Association Between Joint Hypermobility Syndrome and Developmental Coordination Disorder – A Review.

Introduction: The term joint hypermobility syndrome (JHS) was adopted after clinicians became aware of the myriad of symptoms associated with this multisystemic condition. JHS is an inherited disorder of connective tissues affecting the musculoskeletal and visceral systems which may contribute to a reduction in health related physical fitness. Pain associated with JHS may be influenced by hypermobility and biomechanical dysfunction. Biomechanical dysfunction observed in patients with JHS may be as a result of impaired motor control and in particular developmental coordination disorder (DCD). DCD (described in the literature utilising the terms clumsy child syndrome; perceptual motor dysfunction; dyspraxia) is a neurodevelopmental condition characterised by coordination difficulties affecting function. The objective of this review is to examine the association between hypermobility, JHS, motor control impairment and DCD. Methods and data sources: EMBASE, MEDLINE, CINAHL, ASSIA, PsychARTICLES, SPORTDiscus and PsycINFO from 1989 - 2009. Research articles written in English and peer reviewed were included. Results: Five research papers were identified. The studies employed a variety of methodologies and assessment tools for reporting joint hypermobility, JHS, motor delay, motor impairments and DCD. All five studies reported on children between the ages of six months and 12 years. Three out of four studies reported on association between impaired motor development, motor delay and joint hypermobility. There was no consensus as to whether motor delay, impaired motor development and joint hypermobility continued as the child matured. One study ascertained that children with JHS reported similar functional difficulties as children with DCD. Conclusion: There was a paucity of literature relating to an association between joint hypermobility, JHS, impaired motor control, motor delay and DCD in children, there was no literature pertaining to adults. This association requires further exploration if professionals are to understand, nurture and manage those reporting these associated conditions

Dynamic specification of vowels in Hijazi Arabic

\ua9 2024 De Gruyter Mouton. All rights reserved.Research on various languages shows that dynamic approaches to vowel acoustics – in particular Vowel-Inherent Spectral Change (VISC) – can play a vital role in characterising and classifying monophthongal vowels compared with a static model. This study’s aim was to investigate whether dynamic cues also allow for better description and classification of the Hijazi Arabic (HA) vowel system, a phonological system based on both temporal and spectral distinctions. Along with static and dynamic F1 and F2 patterns, we evaluated the extent to which vowel duration, F0, and F3 contribute to increased/decreased discriminability among vowels. Data were collected from 20 native HA speakers (10 females and 10 males) producing eight HA monophthongal vowels in a word list with varied consonantal contexts. Results showed that dynamic cues provide further insights regarding HA vowels that are not normally gleaned from static measures alone. Using discriminant analysis, the dynamic cues (particularly the seven-point model) had relatively higher classification rates, and vowel duration was found to play a significant role as an additional cue. Our results are in line with dynamic approaches and highlight the importance of looking beyond static cues and beyond the first two formants for further insights into the description and classification of vowel systems

Abstract: Pain poses a significant health burden in those with Joint Hypermobility Syndrome

Background Joint hypermobility Syndrome (JHS) is a complex multisystemic connective tissue disorder. JHS is acknowledged as a common clinical entity in musculoskeletal medicine with a prevalence of between 30%-60% in those presenting with musculoskeletal pain. It is more prevalent in females than males may present in childhood and shares symptom overlap with Ehlers-Danlos Syndrome, Marfan Syndrome and Ostegenesis Imperfecta. Patients with JHS report a variety of symptoms associated with this condition. These symptoms include: chronic pain, dislocations, impaired coordination, autonomic nervous system (ANS) and Gastrointestinal (GI) symptoms. Aims The purpose of this study was to investigate the health burden in those with JHS and to understand which symptoms are considered to be most troublesome. Methods A sample of 89 patients with JHS (mean age 34.6 ± 9.9 years, 82 female), diagnosed by a consultant rheumatologist according to the Brighton Criteria were compared with 113 healthy volunteers (mean age 35.7 ± 12.9, 82 female) with no musculoskeletal pain. Information relating to dislocations, ANS, GI symptoms and impaired coordination was collected by means of a self-report questionnaire. Data relating to the reporting of pain for >3 months was collected on a pain chart and the SF-12 was employed for assessing quality of life. SF-12 data is reported as Physical Component Summary (PCS) scores and Mental Component Summary (MCS) Scores. A difference in either the PCS or MCS scores of 5 points is considered to be a clinically important difference. Numerical data were analysed using independent sample t-tests and regression analysis. Results Patients with JHS reported significantly lower mean PCS scores (M = 29.70 SD 10.63) than healthy volunteers (M = 54.45 SD 5.74), t (127.701) = 19.81, p<0.001 (2-tailed). The mean difference was 24.75 points [95%CI 22.44 - 27.06] - a statistically significant and clinically important difference. Patients with JHS were significantly more likely to report the following than healthy volunteers; subluxations/dislocations, GI and ANS symptoms and impaired coordination. The average number of pain sites reported was 10/17. Regression analysis of the reported symptoms revealed the number of pain sites as the only significant predictor of a lowered PCS score (p< 0.01) in a model explaining 23% of the variance. MCS scores of patients with JHS (M = 41.13 SD 11.60) were significantly lower than those of healthy volunteers (M = 45.64 SD 10.95), t (200) = 2.65, p<0.01. The mean difference was <5 points - this might not be clinically important. Conclusion Patients with JHS in this study reported a statistically significant reduction in both PCS and MCS scores compared with healthy volunteers. The large difference in PCS scores is likely to be clinically important. Although multisystemic symptoms were reported multisite pain was the only symptom which contributed significantly to a lowered PCS score of the SF-12. This study high lights the health and personal burden of those with JHS and the importance of recognising and understanding the contribution of multisite pain in this population

An Exploration of Neurophysiological Symptoms in Patients with Joint Hypermobility Syndrome and their Impact on Quality of Life.

Purpose: The purpose of this study was to explore the prevalence of neurophysiological symptoms in patients with Joint Hypermobility Syndrome (JHS) and their impact on quality of life. Relevance: Clinical experience suggests patients with JHS suffer from neurophysiological symptoms contributing to skill and health impairments affecting quality of life. MethodsA sample of 90 JHS-patients (mean age 34.7 ± 9.9 years), diagnosed according to the Brighton Criteria were compared with 113 healthy volunteers (mean age 35.7 ± 12.9) with no musculoskeletal pain. Neurophysiological symptoms were collected in a self report questionnaire. The Functional Difficulties Questionnaire was used for the assessment of developmental coordination disorder (DCD). A pain chart was employed to collect data relating to musculoskeletal pain. The SF-12 medical outcomes questionnaire was used for assessing quality of life. Analysis: Chi-square was employed to compare group proportions. Continuous numerical data comparisons were analysed using independent sample t-tests. Regression analysis was employed to analyse multiple variables. Results: Patients with JHS were significantly more likely to report the following than healthy volunteers; autonomic symptoms (70%, 12%); gastrointestinal symptoms (71%, 9%); DCD (56%, 19%) and chronic fatigue syndrome (31%, 1%). The mean number of pain sites reported for patients with JHS were 9.83 ± 4.18. Patients with JHS reported significantly lower physical component summary scores (PCS) of the SF-12 than healthy volunteers (p < 0.001). Pain was a significant predictor of reduced PCS of the SF-12 (p < 0.001) in a model that explained 23% of the variance. Conclusions Neurophysiological symptoms were common. Pain was a significant contributor to the health burden of patients with JHS. Research is required to explore the connectivity and implications of these symptoms in relation to the central nervous system. Implications: There is a requirement to acknowledge and understand the multidimensional nature of JHS

Sex differences in the effects of exercise on cognition post-stroke: Secondary analysis of a randomized controlled trial

OBJECTIVE: To determine whether there are differences in exercise-associated changes in cognitive func-tion between males and females living with stroke. DESIGN: Secondary analysis of data from a prospective assessor-blinded randomized controlled trial. PARTICIPANTS: Fifty participants (50-80 years, \u3e 1 year post-stroke, able to walk ≥ 5 m). METHODS: Participants were allocated into a 6-month aerobic exercise programme (14 males, 11 females) or balance and flexibility programme (15 males, 10 females). Working memory (Verbal Digit Span Backwards Test), selective attention and conflict resolution (Stroop Colour-Word Test), and set shifting/cognitive flexibility (Trail-Making Test B) were assessed before and after the programmes. RESULTS: There was a group × time interaction in females (effect size 0.28, p = 0.03), which was not observed in males (effect size 0.01, p = 0.62). Females demonstrated a Stroop Colour-Word Interference test change of -2.3 s, whereas males demonstrated a change of +5.5 s following aerobic exercise. There were no differences between exercise groups in either sex for any of the other outcomes (working memory and set-shifting/cognitive flexibility). CONCLUSION: Females living with stroke may demonstrate a greater response to exercise on selective attention and conflict resolution compared with males with stroke. These findings suggest that there may be sex-specific effects of exercise on cognitive func-tion in individuals with stroke

Assessment of the 2016 National Institute for Health and Care Excellence high-sensitivity troponin rule-out strategy.

OBJECTIVE: We aimed to evaluate the limit of detection of high-sensitivity troponin (hs-cTn) and Thrombolysis In Myocardial Infarction (TIMI) score combination rule-out strategy suggested within the 2016 National Institute for Health and Care Excellence (NICE) Chest Pain of Recent Onset guidelines and establish the optimal TIMI score threshold for clinical use. METHODS: A pooled analysis of adult patients presenting to the emergency department with chest pain and a non-ischaemic ECG, recruited into six prospective studies, from Australia, New Zealand and the UK. We evaluated the sensitivity of TIMI score thresholds from 0 to 2 alongside hs-cTnT or hs-cTnI for the primary outcome of major adverse cardiac events within 30 days. RESULTS: Data were available for 3159 patients for hs-cTnT and 4532 for hs-cTnI, of these 376 (11.9%) and 445 (9.8%) had major adverse cardiac events, respectively. Using a TIMI score of 0, the sensitivity for the primary outcome was 99.5% (95% CI 98.1% to 99.9%) alongside hs-cTnT and 98.9% (97.4% to 99.6%)%) alongside hs-cTnI, identifying 17.9% and 21.0% of patients as low risk, respectively. For a TIMI score ≤1 sensitivity was 98.9% (97.3% to 99.7%)%) alongside hs-cTnT and 98.4% (96.8% to 99.4%)%) alongside hs-cTnI, identifying 28.1% and 35.7% as low risk, respectively. For TIMI≤2, meta-sensitivity was <98% with either assay. CONCLUSIONS: Our findings support the rule-out strategy suggested by NICE. The TIMI score threshold suggested for clinical use is 0. The proportion of patients identified as low risk (18%-21%) and suitable for early discharge using this threshold may be sufficient to encourage change of practice. TRIAL REGISTRATION NUMBERS: ADAPT observational study/IMPACT intervention trial ACTRN12611001069943.ADAPT-ADP randomised controlled trial ACTRN12610000766011.EDACS-ADP randomised controlled trial ACTRN12613000745741.TRUST observational study ISRCTN no. 21109279

Simple oxidation of pyrimidinylhydrazones to triazolopyrimidines and their inhibition of Shiga toxin trafficking

The oxidative cyclisation of a range of benzothieno[2,3-d]pyrimidine hydrazones (7a–j) to the 1,2,4-triazolo[4,3-c]pyrimidines (8a–j) catalysed by lithium iodide or to the 1,2,4-triazolo[1,5-c]pyrimidines (10a–j) with sodium carbonate is presented. A complementary synthesis of the 1,2,4-triazolo[1,5-c]pyrimidines starting from the amino imine 11 is also reported. The effect of these compounds on Shiga toxin (STx) trafficking in HeLa cells and comparison to the previously reported Exo2 is also detailed

Ultrasound morphology of carotid plaque and its link with lipid: protein content and 3d microstructure of the plaque.

the 22nd Meeting of the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH), 19-21 May 2017. Berlin, Germany, and published in the International Journal of Stroke 12(1S): 57 (Poster 101), May 2017. ISSN: 1747-4930, eISSN: 1747-4949

Inflammation and muscle weakness in COPD: Considering a renewed role for Theophylline?

© 2018 Bentham Science Publishers. Background: The methyl-xanthine drug theophylline has been used for the treatment of asthma and chronic obstructive pulmonary disease (COPD) for several decades. Phosphodiesterase inhibition leading to smooth muscle relaxation is its main mode of action as a broncho-dilating agent, requiring blood theophylline concentrations close to the toxic range and a consequent problem with side effects. It also has anti-inflammatory effects that occur at relatively low concentrations. Objective: To explore supporting evidence for how other properties of theophylline could be of considerable clinical utility, particularly in reducing weakness and overt sarcopenia, based on its antiinflammatory, steroid-sparing and immune-modulating properties. Methods: PUBMED and MEDLINE were scanned using the search terms: theophylline, antiinflammatory, cytokine, inflammation, ageing, sarcopenia, frailty, chronic obstructive airways disease, pulmonary rehabilitation. High quality articles were selected, read in-depth and discussed by the authors, then used as the basis for a proposition on the potential anti-inflammatory and antisarcopenic use of theophylline. Findings: The anti-inflammatory properties of theophylline are mainly mediated by histone deacetylase induction in immune competent cells with a resulting shift toward the expression of a less inflamed phenotype, including a reduction of the release of pro-inflammatory cytokines and the associated increase in anti-inflammatory cytokines. These effects occur at blood theophylline concentrations well below the range for direct broncho-dilatation. Conclusion: There are potential therapeutic benefits of theophylline that are systemic and not confined to airways inflammation in COPD. There is scope for a beneficial effect in other chronic inflammatory states and post-acute inflammation with slow resolution. There is compelling evidence that theophylline could be used for anti-inflammatory adjunctive treatment to improve independent function, muscle strength and other outcomes in individuals recovering from acute inflammatory episodes, including but not limited to exacerbations of COPD, and as a pharmaceutical intervention in support of pulmonary rehabilitation