Quantitative Assessment of Children with Osteogenesis Imperfecta

Assessments of children with Osteogenesis Imperfecta (OI) are typically limited to a physical exam and observations from a clinician during a hospital visit. Often quantitative information such as bone mineral density and outcome questionnaires is obtained, but with the increasing prevalence of motion analysis and other performance type laboratories, there are many other tools available, which could be beneficial to this patient population. These laboratories can provide date supplementary to morphologic and radiographic data that is helpful in tracking changes in the patient’s functional abilities, recover from fracture, and treatment outcomes. This chapter will cover some useful evaluation methods for children with the most commonly seen types of OI and provide some examples of their test results

Analysis of Push-Off Power During Locomotion in Children with Type 1 Osteogenesis Imperfecta

Background/Purpose Children with type 1 osteogenesis imperfecta (OI) present with abnormal gait characteristics, including reduced power generation during pushoff. However, the exact biomechanical factors associated with reduced power generation are not clearly understood. The purpose of this study was to investigate the biomechanical factors associated with a reduction in ankle power generation in children with type 1 OI. Methods Twenty-four participants with type 1 OI (12.5 ± 3.6 years of age) and 24 typically developing children (12.4 ± 3.7 years of age) were evaluated. Three-dimensional gait analysis, isometric plantar flexion strength using dynamometry, and pedobarography were collected on each participant. Results were statistically compared between the groups and a correlation matrix analyzed the associations among the measures. Results Children with OI presented with weaker plantar flexors, reduced ankle power generation, and decreased sagittal plane ankle angular velocity during pushoff. However, they presented with similar moment arm distances and ground reaction force magnitudes as typically seen in developing children. There was a higher incidence of pes valgus, increased subarch angles, increased time spent loading the midfoot, and deceased time spent loading the forefoot in children with OI. Plantar flexion strength and the time spent at the midfoot and forefoot were most associated with ankle power generation. Conclusion The presence of pes valgus alone does not indicate a reduction of push-off power in children with type 1 OI, but those individuals who have both a flat foot and reduced time spent loading the forefoot during pushoff are the most likely to have reduced push-off power

Hedging Season: The Effect of Hedging Using Financial Derivatives on Firm Value of Publicly-Listed Non-Financial Firms in the Philippines

Firms use financial derivatives as a way to hedge risky transactions to avoid financial risks. Studies have focused on firms’ use of financial derivatives in developed countries. However, there is limited research done on emerging markets like the Philippines because these economies have only recently adapted advanced reporting standards that obligate the disclosure of the nature and extent of risks resulting from the use of financial instruments. We used Tobin’s Q ratio to proxy for firm value and to determine the presence of a hedging premium. Because derivatives are used by firms to hedge against currency risks, interest rate risks, and commodity price risks, we hypothesize that the use of financial derivatives by firms has a positive and statistically significant effect on firm value

Derivative Initiative: Does the Use of Financial Derivatives Influence Firm Value in the Philippine Context?

Firms use financial derivatives as a way to hedge risky transactions to avoid financial risks. Studies have focused on firms’ use of financial derivatives in developed countries. However, there is limited research done on emerging markets like the Philippines because these economies have only recently adapted advanced reporting standards that obligate the disclosure of the nature and extent of risks resulting from the use of financial instruments. We used Tobin’s Q ratio to proxy for firm value and determine the presence of a hedging premium. Because derivatives are used by firms to hedge against currency risks, interest rate risks, and commodity price risks, we hypothesize that the use of financial derivatives by firms has a positive and statistically significant effect on firm value

Long-term Results of Comprehensive Clubfoot Release Versus the Ponseti Method: Which Is Better?

Background Clubfoot can be treated nonoperatively, most commonly using a Ponseti approach, or surgically, most often with a comprehensive clubfoot release. Little is known about how these approaches compare with one another at longer term, or how patients treated with these approaches differ in terms of foot function, foot biomechanics, or quality-of-life from individuals who did not have clubfoot as a child. Questions/purposes We compared (1) focused physical and radiographic examinations, (2) gait analysis, and (3) quality-of-life measures at long-term followup between groups of adult patients with clubfoot treated either with the Ponseti method of nonsurgical management or a comprehensive surgical release through a Cincinnati incision, and compared these two groups with a control group without clubfoot. Methods This was a case control study of individuals treated for clubfoot at two separate institutions with different methods of treatment between 1983 to 1987. One hospital used only the Ponseti method and the other mainly used a comprehensive clubfoot release. There were 42 adults (24 treated surgically, 18 treated with Ponseti method) with isolated clubfoot along with 48 healthy control subjects who agreed to participate in a detailed analysis of physical function, foot biomechanics, and quality-of-life metrics. Results Both treatment groups had diminished strength and motion compared with the control subjects on physical examination measures; however, the Ponseti group had significantly greater ankle plantar flexion ROM (p \u3c 0.001), greater ankle plantar flexor (p = 0.031) and evertor (p = 0.012) strength, and a decreased incidence of osteoarthritis in the ankle and foot compared with the surgical group. During gait the surgical group had reduced peak ankle plantar flexion (p = 0.002), and reduced sagittal plane hindfoot (p = 0.009) and forefoot (p = 0.008) ROM during the preswing phase compared with the Ponseti group. The surgical group had the lowest overall ankle power generation during push off compared with the control subjects (p = 0.002). Outcome tools revealed elevated pain levels in the surgical group compared with the Ponseti group (p = 0.008) and lower scores for physical function and quality-of-life for both clubfoot groups compared with age-range matched control subjects (p = 0.01). Conclusions Although individuals in each treatment group experienced pain, weakness, and reduced ROM, they were highly functional into early adulthood. As adults the Ponseti group fared better than the surgically treated group because of advantages including increased ROM observed at the physical examination and during gait, greater strength, and less arthritis. This study supports efforts to correct clubfoot with Ponseti casting and minimizing surgery to the joints, and highlights the need to improve methods that promote ROM and strength which are important for adult function. Level of Evidence Level III, prognostic study

HIV Co-infection Augments EBV-Induced Tumorigenesis in vivo

In most individuals, EBV maintains a life-long asymptomatic latent infection. However, EBV can induce the formation of B cell lymphomas in immune suppressed individuals including people living with HIV (PLWH). Most individuals who acquire HIV are already infected with EBV as EBV infection is primarily acquired during childhood and adolescence. Although antiretroviral therapy (ART) has substantially reduced the incidence of AIDS-associated malignancies, EBV positive PLWH are at an increased risk of developing lymphomas compared to the general population. The direct effect of HIV co-infection on EBV replication and EBV-induced tumorigenesis has not been experimentally examined. Using a humanized mouse model of EBV infection, we demonstrate that HIV co-infection enhances systemic EBV replication and immune activation. Importantly, EBV-induced tumorigenesis was augmented in EBV/HIV co-infected mice. Collectively, these results demonstrate a direct effect of HIV co-infection on EBV pathogenesis and disease progression and will facilitate future studies to address why the incidence of certain types of EBV-associated malignancies are stable or increasing in ART treated PLWH

The Grizzly, September 12, 1986

Patterns Passes Midpoint • Future of Dorms Fuzzy • Rutgers Rough For Lady Bears • Bomberger Organizes Itself • Pottstown Reich Cracks Down on Cruising • Ursinus\u27 Colors: A Long Tradition • Letter: Maples: The Place Just Ain\u27t the Same • Clean up Cans • The Private Eye • Infirmary Info • AXE: Fraternity With a Difference • Bodolus Bounces Back • Men\u27s and Women\u27s X-Country Off and Running • U.C. Does Dorneyhttps://digitalcommons.ursinus.edu/grizzlynews/1167/thumbnail.jp

The Grizzly, September 12, 1986

Patterns Passes Midpoint • Future of Dorms Fuzzy • Rutgers Rough For Lady Bears • Bomberger Organizes Itself • Pottstown Reich Cracks Down on Cruising • Ursinus\u27 Colors: A Long Tradition • Letter: Maples: The Place Just Ain\u27t the Same • Clean up Cans • The Private Eye • Infirmary Info • AXE: Fraternity With a Difference • Bodolus Bounces Back • Men\u27s and Women\u27s X-Country Off and Running • U.C. Does Dorneyhttps://digitalcommons.ursinus.edu/grizzlynews/1167/thumbnail.jp

Brief Report: Significant Decreases in Both Total and Unbound Lopinavir and Amprenavir Exposures During Coadministration

This secondary analysis explored changes in protein-unbound concentrations of lopinavir and amprenavir when co-administered in HIV-infected subjects. Total and unbound pharmacokinetic parameters were calculated and compared between subjects receiving each agent alone, and co-administration. When co-administered, unbound and total concentrations decrease. Co-administration significantly increased lopinavir unbound clearance, while significant changes in fraction unbound (fu) were not detected. For amprenavir, significant increases in fu and unbound clearance occurred with co-administration. This demonstrates the complex nature of drug-drug interactions between highly protein-bound, CYP-metabolized drugs, and the need to measure unbound concentrations in disease states like hepatitis C, where such agents are co-administered

Macrophages sustain HIV replication in vivo independently of T cells

Macrophages have long been considered to contribute to HIV infection of the CNS; however, a recent study has contradicted this early work and suggests that myeloid cells are not an in vivo source of virus production. Here, we addressed the role of macrophages in HIV infection by first analyzing monocytes isolated from viremic patients and patients undergoing antiretroviral treatment. We were unable to find viral DNA or viral outgrowth in monocytes isolated from peripheral blood. To determine whether tissue macrophages are productively infected, we used 3 different but complementary humanized mouse models. Two of these models (bone marrow/liver/thymus [BLT] mice and T cell–only mice [ToM]) have been previously described, and the third model was generated by reconstituting immunodeficient mice with human CD34+ hematopoietic stem cells that were devoid of human T cells (myeloid-only mice [MoM]) to specifically evaluate HIV replication in this population. Using MoM, we demonstrated that macrophages can sustain HIV replication in the absence of T cells; HIV-infected macrophages are distributed in various tissues including the brain; replication-competent virus can be rescued ex vivo from infected macrophages; and infected macrophages can establish de novo infection. Together, these results demonstrate that macrophages represent a genuine target for HIV infection in vivo that can sustain and transmit infection