Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure : a randomized clinical trial

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty‑one patients were randomized—26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: − 1.78 ± 1.08 kg/day vs placebo: − 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: − 0.74 ± 0.47 kg/40 mg vs placebo: − 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss

Dependence of the fractional anisotropy in cervical spine from the number of diffusion gradients, repeated acquisition and voxel size

The aim of this study is to investigate the consequences of using different gradient schemes, number of repeated measurements and voxel size on the fractional anisotropy (FA) value in a diffusion tensor imaging (DTI) sequence on the cervical tract of the spinal cord. Twenty healthy volunteers underwent a total of 86 DTI axial acquisitions performed by using different voxel size and number of diffusion gradient directions (NDGDs). Three different diffusion gradient schemes were applied, named 6, 15 and 32 according to the NDGD. Furthermore, some acquisitions were repeated to investigate the effects of image averaging on FA value. Our results indicate that the FA value in the cervical spinal cord decreases when increasing the NDGD for a fixed spatial resolution, or when identical acquisitions are repeated, thus, increasing the acquisition time. This effect is observed in all subjects without exceptions, and the differences result statistically significant: the average FA obtained from 6, 15 and 32 NDGD is 0.84 (range, 0.82-0.87), 0.75 (range, 0.68-0.80) and 0.70 (range, 0.65-0.77), respectively, for isotropic 8 mm3 voxel size. When varying the spatial resolution in a volume range of 2 to 8 mm3 for a fixed NDGD (6 or 15), the differences in FA values are smaller albeit still statistically significant: the smaller the voxel, the larger the FA. No significant dependence of the FA value from the spatial resolution is observed in the 32 NDGD acquisitions in the studied volume range. In conclusion, our results indicate that the value of the FA in the cervical tract of the spinal cord vary with regularity in intrasubject acquisitions when modifying the NDGD and when repeated acquisitions are used; these observations confirm that the signal-to-noise ratio introduces a systematic error in FA measurements that does not allow simple comparison of quantitative results obtained from separated studies. © 2010 Elsevier Inc. All rights reserved

Neural bases of language switching in high and early proficient bilinguals

The left inferior frontal cortex, the caudate and the anterior cingulate have been proposed as the neural origin of language switching, but most of the studies were conducted in low proficient bilinguals. In the present study, we investigated brain areas involved in language switching in a sample of 19 early, high-proficient Spanish–Catalan bilinguals using a picture naming task that allowed contrasting switch and non-switch trials. Compared to the non-switching condition, language switching elicited greater activation in the head of the left caudate and the pre-SMA/ACC. When the direction of the switching was considered, the left caudate was more associated with forward switching and the pre-SMA/ACC with backward switching. The discussion is focused on the relevance of these brain structures in language control in early, high-proficient bilinguals, and the comparison with previous results in late bilinguals.This study was supported by two grants of the Spanish Ministry of Science and Technology given to Cesar Avila [the BrainGlot Project, CSD2007-00012 (funded by the Consolider-Ingenio 2010 programme), and the grant PSI2010-20168 and two grants given to Albert Costa (PSI2008-01191 from the MICINN and SGR 2009-1521 from the Catalan Government

A Symbol Digit Modalities Test version suitable for functional MRI studies

The Symbol Digit Modalities Test is an easy test used to assess cognitive impairment in a wide range of neurological diseases, like multiple sclerosis. We adapted the oral version of this cognitive task making it suitable for functional Magnetic Resonance Imaging studies. Symbol Digit Modalities Test performance was associated with increased brain activity in frontal and parietal areas involved in selective attention and working memory functions. These may provide the basis for future studies assessing potential abnormal cortical activations in multiple sclerosis patients and other clinical populations

Bridging language and attention: Brain basis of the impact of bilingualism on cognitive control

Using two languages on an everyday basis appears to have a positive effect on general-purpose executive control in bilinguals. However, the neural correlates of this effect remain poorly understood. To investigate the brain bases of the bilingual advantage in executive control, we tested 21 Spanish monolinguals and 19 Spanish-Catalan early bilinguals in a non-verbal task-switching paradigm. As expected based on previous experiments on non-verbal task switching, we found activation in the right inferior frontal cortex and the anterior cingulate of monolingual participants. While bilingual participants showed a reduced switching cost, they activated the left inferior frontal cortex and the left striatum, a pattern of activation consistent with networks thought to underlie language control. Overall, these results support the hypothesis that bilinguals' early training in switching back and forth between their languages leads to the recruitment of brain regions involved in language control when performing non-linguistic cognitive tasks. © 2010 Elsevier Inc. All rights reserved

Frontostriatal response to set switching is moderated by reward sensitivity

The reinforcement sensitivity theory (RST) relates individual differences in reward sensitivity to the activation of the behavioral approach system (BAS). Dopamine-related brain structures have been repeatedly associated with reward processing, but also with cognitive processes such as task switching. In the present study, we examined the association between reward sensitivity and the event-related fMRI BOLD response with set switching in 31 males. As expected, the right inferior frontal cortex (rIFG) and the striatum (i.e. the left putamen) were involved in set-switching activity for the overall sample. Interindividual differences in Gray’s reward sensitivity were related to stronger activity in the rIFG and the ventral striatum. Thus, trait reward sensitivity contributed to the modulation of brain responsiveness in set-switching tasks. Having considered previous research, we propose that higher BAS activity is associated with a stronger reward to process a better implementation of goal-directed tasks and the diminished processing of secondary cues