Deriving and validating a protocol to determine the need for prophylactic peritoneal dialysis in neonates after cardiopulmonary bypass surgery.

BACKGROUND: Prophylactic peritoneal dialysis (PD) in neonates undergoing cardiopulmonary bypass (CPB) is safe and improves outcomes. We sought to (1) derive the pre-operative characteristics of neonates who are most likely to benefit from PD after CPB and (2) validate a new prophylactic PD protocol based on our retrospective analysis. METHODS: First, we retrospectively evaluated neonates requiring cardiac surgery with CPB from October 2012 to June 2016. We categorized neonates as those who "needed PD" and those who "did not need PD" based on prior experience with neonates requiring kidney support therapy. Pre-operative serum creatinine ≥ 0.8 mg/dL, pre-operative weight ≤ 2.5 kg, or having an open chest post-operatively were independently associated with "needed PD." Next, beginning in March 2019, we implemented a new prophylactic PD protocol in which only those who met at least one of the three criteria derived in the retrospective analysis had a PD catheter placed in the OR. RESULTS: In Era 2, after the implementation of a new prophylactic PD protocol, 100% of neonates in the "needed PD" group had a PD catheter placed in the OR, which was more than in the prior era (Era 1 = 86.6%) (p = 0.05). Only 26.1% in the "did not need PD" group had a PD catheter placed in the OR which was less than in the prior era (Era 1 = 50.6%) (p < 0.01). CONCLUSIONS: We successfully developed and implemented an evidence-based prophylactic PD protocol that has improved our ability to provide prophylactic PD in neonates after CPB.

Survival of Infants With Severe Congenital Kidney Disease After ECMO and Kidney Support Therapy.

Congenital kidney failure not only affects the homeostatic functions of the kidney, but also affects neonatal respiratory integrity. Until recently, extracorporeal membrane oxygenation (ECMO) support was not used in this population because the need for ECMO clearly established nonviability. Since 2016, 31 neonates have been admitted to the NICU at Children's of Alabama with congenital kidney failure. Five patients were placed on ECMO for severe respiratory distress unresponsive to conventional interventions. We evaluated neonates with congenital kidney failure and pulmonary hypoplasia/hypertension refractory to conventional therapies who received ECMO support within the first 9 postnatal days. We describe the pre and postnatal diagnoses, ECMO course details, dialysis modalities, complications, procedures, and long-term outcomes of these patients. All 5 patients received kidney support therapy by postnatal day 7. Diagnoses included posterior urethral valves, bilateral renal dysplasia, and autosomal recessive polycystic kidney disease. Gestational age ranged from 35.6 to 37.1 weeks. Birth weight ranged from 2740 to 3140 g. Days on ECMO ranged from 4 to 23. Four survived and are living today. Pulmonary hypertension resolved in surviving patients. Three surviving patients require no oxygen support, and 1 patient requires nocturnal oxygen. Three survivors received a kidney transplant, and 1 awaits transplant evaluation. Patients with congenital kidney failure with severe pulmonary hypoplasia/pulmonary hypertension no longer warrant a reflexive assignment of nonviability. Meticulous ECMO, respiratory, nutritional, and kidney support therapies may achieve a favorable long-term outcome. Further investigation of strategies for optimal outcome is needed.

Hemolytic Uremic Syndrome-Induced Acute Kidney Injury Treated via Immunomodulation with the Selective Cytopheretic Device.

INTRODUCTION: Shiga-toxin associated-hemolytic uremic syndrome (STEC-HUS) is a severe cause of acute kidney injury (AKI) in children. Although most children recover, about 5% die and 30% develop chronic renal morbidity. HUS pathophysiology includes activated neutrophils damaging vascular endothelial cells. Therapeutic immunomodulation of activated neutrophils may alter the progression of disease. We present 3 pediatric patients treated with the selective cytopheretic device (SCD). METHODS: We describe a 12 y.o. (patient 1) and two 2 y.o. twins (patients 2 and 3) with STEC-HUS requiring continuous renal replacement therapy (CRRT) who were enrolled in two separate studies of the SCD. RESULTS: Patient 1 presented with STEC-HUS causing AKI and multisystem organ failure and received 7 days of SCD and CRRT treatment. After SCD initiation, the patient had gradual recovery of multi-organ dysfunction, with normal kidney and hematologic parameters at 60-day follow-up. Patients 2 and 3 presented with STEC-HUS with AKI requiring dialysis. Each received 24 h of SCD therapy. Thereafter, both gradually improved, with normalization (patient 2) and near-normalization (patient 3) of kidney function at 60-day follow-up. CONCLUSION: Immunomodulatory treatment with the SCD was associated with improvements in multisystem stigmata of STEC-HUS-induced AKI and was well-tolerated without any device-related adverse events.

Input Complexity Affects Long-Term Retention of Statistically Learned Regularities in an Artificial Language Learning Task.

Statistical learning (SL) involving sensitivity to distributional regularities in the environment has been suggested to be an important factor in many aspects of cognition, including language. However, the degree to which statistically-learned information is retained over time is not well understood. To establish whether or not learners are able to preserve such regularities over time, we examined performance on an artificial second language learning task both immediately after training and also at a follow-up session 2 weeks later. Participants were exposed to an artificial language (Brocanto2), half of them receiving simplified training items in which only 20% of sequences contained complex structures, whereas the other half were exposed to a training set in which 80% of the items were composed of complex sequences. Overall, participants showed signs of learning at the first session and retention at the second, but the degree of learning was affected by the nature of the training they received. Participants exposed to the simplified input outperformed those in the more complex training condition. A GLMM was used to model the relationship between stimulus properties and participants' endorsement strategies across both sessions. The results indicate that participants in the complex training condition relied more on an item's chunk strength than those in the simple training condition. Taken together, this set of findings shows that statistically learned regularities are retained over the course of 2 weeks. The results also demonstrate that training on input featuring simple items leads to improved learning and retention of grammatical regularities.

The Relationship Between Artificial and Second Language Learning.

Artificial language learning (ALL) experiments have become an important tool in exploring principles of language and language learning. A persistent question in all of this work, however, is whether ALL engages the linguistic system and whether ALL studies are ecologically valid assessments of natural language ability. In the present study, we considered these questions by examining the relationship between performance in an ALL task and second language learning ability. Participants enrolled in a Spanish language class were evaluated using a number of different measures of Spanish ability and classroom performance, which was compared to IQ and a number of different measures of ALL performance. The results show that success in ALL experiments, particularly more complex artificial languages, correlates positively with indices of L2 learning even after controlling for IQ. These findings provide a key link between studies involving ALL and our understanding of second language learning in the classroom.

How inappropriate high-pass filters can produce artifactual effects and incorrect conclusions in ERP studies of language and cognition.

Although it is widely known that high-pass filters can reduce the amplitude of slow ERP components, these filters can also introduce artifactual peaks that lead to incorrect conclusions. To demonstrate this and provide evidence about optimal filter settings, we recorded ERPs in a typical language processing paradigm involving syntactic and semantic violations. Unfiltered results showed standard N400 and P600 effects in the semantic and syntactic violation conditions, respectively. However, high-pass filters with cutoffs at 0.3 Hz and above produced artifactual effects of opposite polarity before the true effect. That is, excessive high-pass filtering introduced a significant N400 effect preceding the P600 in the syntactic condition, and a significant P2 effect preceding the N400 in the semantic condition. Thus, inappropriate use of high-pass filters can lead to false conclusions about which components are influenced by a given manipulation. The present results also lead to practical recommendations for high-pass filter settings that maximize statistical power while minimizing filtering artifacts.

Linking neurogenetics and individual differences in language learning: the dopamine hypothesis.

Fundamental advances in neuroscience have come from investigations into neuroplasticity and learning. These investigations often focus on identifying universal principles across different individuals of the same species. Increasingly, individual differences in learning success have also been observed, such that any seemingly universal principle might only be applicable to a certain extent within a particular learner. One potential source of this variation is individuals' genetic differences. Adult language learning provides a unique opportunity for understanding individual differences and genetic bases of neuroplasticity because of the large individual differences in learning success that have already been documented, and because of the body of empirical work connecting language learning and neurocognition. In this article, we review the literature on the genetic bases of neurocognition, especially studies examining polymorphisms of dopamine (DA)-related genes and procedural learning. This review leads us to hypothesize that there may be an association between DA-related genetic variation and language learning differences. If this hypothesis is supported by future empirical findings we suggest that it may point to neurogenetic markers that allow for language learning to be personalized.

Second language processing shows increased native-like neural responses after months of no exposure.

Although learning a second language (L2) as an adult is notoriously difficult, research has shown that adults can indeed attain native language-like brain processing and high proficiency levels. However, it is important to then retain what has been attained, even in the absence of continued exposure to the L2--particularly since periods of minimal or no L2 exposure are common. This event-related potential (ERP) study of an artificial language tested performance and neural processing following a substantial period of no exposure. Adults learned to speak and comprehend the artificial language to high proficiency with either explicit, classroom-like, or implicit, immersion-like training, and then underwent several months of no exposure to the language. Surprisingly, proficiency did not decrease during this delay. Instead, it remained unchanged, and there was an increase in native-like neural processing of syntax, as evidenced by several ERP changes--including earlier, more reliable, and more left-lateralized anterior negativities, and more robust P600s, in response to word-order violations. Moreover, both the explicitly and implicitly trained groups showed increased native-like ERP patterns over the delay, indicating that such changes can hold independently of L2 training type. The results demonstrate that substantial periods with no L2 exposure are not necessarily detrimental. Rather, benefits may ensue from such periods of time even when there is no L2 exposure. Interestingly, both before and after the delay the implicitly trained group showed more native-like processing than the explicitly trained group, indicating that type of training also affects the attainment of native-like processing in the brain. Overall, the findings may be largely explained by a combination of forgetting and consolidation in declarative and procedural memory, on which L2 grammar learning appears to depend. The study has a range of implications, and suggests a research program with potentially important consequences for second language acquisition and related fields.

Explicit and implicit second language training differentially affect the achievement of native-like brain activation patterns.

It is widely believed that adults cannot learn a foreign language in the same way that children learn a first language. However, recent evidence suggests that adult learners of a foreign language can come to rely on native-like language brain mechanisms. Here, we show that the type of language training crucially impacts this outcome. We used an artificial language paradigm to examine longitudinally whether explicit training (that approximates traditional grammar-focused classroom settings) and implicit training (that approximates immersion settings) differentially affect neural (electrophysiological) and behavioral (performance) measures of syntactic processing. Results showed that performance of explicitly and implicitly trained groups did not differ at either low or high proficiency. In contrast, electrophysiological (ERP) measures revealed striking differences between the groups' neural activity at both proficiency levels in response to syntactic violations. Implicit training yielded an N400 at low proficiency, whereas at high proficiency, it elicited a pattern typical of native speakers: an anterior negativity followed by a P600 accompanied by a late anterior negativity. Explicit training, by contrast, yielded no significant effects at low proficiency and only an anterior positivity followed by a P600 at high proficiency. Although the P600 is reminiscent of native-like processing, this response pattern as a whole is not. Thus, only implicit training led to an electrophysiological signature typical of native speakers. Overall, the results suggest that adult foreign language learners can come to rely on native-like language brain mechanisms, but that the conditions under which the language is learned may be crucial in attaining this goal.

Second Language Acquisition of Gender Agreement in Explicit and Implicit Training Conditions: An Event-Related Potential Study.

This study employed an artificial language learning paradigm together with a combined behavioral/event-related potential (ERP) approach to examine the neurocognition of the processing of gender agreement, an aspect of inflectional morphology that is problematic in adult second language (L2) learning. Subjects learned to speak and comprehend an artificial language under either explicit (classroomlike) or implicit (immersionlike) training conditions. In each group, both noun-article and noun-adjective gender agreement processing were examined behaviorally and with ERPs at both low and higher levels of proficiency. Results showed that the two groups learned the language to similar levels of proficiency but showed somewhat different ERP patterns. At low proficiency, both types of agreement violations (adjective, article) yielded N400s, but only for the group with implicit training. Additionally, noun-adjective agreement elicited a late N400 in the explicit group at low proficiency. At higher levels of proficiency, noun-adjective agreement violations elicited N400s for both the explicit and implicit groups, whereas noun-article agreement violations elicited P600s for both groups. The results suggest that interactions among linguistic structure, proficiency level, and type of training need to be considered when examining the development of aspects of inflectional morphology in L2 acquisition.