Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS).

SUMMARY: Suicidal thinking, self-harm and suicidal acts are common, although determining their precise prevalence is complex. Epidemiological work has identified a number of associated demographic and clinical factors, though, with the exception of past acts of self-harm, these are non-specific and weak future predictors. There is a critical need shift focus from managing 'suicidality-by-proxy' through general mental health treatments, to better understand the neuropsychology and neurophysiology of such behaviour to guide targeted interventions. The model of the cognitive control of emotion (MCCE) offers such a paradigm, with an underlying pan-diagnostic pathophysiology of a hypoactive prefrontal cortex failing to suitably inhibit an overactive threat-responding limbic system. The result is a phenotype - from any number of causative gene-environment interactions - primed to impulsively self-harm. We argue that such neural dysconnectivity is open to potential therapeutic modification from repetitive transcranial magnetic stimulation (rTMS). The current evidence base for this is undoubtedly extremely limited, but the societal and clinical burden self-harm and suicide pose warrants such investigation. DECLARATION OF INTEREST: K.B. is the Editor of BJPsych Open, but had no editorial involvement in the review or decision process regarding this paper. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.D.K.T., S.S.S. and A.S.D. are supported by the National Institute of Health Research Biomedical Research Centre (BRC) at the South London & Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience, King’s College London

Superconducing Alloys with Weak and Strong Scattering: Anderson's Theorem and a Superconductor-Insulator Transition

We have studied the effects of strong impurity scattering on disordered superconductors beyond the low impurity concentration limit. By applying the full CPA to a superconductiong A-B binary alloy, we calculated the fluctuations of the local order parameters $\Delta_{A}, \Delta_{B}$ and charge densities, $n_{A}, n_{B}$ for weak and strong on site disorder. We find that for narrow band alloy s-wav e superconductors the conditions for Anderson's theorem are satisfied in general only for the case of particle-hole symmetry. In this case it is satisfied regardless whether we are in the weak or strong scattering regimes. Interestingly, we find that strong scattering leads to band splitting and in this regime for any band filling we have a critical concentration where a superconductor-insulator quantum phase transition occurs at T=0.Comment: 28 pages, 13 figure

Differences in muscle oxygenation between young and middle-aged recreationally active men during high-volume resistance exercise

The aim of this study was to compare muscle oxygenation of the vastus lateralis during a high-volume isokinetic resistance exercise protocol (HVP) between young adult (YA) and middle-aged adult (MA) men. Twenty recreationally trained men were assigned to either the YA (age 21.8±2.0 years, body mass 90.7±11.6 kg, body height 179±4.7 cm) or MA (age 47.0±4.4 years, body mass 96.1±21.6 kg, body height 177±7.7 cm) group. The HVP consisted of eight sets of 10 repetitions of unilateral isokinetic concentric knee extension and eccentric knee flexion at 60°·s-1. Changes in tissue hemoglobin saturation index (TSI), tissue oxygenated hemoglobin concentration (O2Hb), deoxygenated hemoglobin (HHb), and muscle oxidation index (O2Hb-HHb) were measured during the exercise session using the near-infrared spectroscopy (NIRS). Data were analyzed using two-way mix factorial analyses of variance. Prior to exercise, TSI was significantly greater (p=.024) for YA compared to MA. Significant decreases in O2Hb and O2Hb-HHb and increases in HHb were observed during each of the eight sets relative to the rest periods (p<.05) for both groups. The average change during the eight sets of the HVP revealed a significantly higher (p=.036) level of HHb and a lower (p=.029) level of O2Hb-HHb for MA compared to YA. A significant negative correlation was also noted at baseline between O2Hb-HHb index and the cross-sectional area of the vastus lateralis muscle (r=-.45, p=.045). During a high- volume resistance exercise, MA experienced reduced muscle oxygen saturation levels compared to YA. These results may be attributed to reductions in local tissue oxidative capacity and reduced blood delivery occurring during middle-age, and possibly due to group differences in muscle morphology

Reciprocal feature encoding by cortical excitatory and inhibitory neurons

In the cortex, the interplay between excitation and inhibition determines the fidelity of neuronal representations. However, while the receptive fields of excitatory neurons are often fine-tuned to the encoded features, the principles governing the tuning of inhibitory neurons are still elusive. We addressed this problem by recording populations of neurons in the postsubiculum (PoSub), a cortical area where the receptive fields of most excitatory neurons correspond to a specific head-direction (HD). In contrast to PoSub-HD cells, the tuning of fast-spiking (FS) cells, the largest class of cortical inhibitory neurons, was broad and heterogeneous. However, we found that PoSub-FS cell tuning curves were often fine-tuned in the spatial frequency domain, which resulted in various radial symmetries in their HD tuning. In addition, the average frequency spectrum of PoSub-FS cell populations was virtually indistinguishable from that of PoSub-HD cells but different from that of the upstream thalamic HD cells, suggesting that this population cotuning in the frequency domain has a local origin. Two observations corroborated this hypothesis. First, PoSub-FS cell tuning was independent of upstream thalamic inputs. Second, PoSub-FS cell tuning was tightly coupled to PoSub-HD cell activity even during sleep. Together, these findings provide evidence that the resolution of neuronal tuning is an intrinsic property of local cortical networks, shared by both excitatory and inhibitory cell populations. We hypothesize that this reciprocal feature encoding supports two parallel streams of information processing in thalamocortical networks.Canadian Institutes of Health ResearchIsrael Science FoundationAzrieli FoundationEMBO Long-Term Postdoctoral FellowshipSir Henry Wellcome Fellowship (A.J.D.

Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures

Purpose: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. Results: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. Conclusion: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery

Long-Term Results from an Epiretinal Prosthesis to Restore Sight to the Blind

PurposeRetinitis pigmentosa (RP) is a group of inherited retinal degenerations leading to blindness due to photoreceptor loss. Retinitis pigmentosa is a rare disease, affecting only approximately 100 000 people in the United States. There is no cure and no approved medical therapy to slow or reverse RP. The purpose of this clinical trial was to evaluate the safety, reliability, and benefit of the Argus II Retinal Prosthesis System (Second Sight Medical Products, Inc, Sylmar, CA) in restoring some visual function to subjects completely blind from RP. We report clinical trial results at 1 and 3 years after implantation.DesignThe study is a multicenter, single-arm, prospective clinical trial.ParticipantsThere were 30 subjects in 10 centers in the United States and Europe. Subjects served as their own controls, that is, implanted eye versus fellow eye, and system on versus system off (native residual vision).MethodsThe Argus II System was implanted on and in a single eye (typically the worse-seeing eye) of blind subjects. Subjects wore glasses mounted with a small camera and a video processor that converted images into stimulation patterns sent to the electrode array on the retina.Main Outcome MeasuresThe primary outcome measures were safety (the number, seriousness, and relatedness of adverse events) and visual function, as measured by 3 computer-based, objective tests.ResultsA total of 29 of 30 subjects had functioning Argus II Systems implants 3 years after implantation. Eleven subjects experienced a total of 23 serious device- or surgery-related adverse events. All were treated with standard ophthalmic care. As a group, subjects performed significantly better with the system on than off on all visual function tests and functional vision assessments.ConclusionsThe 3-year results of the Argus II trial support the long-term safety profile and benefit of the Argus II System for patients blind from RP. Earlier results from this trial were used to gain approval of the Argus II by the Food and Drug Administration and a CE mark in Europe. The Argus II System is the first and only retinal implant to have both approvals

Developing cancer warning statements for alcoholic beverages

Background: There is growing evidence of the increased cancer risk associated with alcohol consumption, but this is not well understood by the general public. This study investigated the acceptability among drinkers of cancer warning statements for alcoholic beverages. Methods: Six focus groups were conducted with Australian drinkers to develop a series of cancer-related warning statements for alcohol products. Eleven cancer warning statements and one general health warning statement were subsequently tested on 2,168 drinkers via an online survey. The statements varied by message frame (positive vs negative), cancer reference (general vs specific), and the way causality was communicated (‘increases risk of cancer’ vs ‘can cause cancer’). Results: Overall, responses to the cancer statements were neutral to favorable, indicating that they are unlikely to encounter high levels of negative reaction from the community if introduced on alcoholic beverages. Females, younger respondents, and those with higher levels of education generally found the statements to be more believable, convincing, and personally relevant. Positively framed messages, those referring to specific forms of cancer, and those using ‘increases risk of cancer’ performed better than negatively framed messages, those referring to cancer in general, and those using the term ‘can cause cancer’. Conclusion: Cancer warning statements on alcoholic beverages constitute a potential means of increasing awareness about the relationship between alcohol consumption and cancer risk

Five-Year Safety and Performance Results from the Argus II Retinal Prosthesis System Clinical Trial

Purpose: The Argus II Retinal Prosthesis System (Second Sight Medical Products, Inc, Sylmar, CA) was developed to restore some vision to patients blind as a result of retinitis pigmentosa (RP) or outer retinal degeneration. A clinical trial was initiated in 2006 to study the long-term safety and efficacy of the Argus II System in patients with bare or no light perception resulting from end-stage RP. / Design: Prospective, multicenter, single-arm clinical trial. Within-patient controls included the nonimplanted fellow eye and patients' native residual vision compared with their vision with the Argus II. / Participants: Thirty participants in 10 centers in the United States and Europe. / Methods: The worse-seeing eye of blind patients was implanted with the Argus II. Patients wore glasses mounted with a small camera and a video processor that converted images into stimulation patterns sent to the electrode array on the retina. / Main Outcome Measures: The primary outcome measures were safety (the number, seriousness, and relatedness of adverse events) and visual function, as measured by 3 computer-based, objective tests. Secondary measures included functional vision performance on objectively scored real-world tasks. / Results: Twenty-four of 30 patients remained implanted with functioning Argus II Systems at 5 years after implantation. Only 1 additional serious adverse event was experienced after the 3-year time point. Patients performed significantly better with the Argus II on than off on all visual function tests and functional vision tasks. / Conclusions: The 5-year results of the Argus II trial support the long-term safety profile and benefit of the Argus II System for patients blind as a result of RP. The Argus II is the first and only retinal implant to have market approval in the European Economic Area, the United States, and Canada