The words of the body: psychophysiological patterns in dissociative narratives

Trauma has severe consequences on both psychological and somatic levels, even affecting the genetic expression and the cell\u2019s DNA repair ability. A key mechanism in the understanding of clinical disorders deriving from trauma is identified in dissociation, as a primitive defense against the fragmentation of the self originated by overwhelming experiences. The dysregulation of the interpersonal patterns due to the traumatic experience and its detrimental effects on the body are supported by influent neuroscientific models such as Damasio\u2019s somatic markers and Porges\u2019 polyvagal theory. On the basis of these premises, and supported by our previous empirical observations on 40 simulated clinical sessions, we will discuss the longitudinal process of a brief psychodynamic psychotherapy (16 sessions, weekly frequency) with a patient who suffered a relational trauma. The research design consists of the collection of self-report and projective tests, pre-post therapy and after each clinical session, in order to assess personality, empathy, clinical alliance and clinical progress, along with the verbatim analysis of the transcripts trough the Psychotherapy Process Q-Set and the Collaborative Interactions Scale. Furthermore, we collected simultaneous psychophysiological measures of the therapeutic dyad: skin conductance and hearth rate. Lastly, we employed a computerized analysis of non-verbal behaviors to assess synchrony in posture and gestures. These automated measures are able to highlight moments of affective concordance and discordance, allowing for a deep understanding of the mutual regulations between the patient and the therapist. Preliminary results showed that psychophysiological changes in dyadic synchrony, observed in body movements, skin conductance and hearth rate, occurred within sessions during the discussion of traumatic experiences, with levels of attunement that changed in both therapist and the patient depending on the quality of the emotional representation of the experience. These results go in the direction of understanding the relational process in trauma therapy, using an integrative language in which both clinical and neurophysiological knowledge may take advantage of each other

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

\u201cReality\u201d of near-death-experience memories: evidence from a psychodynamic and electrophysiological integrated study

The nature of near-death-experiences (NDEs) is largely unknown but recent evidence suggests the intriguing possibility that NDEs may refer to actually \u201cperceived,\u201d and stored, experiences (although not necessarily in relation to the external physical world). We adopted an integrated approach involving a hypnosis-based clinical protocol to improve recall and decrease memory inaccuracy together with electroencephalography (EEG) recording in order to investigate the characteristics of NDE memories and their neural markers compared to memories of both real and imagined events. We included 10 participants with NDEs, defined by the Greyson NDE scale, and 10 control subjects without NDE. Memories were assessed using the Memory Characteristics Questionnaire. Our hypnosis-based protocol increased the amount of details in the recall of all kind of memories considered (NDE, real, and imagined events). Findings showed that NDE memories were similar to real memories in terms of detail richness, self-referential, and emotional information. Moreover, NDE memories were significantly different from memories of imagined events. The pattern of EEG results indicated that real memory recall was positively associated with two memory-related frequency bands, i.e., high alpha and gamma. NDE memories were linked with theta band, a well-known marker of episodic memory. The recall of NDE memories was also related to delta band, which indexes processes such as the recollection of the past, as well as trance states, hallucinations, and other related portals to transpersonal experience. It is notable that the EEG pattern of correlations for NDE memory recall differed from the pattern for memories of immagine events. In conclusion, our findings suggest that, at a phenomenological level, NDE memories cannot be considered equivalent to imagined memories, and at a neural level, NDE memories are stored as episodic memories of events experienced in a peculiar state of consciousness

Radioiodine therapy for thyroid cancer and dysfunction of the salivary and lachrymal glands in the START study: results at 6 months follow-up

International audienceBackgroundUnderstanding of changes in salivary and lachrymal gland functions after radioiodine therapy (131I-therapy) remains limited; and, to-date no studies have evaluated dose-response relationships between absorbed dose from 131I-therapy and dysfunctions of these glands. This study investigates salivary/lachrymal dysfunctions in differentiated thyroid cancer (DTC) patients six months after 131I-therapy, identifies 131I-therapy related risk factors for salivary/lachrymal dysfunctions, and assesses the relationships between 131I-therapy radiation dose and these dysfunctions.MethodsA study was conducted involving 136 DTC patients treated by 131I-therapy of whom 44 and 92 patients received 1.1 and 3.7 GBq, respectively. Absorbed dose to the salivary glands was estimated using a dosimetric reconstruction method based on thermoluminescent dosimeters measurements. Salivary and lachrymal functions were assessed at baseline (T0, i.e., immediately prior to 131I-therapy), and 6 months later (T6) using validated questionnaires and salivary samplings, with and without stimulation of the salivary glands. Statistical analyses included descriptive analyses and random-effects multivariate logistic and linear regressions.ResultsThere was no difference between T0 and T6 in the level of parotid gland pain, nor was there difference in the number of patients with hyposalivation, but there were significantly more patients with dry mouth sensation and dry eyes after therapy compared to baseline. Age, menopause, depression and anxiety symptoms, history of systemic disease, and not taking painkillers in the last 3 months were found to be significantly associated with salivary or lachrymal disorders. Significant associations were found between 131I-exposure and salivary disorders adjusted on the previous variables: e.g. per 1-Gy increase in mean dose to the salivary glands, OR=1.43 (95%CI 1.02-2.04) for dry mouth sensation, ß=-0.08 (95%CI -0.12;-0.02) mL/min for stimulated saliva flow, and ß= 1.07 (95%CI 0.42;1.71) mmol/L for salivary potassium concentration. Conclusions This study brings new knowledge on the relationship between the absorbed dose to the salivary glands from 131I-therapy and salivary/lachrymal dysfunctions in DTC patients 6 months after 131I-therapy. Despite the findings of some dysfunctions, the results do not show any obvious clinical disorders after the 131I-therapy. Nevertheless, by identifying risk factors, this study encourages clinicians to adapt the therapy for patients at risk of salivary/lachrymal complications

Salivary Dysfunctions and Conséquences After RadioiodineTreatment for Thyroid Cancer: Protocol for a Self-Controlled Study(START Study)

International audienceBackground: Following radioiodine (131I) therapy of differentiated thyroid cancer, salivary glands may become inflamed, leading to dysfunctions, then leading to decreases in patients’ nutrition and quality of life. The incidence of these dysfunctions after 131I-therapy is poorly known, and no clinical or genetic factors have been identified to date to define patients at risk, allowing the delivered activity to be adapted to the expected risk of salivary dysfunctions.Objective: this study aims to estimate the incidence of salivary dysfunctions after 131I-therapy, to characterize patients at risk of developing post-treatment dysfunctions using clinical, biomolecular and biochemical factors, and to validate a dosimetric method to calculate the dose received at the salivary gland level in order to analyze the dose response relationship between absorbed doses to salivary glands and salivary dysfunctions.Methods: This prospective cohort aims to include patients for whom a 131I-therapy is indicated within the treatment of their differentiated thyroid cancer in a Paris hospital (40 and 80 patients in a 1.1 GBq and a 3.7 GBq groups respectively). The follow-up is based on 3 scheduled visits: at inclusion (T0, immediately before 131I-therapy), 6 months (T6) and 18 months (T18) after treatment. For each visit, questionnaires on salivary dysfunctions (validated French tool), quality of life (HAD-scale, MOS-SF-36), and nutritional status are administered by a trained clinical research associate. At T0 and at T6, saliva samples and individual measurement of the salivary flow, without and with salivary glands stimulation, are performed. External thermoluminescent dosimeters are positioned on the skin opposite the salivary glands and at the sternal fork immediately before radioiodine administration and removed 5 days after treatment. From dosimeters, an estimation of the dose received at the salivary glands will be performed using physical and computational phantoms.Genetic and epigenetic analyses will be performed in order to look for potential biomarkers of predisposition to develop salivary dysfunctions after 131I-therapy.Results: 139 patients (71% women, mean age=47.4 (±14.3) years old) were included between September 2020 and April 2021 (45 and 94 patients in 1.1GBq and 3.7GBq groups respectively). The 6-months follow-up is still ongoing, and the 18-months follow-up will start in February 2022. Statistical analyses will study the links between salivary dysfunctions and absorbed doses to the salivary glands, taking into account associated factors. In addition, impacts on the patients' quality of life will be analyzed.Conclusions: To our knowledge, this study is the first to investigate the risk of salivary dysfunctions (using both objective and subjective indicators) in relation to organ (salivary glands) doses, based on individual dosimeter records and dose reconstructions. The results will allow the identification of patients at risk of salivary dysfunctions, and thus to propose to clinicians a more adapted follow-up and/or countermeasures to adverse effects

Dysfunction of the salivary and lacrimal glands after radioiodine treatment: Preliminary results of a self-controlled study in france

International audienceFollowing radioiodine (131I) therapy of differentiated thyroid cancer, salivary and lacrimal glands may become inflamed, leading to dysfunctions. The incidence of these dysfunctions after 131I-therapy is poorly known, and no clinical or genetic factors have been identified to date to define patients at risk. The aims of this study are 1) to characterize the dysfunction of salivary and lacrimal glands after 131I-therapy, 2) to identify risk factors of salivary and lacrimal dysfunction.START (Salivary dysfuncTion After Radioiodine Treatment) is a prospective study including 139 patients, candidates for a 131I-therapy in the context of their differentiated thyroid cancer (45 and 94 patients in 1.1GBq and 3.7GBq groups respectively). The follow-up was based on 2 scheduled visits: immediately before 131I-therapy (T0) and 6-months after (T6). At each visit, questionnaires on salivary disorders (validated French tool) and dry eye (OSDI© Questionnaire) were administered, and individual salivary flow measurements (without and with salivary gland stimulation) were performed. Descriptive analyses and paired comparisons tests between T0 and T6 were computed.The T6 follow-up started in March 2021, and is still ongoing. Complete information was provided for 122 patients (71% women, mean age=47.4 (±14.3) y). At 6 months after 131I-therapy, stimulated saliva flow rate decreased (from 6.98 (±3.35) to 6.07 (±3.15) mL/min, p<0.01), as well as the difference between stimulated and unstimulated saliva flow rates (from 1.40 (±0.67) to 1.21 (±0.63) mL/min, p<0.01). Also, after 131I-therapy, 19% and 21% of the study population reported dry eye or dry mouth feeling, respectively.This work presents preliminary results of the START study, showing a decrease in salivary and lacrimal gland activity after 131I-therapy. Further analyses will be performed, including saliva biochemical composition, genetic and epigenetic variants, and dose-response relationships (using dosimetric reconstructions)

Dysfunction of the salivary and lacrimal glands after radioiodine treatment: Preliminary results of a self-controlled study in france

International audienceFollowing radioiodine (131I) therapy of differentiated thyroid cancer, salivary and lacrimal glands may become inflamed, leading to dysfunctions. The incidence of these dysfunctions after 131I-therapy is poorly known, and no clinical or genetic factors have been identified to date to define patients at risk. The aims of this study are 1) to characterize the dysfunction of salivary and lacrimal glands after 131I-therapy, 2) to identify risk factors of salivary and lacrimal dysfunction.START (Salivary dysfuncTion After Radioiodine Treatment) is a prospective study including 139 patients, candidates for a 131I-therapy in the context of their differentiated thyroid cancer (45 and 94 patients in 1.1GBq and 3.7GBq groups respectively). The follow-up was based on 2 scheduled visits: immediately before 131I-therapy (T0) and 6-months after (T6). At each visit, questionnaires on salivary disorders (validated French tool) and dry eye (OSDI© Questionnaire) were administered, and individual salivary flow measurements (without and with salivary gland stimulation) were performed. Descriptive analyses and paired comparisons tests between T0 and T6 were computed.The T6 follow-up started in March 2021, and is still ongoing. Complete information was provided for 122 patients (71% women, mean age=47.4 (±14.3) y). At 6 months after 131I-therapy, stimulated saliva flow rate decreased (from 6.98 (±3.35) to 6.07 (±3.15) mL/min, p<0.01), as well as the difference between stimulated and unstimulated saliva flow rates (from 1.40 (±0.67) to 1.21 (±0.63) mL/min, p<0.01). Also, after 131I-therapy, 19% and 21% of the study population reported dry eye or dry mouth feeling, respectively.This work presents preliminary results of the START study, showing a decrease in salivary and lacrimal gland activity after 131I-therapy. Further analyses will be performed, including saliva biochemical composition, genetic and epigenetic variants, and dose-response relationships (using dosimetric reconstructions)