Pedro R. Almeida

Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis of Type 1 Cardio-Renal Syndrome in the General Ward

BACKGROUND AND OBJECTIVES The early identification of acute heart failure (HF) patients with type 1 cardio-renal syndrome should be the first step for developing prevention and treatment strategies for these patients. This study aimed to assess the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in the early detection of type 1 cardio-renal syndrome in patients with acute HF. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS One-hundred nineteen patients admitted with acute HF were studied. NGAL and creatinine were measured in the first hospitalization morning; creatinine was also measured at least after 48 to 72 hours. Physicians were blinded to NGAL and cystatin C levels. Type 1 cardio-renal syndrome was defined as an increase in the creatinine level of at least 0.3 mg/dl or 50% of basal creatinine. RESULTS Type 1 cardio-renal syndrome developed within 48 to 72 hours in 14 patients (11.8%). Admission NGAL levels were higher in these patients: 212 versus 83 ng/dl. At a cutoff value of 170 ng/L, NGAL determined type 1 cardio-renal syndrome with a sensitivity of 100% and a specificity of 86.7%. The area under the receiver-operating characteristic curve of NGAL was 0.93 and that of cystatin C was 0.68. CONCLUSIONS Above a cutoff value of 170 ng/L, NGAL predicts 48- to 72-hour development of type 1 cardio-renal syndrome with a negative predictive value of 100% and a positive predictive value of 50%. NGAL independently associates with type 1 cardio-renal syndrome and might be a useful biomarker in the early recognition of these patients.

Prognostic value of neutrophil gelatinase-associated lipocalin in acute heart failure

BACKGROUND The identification of patients at risk for worse outcome is still a challenge. We hypothesized that cystatin C, a marker of renal function, and neutrophil gelatinase-associated lipocalin (NGAL), a marker of acute renal injury, would have a role in the prognostic stratification of these patients. METHODS We prospectively evaluated 121 patients admitted for acute HF. Serum NGAL and cystatin C levels were measured on the first morning after admission. The outcome measures used were the occurrence of death from all causes, and the combined endpoint defined as the first occurrence of either death or hospital admission. Patients were followed for up to 3 months. RESULTS The variables associated with a higher occurrence of death in a univariate approach were older age and higher levels of BNP, cystatin C and NGAL, and those associated with the occurrence of the combined endpoint were older age, Diabetes mellitus, lower GFR, type 1 cardio-renal syndrome, BNP, cystatin C and NGAL. BNP and NGAL remained independent predictors of the occurrence of both all-cause death and the combined endpoint. NGAL levels in the 75th percentile (>167.5 ng/mL) were associated with a 2.7-fold increase in the risk of death and a 2.9-fold increase in the risk of the first occurrence of either death or hospitalization. CONCLUSIONS Serum NGAL, a marker of acute renal injury, is an independent predictor of worse short term prognosis in patients with acute HF. This suggests a role of renal damage, apart from renal function, in the prognosis of these patients.

The auditory P200 is both increased and reduced in schizophrenia? A meta-analytic dissociation of the effect for standard and target stimuli in the oddball task

OBJECTIVE Conflicting reports of P200 amplitude and latency in schizophrenia have suggested that this component is increased, reduced or does not differ from healthy subjects. A systematic review and meta-analysis were undertaken to accurately describe P200 deficits in auditory oddball tasks in schizophrenia. METHODS A systematic search identified 20 studies which were meta-analyzed. Effect size (ES) estimates were obtained: P200 amplitude and latency for target and standard tones at midline electrodes. RESULTS The ES obtained for amplitude (Cz) for standard and target stimuli indicate significant effects in opposite directions: standard stimuli elicit smaller P200 in patients (d = -0.36; 95% CI [-0.26, -0.08]); target stimuli elicit larger P200 in patients (d = 0.48; 95% CI [0.16, 0.82]). A similar effect occurs for latency at Cz, which is shorter for standards (d = -0.32; 95% CI [-0.54, -0.10]) and longer for targets (d = 0.42; 95% CI [0.23, 0.62]). Meta-regression analyses revealed that samples with more males show larger ES for amplitude of target stimuli, while the amount of medication was negatively associated with the ES for the latency of standards. CONCLUSIONS The results obtained suggest that claims of reduced or augmented P200 in schizophrenia based on the sole examination of standard or target stimuli fail to consider the stimulus effect. SIGNIFICANCE Quantification of effects for standard and target stimuli is a required first step to understand the nature of P200 deficits in schizophrenia.

Distinct neural activation patterns underlie economic decisions in high and low psychopathy scorers

Psychopathic traits affect social functioning and the ability to make adaptive decisions in social interactions. This study investigated how psychopathy affects the neural mechanisms that are recruited to make decisions in the ultimatum game. Thirty-five adult participants recruited from the community underwent functional magnetic resonance imaging scanning while they performed the ultimatum game under high and low cognitive load. Across load conditions, high psychopathy scorers rejected unfair offers in the same proportion as low scorers, but perceived them as less unfair. Among low scorers, the perceived fairness of offers predicted acceptance rates, whereas in high scorers no association was found. Imaging results revealed that responses in each group were associated with distinct patterns of brain activation, indicating divergent decision mechanisms. Acceptance of unfair offers was associated with dorsolateral prefrontal cortex activity in low scorers and ventromedial prefrontal cortex activity in high scorers. Overall, our findings point to distinct motivations for rejecting unfair offers in individuals who vary in psychopathic traits, with rejections in high psychopathy scorers being probably induced by frustration. Implications of these results for models of ventromedial prefrontal cortex dysfunction in psychopathy are discussed.

Dissociable effects of psychopathic traits on cortical and subcortical visual pathways during facial emotion processing: An ERP study on the N170

This study examined the relation between psychopathic traits and the brain response to facial emotion by analyzing the N170 component of the ERP. Fifty-four healthy participants were assessed for psychopathic traits and exposed to images of emotional and neutral faces with varying spatial frequency content. The N170 was modulated by the emotional expressions, irrespective of psychopathic traits. Fearless dominance was associated with a reduced N170, driven by the low spatial frequency components of the stimuli, and dependent on the tectopulvinar visual pathway. Conversely, coldheartedness was related to overall enhanced N170, suggesting mediation by geniculostriate processing. Results suggest that different dimensions of psychopathy are related to distinct facial emotion processing mechanisms and support the existence of both amygdala deficits and compensatory engagement of cortical structures for emotional processing in psychopathy.

Perceived arousal of facial expressions of emotion modulates the N170, regardless of emotional category: Time domain and time–frequency dynamics

Findings concerning the emotional modulation of the N170 component of the visual event-related potential are mixed. In the present report we tested the hypothesis that the emotional modulation of the N170 may be driven by the perceived emotional arousal of the stimuli, rather than by specific emotional categories. Fifty-four participants viewed facial expressions of anger, disgust, fear and happiness, plus low arousal neutral faces. All emotional categories were matched in arousal, while stimuli within each category varied parametrically in this dimension. The modulation of the electrocortical activity on the N170 time-window was analyzed in the time domain and via time-frequency decomposition. The effects of emotion and arousal were analyzed separately. In the time domain N170 amplitudes co-varied parametrically with perceived arousal, regardless of emotional category. This modulation was linearly associated with the power of the theta, alpha, and beta frequency bands. Moreover, fear was associated with a trend for increased N170 amplitudes, enhanced alpha power, and increased broad band inter-trial phase coherence. These results support the views that a) the activity in N170 time window is fundamentally modulated by perceived arousal, b) the modulation of the N170 may be the product of an increased evoked response, rather than the result of phase resetting processes, and c) facial expressions of fear retain some processing primacy, that may be related to their increased value as environmental cues.

Effects of inter-stimulus interval (ISI) duration on the N1 and P2 components of the auditory event-related potential

The N1 and P2 components of the event-related potential are relevant markers in the processing of auditory information, indicating the presence of several acoustic phenomena, such as pure tones or speech sounds. In addition, the expression of these components seems to be sensitive to diverse experimental variations. The main purpose of the present investigation was to explore the role of inter-stimulus interval (ISI) on the N1 and P2 responses, considering two widely used experimental paradigms: a single tone task (1000 Hz sound repeated in a fixed rhythm) and an auditory oddball (80% of the stimuli were equal to the sound used in the single tone and the remaining were a 1500 Hz tone). Both tasks had four different conditions, and each one tested a fixed value of ISI (600, 1000, 3000, or 6000 ms). A sample of 22 participants performed these tasks, while an EEG was recorded, in order to examine the maximum amplitude of the N1 and P2 components. Analysis of the stimuli in the single tone task and the frequent tones in the oddball task revealed a similar outcome for both tasks and for both components: N1 and P2 amplitudes were enhanced in conditions with longer ISIs regardless of task. This response pattern emphasizes the dependence of both the N1 and P2 components on the ISI, especially in a scenario of repetitive and regular stimulation. The absence of task effects suggests that the ISI effect reported may depend on refractory mechanisms rather than being due to habituation effects.

Psychopathic traits are associated with cortical and subcortical volume alterations in healthy individuals

Research suggests psychopathy is associated with structural brain alterations that may contribute to the affective and interpersonal deficits frequently observed in individuals with high psychopathic traits. However, the regional alterations related to different components of psychopathy are still unclear. We used voxel-based morphometry to characterize the structural correlates of psychopathy in a sample of 35 healthy adults assessed with the Triarchic Psychopathy Measure. Furthermore, we examined the regional grey matter alterations associated with the components described by the triarchic model. Our results showed that, after accounting for variation in total intracranial volume, age and IQ, overall psychopathy was negatively associated with grey matter volume in the left putamen and amygdala. Additional regression analysis with anatomical regions of interests revealed total triPM score was also associated with increased lateral orbitofrontal cortex (OFC) and caudate volume. Boldness was positively associated with volume in the right insula. Meanness was positively associated with lateral OFC and striatum volume, and negatively associated with amygdala volume. Finally, disinhibition was negatively associated with amygdala volume. Results highlight the contribution of both subcortical and cortical brain alterations for subclinical psychopathy and are discussed in light of prior research and theoretical accounts about the neurobiological bases of psychopathic traits.

Prognostic Significance of Applying the European Society of Cardiology Consensus Algorithm for Heart Failure With Preserved Systolic Function Diagnosis

The diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) is challenging. Although diagnostic criteria have been proposed, limited information exists concerning its implication on prognosis. We aimed to evaluate the prognostic significance of applying the European Society of Cardiology algorithm for HFpEF diagnosis, namely the tissue Doppler imaging information, in patients with acute heart failure (HF).

Exploring the dynamics of P300 amplitude in patients with schizophrenia

This study investigated the time-frequency dynamics of P300 generation in patients with first-onset schizophrenia. A group of 40 patients with first-onset schizophrenia and 40 controls performed an auditory oddball task. Wavelet analysis of the single-trial data was used to compute the Event-Related Spectral Perturbation (ERSP) and the Inter-Trial Phase Coherence (ITC) for the delta, theta, alpha, beta and gamma bands on the 50ms window around peak P300 amplitude. The contribution of power and synchrony for P300 amplitudes was studied through correlation and regression analysis. Further, two sub-samples in which patients had lower or higher P300 amplitudes than their control match were contrasted. P300 amplitude did not differ between patients and controls. The frequency domain analysis revealed that controls display larger reductions on gamma power than patients. However, this gamma activity might be the result of micro-saccadic muscular artifacts. Regression analysis shows that P300 amplitude is highly dependent on delta power and synchronization. The analysis of the subsamples confirmed that while gamma power differences are dependent on the diagnosis, delta and theta synchronization are related to P300 amplitude, irrespective of diagnosis.