The duration discrimination respiratory task: A new test to measure respiratory interoceptive accuracy.

Interoception, which refers to the perception of body's internal state, is implicated in emotional processes and psychopathological disorders. Over the last decades, different tools have been developed to measure interoceptive accuracy, or the ability to accurately perceive physiological signals. Most of these tools have focused on cardiac interoception, but respiratory interoception has been less investigated due to the more complex and less portable equipment required. In this study, we suggest a new duration discrimination respiratory (DDR) task that does not require complex equipment. Using an adaptive staircase procedure, this task aims to determine an individual's ability to detect exhalation longer than their resting reference duration. One hundred and twenty-three healthy subjects completed the DDR task, an interoceptive task of heart rate discrimination, and filled out questionnaires on interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness), alexithymia (Toronto Alexithymia Scale [TAS]), affects (Positive and Negative Affect Scale [PANAS]), and anamnestic. Results demonstrated a good internal consistency (Cronbach's alpha = .93) of the DDR task. On average, subjects needed 99.22% (SD = 36.38) of their reference exhalation time in addition to reference exhalation to detect a prolonged exhalation. Higher self-reported fitness levels, not counting during the DDR task and lower difficulty in describing feelings (TAS subscale), predicted higher respiratory discrimination duration. In conclusion, this study demonstrates the utility of the DDR task as a valid measure of interoception.

Electrophysiological correlates of attentional bias towards threat in children with high levels of social anxiety.

Pediatric social anxiety is characterized by attentional biases (AB) towards social threats. This study used a new response-based calculation method to assess AB from response times (RT) in a visual dot-probe task and electroencephalography (EEG) to explore its electrophysiological correlates. Twenty, high socially anxious children (HSA) (mean [M ] = 10.1 years; standard deviation [SD] = 1.01) were compared with 22 healthy control children (HC) (M = 10.20 years; SD = 1.30) matched in age and gender. Participants had to identify targets preceded by disgust-neutral, happy-neutral, or neutral-neutral pairs of faces. RT and electroencephalograms were recorded throughout the task. While no significant group difference was found at the behavioral level, principal component analyses performed on EEG data revealed that event-related potentials for threat-related stimuli were impacted by social anxiety. Analyses indicated a larger N170 amplitude in response to all facial stimuli in HC when compared to the HSA. However, we found increased P2 amplitudes for disgust-neutral pairs compared with happy-neutral pairs in has only. Then, thasHSA group showed increased P2 amplitudes for targets following disgusted faces on the opposite side of the screen compared with targets appearing on the same side of the screen. These results suggest that HSA may display an increased anchorage of attention on threatening stimuli and need more effort to disengage their attentional focus from threats and to perform the task correctly. Taken together, our data confirmed the presence of AB in children with high levels of social anxiety, which are reflected by increased neural processing during the confrontation to faces depicting a potential threatening expression.

Barotrauma in COVID-19 acute respiratory distress syndrome: retrospective analysis of the COVADIS prospective multicenter observational database.

BACKGROUND: Despite evidence suggesting a higher risk of barotrauma during COVID-19-related acute respiratory distress syndrome (ARDS) compared to ARDS due to other causes, data are limited about possible associations with patient characteristics, ventilation strategy, and survival. METHODS: This prospective observational multicenter study included consecutive patients with moderate-to-severe COVID-19 ARDS requiring invasive mechanical ventilation and managed at any of 12 centers in France and Belgium between March and December 2020. The primary objective was to determine whether barotrauma was associated with ICU mortality (censored on day 90), and the secondary objective was to identify factors associated with barotrauma. RESULTS: Of 586 patients, 48 (8.2%) experienced barotrauma, including 35 with pneumothorax, 23 with pneumomediastinum, 1 with pneumoperitoneum, and 6 with subcutaneous emphysema. Median time from mechanical ventilation initiation to barotrauma detection was 3 [0-17] days. All patients received protective ventilation and nearly half (23/48) were in volume-controlled mode. Barotrauma was associated with higher hospital mortality (P < 0.001) even after adjustment on age, sex, comorbidities, PaO2/FiO2 at intubation, plateau pressure at intubation, and center (P < 0.05). The group with barotrauma had a lower mean body mass index (28.6 ± 5.8 vs. 30.3 ± 5.9, P = 0.03) and a higher proportion of patients given corticosteroids (87.5% vs. 63.4%, P = 0.001). CONCLUSION: Barotrauma during mechanical ventilation for COVID-19 ARDS was associated with higher hospital mortality.

Late-Life Depression, Cognitive Impairment, and Relationship with Alzheimer's Disease.

This narrative review aimed to explore the existing knowledge in order to examine the multiple forms of late-life depression (LLD) within a non-neurodegenerative or a neurodegenerative context, in particular Alzheimer's disease (AD). This review will first provide information about different pathogenic hypotheses proposed to describe LLD when it is not linked to a neurodegenerative context. Within the presentation of these syndromes, the literature reports thymic and cognitive specific features and highlights a common preponderance of cognitive impairment, and particularly executive. This review will also report data from research works that have addressed the role of depressive symptoms (DSs) in incidence of AD and mild cognitive impairment (MCI) conversion to AD. These findings support the claim that the relationship between DS (or LLD) and the cognitive decline encountered in AD can be of 2 types: (1) risk factor or (2) prodrome. They also support the hypothesis that the effect of DS on the incidence of AD can be identified between specific characteristics of these symptoms such as a very first apparition late in life, an increasing severity of DS, and a poor response to medical treatment. Finally, longitudinal and cross-sectional research will be presented, aiming to identify the predictive value of DS (or LLD) on AD incidence and/or conversion of MCI (and specifically amnestic MCI). This final section shows that specific features of LLD, such as being of early- or late-onset, can be considered as indices of AD incidence.

Static compliance of the respiratory system in COVID-19 related ARDS: an international multicenter study.

BACKGROUND: Controversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14. METHODS: In this observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation. RESULTS: The mean Crs in 372 patients was 37.6 ± 13 mL/cmH2O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO2/FiO2 ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs [OR 1.0 (CI 95% 0.98-1.02)] neither Crs/IBW [OR 0.63 (CI 95% 0.13-3.1)] were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was [OR 0.93 (CI 95% 0.88-0.99)]. In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH2O vs 37.8 ± 11.4 mL/cmH2O, p < 0.001). The decrease in Crs was not associated with day-28 outcome. CONCLUSION: In a large multicenter cohort of moderate to severe COVID-19 ARDS, mean Crs was decreased below 40 mL/cmH2O and was not associated with day-28 outcome. Crs decreased between day-1 and day-14 but the decrease was not associated with day-28 outcome.

Decision-making of patients with major depressive disorder in the framework of action control.

Introduction: Patients with major depressive disorder (MDD) experience dysfunctional emotional states and cognitive impairments, leading to behavioural, social, and functional issues. Neurocognitive theory proposes that the initiation and maintenance of MDD is primarily the result of a deficit of action control which in turn would lead to decision-making impairments.Methods: We assessed 27 medicated outpatients with MDD who were demographically matched with 16 healthy participants on decision-making (DM) processes (Iowa Gambling Task (IGT) and Reversal Learning Task (RLT)), clinical variables (depressive symptoms and self-efficacy), and volition (Lille Apathy Rating Scale).Results: Patients with MDD displayed deficits on the IGT but not on the RLT. Correlational analysis of patients with MDD revealed no significant associations between IGT or RLT performance and volition, depressive symptom severity, and self-efficacy. However, differences on the IGT between patients with MDD and controls became non-significant when controlling for the variance of these scores.Conclusions: MDD appears to have an impact on dynamic DM processes, while basic processes are preserved. Limitations as well as directions for future research are discussed with regard to the neurocognitive model of depression.

Do Alzheimer's Disease Patients Benefit From Prior-Knowledge in Associative Recognition Memory?

OBJECTIVES: Although the influence of prior knowledge on associative memory in healthy aging has received great attention, it has never been studied in Alzheimer's disease (AD). This study aimed at assessing whether AD patients could benefit from prior knowledge in associative memory and whether such benefit would be related to the integrity of their semantic memory. METHODS: Twenty-one AD patients and 21 healthy older adults took part in an associative memory task using semantically related and unrelated word pairs and were also submitted to an evaluation of their semantic memory. RESULTS: While participants of both groups benefited from semantic relatedness in associative discrimination, related pairs recognition was significantly predicted by semantic memory integrity in healthy older adults only. CONCLUSIONS: We suggest that patients benefitted from semantic knowledge to improve their performance in the associative memory task, but that such performance is not related to semantic knowledge integrity evaluation measures because the two tasks differ in the way semantic information is accessed: in an automatic manner for the associative memory task, with automatic processes thought to be relatively preserved in AD, and in a controlled manner for the semantic knowledge evaluation, with controlled processes thought to be impaired in AD. (JINS, 2019, 25, 443-452).

Attribution of intentions and context processing in psychometric schizotypy.

INTRODUCTION: Impairment in Theory of mind (TOM) has frequently been associated with schizophrenia and with schizotypy. Studies have found that a tendency to over-attribute intentions and special meaning to events and to people is related to positive psychotic symptoms. Further, it has been suggested that this intentionality bias may be due to a broader deficit in context processing (CP). The aim of the present study was thus to investigate the relationship between positive schizotypy and both over-attribution of intentions and contextual processing. METHODS: One-hundred and nineteen healthy individuals completed the Schizotypal Personality Questionnaire and were assessed with tasks measuring contextual treatment and ToM. RESULTS: Results revealed that positive schizotypy was significantly related to an over-attribution of intentions on the ToM task and with a faster processing of implicit context. Partial correlational analyses indicated that the association between the attribution of intentions and positive schizotypy was not explained by a deficit of CP. In contrast, stepwise multiple regression analyses showed that both an over-attribution of intentions and a faster processing of implicit context significantly predicted positive schizotypy. CONCLUSIONS: These results show that an over-attribution of intention is independent from a broader deficit in context information processing and that they both possibly contribute to the development and maintenance of positive psychotic symptoms.

Thinking About One's Feelings: Association Between Alexithymia and Cognitive Styles in a Nonclinical Population.

Alexithymia is described as a disturbance in the cognitive and affective processing of emotions. Little is known about the cognitive styles associated with this personality trait. In this article, we examine to what extent alexithymia is linked with poorer rational cognitive style. A total of 685 participants from a nonclinical sample completed the Toronto Alexithymia Scale-20 along with self-reported and behavioral measures of cognitive styles. Results suggest that people with a high level of self-reported alexithymia show lower rational abilities. The findings of this study extend previous work on cognitive processes underlying emotional self-regulation impairments in alexithymia, suggesting that these difficulties may be linked to a poorer use of rational process.

Goal-directed behaviors in patients with schizophrenia: Concept relevance and updated model.

Goal-directed behaviors are formulated to pursue a given objective by constructing a plan and selecting actions that lead to the intended goal, either immediately or over an extended period. This concept is important to the study of human behavior because of its involvement in the majority of complex or novel situations that an individual may encounter, regardless of the cognitive, affective, or social abilities required. In this paper, we aim to demonstrate the relevance of goal-directed behaviors to our understanding of the cognitive deficits and other symptoms associated with schizophrenia. A systematic analysis of this relation may allow us to develop integrative hypotheses regarding positive, negative, and disorganized symptoms of schizophrenia rather than consider them to be distinct issues. In this article, we review previous studies of goal-directed actions in patients with schizophrenia in order to clarify the relevant concepts and provide a theoretical basis for the integration of existing results. Based on available theoretical models and data, we propose an updated model to facilitate further investigation of schizophrenia-related impairments in goal-directed behaviors.

Impact of auditory-visual bimodality on lexical retrieval in Alzheimer's disease patients.

The aim of this study was to generalize the positive impact of auditory-visual bimodality on lexical retrieval in Alzheimer's disease (AD) patients. In practice, the naming skills of healthy elderly persons improve when additional sensory signals are included. The hypothesis of this study was that the same influence would be observable in AD patients. Sixty elderly patients separated into three groups (healthy subjects, stage 1 AD patients, and stage 2 AD patients) were tested with a battery of naming tasks comprising three different modalities: a visual modality, an auditory modality, and a visual and auditory modality (bimodality). Our results reveal the positive influence of bimodality on the accuracy with which bimodal items are named (when compared with unimodal items) and their latency (when compared with unimodal auditory items). These results suggest that multisensory enrichment can improve lexical retrieval in AD patients.

Cued fluency protocol reveals dynamic symptomatic-dependent processes of goal-directed behaviours in schizophrenia.

INTRODUCTION: Differential impairments of willed actions and routine behaviours are the subject of many studies into schizophrenia. These impairments in generating and controlling goal-directed behaviours are reported in studies showing the effect of cueing in cognitive or motor tasks in people with schizophrenia. The aim of this study was to assess the performance of people with schizophrenia in a cued fluency protocol reworked to fit the concept of goal-directed behaviour. The extent to which results could be better explained by goal-directed generation issues, according to a symptomatic framework, than by semantic retrieval or semantic processing impairments, was also investigated. METHODS: We compared the performance of 43 individuals with schizophrenia to a control group of 26 participants. Participants were assessed with neuropsychological tests. The dominance of positive and negative symptoms, and apathetic profile, were also evaluated. All participants completed a cued fluency protocol. RESULTS: Despite a significant improvement, not all people with schizophrenia exhibited equal cueing benefits. The participants with negative symptom dominance appeared to benefit more from cueing, even though their baseline performance was lower. CONCLUSIONS: These results suggest that, in addition to semantic memory impairments, some cognitive tasks may be more broadly influenced by difficulties in generating goal-directed behaviours.

Empirical antifungal therapy for health care-associated intra-abdominal infection: a retrospective, multicentre and comparative study.

BACKGROUND: Current guidelines recommend using antifungals for selected patients with health care-associated intra-abdominal infection (HC-IAI), but this recommendation is based on a weak evidence. This study aimed to assess the association between early empirical use of antifungals and outcomes in intensive care unit (ICU) adult patients requiring re-intervention after abdominal surgery. METHODS: A retrospective, multicentre cohort study with overlap propensity score weighting was conducted in three ICUs located in three medical institutions in France. Patients treated with early empirical antifungals for HC-IAI after abdominal surgery were compared with controls who did not receive such antifungals. The primary endpoint was the death rate at 90 days, and the secondary endpoints were the death rate at 1 year and composite criteria evaluated at 30 days following the HC-IAI diagnosis, including the need for re-intervention, inappropriate antimicrobial therapy and death, whichever occurred first. RESULTS: At 90 days, the death rate was significantly decreased in the patients treated with empirical antifungals compared with the control group (11.4% and 20.7%, respectively, p = 0.02). No differences were reported for the secondary outcomes. CONCLUSION: The use of early empirical antifungal therapy was associated with a decreased death rate at 90 days, with no effect on the death rate at 1 year, the death rate at 30 days, the rate of re-intervention, the need for drainage, and empirical antibiotic and antifungal therapy failure at 30 days.

Physiological reactivity at rest and in response to social or emotional stimuli after a traumatic brain injury: A systematic review.

Numerous studies have shown that alterations in physiological reactivity (PR) after traumatic brain injury (TBI) are possibly associated with emotional deficits. We conducted a systematic review of these studies that evaluated PR in adults with moderate-to-severe TBI, either at rest or in response to emotional, stressful, or social stimuli. We focused on the most common measures of physiological response, including heart rate (HR), heart rate variability (HRV), respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), salivary cortisol, facial electromyography (EMG), and blink reflex. Methods: A systematic literature search was conducted across six databases (PsycINFO, Psycarticles, SciencDirect, Cochrane Library, PubMed, and Scopus). The search returned 286 articles and 18 studies met the inclusion criteria. Results: Discrepancies were observed according to the type of physiological measure. Reduced physiological responses in patients with TBI have been reported in most EDA studies, which were also overrepresented in the review. In terms of facial EMG, patients with TBI appear to exhibit reduced activity of the corrugator muscle and diminished blink reflex, while in most studies, zygomaticus contraction did not show significant differences between TBI and controls. Interestingly, most studies measuring cardiac activity did not find significant differences between TBI and controls. Finally, one study measured salivary cortisol levels and reported no difference between patients with TBI and controls. Conclusion: Although disturbed EDA responses were frequently reported in patients with TBI, other measures did not consistently indicate an impairment in PR. These discrepancies could be due to the lesion pattern resulting from TBI, which could affect the PR to aversive stimuli. In addition, methodological differences concerning the measurements and their standardization as well as the characteristics of the patients may also be involved in these discrepancies. We propose methodological recommendations for the use of multiple and simultaneous PR measurements and standardization. Future research should converge toward a common methodology in terms of physiological data analysis to improve inter-study comparisons.

The role of semantic assessment in the differential diagnosis between late-life depression and Alzheimer's disease or amnestic mild cognitive impairment: systematic review and meta-analysis.

OBJECT: The cognitive complaints encountered in late-life depression (LLD) make it difficult to distinguish from amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) based on an analysis of neurocognitive disorders. The hypothesis of the early impairment of semantic memory in AD and aMCI is considered a potential differential cognitive clue, but the absence of this impairment has not yet been confirmed in  LLD. METHOD: Based on the PRISMA method, we systematically seek neuropsychological assessments of individuals with LLD, the present study included 31 studies representing 3291 controls and 2820 people with LLD. Wherever possible, studies that tested simultaneously groups with LLD, AD (or aMCI) were also included. The results of the group of neuropsychological tasks relying on semantic memory were analyzed in two groups of tasks with high- or low-executive demand. The mean average effect of LLD was calculated and compared to the incremental effect of aMCI or AD on the scores. Linear regressions including education, age, and severity and type of depression were run to seek their power of prediction for the mean average effects. RESULTS: LLD has a medium effect on scores at semantic and phonemic fluency and naming and a small average effect on the low-executive demand tasks. Differences in education is a predictor of the effect of LLD on phonemic fluency and naming but not on semantic fluency or on low-executive demand tasks. Except for semantic fluency, aMCI did not demonstrate an incremental effect on the scores compared to LLD, while AD did, for all the tasks except phonemic fluency. CONCLUSION: Assessment of semantic memory can be a discriminating clue for the distinction between depression and Alzheimer's disease but some methodological variables are highly influential to the scores, especially education. However, high-executive semantic tasks alone do not allow us to clearly distinguish LLD from AD or aMCI, as both pathologies seem to have a largely dialectical influential relationship, but low-executive semantic tasks appear as more sensible to this pathological distinction.

Case Report: Intercurrent infections in COVID-19-induced sustained immunodepression: is interferon gamma a suitable drug?

Acute immuno-depression syndrome (AIDs) had been observed in many life-threatening conditions leading to the Intensive Care Unit. and is associated with recurrent secondary infections. We report one COVID-19 patient with a severe ARDS, demonstrating acute immunodepression syndrome lasting for several weeks. The occurrence of secondary infections despite long treatment by antibiotics led to combined interferon γ (IFNγ) as reported previously. The response to IFNγ was evaluated by the flowcytometry HLA-DR expression on circulating monocytes, which was repeated from time to time. The severe COVID-19 patients responded well to IFNγ without adverse events.

Enhancing OSA Assessment with Explainable AI.

Explainable Artificial Intelligence (xAI) is a rapidly growing field that focuses on making deep learning models interpretable and understandable to human decision-makers. In this study, we introduce xAAEnet, a novel xAI model applied to the assessment of Obstructive Sleep Apnea (OSA) severity. OSA is a prevalent sleep disorder that can lead to numerous medical conditions and is currently assessed using the Apnea-Hypopnea Index (AHI). However, AHI has been criticized for its inability to accurately estimate the effect of OSAs on related medical conditions. To address this issue, we propose a human-centric xAI approach that emphasizes similarity between apneic events as a whole and reduces subjectivity in diagnosis by examining how the model makes its decisions. Our model was trained and tested on a dataset of 60 patients' Polysomnographic (PSG) recordings. Our results demonstrate that the proposed model, xAAEnet, outperforms models with traditional architectures such as convolutional regressor, autoencoder (AE), and variational autoencoder (VAE). This study highlights the potential of xAI in providing an objective OSA severity scoring method.Clinical relevance- This study provides an objective OSA severity scoring technique which could improve the management of apneic patients in clinical practice.

Executive Profile of the Logopenic Variant of Primary Progressive Aphasia: Comparison with the Semantic and Non-Fluent Variants and Alzheimer's Disease.

The logopenic variant of primary progressive aphasia (lvPPA) shows different features from the non-fluent (nfvPPA) and semantic (svPPA) variants of PPA. Although language impairments remain the core symptoms, studies have highlighted the presence of executive disorders at the onset of the disease. Nevertheless, the results are contradictory, particularly in lvPPA. The aim of this study was to explore the executive profile of lvPPA. We compared executive functioning in lvPPA with the other two variants of PPA, Alzheimer's disease (AD) and a cognitively healthy group. In total, 70 patients with PPA, 32 patients with AD, and 41 healthy controls were included. They underwent a comprehensive executive battery assessing short-term and working memory, inhibition, flexibility, planning, and initiation. The analyses showed significant differences between the lvPPA group and the control group, except on visuospatial spans and the Stroop test, and between the lvPPA group and the other PPA groups and the AD group for several tasks. Thus, this research highlighted the existence of an executive dysfunction from the onset of the disease in lvPPA but also in the other two variants of PPA.