Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study

BACKGROUND In Mongolia, adequate early diagnosis and treatment of developmental hip dysplasia (DDH) have been unavailable and its incidence was unknown. We determined the incidence of ultrasonographic DDH in newborns and established adequate procedures for diagnosis and treatment of DDH at the largest maternity hospital in Ulaanbaatar, Mongolia. METHODOLOGY/PRINCIPAL FINDINGS During one year (Sept 2010 - Aug 2011) we assessed the hips newborns using ultrasound and Graf's classification of DDH. 8,356 newborns were screened; median age at screening was 1 day. We identified 14,873 Type 1 (89.0%), 1715 Type 2a (10.3%), 36 Type 2c (0.2%), 70 Type D (0.4%), 14 Type 3 (0.08%), and 4 Type 4 hips (0.02%). Children with Type 1 hips (normal) were discharged. Children with Type 2a hips (physiologically immature) received follow-up ultrasounds at monthly intervals. Children with Type 2c to 4 (DDH; deformed or misaligned hip joint) hips were treated with a Tubingen hip flexion splint and also followed up. The hip abnormalities resolved to mature hips in all children who were followed up. There was no evidence for severe treatment related complications. CONCLUSION/SIGNIFICANCE This study suggests that the incidence of DDH in Mongolian neonates is comparable to that in neonates in Europe. Early ultrasound-based assessment and splinting treatment of DDH led to mature hips in all children followed up. Procedures are feasible and will be continued.

Creatine supports propagation and promotes neuronal differentiation of inner ear progenitor cells

Long-term propagation of inner ear-derived progenitor/stem cells beyond the third generation and differentiation into inner ear cell types has been shown to be feasible, but challenging. We investigated whether the known neuroprotective guanidine compound creatine (Cr) promotes propagation of inner ear progenitor/stem cells as mitogen-expanded neurosphere cultures judged from the formation of spheres over passages. In addition, we studied whether Cr alone or in combination with brain-derived neurotrophic factor (BDNF) promotes neuronal differentiation of inner ear progenitors. For this purpose, early postnatal rat spiral ganglia, utricle, and organ of Corti-derived progenitors were grown as floating spheres in the absence (controls) or presence of Cr (5 mM) from passage 3 onward. Similarly, dissociated sphere-derived cultures were differentiated for 14 days in the presence or absence of Cr (5 mM) and spiral ganglia sphere-derived cultures in a combination of Cr with the neurotrophin BDNF (50 ng/ml). We found that the cumulative total number of spheres over all passages was significantly higher after Cr supplementation as compared with controls in all the three inner ear cultures. In contrast, sphere sizes were not affected by the administration of Cr. Administration of Cr during differentiation of spiral ganglia cells resulted in a significantly higher density of β-III-tubulin-positive cells compared with controls, whereas densities of myosin VIIa-positive cells in cultures of utricle and organ of Corti were not affected by the treatment. Importantly, a combination of Cr with the neurotrophin BDNF resulted in further significantly increased densities of β-III-tubulin-positive cells in cultures of spiral ganglia cells as compared with single treatments. In sum, Cr promoted continuing propagation of rat inner ear-derived progenitor cells and supported specifically in combination with BDNF the differentiation of neuronal cell types from spiral ganglion-derived spheres.

The onset of Neoglaciation 6000 years ago in western Mongolia revealed by an ice core from the Tsambagarav mountain range

Glacier highstands since the Last Glacial Maximum are well documented for many regions, but little is known about glacier fluctuations and lowstands during the Holocene. This is because the traces of minimum extents are difficult to identify and at many places are still ice covered, limiting the access to sample material. Here we report a new approach to assess minimal glacier extent, using a 72-m long surface-to-bedrock ice core drilled on Khukh Nuru Uul, a glacier in the Tsambagarav mountain range of the Mongolian Altai (4130 m asl, 48°39.338′N, 90°50.826′E). The small ice cap has low ice temperatures and flat bedrock topography at the drill site. This indicates minimal lateral glacier flow and thereby preserved climate signals. The upper two-thirds of the ice core contain 200 years of climate information with annual resolution, whereas the lower third is subject to strong thinning of the annual layers with a basal ice age of approximately 6000 years before present (BP). We interpret the basal ice age as indicative of ice-free conditions in the Tsambagarav mountain range at 4100 m asl prior to 6000 years BP. This age marks the onset of the Neoglaciation and the end of the Holocene Climate Optimum. The ice-free conditions allow for adjusting the Equilibrium Line Altitude (ELA) and derive the glacier extent in the Mongolian Altai during the Holocene Climate Optimum. Based on the ELA-shift, we conclude that most of the glaciers are not remnants of the Last Glacial Maximum but were formed during the second part of the Holocene. The ice core derived accumulation reconstruction suggests important changes in the precipitation pattern over the last 6000 years. During formation of the glacier, more humid conditions than presently prevailed followed by a long dry period from 5000 years BP until 250 years ago. Present conditions are more humid than during the past millennia. This is consistent with precipitation evolution derived from lake sediment studies in the Altai.

Cerebral hemodynamic and oxygenation changes induced by inner and heard speech: a study combining functional near-infrared spectroscopy and capnography

The aim of this study was to investigate the effects of inner and heard speech on cerebral hemodynamics and oxygenation in the anterior prefrontal cortex (PFC) using functional near-infrared spectroscopy and to test whether potential effects were caused by alterations in the arterial carbon dioxide pressure (PaCO2). Twenty-nine healthy adult volunteers performed six different tasks of inner and heard speech according to a randomized crossover design. During the tasks, we generally found a decrease in PaCO2 (only for inner speech), tissue oxygen saturation (StO2), oxyhemoglobin ([O2Hb]), total hemoglobin ([tHb]) concentration and an increase in deoxyhemoglobin concentration ([HHb]). Furthermore, we found significant relations between changes in [O2Hb], [HHb], [tHb], or StO2 and the participants’ age, the baseline PETCO2, or certain speech tasks. We conclude that changes in breathing during the tasks led to lower PaCO2 (hypocapnia) for inner speech. During heard speech, no significant changes in PaCO2 occurred, but the decreases in StO2, [O2Hb], and [tHb] suggest that changes in PaCO2 were also involved here. Different verse types (hexameter and alliteration) led to different changes in [tHb], implying different brain activations. In conclusion, StO2, [O2Hb], [HHb], and [tHb] are affected by interplay of both PaCO2 reactivity and functional brain activity.

Persistence of Artemisia steppe in the Tangra Yumco Basin, west-central Tibet, China: despite or in consequence of Holocene lake-level changes?

The closed Tangra Yumco Basin underwent the strongest Quaternary lake-level changes so far recorded on the Tibetan Plateau. It was hitherto unknown what effect this had on local Holocene vegetation development. A 3.6-m sediment core from a recessional lake terrace at 4,700 m a.s.l., 160 m above the present lake level of Tangra Yumco, was studied to reconstruct Holocene flooding phases (sedimentology and ostracod analyses), vegetation dynamics and human influence (palynology, charcoal and coprophilous fungi analyses). Peat at the base of the profile proves lake level was below 4,700 m a.s.l. during the Pleistocene/Holocene transition. A deep-lake phase started after 11 cal ka BP, but the ostracod record indicates the level was not higher than similar to 4,720 m a.s.l. (180 m above present) and decreased gradually after the early Holocene maximum. Additional sediment ages from the basin suggest recession of Tangra Yumco from the coring site after 2.6 cal ka BP, with a shallow local lake persisting at the site until similar to 1 cal ka BP. The final peat formation indicates drier conditions thereafter. Persistence of Artemisia steppe during the Holocene lake high-stand resembles palynological records from west Tibet that indicate early Holocene aridity, in spite of high lake levels that may have resulted from meltwater input. Yet pollen assemblages indicate humidity closer to that of present potential forest areas near Lhasa, with 500-600 mm annual precipitation. Thus, the early mid-Holocene humidity was sufficient to sustain at least juniper forest, but Artemisia dominance persisted as a consequence of a combination of environmental disturbances such as (1) strong early Holocene climate fluctuations, (2) inundation of habitats suitable for forest, (3) extensive water surfaces that served as barriers to terrestrial diaspore transport from refuge areas, (4) strong erosion that denuded the non-flooded upper slopes and (5) increasing human influence since the late glacial.

The effect of inner speech on arterial CO2 and cerebral hemodynamics and oxygenation: a functional NIRS study

The aim of the present study was (i) to investigate the effect of inner speech on cerebral hemodynamics and oxygenation, and (ii) to analyze if these changes could be the result of alternations of the arterial carbon dioxide pressure (PaCO2). To this end, in seven adult volunteers, we measured changes of cerebral absolute [O2Hb], [HHb], [tHb] concentrations and tissue oxygen saturation (StO2) (over the left and right anterior prefrontal cortex (PFC)), as well as changes in end-tidal CO2 (PETCO2), a reliable and accurate estimate of PaCO2. Each subject performed three different tasks (inner recitation of hexameter (IRH) or prose (IRP) verses) and a control task (mental arithmetic (MA)) on different days according to a randomized crossover design. Statistical analysis was applied to the differences between pre-baseline, two tasks, and four post-baseline periods. The two brain hemispheres and three tasks were tested separately. During the tasks, we found (i) PETCO2 decreased significantly (p < 0.05) during the IRH ( ~ 3 mmHg) and MA ( ~ 0.5 mmHg) task. (ii) [O2Hb] and StO2 decreased significantly during IRH ( ~ 1.5 μM; ~ 2 %), IRP ( ~ 1 μM; ~ 1.5 %), and MA ( ~ 1 μM; ~ 1.5 %) tasks. During the post-baseline period, [O2Hb] and [tHb] of the left PFC decreased significantly after the IRP and MA task ( ~ 1 μM and ~ 2 μM, respectively). In conclusion, the study showed that inner speech affects PaCO2, probably due to changes in respiration. Although a decrease in PaCO2 is causing cerebral vasoconstriction and could potentially explain the decreases of [O2Hb] and StO2 during inner speech, the changes in PaCO2 were significantly different between the three tasks (no change in PaCO2 for MA) but led to very similar changes in [O2Hb] and StO2. Thus, the cerebral changes cannot solely be explained by PaCO2.

Effects of inner and heard speech in arts speech therapy on cerebral oxygenation and hemodynamics

Background: The aim of the present study was to contributing to researching physiological effects of arts speech therapy by (i) investigating effects of inner and heard speech on cerebral hemodynamics and oxygenation, and (ii) analyzing if these changes were affected by alterations of the arterial carbon dioxide pressure (PaCO2). Methods: In 29 healthy adult volunteers we measured changes in cerebral absolute oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]), total hemoglobin ([tHb]) concentrations and tissue oxygen saturation (StO2) (over the left and right anterior prefrontal cortex (PFC)) using functional near-infrared spectroscopy (fNIRS) as well as changes in end-tidal CO2 (PETCO2) using capnography. Each subject performed six different tasks: three types of task modalities, i.e. inner speech, heard speech from a person and heard speech from a record, and, two recitation texts, i.e. hexameter and alliteration on different days according to a randomized crossover design. Statistical analysis was applied to the differences between the baseline, two task and four recovery periods. The two brain hemispheres, i.e. left and right PFC, and six tasks were tested separately. Results: During the tasks we found in general a decrease in PETCO2 (significantly only for inner speech), StO2, [O2Hb], [tHb] as well as in an increase in [HHb]. There was a significant difference between hexameter and alliteration. Particularly, the changes in [tHb] at the left PFC during tasks and after them were statistically different. Furthermore we found significant relations between changes in [O2Hb], [HHb], [tHb] or StO2 and the participants’ age, the baseline PETCO2, or certain speech tasks. Conclusions: Changes in breathing (hyperventilation) during the tasks led to lower PaCO2 (hypocapnia) for inner speech. During heard speech no significant changes in PaCO2 occurred, but the decreases in StO2, [O2Hb], [tHb] suggest that changes in PaCO2 were also relevant here. Different verse types (hexameter, alliteration) led to different changes in [tHb]. Consequently, StO2, [O2Hb], [HHb] and [tHb] are affected by interplay of both PaCO2 reactivity and task dependent functional brain activity.

The influence of inner and heard speech in arts speech therapy on brain oxygenation and hemodynamics

Purpose: Artistic speech therapy is applied in anthroposophically extended medicine to treat several diseases. The aim is to understand the physiology by investigating the effect of inner and heard speech on brain hemodynamics and oxygenation and analyzing whether these changes were affected by changes in arterial carbon dioxide pressure. Methods: In 29 healthy adult volunteers changes in cerebral absolute oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]), total hemoglobin ([tHb]) concentrations and tissue oxygen saturation (StO2) were measured by functional near-infrared spectroscopy (fNIRS). End-tidal CO2 (PETCO2) was assessed by capnography. Each subject performed six tasks: inner speech, heard speech from a person and heard speech from a record with each two different recitation texts: hexameter and alliteration according to a randomized crossover design. Results: Significant changes during tasks: A decrease in StO2, [O2Hb], [tHb] and PETCO2 (only for inner speech); an increase in [HHb]. There was a significant difference between hexameter and alliteration. Particularly, changes in [tHb] at the left prefrontal cortex during tasks and after them were statistically different. Furthermore we found significant relations between changes in [O2Hb], [HHb], [tHb] or StO2 and the participants’ age, the baseline PETCO2, or certain speech tasks. Conclusion: During the inner speech, hyperventilation led to a lower PETCO2 (hypocapnia). During heard speech no significant changes in PETCO2 occurred. But decreases in StO2, [O2Hb], [tHb] suggest hypocapnia also here. Hexameter and alliteration led to different changes in [tHb]. Consequently, our parameters are affected by an interplay of both PETCO2 response and task dependent functional brain activity.