Coupled electrophysiological, hemodynamic, and cerebrospinal fluid oscillations in human sleep.

Science. 2019 Nov 1;366(6465):628-631. doi: 10.1126/science.aax5440.

Coupled electrophysiological, hemodynamic, and cerebrospinal fluid oscillations in human sleep.

Author information

1
Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
2
Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA.
3
Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.
4
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
5
Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
6
Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA. ldlewis@bu.edu.

Abstract

Sleep is essential for both cognition and maintenance of healthy brain function. Slow waves in neural activity contribute to memory consolidation, whereas cerebrospinal fluid (CSF) clears metabolic waste products from the brain. Whether these two processes are related is not known. We used accelerated neuroimaging to measure physiological and neural dynamics in the human brain. We discovered a coherent pattern of oscillating electrophysiological, hemodynamic, and CSF dynamics that appears during non-rapid eye movement sleep. Neural slow waves are followed by hemodynamic oscillations, which in turn are coupled to CSF flow. These results demonstrate that the sleeping brain exhibits waves of CSF flow on a macroscopic scale, and these CSF dynamics are interlinked with neural and hemodynamic rhythms.

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An elegy by Arthur Kleinman

THE LANCET PERSPECTIVES|THE ART OF MEDICINE| VOLUME 394, ISSUE 10199, P630-631, AUGUST 24, 2019

The soul in medicine

Beginning of article:

“When I was a child in New York City in the 1940s, the word “soul” was commonly invoked in school, in the neighbourhood, at home, and on the radio. Soul had a strong religious connotation, and was invoked regularly in the synagogue I attended as well as in the churches my late wife visited as a young girl. The social gospel orientation of many churches in African American communities would intensify its moral significance in the decades that followed. And soul as a lively, deep, and divided humanity in the writings of the early great civil rights activist W E B Du Bois continues to be relevant and resonant. But in recent decades, the term has largely declined in popular use in the USA.” […]

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Toward personalized cognitive diagnostics of at-genetic-risk Alzheimer’s disease

Toward personalized cognitive diagnostics of at-genetic-risk Alzheimer’s disease

Potential use of Big Data mined from a VR game for preclinical diagnostics…

Source: https://www.pnas.org/content/116/19/9285

Significance

We report that assessment of navigational behavior using the Sea Hero Quest app provides a means of discriminating healthy aging from genetically at-risk individuals of Alzheimer’s disease (AD). It further highlights that the global Sea Hero Quest database can be employed as a normative benchmark dataset to efficiently determine the significance of spatial abnormality suspected to be indicative of incipient AD on an individual level.

Abstract

Spatial navigation is emerging as a critical factor in identifying preclinical Alzheimer’s disease (AD). However, the impact of interindividual navigation ability and demographic risk factors (e.g., APOE, age, and sex) on spatial navigation make it difficult to identify persons “at high risk” of AD in the preclinical stages. In the current study, we use spatial navigation big data (n = 27,108) from the Sea Hero Quest (SHQ) game to overcome these challenges by investigating whether big data can be used to benchmark a highly phenotyped healthy aging laboratory cohort into high- vs. low-risk persons based on their genetic (APOE) and demographic (sex, age, and educational attainment) risk factors. Our results replicate previous findings in APOE ε4 carriers, indicative of grid cell coding errors in the entorhinal cortex, the initial brain region affected by AD pathophysiology. We also show that although baseline navigation ability differs between men and women, sex does not interact with the APOE genotype to influence the manifestation of AD-related spatial disturbance. Most importantly, we demonstrate that such high-risk preclinical cases can be reliably distinguished from low-risk participants using big-data spatial navigation benchmarks. By contrast, participants were undistinguishable on neuropsychological episodic memory tests. Taken together, we present evidence to suggest that, in the future, SHQ normative benchmark data can be used to more accurately classify spatial impairments in at-high-risk of AD healthy participants at a more individual level, therefore providing the steppingstone for individualized diagnostics and outcome measures of cognitive symptoms in preclinical AD.

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Whole-Body Cryotherapy a Hot New Treatment for Depression?

Whole-Body Cryotherapy a Hot New Treatment for Depression?

Liam Davenport

April 11, 2019

WARSAW, Poland — Adjunctive whole-body cryotherapy may convey added benefit in patients with depressive disorders, new research suggests.

This type of therapy, which involves subjecting the body to extremely low temperatures for short periods of time, is already used in rheumatoid and neurologic conditions, as well as for biological rejuvenation in athletes.

There is also a small, but growing, body of evidence that the technique may be used in mood disorders, potentially through the modulation of inflammatory or immunologic markers.

In the current randomized study of more than 50 patients already receiving treatment for depression, those exposed to “true cryotherapy” once daily for 10 days experienced significant improvements in depression scores and in measures of motivation, mood, and sleep quality compared with those exposed to low but non-cryotherapy temperatures.

These early results “are very promising and we think [cryotherapy] is worth further exploration” as an adjuvant treatment in depression, said Julia Rymaszewska, a student in the Psychiatry Department at Wrocław Medical University, Poland.

She presented the findings here at the European Psychiatric Association (EPA) 2019 Congress.

To test the use of cryotherapy in depression, the investigators initially assessed 117 patients with depressive disorder already receiving standard psychopharmacology therapy.

From these, 56 patients were randomly assigned to an experimental group
(n = 30) or a control group (n = 26).

Both groups underwent 2- to 3-minute sessions of whole-body cryotherapy once a day for 10 days. The experimental group was exposed to a true cryotherapy temperature of -110°C to -160°C (-166°F to -256°F), while the control group experienced a sham protocol with a temperature of -50°C (-58°F).

The participants completed the Beck Depression Inventory (BDI) and a visual analog scale assessing level of motivation, mood, and sleep quality before, during, and after the treatment period.

Patients who experienced true whole-body cryotherapy showed significant improvements on the BDI compared with the control group, who had relatively stable scores.

In particular, patients in the experimental group showed significant reductions in scores on both the cognitive-affective (P = .000) and the somatic (P = .028) BDI subscales.

Patients in the experimental group also reported significant increases in scores on the visual analog scale compared with those in the control group (P = .035), albeit with both groups showing improvements over the course of the study.

Feasible? Cost Effective?

Jessica Bone, a PhD candidate in the Division of Psychiatry, University College London, UK, chaired the poster presentation. She described the study as “intriguing” but was unsure as to the principle of how cryotherapy would work in depression.

“I would like to hear a bit more about the overall findings from the trial and see the results presented again in more detail,” she told Medscape Medical News.

Bone also expressed doubts over the cost effectiveness and feasibility of cryotherapy in this setting, wondering “therefore how practical it would be on a clinical level.”

Nevertheless, she said that the potential link with the inflammatory therapy of depression is “very interesting” and that “there is a lot more research to be done in that area.”

The study was supported by the Polish Ministry of Science and Higher Education. The study authors and Bone have disclosed no relevant financial relationships.

European Psychiatric Association (EPA) 2019 Congress: Poster EPA19-2584. Presented April 8, 2019.

May just Finnish sauna?

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Use of vitamin D drops leading to kidney failure in a 54-year-old man

Vitamin D supplementation plus sunbathing.

Use of vitamin D drops leading to kidney failure in a 54-year-old man

Bourne L. Auguste, Carmen Avila-Casado and Joanne M. Bargman
KEY POINTS

  • Vitamin D toxicity is rare, but clinicians must be aware of the risks of vitamin D use to limit complications related to hypercalcemia.

  • Calcium levels may get worse before getting better in patients even after cessation of supplements, as vitamin D is fat soluble.

  • Observational data and expert opinion suggest that glucocorticoids, ketoconazole and hydroxychloroquine are reasonable options to treat hypercalcemia related to vitamin D toxicity by decreasing the “active” 1, 25 dihydroxyvitamin D3 levels.

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