MRI economics: Balancing sample size and scan duration in brain wide association studies

A pervasive dilemma in neuroimaging is whether to prioritize sample size or scan duration given fixed resources. Here, we systematically investigate this trade-off in the context of brain-wide association studies (BWAS) using resting-state functional magnetic resonance imaging (fMRI). We find that total scan duration (sample size × scan duration per participant) robustly explains individual-level phenotypic prediction accuracy via a logarithmic model, suggesting that sample size and scan duration are broadly interchangeable. The returns of scan duration eventually diminish relative to sample size, which we explain with principled theoretical derivations. When accounting for fixed costs associated with each participant (e.g., recruitment, non-imaging measures), we find that prediction accuracy in small-scale BWAS might benefit from much longer scan durations (>50 min) than typically assumed. Most existing large-scale studies might also have benefited from smaller sample sizes with longer scan durations. Both logarithmic and theoretical models of the relationships among sample size, scan duration and prediction accuracy explain well-predicted phenotypes better than poorly-predicted phenotypes. The logarithmic and theoretical models are also undermined by individual differences in brain states. These results replicate across phenotypic domains (e.g., cognition and mental health) from two large-scale datasets with different algorithms and metrics. Overall, our study emphasizes the importance of scan time, which is ignored in standard power calculations. Standard power calculations inevitably maximize sample size at the expense of scan duration. The resulting prediction accuracies are likely lower than would be produced with alternate designs, thus impeding scientific discovery. Our empirically informed reference is available for future study design: WEB_APPLICATION_LINK.

Homotopic local-global parcellation of the human cerebral cortex from resting-state functional connectivity

Resting-state fMRI is commonly used to derive brain parcellations, which are widely used for dimensionality reduction and interpreting human neuroscience studies. We previously developed a model that integrates local and global approaches for estimating areal-level cortical parcellations. The resulting local-global parcellations are often referred to as the Schaefer parcellations. However, the lack of homotopic correspondence between left and right Schaefer parcels has limited their use for brain lateralization studies. Here, we extend our previous model to derive homotopic areal-level parcellations. Using resting-fMRI and task-fMRI across diverse scanners, acquisition protocols, preprocessing and demographics, we show that the resulting homotopic parcellations are as homogeneous as the Schaefer parcellations, while being more homogeneous than five publicly available parcellations. Furthermore, weaker correlations between homotopic parcels are associated with greater lateralization in resting network organization, as well as lateralization in language and motor task activation. Finally, the homotopic parcellations agree with the boundaries of a number of cortical areas estimated from histology and visuotopic fMRI, while capturing sub-areal (e.g., somatotopic and visuotopic) features. Overall, these results suggest that the homotopic local-global parcellations represent neurobiologically meaningful subdivisions of the human cerebral cortex and will be a useful resource for future studies. Multi-resolution parcellations estimated from 1479 participants are publicly available (https://github.com/ThomasYeoLab/CBIG/tree/master/stable_projects/brain_parcellation/Yan2023_homotopic).

Selective D3 receptor antagonism modulates neural response during negative emotional processing in substance dependence

Introduction

Negative affective states contribute to the chronic-relapsing nature of addiction. Mesolimbic dopamine D3 receptors are well placed to modulate emotion and are dysregulated in substance dependence. Selective antagonists might restore dopaminergic hypofunction, thus representing a potential treatment target. We investigated the effects of selective D3 antagonist, GSK598809, on the neural response to negative emotional processing in substance dependent individuals and healthy controls.

Methodology

Functional MRI BOLD response was assessed during an evocative image task, 2 h following acute administration of GSK598809 (60 mg) or placebo in a multi-site, double-blind, pseudo-randomised, cross-over design. Abstinent drug dependent individuals (DD, n = 36) comprising alcohol-only (AO, n = 19) and cocaine-alcohol polydrug (PD, n = 17) groups, and matched controls (n = 32) were presented with aversive and neutral images in a block design (contrast of interest: aversive > neutral). Whole-brain mixed-effects and a priori ROI analyses tested for group and drug effects, with identical models exploring subgroup effects.

Results

No group differences in task-related BOLD signal were identified between DD and controls. However, subgroup analysis revealed greater amygdala/insular BOLD signal in PD compared with AO groups. Following drug administration, GSK598809 increased BOLD response across HC and DD groups in thalamus, caudate, putamen, and pallidum, and reduced BOLD response in insular and opercular cortices relative to placebo. Multivariate analyses in a priori ROIs revealed differential effects of D3 antagonism according to subgroup in substantia nigra; GSK598809 increased BOLD response in AO and decreased response in PD groups.

Conclusion

Acute GSK598809 modulates the BOLD response to aversive image processing, providing evidence that D3 antagonism may impact emotional regulation. Enhanced BOLD response within D3-rich mesolimbic regions is consistent with its pharmacology and with attenuation of substance-related hypodopaminergic function. However, the lack of group differences in task-related BOLD response and the non-specific effect of GSK598809 between groups makes it difficult to ascertain whether D3 antagonism is likely to be normalising or restorative in our abstinent populations. The suggestion of differential D3 modulation between AO and PD subgroups is intriguing, raising the possibility of divergent treatment responses. Further study is needed to determine whether D3 antagonism should be recommended as a treatment target in substance dependence.

Alterations in white matter microstructure in alcohol and alcohol‐polydrug dependence: Associations with lifetime alcohol and nicotine exposure

Evidence suggests that alcohol dependence (AD) is associated with microstructural deficits in white matter, but the relationship with lifetime alcohol exposure and the impact of polydrug dependence is not well understood. Using diffusion tensor magnetic resonance (MR) imaging, we examined white matter microstructure in relation to alcohol and polydrug dependence using data from the Imperial College Cambridge Manchester (ICCAM) platform study. Tract‐based spatial statistics were used to examine fractional anisotropy (FA) in a cohort of abstinent AD participants, most of whom had a lifetime history of dependence to nicotine. A further subgroup also had a lifetime history of dependence to cocaine and/or opiates. Individuals with AD had lower FA throughout the corpus callosum, and negative associations with alcohol and nicotine exposure were found. A group‐by‐age interaction effect was found showing greater reductions with age in the alcohol‐dependent group within corpus callosum, overlapping with the group difference. We found no evidence of recovery with abstinence. A comparison of alcohol‐only‐ and alcohol‐polydrug‐dependent groups found no differences in FA. Overall, our findings show that AD is associated with lower FA and suggest that these alterations are primarily driven by lifetime alcohol consumption and cigarette smoking, showing no relationship with exposure to other substances such as cocaine, opiates or cannabis. Reductions in FA across the adult lifespan are more pronounced in AD and offer further support for the notion of accelerated ageing in relation to alcohol dependence. These findings highlight there may be lasting structural differences in white matter in alcohol dependence, despite continued abstinence.

Shared and unique brain network features predict cognitive, personality, and mental health scores in the ABCD study

How individual differences in brain network organization track behavioral variability is a fundamental question in systems neuroscience. Recent work suggests that resting-state and task-state functional connectivity can predict specific traits at the individual level. However, most studies focus on single behavioral traits, thus not capturing broader relationships across behaviors. In a large sample of 1858 typically developing children from the Adolescent Brain Cognitive Development (ABCD) study, we show that predictive network features are distinct across the domains of cognitive performance, personality scores and mental health assessments. On the other hand, traits within each behavioral domain are predicted by similar network features. Predictive network features and models generalize to other behavioral measures within the same behavioral domain. Although tasks are known to modulate the functional connectome, predictive network features are similar between resting and task states. Overall, our findings reveal shared brain network features that account for individual variation within broad domains of behavior in childhood.

Sensory-motor cortices shape functional connectivity dynamics in the human brain

Large-scale biophysical circuit models provide mechanistic insights into the micro-scale and macro-scale properties of brain organization that shape complex patterns of spontaneous brain activity. We developed a spatially heterogeneous large-scale dynamical circuit model that allowed for variation in local synaptic properties across the human cortex. Here we show that parameterizing local circuit properties with both anatomical and functional gradients generates more realistic static and dynamic resting-state functional connectivity (FC). Furthermore, empirical and simulated FC dynamics demonstrates remarkably similar sharp transitions in FC patterns, suggesting the existence of multiple attractors. Time-varying regional fMRI amplitude may track multi-stability in FC dynamics. Causal manipulation of the large-scale circuit model suggests that sensory-motor regions are a driver of FC dynamics. Finally, the spatial distribution of sensory-motor drivers matches the principal gradient of gene expression that encompasses certain interneuron classes, suggesting that heterogeneity in excitation-inhibition balance might shape multi-stability in FC dynamics.

Individual-Specific Areal-Level Parcellations Improve Functional Connectivity Prediction of Behavior

Resting-state functional magnetic resonance imaging (rs-fMRI) allows estimation of individual-specific cortical parcellations. We have previously developed a multi-session hierarchical Bayesian model (MS-HBM) for estimating high-quality individual-specific network-level parcellations. Here, we extend the model to estimate individual-specific areal-level parcellations. While network-level parcellations comprise spatially distributed networks spanning the cortex, the consensus is that areal-level parcels should be spatially localized, that is, should not span multiple lobes. There is disagreement about whether areal-level parcels should be strictly contiguous or comprise multiple noncontiguous components; therefore, we considered three areal-level MS-HBM variants spanning these range of possibilities. Individual-specific MS-HBM parcellations estimated using 10 min of data generalized better than other approaches using 150 min of data to out-of-sample rs-fMRI and task-fMRI from the same individuals. Resting-state functional connectivity derived from MS-HBM parcellations also achieved the best behavioral prediction performance. Among the three MS-HBM variants, the strictly contiguous MS-HBM exhibited the best resting-state homogeneity and most uniform within-parcel task activation. In terms of behavioral prediction, the gradient-infused MS-HBM was numerically the best, but differences among MS-HBM variants were not statistically significant. Overall, these results suggest that areal-level MS-HBMs can capture behaviorally meaningful individual-specific parcellation features beyond group-level parcellations. Multi-resolution trained models and parcellations are publicly available (https://github.com/ThomasYeoLab/CBIG/tree/master/stable_projects/brain_parcellation/Kong2022_ArealMSHBM).

Disturbances across whole brain networks during reward anticipation in an abstinent addiction population

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Analytical methods can capture key features of whole brain networks in addiction.

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We compared reward network connectivity in addiction (ADD) and control (CON) groups.

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The ADD group showed disruptions in global network connectivity.

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Global network measures may be more sensitive than traditional voxel-wise analyses.

The prevalent spatial distribution of abnormalities reported in cognitive fMRI studies in addiction suggests there are extensive disruptions across whole brain networks. Studies using resting state have reported disruptions in network connectivity in addiction, but these studies have not revealed characteristics of network functioning during critical psychological processes that are disrupted in addiction populations. Analytic methods that can capture key features of whole brain networks during psychological processes may be more sensitive in revealing additional and widespread neural disturbances in addiction, that are the provisions for relapse risk, and targets for medication development. The current study compared a substance addiction (ADD; n = 83) group in extended abstinence with a control (CON; n = 68) group on functional MRI (voxel-wise activation) and global network (connectivity) measures related to reward anticipation on a monetary incentive delay task. In the absence of group differences on MID performance, the ADD group showed reduced activation predominantly across temporal and visual regions, but not across the striatum. The ADD group also showed disruptions in global network connectivity (lower clustering coefficient and higher characteristic path length), and significantly less connectivity across a sub-network comprising frontal, temporal, limbic and striatal nodes. These results show that an addiction group in extended abstinence exhibit localised disruptions in brain activation, but more extensive disturbances in functional connectivity across whole brain networks. We propose that measures of global network functioning may be more sensitive in highlighting latent and more widespread neural disruptions during critical psychological processes in addiction and other psychiatric disorders.

Time of day is associated with paradoxical reductions in global signal fluctuation and functional connectivity

The brain exhibits substantial diurnal variation in physiology and function, but neuroscience studies rarely report or consider the effects of time of day. Here, we examined variation in resting-state functional MRI (fMRI) in around 900 individuals scanned between 8 AM and 10 PM on two different days. Multiple studies across animals and humans have demonstrated that the brain’s global signal (GS) amplitude (henceforth referred to as “fluctuation”) increases with decreased arousal. Thus, in accord with known circadian variation in arousal, we hypothesised that GS fluctuation would be lowest in the morning, increase in the midafternoon, and dip in the early evening. Instead, we observed a cumulative decrease in GS fluctuation as the day progressed. Although respiratory variation also decreased with time of day, control analyses suggested that this did not account for the reduction in GS fluctuation. Finally, time of day was associated with marked decreases in resting-state functional connectivity across the whole brain. The magnitude of decrease was significantly stronger than associations between functional connectivity and behaviour (e.g., fluid intelligence). These findings reveal time of day effects on global brain activity that are not easily explained by expected arousal state or physiological artefacts. We conclude by discussing potential mechanisms for the observed diurnal variation in resting brain activity and the importance of accounting for time of day in future studies.

The brain exhibits substantial diurnal variation in physiology and function. A large-scale fMRI study reveals that the brain’s global signal amplitude, typically elevated during drowsy states, unexpectedly reduces steadily as the day progresses.

Somatosensory-Motor Dysconnectivity Spans Multiple Transdiagnostic Dimensions of Psychopathology

BACKGROUND

There is considerable interest in a dimensional transdiagnostic approach to psychiatry. Most transdiagnostic studies have derived factors based only on clinical symptoms, which might miss possible links between psychopathology, cognitive processes, and personality traits. Furthermore, many psychiatric studies focus on higher-order association brain networks, thereby neglecting the potential influence of huge swaths of the brain.

METHODS

A multivariate data-driven approach (partial least squares) was used to identify latent components linking a large set of clinical, cognitive, and personality measures to whole-brain resting-state functional connectivity patterns across 224 participants. The participants were either healthy (n = 110) or diagnosed with bipolar disorder (n = 40), attention-deficit/hyperactivity disorder (n = 37), schizophrenia (n = 29), or schizoaffective disorder (n = 8). In contrast to traditional case-control analyses, the diagnostic categories were not used in the partial least squares analysis but were helpful for interpreting the components.

RESULTS

Our analyses revealed three latent components corresponding to general psychopathology, cognitive dysfunction, and impulsivity. Each component was associated with a unique whole-brain resting-state functional connectivity signature and was shared across all participants. The components were robust across multiple control analyses and replicated using independent task functional magnetic resonance imaging data from the same participants. Strikingly, all three components featured connectivity alterations within the somatosensory-motor network and its connectivity with subcortical structures and cortical executive networks.

CONCLUSIONS

We identified three distinct dimensions with dissociable (but overlapping) whole-brain resting-state functional connectivity signatures across healthy individuals and individuals with psychiatric illness, providing potential intermediate phenotypes that span diagnostic categories. Our results suggest expanding the focus of psychiatric neuroscience beyond higher-order brain networks.

Naltrexone differentially modulates the neural correlates of motor impulse control in abstinent alcohol-dependent and polysubstance-dependent individuals

Identifying key neural substrates in addiction disorders for targeted drug development remains a major challenge for clinical neuroscience. One emerging target is the opioid system, where substance-dependent populations demonstrate prefrontal opioid dysregulation that predicts impulsivity and relapse. This may suggest that disturbances to the prefrontal opioid system could confer a risk for relapse in addiction due to weakened 'top-down' control over impulsive behaviour. Naltrexone is currently licensed for alcohol dependence and is also used clinically for impulse control disorders. Using a go/no-go (GNG) task, we examined the effects of acute naltrexone on the neural correlates of successful motor impulse control in abstinent alcoholics (AUD), abstinent polysubstance-dependent (poly-SUD) individuals and controls during a randomised double blind placebo controlled fMRI study. In the absence of any differences on GNG task performance, the AUD group showed a significantly greater BOLD response compared to the control group in lateral and medial prefrontal regions during both placebo and naltrexone treatments; effects that were positively correlated with alcohol abstinence. There was also a dissociation in the positive modulating effects of naltrexone in the orbitofrontal cortex (OFC) and anterior insula cortex (AIC) of the AUD and poly-SUD groups respectively. Self-reported trait impulsivity in the poly-SUD group also predicted the effect of naltrexone in the AIC. These results suggest that acute naltrexone differentially amplifies neural responses within two distinct regions of a salience network during successful motor impulse control in abstinent AUD and poly-SUD groups, which are predicted by trait impulsivity in the poly-SUD group.

Systematic Study of L-Shell Opacity at Stellar Interior Temperatures

The first systematic study of opacity dependence on atomic number at stellar interior temperatures is used to evaluate discrepancies between measured and modeled iron opacity [J. E. Bailey et al., Nature (London) 517, 56 (2015)NATUAS0028-083610.1038/nature14048]. High-temperature (>180  eV) chromium and nickel opacities are measured with ±6%-10% uncertainty, using the same methods employed in the previous iron experiments. The 10%-20% experiment reproducibility demonstrates experiment reliability. The overall model-data disagreements are smaller than for iron. However, the systematic study reveals shortcomings in models for density effects, excited states, and open L-shell configurations. The 30%-45% underestimate in the modeled quasicontinuum opacity at short wavelengths was observed only from iron and only at temperature above 180 eV. Thus, either opacity theories are missing physics that has nonmonotonic dependence on the number of bound electrons or there is an experimental flaw unique to the iron measurement at temperatures above 180 eV.

Spatial Topography of Individual-Specific Cortical Networks Predicts Human Cognition, Personality, and Emotion

Resting-state functional magnetic resonance imaging (rs-fMRI) offers the opportunity to delineate individual-specific brain networks. A major question is whether individual-specific network topography (i.e., location and spatial arrangement) is behaviorally relevant. Here, we propose a multi-session hierarchical Bayesian model (MS-HBM) for estimating individual-specific cortical networks and investigate whether individual-specific network topography can predict human behavior. The multiple layers of the MS-HBM explicitly differentiate intra-subject (within-subject) from inter-subject (between-subject) network variability. By ignoring intra-subject variability, previous network mappings might confuse intra-subject variability for inter-subject differences. Compared with other approaches, MS-HBM parcellations generalized better to new rs-fMRI and task-fMRI data from the same subjects. More specifically, MS-HBM parcellations estimated from a single rs-fMRI session (10 min) showed comparable generalizability as parcellations estimated by 2 state-of-the-art methods using 5 sessions (50 min). We also showed that behavioral phenotypes across cognition, personality, and emotion could be predicted by individual-specific network topography with modest accuracy, comparable to previous reports predicting phenotypes based on connectivity strength. Network topography estimated by MS-HBM was more effective for behavioral prediction than network size, as well as network topography estimated by other parcellation approaches. Thus, similar to connectivity strength, individual-specific network topography might also serve as a fingerprint of human behavior.

Resting brain dynamics at different timescales capture distinct aspects of human behavior

Linking human behavior to resting-state brain function is a central question in systems neuroscience. In particular, the functional timescales at which different types of behavioral factors are encoded remain largely unexplored. The behavioral counterparts of static functional connectivity (FC), at the resolution of several minutes, have been studied but behavioral correlates of dynamic measures of FC at the resolution of a few seconds remain unclear. Here, using resting-state fMRI and 58 phenotypic measures from the Human Connectome Project, we find that dynamic FC captures task-based phenotypes (e.g., processing speed or fluid intelligence scores), whereas self-reported measures (e.g., loneliness or life satisfaction) are equally well explained by static and dynamic FC. Furthermore, behaviorally relevant dynamic FC emerges from the interconnections across all resting-state networks, rather than within or between pairs of networks. Our findings shed new light on the timescales of cognitive processes involved in distinct facets of behavior.

Global signal regression strengthens association between resting-state functional connectivity and behavior

Global signal regression (GSR) is one of the most debated preprocessing strategies for resting-state functional MRI. GSR effectively removes global artifacts driven by motion and respiration, but also discards globally distributed neural information and introduces negative correlations between certain brain regions. The vast majority of previous studies have focused on the effectiveness of GSR in removing imaging artifacts, as well as its potential biases. Given the growing interest in functional connectivity fingerprinting, here we considered the utilitarian question of whether GSR strengthens or weakens associations between resting-state functional connectivity (RSFC) and multiple behavioral measures across cognition, personality and emotion. By applying the variance component model to the Brain Genomics Superstruct Project (GSP), we found that behavioral variance explained by whole-brain RSFC increased by an average of 47% across 23 behavioral measures after GSR. In the Human Connectome Project (HCP), we found that behavioral variance explained by whole-brain RSFC increased by an average of 40% across 58 behavioral measures, when GSR was applied after ICA-FIX de-noising. To ensure generalizability, we repeated our analyses using kernel regression. GSR improved behavioral prediction accuracies by an average of 64% and 12% in the GSP and HCP datasets respectively. Importantly, the results were consistent across methods. A behavioral measure with greater RSFC-explained variance (using the variance component model) also exhibited greater prediction accuracy (using kernel regression). A behavioral measure with greater improvement in behavioral variance explained after GSR (using the variance component model) also enjoyed greater improvement in prediction accuracy after GSR (using kernel regression). Furthermore, GSR appeared to benefit task performance measures more than self-reported measures. Since GSR was more effective at removing motion-related and respiratory-related artifacts, GSR-related increases in variance explained and prediction accuracies were unlikely the result of motion-related or respiratory-related artifacts. However, it is worth emphasizing that the current study focused on whole-brain RSFC, so it remains unclear whether GSR improves RSFC-behavioral associations for specific connections or networks. Overall, our results suggest that at least in the case for young healthy adults, GSR strengthens the associations between RSFC and most (although not all) behavioral measures. Code for the variance component model and ridge regression can be found here: https://github.com/ThomasYeoLab/CBIG/tree/master/stable_projects/preprocessing/Li2019_GSR.

Inversion of a large-scale circuit model reveals a cortical hierarchy in the dynamic resting human brain

We considered a large-scale dynamical circuit model of human cerebral cortex with region-specific microscale properties. The model was inverted using a stochastic optimization approach, yielding markedly better fit to new, out-of-sample resting functional magnetic resonance imaging (fMRI) data. Without assuming the existence of a hierarchy, the estimated model parameters revealed a large-scale cortical gradient. At one end, sensorimotor regions had strong recurrent connections and excitatory subcortical inputs, consistent with localized processing of external stimuli. At the opposing end, default network regions had weak recurrent connections and excitatory subcortical inputs, consistent with their role in internal thought. Furthermore, recurrent connection strength and subcortical inputs provided complementary information for differentiating the levels of the hierarchy, with only the former showing strong associations with other macroscale and microscale proxies of cortical hierarchies (meta-analysis of cognitive functions, principal resting fMRI gradient, myelin, and laminar-specific neuronal density). Overall, this study provides microscale insights into a macroscale cortical hierarchy in the dynamic resting brain.

Naltrexone ameliorates functional network abnormalities in alcohol-dependent individuals

Naltrexone, an opioid receptor antagonist, is commonly used as a relapse prevention medication in alcohol and opiate addiction, but its efficacy and the mechanisms underpinning its clinical usefulness are not well characterized. In the current study, we examined the effects of 50‐mg naltrexone compared with placebo on neural network changes associated with substance dependence in 21 alcohol and 36 poly‐drug‐dependent individuals compared with 36 healthy volunteers. Graph theoretic and network‐based statistical analysis of resting‐state functional magnetic resonance imaging (MRI) data revealed that alcohol‐dependent subjects had reduced functional connectivity of a dispersed network compared with both poly‐drug‐dependent and healthy subjects. Higher local efficiency was observed in both patient groups, indicating clustered and segregated network topology and information processing. Naltrexone normalized heightened local efficiency of the neural network in alcohol‐dependent individuals, to the same levels as healthy volunteers. Naltrexone failed to have an effect on the local efficiency in abstinent poly‐substance‐dependent individuals. Across groups, local efficiency was associated with substance, but no alcohol exposure implicating local efficiency as a potential premorbid risk factor in alcohol use disorders that can be ameliorated by naltrexone. These findings suggest one possible mechanism for the clinical effects of naltrexone, namely, the amelioration of disrupted network topology.

Acute naltrexone does not remediate fronto-striatal disturbances in alcoholic and alcoholic polysubstance-dependent populations during a monetary incentive delay task

There is a concerted research effort to investigate brain mechanisms underlying addiction processes that may predicate the development of new compounds for treating addiction. One target is the brain's opioid system, because of its role in the reinforcing effects of substances of abuse. Substance-dependent populations have increased numbers of the mu opioid receptor (MOR) in fronto-striatal regions that predict drug relapse, and demonstrate disturbances in these regions during the processing of non-drug rewards. Naltrexone is currently licensed for alcohol and opiate dependence, and may remediate such disturbances through the blockade of MORs in fronto-striatal reward circuitry. Therefore, we examined the potential acute modulating effects of naltrexone on the anticipation of, and instrumental responding for, non-drug rewards in long-term abstinent alcoholics, alcoholic poly substance-dependent individuals and controls using a monetary incentive delay (MID) task during a randomized double blind placebo controlled functional MRI study. We report that the alcoholic poly substance-dependent group exhibited slower and less accurate instrumental responding compared to alcoholics and controls that was less evident after acute naltrexone treatment. However, naltrexone treatment was unable to remediate disturbances within fronto-striatal regions during reward anticipation and 'missed' rewards in either substance-dependent group. While we have not been able to identify the underlying neural mechanisms for improvement observed with naltrexone in the alcoholic poly-substance dependent group, we can confirm that both substance-dependent groups exhibit substantial neural deficits during an MID task, despite being in long-term abstinence.

Acute D3 Antagonist GSK598809 Selectively Enhances Neural Response During Monetary Reward Anticipation in Drug and Alcohol Dependence

This corrects the article DOI: 10.1038/npp.2016.289.

Acute D3 Antagonist GSK598809 Selectively Enhances Neural Response During Monetary Reward Anticipation in Drug and Alcohol Dependence

Evidence suggests that disturbances in neurobiological mechanisms of reward and inhibitory control maintain addiction and provoke relapse during abstinence. Abnormalities within the dopamine system may contribute to these disturbances and pharmacologically targeting the D3 dopamine receptor (DRD3) is therefore of significant clinical interest. We used functional magnetic resonance imaging to investigate the acute effects of the DRD3 antagonist GSK598809 on anticipatory reward processing, using the monetary incentive delay task (MIDT), and response inhibition using the Go/No-Go task (GNGT). A double-blind, placebo-controlled, crossover design approach was used in abstinent alcohol dependent, abstinent poly-drug dependent and healthy control volunteers. For the MIDT, there was evidence of blunted ventral striatal response to reward in the poly-drug-dependent group under placebo. GSK598809 normalized ventral striatal reward response and enhanced response in the DRD3-rich regions of the ventral pallidum and substantia nigra. Exploratory investigations suggested that the effects of GSK598809 were mainly driven by those with primary dependence on alcohol but not on opiates. Taken together, these findings suggest that GSK598809 may remediate reward deficits in substance dependence. For the GNGT, enhanced response in the inferior frontal cortex of the poly-drug group was found. However, there were no effects of GSK598809 on the neural network underlying response inhibition nor were there any behavioral drug effects on response inhibition. GSK598809 modulated the neural network underlying reward anticipation but not response inhibition, suggesting that DRD3 antagonists may restore reward deficits in addiction.

Effects of naltrexone are influenced by childhood adversity during negative emotional processing in addiction recovery

Naltrexone is an opioid receptor antagonist used in the management of alcohol dependence. Although the endogenous opioid system has been implicated in emotion regulation, the effects of mu-opioid receptor blockade on brain systems underlying negative emotional processing are not clear in addiction. Individuals meeting criteria for alcohol dependence alone (n=18, alcohol) and in combination with cocaine and/or opioid dependence (n=21, alcohol/drugs) and healthy individuals without a history of alcohol or drug dependence (n=21) were recruited. Participants were alcohol and drug abstinent before entered into this double-blind, placebo-controlled, randomized, crossover study. Functional magnetic resonance imaging was used to investigate brain response while viewing aversive and neutral images relative to baseline on 50 mg of naltrexone and placebo. We found that naltrexone modulated task-related activation in the medial prefrontal cortex and functional connectivity between the anterior cingulate cortex and the hippocampus as a function of childhood adversity (for aversive versus neutral images) in all groups. Furthermore, there was a group-by-treatment-by-condition interaction in the right amygdala, which was mainly driven by a normalization of response for aversive relative to neutral images under naltrexone in the alcohol/drugs group. We conclude that early childhood adversity is one environmental factor that influences pharmacological response to naltrexone. Pharmacotherapy with naltrexone may also have some ameliorative effects on negative emotional processing in combined alcohol and drug dependence, possibly due to alterations in endogenous opioid transmission or the kappa-opioid receptor antagonist actions of naltrexone.

The ICCAM platform study: An experimental medicine platform for evaluating new drugs for relapse prevention in addiction. Part B: fMRI description

OBJECTIVES

We aimed to set up a robust multi-centre clinical fMRI and neuropsychological platform to investigate the neuropharmacology of brain processes relevant to addiction - reward, impulsivity and emotional reactivity. Here we provide an overview of the fMRI battery, carried out across three centres, characterizing neuronal response to the tasks, along with exploring inter-centre differences in healthy participants.

EXPERIMENTAL DESIGN

Three fMRI tasks were used: monetary incentive delay to probe reward sensitivity, go/no-go to probe impulsivity and an evocative images task to probe emotional reactivity. A coordinate-based activation likelihood estimation (ALE) meta-analysis was carried out for the reward and impulsivity tasks to help establish region of interest (ROI) placement. A group of healthy participants was recruited from across three centres (total n=43) to investigate inter-centre differences. Principle observations: The pattern of response observed for each of the three tasks was consistent with previous studies using similar paradigms. At the whole brain level, significant differences were not observed between centres for any task.

CONCLUSIONS

In developing this platform we successfully integrated neuroimaging data from three centres, adapted validated tasks and applied whole brain and ROI approaches to explore and demonstrate their consistency across centres.

LSD alters eyes-closed functional connectivity within the early visual cortex in a retinotopic fashion

The question of how spatially organized activity in the visual cortex behaves during eyes-closed, lysergic acid diethylamide (LSD)-induced "psychedelic imagery" (e.g., visions of geometric patterns and more complex phenomena) has never been empirically addressed, although it has been proposed that under psychedelics, with eyes-closed, the brain may function "as if" there is visual input when there is none. In this work, resting-state functional connectivity (RSFC) data was analyzed from 10 healthy subjects under the influence of LSD and, separately, placebo. It was suspected that eyes-closed psychedelic imagery might involve transient local retinotopic activation, of the sort typically associated with visual stimulation. To test this, it was hypothesized that, under LSD, patches of the visual cortex with congruent retinotopic representations would show greater RSFC than incongruent patches. Using a retinotopic localizer performed during a nondrug baseline condition, nonadjacent patches of V1 and V3 that represent the vertical or the horizontal meridians of the visual field were identified. Subsequently, RSFC between V1 and V3 was measured with respect to these a priori identified patches. Consistent with our prior hypothesis, the difference between RSFC of patches with congruent retinotopic specificity (horizontal-horizontal and vertical-vertical) and those with incongruent specificity (horizontal-vertical and vertical-horizontal) increased significantly under LSD relative to placebo, suggesting that activity within the visual cortex becomes more dependent on its intrinsic retinotopic organization in the drug condition. This result may indicate that under LSD, with eyes-closed, the early visual system behaves as if it were seeing spatially localized visual inputs. Hum Brain Mapp 37:3031-3040, 2016. © 2016 Wiley Periodicals, Inc.

The Imperial College Cambridge Manchester (ICCAM) platform study: An experimental medicine platform for evaluating new drugs for relapse prevention in addiction. Part A: Study description

Drug and alcohol dependence are global problems with substantial societal costs. There are few treatments for relapse prevention and therefore a pressing need for further study of brain mechanisms underpinning relapse circuitry. The Imperial College Cambridge Manchester (ICCAM) platform study is an experimental medicine approach to this problem: using functional magnetic resonance imaging (fMRI) techniques and selective pharmacological tools, it aims to explore the neuropharmacology of putative relapse pathways in cocaine, alcohol, opiate dependent, and healthy individuals to inform future drug development. Addiction studies typically involve small samples because of recruitment difficulties and attrition. We established the platform in three centres to assess the feasibility of a multisite approach to address these issues. Pharmacological modulation of reward, impulsivity and emotional reactivity were investigated in a monetary incentive delay task, an inhibitory control task, and an evocative images task, using selective antagonists for µ-opioid, dopamine D3 receptor (DRD3) and neurokinin 1 (NK1) receptors (naltrexone, GSK598809, vofopitant/aprepitant), in a placebo-controlled, randomised, crossover design. In two years, 609 scans were performed, with 155 individuals scanned at baseline. Attrition was low and the majority of individuals were sufficiently motivated to complete all five sessions (n=87). We describe herein the study design, main aims, recruitment numbers, sample characteristics, and explain the test hypotheses and anticipated study outputs.

Cost Effectiveness Analysis of Knee Osteoarthritis Treatment

INTRODUCTION

Resource allocation is challenging in times of economic restraint and cannot be based only on clinical judgments, but must also take into account economic aspects. A method for assessing patient outcome is to estimate the quality-adjusted life years (QALYs). These will quantify the benefit gained by a certain treatment by measuring the change in health-related quality of life with time. This study will assess the cost effectiveness of conservative management, consisting in rehabilitation program, and compare the cost effectiveness of total knee arthroplasty when implanted to a non operated arthritic knee with cost effectiveness of the same procedure following high tibial osteotomy.

MATERIALS AND METHODS

This study reviewed 30 patients who were treated for knee osteoarthritis with rehabilitation care (group 1-G1), 30 patients who underwent unilateral TKA to an non-operated knee (group 2-G2) and 30 patients who underwent TKA following HTO for degenerative arthritis of the knee (group 3-G3). The economical endpoint were the total direct costs (Euro), based on DRG rates for procedures. The cost effectiveness analysis was assessed by the ratio between direct costs as assessed by the economical endpoint and the associated patient benefit as assessed by the clinical endpoint (EUR/QALY).

RESULTS

No statistically significant differences was found between G2 and G3 regarding clinical or radiological outcomes of this study. Yet the patients who did not previously suffered a HTO procedure showed lower mean values of KSS, ROM and femurotibial angle. A significant benefit is observed for G2 and G3 towards G1 patients. Neither a clinically relevant nor a statistically significant association between groups is observed in G2 and G3 (median benefit estimates 2.5 versus 2.6 QALYs). Median benefit estimate for patients who did not previously suffered a HTO procedure was though smaller then benefit for those who did. A median cost effectiveness ratio of 1800 EUR/QALY (450 - 2000 EUR / QALY) was found based on the EuroQuol scores for G1; 1268 EUR/QALY (720 - 2160 EUR/QALY), for G2, and 1975 EUR/QALY (720 - 2160 EUR/QALY) for G3.

DISCUSSION

Regarding surgical treatment, the results showed a statistically significant better cost benefit relation for patients from G2 (p 0,001). Conservative management for knee OA is neither clinically effective for pain or disease progression nor cost effective, when applied for late stages of OA.

CONCLUSION

We report the lowest cost per QALY in the literature for TKA. If financial constraints is a cause for rationalizing the medical services, careful patient selection to optimise the clinical and economical aspects of procedures may help to improve further the cost-effectiveness of these interventions.

A novel femtosecond-gated, high-resolution, frequency-shifted shearing interferometry technique for probing pre-plasma expansion in ultra-intense laser experiments

Ultra-intense laser-matter interaction experiments (>10(18) W/cm(2)) with dense targets are highly sensitive to the effect of laser "noise" (in the form of pre-pulses) preceding the main ultra-intense pulse. These system-dependent pre-pulses in the nanosecond and/or picosecond regimes are often intense enough to modify the target significantly by ionizing and forming a plasma layer in front of the target before the arrival of the main pulse. Time resolved interferometry offers a robust way to characterize the expanding plasma during this period. We have developed a novel pump-probe interferometry system for an ultra-intense laser experiment that uses two short-pulse amplifiers synchronized by one ultra-fast seed oscillator to achieve 40-fs time resolution over hundreds of nanoseconds, using a variable delay line and other techniques. The first of these amplifiers acts as the pump and delivers maximal energy to the interaction region. The second amplifier is frequency shifted and then frequency doubled to generate the femtosecond probe pulse. After passing through the laser-target interaction region, the probe pulse is split and recombined in a laterally sheared Michelson interferometer. Importantly, the frequency shift in the probe allows strong plasma self-emission at the second harmonic of the pump to be filtered out, allowing plasma expansion near the critical surface and elsewhere to be clearly visible in the interferograms. To aid in the reconstruction of phase dependent imagery from fringe shifts, three separate 120° phase-shifted (temporally sheared) interferograms are acquired for each probe delay. Three-phase reconstructions of the electron densities are then inferred by Abel inversion. This interferometric system delivers precise measurements of pre-plasma expansion that can identify the condition of the target at the moment that the ultra-intense pulse arrives. Such measurements are indispensable for correlating laser pre-pulse measurements with instantaneous plasma profiles and for enabling realistic Particle-in-Cell simulations of the ultra-intense laser-matter interaction.

Resting state synchrony in anxiety-related circuits of abstinent alcohol-dependent patients

BACKGROUND

Anxiety has been linked to initiation, maintenance and relapse of alcohol dependence. Neurobiological models of anxiety have proposed important roles for amygdala-insula and amygdala-medial prefrontal cortex interactions in the generation and regulation of anxiety states, respectively.

OBJECTIVES

This study tested the hypotheses that abstinent alcohol-dependent patients would show a disruption of synchrony in these circuits as measured by resting state functional MRI.

METHODS

The study examined recently abstinent (n = 13), longer-term abstinent (n = 16) alcohol-dependent patients and healthy controls (n = 22). Resting-state synchrony (RSS) was examined in specific circuits, where degree of synchrony has been found to correlate with state anxiety levels in previous studies.

RESULTS

Alcohol-dependent patients showed significantly elevated scores on anxiety and depression inventories compared with controls. No significant group differences in synchrony were observed between right amygdala and right ventromedial prefrontal cortex (vmPFC), between left amygdala and left vmPFC, or, after correction for multiple comparisons, right amygdala and dorsomedial prefrontal cortex (dmPFC). However, significantly decreased positive synchrony was found between left basolateral amygdala and left anterior insula, in patients relative to controls.

CONCLUSION

Both early and longer-term abstinent alcohol-dependent patients showed increased anxiety levels relative to controls and altered resting state synchrony in circuits previously linked to state anxiety. Notably, the significant group differences in synchrony were in the opposite direction to our predictions based on the literature. These results may point to a lack of generalizability of models derived from young healthy homogeneous samples.

A rare case of ileal metastasis from cervical cancer

We present the case of a 70-year-old woman, with a history of radiation-treated and surgically- resected cervical cancer, who was admitted to our clinic for intermittent sub occlusive symptoms. CT scan revealed a liver nodule and intestinal obstruction. The patient underwent surgery for excision of suspected liver metastasis and resolution of intestinal obstruction.Intraoperatively an ileal tumour was found to be the cause of the obstruction. Anatomo-pathological findings were consistent with an ileal metastasis from the cervical cancer.The liver nodule was only an area of focal steatosis.

Management of hepatocellular carcinoma -- experience of a single center

BACKGROUND AND AIMS

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related death. We aim to study the diagnosis and treatment options for HCC.

METHODS

We used standard methods of diagnosis for HCC:radiology, determining serum alpha fetoprotein (AFP). We included 190 patients diagnosed with HCC between April 2011 and May 2012.

RESULTS

All patients were classified and treated according to the BCLC staging. Our study included 43 patients with early stage HCC, 58 patients with intermediate stage HCC (Stage B) and 89 patients with advanced stage HCC (Stage C). Most patients in the early stage underwent local ablation, while TACE was preferred in 46 patients in the intermediate stage.Systemic therapy was the most frequent treatment for patients in the advanced stage (48 patients), followed by Sorafenib (16 patients). 21 patients with end-stage disease did not receive treatment. Survival rates depended on the HCC stage: 2 - 18 months in the intermediate stage and 1 - 12 months in the advanced stage.

CONCLUSION

Early diagnosis of HCC is essential in improving the patients outcomes, as there are several classic therapeutic options and new emerging ones addressing patients with early stage disease.

Comparative study of design and PCL-substituting systems of total knee prosthesis

The aim of this study is to assess postoperative results obtained by different knee implants. The main implant types differences are given by generally implant design and by PCL substituting systems that are used.

MATERIAL AND METHOD

Between 04.2004 - 02.2012 we have performed 506 total knee arthroplasties (TKA), on a group of 460 patients. Our choice, was for cemented total knee prostheses, using PCL-substituting systems. Regarding general design and PCL-substituting systems of the implant we had divided the main group in three lots. In order to assess post operative result we had used the American Knee Society Score(AKSS).

RESULTS AND DISCUSSIONS

All prostheses types that we had implanted, had registered satisfactory values of AKSS. Our study showed that one group scored higher values of AKSS, compared the other two, but there are not statistical semnificative differences (p=0,09).

Multiple endocrine neoplasia type 2A: case report

Multiple endocrine neoplasia type 2A (MEN 2A) is a complex autosomal dominant inherited syndrome characterized by medullary thyroid carcinoma (MTC), pheochromocytoma and primary parathyroid hyperplasia. In patients with only one or two clinical features, identification of a germline RET(REarranged in Transfection) mutation or the identification of the clinical features of MEN 2A in other first degree relatives is required to make the diagnosis. We present the case of a family with MEN 2A syndrome confirmed by genetic analysis which identified RET gene mutation in 634 codon in father - DV - aged 48 years and also in daughter DM -aged 20 years. The specific feature in this case is that the index case was the daughter (diagnosed and operated for pheochromocytoma at the age of 19 years), the father being diagnosed later with medullary thyroid carcinoma by mutational screening in all family members. This family supports the phenomenon of anticipation, in which severity increases and the age of onset decreases in successive generations, the syndrome being discovered earlier and with a worse prognostic in the daughter.

The influence of total knee arthroplasty on postural control

INTRODUCTION

The aim of this study is to assess the changes induced by the unilateral total knee arthroplasty procedure in human postural control.

MATERIALS AND METHODS

The measurements were performed using the "AMTI AccuGait" force plate. Subjects completed three consecutive double-limb standing balance trials. The mediolateral and anteroposterior displacements were derived from the force and moment profiles measured by the force platform. The path length per unit time (average velocity) and Elipse 95 (collect 95% of data) were also assessed.

RESULTS

Mediolateral displacement increase of 3.4% was observed postoperatively. Postoperative anterolateral displacement increase of 23.2% was recorded. The average velocity also rose by 16.8% postoperatively. The Elipse 95 grew by 33.7%postoperatively.

DISCUSSION

Excepting mediolateral displacement, all the other studied parameters showed significantly (p 0.05) higher values in the postoperative period compared with the preoperative one, in both open and closed eye trials.

CONCLUSIONS

The study results demonstrate that balance control is weaker shortly after unilateral knee arthroplasty,than in the preoperative period. Although proprioception is altered in osteoarthritic knees, the TKA procedure may additionally affect proprioceptors. The TKA causes additional instability in the days after the procedure, therefore the risk of falling injuries is higher in this period.

The importance of early diagnosis of sepsis in severe burned patients: outcomes of 100 patients

BACKGROUND/AIM

The burn-injured patient has a major potential to develop an infection because the wound itself, surgical treatment, mechanical ventilation and blood transfusions may potentially lead to a secondary immunodeficiency syndrome.

PATIENTS AND METHODS

A total number of 100 consecutive burn-injured patients with sepsis were treated in the Clinical Emergency Hospital of Plastic Surgery and Burns, Bucharest,between 2009 and 2011. Their clinical and bioumoral data were analyzed.

RESULTS

Flame was the main cause of burn injuries in the present series (78%). The mean body surface area burn wound was 49.7%. Most of the patients (97%) experienced the first septic episode within two weeks after burn injury.Sepsis was mainly due to Gram-positive (58%) and Gramnegative(26%) bacteria. Staphylococcus aureus (32%) and Pseudomonas aeruginosa (21%) were the most frequently encountered germs. The susceptibility for Gram-positive bacteria was the best for imipenem/cilastatin, followed byamikacin, ceftriaxone and ciprofloxacin. For Gram-negative bacteria, the susceptibility decreased from ciprofloxacin to imipenem/ cilastatin, amikacin and gentamicin. Mortality rate was 9%.

CONCLUSIONS

The extensive knowledge of physiopathology,clinics, epidemiology, bioumoral and microbiology features of the sepsis in burn-injured patients allows an early and precise diagnosis and an adequate and efficient treatment.All these elements have been associated with a significant improvement of the survival rates. Every patient with burn injured sepsis must be treated as a different entity in order to obtain the best results.

Stress distribution on a valgus knee prosthetic inclined interline -- a finite element analysis

Total knee arthroplasty following valgus deformity is a challenging procedure due to the unique set of problems that must be addressed. The aim of this study is to determine, with a finite element analysis, the load distribution for an inclined valgus prosthetic balanced knee and to compare these results with those of a prosthetic balanced knee with an uninclined interline. Computational simulations, using finite element analysis, focused on a comparision between load intensity and distribution for these situations. We studied valgus inclination at 3 and 8 degrees. We noticed that for an inclination of 3 degrees, the forces are distributed almost symmetrically on both condyles, similar to the distribution of forces in the uninclined interline case. The maximum contact pressure is greater, increasing from 15 MPa to 19.3 MPa (28%). At 8 degrees of inclination, the contact patch moved anterolateraly on the tibia, meaning that the tibial condyles will be unequally loaded. The maximum contact pressure increases to 25 MPa (66%). These greater forces could lead to polyethylene wear and collapse. Additional tibial resection could be a useful method for balancing in severe valgus knee, when valgus inlination does not exceed 3 degrees.

Coupling of high-intensity laser light to fast electrons in cone-guided fast ignition

Cu wires attached to Al cones are used to investigate the energy coupling efficiency of laser light to fast electrons through a cone into a dense plasma. We present experimental and simulation results demonstrating the effect on the energy coupling of effectively placing the cone in a surrounding high density plasma as well as the effect of a large preformed plasma inside the cone. Thick cone walls, simulating plasma surrounding the cone in fast ignition, reduce the energy coupling by a factor of up to 4. An increase in prepulse inside the cone by a factor of 50 further reduces coupling by a factor of 3. Simulations with the pic code lsp that include the laser plasma interaction and the preformed plasma from the flash code show that electron refluxing in thin cone-wall targets enhances coupling to the wire. The implications for full-scale cone-guided fast ignition are discussed.

Diagnostic criteria for sepsis in burn patients

Sepsis with multiple-organ dysfunction represents the major cause of death in severe burns patients. Adequate and rapid treatments presume an accurate and prompt diagnosis. Specific criteria for sepsis diagnosis were proposed and introduction in clinical practice of the Surviving Sepsis Campaign has been associated with an improvement in sepsis management and decreased mortality. Hereby, the specific criteria for sepsis diagnosis adapted for burns patients are discussed.

Arthroplasty risk after kidney or liver transplant

In recent years the rate of kidney or liver transplantation has increased considerably, with an increasing rate of immunosuppressant medication for secondary bone disorders. As the rate of organ transplantation increases, the greater predisposition of these patients to hip or knee arthroplasty is noticed. Although arthroplasty is safe in the general population, its safety in liver transplant recipients is unclear. The purpose of this study is to evaluate safety and durability of hip or knee arthroplasties in liver or kidney transplanted patients. Our study included 5 hip and knee arthroplasties performed in transplanted liver and kidney. All patients underwent immunosuppressive therapy. All cases were submitted to postoperative antibiotic therapy and in the case of cemented implants, antibiotic impregnated cement was used. There were no major short-term or long-term complications. We noticed no case of postoperative sepsis, and implant durability has not been affected by the directly transplant related causes. In conclusion arthroplasty for patients with kidney or liver transplant has a positive impact on their quality of life, being a safe and successful procedure with minimum perioperative safeguards.

6 years follow-up of hip revision surgery

Revision total hip arthroplasty often presents surgeons with difficult bone loss problems. The purpose of this study was to evaluate the results of hip revision surgery according to bone stock We evaluated, in a retrospective study, 148 hip revision surgeries during 2004 to 2010. The Harris Hip Score (HHS), the acetabular cementation, the AAOS classification, the SOFCOT 99 bone loss grading and Barrack classification were used for clinical and radiological assessment. It can be observed significant improvement of HHS from a mean value of 45 preoperatively to 77.2 points postoperatively. Grade B acetabular cementation was observed in a significantly higher rate for situations that needed acetabular allograft reconstruction and where it cannot be performed because of allografts lack. Barrack grades C and D cementation were associated with 70% of SOFCOT 99 stage III and IV cases and only 5% of SOFCOT 99 stage 0-II cases.Using bone graft seems to be a reliable solution for restoring bone stock and stabilizing the cup in revision total hip arthroplasty with type II-IV acetabular defect according to the AAOS classification. Because SOFCOT 99 stages III-IV are often associated with poor cementation we prefer using uncemented distally fixed with screws revision stems for these cases.