ABSTRACT
Recent research in autism spectrum disorder (ASD) has aroused interest in anterior cingulate cortex and in the neurometabolite glutamate. We report two studies of pregenual anterior cingulate cortex (pACC) in pediatric ASD. First, we acquired in vivo single-voxel proton magnetic resonance spectroscopy ((1)H MRS) in 8 children with ASD and 10 typically developing controls who were well matched for age, but with fewer males and higher IQ. In the ASD group in midline pACC, we found mean 17.7% elevation of glutamate + glutamine (Glx) (p<0.05) and 21.2% (p<0.001) decrement in creatine + phosphocreatine (Cr). We then performed a larger (26 subjects with ASD, 16 controls) follow-up study in samples now matched for age, gender, and IQ using proton magnetic resonance spectroscopic imaging ((1)H MRSI). Higher spatial resolution enabled bilateral pACC acquisition. Significant effects were restricted to right pACC where Glx (9.5%, p<0.05), Cr (6.7%, p<0.05), and N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (10.2%, p<0.01) in the ASD sample were elevated above control. These two independent studies suggest hyperglutamatergia and other neurometabolic abnormalities in pACC in ASD, with possible right-lateralization. The hyperglutamatergic state may reflect an imbalance of excitation over inhibition in the brain as proposed in recent neurodevelopmental models of ASD.
Subject(s)
Cerebral Cortex/metabolism , Child Development Disorders, Pervasive/metabolism , Glutamic Acid/metabolism , Glutamine/metabolism , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Phosphocreatine/metabolism , Adolescent , Brain Chemistry , Cerebral Cortex/diagnostic imaging , Child , Child Development Disorders, Pervasive/diagnostic imaging , Female , Humans , Male , Models, Neurological , Pilot Projects , RadiographyABSTRACT
Deep sternal infections secondary to bony instability and malunion, can result in mediastinitis. Previous authors have described the use of prophylactic rigid plate fixation in high-risk patients. The purpose of our study is to review the use of prophylactic sternal platting with pectoralis advancement flaps in high-risk patients with a history of chest irradiation. Fourteen patients (July 2003-September 2008) with a history of chest irradiation who underwent a median sternotomy followed by prophylactic rigid plate fixation of the sternum were reviewed. Breast cancer was the most common etiology of chest irradiation (n=11, 78%). The average EuroSCORE was 24.06% with 72% of patients having a preoperative New York Heart Association (NYHA) class≥III. There were no episodes of sternal non-union, mediastinitis or death. Follow-up was 100% with a 0% 30-day and a 7.1% one-year mortality rate (non-cardiac). A comparison between mean preoperative left ventricular ejection fraction (LVEF) (49.6%) and postoperative LVEF (59.7%) was statistically significant (P<0.0001). All living patients currently maintain a NYHA class I/II. Prophylactic rigid plate fixation and pectoralis flap coverage decreases the risk of developing sternal dehiscence and postoperative wound complications and should therefore be considered in high-risk patients with a history of chest irradiation.
Subject(s)
Bone Plates , Cardiac Surgical Procedures , Pectoralis Muscles/surgery , Sternotomy/instrumentation , Surgical Flaps , Thoracic Cavity/radiation effects , Wound Closure Techniques/instrumentation , Aged , Female , Humans , Male , Mediastinitis/etiology , Mediastinitis/prevention & control , Michigan , Radiotherapy/adverse effects , Sternotomy/adverse effects , Sternotomy/mortality , Surgical Flaps/adverse effects , Surgical Wound Dehiscence/etiology , Surgical Wound Dehiscence/prevention & control , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Time Factors , Treatment Outcome , Wound Closure Techniques/adverse effects , Wound Closure Techniques/mortalityABSTRACT
BACKGROUND: Recent studies have demonstrated that cardiopulmonary resuscitation (CPR) of poor quality is associated with worsened outcomes. OBJECTIVE: To compare the quality of CPR delivered on the floor with the quality of CPR delivered on a moving stretcher. The authors hypothesized that CPR performed on the floor would be superior to that performed on a moving stretcher. METHODS: A randomized, crossover experimental design was used. Subjects included emergency medical technician students, paramedic students, and emergency medicine residents. Two-member teams were randomly assigned to perform two-rescuer CPR on a manikin either on the floor or on a moving stretcher. After a 5-minute rest, the teams performed CPR under the opposite condition. Compression and ventilation data were collected using a recording resuscitation manikin. Dependent variables were compression depth, compression rate per minute, percentage of correct chest compressions, tidal volume, and percentage of correct ventilations. Data were compared using two-tailed paired t-test. RESULTS: Sixty-two subjects completed the study. The mean compression depth performed on the floor (39 +/- 9 mm) was greater than that on a moving stretcher (28 +/- 9 mm) (p < 0.001). The mean rates of chest compressions on the floor (110 +/- 17 beats/min) and on a moving stretcher (113 +/- 21 beats/min) were not different (p = 0.49). The percentage of correct compressions performed on the floor (54% +/- 40%) exceeded that on a moving stretcher (21% +/- 29%)(p < 0.001). The percentage of correct ventilations performed on the floor (43% +/- 26%) was greater than that on a moving stretcher (24% +/- 21%)(p < 0.04). CONCLUSIONS: Chest compression and ventilation quality of CPR performed on the floor was superior to that of CPR performed on a moving stretcher in this manikin model. The quality of CPR while moving was significantly compromised.