Charité - Universitätsmedizin Berlin

Selective attention involves prioritising relevant sensory input while suppressing irrelevant stimuli. It has been proposed that oscillatory alpha-band activity (~10 Hz) aids this process by functionally inhibiting early sensory regions. However, recent studies have challenged this notion. Our EEG and MEG studies aimed to investigate whether human alpha oscillations serve as a 'gatekeeper' for downstream signal transmission. We first observed these effects in an EEG study and then replicated them using MEG, which allowed us to localise the sources. We employed a cross-modal paradigm where visual cues indicated whether upcoming targets required visual or auditory discrimination. To assess inhibition, we utilised frequency-tagging, simultaneously flickering the fixation cross at 36 Hz and playing amplitude-modulated white noise at 40 Hz during the cue-to-target interval. Consistent with prior research, we observed an increase in posterior alpha activity following cues signalling auditory targets. However, remarkably, both visual and auditory frequency-tagged responses amplified in anticipation of auditory targets, correlating with alpha activity amplitude. Our findings suggest that when attention shifts to auditory processing, the visual stream remains responsive and is not hindered by occipital alpha activity. This implies that alpha modulation does not solely regulate 'gain control' in early visual areas but rather orchestrates signal transmission to later stages of the processing stream.

Minimally invasive liver surgery is associated with lower complication rates compared to open liver surgery. Due to the growing acceptance and increasing experience with minimally invasive liver resections, open conversions have become rare but are associated with inferior postoperative outcomes. We aimed to investigate the risk factors for conversion and outcomes in patients undergoing minimally invasive liver resections. We performed apost hoc analysis of 1209 consecutive minimally invasive liver resections at our center between 2015 and 2024. The factors and perioperative outcomes of conversion to open procedures were analyzed. The conversion rate was 4.1% and left hemihepatectomy was associated with an increased conversion rate. The Harmonic Ace® and Waterjet® parenchyma dissectors were associated with lower conversion rates. The most common reasons for conversion were technical and adhesions. Major complications (Clavien Dindo ≥ III) within the first 90 days occurred in 18.3% of cases and conversions were associated with an increased complication rate. In conclusion, this study highlights the influencing factors which correlate to open conversion in minimally invasive liver resections. Open conversion was an independent predictor of an increased complication rate.

Plastic and reconstructive surgery (PRS) encompasses a wide range of procedures, and postoperative complications remain a persistentchallenge. While preoperative laboratory values (PLVs) are routinely assessed, their predictive value for postoperative outcomes inPRS is unclear. This study evaluates the association between PLVs and postoperative morbidity to enhance risk stratification. The ACS-NSQIP database (2008-2022) was analyzed for PRS patients. PLVs included sodium, blood urea nitrogen, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white blood cell count, hematocrit, platelets, partial thromboplastin time, international normalized ratio, and prothrombin time (PT). Multivariate logistic regression identified independent predictors of complications, while decision tree analysis established risk thresholds, validated through cross-validation. A total of 200,015 patients with a mean age of 50.3±14.5 years and a mean BMI of 29.1±6.8 kg/m2 were included in this study. Albumin levels emerged as the strongest predictor for the occurrence of any complications. Patients with albumin ≤ 3.3 g/dL had a 36.5% risk for the occurrence of any complication compared to 10.4% in those with higher levels. In the high-risk group, prolonged PT (> 16.2s) further increased risk for the occurrence of any complications. Also, in the lower-risk group (albumin > 3.3 g/dL), prolonged PT (> 13.7 s) were found to significantly influence complication occurrence. Further, multivariate analysis confirmed reduced albumin (OR 0.460) as the strongest independent predictors for any complication occurrence. Albumin and PT are key predictors of 30-day postoperativecomplications in PRS. Preoperative optimization of these values can enhance patient safety and surgical outcomes. Findings support integrating targeted preoperative evaluations into clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Words and sentences can be used to carry out a wide range of different communicative actions. Recognizing these actions quickly is crucial for effective understanding. Previous research indicates that communicative action understanding is a rapid process, as brain signatures of different communicative actions differ within ca. 250 ms following the relevant linguistic information. However, previous work has explored a restricted set of communicative actions, leaving other ones still unexplored. In the present study, we examine emotion-related utterances in the 1st person singular ("I am happy"), which are typically applied to express an emotional state of the speaker, that is, to perform so-called a 'expressive' communicative action. We recorded brain potentials while subjects read such 'expressive sentences' and similar ones in the 3rd person singular, which are likely applied to assert or report facts ("he is happy"). Further assertive control past-tense sentences were included to control for any 1st/3rd person differences. Brain responses to sentences with expressive communicative actions differed from those to assertives 221-270 ms after the critical sentence-final word appeared, and an even earlier dissociation was observed. These results extend previous findings from contrasting assertive and directive communicative actions by demonstrating that the brain is quick in discriminating between communicative actions, therefore suggesting a generalizable temporal pattern. Since communicative action is processed fast, within ca. 250 ms after the critical utterance-related information is presented, our results are consistent with parallel models of language processing stating that pragmatic processing occurs rapidly and near-simultaneously with that of semantic and morphosyntactic information.

Mastering emotion regulation is crucial for social skills and mental health. Hormonal fluctuations, particularly in estradiol (E2) levels across the menstrual cycle, significantly impact emotion processing. E2 is known to influence emotion regulation, mental health, and the plasticity of limbic and striatal regions, which are involved in emotion processing and are rich in E2 receptors. Although research indicates that E2 levels may impact gray matter volume (GMV) of limbic and striatal areas, sufficient causal evidence is missing so far. Furthermore, because of the additional fluctuations of progesterone across the menstrual cycle, the sole impact of E2 on brain volume has been difficult to disentangle. To isolate the effects of E2 from other fluctuating sex hormones, we used a randomized, placebo-controlled, double-blind, crossover design and administered oral E2 to 27 naturally cycling females during their early follicular phase (low endogenous sex hormone levels). We analyzed emotion regulation strategies and E2 levels to assess their impact on regional GMV. Our data showed that a rapid increase of E2 was negatively associated with right striatal GMV. Moreover, greater use of reappraisal was associated with reduced GMV of the right striatum. Rapidly increased E2 did not influence GMV of other limbic regions. These results highlight that rapid increases in E2 and individual differences in emotion regulation dynamically modulate GMV. This offers important implications for female mental and brain health associated with hormonal fluctuations. Considering female endocrine profiles improves hormone-informed health care and therefore supports individualized medicine.

The growing prevalence of dementia highlights the need for a risk assessment tool that is accessible, facilitates the identification of at-risk individuals, and provides evidence-based guidance on how to reduce dementia risk. We developed, deployed, and evaluated the MoCA-CHAI, a self-administered, online dementia risk assessment for the general public. We provide a brief overview of its development, the self-enrolled population that has completed it, and a preliminary evaluation of its predictive performance. Drawing on the 2024 Lancet report, we developed the MoCA-CHAI translating the 14 identified risk factors into a questionnaire. We used the MoCA XpressO as a measure of cognitive impairment and a proxy measure for the probability of having or developing dementia. The MoCA-CHAI was completed by 3886 people. Based on their XpressO score, 11.3% showed a high probability of cognitive impairment. Using a logistic regression analysis, we found that each 1-point increase in MoCA-CHAI score decreases the odds of having cognitive impairment by 1%. Physical inactivity and exposure to air pollution are the most prevalent risk factors across the lifespan. Depression is more prevalent in young adults, while high cholesterol, hypertension, diabetes, and excessive alcohol consumption are more prevalent in middle-aged and older adults. These findings demonstrate that the MoCA-CHAI provides insight into modifiable lifestyle factors and dementia risk. Differences in prevalences of risk factors indicate that prevention strategies need to be tailored to age-specific risk profiles. The MoCA-CHAI may help identify at-risk individuals who could benefit from targeted prevention and monitoring.

Cerebral small vessel disease (CSVD) is a common incidental MRI finding in patients with transient ischemic attack (TIA) and stroke and has been linked to cognitive decline. This study investigated the prevalence of CSVD imaging biomarkers in TIA patients and their association with cognitive performance over 3 years. We included 246 TIA patients from the INSPiRE-TMS study (ClinicalTrials.gov: NCT01586702). CSVD was assessed on baseline 3 T MRI using a composite score (0-4) including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (PVS). Cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA) at baseline and annually for 3 years. At least one CSVD imaging biomarker was present in 58.5% of patients. Lacunes (36.6%) were the most common, followed by PVS (28.1%), WMH (19.5%), and CMBs (17.9%). Higher CSVD-score was independently associated with greater cognitive decline over 3 years (β = -0.52, 95% CI -0.95- -0.08, p = 0.020), along with older age (β = -0.08, 95% CI -0.13 to -0.03, p = 0.001). CMB burden was the strongest predictive component of the CSVD-score (β = 0.42, 95% CI -0.63 to -0.22, p < 0.001). CSVD-score was particularly associated with decline in the memory domain (adjusted β of -0.18, 95% CI -0.32 to -0.04, p = 0.015). CSVD imaging markers are present in over half of TIA patients and are independently associated with cognitive decline up to 3 years, with the strongest effect on memory. Whether the presence of CMBs is the strongest predictive imaging biomarker of cognitive decline in TIA patients requires confirmation in further studies.