Newborn size, infant and childhood growth, and body composition and cardiovascular disease risk factors at the age of 6 years: the Pune Maternal Nutrition Study.

OBJECTIVE: To study associations of size and body proportions at birth, and growth during infancy and childhood, to body composition and cardiovascular disease (CVD) risk factors at the age of 6 years. DESIGN: The Pune Maternal Nutrition Study, a prospective population-based study of maternal nutrition and CVD risk in rural Indian children. METHODS: Body composition and CVD risk factors measured in 698 children at 6 years were related to body proportions and growth from birth. MEASUREMENTS: Anthropometry was performed every 6 months from birth. At 6 years, fat and lean mass (dual X-ray absorptiometry) and CVD risk factors (insulin resistance, blood pressure, glucose tolerance, plasma lipids) were measured. RESULTS: Compared with international references (NCHS, WHO) the children were short, light and thin (mean weight <-1.0 s.d. at all ages). Larger size and faster growth in all body measurements from birth to 6 years predicted higher lean and fat mass at 6 years. Weight and height predicted lean mass more strongly than fat mass, mid-upper arm circumference (MUAC) predicted them both approximately equally and skinfolds predicted only fat mass. Neither birthweight nor the 'thin-fat' newborn phenotype, was related to CVD risk factors. Smaller MUAC at 6 months predicted higher insulin resistance (P<0.001) but larger MUAC at 1 year predicted higher systolic blood pressure (P<0.001). After infancy, higher weight, height, MUAC and skinfolds, and faster growth of all these parameters were associated with increased CVD risk factors. CONCLUSIONS: Slower muscle growth in infancy may increase insulin resistance but reduce blood pressure. After infancy larger size and faster growth of all body measurements are associated with a more adverse childhood CVD risk factor profile. These rural Indian children are growing below international 'norms' for body size and studies are required in other populations to determine the generalizability of the findings.

Cortical organization of sensory corrections in visuomotor skill acquisition.

During sensorimotor skill acquisition, early learning of the required neuromuscular pattern and sensorimotor mappings is followed by an intermediate stage of gradually increasing consistency and efficiency of execution, which gives way, with persistent practice, to the later stages of automatization. It has been suggested that the intermediate stage is distinguished by refinements in the background sensory corrections that support, stabilize and smoothen the fine motor adjustments required by the new coordination. While the later stages of motor refinement are thought to be sub-cortically organized, the neurophysiology of the proposed sensory learning component in the intermediate stage is not well understood. During explicit learning of a visually cued finger-tap sequence, the present research used fMRI to isolate those cortical activations that were significant in the immediate post-learning phase, but were not also observed during the corresponding pre-learning phase. Such exclusively post-learning activation occurred significantly more in visual and somatosensory association areas, than in primary somatosensory or primary and secondary motor areas. These results show that the intermediate stage of skill acquisition has a significant sensory learning component, and that the process has observable cortical correlates.

Fast re-rendering of volume and surface graphics by depth, color, and opacity buffering.

A method for quickly re-rendering volume data consisting of several distinct materials and intermixed with moving geometry is presented. The technique works by storing depth, color and opacity information, to a given approximation, which facilitates accelerated rendering of fixed views at moderate storage overhead without re-scanning the entire volume. Storage information in the ray direction (what we have called super-r depth buffering), allows rapid transparency and color changes of materials, position changes of sub-objects, dealing explicitly with regions of overlap, and the intermixing or separately rendered geometry. The rendering quality can be traded-off against the relative storage cost and we present an empirical analysis of output error together with typical figures for its storage complexity. The method has been applied to the visualization of medical image data for surgical planning and guidance, and presented results include typical clinical data. We discuss the implications of our method for haptic (or tactile) rendering systems, such as for surgical simulation, and present preliminary results of rendering polygonal objects in the volume rendered scene.

Multiresolution, model-based segmentation of MR angiograms.

During the last decade, the quality of MR angiograms has risen substantially and their clinical utility has been demonstrated progressively. This acceptance has created a need for tools with which to summarize and display the information available. We have used a model-based segmentation technique to extract vascular morphology and local flow parameters from phase contrast MR angiograms. A multiresolution data structure is used as the basis of recursive decision-making to identify regions of blood flow. The resulting data representation allows more efficient data handling in subsequent processing and visualization and is directly applicable to the creation of a connected graph model of vascular regions. We describe this flow feature extraction algorithm and demonstrate the utility of the results.

Computer-assisted surgical planning for cerebrovascular neurosurgery.

OBJECTIVE: We used three-dimensional reconstructed magnetic resonance images for planning the operations of 16 patients with various cerebrovascular diseases. We studied the cases of these patients to determine the advantages and current limitations of our computer-assisted surgical planning system as it applies to the treatment of vascular lesions. METHODS: Magnetic resonance angiograms or thin slice gradient echo magnetic resonance images were processed for three-dimensional reconstruction. The segmentation, based on the signal intensities and voxel connectivity, separated each anatomic structure of interest, such as the brain, vessels, and skin. A three-dimensional model was then reconstructed by surface rendering. This three-dimensional model could be colored, made translucent, and interactively rotated by a mouse-controlled cursor on a workstation display. In addition, a three-dimensional blood flow analysis was performed, if necessary. The three-dimensional model was used to assist in three stages of surgical planning, as follows: 1) to choose the best method of intervention, 2) to evaluate surgical risk, 3) to select a surgical approach, and 4) to localize lesions. RESULTS: The generation of three-dimensional models allows visualization of pathological anatomy and its relationship to adjacent normal structures, accurate lesion volume determination, and preoperative computer-assisted visualization of alternative surgical approaches. CONCLUSION: Computer-assisted surgical planning is useful for patients with cerebrovascular disease at various stages of treatment. Lesion identification, therapeutic and surgical option planning, and intraoperative localization are all enhanced with these techniques.

Outcome of teenage pregnancy.

Two hundred consecutive cases up to 19 years of age admitted for confinement at The Nowrosjee Wadia Maternity Hospital, Bombay, were studied. Out of these 200 girls, 6 were unmarried, 51 were anaemic, 20 had toxaemia of pregnancy. Six girls (43%) in the age group 15-17 years delivered prematurely as compared to only 26 girls (14%) in the age group of 17-19 years. This difference is statistically significant. Also, only, 4 girls (29%) in the age group of 15-17 years had full term normal delivery as compared to 113 girls (61%) in the age group of 17-19 years signifying that the outcome of pregnancy becomes worst in girls below the age of 17 years. Ten babies (71%) of mothers in the age group of 15-17 years were LBW as compared to 75 babies (44%) of mothers in the age group of 17-19 years signifying that the incidence of LBW babies is inversely proportional to maternal age. Teenage pregnant girls needed more attention for prevention and treatment of preeclampsia eclampsia, anaemia, prematurity and LBW.

Post-puerperal Cu-T insertion: a prospective study.

One hundred and sixty eight consecutive women accepting copper T (CuT) intrauterine contraceptive device in the post-puerperal period were studied. Out of them, 63 could be followed after 6 weeks of insertion and 65 after 6 months of insertion. The risk of heavy bleeding, pain in abdomen etc. were no greater than those usually found when interval CuT insertion is carried out. There was no case of uterine perforation leading to migration of CuT. But the expulsion rate was found to be high i.e. 16.4%. CuT is a very useful post-puerperal contraceptive method and should be given more importance in MCH programme.

PIP: Copper T IUDs were inserted in 168 postpartum women in Bombay, India, at 6 weeks to 3 months after delivery, and follow-up studies were made to compare results with those reported in the literature. 45.8% of the women were para 1, 46 were para 2, and 69% had accepted IUDs because they had at least one living male child. 63 of the women had follow-up examinations at 6 weeks, and 65 at 6 months. 11.1% and 16.9% complained of pain at 6 weeks and 6 months, respectively. The IUD was observed to be partially expelled and lying in the cervical os in 23.8% of the women at 6 weeks and in 9.2% at 6 months. Mild pelvic infection was diagnosed in 10% at 6 weeks and in 18% at 6 months, based on leukorrhea, erosion, or tenderness. There was 1 (1.5%) intrauterine pregnancy. These findings were comparable to previously reported results of large studies, with the exception of partial expulsion. Reasons cited in the literature for partial expulsion include parity, timing, and low insertion technique. The high incidence of partial expulsion was considered due to the atrophic or bulky uteri present in some of the women, and to the fact that only one size IUD was available.