The awareness of social inference task (TASIT) updated: Signal detection theory (SDT) in emotion recognition and its link to psychotic symptoms

Introduction

Social cognition (SC) is an impaired domain in schizophrenia. However, little is known on the Signal Detection properties of SC deficits.

We analyzed the relationship between emotion perception and psychotic symptoms in a sample of schizophrenic patients. For this scope, we extended the scoring system of the awareness of social inference task-emotion recognition (TASIT-ER) according to signal detection theory (SDT).

Methods

Sample:

– one hundred and nineteen inpatients from L’Aquila Inpatient unit diagnosed with schizophrenia.

Dependent variable:

– Positive and Negative Syndrome Scale (PANSS)’s Positive, Negative, Disorganized, Excited and Depressed dimensions, and total score.

Independent variable:

– a modified version of TASIT-ER. The original scoring system, including only “HITs”, was extended with “False Alarm” (FA), defined as a detection of an emotion when not present.

Statistical analysis:

– multivariable linear regression models for each sub-group of emotions to assess the effect of FAs on psychotic symptoms compared to HITs.

Results

FAs on positive emotions were associated with disorganized (b = 31.95), excited dimensions (b = 41.84) and PANSS Total (b = 152.46); FAs on negative emotions were associated with Excited dimension (b = −57.97) and PANSS Total (b = −243.70). HITs on Negative emotions were associated with Negative (b = −13.37), Disorganized (b = −8.64) Excited (b = −8.74) dimensions and with PANSS total (b = −45.30).

Discussion

FA rates were more strongly associated with total PANSS score than HIT rate, suggesting a prominent role of false recognition in defining psychotic symptoms, especially disorganized and excited ones, consistently with computational models of psychosis that rationalize false recognition as failures of active inference systems in updating their predictive model of sensory information.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Lack of insight as a third variable between subjective appraisal of cognitive impairment and psychotic symptoms

Background

The relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly impacts on both factors. Our aim is to further asses the relationship between the subjective perception of cognitive deficits, symptom severity and lack of Insight as a mediator variable.

Methods

A total of 109 subject diagnosed with schizophrenia. Positive and Negative Syndrome Scale (PANSS) was modelled as dependent variable; Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) was modeled as independent variable and “Lack of Insight” (LoI) PANSS Item was tested as a mediator variable. Mediation was assessed using the Sobel Mediation Test.

Results

LoI acts as a suppressor variable (i.e. it enhances the relation between the independent and dependent variable) between SSTICS and negative symptoms, while showing a mediator effect between SSTICS and depressive symptoms.

Discussion

LoI has a central role in mediating the relationship between subjective appraisal of cognitive deficits on the one hand and positive and depressed symptoms on the other. Its suppressor role between SSTICS and depression is consistent with several reports of an enhanced risk of depression in patients fully aware of their disability. Its mediator role between STICSS and positive symptoms supports the centrality of LoI as a metacognitive function whose failure may worsen psychotic symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Gene expression differences between disseminated tumor cells and tumor cells from overt bone metastases in patients with metastatic breast cancer

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Background: Despite extensive work evaluating molecular differences between primary tumors, circulating tumor cells, disseminated tumor cells (DTCs) and established metastases, it is not apparent which genetic alterations are required to form viable, independent bone metastases (BM). A major limitation in exploring the genetic differences between DTCs and established BM is the paucity of fresh BM tissue available. Methods: Ten breast cancer patients with BM underwent a CT-guided BM biopsy and a bone marrow aspiration (for DTCs). Tumor cells were enriched by immunomagnetic separation and RNA was extracted from each sample. Gene expression profiling was conducted using Illumina Human Ref-8 bead arrays. Microarray data was analyzed using BeadStudio software to identify differentially expressed genes. Ingenuity Pathway Analysis software was used to identify genes integral to specific pathways involved in tumor dissemination. Results: The yield of analyzable malignant cells from BM and bone marrow aspirates was 60% and 80%, respectively. A signature of 133 genes was identified that was differentially expressed between the two sample types. Paired analysis of samples from the same patients identified a subset of 161 genes, of which 52 overlapped with the initial unmatched signature. Several genes relevant to breast cancer metastasis to bone (i.e., osteopontin, CTGF, parathyroid hormone receptor, EGFR) were significantly over-expressed in the BM compared to the DTCs. Conclusions: Results suggest that there are specific subsets of genes, which are required for DTCs in the bone marrow to form overt BM. A number of genes identified are already known to participate in osteolytic BM formation. This signature may allow identification of patients at increased risk for developing BM.

No significant financial relationships to disclose.

Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?

Background: Decisions about systemic treatment of women with metastatic breast cancer are often based on estrogen receptor (ER), progesterone receptor (PgR), and Her2 status of the primary tumor. This study prospectively investigated concordance in receptor status between primary tumor and distant metastases and assessed the impact of any discordance on patient management.

Materials and methods: Biopsies of suspected metastatic lesions were obtained from patients and analyzed for ER/PgR and Her2. Receptor status was compared for metastases and primary tumors. Questionnaires were completed by the oncologist before and after biopsy to determine whether the biopsy results changed the treatment plan.

Results: Forty women were enrolled; 35 of them underwent biopsy, yielding 29 samples sufficient for analysis; 3/29 biopsies (10%) showed benign disease. Changes in hormone receptor status were observed in 40% (P = 0.003) and in Her2 status in 8% of women. Biopsy results led to a change of management in 20% of patients (P = 0.002).

Conclusions: This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence.

Image-guided focused ultrasound ablation of breast cancer: current status, challenges, and future directions

Image-guided focussed ultrasound (FUS) ablation is a non-invasive procedure that has been used for treatment of benign or malignant breast tumours. Image-guidance during ablation is achieved either by using real-time ultrasound (US) or magnetic resonance imaging (MRI). The past decade phase I studies have proven MRI-guided and US-guided FUS ablation of breast cancer to be technically feasible and safe. We provide an overview of studies assessing the efficacy of FUS for breast tumour ablation as measured by percentages of complete tumour necrosis. Successful ablation ranged from 20% to 100%, depending on FUS system type, imaging technique, ablation protocol, and patient selection. Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented. Finally, potential future applications of FUS for breast cancer treatment such as FUS-induced anti-tumour immune response, FUS-mediated gene transfer, and enhanced drug delivery are discussed. Currently, breast-conserving surgery remains the gold standard for breast cancer treatment.

Influence of post-treatment delay on the evaluation of the response to focused ultrasound surgery of breast cancer by dynamic contrast enhanced MRI

The assessment of the effectiveness of MRI-guided focused ultrasound surgery (MRIgFUS) of breast carcinomas can be performed by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters which monitor the presence of residual tumour. The aim of this study was to evaluate the effect of the post-treatment delay on this assessment. DCE-MRI data were acquired immediately and 3-14 days after MRIgFUS treatment of 26 tumours (<7 days, n = 6; = or > ge;7 days, n = 20). The percentage of residual tumour was determined histologically on the resected mass and correlated with two DCE-MRI parameters: increase in signal intensity (ISI) and positive enhancement integral (PEI). No correlation could be found between DCE-MRI data acquired immediately after treatment and the percentage of residual tumour. Good correlation coefficients were found for data acquired several days after treatment (ISI, r = 0.749; PEI, r = 0.778). However, they were higher when the post-treatment time interval was 7 days or more (ISI, r = 0.962; PEI, r = 0.934). These results suggest that a post-treatment delay of 7 days is necessary for the accurate assessment of the presence of residual tumour by DCE-MRI parameters.

Relationship between pre-TIPS liver perfusion by the portal vein and the incidence of post-TIPS chronic hepatic encephalopathy

OBJECTIVE

In the present study we evaluated the predictive value of pretransjugular intrahepatic portosystemic shunt (TIPS) portal perfusion as assessed by Doppler ultrasonography for the onset of chronic encephalopathy after TIPS.

METHODS

A total of 231 cirrhotic patients were followed-up prospectively after TIPS placement. The pattern of intrahepatic portal flow was assessed before TIPS. Patients were divided into two groups according to Doppler findings. Group 1 comprised patients with prograde portal flow (n = 200), whereas group 2 comprised those with loss of portal perfusion (hepatofugal or back-and-forth flow or portal vein thrombosis; n = 31). The presence of chronic encephalopathy during a median follow-up of 32 months was prospectively recorded. The prognostic value of the following parameters for the onset of chronic recurrent encephalopathy after TIPS was evaluated: age, presence of encephalopathy before TIPS, alcoholism, Pugh score, and loss of portal perfusion before TIPS. The independent prognostic value of each variable was tested with a multiple logistic regression analysis.

RESULTS

The two groups were comparable in terms of age, incidence of prior episodes of hepatic encephalopathy, and portacaval gradient before and after the procedure; however, liver failure was more severe in patients in group 2 (Pugh score: 9.2 +/- 1.9 vs 10.3 +/- 1.7). The 3-yr survival was identical for both groups; 25% of the 200 patients in group 1 developed chronic encephalopathy as compared to 6% of the 31 patients in group 2 (p = 0.03). Multiple logistic regression analysis demonstrated that loss of portal perfusion and age >65 yr were the only independent predictors of the onset of post-TIPS chronic encephalopathy (odds ratios 0.24 and 1.98, respectively).

CONCLUSIONS

Cirrhotic patients with loss of portal perfusion before TIPS were protected against post-TIPS chronic hepatic encephalopathy despite a more severe liver dysfunction at baseline. The only other independent predictive factor for the onset of this complication was age.

New imaging techniques for the evaluation of gastrointestinal diseases

This article provides an overview of recently developed, noninvasive imaging modalities for the evaluation of gastrointestinal disease processes. The advent of spiral computed tomography, magnetic resonance cholangiopancreatography and conventional magnetic resonance imaging has facilitated the noninvasive assessment of pancreaticobiliary disease. Magnetic resonance cholangiopancreatography provides projectional images of the biliary tree and pancreatic duct, similar to those achieved by direct cholangiography, without the need to administer contrast medium. Spiral computed tomographic colonography provides virtual colonoscopic images of the colonic mucosa, allowing the detection of polyps without the risk associated with colonoscopy.

Effect of the learning process on procedure times and radiation exposure for CT fluoroscopy-guided percutaneous biopsy procedures

PURPOSE

To assess if the learning process associated with computed tomography fluoroscopy (CTF) technology influences procedure and fluoroscopy times for percutaneous biopsy procedures.

MATERIALS AND METHODS

Prospective analysis of the initial 250 consecutive patients who underwent percutaneous biopsy with use of a CT scanner equipped with rapid image reconstruction and fluoroscopic capabilities in a 24-month period. All procedures were performed with both continuous and spot fluoroscopic technique, with typical radiation parameters of 50 mA, 120 kV, and a 10-mm-slice thickness. The procedures were all performed by a single experienced interventional radiologist to limit the variables of physician expertise, interventional materials used, and biopsy approach. The subject group was divided into five equal consecutive groups of 50 patients. In each subgroup, the authors recorded mean lesion size, success, and complication rates, as well as mean procedure and fluoroscopy times.

RESULTS

The five subgroups were similar patient populations as documented by the absence of statistically significant differences when comparing mean lesion size, procedure success, and complication rates (P > .05; ANOVA test). A statistically significant decrease in mean fluoroscopy (groups 1-5: 50.26 vs 45.24 vs 33.86 vs 32.68 vs 25.8 sec/patient) and mean procedure times (groups 1-5: 30.08 vs 27.9 vs 26.34 vs 25.6 vs 21.6 min/patient) was recorded between the patient subgroups (P < .0001; ANOVA test).

CONCLUSION

The learning process associated with CTF technology impacts procedure parameters by decreasing both mean procedure and fluoroscopy times, thereby increasing patient turnover and decreasing radiation exposure to the patient and the operator.

Value of CT fluoroscopy for percutaneous biopsy procedures

PURPOSE

To assess the clinical impact of computed tomographic (CT) fluoroscopy (CTF) with regard to procedure time and success rate for CT image-guided biopsy procedures.

MATERIALS AND METHODS

One hundred ninety consecutive patients referred to the same radiologist underwent biopsy procedures performed with use of a CT scanner equipped with fluoroscopic capabilities during a 15-month period. CTF procedures were performed predominantly by means of a continuous fluoroscopic technique, with typical exposure factors of 50 mA at 120 kV and a slice thickness of 10 mm. The total procedure time, fluoroscopy time, and complication and procedure success rates were documented prospectively in this group. A control group consisted of retrospective analysis of 93 consecutive patients who had undergone a classic CT-guided procedure performed by the same radiologist.

RESULTS

Procedure success rate was increased in the CTF group (93.7 versus 88.2%), although the difference was not statistically significant (P > .05: Fisher exact test). A statistically significant difference was noted when comparing mean procedure times (CTF, 27.56 minutes; range, 20-60 minutes versus control, 43.17 minutes; range, 35-80 minutes; P < .0001; Welch unpaired t test).

CONCLUSION

CT fluoroscopy facilitates CT-guided biopsy procedures by allowing visualization of the needle trajectory from skin entry to the target point, allowing procedures to be performed more rapidly and efficiently.

Computed tomographic abscessogram: a useful tool for evaluation of percutaneous abscess drainage

OBJECTIVE

To evaluate the role of computed tomographic abscessograms (CTABs, consisting of injection of contrast medium through a drainage catheter followed by computed tomographic examination) in the management of patients referred for percutaneous abscess drainage (PAD).

PATIENTS AND METHODS

Over 50 months, 169 patients with 203 abscesses underwent PAD, and 432 CTABs were performed. CTAB was assessed for its ability to influence treatment decisions, detect fistulae and visualize the septic process.

RESULTS

CTABs allowed the detection of fistulous communications in 32% (65/203) of abscesses. In 60 of the 65 patients with fistulae (92%), the specific etiology of the abscess cavity was established through analysis of CTABs. The presence of a pathologic fistula prolonged the catheter drainage time (20.5 v. 11.9 days, p < 0.0001), and the success rate was lower if the drainage catheter was removed before the fistula was closed (90% v. 72%). CTAB images influenced catheter-manipulation decisions for 23 of the 169 patients (14%).

CONCLUSION

CTABs provide important information about the underlying pathologic process while allowing detection of fistulae and ultimately influencing interventional treatment for PAD.

Aortic graft infection: the value of percutaneous drainage

OBJECTIVE

The goal of this study was to compare patients with aortic graft infection treated by primary percutaneous drainage with patients who initially underwent surgery.

MATERIALS AND METHODS

A retrospective review of 23 consecutive patients treated for aortic graft infection was performed. Eleven patients were initially treated with percutaneous drainage and 12 were treated with surgery. The morbidity, mortality, and postprocedural reintervention rates and clinical outcome were analyzed for each group.

RESULTS

The septic process resolved in nine (82%) of 11 patients treated with percutaneous drainage. Of these nine patients, four were treated with percutaneous drainage alone. Drainage was followed by removal of the infected prosthetic graft in the remaining five patients. In the surgical group, sepsis resolved in only four patients (33%) (p = .036). No periprocedural deaths occurred in the percutaneous drainage group, whereas six patients in the surgical group died in the perioperative period (p = .014).

CONCLUSION

Percutaneous drainage can be used as an initial form of treatment in the management of aortic graft infections. Surgery after percutaneous drainage appears to be safer than surgery alone.

Percutaneous drainage of intra-abdominal abscesses in Crohn's disease: short and long-term outcome

OBJECTIVE

To determine whether percutaneous drainage of Crohn's abscesses obviates the need for early surgical drainage.

METHODS

All cases of percutaneous drainage of Crohn's abscesses between 1990 and 1995 were reviewed and classified as a success or failure on the basis of the need for surgery within < 30 days of catheter removal.

RESULTS

Twenty-seven drainage procedures were performed in 24 patients; 15 (56%) were classified as successes, and 12 (44%) were classified as failures. Successes and failures did not significantly differ with respect to patient demographics and Crohn's disease characteristics. Patients whose abscesses were successfully drained had significantly fewer associated fistulae (46.6 vs 92.0%, p = 0.037), and their abscesses tended more often to be first (vs recurrent), spontaneous (vs postoperative), located in the right lower quadrant, and smaller. Patients whose abscesses were successfully drained also tended to spend more time with the catheter in place and to require more imaging procedures. Complications were noted in four cases (15%), enterocutaneous fistula at the site of catheter insertion in three cases and postprocedure fever in one case. Hospital stay was significantly shorter after successful drainage (16.3 +/- 6.9 vs 31.7 +/- 22.1 days, p = 0.017). After a total of 543.5 patient-months of follow-up, subsequent intra-abdominal Crohn's-related surgery was required in only two of the successes and one failure.

CONCLUSIONS

1) Percutaneous drainage of Crohn's abscess successfully obviates the need for early surgery in approximately 50% of cases, and this benefit is maintained on long term follow-up. 2) Percutaneous drainage shortens hospital stay. 3) Crohn's abscesses in various locations, single or multiple, with or without an associated fistula may be successfully drained percutaneously. 4) Presence of an associated fistula may be a risk factor for failure.

Postoperative changes, complications, and recurrent disease after Whipple's operation: CT features

Whipple's operation consists of resection of the pancreatic head and duodenum, followed by pancreaticojejunostomy, choledochojejunostomy, and gastrojejunostomy or duodenojejunostomy. Indications include neoplasms of the periampullary region, symptomatic chronic pancreatitis, and, occasionally, trauma CT is useful in diagnosing postoperative complications and in detecting disease recurrence during long-term follow-up. This complex surgical procedure causes alterations of the normal anatomy, which may lead to difficulty interpreting images. Familiarity with the appearance of postoperative changes and common complications and with patterns of disease recurrence is a prerequisite to accurate interpretation of CT scans in these patients.

Splenic vein thrombosis after splenectomy: frequency and role of imaging

PURPOSE

To assess the frequency of splenic vein thrombosis (SVT) after splenectomy and its consequences on patient treatment.

MATERIALS AND METHODS

A group of 183 consecutive patients who underwent splenectomy were evaluated. Of these patients, 119 underwent postoperative ultrasound (US) or computed tomography.

RESULTS

SVT was diagnosed in 13 of 119 patients in the first 2 weeks after surgery. In these 13 patients, splenectomy had been performed for hematologic disorders (n = 12) or trauma (n = 1). Seven of the 13 patients were asymptomatic. After anticoagulant therapy, follow-up US of 12 patients showed resolution of thrombosis with no complications in 10 patients; two patients developed cavernous transformation of the portal vein.

CONCLUSION

Since only 65% of patients underwent imaging, the true frequency of SVT could not be determined; however, it occurred in at least 7% of patients who underwent splenectomy. Routine Doppler US should be performed after splenectomy to allow early anticoagulant therapy in patients with SVT.

Hepatic artery: effect of a meal in healthy persons and transplant recipients

Thirty healthy volunteers and 12 liver allograft recipients (two with cirrhotic changes seen at microscopy) were given a standard meal. Doppler sonography of the right and left hepatic arteries, the superior mesenteric artery, and the portal vein was performed. The change in hepatic arterial resistance was evaluated with the resistive index (RI). After the standard meal, portal venous flow increased in both the healthy volunteers and allograft recipients (more so in the latter group). Superior mesenteric arterial RI decreased in all subjects. A postprandial increase in hepatic arterial RI, likely reflecting constriction of the hepatic artery, was seen in both groups. It was absent in the two patients with recurrent transplant cirrhosis. These results show the importance of examining hepatic arterial flow in the fasting subject, since high resistance after a meal may be falsely interpreted as a sign of disease. Absence of a postprandial change in resistance of the hepatic artery could signal abnormal liver function.

Air in the portal vein: sonographic and Doppler manifestations

Three patients with portal venous gas (one with radiographic and computed tomographic findings) had similar sonographic and Doppler patterns in the portal vein (PV). These patterns consisted of hyperechogenic foci moving within the lumen of the PV, producing sharp bidirectional spikes superimposed on the usual Doppler tracing of the PV. An injection of 0.25-0.50 cm3 of air, oxygen, nitrogen, and carbon dioxide into the jejunal vein of nine dogs yielded identical portal venous sonographic and Doppler patterns. In addition, the liver parenchyma of the dogs became hyperechogenic after the injection of gas. Gas in the PV is accompanied by the following signs: echogenic, moving foci within the lumen of the PV; sharp spikes on Doppler spectral display; and hyperechogenic foci within the liver parenchyma.

CT, MRI, and angiography of venous angiomas: a comparative study

Seventeen venous angiomas in 16 patients were evaluated radiologically at the Montreal Neurological Hospital. Radiologic investigations included contrast-enhanced computed tomograms (CECT) in 15 patients, cerebral angiograms with a long venous phase study in 15, and magnetic resonance (MR) imaging with a spin-echo pulse sequence technique in six. CECT revealed abnormalities including six nodular nonspecific enhancing lesions and nine enhanced draining veins, whereas plain CT revealed intracerebral hemorrhages in four patients and calcification in one. All the angiograms showed the characteristic pattern of venous angiomas consisting of medullary veins converging to a large draining vein during the late venous phase. All six patients examined by MR showed abnormal vascular structures; parenchymal hemorrhages were present in two patients. In five patients with venous angiomas, medullary veins converging to a large draining vein were demonstrated as echo-void curvilinear structures. In two patients, the increased signal from medullary veins in long echo delay sequences was suggestive of a slow venous flow rate. Demonstration of the venous nature of the malformation may, in the future, obviate the need for angiography.

Sonography of neck masses in children: is it useful?

111 patients aged two days to 20 years with neck masses were examined by ultrasound. Results were compared to subsequent histo-pathological or clinical diagnosis. Sonography allowed us to divide neck masses into two groups, a sonospecific group in which an accurate presurgical diagnosis was made in 92%, and a non-sonospecific group. The sonospecific group contained 48 patients and included thyroid masses, cystic hygromas, certain cases of adenopathy and a cervical myelomeningocele. The non-sonospecific group contained 63 patients and included a variety of neck masses such as dermoid cysts, branchial cleft cysts, the majority of cases of adenopathy, hemangiomas, lymphangiomas and various other neoplastic masses. Sonography serves to delineate the extent of neck masses, define the relationship of the mass to the thyroid and major neck vessels and guide fine needle aspiration biopsy.