Feed-forward neural networks using cerebral MR spectroscopy and DTI might predict neurodevelopmental outcome in preterm neonates.

OBJECTIVES: We aimed to evaluate the ability of feed-forward neural networks (fNNs) to predict the neurodevelopmental outcome (NDO) of very preterm neonates (VPIs) at 12 months corrected age by using biomarkers of cerebral MR proton spectroscopy (1H-MRS) and diffusion tensor imaging (DTI) at term-equivalent age (TEA). METHODS: In this prospective study, 300 VPIs born before 32 gestational weeks received an MRI scan at TEA between September 2013 and December 2017. Due to missing or poor-quality spectroscopy data and missing neurodevelopmental tests, 173 VPIs were excluded. Data sets consisting of 103 and 115 VPIs were considered for prediction of motor and cognitive developmental delay, respectively. Five metabolite ratios and two DTI characteristics in six different areas of the brain were evaluated. A feature selection algorithm was developed for receiving a subset of characteristics prevalent for the VPIs with a developmental delay. Finally, the predictors were constructed employing multiple fNNs and fourfold cross-validation. RESULTS: By employing the constructed fNN predictors, we were able to predict cognitive delays of VPIs with 85.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99.1% negative predictive value (NPV). For the prediction of motor delay, we achieved a sensitivity of 76.9%, a specificity of 98.9%, a PPV of 90.9% and an NPV of 96.7%. CONCLUSION: FNNs might be able to predict motor and cognitive development of VPIs at 12 months corrected age when employing biomarkers of cerebral 1H-MRS and DTI quantified at TEA. KEY POINTS: • A feed-forward neuronal network is a promising tool for outcome prediction in premature infants. • Cerebral proton magnetic resonance spectroscopy and diffusion tensor imaging can be used for the construction of early prognostic biomarkers. • Premature infants that would most benefit from early intervention services can be spotted at the time of optimal neuroplasticity.

[Persistence of Chlamydia trachomatis in patients with chronic therapy refractory conjunctivitis]. / Persistenz von Chlamydia trachomatis bei Patienten mit chronischer therapieresistenter Konjunktivitis.

We report three patients with recurrent Chlamydia-associated conjunctivitis. The clinical course of the Chlamydial infection was documented by positive conjunctival smears (direct immunofluorescence staining) and the evaluation of the IgA-titer in the sera (immunoperoxidase assay). The recovery of the ocular symptoms after therapy onset correlated well with the negative results of the conjunctival smears and the decrease in IgA level in the sera. The recurrence of the conjunctivitis was accompanied by an increase in the IgA titer in the sera of all three patients and the presence of Chlamydial elementary bodies in the conjunctival scrapings in two cases. Three patients showed immunologic pecularities: two had an allergic diathesis; the third patient developed Wegener disease 3 months after the onset of ocular inflammation. Inclusion bodies or Chlamydial DNA can persist in conjunctival cells. Anderson suggested that a recurrence of active Chlamydial infection may be induced by external causes, which lead to reconstitution of elementary bodies from the persisting DNA. The extraordinary immune situation of our patients might be one cause of the recurrent conjunctivitis.

[Long-term biometric results in glaucoma in children]. / Biometrische Langzeitergebnisse bei Glaukom im Kindesalter.

In a retrospective study 30 eyes of 18 patients suffering from developmental glaucoma (primary congenital glaucoma, Sturge Weber syndrome, juvenile glaucoma) were examined after surgery. The mean follow-up period was 13 years. Eyeball length and anterior chamber depth were measured by means of echooculometry. Biometric data (echooculometry, corneal diameter, cup to disk ratio) were compared with psychophysic data (visual acuity, visual field). Up to an axial length of 26 mm, myopia caused by elongation of the eyeball is compensated by the weak refractive power of the large cornea. In cases with an eyeball length of more than 27 mm, excessive myopia was found. There is a linear correlation between corneal diameter and axial length of the eyeball. In all cases with an axial length of more than 27 mm only low vision was achieved. From our results can be concluded that 27 mm is the "critical" eyeball length which carries a grave prognosis. Due to the late (minimum 4 years) onset of the disease, all the operated eyes with Sturge Weber syndrome and juvenile glaucoma were in normal size.

[Eye injuries in childhood]. / Augenverletzungen im Kindesalter.

A retrospective study was performed of eye injuries sustained by children up to 15 years old who had to be hospitalized for treatment. The period under review covered five years. The authors reviewed 241 cases with regard to cause of injury, type of injury, treatment, duration of hospitalization and consequences, if any. Most of the injuries were caused by other children, while playing. By far the most common injury was contusion of the bulb, seen in 107 cases. The results of the study published here contain a further breakdown of the criteria mentioned above.