Resting energy expenditure and adiposity accretion among children with Down syndrome: a 3-year prospective study.

BACKGROUND: Children with Down syndrome (DS) have a higher prevalence of obesity than other children. Whether this increased risk for obesity is due to a lower resting energy expenditure (REE) is controversial. Our study assessed whether (1) the REE of children with DS adjusted for fat-free mass (FFM) was lower than that of sibling controls, and (2) the changes in fat mass (FM) over 3 years were associated with FFM-adjusted baseline REE. METHODS: This study used cross-sectional and prospective cohort designs. Four annual measurement visits were conducted with 28 children with DS and 35 sibling controls aged 3-10 years. REE and serum thyroxine (T4) were measured at baseline. Anthropometry, skinfold thickness measures, and, in a subsample, dual-energy x-ray absorptiometry (DXA) were used at each visit to calculate FM. RESULTS: Children with DS had significantly lower REE adjusted for FFM (-78 kcal/day, 95% CI: -133 to -27, P=0.003). The difference remained significant after adjustment for FM, sex and African ancestry (-49 kcal/day, 95% CI: -94 to -4, P=0.03). In the longitudinal analysis, the baseline REE adjusted for baseline FFM was not predictive of FM accretion over time (P=0.8). CONCLUSION: Children with DS have lower REE than sibling controls, but REE was not associated with changes in FM over time. The results suggest that the lower REE of children with DS does not explain their increased risk for obesity.

Visual assessment of the accuracy of retrospective registration of MR and CT images of the brain.

In a previous study we demonstrated that automatic retrospective registration algorithms can frequently register magnetic resonance (MR) and computed tomography (CT) images of the brain with an accuracy of better than 2 mm, but in that same study we found that such algorithms sometimes fail, leading to errors of 6 mm or more. Before these algorithms can be used routinely in the clinic, methods must be provided for distinguishing between registration solutions that are clinically satisfactory and those that are not. One approach is to rely on a human observer to inspect the registration results and reject images that have been registered with insufficient accuracy. In this paper, we present a methodology for evaluating the efficacy of the visual assessment of registration accuracy. Since the clinical requirements for level of registration accuracy are likely to be application dependent, we have evaluated the accuracy of the observer's estimate relative to six thresholds: 1-6 mm. The performance of the observers was evaluated relative to the registration solution obtained using external fiducial markers that are screwed into the patient's skull and that are visible in both MR and CT images. This fiducial marker system provides the gold standard for our study. Its accuracy is shown to be approximately 0.5 mm. Two experienced, blinded observers viewed five pairs of clinical MR and CT brain images, each of which had each been misregistered with respect to the gold standard solution. Fourteen misregistrations were assessed for each image pair with misregistration errors distributed between 0 and 10 mm with approximate uniformity. For each misregistered image pair each observer estimated the registration error (in millimeters) at each of five locations distributed around the head using each of three assessment methods. These estimated errors were compared with the errors as measured by the gold standard to determine agreement relative to each of the six thresholds, where agreement means that the two errors lie on the same side of the threshold. The effect of error in the gold standard itself is taken into account in the analysis of the assessment methods. The results were analyzed by means of the Kappa statistic, the agreement rate, and the area of receiver-operating-characteristic (ROC) curves. No assessment performed well at 1 mm, but all methods performed well at 2 mm and higher. For these five thresholds, two methods agreed with the standard at least 80% of the time and exhibited mean ROC areas greater than 0.84. One of these same methods exhibited Kappa statistics that indicated good agreement relative to chance (Kappa > 0.6) between the pooled observers and the standard for these same five thresholds. Further analysis demonstrates that the results depend strongly on the choice of the distribution of misregistration errors presented to the observers.

Quantitative morphology of the lateral ligaments of the spine. Assessment of their importance in maintaining lateral stability.

STUDY DESIGN: This study used human cadaveric material to examine the three-dimensional morphology and biomechanics of the superior and lateral costotransverse ligaments and the intertransverse ligament of the spine. OBJECTIVES: To provide descriptive and quantitative data on the morphology of the lateral ligaments of the spine and to assess their importance in maintaining lateral stability, especially regarding the pathogenesis of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Ligaments have been reported as being able to stabilize the spine by mechanical constraint and by neurologic feed-back. Midline spinal ligaments have been well studied but do not appear to be effective in maintaining lateral stability because of their sites of attachment. Lateral ligaments of the spine have not been adequately documented in the literature. METHODS: The morphology, sites of attachment, and dimensions of the superior costotransverse ligament, lateral costotransverse ligament, and intertransverse ligament from thoracic level 7 to thoracic level 10 were determined on 32 human cadavers. RESULTS: The intertransverse ligament was found not to be a true ligament. The lateral costotransverse ligament was a true ligament but did not have the characteristics appropriate for involvement in lateral stability. The superior costotransverse ligament also was a true ligament and had all of the characteristics appropriate for involvement in the active lateral balancing of the spine. CONCLUSIONS: In contrast to the midline ligaments of the spine, the superior costotransverse ligament perhaps is the most important ligament for active lateral balancing of the spine and warrants further study, particularly regarding the development of idiopathic scoliosis.

Precision surgery with an electromagnetically induced current convergence probe application in aneurysm treatment, angioplasty, and brain tumor resection in in vivo and in vitro models.

A hand-held probe, or one introduced through a catheter, rapidly produces an extremely high, tissue-vaporizing temperature in a precisely defined manner enabling surgeons or interventional radiologists to perform angioplasty, thrombose aneurysms, and vaporize tumors. The probe is operated in a near field of an inductive coil, and the current induced in the biologic tissue is converged maximally at the tip of the probe at the resonance frequency of both the inductor and the probe, producing a maximum temperature in excess of 1400 degrees C. Radio-frequency power controls the probe-tip temperature. The operation of the probe is comparable to that of a CO2 or YAG laser and is complementary to laser-surgical techniques. The low cost relative to lasers and simplicity of the device including its disposable components make the prospect of commercialization of this device promising.

Ammonia and urea in corn silage-based complete mixed diets for dairy cows.

Source of supplemental N was evaluated in three corn silage-based complete mixed diets (CMD) fed to lactating dairy cows. Diets were formulated to be isonitrogenous and contained 60% corn silage and 40% concentrate on a dry matter basis. Diets were: CMD-A, ammoniated corn silage (ammonia provided 16% of total N) plus concentrate; CMD-U, untreated corn silage and concentrate (16% of total N from urea) and CMD-S, untreated corn silage plus concentrate with soybean meal. Ammoniation at 1.0% of dry weight increased crude protein content of silage from 8.5 to 12.7%. Daily means for cows fed CMD-A, CMD-U and CMD-S were: 24.2, 24.3 and 24.5 kg of fat-corrected milk; 3.17, 3.10 and 3.15% milk protein; 3.41, 3.67 and 3.63% milk fat and 3.02, 2.99 and 3.02 kg intake of total dry matter/100 kg body weight. Differences were not significant except for reduced milk fat percentage for cows fed the ammoniated corn silage diet. Both anhydrous ammonia and urea at 16% of total dietary N were found to be practical and economical substitutes for part of the supplemental soy protein. When compared to CMD with all soybean protein, greater savings in feed costs resulted from inclusion of ammoniated corn silage than with inclusion of urea.