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High-beta bursts in SMA mediate anticipatory muscle inhibition in a bimanual motor task
No full textInternational audienceAbstract In motor networks, motor inhibition can be driven by sensorimotor mu rhythm (8-12Hz) or beta bursts (13-30Hz). In this study, we aimed to investigate whether mu or beta activity supports efficient anticipatory inhibition, as reflected by a decrease in electromyographic (EMG) activity. To test this, we recorded magnetoencephalography (MEG) in 16 adults performing a Bimanual Load Lifting Task (BLLT), where participants lifted a load with one hand supported by the other. In anticipation of unloading, elbow flexors in the supporting arm are inhibited to prevent elbow deflection. We observed that optimal postural stabilization occurs when flexor inhibition happens approximately 30 ms before unloading begins. Stronger EMG inhibition in this time interval correlated negatively with high-gamma power (90-130Hz), reflecting reduced neural excitability, and positively with high-beta power in the medial supplementary motor area (SMA). In contrast, no significant correlation was observed in the mu-range (8-12 Hz). Meanwhile, high-beta and high-gamma power were negatively correlated. Mediation analysis confirmed that gamma power significantly mediates the relationship between beta power and EMG inhibition. Beta burst probability and directed connectivity analysis using the Phase Slope Index indicated that high-beta bursts are transmitted from the middle prefrontal cortex (mPFC) and elbow-related primary motor cortex (M1) to the SMA. Our findings suggest that, in the voluntary unloading task, anticipatory muscle inhibition at the optimal time is driven by a reduction in excitability within the SMA, likely facilitated by high-beta bursts originating from the mPFC-M1-SMA network. Significance Anticipatory motor processes represent a form of higher-order motor control evolved in humans to enable precise hand manipulation. In this study, we used a bimanual coordination task where precise force control is achieved by sending an inhibitory motor command to the elbow flexors before an anticipated forearm disturbance, which requires accurate timing and pattern selection. We demonstrate that timely anticipatory inhibition is associated with the transmission of high-beta bursts (22-28Hz) to the supplementary motor area, suppression of which enables precise inhibitory control over the flexor muscle. These findings suggest the neural mechanisms underlying anticipatory postural control and provide the first direct evidence linking beta activity to muscle inhibition
Chronic non-bacterial osteomyelitis: a retrospective international study on clinical manifestations and response to treatment.
No full textInternational audienceChronic non-bacterial osteomyelitis (CNO) is a rare non-infectious bone inflammatory disorder; when multifocal, it is referred to as Chronic Recurrent Multifocal Osteomyelitis (CRMO). This study evaluates the demographic, clinical and radiological characteristics of a multi-centre cohort of patients with CNO/CRMO
Answer to the letter to the editor of S. Pan, et al. concerning “Influence of socioeconomic deprivation and geographic disparities in the management of surgical adolescent idiopathic scoliosis: a multicentric retrospective cohort in Northern France” by B. Kipper, et al. (Eur Spine J [2024]: doi: 10.1007/s00586-024-08556-4)
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Explainable Monotonic Networks and Constrained Learning for Interpretable Classification and Weakly Supervised Anomaly Detection
No full textInternational audienceDeep networks interpretability is fundamental in critical domains like medicine: using easily explainable networks with decisions based on radiological signs and not on spurious confounders would reassure the clinicians. Confidence is reinforced by the integration of intrinsic properties and characteristics of monotonic networks could be used to design such intrinsically explainable networks. As they are considered as too constrained and difficult to train, they are often very shallow and rarely used for image applications. In this work, we propose a procedure to transform any architecture into a trainable monotonic network, identifying the critical importance of weights initialization, and highlight the interest of such networks for explicability and interpretability. By constraining the features and the gradients of a healthy vs pathological images classifier, we show, using counterfactual examples, that the network decision is more based on the radiological signs of the pathology and outperforms state-of-the-art methods for weakly supervised anomaly detection
Birth plans: Developing a shared medical decision aid tool
No full textInternational audienceBirth plans appeared at the end of the twentieth century, enabling women to express their expectations towards childbirth. This reflects a rising demand for patients to take a proactive role in their medical care. This study aimed to collaboratively develop a medical decision aid with expectant mothers to prepare them better for the events surrounding their child's birth
Long-term clinical and biological prognostic factors of anti-NMDA receptor encephalitis in children
No full textInternational audienceBackground and ObjectivesAnti-NMDAR encephalitis (NMDARE) is a severe neurologic condition, and recently, the NMDAR Encephalitis One-Year Functional Status (NEOS) score has emerged as a 1-year prognostic tool. This study aimed to evaluate NEOS score and biomarker (neurofilament light chains [NfL], total-Tau protein, glial fibrillary acidic protein, and serum cytokines) correlation with modified Rankin Scale (mRS), cognitive impairment, and clinical recovery in pediatric NMDARE over 2 years. MethodsIn this French multicenter observational study, 104 pediatric patients with NMDARE were followed for a minimum of 2 years. Clinical data and serum/plasma samples were collected. Biomarker levels, measured using electroluminescence mesoscale discovery (MSD) S-PLEX, were compared between patients and controls and assessed for correlations with disease activity, mRS, cognitive/language impairment, and recovery status at 2 years.ResultsAt a median follow-up of 39.5 months, 68 percent of patients had unfavorable recovery and 54% had significant cognitive impairment. Both outcomes were strongly associated with younger age at diagnosis (OR 6.10 [1.91–27.3] p < 0.01 and 5.69 [1.46–27.7] p = 0.02, respectively). A higher NEOS score was significantly correlated with increased cognitive impairment (OR 2.53 [1.52–4.21], p < 0.001), higher mRS scores (OR 2.12 [1.34–3.57], p < 0.01), and unfavorable recovery at 2 years (OR 2.00 [1.30–3.06], p = 0.015). Elevated NfL levels were significantly associated with unfavorable recovery (OR 3.62 [1.29–10.9] p = 0.012) and severe cognitive impairment (OR 3.77 [1.38–10.9] p = 0.012) at 2 years. The combined area under the curve (AUC) for NfL and NEOS was significantly higher than the AUCs of NEOS and NfL alone (p = 0.01)DiscussionThe NEOS score strongly predicts long-term outcomes in NMDARE, with its predictive value extending beyond the first-year mR prediction. NfL levels at disease onset seem to improve accuracy in predicting poor outcomes, providing valuable information for treatment decisions and future clinical trials
Localisation des nœuds discriminants de réseaux de graphes convolutifs pour la classification du handicap clinique à partir d’IRM-T1 de patients SEP
No full textInternational audienceLa Sclérose en Plaques (SEP) est une maladie auto-immune, démyélinisante et inflammatoire du système nerveux central induisant des lésions majoritairement de la substance blanche ainsi qu'une atrophie de la substance grise.Ces processus pathologiques se traduisent par des troubles physiques et cognitifs variables entre patients, qui sont quantifiés sur l'échelle EDSS (Expanded Disability Status Scale). Afin d'estimer le niveau de handicap du patient, notre travail propose de développer des réseaux de neurones de graphes en utilisant des modèles de connectivité morphologique, construits par similarité des épaisseurs corticales régionales mesurées sur des IRM-T1 acquises en routine clinique. Une méthode de masquage de graphe à l'inférence est miseen œuvre pour évaluer le rôle discriminant des régions cérébrales pour cette tâche
Neuropsychological Profile in Older Adults with End-Stage Kidney Disease during Kidney Transplantation Evaluation
No full textInternational audienceAbstract Background End-stage chronic kidney disease (CKD) is a significant concern for older adults and is often associated with cognitive impairment (CI). The origin of this CI is multifactorial, involving vascular and metabolic factors. Additionally, renal treatments, including dialysis, may affect cognition. This study aimed to assess the neuropsychological profiles of these patients and understand the effects of dialysis treatment. Methods We conducted an observational retrospective study including older adults with end-stage CKD attending for kidney transplantation (KT). Comprehensive neuropsychological assessments were conducted. Composite cognitive scores were computed. Multivariate regression models were used to assess associations between cognition and dialysis status. Results We included 223 patients (151 treated with dialysis, 72 with conservative management), mean age of 73.5 ± 3.4. We observed a high prevalence of CI, around 30% for global cognition and affecting all neuropsychological domains. Patients treated with dialysis exhibited lower cognitive performance compared to those not undergoing dialysis, particularly in episodic (p = .031) and working memory (p = .024). Conclusion This study confirms the high prevalence of CI in end-stage CKD, with dialysis being associated with worse episodic and working memory compared to non-dialyzed participants. Future investigations are needed to track the long-term cognitive trajectory of patients on the KT waiting list and post-transplantation. Trial registration Retrospectively registered, no 22-808 on July 7th, 2022, CNIL register number 22-580
Does the change between the native and the prosthetic posterior tibial slope influence the clinical outcomes after posterior stabilized TKA? A review of 793 knees at a minimum of 5 years follow-up
No full textInternational audienceIntroduction: The understanding of the influence of posterior tibial slope (PTS) on knee kinematics has increased. However, the PTS influence on clinical outcomes remains unclear. The study aimed to evaluate whether a significant change between the native and the prosthetic tibial plateau PTS influences functional results and the risk of complications following total knee arthroplasty (TKA). Methods: This was a retrospective, monocentric comparative study. Clinical and radiological data from 793 knees were collected from a prospective surgical database. Inclusion criteria were patients operated with a posterior-stabilized TKA (PS-TKA) for primary tibiofemoral osteoarthritis, with or without associated patellofemoral osteoarthritis, or osteonecrosis of the femoral condyle or tibial plateau, with a minimum follow-up of 5 years. Range of motion and International Knee Society (IKS) score as well as radiological measurements were collected preoperatively and postoperatively at each follow-up visit. Two groups were composed according to the change in PTS between pre- and post-op (Group 1: ≤10°, n = 703; Group 2: >10°, n = 90). Results: The mean follow-up was 75.5 months ± 9.1. The mean change in PTS from preoperative was 4.96° ± 3.24 in group 1 and 12.7° ± 1.87 in group 2. There was no significant difference in the mean IKS Knee subscore (89.5 ± 10.7 and 89.7 ± 10.2, p = 0.89) and mean IKS Function subscore (88.2 ± 15.7 and 86.3 ± 16.6, p = 0.33) in groups 1 and 2, respectively. Postoperative maximum flexion was very satisfactory in both groups with no clinically relevant difference (120.0 ± 11.9 and 123.0 ± 8.3, p = 0.026). The complication rate was 5.0% (n = 40) (5.5% in group 1; 1.1% in group 2; p = 0.07) while the most common complication requiring further procedure was deep infection (n = 9, 1.1%) and the second most common was stiffness (n = 6, 0.8%). Discussion: PTS did not influence postoperative maximum flexion or clinical scores and was not associated with a higher complication rate at a minimum 5-year follow-up after PS-TKA
Food choices, microstructure of ingestive behavior and sensory perceptions after bariatric surgery in women: A cross-sectional study
No full textInternational audienceResults regarding the impact of bariatric surgery (BS) on food choices are inconsistent between studies based on self-reported questionnaires, and those using direct measurements. Moreover, the determinants of the modifications of food choices after BS, if any, are still poorly understood. This study compared food choices, food liking, microstructure of ingestive behavior and sensory perceptions between women who had BS in the last 18 months (BS group, n = 19; Roux-en-Y gastric bypass or sleeve gastrectomy) and women with BMI >= 35 kg m- 2 (OB group, n = 17) in ecological conditions and explored the associations of food choices with sensory perceptions and food liking. Methods: Food choices and liking were assessed using a standardized ad-libitum buffet. Taste Strips and Scratch and Sniff cards were used to measure sensory perceptions. Microstructure of ingestive behavior of solid foods was studied using video recordings while eating the ad-libitum buffet. Results: Women in the BS group consumed half as many calories at the buffet (p = .004) as the OB group, taking smaller bites (7.5 f 1.9 vs 9.7 f 2.4 g/bite; p = .020) at a slower ingestion rate (2.1 f .7 vs 3.8 f 1.1 bites/min; p = .035). No differences were found in food choices, food liking and sensory perceptions. In the BS group, consuming very high energy density foods was negatively associated with salt taste perceived intensity (p = .021) and the liking of fruits and vegetables (p = .045). Conclusion: This is the first study that assessed the microstructure of ingestive behavior of solid foods in a population who has had BS. Ingestive behavior, but not food choices or liking, were different in women who had BS compared to women with obesity who did not have BS. However, only women with BS had their food choices associated with gustatory perceptions and food liking. Whether taste perceptions or types of food appreciations should be used as healthy-food choice predictors following BS should be further explored in future research