Neural connectivity biotypes: associations with internalizing problems throughout adolescence.

BackgroundNeurophysiological patterns may distinguish which youth are at risk for the well-documented increase in internalizing symptoms during adolescence. Adolescents with internalizing problems exhibit altered resting-state functional connectivity (RSFC) of brain regions involved in socio-affective processing. Whether connectivity-based biotypes differentiate adolescents' levels of internalizing problems remains unknown.MethodSixty-eight adolescents (37 females) reported on their internalizing problems at ages 14, 16, and 18 years. A resting-state functional neuroimaging scan was collected at age 16. Time-series data of 15 internalizing-relevant brain regions were entered into the Subgroup-Group Iterative Multi-Model Estimation program to identify subgroups based on RSFC maps. Associations between internalizing problems and connectivity-based biotypes were tested with regression analyses.ResultsTwo connectivity-based biotypes were found: a Diffusely-connected biotype (N = 46), with long-range fronto-parietal paths, and a Hyper-connected biotype (N = 22), with paths between subcortical and medial frontal areas (e.g. affective and default-mode network regions). Higher levels of past (age 14) internalizing problems predicted a greater likelihood of belonging to the Hyper-connected biotype at age 16. The Hyper-connected biotype showed higher levels of concurrent problems (age 16) and future (age 18) internalizing problems.ConclusionsDifferential patterns of RSFC among socio-affective brain regions were predicted by earlier internalizing problems and predicted future internalizing problems in adolescence. Measuring connectivity-based biotypes in adolescence may offer insight into which youth face an elevated risk for internalizing disorders during this critical developmental period

Outcomes of revision total hip arthroplasty using a vascularised anterior femoral window.

PURPOSE Extraction of the distal femoral cement mantle and restrictor during revision total hip arthroplasty (rTHA) is challenging and can compromise host bone stock. The aim of this study is to report outcomes of our femoral windowing technique for cement removal. METHODS We report on a cohort of 36 patients with an average age of 68.7 years who underwent 40 cemented rTHA between 2011 and 2017 using a vascularised anterior femoral window. Clinical and radiological outcomes were retrospectively reviewed with a mean follow-up of 6.6 years (range, 3.8-10). RESULTS Latest mean WOMAC score was 25.4 and all windows achieved radiographic union by a mean of 7.9 weeks. Femoral component survivorship was 100% and 38 out of 40 rTHAs showed no evidence of radiological loosening. CONCLUSION The vascularised anterior window to remove the distal femoral cement mantle under direct vision is safe and reproducible with excellent clinical and radiographic results

Research Review: Brain network connectivity and the heterogeneity of depression in adolescence – a precision mental health perspective

BackgroundAdolescence is a period of high risk for the onset of depression, characterized by variability in symptoms, severity, and course. During adolescence, the neurocircuitry implicated in depression continues to mature, suggesting that it is an important period for intervention. Reflecting the recent emergence of 'precision mental health' - a person-centered approach to identifying, preventing, and treating psychopathology - researchers have begun to document associations between heterogeneity in features of depression and individual differences in brain circuitry, most frequently in resting-state functional connectivity (RSFC).MethodsIn this review, we present emerging work examining pre- and post-treatment measures of network connectivity in depressed adolescents; these studies reveal potential intervention-specific neural markers of treatment efficacy. We also review findings from studies examining associations between network connectivity and both types of depressive symptoms and response to treatment in adults, and indicate how this work can be extended to depressed adolescents. Finally, we offer recommendations for research that we believe will advance the science of precision mental health of adolescence.ResultsNascent studies suggest that linking RSFC-based pathophysiological variation with effects of different types of treatment and changes in mood following specific interventions will strengthen predictions of prognosis and treatment response. Studies with larger sample sizes and direct comparisons of treatments are required to determine whether RSFC patterns are reliable neuromarkers of treatment response for depressed adolescents. Although we are not yet at the point of using RSFC to guide clinical decision-making, findings from research examining the stability and reliability of RSFC point to a favorable future for network-based clinical phenotyping.ConclusionsDelineating the correspondence between specific clinical characteristics of depression (e.g., symptoms, severity, and treatment response) and patterns of network-based connectivity will facilitate the development of more tailored and effective approaches to the assessment, prevention, and treatment of depression in adolescents

White Matter Microstructural Properties of the Superior Cerebellar Peduncles Predict Change in Internalizing Symptoms in Adolescent Girls

Internalizing symptoms typically emerge in adolescence and are more prevalent in females than in males; in contrast, externalizing symptoms typically emerge in childhood and are more commonly observed in males. Previous research has implicated aspects of white matter organization, including fractional anisotropy (FA), of cerebral tracts in both internalizing and externalizing symptoms. Although the cerebellum has been posited to integrate limbic and cortical regions, its role in psychopathology is not well understood. In this longitudinal study, we investigated whether FA of the superior (SCP), middle, and inferior cerebellar peduncles predict change in symptoms and whether sex moderates this association. 111 adolescents completed the Youth Self-Report, assessing symptoms at baseline (ages 9-13 years) and again two years later. Participants also underwent diffusion-weighted imaging at baseline. We used deterministic tractography to segment and compute mean FA of the cerebellar peduncles. Lower FA of the right SCP at baseline predicted increases in internalizing symptoms in females only (t(103)=−0.47, p=.020). Lower FA in the right SCP and inferior cerebellar peduncle also predicted increases in externalizing symptoms, but these associations did not survive multiple comparisons correction. There was no association between FA of the cerebellar peduncles and change in symptoms in males, or between middle cerebellar peduncle FA and symptom changes in males or females. Organizational properties of the SCP may be a sex-specific marker of internalizing symptom changes in adolescence. The cerebellar peduncles should be explored further in future studies to elucidate sex differences in internalizing and externalizing symptoms

Early Life Stress Predicts Depressive Symptoms in Adolescents During the COVID-19 Pandemic: The Mediating Role of Perceived Stress

Background: Exposure to early life stress (ELS) is alarmingly prevalent, and has been linked to the high rates of depression documented in adolescence. Researchers have theorized that ELS may increase adolescents’ vulnerability or reactivity to the effects of subsequent stressors, placing them at higher risk for developing symptoms of depression. Methods: We tested this formulation in a longitudinal study by assessing levels of stress and depression during the COVID-19 pandemic in a sample of adolescents from the San Francisco Bay Area (N=100; 43 male; ages 13-20 years) who had been characterized 4-7 years earlier (M=5.27, SD=0.75 years) with respect to exposure to ELS and symptoms of depression. Results: As expected, severity of ELS predicted levels of depressive symptoms during the pandemic (r(98)=0.25, p=.012), which were higher in females than in males (t(98)=-3.36, p=.001). Importantly, the association between ELS and depression was mediated by adolescents’ reported levels of stress, even after controlling for demographic and other COVID-19-related variables. Conclusions: These findings underscore the importance of monitoring the mental health of vulnerable children and adolescents during this pandemic and targeting perceived stress and isolation in high-risk youth

Neural responses to implicit forms of peer influence in young adults

Young adults are acutely sensitive to peer influences. Differences have been found in neural sensitivity to explicit peer influences, such as seeing peer ratings on social media. The present study aimed to identify patterns of neural sensitivity to implicit peer influences, which involve more subtle cues that shape preferences and behaviors. Participants were 43 young adults (MAge = 19.2 years; 24 males) who underwent functional magnetic resonance imaging while completing a task used to assess neural responses to implicitly "socially tagged" symbols (previously judged by peers as liked vs. not liked, thus differing in apparent popularity) vs. novel symbols that carried no social meaning (not judged by peers). Results indicated greater activity in brain regions involved in salience detection (e.g., anterior cingulate cortex) and reward processing (e.g., caudate) to socially tagged vs. novel symbols, and particularly to unpopular symbols. Greater self-reported susceptibility to peer influence was related to more activity in the insula and caudate when viewing socially tagged vs. novel symbols. These results suggest that the brain is sensitive to even subtle cues varying in level of peer endorsement and neural sensitivity differed by the tendency to conform to peers' behaviors particularly in regions implicated in social motivation