Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus Ponseti method.

PURPOSE: A mild delay in gross motor milestones and walking age has been reported in infants with clubfoot. The influence of different treatments on motor development has been poorly investigated. Some parents and physical therapists express concern that the Ponseti method (PM) and its constraints (abduction brace, casts) would affect development more than the French physical therapy method (FM) due to greater immobilization and lesser stimulation.The purpose of this study was to evaluate achievement of three motor milestones (pull-to-standing, cruising and independent walking) in two groups of clubfoot patients treated at two experienced institutes respectively with the PM and FM. METHODS: In all, 52 consecutive infants (full-term at birth, mean age at beginning of treatment 24.3 days (sd 10), mean Dimeglio score 12 (sd 3.4)) were prospectively enrolled (26 patients per centre) and followed up to walking age recording milestones. RESULTS: The two groups were not different in terms of age at the beginning of treatment (p = 0.067) and rate of tenotomy. Age at tenotomy was significantly lower in the PM group (p = 0.000). Severity (p = 0.004) and number of bilateral cases (p = 0.012) were higher in the PM group. A non-significant difference was found for age of achievement of pull-to-standing (p = 0.109), cruising (p = 0.253) and independent ambulation (p = 0.349) between the two groups. Overall, milestones were achieved approximately two months later than normal population. Sex, severity, laterality and need of tenotomy were not found to significantly influence milestones. CONCLUSION: Our results confirmed that infants with clubfoot are expected to have a minimum delay in motor development. Infants treated with the PM and those treated with the FM did not show significant differences in gross motor milestones achievement at walking age. LEVEL OF EVIDENCE: Level II - Prospective comparative therapeutic studies.

Proximate, fatty acids and metals in edible marine bivalves from Italian market: Beneficial and risk for consumers health.

Seafood is recognized as a healthy food choice due to high contents of essential nutrients, including polyunsaturated fatty acids (PUFAs) of the n-3 family. However, seafood is often contaminated by toxic compounds, which have adverse effects on human health. The aim of this study was to provide information about the percentage of edible part, condition index and the benefit and risk for human consumers health associated to the consumption of eight bivalve species (Flexopecten glaber, Mimachlamys varia, Modiolus barbatus, Mytilus galloprovincialis, Ostrea edulis, Ruditapes philippinarum, Solen marginatus and Venus verrucosa) of high commercial value, purchased from Taranto local fish markets. High percentage of edibility and condition index were found in all analysed species. The relatively high protein content, low levels of lipid and high percentage of healthy n-3 PUFAs make M. varia, O. edulis, S. marginatus, M. galloprovincialis, M. barbatus more suitable for benefit to consumers. Provisional tolerable weekly intake and hazard index calculated on the basis of trace metals in edible tissues, indicated specific recommendations for a responsible daily consumption of shellfish. For the most part of studied species, the estimated balance between beneficial and risk for consumers recommend a daily portion (RDP) lesser of 60 g/person/day than M. galloprovincialis, O. edulis and R. philippinarum (≥60 g/person/day). Careful risk-benefit considerations should promote seafood consumption while minimizing exposure to toxic contaminants.

Insights into the CuO nanoparticle ecotoxicity with suitable marine model species.

Metal oxide nanoparticles, among them copper oxide nanoparticles (CuO NPs), are widely used in different applications (e.g. batteries, gas sensors, superconductors, plastics and metallic coatings), increasing their potential release in the environment. In aquatic matrix, the behavior of CuO NPs may strongly change, depending on their surface charge and some physical-chemical characteristics of the medium (e.g. ionic strength, salinity, pH and natural organic matter content). Ecotoxicity of CuO NPs to aquatic organisms was mainly studied on freshwater species, few tests being performed on marine biota. The aim of this study was to assess the toxicity of CuO NPs on suitable indicator species, belonging to the ecologically relevant level of consumers. The selected bioassays use reference protocols to identify Effect/Lethal Concentrations (E(L)C), by assessing lethal and sub-lethal endpoints. Mortality tests were performed on rotifer (Brachionus plicatilis), shrimp (Artemia franciscana) and copepod (Tigriopus fulvus). While moult release failure and fertilization rate were studied, as sub-lethal endpoints, on T. fulvus and sea urchin (Paracentrotus lividus), respectively. The size distribution and sedimentation rates of CuO NPs, together with the copper dissolution, were also analyzed in the exposure media. The CuO NP ecotoxicity assessment showed a concentration-dependent response for all species, indicating similar mortality for B. plicatilis (48hLC50 = 16.94 ± 2.68mg/l) and T. fulvus (96hLC50 = 12.35 ± 0.48mg/l), followed by A. franciscana (48hLC50 = 64.55 ± 3.54mg/l). Comparable EC50 values were also obtained for the sub-lethal endpoints in P. lividus (EC50 = 2.28 ± 0.06mg/l) and T. fulvus (EC50 = 2.38 ± 0.20mg/l). Copper salts showed higher toxicity than CuO NPs for all species, with common sensitivity trend as follows: P. lividus ≥ T. fulvus (sublethal endpoint) ≥ B. plicatilis >T. fulvus (lethal endpoint) >A. franciscana. CuO NP micrometric aggregates and high sedimentation rates were observed in the exposure media, with different particle size distributions depending on the medium. The copper dissolution was about 0.16% of the initial concentration, comparable to literature values. The integrated ecotoxicological-physicochemical approach was used to better describe CuO NP toxicity and behavior. In particular, the successful application of ecotoxicological reference protocols allowed to produce reliable L(E)C data useful to identify thresholds and assess potential environmental hazard due to NPs.

Sublethal effects of copper on some biological traits of the amphipod Gammarus aequicauda reared under laboratory conditions.

The common and widespread copper contamination in marine coastal environments make toxicity data necessary to assess the aquatic hazard and risk of this metal. In the present study, the sublethal effects of copper on survival, growth and reproduction of Gammarus aequicauda were investigated. Amphipods were exposed for 77d to 2 nominal copper concentrations (50, 100 µg L(-1)). Survival was the most sensitive measure of effect and was significantly reduced, especially during early life stage (juveniles). Growth of amphipods was also negatively affected by copper and the growth impairment in G. aequicauda increases with increasing metal concentration. The reproductive traits were impaired by each of the copper concentrations, even if there were not any significant differences between control and copper treatments. The size at maturity increased with increasing copper, so the smallest ovigerous females in the control and copper treatments were 0.83 mm and 1.35 mm head length, respectively. There was a positive correlation between the brood size and the body size of the female in all treatments, whilst the fecundity (n°juveniles/female) decreased in the order control, 50 and 100 µg Cu L(-1). Copper demonstrates chronic toxicity to G. aequicauda at realistic environmental concentrations. The results of this study entail that the understanding of chronic toxicity of a substance, especially on population level effects, is crucial to assess the long-term effect of the substance in the ecosystem.

Descripción del uso de la licencia médica psiquiátrica en un servicio especializado de atención ambulatoria / Psychiatric sick-leaves description in a specialized outpatient service

Objetivo: Describir las características de la prescripción del reposo médico de causa psiquiátrica en un servicio de atención especializado. Métodos: Se registraron las atenciones psiquiátricas y las licencias médicas emitidas en un período de 3 meses (julio a septiembre 2009). Resultados: En el período se realizaron 3.105 consultas psiquiátricas, indicándose licencia médica en 399 atenciones (12,7 por ciento). Se eliminaron 16 y se trabajó con 383 licencias. De estas, 184 (48 por ciento) fueron 1° licencia en el período, 190 (49,6 por ciento) fueron prórroga de anterior y 9 (2,3 por ciento) fueron repetición de reposo. El número de pacientes beneficiados con la indicación de reposo fue de 228 (12 por ciento). Los trastornos del ánimo dieron cuenta de un 78,1 por ciento de las licencias y se prescribieron más frecuentemente en mujeres (68,9 por ciento). La duración total del reposo fue 25,5 +/- 20 días y la mediana fue 15. Discusión: En un servicio especializado de Psiquiatría las atenciones generaron 12,7 por ciento de prescripción de licencias médicas. La gravedad de los casos puede explicar la alta frecuencia de prórrogas y repetición de licencias. Los trastornos del ánimo son los diagnósticos más frecuentemente consignados como causa de la licencia médica. Este trabajo aporta datos técnicos sobre el uso y características de la licencia médica psiquiátrica en Chile.

Objectives: To characterize sick leaves prescription in a specialized psychiatric service. Methods: We recorded all of psychiatric attentions as well as all of sick-leaves prescribed during a three months period (July to September, 2009). Results: 3,105 attentions were done, whit a 12,7 percent (399 attentions) of them resulting in a sick-leave prescription, corresponding to 228 out-patients. We discarded 16 sick-leaves because incomplete information. 184 (48 percent) sick-leaves were prescribed in a first visit, 190 (49,6 percent) were a prolongation of a previous sick-leave prescription, and 9 (2,3 percent) were prescribed after a working period posterior to a previous rest. Affective disorder were the most frequent diagnosis observed in sick-leave prescription (78,1 percent), being more frequent in women (68,9). The mean of rest was 25,5 +/- 20 days with a median of 15 days. Discussion: A 12,7 percent of psychiatric attention generated a sick-leave prescription. Severity of disorders seen in a specialized psychiatric service could explain this finding. Our results confirm Affective Disorders are the principal cause of sick-leave prescription. This study add technical knowledge about feature and uses of psychiatric sick-leaves in Chile.

Effects of temperature on the sensitivity of Gammarus aequicauda (Martynov, 1931) to cadmium.

Gammarus aequicauda, collected at different times of the year was used to assess the mortality rates and the sensitivity to cadmium (96 h LC50), at different laboratory temperatures (10, 15, 20, 25 degrees C). The survival in 10 days sediment control test, was high at all tested temperatures, ranging from 4 +/- 1% at 10 degrees C (winter collection) to 13.3 +/- 2.1% at 25 degrees C (spring collection). The 96 h-LC50 values recorded, ranged from 1.50 mgCd/L in winter at 10 degrees C to 0.10 mgCd/L in spring and summer at 25 degrees C. The results showed that temperature and season of collection influenced mortality rates and G. aequicauda sensitivity to cadmium.

A test battery approach for ecotoxicological characterization of Mar Piccolo sediments in Taranto (Ionian Sea, Southern Italy).

The eco-toxicological approach is based on the determination of the toxic effects on organisms pertaining to various ecosystems and supplies information about the contaminants mixture bioavailability, in complex matrices as sediments. The use of a single species for a correct evaluation of the toxicity levels can be reductive, concerning the complexity of the ecosystem. In this work we have used species with various evolutionary levels and habitats; in particular, three different organisms: two amphipods species (Corophium insidiosum and Gammarus aequicauda) and one bacterium Vibrio fischeri. We have compared these organisms for the evaluation of sediments toxicity in four sites along the Ionian coast (Taranto, Italy); in particular, three sites in Mar Piccolo and one site in Mar Grande. The toxicity of sediments measured using Vibrio fischeri (Microtox Solid Phase Test protocol) has been compared with the mortality of the two amphipods. Both in polluted (Mar Piccolo sites) and in non-polluted environments (Mar Grande), the results of the three biological tests carried out converge into the evaluation of sediments quality monitored. In conclusion, these preliminary results show the potential use of Corophium insidiosum and Gammarus aequicauda as test species for a correct evaluation of sediments quality, together with Vibrio fischeri.

Implications for toxicity tests with amphipod Gammarus aequicauda: effects of temperature and salinity on life cycle.

This study explored the effect of temperature and salinity on the life cycle of Gammarus aequicauda in order to establish temperature and salinity ranges advantageous for chronic toxicity testing. A broad range of salinity-temperature conditions (salinities of 10, 20 and 36 per thousand, and temperatures of 10, 18 and 24 degrees C combined in nine different treatments) significantly influenced various reproductive aspects of G. aequicauda reared in the laboratory, from newly released juveniles to first brood production by mature adults. There was a significant linear regression between the brood size and the body size of the female. The number of juveniles released per female was highest at 10 degrees C and lowest at 24 degrees C. The temperature and salinity variations had a significant effect on the fecundity of G. aequicauda. A high temperature led to a faster individual growth and a quicker sexual development than a lower temperature. A temperature acceptable for chronic toxicity tests can be 18 degrees C, at which an acceleration of the life cycle without a lowering of the amphipod's performance was observed. Regarding salinity, results from this study showed that salinities down to 36 per thousand may also be used in sediment toxicity tests with G. aequicauda, so providing a proper and gradual acclimation.

Combined toxicity of mercury, copper and cadmium on embryogenesis and early larval stages of the Mytilus galloprovincialis.

The aim of this study was to investigate the individual and combined toxicity of dissolved copper-cadmium and mercury using the embriotoxicity test with Mytilus galloprovincialis. Adult stocks of Mytilus galloprovincialis were induced to spawn and early larvae were recorded after incubation of fertilized eggs in seawater. The 48h - EC50 for the single metals, ranged from 10 to 590 microg l(-1), with the following toxicity ranking: Hg > Cd > Cu. One-way ANOVA showed that the toxicity of mercury and copper had a significant effect on larval development beginning from the lowest concentration, but there is no significant difference in the mean responses among all concentrations. Cadmium had a significant effect (p < 0.05) already at the lowest concentrations. To identify the kind of interaction in binary mixtures among metals, the additive toxicity index (S) was calculated. All mixtures tested, after 48h, showed an antagonistic response.

Eagle's syndrome secondary surgical treatment. Report of a case.

Eagle's Syndrome is reported to be the symptomatic calcification of the stylohyoid complex. Calcification of the stylohyoid ligament is a relatively common finding in the general population, however only a small percentage of these people presents symptoms. According to the kind of symptoms described by the patients it is possible to recognise two syndromes: the classic one, which occurs after a tonsillectomy, and stylo-carotid artery syndrome, which is independent from a tonsillectomy. The only effective treatment in symptomatic cases is the surgical shortening of the styloid process. The case presented underlines the problems due to the persistence of the calcified caudal portion of the stylohyoid ligament after a first surgical removal. A second surgical treatment is suggested for a complete resection of the calcified ligament which was causing the symptomatology complained by the patient. This patient had previously undergone surgical shortening of the stylohyoid ligament after he was diagnosed as having Eagle's Syndrome, of the styloid-carotid artery type. After a stylohyoidectomy, he still suffered from dysphagia, neck pain and scratching sensation when swallowing. Further surgical treatment was necessary, with the aim of removing the caudal portion of the ligament, which was causing the patient's symptoms. An extra-oral approach was used and, after surgery, the patient was completely relieved of the symptoms. Conventional and three-dimensional CT were performed after surgery, they showed the complete absence of the left calcified stylohyoid ligament.