Comparison of forward and backward gait in males with and without intellectual disabilities.

BACKGROUND: Intellectual disabilities (ID) affect both cognitive and motor functions. The backward gait is a daily activity and its assessment is used for fall risk estimation and training in the general population. For proper use of backward gait as a rehabilitation tool and in fall prevention programmes for people with ID, it is necessary to determine the backward gait characteristics in the ID population. The aim of this study was to compare the differences between forward and backward gait in persons with nonsyndromic mild and moderate ID, persons with Down syndrome (DS) and a control group of healthy adults. METHODS: Fifty males divided into four groups (mild ID: n = 15, moderate ID: n = 19, DS: n = 6, controls: n = 10) participated in this study. All participants were asked to walk both forward and backward, barefooted and at their natural velocity on a Zebris FDM platform. The Kruskal-Wallis H test was used to compare differences between the analysed groups in forward and backward gait. The Mann-Whitney U test was used to compare the differences between forward and backward gait within each group. RESULTS: The velocity was significantly slower in moderate ID and DS compared to controls in forward and backward gait. When comparing forward and backward gait within each group, the gait velocity decreased in backward gait compared with forward gait by 21.80% in controls, by 33.89% in mild ID, by 34.45% in moderate ID, and by 40.32% in DS. In both moderate ID and DS, the mean backward velocity was slower than 2.16 km/h, the velocity used to identify elderly fallers in the general population. CONCLUSIONS: Gait velocity was especially affected in DS and moderate ID compared with controls. In both mentioned groups, the backward gait velocity suggests an increased risk of falling. Future studies are necessary to examine the possibility of improving balance control and leg muscle strength by backward walking training in the ID population.

Characterization of the adaptive immune response following immunization in pregnant sows (Sus scrofa) kept in two different housing systems.

Housing conditions might differentially affect the adaptive immune responses to a neoantigen in pregnant sows with possible consequences for the success of vaccinations. Therefore, this study aimed at characterizing antigen-specific T cell and B cell responses of pregnant sows (German Landrace) either housed in a social group (GP; n = 22) or confined in individual gestation crates (CR; n = 11). All sows were immunized with the neoantigen keyhole limpet hemocyanin (KLH) 7 and 5 wk prepartum. Blood samples were taken 7, 6, 4, and 2 wk prepartum, thus before and after the first as well as second immunization. This study aimed at identifying both the resulting cellular as well as humoral KLH-specific immune response in the pregnant sows. We therefore analyzed total IgG and anti-KLH IgG concentrations and the KLH-specific lymphocyte proliferation as well as the KLH-specific production of the T helper cell type 1 (TH1)-related cytokines tumor necrosis factor (TNF) α and interferon (IFN) γ in main T cell subsets before and after the immunization. Anti-KLH IgG titers significantly increased during the experimental procedure (P < 0.001) reflecting the activation and differentiation of KLH-specific B cells on immunization. However, CR-housed sows showed greater anti-KLH IgG concentrations compared to GP-housed sows (P < 0.05). Keyhole limpet hemocyanin-specific TNFα-producing cytotoxic T cells (CTL) and T helper (TH) cells were detectable in CR-housed sows not before the second immunization (both P < 0.05), whereas those cells were detectable already after the first immunization in GP-housed sows (CTL: P < 0.01 and TH: P < 0.05). Similarly, KLH-specific TNFα/IFNγ-double producing CTL and TH cells were detectable earlier in GP-housed sows than in CR-housed sows (both P < 0.05). Keyhole limpet hemocyanin-induced lymphocyte proliferation and total IgG concentrations were not affected by the housing system. Our results show that housing conditions affect the adaptive immunity to a neoantigen in pregnant sows. Whereas GP housing of pregnant sows induced a rather TH1-mediated cellular response, individual housing in CR resulted in a T helper cell type 2 (TH2)-pronounced humoral response to KLH. The greater anti-KLH IgG concentration and the delayed activation and differentiation of KLH-specific TH1 cells in CR-housed sows support the hypothesis of a shifted TH1:TH2 ratio in individually housed sows of this study. We presume differences in the stressfulness of the housing system to be mainly responsible for the occurring effects.

The effect of normovolemic modified ultrafiltration on inflammatory mediators, endotoxins, terminal complement complexes and clinical outcome in high-risk cardiac surgery patients.

OBJECTIVE: The clinical benefit of normovolemic modified ultrafiltration (N-MUF) after cardiac surgery is still debated. As we have shown in a previous publication, there is a significant improvement in platelet function, so we were interested in whether ultrafiltration can reduce plasma levels of endotoxins, terminal complement complexes and cytokines after cardiopulmonary bypass (CPB) in adults with increased risk profiles. METHODS: In this single-center, prospective, randomized trial, fifty high-risk patients (mean logistic EuroSCORE II: 17.5%) who underwent cardiac surgery were randomized. After CPB, Group 1 (n = 25) served as the control and in, Group 2 (n= 25), an N-MUF of 3000 ml was performed, using a BC140plus filter after weaning from CPB. Blood samples were taken after the induction of anesthesia, before CPB, before CPB weaning, 30 minutes after CPB and at 6, 24 and 48 hours postoperatively. Primary outcomes were plasma levels of lipopolysaccharide-binding protein (LBP), terminal complement complex (C5b9) and cytokines (IL-6, IL-10, IL-1beta, TNF-α). Secondary outcomes focused on differences in the clinical outcome. RESULTS: A significant reduction in LBP concentration (preoperatively: 23.8±8.4 pg/ml, postoperatively: 14.2±12.9 pg/ml) and C5b9 (preoperatively: 4.18±2.6 pg/ml, postoperatively: 3.05±2.39 pg/ml) were detected 6 hours after N-MUF. In the N-MUF group, significantly lower concentrations of lactate could be detected in the early postoperative period. Furthermore, postoperative chest tube blood loss was significantly lower in the N-MUF group at 24 and 48 hours. CONCLUSIONS: N-MUF leads to a significant reduction of lipopolysaccharide-binding protein and terminal complement complex and was associated with reduced blood loss and postoperative lactate concentrations shortly after surgery.