Ontwikkeling van stotteren: Inleiding tot een praktijkmodel

Dit artikel is de inleiding op het direct hierna volgende (Oonk e.a. 2022) waar een nieuw praktijkmodel over het ontstaan en ontwikkeling van stotteren wordt voorgesteld. In de dagelijkse praktijk van vooral Nederlandstalige logopedisten (-stottertherapeuten) is tot nu toe veel gebruik gemaakt van het klinische werkmodel van Bertens (1994; 2017). Dit model gaat uit van een primaire neuromusculaire timingsstoornis, welke zich niet alleen uit in het spreken, maar ook in algemene zin aanwezig is. Dit model echter, is aan revisie toe. Volgens de recente literatuur is de algemene aard van die timingstoornis niet bewezen, en zijn er veel vroegere (meer primaire) factoren aantoonbaar van belang bij het ontstaan van stotteren, met name in de genetica en in de neurologie. In dit artikel wordt deze literatuur kort samengevat, alsmede worden enkele recente modellen omschreven. Met name regulatie en terugkoppeling krijgen in recente modellen meer aandacht. Er is geen volledigheid nagestreefd, maar dit artikel is meer een tutoriale opmaat voor het hierna te presenteren model. (This article serves as an introduction to the accompanying paper, in which a new clinical model of the origin and development of stuttering is presented (Oonk e.a., 2022). In their clinical practice, Dutch speech language pathologists still tend to use the clinical model proposed by Bertens (1994; 2017). This model explains stuttering as de- veloping from a primary neuromuscular timing deficit, which manifests itself not only in speech, but in more general behaviour as well. In our opinion, this model needs to be updated and revised based on current scientific and clinical knowledge. There is littleevidence for the general timing deficit in Bertens’ model and, moreover, several more fundamental factors, especially those related to genetics and neural processes, that have an important role in the onset of stuttering have been reported. This paper provides a review and summary of these recent data, and several newer models are described. An important aspect of these models is the importance given to processes of regulation and feedback. An exhaustive overview of the existing literature has not been strived for but it is hoped that this paper will serve as a useful introduction to the clinical model presented in the accompanying paper.

Structural brain differences in pre-adolescents who persist in and recover from stuttering

Background: Stuttering is a complex speech fluency disorder occurring in childhood. In young children, stuttering has been associated with speech-related auditory and motor areas of the brain. During transition into adolescence, the majority of children who stutter (75–80%) will experience remission of their symptoms. The current study evaluated brain (micro-)structural differences between pre-adolescents who persisted in stuttering, those who recovered, and fluently speaking controls. Methods: This study was embedded in the Generation R Study, a population-based cohort in the Netherlands of children followed from pregnancy onwards. Neuroimaging was performed in 2211 children (mean age: 10 years, range 8–12), of whom 20 persisted in and 77 recovered from stuttering. Brain structure (e.g., gray matter) and microstructure (e.g., diffusion tensor imaging) differences between groups were tested using multiple linear regression. Results: Pre-adolescents who persisted in stuttering had marginally lower left superior frontal gray matter volume compared to those with no history of stuttering (β −1344, 95%CI −2407;-280), and those who recovered (β −1825, 95%CI −2999;-650). Pre-adolescents who recovered, compared to those with no history of stuttering, had higher mean diffusivity in the forceps major (β 0.002, 95%CI 0.001;0.004), bilateral superior longitudinal fasciculi (β 0.001, 95%CI 0.000;0.001), left corticospinal tract (β 0.003, 95%CI 0.002;0.004), and right inferior longitudinal fasciculus (β 0.001, 95%CI 0.000;0.001). Conclusion: Findings suggest that relatively small difference in prefrontal gray matter volume is associated with persistent stuttering, and alterations in white matter tracts are apparent in individuals who recovered. The findings further strengthen the potential relevance of brain (micro-)structure in persistence and recovery from stuttering in pre-adolescents

New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery

PG - e3954 AB - BACKGROUND: Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery. METHODOLOGY/PRINCIPAL FINDINGS: Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(r)CO2, P(r-a)CO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal P(r)CO2, P(r-a)CO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively). CONCLUSIONS/SIGNIFICANCE: This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier los

The ART approach: clinical aspects reviewed

The success of ART as a caries management approach is supported by more than 20 years of scientific evidence. ART follows the contemporary concepts of modern cariology and restorative dentistry. It challenges treatment concepts such as step-wise excavation and the need for complete removal of affected dentine. The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material. Cariostatic and remineralization properties have been ascribed to this material which requires further research to establish its clinical relevance. The adhesion of high-viscosity glass-ionomer to enamel in pits and fissures is apparently strong, as its remnants, blocking the pits and fissures, have been considered a possible reason for the low prevalence of carious lesion development after the glass-ionomer has clinically disappeared from it. Encapsulated high-viscosity glass-ionomers may lead to higher restoration survival results than those of the hand-mixed version and should, therefore, not be neglected when using ART. Similarly, the use of resin-modified glass-ionomer with ART should be researched. The effectiveness of ART when compared to conventional caries management approaches has been shown in numerous studies. Proper case selection is an important factor for long-lasting ART restoration survival. This is based on the caries risk situation of the individual, the size of the cavity opening, the strategic position of the cavitated tooth and the presence of adequate caries control measures. As the operator is one of the main causes for failure of ART restorations, attending a well-conducted ART training course is mandatory for successful implementation of ART

Prediction of visual field defects in newborn infants with perinatal arterial ischemic stroke using early MRI and DTI-based tractography of the optic radiation

Purpose Visual field (VF) defects are common sequelae of perinatal arterial ischemic stroke (PAIS). The aim of this study was to investigate the predictive value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) for VF defects following PAIS. Methods Nineteen infants with unilateral PAIS, who underwent conventional MRI (T1/T2) and DTI at three months of age and a VF examination later in life (median age 3.2 yrs) were included. Conventional T1-weighted MRI was used to assess asymmetry of the optic radiation (OR). DTI-based tractography of the bilateral OR was performed, and the average fractional anisotropy (FA), axial (λ1), radial (λ23) and mean diffusivity (MD) were extracted. Asymmetry of the OR on MRI and DTI was used as a predictor of VF defects using receiver operating characteristic (ROC) analysis. Results Of the 19 infants, nine had a normal VF, eight had a VF defect (six hemianopia and two quadrantanopia), and two had an inconclusive VF test. The presence or absence of a VF defect could be correctly predicted using conventional MRI assessment in the majority of the infants, with an area under the curve (AUC) of 0.90 (95% CI 0.66-0.99). Prediction based on DTI parameter asymmetry indices showed an AUC of 0.96 (95% CI 0.74-1.00), 0.78 (95% CI 0.52-0.94), 0.93 (95% CI 0.70-1.00) and 0.90 (95% CI 0.66-0.99) for FA, λ1, λ23 and MD, respectively. Conclusions VF defects following PAIS can be reliably predicted by assessment of asymmetry of the OR at three months on conventional MRI and DTI-based tractography with comparable predictive values. Conventional T1-weighted MRI can be used in clinical practice

Prediction of visual field defects in newborn infants with perinatal arterial ischemic stroke using early MRI and DTI-based tractography of the optic radiation

Purpose Visual field (VF) defects are common sequelae of perinatal arterial ischemic stroke (PAIS). The aim of this study was to investigate the predictive value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) for VF defects following PAIS. Methods Nineteen infants with unilateral PAIS, who underwent conventional MRI (T1/T2) and DTI at three months of age and a VF examination later in life (median age 3.2 yrs) were included. Conventional T1-weighted MRI was used to assess asymmetry of the optic radiation (OR). DTI-based tractography of the bilateral OR was performed, and the average fractional anisotropy (FA), axial (λ1), radial (λ23) and mean diffusivity (MD) were extracted. Asymmetry of the OR on MRI and DTI was used as a predictor of VF defects using receiver operating characteristic (ROC) analysis. Results Of the 19 infants, nine had a normal VF, eight had a VF defect (six hemianopia and two quadrantanopia), and two had an inconclusive VF test. The presence or absence of a VF defect could be correctly predicted using conventional MRI assessment in the majority of the infants, with an area under the curve (AUC) of 0.90 (95% CI 0.66-0.99). Prediction based on DTI parameter asymmetry indices showed an AUC of 0.96 (95% CI 0.74-1.00), 0.78 (95% CI 0.52-0.94), 0.93 (95% CI 0.70-1.00) and 0.90 (95% CI 0.66-0.99) for FA, λ1, λ23 and MD, respectively. Conclusions VF defects following PAIS can be reliably predicted by assessment of asymmetry of the OR at three months on conventional MRI and DTI-based tractography with comparable predictive values. Conventional T1-weighted MRI can be used in clinical practice

Changing Incidence of Invasive Pneumococcal Disease in Infants Less Than 90 Days of Age Before and After Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Blantyre, Malawi: A 14-Year Hospital Based Surveillance Study.

BackgroundInvasive pneumococcal disease (IPD) in young infants is uncommon but associated with high morbidity and mortality. Accurate data on the burden of IPD in young infants in low-income countries are lacking. We examined the burden of IPD in infants aged MethodsWe conducted laboratory-based prospective IPD surveillance in infants aged ResultsWe identified 130 cases of culture-confirmed IPD in infants ConclusionVaccine serotypes 1 and 5 were the main cause of IPD in neonates and young infants, both before and after PCV13 introduction. This suggests incomplete indirect protection with persisting VT carriage across the population despite vaccination in this setting. Alternative vaccine schedules and other vaccine introduction approaches need to be considered to protect this vulnerable population

Detection of postpartum uterine activity with electrohysterography

OBJECTIVE: Uterine contractions are essential for childbirth, but also for expulsion of the placenta and for limiting postpartum blood loss. Postpartum hemorrhage is associated with almost 25% of the maternal deaths worldwide and the leading cause of maternal death in most low-income countries. Little is known about the physiology of the uterus postpartum, particularly due to the lack of an accurate measurement tool. The primary objective of this pilot study is to explore the potential of using electrohysterography to detect postpartum uterine contractions. If postpartum uterine activity can be objectified, this could contribute to understanding the physiology of the uterus and improve diagnosis and treatment of postpartum hemorrhage.STUDY DESIGN: In this observational study we included women aiming for a vaginal birth in two large maternity clinics in the Netherlands, Amphia Hospital Breda (group A, N2018-0161) and Máxima Medical Center Veldhoven (group B, N17.149). An electrode patch was placed on the maternal abdomen to record real-time electrical uterine activity until one hour postpartum continuously. In group A, the placement of the patch was lower than in group B. For analysis, tracings were divided into five different phases (1: dilatation until start pushing, 2: from start pushing until childbirth, 3: from childbirth until placental expulsion, 4: first hour after placental expulsion and 5: after one hour postpartum). Readability, signal quality and contraction frequency per hour were assessed. Additionally, patient satisfaction was evaluated through a survey.RESULTS: In total 91 pregnant women were included of whom 45 in group A and 46 women in group B. Complete registrations were obtained throughout the five labor phases with very little artefacts or signal loss. The readability of the tracings decreased after childbirth. A significantly better readability was found in tracings where the patch placement was lower on the abdomen for phases 4 and 5. Contraction frequency was highest during phase 2 and decreased towards phase 5. Women rated the satisfaction with electrohysterography as high and mostly did not notice the patch.CONCLUSION: It is possible to detect uterine activity postpartum with electrohysterography. Further investigation is recommended to improve diagnosis and treatment of postpartum hemorrhage.</p