Sex-specific association between infant diet and white matter integrity in 8-y-old children.

BACKGROUND: The American Academy of Pediatrics recommends breastfeeding, which is well known to promote cognitive and behavioral development. The evidence for why this occurs is not well understood. METHODS: Fifty-six 7.5- to 8.5-y-old healthy children were breastfed (BF; n = 22, 10 males) or formula-fed (FF; n = 34, 16 males) as infants. All children were administered: the Reynolds Intellectual Assessment Scale (RIAS); the Clinical Evaluation of Language Fundamentals (CELF-4) tests; and magnetic resonance imaging of the brain. Diffusion tensor imaging (DTI) measured fractional anisotropy (FA) values were correlated with RIAS and CELF-4 scores. RESULTS: DTI tract-based spatial statistics (TBSS) analyses showed multiple white matter regions in the left hemisphere with significantly higher FA (P < 0.05, corrected) values in BF than FF males, but no significant group differences in females. Males who were exclusively BF for at least 1 y appeared to have the greatest differences in FA. Mean FA values positively correlated with composite scores of RIAS (P = 0.03) and CELF-4 (P = 0.02). CONCLUSION: Breastfeeding during infancy was associated with better white matter development at 8 y of age in boys. A similar association was not observed in girls.

Early experience with the cryoablation balloon procedure for the treatment of atrial fibrillation by an experienced radiofrequency catheter ablation center.

BACKGROUND: Radiofrequency (RF) catheter ablation has provided an effective method for treating drug-refractory symptomatic atrial fibrillation. Recently, a cryoablation balloon approach has also received approval. The purpose of this study was to compare RF catheter ablation to cryoablation for the treatment of atrial fibrillation with respect to safety, immediate efficacy, and effects on procedural and fluoroscopy times. In addition, actual procedural costs were compared. METHODS: This study was approved by the Winthrop University Hospital Institutional Review Board to retrospectively examine cryoablation with the Arctic Front Cardiac CryoAblation balloon catheter (Medtronic, Inc) and compare it to RF catheter ablation for the treatment of drug-refractory symptomatic atrial fibrillation. Patient and procedural characteristics as well as immediate success were compared. Immediate failure was defined as incomplete pulmonary vein isolation of all veins. RESULTS: A total of 124 procedures (62 RFs and 62 cryoablations) were performed from December 2010 through July 2012. The cryoablation procedure took longer to perform than RF (171 ± 61 minutes vs 126 ± 49 minutes, respectively; P<.0001). There was no difference in fluoroscopy times between the two groups (29 ± 20 minutes for RF vs 32 ± 18 minutes for cryoablation; P=.39). The infusion of protamine following procedures was much more common in the cryoablation group (30 patients vs 2 patients in the RF group; P<.0001). The immediate success rate was 93.5% with RF ablation vs 96.7% with cryoablation (P=NS). There was not a significant difference in complications between the two approaches. The cost for each procedure was $24,391.88 ± 4826.77 for RF and $31,874.02 ± 8349.70 for cryoablation (P<.0001). CONCLUSION: Cryoablation provides an additional and alternative approach to RF ablation for the treatment of symptomatic drug-refractory atrial fibrillation with comparable immediate success and complications. It is synergistic with RF and permits the ability to tackle the entire gamut of atrial fibrillation (ie, paroxysmal and persistent). This study showed no decrease in procedural or fluoroscopy times with our early experience. One significant limitation with cryoablation is the cost. Cryoablation resulted in over $7000 extra cost to the hospital per procedure. The clinical benefits achieved by this additional cost warrant further investigation.

Decreased activation and increased lateralization in brain functioning for selective attention and response inhibition in adolescents with spina bifida.

We used functional magnetic resonance imaging to evaluate functional activity in the brain of adolescents with spina bifida when performing selective attention and response inhibition tasks. We then compared the results to that of age-matched controls. Our results showed that adolescents with spina bifida had decreased frontal and superior parietal activation and more apparently low involvement of left brain hemisphere during these tasks. Our results indicated activation deficits and possibly abnormal functional organization in adolescents with spina bifida and associated pathologies such as hydrocephalus.

Diffusion tensor imaging evaluation of white matter in adolescents with myelomeningocele and Chiari II malformation.

BACKGROUND: Macrostructural abnormalities in cerebral white matter in patients with myelomeningocele are well known, but microstructural abnormalities are not as well studied. OBJECTIVE: The aim of this study was to evaluate cerebral white matter in adolescents with myelomeningocele using diffusion tensor imaging (DTI), and to investigate the effects of ventricular dilation and CSF shunt presence on white matter microstructure in these patients. MATERIALS AND METHODS: DTI and T1-weighted 3-D (T1-3-D) MRI were performed on nine adolescents with myelomeningocele and Chiari II malformation and nine age-matched controls. The fractional anisotropy (FA) and mean diffusivity (MD) values were measured and compared. RESULTS: Significantly decreased FA and increased MD values were observed in most white matter regions and fibers in adolescents with myelomeningocele compared to controls. Further analysis in patients revealed significant changes in DTI parameters in hemispheres with enlarged lateral ventricles compared to those with normal ventricle size. In addition, a significant difference in FA values in the posterior limb of the internal capsule was found in the comparison of hemispheres in patients with or without CSF shunt catheters. CONCLUSION: This study revealed widespread microstructural abnormalities in white matter in adolescents with myelomeningocele and Chiari II malformation. Ventricular dilation may have additional effects on white matter microstructure in this patient population. CSF shunt diversion effects on white matter may be multifactorial and need further investigation.

Transvenous biventricular defibrillation can improve defibrillation threshold.

A case report of a patient with a high defibrillation threshold at initial implantation that was improved by the insertion of a shocking coil in the left lateral cardiac vein is discussed.