A study on clinical and radiological features and outcome in patients with posterior reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) is characterized clinically by headaches, seizures, vomiting, nausea, visual abnormalities, and altered mental function and is often (but not invariably) accompanied by parieto-occipital imaging features. The aim of this study is to describe the clinical and radiological features and outcome following PRES in a paediatric cohort. From a retrospectively identified cohort, case records were studied to confirm a diagnosis of PRES. Neuroimaging was reviewed again to assign to recently described radiological subtypes parieto-occipital pattern, holohemispheric watershed pattern, dominant superior frontal sulcus pattern, and asymmetrical or partial expression of the three primary patterns (A/P). Patient outcome was measured by the modified Rankin scale (mRS) scores. Nine boys and three girls with mean age of 12 were identified. Hypertensive episodes (n?=?11), tacrolimus toxicity (n?=?4), and autoimmunity (n?=?1) were identified as potential risk factors/etiologies. Their median mRS at the peak of illness was 2 (range 2–5); three children required intensive care support. After mean follow-up of 35 months (median 37 months; range 3–60 months), all patients improved significantly with mean mRS of 1 (median 1; range 0–1). Conclusion: PRES is easily recognizable by the clinical and radiological features. Although severe at presentation, the outcome from this condition is favorable.     

Changes in spectral power of fetal heart rate variability in small-for-gestational-age fetuses are associated with fetal sex

Background

Little is known about the influences of fetal weight and sex on spectral analysis of fetal heart rate (FHR) variability.

Aim

The study aims to assess whether there are differences in spectral power of FHR variability according to fetal weight and sex during labor.

Study design

Case–control study. A total of 414 singleton term deliveries without fetal acidemia were divided into small-for-gestational-age (SGA) (n = 29) and non-SGA (n = 385) groups. Analyses were performed separately according to fetal sex.

Subjects

FHR recordings obtained with cardiotocography during the last 2 h of labor preceding delivery.

Outcome measures

Our outcome measures include spectral power of FHR variability.

Results

For the male group, SGA fetuses had significantly lower values for low, movement, high, and total frequencies of spectral power compared with non-SGA fetuses (all P < 0.005). Normalized low frequency (LFn) was significantly higher, and normalized high frequency (HFn) was significantly lower in SGA fetuses compared with non-SGA fetuses (all P < 0.005). In contrast, for the female group, there were no significant differences in any of the indices of spectral power between the SGA and non-SGA fetuses. In addition, SGA males had significantly higher LFn spectral power and lower HFn spectral power compared to SGA females (P = 0.016, and 0.041, respectively).

Conclusions

SGA males have decreased spectral power of FHR variability compared with non-SGA males during labor. However, there are no differences between SGA and non-SGA female fetuses. It is important in the clinical setting to take fetal weight and sex into account during FHR monitoring using spectral analysis.     

A comparison of the epidemiology of ice hockey injuries between male and female youth in Canada

BACKGROUND:

Hockey is played by youth across Canada, and its popularity has increased dramatically among females in the past decade. Despite this, there has been little epidemiological research comparing the injury patterns of young female and male hockey players.

OBJECTIVE:

To describe and compare injuries sustained by female and male youth hockey players using the Canadian Hospitals Injury Reporting and Prevention Program database.

METHODS:

In the present cross-sectional, retrospective comparison study, the Canadian Hospitals Injury Reporting and Prevention Program database was used to identify all hockey-related injuries sustained by children seven to 17.5 years of age over a 15-year period (January 1995 to December 2009). Exclusion criteria included paid professional players and children with injuries sustained while playing road hockey.

RESULTS:

Inclusion criteria were met by 33,233 children (2637 [7.9%] females and 30,596 [92.1%] males). Compared with males, females reported proportionately more soft tissue injuries (39.8% versus 32.6%; P<0.01) and sprains/strains (21.1% versus 17.6%; P<0.01). Males experienced more fractures (27.1% versus 18.2%; P<0.01) and were most often injured through body checking (42.8% versus 25.7%; P<0.01). Females showed a trend toward increased concussion with age, and were most often injured through collisions (28.6% versus 24.6%; P<0.01).

CONCLUSION:

Compared with males, female hockey players sustained proportionately more soft tissue injures and sprains/strains, and showed a trend toward concussions in late adolecence. Males experienced more fractures, shoulder injuries and injuries due to body checking. Further research is required to identify risk factors for injury in female youth hockey players and to target injury prevention.     

Device Closure of Secundum Atrial Septal Defects in Infants Weighing Less Than 8 Kg

This study aimed to assess the technical aspects of atrial septal defect (ASD) closure using the Amplatzer septal occluder (ASO) and the Gore Helex septal occluder (GHSO) for infants weighing less than 8 kg and to determine the safety, effectiveness, and near-to-intermediate-term outcome of the closure. The Mid-Atlantic Group of Interventional Cardiology Registry of percutaneous, transcatheter ASD closure procedures was reviewed for this analysis. Patients from 10 hospitals in the United States were included. The cohort for this report consisted of 68 patients weighing less than 8 kg (range, 2.3–7.8 kg; mean, 5.5 ± 1.6 kg) and ranging in age from 1 to 24 months (mean, 8.6 ± 4.7 months). The indications for ASD closure were failure to thrive, significant right heart enlargement, shunts otherwise thought to be hemodynamically significant, and poor overall clinical status. Devices were successfully implanted in 66 of the 68 infants (97.1 % procedural success rate). Five minor procedure-related complications occurred. At follow-up assessment, clinical status had improved significantly as measured by improved weight gain and decreased ventilator or oxygen dependence. All residual shunts spontaneously closed during the follow-up period. Six late deaths occurred, none of which were clearly device related. The ASO and GHSO can be safely and effectively implanted for ASD closure in infants weighing less than 8 kg. These procedures usually are successful and seldom complicated, resulting in significant clinical improvement.     

Elevated Serum Level of MicroRNA (miRNA)-200c and miRNA-371-5p in Children with Kawasaki Disease

MicroRNAs (miRNAs) are small, non-coding RNAs that regulate the expression of protein-coding genes. Recently, miRNA levels have been used as a novel non-invasive biomarker for the diagnosis of various diseases. We aimed to identify serum miRNAs elevated in patients with Kawasaki disease (KD) and to explore the potential biological function of identified candidate miRNAs. Serum specimens were collected from children with KD (n = 12) and healthy controls (n = 6). miRNA microarray assays were performed using the PANArray? miRNA expression profiling kit (PANAGENE Co., Daejeon, Korea). We used TargetScan and the database for annotation, visualization, and integrated discovery program to obtain a list of enriched biological pathways targeted by miRNAs elevated in KD patients. As a result, miR-200c and miR-371-5p were significantly upregulated in the KD group compared with the control group (p = 0.032 in both). By using TargetScan, we obtained a list of 421 and 542 genes predicted to be targeted by miR-200c and miR-371, respectively, and these genes were significantly (p < 0.05) clustered in 17 and 3 pathways, respectively. Many of them are major pathways involved in inflammatory responses. The present data support the hypothesis that the inflammatory response is a crucial mechanism for pathogenesis of KD, and miRNAs might be the main regulators of this inflammatory response.     

Predoctoral implant dentistry curriculum survey: European dental schools

PURPOSE: In 2002 a survey of European dental schools was conducted. The purpose of the survey was to determine the curricular structure, teaching philosophies and materials used in predoctoral implant dentistry courses. MATERIALS AND METHODS: Fifty-six European dental schools were randomly selected from the Association for Dental Education in Europe representing 33 countries. A questionnaire was mailed to the predoctoral implant dentistry director/chairperson of the selected European dental schools. Of these, 40 schools returned the completed survey, resulting in a response rate of 71%. The mean, median and range of responses were computed where applicable. RESULTS: The results from this survey show that 80% of the responding schools required a course in implant dentistry. Between 1997 and 1999 over a third of responding schools (36%) incorporated a predoctoral implant dentistry course into their curriculum. Eighty-seven per cent of the schools have some prosthodontists teaching the course. Thirty-seven per cent of schools are offering a laboratory course in conjunction with the implant course. Sixty-three per cent of the schools are not restoring implant cases at the predoctoral level. However, 68% of schools reported students are required to be present during implant surgery. Ten per cent of schools require that the implant-related laboratory work be completed by the students. CONCLUSIONS: Predoctoral implant dentistry educational programmes vary from school to school. Yet a large percentage of schools agree on certain topics, including the importance of including implant education in predoctoral dental programmes.     

Effects of sonicated Enterococcus faecalis extracts on interleukin-2 and interleukin-4 production by human T cells

In the present authors' previous study, sonicated Enterococcus faecalis extracts were shown to suppress the cell cycle progression of human lymphocytes. To study the effect of this microorganism on the function of lymphocytes, the authors investigated the levels of interleukin-2 (IL-2) and interleukin-4 (IL-4) production by T lymphocytes before and after the addition of sonicated E. faecalis extracts. In this study, levels of IL-2 and IL-4 produced from T cells were evaluated by using the quantitative sandwich enzyme immunoassay technique. In response to phytohemagglutinin (PHA) stimulation, T cells produced increased levels of IL-2 and IL-4. However, the expressions of both cytokines were significantly inhibited when PHA-activated T cells were preexposed to 12.5 microg/ml and 25 microg/ml of sonicated E. faecalis extracts (p < 0.05). This effect was concentration-dependent, because the levels of IL-2 and IL-4 expressions were not affected by the addition of a low concentration (5 microg/ml) of sonicated extract. These findings suggest that Th1 and Th2 immunosuppression mediated by E. faecalis could be a part of the pathogenic mechanism of the endodontic failure associated with this microorganism.     

The influence of finishing time on the marginal seal of a resin-modified glass-ionomer and polyacid-modified resin composite

The aim of this study was to compare the effect of immediate and delayed finishing on the microleakage of encapsulated resin-modified glass-ionomer, Fuji II LC and a polyacid-modified resin composite, Dyract compomer at both the enamel and dentine margins. Standardized Class V cavities were prepared along the cemento-enamel junction on buccal and palatal surfaces of 24 freshly extracted non-carious premolars. Equal numbers of buccal and palatal cavities in each group were restored with Fuji II LC and Dyract compomer following the manufacturer's instructions. The groups with delayed finishing were restored 1 week earlier, stored in saline at 37 degrees C and finished on the same day as the groups with immediate finishing. The specimens were then thermocycled 500 times and subjected to dye penetration testing. The results showed that both materials leaked more at the dentine than enamel margins for both regimes of finishing methods. There was no statistical difference in the microleakage of Dyract finished immediately or later at enamel and dentine margins and Fuji II LC finished immediately or later in dentine. However, a statistical difference existed between the microleakage in Fuji II LC finished immediately and later in enamel.