Prediction of large-for-gestational-age infant by fetal growth charts and hemoglobin A1c level in pregnancy complicated by pregestational diabetes.

OBJECTIVES: To compare the ability of three fetal growth charts (Fetal Medicine Foundation (FMF), Hadlock and National Institutes of Child Health and Human Development (NICHD) race/ethnicity-specific) to predict large-for-gestational age (LGA) at birth in pregnant individuals with pregestational diabetes, and to determine whether inclusion of hemoglobin A1c (HbA1c) level improves the predictive performance of the growth charts. METHODS: This was a retrospective analysis of individuals with Type-1 or Type-2 diabetes with a singleton pregnancy that resulted in a non-anomalous live birth. Fetal biometry was performed between 28 + 0 and 36 + 6 weeks of gestation. The primary exposure was suspected LGA, defined as estimated fetal weight ≥ 90th percentile using the Hadlock (Formula C), FMF and NICHD growth charts. The primary outcome was LGA at birth, defined as birth weight ≥ 90th percentile, using 2017 USA natality reference data. The performance of the three growth charts to predict LGA at birth, alone and in combination with HbA1c as a continuous measure, was assessed using the area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: Of 358 assessed pregnant individuals with pregestational diabetes (34% with Type 1 and 66% with Type 2), 147 (41%) had a LGA infant at birth. Suspected LGA was identified in 123 (34.4%) by the Hadlock, 152 (42.5%) by the FMF and 152 (42.5%) by the NICHD growth chart. The FMF growth chart had the highest sensitivity (77% vs 69% (NICHD) vs 63% (Hadlock)) and the Hadlock growth chart had the highest specificity (86% vs 76% (NICHD) and 82% (FMF)) for predicting LGA at birth. The FMF growth chart had a significantly higher AUC (0.79 (95% CI, 0.74-0.84)) for LGA at birth compared with the NICHD (AUC, 0.72 (95% CI, 0.68-0.77); P < 0.001) and Hadlock (AUC, 0.75 (95% CI, 0.70-0.79); P < 0.01) growth charts. Prediction of LGA improved for all three growth charts with the inclusion of HbA1c measurement in comparison to each growth chart alone (P < 0.001 for all); the FMF growth chart remained more predictive of LGA at birth (AUC, 0.85 (95% CI, 0.81-0.90)) compared with the NICHD (AUC, 0.79 (95% CI, 0.73-0.84)) and Hadlock (AUC, 0.81 (95% CI, 0.76-0.86)) growth charts. CONCLUSIONS: The FMF fetal growth chart had the best predictive performance for LGA at birth in comparison with the Hadlock and NICHD race/ethnicity-specific growth charts in pregnant individuals with pregestational diabetes. Inclusion of HbA1c improved further the prediction of LGA for all three charts. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The development of a consensus statement for the prescription of powered wheelchair standing devices in Duchenne muscular dystrophy.

PURPOSE: To develop a consensus statement for the prescription of a Powered Wheelchair Standing Device (PWSD) in young people with Duchenne muscular dystrophy (DMD). MATERIALS AND METHODS: An international multidisciplinary panel comprising clinicians and users (young people with DMD) along with their parents was consulted. A literature review was undertaken and a Delphi method was utilised to generate consensus statements. To supplement limited literature, round one of the Delphi process comprised questions consistent with the International Classification of Functioning, Disability and Health model of disability to generate items based on expert opinion and was completed by 38 clinicians and nine users. Thirty-seven participants completed two further rounds rating the importance of each item with a five-point scale. Agreement of 70% or more participants for items indicated consensus. RESULTS: Consensus was reached for 47 of 80 items. Tolerance and comfort in supported standing for at least 10 min, ankle contracture less than 10 degrees and user goals reflecting motivation to use the standing function were agreed as necessary in guiding the decision to trial a PWSD. Evidence of family, therapist and servicing support were also considered critical in enabling continuity of PWSD use. CONCLUSIONS: PWSD is a mobility option that offers choice, control and opportunity for independence. This consensus statement can assist clinicians with decision-making around factors influencing successful implementation and optimisation of PWSD for young people with DMD.Implications for RehabilitationTolerance and comfort in supported standing for at least 10 minutes, ankle contracture limited to less than 10 degrees and the child's goals reflecting motivation to use the standing position were agreed to be necessary considerations in guiding the decision to trial a PWSD.Trialling a PWSD when the child is predicted to lose the ability to walk within a one to two year period was recommended although a PWSD could be suitable for a child who was unable to walk.Evidence of family, therapist and servicing support was considered critical in enabling continuity of PWSD use.

A summary of reptile and anuran amphibian species from Brazilian sandy coastal plains: 31 years of sampling efforts of the "Laboratório de Ecologia de Vertebrados, Universidade do Estado do Rio de Janeiro" / Um resumo das espécies de répteis e anfíbios anuros das planícies costeiras arenosas brasileiras: 31 anos de esforços de amostragem do "Laboratório de Ecologia de Vertebrados da Universidade do Estado do Rio de Janeiro"

Abstract Although currently there is already a set of studies regarding ecological aspects of some particular reptile and amphibian species living in Brazilian sandy coastal plains (including the so-called "restinga" and "campo nativo" habitats), there is comparatively few information on the species composition usually associated to these environments. During 31 years (1988-2019) of herpetological studies carried out in sandy coastal plains environments by our research team of the Laboratory of Vertebrate Ecology (Department of Ecology, Universidade do Estado do Rio de Janeiro, in Rio de Janeiro Brazil) we have surveyed reptile and amphibian communities and performed different studies with similar methods in 70 sites from 10 different states along the Brazilian coast. Our surveys resulted in records of 87 species of reptile (five turtles, two crocodylians, six amphisbaenians, 36 lizards and 39 snakes) from 24 families, and 77 species of anuran amphibians from nine families. We have studied multiple natural history topics for anurans and reptiles which resulted in the publication of some specific ecological studies, especially regarding some species, encompassing population and community ecology, foraging and feeding habits, species activity, thermoregulation, reproduction, use of microhabitats, and parasitism by ecto and endoparasites. Our results along these three decades have also contributed for the description of four new lizard species (Ameivula nativo, Glaucomastix littoralis, G. abaetensis and G. itabaianensis). Our studies constitute an important contribution to the knowledge of the ecology of anuran amphibians and reptiles in these ecosystems, as well as to the conservation of sandy coastal plains environment. The checklist presented in this study, based on our records of sandy coastal plains herpetofauna, provides for many localities along the Brazilian coast, the needed knowledge on species occurrence, including the presence of endemic and/or endangered species, which can be of value for many conservation actions.

Resumo Embora atualmente exista um conjunto de estudos sobre aspectos ecológicos de algumas espécies de répteis e de anfíbios que ocorrem nas planícies costeiras arenosas brasileiras (incluindo os chamados habitats de "restinga" e de "campo nativo"), há relativamente poucas informações sobre a composição de espécies geralmente associada a esses ambientes. Durante 31 anos (1988-2019) de estudos herpetológicos realizados em restingas por nossa equipe de pesquisa do Laboratório de Ecologia de Vertebrados (Departamento de Ecologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil) nós estudamos comunidades de répteis e de anfíbios e realizamos diferentes estudos com métodos semelhantes em 70 localidades de dez diferentes Estados ao longo da costa brasileira. Nossas pesquisas resultaram em registros de 87 espécies de répteis (cinco tartarugas, dois crocodilianos, seis anfisbênios, 36 lagartos e 39 serpentes) de 24 famílias, e 77 espécies de anfíbios anuros de nove famílias. Estudamos vários tópicos de história natural sobre anuros e répteis, que resultaram na publicação de alguns estudos ecológicos específicos, especialmente em relação a algumas espécies, abrangendo ecologia populacional e de comunidades, forrageamento e dieta, horário de atividade de espécies, termorregulação, reprodução, uso do microhabitat e parasitismo por ecto e endoparasitas. Nossos resultados ao longo dessas três décadas também contribuíram para a descrição de quatro novas espécies de lagartos (Ameivula nativo, Glaucomastix littoralis, G. abaetensis e G. itabaianensis). Nossos estudos constituem uma importante contribuição para o conhecimento da ecologia de répteis e de anfíbios anuros nesses ecossistemas, bem como para a conservação dos ecossistemas de restinga. A lista de espécies apresentada neste estudo, com base em nossos registros de herpetofauna das planícies costeiras arenosas, fornece para muitas localidades ao longo da costa brasileira o conhecimento necessário sobre a ocorrência de espécies, incluindo a presença de espécies endêmicas e/ ou ameaçadas de extinção, que podem ser úteis para muitas ações de conservação.

A summary of reptile and anuran amphibian species from Brazilian sandy coastal plains: 31 years of sampling efforts of the "Laboratório de Ecologia de Vertebrados, Universidade do Estado do Rio de Janeiro".

Although currently there is already a set of studies regarding ecological aspects of some particular reptile and amphibian species living in Brazilian sandy coastal plains (including the so-called "restinga" and "campo nativo" habitats), there is comparatively few information on the species composition usually associated to these environments. During 31 years (1988-2019) of herpetological studies carried out in sandy coastal plains environments by our research team of the Laboratory of Vertebrate Ecology (Department of Ecology, Universidade do Estado do Rio de Janeiro, in Rio de Janeiro Brazil) we have surveyed reptile and amphibian communities and performed different studies with similar methods in 70 sites from 10 different states along the Brazilian coast. Our surveys resulted in records of 87 species of reptile (five turtles, two crocodylians, six amphisbaenians, 36 lizards and 39 snakes) from 24 families, and 77 species of anuran amphibians from nine families. We have studied multiple natural history topics for anurans and reptiles which resulted in the publication of some specific ecological studies, especially regarding some species, encompassing population and community ecology, foraging and feeding habits, species activity, thermoregulation, reproduction, use of microhabitats, and parasitism by ecto and endoparasites. Our results along these three decades have also contributed for the description of four new lizard species (Ameivula nativo, Glaucomastix littoralis, G. abaetensis and G. itabaianensis). Our studies constitute an important contribution to the knowledge of the ecology of anuran amphibians and reptiles in these ecosystems, as well as to the conservation of sandy coastal plains environment. The checklist presented in this study, based on our records of sandy coastal plains herpetofauna, provides for many localities along the Brazilian coast, the needed knowledge on species occurrence, including the presence of endemic and/or endangered species, which can be of value for many conservation actions.

Zeeman spectroscopy as a method for determining the magnetic field distribution in self-magnetic-pinch diodes (invited).

In the self-magnetic-pinch diode, the electron beam, produced through explosive field emission, focuses on the anode surface due to its own magnetic field. This process results in dense plasma formation on the anode surface, consisting primarily of hydrocarbons. Direct measurements of the beam's current profile are necessary in order to understand the pinch dynamics and to determine x-ray source sizes, which should be minimized in radiographic applications. In this paper, the analysis of the C IV doublet (580.1 and 581.2 nm) line shapes will be discussed. The technique yields estimates of the electron density and electron temperature profiles, and the method can be highly beneficial in providing the current density distribution in such diodes.

[Rathke cysts, craniopharyngioma, and colloid cysts : What are the differences between these pathologies?] / Rathke-Zyste, Kraniopharyngeom und Kolloidzyste : Was unterscheidet diese Pathologien?

CLINICAL ISSUE: Headache is the most common symptom of colloid cysts, Rathke cysts, and craniopharyngioma due to their location in the midline, being extra-axial and typically presenting in the parasellar region. THERAPEUTIC PROBLEMS: Although these tumors are generally considered benign, each has its typical characteristics defined by its location and histology. These individual characteristics define whether surgery is necessary at all and if so, the preferred surgical approach and resection's totality. The histopathological findings primarily indicate that embryonic malformations-at the first glance, ectodermal in nature-cause these tumors. ACHIEVEMENT: Due to the fact that these disturbances occur at the boundary between ectodermal stomodeum and endodermal cephalogaster, however, does leave some doubts.

[Relevance and therapy of intracranial arachnoidal cysts]. / Relevanz und Therapie intrakranieller Arachnoidalzysten.

Intracranial arachnoidal cysts (AC) are relevant due to their space-demanding character. The pathophysiological sequelae are dependent on the size and location of the cyst and the patient's age. Direct pressure on surrounding tissue causes headaches (meninges) or rarely seizures (brain tissue). Cerebrospinal fluid (CSF) circulation disturbances resulting from brain mass displacement with occlusion of, for example, the foramen monroi or the aqueduct cause occlusive hydrocephalus, which can lead to an increase in intracranial pressure. Depending on age, the typical primary clinical symptoms or findings differ. In adults and older children, headaches are usually the first clinical symptom. Children, in whom skull growth is not yet complete, present with a head circumference above the 97th percentile. An abnormal one-sided deflection of the calotte in the region of the underlying AC may also be present. Cranial magnetic resonance imaging (cMRI), the first-line diagnostic tool of choice to demonstrate size and location of the cysts and the surrounding intracranial structures, is of utmost importance for therapy planning. In addition, further malformations can be detected. Moreover, cMRI may also be useful for a rough assessment of increased intracranial pressure (ICP). In most symptomatic AC, surgical treatment is unavoidable. The primarily goal is to establish communication between the CSF and the cysts' content in order to effect pressure equalization. If the CSF reabsorption capacity is insufficient, it may also be necessary to implant a CSF shunt. Asymptomatic arachnoidal cysts should be strictly followed clinically and by cMRI over time. The reasonable frequency for follow-up depends on the size and location of the cyst.

A summary of reptile and anuran amphibian species from Brazilian sandy coastal plains: 31 years of sampling efforts of the Laboratório de Ecologia de Vertebrados, Universidade do Estado do Rio de Janeiro

Abstract Although currently there is already a set of studies regarding ecological aspects of some particular reptile and amphibian species living in Brazilian sandy coastal plains (including the so-called restinga and campo nativo habitats), there is comparatively few information on the species composition usually associated to these environments. During 31 years (1988-2019) of herpetological studies carried out in sandy coastal plains environments by our research team of the Laboratory of Vertebrate Ecology (Department of Ecology, Universidade do Estado do Rio de Janeiro, in Rio de Janeiro Brazil) we have surveyed reptile and amphibian communities and performed different studies with similar methods in 70 sites from 10 different states along the Brazilian coast. Our surveys resulted in records of 87 species of reptile (five turtles, two crocodylians, six amphisbaenians, 36 lizards and 39 snakes) from 24 families, and 77 species of anuran amphibians from nine families. We have studied multiple natural history topics for anurans and reptiles which resulted in the publication of some specific ecological studies, especially regarding some species, encompassing population and community ecology, foraging and feeding habits, species activity, thermoregulation, reproduction, use of microhabitats, and parasitism by ecto and endoparasites. Our results along these three decades have also contributed for the description of four new lizard species (Ameivula nativo, Glaucomastix littoralis, G. abaetensis and G. itabaianensis). Our studies constitute an important contribution to the knowledge of the ecology of anuran amphibians and reptiles in these ecosystems, as well as to the conservation of sandy coastal plains environment. The checklist presented in this study, based on our records of sandy coastal plains herpetofauna, provides for many localities along the Brazilian coast, the needed knowledge on species occurrence, including the presence of endemic and/or endangered species, which can be of value for many conservation actions.

Resumo Embora atualmente exista um conjunto de estudos sobre aspectos ecológicos de algumas espécies de répteis e de anfíbios que ocorrem nas planícies costeiras arenosas brasileiras (incluindo os chamados habitats de restinga e de campo nativo), há relativamente poucas informações sobre a composição de espécies geralmente associada a esses ambientes. Durante 31 anos (1988-2019) de estudos herpetológicos realizados em restingas por nossa equipe de pesquisa do Laboratório de Ecologia de Vertebrados (Departamento de Ecologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil) nós estudamos comunidades de répteis e de anfíbios e realizamos diferentes estudos com métodos semelhantes em 70 localidades de dez diferentes Estados ao longo da costa brasileira. Nossas pesquisas resultaram em registros de 87 espécies de répteis (cinco tartarugas, dois crocodilianos, seis anfisbênios, 36 lagartos e 39 serpentes) de 24 famílias, e 77 espécies de anfíbios anuros de nove famílias. Estudamos vários tópicos de história natural sobre anuros e répteis, que resultaram na publicação de alguns estudos ecológicos específicos, especialmente em relação a algumas espécies, abrangendo ecologia populacional e de comunidades, forrageamento e dieta, horário de atividade de espécies, termorregulação, reprodução, uso do microhabitat e parasitismo por ecto e endoparasitas. Nossos resultados ao longo dessas três décadas também contribuíram para a descrição de quatro novas espécies de lagartos (Ameivula nativo, Glaucomastix littoralis, G. abaetensis e G. itabaianensis). Nossos estudos constituem uma importante contribuição para o conhecimento da ecologia de répteis e de anfíbios anuros nesses ecossistemas, bem como para a conservação dos ecossistemas de restinga. A lista de espécies apresentada neste estudo, com base em nossos registros de herpetofauna das planícies costeiras arenosas, fornece para muitas localidades ao longo da costa brasileira o conhecimento necessário sobre a ocorrência de espécies, incluindo a presença de espécies endêmicas e/ ou ameaçadas de extinção, que podem ser úteis para muitas ações de conservação.

Limits on Momentum-Dependent Asymmetric Dark Matter with CRESST-II.

The usual assumption in direct dark matter searches is to consider only the spin-dependent or spin-independent scattering of dark matter particles. However, especially in models with light dark matter particles O(GeV/c^{2}), operators which carry additional powers of the momentum transfer q^{2} can become dominant. One such model based on asymmetric dark matter has been invoked to overcome discrepancies in helioseismology and an indication was found for a particle with a preferred mass of 3 GeV/c^{2} and a cross section of 10^{-37} cm^{2}. Recent data from the CRESST-II experiment, which uses cryogenic detectors based on CaWO_{4} to search for nuclear recoils induced by dark matter particles, are used to constrain these momentum-dependent models. The low energy threshold of 307 eV for nuclear recoils of the detector used, allows us to rule out the proposed best fit value above.

Advancing the framework for considering the effects of climate change on worker safety and health.

In 2009, a preliminary framework for how climate change could affect worker safety and health was described. That framework was based on a literature search from 1988-2008 that supported seven categories of climate-related occupational hazards: (1) increased ambient temperature; (2) air pollution; (3) ultraviolet radiation exposure; (4) extreme weather; (5) vector-borne diseases and expanded habitats; (6) industrial transitions and emerging industries; and (7) changes in the built environment. This article reviews the published literature from 2008-2014 in each of the seven categories. Additionally, three new topics related to occupational safety and health are considered: mental health effects, economic burden, and potential worker safety and health impacts associated with the nascent field of climate intervention (geoengineering). Beyond updating the literature, this article also identifies key priorities for action to better characterize and understand how occupational safety and health may be associated with climate change events and ensure that worker health and safety issues are anticipated, recognized, evaluated, and mitigated. These key priorities include research, surveillance, risk assessment, risk management, and policy development. Strong evidence indicates that climate change will continue to present occupational safety and health hazards, and this framework may be a useful tool for preventing adverse effects to workers.

Differential success in sampling of Atlantic Forest amphibians among different periods of the day.

In general, anurans tend to be nocturnal, though diurnal activity is characteristic of some groups. Studies show that frog activity may be inferred based on the number of individuals collected at different periods of the day, during large-scale field surveys. We investigated the best period of the day to conduct amphibian sampling in nine Atlantic Rainforest areas in southeastern Brazil, based on intensive field surveys. At each locality we employed similar sampling effort during diurnal, crepuscular and nocturnal searches (totaling 704.5 sampling hours). We pooled data from all localities for each period and estimated the proportion of frogs of each species active at each period based on the total number of individuals and on the number of species found during all surveys for that period. We recorded a total of 817 individual frogs from 69 species. Species richness was highest at night (median = 12 species), intermediate at dusk (median = 8), and lowest during the day (median = 4). The percentage of the total number of individual frogs found (pooled species) was highest during the night (ca. 53%) and lowest during the day (ca. 14%). Analyzing each species separately, the number of individuals recorded was consistently higher at dusk and night for most species. Our study evidences a trend for nocturnal activity for most Atlantic Rainforest frogs, with few species having primarily diurnal habits. Those results may favor future studies and conservation efforts for amphibian species.

Species composition, richness and nestedness of lizard assemblages from Restinga habitats along the brazilian coast.

Habitat fragmentation is well known to adversely affect species living in the remaining, relatively isolated, habitat patches, especially for those having small range size and low density. This negative effect has been critical in coastal resting habitats. We analysed the lizard composition and richness of restinga habitats in 16 restinga habitats encompassing three Brazilian states (Rio de Janeiro, Espírito Santo and Bahia) and more than 1500km of the Brazilian coast in order to evaluate if the loss of lizard species following habitat reduction occur in a nested pattern or at random, using the "Nestedness Temperature Calculator" to analyse the distribution pattern of lizard species among the restingas studied. We also estimated the potential capacity that each restinga has to maintain lizard species. Eleven lizard species were recorded in the restingas, although not all species occurred in all areas. The restinga with the richest lizard fauna was Guriri (eight species) whereas the restinga with the lowest richness was Praia do Sul (located at Ilha Grande, a large coastal island). Among the restingas analysed, Jurubatiba, Guriri, Maricá and Praia das Neves, were the most hospitable for lizards. The matrix community temperature of the lizard assemblages was 20.49° (= P <0.00001; 5000 randomisations; randomisation temperature = 51.45° ± 7.18° SD), indicating that lizard assemblages in the coastal restingas exhibited a considerable nested structure. The degree in which an area is hospitable for different assemblages could be used to suggest those with greater value of conservation. We concluded that lizard assemblages in coastal restingas occur at a considerable level of ordination in restinga habitats and that some restinga areas such as Jurubatiba, Guriri, Maricá and Praia das Neves are quite important to preserve lizard diversity of restinga environments.

[Children with specific language impairment: electrophysiological and pedaudiological findings]. / Kinder mit Spezifischer Sprachentwicklungsstörung:Elektrophysiologische und pädaudiologische Befunde.

BACKGROUND: Auditory deficits may be at the core of the language delay in children with Specific Language Impairment (SLI). It was therefore hypothesized that children with SLI perform poorly on 4 tests typically used to diagnose central auditory processing disorder (CAPD) as well in the processing of phonetic and tone stimuli in an electrophysiological experiment. MATERIAL AND METHODS: 14 children with SLI (mean age 61,7 months) and 16 children without SLI (mean age 64,9 months) were tested with 4 tasks: non-word repetition, language discrimination in noise, directional hearing, and dichotic listening. The electrophysiological recording Mismatch Negativity (MMN) employed sine tones (600 vs. 650 Hz) and phonetic stimuli (/ε/ versus /e/). RESULTS: Control children and children with SLI differed significantly in the non-word repetition as well as in the dichotic listening task but not in the two other tasks. Only the control children recognized the frequency difference in the MMN-experiment. The phonetic difference was discriminated by both groups, however, effects were longer lasting for the control children. Group differences were not significant. CONCLUSIONS: Children with SLI show limitations in auditory processing that involve either a complex task repeating unfamiliar or difficult material and show subtle deficits in auditory processing at the neural level.

Comparing the after-effects of continuous theta burst stimulation and conventional 1 Hz rTMS on semantic processing.

Our aim was to evaluate continuous theta burst stimulation (cTBS) as a tool to induce temporary impairment (virtual lesion) in semantic processing. Four groups with 20 subjects each were stimulated. In the three experimental groups the stimulation site was the left superior temporal cortex. Stimulation was either 1Hz repetitive transcranial magnetic stimulation (rTMS) at 100% resting motor threshold (RMT) or cTBS, with intensities of 80% or 90% active motor threshold (AMT). The TMS-control group was stimulated at the right medial prefrontal cortex with 1 Hz rTMS. After stimulation subjects accomplished a lexical decision task with a duration of about 20 min. In an additional fifth group the lexical decision task was performed without TMS. Reaction times were not influenced by cTBS applied with 80% AMT, but prolonged for about 80 ms with 90% AMT compared to the no stimulation condition. An increase of 140 ms was found after 1 Hz rTMS. The effect lasted for the whole task, but declined from the first to the second half of the experiment. The direct comparison of cTBS and 1 Hz rTMS suggests that both stimulation patterns can induce virtual lesions in the left superior temporal cortex and impair semantic processing. We suppose that cTBS could replace 1 Hz rTMS in this field since the application is faster and it is more comfortable to the subjects.

[Treatment of hydrocephalus]. / Therapie des Hydrozephalus.

CLINICAL/METHODICAL ISSUE: Modern treatment of hydrocephalus. STANDARDS OF CLINICAL AND RADIOLOGICAL METHODS: Clinically: shunting and endoscopy. Radiologically: MRT, CCT. METHODICAL INNOVATIONS: Important innovations are gravitational valves and neuroendoscopy standing for new challenges in preoperative imaging and for sufficient interpretation of postoperative imaging. PERFORMANCE: G-valves reduce the complication rate (especially overdrainage) in shunting significantly. While lacking appropriated clinical studies, the UK Shunt Registry still provides the best comparison between shunting and neuroendoscopy, after which the long-term revision rates of both methods are identical. The perioperative risk of endoscopic surgery seems to be higher than for shunts. ACHIEVEMENTS: The superiority of the G-valves in chronic hydrocephalus in comparison with other valves has recently been demonstrated in a class 1 evidence-based study. The neuroendoscopy, has been,-in the absence of a contraindications -, indicated by a guidelines' committee of the German Society of Neurosurgery as method of choice in occlusive hydrocephalus alternatively to shunting. PRACTICAL RECOMMENDATIONS: Preoperatively, to clarify etiology, comorbidity, and surgical planning, MRI is preferable; with planned neuroendoscopy as high-resolution detailed MRI of access-trajectory and region of interest. In post-operative CT or MRI (after endoscopic procedures always MRI) a differentiation between (sub-)acute and chronic hydrocephalus is important for correct interpretation of imaging: a normalization of ventricular size is physiological only in (sub-)acute hydrocephalus, in chronic hydrocephalus, yet, sign of overdrainage. In chronic hydrocephalus, ventricles shrink usually only marginally. Solely, better delineated, vertex-near cisternae are there evidence of sufficient drainage.

Simulation of existing and future electromechanical shunt valves in combination with a model for brain fluid dynamics.

Several models are available to simulate raised intracranial pressure (ICP) in hydrocephalus. However, the hydrodynamic effect of an implanted shunt has seldom been examined. In this study, the simple model of Ursino and Lodi [14]is extended to include (1) the effect of a typical ball-in-cone valve, (2) the effect of the size of the diameter of the connecting tube from valve to abdomen, and (3) the concept of a controlled electromechanical shunt valve in overall cerebrospinal fluid dynamics.By means of simulation, it is shown how a shunt can lower ICP. Simulation results indicate that P and B waves still exist but at a lower ICP level and that, due to the exponential pressure-volume curve, their amplitude is also considerably lowered. A waves only develop if the valve is partially blocked. The resulting ICP is above the opening pressure of the valve, depending on the drain and resistance of the shunt.The concept of a new electromechanical shunt was more successful than the traditional mechanical valves in keeping ICP at a desired level. The influence of the patient's movements or coughing on ICP as well as the body position affecting the reference ICP, which can be measured, has not yet been modeled and should be addressed in future using suitable algorithms.

Cognitive reappraisal modulates performance following negative feedback in patients with major depressive disorder.

BACKGROUND: Depressed patients show impaired performance following negative feedback; the probability of committing an error is increased immediately after an error. This deficit is assumed to be highly specific and to represent a trait marker of major depressive disorder (MDD). Inconsistencies in currently available data could reflect inter-individually different strategies to regulate negative affect. The present study examined modulation of performance following negative feedback by cognitive reappraisal to regulate aversive affect in depressed patients. METHOD: Thirty-three depressed patients and 33 control subjects performed tasks of varying difficulty over a prolonged time. Emotional feedback was given immediately after each trial. Performance was further analysed within subgroups using cognitive reappraisal of aversive events with high and low frequency. RESULTS: A significant group by task difficulty interaction for absolute number of subsequent errors revealed that depressed patients were especially impaired when receiving negative feedback more frequently. An increased probability of subsequent errors was shown in patients irrespective of task difficulty. Analysis of subgroups revealed higher absolute number and probability of subsequent errors only in depressed patients habitually not using cognitive reappraisal to regulate aversive emotions. Depressed patients using this strategy did not differ from controls. CONCLUSIONS: The present results replicate the observation of impaired performance in depressed patients following failure feedback. Most importantly, a subgroup of patients who habitually rely on cognitive reappraisal of aversion-eliciting events, such as negative performance feedback, was not impaired. This modulatory influence of emotion regulation strategies on performance subsequent to negative feedback suggests that training emotion regulation in achievement situations should be incorporated in current concepts to prevent relapse.

Is it possible to minimize overdrainage complications with gravitational units in patients with idiopathic normal pressure hydrocephalus? Protocol of the randomized controlled SVASONA Trial (ISRCTN51046698).

Overdrainage is a common complication observed after shunting patients with idiopathic normal-pressure hydrocephalus (iNPH), with an estimated incidence up to 25%. Gravitational units that counterbalance intracranial pressure changes were developed to overcome this problem. We will set out to investigate whether the combination of a programmable valve and a gravitational unit (proGAV, Aesculap/Miethke, Germany) is capable of reducing the incidence of overdrainage and improving patient-centered outcomes compared to a conventional programmable valve (Medos-Codman, Johnson & Johnson, Germany). SVASONA is a pragmatic randomized controlled trial conducted at seven centers in Germany. Patients with a high probability of iNPH (based on clinical signs and symptoms, lumbar infusion and/or tap test, cranial computed tomography [CCT]) and no contraindications for surgical drainage will randomly be assigned to receive (1) a shunt assistant valve (proGAV) or (2) a conventional, programmable shunt valve (programmable Medos-Codman).We will test the primary hypothesis that the experimental device reduces the rate of overdrainage from 25% to 10%. As secondary analyses, we will measure iNPH-specific outcomes (i.e., the Black grading scale and the NPH Recovery Rate), generic quality of life (Short Form 36), and complications and serious adverse events (SAE). One planned interim analysis for safety and efficacy will be performed halfway through the study. To detect the hypothesized difference in the incidence of overdrainage with a type I error of 5% and a type II error of 20%, correcting for multiple testing and an anticipated dropout rate of 10%, 200 patients will be enrolled.The presented trial is currently recruiting patients, with the first results predicted to be available in late 2008.

Infection rate with application of an antibiotic-impregnated catheter for shunt implantation in children - a retrospective analysis.

BACKGROUND: The infection rate of hydrocephalus shunts in children amounts figures of up to 25% and the according mortality rate is alarming high nowadays yet. An antibiotic impregnated shunt-catheter (AIS) was designed to reduce the incidence of shunt infections. PATIENTS AND METHOD: In a non randomized trial 56 children were examined between January 2002 inclusive December 2007. The minimal follow-up was six months. Only children were included, who were shunted for the first time. In the study group (n=34) AIS (Bactiseal ) Codman, Johnson & Johnson, MA, Boston, USA) were used, while the control group (n=22) was provided with conventional, not-antibiotic impregnated catheters. To compare the risk profile for shunt infections, we defined, - according to the literature -, some risk factors. RESULTS: Despite the incidence of shunt infections has been supposed to be higher according to the higher risk profile of the AIS group compared with controls, the shunt infection rate of the AIS group was lower than the shunt infection rate in the control group. CONCLUSIONS: Apparently, AIS can reduce the incidence of shunt infections in children. Further prospective trials with a larger cohort are necessary for a statistically significant prove.