Progress in brain research
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Pain management in severely brain-damaged patients constitutes a clinical and ethical stake. At the bedside, assessing the presence of pain and suffering is challenging due to both patients' physical condition and inherent limitations of clinical assessment. Neuroimaging studies support the existence of distinct cerebral responses to noxious stimulation in brain death, vegetative state, and minimally conscious state. ⋯ Women and religious caregivers reported more often that minimally conscious patients may experience pain. These results are discussed in terms of existing definitions of pain and suffering, the remaining uncertainty on the clinical assessment of pain as a subjective first-person experience and recent functional neuroimaging findings on nociceptive processing in disorders of consciousness. In our view, more research is needed to increase our understanding of residual sensation in vegetative and minimally conscious patients and to propose evidence-based medical guidelines for the management of possible pain perception and suffering in these vulnerable patient populations.
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When an observer is searching through the environment for a target, what are the consequences of not finding a target in a given environment? We examine this issue in detail and propose that the visual system systematically tags environmental information during a search, in an effort to improve performance in future search events. Information that led to search successes is positively tagged, so as to favor future deployments of attention toward that type of information, whereas information that led to search failures is negatively tagged, so as to discourage future deployments of attention toward such failed information. To study this, we use an oddball-search task, where participants search for one item that differs from all others along one feature or belongs to a different visual category, from the other stimuli in the display. ⋯ Second, we show that the effect is independent of the mode of presentation of stimuli: it happens with both serial and simultaneous stimuli presentation. Third, we show that, when using categorically defined oddballs as the search stimuli (find the face among houses or vice versa), the bias generalizes to unseen members of the "failed" category. Together, these findings support the idea that this inter-trial attentional biases arise from high-level, task-constrained, implicit assessments of performance, involving categorical associations between classes of stimuli and behavioral outcomes (success/failure), which are independent of attentional modality (temporal vs. spatial attention).
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Perceptual decision making is the process by which information gathered from sensory systems is combined and used to influence our behavior. Importantly, however, the route from perception to action is not a one-way street, rather, perception and action interact continuously. ⋯ We conclude that there is evidence for the liaison of action and perception in simple decision-making tasks. This framework may also be extended to reward-based decision making in humans.
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This chapter describes current findings from the research into postoperative cognitive dysfunction (POCD) following cardiac and non-cardiac surgery in older adults. The evidence suggests that a significant proportion of patients show POCD in the early weeks following surgery and anesthesia. Specific domains of cognition are affected, especially memory. ⋯ Increasing age is among the most consistently reported patient-related risk factor. Other factors more directly related to the surgery and anesthesia are likely to contribute to the pathogenesis of POCD, including inflammatory processes triggered by the surgical procedure. Animal studies have provided valuable findings otherwise not possible in human studies; these include a correlation between the inflammatory response in the hippocampus and the development of POCD in rodents.
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Impaired urinary dilution leading to water retention and hyponatremia may occur in patients with cardiac failure, cirrhosis, pregnancy, hypothyroidism, glucocorticoid and mineralocorticoid deficiency. The mechanisms for these defects predominantly involve the non-osmotic stimulation of arginine vasopressin release with upregulation of aquaporin 2 water channel expression and trafficking to the apical membrane of the principal cells of the collecting duct. ⋯ They may involve several factors, such as impaired counter-current concentration secondary to downregulation of Na-K-2Cl co-transporter. Vasopressin-resistant downregulation of aquaporin 2 expression has also been described as a factor in impaired urinary concentration.