Objetivo: Avaliar os efeitos da desnutrição intra-uterina na acuidade visual (AV) de resolução de grades pelo Potencial Visual Evocado de Varredura (PVEv) e Cartões de Acuidade de Teller (CAT). Método: Avaliamos a AV de resolução de grades, binocularmente, de 41 recém-nascidos com idade estacional 37 semanas, destes 23 nasceram com o peso adequado para a idade gestacional (AIG - Idade: 14,3 ± 7,5 semanas) e 18 nasceram pequenos para a idade gestacional (PIG - Idade: 10,7 ± 4,1semanas). A AV foi determinada usando ambas as técnicas psicofísica (CAT) e eletrofisiológica (PVEv). Durante o teste dos CAT foram apresentados cartões contendo em um dos lados grades de ondas quadradas pretas e brancas com freqüência espacial entre 0,23 e 19 ciclos por grau de ângulo visual a 55 cm do participante. O teste iniciou com o cartão com a freqüência espacial mais baixa com orientação randômica desconhecida pelo experimentador. Cartões contendo freqüências espaciais mais altas foram apresentados gradativamente até que uma resposta incorreta ocorresse, então o cartão anterior era apresentado novamente. A AV foi definida pela média aritmética das freqüências espaciais contidas nos cartões para 4 reversões. Para o registro do PVEv, o sistema PowerDiva (Brosnahan et al., 1998) foi usado para gerar todos os estímulos e analisar as repostas provocadas. Estímulos de grades senoidais em reversão de fase em 3, 6 ou 10 Hz foram apresentados em monitor de vídeo monocromático de 21 polegadas com luminância média de 161,13 cd/m2. Registramos o eletroencefalograma com três eletrodos ativos (O1, Oz, O2) relacionados ao eletrodo de referência no vertex. Durante cada tentativa com duração de 10 segundos, resentávamos uma faixa de freqüência espacial que aumentava linearmente. Para cada condição (freqüência temporal - FT) foram usadas no mínimo três tentativas para estimar o limiar. Consideramos o canal que registrou a AV mais alta com boa razão sinal-ruído (SNR>3:1), fase constante e critério estatístico. Resultados: Não encontramos diferenças significativas na AV entre os grupos para nenhum dos métodos. Para o PVEv, não encontramos diferenças significativas na AV, amplitude, ruído ou SNR entre os grupos para nenhuma das FT. Análises intra-grupos mostraram que os valores de amplitude, SNR e ruído foram significativamente diferentes entre as freqüências temporais apenas para os PIG. Entretanto, os PIG até 8 semanas de idade mostraram uma tendência para amplitudes e SNR mais altas para a FT de 3 Hz comparadas aos AIG. Esses mesmos PIG mostraram uma tendência para valores de fase maiores respostas lentas) em comparação aos AIG. Entretanto, a taxa de desenvolvimento da fase foi maior para os PIG do que para os AIG em todas as FT. Conclusão. Não há alteração significativa na AV de recém-nascidos PIG, entretanto as informações de medidas supra-limiares são consistentes com a hipótese que a desnutrição intra-uterina torna as respostas visuais mais lentas entre a retina e o córtex visual. Os dados também sugerem de forma sutil que tais efeitos são passageiros afetando primariamente o grupo de recém-nascidos mais jovens e que o sistema visual dos PIG tem plasticidade suficiente para atingir rapidamente os níveis normais. Mais dados serão necessários para validar esta interpretação. / Objective: To evaluate the effects of intra-uterine malnutrition on grating visual acuity (VA) using Sweep VEP and Teller Acuity Cards (TAC). Method: Binocular grating acuity was evaluated in 41 newborns with gestational age 37 weeks. Twentythree were born with appropriate weight for gestational age (AGA age: 14.3 ± 7.5 weeks) and 18 were born small for gestational age (SGA age: 10.7 ± 4.1 weeks). Visual acuity was determined using both psychophysical (Teller Acuity Cards) and electrophysiological (sVEP) techniques. For the TAC evaluation, cards having calibrated black and white square waves gratings at spatial frequencies (SFs) between 0.23 and 19 cycles/degree were presented 55 cm from the subject. The test began with the lowest SF card in random orientation to which the experimenter was blind. Subsequent cards were presented in order of increasing SF until an incorrect response was made, at which time the prior (lower-SF) card was presented again. Visual acuity was defined as the average of the SF values for 4 reversals. For the sVEP recordings, the PowerDIVA VEP system (Brosnahan et al., 1998) was used to generate all stimuli and analyze the evoked responses. Stimuli were spatial luminance sinewave gratings presented on a 21-inch monochromatic high-resolution monitor (1600x1200 pixels) with an average luminance of 161.1 cd/m2. Gratings were phase-reversed at either 3, 6 or 10 Hz. The electroencephalogram was recorded using 3 active electrodes (O1,Oz,O2) related to the reference electrode at vertex. During each 10-sec sVEP trial a linear sweep of increasing SF was presented. Sweep ranges were selected according to the subjects age. For each condition (each TF), a minimum of 3 trials were used to estimate thresholds, but the majority of measures were the result of a vector average of 5 to 10 trials. For each condition, the acuity estimate used derived from the channel with the highest acuity with statistically significant signal-to-noise ratio (>3:1) and stable phase during the high-SNR portion of the response. Results: There were no statistical differences in visual acuity between the two groups (SGA and AGA) for either method (sVEP or TAC). For the sVEP, acuities were not statistically different for the different TFs. There were also no statistical differences between groups for the sVEP measures of amplitude, phase, noise or signal-to-noise ratio. Intra-group analysis of the sVEP measures at the three TFs revealed statistical differences for amplitude, noise and signal-to-noise ratio, but only for SGA group. However, the SGA subjects less than or equal to 8 weeks of age showed a tendency for higher amplitudes and SNR for 3Hz temporal frequency compared to AGA subjects, and these same SGA subjects showed tendency for larger phase values (slower responses) compared to AGA. However, phase development rate was faster for SGA than for AGA for all temporal frequencies. Conclusion: There were no significant alterations of visual acuity in SGA babies, but the data from suprathreshold measures are consistent with the hypothesis that intrauterine malnutrition results in slower visual responses between retina and cortex. The data obtained so far suggest that such affects are transient, affecting primarily the younger group of infants, and that the visual system in SGA infants has sufficient plasticity to recover rapidly to normal levels. More data is needed to validate this interpretation of the results.

Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Submitted by Emanuel Varela Cardoso (emanuel.varela@ufcg.edu.br) on 2018-06-29T20:52:05Z No. of bitstreams: 1 JOSÉ ALBERTO CAMPOS DA SILVA JÚNIOR – DISSERTAÇÃO (UAEMa) 2015.pdf: 3855504 bytes, checksum: 02bbfa20b694c9416d048edd8410bfd4 (MD5) / Made available in DSpace on 2018-06-29T20:52:05Z (GMT). No. of bitstreams: 1 JOSÉ ALBERTO CAMPOS DA SILVA JÚNIOR – DISSERTAÇÃO (UAEMa) 2015.pdf: 3855504 bytes, checksum: 02bbfa20b694c9416d048edd8410bfd4 (MD5) Previous issue date: 2015-03-17 / O monitoramento neurofisiológico intraoperatório (MNIO) é uma metodologia que agrega diferentes testes neurofisiológicos para uso simultâneo ou alternado num mesmo paciente durante o procedimento cirúrgico, podendo avaliar a neurofisiologia clínica em três campos: eletroencefalografia (EEG), eletromiografia (EMG) e potenciais evocados (PE). O potencial evocado visual (PEV) permite avaliar a função e integridade das estruturas corticais e subcorticais da via visual. Este exame é realizado cotidianamente nos laboratórios de neurofisiologia, auxiliando o esclarecimento de diferentes tipos de acometimentos da visão, seja por doença ou traumatismos. Este trabalho tem como objetivo desenvolver um protótipo para o monitoramento do PEV para avaliação da integridade das vias visuais durante cirurgias neurofisiológicas. Foram realizadas várias etapas para o desenvolvimento do protótipo do dispositivo ocular: simulação computacional; estudo das características do olho humano; prototipagem rápida; caracterização do Biopolímero ácido polilático (PLA) utilizado na prototipagem; desenvolvimento de um protótipo de dispositivo ocular com sistema de iluminação integrado por LEDs a realização dos testes de PEV com o protótipo desenvolvido. O PLA utilizado na prototipagem para o desenvolvimento de partes do dispositivo ocular foi caracterizado por Difração de Raios X (DRX), Espectroscopia na Região do Infravermelho por Transformada de Fourier (FTIR), Calorimetria Exploratória Diferencial (DSC), Microscopia Ótica (MO), Microscopia Eletrônica de Varredura (MEV) e Espectroscopia de Energia Dispersiva (EDS), esses resultados mostraram que a prototipagem rápida não alterou as propriedades físico-químicas e morfológicas do PLA. A simulação computacional forneceu parâmetros adequados ao desenvolvimento do dispositivo ocular que possibilitou uma maior eficiência na montagem do circuito eletrônico. Os resultados dos testes de PEV foram realizados em diferentes pacientes, com os olhos fechados e os mostraram-se promissores para uso em pacientes anestesiados. / Intraoperative neurophysiological monitoring (MNIO) is a methodology that combines different neurophysiological tests for simultaneous or alternating in the same patient during the surgical procedure can evaluate the clinical neurophysiology in three fields: electroencephalography (EEG), electromyography (EMG) and evoked potential (EP). The visual evoked potential (VEP) evaluates the function and integrity of cortical and subcortical structures of the visual pathway. This test is performed daily in neurophysiology laboratories, helping the clarifying of different types of bouts vision, whether by disease or trauma. This study aimed to develop a prototype for monitoring the VEP to assess the integrity of the visual pathways during neurophysiological surgeries. Several steps were performed for the prototype ocular device: computer simulation; study of the characteristics of the human eye; rapid prototyping; Biopolymer characterization of polylactic acid (PLA) used in prototyping; development of an ocular device prototype with integrated lighting system and VEP achievement tests with the prototype. The PLA used in the prototype for the development of parts of the device eye was characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), optical microscopy (OM), Scanning Electron Microscopy (SEM) and Energy Dispersive Spectroscopy (EDS), these results showed that the rapid prototyping did not change the physical-chemical and morphological PLA. The computer simulation provides appropriate parameters for the development of ocular device that allowed greater efficiency in the assembly of electronic circuit. The results of ENP tests were performed in different patients, with closed eyes and have shown promise for use in anesthetized patients.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Introduction Optimal nutrition is vital in the management of infants born preterm. Dietary fat in infancy is fundamental for the provision of energy for growth and development. Essential fatty acids, specifically Long Chain Polyunsaturated Fatty Acids (LC-PUFAs) such as docosahexaenoic acid (DHA), have been under investigation by several international research groups in the past decade. Essential fatty acids are critical in neurodevelopment as DHA is found in high proportions in structural lipids of cell membranes, particularly in the central nervous system (CNS). The accumulation of essential fatty acids and particularly DHA in the brain and retina occurs most rapidly during the perinatal period, therefore preterm infants are of particular concern (Singer, 2001). Current scientific consensus is that the optimum growth rate for preterm infants is equal to the in utero growth rate throughout the last trimester, however, failure to achieve the optimum intrauterine growth rate is common in preterm infants (Olhager and Forsum, 2003). Preterm infants require large amounts of energy and nutrients with which many infants are not provided or are not able to absorb, due to immature gastrointestinal and metabolic systems and other medical complications (Olhager and Forsum, 2003). There are a number of unresolved issues regarding optimal growth rate and total energy requirements (ER) for preterm infants. Hypotheses/Objectives This study is a “side study” to a double blind randomised controlled trial (RCT) of DHA supplementation in preterm infants. The hypothesis of this “side study” is that increased DHA during the neonatal period would increase total energy expenditure (TEE) and improve neurodevelopmental outcome. Specifically, at term postconceptual age (PCA) it was hypothesised that preterm infants receiving higher intake of DHA would have higher TEE’s due to the acceleration in brain maturation. Also, it was hypothesised that preterm infants receiving high levels of DHA would have TEE’s equivalent to term born infants due to their same brain maturation status. Other hypothesised effects of DHA supplementation include an accelerated maturation of the visual cortical pathways, and accelerated white matter (WM) tract development aiding in brain maturation. The first objective of this study was to measure TEE and ER in very preterm infants when they reached an age of 31-33 weeks post conceptional age (PCA). The effects of DHA supplementation on TEE, at simulated in utero levels, in very preterm infants (born < 33 weeks PCA), when assessed at term equivalent (40 weeks PCA) were studied. Another objective was to compare WM brain tissue volume at term PCA between two preterm groups and then with the term born infants. Visual latency was also compared between the two preterm infant groups and then with the term born infants. Methods TEE was measured using the doubly labelled water (DLW) method which is based on the differential elimination of 2H (deuterium) and 18O from the body subsequent to a loading dose of these isotopes. TEE was measured at the preterm age between 31-33 weeks PCA and again at term PCA. TEE measurements are made at term PCA in a term born control group. Brain assessment was by Magnetic Resonance Imaging and (MRI) and Visual Evoked Potential (VEP). Magnetic resonance imaging quantitatively measured brain volumes and WM. Visual evoked potential would provide information on visual latency and amplitude. Results The cohort consisted of 38 infants. The TEE of the very preterm infant group was measured at 31-33 weeks PCA. The mean (±standard deviation) (SD) TEE was calculated at 80(±27) kcal/kg/d, and using data in the literature for foetal energy accretion of 28kcal/kg/d, the mean ER was calculated to be 108(±27) kcal/kg/d. At term PCA TEE was calculated for the preterm DHA supplemented group to be 56(±19) kcal/kg/d and for the non-DHA supplemented group 70(±39) kcal/kg/d. These measurements were not statistically different. Flash VEP conducted on preterm given different amounts of DHA tested at term PCA found no statistically different measurements. When combining these results and comparing them to measurements of term born infants at term PCA, the right eye measurements showed that preterm infants had statistically greater latencies than term infants. When combining the left and right eye measurements the latencies no statistical significance was found. Amplitude was also not statistically significant between the groups. MRI measures at term PCA were not statistically different DHA supplemented and the non-DHA supplemented preterm infant group. When the preterm infant cohort was combined and compared to the term born infant group, the results showed that preterm infants imaged at term PCA had reduced WM development in a number of frontal lobe projections, and anterior and posterior commissarial pathways of the corpus callosum and corona radiata. Discussion The TEE and ER measurements in this study represent the largest preterm infant cohort to date. The ER values reported here are of value in allowing the calculation of appropriate feeding and nutritional strategies for preterm infants. Although no differences in TEE between the DHA and non DHA supplemented groups were found this may have been due to the small sample size. With regard to the latency outcomes, it can be speculated that if measurements were conducted at a later PCA the correlations may have been stronger and significant. Several other factors may have also affected the results, including alertness of the infant at the time of testing, thickness of the cranium, and other health factors could not be controlled for. This study contains the youngest cohort to be compared via Flash VEP. The MRI data did not find significant differences in brain volume and WM between the DHA supplemented and the non-DHA supplemented groups. The infant CNS is rapidly developing and there are multiple environmental factors which may have affected outcomes. The data did however find differences in WM development between the preterm and term infants. The reduced WM development found in the preterm infants compared to term born infants may provide some explanation for the correlation between preterm birth and poorer cognitive and functional outcomes. Larger studies which extend beyond the first months of life are recommended in order to investigate the long-term relationships between DHA supplementation, TEE and brain maturation.

A wide literature of predominantly behavioural experiments that use Stimulus Response Compatibility (SRC) have suggested that visual action information such as object affordance yields rapid and concurrent activation of visual and motor brain areas, but has rarely provided direct evidence for this proposition. This thesis examines some of the key claims from the affordance literature by applying electrophysiological measures to well established SRC procedures to determine the verities of the behavioural claims of rapid and automatic visuomotor activation evoked by viewing affording objects. The temporal sensitivity offered by the Lateralised Readiness Potential and by visual evoked potentials P1 and N1 made ideal candidates to assess the behavioural claims of rapid visuomotor activation by seen objects by examining the timecourse of neural activation elicited by viewing affording objects under various conditions. The experimental work in this thesis broadly confirms the claims of the behavioural literature however it also found a series of novel results that are not predicted by the behavioural literature due to limitations in reaction time measures. For example, while different classes of affordance have been shown to exert the same behavioural facilitation, electrophysiological measures reveal very different patterns of cortical activation for grip-type and lateralised affordances. These novel findings question the applicability of the label ‘visuomotor’ to grip-type affordance processing and suggest considerable revision to models of affordance. This thesis also offers a series of novel and surprising insights into the ability to dissociate afforded motor activity from behavioural output, into the relationship between affordance and early visual evoked potentials, and into affordance in the absence of the intention to act. Overall, this thesis provides detailed suggestions for considerable changes to current models of the neural activity underpinning object affordance.

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