Sporting activity after craniosynostosis surgery in children: a source of parental anxiety

Purpose: Craniosynostosis correction involves major skull surgery in infancy—a potential source of worry for parents when their treated children begin involvement in sports. Methods: Electronic multiple choice survey of parents of children who had undergone craniosynostosis surgery in infancy using 5-point Likert scales. Results: Fifty-nine completed surveys were obtained from parents of children who had undergone previous craniosynostosis surgery. Mean age of children was 7.8 years (range 3 months to 22 years), with 36 non-syndromic and 23 syndromic cases. The most common surgery was fronto-orbital remodelling (18). Fifty-two of 59 were involved in athletic activity. The most intense sport type was non-contact in 23, light contact in 20, heavy contact in 4 and combat in 5. Participation level was school mandatory in 12, school club in 17, non-school sport club in 21 and regional representative in 2. One child had been advised to avoid sport by an external physician. Mean anxiety (1–5 Likert) increased with sport intensity: non-contact 1.7, light contact 2.2, heavy contact 3.5 and combat 3.6. Twenty-nine of 59 parents had been given specific advice by the Craniofacial Team regarding athletic activity, 28 of which found useful. Three sport-related head injuries were reported, none of which required hospitalisation. Conclusion: Little information exists regarding sports for children after craniosynostosis surgery. This study suggests that parental anxiety remains high, particularly for high impact/combat sports, and that parents would like more information from clinicians about the safety of post-operative sporting activities

Role of snow and glacier melt in controlling river hydrology in Liddar watershed (western Himalaya) under current and future climate

This is the publisher's version, also available electronically from http://onlinelibrary.wiley.com/doi/10.1029/2011WR011590/abstract.[1] Snowmelt and icemelt are believed to be important regulators of seasonal discharge of Himalayan rivers. To analyze the long term contribution of snowmelt and glacier/icemelt to river hydrology we apply a water budget model to simulate hydrology of the Liddar watershed in the western Himalaya, India for the 20th century (1901–2010) and future IPCC A1B climate change scenario. Long term (1901–2010) temperature and precipitation data in this region show a warming trend (0.08°C yr−1) and an increase in precipitation (0.28 mm yr−1), with a significant variability in seasonal trends. In particular, winter months have undergone the most warming, along with a decrease in precipitation rates; precipitation has increased throughout the spring. These trends have accelerated the melting and rapid disappearance of snow, causing a seasonal redistribution in the availability of water. Our model results show that about 60% of the annual runoff of the Liddar watershed is contributed from the snowmelt, while only 2% is contributed from glacier ice. The climate trend observed from the 1901 to 2010 time period and its impact on the availability of water will become significantly worse under the IPCC climate change scenarios. Our results suggest that there is a significant shift in the timing and quantity of water runoff in this region of the Himalayas due to snow distribution and melt. With greatly increased spring runoff and its reductions in summer potentially leading to reduced water availability for irrigation agriculture in summer

Prevalence of Helicobacter pylori Infection in Peptic Ulcer Patients of Highly Endemic Kashmir Valley

Objective This study aimed to find out prevalence of Helicobacter pylori (H. pylori) in peptic ulcer disease (PUD) which is highly endemic disease in Kashmir

Isotopic composition of daily precipitation along the southern foothills of the Himalayas: impact of marine and continental sources of atmospheric moisture

The flow of the Himalayan rivers, a key source of fresh water for more than a billion people primarily depends upon the strength, behaviour and duration of the Indian summer monsoon (ISM) and the western disturbances (WD), two contrasting circulation regimes of the regional atmosphere. An analysis of the 2H and 18O isotope composition of daily precipitation collected along the southern foothills of the Himalayas, combined with extensive backward trajectory modelling, was used to gain deeper insight into the mechanisms controlling the isotopic composition of precipitation and the origin of atmospheric moisture and precipitation during ISM and WD periods. Daily precipitation samples were collected during the period from September 2008 to December 2011 at six stations, extending from Srinagar in the west (Kashmir state) to Dibrugarh in the east (Assam state). In total, 548 daily precipitation samples were collected and analysed for their stable isotope composition. It is suggested that the gradual reduction in the 2H and 18O content of precipitation in the study region, progressing from δ18O values close to zero down to ca. −10 ‰ in the course of ISM evolution, stems from regional, large-scale recycling of moisture-driven monsoonal circulation. Superimposed on this general trend are short-term fluctuations of the isotopic composition of rainfall, which might have stem from local effects such as enhanced convective activity and the associated higher degree of rainout of moist air masses (local amount effect), the partial evaporation of raindrops, or the impact of isotopically heavy moisture generated in evapotranspiration processes taking place in the vicinity of rainfall sampling sites. Seasonal footprint maps constructed for three stations representing the western, central and eastern portions of the Himalayan region indicate that the influence of monsoonal circulation reaches the western edges of the Himalayan region. While the characteristic imprint of monsoonal air masses (increase of monthly rainfall amount) can be completely absent in the western Himalayas, the onset of the ISM period in this region is still clearly visible in the isotopic composition of daily precipitation. A characteristic feature of daily precipitation collected during the WD period is the gradual increase of 2H and 18O content, reaching positive δ2H and δ18O values towards the end of the period. This trend can be explained by the growing importance of moisture of continental origin as a source of daily precipitation. High deuterium-excess (d-excess) values of daily rainfall recorded at the monitoring stations (38 cases in total, range from 20.6 to 44.0 ‰) are attributed to moisture of continental origin released into the atmosphere during the evaporation of surface water bodies and/or soil water evaporation

Helicobacter Pylori Infection in Endoscopic Biopsy Specimens of Gastric Cancer: A Preliminary Evaluation in a High Risk Population of Kashmir Valley

Objective: The aim of the present study was to assess the prevalence of Helicobacter pylori (H. pylori) infection in Kashmiri patients with gastric cancer and to compare this with a matched control population

Melanotic neuroectodermal tumour of infancy: A case report and differential diagnosis

Melanotic neuroectodermal tumour of infancy is an uncommon pigmented neoplasm of neural crest origin. It was first described in 1918 by Krompecher, known as congenital melanocarcinoma at that time. Although it is generally agreed upon that it is a benign entity, it is locally aggressive and has a significant recurrent risk, reported to be between 10-15%. There have also been prior reports of malignant behaviour in these tumours, although extremely rare. The majority of cases of this tumour (about 70%) arise from the maxilla and its occurrence in the cranial vault represents approximately 15.6% of cases. We describe a rare case of melanotic neuroectodermal tumour of infancy, with simultaneous involvement of the cranial vault and petrous temporal bone, in a four-month-old child, complicated by post-surgical pseudo-meningocele. This case illustrates the diagnostic dilemma in differentiating reactive osseous sclerosis from direct tumour infiltration, both of which can occur in the context of melanotic neuroectodermal tumour of infancy. The discussion places emphasis on differential diagnoses and useful radiological features to assist in clinching the diagnosis of melanotic neuroectodermal tumour of infancy

A novel soft tissue prediction methodology for orthognathic surgery based on probabilistic finite element modelling

Repositioning of the maxilla in orthognathic surgery is carried out for functional and aesthetic purposes. Pre-surgical planning tools can predict 3D facial appearance by computing the response of the soft tissue to the changes to the underlying skeleton. The clinical use of commercial prediction software remains controversial, likely due to the deterministic nature of these computational predictions. A novel probabilistic finite element model (FEM) for the prediction of postoperative facial soft tissues is proposed in this paper. A probabilistic FEM was developed and validated on a cohort of eight patients who underwent maxillary repositioning and had pre- and postoperative cone beam computed tomography (CBCT) scans taken. Firstly, a variables correlation assessed various modelling parameters. Secondly, a design of experiments (DOE) provided a range of potential outcomes based on uniformly distributed input parameters, followed by an optimisation. Lastly, the second DOE iteration provided optimised predictions with a probability range. A range of 3D predictions was obtained using the probabilistic FEM and validated using reconstructed soft tissue surfaces from the postoperative CBCT data. The predictions in the nose and upper lip areas accurately include the true postoperative position, whereas the prediction under-estimates the position of the cheeks and lower lip. A probabilistic FEM has been developed and validated for the prediction of the facial appearance following orthognathic surgery. This method shows how inaccuracies in the modelling and uncertainties in executing surgical planning influence the soft tissue prediction and it provides a range of predictions including a minimum and maximum, which may be helpful for patients in understanding the impact of surgery on the face

Quantifying the effect of corrective surgery for trigonocephaly: A non-invasive, non-ionizing method using three-dimensional handheld scanning and statistical shape modelling

Trigonocephaly in patients with metopic synostosis is corrected by fronto-orbital remodelling (FOR). The aim of this study was to quantitatively assess aesthetic outcomes of FOR by capturing 3D forehead scans of metopic patients pre- and post-operatively and comparing them with controls. Ten single-suture metopic patients undergoing FOR and 15 age-matched non-craniosynostotic controls were recruited at Great Ormond Street Hospital for Children (UK). Scans were acquired with a three-dimensional (3D) handheld camera and post-processed combining 3D imaging software. 3D scans were first used for cephalometric measurements. Statistical shape modelling was then used to compute the 3D mean head shapes of the three groups (FOR pre-op, post-op and controls). Head shape variations were described via principal component analysis (PCA). Cephalometric measurements showed that FOR significantly increased the forehead volume and improved trigonocephaly. This improvement was supported visually by pre- and post-operative computed mean 3D shapes and numerically by PCA (p < 0.001). Compared with controls, post-operative scans showed flatter foreheads (p < 0.001). In conclusion, 3D scanning followed by 3D statistical shape modelling enabled the 3D comparison of forehead shapes of metopic patients and non-craniosynostotic controls, and demonstrated that the adopted FOR technique was successful in correcting bitemporal narrowing but overcorrected the rounding of the forehead