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Hippocampal volume in different neuropsychiatric cohorts using a semiautomatic a semiautomatic, stereological and automatic method
No full textIntroduction: In the recent literature on the course of different neuropsychiatric disorders, volumetric changes in the hippocampus, a limbic structure with anterior-posterior anatomical and functional segmentation, have been reported. We examined hippocampal volumes in subjects with Cushing’s disease (CD), in female patients with recurrent Familial Pure Depressive Disease (rFPDD) and in a population with mild Traumatic Brain Injury (mTBI), with the hypothesis that cortisol damage on the hippocampus (HC) has an anterior-posterior gradient , depending on the clinical situation and on the interaction between environment and genetic. Additionally, we decided to validate FreeSurfer, an automated software program developed at the Martinos Center for Biomedical Imaging (Harvard University, Boston, USA). This aim is in line with the current research for determining the volume of brain areas, which has been geared towards the development of automated methods of volumetric analysis that are highly reproducible, accurate and potentially more efficient than the current gold standard of the manual technique. I
Methods: We used a semi-automated software program (DCM view, Padova Ricerche, Padova, Italy) for Magnetic Resonance Imaging (MRI) to measure hippocampal volumes in ten patients with CD prior to selective surgical resection of the adrenocorticotropic hormone (ACTH)-secreting pituitary micro-adenomas using a trans-sphenoidal approach and after an interval of one year following surgery. This same program was used to measure hippocampal volumes in 15 female patients with familial recurrent Major Depression (MD) and 15 healthy female subjects. We also examined hippocampal volumes using a stereological method, using Analyze software (version 10., Biomedical Imaging Resource, Mayo Foundation, Rochester, MN, USA), in a sample of subjects with mTBI within a month and a year after head injury. In the validation study, the hippocampal volumes of a sample of elderly subjects with unipolar major depression and healthy controls were estimated using a automated method. Using FreeSurfer software, a stereological method (manual) was then used to validate it. Moreover, the accuracy and precision of the automatic delineation of all images acquired were verified. Using ANCOVA with whole-brain volume and age as covariates, volumetric measurements in the two groups with the different disorders were compared. The agreement between the volumetric measures within and between the two methods was determined by calculating Cronbach's alpha coefficient for intra- and inter-rater reliability tests.
Results: We found a significant difference in the head of the hippocampus bilaterally 12 months after selective trans-sphenoidal surgical resection of the adrenocorticotropic hormone (ACTH)-secreting pituitary micro-adenomas. The right hippocampal body and tail volumes were significantly smaller in female patients with familial depressive disorder when compared to healthy subjects. No significant differences in hippocampal volumes were found in subjects with mTBI. The test of agreement between the volumetric methods was good, whereas the verification analysis for the quality of the tracing using FreeSurfer was not found to be favourable for segmentation of the hippocampus.
Conclusions: The pre-post surgery difference found in our CD patients could contribute to increased the understanding of the pathophysiology of CD as an in vivo model for stress-related hypercortisolemic neuropsychiatric disorders. Our data provide evidence for structural lateralised hippocampal body and tail abnormalities in women with a familial history and recurrent episodes of depression. Although global reductions in hippocampal volume have already been widely reported, data on lateralised regional reductions in samples with familial recurrent depression had not been previously reported. Reductions in right posterior hippocampal volume may be a structural endophenotype for recurrent depressive disorders in women. A bigger sample of subjects and functional neuroimaging studies are necessary to form conclusions concerning changes in the brain structures of subjects with mTBI. The validation data from this study indicate that the automated method should be improved.Introduzione: Variazioni volumetriche dell’ ippocampo, regione cerebrale del lobo limbico che presenta una differente segmentazione anatomica e funzionale lungo il proprio asse antero-posteriore, sono state riportate dalla recente letteratura nel corso di diversi disturbi neuropsichiatrici. In questo studio sono stati misurati i volumi ippocampali di soggetti con Morbo di Cushing, di donne con disturbo depressivo ricorrente familiare e di una popolazione con trauma cranico lieve, supponendo che il danno indotto dal cortisolo nell’ ippocampo possa variare lungo l’ asse antero-posteriore, a seconda della condizione clinica. Ciò sottolinerebbe l'importanza dell'interazione tra ambiente e genetica in questo fenomeno. Inoltre, ci siamo proposti di convalidare FreeSurfer, un software automatico sviluppato presso il Centro Martinos for Biomedical Imaging (Harvard University, Boston, USA), per determinare il volume di differenti regioni cerebrali., in linea con l'attuale ricerca orientata verso lo sviluppo di metodi automatici che avrebbero il vantaggio di elevate riproducibilità, accuratezza, e, potenzialmente, maggiore efficienza di quelli manuali, attualmente considerati il “gold standard” per la determinazione del volume delle aree cerebrali.
Metodi: Un software semi automatico (DCM view, Padova Ricerche, Padova, Italy), su immagini di Risonanza Magnetica Nucleare cerebrale, è stato utilizzato per misurare il volume dell'ippocampo in 10 pazienti con Morbo di Cushing prima e dopo 12 mesi dalla resezione chirurgica selettiva, mediante un approccio transfenoidale, del microadenoma ipofisario ormone-adrenocorticotropo secernente, in 15 pazienti donne con depressione maggiore ricorrente familiare (MD) e 15 soggetti sani di sesso femminile. Un metodo stereologico, utilizzando come programma di riferimento l’Analyze software (versione 10, Biomedical Imaging Resource, Mayo Foundation, Rochester, Minnesota), è sato usato per la determinazione del volume ippocampale, in un campione di soggetti (13) con trauma cranico lieve, entro un mese e un anno dopo il trauma. Nello studio di validazione, su un campione di soggetti anziani con depressione unipolare maggiore e controlli sani, è stato calcolato il volume della regione cerebrale d’interesse sia mediante un metodo stereologico (manuale), sia attraverso il metodo automatico del programma in corso di validazione (FreeSurfer). Successivamente è stato eseguito un controllo sull’accuratezza e sulla precisione della delimitazione automatica di tutte le immagini acquisite. Sono state confrontate le misurazioni volumetriche nei due gruppi delle differenti coorti utilizzando ANCOVA, con il volume cerebrale totale ed età come covariate. L’accordo tra le misure volumetriche all’interno e tra i due metodi, nello studio di validazione, è stato testato usando Cronbach’s alpha mediante l’analisi dell’intra-rater e della inter-rater reliability.
Risultati: Abbiamo trovato una differenza significativa nella testa dell'ippocampo bilateralmente nei soggetti con Morbo di Cushing dopo 12 mesi dalla resezione chirurgica selettiva, mediante approccio trans-sfenoidale, del microadenoma ipofisario ormone adrenocorticotropo secernente. I volumi del corpo e della coda dell’ ippocampo erano significativamente minori nei pazienti di sesso femminile con disturbo depressivo familiare, rispetto ai soggetti sani. Nessuna differenza significativa nei volumi hippocampali sono stati trovati nei soggetti con trauma cranico lieve. In conclusione il metodo automatico dimostra un buon accordo con il metodo stereologico, mentre il controllo sulla qualità della delimitazione automatica ha rilevato una non precisa segmentazione della regione cerebrale d’ interesse.
Discussione e Conclusioni: Il dato di una differenza del volume della testa dell’ ippocampo pre-post intervento chirurgico potrebbe contribuire a comprendere meglio la fisiopatologia del Morbo di Cushing come modello in vivo per i disturbi neuropsichiatrici legati allo stress. Il dato di una riduzione del volume del corpo e della coda ippocampale in donne con storia familiare ed episodi ricorrenti di depressione. forniscono la prova di un danno strutturale lateralizzato dell'ippocampo. Sebbene la riduzione globale delle ippocampo sia già stata ampiamente riportata, i dati sulle riduzioni regionali lateralizzate nella depressione ricorrente e familiare non erano stati precedentemente segnalati. Una riduzione posteriore del volume ippocampale di destra potrebbe essere un endofenotipo strutturale per disturbi depressivi ricorrenti nelle donne. Un campione più elevato di soggetti e studi di neuroimaging funzionale sarebbero necessari per fare considerazioni sul cambiamento delle strutture cerebrali in soggetti con trauma cranico lieve. I risultati, circa la validazione, indicano che il metodo automatizzato dovrà essere ulteriormente migliorato
Is a high dosage aripiprazole-clozapine combination an effective strategy for treatment-resistant schizophrenic patients? A case report.
Full text linkOur case report may represent a treatment option for patients withtreatment-resistant schizophrenia, who display partial responses to clozapine and face the risk of developing a metabolic syndrome. This effective, though extreme, polypharmacy of treatment-resistant schizophrenia
require further evidence and confirmative data and should
be used only in severe, selected cases, with the full consent and
compliance of patients
A meta-analysis of temperament and character dimensions in patients with mood disorders: Comparison to healthy controls and unaffected siblings
No full textCloninger's psychobiological model of personality has been extensively applied to subjects affected by mood disorders (MOOD). However, most studies are widely heterogeneous in terms of sample size, methods of assessment, and selection of participants.
We conducted a systematic review of literature and a random effects meta-analysis of studies comparing at least two of the following groups: (a) adults with a primary MOOD diagnosis (Bipolar Disorder (BP) or major depressive disorder (MDD)), (b) their unaffected siblings (SIB) or (c) healthy subjects (HS), and reporting quantitative results from the Tridimensional Personality Questionnaire (TPQ) or the Temperament and Character Inventory (TCI).
Subgroup, sensitivity and meta-regression analyses were also conducted.
High Harm Avoidance and low Self-Directedness were consistently associated with MOOD and SIB samples. BP was characterized by higher scores in Novelty Seeking and Self-Transcendence than HS, SIB and MDD. Age seemed to have a negative effect on Novelty Seeking and a positive effect on Harm Avoidance, Cooperativeness and Self-Transcendence. An euthymic mood state was associated with reduced Harm Avoidance, but increased Reward Dependence, Self-Directedness and Cooperativeness.
imitations: The quality of the included studies varied and was relatively low. Moreover, publication bias and heterogeneity in the distribution of effect sizes may also have limited our results.
High Harm Avoidance and Low Self-Directedness may be trait markers for MOOD in general, while high Novelty Seeking and high Self-Transcendence may be specific to BP. Future studies are needed to disentangle the state-trait effect of each personality dimension
A naturalistic study comparing two initial duloxetine dosing strategies in a clinical "real world" setting
No full textTo compare, in a "real world" setting. the efficacy and tolerability of two initial duloxetine starting doses: 30 mg once daily (q.d.) for I week, followed by escalation to, 60 mg q.d. versus 60 mg q.d. without titolation, evaluating expecially effects on sexual dysfunction. Methods. The sample is Constituted by outpatients meeting diagnostic criteria for mild-severe (HAMD(17) >= 24 and CGI-S >= 4) Major Depressive Episode as defined by DSM-IV-TR (Diagnostic and Statistic Manual for Mental Disorder. Fourth Edition-Text Revision). based oil the Structured Clinical Interview for DSM-IV-TR (Mini International Neuropsychiatric Interview, MINI),The study design planned all initial evaluation and 4 follow-up visits at each visit the following scales were administered: Hamilton Rating Scale for Depression (HAMD(17)) and Anxiety (HAMA), Clinical Global Impression Severity Scale (CGI-S) for severity evaluation and Arizona Sexual Experience Scale (ASEX) for Sexual disfunction evaluation. Results. Both of the groups showed 90% of response (>= 50% reduction in a patient's HAMD(17) total score from baseline) within 2 months of follow-up. 50%, of patients receiving a 30 mg q.d. starting dose achieved a HAMD(17) total score <= 7 versus 40% of 60 mg q.d. treating group. None showed relapses during the study After the first treatment month, the 60 mg q.d. receiving group showed a statistical significative amelioration of sexual function (Mann-Whitney test: p=0,02). Conclusions. Our naturalistic "real world" study results confirm previous duloxetine tolerability and efficacy findings suggesting a 60 mg q.d. after meal duloxetine somministration without titolation
Prevalence and Risk Factors for QTc Prolongation in Acute Psychiatric Hospitalization
No full textObjective: Prolongation of corrected QT (QTc) interval increases the risk of severe ventricular arrhythmias, in particular torsades de pointes. Patients with severe mental illness (SMI) represent a vulnerable population. This study aimed to measure the prevalence of QTc prolongation in inpatients with SMI and to identify risk factors for QTc prolongation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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