A new anatomic trait for identifying the mendosal suture in young children: the mendosal–lambdoidal angle

Purpose

Radiologic diagnosis of skull fractures in young children is difficult due to numerous accessory sutures. This is especially true around the occipital bone because it has more than one ossification center. Normal anatomic variants, such as the mendosal suture, may be misinterpreted as a skull fracture. We investigated the anatomic traits of the mendosal suture in young children.

Methods

We retrospectively evaluated 52 children, aged between 1 month and 4 years, who had undergone head computed tomography with three-dimensional reconstructions. We evaluated the presence or absence of the mendosal suture. If present, then we measured the length of the suture and the angle between the lambdoidal and mendosal suture lines.

Results

The presence of the mendosal suture was bilateral in 12 children and unilateral in 5 children. The mendosal suture had a mean length of 13.9 ± 3.4 mm on the right side and 11.2 ± 4 mm on the left side. The angle between the mendosal and lambdoidal sutures had a mean value of 54.2° ± 11° for the right side and 53.6° ± 13.9° for the left side. The 95 % confidence interval for the mean value of the angle had a lower and upper bounds of 48° and 60° on the right side and 46° and 61° on the left side, respectively.

Conclusions

The angle between mendosal and lambdoidal suture lines may help radiologists to identify the mendosal suture.

     

Is cognitive behavior therapy developmentally appropriate for young children? A critical review of the evidence

This paper questions the extent to which developmental considerations have been incorporated into the theory and practice of cognitive behavioral therapy (CBT). It focuses on children aged between 5 and 8 years because Piagetian developmental theory places them at a prelogical cognitive level, and thus, the use of a therapeutic approach that is based on a rationalist paradigm would be considered inappropriate. The cognitive demands made upon 5- to 8-year-old children by CBT are outlined, and the current developmental literature is reviewed in the light of this to evaluate the cognitive abilities of this age group. The models underpinning CBT are examined for evidence of the influence of developmental psychology, and the outcome literature of CBT techniques is then scrutinized to evaluate the efficacy of these techniques with young children. Conclusions are reached regarding the appropriateness of current cognitive-behavioral approaches with young children, and the implications for alternative approaches are briefly considered.     

Plateau–patella angle: An option for the evaluation of patellar height in patients with patellar instability

Background

Patellar instability is a debilitating disease. An important factor related to recurrent dislocation is patellar height. A new method of patellar height measurement, the plateau–patella angle (PPA), was proposed in 2011. However, to date, there is no study evaluating the use of this method in patients with patellar instability. The aim of this study was to evaluate the PPA in patients with recurrent patellar dislocation.

Walk–run transition in young and older adults: with special reference to the cardio-respiratory responses

Cardio-respiratory responses of young and older subjects performing walking and running protocols at the walk–run transition speed (WRT) were compared. A total of 26 volunteers assigned to younger (YG, 24 ± 3 years) and older (OG, 64 ± 6 years) groups underwent a protocol to determine the WRT used in 6-min walking and running protocols. Oxygen uptake (VO₂), ventilation (V _E), expired carbon dioxide (VCO₂), heart rate (HR) and perceived exertion (RPE) were assessed. Oxygen pulse (O₂ pulse) and respiratory exchange ratio (RER) were calculated. The WRT was not different between groups (OG: 6.84 ± 0.69 km h⁻¹ vs. YG: 7.04 ± 0.77 km h⁻¹, P = 0.62). No between-group differences were found within a given gait pattern for VO₂ (P = 0.061) and VCO₂ (P = 0.076). However, VO₂ (P = 0.0022) and VCO₂ (P = 0.0041) increased in OG when running, remaining stable in YG (VO₂: P = 0.622; VCO₂: P = 0.412). The VE was higher in OG compared to YG in walking (P = 0.030) and running (P = 0.004) protocols. No age-related (P = 0.180) or locomotion (P = 0.407) effects were found for RER. The HR increased in OG and between-group difference was detected while running (P = 0.003). No within- (P = 0.447) or between-group (P = 0.851) difference was found for O₂ pulse. The net VO₂ increased from walking to running in OG (P < 0.0001) but not in YG (P = 0.53), while RPE was lower in YG (P = 0.041) but stable in OG (P = 0.654). In conclusion, the WRT speed was similar across the age groups. However, the VO₂ and VCO₂ increase from walking to running was larger for OG than YG. The HR, VE and RPE were also higher when running in OG compared to YG. Therefore, the locomotion strategy had different impacts on the metabolic demand of older and younger subjects.     

A human–computer collaborative approach to identifying common data elements in clinical trial eligibility criteria

ObjectiveTo identify Common Data Elements (CDEs) in eligibility criteria of multiple clinical trials studying the same disease using a human–computer collaborative approach.DesignA set of free-text eligibility criteria from clinical trials on two representative diseases, breast cancer and cardiovascular diseases, was sampled to identify disease-specific eligibility criteria CDEs. In this proposed approach, a semantic annotator is used to recognize Unified Medical Language Systems (UMLSs) terms within the eligibility criteria text. The Apriori algorithm is applied to mine frequent disease-specific UMLS terms, which are then filtered by a list of preferred UMLS semantic types, grouped by similarity based on the Dice coefficient, and, finally, manually reviewed.MeasurementsStandard precision, recall, and F-score of the CDEs recommended by the proposed approach were measured with respect to manually identified CDEs.ResultsAverage precision and recall of the recommended CDEs for the two diseases were 0.823 and 0.797, respectively, leading to an average F-score of 0.810. In addition, the machine-powered CDEs covered 80% of the cardiovascular CDEs published by The American Heart Association and assigned by human experts.ConclusionIt is feasible and effort saving to use a human–computer collaborative approach to augment domain experts for identifying disease-specific CDEs from free-text clinical trial eligibility criteria.     

The Halstead‐Reitan neuropsychological test battery for older children: A need for a new standardization

Stratified, random sampling techniques have not been applied to data from reference samples of children administered the Halstead‐Reitan Neuropsychological Test Battery for Older Children (HRB‐OC), ages 9 to 14 years old. Consequently, child neuropsychologists must be aware of the characteristics of various reference samples in order to facilitate interpretation. This article describes the characteristics of HRB‐OC reference samples, namely, gender, age, intelligence, socioeconomic status, education, ethnicity, and race. Empirically documented relationships between these characteristics and HRB‐OC performance also are described. Multiple sources of information, assessment data, and methods of interpretation are combined with clinical judgment to make inferences about the individual child.     

Double innervation of the brachialis muscle: anatomic–physiological study

Introduction

Double innervation of the brachialis muscle has been previously reported in anatomical studies. This study aims to investigate the frequency and clinical significance of double innervation of brachialis by anatomical and electromyographic techniques.

Materials and methods

(1) The existence, origin and pattern of distribution of a branch from the radial nerve to brachialis were dissected on 20 cadaveric arms. (2) Nerve conduction studies (NCS) of 100 patients were performed. The radial nerve was stimulated, registering muscle potentials (MP) in the brachialis muscle. Subsequently, another MP was obtained by Erb’s stimulation, corresponding to the whole brachialis innervation. The relative percentage of innervation from the radial nerve was calculated. (3) Two patients with lesions of the lateral cord of the brachial plexus and preserved elbow flexion were submitted to NCS.

Results

Double innervation was found in 65?% of the anatomical preparations, following different patterns of distribution. In the NCS, 90?% of the patients showed MP in the brachialis muscle after stimulating the radial nerve. The mean percentage of relative innervation was 11?%. Two patients with lesions of the lateral cord showed an important contribution from the radial nerve.

Conclusions

Variations in the relative percentage of innervation from the radial nerve could be due to the different sizes and shapes of this branch. The functional significance of this branch can become crucial if the main innervation to the brachialis muscle fails. When planning surgical antero-external approach to the humerus, it should be kept in mind and preserved.     

The role of the brain renin–angiotensin system in hypertension: Implications for new treatment

Hypertension affects 26% of adults and is in constant progress related to increased incidence of obesity and diabetes. One-third of hypertensive patients may be successfully treated with one antihypertensive agent, one-third may require two agents and in the remaining patients will need three agents for effective blood pressure (BP) control. The development of new classes of antihypertensive agents with different mechanisms of action therefore remains an important goal. Brain renin–angiotensin system (RAS) hyperactivity has been implicated in hypertension development and maintenance in several types of experimental and genetic hypertension animal models. Among the main bioactive peptides of the brain RAS, angiotensin (Ang) II and Ang III have similar affinities for type 1 (AT1) and type 2 (AT2) Ang II receptors. Following intracerebroventricular (i.c.v.) injection, Ang II and Ang III similarly increase arginine–vasopressin (AVP) release and BP. Blocking the brain RAS may be advantageous as it simultaneously (1) decreases sympathetic tone and consequently vascular resistance, (2) decreases AVP release, reducing blood volume and vascular resistance and (3) blocks angiotensin-induced baroreflex inhibition, decreasing both vascular resistance and cardiac output. However, as Ang II is converted to Ang III in vivo, the exact nature of the active peptide is not precisely determined. We summarize here the main findings identifying AngIII as one of the major effector peptides of the brain RAS in the control of AVP release and BP. Brain AngIII exerts a tonic stimulatory effect on BP in hypertensive rats, identifying brain aminopeptidase A (APA), the enzyme generating brain Ang III, as a potentially candidate target for hypertension treatment. This has led to the development of potent orally active APA inhibitors, such as RB150 — the prototype of a new class of centrally acting antihypertensive agents.     

Contribution of syntaxin 1A to the genetic susceptibility to migraine: A case–control association study in the Spanish population

Migraine is a common neurological disorder with a complex inheritance pattern. Mutations in genes encoding proteins that are involved in ion transport across the neuronal membrane have been linked to rare monogenic variants of migraine. These or other related genes and proteins are also candidates to be involved in the inherited predisposition to the more common forms of migraine without aura (MO) or migraine with aura (MA). One of these proteins, syntaxin 1A, encoded by the STX1A gene, is a key molecule in ion channel regulation and synaptic exocytosis. We assessed the contribution of STX1A to migraine by analyzing three SNPs that cover the entire gene (rs6951030–rs941298–rs4363087), in a case–control association study in 210 migraine patients (102 MO, 86 MA, 22 hemiplegic migraine) and 210 sex-matched unrelated controls. The single-marker analysis revealed significant differences in both allele frequencies (P = 0.0087, OR = 1.48) and genotype distributions (P = 0.0133) of the rs941298 SNP between migraineurs and controls, with an overrepresentation of T-allele carriers in the migraine sample (OR = 1.78). We subsequently performed a haplotype-based analysis and observed evidence of an overrepresentation of the A–T–G (rs6951030–rs941298–rs4363087) allelic combination in migraine patients and an increased frequency of carriers of this risk haplotype (P = 0.008, OR = 1.71). These differences remained significant when patients were subdivided into MO and MA. When the control series was enlarged for rs941298, we confirmed the association only with the whole migraine group.     

High trait emotional intelligence in men: Beneficial for perceived stress levels but disadvantageous for the physiological response to acute stressors?

This study examined the relationship between trait emotional intelligence (EI) and stress in 110 male employees. Particularly, the association between trait EI and perceived chronic stress, occupational stress, and the physiological stress response was examined. Trait EI, perceived chronic stress, and occupational stress levels were assessed via questionnaires. The physiological stress response was measured by means of salivary free cortisol and heart rate variability (HRV) in response to the Trier Social Stress Test for Groups. Consistent with previous findings, men with high trait EI showed significantly lower perceived chronic and occupational stress levels than men with low trait EI. However, men with high trait EI also showed significantly higher cortisol reactivity than their low trait EI counterparts. Similarly, HRV in men with high trait EI appeared to be lower than in men with low trait EI but HRV differences between groups were not significant. Our findings suggest that trait EI might play a critical role in the stress regulation process but due to the cross‐sectional design of the study no causal conclusions can be drawn. Experimental studies need to explore further whether and how trait EI affects psychological and physiological stress responses.