A Smart Digital Health Platform to Enable Monitoring of Quality of Life and Frailty in Older Patients with Cancer: A Mixed-Methods, Feasibility Study Protocol.

OBJECTIVES: LifeChamps is an EU Horizon 2020 project that aims to create a digital platform to enable monitoring of health-related quality of life and frailty in patients with cancer over the age of 65. Our primary objective is to assess feasibility, usability, acceptability, fidelity, adherence, and safety parameters when implementing LifeChamps in routine cancer care. Secondary objectives involve evaluating preliminary signals of efficacy and cost-effectiveness indicators. DATA SOURCES: This will be a mixed-methods exploratory project, involving four study sites in Greece, Spain, Sweden, and the United Kingdom. The quantitative component of LifeChamps (single-group, pre-post feasibility study) will integrate digital technologies, home-based motion sensors, self-administered questionnaires, and the electronic health record to (1) enable multimodal, real-world data collection, (2) provide patients with a coaching mobile app interface, and (3) equip healthcare professionals with an interactive, patient-monitoring dashboard. The qualitative component will determine end-user usability and acceptability via end-of-study surveys and interviews. CONCLUSION: The first patient was enrolled in the study in January 2023. Recruitment will be ongoing until the project finishes before the end of 2023. IMPLICATIONS FOR NURSING PRACTICE: LifeChamps provides a comprehensive digital health platform to enable continuous monitoring of frailty indicators and health-related quality of life determinants in geriatric cancer care. Real-world data collection will generate "big data" sets to enable development of predictive algorithms to enable patient risk classification, identification of patients in need for a comprehensive geriatric assessment, and subsequently personalized care.

Effects of psychosis-associated genetic markers on brain volumetry: a systematic review of replicated findings and an independent validation.

BACKGROUND: Given psychotic illnesses' high heritability and associations with brain structure, numerous neuroimaging-genetics findings have been reported in the last two decades. However, few findings have been replicated. In the present independent sample we aimed to replicate any psychosis-implicated SNPs (single nucleotide polymorphisms), which had previously shown at least two main effects on brain volume. METHODS: A systematic review for SNPs showing a replicated effect on brain volume yielded 25 studies implicating seven SNPs in five genes. Their effect was then tested in 113 subjects with either schizophrenia, bipolar disorder, 'at risk mental state' or healthy state, for whole-brain and region-of-interest (ROI) associations with grey and white matter volume changes, using voxel-based morphometry. RESULTS: We found FWER-corrected (Family-wise error rate) (i.e. statistically significant) associations of: (1) CACNA1C-rs769087-A with larger bilateral hippocampus and thalamus white matter, across the whole brain; and (2) CACNA1C-rs769087-A with larger superior frontal gyrus, as ROI. Higher replication concordance with existing literature was found, in decreasing order, for: (1) CACNA1C-rs769087-A, with larger dorsolateral-prefrontal/superior frontal gyrus and hippocampi (both with anatomical and directional concordance); (2) ZNF804A-rs11681373-A, with smaller angular gyrus grey matter and rectus gyri white matter (both with anatomical and directional concordance); and (3) BDNF-rs6265-T with superior frontal and middle cingulate gyri volume change (with anatomical and allelic concordance). CONCLUSIONS: Most literature findings were not herein replicated. Nevertheless, high degree/likelihood of replication was found for two genome-wide association studies- and one candidate-implicated SNPs, supporting their involvement in psychosis and brain structure.

Sex Differences in Functional Connectivity Between Resting State Brain Networks in Autism Spectrum Disorder.

Functional brain connectivity (FBC) has previously been examined in autism spectrum disorder (ASD) between-resting-state networks (RSNs) using a highly sensitive and reproducible hypothesis-free approach. However, results have been inconsistent and sex differences have only recently been taken into consideration using this approach. We estimated main effects of diagnosis and sex and a diagnosis by sex interaction on between-RSNs FBC in 83 ASD (40 females/43 males) and 85 typically developing controls (TC; 43 females/42 males). We found increased connectivity between the default mode (DM) and (a) the executive control networks in ASD (vs. TC); (b) the cerebellum networks in males (vs. females); and (c) female-specific altered connectivity involving visual, language and basal ganglia (BG) networks in ASD-in suggestive compatibility with ASD cognitive and neuroscientific theories.

Cultural differences in vocal emotion recognition: a behavioural and skin conductance study in Portugal and Guinea-Bissau.

Cross-cultural studies of emotion recognition in nonverbal vocalizations not only support the universality hypothesis for its innate features, but also an in-group advantage for culture-dependent features. Nevertheless, in such studies, differences in socio-economic-educational status have not always been accounted for, with idiomatic translation of emotional concepts being a limitation, and the underlying psychophysiological mechanisms still un-researched. We set out to investigate whether native residents from Guinea-Bissau (West African culture) and Portugal (Western European culture)-matched for socio-economic-educational status, sex and language-varied in behavioural and autonomic system response during emotion recognition of nonverbal vocalizations from Portuguese individuals. Overall, Guinea-Bissauans (as out-group) responded significantly less accurately (corrected p < .05), slower, and showed a trend for higher concomitant skin conductance, compared to Portuguese (as in-group)-findings which may indicate a higher cognitive effort stemming from higher difficulty in discerning emotions from another culture. Specifically, accuracy differences were particularly found for pleasure, amusement, and anger, rather than for sadness, relief or fear. Nevertheless, both cultures recognized all emotions above-chance level. The perceived authenticity, measured for the first time in nonverbal cross-cultural research, in the same vocalizations, retrieved no difference between cultures in accuracy, but still a slower response from the out-group. Lastly, we provide-to our knowledge-a first account of how skin conductance response varies between nonverbally vocalized emotions, with significant differences (p < .05). In sum, we provide behavioural and psychophysiological data, demographically and language-matched, that supports cultural and emotion effects on vocal emotion recognition and perceived authenticity, as well as the universality hypothesis.

Prediction of transition to psychosis from an at-risk mental state using structural neuroimaging, genetic, and environmental data.

Introduction: Psychosis is usually preceded by a prodromal phase in which patients are clinically identified as being at in an "At Risk Mental State" (ARMS). A few studies have demonstrated the feasibility of predicting psychosis transition from an ARMS using structural magnetic resonance imaging (sMRI) data and machine learning (ML) methods. However, the reliability of these findings is unclear due to possible sampling bias. Moreover, the value of genetic and environmental data in predicting transition to psychosis from an ARMS is yet to be explored. Methods: In this study we aimed to predict transition to psychosis from an ARMS using a combination of ML, sMRI, genome-wide genotypes, and environmental risk factors as predictors, in a sample drawn from a pool of 246 ARMS subjects (60 of whom later transitioned to psychosis). First, the modality-specific values in predicting transition to psychosis were evaluated using several: (a) feature types; (b) feature manipulation strategies; (c) ML algorithms; (d) cross-validation strategies, as well as sample balancing and bootstrapping. Subsequently, the modalities whose at least 60% of the classification models showed an balanced accuracy (BAC) statistically better than chance level were included in a multimodal classification model. Results and discussion: Results showed that none of the modalities alone, i.e., neuroimaging, genetic or environmental data, could predict psychosis from an ARMS statistically better than chance and, as such, no multimodal classification model was trained/tested. These results suggest that the value of structural MRI data and genome-wide genotypes in predicting psychosis from an ARMS, which has been fostered by previous evidence, should be reconsidered.

Evaluation of Genotype-Based Gene Expression Model Performance: A Cross-Framework and Cross-Dataset Study.

Predicting gene expression from genotyped data is valuable for studying inaccessible tissues such as the brain. Herein we present eGenScore, a polygenic/poly-variation method, and compare it with PrediXcan, a method based on regularized linear regression using elastic nets. While both methods have the same purpose of predicting gene expression based on genotype, they carry important methodological differences. We compared the performance of expression quantitative trait loci (eQTL) models to predict gene expression in the frontal cortex, comparing across these frameworks (eGenScore vs. PrediXcan) and training datasets (BrainEAC, which is brain-specific, vs. GTEx, which has data across multiple tissues). In addition to internal five-fold cross-validation, we externally validated the gene expression models using the CommonMind Consortium database. Our results showed that (1) PrediXcan outperforms eGenScore regardless of the training database used; and (2) when using PrediXcan, the performance of the eQTL models in frontal cortex is higher when trained with GTEx than with BrainEAC.

Pupil dilation reflects the authenticity of received nonverbal vocalizations.

The ability to infer the authenticity of other's emotional expressions is a social cognitive process taking place in all human interactions. Although the neurocognitive correlates of authenticity recognition have been probed, its potential recruitment of the peripheral autonomic nervous system is not known. In this work, we asked participants to rate the authenticity of authentic and acted laughs and cries, while simultaneously recording their pupil size, taken as proxy of cognitive effort and arousal. We report, for the first time, that acted laughs elicited higher pupil dilation than authentic ones and, reversely, authentic cries elicited higher pupil dilation than acted ones. We tentatively suggest the lack of authenticity in others' laughs elicits increased pupil dilation through demanding higher cognitive effort; and that, reversely, authenticity in cries increases pupil dilation, through eliciting higher emotional arousal. We also show authentic vocalizations and laughs (i.e. main effects of authenticity and emotion) to be perceived as more authentic, arousing and contagious than acted vocalizations and cries, respectively. In conclusion, we show new evidence that the recognition of emotional authenticity can be manifested at the level of the autonomic nervous system in humans. Notwithstanding, given its novelty, further independent research is warranted to ascertain its psychological meaning.

Comparing SPM12 and CAT12 segmentation pipelines: a brain tissue volume-based age and Alzheimer's disease study.

BACKGROUND: Brain volumes have been used as research biomarkers both in health and in Alzheimer's disease(AD). In order to improve the comparability between studies and aid future analytical software platform choice in the research setting, here we compare two segmentation pipelines of structural brain magnetic resonance imaging(sMRI): the SPM12 toolbox, and a SPM12 add-on, the CAT12 toolbox. METHODS: We segmented 1.5T and 3T T1-weighted sMRI images (from the OASIS-brain database) using both pipelines and compared them in terms of their impact on: 1)the effect of age on the total grey matter(GM) and white matter(WM), and on the hippocampi GM volumes in a healthy sample(n = 238); 2)the effect of AD diagnosis on the same volume measures; and 3)the accuracy of each volume measure detecting diagnosis (100 patients with AD and 78 age- and gender-matched healthy subjects). RESULTS AND COMPARISON BETWEEN METHODS: Our results demonstrated that: 1)volume estimates from SPM12 were highly correlated with the ones from CAT12, albeit absolute differences between pipelines were tissue specific; 2)the choice of pipeline modulated the effect of age on all volume measures and of diagnosis on hippocampi GM volumes computed from 3 T data; and 3)pipeline had no impact on the accuracy of any brain volume measure detecting AD diagnosis. CONCLUSIONS: Our findings indicate that other studies should take these pipeline effects on age and AD diagnosis, into account, for improved comparability in previous literature. Additionally, we encourage future studies to use CAT12 as this is a more advanced and computationally efficient brain segmentation tool.

[Asthmatic exacerbation in pregnant woman]. / Exacerbation asthmatique chez la femme enceinte.

The physiological changes in the pregnant woman expose her to a risk of faster respiratory decompensation. Asthma affects 2-13% of pregnancies. It is therefore important to ensure regular monitoring to allow good control of asthma to reduce the risk of exacerbations. Finally, the background treatment, such as exacerbations, must be identical to the treatment of other patients.

Les modifications physiologiques chez la femme enceinte l'exposent à un risque de décompensation respiratoire plus rapide. L'asthme concerne 2-13% des grossesses. Il est donc important d'assurer un suivi régulier pour permettre un bon contrôle de l'asthme afin de diminuer le risque d'exacerbations. Enfin, le traitement de fond, comme celui des exacerbations, doivent être identiques aux traitements des autres patients.

The probability of having advanced medical interventions is associated with age in out-of-hospital life-threatening situations.

BACKGROUND: The use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician's initiation of out-of-hospital advanced medical interventions varies with the patient's age. METHODS: We performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient's age. RESULTS: Among 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 - 58 years and significantly lower among those aged ≥ 89 years (OR = 0.66; 95 % CI: 0.53 - 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 - 83, 84 - 88 and ≥ 89 years). CONCLUSION: The number of out-of-hospital advanced medical interventions significantly decreased for patients aged ≥ 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.

[Biliary infections : cholecystitis and cholangitis]. / Infections des voies biliaires : cholécystite et cholangite.

Biliary infections are a common cause of emergency department visit, usually of benign evolution but that can sometimes progress rapidly to a life-threatening emergency.The mainstay of treatment of acute cholecystitis is urgent laparoscopic cholecystectomy, performed in 72 hours.Antibiotic treatment is often sufficient for the initial treatment of mild cholangitis. A percutaneous or endoscopic biliary drainage must be done urgently in case of severe presentations or if the patient doesn't respond to conservative treatment. The definitive treatment of the cause of cholangitis, will be performed in a second time.

Les infections de la vésicule et des voies biliaires sont un motif fréquent de consultation aux urgences. Leur évolution est le plus souvent bénigne, mais elles peuvent parfois devenir rapidement une urgence vitale.Le pilier du traitement de la cholécystite aiguë est la cholécystectomie laparoscopique en urgence, réalisée dans un délai inférieur à 72 heures.L'antibiothérapie est souvent suffisante pour le traitement initial de Ia cholangite simple. Un drainage biliaire percutané ou endoscopique doit être effectué en urgence pour une cholangite sévère ou en cas de non-réponse au traitement conservateur. Le traitement définitif de la cause de la cholangite sera pratiqué dans un deuxième temps.

Let loose technique, an option in band migration.

Obesity is nowadays a serious worldwide public health problem. In order to give patients a better quality of live, there are now medical and surgical treatments that may be offered to those patients. Since 2005, the Hospital de Santarém has been doing bariatric surgery. From 77 procedures with laparoscopic adjustable gastric banding, there were three cases of migration. The authors propose a new procedure to deal with migrations, according to a classification for band migration, as an alternative to a removal by laparoscopy or laparotomy. Let loose technique is a procedure that can be used in patients with band migration beyond the angle of Treitz and without other associated complications. It is consist of removing the port under local anaesthesia, leaving the insufflations' tube, hospitalization for monitoring the patient and awaiting for the elimination of the band with faeces. It's less costly and with minimal risks for patient. The first results are satisfactory and encouraging.