Optimizing an exercise training program in pediatric brain tumour survivors: Does timing postradiotherapy matter?

Background: While exercise training (ET) programs show positive outcomes in cognition, motor function, and physical fitness in pediatric brain tumor (PBT) survivors, little is known about the optimal timing of intervention. The aim of this work was to explore the feasibility and benefits of ET based on its timing after radiotherapy. Methods: This retrospective analysis (ClinicalTrials.gov, NCT01944761) analyzed data based on the timing of PBT survivors' participation in an ET program relative to their completion of radiotherapy: <2 years (n = 9), 2-5 years (n = 10), and > 5 years (n = 13). We used repeated measures analysis of variance to compare feasibility and efficacy indicators among groups, as well as correlation analysis between ET program timing postradiotherapy and preliminary treatment effects on cognition, motor function and physical fitness outcomes. Results: Two to five years postradiotherapy was the optimal time period in terms of adherence (88.5%), retention (100%), and satisfaction (more fun, more enjoyable and recommend it more to other children). However, the benefits of ET program on memory recognition (r = -0.379, P = .047) and accuracy (r = -0.430, P = .032) decreased with increased time postradiotherapy. Motor function improved in all groups, with greater improvements in bilateral coordination (P = .043) earlier postradiotherapy, and in running (P = .043) later postradiotherapy. The greatest improvement in pro-rated work rate occurred in the < 2-year group (P = .008). Conclusion: Participation in an ET program should be offered as part of routine postradiotherapy care in the first 1-2 years and strongly encouraged in the first 5 years.

Network connectivity underlying episodic memory in children: Application of a pediatric brain tumor survivor injury model.

Episodic memory involves personal experiences paired with their context. The Medial Temporal, Posterior Medial, Anterior Temporal, and Medial Prefrontal networks have been found to support the hippocampus in episodic memory in adults. However, there lacks a model that captures how the structural and functional connections of these networks interact to support episodic memory processing in children. Using diffusion-weighted imaging, magnetoencephalography, and memory tests, we quantified differences in white matter microstructure, neural communication, and episodic memory performance, respectively, of healthy children (n = 23) and children with reduced memory performance. Pediatric brain tumor survivors (PBTS; n = 24) were used as a model, as they exhibit reduced episodic memory and perturbations in white matter and neural communication. We observed that PBTS, compared to healthy controls, showed significantly (p < 0.05) (1) disrupted white matter microstructure between these episodic memory networks through lower fractional anisotropy and higher mean and axial diffusivity, (2) perturbed theta band (4-7 Hz) oscillatory synchronization in these same networks through higher weighted phase lag indices (wPLI), and (3) lower episodic memory performance in the Transverse Patterning and Children's Memory Scale (CMS) tasks. Using partial-least squares path modeling, we found that brain tumor treatment predicted network white matter damage, which predicted inter-network theta hypersynchrony and lower verbal learning (directly) and lower verbal recall (indirectly via theta hypersynchrony). Novel to the literature, our findings suggest that white matter modulates episodic memory through effect on oscillatory synchronization within relevant brain networks. RESEARCH HIGHLIGHTS: Investigates the relationship between structural and functional connectivity of episodic memory networks in healthy children and pediatric brain tumor survivors Pediatric brain tumor survivors demonstrate disrupted episodic memory, white matter microstructure and theta oscillatory synchronization compared to healthy children Findings suggest white matter microstructure modulates episodic memory through effects on oscillatory synchronization within relevant episodic memory networks.

Neural and cognitive function in a pediatric brain injury model: The impact of task complexity.

Acquired brain injury (ABI) in childhood/adolescence results in dysfunctional neural and attentional resources during minimal and higher task load. Impact of injury on these resources during increasing load, when task design (e.g., stimuli, timing) is held constant, is not yet well understood. We examined neural communication, processing speed and controlled attention in pediatric brain tumor survivors (PBTS; Mtime since treatment = 6.78 years) and typically developing children (TDC; n = 57). Participants performed simple-go and choice reaction time (RxnT) tasks during magnetoencephalography. The weighted phase lag index estimated seed-based and whole-brain functional connectivity. Group differences were assessed using tmax and network based statistics. Mean RxnT and response accuracy measured performance. Linear models assessed group differences. Tasks were analyzed individually to account for a difference in trial numbers. During both tasks, PBTS demonstrated decreased seed-based connectivity in the high gamma frequency (60-100 Hz; p < .01) relative to TDC. During the choice task alone, PBTS also demonstrated decreased theta (4-7 Hz) and alpha (8-12 Hz) seed-based connectivity (p < .01), and increased RxnT in adolescence (p < .05). ABI in childhood/adolescence may predominantly disrupt recruitment of neural and attentional resources necessary for higher load tasks. These findings advance understanding of the impact of task load on brain function and cognition during development, and effects of injury.

Patterns of white and gray structural abnormality associated with paediatric demyelinating disorders.

The impact of multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein (MOG) - associated disorders (MOGAD) on brain structure in youth remains poorly understood. Reductions in cortical mantle thickness on structural MRI and abnormal diffusion-based white matter metrics (e.g., diffusion tensor parameters) have been well documented in MS but not in MOGAD. Characterizing structural abnormalities found in children with these disorders can help clarify the differences and similarities in their impact on neuroanatomy. Importantly, while MS and MOGAD affect the entire CNS, the visual pathway is of particular interest in both groups, as most patients have evidence for clinical or subclinical involvement of the anterior visual pathway. Thus, the visual pathway is of key interest in analyses of structural abnormalities in these disorders and may distinguish MOGAD from MS patients. In this study we collected MRI data on 18 MS patients, 14 MOGAD patients and 26 age- and sex-matched typically developing children (TDC). Full-brain group differences in fixel diffusion measures (fibre-bundle populations) and cortical thickness measures were tested using age and sex as covariates. Visual pathway analysis was performed by extracting mean diffusion measures within lesion free optic radiations, cortical thickness within the visual cortex, and retinal nerve fibre layer (RNFL) and ganglion cell layer thickness measures from optical coherence tomography (OCT). Fixel based analysis (FBA) revealed MS patients have widespread abnormal white matter within the corticospinal tract, inferior longitudinal fasciculus, and optic radiations, while within MOGAD patients, non-lesional impact on white matter was found primarily in the right optic radiation. Cortical thickness measures were reduced predominately in the temporal and parietal lobes in MS patients and in frontal, cingulate and visual cortices in MOGAD patients. Additionally, our findings of associations between reduced RNFLT and axonal density in MOGAD and TORT in MS patients in the optic radiations imply widespread axonal and myelin damage in the visual pathway, respectively. Overall, our approach of combining FBA, cortical thickness and OCT measures has helped evaluate similarities and differences in brain structure in MS and MOGAD patients in comparison to TDC.

Assessment of cognitive and neural recovery in survivors of pediatric brain tumors in a pilot clinical trial using metformin.

We asked whether pharmacological stimulation of endogenous neural precursor cells (NPCs) may promote cognitive recovery and brain repair, focusing on the drug metformin, in parallel rodent and human studies of radiation injury. In the rodent cranial radiation model, we found that metformin enhanced the recovery of NPCs in the dentate gyrus, with sex-dependent effects on neurogenesis and cognition. A pilot double-blind, placebo-controlled crossover trial was conducted (ClinicalTrials.gov, NCT02040376) in survivors of pediatric brain tumors who had been treated with cranial radiation. Safety, feasibility, cognitive tests and MRI measures of white matter and the hippocampus were evaluated as endpoints. Twenty-four participants consented and were randomly assigned to complete 12-week cycles of metformin (A) and placebo (B) in either an AB or BA sequence with a 10-week washout period at crossover. Blood draws were conducted to monitor safety. Feasibility was assessed as recruitment rate, medication adherence and procedural adherence. Linear mixed modeling was used to examine cognitive and MRI outcomes as a function of cycle, sequence and treatment. We found no clinically relevant safety concerns and no serious adverse events associated with metformin. Sequence effects were observed for all cognitive outcomes in our linear mixed models. For the subset of participants with complete data in cycle 1, metformin was associated with better performance than placebo on tests of declarative and working memory. We present evidence that a clinical trial examining the effects of metformin on cognition and brain structure is feasible in long-term survivors of pediatric brain tumors and that metformin is safe to use and tolerable in this population. This pilot trial was not intended to test the efficacy of metformin for cognitive recovery and brain growth, but the preliminary results are encouraging and warrant further investigation in a large multicenter phase 3 trial.

Eye Movements and White Matter are Associated with Emotional Control in Children Treated for Brain Tumors.

OBJECTIVE: Children treated for brain tumors often experience social and emotional difficulties, including challenges with emotion regulation; our goal was to investigate the attention-related component processes of emotion regulation, using a novel eye-tracking measure, and to evaluate its relations with emotional functioning and white matter (WM) organization. METHOD: Fifty-four children participated in this study; 36 children treated for posterior fossa tumors, and 18 typically developing children. Participants completed two versions of an emotion regulation eye-tracking task, designed to differentiate between implicit (i.e., automatic) and explicit (i.e., voluntary) subprocesses. The Emotional Control scale from the Behavior Rating Inventory of Executive Function was used to evaluate emotional control in daily life, and WM organization was assessed with diffusion tensor imaging. RESULTS: We found that emotional faces captured attention across all groups (F(1,51) = 32.18, p < .001, η2p = .39). However, unlike typically developing children, patients were unable to override the attentional capture of emotional faces when instructed to (emotional face-by-group interaction: F(2,51) = 5.58, p = .006, η2p = .18). Across all children, our eye-tracking measure of emotion regulation was modestly associated with the parent-report emotional control score (r = .29, p = .045), and in patients it was associated with WM microstructure in the body and splenium of the corpus callosum (all t > 3.03, all p < .05). CONCLUSIONS: Our findings suggest that an attention-related component process of emotion regulation is disrupted in children treated for brain tumors, and that it may relate to their emotional difficulties and WM organization. This work provides a foundation for future theoretical and mechanistic investigations of emotional difficulties in brain tumor survivors.

A controlled clinical crossover trial of exercise training to improve cognition and neural communication in pediatric brain tumor survivors.

OBJECTIVE: To assess the efficacy of aerobic exercise training to improve controlled attention, information processing speed and neural communication during increasing task load and rest in pediatric brain tumor survivors (PBTS) treated with cranial radiation. METHODS: Participants completed visual-motor Go and Go/No-Go tasks during magnetoencephalography recording prior to and following the completion of 12-weeks of exercise training. Exercise-related changes in response accuracy and visual-motor latency were evaluated with Linear Mixed models. The Phase Lag Index (PLI) was used to estimate functional connectivity during task performance and rest. Changes in PLI values after exercise training were assessed using Partial Least Squares analysis. RESULTS: Exercise training predicted sustained (12-weeks) improvement in response accuracy (p<0.05) during No-Go trials. Altered functional connectivity was detected in theta (4-7Hz) alpha (8-12Hz) and high gamma (60-100Hz) frequency bands (p<0.001) during Go and Go/No-Go trials. Significant changes in response latency and resting state connectivity were not detected. CONCLUSION: These findings support the efficacy of aerobic exercise to improve controlled attention and enhance functional mechanisms under increasing task load in participants. SIGNIFICANCE: It may be possible to harness the beneficial effects of exercise as therapy to promote cognitive recovery and enhance brain function in PBTS.

Medulloblastoma has a global impact on health related quality of life: Findings from an international cohort.

BACKGROUND: Understanding the global impact of medulloblastoma on health related quality of life (HRQL) is critical to characterizing the broad impact of this disease and realizing the benefits of modern treatments. We evaluated HRQL in an international cohort of pediatric medulloblastoma patients. METHODS: Seventy-six patients were selected from 10 sites across North America, Europe, and Asia, who participated in the Medulloblastoma Advanced Genomics International Consortium (MAGIC). The Health Utilities Index (HUI) was administered to patients and/or parents at each site. Responses were used to determine overall HRQL and attributes (ie specific subdomains). The impact of various demographic and medical variables on HRQL was considered-including molecular subgroup. RESULTS: The majority of patients reported having moderate or severe overall burden of morbidity for both the HUI2 and HUI3 (HUI2 = 60%; HUI3 = 72.1%) when proxy-assessed. Self-care in the HUI2 was rated as higher (ie better outcome) for patients from Western versus Eastern sites, P = .02. Patients with nonmetastatic status had higher values (ie better outcomes) for the HUI3 hearing, HUI3 pain, and HUI2 pain, all P < .05. Patients treated with a gross total resection also had better outcomes for the HUI3 hearing (P = .04). However, those who underwent a gross total resection reported having worse outcomes on the HUI3 vision (P = .02). No differences in HRQL were evident as a function of subgroup. CONCLUSIONS: By examining an international sample of survivors, we characterized the worldwide impact of medulloblastoma. This is a critical first step in developing global standards for evaluating long-term outcomes.

Facial emotion recognition in children treated for posterior fossa tumours and typically developing children: A divergence of predictors.

Facial emotion recognition (FER) deficits are evident and pervasive across neurodevelopmental, psychiatric, and acquired brain disorders in children, including children treated for brain tumours. Such deficits are thought to perpetuate challenges with social relationships and decrease quality of life. The present study combined eye-tracking, neuroimaging and cognitive assessments to evaluate if visual attention, brain structure, and general cognitive function contribute to FER in children treated for posterior fossa (PF) tumours (patients: n = 36) and typically developing children (controls: n = 18). To assess FER, all participants completed the Diagnostic Analysis of Nonverbal Accuracy (DANVA2), a computerized task that measures FER using photographs, while their eye-movements were recorded. Patients made more FER errors than controls (p < .01). Although we detected subtle deficits in visual attention and general cognitive function in patients, we found no associations with FER. Compared to controls, patients had evidence of white matter (WM) damage, (i.e., lower fractional anisotropy [FA] and higher radial diffusivity [RD]), in multiple regions throughout the brain (all p < .05), but not in specific WM tracts associated with FER. Despite the distributed WM differences between groups, WM predicted FER in controls only. In patients, factors associated with their disease and treatment predicted FER. Our study provides insight into predictors of FER that may be unique to children treated for PF tumours, and highlights a divergence in associations between brain structure and behavioural outcomes in clinical and typically developing populations; a concept that may be broadly applicable to other neurodevelopmental and clinical populations that experience FER deficits.

Demanda diagnóstica na escola: entre querer-o-bem-do-sujeito e a escuta analítica / Good and analytical listening / Demanda diagnóstica en la escuela: entre querer-el-bien-del-sujeto y la escucha analítica

Este estudo surge a partir de duas indagações: "qual é a utilidade de um diagnóstico na escola?" e "o que move essa demanda por diagnóstico?". Tais questionamentos foram elaborados em resposta à demanda diagnóstica produzida no contexto do nosso estágio em Psicologia Escolar/Educacional. Para discutir nossa posição, partimos de dois casos e os submetemos à construção e análise. Como resultado, encontramos que não há como saber, a priori, o que será feito de um diagnóstico e quais serão seus usos. Assim, mais do que saber o que move a demanda, o importante são os usos do sujeito e a nossa posição diante dela para que eles possam engendrar um trabalho.

This study arises from two questionings: what is the usefulness of a diagnosis in school? And what moves that demand for diagnosis? Such questions were framed in response to a diagnostic demand produced in the context of our internship in Scholar/Educational Psychology. To discuss our position, we started from two cases and submitted them to construction and analysis. As a result, we found out that one cannot know in advance what is to be done on a diagnosis and how it will be used. Thus, more than knowing what moves the demand, what matters is the subject's uses and our position towards it so that they can produce a work.

Este estudio surge a partir de dos indagaciones: ¿cuál es la utilidad de un diagnóstico en la escuela? ¿Y qué mueve esa demanda de diagnóstico? Tales cuestionamientos fueron elaborados en respuesta a la demanda diagnóstica producida en el contexto de nuestra residencia en Psicología Escolar / Educacional. Para discutir nuestra posición, partimos de dos casos y los sometemos a la construcción y análisis. Como resultado, encontramos que no hay como saber en el a priori qué se hará de un diagnóstico, cuáles serán sus usos. Así, más que saber lo que mueve la demanda, lo importante son los usos del sujeto y nuestra posición frente a la misma para que de esa forma se pueda engendrar un trabajo.

Impaired Recent, but Preserved Remote, Autobiographical Memory in Pediatric Brain Tumor Patients.

Medulloblastomas, the most common malignant brain tumor in children, are typically treated with radiotherapy. Refinement of this treatment has greatly improved survival rates in this patient population. However, radiotherapy also profoundly affects the developing brain and is associated with reduced hippocampal volume and blunted hippocampal neurogenesis. Such hippocampal (as well as extrahippocampal) abnormalities likely contribute to cognitive impairments in this population. While several aspects of memory have been examined in this population, the impact of radiotherapy on autobiographical memory has not previously been evaluated. Here we evaluated autobiographical memory in male and female patients who received radiotherapy for posterior fossa tumors (PFTs), including medulloblastoma, during childhood. Using the Children's Autobiographical Interview, we retrospectively assessed episodic and nonepisodic details for events that either preceded (i.e., remote) or followed (i.e., recent) treatment. For post-treatment events, PFT patients reported fewer episodic details compared with control subjects. For pretreatment events, PFT patients reported equivalent episodic details compared with control subjects. In a range of conditions associated with reduced hippocampal volume (including medial temporal lobe amnesia, mild cognitive impairment, Alzheimer's disease, temporal lobe epilepsy, transient epileptic amnesia, frontal temporal dementia, traumatic brain injury, encephalitis, and aging), loss of episodic details (even in remote memories) accompanies hippocampal volume loss. It is therefore surprising that pretreatment episodic memories in PFT patients with reduced hippocampal volume are retained. We discuss these findings in light of the anterograde and retrograde impact on memory of experimentally suppressing hippocampal neurogenesis in rodents.SIGNIFICANCE STATEMENT Pediatric medulloblastoma survivors develop cognitive dysfunction following cranial radiotherapy treatment. We report that radiotherapy treatment impairs the ability to form new autobiographical memories, but spares preoperatively acquired autobiographical memories. Reductions in hippocampal volume and cortical volume in regions of the recollection network appear to contribute to this pattern of preserved preoperative, but impaired postoperative, memory. These findings have significant implications for understanding disrupted mnemonic processing in the medial temporal lobe memory system and in the broader recollection network, which are inadvertently affected by standard treatment methods for medulloblastoma tumors in children.

Repairing the brain with physical exercise: Cortical thickness and brain volume increases in long-term pediatric brain tumor survivors in response to a structured exercise intervention.

There is growing evidence that exercise induced experience dependent plasticity may foster structural and functional recovery following brain injury. We examined the efficacy of exercise training for neural and cognitive recovery in long-term pediatric brain tumor survivors treated with radiation. We conducted a controlled clinical trial with crossover of exercise training (vs. no training) in a volunteer sample of 28 children treated with cranial radiation for brain tumors (mean age = 11.5 yrs.; mean time since diagnosis = 5.7 yrs). The endpoints were anatomical T1 MRI data and multiple behavioral outcomes presenting a broader analysis of structural MRI data across the entire brain. This included an analysis of changes in cortical thickness and brain volume using automated, user unbiased approaches. A series of general linear mixed effects models evaluating the effects of exercise training on cortical thickness were performed in a voxel and vertex-wise manner, as well as for specific regions of interest. In exploratory analyses, we evaluated the relationship between changes in cortical thickness after exercise with multiple behavioral outcomes, as well as the relation of these measures at baseline. Exercise was associated with increases in cortical thickness within the right pre and postcentral gyri. Other notable areas of increased thickness related to training were present in the left pre and postcentral gyri, left temporal pole, left superior temporal gyrus, and left parahippocampal gyrus. Further, we observed that compared to a separate cohort of healthy children, participants displayed multiple areas with a significantly thinner cortex prior to training and fewer differences following training, indicating amelioration of anatomical deficits. Partial least squares analysis (PLS) revealed specific patterns of relations between cortical thickness and various behavioral outcomes both after training and at baseline. Overall, our results indicate that exercise training in pediatric brain tumor patients treated with radiation has a beneficial impact on brain structure. We argue that exercise training should be incorporated into the development of neuro-rehabilitative treatments for long-term pediatric brain tumor survivors and other populations with acquired brain injury. (ClinicalTrials.gov, NCT01944761).

Escolha profissional na adolescência: um estudo psicanalítico / Professional choice in adolescence: a psychoanalytic study / Elección profesional en la adolescencia: un estudio psicoanalítico / Choix professionnel à l'adolescence: une étude psychanalytique

As profundas transformações de ordem política, econômica e social nas sociedades capitalistas e globalizadas, geradas pelos avanços da ciência, da indústria eletrônica, da informática e da robótica, refletem-se na coletividade e nos modos de organização do mundo do trabalho. Adolescentes e jovens são afetados por essas transformações, apresentando manifestações psíquicas diversas frente à escolha de suas profissões, que denunciam o mal-estar e o sofrimento vivenciado diante das vicissitudes desse processo e das expectativas por ele geradas. Trata-se de um artigo teórico no qual articulamos as dificuldades e os impasses que envolvem a escolha profissional na adolescência às determinações psíquicas inconscientes desse processo e aos lutos que o adolescente precisará fazer para poder optar por uma profissão. A partir do referencial freudiano e lacaniano, realizou-se um estudo do conceito de adolescência que, articulado ao processo de escolha profissional e a fragmentos de casos clínicos, evidenciou as seguintes conclusões: 1. Nas escolhas humanas estão implicados processos psíquicos diversos, que, iniciados na infância, são atualizados na adolescência, determinando as escolhas do adolescente, inclusive a profissional; 2. É necessária a elaboração simbólica da separação dos pais da infância, e dos lutos relativos às perdas e renúncias relacionadas às mudanças corporais e aos objetos infantis, para que o adolescente possa aceder ao seu desejo e sustentar suas possibilidades de escolha; 3. A escuta da dimensão inconsciente, presente nas escolhas do sujeito no campo profissional, é fundamental para uma análise das dificuldades aí surgidas, bem como para o encontro de saídas singulares para elas.

The profound transformation of political, economical and social order in capitalist and globalized societies generated by advances in science, electronics, computer and robotic industries are reflected in the collectivity and modes of organization of the world of work. Adolescents and young people are affected by these changes, presenting various psychical manifestations forward to choosing their professions, denouncing the malaise and suffering being experienced by them on the unpredictable change of the process and the expectations generated by it. This is a theoretical paper in which we articulate the difficulties and dilemmas that involve the professional choice in adolescence to unconscious psychic determinations of this process and the grief that the adolescent will need to do in order to be able to opt for a profession. From the Freudian and Lacanian framework, we performed a study of the concept of adolescence that articulated at the professional choice and fragments of clinical cases revealed the following conclusions: 1. In human choices are involved many psychological processes that started in childhood, in adolescence are updated, determining the choices of the adolescents, including their Professional ones; 2. The symbolic elaboration of separation from parents in childhood, and the grief related to loss and waivers related to bodily changes and infant objects, so that the adolescent can access their desire and support their possibility of choice; 3. Listening to the unconscious dimension present in the subject's choices in the professional field is essential to an analysis of the difficulties that have arisen therein to meet individual outputs to the same.

Las profundas transformacións de la orden política, económica y social en las sociedades capitalistas y globalizadas generadas por los avances en la ciencia, en la industria de la electrónica, en la informática y en la robótica se reflejan en la colectividad y en los modos de organización del mundo del trabajo. Los adolescentes y los jóvenes se ven afectados por estos cambios, con la presentación de diversas manifestaciones psíquicas adelante de la elección de su profesión, denunciando el malestar y el sufrimiento que se vive, las vicisitudes del proceso y las expectativas generadas por el mismo. Se trata de un trabajo teórico en el que articulamos las dificultades y dilemas que implican la elección profesional en la adolescencia a las determinaciones psíquicas inconscientes de este proceso y a la pena que el adolescente tendrá que hacer para ser capaz de elegir una profesión. Desde el marco freudiano y lacaniano, se realizó un estudio sobre el concepto de adolescência que, en articulacion a la elección profesional y a fragmentos de los casos clínicos, reveló las siguientes conclusiones: 1. En las elecciones humanas están involucrados muchos procesos psicológicos que comenzaron en la infancia, se actualizan en la adolescencia, determinando las opciones de los adolescentes, incluida la profesional; 2. Se requiere la elaboración simbólica de la separación de los padres en la infancia, y el dolor relacionado con la pérdida y exenciones relacionadas con los cambios corporales y objetos infantiles, por lo que el adolescente puede acceder a su deseo y apoyar su elección; 3. Escuchar a la dimensión inconsciente presente en las elecciones del sujeto en el campo profesional es esencial para una análisis de las dificultades vividas en el mismo y para encontrar salidas individuales a las mismas.

La transformation profonde de l'ordre politique, économique et sociale dans les sociétés capitalistes et mondialisés générés par les progrès de la science, de l'industrie de l'électronique, de l'informatique et de la robotique se reflète dans la collectivité et des modes d'organisation du monde du travail. Les adolescents et les jeunes sont touchés par ces changements, présentant diverses manifestations psychiques avant de choisir leur profession, dénoncer le malaise et la souffrance vécue par eux, les vicissitudes du processus et les attentes générées par celle-ci. Il s'agit d'un article théorique dans lequel nous articulons les difficultés et les dilemmes qui impliquent le choix professionnel de l'adolescence à des déterminations psychiques inconscients de ce processus et la douleur que votre enfant aura besoin de faire pour être en mesure de choisir une profession. Du cadre freudien et lacanien , nous avons effectué une étude de la notion de l'adolescence que, que articulé a le choix professionnel et les fragments de cas cliniques révélé les conclusions suivantes: 1. Dans les choix humains sont impliqués processus psychologiques qui ont commencé dans l'enfance, à l'adolescence sont mis à jour, déterminer des choix des adolescents, y compris professionnelle; 2. C'est nécessaire l'élaboration symbolique de séparation des parents dans l'enfance, et la douleur liée à la perte et des dérogations des changements corporels et des objets infantiles, de sorte que l'adolescent peut accéder à votre désir et soutenir leur choix; 3. Écouter la dimension inconsciente présente dans les choix du sujet dans le domaine professionnel est essentiel à l'analyse des difficultés à l'intérieur et à répondre à des sorties individuelles de la même rencontrés.

Smaller hippocampal subfield volumes predict verbal associative memory in pediatric brain tumor survivors.

The developing hippocampus is highly sensitive to chemotherapy and cranial radiation treatments for pediatric cancers, yet little is known about the effects that cancer treatents have on specific hippocampal subfields. Here, we examined hippocampal subfield volumes in 29 pediatric brain tumor survivors treated with cranial radiation and chemotherapy, and 30 healthy developing children and adolescents. We also examined associations between hippocampal subfield volumes and short-term verbal memory. Hippocampal subfields (Cornus Ammonis (CA) 1, CA2-3, dentate gyrus (DG)-CA4, stratum radiatum-lacunosum-moleculare, and subiculum) were segmented using the Multiple Automatically Generated Templates for Different Brains automated segmentation algorithm. Neuropsychological assessment of short-term verbal associative memory was performed in a subset of brain tumor survivors (N = 11) and typically developing children (N = 16), using the Children's Memory Scale or Wechsler's Memory Scale-third edition. Repeated measures analysis of variance showed that pediatric brain tumor survivors had significantly smaller DG-CA4, CA1, CA2-3, and stratum radiatum-lacunosum-moleculare volumes compared with typically developing children. Verbal memory performance was positively related to DG-CA4, CA1, and stratum radiatum-lacunosum-moleculare volumes in pediatric brain tumor survivors. Unlike the brain tumor survivors, there were no associations between subfield volumes and memory in typically developing children and adolescents. These data suggest that specific subfields of the hippocampus may be vulnerable to brain cancer treatments, and may contribute to impaired episodic memory following brain cancer treatment in childhood.

Psicose e toxicomanias: um estudo psicanalítico / Psychosis and drug addictions: a psychoanalytical study / Psicosis y toxicomanías: un estudio psicoanalítico

Este artigo tem o objetivo de discutir os diferentes modos como o uso de drogas opera em sujeitos de estrutura psicótica. Tomam-se como unidades de análise os conceitos de psicose e de toxicomania na psicanálise freudolacaniana, juntamente com autores atuais que discutem o tema. Enquanto na neurose as toxicomanias operam o rompimento com o gozo fálico, na psicose, elas funcionam de maneira diversa, já que existe uma ruptura, dada de antemão, pois é de estrutura. Por meio de revisão de literatura, constatouse que o uso de drogas na psicose pode operar de três modos distintos: como solução estabilizadora, como suplência à foraclusão do Nome do Pai e como liberação de gozo. Tal discussão permite que se avence na compreensão sobre o número cada vez maior de psicóticos que recorrem ao uso de drogas e lançar luzes sobre a direção do tratamento a ser seguida com esses sujeitos

This article aims to discuss the different ways in which the drug use operates in subjects in a psychotic structure. We take as the unit of analysis the concepts of psychosis and drug addiction in the Freudian-Lacanian psychoanalysis, along with current authors who discuss the theme. While in neurosis, drug addictions operate to break with the phallic Jouissance, in psychosis they work differently, in that there is a break, given beforehand, because it is structural. From the literature review, it was found that the use of drugs in psychosis could operate in three different modes: as a stabilizing solution; as a supplementation to the foreclosure of the 'Name of the Father'; and as a release of Jouissance. Such discussion allows advances in the understanding of an increase in the number of psychotics who resort to using drugs and sheds light on the direction of the treatment to be followed up with those subjects

Este artículo tiene como objetivo discutir las diferentes formas en las que el consumo de drogas opera en sujetos de estructura psicótica. Tomamos como unidades de análisis los conceptos de psicosis y de toxicomanía en el psicoanálisis freudo-lacaniano, junto con autores actuales que discuten el tema. Mientras en la neurosis las toxicomanías operan la ruptura con el goce fálico, en la psicosis funcionan de forma diferente, ya que hay una ruptura, dada de antemano, pues es de estructura. A partir de la revisión de la literatura, se constató que el uso de drogas en la psicosis puede funcionar de tres modos diferentes: como una solución estabilizadora; como suplencia a la forclusión del Nombre del Padre; y como liberación de goce. Tal discusión permite avanzar en la comprensión sobre el número cada vez mayor de psicóticos que recurren al uso de drogas y arrojan luz sobre la dirección del tratamiento a seguir con esas personas

Exercise training for neural recovery in a restricted sample of pediatric brain tumor survivors: a controlled clinical trial with crossover of training versus no training.

Background: Exercise promotes repair processes in the mouse brain and improves cognition in both mice and humans. It is not known whether these benefits translate to human brain injury, particularly the significant injury observed in children treated for brain tumors. Methods: We conducted a clinical trial with crossover of exercise training versus no training in a restricted sample of children treated with radiation for brain tumors. The primary outcome was change in brain structure using MRI measures of white matter (ie, fractional anisotropy [FA]) and hippocampal volume [mm3]). The secondary outcome was change in reaction time (RT)/accuracy across tests of attention, processing speed, and short-term memory. Linear mixed modeling was used to test the effects of time, training, training setting, and carryover. Results: Twenty-eight participants completed training in either a group (n=16) or a combined group/home (n=12) setting. Training resulted in increased white matter FA (Δ=0.05, P<.001). A carryover effect was observed for participants ~12 weeks after training (Δ=0.05, P<.001). Training effects were observed for hippocampal volume (Δ=130.98mm3; P=.001) and mean RT (Δ=-457.04ms, P=0.36) but only in the group setting. Related carryover effects for hippocampal volume (Δ=222.81mm3, P=.001), and RT (Δ=-814.90ms, P=.005) were also observed. Decreased RT was predicted by increased FA (R=-0.62, P=.01). There were no changes in accuracy. Conclusions: Exercise training is an effective means for promoting white matter and hippocampal recovery and improving reaction time in children treated with cranial radiation for brain tumors.

Efeitos analíticos de uma escuta em grupo: uma discussão sobre a função do analista / Analyticals effects of a group listening: a discussion on the function of the analyst / Efectos analíticos de una escucha en grupo: un debate sobre la función del analista

O artigo parte de um relato clínico de escuta em grupo a professores, no contexto de um trabalho de psicanálise em extensão, no qual se evidencia a produção de efeitos análogos a uma retificação subjetiva. A partir da interrogação acerca do que operou nessa escuta de modo a viabilizar tais efeitos, um percurso realizado junto a obras de Lacan em torno da função do analista permitiu localizar na formulação do desejo do analista uma apreensão possível, autorizando formular sua incidência nesse trabalho como escuta dirigida ao desejo mais além da demanda.

The article is based on a clinical report of group listening to teachers, in the context of a psychoanalytic work in extension, in which the production of similar effects to a subjective rectification is clear. From the question of what worked in this listening mode to enable such effects, a journey conducted with Lacan's work around the analyst's function allowed to locate in the formulating of the analyst's desire a possible perception, authorizing the formulation of the incidence in this work as listening addressed to the desire beyond the demand.

Este trabajo se basa en un informe clínico de escucha en grupo a los maestros, en el contexto de un trabajo psicoanalítico en extensión, en lo cual deja en claro la producción de efectos similares a una rectificación subjetiva. De la cuestión de lo que funcionó en este modo de escucha para permitir tales efectos, un viaje realizado con las obras de Lacan en torno a la función del analista permitió encontrar en la formulación del deseo del analista una posible aprehensión, lo que autoriza a formular su incidencia en este trabajo como escucha dirigida al deseo más allá de la demanda.

Efeitos analíticos de uma escuta em grupo: uma discussão sobre a função do analista1 / Analyticals effects of a group listening: a discussion on the function of the analyst / Efectos analíticos de una escucha en grupo: un debate sobre la función del analista

O artigo parte de um relato clínico de escuta em grupo a professores, no contexto de um trabalho de psicanálise em extensão, no qual se evidencia a produção de efeitos análogos a uma retificação subjetiva. A partir da interrogação acerca do que operou nessa escuta de modo a viabilizar tais efeitos, um percurso realizado junto a obras de Lacan em torno da função do analista permitiu localizar na formulação do desejo do analista uma apreensão possível, autorizando formular sua incidência nesse trabalho como escuta dirigida ao desejo mais além da demanda.

The article is based on a clinical report of group listening to teachers, in the context of a psychoanalytic work in extension, in which the production of similar effects to a subjective rectification is clear. From the question of what worked in this listening mode to enable such effects, a journey conducted with Lacan's work around the analyst's function allowed to locate in the formulating of the analyst's desire a possible perception, authorizing the formulation of the incidence in this work as listening addressed to the desire beyond the demand.

Este trabajo se basa en un informe clínico de escucha en grupo a los maestros, en el contexto de un trabajo psicoanalítico en extensión, en lo cual deja en claro la producción de efectos similares a una rectificación subjetiva. De la cuestión de lo que funcionó en este modo de escucha para permitir tales efectos, un viaje realizado con las obras de Lacan en torno a la función del analista permitió encontrar en la formulación del deseo del analista una posible aprehensión, lo que autoriza a formular su incidencia en este trabajo como escucha dirigida al deseo más allá de la demanda.

Postpartum depression and brain response to infants: Differential amygdala response and connectivity.

Recent evidence suggests that postpartum depression is associated with reduced amygdala (AMY) response to negative stimuli. However, given the anhedonic features of PPD, it is important to consider mothers' brain response specifically to positive infant and to other positive stimuli. Mothers with (n = 28) and without (n = 17) clinically determined PPD (n = 28) viewed smiling pictures of infants (Own and Other), and positive non-infant stimuli (Non-Infant). First, we examined group differences in AMY response across conditions. Next, psychophysiological interaction was used to examine group differences in AMY connectivity across conditions. Connectivity estimates were then correlated with measures of maternal mood and anxiety. PPD mothers, compared to non-PPD mothers, showed overall increased AMY response across conditions in the right AMY. Despite this, PPD mothers demonstrated decreased bilateral AMY-right insular cortex (IC) connectivity as compared to non-PPD mothers when they view Own-Other infants. Furthermore, decreasing AMY-IC connectivity was associated with increasing symptoms of depression and anxiety. These differences were evident only for infant stimuli and did not apply to all positively valenced stimuli. Thus, PPD mothers show altered brain response and connectivity in regions strongly implicated in the processing of socially and emotionally relevant stimuli, as well as interoception and the evaluation of subjective emotional experience.