Neural Correlates of Treatment in Adolescents with Bipolar Depression During Response Inhibition

Abstract Objective: Abnormal prefrontal and subcortical activity during cognitive control tasks is identified in non-depressed adolescents with bipolar disorder (BD); however, little is known about the neural correlates of bipolar adolescents in a depressed state (BDd). We aimed to investigate baseline versus after-treatment patterns of neural activity underlying motor response and response inhibition in adolescents with BDd. Methods: In this functional magnetic resonance imaging (fMRI) study, 10 adolescents with BDd relative to 10 age-and sexmatched healthy controls (HC) completed a well-validated go/no go block-design cognitive control task at baseline and after 6 weeks of naturalistic treatment. We used whole-brain analysis and controlled our results for multiple comparisons. Results: There was significant improvement in depression scores (mean change: 57% -28). There was no behavioral difference in BDd baseline versus HC and after treatment. BDd adolescents relative to HC had higher baseline cortical, but not subcortical, neural activity (e.g., bilateral ventrolateral prefrontal during both the go [motor control] and the no go [response inhibition] conditions, and left superior temporal during the no go condition). However, after-treatment activity relative to baseline neural activity during response inhibition was significantly increased in subcortical (e.g., right hippocampus and left thalamus), but not cortical, regions. In addition, at baseline, lower left thalamus activity was correlated with higher depression scores. Conclusions: Adolescents with BDd had baseline prefrontal and temporal hyperactivity underlying motor control and response inhibition that did not change after treatment in contrast to relatively decreased baseline subcortical activity underlying response inhibition associated with the depressive state that was increased after the treatment

Altered neural function to happy faces in adolescents with and at risk for depression

Background There is accumulating evidence of alterations in neural circuitry underlying the processing of social-affective information in adolescent Major Depressive Disorder (MDD). However the extent to which such alterations are present in youth at risk for mood disorders remains unclear. Method Whole-brain blood oxygenation level-dependent task responses and functional connectivity using generalized psychophysiological interaction (gPPI) analyses to mild and intense happy face stimuli was examined in 29 adolescents with MDD (MDD; M age, 16.0, S.D. 1.2 years), 38 healthy adolescents at risk of a mood disorder, by virtue of having a parent diagnosed with either Bipolar Disorder (BD) or MDD (Mood-risk; M age 13.4, S.D. 2.5 years) and 43 healthy control adolescents, having parents with no psychiatric disorder (HC; M age 14.6, S.D. 2.2 years). Results Relative to HC adolescents, Mood-risk adolescents showed elevated right dorsolateral prefrontal cortex (DLPFC) activation to 100% intensity happy (vs. neutral) faces and concomitant lowered ventral putamen activity to 50% intensity happy (vs. neutral) faces. gPPI analyses revealed that MDD adolescents showed significantly lower right DLPFC functional connectivity with the ventrolateral PFC (VLPFC) compared to HC to all happy faces. Limitations The current study is limited by the smaller number of healthy offspring at risk for MDD compared to BD. Conclusions Because Mood-risk adolescents were healthy at the time of the scan, elevated DLPFC and lowered ventral striatal activity in Mood-risk adolescents may be associated with risk or resiliency. In contrast, altered DLPFC–VLPFC functional connectivity in MDD adolescents may be associated with depressed mood state. Such alterations may affect social-affective development and progression to a mood disorder in Mood-risk adolescents. Future longitudinal follow-up studies are needed to directly answer this research question

Alterations of functional connectivity and intrinsic activity within the cingulate cortex of suicidal ideators

The ‘default mode network’ (DMN), a collection of brain regions including the posterior cingulate cortex (PCC),shows reliable inter-regional functional connectivity at rest. It has been implicated in rumination and othernegative affective states, but its role in suicidal ideation is not well understood. We employed seed basedfunctional connectivity methods to analyze resting state fMRI data in 34 suicidal ideators and 40 healthy controlparticipants. Whole-brain connectivity with dorsal PCC or ventral PCC was broadly intact between the twogroups, but while the control participants showed greater coupling between the dorsal anterior cingulate cortex(dACC) and dorsal PCC, compared to the dACC and ventral PCC, this difference was reversed in the ideators.Furthermore, ongoing low frequency BOLD signal in these three regions (dorsal, ventral PCC, dACC) wasreduced in the ideators. The structural integrity of the cingulum bundle, as measured using diffusion tensorimaging (DTI), also explained variation in the functional connectivity measures but did not abolish the groupdifferences. Together, these findings provide evidence of abnormalities in the DMN underlying the tendencytowards suicidal ideation.</div

Neural Correlates of Treatment in Adolescents with Bipolar Depression During Response Inhibition [Article]

Objective: Abnormal prefrontal and subcortical activity during cognitive control tasks is identified in non-depressed adolescents with bipolar disorder (BD); however, little is known about the neural correlates of bipolar adolescents in a depressed state (BDd). We aimed to investigate baseline versus after-treatment patterns of neural activity underlying motor response and response inhibition in adolescents with BDd. Methods: In this functional magnetic resonance imaging (fMRI) study, 10 adolescents with BDd relative to 10 age- and sex-matched healthy controls (HC) completed a well-validated go/no go block-design cognitive control task at baseline and after 6 weeks of naturalistic treatment. We used whole-brain analysis and controlled our results for multiple comparisons. Results: There was significant improvement in depression scores (mean change: 57%±28). There was no behavioral difference in BDd baseline versus HC and after treatment. BDd adolescents relative to HC had higher baseline cortical, but not subcortical, neural activity (e.g., bilateral ventrolateral prefrontal during both the go [motor control] and the no go [response inhibition] conditions, and left superior temporal during the no go condition). However, after-treatment activity relative to baseline neural activity during response inhibition was significantly increased in subcortical (e.g., right hippocampus and left thalamus), but not cortical, regions. In addition, at baseline, lower left thalamus activity was correlated with higher depression scores. Conclusions: Adolescents with BDd had baseline prefrontal and temporal hyperactivity underlying motor control and response inhibition that did not change after treatment in contrast to relatively decreased baseline subcortical activity underlying response inhibition associated with the depressive state that was increased after the treatment

Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction: An analysis of current clinical practice and a comparison with transvenous ICD reimplantation

Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system. Objective: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation. Methods: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017. Results: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39%) or a single-chamber TV-ICD (139; 61%). S-ICD implantation increased from 9% in 2011 to 85% in 2017 (P <.001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P =.011) and more frequently had undergone extraction owing to infection (73% vs 52%; P <.001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95% confidence interval 0.49–1.92; P =.940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95% confidence interval 0.05–0.87; P =.048). Conclusion: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

reserved19mixedSaeed K.; Esposito S.; Ascione T.; Bassetti M.; Bonnet E.; Carnelutti A.; Chan M.; Lye D.C.; Cortes N.; Dryden M.; Fernando S.; Gottlieb T.; Gould I.; Hijazi K.; Madonia S.; Pagliano P.; Pottinger P.S.; Segreti J.; Spera A.M.Saeed, K.; Esposito, S.; Ascione, T.; Bassetti, M.; Bonnet, E.; Carnelutti, A.; Chan, M.; Lye, D. C.; Cortes, N.; Dryden, M.; Fernando, S.; Gottlieb, T.; Gould, I.; Hijazi, K.; Madonia, S.; Pagliano, P.; Pottinger, P. S.; Segreti, J.; Spera, A. M

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes