Higher prenatal ambient air pollution exposure has been associated with impaired neurodevelopment in preschoolers and school-aged children. The purpose of this study was to explore the relationships ...between prenatal ambient air pollution exposure and neurodevelopment during infancy.
This study examined 161 Latino mother-infant pairs from the Southern California Mother's Milk Study. Exposure assessments included prenatal nitrogen dioxide (NO
) and particulate matter smaller than 2.5 and 10 microns in diameter (PM
and PM
, respectively). The pregnancy period was also examined as three windows, early, mid, and late, which describe the first, middle, and last three months of pregnancy. Infant neurodevelopmental outcomes at 2 years of age were measured using the Bayley-III Scales of Infant and Toddler Development. Multivariable linear models and distributed lag linear models (DLM) were used to examine relationships between prenatal exposures and neurodevelopmental scores, adjusting for socioeconomic status, breastfeeding frequency, time of delivery, pre-pregnancy body mass index, and infant birthweight and sex.
Higher prenatal exposure to PM
and PM
was negatively associated with composite cognitive score (β = -2.01 -3.89, -0.13 and β = -1.97 -3.83, -0.10, respectively). In addition, higher average prenatal exposure to PM
was negatively associated with composite motor (β = -2.35 -3.95, -0.74), scaled motor (β = -0.77 -1.30, -0.24), gross motor (β = -0.37 -0.70, -0.04), fine motor (β = -0.40 -0.71, -0.09), composite language (β = -1.87 -3.52, -0.22), scaled language (β = -0.61 -1.18, -0.05) and expressive communication scaled scores (β = -0.36 -0.66, -0.05). DLMs showed that higher prenatal air pollution exposure during mid and late pregnancy was inversely associated with motor, cognitive, and communication language scores.
Higher exposure to air pollutants during pregnancy, particularly in the mid and late prenatal periods, was inversely associated with scaled and composite motor, cognitive, and language scores at 2 years. These results indicate that prenatal ambient air pollution may negatively impact neurodevelopment in early life.
Arachnoid webs are intradural extramedullary bands of arachnoid tissue that can extend to the pial surface of the spinal cord, causing a focal dorsal indentation of the cord. These webs tend to occur ...in the upper thoracic spine and may produce a characteristic deformity of the cord that we term the "scalpel sign." We describe 14 patients whose imaging studies demonstrated the scalpel sign. Ten of 13 patients who underwent MR imaging demonstrated T2WI cord signal-intensity changes, and 7 of these patients also demonstrated syringomyelia adjacent to the level of indentation. Seven patients underwent surgery, with 5 demonstrating an arachnoid web as the cause of the dorsal indentation demonstrated on preoperative imaging. Although the webs themselves are rarely demonstrated on imaging, we propose that the scalpel sign is a reliable indicator of their presence and should prompt consideration of surgical lysis, which is potentially curative.
Aims Obesity has been shown to be a risk factor for first atrial fibrillation (AF), but whether it is associated with progression from paroxysmal to permanent AF is unknown. Methods and results In ...this longitudinal cohort study, Olmsted County, MN residents confirmed to have developed paroxysmal AF during 1980–2000 were identified and followed passively to 2006. The interrelationships of body mass index (BMI), left atrial (LA) size, and progression to permanent AF were analysed. Of a total of 3248 patients (mean age 71 ± 15 years; 54% men) diagnosed with paroxysmal AF, 557 (17%) progressed to permanent AF (unadjusted incidence, 36/1000 person-years) over a median follow-up period of 5.1 years (interquartile range 1.2–9.4). Adjusting for age and sex, BMI independently predicted the progression to permanent AF (hazard ratio, HR 1.04, CI 1.03–1.06; P < 0.0001). Compared with normal BMI (18.5–24.9 kg/m2), obesity (30–34.9 kg/m2) and severe obesity (≥35 kg/m2) were associated with increased risk for progression HR 1.54 (CI 1.2–2.0; P = 0.0004) and 1.87 (CI 1.4–2.5; P < 0.0001, respectively). BMI remained highly significant even after multiple adjustments. In the subgroup with echocardiographic assessment (n = 744), LA volume was incremental to BMI for independent prediction of progression after multiple adjustments, and did not weaken the association between BMI and progression to permanent AF (HR 1.04; CI 1.02–1.05; P < 0.0001). Conclusion There was a graded risk relationship between BMI and progression from paroxysmal to permanent AF. This relationship was not weakened by LA volume, which was independent of and incremental to BMI for the prediction of progression to permanent AF.
Electrical storm (ES), defined as recurrent multiple ventricular fibrillation (VF) episodes, often occurs in patients with recent myocardial infarction. Because treating ES according to the Advanced ...Cardiac Life Support (ACLS) guidelines yields a poor outcome, we evaluated the efficacy of sympathetic blockade in treating ES patients and compared their outcome with that of patients treated according to the ACLS guidelines.
Forty-nine patients (36 men, 13 women, mean age 57+/-10 years) who had ES associated with a recent myocardial infarction were separated into 2 groups. Patients in group 1 (n=27) received sympathetic blockade treatment: 6 left stellate ganglionic blockade, 7 esmolol, and 14 propranolol. Patients in group 2 (n=22) received antiarrhythmic medication as recommended by the ACLS guidelines. Patient characteristics were similar in the 2 groups. The 1-week mortality rate was higher in group 2: 18 (82%) of the 22 patients died, all of refractory VF; 6 (22%) of the 27 group 1 patients died, 3 of refractory VF (P<0.0001). Patients who survived the initial ES event did well over the 1-year follow-up period: Overall survival in group 1 was 67%, compared with 5% in group 2 (P<0.0001).
Sympathetic blockade is superior to the antiarrhythmic therapy recommended by the ACLS guidelines in treating ES patients. Our study emphasizes the role of increased sympathetic activity in the genesis of ES. Sympathetic blockade-not class 1 antiarrhythmic drugs-should be the treatment of choice for ES.
Background
The non-uniform distribution of atherosclerosis within the arterial system is widely attributed to variation in haemodynamic wall shear stress. It may also depend on variation in ...pressure-induced stresses and strains within the arterial wall; these have been less widely investigated, at least in part because of a lack of suitable techniques.
Objectives
Here we show that local arterial strain can be determined from impressions left by endothelial cells on the surface of vascular corrosion casts made at different pressures, even though only one pressure can be examined in each vessel. The pattern of pits in the cast caused by protruding endothelial nuclei was subject to “retro-deformation” to identify the pattern that would have occurred in the absence of applied stresses.
Methods
Retaining the nearest-neighbour pairs found under this condition, changes in nearest-neighbour vectors were calculated for the pattern seen in the cast, and the ratio of mean changes at different pressures determined. This approach removes errors in simple nearest-neighbour analyses caused by the nearest neighbour changing as deformation occurs.
Results
The accuracy, precision and robustness of the approach were validated using simulations. The method was implemented using confocal microscopy of casts of the rabbit aorta made at systolic and diastolic pressures; results agreed well with the ratio of the macroscopic dimensions of the casts.
Conclusions
Applying the new technique to areas around arterial branches could support or refute the hypothesis that the development of atherosclerosis is influenced by mural strain, and the method may be applicable to other tissues.
We review the diagnosis, management and potential pitfalls of acute soft tissue injuries in the skeletally immature knee, including anterior cruciate ligament (ACL) injuries, meniscal injuries, ...patellar dislocation and patellofemoral instability (PFI). There has been an increasing incidence of such injuries in the paediatric population, and controversy remains regarding their treatment. We summarise evidence-based treatments for these injuries and discuss strategies to minimise complications as the child reaches skeletal maturity.
Aim
To summarise our centre’s experience managing patients with neuroendocrine tumours (NETs) in the first 5 years after the introduction of peptide receptor radionuclide therapy (PRRT) with
177
...LuLu-DOTA-octreotate (LUTATE). The report emphasises aspects of the patient management related to functional imaging and use of radionuclide therapy.
Methods
We describe the criteria for treatment with LUTATE at our centre, the methodology for patient selection, and the results of an audit of clinical measures, imaging results and patient-reported outcomes. Subjects are treated initially with four cycles of ~ 8 GBq of LUTATE administered as an outpatient every 8 weeks.
Results
In the first 5 years offering LUTATE, we treated 143 individuals with a variety of NETs of which approx. 70% were gastroentero-pancreatic in origin (small bowel: 42%, pancreas: 28%). Males and females were equally represented. Mean age at first treatment with LUTATE was 61 ± 13 years with range 28–87 years. The radiation dose to the organs considered most at risk, the kidneys, averaged 10.6 ± 4.0 Gy in total. Median overall survival (OS) from first receiving LUTATE was 72.5 months with a median progression-free survival (PFS) of 32.3 months. No evidence of renal toxicity was seen. The major long-term complication seen was myelodysplastic syndrome (MDS) with a 5% incidence.
Conclusions
LUTATE treatment for NETs is a safe and effective treatment. Our approach relies heavily on functional and morphological imaging informing the multidisciplinary team of NET specialists to guide appropriate therapy, which we suggest has contributed to the favourable outcomes seen.
The Aeronomy of Ice in the Mesosphere (AIM) mission was launched from Vandenberg Air Force Base in California at 1:26:03 PDT on April 25, 2007 becoming the first satellite mission dedicated to the ...study of polar mesospheric clouds. A Pegasus XL rocket launched the satellite into a near perfectly circular 600
km sun synchronous orbit. AIM carries three instruments selected because of their ability to provide key measurements needed to address the AIM goal which is to determine why these clouds form and vary. The instrument payload includes a nadir imager, a solar occultation instrument and an in-situ cosmic dust detector. Detailed descriptions of the science, instruments and observation scenario are presented. Early science results from the first northern and southern hemisphere seasons show a highly variable cloud morphology, clouds that are ten times brighter than measured by previous space-based instruments, and complex features that are reminiscent of tropospheric weather phenomena. The observations also confirm a previously theorized but never before directly observed population of small ice particles in the altitude region above the main Polar Mesospheric Cloud (PMC) layer that are widely believed to be the indirect cause of summertime radar echoes.
Estuarine and coastal marine sediment-water fluxes are considered to be important ecological features, but a global-scale assessment has yet to be developed. Goals of this work were to assemble a ...global-scale database of net sediment-water flux measurements, examine measurement techniques, characterize the geographic distribution and magnitude of sediment fluxes, explore the data for controls on sediment flux magnitude, and assess the importance of sediment fluxes in ecosystem-level metabolism and primary production. We examined 480 peer-reviewed sources and found sediment flux data for 167 estuarine and coastal systems. Most measurements were made in North America, Europe, and Australia. Fluxes varied widely among systems, some by several orders of magnitude. Inter-annual variability within sites was less than an order of magnitude but time series flux data to evaluate this were rare. However, limited time series data exhibited large and rapid responses to decreased external nutrient loading rates, climate change effects (possible temperature effects), and variability in trophic conditions. Comparative analyses indicated organic matter supply to sediments set the upper limits of flux magnitude, with other factors playing secondary roles. Two metrics were developed to assess ecosystem-level importance of sediment-water fluxes. Sediments represented 30% or more of depth-integrated rates of aerobic system respiration at depths of <10 m. An annual phytoplankton production data set was used to estimate N and P demand; sediments supplied an average of 15-32% of N and 17-100% of P demand and, in some cases, was as large or larger than external nutrient inputs. The percent of demand supplied by sediments was highest in temperate latitudes and lower in high and tropical latitudes.
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