Stimulus probability affects the visual N700 component of the event-related potential

ObjectiveTo examine whether the occipito-temporal visual N700 component of the event-related potential is sensitive to stimulus probabilities.MethodsP1, N1, P3, and, in particular, the occipito-temporal N700 component of the event-related potential were analysed in response to frequent and rare non-target letters of a continuous performance task in 200 healthy adolescents. Additionally, amplitude habituation with time was examined for the occipito-temporal N700 and N1 components.ResultsThe visual P1, N1, and occipito-temporal N700 components were significantly larger in response to rare letters than to frequent letters, whereas the P3 component demonstrated no amplitude difference. Over time, the occipito-temporal N700 amplitude decreased in response to the rare letters, while the N1 amplitude increased, to both, frequent and rare letters.ConclusionsThis study provides first evidence that the visual occipito-temporal N700 is sensitive to stimulus probabilities, suggesting an enhanced post-processing of rare stimuli in secondary visual areas. The distinct habituation patterns of occipito-temporal N700 and N1 amplitudes distinguish repetition effects on stimulus post-processing (N700) from those on perception (N1).SignificanceThe enhanced N700 component to rare stimuli might reflect an orienting response and underlying attentional processes. The N700 sensitivity to stimulus probabilities should be examined in patient groups with attentional deficits.     

Higher Risk Taking and Impaired Probability Judgment in Behavioral Addiction

BackgroundAccumulating evidence suggests that deficits in decision-making and judgment may be involved in several psychiatric disorders, including addiction. Behavioral addiction is a conceptually new psychiatric condition, raising a debate of what criteria define behavioral addiction, and several impulse control disorders are equivalently considered as types of behavioral addiction. In this preliminary study with a relatively small sample size, we investigated how decision-making and judgment were compromised in behavioral addiction to further characterize this psychiatric condition.MethodHealthy control subjects (n = 31) and patients with kleptomania and paraphilia as behavioral addictions (n = 16) were recruited. A battery of questionnaires for assessments of cognitive biases and economic decision-making were conducted, as was a psychological test for the assessment of the jumping-to-conclusions bias, using functional near-infrared spectroscopy recordings of prefrontal cortical (PFC) activity.ResultsAlthough behavioral addicts exhibited stronger cognitive biases than controls in the questionnaire, the difference was primarily due to lower intelligence in the patients. Behavioral addicts also exhibited higher risk taking and worse performance in economic decision-making, indicating compromised probability judgment, along with diminished PFC activity in the right hemisphere.ConclusionOur study suggests that behavioral addiction may involve impairments of probability judgment associated with attenuated PFC activity, which consequently leads to higher risk taking in decision-making.     

Mock jurors’ awareness of age-related changes in memory and cognitive capacity

While age-related changes in memory have been well documented, findings about jurors’ perceptions of older witnesses are conflicting. We investigated the effect of victim age (25 vs. 75?years old) and crime severity (victim injured vs. not injured) on mock jurors’ decisions in a robbery trial. Jury-eligible participants (120 women; 84 men) read a mock trial summary and delivered their verdicts online. Mock jurors believed the young victim more than the older victim when the crime was severe, while no age differences emerged for the less severe crime. Whereas previous research demonstrated that juror characteristics were generally associated with culpability, we demonstrated that with case-specific information, these general views became less important. In all, mock jurors were aware of age-related decline in memory provided by eyewitnesses only to a limited extent. Accordingly, in trials involving older witnesses, jurors will benefit from educative information about age-related memory changes.     

Concomitant ablation of atrial fibrillation in rheumatic mitral valve surgery

Objective

Efficacy of atrial fibrillation ablation in rheumatic mitral valve disease has been regarded inferior to that in nonrheumatic diseases. This study aimed to evaluate net clinical benefits by the addition of concomitant atrial fibrillation ablation in rheumatic mitral valve surgery.

Demonstrating effectiveness or demonstrating not ineffectiveness – A potential solution for rare disease drug product development?

ABSTRACT

For review and approval of new drug products, substantial evidence regarding safety and effectiveness of the drug products under investigation are necessarily provided. A traditional approach is to test a null hypothesis of ineffectiveness against an alternative hypothesis of effectiveness at the 5% level of significance. The rejection of the null hypothesis of ineffectiveness is in favor of the alternative hypothesis of effectiveness. This approach, however, is somewhat misleading because the rejection of the null hypothesis of ineffectiveness leads to the conclusion of not ineffectiveness, which consists of the proportion of inconclusiveness and the proportion of effectiveness. In this article, we explore the potential use of the concept of demonstrating not ineffectiveness and then effectiveness for regulatory approval of new drug products, especially for rare disease drug products. For rare disease drug product development, one of the major obstacles and challenges is how to use small patient population available for achieving the same standards for regulatory approval. To address this problem, a two-stage approach by first demonstrating not ineffectiveness and then ruling out (or controlling) the probability of inconclusiveness for demonstrating effectiveness is proposed. The proposed two-stage approach is useful with small patient population available for achieving the same standards for regulatory approval of rare disease drug products.     

Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists

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Ankle fracture follow up using the Chertsey Outcome score for Trauma. Floor and ceiling effect of the scale

BackgroundPatient reported outcome measures (PROMs) are increasingly used by orthopaedic surgeons in order to measure their results. The Chertsey Outcome Score for Trauma (COST) is a recently validated PROM, which treats trauma as pathology, is not site or pathology specific. It measures the rehabilitation of the patients after an injury, using the pre-injury status as the default state of the patients. The aim of the present study was to focus on a narrow group of patients with similar ankle fracture injuries, investigate if there is any floor or ceiling effect of the scale and examine its use during the ankle fracture at the immediate post-injury rehabilitation period.Materials and methodsAll patients who had isolated ankle fractures treated either operatively or conservatively between March 2018 and December 2019, were included in the study. A COST and a FADI questionnaire was completed prior to their follow-up at 2, 6 and 12 weeks post injury/operation. Demographic data were also collected.ResultsA total of 527 COST questionnaires from 314 different patients (aged 51.4 ± 18.4 years) were included in the study. The average COST score was 40.28 ± 18 and the average FADI score was 60.1 ± 21.8. The VAS score reached 3.57 ± 2.2. There was no significant floor and ceiling effect for the COST score. The COST score had good correlation with the FADI score (Spearman’s Rho=0.69) and good internal consistency (Cronbach’s Alpha=0.85).ConclusionNo significant floor or ceiling effect was identified for the COST score, during the short and medium term follow up period following an ankle fracture, treated with either conservative or operative management. The scale was found to be valid and with good internal consistency.     

手术备血现况调查及优化手术备血策略的应用价值探讨

目的回顾分析本院手术备、用血情况,探讨优化手术备血策略的应用价值。方法收集四川大学华西医院2012~2018年的手术备、用血数据,计算输血率、备血输注率、输血指数等指标,评判手术备血合理性,并分别以输血指数≥0.3、输血率≥5%、输血指数≥0.5推荐备血来计算可节省的费用。结果 1)手术备血相对合理的外科科室有心脏外科和烧伤整形科,其他外科科室手术备血存在过度的现象,尤以胸外科最为明显;2)备血率排前15位的手术中,备血较合理的手术有二尖瓣置换术、室间隔修补/封堵、主动脉瓣置换,其他12种手术均存在备血过度的情况,尤以肺切除术最为严重;3)分别用3个指标推荐手术备血,备血人数理论上可减少19%~80%,每年节约检测费用39~128万元。结论本院心脏外科和烧伤整形科的手术备血较为合理,其他科室手术备血过度的现象较普遍,尤其是胸外科,通过建立手术最大备血量目录可减少不必要的备血,从而提高血液资源利用率,节省人力物力资源,减少患者的住院费用。