First-night effect reduces the beneficial effects of sleep on visual plasticity and modifies the underlying neurochemical processes.

Individuals experience difficulty falling asleep in a new environment, termed the first night effect (FNE). However, the impact of the FNE on sleep-induced brain plasticity remains unclear. Here, using a within-subject design, we found that the FNE significantly reduces visual plasticity during sleep in young adults. Sleep-onset latency (SOL), an indicator of the FNE, was significantly longer during the first sleep session than the second session, confirming the FNE. We assessed performance gains in visual perceptual learning after sleep and increases in the excitatory-to-inhibitory neurotransmitter (E/I) ratio in early visual areas during sleep using magnetic resonance spectroscopy and polysomnography. These parameters were significantly smaller in sleep with the FNE than in sleep without the FNE; however, these parameters were not correlated with SOL. These results suggest that while the neural mechanisms of the FNE and brain plasticity are independent, sleep disturbances temporarily block the neurochemical process fundamental for brain plasticity.

First-night effect reduces the beneficial effects of sleep on visual plasticity and modifies the underlying neurochemical processes.

Individuals experience difficulty falling asleep in a new environment, termed the first night effect (FNE). However, the impact of the FNE on sleep-induced brain plasticity remains unclear. Here, using a within-subject design, we found that the FNE significantly reduces visual plasticity during sleep in young adults. Sleep-onset latency (SOL), an indicator of the FNE, was significantly longer during the first sleep session than the second session, confirming the FNE. We assessed performance gains in visual perceptual learning after sleep and increases in the excitatory-to-inhibitory neurotransmitter (E/I) ratio in early visual areas during sleep using magnetic resonance spectroscopy and polysomnography. These parameters were significantly smaller in sleep with the FNE than in sleep without the FNE; however, these parameters were not correlated with SOL. These results suggest that while the neural mechanisms of the FNE and brain plasticity are independent, sleep disturbances temporarily block the neurochemical process fundamental for brain plasticity.

Impaired self-monitoring ability on reaction times of psychomotor vigilance task of nurses after a night shift.

The cognitive ability to self-monitor one's current performance is important for hospital nurses to maintain safety and health. However, studies on the effects of rotating shift work on self-monitoring ability are insufficient. We examined the differences in self-monitoring accuracy across shifts in a rotating three-shift system among 30 female ward nurses (mean age 28.2 years). Their self-monitoring ability was calculated by subtracting the predicted reaction times of the psychomotor vigilance task performed just before exiting the workplace from the actual reaction times. A mixed-effect model was employed to assess the effects of shift, awake hours, and prior sleep duration on self-monitoring ability. We observed impaired self-monitoring ability in nurses, particularly after the night shift. Although actual performance remained high across all shifts, their self-predictions on reaction times became pessimistic in the night shift, resulting in a difference of approximately-100 msec. The effect of the shift on self-monitoring was obvious even after adjusting for sleep duration and hours awake. Our findings indicate that the misalignment between their working hours and circadian rhythms may affect even professional nurses. Occupational management that emphasizes maintaining circadian rhythms will improve the safety and health of nurses.

Sleep, learning, and memory in human research using noninvasive neuroimaging techniques.

An accumulating body of evidence indicates that sleep is beneficial for learning and memory. Task performance improves significantly after a period that includes sleep, whereas a lack of sleep nullifies or impairs such improvements. Our current knowledge about sleep's role in learning and memory has been obtained based on studies that were conducted in both animal models and human subjects. Nevertheless, how sleep promotes learning and memory in humans is not fully understood. In this review, we overview our current understating of how sleep may contribute to learning and memory, covering different roles of non-rapid eye movement and rapid eye movement sleep. We then discuss cutting-edge advanced techniques that are currently available, including simultaneous functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG) and simultaneous functional magnetic resonance spectroscopy (fMRS) and EEG measurements, and evaluate how these may contribute to advance the understanding of the role of sleep in human cognition. We also highlight the current limitations and challenges using these methods and discuss ways that may allow us to overcome these limitations.

Shift-Work Schedule Intervention for Extending Restart Breaks after Consecutive Night Shifts: A Non-randomized Controlled Cross-Over Study.

More knowledge is required to determine the optimal shiftwork schedule to reduce the harmful effects of short restart breaks between shifts. This 5-month intervention study aimed to examine the effectiveness of extended restart breaks from 31 h to 55 h after consecutive night shifts by considering the characteristics of the circadian rhythm to mitigate fatigue and sleep among 30 shift-working nurses. Subjective and objective variables, such as vital exhaustion, distress, hair cortisol, salivary C-reactive protein, and sleep mattress sensor sensation, were repeatedly measured to examine the differences between the intervention and control conditions. Two-way (condition × time) multilevel analyses showed significantly lower levels of vital exhaustion and distress in the intervention condition (p = 0.005 and p = 0.004, respectively). However, the expected benefit of the intervention was not observed in objectively measured variables. These findings suggested that an extended restart break after consecutive night shifts can moderately decrease occupational fatigue and stress.

Sleep-Dependent Facilitation of Visual Perceptual Learning Is Consistent with a Learning-Dependent Model.

How sleep leads to offline performance gains in learning remains controversial. A use-dependent model assumes that sleep processing leading to performance gains occurs based on general cortical usage during wakefulness, whereas a learning-dependent model assumes that this processing is specific to learning. Here, we found evidence that supports a learning-dependent model in visual perceptual learning (VPL) in humans (both sexes). First, we measured the strength of spontaneous oscillations during sleep after two training conditions that required the same amount of training or visual cortical usage; one generated VPL (learning condition), while the other did not (interference condition). During a post-training nap, slow-wave activity (SWA) and sigma activity during non-rapid eye movement (NREM) sleep and theta activity during REM sleep were source localized to the early visual areas using retinotopic mapping. Inconsistent with a use-dependent model, only in the learning condition, sigma and theta activity, not SWA, increased in a trained region-specific manner and correlated with performance gains. Second, we investigated the roles of occipital sigma and theta activity during sleep. Occipital sigma activity during NREM sleep was significantly correlated with performance gains in presleep learning; however, occipital theta activity during REM sleep was correlated with presleep learning stabilization, shown as resilience to interference from postsleep learning in a trained region-specific manner. Occipital SWA was not associated with offline performance gains or stabilization. These results demonstrate that sleep processing leading to performance gains is learning dependent in VPL and involves occipital sigma and theta activity during sleep.SIGNIFICANCE STATEMENT The present study shows strong evidence that could help resolve the long-standing controversy surrounding sleep processing that strengthens learning (performance gains). There are two conflicting models. A use-dependent model assumes that sleep processing leading to performance gains occurs because of general cortical usage during wakefulness, whereas a learning-dependent model assumes that processing occurs specifically for learning. Using visual perceptual learning and interference paradigms, we found that processing did not take place after general cortical usage. Moreover, sigma activity during non-rapid eye movement (REM) sleep and theta activity during REM sleep in occipital areas were found to be involved in processing, which is consistent with the learning-dependent model and not the use-dependent model. These results support the learning-dependent model.

Coregistration of magnetic resonance spectroscopy and polysomnography for sleep analysis in human subjects.

We developed a protocol for simultaneous magnetic resonance spectroscopy (MRS) and polysomnography (PSG) recordings while subjects are in sleep. The approach is useful to estimate plasticity-stability balances by measuring neurochemical changes in the brain during sleep. We detail the steps needed to minimize artifacts in PSG recordings and the setup and coregistration of MRS data to sleep stages. We also describe useful information for various types of electroencephalogram (EEG) experiments in magnetic resonance imaging (MRI) environments. For complete details on the use and execution of this protocol, please refer to Tamaki et al. (2020b).

Visual perceptual learning of a primitive feature in human V1/V2 as a result of unconscious processing, revealed by decoded functional MRI neurofeedback (DecNef).

Although numerous studies have shown that visual perceptual learning (VPL) occurs as a result of exposure to a visual feature in a task-irrelevant manner, the underlying neural mechanism is poorly understood. In a previous psychophysical study (Watanabe et al., 2002), subjects were repeatedly exposed to a task-irrelevant Sekuler motion display that induced the perception of not only the local motions, but also a global motionmoving in the direction of the spatiotemporal average of the local motion vectors. As a result of this exposure, subjects enhanced their sensitivity only to the local moving directions, suggesting that early visual areas (V1/V2) that process local motions are involved in task-irrelevant VPL. However, this hypothesis has never been tested directly using neuronal recordings. Here, we employed a decoded neurofeedback technique (DecNef) using functional magnetic resonance imaging in human subjects to examine the involvement of early visual areas (V1/V2) in task-irrelevant VPL of local motion within a Sekuler motion display. During the DecNef training, subjects were trained to induce the activity patterns in V1/V2 that were similar to those evoked by the actual presentation of the Sekuler motion display. The DecNef training was conducted with neither the actual presentation of the display nor the subjects' awareness of the purpose of the experiment. After the experiment, subjects reported that they neither perceived nor imagined the trained motion during the DecNef training. As a result of DecNef training, subjects increased their sensitivity to the local motion directions, but not specifically to the global motion direction. Neuronal changes related to DecNef training were confined to V1/V2. These results suggest that V1/V2 are involved in exposure-based task-irrelevant VPL of local motion.

Complementary contributions of non-REM and REM sleep to visual learning.

Sleep is beneficial for learning. However, it remains unclear whether learning is facilitated by non-rapid eye movement (NREM) sleep or by REM sleep, whether it results from plasticity increases or stabilization, and whether facilitation results from learning-specific processing. Here, we trained volunteers on a visual task and measured the excitatory and inhibitory (E/I) balance in early visual areas during subsequent sleep as an index of plasticity. The E/I balance increased during NREM sleep irrespective of whether pre-sleep learning occurred, but it was associated with post-sleep performance gains relative to pre-sleep performance. In contrast, the E/I balance decreased during REM sleep but only after pre-sleep training, and the decrease was associated with stabilization of pre-sleep learning. These findings indicate that NREM sleep promotes plasticity, leading to performance gains independent of learning, while REM sleep decreases plasticity to stabilize learning in a learning-specific manner.

Reward does not facilitate visual perceptual learning until sleep occurs.

A growing body of evidence indicates that visual perceptual learning (VPL) is enhanced by reward provided during training. Another line of studies has shown that sleep following training also plays a role in facilitating VPL, an effect known as the offline performance gain of VPL. However, whether the effects of reward and sleep interact on VPL remains unclear. Here, we show that reward interacts with sleep to facilitate offline performance gains of VPL. First, we demonstrated a significantly larger offline performance gain over a 12-h interval including sleep in a reward group than that in a no-reward group. However, the offline performance gains over the 12-h interval without sleep were not significantly different with or without reward during training, indicating a crucial interaction between reward and sleep in VPL. Next, we tested whether neural activations during posttraining sleep were modulated after reward was provided during training. Reward provided during training enhanced rapid eye movement (REM) sleep time, increased oscillatory activities for reward processing in the prefrontal region during REM sleep, and inhibited neural activation in the untrained region in early visual areas in non-rapid eye movement (NREM) and REM sleep. The offline performance gains were significantly correlated with oscillatory activities of visual processing during NREM sleep and reward processing during REM sleep in the reward group but not in the no-reward group. These results suggest that reward provided during training becomes effective during sleep, with excited reward processing sending inhibitory signals to suppress noise in visual processing, resulting in larger offline performance gains over sleep.

Surveillance During REM Sleep for the First-Night Effect.

We experience disturbed sleep in a new place, and this effect is known as the first-night effect (FNE) in sleep research. We previously demonstrated that the FNE is associated with a surveillance system in one brain hemisphere during NREM sleep, which manifests as interhemispheric asymmetry in sleep depth in the default-mode network (DMN) and increased vigilance toward monitoring external stimuli. This surveillance system may be useful for protecting vulnerable sleepers from abnormal events in unfamiliar environments. The present study investigated whether a similar surveillance system is exhibited during rapid eye movement (REM) sleep. The impacts of the FNE could be different between the phasic period, in which eyes move rapidly, and the tonic period, in which eye movement ceases, of REM sleep; without the FNE, vigilance to external stimuli is generally reduced during the phasic period but not the tonic period. Thus, REM sleep was split into phasic and tonic periods. First, we replicated previous findings showing interhemispheric asymmetry in delta activity in the DMN associated with the FNE during NREM sleep. However, during REM sleep, interhemispheric asymmetry in delta activity or theta activities, two oscillatory activities during REM sleep, was not found during the phasic or tonic periods. Next, we tested whether vigilance, as measured by evoked brain responses (P2) to deviant tones, associated with the FNE was increased in one hemisphere during REM sleep. The P2 amplitudes during the phasic period were augmented by the FNE on day 1 and were significantly larger than those on day 2 when the FNE was not present. In contrast, the P2 amplitudes during the tonic period were not different across days. The P2 amplitudes showed no interhemispheric asymmetry during the phasic or tonic periods. These results suggest that while the surveillance system exhibits interhemispheric asymmetry in sleep depth and vigilance during NREM sleep, this system shows no interhemispheric asymmetry in oscillatory activities and exhibits increased vigilance in both hemispheres only during the phasic period of REM sleep. Therefore, the surveillance system associated with the FNE may involve different mechanisms during NREM and REM sleep.

Trained-feature-specific offline learning by sleep in an orientation detection task.

Training-induced performance gains in a visual perceptual learning (VPL) task that take place during sleep are termed "offline performance gains." Offline performance gains of VPL so far have been reported in the texture discrimination task and other discrimination tasks. This raises the question as to whether offline performance gains on VPL occur exclusively in discrimination tasks. The present study examined whether offline performance gains occur in detection tasks. In Experiment 1, subjects were trained on a Gabor orientation detection task. They were retested after a 12-hr interval, which included either nightly sleep or only wakefulness. Offline performance gains occurred only after sleep on the trained orientation, not on an untrained orientation. In Experiment 2, we tested whether offline performance gains in the detection task occur over a nap using polysomnography. Moreover, we tested whether sigma activity during non-rapid eye movement (NREM) sleep recorded from occipital electrodes, previously implicated in offline performance gains of the texture discrimination task, was associated with the degree of offline performance gains of the Gabor orientation detection task. We replicated offline performance gains on the trained orientation in the detection task over the nap. Sigma activity during NREM sleep was significantly larger in the occipital electrodes relative to control electrodes in correlation with offline performance gains. The results suggest that offline performance gains occur over the sleep period generally in VPL. Moreover, sigma activity in the occipital region during NREM sleep may play an important role in offline performance gains of VPL.

Overlearning hyperstabilizes a skill by rapidly making neurochemical processing inhibitory-dominant.

Overlearning refers to the continued training of a skill after performance improvement has plateaued. Whether overlearning is beneficial is a question in our daily lives that has never been clearly answered. Here we report a new important role: overlearning in humans abruptly changes neurochemical processing, to hyperstabilize and protect trained perceptual learning from subsequent new learning. Usually, learning immediately after training is so unstable that it can be disrupted by subsequent new learning until after passive stabilization occurs hours later. However, overlearning so rapidly and strongly stabilizes the learning state that it not only becomes resilient against, but also disrupts, subsequent new learning. Such hyperstabilization is associated with an abrupt shift from glutamate-dominant excitatory to GABA-dominant inhibitory processing in early visual areas. Hyperstabilization contrasts with passive and slower stabilization, which is associated with a mere reduction of excitatory dominance to baseline levels. Using hyperstabilization may lead to efficient learning paradigms.

Night Watch in One Brain Hemisphere during Sleep Associated with the First-Night Effect in Humans.

We often experience troubled sleep in a novel environment [1]. This is called the first-night effect (FNE) in human sleep research and has been regarded as a typical sleep disturbance [2-4]. Here, we show that the FNE is a manifestation of one hemisphere being more vigilant than the other as a night watch to monitor unfamiliar surroundings during sleep [5, 6]. Using advanced neuroimaging techniques [7, 8] as well as polysomnography, we found that the temporary sleep disturbance in the first sleep experimental session involves regional interhemispheric asymmetry of sleep depth [9]. The interhemispheric asymmetry of sleep depth associated with the FNE was found in the default-mode network (DMN) involved with spontaneous internal thoughts during wakeful rest [10, 11]. The degree of asymmetry was significantly correlated with the sleep-onset latency, which reflects the degree of difficulty of falling asleep and is a critical measure for the FNE. Furthermore, the hemisphere with reduced sleep depth showed enhanced evoked brain response to deviant external stimuli. Deviant external stimuli detected by the less-sleeping hemisphere caused more arousals and faster behavioral responses than those detected by the other hemisphere. None of these asymmetries were evident during subsequent sleep sessions. These lines of evidence are in accord with the hypothesis that troubled sleep in an unfamiliar environment is an act for survival over an unfamiliar and potentially dangerous environment by keeping one hemisphere partially more vigilant than the other hemisphere as a night watch, which wakes the sleeper up when unfamiliar external signals are detected.

Efficacy of lapatinib monotherapy on occult breast cancer presenting with cutaneous metastases: A case report.

The case of a 72-year-old female who identified a lymph node enlargement in the left axilla is reported in the present study. A lymph node biopsy revealed a metastatic adenocarcinoma of the axillary lymph node. Following various assessments, the patient was diagnosed with occult breast cancer and lymph node metastases, for which treatment was initiated. Trastuzumab monotherapy was administered as the patient was elderly, positive for the hepatitis B virus and exhibited the following immunostaining/immunohistochemical analysis results: Estrogen receptor (ER) negative (-), progesterone receptor (PgR) negative (-) and human epidermal growth factor receptor 2 (HER2) positive (3+). Breast ultrasonography was performed 10 months after the initial trastuzumab administration and the left axillary lymph node enlargement had reduced in size and severity. However, a skin rash (erythema) was observed encompassing the left breast and extending into the axilla. As determined by the result of a skin biopsy of this area, the patient was diagnosed with occult breast cancer with cutaneous metastases. The immunohistochemical analysis results obtained from the skin biopsy were similar to those obtained from the lymph nodes: ER (-), PgR (-) and HER2 (3+). Therefore, the patient was switched from trastuzumab to lapatinib monotherapy. The erythema completely disappeared after two months of treatment. At present (34 months following lapatinib monotherapy initiation) no new lesions or severe side-effects have been observed.

The first-night effect suppresses the strength of slow-wave activity originating in the visual areas during sleep.

Our visual system is plastic and adaptive in response to the stimuli and environments we experience. Although visual adaptation and plasticity have been extensively studied while participants are awake, little is known about what happens while they are asleep. It has been documented that sleep structure as measured by sleep stages using polysomnography is altered specifically in the first sleep session due to exposure to a new sleep environment, known as the first-night effect (FNE). However, the impact of the FNE on spontaneous oscillations in the visual system is poorly understood. How does the FNE affect the visual system during sleep? To address this question, the present study examined whether the FNE modifies the strength of slow-wave activity (SWA, 1-4Hz)-the dominant spontaneous brain oscillation in slow-wave sleep-in the visual areas. We measured the strength of SWA originating in the visual areas during the first and the second sleep sessions. Magnetoencephalography, polysomnography, and magnetic resonance imaging were used to localize the source of SWA to the visual areas. The visual areas were objectively defined using retinotopic mapping and an automated anatomical parcellation technique. The results showed that the strength of SWA was reduced in the first sleep session in comparison to the second sleep session, especially during slow-wave sleep, in the ventral part of the visual areas. These results suggest that environmental novelty may affect the visual system through suppression of SWA. The impact of the FNE may not be negligible in vision research.

The relevance of the intrinsic subtype to the clinicopathological features and biomarkers in Japanese breast cancer patients.

BACKGROUND: Breast cancer is a disease rich in diversity, and it can be categorized into the immunohistochemical intrinsic subtypes : ER/PR + and HER2-, ER/PR + and HER2+, HER2 type, basal-like and unclassified. METHODS: In this study, in addition to the clinicopathological features potentially associated with the intrinsic subtypes, protein expression and genetic mutations of key molecules associated with breast cancer prognosis and treatment sensitivity were analyzed. The distribution of subtypes in the patient population and the differences in marker distribution across the subtypes were investigated. RESULTS: The immunohistochemical features of 471 consecutive surgical cases of women with primary breast cancer, treated in a single institution, were examined. There were 306 patients who were ER/PR + HER2- (65%); 41 who were ER/PR + HER2+ (8.7%); 59 with HER2 type (12.5%); 37 with basal-like (7.9%); and 28 patients whose breast cancer was unclassified (5.9%). There were no significant differences between the subtypes regarding age, menopausal status, disease stage, lymphatic invasion, blood vessel invasion and lymph node metastasis. Statistically significant differences were found for histological type and grade. Regarding protein expression and genetic mutation, significant differences were found in the distribution within each subtype for six out of 12 molecules investigated. CONCLUSIONS: This study revealed that subtypes differ not only in their clinical pathological profiles, such as histological types and histological grades, but also in molecular expression. The molecular expression patterns observed for each intrinsic subtype may help the selection of an optimal treatment strategy.

Enhanced spontaneous oscillations in the supplementary motor area are associated with sleep-dependent offline learning of finger-tapping motor-sequence task.

Sleep is beneficial for various types of learning and memory, including a finger-tapping motor-sequence task. However, methodological issues hinder clarification of the crucial cortical regions for sleep-dependent consolidation in motor-sequence learning. Here, to investigate the core cortical region for sleep-dependent consolidation of finger-tapping motor-sequence learning, while human subjects were asleep, we measured spontaneous cortical oscillations by magnetoencephalography together with polysomnography, and source-localized the origins of oscillations using individual anatomical brain information from MRI. First, we confirmed that performance of the task at a retest session after sleep significantly increased compared with performance at the training session before sleep. Second, spontaneous δ and fast-σ oscillations significantly increased in the supplementary motor area (SMA) during post-training compared with pretraining sleep, showing significant and high correlation with the performance increase. Third, the increased spontaneous oscillations in the SMA correlated with performance improvement were specific to slow-wave sleep. We also found that correlations of δ oscillation between the SMA and the prefrontal and between the SMA and the parietal regions tended to decrease after training. These results suggest that a core brain region for sleep-dependent consolidation of the finger-tapping motor-sequence learning resides in the SMA contralateral to the trained hand and is mediated by spontaneous δ and fast-σ oscillations, especially during slow-wave sleep. The consolidation may arise along with possible reorganization of a larger-scale cortical network that involves the SMA and cortical regions outside the motor regions, including prefrontal and parietal regions.

[Decoding subjective mental states from FMRI activity patterns].

In recent years, functional magnetic resonance imaging (fMRI) decoding has emerged as a powerful tool to read out detailed stimulus features from multi-voxel brain activity patterns. Moreover, the method has been extended to perform a primitive form of 'mind-reading,' by applying a decoder "objectively" trained using stimulus features to more "subjective" conditions. In this paper, we first introduce basic procedures for fMRI decoding based on machine learning techniques. Second, we discuss the source of information used for decoding, in particular, the possibility of extracting information from subvoxel neural structures. We next introduce two experimental designs for decoding subjective mental states: the "objective-to-subjective design" and the "subjective-to-subjective design." Then, we illustrate recent studies on the decoding of a variety of mental states, such as, attention, awareness, decision making, memory, and mental imagery. Finally, we discuss the challenges and new directions of fMRI decoding.