Neural mechanisms of acceptance-commitment therapy for obsessive-compulsive disorder: a resting-state and task-based fMRI study.

BACKGROUND: There is growing evidence for the use of acceptance-commitment therapy (ACT) for the treatment of obsessive-compulsive disorder (OCD). However, few fully implemented ACT have been conducted on the neural mechanisms underlying its effect on OCD. Thus, this study aimed to elucidate the neural correlates of ACT in patients with OCD using task-based and resting-state functional magnetic resonance imaging (fMRI). METHODS: Patients with OCD were randomly assigned to the ACT (n = 21) or the wait-list control group (n = 21). An 8-week group-format ACT program was provided to the ACT group. All participants underwent an fMRI scan and psychological measurements before and after 8 weeks. RESULTS: Patients with OCD showed significantly increased activation in the bilateral insula and superior temporal gyri (STG), induced by the thought-action fusion task after ACT intervention. Further psycho-physiological interaction analyses with these regions as seeds revealed that the left insular-left inferior frontal gyrus (IFG) connectivity was strengthened in the ACT group after treatment. Increased resting-state functional connectivity was also found in the posterior cingulate cortex (PCC), precuneus, and lingual gyrus after ACT intervention Most of these regions showed significant correlations with ACT process measures while only the right insula was correlated with the obsessive-compulsive symptom measure. CONCLUSIONS: These findings suggest that the therapeutic effect of ACT on OCD may involve the salience and interoception processes (i.e. insula), multisensory integration (i.e. STG), language (i.e. IFG), and self-referential processes (i.e. PCC and precuneus). These areas or their interactions could be important for understanding how ACT works psychologically.

Risk Factors and Trends in Adolescent's Suicide Attempt Rates Before and After the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Understanding adolescents' mental health during the coronavirus disease 2019 (COVID-19) pandemic and identifying those most at risk is an urgent public health challenge. This study explored the trend of suicide attempts and the association between loneliness, family financial stress, and suicide attempts during the COVID-19 pandemic among adolescents. METHODS: Data of the 2020 to 2022 Korea Youth Risk Behavior Surveys for adolescents aged 13-18 years were used. Multivariate logistic regression analyses were performed to examine the association between suicide attempts, family financial stress, and loneliness during the COVID-19 pandemic. RESULTS: The trend of suicide attempt rates was lowest in 2020 (1.9%, 1,034 out of 53,534) and it showed an increasing trend with rates of 2.2% (1,159 out of 53,445) in 2021 and 2.5% (1,271 out of 50,455) in 2022. The risk of suicide attempt was higher among adolescents who experienced financial stress (in 2020: adjusted odds ratio [AOR], 1.53, 95% confidence interval [CI], 1.26-1.88; in 2021: AOR, 1.63, 95% CI, 1.03-1.54) and felt lonely (in 2020: AOR, 2.19, 95% CI, 1.78-2.70; in 2021: AOR, 2.65, 95% CI, 2.16-3.26; in 2022: AOR, 1.3, 95% CI, 1.04-1.55) than those who did not. CONCLUSION: The COVID-19 pandemic affected the suicide attempts of adolescents, with financial stress and feelings of loneliness closely linked to this impact. Although the pandemic nears its end, the persistent risk of suicide attempts among adolescents remains a concern. Therefore, it is imperative to implement targeted screening and interventions to address adolescent suicide risk.

Change Point Test for the Conditional Mean of Time Series of Counts Based on Support Vector Regression.

This study considers support vector regression (SVR) and twin SVR (TSVR) for the time series of counts, wherein the hyper parameters are tuned using the particle swarm optimization (PSO) method. For prediction, we employ the framework of integer-valued generalized autoregressive conditional heteroskedasticity (INGARCH) models. As an application, we consider change point problems, using the cumulative sum (CUSUM) test based on the residuals obtained from the PSO-SVR and PSO-TSVR methods. We conduct Monte Carlo simulation experiments to illustrate the methods' validity with various linear and nonlinear INGARCH models. Subsequently, a real data analysis, with the return times of extreme events constructed based on the daily log-returns of Goldman Sachs stock prices, is conducted to exhibit its scope of application.

Robust Estimation for Bivariate Poisson INGARCH Models.

In the integer-valued generalized autoregressive conditional heteroscedastic (INGARCH) models, parameter estimation is conventionally based on the conditional maximum likelihood estimator (CMLE). However, because the CMLE is sensitive to outliers, we consider a robust estimation method for bivariate Poisson INGARCH models while using the minimum density power divergence estimator. We demonstrate the proposed estimator is consistent and asymptotically normal under certain regularity conditions. Monte Carlo simulations are conducted to evaluate the performance of the estimator in the presence of outliers. Finally, a real data analysis using monthly count series of crimes in New South Wales and an artificial data example are provided as an illustration.

A Critical Role of Sodium Flux via the Plasma Membrane Na+/H+ Exchanger SOS1 in the Salt Tolerance of Rice.

Rice (Oryza sativa) stands among the world's most important crop species. Rice is salt sensitive, and the undue accumulation of sodium ions (Na+) in shoots has the strongest negative correlation with rice productivity under long-term salinity. The plasma membrane Na+/H+ exchanger protein Salt Overly Sensitive 1 (SOS1) is the sole Na+ efflux transporter that has been genetically characterized to date. Here, the importance of SOS1-facilitated Na+ flux in the salt tolerance of rice was analyzed in a reverse-genetics approach. A sos1 loss-of-function mutant displayed exceptional salt sensitivity that was correlated with excessive Na+ intake and impaired Na+ loading into the xylem, thus indicating that SOS1 controls net root Na+ uptake and long-distance Na+ transport to shoots. The acute Na+ sensitivity of sos1 plants at low NaCl concentrations allowed analysis of the transcriptional response to sodicity stress without effects of the osmotic stress intrinsic to high-salinity treatments. In contrast with that in the wild type, sos1 mutant roots displayed preferential down-regulation of stress-related genes in response to salt treatment, despite the greater intensity of stress experienced by the mutant. These results suggest there is impaired stress detection or an inability to mount a comprehensive response to salinity in sos1 In summary, the plasma membrane Na+/H+ exchanger SOS1 plays a major role in the salt tolerance of rice by controlling Na+ homeostasis and possibly contributing to the sensing of sodicity stress.

The Brain-Gut-Microbiome Axis in Psychiatry.

Beginning with the concept of the brain-gut axis, the importance of the interaction between the brain and the gastrointestinal tract has been extended to the microbiome with increasing clinical applications. With the recent development of various techniques for microbiome analysis, the number of relevant preclinical and clinical studies on animals and human subjects has rapidly increased. Various psychotic symptoms affect the intestinal microbiome through the hypothalamus-pituitary-adrenal gland axis. Conversely, the intestinal microbiome regulates the gastrointestinal tract environment and affects psychological factors by means of the microorganisms or their metabolites, either acting directly on the brain or through the synthesis of various neurotransmitters. This review discusses the clinical applicability of the brain-gut-microbiome axis and directions for improving psychological symptoms based on the studies published to date.

Robust Change Point Test for General Integer-Valued Time Series Models Based on Density Power Divergence.

In this study, we consider the problem of testing for a parameter change in general integer-valued time series models whose conditional distribution belongs to the one-parameter exponential family when the data are contaminated by outliers. In particular, we use a robust change point test based on density power divergence (DPD) as the objective function of the minimum density power divergence estimator (MDPDE). The results show that under regularity conditions, the limiting null distribution of the DPD-based test is a function of a Brownian bridge. Monte Carlo simulations are conducted to evaluate the performance of the proposed test and show that the test inherits the robust properties of the MDPDE and DPD. Lastly, we demonstrate the proposed test using a real data analysis of the return times of extreme events related to Goldman Sachs Group stock.

Monitoring Parameter Change for Time Series Models of Counts Based on Minimum Density Power Divergence Estimator.

In this study, we consider an online monitoring procedure to detect a parameter change for integer-valued generalized autoregressive heteroscedastic (INGARCH) models whose conditional density of present observations over past information follows one parameter exponential family distributions. For this purpose, we use the cumulative sum (CUSUM) of score functions deduced from the objective functions, constructed for the minimum power divergence estimator (MDPDE) that includes the maximum likelihood estimator (MLE), to diminish the influence of outliers. It is well-known that compared to the MLE, the MDPDE is robust against outliers with little loss of efficiency. This robustness property is properly inherited by the proposed monitoring procedure. A simulation study and real data analysis are conducted to affirm the validity of our method.

Hybrid CUSUM Change Point Test for Time Series with Time-Varying Volatilities Based on Support Vector Regression.

This study considers the problem of detecting a change in the conditional variance of time series with time-varying volatilities based on the cumulative sum (CUSUM) of squares test using the residuals from support vector regression (SVR)-generalized autoregressive conditional heteroscedastic (GARCH) models. To compute the residuals, we first fit SVR-GARCH models with different tuning parameters utilizing a time series of training set. We then obtain the best SVR-GARCH model with the optimal tuning parameters via a time series of the validation set. Subsequently, based on the selected model, we obtain the residuals, as well as the estimates of the conditional volatility and employ these to construct the residual CUSUM of squares test. We conduct Monte Carlo simulation experiments to illustrate its validity with various linear and nonlinear GARCH models. A real data analysis with the S&P 500 index, Korea Composite Stock Price Index (KOSPI), and Korean won/U.S. dollar (KRW/USD) exchange rate datasets is provided to exhibit its scope of application.

Monitoring Volatility Change for Time Series Based on Support Vector Regression.

This paper considers monitoring an anomaly from sequentially observed time series with heteroscedastic conditional volatilities based on the cumulative sum (CUSUM) method combined with support vector regression (SVR). The proposed online monitoring process is designed to detect a significant change in volatility of financial time series. The tuning parameters are optimally chosen using particle swarm optimization (PSO). We conduct Monte Carlo simulation experiments to illustrate the validity of the proposed method. A real data analysis with the S&P 500 index, Korea Composite Stock Price Index (KOSPI), and the stock price of Microsoft Corporation is presented to demonstrate the versatility of our model.

Psychological factors influence the overlap syndrome in functional gastrointestinal disorders (FGIDs) among middle-aged women in South Korea.

This study investigated the psychological factors related to the overlap syndrome, i.e., multiple gastrointestinal conditions that are part of functional gastrointestinal disorders (FGIDs) in the same individual and potentially related to quality of life (QOL) among women aged 45-60 years (n = 627) in South Korea. The study was undertaken between July 2014 and March 2015. Depressive and anxiety symptoms were ascertained using the Center for Epidemiologic Studies Depression scale (CES-D) and the Beck Anxiety Inventory (BAI), respectively. Negative cognition and the cognitive triad were identified using the Automatic Thoughts Questionnaire-Negative (ATQ-N) and the Cognitive Triad Inventory (CTI), respectively. Resilience and QOL were assessed using the Connor-Davidson Resilience Scale (CD-RISC) and World Health Organization Quality of Life scale abbreviated version (WHOQOL-BREF). Women with the overlap syndrome had the highest CES-D (mean = 16.66 ± 11.79, p < .001), BAI (mean = 17.46 ± 12.67, p < .001), and ATQ-N scores (mean = 53.61 ± 20.88, p < .001), followed by women with gastrointestinal disorders but without the overlap syndrome and healthy controls. Healthy controls had the highest WHOQOL-BREF score (mean = 77.69 ± 12.53, p < .001). After stepwise selection, the final model explained 61.8 percent of the variance in QOL. Thus, depressive symptoms, anxiety, negative cognition, cognitive triad, and resilience were significantly related to QOL in women with the overlap syndrome.

Adverse Events With Sustained-Release Donepezil in Alzheimer Disease: Relation to Body Mass Index.

PURPOSE/BACKGROUND: Sustained-release, high-dose (23 mg/d) donepezil has been approved for treatment of moderate to severe Alzheimer disease (AD). Based on a previous clinical trial, body weight of less than 55 kg is a risk factor for adverse events with donepezil 23 mg/d treatment in global population. METHODS/PROCEDURES: To clarify whether this finding is consistent across ethnic groups that vary in absolute body mass, we recruited Korean patients aged 45 to 90 years with moderate to severe AD who had been receiving standard donepezil immediate release 10 mg/d for at least 3 months. After screening, we analyzed a final cohort of 166 patients who received donepezil 23 mg/d for 24 weeks to compare the occurrence of treatment-emergent adverse events (TEAEs) between patients with high versus low body mass index (BMI) based on the World Health Organization overweight criteria for Asian populations (23 kg/m). FINDINGS/RESULTS: Treatment-emergent adverse events were reported by 79.45% of patients in the lower BMI group and 58.06% of patients in the higher BMI group (odds ratio, 2.79; 95% confidence interval, 1.39-5.63; χ = 7.58, P = 0.006). In a multivariable survival analysis, the group with lower BMI showed a higher occurrence of TEAEs (hazard ratio, 1.83; 95% confidence interval, 1.25-2.68; P = 0.002). IMPLICATIONS/CONCLUSIONS: In Korean patients with moderate to severe AD receiving high-dose donepezil over 24 weeks, TEAEs were significantly more common in those with lower BMI (not clinically overweight), especially nausea. This finding may inform clinical practice for Asian patients.

The effects of ratio in the multifidus muscle thickness according to various angle of mediolateral ramp during double stance.

[Purpose] This study was conducted to predict the risks of standing on mediolateral ramps by identifying the ratios of the multifidus muscles on the two sides of the spine when standing postures are maintained on mediolateral ramps of diverse angles. [Subjects and Methods] The study was conducted with 15 healthy adult males. All subjects participated voluntarily. Mediolateral ramps at five angles (0°, 5°, 10°, 15°, and 20°) were used. Ultrasonography was used to determine the thicknesses of the multifidus muscles under individual conditions. [Results] The ratio of the left/right multifidus muscles showed statistically significant differences as the angle of the mediolateral ramp increased. Post-hoc test results showed that the use of the two multifidus muscles was asymmetric on mediolateral ramps at angles equal to or larger than 10°. [Conclusion] The asymmetric use of the multifidus muscles began on a mediolateral ramp at an angle of 10°, suggesting that subjects with instability in body control might have risk factors such as falls on mediolateral ramps with angles equal to or larger than 10°. Therefore, caregivers must be attentive and/or assist patients and older adults when they are walking on ramps at angles of approximately 10° and up in their daily lives.

Effect of various wheelchair handle grip directions on muscle activities of upper body of assistant during movement on ascending and descending ramps.

[Purpose] This study aims to determine the effects of various wheelchair handle grip directions on the muscle activities of the upper body of an assistant during movement on ascending and descending ramps. [Subjects and Methods] The study subjects were 17 young and healthy participants whose mean age, height, and weight was 23.0 ± 2.7 years, 175.5 ± 4.7 cm, and 70.0 ± 14.2 kg, respectively; all subjects voluntarily consented to participate. Three grip directions were tested: general grip, medial grip, and neutral grip. Muscle activities in the serratus anterior, rhomboid, erector spine, biceps brachii, triceps brachii, bracioradialis, flexor carpi radialis, and extensor carpi radialis were measured using an electromyograph (EMG). [Results] Significant differences were seen in the muscle activities of the biceps brachii, bracioradialis, and flexor carpi radialis during wheelchair movement on an ascending ramp and in the biceps brachii and triceps brachii during movement on a descending ramp. [Conclusion] Measurement results showed that the general grip resulted in the highest muscle activities in the upper body of assistants during wheelchair movement on both ascending and descending ramps.

Effect of a modified grip angle of a walker on the wrist deviation angle, muscle activation and palmar load during walker-assisted gait in elderly people.

[Purpose] The aim of this study was to develop a new handle holder by modifying the inclination of the existing handle holder to reduce load on the wrist joints. [Subjects and Methods] The subjects of this study consisted of 25 elderly people aged 65 years or older accustomed to a walker-assisted gait. Two types of handle holders ((1) standard handle holder (2) inclination handle holder) were applied to all subjects and their wrist joint movement and muscle activity were measured while they conducted 10 cycle walker-assisted gait. [Results] The use of an inclination handle holder during the walker-assisted gait decreased considerably the extensor carpi radialis longus activity and angles of the ulnar deviation and wrist extension. [Conclusion] Improvements in the overall structure of a walker may be a new tool for improving existing walker users but the replacement cost will be expensive. The inclination handle holder presented in this study decreases the burden on the wrist joints of walker users without any overall structural changes in the walker, thereby reducing the occurrence of musculoskeletal diseases of the wrist joint during the walker-assisted gait of elderly people.

A novel phase variant of the cholera pathogen shows stress-adaptive cryptic transcriptomic signatures.

BACKGROUND: In a process known as phase variation, the marine bacterium and cholera pathogen Vibrio cholerae alternately expresses smooth or rugose colonial phenotypes, the latter being associated with advanced biofilm architecture and greater resistance to ecological stress. To define phase variation at the transcriptomic level in pandemic V. cholerae O1 El Tor strain N16961, we compared the RNA-seq-derived transcriptomes among the smooth parent N16961, its rugose derivative (N16961R) and a smooth form obtained directly from the rugose at high frequencies consistent with phase variation (N16961SD). RESULTS: Differentially regulated genes which clustered into co-expression groups were identified for specific cellular functions, including acetate metabolism, gluconeogenesis, and anaerobic respiration, suggesting an important link between these processes and biofilm formation in this species. Principal component analysis separated the transcriptome of N16961SD from the other phase variants. Although N16961SD was defective in biofilm formation, transcription of its biofilm-related vps and rbm gene clusters was nevertheless elevated as judged by both RNA-seq and RT-qPCR analyses. This transcriptome signature was shared with N16961R, as were others involving two-component signal transduction, chemotaxis, and c-di-GMP synthesis functions. CONCLUSIONS: Precise turnarounds in gene expression did not accompany reversible phase transitions (i.e., smooth to rugose to smooth) in the cholera pathogen. Transcriptomic signatures consisting of up-regulated genes involved in biofilm formation, environmental sensing and persistence, chemotaxis, and signal transduction, which were shared by N16961R and N16961SD variants, may implicate a stress adaptation in the pathogen that facilitates transition of the N16961SD smooth form back to rugosity should environmental conditions dictate.

Current prescription pattern of maintenance treatments for bipolar patients in Korea: A focus on the transition from acute treatments.

AIMS: We examined prescription patterns in maintenance treatment for recovered bipolar patients and compared these with acute treatments. METHODS: Using retrospective methods, the bipolar patients in clinical recovery (Clinical Global Impression Bipolar Version score ≤ 2 for 6 months) after acute episode were selected. We reviewed differences between prescription patterns at remission and after a maintenance period of at least 6 months. RESULTS: A total of 340 bipolar disorder patients were selected. During the maintenance period, more than half of the patients (192, 56.5%) took a mood stabilizer (MS) + antipsychotic (AP) combination. Among the MS, valproate (149, 43.8%) was most prescribed, and lithium (98, 28.8%) was second, but as patients moved into maintenance treatment, lithium use decreased, and the use of lamotrigine (86, 25.3%) increased. Preferred AP were quetiapine (125, 36.8%), aripiprazole (67, 19.7%), risperidone (48, 14.1%), and olanzapine (39, 11.5%). The use of olanzapine in maintenance was greatly decreased compared with that during acute treatment (67, 19.7%). Most patients did not take an antidepressant (AD), but the proportion using one or more AD was increased during maintenance (17.9% to 30.3%), and bupropion (28, 8.2%) was the preferred AD. Doses were decreased in all drugs, but lamotrigine was maintained at a dose of 133.2 ± 68.5 mg/day. CONCLUSIONS: The most common prescription combination for bipolar maintenance treatment was MS + AP. The use of AP was decreased, whereas the use of AD in combination with MS and/or AP was increased. The doses of MS and AP were generally decreased during the maintenance periods, with the exception of lamotrigine.

Mean individual muscle activities and ratios of total muscle activities in a selective muscle strengthening experiment: the effects of lower limb muscle activity based on mediolateral slope angles during a one-leg stance.

[Purpose] The purpose of this study was to provide basic data for research on selective muscle strengthening by identifying mean muscle activities and calculating muscle ratios for use in developing strengthening methods. [Subjects and Methods] Twenty-one healthy volunteers were included in this study. Muscle activity was measured during a one-leg stance under 6 conditions of slope angle: 0°, 5°, 10°, 15°, 20°, and 25°. The data used in the analysis were root mean square and % total muscle activity values. [Results] There were significant differences in the root mean square of the gluteus medius, the hamstring, and the medial gastrocnemius muscles. There were significant differences in % total muscle activity of the medial gastrocnemius. [Conclusion] Future studies aimed at developing selective muscle strengthening methods are likely to yield more effective results by using muscle activity ratios based on electromyography data.

Comparison of maximum voluntary isometric contraction of the biceps on various posture and respiration conditions for normalization of electromyography data.

[Purpose] Maximum voluntary isometric contraction can increase the reliability of electromyography data by controlling respiration; however, many studies that use normalization of electromyography data fail to account for this. This study aims to check changes in maximum voluntary isometric contraction based on changes in posture and respiration conditions. [Subjects and Methods] Twenty-two healthy volunteers were included in this study. Using 22 healthy subjects, MVIC of the biceps brachii muscle was measured in three respiration conditions: (1) Maximum voluntary isometric contraction during inspiration after maximal expiration, (2) Maximum voluntary isometric contraction during expiration after maximal inspiration and (3) Maximum voluntary isometric contraction during the Valsalva maneuver. The subjects were in tested in standing and supine postures under all three respiration conditions. [Results] A significant difference was observed in the standing and supine postures based on the respiration condition. A significant difference was observed in the maximum voluntary isometric contraction during inspiration after maximal expiration and maximum voluntary isometric contraction during the Valsalva maneuver conditions when the subjects were in the supine posture. [Conclusion] It is necessary to apply the same respiration condition and the same posture to each subject when measuring Maximum voluntary isometric contraction for the normalization of electromyography data.

Cell type-specific responses to salinity - the epidermal bladder cell transcriptome of Mesembryanthemum crystallinum.

Mesembryanthemum crystallinum (ice plant) exhibits extreme tolerance to salt. Epidermal bladder cells (EBCs), developing on the surface of aerial tissues and specialized in sodium sequestration and other protective functions, are critical for the plant's stress adaptation. We present the first transcriptome analysis of EBCs isolated from intact plants, to investigate cell type-specific responses during plant salt adaptation. We developed a de novo assembled, nonredundant EBC reference transcriptome. Using RNAseq, we compared the expression patterns of the EBC-specific transcriptome between control and salt-treated plants. The EBC reference transcriptome consists of 37 341 transcript-contigs, of which 7% showed significantly different expression between salt-treated and control samples. We identified significant changes in ion transport, metabolism related to energy generation and osmolyte accumulation, stress signalling, and organelle functions, as well as a number of lineage-specific genes of unknown function, in response to salt treatment. The salinity-induced EBC transcriptome includes active transcript clusters, refuting the view of EBCs as passive storage compartments in the whole-plant stress response. EBC transcriptomes, differing from those of whole plants or leaf tissue, exemplify the importance of cell type-specific resolution in understanding stress adaptive mechanisms.