Motor planning and control in autism. A kinematic analysis of preschool children

Kinematic recordings in a reach and drop task were compared between 12 preschool children with autism without mental retardation and 12 gender and age-matched normally developing children. Our aim was to investigate whether motor anomalies in autism may depend more on a planning ability dysfunction or on a motor control deficit. Planning and control processes were separately investigated by examining kinematic recordings divided into primary movement- (planning-based) and corrective submovement- (control-based) phases.Despite longer movement durations, participants with autism were as accurate in their movements as normally developing children were and showed a preserved movement structure. No differences were observed for the initial movement phases for hand velocity, accuracy and inter-trial variability.Our main finding was that of a group difference in proximity of the target, at transition from planning-based to control-based movement guidance. At primary movement conclusion, the normally developing children had already reduced velocity and begun orienting their hands for ball drop. Also, they tended to terminate movements within the same movement unit that had transported the hand into the target box. Compared to this group, participants with autism reached this stage with less preparation: their speed was significantly higher, wrist inclination reduced and they showed further movement units after entering the box over the vast majority of trials. These additional movement units were presumed to represent late control-based spatial adjustments. Hence, our data support the hypothesis that children with autism have a greater need for corrective submovements.We provide evidence that motor anomalies in autism might be determined either by a disruption in planning-control integration, or by a limited planning process capacity, as participants with autism might have been able to plan only the very beginning of the movement, leaving its final phases to further planning on the fly, with important consequences on movement time optimization.     

Maternal body mass index and duration of labor

Objective

To evaluate whether the duration of the active phase of labor is associated with maternal body mass index (BMI), in nulliparous women with spontaneous onset of labor.

Study design

Historical prospective cohort study including 63,829 nulliparous women with a singleton pregnancy and a spontaneous onset of labor, who delivered between January 1, 1995 and December 31, 2009. Data were collected from the Perinatal Revision South registry, a regional perinatal database in Southern Sweden. Women were categorized into six classes of BMI. Overweight and obese women were compared to normal weight women regarding duration of active labor. Adjustments were made for year of delivery, maternal age and infant birth weight.

Results

The median duration of labor was significantly longer in obese women (class I obesity (BMI 30–34.9) = 9.1 h, class II obesity (BMI 35–39.9) = 9.2 h and class III obesity (BMI > 40) = 9.8 h) compared to normal-weight women (BMI 18.5–24.9) = 8.8 h (p < 0.001). The risk of labor lasting more than 12 h increased with increasing maternal BMI: OR 1.04 (1.01–1.06) (OR per 5-units BMI-increase).The risk of labor lasting more than 12 h or emergency cesarean section within 12 h, compared to vaginal deliveries within 12 h, increased with increasing maternal BMI. Duration of the second stage of labor was significantly shorter in obese women: in class III obesity the median value was 0.45 h compared to normal weight women, 0.55 h (p < 0.001).

Conclusion

In nulliparous women with a spontaneous onset of labor, duration of the active phase of labor increased significantly with increasing maternal BMI. Once obese women reach the second stage they deliver more quickly than normal weight women, which implies that the risk of prolonged labor is restricted to the first stage of labor. It is clinically important to consider the prolonged first stage of labor in obese women, for example when diagnosing first stage labor arrest, in order to optimize management of this rapidly growing at-risk group of women. Thus, it might be reasonable to adapt the considered upper limit for duration of labor, according to maternal BMI.     

Complete loss of unilateral renal function secondary to endometriosis: a report of three cases

Objectives

To report the impact that urinary tract endometriosis may have on renal function. Ureteral endometriosis is an uncommon and silent cause of renal injury. It is therefore very important to be highly suspicious in order to be able to make an early diagnosis and thus prevent renal failure.

Study design

Case reports of the management and outcome of three cases of premenopausal women with deep endometriosis affecting the ureter, associated with secondary unilateral complete loss of renal function.

Results and conclusions

Ureteral involvement by endometriosis is a rare and often silent disease which is capable of producing significant morbidity, as it can lead to hydronephrosis and ultimately to renal failure. Because of the lack of specific symptoms and the limitations of imaging methods, a high index of suspicion is necessary to obtain an early diagnosis. On diagnosis of deep infiltrating endometriosis, urinary tract ultrasound is a screening tool to detect ureterohydronephrosis due to ureteral obstruction. MRI is of value to map the extent of disease. Surgery is the treatment of choice to remove endometriotic lesions and relieve ureteral obstruction if the kidney is still functional, or to perform a nephrectomy if there is a complete loss of renal function.     

Prophylaxis of Recurrent Preeclampsia: Low-Molecular-Weight Heparin plus Low-Dose Aspirin versus Low-Dose Aspirin Alone

Objective: To verify whether prophylaxis with low-molecular-weight heparin (LMWH) and low-dose aspirin (LDA) could positively affect pregnancy outcome in women with a history of severe preeclampsia. Methods: We compared 23 pregnancies treated with LDA alone to 31 pregnancies treated with LMWH plus LDA. Results: Women treated with LMWH-LDA (n = 31) showed a better pregnancy outcome than those treated with LDA alone (n = 23) in terms of gestational age at delivery (p < 0.05), birth weight (p < 0.01), birth weight percentile (p < 0.01), and rate of preeclampsia (p < 0.01). Furthermore, comparing the intra-group outcome variation between previous and index pregnancies, an improvement appeared in each group, but a more pronounced gain was noted in the LMWH-LDA group in terms of gestational age at delivery (p< 0.005), birth weight (p < 0.005), and birth weight percentile (p < 0.005). Conclusions: Thromboprophylaxis with LMWH plus LDA can improve pregnancy outcome in women with previous severe preeclampsia.     

Cytological aspects of the nasal respiratory epithelium in reproductive-age women taking oral contraceptives

Objective To determine the effects of monophasic oral contraceptives on the nasal respiratory epithelium in premenopausal women.

Design Prospective open clinical trial.

Setting Outpatient Family Planning Centre.

Patient(s) Eighty-eight premenopausal women, with ovulatory cycle, who were planning to take oral contraceptives.

Intervention(s) Baseline endovaginal ultrasound examination and blood test to measure serum progesterone to confirm ovulatory cycle. Thirty-eight women on pill containing 30 μg ethinylestradiol (EE) plus 75 μg gestodene, and 35 women on pill containing 15 μg ethinylestradiol plus 60 μg gestodene.

Main outcomes/Measure(s) Cytological changes on the nasal respiratory epithelium evaluated with the maturation index performed during the follicular, periovular, and luteal phases of the menstrual cycle, and on the sixth cycle of pill intake.

Result(s) Hematoxylin-eosin staining for the maturation index showed similar trophic cytological aspects between the nasal and vaginal epithelium during the menstrual cycle and pill usage. Both the nasal and vaginal cytological samples showed higher maturation indexes during both the follicular and the periovular phases than during the luteal phase. Women on pill containing 15 μg EE showed lower trophic aspects in the nasal cytological samples compared with those on pill with 30 μg EE.

Conclusion(s) Along with the vaginal cells, the nasal respiratory epithelium is an ovarian steroid target. The maturation index of the nasal respiratory epithelium seems to depend on the variation of the ovarian steroids during the menstrual cycle and on the iatrogenic effects of oral contraceptives.     

Surgical Outcome of Extraperitoneal Paraaortic Lymph Node Dissections Compared With Transperitoneal Approach in Gynecologic Cancer Patients

Study ObjectiveTo evaluate the surgical outcome of extraperitoneal paraaortic lymph node dissection compared with the traditional transperitoneal approach.DesignRetrospective review (Canadian Task Force classification III).SettingUniversity hospital.PatientsWomen with gynecologic malignancies admitted to our hospital between 2007 and 2011 who underwent laparoscopic paraaortic lymphadenectomy.InterventionsIndication, diagnosis, and outcome according to type of surgery were evaluated.Measurements and Main ResultsOf 47 patients who underwent laparoscopic paraaortic lymphadenectomy because of gynecologic indications, 28 patients underwent extraperitoneal paraaortic lymph node dissection and 19 underwent the same procedure via the classic transperitoneal technique. The most frequent indication for extraperitoneal lymph node dissection was cervical cancer (71.4%), and for the transperitoneal technique was endometrial cancer (47.4%). The mean (SD) duration of surgery was 211 (38) minutes in the transperitoneal approach group, and 173 (51) minutes in the extraperitoneal lymphadenectomy group (p = .009). No significant differences between groups were found in the number of lymph nodes removed (15 [5.9] nodes in the extraperitoneal group vs 17.4 [8.6] in the transperitoneal group; p = .25). However, a higher rate of positive nodes was observed in the extraperitoneal group than in the transperitoneal group (42.8% vs 36.2%, respectively [p = .001]), and a significantly shorter stay in the intensive care unit in the extraperitoneal group (0.59 [0.5] vs 1.1 [0.5] days, respectively; p = .02). No significant differences in complication rate were found between groups.ConclusionsExtraperitoneal paraaortic lymph node dissection is a minimally invasive procedure that is an excellent and safe approach to the paraaortic area, with a low complication rate, sufficient number of lymph nodes, and short hospital stay. It seems to be a good alternative to the classic transperitoneal approach.     

The Impact of Increasing Obesity Class on Obstetrical Outcomes

ObjectiveNationally, rates of obesity continue to rise, resulting in increased health concerns for women of reproductive age Identifying the impact of maternal obesity on obstetrical outcomes is important to enhance patient care.MethodsWe conducted a retrospective cohort study of 6674 women who delivered a singleton infant at ≥ 20 weeks’ gestation between December 1, 2007, and March 31, 2010, at The Ottawa Hospital. Maternal pre-pregnancy BMI was used to classify women into normal, overweight, and obese (class I/II/III) categories according to WHO classifications. Obstetrical outcomes among obese women were compared with those of women with normal BMI Multivariable regression models were used to determine adjusted odds ratios and 95% confidence intervals.ResultsCompared with women with normal BMI, obese women had significantly higher rates of preeclampsia, gestational hypertension, and gestational diabetes, and these rates increased with increasing BMI (trend-test P < 0.001). There was a significant increase in rates of induction of labour in the obesity categories, from 25 3% in women with normal BMI to 42 9% in women with class III morbid obesity (aOR 1.67; 95% CI 1.43 to 1.93). Rates of primary Caesarean section rose with increasing BMI and were highest in women with class III morbid obesity (36 2% vs 22 1% in women with normal BMI) (aOR 1.46; 95% CI 1. 23 to 1.73).ConclusionIncreasing BMI is associated with increasing rates of preeclampsia, gestational hypertension, and gestational diabetes There is a significant increase in rates of induction of labour with increasing obesity class, and a significantly increased Caesarean section rate with higher BMI Obstetrical care providers should counsel obese patients about the risks they face and the importance of weight loss before pregnancy.     

Early postoperative voiding dysfunction after insertion of retropubic midurethral tape

Introduction and hypothesis

A significant proportion of patients develop voiding dysfunction after midurethral tape (MUT) insertion, which reduces patient satisfaction. The study’s purpose was to identify predictive factors of voiding dysfunction after a retropubic MUT procedure.

Methods

This was a retrospective study of 100 patients who underwent only a retropubic MUT procedure between January 2010 and December 2011. Early voiding dysfunction was defined when patients required a Foley catheter within 48 h. Data including demographic information, urogenital symptoms, previous surgery, preoperative uroflowmetry and urodynamic parameters were analysed using SPSS v22. Univariate analysis of all demographic variables was performed; those significant at 10 % were entered into a multivariate logistic regression.

Results

Fourteen patients required Foley catheter insertion, with a median age of 58 years (26–83 years), median BMI 28 kg/m² (20–48 kg/m2), and median parity 2 (0–4). Univariate analysis revealed peak flow rate <15 ml/s (OR 3.79; 1.07, 13.4; p?=?0.046), bladder capacity (p?=?0.044), stress incontinence versus mixed or urge incontinence (p?=?0.064) and previous surgery (OR 4.39; 1.34, 14.41; p?=?0.015) to be associated with voiding dysfunction. Multivariate analysis showed only previous pelvic floor surgery to be independently associated (OR 3.76; 1.14, 12.23, p?=?0.029).

Conclusions

Only previous pelvic-floor surgery was found to be a strong predictive factor of voiding dysfunction. The rate of voiding dysfunction was similar to those of published data. Previous studies revealed different predictive factors. A larger cohort is needed to provide a definite answer. Those with previous surgery appear to be those most at risk and pre-surgical counselling for these women could be suggested.

     

Utilizing Dual Mobility Components for First-Time Revision Total Hip Arthroplasty for Instability

Background

Dislocation following total hip arthroplasty (THA) remains a significant clinical problem. Few studies have focused on the use of dual mobility (DM) components in the setting of first-time revision for instability following THA. Here, we investigate patient outcomes following first-time revision THA with DM components for a diagnosis of instability.