White Matter Injury and General Movements in High-Risk Preterm Infants

BACKGROUND AND PURPOSE: Very preterm infants (birth weight, MATERIALS AND METHODS: In this prospective study of 47 preterm infants of 24-30 weeks' gestation, brain MR imaging was performed at term-equivalent age. Infants underwent T1- and T2-weighted imaging for volumetric analysis and DTI. General movements were assessed at 10-15 weeks' postterm age, and neurodevelopmental outcomes were evaluated at 2 years by using the Bayley Scales of Infant and Toddler Development Ill. RESULTS: Nine infants had aberrant general movements and were more likely to have adverse neurodevelopmental outcomes, compared with infants with normal movements. In infants with aberrant movements, Tract-Based Spatial Statistics analysis identified significantly lower fractional anisotropy in widespread white matter tracts, including the corpus callosum, inferior longitudinal and fronto-occipital fasciculi, internal capsule, and optic radiation. The subset of infants having both aberrant movements and abnormal neurodevelopmental outcomes in cognitive, language, and motor skills had significantly lower fractional anisotropy in specific brain regions. CONCLUSIONS: Aberrant general movements at 10-15 weeks' postterm are associated with adverse neurodevelopmental outcomes and specific white matter microstructure abnormalities for cognitive, language, and motor delays

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy International Clinical Practice Guideline Based on Systematic Reviews:International Clinical Practice Guideline Based on Systematic Reviews

IMPORTANCE: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE: To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW: The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS: Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE: When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline

High frequency properties of Si/SiGe n-MODFETs: dependence on gate length and temparture

The HF performances of n-type strained Si channel Modulation Doped Field Effect Transistors (MODFETs) with 0.118 µm, 0.130 µm and 0.250 µm gate lengths are reported at 300 K and 50 K. At 300K, intrinsic cut-off frequencies fTi are 65 GHz, 58 GHz, 37 GHz and maximum oscillation frequencies fMAX are 76 GHz ,60 GHz, and 100 GHz , respectively. The 0.130 µm device presents at 300 K a record intrinsic transconductance of 715 mS/mm and excellent noise performances with a de-embedded Minimum Noise Figure NFmin of 0.3 dB at 2.5 GHz. The variation of fMAX underlines the importance of the device parasitic resistances

Modèle analytique du MESFET AsGa pour simulation de circuits logiques ultra-rapides

A model of the GaAs MESFET is developped for the design of picosecond circuits at the MSI or LSI level. The parameter description is optimized both for dynamic response and computer time efficiency. The model is implemented in the time simulator MACPRO designed for the analysis of propagation and coupling effects in very fast integrated circuits. The model is fully presented and validated against both experimental I-V curves and microwave S parameters measurements of a single MESFET, and analog dynamic response of a BFL ring oscillator. The influence of the main model parameters on the circuit dynamic response is discussed relatively to a BFL technology.Un modèle de MESFET AsGa est développé pour la conception des circuits logiques picosecondes à moyenne et grande intégration. La formulation des paramètres du modèle est optimisée à la fois pour un bon comportement dynamique des portes logiques et pour une grande efficacité en temps de calcul. Ce modèle est implanté sur le macro-simulateur MACPRO qui a été conçu pour l'étude des effets de propagation et de couplage dans les circuits intégrés ultrarapides. Le modèle est présenté de façon exhaustive et il est comparé à des mesures statiques (caractéristiques I-V de transistors hyperfréquence) et dynamiques (comportement en paramètres S d'un MESFET hyperfréquence, oscillateur en anneau en technologie BFL). La dernière partie de l'article étudie l'influence des paramètres importants de ce modèle sur le régime transitoire des portes logiques BFL

Seguimento nutricional de pacientes com fibrose cística: papel do aconselhamento nutricional Nutritional follow-up of cystic fibrosis patients: the role of nutrition education

OBJETIVO: Avaliar o estado nutricional de um grupo de pacientes com fibrose cística e analisar a repercussão do aconselhamento nutricional através de um estudo comparativo pré- e pós-intervenção. MÉTODOS: Todos os pacientes com fibrose cística em seguimento regular no ambulatório de pneumologia do Instituto da Criança no período de 1996-99 foram prospectivamente acompanhados durante 3,5 anos. Em quatro etapas (I = inicial, II = 7 meses, III = 13 meses, IV = 43 meses), foi realizada uma avaliação nutricional que consistia de medidas de peso, estatura/comprimento, circunferência do braço e pregas cutâneas, e cálculos de escores z para peso/idade, estatura/idade, peso/estatura, circunferência do braço e da prega cutânea tricipital, porcentagem de peso/estatura e porcentagem de gordura corpórea. Era feita verificação do uso das enzimas pancreáticas e do uso de suplementos nutricionais. Aconselhamento nutricional verbal e através de uma cartilha explicativa foi realizado em todos os pacientes. RESULTADOS: Foram avaliados 74 pacientes, 38 do sexo feminino e 36 do masculino, com idades de 6 meses a 18,4 anos. Na etapa inicial, os dados antropométricos revelaram: porcentagem de peso/estatura = 94&plusmn;13, porcentagem de gordura corpórea = 15&plusmn;7,1, escore z peso/idade = -1,13&plusmn;1,3, escore z estatura/idade = -0,94&plusmn;1,2, escore z peso/estatura = -0,69&plusmn;,1, escore z circunferência do braço = -1,35&plusmn;1,3, escore z prega cutânea tricipital = -0,74&plusmn;0,9. A aderência ao uso de enzimas e suplementos melhorou durante o estudo. Houve um aumento significativo no escore z de peso/idade e da prega tricipital e na porcentagem de gordura corpórea durante todo o período de estudo. Dividindo-se os pacientes em três grupos etários, a melhora antropométrica só foi significativa nos menores de 5 anos. CONCLUSÕES: Desnutrição leve estava presente nesse grupo de pacientes com fibrose cística. O aconselhamento nutricional realizado possibilitou melhora na aderência ao uso de enzimas pancreáticas e de suplementos nutricionais e no estado nutricional, principalmente nos pacientes de baixa idade.<br>OBJECTIVE: To evaluate the nutritional status of a group of cystic fibrosis patients and establish the role of nutrition education addressed to them in a comparative study before and after intervention. METHODS: All cystic fibrosis patients in regular follow-up in the pulmonology clinic of Instituto da Criança during 1996-99 were prospectively monitored for 3.5 years. Measurements of weight, height, mid upper arm circumference, skinfolds and calculations of weight/age, height/age, weight/height, mid upper arm circumference and triceps z scores, percentage of ideal weight for height, percentage of body fat, check of the use of enzymes with meals and of the use of nutritional supplements were performed at four points in time: initial (I), 7 (II), 13 (III) and 43 (IV) months after the first evaluation. Nutritional counseling was given both verbally and in writing (booklet) to all patients. RESULTS: Seventy-four patients, 38F/36M, age range 6 months to 18.4 years were evaluated. At study entry the anthropometric data showed: percentage of ideal weight for height = 94&plusmn;13, percentage of body fat = 15&plusmn;7.1, z scores for weight/age = -1.13&plusmn;1.3, z scores for height/age = -0.94&plusmn;1.2, z scores for weight/height = -0.69&plusmn;1.1, z scores for mid upper arm circumference = -1.35&plusmn;1.3, triceps z scores = -0.74&plusmn;0.9. Compliance with enzyme therapy and use of high-calorie supplements improved during the study period. There was a significant increase in weight/height and triceps z scores and percentage of body fat throughout the study period. After stratifying patients into three age groups the anthropometric improvement was only significant among children under 5 years of age. CONCLUSIONS: Mild malnutrition was present in this group of cystic fibrosis patients. The nutrition education led to an improvement in compliance with enzyme therapy, use of nutritional supplements and in nutritional status, mostly among the younger patients