Peri-operative individually tailored psychological intervention in breast cancer patients improves psychological indices and molecular biomarkers of metastasis in excised tumors

Perioperative stress and inflammatory signaling can invigorate pro-metastatic molecular processes in patients' tumors, potentially worsening long-term survival. Yet, it is unknown whether pre-operative psychotherapeutic interventions can attenuate such effects. Herein, three weeks before surgery, forty women diagnosed with stage I-III invasive ductal/lobular breast carcinoma were randomized to a 6-week one-on-one psychological intervention (6 meetings with a medical psychologist and bi-weekly phone calls) versus standard nursing-staff-attention. The intervention protocol was individually tailored based on evaluation of patients' emotional, cognitive, physiological, and behavioral stress response-patterns, and also included psychoeducation regarding medical treatments and recruitment of social support. Resected primary tumors were subjected to whole-genome RNA sequencing and bioinformatic analyses, assessing a priori hypothesized cancer-relevant molecular signatures. Self-report questionnaires (BSI-18, Hope-18, MSPSS, and a stress-scale) were collected three (T1) and one (T2) week before surgery, a day before (T3) and after (T4) surgery, and three weeks (T5) and 3-months (T6) following surgery. The intervention reduced distress (GSI), depression, and somatization scores (BSI-18: p < 0.01, p < 0.05, p < 0.05; T5 vs. T1). Additionally, tumors from treated patients (vs. controls) showed: (i) decreased activity of transcription control pathways involved in adrenergic and glucocorticoid signaling (CREB, GR) (p < 0.001), pro-inflammatory signaling (NFkB) (p < 0.01), and pro-malignant signaling (ETS1, STAT and GATA families) (p < 0.001, p < 0.01, p < 0.005); (ii) increased M1 macrophage polarization (p < 0.05), and CD4+ T cell activity (p < 0.01); and an unexpected increase in epithelial-to-mesenchymal-transition (EMT) signature (p < 0.005). This is the first randomized controlled trial to show beneficial effects of a psychological perioperative intervention on tumor pro-metastatic molecular biomarkers.

Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study

Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice (n = 10) and wait-list control (n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.

Critical Dynamics in Spontaneous Resting-State Oscillations Are Associated With the Attention-Related P300 ERP in a Go/Nogo Task

Sustained attention is the ability to continually concentrate on task-relevant information, even in the presence of distraction. Understanding the neural mechanisms underlying this ability is critical for comprehending attentional processes as well as neuropsychiatric disorders characterized by attentional deficits, such as attention deficit hyperactivity disorder (ADHD). In this study, we aimed to investigate how trait-like critical oscillations during rest relate to the P300 evoked potential-a biomarker commonly used to assess attentional deficits. We measured long-range temporal correlations (LRTC) in resting-state EEG oscillations as index for criticality of the signal. In addition, the attentional performance of the subjects was assessed as reaction time variability (RTV) in a continuous performance task following an oddball paradigm. P300 amplitude and latencies were obtained from EEG recordings during this task. We found that, after controlling for individual variability in task performance, LRTC were positively associated with P300 amplitudes but not latencies. In line with previous findings, good performance in the sustained attention task was related to higher P300 amplitudes and earlier peak latencies. Unexpectedly, we observed a positive relationship between LRTC in ongoing oscillations during rest and RTV, indicating that greater criticality in brain oscillations during rest relates to worse task performance. In summary, our results show that resting-state neuronal activity, which operates near a critical state, relates to the generation of higher P300 amplitudes. Brain dynamics close to criticality potentially foster a computationally advantageous state which promotes the ability to generate higher event-related potential (ERP) amplitudes.

The functional significance of the P600: Some linguistic P600's do localize to language areas

A recent paper in the journal Neuroreport suggested that, upon source localization, the semantic P600 localizes to executive function areas, that is, outside language. But is this true for all types of linguistic P600? We report a cross-sectional source localization study of a classical (agreement) syntactic paradigm.The results show a clear localization to the temporal lobe, in classical language areas.The P600 is probably not a unitary phenomenon in term of source localization, and the question whether it localizes within or outside the language system depends on the type of P600.

Placental vascular tree characterization based on ex-vivo MRI with a potential application for placental insufficiency assessment

INTRODUCTION

Understanding regarding the whole placental vascular network structure is limited. Our aim was to quantitatively characterize the human placental vascular tree ex-vivo using high-resolution MRI.

METHODS

34 normal placentas were rinsed and injected with a solution of gelatin and contrast agent through the umbilical vessels. A sample of six placentas taken from pregnancies with intrauterine-growth-restriction (IUGR) was used to demonstrate the potential application to cases with placental insufficiency. Structural ex-vivo MR scans of the placenta were performed using high resolution T₁ weighted images. A semi-automatic method was developed to segment and characterize the placental vascular architecture: placental volume and cord insertion location; number of bifurcations, generations and vessels diameters.

RESULTS

Different vascular patterns were found in placentas with central versus marginal cord-insertion. Based on the placental volume and number of bifurcations we were able to predict birth weight. Furthermore, preliminary results on IUGR sample demonstrated the potential of this method to differentiate between small newborns with suspected IUGR from small normal newborns who reached their full growth potential. Results obtained using the automatic method were validated against manual values demonstrating no significant differences or bias. Histopathology supported the imaging findings.

DISCUSSION

This is the first study to quantitatively characterize the human placental vascular architecture using high resolution ex-vivo MRI. Different patterns of vascular architecture may be related to different functioning of the placenta and affect fetal development. This method is simple, relatively fast, provides detailed information of the placental vascular architecture, and may have important clinical applications.

The influence of mindfulness meditation on inattention and physiological markers of stress on students with learning disabilities and/or attention deficit hyperactivity disorder

BACKGROUND

Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education.

AIMS

The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group.

METHODS

Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected.

RESULTS

Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group.

CONCLUSIONS

Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students.

Macro- and microstructural gray matter alterations in sexually assaulted women

BACKGROUND

Studies with trauma survivors documented structural alterations in brain regions involved in posttraumatic stress disorder (PTSD) neurocircuitry. Nonetheless, whether such alterations exist in women who were sexually assaulted in adulthood is not clear. We investigated the macro- and microstructure of key regions implicated in PTSD pathophysiology, namely the amygdala, hippocampus, anterior cingulate cortex (ACC), and insula, in this population.

METHODS

Thirty-eight sexually assaulted women (PTSD, n = 25; non-PTSD, n = 13) and 24 non-exposed controls (NEC) were studied with T1- and diffusion-weighted MRI. Gray matter volume, mean diffusivity (MD), and fractional anisotropy (FA) were calculated for each region. Between-group comparisons and correlations with PTSD symptom severity were performed.

RESULTS

Volumetric analyses revealed lower amygdala and insula volumes in the PTSD compared with the non-PTSD group. In contrast, altered microstructure was observed in both traumatized groups compared with NEC, including higher MD and lower FA in the right amygdala, and higher FA in the ACC bilaterally. Finally, the non-PTSD group had higher FA in the right insula compared with the PTSD group. PTSD symptom severity was correlated with amygdala and insula volumes, as well as with hippocampal FA and MD.

LIMITATIONS

Sample size may have led to reduced statistical power.

CONCLUSIONS

Sexual assault and the development of PTSD in women are linked with structural alterations in key regions implicated in PTSD following other trauma types (e.g., combat), though hippocampal and ACC volumes were preserved. Further studies are needed to disentangle the unique contribution of trauma type and of sex/gender to these observations.

Surprise-related activation in the nucleus accumbens interacts with music-induced pleasantness

How can music-merely a stream of sounds-be enjoyable for so many people? Recent accounts of this phenomenon are inspired by predictive coding models, hypothesizing that both confirmation and violations of musical expectations associate with the hedonic response to music via recruitment of the mesolimbic system and its connections with the auditory cortex. Here we provide support for this model, by revealing associations of music-induced pleasantness with musical surprises in the activity and connectivity patterns of the nucleus accumbens (NAcc)-a central component of the mesolimbic system. We examined neurobehavioral responses to surprises in three naturalistic musical pieces using fMRI and subjective ratings of valence and arousal. Surprises were associated with changes in reported valence and arousal, as well as with enhanced activations in the auditory cortex, insula and ventral striatum, relative to unsurprising events. Importantly, we found that surprise-related activation in the NAcc was more pronounced among individuals who experienced greater music-induced pleasantness. These participants also exhibited stronger surprise-related NAcc-auditory cortex connectivity during the most pleasant piece, relative to participants who found the music less pleasant. These findings provide a novel demonstration of a direct link between musical surprises, NAcc activation and music-induced pleasantness.

Repeated oral ketamine for out-patient treatment of resistant depression: randomised, double-blind, placebo-controlled, proof-of-concept study

BACKGROUND

Ketamine has been demonstrated to improve depressive symptoms.AimsEvaluation of efficacy, safety and feasibility of repeated oral ketamine for out-patients with treatment-resistant depression (TRD).

METHOD

In a randomised, double-blind, placebo-controlled, proof-of-concept trial, 41 participants received either 1 mg/kg oral ketamine or placebo thrice weekly for 21 days (ClinicalTrials.gov Identifier: NCT02037503). Evaluation was performed at baseline, 40 and 240 min post administration and on days 3, 7, 14 and 21. The main outcome measure was change in Montgomery-Åsberg Depression Rating Scale (MADRS).

RESULTS

Twenty-two participants were randomised to the ketamine group, and 19 to the control, with 82.5% (n = 33) completing the study. In the ketamine group, a decrease in depressive symptoms was evident at all time points, whereas in the control group a decrease was evident only 40 min post administration. The reduction in MADRS score on day 21 was 12.75 in the ketamine group versus 2.49 points with placebo (P &lt; 0.001). Six participants in the ketamine group (27.3%) achieved remission compared with none of the controls (P &lt; 0.05). The number needed to treat for remission was 3.7. Side-effects were mild and transient.

CONCLUSIONS

Repeated oral ketamine produced rapid and persistent amelioration of depressive symptoms in out-patients with TRD, and was well tolerated. These results suggest that add-on oral ketamine may hold significant promise in the care of patients suffering from TRD in the community.Declaration of interestNone.

Assault-related self-blame and its association with PTSD in sexually assaulted women: an MRI inquiry

Sexual assault is a frequent interpersonal trauma, which often leads to post-traumatic stress disorder (PTSD). Among other postassault characteristics, self-blame attributions were suggested to play an important role in sexually assaulted individuals' coping and were consistently associated with PTSD in this population. The present study aimed to elucidate the neural underpinnings that may associate self-blame and PTSD in women who experienced sexual assault at adulthood, using structural and resting-state functional MRI. Thirty-eight sexually assaulted women and 24 non-exposed matched controls were studied (mean age: 25 years). Among the sexually assaulted participants, assault-related self-blame was negatively correlated with gray matter volume (GMV) bilaterally in the lingual gyrus and adjacent intracalcarine cortex. GMV in this cluster was also predicted by intrusion symptoms and negative social reactions. Resting-state functional connectivity (rs-FC) of this cluster with the left anterior temporal fusiform cortex significantly differed between PTSD and non-PTSD sexually assaulted participants, and was inversely correlated with intrusion symptoms and with peritraumatic dissociation. Finally, lingual cluster's GMV and rs-FC with the anterior fusiform mediated the association between self-blame and intrusion symptoms across sexually assaulted participants. These findings link assault-related self-blame, disrupted postassault recovery and the neural circuitry involved in the processing of traumatic memories.

Clinical utility of biomarkers of the hand in the diagnosis of schizophrenia

A number of biomarkers were assessed in photos and prints of the hands of 95 patients with a variety of mental disorders to determine whether patients with schizophrenia could be distinguished from the others. Patients were recruited as consecutive admissions from an outpatient psychiatric day hospital population. Fourteen patients were diagnosed with schizophrenia/schizoaffective disorder and 81 were diagnosed with other mental disorders. A discriminant analysis yielded an overall 80% correct classification, with a sensitivity (schizophrenia patients identified correctly) of 78.6% and a specificity (non-schizophrenia patients identified correctly) of 80.2%. Significant differences were noted in the proximal interphalangeal joint, eponychium of the middle digit and fingernails. To determine biomarker frequency distribution patients with bipolar disorder were then compared to those with schizophrenia/schizoaffective disorder and then to patients with PTSD. The former yielded an overall 78.6% correct classification, with a sensitivity of 71.4% and a specificity of 85.7% and with similar biomarker frequency distribution for bipolar disorder as for the entire non schizophrenia group. The latter comparison yielded an overall 58.6% correct classification, with no significant differences between the features. The application of these biomarkers in clinical practice could constitute an additional tool for the psychiatrist in cases lacking diagnostic clarity.

The Effect of Reflexology on the Pain-Insomnia-Fatigue Disturbance Cluster of Breast Cancer Patients During Adjuvant Radiation Therapy

OBJECTIVE

To evaluate the effects of reflexology treatment on quality of life, sleep disturbances, and fatigue in breast cancer patients during radiation therapy.

METHODS/SUBJECTS

A total of 72 women with breast cancer (stages 1-3) scheduled for radiation therapy were recruited.

DESIGN

Women were allocated upon their preference either to the group receiving reflexology treatments once a week concurrently with radiotherapy and continued for 10 weeks or to the control group (usual care).

OUTCOME MEASURES

The Lee Fatigue Scale, General Sleep Disturbance Scale, and Multidimensional Quality of Life Scale Cancer were completed by each patient in both arms at the beginning of the radiation treatment, after 5 weeks, and after 10 weeks of reflexology treatment.

RESULTS

The final analysis included 58 women. The reflexology treated group demonstrated statistically significant lower levels of fatigue after 5 weeks of radiation therapy (p < 0.001), compared to the control group. It was also detected that although the quality of life in the control group deteriorated after 5 and 10 weeks of radiation therapy (p < 0.01 and p < 0.05, respectively), it was preserved in the reflexology group, which also demonstrated a significant improvement in the quality of sleep after 10 weeks of radiation treatment (p < 0.05). Similar patterns were obtained in the assessment of the pain levels experienced by the patients.

CONCLUSIONS

The results of the present study indicate that reflexology may have a positive effect on fatigue, quality of sleep, pain, and quality of life in breast cancer patients during radiation therapy. Reflexology prevented the decline in quality of life and significantly ameliorated the fatigue and quality of sleep of these patients. An encouraging trend was also noted in amelioration of pain levels.

Enhancing Visual Perception and Motor Accuracy among School Children through a Mindfulness and Compassion Program

The present study assessed the effects of the mindfulness/compassion cultivating program: "Call to Care-Israel" on the performance in visual perception (VP) and motor accuracy, as well as on anxiety levels and self-reported mindfulness among 4th and 5th grade students. One hundred and thirty-eight children participated in the program for 24 weekly sessions, while 78 children served as controls. Repeated measures ANOVA's yielded significant interactions between time of measurement and group for VP, motor accuracy, reported mindfulness, and anxiety. Post hoc tests revealed significant improvements in the four aforementioned measures in the experimental group only. In addition, significant correlations were obtained between the improvement in motor accuracy and the reduction in anxiety and the increase in mindfulness. Since VP and motor accuracy are basic skills associated with quantifiable academic characteristics, such as reading and mathematical abilities, the results may suggest that mindfulness practice has the ability to improve academic achievements.

How Attention Modulates Encoding of Dynamic Stimuli

When encoding a real-life, continuous stimulus, the same neural circuits support processing and integration of prior as well as new incoming information. This ongoing interplay is modulated by attention, and is evident in regions such as the prefrontal cortex section of the task positive network (TPN), and in the posterior cingulate cortex (PCC), a hub of the default mode network (DMN). Yet the exact nature of such modulation is still unclear. To investigate this issue, we utilized an fMRI task that employed movies as the encoded stimuli and manipulated attentional load via an easy or hard secondary task that was performed simultaneously with encoding. Results showed increased intersubject correlation (inter-SC) levels when encoding movies in a condition of high, as compared to low attentional load. This was evident in bilateral ventrolateral and dorsomedial prefrontal cortices and the dorsal PCC (dPCC). These regions became more attuned to the combination of the movie and the secondary task as the attentional demand of the latter increased. Activation analyses revealed that at higher load the prefrontal TPN regions were more activated, whereas the dPCC was more deactivated. Attentional load also influenced connectivity within and between the networks. At high load the dPCC was anti-correlated to the prefrontal regions, which were more functionally coherent amongst themselves. Finally and critically, greater inter-SC in the dPCC at high load during encoding predicted lower memory strength when that information was retrieved. This association between inter-SC levels and memory strength suggest that as attentional demands increased, the dPCC was more attuned to the secondary task at the expense of the encoded stimulus, thus weakening memory for the encoded stimulus. Together, our findings show that attentional load modulated the function of core TPN and DMN regions. Furthermore, the observed relationship between memory strength and the modulation of the dPCC points to this region as a key area involved in the manipulation of attentional load on memory function.

Emotion regulation choice in female patients with borderline personality disorder: Findings from self-reports and experimental measures

Emotion dysregulation is a core feature of borderline personality disorder (BPD). So far, many studies have tested the consequences of the implementation of certain emotion regulation (ER) strategies, but there have been no investigations about ER choices in BPD. Thus, the aim of this study was to investigate habitual ER choices by self-report questionnaires and experimentally by testing the preference to select between distraction and reappraisal when facing different emotional intensities (high vs. low) and contents (borderline-specific vs. unspecific negative) in patients with BPD (n=24) compared with clinical controls (patients with major depression, n=19) and a healthy control group (n=32). Additionally, heart rate (HR) responses were continuously assessed. Main results revealed that both patient groups showed maladaptive self-reported ER choice profiles compared with HC. We found, however, no differences between the groups in the choice of distraction and reappraisal on the behavioral level and in HR responses. In BPD, within-group analyses revealed a positive correlation between symptom severity and the preference for distraction under high-intensity borderline-specific stimuli. Our findings provide preliminary evidence of ER choices in BPD and show the robustness of the choice effect in patients with affective disorders.

Mindfulness Meditation Modulates Pain Through Endogenous Opioids

BACKGROUND

Recent evidence supports the beneficial effects of mindfulness meditation on pain. However, the neural mechanisms underlying this effect remain poorly understood. We used an opioid blocker to examine whether mindfulness meditation-induced analgesia involves endogenous opioids.

METHODS

Fifteen healthy experienced mindfulness meditation practitioners participated in a double-blind, randomized, placebo-controlled, crossover study. Participants rated the pain and unpleasantness of a cold stimulus prior to and after a mindfulness meditation session. Participants were then randomized to receive either intravenous naloxone or saline, after which they meditated again, and rated the same stimulus.

RESULTS

A (3) × (2) repeated-measurements analysis of variance revealed a significant time effect for pain and unpleasantness scores (both P <.001) as well as a significant condition effect for pain and unpleasantness (both P <.2). Post hoc comparisons revealed that pain and unpleasantness scores were significantly reduced after natural mindfulness meditation and after placebo, but not after naloxone. Furthermore, there was a positive correlation between the pain scores following naloxone vs placebo and participants' mindfulness meditation experience.

CONCLUSIONS

These findings show, for the first time, that meditation involves endogenous opioid pathways, mediating its analgesic effect and growing resilient with increasing practice to external suggestion. This finding could hold promising therapeutic implications and further elucidate the fine mechanisms involved in human pain modulation.

Mindful Reading: Mindfulness Meditation Helps Keep Readers with Dyslexia and ADHD on the Lexical Track

This study explored the effects of a Mindfulness-Based Stress Reduction (MBSR) intervention on reading, attention, and psychological well-being among people with developmental dyslexia and/or attention deficits. Various types of dyslexia exist, characterized by different error types. We examined a question that has not been tested so far: which types of errors (and dyslexias) are affected by MBSR training. To do so, we tested, using an extensive battery of reading tests, whether each participant had dyslexia, and which errors types s/he makes, and then compared the rate of each error type before and after the MBSR workshop. We used a similar approach to attention disorders: we evaluated the participants’ sustained, selective, executive, and orienting of attention to assess whether they had attention-disorders, and if so, which functions were impaired. We then evaluated the effect of MBSR on each of the attention functions. Psychological measures including mindfulness, stress, reflection and rumination, lifesatisfaction, depression, anxiety, and sleep-disturbances were also evaluated. Nineteen Hebrew-readers completed a 2-month mindfulness workshop. The results showed that whereas reading errors of letter-migrations within and between words and vowelletter errors did not decrease following the workshop, most participants made fewer reading errors in general following the workshop, with a significant reduction of 19% from their original number of errors. This decrease mainly resulted from a decrease in errors that occur due to reading via the sublexical rather than the lexical route. It seems, therefore, that mindfulness helped reading by keeping the readers on the lexical route. This improvement in reading probably resulted from improved sustained attention: the reduction in sublexical reading was significant for the dyslexic participants who also had attention deficits, and there were significant correlations between reduced reading errors and decreases in impulsivity. Following the meditation workshop, the rate of commission errors decreased, indicating decreased impulsivity, and the variation in RTs in the CPT task decreased, indicating improved sustained attention. Significant improvements were obtained in participants’ mindfulness, perceived-stress, rumination, depression, state-anxiety, and sleep-disturbances. Correlations were also obtained between reading improvement and increased mindfulness following the workshop. Thus, whereas mindfulness training did not affect specific types of errors and did not improve dyslexia, it did affect the reading of adults with developmental dyslexia and ADHD, by helping them to stay on the straight path of the lexical route while reading. Thus, the reading improvement induced by mindfulness sheds light on the intricate relation between attention and reading. Mindfulness reduced impulsivity and improved sustained attention, and this, in turn, improved reading of adults with developmental dyslexia and ADHD, by helping them to read via the straight path of the lexical route.

The Impact of Childhood Hearing Loss on the Family: Mothers' and Fathers' Stress and Coping Resources

Parenting children who are deaf or hard of hearing (D/HH) presents unique long-term challenges that can place the parents at a greater risk for elevated levels of parenting stress. Adaptation of families to the various challenges presented by childhood hearing loss is influenced by their personal and social coping resources available for managing these stressors and challenges. The current study examined differences in parenting stress and personal (i.e., acceptance of the child who is D/HH and parents' sense of parenting self-efficacy) and social (i.e., formal and informal social support) coping resources between mothers and fathers of children who are D/HH in the Arab sector in Israel. Further, the study examined the relations between coping resources and parenting stress among these parents. Participants included 30 Israeli Arab mother-father couples (n = 60) having a child who is D/HH aged 3-8 years. Findings revealed no significant differences between mothers and fathers regarding parenting stress, child acceptance, or parental support systems. However, mothers reported significantly higher self-efficacy. In addition, correlation analysis indicated that higher coping resources decreased parenting stress levels. Theoretical and practical implications of parental gender in the context of cultural background are discussed regarding parent intervention programs.

Do biometric parameters of the hand differentiate schizophrenia from other psychiatric disorders? A comparative evaluation using three mental health modules

The link between schizophrenia and anomalies in the distal upper limb is well documented. Preliminary studies have identified a number of biometric parameters of the hand by which schizophrenics can be distinguished from matched controls. The current study seeks to determine whether patients with schizophrenia can be singled out from a disparate group of other mental disorders by using the same parameters. We studied three groups, totaling 134 men: 51 diagnosed with schizophrenia, 29 with anxiety and mood disorders, and 54 comprising a control group. Seven parameters were studied: the proximal interphalangeal joint, the eponychia of the middle and ring digits, two dermatoglyphic features, and two constitutional factors. Examiners evaluated the parameters based on photographs and prints. An initial Mann Whitney comparison showed no significant difference between the control group and those identified with anxiety and mood disorders. We therefore accounted for them as a single group. In a discriminant analysis, an overall accuracy of 78.4% was established with a sensitivity of 80.4% (schizophrenics identified correctly) and a specificity of 77.1% (controls identified correctly). These results suggest that the biometric parameters employed may be useful in identifying patients with schizophrenia from a disparate group of other mental disorders.

The Use of Tilted Implant for Posterior Atrophic Maxilla

PURPOSE

To retrospectively analyze the influence of implant inclination on marginal bone loss at freestanding implant-supported fixed partial prostheses (FPPs) over a medium-term period of functional loading.

MATERIALS AND METHODS

Twenty-nine partially edentulous patients with freestanding FPDs supported by two implants placed in a two-stage procedure comprised the study group. The anterior implant was placed axially, and the posterior tilted distally. Mesial or distal inclination of each implant was measured in relation to the vertical axis perpendicular to the occlusal plane. Average bone loss was compared between straight and tilted implants, smokers, and nonsmokers.

RESULTS

Mean angulation of the anterior axial-positioned implant was 3.45 degrees distally (range 0-8) and of the distal implants was 32.83 degrees distally (range 20-50 degrees). Average bone loss after 1, 3, and 5 years was 0.89 (SD = 0.73), 1.18 (SD = 0.74), and 1.50 (SD = 0.81), respectively, for axial implants, and 0.98 (SD = 0.69), 1.10 (SD = 0.60) and 1.50 (SD = 0.67) for tilted implants, with no significant correlation between implant angulation and bone loss. A significant correlation between implant angulation and annual bone loss was obtained for tilted implants only (r = 0.52, p = .004).Using Albrektsson criteria, the success rate was 89.6% (26 out of 29 implants) for straight and 93.1% (27 out of 29) for tilted implants.

CONCLUSION

The study demonstrates no effect of implant angulation on peri-implant bone loss in the posterior maxilla.

Relation between contemplative exercises and an enriched psychology students' experience in a neuroscience course

This article examines the relation of contemplative exercises with enhancement of students' experience during neuroscience studies. Short contemplative exercises inspired by the Buddhist tradition of self-inquiry were introduced in an undergraduate neuroscience course for psychology students. At the start of the class, all students were asked to participate in short “personal brain investigations” relevant to the topic presented. These investigations were aimed at bringing stable awareness to a specific perceptual, emotional, attentional, or cognitive process and observing it in a non-judgmental, non-personal way. In addition, students could choose to participate, for bonus credit, in a longer exercise designed to expand upon the weekly class activity. In the exercise, students continued their “personal brain investigations” for 10 min a day, 4 days a week. They wrote “lab reports” on their daily observations, obtained feedback from the teacher, and at the end of the year reviewed their reports and reflected upon their experiences during the semester. Out of 265 students, 102 students completed the bonus track and their final reflections were analyzed using qualitative methodology. In addition, 91 of the students answered a survey at the end of the course, 43 students participated in a quiz 1 year after course graduation, and the final grades of all students were collected and analyzed. Overall, students reported satisfaction from the exercises and felt they contributed to their learning experience. In the 1-year follow-up, the bonus-track students were significantly more likely than their peers to remember class material. The qualitative analysis of bonus-track students' reports revealed that the bonus-track process elicited positive feelings, helped students connect with class material and provided them with personal insights. In addition, students acquired contemplative skills, such as increased awareness and attention, non-judgmental attitudes, and better stress-management abilities. We provide examples of “personal brain investigations” and discuss limitations of introducing a contemplative approach.

Cognitive state following stroke: the predominant role of preexisting white matter lesions

Background and purpose

Stroke is a major cause of cognitive impairment and dementia in adults, however the role of the ischemic lesions themselves, on top of other risk factors known in the elderly, remains controversial. This study used structural equation modeling to determine the respective impact of the new ischemic lesions' volume, preexisting white matter lesions and white matter integrity on post stroke cognitive state.

Methods

Consecutive first ever mild to moderate stroke or transient ischemic attack patients recruited into the ongoing prospective TABASCO study underwent magnetic resonance imaging scans within seven days of stroke onset and were cognitively assessed one year after the event using a computerized neuropsychological battery. The volumes of both ischemic lesions and preexisting white matter lesions and the integrity of the normal appearing white matter tissue were measured and their contribution to cognitive state was assessed using structural equation modeling path analysis taking into account demographic parameters. Two models were hypothesized, differing by the role of ischemic lesions' volume.

Results

Structural equation modeling analysis of 142 patients confirmed the predominant role of white matter lesion volume (standardized path coefficient β = −0.231) and normal appearing white matter integrity (β = −0.176) on the global cognitive score, while ischemic lesions' volume showed no such effect (β = 0.038). The model excluding the ischemic lesion presented better fit to the data (comparative fit index 0.9 versus 0.092).

Conclusions

Mild to moderate stroke patients with preexisting white matter lesions are more vulnerable to cognitive impairment regardless of their new ischemic lesions. Thus, these patients can serve as a target group for studies on cognitive rehabilitation and neuro-protective therapies which may, in turn, slow their cognitive deterioration.

Biometric parameters of the hand as an index of schizophrenia--a preliminary study

Since abnormalities in distal upper limb development are among the minor physical anomalies associated with schizophrenia we attempted to determine whether patients with schizophrenia can be identified on the basis of specific morphologic and dermatoglyphic features of the hand. Photographs and prints of the hands of 38 patients with schizophrenia and those of 42 control subjects were evaluated and graded on 13 biometric parameters. Results were statistically evaluated. A combination of three of the parameters was found to have good predicting abilities to distinguish between schizophrenics and controls. Subjects having high values in these three parameters were found to have a higher propensity to be defined as schizophrenics. In order to define a simple rule for classifying subjects we chose a criterion of having a value of 3 (in a scale from 1 to 3) in at least one of these three discriminating variables. This rule yielded an overall accuracy of 81.2%. Among controls, 85.7% of subjects did not fulfill such criteria, while 14.3% were defined as false positives. Among schizophrenics 76.3% achieved this condition while 23.7% were false negatives. The technique's objectivity and ease of application could facilitate the diagnosis of this disease.

Neural traces of stress: cortisol related sustained enhancement of amygdala-hippocampal functional connectivity

Stressful experiences modulate neuro-circuitry function, and the temporal trajectory of these alterations, elapsing from early disturbances to late recovery, heavily influences resilience and vulnerability to stress. Such effects of stress may depend on processes that are engaged during resting-state, through active recollection of past experiences and anticipation of future events, all known to involve the default mode network (DMN). By inducing social stress and acquiring resting-state functional magnetic resonance imaging (fMRI) before stress, immediately following it, and 2 h later, we expanded the time-window for examining the trajectory of the stress response. Throughout the study repeated cortisol samplings and self-reports of stress levels were obtained from 51 healthy young males. Post-stress alterations were investigated by whole brain resting-state functional connectivity (rsFC) of two central hubs of the DMN: the posterior cingulate cortex (PCC) and hippocampus. Results indicate a ’recovery’ pattern of DMN connectivity, in which all alterations, ascribed to the intervening stress, returned to pre-stress levels. The only exception to this pattern was a stress-induced rise in amygdala-hippocampal connectivity, which was sustained for as long as 2 h following stress induction. Furthermore, this sustained enhancement of limbic connectivity was inversely correlated to individual stress-induced cortisol responsiveness (AUCi) and characterized only the group lacking such increased cortisol (i.e., non-responders). Our observations provide evidence of a prolonged post-stress response profile, characterized by both the comprehensive balance of most DMN functional connections and the distinct time and cortisol dependent ascent of intra-limbic connectivity. These novel insights into neuro-endocrine relations are another milestone in the ongoing search for individual markers in stress-related psychopathologies.

White matter correlates of cognitive domains in normal aging with diffusion tensor imaging

The ability to perform complex as well as simple cognitive tasks engages a network of brain regions that is mediated by the white matter fiber bundles connecting them. Different cognitive tasks employ distinctive white matter fiber bundles. The temporal lobe and its projections subserve a variety of key functions known to deteriorate during aging. In a cohort of 52 healthy subjects (ages 25–82 years), we performed voxel-wise regression analysis correlating performance in higher-order cognitive domains (executive function, information processing speed, and memory) with white matter integrity, as measured by diffusion tensor imaging (DTI) fiber tracking in the temporal lobe projections [uncinate fasciculus (UF), fornix, cingulum, inferior longitudinal fasciculus (ILF), and superior longitudinal fasciculus (SLF)]. The fiber tracts were spatially registered and statistical parametric maps were produced to spatially localize the significant correlations. Results showed that performance in the executive function domain is correlated with DTI parameters in the left SLF and right UF; performance in the information processing speed domain is correlated with fractional anisotropy (FA) in the left cingulum, left fornix, right and left ILF and SLF; and the memory domain shows significant correlations with DTI parameters in the right fornix, right cingulum, left ILF, left SLF and right UF. These findings suggest that DTI tractography enables anatomical definition of region of interest (ROI) for correlation of behavioral parameters with diffusion indices, and functionality can be correlated with white matter integrity.

Recurrent aphthous stomatitis: stress, trait anger and anxiety of patients

In this case-control study, recent stress and trait anger/anxiety of otherwise healtlhy patients with active recurrent aphthous stomatitis were compared to those of dental patients with no history of RAS (controls). RAS group reported more angry/anxious feelings than controls (2.11 +/- 0.38/1.84 +/- 0.30, respectively; p < 0.001), and more recent stress (2.81 +/- 1.36/1.96 +/- 1.02; p < 0.01). Among subjects with high angriness/ anxiety, RAS subjects showed higher stress level (p < 0.005). The study revealed that anger/anxiety level mediates the relationship between stress level and RAS.

Abnormal white matter integrity in young children with autism

This study investigated white matter integrity in young children with autism using diffusion tensor imaging (DTI). Twenty-two children with autism, mean age 3:2 years, and 32 controls, mean age 3:4 years, participated in the study. Tract-based spatial statistics (TBSS) revealed white matter abnormalities in several distinct clusters within the genu and body of the corpus callosum (CC), left superior longitudinal fasciculus (SLF) and right and left cingulum (Cg). TBSS-VOIs analysis was performed in the clusters where differences in fractional anisotropy (FA) were detected to investigate the relationship between changes in FA and diffusivity indices. In all VOIs, increase in FA was caused by a decrease in radial diffusivity (Dr), while no changes in axial diffusivity (Da) or mean diffusivity (MD) were observed. Tractography analysis was applied to further study the CC, SLF, and Cg. Witelson parcellation scheme was used for the CC. Significant increase in FA was seen in children with autism in the mid-body of the CC as well as in the left Cg. It is suggested that such abnormal white matter integrity in young children with autism may adversely affect connectivity between different brain regions and may be linked to some of the behavioral impairments apparent in autism.

Accelerated maturation of white matter in young children with autism: a high b value DWI study

The goal of this work was to study white matter maturation in young children with autism following previous reports of increased cerebral volume during early development, as well as arguments for abnormal neural growth patterns and regulation at this critical developmental period. We applied diffusion tensor imaging (DTI) and high b value diffusion-weighted imaging (DWI) to young children diagnosed with autism and to a typically developing (TD) control group. Fractional anisotropy (FA), probability and displacement were measured in overall analysis as well as in regions of interest (ROI). Individual data points of children with autism were compared to the developmental curves obtained from typically developing children. Increased restriction, reflected in significantly increased FA and probability along with reduced displacement values, was detected in overall analysis as well as in several brain regions. Increased restriction, suggesting an early and accelerated abnormal maturation of white matter, was more dominant in the left hemisphere and was mainly detected in the frontal lobe. No changes were detected in the occipital lobes. These results support previous claims of abnormal brain overgrowth in young children with autism and are in contrast to the decreased restricted diffusion reported in previous studies in adolescent with autism.

Dextromethorphan premedication reduces midazolam requirement: objective and subjective parameters in peribronchoscopy

BACKGROUND

Coughing is increased during bronchoscopy and may last for several hours after the procedure. Also prior to the procedure patients show high levels of anxiety due to fear of the pain and breathing difficulties that they might experience during the procedure.

OBJECTIVES

To evaluate the antitussive, anxiolytic and sedative effect of dextromethorphan (DM) premedication on the amount of intravenous midazolam during bronchoscopic procedures.

METHODS

Sixty consecutive patients undergoing scheduled bronchoscopy were randomly allocated in a double-blind, placebo-controlled study. Half received 90 mg DM and half placebo. Local anesthesia with 2 ml of repeated intratracheal instillation of 1% lidocaine as needed during bronchoscopy was applied. Midazolam 1 mg (maximum of 5 mg) was administered intravenously until a satisfactory sedation was achieved.

RESULTS

Heart rate, systolic and diastolic pressure and SpO(2) were assessed before and during bronchoscopy. A visual analog score (VAS) for pain, cough, communication, cooperation, emotional state, complaints, expectoration, level of information about the procedure, feeling of unpleasantness and stress level assessed before and after the examination by the patient and the physician was used. There were no significant differences in the reported degrees of difficulty in undergoing bronchoscopic procedures. DM patients needed significantly fewer lidocaine instillations and lower midazolam dosage, achieved better analgesia, had lower emotion and complaint scores, significantly less coughing, significantly less stress, were significantly more cooperative, found that the procedure was much less unpleasant than they had expected, and produced less sputum at end of the procedure.

CONCLUSIONS

DM is an effective bronchoscopic premedication in combination with midazolam and improves the overall well-being of the patients.

Bruxism in military pilots and non-pilots: tooth wear and psychological stress

BACKGROUND

Bruxism is the diurnal or nocturnal para-functional habit of clenching or grinding the teeth and affects 5-10% of the general western population. Bruxism can cause pain and irreversible damage to the teeth, periodontium, masticatory muscles, and temporo-mandibular joint. Variables such as general stress, work-related stress, and personality traits have been increasingly considered as initiating, predisposing, and perpetuating factors for bruxism. We sought to evaluate the potential of work-related stress and personality factors to induce bruxism among military pilots and non-pilot officers.

METHODS

Subjects were 57 healthy male Israel Air Force officers (mean age 25.8+/-4.3 yr). Of these, 17 were jet-pilots, 18 helicopter-pilots, and 22 non-pilot officers. Tooth-wear was classified according to a six-point scale. In addition, the subjects responded to a battery of psychological questionnaires for self-assessment of stress at the workplace and their coping behavior.

RESULTS

Bruxism of clinical importance (i.e., with dentin exposure) was found in 69% of the aircrew members but only 27% of the non-pilot group. No difference was found between groups regarding stress levels.

DISCUSSION

Military aircrews may be relatively vulnerable to deleterious bruxism as well as other signs of chronic stress. Among bruxers, pilots tended to show coping strategies that were significantly more emotional and less task-oriented than non-pilots, whereas non-bruxers showed no significant differences in coping behavior. This study suggest that integrating dental and psychological preventive intervention may be helpful.

Factors associated with self-evaluated severity of illness and quality of life in male Israeli asthmatic soldiers

OBJECTIVE

To evaluate whether the asthmatic condition and quality of life of male asthmatic Israeli soldiers deteriorate during army service.

METHOD

We retrospectively assessed 178 asthmatic soldiers during service using an adapted version of the Mini Asthma Quality of Life Questionnaire, and compared it to their condition before service. The participants responded additionally to questionnaires assessing psychosocial resources and adjustment to illness.

RESULTS

The self-evaluated degree of asthma disease severity (SEDOAD) of the participants deteriorated in the army compared to before service. Soldiers with mild SEDOAD during service, compared to soldiers with severe (and in most cases also moderate) SEDOAD, had less severe medically evaluated and self-evaluated asthma before service. Mild SEDOAD participants showed, additionally, lower inclination towards active seeking of asthma-related information, more favorable health care-related attitudes, less unfavorable effects of their illness on military and extra-military functioning, greater reported pre-enlistment optimism, and a greater belief in their ability to cope successfully with their asthma during service.

CONCLUSION

SEDOAD and the quality of life during service are associated not only with pre-enlistment asthma severity, but also with the manner in which the soldier perceives the influence of the illness on his health condition, and the manner in which he copes with this influence.

Long-term functional consequences of quinolinic acid striatal lesions and their alteration following an addition of a globus pallidus lesion assessed using pharmacological magnetic resonance imaging

The present study tested the hypothesis that lesion to the rat globus pallidus (GP) can "normalize" the functioning of the basal ganglia-thalamocortical circuits in striatal-lesioned rats by assessing the functional connectivity of these regions using functional magnetic resonance imaging (fMRI). Changes in brain activation following systemic administration of amphetamine were assessed in (1) rats sustaining a unilateral lesion to the striatum, (2) rats sustaining a combined striatal and pallidal lesion, and (3) control rats. Striatal-lesioned rats showed attenuated cortical activation following amphetamine administration and lower correlations between the responses to amphetamine in different brain regions compared to control rats. Although the addition of an excitotoxic GP lesion failed to prevent striatal lesion-induced attenuation of cortical activation by amphetamine, it was effective in "normalizing" the correlations between the responses to amphetamine in the different areas. These results suggest that, although the GP lesion is ineffective in correcting the global changes in activity caused by the striatal lesion, it may have the capacity to partially restore alterations in functional connectivity resulting from the striatal lesion. These results are further discussed in view of our previous demonstration that lesions to the GP can reverse several behavioral deficits produced by a striatal lesion.

Deficits induced by quinolinic acid lesion to the striatum in a position discrimination and reversal task are ameliorated by permanent and temporary lesion to the globus pallidus: a potential novel treatment in a rat model of Huntington's disease

Symptoms in the early stages of Huntington's disease (HD) are assumed to reflect basal ganglia circuit dysfunction secondary to degeneration of striatal projections to the external segment of the globus pallidus (GPe). The hypothesis that GPe lesion would ameliorate HD symptoms by "normalizing" the circuit's functioning was tested in a rat model of this disease. The performance of rats sustaining quinolinic acid lesion to the striatum (a rat model of HD) in a position discrimination and reversal task was compared with the performance of rats sustaining in addition a bilateral excitotoxic lesion to the globus pallidus (GP) carried out simultaneously with the striatal lesion (Experiment 1) or 1 month after the striatal lesion (Experiment 2), as well as a unilateral temporary lesion of the GP (Experiment 3). The striatal lesion-induced deficit in the task was effectively reversed by a bilateral excitotoxic GP lesion carried out simultaneously or 1 month after the striatal lesion, as well as by a temporary unilateral GP inactivation. Given that a similar dysfunction of basal ganglia circuitry is thought to subserve the behavioral alterations seen in quinolinic acid lesioned rats and some of the symptoms in HD, these results raise the possibility that lesion or inactivation of the GPe may alleviate some of HD symptoms.

Cross-cultural validation of the Leeds sleep evaluation questionnaire (LSEQ) in insomnia patients

The Leeds sleep evaluation questionnaire (LSEQ) is a standardized self-reporting instrument comprising ten 100 mm visual analogue scales that pertain to the ease of getting to sleep (GTS), quality of sleep (QOS), ease of awakening from sleep (AFS) and alertness and behaviour following wakefulness (BFW). Although the LSEQ has been used in a variety of populations, published psychometric data on insomnia patients are limited. The LSEQ reliability and construct validity was evaluated in 396 French insomnia patients aged 55 years and over, who were treated with placebo (2 weeks) and melatonin (3 weeks). The results supported LSEQ internal consistency, reliability and construct validity with minor differences from those of the original English version. Then the internal consistency of the LSEQ was evaluated in 257 insomnia patients (age 20-80 years) in France and Israel who, following a 1 week placebo baseline, were randomized to placebo or melatonin treatment for 3 weeks. Cronbach's alpha and Pearson's r correlation coefficients for placebo and drug treatment conditions (p<0.001 for all) supported LSEQ internal consistency in different treatment and age groups and in different languages. It is concluded that the consistency, reliability and validity of the four LSEQ domains allows them to be singled out as independent outcome variables in cross cultural sleep research and clinical practice in adult and elderly patients with insomnia.

Melatonin treatment for tardive dyskinesia: a double-blind, placebo-controlled, crossover study

BACKGROUND

Antipsychotics remain the mainstay of drug intervention in the management of schizophrenia. However, long-term treatment with antipsychotics is associated with a variety of movement disorders, the most disabling of which is tardive dyskinesia (TD), which occurs in up to 50% of patients hospitalized with chronic schizophrenia. The pathophysiology of TD is still unclear and no definite treatment exists. Both dopamine receptor supersensitivity and oxidative stress-induced neurotoxicity in the nigrostriatal system are apparently implicated. The pineal hormone melatonin is a potent antioxidant and attenuates dopaminergic activity in the striatum and dopamine release from the hypothalamus. Thus, it may have a beneficial effect for both the treatment and prevention of TD.

METHODS

Using a double-blind, placebo-controlled, crossover study, we evaluated the efficacy of 10 mg/d of melatonin for 6 weeks in 22 patients with schizophrenia and TD. The primary outcome measure was the change from baseline in Abnormal Involuntary Movement Scale (AIMS) score.

RESULTS

The decrease (mean +/- SD) in AIMS score was 2.45 +/- 1.92 for the melatonin and 0.77 +/- 1.11 for the placebo treatment groups (P<.001). No adverse events or side effects were noted.

CONCLUSION

This is the first clinical evidence for efficacy of melatonin in the treatment of TD.

Fimbria-fornix cut affects spontaneous activity, two-way avoidance and delayed non matching to sample, but not latent inhibition

Latent inhibition (LI) consists of a decrement in conditioning to a stimulus as a result of its prior nonreinforced preexposure. Based on evidence pointing to the involvement of the hippocampus and the nucleus accumbens (NAC) in LI disruption, it has been proposed that LI depends on the integrity of the subicular input to the NAC. Since fibers originating in the subiculum and destined for the NAC run through the fimbria-fornix, we assessed the effects of fimbria-fornix lesion, made using a knife cut, on LI. In addition, we assessed the effects of the fimbria-fornix cut in three tests known to be sensitive to lesions to the hippocampal region, namely, spontaneous activity, two-way active avoidance and delayed-non-matching-to-sample. In accord with previously documented effects of lesions to the hippocampus and related structures, the fimbria-fornix cut increased spontaneous activity (Experiment 1), facilitated the acquisition of two-way active avoidance (Experiment 3), and produced a delay-dependent deficit in the delayed-non-match-to-sample task (Experiment 4), demonstrating that it disrupted hippocampal functioning. In contrast, LI remained unaffected by the fimbria-fornix cut (Experiment 2), indicating that disruption of subicular input to the NAC is not responsible for the attenuation of LI following non-selective hippocampal lesions. The implications of these results for the neural circuitry of LI are discussed.

Electrolytic lesion of globus pallidus ameliorates the behavioral and neurodegenerative effects of quinolinic acid lesion of the striatum: a potential novel treatment in a rat model of Huntington's disease

Bilateral electrolytic pallidal lesion ameliorated the deleterious effects of bilateral quinolinic acid (QA) lesion to the striatum on post-surgery weight, activity level, and performance in a water maze task, and reduced the extent of striatal damage. Given that the neurodegenerative and behavioral effects of QA striatal lesion are thought to mimic those seen in Huntington's disease, these results may point to a potential novel treatment for this disease.

Compliance to naltrexone treatment after ultra-rapid opiate detoxification: an open label naturalistic study

Studies have found that naltrexone, a long-acting opiate antagonist, owing to poor patient compliance, is of limited value in preventing relapse. The current study investigates compliance with a 9-month course of naltrexone (25-50 mg daily) given with counseling after ultra-rapid opiate detoxification which uses clonidine and naltrexone under general anesthesia. Eighty-three of 113 randomly selected patients (out of 640), who were detoxified more than 1 year prior (average 1.5 years), responded to phone interviews. Phone questionnaire asked about patients' compliance with naltrexone, counseling and drug use since detoxification. Similar interviews were also conducted with patients' significant other. Non-relapse patients (n = 47, 57%) took naltrexone an average of 2 months longer than did relapse patients (n = 36, 43%). About half of the non-relapse patients completed at least 5 months of naltrexone, 30% completed at least 7 months and about 20% completed 9 months. Fifty-five percent of the relapse patients stopped using naltrexone by the end of the 3rd month, and by the end of 7th month 10% continued to take it. After the first 2 months the decline in naltrexone compliance was about the same for relapse and non-relapse patients. These results are more encouraging about the use of naltrexone for relapse prevention than previous studies. This method of using naltrexone should be further tested in prospective random assignment controlled studies.