Migraine aura discrimination using machine learning: an fMRI study during ictal and interictal periods

Functional magnetic resonance imaging (fMRI) studies on migraine with aura are challenging due to the rarity of patients with triggered cases. This study optimized methodologies to explore differences in ictal and interictal spatiotemporal activation patterns based on visual stimuli using fMRI in two patients with unique aura triggers. Both patients underwent separate fMRI sessions during the ictal and interictal periods. The Gaussian Process Classifier (GPC) was used to differentiate these periods by employing a machine learning temporal embedding approach and spatiotemporal activation patterns based on visual stimuli. When restricted to visual and occipital regions, GPC had an improved performance, with accuracy rates for patients A and B of roughly 86-90% and 77-81%, respectively (p < 0.01). The algorithm effectively differentiated visual stimulation and rest periods and identified times when aura symptoms manifested, as evident from the varying predicted probabilities in the GPC models. These findings contribute to our understanding of the role of visual processing and brain activity patterns in migraine with aura and the significance of temporal embedding techniques in examining aura phenomena. This finding has implications for diagnostic tools and therapeutic techniques, especially for patients suffering from aura symptoms.

Impact of Loneliness on Training Gains with Heart Rate Variability Biofeedback in the Elderly: A Pilot Study

The negative impact of loneliness on the health of the elderly is particularly noticeable because of the effects of central control on the autonomic nervous system. Such an impact can be assessed through heart rate variability (HRV) analysis and can be modified using HRV biofeedback training. This study aimed to investigate the impact of different levels of social interaction reported by the elderly on HRV before and after training with HRV biofeedback and after a follow-up period. The participants of this pilot study comprised 16 elderly people of both sexes with a mean age of 71.20 ± 4.92 years. The participants were divided into two groups, the loneliness group (N = 8) and the no-loneliness group (N = 8), based on a combination of both criteria: the institutionalization condition (institutionalized or not) and the score on the loneliness scale (high or low). All participants had their HRV components recorded at baseline, after 14 training sessions with HRV biofeedback (three times a week, 15 min each for 4.5 weeks), and after 4.5 weeks of follow-up without training. After HRV biofeedback training, HRV components increased in both groups. However, the gains lasted at follow-up only in the no-loneliness group. In conclusion, loneliness can influence the maintenance of HRV after interruption of training with HRV biofeedback in the elderly. HRV biofeedback training can be an innovative and effective tool for complementary treatment of elderly individuals, but its effects on lonely elderly individuals need to be further investigated.

Emotion regulation effects of Ayahuasca in experienced subjects during implicit aversive stimulation: An fMRI study

ETHNOPHARMACOLOGICAL RELEVANCE

Ayahuasca is a beverage used in Amazonian traditional medicine and it has been part of the human experience for millennia as well as other different psychoactive plants. Although Ayahuasca has been proposed as potentially therapeutic as an anxiolytic and antidepressant, whilst no studies have been carried out so far investigating their direct effect on brain emotional processing.

AIM OF THE STUDY

This study aimed to measure the emotional acute effect of Ayahuasca on brain response to implicit aversive stimulation using a face recognition task in functional magnetic resonance imaging (fMRI).

MATERIALS AND METHODS

Nineteen male experienced Ayahuasca users participated in this study in two fMRI sessions before and after 50 min of the Ayahuasca ingestion. Subjects were presented with pictures of neutral (A) and aversive (B) (fearful or disgusted) faces from the Pictures of Facial Affect Series. Subjects were instructed to identify the gender of the faces (gender discrimination task) while the emotional content was implicit. Subjective mood states were also evaluated before Ayahuasca intake and after the second fMRI session, using a visual analogue mood scale (VAMS).

RESULTS

During the aversive stimuli, the activity in the bilateral amygdala was attenuated by Ayahuasca (qFDR<0.05). Furthermore, in an exploratory analysis of the effects after intake, Ayahuasca enhances the activation in the insular cortex bilaterally, as well as in the right dorsolateral prefrontal cortex (qFDR<0.05). In the psychometric VAMS scale, subjects reported attenuation of both anxiety and mental sedation (p < 0.01) during acute effects.

CONCLUSIONS

Together, all reported results including neuroimaging, behavioral data and psychometric self-report suggest that Ayahuasca can promote an emotion regulation mechanism in response to aversive stimuli with corresponding improved cognition including reduced anxiety and mental sedation.

The impact of a violent community on mental health and the benefits of a sport program for social development

The aim of the present study was to evaluate the impact of a violent environment on mental health and the impact of a sport for social development (SSD) program on quality of life, mental distress symptoms, and heart rate variability (HRV). HRV and psychometric data were measured from 20 men professional athletes assisted by the SSD and 20 men living in the same violent community. The comparison of groups revealed greater sympathetic parameters of HRV, positive affect, and quality of life in the SSD group. Multiple regression analysis showed that the quality of life in the SSD group was positively predicted by positive affect, while in the control group the quality of life was negatively predicted by their history of traumatic events. Both groups reported high levels of exposure to traumatic events and posttraumatic stress symptoms. However, this study demonstrates the benefits of SSD programs in mental health.

The digiti quinti sign in hemiplegic migraine: An fMRI study

BACKGROUND AND PURPOSE

The digiti quinti sign (DQS) consists of a wider angle between the fourth and fifth fingers (ANG) indicative of subtle hemiparesis that has been found interictally in hemiplegic migraine (HM), suggesting a permanent subtle motor dysfunction. The aim of this study was to find a possible cortical origin for the DQS using blood oxygen level dependent (BOLD) functional (f) MRI.

METHODS

Eight HM patients and 13 controls entered the cross-sectional study. We examined hand dominance, performed handgrip tests with dynamometry, documented the DQS graphically in two consecutive sessions, and used BOLD-fMRI during a motor task specifically designed to measure the evoked activation in the motor cortex (M1). The brain activation at the symptomatic side was compared with the contralateral hemisphere and with both correspondent hemispheres in controls.

RESULTS

Subjects had a normal neurological examination, except for DQS in all HM patients. The activation amplitude (beta values) and the cluster extension (mm³ ) of the activation area in M1 was smaller at the affected side. Besides, the cluster extension correlated negatively with the disease time span. The ANG was wider bilaterally in patients and the fMRI signals were reduced in the patient's group.

CONCLUSION

The DQS, a relevant clinical finding in HM, indicates a disrupted cortical activation.

Autonomic dysregulation and impairments in the recognition of facial emotional expressions in patients with chronic musculoskeletal pain

OBJECTIVES

Emotions are involved in the identification of safety cues in the environment, and are also related to social interaction through recognition of emotional facial expressions. Heart rate variability (HRV) can be an indicator of the adaptive response of the autonomic nervous system to stressful conditions, including pain. This study aimed to investigate the emotional processing in a sample of patients with chronic musculoskeletal by measuring the resting-state HRV and the ability to recognize facial emotion expressions.

METHODS

This cross-sectional study was composed of 40 participants with chronic musculoskeletal pain and 40 asymptomatic participants. Resting HRV was measured for 10 min. The facial emotion recognition task was presented in videos and included modification from a neutral expression to faces of fear, anger, sadness, happiness, and disgust. For the facial emotion recognition task, the hit rate (%) and response time for each emotional category were measured.

RESULTS

The symptomatic group had a mean high frequency (HF) lower (mean = 34.14; SD = 16.95; p<0.001) than the asymptomatic group (mean = 51.11; SD = 13.01; p<0.001). The emotional facial expressions of disgust (H (1, 80)=7.82; p<0.01), anger (H (1, 80)=13.56; p<0.01), sadness (H (1, 80)=6.58; p=0.01), and happiness (H (1, 80)=12.68; p<0.01) were those for which volunteers from the symptomatic group had a lower hit rate of correct answers compared to the asymptomatic group. The response time to corrected answers showed a major group effect (F (1.77)=21.11; p<0.001) and emotional category (F (4.308)=174.21; p<0.001), without presenting any interaction between the factors (F (4.308)=0.446; p=0.775). The symptomatic group was slower to perform the task of identifying facial emotional expression (7.066 s; SD = 1.188) than the participants in the asymptomatic group (6.298 s; SD = 1.203) for all emotional categories.

CONCLUSIONS

Participants with chronic musculoskeletal pain presented a lower vagal activity evidenced by HRV. Participants in the symptomatic group showed lower ability to recognize faces of disgust, anger, and sadness when compared to asymptomatic participants. Considering that individuals with low resting HF-HRV have difficulties with regulating their emotions, the lower vagal activity and lower ability to recognize faces of emotional expressions observed in chronic musculoskeletal pain may suggest alterations in emotional processing. This study may shed light on changes in the emotional processing and in the autonomic nervous system in this population.

Interactions between emotion and action in the brain

A growing literature supports the existence of interactions between emotion and action in the brain, and the central participation of the anterior midcingulate cortex (aMCC) in this regard. In the present functional magnetic resonance imaging study, we sought to investigate the role of self-relevance during such interactions by varying the context in which threating pictures were presented (with guns pointed towards or away from the observer). Participants performed a simple visual detection task following exposure to such stimuli. Except for voxelwise tests, we adopted a Bayesian analysis framework which evaluated evidence for the hypotheses of interest, given the data, in a continuous fashion. Behaviorally, our results demonstrated a valence by context interaction such that there was a tendency of speeding up responses to targets after viewing threat pictures directed towards the participant. In the brain, interaction patterns that paralleled those observed behaviorally were observed most notably in the middle temporal gyrus, supplementary motor area, precentral gyrus, and anterior insula. In these regions, activity was overall greater during threat conditions relative to neutral ones, and this effect was enhanced in the directed towards context. A valence by context interaction was observed in the aMCC too, where we also observed a correlation (across participants) of evoked responses and reaction time data. Taken together, our study revealed the context-sensitive engagement of motor-related areas during emotional perception, thus supporting the idea that emotion and action interact in important ways in the brain.

A new approach for radiosynoviorthesis: A dose-optimized planning method based on Monte Carlo simulation and synovial measurement using 3D slicer and MRI

PURPOSE

Recently, there has been a growing interest in a methodology for dose planning in radiosynoviorthesis to substitute fixed activity. Clinical practice based on fixed activity frequently does not embrace radiopharmaceutical dose optimization in patients. The aim of this paper is to propose and discuss a dose planning methodology considering the radiological findings of interest obtained by three-dimensional magnetic resonance imaging combined with Monte Carlo simulation in radiosynoviorthesis treatment applied to hemophilic arthropathy.

METHOD

The parameters analyzed were: surface area of the synovial membrane (synovial size), synovial thickness and joint effusion obtained by 3D MRI of nine knees from nine patients on a SIEMENS AVANTO 1.5 T scanner using a knee coil. The 3D Slicer software performed both the semiautomatic segmentation and quantitation of these radiological findings. A Lucite phantom 3D MRI validated the quantitation methodology. The study used Monte Carlo N-Particle eXtended code version 2.6 for calculating the S-values required to set up the injected activity to deliver a 100 Gy absorbed dose at a determined synovial thickness. The radionuclides assessed were: 90Y, 32P, 188Re, 186Re, 153Sm, and 177Lu, and the present study shows their effective treatment ranges.

RESULT

The quantitation methodology was successfully tested, with an error below 5% for different materials. S-values calculated could provide data on the activity to be injected into the joint, considering no extra-articular leakage from joint cavity. Calculation of effective treatment range could assist with the therapeutic decision, with an optimized protocol for dose prescription in RSO.

CONCLUSION

Using 3D Slicer software, this study focused on segmentation and quantitation of radiological features such as joint effusion, synovial size, and thickness, all obtained by 3D MRI in patients' knees with hemophilic arthropathy. The combination of synovial size and thickness with the parameters obtained by Monte Carlo simulation such as effective treatment range and S-value, from which is calculated the injected activity, could be used for treatment planning in RSO. Data from this methodology could be a potential aid to clinical decision making by selecting the most suitable radionuclide; justifying the procedure, fractioning the dose, and the calculated injected activity for children and adolescents, considering both the synovial size and thickness.

Default mode and task-positive networks connectivity during the N-Back task in remitted depressed patients with or without emotional residual symptoms

Clinical remission of depression may be associated with emotional residual symptoms. We studied the association of emotional blunting, rumination with neural networks dynamics in remitted depressed patients and cognitive performance during an N-Back task. Twenty-six outpatients in remission of depression (Hamilton Depressive rating scale score <7) performed an N-Back task during fMRI assessment. All patients had been treated by paroxetine for a minimum of 4 months. Two subgroups of patients [Nonemotionally blunted (NEB) = 14 and emotionally blunted (EB) = 12] were determined. To identify functional network maps across participants, the Network Detection using Independent Component Analysis approach was employed. Within and between Task Positive Network (TPN) and Default Mode Network (DMN) connectivity were assessed and related to variability of performance on the N-Back task and rumination. EB and NEB patients were not different for the level of accurate responses at the N-Back. However over the entire working memory task, the negative correlation between DMN and TPN was significantly lower in the EB than NEB group and was differently related to cognitive performance and rumination. The stronger the negative correlation between DMN and TPN was, the less variable the reaction time during 3-Back task in NEB patients. Moreover the greater the negative correlation between DMN and TPN was, the lower the rumination score in EB patients. Emotional blunting may be associated with compromised monitoring of rumination and cognitive functioning in remitted depressed patients through altered cooperation between DMN and TPN. The study suggests clinical remission in depression is associated with biological heterogeneity. Hum Brain Mapp 38:3491-3501, 2017. © 2017 Wiley Periodicals, Inc.

Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy

BACKGROUND

Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS).

METHODS

In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p<0.05.

FINDINGS

Dynamometry performance of the patients' most affected hand (MAH), was worse than that of the less affected hand (LAH) and of healthy controls participants (p = 0.031), confirming handgrip impairment. Motor threshold (MT) of the FDS muscle was higher in both hemispheres in patients as compared to controls, and lower in the hemisphere contralateral to the MAH when compared to that of the LAH. Moreover, motor evoked potential (MEP) amplitudes collected in the FDS of the MAH were higher in comparison to those of controls. Strikingly, MEPs in the intrinsic hand muscle FDI had lower amplitudes in the hemisphere contralateral to MAH as compared to those of the LAH and the control group. Taken together, these results are suggestive of a more robust representation of an extrinsic hand flexor and impaired intrinsic hand muscle function in the hemisphere contralateral to the MAH due to leprosy.

CONCLUSION

Decreased sensory-motor function induced by leprosy affects handgrip muscle representation in M1.

Euterpe Olerácea (Açaí) as an alternative oral contrast agent in MRI of the gastrointestinal system: preliminary results

Using contrast agents is a common practice in medical imaging protocols. Paramagnetic properties of certain compounds present in contrast agents can affect magnetic resonance imaging (MRI) signals. For abdominal applications, they are usually injected, but may also be administered orally. However, their use as a routine technique is limited, mainly due to the lack of appropriate oral contrast agents. We herein present the preliminary characterization and results for implementation of Euterpe Olerácea (popularly named Açaí) as a possible clinical oral contrast agent for MRI of the gastrointestinal tract. The pulp of Açaí, a fruit from the Amazon area, presented an increase in T(1)-weighted MRI signal, equivalent to that of gadolinium-diethyltriamine pentaacetic acid, and a decrease in T(2)-weighted images. We looked for intrinsic properties that could be responsible for the T(1) signal enhancement and T(2) opacification. Atomic absorption spectra revealed the presence of Fe, Mn and Cu ions in Açai. The presence of such ions contribute to the susceptometric value found of chi = -4.83 x 10(-6). This finding assents with the hypothesis that image contrast changes were due to the presence of paramagnetic material. The first measurements in vivo demonstrate a clear increase of contrast, in T(1)-weighted images, due to the presence of Açaí. Consistently, the opacification in a T(2)-weighted acquisition was evident, revealing a good contrast on bowel walls of gastric tissues.

Zinc finger and carboxyl regions of adenovirus E1A 13S CR3 are important for transactivation of the cytomegalovirus major immediate early promoter by adenovirus

Reactivation of latent cytomegalovirus (CMV) is an important cause of disease in susceptible patients. We previously demonstrated that an adenovirus early gene product can transactivate the CMV major immediate early (IE) promoter in inflammatory cells. This effect was due to the conserved region 3 (CR3) of the adenovirus E1A 13S gene product. There are two domains in the CR3 region, a zinc finger (aa 147-177) and a carboxyl (aa 180-188) domain. Both are crucial for transactivation of downstream promoter elements of adenovirus in E1A 13S. We sought to determine if either or both of these specific domains is also necessary for transactivation of the CMV IE promoter by the adenovirus E1A 13S gene product. We cotransfected T-lymphocyte Jurkat cells and monocyte/macrophage-like THP-1 cells with plasmids expressing wild-type (WT) or CR3 mutant E1A 13S and a CMV IE chloramphenicol acetyltransferase (CAT) reporter construct. With extracts of cells coinfected with E1A WT set to 100%, mutation in the zinc finger domain, the carboxyl domain, or both domains decreased CMV IE CAT activity by >/= 96%. In contrast, a mutation in the region between the zinc finger and carboxyl domains reduced CMV IE CAT activity by only 24 to 26%. Mixing studies in Jurkat cells confirmed the importance of these domains. We also evaluated the active site of the CMV IE promoter involved in transactivation in THP-1 cells using CMV IE promoter deletions and single promoter element constructs. These studies showed that progressive deletion of the 19-bp CMV IE repeats containing cyclic AMP response element binding protein/activating transcription factor (CREB/ATF) sites resulted in progressive loss of activity. The importance of this element was confirmed using single promoter elements containing CMV IE 16-, 18-, 19-, and 21-bp repeats. Finally, using a 19-bp single promoter element construct and the CR3 mutants we demonstrated that mutations in the zinc finger (C171S) carboxyl region (S185N) or both regions (C171S/ S185N) resulted in significant (83, 94, and 85%) loss of activity. We conclude that the zinc finger and carboxyl domains of the CR3 region of E1A 13S are necessary for transactivation of the CMV promoter and that this occurs mainly through activation of the 19-bp CREB/ATF site of the promoter.