Simulations of photochemical smog formation in complex urban areas

Publication date: December 2016
Source:Atmospheric Environment, Volume 147
Author(s): C. Muilwijk, P.J.C. Schrijvers, S. Wuerz, S. Kenjereš
In the present study we numerically investigated the dispersion of photochemical reactive pollutants in complex urban areas by applying an integrated Computational Fluid Dynamics (CFD) and Computational Reaction Dynamics (CRD) approach. To model chemical reactions involved in smog generation, the Generic Reaction Set (GRS) approach is used. The GRS model was selected since it does not require detailed modeling of a large set of reactive components. Smog formation is modeled first in the case of an intensive traffic emission, subjected to low to moderate wind conditions in an idealized two-dimensional street canyon with a building aspect ratio (height/width) of one. It is found that Reactive Organic Components (ROC) play an important role in the chemistry of smog formation. In contrast to the NOx/O3 photochemical steady state model that predicts a depletion of the (ground level) ozone, the GRS model predicts generation of ozone. Secondly, the effect of direct sunlight and shadow within the street canyon on the chemical reaction dynamics is investigated for three characteristic solar angles (morning, midday and afternoon). Large differences of up to one order of magnitude are found in the ozone production for different solar angles. As a proof of concept for real urban areas, the integrated CFD/CRD approach is applied for a real scale (1 × 1 km²) complex urban area (a district of the city of Rotterdam, The Netherlands) with high traffic emissions. The predicted pollutant concentration levels give realistic values that correspond to moderate to heavy smog. It is concluded that the integrated CFD/CRD method with the GRS model of chemical reactions is both accurate and numerically robust, and can be used for modeling of smog formation in complex urban areas.



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Prevalence and oral health-related quality of life of self-reported orofacial conditions in Sweden

Abstract

Objectives

To (i) determine the prevalences of self-report in a Swedish adult population, of temporomandibular disorders, burning mouth syndrome, dry mouth, and bad breath and (ii) determine oral health-related quality of life impairment in subjects reporting these conditions.

Subjects and Methods

A cross-sectional, randomized sample of the adult Swedish population (response rate: 46%, N=1309 subjects) self-reported their condition from the preceding month to assess prevalences of self-report for the studied conditions together with comorbidity group of subjects who reported more than one condition. The 49-item Oral Health Impact Profile (OHIP) used to assess oral health-related quality of life.

Results

The most prevalent condition was bad breath (39%), followed by dry mouth (22%), temporomandibular disorders (18%), and burning mouth syndrome (4%). High comorbidity of conditions occurred in 27% of the population. Quality of life impairment increased with the number of comorbid conditions. Among individual conditions, burning mouth syndrome and temporomandibular disorders (57% and 40% OHIP points) presented higher impairment than dry mouth and bad breath (32% and 26% OHIP points).

Conclusions

Orofacial conditions were common and often coexist. The comorbidity group experienced the highest impact on oral health-related quality of life: the more comorbid conditions, the greater the negative impact.

This article is protected by copyright. All rights reserved.

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Central Xanthoma of the Jaw Bones: A Benign Tumor

Abstract

Extragnathic xanthomas are seen in the bones or as soft tissue masses. They are often associated with hyperlipidemia and are considered as reactive or metabolic lesions. Only 19 cases of xanthomas of the jaws have been reported so far in the English literature. A total of ten cases of central xanthoma of the jaw bones were identified from the Oral and Maxillofacial Pathology biopsy services of the University of Washington and the Tufts University School of Dental Medicine, between the years 2000–2016. The demographic and clinical information on these cases was tabulated logically on the basis of age, gender, location and presence or absence of symptoms, extragnathic lesions and serum hyperlipidemia. Radiographic and histopathological features were also examined. The findings in these cases were correlated with those available from the previously reported cases. Majority of cases are seen in the second and third decades of life. There is no gender predilection. Jaw lesions presented as solitary radiolucencies with a predilection for the posterior mandible. Unlike maxillary lesions, pain and expansion are inconsistent findings in mandibular lesions. Jaw lesions are not associated with extragnathic bone or soft tissue involvement or a hyperlipidemia. The central xanthoma of the jaws is a unique benign tumor. Histopathologically, many other jaw lesions contain variable numbers of foamy histiocytes. Therefore, a diagnosis of a central xanthoma of the jaws must be made after excluding all other such histiocyte containing lesions. This requires correlation of histopathological findings with clinical and radiographic features.

http://ift.tt/2ewRxBA

Papillary Thyroid Carcinoma Cervical Lymph Node Metastasis with Cystic Change Differentiated from Congenital Cystic Lesions with the Assistance of Immunohistochemistry: A Case Study

Abstract

Diagnosis of cystic papillary thyroid carcinoma (PTC) lymph node metastasis at head neck region can be a challenge in the absence of known PTC history. The congenital cystic lesions of head neck, especially thyroglossal duct cyst (TGDC) and branchial cleft cyst (BCC), are major differential diagnoses in this clinicopathological scenario. The location of cyst and morphology of lining epithelium are critical clues for reaching correct diagnosis. However it is not uncommon that the flattened bland epithelial lining can be seen in both cystic metastases and congenital cystic lesions. Given that Pax8 and TTF-1 are common markers in thyroid follicular epithelium; we applied immunohistochemical stains of those two markers on aforementioned cystic lesions. Here we reported a case of cystic PTC metastasis to lymph node without prior malignancy history and cases of TGDC and BCC. Both Pax8 and TTF-1 stainings highlighted the cyst lining in PTC metastatic lymph node, while they were negative in the lining of TGDC and BCC. Collectively, Pax8 and TTF-1 immunohistochemical studies are very helpful tools for making correct diagnosis of head neck cystic lesions in the challenging clinical cases.

http://ift.tt/2dtYA0p

Comparison of Extended Nasolabial Flap Versus Buccal Fat Pad Graft in the Surgical Management of Oral Submucous Fibrosis: A Prospective Pilot Study

Abstract

Aim

To evaluate the application of extended nasolabial flap versus buccal fat pad graft in the surgical management of oral submucous fibrosis.

Settings and Design

This prospective study was carried out in the Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai.

Material and Methods

A total of 8 patients (6 men and 2 women) with age range from 21 to 65 years were selected for study. These 8 patients were randomly divided into two groups of four namely group 1 and group 2. In group 1 patients, reconstruction was planned with extended nasolabial flaps and in group 2 patients, reconstruction was planned with buccal fat pad graft respectively.

Statistical Analysis Used

Paired t test, Independent sample t test, ANOVA test.

Results

The mean preoperative mouth opening in group 1 was 8.5 mm and in group 2 was 11.75 mm. The mean increase in group 1 after one year of postoperative period was 21.50 mm and in group 2 was 24.75 mm.

Conclusions

In the present study, buccal fat pad graft proved to give better results as the interposition material as it has good patient acceptance, rapid epithelization, minimal donor site morbidity and minimal intra and postoperative complications.

http://ift.tt/2ewHNrf

Mercury toxicity to Eisenia fetida in three different soils

Abstract

Three different soils were spiked with 12 different concentrations of inorganic mercury (Hg). Sub-chronic Hg toxicity tests were carried out with Eisenia fetida in spiked soils by exposing the worms for 28 days following standard procedures. The toxicity studies revealed that Hg exerted less lethal effect on earthworms in acidic soil with higher organic carbon (S-3 soil) where water soluble Hg recovery was very low compared to the water soluble Hg fractions in soils with less organic carbon and higher pH (S-1 and S-2 soils). The concentrations of total Hg that caused 50 % lethality to E. fetida (LC₅₀) after 28 days of exposure in S-1, S-2 and S-3 soils were 152, 294 and 367 mg kg⁻¹, respectively. The average weight loss of E. fetida in three soils ranged from 5 to 65 %. The worms showed less weight loss in the organic carbon-rich soil (S-3) compared to less organic carbon containing soils (S-1 and S-2). The bioconcentration of Hg in E. fetida increased with increased Hg concentrations. The highest bioaccumulation took place in the acidic soil with higher organic carbon contents with estimated bioaccumulation factors ranging from 2 to 7.7. The findings of this study will be highly useful for deriving a more robust soil ecological guideline value for Hg.

http://ift.tt/2etZxmg

Quantifying the environmental impact of a Li-rich high-capacity cathode material in electric vehicles via life cycle assessment

Abstract

A promising Li-rich high-capacity cathode material (xLi₂MnO₃·(1-x)LiMn_0.5Ni_0.5O₂) has received much attention with regard to improving the performance of lithium-ion batteries in electric vehicles. This study presents an environmental impact evaluation of a lithium-ion battery with Li-rich materials used in an electric vehicle throughout the life cycle of the battery. A comparison between this cathode material and a Li-ion cathode material containing cobalt was compiled in this study. The battery use stage was found to play a large role in the total environmental impact and high greenhouse gas emissions. During battery production, cathode material manufacturing has the highest environmental impact due to its complex processing and variety of raw materials. Compared to the cathode with cobalt, the Li-rich material generates fewer impacts in terms of human health and ecosystem quality. Through the life cycle assessment (LCA) results and sensitivity analysis, we found that the electricity mix and energy efficiency significantly influence the environmental impacts of both battery production and battery use. This paper also provides a detailed life cycle inventory, including firsthand data on lithium-ion batteries with Li-rich cathode materials.

http://ift.tt/2eibj7U

Removal of methylparaben from synthetic aqueous solutions using polyacrylonitrile beads: kinetic and equilibrium studies

Abstract

The removal of methylparaben (MP), a well-known endocrine disruptor, from aqueous solutions using polyacrylonitrile (PAN) beads has been studied under batch conditions, at room temperature and at different initial MP concentrations. The kinetic and equilibrium results have been analyzed. Kinetic modeling analysis has been carried out with three different types of adsorption models: pseudo-first-order, pseudo-second-order, and Elovich model. Kinetic data analysis indicated that the adsorption was a second-order process. The MP adsorption by PAN was also quantitatively evaluated by using the equilibrium adsorption isotherm models of Langmuir, Freundlich, Dubinin–Radushkevich (D–R), and Temkin and the applicability of the respective isotherm equations has been compared through the correlation coefficients. Adsorption data resulted well fitted by the Freundlich isotherm model. Data of MP adsorption have also been used to test different adsorption diffusion models. The diffusion rate equations inside particulate of Dumwald–Wagner and the intraparticle diffusion model have been used to calculate the diffusion rate. The actual rate-controlling step involved in the MB adsorption process was determined. The kinetic expression by Boyd gave the right indications. All together, our results indicate that PAN beads are a useful tool to remediate water bodies polluted by endocrine disruptors.

http://ift.tt/2eu0FWP

Efficacy of indigenous probiotic Lactobacillus strains to reduce cadmium bioaccessibility - An in vitro digestion model

Abstract

The toxic heavy metal cadmium (Cd) appears as one of the major global threats to human and animal health. Human being and aquatic life are exposed to Cd by breathing, eating, or drinking when industrial effluents released into environment. The study was aimed to identify cadmium-binding Lactobacillus strain to reduce its bioaccessibility in in vitro digestion model. In this context, forty-eight lactobacilli strains isolated and characterized from fermented dairy products and human origin were screened for their Cd biosorption potential using Flame Atomic Absorption Spectroscopy (FAAS). The present study revealed that Cd biosorption potential of 48 lactobacilli strains ranged from 1.0832 ± 0.012 to 3.562 ± 0.03 mg Cd g⁻¹ of cells from initial 10 mg L⁻¹ cadmium chloride (CdCl₂) aqueous solution. Lactobacillus plantarum strain HD 48 demonstrated highest biosorption of 3.562 ± 0.03 mg Cd g⁻¹ of cells. Lactobacilli-Cd complex stability indicated its strong stability as even after three washes with Milli-Q water metal desorption was nonsignificant (p < 0.05) and further studies to delineate the influence of Cd (100 mg L⁻¹ CdCl₂) on their growth. Moreover, these strains were able to reduce Cd bioaccessibility in the in vitro digestion model in the range of 24.71 to 41.62 %. Transmission electron microscopy (TEM) investigations on Cd bioadsorption also revealed its surface associated bioadsorption phenomenon. These findings depicted that probiotic strain L. plantarum HD 48 was found to be endowed with remarkable Cd biosorption ability as well as reduction in its bioaccessibility. These results suggest that probiotic strain L. plantarum HD 48 has immense potential to sequester Cd from aqueous solution which could be further explored as a potent source to diminish body Cd burden.

http://ift.tt/2eiawEd

Aspirin and paracetamol removal using a commercial micro-sized TiO 2 catalyst in deionized and tap water

Abstract

Micro-sized TiO₂ catalyst was employed to degrade pharmaceutical compounds, i.e. aspirin and paracetamol, two of the most widely used drugs, purchasable without prescription. Their active agents, acetylsalicylic acid and acetaminophen, are characterized by different substituent groups, linked to the aromatic ring, which affect both the photodegradation and mineralization processes. The experimental conditions highlight the relationship between the nature of the pristine molecules, their degradation mechanisms, their mutual interference and the water's role. The research started from model systems with a single pollutant to the mixture of them and finally by moving from deionized water to tap water.

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Extracellular matrix 1 (ECM1) regulates the actin cytoskeletal architecture of aggressive breast cancer cells in part via S100A4 and Rho-family GTPases

Abstract

ECM1 overexpression is an independent predictor of poor prognosis in primary breast carcinomas, however the mechanisms by which ECM1 affects tumor progression have not been completely elucidated. ECM1 was silenced in the triple-negative breast cancer cell lines Hs578T and MDAMB231 using siRNA and the cells were evaluated for changes in morphology, migration, invasion and adhesion. Actin cytoskeleton alterations were evaluated by fluorescent staining and levels of activated Rho GTPases by pull down assays. ECM1 downregulation led to significantly diminished cell migration (p = 0.0005 for Hs578T and p = 0.02 for MDAMB231) and cell adhesion (p < 0.001 for Hs578T and p = 0.01 for MDAMB231). Cell invasion (matrigel) was reduced only in the Hs578T cells (p < 0.01). Silencing decreased the expression of the prometastatic molecules S100A4 and TGFβR2 in both cell lines and CD44 in Hs578T cells. ECM1–silenced cells also exhibited alterations in cell shape and showed bundles of F-actin across the cell (stress fibers) whereas NT-siRNA treated cells showed peripheral membrane ruffling. Downregulation of ECM1 was also associated with an increased F/G actin ratio, when compared to the cells transfected with NT siRNA (p < 0.001 for Hs578T and p < 0.00035 for MDAMB231) and a concomitant decline of activated Rho A in the Hs578T cells. Re-expression of S100A4 in ECM1-silenced cells rescued the phenotype in the Hs578T cells but not the MDAMB231 cells. We conclude that ECM1 is a key player in the metastatic process and regulates the actin cytoskeletal architecture of aggressive breast cancer cells at least in part via alterations in S100A4 and Rho A.

http://ift.tt/2dJqXG9

Hemodynamic Instability Following Airway Spray Cryotherapy

BACKGROUND: Spray cryotherapy (SCT) of airway lesions is used to effectively palliate respiratory symptoms related to airway obstruction, but significant intraoperative hemodynamic complications have been noted. We reviewed the experience at a single institution using SCT for the treatment of obstructive airway tumors. METHODS: A retrospective review of a single institution experience with intraoperative and postoperative hemodynamic complications associated with SCT was performed. Descriptive statistics were performed. RESULTS: Between June 2009 and April 2010, 34 treatment sessions were performed on 28 patients. Median age was 60 years (range, 15–88 years). Tumor characteristics were as follows: 13 primary lung cancers (43%), 11 pulmonary metastases (50%), 1 direct extension of an esophageal cancer (3%), and 2 benign pulmonary lesions (7%). Twenty-one tumors (75%) were distal to the carina; 14 (50%) were >95% occlusive. Median procedure length was 78 minutes (range, 15–176 minutes). Eleven sessions (31%) led to severe hypotension and/or bradycardia, with 2 patients requiring cardiopulmonary resuscitation. One patient died intraoperatively after cardiac arrest; a second patient was stable intraoperatively but died within 24 hours of SCT. Four patients required reintubation and short-term mechanical ventilation. CONCLUSIONS: Unpredictable life-threatening hemodynamic instability can follow endobronchial SCT. We propose that the most likely cause is pulmonary venous gaseous emboli entering the right heart, the coronary arteries, and the systemic circulation. Although SCT may offer advantages over airway laser therapy (such as no risk of fire and rapid hemostasis), further study is needed to delineate the relative likelihood of therapeutic benefit versus catastrophic complications.

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Further Clarification of Postoperative Anemia and Its Effects on the Kidney

No abstract available

http://ift.tt/2eDVtim

Unlocking the Mechanisms of Anesthesia

No abstract available

http://ift.tt/2e9BcTX

Influence of Renal Replacement Therapy on Transpulmonary Thermodilution: Turbulence in Blood Flow Is Key

No abstract available

http://ift.tt/2dJorQA

“If I Had Some Duct Tape, I Could Fix That”

No abstract available

http://ift.tt/2dvwhyL

Active Management of Labor Epidural Analgesia Is the Key to Successful Conversion of Epidural Analgesia to Cesarean Delivery Anesthesia

No abstract available

http://ift.tt/2e9BcmV

Regional Nerve Blocks in Anesthesia and Pain Therapy

No abstract available

http://ift.tt/2eDZ5AU

An Investigation Into the Effects of In Vitro Dilution With Different Colloid Resuscitation Fluids on Clot Microstructure Formation

BACKGROUND: Balancing the beneficial effects of resuscitation fluids against their detrimental effect on hemostasis is an important clinical issue. We aim to compare the in vitro effects of 3 different colloid resuscitation fluids (4.5% albumin, hydroxyethyl starch [Voluven 6%], and gelatin [Geloplasma]) on clot microstructure formation using a novel viscoelastic technique, the gel point. This novel hemorheologic technique measures the biophysical properties of the clot and provides an assessment of clot microstructure from its viscoelastic properties. Importantly, in contrast to many assays in routine clinical use, the measurement is performed using unadulterated whole blood in a near-patient setting and provides rapid assessment of coagulation. We hypothesized that different colloids will have a lesser or greater detrimental effect on clot microstructure formation when compared against each other. METHODS: Healthy volunteers were recruited into the study (n = 104), and a 20-mL sample of whole blood was obtained. Each volunteer was assigned to 1 of the 3 fluids, and the sample was diluted to 1 of 5 different dilutions (baseline, 10%, 20%, 40%, and 60%). The blood was tested using the gel point technique, which measures clot mechanical strength and quantifies clot microstructure (df) at the incipient stages of fibrin formation. RESULTS: df and clot mechanical strength decrease with progressive dilution for all 3 fluids. A significant reduction in df from baseline was recorded at dilutions of 20% for albumin (P

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Supine Position, Sleep, Wet Airways, and Wet Lungs

No abstract available

http://ift.tt/2eDYJdz

Three-Dimensional Transthoracic Echocardiography for Evaluation of Mitral Stenosis Identification of Severe Mitral Stenosis Using Real-Time Three-Dimensional Transesophageal Echocardiography During an Left Ventricular Assist Device Insertion

No abstract available

http://ift.tt/2e9xMQY

A Comment on “Airway Assessment Before Intervention: What We Know and What We Do”

No abstract available

http://ift.tt/2eDW7MW

Abnormalities of Mitral Subvalvular Apparatus in Hypertrophic Cardiomyopathy: Role of Intraoperative 3D Transesophageal Echocardiography

No abstract available

http://ift.tt/2dvvu0q

Recent Insights Into Molecular Mechanisms of Propofol-Induced Developmental Neurotoxicity: Implications for the Protective Strategies

Mounting evidence has demonstrated that general anesthetics could induce developmental neurotoxicity, including acute widespread neuronal cell death, followed by long-term memory and learning abnormalities. Propofol is a commonly used intravenous anesthetic agent for the induction and maintenance of anesthesia and procedural and critical care sedation in children. Compared with other anesthetic drugs, little information is available on its potential contributions to neurotoxicity. Growing evidence from multiple experimental models showed a similar neurotoxic effect of propofol as observed in other anesthetic drugs, raising serious concerns regarding pediatric propofol anesthesia. The aim of this review is to summarize the current findings of propofol-induced developmental neurotoxicity. We first present the evidence of neurotoxicity from animal models, animal cell culture, and human stem cell–derived neuron culture studies. We then discuss the mechanism of propofol-induced developmental neurotoxicity, such as increased cell death in neurons and oligodendrocytes, dysregulation of neurogenesis, abnormal dendritic development, and decreases in neurotrophic factor expression. Recent findings of complex mechanisms of propofol action, including alterations in microRNAs and mitochondrial fission, are discussed as well. An understanding of the toxic effect of propofol and the underlying mechanisms may help to develop effective novel protective or therapeutic strategies for avoiding the neurotoxicity in the developing human brain.

http://ift.tt/2e9z1PW

The Effect of Preoperative Pregabalin on Postoperative Nausea and Vomiting: A Meta-analysis

BACKGROUND: Nonopioid adjuvant medications are increasingly included among perioperative Enhanced Recovery After Surgery protocols. Preoperative pregabalin has been shown to improve postoperative pain and limit reliance on opioid analgesia. Our group investigated the ability of preoperative pregabalin to also prevent postoperative nausea and vomiting (PONV). METHODS: Our group performed a meta-analysis of randomized trials that report outcomes on the effect of preoperative pregabalin on PONV endpoints in patients undergoing general anesthesia. RESULTS: Among all included trials (23 trials; n = 1693), preoperative pregabalin was associated with a significant reduction in PONV (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.39–0.73; P = 0.0001), nausea (RR = 0.62; 95% CI, 0.46–0.83; P = 0.002), and vomiting (RR = 0.68; 95% CI, 0.52–0.88; P = 0.003) at 24 hours. Subgroup analysis designed to account for major PONV confounders, including the exclusion trials with repeat dosing, thiopental induction, nitrous oxide maintenance, and prophylactic antiemetics and including high-risk surgery, resulted in similar antiemetic efficacy. Preoperative pregabalin is also associated with significantly increased rates of postoperative visual disturbance (RR = 3.11; 95% CI, 1.34–7.21; P = 0.008) compared with a control. CONCLUSIONS: Preoperative pregabalin is associated with significant reduction of PONV and should not only be considered as part of a multimodal approach to postoperative analgesia but also for prevention of PONV.

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Optimizing Pain and Rehabilitation After Knee Arthroplasty: A Two-Center, Randomized Trial

BACKGROUND: This randomized trial compared (1) continuous femoral nerve block (cFNB), (2) single femoral nerve block (sFNB), and (3) local infiltration analgesia (LIA) with respect to analgesic and functional outcomes after primary tricompartmental knee arthroplasty (TKA). METHODS: One hundred twenty patients undergoing primary tricompartmental knee arthroplasty were randomly assigned to 1 of 3 interventions for postoperative analgesia: (1) cFNB—preoperative bolus of ropivacaine 0.5% 20 mL followed by ropivacaine 0.2% 5 mL per hour for 48 hours; (2) sFNB—preoperative bolus of ropivacaine 0.5% 20 mL with placebo 0.9% saline 5 mL per hour for 48 hours; or (3) LIA—intraoperative tricompartmental injection of ropivacaine 0.2% (150 mL) with epinephrine (10 µg/mL) and ketorolac 30 mg with femoral placebo 0.9% saline 20 mL preoperative bolus and 0.9% saline placebo 5 mL per hour for 48 hours. All participants received an identical, standardized, postoperative multimodal analgesic regimen. Participants, health care providers, data collectors, and analysts were blinded. All participants received identical perineural catheters and perineural/LIA solution (depending on randomized intervention) to maintain blinding. The primary outcome measure was numeric rating scale for pain (NRS) during physiotherapy on postoperative day (POD) 2 at 9:00 AM. Secondary outcomes included opioid consumption, NRS on POD 1 (rest/physiotherapy/worst), functional outcomes, and block complications. RESULTS: For the primary outcome, pain during physiotherapy on POD 2 at 9:00 AM, the overall analysis of covariance (ANCOVA) was significant (P = .049), but pairwise comparisons did not demonstrate any significant differences between treatment arms. NRS was 4.6 (95% confidence interval [CI], 3.3–6.0) for the cFNB group, 4.6 (95% CI, 3.3–6.0) for the sFNB group, and 3.4 (95% CI, 2.2–4.8) for the LIA group. The following is the mean difference in NRS on POD 2 at 9:00 AM among groups: cFNB−LIA (1.2, 95% CI, −0.1 to 2.5; P = .073); sFNB−LIA (1.2, 95% CI, −0.2 to 2.5; P = .097); cFNB−sFNB (0.0, 95% CI, −1.3 to 1.4; P = .996). There were no statistically significant differences between groups in cumulative 48-hour opioid consumption or functional outcomes. cFNB and LIA were superior to sFNB for NRS on POD 1 for worst pain experienced and pain during physiotherapy, respectively. There were no adverse events associated with study procedures reported among participants in the 3 groups. CONCLUSIONS: Our findings suggest no clinically significant differences between cFNB, LIA, and sFNB for pain during physiotherapy on POD 2 after TKA. Secondary analyses suggest that cFNB and LIA are superior to sFNB for early analgesic outcomes (NRS on POD 1) after TKA.

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Implication of UGT2B15 Genotype Polymorphism on Postoperative Anxiety Levels in Patients Receiving Lorazepam Premedication

BACKGROUND: Lorazepam is used as premedication for its anxiolytic properties. The UGT2B15 genotype is of importance for the metabolism of lorazepam. The clinical effect of genetic polymorphisms in UGT2B15 genotype on the treatment of anxiety levels in same-day surgery patients receiving lorazepam, however, is unknown. METHODS: Three hundred ninety-eight same-day surgery patients of mixed sex (from a previous double-blinded randomized controlled trial who were assigned to either lorazepam [n = 198] or placebo [n = 200]) were assessed for the UGT2B15*2 variant allele. Anxiety was measured preoperatively and postoperatively by the State part of the State-Trait Anxiety Inventory. The difference between these 2 measurements served as outcome of the study. Analysis of variance was used to assess the State part of the State-Trait Anxiety Inventory difference for interactions among the following factors: UGT2B15 genotype status, treatment condition (lorazepam or placebo), patient sex, and preoperative anxiety score. RESULTS: The anxiety difference was complex in that the interaction of lorazepam and UGT2B15 genotype status also was dependent on the joint effect of patient sex and preoperative anxiety score (F = 7.15, P = .008). Further exploration showed clinical relevant results in patients with high preoperative anxiety scores. Striking was that females with high preoperative anxiety scores and genetically reduced lorazepam glucuronidation (UGT2B15*2 homozygotes) showed more postoperative anxiety reduction than males with the same genotype. CONCLUSIONS: UGT2B15 genotype contributes to postoperative anxiety reduction after lorazepam premedication. Future research that focuses on patients with high preoperative anxiety scores could help to gain a deeper understanding in the clinical relevance of the interaction between lorazepam and UGT2B15 genotype on postoperative anxiety levels.

http://ift.tt/2dvxPIW

In Response

No abstract available

http://ift.tt/2etVxSQ

The Effect of Lipid Emulsion on Pharmacokinetics of Bupivacaine in Rats: Long-Chain Triglyceride Versus Long- and Medium-Chain Triglyceride

BACKGROUND: Lipid infusions have been proposed to treat local anesthetic–induced cardiac toxicity. This study compared the effects of long-chain triglyceride (LCT) emulsions with those of long- and medium-chain triglyceride (LCT/MCT) emulsions on the pharmacokinetics of bupivacaine in a rat model. METHODS: After administration of intravenous infusion of bupivacaine at 2 mg·kg−1·min−1 for 5 minutes in Sprague–Dawley (SD) rats, either Intralipid 20%, an LCT emulsion (LCT group, n = 6), or Lipovenoes 20%, an LCT/MCT emulsion (LCT/MCT group, n = 6), was infused at 2mg·kg−1·min−1 for 5 minutes. The concentrations of total plasma bupivacaine and bupivacaine that were not bound by lipid (lipid unbound) were measured by a liquid chromatography–tandem mass spectrometric method. A 2-compartmental analysis was performed to calculate the lipid-bound percentage of bupivacaine and its pharmacokinetics. RESULTS: In the LCT group, the clearance (15 ± 2 vs 10 ± 1 mL·min−1·kg−1, P = .003) was higher; the volume of distribution (0.57 ± 0.10 vs 0.36 ± 0.11 L·kg−1, P = .007) and K21 (0.0100 ± 0.0018 vs 0.0070 ± 0.0020 min−1, P = .021, P′ = .032) were larger; and the area under the blood concentration–time curve 0 − t; (605 ± 82 vs 867 ± 110 mgL−1·min−1, P =.001) and the area under the blood concentration–time curve (0 − ∞) (697 ± 111 vs 991 ± 121 mgL−1·min−1, P =.001) were less, when compared with the LCT/MCT group. CONCLUSIONS: LCT emulsions are more effective than LCT/MCT emulsions in the metabolism of bupivacaine through demonstration of a superior pharmacokinetic profile.

http://ift.tt/2e9xOs4

Confusion Between Integration and Receiver Operator Curves?

No abstract available

http://ift.tt/2etWs5s

The American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer

Publication date: Available online 19 October 2016
Source:Brachytherapy
Author(s): Daniel E. Spratt, Payal D. Soni, Patrick W. McLaughlin, Gregory S. Merrick, Richard G. Stock, John C. Blasko, Michael J. Zelefsky
PurposeTo review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost.Methods and MaterialsThe available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized.ResultsAt this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone.ConclusionsDue to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers.



http://ift.tt/2eEkSKf

Incorporating three-dimensional ultrasound into permanent breast seed implant brachytherapy treatment planning

Publication date: Available online 19 October 2016
Source:Brachytherapy
Author(s): Daniel Morton, Deidre Batchelar, Michelle Hilts, Tanya Berrang, Juanita Crook
PurposePlanning permanent breast seed implant (PBSI) brachytherapy using CT alone may reduce treatment accuracy because of differences in seroma visualization compared with ultrasound (US). This study evaluates dosimetric effects of seroma delineation in PBSI and the potential impact of incorporating three-dimensional (3D) US into PBSI treatment planning.Methods and MaterialsSpatially coregistered CT and 3D US images from 10 patients were retrospectively analyzed to simulate the PBSI procedure. Seromas contoured on CT and US defined clinical target volumes, CTVCT and CTVUS, which were expanded to create planning target volumes (PTVs). PBSI plans were generated using PTVCT alone, and the resulting coverage to PTVUS was evaluated. To assess the potential impact of transferring to an US-guided procedure, the CT-based plans were centered on CTVUS. The volume encompassed by both PTVs was used to evaluate how 3D US can affect the planning procedure.ResultsMedian (range) PTVCTV100 was 95.6% (93.3–97.3%), resulting in PTVUS coverage of 91.5% (80.5–97.9%). Centering plans on CTVUS decreased PTVCTV100 by a mean of 10 ± 8%, and increased PTVUSV100 by 5 ± 4%. The combined PTVs were a mean 9±6% larger than PTVCT. Acceptable dosimetry to the combined PTVs resulted in sufficient coverage to individual PTVs but with a mean 11 ± 24% increase to skin dose and 6 ± 8% increase in breast V200.ConclusionsDifferences in seroma visualization have dosimetric effects in PBSI. CT-based plans can underdose US-defined volumes and may not adequately translate to an US-guided procedure. Implementing 3D US into planning can potentially compensate for differences in delineation.



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JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):936

Authors:

PMID: 27768199 [PubMed - in process]

http://ift.tt/2es1lAB

Highlights.

Highlights.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):935

Authors:

PMID: 27768198 [PubMed - in process]

http://ift.tt/2dxoQCi

Updated Affiliation and Contact Information.

Updated Affiliation and Contact Information.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):1027

Authors:

PMID: 27768197 [PubMed - in process]

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Choice of Analgesics After Adenotonsillectomy: Are We Between a Rock and a Hard Place?

Choice of Analgesics After Adenotonsillectomy: Are We Between a Rock and a Hard Place?

JAMA Otolaryngol Head Neck Surg. 2016 Oct 20;:

Authors: Pinto JM, Salvador R, Naclerio RM

PMID: 27768163 [PubMed - as supplied by publisher]

http://ift.tt/2dITbAQ

Integrating Quality Improvement Into the Otolaryngology Morbidity and Mortality Conference.

Integrating Quality Improvement Into the Otolaryngology Morbidity and Mortality Conference.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 20;:

Authors: McMullen CP, Mehta V

PMID: 27768161 [PubMed - as supplied by publisher]

http://ift.tt/2dxoICt

Integrating Morbidity and Mortality Core Competencies and Quality Improvement in Otolaryngology.

Integrating Morbidity and Mortality Core Competencies and Quality Improvement in Otolaryngology.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 20;:

Authors: Laury AM, Bowe SN, Lospinoso J

Abstract
Importance: To date, an otolaryngology-specific morbidity and mortality (M&M) conference has never been reported or evaluated.
Objective: To propose a novel otolaryngology-specific M&M format and to assess its success using a validated assessment tool.
Design, Setting, and Participants: Preintervention and postintervention cohort study spanning 14 months (September 2014 to November 2015), with 32 faculty, residents, and medical students attending the department of otolaryngology M&M conference, conducted at the the San Antonio Uniformed Services Health Education Consortium.
Interventions: A novel quality assurance conference was implemented in the department of otolaryngology at the San Antonio Uniformed Services Health Education Consortium. This conference incorporates patient safety reports, otolaryngology-specific quality metrics, and individual case presentations. The revised format integrates the Accreditation Council for Graduate Medical Education (ACGME) core competencies and Quality Improvement and Patient Safety (QI/PS) system. This format was evaluated by faculty, residents, and medical students every other month for 14 months to assess changes in attitudes regarding the M&M conference as well as changes in presentation quality.
Results: Overall, 13 faculty, 12 residents, and 7 medical students completed 232 evaluations. Summary statistics of both resident and faculty attitudes about the success of the M&M format seem to improve over the 14 months between the prequestionnaires and postquestionnaires. General attitudes for both residents and faculty significantly improved from the pretest to posttest (odds ratio, 0.32 per month; 95% CI, 0.29-0.35). In the pretest period, "established presentation format" was considered the most necessary improvement, whereas in the posttest period this changed to "incorporate more QI." For resident presentations evaluated using the situation, background, assessment, and review/recommendations (SBAR) tool, all evaluations, from all participants, improved over time.
Conclusions and Relevance: The M&M conference is an essential component of all otolaryngology residency programs and provides a unique opportunity to successfully incorporate the ACGME core competencies and regularly implement QI/PS.

PMID: 27768160 [PubMed - as supplied by publisher]

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Initial Experience With Low-Dose Methotrexate as an Adjuvant Treatment for Rapidly Recurrent Nonvasculitic Laryngotracheal Stenosis.

Initial Experience With Low-Dose Methotrexate as an Adjuvant Treatment for Rapidly Recurrent Nonvasculitic Laryngotracheal Stenosis.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 20;:

Authors: Rosow DE, Ahmed J

Abstract
Importance: Adult laryngotracheal stenosis (LTS) is typically managed surgically, but some patients fail treatment because of rapid restenosis or granulation tissue formation. The need for frequent surgery or tracheostomy reduces the quality of life in these patients and poses a significant challenge for the treating physician. New adjuvant treatments are required to reduce the surgical burden of this condition.
Objective: To examine whether patients with rapidly recurrent nonvasculitic LTS who fail surgical management of their stenosis (ie, requiring dilation more frequently than every 6 months) experience longer intervals between surgical procedures when receiving adjuvant treatment with low-dose methotrexate.
Design, Setting, and Participants: This study was a retrospective case series study of patients treated with methotrexate from January 2014 to January 2016 at a tertiary academic medical center. Participants were 10 patients with LTS without any diagnosis of vasculitis or granulomatous disease who underwent low-dose methotrexate therapy.
Interventions: Once-weekly treatment with oral methotrexate, 15 or 20 mg.
Main Outcomes and Measures: The mean number of days between operations before and after starting methotrexate therapy was compared. Clinical courses and adverse effects of each patient were also reviewed.
Results: Among 10 patients, the mean (SD) age at the outset of study inclusion was 52 (19) years; 8 were female and 2 were male. All 10 patients experienced some clinical improvement. Three patients who were previously tracheostomy dependent were able to be decannulated. Two other patients who were tracheostomy dependent and had failed endoscopic management of their granulation tissue had complete resolution. In 6 patients who underwent at least 1 surgical procedure before and after the initiation of methotrexate treatment, the mean (SD) interval between operations increased from 61 (35) days (95% CI, 26-96 days) before starting methotrexate therapy to 312 (137) days (95% CI, 175-449 days) after starting methotrexate therapy, for an absolute difference of 251 (58) days (95% CI, 193-309 days). The median number of days between surgical procedures was 44 days before starting methotrexate therapy and 289 days after starting methotrexate therapy. Adverse effects observed included mild hair thinning and onychomycosis in 2 patients and herpes zoster infection in 1 patient.
Conclusions and Relevance: Low-dose methotrexate appears to be an effective adjunct to surgery in select patients with LTS that is resistant to surgical management and leads to a substantial increase in the number of days between surgical procedures. The patient and clinician must be aware of the adverse effects of methotrexate therapy and balance these factors against the risk of poorly controlled airway stenosis. Randomized, placebo-controlled, double-blind trials are needed to examine whether the clinical efficacy in this series of patients translates to a larger population.

PMID: 27768157 [PubMed - as supplied by publisher]

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Effects of Genetic and Non-genetic Factors on Total and Bioavailable 25(OH)D Responses to Vitamin D Supplementation

The Journal of Clinical Endocrinology &Metabolism, Early Release.


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Population Survey of Iodine Deficiency and Environmental Disruptors of Thyroid Function in Young Children in Haiti

The Journal of Clinical Endocrinology &Metabolism, Early Release.


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Elevated serum tetrac in Graves’ disease: potential pathogenic role in thyroid-associated ophthalmopathy

The Journal of Clinical Endocrinology &Metabolism, Early Release.


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WhatsApp is an effective tool for obtaining second opinion in oral pathology practice

Abstract

Background

The aim of the present study was to find out the efficacy of WhatsApp application for obtaining second opinion on histopathological diagnosis in oral pathology practice.

Methods

A total of 247 cases comprising of 34 different oral pathologies were photomicrographed using smartphone cameras through compound microscopes and sent for second opinion diagnosis (SOD) to 20 different oral pathologists using WhatsApp.

Results

Out of 4795 (97.06%) total second opinion received, correct SOD was received for 4710 (98.22%) cases. 100% times correct SOD was received for lesions including adenomatoid odontogenic tumor, keratinizing cystic odontogenic tumor, odontome, dentigerous cyst, etc. Lesions such as myoepithelial carcinoma, osteosarcoma, fibrosarcoma and intravascular papillary endothelial hyperplasia received less percentage of correct SOD (85.71 to 75.75%). Correct SOD was obtained for variants of ameloblastoma (99.01%), grading of epithelial dysplasia (87.54%) and squamous cell carcinoma (95.26%). A positive correlation was observed between correct SOD and age (p = 0.0143) and experience (p = 0.0189) of the pathologist. The time taken for giving second opinion by the pathologists ranged from 81.98 ± 32.89 minutes to 90.72 ± 38.88 minutes.

Conclusion

Smartphone camera is a handy and efficient tool in capturing photomicrographs from the compound microscope. Transfer of such photomicrograph via WhatsApp is an effective and convenient approach in procuring second opinion on histopathological diagnosis of oral pathologies.

This article is protected by copyright. All rights reserved.

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Editorial Board/Aims and Scope

Publication date: 4 November 2016
Source:Vaccine, Volume 34, Issue 46





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A paper-based immunoassay to determine HPV vaccination status at the point-of-care

Publication date: 4 November 2016
Source:Vaccine, Volume 34, Issue 46
Author(s): Benjamin D. Grant, Chelsey A. Smith, Philip E. Castle, Michael E. Scheurer, Rebecca Richards-Kortum
ObjectiveTo develop and evaluate a paper-based point-of-care HPV serology test to determine if an individual has received two or more HPV immunizations.MethodsThe paper-based immunoassay was constructed using a nitrocellulose lateral flow strip with adsorbed HPV16 virus-like particles serving as the capturing moiety. Three capture zones containing virus-like particles were placed in series to allow for visual discrimination between high and low HPV16 plasma antibody concentrations. A plasma separation membrane was used to allow whole blood to be applied directly to the assay. All reagents were dried on glass fiber pads during device fabrication and were rehydrated with buffer at the time of use. A pilot study consisting of 35 subjects with a history of zero, one, two or three HPV vaccines was conducted to evaluate the immunoassay. The completed paper-based immunoassays were scanned for visual interpretation by three researchers who were blinded to the true results and separately evaluated quantitatively using MATLAB.ResultsFor the 28 tests valid for analysis, fifteen subjects reported receiving two or more HPV vaccines, three reported receiving one, and ten reported having no HPV vaccinations. The paper-based immunoassays for all fifteen subjects who reported having received two or more HPV vaccines were judged positive by all researchers. Twelve of the thirteen tests from individuals reporting one or zero vaccinations were deemed negative by all observers. One test from an unvaccinated individual was judged positive by two out of three reviewers. Quantitatively, all tests were correctly separated between the two groups.ConclusionsWe successfully designed and tested a HPV serology test amenable to the point-of-care. The device showed promising results in a pilot study for discriminating between those who received two or more HPV vaccinations and those who did not. Furthermore, this device offers a platform for producing other semi-quantitative point-of-care serological tests.



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Knowledge, attitudes, and practices of healthcare providers in the country of Georgia regarding influenza vaccinations for pregnant women

Publication date: Available online 20 October 2016
Source:Vaccine
Author(s): Mariam Dvalishvili, Darejan Mesxishvili, Maia Butsashvili, George Kamkamidze, Deborah McFarland, Robert A. Bednarczyk
ObjectiveTo document knowledge, attitudes, and practices of Georgian obstetrician-gynecologists concerning influenza infection and vaccination during pregnancy.MethodsWe conducted a cross-sectional study of obstetrician-gynecologists in 8 cities in the country of Georgian, from June to July, 2015, using an anonymous, self-administered, written survey. Collected data included demographics; knowledge, attitudes, and practices related to influenza vaccination during pregnancy; perceptions of influenza infection in pregnancy; perceived barriers to influenza vaccination during pregnancy; and willingness to receive education about influenza infection and vaccination during pregnancy.ResultsA total of 278 obstetrician-gynecologists completed surveys. Most physicians perceived influenza to be a serious infectious disease (88%) and that pregnant women are more susceptible to it than the general population. Only 43% of physicians reported recommending influenza vaccination during pregnancy; 18% reported vaccinating any pregnant patients during the last influenza season. Most (75%) physicians reported a perception that there is insufficient evidence supporting influenza vaccination during pregnancy. Most (93%) were receptive to receiving additional education on maternal vaccination.ConclusionsGeorgian physicians are hesitant to vaccinate pregnant women, but are receptive to education about maternal vaccination. Future educational outreach to Georgian physicians could reduce concerns about maternal vaccination, potentially increasing influenza vaccination among pregnant Georgian women.



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Prevalence of serum neutralizing antibodies to adenovirus type 5 (Ad5) and 41 (Ad41) in children is associated with age and sanitary conditions

Publication date: 4 November 2016
Source:Vaccine, Volume 34, Issue 46
Author(s): Wei-Xiong Yang, Xiao-Hui Zou, Shuang-Ying Jiang, Nan-Nan Lu, Mei Han, Jian-Hai Zhao, Xiao-Juan Guo, Sheng-Cang Zhao, Zhuo-Zhuang Lu
Neutralizing antibody (NAb) can dampen the immunogenicity of adenovirus (Ad) vector-based vaccine. Vector systems based on human adenovirus type 41 (Ad41) have been constructed and used to develop recombinant vaccines. Here, we attempted to study the seroprevalence of NAbs to Ad5 and Ad41 among children and adults in Qinghai province, China. The positive rates (titer⩾40) of Ad5 and Ad41 NAb in adults from Xining city were 75.7% and 94.7%, respectively. The moderate/high-positive rates (titer⩾160) of NAb were quite close between the two viruses in adults (70.4% for Ad5 and 73.5% for Ad41). Age-dependent increase of NAb seroprevalence was observed for both viruses in children. NAb-positive rate of Ad41 reached 50% at 3.3–4.6years of age for children from Chengxi district, Xining city, approximately 1.5years earlier than that of Ad5 did. Interestingly, NAb level was also associated with sanitary conditions among young children. For Ad5, 8–15% children (0.2–3.0years of age) from city or town, where the sanitations were relatively better, had moderate/high-positive NAb, while the same rate was 62% for children from villages. For Ad41, 22% children from city, 47% from town and 88% from villages possessed moderate/high-positive NAb. The possible influence of NAb titer distributions on the application of Ad41-vectored vaccines was discussed in detail. Our results suggested that children from places with poor sanitations should be included for comprehensive Ad NAb seroprevalence studies, and provided insights to the applications of Ad41 vectors.



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Vaccine impact: Benefits for human health

Publication date: Available online 20 October 2016
Source:Vaccine
Author(s): Mark Doherty, Philippe Buchy, Baudouin Standaert, Carlo Giaquinto, David Prado- Cohrs
Unlike most drugs, whose benefit is restricted to the individual who takes the drug, prophylactic vaccines have the potential for far-reaching effects that encompass health service utilisation, general health and wellbeing, cognitive development and, ultimately, economic productivity. The impact of immunisation is measured by evaluating effects directly on the vaccinated individual, indirectly on the unvaccinated community (herd protection), the epidemiology of the pathogen (such as changing circulating serotypes or prevention of epidemic cycles), and the additional benefits arising from improved health. Aside from protection of the individual, the broader success of immunisation is dependent on achieving a level of coverage sufficient to interrupt transmission of the pathogen. When evaluating the cost-effectiveness of vaccines, all of these potential benefits need to be accounted for. In many countries where immunisation programmes have been highly successful, the control of disease has meant that the benefits of immunisation have become less obvious. Once a well-known and much-feared disease appears to have disappeared, individuals, including healthcare professionals, no longer view ongoing prevention with the same sense of urgency. Reduced coverage is inevitably associated with resurgence in disease, with outbreaks potentially leading to significant morbidity and loss of life. Ensuring the continued success of immunisation programmes is the responsibility of all: individuals, healthcare professionals, government and industry.



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A monoclonal antibody that targets the conserved core/lipid A region of lipopolysaccharide affects motility and reduces intestinal colonization of both classical and El Tor Vibrio cholerae biotypes

Publication date: Available online 20 October 2016
Source:Vaccine
Author(s): Kara J. Levinson, Danielle E. Baranova, Nicholas J. Mantis
Vibrio cholerae is the causative agent of cholera, an acute diarrheal disease that remains endemic in many parts of the world. The mechanisms underlying immunity to cholera remain poorly defined, though it is increasingly clear that protection is associated with antibodies against lipopolysaccharide (LPS). Here we report that ZAC-3, a monoclonal antibody against the core/lipid A region of V. cholerae LPS is a potent inhibitor of V. cholerae flagellum-based motility in viscous and liquid environments. ZAC-3 arrested motility of the classical Ogawa strain O395, as well as the El Tor Inaba strain C6706. In addition, we demonstrate, in the neonatal mouse model, that ZAC-3 IgG and Fab fragments significantly reduced the ability of both V. cholerae strains O395 and C6706 to colonize the intestinal epithelium, revealing the potential of antibodies against the core/lipid A to contribute to immunity across biotypes, possibly through a mechanism involving motility arrest.



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Effect of prematurity and low birth weight in visual abilities and school performance

Publication date: December 2016
Source:Research in Developmental Disabilities, Volume 59
Author(s): T. Perez-Roche, I. Altemir, G. Giménez, E. Prieto, I. González, J.L. Peña-Segura, O. Castillo, V. Pueyo
BackgroundPrematurity and low birth weight are known risk factors for cognitive and developmental impairments, and school failure. Visual perceptual and visual motor skills seem to be among the most affected cognitive domains in these children.AimsTo assess the influence of prematurity and low birth weight in visual cognitive skills and school performance.MethodsWe performed a prospective cohort study, which included 80 boys and girls in an age range from 5 to 13. Subjects were grouped by gestational age at birth (preterm, <37 weeks; term, 37–42 weeks) and birth weight (small for gestational age (SGA), <10th centile; appropriate weight for gestational age (AGA), ≥10th centile). Each child underwent full ophthalmologic assessment and standardized testing of visual cognitive abilities (Test of Visual Perceptual Skills and Test of Visual Analysis Skills). Parents completed a questionnaire on school performance in children.ResultsFigure-ground skill and visual motor integration were significantly decreased in the preterm birth group, compared with term control subjects (figure-ground: 45.7 vs 66.5, p=0.012; visual motor integration, TVAS: (9.9 vs 11.8, p=0.018), while outcomes of visual memory (29.0 vs 47.7, p=0.012), form constancy (33.3 vs 52.8, p=0.019), figure-ground (37.4 vs 65.6, p=0.001), and visual closure (43.7 vs 62.6 p=0.016) testing were lower in the SGA (vs AGA) group. Visual cognitive difficulties corresponded with worse performance in mathematics (r=0.414, p=0.004) and reading (r=0.343, p=0.018).ConclusionSpecific patterns of visual perceptual and visual motor deficits are displayed by children born preterm or SGA, which hinder mathematics and reading performance.



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