Consensus paper on postural dysfunction: recommendations for prevention, diagnosis and therapy

Good fundamentals of posture and balance are essential for the efficient performance of both simple daily tasks and more complex movement patterns. In particular, postural balance is the ability to keep the body in equilibrium and to regain balance after the shift of body segments: postural control mechanisms of integration of the visual, vestibular and foot afferential channels contribute to this. This document provides recommendations based on scientific evidence, clinical practice, and consensus between experts concerning the prevention, diagnosis, and treatment of postural dysfunction at the three stages of life as the developmental age, adult age, and old age > 65 years and follows the "National Guidelines on Classification and Measuring of Posture and its Dysfunctions" per the Italian Ministry of Health (December 2017). The paper answers four main questions: i) "Which measures can be adopted to prevent postural dysfunctions?" ii) "What can we do in order to make a correct diagnosis of postural dysfunction?" iii) "What are the correct treatment programs for postural dysfunctions?" iv) Which professional competencies and experiences are useful for preventing, diagnosing and treating postural dysfunctions? By the Consensus of the Experts and the scientific evidence, emerge that the approach to postural dysfunctions requires a multidisciplinary and interdisciplinary team. Furthermore, rehabilitation treatment interventions must be specific to the age groups that have been indicated, to consider the integration of the main systems and subsystems of postural control that change with age.

Post-traumatic Stress Spectrum and Adult Autism Subthreshold Spectrum in Parents of Children with Epilepsy: Correlations and Gender Differences

Introduction

Data that assess the co-morbidity between post-traumatic stress symptoms and autism spectrum are scarce. Nevertheless, some authors suggested that subjects with autism spectrum disorder (ASD), due to their difficulty in understanding the codes of communication, empathy, expression, are lower resilience to traumas.

Objectives

The aim of this study was to explore in a sample of parents of children with epilepsy, the presence of correlations between the symptoms of post-traumatic stress and adult autism subthreshold spectrum.

Methods

Seventy-seven parents completed the Trauma and Loss Spectrum Self-Report (TALS-SR), specifically modified for one's son epileptic disease, and 72 parents completed the AdAS Spectrum (Adult Autism subthreshold Spectrum).

Results

Eight subjects (11.1%) presented a total score ≥45 at the AdAS Spectrum, corresponding to the satisfaction of a symptomatic ASD criteria and indicative of the Adult Autism Spectrum subthreshold. More specifically, a total score ≥45 was found in 7 (15.9%) of mothers and 1 (3.6%) of the fathers, with no statistically significant differences between the two groups (P = 0.139).

Noteworthy correlations between TALS and AdAS, emerged only in the subgroup of the fathers. In particular, a relevant number of moderate to good correlations emerged between the Domain II (reactions to the events of loss) of the TALS-SR and the AdAS Domain III (non verbal communication), Domain VI (restricted interests and ruminations) and total score.

Conclusions

Results indicate that this peculiar psychopathological model could lead to increased vulnerability to effects of the trauma, in particular in male.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Efficacy and tolerability of mycophenolate mofetil in a pediatric Rasmussen syndrome

Rasmussen syndrome (RS) is a chronic encephalopathy with uncertain etiology and immune-mediated pathogenesis. The only definitive treatment is represented by functional hemispherectomy. We describe the case of a 6.5-year-old female patient who developed several episodes of focal, unilateral clonic seizures. Following laboratory and instrumental investigations, the patient was diagnosed as having RS. A treatment with corticosteroids, intravenous immunoglobulin, and the antiseizure medication (carbamazepine and levetiracetam) did not completely control the seizures. Therefore, the patient was treated with mycophenolate mofetil (MMF), showing a good clinical response, with reduction of the seizures, and stability of the radiological findings. This case suggests the potential utility of MMF in the immune approach to RS.

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Rasmussen encephalitis (RE) is an immune-mediated disease of unknown etiology.

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Current definitive treatment for RE is represented by hemispherectomy.

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The immune approach of RE has been performed with several agents.

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In this case, mycophenolate mofetil was successfully used in a patient with RE.

Length measurement and spatial orientation reconstruction of single nanowires

The accurate determination of the geometrical features of quasi one-dimensional nanostructures is mandatory for reducing errors and improving repeatability in the estimation of a number of geometry-dependent properties in nanotechnology. In this paper a method for the reconstruction of length and spatial orientation of single nanowires (NWs) is presented. Those quantities are calculated from a sequence of scanning electron microscope (SEM) images taken at different tilt angles using a simple 3D geometric model. The proposed method is evaluated on a collection of SEM images of single GaAs NWs. It is validated through the reconstruction of known geometric features of a standard reference calibration pattern. An overall uncertainty of about 1% in the estimated length of the NWs is achieved.

Methylenetetrahydrofolate reductase polymorphism (MTHFR C677T) and headache in children: a retrospective study from a tertiary level outpatient service

Background

In adult studies the MTHFR C677T polymorphism has been associated with an increased risk of migraine, but little research has been done in this area in children.

Methods

A retrospective study of children referred with headache to a tertiary level Paediatric Neurology Service between 2008 and 2012. This study included only patients who had been genotyped for the MTHFR C677T polymorphism. An evaluation of homocysteine serum levels was necessary to exclude other types of migraine.

Conclusion

Compared with the wild-type genotype, the T/T genotype was associated with an increased risk of any type of migraine, though the statistical significance was greatest in migraine with aura. The homocysteine serum levels were significantly higher in migraine with aura compared to migraine without aura. In a pediatric population MTHFR T/T homozygosity influences susceptibility to migraine.

Beyond the floor effect on the WISC-IV in individuals with Down syndrome: are there cognitive strengths and weaknesses?

BACKGROUND

Individuals with Down syndrome generally show a floor effect on Wechsler Scales that is manifested by flat profiles and with many or all of the weighted scores on the subtests equal to 1.

METHOD

The main aim of the present paper is to use the statistical Hessl method and the extended statistical method of Orsini, Pezzuti and Hulbert with a sample of individuals with Down syndrome (n = 128; 72 boys and 56 girls), to underline the variability of performance on Wechsler Intelligence Scale for Children-Fourth Edition subtests and indices, highlighting any strengths and weaknesses of this population that otherwise appear to be flattened.

RESULTS

Based on results using traditional transformation of raw scores into weighted scores, a very high percentage of subtests with weighted score of 1 occurred in the Down syndrome sample, with a floor effect and without any statistically significant difference between four core Wechsler Intelligence Scale for Children-Fourth Edition indices. The results, using traditional transformation, confirm a deep cognitive impairment of those with Down syndrome. Conversely, using the new statistical method, it is immediately apparent that the variability of the scores, both on subtests and indices, is wider with respect to the traditional method.

CONCLUSION

Children with Down syndrome show a greater ability in the Verbal Comprehension Index than in the Working Memory Index.

Adult Autism Subthreshold Spectrum (AdAS Spectrum) in parents of pediatric patients with epilepsy: Correlations with post-traumatic stress symptoms

Increasing literature has shown the usefulness of a dimensional approach to mental disorders, particularly when exploring subjects exposed to traumatic experiences such as a severe illness in one's child. Recent evidence suggests an increased vulnerability in subjects with autism spectrum symptoms to develop post-traumatic stress symptoms. The aim of the present study was to evaluate the presence of adult autism subthreshold spectrum in a sample of parents of children with epilepsy and its impact on post-traumatic stress spectrum symptoms in the same study sample. Results revealed noteworthy correlations between post-traumatic stress symptoms and adult autism subthreshold spectrum (AdAS Spectrum) only in the subgroup of the fathers. In particular, were evidenced correlations between AdAS Spectrum domain of rumination and narrow interests and some TALS-SR nuclear domains: reaction to traumatic events, reexperiencing and arousal. These findings corroborate the hypothesis that subthreshold autistic features may influence the possible psychopathological reaction to trauma.

Generalized epilepsy and mild intellectual disability associated with 13q34 deletion: A potential role for SOX1 and ARHGEF7

Terminal deletions of long arm of chromosome 13 are rare and poorly characterized by cytogenetic studies, making for difficult genotype-phenotype correlations. We report two siblings presenting generalized epilepsy, intellectual disability, and genitourinary tract defects. Array CGH detected a 1.3 Mb deletion at 13q34; it contains two protein-coding genes, SOX1 and ARHGEF7, whose haploinsufficiency can contribute to the epileptic phenotype.

Full and Partial DSM-5 PTSD in Parents of Children with Epilepsy: Exploring Gender Differences

Introduction

Increasing literature suggests the need to explore PTSD and post-traumatic stress symptoms among parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy.

Objectives

The aim of this study was to estimate full and partial PTSD rates among parents of children with epilepsy according to DSM-5 criteria. Further, aim of this study was to examine eventual gender differences between mothers and fathers.

Methods

One hundred and thirty-eight parents, 91 mothers (65.9%) and 47 (34.1%) fathers, of children diagnosed with epilepsy were interviewed using the SCID-5.

Results

Full and partial DSM-5 PTSD were reported by 10.4% and 37.3% of patients, respectively. Significant gender differences, with the mother more affected, emerged in the rates of partial A PTSD rates (P = 0.048) and in the endorsement rates of criterion B (intrusion symptoms) (P = 0.047), criterion D (negative alterations in cognitions and mood) (P = 0.010) and criterion E (alterations in arousal and reactivity) (P < 0.001) too.

Conclusions

This is the first study to identify post-traumatic symptoms in caregivers of pediatric patients with epilepsy with the use of current diagnostic criteria and the relevance of the results suggests the need for further studies on this risk population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Autosomal dominant SCN8A mutation with an unusually mild phenotype

BACKGROUND

Mutations in SCN8A, coding for the voltage-gated sodium channel Nav 1.6, have been described in relation to infantile onset epilepsy with developmental delay and cognitive impairment, in particular early onset epileptic encephalopathy (EIEE) type 13.

CASE REPORT

Here we report an infant and his father with early onset focal epileptic seizures but without cognitive or neurological impairment in whom next generation sequence analysis identified a heterozygous mutation (c.5630A > G, p. (Asn1877Ser)) in the SCN8A gene. This mutation, confirmed by Sanger sequence analysis, affects a highly conserved amino acid and in silico tools predicts that it may be pathogenic. The reported infant has a normal developmental profile at 16-month follow-up. His father also had normal development and has no cognitive impairment at 42 years. This is the second known SCN8A mutation associated with a phenotype of benign familial infantile epilepsy. Good seizure control was achieved in our patients with sodium channel blockers.

CONCLUSION

Based on our proband and a recently described group of families with benign familial infantile epilepsy and SCN8A variant we suggest expanding testing to patients with infantile epilepsy and no cognitive impairment. In addition, the same SCN8A variant (c.5630A > G, p. (Asn1877Ser)) is also found in patients with epilepsy and developmental delay highlighting the phenotypic variability and the possible role of other protective genetic factors.

Corsi's Block-Tapping Test: Some Characteristics of the Spatial Path Which Influence Memory

By using a sequence of digits it is possible to indicate the path of Corsi's block-tapping test by drawing a line to join the central points of the cubes which make up the sequence. By doing this one can analyze the sequence of digits according to quantitative parameters. There were three characteristics of the spatial path taken into consideration in this research: the number of cubes which constitute a series of digits, the number of times the path intersected itself, and the length of the path measured in millimeters. The experiment, carried out with 70 university students, showed that all three factors were significant on analysis of variance, and also that there were differences between the sexes, the men performing better. No interactions were significant. Despite this, additional significant differences were found among the series with the same number of cubes, intersections, and length, meaning that other variables influence the difficulty of the spatial path.

Deep vein thrombosis of the lower limb secondary to lumbar discal hernia compression: a rarity? Review of the literature

This case report is about a 70-years-old female patient, suffering from discal hernia, with compression of the iliac vein, that led to the formation of deep vein thrombosis of the lower limbs. The angio-CT scan revealed the starting point of the L4- L5 compression where a voluminous discal hernia caused deep vein thrombosis, with the involvement the femoro-popliteal venous axis. Blood samples and PET-CT scans excluded other possible etiologic factors. This case demonstrates how a voluminous discal hernia can cause venous thrombosis.

17q12 microduplications: a challenge for clinicians

In the recent years, some cases of 17q12 deletions and duplications have been reported, but the clinical impact of these imbalances is still to be fully elucidated. In particular, 17q12 duplications elude syndrome classification, since they are associated with a wide phenotypic spectrum, ranging from very mild to quite severe phenotypes. Here, two unrelated patients with the same 1.2 Mb microduplication of 17q12 are reported. Comparing these patients' phenotype with those previously published, it emerges that the more patients reported, the more difficult is finding common characteristics, even in presence of exactly the same genetic anomaly. The role of the genes duplicated in this region and the impact of this chromosomal imbalance are discussed.

Beyond the floor effect on the Wechsler Intelligence Scale for Children--4th Ed. (WISC-IV): calculating IQ and Indexes of subjects presenting a floored pattern of results

BACKGROUND

It is now widely known that children with severe intellectual disability show a 'floor effect' on the Wechsler scales. This effect emerges because the practice of transforming raw scores into scaled scores eliminates any variability present in participants with low intellectual ability and because intelligence quotient (IQ) scores are limited insofar as they do not measure scores lower than 40.

METHOD

Following Hessl et al.'s results, the present authors propose a method for the computation of the Wechsler Intelligence Scale for Children--4th Ed. (WISC-IV)'s IQ and Indexes in intellectually disabled participants affected by a floored pattern of results. The Italian standardization sample (n = 2200) for the WISC-IV was used. The method presented in this study highlights the limits of the 'floor effect' of the WISC-IV in children with serious intellectual disability who present a profile with weighted scores of 1 in all the subtests despite some variability in the raw scores.

RESULTS

Such method eliminates the floor effect of the scale and therefore makes it possible to analyse the strengths and weaknesses of the WISC-IV's Indexes in these participants.

CONCLUSIONS

The Authors reflect on clinical utility of this method and on the meaning of raw score of 0 on subtest.

Evaluation of the cephalometrics modification of growing Class II Division I patients after treatment with the PUL appliance: a pilot study

AIM

The aim of this preliminary study was to evaluate short-term dentoskeletal changes obtained with a functional appliance for Class II Division I malocclusions called propulsor universal light (PUL).

METHODS

Fifteen Class II Division 1 patients (10.6±1.2 years) were consecutively treated by one expert operator with PUL appliance and they were compared with a longitudinal group of Class II Division I untreated patients (9.9±1.9 years) matched for pubertal growth spurt stage and sex. Lateral cephalograms were taken before PUL therapy and at the end of treatment. The mean duration of treatment was 11.2±0.3 months; t-test or Mann-Whitney U-test was used (P <0.05).

RESULTS

Statistically significant reduction of the overjet, WITS and ANB was noticed in treated group as well as a significant improvement of CoGo and Ramus.

CONCLUSION

Class II Division I malocclusion in the short term was efficiently treated by PUL appliance with both skeletal and dentoalveolar changes.

Cognitive sequencing impairment in patients with focal or atrophic cerebellar damage

Although cognitive impairment after cerebellar damage has been widely reported, the mechanisms of cerebro-cerebellar interactions are still a matter of debate. The cerebellum is involved in sequence detection and production in both motor and sensory domains, and sequencing has been proposed as the basic mechanism of cerebellar functioning. Furthermore, it has been suggested that knowledge of sequencing mechanisms may help to define cerebellar predictive control processes. In spite of its recognized importance, cerebellar sequencing has seldom been investigated in cognitive domains. Cognitive sequencing functions are often analysed by means of action/script elaboration. Lesion and activation studies have localized this function in frontal cortex and basal ganglia circuits. The present study is the first to report deficits in script sequencing after cerebellar damage. We employed a card-sequencing test, developed ad hoc, to evaluate the influence of the content to be sequenced. Stimuli consisted of sets of sentences that described actions with a precise logical and temporal sequence (Verbal Factor), sets of cartoon-like drawings that reproduced behavioural sequences (Behavioural Factor) or abstract figures (Spatial Factor). The influence of the lesion characteristics was analysed by grouping patients according to lesion-type (focal or atrophic) and lesion-side (right or left). The results indicated that patients with cerebellar damage present a cognitive sequencing impairment independently of lesion type or localization. A correlation was also shown between lesion side and characteristics of the material to be sequenced. Namely, patients with left lesions perform defectively only on script sequences based on pictorial material and patients with right lesions only on script sequences requiring verbal elaboration. The present data support the hypothesis that sequence processing is the cerebellar mode of operation also in the cognitive domain. In addition, the presence of right/left and pictorial/verbal differences is in agreement with the idea that cerebro-cerebellar interactions are organized in segregated cortico-cerebellar loops in which specificity is not related to the mode of functioning, but to the characteristics of the information processed.

Evidence based medicine and effective interventions of pharmacological therapy for the prevention of osteoporotic fractures

Osteoporosis and fractures associated with it constitute a real and serious socio-medical problem, which only recently has come to the forefront of social consciousness. The authors are carrying out a critical re-examination of the medical literature of osteoporosis pharmacological treatment. Particular attention has been paid to studies which show a clear reduction of the primary endpoint that, in the case of this pathology, consists of a reduction of the fracturing event. According to the examination of the clinical studies introduced, antiresorptive bone agents, such as alendronate and risenderonate, turn out to be molecules with higher levels of evidence implicated on the reduction of the main osteoporotic fractures, in particular the reduction of vertebral and femoral fractures. The 10 years long-term extension studies, in particular those that have seen the employment of alendronate, found a positive outcome regarding densitometry data and a favorable trend in antifracture effectiveness. Ibandronate is another amino-bisphosphonate which was recently validated as an effective drug for the treatment of osteoporosis with its documented ability to meaningfully reduce vertebral fractures. Also ranelate of strontium, a drug that seems to explain its own result in a different way from the other antiresorptive bone agents, constitutes another valid alternative in the treatment of this pathology. Both of these molecules however, need further studies in order to estimate their antifracture effectiveness in the long term, particularly those related to femoral fractures. Teriparatide and the entire molecule paratohormone are usually not prescribed for its high cost in treatment and because, typically, patients with high-risk level fractures that are already affected, produce more vertebral fractures from moderate to severe intensity.

Parasitofauna study of the brown trout, Salmo trutta (Pisces, Teleostei) from Corsica (Mediterranean island) rivers

Corsica is a Mediterranean island characterised by a great number of rivers. Salmonides are the main fishes which populate these rivers. Very appreciated by fishermen, Salmonides are represented by three species in the insular hydrographical network, among which an autochthonous species, the brown trout (Salmo trutta). In the present work, we have analysed the parasitofauna of this species. According to our knowledge, this research has never been carried out in Corsica. In a first step, we drew up an inventory of the parasites found in this freshwater fish. In a second step, we studied the differences which appeared in the composition of parasite communities of this species.

Hb Marseille [α2β2N methionyl - 2 (NA2) His → Pro]: a new β chain variant having an extended N-terminus

A new abnormal hemoglobin was found in a diabetic Maltese woman by citrate agar electrophoresis. This variant was undetectable by isoelectric focusing. No hematological abnormalities were observed. The structural analysis included isolation of the abnormal beta chain, high pressure liquid chromatography of the corresponding tryptic peptides and then microsequencing of the abnormal T1. These procedures revealed a double abnormality: the presence of a methionyl residue extending the NH2 terminus and a histidine to proline substitution in position NA2.

The importance of anatomical variants of the sapheno-femoral junction in lower-limb varicose vein surgery

BACKGROUND

In the surgical strategy of lower limb varicose veins, the fundamental objective is to prevent relapses. For this purpose, after having examined the international literature on the most frequent relapse causes, the authors emphasize that erroneous diagnosis, varicose disease natural development and incorrect surgical treatment are very important.

METHODS

They report their experience about the sapheno-femoral junction anatomic variants that have been verified at the surgical table on 532 consecutive patients operated on for lower limb varicose veins. Of 532 patients 449 (84.4%) patients were women and 83 (15.6%) were men; all of them were, on average 49+/-26 years old. They were all with derivative from sapheno-femoral junction incontinence varicose veins that can be classified according to CEAP (C2-3-4/Ep/As 2-3/Pr). On these patients, 430 (80.8%) patients have had an operation of internal saphena long stripping; 65 (12.3%) patients have had an operation of saphena short stripping and 37 (6.9%) patients have had an operation of internal simple rossectomy.

RESULTS

The authors have inspected all collateral veins of the sapheno-femoral junction and they have noticed 135 variants (25.2%) that are very important for the surgeon and, among these variants, they have discovered some collaterals, that flow under the sapheno-femoral junction (about 4%), are particularly insidious and they are the cause of sure relapse if they are ignored.

CONCLUSIONS

The purpose of the work is to emphasize the importance of knowing sapheno-femoral junction changeability that is often the cause of relapse after surgical treatment.

Factors which influence the difficulty of the spatial path in Corsi's block-tapping test

Spatial path in Corsi's test is defined as the ideal line joining the blocks tapped by the Examiner so the difficulty of the spatial path was analysed vis-á-vis the numbers of blocks tapped by the Examiner and the number of times the line criss-crosses itself through the spatial path. During an experiment with two different numbers of blocks and three different numbers of crosses, an analysis of variance showed that both factors, i.e., the number of blocks and the number of crosses, gave significant results. The experiment showed that it is possible to create a series with a decreased number of blocks, but with an increased number of crosses, which was more difficult than a series with a greater number of blocks but with a decreased number of crosses. Despite this, additional significant differences have been found among the series with the same number of blocks and crosses, meaning that the variables examined, although important, do not solve the problem with the complexity of the spatial path. At this stage, the length of the path, measured in millimetres, had to be considered as a further source of variance which could explain the difficulty of the spatial path. The correlation between path length and mean number correct achieved, through a single series of digits utilised in this research, was -.78. This value encourages further research.

Factor structure of the Italian version of the WAIS-R compared with the American standardization

Factor analysis for responses to the WAIS-R by 1,630 adults of the Italian standardization sample produced two factor solutions in different age groups, and showed high factorial similarity when compared with the same American solution. An estimate of g factor and variance components showed some difference with American data: a lower proportion of g and common variance, and a greater specificity characterized the Italian version with an almost identical error variance. For both the estimate of g and variance components some change across age groups was observed with g and common variance increasing and specific variance decreasing from youngest to oldest groups.

CTG repeat number in the nonaffected allele of myotonic dystrophy patients is not critical for disease expression

To investigate whether unusual allele segregation might explain the dominant negative effect of the expanded allele for myotonic dystrophy on myotonin protein kinase mRNA metabolism, which is suggested to cause the disease, we determined the number of CTG repeats at the DM locus in the nonaffected alleles of 64 DM (dystrophia myotonia) patients. The relative distribution was then compared with the distributions obtained from alleles of the normal parents and normal siblings of DM patients. Comparison was also made with the allele distribution of normal subjects from the same geographic area. It appears that the CTG repeat number of the nonaffected allele in DM patients is not critical for the expression of the disease.

A prospective study of fifty-three consecutive calcium heparin treated pregnancies in patients with antiphospholipid antibody-related fetal loss

OBJECTIVE

In this study the efficacy and safety of calcium heparin administered alone for the prevention of fetal loss related to antiphospholipid antibodies (aPL) were evaluated.

METHODS

Fifty-three consecutively ascertained pregnancies were followed in 53 patients who had a history of at least 2 consecutive miscarriages during the first trimester and/or 1 fetal death during the second or third trimesters. In addition, all patients had at least 2 positive aPL tests more than 8 weeks apart before pregnancy, or a positive aPL test at the beginning of pregnancy. They were treated with calcium heparin alone, self-administered subcutaneously 3 times daily at dosages varying between 15,000 and 37,500 units. Treatment was started soon after a sonogram demonstrated a live embryo and was continued throughout pregnancy until the end of puerperium.

RESULTS

All pregnancies terminated favourably between the 25th and 40th weeks (mean +/- SD: 36.69 +/- 2.91) with planned caesarean section in 27 cases and vaginal delivery in 26. Delivery was brought forward due to maternal and/or fetal complications in 18 cases (33.96%). Calcium heparin was associated with intravenous immunoglobulin therapy in 2 patients with fetal problems unresponsive to anticoagulant treatment alone. The newborns, 30 females and 25 males, had a mean birth weight of 2,828.3 g +/- 706.5 and a mean Apgar score at 5 minutes of 9.60 +/- 0.68. No malformations were observed. Thirty of the 37 examined placentas (81.08%) showed signs of thrombotic events. Only minor side effects of calcium heparin were observed during treatment.

CONCLUSION

Our study suggests that calcium heparin administered alone using the dosages and timing described here is effective in achieving the delivery of viable infants, and that it is well tolerated.

A quantitative polymerase chain reaction (PCR) assay completely discriminates between Duchenne and Becker muscular dystrophy deletion carriers and normal females

Duchenne/Becker muscular dystrophy (DMD/BMD) is a severe X-linked myopathy. In 65% of the patients, the mutations responsible for the disease are macrodeletions in the dystrophin-encoding gene that can be identified with multiplex polymerase chain reaction (PCR) technology. We developed a method for quantitative PCR analysis of deletion carriers involving the use of phosphorimager-based scanning of radioactive-labelled PCR products. We calculated the ratios between the areas of two peaks, one corresponding to the deleted segments to be analysed and the other taken as a reference. In carriers, these ratios (R value) were always about half those obtained in normal females. The final diagnostic result, the diagnostic index (DI), is the ratio of the R values between the propositus and a normal subject. We also assessed the variability of each step of the procedure and the overall variability of the DI value, thus obtaining cut-off values that completely discriminated BMD/DMD deletion carriers from normal females. We were also able to classify, as either 'carrier' or 'normal', several females whose status was not identified with linkage analysis.

Corsi's block-tapping test: standardization and concurrent validity with WISC-R for children aged 11 to 16

Corsi's block-tapping test and WISC-R were given to 1122 children from 11 to 16 years of age. Corsi's raw scores were transformed into standard scores like those for the WISC-R subtests. Reliabilities, standard score equivalents of raw scores, correlations with scores on WISC-R subtests, scales and factor scores are presented. A Principal Factor analysis of intercorrelations for Corsi's test and WISC-R subtests shows a three-factor solution with Corsi's test loading on the Third Factor. Results agree with Wielkiewicz's (1990) hypothesis about the construct underlying WISC-R Third Factor as "executive" and short-term memory processes.

"Experimental amnesia" induced by emotional items

Tulving described an effect of retrograde amnesia in a free-recall task of word lists, produced by inserting items having priority in recall. Other authors confirmed the amnesic effect without giving instructions for priority both in recall and in recognition tasks. The effect was explained by Tulving as a premature termination of encoding processes. The similarity between these experiments and the researches aimed at reproducing amnesia by emotional trauma led us to hypothesize that the two phenomena might be due to the same functional mechanisms. We have organized a free-recall task of word lists into which emotional items were inserted. Our aim was to verify whether with these experimental conditions Tulving's results would be reproduced. The obtained data show amnesic effects in free recall; nevertheless, they do not seem to confirm closely the experimental hypothesis. Lastly, changes in primacy and recency effects produced by emotional items are analyzed.

The appropriateness of human albumin use in the hospital of Padova, Italy

The authors present the findings of a study in three stages (1989-1991) on the appropriateness of human albumin use at the hospital of Padova, Italy. In the first stage, guidelines for appropriate use were defined and a monitoring system was set up. In the second stage, compliance of the hospital departments with the new guidelines was assessed in a sample of human albumin prescription charts and related medical records. This revealed a reduction in consumption of 25%. Sixty-eight per cent of all albumin was given for indications that are only occasionally appropriate. The information given in the prescription chart agreed with the diagnosis contained in the medical records in 78% of cases. At the end of this stage new regulating mechanisms were introduced. The third stage consisted of a medium-term assessment and produced basically the same results as the previous stage. Crucial steps in the implementation of effective actions in quality improvement processes have been discussed.

Memory encoding processes in mild and severe dementia. Preliminary data

Memory coding processes can be divided according to their attentional requirement into "automatic" and "effortful". The aim of current research was to explore both automatic and effortful processes in early and late stages of Alzheimer type dementia. Patients were classified on the basis of restrictive clinical and neuropsychological criteria, in order to pinpoint possible specific impairments in the two patients' subgroups. The present paper reports preliminary data about 15 mildly and 15 severely demented patients. Statistical analysis showed that both the automatic and the effortful coding processes are impaired at the late but also at the early stages of dementia.

Hb Bruxelles: alpha 2A beta (2)41 or 42(C7 or CD1)Phe deleted

Hb Bruxelles is a new beta-globin variant producing severe congenital Heinz body anemia. It results from the deletion of one of the two adjacent phenylalanines, beta 41 or beta 42, presumably by frameshift mutagenesis. Its whole blood oxygen affinity is significantly lowered.

Selective "semantic amnesia" after closed-head injury. A case report

An 18-year-old girl with a left parietal lesion caused by a closed-head injury exhibited a peculiar memory impairment. The patient showed selective "semantic amnesia" (severe loss of the stock of notions acquired prior to the disease), while autobiographic memory and spatial learning ability were preserved. The semantic/episodic distinction is discussed in the light of the patient's performance on neuropsychological tasks.

Maturation of immunological reactivity in the fetal lamb infected with Akabane virus

The development of cell-mediated immunological reactivity was studied in fetal lambs infected with Akabane virus. Examination of hepatic cells from fetuses between 40 and 75 days' gestation that had been infected via the transplacental route revealed inconsistent responses to Akabane, together with a uniform failure to respond to non-specific mitogens which contrasted with the behaviour of control, uninfected lambs. Following direct inoculation of fetal lambs with virus between 50 and 120 days' gestation, specific proliferative responses were observed on the part of the spleen cells from some. Direct challenge of fetal lambs of 4 months' gestation evoked cellular responses in lymph draining from the site of virus inoculation similar to those produced by challenge of adult sheep. The proliferative response of lymph-borne cells was substantially better if live, rather than inactivated, virus had been used.

Immediate memory spans in dementia

Spatial span (Corsi's block-tapping test) and verbal spans for digits (Wechsler Digits Forward Test) and for words were measured in 30 normal subjects and in 51 demented patients, divided into two groups (mildly demented and severely demented) according to selective clinical and neuropsychological criteria. Statistical analysis showed significant differences among the three groups for spatial span. By contrast, controls' and mildly demented patients' performances on both verbal spans were not significantly different. These findings are discussed in the light of theory about working memory.

Verbal and spatial immediate memory span: normative data from 1355 adults and 1112 children

Norms are provided for verbal and visuo-spatial immediate memory span, two tasks widely used in the clinical assessment of short-term memory and its neurological disorders. Data have been collected from 1355 male and female adult subjects, with various educational backgrounds and a 20-99 years age range. Span shows a major decrement after the late sixties and is affected by educational level. Male subjects score better on the spatial task. Data collected from 1112 male and female children, 4-to-10 year-old, show that span increases with age and boys score better on the spatial test.

Verbal and spatial memory span in patients with extrapyramidal diseases

Spatial span (Corsi's block-tapping test) and verbal span (Wechsler's Digits Forward test) were measured in 651 normal subjects and in three groups of extrapyramidal patients (Progressive supranuclear palsy, Parkinson, and Huntington's Chorea). Analysis showed Huntington's Chorea patients scored lower on both tests than did controls and other groups.

[School screening of hemoglobinopathies in the Marseilles area. An analytic study of 35,289 tests]

A systematic screening for thalassemias and hemoglobinopathies was performed in 35,289 children with a double test associating blood cell counts and hemoglobin electrophoresis. Four hundred thirty-seven (1.23%) hemoglobin abnormalities were found, consisting of 274 cases with thalassemia (0.77%) and 159 hemoglobinopathies (0.45%) among which there were 80 cases with sickle-cell trait (0.22%), 30 with hemoglobin C (Hb C) (0.08%), 19 with Hb D (0.05%), 12 with HbJ (0.03%), 12 with Hb E (0.03%). There was an obvious ethnic influence as, among 17,180 autochtonal French children, only 15 abnormalities were found (0.08%) while 392 were found in 16,850 non autochtonal children (2.32%) and 30 in 1,259 French children from Corsica (2.38%). The highest incidence was found in Italians (173 of 6,455-2.68%) and Maugrabins (105 of 3,014-3.48%).