Neurovascular complications post bronchial artery embolisation in patients with cystic fibrosis. A 7-year single centre retrospective review.

Bronchial artery embolisation (BAE) is a treatment used to manage haemoptysis. We performed a 7-year review of BAE procedures for haemoptysis at our CF centre aiming to evaluate the incidence and outcomes of patients with neurovascular complications post-BAE. Our review suggests that whilst BAE is an effective method for controlling life-threatening haemoptysis, patients are at risk of developing neurovascular complications with long term residual symptoms, and therefore careful consideration should be given in offering BAE, especially to otherwise well patients with chronic small volume haemoptysis and managing teams should have a low threshold to image symptomatic patients.

Endovascular Hepatic Artery Stents in the Modern Management of Postpancreatectomy Hemorrhage.

Background: Postoperative hemorrhage is a potentially lethal complication of pancreatoduodenectomy. This study reports on the use of endovascular hepatic artery stents in the management of postpancreatectomy hemorrhage. Methods: This is a retrospective analysis of a prospectively maintained, consecutive dataset of 440 patients undergoing pancreatoduodenectomy over 68 months. Data are presented on bleeding events and outcomes, and contextualized by the clinical course of the denominator population. International Study Group of Pancreatic Surgery terminology was used to define postpancreatectomy hemorrhage. Results: Sixty-seven (15%) had postoperative hemorrhage. Fifty (75%) were male and this gender difference was significant (P = 0.001; 2 proportions test). Postoperative pancreatic fistulas were more frequent in the postoperative hemorrhage group (P = 0.029; 2 proportions test). The median (interquartile range [IQR]) delay between surgery and postoperative hemorrhage was 5 days (2-14 days). Twenty-six (39%) required intervention comprising reoperation alone in 12, embolization alone in 5, and endovascular hepatic artery stent deployment in 5. Four further patients underwent more than 1 intervention with 2 of these having stents. Endovascular stent placement achieved initial hemostasis in 5 of 7 (72%). Follow-up was for a median (IQR) of 199 days (145-400 days) poststent placement. In 2 patients, the stent remained patent at last follow-up. The remaining 5 stents occluded with a median (IQR) period of proven patency of 10 days (8-22 days). Conclusions: This study shows that in the specific setting of postpancreatoduodenectomy hemorrhage with either a short remnant gastroduodenal artery bleed or a direct bleed from the hepatic artery, where embolization risks occlusion with compromise of liver arterial inflow, endovascular hepatic artery stent is an important hemostatic option but is associated with a high risk of subsequent graft occlusion.

Validation of the Timed Up and Go Test for Assessing Balance Variables in Adults Aged 65 and Older.

The Timed Up and Go (TUG) test is recommended by the U.S. Centers for Disease Control and Prevention as an easy to administer clinical test to evaluate a senior citizen's fall risk. Limited evidence has been presented in the literature validating the TUG test. In this study, the authors sought to assess correlations between the TUG test and various balance markers utilizing the OptoGait system. A total of 51 healthy seniors completed randomized trials of the TUG test and a gait test utilizing OptoGait photoelectric technology. Correlations among mean and SD values for these variables and TUG performance were calculated. Utilizing a Bonferroni adjustment and an alpha level of .05, eight significant correlations of a moderately strong degree (absolute r scores between .51 and .78) emerged. Correlation results indicate that the TUG test is a valid tool for screening balance deficits that lead to increased fall risk in senior citizens.

PACER Performance of Children Aged 11-14 With Attention-Deficit Hyperactive Disorder.

PURPOSE: The purposes of this study were to examine the performance on the progressive aerobic cardiovascular endurance run (PACER) test in children with and without attention-deficit hyperactive disorder (ADHD) over the course of a school year, and also to investigate the possible influence of age, sex, school sport participation, and body mass index on results. METHODS: Utilizing a repeated measures design, 892 middle school children aged 11-14 years (mean = 12.25, SD = 0.94) including 55 children with ADHD participated. While controlling for age, sex, sports participation, and body mass index, children were tested on the PACER 3 times during the school year. Procedures specified in the FITNESSGRAM test manual were explicitly followed. Hierarchical linear modeling was applied to analyze the data. RESULTS: Children with ADHD performed 8.6 fewer laps at intercept (baseline), than did healthy children without ADHD (t878 = -6.20, P < .001). However, no significant differences emerged for time (slope). In addition, no significant interactions were found for ADHD with age, sex, sports participation, or body mass index. CONCLUSION: A diagnosis of ADHD, independent of selected predictor variables, explained lower PACER performance.

Validation of the OptoGait System for Monitoring Treatment and Recovery of Post-Concussion Athletes.

OBJECTIVE: This study sought to investigate correlations between OptoGait motion analysis technology and 2 commonly used concussion assessment instruments, the Balance Evaluation Scoring System (BESS) and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized neurocognitive assessment software, to see if OptoGait might be a valid concussion assessment tool. METHODS: Twenty Division-1 college women varsity soccer players completed trials of 8 different conditions of the OptoGait test battery. Then participants completed the BESS and ImPACT tests. One hundred twenty-eight total spatiotemporal variables were recorded for each trial of OptoGait. Pearson's r correlations among these variables and BESS and ImPACT results were calculated, and pattern analysis was completed to evaluate for emergent patterns in the data. RESULTS: Correlations for the 8 OptoGait mean-score subtests were related to the balance double-leg foam test (BESS). Correlations for the 8 OptoGait mean-score subtests were related to the balance double-leg foam test (BESS), and correlations between OptoGait standard deviation measures and the balance tandem hard surface test (BESS) both indicated potentially significant patterns. No consistent patterns of correlation existed between the OptoGait variables and the ImPACT results. CONCLUSION: OptoGait conditions correlate at higher than predicted rates with subtests of the BESS instruments but not the ImPACT measures.

Predictors of Speed Using Off-Ice Measures of College Hockey Players.

The purpose of this study was to examine the relationship between commonly employed dry-land performance tests and skating speed in male collegiate ice hockey players. Forty male National Collegiate Athletic Association Division I hockey players were tested on the following performance variables: vertical jump (VJ), standing broad jump, 40-yard dash, and maximal back squat (SQT). The subjects also performed 3 skating tests: the 90-ft forward acceleration test, the 90-ft backward acceleration test, and the 50-ft flying top speed test (F50). Pearson correlation coefficients were applied to compare the strength of association between each selected off-ice measure and each on-ice measure. Three multiple regression equations were then used to compare the weighted strengths of association between predictor and criterion variables. Only VJ showed significance in relation to skating speed (p = 0.011). These results suggest that meaningful performance testing in ice hockey players should occur mainly on the ice.

Performance by middle school children with and without asthma on the pacer.

Asthma is a chronic lung disease characterized by airway hyper-reactivity, inflammation, and obstruction. Asthma is also a leading cause of school absenteeism, and thus of concern to physical educators and health professionals. The purpose of this study was to assess aerobic performance by children with and without asthma. All participants were tested on the Progressive Aerobic Cardiovascular Endurance Run (PACER). Of particular interest was children's aerobic performance over an extended time, i.e., 15 months. Participants (Grades 4-8, N=809) were tested on the PACER three times during the school year with two follow-up tests during the succeeding school year. Among the 809 participants were 103 children with mild-moderate asthma. Hierarchical Linear Modeling (HLM) was applied to analyze the data. Notwithstanding their lower scores at baseline (intercept), children with asthma increased their PACER scores at a rate more than double that of their peers without asthma. Although more than one PACER trial may be needed to accurately determine children's aerobic performance, repeated trials may be especially necessary for children with asthma. It was further concluded that the PACER is an effective tool with which to assess aerobic performance by middle school children with well-managed asthma.

A therapeutic conundrum: recurrent cystic-fibrosis-related haemoptysis complicated by acute pulmonary embolism.

The authors present the case of an older patient with cystic fibrosis (CF) and recurrent haemoptysis complicated by acute pulmonary embolism. The patient was treated successfully with a combination of anticoagulation and bronchial artery embolisation. The management of CF-related haemoptysis, the impact of an ageing CF population and the incidence of thromboembolic disease in CF are discussed.

Age and sex differences in object control skills by children ages 5 to 14.

Object control skills provide children the tools to be physically active-a major societal priority. At the fundamental movement level, object control skills form the foundation of further sports skill development. The purpose of this study was to examine children's (ages 5 to 14 years, Grades K-8) development of four key object control skills: catching, throwing, kicking, and striking. 186 children were tested on selected items from the Object Control Subtest of the Test of Gross Motor Development-2, using a cross-sectional and correlational design. As anticipated, significant differences were found for age on all four skills. These improvements were characterized by early, rapid gains at ages 9 to 10, beyond which development occurred at a slower rate for catching, throwing, and kicking; striking development continued at a steady rate to age 14 years. Contrary to previous findings, no overall sex differences were found for catching or kicking. Overall sex differences favoring boys were observed for throwing and striking. Implications for evolutionary contributions to throwing and striking were discussed.

Grip strength performances by 5- to 19-year-olds.

Accurate measures of muscular strength can yield insights about children's growth and development. The purpose of this study was to examine grip strength performances by boys and girls ages 5 to 19 years. A Jamar dynamometer was used to measure grip strength by 736 boys and girls ages 5 to 19 years. Multiple regression equations were applied to analyze the data. Overall, age-sex trends were similar to previous reports as boys and girls increased their performances across age levels. After age 12, boys' mean grip strength increased at a faster rate than girls'. However, participants in the present study performed better in the upper age ranges (13-19 yr.) than did boys and girls tested a generation ago. Potential associations between activity choices and grip strength are discussed.

Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava.

We present an interesting case of a symptomatic high flow AV fistula between the right common iliac artery (CIA) and the inferior vena cava (IVC), successfully treated by endovascular coil embolization. The patient was found to have a right lower polar renal artery crossing the ipsilateral ureter arising from the CIA, causing pelvi-ureteric junction (PUJ) obstruction and recurrent pyelonephritis. It is hypothesized that this fistula arising from the lower polar renal artery and entering the IVC, may have occurred as a result of trauma during a previous pyeloplasty, or a pathologically induced process of angiogenesis stemming from recurrent pyelonephritis.

Development of catching by children in kindergarten to grade 8: a multicohort longitudinal study.

The purpose of this study was to examine developmental change associated with catching by children in Grades Kindergarten through 8. Children's performance was tested on the Catching Subtest of the Ohio State University Scale of Intra Gross Motor Assessment (OSU-SIGMA). More precisely, four cohorts of boys and girls in Grades K-8 (N = 340) from 1992 to 2000: in 1992 Grades K-8, in 1994 Grades 2-8, in 1996 Grades 4-8, and in 1998 Grades 6-8. In 2000, the original Kindergarten cohort was tested again. Data, analyzed by hierarchical nonlinear modeling, yielded significant differences in mean initial status (intercept) of all three cohorts, in mean growth rate (slope) for the K-8 cohort only, in initial status of the K-8 cohort, and for participants in baseball and softball.

Aerobic performance by children in grades 4 to 8: a repeated-measures study.

Aerobic capacity reflects consumption of O2 by working muscles during vigorous physical activity and is an indicator of cardiovascular health. This study examined change in aerobic performance by children in Grades 4 to 8 (Ages= 9-14) over 14 mo. 105 healthy children in a small, rural, middle-class school participated. All were tested five times on the Progressive Aerobic Cardiovascular Endurance Run (PACER) at 8- or 9-wk. intervals during the 2004-2005 school year, with follow-up measurements the next September and December. Hierarchical Linear Modeling applied to analyze the data showed that overall improvement in aerobic performance from September to May was statistically significant as children increased their PACER scores from 26 to 49 laps. These gains were lost over the summer but returned to the original slope by the second follow-up measurement. Regardless of age, sex, Body Mass Index, or sports participation, children followed a similar pattern: steady improvement during the school year, loss of those gains over the summer, and return to the original slope the following year.

Growth rates in running speed and vertical jumping by boys and girls ages 11-13.

This study examined growth rates in running speed and vertical jump among middle school children. 45 boys and 31 girls ages 11-13 years were tested on running speed and vertical jump three times (September, February, and May) during the school year. Hierarchical linear modeling was used to estimate initial status and growth rates for the entire sample (base model) and the association of running and vertical jump with height, weight, and sex (conditional model). Positive overall growth rates were found for both running speed and vertical jump. Increased heightand weight at the time of measurement were not significantly associated with growth rate for running. The growth rate for vertical jump was positively associated with height but unrelated to increased weight. Boys showed steeper growth rates than girls in jumping. No sex differences were found in running speed for either initial status or in growth rate. Furthermore, these results suggest highly variable rates of physical maturation but no general period of 'adolescent awkwardness'.

Relationship of hand length to catching performance by children in kindergarten to grade 2.

This study examined the relationship between hand length and catching performance by 257 children (142 boys, 115 girls) in Grades K-2. Children's catching performance was determined by the number of successful catches (0-5) when a small ball was tossed underhand from 10 ft. Specifically, the children were tested on the qualitative aspects of catching, i.e., form, and catching accuracy, i.e., successful catching. Hand length was measured by standard anthropometric technique. A multiple regression analysis showed age, sex, and hand length contributed significantly (p = .001) to catching accuracy and catching form. Implications for instruction and further research are offered.