Late Closure Research Articles

PD34 São Paulo Congenital Heart Corrections: Three-Years' Assist Registry

Introduction:Death from congenital heart disease (CHD) can be avoided, contributing to reduced infant mortality. The objective of this study was to identify the profile of patients undergoing surgical correction for CHD in three São Paulo State hospitals, and to determine factors that contribute to morbidity and mortality.Methods:The Voluntary Pediatric Cardiovascular Surgery Multicenter Registry (ASSIST) was created in 2014 through a Research Grant Program for the Public Healthcare System (Pesquisas para o Sistema Único de Saúde, PPSUS)* project, a federal-state joint strategic public policies research grant, coordinated by the Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo (InCor-HCFMUSP-SP) and Ribeirão Preto's Hospital das Clínicas, both linked to the São Paulo University Medical School.Results:We analyzed 1,842 patients, with an average age of 1.2 (range 0.4–8.6) years, 50.9 percent were male. Procedural complexity was classified as “Risk Adjustment in Congenital Heart Surgery” version 1 score, RACHS-1: 18.2 percent RACHS1, 25.5 percent RACHS2, 41.2 percent RACHS3, 9.6 percent RACHS4 and 5.4 percent RACHS5–6. Overall hospital mortality was 12.2 percent, and preoperative risk factors included: age <30 days (Odds Ratio, OR = 1.7 p = 0.012), prolonged ICU admission (OR = 3.3 p = 0.001). Other significant factors were RACHS score >4 (OR = 5.3 p < 0.001), heart dysfunction (OR = 3.4 p = 0.001), sepsis (OR = 3 p = 0.001), hemodynamic or surgical re-intervention required (OR = 6.2 p < 0.001), cardiorespiratory arrest (CPR, OR = 24.9 p < 0.001) and renal failure (OR = 5.4 p<0.001). The frequency of related morbidity was 16.2 heart failure, 7.1 percent arrythmia, 5.9 percent pneumonia, 5.9 percent pneumotórax, 4.2 percent pleural and pericardial effusion, 10 percent mechanical ventiation > 7 days, 13.2 percent late sternal closure, 2.8 percent had wound infection, 3.7 percent neurological alterations, 2.3 percent diaphragmatic dysfunction, 11.5 percent CPR, 3.2 percent renal failure, 4.5 percent sepsis, 55.1 percent length of hospital stay longer than 5 days with 45.8 percent postoperative hospital admission longer than 15 days and 6.1 percent needed surgical or hemodynamic re-intervention.Conclusions:The information collected in the ASSIST registry was of great importance in the São Paulo State CHD surgical practice evaluation. Morbi-mortality related factors elicited critical points and allowed improvement actions. Excluding age and intrinsic procedure complexity, identified outcome modifier factors can be manageable, aiming to increase patient safety and program resolubility or performance.

Аspects of late closing of the stent as complication of coronary stentigation in a clinical example

A clinical case of a patient with late closure of a stent (thrombosis) as a complication of coronary stenting, which appeared in a patient with diabetes mellitus, CKD II , has been presented. It is expanded the idea of the features of preparation for coronary stenting, as well as management of patients with an increased risk of complications after stenting. The choice of the stent may be varied with or without a coating, but there is always a risk of complications such as thrombosis (closure of the stent) that can lead to a re-MI, so patients should remain under the supervision of a physician within a week in the resuscitation unit, after coronary stenting, This is especially true for elderly patients who have a concomitant pathology - SD, CKD, GB, as in this clinical case. It is also necessary to conduct a thorough examination of the patient, careful collection of anamnesis before conducting coronary stenting in order to timely identify the concomitant pathology and assess the possible risk of complications. It is also necessary to select the best antiplatelet therapy. In order to prevent the complications of restenosis of the vessel and thrombosis in the future, patients who have passed stenting need to be registered with the cardiologist for timely control of relapses. We hope that the problem will help practitioners to carefully collect the history, identify, evaluate the risk of complications in patients, in order to prevent.

Valproic acid disrupts the biomechanics of late spinal neural tube closure in mouse embryos

Failure of neural tube closure in the early embryo causes neural tube defects including spina bifida. Spina bifida lesions predominate in the distal spine, particularly after exposure to the anticonvulsant valproic acid (VPA). How VPA specifically disturbs late stages of neural tube closure is unclear, as neurulation is usually viewed as a uniform ‘zippering’ process along the spine. We recently identified a novel closure site (“Closure 5”) which forms at the caudal extremity of the mouse posterior neuropore (PNP) when completion of closure is imminent. Here we investigated whether distal spina bifida in VPA-exposed embryos involves disruption of Closure 5. Exposure of E8.5 mouse embryos to VPA in whole embryo culture had marked embryotoxic effects, whereas toxic effects were less pronounced in more developmentally advanced (E9) embryos. Only 33% of embryos exposed to VPA from E9 to E10.5 achieved PNP closure (control=90%). Short-term (8h) VPA treatment diminished supra-cellular F-actin cables which normally run along the lateral neural folds, and prevented caudal PNP narrowing normally characteristic of Closure 5 formation. Laser ablation of Closure 5 caused rapid neuropore widening. Equivalent ablations of the caudal PNP in VPA treated embryos resulted in significantly less widening, suggesting VPA prevents formation of Closure 5 as a biomechanically active structure. Thus, VPA exposure prevents morphological and biomechanical conversion of the caudal extreme of the PNP during late spinal closure. Closure 5 facilitates neural fold apposition when completion of closure is imminent, such that its disruption in VPA-exposed embryos may lead to distal spina bifida.

An enhanced rotary compressor with gas injection through a novel end-plate injection structure

The gas-injected single-cylinder rotary compressor has potential in better seasonal performance than the twin-cylinder rotary compressor for air conditioning application. However, the gas-injected single-cylinder rotary compressor with traditional injection structure could not improve the thermodynamic performance as expected. Analysis shows that back-flowing of injected gas into the suction tube, quite limited injection port area, too early or too late closure of the injection port under variable working conditions are the main reasons. In this paper, a novel end-plate injection structure to overcome the shortcomings of the traditional vapor injection structures and maximize the mass of the injected gas under arbitrary working conditions are proposed. Based on geometrical analysis, the space on the end-plate for drilling the injection port without back-flowing is investigated. The results indicated that the injection region for the proposed end-plate injection structure are always existed and the injection port can be substantially enlarged. Furthermore, the performance of the rotary compressor with the traditional end-plate injection and with the proposed gas injection configuration are comparatively studied.

Retraction: Middle Miocene to Early Pliocene Contraction in the Chos Malal Fold‐and‐Thrust Belt (Neuquén Basin, Argentina): Insights from Structural Analysis and Apatite Fission‐Tracks Thermochronology

In the southern Central Andes at 37-38 °S latitude, the Chos Malal fold-and-thrust belt (FTB), which results from the Late Cretaceous closure of the Neuquen Basin, has generated increasing interest because of its potential for hydrocarbon exploration. Using detailed field mapping, seismic reflection and well data analysis, cross-section balancing, and detrital apatite fission-track thermochronology from 18 samples distributed along the FTB, we bring new quantitative constraints on the chronology of the Neogene structural development of the Chos Malal FTB. Our dataset reveals that extensive tectonically-driven exhumation through basement-involved thrusting, occurred at ~15-7 Ma in both the inner and outer sectors of the FTB. This age range is corroborated by indirect dating of the Chos Malal Formation, a syntectonic unit also deformed after deposition, which we find was deposited after 7.2 Ma ± 1.6 / 2.0 Ma, an age much younger than the Miocene age it was previously assigned. We document for the first time an Early Pliocene rapid cooling stage that was ongoing ~ 5.5 to 5.1 Ma ago in the interior of the orogenic wedge, which we attribute to out-of-sequence thrusting along basement-involved thrust faults bounding the Cordillera del Viento, driving the surface uplift of this prominent topographic feature. Finally, our sequential reconstruction of the thick and thin-skinned structures of the Chos Malal FTB shows that most of the horizontal shortening was accommodated after the Middle Miocene, which we thus consider as being the main phase of orogenic building in this sector of the Andes.

Fishes in the desert: mitochondrial variation and phylogeography of Danakilia (Actinopterygii: Cichlidae) and Aphanius (Actinopterygii: Cyprinodontidae) in the Danakil Depression of northeastern Africa

The Danakil Depression in northeastern Africa represents one of the harshest arid environments on Earth, yet two genera of fishes, Danakilia (Cichlidae) and Aphanius (Cyprinodontidae), share its sparse aquatic habitats. The evolutionary history of these fishes is investigated here in the context of genetic, geological and paleoenvironmental information. We collected samples from seven sites and assessed phylogeographic relationships using concatenated COI and cytb mtDNA genes. Danakilia morphospecies show low differentiation at mitochondrial markers, but variation is partitioned between a northern cluster containing D. dinicolai plus three undescribed riverine populations, and a southern cluster including two creek populations of D. franchettii separated by the hypersaline waters of Lake Afrera. Aphanius displayed four genetically distinct clades (A. stiassnyae in Lake Afrera; one distributed across the entire area; one in Lake Abaeded; and one in the Shukoray River), but without clear large-scale geographic structure. However, Danakil Aphanius are clearly differentiated from A. dispar sensu stricto from the Sinai Peninsula. Geological evidence suggests that after the Late Pleistocene closure of the Danakil-Red Sea connection, increased post-glacial groundwater availability caused the formation of a brackish paleo-lake flooding the entire region below the –50 m contour. Fish populations previously isolated in coastal oases during glaciation were able to mix in the paleo-lake. Subsequently, in a more arid phase starting ∼7300 BP, paleo-lake regression isolated fishes in separate drainages, triggering their still ongoing diversification.

Constraining lithospheric removal and asthenospheric input to melts in Central Asia: A geochemical study of Triassic to Cretaceous magmatic rocks in the Gobi Altai (Mongolia)

Throughout northeast China, eastern and southern Mongolia, and eastern Russia there is widespread Mesozoic intracontinental magmatism. Extensive studies on the Chinese magmatic rocks have suggested lithospheric mantle removal was a driver of the magmatism. The timing, distribution and potential diachroneity of such lithospheric mantle removal remains poorly constrained. Here, we examine successions of Mesozoic lavas and shallow intrusive volcanic plugs from the Gobi Altai in southern Mongolia that appear to be unrelated to regional, relatively small-scale deformation; at the time of magmatism, the area was ~200km from any active margin, or, after its Late Jurassic-Early Cretaceous closure, from the suture of the Mongol-Okhotsk Ocean. 40Ar/39Ar radiometric age data place magmatic events in the Gobi Altai between ~220 to 99.2Ma. This succession overlaps Chinese successions and therefore provides an opportunity to constrain whether Mesozoic lithosphere removal may provide an explanation for the magmatism here too, and if so, when.We show that Triassic to Lower Cretaceous lavas in the Gobi Altai (from Dulaan Bogd, Noyon Uul, Bulgantiin Uul, Jaran Bogd and Tsagaan Tsav) are all light rare-earth element (LREE) and large-ion lithophile element (LILE)-enriched, with negative Nb and Ta anomalies (NbLa and TaLa≤1). Geochemical data suggest that these lavas formed by low degrees of partial melting of a metasomatised lithospheric mantle that may have been modified by melts derived from recycled rutile-bearing eclogite. A gradual reduction in the involvement of garnet in the source of these lavas points towards a shallowing of the depth of melting after ~125Ma.By contrast, geochemical and isotope data from the youngest magmatic rocks in the area — 107-99Ma old volcanic plugs from Tsost Magmatic Field — have OIB-like trace element patterns and are interpreted to have formed by low degrees of partial melting of a garnet-bearing lherzolite mantle source. These rocks did not undergo significant crustal contamination, and were derived from asthenospheric mantle. The evidence of a gradual shallowing of melting in the Gobi lava provinces, culminating in an asthenospheric source signature in the youngest magmatic rocks is similar to examples from neighboring China, emphasising the wide-scale effect of a regional Mesozoic magmatic event during similar time periods. We suggest that Mongolia underwent lithospheric thinning/delamination during the Mesozoic (between ~125 and ~107Ma) with patchy areas thinning sufficiently to enable the generation of relatively small-scale asthenospheric-derived magmatism to predominate in the late Cretaceous.

Electrophysiological evidence for the interaction of prosody and thematic fit during sentence comprehension

ABSTRACTThis study investigated the interaction of prosody and thematic fit/plausibility information during the processing of sentences containing temporary early closure (correct) or late closure (incorrect) syntactic ambiguities using event-related potentials (ERPs). Early closure sentences with congruent and incongruent prosody were presented where the temporarily ambiguous NP was either a plausible or an implausible continuation for the subordinate verb (e.g. “While the band played the song/beer pleased all the customers.”). N400 and P600 components were examined at critical points in each condition. The CPS was examined in sentences with congruent prosody. Prosodic and thematic fit cues interacted immediately (N400–P600) at the implausible NP (beer), when it was paired with incongruent prosody. Incongruent prosody paired with a plausible NP (song) resulted in garden-path effects (N400–P600) at the critical verb (pleased). These findings provide strong evidence that prosodic and thematic fit/plausibility cues interact to aid the parser in syntactic structure building.

Electrophysiology of prosodic and lexical-semantic processing during sentence comprehension in aphasia

Event-related potentials (ERPs) were used to examine how individuals with aphasia and a group of age-matched controls use prosody and themattic fit information in sentences containing temporary syntactic ambiguities. Two groups of individuals with aphasia were investigated; those demonstrating relatively good sentence comprehension whose primary language difficulty is anomia (Individuals with Anomic Aphasia (IWAA)), and those who demonstrate impaired sentence comprehension whose primary diagnosis is Broca's aphasia (Individuals with Broca's Aphasia (IWBA)). The stimuli had early closure syntactic structure and contained a temporary early closure (correct)/late closure (incorrect) syntactic ambiguity. The prosody was manipulated to either be congruent or incongruent, and the temporarily ambiguous NP was also manipulated to either be a plausible or an implausible continuation for the subordinate verb (e.g., "While the band played the song/the beer pleased all the customers."). It was hypothesized that an implausible NP in sentences with incongruent prosody may provide the parser with a plausibility cue that could be used to predict syntactic structure. The results revealed that incongruent prosody paired with a plausibility cue resulted in an N400-P600 complex at the implausible NP (the beer) in both the controls and the IWAAs, yet incongruent prosody without a plausibility cue resulted in an N400-P600 at the critical verb (pleased) only in healthy controls. IWBAs did not show evidence of N400 or P600 effects at the ambiguous NP or critical verb, although they did show evidence of a delayed N400 effect at the sentence-final word in sentences with incongruent prosody. These results suggest that IWAAs have difficulty integrating prosodic cues with underlying syntactic structure when lexical-semantic information is not available to aid their parse. IWBAs have difficulty integrating both prosodic and lexical-semantic cues with syntactic structure, likely due to a processing delay.

Large-scale porphyry-type mineralization in the Central Asian metallogenic domain: A review

A series of porphyry-type Cu-(Mo)-(Au) deposits including some giant world-class deposits such as Kounrad, Aktogai, Kal’makyr, Oyu Tolgoi and Chalukou occur in the Central Asian metallogenic domain (CAMD). The outline of the CAMD almost overlaps with that of the Central Asian orogenic belt (CAOB), which is located between the East Europe, Siberia, Tarim and North China cratons. The CAMD comprises sparsely exposed tectonic slices of Precambrian high-grade metamorphic basement rocks that are sandwiched between Phanerozoic accretionary complexes and arc rocks. According to geological, metallogenic, geochronological and tectonic setting characteristics, the CAMD comprises three metallogenic provinces: (1) the Kazakhstan Cu-Au-Mo, (2) the Mongolia Cu-Au and (3) the Northeast China Mo-Cu metallogenic provinces. Early Paleozoic (∼490 to 440 Ma) and Late Paleozoic (∼330 to 295 Ma) large scale porphyry-type mineralization in the Kazakhstan metallogenic province is intimately associated with the evolution of the Central Tianshan–Yili–Northern Tianshan–Kokchetav–Chingiz Paleozoic arc system which was terminated by the late Permian closure of the western segment of the Paleo-Asian Ocean. In contrast, the ∼370 Ma and ∼240 Ma porphyry-type mineralization of the Mongolia metallogenic province is related to the Tuva–Mongolia arc collage system that was formed during the evolution of the Paleo-Asian Ocean in the Paleozoic and the Mongol–Okhotsk Ocean in the early Mesozoic. Furthermore, the Northeast China metallogenic province was affected by three distinct geodynamic processes that were associated with the Paleo-Asian, Mongol–Okhotsk and Paleo-Pacific Oceans during the Paleozoic (>250 Ma), the early Mesozoic (>200 Ma) and the late Mesozoic (200–90 Ma), respectively. Except for the Early Paleozoic Cu mineralization at Duobaoshan (∼480 Ma) and Bainaimiao (440 Ma), the porphyry-type mineralization of this metallogenic province is predominantly characterized by widespread Mesozoic Mo mineralization.In general, porphyry-type deposits of the CAMD have geological, structural, metallogenic, alteration and fluid characteristics, which are consistent either with those related to the oceanic subductional arc settings of the Circum-Pacific metallogenic domain or with those of the continental collisional environment in the Tethyan metallogenic domain. The involvement of highly oxidized intermediate to felsic magmas is fundamental for the formation of porphyry deposits. Even though the prevalent MASH and slab melting models can be employed to interpret the genesis of some porphyry Cu deposits in the CAMD, a here newly suggested model, which is based on ‘pre-enriched mafic lower crust and the subduction of a relictic mid-oceanic ridge’, is thought to explain the large scale copper mineralization in the Balkhash–West Junggar metallogenic belt of the Kazakhstan metallogenic province. Nevertheless, most of the porphyritic suites associated with the Mo deposits in the Northeast China metallogenic province have relatively depleted mantle-like neodymium and hafnium isotopic compositions, suggesting that the ore-forming granitic magma may have predominantly been derived from juvenile lower crust. Upwelling of asthenosphere may have triggered the melting of the lower crust during post-collisional extension subsequent to the closure of the Paleo-Asian Ocean in the Triassic, the subduction of the Paleo-Pacific ocean in the Jurassic and the thinning of the lithosphere caused by rollback of the Paleo-Pacific plate in the Cretaceous. Ancient crustal components were only locally found to have been involved in the magma source of several medium-large Mo deposits.

Retracted: Middle Miocene to Early Pliocene Contraction in the Chos Malal Fold‐and‐Thrust Belt (Neuquén Basin, Argentina): Insights From Structural Analysis and Apatite Fission‐Tracks Thermochronology

AbstractIn the southern central Andes at 37–38°S latitude, the Chos Malal fold‐and‐thrust belt (FTB), which results from the Late Cretaceous closure of the Neuquén Basin, has generated increasing interest because of its potential for hydrocarbon exploration. Using detailed field mapping, seismic reflection and well data analysis, cross‐section balancing, and detrital apatite fission‐track thermochronology from 18 samples distributed along the FTB, we bring new quantitative constraints on the chronology of the Neogene structural development of the Chos Malal FTB. Our data set reveals that extensive tectonically driven exhumation through basement‐involved thrusting occurred at ~15–7 Ma in both the inner and outer sectors of the FTB. This age range is corroborated by indirect dating of the Chos Malal Formation, a syntectonic unit also deformed after deposition, which we find was deposited after 7.2 Ma ± 1.6/2.0 Ma, an age much younger than the Miocene age it was previously assigned. We document for the first time an early Pliocene rapid cooling stage that was ongoing ~5.5 to 5.1 Ma ago in the interior of the orogenic wedge, which we attribute to out‐of‐sequence thrusting along basement‐involved thrust faults bounding the Cordillera del Viento, driving the surface uplift of this prominent topographic feature. Finally, our sequential reconstruction of the thick‐ and thin‐skinned structures of the Chos Malal FTB shows that most of the horizontal shortening was accommodated after the middle Miocene, which we thus consider as being the main phase of orogenic building in this sector of the Andes.

Birth, life, and demise of the Andean–syn‐collisional Gissar arc: Late Paleozoic tectono‐magmatic‐metamorphic evolution of the southwestern Tian Shan, Tajikistan

AbstractThe amalgamation of the Central Asian Orogenic Belt in the southwestern Tian Shan in Tajikistan is represented by tectono‐magmatic‐metamorphic processes that accompanied late Paleozoic ocean closure and collision between the Karakum‐Tarim and Kazakh‐Kyrgyz terranes. Integrated U‐Pb geochronology, thermobarometry, pseudosection modeling, and Hf geochemistry constrain the timing and petro‐tectonic nature of these processes. The Gissar batholith and the Garm massif represent an eastward, along‐strike increase in paleodepth from upper‐batholith (~21–7 km) to arc‐root (~36–19 km) levels of the Andean–syn‐collisional Gissar arc, which developed from ~323–288 Ma in two stages: (i) Andean, I‐type granitoid magmatism from ~323–306 Ma due to northward subduction of the Gissar back‐arc ocean basin under the Gissar microcontinent, which was immediately followed by (ii) syn‐collisional, I‐S‐type granitoid magmatism in the Gissar batholith and the Garm massif from ~304–288 Ma due to northward subduction/underthrusting of Karakum marginal‐continental crust under the Gissar microcontinent. A rapid isotopic pull‐up from ~288–286 Ma signals the onset of juvenile, alkaline‐syenitic, post‐collisional magmatism by ~280 Ma, which was driven by delamination of the Gissar arclogite root and consequent convective asthenospheric upwelling. Whereas M–HT/LP prograde metamorphism in the Garm massif (650–750°C/6–7 kbar) from ~310–288 Ma was associated with subduction‐magma inundation and crustal thickening, HT/LP heating and decompression to peak‐metamorphic temperatures (~800–820°C/6–4 kbar) at ~288 ± 6 Ma was driven by the transmission of a post‐collisional, mantle‐derived heat wave through the Garm‐massif crust.

Power and fuel economy optimizations of gasoline engines using hydraulic variable valve actuation system

The hydraulic variable valve actuation (HVVA) system can provide greater freedoms to the engine valve motions than most of the traditional cam-based valve train systems do. By considering the characteristics of the HVVA system, the strategies of putting its outstanding flexibilities into use for further improving the performances of gasoline engines with respect to power and fuel economy are developed in this research. A new GT-suite HVVA engine model is proposed which is able to realize the interdependencies of the HVVA system and the engine. In addition, the model is calibrated by experimental data and the proposed genetic algorithm (GA) optimization schemes are carried out for optimizing the engine outputs at full engine load and fuel economy at partial engine load. A potential average improvement of 10.4% on the engine outputs at full load over the entire operating speed range of the test engine is noticed from implementing the optimized HVVA valve motions. Moreover, the advanced GA algorithm for fuel economy optimization ensures the GA optimizer could maintain its proper functionality while non-linear constraints are taken into considerations. The late exhaust valve closure (LEVC) and early intake valve closure (EIVC) strategies are adopted at the same time for granting the engine an internal exhaust gas recirculation (IEGR) feature and together evolved into the HVVA strategy for fulfilling the partial engine loads without throttling. By conducting the advanced GA optimizations with the proposed HVVA strategy for partial engine load operations, the resulted break specific fuel consumption (BSFC) of the HVVA engine could be brought down by 13.1% on average with a maximum of 15.8% over its working speed range at the exemplary 7Nm load point comparing to those of the original test engine.

Tectonic significance of the cumulate gabbros within Kuluncak Ophiolitic suite (Malatya, SE Turkey) inferred from geochemical data

The Kuluncak (Malatya) ophiolite in the Eastern Tauride, Turkey, consists of mantle tectonites, ultramafic-mafic cumulates, isotropic gabbros, a sheeted dike complex, plagiogranites, and a volcanic complex. The best exposure of the mafic cumulate rocks of the Kuluncak ophiolite is in the Hekimhan region, where they are represented by olivine gabbro and gabbro showing orthocumulate to mesocumulate textures. The cumulus and postcumulus minerals do not show significant zoning. The crystallization order of the cumulates is olivine, plagioclase, clinopyroxene and orthopyroxene. Whole-rock major- and trace-element geochemistry of the mafic cumulate rocks indicates that the primary magma generating the Kuluncak ophiolite is similar in composition to those observed in modern island-arc tectonic settings. Rare earth element (REE) concentrations of the mafic cumulates exhibit depleted light rare earth element (LREE) patterns, with CeN/SmN and CeN/YbN ratios ranging from 0.21 to 0.75 and from 0.17 to 0.66, respectively. The coexistence of anorthite-rich plagioclase (An 73.4-93.7 ), highly magnesian olivine (Fo 65.2-86.9 ), clinopyroxene (Mg# 75-92.1 ), and orthopyroxene (Mg# 77.6-84.3 ) in the cumulate gabbroic rocks is indicative of an intraoceanic subduction setting and suggests that the Kuluncak ophiolite was formed during the Late Cretaceous closure of the Inner Tauride Ocean.

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate.

Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p < .001). In addition, children with LHPC produced significantly more active cleft speech characteristics than children with EHPC (p < .001). Boys achieved significantly lower PCC-A scores than girls (p = .04) and produced significantly more consonant errors than girls (p = .02). No significant differences were found between groups regarding burden of treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables.

Speech and swallowing abnormalities in adults with POLG associated ataxia (POLG-A)

BackgroundMutations in the nuclear-encoded mitochondrial DNA polymerase gamma (POLG) can result in a wide spectrum of neurological deficits. A common presentation is progressive ataxia (POLG-A) which includes impaired speech and swallowing. The nature, severity and impact of these deficits in POLG-A is not known. A comprehensive quantitative and qualitative characterization of dysarthria and dysphagia in this recurrent ataxia disorder will assist in diagnostics, provide insights into the underlying pathology, and establish the foundation for future therapy trials. Methods14 consecutive patients with POLG (9 females, mean age=50.1y, SD=11.2) and 34 healthy controls were enrolled. Comprehensive assessments of motor speech and swallowing function, acoustic analysis of speech, videofluoroscopy and measures of quality of life were conducted. ResultsThe speech profile of individuals with POLG-A was characterized by poor control of pitch and strain-strangled voice quality, reduced rate of speech and longer variable silences between words, and articulatory breakdown including imprecise consonants and vowel distortions. Swallowing deficits included slower initiation of the swallow reflex, poor control of bolus and late epiglottic closure. Speech and swallowing related quality of life was worse than healthy controls. ConclusionsThe dysarthria and dysphagia profiles in POLG-A are largely symptomatic of impaired timing, indicating a mainly spinocerebellar deficit. Dysarthria and dysphagia contribute to a significant impairment in functional quality of life, and progress distinctly from other POLG-A dysfunctions like ataxia or cognitive impairment. Our assessments establish meaningful patient focused outcome measures that will be suitable for use in natural history studies and clinical trials.

Prosodic graphic processing of sentences ambiguas in the quiet reading of bilingual deaf

We start from the proposal of Fodor (2002) that both syntactic structures as the prosodic are computed during silent reading. We examined the effect of prosodic marking graphical processing of silent reading of temporary ambiguous sentences as: When dogs attacked / a girl (,) / tore her dress / yellow, considering the integration syntax-prosody. We compare the silent reading time of the third fragment of temporary subordinate ambiguous sentences in written texts of the Portuguese language for deaf bilingual Libras/Portuguese. We assume that deaf people spend more time reading than listeners, but there would also be a difference as one disambiguator comma were or not present in the sentence. The experiment made up an online test of 108 subordinate temporary ambiguous sentences, in 6 conditions, through DMDX program. 18 deaf bilingual Libras/Portuguese and 18 listeners participated. There was no significant difference in the reading time of the third fragment of temporary subordinate ambiguous sentences between deaf and listeners; also, there was no significant difference with the use of the comma. There were differences between the means Late Closure (LC) and Early Closure (EC); Semantic Control (SC) and Early Closure (EC). There was no significant difference between the types of Late Closure (LC) and Semantic Coutrol (SC) sentence.

Does the timing of loop ileostomy closure affect outcome: A case-matched study

IntroductionThe optimal timing for the closure of loop ileostomies remains controversial. The aim of this study is to determine whether ileostomy closure (<3 months post formation) affects stoma-related morbidity compared to late closure (≥3 months post formation). MethodsAll patients who had loop ileostomy and ileostomy closure between 2012 and 2015 were identified from an IRB-approved, prospectively maintained institutional database.The patients who underwent ileostomy closure (<3 months) were compared against matched patients undergoing ileostomy closure (≥3 months). The outcomes for the two groups were compared. ResultsA total of 358 patients were analyzed. Mean age was 46 ± 17 years. There were 179 patients in each group [ileostomy closure (<3 months) and ileostomy closure (≥3 months)]. Both groups were matched. Groups were comparable in preoperative characteristics and demographics. All of the peri-operative variables were comparable. No difference was observed in estimated blood loss (EBL), operative time (OT) and length of stay (LOS) (all p > 0.05). Postoperative outcomes including wound infection, post-operative bleeding, intra-abdominal abscess, ileus, small bowel obstruction (SBO), anastomotic leak, reoperation, surgery related readmission, postoperative transfusion were also similar among the groups (p > 0.05). ConclusionsIleostomy closure (<3 months) is practical and safe. It does not increase morbidity and significantly reduces the time patient has a stoma. This may be advantageous in regards to having a reduced possibility of stoma related complications.

Late canopy closure delays senescence and promotes growth of the spring ephemeral wild leek (Allium tricoccum)

Spring ephemerals take advantage of the high light conditions in spring to accumulate carbon reserves through photosynthesis before tree leaves unfold. Recent work has reported delayed leaf senescence under constant light availability in some spring ephemerals, such as wild leek (Allium tricoccum). This paper aims to establish whether tree canopy composition and phenology can influence the growth of spring ephemerals through changes in their phenology. Wild leek bulbs were planted in 31 plots in southern Quebec, Canada, under canopies varying in composition and densities. Light availability and tree phenology were measured, along with other environmental conditions, and their effect on the growth of wild leeks was assessed with a redundancy analysis. Higher light availability resulted in better growth of wild leeks. The plants postponed their senescence under trees with late bud-burst, and thus better bulb growth and seed production were achieved. The tree litter and temperature and moisture levels of the soil also influenced the growth and survival of wild leeks. Thus, tree leaf phenology appears to have a strong impact on the growth of spring ephemerals by modulating the length of their growing season and their photosynthetic capacity. This underlines the importance of considering the variation of light availability throughout the growing season in the study of spring ephemerals.

The Effects of Prosodic Cues on Auditory Sentence Processing: An Analysis Focusing on Early and Late Closure

The Effects of Prosodic Cues on Auditory Sentence Processing: An Analysis Focusing on Early and Late Closure