Differences between males and females in the seasonality of birth and month of clinical onset of disease in children with type 1 diabetes mellitus in Ireland

The aim was to study the monthly rhythm of birth and clinical onset in 303 children with type 1 diabetes mellitus (DM1) aged 0-15 years (156 males, 147 females) born between 1980 and 1996 in Ireland and compare to 951,717 infants born in the general population during the same period. Analysis was performed using the cosine fit for rhythm and t-test between the seasons of the year. Whereas the males showed a rhythmic pattern of month of birth, peaking in the summer (p < 0.05), similar to that in the general population, the females showed no seasonal differences in either month of birth or month of onset. A mirror image pattern, nadir in spring and summer (p < 0.01), was observed in month of clinical onset, also only in males. If we assume a viral infectious etiology of DMI, females seem to be less susceptible than males to the environmental infectious influences.     

The KickStrip: a novel testing device for periodic limb movement disorder

STUDY OBJECTIVES: In light of the ongoing debate over the clinical significance of periodic limb movement disorder (PLMD) and its monitoring in overnight sleep studies, we introduce a novel, portable, low-cost device for PLMD testing. The KickStrip is a disposable device, which includes a movement sensor, a central processing unit with real-time software, and a display. In the present study, the KickStrip final score (Kscore) is validated against the traditional periodic limb movement index (PLMI) based on overnight recordings in the sleep laboratory. DEISGN: Patients underwent full polysomnographic recordings concomitantly with the use of the KickStrip for a single night. SETTING: Sleep Disorders Unit at Loewenstein Rehabilitation Hospital and Sleep Medicine Center at Rambam Medical Center, Israel. PATIENTS: Eighty-two patients referred for overnight sleep recordings due to sleep disturbance of any kind. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The Kscores were collected and the PLMI computed for each leg separately. Pearson correlations between Kscores and PLMI ranged between r = 0.83 to r = 0.88 (p < 0.001). Sensitivity and specificity values of the Kscores for increasing PLMD thresholds showed sensitivity ranging from 50% to 100% and specificity ranging from 83% to 100%. Receiver operating characteristic curves showed area-under-the-curve values ranging from 82% to 92%. Bland-Altman plot showed high agreement between the methods. CONCLUSIONS: Comparisons between the Kscores and the traditional PLMI show increased accuracy with severity level and excellent agreement. The KickStrip is a valuable tool for PLMD testing for both clinical and research purposes.     

Mechanisms of matrix metalloproteinase-9 and matrix metalloproteinase-2 inhibition by N-acetylcysteine in the human term decidua and fetal membranes

OBJECTIVE: The purpose of this study was to evaluate the effect of N-acetylcysteine on the activity and secretion of the matrix metalloproteinases in the decidua, amnion, and chorion and the secretion of the tissue inhibitor of matrix metalloproteinase-1. STUDY DESIGN: Samples from eight nonlaboring women were taken at elective cesarean section and incubated in an in vitro organ culture in the absence or presence of N-acetylcysteine. Matrix metalloproteinase-2 and matrix metalloproteinase-9 activity was measured with the use of gel zymography. Western blot analysis was used to measure matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase-1 secretion. Data were analyzed with the paired Student t test. RESULTS: N-acetylcysteine had a direct inhibitory effect on matrix metalloproteinase-2 and matrix metalloproteinase-9 activity, regardless of tissue origin, starting at 1.0 mmol/L. In cultured media, 20 mmol/L N-acetylcysteine inhibited matrix metalloproteinase-2 and matrix metalloproteinase-9 activity in all three tissues. A differential response was demonstrated for matrix metalloproteinase-2 secretion, depending on the tissue that was studied. Its secretion was decreased in decidua at 10 mmol/L and 20 mmol/L; in amnion, the secretion was inhibited at 0.1 mmol/L and not affected at all in chorion. Matrix metalloproteinase-9 secretion was not affected in a statistically significant manner in any tissue. In the chorion, matrix metalloproteinase-9 showed a trend toward increased secretion. Tissue inhibitor of matrix metalloproteinase-1 secretion significantly decreased in the decidua at 20 mmol/L. CONCLUSION: N-acetylcysteine, at higher concentrations, has an inhibitory effect on matrix metalloproteinase-2 and matrix metalloproteinase-9 activity, regardless of the tissue origin and the differential effect on secretion depending on the tissue and N-acetylcysteine concentration.     

Clinical and ultrasonographic weight estimation in large for gestational age fetus

OBJECTIVE: To examine prospectively the effect on pregnancy outcome of a management protocol, that adds ultrasonographic weight estimation in fetuses suspected clinically as large. STUDY DESIGN: Prospective follow up study of all singleton deliveries during a 1 year period. All patients underwent routine clinical estimation of fetal weight. When clinical estimation of fetal weight was > or = 3700 g, patients were referred for ultrasonographic estimation of fetal weight. When the latter was > or = 4000 g the patient was informed about the risks of birth trauma. Cesarean section was recommended only when > or = 4500 g. Ultrasonography was repeated every 4 days when possible. Predictive values of clinical and ultrasonographic estimations of fetal weight for diagnosing macrosomia, defined for the purpose of this study as 4000 g or more, and their effect on the rate of cesarean sections. RESULTS: Five hundred fifty-five (14.4%) out of 3844 singletons were estimated as 3700 g or more. Only 315 fetuses had ultrasonographic estimation of weight within 3 days of delivery. The sensitivity of clinical and ultrasonographic prediction of macrosomia was 68 and 58%, respectively. Cesarean section rate in newborns weighing 4000 g or more was 22% when macrosomia was clinically suspected compared to 11% when it was not (P<0.05). In fetuses estimated ultrasonographically as 4000 g or larger the cesarean section rate was doubled (50.7% versus 24.9%, P<0.05) compared to those estimated as smaller than 4000 g, although actual weight of 4500 g or more was recorded in 10.6 and 8.5% of these groups, respectively. There were no cases of shoulder dystocia in macrosomic babies when macrosomia was not detected by ultrasound compared to two cases of shoulder dystocia (2.7%) when macrosomia was detected by ultrasound. CONCLUSION: Antenatal suspicion of macrosomia increased the cesarean section rate while the associated improvement in pregnancy outcome remains questionable. The contribution of ultrasound, added to routine clinical estimation of fetal weight, was clinically insignificant apart from a further increase in cesarean section rate.     

Implicit location encoding via stored representations of familiar objects: neuropsychological evidence

We report data on the visual localisation ability of a patient with Balint's syndrome, GK. We show that, with relatively long exposures of displays, GK is better able to judge the spatial relations between separate objects (a "between-object judgement") than the spatial relations between a part and a whole object (a "within-object judgement") (Experiments 1-3). This dissociation occurred even when the same stimulus was used for both judgements, and the task instructions biased GK to parse the stimulus as either a single or as two separate objects (Experiments 2 and 6). However, when he could use a stored representation to make a within-object judgement, then performance was better than on a comparable spatial judgement of the relations between two separate objects (Experiments 4-7). The data demonstrate that stored representations of objects can support the spatial coding of parts to perceptual wholes. In the absence of stored representations, part-whole relations must be explicitly coded by attention, a process that is impaired in this patient.     

Retinopathy of prematurity: molecular pathology and therapeutic strategies

Retinopathy of prematurity (ROP) is an ischemia-induced proliferative retinopathy, which affects premature infants with low birth weight. It is a leading cause of visual impairment and blindness in children, and shares pathophysiological characteristics with other common ocular diseases such as diabetic retinopathy, central vein occlusion, and age-related macular degeneration. Pathologically similar inherited diseases such as Norrie disease suggest a possible genetic component in the susceptibility to ROP. The process of retinal neovascularization in ROP and in animal models of oxygen-induced retinopathy is complex, and involves angiogenic factors, such as vascular endothelial growth factor, and basement membrane components. Potential medical therapies for ROP, including modulators of angiogenic factors, inhibitors of basement membrane changes, endogenous inhibitors such as pigment epithelium derived factor, and anti-inflammatory drugs, have shown efficacy against neovascularization in several animal models. Some of these therapies are in clinical trials now for diabetic retinopathy and age-related macular degeneration, and in the future may prove efficacious for the treatment of ROP.     

Comparison of blood pressure measurements on the bare arm, below a rolled-up sleeve, or over a sleeve

BACKGROUND: This study examined the effect of measuring blood pressure below subjects' rolled-up sleeves, over the sleeve, or on the bare arm. This is an important day-to-day issue for the busy GP. METHODS: The sample consisted of 201 subjects in family practice clinics and residents of a senior citizens' home. A digital device was used in all cases. Each participant underwent three blood pressure measurements in each of the following conditions in random order: cuff on bare arm; cuff over the sleeve; and cuff below the rolled-up sleeve. Differences between measurements were plotted against the mean blood pressure. Confounding factors controlled for were age, sex, clothing pressure and skin-fold thickness. RESULTS: Differences in mean blood pressure readings between the clothed and bare arm were 0.5 mmHg (SD 7.5) for systolic pressure and 1 mmHg (SD 5) for diastolic pressure; neither difference was significant. However, in hypertensive subjects (>140 mmHg systolic), although the mean difference remained small (systolic pressure, 2 mmHg, SD 10), the range of difference for individual subjects was -32 mmHg to +22 mmHg. CONCLUSION: The degree of clothing under the sphygmomanometer cuff does not have a clinically important effect on the blood pressure measurement. In patients known or found to be hypertensive, measurement on the bare arm is recommended.