Functional outcome of patients with spinal cord injury: rehabilitation outcome study

Objective: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals.Design: Descriptive analysis of data gathered in an information system.Setting: Rehabilitation centre in The Netherlands with special department for patients with spinal cord injuries.Subjects: Fifty-five patients with traumatic spinal cord lesions admitted to the rehabilitation centre from 1988 to 1994. Main outcome measures: The functional improvement was presented in terms of progress in independence in nine daily activity skills. Independence was rated on a four-point scale.Results: From admission to discharge, lesions in 100% of patients with tetraplegia and 96% of patients with paraplegia remained complete. Significant progress in independence was made in self-care, ambulation and bladder and bowel care. Differences were found in the extent of functional improvement between subgroups of patients with different levels and extent of lesion. Contrary to expectations based on theoretical models, patients with complete paraplegia did not achieve maximal independence in self-care. Independent walking was only attained by patients with incomplete lesions. Regarding outcome of bladder and bowel care, poor results were found, especially the independence in defaecation and toilet transfers.Conclusions: The results of this study provided more insight into the functional outcome of a group of patients with traumatic spinal cord injury. More research is needed to evaluate the rehabilitation programmes for these patients

The life and miracles of kinetochores

Kinetochores are large protein assemblies built on chromosomal loci named centromeres. The main functions of kinetochores can be grouped under four modules. The first module, in the inner kinetochore, contributes a sturdy interface with centromeric chromatin. The second module, the outer kinetochore, contributes a microtubule-binding interface. The third module, the spindle assembly checkpoint, is a feedback control mechanism that monitors the state of kinetochore–microtubule attachment to control the progression of the cell cycle. The fourth module discerns correct from improper attachments, preventing the stabilization of the latter and allowing the selective stabilization of the former. In this review, we discuss how the molecular organization of the four modules allows a dynamic integration of kinetochore–microtubule attachment with the prevention of chromosome segregation errors and cell-cycle progression

A close halo of large transparent grains around extreme red giant stars

Intermediate-mass stars end their lives by ejecting the bulk of their envelope via a slow dense wind back into the interstellar medium, to form the next generation of stars and planets. Stellar pulsations are thought to elevate gas to an altitude cool enough for the condensation of dust, which is then accelerated by radiation pressure from starlight, entraining the gas and driving the wind. However accounting for the mass loss has been a problem due to the difficulty in observing tenuous gas and dust tens of milliarcseconds from the star, and there is accordingly no consensus on the way sufficient momentum is transferred from the starlight to the outflow. Here, we present spatially-resolved, multi-wavelength observations of circumstellar dust shells of three stars on the asymptotic giant branch of the HR diagram. When imaged in scattered light, dust shells were found at remarkably small radii (<~ 2 stellar radii) and with unexpectedly large grains (~300 nm radius). This proximity to the photosphere argues for dust species that are transparent to starlight and therefore resistant to sublimation by the intense radiation field. While transparency usually implies insufficient radiative pressure to drive a wind, the radiation field can accelerate these large grains via photon scattering rather than absorption - a plausible mass-loss mechanism for lower-amplitude pulsating stars.Comment: 13 pages, 1 table, 6 figure

'Mutations in LAMB2 associate with albuminuria and Optic Nerve Hypoplasia with Hypopituitarism'

CONTEXT: Mutations in LAMB2, encoding the basement membrane protein, laminin β2, are associated with an autosomal recessive disorder characterized by congenital nephrotic syndrome, ocular abnormalities and neurodevelopmental delay (Pierson Syndrome). CASE DESCRIPTION: This report describes a twelve year old boy with short stature, visual impairment and developmental delay who presented with macroscopic haematuria and albuminuria. He had isolated growth hormone deficiency, optic nerve hypoplasia and a small anterior pituitary with corpus callosum dysgenesis on his cranial MRI, thereby supporting a diagnosis of optic nerve hypoplasia syndrome. Renal histopathology revealed focal segmental glomerulosclerosis. Using next generation sequencing on a targeted gene panel for steroid resistant nephrotic syndrome, compound heterozygous missense mutations were identified in LAMB2 [c.737G>A p.Arg246Gln, c.3982G>C p.Gly1328Arg]. Immunohistochemical analysis revealed reduced glomerular laminin β2 expression compared to control kidney and a thin basement membrane on electron microscopy. Laminin β2 is expressed during pituitary development and Lamb2-/- mice exhibit stunted growth, abnormal neural retinae and here, we show, abnormal parenchyma of the anterior pituitary gland. CONCLUSION: We propose that patients with genetically undefined optic nerve hypoplasia syndrome should be screened for albuminuria and if present, screened for mutations in LAMB2

A Plasmodium Whole-Genome Synteny Map: Indels and Synteny Breakpoints as Foci for Species-Specific Genes

Whole-genome comparisons are highly informative regarding genome evolution and can reveal the conservation of genome organization and gene content, gene regulatory elements, and presence of species-specific genes. Initial comparative genome analyses of the human malaria parasite Plasmodium falciparum and rodent malaria parasites (RMPs) revealed a core set of 4,500 Plasmodium orthologs located in the highly syntenic central regions of the chromosomes that sharply defined the boundaries of the variable subtelomeric regions. We used composite RMP contigs, based on partial DNA sequences of three RMPs, to generate a whole-genome synteny map of P. falciparum and the RMPs. The core regions of the 14 chromosomes of P. falciparum and the RMPs are organized in 36 synteny blocks, representing groups of genes that have been stably inherited since these malaria species diverged, but whose relative organization has altered as a result of a predicted minimum of 15 recombination events. P. falciparum-specific genes and gene families are found in the variable subtelomeric regions (575 genes), at synteny breakpoints (42 genes), and as intrasyntenic indels (126 genes). Of the 168 non-subtelomeric P. falciparum genes, including two newly discovered gene families, 68% are predicted to be exported to the surface of the blood stage parasite or infected erythrocyte. Chromosomal rearrangements are implicated in the generation and dispersal of P. falciparum-specific gene families, including one encoding receptor-associated protein kinases. The data show that both synteny breakpoints and intrasyntenic indels can be foci for species-specific genes with a predicted role in host-parasite interactions and suggest that, besides rearrangements in the subtelomeric regions, chromosomal rearrangements may also be involved in the generation of species-specific gene families. A majority of these genes are expressed in blood stages, suggesting that the vertebrate host exerts a greater selective pressure than the mosquito vector, resulting in the acquisition of diversity

Developing an award program for children's settings to support healthy eating and physical activity and reduce the risk of overweight and obesity

<p>Abstract</p> <p>Background</p> <p>This paper aimed to identify the best way to engage, motivate and support early childhood services (ECS) and primary schools (PS) to create policy and practise changes to promote healthy eating and physical activity. This information would be used to develop a suitable program to implement within these children's settings to reduce the risk of childhood overweight and obesity.</p> <p>Methods</p> <p>The Medical Research Council's (UK) framework for the design and evaluation of complex interventions was used to guide the development of the healthy eating and physical activity program suitable for ECS and PS. Within this framework a range of evaluation methods, including stakeholder planning, in-depth interviews with ECS and PS staff and acceptability and feasibility trials in one local government area, were used to ascertain the best way to engage and support positive changes in these children's settings.</p> <p>Results</p> <p>Both ECS and PS identified that they had a role to play to improve children's healthy eating and physical activity. ECS identified their role in promoting healthy eating and physical activity as important for children's health, and instilling healthy habits for life. PS felt that these were health issues, rather than educational issues; however, schools saw the link between healthy eating and physical activity and student learning outcomes. These settings identified that a program that provides a simple guide that recognises good practise in these settings, such as an award scheme using a health promoting schools approach, as a feasible and acceptable way for them to support children's healthy eating and physical activity.</p> <p>Conclusion</p> <p>Through the process of design and evaluation a program - <it>Kids - 'Go for your life'</it>, was developed to promote and support children's healthy eating and physical activity and reduce the risk of childhood overweight and obesity. <it>Kids - 'Go for your life' </it>used an award program, based on a health promoting schools approach, which was demonstrated to be a suitable model to engage ECS and PS and was acceptable and feasible to create policy and practise changes to support healthy eating and physical activity for children.</p

A firearm bullet lodged into the thoracic spinal canal without vertebral bone destruction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Firearm injuries account for 13% to 17% of all spinal cord injuries, and are generally caused during warfare or assault with intent to kill. Spinal cord injuries caused by firearms are usually observed in patients aged 15 to 34 years old, and are especially common among men.</p> <p>Case presentation</p> <p>We report the case of a 28-year-old Iraqi man who was referred to our radiology department with lower limb paraplegia secondary to a gunshot wound. We performed 64-slice computerized tomography with two-dimensional and three-dimensional reconstruction of the thoracolumbar spine. On the two-dimensional and three-dimensional reconstructed axial images of the thoracolumbar spine, an intra-canalicular bullet nucleus was found at the mid-spinal cord at the T8 level, with no evidence of vertebral bone destruction.</p> <p>Conclusions</p> <p>To the best of our knowledge, there is only one previous report in the literature describing a case of a bullet nucleus lodged into the inferior epidural spinal canal without destruction of the vertebral bone. With the rise of violence worldwide the incidence of gunshot injuries continues to increase, and, thus, it is essential for radiologists to have a clear understanding of gunshot injuries and the findings on radiographic images.</p

Haptoglobin Phenotype, Preeclampsia Risk and the Efficacy of Vitamin C and E Supplementation to Prevent Preeclampsia in a Racially Diverse Population

Haptoglobin's (Hp) antioxidant and pro-angiogenic properties differ between the 1-1, 2-1, and 2-2 phenotypes. Hp phenotype affects cardiovascular disease risk and treatment response to antioxidant vitamins in some non-pregnant populations. We previously demonstrated that preeclampsia risk was doubled in white Hp 2-1 women, compared to Hp 1-1 women. Our objectives were to determine whether we could reproduce this finding in a larger cohort, and to determine whether Hp phenotype influences lack of efficacy of antioxidant vitamins in preventing preeclampsia and serious complications of pregnancy-associated hypertension (PAH). This is a secondary analysis of a randomized controlled trial in which 10,154 low-risk women received daily vitamin C and E, or placebo, from 9-16 weeks gestation until delivery. Hp phenotype was determined in the study prediction cohort (n = 2,393) and a case-control cohort (703 cases, 1,406 controls). The primary outcome was severe PAH, or mild or severe PAH with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclampsia, fetal growth restriction, medically indicated preterm birth or perinatal death. Preeclampsia was a secondary outcome. Odds ratios were estimated by logistic regression. Sampling weights were used to reduce bias from an overrepresentation of women with preeclampsia or the primary outcome. There was no relationship between Hp phenotype and the primary outcome or preeclampsia in Hispanic, white/other or black women. Vitamin supplementation did not reduce the risk of the primary outcome or preeclampsia in women of any phenotype. Supplementation increased preeclampsia risk (odds ratio 3.30; 95% confidence interval 1.61-6.82, p<0.01) in Hispanic Hp 2-2 women. Hp phenotype does not influence preeclampsia risk, or identify a subset of women who may benefit from vitamin C and E supplementation to prevent preeclampsia

On the physical structure of IRC+10216 Ground-based and Herschel observations of CO and C2H

Context. The carbon-rich asymptotic giant branch star IRC +10 216 undergoes strong mass loss, and quasi-periodic enhancements of the density of the circumstellar matter have previously been reported. The star’s circumstellar environment is a well-studied and complex astrochemical laboratory, in which many molecular species have been proved to be present. CO is ubiquitous in the circumstellar envelope, while emission from the ethynyl (C2H) radical is detected in a spatially confined shell around IRC +10 216. We recently detected unexpectedly strong emission from the N = 4−3,   6−5,   7−6,   8−7, and 9−8 transitions of C2H with the IRAM 30 m telescope and with Herschel/HIFI, which challenges the available chemical and physical models. Aims. We aim to constrain the physical properties of the circumstellar envelope of IRC +10 216, including the effect of episodic mass loss on the observed emission lines. In particular, we aim to determine the excitation region and conditions of C2H to explain the recent detections and to reconcile them with interferometric maps of the N = 1−0 transition of C2H. Methods. Using radiative-transfer modelling, we provide a physical description of the circumstellar envelope of IRC +10 216, constrained by the spectral-energy distribution and a sample of 20 high-resolution and 29 low-resolution CO lines – to date, the largest modelled range of CO lines towards an evolved star. We furthermore present the most detailed radiative-transfer analysis of C2H that has been done so far. Results. Assuming a distance of 150 pc to IRC +10 216, the spectral-energy distribution was modelled with a stellar luminosity of 11300 L⊙ and a dust-mass-loss rate of 4.0 × 10-8   M⊙ yr-1. Based on the analysis of the 20 high-frequency-resolution CO observations, an average gas-mass-loss rate for the last 1000 years of 1.5 × 10-5 M⊙ yr-1 was derived. This results in a gas-to-dust-mass ratio of 375, typical for this type of star. The kinetic temperature throughout the circumstellar envelope is characterised by three power laws: Tkin(r) ∝ r-0.58 for radii r ≤ 9 stellar radii, Tkin(r) ∝ r-0.40 for radii 9 ≤ r ≤ 65 stellar radii, and Tkin(r) ∝ r-1.20 for radii r ≥ 65 stellar radii. This model successfully describes all 49 observed CO lines. We also show the effect of density enhancements in the wind of IRC +10 216 on the C2H-abundance profile, and the close agreement we find of the model predictions with interferometric maps of the C2H N = 1−0 transition and with the rotational lines observed with the IRAM 30 m telescope and Herschel/HIFI. We report on the importance of radiative pumping to the vibrationally excited levels of C2H and the significant effect this pumping mechanism has on the excitation of all levels of the C2H-molecule