is limited by difficult access to the trophoblast.

Temporal brain dynamics of multiple object processing: the flexibility of individuation

The ability to process concurrently multiple visual objects is fundamental for a coherent perception of the world. A core component of this ability is the simultaneous individuation of multiple objects. Many studies have addressed the mechanism of object individuation but it remains unknown whether the visual system mandatorily individuates all relevant elements in the visual field, or whether object indexing depends on task demands. We used a neural measure of visual selection, the N2pc component, to evaluate the flexibility of multiple object individuation. In three ERP experiments, participants saw a variable number of target elements among homogenous distracters and performed either an enumeration task (Experiment 1) or a detection task, reporting whether at least one (Experiment 2) or a specified number of target elements (Experiment 3) was present. While in the enumeration task the N2pc response increased as a function of the number of targets, no such modulation was found in Experiment 2, indicating that individuation of multiple targets is not mandatory. However, a modulation of the N2pc similar to the enumeration task was visible in Experiment 3, further highlighting that object individuation is a flexible mechanism that binds indexes to object properties and locations as needed for further object processing.

Cooperative and opposing effects of strategic and involuntary attention

To assess whether working memory contents can effectively bias visual selection even when they do not represent the current target in the attention task, we recorded the ERP activity from participants performing both a memory task and, in the retention period, a visual search task. In this task, a distracter matching the memory content could be presented on the same side (congruent trials) or on the opposite side (incongruent trials) relative to the target location (Experiment 1 and Experiment 2). On some trials, only the matching distracter (but no target) was presented (catch trials, Experiment 2). Results showed that the N2pc component was modulated by the presence and location of a matching distracter. We interpret these results as evidence that the involuntary control exerted by the irrelevant memory contents coexists with the strategic mechanism related to the search target, influencing attention selection with roughly equal power. In Experiment 3, we found that the modulation of the N2pc is not strictly related to the active maintenance of the memory-target features but can also be elicited by repetition priming. Overall, these findings suggest that, together with the physical properties of the stimuli presented in the visual field, irrelevant memory contents represent a powerful class of factors that lead to involuntary attentional control.

Intrapartum translabial three-dimensional ultrasound visualization of levator trauma

OBJECTIVES

The aim of this study was to visualize levator trauma by three-dimensional (3D) ultrasound performed during labor and soon after the crowning of the fetal head and to determine how often levator trauma occurs.

METHODS

This was a prospective, observational study of 66 women enrolled during the first stage of labor. The women underwent intrapartum 3D transperineal ultrasound examination during the first and second stages of labor and within 12 h after delivery. Volume datasets were acquired and analyzed to determine the presence of levator trauma.

RESULTS

Data from 10 of the 66 women were excluded from analysis-nine because they underwent Cesarean section in the first or second stage of labor and one because she underwent hysterectomy and no postpartum volumes were collected. Thus our study group comprised 56 women-35 nulliparous and 21 parous. A total of 504 volumes were collected in the 56 women (three volumes for each stage of labor). One hundred and twenty levator volumes were excluded from analysis, but volumes of acceptable quality were available for all three stages of labor in all women. Eleven (31.4%) of the 35 nulliparae had levator lesions detected postpartum and none of them had levator lesions before delivery. Five (23.8%) of the 21 parous women had a levator tear detected in their postpartum volumes. In two of these five women the levator tear was also present in both volumes taken during labor.

CONCLUSIONS

Visualization of the levator ani during labor by 3D ultrasound examination is feasible. Comparison of volumes obtained during labor and within the first 2 h after delivery supports the theory that crowning of the head is the immediate cause of avulsion of the levator ani muscle.

Sonographic assessment of fetal spine and head position during the first and second stages of labor for the diagnosis of persistent occiput posterior position: a pilot study

OBJECTIVES

The aim of this pilot study was to perform a preliminary investigation into the predictive values of the position of the fetal spine and of the occiput measured during the first and second stages of labor by intrapartum ultrasound for persistent occiput posterior (OP) position.

METHODS

This was a prospective, cohort study, in which 100 women with singleton pregnancies were enrolled during the first or second stage of labor. The women underwent intrapartum transabdominal sonography and the positions of the fetal head and spine were recorded. The women were followed up until delivery and occiput position at birth was assessed.

RESULTS

Eighty-four pregnancies were evaluated in the second stage of labor, with 74 of these also evaluated in the first stage. Fifty-one percent of fetuses were found to be in an OP position during the first stage of labor, but the majority of these rotated to an anterior position before delivery. There were six cases of OP at delivery, and all of these were among the 23 fetuses that were found to be in an OP position on ultrasound evaluation during the second stage of labor. All six were also found to have a posterior spine position during the second stage of labor, with this finding observed in only one fetus with occiput anterior position at delivery.

CONCLUSIONS

The results of this study suggest that the position of the head and spine during the second stage of labor could be useful indicators for predicting the OP position at delivery. The results also suggest that the OP position at delivery results from a failure of rotation from the OP position, rather than a malrotation from the anterior position. Studies with larger sample sizes are needed to confirm these results.

Change detection evokes a Simon-like effect

A change detection paradigm was used to estimate the role of explicit change detection in the generation of the irrelevant spatial stimulus coding underlying the Simon effect. In one condition, no blank was interposed between two successive displays, which produced efficient change detection. In another condition, the presence of a blank frame produced a robust change blindness effect, which is crucially assumed to occur as the consequence of impaired attentional orienting to the change location. The results showed a strong Simon-like effect under conditions of efficient change detection. By contrast, no Simon-like effect was observed under conditions of change blindness, namely when attention shifting towards the change location was hampered. Experiment 2 supported this pattern by showing that a Simon-like effect could be observed when the blank was present, but only when participants detected the change by means of a cue that was informative as to change location. Overall, our findings show that a Simon-like effect can only be observed under conditions of explicit change detection, likely because a shift of attention towards the change location has occurred.