The trajectory of self

In a recent Opinion article, Sui and Humphreys [1] argue that experimental findings suggest self is ‘special’, in that self-reference serves a binding function within human cognitive economy. Contrasting their view with other functionalist positions, chiefly Dennett's [2], they deny that self is a convenient fiction and adduce findings to show that a ‘core self representation’ serves as an ‘integrative glue’ helping to bind distinct types of information as well as distinct stages of psycho- logical processing. In other words, where Dennett regards self as analogous to a center of gravity, a simplification posited by observers, Sui and Humphreys regard self as a function that modulates mental processes. In practice, however, the concept of ‘self’ they employ is not unlike Dennett's. We side with Sui and Humphreys in hold- ing that self-reference modulates mental processes: reference to self during a task can bind memory to source, increase perceptual integration, and link attention to decision making, among other things. What is more, these functions are not reducible to other factors such as semantic coding, familiarity, or reward [3]. But whereas Sui and Humphreys contribute important empirical detail, the binding functions they describe are compatible with Dennett's version of functionalism, which treats self as an artifact of social process

Localization of type 1 diabetes susceptibility to the MHC class I genes HLA-B and HLA-A

The major histocompatibility complex (MHC) on chromosome 6 is associated with susceptibility to more common diseases than any other region of the human genome, including almost all disorders classified as autoimmune. In type 1 diabetes the major genetic susceptibility determinants have been mapped to the MHC class II genes HLA-DQB1 and HLA-DRB1 (refs 1-3), but these genes cannot completely explain the association between type 1 diabetes and the MHC region. Owing to the region's extreme gene density, the multiplicity of disease-associated alleles, strong associations between alleles, limited genotyping capability, and inadequate statistical approaches and sample sizes, which, and how many, loci within the MHC determine susceptibility remains unclear. Here, in several large type 1 diabetes data sets, we analyse a combined total of 1,729 polymorphisms, and apply statistical methods - recursive partitioning and regression - to pinpoint disease susceptibility to the MHC class I genes HLA-B and HLA-A (risk ratios >1.5; Pcombined = 2.01 × 10-19 and 2.35 × 10-13, respectively) in addition to the established associations of the MHC class II genes. Other loci with smaller and/or rarer effects might also be involved, but to find these, future searches must take into account both the HLA class II and class I genes and use even larger samples. Taken together with previous studies, we conclude that MHC-class-I-mediated events, principally involving HLA-B*39, contribute to the aetiology of type 1 diabetes. ©2007 Nature Publishing Group

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Geographical and economic influences on neuroimaging modality choice

The current neuroimaging literature is unrepresentative of the world's population due to bias towards particular types of people living in a subset of geographical locations. This is true of both the people running the research and those participating in it. These biases mean we may be missing insights into how the brain works. As neuroimaging research expands out to more of the world, the reality of global economic disparities become salient. With economic conditions having an effect on many background conditions for research, we can ask whether they also influence the neuroimaging research being done. To investigate this, the number of neuroimaging publications originating from a country was used as a proxy for the type of research being done there in terms of imaging modalities employed. This was then related to local economic conditions, as represented by national gross domestic product and research and development spending. National financial metrics were positively associated with neuroimaging output. The imaging modalities used were also found to be associated with local economic conditions, with MRI research positively and EEG negatively associated with national research spending. These results suggest that economic conditions may be relevant when planning how neuroimaging research can be expanded globally

Geographical and economic influences on neuroimaging modality choice

The current neuroimaging literature is unrepresentative of the world’s population due to bias towards particular types of people living in a subset of geographical locations. This is true of both the people running the research and those participating in it. These biases mean we may be missing insights into how the brain works. As neuroimaging research expands out to more of the world, the reality of global economic disparities become salient. With economic conditions having an effect on many background conditions for research, we can ask whether they also influence the neuroimaging research being done. To investigate this, the number of neuroimaging publications originating from a country was used as a proxy for the type of research being done there in terms of imaging modalities employed. This was then related to local economic conditions, as represented by national gross domestic product and research and development spending. National financial metrics were positively associated with neuroimaging output. The imaging modalities used were also found to be associated with local economic conditions, with MRI research positively and EEG negatively associated with national research spending. These results suggest that economic conditions may be relevant when planning how neuroimaging research can be expanded globally.</p

Why and how is the self related to the brain midline regions?

What the self is and where it comes from has been one of the great problems of philosophy for thousands of years. As science and medicine have progressed this question has moved to also become a central one in psychology, psychiatry, and neuroscience. The advent of in vivo brain imaging has now allowed the scientific investigation of the self to progress further than ever. Many such imaging studies have indicated that brain structures along the cortical midline are particularly closely related to self-specific processing. This association between cortical midline structures (CMS) and self is reinforced by the involvement of these regions in other self-oriented processes, such as mind-wandering or stimulus valuation. Those midline regions involved in self- processing also overlap with another network, the default mode network, which shows high brain activity during the so-called resting state, indicating that there may be a special relationship between self-processing and intrinsic activity. Although such promising groundwork linking the self and CMS has been carried out, many questions remain. These include: what features of the midline regions lead to their apparent importance in self-processing? How can we appropriately account for confounding factors such as familiarity or task-effects in our experiments? How is the self-related to other features of the mind, such as consciousness? How is our methodology influencing our attempts to link the self and the brain? The purpose of this ebook is to address some of these questions, including opinions, perspectives, and hypotheses about the concept of the self, the relationship between CMS and the self, and the specific function of these brain regions in self-processing. It also includes original research papers describing EEG, fMRI, and behavioral experiments investigating different aspects of the self