Treatment and Outcomes of Congenital Ovarian Cysts A Study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS).

OBJECTIVE: We conducted a multicenter study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts. SUMMARY BACKGROUND DATA: Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known. METHODS: Female infants diagnosed with congenital intra-abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centers were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter. RESULTS: The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally, and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary sparing resection (14, 23%), or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4weeks. Independent predictors of surgery included postnatal cyst diameter ≥40 mm [odds ratio (OR) 6.19, 95% confidence interval (CI) 1.66-35.9] and sonographic complex cyst character (OR 63.6, 95% CI 10.9-1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 -13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131). CONCLUSIONS: Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.

Psychotic symptoms are associated with lower cortical folding in youth at risk for mental illness

Background: Cortical folding is essential for healthy brain development. Previous studies have found regional reductions in cortical folding in adult patients with psychotic illness. It is unknown whether these neuroanatomical markers are present in youth with subclinical psychotic symptoms. Methods: We collected MRIs and examined the local gyrification index in a sample of 110 youth (mean age ± standard deviation 14.0 ± 3.7 yr; range 9­25 yr) with a family history of severe mental illness: 48 with psychotic symptoms and 62 without. Images were processed using the Human Connectome Pipeline and FreeSurfer. We tested for group differences in local gyrification index using mixed-effects generalized linear models controlling for age, sex and familial clustering. Sensitivity analysis further controlled for intracranial volume, IQ, and stimulant and cannabis use. Results: Youth with psychotic symptoms displayed an overall trend toward lower cortical folding across all brain regions. After adjusting for multiple comparisons and confounders, regional reductions were localized to the frontal and occipital lobes. Specifically, the medial (B = ­0.42, pFDR = 0.04) and lateral (B = ­0.39, pFDR = 0.04) orbitofrontal cortices as well as the cuneus (B = ­0.47, pFDR = 0.03) and the pericalcarine (B = ­0.45, pFDR = 0.03) and lingual (B = ­0.38, pFDR = 0.04) gyri. Limitations: Inference about developmental trajectories was limited by the cross-sectional data. Conclusion: Psychotic symptoms in youth are associated with cortical folding deficits, even in the absence of psychotic illness. The current study helps clarify the neurodevelopmental basis of psychosis at an early stage, before medication, drug use and other confounds have had a persistent effect on the brain.

Quit Intentions Moderate Subjective and Physiological Responses to Acute Nicotine Replacement Therapy Administration in Dependent Smokers.

INTRODUCTION: This study assessed the impact of expectancy and administration components of acute nicotine inhaler use on craving, heart rate, and smoking behavior in smokers with varying intentions to quit. METHODS: 47 dependent smokers that differed in self-reported intention to quit (no intention to quit during the next month N = 26 vs. intention to initiate a quit attempt within 2 weeks N = 21) were randomly administered a 4 mg nicotine or nicotine-free inhaler across two sessions. Instructions regarding the inhaler's nicotine content (expect nicotine vs. expect nicotine-free; nicotine expectancy) and flavor (mint vs. citrus) varied across sessions. Craving and heart rate were assessed before and after inhaler administration (two-second inhalations every 10 seconds over 20 minutes). Next, participants were offered an opportunity to self-administer puffs of their preferred tobacco brand during an hour-long progressive ratio task. RESULTS: Across participants, nicotine expectancy independently reduced withdrawal related craving (p = .018), but no comparable effects of nicotine administration were evident. In quitting motivated smokers, nicotine expectancy and administration interacted to reduce intention to smoke (p = .040), while nicotine expectancy (p = .047) and administration (p = .025) independently reduced intention to smoke in quitting unmotivated smokers. Blunted heart rate reactivity to nicotine administration was observed in quitting motivated relative to unmotivated smokers (p = .042); however, neither expectancy nor administration impacted smoking behavior in either group (p values > .25). CONCLUSIONS: Findings indicate that participant quitting intentions moderate acute nicotine replacement therapy responses. In quitting motivated smokers, a combination of pharmacological and psychological factors may be necessary for nicotine replacement therapy to impact craving. IMPLICATIONS: Findings from this study demonstrate that motivations to quit smoking moderate subjective and physiological responses to acute nicotine administration and expectancy in dependent cigarette smokers. Quitting motivated smokers showed blunted heart rate reactivity to nicotine administration, suggesting that they may be less sensitive to the rewarding aspects of nicotine consumption. Nicotine administration and expectancy were found to interact to reduce craving in quitting motivated but not in unmotivated smokers, suggesting that pharmacological and psychological factors may be necessary for nicotine replacement therapy to impact craving in smokers who plan to quit.

Four best-practice recommendations for improving the conceptualization and operationalization of motivational intensity: Reply to Kaczmarek and Harmon-Jones.

Replies to the comments made by Kaczmarek and Harmon-Jones (see record 2024-44184-002) on the current authors original article (see record 2021-21096-001). Kaczmarek and Harmon-Jones (2023) provide a commentary on our original empirical piece, does motivational intensity exist distinct from valence and arousal? (Campbell et al., 2021). In this response, we articulate the motivation behind our work, including the major issues with the conceptualization and operationalization of motivational intensity in prior literature. For example, while motivational intensity was proposed to replace valence as the determinant of cognitive scope more than a decade and a half ago, in both this original work and ongoing work since then, motivational intensity has been operationalized in a variety of questionable ways, including via participants' ratings of valence, rather than motivational intensity. That is, in multiple studies, differences in cognitive processes measured in two conditions have been attributed to motivational intensity which was not explicitly measured, while the conditions do demonstrably differ in the valence participants experienced. We explain exactly what we found in Campbell et al. (2021) and our subsequent follow-up work (Campbell et al., 2023), and what aspects of our interpretation converge versus diverge with the views offered in Kaczmarek and Harmon-Jones' commentary. We also identify four important recommendations for best-practice research going forward. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Motivational direction diverges from valence for sadness, anger, and amusement: A role for appraisals?

Recent work has cast doubt on whether the strength of motivation (strength of avoidance or approach tendencies) experienced while viewing emotion-eliciting pictures is dissociable from felt valence (negative versus positive). The present study extended this work by testing specific discrete emotions (amusement, anger, awe, desire, sadness). Previous work has proposed separate motivational direction (avoid versus approach) from valence. In Study 1, participants (N = 60) rated the motivational direction or valence they experienced while viewing 100 pictures that each evoked one of the five discrete emotions. We found significant differences between average motivational direction and valence ratings for sadness, anger, and amusement. Critically, underlying these averages, we found that while valence responses were highly consistent, there was large variability in motivational direction, with some people indicating they wanted to approach and others indicating they wanted to avoid while viewing the same picture. Individual differences in motivational direction were largest for sadness, so in Study 2 (N = 100) we tested whether they were predicted by appraisals of the situation (e.g., ratings of how welcome or useful people believed their help would be). The three appraisals tested accounted for 64% of the variance in motivational direction, after which valence made a very small unique contribution. These findings highlight that motivational direction and valence can diverge. Given the variability in individuals' motivational direction responses, future studies designed to assess the effects of motivational direction on cognitive processes need to tailor stimuli for each participant to ensure they activate the intended motivational direction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Developmental Trajectory of Body Weight in Youths at Risk for Major Mood Disorders.

Importance: Mood disorders are associated with increased body weight, especially in females, but it remains unknown when the weight increase starts. Objectives: To examine sex-specific weight trajectories associated with familial mood disorder risk and determine the age at which youth at familial risk for mood disorders begin to diverge in weight from controls. Design, Setting, and Participants: This community-based, single-center, acceleration cohort study of youth at familial risk for mood disorders and controls with yearly follow-ups (mean [SD], 5 [2.1] years) from January 1, 2014, to December 31, 2022, assessed 394 unaffected female and male offspring (aged 3 to 20 years) of parents with or without a mood disorder. Parents with mood (depressive or bipolar) disorders were recruited through adult mental health services. Parents of control participants were matched on age and socioeconomic factors and recruited through acquaintance referrals or schools. Exposures: The youth in the familial mood risk group had at least 1 parent with a major mood disorder, whereas control youth did not have a parent with a mood disorder. Main Outcomes and Measures: Body mass indexes (BMIs) were calculated as weight in kilograms divided by height in meters squared from measured weight and height at annual assessments and then converted to age- and sex-adjusted z scores (zBMIs). Repeated-measure regressions examined the association between zBMI and age in youth at familial risk of mood disorders and controls while accounting for sex. Sensitivity analyses accounted for socioeconomic status, prematurity, and birth weight. Results: Of 394 participants (mean [SD] age, 11.5 [3.6] years; 203 [51.5%] female), youths at familial risk for mood disorders showed overall no difference in body weight (ß = 0.12; 95% CI, 0.01-0.24) from controls. A sex-specific difference was detected, with females at familial risk showing a rapid peripubertal increase in body weight, leading to significantly increased zBMIs at 12 years and older compared with controls (ß = 0.57; 95% CI, 0.31-0.82) independent of socioeconomic status, prematurity, or birth weight. Males did not differ from controls at any age. Conclusions and Relevance: In this cohort study, females with a family history of mood disorders were prone to weight gain starting around puberty and predating mood disorder onset. Early interventions aiming to prevent adverse mental and physical outcomes in this vulnerable group need to start in childhood.

Differentiating congenital ovarian cysts from other abdominal cystic lesions in female infants: A study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS).

PURPOSE: The origin of congenital abdominal cysts in the female fetus often dictates management. While most arise from the ovary and are often managed non-operatively, some are non-ovarian and are frequently removed. We analyzed a national sample of female infants with congenital abdominal cysts to elucidate prenatal and postnatal factors associated with the diagnosis of a non-ovarian cyst. METHODS: A retrospective cohort study of female infants who were prenatally diagnosed with abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centres was performed. Clinical characteristics, pre- and postnatal sonographic findings, and cyst trajectories were compared between patients with proven ovarian etiology and those with cysts arising from other organs. RESULTS: Of 185 infants with prenatally diagnosed abdominal cysts, 22 (12%) were non-ovarian, five of which had clear non-ovarian organ of origin on prenatal ultrasound. Comparison of the other 17 cysts with 163 congenital ovarian cysts showed the following factors to be associated with a non-ovarian origin: earlier gestational age at diagnosis (23.5 vs 33.5 weeks, p <0.001), smaller diameter on first prenatal ultrasound (15.8 vs. 39.7 mm, p <0.001), change in sonographic character from simple to complex (87% vs 22%, p <0.001), and postnatal sonographic characteristics of complex cyst (87% vs. 48%, p = 0.004). CONCLUSION: Clear organ of origin, diagnosis earlier in gestation, smaller initial prenatal cyst diameter, and sonographic cyst character change differentiate congenital non-ovarian cysts from their ovarian counterparts. These characteristics may be used to guide diagnosis and management.

Does motivational intensity exist distinct from valence and arousal?

The motivational intensity model proposes that the strength of one's urge to approach or avoid a stimulus is the primary driver of cognitive broadening/narrowing (Gable & Harmon-Jones, 2010d; Harmon-Jones et al., 2012). However, it is unclear whether motivational intensity is truly distinct from well-established dimensions of valence and arousal. Here we found an overwhelmingly strong relationship between motivational intensity and valence across all studies. In Study 1, we operationalized motivational intensity on 2 response rating scales and had multiple groups of participants (total 150) rate their response of motivational intensity, valence, and arousal to 300 pictures. There was a very strong relationship between motivational intensity and valence (rs in excess of .9, in studies 1a and 1b), which challenges the idea that these 2 constructs are distinct. In contrast, motivational intensity ratings were not consistently positively related to arousal ratings, with only a moderate relationship found with avoidance motivation. In Study 2 we used an implicit measure of motivational intensity and valence and asked participants to classify their motivational intensity and valence in response to 100 pictures from Study 1. A high degree of correspondence was found between motivational intensity and valence on this measure. Overall, our findings are at odds with proposals in the literature that arousal can be used as a proxy for motivational intensity across the full approach-avoidance spectrum. Furthermore, these studies suggest that the cognitive effects attributed to motivational intensity in previous literature are best explained by valence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Should all patients with septic shock have a mean arterial pressure threshold of 65 mmHg?

Sepsis requiring cardiovascular support is a common reason for critical care admission. The threshold for mean arterial pressure in septic shock has been set at a population-wide threshold of 65 mmHg by a European consensus statement, but should the threshold be higher?

Should the femoral or brachial artery be used if radial artery cannulation is difficult?

Current best practice in placement of arterial lines is to attempt to cannulate the radial artery in the first instance. However, if the radial artery is difficult to cannulate there is no consensus among clinicians on how best to proceed. This article looks at the evidence for the different options.