Determinants of Intima-Media Thickness in the Young: The ALSPAC Study

ObjectivesThis study characterized the determinants of carotid intima-media thickness (cIMT) in a large (n > 4,000) longitudinal cohort of healthy young people age 9 to 21 years.BackgroundGreater cIMT is commonly used in the young as a marker of subclinical atherosclerosis, but its evolution at this age is still poorly understood.MethodsAssociations between cardiovascular risk factors and cIMT were investigated in both longitudinal (ages 9 to 17 years) and cross-sectional (ages 17 and 21 years) analyses, with the latter also related to other measures of carotid structure and stress. Additional use of ultra-high frequency ultrasound in the radial artery at age 21 years allowed investigation of the distinct layers (i.e., intima or media) that may underlie observed differences.ResultsFat-free mass (FFM) and systolic blood pressure were the only modifiable risk factors positively associated with cIMT (e.g., mean difference in cIMT per 1-SD increase in FFM at age 17: 0.007 mm: 95% confidence interval [CI]: 0.004 to 0.010; p < 0.001), whereas fat mass was negatively associated with cIMT (difference: ?0.0032; 95% CI: 0.004 to ?0.001; p = 0.001). Similar results were obtained when investigating cumulative exposure to these factors throughout adolescence. An increase in cIMT maintained circumferential wall stress in the face of increased mean arterial pressure when increases in body mass were attributable to increased FFM, but not fat mass. Risk factor?associated differences in the radial artery occurred in the media alone, and there was little evidence of a relationship between intimal thickness and any risk factor.ConclusionsSubtle changes in cIMT in the young may predominantly involve the media and represent physiological adaptations as opposed to subclinical atherosclerosis. Other vascular measures may be more appropriate for the identification of arterial disease before adulthood.     

Delayed diagnosis of carpal scaphoid fracture in a young boy

Emergency Radiology - Carpal scaphoid fracture is rare in children and is important to recognize early because of an increased risk for serious complications including non-union, avascular...     

Predictors of severity and necrosis in acute pancreatitis

C-reactive protein remains the single standard biochemical marker for predicting the severity of AP. Because the combination of clinical-physiological scores and CRP provide good information at 48 hours, research has focused on the predictive ability of various markers when applied in the initial 24 hours after admission to the hospital. After detailed review of the literature, the authors conclude that there is no single tool that serves as the optimal predictor of severity. There are, however, data that support the use of certain tests to improve upon the clinician's early predictive ability on the subsequent course of AP. These include an APACHE II score greater than 7 and IL-6 at the time of admission, and urine TAP, urine trypsinogen-2, and serum PMN elastase at 24 hours (Table 4). These markers only will be able to help the clinician's predictive ability if they can be performed locally and if the results can be available ina timely manner. Future research should focus on promising markers such as procalcitonin, IL-8, IL-I ra, sTNFR, CAPAP, PLA-2, novel markers, and the combined use of more than one marker. The conventional research approach in predicting severity used in the last 15 years has limitations and appears to have reached its maximal potential. Novel conceptions and approaches, such as identification of genetic polymorphisms that predispose to severe course and complications of AP or other approaches are needed for a quantum step forward.     

Immune-mediated mechanisms of endothelial damage in atherosclerosis

The endothelium of the vessel wall as a barrier between blood and the subendothelial matrix proteins is essential for preventing thrombus formation and subsequent atherosclerosis development. Atherosclerosis is an inflammatory disease in which immune and autoimmune mechanisms are involved. Recently, it was demonstrated that endothelial cells in the vessel wall can be damaged not only by classic risk factors, such as hyperlipidemia, smoking and disturbed blood flow, but also (auto)immune reactions to autoantigens present in the cell surface, among which heat shock protein 60 (HSP60) was mostly studied. HSP60 normally located in mitochondria can be translocated into the cell member in response to stress stimuli. Meanwhile, autoantibodies against HSP60 are present in most subjects, especially patients with heart attack and stroke. These autoantibodies may bind to HSP60 expressed in endothelial cells resulting in the cell damage, subsequently initiating the formation of atherosclerotic lesions. Based on the recent progress in the research field, the present review will update the mechanisms of immune response to endothelial cells by which cell damage can initiate the development of atherosclerosis.     

Memory Load Alters Perception-Related Neural Oscillations during Multisensory Integration

Integrating information across different senses is a central feature of human perception. Previous research suggests that multisensory integration is shaped by a context-dependent and largely adaptive interplay between stimulus-driven bottom-up and top-down endogenous influences. One critical question concerns the extent to which this interplay is sensitive to the amount of available cognitive resources. In the present study, we investigated the influence of limited cognitive resources on audiovisual integration by measuring high-density electroencephalography (EEG) in healthy participants performing the sound-induced flash illusion (SIFI) and a verbal n-back task (0-back, low load and 2-back, high load) in a dual-task design. In the SIFI, the integration of a flash with two rapid beeps can induce the illusory perception of two flashes. We found that high compared with low load increased illusion susceptibility and modulated neural oscillations underlying illusion-related crossmodal interactions. Illusion perception under high load was associated with reduced early β power (18–26 Hz, ∼70 ms) in auditory and motor areas, presumably reflecting an early mismatch signal and subsequent top-down influences including increased frontal θ power (7–9 Hz, ∼120 ms) in mid-anterior cingulate cortex (ACC) and a later β power suppression (13–22 Hz, ∼350 ms) in prefrontal and auditory cortex. Our study demonstrates that integrative crossmodal interactions underlying the SIFI are sensitive to the amount of available cognitive resources and that multisensory integration engages top-down θ and β oscillations when cognitive resources are scarce.SIGNIFICANCE STATEMENT The integration of information across multiple senses, a remarkable ability of our perceptual system, is influenced by multiple context-related factors, the role of which is highly debated. It is, for instance, poorly understood how available cognitive resources influence crossmodal interactions during multisensory integration. We addressed this question using the sound-induced flash illusion (SIFI), a phenomenon in which the integration of two rapid beeps together with a flash induces the illusion of a second flash. Replicating our previous work, we demonstrate that depletion of cognitive resources through a working memory (WM) task increases the perception of the illusion. With respect to the underlying neural processes, we show that when available resources are limited, multisensory integration engages top-down θ and β oscillations.     

Correction to: Identifying Subgroups of Toddlers with DSM‑5 Autism Spectrum Disorder Based on Core Symptoms

Journal of Autism and Developmental Disorders - A correction to this paper has been published: https://doi.org/10.1007/s10803-021-04954-5