Evaluation of gross motor abilities and self perception in children with amblyopia

Purpose. The present study evaluates gross motor abilities and self perception about the physical abilities of pre-school children with amblyopia, in comparison to their unaffected peers.

Method. Twenty-two children with amblyopia, and 25 children with normal vision, aged 4 – 7, were included in this study. Gross motor abilities were evaluated by the Movement Assessment Battery for Children (MABC). The Pictorial Scale of Perceived Competence and Social Acceptance for Young Children were used to measure physical self perception. Parents completed a questionnaire about everyday situations revolving around the child's balance and posture abilities.

Results. Amblyopic children performed significantly worse than the controls according to the MABC subtests and the parents' questionnaire total score. In the scale of perceived competence evaluation the amblyopic children had lower scores in half of the items as well as in the total mean score, but the differences between the groups were not significant. Among the study group, significant correlations were found between several items in the parents' questionnaire and the children's' mean balance score in MABC.

Conclusions. Amblyopia may negatively impact children's motor abilities as expressed by the objective measures in daily living, while self perception is less affected.     

Performance of Serology Assays for Diagnosing Celiac Disease in a Clinical Setting

Diagnosis of celiac disease frequently depends upon serology assays. We set out to prospectively assess the diagnostic value of five serology tests: an enzyme-linked immunosorbent assay (ELISA) for tissue transglutaminase (tTG)-immunoglobulin A (IgA) and tTG-IgG, a chemiluminescence assay for tTG-IgA, an ELISA for deamidated gliadin peptide (DGP) IgG and IgA screening, and detection of endomysial antibodies (Abs) by indirect immunofluorescence. One hundred sixteen children at high risk for developing celiac disease were evaluated clinically and underwent small bowel biopsies and blood serology tests. We examined differences between younger and older children in terms of clinical presentation, test performance, and the ability of high Ab levels to correctly predict diagnosis of celiac disease. Celiac disease was diagnosed for 85 (73%) children. No significant clinical differences were observed between the biopsy-positive and biopsy-negative groups. Children ≤3 years of age revealed higher concentrations of tTG-IgA and DGP Abs than children >3 years old (P = 0.017 and 0.007, respectively). High Ab concentrations were predictive of villous atrophies, with sensitivities ranging from 92.8% to 97.9%, depending on the assay and the cutoff points applied. Sensitivities, specificities, positive predictive values, and negative predictive values varied among assays and improved after correction for best cutoff points. Assay specificities obtained in the clinical setting were lower than expected. The new tTG-IgA chemiluminescence assay demonstrated high throughput but low specificity (74.2%). The tTG-IgA ELISA exhibited the highest test efficiency, and the tTG-IgA chemiluminescence assay was suitable for large-scale screening, with reduced specificity. High concentrations of celiac disease-specific Abs bring into question the need for performance of biopsies on children at high risk.Celiac disease (CD) is a common autoimmune enteropathy that occurs in genetically predisposed children and adults upon ingestion of gluten or related proteins (19). The diverse presentation of CD includes classical clinical symptoms, such as diarrhea, weight loss, failure to thrive, malabsorption, and anemia, and atypical manifestations, such as nonspecific abdominal pain, esophageal reflux, osteoporosis, hypertransaminasemia, and neurological symptoms (15, 25). Population studies have shown that the incidences of CD in Europe and North America are 0.5 to 1% (10). Even though the rate of diagnosis has increased in recent years, according to the accepted iceberg concept (11), the majority of affected individuals are still undiagnosed (10, 18).According to the latest consensus report on CD, small bowel biopsies are considered the gold standard and are mandatory for diagnosis (15). Obtaining a biopsy specimen is an invasive procedure and at times may miss patchy mucosal changes. Poor orientation of the removed tissue may lead to difficulties in interpretation. On the other hand, serology testing for CD-specific antibodies (Abs) is easy to perform and a wide range of commercial kits are now available. The serology tests are sensitive and specific and are becoming the obligatory tool for correctly referring patients for biopsies. Immunoglobulin A (IgA) against the tissue transglutaminase (tTG) antigen is accepted as the best serology screening tool performed by the enzyme-linked immunosorbent assay (ELISA) method (15). Recently, a new human recombinant tTG-IgA chemiluminescence assay was developed for use with the Immulite 2000 analyzer. This platform enables large-scale testing at a high throughput, an advantage which should be taken into account due to the increasing requests for serology testing. In many clinical laboratories, the fluorescence endomysial Ab (EMA) assay is used for confirming the presence of tTG-IgA. The EMA assay is known for its high sensitivity and specificity for diagnosing CD but requires much technologist labor and yet suffers from interobserver variability in interpretation. Abs to deamidated gliadin peptides (DGP) were shown to be of diagnostic value, and DGP Ab kits are being extensively evaluated (2, 28, 29, 32, 36). A DGP assay recognizing both IgA and IgG Abs, known as the DGP (IgA+IgG) screen, is intended for detecting both IgA-deficient and IgA-sufficient CD patients. Thus, the need for measuring total IgA for all tested subjects is eliminated. IgA deficiency affects approximately 1/500 of the general population and is a 10-fold-increased risk factor for CD (8). Performance of the DGP (IgA+IgG) screen could reduce test costs by eliminating the need for IgA screening.tTG-IgA Ab titer was shown to correlate well with severity of biopsy result in adults and pediatric populations (14, 33). This positive correlation has raised the possibility of avoiding small bowel biopsies, when tTG-IgA Ab concentrations are especially high, for diagnosing high-risk populations (3, 13). This concept is not thoroughly studied with the various tTG-IgA commercial kits or other CD Ab specificities. The majority of studies regarding the diagnostic value of CD serology were conducted in research settings. A few publications raised the possibility that serology assays may be less accurate when used in clinical settings (1, 21). We therefore examined a group of children presenting clinical suspicion for developing CD in our community clinical setting. The high prevalence of biopsy-proven CD children in this population enabled us to examine the diagnostic value of several serology kits by comparing the results for two age groups. We also calculated the correlations between Ab titer and severity of biopsy result and assessed the possibility that high Ab titers have predictive value for biopsy results.     

Frequency discrimination thresholds: the effect of increment versus decrement detection of frequency

Difference limen for frequency (DLF) is traditionally tested using a frequency increment detection paradigm in which listeners are requested to distinguish between a reference tone and a series of comparison tones of higher frequency. Sporadic findings indicated that an increment paradigm is not necessarily comparable to a decrement paradigm, in which the comparison tones are lower than the reference tone. The purpose of the present study was to test whether the ability to detect frequency increments is different from that of frequency decrements. DLFs of 16 young women were measured at 200 Hz and 1,000 Hz, using detection of both frequency increment and decrement paradigms. Results indicated that: (1) the frequency increment detection paradigm was significantly smaller (i.e., superior) to the decrement paradigm for the DLF task at 200 Hz, (2) for both frequencies, the number of participants who exhibited better DLF using the frequency increment detection paradigm was significantly larger than the number of those who had better DLFs using the frequency decrement paradigm, and (3) for both frequencies, strong correlations were found between DLFs obtained in the increment versus the decrement paradigms. These results have implications: (1) to studies whose subjects may have reduced sensitivities at frequencies higher than the reference tone (such as the hearing impaired), and (2) to models related to the role of auditory feedback on voice accuracy and to the underlying processes of frequency discrimination.     

Effect of erythropoietin therapy on polyneuropathy in predialytic patients

BACKGROUND: Peripheral neuropathy commonly develops in patients with advanced chronic renal failure. The uremic neuropathy is often subclinical and detectable only by electrophysiological studies. Receptors to erythropoietin (EPO) have been described on non-hematopoietic cells including neuronal cells. METHODS: In order to evaluate the effect of five months' EPO therapy on polyneuropathy in predialytic patients, nerve conduction studies (NCS) were done in 46 anemic predialytic patients without neurological complaints. In 22 (twelve non-diabetic and ten diabetic) neuropathy was detected and these patients were included in the study. After five months of subcutaneous EPO therapy NCSs were repeated. RESULTS: Hemoglobin increased significantly (p=0.0001) with no significant increase in plasma creatinine. Motor nerve conduction velocity (MNCV) and compound muscle action potentials (CMAP) of the ulnar nerve were normal before EPO therapy and at the end of the study. MNCV of the median, peroneal and tibial nerves improved significantly (p<0.05). CMAP of the median nerve rose significantly, to the normal range (p=0.01). Sensory nerve conduction velocity (SNCV ) and sensory nerve action potentials (SNAP) were reduced in all sensory nerves and did not improve. The improvement in non-diabetic patients was better than in diabetic patients. No significant correlation was found between the increase in hemoglobin and the improvement in MNCV. CONCLUSIONS: Subcutaneous EPO therapy improved motor polyneuropathy in uremic patients, especially non-diabetic individuals. The improvement in MNCV may reflect remyelination. This non-hematopoietic effect may be related to some direct action through EPO receptors on peripheral neuronal cells.     

Expression and role in growth regulation of tumour necrosis factor receptors p55 and p75 in acute myeloblastic leukaemia cells

Tumour necrosis factor (TNF)-α exerts multiple effects on human acute myeloblastic leukaemia (AML) cells in vitro , including (1) synergistic stimulation of proliferation with interleukin-3 (IL-3) and granulocyte-macrophage colony-stimulating factor (GM-CSF); (2) inhibition of granulocyte-CSF (G-CSF) and stem cell factor (SCF)-induced growth; (3) suppression of multiplication of clonogenic leukaemic cells; (4) induction of autocrine growth. Recently, two distinct TNF receptors (TNF-Rs), TNF-Rp55 and TNF-Rp75, have been identified. In this study we show that both receptors are expressed on freshly isolated AML blasts, with p75 being the predominant TNF-receptor type. This study investigates the roles of these two receptors in TNF-α-driven growth regulation of AML blasts in vitro . Using a receptor-specific antibody, it is shown that both receptor types participate in TNF-α-mediated stimulation of GM-CSF/IL-3-induced proliferation and in TNF-α-induced autocrine growth. In contrast, the TNF-α-triggered growth inhibition (antiproliferation) and the potent suppression of G-CSF- and SCF-induced proliferation exclusively result from activation of TNF-Rp55. Taken together, these results suggest that the proliferative effects of TNF-α on AML blasts are mediated through both p55 and p75 TNF receptors, whereas the TNF-α-signalled growth inhibition is exclusively transduced via TNF-Rp55.     

Primed peripheral polymorphonuclear leukocyte: a culprit underlying chronic low-grade inflammation and systemic oxidative stress in chronic kidney disease

This study characterizes the causal relationship between peripheral polymorphonuclear leukocyte (PMNL) priming, systemic oxidative stress (OS), and inflammation in patients with varying degrees of renal insufficiency (chronic kidney disease [CKD] not on renal replacement therapy [RRT]: continuous ambulatory peritoneal dialysis or hemodialysis [HD]) and healthy control subjects. Rate of superoxide release was measured after stimulation of PMNL with phorbol 12-myristate 13-acetate or zymosan. Priming was estimated by the rate of superoxide release after phorbol 12-myristate 13-acetate stimulation. Systemic OS was related to PMNL priming and intracellular myeloperoxidase activity. Inflammation was linked to peripheral white blood cells and PMNL counts, PMNL apoptosis, and PMNL ex vivo survival in autologous and heterologous sera. PMNL priming and counts were related to the severity of renal failure in CKD not on RRT. Compared with control subjects, PMNL from all CKD patients showed increased priming, highest in HD, with a significant decrease in their response to zymosan. PMNL myeloperoxidase activity and apoptosis were increased in all renal failure patients. Decreased ex vivo cell survival and elevated leukocyte counts were found in all patients, highest in HD. Both PMNL priming and counts correlated negatively with the GFR. A positive significant correlation was shown between PMNL counts and their priming in all groups, suggesting that the increased PMNL count in peripheral blood is an adaptive response to PMNL priming. Hence, PMNL priming is a key mediator of low-grade inflammation and OS associated with renal failure, occurring before the onset of RRT and further augmented in chronic HD.     

Electrophysiological abnormalities in upper extremities after brachiocephalic A-V fistulas construction in predialysis patients

BACKGROUND: Peripheral neuropathy is considered a common complication in patients suffering from advanced chronic kidney disease (CKD). Superimposed peripheral multiple neuropathies may complicate arteriovenous (A-V) fistulas construction. AIM: To evaluate, prospectively, the influence of brachiocephalic A-V fistulas construction on the peripheral nerves of the same extremity and to characterize the patients at risk for developing ischemic and neurological complications. PATIENTS AND METHODS: Twenty patients suffering from advanced CKD were enrolled in the study: 10 diabetic and 10 non-diabetic patients. All patients underwent electrophysiological evaluation one week before, 3 weeks and 3 months after surgery. Median, ulnar and radial nerves were studied. RESULTS: In non-diabetic patients MNCV was normal before and after surgery, but were significantly lower and reduced progressively and significantly after surgery in diabetic patients (p< or =0.02). In both non-diabetic and diabetic patients SNCV was reduced, but were significantly lower in diabetic patients before and after surgery (p< or =0.03). In diabetic patients it reduced progressively and significantly after surgery (p<0.01). Thirty percent of patients developed local edema and significant decrease of CMAP of median nerve three weeks after surgery (p=0.02) with complete resolution at three months. CONCLUSION: Diabetic uremic patients are at increased risk to develop disabling neurological complications after the construction of A-V fistulas. Diabetes was the only predictive risk factor for developing these complications. Prevention requires careful preoperative electrophysiological evaluation and postoperative follow-up.     

An evidence-based approach to fall risk assessment, prevention, and management: lessons learned

Nurses at an academic medical institution undertook a fall safety initiative. Using an evidence-based approach, they created a risk stratification tool, developed a comprehensive protocol, investigated fall-prevention products and technologies, and piloted the protocol and products/technologies before the full implementation. This article describes their journey and lessons learned along the way, the most compelling of which is the need for a simple, guided, and time-efficient approach to implementing the best practices into clinical care.