Clinical utility of family history of depression for prognosis of adolescent depression severity and duration assessed with predictive modeling.

BACKGROUND: Family history of depression (FHD) is a known risk factor for the new onset of depression. However, it is unclear if FHD is clinically useful for prognosis in adolescents with current, ongoing, or past depression. This preregistered study uses a longitudinal, multi-informant design to examine whether a child's FHD adds information about future depressive episodes and depression severity applying state-of-the-art predictive out-of-sample methodology. METHODS: We examined data in adolescents with current or past depression (age 11-17 years) from the National Institute of Mental Health Characterization and Treatment of Adolescent Depression (CAT-D) study. We asked whether a history of depression in a first-degree relative was predictive of depressive episode duration (72 participants) and future depressive symptom severity in probands (129 participants, 1,439 total assessments). RESULTS: Family history of depression, while statistically associated with time spent depressed, did not improve predictions of time spent depressed, nor did it improve models of change in depression severity measured by self- or parent-report. CONCLUSIONS: Family history of depression does not improve the prediction of the course of depression in adolescents already diagnosed with depression. The difference between statistical association and predictive models highlights the importance of assessing predictive performance when evaluating questions of clinical utility.

Motor planning is not restricted to only one hemisphere: evidence from ERPs in individuals with hemiplegic cerebral palsy.

The evidence for the hemispheric specialization of motor planning reveals several inconsistencies between the left-lateralized hypothesis and a distributed system across the hemispheres. We compared participants with left hemiplegic cerebral palsy (HCP) to right-handed control subjects in this study's first experiment by inviting them to perform a motor planning task. Participants were required to release the start button, grasp a hexagon, and rotate it according to the instructions. In the second experiment, we compared left-HCP subjects with right-HCP subjects inviting them to perform the same task (we used the data for left-HCP subjects from the first experiment). P2 amplitude, as well as planning time, grasping time, releasing time, and initial grip selection planning patterns, were used as outcome measures in both experiments. The first experiment revealed that controls acted more quickly and chose more effective planning patterns. Also, the P2 amplitude was smaller in left-HCP subjects than in control subjects. No significant group effect was observed in the second experiment for any movement-related measure or P2. At the neural level, however, there was an interaction between 'region' and 'group,' indicating the distinction between the two groups in the right region. The results are discussed in terms of motor planning's hemispheric distribution and individual differences in the HCP group.

On-Body Placement of Wearable Safety Promotion Devices Based on Wireless Communication for Construction Workers-on-Foot: State-of-the-Art Review.

High auditory noise levels and limited visibility are often considered among the main factors that hinder seamless communication on construction sites. Many previous research studies have leveraged technology to overcome these obstacles and communicate using the hearing, sight and touch senses. However, the technological efficacy does not secure the users' perceptivity of the wireless communication devices. Statistical data regarding the number of fatal accidents on construction sites have remained steady despite regular efforts. This study analyzed prior research on wearable safety promotion devices for personnel that move around the jobsite on foot. A seven-point checklist was utilized to shortlist prior studies (2005-2021) attempting to provide safety information wirelessly to the construction workers-on-foot. The reasoning behind various on-body placements was investigated along with the information conveyed using the three communication modalities. A novel communication network is also introduced to visualize the technical details. Lastly, limitations and future recommendations have been presented to gain insights about the factors that might affect the placement of the wearable safety promotion devices.

Improved reproducibility of diffusion MRI of the human brain with a four-way blip-up and down phase-encoding acquisition approach.

PURPOSE: To assess the effects of blip-up and -down echo planar imaging (EPI) acquisition designs, with different choices of phase-encoding directions (PEDs) on the reproducibility of diffusion MRI (dMRI)-derived metrics in the human brain. METHODS: Diffusion MRI data in seven subjects were acquired five times, each with five different protocols. The base design included 64 diffusion directions acquired with anterior-posterior (AP) PED, the first and second protocols added reverse phase-encoded b=0s/mm2 posterior-anterior (PA) PED images. The third one included 32 directions all with PED acquisitions with opposite polarity (AP and PA). The fourth protocol, also with 32 unique directions used four PEDs (AP, PA, right-left (RL), and left-right (LR)). The scan time was virtually identical for all protocols. The variability of diffusion MRI metrics for each subject and each protocol was computed across the different sessions. RESULTS: The highest reproducibility for all dMRI metrics was obtained with protocol four (AP/PA-RL/LR, ie, four-way PED). Protocols that used only b=0s/mm2 for distortion correction, which are the most widely used designs, had the lowest reproducibility. CONCLUSIONS: An acquisition design with four PEDs, including all DWIs in addition to b=0s/mm2 images should be used to achieve high reproducibility in diffusion MRI studies.

Motor control times and strategies in left- and right-handed participants: Behavioral evidence for the hemispheric distribution of motor planning.

Background: There is conflicting evidence in favor of the hemispheric distribution of motor planning. Some studies supported the left-hemisphere-dominance hypothesis for motor planning and claimed that the left-hemisphere has a crucial function in motor control even in left-handers. The present study aimed to compare the right- and left-handed participants on motor planning ability and to investigate the performance of their dominant hands in a specific action selection task. Also, the effect of task complexity was assessed. Methods: Twenty right-handers and 20 left-handers performed an action selection task. The participants had to grasp a hexagonal knob with their dominant hand and consequently rotated it 60° or 180 ° clockwise or counterclockwise. Depending on our objects, we used mixed factorial ANOVA and the groups were examined in terms of the planning time, grasping time, releasing time and planning pattern for initial grip selection. The SPSS 19 was used for analyzing the data and p≤0.05 was considered as the significant level. Results: No significant differences were observed between the two groups. The movement-related measures revealed a main effect of rotation (p˂0.001). However, a significant interaction between direction × planning pattern × group (p˂0.001) indicated a preferential bias for rotatory movements in the medial direction which is consistent with the "medial over lateral advantage". Conclusion: Both left- and right-handed participants had a similar motor planning ability while performing a planning task with their dominant hands. Because our study was behavioral, it only provided a test of the left-hemisphere hypothesis of motor planning.

Impact of time-of-day on diffusivity measures of brain tissue derived from diffusion tensor imaging.

Diurnal fluctuations in MRI measures of structural and functional properties of the brain have been reported recently. These fluctuations may have a physiological origin, since they have been detected using different MRI modalities, and cannot be explained by factors that are typically known to confound MRI measures. While preliminary evidence suggests that measures of structural properties of the brain based on diffusion tensor imaging (DTI) fluctuate as a function of time-of-day (TOD), the underlying mechanism has not been investigated. Here, we used a longitudinal within-subjects design to investigate the impact of time-of-day on DTI measures. In addition to using the conventional monoexponential tensor model to assess TOD-related fluctuations, we used a dual compartment tensor model that allowed us to directly assess if any change in DTI measures is due to an increase in CSF/free-water volume fraction or due to an increase in water diffusivity within the parenchyma. Our results show that Trace or mean diffusivity, as measured using the conventional monoexponential tensor model tends to increase systematically from morning to afternoon scans at the interface of grey matter/CSF, most prominently in the major fissures and the sulci of the brain. Interestingly, in a recent study of the glymphatic system, these same regions were found to show late enhancement after intrathecal injection of a CSF contrast agent. The increase in Trace also impacts DTI measures of diffusivity such as radial and axial diffusivity, but does not affect fractional anisotropy. The dual compartment analysis revealed that the increase in diffusivity measures from PM to AM was driven by an increase in the volume fraction of CSF-like free-water. Taken together, our findings provide important insight into the likely physiological origins of diurnal fluctuations in MRI measurements of structural properties of the brain.

Tensor-based morphometry using scalar and directional information of diffusion tensor MRI data (DTBM): Application to hereditary spastic paraplegia.

Tensor-based morphometry (TBM) performed using T1-weighted images (T1WIs) is a well-established method for analyzing local morphological changes occurring in the brain due to normal aging and disease. However, in white matter regions that appear homogeneous on T1WIs, T1W-TBM may be inadequate for detecting changes that affect specific pathways. In these regions, diffusion tensor MRI (DTI) can identify white matter pathways on the basis of their different anisotropy and orientation. In this study, we propose performing TBM using deformation fields constructed using all scalar and directional information provided by the diffusion tensor (DTBM) with the goal of increasing sensitivity in detecting morphological abnormalities of specific white matter pathways. Previously, mostly fractional anisotropy (FA) has been used to drive registration in diffusion MRI-based TBM (FA-TBM). However, FA does not have the directional information that the tensors contain, therefore, the registration based on tensors provides better alignment of brain structures and better localization of volume change. We compare our DTBM method to both T1W-TBM and FA-TBM in investigating differences in brain morphology between patients with complicated hereditary spastic paraplegia of type 11 (SPG11) and a group of healthy controls. Effect size maps of T1W-TBM of SPG11 patients showed diffuse atrophy of white matter. However, DTBM indicated that atrophy was more localized, predominantly affecting several long-range pathways. The results of our study suggest that DTBM could be a powerful tool for detecting morphological changes of specific white matter pathways in normal brain development and aging, as well as in degenerative disorders.

Twin-singleton developmental study of brain white matter anatomy.

Twin studies provide valuable insights into the analysis of genetic and environmental factors influencing human brain development. However, these findings may not generalize to singletons due to differences in pre- and postnatal environments. One would expect the effect of these differences to be greater during the early years of life. To address this concern, we compare longitudinal diffusion data of white matter regions for 26 singletons and 76 twins (monozygotic and dizygotic) from birth to 2 years of age. We use nonlinear mixed effect modeling where the temporal changes in the diffusion parameters are described by the Gompertz function. The Gompertz function describes growth trajectory in terms of intuitive parameters: asymptote, delay, and speed. We analyzed fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) for 21 regions of interest (ROIs). These ROIs included areas in the association, projection, and commissural fiber tracts. We did not find any differences in the diffusion parameters between monozygotic and dizygotic twins. In addition, FA and RD showed no developmental differences between singletons and twins for the regions analyzed. However, the delay parameter of the Gompertz function of AD for the anterior limb of the internal capsule and anterior corona radiata was significantly different between singletons and twins. Further analysis indicated that the differences are small, and twins "catch up" by the first few months of life. These results suggest that the effects of differences of pre- and postnatal environments between twins and singletons are minimal on white matter development and disappear early in life. Hum Brain Mapp 38:1009-1024, 2017. © 2016 Wiley Periodicals, Inc.

Impact of time-of-day on brain morphometric measures derived from T1-weighted magnetic resonance imaging.

Measures of brain morphometry derived from T1-weighted (T1W) magnetic resonance imaging (MRI) are widely used to elucidate the relation between brain structure and function. However, the computation of T1W morphometric measures can be confounded by subject-related factors such as head motion and level of hydration. A recent study reported subtle yet significant changes in brain volume from morning to evening in a large group of patient populations as well as in healthy elderly individuals. In addition, there is a growing recognition that factors such as circadian rhythm can impact MRI measures of brain function and structure. Here, we provide a comprehensive assessment of the impact of time-of-day (TOD) on widely used measures of brain morphometry in a group of 19 healthy young adults. Our results show that (a) even in a small group of healthy adult volunteers, a highly significant reduction in apparent brain volume, from morning to evening, could be detected; (b) the apparent volume of all three major tissue compartments - gray matter, white matter, and cerebrospinal fluid - were influenced by TOD, and the magnitude of the TOD effect varied across the tissue compartments; (c) measures of cortical thickness, cortical surface area, and gray matter density computed with widely used neuroimaging software suites (i.e., FreeSurfer, FSL-VBM) were all affected by TOD, while other measures, such as curvature indices and sulcal depth, were not; and (d) the effect of TOD appeared to have a greater impact on morphometric measures of the frontal and temporal lobe than on other major lobes of the brain. Our results suggest that the TOD effect is a physiological phenomenon and that controlling for the effect of TOD is crucial for proper interpretation of apparent structural differences measured with T1W morphometry.

DR-TAMAS: Diffeomorphic Registration for Tensor Accurate Alignment of Anatomical Structures.

In this work, we propose DR-TAMAS (Diffeomorphic Registration for Tensor Accurate alignMent of Anatomical Structures), a novel framework for intersubject registration of Diffusion Tensor Imaging (DTI) data sets. This framework is optimized for brain data and its main goal is to achieve an accurate alignment of all brain structures, including white matter (WM), gray matter (GM), and spaces containing cerebrospinal fluid (CSF). Currently most DTI-based spatial normalization algorithms emphasize alignment of anisotropic structures. While some diffusion-derived metrics, such as diffusion anisotropy and tensor eigenvector orientation, are highly informative for proper alignment of WM, other tensor metrics such as the trace or mean diffusivity (MD) are fundamental for a proper alignment of GM and CSF boundaries. Moreover, it is desirable to include information from structural MRI data, e.g., T1-weighted or T2-weighted images, which are usually available together with the diffusion data. The fundamental property of DR-TAMAS is to achieve global anatomical accuracy by incorporating in its cost function the most informative metrics locally. Another important feature of DR-TAMAS is a symmetric time-varying velocity-based transformation model, which enables it to account for potentially large anatomical variability in healthy subjects and patients. The performance of DR-TAMAS is evaluated with several data sets and compared with other widely-used diffeomorphic image registration techniques employing both full tensor information and/or DTI-derived scalar maps. Our results show that the proposed method has excellent overall performance in the entire brain, while being equivalent to the best existing methods in WM.

Analysis of the contribution of experimental bias, experimental noise, and inter-subject biological variability on the assessment of developmental trajectories in diffusion MRI studies of the brain.

Metrics derived from the diffusion tensor, such as fractional anisotropy (FA) and mean diffusivity (MD) have been used in many studies of postnatal brain development. A common finding of previous studies is that these tensor-derived measures vary widely even in healthy populations. This variability can be due to inherent inter-individual biological differences as well as experimental noise. Moreover, when comparing different studies, additional variability can be introduced by different acquisition protocols. In this study we examined scans of 61 individuals (aged 4-22 years) from the NIH MRI study of normal brain development. Two scans were collected with different protocols (low and high resolution). Our goal was to separate the contributions of biological variability and experimental noise to the overall measured variance, as well as to assess potential systematic effects related to the use of different protocols. We analyzed FA and MD in seventeen regions of interest. We found that biological variability for both FA and MD varies widely across brain regions; biological variability is highest for FA in the lateral part of the splenium and body of the corpus callosum along with the cingulum and the superior longitudinal fasciculus, and for MD in the optic radiations and the lateral part of the splenium. These regions with high inter-individual biological variability are the most likely candidates for assessing genetic and environmental effects in the developing brain. With respect to protocol-related effects, the lower resolution acquisition resulted in higher MD and lower FA values for the majority of regions compared with the higher resolution protocol. However, the majority of the regions did not show any age-protocol interaction, indicating similar trajectories were obtained irrespective of the protocol used.

Regional characterization of longitudinal DT-MRI to study white matter maturation of the early developing brain.

The human brain undergoes rapid and dynamic development early in life. Assessment of brain growth patterns relevant to neurological disorders and disease requires a normative population model of growth and variability in order to evaluate deviation from typical development. In this paper, we focus on maturation of brain white matter as shown in diffusion tensor MRI (DT-MRI), measured by fractional anisotropy (FA), mean diffusivity (MD), as well as axial and radial diffusivities (AD, RD). We present a novel methodology to model temporal changes of white matter diffusion from longitudinal DT-MRI data taken at discrete time points. Our proposed framework combines nonlinear modeling of trajectories of individual subjects, population analysis, and testing for regional differences in growth pattern. We first perform deformable mapping of longitudinal DT-MRI of healthy infants imaged at birth, 1 year, and 2 years of age, into a common unbiased atlas. An existing template of labeled white matter regions is registered to this atlas to define anatomical regions of interest. Diffusivity properties of these regions, presented over time, serve as input to the longitudinal characterization of changes. We use non-linear mixed effect (NLME) modeling where temporal change is described by the Gompertz function. The Gompertz growth function uses intuitive parameters related to delay, rate of change, and expected asymptotic value; all descriptive measures which can answer clinical questions related to quantitative analysis of growth patterns. Results suggest that our proposed framework provides descriptive and quantitative information on growth trajectories that can be interpreted by clinicians using natural language terms that describe growth. Statistical analysis of regional differences between anatomical regions which are known to mature differently demonstrates the potential of the proposed method for quantitative assessment of brain growth and differences thereof. This will eventually lead to a prediction of white matter diffusion properties and associated cognitive development at later stages given imaging data at early stages.

Does absolute neutrophil count predict high tumor grade in African-American men with prostate cancer?

BACKGROUND: African-Americans (AA) are at risk for benign ethnic neutropenia (BEN), which has been implicated as a potential source of disparity in cancer outcomes among AAs. Since AAs with prostate cancer (PCa) are more likely to have aggressive pathological features, this investigation sought to determine if absolute neutrophil count (ANC) is associated with adverse pathologic findings at radical prostatectomy (RP) within a cohort of AA men. METHODS: A single-institution, retrospective review was conducted of all AA patients undergoing RP who had a pre-operative CBC with differential and known RP pathology. Neutropenia was defined as ANC ≤1.5 × 10(9) /L (1.5). Clinical and pathologic variables were characterized for the study cohort, and Cox regression and Kaplan-Meier analyses performed to evaluate the association between ANC and adverse pathology. RESULTS: A total of 336 patients were included, and 18 patients (5.4%) had ANC ≤1.5. Mean age was 59.8 ± 7.5 years; mean follow-up time 47.4 ± 43.3 months. Neutropenic patients had significantly higher clinical stages and pathologic Gleason scores (P < 0.05). On multivariable analysis, ANC ≤1.5 was significantly predictive of high tumor grade (HR 1.22, CI 1.01-1.48). CONCLUSIONS: Neutropenia in AAs predicts high tumor grade at prostatectomy. Further studies are necessary to further characterize the importance of these findings with regard to the pathogenesis of PCa, particularly as it relates to the AA population.

Predictors of locally advanced and metastatic disease in patients with small renal masses.

UNLABELLED: Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? There is a small cohort of patients who have small renal masses with metastatic potential, yet risk factors for having this more aggressive disease are largely unknown. In a large sampling of the US population, older patients and men were more likely to have small renal masses at an advanced stage. OBJECTIVES: To assess the prevalence metastatic and locally advanced renal cell carcinoma (RCC) in the US population with small renal masses (SRMs). To determine what patient and tumour characteristics predict having more advanced SRMs. PATIENTS AND METHODS: Using the Surveillance, Epidemiology and End Results (SEER) registry, we identified 14, 962 patients who were diagnosed between 1988 and 2007 with RCC ≤ 3 cm in size. Patients were separated by stage into those with metastatic, locally advanced and localized disease. Differences in baseline characteristics between patients in these three groups were assessed. After controlling for age, sex, grade, tumour size and year of surgery, a logistic regression analysis was performed to determine the likelihood of having non-localized disease. RESULTS: In the SEER cohort, 13, 574 (90.7%) patients with RCC ≤ 3 cm in size were diagnosed with localized disease, 938 (6.3%) patients had invasion beyond the kidney into regional lymph nodes or nearby organs, and 450 (3.0%) patients had distant metastasis. Patients with metastasis were older (65.9 years) compared to those with localized disease (59.5 years) (P < 0.001). Independent preoperative predictors of having more aggressive disease at diagnosis (locally advanced/metastatic) included older age, particularly age >70 years (odds ratio, OR, 2.42; 95% confidence interval, CI, 2.03-2.88), male sex (OR, 1.50; 95% CI, 1.33-1.70) and tumour size >2.5 (OR, 1.41; 95% CI, 1.25-1.58). CONCLUSIONS: A small subset (3%) of patients in the USA with RCC ≤ 3 cm in size have distant metastasis. Older patients, men and those with tumours 2.5-3.0 cm in size have a greater probability of presenting with non-localized disease . Clinicians should be aware that there is a risk of metastases in patients with SRMs and also familiarize themselves with the characteristics associated with advanced disease.

Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference?

OBJECTIVE: To determine whether a survival difference exists between patients with high grade (HG) cT1 urothelial cell carcinoma (UCC) receiving immediate radical cystectomy (IRC) as opposed to those choosing bladder-sparing therapy. PATIENTS AND METHODS: Between January 1990 and August 2010, 349 patients were retrospectively identified with a diagnosis of HG cT1 UCC of the bladder. Patients were divided into two groups: those who underwent IRC and those treated with conservative management (CM), consisting of transurethral resection of the bladder tumour (TURBT) and intravesical therapy. IRC was defined as surgery within 90 days of HG cT1 diagnosis with no intervening transurethral resection (TUR) or intravesical therapy (IVT). Trends in patient selection and cancer-specific survival (CSS) were analyzed over consecutive decades. The primary outcome was to compare CSS among patients during consecutive decades whereby management paradigms shifted from IRC to CM. The secondary outcome was to examine whether patient selection changed over time for each respective intervention. RESULTS: One hundred and thirteen patients underwent IRC and 236 had CM. From 1990 to 1999, only 90 patients were diagnosed with HG cT1 disease, and a majority of patients (n= 54) underwent IRC. From 2000 to 2010, only 23% (59/259) of the patients with HG cT1 underwent IRC. Despite 42.3% more patients successfully maintaining their bladder in the long-term, no difference in 5 year bladder CSS was noted between decades (77% vs 80% consecutively, P= 0.566). A subset analysis of risk factors for bladder cancer progression/recurrence demonstrated more patients with lymphovascular invasion (LVI) on TUR underwent IRC in the current era (13/59 (22.0%) vs 13/200 (6.5%), P < 0.001). These findings remain to be validated in prospective work at other institutions. CONCLUSION: Conservative management strategies are a viable treatment option within a well selected subset of patients with HG cT1 UCC.

The impact of perioperative blood transfusion on survival following radical cystectomy for urothelial carcinoma.

INTRODUCTION: Perioperative blood transfusion (PBT) has been shown to contribute to cancer progression and mortality. This study sought to determine the impact of PBT during radical cystectomy on cancer-specific survival (CSS) and overall survival (OS). MATERIALS AND METHODS: The Columbia University Urologic Oncology Database was reviewed for patients who underwent a RC from 1989 to 2010 (n = 638). PBT was defined as non-autologous packed red blood cells (PRBC) received during the same hospital stay as the radical cystectomy. Clinical and pathological variables were compared between the cohorts and survival analysis was performed with the Kaplan-Meier and Cox-regression methods. The primary outcomes were CSS and OS. RESULTS: Of 638 patients identified, 209 patients (32.8%) underwent PBT with an average of 2.21 ± 1.66 units transfused PRBC. Mean age was 68.1 ± 11.2 years; median follow up was 25.5 months (range 1-164 months). The number of units of PRBC transfused was inversely associated with OS (HR 1.12; p = 0.008) and CSS (HR 1.12; p = 0.049) on univariable analysis. Additionally, Kaplan-Meier analysis demonstrated a significant difference in OS (p = 0.0211) in patients who received more units of PRBC. However, on multivariable analysis, the number of units of PRBC transfused was not an independent predictor of outcome for CSS (p = 0.300) or OS (p = 0.246). CONCLUSIONS: Each additional unit of PRBC received during radical cystectomy is associated with a decrease in survival. However, after controlling for clinical and pathologic factors which predict survival, PBT does not have an independent affect upon CSS or OS.

Differences in behavioral and cortical indices in pianists and non-musicians during a non-musical motor planning task: An event-related potential study.

Psychological studies have shown that music has an impact on human cognitive function. We aimed to compare the performance and neural activity of pianists and non-musicians during a non-musical motor-planning task. In addition, we investigated the effect of task complexity on the characteristics of the behavioral and neural responses. The participants had to grasp a hexagonal knob with their right hand and rotate it 60° or 180° clockwise (CW) or counterclockwise (CCW). We examined the groups in terms of the amplitude of the P2 component in the event-related potential (at the neural level) and the planning time, grasping time, releasing time, and planning pattern for initial grip selection (at the behavioral level). At the behavioral level, we observed no significant difference between groups, while at the neural level; we found an interaction between direction and group indicating that pianists showed lower P2 amplitude in the CW directions. However, there was no significant difference between groups in the CCW direction. A significant main effect of rotation was revealed at both the neural and behavioral levels; increasing the rotation angle led to an increase in the planning time and the P2 amplitude, indicating a complexity effect. In conclusion, we observed that pianists had lower P2 amplitude in lateral movements than non-musicians; however, due to the lack of behavioral group differences, further research is warranted to support the far-transfer theory in this field.