Search

BACKGROUND: Major congenital heart diseases (CHD) often demand intervention in the neonatal period. Prenatal diagnosis may improve mortality by eliminating the diagnostic delay; however, there is controversy concerning its true effect. We aimed to evaluate the effect of general prenatal screening on prognosis by comparing a period without general prenatal screening to a period with general prenatal screening.METHODS: We conducted a nationwide retrospective study including live born children and terminated fetuses diagnosed with major CHD. Prenatal screening was recommended only in high risk pregnancies between 1996 and 2004, whereas general prenatal screening was recommended between 2005 and 2013. We assessed the influence of general prenatal screening on all-cause mortality, cardiac death, preoperative and postoperative 30-day mortality and complication rate.RESULTS: 1-year mortality decreased over both periods, but the decrease was greater in the screening period (Odds ratio 0.92 (CI 0.83-1.00), p = 0.047). Prenatal detection of major CHD was associated with cardiac death in the period without general screening (Hazard Ratio 2.40 (CI 1.72-3.33), p CONCLUSION: Mortality in major CHD decreased throughout the study, especially in the period with general prenatal screening. However, comparing a prenatally diagnosed group with a postnatally diagnosed group is vulnerable to selection bias and proper interpretation is difficult.

BACKGROUND AND PURPOSE: In this pilot study, we investigated functional brain activation changes in patients with Crohn’s disease (CD) in remission compared to age and gender matched healthy controls (HCs). METHODS: Data from 20 patients with CD in remission (age range 19 to 63 years) and 20 HCs (matched in age and gender) were analyzed. Task fMRI data was collected while participants performed a cognitive (phonemic verbal fluency) task in the scanner. All participants also performed the same task outside the scanner. RESULTS: Task fMRI results showed greater bi-hemispheric activation in CD patients compared to controls. Because this pattern is commonly reported with normal aging, we performed further analyses to investigate fMRI responses in a sub-set of the younger CD patients (N=12, age < = 35 years) compared to matched young HCs (age < = 35 years), and an older cohort of HCs (age > =50 years). Results showed that task activation patterns were similar between young CD patients and older HCs, and that both groups differed significantly from younger HCs. Activation intensity in specific brain regions for patients was associated with disease duration. CONCLUSIONS: These results suggest that Crohn’s disease patients in remission may show accelerated signs of aging in terms of brain responses to a typical cognitive task. Future work with larger sample size will need to replicate these results as well as investigate influence of factors such as chronicity of the disease and medication effects on task associated brain activation patterns in this patient population.

Previous studies have found neural alterations in regions involved in cognitive and affective functions among Crohn’s disease (CD) patients. The present work recruited 18 CD patients and 18 age-gender matched healthy controls (HC) and specifically compared differences in resting-state functional connectivity (RSFC) within the executive control network (ECN) which has been implicated in cognitive function and default mode network (DMN), which has been implicated in affective function. Additionally, we examined the correlations between RSFC in ECN and verbal fluency (VF) in both groups as well as RSFC in DMN and anxiety level in the CD group. Results showed significantly increased RSFC between the right middle frontal gyrus and right inferior parietal lobule in ECN, as well as increased RSFC between the right precuneus and right posterior cingulate cortex in DMN, among CD patients compared to HC. However, the correlations between ECN/DMN and behavioral scores in each group were not significant, which was possibility due to the limited sample size. These findings suggest that CD patients may experience changes in the connectivity patterns in ECN and DMN. Increased connectivity observed on these networks could be a potential biomarker of a neuropsychiatric manifestation of CD.

Regular audit of results of prenatal screening for congenital heart disease (CHD) is crucial to ensure reliable prenatal diagnosis. We aimed to assess the accuracy of prenatal diagnosis of major CHD between 1996 and 2013. During the study period, prenatal detection of major CHD improved from 4.5% to 71.0% (p

Diffusion tensor imaging (DTI) has fundamentally transformed how we interrogate diseases and disorders of the brain in neuropsychiatric illness. DTI and recently developed multicompartment diffusion-weighted imaging (MC-DWI) techniques, such as NODDI (neurite orientation dispersion and density imaging), measure diffusion anisotropy presuming a static neuroglial environment; however, microglial morphology and density are highly dynamic in psychiatric illness, and how alterations in microglial density might influence intracellular measures of diffusion anisotropy in DTI and MC-DWI brain microstructure is unknown. To address this question, DTI and MC-DWI studies of murine brains depleted of microglia were performed, revealing significant alterations in axonal integrity and fiber tractography in DTI and in commonly used MC-DWI models. With accumulating evidence of the role of microglia in neuropsychiatric illness, our findings uncover the unexpected contribution of microglia to measures of axonal integrity and structural connectivity and provide unanticipated insights into the potential influence of microglia in diffusion imaging studies of neuropsychiatric disease.

Patients with inflammatory bowel disease have been shown to have abnormal brain morphometry or function, which are associated with psychological symptoms such as stress, depression or anxiety. The present work recruited 20 Crohn’s disease patients in remission (CDs) and 20 age-gender-handedness-education matched healthy controls (HCs) and compared their brain white matter microstructural properties using Diffusion Tensor Imaging (DTI). Additionally, we examined the correlations between the microstructural properties and cognition (verbal fluency language task, VF) and affect (anxiety) in both groups as well as disease duration in CDs. Results showed that CDs exhibited significant alterations in microstructural properties compared to HCs in various white matter tracts relevant to language function despite no significant difference in VF scores. Furthermore, CDs’ microstructural changes exhibited correlations with anxiety level and disease duration. These findings suggest that CD patients may experience changes in white matter microstructural properties which may be a biomarker of neuropsychiatric comorbidities of CD.

Neurite orientation dispersion and density imaging (NODDI) is an emerging magnetic resonance (MR) diffusion weighted imaging (DWI) technique that permits non-invasive quantitative assessment of neurite density and morphology. NODDI has improved our ability to image neuronal microstructure over conventional techniques such as diffusion tensor imaging (DTI) and is particularly suited for studies of the developing brain as it can measure and characterize the dynamic changes occurring in dendrite cytoarchitecture that are critical to early brain development. Neurodevelopmental alterations to the diffusion tensor have been reported in psychiatric illness, but it remains unknown whether advanced DWI techniques such as NODDI are able to sensitively and specifically detect neurodevelopmental changes in brain microstructure beyond those provided by DTI. We show, in an extension of our previous work with a Disc1 svΔ2 rat genetic model of psychiatric illness, the enhanced sensitivity and specificity of NODDI to identify neurodevelopmental and sex-specific changes in brain microstructure that are otherwise difficult to observe with DTI and further corroborate observed changes in brain microstructure to differences in sex-specific systems-level animal behavior. Together, these findings inform the potential application and clinical translational utility of NODDI in studies of brain microstructure in psychiatric illness throughout neurodevelopment and further, the ability of advanced diffusion weighted imaging methods such as NODDI to examine the role of biological sex and its influence on brain microstructure in psychiatric illness. SIGNIFICANCE STATEMENT This research presents the first demonstration of the ability of NODDI multicompartment diffusion imaging to uncover both neurodevelopmental and sex-specific alterations in brain microstructure in psychiatric illness. We show, in a genetic Disc1 svΔ2 rat model, sex-specific neurodevelopmental patterns of neural microstructural change with NODDI and corresponding evidence of sex differences in behavioral endophenotypes of anxiety, cognition, and general activity. Together, our results support the potential impact and translational utility of NODDI to identify salient neurodevelopmental and sex-specific changes in brain microstructure in psychiatric illness beyond traditional morphometric and diffusion tensor approaches currently employed.

Introduction: Many stroke survivors are often left with persistent upper extremity motor impairment that affect their overall quality of life. This study aims to evaluate the efficacy of using non-invasive electroencephalographic (EEG) based brain-computer interface (BCI) therapy to facilitate distal upper extremity motor function. Data was acquired from 18 participants ((mean age = 60 years, F = 9, M = 9, 5 = sub-chronic (over 1 year from stroke onset), 13 = chronic (less than 1 year)). Behavioral outcomes were measured using the Modified Ashworth Scale (MAS), a Motor Activity Log (MAL), and the Stroke Impact Scale (SIS). We investigated whether severely-impaired, chronic stroke survivors could use BCI treatment to recover from stroke at a rate similar to that of severely-impaired, sub-chronic stroke survivors after BCI intervention. Methods: EEG data was acquired using BCI2000 software and 16 channel EEG cap with electrodes positioned according to the standard 10-20 system over the sensorimotor cortex at C3 & C4. Participants were cued to move either their left or right hand to control a cursor towards the right or left side of a monitor. Data acquired at baseline (no more than one week prior to BCI therapy) and post-therapy (no more than one week following BCI therapy) were used in this analyses. Results: No significant decrease in improvement in the chronic group compared to the sub-chronic group (0.95 confidence interval) was observed. The chronic group showed significant improvement in their affected arm in: MAS elbow flexion (p = 0.03746), MAS finger extension (p = 0.01896), MAL arm use (p = 0.02065), MAL how well they could use their arm (p = 0.02065), SIS perceived strength (p = 0.04105), and SIS arm use for daily life tasks (p = 0.01741). Conclusion: For chronic stroke survivors, BCI intervention for restoration of upper extremity motor function may promote recovery at a rate similar to that of sub-chronic survivors.

Background: Changes in cortical gray matter volume is associated with cognitive impairment after ischemic stroke. Here, we investigated the differences of whole brain gray matter volume and gray matter density between acute stroke patients (AS), patients with risk factors for stroke (RS), and healthy controls (HC). Methods: Patients with acute stroke (N = 65, ischemic stroke within 8 days of stroke onset, mean age = 60.64 years, SD = 12.24, SEM = 1.71), patients with risk factors for stroke (N = 27, mean age = 64.12 years, SD = 11.96, SEM = 2.30) and age-matched healthy controls (N = 57, mean age = 58.05 years, SD = 6.06, SEM = 0.80) were scanned on a GE 3T MRI scanner. High-resolution 3D T1-weighted whole brain BRAVO FSPGR images were collected: repetition time = 8160 ms, echo time = 3.18 ms, flip angle = 12°, field-of-view = 100 х 100 mm, slice thickness = 1 mm. Gray matter volume and density changes were assessed using VBM8 toolbox and SPM8, with Gaussian Random Field as multiple comparison (voxel p < .001, cluster p < .05). Results: Two sample t-test indicated that: (1) AS had significantly decreased gray matter volume compared to RS (only on the postcentral gyrus) and HC (in sub-regions of frontal, temporal, occipital lobes, sub-lobar, cerebellum); (2) AS also had significantly decreased gray matter density compared to RS (in sub-regions of frontal, temporal, parietal, occipital lobes, limbic lobe) and to HC (in sub-regions of frontal, temporal, occipital lobes, sub-lobar, limbic lobe, cerebellum) but except two regions with increased density compared to HC (anterior and posterior cingulum). (3) RS had both significantly decreased gray matter volume and density compared to HC (in sub-regions of frontal, temporal, occipital lobes, sub-lobar, cerebellum). Conclusion: Compared to RS and HC, AS may induce changes in both gray matter volume and density, which result in subsequent cognitive impairments such as language or working memory. Significant changes in RS indicate that brain and associated behavioral changes in this population merits further investigation before progression to stroke.

Loss of motor function is a common deficit following stroke insult and often manifests as persistent upper extremity (UE) disability which can affect a survivor's ability to participate in activities of daily living. Recent research suggests the use of brain-computer interface (BCI) devices might improve UE function in stroke survivors at various times since stroke. This randomized crossover-controlled trial examines whether intervention with this BCI device design attenuates the effects of hemiparesis, encourages reorganization of functional connectivity, and improves movement, as measured by the Action Research Arm Test (ARAT). 21 stroke survivors, presenting with varied times since stroke and levels of UE impairment, received a maximum of 18 - 30 hours of intervention with a novel electroencephalogram based BCI driven functional electrical stimulator (EEG-BCI-FES) device. Driven by spectral power recordings from contralateral EEG electrodes during cued attempted grasping of the hand, the EEG-BCI-FES device modulates horizontal movement of a virtual cursor as well as facilitating concurrent FES stimulation of only the impaired upper extremity. Primary outcome measure of function, ARAT was assessed at baseline, mid-therapy, and at completion of therapy. The signed r-squared value (at the ipsilesional C4 or C3 sites) for the Mu (8-12Hz) rhythm significantly decreased in the post-therapy stage compared to the pre-therapy stage (one-tailed paired t-test: t(20)= 1.85; p = 0.039; meanPRE = -0.142; meanPOST = -0.161), while the subject attempted movements of the impaired hand. These findings suggests that as the result of the intervention sessions, the “desynchronization” of the Mu rhythm signals significantly increases post-therapy at the ipsilesional motor site and this change is related to changes in behavior as a result of intervention. BCI intervention may be an effective way of addressing the stroke recovery of a stroke impaired upper extremity.

IMPORTANCE The occurrence of major congenital heart disease (CHD) is affected by several variables. Determining the development of the true incidence is critical to the establishment of proper treatment of these patients. OBJECTIVE To evaluate time trends in incidence, detection rate, and termination of pregnancy (TOP) rate of major CHD in fetuses in Denmark and assess the influence of the introduction of general prenatal screening in 2004. DESIGN, SETTING, AND PARTICIPANTS Nationwide, population-based, retrospective observational study in Denmark from 1996 to 2013 that included a consecutive sample of 14 688 live-born children and terminated fetuses diagnosed as having CHD. Patient records on TOP and children with major CHD were reviewed to validate the diagnoses. Major CHD included univentricular heart, transposition of the great arteries, congenitally corrected transposition of the great arteries, truncus arteriosus, interrupted aortic arch, atrioventricular septal defects, double outlet right ventricle, coarctatio of the aorta, Ebstein anomaly, pulmonary atresia with ventricular septal defect, pulmonary atresia with intact ventricular septum, and tetralogy of Fallot. Data were analyzed between January 2017 and March 2018. MAIN OUTCOMES AND MEASURES Temporal changes in incidence, detection rate, and TOP of major CHD. RESULTS Of 14 688 children and fetuses diagnosed with CHD, 2695 (18.4%; 95%CI, 17.8-19.1) had major CHD. A total of 7131 boys (1304 with major CHD) and 6926 girls (920 with major CHD) were included, with a median age of 11 years (interquartile range, 6-15 years). During the study period, the live-birth incidence of CHD was constant at 1.22%(95%CI, 1.18-1.26), whereas it decreased for major CHD. When including TOP, the incidence of major CHD did not change over time. The detection rate of major CHD increased from 4.5%(95%CI, 1.2-7.8) to 71.0%(95%CI, 63.3-78.7) (P < .001). At the end of the study, all cases of double outlet right ventricle, Ebstein anomaly, congenitally corrected transposition of the great arteries, and pulmonary atresia with ventricular septal defect were detected prenatally, whereas coarctation of the aorta had the lowest detection rate (21.7%; 95%CI, 3.5-40.0). The TOP rate increased from 0.6%(95%CI, -0.6 to 1.9) to 39.1%(95%CI, 30.9-47.4) (P < .001) among all major CHD. For prenatally diagnosed major CHD, 57.8%of cases were terminated and the proportion did not change significantly throughout the study. Diagnoses leading to TOP included all major CHD diagnoses. CONCLUSIONS AND RELEVANCE Detection rates of major CHD improved during the study. This has led to increased TOP rates, with a subsequent 39%decrease in the live-birth incidence of major CHD.

Minimally invasive surgery (MIS) reduces unnecessary tissue damage to the patient but obscures the natural surgical interface that is provided by open surgical procedures. Multiple feedback mechanisms, mainly visual and tactile, are greatly reduced in MIS. Microscopes, endoscopes, and image-guided navigation traditionally provide enough visual information for successful minimally invasive procedures, although the limited feedback makes these procedures more difficult to learn. Research has been performed to develop alternative solutions that regain additional feedback. Augmented reality (AR), a more recent guidance innovation that overlays digital visual data physically, has begun to be implemented in various applications to improve the safety and efficacy of minimally invasive procedures. This review focuses on the recent implementation of augmented display and direct visual overlay and discusses how these innovations address common feedback concerns associated with minimally invasive surgeries.

The editors here describe the development of the College relationships with government, the NHS and other outside bodies.

Council was the governing body of the BPA and has similar authority in the College. The elected members of Council are trustees of the college and are elected on a regional basis, but as detailed in the governance section, this will soon change. Many of the College officers started their BPA/College careers as regional representatives.

Summary Objective This study aims to collect data throughout the complete phonatory range using rabbit larynges. Study Design This is a methodological excised rabbit larynx study. Methods Seven rabbit larynges were dissected and mounted on a modified excised laryngeal apparatus. Phonation was initiated at phonation threshold pressure (PTP) and airflow was increased by consistent increments until phonation instability pressure (PIP) was reached. At each airflow level, aerodynamic measurements, acoustic recordings, and high-speed videos were recorded. This procedure was repeated at multiple elongation conditions to further explore the parameters. Data were then compared across subjects and elongation conditions. Results At PTP, subglottal pressure, fundamental frequency, and sound pressure level were found to increase significantly as elongation was increased. As elongation was increased at PIP, airflow was found to significantly decrease, whereas fundamental frequency was found to significantly increase. Vibratory amplitude decreased at both PTP and PIP as elongation increased. Also, as elongation increased, the range of all parameters was found to decrease significantly. Conclusions The results obtained, combined with the similarities of the histologic structure of the vocal fold lamina propria between rabbits and humans, validate the rabbit larynx as an effective and reliable model for tissue inflammation studies.

Currently, there are no objective measures capable of distinguishing between all four voice signal types proposed by Titze in 1995 and updated by Sprecher in 2010. We propose an objective metric that distinguishes between voice signal types based on the aperiodicity present in a signal.One hundred fifty voice signal samples were randomly selected from the Disordered Voice Database and subjectively sorted into the appropriate voice signal category on the basis of the classification scheme presented in Sprecher 2010.Short-time Fourier transform was applied to each voice sample to produce a spectrum for each signal. The spectrum of each signal was divided into 250 time segments. Next, these segments were compared to each other and used to calculate an outcome named spectrum convergence ratio (SCR). Finally, the mean SCR was calculated for each of the four voice signal types.SCR was capable of significantly differentiating between each of the four voice signal types (P 0.001). Additionally, this new parameter proved equally as effective at distinguishing between voice signal types as currently available parameters.SCR was capable of objectively distinguishing between all four voice signal types. This metric could be used by clinicians to quickly and efficiently diagnose voice disorders and monitor improvements in voice acoustical signals during treatment methods.

Objective To examine trends in the incidence of hypoxic-ischaemic encephalopathy over a 13-year period. Design A retrospective analysis of medical records of all infants admitted in the years 1976–1980 and 1984–1988. Setting A large non-teaching district health authority in central England. Subjects Infants admitted to a district general hospital neonatal unit with clinical features of hypoxic-ischaemic encephalopathy. Main outcome measures Incidence of three grades of hypoxic-ischaemic encephalopathy, handicap and mortality. Results During the first 5-year period the overall incidence of hypoxic-ischaemic encephalopathy was 7.7 per 1000 live births with 2.6 per 1000 live births being severely affected (grades II and III). In the second 5-year period the overall incidence was 4.6 per 1000 live births with 1.8 per 1000 live births being severely affected. The difference in the overall rate is statistically significant. Of the infants with severe encephalopathy 61 % had Apgar scores below 4 at 1 min and 60% were born by instrumental or operative delivery. Conclusions The fall in incidence of hypoxic-ischaemic encephalopathy has occurred during a period of falling perinatal mortality rate. It was instructive to find that infants born vaginally and without obstetric intervention formed a larger fraction of the severely affected infants in the later period.

Most patient contacts with hospital services are as outpatients and paediatricians spend a great deal of their working lives in outpatient clinics. Yet this work has a low profile in comparison to other areas of clinical practice, is usually poorly organised and managed, and is often provided in outdated and unsuitable facilities. As a consequence it attracts poor support in terms of clinical and other staff. Since 1991, new appointments in the NHS have increased overall by 4.8% per year and in paediatrics the rise is greater than this. A new report from the Clinical Standards Advisory Group (CSAG), Services for outpatients ,1 has identified current problems and suggests ways of tackling them. The report considers the whole range of outpatient services for adults and children—medical, surgical, and specialist—but has important implications for the provision of children's outpatient services. CSAG was set up in 1991 as an independent source of expert advice in order to address concerns about access to and availability of specialist services following the NHS reorganisation which introduced the purchaser–provider split. Early reports included studies on neonatal intensive care,2 cystic fibrosis,3and childhood leukaemia,4 and more recently back pain, clinical effectiveness, and cleft lip and palate.5 The report on hospital outpatient services, together with others on depression, epilepsy, and pain concludes the work of CSAG which was abolished in November 1999. Its work has been subsumed under the remit of the Commission for Health Improvement. However, it seems increasingly unlikely that the new Commission will undertake clinically based topic reviews in the style of the CSAG. The main strength of CSAG lay in its membership, which was senior and multidisciplinary, backed by academic support and commissioned research. CSAG was never given a remit to implement its findings, but recent reports have helped …

Objective To examine trends in incidence of hypoxic-ischaemic encephalopathy in term infants over a twenty-one year period. Design A retrospective analysis of medical records of all term infants admitted to a neonatal unit with hypoxic-ischaemic encephalopathy during the years 1992–1996 (period C) and a comparison with data from the years 1976–1980 (period A) and 1984–1988 (period B) from the same unit (previously published1). Setting A District Health Authority in Central England serving a population of about 450,000. Sample All term infants admitted with clinical features of hypoxic-ischaemic encephalopathy. Main outcome measures Incidence of three grades of hypoxic-ischaemic encephalopathy, disability and mortality. Results In each five year period there were similar numbers of births. Over the time-span of this study the stillbirth rate and neonatal mortality rate has consistently fallen. The overall incidence of hypoxicischaemic encephalopathy in term infants was significantly lower (P < 0.001; OR 0.42 CI 0.29–0.59) in the present study period (C) compared with the earlier study period B (1.9 vs 4.6 per 1000 total live births). The fall in moderately and severely affected infants between the present and the first study period was significant (1.2 vs 2.6 per 1000 total live births, P < 0.001: OR 0.46 CI 0.29–0.72). The number of deaths and the incidence of cerebral palsy in survivors fell progressively over the 21 years spanned by this study. Conclusion This study shows that the incidence of hypoxic-ischaemic encephalopathy and its sequelae in term infants has fallen significantly. The use of cardiotocography and caesarean section rates have risen but the relative contributions of changes in clinical practice are uncertain.

The value of and need for paediatric outpatient review attendance as perceived by parents, children, consultants, and general practitioners (GPs) were assessed. One hundred and ninety one parents of 239 children over 7 years of age undergoing review were randomly selected for a semistructured interview. For each parent interviewed, an audit questionnaire was completed after case note review by another paediatrician. A random sample of the patients' GPs was surveyed by postal questionnaire. Twenty per cent of parents and 26% of GPs felt that the GP could care for the child as well as or better than the hospital, whereas only 6% of consultants felt this to be so. Regarding future attendance of the child at the hospital, 48% of parents and 32% of GPs felt the child could either be discharged or seen when parents were worried, whereas consultants felt 24% of patients should have been discharged.

EDITOR, - It is now 10 months since the two paediatricians in Grantham, Drs Nelson Porter and Charith Nanayakkara, were made redundant after the conviction of Beverly Allitt for the murder of four children under their care. Both are appealing to the secretary of state for health under paragraph 190 of the terms and conditions of service for hospital and dental staff. The British Paediatric Association is concerned to ensure that its views are known. Soon after the suspension of Drs Porter and Nanayakkara a small committee was established at the request of the British Paediatric Association's council to produce a submission to …