Low contralateral neck recurrence risk with ipsilateral neck radiotherapy in N2b tonsillar squamous cell carcinoma

OBJECTIVES

To characterize factors including nodal burden, pre-treatment imaging, and other patient factors which may influence the role of ipsilateral neck radiotherapy (IRT) in tonsillar squamous cell carcinoma (SCC) with multiple involved ipsilateral nodes.

METHODS

Patients with cT1-2N0-2bM0 (AJCC 7th edition) tonsillar SCC treated with definitive radiation therapy (RT) at Duke University Medical Center from 1/1/1990-10/1/2019 were identified. Patient, tumor, and treatment characteristics were compared between those that received bilateral neck RT (BRT) versus IRT. Recurrence-free survival (RFS) was estimated with Kaplan-Meier method. A subset analysis of patients with N2b disease was performed. Patterns of recurrence were analyzed.

RESULTS

120 patients with cT1-2N0-2b tonsillar SCC were identified, including 71 with N2b disease (BRT: n = 30; IRT: n = 41). Median follow-up was 80 months (range: 7-209). No N2b patients who received IRT had > 1 cm of soft palate/base of tongue extension. N2b patients treated with IRT had a median of 3 (range 2-9) involved lymph nodes, with median largest nodal dimension of 2.8 cm (range 1.3-4.8 cm). 93 % of N2b patients who received IRT had staging by PET/CT, and 100 % received IMRT. For N2b patients treated with IRT, there were no contralateral neck recurrences, and 10 year RFS was 95 % (95 % CI 82 %-98 %).

CONCLUSIONS

For patients treated with IRT for well-lateralized N2b tonsillar SCC, we observed high rates of local control with no observed contralateral neck recurrence. These data suggest that BRT is not universally necessary for patients with multiple involved ipsilateral nodes, particularly in the setting of baseline staging with PET/CT.

Effects of Acute Visual Stimulation Exercise on Attention Processes: An ERP Study

BACKGROUNDS

It remains to be determined whether visual stimuli during exercise differentially influence the attention process. The purpose of the present study was to examine if different color stimuli during aerobic exercise are associated with different attention processes.

METHODS

22 college students completed a four 30-min running session during the presentation of different color stimuli (blue, green, red, and yellow) and without color stimulus on separate visits. The Kanizsa triangle task was administrated before and immediately after exercise to assess the attention process. Behavioral performance (accuracy and response time (RT)) and event-related potential (P2, N2b and P3a) were recorded during the test.

RESULTS

Valid/invalid cue RT during the Kaniza test performance was significantly faster following the presentation of color stimuli during treadmill exercise compared to the seated rest. During exercise, these changes were larger after green and yellow stimuli than red in invalid cue RT. P2, N2b and P3a amplitudes of green were significantly larger than the other colors for both valid and invalid cues. Red color showed the lowest P2 and P3a amplitudes for both valid and invalid cues among colors.

CONCLUSION

The distinctive neurocognitive changes during aerobic exercise suggest different effects of color stimuli on visual search attention, attention capture, attentional orienting and processing speed. This study will be a first step to understand the optimal environmental setting during exercise for subsequent improvements in the attention process.

Implicit learning seems to come naturally for children with autism, but not for children with specific language impairment: Evidence from behavioral and ERP data

Autism spectrum disorder (ASD) and specific language impairment (SLI) are two neurodevelopmental disorders characterized by deficits in verbal and nonverbal communication skills. These skills are thought to develop largely through implicit-or automatic-learning mechanisms. The aim of the current paper was to investigate the role of implicit learning abilities in the atypical development of communication skills in ASD and SLI. In the current study, we investigated Response Times (RTs) and Event Related Potentials (ERPs) during implicit learning on a Serial Reaction Time (SRT) task in a group of typically developing (TD) children (n = 17), a group of autistic children (n = 16), and a group of children with SLI (n = 13). Findings suggest that learning in both ASD and SLI are similar to that in TD. However, electrophysiological findings suggest that autistic children seem to rely mainly on more automatic processes (as reflected by an N2b component), whereas the children with SLI seem to rely on more controlled processes (as reflected by a P3 component). The TD children appear to use a combination of both learning mechanisms. These findings suggest that clinical interventions should aim at compensating for an implicit learning deficit in children with SLI, but not in children with ASD. Future research should focus on developmental differences in implicit learning and related neural correlates in TD, ASD, and SLI. Autism Res 2018, 11: 1050-1061. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc.

LAY SUMMARY

Autism and Specific Language Impairment (SLI) are two disorders characterized by problems in social communication and language. Social communication and language are believed to be learned in an automatic way. This is called "implicit learning." We have found that implicit learning is intact in autism. However, in SLI there seems different brain activity during implicit learning. Maybe children with SLI learn differently, and maybe this different learning makes it more difficult for them to learn language.

Background Suppression and its Relation to Foreground Processing of Speech Versus Non-speech Streams

Since sound perception takes place against a background with a certain amount of noise, both speech and non-speech processing involve extraction of target signals and suppression of background noise. Previous works on early processing of speech phonemes largely neglected how background noise is encoded and suppressed. This study aimed to fill in this gap. We adopted an oddball paradigm where speech (vowels) or non-speech stimuli (complex tones) were presented with or without a background of amplitude-modulated noise and analyzed cortical responses related to foreground stimulus processing, including mismatch negativity (MMN), N2b, and P300, as well as neural representations of the background noise, that is, auditory steady-state response (ASSR). We found that speech deviants elicited later and weaker MMN, later N2b, and later P300 than non-speech ones, but N2b and P300 had similar strength, suggesting more complex processing of certain acoustic features in speech. Only for vowels, background noise enhanced N2b strength relative to silence, suggesting an attention-related speech-specific process to improve perception of foreground targets. In addition, noise suppression in speech contexts, quantified by ASSR amplitude reduction after stimulus onset, was lateralized towards the left hemisphere. The left-lateralized suppression following N2b was associated with the N2b enhancement in noise for speech, indicating that foreground processing may interact with background suppression, particularly during speech processing. Together, our findings indicate that the differences between perception of speech and non-speech sounds involve not only the processing of target information in the foreground but also the suppression of irrelevant aspects in the background.

Separate and concurrent symbolic predictions of sound features are processed differently

The studies investigated the impact of predictive visual information about the pitch and location of a forthcoming sound on the sound processing. In Symbol-to-Sound matching paradigms, symbols induced predictions of particular sounds. The brain's error signals (IR and N2b components of the event-related potential) were measured in response to occasional violations of the prediction, i.e., when a sound was incongruent to the corresponding symbol. IR and N2b index the detection of prediction violations at different levels, IR at a sensory and N2b at a cognitive level. Participants evaluated the congruency between prediction and actual sound by button press. When the prediction referred to only the pitch or only the location feature (Experiment 1), the violation of each feature elicited IR and N2b. The IRs to pitch and location violations revealed differences in the in time course and topography, suggesting that they were generated in feature-specific sensory areas. When the prediction referred to both features concurrently (Experiment 2), that is, the symbol predicted the sound's pitch and location, either one or both predictions were violated. Unexpectedly, no significant effects in the IR range were obtained. However, N2b was elicited in response to all violations. N2b in response to concurrent violations of pitch and location had a shorter latency. We conclude that associative predictions can be established by arbitrary rule-based symbols and for different sound features, and that concurrent violations are processed in parallel. In complex situations as in Experiment 2, capacity limitations appear to affect processing in a hierarchical manner. While predictions were presumably not reliably established at sensory levels (absence of IR), they were established at more cognitive levels, where sounds are represented categorially (presence of N2b).

Auditory event-related potentials in children with benign epilepsy with centro-temporal spikes

Benign focal epilepsy in childhood with centro-temporal spikes (BECTS) is one of the most common forms of idiopathic epilepsy, with onset from age 3 to 14 years. Although the prognosis for children with BECTS is excellent, some studies have revealed neuropsychological deficits in many domains, including language. Auditory event-related potentials (AERPs) reflect activation of different neuronal populations and are suggested to contribute to the evaluation of auditory discrimination (N1), attention allocation and phonological categorization (N2), and echoic memory (mismatch negativity--MMN). The scarce existing literature about this theme motivated the present study, which aims to investigate and document the existing AERP changes in a group of children with BECTS. AERPs were recorded, during the day, to pure and vocal tones and in a conventional auditory oddball paradigm in five children with BECTS (aged 8-12; mean=10 years; male=5) and in six gender and age-matched controls. Results revealed high amplitude of AERPs for the group of children with BECTS with a slight latency delay more pronounced in fronto-central electrodes. Children with BECTS may have abnormal central auditory processing, reflected by electrophysiological measures such as AERPs. In advance, AERPs seem a good tool to detect and reliably reveal cortical excitability in children with typical BECTS.

Effects of aging and involuntary capture of attention on event-related potentials associated with the processing of and the response to a target stimulus

The main aim of the present study was to assess whether aging modulates the effects of involuntary capture of attention by novel stimuli on performance, and on event-related potentials (ERPs) associated with target processing (N2b and P3b) and subsequent response processes (stimulus-locked Lateralized Readiness Potential -sLRP- and response-locked Lateralized Readiness Potential -rLRP-). An auditory-visual distraction-attention task was performed by 77 healthy participants, divided into three age groups (Young: 21-29, Middle-aged: 51-64, Old: 65-84 years old). Participants were asked to attend to visual stimuli and to ignore auditory stimuli. Aging was associated with slowed reaction times, target stimulus processing in working memory (WM, longer N2b and P3b latencies) and selection and preparation of the motor response (longer sLRP and earlier rLRP onset latencies). In the novel relative to the standard condition we observed, in the three age groups: (1) a distraction effect, reflected in a slowing of reaction times, of stimuli categorization in WM (longer P3b latency), and of motor response selection (longer sLRP onset latency); (2) a facilitation effect on response preparation (later rLRP onset latency), and (3) an increase in arousal (larger amplitudes of all ERPs evaluated, except for N2b amplitude in the Old group). A distraction effect on the stimulus evaluation processes (longer N2b latency) were also observed, but only in middle-aged and old participants, indicating that the attentional capture slows the stimulus evaluation in WM from early ages (from 50 years onwards, without differences between middle-age and older adults), but not in young adults.