The "why" and "how" of JointICA: results from a visual detection task

Since several years, neuroscience research started to focus on multimodal approaches. One such multimodal approach is the combination of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). However, no standard integration procedure has been established so far. One promising data-driven approach consists of a joint decomposition of event-related potentials (ERPs) and fMRI maps derived from the response to a particular stimulus. Such an algorithm (joint independent component analysis or JointICA) has recently been proposed by Calhoun et al. (2006). This method provides sources with both a fine spatial and temporal resolution, and has shown to provide meaningful results. However, the algorithm's performance has not been fully characterized yet, and no procedure has been proposed to assess the quality of the decomposition. In this paper, we therefore try to answer why and how JointICA works. We show the performance of the algorithm on data obtained in a visual detection task, and compare the performance for EEG recorded simultaneously with fMRI data and for EEG recorded in a separate session (outside the scanner room). We perform several analyses in order to set the necessary conditions that lead to a sound decomposition, and to give additional insights for exploration in future studies. In that respect, we show how the algorithm behaves when different EEG electrodes are used and we test the robustness with respect to the number of subjects in the study. The performance of the algorithm in all the experiments is validated based on results from previous studies.     

Early Impact of Bariatric Surgery on Type II Diabetes,Hypertension, and Hyperlipidemia: A Systematic Review,Meta-Analysis and Meta-Regression on 6,587 Patients

Background

This study aims to evaluate the 12–24-month impact of bariatric surgery on the foremost modifiable traditional risk factors of cardiovascular disease.

Methods

A systematic review and meta-analysis of prospective interventional studies reporting the most commonly performed laparoscopic surgical procedures, i.e., Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and cardiovascular risk reduction after surgery.

Results

The bibliographic research conducted independently by two authors yielded 18 records. When looking at RYGB and AGB separately, we observed a relevant heterogeneity (I ² index ≥87 %) when BMI reduction was considered as the main outcome. When hypertension, type II diabetes, and hyperlipidemia risk reduction was estimated, a highly significant beneficial effect was found. The risk reduction was 0.33 [0.26; 0.42] for type II diabetes, 0.52 [0.42; 0.64] for hypertension, and 0.39[0.27; 0.56] for hyperlipidemia (P?<?0.0001 for all outcomes considered). When looking at surgical technique separately, a higher but not statistically significant risk reduction for all outcomes considered was found. Results from the meta-regression approach showed an inverse relation between cardiovascular risks and BMI reduction.

Conclusions

The present study showed an overall reduction of cardiovascular risk after bariatric surgery. According to our analysis a BMI reduction of 5 after surgery corresponds to a type II diabetes reduction of 33 % (as reported by Peluso and Vanek (Nutr Clin Pract 22(1):22–28, 2007); SAS Institute Inc., (2000–2004)), a hypertension reduction of 27 % (as reported by Buchwald and Oien (Obes Surg 23(4):427–436, 2013); Valera-Mora et al. (Am J Clin Nutr 81(6):1292–1297, 2005)), and a hyperlipidemia reduction of 20 %(as reported by Adams et al. (JAMA 308(11):1122–31, 2012)); Alexandrides et al. (Obes Surg 17(2):176–184, 2007). In summary, our study showed that laparoscopic bariatric surgery is an effective therapeutic option to reduce the cardiovascular risk in severe obese patients.     

Are urological procedures in tetraplegic patients safely performed without anesthesia? a report of three cases

Background

Some tetraplegic patients may wish to undergo urological procedures without anaesthesia, but these patients can develop autonomic dysreflexia if cystoscopy and vesical lithotripsy are performed without anaesthesia.

Case presentation

We describe three tetraplegic patients, who developed autonomic dysreflexia when cystoscopy and laser lithotripsy were carried out without anesthesia. In two patients, who declined anaesthesia, blood pressure increased to more than 200/110 mmHg during cystoscopy. One of these patients developed severe bleeding from bladder mucosa and lithotripsy was abandoned. Laser lithotripsy was carried out under subarachnoid block a week later in this patient, and this patient did not develop autonomic dysreflexia. The third patient with C-3 tetraplegia had undergone correction of kyphoscoliotic deformity of spine with spinal rods and pedicular screws from the level of T-2 to S-2. Pulmonary function test revealed moderate to severe restricted curve. This patient developed vesical calculus and did not wish to have general anaesthesia because of possible need for respiratory support post-operatively. Subarachnoid block was not considered in view of previous spinal fixation. When cystoscopy and laser lithotripsy were carried out under sedation, blood pressure increased from 110/50 mmHg to 160/80 mmHg.

Conclusion

These cases show that tetraplegic patients are likely to develop autonomic dysreflexia during cystoscopy and vesical lithotripsy, performed without anaesthesia. Health professionals should educate spinal cord injury patients regarding risks of autonomic dysreflexia, when urological procedures are carried out without anaesthesia. If spinal cord injury patients are made aware of potentially life-threatening complications of autonomic dysreflexia, they are less likely to decline anaesthesia for urological procedures. Subrachnoid block or epidural meperidine blocks nociceptive impulses from urinary bladder and prevents occurrence of autonomic dysreflexia. If spinal cord injury patients with lesions above T-6 decline anaesthesia, nifedipine 10 mg should be given sublingually prior to cystoscopy to prevent increase in blood pressure due to autonomic dysreflexia.     

A controlled study on the effect of verapamil on atrial tachycaarrhythmias in patients with brady-tachy syndrome implanted with a DDDR pacemaker

While verapamil has been proposed as a treatment for reducing electrophysiological remodeling due to atrial fibrillation and atrial tachyarrhythmias, no previous study has tested its effects in brady-tachy patients implanted with a dual-chamber pacemaker. Fourteen patients with frequent episodes of atrial fibrillation (> or =2 episodes/month) in the setting of brady-tachy syndrome, implanted with a DDDR pacing system with extensive monitor function (Selection 900, Vitatron) were enrolled. Four months after implantation, they were randomly allocated to a 2-month period of treatment with verapamil (240 mg/day) or to no treatment, followed by a crossover. The burden of atrial tachyarrhythmias, the total number of hours spent in atrial tachyarrhythmia and the mean number of hours per day spent in atrial tachyarrhythmia were retrieved from diagnostic devices. The accuracy of atrial tachyarrhythmias detection was confirmed independently by two observers. The main results showed that treatment with verapamil was associated with a trend towards an higher percentage of atrial pacing in comparison with control (mean value+/-S.D.=63.2+/-29.9% vs. 57.3+/-30.6%, median value 53% vs. 49%, P value at Wilcoxon signed rank test=0.069), but without any significant reduction in atrial tachyarrhythmia burden (4.5+/-11.8 vs. 3.3+/-9.1%) or total hours spent in atrial tachyarrhythmia (65+/-161 vs. 48+/-131 h). Palpitation episodes were not significantly reduced by verapamil treatment in comparison with control (10.3+/-7.8 vs. 6.1+/-6.5). In conclusion, verapamil does not exert any beneficial effect on documented episodes of atrial tachyarrhythmia in patients with brady-tachy syndrome implanted with a DDDR device. Moreover, this drug was ineffective in reducing the number of palpitation episodes reported by the patient.     

Interstitial cells of Cajal in the gut-A gastroenterologist’s point of view

Alterations of normal function of interstitial cells of Cajal （ICC） are reported in many intestinal disorders. Diagnosis of their involvement is rare （infrequent）, but necessary to propose a specifi c treatment. This article reviews the place of ICC in the pathogenesis of achalasia, gastroesophageal reflux disease, infantile hypertrophic pyloric stenosis, chronic intestinal pseudoobstruction and slow transit constipation. Moreover we discuss the role of the Cajal cells in the development of stromal tumors of the gastrointestinal tract.     

Characterizing Biomedical HIV Prevention Awareness and Use Among Black Transgender Women in the United States

Black transgender women (BTW) in the United States experience disproportionate rates of HIV despite biomedical prevention interventions such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP). Using a sample of 490 BTW collected from 2014 to 2017, bivariate, multivariable, and multinomial analyses were conducted to determine factors associated with awareness and use of PrEP and nPEP. BTW living with HIV were more aware of PrEP than HIV-negative BTW. Structural, demographic, and trans-specific factors (e.g., experiences of homelessness, violence, and current hormone use) related to HIV risk were associated with PrEP and nPEP awareness. PrEP use was associated with behavioral HIV risks (e.g., STI diagnosis, having an HIV-positive partner, and needle-sharing) and may demonstrate risk recognition among BTW. Knowing someone using PrEP was significantly positively associated with PrEP use. Development of guidelines for PrEP and nPEP use for BTW should leverage the strengths of guidelines for other populations, while also acknowledging the unique risks for this population.

     

Left Atrial Structure and Function,and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review

Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.     

Food Habits and Screen Time Play a Major Role in the Low Health Related to Quality of Life of Ethnic Ascendant Schoolchildren

The objective of the present study was to determine the association between lifestyle parameters (i.e., physical activity (PA) level, screen time (ST), fitness and food habits) and health-related quality of life (HRQoL) in ethnic ascendant schoolchildren (i.e., Mapuche ascendant). This cross-sectional study included 619 schoolchildren with ethnic (EA; n = 234, 11.6 ± 1.0 years) and non-ethnicity ascendant (NEA; n = 383, 11.7 ± 1.1 years) from Araucanía, Chile. HRQoL and lifestyle were measured using a standard questionnaire and cardiometabolic markers (body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), systolic (SBP) and diastolic blood pressure (DBP)) and cardiorespiratory fitness (CRF) were additionally included. In the EA schoolchildren, the HRQoL reported association with CRF adjusted by age and sex (β; 0.12, p = 0.018) and non-adjusted with foods habits (β; 0.11, p = 0.034). By contrast, ST adjusted by age and sex presented an inverse association with HRQoL (β; −2.70, p < 0.001). EA schoolchildren showed low HRQoL (p = 0.002), low nutritional level (p = 0.002) and low CRF (p < 0.001) than NEA peers. Moreover, children’s ethnic presence showed an association with low nutritional levels (odd ratio (OR): 3.28, p = 0.002) and ST 5 h/day (OR: 5.34, p = 0.003). In conclusion, in the present study, EA schoolchildren reported lower HRQoL than NEA schoolchildren, which could be explained by the lifestyle patterns such as a low nutritional level and more ST exposure.