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Dysfunctional labor and delivery: adverse effects on offspring. Am J Obstet Gynecol 2023; 228:S1104-S1109. [PMID: 36997398 DOI: 10.1016/j.ajog.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/10/2022] [Indexed: 03/18/2023]
Abstract
There is no doubt that parturition can produce fetal and neonatal adversity, but the frequency with which this occurs is uncertain, particularly in modern healthcare settings. Moreover, there is a paucity of recent studies in this area. Substantial challenges impede epidemiologic study of the effect of parturition on offspring. Randomized trials would be ethically fraught. Therefore, large observational samples with detailed data concerning labor and delivery events are needed. Importantly, long-term follow-up of infants is necessary to reach reliable conclusions. Few such data sets exist, and it is difficult, expensive, and time-consuming to create and to study them. Reports of immediate newborn condition in relation to the antecedent labor are helpful, but this evidence is an imperfect predictor of long-term neurologic status. In this review, we endeavor to summarize existing information about the relationship between objectively defined abnormalities of labor progress and long-term disability in offspring. The only data available are from collected experiential information on outcomes stratified according to labor and delivery events. Most studies do not ensure against confounding by the many concurrent conditions that may affect outcome, or use inconsistent criteria to define abnormal labor. According to the best available evidence, dysfunctional labor patterns are potentially associated with poor outcomes for surviving infants. The question of whether these adverse effects can be mitigated by early diagnosis and expeditious management deserves to be answered, but cannot be at this time. In the absence of more conclusive results from well-designed studies, we can conclude that the best interests of offspring are served by adhering to evidence-based paradigms for the prompt identification and treatment of dysfunctional labor patterns.
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Mahalingam M. Reforms, Errors, and Dermatopathology Malpractice: Then and Now: A Comprehensive Retrospective. Adv Anat Pathol 2022; 29:81-96. [PMID: 34561375 DOI: 10.1097/pap.0000000000000319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medical malpractice occurs when a hospital, doctor, or other health care professional, through a negligent act or omission, causes an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, aftercare, or health management. To be considered medical malpractice under the law, the claim must violate the standard of care, the injury must be caused by the negligence and, last but most certainly not least, the injury must result in significant damages. This review is an overview of medicolegal issues specific to the practice of Dermatopathology with the caveat that most are likely pertinent to other specialties of pathology as well. The safety of patients remains the priority in pathology as it does in any medical undertaking, and this is no different in the practice of Dermatopathology. The review is broadly divided in 2 parts-we begin with an overview of tort reforms, advocated by physicians to reduce costs associated with malpractice defense. In the second part we address practical issues specific to the practice of pathology and dermatopathology. These include among others, errors-related to the biopsy type, inadequacy of clinical information regarding the lesion that is biopsied, role of interstate dermatopathology as well as examples of select entities commonly misdiagnosed in dermatopathology. In the last decade, artificial intelligence (AI) has moved to the forefront of technology. While research into the uses of AI in pathology is promising, the use of AI in diagnostic practice is still somewhat uncommon. Given that AI is not fully integrated routinely as a diagnostic adjunct, its' impact on pathology-specific medicolegal issues cannot, as yet at least, be defined. Restriction of medical malpractice is of particular relevance in the COVID-19 era, a period that is anything but normal. The response of states with specific pandemic-related guidelines is addressed with the caveat that this particular issue is only covered in select states. Furthermore, given that the COVID pandemic is only a year old, while it does not appear to have had an immediate impact on pathology-specific medicolegal matters, it is possible that the role of COVID on this issue, if any at all, will and can only be fully defined a few years down the line.
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Affiliation(s)
- Meera Mahalingam
- *Department of Dermatology, Tufts University School of Medicine, Boston
- †Dermatopathology Section, VA Consolidated Laboratories, Department of Pathology and Laboratory Medicine, West Roxbury, MA
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Li E, Smithson L, Khan M, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Effects of Perinatal Stroke on Executive Functioning and Mathematics Performance in Children. J Child Neurol 2022; 37:133-140. [PMID: 34985353 PMCID: PMC8801623 DOI: 10.1177/08830738211063683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this study was to examine executive functioning, math performance, and visuospatial processing skills of children with perinatal stroke, which have not been well explored in this population. Participants included 18 children with perinatal stroke (aged 6-16 years old) and their primary caregiver. Each child completed standardized tests of executive function and visuospatial processing skills, Intelligence Quotient (IQ), and math achievement. Performance on executive function, IQ, math, and visuospatial processing tests was significantly lower in children with perinatal stroke when compared to normative means. Poorer inhibitory control was associated with worse math performance. Increased age at testing was associated with better performance on visuospatial ability (using standardized scores), and females performed better than males on a test of inhibitory control. Children with perinatal stroke displayed a range of neuropsychological impairments, and difficulties with executive function (inhibition) may contribute to math difficulties in this population.
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Affiliation(s)
- Eliza Li
- University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Smithson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - John Andersen
- University of Alberta, Edmonton, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | | | - Brian L. Brooks
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada,Faculty of Arts, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Carmen Rasmussen
- University of Alberta, Edmonton, Alberta, Canada,Carmen Rasmussen, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 4-478, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
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Reid C, Romero M, Chang SB, Osman N, Puglisi JL, Wilson CG, Blood AB, Zhang L, Wilson SM. Long-Term Hypoxia Negatively Influences Ca2+ Signaling in Basilar Arterial Myocytes of Fetal and Adult Sheep. Front Physiol 2022; 12:760176. [PMID: 35115953 PMCID: PMC8804533 DOI: 10.3389/fphys.2021.760176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Cerebral arterial vasoreactivity is vital to the regulation of cerebral blood flow. Depolarization of arterial myocytes elicits whole-cell Ca2+ oscillations as well as subcellular Ca2+ sparks due to activation of ryanodine receptors on the sarcoplasmic reticulum. Previous evidence illustrates that contraction of cerebral arteries from sheep and underlying Ca2+ signaling pathways are modified by age and that long-term hypoxia (LTH) causes aberrations in Ca2+ signaling pathways and downstream effectors impacting vasoregulation. We hypothesize that age and LTH affect the influence of membrane depolarization on whole-cell intracellular Ca2+ oscillations and sub-cellular Ca2+ spark activity in cerebral arteries. To test this hypothesis, we examined Ca2+ oscillatory and spark activities using confocal fluorescence imaging techniques of Fluo-4 loaded basilar arterial myocytes of low- and high-altitude term fetal (∼145 days of gestation) and adult sheep, where high-altitude pregnant and non-pregnant sheep were placed at 3,801 m for >100 days. Ca2+ oscillations and sparks were recorded using an in situ preparation evaluated in the absence or presence of 30 mM K+ (30K) to depolarize myocytes. Myocytes from adult animals tended to have a lower basal rate of whole-cell Ca2+ oscillatory activity and 30K increased the activity within cells. LTH decreased the ability of myocytes to respond to depolarization independent of age. These observations illustrate that both altitude and age play a role in affecting whole-cell and localized Ca2+ signaling, which are important to arterial vasoreactivity and cerebral blood flow.
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Affiliation(s)
- Casey Reid
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Monica Romero
- Advanced Imaging and Microscopy Core, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Stephanie B. Chang
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Noah Osman
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Jose L. Puglisi
- Department of Biostatistics, School of Medicine, California Northstate University, Elk Grove, CA, United States
| | - Christopher G. Wilson
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Arlin B. Blood
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Lubo Zhang
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Sean M. Wilson
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
- Advanced Imaging and Microscopy Core, Loma Linda University School of Medicine, Loma Linda, CA, United States
- *Correspondence: Sean M. Wilson,
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5
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Fröhlich M, Koga C, Bührer C, Mori C, Yamamoto M, Sakurai K, Hinkson L. Differences in rate and medical indication of caesarean section between Germany and Japan. Pediatr Int 2020; 62:1086-1093. [PMID: 32534466 DOI: 10.1111/ped.14340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are growing concerns about the increasing rate of caesarean section (CS) worldwide. Various strategies have been implemented to reduce the proportion of CS to a reasonable level. Most research on medical indications for CS focuses on nationwide evaluations. Comparative research between different countries is sparse. The aim of this study was to evaluate differences in the rate and indications for CS between Japan and Germany in 2012 and 2013. METHODS Comparison of the overall rate and medical indications for CS in two cohort studies from Germany and Japan. We used data from the German Perinatal Survey and the Japan Environment and Children's Study (JECS). RESULTS We analyzed data of 1 335 150 participants from the German perinatal survey and of 62 533 participants from JECS and found significant differences between the two countries in CS rate (30.6% vs 20.6%) and main medical indications: cephalopelvic disproportion (3.2% vs 1.3%; OR: 2.4 [95% CI: 2.2-2.6]), fetal distress (7.3% vs 2.3%; OR: 3.4 [95%-CI: 3.2-3.6]), and past uterine surgery/repeat CS (8.4% vs 8.8%; OR: 0.9 [95%-CI: 0.9-1]). CONCLUSION There are differences in the rate and medical indications for CS between Germany and Japan at the population level. Fetal distress was identified as a medical indication for CS more often Germany than in Japan. Considering the substantial diagnostic uncertainty of electronic fetal monitoring (EFM) as the major indicator for fetal distress, it would seem to be reasonable to rethink CS decision algorithms.
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Affiliation(s)
- Matthias Fröhlich
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Chie Koga
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Chisato Mori
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Sustainable Health Science, Center of Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Midori Yamamoto
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Kenichi Sakurai
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Larry Hinkson
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Jung E, Romero R, Yeo L, Diaz-Primera R, Marin-Concha J, Para R, Lopez AM, Pacora P, Gomez-Lopez N, Yoon BH, Kim CJ, Berry SM, Hsu CD. The fetal inflammatory response syndrome: the origins of a concept, pathophysiology, diagnosis, and obstetrical implications. Semin Fetal Neonatal Med 2020; 25:101146. [PMID: 33164775 PMCID: PMC10580248 DOI: 10.1016/j.siny.2020.101146] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The fetus can deploy a local or systemic inflammatory response when exposed to microorganisms or, alternatively, to non-infection-related stimuli (e.g., danger signals or alarmins). The term "Fetal Inflammatory Response Syndrome" (FIRS) was coined to describe a condition characterized by evidence of a systemic inflammatory response, frequently a result of the activation of the innate limb of the immune response. FIRS can be diagnosed by an increased concentration of umbilical cord plasma or serum acute phase reactants such as C-reactive protein or cytokines (e.g., interleukin-6). Pathologic evidence of a systemic fetal inflammatory response indicates the presence of funisitis or chorionic vasculitis. FIRS was first described in patients at risk for intraamniotic infection who presented preterm labor with intact membranes or preterm prelabor rupture of the membranes. However, FIRS can also be observed in patients with sterile intra-amniotic inflammation, alloimmunization (e.g., Rh disease), and active autoimmune disorders. Neonates born with FIRS have a higher rate of complications, such as early-onset neonatal sepsis, intraventricular hemorrhage, periventricular leukomalacia, and death, than those born without FIRS. Survivors are at risk for long-term sequelae that may include bronchopulmonary dysplasia, neurodevelopmental disorders, such as cerebral palsy, retinopathy of prematurity, and sensorineuronal hearing loss. Experimental FIRS can be induced by intra-amniotic administration of bacteria, microbial products (such as endotoxin), or inflammatory cytokines (such as interleukin-1), and animal models have provided important insights about the mechanisms responsible for multiple organ involvement and dysfunction. A systemic fetal inflammatory response is thought to be adaptive, but, on occasion, may become dysregulated whereby a fetal cytokine storm ensues and can lead to multiple organ dysfunction and even fetal death if delivery does not occur ("rescued by birth"). Thus, the onset of preterm labor in this context can be considered to have survival value. The evidence so far suggests that FIRS may compound the effects of immaturity and neonatal inflammation, thus increasing the risk of neonatal complications and long-term morbidity. Modulation of a dysregulated fetal inflammatory response by the administration of antimicrobial agents, anti-inflammatory agents, or cell-based therapy holds promise to reduce infant morbidity and mortality.
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Affiliation(s)
- Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA; Detroit Medical Center, Detroit, MI, USA; Department of Obstetrics and Gynecology, Florida International University, Miami, FL, USA.
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ramiro Diaz-Primera
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julio Marin-Concha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert Para
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ashley M Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bo Hyun Yoon
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chong Jai Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Stanley M Berry
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
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Sinha AG, Sharma R. Factors Influencing Utilization of Physiotherapy Service among Children with Cerebral Palsy in Jalandhar District of Punjab. J Neurosci Rural Pract 2019; 8:209-215. [PMID: 28479794 PMCID: PMC5402486 DOI: 10.4103/0976-3147.203852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Physiotherapy plays a central role in the management of children with cerebral palsy (CP); however, literature describing the use of physiotherapy service and the factors affecting utilization of physiotherapy service for this group of children in the Indian context remain unexplored. Aims and Objectives: To describe the utilization of physiotherapy services and explore the factors affecting utilization of physiotherapy services among children with CP of Jalandhar district of Punjab. Methodology: During June 2009 to March 2012 interview of family members of 248 children with CP (male = 159; female = 89) was conducted using a schedule focusing on demography, constraints of resources, expectations, beliefs, awareness, and service utilization. Cross tabulation with Chi-square, univariate, and multivariate logistic regression analysis were the tools of statistical analysis. Results: 44.4% children had not received any physiotherapy in their life time. In univariate analysis exposure to physiotherapy was found significantly associated with age of diagnosis (odds ratio [OR] = 2.47), finance constraint (OR = 2.27), personal constraint (OR = 2.54), transportation constraint (OR = 3.01), lack of advice for rehabilitation (OR = 2.36), ignorance about condition (OR = 11.94), and rehabilitation services (OR = 2.88). Multivariate model (χ2 = 57.16, df = 15, P < 0.001, pseudo R2 Cox and Snell = 0.22, Nagelkerke = 0.27) identified two main predictor variables of nonexposure to physiotherapy-ignorance about condition (OR = 7.3) and expectation of normalcy (OR = 0.43). Conclusion: The main drivers for the use of physiotherapy among children with CP in Jalandhar district of Punjab were awareness about the condition of CP and expectation of normalcy which demonstrated a complex relationship with sociodemographic factors.
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Affiliation(s)
- Akhoury Gourang Sinha
- Department of Physiotherapy, Faculty of Medicine, Punjabi University, Patiala, Punjab, India
| | - Raju Sharma
- Department of Physiotherapy, Lyallpur Khalsa College, Jalandhar, Punjab, India
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8
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Herrera AS, A Esparza MDC, Arias PES, Ashraf GM, Mosa OF, Fisenko VP, Sologova SS, Dostdar SA, Sokolov AV, Bovina EV, Chubarev VN, Tarasov VV, Somasundaram SG, Kirkland CE, Aliev G. The Role of Melanin to Dissociate Oxygen from Water to Treat Retinopathy of Prematurity. Cent Nerv Syst Agents Med Chem 2019; 19:215-222. [PMID: 31267880 DOI: 10.2174/1871524919666190702164206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Retinopathy of Prematurity (ROP) is a potentially blinding disorder that commonly afflicts premature infants who are born prior to 31weeks of gestation or with a body weight less than 1250 grams (about 2.75 pounds). Another risk factor is excessive oxygen in incubators, which can lead to blindness. A compounding factor is that survival rates for premature infants are rising with concomitantly more cases of ROP. We have reported an unsuspected intrinsic property of melanin to dissociate water. This capability can be considered an alternative treatment option for adult and neonatal diseases. It is known that exogenous surfactant administration suppresses bronchopulmonary dysplasia and consequent death, randomized, controlled trials with various respiratory interventions did not show any significant reductions in morbidity and mortality rates. During a descriptive study about the three leading causes of blindness in the world, the ability of melanin to transform light energy into chemical energy through the dissociation of water molecule was unraveled. Initially, during 2 or 3 years; we tried to link together our findings with the widely accepted metabolic pathways already described in molecular pathway databases, which have been developed to collect and organize the current knowledge on metabolism scattered across a multitude of scientific evidence. OBSERVATIONS The current report demonstrates the main problems that afflict premature babies with an emphasis on the growth of abnormal vessels in the retina, the explanation for which is unknown until date. We also reported a case of a baby who suffered digestive and respiratory problems with a brain haemorrhage that was successfully treated by laser photocoagulation. We hypothesise that most likely this effect was due to the melanin level and melanin itself produces oxygen via dissociating with water molecules. CONCLUSION We postulate that the intrinsic effect of melanin may easily convert visible and invisible light into chemical energy via a water dissociation reaction similar to the one in plant's chlorophyll, and markedly elevated with diagnosis and treatment of the complications related to premature babies.
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Affiliation(s)
- Arturo S Herrera
- Human Photosynthesis® Study Center. Sierra del Laurel 212, Bosques del Prado Norte, Aguascalientes, CP 20000, Mexico
| | - María Del Carmen A Esparza
- Human Photosynthesis® Study Center. Sierra del Laurel 212, Bosques del Prado Norte, Aguascalientes, CP 20000, Mexico
| | - Paola E S Arias
- Human Photosynthesis® Study Center. Sierra del Laurel 212, Bosques del Prado Norte, Aguascalientes, CP 20000, Mexico
| | - Ghulam M Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama F Mosa
- Health Sciences College at Leith, UQU, Saudi Arabia
| | - Vladimir P Fisenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, bld. 2, Moscow, 119991, Russian Federation
| | - Susanna S Sologova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, bld. 2, Moscow, 119991, Russian Federation
| | - Samira A Dostdar
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, bld. 2, Moscow, 119991, Russian Federation
| | - Alexander V Sokolov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, bld. 2, Moscow, 119991, Russian Federation
| | - Elena V Bovina
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russian Federation
| | - Vladimir N Chubarev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, bld. 2, Moscow, 119991, Russian Federation
| | - Vadim V Tarasov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, bld. 2, Moscow, 119991, Russian Federation
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Gjumrakch Aliev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, bld. 2, Moscow, 119991, Russian Federation.,Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russian Federation.,GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX, 78229, United States
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9
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Gutvirtz G, Wainstock T, Masad R, Landau D, Sheiner E. Does nuchal cord at birth increase the risk for cerebral palsy? Early Hum Dev 2019; 133:1-4. [PMID: 30991236 DOI: 10.1016/j.earlhumdev.2019.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/31/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nuchal cord is a common finding in pregnancy. It is unclear whether a nuchal cord at birth causes birth asphyxia and raises the risk for developing cerebral palsy of the offspring. AIM To evaluate the incidence of cerebral palsy in children born with and without nuchal cord. STUDY DESIGN A population-based cohort analysis including all singleton deliveries over >20 years at a single tertiary medical center was conducted. The incidence of cerebral palsy in children up to 18 years of age was evaluated. Kaplan-Meier survival curve was used to compare cumulative incidence between the groups, and a Cox proportional hazards model was used to control for confounders. RESULTS During the study period, 243,682 singleton deliveries met the inclusion criteria. Of them, 14.1% (n = 34,332) were diagnosed with nuchal cord at birth. Rates of cerebral palsy were comparable between the groups (0.1% vs. 0.1%, OR = 1.03, 95% CI 0.69-1.52, p = 0.89). The Kaplan-Meier survival curve demonstrated no significant differences in cumulative incidence of cerebral palsy for children born with or without nuchal cord (log rank p = 0.92, Fig. 1). The Cox proportional hazards model, controlled for preterm delivery, maternal age, diabetes and hypertensive disorders, showed no association between nuchal cord and cerebral palsy (adjusted HR = 1.06; 95% CI 0.71-1.57; p = 0.77). CONCLUSION In our population, nuchal cord at birth was not associated with higher risk for cerebral palsy.
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Affiliation(s)
- Gil Gutvirtz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roee Masad
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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10
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Koning G, Leverin AL, Nair S, Schwendimann L, Ek J, Carlsson Y, Gressens P, Thornton C, Wang X, Mallard C, Hagberg H. Magnesium induces preconditioning of the neonatal brain via profound mitochondrial protection. J Cereb Blood Flow Metab 2019; 39:1038-1055. [PMID: 29206066 PMCID: PMC6547197 DOI: 10.1177/0271678x17746132] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Magnesium sulphate (MgSO4) given to women in preterm labor reduces cerebral palsy in their offspring but the mechanism behind this protection is unclear, limiting its effective, safe clinical implementation. Previous studies suggest that MgSO4 is not neuroprotective if administered during or after the insult, so we hypothesised that MgSO4 induces preconditioning in the immature brain. Therefore, we administered MgSO4 at various time-points before/after unilateral hypoxia-ischemia (HI) in seven-day-old rats. We found that MgSO4 treatment administered as a bolus between 6 days and 12 h prior to HI markedly reduced the brain injury, with maximal protection achieved by 1.1 mg/g MgSO4 administered 24 h before HI. As serum magnesium levels returned to baseline before the induction of HI, we ascribed this reduction in brain injury to preconditioning. Cerebral blood flow was unaffected, but mRNAs/miRNAs involved in mitochondrial function and metabolism were modulated by MgSO4. Metabolomic analysis (H+-NMR) disclosed that MgSO4 attenuated HI-induced increases in succinate and prevented depletion of high-energy phosphates. MgSO4 pretreatment preserved mitochondrial respiration, reducing ROS production and inflammation after HI. Therefore, we propose that MgSO4 evokes preconditioning via induction of mitochondrial resistance and attenuation of inflammation.
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Affiliation(s)
- Gabriella Koning
- 1 Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna-Lena Leverin
- 1 Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Syam Nair
- 1 Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Leslie Schwendimann
- 2 PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Joakim Ek
- 1 Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ylva Carlsson
- 3 Perinatal Center, Department of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Pierre Gressens
- 2 PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,4 Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, London, UK
| | - Claire Thornton
- 4 Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, London, UK
| | - Xiaoyang Wang
- 1 Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Carina Mallard
- 1 Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Henrik Hagberg
- 1 Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,3 Perinatal Center, Department of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,4 Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, London, UK
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11
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Synowiec S, Lu J, Yu L, Goussakov I, Lieber R, Drobyshevsky A. Spinal Hyper-Excitability and Altered Muscle Structure Contribute to Muscle Hypertonia in Newborns After Antenatal Hypoxia-Ischemia in a Rabbit Cerebral Palsy Model. Front Neurol 2019; 9:1183. [PMID: 30705663 PMCID: PMC6344443 DOI: 10.3389/fneur.2018.01183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/21/2018] [Indexed: 12/17/2022] Open
Abstract
Rabbit kits after global antenatal hypoxic-ischemic injury exhibit motor deficits similar to humans with cerebral palsy. We tested several mechanisms previously implicated in spinal hyper-excitability after perinatal brain injury that may explain muscle hypertonia in newborns. Stiffness of hind limb muscles during passive stretch, electromyogram, and spinal excitability by Hoffman reflex, were assessed in rabbit kits with muscle hypertonia after global hypoxic-ischemic brain injury and naïve controls. Affected muscle architecture, motoneuron morphology, primary afferents density, gliosis, and KCC2 expression transporter in the spinal cord were also examined. Decrease knee stiffness after anesthetic administration was larger, but residual stiffness was higher in hypertonic kits compared to controls. Hypertonic kits exhibited muscle shortening and atrophy, in both agonists and antagonists. Sarcomere length was longer in tibialis anterior in hypertonic kits than in controls. Hypertonic kits had decreased rate dependent depression and increased Hmax/Mmax in H-reflex. Motor neuron soma sizes, primary afferent density were not different between controls and hypertonic kits. Length of dendritic tree and ramification index were lower in hypertonic group. Gene expression of KCC2 was lower in hypertonic kits, but protein content was not different between the groups. In conclusion, while we found evidence of decreased supraspinal inhibitory control and increased excitability by H-reflex that may contribute to neuronal component in hypertonia, increased joint resistance to stretch was explained predominantly by changes in passive properties of muscles and joints. We did not find structural evidence of increased sensory afferent input or morphological changes in motoneurons that might explain increased excitability. Gliosis, observed in spinal gray matter, may contribute to muscle hypertonia.
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Affiliation(s)
- Sylvia Synowiec
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
| | - Jing Lu
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Lei Yu
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
| | - Ivan Goussakov
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
| | - Richard Lieber
- Department of Physical Medicine and Rehabilitation, Northwestern University and the Shirley Ryan Ability Lab, Chicago, IL, United States
| | - Alexander Drobyshevsky
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
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12
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Sensory-motor network functional connectivity in children with unilateral cerebral palsy secondary to perinatal stroke. NEUROIMAGE-CLINICAL 2019; 21:101670. [PMID: 30642756 PMCID: PMC6412078 DOI: 10.1016/j.nicl.2019.101670] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022]
Abstract
Background Perinatal stroke is the most common cause of unilateral cerebral palsy. Mechanisms of post-stroke developmental plasticity in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used resting-state fMRI to compare sensorimotor connectivity with clinical dysfunction. Methods School-aged children with periventricular venous infarction (PVI) and unilateral cerebral palsy were compared to controls. Resting-state BOLD signal was acquired on 3 T MRI and analyzed using CONN in SPM12. Functional connectivity was computed between S1, M1, supplementary motor area (SMA), and thalamus of the left/non-lesioned and right/lesioned hemisphere. Primary outcome was connectivity expressed as a Fisher-transformed correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY). Results Participants included 15 PVI and 21 controls. AHA and MA in stroke patients were negatively correlated with connectivity (increased connectivity = poorer performance). Position sense was inversely correlated with connectivity (increased connectivity = improved performance) between the non-lesioned S1 and thalamus/SMA. In controls, VarXY was positively correlated with connectivity between the thalamus and bilateral sensorimotor regions. Conclusions Resting state fMRI measures of sensorimotor connectivity are associated with clinical sensorimotor function in children with unilateral cerebral palsy secondary to PVI. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation. Sensorimotor resting-state networks can be measured in children with PVI. Thalamic connectivity appears to be altered by PVI. Resting state connectivity is associated with motor performance in PVI.
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13
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Abstract
BACKGROUND In children, cerebral palsy (CP) is one of the most common causes of irreversible neurological sequelae. Acupotomy, a modernized acupuncture form combining the effects of microsurgery and conventional acupuncture, may show specific benefits in the treatment of CP, especially with respect to spasticity. The aim of this review was to evaluate the efficacy of acupotomy for CP. METHODS Eleven databases were comprehensively searched from their inception dates to November 27, 2018. Randomized controlled trials (RCTs) or quasi-RCTs evaluating acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment for CP were included. The methodological quality of included studies was assessed using the risk of bias tool. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analysis was performed, and the pooled data were presented as mean difference (MD) with 95% confidence interval (CI) for continuous outcomes and as risk ratio (RR) with 95% CI for dichotomous outcomes. RESULTS Eight studies involving 530 participants were included. In 1 study, acupotomy was associated with significantly higher total effective rate (TER) compared with Bobath (P < .01). Acupotomy combined with rehabilitation was associated with significantly higher TER (RR 1.24, 95% CI 1.01-1.52, I = 77%) and gross motor function measure score (MD 12.62, 95% CI 11.75-13.49, I = 54%), and significantly lower muscle tone of gastrocnemius measured by the Ashworth scale or the modified Ashworth scale (MD -0.97, 95% CI -1.07 to -0.88, I = 0%) compared with rehabilitation alone. No studies reported the incidence of adverse events. The methodological quality of the included studies and quality of evidence for the main finding were generally low. CONCLUSION Current evidence shows that acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment might have benefits in the treatment of CP. However, due to the small number of studies included, the lack of sample size, poor methodological qualities, and low quality of evidence, the findings of this review should be interpreted with caution. Larger and more rigorous, high-quality RCTs should be performed on this topic. PROSPERO REGISTRATION NUMBER CRD42018105891.
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Affiliation(s)
- Chan-Young Kwon
- Chung-Yeon Central Institute, Gwangju
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Boram Lee
- Department of Pediatrics of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
| | - Gyu Tae Chang
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
- Department of Pediatrics of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
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14
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Zhou L, Li H, Li C, Li G. Risk management and provider liabilities in infantile cerebral palsy based on malpractice litigation cases. J Forensic Leg Med 2018; 61:82-88. [PMID: 30502590 DOI: 10.1016/j.jflm.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/22/2018] [Indexed: 12/13/2022]
Abstract
AIM Infantile cerebral palsy (CP) severely affects the survival and quality of life of infants. CP is typically caused by multiple factors, leading to causal uncertainty of the role of medical errors in CP and resulting in frequent medical disputes. No relevant research exists on risk management and malpractice liabilities in CP, including in China. METHOD A retrospective analysis of 400 CP malpractice litigation cases from 18th June 1999 to 23rd November 2017, collected from China Judgments Online, included basic case information, CP risk factors, medical errors, medical malpractice liability determination, and compensation. RESULTS Up to 63.5% of infants with CP were affected by asphyxia, followed by hypoxic-ischemic encephalopathy (63.3%), neonatal infection (52.3%) and intracranial hemorrhage (36.0%). Most (89.1%) of civil judgments resulted in liability for medical errors, with the highest proportion of ultimate liability. The three most frequent medical errors were failure of completing delivery in time (30.2%), incomplete assessment of birth process detection (28.8%), and nonstandard medical records (25.3%). Each case involved 2.5 medical errors on average. No difference in the distribution of medical errors between premature and full-term CP infants (P > 0.05) was found. Compensation for damage was awarded in 91.4% of claims, and the mean value of compensation was $73,506. The mean value of the total actual loss of the family was $128,198. INTERPRETATION Contradictions between the doctors and patients were prominent in malpractice CP litigation cases, with a total loss of $3.97 billion attributable to new CP cases in China in 2017. Asphyxia was the most frequent risk factor for CP since it may easily draw the attention of the sufferer's family. Medical service providers did not pay attention to risk management in preterm infants. The importance of fetal monitoring and standardized medical record writing should be emphasized.
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Affiliation(s)
- Leyin Zhou
- Shanghai Jiao Tong University School of Public Health, China.
| | - Heng Li
- Shanghai Jiao Tong University School of Public Health, China Hospital Development Institute of Shanghai Jiao Tong University, China.
| | - Chong Li
- Seattle Children's Hospital Research Institute, USA.
| | - Guohong Li
- Shanghai Jiao Tong University School of Public Health, China Hospital Development Institute of Shanghai Jiao Tong University, China.
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15
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Cavallin F, Trevisanuto D, Thein A, Booth A, Arnolda G, Kumara D, U P, Myint S, Moccia L. Birthplace is a risk factor for exchange transfusion in outborn infants admitted for jaundice in Myanmar: a case-control study. J Matern Fetal Neonatal Med 2018; 33:1526-1531. [PMID: 30407090 DOI: 10.1080/14767058.2018.1521796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aim: To evaluate the role of pathway to admission for jaundice among the risk factors for exchange transfusion in outborn infants in a low resource setting.Methods: This retrospective case-control study (1:1 ratio) was carried out at the Yankin Children's Hospital in Yangon (Myanmar). All cases were neonates admitted for treatment of jaundice between March 2013 and February 2014 and who required an exchange transfusion. Each control was the next noncase neonate admitted for treatment of jaundice and treated with phototherapy. Infant characteristics, pathways of admission and clinically relevant factors for exchange transfusion were collected.Results: One hundred thirty-four cases and 134 controls were included in the study. Among cases, home was the most common place of birth while public hospital was the most frequent source of referral. Among controls, private/public hospitals were the commonest places of birth and referral. At multivariable analysis, homebirth was associated with increased likelihood of receiving exchange transfusion at admission (OR 3.30, 95% C.I. 1.31-8.56).Conclusion: Homebirth was an independent risk factor for exchange transfusion at admission for jaundice in a low-resource setting. Appropriate health education of pregnant women and traditional/home birth attendants may contribute to reduce the need for exchange transfusion in low-resource settings.
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Affiliation(s)
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy.,Amici della Neonatologia Trentina, Trento, Italy
| | - Aye Thein
- Department of Neonatology, University of Medicine 1, Yangon, Myanmar
| | | | - Gaston Arnolda
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Phyu U
- Department of Neonatology, University of Medicine 2, Yangon, Myanmar
| | - Sandar Myint
- Department of Neonatology, University of Medicine 2, Yangon, Myanmar
| | - Luciano Moccia
- Amici della Neonatologia Trentina, Trento, Italy.,Day One Health, Redding, CA, USA
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16
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Decreasing prevalence and severity of cerebral palsy in Norway among children born 1999 to 2010 concomitant with improvements in perinatal health. Eur J Paediatr Neurol 2018; 22:814-821. [PMID: 29779984 DOI: 10.1016/j.ejpn.2018.05.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/16/2018] [Accepted: 05/01/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of our study was to explore if the prevalence and clinical characteristics of cerebral palsy (CP), concomitant with perinatal health indicators in the general population, remained unchanged for children born in Norway between 1999 and 2010. METHODS This national multi-register cohort study included 711 174 children recorded in the Medical Birth Registry of Norway. Among these, 707 916 were born alive, and 1664 had a validated diagnosis of CP recorded in the Cerebral Palsy Registry of Norway and/or the Norwegian Patient Registry. Prevalence per 1000 live births as a function of birth year was analyzed using logistic regression with fractional polynomials to allow for non-linear trends. Chi-square statistics were used to estimate trends in proportions of clinical characteristics. RESULTS The prevalence of CP in Norway decreased from 2.62 per 1000 live births in 1999 to 1.89 in 2010. The reduction was most evident among children with bilateral CP, in particular those with diplegia. During the study period, the proportions of children with severe motor impairments, epilepsy, intellectual impairment and reduced speech also decreased. At the same time, perinatal mortality has decreased in Norway, along with the proportion of women with preeclampsia, children born preterm or as a multiple. CONCLUSION We observed a significant decrease in the prevalence and severity of CP subtypes and associated impairments among children with CP in Norway. This coincided with improvements in perinatal health indicators in the general population. These improvements are most likely explained by advancements in obstetric and neonatal care.
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17
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Okur SÇ, Erdoğan S, Demir CS, Günel G, Karaöz E. The Effect of Umbilical Cord-derived Mesenchymal Stem Cell Transplantation in a Patient with Cerebral Palsy: A Case Report. Int J Stem Cells 2018; 11:141-147. [PMID: 29699386 PMCID: PMC5984068 DOI: 10.15283/ijsc17077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/05/2018] [Accepted: 04/13/2018] [Indexed: 12/14/2022] Open
Abstract
Background Cerebral Palsy (CP) is the most common motor disability reason of childhood that occurs secondarily to non-progressive damage in the brain whose development is still ongoing. Methods 6-year-old dystonic-spastic male CP patient received allogenic mesenchymal stem cells treatment four times as 1×10⁶/kg in intrathecal and intravenous administration of Umbilical Cord-derived mesenchymal stem cells (UC-MSCs) ways. Before and after the treatment, the patient was followed-up with FIM (Functional Independent Measurement), GMFCS (Gross Motor Function Classification System 88), Tardieu Scale, TCMS (Trunk Control Measurement Scale), MACS (Manual Ability Classification Scale), CFSS (Communication Function Classification System) for 18 months and received intensive rehabilitation. Results Improvements were observed especially in functional scales except for the Tardieu Scale, and no adverse effects were detected aside from a slight pain in the back. Conclusion Wider future case studies on UC-MSCs will enable us to assess the efficacy of UC-MSCs which have positive impacts especially on functional scales.
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Affiliation(s)
- Sibel Çağlar Okur
- Department of Physical Therapy and Rehab, Health Science University, Bakirköy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Sinan Erdoğan
- Department of Histology and Embryology, İstinye University, Faculty of Medicine, İstanbul, Turkey
| | - Cansu Subaşı Demir
- Center for Stem Cell and Tissue Engineering Research and Practice, İstinye University, İstanbul, Turkey
| | - Gülşen Günel
- Center for Stem Cell and Tissue Engineering Research and Practice, İstinye University, İstanbul, Turkey
| | - Erdal Karaöz
- Department of Histology and Embryology, İstinye University, Faculty of Medicine, İstanbul, Turkey.,Center for Stem Cell and Tissue Engineering Research and Practice, İstinye University, İstanbul, Turkey.,Center for Regenerative Medicine and Stem Cell Manufacturing (LivMedCell), Liv Hospital, İstanbul, Turkey
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18
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Propensity Score-Matched Analysis on the Association Between Pregnancy Infections and Adverse Birth Outcomes in Rural Northwestern China. Sci Rep 2018; 8:5154. [PMID: 29581446 PMCID: PMC5979963 DOI: 10.1038/s41598-018-23306-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/08/2018] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study is to examine the relationship between infections and birth outcomes in pregnant Chinese women by using propensity score (PS) matching. The data used here was from a large population-based cross-sectional epidemiological survey on birth defects in Shaanxi province, Northwest China. The babies born during 2010–2013 and their mothers were selected with a stratified multistage sampling method. We used PS-matched (1:1) analysis to match participants with infections to participants without infections. Of 22916 rural participants, the overall prevalence of infection was about 39.96%. 5381 pairs were matched. We observed increased risks of birth defects with infections, respiratory infections and genitourinary infections during the pregnancy (OR, 1.59; 95% CI: 1.21–2.08; OR, 1.44; 95% CI: 1.10–1.87; OR, 3.11; 95% CI: 1.75–5.54). There was also a significant increase of low birth weight associated with respiratory infections (1.13(1.01–1.27)). The association of birth defect with the infection could be relatively stable but the effect could be mediated by some important factors such as mother’s age, education level and economic level. The infection during pregnancy is common in Chinese women and might increase the risk of offspring birth defects and low birth weight, especially in younger, lower education, poor pregnant women.
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Nam SM, Kim WH, Yun CK. The effects of a multisensory dynamic balance training on the thickness of lower limb muscles in ultrasonography in children with spastic diplegic cerebral palsy. J Phys Ther Sci 2017; 29:775-778. [PMID: 28533629 PMCID: PMC5430292 DOI: 10.1589/jpts.29.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the effects of multisensory dynamic balance training on muscles thickness such as rectus femoris, anterior tibialis, medial gastrocnemius, lateral gastrocnemius in children with spastic diplegic cerebral palsy by using ultrasonography. [Subjects and Methods] Fifteen children diagnosed with spastic diplegic cerebral palsy were divided randomly into the balance training group and control group. The experimental group only received a multisensory dynamic balance training, while the control group performed general physiotherapy focused balance and muscle strengthening exercise based Neurodevelopmental treatment. Both groups had a therapy session for 30 minutes per day, three times a week for six weeks. The ultrasonographic muscle thickness were obtained in order to compare and analyze muscle thickness before and after in each group. [Result] The experimental group had significant increases in muscle thickness in the rectus femoris, tibialis anterior, medial gastrocnemius and lateral gastrocnemius muscles. The control group had significant increases in muscle thickness in the tibialis anterior. The test results of the rectus femoris, medial gastrocnemius and lateral gastrocnemius muscle thickness values between the groups showed significant differences. [Conclusion] In conclusion, a multisensory dynamic balance training can be recommended as a treatment method for patients with spastic diplegic cerebral palsy.
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Affiliation(s)
- Seung-Min Nam
- Department of Physical Therapy, College of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
| | - Won-Hyo Kim
- Department of Physical Therapy, College of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
| | - Chang-Kyo Yun
- Department of Physical Therapy, College of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
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20
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Kirton A. Advancing non-invasive neuromodulation clinical trials in children: Lessons from perinatal stroke. Eur J Paediatr Neurol 2017; 21:75-103. [PMID: 27470654 DOI: 10.1016/j.ejpn.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 12/18/2022]
Abstract
Applications of non-invasive brain stimulation including therapeutic neuromodulation are expanding at an alarming rate. Increasingly established scientific principles, including directional modulation of well-informed cortical targets, are advancing clinical trial development. However, high levels of disease burden coupled with zealous enthusiasm may be getting ahead of rational research and evidence. Experience is limited in the developing brain where additional issues must be considered. Properly designed and meticulously executed clinical trials are essential and required to advance and optimize the potential of non-invasive neuromodulation without risking the well-being of children and families. Perinatal stroke causes most hemiplegic cerebral palsy and, as a focal injury of defined timing in an otherwise healthy brain, is an ideal human model of developmental plasticity. Advanced models of how the motor systems of young brains develop following early stroke are affording novel windows of opportunity for neuromodulation clinical trials, possibly directing neuroplasticity toward better outcomes. Reviewing the principles of clinical trial design relevant to neuromodulation and using perinatal stroke as a model, this article reviews the current and future issues of advancing such trials in children.
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Affiliation(s)
- Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, 2888 Shaganappi Trail NW, Calgary, AB T3B6A8, Canada.
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21
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Wu CW, Huang SW, Lin JW, Liou TH, Chou LC, Lin HW. Risk of stroke among patients with cerebral palsy: a population-based cohort study. Dev Med Child Neurol 2017; 59:52-56. [PMID: 27346658 DOI: 10.1111/dmcn.13180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/28/2022]
Abstract
AIM The aim of the study was to investigate the risk of stroke in patients with cerebral palsy (CP), based on nationwide data in Taiwan. METHOD This prospective cohort study was comprised of patients recorded on the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005) who had a diagnosis of CP (n=1975) in records between 1 January 2004 and 31 December 2007. A comparison group (1:5) drawn from the same database was matched for age and sex (n=9875). Each patient was tracked by data until the development of stroke or the end of 2008. Cox proportional-hazards regression analysis was used to evaluate the hazard ratios after adjusting for potential confounding factors. RESULTS Patients with CP were more likely to suffer stroke than the comparison population, after adjusting for potential confounding factors (adjusted hazard ratio: 2.17; 95% confidence interval [CI]: 1.74-2.69). The hazard ratio of stroke was 4.78 (95% CI: 3.18-7.17) and 1.57 (95% CI: 1.20-2.05) for patients with CP aged 50 years and under, and over 50 years respectively. INTERPRETATION Cerebral palsy is a risk factor or marker for stroke that is independent of traditional stroke risk factors. Further research in this area is warranted.
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Affiliation(s)
- Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jia-Wei Lin
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Lin-Chuan Chou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan.,Evidence Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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22
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Jung SH, Song SH, Kim DR, Kim SG, Park YJ, Son YJ, Lee G. Effects of kinesio taping on the gait parameters of children with cerebral palsy: a pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.14474/ptrs.2016.5.4.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sun-Hye Jung
- JungWoo Children Development Center, Changwon, Republic of Korea
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - Sun-Hae Song
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - Da-Rye Kim
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Seul-Gi Kim
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Ye-Jin Park
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Yeon-Jung Son
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
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23
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Lisovska N, Daribayev Z, Lisovskyy Y, Kussainova K, Austin L, Bulekbayeva S. Pathogenesis of cerebral palsy through the prism of immune regulation of nervous tissue homeostasis: literature review. Childs Nerv Syst 2016; 32:2111-2117. [PMID: 27638717 DOI: 10.1007/s00381-016-3245-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cerebral palsy is highly actual issue of pediatrics, causing significant neurological disability. Though the great progress in the neuroscience has been recently achieved, the pathogenesis of cerebral palsy is still poorly understood. METHODS In this work, we reviewed available experimental and clinical data concerning the role of immune cells in pathogenesis of cerebral palsy. Maintaining of homeostasis in nervous tissue and its transformation in case of periventricular leukomalacia were analyzed. RESULTS The reviewed data demonstrate involvement of immune regulatory cells in the formation of nervous tissue imbalance and chronicity of inborn brain damage. The supported opinion, that periventricular leukomalacia is not a static phenomenon, but developing process, encourages our optimism about the possibility of its correction. CONCLUSIONS The further studies of changes of the nervous and immune systems in cerebral palsy are needed to create fundamentally new directions of the specific therapy and individual schemes of rehabilitation.
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Affiliation(s)
- Natalya Lisovska
- Republican Children's Rehabilitation Center, Turan str., 36, Astana, Kazakhstan, 010000.
| | - Zholtay Daribayev
- Republican Children's Rehabilitation Center, Turan str., 36, Astana, Kazakhstan, 010000
| | - Yevgeny Lisovskyy
- Republican Children's Rehabilitation Center, Turan str., 36, Astana, Kazakhstan, 010000
| | - Kenzhe Kussainova
- Republican Children's Rehabilitation Center, Turan str., 36, Astana, Kazakhstan, 010000
| | - Lana Austin
- Department of Pediatrics, Parirenyatwa Group of hospitals, Harare, Zimbabwe
| | - Sholpan Bulekbayeva
- Republican Children's Rehabilitation Center, Turan str., 36, Astana, Kazakhstan, 010000
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24
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Redelmeier DA, Naqib F, Thiruchelvam D, R Barrett JF. Motor vehicle crashes during pregnancy and cerebral palsy during infancy: a longitudinal cohort analysis. BMJ Open 2016; 6:e011972. [PMID: 27650764 PMCID: PMC5051428 DOI: 10.1136/bmjopen-2016-011972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To assess the incidence of cerebral palsy among children born to mothers who had their pregnancy complicated by a motor vehicle crash. DESIGN Retrospective longitudinal cohort analysis of children born from 1 April 2002 to 31 March 2012 in Ontario, Canada. PARTICIPANTS Cases defined as pregnancies complicated by a motor vehicle crash and controls as remaining pregnancies with no crash. MAIN OUTCOME Subsequent diagnosis of cerebral palsy by age 3 years. RESULTS A total of 1 325 660 newborns were analysed, of whom 7933 were involved in a motor vehicle crash during pregnancy. A total of 2328 were subsequently diagnosed with cerebral palsy, equal to an absolute risk of 1.8 per 1000 newborns. For the entire cohort, motor vehicle crashes correlated with a 29% increased risk of subsequent cerebral palsy that was not statistically significant (95% CI -16 to +110, p=0.274). The increased risk was only significant for those with preterm birth who showed an 89% increased risk of subsequent cerebral palsy associated with a motor vehicle crash (95% CI +7 to +266, p=0.037). No significant increase was apparent for those with a term delivery (95% CI -62 to +79, p=0.510). A propensity score-matched analysis of preterm births (n=4384) yielded a 138% increased relative risk of cerebral palsy associated with a motor vehicle crash (95% CI +27 to +349, p=0.007), equal to an absolute increase of about 10.9 additional cases per 1000 newborns (18.2 vs 7.3, p=0.010). CONCLUSIONS Motor vehicle crashes during pregnancy may be associated with an increased risk of cerebral palsy among the subgroup of cases with preterm birth. The increase highlights a specific role for traffic safety advice in prenatal care.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Faisal Naqib
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
| | - Jon F R Barrett
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
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25
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Rogoveanu OC, Tuțescu NC, Kamal D, Alexandru DO, Kamal C, Streba CT, Trăistaru MR. The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia. J Med Life 2016; 9:263-269. [PMID: 27974931 PMCID: PMC5154311 DOI: pmid/27974931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.
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Affiliation(s)
- O C Rogoveanu
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, Romania
| | - N C Tuțescu
- Faculty of Nursing and Midwives, University of Medicine and Pharmacy of Craiova, Romania
| | - D Kamal
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, Romania
| | - D O Alexandru
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania
| | - C Kamal
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - C T Streba
- Department of Research Methodology, University of Medicine and Pharmacy of Craiova, Romania
| | - M R Trăistaru
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, Romania
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26
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Fukushima K, Morokuma S, Kitadai Y, Tazaki Y, Sumie M, Nakanami N, Ushiro S, Matsuda Y, Tsukimori K. Analysis of antenatal-onset cerebral palsy secondary to transient ischemia in utero
using a national database in Japan. J Obstet Gynaecol Res 2016; 42:1297-1303. [DOI: 10.1111/jog.13046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Kotaro Fukushima
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Seiichi Morokuma
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
| | - Yuzo Kitadai
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Yukiko Tazaki
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Masahiro Sumie
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Naoyuki Nakanami
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Shin Ushiro
- Division of Patient Safety; Kyushu University Hospital; Fukuoka Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology; International University of Health and Welfare Hospital; Tochigi Japan
| | - Kiyomi Tsukimori
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
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27
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Reid SM, Meehan E, McIntyre S, Goldsmith S, Badawi N, Reddihough DS. Temporal trends in cerebral palsy by impairment severity and birth gestation. Dev Med Child Neurol 2016; 58 Suppl 2:25-35. [PMID: 26762733 DOI: 10.1111/dmcn.13001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 11/30/2022]
Abstract
AIM Our aim was to build on previous research indicating that rates of cerebral palsy (CP) in the Australian state of Victoria are declining, and examine whether severity of impairments is also decreasing. METHOD Data on individuals with CP were extracted from the Victorian Cerebral Palsy Register for birth years 1983 to 2009. The yearly rates of dichotomized categories for gross motor function, motor laterality, intellectual impairment, and epilepsy per 1000 neonatal survivors and proportions in the CP cohort were tabulated and plotted by birth gestation. Linear regression modelling was used to fit prediction curves; likelihood ratio tests were used to test for differences in trends between impairment severity groups. RESULTS Since the mid-1990s, CP rates declined in neonatal survivors of birth at all gestations. Our data suggest that the decreasing CP rates were associated with relatively greater decreases in the rates of Gross Motor Function Classification System levels III to V, bilateral CP, epilepsy, and intellectual impairment (all p<0.005). Some variation was seen between birth gestation groups. INTERPRETATION Declines in rates of CP of all levels of severity and complexity from the mid-1990s provides 'real-world' support for the effectiveness of concurrent neuroprotective strategies and continual innovation in perinatal practices.
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Affiliation(s)
- Susan M Reid
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Elaine Meehan
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Grace Centre for Newborn Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Dinah S Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
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28
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Strand KM, Andersen GL, Haavaldsen C, Vik T, Eskild A. Association of placental weight with cerebral palsy: population-based cohort study in Norway. BJOG 2015; 123:2131-2138. [DOI: 10.1111/1471-0528.13827] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/27/2022]
Affiliation(s)
- KM Strand
- Department of Laboratory Medicine, Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - GL Andersen
- Department of Laboratory Medicine, Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- The Cerebral Palsy Register of Norway; Habilitation Centre; Vestfold Hospital Trust; Tønsberg Norway
| | - C Haavaldsen
- Department of Obstetrics and Gynecology; Akershus University Hospital; Lørenskog Norway
| | - T Vik
- Department of Laboratory Medicine, Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - A Eskild
- Department of Obstetrics and Gynecology; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
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29
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Wu YW, Mehravari AS, Numis AL, Gross P. Cerebral palsy research funding from the National Institutes of Health, 2001 to 2013. Dev Med Child Neurol 2015; 57:936-41. [PMID: 25951080 DOI: 10.1111/dmcn.12789] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 11/27/2022]
Abstract
AIM Cerebral palsy (CP) is a poorly understood disorder with no cure. We determined the landscape of National Institutes of Health (NIH) funding for CP-related research. METHOD We searched NIH databases Research Portfolio Online Reporting Tools Expenditures and Results, and Research, Condition, and Disease Categorization for keywords 'cerebral palsy' among all NIH-funded studies, 2001 to 2013. We classified grants by type and area of study. RESULTS NIH funding, averaging $30 million per year, supported clinical ($215 million), basic ($187 million), and translational ($26.3 million) CP-related research. Clinical intervention studies comprised 19% of funding, and focused on treatments ($60.3 million), early parent intervention ($2.7 million), and CP prevention ($2.5 million). Among grants that specified gestational age, more funds were devoted to preterm ($166 million) than term infants ($15 million). CP in adulthood was the main focus of 4% of all funding. Annual NIH funding for CP increased steadily over the study period from $3.6 to $66.7 million. However, funding for clinical intervention studies peaked in 2008, and has since decreased. INTERPRETATION Additional research funds are needed to improve the treatment and prevention of CP. Topics that have been relatively underfunded include clinical interventions, prevention, and term infants and adults with CP.
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Affiliation(s)
- Yvonne W Wu
- Departments of Neurology and Pediatrics, University of California, San Francisco, CA, USA
| | | | - Adam L Numis
- Departments of Neurology and Pediatrics, University of California, Los Angeles, CA, USA
| | - Paul Gross
- Hydrocephalus Association, Bethesda, MD, USA
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30
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Panteliadis CP, Hagel C, Karch D, Heinemann K. Cerebral Palsy: A Lifelong Challenge Asks for Early Intervention. Open Neurol J 2015; 9:45-52. [PMID: 26191093 PMCID: PMC4503828 DOI: 10.2174/1874205x01509010045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/09/2015] [Accepted: 04/05/2015] [Indexed: 01/03/2023] Open
Abstract
One of the oldest and probably well-known examples of cerebral palsy is the mummy of the Pharaoh Siptah about 1196-1190 B.C., and a letter from Hippocrates (460-390 B.C.). Cerebral palsy (CP) is one of the most common congenital or acquired neurological impairments in paediatric patients, and refers to a group of children with motor disability and related functional defects. The visible core of CP is characterized by abnormal coordination of movements and/or muscle tone which manifest very early in the development. Resulting from pre- or perinatal brain damage CP is not a progressive condition per se. However, without systematic medical and physiotherapeutic support the dystonia leads to muscle contractions and to deterioration of the handicap. Here we review the three general spastic manifestations of CP hemiplegia, diplegia and tetraplegia, describe the diagnostic procedures and delineate a time schedule for an early intervention.
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Affiliation(s)
- Christos P Panteliadis
- Paediatric, Division of Paediatric Neurology and Developmental Medicine, Aristotle University of Thessaloniki, Greece
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Dieter Karch
- Clinic of Paediatric Neurology and Social Paediatrics, Children Centre Maulbronn, Germany
| | - Karl Heinemann
- Clinic of Paediatric Neurology and Social Paediatrics, Children Centre Maulbronn, Germany
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31
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Goyal R, Longo LD. Metabolic Profiles in Ovine Carotid Arteries with Developmental Maturation and Long-Term Hypoxia. PLoS One 2015; 10:e0130739. [PMID: 26110419 PMCID: PMC4482414 DOI: 10.1371/journal.pone.0130739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/23/2015] [Indexed: 02/01/2023] Open
Abstract
Background Long-term hypoxia (LTH) is an important stressor related to health and disease during development. At different time points from fetus to adult, we are exposed to hypoxic stress because of placental insufficiency, high-altitude residence, smoking, chronic anemia, pulmonary, and heart disorders, as well as cancers. Intrauterine hypoxia can lead to fetal growth restriction and long-term sequelae such as cognitive impairments, hypertension, cardiovascular disorders, diabetes, and schizophrenia. Similarly, prolonged hypoxic exposure during adult life can lead to acute mountain sickness, chronic fatigue, chronic headache, cognitive impairment, acute cerebral and/or pulmonary edema, and death. Aim LTH also can lead to alteration in metabolites such as fumarate, 2-oxoglutarate, malate, and lactate, which are linked to epigenetic regulation of gene expression. Importantly, during the intrauterine life, a fetus is under a relative hypoxic environment, as compared to newborn or adult. Thus, the changes in gene expression with development from fetus to newborn to adult may be as a consequence of underlying changes in the metabolic profile because of the hypoxic environment along with developmental maturation. To examine this possibility, we examined the metabolic profile in carotid arteries from near-term fetus, newborn, and adult sheep in both normoxic and long-term hypoxic acclimatized groups. Results Our results demonstrate that LTH differentially regulated glucose metabolism, mitochondrial metabolism, nicotinamide cofactor metabolism, oxidative stress and antioxidants, membrane lipid hydrolysis, and free fatty acid metabolism, each of which may play a role in genetic-epigenetic regulation.
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Affiliation(s)
- Ravi Goyal
- Center for Perinatal Biology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
- * E-mail:
| | - Lawrence D. Longo
- Center for Perinatal Biology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
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32
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Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg 2015; 120:1337-51. [PMID: 25988638 PMCID: PMC4438860 DOI: 10.1213/ane.0000000000000705] [Citation(s) in RCA: 424] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and is now approximately 11.39%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23 to 24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal estimated date of confinement. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (<1000 g) remain at high risk for death and disability with 30% to 50% mortality and, in survivors, at least 20% to 50% risk of morbidity. The introduction of continuous positive airway pressure, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91% and 95% (compared with 85%-89%) avoids excess mortality; however, final analyses of data from these trials have not been published, so definitive recommendations are still pending. The development of neonatal neurocritical intensive care units may improve neurocognitive outcomes in this high-risk group. Long-term follow-up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages.The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, because therapy and supportive care continue to change, the outcomes of extremely low birth weight infants are ever evolving. Efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated. Thus, treating and preventing long-term deficits must be developed in the context of a "moving target."
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Affiliation(s)
- Hannah C Glass
- From the *Department of Neurology and Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California; †Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; ‡Department of Pediatric Anesthesiology, The Alfred I. duPont Hospital for Children, Wilmington, Delaware; §Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; ∥Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, California; and ¶Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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33
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Parolin Schnekenberg R, Perkins EM, Miller JW, Davies WIL, D'Adamo MC, Pessia M, Fawcett KA, Sims D, Gillard E, Hudspith K, Skehel P, Williams J, O'Regan M, Jayawant S, Jefferson R, Hughes S, Lustenberger A, Ragoussis J, Jackson M, Tucker SJ, Németh AH. De novo point mutations in patients diagnosed with ataxic cerebral palsy. Brain 2015; 138:1817-32. [PMID: 25981959 PMCID: PMC4572487 DOI: 10.1093/brain/awv117] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/25/2015] [Indexed: 01/06/2023] Open
Abstract
Cerebral palsy is commonly attributed to perinatal asphyxia. However, Schnekenberg et al. describe here four individuals with ataxic cerebral palsy likely due to de novo dominant mutations associated with increased paternal age. Therefore, patients with cerebral palsy should be investigated for genetic causes before the disorder is ascribed to asphyxia. Cerebral palsy is a sporadic disorder with multiple likely aetiologies, but frequently considered to be caused by birth asphyxia. Genetic investigations are rarely performed in patients with cerebral palsy and there is little proven evidence of genetic causes. As part of a large project investigating children with ataxia, we identified four patients in our cohort with a diagnosis of ataxic cerebral palsy. They were investigated using either targeted next generation sequencing or trio-based exome sequencing and were found to have mutations in three different genes, KCNC3, ITPR1 and SPTBN2. All the mutations were de novo and associated with increased paternal age. The mutations were shown to be pathogenic using a combination of bioinformatics analysis and in vitro model systems. This work is the first to report that the ataxic subtype of cerebral palsy can be caused by de novo dominant point mutations, which explains the sporadic nature of these cases. We conclude that at least some subtypes of cerebral palsy may be caused by de novo genetic mutations and patients with a clinical diagnosis of cerebral palsy should be genetically investigated before causation is ascribed to perinatal asphyxia or other aetiologies.
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Affiliation(s)
- Ricardo Parolin Schnekenberg
- 1 Wellcome Trust Centre for Human Genetics, University of Oxford, OX3 7BN, UK 2 Universidade Positivo, School of Medicine, Rua Parigot de Souza 5300, 81280-330, Curitiba, Brazil
| | - Emma M Perkins
- 3 Centre for Integrative Physiology, Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Jack W Miller
- 4 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Wayne I L Davies
- 4 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK 5 School of Animal Biology, University of Western Australia, Perth, Australia 6 Section of Physiology & Biochemistry, Department of Experimental Medicine, School of Medicine & Surgery, University of Perugia, P.le Gambuli 1, Edificio D, Piano 106132 San Sisto, Perugia, Italy
| | - Maria Cristina D'Adamo
- 6 Section of Physiology & Biochemistry, Department of Experimental Medicine, School of Medicine & Surgery, University of Perugia, P.le Gambuli 1, Edificio D, Piano 106132 San Sisto, Perugia, Italy
| | - Mauro Pessia
- 6 Section of Physiology & Biochemistry, Department of Experimental Medicine, School of Medicine & Surgery, University of Perugia, P.le Gambuli 1, Edificio D, Piano 106132 San Sisto, Perugia, Italy 7 Department of Neural and Behavioral Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033-0850, USA
| | - Katherine A Fawcett
- 8 CGAT Programme, MRC Functional Genomics Unit, Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford, OX1 3PT, UK
| | - David Sims
- 8 CGAT Programme, MRC Functional Genomics Unit, Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford, OX1 3PT, UK
| | - Elodie Gillard
- 4 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Karl Hudspith
- 4 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Paul Skehel
- 3 Centre for Integrative Physiology, Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Jonathan Williams
- 9 Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, OX3 7LJ, UK
| | - Mary O'Regan
- 10 Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK
| | - Sandeep Jayawant
- 11 Department of Paediatrics, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - Rosalind Jefferson
- 12 Department of Paediatrics, Royal Berkshire Foundation Trust Hospital, Reading, UK
| | - Sarah Hughes
- 12 Department of Paediatrics, Royal Berkshire Foundation Trust Hospital, Reading, UK
| | - Andrea Lustenberger
- 13 Department of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Jiannis Ragoussis
- 1 Wellcome Trust Centre for Human Genetics, University of Oxford, OX3 7BN, UK
| | - Mandy Jackson
- 3 Centre for Integrative Physiology, Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Stephen J Tucker
- 14 Clarendon Laboratory, Department of Physics, University of Oxford, OX1 3PU, UK 15 OXION Initiative in Ion Channels and Disease, University of Oxford, OX1 3PT, UK
| | - Andrea H Németh
- 4 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK 16 Department of Clinical Genetics, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LJ, UK
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Tao X, Lin MT, Thorington GU, Wilson SM, Longo LD, Hessinger DA. Long-term hypoxia increases calcium affinity of BK channels in ovine fetal and adult cerebral artery smooth muscle. Am J Physiol Heart Circ Physiol 2015; 308:H707-22. [PMID: 25599571 DOI: 10.1152/ajpheart.00564.2014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/14/2015] [Indexed: 01/31/2023]
Abstract
Acclimatization to high-altitude, long-term hypoxia (LTH) reportedly alters cerebral artery contraction-relaxation responses associated with changes in K(+) channel activity. We hypothesized that to maintain oxygenation during LTH, basilar arteries (BA) in the ovine adult and near-term fetus would show increased large-conductance Ca(2+) activated potassium (BK) channel activity. We measured BK channel activity, expression, and cell surface distribution by use of patch-clamp electrophysiology, flow cytometry, and confocal microscopy, respectively, in myocytes from normoxic control and LTH adult and near-term fetus BA. Electrophysiological data showed that BK channels in LTH myocytes exhibited 1) lowered Ca(2+) set points, 2) left-shifted activation voltages, and 3) longer dwell times. BK channels in LTH myocytes also appeared to be more dephosphorylated. These differences collectively make LTH BK channels more sensitive to activation. Studies using flow cytometry showed that the LTH fetus exhibited increased BK β1 subunit surface expression. In addition, in both fetal groups confocal microscopy revealed increased BK channel clustering and colocalization to myocyte lipid rafts. We conclude that increased BK channel activity in LTH BA occurred in association with increased channel affinity for Ca(2+) and left-shifted voltage activation. Increased cerebrovascular BK channel activity may be a mechanism by which LTH adult and near-term fetal sheep can acclimatize to long-term high altitude hypoxia. Our findings suggest that increasing BK channel activity in cerebral myocytes may be a therapeutic target to ameliorate the adverse effects of high altitude in adults or of intrauterine hypoxia in the fetus.
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Affiliation(s)
- Xiaoxiao Tao
- Division of Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Mike T Lin
- Division of Physiology, School of Medicine, Loma Linda University, Loma Linda, California; Department of Physiology and Cell Biology, University of South Alabama, Mobile, Alabama
| | - Glyne U Thorington
- Division of Physiology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Sean M Wilson
- Division of Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California; Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, California; and
| | - Lawrence D Longo
- Division of Physiology, School of Medicine, Loma Linda University, Loma Linda, California; Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, California; and
| | - David A Hessinger
- Division of Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California; Division of Physiology, School of Medicine, Loma Linda University, Loma Linda, California;
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Goyal R, Goyal D, Chu N, Van Wickle J, Longo LD. Cerebral artery alpha-1 AR subtypes: high altitude long-term acclimatization responses. PLoS One 2014; 9:e112784. [PMID: 25393740 PMCID: PMC4231100 DOI: 10.1371/journal.pone.0112784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 10/14/2014] [Indexed: 11/19/2022] Open
Abstract
In response to hypoxia and other stress, the sympathetic (adrenergic) nervous system regulates arterial contractility and blood flow, partly through differential activities of the alpha1 (α1) - adrenergic receptor (AR) subtypes (α1A-, α1B-, and α1D-AR). Thus, we tested the hypothesis that with acclimatization to long-term hypoxia (LTH), contractility of middle cerebral arteries (MCA) is regulated by changes in expression and activation of the specific α1-AR subtypes. We conducted experiments in MCA from adult normoxic sheep maintained near sea level (300 m) and those exposed to LTH (110 days at 3801 m). Following acclimatization to LTH, ovine MCA showed a 20% reduction (n = 5; P<0.05) in the maximum tension achieved by 10-5 M phenylephrine (PHE). LTH-acclimatized cerebral arteries also demonstrated a statistically significant (P<0.05) inhibition of PHE-induced contractility in the presence of specific α1-AR subtype antagonists. Importantly, compared to normoxic vessels, there was significantly greater (P<0.05) α1B-AR subtype mRNA and protein levels in LTH acclimatized MCA. Also, our results demonstrate that extracellular regulated kinase 1 and 2 (ERK1/2)-mediated negative feedback regulation of PHE-induced contractility is modulated by α1B-AR subtype. Overall, in ovine MCA, LTH produces profound effects on α1-AR subtype expression and function.
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Affiliation(s)
- Ravi Goyal
- Center for Perinatal Biology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
- Epigenuity LLC, Loma Linda, California, United States of America
| | - Dipali Goyal
- Center for Perinatal Biology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
- Epigenuity LLC, Loma Linda, California, United States of America
| | - Nina Chu
- Center for Perinatal Biology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
- Epigenuity LLC, Loma Linda, California, United States of America
| | - Jonathan Van Wickle
- Center for Perinatal Biology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
- Epigenuity LLC, Loma Linda, California, United States of America
| | - Lawrence D. Longo
- Center for Perinatal Biology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, California, United States of America
- Epigenuity LLC, Loma Linda, California, United States of America
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Fisher PG. 50 years ago in the Journal of Pediatrics: an etiologic and diagnostic study of cerebral palsy. J Pediatr 2014; 165:273. [PMID: 25060875 DOI: 10.1016/j.jpeds.2014.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Paul Graham Fisher
- Departments of Neurology, Pediatrics, and Human Biology, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
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Goyal R, Longo LD. Acclimatization to long-term hypoxia: gene expression in ovine carotid arteries. Physiol Genomics 2014; 46:725-34. [PMID: 25052263 DOI: 10.1152/physiolgenomics.00073.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exposure to acute high-altitude hypoxia is associated with an increase in cerebral blood flow (CBF) as a consequence of low arterial O2 tension. However, in response to high altitude acclimatization, CBF returns to levels similar to those at sea level, and tissue blood flow is maintained by an increase in angiogenesis. Of consequence, dysregulation of the acclimatization responses and CBF can result in acute mountain sickness, acute cerebral and/or pulmonary edema. To elucidate the signal transduction pathways involved in successful acclimatization to high altitude, in ovine carotid arteries, we tested the hypothesis that high altitude-associated long-term hypoxia results in changes in gene expression of critical signaling pathways. We acclimatized nonpregnant adult sheep to 3,801 m altitude for ∼110 days and conducted oligonucleotide microarray experiments on carotid arteries. Of a total of 116 regulated genes, 58 genes were significantly upregulated and 58 genes were significantly downregulated (each >2-fold, P < 0.05). Major upregulated genes included suprabasin and myelin basic protein, whereas downregulated genes included BAG2. Several of these genes are known to activate the ERK canonical signal transduction pathway and the process of angiogenesis. We conclude that among other changes, the altered signal transduction molecules involved in high-altitude acclimatization are associated ERK activation and angiogenesis.
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Affiliation(s)
- Ravi Goyal
- Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, California; and Epigenuity LLC, Loma Linda, California
| | - Lawrence D Longo
- Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, California; and Epigenuity LLC, Loma Linda, California
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Strickland AD. Prevention of cerebral palsy, autism spectrum disorder, and attention deficit-hyperactivity disorder. Med Hypotheses 2014; 82:522-8. [PMID: 24581674 DOI: 10.1016/j.mehy.2014.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/24/2014] [Accepted: 02/03/2014] [Indexed: 12/31/2022]
Abstract
This hypothesis states that cerebral palsy (CP), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) are all caused by an exaggerated central nervous system inflammatory response to a prenatal insult. This prenatal insult may be one or more episodes of ischemia-reperfusion, an infectious disease of the mother or the fetus, or other causes of maternal inflammation such as allergy or autoimmune disease. The resultant fetal inflammatory hyper-response injures susceptible neurons in the developing white matter of the brain in specific areas at specific gestational ages. The exaggerated neuroinflammatory response is theorized to occur between about 19 and 34 post-conception weeks for CP, about 32 and 40 weeks for ADHD, and about 36 and 48 weeks (i.e. 2 months after delivery) for ASD. The exaggerated inflammatory response is hypothesized to occur because present diets limit intake of effective antioxidants and omega-3 polyunsaturated fatty acids while increasing intake of omega-6 polyunsaturated fatty acids. Oxidation products of the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) limit neuroinflammation while oxidation products of the omega-6 fatty acid arachidonic acid exacerbate inflammation. Preventative treatment should begin in all pregnant women during the first trimester and should include both DHA and an effective antioxidant for prevention of neuroinflammation. The suggested antioxidant would be N-acetylcysteine, though melatonin could be chosen instead. Combined DHA and NAC therapy is theorized to decrease the incidence of the three disorders by more than 75%.
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Dahlseng MO, Andersen GL, Irgens LM, Skranes J, Vik T. Risk of cerebral palsy in term-born singletons according to growth status at birth. Dev Med Child Neurol 2014; 56:53-8. [PMID: 24117018 DOI: 10.1111/dmcn.12293] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 11/28/2022]
Abstract
AIMS An excess risk of cerebral palsy (CP) has been reported in children of both low and high birthweight. However, the risk associated with deviations from the mean of other anthropometric measurements has been less well studied. The aim of our study therefore was to determine the association between size measurements at birth and incidence of CP in singletons born at term. METHOD Standard deviation z-scores for weight, length, head circumference, and ponderal index at birth of term-born singletons born between 1996 and 2006 were calculated using data from the Medical Birth Registry of Norway. The measurements of 398 children with CP recorded in the Cerebral Palsy Registry of Norway were compared with those of 490,022 typically developing infants. RESULTS Children with low birthweight (p<0.001; <10th centile) as well as low and high z-scores for length (p<0.001 and p<0.001) and head circumference (p<0.001 and p<0.003; <90th centile) had an excess risk of CP, in particular of spastic bilateral CP. Spastic unilateral CP was associated only with low z-scores, whereas children with the greatest body length and largest head circumference, but with low ponderal index, had an excess risk of spastic quadriplegic and dyskinetic CP. INTERPRETATION Our results are consistent with the notion that most subtypes of CP are due to antenatal factors leading to poor intrauterine growth, whereas CP in children who were large at birth is more likely to be due to intrapartum factors.
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Affiliation(s)
- Magnus Odin Dahlseng
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
The central nervous system is comprised of numerous cell types that work in concert to facilitate proper function and homeostasis. Disruption of these carefully orchestrated networks results in neuronal dysfunction, manifesting itself in a variety of neurologic disorders. Although neuronal dysregulation is causative of symptoms that manifest in the clinic, the etiology of these disorders is often more complex than simply a loss of neurons or intrinsic dysregulation of their function. In the adult brain, astrocytes comprise the most abundant cell type and play key roles in central nervous system physiology; therefore, it stands to reason that dysregulation of normal astrocyte function contributes to the etiology and progression of varied neurologic disorders. We review here some neurologic disorders associated with an astrocyte factor and discuss how the related astrocyte dysfunction contributes to the etiology or progression of these disorders or both.
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Stigger F, Lovatel G, Marques M, Bertoldi K, Moysés F, Elsner V, Siqueira IR, Achaval M, Marcuzzo S. Inflammatory response and oxidative stress in developing rat brain and its consequences on motor behavior following maternal administration of LPS and perinatal anoxia. Int J Dev Neurosci 2013; 31:820-7. [PMID: 24140242 DOI: 10.1016/j.ijdevneu.2013.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/20/2013] [Accepted: 10/05/2013] [Indexed: 11/15/2022] Open
Abstract
Cerebral palsy (CP) is a disorder of locomotion, posture and movement that can be caused by prenatal, perinatal or postnatal insults during brain development. An increased incidence of CP has been correlated to perinatal asphyxia and maternal infections during gestation. The effects of maternal exposure to low doses of bacterial endotoxin (lipopolysaccharide, LPS) associated or not with perinatal anoxia (PA) in oxidative and inflammatory parameters were examined in cerebral cortices of newborns pups. Concentrations of TNF-α, IL-1, IL-4, SOD, CAT and DCF were measured by the ELISA method. Other newborn rats were assessed for neonatal developmental milestones from day 1 to 21. Motor behavior was also tested at P29 using open-field and Rotarod. PA alone only increased IL-1 expression in cerebral cortex with no changes in oxidative measures. PA also induced a slight impact on development and motor performance. LPS alone was not able to delay motor development but resulted in changes in motor activity and coordination with increased levels of IL-1 and TNF-α expression associated with a high production of free radicals and elevated SOD activity. When LPS and PA were combined, changes on inflammatory and oxidative stress parameters were greater. In addition, greater motor development and coordination impairments were observed. Prenatal exposure of pups to LPS appeared to sensitize the developing brain to effects of a subsequent anoxia insult resulting in an increased expression of pro-inflammatory cytokines and increased free radical levels in the cerebral cortex. These outcomes suggest that oxidative and inflammatory parameters in the cerebral cortex are implicated in motor deficits following maternal infection and perinatal anoxia by acting in a synergistic manner during a critical period of development of the nervous system.
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Affiliation(s)
- Felipe Stigger
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil; Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil.
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Savard A, Lavoie K, Brochu ME, Grbic D, Lepage M, Gris D, Sebire G. Involvement of neuronal IL-1β in acquired brain lesions in a rat model of neonatal encephalopathy. J Neuroinflammation 2013; 10:110. [PMID: 24007297 PMCID: PMC3844447 DOI: 10.1186/1742-2094-10-110] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background Infection-inflammation combined with hypoxia-ischemia (HI) is the most prevalent pathological scenario involved in perinatal brain damage leading to life-long neurological disabilities. Following lipopolysaccharide (LPS) and/or HI aggression, different patterns of inflammatory responses have been uncovered according to the brain differentiation stage. In fact, LPS pre-exposure has been reported to aggravate HI brain lesions in post-natal day 1 (P1) and P7 rat models that are respectively equivalent - in terms of brain development - to early and late human preterm newborns. However, little is known about the innate immune response in LPS plus HI-induced lesions of the full-term newborn forebrain and the associated neuropathological and neurobehavioral outcomes. Methods An original preclinical rat model has been previously documented for the innate neuroimmune response at different post-natal ages. It was used in the present study to investigate the neuroinflammatory mechanisms that underline neurological impairments after pathogen-induced inflammation and HI in term newborns. Results LPS and HI exerted a synergistic detrimental effect on rat brain. Their effect led to a peculiar pattern of parasagittal cortical-subcortical infarcts mimicking those in the human full-term newborn with subsequent severe neurodevelopmental impairments. An increased IL-1β response in neocortical and basal gray neurons was demonstrated at 4 h after LPS + HI-exposure and preceded other neuroinflammatory responses such as microglial and astroglial cell activation. Neurological deficits were observed during the acute phase of injury followed by a recovery, then by a delayed onset of profound motor behavior impairment, reminiscent of the delayed clinical onset of motor system impairments observed in humans. Interleukin-1 receptor antagonist (IL-1ra) reduced the extent of brain lesions confirming the involvement of IL-1β response in their pathophysiology. Conclusion In rat pups at a neurodevelopmental age corresponding to full-term human newborns, a systemic pre-exposure to a pathogen component amplified HI-induced mortality and morbidities that are relevant to human pathology. Neuronal cells were the first cells to produce IL-1β in LPS + HI-exposed full-term brains. Such IL-1β production might be responsible for neuronal self-injuries via well-described neurotoxic mechanisms such as IL-1β-induced nitric oxide production, or IL-1β-dependent exacerbation of excitotoxic damage.
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Affiliation(s)
- Alexandre Savard
- Laboratoire de Neurologie Pédiatrique, Université de Sherbrooke, 3001 12e Avenue Nord, J1H 5N4 Sherbrooke, Québec, Canada.
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McIntyre S, Taitz D, Keogh J, Goldsmith S, Badawi N, Blair E. A systematic review of risk factors for cerebral palsy in children born at term in developed countries. Dev Med Child Neurol 2013. [PMID: 23181910 DOI: 10.1111/dmcn.12017] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study was to conduct a systematic review in order to identify the risk factors for cerebral palsy (CP) in children born at term. The secondary aim was to ascertain if the potential for prevention of these risk factors has been adequately explored. METHOD A MEDLINE search up to 31 July 2011 was completed, following the Meta-Analysis of Observational Studies in Epidemiology guidelines. Publications were reviewed to identify those with both a primary aim of identifying risk factors for all children or term-born children with CP and a cohort or case-control study design. Studies were examined for potential chance or systematic bias. The range of point estimates of relative risk is reported. RESULTS From 21 articles meeting inclusion/exclusion criteria and at low risk of bias, data from 6297 children with CP and 3 804 791 children without CP were extracted. Ten risk factors for term-born infants were statistically significant in each study: placental abnormalities, major and minor birth defects, low birthweight, meconium aspiration, instrumental/emergency Caesarean delivery, birth asphyxia, neonatal seizures, respiratory distress syndrome, hypoglycaemia, and neonatal infections. Strategies for possible prevention currently exist for three of these. INTERPRETATION Ten consistent risk factors have been identified, some with potential for prevention. Efforts to prevent these risk factors to interrupt the pathway to CP should be extended.
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Affiliation(s)
- Sarah McIntyre
- Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia.
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Gómez-Durán EL, Mulà-Rosías JA, Lailla-Vicens JM, Benet-Travé J, Arimany-Manso J. Analysis of obstetrics and gynecology professional liability claims in Catalonia, Spain (1986-2010). J Forensic Leg Med 2013; 20:442-6. [PMID: 23756513 DOI: 10.1016/j.jflm.2012.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify relevant factors involved in obstetrics and gynecology (OG) professional liability claims to help archive better management of risks. STUDY DESIGN Analysis of 885 OG claims opened between 1986 and 2010, with the identification of the most common events leading to a claim, the economical and juridical characteristics of the claims, as well as the relevant trends over the study period. RESULTS Most claims related to obstetrics. Labor, delivery and its complications accounted for 33.1% of the claims; 12.77% related specifically to cesarean. Oncological diseases, fetus death during labor and delivery, neurologically impaired infant and histerectomy-related problems were the most frequently claimed events. Most cases ended up without an indemnity payment and 37.7% of closed files were solved by an out-of-court procedure. Average payment was higher for the obstetric procedures than for those concerning gynecology cases. The proportion of claims relating to obstetrics increased during the study period, as well as the average payment. CONCLUSION OG is at high-risk for malpractice claims, but compensation awards are not frequent. However, particular events, such as retained foreign objects, tubal ligation, ultrasound diagnosis or neurologically impaired newborns, deserve special attention regarding medico-legal issues.
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Affiliation(s)
- Esperanza L Gómez-Durán
- Professional Liability Department, Barcelona's Official College of Physicians, Passeig Bonanova, 47, 08017 Barcelona, Spain.
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Dhote SN, Khatri PA, Ganvir SS. Reliability of "Modified timed up and go" test in children with cerebral palsy. J Pediatr Neurosci 2012; 7:96-100. [PMID: 23248683 PMCID: PMC3519092 DOI: 10.4103/1817-1745.102564] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Timed up and go (TUG) is a quick test used in clinical practice as an outcome measure to assess functional ambulatory mobility or dynamic balance in adults. However, little information is available on TUG test used in cerebral palsy. Hence, the purpose of our study was to assess the intra-rater reliability of TUG test in cerebral palsy children. Aim and Objective: To assess within–session and test-retest reliability after 1 week of TUG test in cerebral palsy children. Setting and Design: It was an a cross-sectional observational study conducted in a neurorehabilitation unit, with 30 cerebral palsy children of 4–12 years, within Gross Motor Function Classification System (GMFCS) level I, II, III, and with an IQ ≥50.The sampling technique used was purposive sampling excluding children with cognitive deficit. Materials and Methods: Subjects performed TUG on three occasions – Initial assessment (time 1), 30 min after initial assessment (time 2), and 1 week after initial assessment (time 3). Three trails were conducted for each of the three occasions. The mean score of three trials was documented as the final score. Within-session and test–retest reliability were analyzed using scores of time 1 and 2, and time 1 and 3, respectively. Statistical Analysis: The documented data were analyzed for within-session and test–retest reliability after 1 week of TUG test by using intraclass correlation coefficient (ICC). Results: Reliability of TUG test was high, with ICC of 0.99 for within-session reliability and 0.99 for test–retest reliability. Conclusion: Intra-rater reliability of TUG test in cerebral palsy children was found to be high.
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Girard S, Sébire H, Brochu ME, Briota S, Sarret P, Sébire G. Postnatal administration of IL-1Ra exerts neuroprotective effects following perinatal inflammation and/or hypoxic-ischemic injuries. Brain Behav Immun 2012; 26:1331-9. [PMID: 22982341 PMCID: PMC5023428 DOI: 10.1016/j.bbi.2012.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/01/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023] Open
Abstract
New therapeutic strategies are needed to protect neonates, especially premature newborns, against brain injury and associated neurobehavioral deficits. The role of pro-inflammatory cytokines, especially IL-1β, in the pathophysiological pathway leading to neonatal brain damage is increasingly recognized and represents an attractive therapeutic target. We investigated the therapeutic potential of postnatal systemic administration of the interleukin (IL)-1 receptor antagonist (IL-1Ra) in an animal model of perinatal brain injury using the insults most common to human neonates, i.e. prenatal exposure to inflammation and/or postnatal hypoxia-ischaemia (HI). We found that postnatal administration of IL-1Ra preserved motor function and exploratory behavior after either prenatal exposure to inflammatory agent lipopolysaccharide (LPS) or postnatal HI insult. The deleterious effect of combined prenatal LPS and postnatal HI on brain development was also alleviated by administration of IL-1Ra, as seen by the protected neural stem cell population, prevention of myelin loss in the internal capsule, decreased gliosis, and decreased neurobehavioral impairment. This study showed the distinct pattern of functional deficits induced by prenatal inflammation as compared to postnatal HI and the therapeutic potential of IL-1Ra administration against neonatal brain injury. Furthermore, our results highlight the potential for postnatal treatment of prenatal inflammatory stressors.
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Affiliation(s)
- Sylvie Girard
- Laboratoire de Neurologie Pédiatrique, Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
| | - Hugues Sébire
- Laboratoire de Neurologie Pédiatrique, Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Elsa Brochu
- Laboratoire de Neurologie Pédiatrique, Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sinziana Briota
- Laboratoire de Neurologie Pédiatrique, Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Philippe Sarret
- Département de Physiologie et Biophysique, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume Sébire
- Laboratoire de Neurologie Pédiatrique, Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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Goyal R, Longo LD. Gene expression in sheep carotid arteries: major changes with maturational development. Pediatr Res 2012; 72:137-46. [PMID: 22565503 PMCID: PMC3531548 DOI: 10.1038/pr.2012.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND With development from immature fetus to near-term fetus, newborn, and adult, the cerebral vasculature undergoes a number of fundamental changes. Although the near-term fetus is prepared for a transition from an intra- to extra-uterine existence, this is not necessarily the case with the premature fetus, which is more susceptible to cerebrovascular dysregulation. In this study, we tested the hypothesis that the profound developmental and age-related differences in cerebral blood flow are associated with significant underlying changes in gene expression. METHODS With the use of oligonucleotide microarray and pathway analysis, we elucidated significant changes in the transcriptome with development in sheep carotid arteries. RESULTS As compared with adult, we demonstrate a U-shaped relationship of gene expression in major cerebrovascular network/pathways during early life, e.g., the level of gene expression in the premature fetus and newborn is considerably greater than that of the near-term fetus. Specifically, cell proliferation, growth, and assembly pathway genes were upregulated during early life. In turn, as compared with adult, mitogen-activated protein kinase-extracellular regulated kinase, actin cytoskeleton, and integrin-signaling pathways were downregulated during early life. CONCLUSION In cranial vascular smooth muscle, highly significant changes occur in important cellular and signaling pathways with maturational development.
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Bae SH, Kong TH, Lee HS, Kim KS, Hong KS, Chopp M, Kang MS, Moon J. Long-lasting paracrine effects of human cord blood cells on damaged neocortex in an animal model of cerebral palsy. Cell Transplant 2012; 21:2497-515. [PMID: 22524897 DOI: 10.3727/096368912x640457] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Neonatal asphyxia is an important contributor to cerebral palsy (CP), for which there is no effective treatment to date. The administration of human cord blood cells (hUCBCs) is emerging as a therapeutic strategy for the treatment of neurological disorders. However, there are few studies on the application of hUCBCs to the treatment of neonatal ischemia as a model of CP. Experiments and behavioral tests (mainly motor tests) performed on neonatal hypoxia/ischemia have been limited to short-term effects of hUCBCs, but mechanisms of action have not been investigated. We performed a study on the use of hUCBCs in a rat model of neonatal hypoxia/ischemia and investigated the underlying mechanism for therapeutic benefits of hUCBC treatment. hUCBCs were intravenously transplanted into a rat model of neonatal hypoxia ischemia. hUCBCs increased microglia temporarily in the periventricular striatum in the early phase of disease, protected mature neurons in the neocortex from injury, paved the way for the near-normalization of brain damage in the subventricular zone (SVZ), and, in consequence, significantly improved performance in a battery of behavioral tests compared to the vehicle-treated group. Although the transplanted cells were rarely observed in the brain 3 weeks after transplantation, the effects of the improved behavioral functions persisted. Our preclinical findings suggest that the long-lasting positive influence of hUCBCs is derived from paracrine effects of hUCBCs that stimulate recovery in the injured brain and protect against further brain damage.
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Affiliation(s)
- Sang-Hun Bae
- College of Life Science, Department of Applied Bioscience, CHA University, Seoul, South Korea
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Genetic [corrected] insights into the causes and classification of [corrected] cerebral palsies. Lancet Neurol 2012; 11:283-92. [PMID: 22261432 DOI: 10.1016/s1474-4422(11)70287-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cerebral palsy-the most common physical disability of childhood-is a clinical diagnosis encompassing a heterogeneous group of neurodevelopmental disorders that cause impairments of movement and posture that persist throughout life. Despite being commonly attributed to a range of environmental factors, particularly birth asphyxia, the specific cause of cerebral palsy remains unknown in most individuals. A growing body of evidence suggests that cerebral palsy is probably caused by multiple genetic factors, similar to other neurodevelopmental disorders such as autism and intellectual disability. Recent advances in next-generation sequencing technologies have made possible rapid and cost-effective sequencing of the entire human genome. Novel cerebral palsy genes will probably be identified as more researchers and clinicians use this approach to study individuals with undiagnosed neurological disorders. As our knowledge of the underlying pathophysiological mechanisms of cerebral palsy increases, so will the possibility of developing genomically guided therapeutic interventions.
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Bhatoe HS. The hypoxic-ischemic brain injury: Beyond semantics. INDIAN JOURNAL OF NEUROTRAUMA 2011. [DOI: 10.1016/s0973-0508(11)80001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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