Periventricular hemorrhagic infarction in preterm neonates: Etiology and time of development.

BACKGROUND: To find the obstetrical and delivery associated risk factors of antenatal and postnatal grade III intraventricular hemorrhage (IVH) or periventricular hemorrhagic infarction (PVHI) in preterm neonates. METHODS: A retrospective study of obstetric and delivery associated risk factors included neonates (<35 gestational weeks) with severe IVH/PVHI (n = 120) and a prospectively collected control group (n = 50). The children were divided into: (1) antenatal onset group (n = 27) with insult visible on cerebral ultrasonography within the first 12 hours of birth or periventricular cystic changes visible in PVHI within the first 3 days; (2) neonatal onset group (n = 70) with insult diagnosed after initial normal findings or I-II grade IVH, and (3) unknown time-onset group (n = 23) with insult visible at > 12 h of age. RESULTS: The mothers of the antenatal onset group had significantly more bacterial infections before delivery compared to the neonatal onset group: 20/27 (74.1%) versus 23/69 (33.3%), (odds ratio (OR) 5.7 [95% confidence interval 2.1-16]; p = 0.0008) or compared to the control group (11/50 (22%); OR 11 [2.8-42]; p = 0.0005). Placental histology revealed chorioamnionitis more often in the antenatal compared to the neonatal onset group (14/21 (66.7%) versus 16/42 (38.1%), respectively; OR 3.7 [1.18-11]; p = 0.025). Neonates with neonatal development of severe IVH/PVHI had significantly more complications during delivery or intensive care. CONCLUSIONS: Bacterial infection during pregnancy is an important risk factor for development of antenatal onset severe IVH or PVHI. In neonates born to mothers with severe bacterial infection during pregnancy, cerebral ultrasonography is indicated for early detection of severe IVH or PVHI.

The associations between the changes in serum inflammatory markers and bone mineral accrual in boys with overweight and obesity during pubertal maturation: a 3-year longitudinal study in Estonian boys.

Adipose tissue produces different inflammatory cytokines which compromise bone mineral accrual during puberty. Vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), interleukin (IL)-8, and interferon-gamma (IFN-γ) are significantly related to bone mineral accrual during pubertal maturation in boys with different BMI values. INTRODUCTION: This longitudinal study aims to identify the inflammatory markers that most strongly associate with pubertal bone mineral density (BMD) increment in boys with overweight and obesity (OWB). METHODS: Twenty-six OWB and 29 normal-weight boys were followed yearly for 3 years to measure changes in 12 serum inflammatory markers, BMD (by DXA), and apparent volumetric BMD. The OWB group was further divided into two subgroups according to their BMI gain during the 3-year period. Data through time points presented as slopes were used to calculate correlation coefficients to explore the possible relationships between variables of interest. In the whole study group, linear mixed effects (LME) models were also used. RESULTS: Increment in serum VEGF concentration was inversely associated with an increase in total body (TB) BMD (r = - 0.82, P = 0.02) and TB bone mineral content (BMC)/height (r = - 0.82, P = 0.02) in those OWB whose BMI gain was higher during pubertal years. In the whole study group, the LME model confirmed the inverse association between VEGF and TB BMC/height (P < 0.05). EGF was inversely associated with LS BMD and LS BMAD (P < 0.05), whereas there was a positive association between IL-8 and TB BMAD and between IFN-γ and LS BMD (P < 0.05). CONCLUSIONS: Lower increment in BMD in OWB with higher BMI gain is associated with increasing serum VEGF concentration during pubertal maturation. VEGF, EGF, IL-8, and IFN-γ are significantly associated with BMD during pubertal maturation in boys with different BMI values.

Early postnatal growth in children with HLA-conferred susceptibility to type 1 diabetes.

AIMS/HYPOTHESIS: An association between increased length/height and weight gain and risk of type 1 diabetes (T1D) has been reported in children. We set out to investigate the potential contribution of T1D human leukocyte antigen (HLA) risk genotypes to this association in two countries with a contrasting disease incidence. METHODS: In Estonia and Finland, length and weight were monitored up to the age of 24 months in 688 subjects. According to their HLA genotypes, the children were divided into four groups, those with very high, high or moderate risk for T1D, as well as a neutral/control group. Relative length and weight (SDS) were assessed and compared at 3, 6, 12, 18 and 24 months using World Health Organization (WHO) growth curves. RESULTS: The mean relative length at the age of 24 months was lower in the group with the very high risk HLA genotype compared to the controls (p < 0.05). The mean relative weight differed between those two groups at the age of 12, 18 and 24 months (p < 0.05). When Estonian and Finnish cohorts were analyzed separately, the relative length showed similar but non-significant trends in both countries, while in Estonia the changes in weight at some time points still remained significant (p < 0.05). CONCLUSIONS: Children with the highest HLA-conferred risk for T1D gained less weight and length during the first 24 months of life, and this feature was more pronounced in the Estonian children.

Morphology and kinematics of the atlanto-axial joints and their interaction during manual cervical rotation mobilization.

BACKGROUND DATA: At present little data are available on the relationship between spinal anatomy and kinematics. No studies have verified the relationship between atlanto-axial kinematics during manual mobilization and the spatial features of the atlanto-axial ligaments and the lateral joints. MATERIALS AND METHODS: Twenty un-embalmed cervical spine specimens (9 male and 11 female; 80 ± 11 years) were studied. Atlanto-axial kinematics were registered during manual axial rotation mobilization using an ultrasound-based motion tracking system. Anatomical landmarks were digitized and spatial features of the lateral atlanto-axial joint surfaces and alar ligaments were extracted. The relationship between the anatomical features and the spinal kinematics was analyzed using statistical regression analysis. RESULTS: Only the range of motion of the coupled flexion-extension motion component, the ratio and the time shift between main axial rotation and coupled lateral bending motion components could be predicted for about 52%, 49% and 73%, respectively, by a selected set of anatomical features. CONCLUSION: Supposed relationships between anatomical features and joint kinematics are only partially confirmed. The results indicate that the kinematics of the atlanto-axial joint during manual regional axial mobilization are not completely predetermined by the specimens' specific anatomy.

Iron deficiency and Helicobacter pylori infection in children.

AIM: To examine the relationship between iron deficiency (ID) and Helicobacter pylori infection in school-aged children. METHODS: Altogether 363 children from ambulatory admission were consecutively enrolled in the study. Haemoglobin (Hb), soluble transferrin receptor (sTfR), IgG against H. pylori and IgA against tissue transglutaminase were measured. The criteria for ID were sTfR > 5.7 mg/L in children aged 7-12 years and sTfR > 4.5 mg/L in older children, for anaemia Hb < 115 g/L in the younger group and Hb < 130 g/L for older boys and Hb < 120 g/L for girls. RESULTS: Iron deficiency was found in 17% of the children, 5% had also anaemia. H. pylori colonization was detected in 27% and serum markers for coeliac disease in 0.6% of the children. The prevalence of ID and H. pylori seropositivity was higher in older children (23% and 29%, vs 9% and 22%, respectively). Children with H. pylori were significantly shorter [length SDS 1.0 (0.98-1.01) vs 0.98 (0.97-0.99)]. Older children had risk for ID (OR 1.1, 95% CI 1.0-1.3, p = 0.03). Although the prevalence of H. pylori seropositivity was higher in the ID group, it was not significantly associated with ID in multivariate analysis. CONCLUSION: Helicobacter pylori seropositivity was not associated with ID. The associated factor for ID was age.

Factor V Leiden and prothrombin 20210G>A [corrected] mutation and paediatric ischaemic stroke: a case-control study and two meta-analyses.

AIM: To determine whether factor V Leiden (FVL) and prothrombin (PT) 20210G>A mutation are associated with paediatric ischaemic stroke. METHODS: The study consisted of two parts. Case-control study included neuroradiologically confirmed paediatric ischaemic stroke patients from two tertiary children's hospitals in Estonia. For control group, DNA was obtained from 400 anonymous screening test cards of newborns born consecutively in all delivery departments of Estonia in January 2005. Meta-analyses was performed to assess the association between paediatric sinovenous thrombosis and FVL and PT 20210G>A. RESULTS: A total of 75 children (45 boys, 30 girls) were included into the case-control study: 19 with childhood arterial ischaemic stroke, 49 with perinatal arterial ischaemic stroke and seven with cerebral venous thrombosis. Both FVL and PT 20210G>A occurred significantly more frequently among patients with sinovenous thrombosis compared with controls (OR = 12.9; 95% CI: 2.3-73.0 and OR = 11.9; 95% CI: 2.1-67.2, respectively). The difference was not significant between childhood/perinatal arterial ischaemic stroke and controls. Meta-analyses (including our study) revealed that both FVL and PT 20210G>A are associated with paediatric sinovenous thrombosis (OR = 3.1; 95% CI: 1.8-5.5 and OR = 3.1; 95% CI: 1.4-6.8, respectively). CONCLUSION: FVL and PT 20210G>A are associated with paediatric sinovenous thrombosis.

Reproducibility of kinematic motion coupling parameters during manual upper cervical axial rotation mobilization: a 3-dimensional in vitro study of the atlanto-axial joint.

INTRODUCTION: The reproducibility of the 3-dimensional (3D) kinematic aspects of motion coupling patterns of segmental manual mobilizing techniques is not yet known. This study analyzes the segmental 3D aspects of manual mobilization of the atlanto-axial joint in vitro. METHODS AND MATERIALS: Twenty fresh human cervical specimens were studied in a test-retest situation with two examiners. The specimens were manually mobilized using three different techniques: a regional mobilization technique, a segmental mobilization technique on the atlas with manual fixation of the axis and a segmental mobilization applying a locking technique. Segmental kinematics were registered with a Zebris CMS20 ultrasound-based tracking system. The 3D aspects of motion coupling between main axial rotation and coupled lateral bending were analyzed by six parameters: the range of motion the three motion components, the cross-correlation, the ratio and the shift. RESULTS: The results indicate stronger intra- than inter-examiner reproducibility. The range of motion of the axial rotation component shows a substantial level of intra- and inter-examiner reproducibility (ICC's 0.67-0.76). The parameters describing the coupling patterns show only moderate to substantial intra-examiner reproducibility for the more experienced of the two examiners (ICC's 0.55-0.68). All other correlations were not significant and no differences could be observed between regional versus segmental techniques. CONCLUSION: Reproducibility of segmental 3D-aspects of manual mobilization of the atlanto-axial joint in an in vitro situation can differ between examiners. The results of the present study may indicate a possible tendency to higher reproducibility if mobilizations are performed by an examiner with high expertise and experience in applying the specific techniques. Continued investigation including more examiners with different levels of experience and different techniques is necessary to confirm these observations.

Clean intermittent self-catheterization in persons with multiple sclerosis: the influence of cognitive dysfunction.

BACKGROUND: Bladder problems are very common in persons with multiple sclerosis (PwMS). OBJECTIVE: The aim of this study was to investigate the ability of PwMS to learn clean intermittent self-catheterization (CISC). METHODS: The physical disability of 23 PwMS was evaluated with the Expanded Disability Status Scale (EDSS), and cognitive status was evaluated with the Brief Repeatable Battery of Neuropsychological Tests (BRB-N). CISC was taught by the same continence advisor who was blinded to the cognitive test results. The ability to learn CISC was evaluated immediately after sessions and 3 months later. Twenty-three consecutive PwMS participated in the study. RESULTS: In all, 87% (20/23) of the PwMS successfully finished CISC training. The number of lessons needed to acquire CISC skills differed significantly depending on the EDSS (Spearman r=0.682, P=0.0003), but the total cognitive decline subscore did not influence the ability to learn CISC. Only 13% (3/23) of the PwMS failed to learn CISC. The ability to learn CISC depended on the number of lessons needed to acquire CISC (r=-0.499, P=0.0313) and the EDSS score (r=-0.433, P=0.0390) but not on the course of the disease (r=0.125, P=0.5696) or on cognitive decline (r=-0.311, P=0.1480). After 3 months of follow-up, 30% (6/20) of the PwMS had ceased performing CISC. A follow-up indicated no statistically significant correlations among any of the subscores of the cognitive test battery, the EDSS score, the course of the disease, and the time required to learn CISC and effective bladder management. CONCLUSIONS: Our study thus confirmed that most (87%) PwMS were able to learn CISC in spite of cognitive dysfunction and therefore to improve their quality of life.

The reference limits and cut-off value for serum soluble transferrin receptors for diagnosing iron deficiency in infants.

Serum soluble transferrin receptors (sTfR) concentration is a useful test in the diagnosis of childhood iron deficiency (ID). The aims of this study were to establish reference limits and to evaluate the diagnostic characteristics of sTfR in the diagnosis of ID in infants aged 9-12 months. In addition to mean erythrocyte cell volume, haemoglobin and ferritin measurements, sTfR concentration was measured in 179 healthy children in Estonia using the IDeA and Tina-quant methods. Using the ID criteria of ferritin <10 microg/l, subjects were divided into healthy (n = 146) and ID (n = 33) groups. The reference limits (5th and 95th percentile) were calculated in the study group. We used receiver operating characteristic curves to find out the cut-off values for the best diagnostic characteristics. The reference limits for sTfR were 1.5-2.7 mg/l in the IDeA method and 4.1-7.8 mg/l in the Tina-quant) method. The methods had poor agreement, the mean ratio with 95% limits of agreement was 2.9 (2.4-3.6). The best cut-off value in order to identify ID by hypoferritinaemia in this population is an sTfR level > 2.4 mg/l in the IDeA (sensitivity 84%, specificity 94%) and an sTfR level > 7.4 mg/l in the Tina-quant (sensitivity 80%, specificity 92%). We conclude that sTfR concentration is an efficient tool in the diagnosis of ID, but that every method needs its own cut-off value.

Does manual mobilization influence motion coupling patterns in the atlanto-axial joint?

BACKGROUND: A restricted number of publications have reported on the analysis of coupling patterns in the atlanto-axial joint using an in vitro set-up applying pure moments of forces. The aim of this study is to analyze segmental motion coupling patterns during cervical manual mobilization. METHODS: The position and attitudes of sensors mounted on the atlas and axis were traced in nine embalmed and one fresh human spinal specimen using an electromagnetic tracking system. Segmental bony reference points were registered using a 3D-digitizing stylus for the definition of bone embedded coordinate systems. Segmental motion coupling was recorded for the atlanto-axial joints during manual mobilization through the full range of axial rotation and lateral bending. RESULTS: Coupled motions were described by the direction of the associated motion and by cross-correlation analysis. The results confirm the contra-lateral coupling pattern of axial rotation with lateral bending at C1-C2 observed in previous studies. The cross-correlation analysis offered a more objective interpretation of the coupling pattern for the analysis of the more irregular coupling patterns during lateral bending. Inter-individual differences in coupling patterns were observed. INTERPRETATIONS: The presented method provides possibilities for the study of coupled motion during manual diagnostic and therapeutic practice. Practitioners should be aware of the segmental 3D-aspects of manually induced so called planar mobilizations and their possible influence on motion coupling. Motion coupling patterns may be related to specimen specific anatomy.

3D morphometry of the transverse and alar ligaments in the occipito-atlanto-axial complex: an in vitro analysis.

This study verifies the three-dimensional anatomical features of the transverse and alar ligaments with reference to the axis using a direct in vitro approach. In 20 fresh spine specimens, metal markers were inserted on the cranium, atlas, and axis. After registration of the intact specimen, the bony segments were separated, and markers and anatomical landmarks were digitized. The length and the orientation of the ligaments with reference to the axis were derived from the relative position data. The transverse ligaments of the atlas have a mean estimated length of 21 mm and an absolute angle (i.e., independent of any reference frame) of 119 degrees +/- 17 degrees . The alar ligaments have a mean length of 9 +/- 2.5 mm, and the mean absolute angle between the ligaments is 117 degrees +/- 31 degrees . The plane of the alar ligaments shows a mean backward inclination of -10 degrees +/- 52 degrees . This plane has a mean inclination of 6 degrees +/- 4 degrees with reference to the sagittal plane indicating left-right symmetries. The transverse ligament arches around the dens and demonstrating its function as a stabilizer for the dens as well as guidance for axial rotation movements. A posterior inclination of the alar ligaments may induce a coupled extension in combination with a lateral bending during axial rotation. These detailed aspects of motion steering may be important to consider when attempting to reduce or restore movement.

[Autochthonous babesiosis in dogs in the Netherlands?]. / Autochtone babesiose bij de hond in Nederland?

For the first time cases of babesiosis have been diagnosed in dogs that had not been abroad. Three cases were seen in the province of Gelderland (Bennekom, Elspeet), two in North-Holland (Koog aan de Zaan). A female Dermacentor reticulatus tick, the main vector of the disease in Europe, was found on one of the dogs at Koog; previously specimens of this tick species had only occasionally been seen on dogs returning from abroad. Serological evidence was obtained that in at least four of the cases European Babesia canis, transmitted by Dermacentor ticks, was involved.