Renal outcome after kidney-transplantation in Korean patients with lupus nephritis

We investigated renal outcome of kidney-transplantation in 19 Korean recipients with biopsy-proven lupus nephritis and compared it with 18 Korean age- and gender-matched recipients without lupus nephritis who were diagnosed with end-stage renal disease caused by renal diseases other than lupus nephritis in a single centre. We reviewed histological findings of kidneys and calculated cumulative dose of immunosuppressive agents. We assessed renal flare of systemic lupus erythematosus, recurrence of lupus nephritis and graft failure as prognosis. The mean age of recipients with lupus nephritis was 43.5 years and all patients were female. Six patients had class III, 10 had class IV and three had class V. There were no meaningful differences in demographic data, renal replacement modality, cumulative doses of immunosuppressants and prognosis between recipients with and without lupus nephritis. Eight patients experienced renal flare of systemic lupus erythematosus, but there were no cases of recurrence of lupus nephritis or graft failure in recipients with lupus nephritis. Kidney-recipients with class IV lupus nephritis exhibited a lower cumulative renal flare of systemic lupus erythematosus free survival rate than those with class III lupus nephritis. In conclusion, renal outcome of kidney-transplantation in patients with lupus nephritis is similar to that in those without lupus nephritis, and class IV was associated with renal flare of systemic lupus erythematosus.

Analysis of structure-function network decoupling in the brain systems of spastic diplegic cerebral palsy

Manifestation of the functionalities from the structural brain network is becoming increasingly important to understand a brain disease. With the aim of investigating the differential structure-function couplings according to network systems, we investigated the structural and functional brain networks of patients with spastic diplegic cerebral palsy with periventricular leukomalacia compared to healthy controls. The structural and functional networks of the whole brain and motor system, constructed using deterministic and probabilistic tractography of diffusion tensor magnetic resonance images and Pearson and partial correlation analyses of resting-state functional magnetic resonance images, showed differential embedding of functional networks in the structural networks in patients. In the whole-brain network of patients, significantly reduced global network efficiency compared to healthy controls were found in the structural networks but not in the functional networks, resulting in reduced structural-functional coupling. On the contrary, the motor network of patients had a significantly lower functional network efficiency over the intact structural network and a lower structure-function coupling than the control group. This reduced coupling but reverse directionality in the whole-brain and motor networks of patients was prominent particularly between the probabilistic structural and partial correlation-based functional networks. Intact (or less deficient) functional network over impaired structural networks of the whole brain and highly impaired functional network topology over the intact structural motor network might subserve relatively preserved cognitions and impaired motor functions in cerebral palsy. This study suggests that the structure-function relationship, evaluated specifically using sparse functional connectivity, may reveal important clues to functional reorganization in cerebral palsy. Hum Brain Mapp 38:5292-5306, 2017. © 2017 Wiley Periodicals, Inc.

Language Development and Brain Magnetic Resonance Imaging Characteristics in Preschool Children With Cerebral Palsy

PURPOSE

The purpose of this study was to investigate characteristics of language development in relation to brain magnetic resonance imaging (MRI) characteristics and the other contributing factors to language development in children with cerebral palsy (CP).

METHOD

The study included 172 children with CP who underwent brain MRI and language assessments between 3 and 7 years of age. The MRI characteristics were categorized as normal, malformation, periventricular white matter lesion (PVWL), deep gray matter lesion, focal infarct, cortical/subcortical lesion, and others. Neurodevelopmental outcomes such as ambulatory status, manual ability, cognitive function, and accompanying impairments were assessed.

RESULTS

Both receptive and expressive language development quotients (DQs) were significantly related to PVWL or deep gray matter lesion severity. In multivariable analysis, only cognitive function was significantly related to receptive language development, whereas ambulatory status and cognitive function were significantly associated with expressive language development. More than one third of the children had a language developmental discrepancy between receptive and expressive DQs. Children with cortical/subcortical lesions were at high risk for this discrepancy.

CONCLUSIONS

Cognitive function is a key factor for both receptive and expressive language development. In children with PVWL or deep gray matter lesion, lesion severity seems to be useful to predict language development.

Immediate Effect of a Single Session of Whole Body Vibration on Spasticity in Children With Cerebral Palsy

Objective

To investigate the immediate effect of a single session of whole body vibration (WBV) on lower extremity spasticity in children with cerebral palsy (CP).

Methods

Seventeen children with spastic CP were included. A single session of WBV was administered: 10-minute WBV, 1-minute rest, and 10-minute WBV. The effects of WBV were clinically assessed with the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) before and immediately, 30 minutes, 1 hour, 2 hours, 3 hours, and 4 hours after WBV.

Results

Spasticity of the ankle plantarflexor, as assessed by MAS and MTS scores, was reduced after WBV. Post-hoc analysis demonstrated that, compared to baseline, the MAS significantly improved for a period of 1 hour after WBV, and the R1 and R2–R1 of the MTS significantly improved for a period of 2 hours after WBV.

Conclusion

A single session of WBV improves spasticity of ankle plantarflexors for 1–2 hours in children with CP. Future studies are needed to test whether WBV is an effective preparation before physiotherapy and occupational therapy.

The clinical outcomes of deep gray matter injury in children with cerebral palsy in relation with brain magnetic resonance imaging

In the present study we investigated the nature and extent of clinical outcomes using various classifications and analyzed the relationship between brain magnetic resonance imaging (MRI) findings and the extent of clinical outcomes in children with cerebral palsy (CP) with deep gray matter injury. The deep gray matter injuries of 69 children were classified into hypoxic ischemic encephalopathy (HIE) and kernicterus patterns. HIE patterns were divided into four groups (I-IV) based on severity. Functional classification was investigated using the gross motor function classification system-expanded and revised, manual ability classification system, communication function classification system, and tests of cognitive function, and other associated problems. The severity of HIE pattern on brain MRI was strongly correlated with the severity of clinical outcomes in these various domains. Children with a kernicterus pattern showed a wide range of clinical outcomes in these areas. Children with severe HIE are at high risk of intellectual disability (ID) or epilepsy and children with a kernicterus pattern are at risk of hearing impairment and/or ID. Grading severity of HIE pattern on brain MRI is useful for predicting overall outcomes. The clinical outcomes of children with a kernicterus pattern range widely from mild to severe.

WHAT THIS PAPER ADDS

Delineation of the clinical outcomes of children with deep gray matter injury, which are a common abnormal brain MRI finding in children with CP, is necessary. The present study provides clinical outcomes for various domains in children with deep gray matter injury on brain MRI. The deep gray matter injuries were divided into two major groups; HIE and kernicterus patterns. Our study showed that severity of HIE pattern on brain MRI was strongly associated with the severity of impairments in gross motor function, manual ability, communication function, and cognition. These findings suggest that severity of HIE pattern can be useful for predicting the severity of impairments. Conversely, children with a kernicterus pattern showed a wide range of clinical outcomes in various domains. Children with severe HIE pattern are at high risk of ID or epilepsy and children with kernicterus pattern are at risk of hearing impairment or ID. The strength of our study was the assessment of clinical outcomes after 3 years of age using standardized classification systems in various domains in children with deep gray matter injury.

Characteristics of psychosexual functioning in adults with cerebral palsy

Objective: To investigate the characteristics of psychosexual functioning in adults with cerebral palsy, as compared with able-bodied control subjects, matched by gender and marital status, and to identify the factors affecting psychosexual functioning.

Design: Interview and survey using the Derogatis Sexual Functioning Inventory (DSFI).

Setting: Inpatient and outpatient units in a rehabilitation hospital and welfare facilities.

Subjects: Sixty-two adults with cerebral palsy and 142 age-matched able-bodied controls participated in this study. The participants were grouped into four subgroups according to gender and marital status.

Main measures: General characteristics of the subjects, 10 domain scores of the DSFI and Sexual Functioning Index (SFI) as a global score were assessed. The scores for each cerebral palsy group according to gender and marital status were compared with those of their corresponding able-bodied control group.

Results: Unmarried men with cerebral palsy demonstrated lower SFI and weakness in sexual information, experience, drive, attitude, psychological symptoms, affect and satisfaction, compared with unmarried able-bodied men (p B=0.05). In contrast to unmarried men, unmarried women did not reveal any significant differences in all but body image domain score (p B=0.05) between the groups. Married adults with cerebral palsy showed higher levels of psychological distress in both men and women and lower sexual satisfaction in women (p B=0.05). Nonambulatory people with cerebral palsy had significantly a lower sexual information, experience and satisfaction, and a lower SFI than ambulatory (p B=0.05). Barthel Index was significantly related to body image (p B=0.05). Psychosexual functioning was not significantly different according to cerebral palsy type.

Conclusion: This study revealed the characteristics on psychosexual functioning in adults with cerebral palsy, depending on gender and marital status. The results suggested that nonambulatory unmarried men with cerebral palsy were at high risk in terms of psychosexual dysfunction.

The effect of botulinum toxin type A injection into the gastrocnemius muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy

Objective: To investigate the benefit of botulinum toxin type A injection into the ankle plantarflexor muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy.

Design: Case-control study.

Setting: Inpatients in a university-affiliated hospital.

Subjects: Forty spastic diplegic children aged from 2 to 6 years (18 children with botulinum toxin type A injection into both gastrocnemius muscles as an experimental group and 14 children without injection as a control group).

Main measures: Sit-to-stand transfer task was evaluated using a motion analyser (Vicon 370 MA with six infrared cameras). The tests were performed twice with a two-week interval. The changes in temporal, kinematic and kinetic parameters were investigated in each group.

Results: In the control group there were no significant changes in any of the measured parameters between the tests. In the experimental group, total duration (s) of sit-to-stand transfer was shortened after injection (4.359 ± 2.49 to 2.899 ± 1.48, P < 0.05). The maximal angles (degrees) of pelvic and hip joints were reduced (28.889 ± 5.53 to 26.579 ± 3.73 and 90.789 ± 8.69 to 87.239 ± 8.76) and the initial angle of ankle dorsiflexion was increased (4.419 ± 6.16 to 7.089 ± 6.09) after injection (P < 0.05). The maximal moments (Nm/kg) of the hip and knee joints (0.449 ± 0.17 to 0.519 ± 0.21 and 0.139 ± 0.05 to 0.189 ± 0.14) were increased while that of the ankle joint was reduced (0.329 ± 0.09 to 0.289 ± 0.10) after injection (P < 0.05). Only the cases with greater reduction of spasticity showed an improvement on kinematic and kinetic parameters.

Conclusion: Botulinum toxin type A injection into spastic ankle plantarflexors led to better accomplishment of sit-to-stand transfer in children with spastic diplegic cerebral palsy.

Intramuscular nerve distribution of the hamstring muscles: Application to treating spasticity

The aim of this article is to elucidate the ideal sites for botulinum toxin injection by examining the intramuscular nerve distributions in the hamstring muscles. The hamstring muscles, biceps femoris, semitendinosus, and semimembranosus (10 specimens each) were stained by the modified Sihler method. The locations of the muscle origins, nerve entry points, and intramuscular arborized areas were recorded as percentages of the total distance from the line crossing the medial and lateral tibial condyles (0%) to the ischial tuberosity (100%). Intramuscular arborization patterns were observed at 15-30% and 50-60% for the biceps femoris, 25-40% and 60-80% for the semitendinosus, and 20-40% for the semimembranosus. This study suggests that botulinum toxin injection for spasticity of the hamstring muscles should be targeted to specific areas. These areas, where the arborization of intramuscular nerve branches is maximal, are recommended as the most effective and safest points for injection. Clin. Anat. 29:746-751, 2016. © 2016 Wiley Periodicals, Inc.

Change in Pulmonary Function after Incentive Spirometer Exercise in Children with Spastic Cerebral Palsy: A Randomized Controlled Study

PURPOSE

The aim of this study was to investigate the effect of incentive spirometer exercise (ISE) on pulmonary function and maximal phonation time (MPT) in children with spastic cerebral palsy (CP).

MATERIALS AND METHODS

Fifty children with CP were randomly assigned to two groups: the experimental group and the control group. Both groups underwent comprehensive rehabilitation therapy. The experimental group underwent additional ISE. The forced vital capacity (FVC), forced expiratory volume at one second (FEV₁), FEV₁/FVC ratio, peak expiratory flow (PEF), and MPT were assessed as outcome measures before and after 4 weeks of training.

RESULTS

There were significant improvements in FVC, FEV₁, PEF, and MPT in the experimental group, but not in the control group. In addition, the improvements in FVC, FEV₁, and MPT were significantly greater in the experimental group than in the control group.

CONCLUSION

The results of this randomized controlled study support the use of ISE for enhancing pulmonary function and breath control for speech production in children with CP.

The Effects of the Severity of Periventricular Leukomalacia on the Neuropsychological Outcomes of Preterm Children

This study investigates the developmental outcomes of preterm children according to severity of periventricular leukomalacia. One hundred preterm children with periventricular leukomalacia evident on brain magnetic resonance imaging and who had undergone neuropsychologic evaluation were selected. Intellectual disability was noted in 27.8% of the children with mild periventricular leukomalacia, 53.2% with moderate periventricular leukomalacia, and 77.1% with severe periventricular leukomalacia. The rates of major neurodevelopmental impairments such as cerebral palsy or intellectual disability were related to the severity of periventricular leukomalacia but not to gestational age or epilepsy. There were significant differences in the intelligence quotient (IQ) and social maturity quotient between 3 groups of periventricular leukomalacia. The performance IQ was significantly lower than the verbal IQ. Behavioral problems were noted in about one-third of the children but the rate was not related with the severity of periventricular leukomalacia. Our study revealed the significant associations between severity of periventricular leukomalacia and cognitive and social adaptive functions in the preterm children.

Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution

PURPOSE

To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot.

MATERIALS AND METHODS

Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection.

RESULTS

Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data.

CONCLUSION

Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.

GFP-specific CD8 T cells enable targeted cell depletion and visualization of T-cell interactions

There are numerous cell types with scarcely understood functions, and whose interactions with the immune system are not well characterized. To facilitate their study, we generated a mouse bearing enhanced green fluorescent protein (EGFP)-specific CD8+ T-cells. Transfer of the T-cells into EGFP reporter animals killed GFP-expressing cells, allowing selective depletion of desired cell types, or interrogation of T-cell interactions with specific populations. Using this system, we eliminate HCN4+ GFP-expressing cells in the heart and elicit their importance in cardiac function. We also show that naïve T-cells are recruited into the mouse brain by antigen-expressing microglia, providing evidence of an immune surveillance pathway in the central nervous system. The just EGFP death-inducing (JEDI) T-cells enable visualization of a T-cell antigen. They also make it possible to utilize hundreds of GFP-expressing mice, tumors, and pathogens, to study T-cell interactions with virtually any cell type, to model disease states, or to determine the functions of poorly characterized cell populations.

Neuropsychological Outcomes of Preterm Birth in Children With No Major Neurodevelopmental Impairments in Early Life

Objectives

To investigate cognition, social adaptive functioning, behavior, and emotional development in the preschool period and to determine the effects of the age of onset of walking on those developmental areas in children who were born preterm without major neurodevelopmental impairments (NDI) early in life.

Methods

Fifty-eight children who were born preterm without major NDI early in life participated in this study. The Korean versions of the Wechsler Preschool and Primary Scale of Intelligence or the Bayley Scales of Infant Development, the social maturity scale, the Korean version of the Child Behavior Checklist (CBCL), Conners' abbreviated parent/teacher rating scale, the Childhood Autism Rating Scale, and a speech developmental test were administered. The participants were divided into two groups: early walkers (group A) and late walkers (group B).

Results

The full-scale intelligence quotient (IQ) and performance IQ were significantly lower in group B than in group A, while the verbal IQ did not differ significantly between the groups. The children in group B had greater risks of cognitive deficits than did the children in group A, especially in performance skills. The social quotient (SQ) was significantly lower in group B than in group A (p<0.05). The rates of mild or significant deficits based on SQ and the CBCL did not differ significantly between the groups. Four children in group A and one child in group B had attention/hyperactivity problems. One child in group A had autistic behavior. Only one child in group B showed a significant speech developmental delay.

Conclusions

Problems in cognition, social adaptive functioning, and emotional and behavioral development can occur in children without major NDI early in life. Late walkers had significantly lower scores in cognition and social adaptive functioning than did early walkers.

Progress of PTSD symptoms following birth: a prospective study in mothers of high-risk infants

OBJECTIVE

To understand how postpartum posttraumatic stress disorder (PTSD) symptoms in mothers of high-risk infants progress and identify what factors predict postpartum PTSD.

STUDY DESIGN

We prospectively obtained self-reported psychological data from neonatal intensive care unit discharged infants' mothers (NICU mothers) at the infants' corrected ages of 1 (T0), 3 (T1) and 12 months (T2) and mothers of healthy infants (controls). Maternal sociodemographic and infant-related factors were also investigated.

RESULT

PTSD was present in 25 and 9% of NICU mothers and controls, respectively. We identified four PTSD patterns: none, persistent, delayed and recovered. The postpartum PTSD course was associated with trait anxiety. Whether the infant was the first child who predicted PTSD at year 1 (adjusted odds ratio=7.62, 95% confidence interval=1.07 to 54.52).

CONCLUSION

Mothers of high-risk infants can develop early or late PTSD, and its course can be influenced by factors besides medical status. We therefore recommend regular screenings of postpartum PTSD.

Metabolic stress induces a Wnt-dependent cancer stem cell-like state transition

Reciprocal interactions between cancer cells and the tumor microenvironment drive multiple clinically significant behaviors including dormancy, invasion, and metastasis as well as therapy resistance. These microenvironment-dependent phenotypes share typical characteristics with cancer stem cells (CSC). However, it is poorly understood how metabolic stress in the confined tumor microenvironment contributes to the emergence and maintenance of CSC-like phenotypes. Here, we demonstrate that chronic metabolic stress (CMS) in a long-term nutrient deprivation induces a Wnt-dependent phenoconversion of non-stem cancer cells toward stem-like state and this is reflected in the transcriptome analysis. Addition of Wnt3a as well as transfection of dominant-negative Tcf4 establishes an obligatory role for the Wnt pathway in the acquisition of CSC-like characteristics in response to metabolic stress. Furthermore, systematic characterization for multiple single cell-derived clones and negative enrichment of CD44+/ESA+ stem-like cancer cells, all of which recapitulate stem-like cancer characteristics, suggest stochastic adaptation rather than selection of pre-existing subclones. Finally, CMS in the tumor microenvironment can drive a CSC-like phenoconversion of non-stem cancer cells through stochastic state transition dependent on the Wnt pathway. These findings contribute to an understanding of the metabolic stress-driven dynamic transition of non-stem cancer cells to a stem-like state in the tumor metabolic microenvironment.

Anticancer effect of tectochrysin in colon cancer cell via suppression of NF-kappaB activity and enhancement of death receptor expression

Background

Flavonoids are a diverse family of natural phenolic compounds commonly found in fruits and vegetables. Epidemiologic studies showed that flavonoids also reduce the risk of colon cancer. Tectochrysin is one of the major flavonoids of Alpinia oxyphylla Miquel. However, the anti-cancer effects and the molecular mechanisms of tectochrysin in colon cancer cells have not yet been reported. We investigated whether tectochrysin could inhibit colon cancer cell growth at 1, 5, 10 μg/ml. In in vivo study, we injected a tectochrysin treatment dose of 5 mg/kg to each mouse.

Results

Tectochrysin suppressed the growth of SW480 and HCT116 human colon cancer cells. The expression of DR3, DR4 and Fas were significantly increased, and pro-apoptotic proteins were also increased. Tectochrysin treatment also inhibited activity of NF-κB. A docking model indicated that tectochrysin binds directly to the p50 unit. In in vivo, tumor weights and volumes in mice were reduced when treated with tectochrysin. Tectochrysin leads to apoptotic cell death in colon cancer cells through activation of death receptors expression via the inhibition of NF-κB.

Conclusions

Tectochrysin can be a useful agent for the treatment of colon cancer cell growth as well as an adjuvant agent for chemo-resistant cancer cells growth.

Reliability and validity of the Upper Limb Physician's Rating Scale in children with cerebral palsy

PURPOSE

The Upper Limb Physician's Rating Scale (ULPRS) is a tool that assesses movement quality of the upper limbs. It is used as an outcome measure after botulinum toxin type A injection in children with cerebral palsy (CP). This study aimed to investigate the reliability and validity of the ULPRS in children with spastic CP.

MATERIALS AND METHODS

Thirty children with spastic CP (M:F=17:13) aged 5 to 13 years old were recruited. The ULPRS was scored based on recorded videotapes by four physicians on two separate occasions. The Melbourne Assessment of Unilateral Upper Limb Function (MUUL) was scored by an occupational therapist. Intraclass correlation coefficients (ICCs), 95% confidence intervals and weighted kappa statistics were calculated for the scores of ULPRS to obtain interrater and intrarater reliability. The relationship between ULPRS and MUUL was assessed using Pearson correlation coefficients.

RESULTS

The ICCs for the total ULPRS scores were 0.94 between raters and 0.99 to 1.00 within raters. The weighted kappa statistics for subitem scores for the ULPRS ranged from 0.67 to 1.00 within raters and from 0.46 to 0.86 between raters. The relationship between ULPRS and MUUL was strong (Pearson correlation coefficient=0.751; p<0.05).

CONCLUSION

The results demonstrated the high reliability of the total ULPRS score within and between raters. A significant concurrent validity between ULPRS and MUUL also supports the clinical utility of the ULPRS as an outcome measure of spastic upper limb in children with CP.

Effects of hippotherapy on gross motor function and functional performance of children with cerebral palsy

PURPOSE

The purpose of our study was to investigate the effects of hippotherapy on gross motor function and functional performance in children with spastic cerebral palsy (CP).

MATERIALS AND METHODS

We recruited 34 children (M:F=15:19, age: 3-12 years) with spastic CP who underwent hippotherapy for 45 minutes twice a week for 8 weeks. Twenty-one children with spastic CP were recruited for control group. The distribution of gross motor function classification system level and mean age were not significantly different between the two groups. Outcome measures, including the Gross Motor Function Measure (GMFM)-66, GMFM-88 and the Pediatric Evaluation of Disability Inventory: Functional Skills Scale (PEDI-FSS), were assessed before therapy and after the 8-weeks intervention as outcome measures.

RESULTS

There were no significant differences between intervention and control groups in mean baseline total scores of GMFM-66, GMFM-88 or PEDI-FSS. After the 8-weeks intervention, mean GMFM-66 and GMFM-88 scores were significantly improved in both groups. However, the hippotherapy group had significantly greater improvement in dimension E and GMFM-66 total score than the control group. The total PEDI-FSS score and the sub-scores of its 3 domains were significantly improved in the hippotherapy group, but not in the control group.

CONCLUSION

The results of our study demonstrate the beneficial effects of hippotherapy on gross motor function and functional performance in children with CP compared to control group. The significant improvement in PEDI-FSS scores suggests that hippotherapy may be useful to maximize the functional performance of children with CP.

Architectural changes of the gastrocnemius muscle after botulinum toxin type A injection in children with cerebral palsy

PURPOSE

This study used ultrasonography (US) to investigate the architectural changes in gastrocnemius muscles (GCM) after botulinum toxin injection (BoNT-A) in children with cerebral palsy (CP).

MATERIALS AND METHODS

Thirteen children with CP who received a BoNT-A injection into their GCM to treat equinus were recruited (9 males and 4 females). Architectural changes in both the medial and lateral heads of the GCM from a total of 20 legs were assessed using B-mode, real-time US. Muscle thickness (MT), fascicle length (FL), and fascicle angle (FA) were measured over the middle of the muscle belly in both a resting and neutral ankle position. Measures at 1 and 3 months after the injection were compared with baseline data taken before the injection.

RESULTS

The mean age of the subjects was 5.8 (±1.6) years. Spasticity was significantly reduced when measured by both the modified Tardieu scale and the modified Ashworth scale at 1 and 3 months after injection (p<0.05). The MT and FA of both the medial and lateral heads of the GCM were significantly reduced for both neutral and resting ankle positions at 1 and 3 months after the injection. The FL of both the medial and lateral heads of the GCM were significantly increased in a resting position (p<0.05), but not in a neutral position.

CONCLUSION

Our results demonstrated muscle architectural changes induced by BoNT-A injection. The functional significances of these changes were discussed.

Estimation of gastrocnemius muscle volume using ultrasonography in children with spastic cerebral palsy

PURPOSE

This study aimed to investigate useful parameters for estimating gastrocnemius (GCM) muscle volume (MV) using ultrasonography (US) and anthropometry in children with spastic cerebral palsy (CP).

MATERIALS AND METHODS

Eighteen legs from nine children with spastic CP aged 2 to 6 years were investigated in this study. Tibial length (TL) of each leg was measured and muscle thickness (MT) and anatomical cross-sectional area (aCSA) of GCM muscles were assessed using US. The volume of the GCM was measured by magnetic resonance imaging (MRI) scans. The relationship of TL, MT, and aCSA with MV measured by MRI was investigated. Simple and multiple regression analyses were performed to establish muscle volume prediction equations.

RESULTS

Resting MT, aCSA, and TL were highly related to MV of both medial and lateral head of GCM determined by MRI. The MV prediction equation based on simple regression analysis resulted in r² values ranging from 0.591 to 0.832 (p<0.05). The r² values were higher using aCSA as independent variable than using MT. The MV prediction equation based on multiple regression analysis resulted in r² values ranging from 0.779 to 0.903 (p<0.05). However, the relatively high standard error of the estimate values ranged from 18.0-33.6% on simple regression and 15.5-25.6% on multiple regression. The contribution of aCSA was higher than that of MT for predicting MV of GCM.

CONCLUSION

Our study demonstrated the suitability of US assessment of aCSA and MT combined with TL for estimating MV of GCM in children with spastic CP and showed that aCSA is more useful parameter than MT.

Acute calcium deposits in the hand and wrist; comparison of acute calcium peritendinitis and acute calcium periarthritis

Acute calcium deposits are characterized by acute pain and a radiographic finding of amorphous calcification. A prospective, observational study was carried out on 30 consecutive patients undergoing conservative treatment for acute calcium deposits of the hand and wrist. Thirteen patients presented with acute calcific peritendinitis (Group A), and the other 17 with acute calcific periarthritis (Group B). All patients were followed for more than 12 months (mean 29 months). The average age at onset and recurrence rate of acute calcific peritendinitis were both significantly greater than for acute calcific periarthritis.

Two-year outcomes of deep brain stimulation in adults with cerebral palsy

Objective

To investigate the effect of deep brain stimulation (DBS) on reducing dystonia and disability in adults with cerebral palsy (CP) and to compare the therapeutic outcomes between primary dystonia patients and CP patients over two years after bilateral pallidal DBS.

Methods

Five patients with primary dystonia and seven CP patients with dystonia were recruited. All subjects received DBS surgery in both globus pallidus. Burke-Fahn-Marsden dystonia rating scale consisting of dystonia movement score and disability score and subjective satisfaction scale were assessed after 1 month and every 6 months over two years following DBS treatment.

Results

On the dystonia movement scale, both groups of primary dystonia patients and CP patients showed a significant decrease over time following DBS. On the disability scale, patients with primary dystonia showed a significant decrease over time, whereas the disability score of CP patients did not change over the two years. Comparing the dystonia movement and disability scores of CP patients at each assessment, patients with primary dystonia showed a significant reduction after 6 months. Comparing the satisfaction scores of CP patients after DBS, patients with primary dystonia showed significantly higher subjective satisfaction.

Conclusion

Whereas dystonia can be significantly reduced in patients with primary dystonia, CP patients showed a modest improvement on the dystonia movement scale, but not on the disability scale. Therefore, DBS may be considered with caution as a treatment modality of CP patients with dystonia.