Ocular findings in patients with cholestatic disorders of infancy: A single-centre experience

Publication date: Available online 3 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Hanaa El-Karaksy, Dalia Hamed, Hanan Fouad, Engy Mogahed, Heba Helmy, Fotouh Hasanain
Background and study aimsNeonatal cholestasis can be associated with ocular findings that might aid in its diagnosis, e.g., Alagille syndrome (AGS) and Niemann Pick disease (NPD). We aimed to investigate the frequency of ocular manifestations in infants with cholestasis.Patients and methodsThis cross-sectional study included cholestatic infants presenting to the Paediatric Hepatology Unit, Cairo University Paediatric Hospital, Cairo, Egypt. All infants underwent examination of lid, ocular motility, anterior and posterior segments and measurement of intraocular pressure, cycloplegic refraction, ocular ultrasonography and vision.ResultsThe study included 112 infants with various cholestasis; 73 (65.2%) were males. The median age was 2months. Diagnosis was reached in 39 cases: 14 had AGS, 14 had biliary atresia (BA), 4 had NPD, 4 had post-haemolytic cholestasis, 2 had cytomegalovirus neonatal hepatitis, and one case had hepatorenal tyrosinaemia. Thirteen cases were probably having progressive familiar intrahepatic cholestasis (PFIC) type 1 or 2 considering their persistent cholestasis in the presence of normal gamma-glutamyl transpeptidase; 28 were left with a diagnosis of "idiopathic neonatal hepatitis" (INH), and 32 (28.6%) had no definite diagnosis. Ophthalmologic abnormalities were found in 39 cases (34.8%). The commonest finding was unilateral/bilateral optic nerve drusen in 12 (10.7%), followed by posterior embryotoxon in 11 (9.8%). Ocular findings were observed in 64.3% patients with AGS, 50% patients with NPD, 30.8% cases with suspected PFIC type 1or 2, 28.6% infants with INH, and 14.3% patients with BA.ConclusionOphthalmologic findings are not uncommon among cholestatic infants. Ophthalmologic examination should be routinely performed, including assessment of anterior segment, fundus examination, and ocular ultrasound.



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Foot use during vertical climbing in chimpanzees (Pan troglodytes)

Publication date: August 2017
Source:Journal of Human Evolution, Volume 109
Author(s): R.E. Wunderlich, S.B. Ischinger
Upright bipedalism is a hallmark of hominin locomotion, however debates continue regarding the extent of arboreal locomotion and the nature of bipedalism practiced by early hominins. Pedal form and function play a prominent role in these debates, as the foot is the element that directly interacts with the locomotor substrate. Recent finds have substantially increased the availability of associated foot remains of early hominins and emphasized the enigmatic nature of the early evolution of human bipedalism. New discoveries of associated forefoot remains have afforded the opportunity to assess relative proportions across the forefoot of fossil hominins and illuminated the need for data on relative loading across the forefoot in extant hominoids. In order to provide functional data with which to examine the relationship between bony features and load distribution across the forefoot during climbing, we present the first analysis of plantar pressure distribution across the forefoot of chimpanzees climbing a vertical support. Chimpanzees load the medial metatarsals and first toe disproportionately during vertical climbing. Peak pressures on these elements occur at the end of stance phase during climbing and are higher than on any other elements of the foot. Toe pressures are considerably higher during vertical climbing than during knuckle-walking or movement on horizontal poles, supporting the notion that the plantarly-broad and dorsally-narrow metatarsal heads in chimpanzees and some early hominins are associated with close-packing of the metatarsophalangeal joint during climbing.



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Associated anomalies in cases with esophageal atresia

Esophageal atresia (EA) is a common type of congenital anomaly. The etiology of esophageal atresia is unclear and its pathogenesis is controversial. Infants with esophageal atresia often have other non-EA associated congenital anomalies. The purpose of this investigation was to assess the prevalence and the types of these associated anomalies in a defined population. The associated anomalies in cases with EA were collected in all livebirths, stillbirths, and terminations of pregnancy during 29 years in 387,067 consecutive births in the area covered by our population-based registry of congenital malformations. Of the 116 cases with esophageal atresia, representing a prevalence of 2.99 per 10,000, 54 (46.6%) had associated anomalies. There were 9 (7.8%) cases with chromosomal abnormalities including 6 trisomies 18, and 20 (17.2%) nonchromosomal recognized dysmorphic conditions including 12 cases with VACTERL association and 2 cases with CHARGE syndrome. Twenty five (21.6%) of the cases had multiple congenital anomalies (MCA). Anomalies in the cardiovascular, the digestive, the urogenital, the musculoskeletal, and the central nervous systems were the most common other anomalies. The anomalies associated with esophageal atresia could be classified into a recognizable malformation syndrome or pattern in 29 out of 54 cases (53.7%). This study included special strengths: each affected child was examined by a geneticist, all elective terminations were ascertained, and the surveillance for anomalies was continued until 2 years of age. In conclusion the overall prevalence of associated anomalies, which was close to one in two cases, emphasizes the need for a thorough investigation of cases with EA. A routine screening for other anomalies may be considered in infants and in fetuses with EA.

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Neuroradiographic findings in 22q11.2 deletion syndrome

22q11.2 deletion syndrome (22q11.2DS) is a common genetic disorder with enormous phenotypic heterogeneity. Despite the established prevalence of developmental and neuropsychiatric issues in this syndrome, its neuroanatomical correlates are not as well understood. A retrospective chart review was performed on 111 patients diagnosed with 22q11.2DS. Of the 111 patients, 24 with genetically confirmed 22q11.2 deletion and brain MRI or MRA were included in this study. The most common indications for imaging were unexplained developmental delay (6/24), seizures of unknown etiology (5/24), and unilateral weakness (3/24). More than half (13/24) of the patients had significant radiographic findings, including persistent cavum septi pellucidi and/or cavum vergae (8/24), aberrant cortical veins (6/24), polymicrogyria or cortical dysplasia (4/24), inner ear deformities (3/24), hypoplastic internal carotid artery (2/24), and hypoplastic cerebellum (1/24). These findings reveal the types and frequencies of brain malformations in this case series, and suggest that the prevalence of neuroanatomical abnormalities in 22q11.2DS may be underestimated. Understanding indications for imaging and frequently encountered brain malformations will result in early diagnosis and intervention in an effort to optimize patient outcomes.

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University study explores heart monitoring in vehicles

Researchers have teamed up with Toyota to examine whether new vehicle technology could predict emergencies

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Anthropometric and Physical Qualities of Elite Male Youth Rugby League Players

Abstract

Rugby league is a collision team sport played at junior and senior levels worldwide, whereby players require highly developed anthropometric and physical qualities (i.e. speed, change-of-direction speed, aerobic capacity, muscular strength and power). Within junior levels, professional clubs and national governing bodies implement talent identification and development programmes to support the development of youth (i.e. 13–20 years) rugby league players into professional athletes. This review presents and critically appraises the anthropometric and physical qualities of elite male youth rugby league players aged between 13 and 20 years, by age category, playing standard and playing position. Height, body mass, body composition, linear speed, change-of-direction speed, aerobic capacity, muscular strength and power characteristics are presented and demonstrate that qualities develop with age and differentiate between playing standard and playing position. This highlights the importance of anthropometric and physical qualities for the identification and development of youth rugby league players. However, factors such as maturity status, variability in development, longitudinal monitoring and career attainment should be considered to help understand, identify and develop the physical qualities of youth players. Further extensive research is required into the anthropometric and physical qualities of youth rugby league players, specifically considering national standardised testing batteries, links between physical qualities and match performance, together with intervention studies, to inform the physical development of youth rugby league players for talent identification and development purposes.

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Editorial Board

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Erratum to: Global skin colour prediction from DNA

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Psychometric Properties of Two Participation Measures in Veterans with Mild Traumatic Brain Injury

Publication date: Available online 3 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Pey-Shan Wen, J. Kay Waid-Ebbs, David P. Graham, Drew A. Helmer
ObjectiveTo compare the psychometric properties of two commonly used participation measures: the Community Reintegration of Service Members (CRIS) and the Participation Assessment with Recombined Tools-Objective (PART-O) in Veterans with mild traumatic brain injury (mTBI).DesignThe data were collected from two cross-sectional observation studies conducted in two Veterans Affairs medical centers.SettingQuestionnaires were completed in-person or by mail.ParticipantsVeterans with mild TBI were recruited from the Michael E. DeBakey Veterans Affairs Medical Center in Houston (N=94) and the Malcom Randall North Florida/South Georgia Veterans Health System (N=107).InterventionsNot applicable.Main Outcome Measures:CRIS and PART-O.ResultsWe conducted Rasch analysis on the PART-O and on three subscales of the CRIS (Extent of Participation, Perceived Limitation, and Satisfaction). For PART-O, results showed PART-O has questionable unidimensionality. For both instruments, some rating categories were under used and rating scales did not advance accordingly. Compared with PART-O, the CRIS was able to distinguish more categories of a person's ability (>5 vs 2 by PART-O ) and had better internal consistency as indicated by higher Cronbach's Alpha (0.96-0.98vs 0.65 for PART-O).ConclusionsTo capture participation unique to Veterans with mTBI, CRIS has greater potential to detect a change in participation and is therefore recommended over PART-O. Rating scales of both instruments, however, need further refinement. We suggest future studies examine collapsed rating categories and use qualitative methods to redefine categories.



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Decreased Anticipatory Postural Adjustments During Gait Initiation Acutely Post-Concussion

Publication date: Available online 3 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Thomas A. Buckley, Jessie R. Oldham, Barry A. Munkasy, Kelsey E. Evans
ObjectiveThe purpose of this study was to investigate anticipatory postural adjustments (APA) during the transitional movement task of gait initiation (GI) in individuals acutely following a concussion.DesignCohort Study.SettingUniversity Research Center.ParticipantsA population based sample of 84 participants divided into two equal groups of acutely post-concussion (CONC) and healthy student athletes.InterventionParticipants were tested on two occasions – a pre-injury baseline test and then the CONC group was retested acutely post-concussion and the control group again at a similar time. All participants completed 5 trials of GI on 4 forceplates.Main Outcome MeasuresThe dependent variables were the displacement and velocity of the center of pressure (COP) during the APA phase and initial step kinematics. Comparisons were made with a 2 (Group) x 2 (Time) repeated measures ANOVA.ResultsThere was a significant interaction for COP posterior displacement (P<0.001) and lateral displacement (P<0.001). Posteriorly, post-hoc testing identified a significant reduction in CONC (PRE: 5.7 + 1.6 cm and POST: 2.6 + 2.1 cm, P<0.001), but no difference in Control (PRE: 4.0 + 1.6 cm and POST: 4.0 + 2.5 cm, P=0.921). Laterally, post-hoc testing identified a significant reduction in CONC (PRE: 5.8 + 2.1 cm and POST: 3.8 + 1.8 cm, P<0.001), but no difference in Control (PRE: 5.0 + 2.5 cm and POST: 5.2 + 2.4 cm, P=0.485).ConclusionsThe results of this study suggest difficulty in the planning and execution of GI acutely post-concussion and posterior APA displacement and velocity are highly effective measures of impaired postural control. Finally, the APA phase is linked to the supplementary motor area which suggests a supraspinal contribution to post-concussion impaired postural control.



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Functional Status is Associated with 30-day Potentially Preventable Hospital Readmissions following Inpatient Rehabilitation among Aged Medicare Fee-for-Service Beneficiaries

Publication date: Available online 3 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Addie Middleton, James E. Graham, Kenneth J. Ottenbacher
ObjectiveTo determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions.DesignRetrospective cohort study.SettingInpatient rehabilitation facilities submitting claims to Medicare.ParticipantsNational cohort of 371,846 inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013-2014. The average age was 79.1 (SD, 7.6) years. A majority were female (59.7%) and non-Hispanic white (84.5%).InterventionsNot applicable.Main Outcome Measures1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions following inpatient rehabilitation and 2) primary diagnoses for readmissions.ResultsThe overall rate of any 30-day hospital readmission following inpatient rehabilitation was 12.4% (N=46,265) and the overall rate of potentially preventable readmissions was 5.0% (N=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates (95% CI) for the highest vs. lowest quartiles within each functional domain were as follows: self-care: 3.4% (3.3-3.5) vs 6.9% (6.7-7.1); mobility: 3.3% (3.2-3.4) vs 7.2% (7.0-7.4); cognition 3.5% (3.4-3.6) vs 6.2% (6.0-6.4). Similarly, adjusted odds ratios were as follows: self-care: 0.70 (0.67-0.74); mobility: 0.64 (0.61-0.68); cognition: 0.84 (0.80-0.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%).ConclusionsFunctional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates.



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Falls are Associated with Lower Self-reported Functional Status in Patients after Stroke

Publication date: Available online 3 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Eline van der Kooi, Sven Kersten Schiemanck, Frans Nollet, Gert Kwakkel, Jan-Willem Meijer, Ingrid Gerrie Lambert van de Port
ObjectiveTo evaluate the association between falls and functional status after stroke.DesignSecondary analysis of data from the randomised, controlled FIT-Stroke trial. Outcomes were measured at the time of discharge from inpatient rehabilitation (T0) and after 12 weeks (T1). Between T0 and T1, all patients attended an outpatient rehabilitation program that included the FIT-Stroke intervention.SettingNine Dutch centres for rehabilitation medicine.ParticipantsOutpatients after stroke with mild cognitive impairments (Mini-Mental State Examination [MMSE] ≥ 24), discharged home after inpatient rehabilitation and able to walk 10 meters independently.InterventionsNot applicable.Main Outcome MeasuresThe primary outcome was the change in Stroke Impact Scale (SIS)-16 score. The independent variable was one or more falls after stroke. The outcome was corrected for type of outpatient rehabilitation (group allocation), severity of hemiplegia (Motricity Index; MI), and cognition (MMSE) at baseline using multiple regression analysis.ResultsThe study included 250 patients after stroke. Complete data were available for 199 patients with a mean age of 58 years (SD 10), MMSE of 28.1 (SD 2), and MI of 130 (SD 43). Fifty-five patients (28%) reported falls during the 12 weeks after discharge from inpatient rehabilitation. Falls were significantly associated with less improvement in functional status as assessed with the SIS-16 (p=0.009).ConclusionAlmost 30% of this stroke population with minor cognitive deficits and moderate to high mobility scores reported falls during the 12 weeks of outpatient rehabilitation. Falls were negatively associated with self-reported functional status measured by the change in SIS-16 score. Therefore, it is important to identify patients with high risk of falls and implement strategies to reduce falls.



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A latent structural analysis of health outcomes among people living with spinal cord injury

Publication date: Available online 3 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Chao Li, Jillian M.R. Clark, James S. Krause
ObjectiveTo develop a latent structural model of health outcomes among people with spinal cord injury (SCI) that accounts for measurement of underlying factors and their association with demographic and injury-related exogenous variables.DesignCross-sectional studySettingsData were collected at a large specialty hospital and analyzed at a medical university in the Southeastern United StatesParticipants1871 participants with traumatic SCI of at least 1-year durationInterventionsN/AMain Outcome MeasuresExploratory factor analysis (EFA) was used to identify latent health outcome structures. Several key exogenous variables were also linked with the latent health outcome factors.ResultsSix latent health outcome factors were identified by the EFA with excellent model fit (root mean square error of approximation = 0.040). These latent factors included: (1) global health problems, (2) chronic disease, (3) acute treatments, (4) symptoms of SCI complications, (5) pressure ulcers, and (6) subsequent injuries. Sex, race/ethnicity, age, years since injury, and injury severity were all significantly associated with at least 1 latent health outcome factor, which indicates these latent health outcomes varied as a function of the exogenous variables.ConclusionThis study improved our understanding of the structure of health outcomes, and utilization of latent health outcome factors provides more stable and comprehensive composite scores than does utilization of a single observed health outcome indicator.



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Comment on "Stories of an Emigrant Physician: What It Has Been Like to Practice in Canada Compared With the United States".

No abstract available

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Precise Target Site of Ultrasound-Guided C5 Cervical Root Block.

No abstract available

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Crouch gait can be an effective form of forced-use/no constraint exercise for the paretic lower limb in stroke.

In hemiplegic gait the paretic lower limb provides less muscle power and shows a briefer stance compared with the unaffected limb. Yet, a longer stance and a higher power can be obtained from the paretic lower limb if gait speed is increased. This supports the existence of a 'learned non-use' phenomenon, similar to that underlying some asymmetric impairments of the motion of the eyes and of the upper limbs. Crouch gait (CG) (bent-hip bent-knee, about 30[degrees] minimum knee flexion) might be an effective form of 'forced-use' treatment of the paretic lower limb. It is not known whether it also stimulates a more symmetric muscle power output. Gait analysis on a force treadmill was carried out in 12 healthy adults and seven hemiplegic patients (1-127 months after stroke, median: 1.6). Speed was imposed at 0.3 m/s. Step length and single and double stance times, sagittal joint rotations, peak positive power, and work in extension of the hip, knee, and ankle (plantar flexion), and surface electromyography (sEMG) area from extensor muscles during the generation of power were measured on either side during both erect and crouch walking. Significance was set at P less than 0.05; corrections for multiplicity were applied. Patients, compared with healthy controls, adopted in both gait modalities and on both sides a shorter step length (61-84%) as well as a shorter stance (76-90%) and swing (63-83%) time. As a rule, they also provided a higher muscular work (median: 137%, range: 77-250%) paralleled by a greater sEMG area (median: 174%, range: 75-185%). In erect gait, the generation of peak extensor power across hip, knee, and ankle joints was in general lower (83-90%) from the paretic limb and higher (98-165%) from the unaffected limb compared with control values. In CG, peak power generation across the three lower limb joints was invariably higher in hemiparetic patients: 107-177% from the paretic limb and 114-231% from the unaffected limb. When gait shifted from erect to crouch, only for hemiplegic patients, at the hip, the paretic/unaffected ratio increased significantly. For peak power, work, sEMG area, and joint rotation, the paretic/unaffected ratio increased from 55 to 85%, 56 to 72%, 68 to 91%, and 67 to 93%, respectively. CG appears to be an effective form of forced-use exercise eliciting more power and work from the paretic lower limb muscles sustained by a greater neural drive. It also seems effective in forcing a more symmetric power and work from the hip extensor muscles, but neither from the knee nor the ankle. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/1hexVwJ Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Physical Activity and Abdominal Fat Distribution in Greenland.

Purpose: We examined how total volume of physical activity and reallocation of time spent at various objectively measured intensities of physical activity (PA) were associated with overall and abdominal fat distribution in adult Inuit in Greenland. Methods: Data were collected as part of a countrywide cross-sectional health survey in Greenland. A combined accelerometer and heart rate monitor measured total physical activity energy expenditure (PAEE) and intensities of PA (N=1536). Visceral- and subcutaneous adipose tissue (VAT, SAT) was assessed by ultrasonography. Isotemporal substitution modeling was used to analyse the association between substitution of 1-hour of sedentary time to light or moderate intensity PA and 1-hour light intensity PA to moderate or vigorous intensity PA in relation to BMI, waist circumference (WC), SAT and VAT. Results: A negative linear association was found for total PAEE and BMI, WC, VAT and SAT. Exchanging 1-hour of sedentary time with light intensity PA was associated with lower WC (-0.6 cm., p=0.01), SAT (-0.08 cm., p

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Physical Activity, Not Sedentary Time, Predicts DXA-Measured Adiposity Age 5-19 Years.

Purpose: To examine the associations among physical activity (PA), sedentary time (SED), and TV viewing (TV) with fat mass (FAT) and visceral adipose tissue mass (VAT) from childhood through adolescence (5-19 years). Methods: Participants in the Iowa Bone Development Study (n = 230 males and 233 females) were examined at ages 5, 8, 11, 13, 15, 17 & 19 years. Accelerometers measured moderate- or vigorous-intensity PA (MVPA; min/day), light-intensity PA (LPA; min/day), and SED (h/day). Parent-proxy report (5 & 8 years) and child-report (11, 13, 15, 17, & 19 years) measured TV (h/day). DXA scans measured FAT (kg) and VAT (g). Sex-specific growth models were used to create FAT and VAT growth curves for individual participants (level 1), and to test the effect of MVPA, LPA, SED, & TV (level 2) after adjusting for weight, height, linear age, non-linear age, and maturity. Results: Growth models indicated that low levels of MVPA were associated with high levels of FAT and VAT for males and high levels of FAT for females. TV was positively associated with FAT and VAT for males and females. LPA was positively associated with FAT in males. SED was not associated with FAT or VAT for males or females (p > 0.05). Conclusion: This study supports current PA guidelines focusing on MVPA rather than SED. The contribution of high TV, but not high SED, to high levels of adiposity suggests that TV's contribution to obesity is not just a function of low energy expenditure. (C) 2017 American College of Sports Medicine

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