Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway

<p>Abstract</p> <p>Background</p> <p>Hip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services.</p> <p>Methods</p> <p>This is a cross-sectional study in seven Norwegian counties providing regular care and one Swedish healthcare region where a hip surveillance programme was introduced in 1994. Data were provided by the Norwegian Cerebral Palsy Register and the CP Register in Southern Sweden. Children born 1996 - 2003 with moderate to severe CP, defined as Gross Motor Classification System (GMFCS) levels III - V, were included. In all, 119 Norwegian and 136 Swedish children fulfilled the criteria. In Norway, data on hip operations and radiographs of the hips were collected from medical records, while these data are collected routinely in the Swedish register. The hip migration percentage was measured on the recent radiographs. Hip dislocation was defined as a migration percent of 100%.</p> <p>Results</p> <p>The proportion of children at GMFCS levels III - V was 34% in the Norwegian and 38% in the Swedish population. In the Norwegian population, hip dislocation was diagnosed in 18 children (15.1%; CI: 9.8 - 22.6) compared with only one child (0.7%; 95% CI: 0.01 - 4.0) in Southern Sweden (p = < 0.001). Hip surgery was performed in 53 (44.5%) of the Norwegian children and in 43 (32%) of the Swedish children (p = 0.03). The total number of hip operations was 65 in Norway and 63 in Sweden. Norwegian children were first operated at a mean age of 7.6 years (SD: 2.9) compared with 5.7 years (SD: 2.3) in Sweden (p = 0.001).</p> <p>Conclusions</p> <p>The surveillance programme reduced the number of hip dislocations and the proportion of children undergoing hip surgery was lower. However, with the surveillance programme the first operation was performed at a younger age. Our results strongly support the effectiveness of a specifically designed follow-up programme for the prevention of hip dislocation in children with CP.</p

Learning To Be Affected: Social suffering and total pain at life’s borders.

The practice of Live Sociology in situations of pain and suffering is the author’s focus. An outline of the challenges of understanding pain is followed by a discussion of Bourdieu’s ‘social suffering’ (1999) and the palliative care philosophy of ‘total pain’. Using examples from qualitative research on disadvantaged dying migrants in the UK, attention is given to the methods that are improvised by dying people and care practitioners in attempts to bridge intersubjective divides, where the causes and routes of pain can be ontologically and temporally indeterminate and/or withdrawn. The paper contends that these latter phenomena are the incitement for the inventive bridging and performative work of care and Live Sociological methods, both of which are concerned with opposing suffering. Drawing from the ontology of total pain, I highlight the importance of (i) an engagement with a range of materials out of which attempts at intersubjective bridging can be produced, and which exceed the social, the material, and the temporally linear; and (ii) an empirical sensibility that is hospitable to the inaccessible and non-relational

Use of manual and powered wheelchair in children with cerebral palsy: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Mobility is important for the cognitive and psychosocial development of children. Almost one third of children with cerebral palsy (CP) are non-ambulant. Wheelchairs can provide independent mobility, allowing them to explore their environment. Independent mobility is vital for activity and participation and reduces the dependence on caregivers. The purpose of this study was to describe the use of manual and powered wheelchair indoors and outdoors in relation to the degree of independent wheelchair mobility or need for assistance in a total population of children with CP.</p> <p>Methods</p> <p>A cross-sectional study was performed including all children aged 3-18 years with CP living in southern Sweden during 2008. Data was extracted from a register and health care programme for children with CP (CPUP). There were a total of 562 children (326 boys, 236 girls) in the register. Information on the child's use of manual and powered wheelchair indoors and outdoors and the performance in self-propelling or need for assistance were analysed related to age, CP subtype and gross motor function.</p> <p>Results</p> <p>Wheelchairs for mobility indoors were used by 165 (29%) of the 562 children; 61 used wheelchair for independent mobility (32 using manual only, 12 powered only, 17 both) and 104 were pushed by an adult. For outdoor mobility wheelchairs were used by 228 children (41%); 66 used a wheelchair for independent mobility (18 using manual only, 36 powered only, 12 both) and 162 were pushed. The use of wheelchair increased with age and was most frequent in the spastic bilateral and dyskinetic subtypes. Most powered wheelchairs were operated by children at GMFCS level IV.</p> <p>Conclusion</p> <p>In this total population of children with CP, aged 3-18 years, 29% used a wheelchair indoors and 41% outdoors. A majority using manual wheelchairs needed adult assistance (86%) while powered wheelchairs provided independent mobility in most cases (86%). To achieve a high level of independent mobility, both manual and powered wheelchairs should be considered at an early age for children with impaired walking ability.</p

Evaluation of prognostic factors among patients with chronic graft-versus-host disease

Background: Chronic graft-versus-host disease (cGVHD) is a major complication after allogeneic stem cell transplantation with an adverse effect on both mortality and morbidity. In 2005, the National Institute of Health proposed new criteria for diagnosis and classification of chronic graft-versus-host disease for clinical trials. New sub-categories were recognized such as late onset acute graft-versus-host disease and overlap syndrome. Design and methods: We evaluated the prognostic impact of the new sub-categories as well as the clinical scoring system proposed by the National Institute of Health in a retrospective, multicenter study of 820 patients undergoing allogeneic stem cell transplantation between 2000 and 2006 at 3 different institutions. Patients were retrospectively categorized according to the National Institute of Health criteria from patients' medical histories. Results: As far as the new sub-categories are concerned, in univariate analysis diagnosis of overlap syndrome adversely affected the outcome. Also, the number of organs involved for a cut-off value of 4 significantly influenced both cGVHD related mortality and survival. In multivariate analysis, in addition to NIH score, platelet count and performance score at the time of cGVHD diagnosis, plus gut involvement, significantly influenced outcome. These 3 variables allowed us to develop a simple score system which identifies 4 subgroups of patients with 84%, 64%, 43% and 0% overall survival at five years after cGVHD diagnosis (score 0: HR=15.96 (95% CI: 6.85-37.17), P<0.001; score 1: HR=5.47 (95% CI: 2.6-11.5), P<0.001; score 2: HR=2.8 (95% CI: 1.32-5.93), P=0.007). Conclusions: In summary, we have identified a powerful and simple tool to discriminate different subgroups of patients in terms of chronic graft-versus-host disease related mortality and survival

Robustness analysis of discrete predictor-based controllers for input-delay systems

In this article, robustness to model uncertainties are analysed in the context of discrete predictor-based state-feedback controllers for discrete-time input-delay systems with time-varying delay, in an LMI framework. The goal is comparing robustness of predictor-based strategies with respect to other (sub)optimal state feedback ones. A numerical example illustrates that improvements in tolerance to modelling errors can be achieved by using the predictor framework.The authors are grateful for grant nos. DPI2008-06737-C02-01, DPI2008-06731-C02-01, DPI2011-27845-C02-01 and PROMETEO/2008/088 from the Spanish and Valencian governments.González Sorribes, A.; Sala, A.; García Gil, PJ.; Albertos Pérez, P. (2013). Robustness analysis of discrete predictor-based controllers for input-delay systems. International Journal of Systems Science. 44(2):232-239. https://doi.org/10.1080/00207721.2011.600469S232239442Boukas, E.-K. (2006). Discrete-time systems with time-varying time delay: Stability and stabilizability. Mathematical Problems in Engineering, 2006, 1-10. doi:10.1155/mpe/2006/42489Du, D., Jiang, B., & Zhou, S. (2008). Delay-dependent robust stabilisation of uncertain discrete-time switched systems with time-varying state delay. International Journal of Systems Science, 39(3), 305-313. doi:10.1080/00207720701805982El Ghaoui, L., Oustry, F., & AitRami, M. (1997). A cone complementarity linearization algorithm for static output-feedback and related problems. IEEE Transactions on Automatic Control, 42(8), 1171-1176. doi:10.1109/9.618250Gao, H., & Chen, T. (2007). New Results on Stability of Discrete-Time Systems With Time-Varying State Delay. IEEE Transactions on Automatic Control, 52(2), 328-334. doi:10.1109/tac.2006.890320Gao, H., Wang, C., Lam, J., & Wang, Y. (2004). Delay-dependent output-feedback stabilisation of discrete-time systems with time-varying state delay. IEE Proceedings - Control Theory and Applications, 151(6), 691-698. doi:10.1049/ip-cta:20040822Gao, H., Chen, T., & Lam, J. (2008). A new delay system approach to network-based control. Automatica, 44(1), 39-52. doi:10.1016/j.automatica.2007.04.020Garcia , P , Castillo , P , Lozano , R and Albertos , P . 2006 . Robustness with Respect to Delay Uncertainties of a Predictor Observer Based Discrete-time Controller . Proceeding of the 45th IEEE Conference on Decision and Control . 2006 . pp. 199 – 204 .Guo , Y and Li , S . 2009 . New Stability Criterion for Discrete-time Systems with Interval Time-varying State Delay . Joint 48th IEEE Conference on Decision and Control and 28th Chinese Control Conference . 2009 . pp. 1342 – 1347 .Hägglund, T. (1996). An industrial dead-time compensating PI controller. Control Engineering Practice, 4(6), 749-756. doi:10.1016/0967-0661(96)00065-2V.J.S. Leite, and Miranda, M.F. (2008), ‘Robust Stabilization of Discrete-time Systems with Time-varying Delay: An LMI Approach’,Mathematical Problems in Engineering, 2008, 15 pages (doi:10.1155/2008/875609)Liu, X. G., Tang, M. L., Martin, R. R., & Wu, M. (2006). Delay-dependent robust stabilisation of discrete-time systems with time-varying delay. IEE Proceedings - Control Theory and Applications, 153(6), 689-702. doi:10.1049/ip-cta:20050223Lozano, R., Castillo, P., Garcia, P., & Dzul, A. (2004). Robust prediction-based control for unstable delay systems: Application to the yaw control of a mini-helicopter. Automatica, 40(4), 603-612. doi:10.1016/j.automatica.2003.10.007Manitius, A., & Olbrot, A. (1979). Finite spectrum assignment problem for systems with delays. IEEE Transactions on Automatic Control, 24(4), 541-552. doi:10.1109/tac.1979.1102124Michiels, W., & Niculescu, S.-I. (2003). On the delay sensitivity of Smith Predictors. International Journal of Systems Science, 34(8-9), 543-551. doi:10.1080/00207720310001609057Palmor, Z.J. (1996), ‘Time-delay Compensation – Smith Predictor and Its Modifications’, inThe Control Handbook, ed. W.S. Levine, Boca Raton: CRC Press, pp. 224–237Pan, Y.-J., Marquez, H. J., & Chen, T. (2006). Stabilization of remote control systems with unknown time varying delays by LMI techniques. International Journal of Control, 79(7), 752-763. doi:10.1080/00207170600654554Richard, J.-P. (2003). Time-delay systems: an overview of some recent advances and open problems. Automatica, 39(10), 1667-1694. doi:10.1016/s0005-1098(03)00167-5Wang, Q.-G., Lee, T. H., & Tan, K. K. (1999). Finite-Spectrum Assignment for Time-Delay Systems. Lecture Notes in Control and Information Sciences. doi:10.1007/978-1-84628-531-8He, Y., Wu, M., Han, Q.-L., & She, J.-H. (2008). Delay-dependentH∞control of linear discrete-time systems with an interval-like time-varying delay. International Journal of Systems Science, 39(4), 427-436. doi:10.1080/00207720701832531Yue, D., & Han, Q.-L. (2005). Delayed feedback control of uncertain systems with time-varying input delay. Automatica, 41(2), 233-240. doi:10.1016/j.automatica.2004.09.006Zhang, B., Xu, S., & Zou, Y. (2008). Improved stability criterion and its applications in delayed controller design for discrete-time systems. Automatica, 44(11), 2963-2967. doi:10.1016/j.automatica.2008.04.01

Imaging the Dopamine Uptake Site with Ex Vivo [ 18 F]GBR 13119 Binding Autoradiography in Rat Brain

We studied the binding of [ 18 F]GBR 13119 {1-[[(4-[ 18 F]fluorophenyl) (phenyl)methoxy]ethyl]-4-(3-phenylpropyl)piperazine} to rat brain with autoradiography after intravenous injection. The rank order of binding was dorsal striatum > nucleus accumbens = olfactory tubercle > sub-stantia nigra = ventral tegmental area > other areas. Binding was blocked by prior injection of dopamine uptake blockers but not by injection of dopamine receptor antagonists or drugs that bind to the dialkylpiperazine site. Unilateral 6-hydroxy dopamine lesions of dopamine neurons caused a marked decrease in striatal and nigral binding on the side of the lesion. We conclude that intravenous injection of [ 18 F]GBR 13119 provides a useful marker of presynaptic dopamine uptake sites.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66209/1/j.1471-4159.1990.tb04178.x.pd

Regulation of MMP2 and MMP9 metalloproteinases by FSH and growth factors in bovine granulosa cells

Matrix metalloproteinases (MMP) are key enzymes involved in tissue remodeling. Within the ovary, they are believed to play a major role in ovulation, and have been linked to follicle atresia. To gain insight into the regulation of MMPs, we measured the effect of hormones and growth factors on MMP2 and MMP9 mRNA levels in non-luteinizing granulosa cells in serum-free culture. FSH and IGF1 both stimulated estradiol secretion and inhibited MMP2 and MMP9 mRNA abundance. In contrast, EGF and FGF2 both inhibited estradiol secretion but had no effect on MMP expression. At physiological doses, none of these hormones altered the proportion of dead cells. Although we cannot link MMP expression with apoptosis, the specific down regulation by the gonadotropic hormones FSH and IGF1 in vitro suggests that excess MMP2 and MMP9 expression is neither required nor desired for follicle development

An Improved Protocol for N-Glycosylation Analysis of Gel-Separated Sialylated Glycoproteins by MALDI-TOF/TOF

Different glycoforms of some proteins have been identified as differential spots for certain diseases in 2-DE, indicating disease-related glycosylation changes. It is routine to determine the site-specific glycosylation of nonsialylated N-glycoproteins from a single gel spot, but some obstacles still exist in analyzing sialylated glycoproteins due to the lability and higher detection limit of acid glycans in MALDI-TOF/TOF analysis. Thus, we present an improved protocol here. Tryptic glycopeptides were separated and subjected to MALDI-TOF/TOF analysis, resulting in the identification of site-specific glycosylation of high-intensity glycopeptides. Sequential deglycosylation and desialylation were used to improve the identification of glycosylation sites and desialylated glycans. The site-specific glycosylation of large glycopeptides and low-intensity glycopeptides was deduced based on the masses of glycopeptides, deglycosylated peptides and desialylated glycans. By applying it to 2-DE separated human serum, the difference of N-glycosylation was successfully determined for α1-antitrypsin between different gel spots

Expression of Trichoderma reesei β-Mannanase in Tobacco Chloroplasts and Its Utilization in Lignocellulosic Woody Biomass Hydrolysis

Lignocellulosic ethanol offers a promising alternative to conventional fossil fuels. One among the major limitations in the lignocellulosic biomass hydrolysis is unavailability of efficient and environmentally biomass degrading technologies. Plant-based production of these enzymes on large scale offers a cost-effective solution. Cellulases, hemicellulases including mannanases and other accessory enzymes are required for conversion of lignocellulosic biomass into fermentable sugars. β-mannanase catalyzes endo-hydrolysis of the mannan backbone, a major constituent of woody biomass. In this study, the man1 gene encoding β-mannanase was isolated from Trichoderma reesei and expressed via the chloroplast genome. PCR and Southern hybridization analysis confirmed site-specific transgene integration into the tobacco chloroplast genomes and homoplasmy. Transplastomic plants were fertile and set viable seeds. Germination of seeds in the selection medium showed inheritance of transgenes into the progeny without any Mendelian segregation. Expression of endo-β-mannanase for the first time in plants facilitated its characterization for use in enhanced lignocellulosic biomass hydrolysis. Gel diffusion assay for endo-β-mannanase showed the zone of clearance confirming functionality of chloroplast-derived mannanase. Endo-β-mannanase expression levels reached up to 25 units per gram of leaf (fresh weight). Chloroplast-derived mannanase had higher temperature stability (40°C to 70°C) and wider pH optima (pH 3.0 to 7.0) than E.coli enzyme extracts. Plant crude extracts showed 6–7 fold higher enzyme activity than E.coli extracts due to the formation of disulfide bonds in chloroplasts, thereby facilitating their direct utilization in enzyme cocktails without any purification. Chloroplast-derived mannanase when added to the enzyme cocktail containing a combination of different plant-derived enzymes yielded 20% more glucose equivalents from pinewood than the cocktail without mannanase. Our results demonstrate that chloroplast-derived mannanase is an important component of enzymatic cocktail for woody biomass hydrolysis and should provide a cost-effective solution for its diverse applications in the biofuel, paper, oil, pharmaceutical, coffee and detergent industries