Search

Introduction: Valvular diseases, especially Mitral regurgitation (MR) confer a high cardiovascular burden in cancer survivors. Transcatheter Edge-to-Edge Repair (TEER) with the MitraClip TM system has shown promising results in the management of severe MR regardless of etiology. However, little is known about the impact of cancer history on patient outcomes. Methods: We studied 456 consecutive patients (cancer: 86; non-cancer: 370) with severe mitral regurgitation who underwent mitral valve TEER at our institution from 2005 to 2020. In addition to pre-and post-procedural characteristics, we examined imaging parameters and outcome data including all-cause mortality. We used Cox regression analysis to identify factors associated with mortality. Results: Patients were followed for a mean of 9.2 months (SD 19). Table 1 shows the baseline and follow-up characteristics for both groups. At 1-year follow-up, only 4 (5%) cancer survivors and 23 (6%) non-cancer patients had died. In a Cox regression analysis, short-term (0.05). Age and sex were also not significantly associated with mortality (p>0.05). In subgroup analyses, at 1-year follow-up, cancer survivors who had received prior radiation therapy were more likely to have died (11% vs 0; X2=5.07, p=0.024) and cancer survivors with solid tumors were more likely to have an NYHA functional class III-IV at 1-year follow-up than those with hematologic malignancies (X2=4.75, p=0.029). Conclusions: In this large retrospective study, short- and long-term all-cause mortality after mitral valve TEER were similar in both cancer survivors and non-cancer patients. Prior radiation therapy and history of solid tumors may be poor prognostic markers.

Background: There have been significant challenges in understanding functional brain connectivity associated with adolescent depression, including the need for a more comprehensive approach to defining risk, the lack of representation of participants from low- and middle-income countries, and the need for network-based approaches to model connectivity. The current study aimed to address these challenges by examining resting-state functional connectivity of frontolimbic circuitry associated with the risk and presence of depression in adolescents in Brazil. Methods: Adolescents in Brazil ages 14 to 16 years were classified into low-risk, high-risk, and depressed groups using a clinical assessment and composite risk score that integrates 11 sociodemographic risk variables. After excluding participants with excessive head movement, resting-state functional magnetic resonance imaging data of 126 adolescents were analyzed. We compared group differences in frontolimbic network connectivity using region of interest–to–region of interest, graph theory, and seed-based connectivity analyses. Associations between self-reported depressive symptoms and brain connectivity were also explored. Results: Adolescents with depression showed greater dorsal anterior cingulate cortex (ACC) connectivity with the orbitofrontal cortex compared with the 2 risk groups and greater dorsal ACC global efficiency than the low-risk group. Adolescents with depression also showed reduced local efficiency and a lower clustering coefficient of the subgenual ACC compared with the 2 risk groups. The high-risk group also showed a lower subgenual ACC clustering coefficient relative to the low-risk group. Conclusions: These findings highlight altered connectivity and topology of the ACC within frontolimbic circuitry as potential neural correlates and risk factors of developing depression in adolescents in Brazil. This study broadens our understanding of the neural connectivity associated with adolescent depression in a global context.

Adolescents comprise one fourth of the world's population, with about 90% of them living in low- and middle-income countries (LMICs). The incidence of depression markedly increases during adolescence, making the disorder a leading cause of disease-related disability in this age group. However, most research on adolescent depression has been performed in high-income countries (HICs). To ascertain the extent to which this disparity operates in neuroimaging research, a systematic review of the literature was performed. A total of 148 studies were identified, with neuroimaging data available for 4,729 adolescents with depression. When stratified by income group, 122 (82%) studies originated from HICs, while 26 (18%) were conducted in LMICs, for a total of 3,705 and 1,024 adolescents with depression respectively. A positive Spearman rank correlation was observed between country per capita income and sample size (rs=0.673, p = 0.023). Our results support the previous reports showing a large disparity between the number of studies and the adolescent population per world region. Future research comparing neuroimaging findings across populations from HICs and LMICs may provide unique insights to enhance our understanding of the neurobiological processes underlying the development of depression.

The review aims to summarize the present knowledge about cardiovascular toxicities associated with immune checkpoint inhibitors (ICI) and dissect underlying mechanism associated with individual cardiovascular toxicity. Widespread use of ICI therapy has allowed for increasing recognition of a wide spectrum of immune-related adverse events that leave all organ systems vulnerable. Immune-mediated cardiovascular toxicities, initially thought to be rare, are more often being reported and present considerable challenges due to their non-specific clinical presentation, potential to have a fulminant progression, and overlap with other cardiovascular and general medical illnesses. Myocarditis is the most common manifestation of ICI-associated cardiovascular toxicity. Pericardial diseases, vasculitis, Takotsubo syndrome, conduction abnormalities, and destabilization of atherosclerotic lesions constitute other significant adverse events. At this stage, mechanisms underlying fundamental biology of cardiac toxicity have not been studied comprehensively and there remain gaps of knowledge in the current literature concerning the underlying pathomechanisms. It is hypothesized that immune-mediated myocarditis is a result of an exaggerated adaptive immune response against shared epitopes in the myocardium and tumor cells. Further, underlying mechanism of other cardiovascular toxicities is still unclear, further compounded by sparsity of epidemiological data. It is paramount to understand the mechanisms behind ICI-induced cardiovascular toxicities to develop appropriate treatment and prevention strategies and minimize the morbidity and mortality of cancer patients undergoing ICI therapy.

Objective: To test the feasibility and to present preliminary results of a neuroimaging protocol to evaluate adolescent depression in a middle-income setting. Methods: We assessed psychotropic medication-free adolescents (age range 14-16 years) with a diagnosis of major depressive disorder (MDD). Participants underwent a comprehensive clinical evaluation and both structural and functional magnetic resonance imaging (fMRI). In this pilot study, a preliminary single-group analysis of resting-state fMRI (rs-fMRI) data was performed, with a focus on the default mode network (DMN), cognitive control network (CCN), and salience network (SN). Results: The sample included 29 adolescents with MDD (mean age 16.01, SD 0.78) who completed the protocol. Only two participants were excluded due to MRI quality issues (head movement), and were not included in the analyses. The scans showed significant connectivity between the medial prefrontal cortex and posterior cingulate cortex (DMN), the ACC and anterior insula (SN), and the lateral prefrontal cortex and dorsal parietal cortex (CCN). Conclusion: We demonstrated the feasibility of implementing a complex neuroimaging protocol in a middle-income country. Further, our preliminary rs-fMRI data revealed patterns of resting-state connectivity consistent with prior research performed in adolescents from high-income countries.

Although widely used for the treatment of attention-deficit/hyperactivity disorder (ADHD) across the life span, the effects of methylphenidate (MPH) on the brain are not completely understood. Functional neuroimaging techniques may help increase knowledge about the mechanisms of MPH action.To evaluate changes in functional connectivity patterns of the default mode network (DMN) in children with ADHD following long-term treatment with MPH.Twenty-three right-handed treatment-naïve boys with ADHD underwent a protocol of intrinsic functional connectivity before and after 6 months of treatment with MPH. Functional connectivity was analyzed using a region of interest (ROI) approach and independent component analysis (ICA).ROI analyses showed no significant changes in connectivity between regions of the DMN following treatment, with a relatively small increase in the anterior-posterior connectivity of the network. ICA revealed a significant increase in connectivity between the left putamen and the DMN (p 0.001, corrected). There was a correlation between the reduction of symptoms and the increased connectivity between the putamen and the DMN after treatment (rho = -0.65, p = 0.017).Dysfunctions in cortical-subcortical circuits have often been associated with the pathophysiology of ADHD. Our findings suggest that effective treatment with MPH in children with ADHD may affect brain functioning by increasing connectivity between the DMN and subcortical nuclei.