Targeted memory reactivation (TMR) is a methodology employed to manipulate memory processing during sleep. TMR studies have great potential to advance understanding of sleep-based memory ...consolidation and corresponding neural mechanisms. Research making use of TMR has developed rapidly, with over 70 articles published in the last decade, yet no quantitative analysis exists to evaluate the overall effects. Here we present the first meta-analysis of sleep TMR, compiled from 91 experiments with 212 effect sizes (N = 2,004). Based on multilevel modeling, overall sleep TMR was highly effective (Hedges' g = 0.29, 95% CI 0.21, 0.38), with a significant effect for two stages of non-rapid-eye-movement (NREM) sleep (Stage NREM 2: Hedges' g = 0.32, 95% CI 0.04, 0.60; and slow-wave sleep: Hedges' g = 0.27, 95% CI 0.20, 0.35). In contrast, TMR was not effective during REM sleep nor during wakefulness in the present analyses. Several analysis strategies were used to address the potential relevance of publication bias. Additional analyses showed that TMR improved memory across multiple domains, including declarative memory and skill acquisition. Given that TMR can reinforce many types of memory, it could be useful for various educational and clinical applications. Overall, the present meta-analysis provides substantial support for the notion that TMR can influence memory storage during NREM sleep, and that this method can be useful for understanding neurocognitive mechanisms of memory consolidation.
Public Significance Statement
Sensory cues can be used to reactivate associated memories during sleep and thus promote memory consolidation. This meta-analysis shows that targeted memory reactivation during sleep can improve memory performance with a small to moderate effect, and that this effect is most clearly evident when memories are reactivated during Stages 2 and 3 of non-rapid-eye-movement (NREM) sleep.
New memories are not quarantined from each other when first encoded; rather, they are interlinked with memories that were encoded in temporal proximity or that share semantic features. By selectively ...biasing memory processing during sleep, here we test whether context influences sleep consolidation. Participants first formed 18 idiosyncratic narratives, each linking four objects together. Before sleep, they also memorized an on-screen position for each object. During sleep, 12 object-specific sounds were unobtrusively presented, thereby cuing the corresponding spatial memories and impacting spatial recall as a function of initial memory strength. As hypothesized, we find that recall for non-cued objects contextually linked with cued objects also changed. Post-cue electrophysiological responses suggest that activity in the sigma band supports context reinstatement and predicts context-related memory benefits. Concurrently, context-specific electrophysiological activity patterns emerge during sleep. We conclude that reactivation of individual memories during sleep evokes reinstatement of their context, thereby impacting consolidation of associated knowledge.
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•Memory cues presented during sleep impact non-cued contextually bound memories•Contextual benefits are linked with sigma-band electrophysiological activity•Context-specific electrophysiological activity patterns emerge during sleep•Our results show that memories that were made together subsequently replayed together
Memories are embedded in specific encoding contexts, and these contexts are critical for guiding retrieval. In this report, Schechtman et al. show that contexts also play a role during intermittent consolidation during human sleep. Context reinstatement drives changes in performance and is accompanied by electrophysiological activity in the sigma band.
Summary
Background
Atopic dermatitis (AD) is associated with chronic itch, allergic disease and sleep disturbance, all of which might increase the risk of attention deficit (hyperactivity) disorder ...(ADD/ADHD). Previous analyses have found a consistent association between AD and ADD/ADHD, although the underlying factors contributing to such an association remain underexplored. Additionally, the relationship has been underexplored in adults.
Objectives
To determine if childhood and adult AD and AD severity are associated with ADD/ADHD and to delineate the factors contributing to such an association.
Methods
We analysed data on 354 416 children aged 2–17 years and 34 613 adults age 18+ years from 19 U.S. population‐based surveys, including the National Health Interview Survey 1997–2013 and the National Survey of Children's Health 2003/4 and 2007/8.
Results
In multivariate models adjusting for age, sex, sociodemographics, allergic disease and healthcare utilization, AD was associated with ADD/ADHD in both children adjusted odds ratio (95% confidence interval), 1·14 (1·03–1·26) and adults 1·61 (1·25–2·06). Children with both severe AD and only 0–3 nights of adequate sleep per week had much higher odds of ADD/ADHD 16·83 (7·02–40·33) than those with 0–3 nights of adequate sleep per week 1·83 (1·47–2·26) or mild–moderate AD alone 1·56 (1·22–1·99). AD was most strongly associated with severe ADHD. AD unaccompanied by other allergic disease was also associated with increased risk of ADD/ADHD in children. Among children with AD, history of anaemia, headaches and obesity were associated with even higher odds of ADD/ADHD. Asthma, insomnia and headaches increased the odds of ADHD in adults with AD, although underweight body mass index was protective.
Conclusions
Atopic dermatitis is associated with increased odds of ADD/ADHD in adults and children. Several factors increase the risk of ADHD in adults and children with AD.
What's already known about this topic?
Childhood atopic dermatitis (AD) is associated with increased risk of attention deficit hyperactivity disorder (ADHD); sleep disturbance and disease severity have been implicated as modifying factors.
What does this study add?
Severe AD and sleep disturbance independently and synergistically contribute to increased risk of ADHD.
AD unaccompanied by other allergic diseases is associated with increased risk of attention deficit disorder (ADD)/ADHD.
Obesity, headaches and anaemia further increase the risk of ADD/ADHD in children with AD.
Adult AD is associated with increased risk of ADHD. Asthma, headaches and insomnia increase the risk of ADHD in adult patients with AD, and underweight body mass index is protective.
Linked Comment: Genuneit. Br J Dermatol 2016; 175:863–864.
Plain language summary available online
Psoriasis is a common chronic immune-mediated inflammatory skin disorder and begins in childhood in almost one-third of the cases. Although children present with the same clinical subtypes of ...psoriasis seen in adults, lesions may differ in distribution and morphology, and their clinical symptoms at presentation may vary from those reported by adult patients. Nevertheless, diagnosis of psoriasis is primarily based on clinical features. Pediatric psoriasis can have a profound long-term impact on the psychological health of affected children. Additionally, pediatric psoriasis has been associated with certain comorbidities, such as obesity, hypertension, hyperlipidemia, diabetes mellitus and rheumatoid arthritis, making early diagnosis and management essential. As guidelines are lacking and most (systemic) treatments are not approved for use in children, treatment of pediatric psoriasis remains a challenge. A prospective, multicenter, international registry is needed to evaluate these treatments in a standardized manner and ultimately to develop international guidelines on pediatric psoriasis. This article reviews current concepts in pediatric psoriasis including epidemiology, clinical features, diagnosis, the role of topical and systemic agents and the association with other morbidities in childhood.
•Statistical learning was measured through recognition and RT tasks.•Successful recognition associated with stronger recollection and an enhanced LPC.•Statistical learning reduced RTs and P300 ...amplitude to predictable stimuli.•Recognition and RT effects did not significantly correlate.•Indirect RT-based measures can be sensitive indices of statistical learning.
Statistical learning allows learners to detect regularities in the environment and appears to emerge automatically as a consequence of experience. Statistical learning paradigms bear many similarities to those of artificial grammar learning and other types of implicit learning. However, whether learning effects in statistical learning tasks are driven by implicit knowledge has not been thoroughly examined. The present study addressed this gap by examining the role of implicit and explicit knowledge within the context of a typical auditory statistical learning paradigm. Learners were exposed to a continuous stream of repeating nonsense words. Learning was tested (a) directly via a forced-choice recognition test combined with a remember/know procedure and (b) indirectly through a novel reaction time (RT) test. Behavior and brain potentials revealed statistical learning effects with both tests. On the recognition test, accurate responses were associated with subjective feelings of stronger recollection, and learned nonsense words relative to nonword foils elicited an enhanced late positive potential indicative of explicit knowledge. On the RT test, both RTs and P300 amplitudes differed as a function of syllable position, reflecting facilitation attributable to statistical learning. Explicit stimulus recognition did not correlate with RT or P300 effects on the RT test. These results provide evidence that explicit knowledge is accrued during statistical learning, while bringing out the possibility that dissociable implicit representations are acquired in parallel. The commonly used recognition measure primarily reflects explicit knowledge, and thus may underestimate the total amount of knowledge produced by statistical learning. Indirect measures may be more sensitive indices of learning, capturing knowledge above and beyond what is reflected by recognition accuracy.
For a large proportion of our daily lives, spontaneously occurring thoughts tend to disengage our minds from goal-directed thinking. Previous studies showed that EEG features such as the P3 and alpha ...oscillations can predict mind-wandering to some extent, but only with accuracies of around 60%. A potential candidate for improving prediction accuracy is the Steady-State Visual Evoked Potential (SSVEP), which is used frequently in single-trial contexts such as brain-computer interfaces as a marker of the direction of attention. In this study, we modified the sustained attention to response task (SART) that is usually employed to measure spontaneous thought to incorporate the SSVEP elicited by a 12.5-Hz flicker. We then examined whether the SSVEP could track and allow for the prediction of the stickiness and task-relatedness dimensions of spontaneous thought. Our results show that the SSVEP evoked by flickering words was able to distinguish between more and less sticky thinking but not between whether a participant was on- or off-task. This suggests that the SSVEP is able to track spontaneous thinking when it is strongly disengaged from the task (as in the sticky form of off-task thinking) but not off-task thought in general. Future research should determine the exact dimensions of spontaneous thought to which the SSVEP is most sensitive.
Summary
Background
Baricitinib, an oral selective Janus kinase 1 and 2 inhibitor, effectively reduced atopic dermatitis (AD) severity in a phase II study with concomitant topical corticosteroids.
...Objectives
To evaluate the efficacy and safety of baricitinib in patients with moderate‐to‐severe AD who had an inadequate response to topical therapies.
Methods
In two independent, multicentre, double‐blind, phase III monotherapy trials, BREEZE‐AD1 and BREEZE‐AD2, adults with moderate‐to‐severe AD were randomized 2 : 1 : 1 : 1 to once‐daily placebo, baricitinib 1 mg, 2 mg, or 4 mg for 16 weeks.
Results
At week 16, more patients achieved the primary end point of Validated Investigator's Global Assessment of AD (0, 1) on baricitinib 4 mg and 2 mg compared with placebo in BREEZE‐AD1 N = 624; baricitinib 4 mg 16·8% (P < 0·001), 2 mg 11·4% (P < 0·05), 1 mg 11·8% (P < 0·05), placebo 4·8%, and BREEZE‐AD2 N = 615; baricitinib 4 mg 13·8% (P = 0·001), 2 mg 10·6% (P < 0·05), 1 mg 8·8% (P = 0·085), placebo 4·5%. Improvement in itch was achieved as early as week 1 for 4 mg and week 2 for 2 mg. Improvements in night‐time awakenings, skin pain and quality‐of‐life measures were observed by week 1 for both 4 mg and 2 mg (P ≤ 0·05, all comparisons). The most common adverse events in patients treated with baricitinib were nasopharyngitis and headache. No cardiovascular events, venous thromboembolism, gastrointestinal perforation, significant haematological changes, or death were observed with any baricitinib dosage.
Conclusions
Baricitinib improved clinical signs and symptoms in patients with moderate‐to‐severe AD within 16 weeks of treatment and induced rapid reduction of itch. The safety profile remained consistent with prior findings from baricitinib clinical development in AD, with no new safety concerns.
What is already known about this topic?
Atopic dermatitis (AD) is a chronic heterogeneous inflammatory skin disease with few approved therapies for patients with moderate‐to‐severe disease.
What does this study add?
These two phase III trials show that baricitinib, an oral inhibitor of Janus kinase 1 and 2, significantly improved clinical signs and symptoms of AD compared with placebo within the first 16 weeks of treatment.
Baricitinib may represent a first‐in‐class oral treatment option for adult patients with moderate‐to‐severe AD.
Linked Comment: Drucker. Br J Dermatol 2020; 183:199–200.
Plain language summary available online
Acoustic stimulation methods applied during sleep in young adults can increase slow wave activity (SWA) and improve sleep-dependent memory retention. It is unknown whether this approach enhances SWA ...and memory in older adults, who generally have reduced SWA compared to younger adults. Additionally, older adults are at risk for age-related cognitive impairment and therefore may benefit from non-invasive interventions. The aim of this study was to determine if acoustic stimulation can increase SWA and improve declarative memory in healthy older adults. Thirteen participants 60-84 years old completed one night of acoustic stimulation and one night of sham stimulation in random order. During sleep, a real-time algorithm using an adaptive phase-locked loop modeled the phase of endogenous slow waves in midline frontopolar electroencephalographic recordings. Pulses of pink noise were delivered when the upstate of the slow wave was predicted. Each interval of five pulses ("ON interval") was followed by a pause of approximately equal length ("OFF interval"). SWA during the entire sleep period was similar between stimulation and sham conditions, whereas SWA and spindle activity were increased during ON intervals compared to matched periods during the sham night. The increases in SWA and spindle activity were sustained across almost the entire five-pulse ON interval compared to matched sham periods. Verbal paired-associate memory was tested before and after sleep. Overnight improvement in word recall was significantly greater with acoustic stimulation compared to sham and was correlated with changes in SWA between ON and OFF intervals. Using the phase-locked-loop method to precisely target acoustic stimulation to the upstate of sleep slow oscillations, we were able to enhance SWA and improve sleep-dependent memory storage in older adults, which strengthens the theoretical link between sleep and age-related memory integrity.
Summary
Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus ...colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey‐coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD – cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy – overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site‐ and skin‐type‐specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.
Humans are highly attuned to patterns in the environment. This ability to detect environmental patterns, referred to as statistical learning, plays a key role in many diverse aspects of cognition. ...However, the spatiotemporal neural mechanisms underlying implicit statistical learning, and how these mechanisms may relate or give rise to explicit learning, remain poorly understood. In the present study, we investigated these different aspects of statistical learning by using an auditory nonlinguistic statistical learning paradigm combined with magnetoencephalography. Twenty-four healthy volunteers were exposed to structured and random tone sequences, and statistical learning was quantified by neural entrainment. Already early during exposure, participants showed strong entrainment to the embedded tone patterns. A significant increase in entrainment over exposure was detected only in the structured condition, reflecting the trajectory of learning. While source reconstruction revealed a wide range of brain areas involved in this process, entrainment in areas around the left pre-central gyrus as well as right temporo-frontal areas significantly predicted behavioral performance. Sensor level results confirmed this relationship between neural entrainment and subsequent explicit knowledge. These results give insights into the dynamic relation between neural entrainment and explicit learning of triplet structures, suggesting that these two aspects are systematically related yet dissociable. Neural entrainment reflects robust, implicit learning of underlying patterns, whereas the emergence of explicit knowledge, likely built on the implicit encoding of structure, varies across individuals and may depend on factors such as sufficient exposure time and attention.
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