Increased Risk of Gestational Hypertension by Periconceptional Exposure to Ambient Air Pollution and Effect Modification by Prenatal Depression.

BACKGROUND: Air pollution has been associated with gestational hypertension (GH) and preeclampsia, but susceptible windows of exposure and potential vulnerability by comorbidities, such as prenatal depression, remain unclear. METHODS: We ascertained GH and preeclampsia cases in a prospective pregnancy cohort in Los Angeles, CA. Daily levels of ambient particulate matters (with a diameter of ≤10 µm [PM10] or ≤2.5 µm [PM2.5]), nitrogen dioxide, and ozone were averaged for each week from 12 weeks preconception to 20 gestational weeks. We used distributed lag models to identify susceptible exposure windows, adjusting for potential confounders. Analyses were additionally stratified by probable prenatal depression to explore population vulnerability. RESULTS: Among 619 participants, 60 developed preeclampsia and 42 developed GH. We identified a susceptible window for exposure to PM2.5 from 1 week preconception to 11 weeks postconception: higher exposure (5 µg/m3) within this window was associated with an average of 8% (95% CI, 1%-15%) higher risk of GH. Among participants with probable prenatal depression (n=179; 32%), overlapping sensitive windows were observed for all pollutants from 8 weeks before to 10 weeks postconception with increased risk of GH (PM2.5, 16% [95% CI, 3%-31%]; PM10, 39% [95% CI, 13%-72%]; nitrogen dioxide, 65% [95% CI, 17%-134%]; and ozone, 45% [95% CI, 9%-93%]), while the associations were close to null among those without prenatal depression. Air pollutants were not associated with preeclampsia in any analyses. CONCLUSIONS: We identified periconception through early pregnancy as a susceptible window of air pollution exposure with an increased risk of GH. Prenatal depression increases vulnerability to air pollution exposure and GH.

Rudimentary Dexterity Corresponds With Reduced Ability to Move in Synergy After Stroke: Evidence of Competition Between Corticoreticulospinal and Corticospinal Tracts?

OBJECTIVE: When a stroke damages the corticospinal tract (CST), it has been hypothesized that the motor system switches to using the corticoreticulospinal tract (CRST) resulting in abnormal arm synergies. Is use of these tracts mutually exclusive, or can the motor system spontaneously switch between them depending on the type of movement it wants to make? If the motor system can share control at will, then people with a rudimentary ability to make dexterous movements should be able to perform synergistic arm movements as well. METHODS: We analyzed clinical assessments of 319 persons' abilities to perform "out-of-synergy" and "in-synergy" arm movements after chronic stroke using the Upper Extremity Fugl-Meyer (UEFM) scale. RESULTS: We identified a moderate range of arm impairment (UEFM = ~30-40) where subjects had a rudimentary ability to make out-of-synergy (~23%-50% on the out-of-synergy score) and dexterous hand movements (~3-10 blocks on Box and Blocks Test). Below this range persons could perform in-synergy but not out-of-synergy or dexterous movements. In the moderate range, however, scoring better on out-of-synergy movements correlated with scoring worse on in-synergy movements (P = .001, r ≈ -0.6). CONCLUSION: Rudimentary dexterity corresponded with reduced ability to move the arm in-synergy. This finding supports the idea that CST and CRST compete and has implications for rehabilitation therapy.

Cierre de fístulas nasopalatinas recurrentes con plasma rico en factores de crecimiento en pacientes con paladar hendido / Closure of recurrent cleft palate fistulas with plasma rich in growth factors

Introducción y objetivo: Las fístulas palatinas representan un desafío importante en el tratamiento del paladar hendido. Los mejores resultados de una palatoplastia se obtienen con un esfínter velofaríngeo competente y un paladar sin fístulas. En la literatura se describe que la recurrencia de fístulas palatinas primarias es de hasta el 76% y las recurrentes es de aproximadamente el 100%. El plasma rico en factores de crecimiento (PRGF) es un hemoderivado autólogo con sustancias biológicamente activas que promueven los mecanismos de reparación tisular como quimiotaxis, proliferación celular, angiogénesis, osteogénesis y remodelación. No se ha descrito su uso en reparación de fístulas nasopalatinas. Nuestro objetivo fue evaluar el cierre exitoso de fístulas palatinas recurrentes con el uso del PRGF combinado con injerto óseo autólogo. Pacientes y método: Se realizó un estudio experimental, prospectivo, longitudinal desde abril 2008 a julio 2010, con un total de 11 fístulas nasopalatinas, las cuales se cerraron por medio de colgajos mucoperiósticos locales y colocación de injerto óseo autólogo mezclado con PRGF. Resultados: Con un seguimiento de 6-24 meses, se demostró el cierre completo de las fístulas en el 90,9%, disminuyendo el índice de recurrencia descrito con otras técnicas por otros autores. Conclusión: El uso de PRGF mezclado con injerto óseo autólogo parece ser una alternativa eficaz, segura y de bajo costo para el cierre de fístulas palatinas, sin embargo su estudio debe ser ampliado (AU)

Introduction and objective: Fistulas represent a significant challenge in the treatment of cleft palate. The best outcome of a palatoplasty is obtained with a competent velopharyngeal sphincter and a palate without fistulas. The recurrence of primary cleft palate fistula is reported as high as up to 76%, and to nearly 100% in recurrent fistulas. Plasma rich in growth factors (PRGF) is an autologous blood product with biologically active substances that enhance tissue repair mechanisms such as chemotaxis, cell proliferation, angiogenesis, osteogenesis and remodeling. Its use in cleft palate fistulas has not been reported. Our objective was to evaluate closure of recurrent cleft palate fistulas using PRGF mixed with autologous bone graft. Methods: An experimental, prospective, longitudinal study was carried out from April 2008 to July 2010 on 11 recurrent cleft palate fistulas that were closed with local mucoperiosteal flaps and placement of autologous bone graft mixed with PRGF. Results: Complete closure of palate fistulas was achieved in 90.9% (follow-up of 6-C24 months), decreasing the reported incidence for the recurrence by other authors with other techniques. Conclusions: The use of PRGF mixed with autologous bone graft seems to be an effective, safe and low-cost technique for the closure of recurrent cleft palate fistulas. However, we consider its study must be extended (AU)

[Closure of recurrent cleft palate fistulas with plasma rich in growth factors]. / Cierre de fístulas nasopalatinas recurrentes con plasma rico en factores de crecimiento en pacientes con paladar hendido.

INTRODUCTION AND OBJECTIVE: Fistulas represent a significant challenge in the treatment of cleft palate. The best outcome of a palatoplasty is obtained with a competent velopharyngeal sphincter and a palate without fistulas. The recurrence of primary cleft palate fistula is reported as high as up to 76%, and to nearly 100% in recurrent fistulas. Plasma rich in growth factors (PRGF) is an autologous blood product with biologically active substances that enhance tissue repair mechanisms such as chemotaxis, cell proliferation, angiogenesis, osteogenesis and remodeling. Its use in cleft palate fistulas has not been reported. Our objective was to evaluate closure of recurrent cleft palate fistulas using PRGF mixed with autologous bone graft. METHODS: An experimental, prospective, longitudinal study was carried out from April 2008 to July 2010 on 11 recurrent cleft palate fistulas that were closed with local mucoperiosteal flaps and placement of autologous bone graft mixed with PRGF. RESULTS: Complete closure of palate fistulas was achieved in 90.9% (follow-up of 6-24 months), decreasing the reported incidence for the recurrence by other authors with other techniques. CONCLUSIONS: The use of PRGF mixed with autologous bone graft seems to be an effective, safe and low-cost technique for the closure of recurrent cleft palate fistulas. However, we consider its study must be extended.