AMBLYOPIA IN THE FOUR TO NINE YEAR AGE GROUP. A FOUR-YEAR SURVEY

A guide to the ophthalmologist in the choice of the older child with amblyopia most likely to respond to active intensive visual stimulation in short bursts is presented. A series of 99 children treated on a CAM vision-stimulator is described. Visual improvement of at least two rows of letters on the Snellen chart was maintained for at least three years after treatment in 62% of these patients aged between five and nine years with visual fixation within 3^° of the fovea. Amblyopia following minor trauma or minor pathology also responded well. Children maintaining the visual improvement were those with esophoria up to 13^°. those with hypermetropia up to 11.0 D and those with astigmatism of 1.5 D. Also responding well were children with anisometropia with up to 3.0 D of either hypermetropia or astigmatism     

Neuropsychological profile of children with subcortical band heterotopia

Aim  Subcortical band heterotopia (SBH) or 'double cortex' is a malformation of cortical development resulting from impaired neuronal migration. So far, research has focused on the neurological, neuroimaging, and genetic correlates of SBH. More recently, clinical reports and small sample studies have documented neuropsychological dysfunction in patients with this malformation. This study aimed to characterize further the phenotype of patients with SBH by describing the neuropsychological profiles of children.
Method  Seven children (six females) aged 4 to 15 years were assessed for cognitive functioning (intellectual ability, processing speed, attention, working memory) and academic achievement (reading, spelling, arithmetic). Parents completed questionnaires examining their child's social skills and problem behaviours. Magnetic resonance images (MRI) conducted for routine clinical follow-up were coded by a paediatric neurologist. Genetic and seizure history were obtained from medical records.
Results  There was variation in the neurological, neuroimaging, and genetic presentation of children in the sample. Impairments were observed in all areas of neuropsychological functioning examined. Intellectual ability was generally within the 'extremely low' range (full-scale IQ 44–74; performance IQ 45–72; verbal IQ 57–80). Generalized impairments in cognitive skills were typical, with severe impairments (scores greater than 2SD below the test mean) reported in processing speed, working memory, and arithmetic. Impairments in academic, social, and behavioural functioning were less generalized. No clear relationship between neuroimaging and neuropsychological impairments was found.
Interpretation  Children with SBH demonstrate cognitive, academic, social, and behavioural problems, with the greatest difficulties in processing speed and complex cognitive skills.     

Overgrowth and Enlarged Heart in Mouse Fetuses with Maternally Inherited ThP and twLub2: An Example of Genomic Imprinting in Animals

ABSTRACT T^hp/+ mouse is known to have differing phenotypes depending on gender of the T^hP parent. In the present study, fetuses with maternally [Group A (until day 18 of pregnancy) and Group C (day 19)] and paternally [Group B] inherited T^hP were examined with particular reference to the developmental abnormalities of hearts. In addition, a small number of fetuses with maternally inherited t^wLub2 on day 19 were compared with T^hp. Group A T^hP fetuses had greater body weight, possibly larger body size, generalized edema (100%), marked enlargement of the hearts (100%) and hypoplastic pulmonary trunk (73.7%). There were no such malformations in Group B T^hP fetuses or in the controls (+/+) for both groups. The bilaterally thickened ventricular wall of fetal hearts in Group A and C T^hP fetuses bulged into ventricular cavity. The pulmonary valve was also thickened. The labeling indices of the ventricular myocardial cells by BrdU were inclined to be higher in Group A T^hP than in the control (+/+) fetuses. Fetuses of t^wLub2 had abnormalities of the cardiovascular system similar to Group C T^hp. The results suggest that cardiac lesions in fetuses with maternally inherited T^hP and t^wLub2 correspond to cardiomyopathy. Overgrowth and enlarged heart indicate the possibility of T^hP as an animal model for Wiedemann-Beckwith syndrome.     

Effects of therapeutic suggestion in children undergoing general anesthesia: a randomized controlled trial

Objectives and aim: The goal of this randomized controlled trial was to examine the effect of intraoperative positive therapeutic suggestion on postoperative nausea and vomiting (PONV) in children undergoing general anesthesia and otolaryngological surgery. Background: Because of the high incidence of PONV following otolaryngological surgery and its negative impact on recovery, researchers have examined various nonpharmacological interventions to target this phenomenon. To date, the effectiveness of therapeutic suggestion has not been studied in children. Methods: Participants were 67 children undergoing tonsillectomy and adenoidectomy and their mothers. Children received a standardized anesthetic procedure and were randomly assigned to one of three interventions administered under general anesthesia: therapeutic suggestion, story (prosody control), or standard operating room noise. Children, parents, and healthcare personnel were blinded to group assignment. Nausea and vomiting were recorded in the postanesthesia care unit (PACU) and for the first 3 days at home. Results: Results demonstrated a decrease in nausea severity across the first 3 days, F_2,49 = 10.37, P < 0.001, but no group differences in nausea severity in the PACU (F_2,49 = 0.87, P = 0.43) or at home (F_2,49 = 0.80, P = 0.46). There were also no group differences in vomiting episodes in the PACU (χ² (2) = 1.25, P > 0.05) or at home (F_2,49 = 1.59, P = 0.21). Conclusions: In this blinded controlled trial, therapeutic suggestion delivered intraoperatively did not impact children’s PONV. However, because this is the first study of this kind, replication may be needed.     

Long-Term Efficacy of Anchored Barbed Sutures in the Face and Neck

BACKGROUND The thread lift is a minimally invasive procedure that uses barbed sutures, inserted subcutaneously, to produce lifting of ptotic tissue of the face and neck. There are currently very limited data on longevity and patient satisfaction following barbed suture lifting procedures.
OBJECTIVE The purpose of this study was to assess long-term efficacy following the use of barbed sutures.
MATERIALS AND METHODS A satisfaction survey was mailed to 20 patients who were a minimum of 6 months (range, 6 to 16 months) postprocedure. Physician assessment of pre- and postprocedure photographs was also performed.
RESULTS At an average of 11.5 months postprocedure, patients felt that the barbed suture lift met their expectations, rating their satisfaction a 6.9 on a scale of 1 to 10. Independent physicians rated the overall improvement an average of 4.6 of 10. Higher scores were noted in Zone 1 (tear trough/malar fat pad and nasolabial folds) compared to Zone 2 (marionette lines, jowls, and jawline definition) and Zone 3 (platysmal bands and neck contour).
CONCLUSION The barbed suture lift procedure provides moderate long-term and sustained improvement for facial laxity, with most improvement seen in the tear trough/malar fat pads and nasolabial folds. In this study, clinical efficacy was seen up to 16 months postprocedure.     

Purification and Partial Characterization of an Early Pregnancy Factor-Induced Suppressor Factor (EPF-S1)

PROBLEM : The immunomodulatory properties of early pregnancy factor (EPF) are mediated through induction of at least two lymphokines, designated EPF-S₁ and EPF-S₂ (previously estimated M_r 15,000 and 55,000 respectively). The activity of the former is MHC-restricted while the latter is restricted to a locus (or loci) outside the MHC. The present study established further criteria by which EPF-S₁ and EPF-S₂ might be distinguished from each other and compared with other suppressor factors. In addition, techniques have been developed to purify EPF-S₁ to homogeneity. METHOD : Congenic mouse strains were used to map the genetic restriction of EPF-S₂ in the rosette inhibition test and high performance gel permeation chromatography was used to demonstrate that EPF-S₁ induces EPF-S₂ but not vice versa. Further studies then focused on isolation of this first component of the cascade, EPF-S₁, from immune ascites (from growth in athymic mice of the anti-EPF-S₁-producing rat-mouse hybridoma R2Tγ, in which EPF-S₁ is complexed to antibody). Techniques used were acidification followed by application to Sep-pak C₁₈ cartridges, high performance cation-exchange chromatography and two reversed-phase HPLC steps on a C₃ column. Purified material was analyzed by SDS-PAGE and Edman degradation. RESULTS : Approximately 10 μg EPF-S₁ were isolated from 60 ml ascitic fluid. Homogeneity of the purified material was demonstrated by SDS-PAGE, where it ran as a single band of approximate M_r 12,000 coincident with biological activity. Attempts at Edman degradation indicate that the molecule is N-blocked. CONCLUSION : Definitive primary characterization of EPF-S₁ must await the preparation and isolation of proteolytic fragments of the molecule, but the present studies establish conditions which make such structural analysis possible.     

Construct validity of the Quality of Upper Extremity Skills Test for children with cerebral palsy

Aim The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). Method A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD 2y 11mo, range 2–16y; Gross Motor Function Classification System levels I–V) were reviewed. Results The QUEST was not unidimensional; many items demonstrated poor fit when total scores were analysed; goodness of fit improved when domains were considered independently and limbs separately examined. QUEST items involving elbow flexion and/or forearm in pronation were easily achieved, thus reducing test sensitivity. Postures items in the grasp domain behaved erratically, with little total score relationship. Interpretation Calculating total scores is discouraged. Reporting QUEST results separately for domains and each limb is recommended. Posture items in the grasp domain had little relationship with total scores and it is recommended that they be removed from the test.     

Comparison of Manufacturer-Recommended Exposure Durations with Those Determined Using Biaxial Flexure Strength and Scraped Composite Thickness Among a Variety of Light-Curing Units

ABSTRACT

Statement of the Problem: Manufacturer‐recommended exposure durations for light‐curing units are often understated and might not have true clinical relevance. Purpose: To compare composite depths of cure among exposure durations provided by the manufacturer and those obtained when optimizing exposure duration for biaxial flexural strength or for composite compule‐scraping tests when using different light‐curing units. Methods/Materials: A hybrid composite (Prodigy, A3, Kerr, Orange, CA, USA) was exposed to different light‐curing units (all manufactured by Kerr Demetron) (conventional quartz‐tungsten‐halogen [QTH], conventional blue light‐emitting diode [LED_CONV] or a high‐intensity blue LED light [LED_HIGH]) for various amounts of time, including that recommended by the manufacturer for thegiven light. A test model was designed in which 0.5‐mm thick composite discs were stacked between Mylar sheets to a total composite thickness of 3.0 mm. The top of each stack was exposed to the different lights for a variety of exposures at a 2‐mm distance. Twenty‐four hours later, the stacks were disassembled, and the individual discs from each 0.5‐mm thick increment were tested for biaxial flexure strength. Ten discs were made for each exposure duration from each light. Statistical analysis (analysis of variance, Dunnett–Hsu post hoc test, α = 0.05) was used to identify the exposure duration needed for the flexural strength at a 2.5‐mm depth (manufacturer‐recommended thickness) to be similar to that at the topmost 0.5‐mm thick increment. Compules of the same composite were modified to form cylinders in which their contents were forced to one end and photopolymerized (at a 2‐mm distance) for a variety of exposure durations using the same light units mentioned above (N = 5). Twenty‐four hours later, compule contents were extruded, and the unpolymerized residue was removed using hand scraping with a plastic spatula. The thickness of the resulting specimen was measured, and was plotted as a function of exposure duration for each light. Regression analysis was applied to generate the mathematical correlation between exposure duration and resulting composite scraped thickness. Manual line‐drawing methods were used on that generated plot to determine the major inflection in the exposure–thickness relationship that changed, and the exposure time correlated to that inflection point was considered the optimal exposure duration from this method. Results: Manufacturer‐recommended exposures for a 2.5‐mm thick composite increment from the lights used were: QTH 20 seconds; LED_CONV 10 seconds; and LED_HIGH 5 seconds. Flexural strength and scraped composite compule thickness values markedly changed with increase in exposure duration and differed among the lights. Exposure durations needed to provide similar flexural strength at 2.5 mm as that of the topmost increment were: QTH 30 seconds; LED_CONV 15 seconds; and LED_HIGH 20 seconds. Exposure durations derived from inflection points of the scraping plots provided optimal exposure duration values of: QTH 25 seconds; LED_CONV 15 seconds; and LED_HIGH 17 seconds. Conclusions: In all cases, use of manufacturer‐recommended exposure duration provided a lower flexural strength or scraped composite thickness than did longer exposures used. Exposure durations using the simple scraping method correlated very well with those of the much more sophisticated biaxial test.

CLINICAL SIGNIFICANCE

No one can provide a clinician with the optimal exposure duration to use for a given light and a specific lot, shade, and brand of composite. Instead, manufacturers offer a single exposure that is meant to be used for all clinical scenarios and operating conditions. The results of this test indicate that manufacturer‐recommended exposures proved inadequate to optimize the flexural strength of the recommended increment of composite, but longer exposures were required. The exposure durations determined from the much more simplified composite compule‐scrape test proved to match those found to optimize biaxial flexure testing for each light used. Clinicians can thus adapt this very simple in‐office scraping test to develop their own customized exposure guide, providing them with exact exposure durations that willoptimize composite properties, thus eliminating the guesswork from this most important aspect of chairside dentistry.