Preterm nutritional intake and MRI phenotype at term age: a prospective observational study

Objective: To describe (1) the relationship between nutrition and the preterm-at-term infant phenotype, (2) phenotypic differences between preterm-at-term infants and healthy term born infants and (3) relationships between somatic and brain MRI outcomes. Design: Prospective observational study. Setting: UK tertiary neonatal unit. Participants: Preterm infants (<32 weeks gestation) (n=22) and healthy term infants (n=39) Main outcome measures: Preterm nutrient intake; total and regional adipose tissue (AT) depot volumes; brain volume and proximal cerebral arterial vessel tortuosity (CAVT) in preterm infants and in term infants. Results: Preterm nutrition was deficient in protein and high in carbohydrate and fat. Preterm nutrition was not related to AT volumes, brain volume or proximal CAVT score; a positive association was noted between human milk intake and proximal CAVT score (r=0.44, p=0.05). In comparison to term infants, preterm infants had increased total adiposity, comparable brain volumes and reduced proximal CAVT scores. There was a significant negative correlation between deep subcutaneous abdominal AT volume and brain volume in preterm infants (r=−0.58, p=0.01). Conclusions: Though there are significant phenotypic differences between preterm infants at term and term infants, preterm macronutrient intake does not appear to be a determinant. Our preliminary data suggest that (1) human milk may exert a beneficial effect on cerebral arterial vessel tortuosity and (2) there is a negative correlation between adiposity and brain volume in preterm infants at term. Further work is warranted to see if our findings can be replicated and to understand the causal mechanisms

Mobile Jacobi schemes for parallel computation

AbstractParallel computers (such as the distributed array professor and systolic arrays) bring into consideration the Jacobi method where several non-interacting rotations can be performed simultaneously. However, the design of the algorithm is much more crucial in a parallel environment; inefficiencies can lead to considerable organizationa costs. This paper provides a general framework for the description of mobile schemes together with two specific schemes, the better of which reduces the organizational overheads for the jacobi method to zero

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Adipose tissue magnetic resonance imaging in the newborn

Infancy is a period of rapid adipose tissue accumulation, and influences during early development are plausible determinants of altered adiposity. The distribution, as well as the quantity of adipose tissue, is a marker of health and disease. Previous methods for the assessment of body composition in infants have been indirect and thus unable to determine adipose quantity reliably, nor assess adipose tissue distribution. Adipose tissue magnetic resonance imaging is direct, non-invasive, radiation free and suitable for serial examinations in infancy. Adipose tissue depots are quantified individually and summated to provide an accurate measure of depot-specific and total adiposity. We have adapted this technique for application to newborns and, to date, have imaged over 100 term and preterm infants

Distribution of adipose tissue in the newborn

Regional differences in adipose tissue distribution are associated with differences in adipocyte metabolism and obesity-related morbidities. Intrauterine growth restriction appears to place individuals at greater risk of obesity associated morbidities in later life. Despite this, little is known regarding the quantity and distribution of adipose tissue in infants during early development. The aim of this study was to compare total and regional adipose tissue content in appropriate-for-gestational-age (AGA) and growth-restricted (GR) newborn infants born at or near term. Whole body adipose tissue magnetic resonance imaging (MRI) was performed as soon as possible after birth. Total and regional adipose tissue depots were quantified. A total of 35 infants (10 GR; 25 AGA) were studied. Mean (SD) total percentage adipose tissue was lower in GR infants than AGA infants [GR: 17.70% (2.17); AGA: 23.40% (3.85); p = 0.003]. This difference arose from differences in subcutaneous adipose tissue mass [mean (SD) percentage subcutaneous adipose tissue mass, GR: 16.13% (2.20); AGA: 21.44% (3.81); p = 0.004], but not intra-abdominal adipose tissue mass [mean (SD) percentage intra-abdominal adipose tissue, GR: 0.42% (0.22); AGA: 0.61% (0.31); p = 0.45]. In contrast to subcutaneous adipose tissue, intra-abdominal adipose tissue is not reduced in infants with intrauterine growth restriction. This suggests that subcutaneous and intra-abdominal adipose tissue compartments may be under different regulatory control during intrauterine life

Preterm infants at term show increased intrahepatocellular lipid content on proton magnetic resonance spectroscopy

Proton magnetic resonance spectroscopy (1H MRS) offers a non-invasive means to quantify intrahepatocellular (IHCL) lipid content which until recently was only possible using liver biopsy. Non alcoholic fatty liver disease is a spectrum varying from fatty infiltration to cirrhosis. The prevalence of this condition is increasing worldwide and is increasingly being reported in younger populations. Increased IHCL is associated with obesity, particularly intra-abdominal adiposity, insulin resistance and type II diabetes. We have shown that adipose tissue (AT) distribution is altered in the preterm infant at term, with increased intra-abdominal AT. The aim of this study was to establish the feasibility of investigating IHCL deposition in infants using 1H MRS. Whole body MR AT imaging was performed as previously described on a 1.5T Eclipse system. Preterm infants were studied at term and term infants in the first week. Hepatic 1H MR spectra were obtained using a PRESS sequence (TR 1500ms, TE 135ms). We employed one way analysis of variance. The study was approved by the local research ethics committee. To date we have studied 9 infants, 5 preterm (gestational age 29 - 31 weeks) and 4 healthy term infants. These were compared with 5 healthy control adults. Although adults had a significantly increased content of total AT (p=0.008) with an increased ratio of intra-abdominal to subcutaneous AT (p=0.028), the preterm infants had significantly elevated IHCL compared with term infants and adults (Kruskal Wallis, p=0.016). We have demonstrated the feasibility of obtaining hepatic 1H MR spectra for quantification of IHCL in infants. The clinical relevance of increased hepatic lipid in preterm infants is as yet unknown. It may be transient and represent recovery from previous nutrient deprivation. Alternatively persisting increase in IHCL might underlie the observed abnormalities in insulin sensitivity in adolescence in children born preterm