Age related progression of clinical measures and gait in ambulant children and youth with bilateral cerebral palsy without a history of surgical intervention

BackgroundAge related progression needs to be considered when assessing current status and treatment outcomes in cerebral palsy (CP).Research questionWhat is the association between age, gait kinematics and clinical measures in children with bilateral CP?MethodA retrospective database review was conducted. Subjects with bilateral CP with baseline and follow-up 3D gait analyses, but no history of intervening surgery were identified. Clinical and summary kinematic measures were examined for age related change using repeat measures correlation. Interactions with GMFCS classification and whether surgery was recommended were examined using robust linear regression. Timeseries kinematic data for baseline and most recent follow-up analyses were analysed using statistical parametric mapping.Results180 subjects were included. 75% of participants were classified as GMFCS I or II at baseline. Mean time to follow-up was 4.89 (2.8) years (range 1–15.9 years) with a mean age of 6.4 (2.4) at baseline and 11.3 (3.4) at final follow-up. 15.5% of subjects demonstrated an improvement in GMFCS classification while GDI remained stable. Age related progression was noted across many clinical measures with moderate correlations (r ≥ 0.5) noted for reduced popliteal angle, long lever hip abduction and internal hip rotation range. In gait, there was reduced hip extension in late stance (p < 0.001), increased knee flexion in mid-stance (p < 0.001), reduced peak knee flexion in swing (p < 0.001) and increased ankle dorsiflexion in stance (p < 0.001). In the coronal plane, there was reduced hip abduction in swing (p < 0.001). In the transverse plane, increased external rotation of the knee (p < 0.001) and reduced external ankle rotation were noted in early stance and through swing (p < 0.001). There were no changes in foot progression or hip rotation.SignificanceIndividuals with CP show age related progression of clinical and kinematic variables. Treatment can only be deemed successful if outcomes exceed or match these age-related changes.     

Prediction of labor outcome using serial transperineal ultrasound in the first stage of labor

Objective: The objective of this study is to evaluate the feasibility of predicting labor outcome using serial transperineal ultrasound (TPU) in the early active phase of labor.

Methods: This is a single center prospective observational study in a tertiary obstetrics unit in Hong Kong. Nulliparous women carrying singleton pregnancy at the onset of active phase of labor were recruited. Serial 3D volumes by TPU were acquired and then repeated after 1 and 2?h, which were subsequently analyzed for fetal head symphyseal distance (HSD), angle of progression (AoP), and fetal head progression distance (PD). The women were classified into two groups, according to whether they had vaginal delivery or cesarean section (CS) for reasons other than non-progressive labor (Group A) or CS for non-progressive labor (Group B). The TPU parameters were then compared between the groups.

Results: Group A consisted of 74 (60.0%) women with vaginal delivery, 27 (21.8%) with instrumental delivery and 3 (2.4%) CS for reasons other than non-progressive labor, while Group B consisted of 20 (16.1%) women who had a CS for non-progressive labor. Group B had a significant slower hourly progression rate of AoP, HSD, and PD at 1-h and 2-h from the initial assessment, compared with Group A. Multivariate logistic regression analysis demonstrated that PD progression at 2-h and the use of oxytocin were significant independent predictors for CS for non-progressive labor.

Conclusion: It is feasible to predict CS for non-progressive labor in the early active phase of labor by a slower rate of fetal head descent determined by TPU.     

Subclinical focal seizures as a sign of progression in gliomas

Background. Subclinical seizures are ictal electrographic discharges lacking signs of clinical seizures, behavioural alteration or subjective symptoms. The diagnosis and detection of this type of non‐convulsive seizures remain challenging, and information is scarce regarding this electroclinical picture in subjects with gliomas. The aim of this report is to describe two patients with gliomas who, after treatment with surgery and radiotherapy, exhibited subclinical seizures on video‐EEG monitoring, as a manifestation of recurrence or progression of their brain tumour. Methods. Case report and video‐EEG monitoring analysis. Results. Two patients with gliomas were admitted to our neurosurgical unit after a generalized tonic‐clonic seizure. Brain MRI revealed a recurrence of their tumour. The use of video‐EEG monitoring allowed the detection and characterization of subclinical seizures in both patients that otherwise would have gone undetected. In both cases, subclinical seizures arose from the frontal lobe and were not associated with motor manifestations or subjective symptoms. Conclusions. We emphasize that the existence of subclinical seizures in patients with gliomas is likely to be underestimated, and can occur in advanced progressive tumours. It is important to carry out continuous video‐EEG monitoring in brain tumour patients who have had recent clinical seizures in order to be able to detect subclinical seizures and make appropriate diagnosis.     

多靶联合治疗在进展性脑卒中治疗中的临床应用价值

目的探讨和分析进展性脑卒中多靶联合治疗的临床效果与安全性。方法选取该院自2012年11月—2013年10月收治的进展性脑卒中患者共172例,按照随机原则分成观察组和对照组,对照组给予参麦、单唾液酸四己糖神经节苷脂与低分子肝素进行治疗,观察组则在对照组的基础上另外加用药物巴曲酶注射液,然后对比该两组患者的治疗效果和不良临床事件的发生状况。结果经治疗后,观察组患者的总有效率为89.8%,明显高于对照组患者的72.9%,在治疗以后的第11天,观察组血纤维蛋白原（FIB）指标明显低于对照组患者,但是两组间的活化部分凝血酶原时间（APTT）以及凝血酶原时间（PT）指标对比,没有明显的差异,该两组患者均没有明显的并发症发生。结论对于进展性脑卒中患者,通过抗凝、降纤及抗血小板聚集等多靶联合治疗,效果明显,且不良临床事件的发生率低,值得临床推广。     

Dynamic interplay between autophagic flux and Akt during melanoma progression in vitro

Despite advances in cancer diagnosis and therapy, metastatic melanoma remains untreatable, due to its notorious resistance to apoptosis, deeming traditional therapies obsolete. Deregulated PI3K/Akt signalling is a common oncogenic event enabling melanocyte transformation and represents a significant and ‘druggable’ pathway in melanoma. Emerging data show that the ability of cancer cells to survive is also facilitated by alteration of vital homoeostatic mechanisms, such as autophagy. Although the role of autophagy in melanoma is still controversial, recent studies suggest that basal autophagy is down‐modulated in primary melanomas. However, the dynamic connection between pro‐tumorigenic PI3K/Akt and autophagy during melanoma progression has not been systematically studied. By using human primary melanocytes, incipient melanoma and metastatic melanoma cell lines, we show that early in melanomagenesis, increased Akt activity is associated with a low baseline autophagic flux. However, during melanoma progression, metastatic melanoma cells regain the ability to stimulate autophagic flux, supporting survival. Heightened autophagy is associated with an attenuated Akt activation status and can be suppressed by overexpressing a constitutive active mutant of Akt. On the other hand, blocking the higher Akt activity of primary melanoma is sufficient to incite autophagy. Interestingly, we found that although Akt supports survival of melanocytes and all melanoma cell lines, autophagy inhibition specifically targeted the metastatic melanoma cells, thus indicating a stage‐specific requirement for Akt and autophagic flux, throughout melanoma progression. Therefore, this study highlights a dynamic interplay between Akt signalling and autophagic rescue in melanoma, which should be considered in the design of therapeutic strategies targeting these pathways.     

Association of X4 tropism with disease progression in antiretroviral-treated children and adolescents living with HIV/AIDS in São Paulo,Brazil

Management of children with HIV/AIDS is specially challenging. Age-related issues do not allow for direct transposition of adult observations to this population. CXCR4 tropism has been associated with disease progression in adults. The geno2pheno web-base is a friendly tool to predict viral tropism on envelope V3 sequences, generating a false positive rate for a CXCR4 prediction. We evaluated the association of HIV-1 tropism prediction with clinical and laboratory outcome of 73 children with HIV/AIDS in São Paulo, Brazil. The CXCR4 tropism was strongly associated with a lower (nadir) CD4 documented during follow-up (p < 0.0001) and with disease severity (clinical event and/or CD4 below 200 cells/mm³) at the last observation, using commonly applied clinical cutoffs, such as ^10%FPR_clonal (p = 0.001). When variables obtained during follow-up are included, both treatment adherence and viral tropism show a significant association with disease severity. As for viremia suppression, 30% (22/73) were undetectable at the last observation, with only adherence strongly associated with suppression after adjustment. The study brings further support to the notion that antiretroviral treatment adherence is pivotal to management of HIV disease, but suggests that tropism prediction may provide an additional prognostic marker to monitor HIV disease in children.     

Outcomes of Patients with Hepatocellular Carcinoma Treated with Conventional Transarterial Chemoembolization Using Guidance Software

Purpose

To evaluate the outcomes of conventional transarterial chemoembolization using guidance software for hepatocellular carcinoma (HCC) patients.

进展性脑卒中的相关危险因素分析

目的:探讨影响进展性脑卒中(stroke in progression,SIP)的主要危险因素。方法:回顾分析106例急性脑卒中患者的临床资料,其中SIP患者(SIP组)54例,年龄、性别相匹配的非SIP患者(非SIP组)52例。比较两组患者中有吸烟史、饮酒史、发热以及高血压、高血糖、高血脂患者的比例,分析并比较两组患者颈部血管超声、头颅磁共振血管造影(magnetic resonance angiography,MRA)等检查结果。对各危险因素进行单因素分析。结果:两组患者的年龄、性别差异无统计学意义(P0.05)。与非SIP组相比,SIP组有高血压、高血糖、高尿酸血症、发热及颈部/颅内外大血管狭窄患者的比例较高(P0.05);其他因素如冠心病、高脂血症、脑卒中史、吸烟以及饮酒在两组间差异无统计学意义(P0.05)。结论:高血压、高血糖、高尿酸、发热以及颅内外血管狭窄是SIP的主要危险因素。