Comparison of gait with and without ankle-foot orthoses after lower limb surgery in children with unilateral cerebral palsy.

PURPOSE: Children with spastic unilateral cerebral palsy (SUCP) frequently undergo lower limb surgery to improve gait. Postoperatively, ankle-foot orthoses (AFOs) are used to maintain the surgical corrections and provide adequate mechanical support. Our aim was to evaluate changes in gait and impacts of AFOs one-year postoperatively. METHODS: In all, 33 children with SUCP, 17 girls and 16 boys, mean age 9.2 years (5 to 16.5) were measured by 3D gait analysis walking barefoot preoperatively and walking barefoot and with AFOs one-year postoperatively. Changes in Gait Profile Scores (GPS), kinematic, kinetic and temporal spatial variables were examined using linear mixed models, with gender, gross motor function and AFO type as fixed effects. RESULTS: The results confirm significant gait improvements in the GPS, kinematics and kinetics walking barefoot one year after surgery. Comparing AFOs with barefoot walking postoperatively, there was additionally reduced ankle plantarflexion by an average of 5.1° and knee flexion by 4.7° at initial contact, enhanced ankle moments during loading response, increased velocity, longer steps and inhibited push-off power generation. Stance and swing phase dorsiflexion increased in children walking with hinged AFOs versus children walking with ground reaction AFOs. Changes in the non-affected limbs indicated less compensatory gait postoperatively. CONCLUSION: Major changes were found between pre- and postoperative barefoot conditions. The main impact of AFOs was correction of residual drop foot and improved prepositioning for initial contact, which could be considered as indications for continued use after the one-year follow-up. LEVEL OF EVIDENCE: Level II - Therapeutic.

Antioxidant and radical scavenging effects of anthraquinones and anthrones.

The activity of seven anthraquinones and four anthrones against nonenzymatic and enzymatic lipid peroxidation in vitro and their ability to scavenge free radicals have been studied. In nonenzymatic peroxidation in rat hepatocytes induced by t-butyl hydroperoxide, dithranol and anthrone were the strongest antioxidants, having IC50 values of 8 +/- 1 and 24 +/- 5 mumol/l, respectively. Rhein (IC50 64 +/- 2 mumol/l) and aloe-emodin (IC50 65 +/- 3 mumol/l) showed the highest inhibitory activity against peroxidation of linoleic acid catalyzed by soybean 15-lipoxygenase. Anthrone (IC50 62 +/- 2 mumol/l), dithranol (IC50 72 +/- 1 mumol/l) and rhein anthrone (IC50 76 +/- 6 mumol/l) were the most effective radical scavengers of the diphenylpicrylhydrazyl radical. The antioxidant activities in hepatocytes and the radical scavenging activities were correlated, whereas the inhibition of enzymatic lipid peroxidation showed no correlation with the two other effects.

[A case of small cell carcinoma of the esophagus].

The case of a 51-year-old man, complaining of a sense of pressure on his chest, is reported. Tests led to a diagnosis of a cancer in the midesophagus and a subtotal esophagectomy was performed. The tumor was found to be a protruded type, 8.5 X 7.0 cm in size. A histologic diagnosis revealed it to be a small cell anaplastic carcinoma. The tumor cells were found negative in a Grimelius staining and did not contain hormones such as ACTH. Some cytokeratins, however, were detected by an immunohistochemical examination, Cancer invasion into the adventitia was seen, though no lymph node metastasis or a distant metastasis was shown. Six months after operation, a recurrence in the mediastinum and in the distant lymph nodes was found. Chemotherapy and irradiation were found to be useful, and the postoperative survival period was 25 months.

Type II collagen-induced arthritis in mice. IV. Variations in immunogenetic regulation provide evidence for multiple arthritogenic epitopes on the collagen molecule.

Type II collagen from six mammalian species was investigated for the capacity to induce an immune response and collagen-induced arthritis (CIA) in C57/B10 congenic mouse strains. H-2q haplotype mice were susceptible to chick, bovine, deer, rat, and human type II collagen, but were resistant to arthritis induced by porcine type II collagen. H-2r haplotype mice only developed CIA in response to bovine, deer, and porcine collagen. High antibody responses in the absence of disease, directed against a specific type II collagen, were observed in many independent haplotypes. The cross-reactive capacity of different antisera to the various collagen species was studied. The data support the existence of two arthritogenic and multiple nonarthritogenic epitopes on the type II collagen molecule.

Type II collagen-induced arthritis in mice. III. Suppression of arthritis by using monoclonal and polyclonal anti-Ia antisera.

Pretreatment of mice genetically susceptible to type II collagen-induced arthritis (CIA) with monoclonal or polyclonal antisera specific for I region gene products (Ia antigens) suppressed or delayed the onset of CIA, whereas pretreatment with anti-Ia to an irrelevant haplotype was without effect. The humoral response to type II collagen was transiently depressed 14 days after immunization but antibody levels did not differ significantly after 28 days. The peak delayed-type hypersensitivity to type II collagen was unaffected by anti-Ia treatment. Monoclonal antibody of one anti-Ia specificity enhanced both the antibody response and the arthritis incidence in one mouse strain.

Passive transfer of arthritis to mice by injection of human anti-type II collagen antibody.

The serum IgG fraction from a patient with seronegative rheumatoid-like arthritis which contained a high anti-type II collagen antibody titer was injected intravenously into mice susceptible to type II collagen-induced arthritis. A mild, transient, inflammatory arthritis was observed in 20 to 25% of the animals, whereas histologic signs of disease were evident in most of the injected mice. Purified human anti-type II collagen immunoglobulin injected into the knee joints of mice was also shown to induce a transient, inflammatory arthritis. Radiolabeled human anti-type II collagen IgG was shown to accumulate in the peripheral joints of mice, and the specificity of the antibody was shown to be similar to the specificity of anticollagen antibody eluted from the joints of mice with collagen-induced arthritis.