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- BookEric Topol.Summary: "Despite having access to more resources than ever, our doctors are overloaded with demands for their time and expertise. In Deep Medicine, leading physician Eric Topol shows how artificial intelligence can help. Natural-language processing can record our doctor's notes, make sense of our medical histories, and read more deeply into the scientific literature than any human ever could. Deep-learning algorithms -- applied to wearable sensors, genomic information, blood work, scans, and all of our medical data -- can create bespoke treatment plans. And virtual medical assistants, powered by personalized AI, can provide us with coaching to promote our health, shape our diet, and even prevent illness. Bust most importantly, by freeing physicians from the tasks that interfere with human connection, AI will give doctors the gift of time -- to restore the care in healthcare. Innovative, provocative, and hopeful, Deep Medicine shows us how the awesome power of AI can make medicine better, and reveals the paradox that machines can make humans healthier -- and more human"--Provided by publisher.
Contents:
Introduction to deep medicine
Shallow medicine
Medical diagnosis
The skinny on deep learning
Deep liabilities
Doctors and patterns
Clinicians without patterns
Mental health
AI and health systems
Deep discovery
Deep diet
The virtual medical assistant
Deep empathy.PrintLocationVersionCall NumberItems - ArticleHansen K, Machin R, James J, Coats T, Rutty GN.Resuscitation. 2020 08;153:149-153.AIM: To mimic chest compression during cardiopulmonary resuscitation (CPR), this study aimed to produce time-resolved 3D (volumetric) reformats of thoracic and upper abdominal tissue movement during incremental closed chest compression/decompression from 0 to 8 to 0 cm.
METHODS: Sequential angiography enhanced computed tomography (CT) scans were acquired from a recently deceased, consented adult cadaver with 1 cm incremental closed chest compression/decompression. Three compression/decompression sequences from 0 to 3 cm, 0 to 5 cm, and 0 to 8 cm, respectively, were scanned using a radio-opaque, manually operated, chest compression device. The multiphase volumetric data sets were compiled into 4D models that allowed for multiplanar reformatted and volume rendered image manipulation.
RESULTS: Time-resolved volumetric (4D) models were produced using freeware to post-process the static CT scans. The 4D models allowed the study of simulated thoracic and upper abdominal content movement during closed chest compression.
CONCLUSIONS: The method described could assist CPR researchers and educators in the development and demonstration of effective CPR protocols. - ArticleSawarkar DP, Singh PK, Agrawal D, Gupta DK, Satyarthee GD, Doddamani R, Verma S, Meena R, Tandon V, Gurjar HK, Jagdevan A, Kumar R, Chandra PS, Kale SS.World Neurosurg. 2021 09;153:e153-e167.OBJECTIVE: Management of pediatric odontoid fractures is tricky and controversial. This study will enrich world literature with intricacies of anterior odontoid screw (OS) fixation in the pediatric population learned over the last decade.
METHODS: In this retrospective study, all patients with pediatric odontoid fracture who underwent anterior odontoid screw fixation from January 2010 to December 2019 were included and evaluated for surgical outcome.
RESULTS: Thirteen patients were included in this study (mean age, 15 years; range, 6-18 years; male/female, 11:2; type II, 10; type IIA, 1; type III, 2). Common causes of injury were motor vehicle accidents (61.5%) followed by fall from height (38.5%) and all were acute fractures (2-30 days). Five patients had neurologic deficits. Accurate placement of screw was achieved in 92.3% of patients, including all 9 patients who used intraoperative O-arm. K wire migration during bicortical drilling resulted in neurovascular injury, with 1 mortality (7.7%). The remaining 12 patients were available for follow-up (mean, 36 months; range, 20-72 months) and all had preservation of neck movements. Successful OS fixation was achieved in 84.6% of patients, including 1 patient (7.7%) who had a fibrous union. One patient (8.3%) had nonunion because of migration of the screw head in the C2 body.
CONCLUSIONS: Anterior odontoid screw fixation in the pediatric population provides good functional outcomes with instant fixation by direct osteosynthesis. However, the surgeon should be meticulous in the surgical approach and should achieve a lag effect. The surgeon should stop after engaging the outer cortex of the odontoid peg with K wire to avoid cranial migration. Intraoperative O-arm guidance is useful. - ArticleDono A, Mitra S, Shah M, Takayasu T, Zhu JJ, Tandon N, Patel CB, Esquenazi Y, Ballester LY.J Neurooncol. 2021 May;153(1):153-160.INTRODUCTION: Optimal treatment for recurrent glioblastoma isocitrate dehydrogenase 1 and 2 wild-type (rGBM IDH-WT) is not standardized, resulting in multiple therapeutic approaches. A phase III clinical trial showed that tumor treating fields (TTFields) monotherapy provided comparable survival benefits to physician's chemotherapy choice in rGBM. However, patients did not equally benefit from TTFields, highlighting the importance of identifying predictive biomarkers of TTFields efficacy.
METHODS: A retrospective review of an institutional database with 530 patients with infiltrating gliomas was performed. Patients with IDH-WT rGBM receiving TTFields at first recurrence were included. Tumors were evaluated by next-generation sequencing for mutations in 205 cancer-related genes. Post-progression survival (PPS) was examined using the log-rank test and multivariate Cox-regression analysis.
RESULTS: 149 rGBM patients were identified of which 29 (19%) were treated with TTFields. No significant difference in median PPS was observed between rGBM patients who received versus did not receive TTFields (13.9 versus 10.9 months, p = 0.068). However, within the TTFields-treated group (n = 29), PPS was improved in PTEN-mutant (n = 14) versus PTEN-WT (n = 15) rGBM, (22.2 versus 11.6 months, p = 0.017). Within the PTEN-mutant group (n = 70, 47%), patients treated with TTFields (n = 14) had longer median PPS (22.2 versus 9.3 months, p = 0.005). No PPS benefit was observed in PTEN-WT patients receiving TTFields (n = 79, 53%).
CONCLUSIONS: TTFields therapy conferred a significant PPS benefit in PTEN-mutant rGBM. Understanding the molecular mechanisms underpinning the differences in response to TTFields therapy could help elucidate the mechanism of action of TTFields and identify the rGBM patients most likely to benefit from this therapeutic option. - ArticleYajima K, Akiyoshi T, Sakamoto K, Suzuki Y, Oka T, Imaoka A, Yamamura H, Kurokawa J, Ohtani H.J Pharmacol Sci. 2023 Nov;153(3):153-160.Transporter-mediated clearance is determined by two factors, its single-molecule clearance, and expression level. However, no reliable method has been developed to evaluate them separately. This study aimed to develop a reliable method for evaluating the single-molecule activity of membrane transporters, such as organic anion transporting polypeptide (OATP) 2B1. HEK293 cells that co-expressed large conductance calcium-activated potassium (BK) channel and OATP2B1 were established and used for the following experiments. i) BK channel-mediated whole-cell conductance was measured using patch-clamp technique and divided by its unitary conductance to estimate the number of channels on plasma membrane (QI). ii) Using plasma membrane fraction, quantitative targeted absolute proteomics determined the stoichiometric ratio (ρ) of OATP2B1 to BK channel. iii) The uptake of estrone 3-sulfate was evaluated to calculate the Michaelis constant and uptake clearance (CL) per cell. Single-molecule clearance (CLint) was calculated by dividing CL by QI·ρ. QI and ρ values were estimated to be 916 and 2.16, respectively, yielding CLint of 5.23 fL/min/molecule. We successfully developed a novel method to reliably measure the single-molecule activity of a transporter, which could be used to evaluate the influences of factors such as genetic variations and post-translational modifications on the intrinsic activity of transporters.
- ArticleCuoco JA, Rogers CM.World Neurosurg. 2021 09;153:153.
- ArticleZhao Y, Han Y, Bu DF, Zhang J, Li QR, Jin HF, Du JB, Qin J.Life Sci. 2016 May 15;153:153-62.AIMS: Febrile seizure (FS) is one of the most common types of seizures in childhood. Recurrent FS can result in hippocampus injury and thus impair learning capacity and memory, while the underlying molecular mechanisms are still elusive. Studies indicated that endoplasmic reticulum stress (ERS), involved in many diseases including some neurodegenerative diseases, can increase the expression of tribbles-related protein 3 (TRIB3), which thus inhibits the activity of AKT. The current study assessed whether ERS, TRIB3 and AKT signalling is involved in the hippocampus injury following recurrent FS.
MAIN METHODS: Recurrent FS was induced in Sprague-Dawley (SD) rats by using a heated water-bath. TdT-mediated dUTP nick-end labeling (TUNEL) assay was performed to assess hippocampus apoptosis, and electron microscopy was used to examine ultrastructural changes. Protein expression and localization of TRIB3, glucose-regulated protein 78(GRP78) and CCAAT/enhancer-binding protein homologous protein (CHOP) as well as AKT were examined by using western blot and double immunofluorescence staining. Knockdown of TRIB3 was studied in primary cultured neurons treated with hyperthermia.
KEY FINDINGS: As compared with control, apoptosis of hippocampus was significantly induced in FS group. Abundance of TRIB3, GRP78 and CHOP was remarkably elevated, while phosphor-AKT decreased significantly in hippocampus of rats with recurrent FS. Double immunofluorescence indicated that phosphor-AKT was not detected in cells with induction of TRIB3 in FS rats. Hyperthermia-treated cells showed up-regulates TRIB3 expression and that TRIB3 reduces AKT phosphorylation.
SIGNIFICANCE: These results show that recurrent FS may induce injury of hippocampal cell by interfering with AKT activation through ERS-mediated up-regulation of TRIB3. - ArticleEstrada Alarcón P, Reina D, Navarro Ángeles V, Cerdà D, Roig-Vilaseca D, Corominas H.Med Clin (Barc). 2019 08 16;153(4):151-153.BACKGROUND AND OBJECTIVE: Giant cell arteritis (GCA) is the most frequent systemic vasculitis in adults. In recent years, the usefulness of temporal artery ultrasound (TAUS) as a diagnostic tool to assess the underlying inflammation of the vascular wall during the inflammatory process has been under clinical investigation.
MATERIAL AND METHODS: Observational and descriptive cohort study of 120 TAUS in 60 patients with clinical suspicions of GCA, according to the ACR (American College of Rheumatology) classification criteria.
RESULTS: Among all patients who underwent ultrasound, 42.3% met clinical criteria for GCA according to ACR. Sensitivity and specificity of TAUS in our cohort with clinical suspicion was 81.8% and 93.3%, respectively. A PPV of 90.1% and a VPN of 87.5% were observed.
CONCLUSION: Our results showed that TAUS as a useful, indolent, fast, and accessible tool with high diagnostic specificity and diagnostic value. - ArticleOmar A, Patil PD, Hoshi S, Huang J, Collum E, Panchabhai TS.Chest. 2018 06;153(6):e153-e157.CASE PRESENTATION: A 68-year-old man presented to our ED with shortness of breath, weakness, and a 25-lb unintentional weight loss. He had undergone bilateral lung transplantation (cytomegalovirus [CMV]: donor+, recipient+; Epstein-Barr virus: donor+; recipient+) for idiopathic pulmonary fibrosis (IPF) 18 months prior. His posttransplant course was fairly unremarkable until 1 month earlier, when he was admitted for breathlessness and weakness. CT of the chest during that admission revealed mild intralobular and interlobular septal thickening. A bronchoscopy with BAL and transbronchial biopsies did not show acute cellular rejection, but the BAL fluid was positive for coronavirus. His cortisol level was undetectable; he was diagnosed with adrenal insufficiency and fludrocortisone was initiated. He was taking prednisone, tacrolimus, and everolimus for immunosuppression and valganciclovir, itraconazole, and trimethoprim-sulfamethoxazole for antimicrobial prophylaxis. His 25-lb weight loss occurred over the span of just one month.
- ArticleZakian A, Ahmadi HA, Keleshteri MH, Madani A, Tehrani-Sharif M, Rezaie A, Davoodi F, Kish GF, Raisi A, Langerudi MT, Pasha MBM.Res Vet Sci. 2022 Dec 31;153:153-168.The possible impacts of alternative and conventional medicines on wound healing are now of growing interest. This study aimed to evaluate and elucidate the wound healing activity of medicinal leech therapy in wound excision of the rat model. After a round, full-thickness excision was made in the dorsal region of the body, the animals (n = 30) were randomly divided into three equal groups: I) the treatment group (MLT), where the wounds received leech treatment; II) the positive control group (PC), where the wounds received 1% sodium phenytoin treatment; and III) the negative control group (NC), where the wounds did not receive any treatment. On days 6 and 16, wound biopsy specimens were taken, and prepared sections were stained using various methods. The contraction rate differed significantly (P < 0.05) between the NC group and the other groups. The histopathological evaluation revealed that MLT group showed an accelerated healing process and lower inflammatory response compared to other groups. In ML-treated group maturation and remodeling of collagen had occurred, while in 1% sodium phenytoin treated group, proliferation was the prominent feature. Results showed that the fibroblast was significantly lower in the NC group in comparison to other groups. The number of MNC, s, and PMN, s was significantly higher in the NC group compared to other groups (P < 0.0001). In our study, medicinal leech therapy had a higher success rate in healing for the treatment of excisional wounds in animal models.
- ArticleWelsh TN, Manzone J, McDougall L.Acta Psychol (Amst). 2014 Nov;153:153-9.Previous research has revealed that the inhibition of return (IOR) effect emerges when individuals respond to a target at the same location as their own previous response or the previous response of a co-actor. The latter social IOR effect is thought to occur because the observation of co-actor's response evokes a representation of that action in the observer and that the observation-evoked response code subsequently activates the inhibitory mechanisms underlying IOR. The present study was conducted to determine if knowledge of the co-actor's response alone is sufficient to evoke social IOR. Pairs of participants completed responses to targets that appeared at different button locations. Button contact generated location-contingent auditory stimuli (high and low tones in Experiment 1 and colour words in Experiment 2). In the Full condition, the observer saw the response and heard the auditory stimuli. In the Auditory Only condition, the observer did not see the co-actor's response, but heard the auditory stimuli generated via button contact to indicate response endpoint. It was found that, although significant individual and social IOR effects emerged in the Full conditions, there were no social IOR effects in the Auditory Only conditions. These findings suggest that knowledge of the co-actor's response alone via auditory information is not sufficient to activate the inhibitory processes leading to IOR. The activation of the mechanisms that lead to social IOR seems to be dependent on processing channels that code the spatial characteristics of action.
- ArticleBarry AR, Semchuk WM, Thompson A, LeBras MH, Koshman SL.Can Pharm J (Ott). 2020 May-Jun;153(3):153-160.Low-dose acetylsalicylic acid (ASA) is recommended in patients with established cardiovascular disease. However, the role of ASA in those without cardiovascular disease (i.e., primary prevention) is less clear, which has led to discordance among Canadian guidelines. In 2018, 3 double-blind, randomized controlled trials were published that evaluated ASA 100 mg daily versus placebo in patients without established cardiovascular disease. In the ASPREE trial, ASA did not reduce the risk of all-cause death, dementia, or persistent physical disability in patients ≥70 years of age but increased the risk of major bleeding. In the ARRIVE trial, ASA failed to lower the risk of a composite of cardiovascular events but increased any gastrointestinal bleeding in patients at intermediate risk of cardiovascular disease. In the ASCEND trial, ASA significantly reduced the primary composite cardiovascular outcome in patients with diabetes for a number needed to treat of 91 over approximately 7.4 years. Yet major bleeding was increased with ASA for a number needed to harm of 112. Therefore, in most situations, ASA should not be recommended for primary cardiovascular prevention. However, there are additional indications for ASA beyond cardiovascular disease. Thus, a sequential algorithm was developed based on contemporary evidence to help pharmacists determine the suitability of ASA in their patients and play an active role in educating their patients about the potential benefits (or lack thereof) and risks of ASA. Can Pharm J (Ott) 2020;153:xx-xx.
- ArticleNarita M, Hata H, Ikai I.J Visc Surg. 2016 Apr;153(2):153-5.
- ArticleXu K, Wang Y, Ding X, Huang Y, Li N, Wen Q.Talanta. 2016;148:153-62.As a new type of green solvent, four kinds of choline chloride (ChCl)-based deep eutectic solvents (DESs) have been synthesized, and then a core-shell structure magnetic graphene oxide (Fe3O4-NH2@GO) nanoparticles have been prepared and coated with the ChCl-based DESs. Magnetic solid-phase extraction (MSPE) based Fe3O4-NH2@GO@DES was studied for the first time for the extraction of proteins. The characteristic results of vibrating sample magnetometer (VSM), X-ray diffraction (XRD), Fourier transform infrared spectrometry (FT-IR), thermal gravimetric analysis (TGA) and field emission scanning electron microscopy (FESEM) indicated the successful preparation of Fe3O4-NH2@GO@DES. The concentrations of proteins in studies were determined by a UV-vis spectrophotometer. The advantages of Fe3O4-NH2@GO@DES in protein extraction were compared with Fe3O4-NH2@GO and Fe3O4-NH2, and Fe3O4-NH2@GO@ChCl-glycerol was selected as the suitable extraction solvent. The influence factors of the extraction process such as the pH value, the temperature, the extraction time, the concentration of protein and the amount of Fe3O4-NH2@GO@ChCl-glycerol were evaluated. Desorption experimental result showed 98.73% of BSA could be eluted from the solid extractant with 0.1 mol/L Na2HPO4 solution contained 1 mol/L NaCl. Besides, the conformation of BSA was not changed during the elution by the investigation of circular dichromism (CD) spectra. Furthermore, the analysis of real sample demonstrated that the prepared magnetic nanoparticles did have extraction ability on proteins in bovine whole blood.
- ArticleMiyao K, Kuwatsuka Y, Murata M, Nagafuji K, Teshima T, Takeuchi Y, Shiratori S, Najima Y, ... Show More Uchida N, Tanaka M, Sawa M, Ota S, Fukuda T, Ozawa Y, Kako S, Kawakita T, Ara T, Tanaka J, Kanda Y, Atsuta Y, Kanda J, Terakura S, GVHD Working Group and Donor/Source Working Group of the Japanese Society for Transplantation and Cellular Therapy.Transplant Cell Ther. 2022 03;28(3):153.e1-153.e11.Previous Japanese studies have shown that bone marrow transplantation (BMT) is associated with better survival compared with peripheral blood stem cell transplantation (PBSCT) from a matched related donor (MRD). PBSCT recipients have shown higher incidences of severe graft-versus-host disease (GVHD) and nonrelapse mortality (NRM) compared with BMT recipients. In recent years, the efficacy and safety of antithymocyte globulin (ATG) for PBSCT recipients has been evaluated worldwide. In the present study, we aimed to compare BMT and PBSCT recipients to identify current improvements and unmet needs among MRD PBSCT recipients. In addition, we evaluated the impact of ATG administration on the outcomes of PBSCT recipients. We retrospectively analyzed patients age ≥16 years with acute leukemia, myelodysplastic syndrome, or chronic myelogenous leukemia who underwent their first BMT or PBSCT from an MRD between 2009 and 2018 in Japan. A total of 3599 transplantations were performed (BMT, n = 1218; PBSCT without ATG [PBSCT-ATG(-)], n = 2288; PBSCT with ATG [PBSCT-ATG(+)], n = 93). The PBSCT-ATG(-) group had a higher NRM (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.08 to 1.57; P = .005) and lower overall survival (OS) (HR, 1.16; 95% CI, 1.04 to 1.30; P = .011) compared with the BMT group. Furthermore, the PBSCT-ATG(-) group had higher incidences of grade III-IV, stage 2-4 gut, high-risk, and steroid-refractory acute GVHD compared with the BMT group. Acute GVHD had a negative impact on NRM and OS. The PBSCT-ATG(-) group also was associated with an elevated risk of chronic GVHD (HR, 1.89; 95% CI, 1.24 to 2.57; P < .001) and extensive chronic GVHD (HR, 1.44; 95% CI, 1.23 to 1.68; P < .001). The incidences of acute GVHD, chronic GVHD, and NRM and chronic GVHD-free relapse-free survival rates were comparable between the PBSCT-ATG(+) and BMT groups. The OS of patients with acute GVHD was similar in the 3 donor groups. Patients treated with reduced-intensity conditioning in the PBSCT-ATG(+) group had a higher relapse rate and lower OS rate compared with those in the BMT group. In this Japanese cohort, standard calcineurin inhibitor-based GVHD prophylaxis was not sufficient for recipients of MRD PBSCT because of the high incidence of severe acute GVHD. Prophylactic ATG was found to be a promising strategy against GVHD.
- ArticleKorkutata M, Saitoh T, Cherasse Y, Ioka S, Duo F, Qin R, Murakoshi N, Fujii S, Zhou X, Sugiyama F, Chen JF, Kumagai H, Nagase H, Lazarus M.Neuropharmacology. 2019 Jul 15;153:153.
- ArticleRoyer CP, Schweiger C, Manica D, Rabaioli L, Guerra V, Sbruzzi G.Sleep Med. 2019 01;53:153-164.OBJECTIVE: To systematically review the effects of bilevel ventilatory support (BVS) in patients with Obesity Hypoventilation Syndrome (OHS).
METHODS: A search of databases (MEDLINE accessed by PubMed, Cochrane CENTRAL, EMBASE and LILACS) was conducted from inception to June 2018. Randomized trials comparing BVS to other therapeutic modalities such as lifestyle counseling, continuous positive airway pressure (PAP) or BVS with average volume assured pressure support for the treatment of patients with OHS were included. The primary outcome was a change in daytime arterial carbon dioxide levels (PaCO2). Secondary outcome measures included arterial partial pressure of oxygen (PaO2), blood bicarbonate (HCO3), percentage of total sleep time (TST) with oxygen saturation <90%, transcutaneous pressure of carbon dioxide (PtcCO2), Epworth Sleepiness Scale (ESS), Medical Outcome Survey Short Form (SF36), Functional Outcomes of Sleep Questionnaire (FOSQ), Severe Respiratory Insufficiency Questionnaire (SRI), compliance with treatment, and weight loss.
RESULTS: Of 176 articles identified, seven studies were included. When BVS was compared to lifestyle counseling, the intervention was superior in improving PaCO2 (-2.90 mmHg; 95%CI -4.28 to -1.52), PaO2 (2.89 mmHg; 95%CI 0.33 to 5.46), HCO3 (-2.55 mmol/L; 95%CI -3.28 to -1.81), percentage of TST<90% (-30.55%; 95%CI -37.98 to -23.12), ESS (-2.52; 95%CI -4.16 to -0.88) and FOSQ (6.33; 95%CI 1.78 to 10.88). However, when BVS was compared to other PAP modalities, there was no difference in any of the outcomes evaluated.
CONCLUSIONS: Treatment using BVS therapy is superior to lifestyle counseling. Different PAP modalities appear to be equally effective in improving outcomes. CRD42017065326. - ArticleJiang SJ, Zhang X, Ma Y, Tuo Y, Qian F, Fu W, Mu G.Carbohydr Polym. 2016 Nov 20;153:153-159.Edible composite packaging has the advantage of complementary functional properties over its each bio-components. However, reports on whey protein concentrates (WPC)-carboxymethylated chitosan (CMC) composite films have not yet been released. To investigate the preparation of WPC-CMC composite films and its functional properties, four types of WPC-CMC composite films were prepared with and without Transglutaminase (TGase) treatment by mixing WPC aqueous solutions (10%, w/v) with CMC aqueous solutions (3%, w/v) at WPC to CMC volume ratios of (100:0), (75:25), (50:50), and (25:75). SDS-PAGE confirmed that TGase catalyzed crosslinking of whey protein. Results revealed that CMC incorporation conferred a smooth and even surface microstructure on the films and markedly improved the transparency, water barrier properties, mechanical properties and solubility of the composite film. Furthermore, TGase resulted in an improvement in the water vapor barrier properties and mechanical properties of WPC-CMC (75:25 and 50:50, v/v) composite films, and there was no impairment of thermal stability of composite films. Therefore, TGase successfully facilitated the formation of WPC-CMC composite films with some improved functional properties. This offers potential applications as an alternative approach to the preparation of edible packaging films.
- ArticleButler C, Adamowski J.J Environ Manage. 2015 Apr 15;153:153-62.Within the field of water resource management, Group Model Building (GMB) is a growing method used to engage stakeholders in the development of models that describe environmental and socioeconomic systems to create and test policy alternatives. While there is significant focus on improving stakeholder engagement, there is a lack of studies specifically looking at the experiences of marginalized communities and the barriers that prevent their fuller participation in the decision-making process. This paper explores the common issues and presents recommended improved practices, based on anti-oppression, related to the stages of problem framing, stakeholder identification and selection, workshop preparation, and workshop facilitation. For problem defining and stakeholder selection, the major recommendations are to engage diverse stakeholder communities from the earliest stages and give them control over framing the project scope. With regards to planning the model building workshops, it is recommended that the facilitation team work closely with marginalized stakeholders to highlight and address barriers that would prevent their inclusion. With the actual facilitation of the workshops, it is best to employ activities that allow stakeholders to provide knowledge and input in mediums that are most comfortable to them; additionally, the facilitation team needs to be able to challenge problematic interpersonal interactions as they manifest within conversations. This article focuses on building comfortability with political language so that the systemic oppression in which existing participatory processes occur can be understood, thus allowing GMB practitioners to engage in social justice efforts.
- ArticleNuber-Champier A, Cionca A, Breville G, Voruz P, de Alcântara IJ, Allali G, Lalive PH, Benzakour L, Lövblad KO, Braillard O, Nehme M, Coen M, Serratrice J, Reny JL, Pugin J, Guessous I, Landis BN, Griffa A, De Ville DV, Assal F, Péron JA.Psychoneuroendocrinology. 2023 07;153:106104.BACKGROUND: A neurocognitive phenotype of post-COVID-19 infection has recently been described that is characterized by a lack of awareness of memory impairment (i.e., anosognosia), altered functional connectivity in the brain's default mode and limbic networks, and an elevated monocyte count. However, the relationship between these cognitive and brain functional connectivity alterations in the chronic phase with the level of cytokines during the acute phase has yet to be identified.
AIM: Determine whether acute cytokine type and levels is associated with anosognosia and functional patterns of brain connectivity 6-9 months after infection.
METHODS: We analyzed the predictive value of the concentration of acute cytokines (IL-1RA, IL-1β, IL-6, IL-8, IFNγ, G-CSF, GM-CSF) (cytokine panel by multiplex immunoassay) in the plasma of 39 patients (mean age 59 yrs, 38-78) in relation to their anosognosia scores for memory deficits via stepwise linear regression. Then, associations between the different cytokines and brain functional connectivity patterns were analyzed by MRI and multivariate partial least squares correlations for the whole group.
RESULTS: Stepwise regression modeling allowed us to show that acute TNFα levels predicted (R2 = 0.145; β = -0.38; p = .017) and were associated (r = -0.587; p < .001) with scores of anosognosia for memory deficits observed 6-9 months post-infection. Finally, high TNFα levels were associated with hippocampal, temporal pole, accumbens nucleus, amygdala, and cerebellum connectivity.
CONCLUSION: Increased plasma TNFα levels in the acute phase of COVID-19 predict the presence of long-term anosognosia scores and changes in limbic system functional connectivity.