[Recognizing depression through computational language analysis]. / Herkennen van depressie met computationele taalanalyse.

BACKGROUND: Currently, clinical practice lacks a usable biomarker for the detection and differentiation of depression. Such a biomarker may be found in speech, from which important information can be distilled using automated speech analysis. AIM: To provide an overview of the fast-developing field of automated speech analysis for depression. METHOD: We summarize the current literature on speech features in depression. RESULTS: Current computational models can detect depression with high accuracy, rendering them applicable for diagnostic tools based on automatic speech analysis. Such tools are developing at a fast rate. CONCLUSION: Some challenges are still in the way of clinical implementation. For example, results differ largely between studies due to much variation in methodology. Furthermore, privacy and ethical issues need to be addressed before tools can be used.

Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study.

OBJECTIVE: Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data. DESIGN: Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery. SETTING: Two European tertiary referral hospitals. POPULATION: Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS). METHODS: Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7). MAIN OUTCOME MEASURES: Primary outcome: anatomical and subjective cure. SECONDARY OUTCOMES: surgical safety and intraoperative variables. RESULTS: A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%). CONCLUSIONS: This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results. TWEETABLE ABSTRACT: European bi-centre trial concludes that robot-assisted surgery is a viable approach to managing apical prolapse.

Prefrontal cortical thinning links to negative symptoms in schizophrenia via the ENIGMA consortium.

BACKGROUND: Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity. METHODS: This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores). RESULTS: Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (ß std = -0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged. CONCLUSIONS: Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.

Positive symptoms associate with cortical thinning in the superior temporal gyrus via the ENIGMA Schizophrenia consortium.

OBJECTIVE: Based on the role of the superior temporal gyrus (STG) in auditory processing, language comprehension and self-monitoring, this study aimed to investigate the relationship between STG cortical thickness and positive symptom severity in schizophrenia. METHOD: This prospective meta-analysis includes data from 1987 individuals with schizophrenia collected at seventeen centres around the world that contribute to the ENIGMA Schizophrenia Working Group. STG thickness measures were extracted from T1-weighted brain scans using FreeSurfer. The study performed a meta-analysis of effect sizes across sites generated by a model predicting left or right STG thickness with a positive symptom severity score (harmonized SAPS or PANSS-positive scores), while controlling for age, sex and site. Secondary models investigated relationships between antipsychotic medication, duration of illness, overall illness severity, handedness and STG thickness. RESULTS: Positive symptom severity was negatively related to STG thickness in both hemispheres (left: ßstd = -0.052; P = 0.021; right: ßstd = -0.073; P = 0.001) when statistically controlling for age, sex and site. This effect remained stable in models including duration of illness, antipsychotic medication or handedness. CONCLUSION: Our findings further underline the important role of the STG in hallmark symptoms in schizophrenia. These findings can assist in advancing insight into symptom-relevant pathophysiological mechanisms in schizophrenia.

[Non-invasive brain stimulation in schizophrenia: hallucinations and negative symptoms]. / Non-invasieve hersenstimulatie bij schizofrenie, gericht op hallucinaties en negatieve symptomen.

BACKGROUND: New approaches are needed in the treatment of characteristic symptoms of schizophrenia such as hallucinations and negative symptoms. Non-invasive brain stimulation can make a useful contribution.
AIM: To discuss the published evidence regarding efficacy and safety of repetitive transcranial magnetic stimulation (rtms) and transcranial direct current stimulation (tdcs) when used in the treatment of auditory verbal hallucinations and negative symptoms.
METHOD: We review and discuss recent meta-analyses and we analyse relevant factors.
RESULTS: On average, when compared to sham-stimulation, rtms was found to have a significant effect on hallucinations and negative symptoms. Nevertheless, the results of some studies were variable and some studies did not report any improvement. There are indications that some factors such as age and distance between scalp and cortex may influence efficiency. There were only a few studies relating to the use of tdcs and none of these reported a clear effect.
CONCLUSION: There is reasonable evidence that rtms is an efficient treatment for hallucinations and negative symptoms, although some variable results have been reported. There is insufficient evidence for conclusions to be drawn about the efficacy of tdcs for the treatment of hallucinations and negative symptoms. However, both simulation methods are safe and largely without side-effects.

Combining automatic speech recognition with semantic natural language processing in schizophrenia.

Natural language processing (NLP) tools are increasingly used to quantify semantic anomalies in schizophrenia. Automatic speech recognition (ASR) technology, if robust enough, could significantly speed up the NLP research process. In this study, we assessed the performance of a state-of-the-art ASR tool and its impact on diagnostic classification accuracy based on a NLP model. We compared ASR to human transcripts quantitatively (Word Error Rate (WER)) and qualitatively by analyzing error type and position. Subsequently, we evaluated the impact of ASR on classification accuracy using semantic similarity measures. Two random forest classifiers were trained with similarity measures derived from automatic and manual transcriptions, and their performance was compared. The ASR tool had a mean WER of 30.4%. Pronouns and words in sentence-final position had the highest WERs. The classification accuracy was 76.7% (sensitivity 70%; specificity 86%) using automated transcriptions and 79.8% (sensitivity 75%; specificity 86%) for manual transcriptions. The difference in performance between the models was not significant. These findings demonstrate that using ASR for semantic analysis is associated with only a small decrease in accuracy in classifying schizophrenia, compared to manual transcripts. Thus, combining ASR technology with semantic NLP models qualifies as a robust and efficient method for diagnosing schizophrenia.

Implementation of automatic speech analysis for early detection of psychiatric symptoms: What do patients want?

Psychiatry is in dire need of a method to aid early detection of symptoms. Recent developments in automatic speech analysis prove promising in this regard, and open avenues for implementation of speech-based applications to detect psychiatric symptoms. The current survey was conducted to assess positions with regard to speech recordings among a group (n = 675) of individuals who experience psychiatric symptoms. Overall, respondents are open to the idea of speech recordings in light of their mental welfare. Importantly, concerns with regard to privacy were raised. Given that speech recordings are privacy sensitive, this requires special attention upon implementation of automatic speech analysis techniques. Furthermore, respondents indicated a preference for speech recordings in the presence of a clinician, as opposed to a recording made at home without the clinician present. In developing a speech marker for psychiatry, close collaboration with the intended users is essential to arrive at a truly valid and implementable method.

Benign and malignant salivary gland diseases in children A retrospective study of 549 cases from the Salivary Gland Registry, Hamburg.

OBJECTIVE: Tumors of salivary glands in children are rare. Basically all types of salivary gland diseases during the period of childhood are described. The incidences of salivary gland tumors in children (0-14 years) differ completely from those in adults. Especially the malignant neoplasms are very rarely described in literature. Only some collective reviews and case reports try to summarize frequency, distribution concerning sex and age, morphology and localization. METHODS: In our study we were able to draw data from the Hamburg Salivary Gland Registry, concerning the last 25 years regarding histopathological diagnosis, age, gender and localisation of the pathologies. Findings were compared to other studies. Most of the specimens were presented by the Clinic for Otorhinolaryngology and Head and Neck Surgery, University Hamburg, Eppendorf. As a reference centre for salivary gland diseases some material was sent by other institutions. RESULTS: This study will give a detailed survey of salivary gland diseases and tumors in children up to the age of 14 which have undergone surgical therapy/biopsy. We present the general distribution of the different tumors/diseases, the distribution in certain age groups and the various locations. 549 cases could be examined. Comparing the distribution of malignant tumors with other studies, the epithelial-myoepithelial carcinomas followed by salivary duct carcinomas represent the largest group in childhood. CONCLUSIONS: The study shows that comparing to adulthood different tumors play an important role in adolescence. The distribution of tumors in childhood may help in diagnostic. Further many salivary gland diseases in childhood underwent surgery/biopsy although this is not supposed to be the proper treatment. The study shows that the right diagnosis most often can only be reached by surgery and histology.

[How reliable are our cancer statistics? Cancer cases in Hamburg's autopsy material]. / Wie zuverlässig sind unsere Krebsstatistiken? Krebsfälle im Hamburger Sektionsgut.

BACKGROUND: Among the causes of death, cancer ranks second after cardiovascular diseases. If a cancer patient dies before the tumor is diagnosed the malignancy may be unreported among post-mortem findings and thus is often not included in cancer and cause of death statistics. METHOD: All 8844 autopsies carried out at the Institute of Forensic Medicine for the City of Hamburg from 1994 to 2001 were analysed and those cases with malignant tumor identified. The cases were then included in the cancer registry if this had not been done previously. The postmortem diagnosis of malignancy was made histologically on formalin-fixed tissue. In these cases attempts were made to find out if the initial diagnosis of malignancy had been made before death. RESULTS: A malignancy was found in 519 autopsies (5.9 %). In 67.3 % of these (349/519) the patients had been aware of the disease. 27.2 % of all malignant tumors (141/519) were discovered during the post-mortem examination. In 5.6 % of cases (29/519) the question of whether the tumor had been diagnosed before death could not be answered because of lack of data or an incomplete case history. In 52.2 % (271/519) of the autopsies the tumor had definitely been the cause of death. Of these 271 tumors 17 % (46/271) were discovered only during the forensic post-mortem examination. The Hamburg Cancer Registry had been notified of only 58 cases of the 519. As a result of this study 451 new cancer cases (86.9 %) were notified to the Hamburg cancer registry. CONCLUSIONS: The registration of cancer deaths in Hamburg is incomplete and the notification of cancer to the Cancer Registry is inadequate. The estimated number of unreported cases is probably greater and cancer as the cause of death is higher than reported in the statistics.

Anorectal symptoms after various modes of vaginal delivery.

The aim of this study was to determine the prevalence of, and the changes in, anorectal symptoms following different modes of vaginal delivery in primiparous women. Six hundred and seventeen questionnaires were distributed to primiparous women 3-4 years after delivery. The questionnaires were designed to obtain information regarding the development of anorectal symptoms, including the type of symptoms experienced, their severity and their impact on lifestyle. A total of 479 questionnaires were returned, representing a response rate of 77.6%. Women included in the study were divided into three groups on the basis of the mode of delivery (normal vaginal, vacuum extraction and forceps). Any episode of fecal incontinence was considered to be abnormal. Following delivery, de novo incontinence developed in 22%. There was no significant difference between the three modes of vaginal delivery in terms of the development of fecal incontinence (normal vaginal delivery 22%, vacuum extraction 20%, forceps delivery 26%). Furthermore, analysis of obstetric variables could not identify one significant independent risk factor for anorectal incontinence. The results of this study suggest that instrumental vaginal deliveries are as safe as a normal vaginal delivery in terms of the development of anorectal symptoms.