The prevalence and clinical relevance of hyperhomocysteinemia suggesting vitamin B12 deficiency in presumed healthy infants

Background Previous studies have demonstrated a high prevalence of biochemical vitamin B12 deficiency in infants in Norway. Increased total homocysteine (tHcy) is the most important marker of B12 deficiency in infants. There is a need to evaluate its clinical relevance. Aims To investigate the prevalence of hyperhomocysteinemia (S-tHcy > 8 μmol/L) suggestive of suboptimal B12 status and the prevalence of clinically relevant hyperhomocysteinemia in presumed healthy infants in Norway. Further, to evaluate risk factors, presence of symptoms and psychomotor development in these children. Methods In a prospective study we clinically examined 252 infants aged 3–7 months using standardized neurological and psychomotor tests prior to analyzing biochemical B12 deficiency markers in 250 infants. Results Twenty-five of 250 (10%) infants had hyperhomocysteinemia combined with clinically relevant symptoms suggestive of B12 deficiency. Hyperhomocysteinemia was associated with tremor, excessive sleep, and sub-normal scores in the fine motor section of the Ages and Stages Questionnaire. One-hundred and fourteen of 250 (46%) infants had hyperhomocysteinemia. Multiple regression analysis showed months of infant formula use as the strongest negative predictor for hyperhomocysteinemia. Conclusion We have demonstrated associations between symptoms suggestive of infant B12 deficiency and increased levels of tHcy in presumed healthy infants The combination of hyperhomocysteinemia and associated relevant symptoms suggestive of B12 deficiency was a common finding, albeit most infants with hyperhomocysteinemia did not show symptoms.publishedVersio

The in-motion-app for remote general movement assessment : a multi-site observational study

Objectives To determine whether videos taken by parents of their infants' spontaneous movements were in accordance with required standards in the In-Motion-App, and whether the videos could be remotely scored by a trained General Movement Assessment (GMA) observer. Additionally, to assess the feasibility of using home-based video recordings for automated tracking of spontaneous movements, and to examine parents' perceptions and experiences of taking videos in their homes. Design The study was a multi-centre prospective observational study. Setting Parents/families of high-risk infants in tertiary care follow-up programmes in Norway, Denmark and Belgium. Methods Parents/families were asked to video record their baby in accordance with the In-Motion standards which were based on published GMA criteria and criteria covering lighting and stability of smartphone. Videos were evaluated as GMA 'scorable' or 'non-scorable' based on predefined criteria. The accuracy of a 7-point body tracker software was compared with manually annotated body key points. Parents were surveyed about the In-Motion-App information and clarity. Participants The sample comprised 86 parents/families of high-risk infants. Results The 86 parent/families returned 130 videos, and 121 (96%) of them were in accordance with the requirements for GMA assessment. The 7-point body tracker software detected more than 80% of body key point positions correctly. Most families found the instructions for filming their baby easy to follow, and more than 90% reported that they did not become more worried about their child's development through using the instructions. Conclusions This study reveals that a short instructional video enabled parents to video record their infant's spontaneous movements in compliance with the standards required for remote GMA. Further, an accurate automated body point software detecting infant body landmarks in smartphone videos will facilitate clinical and research use soon. Home-based video recordings could be performed without worrying parents about their child's development

Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines

BACKGROUND AND PURPOSE: The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. MATERIALS AND METHODS: An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. RESULTS: The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. CONCLUSIONS: Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS)

“A house to die in”. En performance?

Fascinasjonen over at Bjarne Melgaards skulpturhusprosjekt "A House to Die In" engasjerer et stort antall aktører i noe som mest av alt ligner en kunstperformance, selv før skulpturhuset har fått sin form, ga meg problemstillingen. Jeg ønsket derfor å tydeliggjøre hvordan performance-begrepet viser verket "A House to Die In" som kulturelt uttrykk. Aktørenes handlinger gir performancen form, mening og tyngde. Det perspektivet som performance-begrepet åpner, supplert med innsikter fra relasjonell estetikk, setter meg i stand til å følge og forstå den forhandlingsprosessen som nesten er blitt mer interessant i Melgaards prosjekt enn skulpturhuset som fysisk verk. I tråd med dramaturgien i Melgaards prosjekt har jeg delt min undersøkelse inn i akter, som får sin form og mening gjennom aktørenes handlinger. Den relasjonelle estetikken tydeliggjør aktørenes ulike former for drivkraft og interaksjoner. Reaksjonene omkring "A House to Die In" belyser også kampen om definisjonsmakten som foregår på kunstscenen og hvem som føler seg meningsberettiget. Aktørene øker omfanget av performancen bevisst og ubevisst. At Snøhetta/Selvaag og Melgaard dokumenterte absolutt alt fra hele prosjektet i noe de valgte å kalle en «Roadmap» som ble utstillt på Tjuvholmen i februar 2018, kan tyde på at de selv forventet noe «mer» av prosjektet. Denne oppgaven ender ikke i en bastant konklusjon. Jeg har valgt å skrive refleksjoner under hver akt, og avslutter med en «konkluderende refleksjon» til slutt i oppgaven. Performancen foregår fremdeles, og siste akt er fortsatt ikke skrevet

Reference material for Hammersmith Infant Neurological Examination scores based on healthy, term infants aged 3 to 7 months

Objective To provide a valid, continuous reference interval, including a 10 th percentile cut-off, for Hammersmith Infant Neurological Examination (HINE) scores based on 3-7 months old term infants with weight appropriate for gestational age. Study design In a prospective study we examined 168 Norwegian infants at one timepoint with HINE at 3-7 months of age. In 134 of these infants Ages and Stages Questionnaire was completed by their parents at two years of age to ensure typical motor development. We calculated a reference interval for HINE scores with the 10 th percentile as cut-off for age-dependent optimal scores. Results The best fitting mean model for HINE total score was 78.1358+9659.231*1/age 2 -5104.174*LN(age)/age 2 , which explained 49.8% of the variance. The HINE total score 10 th percentile cut-off corresponded to 52.1 points at age 12 weeks, 55.6 points at 16 weeks, 59.0 points at 20 weeks, 61.8 points at 24 weeks and 63.8 points at 28 weeks. We found an excellent intra-class correlation coefficient of 0.953 (0.931-0.968) between two examiners. The infants had a typical motor development at two years follow-up. Conclusion We have presented a valid, continuous reference interval and a 10 th percentile cut-off for HINE scores for infants aged 3 to 7 months

The prevalence and clinical relevance of hyperhomocysteinemia suggesting vitamin B12 deficiency in presumed healthy infants

Background Previous studies have demonstrated a high prevalence of biochemical vitamin B12 deficiency in infants in Norway. Increased total homocysteine (tHcy) is the most important marker of B12 deficiency in infants. There is a need to evaluate its clinical relevance. Aims To investigate the prevalence of hyperhomocysteinemia (S-tHcy > 8 μmol/L) suggestive of suboptimal B12 status and the prevalence of clinically relevant hyperhomocysteinemia in presumed healthy infants in Norway. Further, to evaluate risk factors, presence of symptoms and psychomotor development in these children. Methods In a prospective study we clinically examined 252 infants aged 3–7 months using standardized neurological and psychomotor tests prior to analyzing biochemical B12 deficiency markers in 250 infants. Results Twenty-five of 250 (10%) infants had hyperhomocysteinemia combined with clinically relevant symptoms suggestive of B12 deficiency. Hyperhomocysteinemia was associated with tremor, excessive sleep, and sub-normal scores in the fine motor section of the Ages and Stages Questionnaire. One-hundred and fourteen of 250 (46%) infants had hyperhomocysteinemia. Multiple regression analysis showed months of infant formula use as the strongest negative predictor for hyperhomocysteinemia. Conclusion We have demonstrated associations between symptoms suggestive of infant B12 deficiency and increased levels of tHcy in presumed healthy infants The combination of hyperhomocysteinemia and associated relevant symptoms suggestive of B12 deficiency was a common finding, albeit most infants with hyperhomocysteinemia did not show symptoms