Getting in touch: segregated somatosensory what and where pathways in humans revealed by electrical neuroimaging.

Whether the somatosensory system, like its visual and auditory counterparts, is comprised of parallel functional pathways for processing identity and spatial attributes (so-called what and where pathways, respectively) has hitherto been studied in humans using neuropsychological and hemodynamic methods. Here, electrical neuroimaging of somatosensory evoked potentials (SEPs) identified the spatio-temporal mechanisms subserving vibrotactile processing during two types of blocks of trials. What blocks varied stimuli in their frequency (22.5 Hz vs. 110 Hz) independently of their location (left vs. right hand). Where blocks varied the same stimuli in their location independently of their frequency. In this way, there was a 2x2 within-subjects factorial design, counterbalancing the hand stimulated (left/right) and trial type (what/where). Responses to physically identical somatosensory stimuli differed within 200 ms post-stimulus onset, which is within the same timeframe we previously identified for audition (De Santis, L., Clarke, S., Murray, M.M., 2007. Automatic and intrinsic auditory "what" and "where" processing in humans revealed by electrical neuroimaging. Cereb Cortex 17, 9-17.). Initially (100-147 ms), responses to each hand were stronger to the what than where condition in a statistically indistinguishable network within the hemisphere contralateral to the stimulated hand, arguing against hemispheric specialization as the principal basis for somatosensory what and where pathways. Later (149-189 ms) responses differed topographically, indicative of the engagement of distinct configurations of brain networks. A common topography described responses to the where condition irrespective of the hand stimulated. By contrast, different topographies accounted for the what condition and also as a function of the hand stimulated. Parallel, functionally specialized pathways are observed across sensory systems and may be indicative of a computationally advantageous organization for processing spatial and identity information.

Current standards and progress in understanding and treatment of GIST.

Gastrointestinal stromal tumours (GIST), despite being rare, pose a relevant medical problem from the viewpoint of diagnosis and management. GIST are fragile, liable to metastasize and often located in delicate structures. Surgical options, therefore, are limited. In the last decade an improved understanding of the molecular mechanisms of the disease has resulted in novel modes of treatment. The introduction of systemic tyrosine kinase inhibitor therapy with imatinib has significantly improved the outcome of the disease and prolonged the survival of GIST patients. For many patients the acute threat of a deadly cancer has been transformed into a manageable chronic condition. Drug safety, tolerability and compliance, subjects of concern in all long-term therapies, have proven to be acceptable for the tyrosine kinase inhibitor imatinib. The present paper provides a compact overview of the epidemiology, pathophysiology and morphology of GIST, with special reference to the underlying molecular biology. Relevant aspects of diagnosis, therapy and monitoring of the disease are reviewed with particular emphasis on the available clinical evidence and recent guidelines.