Changes in lower limb rotation after soft tissue surgery in spastic diplegia: 3-dimensional gait analysis in 28 children

Background and purpose Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to correct deformities in the sagittal plane, would also have an effect on rotational parameters

The rise of naval powes in Asia and Europe's decline

For the first time in modern history Asian states are spending more on defence than their European counterparts. The sea power ambitions of leading land powers such as China, Russia and India stand as a challenge to US naval supremacy in the region. The old European great powers are becoming marginalised in an increasingly Asia-centred world. The edited volume The Rise of Naval Powers in Asia and Europe’s Decline examines this new geopolitical landscape of the 21st century, emphasising the role of the great powers and the importance of sea power in shaping international politics

Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait

PURPOSE: The purpose was to assess the local and distant effects of isolated calf muscle lengthening in ambulant children with cerebral palsy. METHODS: The study included fifteen ambulant children with cerebral palsy (nine with diplegia and six with hemiplegia), average age 8.8 years, Gross Motor Function Classification System (GMFCS) level I and II. None of the children had previously undergone orthopaedic surgery, apart from one child who had tendo-achilles lengthening (TAL) nine years earlier. All the children underwent pre and post-operative clinical examination and three-dimensional gait analysis (gait analysis). Twenty calf muscle lengthenings were performed, ten TAL and ten gastrocnemius recessions (GR). RESULTS: Post-operative ankle kinematics showed significant improvements in all parameters. Ankle power during push-off increased, but only significantly after TAL. Only one limb (5%) was over-corrected. Four limbs (20%) were under-corrected and one of these limbs remained in mild equinus position in stance. There was one recurrent equinus (5%) during the follow-up period of three years (range: 13-55 months). Distant effects on joints and segments were more marked in diplegia than in hemiplegia. Ten of 17 kinematic parameters distant from the ankle joint improved significant post-operatively when the preoperative values were 1SD below or above the mean of the normal material. There was no significant deterioration in any of the measured parameters. CONCLUSION: The improvement in ankle kinematics and kinetics supported the experience of other studies. The distant effects, which have previously not been evaluated in three planes, showed improvement in several kinematic parameters indicating that additional surgery in selected patients could be abandoned or delayed

Gait improvement surgery in ambulatory children with diplegic cerebral palsy

<div><p><b>Background and purpose —</b> Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery.</p><p><b>Patients and methods —</b> 34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6–19) years. On average, 5.7 (1–11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction.</p><p><b>Results —</b> The mean GPS improved from 20.7° (95% CI: 19–23) preoperatively to 15.4° (95% CI: 14–17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2–10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age.</p><p><b>Interpretation —</b> The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.</p></div

Performance and welfare of Atlantic salmon, Salmo salar L. post-smolts in recirculating aquaculture systems: Importance of salinity and water velocity

Producing a larger post‐smolt in recirculating aquaculture systems (RAS) could shorten the production time in sea cages and potentially reduce mortality. Knowledge of the biological requirements of post‐smolts in closed‐containment systems is however lacking. In the present study, the effects of salinity and water velocity on growth, survival, health, and welfare of Atlantic salmon reared in RAS were examined. Salmon smolts were stocked in three separate RAS with salinities of 12, 22, and 32‰ and subjected to high (1.0 body lengths per s−1) or low (0.3 body lengths second−1) water velocity. Growth performance, survival, welfare, and physiological stress responses were monitored until the fish reached a bodyweight of around 450 g. Growth rate was higher at lower salinity and higher water velocity generally had a positive effect on growth in all salinities. Feed conversion ratio was lower at 12‰ compared to the 22 and 32‰ when the fish were between 250 and 450 g. Higher mortality, elevated plasma cortisol levels, higher incidence of cataract, and a higher expression of stress‐induced genes in the skin (iNOS, Muc5ac‐like) indicated a negative effect of higher salinity on fish welfare. Male maturation was low (<1%), and not affected by salinity or water velocity

Performance and welfare of Atlantic salmon, Salmo salar L. post-smolts in recirculating aquaculture systems: Importance of salinity and water velocity

Producing a larger post‐smolt in recirculating aquaculture systems (RAS) could shorten the production time in sea cages and potentially reduce mortality. Knowledge of the biological requirements of post‐smolts in closed‐containment systems is however lacking. In the present study, the effects of salinity and water velocity on growth, survival, health, and welfare of Atlantic salmon reared in RAS were examined. Salmon smolts were stocked in three separate RAS with salinities of 12, 22, and 32‰ and subjected to high (1.0 body lengths per s−1) or low (0.3 body lengths second−1) water velocity. Growth performance, survival, welfare, and physiological stress responses were monitored until the fish reached a bodyweight of around 450 g. Growth rate was higher at lower salinity and higher water velocity generally had a positive effect on growth in all salinities. Feed conversion ratio was lower at 12‰ compared to the 22 and 32‰ when the fish were between 250 and 450 g. Higher mortality, elevated plasma cortisol levels, higher incidence of cataract, and a higher expression of stress‐induced genes in the skin (iNOS, Muc5ac‐like) indicated a negative effect of higher salinity on fish welfare. Male maturation was low (<1%), and not affected by salinity or water velocity