Barbara F. M. Marino

Are Colonoscopy and Bowel Ultrasound Useful for Assessing Response to Short-Term Therapy and Predicting Disease Outcome of Moderate-to-Severe Forms of Ulcerative Colitis?: A Prospective Study

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

How the motor system handles nouns: a behavioral study

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

Distorting the visual size of the hand affects hand pre-shaping during grasping

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

A combination of faecal tests for the detection of colon cancer: a new strategy for an appropriate selection of referrals to colonoscopy? A prospective multicentre Italian study

Introduction Colonoscopy workload for endoscopy services in Western countries is increasing markedly because of the implementation of faecal occult blood-based mass screening programmes against colorectal cancer (CRC). We therefore explored the possibility of using a combination of faecal tests to prioritize the access to colonoscopy with criteria other than symptoms and/or time of referral. Aims and methods We tested a combination of faecal tests [immunochemical faecal occult blood test (i-FOBT), M2-PK, calprotectin] as markers for advanced neoplasia in a selected series of patients requiring colonoscopy for the suspicion of CRC. All the tests were performed in a 1-day stool sample of patients aged 50–80 years, without any dietary restriction, before colonoscopy. Results A total of 280 patients’ stool single samples were analysed. Forty-seven patients had CRC and 85 patients had one or more advanced adenoma(s) at colonoscopy/histology. CRCs were associated with a highly significant increase (P<0.001) in faecal tumour M2-PK (mean 24.2 kU/l), which correlated with Dukes’ staging. For CRC detection, i-FOBT was the test with the highest specificity and positive predictive value (0.89 and 0.53), whereas M2-PK had the highest sensitivity and negative predictive value (0.87 and 0.96). Calprotectin showed performance similar to M2-PK in terms of sensitivity and negative predictive value (0.93), but had lower specificity (0.39). The best combination of tests to predict the risk of CRC in this series was i-FOBT+M2-PK, as in patients showing positivity to both markers, the risk of cancer was as high as 79%. Conclusion The combination of i-FOBT and M2-PK is a sensitive tool in clinical practice for the appropriate management of waiting lists for colonoscopy, as it allows the classification of patients into different degrees of priority for investigation, according to their foreseeable risk of CRC.

Language sensorimotor specificity modulates the motor system

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

Impact of a Population-Based Colorectal Cancer Screening Program on Local Health Services Demand in Italy: A 7-Year Survey in a Northern Province

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

Viewing photos and reading nouns of natural graspable objects similarly modulate motor responses

It is well known that the observation of graspable objects recruits the same motor representations involved in their actual manipulation. Recent evidence suggests that the presentation of nouns referring to graspable objects may exert similar effects. So far, however, it is not clear to what extent the modulation of the motor system during object observation overlaps with that related to noun processing. To address this issue, 2 behavioral experiments were carried out using a go-no go paradigm. Healthy participants were presented with photos and nouns of graspable and non-graspable natural objects. Also scrambled images and pseudowords obtained from the original stimuli were used. At a go-signal onset (150 ms after stimulus presentation) participants had to press a key when the stimulus referred to a real object, using their right (Experiment 1) or left (Experiment 2) hand, and refrain from responding when a scrambled image or a pseudoword was presented. Slower responses were found for both photos and nouns of graspable objects as compared to non-graspable objects, independent of the responding hand. These findings suggest that processing seen graspable objects and written nouns referring to graspable objects similarly modulates the motor system.

Face age modulates gaze following in young adults

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

Grasping in wonderland: altering the visual size of the body recalibrates the body schema

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

Spatial stimulus-response compatibility and affordance effects are not ruled by the same mechanisms

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