Passive Range-of-Motion Exercise and Bone Mineralization in Preterm Infants: A Randomized Controlled Trial.

OBJECTIVE: To assess the effect of range-of-motion exercise program on bone mineralization and somatic growth of very low birth weight (VLBW) infants. STUDY DESIGN: A total of 36 VLBW infants were randomized into 18 VLBW infants receiving range-of-motion exercise and 18 VLBW control infants receiving tactile stimulation for 4 weeks. Laboratory investigations were performed at baseline and postexercise and included serum calcium, serum phosphorus (s.PO4), magnesium, alkaline phosphatase (ALP), urinary calcium/phosphate ratio, and serum carboxy-terminal cross-linked telopeptide of type 1 collagen (CTX). Dual-energy X-ray absorptiometry was performed at the end of the exercise protocol to measure bone mineral content, bone mineral density (BMD), bone area, lean mass, and fat mass. RESULTS: The weight and the rate of weight gain were significantly higher (p < 0.001) in the exercise group compared with controls postexercise. Also, higher s.PO4, lower ALP, and lower urinary calcium/phosphate ratio were observed postexercise in the exercise group (p = 0.001, p = 0.005, and p = 0.04, respectively), whereas serum CTX showed no difference between the two groups (p = 0.254). Postexercise BMD significantly improved in the exercise group (p < 0.001) compared with controls. CONCLUSION: Although the sample size was small, we may be able to suggest favorable effects of range-of-motion exercise versus tactile stimulation on bone metabolism, BMD, and short-term growth in VLBW infants.

Neurophysiologic study in idiopathic overactive bladder.

AIM: Idiopathic overactive bladder (OAB) is a prevalent, mystifying disorder with a questionable neurogenic background. We aimed to investigate the possible subtle neuropathic affection underlying its pathogenesis. METHODS: A cross-sectional cut off study was carried out on a series of 38 females with idiopathic OAB and 22 healthy matched female volunteers. The following was performed: symptom score questionnaire, determination of pudendal nerve terminal motor latency (PNTML), sacral reflexes' latencies, pudendal somatosensory evoked potentials, and needle electromyography of the external anal and urethral sphincters. RESULTS: A highly significant prolongation of PNTMLs and sacral reflexes latencies among the patients group was detected (P ≥ 0.001). Pudendal somatosensory evoked potentials showed non- significance among the two studied groups (P ≥ 0.05). External anal sphincter neuropathic affection was detected in 27 patients (71%) and external urethral sphincter neuropathic affection was detected in 30 patients (78.9%). The clitoral anal reflex showed the highest sensitivity and specificity among the neurophysiologic tests used in assessing the neuropathic affection (86.7 and 83%, respectively), followed by PNTML (83.3 and 80%, respectively). CONCLUSION: Pudendal neuropathy is the dominating possible attributing factor in the pathogenesis underlying idiopathic OAB. An integrated clinical, urodynamic, and electro-physiological assessment is recommended for evaluation of any overactive bladder patients.

Cerebral blood flow and serum neuron-specific enolase in early-onset neonatal sepsis.

BACKGROUND AND OBJECTIVES: Sepsis leads to systemic inflammatory response with cerebral blood flow (CBF) alteration and blood-brain barrier disruption that contribute to sepsis-associated encephalopathy (SAE). We aimed to evaluate cord blood neuron-specific enolase (cNSE) and CBF in early-onset neonatal sepsis (EONS) as predictors of SAE and to define short-term neurodevelopmental outcomes among survivors. METHODS: cNSE was measured in 200 neonates with antenatal risk factors for EONS, stratified into two groups: sepsis (n = 96) and no-sepsis (n = 104). Trans-cranial Doppler of peak systolic velocities (PSV), end diastolic velocities (EDV) and resistive indices (RI) of anterior (ACA) and middle (MCA) cerebral arteries recorded on day 1 postnatal. Griffiths mental developmental scale (GMDS) was assessed at 6 months. RESULTS: Increased cNSE, PSV, EDV, and decreased RI of both ACA and MCA were found in sepsis group compared to no-sepsis group (p < 0.001 for all). Patients with SAE (n = 34) had higher NSE, PSV, and EDV as well as lower RI of ACA and MCA compared to those without (p < 0.01 for all). SAE neonates had lower GMDS than those without. ACA RI of ≤0.61 was the best predictor of SAE. CONCLUSION: High CBF and cNSE could be useful markers for prediction of SAE. SAE impairs neurodevelopmental scales at 6 months.

Proposed Sonographic Criteria for the Diagnosis of Idiopathic Tarsal Tunnel Syndrome.

OBJECTIVE: To propose new sonographic criteria for the diagnosis of idiopathic tarsal tunnel syndrome (TTS). DESIGN: Prospective case-control study. SETTING: Academic referral center. PARTICIPANTS: Adult healthy volunteers (n=17) and adult patients (n=14) with electrodiagnostically proven idiopathic TTS (mean age, 43.4±8.7y; height, 161.4±7.0cm; weight, 90.6±13.9kg) (N=31). The exclusion criteria were patients with diabetes, neurological disorders, associated ankle and/or foot disorders, electrodiagnostic evidence of a widespread lesion, or feet that were electrophysiologically negative for TTS or with structural abnormalities detected via ultrasound imaging. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Tibial nerve CSA at the proximal tarsal tunnel, tibial nerve CSA within the tunnel, within tunnel-to-proximal tunnel CSA ratio. RESULTS: There was a significant difference in the within tunnel CSA and within tunnel-to-proximal tunnel CSA ratio between the TTS group and controls (P=.002 and P=.001, respectively). The optimum cutoff value was 19mm(2) for the within tunnel CSA and 1 for the within tunnel-to-proximal tunnel CSA ratio. Sensitivities were 61% and 74%, respectively. CONCLUSIONS: The within tunnel-to-proximal tunnel CSA ratio and the within tunnel CSA are the most accurate sonographic parameters and can be helpful in the assessment of idiopathic TTS.