Limb reconstruction in Ollier's disease

We present our experience of lengthening and correction of complex deformities in the management of patients with Ollier’s dysplasia (multiple enchondromatosis) from 1985 and 2002. All patients were under 18 years with a minimum follow-up time of 2 years (mean 9.6 years, range 2–15 years). There were a total of ten patients of which seven were male and three female. The mean age at presentation was 10.7 years (range 5–17 years; SD 3.7 years). The total length gain was 42.3 mm (range 30–110 mm; SD 28.9 mm). The number of days in external fixation was 164.8 days (range 76–244 days; SD 42.9 days). The bone healing index was 32.5 days/cm (18–50 days/cm; SD 10.3 days/cm). Patients with Ollier’s disease have limb length inequality and angular deformities and require multiple reconstructive procedures owing to a high incidence of recurrence. We identified a tendency for the osteotomy to prematurely consolidate and advise the latency period after surgery to be 4–5 days and for distraction to proceed at a faster rate.

Diagnosis of Glanzmann thrombasthenia by whole blood impedance analyzer (MEA) vs. light transmission aggregometry

BACKGROUND

Glanzmann thrombasthenia (GT) is a rare inherited platelet disorder that is characterized by spontaneous or postprocedural bleeding. The diagnosis of GT depends on identifying the dysfunction of the platelets.

AIM

The aim of this study was to compare a whole blood impedance Multiplate analyzer (MEA) with the standard method, light transmission aggregometry (LTA) in diagnosis of GT.

METHODS

Fifteen patients with GT were assessed on MEA and LTA using arachidonic acid (ASPI: 15 mm), (TRAP: 1 mm), collagen (100 μg/mL), ADP (0.2 mm), and ristocetin (Risto: 10 mg/mL). Whole blood samples were collected in sodium citrate and hirudin vacuum, blood collection tubes and tested within 4 h. Platelet-rich plasma was used for LTA using platelet agonists (ristocetin 1.5 mg/mL) (arachidonic acid 0.5 mg/mL) (ADP 2.5 mg/mL) and (collagen 1 mg/mL).

RESULTS

The platelet count and PFA-100 results were (average and SD) 319 ± 93 × 10(9) L and 252 ± 34 s, respectively. Flow cytometry analysis showed that all samples are positive for CD42a and CD42b, whereas 9/15 samples were negative for CD61 and CD41. The other six patients had either partial or full expression of CD61/CD41. Aggregation analysis using both methods showed that all samples had no aggregation response to any of the agonists used apart from six samples which, using only the MEA, showed minimal aggregation in response to collagen (average = 14.3 ± 7 μg, which may suggest ability to detect qualitative abnormality of GPIIb/IIIa).

CONCLUSION

These results suggest that the MEA is sensitive for the detection of Glanzmann thrombasthenia. Furthermore, MEA may also be able to differentiate between the subtypes of Glanzmann thrombasthenia.

Development of a novel in vitro method for drug development for fish; application to test efficacy of antimicrosporidian compounds

Few drugs are approved for treating diseases caused by parasites in minor species such as fish. This is due, in part, to the expense of drug development and to the comparatively small market. In vivo effectiveness trials for antiparasitic drugs are costly, time consuming and require ethics approval, therefore an in vitro screening approach is a cost-effective alternative to finding promising drug candidates. We developed an in vitro testing system to test antimicrosporidial compounds against a microsporidian pathogen Heterosporis saurida. Five antiparasitic compounds, albendazole, fumagillin, TNP-70, nitazoxanide and lufenuron, were assayed for antimicrosporidial activity. All compounds reduced the number of H saurida spores in infected cells when applied at a concentration that did not appear to be toxic to the host cells. Albendazole inhibited replication of H saurida by >60 per cent, fumagillin and its analogue TNP-470 inhibited H saurida >80 per cent, nitazoxanide and lufenuron inhibited growth >70 per cent. The data suggest that both fumagillin and its analogous TNP-70 hold the best promise as therapeutic agents against H saurida. The ability to use fish cell cultures to assess drugs against H saurida demonstrates an approach that may be helpful to evaluate other drugs on different microsporidia and host cells.

Use of the Measure of Processes of Care (MPOC-20) to evaluate health service delivery for children with cerebral palsy and their families in Jordan: validation of Arabic-translated version (AR-MPOC-20)

BACKGROUND

Family-centred service (FCS) is widely accepted now as best practice in paediatric rehabilitation. The Measure of Processes of Care-20 items set (MPOC-20) is a valid and reliable self-report measure of parents' perceptions of the extent to which health services are family-centred. Arabic-translated and validated version of the MPOC-20 (AR-MPOC-20) is used to examine Jordanian families' perception of service providers' caregiving behaviours as they receive rehabilitation services for their children with cerebral palsy (CP).

METHODS

Parents of 114 children with CP who are receiving services at different settings in Jordan were interviewed using the AR-MPOC-20. Participating children aged 4.1 ± 4.4 years, 53.5% were males. Children varied across gross motor functional classification system (GMFCS). Parents were mostly mothers (76.3%), with at least high school education (71.9%).

RESULTS

Factor analyses of the AR-MPOC-20 yielded a five-factor solution with items loaded differently from the original measure. All items correlated best and significantly with their own Arabic scale score (rs: 0.91-0.26, P < 0.01). Internal consistency values of AR-MPOC-20 scales were acceptable (Cronbach's α: 0.69-0.82). Scale 'Providing Written Information' has the lowest average score (1.9 ± 1.6), while scale 'Respectful & Coordinated Care' has the highest average score (5.2 ± 1.5).

CONCLUSION

The AR-MPOC-20 is found to be a valid and reliable measure for use with Arabic-Jordanian families of children with CP. FCS is not yet well implemented in Jordan, with parents reporting more need for information about their children's health and available services. Service providers are encouraged to apply FCS in paediatric rehabilitation, and giving more attention to effective communication and information exchange with families. AR-MPOC-20 is recommended for use for program evaluation.

A phase I dose escalation study of oral c-MET inhibitor tivantinib (ARQ 197) in combination with gemcitabine in patients with solid tumors

BACKGROUND

Tivantinib (ARQ 197) is an orally available, non-adenosine triphosphate competitive, selective c-MET inhibitor. The primary objective of this study was to evaluate the safety, tolerability and to establish the recommended phase II dose (RP2D) of tivantinib and gemcitabine combination.

PATIENTS AND METHODS

Patients with advanced or metastatic solid tumors were treated with escalating doses of tivantinib (120-360 mg capsules) in combination with gemcitabine (1000 mg/m(2) weekly for 3 of 4 weeks). Different schedules of administration were tested and modified based on emerging preclinical data. Tivantinib was given continuously, twice a day (b.i.d.) for 2, 3 or 4 weeks of a 28-day cycle or on a 5-day on, 2-day off schedule (the day before and day of gemcitabine administration).

RESULTS

Twenty-nine patients were treated with gemcitabine and escalating doses of tivantinib: 120 mg b.i.d. (n = 4), 240 mg b.i.d. (n = 6) and 360 mg b.i.d. (n = 19). No dose-limiting toxicities were observed in escalation. The RP2D was 360 mg b.i.d. daily, and 45 additional patients were enrolled in the expansion cohort. Grade ≥3 treatment-related toxicities were observed in 54 of 74 (73%) patients with the most common being neutropenia (43%), anemia (30%), thrombocytopenia (28%) and fatigue (15%). There was one treatment-related death due to neutropenia. Administration of gemcitabine did not affect tivantinib concentration. Fifty-six patients were assessable for response. Eleven (20%) patients achieved a partial response and 26 (46%) had stable disease (SD), including 15 (27%) who achieved SD for over 4 months. Ten of 37 patients with clinical benefit had prior exposure to gemcitabine.

CONCLUSION

The combination of tivantinib at its monotherapy dose and standard dose gemcitabine was safe and tolerable. Early signs of antitumor activity may warrant further development of this combination in nonsmall-cell lung cancer, ovarian, pancreatic and cholangiocarcinoma.

CLINICALTRIALSGOV IDENTIFIER

NCT00874042.

Family resources for families of children with cerebral palsy in Jordan: psychometric properties of the Arabic-family resources scale

BACKGROUND

Resource-based, family-centred practices are associated with better health, emotional, and social well-being of children with disabilities. The adequacy of resources available for families of children with disabilities in Middle Eastern countries has not been described adequately in part because of lack of measures that are culturally adapted to be used in Arabic countries. Therefore, this study aims to (1) to evaluate the psychometric properties of the Arabic-Family Resource Scale (A-FRS) on a sample of families of children cerebral palsy (CP); (2) examine the adequacy of family resources as perceived by parents of children with CP in Jordan; and (3) examine the influence of child and family demographic variables on how parents report resources available to their families.

METHOD

A cross-section design was applied. One-hundred fifteen parents of children with CP with mean age 4.6 years (SD = 4.4) and their parents participated in the study. Research assistants interviewed the participants to complete the A-FRS, and family and child demographic questionnaire, and determined the Gross Motor Function Classification System level of children.

RESULTS

The principal axis factoring of the A-FRS yielded a six-factor solution that accounted for 67.39% of the variance and that is different than the factor structure reported by the developers of the FRS. Cronbach’s coefficient alpha of the total score of family resources was 0.86 indicating a good internal consistency and the test–retest reliability for the total scale score was r = 0.92 (P = 0.000) indicating excellent test–retest reliability. Child health and family income were significantly associated with the total score of the A-FRS.

CONCLUSIONS

The A-FRS is a valid and reliable measure of family resources for Jordanian families of children with CP. Service providers are encouraged to use A-FRS with families to plan resource-based interventions in which family resources are mobilized to meet family needs.

In vitro cultivation model for Heterosporis saurida (Microsporidia) isolated from lizardfish, Saurida undosquamis (Richardson)

Heterosporis saurida is a microsporidian that infects lizardfish, Saurida undosquamis (Richardson, 1848), in the Arabian Sea. Spores were isolated from infected lizardfish and used to infect derived fish cell lines: common carp brain (CCB), epithelioma papulosum cyprinid (EPC), fathead minnow epithelial (FHM), rainbow trout gonad (RTG), bluegill fry (BF-2) and chinook salmon embryo (CHSE). Non-fish cell lines were also tested that include: insect (SF-9), rabbit (RK-13) and African green monkey (Vero E6). No growth of H. saurida was observed in any fish cell line, SF-9 or Vero E6 cell lines. H. saurida spores grew only in RK-13 cell line and were detected by immunofluorescence. Developmental stages of H. saurida were seen in RK-13 cells by light and transmission electron microscopy, and species identification was confirmed by sequencing. This study demonstrated that H. saurida was able to proliferate in the mammalian RK-13 cell line, which thus represents an in vitro model for conducting molecular genetics and cell-pathogen interaction studies of Heterosporis.

Odor is a time cue for circadian behavior

Many physiological and behavioral processes such as sleep and wakefulness, hormone secretion, and olfactory sensitivity exhibit a 24-h rhythmicity that persists in constant conditions with a period close to (circa) 24 h. These circadian rhythms are driven by a network of endogenous clocks residing in various tissues, including the olfactory system, and are synchronized to the outside world by environmental time cues such as light, temperature, and food. In addition to having these well-known zeitgebers of circadian clocks, most environments consist of a multitude of odors that report, for example, the availability of food or the presence of predators--and often, they do so in a time-of-day-dependent manner. Considering the evolutionary significance of odors for various fitness-related behaviors such as mate choice, predator avoidance, and foraging strategies, we asked whether odors--similar to light, temperature, or food--might act as a circadian time cue able to influence circadian locomotor behavior in mammals. Administering individual air flow, periodically saturated with an artificial odor mix, to running wheel-equipped mouse cages, we found that rhythmic odor administrations significantly lengthened the period of circadian activity rhythms. Additionally, odor cues led to partial reemergence of circadian locomotor rhythmicity in suprachiasmatic nuclei (SCN)-lesioned mice, suggesting that the SCN as the central circadian pacemaker are not immediately required for odor-mediated effects on circadian behavior. However, odor-based modulation of circadian behavior did not occur in clock mutant (cry1(-/-) /cry2(-/-)) mice, indicating an odor-mediated mechanism that involves extra-SCN canonical clocks, such as the olfactory clock itself. Our results indicate not only that odor stimuli can act as a circadian time cue modulating circadian behavior but also that odor effects are even more pronounced in the absence of the SCN but nevertheless require the presence of a functional canonical clock.

[Choroidal melanoma treated by protontherapy: anatomical and functional results at Strasbourg University Medical Center]

PURPOSE

To report anatomical and functional results of choroidal melanoma treated by protontherapy between 2001 and 2011 and to compare these with data reported in the literature.

METHODS

The present study is a retrospective review of the charts of patients presenting with choroidal melanoma, managed at Strasbourg University Medical Center between 2001 and 2011, and receiving protontherapy. Visual acuity and a complete ophthalmologic examination, including intraocular pressure, dilated fundus exam, and ultrasonography with measurement of the major diameter of the tumor, were performed prior to treatment and at various follow-up visits (every six months for five years, then once a year for ten years). The rates and timing of local complications (cataract, rubeosis, retinal detachment, neovascular glaucoma and secondary enucleation) and systemic complications (metastasis) are also reported.

RESULTS

Seventy charts were included. Mean age of the treated population was 61.4 ± 15.2 years. Male/female ratio was 1.06. Mean visual acuity, 0.55 ± 0.6 (20/67) on presentation, decreased progressively from month 42. Mean tumor thickness was 5.8 ± 2.8mm and major diameter 11.2 ± 2.9 mm. Decreased tumor thickness was noted beginning at month 12 of follow-up (Anova, P<0.0001), while major diameter remained unchanged over time (P>0.05). The risk of complications (retinal detachment, rubeosis, neovascular glaucoma) was greater between the second and third year. Mean 5-year survival was 87.5%. The rate of secondary enucleation was 8.5%.

CONCLUSION

Protontherapy most often allows for preservation of the globe. Visual loss, often significant and permanent, is frequent.

Assessment of pain and discomfort during early orthodontic treatment of skeletal Class III malocclusion using the Removable Mandibular Retractor Appliance

AIM

To determine the degree of pain and discomfort during the orthodontic treatment of skeletal Class III malocclusion using the Removable Mandibular Retractor (RMR).

MATERIALS AND METHODS

The sample consisted of 33 skeletal Class III patients (17 males and 16 females; average age: 7.5 ± 1.33 years) who had been assigned to the RMR treatment group in a randomised controlled trial comparing this treatment versus a control group of no treatment at the Orthodontic Department, University of Al-Baath Dental School in Syria. Pain and discomfort were assessed using standardised questionnaires at the following assessment times: 7 days (T1), 14 days (T2), 6 weeks (T3), 3 months (T4) and 6 months (T5) after appliance insertion.

RESULTS

Levels of pain and discomfort decreased gradually by time in general. No significant changes in the levels of pain, tooth sensitivity and soft tissues tension were detected, whereas a significant decrease in the levels of pressure, impaired speech, impaired swallowing and lack of confidence in public was observed two weeks following appliance insertion. Mandibular constraint feeling required three months to decrease significantly. No difference was found between males and females with regard to acceptance.

CONCLUSION

The RMR is well accepted by Class III patients in the early mixed dentition.

[Detection of prostate cancer by real-time MR/ultrasound fusion-guided biopsy: 3T MRI and state of the art sonography]

PURPOSE

Multiparametric MRI of the prostate is a noninvasive diagnostic method with high sensitivity and specificity for prostate cancer. The aim of this study is to evaluate whether prostate cancer detection rates of transrectal ultrasound (TRUS)-guided biopsy may be improved by an image fusion of state-of-the-art ultrasound (CEUS, elastography) and MR (T2w, DWI) imaging.

MATERIALS AND METHODS

32 consecutive patients with a history of elevated PSA levels and at least one negative TRUS-guided biopsy with clinical indication for a systematic re-biopsy underwent multiparametric 3 T MRI without endorectal coil. MR data (T2w) were uploaded to a modern sonography system and image fusion was performed in real-time mode during biopsy. B-mode, Doppler, elastography and CEUS imaging were applied to characterize suspicious lesions detected by MRI. Targeted biopsies were performed in MR/US fusion mode followed by a systematic standard TRUS-guided biopsy. Detection rates for both methods were calculated and compared using the Chi²-test.

RESULTS

Patient age was not significantly different in patients with and without histologically confirmed prostate cancer (65.2 ± 8.0 and 64.1 ± 7.3 age [p = 0.93]). The PSA value was significantly higher in patients with prostate cancer (15.5 ± 9.3 ng/ml) compared to patients without cancer (PSA 10.4 ± 9.6 ng/ml; p = 0.02). The proportion of histologically confirmed cancers in the study group (n = 32) of the MR/US fusion biopsy (11/12; 34.4 %) was significantly higher (p = 0.01) in comparison to the TRUS systematic biopsy (6/12; 18.8 %).

CONCLUSION

Real-time MR/US image fusion may enhance cancer detection rates of TRUS-guided biopsies and should therefore be studied in further larger studies.