Measuring the quality of life of children with cerebral palsy: comparing the conceptual differences and psychometric properties of three instruments

Aim To compare the conceptual differences, internal consistency, and validity of the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL‐Child), the Child Health Questionnaire (CHQ), and a European generic health‐related quality of life (HRQOL) questionnaire (10‐domain version; KIDSCREEN‐10) for children with cerebral palsy (CP). Method Two hundred and four primary caregivers (185 females [91%], 19 males [9%]) of children with CP aged 4 to 12 years (mean 8y 4mo [SD 2.51]; 112 males [55%], 92 females [46%], Gross Motor Function Classification System level I=18%, II=28%, III=14%, IV=11%, V=28%) provided demographic data and completed the CP QOL‐Child, CHQ, and KIDSCREEN‐10. Fifty‐four children with CP aged 9 to 12 years completed the CP QOL‐Child and KIDSCREEN‐10. Results The KIDSCREEN‐10 and CP QOL‐Child were developed to measure general HRQOL and CP‐specific QOL respectively, whereas the CHQ was developed to measure functional health and well‐being. In terms of internal consistency, KIDSCREEN‐10 (Cronbach’s α=0.86) and CP QOL‐Child (0.74–0.91) outperformed the CHQ (0.18–0.96). In terms of validity, all instruments were moderately correlated. Floor and ceiling effects, although minimal or not evident for KIDSCREEN‐10 and CP QOL‐Child (1–4.9%), were apparent for CHQ (0.5–62.9%). Interpretation Conceptually and psychometrically, KIDSCREEN‐10 and CP QOL‐Child performed more strongly than the CHQ, for children with CP. The choice between these two instruments will depend on the questions posed and outcomes sought by the researcher or clinician.     

Transcatheter aortic valve replacement for native aortic valve regurgitation as a bridge to liver transplantation

Coexistence of end‐stage liver disease (ESLD) and severe valvular heart disease conveyed substantial risk for patients, oftentimes leading to exclusion from liver transplantation candidacy due to inability to safely offer cardiac surgery prior to transplantation. Several approaches have been described, including performing transplantation and valve surgery concurrently, or in sequence. Both options, however, have associated complications: catastrophic repercussion of peri‐operative coagulopathy and organ dysfunction post‐transplantation, respectively. The introduction of transcatheter procedures offered a safer alternative for high‐risk patients; however, its recognized indications remained limited. A novel approach to this surgical dilemma by performing transcatheter aortic valve replacement (TAVR) for severe native aortic valve regurgitation in a patient on the liver transplant list has been presented. The procedure proved to be an effective management for the aortic valve insufficiency, improving our patient's hemodynamics in preparation for the subsequent orthotopic liver transplantation (OLT). © 2015 Wiley Periodicals, Inc.     

In vitro studies on the antioxidant and growth stimulatory activities of a polyphenolic extract from Cudrania cochinchinensis used in the treatment of wounds in Vietnam

The leaves of Cudrania cochinchinensis, a Vietnamese folk remedy, have been suggested as a beneficial agent for wound healing. Animal studies and clinical observations in Vietnam have shown positive wound healing activity. We studied the effects of a polyphenolic extract from the plant on the proliferation of cells in culture and their response to oxidative damage by hydrogen peroxide. Fibroblasts were incubated with different concentrations of the extract in 0.4% fetal calf serum, and proliferation was monitored by a colorimetric assay. Cell damage was induced by exposure to hydrogen peroxide 7 x 10(-5) mol/L for 3 hours. The same colorimetric assay was used to assess cell damage and the protective effect of the extract against oxidative damage. The extract at low concentrations (0.1 to 5 microg/ml) had a stimulatory effect on fibroblast growth. The effect was significant by 7 days after the addition of the extract and was strongest at a concentration of 1 microg/ml of extract (p< or = 0.01). The extract at concentrations of 5 or 50 microg/ml protected fibroblasts and endothelial cells against hydrogen peroxide-induced damage. Pretreatment with the extract or exposure to extract simultaneously with hydrogen peroxide gave only partial protection against oxidative damage, whereas a combination of the two treatments gave complete protection (p< or = 0.005). Stimulation of fibroblast proliferation and protection of cells against destruction by inflammatory mediators may be ways in which the polyphenolic substances from the plant, Cudrania cochinchinensis, contribute to wound healing.     

Common Association of HPV 2 with Anogenital Warts in Prepubertal Children

Abstract: Anogenital (AG) warts in 31 prepubertal children were HPV typed by nonisotopic in situ hybridization (NISH) using digoxigenin labeled probes for human papilloma virus (HPV) types 1–5, 6,11,16,18, 31, and 33. Mode of transmission was determined from historical, clinical, and laboratory data independent of HPV typing. HPV 2 was detected most commonly (13/31 warts) followed by HPV 6 (7/31), HPV 11 (5/31), and HPV 16 (1/31). Although not reaching statistical significance, our results suggested that a mucosal HPV type (6,11,16) in a child's AG warts implied transmission from mucosal warts and conversely cutaneous HPV 2 transmission from warts at a cutaneous site. HPV typing provided no helpful information regarding actual mode of transmission of AG warts In these children. The high prevalence of HPV 2 in children's AG warts and the low prevalence of sexual abuse (2 of 31 children) found in this study suggest innocent auto- or heteroinoculation from cutaneous warts may be a common means by which children acquire AG warts.     

Widespread early dendritic injury associated with loss of cortical MAP-2 immunostaining in a focal ovine head impact model

Dendritic pathology associated with traumatic brain injury may be identified by microtubule associated protein-2 (MAP-2) immunohistochemistry. The aim of this study was to examine the dendritic response in the cerebral cortical mantle in an ovine head impact model using MAP-2 immunostaining as a marker for dendritic injury. The loss of cortical MAP-2 immunoreactivity at 2 h was recorded and quantitated using a computerised image analysis system applied to standard coronal brain sections obtained from 10 impacted and 3 control sheep. Coup and contrecoup cortical contusions were present in 9 of 10 impacted brains examined 2 h after injury. MAP-2 immunoreactivity was lost in all areas of cortical contusion irrespective of site and in otherwise histologically normal cortex. MAP-2 immunostaining was lost in over 45% of the whole cortical area (range 32-54%) and only 2% (range 0-5.5%) was associated with contusions. This study has shown that there is widespread loss of MAP-2 immunostaining following head impact in the cerebral cortical mantle (up to 54%) suggestive of early dendritic injury.     

The changing face of Phase 1 cancer clinical trials

Phase 1 studies in cancer have changed in recent years. Now, with the advent of new, less toxic, targeted agents, more patients may be candidates for new drug studies earlier in the course of their disease. It is to the advantage of the members of the oncology community to know more regarding the details and requirements for participation in early‐phase clinical trials so they can advocate for their patients and help them decide when such trials may be an appropriate choice. To examine the work intensity of early phase cancer clinical trials, the authors of this report compared the study requirements of phase 1 and 2 protocols. Five parameters were studied as a surrogate of study complexity—the number of physical examinations, vital sign determinations, electrocardiograms (ECGs), nonpharmacokinetic laboratory tests, and pharmacokinetic (PK) sampling—in the first 4 weeks of protocol in 90 studies (49 phase 1 studies and 41 phase 2 studies). From July 2004 through March 2007, there were 49 phase 1 trials in the phase 1 Program, 9 phase 2 studies that were conducted by physicians appointed in that program, and 32 phase 2 trials with accessible data in the Department of Thoracic/Head & Neck Medical Oncology. In the phase 1 trials versus the phase 2 trials, there were significantly more (P < .05) physical examinations (mean ± standard error, 3.16 ± 0.24 vs 2.22 ± 0.13), vital sign determinations (5.63 ± 0.61 vs 2.80 ± 0.26), ECGs (4.36 ± 1.16 vs 0.80 ± 0.17), nonpharmacokinetic laboratory tests (18.08 ± 1.31 vs 10.12 ± 0.65), and PK sampling (15.14 ± 1.79 vs 1.02 ± 0.53). These values also differed significantly (P < .005 for each) when the median values were compared in nonparametric tests. Although both phase 1 and phase 2 trials had substantial study requirements, those for the phase 1 studies were significantly higher. The successful conduct of early‐phase clinical trials requires significant research infrastructure. Cancer 2009. © 2009 American Cancer Society.     

Experience and accuracy can result in parity of outcomes following one or two stents for left main stem bifurcation disease

• Approximately one‐third of patients presenting with significant distal left main stem disease, due to the complexity of disease, require the implantation of two‐stents to achieve acceptable revascularization.
• In patients with complex distal unprotected left main stem bifurcation disease, a two‐stent strategy is associated with long‐term outcomes that are comparable to a single‐stent strategy in spite of the presence of higher plaque burden and greater lesion complexity.
• Future studies should focus upon the impact of procedure optimization (e.g. with the routine use of intravascular imaging) and newer generation coronary stents upon long‐term outcomes in this challenging patient group.