Prenatal exposure to ambient air pollution and autism spectrum disorders: Results from a family-based case-control study.

Background: Autism prevalence has increased considerably, but its etiology is still poorly understood. While there have been suggestions regarding associations between air pollution exposure and neurodevelopmental disorders, several studies have looked at the effect of air pollution exposure on autism. However, the results are inconsistent. The possible role of unknown confounders is mainly blamed for this inconsistency. Methods: To minimize confounding effects, we evaluated the impact of air pollution exposure on autism using a family-based case-control study. Cases were individuals with a diagnosis of autism born between 2009 and 2012 in Isfahan city, Iran. The controls did not have a previous history of autism and were cousins of the case person. The controls were matched with the autistic cases in terms of residential location and age range. For each trimester of pregnancy, carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and PM10 exposure were estimated using the inverse distance weighted method. Results: The analysis indicates a significant association between CO exposure and autism in the second trimester (OR = 1.59; p = 0.046, 95% CI: 1.01-2.51) and entire pregnancy (OR = 2.02; p = 0.049, 95% CI: 1.01-2.95). Likewise, exposure to NO2 during the second trimester (OR = 1.17; p = 0.006, 95% CI: 1.04-1.31), third trimester (OR = 1.11; p = 0.046, 95% CI: 1.01-1.24), and entire pregnancy (OR = 1.27; p = 0.007, 95% CI: 1.07-1.51) were found to be associated with increased risk of autism. Conclusions: Overall, our study found higher exposure to CO and NO2, particularly during the second and third trimesters of pregnancy, was significantly associated with a higher risk of autism.

Enhanced myometrial vascularity and AVM: A review on diagnosis and management.

Uterine Arteriovenous malformations (AVM) are vascular disorders characterized by complex high-flow tangles of abnormal vessels connecting arteries and veins with bypassing capillaries. Recently, the terminology applied to describe uterine AVMs has been modified. Most AVMs are acquired. The term enhanced myometrial vascularity (EMV) is used to describe any condition in which any uterine pathology may lead to increased myometrial vascularity regardless of the absence or presence of residual tissue of gestation.

Arthroscopic lunate fossa resection arthroplasty for Kienböck's disease.

The aim of this study was to assess the outcome of arthroscopic lunate fossa resection arthroplasty for patients with Kienböck's disease, previously managed without operation, and a non-functional lunate fossa. For adult patients with relapse or exacerbation of pain from Kienböck's disease 2 years after the onset of symptoms, arthroscopic removal of lunate fossa cartilage was performed to reach bleeding bone, if the cartilage in the lunate fossa was non-functional and the scaphoid fossa was intact. Sixteen patients (mean age 35 years; range 27-56) were included. At a mean follow-up of 39 months (range 24-64), the preoperative mean visual analogue pain scale and QuickDASH score decreased from 7 (SD 2.2) and 50 (SD 16) to 1.4 (SD 1.6) and 13 (SD 9.6), respectively. A minor deterioration in mean radioscaphoid angle and carpal height ratio occurred. Arthroscopic lunate fossa resection arthroplasty is a viable option for selected patients with Kienböck's disease.Level of evidence: IV.

A Spectrum of Ultrasound and MR Imaging of Fetal Gastrointestinal Abnormalities: Part 2 Anorectal Malformation, Liver, and Abdominal Wall Anomalies.

Ultrasound (US) and magnetic resonance imaging (MRI) are two modalities for diagnosing fetal gastrointestinal (GI) anomalies. Ultrasound (US) is the modality of choice. MRI can be used as a complementary method. Despite its expanding utilization in central nervous system (CNS) fetal malformation, MRI has not yet been established for evaluation of fetal GI abnormalities. Therefore, more attention should be paid to the clinical implications of MRI investigations following screening by US.

Outcomes of Arthroscopic Lunate Core Decompression Versus Radial Osteotomy in Treatment of Kienböck Disease.

PURPOSE: The purpose of the study was to evaluate the functional and radiographic outcomes of arthroscopic lunate decompression versus radial osteotomy in the treatment of Kienböck disease (KD). METHODS: In a prospective cohort design, we enrolled 82 patients with KD with Lichtman stages I to IIIb. Participants assigned themselves to groups by choosing either arthroscopic lunate core decompression and synovectomy (group A; n = 54) or radial osteotomy (group B; n = 28). For radial osteotomy, a distal radius volar approach was used and a shortening osteotomy (in negative and neutral ulnar variance) or lateral closing wedge osteotomy (in positive ulnar variance) was performed. Arthroscopic lunate core decompression was performed under direct visualization from the 3-4 portal using a shaver (through the 6R portal) and a cutting burr (through the trans-4 portal). The shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, visual analog scale (VAS) score for pain, wrist passive flexion/extension, grip strength, and radiographic assessments (Lichtman classification, radioscaphoid angle, carpal height ratio) were recorded before surgery and at the final follow-up. RESULTS: Sixty-four patients were included in the final analysis (44 in group A and 20 in group B). The mean ages of participants were 33 ± 11 years in group A and 31 ± 8 years in group B. The mean follow-up periods were 44 ± 20 months in group A and 37 ± 23 months in group B. The QuickDASH score, VAS score, and passive wrist movements significantly improved in both groups. Grip strength showed a significant increase in group A only. The postoperative functional analysis between the 2 groups showed no significant difference, except for the wrist passive extension, which was higher in group A. Lichtman staging remained the same in 79.5% and 73.6% of patients in groups A and B, respectively. CONCLUSIONS: An arthroscopic lunate core decompression and wrist synovectomy has comparable midterm results to radial shortening osteotomy in the treatment of KD. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Larger-scale ocean-atmospheric patterns drive synergistic variability and world-wide volatility of wheat yields.

Diagnosing potential predictability of global crop yields in the near term is of utmost importance for ensuring food supply and preventing socio-economic consequences. Previous studies suggest that a substantial proportion of global wheat yield variability depends on local climate and larger-scale ocean-atmospheric patterns. The science is however at its infancy to address whether synergistic variability and volatility (major departure from the normal) of multi-national crop yields can be potentially predicted by larger-scale climate drivers. Here, using observed data on wheat yields for 85 producing countries and climate variability from 1961-2013, we diagnose that wheat yields vary synergistically across key producing nations and can also be concurrently volatile, as a function of shared larger-scale climate drivers. We use a statistical approach called robust Principal Component Analysis (rPCA), to decouple and quantify the leading modes (PC) of global wheat yield variability where the top four PCs explain nearly 33% of the total variance. Diagnostics of PC1 indicate previous year's local Air Temperature variability being the primary influence and the tropical Pacific Ocean being the most dominating larger-scale climate stimulus. Results also demonstrate that world-wide yield volatility has become more common in the current most decades, associating with warmer northern Pacific and Atlantic oceans, leading mostly to global supply shortages. As the world warms and extreme weather events become more common, this diagnostic analysis provides convincing evidence that concurrent variability and world-wide volatility of wheat yields can potentially be predicted, which has major socio-economic and commercial importance at the global scale, underscoring the urgency of common options in managing climate risk.

Data of variability and joint variability of global crop yields and their association with climate.

We present the output data of Robust Principal Component Analysis (RPCA) applied to global crop yield variability of maize, rice, sorghum and soybean (MRSS) as presented in the publication "Climate drives variability and joint variability of global crop yields" (Najafi et al., 2019). Global maps of the correlation between all the principal components (PCs) acquired from the low rank matrix (L) of MRSS and Palmer Drought Severity Index (PDSI), air temperature anomalies (ATa) and sea surface temperature anomalies (SSTa) are provided in this article. We present co-varying countries, impacted cropland areas across global countries, and 10 global regions by climate and the association between PCs and multiple atmospheric and oceanic indices. Moreover, the joint dependency between PCs of MRSS yields are presented using two different approaches.

Climate drives variability and joint variability of global crop yields.

In this study, long-term national-based yields of maize, rice, sorghum and soybean (MRSS) from 1961 to 2013 are decomposed using Robust Principal Component Analysis (RPCA). After removing outliers, the first three principal components (PC) of the persistent yield anomalies are scrutinized to assess their association with climate and to identify co-varying countries and crops. Sea surface temperature anomalies (SSTa), atmospheric and oceanic indices, air temperature anomalies (ATa) and Palmer Drought Severity Index (PDSI) are used to study the association between the PCs and climate. Results show that large-scale climate, especially El Niño-Southern Oscillation (ENSO) and North Atlantic Oscillation (NAO) are strongly correlated with crop yield variability. Extensive maize harvesting regions in Europe and North America, rice in South America, Oceania and east of Asia, sorghum in west and southeast of Asia, North America and Caribbean and soybean in North and South America, Oceania and south of Asia experienced the influence of local climate variability in this period. Sorghum yield variability across the globe exhibits significant correlations with many atmospheric and oceanic indices. Results indicate that not only do the same crops in many countries co-vary significantly, but different crops, in particular maize, in different PCs also co-vary with other crops. Identifying the association between climate and crop yield variability and recognizing similar and dissimilar countries in terms of yield fluctuations can be informative for the identified nations with regard to the periodic and predictable nature of many large-scale climatic patterns.

Prevalence and Associated Risk Factors of Hyperglycemia and Diabetes Mellitus Among HIV Positive Patients in Tehran, Iran.

BACKGROUND: The introduction of Antiretroviral Therapy (ART) has resulted in the emergence of some metabolic complications including hyperglycemia and diabetes mellitus among HIV positive patients. The aim of this study was to investigate the prevalence of hyperglycemia, diabetes mellitus and their associated risk factors in HIV positive patients. METHODS: This cross-sectional study was conducted on HIV positive patients who visited Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital, Tehran, Iran (2004-2013). Medical records of patients were reviewed retrospectively. A logistic regression model was applied for analysis of the association between glycemic status and relevant risk factors. RESULTS: Out of 480 patients who were included in this study, 267 (55.6%) had hyperglycemia, including 28 (5.8%) with diabetes mellitus and 239 (49.8%) with pre-diabetes. The higher frequency of hyperglycemia, was found to be significantly associated with older age (OR for patients ˃40 years old, 2.260; 95% CI, 1.491, 3.247), male gender (OR, 1.555; 95% CI, 1.047, 2.311), higher Body Mass Index (OR for patients with BMI˃25 Kg/m², 1.706; 95% CI, 1.149, 2.531) and prolonged duration of HIV infection (OR for patients with duration of HIV infection ≥60 months, 2.027; 95% CI, 1.372, 2.992). CONCLUSION: Hyperglycemia, especially pre-diabetes, is highly frequent among Iranian people living with HIV. Male gender, older age, prolonged duration of HIV infection, and higher BMI were associated with a higher prevalence of hyperglycemia. Hence, it is important to screen all HIV infected patients at the time of diagnosis and then periodically for hyperglycemia.