Posture analysis in predicting fall-related injuries during French Navy Special Forces selection course using machine learning: a proof-of-concept study

INTRODUCTION

Injuries induced by falls represent the main cause of failure in the French Navy Special Forces selection course. In the present study, we made the assumption that probing the posture might contribute to predicting the risk of fall-related injury at the individual level.

METHODS

Before the start of the selection course, the postural signals of 99 male soldiers were recorded using static posturography while they were instructed to maintain balance with their eyes closed. The event to be predicted was a fall-related injury during the selection course that resulted in the definitive termination of participation. Following a machine learning methodology, we designed an artificial neural network model to predict the risk of fall-related injury from the descriptors of postural signal.

RESULTS

The neural network model successfully predicted with 69.9% accuracy (95% CI 69.3-70.5) the occurrence of a fall-related injury event during the selection course from the selected descriptors of the posture. The area under the curve value was 0.731 (95% CI 0.725-0.738), the sensitivity was 56.8% (95% CI 55.2-58.4) and the specificity was 77.7% (95% CI 76.8-0.78.6).

CONCLUSION

If confirmed with a larger sample, these findings suggest that probing the posture using static posturography and machine learning-based analysis might contribute to inform risk assessment of fall-related injury during military training, and could ultimately lead to the development of novel programmes for personalised injury prevention in military population.

Sleep Biomarkers for Stress-Induced Vulnerability to Depression

Stress can push individuals close to the threshold to depression. An individual's intrinsic vulnerability before a stressful event determines how close they come to the threshold of depression. Identification of vulnerability biomarkers at early (before the stressful event) and late (close to the threshold after the stressful event) stages would allow for corrective actions. Social defeat is a stressful event that triggers vulnerability to depression in half of exposed rats. We analyzed the sleep properties of rats before (baseline) and after (recovery) social defeat by telemetry electroencephalogram recordings. Using Gaussian partitioning, we identified three non-Rapid Eye Movement (NREM) stages (N-S1, N-S2, and N-S3) in rats based on a sleep-depth index (relative δ power) and a cortical activity index (fractal dimension). We found (i) that, at baseline, N-S3 lability and high-θ relative power in wake identified, with 82% accuracy, the population of rats that will become vulnerable to depression after social defeat, and (ii) that, at recovery, N-S1 instability identified vulnerable rats with 83% accuracy. Thus, our study identified early and late sleep biomarkers of vulnerability to depression, opening the way to the development of treatments at a prodromal stage for high sensitivity to stress, and for stress-induced vulnerability to depression.

Steady electrocorticogram characteristics predict specific stress-induced behavioral phenotypes

Introduction

Depending on the individual, exposure to an intense stressor may, or may not, lead to a stress-induced pathology. Predicting the physiopathological evolution in an individual is therefore an important challenge, at least for prevention. In this context, we developed an ethological model of simulated predator exposure in rats: we call this the multisensorial stress model (MSS). We hypothesized that: (i) MSS exposure can induce stress-induced phenotypes, and (ii) an electrocorticogram (ECoG) recorded before stress exposure can predict phenotypes observed after stress.

Methods

Forty-five Sprague Dawley rats were equipped with ECoG telemetry and divided into two groups. The Stress group (n = 23) was exposed to an MSS that combined synthetic fox feces odor deposited on filter paper, synthetic blood odor, and 22 kHz rodent distress calls; the Sham group (n = 22) was not exposed to any sensorial stimulus. Fifteen days after initial exposure, the two groups were re-exposed to a context that included a filter paper soaked with water as a traumatic object (TO) reminder. During this re-exposure, freezing behavior and avoidance of the filter paper were measured.

Results

Three behaviors were observed in the Stress group: 39% developed a fear memory phenotype (freezing, avoidance, and hyperreactivity); 26% developed avoidance and anhedonia; and 35% made a full recovery. We also identified pre-stress ECoG biomarkers that accurately predicted cluster membership. Decreased chronic 24 h frontal Low θ relative power was associated with resilience; increased frontal Low θ relative power was associated with fear memory; and decreased parietal β2 frequency was associated with the avoidant-anhedonic phenotype.

Discussion

These predictive biomarkers open the way to preventive medicine for stress-induced diseases.

[The French Armed Forces Biomedical Research Institute (IRBA) and wastewater-based epidemiology: Applicability and relevance in armed forces]

The French Armed Forces Biomedical Research Institute (IRBA) deeply involved in research on SARS-COV-2, participated in the creation of the Obépine sentinel network in charge of detecting, qualifying and quantifying the virus genome in wastewater in France. During this pandemic, wastewater-based epidemiology has proven to be a first class public health tool for assessing viral dynamics in populations and environment. Obépine has also conducted research demonstrating the low infectivity of faeces and wastewater and allowed for early detection of epidemic waves linked to new variants. The IRBA has adapted this powerful tool to the monitoring of viral infections on board the aircraft carrier Charles-de-Gaulle in order to get an operational system for anticipation after the first local outbreak in 2020. The presence of this surveillance and anticipation tool has allowed a better management of SARS-CoV-2 contingent introductions on board during stopovers or crewmembers entries. The combination of a mandatory vaccination protocol and the surveillance of viral circulation in black waters has made it possible to identify and locate cases, and thus to continue the operational mission in the COVID-19 environment while limiting the spread and preserving the health of the crew. This innovative tool can easily be redirected to the search for any other pathogens in blackwater or even, in the long term, to ensure health surveillance of any military establishment, at sea or on land, in France or on overseas bases.

The Relationship between Allostasis and Mental Health Patterns in a Pre-Deployment French Military Cohort

(1) Background: While a number of studies among military personnel focus on specific pathologies such as post-traumatic stress disorder (PTSD), anxiety, and depression, they do not address the cumulative impact on mental health of stressors related to the profession. The present study aims to determine the relationship between allostatic load and mental health status in a cohort of fit-for-duty soldiers prior to their deployment to Afghanistan. The aim is to better-define the consequences of stressor adjustment. (2) Methods: A cohort of 290 soldiers was evaluated in a cross-sectional study with respect to psychopathology (PTSD, anxiety, depression), psychological functioning (stress reactivity, psychological suffering), and allostatic profile (urinary cortisol and 8-iso-PGF2α, blood cortisol and BDNF). A hierarchical cluster analysis was used to identify allostatic patterns. (3) Results: Around 10% of the cohort reported high scores for psychopathology, and biological alterations were identified. For the remainder, four allostatic profiles could be identified by their psychological functioning. (4) Conclusions: Both biological and psychological assessments are needed to characterize subthreshold symptomatology among military personnel. The psychological significance of allostatic load should be considered as a way to improve health outcomes.

Psychophysiological dynamics of emotional reactivity: Interindividual reactivity characterization and prediction by a machine learning approach

The fast reaction of the autonomic nervous system (ANS) to an emotional challenge (EC) is the result of a functional coupling between parasympathetic (PNS) and sympathetic (SNS) branches. This coupling can be characterized by measures of cross-correlations between electrodermal activity (EDA) (under the influence of the SNS) and the RR interval (the interval between R peaks) (under the influence of the PNS and the SNS). Significant interindividual variability has previously been reported in SNS-PNS coupling in emotional situations, and the present study aimed to identify interindividual cross-correlation variability in ANS reactivity. We therefore studied EDA and the RR interval in 62 healthy subjects, recorded during a 24-minute EC. A Gaussian Mixture Model was used to cluster tonic EDA-RR cross-correlations during the EC. This identified two clusters that were characterized by significant or non-significant cross-correlations (SCC and NCC clusters, respectively). The SCC cluster reported higher negative emotion after the EC, while the NCC cluster reported higher scores on the Center for Epidemiologic Studies-Depression scale. The latter finding suggests that NCC is a pathological mood pattern with altered negative perception. Furthermore, a machine learning model that included three parameters indexing the functionality of both branches of the ANS, measured at baseline, predicted cluster membership. Our results are a first step in detecting dysfunctional ANS reactivity in general population.

Subsurface Confinement: Evidence from Submariners of the Benefits of Mindfulness

Objectives

The subsurface ballistic missile nuclear submarine (SSBN) is an extreme professional environment in which personnel are both isolated and confined during patrols, which can last longer than 2 months. This environment is known to degrade submariners’ mood and cognition.

Methods

This exploratory, empirical study followed a cohort of 24 volunteer submariners. Dispositional mindfulness was assessed with the Freiburg Mindfulness Inventory, in order to identify two groups (mindful and non-mindful) and compare change in emotional state, interoception, and health behaviors during the patrol.

Results

Overall, psychological health deteriorated during the patrol. However, mindful submariners demonstrated better psychological adaptation and interoception than the non-mindful group. This was associated with better subjective health behaviors (sleeping and eating).

Conclusions

Dispositional mindfulness appears to protect against the negative effects of long-term containment in a professional environment, such as a submarine patrol. Our work highlights that mindfulness may help individuals to cope with stress in such situations. Developing mindfulness could also be an important preventive healthcare measure during quarantine imposed by the outbreak of a serious infectious disease.

The heartbeat evoked potential does not support strong interoceptive sensibility in trait mindfulness

The enhancement of body awareness is proposed as one of the cognitive mechanisms that characterize mindfulness. To date, this hypothesis is supported by self-report and behavioral measures but still lacks physiological evidence. The current study investigated relation between trait mindfulness (i.e., individual differences in the ability to be mindful in daily life) and body awareness in combining a self-report measure (Multidimensional Assessment of Interoceptive Awareness [MAIA] questionnaire) with analysis of the heartbeat evoked potential (HEP), which is an event-related potential reflecting the cortical processing of the heartbeat. The HEP data were collected from 17 healthy participants under five minutes of resting-state condition. In addition, each participant completed the Freiburg Mindfulness Inventory and the MAIA questionnaire. Taking account of the important variability of HEP effects, analyses were replicated with the same participants three times (in three distinct sessions). First, group-level analyses showed that HEP amplitude and trait mindfulness do not correlate. Secondly, we observed that HEP amplitude could positively correlate with self-reported body awareness; however, this association was unreliable over time. Interestingly, we found that HEP measure shows very poor reliability over time at the individual level, potentially explaining the lack of reliable association between HEP and psychological traits. Lastly, a reliable positive correlation was found between self-reported trait mindfulness and body awareness. Taken together, these findings provide preliminary evidence that the HEP might not support the increased subjective body awareness in trait mindfulness, thus suggesting that perhaps objective and subjective measures of body awareness could be independent.

Heterogeneity of Psychological Profiles in French Army Units and Psychological Changes Between Pre- and Post-deployment: Two Pilot Studies

INTRODUCTION

Over the past two decades, overseas deployments of the French Army have been characterized by the exposure of its service personnel to sustained, high levels of combat stress. There is a need to assess their mental health throughout the deployment cycle, identify risk factors associated with stress-related disorders, and characterize the factors that promote long-term well-being.

METHODS

We conducted two pilot studies within four units of the French Army: a conventional combat unit, a counterterrorist unit, a combat service support unit, and a medical support unit. Study 1 (n = 65) analyzed the psychological functioning of service personnel with respect to their personality and stress management characteristics. Study 2 (n = 40) analyzed the impact of overseas deployment on stress-related psychological outcomes.

RESULTS

Overall, results from study 1 showed that service personnel have a protective psychological functioning, which is particularly developed in the counterterrorist unit. In study 2, although no stress-related disorder symptoms were observed with the psychometric tools used, a certain degree of psychological dysfunction (social dysfunction and lower positive affect) was detected post-deployment.

CONCLUSIONS

These two complementary studies are key elements in developing a better understanding of unmet, medico-military needs that lie on the pathway that links exposure to stressors to impaired health. Certain personnel enrolled in the French Army (notably, the counterterrorist unit) were found to have a high level of protective psychological functioning, largely due to the training they receive. Nevertheless, overall, overseas deployment was associated with poorer psychological functioning and the emergence of social dysfunction, especially in units responsible for the care of service personnel (medical support and combat service support units).

How do we fight COVID-19? Military medical actions in the war against the COVID-19 pandemic in France

'We are at war', French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas. Experts in the field reported major actions conducted by the FMMS during the COVID-19 pandemic in France. In just few weeks, the FMMS developed ad hoc medical capabilities to support national health authorities. It additionally developed adaptive, collective en route care via aeromedical and naval units and deployed a military intensive care field hospital. A COVID-19 crisis cell coordinated the French Armed Forces health management. The French Military Centre for Epidemiology and Public Health provided all information needed to guide the decision-making process. Medical centres of the French Armed Forces organised the primary care for military patients, with the widespread use of telemedicine. The Paris Fire Brigade and the Marseille Navy Fire Battalion emergency departments ensured prehospital management of patients with COVID-19. The eight French military training hospitals cooperated with civilian regional health agencies. The French military medical supply chain supported all military medical treatment facilities in France as well as overseas, coping with a growing shortage of medical equipment. The French Armed Forces Biomedical Research Institute performed diagnostics, engaged in multiple research projects, updated the review of the scientific literature on COVID-19 daily and provided expert recommendations on biosafety. Finally, even students of the French military medical academy volunteered to participate in the fight against the COVID-19 pandemic. In conclusion, in an unprecedented medical crisis, the FMMS engaged multiple innovative and adaptive actions, which are still ongoing, in the fight against COVID-19. The collaboration between military and civilian healthcare systems reinforced the shared objective to achieve the goal of 'saving the greatest number'.

Neuropeptide S promotes wakefulness through the inhibition of sleep-promoting ventrolateral preoptic nucleus neurons

STUDY OBJECTIVES

The regulation of sleep-wake cycles is crucial for the brain's health and cognitive skills. Among the various substances known to control behavioral states, intraventricular injection of neuropeptide S (NPS) has already been shown to promote wakefulness. However, the NPS signaling pathway remains elusive. In this study, we characterized the effects of NPS in the ventrolateral preoptic nucleus (VLPO) of the hypothalamus, one of the major brain structures regulating non-rapid eye movement (NREM) sleep.

METHODS

We combined polysomnographic recordings, vascular reactivity, and patch-clamp recordings in mice VLPO to determine the NPS mode of action.

RESULTS

We demonstrated that a local infusion of NPS bilaterally into the anterior hypothalamus (which includes the VLPO) significantly increases awakening and specifically decreases NREM sleep. Furthermore, we established that NPS application on acute brain slices induces strong and reversible tetrodotoxin (TTX)-sensitive constriction of blood vessels in the VLPO. This effect strongly suggests that the local neuronal network is downregulated in the presence of NPS. At the cellular level, we revealed by electrophysiological recordings and in situ hybridization that NPSR mRNAs are only expressed by non-Gal local GABAergic neurons, which are depolarized by the application of NPS. Simultaneously, we showed that NPS hyperpolarizes sleep-promoting neurons, which is associated with an increased frequency in their spontaneous IPSC inputs.

CONCLUSION

Altogether, our data reveal that NPS controls local neuronal activity in the VLPO. Following the depolarization of local GABAergic neurons, NPS indirectly provokes feed-forward inhibition onto sleep-promoting neurons, which translates into a decrease in NREM sleep to favor arousal.

Toward a Refined Mindfulness Model Related to Consciousness and Based on Event-Related Potentials

Neuroimaging, behavioral, and self-report evidence suggests that there are four main cognitive mechanisms that support mindfulness: (a) self-regulation of attention, (b) improved body awareness, (c) improved emotion regulation, and (d) change in perspective on the self. In this article, we discuss these mechanisms on the basis of the event-related potential (ERP). We reviewed the ERP literature related to mindfulness and examined a data set of 29 articles. Our findings show that the neural features of mindfulness are consistently associated with the self-regulation of attention and, in most cases, reduced reactivity to emotional stimuli and improved cognitive control. On the other hand, there appear to be no studies of body awareness. We link these electrophysiological findings to models of consciousness and introduce a unified, mechanistic mindfulness model. The main idea in this refined model is that mindfulness decreases the threshold of conscious access. We end with several working hypotheses that could direct future mindfulness research and clarify our results.

Acute emotional stress and high fat/high fructose diet modulate brain oxidative damage through NrF2 and uric acid in rats

Studies focusing on the interaction of dietary and acute emotional stress on oxidative stress in cortex frontal and in brain mitochondria are scarce. Dietary-induced insulin resistance, as observed in Western diets, has been associated with increased oxidative stress causing mitochondrial dysfunction. We hypothesized that acute emotional stress could be an aggravating factor by impacting redox status in cortex and brain mitochondria. Thus, the aim of the present study was to evaluate the combination of an insulin resistance inducing high-fat/high-fructose (HF/HFr) diet and acute emotional stress on brain oxidative stress in rats. We measured several oxidative stress parameters (carbonyls, FRAP, TBARS assays, GSH, GSSG, oxidized DNA, mRNA expression of redox proteins (Nrf2), and uric acid). The HF/HFr diet resulted in increased oxidative stress both in the brain mitochondria and in the frontal cortex and decreased expression of the Nrf2 gene. The emotional stress induced an oxidative response in plasma and in brain mitochondria of the control group. In the HF/HFr group it triggered an increase expression of the redox transcription factor Nrf2 and its downstream antioxidant genes. This suggests an improvement of the redox stress tolerance in response to an enhanced production of reactive oxygen species. Accordingly, a blunted oxidative effect on several markers was observed in plasma and brain of HF/HFr-stressed group. This was confirmed in a parallel study using lipopolysaccharide as a stress model. Beside the Nrf2 increase, the stress induced a stronger UA release in HF/HFr which could take a part in the redox stress.

Emotional overactivity in patients with irritable bowel syndrome

BACKGROUND

Negativity is often observed in patients with irritable bowel syndrome (IBS). No study has examined their emotional expressiveness as a marker of emotional reactivity. We investigated IBS patients' vulnerability to an emotional load by associating their expressiveness with psychological and neurophysiological assessments. We hypothesized that IBS would be characterized by a lack of expressiveness coupled with high scores in psychological and neurophysiological parameters.

METHODS

We assessed the emotional facial expressions (EMFACS), psychological (anxiety, depression, alexithymia), and neurophysiological (cortisol, heart rate variability (HRV)) parameters of 25 IBS patients and 26 healthy controls (HC) while they watched fear-eliciting movie extracts.

KEY RESULTS

Overall, the task elicited an increase in state anxiety and consistent HRV responses. However, IBS patients differed from HC as they displayed more sadness and tended to display more rage. Contrary to HC, IBS patients showed an increase in heart rate and a decrease in parasympathetic regulation, reflecting an enhanced responsiveness corroborated by higher scores in depression and state anxiety. Consistent with their higher difficulty in identifying feelings, a component of alexithymia positively correlated with their expressions of rage, they were not aware of their increase in anxiety during the task, whereas HC were. No linear relationship between patients' expressions and their neurophysiological responses was found.

CONCLUSIONS & INFERENCES

Irritable bowel syndrome patients displayed greater emotional expressiveness with negative prevalence. This reflects an emotional vulnerability potentially related to low regulation skills and underscores the importance of considering the central dysregulation hypothesis in IBS as a promising avenue of research.

Anxiety and Psycho-Physiological Stress Response to Competitive Sport Exercise

Introduction: Sport is recognized as beneficial for health. In certain situation of practice, it nevertheless appears likely to induce a stress response. Anxiety is a stress response-modulating factor. Our objective is to characterize the role of anxiety in the stress response induced by a selective physical exercise.

Method: Sixty-three young male military conducted a selective sporting running event (a 8-km commando-walk) and were recorded the day before, the day of the race, and the day after. The variables were psychometric [personality questionnaires, coping and anxious/stress state, and physiological (nocturnal heart rate variability and actigraphy)]. The subjects were classified, using scores on anxiety questionnaires at baseline, into two groups according to their anxious (G ANX) or non-anxious (G N-ANX).

Results: Before the race, the G ANX was characterized by a lower level of self-esteem, higher scores in dysfunctional coping and a greater perceived stress compared to the G N-ANX. Compared to G N-ANX, the stress response to the exercise was higher in G ANX: G ANX exhibited (Selye, 1950) in immediate post-exercise, greater level in activation markers, and mental fatigue associated with a same level of physical fatigue and (Kim et al., 2018) in nocturnal post-exercise, an increase in sympathetic activation associated with a higher sleep fragmentation.

Conclusion: A competition selection sport exercise causes a stress response, particularly for anxious subjects. Anxious status could be involved in the risk of emergence of overtraining in sport practice. These results must be taken into account when sport practice is used for anxiety management.

Thermoregulatory Response to Exercise After Exertional Heat Stroke

BACKGROUND

After one episode of exertional heat stroke (EHS), risk factors must be identified to determine the potential for subsequent episodes. One of these risk factors, core body temperature (T_co) kinetics during strenuous exercise, may be a surrogate marker suggestive of impaired thermoregulation. This study aimed to determine the kinetics of increases in T_co among military subjects who had a history of EHS.

METHODS

Forty subjects (38 males, mean age 28.4 ± 4.9 years, mean body mass index 24.9 ± 2.4) who had a history of EHS ran 8 km in full combat gear with continuous monitoring of T_co and heart rate. The run was a qualifying event for military service. T_co was assessed using an ingestible sensor (Cortemp HQ Inc., Palmetto, Florida). Maximum oxygen uptake (VO_2max) was measured on the day before the run.

FINDINGS

The mean performance time for the run was 44.6 ± 6.6 minutes achieved under mild climatic conditions. No neurological impairment was observed. The mean maximum T_co was 39.9 ± 0.5°C. On the basis of T_co during the last 10 minutes of running, two T_co profiles were identified: increased T_co (T_co increase > 0.5°C) and plateaued T_co. Neither profile depended on initial, mid-run, or maximal T_co, VO_2max, speed running, body surface area or body fat mass.

DISCUSSION

Subjects who had a history of EHS exhibited different T_co profiles at the end of an 8-km run. Laboratory studies will be necessary to identify the mechanisms underlying these profiles; future longitudinal studies can determine whether a T_co increase >0.5°C during the last 10 minutes is a risk factor for EHS recurrence.

Neuropeptide S overcomes short term memory deficit induced by sleep restriction by increasing prefrontal cortex activity

Sleep restriction (SR) impairs short term memory (STM) that might be related to different processes. Neuropeptide S (NPS), an endogenous neuropeptide that improves short term memory, activates arousal and decreases anxiety is likely to counteract the SR-induced impairment of STM. The objective of the present study was to find common cerebral pathways in sleep restriction and NPS action in order to ultimately antagonize SR effect on memory. The STM was assessed using a spontaneous spatial alternation task in a T-maze. C57-Bl/6J male mice were distributed in 4 groups according to treatment (0.1nmol of NPS or vehicle intracerebroventricular injection) and to 20h-SR. Immediately after behavioural testing, regional c-fos immunohistochemistry was performed and used as a neural activation marker for spatial short term memory (prefrontal cortex, dorsal hippocampus) and emotional reactivity (basolateral amygdala and ventral hippocampus). Anxiety-like behaviour was assessed using elevated-plus maze task. Results showed that SR impaired short term memory performance and decreased neuronal activation in cingular cortex.NPS injection overcame SR-induced STM deficits and increased neuronal activation in infralimbic cortex. SR spared anxiety-like behavior in the elevated-plus maze. Neural activation in basolateral nucleus of amygdala and ventral hippocampus were not changed after SR.In conclusion, the present study shows that NPS overcomes SR-induced STM deficits by increasing prefrontal cortex activation independently of anxiety-like behaviour.

Cognitive Deficits and Inflammatory Response Resulting from Mild-to-Moderate Traumatic Brain Injury in Rats Are Exacerbated by Repeated Pre-Exposure to an Innate Stress Stimulus

Traumatic brain injury (TBI) is common in both military and civilian populations, and often results in neurobehavioral sequelae that impair quality of life in both patients and their families. Although individuals who are chronically exposed to stress are more likely to experience TBI, it is still unknown whether pre-injury stress influences the outcome after TBI. The present study tested whether behavioral and cognitive long-term outcome after TBI in rats is affected by prior exposure to an innate stress stimulus. Young adult male Sprague-Dawley rats were exposed to the predator odor 2,5-dihydro-2,4,5-trimethylthiazoline (TMT) or to water (WAT); exposure was repeated eight times at irregular intervals over a 2-week period. Rats were subsequently subjected to either mild-to-moderate bilateral brain injury (lateral fluid percussion [LFP]) or sham surgery (Sham). Four experimental groups were studied: Sham-WAT, Sham-TMT, LFP-WAT and LFP-TMT. Compared with Sham-WAT rats, LFP-WAT rats exhibited transient locomotor hyperactivity without signs of anxiety, minor spatial learning acquisition and hippocampal long-term potentiation deficits, and lower baseline activity of the hypothalamic-pituitary-adrenal axis with slightly stronger reactivity to restraint stress. Exposure to TMT had only negligible effects on Sham rats, whereas it exacerbated all deficits in LFP rats except for locomotor hyperactivity. Early brain inflammatory response (8 h post-trauma) was aggravated in rats pre-exposed to TMT, suggesting that increased brain inflammation may sustain functional deficits in these rats. Hence, these data suggest that pre-exposure to stressful conditions can aggravate long-term deficits induced by TBI, leading to severe stress response deficits, possibly due to dysregulated inflammatory response.

Validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in French psychiatric and general populations

The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) has been validated in general population samples in many countries. Interest in using this measure in clinical populations is growing, particularly for tertiary prevention and mental health promotion. This paper reports validation of the French WEMWBS in healthy and chronic remitted schizophrenia populations. The French WEMWBS was administered to 319 workers, 75 students and 121 patients. For non-patients, self-reported Trait- and State-Anxiety, Mindfulness, Positive and Negative Affect and the General Health Questionnaire were completed. For patients, the Positive and Negative Syndrome Scale, Clinical Global Impression Severity Scale, Birchwood Insight Scale, Social Adjustment Scale, and Global Assessment of Functioning scale were completed. Test-retest reliability and responsiveness to intervention was assessed at 6 months. Whatever the sample, response frequencies showed normal distributions, and internal consistency was good (Cronbach's α). Scree plots of eigenvalues suggested a single factor in the samples. The one-dimensional solution yielded suboptimal fit indices. Construct validity was confirmed. Significant improvement in scores was observed before and after intervention. Test-retest variation was non-significant. Impairment of insight and cognition in the assessed patients implies that attention must be paid before applying WEMWBS to all patients. Nevertheless, WEMWBS proved valid and reliable in a further European population, suggesting transcultural validity for both monitoring and evaluation of interventions in healthy as well as chronic remitted schizophrenia populations.

Clinical Follow-Up in the Rat Experimental Model of African-Trypanosomiasis

Animal models of Human African Trypanosomiasis (HAT) have been developed to understand the pathogenic mechanisms leading to the passage into the neurological phase, most of them referring to histological aspects but not clinical or behavioral data. Our study aimed at defining simple clinical and/or behavioral markers of the passage between the hemolymphatic phase and the meningo-encephalitic stage of the disease. Sprague-Dawley rats (n=24) were infected with Trypanosoma brucei brucei AnTat 1.1E. Food intake and body weight were measured daily from the day of infection until death. Hematocrit was measured twice a week. Behavioral disturbances were evaluated through an Open-field test. A sudden weight loss occurred on the twelfth day after infection, due to a significant drop of food intake starting two days before. The rats developed an anemic state shown by the hematocrit measurements. The Open-field test showed them to be less active and reactive as soon as the second week after infestation. A complementary histological study observed trypanosomes and inflammatory cells in the choroid plexus at the same period. These results are in favor of central nervous system functional disturbances. The observed weight loss is discussed as being a parameter of the entry in the meningo-encephalitic phase. The rat model reproduces neurological symptoms observed in the human disease and may prove to be useful for further neurohistological and therapeutic studies.

Low β2 Main Peak Frequency in the Electroencephalogram Signs Vulnerability to Depression

Objective: After an intense and repeated stress some rats become vulnerable to depression. This state is characterized by persistent low serum BDNF concentration. Our objective was to determine whether electrophysiological markers can sign vulnerability to depression.

Methods: Forty-three Sprague Dawley rats were recorded with supradural electrodes above hippocampus and connected to wireless EEG transmitters. Twenty-nine animals experienced four daily social defeats (SD) followed by 1 month recovery. After SD, 14 rats had persistent low serum BDNF level and were considered as vulnerable (V) while the 15 others were considered as non-vulnerable (NV). EEG signals were analyzed during active waking before SD (Baseline), just after SD (Post-Stress) and 1 month after SD (Recovery).

Results: We found that V animals are characterized by higher high θ and α spectral relative powers and lower β2 main peak frequency before SD. These differences are maintained at Post-Stress and Recovery for α spectral relative powers and β2 main peak frequency. Using ROC analysis, we show that low β2 main peak frequency assessed during Baseline is a good predictor of the future state of vulnerability to depression.

Conclusion: Given the straightforwardness of EEG recordings, these results open the way to prospective studies in humans aiming to identify population at-risk for depression.

Cardiac Coherence Training to Reduce Anxiety in Remitted Schizophrenia, a Pilot Study

Health care that addresses the emotional regulation capacity of patients with schizophrenia confronted with daily stress may contribute to a less anxious life. A psycho-physiological training [cardiac coherence training (CCT)] focusing on emotion regulation is known to decrease anxiety for healthy individuals. We performed a pilot cross sectional survey to explore the benefits of CCT for clinically stable patients with schizophrenia. Ten patients were enrolled in the program consisting of twelve weekly 1-h session programs monitored over a 2-month period. Standardised questionnaires were used before and after the intervention to assess anxiety, well-being outcomes, and how patients deal with stress and stressors. Results showed that this quite-well accepted intervention improved (or tended to improve) well-being outcomes, state-anxiety, and emotional stressors evaluation. The successful transformations were higher for patients with the highest clinical and emotional suffering. Thus, this pilot study revealed that CCT may help patients with schizophrenia to deal with anxiety in daily life.

[How to assess mindfulness? Problems and future]

INTRODUCTION

The concept of mindfulness is characterized by awareness and acceptance of experiences; flexible regulation of attention; an objective receptivity to experience and an orientation to the here-and-now. Interest in 'mindfulness' and 'mindfulness meditation' is recent and growing both at the levels of research and of clinical practice in the West as mindfulness is associated with health and well-being. It (mindfulness) is attained by the practice of certain types of meditation. One of the current key challenges is to evaluate and measure the level of mindfulness of a subject and its evolution.

OBJECTIVES

The paper proposes a reflexion on the concept of mindfulness with a view to improving the operational evaluation of mindfulness level for clinical and non-clinical subjects.

METHODS

First, the problems with the use of existing self-report questionnaires assessing mindfulness level are discussed. Second, an analysis of the cognitive processes that come into play in mindfulness acquisition (by meditation) can highlight the significance of certain cognitive tools in a more accurate evaluation of the level of mindfulness of individuals.

CONCLUSION

Self-regulation of attention, and orientation to lived experience could be operational candidates for assessing the level of mindfulness. The pertinence of well-known paradigms evaluating self-regulation of attention and orientation to experience are discussed.

Is there a link between exertional heat stroke and susceptibility to malignant hyperthermia?

Objective

The identification of a predisposition toward malignant hyperthermia (MH) as a risk factor for exertional heat stroke (EHS) remains a matter of debate. Such a predisposition indicates a causal role for MH susceptibility (MHS) after EHS in certain national recommendations and has led to the use of an in vitro contracture test (IVCT) to identify the MHS trait in selected or unselected EHS patients. The aim of this study was to determine whether the MHS trait is associated with EHS.

Methods

EHS subjects in the French Armed Forces were routinely examined for MHS after experiencing an EHS episode. This retrospective study compared the features of IVCT-diagnosed MHS (iMHS) EHS subjects with those of MH-normal EHS patients and MH patients during the 2004–2010 period. MHS status was assessed using the European protocol.

Results

During the study period, 466 subjects (median age 25 years; 31 women) underwent MHS status investigation following an EHS episode. None of the subjects reported previous MH events. An IVCT was performed in 454 cases and was diagnostic of MHS in 45.6% of the study population, of MH susceptibility to halothane in 18.5%, of MH susceptibility to caffeine in 9.9%, and of MH susceptibility to halothane and caffeine in 17.2%. There were no differences in the clinical features, biological features or outcomes of iMHS EHS subjects compared with those of MH-normal or caffeine or halothane MHS subjects without known prior EHS episode. The recurrence rate was 12.7% and was not associated with MH status or any clinical or biological features. iMHS EHS patients exhibited a significantly less informative IVCT response than MH patients.

Conclusions

The unexpected high prevalence of the MHS trait after EHS suggested a latent disturbance of calcium homeostasis that accounted for the positive IVCT results. This study did not determine whether EHS patients have an increased risk of MH, and it could not determine whether MH susceptibility is a risk factor for EHS.

Is muscle energy production disturbed in exertional heat stroke?

BACKGROUND

Exertional heat stroke (EHS) is a life-threatening disease that shares some clinical similarities with malignant hyperthermia (MH). By use of (31)Phosphorus magnetic resonance spectroscopy (MRS), EHS patients with MH susceptibility and MH patients shared common metabolic abnormalities. The aim of this study was to determine whether subjects who suffered from an EHS episode had disturbed muscle energetics.

METHOD

This retrospective study was performed within the French database of military subjects that were explored from 2004 to 2010 after they suffered an EHS. All subjects had both in vitro contracture test to determine their MH susceptibility and (31)Phosphorus MRS at 4.7 Tesla to assess muscle energetics by means of MRS score, a composite score corresponding to the sum of metabolic abnormalities recorded during a standardized rest-exercise-recovery protocol.

RESULTS

437 subjects were investigated and 32.5% of them exhibited abnormal MRS score. MRS score did not segregate subjects on demographic, clinical, or biological grounds. No clear correlation could be done between MH status and MRS score.

DISCUSSION

These results did not confirm the potential relationship between calcium homeostasis and muscle energetics previously reported. However, muscle energy production was disturbed in a significant number of EHS subjects.

High-frequency stimulation of the hippocampus blocks fear learning sensitization and return of extinguished fear

Patients with post-traumatic stress disorder (PTSD) present hippocampal (HPC) dysfunction, which may facilitate fear-related phenomena such as fear learning sensitization (i.e. potentiation of fear acquisition by initial fear conditioning (FC1)) and fear return (i.e. reactivation of extinguished fear). Fear return is sensitive to HPC high-frequency stimulation (HFS) in rats. The goal of the present study was to examine whether fear learning sensitization is also sensitive to HPC HFS in rats. We found in control conditions that, after FC1 (with 15 shock administrations) and extinction, conditioning in a different context with one shock administration was potentiated (proactive effect) and associated with fear return in the initial context (retroactive effect). Both phenomena were prevented by HPC HFS applied before the second conditioning. We also found that the effect of HPC HFS on fear learning sensitization required initial extinction. These findings suggest a pivotal role of the HPC in preventing proactive and retroactive effects of successive fear conditionings. These data also support the concept that HPC deactivation may be involved in fear learning sensitization and fear return in PTSD patients.

Differences in prefrontal cortex GABA/glutamate ratio after acute restraint stress in rats are associated with specific behavioral and neurobiological patterns

In patients suffering from stress-related pathologies and depression, frontal cortex GABA and glutamate contents are reported to decrease and increase, respectively. This suggests that the GABA and/or glutamate content may participate in pathological phenotype expression. Whether differences in frontal cortex GABA and glutamate contents would be associated with specific behavioral and neurobiological patterns remains unclear, especially in the event of exposure to moderate stress. We hypothesized that an increase in prefrontal cortex GABA/glutamate ratio would be associated with a blunted prefrontal cortex activation, an enhanced hypothalamo-pituitary-adrenocortical (HPA) axis activation and changes in behavior. Rats being restrained for 1-h were then tested in an open-field test in order to assess their behavior while under stress, and were sacrificed immediately afterward. The GABA/glutamate ratio was assessed by (1)H high-resolution magic angle spinning magnetic resonance spectroscopy ((1)H-HRMAS-MRS). The neurobiological response was evaluated through prefrontal cortex mRNA expression and plasma corticosterone levels. The stressed rats were distributed into two subgroups according to their high (H-G/g) or low (L-G/g) GABA/glutamate ratio. Compared to the L-G/g rats, the H-G/g rats exhibited a decrease in c-fos, Arc, Npas4, Nr4a2 mRNA expression suggesting blunted prefrontal cortex activation. They also showed a more pronounced stress with an enhanced rise in corticosterone, alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), creatine kinase (CK) and lactate dehydrogenase (LDH) levels, as well as behavioral disturbances with decreased locomotion speed. These changes were independent from prefrontal cortex energetic status as mammalian target of rapamycin (mTOR) and adenosine monophosphate-activated protein kinase (AMPK) pathway activities were similar in both subpopulations. The differences in GABA/glutamate ratio in the frontal cortex observed in the stressed animals may participate in shaping individual differences in psychophysiological reactions.

Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn's disease and irritable bowel syndrome

Crohn's disease (CD) and irritable bowel syndrome (IBS) involve brain-gut dysfunctions where vagus nerve is an important component. The aim of this work was to study the association between vagal tone and markers of stress and inflammation in patients with CD or IBS compared to healthy subjects (controls). The study was performed in 73 subjects (26 controls, 21 CD in remission and 26 IBS patients). The day prior to the experiment, salivary cortisol was measured at 8:00 AM and 10:00 PM. The day of the experiment, subjects completed questionnaires for anxiety (STAI) and depressive symptoms (CES-D). After 30 min of rest, ECG was recorded for heart rate variability (HRV) analysis. Plasma cortisol, epinephrine, norepinephrine, TNF-alpha and IL-6 were measured in blood samples taken at the end of ECG recording. Compared with controls, CD and IBS patients had higher scores of state-anxiety and depressive symptomatology. A subgroup classification based on HRV-normalized high frequency band (HFnu) as a marker of vagal tone, showed that control subjects with high vagal tone had significantly lower evening salivary cortisol levels than subjects with low vagal tone. Such an effect was not observed in CD and IBS patients. Moreover, an inverse association (r =  -0.48; p<0.05) was observed between the vagal tone and TNF-alpha level in CD patients exclusively. In contrast, in IBS patients, vagal tone was inversely correlated with plasma epinephrine (r =  -0.39; p<0.05). No relationship was observed between vagal tone and IL-6, norepinephrine or negative affects (anxiety and depressive symptomatology) in any group. In conclusion, these data argue for an imbalance between the hypothalamus-pituitary-adrenal axis and the vagal tone in CD and IBS patients. Furthermore, they highlight the specific homeostatic link between vagal tone and TNF-alpha in CD and epinephrine in IBS and argue for the relevance of vagus nerve reinforcement interventions in those diseases.

Acute stress delays brain mitochondrial permeability transition pore opening

Since emotional stress elicits brain activation, mitochondria should be a key component of stressed brain response. However, few studies have focused on mitochondria functioning in these conditions. In this work, we aimed to determine the effects of an acute restraint stress on rat brain mitochondrial functions, with a focus on permeability transition pore (PTP) functioning. Rats were divided into two groups, submitted or not to an acute 30-min restraint stress (Stress, S-group, vs. Control, C-group). Brain was removed immediately after stress. Mitochondrial respiration and enzymatic activities (complex I, complex II, hexokinase) were measured. Changes in PTP opening were assessed by the Ca(2+) retention capacity. Cell signaling pathways relevant to the coupling between mitochondria and cell function (adenosine monophosphate-activated protein kinase, phosphatidylinositol 3-kinase, glycogen synthase kinase 3 beta, MAPK, and cGMP/NO) were measured. The effect of glucocorticoids was also assessed in vitro. Stress delayed (43%) the opening of PTP and resulted in a mild inhibition of complex I respiratory chain. This inhibition was associated with significant stress-induced changes in adenosine monophosphate-activated protein kinase signaling pathway without changes in brain cGMP level. In contrast, glucocorticoids did not modify PTP opening. These data suggest a rapid adaptive mechanism of brain mitochondria in stressed conditions, with a special focus on PTP regulation. In a rat model of acute restraint stress, we observed substantial changes in brain mitochondria functioning. Stress significantly (i) delays (43%) the opening of permeability transition pore (PTP) by the calcium (Ca(2+) ), its main inductor and (ii) results in an inhibition of complex I in electron transport chain associated with change in AMPK signaling pathway. These data suggest an adaptive mechanism of brain mitochondria in stressed condition, with a special focus on PTP regulation.

[Hyperbaric oxygen therapy and inert gases in cerebral ischemia and traumatic brain injury]

Cerebral ischemia is a common thread of acute cerebral lesions, whether vascular or traumatic origin. Hyperbaric oxygen (HBO) improves tissue oxygenation and may prevent impairment of reversible lesions. In experimental models of cerebral ischemia or traumatic brain injury, HBO has neuroprotective effects which are related to various mechanisms such as modulation of oxidative stress, neuro-inflammation or cerebral and mitochondrial metabolism. However, results of clinical trials failed to prove any neuroprotective effects for cerebral ischemia and remained to be confirmed for traumatic brain injury despite preliminary encouraging results. The addition of inert gases to HBO sessions, especially argon or xenon which show neuroprotective experimental effects, may provide an additional improvement of cerebral lesions. Further multicentric studies with a strict methodology and a better targeted definition are required before drawing definitive conclusions about the efficiency of combined therapy with HBO and inert gases in acute cerebral lesions.

Relationship between emotional experience and resilience: an fMRI study in fire-fighters

Resilience refers to the capacity to cope effectively in stressful situations or adversity. It may involve the ability to experience emotions matching the demands of environmental circumstances. The brain mechanisms underlying resilience remain unclear. In this study, we aim to investigate the relationship between the neural basis of emotional experience and resilience. Thirty-six fire-fighters were included. They performed an fMRI script-driven paradigm comprising relaxing and trauma-related scripts to evaluate the cerebral substrate of emotional experience (p<0.05, FDR-corrected). Correlations were examined between fMRI activations and the resilience DRS15 scale (p<0.05). Resilience was positively correlated with the right amygdala and left orbitofrontal activations when performing the contrast of trauma vs. relaxing script. The present study provides neural data on the mechanisms underlying resilience and their relationship with emotional reactivity, suggesting that appropriate emotional response in stressful situations is essential for coping with aversive events in daily life.

Low-frequency stimulation of the ventral hippocampus facilitates extinction of contextual fear

Difficulties to treat fear-associated disorders, including posttraumatic stress disorder, are thought to result from dysfunction in fear extinction learning and/or memory. Animal studies on extinction modulation are therefore promising for the development of new treatments. Recent rat studies, including ones using low-frequency stimulation (LFS), have demonstrated that the ventral hippocampus (VH) modulates extinction memory. The present study explores whether the VH also modulates extinction learning. For this, rats were implanted with stimulating electrodes in the VH and experienced contextual fear conditioning, followed 6 or 24 h later by VH LFS and three sessions of extinction training. We found that, whatever the delay used (6 or 24 h), animals that received VH LFS displayed persistent low levels of freezing from the second extinction session, whereas control rats showed low levels of freezing only during the third session. In animals submitted to a stress condition (provoked by a single inescapable foot-shock followed by three sessions of situational reminders) prior to fear conditioning, VH LFS also reduced freezing levels, which, in contrast, remained high in control rats during the course of extinction training. These data suggest that LFS, targeting the VH, may be useful in reducing fear responses during extinction learning.

War psychic disorders treatment: Current perspectives

Background

The confrontation with extreme events, such as a death threat, may release acute psychiatric troubles named “acute stress disorders” in the DSMIV-TR. Current operational context in Afghanistan is unpredictable and leads military surgeons to support soldiers facing major psychic suffering. Clinical practice confronts them with the difficulty to decrease the symptoms often strong, especially sleep disorders. Circadian rhythm disruption, lack of recovery may be at the origin of somatic and mental exhaustion.

Methods

We propose a debate about the principles of a medico-psychological handling based on the current operational experiences of the French military psychiatry. Special operational circumstances led military psychiatrists to prescribe an antipsychotic, small-dose, in the evening.

Results

Unexpected results are observed on some symptoms like sleep disorders (improvement of sleep disorders, less traumatic nightmares, sensation of restorative night) and hyperarousal.

Conclusions

This clinical discovery leads to a reflection on physiopathological and pharmacological perspectives and to engage an observational study over 30 clinical cases and clinical trial project. Identifying, preventing, and treating operational stress at battlefront can provide the opportunity not only to improve operational performance, but also possibly to improve case by case the mental health.

Anti-inflammatory effect of vagus nerve stimulation in a rat model of inflammatory bowel disease

Vagus nerve stimulation of afferents is used as an adjunctive treatment for drug-resistant epilepsy and depression. In addition, anti-inflammatory properties of vagus nerve stimulation have been reported in various experimental models of inflammation but not in colitis. These effects are thought to be mediated via peripheral release of acetylcholine from the vagus and subsequent activation of macrophages. Our aim was to evaluate in rats the anti-inflammatory effects of chronic vagus nerve stimulation on colonic inflammation. Colitis was induced by intracolonic instillation of trinitrobenzene sulfonic acid. Vagus nerve stimulation (left cervical) was performed in freely moving animals 3 h per day for five consecutive days. Assessment of colonic inflammation was obtained using physiological (e.g. body weight, temperature and locomotor activity) parameters, macroscopical (area of lesions), histological, and biological parameters (e.g. myeloperoxidase activity, cytokine and cytokine-related mRNAs), both at the level of the damaged colon and the colon immediately above. A global multivariate index of colitis was then generated for a better characterization of colonic inflammation. Vagus nerve stimulation reduced the degree of body weight loss and inflammatory markers as observed above the lesion by histological score and myeloperoxidase quantification. This anti-inflammatory effect was also demonstrated by the improvement of the multivariate index of colitis. These data argue for an anti-inflammatory role of vagus nerve stimulation chronically performed in freely moving rats with colitis and provide potential therapeutic applications for patients with inflammatory bowel diseases.

Metyrapone blunts stress-induced hyperthermia and increased locomotor activity independently of glucocorticoids and neurosteroids

Metyrapone, a cytochrome P(450) inhibitor used to inhibit corticosterone synthesis, triggers biological markers of stress and also reduces stress-induced anxiety-like behaviors. To address these controversial effects, 6 separate investigations were carried out. In a first set of investigations, abdominal temperature (T(abd)), spontaneous locomotor activity (A(S)) and electroencephalogram (EEG) were recorded in freely moving rats treated with either saline or 150 mg kg(-1) metyrapone. An increase in T(abd) and A(S) occurred in saline rats, while, metyrapone rats exhibited an immediate decrease, both variables returning to basal values 5h later. Concomitantly, the EEG spectral power increased in the gamma and beta 2 bands and decreased in the alpha frequency band, and the EMG spectral power increased. This finding suggests that metyrapone depressed stress-induced physiological response while arousing the animal. In a second step, restraint stress was applied 5h after injection. Metyrapone significantly blunted the stress-induced T(abd) and A(S) rise, without affecting the brain c-fos mRNA increase. Corticosterone (5 and 40 mg kg(-1)) injected concomitantly to metyrapone failed to reverse the observed metyrapone-induced effects in T(abd) and A(S). Finasteride (50 mg kg(-1)), which blocks neurosteroid production, was also unable to block these effects. In conclusion, metyrapone acutely reduced stress-induced physiological response in freely behaving rats independently from glucocorticoids and neurosteroids.

Validation of a French version of the Freiburg Mindfulness Inventory - short version: relationships between mindfulness and stress in an adult population

Background

Whereas interest in incorporating mindfulness into interventions in medicine is growing, data on the relationships of mindfulness to stress and coping in management is still scarce. This report first presents a French validation of the Freiburg Mindfulness Inventory-short form (FMI) in a middle-aged working population. Secondly, it investigates the relationship between psychological adjustment and mindfulness.

Methods

Five hundred and six non-clinical middle-aged working individuals rated themselves on the self-report French version FMI and completed measures of psychological constructs potentially related to mindfulness levels.

Results

Results were comparable to results of the original short version. Internal consistency of the scale based on the one-factor solution was .74, and test-retest reliability was good. The one-dimensional solution as the alternative to the two-factor structure solution yielded suboptimal fit indices. Correlations also indicated that individuals scoring high on mindfulness are prone to stress tolerance, positive affects and higher self-efficacy. Furthermore, subjects with no reports of stressful events were higher on mindfulness.

Conclusion

These data showed that mindfulness can be measured validly and reliably with the proposed French version of the FMI. The data also highlighted the relationship between mindfulness and stress in an adult population. Mindfulness appears to reduce negative appraisals of challenging or threatening events.