Serum amyloid A as a marker to detect sepsis and predict outcome in hospitalized neonatal foals.

BACKGROUND: Serum amyloid A (SAA) has been reported to hold promise as diagnostic and prognostic marker in foals. This has not been investigated thoroughly. OBJECTIVES: Evaluate admission SAA concentrations as predictor of sepsis and outcome. ANIMALS: Five hundred and ninety hospitalized foals <14 days old. METHODS: Retrospective multicenter study. Foals were scored with sepsis and survival scores, grouped according to health category (septic, sick but nonseptic, uncertain sepsis status) and outcome; septic foals were further categorized according to severity (normal sepsis, severe sepsis, and septic shock). SAA was compared between groups using Mann-Whitney test and Kruskal-Wallis test. Receiver operating characteristic curves identified optimal SAA cut off values for detecting sepsis and predicting outcome. RESULTS: Admission SAA concentrations differed significantly between sick nonseptic foals (312.1 ± 685.4 mg/L) and septic foals (1079.7 ± 1254.5 mg/L) and increased with increasing sepsis score. SAA did not differ between sepsis severity groups. The optimal cut off for sepsis detection was 1050 mg/L (sensitivity 30.2%, specificity 90.7%). Admission SAA concentrations were lower in surviving (435.0 ± 723.6 mg/L) compared to nonsurviving foals (1062.7 ± 1440.1 mg/L) and decreased with increasing survival score. The optimal cut off for nonsurvival prediction was 1250 mg/L (sensitivity 22.1%, specificity 90.8%). CONCLUSIONS AND CLINICAL IMPORTANCE: SAA concentration was higher in septic foals and nonsurviving foals. Even though optimal cut offs for SAA to detect sepsis and predict outcome had low sensitivity, they had good specificity. SAA can therefore be used as a marker to rule out sepsis and nonsurvival.

Evaluation of the foal survival score in a Danish-Swedish population of neonatal foals upon hospital admission.

BACKGROUND: It is highly desirable to assess the probability of survival in sick neonatal foals upon admission. The foal survival score (FSS) is a published scoring system used to estimate the probability of survival in hospitalized neonatal foals <4 days old. HYPOTHESIS/OBJECTIVES: To evaluate the ability of the FSS to predict survival in older foals from a geographically different area compared to the original study. ANIMALS: Five-hundred ninety hospitalized neonatal foals ≤14 days of age. METHODS: Retrospective Danish-Swedish multicenter study that included details of signalment, history, clinical examination, laboratory results, necropsy findings, and outcome. Scores and score variables were compared between survivors and nonsurvivors using logistic regression. The optimal cutoff and its test parameters were calculated using a receiver operator characteristic curve. RESULTS: Prematurity, cold extremities, ≥2 infectious or inflammatory sites, blood glucose concentration, and total white blood cell counts were significantly associated with nonsurvival (P ≤ .02). The optimal cutoff to predict survival was ≥6, resulting in sensitivity 78%, specificity 58%, 92% positive predictive value, and 31% negative predictive value. The test performed equally well in foals <4 days old compared to those 4-14 days old. CONCLUSIONS AND CLINICAL IMPORTANCE: Using the suggested optimal cutoff of ≥6, the FSS performed moderately well and may aid in early determination of prognosis for survival. However, the FSS did perform differently in another population and therefore should be assessed under local conditions so that its diagnostic potential is not overestimated.

Lawsonia intracellularis associated equine proliferative enteropathy in Danish weanling foals.

BACKGROUND: Lawsonia intracellularis, an obligate intracellular bacterium, causes equine proliferative enteropathy, mainly in horses around weaning. This disease is rarely reported in the Scandinavian countries. RESULTS: Five cases of equine proliferative enteropathy were diagnosed between 2008-2016 at the University of Copenhagen Large Animal Teaching Hospital. Cases were Danish Warmbloods and a Friesian horse, aged 6-7 months, presenting with typical clinical signs of lethargy, poor body condition, pyrexia and diarrhea. Clinical pathology was consistent with previous reports of severe hypoalbuminemia and leukocytosis. Diagnosis was confirmed by fecal polymerase chain reaction, serum immunomonolayer peroxidase assay and/or immunofluorescence and fluorescence in situ hybridization performed on formalin-fixed ileum samples. Concurrent intestinal parasitism was present in all five cases. Treatment consisted of antimicrobial therapy, anti-inflammatories, intravenous crystalloids and plasma. Three foals were euthanised due to deterioration and poor response to treatment, one with complications of septic arthritis and Strongylus vulgaris associated intestinal infarct. The other two foals survived and were reported by the owners to be healthy on long-term follow-up. CONCLUSIONS: Equine proliferative enteropathy is a disease to consider in young horses presenting with diarrhea and hypoproteinemia in Denmark.

Updated Swedish advice on reducing the risk of sudden infant death syndrome.

UNLABELLED: This article reviews updated advice and factual material from the Swedish National Board of Health and Welfare on reducing the risk of sudden infant death syndrome. Issues covered by the guidance for parents and healthcare professionals include sleeping positions, smoking, breastfeeding, bed sharing and using pacifiers. CONCLUSION: The guidelines conclude that infants under three months of age are safest sleeping in their own cot and that a pacifier can be used when they are going to sleep.

The immediate effect of kinesiology taping on muscular imbalance in the lateral flexors of the neck in infants: a randomized masked study.

OBJECTIVE: To investigate the immediate effect of kinesiology taping (KT) on muscular imbalance in the lateral flexors of the neck. DESIGN: Randomized controlled trial. PARTICIPANTS: Twenty-nine infants with congenital muscular torticollis and muscular imbalance in the lateral flexors of the neck were chosen consecutively. In addition, 5 healthy infants with no signs of muscular imbalance in the neck were tested. METHOD: The infants were randomly allocated to either an intervention group or a control group. The intervention group had kinesiology taping applied on the affected side using the muscle-relaxing technique. The healthy infants were tested both with and without kinesiology taping. The evaluator was blinded to whether the infants were or were not taped. RESULTS: There was a significant difference in the change of Muscle Function Scale (MFS) scores between the groups (P < .0001). In the intervention group, there were significantly lower scores on the affected side that had been taped (P < .0001) and also significantly higher scores on the unaffected side (P = .01). There were no significant differences in the control group. For the healthy infants, with no imbalance in the lateral flexors of the neck, there were no changes to the MFS scores regardless of whether the kinesiology tape was applied. CONCLUSIONS: For infants with congenital muscular torticollis, kinesiology taping applied on the affected side had an immediate effect on the MFS scores for the muscular imbalance in the lateral flexors of the neck.

Children who had congenital torticollis as infants are not at higher risk for a delay in motor development at preschool age.

OBJECTIVE: To investigate whether congenital muscular torticollis (CMT) or the time in a prone position as an infant had any influence on motor development at preschool age. DESIGN: A case-control study. PARTICIPANTS: Eighty-one children who had participated in a previous study that investigated motor development in infants with CMT and a control group of infants without CMT. METHOD: A follow-up at the age of 3.5-5 years; the Movement Assessment Battery for Children was used with the earlier CMT group and the control group to assess their motor development. An independent physiotherapist, who was blinded of the children's previous group belonging, assessed the children. MAIN OUTCOME MEASUREMENTS: Percentile scores of motor development. RESULTS: Multiple regression showed no impact on earlier group belonging or the amount of time spent in a prone position as an infant. The left-handed children had a significantly (P < .01) lower percentile in the Movement Assessment Battery for Children. CONCLUSION: Neither CMT nor spending limited periods of time as an infant in the prone position when awake have any significant long-term effects on motor development. Children who had CMT as infants were not at higher risk for a delay in motor development at preschool age.

Qualitative interviews with adolescents about "friends-with-benefits" relationships.

OBJECTIVE: To describe the thoughts, reflections, and experiences of friends-with-benefits relationships among a group of Swedish adolescents. DESIGN AND SAMPLE: A qualitative study with an explorative and descriptive design. Eight adolescents, aged 16-18, were interviewed. MEASURES: Individual in-depth interviews were undertaken. Data were analyzed using latent content analysis. RESULTS: The informants involved themselves in Friends-with-benefits (FWB) relationships to find physical and psychological intimacy without any expectations or demands. FWB relationships were perceived to have more advantages when the partner was a close friend with whom an informant felt comfortable. There was ambivalence about the legitimacy of romantic feelings in an FWB relationship, although it was quite common. Sexual concurrency was common and often accepted. Sexual risk-taking behavior involving the use of alcohol and a lack of contraception was considered common in FWB relationships. Informants requested more education and support as regards their sexual behavior. CONCLUSIONS: FWB relationships were often initiated to find physical and psychological intimacy with no expectations or demands. Advantages such as sexual concurrency and no demands were central. A deeper understanding of how adolescents think and reason about sexuality and relationships can make a difference when working to improve young people's sexual and reproductive health.

A pilot study on changes in passive range of motion in the cervical spine, for children aged 0-5 years.

BACKGROUND: The aim of this study was to investigate the values for passive range of motion (PROM) in rotation and lateral flexion of the neck, for children aged 3.5-5 years, and to compare the results with the measurements carried out on the same group of children as infants. METHOD: Twenty-three children (10 females) were assessed in PROM in rotation and lateral flexion of the neck. Both measurements were performed with the children in a lying position using a large protractor. The dependent t-test was used to compare PROM with the PROM from an earlier study when the children were infants. RESULT: PROM of the neck was found to be a mean 100° in rotation and 70° in lateral flexion at the age of 3.5-5 years. There was a significant decrease in rotation when comparing the measurements with values from infancy. CONCLUSIONS: These data suggest that there is a decrease in PROM in rotation during the first 5 years of life, and that PROM in lateral flexion remains unchanged.

Pain, balance, activity, and participation in children with hypermobility syndrome.

PURPOSE: To describe hypermobility, balance, pain, activity, and participation in children with hypermobility and compare these characteristics with those of a control group. METHOD: Twenty children aged 8 to 16 years with hypermobility syndrome (HMS) or Ehlers-Danlos syndrome and a control group of 24 children of the same age participated in the study. Hypermobility was assessed according to the Del Mar scale, balance was assessed with the Bruininks-Oseretsky test of motor proficiency, and participation in daily life activities was assessed with the frequency of participation questionnaire. Pain and physical activity were assessed in a diary. RESULTS: In comparison with the control group, the children with hypermobility had significantly more hypermobile joints and more pain and scored lower in the balance test, and their activity was affected on a daily basis. CONCLUSION: Pain appears to affect activity and participation in children with HMS. Balance is decreased in children with HMS compared with healthy controls.

The immediate effect of kinesiology taping on muscular imbalance for infants with congenital muscular torticollis.

OBJECTIVE: To investigate the immediate effect of kinesiology taping (KT) on muscular imbalance in the lateral flexors of the neck. DESIGN: A retrospective study. PARTICIPANTS: Twenty-eight infants with congenital muscular torticollis and muscular imbalance in the lateral flexors of the neck were chosen consecutively. METHODS: Data regarding the Muscle Function Scale (MFS) score before and after the first taping session were obtained from the records. RESULTS: A significant decrease in the difference between the MFS scores was found after KT was applied (P < .001). Significantly greater scores were noted on the unaffected side after KT (P = .02) and significantly lower scores were noted on the affected side after KT (P = .003). Multiple regression demonstrated that the MFS score on the unaffected side (P < .001) and use of the muscle-relaxing technique (P = .009) were significantly associated with a decrease in the difference between the MFS scores of the 2 sides. CONCLUSIONS: KT has an immediate effect on muscular imbalance in infants with congenital muscular torticollis.

The inter-rater and intra-rater reliability of a modified "severity scale for assessment of plagiocephaly" among physical therapists.

Infants with congenital muscular torticollis (CMT) are at risk of developing skull asymmetry. The aim of this study was to investigate the inter-rater and intra-rater reliability of a modified "severity scale for assessment of plagiocephaly" among physical therapists (PT). Thirty-nine members of a network of PTs working with infants with CMT participated in the study. Photos of infants were used in this study. They were taken from above (superior view) to estimate posterior flattening and forehead asymmetry, and from the front (anterior view) to estimate neck involvement and facial asymmetry. The photos were coded and sent to the PTs together with instructions and a protocol for estimation. A second estimate was carried out with the same photos in a different order. The PTs also answered questions concerning their experience of CMT and the scale used. The participants had worked as PTs for an average of 20 years, and with CMT for an average of 7 years. The inter-rater reliability kappa was 0.71, and the intra-rater reliability was mean 0.68. Intra-rater reliability was significantly higher for years of experience and for years working with CMT. There was no significant impact on reliability in relation to how many infants the PTs usually examine yearly, whether they found the scale easy to use, or how much experience they had using it. In conclusion, the modified "severity scale for assessment of plagiocephaly" has satisfying statistical agreement. Reliability is affected by the number of years of experience of the PTs.

Evaluation of treatment strategies for muscle function in infants with congenital muscular torticollis.

This study focuses on the treatment of the muscle function imbalance and asymmetric head posture for infants with congenital muscular torticollis (CMT). The aim of this study was to compare treatment time for groups with different strategies for muscle function training. The treatment goal was to achieve a symmetric head posture. Thirty-seven infants were randomised to three groups. Group I was treated only with handling strategies. Group II got the same handling strategies but also received specific strength exercises. Group III received the same treatment as group II but was also provided with weekly training by a physiotherapist. Mean age at the start of treatment was 4.5 months of age, range 1-10.5. The possible effect of covariates was also investigated; age at the start of treatment, range of motion (ROM) in rotation of the neck, ROM in lateral flexion of the neck, the muscle function scale (MFS) score, plagiocephaly, and gender were analysed with ANCOVA. Thirty-one treated infants achieved symmetric head posture before the age of 12 months. Mean treatment time (3.5 month) did not differ significantly between the groups. All infants randomised to group I could stay in that group. The MFS score and age at the start of the treatment influenced treatment time (p < 0.05). The treatment time for all groups was similar. Early referral to physical therapy of infants with CMT and muscle function imbalance in lateral righting could shorten treatment time. Studies about natural course and long-term effects of muscular imbalance must be investigated in future research.

Stretching treatment for infants with congenital muscular torticollis: physiotherapist or parents? A randomized pilot study.

OBJECTIVE: To investigate the time needed to achieve a good result in the range of motion (ROM) in the neck for infants with congenital muscular torticollis (CMT). DESIGN: Comparison of stretching treatments performed by physical therapists and parents. PARTICIPANTS: Twenty infants (10 female and 10 male) with CMT. METHOD: The infants were randomly assigned to 1 of 2 groups. Stretching treatment was continued until a good ROM was obtained in both rotation (≥ 90°) and lateral flexion (no side difference). The main outcome measurement was treatment time. The infants were evaluated for ROM in rotation and lateral flexion, muscle function in the lateral flexor muscles of the neck, plagiocephaly, and head tilt. RESULTS: The time needed to achieve a good result according to the ROM in the neck was significantly shorter (P < .001) in the physical therapist group than in the parent group. Symmetrical head posture was achieved sooner (P = .03) in the physical therapist group. CONCLUSION: Infants with CMT gained good ROM and symmetric head posture approximately 2 months sooner when treated by an experienced physical therapist; however, interpretation of the results of this small study should be guarded. Further studies are needed to confirm these results.

Validity and reliability of the muscle function scale, aimed to assess the lateral flexors of the neck in infants.

Infants with congenital muscular torticollis (CMT) often have an imbalance in muscle function in the lateral flexors of the neck, and the need for a valid and reliable assessment tool to determine muscle function in these muscles is essential. The lateral uprighting response is used to examine and to strengthen the sternocleidomastoid muscle. A Muscle Function Scale (MFS) has been refined and used for several years in a clinic for infants with CMT. The MFS describes an infant's muscle function in the lateral flexors of the neck through ordered categorical scores. The aim of this study was to find out if the muscle function scale (MFS) is valid and reliable. A panel of experts examined validity, and the kappa statistic and intraclass correlation coefficient were calculated for interrater and intrarater reliability. The MFS is found to be a valid tool to measure the muscle function of the lateral flexors of the neck in infants with CMT. The interrater and intrarater reliability is high for both novice and experienced physiotherapists (kappa>0.9; ICC>0.9).

Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants?

Recently it has been claimed that infants with congenital muscular torticollis (CMT) are at risk of a delay in early motor milestones. The aim of the present study was to investigate whether infants with CMT are indeed at risk in comparison with a control group of healthy infants. A second aim was to investigate whether the time spent in a prone position and plagiocephaly had any influence on motor development. Eighty-two infants with CMT (35 females and 47 males) were compared with 40 healthy infants (18 females and 22 males). Motor development was assessed with the Alberta Infant Motor scale (AIMS). Multiple regression showed that infants in the CMT group had a significantly lower AIMS score than the control group at 2 months (p=0.03) and 6 months of age (p=0.05). Infants who spent at least three occasions daily in a prone position when awake had significantly higher AIMS scores than infants who spent less time prone at 2 months (p=0.001), 6 months (p<0.001), and 10 months of age (p<0.001). The CMT group achieved early motor milestones significantly later than the control group until the age of 10 months, but the risk of delay seems to be more strongly associated with little or no time prone when awake than with CMT.

Reference values for range of motion and muscle function of the neck in infants.

PURPOSE: To determine reference values for cervical range of motion (ROM) in rotation and lateral flexion and for muscle function in the lateral neck flexors in a sample of infants who were healthy. METHOD: ROM was measured, and muscle function was estimated in 38 infants at the ages of 2, 4, 6, and 10 months. RESULTS: For rotation the mean ROM was 110 degrees and for lateral flexion it was 70 degrees. Infants of 2 months of age had a median muscle function score of 1 (interquartile range, 1-2). Muscle function increased to score 3 to 4 by 10 months. CONCLUSION: Infants below 1 year of age have good ROM in rotation (> or = 100 degrees ) and lateral flexion (> or = 65 degrees ) of the neck. These reference values for passive ROM and muscle function of the neck may have clinical utility in assessing and documenting the initial evaluation and progress of infants with congenital muscular torticollis.

Steric Modulation of Electrocatalytic Benzyl Alcohol Oxidation by [Ru(trpy)(R(2)dppi)(O)](2+) Complexes.

The complexes [Ru(trpy)(H(2)dppi)Cl](+) (1a), [Ru(trpy)(Me(2)dppi)Cl](+) (1b), and [Ru(trpy)(Cl(2)dppi)Cl](+) (1c), where trpy is 2,2',2"-terpyridine, H(2)dppi is 3,6-bis(pyrid-2-yl)pyridazine, Me(2)dppi is 3,6-bis(6-methylpyrid-2-yl)pyridazine, and Cl(2)dppi is 3,6-bis(6-chloropyrid-2-yl)pyridazine, were synthesized and characterized by UV-visible and (1)H NMR spectroscopy. Compounds 1a and 1b were additionally characterized by X-ray crystallography. [Ru(trpy)(H(2)dppi)Cl](PF(6)).2CH(3)CN crystallizes in the triclinic space group, P&onemacr;, with a = 8.628(1) Å, b = 14.586(2) Å, c = 14.963(2) Å, alpha = 70.857(8) degrees, beta = 77.70(1) degrees, gamma = 74.29(1) degrees, V = 1696.5(4) Å(3), and Z = 2; R(1) = 0.0739 (I > 2sigma(I)) with 5920 unique reflections. [Ru(trpy)(Me(2)dppi)Cl](PF(6)).0.5(CH(3)CH(2))(2)O crystallizes in the triclinic space group P&onemacr;, with a = 8.820(2) Å, b = 13.580(2) Å, c = 15.260(2) Å, alpha = 88.84(1) degrees, beta = 74.25(1) degrees, gamma = 73.27(1) degrees, V = 1681.4(5) Å(3), and Z = 2; R(1) = 0.0693 (I > 2sigma(I)) with 4407 unique reflections. Reaction of 1a, 1b, and 1c with aqueous silver ion produces the corresponding aqua complexes, 2a, 2b, and 2c, which, after dissolution in acetonitrile, form the analogous acetonitrile complexes, 4a, 4b, and 4c. [Ru(trpy)(H(2)dppi)(CH(3)CN)](PF(6))(ClO(4)).2 CH(3)CN, 4a, crystallizes in the triclinic space group P&onemacr;, with a = 12.376(1) Å, b = 12.835(2) Å, c = 13.029(2) Å, alpha = 109.252(9) degrees, beta = 102.766(8) degrees, gamma = 90.847(9) degrees, V = 1896.9(3) Å(3), and Z = 2; R(1) = 0.0397 (I > 2sigma(I)) with 4844 unique reflections. {[Ru(trpy)(Cl(2)dppi)(CH(3)CN)](ClO(4))(2)}(2).CH(3)CN, 4c, crystallizes in the triclinic space group, P&onemacr;, with a = 13.075(2) Å, b = 16.807(3) Å, c = 17.913(2) Å, alpha = 70.83(1) degrees, beta = 89.76(1) degrees, gamma = 82.44(1) degrees, V = 3682.6(1) Å(3), and Z = 2; R(1) = 0.0777 (I > 2sigma(I)) with 9459 unique reflections. The redox properties of 1a, 1b, 1c, 2a, 2b, and 2c were examined using cyclic voltammetry and spectroelectrochemistry. In acetonitrile, compounds 1a, 1b, and 1c display reversible 1e(-) waves assigned to the Ru(III)/Ru(II) couple, while, in aqueous solutions, 2a, 2b, and 2c show pH-dependent, 2e(-) waves corresponding to the formation of Ru(IV)=O complexes. Second-order rate constants, k(cat), for benzyl alcohol oxidation by the Ru(IV)=O complexes were determined electrochemically, yielding values of 22(1) M(-)(1) s(-)(1) for [Ru(trpy)(H(2)dppi)(O)](2+), 9(3) M(-)(1) s(-)(1) for [Ru(trpy)(Me(2)dppi)(O)](2+), and 6(4) M(-)(1) s(-)(1) for [Ru(trpy)(Cl(2)dppi)(O)](2+). Interestingly, the Ru(IV)=O complex with the highest reduction potential ([Ru(trpy)(Cl(2)dppi)(O)](2+)) is the slowest catalyst for benzyl alcohol oxidation. The unusual driving-force dependence of the oxidation rates exhibited by these complexes can be attributed to steric effects that result from incorporating chloro or methyl groups into the 6- and 6'-positions of the dppi ligand. These data are consistent with a mechanism in which the rate-determining step involves preassociation of the substrate with the Ru(IV)=O unit.