Network-targeted cerebellar transcranial magnetic stimulation improves attentional control.

Developing non-invasive brain stimulation interventions to improve attentional control is extremely relevant to a variety of neurological and psychiatric populations, yet few studies have identified reliable biomarkers that can be readily modified to improve attentional control. One potential biomarker of attention is functional connectivity in the core cortical network supporting attention - the dorsal attention network (DAN). We used a network-targeted cerebellar transcranial magnetic stimulation (TMS) procedure, intended to enhance cortical functional connectivity in the DAN. Specifically, in healthy young adults we administered intermittent theta burst TMS (iTBS) to the midline cerebellar node of the DAN and, as a control, the right cerebellar node of the default mode network (DMN). These cerebellar targets were localized using individual resting-state fMRI scans. Participants completed assessments of both sustained (gradual onset continuous performance task, gradCPT) and transient attentional control (attentional blink) immediately before and after stimulation, in two sessions (cerebellar DAN and DMN). Following cerebellar DAN stimulation, participants had significantly fewer attentional lapses (lower commission error rates) on the gradCPT. In contrast, stimulation to the cerebellar DMN did not affect gradCPT performance. Further, in the DAN condition, individuals with worse baseline gradCPT performance showed the greatest enhancement in gradCPT performance. These results suggest that temporarily increasing functional connectivity in the DAN via network-targeted cerebellar stimulation can enhance sustained attention, particularly in those with poor baseline performance. With regard to transient attention, TMS stimulation improved attentional blink performance across both stimulation sites, suggesting increasing functional connectivity in both networks can enhance this aspect of attention. These findings have important implications for intervention applications of TMS and theoretical models of functional connectivity.

Frontal eye field involvement in sustaining visual attention: evidence from transcranial magnetic stimulation.

The frontal eye field (FEF), particularly the right FEF, is broadly implicated in top-down control of transient acts of attention, but less is known about its involvement in sustained attention. Although neuroimaging studies of sustained attention tasks commonly find FEF activation, it is unclear how this region contributes to moment-to-moment fluctuations in sustained performance. We sought to determine if the FEF plays a critical role in sustained attention, and if that role differs between periods of worse performance (out-of-the-zone) and periods of better performance (in-the-zone). We used offline 1 Hz repetitive transcranial magnetic stimulation (TMS) to temporarily attenuate either right or left FEF excitability while participants performed a go/no-go sustained attention task (the gradual onset continuous performance task). The results demonstrate that following TMS to the right FEF, sustained attention during in-the-zone periods significantly worsened both in terms of lower accuracy and increased reaction time variability. In contrast, applying TMS to the left FEF did not significantly affect accuracy or variability. These results demonstrate that the right FEF plays a crucial role in supporting optimal sustained attention.

Prognostic influence of an early time to chemotherapy following primary cytoreductive surgery for advanced epithelial ovarian cancer.

OBJECTIVE: The current investigation analyzes the prognostic role of the time to chemotherapy (TTC) interval following primary cytoreductive surgery for patients with advanced epithelial ovarian cancer. METHODS: Characteristics and outcome data for 509 consecutive patients with stage IIIB-IVB ovarian, fallopian tube, and peritoneal cancer who had primary cytoreductive surgery between January 2000 and December 2019 are utilized. A univariate Cox regression determined the association of categorical variables with progression-free survival (PFS) and overall survival (OS). Significant variables (p≤0.05) on univariate analysis were applied to Cox proportional hazard regression. RESULTS: The median TTC was 19 days and overall follow-up was 62.2 months. The PFS and OS were 25.5 months and 78.4 months for the study cohort plus 28.4 months and OS 84.5 months for patients rendered grossly disease-free. An early TTC (7-14 vs. 15-21 vs. 22-28 vs. >28 days) was associated with an improved PFS (41.7 vs. 30.6 vs. 18.9 vs. 17.9 months; p<0.001) and OS (132.7 vs. 104.6 vs. 56.5 vs. 48.0 months; p<0.001). The performance status, histology, disease distribution, dimension of residual disease, and categorical plus continuous TTC were predictors of PFS and OS. The use of maintenance therapy was also a predictor of PFS, and the route of chemotherapy administration was a predictor of OS. CONCLUSIONS: For advanced epithelial ovarian cancer, a TTC of less than 21-days was observed to independently improve the PFS and OS. A 7-14 days TTC trended towards a further extension of the OS.

Correction: Gender Differences in Sustained Attentional Control Relate to Gender Inequality across Countries.

[This corrects the article DOI: 10.1371/journal.pone.0165100.].

Gender Differences in Sustained Attentional Control Relate to Gender Inequality across Countries.

Sustained attentional control is critical for everyday tasks and success in school and employment. Understanding gender differences in sustained attentional control, and their potential sources, is an important goal of psychology and neuroscience and of great relevance to society. We used a large web-based sample (n = 21,484, from testmybrain.org) to examine gender differences in sustained attentional control. Our sample included participants from 41 countries, allowing us to examine how gender differences in each country relate to national indices of gender equality. We found significant gender differences in certain aspects of sustained attentional control. Using indices of gender equality, we found that overall sustained attentional control performance was lower in countries with less equality and that there were greater gender differences in performance in countries with less equality. These findings suggest that creating sociocultural conditions which value women and men equally can improve a component of sustained attention and reduce gender disparities in cognition.