Personalized prediction of transcranial magnetic stimulation clinical response in patients with treatment-refractory depression using neuroimaging biomarkers and machine learning.

BACKGROUND: Functional connectivity between the left dorsolateral prefrontal cortex (DLPFC) and subgenual cingulate (sgACC) may serve as a biomarker for transcranial magnetic stimulation (rTMS) treatment response. The first aim was to establish whether this finding is veridical or artifactually induced by the pre-processing method. Furthermore, alternative biomarkers were identified and the clinical utility for personalized medicine was examined. METHODS: Resting-state fMRI data were collected in medication-refractory depressed patients (n = 70, 16 males) before undergoing neuronavigated left DLPFC rTMS. Seed-based analyses were performed with and without global signal regression pre-processing to identify biomarkers of short-term and long-term treatment response. Receiver Operating Characteristic curve and supervised machine learning analyses were applied to assess the clinical utility of these biomarkers for the classification of categorical rTMS response. RESULTS: Regardless of the pre-processing method, DLPFC-sgACC connectivity was not associated with treatment outcome. Instead, poorer connectivity between the sgACC and three clusters (peak locations: frontal pole, superior parietal lobule, occipital cortex) and DLPFC-central opercular cortex were observed in long-term nonresponders. The identified connections could serve as acceptable to excellent markers. Combining the features using supervised machine learning reached accuracy rates of 95.35% (CI=82.94-100.00) and 88.89% (CI=63.96-100.00) in the cross-validation and test dataset, respectively. LIMITATIONS: The sample size was moderate, and features for machine learning were based on group differences. CONCLUSIONS: Long-term nonresponders showed greater disrupted connectivity in regions involving the central executive network. Our findings may aid the development of personalized medicine for medication-refractory depression.

Staff exchange within and between nursing homes in The Netherlands and potential implications for MRSA transmission.

A recent countrywide MRSA spa-type 1081 outbreak in The Netherlands predominantly affected nursing homes, generating questions on how infection spreads within and between nursing homes despite a low national prevalence. Since the transfer of residents between nursing homes is uncommon in The Netherlands, we hypothesized that staff exchange plays an important role in transmission. This exploratory study investigated the extent of former (last 2 years) and current staff exchange within and between nursing homes in The Netherlands. We relied on a questionnaire that was targeted towards nursing-home staff members who had contact with residents. We found that 17·9% and 12·4% of the nursing-home staff formerly (last 2 years) or currently worked in other healthcare institutes besides their job in the nursing home through which they were selected to participate in this study. Moreover, 39·7% of study participants worked on more than one ward. Our study shows that, in The Netherlands, nursing-home staff form a substantial number of links between wards within nursing homes and nursing homes are linked to a large network of healthcare institutes through their staff members potentially providing a pathway for MRSA transmission between nursing homes and throughout the country.

[Ultrasonic doppler technique for microvascular bypass (author's transl)]. / Doppler-Sonographie bei mikrovaskulärem Bypass

Following an operative microvascular extraintracranial bypass, 50 patients were re-examined by the ultrasonic Doppler technique. The findings were compared with the results achieved by post-operative angiography. This examination of the patency of extraintracranial anastomoses with the ultrasonic Doppler technique can be conducted on an outpatient basis, is noninvasive and can be frequently repeated. It has a high degree of accuracy (96%). In addition, there were indications that, in certain areas, a gauge could be established for the function of the anastomosis by comparing the amplitude indices from the bypass and the afferent vessels. Key-words: Ultrasonic Doppler technique - microvascular bypass - cerebral blood flow - cerebrovascular disorders

Clinical experience with automatic midline echoencephalography: cooperative study of three neurosurgical clinics.

Computerized midline echoencephalography was developed in order to make the determination of the midline more objective. In a group study involving the neurosurgical clinics in Berlin, Erlangen, and Munich, a total of 1,889 patients with various intracranial diseases was examined by this method. An exact analysis of the results obtained is presented: 18 percent were unsatisfactory.

[The advantages and limitations of an automatic ultrasound determination of the cerebral midline--a study of 1889 cases]. / Möglichkeiten und Grenzen einer automatisierten Mittellinienbestimmung bei der Ultraschalluntersuchung des Schädels--Eine Untersuchung von 1889 Fällen

The examination of the brain with ultrasound has become an indispensible diagnostic tool in all cases of intracranial pathology. Valuable information is obtained both in emergencies and in follow-up studies. Since long practice is necessary before the results of echoencephalograms can be interpreted accurately, a need was felt for a standardization of the examination which would eliminate the subjective influence of the investigator. The automatic midline computer, called Midliner, which has recently become available, makes fewer demands on the experience of the investigator although the diagnostic possibilities are not as broad. The position of the midline echo is of primary interest, although the width of the third ventricle can be successfully determined in occasional cases. this study, which presents the results of the Midliner examinations in three clinics, is grouped according to diagnosis. Through a comparison with conventional A-scan echoencephalograms, as well as with neuroradiological and operative findings in 1889 cases, the reliability of this method is clearly demonstrated. The advantages and disadvantages of the examination are discussed and the field of application indicated.