Physical strain: a new perspective on walking in cerebral palsy

Publication date: Available online 6 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Astrid CJ. Balemans, Eline Bolster, Merel-Anne Brehm, Annet J. Dallmeijer
ObjectiveThe objectives of this study in children and adolescents with cerebral palsy (CP) were to 1) describe physical strain of walking, 2) describe the proportion of participants walking above the anaerobic threshold and 3) describe 4 phenotypes of physical strain of walking based on deviations in aerobic capacity and walking energy cost (EC).DesignCohortSettingAcademic medical centerParticipantsThirty-seven participants (13y5mo(4y0mo)) with CP (Gross Motor Function Classification System (GMFCS) levels I[n=13], II[N=17] and III[N=7]) and 20 typically developing participants (TD) (11y8mo(3y5mo)).InterventionsNot applicableMain Outcome Measure(s)Oxygen consumption (VO2walk), speed and EC were determined during walking at comfortable speed. Peak oxygen uptake (VO2peak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was decreased if <10^th percentile and EC was increased if >3SD's. Physical strain was defined as [VO2walk/VO2peak]*100.ResultsParticipants with CP had a higher physical strain (GMFCS levels I:55±12%, II:62±17% and III:78±14%) than TD (40±11%, p<0.001). 43% of the participants with CP showed a VO2walk at or higher than their anaerobic threshold compared to 10% in TD (p=0.007). Phenotypes showed that a decreased VO2peak [N=9] or an increased EC [N=9] lead to 18-20% higher physical strain, while a combination [N=12] leads to 40% increase.ConclusionsChildren and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable part walks around or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and/or a decreased VO2peak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in CP require different intervention strategies.



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Physical strain: a new perspective on walking in cerebral palsy

Publication date: Available online 6 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Astrid CJ. Balemans, Eline Bolster, Merel-Anne Brehm, Annet J. Dallmeijer
ObjectiveThe objectives of this study in children and adolescents with cerebral palsy (CP) were to 1) describe physical strain of walking, 2) describe the proportion of participants walking above the anaerobic threshold and 3) describe 4 phenotypes of physical strain of walking based on deviations in aerobic capacity and walking energy cost (EC).DesignCohortSettingAcademic medical centerParticipantsThirty-seven participants (13y5mo(4y0mo)) with CP (Gross Motor Function Classification System (GMFCS) levels I[n=13], II[N=17] and III[N=7]) and 20 typically developing participants (TD) (11y8mo(3y5mo)).InterventionsNot applicableMain Outcome Measure(s)Oxygen consumption (VO2walk), speed and EC were determined during walking at comfortable speed. Peak oxygen uptake (VO2peak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was decreased if <10^th percentile and EC was increased if >3SD’s. Physical strain was defined as [VO2walk/VO2peak]*100.ResultsParticipants with CP had a higher physical strain (GMFCS levels I:55±12%, II:62±17% and III:78±14%) than TD (40±11%, p<0.001). 43% of the participants with CP showed a VO2walk at or higher than their anaerobic threshold compared to 10% in TD (p=0.007). Phenotypes showed that a decreased VO2peak [N=9] or an increased EC [N=9] lead to 18-20% higher physical strain, while a combination [N=12] leads to 40% increase.ConclusionsChildren and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable part walks around or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and/or a decreased VO2peak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in CP require different intervention strategies.



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Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience

Publication date: August 2017
Source:World Neurosurgery, Volume 104
Author(s): Jared D. Ament, Timothy Kim, Judah Gold-Markel, Isabelle M. Germano, Robert Dempsey, John P. Weaver, Arthur J. DiPatri, Russell J. Andrews, Mary Sanchez, Juan Hinojosa, Richard P. Moser, Roberta Glick
BackgroundThe neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting.MethodsIn a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness.ResultsTwenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5–5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount.ConclusionThe first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery.



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Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments

Publication date: August 2017
Source:World Neurosurgery, Volume 104
Author(s): Luis Augusto Dias, Geisa de Angelis, Wagner Afonso Teixeira, Luiz Augusto Casulari
ObjectiveWe aimed to evaluate long-term surgical outcomes in patients treated for mesial temporal lobe epilepsy compared with a similar group of patients who underwent a preoperative evaluation.MethodsPatient interviews were conducted by an independent neuropsychologist and included a sociodemographic questionnaire and validated versions of the Beck Depression Inventory-II, Adverse Events Profile, Quality of Life in Epilepsy-31, and Rey Auditory Verbal Learning Test.ResultsSeventy-one patients who underwent surgery and 20 who underwent mesial temporal lobe epilepsy preoperative evaluations were interviewed. After an 81-month mean postoperative follow-up, 44% of the surgical patients achieved complete seizure relief according to the Engel classification and 68% according to the International League Against Epilepsy classification. The surgical group had a significantly lower prevalence of depression (P = 0.002) and drug-related adverse effects (P = 0.002). Improvement on unemployment (P = 0.02) was achieved but not on driving or education. Delayed verbal memory recall was impaired in 76% of the surgical and 65% of the control cases (P = 0.32). Regarding the Quality of Life in Epilepsy-31, the operated patients scored higher in their total score (mean, 75.44 vs. mean, 60.08; P < 0.001) and in all but the cognitive functioning domain irrespective of the follow-up length. Seizure control, Beck Depression Score, and Adverse Events Profile severity explained 73% of the variance in the surgical group quality of life.ConclusionsOur study found that, although surgical treatment was effective, its impact on social indicators was modest. Moreover, the self-reported quality of life relied not only on seizure control but also on depressive symptoms and antiepileptic drug burden.



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Combined Hyperactive Dysfunction Syndrome of the Cranial Nerves: A Retrospective Systematic Study of Clinical Characteristics in 44 Patients

Publication date: August 2017
Source:World Neurosurgery, Volume 104
Author(s): Jingwei Cao, Jie Jiao, Zhenhui Du, Wenzhe Xu, Bin Sun, Feng Li, Yuguang Liu
BackgroundCombined hyperactive dysfunction syndrome (HDS) is defined as the combination symptoms arising from overactivity in cranial nerves, specifically, trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN), without an obvious explanatory structural lesion. This study retrospectively analyzes the clinical characteristics of combined HDS treated with microvascular decompression (MVD) in a single institution.MethodsA total of 1450 patients with HDS were treated with MVD in our department during a 10-year period, among which 44 cases of combined HDS were identified. Clinical records and follow-ups were reviewed.ResultsCombined HDS comprised 3.03% (44/1450) of all HDS in our series, with female predominance compared with single HDS (P = 0.002), including combined TN-HFS (14 cases), combined TN-GPN (26 cases), bilateral TN (2 cases), and combined TN-HFS-GPN (2 cases). The average age at diagnosis of patients with combined HDS (60.9 years) was significantly older than that of patients with single HDS (53.5 years) (P = 0.035). Hypertension was closely associated with the prevalence of combined HDS compared with single HDS (P = 0.009). The curative rate was 97.7% (43/44) after MVD, and the recurrence rate was 3.33%. The incidence rates of postoperative cardiac, pulmonary, thromboembolic, and delirium complications were higher in combined HDS than in single HDS (P < 0.05).ConclusionsCombined HDS is a rarely occurring syndrome usually observed in older females, and the most common types are combined TN-GPN and combined TN-HFS. Age and gender seemed to be causes for developing combined HDS, and MVD shows potential as a favorable treatment choice.



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Joseph Buford Pennybacker, C.B.E., M.D., F.R.C.S. (1907–1983): Continuing Sir Hugh Cairns' Oxford Legacy and Pioneer of the Modern Management of Cerebral Abscesses

Publication date: August 2017
Source:World Neurosurgery, Volume 104
Author(s): Ravindran Visagan, Harold Ellis
The authors examine the life and contribution of Joseph Buford Pennybacker to British neurosurgery and the modern management of cerebral abscesses.Pennybacker's inspirational journey began with him aspiring to follow in the footsteps of the pioneering surgeon, Ephraim McDowell. It saw him cross the Atlantic, learn medicine at Edinburgh, train in neurology at Queen Square in London, and study neurosurgery under Sir Hugh Cairns in Oxford. Pennybacker navigated a successful career through World War II and together with Cairns established the Radcliffe Infirmary in Oxford as a highly esteemed neurosurgical unit.By increasing the operative tempo yet uncompromising the meticulousness of his operative technique, Pennybacker challenged the Halstedian and Cushing traditions. The pioneering Pennybacker system of managing cerebral abscesses stood the test of time and the ethos of preoperative imaging, intervention, and postoperative monitoring—clinically, biochemically, and with imaging results—remains today.Pennybacker contributed significantly to British neurosurgery and the training of both home-grown and international neurosurgeons and he was also a remarkably kind-hearted and calm individual. These qualities inspired many of his contemporaries and junior colleagues, and we hope will continue to do so for generations to come.



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Differential expression between “DSP-only” and DSP-PP523 transcripts in rat molar teeth

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Ya-Qin Zhu, Ryan M. Song, Helena H. Ritchie
ObjectiveTo compare the expression patterns of two multiple transcripts derived from DSP-PP gene during tooth development. One is DSP-only transcript (i.e. does not encode PP) and the other is DSP-PP523 transcript, a main DSP-PP transcript.DesignUnique antisense and sense riboprobes were generated from DSP-only and DSPPP523 cDNAs for in situ studies to examine DSP-only and DSP-PP523 transcript expression in developing molars. Paraffin-embedded sections (5–7μ m) from embryonic 20day, postnatal 2, 3 and 6days were deparaffined and hydrated. Tissues were prehybridized, then hybridized with DSP-only and DSP-PP523 anti-sense (AS) or sense (S) Digoxigenin labeled-riboprobes overnight, and washed. Anti-Digoxigenin antibodies conjugated to alkaline phosphatase were used to detect the presence of bound riboprobes by color reaction with NBT/BCIP. Stro-1 antibody was used for immunohistochemical analysis of Stro-1 protein expression in rat molars.ResultsWe found that unlike the DSP-PP523 transcript, the DSP-only transcript does not express in the entire polarized mature odontoblasts but is expressed in the areas subjacent to the mature odontoblast layer. In addition, DSP-only transcript is expressed in the dental pulp. Interestingly, Stro-1 protein, a stem cell marker, was also identified in the areas subjacentto odontoblasts and in dental pulp.ConclusionDifferential expression of DSP-only and DSP-PP523 transcripts suggest that these two kinds of transcripts may play different roles during dentinogenesis. DSP-PP523 transcript is expressed in mature odontoblasts, which actively participates in dentin formation. DSP-only transcript might have a different function.



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