Skin prick test to egg white provides additional diagnostic utility to serum egg white-specific IgE antibody concentration in children

BACKGROUND: Levels of IgE antibody to egg white of greater than 7 kIU/L are highly predictive of clinical reactivity to egg, and lower levels often require evaluation with oral food challenge (OFC) to establish definitive diagnosis. OFCs have inherent risks, and diagnostic criteria indicating high likelihood of passing would be clinically useful. OBJECTIVE: We sought to determine whether the size of the skin prick test (SPT) to egg white adds diagnostic utility for children with low egg white-specific IgE antibody levels. METHODS: A retrospective analysis of clinical history, egg white-specific IgE antibody levels, SPT responses, and egg OFC outcomes was performed. RESULTS: Children who passed (n = 29) egg OFCs and those who failed (n = 45) did not differ significantly in age, clinical characteristics, or egg white-specific IgE levels. There were, however, significant differences between both egg white SPT wheal response size and egg/histamine SPT wheal index. Children who failed egg OFCs had a median wheal of 5.0 mm; those who passed had a median wheal of 3.0 mm (P = .003). Children who failed egg OFCs had a median egg/histamine index of 1.00; those who passed had a median index of 0.71 (P = .001). For egg white-specific IgE levels of less than 2.5 kIU/L, an SPT wheal of 3 mm or an egg/histamine index of 0.65 was associated with a 50% chance of passing. CONCLUSION: In children with low egg white-specific IgE levels, those with smaller SPT wheal responses to egg were more likely to pass an egg OFC than those with larger wheal responses. The size of the egg white SPT response might provide additional information to determine the timing of egg OFC. CLINICAL IMPLICATIONS: The size of the egg white SPT wheal response might provide the clinician with additional information to determine the timing of egg OFC in children with low egg white-specific IgE antibody levels.     

Reliability of center of pressure measures of postural stability in healthy older adults: effects of postural task difficulty and cognitive load

Postural instability is a major risk factor of falling in the elderly. It is well documented that postural control may decline while performing a concurrent cognitive task and this effect increases with age. Despite the extensive use of dual tasking in balance assessment protocols, a lack of sufficient reliability information is evident. This study determines the reliability of the postural stability measures in older adults, assessed under single and dual-task conditions and different levels of postural difficulty. Sixteen older adults completed quiet stance postural measurements at three levels of difficulty (rigid surface-eyes open, rigid surface-eyes closed, and foam surface-eyes closed), with or without performing a concurrent backward counting task, in two sessions 1 week apart. Force plate data was used to calculate center of pressure (COP) parameters including mean velocity, phase plane portrait, area (95% confidence ellipse), standard deviation (SD) of amplitude, and SD of velocity. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), coefficient of variation (CV), and minimal metrically detectable change (MMDC) were calculated for each COP measure in all test conditions. Mean velocity, total phase plane, phase plane in ML direction, and SD of velocity in ML direction were the most reliable COP measures across all test conditions. ICC values were consistently higher in ML direction compared with AP direction. In general, velocity-related COP measures in ML direction showed to be highly reliable. Further research may explore the predictive and evaluative value of these COP parameters.     

Dental amalgam and multiple sclerosis: a systematic review and meta-analysis

OBJECTIVES: Amalgam restorations have long been controversial due to their mercury content. Allegations that the mercury may be linked to nervous disorders such as Alzheimer's, chronic fatigue syndrome, and multiple sclerosis (MS) have fueled the calls for the removal of amalgam restorations from dentists' armamentarium. To explore and quantify the association between amalgam restorations and MS we have conducted a systematic review and meta-analysis of the literature. METHODS: A systematic search in Medline (from 1966 to April 2006), EMBASE (2006, Week 16), and the Cochrane library (Issue 2, 2006) for English-language articles meeting specific definitions of MS and amalgam exposure was conducted. Studies were also identified using the references of retrieved articles. Studies were independently reviewed by two authors and disagreements were resolved by consensus. Studies were selected based on an a priori of defined criteria. Odds ratios (ORs) or relative risks were pooled using the random effects model. Heterogeneity was assessed using Q statistics. RESULTS: The pooled OR for the risk of MS among amalgam users was consistent, with a slight, nonstatistically significant increase between amalgam use and risk of MS. CONCLUSION: Future studies that take into consideration the amalgam restoration size and surface area along with the duration of exposure are needed in order to definitively rule out any link between amalgam and MS.     

Study of the anti-seizure effects of low-frequency stimulation following kindling (a review of the cellular mechanism related to the anti-seizure effects of low-frequency electrical stimulation)

Epilepsy affects about 1–2 % of world population as a chronic neurological disease that is manifested by repeated and consecutive seizures (Grone and Baraban, Nat Neurosci 18(3):339–343, 2015). There is no definitive therapy for epilepsy and antiepileptic drugs cannot offer a permanent and definitive cure for epilepsy, and most epileptic patients become drug resistant (Sasa, J Pharmacol Sci 100(5):487–494, 2006). Surgery and removal of the epileptic focus is a substitute method for treating drug-resistant patients and epilepsy surgery of either side of the brain improves seizure control. Temporal lobectomy is the most common epilepsy surgery and is associated with high success rates. Other studies have reported higher success rates for carefully selected temporal lobe seizure patients. Some physicians still consider temporal lobectomy an extreme procedure, citing the risks of side effects, including loss of memory, visual disturbances, and emotional change, associated with the removal of brain tissue (Spencer, Lancet Neurol 1(6):375–382, 2002; Wiebe et al., N Engl J Med 345(5):311–318, 2001; Yasargil et al., J Neurosurg 112(1):168–185, 2010). Nowadays, direct electrical stimulation (in the form of low- or high-frequency stimulation) in the location involved in seizures is used as a potentially suitable treatment method for this destructive disease in both laboratory animals and humans (Goodman et al., Epilepsia 46(1):1–7, 2005; Richardson et al., Epilepsia 44(6):768–777, 2003; Velasco et al., Epilepsia 41(2):158–169, 2000). Low-frequency stimulation causes less damage to the epileptic area and surrounding neuronal structures compared to high-frequency stimulation, and it can be a suitable option for patients suffering from epilepsy (Goodman et al., Epilepsia 46(1):1–7, 2005). Since the cellular mechanism of this stimulation is not clearly known, the purpose of this review research was to investigate the anticonvulsive effects of low-frequency electrical stimulation and the probable cellular mechanism involved in it.     

INTRA AND INTERSESSION RELIABILITY OF A POSTURAL CONTROL PROTOCOL IN ATHLETES WITH AND WITHOUT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A DUAL‐TASK PARADIGM

Background:

Quantification of dynamic balance is essential to assess a patient''s level of injury or ability to function so that a proper plan of care may commence. In spite of comprehensive utilization of dual‐tasking in balance assessment protocols, a lack of sufficient reliability data is apparent.

Purpose:

The purpose of the present study was to determine the intra‐ and inter‐session reliability of dynamic balance measures obtained using the Biodex Balance System® (BBS) for a group of athletes who had undergone anterior cruciate ligament reconstruction (ACLR) and a matched control group without ACLR, while using a dual‐task paradigm.

Methods:

Single‐limb postural stability was assessed in 15 athletes who had undergone ACLR and 15 healthy matched controls. The outcome variables included measures of both postural and cognitive performance. For measuring postural performance, the overall stability index (OSI), anterior‐posterior stability index (APSI), and medial‐lateral stability index (MLSI), were recorded. Cognitive performance was evaluated by measuring error ratio and average reaction time. Subjects faced 4 postural task difficulty levels (platform stabilities of 8 and 6 with eyes open and closed), and 2 cognitive task difficulty levels (with or without auditory Stroop task). During dual task conditions (conditions with Stroop task), error ratio and average reaction time were calculated.

Results:

Regarding intrasession reliability, ICC values of test session were higher for MLSI [ACL‐R group (0.83‐0.95), control group (0.71‐0.95)] compared to OSI [ACL‐R group (0.80‐0.92), control group (0.67‐0.95)] and APSI [ACL‐R group (0.73‐0.90), control group (0.62‐0.90)]. Furthermore, ICC values of first test session were higher in reaction time [ACL‐R group (0.92‐0.95), control group (0.80‐0.92)] than error ratio [ACL‐R group (0.72‐0.88), control group (0.61‐0.83)]. ICC values of retest session were higher for MLSI [ACL‐R group (0.83‐0.94), control group (0.87‐0.93)] than OSI [ACL‐R group (0.81‐0.91), control group (0.83‐0.93)] and APSI [ACL‐R group (0.73‐0.90), control group (0.53‐0.90)]. Moreover, ICC values of retest session were higher in reaction time [ACL‐R group (0.89‐0.98), control group (0.80‐0.92)] equated with error ratio [ACL‐R group (0.73‐0.87), control group (0.57‐0.79)].With respect to intersession reliability, ICC values were higher for MLSI [ACL‐R group (0.72‐0.96), control group (0.75‐0.92)] than OSI [ACL‐R group (0.55‐0.91), control group (0.64‐0.87)] and APSI [ACL‐R group (0.55‐0.79), control group (0.46‐0.89)]. Additionally, ICC values were higher in reaction time [ACL‐R group (0.87‐0.95), control group (0.68‐0.81)] in contrast to error ratio [ACL‐R group (0.42‐0.64), control group (0.54‐0.74)].

Conclusion:

Biodex Balance System® measures of postural stability demonstrated moderate to high reliability in athletes with and without ACLR during dual‐tasking. Results of the current study indicated that assessment of postural and cognitive performance in athletes with ACLR may be reliably incorporated into the evaluation of functional activity.

Level of Evidence:

2b     

Systemic air embolism after percutaneous transthorasic needle biopsy of the lung

Computed tomography (CT)-guided percutaneous transthoracic biopsy of the lung is a well-established diagnostic technique, but it can pose complications to the patients. Air embolism is one of the rarest but potentially fetal complications of this procedure. The authors report a fetal case of systemic and massive air embolism to the coronary and cerebral arteries after the performance of lung biopsy. Careful reviewing of the obtained CT images during the procedure may avoid a missing systemic air embolism and can immediately provide an adequate therapy also in asymptomatic patients. This extremely rare complication is an inevitable event and may happen in spite of appropriate experience and meticulous care.     

Painful oculosympathetic palsy as the sole presentation of spontaneous dissection of the distal internal carotid artery

Spontaneous dissection of the carotid artery is an important differential diagnosis to consider in cases of early onset stroke. Its natural history is variable, ranging from a benign course to permanent disability or death. Dissection usually occurs in the cervical portion of the artery, rendering it amenable to surgical therapy. These issues are compounded if there is intrapetral extension, with associated mortality rates up to 75%. The authors describe such a case of spontaneous dissection and discuss imaging and therapy issues that result.     

Association between plaque instability, angiogenesis and symptomatic carotid occlusive disease.

BACKGROUND: Angiogenesis is a recognized feature of the atherosclerotic process and has been described in the context of unstable coronary atherosclerotic lesions. The aim of this study was to assess the association between angiogenesis in atherosclerotic carotid plaques and microscopic features of plaque instability, in particular intraplaque haemorrhage. METHODS: Consecutive patients undergoing carotid endarterectomy were included. Endarterectomy specimens were divided into their constituent atherosclerotic lesions. Histological sections were prepared and stained with haematoxylin and eosin, and immunohistochemically with an endothelial cell marker (CD34). The quantity of intraplaque haemorrhage was measured in transverse histological sections using computerized image analysis. Microvessel counts were performed in CD34-stained sections and were verified through computerized image analysis. RESULTS: Some 239 atherosclerotic lesions from 73 patients were available for analysis; 73 were early lesions, 74 were raised fibroatheromas and 92 were unstable atherosclerotic plaques. One hundred and fifty lesions were not haemorrhagic; 89 exhibited intraplaque haemorrhage, of which 28 involved less than 50 per cent of the plaque sectional area. There were higher microvessel counts in plaques containing over 50 per cent haemorrhage (P < 0.0001), unstable atherosclerotic lesions (P < 0.0001) and atherosclerotic lesions obtained from symptomatic patients (P < 0.001). CONCLUSION: There are strong associations between plaque vascularity, quantity of intraplaque haemorrhage and presence of symptomatic carotid occlusive disease.