soulspace: Integrated youth mental health care in Berlin, Germany-An introduction to the program and a description of its users.

AIM: A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe soulspace as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany. METHODS: We introduce soulspace as easily accessible mental health care for young people, and we characterize soulspace along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). Soulspace is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community-based counselling service. It provides initial contact, counselling, diagnostics, and treatment. RESULTS: Our analyses of the pathways to soulspace and the characteristics of the soulspace users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth-facing counselling service as was done in soulspace seems to have reduced the threshold to seek help for families and for young people in need for support. CONCLUSIONS: In summary, with soulspace, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed.

Better than expected: the gap between self-reported and objective measures of cognitive performance in remitted bipolar disorder.

Background: Studies comparing objective and self-reported cognitive functioning as well as influencing factors in individuals with remitted bipolar disorder are scarce and contradictory. Methods: The aim of this study was to compare executive functioning and other objective and self-reported cognitive impairment between 26 individuals with remitted bipolar disorder (15 BD I) and 24 healthy controls using a cross-sectional design. Executive functions were measured by the TAP Go/No-go subtest as well as the Stroop Task. Self-rated functioning was assessed using the Attention Deficit Experience Questionnaire. In addition, possible predictors of self-reported and objective cognitive functioning were examined to perform regression analyses. Results: Individuals with remitted bipolar disorder did not differ significantly in executive functions or other objective cognitive domains from the healthy control group, but showed a significantly lower level of self-reported cognitive functioning and self-esteem. While self-esteem was the strongest predictor in healthy controls for self-reported cognitive functioning, severity of illness and subthreshold depressive mood were the most important predictors in individuals with remitted bipolar disorder. Conclusion: The results once again demonstrate the cognitive heterogeneity in bipolar disorder. In the treatment of cognitive deficits, factors such as subthreshold depressive symptomatology and self-esteem should be focused on in addition to cognitive training in remitted patients.

Contrast-Enhanced Mammography-Guided Breast Biopsy: Single-Center Experience.

This prospective single-center study enrolled 50 women with 51 contrast-enhanced mammography (CEM)-enhancing lesions that lacked a sonographic or mammographic correlate. Trial participants underwent CEM-guided biopsy. Biopsy was technically successful for 46 lesions and was not performed for five nonvisualized lesions (all nonmass enhancement), yielding a cancellation rate of 9.8%. Mean biopsy time was 16.6 minutes. All biopsies revealed concordant pathology (25 benign, 10 high-risk, 11 malignant). No non-visualized or benign lesion yielded malignancy at follow-up.

Intrafraction motion monitoring to determine PTV margins in early stage breast cancer patients receiving neoadjuvant partial breast SABR.

BACKGROUND AND PURPOSE: To quantify intra-fraction tumor motion using imageguidance and implanted fiducial markers to determine if a 5 mm planning-target-volume (PTV) margin is sufficient for early stage breast cancer patients receiving neoadjuvant stereotactic ablative radiotherapy (SABR). MATERIALS AND METHODS: A HydroMark© (Mammotome) fiducial was implanted at the time of biopsy adjacent to the tumor. Sixty-one patients with 62 tumours were treated prone using a 5 mm PTV margin. Motion was quantified using two methods (separate patient groups): 1) difference in 3D fiducial position pre- and post-treatment cone-beam CTs (CBCTs) in 18 patients receiving 21 Gy/1fraction (fx); 2) acquiring 2D triggered-kVimages to quantify 3D intra-fraction motion using a 2D-to-3D estimation method for 44 tumours receiving 21 Gy/1fx (n = 22) or 30 Gy/3fx (n = 22). For 2), motion was quantified by calculating the magnitude of intra-fraction positional deviation from the pretreatment CBCT. PTV margins were derived using van Herkian analysis. RESULTS: The average ± standard deviation magnitude of motion across patients was 1.3 ± 1.15 mm Left/Right (L/R), 1.0 ± 0.9 mm Inferiorly/Superiorly (I/S), and 1.8 ± 1.5 mm Anteriorly/Posteriorly (A/P). 85/105 (81%) treatment fractions had dominant anterior motion. 6/62patients (9.7%) had mean intra-fraction motion during any fraction > 5 mm in any direction, with 4 in the anterior direction. Estimated PTV margins for single and three-fx patients in the L/R, I/S, and A/P directions were 6.0x4.1x5.9 mm and 4.5x2.9x4.3 mm, respectively. CONCLUSION: Our results suggest that a 5 mm PTV margin is sufficient for the I/S and A/P directions if a lateral kV image is acquired immediately before treatment. For the L/R direction, either further immobilization or a larger margin is required.

The Effect of Registration on Voxel-Wise Tofts Model Parameters and Uncertainties from DCE-MRI of Early-Stage Breast Cancer Patients Using 3DSlicer.

We quantitatively investigate the influence of image registration, using open-source software (3DSlicer), on kinetic analysis (Tofts model) of dynamic contrast enhanced MRI of early-stage breast cancer patients. We also show that registration computation time can be reduced by reducing the percent sampling (PS) of voxels used for estimation of the cost function. DCE-MRI breast images were acquired on a 3T-PET/MRI system in 13 patients with early-stage breast cancer who were scanned in a prone radiotherapy position. Images were registered using a BSpline transformation with a 2 cm isotropic grid at 100, 20, 5, 1, and 0.5PS (BRAINSFit in 3DSlicer). Signal enhancement curves were analyzed voxel-by-voxel using the Tofts kinetic model. Comparing unregistered with registered groups, we found a significant change in the 90th percentile of the voxel-wise distribution of Ktrans. We also found a significant reduction in the following: (1) in the standard error (uncertainty) of the parameter value estimation, (2) the number of voxel fits providing unphysical values for the extracellular-extravascular volume fraction (ve > 1), and (3) goodness of fit. We found no significant differences in the median of parameter value distributions (Ktrans, ve) between unregistered and registered images. Differences between parameters and uncertainties obtained using 100PS versus 20PS were small and statistically insignificant. As such, computation time can be reduced by a factor of 2, on average, by using 20PS while not affecting the kinetic fit. The methods outlined here are important for studies including a large number of post-contrast images or number of patient images.

DCE-MRI assessment of response to neoadjuvant SABR in early stage breast cancer: Comparisons of single versus three fraction schemes and two different imaging time delays post-SABR.

PURPOSE: To determine the effect of dose fractionation and time delay post-neoadjuvant stereotactic ablative radiotherapy (SABR) on dynamic contrast-enhanced (DCE)-MRI parameters in early stage breast cancer patients. MATERIALS AND METHODS: DCE-MRI was acquired in 17 patients pre- and post-SABR. Five patients were imaged 6-7 days post-21 Gy/1fraction (group 1), six 16-19 days post-21 Gy/1fraction (group 2), and six 16-18 days post-30 Gy/3 fractions every other day (group 3). DCE-MRI scans were performed using half the clinical dose of contrast agent. Changes in the surrounding tissue were quantified using a signal-enhancement threshold metric that characterizes changes in signal-enhancement volume (SEV). Tumour response was quantified using Ktrans and ve (Tofts model) pre- and post-SABR. Significance was assessed using a Wilcoxin signed-rank test. RESULTS: All group 1 and 4/6 group 2 patients' SEV increased post-SABR. All group 3 patients' SEV decreased. The mean Ktrans increased for group 1 by 76% (p = 0.043) while group 2 and 3 decreased 15% (p = 0.028) and 34% (p = 0.028), respectively. For ve, there was no significant change in Group 1 (p = 0.35). Groups 2 showed an increase of 24% (p = 0.043), and Group 3 trended toward an increase (23%, p = 0.08). CONCLUSION: Kinetic parameters measured 2.5 weeks post-SABR in both single fraction and three fraction groups were indicative of response but only the single fraction protocol led to enhancement in the surrounding tissue. Our results also suggest that DCE-MRI one-week post-SABR may be too early for response assessment, at least for single fraction SABR, whereas 2.5 weeks appears sufficiently long to minimize confounding acute effects.

Should I smile or should I frown? An ERP study on the voluntary control of emotion-related facial expressions.

We investigated the motor planning and reprogramming of facial expressions of happiness and anger with a response-priming task. A response signal commanded the production of a validly or invalidly cued facial expression. Electromyogram showed performance costs of inhibiting the falsely prepared expression and reprogramming the correct one in invalid trials. These performance costs were larger in zygomaticus major than corrugator supercilii, indicating better control over the latter. Event-related potentials indicated no emotion specificity in the initial preparation of anger and happiness in the contingent negative variation. During reprogramming, anger came along with greater allocation of processing resources for the inhibition of the preactivated motor plan (N2), and the updating of a new one (P3). These additional processing resources and the faster control over corrugator may reflect the need for being quick and accurate in displaying threat.

Differential task effects on N400 and P600 elicited by semantic and syntactic violations.

Syntactic violations in sentences elicit a P600 component in the event-related potential, which is frequently interpreted as signaling reanalysis or repair of the sentence structure. However, P600 components have been reported also for semantic and combined semantic and syntactic violations, giving rise to still other interpretations. In many of these studies, the violation might be of special significance for the task of the participants; however there is a lack of studies directly targeting task effects on the P600. Here we repeated a previously published study but using a probe verification task, focusing on individual words rather than on sentence correctness and directly compared the results with the previous ones. Although a (somewhat smaller) N400 component occurred also in the present study, we did not observe a parietal P600 component. Instead, we found a late anterior negativity. Possibly, the parietal P600 observed in sentence acceptability paradigms relates to the target value of the violations or to late sentence structure-specific processes that are more task-sensitive than the N400 and which are or not initiated in the probe verification task. In any case the present findings show a strong dependency of P600-eliciting processes from attention to the sentences context whereas the N400 eliciting processes appear relatively robust.

How about lunch? Consequences of the meal context on cognition and emotion.

Although research addresses the effects of a meal's context on food preference, the psychological consequences of meal situations are largely unexplored. We compared the cognitive and emotional effects of a restaurant meal eaten in the company of others to a solitary meal consumed in a plain office using pre- and post-tests analysis and controlling for the kind and amount of food consumed. Three tasks were conducted, measuring: (1) semantic memory (2) cognitive control and error monitoring, and (3) processing of emotional facial expressions. Covert processes in these tasks were assessed with event-related brain potentials. A mood rating questionnaire indicated a relaxation effect of the restaurant as compared to the plain meal situation. The restaurant meal increased sensitivity to threatening facial expressions and diminished cognitive control and error monitoring. No effects were observed for semantic memory. These findings provide the first experimental evidence that a restaurant meal with a social component may be more relaxing than a meal eaten alone in a plain setting and may reduce cognitive control.

Optimization of time-to-peak analysis for differentiating malignant and benign breast lesions with dynamic contrast-enhanced MRI.

RATIONALE AND OBJECTIVES: The aim of this study was to investigate the feasibility of applying measures sensitive to time-to-peak (T(peak)) heterogeneity as indicators for malignancy on breast dynamic contrast-enhanced magnetic resonance imaging. MATERIALS AND METHODS: The study included 39 benign and 97 malignant breast lesions from 103 patients. Lesions were automatically segmented by k-means clustering. Voxel-by-voxel T(peak) values were extracted using an empirical model. The pth percentile values (p = 10, 20…) of the T(peak) distribution within each lesion and the fractional and absolute hot spot volumes were determined, where the hot spot volume is the volume of tissue with T(peak) less than a threshold value. Using the area under the receiver-operating characteristic curve (AUC), these measures were tested as indicators for differentiating fibroadenomas from invasive lesions and from ductal carcinoma in situ, as well as for differentiating nonfibroadenoma benign lesions from these malignant lesions. Region of interest-based T(peak) measurements were also tested. Finally, the relationship between hot spot volume and lesion volume was investigated. RESULTS: For differentiating fibroadenomas from malignant lesions, AUC values increased with decreasing values of p. At the optimal threshold (3 minutes), the hot spot volume provided high diagnostic performance (AUC ≥0.96 ± 0.02 for absolute hot spot volume). However, for differentiating nonfibroadenoma benign lesions from malignant lesions, AUC values were low. A significant correlation between absolute hot spot volume and lesion volume was found for malignant lesions and nonfibroadenoma benign lesions. CONCLUSION: Quantitative analysis of the T(peak) distribution can be optimized for diagnostic performance, providing indicators sensitive to intralesion T(peak) heterogeneity.

Prognostic significance of blood brain barrier permeability in acute hemorrhagic stroke.

BACKGROUND: Blood brain barrier (BBB) disruption is accompanied by edema in the surrounding areas of the intracerebral hemorrhage (ICH). The aim of the study was to clarify the correlation between BBB breakdown and outcome in ICH. PATIENTS: Twenty-seven patients with primary ICH were included in the study. Each patient underwent CT and DTPA-SPECT, and the National Institutes of Health (NIH) and modified Rankin score were performed as well. RESULTS: DTPA-SPECT had a significant correlation with the modified Rankin score after 3 months (p = 0.008) and 6 months (p = 0.01). The CT scan was directly correlated with the NIH score on days 1, 7 and 30 (p = 0.01, p = 0.01 and p = 0.04, respectively). No correlation was found between DTPA-SPECT and CT scan data. CONCLUSIONS: The degree of BBB breakdown, as imaged by the DTPA-SPECT technique, was directly correlated with the late functional outcome. The CT scan has an inverse correlation with the NIH score. These findings may have broad clinical implications.