Recommendations concerning fluid management have been modified to reflect recent findings from a randomized controlled clinical trial showing no difference in cerebral injury in patients rehydrated at different rates with either 0.45% or 0.9% saline. This article is protected by copyright. All rights reserved.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state.

aDivision of Endocrinology, Boston Children’s Hospital, Boston, MA, USA; bBarts Health NHS Trust, Royal London Hospital, London, UK; cInstitute of Endocrinology and Diabetes, The Children’s Hospital at Westmead; School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia; dOxfordshire Children’s Diabetes Service, Oxford Children’s Hospital, Oxford, UK; eSection of Endocrinology, University of California, Davis School of Medicine, Sacramento, CA, USA; fPediatric Endocrinology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India; gEndocrinology Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore; hDepartment of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya ; iDepartment of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA; jDivision of Endocrinology, Diabetes and Metabolism, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA and kDepartment of Pediatrics, NU Hospital Group, Uddevalla and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

/pdf/diabetic-ketoacidosis-and-hyperglycemic-hyperosmolar-state-xxi9f7afbq.pdf

Diabetic ketoacidosis and hyperglycemic hyperosmolar state

The episodic memory system enables accurate retrieval while maintaining flexibility by representing both specific episodes and generalizations across events. Although theories suggest that the hippocampus (HPC) is dedicated to represent specific episodes while the medial prefrontal cortex (MPFC) generalizes, other accounts posit that HPC can also integrate related memories. Here we use high-resolution functional magnetic resonance imaging in humans to examine how representations of memory elements change to either differentiate or generalize across related events. We show that while posterior HPC and anterior MPFC maintain distinct memories for individual events, anterior HPC and posterior MPFC integrate across memories. Integration is particularly likely for established memories versus those encoded simultaneously, highlighting the greater impact of prior knowledge on new encoding. We also show dissociable coding signatures in ventrolateral PFC, a region previously implicated in interference resolution. These data highlight how memory elements are represented to simultaneously promote generalization across memories and protect from interference.

/pdf/learning-related-representational-changes-reveal-dissociable-2sngewix8j.pdf

Learning-related representational changes reveal dissociable integration and separation signatures in the hippocampus and prefrontal cortex

The preschool years represent a time of expansive mental growth, with the initial expression of many psychological abilities that will continue to be refined into young adulthood. Likewise, brain development during this age is characterized by its "blossoming" nature, showing some of its most dynamic and elaborative anatomical and physiological changes. In this article, we review human brain development during the preschool years, sampling scientific evidence from a variety of sources. First, we cover neurobiological foundations of early postnatal development, explaining some of the primary mechanisms seen at a larger scale within neuroimaging studies. Next, we review evidence from both structural and functional imaging studies, which now accounts for a large portion of our current understanding of typical brain development. Within anatomical imaging, we focus on studies of developing brain morphology and tissue properties, including diffusivity of white matter fiber tracts. We also present new data on changes during the preschool years in cortical area, thickness, and volume. Physiological brain development is then reviewed, touching on influential results from several different functional imaging and recording modalities in the preschool and early school-age years, including positron emission tomography (PET), electroencephalography (EEG) and event-related potentials (ERP), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS). Here, more space is devoted to explaining some of the key methodological factors that are required for interpretation. We end with a section on multimodal and multidimensional imaging approaches, which we believe will be critical for increasing our understanding of brain development and its relationship to cognitive and behavioral growth in the preschool years and beyond.

https://scottbarrykaufman.com/wp-content/uploads/2012/12/Brown-Jernigan-20121.pdf

Brain Development During the Preschool Years

Adolescence is a developmental period when physical and cognitive abilities are optimized, when social skills are consolidated, and when sexuality, adolescent behaviors, and frontal cortical functions mature to adult levels. Adolescents also have unique responses to alcohol compared with adults, being less sensitive to ethanol sedative–motor responses that most likely contribute to binge drinking and blackouts. Population studies find that an early age of drinking onset correlates with increased lifetime risks for the development of alcohol dependence, violence, and injuries. Brain synapses, myelination, and neural circuits mature in adolescence to adult levels in parallel with increased reflection on the consequence of actions and reduced impulsivity and thrill seeking. Alcohol binge drinking could alter human development, but variations in genetics, peer groups, family structure, early life experiences, and the emergence of psychopathology in humans confound studies. As adolescence is common to mammalian species, preclinical models of binge drinking provide insight into the direct impact of alcohol on adolescent development. This review relates human findings to basic science studies, particularly the preclinical studies of the Neurobiology of Adolescent Drinking in Adulthood (NADIA) Consortium. These studies focus on persistent adult changes in neurobiology and behavior following adolescent intermittent ethanol (AIE), a model of underage drinking. NADIA studies and others find that AIE results in the following: increases in adult alcohol drinking, disinhibition, and social anxiety; altered adult synapses, cognition, and sleep; reduced adult neurogenesis, cholinergic, and serotonergic neurons; and increased neuroimmune gene expression and epigenetic modifiers of gene expression. Many of these effects are specific to adolescents and not found in parallel adult studies. AIE can cause a persistence of adolescent-like synaptic physiology, behavior, and sensitivity to alcohol into adulthood. Together, these findings support the hypothesis that adolescent binge drinking leads to long-lasting changes in the adult brain that increase risks of adult psychopathology, particularly for alcohol dependence.

https://pharmrev.aspetjournals.org/content/pharmrev/68/4/1074.full.pdf

Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior

The ability to recollect details about past events improves during childhood. Most researchers favor the view that this improvement depends largely on the development of the prefrontal cortex, which is thought to have a protracted course of development relative to the medial temporal lobes (MTL). The primary goal of the present study was to test the hypothesis that the development of detail recollection is also associated with changes in MTL function. We collected functional magnetic resonance imaging data during an incidental encoding task in 80 participants, divided equally across four age groups: 8-year-olds, 10- to 11-year-olds, 14-year-olds, and young adults. Developmental differences in MTL activation profiles were observed. Fourteen-year-olds and adults engaged regions of the hippocampus and posterior parahippocampal gyrus selectively for subsequent detail recollection, whereas 8- and 10- to 11-year-olds did not. In 8-year-olds, these regions were recruited indiscriminately for detail recollection and item recognition; in 10- to 11-year-olds, activation in these regions did not consistently predict subsequent memory. These results suggest there are changes in the functional organization of the MTL, such that the hippocampus and posterior parahippocampal gyrus become increasingly specialized for recollection; these changes may be in part responsible for long-term memory improvements during childhood.

/pdf/developmental-differences-in-medial-temporal-lobe-function-1z0ac3c8zp.pdf

Developmental Differences in Medial Temporal Lobe Function during Memory Encoding

The hippocampus is critically involved in episodic memory, yet relatively little is known about how the development of this structure contributes to the development of episodic memory during middle to late childhood. Previous research has inconsistently reported associations between hippocampal volume and episodic memory performance during this period. We argue that this inconsistency may be due to assessing the hippocampus as a whole, and propose to examine associations separately for subregions along the longitudinal axis of the hippocampus. In the present study, we examined age-related differences in volumes of the hippocampal head, body, and tail, and collected episodic memory measures in children ages 8-11 years and young adults (N = 62). We found that adults had a smaller right hippocampal head, larger hippocampal body bilaterally, and smaller right hippocampal tail compared with children. In adults, but not in children, better episodic memory performance was associated with smaller right hippocampal head and larger hippocampal body. In children, but not in adults, better episodic memory was associated with larger left hippocampal tail. Overall, the results suggest that protracted development of hippocampal subregions contribute to age-related differences in episodic memory.

Dana M. DeMaster

Papers

Developmental Differences in Medial Temporal Lobe Function during Memory Encoding

Structural Development of the Hippocampus and Episodic Memory: Developmental Differences Along the Anterior/Posterior Axis

Developmental differences in hippocampal and cortical contributions to episodic retrieval.

Diabetic ketoacidosis and memory dysfunction in children with type 1 diabetes.

Children's head motion during fMRI tasks is heritable and stable over time.