Pediatric Power Wheelchairs: Evaluation of Function in the Home and School Environments

The purpose of this study was to compare the performance of four power wheelchairs when used by children to perform a variety of indoor activities. Eight boys and eight girls performed a series of 11 functional tasks when positioned in each of four different power wheelchairs reflecting different design classes. There were no significant differences for many of the dependent variables. However, the Everaid Turbo was significantly better for functional positioning at a standard kitchen table and at school desks and for accessing objects at different heights. By contrast the Invacare Jaguar was better for straight-line driving speed. Other findings include children's subjective impressions of the four power wheelchairs.     

Scan-rescan variability in perfusion assessment of tumors in MRI using both model and data-derived arterial input functions

PURPOSE: To evaluate the contribution to scan-rescan coefficient of variation (CV) of patient-specific arterial input function (AIF) measurement in dynamic contrast-enhanced MRI (DCE-MRI) data, and to determine whether any advantage or disadvantage to using a data-derived arterial input function is related to the anatomical location of the target lesion. MATERIALS AND METHODS: Two methods are presented for the calculation of perfusion parameters from DCE-MRI data using a two-compartment model. The first method makes use of a single-model AIF across all study data sets, while the second uses an automated process to derive an AIF specific to each data set. Both methods are applied to the analysis of a 25-subject scan-rescan study of patients with advanced solid tumors located in either the lungs or the liver. The parameters of interest in this study are the volume transfer constant between arterial plasma and extracellular extravascular space (K(trans)) and the blood-normalized initial area under the tumor enhancement curve over the first 90 seconds postinjection (IAUCBN(90)). RESULTS: The use of a data-derived AIF reduces the visit-to-visit CV in both parameters for liver lesions by approximately 70% while the improvement is less than 20% for lung lesions. CONCLUSION: The use of a data-derived AIF in the analysis of DCE-MRI data provides a substantial reduction in scan-rescan CV in the measurement of vascular parameters such as K(trans) and IAUCBN(90). These results show a much larger advantage in the liver than in the lungs. However, this difference is largely driven by a small number of outliers, and may be spurious. J. Magn. Reson. Imaging 2008;28:791-796. (c) 2008 Wiley-Liss, Inc.     

Postoperative Cognitive Dysfunction in Middle-aged Patients

Background: Postoperative cognitive dysfunction (POCD) after noncardiac surgery is strongly associated with increasing age in elderly patients; middle-aged patients (aged 40-60 yr) may be expected to have a lower incidence, although subjective complaints are frequent.

Methods: The authors compared the changes in neuropsychological test results at 1 week and 3 months in patients aged 40-60 yr, using a battery of neuropsychological tests, with those of age-matched control subjects using Z-score analysis. They assessed risk factors and associations of POCD with measures of subjective cognitive function, depression, and activities of daily living.

Results: At 7 days, cognitive dysfunction as defined was present in 19.2% (confidence interval [CI], 15.7-23.1) of the patients and in 4.0% (CI, 1.6-8.0) of control subjects (P < 0.001). After 3 months, the incidence was 6.2% (CI, 4.1-8.9) in patients and 4.1% (CI, 1.7-8.4) in control subjects (not significant). POCD at 7 days was associated with supplementary epidural analgesia and reported avoidance of alcohol consumption. At 3 months, 29% of patients had subjective symptoms of POCD, and this finding was associated with depression. Early POCD was associated with reports of lower activity scores at 3 months.     

Avoiding Axillary Treatment in Sentinel Lymph Node Micrometastases of Breast Cancer: A Prospective Analysis of Axillary or Distant Recurrence

Background

The need for axillary lymph node dissection (ALND) in breast cancer patients with sentinel lymph node (SLN) micrometastases remains controversial. The aims of the study were to evaluate the locoregional failure and outcome of breast cancer patients with sentinel node micrometastases who did not undergo completion ALND.

Methods

Between November 2000 and December 2006, SLN biopsy was successfully performed in 1178 patients with invasive breast carcinoma. Only patients with macrometastasis (>2 mm) underwent ALND, while patients with negative SLN or micrometastases did not undergo further treatment of the axilla, by either surgery or radiotherapy. Regarding adjuvant therapy decision, patients with SLN-micrometastases (pN1_mi) were considered as node-positive patients.

Results

Of 1,178 patients, 59 (5%) had micrometastases. Of those with micrometastases, 14 (24%) underwent ALND because the intraoperative study of the SLN yielded a positive result. With a median follow-up of 60 (range, 8–94) months, none of the patients with SLN micrometastases in whom ALND was omitted developed an axillary recurrence, while one patient in whom ALND was performed developed infraclavicular lymph node recurrence. One patient, who declined postoperative breast irradiation, developed breast recurrence and distant metastasis.

Conclusions

Breast cancer patients with SLN micrometastases in whom ALND was omitted had a very low locoregional failure rate. This study supports the theory that ALND might be avoided in these patients, providing that adjuvant systemic treatment equal to treatment provided to treat node-positive disease is administered. However, longer follow-up and results of additional prospective studies are needed.     

Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: results with pathological correlation

PURPOSE: We assessed the sensitivity of preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging the inguinal region of patients with penile cancer and no palpable inguinal adenopathy. MATERIALS AND METHODS: The records of 31 patients with invasive penile cancer and nonpalpable (29) or nonsuspicious (2) inguinal lymph nodes were reviewed. Preoperatively lymphoscintigraphy plus dynamic sentinel node biopsy with (99m)technetium labeled sulfur colloid and isosulfan blue dye was performed in 21 patients and dynamic sentinel node biopsy alone with blue dye only was done in 10. All patients underwent superficial lymph node dissection regardless of preoperative lymphoscintigraphy or dynamic sentinel node biopsy findings to establish pathological nodal status. RESULTS: Six of 32 groins that showed drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. The sensitivity of preoperative lymphoscintigraphy drainage for cancer detection was 86%. Using dynamic sentinel node biopsy with blue dye plus radiotracer 5 sentinel lymph nodes were positive for cancer, although 2 false-negative results were obtained. Thus, the sensitivity of dynamic sentinel node biopsy per groin for cancer detection was 71%. CONCLUSIONS: In our experience preoperative lymphoscintigraphy and dynamic sentinel node biopsy as currently performed remain insufficient for detecting occult inguinal disease. Superficial lymph node dissection remains the gold standard for detecting inguinal microscopic metastasis in select patients.     

Relationship of early life stress and psychological functioning to adult C-reactive protein in the coronary artery risk development in young adults study.

BACKGROUND: Low socioeconomic status (SES) and a harsh family environment in childhood have been linked to mental and physical health disorders in adulthood. The objective of the present investigation was to evaluate a developmental model of pathways that may help explain these links and to relate them to C-reactive protein (CRP) in the Coronary Artery Risk Development in Young Adults (CARDIA) dataset. METHODS: Participants (n = 3248) in the CARDIA study, age 32 to 47 years, completed measures of childhood SES (CSES), early family environment (risky families [RF]), adult psychosocial functioning (PsyF, a latent factor measured by depression, mastery, and positive and negative social contacts), body mass index (BMI), and C-reactive protein. RESULTS: Structural equation modeling indicated that CSES and RF are associated with C-reactive protein via their association with PsyF (standardized path coefficients: CSES to RF, RF to PsyF, PsyF to CRP, CSES to CRP, all p < .05), with good overall model fit. The association between PsyF and CRP was partially mediated by BMI (PsyF to BMI, BMI to CRP, both p < .05). CONCLUSIONS: Low childhood SES and a harsh early family environment appear to be related to elevated C-reactive protein in adulthood through pathways involving psychosocial dysfunction and high body mass index.     

Re-visiting "semantic facilitation" of word retrieval for people with aphasia: facilitation yes but semantic no

Previous research has shown that word-to-picture matching for targets that cannot be named at pre-test results in improved naming relative to untreated control items for people with aphasia. This paper replicates and extends this finding and investigates its source. Is the effect a result of priming of semantic representations, or of post-semantic mechanisms in word retrieval? The first experiment shows that word-to-picture matching with unrelated distractors improves naming at short (2-3 minutes) and long (up to 25 minute) lags. There was no effect of being made aware of the relationship between word-to-picture matching and picture naming. People who have a semantic impairment improve only with a short lag between word-to-picture matching and naming. Participants with less semantic impairment show larger priming effects that are equal at short and long lags between word-to-picture matching and naming. The second experiment shows that the facilitation effect is just as large for word-to-picture matching with unrelated distractors as with semantically-related distractors. Furthermore, overall there was no difference between matching with coordinate items and with associated items. The results of these experiments show that facilitation of naming by word-to-picture matching in people with aphasia cannot be a result of the priming of semantic representations. Instead they are consistent with two effects: word-to-picture matching results in priming at a lemma level for aphasic people with a semantic impairment that is only found with a short lag between word-to-picture matching and naming. Word-to-picture matching causes priming of the lemma to output lexicon entry mapping that benefits participants with less semantic impairment that is evident at both a short and long lag between word-to-picture matching and naming. These findings fit well with previous research on repetition priming of naming with normal subjects.     

Saccadic adaptation in Chiari type II malformation

BACKGROUND: Saccadic adaptation corrects errors in saccadic amplitude. Experimentally-induced saccadic adaptation provides a method for studying motor learning. The cerebellum is a major participant in saccadic adaptation. Chiari type II malformation (CII) is a developmental deformity of the cerebellum and brainstem that is associated with spina bifida. We investigated the effects of CII on saccadic adaptation. METHOD: We measured eye movements using an infrared eye tracker in 21 subjects with CII (CII group) and 39 typically developing children (control group), aged 8-19 years. Saccadic adaptation was induced experimentally using targets that stepped horizontally 120 to the right and then stepped backward 3 degrees during saccades. RESULTS: Saccadic adaptation was achieved at the end of the adaptation phase in participants in each group. Saccadic amplitude gain decreased by 6.9% in the CII group and 9.3% in the control group. The groups did not differ significantly (p = 0.27). Amplitude gain reduction was significantly less in the CII participants who had multiple shunt revisions. Regression analyses revealed no effects of spinal lesion level, presence of nystagmus, or cerebellar vermis dysmorphology on saccadic adaptation. CONCLUSION: The neural circuits involved in saccadic adaptation appear to be functionally intact in CII.     

Effects of temporal lobe epilepsy on retrograde memory

PURPOSE: In a previous investigation (Lah et al., 2004), we found deficits in retrograde memory in patients who had undergone temporal lobectomy (TL). In this study, we set out to determine whether such deficits are present before surgery in patients with temporal lobe epilepsy (TLE). METHODS: Memory for public and autobiographic facts and events was assessed in patients with focal left-sided (n=15) or right-sided (n=14) TLE and healthy control subjects (n=15). The impact of epilepsy and underlying cognitive deficits on retrograde memory also was examined. RESULTS: Patients with left TLE demonstrated retrograde memory deficits across domains. Patients with right TLE showed defective recall only in the autobiographic domain. Young age at onset (younger than 14 years) was associated with greater difficulties in recall of famous events, and patients receiving polytherapy had significantly reduced recall of autobiographic events compared with those receiving monotherapy. In most cases, deficient memory for the past was associated with impairments in other cognitive skills, especially language abilities. CONCLUSIONS: In unoperated-on patients with TLE, we found deficits in retrograde memory that were similar to those seen after TL, with the pattern of deficits being influenced by side of lesion, anticonvulsant medication, and word-finding deficits. Unlike patients tested after right TL, patients with right TLE did not have difficulty recalling details of famous events, which raises the possibility that right TL results in a decline in this aspect of retrograde memory.