Increased morbidity and mortality in very preterm/VLBW infants with congenital heart disease

Purpose

To study the association between congenital heart diseases (CHD) and in-hospital mortality and morbidity of very preterm/very low birth weight (VLBW) infants.

Methods

The area-based prospective cohort study ACTION included all infants with gestational age (GA) 22–31 weeks or birth weight <1,500 g admitted to neonatal care between July 2003 and June 2005 in six Italian regions (n = 3,684). CHD were coded according to ICD9-CM. Cluster multivariable logistic regression analyses were used to assess the relationship between CHD and mortality and selected morbidities [neonatal infection, ultrasound brain abnormalities, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD)] adjusting for potential confounders.

Results

Seventy-one patients had CHD [19.3 ‰, 95 % confidence interval (CI) 15.1–24.2 ‰]. The most common lesions were isolated atrial and ventricular septal defects (31.1 and 26.8 %, respectively), pulmonary valvar stenosis (12.7 %), and tetralogy of Fallot (5.6 %). Compared with other infants, CHD patients showed significantly higher GA and frequency of small for gestational age (SGA, i.e., birth weight ≤3rd centile). After adjustment for GA, sex, SGA, presence of extracardiac malformations or chromosomal anomalies, and region of birth, CHD patients had a significantly higher likelihood of infection, BPD, ROP, and, after 27 weeks gestation only, hospital mortality. The increased risk of ROP appeared to be partly due to infection.

Conclusions

In very preterm/VLBW infants CHD are more prevalent than in the general liveborn population, and confer an increased risk of death and serious morbidities independently of other risk factors. These results may be useful to better tailor prognostic assessment and diagnostic and therapeutic interventions for these children.     

Fully Automated Radiosynthesis of 2-[18F]Fludarabine for PET Imaging of Low-Grade Lymphoma

Purpose

An efficient and fully automated radiosynthesis of 2-[¹⁸F]fluoro-9-β-d-arabinofuranosyl-adenine (2-[¹⁸F]fludarabine, [¹⁸F]-5) based on a GE TRACERlab? FX-FN module has been developed.

Procedures

A 2-nitro purine derivative 3 was developed as precursor for labeling with fluorine-18. The radiosynthesis of [¹⁸F]-5 was performed in two steps in a single reactor with an intermediary purification on Sep-Pak® silica which involved the addition of a three-way valve on the original module. After hydrolysis, [¹⁸F]-5 was purified by semi-preparative high-pressure liquid chromatography (HPLC) and a quality control was established.

Results

The labeling precursor 3 was obtained in 45 % overall yield. Nucleophilic substitution with K¹⁸F/K_2.2.2 afforded protected 2-[¹⁸F]fludarabine ([¹⁸F]-4) in 73?±?4 % , radiochemical yield (decay corrected to the end of bombardment (EOB)) and based on the initial [¹⁸F]F^? activity. An aqueous ammonia/methanol solution was used for the deprotection reaction and gave the desired [¹⁸F]-5 in 67?±?3 % yield after 20 min at 70 °C based on HPLC profile.

Conclusions

The process afforded pure 2-[¹⁸F]fludarabine in 48?±?3 % yield (decay corrected to the EOB) in 85 min, with a specific activity of 310?±?72 GBq/μmol at the end of synthesis (EOS) and a radiochemical purity up to 99 %.     

TEG® and RapidTEG® are unreliable for detecting warfarin-coagulopathy: a prospective cohort study

Background

Thromboelastography^® (TEG) utilizes kaolin, an intrinsic pathway activator, to assess clotting function. Recent published studies suggest that TEG results are commonly normal in patients receiving warfarin, despite an increased International Normalized Ratio (INR). Because RapidTEG? includes tissue factor, an extrinsic pathway activator, as well as kaolin, we hypothesized that RapidTEG would be more sensitive in detecting a warfarin-effect.

Methods

Included in this prospective study were 22 consecutive patients undergoing elective cardioversion and receiving warfarin. Prior to cardioversion, blood was collected to assess INR, Prothrombin Time, TEG, and RapidTEG.

Results

INR Results: 2.8?±?0.5 (1.6 to 4.2). Prothrombin Time Results: 19.1?±?2.2 (13.9. to 24.3). TEG Results (Reference Range): R-Time: 8.3?±?2.7 (2–8); K-Time: 2.1?±?1.4 (1–3); Angle: 62.5?±?10.3 (55–78); MA: 63.2?±?10.3 (51–69); G: 9.4?±?3.5 (4.6-10.9); R-Time within normal range: 10 (45.5%) with INR 2.9?±?0.3; Correlation coefficients for INR and each of the 5 TEG variables were insignificant (P?>?0.05). RapidTEG Results (Reference Range): ACT: 132?±?58 (86–118); K-Time: 1.2?±?0.5 (1–2); Angle: 75.4?±?5.2 (64–80); MA: 63.4?±?5.1 (52–71); G: 8.9?±?2.0 (5.0-11.6); ACT within normal range: 9 (40.9%) with INR 2.7?±?0.5; Correlation coefficients for INR and each of the 5 RapidTEG variables were insignificant (P?>?0.05).

Conclusions

TEG, using kaolin activation, and RapidTEG, with kaolin and tissue factor activation, were normal in a substantial percent of warfarin patients, despite an increased INR. The false-negative rate for detecting warfarin coagulopathy with either test is unacceptable. The lack of correlation between INR and all TEG and RapidTEG components further indicates that these methodologies are insensitive to warfarin effects. Findings suggest that intrinsic pathway activation may mitigate detection of an extrinsic pathway coagulopathy.     

Complex signals bioinformatics: evaluation of heart rate characteristics monitoring as a novel risk marker for neonatal sepsis

Purposes

Heart rate characteristics monitoring for early detection of late-onset neonatal sepsis was first described in 2003. This technique, which uses mathematical methods to report the fold-increase in the risk of imminent neonatal sepsis, adds independent information to laboratory tests and clinical findings, and, in a large randomized trial, reduced NICU mortality of very low birth weight infants. Through re-analysis and new secondary analyses of published studies, we have systematically evaluated the utility of this new risk marker for screening the growing population of premature infants.

Methods

We followed the guidelines proposed by Hlatky et al. (Circulation, 119:2408–2416, 2009), reviewed past works, and re-analyzed data from 1,489 patients receiving conventional monitoring alone, 348 of whom had 488 episodes of proven sepsis, in the large randomized trial.

Results

Heart rate characteristics monitoring passed all phases of risk marker development from proof of concept to improvement of clinical outcomes. The predictiveness curve affirmed good calibration, and addition of the heart rate characteristics index to predictive models using standard risk factors favorably impacted the receiver operating characteristic curve area (increase of 0.030), continuous net reclassification index (0.389) and the integrated discrimination index (0.008), and compares well to other modern risk factors.

Conclusion

Heart rate characteristics monitoring is a validated risk marker for sepsis in the NICU.     

Syntheses and Radiosyntheses of Two Carbon-11 Labeled Potent and Selective Radioligands for Imaging Vesicular Acetylcholine Transporter

Purpose

The vesicular acetylcholine transporter (VAChT) is a specific biomarker for imaging presynaptic cholinergic neurons. The syntheses and C-11 labeling of two potent enantiopure VAChT inhibitors are reported here.

Procedures

Two VAChT inhibitors, (±)-2 and (±)-6, were successfully synthesized. A chiral HPLC column was used to resolve the enantiomers from each corresponding racemic mixture for in vitro characterization. The radiosyntheses of (?)-[¹¹C]2 and (?)-[¹¹C]6 from the corresponding desmethyl phenol precursor was accomplished using [¹¹C]methyl iodide or [¹¹C]methyl triflate, respectively.

Results

The synthesis of (?)-[¹¹C]2 was accomplished with 40–50 % radiochemical yield (decay-corrected), SA?>?480 GBq/μmol (EOB), and radiochemical purity >99 %. Synthesis of (?)-[¹¹C]6 was accomplished with 5–10 % yield, SA?>?140 GBq/μmol (EOB), and radiochemical purity >97 %. The radiosynthesis and dose formulation of each tracer was completed in 55–60 min.

Conclusions

Two potent enantiopure VAChT ligands were synthesized and ¹¹C-labeled with good radiochemical yield and specific activity.     

In Vitro and In Vivo Characterization of Two C-11-Labeled PET Tracers for Vesicular Acetylcholine Transporter

Purpose

The vesicular acetylcholine transporter (VAChT) is a specific biomarker for imaging presynaptic cholinergic neurons. Herein, two potent and selective ¹¹C-labeled VAChT inhibitors were evaluated in rodents and nonhuman primates for imaging VAChT in vivo.

Procedures

For both (?)-[¹¹C]2 and (?)-[¹¹C]6, biodistribution, autoradiography, and metabolism studies were performed in male Sprague Dawley rats. Positron emission tomography (PET) brain studies with (?)-[¹¹C]2 were performed in adult male cynomolgus macaques; 2 h dynamic data was acquired, and the regions of interest were drawn by co-registration of the PET images with the MRI.

Results

The resolved enantiomers (?)-2 and (?)-6 were very potent and selective for VAChT in vitro (K _i ?35-fold selectivity for VAChT vs. σ receptors); both radioligands, (?)-[¹¹C]2 and (?)-[¹¹C]6, demonstrated high accumulation in the VAChT-enriched striatum of rats. (?)-[¹¹C]2 had a higher striatum to cerebellum ratio of 2.4-fold at 60 min; at 30 min, striatal uptake reached 0.550?±?0.086 %ID/g. Uptake was also specific and selective; following pretreatment with (±)-2, striatal uptake of (?)-[¹¹C]2 in rats at 30 min decreased by 50 %, while pretreatment with a potent sigma ligand had no significant effect on striatal uptake in rats. In addition, (?)-[¹¹C]2 displayed favorable in vivo stability in rat blood and brain. PET studies of (?)-[¹¹C]2 in nonhuman primates indicate that it readily crosses the blood-brain barrier (BBB) and provides clear visualization of the striatum; striatal uptake reaches the maximum at 60 min, at which time the target to nontarget ratio reached ~2-fold.

Conclusions

The radioligand (?)-[¹¹C]2 has high potential to be a suitable PET radioligand for imaging VAChT in the brain of living subjects.     

Synthesis and Evaluation of 13N-Labelled Azo Compounds for β-Amyloid Imaging in Mice

Purpose

The aim of the present study was to develop short half-lived tools for in vitro and in vivo β-amyloid imaging in mice, for which no suitable PET tracers are available.

Procedures

Five ¹³N-labelled azo compounds (1–5) were synthesized using a three-step process using cyclotron-produced [¹³N]NO₃ ^?. Biodistribution studies were performed using positron emission tomography–computed tomography (PET–CT) on 20-month-old healthy, wild-type (WT) mice. In vivo and in vitro binding assays were performed using PET-CT and autoradiography, respectively, on 20-month-old healthy (WT) mice and transgenic (Tg2576) Alzheimer's disease model mice.

Results

¹³N-labelled azo compounds were prepared with decay corrected radiochemical yields in the range 27?±?4 % to 39?±?4 %. Biodistribution studies showed good blood–brain barrier penetration for compounds 1 and 3–5; good clearance data were also obtained for compounds 1–3 and 5. Compounds 2, 3 and 5 (but not 1) showed a significant uptake in β-amyloid-rich structures when assayed in in vitro autoradiographic studies. PET studies showed significant uptake of compounds 2 and 3 in the cortex of transgenic animals that exhibit β-amyloid deposits.

Conclusions

The results underscore the potential of compounds 2 and 3 as in vitro and in vivo markers for β-amyloid in animal models of Alzheimer's disease.     

Effects of Chelator Modifications on 68Ga-Labeled [Tyr3]Octreotide Conjugates

Purpose

Somatostatin receptors (SSTR) have been reported as promising targets for imaging agents for cancer. Recently, ⁶⁸Ga-DOTATOC-based PET imaging has been used successfully for diagnosis and management of SSTR-expressing tumors. The purpose of this study was to evaluate the influence of chelator modifications and charge on ⁶⁸Ga-labeled peptide conjugates.

Procedures

We have synthesized a series of [Tyr³]octreotide conjugates that consisted of different NOTA-based chelators with two to five carboxylate moieties, and compared our results with ⁶⁸Ga-DOTATOC in both in vitro and in vivo studies.

Results

With the exception of ⁶⁸Ga-1 (three carboxylates), the increased number of carboxylates on the NOTA-based chelators resulted in a reduced binding affinity and internalization. Additionally, the tumor uptake for ⁶⁸Ga-2 (four carboxylates) and ⁶⁸Ga-3 (five carboxylates) was reduced compared to that of ⁶⁸Ga-DOTATOC (three carboxylates) and ⁶⁸Ga-NO2ATOC (two carboxylates) and ⁶⁸Ga-1 (three carboxylates) at 2 h p.i. suggesting the presence of an optimal charge for this compound.

Conclusions

Chelator modifications can lead to the altered pharmacokinetics. These results may impact further design considerations for peptide-based imaging agents.     

Surface cooling for induction of mild hypothermia in conscious healthy volunteers - a feasibility trial

Introduction

Animal and human studies suggest beneficial outcome effects of mild hypothermia for stroke, for acute myocardial infarction, and for cardiogenic shock. The aim of this study was to investigate the feasibility and safety of non-invasive surface cooling for induction and maintenance of mild hypothermia (32 to 34°C) in healthy, conscious volunteers.

Methods

The trial was set at a clinical research ward in a tertiary care center, and included 16 healthy male volunteers 18 to 70 years old. Surface cooling was established by a novel non-invasive cooling pad with an esophageal target temperature of 32 to 34°C and maintenance for six hours. Shivering-control was achieved with meperidine and buspirone and additional administration of magnesium in eight subjects.

Results

The primary endpoint to reach a target temperature of 32 to 34°C was only reached in 6 of the 16 participating subjects. Temperatures below 35°C were reached after a median cooling time of 53 minutes (38 to 102 minutes). Cooling rate was 1.1°C/h (0.7 to 1.8°C). Additional administration of magnesium had no influence on cooling rate. At no time during the cooling procedure did the participants report uncomfortable conditions for which termination of cooling had to be considered. No severe skin damage was reported.

Conclusions

Cooling to body temperature below 35°C by the use of non-invasive surface cooling is feasible and safe in conscious healthy volunteers. Further studies are needed to investigate an altered cooling protocol to achieve temperatures below 35°C.

Trial Registration

ISRCTN: ISRCTN50530495     

Quantification of Iron-Labeled Cells with Positive Contrast in Mouse Brains

Purpose

To quantify small amounts of iron-labeled cells in mouse brains with magnetic resonance imaging (MRI).

Procedures

Iron-labeled cells (from 500 to 7,500) were stereotaxically transplanted into the brain of living mice that were subsequently imaged with MRI at 4.7 T. We compared four quantitative methods: (1) T2 relaxometry, (2) T2* relaxometry, (3) the volume of the cloverleaf hypointense artifact generated on T2*-weighted images, and (4) the volume of the cloverleaf hyperintense artifact generated on positive contrast images.

Results

The methods based on relaxometry, whether T2 or T2*, did not correlate with the number of injected cells. By contrast, those based on measurement of cloverleaf artifact volume, whether using negative or positive enhancement, showed a significant linear relationship for the given range of cells (R [0.92?C0.95], p?<?0.05).

Conclusions

T2* artifact volume imaging (negative or positive) appears promising for the quantification of magnetically labeled cells following focal injection in the brain.     

Imaging neonatal spontaneous pneumomediastinum using ultrasound

Purpose

To evaluate the feasibility of ultrasound in detecting spontaneous pneumomediastinum in the neonatal intensive care unit (NICU) and illustrate the ultrasound features.

Methods

Among neonates with abnormal mediastinal radiolucency suspected on chest radiography, those referred for ultrasound examination within 2 days were included. Anterior mediastinal ultrasound was performed using a linear transducer (5–12 MHz) to determine the presence and location of abnormal air in the mediastinum. Clinical data for the neonates were also reviewed.

Results

On ultrasound, pneumomediastinum appeared as thick linear/curvilinear echogenic lines, some with posterior shadowing located between the anterior chest wall and thymus, in lateral margins of the thymus, between the thymus and the great vessels, and in the middle of the thymic parenchyma.

Conclusions

Using ultrasound, pneumomediastinum was easily visualized, and localization of the abnormal air accumulation was possible. Ultrasound may be used as a radiation-free supplementary imaging modality for neonates with abnormal mediastinal air.     

Antithrombin III (AT) and recombinant tissue plasminogen activator (R-TPA) used singly and in combination versus supportive care for treatment of endotoxin-induced disseminated intravascular coagulation (DIC) in the neonatal pig

Background

Disseminated intravascular coagulation (DIC) is a pathological disturbance of the complex balance between coagulation and anticoagulation that is precipitated by vascular injury, acidosis, endotoxin release and/or sepsis and characterized by severe bleeding and excessive clotting. The innately low levels of coagulation factors found in newborn infants place them at extremely high risk for DIC. Anecdotal reports suggest that either anticoagulant or fibrinolytic therapy may alleviate some of the manifestations of DIC. To test the hypothesis that replacement of both anticoagulants and fibrinolytics may improve survival and outcome better than either single agent or supportive care alone, we utilized a neonatal piglet model of endotoxin-induced DIC.

Methods

DIC was induced in twenty-seven neonatal pigs (7 to 14 days of age) by intravenous administration of E. coli endotoxin (800 μg/kg over 30 min). The piglets were divided into 4 groups on the basis of treatment protocol [A: supportive care alone; B: Antithrombin III (AT, 50 μg/kg bolus, 25 μg/kg per hr continuous infusion) and supportive care; C: Recombinant Tissue Plasminogen Activator (R-TPA, 25 μg/kg per hr continuous infusion) and supportive care; D: AT, R-TPA and supportive care] and monitored for 3 primary outcome parameters (survival time, macroscopic and microscopic organ involvement) and 4 secondary outcome parameters (hematocrit; platelet count; fibrinogen level; and antithrombin III level).

Results

Compared with supportive care alone, combination therapy with AT and R-TPA resulted in a significant improvement of survival time, hematocrit, AT level, macroscopic and microscopic organ involvement, p < 0.05. Compared with supportive care alone, R-TPA alone significantly reduced macroscopic organ involvement and AT alone increased AT levels.

Conclusion

The findings suggest that combining AT, R-TPA and supportive care may prove more advantageous in treating the clinical manifestations of DIC in this neonatal pig model than either single modality or supportive care alone.     

Early phase detection of bile leak after hepatobiliary surgery: value of Gd-EOB-DTPA-enhanced MR cholangiography

Purpose

To assess the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography for the detection of bile leaks after hepatobiliary surgery.

Methods

Twenty-three patients with symptoms suggestive of bile leak underwent conventional fat-suppressed T1- and T2-weighted MR cholangiography followed by Gd-EOB-DTPA-enhanced MR cholangiography using gradient-echo (GRE) T2-weighted sequences and fat-suppressed T1-weighted 3D gradient-echo sequences 20?min after an intravenous bolus of Gd-EOB-DTPA. The results of Gd-EOB-DTPA-enhanced MR cholangiography correlated with clinical findings, surgical repair, and the results of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.

Results

The results of Gd-EOB-DTPA-enhanced MR cholangiography were negative in 13 patients (cholecystectomy 5, liver transplantation 2, liver resection for focal lesions 2, cholangiocarcinoma 1, and partial hepatectomy after liver injury 1). In 10 patients in whom bile leaks were detected, this complication occurred after liver resection for focal lesions in 3, cholecystectomy in 4, liver transplantation in 2, and liver resection for intrahepatic cholangiocarcinoma in 1. The diagnostic accuracy of Gd-EOB-DTPA-enhanced MR for the detection or exclusion of bile leaks was 100%.

Conclusions

Gd-EOB-DTPA-enhanced MR cholangiography is a highly reliable technique for the detection of bile leaks after hepatobiliary surgery and may avoid the use of other, potentially risky invasive diagnostic techniques.     

System ergonomic analysis of the morning ward round in an intensive care unit

Objective. Our objective was to find out what is discussed during a bedside morning ward round (MWR), whether there are any weak points, and if a standard work process structure can be recommended.Methods. An intensive care unit (ICU) consultant recorded in a predefined form the topics that were discussed in 225 bedside discussions.Results. The median length of discussions was 5 min. In more than 60% of the discussions, items were considered related to the respiratory, neurological, and cardiovascular systems, as well as to surgical and nursing problems. Specific variables relating to organ system conditions were seldom used (e.g., inspired O₂ concentration, 35%; temperature, 28%; ventilation mode, 25%). We recorded two interruptions per MWR; only 17% of them were related to urgent decisions. Information that could not be found in the patient’s file usually concerned microbiology findings (10%) or surgical procedures (6%).Conclusions. We recommend the following structure: (1) Addressing the patient by saying “hello”; (2) presentation of information related to case history, acute status (findings and strategy) (including the function of the main organ systems), infection status, and nursing problems; (3) patient-related discussion; and (4) discussion of general treatment rules, triggered by individual patient condition.     

Effect of erythropoietin on level of circulating endothelial progenitor cells and outcome in patients after acute ischemic stroke

Introduction

Erythropoietin (EPO) enhances the circulating level of endothelial progenitor cells (EPCs), which has been reported to be associated with prognostic outcome in ischemic stroke (IS) patients. The aim of this study was to evaluate the time course of circulating EPC level and the impact of EPO therapy on EPC level and clinical outcome in patients after acute IS.

Methods

In total, 167 patients were prospectively randomized to receive either EPO therapy (group 1) (5,000 IU each time, subcutaneously) at 48 h and 72 h after acute IS, or serve as placebo (group 2). The circulating level of EPCs (double-stained markers: CD31/CD34 (E₁), CD62E/CD34 (E₂) and KDR/CD34 (E₃)) was determined using flow cytometry at 48 h and on days 7 and 21 after IS. EPC level was also evaluated once in 60 healthy volunteers.

Results

Circulating EPC (E₁ to E₃) level at 48 h after IS was remarkably higher in patients than in control subjects (P < 0.02). At 48 h and on Day 7 after IS, EPC (E₁ to E₃) level did not differ between groups 1 and 2 (all P > 0.1). However, by Day 21, EPC (E₁ to E₃) level was significantly higher in group 1 than in group 2 (all P < 0.03). Additionally, 90-day recurrent stroke rate was notably lower in group 1 compared with group 2 (P = 0.022). Multivariate analysis demonstrated that EPO therapy (95% confidence interval (CI), 0.153 to 0.730; P = 0.006) and EPC (E3) (95% CI, 0.341 to 0.997; P = 0.049) levels were significantly and independently predictive of a reduced 90-day major adverse neurological event (MANE) (defined as recurrent stroke, National Institutes of Health Stroke scale ≥8, or death).

Conclusions

EPO therapy significantly improved circulating EPC level and 90-day MANE.

Trial registration number

ISRCTN: ISRCTN96340690     

Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis

Introduction

Metabolic acidosis is the most frequent acid–base disorder in the intensive care unit. The optimal analysis of the underlying mechanisms is unknown.

Aim

To compare the conventional approach with the physicochemical approach in quantifying complicated metabolic acidosis in patients in the intensive care unit

Patients and methods

We included 50 consecutive patients with a metabolic acidosis (standard base excess ≤ -5). We measured sodium, potassium, calcium, magnesium, chloride, lactate, creatinine, urea, phosphate, albumin, pH, and arterial carbon dioxide and oxygen tensions in every patient. We then calculated HCO₃ ^-, the base excess, the anion gap, the albumin-corrected anion gap, the apparent strong ion difference, the effective strong ion difference and the strong ion gap.

Results

Most patients had multiple underlying mechanisms explaining the metabolic acidosis. Unmeasured strong anions were present in 98%, hyperchloremia was present in 80% and elevated lactate levels were present in 62% of patients. Calculation of the anion gap was not useful for the detection of hyperlactatemia. There was an excellent relation between the strong ion gap and the albumin-corrected and lactate-corrected anion gap (r ² = 0.934), with a bias of 1.86 and a precision of 0.96.

Conclusion

Multiple underlying mechanisms are present in most intensive care unit patients with a metabolic acidosis. These mechanisms are reliably determined by measuring the lactate-corrected and albumin-corrected anion gap. Calculation of the more time-consuming strong ion gap according to Stewart is therefore unnecessary.     

The gap between clinical gaze and systematic assessment of movement disorders after stroke

Background

In rehabilitation, training intensity is usually adapted to optimize the trained system to attain better performance (overload principle). However, in balance rehabilitation, the level of intensity required during training exercises to optimize improvement in balance has rarely been studied, probably due to the difficulty in quantifying the stability level during these exercises. The goal of the present study was to test whether the stabilizing/destabilizing forces model could be used to analyze how stability is challenged during several exergames, that are more and more used in balance rehabilitation, and a dynamic functional task, such as gait.

Methods

Seven healthy older adults were evaluated with three-dimensional motion analysis during gait at natural and fast speed, and during three balance exergames (50/50 Challenge, Ski Slalom and Soccer). Mean and extreme values for stabilizing force, destabilizing force and the ratio of the two forces (stability index) were computed from kinematic and kinetic data to determine the mean and least level of dynamic, postural and overall balance stability, respectively.

Results

Mean postural stability was lower (lower mean destabilizing force) during the 50/50 Challenge game than during all the other tasks, but peak postural instability moments were less challenging during this game than during any of the other tasks, as shown by the minimum destabilizing force values. Dynamic stability was progressively more challenged (higher mean and maximum stabilizing force) from the 50/50 Challenge to the Soccer and Slalom games, to the natural gait speed task and to the fast gait speed task, increasing the overall stability difficulty (mean and minimum stability index) in the same manner.

Conclusions

The stabilizing/destabilizing forces model can be used to rate the level of balance requirements during different tasks such as gait or exergames. The results of our study showed that postural stability did not differ much between the evaluated tasks (except for the 50/50 Challenge), compared to dynamic stability, which was significantly less challenged during the games than during the functional tasks. Games with greater centre of mass displacements and changes in the base of support are likely to stimulate balance control enough to see improvements in balance during dynamic functional tasks, and could be tested in pathological populations with the approach used here.     

Evaluation of Depression and Anxiety Levels in Mothers of Babies' Following Due to Premature Retinopathy

AIM

There are significant increases in the survival rates of premature babies owing to rapid developments in medical technology. As the number of premature babies that can survive in neonatal intensive care increases, so does the frequency of complications due to prematurity. The aim of this study was to investigate the depressive and anxiety symptom levels, and factors affecting these, in mothers of infants who were followed up owing to a diagnosis of premature retinopathy (ROP).

Entwicklung eines Migräneprophylaxe-Screeninginstruments (MPS)

The aim of the present study was to develop a screening tool to aid non-headache specialists, like general practitioners, in deciding whether migraine prophylaxis in the individual migraine patient is useful or not. The first step was the development of a questionnaire, consisting of 10 items, which was filled in by 132 migraineurs who called on neurologists or headache experts. Independently, the physicians filled in another questionnaire to answer the question of whether they decided to prescribe migraine prophylaxis and if they had, to give their reasons for doing so. Using logistic regression analysis, we identified the three questions which had the most influence on the decision regarding prophylaxis in the data set. As results, we identified the following three questions:

1. Do you suffer from migraine on more than 3 days/month?
2. Do you have to rest in bed while experiencing a migraine attack?
3. Do you have to take medication against migraine on more than 5 days/month?

Validation of this reduced questionnaire is currently ongoing and involves 150 migraine patients of general practitioners.     

Evaluation einer zweidimensionalen Skala zur Erfassung von Angst-Vermeidungs-��berzeugungen an ?lteren Patienten mit chronischem R��ckenschmerz

Background

There is evidence on the importance of fear avoidance beliefs (FAB) as prognostic risk factors in elderly patients suffering from chronic low back pain (CLBP). However, so far there is no validated German instrument for measuring FAB in elderly CLBP patients. The aim of the study presented was to evaluate the psychometric properties of the Catastrophizing Avoidance Scale D-65+ (CAS-D-65+) within a population of elderly patients with CLBP.

Methods

A cross-sectional study was conducted with measurement repeated after 4 weeks in 68 CLBP patients aged 64?years and older. The CAS-D-65+ was analyzed performing an item analysis and retest reliability. For validation standardized assessment methods (Tampa Scale of Kinesiophobia [TSK], Photography of Daily Activity ?C Short electronic Version [Phoda-SeV], 5-Item-FAB, pain, disability, well-being and strain) were used.

Results

Internal consistency (Cronbach??s???) ranged from 0.87 to 0.92 for total scale and from 0.71 to 0.89 for the sub-scales ??catastrophizing?? and ??avoidance??, retest reliability (r_tt) ranged from 0.67 for the sub-scale ??catastrophizing?? to 0.70 for total scale and sub-scale ??avoidance??. The CAS-D-65+ showed moderate and strong effect sizes (Cohen??s d) with other related FAB scales and external criteria.

Conclusion

As shown in this study the CAS-D-65+ is a reliable and a valid instrument for the assessment of FAB in older patients with CLBP.