Childhood adversities characterize the heterogeneity in the brain pattern of individuals during neurodevelopment

BACKGROUND

Several factors shape the neurodevelopmental trajectory. A key area of focus in neurodevelopmental research is to estimate the factors that have maximal influence on the brain and can tip the balance from typical to atypical development.

METHODS

Utilizing a dissimilarity maximization algorithm on the dynamic mode decomposition (DMD) of the resting state functional MRI data, we classified subjects from the cVEDA neurodevelopmental cohort (n = 987, aged 6-23 years) into homogeneously patterned DMD (representing typical development in 809 subjects) and heterogeneously patterned DMD (indicative of atypical development in 178 subjects).

RESULTS

Significant DMD differences were primarily identified in the default mode network (DMN) regions across these groups (p < 0.05, Bonferroni corrected). While the groups were comparable in cognitive performance, the atypical group had more frequent exposure to adversities and faced higher abuses (p < 0.05, Bonferroni corrected). Upon evaluating brain-behavior correlations, we found that correlation patterns between adversity and DMN dynamic modes exhibited age-dependent variations for atypical subjects, hinting at differential utilization of the DMN due to chronic adversities.

CONCLUSION

Adversities (particularly abuse) maximally influence the DMN during neurodevelopment and lead to the failure in the development of a coherent DMN system. While DMN's integrity is preserved in typical development, the age-dependent variability in atypically developing individuals is contrasting. The flexibility of DMN might be a compensatory mechanism to protect an individual in an abusive environment. However, such adaptability might deprive the neural system of the faculties of normal functioning and may incur long-term effects on the psyche.

Balloon-Expandable Pulmonary Valves for Patched or Native Right Ventricular Outflow Tracts

The implantation of percutaneous balloon expandable valves in native or patched right ventricular outflow tracts (nRVOT) is a challenging technique due to the diversity of anatomies and shapes, the large sizes, and the distensibility of the nRVOT, for which specific techniques have been developed. We present a single center experience with balloon expandable percutaneous pulmonary valves in nRVOT, describing the techniques used, complications observed, and a short-mid term follow-up.. This is a single center descriptive study of patients who underwent a percutaneous pulmonary valve implantation in a nRVOT with a balloon expandable pulmonary valve in our center between September 2012 and June 2022.. We implanted successfully 45 valves in 46 patients (20 Sapien and 25 Melody). Tetralogy of Fallot or pulmonary atresia with VSD were the main congenital heart disease (n = 32). All were pre-stented, 18 in a one step procedure. We used a Dryseal sheath in 13/21 Sapien. In 6 patients we used the anchoring technique, 5 with a very large nRVOT and one pyramidal nRVOT. In the 3.5 year follow-up 7 patients developed endocarditis and 3 required a valve redilation, no fractures were observed. PPVI of native RVOT with balloon expandable valves is feasible in a number of selected anatomies, including large or pyramidal nRVOT, using specific techniques, (presenting, LPA anchoring).

Risk clustering and psychopathology from a multi-center cohort of Indian children, adolescents, and young adults

Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of children, adolescents, and young adults, based on adverse environmental exposure and developmental characteristics, and to examine the association of risk clusters with manifest psychopathology. Participants (n = 8300) between 6 and 23 years were recruited from seven sites in India. We administered questionnaires to elicit history of previous exposure to adverse childhood environments, family history of psychiatric disorders in first-degree relatives, and a range of antenatal and postnatal adversities. We used these variables to generate risk clusters. Mini-International Neuropsychiatric Interview-5 was administered to evaluate manifest psychopathology. Two-step cluster analysis revealed two clusters designated as high-risk cluster (HRC) and low-risk cluster (LRC), comprising 4197 (50.5%) and 4103 (49.5%) participants, respectively. HRC had higher frequencies of family history of mental illness, antenatal and neonatal risk factors, developmental delays, history of migration, and exposure to adverse childhood experiences than LRC. There were significantly higher risks of any psychiatric disorder [Relative Risk (RR) = 2.0, 95% CI 1.8-2.3], externalizing (RR = 4.8, 95% CI 3.6-6.4) and internalizing disorders (RR = 2.6, 95% CI 2.2-2.9), and suicidality (2.3, 95% CI 1.8-2.8) in HRC. Social-environmental and developmental factors could classify Indian children, adolescents and young adults into homogeneous clusters at high or low risk of psychopathology. These biopsychosocial determinants of mental health may have practice, policy and research implications for people in low- and middle-income countries.

Neurocognitive Analysis of Low-level Arsenic Exposure and Executive Function Mediated by Brain Anomalies Among Children, Adolescents, and Young Adults in India

Importance

Arsenic, a contaminant of groundwater and irrigated crops, is a global public health hazard. Exposure to low levels of arsenic through food extends well beyond the areas with high arsenic content in water.

Objective

To identify cognitive impairments following commonly prevalent low-level arsenic exposure and characterize their underlying brain mechanisms.

Design, Setting, and Participants

This multicenter population-based cohort study analyzed cross-sectional data of the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, recruited between November 4, 2016, and May 4, 2019. Participants aged 6 to 23 years were characterized using deep phenotyping measures of behavior, neuropsychology, psychopathology, brain neuroimaging, and exposure to developmental adversities and environmental neurotoxins. All analyses were performed between June 1, 2020, and December 31, 2021.

Exposure

Arsenic levels were measured in urine as an index of exposure.

Main Outcomes and Measures

Executive function measured using the cVEDA neuropsychological battery, gray matter volume (GMV) from T1-weighted magnetic resonance imaging, and functional network connectivity measures from resting state functional magnetic resonance imaging.

Results

A total of 1014 participants aged 6 to 23 years (589 male [58.1%]; mean [SD] age, 14.86 [4.79] years) were included from 5 geographic locations. Sparse-partial least squares analysis was used to describe a negative association of arsenic exposure with executive function (r = -0.12 [P = 5.4 × 10-4]), brain structure (r = -0.20 [P = 1.8 × 10-8]), and functional connectivity (within network, r = -0.12 [P = 7.5 × 10-4]; between network, r = -0.23 [P = 1.8 × 10-10]). Alterations in executive function were partially mediated by GMV (b = -0.004 [95% CI, -0.007 to -0.002]) and within-network functional connectivity (b = -0.004 [95% CI, -0.008 to -0.002]). Socioeconomic status and body mass index moderated the association between arsenic and GMV, such that the association was strongest in participants with lower socioeconomic status and body mass index.

Conclusions and Relevance

The findings of this cross-sectional study suggest that low-level arsenic exposure was associated with alterations in executive functioning and underlying brain correlates. These results indicate potential detrimental consequences of arsenic exposure that are below the currently recommended guidelines and may extend beyond endemic risk areas. Precision medicine approaches to study global mental health vulnerabilities highlight widespread but potentially modifiable risk factors and a mechanistic understanding of the impact of low-level arsenic exposure on brain development.

Growth trajectories for executive and social cognitive abilities in an Indian population sample: Impact of demographic and psychosocial determinants

Cognitive abilities are markers of brain development and psychopathology. Abilities, across executive, and social domains need better characterization over development, including factors that influence developmental change. This study is based on the cVEDA [Consortium on Vulnerability to Externalizing Disorders and Addictions] study, an Indian population based developmental cohort. Verbal working memory, visuo-spatial working memory, response inhibition, set-shifting, and social cognition (faux pas recognition and emotion recognition) were cross-sectionally assessed in > 8000 individuals over the ages 6-23 years. There was adequate representation across sex, urban-rural background, psychosocial risk (psychopathology, childhood adversity and wealth index, i.e. socio-economic status). Quantile regression was used to model developmental change. Age-based trajectories were generated, along with examination of the impact of determinants (sex, childhood adversity, and wealth index). Development in both executive and social cognitive abilities continued into adulthood. Maturation and stabilization occurred in increasing order of complexity, from working memory to inhibitory control to cognitive flexibility. Age related change was more pronounced for low quantiles in response inhibition (β∼4 versus  -1 versus -0.25 for lower quantiles). Wealth index had the largest influence on developmental change across cognitive abilities. Sex differences were prominent in response inhibition, set-shifting and emotion recognition. Childhood adversity had a negative influence on cognitive development. These findings add to the limited literature on patterns and determinants of cognitive development. They have implications for understanding developmental vulnerabilities in young persons, and the need for providing conducive socio-economic environments.

Federated Analysis in COINSTAC Reveals Functional Network Connectivity and Spectral Links to Smoking and Alcohol Consumption in Nearly 2,000 Adolescent Brains

With the growth of decentralized/federated analysis approaches in neuroimaging, the opportunities to study brain disorders using data from multiple sites has grown multi-fold. One such initiative is the Neuromark, a fully automated spatially constrained independent component analysis (ICA) that is used to link brain network abnormalities among different datasets, studies, and disorders while leveraging subject-specific networks. In this study, we implement the neuromark pipeline in COINSTAC, an open-source neuroimaging framework for collaborative/decentralized analysis. Decentralized exploratory analysis of nearly 2000 resting-state functional magnetic resonance imaging datasets collected at different sites across two cohorts and co-located in different countries was performed to study the resting brain functional network connectivity changes in adolescents who smoke and consume alcohol. Results showed hypoconnectivity across the majority of networks including sensory, default mode, and subcortical domains, more for alcohol than smoking, and decreased low frequency power. These findings suggest that global reduced synchronization is associated with both tobacco and alcohol use. This proof-of-concept work demonstrates the utility and incentives associated with large-scale decentralized collaborations spanning multiple sites.

Modelling of daily radiofrequency electromagnetic field dose for a prospective adolescent cohort

INTRODUCTION

Radiofrequency electromagnetic fields originate from a variety of wireless communication sources operating near and far from the body, making it challenging to quantify daily absorbed dose. In the framework of the prospective cohort SCAMP (Study of Cognition, Adolescents and Mobile Phones), we aimed to characterize RF-EMF dose over a 2-year period.

METHODS

The SCAMP cohort included 6605 children from greater London, UK at baseline (age 12.1 years; 2014-2016) and 5194 at follow-up (age 14.2; 2016-2018). We estimated the daily dose of RF-EMF to eight tissues including the whole body and whole brain, using dosimetric algorithms for the specific absorption rate transfer into the body. We considered RF-EMF dose from 12 common usage scenarios such as mobile phone calls or data transmission. We evaluated the association between sociodemographic factors (gender, ethnicity, phone ownership and socio-economic status), and the dose change between baseline and follow-up.

RESULTS

Whole body dose was estimated at an average of 170 mJ/kg/day at baseline and 178 mJ/kg/day at follow-up. Among the eight tissues considered, the right temporal lobe received the highest daily dose (baseline 1150 mJ/kg/day, follow-up 1520 mJ/kg/day). Estimated daily dose [mJ/kg/day] increased between baseline and follow-up for head and brain related tissues, but remained stable for the whole body and heart. Doses estimated at baseline and follow-up showed low correlation among the 3384 children who completed both assessments. Asian ethnicity (compared to white) and owning a bar phone or no phone (as opposed to a smartphone) were associated with lower estimated whole-body and whole-brain RF-EMF dose, while black ethnicity, a moderate/low socio-economic status (compared to high), and increasing age (at baseline) were associated with higher estimated RF-EMF dose.

CONCLUSION

This study describes the first longitudinal exposure assessment for children in a critical period of development. Dose estimations will be used in further epidemiological analyses for the SCAMP study.

Percutaneous interventions in Fontan circulation

Background

In light of increased survival of patients with Fontan circulation, percutaneous interventions in these patients have become growingly significant in the recent years. Percutaneous treatments in patients with univentricular physiology can optimize the short term hemodynamics in these patients. However, information on long term outcomes is scarce.

Purpose

To present the cumulative work experience in percutaneous interventions of a tertiary center in the past 12 years in patients that have undergone total cavopulmonary deviation (TCD) and to investigate long term outcomes.

Methods

In this retrospective study, all patients with TCD that underwent follow-up in our specialized department of congenital heart disease in the past 12 years, were eligible for chart-review. Cardiac catheterization was performed by experienced interventional cardiologists, specialized in structural interventions in congenital heart disease. All catheterizations were performed under general anesthesia and mechanical ventilation. All patients underwent Fontan pressure measurements and cardiac output estimation with Fick method.

Results

A total of 80 patients, with a mean follow-up time of 24 (±7.1) years, were included in the study. Details on baseline characteristics are depicted in Table 1. Fifty-two (65%) patients underwent percutaneous intervention during follow-up, and 33% (n=17) of these patients required multiple interventions. Angioplasty with stent implantation of the Fontan conduit or the pulmonary arteries was the most common intervention (30 (58%) and 8 (15%) patients, respectively), followed by embolization of collaterals (11 (21%) patients). Patients with right systemic ventricle physiology needed more interventions and had a shorter time-to-first-intervention period. (Figure 1) Pacemaker implantation was required in a total of 15 patients, being significantly more frequent in patients with atriopulmonary connection than in patients with lateral tunnel or extracardiac conduit (11 (36%) vs 4 (11%), p&lt;0.01). Overall long-term outcome (with regards to mortality) was good (4 (0.5%) patients). Patients that required percutaneous structural interventions showed a tendency towards a higher mortality than those not in need of intervention (4 (8%) vs 0 (0%), respectively, p=0.14).

Conclusions

During long-term follow-up of patients with Fontan circulation, almost two thirds of the patients required percutaneous intervention. Patients with right systemic ventricle physiology were in greater need of intervention. Patients that required intervention had a tendency towards a worse clinical outcome.

Funding Acknowledgement

Type of funding sources: None.

Comparison of mitral regurgitant volume assessment between proximal flow convergence and volumetric methods in patients with significant primary mitral regurgitation

Funding Acknowledgements

Type of funding sources: None.

Background. Discrepancies have been observed between transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (MRI) severity grading in primary mitral regurgitation (MR).

Purpose. To compare mitral regurgitant volume (RV) obtained by the proximal flow convergence method (PISA) method by TTE and by volumetric methods (TTE and MRI), and study the relationship between LV size and RV obtained by either the PISA or volumetric methods.

Methods and results. 188 patients from 2 heart valve clinics with at least moderate-to-severe primary MR due to prolapse in sinus rhythm who underwent evaluation with TTE and MRI were included. RV was estimated by either PISA or volumetric methods (Left ventricular [LV] stroke volume minus systolic aortic outflow volume)) by either MRI (MRI-RV) or TTE (TTE-RV)). PISA-RV and either MRI-RV or TTE-RV weakly correlated (r = 0.29 and 0.30,p &lt; 0.001). On multivariable analysis, LV end-diastolic volume (LVEDV) and bileaflet prolapse independently correlated with the magnitude of the difference between PISA and volumetric methods. While PISA-RV and LVEDV were unrelated, MRI-RV and TTE-RV strongly correlated with LVEDV (r = 0.66 and 0.68,p &lt; 0.001). In contrast, LVEDV and regurgitant fraction (RF = RV/LVEDV) either with TTE or MRI were poorly related (r = 0.17,p = 0.02 and r = 0.12,p = 0.10).

Conclusion. RV estimated by the PISA and volumetric methods are not comparable. The expected proportional relationship between volumetric RV and LV size, which is not observed with PISA-RV suggests the inaccuracy of PISA-RV. Given that RV by volumetric methods depends on LV size, determination of a unique RV threshold for severe MR is challenging. Calculation of RF may overcome this limitation. Abstract Figure. RV assessed by PISA or volumetric method  Abstract Figure. Illustrative example

The effects of radiofrequency exposure on male fertility and adverse reproductive outcomes: A protocol for two systematic reviews of human observational studies with meta-analysis

BACKGROUND

The World Health Organization (WHO) is bringing together evidence on radiofrequency electromagnetic field (RF-EMF) exposure in relation to health outcomes, previously identified as priorities for evaluation by experts in the field, to inform exposure guidelines. A suite of systematic reviews are being undertaken by a network of topic experts and methodologists in order to collect, assess and synthesise data relevant to these guidelines. Here, we present the protocol for the systematic review on the effect of exposure to RF on adverse reproductive outcomes (human observational studies), also referred to as Systematic Review (SR) 3 within the series of systematic reviews currently being commissioned.

OBJECTIVES

Following the WHO handbook for guideline development and the COSTER conduct guidelines, we will systematically review the effect of RF-EMF exposure on both male fertility (SR3A) and adverse pregnancy outcomes (SR3B) in human observational studies. Herein we adhere to the PRISMA-P reporting guidelines.

DATA SOURCES

We will conduct a broad search for potentially relevant records relevant for both reviews within the following bibliographic databases: MEDLINE; Embase; and EMF Portal. We will also conduct searches of grey literature through relevant databases and organisational websites. RF-EMF experts will also be consulted. We will hand search citation and reference lists of included study records.

STUDY ELIGIBILITY CRITERIA

We will include quantitative human observational studies on the effect of RF-EMF exposure: (in SR3A) in adult male participants on infertility, sperm morphology, concentration or total sperm count or motility; and (in SR3B) in preconception adults or pregnant women on preterm birth, small for gestational age (associated with intrauterine growth restriction), miscarriage, stillbirth and congenital anomalies.

STUDY APPRAISAL AND SYNTHESIS METHODS

Titles, abstracts and then full texts will be screened in blinded duplicate against eligibility criteria with input from a third reviewer as required. Data extraction from included studies will be completed by two reviewers as will risk of bias assessment using the Office of Health Assessment and Translation (OHAT) tool. If appropriate we will undertake meta-analysis to pool effect measures and explore heterogeneity using sub-group analyses or meta-regression as feasible. We will conduct sensitivity analysis to assess the impact of any assumptions made throughout the review process. The OHAT methodology, based on the GRADE guidelines for evidence assessment, will be used to evaluate the certainty of evidence per outcome and to conclude the level of evidence of a health effect.

CONCLUSION

This manuscript details the protocols for two systematic reviews. The aims of publishing details of both protocols are to: pre-specify their scope and methods; reduce the impact of reviewer bias; promote transparency and replicability; and improve the review process.

PROSPERO REGISTRATION

CRD42021265401 (SR3A), CRD42021266268 (SR3B).

Digital Technology Use and Body Mass Index: Evidence From Cross-sectional Analysis of an Adolescent Cohort Study (Preprint)

Background

Objective

Methods

Results

Conclusions

Doxycycline-functionalized polymeric nanoparticles inhibit Enterococcus faecalis biofilm formation on dentine

AIM

To evaluate in a laboratory setting the antimicrobial properties and the potential to inhibit biofilm formation of novel remineralizing polymeric nanoparticles (NPs) when applied to dentine surfaces and to ascertain the effect of the functionalization of these NPs with zinc, calcium or doxycycline.

METHODOLOGY

The antimicrobial activity and inhibition of biofilm formation of polymeric NPs were analysed on human dentine blocks that were infected with Enterococcus faecalis before or after application of NPs. LIVE/DEAD ® testing under Confocal Laser Scanning Microscopy and bacterial culturing were employed to analyse biofilm biovolume and bacterial viability. Field Emission Scanning Electron Microscopy was also employed to assess biofilm morphology. One-way anova with Welch's correction and post hoc comparison by the Games-Howell test were performed for comparisons between groups.

RESULTS

The un-functionalized NPs displayed the greatest antimicrobial activity against E. faecalis biofilms as they provided the lowest biovolume (3865.7 ± 2926.97 µm³ ; P < 0.001) and the highest dead/injured cells percentage (79.93 ± 18.40%; P < 0.001), followed by Dox-NPs (biovolume: 19,041.55 ± 17,638.23 µm³ , dead/injured cells: 45.53 ± 26.50%; P < 0.001). Doxycycline-loaded NPs had the largest values of inhibition of biofilm formation with the lowest biofilm biovolume (8517.65 ± 7055.81 µm³ ; P < 0.001) and a high dead/injured bacterial percentage (68.68 ± 12.50%; P < 0.001). Un-functionalized NPs did not reduce biomass growth (P > 0.05), but attained the largest percentage of compromised cells (93 ± 8.23%; P < 0.001), being able to disrupt biofilm formation. It also produced occlusion of dentinal tubules, potentially interfering with bacterial tubule penetration.

CONCLUSIONS

A new generation of bioactive nano-fillers (doxycycline-functionalized polymeric NPs) had antibacterial activity and occluded dentinal tubules. Incorporating these NPs into endodontic sealers may have the potential to enhance the outcome of root canal treatment.

Antimicrobial effect of nanostructured membranes for guided tissue regeneration: an in vitro study

OBJECTIVE

The purpose of this in vitro study was to evaluate the antibacterial effect of a novel non-resorbable, bioactive polymeric nanostructured membrane (NMs), when doped with zinc, calcium and doxycycline.

METHODS

A validated in vitro subgingival biofilm model with six bacterial species (Streptococcus oralis, Actinomyces naeslundii, Veillonela parvula, Fusobacterium nucleatum, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans) was used. The experimental NMs, with and without being doped with doxycycline, calcium and zinc, were placed on hydroxyapatite (HA) discs. As positive control membranes, commercially available dense polytetrafluoroethylene (d-PTFE) membranes were used and, as negative controls, the HA discs without any membrane. The experimental, positive and negative control discs were exposed to a mixed bacterial suspension, at 37 °C under anaerobic conditions, during 12, 24, 48 and 72 h. The resulting biofilms were analyzed through scanning electron microscopy (SEM), to study their structure, and by quantitative polymerase chain reaction (qPCR), to assess the bacterial load, expressed as colony forming units (CFU) per mL. Differences between experimental and control groups were evaluated with the general linear model and the Bonferroni adjustment.

RESULTS

As shown by SEM, all membrane groups, except the NMs with doxycycline, resulted in structured biofilms from 12-72 hours. Similarly, only the membranes loaded with doxycycline demonstrated a significant reduction in bacterial load during biofilm development, when compared with the control groups (p < 0.001).

SIGNIFICANCE

Doxycycline-doped nanostructured membranes have an impact on biofilm growth dynamics by significant reducing the bacterial load.

The Consortium on Vulnerability to Externalizing Disorders and Addictions (c-VEDA): an accelerated longitudinal cohort of children and adolescents in India

The global burden of disease attributable to externalizing disorders such as alcohol misuse calls urgently for effective prevention and intervention. As our current knowledge is mainly derived from high-income countries such in Europe and North-America, it is difficult to address the wider socio-cultural, psychosocial context, and genetic factors in which risk and resilience are embedded in low- and medium-income countries. c-VEDA was established as the first and largest India-based multi-site cohort investigating the vulnerabilities for the development of externalizing disorders, addictions, and other mental health problems. Using a harmonised data collection plan coordinated with multiple cohorts in China, USA, and Europe, baseline data were collected from seven study sites between November 2016 and May 2019. Nine thousand and ten participants between the ages of 6 and 23 were assessed during this time, amongst which 1278 participants underwent more intensive assessments including MRI scans. Both waves of follow-ups have started according to the accelerated cohort structure with planned missingness design. Here, we present descriptive statistics on several key domains of assessments, and the full baseline dataset will be made accessible for researchers outside the consortium in September 2019. More details can be found on our website [cveda.org].

Small-area methods for investigation of environment and health

Small-area studies offer a powerful epidemiological approach to study disease patterns at the population level and assess health risks posed by environmental pollutants. They involve a public health investigation on a geographical scale (e.g. neighbourhood) with overlay of health, environmental, demographic and potential confounder data. Recent methodological advances, including Bayesian approaches, combined with fast-growing computational capabilities, permit more informative analyses than previously possible, including the incorporation of data at different scales, from satellites to individual-level survey information. Better data availability has widened the scope and utility of small-area studies, but has also led to greater complexity, including choice of optimal study area size and extent, duration of study periods, range of covariates and confounders to be considered and dealing with uncertainty. The availability of data from large, well-phenotyped cohorts such as UK Biobank enables the use of mixed-level study designs and the triangulation of evidence on environmental risks from small-area and individual-level studies, therefore improving causal inference, including use of linked biomarker and -omics data. As a result, there are now improved opportunities to investigate the impacts of environmental risk factors on human health, particularly for the surveillance and prevention of non-communicable diseases.

Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA): A developmental cohort study protocol

BACKGROUND

Low and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectories and vulnerability to psychopathology, with a focus on externalizing disorders.

METHODS

cVEDA is a longitudinal cohort study, with planned missingness design for yearly follow-up. Participants have been recruited from multi-site tertiary care mental health settings, local communities, schools and colleges. 10,000 individuals between 6 and 23 years of age, of all genders, representing five geographically, ethnically, and socio-culturally distinct regions in India, and exposures to variations in early life adversity (psychosocial, nutritional, toxic exposures, slum-habitats, socio-political conflicts, urban/rural living, mental illness in the family) have been assessed using age-appropriate instruments to capture socio-demographic information, temperament, environmental exposures, parenting, psychiatric morbidity, and neuropsychological functioning. Blood/saliva and urine samples have been collected for genetic, epigenetic and toxicological (heavy metals, volatile organic compounds) studies. Structural (T1, T2, DTI) and functional (resting state fMRI) MRI brain scans have been performed on approximately 15% of the individuals. All data and biological samples are maintained in a databank and biobank, respectively.

DISCUSSION

The cVEDA has established the largest neurodevelopmental database in India, comparable to global datasets, with detailed environmental characterization. This should permit identification of environmental and genetic vulnerabilities to psychopathology within a developmental framework. Neuroimaging and neuropsychological data from this study are already yielding insights on brain growth and maturation patterns.

P3696Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: an echocardiographic and computed tomography study

Background

Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS).

Purpose

To identify the determinants associated with increased AT/ET.

Methods

The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were studied in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (EF), with Computed Tomography – Aortic Valve Calcium (CT-AVC) score studied in a subgroup of 342 patients.

Results

In univariate analysis, AT/ET ratio did correlate with aortic peak velocity (Vmax, r=0.57, p<0.0001), mean pressure gradient (MPG, r=0.60, p<0.0001), aortic valve area (AVA, r=−0.50, p<0.0001) and CT-AVC score (r=0.24, p<0.0001). An AT/ET ratio had a good accuracy to predict an aortic peak velocity ≥4 m/s, a MPG≥40 mmHg, or an AVA≤1.0 cm2, with an optimal cut-off value of 0.34. By multivariate linear regression analysis, presence of AS-related symptoms, decreased LV stroke volume index, LVEF, systolic blood pressure (SBP), absence of diabetes mellitus, and increased LV mass index, relative wall thickness, and Vmax were independently associated with increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC, CT-AVC score was independently associated with increased AT/ET ratio (P<0.05).

Conclusion

AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond hemodynamic and anatomic severity of AS influence AT/ET ratio including LV geometry, function and SBP. These findings should be considered when assessing AT/ET in patients with AS and preserved LVEF.

Acknowledgement/Funding

Local funding

Silver-loaded nanoparticles affect ex-vivo mechanical behavior and mineralization of dentin

Background

The aim was to evaluate the effect of silver loaded nanoparticles (NPs) application on the triboscopic, crystallographic and viscoelastic properties of demineralized dentin. Polymethylmetacrylate-based NPs and Ag loaded NPs were applied on demineralized dentin.

Material and Methods

Treated and untreated surfaces were probed by a nanoindenter to test viscoelasticity, and by atomic force microscopy to test nanoroughness and collagen fibril diameter. X-ray diffraction and transmission electron microscopy through selected area diffraction and bright-field imaging were also used.

Results

Dentin treated with Ag-NPs attained the lowest complex modulus, and the highest tan delta values after 7 days of storage. Dentin treated with undoped-NPs achieved the lowest nanoroughness and the greatest collagen bandwidths among groups. Crystals were identified as hydroxyapatite with the highest crystallographic maturity and crystallite size in dentin treated with undoped-NPs. Texture increased in all samples from 24 h to 7 d, except in dentin surfaces treated with Ag-NPs at 310 plane. Polyhedral, block-like, hexagonal or plate-like shaped apatite crystals constituted the bulk of minerals in dentin treated with Ag-NPs, after 7 d. Polyhedral or rounded/drop-like, and polymorphic in strata crystal apatite characterized the minerals when undoped-NPs were used, with more crystalline characteristics after 7 d than that found when Ag-NPs were applied. Ag-NPs application did not improve the mechanical performance of dentin and did not produce dentin remineralization. However, energy was dissipated through the dentin without showing stress concentration; contrary was occurring at dentin treated with undoped-NPs, that provoked bridge-like mineral deposits at the dentin surface.

Conclusions

Ag-NPs application did not enhance the mechanical properties of cervical dentin, though the energy dissipation did not damage the dentin structure. Remineralization at dentin was not produced after Ag-NPs application, though improved crystallinity may lead to increase stability of the apatite that was generated at the dentin surface.

Key words:Dentin, mechanical, mineralization, roughness, silver, viscoelastic.

Antibacterial effects of polymeric PolymP-n Active nanoparticles. An in vitro biofilm study

OBJECTIVE

to study the antibacterial effect of polymeric PolymP-n Active nanoparticles using an in vitro subgingival biofilm model.

METHODS

Hydroxyapatite discs coated with five modalities of nanoparticles (NPs): NPs, NPs doped with zinc, calcium, silver and doxycycline, PBS as control, and Streptococcus oralis, Actinomyces naeslundii, Veillonella parvula, Fusobacterium nucleatum, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were studied in a static in vitro biofilm model (12, 24, 48, and 72h). Nano-roughness of the different disc surfaces (SRa, in nm) and morphological characteristic of the biofilms (thickness (μm) and bacterial viability) were studied by different microscopy modalities. Quantitative Polymerase Chain Reaction was used to assess the effect of the nanoparticles on the bacterial load (colony forming unit per milliliter) (CFUmL^-1). Analysis of variance and post-hoc testing with T3 Dunnett́s, and Student Newman Keuls correction was used. Results were considered statistically significant at p<0.05.

RESULTS

Surfaces containing the different nanoparticles showed significant increments in roughness when compared to controls (p<0.05). A similar biofilm formation and dynamics was observed, although reductions in bacterial viability were detected in biofilms in contact with the different nanoparticles, more pronounced with silver and doxycycline NPs. Doxycycline-NPs biofilms resulted in unstructured biofilm formation and significantly lower number of the six species when compared with the other nanoparticles specimens and controls (p<0.001 in all cases).

SIGNIFICANCE

Polymeric PolymP-n Active nanoparticles when combined with silver and doxycycline showed a significant antibacterial effect when tested in an in vitro subgingival biofilm model.

A zinc-doped endodontic cement facilitates functional mineralization and stress dissipation at the dentin surface

BACKGROUND

The purpose of this study was to evaluate nanohardness and viscoelastic behavior of dentin surfaces treated with two canal sealer cements for dentin remineralization.

MATERIAL AND METHODS

Dentin surfaces were subjected to: i) 37% phosphoric acid (PA) or ii) 0.5 M ethylenediaminetetraacetic acid (EDTA) conditioning prior to the application of two experimental hydroxyapatite-based cements, containing sodium hydroxide (calcypatite) or zinc oxide (oxipatite), respectively. Samples were stored in simulated body fluid during 24 h or 21 d. The intertubular and peritubular dentin were evaluated using a nanoindenter to assess nanohardness (Hi). The load/displacement responses were used for the nano-dynamic mechanical analysis to estimate complex modulus (E*) and tan delta (δ). The modulus mapping was obtained by imposing a quasistatic force setpoint to which a sinusoidal force was superimposed. AFM imaging and FESEM analysis were performed.

RESULTS

After 21 d of storage, dentin surfaces treated with EDTA+calcypatite, PA+calcypatite and EDTA+oxipatite showed viscoelastic discrepancies between peritubular and intertubular dentin, meaning a risk for cracking and breakdown of the surface. At both 24 h and 21 d, tan δ values at intertubular dentin treated with the four treatments performed similar. At 21 d time point, intertubular dentin treated with PA+oxipatite achieved the highest complex modulus and nanohardness, i.e., highest resistance to deformation and functional mineralization, among groups.

CONCLUSIONS

Intertubular and peritubular dentin treated with PA+oxipatite showed similar values of tan δ after 21 d of storage. This produced a favorable dissipation of energy with minimal energy concentration, preserving the structural integrity at the dentin surface.

Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse

BACKGROUND

Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP.

METHODS

Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed.

RESULTS

The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%.

CONCLUSIONS

Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.

Ion-modified nanoparticles induce different apatite formation in cervical dentine

AIM

To investigate if crystallinity and ultrastructure are modified when cervical dentine is treated with four different nanogels-based solutions for remineralizing purposes.

METHODOLOGY

Experimental nanogels based on polymeric nanoparticles (NPs) and zinc, calcium or doxycycline-loaded NPs were applied to citric acid etched dentine to facilitate the occlusion of tubules and the mineralization of the dentine surface. Dentine surfaces were studied by X-ray diffraction and transmission electron microscopy through selected area diffraction and bright-field imaging.

RESULTS

Crystals at the dentine surface were identified as hydroxyapatite with the highest crystallographic maturity and crystallite size in dentine treated with Zn-NPs-based gel. Texture increased in all samples from 24 h to 7 days, except in dentine surfaces treated with Zn-NPs gel. Polyhedral, plate-like and drop-like shaped apatite crystals constituted the bulk of minerals in dentine treated with Zn-NPs gel, after 7 days. Polymorphic, cubic and needle-like shaped crystals distinguished minerals, with more amorphous characteristics in dentine treated with Ca-NPs gel after 7 days than that found when Zn-NPs were applied. Doxycycline-NPs produced the smallest crystallites with poor crystallinity, maturity and chemical stability.

CONCLUSIONS

Crystalline and amorphous phases of newly formed hydroxyapatite were described in both types of dentine treated with Zn-NPs as well as Ca-NPs gels with multiple shapes of crystallites. Crystal shapes ranged from rounded/drop-like or plate-like crystals to needle-like or polyhedral and cubic apatite appearance.

Bonding to Er-YAG-laser-treated Dentin

Er-YAG laser irradiation has been claimed to improve the adhesive properties of dentin. We tested the hypothesis that dentin adhesion is affected by Er-YAG laser conditioning. Superficial or deep dentin from human molars was: (a) acid-etched with 35% H3PO4; (b) irradiated with an Er-YAG laser (KaVo) at 2 Hz and 180 mJ, with water-cooling; and (c) laser- and acid-etched. Single Bond (3M ESPE) and Z100 composite (3M ESPE) were bonded to the prepared surfaces. After storage, specimens were tested in shear to failure. Bonded interfaces were demineralized in EDTA and processed for transmission electron microscopy. Two-way ANOVA revealed that conditioning treatment and interaction between treatment and dentin depth significantly influenced shear bond strength results. Acid-etching alone yielded shear bond strength values that were significantly higher than those achieved with laser ablation alone, or in combination with acid-etching. The Er-YAG laser created a laser-modified layer that adversely affects adhesion to dentin, so it does not constitute an alternative bonding strategy to conventional acid etching.

Posterior reversible encephalopathy in the intensive care unit

Posterior reversible encephalopathy syndrome (PRES) is increasingly diagnosed in the emergency department, and medical and surgical intensive care units. PRES is characterized by acute onset of neurologic symptoms in the setting of blood pressure fluctuations, eclampsia, autoimmune disease, transplantation, renal failure, or exposure to immunosuppressive or cytotoxic drugs, triggers known to admit patients to the intensive care unit (ICU). Although the exact pathophysiology remains unknown, there is growing consensus that PRES results from endothelial dysfunction. Because of the heterogeneous nature of the disorder, it is probable that different mechanisms of endothelial injury are etiologically important in different clinical situations. The presence of bilateral vasogenic edema on brain imaging, particularly in parieto-occipital regions, is of great diagnostic utility but PRES remains a clinical diagnosis. Although largely reversible, PRES can result in irreversible neurologic injury and even death. The range of clinical and radiographic manifestations of the syndrome is probably broader than previously thought, and it is imperative that clinicians become familiar with the full spectrum of the disorder, as prompt recognition and elimination of an inciting factor improve outcome. PRES may be the most frequent toxic-metabolic encephalopathy seen in the ICU.

Polymer nanocarriers for dentin adhesion

To obtain more durable adhesion to dentin, and to protect collagen fibrils of the dentin matrix from degradation, calcium- and phosphate-releasing particles have been incorporated into the dental adhesive procedure. The aim of the present study was to incorporate zinc-loaded polymeric nanocarriers into a dental adhesive system to facilitate inhibition of matrix metalloproteinases (MMPs)-mediated collagen degradation and to provide calcium ions for mineral deposition within the resin-dentin bonded interface. PolymP- N : Active nanoparticles (nanoMyP) were zinc-loaded through 30-minute ZnCl2 immersion and tested for bioactivity by means of 7 days' immersion in simulated body fluid solution (the Kokubo test). Zinc-loading and calcium phosphate depositions were examined by scanning and transmission electron microscopy, elemental analysis, and x-ray diffraction. Nanoparticles in ethanol solution infiltrated into phosphoric-acid-etched human dentin and Single Bond (3M/ESPE) were applied to determine whether the nanoparticles interfered with bonding. Debonded sticks were analyzed by scanning electron microscopy. A metalloproteinase collagen degradation assay was also performed in resin-infiltrated dentin with and without nanoparticles, measuring C-terminal telopeptide of type I collagen (ICTP) concentration in supernatants, after 4 wk of immersion in artificial saliva. Numerical data were analyzed by analysis of variance (ANOVA) and Student-Newman-Keuls multiple comparisons tests (p < .05). Nanoparticles were effectively zinc-loaded and were shown to have a chelating effect, retaining calcium regardless of zinc incorporation. Nanoparticles failed to infiltrate demineralized intertubular dentin and remained on top of the hybrid layer, without altering bond strength. Calcium and phosphorus were found covering nanoparticles at the hybrid layer, after 24 h. Nanoparticle application in etched dentin also reduced MMP-mediated collagen degradation. Tested nanoparticles may be incorporated into dental adhesive systems to provide the appropriate environment in which dentin MMP collagen degradation is inhibited and mineral growth can occur.

Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy

OBJECTIVE

To evaluate a trial of immunotherapy as an aid to diagnosis in suspected autoimmune epilepsy.

METHOD

We reviewed the charts of 110 patients seen at our autoimmune neurology clinic with seizures as a chief complaint. Twenty-nine patients met the following inclusion criteria: (1) autoimmune epilepsy suspected based on the presence of ≥ 1 neural autoantibody (n = 23), personal or family history or physical stigmata of autoimmunity, and frequent or medically intractable seizures; and (2) initiated a 6- to 12-week trial of IV methylprednisolone (IVMP), IV immune globulin (IVIg), or both. Patients were defined as responders if there was a 50% or greater reduction in seizure frequency.

RESULTS

Eighteen patients (62%) responded, of whom 10 (34%) became seizure-free; 52% improved with the first agent. Of those receiving a second agent after not responding to the first, 43% improved. A favorable response correlated with shorter interval between symptom onset and treatment initiation (median 9.5 vs 22 months; p = 0.048). Responders included 14/16 (87.5%) patients with antibodies to plasma membrane antigens, 2/6 (33%) patients seropositive for glutamic acid decarboxylase 65 antibodies, and 2/6 (33%) patients without detectable antibodies. Of 13 responders followed for more than 6 months after initiating long-term oral immunosuppression, response was sustained in 11 (85%).

CONCLUSIONS

These retrospective findings justify consideration of a trial of immunotherapy in patients with suspected autoimmune epilepsy.

CLASSIFICATION OF EVIDENCE

This study provides Class IV evidence that in patients with suspected autoimmune epilepsy, IVMP, IVIg, or both improve seizure control.

Setting research priorities for preconception care in low- and middle-income countries: aiming to reduce maternal and child mortality and morbidity

Sohni Dean and colleagues report their CHNRI exercise that developed health research priorities for effective pre-conception care in low- and middle-income countries. Please see later in the article for the Editors' Summary

Computed tomography of the parathyroids: the value of density measurements to distinguish between parathyroid adenomas of the lymph nodes and the thyroid parenchyma

PURPOSE

To compare the densities of parathyroid adenomas, lymph nodes and the thyroid parenchyma during multi-phase cervico-thoracic computed tomography to determine the differentiating threshold values.

MATERIALS AND METHODS

This study comprises 30 patients operated for a parathyroid adenoma after computed tomography without injection and then 45 and 70 seconds after the injection of an iodine based contrast product (350 mgI/mL, 150 mL, 3 mL/s). The density of the adenomas, lymph nodes and thyroid was measured during the three phases (D0, D45, D70). The relative enhancement (RE) at 45 seconds was calculated: RE=(D45-D0)/D0.

RESULTS

A significant difference was found in the spontaneous density of the parathyroid adenomas of the thyroid (P<0.01) with a threshold value of 75 HU. A significant difference is found in the enhancement after injection of the adenomas and lymph nodes (P<0.01). The adenomas present an enhancement peak at 45 seconds while the maximum enhancement of the lymph nodes is at 70 seconds. At 45 seconds, a threshold value of 114 HU and an RE 125% allows them to be distinguished (sensitivity and specificity 0.96).

CONCLUSION

Measurement of the densities can differentiate between the parathyroid adenomas, lymph nodes and thyroid.

[Cancer, fertility preservation and gonadotropins]

The recent emergence of oncofertility raises the question of ovarian stimulation and its risks when performed for oocyte or/and embryo cryopreservation in a fertility preservation program. The relation between ovarian stimulation and cancer has been marked by the possible direct or indirect tumorigenic role for pituitary gonadotrophins in the tumorogenesis. Although the growth of many gonadal and extragonadal tumors is stimulated by gonadal sex hormones, whose production is regulated by gonadotrophins, there is still a lack of data to consider FSH and LH as tumor promoters. The purpose of this brief review is to present on one hand, the questions raised by the administration of exogenous gonadotrophins in cancer patients and on the other, to evaluate both experimental and clinical data about the possible relation between gonadotrophins and tumorogenesis.

[Characteristics of human immunodeficiency virus-1 infected children receiving highly active antiretroviral therapy: a cross-sectional study]

INTRODUCTION

Since 1996, when HAART became available, there has been a change in the course of HIV-infection, leading it to become a chronic disease. Our aim was to describe the characteristics of the children followed up in our hospital.

PATIENTS AND METHODS

A cross-sectional study was conducted on 32 HIV-infected children followed up until December-2010, at the University-Hospital de Getafe. Clinical and laboratory information from the last visit was collected for the evaluation of patients.

RESULTS

Thirty-two children with HIV-1 were evaluated, 29 infected through vertical-transmission. The median age was 14 years. According to the CDC classification, 56% (18/32) of children were in category A, 28% (9/32) B and 16% (5/32) C. Immunological class was 3 in 75% of children, class 2 in 9% and class 1 in 16%. The median nadir of CD4 was 337 cells/ml (12%). The median current CD4 was 749 (31%). Only one adolescent had a CD4% below 200 cells/ml due to lack of adherence. Twenty-eight patients (87%) were receiving HAART, and 4 patients were off antiretroviral treatment. Among the patients treated, 26 (93%) had viral loads <200 copies/ml. The median viral-load was<20 copies/ml. Median time on antiretroviral treatment was 10 years. The combination more frequently used was two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI), that was given to 15 patients (47%), followed by 2 NRTI, and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in 8 patients (29%). Two children received rescue therapy including raltegravir, one with tipranavir and the other with darunavir. A total of 12 patients (43%) received medication once a day, 7 of them with fixed-dose combinations in a single tablet (25%). There were metabolic complications, including hyperlipidaemia or lipodystrophy were observed in 17 children (53%).

CONCLUSIONS

Most of our patients are receiving HAART, with good virological and immunological control. The prevalence of metabolic abnormalities was high. Strategies to improve adherence and decrease toxicities are needed in perinatally-acquired HIV-infected children.