Definition, Epidemiology, and Etiological Factors of Cerebral Palsy

CP is not a diagnosis but an “umbrella term for many clinical descriptions. It refers to a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorerders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition. First description was made in 19th century by William Little. CP prevalence is generally reported around 2-3 per 1000 live births in both developed and developing countries (even if for very different reasons). Additionally for term children CP prevalence is 1 per 1000 live births. This rates are 6-10 times higher in preterm birth. The etiology of CP has been reported very diverse and multifactorial as prenatal, perinatal and postnatal. The causes and risk factors are congenital, genetic, inflammatory, infectious, anoxic, traumatic and metabolic. Knowledge of the epidemiology and etiology of cerebral palsy is important. Thus, at least in some cases, early diagnosis and prevention can be achieved

Nonpharmacologic Treatment for Fibromyalgia

Fibromyalgia is a common musculoskeletal pain condition associated with chronic widespread pain, tenderness at various points on the body, fatigue, and sleep abnormalities. Individuals with fibromyalgia often have comorbid anxiety, depression, and/or other pain syndromes. Research into pharmacologic remedies for fibromyalgia has demonstrated efficacy for a variety of agents, but pharmacology is only one piece of the puzzle when it comes to successful management of fibromyalgia. Nonpharmacological treatments, complementary and alternative medicines, and therapies can support alleviating fibromyalgia symptoms.There are many studies with regard to these treatment options

Superior cluneal nerve entrapment neuropathy due to lower crossed syndrome: A case with low back pain [Alt çapraz sendroma bağlı superior kluneal sinir tuzaklanma nöropatisi: Bel ağrılı bir olgu sunumu]

The superior cluneal nerve (SCN) is a sensory nerve known to be originated from the dorsal rami of the lower thoracic and lumbar nerve roots. One of the overlooked causes of low back pain (LBP) is the SCN Entrapment Neuropathy (SCNEN). SCNEN may also be associated with SCN stretching due to lumbar movement and the poor body posture through an increase in the paravertebral muscle tonus. A 59-year-old female patient presented with chronic LBP localized on the right iliac crest and radiating to the right buttock, groin, and leg. She had increased lumbar lordosis and anterior pelvic tilt. She had a tender point over the right iliac crest, and the pain was radiating to the buttock and posterolateral thigh (Tinel sign +). She was diagnosed with lower crossed syndrome and SCNEN, and a therapeutic nerve block was performed. Clinicians should consider SCNEN as a possible diagnosis of LBP

Characterization of FcγRIa (CD64) as a ligand molecule for site-specific IgG1 capture: A side-by-side comparison with protein a

Fc γreceptors (FcγRs) are one of the structures that can initiate effector function for monoclonal antibodies. FcγRIa has the highest affinity toward IgG1-type monoclonal antibodies among all FcγRs. In this study, a comprehensive characterization was performed for FcγRIa as a potential affinity ligand for IgG1-type monoclonal antibody binding. The binding interactions were assessed with the SPR technique using different immobilization techniques such as EDC-NHS coupling, streptavidin-biotin interaction, and His-tagged FcγRIa capture. The His-tagged FcγRIa capture was the most convenient method based on assay repeatability. Next, a crude IgG1 sample and its fractions with different monomer contents obtained from protein A affinity chromatography were used to evaluate FcγRIa protein in terms of monoclonal antibody binding capacity. The samples were also compared with a protein A-immobilized chip (a frequently used affinity ligand) for IgG1 binding responses. The antibody binding capacity of the protein A-immobilized chip surface was significantly better than that of the FcγRIa-immobilized chip surface due to its 5 Ig binding domains. The antibody binding responses changed similarly with protein A depending on the monomer content of the sample. Finally, a different configuration was used to assess the binding affinity of free FcγRs (FcγRIa, FcγRIIa, and FcγRIIIa) to three different immobilized IgGs by immobilizing protein L to the chip surface. Unlike previous immobilization techniques tested where the FcγRIa was utilized as a ligand, nonimmobilized or free FcγRIa resulted in a significantly higher antibody binding response than free protein A. In this configuration, kinetics data of FcγRI revealed that the association rate (ka 50-80 × 105 M-1 s-1) increased in comparison to His capture method (1.9-2.4 × 105 M-1 s-1). In addition, the dissociation rate (kd 10-5 s-1) seemed slower over the His capture method (10-4 s-1) and provided stability on the chip surface during the dissociation phase. The KD values for FcγRIa were found in the picomolar range (2.1-10.33 pM from steady-state affinity analysis and 37.5-46.2 pM from kinetic analysis) for IgG1-type antibodies. FcγRIa possesses comparable ligand potential as well as protein A. Even though the protein A-immobilized surface bound more antibodies than the FcγRIa-captured surface, FcγRIa presented a significant antibody binding capacity in protein L configuration. The results suggest FcγRIa protein as a potential ligand for site-oriented immobilization of IgG1-type monoclonal antibodies, and it needs further performance investigation on different surfaces and interfaces for applications such as sensing and antibody purification

Complex Regional Pain Syndrome in a Child: A Case Report

Complex regional pain syndrome (CRPS) is a painful clinical condition that usually seen on the distal extremity, affects children and adults. It is more common in adults. CRPS is usually characterized by severe pain, swelling, limitation of movement, trophic disorders, and spotted osteoporosis following triggering stimulus. CRPS-1 is not a peripheral nerve lesion, it develops following trauma, surgical applications and central nervous system lesion. On the other hand CRPS-2 occurs after peripheral nerve lesion. In CRPS-1, a more severe effect is seen than the initiating factor. CRPS-1 is a rare clinical condition in children. In this article, a 9-year-old male patient which developed CRPS-1 following lower extremity fracture is presented in company with current literature

Disability Distribution of Geriatric Patients Applying to the Board of Health for Disabled in a Rural Region

Objective:To determine the demographic characteristics, disability ratios, and disability distribution of geriatric patients who applied to an educational research hospital in the rural region to receive a health board report in order to benefit from the disability rights.Materials and Methods:The hospital archive was searched and the records between 01/01/2016 and 31/12/2016 were examined. The demographic characteristics of the patients, whether they were “severely disabled” or not, the number of patients with disabilities according to organ systems were determined and the disability ratios were calculated based on the “Regulation on Disability Criterion, Classification and Health Board Reports for Disability”. A list of diseases constituting the rate of disability was established and its numbers were determined.Results:Among the 699 geriatric patients who referred to the health board, 426 (60.9%) were female and 273 (39.1%) were male. The mean age of the patients was 77.62±7.74 years (minimum: 65, maximum: 104) (female: 78.07±7.54, male: 76.93±8.02), the mean disability ratio was 79.96±17.79% (10-100). The average disability ratio of females was 79.66±17.61% and the average disability ratio of males were 80.41±18.24%. There was no statistically significant difference between the male and female groups in terms of the mean disability ratio (p=0.239). Of the 202 (28.9%) patients who were considered to be severely disabled, 123 were female (60.9%) and 79 were male (39.1%). There was no statistically significant difference between male and female groups in severely disabled ratios (p=0.457). The first three organ systems constituting disability ratio in patients were the cardiovascular system, the musculoskeletal system, and the visual system. The number of patients with disabilities in the cardiovascular and musculoskeletal system was higher in women, but there was no statistically significant difference between the disability percentages of these systems.Conclusion:The highest rate of disability has been seen in the cardiovascular, musculoskeletal, and visual system in geriatric patients. In the practice of routine geriatric outpatient clinics, the pathologies of these organ systems should be evaluated in more detail and managed before creating disability

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia