Improving glycemic control in patients with type 2 diabetes mellitus through a peer support instant messaging service intervention (DiabPeerS): study protocol for a randomized controlled trial.

BACKGROUND: Diabetes mellitus is one of the four priority non-communicable diseases worldwide. It can lead to serious long-term complications and produces significant costs. Due to the chronicle character of the disease, it requires continuous medical treatment and good therapy adherence of those suffering. Therefore, diabetes self-management education (DSME) (and support DSMES) plays a significant role to increase patient's self-management capacity and improve diabetes therapy. Research indicates that these outcomes might be difficult to maintain. Consequently, effective strategies to preserve the positive effects of DSMES are needed. Preliminary results show that peer support, which means support from a person who has experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, is associated with better outcomes in terms of HbA1c, cardiovascular disease risk factors or self-efficacy at a lower cost compared to standard therapy. Peer-supported instant messaging services (IMS) approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort to attend compared to standard therapy. The major objective of the study is to analyze the impact of a peer-supported IMS intervention in addition to a standard diabetes therapy on the glycemic control of type 2 diabetic patients. METHODS: A total of 205 participants with type 2 diabetes mellitus will be included and randomly assigned to an intervention or control group. Both groups will receive standard therapy, but the intervention group will participate in the peer-supported IMS intervention, additionally. The duration of the intervention will last for 7 months, followed by a follow-up of 7 months. Biochemical, behavioral, and psychosocial parameters will be measured before, in the middle, and after the intervention as well as after the follow-up. DISCUSSION: Type 2 diabetes mellitus and other non-communicable diseases put healthcare systems worldwide to the test. Peer-supported IMS interventions in addition to standard therapy might be part of new and cost-effective approaches to support patients independent from time and place. TRIAL REGISTRATION: ClinicalTrials.gov NCT04797429 . Registered on 15 March 2021.

Towards understanding rTMS mechanism of action: Stimulation of the DLPFC causes network-specific increase in functional connectivity.

Transcranial magnetic stimulation (TMS) is a powerful non-invasive technique for the modulation of brain activity. While the precise mechanism of action is still unknown, TMS is applied in cognitive neuroscience to establish causal relationships between stimulation and subsequent changes in cerebral function and behavioral outcome. In addition, TMS is an FDA-approved therapeutic agent in psychiatric disorders, especially major depression. Successful repetitive TMS in such disorders is usually applied over the left dorso-lateral prefrontal cortex (DLPFC) and treatment response mechanism was therefore supposed to be based on modulations in functional networks, particularly the meso-cortico-limbic reward circuit. However, mechanistic evidence for the direct effects of rTMS over DLPFC is sparse. Here we show the specificity and temporal evolution of rTMS effects by comparing connectivity changes within 20 common independent components in a sham-controlled study. Using an unbiased whole-brain resting-state network (RSN) approach, we successfully demonstrate that stimulation of left DLPFC modulates anterior cingulate cortex (ACC) connectivity in one specific meso-cortico-limbic network, while all other networks are neither influenced by rTMS nor by sham treatment. The results of this study show that the neural correlates of TMS treatment response are also traceable in DLPFC stimulation of healthy brains and therefore represent direct effects of the stimulation procedure.

Event-related potentials in performance monitoring are influenced by the endogenous opioid system.

Recent research suggests that not only the dopamine neurotransmitter system but also the endogenous opioid system is involved in performance monitoring and the generation of prediction error signals. Heightened performance monitoring is also associated with psychopathology such as internalizing disorders. Therefore, the current study investigated the potential link between the functional opioid peptide prodynorphin (PDYN) 68 bp VNTR genetic polymorphism and neuronal correlates of performance monitoring. To this end, 47 healthy participants genotyped for this polymorphism, related to high-, intermediate-, and low-expression levels of PDYN, performed a choice-reaction task while their electroencephalogram (EEG) was recorded. On the behavioural level, no differences between the three PDYN groups could be observed. EEG data, however, showed significant differences. High PDYN expression individuals showed heightened neural error processing indicated by higher ERN amplitudes, compared to intermediate and low expression individuals. Later stages of error processing, indexed by late Pe amplitudes, and stimulus-driven conflict processing, indexed by N2 amplitudes, were not affected by PDYN genotype. The current results corroborate the notion of an indirect effect of endogenous opioids on performance monitoring, probably mediated by the mesencephalic dopamine system. Overall, enhanced ERN amplitudes suggest a hyper-active performance monitoring system in high PDYN expression individuals, and this might also be an indicator of a higher risk for internalizing disorders.

Focused transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex modulates specific domains of self-regulation.

Recent neuroscience theories suggest that different kinds of self-regulation may share a common psychobiological mechanism. However, empirical evidence for a domain general self-regulation mechanism is scarce. The aim of this study was to investigate whether focused anodal transcranial direct current stimulation (tDCS), facilitating the activity of the dorsolateral prefrontal cortex (dlPFC), acts on a domain general self-regulation mechanism and thus modulates both affective and appetitive self-regulation. Twenty smokers participated in this within-subject sham controlled study. Effects of anodal left, anodal right and sham tDCS over the dlPFC on affective picture appraisal and nicotine craving-cue appraisal were assessed. Anodal right tDCS over the dlPFC reduced negative affect in emotion appraisal, but neither modulated regulation of positive emotion appraisal nor of craving appraisal. Anodal left stimulation did not induce any significant effects. The results of our study show that domain specific self-regulation networks are at work in the prefrontal cortex. Focused tDCS modulation of this specific self-regulation network could probably be used during the first phase of nicotine abstinence, during which negative affect might easily result in relapse. These findings have implications for neuroscience models of self-regulation and are of relevance for the development of brain stimulation based treatment methods for neuropsychiatric disorders associated with self-regulation deficits.

Transcranial magnetic stimulation of the left dorsolateral prefrontal cortex decreases cue-induced nicotine craving and EEG delta power.

BACKGROUND: TMS has high potential as smoking cessation treatment. However, the neural mechanisms underlying TMS induced reduction of tobacco craving remain unclear. Electroencephalographic (EEG) delta frequency has been associated with the activity of the dopaminergic brain reward system, which is crucial for nicotine induced effects, and decreases after nicotine admission in smokers. OBJECTIVE: The aim of this study was to investigate EEG delta power changes induced by hf rTMS of the left dorsolateral prefrontal cortex (DLPFC) in nicotine deprived smokers and it's relation to cue-induced nicotine craving. METHODS: Fourteen healthy smokers meeting ICD-10 criteria for tobacco addiction participated in this within-subject sham controlled study. Participants had to abstain from smoking 6 h before the experiment. Effects of high-frequency repetitive TMS (hf rTMS) (10 Hz) for verum (left DLPFC) and sham (vertex) stimulations on cue-induced nicotine craving and resting state EEG delta power were assessed before and three times within 40 min after rTMS. RESULTS: Both craving (P = 0.046) and EEG delta power (P = 0.048) were significantly lower after verum stimulation compared to sham stimulation across the whole post stimulation time period assessed. However, changes of craving ratings and delta power did not correlate. CONCLUSION: Hf rTMS applied to the left DLPFC reduces nicotine craving in short-term abstinent smokers. Changes in delta activity support the idea that stimulation induced effects are mediated by the dopaminergic brain reward system, which presumably plays a prominent, but probably not exclusive, role in this stimulation induced behavioral modulation, making this method a promising smoking cessation treatment candidate.

Effects of transcranial direct current stimulation on risky decision making are mediated by 'hot' and 'cold' decisions, personality, and hemisphere.

Previous results point towards a lateralization of dorsolateral prefrontal cortex (DLPFC) function in risky decision making. While the right hemisphere seems involved in inhibitory cognitive control of affective impulses, the left DLPFC is crucial in the deliberative processing of information relevant for the decision. However, a lack of empirical evidence precludes definitive conclusions. The aim of our study was to determine whether anodal transcranial direct current stimulation (tDCS) over the right DLPFC with cathodal tDCS over the lDLPFC (anodal right/cathodal left) or vice versa (anodal left/cathodal right) differentially modulates risk-taking in a task [the Columbia Card Task (CCT)] specifically engaging affect-charged (Hot CCT) vs. deliberative (Cold CCT) decision making. The facilitating effect of the anodal stimulation on neuronal activity was emphasized by the use of a small anode and a big cathode. To investigate the role of individual differences in risk-taking, participants were either smokers or non-smokers. Anodal left/cathodal right stimulation decreased risk-taking in the 'cold' cognition version of the task, in both groups, probably by modulating deliberative processing. In the 'hot' version, anodal right/cathodal left stimulation led to opposite effects in smokers and non-smokers, which might be explained by the engagement of the same inhibitory control mechanism: in smokers, improved controllability of risk-seeking impulsivity led to more conservative decisions, while inhibition of risk-aversion in non-smokers resulted in riskier choices. These results provide evidence for a hemispheric asymmetry and personality-dependent tDCS effects in risky decision making, and may be important for clinical research on addiction and depression.

The impact of EPI voxel size on SNR and BOLD sensitivity in the anterior medio-temporal lobe: a comparative group study of deactivation of the Default Mode.

OBJECTIVES: To quantify the gain in time-series SNR that can be achieved in the amygdala by reducing EPI voxel size, and to assess the extent to which this advantage is carried through to statistical significance in a group fMRI study, using a cognitive task to trigger task-independent deactivation of anterior medial temporal structures. MATERIALS AND METHODS: Two groups of seven subjects were posed number-series tasks to induce deactivation of the Default Mode network. This is known from PET work to include the amygdala, which lies in a region of high magnetic field gradient. In 3 T imaging, one group was studied with high resolution EPI with 6 mul voxels, the other with lower resolution EPI with 17 mul voxels. Field maps were acquired to allow field gradients in relevant ROIs to be assessed. RESULTS: Time-series SNR was 45% higher in the amygdala in the high resolution EPI data than in the low resolution data. In activation results, whilst there was good agreement between other areas, the involvement of the amygdala could only be demonstrated in the high resolution data. CONCLUSION: We find that reduction in signal dephasing afforded by high resolution EPI is realized as a substantial increase in SNR and BOLD sensitivity in group fMRI data. This has allowed the first demonstration of the involvement of the amygdala in the Default Mode in fMRI.

Using ICA for removal of ocular artifacts in EEG recorded from blind subjects.

One of the standard applications of Independent Component Analysis (ICA) to EEG is removal of artifacts due to movements of the eye bulbs. Short blinks as well as slower saccadic movements are removed by subtracting respective independent components (ICs). EEG recorded from blind subjects poses special problems, since it shows a higher quantity of eye movements, which are also more irregular and very different across subjects. It is demonstrated that ICA can still be of use by comparing results from four blind subjects with results from one subject without eye bulbs who therefore does not show eye movement artifacts at all.

Functional neuroanatomy of learned helplessness.

In the experiments reported here, female subjects were presented with reasoning tasks that changed from solvable to unsolvable, evoking "learned helplessness" or "loss of control" reactions in some subjects. Significant differences in slow cortical potential (SCP) changes were found between emotionally highly and lowly reactive subjects (grouped according to responses in postexperimental questionnaires) when processing unsolvable tasks. Cortical LORETA of SCP topographies and subsequent statistical nonparametric mapping (SnPM; analysis indicate clear reduction of anterior cingulate activity only with emotionally highly reactive subjects. In these subjects a region of the brain that is indispensable for goal-directed handling of tasks was switched off, whereas regions that are primarily engaged in processing the task stimuli were even more active during loss of control, although not at a statistically significant level. According to the anterior cingulate monitors the conflicts among brain regions and issues calls for further processing to the PFC that then guides behavior toward a goal. Learned helplessness might then be seen a state in which the function of the anterior cingulate is no longer maintained, perhaps due to the inhibitory influence of the amygdala possibly mediated via the brainstem dopaminergic ventral tegmental area.