Influences of age and gender on operative risks following carotid endarterectomy: A systematic review and meta-analysis.

OBJECTIVES: This review aims to undertake a comprehensive review of the literature and investigate associations of age and gender on 30 days post carotid endarterectomy (CEA) and up to 5 years post CEA stroke, death, and combined stroke and death. DESIGN: A systematic review and meta-analysis. METHODS: Three main electronic databases including the Cochrane Library, MEDLINE, and Embase were searched from their inception to July 2022. Studies examining operative risks (i.e., stroke, death, and combined stroke and death following CEA) linked to age or gender were included. Two independent reviewers were responsible for study selection, quality assessment, and data extraction. Odds ratio (OR) and 95% confidence interval (CI) of all outcomes were calculated. RESULTS: 44609 studies were retrieved from the search. There were 127 eligible studies (80 studies of age, 72 studies of gender, 25 studies of age and gender) for pooling in the meta-analysis. With regards to stroke and death risks within 30 days post CEA; patients aged ≥75 had higher death (OR 1.38; 95% CI 1.10-1.75) than patients aged <75. Patients aged ≥80 had higher stroke risk (OR 1.17; 95% CI 1.07-1.27) and death risk (OR 1.85; 95% CI 1.48-2.30) particular in asymptomatic patients (OR 2.4; 95% CI 1.56-3.81). Pooled effect estimates by gender, at 30 days post CEA, showed that female was associated with increased risk of stroke (OR 1.28; 95% CI 1.16-1.40), with more risk in asymptomatic female patients (OR 1.51; 95% CI 1.14-1.99). CONCLUSIONS: This meta-analysis highlights that older people is associated with increased stroke risk, particularly asymptomatic octogenarians who had higher likelihood of death within 30 days post CEA. In addition, female especially those with asymptomatic carotid stenosis had greater likelihood of stroke within 30 days post CEA surgery.

Impact of a Standardized Nutrition Bundle Including Donor Human Milk on Hospital Outcomes in Very Low Birth-Weight (VLBW) Infants in a Safety-Net Hospital.

BACKGROUND: Standardized protocols have been shown to reduce clinical practice variation and improve patient outcomes. PURPOSE: To measure the impact of a standardized nutrition bundle inclusive of donor human milk (DHM) on hospital outcomes of very low birth-weight (VLBW) infants in a safety-net hospital. METHODS: The study used the Model for Improvement methodology to drive improvement in practice. Outcome measures consisted of necrotizing enterocolitis (NEC), mortality, growth at 36 weeks' postmenstrual age and discharge, as well as volume and type of milk consumption during hospitalization. FINDINGS: NEC rate decreased from 16.67% in the control group to 6.78% in the standardized nutrition bundle group (P = .07). Similarly, there was significant reduction in mortality with the bundled intervention (15.6% in the control group vs 1.6% in the nutrition bundle group; P = .006). Time to first (15 vs 27.5 hours of life; P < .001) and full-volume enteral feeding (8.5 vs 10 days; P = .086) were reduced in the standardized nutrition bundle group compared with the control group. The human milk volume almost doubled with the intervention. IMPLICATIONS FOR PRACTICE: Our standardized nutrition bundle protocol inclusive of DHM resulted in lower NEC rates and reduced mortality. The implementation of the DHM program proved to be cost-effective and saved lives. Our findings may help guide development of a structured approach to nutrition protocols inclusive of DHM that can be adapted by other units located in safety-net hospitals. IMPLICATIONS FOR RESEARCH: Future research on ethnic and racial barriers to access and affordability of DHM is warranted and much needed.

Improving the Communication and Understanding of the Opt-Out Organ Donation Law Among Young Adults.

Lack of knowledge adversely affects one's attitude toward organ donation. To increase understanding, Singapore informs each citizen and permanent resident turning 21 years old through information mailers sent to their place of residence. This study measured the current knowledge on organ donation of 106 polytechnic students (aged 16-24 years) and their reception toward 3 versions of the information mailers (current, revised version 1, and version 2). It was found that 69% of respondents were unaware of the Human Organ Transplant Act. The current mailer also lacks appeal, with only 3.8% of respondents preferring the current version, compared with 42% to 44% who preferred revised version 1 and 52% to 55% who preferred revised version 2. Qualitative responses suggest that the assimilation of elements in both new versions (ie, visuals, layout, and font) will likely lead to better appeal. Findings therefore reinforced the need for revision of current information mailers to captivate young adults to find out about organ donation in Singapore and make informed end-of-life decisions. Further research should consider eliciting more detailed qualitative responses in a conducive setting under a wider time frame.

Altruism in Parkinson's disease.

Objective: Reward-based decision-making is a growing area of research in Parkinson's disease (PD), a disorder characterized by alterations in dopamine and cortico-striatal circuits. While reward is typically operationalized as a gain, altruistic decisions also engage the reward system in fMRI studies. Although altruism comes at a cost, individuals may be motivated by the social reward associated with benefitting another. At present, it is unclear how PD affects altruism because both increased egoistic tendencies and increased generosity have been documented. Method: To address this, 32 individuals with PD and 32 age-matched healthy controls completed two tasks of implicit and explicit altruism. First, in an intertemporal choice task, participants chose between a smaller immediate or larger later outcome. Outcome types included gains, losses, and donations, and an implicit altruism measure was derived. Second, participants completed two versions of the dictator game, which assesses nonreciprocal giving and yields an explicit measure of altruism. Results: Patients and controls showed similar altruism in the intertemporal choice task and in a dictator game for a charity, but patients were more generous than controls in the dictator game in which the recipient was a stranger. Among patients, altruism measures were moderated by laterality of hemispheric burden and medication type. Conclusions: This study was the first to examine altruistic decision-making in PD patients using both implicit and explicit measures. PD patients were neither overly generous nor egoistic in their decisions, although some disease and treatment characteristics may have a modest association with altruism in PD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Atypical spatiotemporal activation of cerebellar lobules during emotional face processing in adolescents with autism.

Autism spectrum disorder (ASD) is characterized by social deficits and atypical facial processing of emotional expressions. The underlying neuropathology of these abnormalities is still unclear. Recent studies implicate cerebellum in emotional processing; other studies show cerebellar abnormalities in ASD. Here, we elucidate the spatiotemporal activation of cerebellar lobules in ASD during emotional processing of happy and angry faces in adolescents with ASD and typically developing (TD) controls. Using magnetoencephalography, we calculated dynamic statistical parametric maps across a period of 500 ms after emotional stimuli onset and determined differences between group activity to happy and angry emotions. Following happy face presentation, adolescents with ASD exhibited only left-hemispheric cerebellar activation in a cluster extending from lobule VI to lobule V (compared to TD controls). Following angry face presentation, adolescents with ASD exhibited only midline cerebellar activation (posterior IX vermis). Our findings indicate an early (125-175 ms) overactivation in cerebellar activity only for happy faces and a later overactivation for both happy (250-450 ms) and angry (250-350 ms) faces in adolescents with ASD. The prioritized hemispheric activity (happy faces) could reflect the promotion of a more flexible and adaptive social behavior, while the latter midline activity (angry faces) may guide conforming behavior.

Frequency-specific neural synchrony in autism during memory encoding, maintenance and recognition.

Working memory impairment is associated with symptom severity and poor functional outcome in autistic individuals, and yet the neurobiology underlying such deficits is poorly understood. Neural oscillations are an area of investigation that can shed light on this issue. Theta and alpha oscillations have been found consistently to support working memory in typically developing individuals and have also been shown to be functionally altered in people with autism. While there is evidence, largely from functional magnetic resonance imaging studies, that neural processing underlying working memory is altered in autism, there remains a dearth of information concerning how sub-processes supporting working memory (namely encoding, maintenance and recognition) are impacted. In this study, we used magnetoencephalography to investigate inter-regional theta and alpha brain synchronization elicited during the widely used one-back task across encoding, maintenance and recognition in 24 adults with autism and 30 controls. While both groups performed comparably on the working-memory task, we found process- and frequency-specific differences in networks recruited between groups. In the theta frequency band, both groups used similar networks during encoding and recognition, but different networks specifically during maintenance. In comparison, the two groups recruited distinct networks across encoding, maintenance and recognition in alpha that showed little overlap. These differences may reflect a breakdown of coherent theta and alpha synchronization that supports mnemonic functioning, or in the case of alpha, impaired inhibition of task-irrelevant neural processing. Thus, these data provide evidence for specific theta and widespread alpha synchrony alterations in autism, and underscore that a detailed examination of the sub-processes that comprise working memory is warranted for a complete understanding of cognitive impairment in this population.

Development of a Pertactin-Coated Beads Approach for Screening of Functional Monoclonal Antibodies.

Vaccine manufacturers have recently focused on the development of in vitro potency assays to promote 3R's strategy to replace animal testing. To be able to develop an in vitro potency assay, the immunological characteristics of the monoclonal antibodies used in the assay should be well understood as these antibodies likely reflect the biological activity of a vaccine product. The PRN antigen is one of the immunogenic antigens included in many commercialized acellular pertussis vaccines. Development of an in vitro potency assay for PRN is challenging as the biological properties of PRN are not well understood. In addition, binding of Bordetella pertussis to human cells occurs through multiple bacterial molecules, which makes it very challenging to assess if antibodies contribute to prevention of bacterial adhesion. To overcome these challenges, the functionality of several in-house anti-PRN mAbs has been investigated through a novel approach using PRN-coated beads. We were able to consistently quantify the inhibition of PRN-mediated adhesion for each anti-PRN mAb. Application of the protein-coated beads model has not only enabled screening of functional anti-PRN mAbs but can also be expanded for screening of antibodies against other bacterial or viral antigens.

Emotional face processing in autism spectrum disorder: Effects in gamma connectivity.

Impairments in social functioning are characteristic of autism spectrum disorder (ASD). Differences in functional networks during face processing in ASD compared to controls have been reported; however, the spatial-temporal dynamics of networks underlying affective processing are still not well understood. The current magnetoencephalography study examined whole-brain functional connectivity to implicit happy and angry faces in 104 adults with and without ASD. A network of reduced gamma band (30-55 Hz) phase synchrony occurring 80-308 ms following angry face presentation was found in adults with ASD compared to controls. The network involved widespread connections primarily anchored in frontal regions, including bilateral orbitofrontal areas, bilateral inferior frontal gyri, and left middle frontal gyrus extending to occipital, temporal, parietal, and subcortical regions. This finding suggests disrupted long-range neuronal communication to angry faces. Additionally, reduced gamma band-specific connectivity may reflect altered E/I balance in brain regions critical for emotional face processing in ASD.

Potential exerkines for physical exercise-elicited pro-cognitive effects: Insight from clinical and animal research.

A sedentary lifestyle is now known as a critical risk factor for accelerated aging-related neurodegenerative disorders. In contract, having regular physical exercise has opposite effects. Clinical findings have suggested that physical exercise can promote brain plasticity, particularly the hippocampus and the prefrontal cortex, that are important for learning and memory and mood regulations. However, the underlying mechanisms are still unclear. Animal studies reveal that the effects of physical exercise on promoting neuroplasticity could be mediated by different exerkines derived from the peripheral system and the brain itself. This book chapter summarizes the recent evidence from clinical and pre-clinical studies showing the emerging mediators for exercise-promoted brain health, including myokines secreted from skeletal muscles, adipokines from adipose tissues, and other factors secreted from the bone and liver.

Happy and Angry Faces Elicit Atypical Neural Activation in Children With Autism Spectrum Disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by significant impairments in social interactions and communication. The ability to accurately perceive and interpret emotional faces is critical to successful social interactions. However, few studies have investigated the spatiotemporal profile of the neural mechanisms underlying emotional face processing in ASD, particularly in children. The current study fills this important gap. METHODS: Participants were 55 children: 28 children with ASD (mean age = 9.5 ± 1.3 years) and 27 control children (mean age = 8.5 ± 1.3 years). All children completed an implicit emotional face task while magnetoencephalography was recorded. We examined spatiotemporal differences between the groups in neural activation during implicit processing of emotional faces. RESULTS: Within-group analyses demonstrated greater right middle temporal (300-375 ms) and superior temporal (300-400 ms) activation to angry faces than to happy faces in control children, while children with ASD showed greater activation from 250 to 500 ms to happy faces than to angry faces across frontal and temporal regions. Between-group analyses demonstrated that children with ASD showed similar patterns of late (425-500 ms) posterior cingulate and thalamic underactivity to both angry and happy faces relative to control children, suggesting general atypical processing of emotional information. CONCLUSIONS: Atypical posterior cingulate cortex and thalamus recruitment in children with ASD to emotional faces suggests poor modulation of toggling between the default mode network and task-based processing. Increased neural activity to happy faces compared with angry faces in children with ASD suggests reduced salience or immature response to anger, which in turn could contribute to deficits in social cognition in ASD.

Characterization of Autism Spectrum Disorder across the Age Span by Intrinsic Network Patterns.

Autism spectrum disorder (ASD) is characterized by abnormal functional organization of brain networks, which may underlie the cognitive and social impairments observed in affected individuals. The present study characterizes unique intrinsic connectivity within- and between- neural networks in children through to adults with ASD, relative to controls. Resting state fMRI data were analyzed in 204 subjects, 102 with ASD and 102 age- and sex-matched controls (ages 7-40 years), acquired on a single scanner. ASD was assessed using the autism diagnostic observation schedule (ADOS). BOLD correlations were calculated between 47 regions of interest, spanning seven resting state brain networks. Partial least squares (PLS) analyses evaluated the association between connectivity patterns and ASD diagnosis as well as ASD severity scores. PLS demonstrated dissociable connectivity patterns in those with ASD, relative to controls. Similar patterns were observed in the whole cohort and in a subgroup analysis of subjects under 18 years of age. Greater inter-network connectivity was seen in ASD with greater intra-network connectivity in controls. In conclusion, stronger inter-network and weaker intra-network resting state-fMRI BOLD correlations characterize ASD and may differentiate control and ASD cohorts. These findings are relevant to understanding ASD as a disruption of network topology.

Increased Functional Connectivity During Emotional Face Processing in Children With Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) demonstrate poor social functioning, which may be related to atypical emotional face processing. Altered functional connectivity among brain regions, particularly involving limbic structures may be implicated. The current magnetoencephalography (MEG) study investigated whole-brain functional connectivity of eight a priori identified brain regions during the implicit presentation of happy and angry faces in 20 7 to 10-year-old children with ASD and 22 typically developing controls. Findings revealed a network of increased alpha-band phase synchronization during the first 400 ms of happy face processing in children with ASD compared to controls. This network of increased alpha-band phase synchronization involved the left fusiform gyrus, right insula, and frontal regions critical for emotional face processing. In addition, greater connectivity strength of the left fusiform gyrus (maximal 85 to 208 ms) and right insula (maximal 73 to 270 ms) following happy face presentation in children with ASD compared to typically developing controls was found. These findings reflect altered neuronal communication in children with ASD only to happy faces during implicit emotional face processing.

Longitudinal Examination of Everyday Executive Functioning in Children With ASD: Relations With Social, Emotional, and Behavioral Functioning Over Time.

Executive functioning (EF) deficits are well-documented in Autism Spectrum Disorder (ASD), yet little is known about the longitudinal trajectory of "everyday" EF and links to social, emotional and behavioral outcomes in ASD. This study examined the profile of everyday EF utilizing parent-reported measures over 2 years, and explored whether prior estimates of EF were related to later co-morbid psychopathology and social functioning in 39 children with ASD and 34 typically developing (TD) children (ages 7-14 years). According to parent reports, children with ASD had impaired scores of EF in all domains at both time points, and showed no significant improvement across 2 years, compared to controls. Regression analyses showed that prior estimates of behavior regulation difficulties at time 1 uniquely predicted later emotional (i.e., symptoms of anxiety/depression) and behavioral (i.e., oppositionality/aggressiveness) problems in children with ASD 2 years later. Furthermore, an improvement of metacognitive skills predicted a reduction of social difficulties over 2 years in ASD. These results imply that EF may be a potential target of intervention for preventing and reducing co-morbid psychopathology and promoting social competence in youth with ASD. Furthermore, the findings that EF related to behavior is more critical for later emotional and behavioral functioning, whereas EF related to cognition is more critical for social functioning, indicates that it may be beneficial to tailor treatment. Future studies investigating the effectiveness of EF-based interventions in improving the cognitive, psychological and social outcomes in ASD are of high priority.

Structure-function relationships of hydroxyl radical scavenging and chromium-VI reducing cysteine-tripeptides derived from rye secalin.

The aim of the study was to determine the activity of four rye peptides and molecular descriptors responsible for the detected biological function. The activity was determined using hydroxyl radical scavenging and chromium-VI (Cr(VI) reducing assays while the density functional theory (DFT) was used for molecular descriptors (i.e. structure-activity relationships). It was found that at pH 7.4, peptide CQV had the highest Cr(VI) reducing activity (76%) followed by QCA (30.8%) while other peptides had less than 25% reduction. All tested peptides were less active at pH 3.0 and this was due to poor spatial proximity of thiol and amine on the glutamine side chain. In the hydroxyl radical scavenging assay, CQV had the highest activity with 28.9 ±â€¯1.3% inhibition of the formation of HO radicals compared to 19.0-13.6% for other peptides. Cysteine at the N-terminal was important for both the reduction of chromium (pH 7.4) and the HO activity because S-H bond energies at that position were lower based on DFT calculations.

Young Adults with Autism Spectrum Disorder Show Early Atypical Neural Activity during Emotional Face Processing.

Social cognition is impaired in autism spectrum disorder (ASD). The ability to perceive and interpret affect is integral to successful social functioning and has an extended developmental course. However, the neural mechanisms underlying emotional face processing in ASD are unclear. Using magnetoencephalography (MEG), the present study explored neural activation during implicit emotional face processing in young adults with and without ASD. Twenty-six young adults with ASD and 26 healthy controls were recruited. Participants indicated the location of a scrambled pattern (target) that was presented alongside a happy or angry face. Emotion-related activation sources for each emotion were estimated using the Empirical Bayes Beamformer (pcorr ≤ 0.001) in Statistical Parametric Mapping 12 (SPM12). Emotional faces elicited elevated fusiform, amygdala and anterior insula and reduced anterior cingulate cortex (ACC) activity in adults with ASD relative to controls. Within group comparisons revealed that angry vs. happy faces elicited distinct neural activity in typically developing adults; there was no distinction in young adults with ASD. Our data suggest difficulties in affect processing in ASD reflect atypical recruitment of traditional emotional processing areas. These early differences may contribute to difficulties in deriving social reward from faces, ascribing salience to faces, and an immature threat processing system, which collectively could result in deficits in emotional face processing.

Sexual behaviour in early adolescence: a cross-national comparison of Australian and United States youth.

OBJECTIVE: This study used matched samples from schools in the states of Victoria, Australia and Washington, United States (US), to compare sexual behaviour in early adolescence. It was hypothesised that the contrasting dominant policy objectives of harm minimisation in Australia and abstinence in the US would result in state differences for markers of sexual risk, mirroring prior cross-national findings in substance use. METHOD: A two-stage cluster sampling approach was used to recruit students from the two states. Self-reported sexual behaviour was examined for 1,596 students in annual surveys from Grade 7 in 2002 to Grade 9 in 2004. Prevalence estimates were derived for each measure of sexual behaviour, and comparisons were made between gender groups in each state. RESULTS: State differences were found for girls' first sex, with significantly more girls in Washington than Victoria having had sex by Grade 7. By Grade 9, significantly more girls in Victoria reported sex in the last year and more sexual partners than girls in Washington. A large proportion of Grade 9 students across both states reported inconsistent contraception use. CONCLUSIONS: Contradicting the abstinence policy objective, first sex by Grade 7 was more prevalent in Washington than Victoria. Whilst sexual behaviour was more prevalent in Grade 9 in Victoria, the sexually active showed no clear cross-national differences in markers of risk such as contraception use and pregnancy outcomes. Findings demonstrate few cross-national differences in adolescent sexual behaviour despite the different policy contexts of Victoria, Australia and Washington, US.

Disconnection from others in autism is more than just a feeling: whole-brain neural synchrony in adults during implicit processing of emotional faces.

BACKGROUND: Socio-emotional difficulties in autism spectrum disorder (ASD) are thought to reflect impaired functional connectivity within the "social brain". Nonetheless, a whole-brain characterization of the fast responses in functional connectivity during implicit processing of emotional faces in adults with ASD is lacking. METHODS: The present study used magnetoencephalography to investigate early responses in functional connectivity, as measured by interregional phase synchronization, during implicit processing of angry, neutral and happy faces. The sample (n = 44) consisted of 22 young adults with ASD and 22 age- and sex-matched typically developed (TD) controls. RESULTS: Reduced phase-synchrony in the beta band around 300 ms emerged during processing of angry faces in the ASD compared to TD group, involving key areas of the social brain. In the same time window, de-synchronization in the beta band in the amygdala was reduced in the ASD group across conditions. CONCLUSIONS: This is the first demonstration of atypical global and local synchrony patterns in the social brain in adults with ASD during implicit processing of emotional faces. The present results replicate and substantially extend previous findings on adolescents, highlighting that atypical brain synchrony during processing of socio-emotional stimuli is a hallmark of clinical sequelae in autism.

Developmental changes in neuromagnetic rhythms and network synchrony in autism.

OBJECTIVE: There is gathering consensus that altered connectivity is a hallmark of the autistic brain. This includes atypical neural oscillations and their coordination across brain regions, which are understood to mediate information processing and integration. It remains unclear whether and how connectivity in various neurophysiological frequency ranges develops atypically in autism spectrum disorder (ASD). METHODS: To address this in a cross-sectional sample, we recorded resting-state magnetoencephalography from 134 children and adolescents with and without ASD, and calculated resting spectral power and inter-regional synchrony (functional connectivity). RESULTS: Although no overall group differences were observed, significant alterations in linear and nonlinear age-related changes in resting oscillatory power and network synchrony were found. These differences were frequency- and region-specific and implicated brain systems thought to play a prominent role in ASD, such as the frontal cortex and cerebellum. We also found correlations between Autism Diagnostic Observation Schedule scores and the degree to which connectivity in cerebellar networks is "idiosyncratic" in an individual with autism. INTERPRETATION: We provide the first evidence that it is the curvatures of maturational changes in neurophysiological oscillations and synchrony, rather than disturbances in a particular direction, that characterize the brain function in individuals with ASD. Moreover, the patterns of idiosyncratic distortions of network synchrony relative to the group curve are associated with behavioral symptoms of ASD. Ann Neurol 2017;81:199-211.

Stimulus exposure duration alters implicit processing of neutral and emotional faces.

Stimulus exposure duration in emotion perception research is often chosen pragmatically; however, little work exists on the consequences of stimulus duration for the processing of emotional faces. We utilized the spatiotemporal resolution capabilities of magnetoencephalography (MEG) to characterize early implicit processing of emotional and neutral faces in response to stimuli presented for 80 and 150ms. We found that the insula was recruited to a greater degree within the short (80ms) condition for all face categories, and this effect was more pronounced for emotional compared to neutral faces. The orbitofrontal cortex was more active in the 80-ms condition for neutral faces only, suggesting a modulation of task difficulty by both the duration and the emotional category of the stimuli. No effects on reaction time or accuracy were observed. Our findings caution that differences in stimulus duration may result in differential neural processing of emotional faces and challenge the idea that neutral faces constitute a neutral baseline.

Mapping the Network of Neuropsychological Impairment in Children with Autism Spectrum Disorder: A Graph Theoretical Analysis.

Children with autism spectrum disorder (ASD) exhibit social-communicative impairments. Less is known about the neuropsychological profile of ASD, although cognitive and neuropsychological deficits are evident. We modelled neuropsychological function in 20 children with ASD and 20 sex, age and IQ matched typically-developing controls (ages 7-14) as a network of interacting parameters. Graph theoretical analysis was applied to identify critical topographic regions within this network. Two areas were significantly stronger hubs in typically-developing children, the ability to shift attention (p < 0.001) and overall executive function (p < 0.001). Planning/organization was a stronger hub in the cognitive networks of children with ASD (p = 0.001). We show that ASD is not only characterized by impairments in various neurocognitive domains, but also alterations in their interaction.