Comparing the cognitive performance of action video game players and age-matched controls following a cognitively fatiguing task: A stage 2 registered report

Recent work demonstrates that those who regularly play action video games (AVGs) consistently outperform non-gamer (NG) controls on tests of various cognitive abilities. AVGs place high demands on several cognitive functions and are often engaged with for long periods of time (e.g., over 2 h), predisposing players to experiencing cognitive fatigue. The detrimental effects of cognitive fatigue have been widely studied in various contexts where accurate performance is crucial, including aviation, military, and sport. Even though AVG players may be prone to experiencing cognitive fatigue, this topic has received little research attention to date. In this study, we compared the effect of a cognitively fatiguing task on the subsequent cognitive performance of action video game players and NG control participants. Our results indicated AVGs showed superior spatial working memory and complex attention abilities while showing no difference from NGs on simple attention performance. Additionally, we found that our cognitive fatigue and control interventions did not differentially affect the cognitive performance of AVGs and NGs in this study. This pre-registered study provides evidence that AVGs show superior cognitive abilities in comparison to a non-gaming population, but do not appear more resilient to cognitive fatigue.

658 Managing the Acute Surgical Patient – How has COVID-19 Changed Our Approach?

Aim

COVID-19 has changed how surgical admissions are triaged and treated. This retrospective cohort study aims to detail the effects of a national lockdown on emergency general surgical referrals at a tertiary centre.

Method

A retrospective search identified all emergency general surgery referrals prior to and during the UK national lockdown. Pre (10-23 Feb 2020;PLG) and intra-lockdown (30 Mar-12 Apr 2020;ILG) groups were compared using descriptive statistics and significance was quantified with Chi-squared.

Results

600 patients were included of which 426 (71%) presented in the PLG. The PLG had proportionally fewer ED referrals (40.8%vs.51.1%, p = 0.02) and less cross-sectional imaging performed (31.5%vs.40.8%, p = 0.03). There was a significant reduction in non-specific abdominal pain (NSAP) during lockdown (25.12%vs.14.94%, p = 0.007). GP referrals (48.8%vs.46.6%, p = 0.61), admission (46.2%vs.44.8%, p = 0.09) and operative intervention (21.4% vs.17.24%, p = 0.25) showed no disparity.

Conclusions

Predictably, the advent of lockdown resulted in a reduction in hospital attendance and surgical referrals. Our data showed a similar proportion of referred patients admitted pre- and intra-lockdown despite a reduction in absolute terms. This may be due to a trend towards later presentation coupled with a focus on conservative management and prevention of admission. The decrease in NSAP raises questions that require further exploration. Cross-sectional imaging was used more freely as an adjunct in the ILG suggesting increasing acuity and delayed presentation or may result from a tendency towards image-guided discharge. Admissions have since trended towards pre-lockdown levels, but it is yet to be seen if a reduction in elective operating will lead to an increase in emergency admissions.

389 Impact of Surgical Drain Output Monitoring on Patient Outcomes in Gastrointestinal Surgery: A Systematic Review

Aim

Surgical drains are widely utilised in Gastrointestinal Surgery to prevent intra-abdominal collections and identify post-operative complications. Surgical drain monitoring ranges from simple output measurements through to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect post-operative complications and impact on patient outcomes.

Method

A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing gastrointestinal surgery were considered. Other invasive methods of intra-abdominal sampling were excluded.

Results

The search returned 396 articles. Following abstract review, 383 were excluded and 13 articles were included for full review. The studies were classified according to speciality: Oesophagogastric (1), Pancreatic (6), Hepatobiliary (2), Colorectal (3) and Emergency General Surgery (1). Post-operative monitoring of amylase and bilirubin decreased the incidence of post-operative complications (pancreatic fistulas, intra-abdominal infections, surgical site infections), length of stay and mortality rate in Pancreatic and Hepatobiliary Surgery. Testing of drain contents following Colorectal Surgery can aid anastomotic leak and the detection of peritonitis, however this did not confer any improvement in patient outcome. Surgical drain monitoring did not improve patient outcomes in Oesophagogastric Surgery.

Conclusions

Surgical drain monitoring has established advantages in the post-operative care for patients undergoing Gastrointestinal Surgery. Enhanced surgical drain monitoring involving the testing of drain amylase, bilirubin, lactate, and cytokines may improve detection of complications in the immediate post-operative period.

The effect of sleep restriction on cognitive performance in elite cognitive performers: a systematic review

STUDY OBJECTIVES

To synthesize original articles exploring the effects of sleep restriction on cognitive performance specifically for Elite Cognitive Performers, i.e. those who engage in cognitively demanding tasks with critical or safety-critical outcomes in their occupation or area of expertise.

METHODS

Backward snowballing techniques, gray literature searches, and traditional database searches (Embase, MEDLINE, Web of Science, Google Scholar, PSYCinfo, and SportDiscus) were used to obtain relevant articles. A quality assessment was performed, and the risk of training effects was considered. Results were narratively synthesized. Fourteen articles fit the criteria. Cognitive outcomes were divided into three categories defined by whether cognitive demands were "low-salience," "high-salience stable," or "high-salience flexible."

RESULTS

Low-salience tests (i.e. psychomotor vigilance tasks & serial reaction tests), mainly requiring vigilance and rudimentary attentional capacities, were sensitive to sleep restriction, however, this did not necessarily translate to significant performance deficits on low-salience occupation-specific task performance. High-salience cognitive outcomes were typically unaffected unless when cognitive flexibility was required.

CONCLUSIONS

Sleep restriction is of particular concern to occupations whereby individuals perform (1) simple, low-salience tasks or (2) high-salience tasks with demands on the flexible allocation of attention and working memory, with critical or safety-critical outcomes.

Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games

Globally, depression and anxiety are the two most prevalent mental health disorders. They occur both acutely and chronically, with various symptoms commonly expressed subclinically. The treatment gap and stigma associated with such mental health disorders are common issues encountered worldwide. Given the economic and health care service burden of mental illnesses, there is a heightened demand for accessible and cost-effective methods that prevent occurrence of mental health illnesses and facilitate coping with mental health illnesses. This demand has been exacerbated post the advent of the COVID-19 pandemic and the subsequent increase in incidence of mental health disorders. To address these demands, a growing body of research is exploring alternative solutions to traditional mental health treatment methods. Commercial video games have been shown to impart cognitive benefits to those playing regularly (ie, attention control, cognitive flexibility, and information processing). In this paper, we specifically focus on the mental health benefits associated with playing commercial video games to address symptoms of depression and anxiety. In light of the current research, we conclude that commercial video games show great promise as inexpensive, readily accessible, internationally available, effective, and stigma-free resources for the mitigation of some mental health issues in the absence of, or in addition to, traditional therapeutic treatments.

The Color-Word Stroop Task Does Not Differentiate Cognitive Inhibition Ability Among Esports Gamers of Varying Expertise

This study set out for the first time to identify whether gamers of low, intermediate, and elite skill level in a prominent esports game, Counter-Strike: Global Offensive, demonstrated increasingly superior performance on a test of a specific cognitive skill (cognitive inhibition). Here we tested low, intermediate, and high ranked gamers and compared their performance on a color-word Stroop Task and also compared the performance of players in each gaming rank group to non-gamers. Contrary to our hypothesis, the Stroop Task did not differentiate significantly gamers of varying expertise. Although, we found that when considering both accuracy and response times, elite gamers performed significantly better than both intermediate and low ranked gamers on the simple choice reaction time condition and both elite and novice gamers performed significantly better than intermediate ranked gamers on the incongruent condition (a measure of cognitive inhibitory ability).

eSports: A new window on neurocognitive expertise?

Understanding the neurological changes that take place as expertise develops is a central topic in both cognitive psychology and cognitive neuroscience. Here, we argue that video games, despite previous misconceptions, are an excellent model environment from which one can examine the development of neurocognitive expertise. Of particular relevance we argue is the area of esports, which encompass video/computer games played within the medium of cyberspace competitively and increasingly professionally. The massive scale of participation, controlled environments, structured skill ratings, pervasive social nature, and large repositories of data, together make esports potentially a very fruitful area for scientific research to increase our understanding of a new era of cognitive athletes. This chapter reviews the progress and prospects for esports research with a particular focus on the effects of gaming on neurocognition. We also outline some exciting new avenues and techniques from which we hope to further elucidate the benefits of esports on the brain.

Efficacy and Safety of Fludarabine and Cyclophosphamide Combined Therapy in Patients with Refractory/Recurrent B-Cell Chronic Lymphocytic Leukaemia (B-CLL)—Polish Multicentre Study

The aim of this study was to investigate the efficacy of a combination of fludarabine (F) and cyclophosphamide (C) in the treatment of patients with refractory/recurrent B-cell chronic lymphocytic leukaemia (B-CLL). Between November 1999 and December 2001, 63 patients with B-CLL (median age 60 years) received a regimen that consisted of F 25 mg/m2 and C 250 mg/m2, days 1-3, intravenously, every 4 weeks, for a maximum of 6 courses, Response and toxicity were assessed according to current criteria (NCI-WG and WHO). Complete and partial remissions were achieved in 17.5% and 55.6% of patients, respectively; 19% of patients had stable disease and 7.9% of patients showed disease progression. The median follow-up was 16.5 (range 1.5-32) months. The median duration of progression-free survival (PFS) has not been reached among patients treated with FC regimen as second-line therapy. The median PFS was 13 (range 8-26) months in the 19 responding patients treated with FC regimen as third-line therapy. The most frequent side-effects were neutropenia (45%), thrombocytopenia (42%) and infections (57%). We conclude that the combination of fludarabine and cyclophosphamide demonstrated significant efficacy in pretreated, advanced B-CLL patients, with tolerable toxicity.

Thalidomide exerts distinct molecular antileukemic effects and combined thalidomide/fludarabine therapy is clinically effective in high-risk chronic lymphocytic leukemia

Thalidomide represents a promising immunomodulatory drug that targets both leukemia cells and the tumor microenvironment. We treated patients with chronic lymphocytic leukemia (CLL) with a combined thalidomide/fludarabine regimen and monitored cellular and molecular changes induced by thalidomide in vivo before fludarabine treatment. Thalidomide was given daily (100 mg p.o. per day) and fludarabine was administered on days 7-11 (25 mg/m(2) i.v. per day) within each 4-week cycle (maximum of 6 cycles). Twenty patients received thalidomide/fludarabine as first-line therapy and 20 patients were previously treated. Unmutated IgVH mutation status was found in 36 cases and 13 had high-risk cytogenetic aberrations (del17p, del11q). The overall response rate was 80 and 25% for untreated and previously treated patients, respectively. Although thalidomide reduced the number of CLL cells, the number of CD3 lymphocytes showed no significant change, but the number of CD4(+)CD25(hi)FOXP3(+) regulatory T cells (Tregs) was significantly decreased. Gene expression profiling revealed a thalidomide-induced signature containing both targets known to have a function in immunomodulatory drug action as well as novel candidate genes. Combined thalidomide/fludarabine therapy demonstrated efficacy in high-risk patients with CLL. Furthermore, our study provides novel biological insights into thalidomide effect, which might act by enhancing apoptosis of CLL cells and reducing Tregs, thereby enabling T-cell-dependent antitumor effect.

A multicenter, open, non-comparative, phase II study of the combination of cladribine (2-chlorodeoxyadenosine), cytarabine, and G-CSF as induction therapy in refractory acute myeloid leukemia - a report of the Polish Adult Leukemia Group (PALG)

OBJECTIVES

To evaluate the efficacy and toxicity of cladribine (2-chlorodeoxyadenosine, 2-CdA), cytarabine (Ara-C), and granulocyte-colony stimulating factor (G-CSF) (CLAG) regimen in refractory acute myeloid leukemia (AML) in the multicenter phase II study.

METHODS

The induction chemotherapy consisted of 2-CdA 5 mg/m2, Ara-C2 g/m2, and G-CSF. In the case of partial remission (PR), a second CLAG was administered. Patients in complete remission (CR) received two consolidation courses based on HD Ara-C, mitoxantrone or idarubicine, with or without 2-CdA.

RESULTS

Fifty-eight patients from 11 centers were registered; 50 primary resistant and eight early relapsed (CR1 < 6 months). CR was achieved in 29 (50%) patients, 19 (33%) were refractory, and 10 (17%) died early. Forty of 50 primary resistant patients received daunorubicin (DNR) and Ara-C as the first-line induction therapy (DA-7), 10 received additional 2-CdA (DAC-7). The CR rates after CLAG were 58% and 10%, respectively in each group (P = 0.015). Five of six patients with myelodysplastic syndrome (MDS)/AML achieved CR. Hematologic toxicity was the most prominent toxicity of this regimen. The overall survival (OS, 1 yr) for the 58 patients as a whole, and the 29 patients in CR were 42% and 65%, respectively. Disease-free survival (DFS, 1 yr) was 29%. Only first-line induction treatment with DA-7 significantly influenced the probability of CR after CLAG. None of the analyzed factors significantly influenced DFS and OS.

CONCLUSION

CLAG regimen has significant anti-leukemic activity and an acceptable toxicity in refractory AML. The addition of 2-CdA to the first-line induction treatment may worsen the results of salvage with CLAG. The high CR rate in patients with MDS preceding AML deserves further observation.

Immunohistochemical localization of androgen receptors in testicular cells of mice with mosaic mutation

Mice with mosaic mutation could be one of the models of human Menkes disease, which is associated with abnormal cooper metabolism. The aim of the present study was to localize androgen receptors (ARs) in the testes by means of immunohistochemistry. AR expression was observed in the nuclei of all somatic cells such as Leydig cells, Sertoli cells, and peritubular cells in sections from testes of control and mosaic mutant males. In the latter, very strong immunoreactivity for AR as well as higher levels of steroid hormones in homogenates were noticed in comparison to control mice. No positive immunoreaction for ARs was seen in control sections incubated without the primary antibody.

Pathological structure of the kidney from adult mice with mosaic mutation

The mosaic (Atp7a(mo-ms)) is an X-linked, lethal mutation in mice. In mosaic mutant males, many clinical features characteristic of defective copper metabolism have been observed and they die at the age of 15 days, exhibiting strong similarities to the brindled and macular mutants. About 4% of the mutant males live to sexual maturity and some of them are fertile. In this paper, alterations in the structure of the kidney from adult mutants are described. Owing to an inherited defect of efflux, copper is accumulated in the kidney of the mutants up to a toxic level and this leads to severe damage of the renal cortex. Pathological changes in the kidney mostly affected the structure of the renal corpuscle and renal tubules.

Activity of Tumor Necrosis Factor-alfa (TNF-alpha) and selected acute phase proteins in plasma of psoriatic patients receiving local treatment

Plasma concentrations of Tumor Necrosis Factor-alpha (TNF-alpha), C-reactive protein (CRP) and alpha-2 macroglobulin (alpha-2 MG) were examined in 100 patients with medium-severe and severe psoriasis. Activity of selected proteins were measured using the ELISA method in the active stage of psoriasis and in remission achieved due to the local treatment with 0.125-2% dithranol treatment. In the active stage of disease highly increased plasma levels of TNF-alpha, CRP and alpha-2 MG were found (p < 0.001) and remission was connected with a considerable decrease of the examined proteins towards the control values. But despite its lowering, CRP mean plasma level remained in remission significantly elevated in comparison with healthy control. Results of this study indicate that in severe psoriasis the acute phase response can be initiated and is not completely extinguished with achievement of clinical remission.

Combination regimen of cladribine (2-chlorodeoxyadenosine), cytarabine and G-CSF (CLAG) as induction therapy for patients with relapsed or refractory acute myeloid leukemia

The aim of the study was efficacy and toxicity evaluation of combination of 2-Chlorodeoxyadenosine (2-CdA) with cytarabine (Ara-C) and G-CSF (CLAG regimen) as reinduction therapy in patients with refractory or relapsed acute myeloid leukemia (AML). The protocol stipulated an infusion of 5 mg/m2 of 2-CdA over 2 hours daily for 5 consecutive days. A 4-hour infusion of Ara-C (2 g/m2) was started 2 hours after each infusion of 2-CdA. G-CSF at a dose 300 microg s.c was given 24 hours before the first dose of 2-CdA for 6 days. In case of WBC>20x10(9)/l G-CSF was started simultaneously with 2-CdA. In the case of complete response (CR) consolidation treatment with 2-CdA containing regimens was started. In case of partial response a second identical course of CLAG was given. Response criteria were established according to those developed by the NCI Sponsored Workshop. Among 20 patients accrued all but 2 received at least one course of CLAG induction therapy in the planned doses. 10/20 (50%) (95% CI 27-73%) patients achieved a CR with a median duration of 22.5 weeks (range 3.5-53 weeks). Two (10%) patients had a PR and 8 were non-responders. One patient underwent peripheral blood stem cell transplantation. Overall 4 patients are in continuous CR with a median duration of 16.2 weeks (range 3.5-36.5). Among non-responders two patients did not receive the full dose of treatment because of complications during the cycle, both of them died; 3 died early after complete induction therapy before recovery of the bone marrow and 3 were resistant to CLAG. All 20 patients but one experienced granulocytopenia <0.2x10(9)/l and thrombocytopenia <20x10(9)/l. Median time to reach PMN>0.5x10(9) G/l was 18.7 days and platelets>50x10(9)/l was 27.2 days. In conclusion, the CLAG regimen had significant antileukemic activity and acceptable toxicity as reinduction treatment in refractory or relapsed AML patients.

[Polyradicular neural syndrome in a patient with leukemic variant of malignant histiocytosis]

Malignant histiocytosis is rapidly progressive, fatal disorder characterised by systemic proliferation of abnormal histiocytic cells. We report a case of a 23-year old patient with leukaemia variant of malignant histiocytosis and nervous system involvement as polyradiculoneural syndrome. The leukaemia variant as well as nervous system involvement are extremely rare in malignant histiocytosis.

Formaldehyde-fixed semen is suitable and safer for leukocyte detection and DNA amplification

This pilot study indicates the use of formalin-fixation may offer a significant advance in the cytologic and pathological evaluation of semen. We are reporting this novel method to stimulate further assessment of this safer approach to semen analysis. The immunohistochemistry and PCR methods described here may also prove useful in improving the safety of studies of pathogen-infected cells in other laboratory settings.

[Giant granular lymphocyte leukemia--case report]

A 26-year old man had pancytopenia and marrow hypoplasia in association with a CD 3+, CD 8+ clonal large granular lymphocyte. At first treatment with cyclophosphamide and prednisone resulted in normalization of the patient's cell counts. During the second episode of illness it was observed infiltration of lymphnodes, stomach and bones. Application of steroids combination chemotherapy was inefective. The patient died.

[Results of the pilot treatment of 9 patients with chronic lymphocytic leukemia or CLL lymphoplasmacytoid lymphoma by the CHOP protocol]

In a group of 9 patients with chronic lymphocytic or lymphoplasmocytic leukaemia in clinical stage from 2 to 4 (classification of Rai et al.) 8 various CHOP programmes (cyclophosphamide, hydroxyldaunomycin, oncovin, prednisone) were used. In 6 cases (67%) partial remission was obtained, with normalization of peripheral blood and bone marrow patterns, with statistically significant decrease of the proportion of cells forming rosettes with murine erythrocytes, and with reduction or full normalization of the size of previously enlarged lymph nodes. In one case the control examination of a lymph node failed to demonstrate the previously present clone of cells with chromosomal aberration, although in histological examination the diagnosis of lymphoplasmocytic lymphoma was maintained. In the remaining 3 cases no partial remission was noted, and in one case progression was recognized. We think similarly as the French haematologists studying chronic lymphatic leukaemia, that the CHOP programme is effective in the treatment of chronic lymphatic or lymphoplasmocytic leukaemia.

[Phenotypic changes in peripheral blood lymphocytes of patients with chronic lymphoma and B-cell leukemia after treatment]

The purpose of the study was evaluation of the effect of treatment on the immunological phenotype of peripheral blood lymphocytes in patients with chronic lymphocytic leukaemia or in leukaemic forms of non-Hodgkin lymphomas, with low or medium grade malignancy. The study was carried out in 13 patient. In those responding to treatment a tendency was observed for normalization of the immunological phenotype of peripheral blood lymphocytes (increased proportion of cells forming rosettes with sheep erythrocytes, reduced proportion of cells forming rosettes with murine erythrocytes), and a tendency for polyclonal pattern of B-cells with immunoglobulins on their surface (although this feature was not a rule). In non-responders these tendencies were much less pronounced or absent. Similarly, in non-responders the tendency for polyclonal B-cell pattern may be only apparent, and may be connected with proliferation of a new lymphocyte population with another type of light chain.

[Heterogeneity of the cases of chronic B-cell leukemia and the heterogeneity of leukemic cell populations]

In a group of 23 patients with chronic lymphocytic leukaemia in 1-4 clinical stages of the disease according to Rai et al (34) classification, mostly untreated (only 5 treated) considerable heterogeneity was found as evidenced by: variability of the morphological patterns of bone marrow, differences of immunological phenotypes of peripheral blood lymphocytes between individual cases, --coexistence of the features of maturity and immaturity in the populations of peripheral blood lymphocytes in the same case.