Embodied metacognition as strengthened functional connection between neural correlates of metacognition and dance in dancers: exploring creativity implications

Introduction

Dance education fosters embodied metacognition, enhancing student's creativity. This study examines the crucial role of functional connectivity (FC) between the neural correlates of metacognition (NCM) and dance (NCD) as the neurological foundation for dancers' embodied metacognition. The investigation also explores whether these consolidated FCs inform the general creativity in dancers.

Methods

The research involved 29 dancers and 28 non-dancer controls. The study examined resting-state connections of the NCM through seed-based FC analysis. Correlation analyses were employed to investigate the connections between the targeted NCM-NCD FCs, initiated from the a priori NCM seed, and general creativity.

Results

Dancers demonstrated heightened FC between NCM and NCD compared to non-dancer controls. The targeted regions included the putamen, globus pallidus, posterior cerebellum, and anterior insula of NCD. The dancers exhibited higher originality scores. In dancers, the enhanced FC showed a negative correlation with originality and a positive correlation with flexibility. Conversely, the controls exhibited no significant correlations.

Discussion

Extended dance training enhances the NCM-NCD connection signifying embodied metacognition. This interconnectedness may serve as the neural predisposition for fostering general creativity performance in dancers. Dancers with heightened levels of originality could leverage the relatively weaker NCM-NCD FCs to facilitate better integration and coordination of creative cognitive processes. Our findings suggest that the consolidated functional connections as sculpted by domain-specific training may inform general creativity.

Inner sense of rhythm: percussionist brain activity during rhythmic encoding and synchronization

Introduction

The main objective of this research is to explore the core cognitive mechanisms utilized by exceptionally skilled percussionists as they navigate complex rhythms. Our specific focus is on understanding the dynamic interactions among brain regions, respectively, related to externally directed cognition (EDC), internally directed cognition (IDC), and rhythm processing, defined as the neural correlates of rhythm processing (NCRP).

Methods

The research involved 26 participants each in the percussionist group (PG) and control group (CG), who underwent task-functional magnetic resonance imaging (fMRI) sessions focusing on rhythm encoding and synchronization. Comparative analyses were performed between the two groups under each of these conditions.

Results

Rhythmic encoding showed decreased activity in EDC areas, specifically in the right calcarine cortex, left middle occipital gyrus, right fusiform gyrus, and left inferior parietal lobule, along with reduced NCRP activity in the left dorsal premotor, right sensorimotor cortex, and left superior parietal lobule. During rhythmic synchronization, there was increased activity in IDC areas, particularly in the default mode network, and in NCRP areas including the left inferior frontal gyrus and bilateral putamen. Conversely, EDC areas like the right dorsolateral prefrontal gyrus, right superior temporal gyrus, right middle occipital gyrus, and bilateral inferior parietal lobule showed decreased activity, as did NCRP areas including the bilateral dorsal premotor cortex, bilateral ventral insula, bilateral inferior frontal gyrus, and left superior parietal lobule.

Discussion

PG's rhythm encoding is characterized by reduced cognitive effort compared to CG, as evidenced by decreased activity in brain regions associated with EDC and the NCRP. Rhythmic synchronization reveals up-regulated IDC, down-regulated EDC involvement, and dynamic interplay among regions with the NCRP, suggesting that PG engages in both automatic and spontaneous processing simultaneously. These findings provide valuable insights into expert performance and present opportunities for improving music education.

[Hepatitis B virus infection status and clinical characteristics in patients with rheumatoid arthritis]

Objective: To investigate the epidemiology of hepatitis B virus (HBV) infection in patients with rheumatoid arthritis (RA) in China and its association with RA disease characteristics. Methods: A cross-sectional study. A retrospective study was conducted on RA patients recruited from January 2001 to February 2023 in the Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital. Demographic and clinical data were collected including age, gender, disease duration, active smoking, RA disease activity, physical function, radiographic assessment, serological markers of HBV infection and liver function indicators. According to the status of HBV infection, RA patients were grouped as chronic HBV infection, resolved HBV infection and no HBV infection groups. The distribution of each group and the clinical characteristics of RA patients were analyzed. Results: Among 1 941 RA patients, 1 461 (75.3%) completed HBV screening, including 335 males (22.9%) and 1 126 females (77.1%), with a mean age of (55.4±13.1) years. The prevalence of chronic HBV infection was 10.1%(148/1 461), which was significantly higher in male patients than in females [14.6%(49/335) vs 8.8%(99/1 126), P<0.001], especially among those males born from 1970 to 1979[20.0%(7/35) vs 8.5%(17/201), P=0.037] and 1980-1989 [31.8%(7/22) vs 10.5%(14/133), P=0.007]. Among 148 RA patients with chronic HBV infection, there were 5 cases (3.4%) of chronic hepatitis B, 2 cases (1.4%) of HBV-associated cirrhosis and 1 case (0.7%) of hepatocellular carcinoma. The prevalence of resolved HBV infection was 57.6%(841/1 461). There were 472(32.3%) patients with no HBV infection and 267(56.6%) of them showed negative anti-HBs. Among all RA patients, 15 (1.0%) patients had abnormal liver function, of which 7 cases were drug-induced liver injury, 5 cases were chronic hepatitis B, 2 cases were non-alcoholic fatty liver disease, and 1 case was primary biliary cholangitis. Conclusion: Chronic HBV infection remains a common complication in RA patients in China, the infection rate is 10.1%, and the screening and management of HBV infection should be strengthened in clinical practice.

Versatile Effects of GABA Oolong Tea on Improvements in Diastolic Blood Pressure, Alpha Brain Waves, and Quality of Life

Emerging evidence has demonstrated that using a new manufacturing technology to produce γ-aminobutyric acid (GABA)-fortified oolong (GO) tea could relieve human stress and exert versatile physiological benefits. The purpose of this human study was to investigate the therapeutic effects of daily GO tea consumption on improvements in blood pressure, relaxation-related brain waves, and quality of life (QOL) over a period of 28 consecutive days. Total polyphenols, major catechins, and free amino acids were analyzed via an HPLC assay. Changes in heart rate, blood pressure, α brain waves (index of relaxation), and the eight-item QOL score were investigated on days 0, 7, 14, 21, and 28. The chemical analysis results showed that GO tea contained the most abundant amino acids and GABA, contributing to the relaxation activity. Among all study participants, the daily consumption of GO tea could reduce systolic blood pressure on day 21 and diastolic blood pressure on day 28 (p < 0.05 for both). For participants with pre-hypertension, GO tea could effectively reduce heart rate and systolic and diastolic blood pressure on day 28 (p < 0.05). At the end of the study, incremental changes in alpha brain waves and QOL scores were also demonstrated (p < 0.05 for both). This study suggests that GO tea might potentially serve as a natural source for alternative therapy to improve blood pressure, stress relief, and QOL.

Enhanced white matter fiber tract of the cortical visual system in visual artists: implications for creativity

Introduction

This study aimed to examine the white matter characteristics of visual artists (VAs) in terms of visual creativity and the structural connectivity within the cortical visual system.

Methods

Diffusion spectrum imaging was utilized to examine the changes in white matter within the cortical visual system of a group of VAs (n = 25) in comparison to a group of healthy controls matched for age and education (n = 24). To assess the integrity of white matter and its relationship with visual creativity, we conducted a comprehensive analysis using region-based and track-specific tractographic examinations.

Results

Our study uncovered that VAs demonstrated increased normalized quantitative anisotropy in specific brain regions, including the right inferior temporal gyrus and right lateral occipital gyrus, along with the corresponding white matter fiber tracts connecting these regions. These enhancements within the cortical visual system were also found to be correlated with measures of visual creativity obtained through psychological assessments.

Discussion

The noted enhancement in the white matter within the cortical visual system of VAs, along with its association with visual creativity, is consistent with earlier research demonstrating heightened functional connectivity in the same system among VAs. Our study's findings suggest a link between the visual creativity of VAs and structural alterations within the brain's visual system.

Corrigendum: Enhanced intrinsic functional connectivity in the visual system of visual artist: implications for creativity

[This corrects the article DOI: 10.3389/fnins.2023.1114771.].

[The application of a new type of sterile elastic exsanguination tourniquet in aspiration surgery for upper limb lymphedema]

Objective: To evaluate the effect of a new type of sterile elastic exsanguination tourniquet (SEET) in aspiration surgery for upper limb lymphedema. Methods: The clinical data of 159 patients who underwent aspiration surgery for upper limb lymphedema from January 2017 to June 2022 in the Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. Among them, 54 patients were treated with SEET (SEET group), while 105 patients were not treated with SEET (No-SEET group). The propensity score matching method was used, and the surgical indicators and complications were compared between the two groups. The factors affecting intraoperative bleeding volume were analyzed through multiple linear regression analysis. Results: A total of 49 pairs of patients were successfully matched by the propensity score method. The age of patients in the SEET and No-SEET groups was (57.7±8.9) years and (56.8±9.1) years, respectively. Compared with the Non-SEET group, the SEET group had less bleeding volume [(311±164) ml vs (437±173) ml, P<0.001]. The results of multiple linear regression analysis showed that the factors affecting intraoperative bleeding volume included age (β=-0.142, P=0.041), using the SEET (β=-0.249, P=0.002), surgical time (β=0.195, P=0.010) and the amount of fat mixture sucked out (β=0.464, P<0.001). Conclusions: The clinical application of the SEET in aspiration surgery for upper limb lymphedema is safe, and can significantly reduce the bleeding volume and alleviate blood shortage.

Trait representation of embodied cognition in dancers pivoting on the extended mirror neuron system: a resting-state fMRI study

Introduction

Dance is an art form that integrates the body and mind through movement. Dancers develop exceptional physical and mental abilities that involve various neurocognitive processes linked to embodied cognition. We propose that dancers' primary trait representation is movement-actuated and relies on the extended mirror neuron system (eMNS).

Methods

A total of 29 dancers and 28 non-dancer controls were recruited. A hierarchical approach of intra-regional and inter-regional functional connectivity (FC) analysis was adopted to probe trait-like neurodynamics within and between regions in the eMNS during rest. Correlation analyses were employed to examine the associations between dance training, creativity, and the FC within and between different brain regions.

Results

Within the eMNS, dancers exhibited increased intra-regional FC in various brain regions compared to non-dancers. These regions include the left inferior frontal gyrus, left ventral premotor cortex, left anterior insula, left posterior cerebellum (crus II), and bilateral basal ganglia (putamen and globus pallidus). Dancers also exhibited greater intrinsic inter-regional FC between the cerebellum and the core/limbic mirror areas within the eMNS. In dancers, there was a negative correlation observed between practice intensity and the intrinsic FC within the eMNS involving the cerebellum and basal ganglia. Additionally, FCs from the basal ganglia to the dorsolateral prefrontal cortex were found to be negatively correlated with originality in dancers.

Discussion

Our results highlight the proficient communication within the cortical-subcortical hierarchy of the eMNS in dancers, linked to the automaticity and cognitive-motor interactions acquired through training. Altered functional couplings in the eMNS can be regarded as a unique neural signature specific to virtuoso dancers, which might predispose them for skilled dancing performance, perception, and creation.

Delay Analysis in Closed-Loop EEG Phase-Triggered Transcranial Magnetic Stimulation

The recent development of closed-loop EEG phase-triggered transcranial magnetic stimulation (TMS) has advanced potential applications of adaptive neuromodulation based on the current brain state. Closed-loop TMS involves instantaneous acquisition of the EEG rhythm, timing prediction of the target phase, and triggering of TMS. However, the accuracy of EEG phase prediction algorithms is largely influenced by the system's transport delay, and their relationship is rarely considered in related work. This paper proposes a delay analysis that considers the delay of the closed-loop EEG phase-triggered TMS system as a primary factor in the validation of phase prediction algorithms. An in-silico validation using real EEG data was performed to compare the performance of commonly used algorithms. The experimental results indicate a significant influence of the total delay on the algorithm performance, and the performance ranking among algorithms varies at different levels of delay. We conclude that the delay analysis framework should be widely adopted in the design and validation of phase prediction algorithms for closed-loop EEG phase-triggered TMS systems.

OPRM1 A118G polymorphism modulating motor pathway for pain adaptability in women with primary dysmenorrhea

Introduction

Primary dysmenorrhea (PDM) is a common condition among women of reproductive age, characterized by menstrual pain in the absence of any organic causes. Previous research has established a link between the A118G polymorphism in the mu-opioid receptor (OPRM1) gene and pain experience in PDM. Specifically, carriers of the G allele have been found to exhibit maladaptive functional connectivity between the descending pain modulatory system and the motor system in young women with PDM. This study aims to explore the potential relationship between the OPRM1 A118G polymorphism and changes in white matter in young women with PDM.

Methods

The study enrolled 43 individuals with PDM, including 13 AA homozygotes and 30 G allele carriers. Diffusion tensor imaging (DTI) scans were performed during both the menstrual and peri-ovulatory phases, and tract-based spatial statistics (TBSS) and probabilistic tractography were used to explore variations in white matter microstructure related to the OPRM1 A118G polymorphism. The short-form McGill Pain Questionnaire (MPQ) was used to access participants' pain experience during the MEN phase.

Results

Two-way ANOVA on TBSS analysis revealed a significant main effect of genotype, with no phase effect or phase-gene interaction detected. Planned contrast analysis showed that during the menstrual phase, G allele carriers had higher fractional anisotropy (FA) and lower radial diffusivity in the corpus callosum and the left corona radiata compared to AA homozygotes. Tractographic analysis indicated the involvement of the left internal capsule, left corticospinal tract, and bilateral medial motor cortex. Additionally, the mean FA of the corpus callosum and the corona radiata was negatively correlated with MPQ scales in AA homozygotes, but this correlation was not observed in G allele carriers. No significant genotype difference was found during the pain-free peri-ovulary phase.

Discussion

OPRM1 A118G polymorphism may influence the connection between structural integrity and dysmenorrheic pain, where the G allele could impede the pain-regulating effects of the A allele. These novel findings shed light on the underlying mechanisms of both adaptive and maladaptive structural neuroplasticity in PDM, depending on the specific OPRM1 polymorphism.

[Efficacy and safety of low-dose rasburicase for refractory chronic gouty arthritis]

Objective: To explore the efficacy and safety of low-dose rasburicase for refractory chronic gouty arthritis. Methods: A cohort study. The clinical data of patients with refractory chronic gouty arthritis who were treated with rasburicase at Sun Yat-sen Memorial Hospital, Sun Yat-sen University between January 2021 and July 2022 were retrospectively analyzed. Refractory chronic gouty arthritis was defined as serum uric acid (sUA)>360 μmol/L and urate volume>10 cm³ under dual-energy computed tomography after tolerable maximal oral urate-lowering therapy for at least 3 months. The administration of low-dose rasburicase was applied intravenously with total dosage ranging from 4.5 to 7.5 mg each dose, at 4-week intervals for a maximum of three doses. Efficacy was evaluated by the changes of sUA level, tophus and urate volume. Results: A total of 22 patients were included for analysis, with 95.4% (21/22) male, the mean age was (44±15) years, and the median duration of gout was 11 (6-15) years. The mean sUA at baseline was (667±112) μmol/L. The levels of sUA significantly decreased after each dose of rasburicase (P<0.001), and the median reduction of sUA after each dose of rasburicase was 568 (471-635), 187 (66-335) and 123 (49-207) μmol/L, respectively. At week 12, nine patients (40.9%) exhibited sUA<360 μmol/L and tophus disappeared in one patient. The urate volume significantly decreased at week 12 when compared with that before the first dose of rasburicase in all the patients [40 (16-172) cm³ vs 17 (7-134) cm³, P<0.001], with a median reduction rate of 41.6% (22.9%-58.5%). The everall safety of rasburicase was good, and no serious adverse reactions occurred. Conclusions: Low-dose rasburicase is well-tolerated and effective for decreasing the urate burden in patients with refractory chronic gouty arthritis. Further prospective randomized controlled trials are needed to validate these findings.

Right dorsolateral prefrontal cortex volumetric reduction is associated with antidepressant effect of low-dose ketamine infusion: A randomized, double-blind, midazolam-controlled PET-MRI clinical trial

BACKGROUND

Evidence has shown a rapid antidepressant and antisuicidal effects of low-dose ketamine infusion among patients with treatment-resistant depression (TRD) and prominent suicidal ideation (SI). The dorsolateral prefrontal cortex (DLPFC) plays a crucial role in the TRD pathomechanisms.

OBJECTIVE

Whether the structural and functional changes of the DLPFC, particularly Brodmann area 46, are associated with the antidepressant and antisuicidal effects of ketamine infusion among such patients is unknown.

METHODS

We randomized 48 patients with TRD and SI into groups receiving a single infusion of 0.5 mg/kg ketamine or 0.045 mg/kg midazolam. The Hamilton Depression Rating Scale and the Montgomery-Asberg Depression Rating Scale were used to assess symptoms. Positron emission tomography (PET)-magnetic resonance imaging was conducted prior to infusion and on Day 3 postinfusion. We performed longitudinal voxel-based morphometry (VBM) analysis to evaluate the gray matter (GM) volume changes of the DLPFC. The standardized uptake value ratio (SUVr) of ¹⁸F-fluorodeoxyglucose PET images was calculated using the SUV of the cerebellum as a reference region.

RESULTS

The VBM analysis revealed a small but significant volumetric reduction in the right DLPFC in the ketamine group compared with that in the midazolam group. A greater reduction in depressive symptoms was associated with a smaller decrease in right DLPFC volumes (p = 0.025). However, we found no SUVr changes of the DLPFC between baseline and post-Day 3 ketamine infusion.

DISCUSSION

The optimal modulation of the right DLPFC GM volumes may play an essential role in the antidepressant neuromechanisms of low-dose ketamine.

Community-based exercise and nutritional interventions to improve frailty syndrome among older adults: A quasi-experimental study

This study aimed to explore the efficacy of single and combined effects of exercise and branched-chain amino acid (BCAA) supplements on improving frailty and quality of life in older adults. In total, 120 study participants were allocated into a combined exercise-and-BCAA supplementation group, an exercise-only group, a BCAA supplementation-only group, and a control group. Results showed that Fried's frailty score significantly decreased in the combined exercise-and-BCAA supplementation group (β= -1.73, p<0.001), exercise-only group (β= -1.68, p<0.001), and BCAA supplementation-only group (β= -0.73, p=0.005) compared to the control group. Moreover, the combination of exercise and BCAA supplements and the exercise-only program produced significant improvements in frailty compared to the BCAA supplement-only group and control group (p<0.05). Exercise should be a critical approach for older adults to improve frailty. Healthcare professionals in geriatric care should incorporate exercise programs as frailty management and prevention for older adults.

A Randomized Double-Blind Midazolam-Controlled Trial of Low-Dose Ketamine Infusion in Patients With Treatment-Resistant Depression and Prominent Suicidal Ideation

BACKGROUND

The benefits of low-dose ketamine for patients with treatment-resistant depression (TRD) and prominent suicidal ideation require further investigation. The effects of treatment refractoriness, the duration of the current depressive episode, and the number of prior antidepressant failures on ketamine efficacy also require clarification.

METHODS

We recruited 84 outpatients with TRD and prominent suicidal ideation- defined as a score of ≥4 on Item 10 of the Montgomery-Asberg Depression Rating Scale (MADRS)-and randomized them into two groups to receive 0.5 mg/kg ketamine or 0.045 mg/kg midazolam. We assessed depressive and suicidal symptoms prior to infusion, 240 min postinfusion, and 2, 3, 5, 7, and 14 days postinfusion.

RESULTS

According to the MADRS scores, the antidepressant effect (p = .035) was noted significantly in the ketamine group up to 14 days than in the midazolam group. However, the antisuicidal effect of ketamine, as measured by the Columbia-Suicide Severity Rating Scale Ideation Severity Subscale (p = .040) and MADRS Item 10 (p = .023) persisted only 5 days postinfusion. Furthermore, the antidepressant and antisuicidal effects of ketamine infusion were noted particularly in patients whose current depressive episode lasted for <24 months or whose number of failed antidepressants was ≤4.

DISCUSSION

Low-dose ketamine infusion is a safe, tolerable, and effective treatment for patients with TRD and prominent suicidal ideation. Our study highlights the importance of timing; specifically, ketamine is more likely to achieve therapeutic response when the current depressive episode lasted for <24 months and the number of failed antidepressants is ≤4.

Cortical inhibition function is associated with baseline suicidal symptoms and post-ketamine suicidal symptom reduction among patients with treatment-resistant depression and strong suicidal ideation

BACKGROUND

Whether cortical excitation and inhibition functions differ between patients with treatment-resistant depression (TRD) and strong suicidal ideation (SI) and healthy subjects and whether 0.5 mg/kg ketamine infusion can modulate cortical excitation and inhibition functions among patients with TRD-SI remain unclear.

METHODS

A total of 29 patients with TRD-SI and 35 age- and sex-matched healthy controls were assessed using paired-pulse transcranial magnetic stimulation. The patients were randomly assigned to receive either a single 0.5-mg/kg ketamine or 0.045-mg/kg midazolam infusion. Depressive and suicidal symptoms were assessed at baseline and 240 min after infusion. Intracortical facilitation (ICF), short-interval intracortical inhibition (SICI), and long-interval intracortical inhibition (LICI), all of which reflect cortical excitability and inhibition functions, were measured at the same time points.

RESULTS

The patients with TRD-SI had lower ICF (p < 0.001) estimates (worse cortical excitatory function) and higher SICI (p = 0.032) and LICI (p < 0.001) estimates (worse cortical inhibitory function) compared with the control group. Higher SICI estimates at baseline were associated with greater baseline suicidal symptoms. No differences were found in the SICI, ICF, and LICI estimates at 240 min after the infusion between the two groups. Low-dose ketamine did not alter the cortical excitation and inhibition functions of the patients with TRD-SI. However, decreased SICI estimates (greater cortical inhibition function) were related to the reduction of suicidal symptoms.

DISCUSSION

Dysfunction of cortical excitation and inhibition may play a crucial role in the pathomechanisms of TRD and suicidal symptoms. However, we found a lack of predictive ability of the baseline cortical excitation and inhibition parameters on the antidepressant and antisuicidal effect of low-dose ketamine infusion.

Enhanced intrinsic functional connectivity in the visual system of visual artist: Implications for creativity

Introduction

This study sought to elucidate the cognitive traits of visual artists (VAs) from the perspective of visual creativity and the visual system (i.e., the most fundamental neural correlate).

Methods

We examined the local and long-distance intrinsic functional connectivity (FC) of the visual system to unravel changes in brain traits among VAs. Twenty-seven university students majoring in visual arts and 27 non-artist controls were enrolled.

Results

VAs presented enhanced local FC in the right superior parietal lobule, right precuneus, left inferior temporal gyrus (ITG), left superior parietal lobule, left angular gyrus, and left middle occipital gyrus. VAs also presented enhanced FC with the ITG that targeted the visual area (occipital gyrus and cuneus), which appears to be associated with visual creativity.

Discussion

The visual creativity of VAs was correlated with strength of intrinsic functional connectivity in the visual system. Learning-induced neuroplasticity as a trait change observed in VAs can be attributed to the macroscopic consolidation of consociated neural circuits that are engaged over long-term training in the visual arts and aesthetic experience. The consolidated network can be regarded as virtuoso-specific neural fingerprint.

Adaptive neuroplasticity in the default mode network contributing to absence of central sensitization in primary dysmenorrhea

Introduction

Primary dysmenorrhea (PDM), the most prevalent gynecological problem among women of reproductive age, presents as a regular pattern of cyclic menstrual pain. The presence or absence of central sensitization (i.e., pain hypersensitivity) in cases of PDM is a contentious issue. Among Caucasians, the presence of dysmenorrhea is associated with pain hypersensitivity throughout the menstrual cycle, indicating pain amplification mediated by the central nervous system. We previously reported on the absence of central sensitization to thermal pain among Asian PDM females. In this study, functional magnetic resonance imaging was used to reveal mechanisms underlying pain processing with the aim of explaining the absence of central sensitization in this population.

Methods

Brain responses to noxious heat applied to the left inner forearm of 31 Asian PDM females and 32 controls during their menstrual and periovulatory phases were analyzed.

Results and discussion

Among PDM females experiencing acute menstrual pain, we observed a blunted evoked response and de-coupling of the default mode network from the noxious heat stimulus. The fact that a similar response was not observed in the non-painful periovulatory phase indicates an adaptive mechanism aimed at reducing the impact of menstrual pain on the brain with an inhibitory effect on central sensitization. Here we propose that adaptive pain responses in the default mode network may contribute to the absence of central sensitization among Asian PDM females. Variations in clinical manifestations among different PDM populations can be attributed to differences in central pain processing.

PADAr: physician-oriented artificial intelligence-facilitating diagnosis aid for retinal diseases

Purpose: Retinopathy screening via digital imaging is promising for early detection and timely treatment, and tracking retinopathic abnormality over time can help to reveal the risk of disease progression. We developed an innovative physician-oriented artificial intelligence-facilitating diagnosis aid system for retinal diseases for screening multiple retinopathies and monitoring the regions of potential abnormality over time. Approach: Our dataset contains 4908 fundus images from 304 eyes with image-level annotations, including diabetic retinopathy, age-related macular degeneration, cellophane maculopathy, pathological myopia, and healthy control (HC). The screening model utilized a VGG-based feature extractor and multiple-binary convolutional neural network-based classifiers. Images in time series were aligned via affine transforms estimated through speeded-up robust features. Heatmaps of retinopathy were generated from the feature extractor using gradient-weighted class activation mapping++, and individual candidate retinopathy sites were identified from the heatmaps using clustering algorithm. Nested cross-validation with a train-to-test split of 80% to 20% was used to evaluate the performance of the screening model. Results: Our screening model achieved 99% accuracy, 93% sensitivity, and 97% specificity in discriminating between patients with retinopathy and HCs. For discriminating between types of retinopathy, our model achieved an averaged performance of 80% accuracy, 78% sensitivity, 94% specificity, 79% F1-score, and Cohen's kappa coefficient of 0.70. Moreover, visualization results were also shown to provide reasonable candidate sites of retinopathy. Conclusions: Our results demonstrated the capability of the proposed model for extracting diagnostic information of the abnormality and lesion locations, which allows clinicians to focus on patient-centered treatment and untangles the pathological plausibility hidden in deep learning models.

MEG-based Classification and Grad-CAM Visualization for Major Depressive and Bipolar Disorders with Semi-CNN

Major depressive disorder (MDD) and bipolar disorder (BD) are two major mood disorders with partly overlapped symptoms but different treatments. However, their misdiagnosis and mistreatment are common based on the DSM-V criteria, lacking objective and quantitative indicators. This study aimed to develop a novel approach that accurately classifies MDD and BD based on their resting-state magnetoencephalography (MEG) signals during euthymic phases. A revisited 3D CNN model, Semi-CNN, that could automatically detect brainwave patterns in spatial, temporal, and frequency domains was implemented to classify wavelet-transformed MEG signals of normal controls and MDD and BD patients. The model achieved a test accuracy of 96.05% and an average of 95.71% accuracy for 5-fold cross-validation. Furthermore, saliency maps of the model were estimated using Grad-CAM++ to visualize the proposed classification model and highlight disease-specific brain regions and frequencies. Clinical Relevance - Our model provides a stable pipeline that accurately classifies MDD, BD, and healthy individuals based on resting-state MEG signals during the euthymic phases, opening the potential for quantitative and accurate brain-based diagnosis for the highly misdiagnosed MDD/BD patients.

[Hashimoto's encephalopathy presenting with isolated cerebellar ataxia in 13 children]

Objective: To analyze the clinical characteristics, treatment and prognosis of Hashimoto's encephalopathy presenting with isolated cerebellar ataxia in children. Methods: A retrospective analysis was performed on the clinical features, laboratory tests, neuroelectrophysiological examination, imaging, treatment and outcomes of 13 patients with Hashimoto's encephalopathy presenting with isolated cerebellar ataxia, who were admitted to the Department of Pediatric Neurology of Guangzhou Women and Children's Medical Center from January 2016 to May 2021. Results: Among the 13 cases, 6 were males and 7 were females. The onset age was 2.6 (2.0,3.3) years, 9 children had precursor infection or vaccination before the first course of disease. All the 13 children had gait abnormalities or unsteady sitting, 10 had intentional tremor, 6 had dysarthria, 3 had body tremor, 2 had nystagmus, 3 had fatigue, 3 had hypotonia, 2 had vomiting and 1 had irritability. Thyroglobulin antibody (TgAb) was 500.0 (298.9,587.2) kU/L and thyroid peroxidase antibody (TPOAb) was 621.9 (449.6,869.4) kU/L in 13 cases. Autoantibodies were positive in 9 cases, and cerebrospinal fluid leukocytosis was seen in 4 cases. Regarding electroencephalography result, 4 cases had background slowing and 1 case had occasional sharp waves. Among the 3 patients who had relapses, 1 had cerebellar atrophy shown on cranial magnetic resonance imaging (MRI) during the recurrence. All the patients received intravenous immunoglobulin (IVIG) and intensive methylprednisolone therapy during the first onset, followed by the disappearance of the symptoms, 1 patient had repeated episodes which was decreased after immunosuppressive treatment with Rituximab.Followed up for 25.0 (22.5,33.3) months after the last episode, 12 achieved complete remission and 1 had a wide base gait. Conclusions: Trunk ataxia is the common symptom of Hashimoto's encephalopathy presenting with isolated cerebellar ataxia in children.Children with cerebellar ataxia should be tested for TgAb and TPOAb to detect Hashimoto's encephalopathy, avoiding missed diagnosis and treatment delays; IVIG and intensive steroid therapy is effective, and immunosuppressive therapy for patients with multiple relapses could reduce the recurrence.

A novel beamformer-based imaging of phase-amplitude coupling (BIPAC) unveiling the inter-regional connectivity of emotional prosody processing in women with primary dysmenorrhea

Objective. Neural communication or the interactions of brain regions play a key role in the formation of functional neural networks. A type of neural communication can be measured in the form of phase-amplitude coupling (PAC), which is the coupling between the phase of low-frequency oscillations and the amplitude of high-frequency oscillations. This paper presents a beamformer-based imaging method, beamformer-based imaging of PAC (BIPAC), to quantify the strength of PAC between a seed region and other brain regions.Approach. A dipole is used to model the ensemble of neural activity within a group of nearby neurons and represents a mixture of multiple source components of cortical activity. From ensemble activity at each brain location, the source component with the strongest coupling to the seed activity is extracted, while unrelated components are suppressed to enhance the sensitivity of coupled-source estimation.Main results. In evaluations using simulation data sets, BIPAC proved advantageous with regard to estimation accuracy in source localization, orientation, and coupling strength. BIPAC was also applied to the analysis of magnetoencephalographic signals recorded from women with primary dysmenorrhea in an implicit emotional prosody experiment. In response to negative emotional prosody, auditory areas revealed strong PAC with the ventral auditory stream and occipitoparietal areas in the theta-gamma and alpha-gamma bands, which may respectively indicate the recruitment of auditory sensory memory and attention reorientation. Moreover, patients with more severe pain experience appeared to have stronger coupling between auditory areas and temporoparietal regions.Significance. Our findings indicate that the implicit processing of emotional prosody is altered by menstrual pain experience. The proposed BIPAC is feasible and applicable to imaging inter-regional connectivity based on cross-frequency coupling estimates. The experimental results also demonstrate that BIPAC is capable of revealing autonomous brain processing and neurodynamics, which are more subtle than active and attended task-driven processing.

Brain Dynamics Altered by Photic Stimulation in Patients with Alzheimer's Disease and Mild Cognitive Impairment

Individuals with mild cognitive impairment (MCI) are at high risk of developing Alzheimer's disease (AD). Repetitive photic stimulation (PS) is commonly used in routine electroencephalogram (EEG) examinations for rapid assessment of perceptual functioning. This study aimed to evaluate neural oscillatory responses and nonlinear brain dynamics under the effects of PS in patients with mild AD, moderate AD, severe AD, and MCI, as well as healthy elderly controls (HC). EEG power ratios during PS were estimated as an index of oscillatory responses. Multiscale sample entropy (MSE) was estimated as an index of brain dynamics before, during, and after PS. During PS, EEG harmonic responses were lower and MSE values were higher in the AD subgroups than in HC and MCI groups. PS-induced changes in EEG complexity were less pronounced in the AD subgroups than in HC and MCI groups. Brain dynamics revealed a "transitional change" between MCI and Mild AD. Our findings suggest a deficiency in brain adaptability in AD patients, which hinders their ability to adapt to repetitive perceptual stimulation. This study highlights the importance of combining spectral and nonlinear dynamical analysis when seeking to unravel perceptual functioning and brain adaptability in the various stages of neurodegenerative diseases.

Association between the use of antidepressants and the risk of preterm birth among pregnant women with depression: a retrospective cohort study in Taiwan

Our study was aimed to investigate the association between the use of antidepressants and the risk of preterm birth in pregnant women who have had perinatal depression. We extracted data from the Taiwanese National Health Insurance Research Database (NHIRD) and analyzed them using multivariate Cox proportional hazard regression models. Identified from the NHIRD, we matched 1789 women aged 18-55 years who were using antidepressants during pregnancy and 1789 women who were experiencing depression but who were not using antidepressants during pregnancy for age, index date, and medical comorbidities. We enrolled the women in our study, which we conducted using 12 years' worth of data between 2000 and 2012, and then followed up individually with them for up to 1 year to identify any occurrence of preterm birth. Results highlighted that, compared with the women with perinatal depression who were not using antidepressants during pregnancy, the women taking antidepressants had a 1.762-fold risk of preterm birth (adjusted HR=1.762, 95% CI 1.351 to 2.294, p<0.001). The use of antidepressants in women with perinatal depression may increase the risk of preterm birth. However, the decision to start, stop, or change the use of antidepressants during pregnancy requires evaluating the risks of treatment versus untreated depression for both mother and child.

Neuroprotective effect of Val variant of BDNF Val66Met polymorphism on hippocampus is modulated by the severity of menstrual pain

Primary dysmenorrhea (PDM) refers to menstrual pain of which the pathological cause(s) are unknown. This study examined the associations among BDNF Val66Met polymorphisms, menstrual pain severity, and hippocampal volume among young PDM subjects. We recruited 115 PDM subjects, including severe cases (n = 66) and moderate cases (n = 44), and 117 young females (aged 20-30 years) as a control group (CON) for BDNF Val66Met genotyping and MRI examination. The assessment of hippocampal volume involved analysis at various anatomical resolutions, i.e., whole hippocampal volume, hippocampal subfields, and voxel-based morphometry (VBM) volumetric analysis. Two-way ANOVA analyses with planned contrasts and Bonferroni correction were conducted for the assessment of hippocampal volume. Linear regression was used to test for BDNF Val66Met Val allele dosage-dependent effects. We observed no main effects of group, genotype, or group-genotype interactions on bilateral whole hippocampal volumes. Significant interactions between PDM severity and BDNF Val66Met genotype were observed in the right whole hippocampus, subiculum, and molecular layer. Post-hoc analysis revealed that the average hippocampal volume of Val/Val moderate PDM subjects was greater than that of Val/Val severe PDM subjects. Note that right hippocampal volume was greater in the Val/Val group than in the Met/Met group, particularly in the right posterior hippocampal region. Dosage effect analysis revealed a positive dosage-dependent relationship between the Val allele and volume of the right whole hippocampus, subiculum, molecular layer, and VBM-defined right posterior hippocampal region in the moderate PDM subgroup only. These findings indicate that Val/Val PDM subjects are resistant to intermittent moderate pain-related stress, whereas Met carrier PDM subjects are susceptible. When confronted with years of repeated PDM stress, the hippocampus can undergo differential structural changes in accordance with the BDNF genotype and pain severity. This triad study on PDM (i.e., combining genotype with endophenotype imaging results and clinical phenotypes), underscores the potential neurobiological consequences of PDM, which may prefigure in neuroimaging abnormalities associated with various chronic pain disorders. Our results provide evidence for Val allele dosage-dependent protective effects on the hippocampal structure; however, in cases of the Val variant, these effects were modulated in accordance with the severity of menstrual pain.

Association between concurrent antidepressant and hypnotic treatment and the risk of dementia: A nationwide cohort study

OBJECTIVE

This study aimed to investigate the risk of dementia among subgroups of patients receiving concurrent antidepressant and hypnotic treatment, antidepressants alone, and hypnotics alone.

METHODS

Multivariate Cox proportional hazards regression models were used to determine the effects of antidepressants and hypnotics on dementia risk after adjusting for potential confounders.

RESULTS

Compared with the reference group, patients receiving concurrent antidepressant and hypnotic treatment had the highest adjusted hazard ratio (aHR: 2.390, 95% CI: 2.224-2.536; P < 0.001) for all-cause dementia, followed by those receiving antidepressants alone (aHR: 1.919, 95% CI: 1.811-2.012; P < 0.001) and hypnotics alone (aHR: 1.458, 95% CI: 1.397-1.527; P < 0.001). With regard to dementia subtypes, trends similar to those for all-cause dementia were observed for Alzheimer's dementia, vascular dementia and other types of dementia. The sensitivity analysis conducted also found the robustness of findings. Notably, inconsistent findings were observed in subgroup with depression, revealing a null association between concurrent antidepressant and hypnotic treatment (aHR: 0.496; 95% CI: 0.183-1.343; P = 0.175) or hypnotics alone (aHR: 2.750; 95% CI: 0.797-9.482; P = 0.102) and the risk of dementia, and a negative association between antidepressants alone (aHR: 0.351; 95% CI: 0.130-0.942; P = 0.032) and the risk of dementia.

CONCLUSION

A null or negative association was observed between concurrent antidepressant and hypnotic treatment, antidepressants alone, hypnotics alone, and the dementia risk in the subgroup of patients with depression, suggesting the absence of an association between dementia risk and antidepressants alone or hypnotics alone.

Cerebral Microbleed Burdens in Specific Brain Regions Are Associated With Disease Severity of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

Background

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, caused by NOTCH3 mutations, is characterized by recurrent ischemic strokes and progressive cognitive decline. It remains unclear whether cerebral microbleeds (CMBs) can serve as a surrogate marker for disease progression in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. We aimed to investigate the CMB burdens in NOTCH3 mutation carriers at different disease stages and test their associations with cognitive performance.

Methods and Results

Forty‐nine individuals carrying NOTCH3 cysteine‐altering mutations received brain magnetic resonance imaging with T1‐weighted and susceptibility‐weighted images. Whole brain images were segmented into 14 regions using Statistical Parametric Mapping and FreeSurfer software, and semiautomatic methods were used to locate and quantify the number and volume of CMBs. In our study participants, the median of CMB counts was 13, with a wide individual variation (range, 0–286). CMBs were most frequently present in thalamus, followed by temporal lobe. In the whole brain, the CMB counts and CMB volume ratios (ie, CMB volume divided by the volume of corresponding brain region) gradually increased as the disease advanced. CMB counts in the thalamus and temporal and frontal lobes increased more rapidly than other brain regions as disease progressed. There were significant associations between Mini‐Mental State Examination scores and CMB counts in the frontal lobe, temporal lobe, and pons.

Conclusions

CMBs may have an influential role in the clinical manifestations of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. CMB burdens and their distribution in different brain regions may be capable to serve as a disease marker for monitoring the disease severity of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

[Clinical characteristics, treatment and prognosis of myelin oligodendrocyte glycoprotein antibody-associated optic neuritis in children]

Objective: To investigate the clinical characteristics, treatment and prognosis of myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) in pediatric patients. Methods: Clinical data, laboratory examination, the initial best corrected visual acuity (BCVA), fundus, neuroelectrophysiological results, MRI imaging, treatment and prognosis of children diagnosed with MOG-ON from 2016 to 2019 were retrospectively analyzed. Results: A total of 29 eyes from 16 children were involved, with a male/female ratio of 1∶1, onset age of (7.0±2.9) years. Seven of 16 patients had prodromal infection, with a unilateral/bilateral ratio of 3∶13, and 2 cases had recurrent optic neuritis. Before treatment, BCVA of 19 eyes (65.5%) was ≤0.1, among them, 4 had no sense of light, 5 had light sense, 5 with sense of hands in front of eyes, and 5 with sense of fingers in front of eyes. There were 10 eyes (34.5%) with BCVA of 0.1-0.5. After treatment, there were 4 eyes (13.8%), 5 eyes (17.2%) and 20 eyes (69.0%) in groups with BCVA of 0.1-0.5, 0.5-1.0, and>1.0, respectively. Twelve of 16 patients had optic papillitis in fundus examination during acute phase. The latency was prolonged and the amplitude was decreased in P100 wave of all the children. Thirteen out of 16 children showed swelling and thickening of optic nerve in MRI T2WI. MRI images exhibited intracranial demyelinating lesions in 12 of 16 children and long segment spinal cord lesions in 3 of 16 children. Thirteen of 16 patients showed effective results after intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG) treatment. There was no relapse after administration of mycophenolate mofetil in 2 recurrent children. No progression after administration of rituximab was found in 1 child with corticosteroid insensitivity. The average follow-up time was (16±9) months and no recurrence occurred. Ten of 16 patients had full recovery, 4 had significant improvement, and 2 showed no significant improvement. Conclusions: There is no significant gender difference in the incidence of pediatric MOG-ON. Bilateral involvement and severe visual impairment are common in acute phase. Most patients have good response to IVMP combined with IVIG treatment and hence have a good prognosis. Only a few of them have neurological sequelae.

Increased Risk of Pain after Electroconvulsive Therapy among Depressed Patients: a Nationwide Study in Taiwan

The risk of pain after electroconvulsive therapy (ECT) among depressed patients is still controversial. We aimed to investigate the risk of pain post-ECT among patients with depression. We investigated patients with depression, based on the data in the National Health Insurance Research Database. A comparison cohort comprising depressed non-ECT patients with at least three psychiatric admissions were matched. A Cox proportional regression model was used to investigate the risk of pain between the ECT and comparison cohorts. The ECT and comparison cohorts consisted of 1246 and 4984 patients, respectively. Compared to the control group patients, the ECT group patients had a significantly increased risk of developing overall pain (aHR = 5.753; 95% CI: 2.405-11.760; P < 0.001). Specifically, the risk of developing headache (aHR = 7.270; 95% CI: 1.226-47.731; P = 0.026) and musculoskeletal pain (MSP; aHR = 5.330; 95% CI: 2.937-11.663; P = 0.001) was significantly higher than in the control group. The sensitivity analysis, which involved checking pain events for each week to the end of the study, also provided significant findings in overall pain (aHR = 13.013, 95% CI: 2.121-94.258, P < 0.001), headache (aHR = 10.995; 95% CI: 1.099-122.601; P = 0.042) and MSP (aHR = 14.210, 95% CI: 2.436-82.898, P = 0.003) within 3 weeks of follow-up. This study suggests that depressed patients who undergo ECT may have an increased risk of developing subsequent pain. Further research is warranted to elucidate whether pain is associated with ECT because several potential confounders existed.

[Clinical features and prognosis of pediatric myelin oligodendrocyte glycoprotein antibody associated acute disseminated encephalomyelitis]

Objective: To analyze the clinical features, outcome and prognosis of pediatric myelin oligodendrocyte glycoprotein (MOG) antibody associated acute disseminated encephalomyelitis (ADEM), and provide evidence for improving the diagnosis and treatment of this disease. Methods: This study involved 30 MOG antibody-associated ADEM patients in the Department of Neurology, Guangzhou Women and Children's Medical Center. Patients' clinical information were analyzed. Results: The mean onset age was (5.2±3.3) years old, the ration of male to female was 16∶14. Fifty percent of these patients had a history of precede infection or vaccination before onset. Encephalopathy and seizures were the most common clinical manifestations, followed by movement disorder. In addition, some patients had other positive autoantibodies. Brain Magnetic resonance imaging (MRI) showed extensive, asymmetrical, indefinite large patchy lesions in bilateral cortical and subcortical areas and the spinal cord was characterized by long segmental myelitis. In acute attack, the patients had a good response to corticosteroid combined immunoglobulin therapy. Most of these patients had a good prognosis and recurrence rate was about 20%. Conclusions: The onset age of MOG antibody-associated ADEM is around 5 years old. Encephalopathy and seizures were the most common clinical manifestations. Most patients have a good response to corticosteroid combined immunoglobulin therapy. Some patients may have a recurrent disease course.

[Value of dual-energy CT-based volumetric iodine-uptake in the evaluation of chemotherapy efficacy in advanced gastric cancer]

Objective: To explore the value of dual-energy CT-based volumetric iodine-uptake (VIU) in the evaluation of chemotherapy efficacy in advanced gastric cancer. Methods: Inclusion criteria of subjects: (1) without previous systematic therapy; (2) with complete clinical information before and after chemotherapy; (3) without contraindications of chemotherapy. Exclusion criteria of subjects: (1) unfinished duration and times of chemotherapy; (2) unmeasurable primary lesions; (3) poor imaging quality or poor gastric filling. Clinical and image data of 52 patients with advanced gastric cancer who were diagnosed by pathology from gastroscopic biopsy, and needed chemotherapy evaluated by imaging and clinical information in the First Affiliated Hospital of Wenzhou Medical University from February 2017 to February 2018 were collected and analyzed. Of 52 patients, 38 were male and 14 were female with the median age of 65 (31-88) years old. All the patients underwent a dual-energy, dual phase-enhanced CT scanning before chemotherapy and after the third chemotherapy session. The parameters of the lesions measured before and after chemotherapy in portal vein phase were as follows: the maximum diameter (the largest diameter among those measured in the cross-sectional, coronal, and sagittal planes), average CT value (the regions of interest were manually pinpointed under cross-sectional planes with largest diameter of the tumor, which did not include regions less than 2 mm to the edge of the tumor) and VIU (lesion volume × iodine concentration). The change rates of maximum lesion diameter, average CT value and VIU before and after chemotherapy were calculated [(post-chemotherapy parameters-pre-chemotherapy parameters)/ pre-chemotherapy parameters]. The efficacy of chemotherapy was evaluated by RECIST 1.1 (the change of maximum tumor diameter after chemotherapy), Choi (the change of average CT value after chemotherapy) and VIU (the change of VIU after chemotherapy), respectively, which was categorized by complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Patients with CR, PR, and SD were assigned to the effective group, while those with PD were classified as the ineffective group. Paired t - test or Wilcoxon signed ranks test was used to compare the changes of parameters before and after chemotherapy, whereas Spearman correlation analysis and Kappa test were used for the correlation analysis and the consistency test between the three evaluation criteria (Kappa≥0.75 indicated good consistency). Results: After chemotherapy, the average CT value [(74.01±16.75) HU vs. (81.06±15.87) HU, t=2.202, P=0.030] and median VIU (668.53×10(2) μg vs. 272.52×10(2) μg, Z=4.761, P<0.001) decreased significantly, while the difference of the maximum diameter was not statistically significant [(66.71±34.49) mm vs. (78.45±35.62) mm, t=1.708, P=0.091]. The median change rate of VIU (-53.33%) was greater than that of CT values (-5.75%) with significant difference (Z=-5.408, P<0.001). According to the RECIST 1.1 criteria, 47 patients (90.4%, including 19 with PR and 28 with SD) were effective and 5 patients (9.6%) were ineffective. According to the Choi criteria, 45 patients (86.5%, including 37 with PR and 8 with SD) were effective and 7 patients (13.5%) were ineffective. According to the VIU criteria, 46 patients (88.5%, including 41 with PR and 5 with SD) were effective and 6 patients (11.5%) were ineffective. Efficacy comparison among these three criteria showed no significant difference (χ(2)=0.377, P=0.828). As compared to RECIST 1.1 evaluation, the proportion of PR evaluated by Choi and VIU was significantly higher (χ(2)=16.861, P<0.001), whereas the proportion of SD was significantly lower (χ(2)=24.089, P<0.001). There was no significant difference in the proportions of PR and SD between VIU and Choi criteria (χ(2)=0.887, P=0.346). Consistency and correlation analysis showed that the VIU and Choi evaluation criteria presented the highest consistency and correlation (Kappa=0.912, P<0.001; r=0.916, P<0.001). Conclusion: VIU is a feasible parameter for the evaluation of chemotherapy efficacy in advanced gastric cancer, and may be more sensitive than the evaluation criteria based on maximum diameter or change of CT value in the tumor.

The Impact of Antidepressants on the Risk of Developing Obstructive Sleep Apnea in Posttraumatic Stress Disorder: A Nationwide Cohort Study in Taiwan

STUDY OBJECTIVES

The association between posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) has been reported inconsistently, and the association between antidepressant use and the risk of developing OSA in patients with PTSD has not been previously studied. Therefore, we used the Longitudinal National Health Insurance Database (LHID) to investigate the impact of PTSD and antidepressant use on the risk of OSA development.

METHODS

Identified from the LHID, 2,316 individuals aged ≥ 18 years with PTSD, but with no history of OSA, and 23,160 control individuals matched for age, sex, obesity and index date were enrolled between 2000 and 2015 and followed up until the end of 2015 to identify the development of OSA. A two-tailed Bonferroni-corrected P < .00038 (.05/13) was considered statistically significant as we examined 13 antidepressants.

RESULTS

Individuals with PTSD had increased risk of developing OSA (adjusted hazard ratio 4.672, 95% confidence interval 2.246-9.787, P < .001) after adjusting for demographic data, medical comorbidities, and medication. Treatment with antidepressants was not significantly associated with an increased risk of developing OSA compared to no antidepressant treatment.

CONCLUSIONS

Asian patients with PTSD had increased risk of developing OSA, and treatment with antidepressants did not play a key role in increasing the risk of OSA development. Further studies are required to investigate the underlying mechanisms of PTSD and the roles of antidepressants on the risk of developing OSA.

CITATION

Lin C-E, Chung C-H, Chen L-F, Chien W-C, Chou P-H. The impact of antidepressants on the risk of developing obstructive sleep apnea in posttraumatic stress disorder: a nationwide cohort study in taiwan. J Clin Sleep Med. 2019;15(9):1233-1241.

Does Compulsory Admission Prevent Inpatient Suicide Among Patients with Schizophrenia? A Nationwide Cohort Study in Taiwan

OBJECTIVE

The aim of this study was to analyze the risk of inpatient suicide in patients with schizophrenia during 2007-2013 and to determine putative risk factors.

METHODS

We conducted a national population-based cohort study of 2,038 psychiatric inpatients in their first compulsory admission, matched with 8,152 controls who were voluntary inpatients. Only patients with schizophrenia were included in the study. We used data derived from the Taiwanese National Health Insurance Database 2005, comprising 1 million beneficiaries randomly selected from the entire population of Taiwan.

RESULTS

During the follow-up period, 23 and 75 inpatient suicides were observed in the compulsory and control groups, respectively. Kaplan-Meier curves showed that the cumulative incidence rate of inpatient suicide was not significantly different between compulsory and voluntary admissions (log-rank test, p = .206).

CONCLUSIONS

Our results suggest that compulsory admission has no protective effects on risk reduction of inpatient suicide for patients with schizophrenia who are compulsorily admitted compared with voluntarily admitted controls. Clinicians should be more alert for the prevention of inpatient suicide among patients with schizophrenia and consider the close monitoring of inpatient suicide risk in the first week of admission.

[Efficacy and safety of domestic dasatinib as second-line treatment for chronic myeloid leukemia patients in the chronic phase]

目的

探讨国产酪氨酸激酶抑制剂（TKI）达沙替尼（商品名：依尼舒）二线治疗慢性髓性白血病慢性期（CML-CP）患者的疗效及安全性。

方法

回顾性分析2016年3月至2018年7月湖北省CML协作组成员医院收治的二线服用国产达沙替尼的CML-CP患者的病例资料，统计患者治疗3、6和12个月时最佳反应率、累积完全细胞遗传学反应（CCyR）率、累积主要分子学反应（MMR）率、无进展生存（PFS）、无事件生存（EFS）情况及不良反应情况。

结果

共纳入83例CML-CP患者，中位随访时间为23（4~45）个月，达沙替尼治疗3、6、12个月最佳反应率分别为77.5%（54/71）、72.6%（61/75）、60.7%（51/69）。至随访截止，累积CCyR率、MMR率分别为65.5%（55/80）、57.1%（48/73），达CCyR和MMR的中位时间均为3个月。随访时间内，PFS率为94.0%（79/83），EFS率为77.4%（65/83）。国产达沙替尼最常见非血液学不良反应为水肿（32.5%），其次为皮疹瘙痒（18.1%）、乏力（13.3%），血液学不良反应主要有血小板减少（31.3%）、白细胞减少（19.3%）和贫血（6.0%）。

结论

国产达沙替尼二线治疗CML-CP患者具有较好的疗效及安全性，可作为CML-CP患者的治疗选择。

[Analysis of adverse events of clinical blood use except for the adverse reactions of blood transfusion]

Objective: To reduce the occurrence of adverse events of clinical blood use by analyzing the clinical adverse events of blood use except for the adverse reactions of blood transfusion. Methods: A retrospective analysis was performed on 294 cases of adverse events of clinical blood use other than adverse blood transfusion reactions in Shijitan hospital from January 2014 to December 2017, and a statistical analysis was made on the types of adverse events of clinical blood use, blood transfusion related departments, and internal and surgical blood use. Results: The incidence of adverse events of clinical blood use was 10.3‰, 9.6‰, 4.2‰ and 4.6‰ in these 4 years respectively, and there were 216 cases (73.5%) of external departments, 49 cases (16.7%) of internal departments, 8 cases (2.7%) of nursing departments, and 21 cases of others(7.1%), which includes 12 cases of errand department, 4 cases of the clinical laboratory and 5 cases of transfusion department. The adverse events of clinical blood use were divided into 4 types: 71 cases (24.1%) of transfusion process problems, 36 cases (12.2%) of clinical communication between departments, 182 cases (61.9%) of clinical unreasonable transfusion and 5 others (1.8%). There were statistically significant differences in the occurrence of adverse events of different types of blood use in external and internal departments based on the property of the department, among which there were significant differences in unreasonable transfusion between them. According to the purpose of blood use, there were statistically significant differences in the occurrence of different types of adverse events between the two departments, and the incidence of different types of external departments were higher than that of internal departments. Conclusions: The incidence of adverse events of blood use in external departments is higher than that in internal departments. Reasonable transfusion should be strengthened to avoid the occurrence of adverse events of clinical blood use, so as to ensure the safety of blood transfusion.

Compulsory admission is associated with an increased risk of readmission in patients with schizophrenia: a 7-year, population-based, retrospective cohort study

PURPOSE

The aim of this study was to assess the risk of psychiatric readmission in patients with schizophrenia, compare it between patients prescribed compulsory admission and those consenting to voluntary admission, and determine risk factors for psychiatric readmission.

METHODS

This 7-year (2007-2013), population-based, cohort study retrospectively compared data of 2038 schizophrenic inpatients who initially underwent compulsory admission (the CA group) and of 8152 matched controls with schizophrenia who initially underwent voluntary admission (the VA group).

RESULTS

During the study period, there were 1204 and 3806 readmissions in the CA and VA groups, respectively. Compared with the VA group, the CA group was associated with a greater risk of psychiatric readmission [adjusted hazard ratio (AHR) = 1.765; 95% confidence interval (CI) 1.389-2.243; P < 0.001]. Stratified analyses showed that the CA group was associated with a higher risk of subsequent compulsory (AHR = 1.307; 95% CI 1.029-1.661; P < 0.001) and voluntary (AHR = 1.801; 95% CI 1.417-2.289; P < 0.001) readmissions compared to the VA group. Sensitivity analyses, after excluding data from the first year of observation, also provided significant findings with respect to compulsory and voluntary readmissions. Kaplan-Meier curves revealed that cumulative survival rates of psychiatric readmissions, compulsory and voluntary readmissions were significantly lower in the CA group than in the VA group among patients with schizophrenia (log-rank test, P < 0.001).

CONCLUSIONS

CA was associated with higher subsequent psychiatric readmissions, compulsory, and voluntary readmissions. Clinicians would need to focus on patients undergoing CAs to reduce readmissions.

Interactions of BDNF Val66Met Polymorphism and Menstrual Pain on Brain Complexity

The irregularity and uncertainty of neurophysiologic signals across different time scales can be regarded as neural complexity, which is related to the adaptability of the nervous system and the information processing between neurons. We recently reported general loss of brain complexity, as measured by multiscale sample entropy (MSE), at pain-related regions in females with primary dysmenorrhea (PDM). However, it is unclear whether this loss of brain complexity is associated with inter-subject genetic variations. Brain-derived neurotrophic factor (BDNF) is a widely expressed neurotrophin in the brain and is crucial to neural plasticity. The BDNF Val66Met single-nucleotide polymorphism (SNP) is associated with mood, stress, and pain conditions. Therefore, we aimed to examine the interactions of BDNF Val66Met polymorphism and long-term menstrual pain experience on brain complexity. We genotyped BDNF Val66Met SNP in 80 PDM females (20 Val/Val, 31 Val/Met, 29 Met/Met) and 76 healthy female controls (25 Val/Val, 36 Val/Met, 15 Met/Met). MSE analysis was applied to neural source activity estimated from resting-state magnetoencephalography (MEG) signals during pain-free state. We found that brain complexity alterations were associated with the interactions of BDNF Val66Met polymorphism and menstrual pain experience. In healthy female controls, Met carriers (Val/Met and Met/Met) demonstrated lower brain complexity than Val/Val homozygotes in extensive brain regions, suggesting a possible protective role of Val/Val homozygosity in brain complexity. However, after experiencing long-term menstrual pain, the complexity differences between different genotypes in healthy controls were greatly diminished in PDM females, especially in the limbic system, including the hippocampus and amygdala. Our results suggest that pain experience preponderantly affects the effect of BDNF Val66Met polymorphism on brain complexity. The results of the present study also highlight the potential utilization of resting-state brain complexity for the development of new therapeutic strategies in patients with chronic pain.

Unaltered intrinsic functional brain architecture in young women with primary dysmenorrhea

Primary dysmenorrhea (PDM), painful menstruation without organic causes, is the most prevalent gynecological problem in women of reproductive age. Dysmenorrhea later in life often co-occurs with many chronic functional pain disorders, and chronic functional pain disorders exhibit altered large-scale connectedness between distributed brain regions. It is unknown whether the young PDM females exhibit alterations in the global and local connectivity properties of brain functional networks. Fifty-seven otherwise healthy young PDM females and 62 age- and education-matched control females participated in the present resting-state functional magnetic resonance imaging study. We used graph theoretical network analysis to investigate the global and regional network metrics and modular structure of the resting-state brain functional networks in young PDM females. The functional network was constructed by the interregional functional connectivity among parcellated brain regions. The global and regional network metrics and modular structure of the resting-state brain functional networks were not altered in young PDM females at our detection threshold (medium to large effect size differences [Cohen's d ≥ 0.52]). It is plausible that the absence of significant changes in the intrinsic functional brain architecture allows young PDM females to maintain normal psychosocial outcomes during the pain-free follicular phase.

Increased risk of dementia in patients with Schizophrenia: A population-based cohort study in Taiwan

Background:

The extent to which schizophrenia is associated with the risk of all-cause dementia is controversial. This study investigated the risk of dementia by type in patients with schizophrenia.

Methods:

Data were collected from the Taiwanese National Health Insurance Database 2005 and analyzed using multivariate Cox proportional hazard regression models to determine the effect of schizophrenia on the dementia risk after adjusting for demographic characteristics, comorbidities, and medications. Fine and Gray's competing risk analysis was used to determine the risk of dementia, as death can act as a competing risk factor for dementia.

Results:

We assessed 6040 schizophrenia patients and 24,160 propensity scale-matched control patients. Schizophrenia patients exhibited a 1.80-fold risk of dementia compared to controls (adjusted hazard ratio [aHR] = 1.80, 95% confidence interval [CI] = 1.36 ∼ 2.21,p <0.001) after adjusting for covariates. Cardiovascular disease (aHR = 5.26; 95% CI = 4.50 ∼ 6.72;p <0.001), hypertension (aHR = 1.83; 95% CI = 1.77 ∼ 2.04;p= 0.002), traumatic head injury (aHR = 1.35; 95% CI = 1.24 ∼ 1.78;p <0.001), chronic lung diseases (aHR = 1.64; 95% CI = 1.13 ∼ 2.56;p <0.001), alcohol-related disorders (aHR = 3.67; 95% CI = 2.68 ∼ 4.92;p <0.001), and Parkinson’s disease (aHR = 1.72; 95% CI = 1.25 ∼ 2.40;p <0.001) were significantly associated with dementia risk. Notably, first-generation antipsychotics (aHR = 0.80; 95% CI = 0.56 ∼ 0.95;p=0.044) and second-generation antipsychotics (aHR = 0.24; 95% CI = 0.11 ∼ 0.60;p <0.001) were associated with a lower dementia risk. Sensitivity tests yielded consistent findings after excluding the first year and first 3 years of observation. Patients with schizophrenia had the highest risk of developing Alzheimer’s [dementia/disease?] among dementia subtypes (aHR = 2.10; 95% CI = 1.88 ∼ 3.86;p< 0.001), followed by vascular dementia (aHR = 1.67; 95% CI = 1.27 ∼ 2.12;p< 0.001) and unspecified dementia (aHR = 1.30; 95% CI = 1.04 ∼ 2.01;p< 0.001).

Conclusions:

Schizophrenia was significantly associated with the risk of all-cause dementia. Data are scarce on the mechanisms through which antipsychotic agents protect persons with schizophrenia from developing dementia. Further research is recommended to elucidate the neurobiological mechanisms underlying the association between schizophrenia and dementia, and whether antipsychotics protect against the development of dementia in schizophrenia.

Manifold decoding for neural representations of face viewpoint and gaze direction using magnetoencephalographic data

The main challenge in decoding neural representations lies in linking neural activity to representational content or abstract concepts. The transformation from a neural-based to a low-dimensional representation may hold the key to encoding perceptual processes in the human brain. In this study, we developed a novel model by which to represent two changeable features of faces: face viewpoint and gaze direction. These features are embedded in spatiotemporal brain activity derived from magnetoencephalographic data. Our decoding results demonstrate that face viewpoint and gaze direction can be represented by manifold structures constructed from brain responses in the bilateral occipital face area and right superior temporal sulcus, respectively. Our results also show that the superposition of brain activity in the manifold space reveals the viewpoints of faces as well as directions of gazes as perceived by the subject. The proposed manifold representation model provides a novel opportunity to gain further insight into the processing of information in the human brain.

Increased prevalence and risk of anxiety disorders in adults with tinnitus: A population-based study in Taiwan

OBJECTIVE

Tinnitus is a common disorder that may cause psychological distress and anxiety. The aim of this study was to investigate the association between anxiety disorders (ADs) and tinnitus in a large population.

METHOD

We conducted a cross-sectional study using the National Health Insurance Research Database in Taiwan. Study subjects included 14,772 patients with tinnitus and 709,963 people in the general population who sought treatment in 2005. Distributions in ADs, age, sex, and medical comorbidities were compared between groups using chi-squared tests. Multivariate logistic regression models adjusted for age, sex, and medical comorbidities were used to analyze the association between tinnitus and ADs.

RESULTS

Prevalence of ADs in tinnitus and general population groups was 3.9% and 1.5%, respectively, and this difference was significant (P<0.001). Diabetes mellitus, hypertension, hyperlipidemia, concussion or head injury, Meniere's disease, sensorineural hearing impairment, renal disease, coronary artery disease, and cerebrovascular disease were significantly more prevalent in the tinnitus group (all P-values<0.001). Multivariate logistic regression model demonstrated that patients with tinnitus were significantly associated with increased risk of ADs (adjusted OR=1.99; 95% CI=1.81-2.19; P<0.001).

CONCLUSION

Because the risk of ADs was significantly higher in patients with tinnitus than in the general population, physicians should be aware of the importance of psychological factors in tinnitus management.