Early wheeze as reported by mothers and lung function in 4‐year‐olds. Prospective cohort study in Krakow

The purpose of the study was to check the hypothesis that early wheezing as reported by mothers would be associated with reduced lung function in 4‐year olds. Study participants were recruited prenatally, as part of a prospective cohort study on the respiratory health of young children exposed to various ambient air pollutants. After delivery, infants were followed over 4 years and the interviewers visited participants at their home to record respiratory symptoms every 3 months in the child's first 2 years of life and every 6 months in the 3rd and 4th years. In the 4th year of follow‐up, children were invited for standard lung function testing by spirometry quantified by forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV₁), and forced expiratory volume in 0.5 sec (FEV_0.5) levels. Out of 258 children attending spirometry testing 139 performed at least two acceptable exhalation efforts. Cohort children with acceptable spirometric measurements did not differ with respect to wheezing experience and exposure characteristics from those without. The study shows that episodic wheeze was reported in 28.1% of 4‐year olds, 6.5% had transient wheeze, and 4.3% had recurrent wheeze. There was an increased frequency of wheezing symptoms and their duration in transient and recurrent wheezers. Adjusted multivariable regression models for gender and height showed that children who reported more than two episodes of wheezing at any point over the follow‐up had FVC values lower by 120.5 ml (P = 0.016) and FEV₁ values lower by 98.3 ml (P = 0.034) compared to those who did not report any wheezing; children experiencing more than 10 wheezing days by age 4 showed FVC deficit of 87.4 ml (P = 0.034) and FEV₁ values of 65.7 ml (P = 0.066). The ratios of FEV₁/FVC%, and FEV_0.5/FVC% were neither associated with wheezing episodes nor wheezing days. In recurrent wheezers, lung function decrement amounted to 207 ml of FVC, 175 ml of FEV₁, and 104 ml of FEV_0.5. In conclusion, our findings show that wheezing experience during early postnatal life may be associated with lung function deficit of restrictive character in preschool children and detailed history of wheeze in early postnatal life, even though not physician‐confirmed, may help define the high risk group of children for poor lung function testing. Pediatr. Pulmonol. 2010; 45:919–926. © 2010 Wiley‐Liss, Inc.     

Effect of Tai Chi on body balance: randomized controlled trial in elderly men with dizziness

The purpose of this study was to assess the effect of 18-week Tai Chi training on body balance in a dynamic trial among elderly men with dizziness. The study covered subjects aged 60 to 80 years. We identified 40 men who reported a history of dizziness. The subjects were recruited using direct mailings and a community information campaign. The participants were randomly assigned to either the exercise intervention (n = 20) or control group (n = 20). The Tai Chi group participated in an 18-week exercise class held for 45 minutes twice a week. Body balance was studied in two ways: using the "8 foot up and go test" (Rikli and Jones 2001) and using a Computer Posturographic System PE 90 (manufactured by Military Institute of Aviation Medicine in Warsaw and outfitted with Pro-Med modified software). The ability to perform specific tasks (maximal deflections in four directions) was measured on the posturographic platform. The variation in results obtained on the first and second date of tests in the experimental and control groups was confirmed statistically using four parameters, i.e. "8 foot up to and go test (H = 8.21;p = 0.003), forward deflection (H = 3.70;p = 0.050), backward deflection (H = 5.04;p = 0.024) and maximum sway area (H = 8.86;p = 0.002). Consequently, we found that the 18-week period of Tai-Chi exercises, with a frequency of twice a week for 45 minutes, is beneficial for dynamic balance, which is important for the reduction of fall risk factors among elderly men with dizziness.     

Apoptotic cell clearance in chronic inflammation of lateral neck cysts

The mechanism driving accumulation of large numbers of apoptotic and necrotic neutrophils in inflamed lateral neck cysts (LNC), in the absence of infection, remains obscure. The cellular content of cysts obtained from 17 patients was co-cultured with human macrophages. Phagocytosis levels of cyst-derived neutrophils were determined and compared to the uptake of spontaneously apoptotic neutrophils. Simultaneously, the expression of cytokines in macrophages exposed to cyst contents was measured. In comparison to spontaneously apoptotic neutrophils, the phagocytosis of LNC-derived neutrophils by macrophages was inefficient. An inverse correlation between neutrophil content in LNC and their uptake was observed. Macrophages co-cultured with cyst contents responded with variable expression of IL-6, TNF-α and IL-10. The hindered clearance of apoptotic neutrophils in LNC may lead to secondary necrosis of these cells and stimulation of the inflammatory reaction. Together with local production of anti-inflammatory cytokines, this may fuel chronic inflammation in the cysts.     

Effect of prenatal exposure to fine particulate matter on ventilatory lung function of preschool children of non‐smoking mothers

Jedrychowski WA, Perera FP, Maugeri U, Mroz E, Klimaszewska‐Rembiasz M, Flak E, Edwards S, Spengler JD. Effect of prenatal exposure to fine particulate matter on ventilatory lung function of preschool children of non‐smoking mothers. Paediatric and Perinatal Epidemiology 2010. Impaired fetal development is associated with a number of adult chronic diseases and it is believed that these associations arise as a result of the phenomenon of prenatal programming, which involves persisting changes in structure and function of various body organs caused by ambient factors during critical and vulnerable periods of early development. The main goal of the study was to assess the association between lung function in early childhood and prenatal exposure to fine particulate matter (PM_2.5), which represents a wide range of chemical compounds potentially hazardous for fetal development. Among pregnant women recruited prenatally to the study, personal measurements of PM_2.5 were performed over 48 h in the second trimester of pregnancy. After delivery, infants were followed for 5 years; the interviewers visited participants in their homes to record children's respiratory symptoms every 3 months in the child's first 2 years of life and every 6 months thereafter. In the fifth year of the follow‐up, children were invited for standard lung function testing of levels of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁) and forced expiratory volume in 0.5 s (FEV_0.5). There were 176 children of non‐smoking mothers, who performed at least two acceptable spirometry measurements. Multivariable linear regression showed a significant deficit of FVC at the highest quartile of PM_2.5 exposure (beta coefficient = ?91.9, P = 0.008), after adjustment for covariates (age, gender, birthweight, height and wheezing). Also FEV₁ level in children was inversely correlated with prenatal exposure to PM_2.5, and the average FEV₁ deficit amounted to 87.7 mL (P = 0.008) at the higher level of exposure. Although the effect of PM_2.5 exposure on FEV_0.5 was proportionally weaker (?72.7, P = 0.026), it was also statistically significant. The lung function level was inversely and significantly associated with the wheezing recorded over the follow‐up. The findings showed that significant lung function deficits in early childhood are associated with prenatal exposure to fine particulate matter, which may affect fetal lung growth.     

Methods for detecting interactions between genetic polymorphisms and prenatal environment exposure with a mother‐child design

Prenatal exposures such as polycyclic aromatic hydrocarbons and early postnatal environmental exposures are of particular concern because of the heightened susceptibility of the fetus and infant to diverse environmental pollutants. Marked inter‐individual variation in response to the same level of exposure was observed in both mothers and their newborns, indicating that susceptibility might be due to genetic factors. With the mother‐child pair design, existing methods developed for parent‐child trio data or random sample data are either not applicable or not designed to optimally use the information. To take full advantage of this unique design, which provides partial information on genetic transmission and has both maternal and newborn outcome status collected, we developed a likelihood‐based method that uses both the maternal and the newborn information together and jointly models gene‐environment interactions on maternal and newborn outcomes. Through intensive simulation studies, the proposed method has demonstrated much improved power in detecting gene‐environment interactions. The application on a real mother‐child pair data from a study conducted in Krakow, Poland, suggested four significant gene‐environment interactions after multiple comparisons adjustment. Genet. Epidemiol. 34: 125–132, 2010. © 2009 Wiley‐Liss, Inc.     

Rapid and automatic localization of the anterior and posterior commissure point landmarks in MR volumetric neuroimages

RATIONALE AND OBJECTIVE: Accurate identification of the anterior commissure (AC) and posterior commissure (PC) is critical in neuroradiology, functional neurosurgery, human brain mapping, and neuroscience research. Moreover, major stereotactic brain atlases are based on the AC and PC. Our goal is to provide an algorithm for a rapid, robust, accurate and automatic identification of AC and PC. MATERIALS AND METHOD: The method exploits anatomical and radiological properties of AC, PC and surrounding structures, including morphological variability. The localization is done in two stages: coarse and fine. The coarse stage locates the AC and PC on the midsagittal plane by analyzing their relationships with the corpus callosum, fornix, and brainstem. The fine stage refines the AC and PC in a well-defined volume of interest, analyzing locations of lateral and third ventricles, interhemispheric fissure, and massa intermedia. RESULTS: The algorithm was developed using simple operations, like histogramming, thresholding, region growing, 1D projections. It was tested on 94 diversified T1W and SPGR datasets. After the fine stage, 71 (76%) volumes had an error between 0-1 mm for the AC and 55 (59%) for the PC. The mean errors were 1.0 mm (AC) and 1.0 mm (PC). The accuracy has improved twice due to fine stage processing. The algorithm took about 1 second for coarse and 4 seconds for fine processing on P4, 2.5 GHz. CONCLUSION: The use of anatomical and radiological knowledge including variability in algorithm formulation aids in localization of structures more accurately and robustly. This fully automatic algorithm is potentially useful in clinical setting and for research.     

A hybrid approach to shape-based interpolation of stereotactic atlases of the human brain

Stereotactic human brain atlases, either in print or electronic form, are useful not only in functional neurosurgery, but also in neuroradiology, human brain mapping, and neuroscience education. The existing atlases represent structures on 2D plates taken at variable, often large intervals, which limit their applications. To overcome this problem, we propose a hybrid interpolation approach to build high-resolution brain atlases from the existing ones. In this approach, all section regions of each object are grouped into two types of components: simple and complex. A NURBS-based method is designed for interpolation of the simple components, and a distance map-based method for the complex components. Once all individual objects in the atlas are interpolated, the results are combined hierarchically in a bottom-up manner to produce the interpolation of the entire atlas. In the procedure, different knowledge-based and heuristic strategies are used to preserve various topological relationships. The proposed approach has been validated quantitatively and used for interpolation of two stereotactic brain atlases: the Talairach-Tournoux atlas and Schaltenbrand-Wahren atlas. The interpolations produced are of high resolution and feature high accuracy, 3D consistency, smooth surface, and preserved topology. They potentially open new applications for electronic stereotactic brain atlases, such as atlas reformatting, accurate 3D display, and 3D nonlinear warping against normal and pathological scans. The proposed approach is also potentially useful in other applications, which require interpolation and 3D modeling from sparse and/or variable intersection interval data. An example of 3D modeling of an infarct from MR diffusion images is presented.