RMSSD Is More Sensitive to Artifacts Than Frequency-Domain Parameters: Implication in Athletes' Monitoring.

Easy-to-use and accurate heart rate variability (HRV) assessments are essential in athletes' follow-up, but artifacts may lead to erroneous analysis. Artifact detection and correction are the purpose of extensive literature and implemented in dedicated analysis programs. However, the effects of number and/or magnitude of artifacts on various time- or frequency-domain parameters remain unclear. The purpose of this study was to assess the effects of artifacts on HRV parameters. Root mean square of the successive differences (RMSSD), standard deviation of the normal to normal inter beat intervals (SDNN), power in the low- (LF) and high-frequency band (HF) were computed from two 4-min RR recordings in 178 participants in both supine and standing positions, respectively. RRs were modified by (1) randomly adding or subtracting 10, 30, 50 or 100 ms to the successive RRs; (2) a single artifact was manually inserted; (3) artifacts were automatically corrected from signal naturally containing artifacts. Finally, RR recordings were analyzed before and after automatic detection-correction of artifacts. Modifying each RR by 10, 30, 50 and 100 ms randomly did not significantly change HRV parameters (range -6%, +6%, supine). In contrast, by adding a single artifact, RMSSD increased by 413% and 269%, SDNN by 54% and 47% in supine and standing positions, respectively. LF and HF changed only between -3% and +8% (supine and standing) in the artifact condition. When more than 0.9% of the signal contained artifacts, RMSSD was significantly biased, whilst when more than 1.4% of the signal contained artifacts LF and HF were significantly biased. RMSSD and SDNN were more sensitive to a single artifact than LF and HF. This indicates that, when using RMSSD only, a single artifact may induce erroneous interpretation of HRV. Therefore, we recommend using both time- and frequency-domain parameters to minimize the errors in the diagnoses of health status or fatigue in athletes.

Association between anhedonia and suicidal events in patients with mood disorders: A 3-year prospective study.

BACKGROUND: As almost all mental disorders are associated with increased suicidal-related behavior, anhedonia might be a trans-diagnostic dimension to target for suicide prevention. METHODS: For this 3-year-long prospective study, 2,839 outpatients with mood disorders were recruited. They were divided in: (a) two groups according to the occurrence or not of suicidal ideation during the follow-up, and (b) two groups according to the occurrence or not of suicide attempts during the follow-up. Anhedonia was assessed using a composite score (the French version of the 14-item Snaith-Hamilton Pleasure Scale and item 13 of the Quick Inventory of Depressive Symptomatology scale) at inclusion and at 6, 12, 24, and 36 months after inclusion. RESULTS: Patients with mood disorders and anhedonia at least at one follow-up visit had a 1.4-fold higher risk of suicidal ideation (adjusted odds ratio = 1.35; 95% confidence interval [1.07, 1.70]), even after adjustment for confounding factors of suicide risk (i.e., bipolar or unipolar disorder, sex, age, marital status, education level, antidepressant intake, personal history of suicide attempt, at least one childhood trauma, and mean of the maximum depression score during the follow-up). Conversely, association between anhedonia and suicide attempt did not remain significant after adjustment. CONCLUSIONS: The significant association between anhedonia and suicide ideation in patients with mood disorders stresses the need of targeting hedonia in mood disorders, and of research focusing on the position to pleasure in life through eudaimonia.

Post-exercise Heart Rate Variability: Whole-body Cryotherapy vs. Contrast Water Therapy.

High-intensity training sessions are known to alter cardiac autonomic modulation. The purpose of this study was to compare the effects of whole-body cryotherapy, contrast water therapy and passive recovery on the time course of cardiac autonomic markers following a standardized HIT session. Eleven runners completed a high intensity session followed by one of the following recovery interventions: whole-body cryotherapy, contrast water therapy or passive recovery. Changes in cardiac autonomic modulation were assessed in supine and standing positions during an active tilt test at pre-, post-14 h and post-38 h. In supine, high-frequency power increased from pre- to post-14 h following whole-body cryotherapy (1661.1±914.5 vs. 2799.0±948.4 ms2, respectively; p=0.023) and contrast water therapy (1906.1±1327.9 vs. 4174.3±2762.9 ms2, respectively; p=0.004) whereas high frequency power decreased in response to passive recovery (p=0.009). In standing, low-frequency power increased from pre-to post-38 h (1784.3 ± 953.7 vs. 3339.8±1862.7 ms2, respectively; p=0.017) leading to an increase in total power from pre- to post-38 h (1990.8 ± 1089.4 vs. 3606.1±1992.0 ms2, respectively; p=0.017). Spectral analysis revealed that contrast water therapy appears to be a more efficient recovery strategy than whole-body cryotherapy in restoring cardiac autonomic homeostasis.

Teaching emergency situations during a psychiatry residency programme using a blended learning approach: a pilot study.

BACKGROUND: Emergency psychiatry is an essential component in the training of psychiatry residents who are required to make patient-centred orientation decisions. This training calls for specific knowledge as well as skills and attitudes requiring experience. Kolb introduced a theory on experiential learning which suggested that effective learners should have four types of abilities: concrete experience, reflective observation, abstract conceptualisation and active experimentation. We aimed to evaluate a resident training programme that we designed for use in an emergency psychiatry setting based on the experimental learning theory. METHODS: We designed a four-step training programme for all first-year psychiatry residents: (i) theoretical teaching of psychiatric emergency knowledge, (ii) concrete experience of ability teaching involving an initial simulation session based on three scenarios corresponding to clinical situations frequently encountered in emergency psychiatry (suicidal crisis, hypomania and depressive episodes), (iii) reflective observation and abstract conceptualisation teaching based on videos and clinical interview commentary by a senior psychiatrist for the same three scenarios, (iv) active experimentation teaching during a second simulation session based on the same three frequently encountered clinical situations but with different scenarios. Training-related knowledge acquisition was assessed after the second simulation session based on a multiple-choice quiz (MCQ), short-answer questions and a script concordance test (SCT). The satisfaction questionnaire was assessed after the resident had completed his/her initial session in order to evaluate the relevance of teaching in clinical practice. The descriptive analyses were described using the mean (+/- standard deviation). The comparative analyses were conducted with the Wilcoxon or Student's t tests depending on data distribution. RESULTS: The residents' mean MCQ and short-answer question scores and SCT were 7.25/10 (SD = 1.2) 8.33/10 (SD = 1.4), 77.5/100 (SD = 15.8), respectively. The satisfaction questionnaire revealed that 67 % of residents found the teaching consistent. CONCLUSION: We designed a blended learning programme that associated, classical theoretical learning to acquire the basic concepts, a learning with simulation training to experiment the clinical situations and a video support to improve learning of interview skills and memory recall. The residents indicate that this training was adequate to prepare them to be on duty. However, despite this encouraging point, this program needs further studies to attest of its efficiency.

Childhood maltreatment and clinical severity of treatment-resistant depression in a French cohort of outpatients (FACE-DR): One-year follow-up.

BACKGROUND: Childhood maltreatment is associated with major depressive disorder (MDD). It not only increases the risk of lifetime MDD, but it also aggravates its course. Among depressed patients, 20-30% of them experience treatment-resistance depression (TRD). We aimed to assess the association between childhood maltreatment, severity of depression in a unipolar TRD sample, and patient outcomes after one-year of follow-up. METHODS: Patients were recruited for a prospective cohort from the French network of TRD expert centers. Depressive symptom severity was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology self-report (QIDS-SR). Childhood maltreatment was evaluated with the Childhood Trauma Questionnaire (CTQ). RESULTS: In total, 256 patients filled in the CTQ at baseline between 2012 and 2019. At baseline, the MADRS score was associated with CTQ score (ß = .185; p = .004). QIDS was also associated with CTQ scores (ß = .27; p < .001). Regarding the different subtypes of childhood maltreatment, MADRS was associated with physical (ß = .21; p = .005) and sexual abuse (ß = .22; p = .002), while QIDS with physical abuse (ß = .304; p < .001) and physical neglect (ß = .254; p < .001). However, we did not find any significant association focusing on the other types of traumas. During a 1-year follow-up focusing on remission, CTQ scores (baseline) were less important in remittent patients [n = 38; CTQ score = 39.26 (9.68)] than in nonremittent ones [n = 92; CTQ score = 46.02 (17.53)] (p = .027). There was no significant difference among remitters and nonremitters based on trauma subtypes. At baseline, CTQ scores had a significant influence on remission at 1 year (χ2 (1) = 5.57; p < .05). We lost this influence adding MADRS scores at baseline in the model (p = .063). CONCLUSION: We highlighted a significant association between the severity of depressive disorders and childhood maltreatment in the TRD population. Information about a history of childhood maltreatment helps in identifying individuals who could be less likely to go into remission after treatment.

[Heart rate variability: methods, limitations and clinical examples]. / Analyse de la variabilité de la fréquence cardiaque†: méthodes, limites et exemples cliniques.

Heart rate variability (HRV) is an analysis of milliseconds variations in intervals between heartbeats and has become an increasingly used tool for clinical investigation of fatigue, especially in athletes. Eliciting an indirect index of the autonomic nervous system regulation on the heart rate, HRV correlates with different fatigue states and appears to be a powerful biomarker in their monitoring. This article presents the tools to familiarize with this method while detailing good practices for use and interpretation. A method allowing characterization of different fatigue states is also presented for a clinical use with a systemic approach.

L'analyse de la variabilité de la fréquence cardiaque (VFC) s'intéresse à l'observation des variations en millisecondes des intervalles entre les battements cardiaques et devient un outil d'investigation clinique de la fatigue de plus en plus utilisé, notamment chez les athlètes. Les paramètres étudiés reflètent indirectement la régulation de la fréquence cardiaque par le système nerveux autonome et la VFC est corrélée à différents états de fatigue, se révélant être un puissant biomarqueur dans le suivi de ces derniers. Cet article vise à donner les bases permettant de cerner la thématique et précise les bonnes pratiques quant à son utilisation et son interprétation. Une méthode permettant de caractériser différents états de fatigue est également présentée et donne des pistes pour une utilisation en clinique avec une approche systémique.

Traumatic Hystero-Neurasthenia in Professor Charcot's Leçons du Mardi.

At the end of the 19th century, several authors became interested in the physical and psychological symptoms resulting from traumatic life events. Oppenheim presented 42 detailed clinical observations. He suggested the term "traumatic neurosis." Charcot, who was interested in male hysteria, published over 20 cases of traumatic hysteria between 1878 and 1893. The symptoms were considered to have a dynamic or functional origin. The role of horror and terror during the trauma was emphasized. However, Charcot opposed the idea of traumatic neuroses as specific syndromes as he considered them to be only an etiological form of hystero-neurasthenia. In The Tuesday Lessons (Les Leçons du Mardi), he presents several observations. They are surprising when compared with the current criteria for posttraumatic stress disorder (PTSD). Although he had rejected this new entity, a hundred years before the appearance of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Charcot described most of the symptoms mentioned for a diagnosis of PTSD such as intrusion (reliving the trauma, nightmares, and severe emotional distress), avoidance, negative changes in thinking and mood (negative thoughts, lack of interest, etc.), arousal, and reactivity (trouble sleeping, trouble concentrating, being easily startled or frightened, irritability, etc.).

Neuroimaging Biomarkers at Baseline Predict Electroconvulsive Therapy Overall Clinical Response in Depression: A Systematic Review.

OBJECTIVE: Major depressive disorder is a frequent and disabling disease and can be treated with antidepressant drugs. When faced with severe or resistant major depressive disorder, however, psychiatrists may resort to electroconvulsive therapy (ECT). Although very effective, the response falls short of 100%. A recent meta-analysis established clinical and biological predictive factors of the response to ECT. We decided to explore neuroimaging biomarkers that could be predictors of the ECT response. METHODS: We performed a systematic literature review up to January 1, 2018, using a Boolean combination of MeSH terms. We included 19 studies matching our inclusion criteria. RESULTS: Lower hippocampal, increased amygdala, and subgenual cingulate gyrus volumes were predictive for a better ECT response. Functional magnetic resonance imaging also found that the connectivity between the dorsolateral prefrontal cortex and posterior default-mode network is predictive of increased efficacy. Conversely, deep white matter hyperintensities in basal ganglia and Virchow-Robin spaces, medial temporal atrophy, ratio of left superior frontal to left rostral middle frontal cortical thickness, cingulate isthmus thickness asymmetry, and a wide range of gray and white matter anomalies were predictive for a poorer response. CONCLUSIONS: Our review addresses the positive or negative predictive value of neuroimaging biomarkers for the ECT response, indispensable in a personalized medicine dynamic. These data could reduce the risk of nonresponders or resistance with earlier effective management. It might also help researchers elucidate the complex pathophysiology of depressive disorders and the functioning of ECT.

Psychotic Decompensation During Nalmefene Treatment in a Patient With Schizoaffective Disorder: A Case Report.

Objective: Nalmefene is a kappa-opioid receptor agonist/antagonist which is currently prescribed to reduce heavy drinking days. Adverse events (AEs) have previously been described in trials, but these trials excluded patients with psychiatric comorbidities. This is important as psychiatric disorders are frequently associated with alcohol use disorders; therefore, the specific AEs in this population should be investigated. Methods: Here, we describe the case of a patient with diagnosed alcohol use disorder and schizoaffective disorder who received treatment with nalmefene. Results: The patient showed decompensation of psychotic symptoms after two doses of medication, consisting of auditory hallucinations, delusions, and ideas of persecution. The symptoms improved two days after treatment discontinuation. Conclusions: This case indicates that the AEs of nalmefene should be specifically investigated in patients with psychiatric disorders.

Reconsidering the seizure threshold? A retrospective study about seizure quality among patients with maintenance ECT.

OBJECTIVES: Electroconvulsive therapy (ECT) is a safe and validated technique used to treat various psychiatric conditions. It triggers an artificially-induced seizure. This seizure is defined using several parameters such as the amount of energy, duration, frequency, pulse width and intensity. Efficacy and adverse events depend on the amount of energy delivered. Due to technical control, the amount of energy delivered by our unit's ECT device was limited to 614 mC, 60% of the maximum possible output of the device. We wondered if lowering the dose would lead to better seizure quality among maintenance ECT patients. METHODS: We assessed seizure quality based on the EEG, using a validated tool created by MacPherson. Two evaluators independently rated the seizures. Pre- and post-control scores were compared using Student's t-test for paired samples. RESULTS: We analysed data from 15 patients. Mean age was 65 years old. Twelve had depressive disorder, two had schizophrenia and one had schizo-affective disorder. Mean duration of seizure before control was 41.1 s [95% confidence interval (95CI)=26.1, 51.1]. The mean MacPherson's score was 20.3 (95CI=16.2, 24.4). After control, the mean MacPherson's score was 28.2 (23.1, 33.3), showing a significant difference with the pre-control dataset (p=0.032; t=-2.4; df=14). Specifically, peak mid-ictal amplitude increased from 6.9 (95CI=5.1, 8.7) to 10.0 (95CI=7.2, 12.8). Other sub-scores remained unchanged. CONCLUSION: Lowering the energy delivered led to an overall increase of seizure quality among our sample. This highlights the necessity and utility of retitration during ECT maintenance, possibly leading to better management of our patients.

[Secrecy in the individual or shared care relationship]. / Le secret dans la relation de soins individuelle ou partagée.

Secrecy in the care relationship raises questions. For caregivers in psychiatry, it is an ethical requirement. However, the transparency of the information collected or recommendations upheld by quality departments rock the foundations of the therapeutic relationship. On which aspects is the therapeutic alliance based? How should secrecy be evoked in the team today? Beyond the dual caregiver-patient relationship, mechanisms to ensure the respect of secrecy relies on the institutional level.

Do male athletes with already high initial haemoglobin mass benefit from 'live high-train low' altitude training?

NEW FINDINGS: What is the central question of this study? It has been assumed that athletes embarking on an 'live high-train low' (LHTL) camp with already high initial haemoglobin mass (Hbmass ) have a limited ability to increase their Hbmass further post-intervention. Therefore, the relationship between initial Hbmass and post-intervention increase was tested with duplicate Hbmass measures and comparable hypoxic doses in male athletes. What is the main finding and its importance? There were trivial to moderate inverse relationships between initial Hbmass and percentage Hbmass increase in endurance and team-sport athletes after the LHTL camp, indicating that even athletes with higher initial Hbmass can reasonably expect Hbmass gains post-LHTL. It has been proposed that athletes with high initial values of haemoglobin mass (Hbmass ) will have a smaller Hbmass increase in response to 'live high-train low' (LHTL) altitude training. To verify this assumption, the relationship between initial absolute and relative Hbmass values and their respective Hbmass increase following LHTL in male endurance and team-sport athletes was investigated. Overall, 58 male athletes (35 well-trained endurance athletes and 23 elite male field hockey players) undertook an LHTL training camp with similar hypoxic doses (200-230 h). The Hbmass was measured in duplicate pre- and post-LHTL by the carbon monoxide rebreathing method. Although there was no relationship (r = 0.02, P = 0.91) between initial absolute Hbmass (in grams) and the percentage increase in absolute Hbmass , a moderate relationship (r = -0.31, P = 0.02) between initial relative Hbmass (in grams per kilogram) and the percentage increase in relative Hbmass was detected. Mean absolute and relative Hbmass increased to a similar extent (P ≥ 0.81) in endurance (from 916 ± 88 to 951 ± 96 g, +3.8%, P < 0.001 and from 13.1 ± 1.2 to 13.6 ± 1.1 g kg-1 , +4.1%, P < 0.001, respectively) and team-sport athletes (from 920 ± 120 to 957 ± 127 g, +4.0%, P < 0.001 and from 11.9 ± 0.9 to 12.3 ± 0.9 g kg-1 , +4.0%, P < 0.001, respectively) after LHTL. The direct comparison study using individual data of male endurance and team-sport athletes and strict methodological control (duplicate Hbmass measures and matched hypoxic dose) indicated that even athletes with higher initial Hbmass can reasonably expect Hbmass gain post-LHTL.

Factors associated with hospitalization after self-poisoning in France: special focus on the impact of alcohol use disorder.

BACKGROUND: Previous studies have identified factors associated with admission to hospital after suicide spectrum behaviors. In this study, we aim to identify specific factors associated with psychiatric hospitalization after self-poisoning. Given earlier findings suggesting that alcohol use disorder is not associated with hospital admission, we also aim to consider its impact, as well as blood alcohol concentrations, on hospitalization decisions after a suicide attempt. METHODS: We studied the association between demographic features, suicide intent, psychiatric characteristics and admission to hospital in self-poisoning patients in an emergency department in France. RESULTS: Suicide intent, a past history of suicide attempts, bipolar disorder and depression were associated with psychiatric hospital admissions. Despite alcohol use disorder being known to be associated with a suicide risk, it was not linked with psychiatric hospitalization. A positive blood alcohol concentration in the emergency department likewise had no association with admission to a psychiatric ward for inpatient care. CONCLUSIONS: Our findings were similar to those reported for other suicide spectrum behaviors. Alcohol use disorder was not associated with admission for inpatient psychiatric care, whereas depression clearly was. The cause of this discrepancy must be determined in future research.

Live high-train low guided by daily heart rate variability in elite Nordic-skiers.

PURPOSE: To analyze if live high-train low (LHTL) effectiveness is improved when daily training is guided by heart rate variability (HRV). METHODS: Twenty-four elite Nordic skiers took part in a 15-day LHTL study and were randomized into a HRV-guided training hypoxic group (H-HRV, n = 9, sleeping in normobaric hypoxia, FiO2 = 15.0%) and two predefined training groups sleeping either in hypoxia (H, n = 9, FiO2 = 15.0%) or normoxia (N, n = 6). HRV and training loads (TL) were recorded daily. Prior (Pre), one (Post-1), and 21 days (Post-21) following LHTL, athletes performed a 10-km roller-ski test, and a treadmill test for determination of [Formula: see text] was performed at Pre and Post-1. RESULTS: Some HRV parameters measured in supine position were different between H-HRV and H: low and high (HF) frequency power in absolute (ms2) (16.0 ± 35.1 vs. 137.0 ± 54.9%, p = 0.05) and normalized units (- 3.8 ± 10.1 vs. 53.0 ± 19.5%, p = 0.02), HF(nu) (6.3 ± 6.8 vs. - 13.7 ± 8.0%, p = 0.03) as well as heart rate (3.7 ± 6.3 vs. 12.3 ± 4.1%, p = 0.008). At Post-1, [Formula: see text] was improved in H-HRV and H (3.8 ± 3.1%; p = 0.02 vs. 3.0 ± 4.4%; p = 0.08) but not in N (0.9 ± 5.1%; p = 0.7). Only H-HRV improved the roller-ski performance at Post-21 (- 2.7 ± 3.6%, p = 0.05). CONCLUSION: The daily individualization of TL reduced the decrease in autonomic nervous system parasympathetic activity commonly associated with LHTL. The improved performance and oxygen consumption in the two LHTL groups confirm the effectiveness of LHTL even in elite endurance athletes.

Influence of Training Load and Altitude on Heart Rate Variability Fatigue Patterns in Elite Nordic Skiers.

We aimed to analyse the relationship between training load/intensity and different heart rate variability (HRV) fatigue patterns in 57 elite Nordic-skiers. 1063 HRV tests were performed during 5 years. R-R intervals were recorded in resting supine (SU) and standing (ST) positions. Heart rate, low (LF), high (HF) frequency powers of HRV were determined. Training volume, training load (TL, a.u.) according to ventilatory threshold 1 (VT1) and VT2 were measured in zones I≤VT1; VT1VT2, IV for strength. TL was performed at 81.6±3.5% in zone I, 0.9±0.9% in zone II, 5.0±3.6% in zone III, 11.6±6.3% in zone IV. 172 HRV tests matched a fatigue state and four HRV fatigue patterns (F) were statistically characterized as F(HF-LF-)SU_ST for 121 tests, F(LF+SULF-ST) for 18 tests, F(HF-SUHF+ST) for 26 tests and F(HF+SU) for 7 tests. The occurrence of fatigue states increased substantially with the part of altitude training time (r2=0.52, p<0.001). This study evidenced that there is no causal relationship between training load/intensity and HRV fatigue patterns. Four fatigue-shifted HRV patterns were sorted. Altitude training periods appeared critical as they are likely to increase the overreaching risks.

How Does Repetitive Transcranial Magnetic Stimulation Influence the Brain in Depressive Disorders?: A Review of Neuroimaging Magnetic Resonance Imaging Studies.

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is a nonpharmacological technique used to stimulate the brain. It is a safe and proven alternative tool to treat resistant major depressive disorders (MDDs). Neuroimaging studies suggest a wide corticolimbic network is involved in MDDs. We researched observable changes in magnetic resonance imaging induced by rTMS to clarify the operational mechanism. METHODS: A systematic search of the international literature was performed using PubMed and Embase, using papers published up to January 1, 2017. The following MESH terms were used: (depression or major depressive disorder) and (neuroimaging or MRI) and (rTMS or repetitive transcranial magnetic stimulation). We searched the databases using a previously defined strategy to identify potentially eligible studies. RESULTS: Both structural and functional changes were observed on magnetic resonance imagings performed before and after rTMS. Various areas of the brain were impacted when rTMS was used. Although the results were very heterogeneous, a pattern that involved the anterior cingulate cortex and the prefrontal cortex emerged. These are known to be regions of interest in MDDs. However, the various parameters used in rTMS make any generalization difficult. CONCLUSIONS: Repetitive transcranial magnetic stimulation helps to treat MDDs with good efficacy. Its effect on the brain, as observed in several neuroimaging studies, seems to impact on the structural and functional features of several networks and structures involved in major depressive disorders.

Structural-functional brain changes in depressed patients during and after electroconvulsive therapy.

OBJECTIVES: Electroconvulsive therapy (ECT) is a non-pharmacological treatment that is effective in treating severe and treatment-resistant depression. Although the efficacy of ECT has been demonstrated to treat major depressive disorder (MDD), the brain mechanisms underlying this process remain unclear. Structural-functional changes occur with the use of ECT as a treatment for depression based on magnetic resonance imaging (MRI). For this reason, we have tried to identify the changes that were identified by MRI to try to clarify some operating mechanisms of ECT. We focus to brain changes on MRI [structural MRI (sMRI), functional MRI (fMRI) and diffusion tensor imging (DTI)] after ECT. METHODS: A systematic search of the international literature was performed using the bibliographic search engines PubMed and Embase. The research focused on papers published up to 30 September 2015. The following Medical Subject Headings (MESH) terms were used: electroconvulsive therapy AND (MRI OR fMRI OR DTI). Papers published in English were included. Four authors searched the database using a predefined strategy to identify potentially eligible studies. RESULTS: There were structural changes according to the sMRI performed before and after ECT treatment. These changes do not seem to be entirely due to oedema. This investigation assessed the functional network connectivity associated with the ECT response in MDD. ECT response reverses the relationship from negative to positive between the two pairs of networks. CONCLUSION: We found structural-functional changes in MRI post-ECT. Because of the currently limited MRI data on ECT in the literature, it is necessary to conduct further investigations using other MRI technology.

Acute and chronic changes in baroreflex sensitivity in hypobaric vs. normobaric hypoxia.

Normobaric hypoxia (NH) is used as a surrogate for hypobaric hypoxia (HH). Recent studies reported physiological differences between NH and HH. Baroreflex sensitivity (BRS) decreases at altitude or following intense training. However, until now no study compared the acute and chronic changes of BRS in NH vs. HH. First, BRS was assessed in 13 healthy male subjects prior and after 20 h of exposure at 3450 m (study 1), and second in 15 well-trained athletes prior and after 18 days of "live-high train-low" (LHTL) at 2250 m (study 2) in NH vs. HH. BRS decreased (p < 0.05) to the same extent in NH and HH after 20 h of hypoxia and after LHTL. These results confirm that altitude decreases BRS but the decrease is similar between HH and NH. The persistence of this decrease after the cessation of a chronic exposure is new and does not differ between HH and NH. The previously reported physiological differences between NH and HH do not appear strong enough to induce different BRS responses.

Posttraumatic Stress, Somatization, and Quality of Life Among Ivorian Refugees.

The present study examined the relationship between peritraumatic reactions, posttraumatic stress disorder (PTSD) symptoms, somatization, and quality of life (QoL) in a sample of refugees, two years after the 2011 Ivory Coast sociopolitical crisis. Participants were 101 Ivorian adult refugees (mean age = 31.61 years, SD = 7.84; 45.5% women) who completed several questionnaires relating to peritraumatic reactions, PTSD symptoms, somatization, and QoL. Most participants (86.1%) scored above the cutoff for probable PTSD. Peritraumatic dissociation and peritraumatic distress were significantly associated with PTSD symptoms, (r = .64, p < .001) and (r = .60, p < .001), respectively, and somatization, (r = .21, p = .038) and (r = .35, p < .001), respectively, as well as with QoL, (r = -.20, p = .045) and (r = -.21, p = .037), respectively. Similarly, QoL was significantly negatively correlated with PTSD symptoms (r = -.33, p < .001) and somatization (r = -.39, p < .001). In multivariate analyses, somatization was the strongest predictor of QoL (ß = -.31, p = .003). Finally, somatization statistically mediated the association between peritraumatic distress and QoL. These findings suggest that PTSD may be frequent among Ivorian refugees, and that somatization may be an important feature of the traumatic experiences. Targeting somatization in conjunction with trauma-centered therapy may improve outcomes in sub-Saharan Africans with PTSD.

Accuracy and Reliability of a New Tennis Ball Machine.

UNLABELLED: The aim was to evaluate the reliability of a newly-developed ball machine named 'Hightof', on the field and to assess its accuracy. The experiment was conducted in the collaboration of the 'Hawk-Eye' technology. The accuracy and reliability of this ball machine were assessed during an incremental test, with 1 min of exercise and 30 sec of recovery, where the frequency of the balls increased from 10 to 30 balls·min(-1). The initial frequency was 10 and increased by 2 until 22, then by 1 until 30 balls·min(-1). The reference points for the impact were 8.39m from the net and 2.70m from lateral line for the right side and 2.83m for the left side. The precision of the machine was similar on the right and left sides (0.63 ± 0.39 vs 0.63 ± 0.34 m). The distances to the reference point were 0.52 ± 0.42, 0.26 ± 0.19, 0.52 ± 0.37, 0.28 ± 0.19 m for the Y-right, X-right, Y-left and X-left impacts. The precision was constant and did not increase with the intensity. (e.g ball frequency). The ball velocity was 86.3 ± 1.5 and 86.5 ± 1.3 km·h(-1) for the right and the left side, respectively. The coefficient of variation for the velocity ranged between 1 and 2% in all stages (ball velocity ranging from 10 to 30 balls·min(-1)). CONCLUSION: both the accuracy and the reliability of this new ball machine appear satisfying enough for field testing and training. Key pointsThe reliability and accuracy of a new ball machine named 'Hightof' were assessed.The impact point was reproducible and similar on the right and left sides (±0.63 m).The precision was constant and did not increase with the intensity (e.g ball frequency).The coefficient of variation of the ball velocity ranged between 1 and 2% in all stages (ball velocity ranging from 10 to 30 balls·min(-1)).