The use of minimally invasive techniques in multi-level surgery for children with cerebral palsy

This study compares the initial outcomes of minimally invasive techniques for single-event multi-level surgery with conventional single-event multi-level surgery. The minimally invasive techniques included derotation osteotomies using closed corticotomy and fixation with titanium elastic nails and percutaneous lengthening of muscles where possible. A prospective cohort study of two matched groups was undertaken. Ten children with diplegic cerebral palsy with a mean age of ten years six months (7.11 to 13.9) had multi-level minimally invasive surgery and were matched for ambulatory level and compared with ten children with a mean age of 11 years four months (7.9 to 14.4) who had conventional single-event multi-level surgery. Gait kinematics, the Gillette Gait Index, isometric muscle strength and gross motor function were assessed before and 12 months after operation.

The minimally invasive group had significantly reduced operation time and blood loss with a significantly improved time to mobilisation. There were no complications intra-operatively or during hospitalisation in either group. There was significant improvement in gait kinematics and the Gillette Gait Index in both groups with no difference between them. There was a trend to improved muscle strength in the multi-level group. There was no significant difference in gross motor function between the groups.

We consider that minimally invasive single-event multi-level surgery can be achieved safely and effectively with significant advantages over conventional techniques in children with diplegic cerebral palsy.

Molecular markers show a complex mosaic pattern of wheat-Thinopyrum intermedium translocations carrying resistance to YDV

Thinopyrum intermedium translocations derived from the wheat (Triticum aestivum L.) substitution line P-29 were previously characterized by RFLP. We have further analyzed these lines and additional related germplasm with publicly available STS and SSRs. Primers which showed a polymorphism between wheat and P-29, were tested in all recombinant and nulli-tetrasomic lines confirming their position on chromosome 7D. The resulting 7D/7E chromosome maps appeared as a mosaic of wheat and Th. intermedium chromatin sections. To verify the composition of the translocation lines suggested by the RFLP-PCR map, F(2) progeny of two crosses (CS/216-1 and CS/260-1) were analyzed with molecular markers. Both populations gave an unexpectedly diverse number of recombinant individuals, suggesting that interstitial translocations occur more frequently than previously thought. This analysis also showed that there is a wide range in the number and position of the interstitial translocations within a given line such as the mosaic chromosome in recombinant line 260-1/CS-26, which has four Th. intermedium chromosome segments. Phenotypic data of the two populations suggested the presence of one gene which we have called Bdv3 to differentiate it from the previously reported orthologous gene Bdv2. Using the PCR-based molecular markers identified in this study, 5 out of 12 elite lines that showed good yields and no YDV symptoms contained Th. intermedium chromatin. Due to the multiple components involved in the YDV disease complex, combining selection for YDV resistance with the molecular markers and maps identified in this study will increase the efficiency of introgressing Th. intermedium chromatin containing YDV resistance or other beneficial traits into elite wheat germplasm.

Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school

BACKGROUND

In April 2009, an outbreak of novel swine-origin influenza A (2009 H1N1 influenza) occurred at a high school in Queens, New York. We describe the outbreak and characterize the clinical and epidemiologic aspects of this novel virus.

METHODS

The New York City Department of Health and Mental Hygiene characterized the outbreak through laboratory confirmation of the presence of the 2009 H1N1 virus in nasopharyngeal and oropharyngeal specimens and through information obtained from an online survey. Detailed information on exposure and the onset of symptoms was used to estimate the incubation period, generation time, and within-school reproductive number associated with 2009 H1N1 influenza, with the use of established techniques.

RESULTS

From April 24 through May 8, infection with the 2009 H1N1 virus was confirmed in 124 high-school students and employees. In responses to the online questionnaire, more than 800 students and employees (35% of student respondents and 10% of employee respondents) reported having an influenza-like illness during this period. No persons with confirmed 2009 H1N1 influenza or with influenza-like illness had severe symptoms. A linkage with travel to Mexico was identified. The estimated median incubation period for confirmed 2009 H1N1 influenza was 1.4 days (95% confidence interval [CI], 1.0 to 1.8), with symptoms developing in 95% of cases by 2.2 days (95% CI, 1.7 to 2.6). The estimated median generation time was 2.7 days (95% CI, 2.0 to 3.5). We estimate that the within-school reproductive number was 3.3.

CONCLUSIONS

The findings from this investigation suggest that 2009 H1N1 influenza in the high school was widespread but did not cause severe illness. The reasons for the rapid and extensive spread of influenza-like illnesses are unknown. The natural history and transmission of the 2009 H1N1 influenza virus appear to be similar to those of previously observed circulating pandemic and interpandemic influenza viruses.

Is the gonadotropin releasing hormone system vulnerable to endocrine disruption in birds?

Endocrine disrupting chemicals (EDCs) from a variety of sources occur widely in the environment, but relationships between exposure to EDCs and long term effects on bird populations can be difficult to prove. Embryonic exposure to EDCs may be particularly detrimental, with potential long-term effects on reproduction and ultimately individual fitness. Because many EDCs may have subtle sublethal effects, it is necessary to establish sensitive end points as biomarkers of EDC exposure in birds. Because the effects of EDCs may be both short- and long-term, it is important to determine if embryonic exposure impacts sexual differentiation and development of the reproductive axis in hatchlings and if there are effects on reproductive function in adults. Our studies have focused on the effects of estrogen- and androgen-active EDCs on the hypothalamic gonadotropin releasing hormone-I (GnRH-I) system in an avian model of precocial species, the Japanese quail. Estrogen- or androgen-active EDCs were administered between 0 and embryonic day 4, and hypothalamic GnRH-I was measured in hatchlings and adults. Treatment with vinclozolin and PCB126 depressed the concentration of embryonic GnRH-I peptide while methoxyclor had an inconsistent stimulatory effect. Treatment with atrazine or trenbolone had no significant effects on hypothalamic GnRH-I in adults. Overall these observations support the view that the developing avian GnRH-I neural system may be vulnerable to EDCs with potential to alter lifelong reproductive function.

A discussion of the British Society of Gastroenterology survey of emergency gastroenterology workload

An electronic survey of 188 acute NHS hospitals was carried out to assess the provision of out-of-hours services for gastrointestinal emergencies in England. The response rate was 167/188 (89%) for the main questionnaire and 157/188 (84%) for a supplementary questionnaire. The survey revealed that the majority of gastroenterologists (135/157, 86%) participate in acute general medicine. A rota for out-of-hours endoscopy was in place in only 82/167 (49%) of hospitals. Trained nurse endoscopy assistance was available in 51/82 (62%) of those hospitals with a formal rota. Two thirds of gastroenterologists were telephoned up to five times each month for advice when not on call; 64% felt their emergency endoscopy service provision was unsatisfactory and 38% thought it was unsafe. This paper concludes that there is serious under provision of services for patients presenting with gastrointestinal emergencies in England.

Investigation of proton-proton short-range correlations via the 12C(e,e'pp) reaction

We investigated simultaneously the 12C(e,e'p) and 12C(e,e'pp) reactions at Q2=2 (GeV/c)2, xB=1.2, and in an (e, e'p) missing-momentum range from 300 to 600 MeV/c. At these kinematics, with a missing momentum greater than the Fermi momentum of nucleons in a nucleus and far from the delta excitation, short-range nucleon-nucleon correlations are predicted to dominate the reaction. For (9.5+/-2)% of the 12C(e,e'p) events, a recoiling partner proton was observed back-to-back to the 12C(e,e'p) missing-momentum vector, an experimental signature of correlations.

Reproductive aging in Japanese quail, Coturnix japonica is associated with changes in central opioid receptors

Quantitative in vitro autoradiography was used to measure specific mu and delta opioid receptor densities in regions of the Japanese quail, Coturnix japonica, brain that regulates reproductive endocrine and behavioral responses to determine the possible involvement of the opioid system in reproductive decline seen during aging. Densities were measured in selected brain regions of young sexually active (YAM), young photoregressed (YPM), old reproductively senescent (OIM) male, young active (YF), and old senescent female (OF) Japanese quail. Medial and lateral septum (SM, SL), medial preoptic area (POM), and n. intercollicularis (ICo) were of particular interest for reproductive responses. Similar to previous observations, mu and delta opioid receptors showed differential distributions in the areas measured. Some age-related changes were observed, with lower SM mu receptor densities in aged males (OIM) than females or young males (YAM). Densities of mu receptors in the POM and in other areas examined did not vary with sex or age. Similarly, OIM males had lower densities of delta receptors in the SM than young males (YAM and YPM); POM delta receptor densities were also low in OIM males compared to the YPM males, and YAM males were intermediate. Interestingly, photoregressed males (YPM) had higher SL delta receptor densities than any other group. Thus there were age-related differences detected in mu receptor densities among groups in the SM of OIM relative to other groups; and the mu and delta receptor densities did not differ in females with brain region. Additionally for delta receptors specifically, YF and OF did not differ from OIM for any brain region and similarly had lower densities of delta receptors compared to YAM males. These data provide support for regional differences in opioid receptor distribution and for age- and sex-related differences in delta opioid receptor densities. The direction of change presents an interesting dichotomy in that, compared to young active males, delta opioid receptor densities increased with loss of reproductive function in the YPM, whereas receptor densities decreased in the OIM. Plasma androgen levels were relatively low in both these groups compared to the young active males. This observation suggests that there is an age-related loss in the ability of this receptor system to respond to circulating and centrally produced steroid hormones in the POM and in some septal regions, compared to young animals that are responding to environmental cues. Furthermore, these data support an active role of the opioid peptide system in the inhibition of the reproductive axis in photoregression.

Repeatability of a model for measuring multi-segment foot kinematics in children

This study used a previously tested foot model and adapted it for use with children. A number of variations on this adapted model were implemented and tested for repeatability and accuracy on 15 healthy children on three occasions. These included redefinition of the long axes of the tibia and forefoot, assessment of the flexibility of the forefoot and evaluation of the variability of the wand marker on the heel for both static and dynamic trials. It was found that variations on the model produced only minimal changes in repeatability, the only significant change being elimination of the wand marker on the heel in the static trial, which reduced between-day variability of hindfoot motion in the transverse plane. However, some differences were evident in the mean values for all variations. Based on these results, the most accurate and appropriate version of the model is proposed, and average kinematic curves are presented based on the measurements from 14 healthy children.

Hydrogen peroxide as an irrigation solution in arthroplasty – A potential contributing factor to the development of aseptic loosening

The reason for revision of primary total hip arthroplasty is quoted as aseptic loosening in 60.6% of cases between 1979 and 2003 in the Swedish National Hip Arthroplasty Registry. Much research effort has been directed toward enhancing the bone-cement interface of total joint arthroplasties, in an attempt to reduce this complication. Haemostatic agents have been popularized as effective means of retarding the development of potentially harmful debris interposition adjacent to, and blood lamination patterns within, the methylmethacrylate. Such agents include hydrogen peroxide (H(2)O(2)), local freezing saline, saline at room temperature and adrenaline solution. One main concern with the use of hydrogen peroxide is whether it affects the material properties of bone cement such that in the long term it contributes to aseptic loosening. This would have enormous clinical consequences. Preliminary studies indicate that porosity increases and that the tensile strength and yield stresses are reduced by up to a factor of 10 by contaminating samples with increasing concentrations of hydrogen peroxide. We postulate that the current use of hydrogen peroxide as an irrigation solution in arthroplasty contributes to the development of aseptic loosening.

Assessment of sub-division of plantar pressure measurement in children

Methods for the measurement of plantar pressure are poorly defined particularly when describing sub-sections of the plantar surface of the foot in the presence of deformity. The aim of this study was to assess foot pressure measurement in healthy children, using an automatic technique of sub-area definition that has the potential for objective evaluation of treatment of foot deformity. Twelve healthy children were examined on three occasions. Plantar pressure data were collected and time synchronised with force plate and stereophotogrammetric data. The footprint was divided into five sub-sections by using the position of the markers on the foot at mid-stance projected onto the pressure footprint. Repeatability for peak pressure and peak force was assessed. Automatic sub-area definition based on marker placement was found to be reliable in healthy children. A comparison of results revealed that peak vertical force was a more consistent measure than peak pressure for each of the five sub-areas. This suggests that force may be a more appropriate measurement for outcome studies.

Consequences of endocrine disrupting chemicals on reproductive endocrine function in birds: establishing reliable end points of exposure

It has been difficult to establish reliable indices of exposure to endocrine disrupting chemicals (EDCs) appropriate for a variety of avian species because of a vast array of reproductive strategies. Data from mammals, reptiles and fish provide insight on likely mechanisms of action for EDCs. However, many of the effects of EDCs are weaker than the actions of the native hormones, making it difficult to assess adverse effects in domestic and wild birds. It is clear that differential sensitivity to EDCs exists across species, due to the timing and mode of exposure, compound toxicity and age of the individual. Our studies on EDCs are conducted in the quail model system, with focus on reproductive endocrine, neuroendocrine and behavioral responses. Studies have included EDC exposure, either by egg injection or via diet. Results from egg injection studies showed the following: (1) estradiol administered by embryonic day 12 demasculinized male sexual behavior, altered hypothalamic neurotransmitters and reduced hen day production and fertility in a dose dependent fashion, (2) methoxychlor (MXC) or vinclozolin impaired male sexual behavior in adult quail and (3) DDE exposure impaired reproductive and immune related end points. Two-generation studies were conducted on Japanese and northern bobwhite quail with dietary methoxychlor (MXC) exposure (0, 5 and 10 ppm) beginning in adults (P1), continuing in their offspring (F1), with F2 offspring raised on control diet. MXC exposure impaired male sexual behavior, hypothalamic catecholamines and plasma steroid hormones. Moreover, MXC exposure had reproductive consequences observable at both the lower and higher doses of MXC in F1 and F2 generations. These data demonstrate that embryonic EDC exposure interferes with sexual differentiation of neural systems that direct reproduction.