Perinatal risk factors for developmental coordination disorder in children born extremely preterm

Peer reviewe

Toxicity and morbility after isolated lower limb perfusion in 242 chemo-hyperthermal treatments for cutaneous melanoma: The experience of the Tuscan Reference Centre

<p>Abstract</p> <p>Background</p> <p>The aim of this retrospective study was to assess the results concerning the regional and systemic toxicity and complications in 242 chemo-hyperthermal treatments (HILPs) for lower limb melanoma.</p> <p>Patients and methods</p> <p>60 HILPs (G-A) were performed with mild HT plus L-PAM (10 mg/lt) ± D-actimomycin; 74 HILPs (G-B) with true HT (40–41.8°C) plus L-PAM (10 mg/lt) ± D-act; 108 HILPs (G-C) with true HT plus L-PAM (10 mg/lt) ± D-act plus L-PAM (5 mg/lt) additional bolus.</p> <p>Results</p> <p>Limb toxicity was very low in G-A and in G-B; increasing toxicity (grade III = 37%) in G-C; no grade IV statistical difference was registered in all three groups, with percentage values among 1.6% and 2.7%. Systemic toxicity showed itself only in the haemopoietic parameters. No differences were registered in G-B vs G-A group. In G-C vs G-B a significative increase of systemic toxicity was seen in grade 3 (p < 0.05). Postoperative complications were acceptable. Local and systemic side-effects were transient; no permanent neurological limb deficit was registered. The postoperative mortality was recorded in 3/182 HILPs (1.6%) of the G-B and G-C groups.</p> <p>Conclusion</p> <p>These data suggested that the technical implementations reduced the occurrence and the severity of the side effects and complications. The essential requirement for HILP is the quality assurance of the procedures. Although higher regional and systemic toxicity were observed in the G-C group caused by L-PAM additional bolus, the safeness of the procedures under the true hyperthermal regimen and the time increase of the high L-PAM concentration have assured the treatment reliability along with the increased clinical efficacy expectations of the treatments.</p

Non-nutritive sucking in the neonate

Non-nutritive sucking (NNS) by the newborn infant is a fundamental behaviour and is one of the first coordinated muscular activities in the foetus. A new specially designed computer-based method for automatic analysis of the NNS pattern in neonates has been produced. It records, identifies, analyses and quantifies the pressure signals obtained from a pressure transducer inside a pacifier when the infants suck. Validation of the system was carried out with four independent methods: EMG, visual identification, control of the automatic treatment and comparison of inter-observer results. A high degree of correspondence is shown.The automatic method was applied in 249 infants. A rhythmic NNS pattern of alternating sucking and pauses was elicited in 507 out of 529 recordings. The chance of achieving a recording without regular sucking activity is higher in younger neonates, but no limit in age or maturation is shown for NNS ability. The most immature, recorded at post-menstrual age (PMA) 26 weeks, provided an NNS pattern. Neither were the chances of no sucking increased in clinical stable sick pre-term infants, in those who developed sequelae nor in those exposed to pethidine (meperidine) in utero. The quantification of the NNS pattern showed significant variations between different groups. In healthy full-term infants the one-day-olds demonstrated a lower frequency of their sucking, a greater variability in sucking pattern and longer duration of their bursts compared with the 3-day-olds. Pethidine-exposed babies sucked with lower sucking frequency and with a tendency to less stable rhythm. In healthy pre-term neonates a gradual change of their NNS was seen. Post-menstrual age (PMA) was the dominant predictor of the result but gender, state of activity and weight also influenced it to some extent. The sucking activity, sucking frequency, amplitude and burst duration all increased with maturation, while the variability of the sucking frequency and the duration of the intervals between bursts declined. At term conceptional age pre-terms sucked with higher frequency and lower amplitude than full-term infants. The role of PMA as the dominant predictor for the NNS pattern is diminished in pre-term infants with risk factors. Follow-up of a subgroup revealed fewer sucking bursts per minute, slower sucking frequency and a greater variability of the frequency and amplitude in those who developed sequelae. Conclusions: NNS is in neonates a basic rhythmic motor behaviour that is present even in those born early pre-term. The pattern of bursts of sucking and pauses is robust and present in the vast majority of all neonates. Several variables, with maturation as the most important, are found to affect the rhythm. It appears as a pre-programmed rhythm generator, primarily modulated by maturation in healthy infants regulates their NNS behaviour. This modulation is affected by known risk associated events, in the infants who later develop sequelae and in those exposed to pethidine.Quantification of the NNS pattern in infants may be a valuable future component of their evaluation

”Social utveckling i skolan” – en studie om hur gruppen kan påverka individen

I skolan arbetar varje dag lärare med elever sammansatta i olika grupper. För att skolarbetet ska kunna flyta på och kunskap införskaffas krävs det att eleverna i de olika grupperna ska fungera bra tillsammans. Lpo 94 skriver om hur skolan ska sträva efter en levande social gemenskap där man känner trygghet. Socialisationsprocessen är den process där individen anpassas efter gruppens och samhällets krav, där ibland finns regler, attityder samt beteendemönster. Individen ska också kunna anpassa sig efter andra regler och beteende i situationer som kräver detta. Prosociala egenskaper innebär att individen kan agera utifrån vad som är bäst för andra, man delar med sig, hjälper och skyddar andra

Seizure-like events leading to hospital referrals in infants: A retrospective population-based study

Aim: To identify the aetiology and outcome of seizure-like events leading to hospital referrals in infants and to identify early predictors of epilepsy and delayed neurodevelopment. Methods: This Norwegian population-based study focused on all children born in Sør-Trøndelag county, who were up to one year of age in 2014-2015. They were identified by diagnostic codes for seizure-like events and electroencephalography (EEG) examinations. Hospital records were examined up to 1.5 years of age. Results: The one-year prevalence of seizure-like events was 1.5% (114/7430). Epilepsy was diagnosed in 17%, 57% had non-epileptic paroxysmal events (NEPE), 16% had febrile seizures, and 10% had other acute symptomatic epileptic seizures. Neurodevelopmental delay occurred in 21%. The cumulative incidence was 0.22% for epilepsy and 0.79% for NEPE. Abnormal brain magnetic resonance imaging, abnormal first EEGs and neonatal care increased the likelihood of epilepsy and delayed development. Identifying situation-related factors decreased the epilepsy risk. Occurrence at a younger age increased the risk of delayed development. Absence of unambiguous motor symptoms was less common in epilepsy than in NEPE. Conclusion: Seizure-like events were common in infants and most were not caused by epilepsy. Specific anamnestic clues, and detailed descriptions of the entire event, helped to predict adverse outcomes

Comparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis - A BARFOT Study.

The objective of the study was to compare disease characteristics over the first 5 years of disease in patients with RA, with disease onset in 1990s and 2000s, respectively

Patients with early rheumatoid arthritis in the 2000s have equal disability and pain despite less disease activity compared with the 1990s : Data from the barfot study over 8 years

Objective. To compare outcomes over the first 8 years in patients with early rheumatoid arthritis (RA) recruited in the 1990s and the 2000s, with a special focus on functional disability and its possible predictors. Methods. Data were acquired from 1938 patients with early RA (American College of Rheumatology 1987 criteria) included in the BARFOT study, who had completed the 8-year followup. The patients were divided into 2 cohorts: cohort 1 (n = 928, 68% women) included from 1992 to 1999 and cohort 2 (n = 1010, 70% women) included from 2000 to 2006. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), visual analog scale pain, and radiographs of hands and feet scored by the van der Heijde modified Sharp method were assessed during the 8 years. Longitudinal data analyses were performed using a generalized linear model. Results. Despite more active medical treatment during the 2000s, the courses of HAQ and pain showed no difference between the cohorts during followup, in either women or in men, with significantly higher levels in women compared with men. However, as expected, disease activity decreased more over time in cohort 2 compared with cohort 1, for both sexes, and women in cohort 2 had less radiographic progression compared with cohort 1. HAQ was associated with DAS28, pain, radiological scores, and sex in both cohorts, and in cohort 2 also with age and smoking. Conclusion. Patients included in the 2000s had lower disease activity, but not less activity limitation and pain over 8 years of followup despite more active treatment. Pain, aging, and smoking might explain why patients included in the 2000s still had the same disability levels as those included in the 1990s

Disease Factors in Early Rheumatoid Arthritis Are Associated with Differential Risks for Cardiovascular Events and Mortality Depending on Age at Onset: A 10-year Observational Cohort Study.

To investigate, within the first 2 years of diagnosis with rheumatoid arthritis (RA), associations between disease-related measures and cardiovascular disease (CVD) and mortality in patients with RA onset before and after 65 years of age

Higher levels of anti-phosphorylcholine autoantibodies in early rheumatoid arthritis indicate lower risk of incident cardiovascular events

Background: The increased risk of cardiovascular events (CVE) in rheumatoid arthritis (RA) is not fully explained by traditional risk factors. Immuno-inflammatory mechanisms and autoantibodies could be involved in the pathogenesis of atherosclerotic disease. It has been suggested that anti-phosphorylcholine antibodies (anti-PC) of the IgM subclass may have atheroprotective effects. Here, we aimed to investigate the association between levels of IgM anti-PC antibodies with CVE in patients with early RA. Methods: The study population was derived from the BARFOT early RA cohort, recruited in 1994–1999. The outcome of incident CVE (AMI, angina pectoris, coronary intervention, ischemic stroke, TIA) was tracked through the Swedish Hospital Discharge and the National Cause of Death Registries. Sera collected at inclusion and the 2-year visit were analyzed with ELISA to determine levels of anti-PC IgM. The Kaplan-Meier estimates and Cox proportional hazards regression models were used to compare CV outcome in the groups categorized by baseline median level of IgM anti-PC. Results: In all, 653 patients with early RA, 68% women, mean (SD) age 54.8 (14.7) years, DAS28 5.2 (1.3), 68% seropositive, and without prevalent CVD, were included. During the follow-up of mean 11.7 years, 141 incident CVE were recorded. Baseline IgM anti-PC above median was associated with a reduction in risk of incident CVE in patients aged below 55 years at inclusion, HR 0.360 (95% CI, 0.142–0.916); in males, HR 0.558 (0.325–0.958); in patients with BMI above 30 kg/m2, HR 0.235 (0.065–0.842); and in those who did not achieve DAS28 remission at 1 year, HR 0.592 (0.379–0.924). The pattern of associations was confirmed in the models with AUC IgM anti-PC over 2 years. Conclusion: Protective effects of higher levels of innate IgM anti-PC autoantibodies on CVE were detected in younger patients with RA and those at high risk of CVE: males, presence of obesity, and non-remission at 1 year