Hippocampal-cortical interactions during event boundaries support retention of complex narrative events.

According to most memory theories, encoding involves continuous communication between the hippocampus and neocortex, but recent work has shown that key moments at the end of an event, called event boundaries, may be especially critical for memory formation. We sought to determine how communication between the hippocampus and neocortical regions during the encoding of naturalistic events related to subsequent retrieval of those events and whether this was particularly important at event boundaries. Participants encoded and recalled two cartoon movies during fMRI scanning. Higher functional connectivity between the hippocampus and the posterior medial network (PMN) at an event's offset is related to the subsequent successful recall of that event. Furthermore, hippocampal-PMN offset connectivity also predicted the amount of detail retrieved after a 2-day delay. These data demonstrate that the relationship between memory encoding and hippocampal-neocortical interaction is dynamic and biased toward boundaries.

Integration of event experiences to build relational knowledge in the human brain.

We investigated how the human brain integrates experiences of specific events to build general knowledge about typical event structure. We examined an episodic memory area important for temporal relations, anterior-lateral entorhinal cortex, and a semantic memory area important for action concepts, middle temporal gyrus, to understand how and when these areas contribute to these processes. Participants underwent functional magnetic resonance imaging while learning and recalling temporal relations among novel events over two sessions 1 week apart. Across distinct contexts, individual temporal relations among events could either be consistent or inconsistent with each other. Within each context, during the recall phase, we measured associative coding as the difference of multivoxel correlations among related vs unrelated pairs of events. Neural regions that form integrative representations should exhibit stronger associative coding in the consistent than the inconsistent contexts. We found evidence of integrative representations that emerged quickly in anterior-lateral entorhinal cortex (at session 1), and only subsequently in middle temporal gyrus, which showed a significant change across sessions. A complementary pattern of findings was seen with signatures during learning. This suggests that integrative representations are established early in anterior-lateral entorhinal cortex and may be a pathway to the later emergence of semantic knowledge in middle temporal gyrus.

Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings.

PURPOSE: Prolonged ureteroscopy (URS) is associated with complications including ureteral perforation, stricture, and urosepsis. As laser lithotripsy is one of the most common urologic procedures, small cost savings per case can have a large financial impact. This retrospective study was designed to determine if Thulium fiber laser (TFL) lithotripsy decreases operative time and costs compared to standard Holmium:YAG (Ho:YAG) lithotripsy without pulse modulation. METHODS: A retrospective review of URS with laser lithotripsy was conducted for 152 cases performed from August 2020 to January 2021. Variables including cumulative stone size, location, chemical composition, prior ureteral stenting, and ureteral access sheath use were recorded for each case. A cost benefit analysis was performed to show projected cost savings due to potentially decreased operative times. RESULTS: Compared to Ho:YAG, use of TFL resulted in an average decrease of 12.9 min per case (p = .021, 95% CI [2.03-23.85]). In subgroup analysis of cases with cumulative stone diameter less than 15 mm, the difference was 14.0 min (p = .007, CI [3.95-23.95]). For cases less than 10 mm, the mean difference was 17.3 min in favor of TFL (p = .002, 95% CI [6.89-27.62]). This ~ 13 min reduction in operative time resulted in saving $440/case in direct operating room costs giving our institution a range of $294,000 to $381,900 savings per year. CONCLUSIONS: TFL has a significantly shorter operative time and decreased cost when compared to the standard Ho:YAG for equivalent kidney stone and patient characteristics. Longer term follow up is needed to see if recurrence rates are affected.