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Silva, Claudio

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Silva

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Claudio

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End date: 2024 × Start date: 2022 ×

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    A real-time fMRI neurofeedback system for the clinical alleviation of depression with a subject-independent classification of brain states: A proof of principle study
    (2022) Pereira, Jaime A.; Ray, Andreas; Rana, Mohit; Silva, Claudio; Salinas, César; Zamorano, Francisco; Irani, Martín; Opazo, Patricia; Sitaram, Ranganatha; Ruíz, Sergio
    Most clinical neurofeedback studies based on functional magnetic resonance imaging use the patient's own neural activity as feedback. The objective of this study was to create a subject-independent brain state classifier as part of a real-time fMRI neurofeedback (rt-fMRI NF) system that can guide patients with depression in achieving a healthy brain state, and then to examine subsequent clinical changes. In a first step, a brain classifier based on a support vector machine (SVM) was trained from the neural information of happy autobiographical imagery and motor imagery blocks received from a healthy female participant during an MRI session. In the second step, 7 right-handed female patients with mild or moderate depressive symptoms were trained to match their own neural activity with the neural activity corresponding to the “happiness emotional brain state” of the healthy participant. The training (4 training sessions over 2 weeks) was carried out using the rt-fMRI NF system guided by the brain-state classifier we had created. Thus, the informative voxels previously obtained in the first step, using SVM classification and Effect Mapping, were used to classify the Blood-Oxygen-Level Dependent (BOLD) activity of the patients and converted into real-time visual feedback during the neurofeedback training runs. Improvements in the classifier accuracy toward the end of the training were observed in all the patients [Session 4–1 Median = 6.563%; Range = 4.10–27.34; Wilcoxon Test (0), 2-tailed p = 0.031]. Clinical improvement also was observed in a blind standardized clinical evaluation [HDRS CE2-1 Median = 7; Range 2 to 15; Wilcoxon Test (0), 2-tailed p = 0.016], and in self-report assessments [BDI-II CE2-1 Median = 8; Range 1–15; Wilcoxon Test (0), 2-tailed p = 0.031]. In addition, the clinical improvement was still present 10 days after the intervention [BDI-II CE3-2_Median = 0; Range −1 to 2; Wilcoxon Test (0), 2-tailed p = 0.50/ HDRS CE3-2 Median = 0; Range −1 to 2; Wilcoxon Test (0), 2-tailed p = 0.625]. Although the number of participants needs to be increased and a control group included to confirm these findings, the results suggest a novel option for neural modulation and clinical alleviation in depression using noninvasive stimulation technologies.
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    Consenso de recomendaciones para tamizaje del cáncer pulmonar en Chile
    (2024) Suárez, Francisco; Saavedra, María; Roberti, Javier; Boyeras, Iris; Seijo, Mariana; Rodríguez, Ana; Silva, Claudio; Verdugo, Jaime; Sánchez, Felipe; Solé, Claudio; Valenzuela, Rubén; Jalilie, Alfredo; García, Ezequiel
    Aim: This initiative aimed to develop recommendations for lung cancer screening in Chile through an expert consensus process. Methods: A mixed approach was used in this study. A literature review was conducted to identify recommendations. A group of 18 Chilean experts was selected to form the Delphi panel. The RAND/UCLA method and evidence-based decision-making criteria were used to guide the evaluation process. Three rounds of voting and one synchronous meeting were conducted. Results: Following a literature review and expert evaluation, 25 recommendations relevant to lung cancer screening in Chile were selected. These recommendations cover the selection of the target population, the frequency and duration of the program, and the implementation and characteristics of the programs and the health institutions that would host them. Discussion: Experts expressed concerns about the feasibility and acceptability of implementing screening programs in the local context, noting possible barriers, such as lack of awareness and costs. Local evidence needs to be generated to address the regional particularities and ensure the feasibility and effectiveness of lung cancer screening programs in Chile. Objetivo: El objetivo de este estudio es desarrollar recomendaciones para el tamizaje del cáncer pulmonar (CP) en Chile mediante un proceso de consenso de expertos. Método: Se implementó un enfoque mixto. Se realizó una revisión de literatura para identificar posibles recomendaciones y luego se seleccionó un grupo de 18 expertos chilenos que conformaron un panel Delphi. Se utilizó el método RAND/UCLA y los criterios de Evidencia a Decisión para guiar el proceso de evaluación. Se realizaron tres rondas de votación y una reunión sincrónica. Resultados: Tras la revisión de la literatura y la evaluación por parte de expertos, se seleccionan 25 recomendaciones pertinentes para el tamizaje de CP en Chile. Estas recomendaciones abarcan la selección de la población objetivo, la frecuencia y duración del programa, la implementación y características de los programas y las instituciones de salud que los albergarían. Discusión: Los expertos expresan preocupaciones sobre la factibilidad y aceptabilidad de implementar programas de tamizaje en el contexto local, señalando posibles barreras como la falta de concientización y los costos. Es necesario generar evidencia local para abordar las particularidades regionales y garantizar la viabilidad y eficacia de los programas de tamizaje de CP en Chile.

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