Regression models for partially localized fMRI connectivity analyses.

Background: Brain functional connectivity analysis of resting-state functional magnetic resonance imaging (fMRI) data is typically performed in a standardized template space assuming consistency of connections across subjects. Analysis methods can come in the form of one-edge-at-a-time analyses or dimension reduction/decomposition methods. Common to these approaches is an assumption that brain regions are functionally aligned across subjects; however, it is known that this functional alignment assumption is often violated. Methods: In this paper, we use subject-level regression models to explain intra-subject variability in connectivity. Covariates can include factors such as geographic distance between two pairs of brain regions, whether the two regions are symmetrically opposite (homotopic), and whether the two regions are members of the same functional network. Additionally, a covariate for each brain region can be included, to account for the possibility that some regions have consistently higher or lower connectivity. This style of analysis allows us to characterize the fraction of variation explained by each type of covariate. Additionally, comparisons across subjects can then be made using the fitted connectivity regression models, offering a more parsimonious alternative to edge-at-a-time approaches. Results: We apply our approach to Human Connectome Project data on 268 regions of interest (ROIs), grouped into eight functional networks. We find that a high proportion of variation is explained by region covariates and network membership covariates, while geographic distance and homotopy have high relative importance after adjusting for the number of predictors. We also find that the degree of data repeatability using our connectivity regression model-which uses only partial location information about pairs of ROI's-is comparably as high as the repeatability obtained using full location information. Discussion: While our analysis uses data that have been transformed into a common template-space, we also envision the method being useful in multi-atlas registration settings, where subject data remains in its own geometry and templates are warped instead. These results suggest the tantalizing possibility that fMRI connectivity analysis can be performed in subject-space, using less aggressive registration, such as simple affine transformations, multi-atlas subject-space registration, or perhaps even no registration whatsoever.

Regression models for partially localized fMRI connectivity analyses.

Brain functional connectivity analysis of resting-state functional magnetic resonance imaging (fMRI) data is typically performed in a standardized template space assuming consistency of connections across subjects. This can come in the form of one-edge-at-a-time analyses or dimension reduction/decomposition methods. Common to these approaches is the assumption of complete localization (or spatial alignment) of brain regions across subjects. Alternative approaches completely eschew localization assumptions by treating connections as statistically exchangeable (for example, using the density of connectivity between nodes). Yet other approaches, such as hyperalignment, attempt to align subjects on function as well as structure, thereby achieving a different sort of template-based localization. In this paper, we propose the use of simple regression models to characterize connectivity. To that end, we build regression models on subject-level Fisher transformed regional connection matrices using geographic distance, homotopic distance, network labels, and region indicators as covariates to explain variation in connections. While we perform our analysis in template-space in this paper, we envision the method being useful in multi-atlas registration settings, where subject data remains in its own geometry and templates are warped instead. A byproduct of this style of analysis is the ability to characterize the fraction of variation in subject-level connections explained by each type of covariate. Using Human Connectome Project data, we found that network labels and regional characteristics contribute far more than geographic or homotopic relationships (considered non-parametrically). In addition, visual regions had the highest explanatory power (i.e., largest regression coefficients). We also considered subject repeatability and found that the degree of repeatability seen in fully localized models is largely recovered using our proposed subject-level regression models. Further, even fully exchangeable models retain a sizeable amount of repeatability information, despite discarding all localization information. These results suggest the tantalizing possibility that fMRI connectivity analysis can be performed in subject-space, using less aggressive registration, such as simple affine transformations, multi-atlas subject-space registration, or perhaps even no registration whatsoever.

The feasibility of screening for malnutrition in the outpatient setting and the prevalence of malnutrition in patients with newly-diagnosed ovarian carcinoma.

Introduction: Malnutrition is an independent risk factor for poor surgical outcomes, early chemotherapy discontinuation, and increased mortality. We evaluated the feasibility of outpatient malnutrition screening in patients with suspected gynecologic malignancy. We estimated the prevalence of malnutrition using Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (AND-ASPEN) criteria in patients undergoing surgery for newly-diagnosed ovarian carcinoma (OC). Methods: Patients scheduling a new clinic appointment for suspected gynecologic malignancy from 2/2018-2/2019 completed the Malnutrition Screening Tool via phone. Patients with positive screening test were recommended expedited Nutrition consultation. To estimate the prevalence of malnutrition in patients with newly-diagnosed OC, formal malnutrition evaluation by a Registered Dietician was ordered during hospitalization for all patients undergoing surgery (primary cytoreduction and interval cytoreduction) for newly-diagnosed OC. Results: Of 187 outpatients screened, 29 (16%) had a positive malnutrition screen. Eleven of 29 (38%) were willing to schedule outpatient Nutrition appointment; four were evaluated. Two (1% of all outpatients screened) were diagnosed with malnutrition. 107 patients underwent surgery for primary OC; 70 received Nutrition consult. Only 3 of 70 (4%) were formally diagnosed with malnutrition using AND-ASPEN criteria. Conclusion: Outpatient screening of patients with suspected gynecologic malignancy for malnutrition is feasible. However, the prevalence of malnutrition detected through outpatient screening and in the newly-diagnosed OC population is surprisingly low, suggesting that outpatient screening at time of initial consultation may not be ideal timing. Improving access to dietitians during chemotherapy and later in the cancer course when malnutrition is likely more prevalent may be beneficial.

Discussion of Weight Loss Surgery in Instagram Posts: Successive Sampling Study.

BACKGROUND: The majority of American adults search for health and illness information on the internet. However, the quality and accuracy of this information are notoriously variable. With the advent of social media, US individuals have increasingly shared their own health and illness experiences, including those related to bariatric surgery, on social media platforms. Previous research has found that peer-to-peer requesting and giving of advice related to bariatric surgery on social media is common, that such advice is often presented in stark terms, and that the advice may not reflect patient standards of care. These previous investigations have helped to map bariatric surgery content on Facebook and YouTube. OBJECTIVE: This objective of this study was to document and compare weight loss surgery (WLS)-related content on Instagram in the months leading up to the COVID-19 pandemic and 1 year later. METHODS: We analyzed a total of 300 Instagram posts (50 posts per week for 3 consecutive weeks in late February and early March in both 2020 and 2021) uploaded using the hashtag #wls. Descriptive statistics were reported, and independent 1-tailed chi-square tests were used to determine if a post's publication year statistically affected its inclusion of a particular type of content. RESULTS: Overall, advice giving and personal responsibility for outcomes were emphasized by WLS posters on Instagram. However, social support was less emphasized. The safety, challenges, and risks associated with WLS were rarely discussed. The majority of posts did not contain references to facts from reputable medical sources. Posts published in 2021 were more likely to mention stress/hardships of living with WLS (45/150, 30%, vs 29/150, 19.3%; P=.03); however, those published in 2020 more often identified the importance of ongoing support for WLS success (35/150, 23.3%, vs 16/150, 10.7%; P=.004). CONCLUSIONS: Given that bariatric patients have low rates of postoperative follow-up, yet post-operative care and yet support are associated with improved health and weight loss outcomes, and given that health content on the web is of mixed accuracy, bariatric professionals may wish to consider including an online support forum moderated by a professional as a routine part of postoperative care. Doing so may not only improve follow-up rates but may offer providers the opportunity to counter inaccuracies encountered on social media.

Focused Microbiome Shifts in Reconstructed Wetlands Correlated with Elevated Copper Concentrations Originating from Micronized Copper Azole-Treated Wood.

Micronized copper (Cu) azole (MCA) wood preservative formulations include Cu in nano form, and relatively little is known about longer term effects of Cu leached from MCA into wetland ecosystems. We tested the hypothesis that changes in soil microbiomes within reconstructed freshwater wetlands will be associated with exposure to elevated Cu concentrations originating from immersed MCA-treated wood stakes. Eight replicate communities were assembled with Willamette Valley (OR, USA) flood plain soil and clonally propagated wetland plants within mesocosms. Inundated communities were equilibrated for 5 months before installation of MCA or control southern yellow pine stakes (n = 4 communities/experimental group). Soil samples were collected for 16S and internal transcribed spacer amplicon sequencing to quantify responses in prokaryotes and eukaryotes, respectively, at 15 time points, spanning two simulated seasonal dry downs, for up to 678 days. Physiochemical properties of water and soil were monitored at 20 and 12 time points respectively, over the same period. For both taxonomic groups of organisms, phylogenetic diversity increased and was positively correlated with elapsed days. Furthermore, there was significant divergence among eukaryotes during the second year based on experimental group. Although the composition of taxa underwent succession over time, there was significantly reduced relative abundance of sequence variants from Gomphonema diatoms and Scutellinia fungi in communities where MCA wood stakes were present compared with the controls. These focused microbiome shifts were positively correlated with surface water Cu and soil Cu concentrations, which were significantly elevated in treated communities. The reconstructed communities were effective systems for assessing potential impacts to wetland microbiomes after exposure to released copper. The results further inform postcommercialization risk assessments on MCA-treated wood. Environ Toxicol Chem 2021;40:3351-3368. Published 2021. This article is a U.S. Government work and is in the public domain in the USA.

Where to from here? Identifying and prioritising future directions for addressing drug-resistant infection in Australia.

BACKGROUND: The Australian National Antimicrobial Resistance Strategy calls for a collaborative effort to change practices that have contributed to the development of drug-resistance and for implementation of new initiatives to reduce antibiotic use. METHODS: A facilitated workshop was undertaken at the 2019 National Australian Antimicrobial Resistance Forum to explore the complexity of antimicrobial stewardship (AMS) implementation in Australia and prioritise future action. Participants engaged in rotating rounds of discussion using a world café format addressing six topics relating to AMS implementation. Once all tables had discussed all themes the discussion concluded and notes were summarised. The documents were independently openly coded by two researchers to identify elements relating to the implementation of antimicrobial stewardship. RESULTS: There were 39 participants in the facilitated discussions, including pharmacists, infectious disease physicians, infection prevention nurses, and others. Participants discussed strategies they had found successful, including having a regular presence in clinical areas, adapting messaging and implementation strategies for different disciplines, maintaining positivity, and being patient-focused. Many of the recommendations for the next step involved being patient focussed and outcomesdriven. This involves linking data to practice, using patient stories, using data to celebrate wins and creating incentives. DISCUSSION: Recommendations from the workshop should be included in priority setting for the implementation of AMS initiatives across Australia.

Douglas-Fir ( Pseudotsuga menziesii (Mirb.) Franco) Transcriptome Profile Changes Induced by Diesel Emissions Generated with CeO2 Nanoparticle Fuel Borne Catalyst.

It is important to understand molecular effects on plants exposed to compounds released from use of products containing engineered nanomaterials. Here, we present mRNA sequencing data on transcriptome impacts to Douglas-fir following 2 weeks of sublethal exposure to 30:1 diluted airborne emissions released from combustion of diesel fuel containing engineered CeO2 nanoparticle catalysts (DECe). Our hypothesis was that chamber exposure to DECe would induce distinct transcriptome changes in seedling needles compared with responses to conventional diesel exhaust (DE) or filtered DECe Gas Phase. Significantly increased uptake/binding of Ce in needles of DECe treated seedlings was 2.7X above background levels and was associated with altered gene expression patterns. All 225 Blast2GO gene ontologies (GOs) enriched by up-regulated DECe transcripts were nested within GOs for DE, however, 29 of 31 enriched GOs for down-regulated DECe transcripts were unique. MapMan analysis also identified three pathways enriched with DECe down-regulated transcripts. There was prominent representation of genes with attenuated expression in transferase, transporter, RNA regulation and protein degradation GOs and pathways. CeO2 nanoparticle additive decreased and shifted molecular impact of diesel emissions. Wide-spread use of such products and chronic environmental exposure to DECe may adversely affect plant physiology and development.

Clinical Validation of a Test for the Diagnosis of Vaginitis.

OBJECTIVE: Vaginitis may be diagnosed as bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, or coinfection. A new molecular test assays the vaginal microbiome and organisms that cause three common infections. The objective of the trial was to evaluate the clinical accuracy of the investigational test for vaginal swabs collected by patients (self) or clinicians. The primary and secondary outcomes were to compare the investigational test with reference methods for the three most common causes of vaginitis and compare clinician-collected with self-collected swabs. METHODS: We conducted a cross-sectional study in which women with symptoms of vaginitis were recruited at ten clinical centers and consented to the investigation between May and September 2015. The woman collected a vaginal swab, sheathed, and then handed it to the clinician. These swabs were to evaluate how self-collected swabs compared with clinician-collected swabs. The clinician collected an investigational test swab and reference test swabs. From 1,740 symptomatic patients, clinician-collected and self-collected vaginal swabs were evaluated by the molecular test and six tests. The reference methods for bacterial vaginosis were Nugent's score and Amsel's criteria for intermediate Nugent results. The reference methods for Candida infection were isolation of any potential Candida microorganisms from inoculation of two culture media: chromogenic and Sabouraud agar and sequencing. The reference methods for trichomoniasis were wet mount and culture. RESULTS: For clinician-collected swabs, by reference methods, bacterial vaginosis was diagnosed in 56.5%, vaginal candidiasis in 32.8%, trichomoniasis in 8%, and none of the three infections in 24% with a coinfection rate of 20%. The investigational test sensitivity was 90.5% (95% confidence interval [CI] 88.3-92.2%) and specificity was 85.8% (95% CI 83.0-88.3%) for bacterial vaginosis. The investigational test sensitivity was 90.9% (95% CI 88.1-93.1%) and specificity was 94.1% (95% CI 92.6-95.4%) for the Candida group. Sensitivity for Candida glabrata was 75.9% (95% CI 57.9-87.8%) and specificity was 99.7% (95% CI 99.3-99.9%). Investigational test sensitivity was 93.1% (95% CI 87.4-96.3%) and specificity was 99.3% (95% CI 98.7-99.6%) for trichomoniasis. Results from self-collected swabs were similar to clinician-collected swabs. CONCLUSION: A molecular-based test using vaginal swabs collected by clinicians or patients can accurately diagnose most common bacterial, fungal, and protozoan causes of vaginitis. Women and their clinicians seeking accurate diagnosis and appropriate selection of efficacious treatment for symptoms of vaginitis might benefit from this molecular test.

Performance of the BD CTQx and GCQx Amplified Assays on the BD Viper LT Compared With the BD Viper XTR System.

We evaluated the BD Viper LT System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae using samples collected from symptomatic patients that included urine, vaginal swabs, and cervical samples in liquid-based cytology media. Results were compared with those obtained using the BD Viper XTR platform. The positive and negative percent agreements for all sample types were at least 95.8% and at least 96.4% for chlamydia and gonorrhea and at least 95.0% when both organisms were present, respectively. This medium throughput system performs well compared with a high-throughput platform and may offer smaller health care facilities the opportunity to test for these infections locally.

Changes in constructed Brassica communities treated with glyphosate drift.

We constructed a mixed-species community designed to simulate roadside and field edge plant communities and exposed it to glyphosate drift in order to test three hypotheses: (1) higher fitness in transgenic Brassica carrying the CP4 EPSPS transgene that confers resistance to glyphosate will result in significant changes in the plant community relative to control communities; (2) given repeated years of glyphosate drift selective pressure, the increased fitness of the transgenic Brassica with CP4 EPSPS will contribute to an increase in the proportion of transgenic progeny produced in plant communities; and (3) the increased fitness of Brassica carrying the CP4 EPSPS transgene will contribute to decreased levels of mycorrhizal infection and biomass in a host species (Trifolium incarnatum). Due to regulatory constraints that prevented the use of outdoor plots for our studies, in 2005 we established multispecies communities in five large cylindrical outdoor sunlit mesocosms (plastic greenhouses) designed for pollen confinement. Three of the community members were sexually compatible Brassica spp.: transgenic glyphosate-resistant canola (B. napus) cultivar (cv.) RaideRR, glyphosate-sensitive non-transgenic B. napus cv. Sponsor, and a weedy B. rapa (GRIN Accession 21735). Additional plant community members were the broadly distributed annual weeds Digitaria sanguinalis, Panicum capillare, and Lapsana communis. Once annually in 2006 and 2007, two mesocosms were sprayed with glyphosate at 10% of the field application rate to simulate glyphosate drift as a selective pressure. After two years, changes were observed in community composition, plant density, and biomass in both control and treatment mesocosms. In control mesocosms, the weed D. sanguinalis (crabgrass) began to dominate. In glyphosate drift-treated mesocosms, Brassica remained the dominant genus and the incidence of the CP4 EPSPS transgene increased in the community. Shoot biomass and mycorrhizal infection in Trifolium incarnatum planted in 2008 were significantly lower in mesocosms that had received glyphosate drift treatments. Our results suggest that, over time, glyphosate drift can contribute to persistence of Brassica that express the CP4 EPSPS transgene and that increased representation of Brassica (a non-mycorrhizal host) within plant communities may indirectly negatively impact beneficial ecosystem services associated with arbuscular mycorrhiza.

Effect of patient handling education on radiation therapy students.

OBJECTIVE: To assess the influence of an educational intervention on the knowledge, attitude, behavior and intention to use safe patient handling and movement (SPHM) of radiation therapy students during their initial clinical education experience. METHOD: Seventeen first-year students in a 2-year radiation therapy baccalaureate program received education on traditional manual patient handling and SPHM through 2 1-hour lectures and a 2-hour skills laboratory. Questionnaires and a group discussion were used to collect data on the students' knowledge, attitude, behavior and intention to use SPHM in clinical practice. RESULTS: Although students' patient handling knowledge improved following the educational intervention, their overall knowledge, attitude and intention to use SPHM did not change. However, fewer students perceived patient handling injuries to be a problem in radiation therapy after their initial clinical education. CONCLUSION: A gap exists between students' SPHM knowledge and their performance of the techniques. Educators should incorporate SPHM into their curriculum because the information helped students achieve high levels of perceived behavioral control, increased patient handling knowledge and positive attitudes regarding SPHM.

Patient factors related to voice therapy attendance and outcomes.

Limited information is available concerning factors that may be associated with attendance and outcomes among patients referred for voice therapy. The purpose of this study was to determine whether patient-related factors could be identified which distinguished patients who attended voice therapy and had positive voice change from those who did not. This retrospective study included medical record information for 100 patients seen at a major urban, academic medical center. The attendance/outcomes of voice therapy resulted in patient division into five groups, those who (1) were successfully discharged from therapy, (2) attended a few sessions, had voices that improved to normal or were near normal and then stopped attending therapy, (3) attended many sessions with some voice gain, (4) failed to improve despite attending voice therapy, or (5) failed to attend voice therapy as recommended. Outcomes for groups 1-3 (53% of patients) were considered successful (positive voice change), whereas outcomes for groups 4 and 5 (47% of patients) were considered unsuccessful. A high percentage of patients (44%) essentially did not attend therapy. Patients having successful outcomes were more likely to be female, younger, employed, with fewer laryngeal diagnoses and medical problems, a less severe voice disorder and lower Voice Handicap Index (VHI) scores at the start of therapy. Patients with more complex laryngeal diagnoses, more perceived vocal severity, occupational issues, more health issues, and higher VHI scores at the time of the initial voice evaluation may be at greater risk for failing to attend voice therapy sessions.

Influence of palatal expanders on oral comfort, speech, and mastication.

INTRODUCTION: It is not known whether the design of the expander has an effect on initial adaptation, comfort level, speech, chewing, and swallowing, or whether age is a crucial aspect when dealing with speech adaptations. The objectives of this study were to assess whether patients of different age groups undergoing palatal expansion with various types of expanders experienced discomfort, speech impairment, chewing difficulty, and swallowing disturbances. METHODS: A questionnaire was developed and distributed to patients who had received palatal expanders in the preceding 3 to 12 months. RESULTS: Regardless of the type of expander, most patients initially felt oral discomfort, and had problems with speech and mastication. However, these disturbances were confined to the first week after cementation of the device. Remarkable adaptation to the device in all aspects studied was observed by the end of the first week. In addition, age did not influence the variables; younger patients and older teenagers responded similarly to the survey. In addition, the questionnaire responses did not appear to be related to the respondents' sex. CONCLUSIONS: Discomfort might not be a deciding variable when choosing an appliance. Instead, clinicians should base their decision on factors such as its biomechanics.

My thoughts on teaching.

The Pfizer Distinguished Teacher Award, presented annually to a faculty member at each college or school of veterinary medicine in the United States, is the most prestigious teaching award in veterinary medicine. Originally this award was known as the Norden Award, named in honor of Carl J. Norden, founder of Norden Laboratories, but since 1963 it has been sponsored by Pfizer Animal Health. Awardees are selected by their individual colleges and schools based on the following criteria: teaching excellence in lectures, laboratories, and/or clinical settings; support of student learning and development outside of traditional venues, such as by counseling, advising of specialty clubs, and so on (extracurricular activities); and character and leadership. Students, peers, and administrators provide input into the various criteria. Each of the 28 colleges or schools of veterinary medicine in the United States is invited to submit the dossier of their awardee to a national selection committee sponsored by the Association of American Veterinary Medical Colleges (AAVMC). It gives me great pleasure to note that the committee has awarded the 2008 Pfizer Teaching Award to Dr. Bonnie Smith, Associate Professor of Anatomy, Embryology, and Physiology at the Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) at Virginia Tech. Dr. Smith began her faculty service at VMRCVM in 1991, and previous to that spent four years on the faculty at North Carolina State University. Her ability to make a positive impact in the lives of students and their learning has become legendary over the years. Likewise, as a member of the Curriculum Board (Committee) and serving on various course design teams, Dr. Smith has been a steadying force in guiding the curriculum through various iterations. Helping students and faculty keep a sense of balance throughout these changes has been one of her major contributions. As a testament to her long-term teaching excellence, Dr. Bonnie Smith has received at least 22 different awards and citations for teaching excellence, two of which came very early in her career while she was at North Carolina State University. Most notable among these many awards is the fact that she is now a three-time recipient of the Pfizer Teaching Award. Dr. Smith has also been nominated by Student AVMA for a Teaching Excellence Award in Basic Sciences and has received an Honorable Mention, Teacher of the Year Award from the AVMA. Additionally, she has received an Alumni Teaching Award and a University Award for Teaching Excellence, and she has been elected to the Virginia Tech Academy of Teaching Excellence. Each of these three awards recognizes the best educators on Virginia Tech's faculty. Students have been very articulate in their praise of Dr. Smith's teaching. The comments received include "She has developed a unique teaching style that infuses traditional lectures with her unrelenting energy while never sacrificing content or complexity" and "She approaches the material from many angles, with clear verbalization of concepts, creatively utilizing stories and metaphors for clarification." Finally, a very fitting comment that illustrates her impact on her students: "Outside the classroom, Dr. Smith also influences many of us by serving as a strong female role model. In the face of life's hardships, she perseveres with an unshakably positive spirit. She encourages us to excel in all we do within the walls of our school and in our own lives." Peers have likewise been most complimentary of Dr. Smith's abilities as an educator. Examples from her nomination packet include the following: "Dr. Smith is truly a Master Teacher of the college. She has consistently demonstrated exemplary qualities of teaching, dedication and work ethic. She has received every teaching award the College has to offer and is consistently recognized by students, peers and the University" and "She epitomizes the qualities we have come to associate with teaching excellence. First and foremost is her dedication and commitment to student learning. Second, Dr. Smith's rapport with her students is outstanding because she invests the time necessary to gain their trust so she knows exactly what they are struggling with in her course. Third, she has the uncommon ability and desire to reach into students' minds and hearts to tailor instruction to meet individual learning styles and needs. Indeed, Dr. Smith is extremely gifted in being able to take complex details and concepts, and simplify, organize and present them in a very clear, understandable fashion." Other peer comments include: "Dr. Smith's animated and enthusiastic style was very effective and well-received"; "She is commended for her very good use of metaphors, examples and humor"; and "We all agree that attending Dr. Smith's lectures was beneficial to us as well as to the students! Keep up the fine work." In summary, Dr. Smith is to be sincerely congratulated on receiving this prestigious award. It is well deserved, based on her long history of teaching excellence and on the positive impact she has had in the lives of her students. -J. Blair Meldrum, Professor of Toxicology, Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, and Chair, VMRCVM Pfizer Teaching Award Selection Committee.

Late-gestation ventricular myocardial reduction in fetuses of hyperglycemic CD1 mice is associated with increased apoptosis.

BACKGROUND: Previous work in our laboratory showed reduced myocardium and dilated ventricular chambers in gestation day (GD) 17 hearts that were collected from hyperglycemic CD1 mouse dams. Pre-breeding maternal immune stimulation, using Freund's complete adjuvant (FCA), diminished the severity of these fetal heart lesions. The following experiments were performed to detect possible changes in fetal heart apoptotic cell death, under hyperglycemic conditions and with or without maternal immune stimulation. METHODS: Female CD1 mice were injected with 200 mg/kg of streptozocin (STZ) to induce insulin-dependent diabetes mellitus. Half of these mice received prior FCA injection. Fetal hearts were collected on GD 17 and myocardial apoptotic cells were quantified using flow cytometry. A panel of apoptosis regulatory genes (Bcl2, p53, Casp3, Casp9, PkCe) was then examined in the fetal myocardium using RT-PCR. RESULTS: Early apoptotic cells and late apoptotic/necrotic cells were significantly increased in fetal hearts from STZ or STZ+FCA dams. Pre-treatment with FCA reduced late apoptotic/necrotic cells to control level, suggesting some cell death protection was rendered by FCA. Paradoxically in the face of such increased cell death, the expression of pro-apoptotic genes Casp3 and Casp9 was decreased by diabetes, while the anti-apoptotic gene Bcl2 was increased. CONCLUSIONS: Maternal hyperglycemia causes dys-regulated apoptosis of fetal myocardial cells. Such effect may be prevented by maternal immune stimulation.

Long-term effects of orthodontic therapy on the maxillary dental arch and nasal cavity.

INTRODUCTION: Rapid maxillary expansion (RME) can enlarge the maxillary dental arch while increasing nasal cavity volume and nasal valve area, and decreasing upper airway resistance over time. However, the long-term effects of RME on arch morphology and nasal cavity geometry in patients treated with RME compared with the general population are unclear. METHODS: Three-dimensional morphometic analysis and acoustic rhinometry were used to evaluate the maxillary dental arches and nasal cavities in a post-RME-treatment group (n = 25) and a control group (n = 25). RESULTS: Palatal area and volume increased substantially after expansion and remained stable until posttreatment. Small increases in intermolar distance were not significant between the time points. Nasal airway resistance significantly decreased after RME and remained stable until posttreatment. Nasal cavity volume was stable during expansion and posttreatment. It increased significantly during expander stabilization and 9-12 months after expander removal. The minimal cross-sectional area significantly increased between the end of expansion and expander removal and remained stable until posttreatment. All measurements were comparable with those of the matched controls at posttreatment except for palatal area, which was smaller in the treatment group. CONCLUSIONS: RME is a powerful tool to normalize most of the variables investigated. Edgewise orthodontic treatment and a retention regimen that consisted of maxillary circumferential or traditional Hawley retainers met satisfactory standards to stabilize the achieved outcomes. Future studies should include morphometric, functional, and skeletal analyses so that the effects of growth and remodeling are better elucidated.

Heart changes in 17-day-old fetuses of diabetic ICR (Institute of Cancer Research) mothers: improvement with maternal immune stimulation.

Maternal diabetes mellitus is associated with increased fetal teratogenesis, including cardiovascular defects. Non-specific maternal immune stimulation with Freund's complete adjuvant (FCA) or interferon gamma (IFNgamma) has been associated with protection against birth malformations. Using a diabetic mouse model, late-gestation fetal heart and great vessel morphology were analyzed. Four groups of mice were used: non-diabetic females as a control group, hyperglycemic females induced by streptozotocin as a diabetic group, and diabetic females injected either with FCA or IFNgamma. At day 17 of gestation, females were euthanized and one fetus was arbitrarily selected per litter for fixation and sectioning. Treatment-induced changes in cardiac development were assessed from digital images of serial sections taken at standardized levels in the thorax. One-way parametric and non-parametric ANOVA and ordinal logistic regression were performed to compare the difference among groups (P<0.05). Maternal hyperglycemia altered morphology of the late-gestation fetal mouse heart by causing ventricular chamber dilation, sectional myocardial reduction, and an increase in transversal aortic area. FCA protected the fetal heart from cavitary dilation in diabetic mothers. FCA and IFNgamma protected the fetal heart against reduction of myocardial area, and ascending thoracic aorta dilation. Consequences of late gestation heart chamber dilation and myocardial reduction are not yet known. Maternal immune stimulation partially protected against these developmental defects by mechanisms that remain unclear.

Atrial fibrillation after cardiac surgery: does prophylactic therapy decrease adverse outcomes associated with atrial fibrillation.

Atrial fibrillation is a common problem following cardiac surgery. Atrial fibrillation occurs in 30% to 50% patients during postoperative period. Postoperative atrial fibrillation often results in increased length of hospital stay, increased cost of postoperative hospitalization, heart failure, and, less frequently, cerebrovascular accident and death. Because postoperative atrial fibrillation is such a significant problem, several studies have attempted to find a safe and effective treatment for its prevention. In this article, we review the evidence for various prophylactic therapies and make an attempt to answer the following: (1) Can postoperative atrial fibrillation be prevented? (2) Is prophylactic therapy for postoperative atrial fibrillation safe? (3) Does prevention of postoperative atrial fibrillation prevent adverse outcomes associated with it? Evidence for safety and efficacy or lack of beta-blockers, sotalol, amiodarone, intravenous magnesium, and atrial pacing is reviewed and current recommendations by the American College of Cardiology/American Heart Association/European Society of Cardiology are presented.

Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: short- and long-term effects.

INTRODUCTION: The availability of new, reliable, objective, and 3-dimensional techniques to assess the effects of rapid maxillary expansion on the morphology of the maxillary dental arch, nasal cavity dimensions, and nasal airway resistance led to the development of this research. METHODS: Thirty-eight subjects participated in this study (mean age, 13 years). Data were collected before expansion, when the expander was stabilized, when the expander was removed, and 9 to 12 months after the expander was removed. Subjective assessment of improvement in nasal respiration was obtained when the expander was stabilized. Three-dimensional imaging and acoustic rhinometry were used to assess the virtual cast and the nasal cavity, respectively. RESULTS AND CONCLUSIONS: The statistically significant short-term effects of RME were (1) mean increases in palatal area, volume, and intermolar distance; (2) a mean reduction of nasal airway resistance; and (3) mean increases in total nasal volume and nasal valve area. Our long-term findings were the following: (1) mean palatal area and intermolar distance were reduced, while palatal volume was stable, and (2) nasal airway resistance was stable, whereas mean nasal cavity volume and minimal cross-sectional area increased. Additionally, 61.3% of our subjects reported subjective improvement in nasal respiration. Weak correlations were found between all variables analyzed.