Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation

Understanding of action-related and abstract verbs in comparison: a behavioral and TMS study

Does the comprehension of both action-related and abstract verbs rely on motor simulation? In a behavioral experiment, in which a semantic task was used, response times to hand-action-related verbs were briefer than those to abstract verbs and both decreased with repetition of presentation. In a transcranial magnetic stimulation (TMS) experiment, single-pulse stimulation was randomly delivered over hand motor area of the left primary motor cortex to measure cortical-spinal excitability at 300 or 500 ms after verb presentation. Two blocks of trials were run. In each block, the same verbs were randomly presented. In the first block, stimulation induced an increase in motor evoked potentials only when TMS was applied 300 ms after action-related verb presentation. In the second block, no modulation of motor cortex was found according to type of verb and stimulation-delay. These results confirm that motor simulation can be used to understand action rather than abstract verbs. Moreover, they suggest that with repetition, the semantic processing for action verbs does not require activation of primary motor cortex anymore