Spatial Dynamic Subspaces Encode Sex-Specific Schizophrenia Disruptions in Transient Network Overlap and its Links to Genetic Risk.

Background: Recent advances in resting-state fMRI allow us to study spatial dynamics, the phenomenon of brain networks spatially evolving over time. However, most dynamic studies still use subject-specific, spatially-static nodes. As recent studies have demonstrated, incorporating time-resolved spatial properties is crucial for precise functional connectivity estimation and gaining unique insights into brain function. Nevertheless, estimating time-resolved networks poses challenges due to the low signal-to-noise ratio, limited information in short time segments, and uncertain identification of corresponding networks within and between subjects. Methods: We adapt a reference-informed network estimation technique to capture time-resolved spatial networks and their dynamic spatial integration and segregation. We focus on time-resolved spatial functional network connectivity (spFNC), an estimate of network spatial coupling, to study sex-specific alterations in schizophrenia and their links to multi-factorial genomic data. Results: Our findings are consistent with the dysconnectivity and neurodevelopment hypotheses and align with the cerebello-thalamo-cortical, triple-network, and frontoparietal dysconnectivity models, helping to unify them. The potential unification offers a new understanding of the underlying mechanisms. Notably, the posterior default mode/salience spFNC exhibits sex-specific schizophrenia alteration during the state with the highest global network integration and correlates with genetic risk for schizophrenia. This dysfunction is also reflected in high-dimensional (voxel-level) space in regions with weak functional connectivity to corresponding networks. Conclusions: Our method can effectively capture spatially dynamic networks, detect nuanced SZ effects, and reveal the intricate relationship of dynamic information to genomic data. The results also underscore the potential of dynamic spatial dependence and weak connectivity in the clinical landscape.

Robotic complete mesocolic excision for transverse colon cancer can be performed with a morbidity profile similar to that of conventional laparoscopic colectomy.

BACKGROUND: In minimally invasive surgery, complete mesocolic excision (CME) for transverse colon cancer is challenging; thus, non-CME resections are commonly preferred when laparoscopy is used. Robotic technology has been developed to reduce the limitations of laparoscopy. The aim of our study was to evaluate whether robotic CME for transverse colon cancer can be performed with short-term outcomes similar to those of laparoscopic conventional colectomy (CC). METHODS: A retrospective review of 118 consecutive patients having robotic CME or laparoscopic CC for transverse colon cancer in two specialized centers between May 2011 and September 2018 was performed. Perioperative 30-day outcomes of the two procedures were compared. RESULTS: There were 38 and 80 patients in the robotic CME group and laparoscopic CC group, respectively. The groups were comparable regarding preoperative characteristics. Intraoperative results were similar, including blood loss (median 50 vs 25 ml), complications (5.3% vs 3.8%), and conversions (none vs 7.5%). The rate of intracorporeal anastomosis was significantly higher (86.8% vs 20.0%), mean operative time was longer (325.0 ± 123.2 vs 159.3 ± 56.1 min (p < 0.001), and the mean number of harvested lymph nodes was higher in the robotic CME group (46.1 ± 22.2 vs 39.1 ± 17.8, p = 0.047). There were only minor differences in length of hospital stay (7.2 ± 3.1 vs 7.9 ± 4.0 days), anastomotic leak (none vs 2.6%), bleeding (none vs 1.3%), surgical site infections (10.5% vs 12.5%), and reoperations (2.6% vs 6.3%). CONCLUSIONS: Robotic CME can be performed with a similar morbidity profile as laparoscopic CC for transverse colon cancer along with a higher rate of intracorporeal anastomosis, and higher number of lymph nodes retrieved, but longer operative times.

Decreased hemispheric connectivity and decreased intra- and inter- hemisphere asymmetry of resting state functional network connectivity in schizophrenia.

Many studies have shown that schizophrenia patients have aberrant functional network connectivity (FNC) among brain regions, suggesting schizophrenia manifests with significantly diminished (in majority of the cases) connectivity. Schizophrenia is also associated with a lack of hemispheric lateralization. Hoptman et al. (2012) reported lower inter-hemispheric connectivity in schizophrenia patients compared to controls using voxel-mirrored homotopic connectivity. In this study, we merge these two points of views together using a group independent component analysis (gICA)-based approach to generate hemisphere-specific timecourses and calculate intra-hemisphere and inter-hemisphere FNC on a resting state fMRI dataset consisting of age- and gender-balanced 151 schizophrenia patients and 163 healthy controls. We analyzed the group differences between patients and healthy controls in each type of FNC measures along with age and gender effects. The results reveal that FNC in schizophrenia patients shows less hemispheric asymmetry compared to that of the healthy controls. We also found a decrease in connectivity in all FNC types such as intra-left (L_FNC), intra-right (R_FNC) and inter-hemisphere (Inter_FNC) in the schizophrenia patients relative to healthy controls, but general patterns of connectivity were preserved in patients. Analyses of age and gender effects yielded results similar to those reported in whole brain FNC studies.

Increased spatial granularity of left brain activation and unique age/gender signatures: a 4D frequency domain approach to cerebral lateralization at rest.

Cerebral lateralization is a well-studied topic. However, most of the research to date in functional magnetic resonance imaging (fMRI) has been carried out on hemodynamic fluctuations of voxels, networks, or regions of interest (ROIs). For example, cerebral differences can be revealed by comparing the temporal activation of an ROI in one hemisphere with the corresponding homotopic region in the other hemisphere. While this approach can reveal significant information about cerebral organization, it does not provide information about the full spatiotemporal organization of the hemispheres. The cerebral differences revealed in literature suggest that hemispheres have different spatiotemporal organization in the resting state. In this study, we evaluate cerebral lateralization in the 4D spatiotemporal frequency domain to compare the hemispheres in the context of general activation patterns at different spatial and temporal scales. We use a gender-balanced resting fMRI dataset comprising over 600 healthy subjects ranging in age from 12 to 71, that have previously been studied with a network specific voxel-wise and global analysis of lateralization (Agcaoglu, et al. NeuroImage, 2014). Our analysis elucidates significant differences in the spatiotemporal organization of brain activity between hemispheres, and generally more spatiotemporal fluctuation in the left hemisphere especially in the high spatial frequency bands, and more power in the right hemisphere in the low and middle spatial frequencies. Importantly, the identified effects are not visible in the context of a typical assessment of voxelwise, regional, or even global laterality, thus our study highlights the value of 4D spatiotemporal frequency domain analyses as a complementary and powerful tool for studying brain function.

Lateralization of resting state networks and relationship to age and gender.

Brain lateralization is a widely studied topic, however there has been little work focused on lateralization of intrinsic networks (regions showing similar patterns of covariation among voxels) in the resting brain. In this study, we evaluate resting state network lateralization in an age and gender-balanced functional magnetic resonance imaging (fMRI) dataset comprising over 600 healthy subjects ranging in age from 12 to 71. After establishing sample-wide network lateralization properties, we continue with an investigation of age and gender effects on network lateralization. All data was gathered on the same scanner and preprocessed using an automated pipeline (Scott et al., 2011). Networks were extracted via group independent component analysis (gICA) (Calhoun et al., 2001). Twenty-eight resting state networks discussed in previous (Allen et al., 2011) work were re-analyzed with a focus on lateralization. We calculated homotopic voxelwise measures of laterality in addition to a global lateralization measure, called the laterality cofactor, for each network. As expected, many of the intrinsic brain networks were lateralized. For example, the visual network was strongly right lateralized, auditory network and default mode networks were mostly left lateralized. Attentional and frontal networks included nodes that were left lateralized and other nodes that were right lateralized. Age was strongly related to lateralization in multiple regions including sensorimotor network regions precentral gyrus, postcentral gyrus and supramarginal gyrus; and visual network regions lingual gyrus; attentional network regions inferior parietal lobule, superior parietal lobule and middle temporal gyrus; and frontal network regions including the inferior frontal gyrus. Gender showed significant effects mainly in two regions, including visual and frontal networks. For example, the inferior frontal gyrus was more right lateralized in males. Significant effects of age were found in sensorimotor and visual networks on the global measure. In summary, we report a large-sample of lateralization study that finds intrinsic functional brain networks to be highly lateralized, with regions that are strongly related to gender and age locally, and with age a strong factor in lateralization, and gender exhibiting a trend-level effect on global measures of laterality.

The use of Ligasure vessel sealing system in axillary dissection; effect on seroma formation.

BACKGROUND: Seroma formation is the most frequent postoperative complication after axillary dissection for breast surgery with an incidence of 10 - 50 %. This prospective clinical randomized study was carried out to evaluate the Ligasure vessel sealing system and its effect on seromaformation and other complications for axillary dissection. METHODS: Between January 2006 and November 2007, the patients with histopathological diagnosis of breast cancer were analysed prospectively. The patients with positive sentinel lymph node biopsy or clinical axillary involvement were included in the study, and the patients who underwent neoadjuvant therapy or using anticoagulants have been excluded from the study. Patients were divided into two study groups.Axillary dissection was performed in the first group by LigaSure and in the second group by linking and electrocautery. RESULTS: There were a total of thirty three patients with a mean age of 51.4 +- 13.7. In group one, mean age of patients was 54.1 +- 13.2 and 48.68 +- 14.1 in group two. There was no significant statistical difference between the groups regarding age, body mass index, excised tissue weight,tumour size and number of excised lymph nodes. The use of Ligasure reduced drainage amount and duration of drain till removal, but increased operative time. CONCLUSION: There were no significant differences between study groups regarding the complications. LigaSure electrothermal bipolar vessel sealing system can be safely used in axillary dissection as an alternative to traditional methods.

Our early experience with iliofemoral vein stenting in patients with post-thrombotic syndrome.

INTRODUCTION: Venous balloon dilation and stent therapy have been proposed as effective treatments for chronic iliofemoral thrombosis. In this study, we report our experience and describe the one-year outcome and efficacy of balloon angioplasty and stenting for the treatment of post-thrombotic syndrome (PTS) in iliofemoral vein segments. METHODS: From June 2011 to June 2012, 52 consecutive patients with chronic PTS (59 limbs; 75% women; median age 58 years; range: 23-76 years) referred to our unit for interventional assessment were included in the study. Treatment effects were assessed using Villalta scale, Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Questionnaire (CIVIQ)-20 for PTS, CEAP (clinical, aetiological, anatomical and pathological elements) grading and measurement of leg circumference, before and after intervention. RESULTS: Stenting was successfully accomplished in all patients. Coagulation abnormality was identified in 21 subjects (40.3%). CEAP grades were as follows: C3 in 19 patients, C4 in 24 patients, C5 in one patient and C6 in eight patients. According to Villalta scores, three patients were mild, seven patients were moderate and 42 patients were severe PTS. VCSS, Villalta scale and CIVIQ-20 showed a significant decrease in the severity of PTS signs and symptoms (P < 0.001). The calf and middle thigh circumferences decreased significantly on both sides (P < 0.001). CONCLUSION: Treatment of iliac venous obstruction with balloon angioplasty and stenting appears to be a minimally invasive and safe therapeutic approach in patients with PTS offering quick symptomatic relief, good patency and minimal morbidity.

Is heparinization necessary in the early postoperative period of renal transplantation from cadaveric donors?

INTRODUCTION: Venous thromboemboli and bleeding are the complications that threaten the graft and patient's life in the early postoperative period after cadaveric renal transplantation. For this reason, heparin administration after renal transplantation should be administered carefully. The aim of this study was to evaluate the necessity for heparinization after cadaveric renal transplantation. METHODS: Between March 2009 and October 2010, we formed 2 study groups among 50 recipients who underwent either cadaveric (n = 25) or living donor transplantations (n = 25). We did not observe any risk factors for thromboembolism while group 1 did not undergo heparinization, group 2 received a prophylactic dose of low-molecular weight heparin for 1 week. Doppler ultrasonography (USG) was performed between postoperative 24-48 hours to examine the transplanted kidney vessels, and in one group 1 case for a bilateral lower extremity venous system examination. We were also compared postoperative thromboembolic and hemorrhagic complications, lymphorrhagia, and serum creatinine levels. RESULTS: The female/male ratios in group 1 and 2 were 14/11 and 8/17 with mean ages of 36.7 (range, 17-51) and 35.9 (range, 17-59) years, respectively. The mean preoperative serum creatinine levels were 7.9 ± 2.9 mg/dL and 6.8 ± 2.4 mg/dL, and at postoperative week 1, they were 5.1 ± 4.3 mg/dL and 1.2 ± 0.5 mg/dL, respectively. We did not encounter any partial or total thrombus upon doppler USG studies for renal and lower extremity venous systems. No clinical symptoms of pulmonary emboli were detected in any patients. Only 1 subject group 2 experienced massive postoperative bleeding. CONCLUSION: Herein, we have reported that, except for the patients with risk factors for venous thromboemboli, heparinization was not necessary in the early postoperative period and did not add benefits to outcomes of cadaveric renal transplant recipients.