1
|
Bettuzzi C, Abati CN, Salvatori G, Zanardi A, Lampasi M. Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: a need for improved scoring systems. J Child Orthop 2019; 13:478-485. [PMID: 31695815 PMCID: PMC6808069 DOI: 10.1302/1863-2548.13.190010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. METHODS Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. RESULTS For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved.For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. CONCLUSIONS In a clinical setting, despite a high correlation of evaluations for total scores, the interobserver agreement of DimS and PirS was not adequate and only a few items were substantially reliable. Simultaneous use of two scores seemed redundant and some overlapping features showed different reliability according to criterion or scale used. Future scoring systems should improve these limitations. LEVEL OF EVIDENCE Level I - Diagnostic studies.
Collapse
Affiliation(s)
- C. Bettuzzi
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy,Correspondence should be sent to C. Bettuzzi, Anna Meyer Children’s Hospital, Department of Paediatric Orthopaedics, Viale Pieraccini 24, 50139, Florence, Italy. E-mail:
| | - C. N. Abati
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
| | - G. Salvatori
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
| | - A. Zanardi
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
| | - M. Lampasi
- Department of Paediatric Orthopaedics, Anna Meyer Children’s Hospital, Florence, Italy
| |
Collapse
|
2
|
Zanardi A, Fortini V, Abati CN, Bettuzzi C, Salvatori G, Prato E, Di Giacinto S, Lampasi M. Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus Ponseti method. J Child Orthop 2019; 13:471-477. [PMID: 31695814 PMCID: PMC6808080 DOI: 10.1302/1863-2548.13.190097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE A mild delay in gross motor milestones and walking age has been reported in infants with clubfoot. The influence of different treatments on motor development has been poorly investigated. Some parents and physical therapists express concern that the Ponseti method (PM) and its constraints (abduction brace, casts) would affect development more than the French physical therapy method (FM) due to greater immobilization and lesser stimulation.The purpose of this study was to evaluate achievement of three motor milestones (pull-to-standing, cruising and independent walking) in two groups of clubfoot patients treated at two experienced institutes respectively with the PM and FM. METHODS In all, 52 consecutive infants (full-term at birth, mean age at beginning of treatment 24.3 days (sd 10), mean Dimeglio score 12 (sd 3.4)) were prospectively enrolled (26 patients per centre) and followed up to walking age recording milestones. RESULTS The two groups were not different in terms of age at the beginning of treatment (p = 0.067) and rate of tenotomy. Age at tenotomy was significantly lower in the PM group (p = 0.000). Severity (p = 0.004) and number of bilateral cases (p = 0.012) were higher in the PM group. A non-significant difference was found for age of achievement of pull-to-standing (p = 0.109), cruising (p = 0.253) and independent ambulation (p = 0.349) between the two groups. Overall, milestones were achieved approximately two months later than normal population. Sex, severity, laterality and need of tenotomy were not found to significantly influence milestones. CONCLUSION Our results confirmed that infants with clubfoot are expected to have a minimum delay in motor development. Infants treated with the PM and those treated with the FM did not show significant differences in gross motor milestones achievement at walking age. LEVEL OF EVIDENCE Level II - Prospective comparative therapeutic studies.
Collapse
Affiliation(s)
- A. Zanardi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - V. Fortini
- Department of Paediatric Rehabilitation, Anna Meyer Children’s Hospital, Florence, Italy
| | - C. N. Abati
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - C. Bettuzzi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - G. Salvatori
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - E. Prato
- Department of Paediatric Rehabilitation, Anna Meyer Children’s Hospital, Florence, Italy
| | - S. Di Giacinto
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy
| | - M. Lampasi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children’s Hospital, Florence, Italy,Correspondence should be sent to M. Lampasi, Anna Meyer Children’s Hospital, Chief of the Department of Paediatric Orthopaedics and Traumatology, Viale Pieraccini 24, 50139, Florence, Italy. E-mail:
| |
Collapse
|
3
|
Cappelli A, Grisci G, Paolino M, Giuliani G, Donati A, Mendichi R, Artusi R, Demiranda M, Zanardi A, Giorgi G, Vomero S. Hyaluronan derivatives bearing variable densities of ferulic acid residues. J Mater Chem B 2014; 2:4489-4499. [PMID: 32261551 DOI: 10.1039/c3tb21824d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A synthetic procedure has been developed to conjugate ferulic acid (FA) to an important natural polysaccharide derivative such as hyaluronic acid (HA). The activation of FA with 1,1'-carbonyldiimidazole (CDI) has been investigated. Two reactive intermediates, namely monoimidazolide 2 [i.e. (E)-3-(4-hydroxy-3-methoxyphenyl)-1-(1H-imidazol-1-yl)prop-2-en-1-one] and bisimidazolide 3 [i.e. (E)-4-(3-(1H-imidazol-1-yl)-3-oxoprop-1-enyl)-2-methoxyphenyl 1H-imidazole-1-carboxylate] were characterized from the point of view of their structure and reactivity. The ready isolation of bisimidazolide 3 and its reactivity support its potential usefulness in the feruloylation of molecular or macromolecular materials bearing hydroxyl moieties. Bisimidazolide derivative 3 has been found to be an effective reagent in the feruloylation of HA to give HAFA graft copolymers showing different grafting degrees (GD), which could be modulated by varying the reaction conditions. A series of HAFA derivatives showing different GD values has been prepared and submitted to an extensive macromolecular and rheological characterization in order to ascertain that the grafting of HA with FA does not degrade the polysaccharide backbone and to evaluate the role of GD in affecting solubility and rheological properties. The results suggested that relatively low GD values were sufficient to confer physical cross-linking capabilities resulting in the features of a strong gel of HAFA dispersions.
Collapse
Affiliation(s)
- A Cappelli
- Dipartimento di Biotecnologie, Chimica e Farmacia and European Research Centre for Drug Discovery and Development, Università degli Studi di Siena, Via A. Moro 2, 53100 Siena, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Linguadoca C, Parazza S, Musi E, Zanardi A, Caliumi F, Antonini MV, Caspani ML. GRP-163 Risk Management Measures to Prevent Physical-Chemical Incompatibilities During Continuous IV Infusion. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Ceccuzzi R, Zanardi A, Fiorentino A, Tinelli C, Bianchi PE. Corneal sensitivity in keratoconus after penetrating and deep anterior lamellar keratoplasty. ACTA ACUST UNITED AC 2010; 224:247-50. [PMID: 20110740 DOI: 10.1159/000277615] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 06/26/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate recovery of corneal sensitivity in the graft following penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. MATERIALS AND METHODS 113 eyes of 113 patients (39 females, 74 males) were examined. All eyes had undergone corneal grafting: 39 PK, 74 DALK. Corneal sensitivity tested using the Cochet-Bonnet esthesiometer was evaluated the day before and 3 days, 3, 6, 12 and 24 months after surgery. The corneal sensitivity recovery was associated with surgical techniques (PK or DALK), age and sex of recipient and donor, cadaver time and type of preservation of the cornea. RESULTS The average percentage of recovery of corneal sensitivity was 91% at 2 years. Surgical techniques and other qualitative and quantitative variables did not affect the statistically significant recovery of corneal sensitivity. CONCLUSIONS In both surgical techniques, PK and DALK, we noticed a good recovery of corneal sensitivity in 2 years.
Collapse
Affiliation(s)
- R Ceccuzzi
- Department of Ophthalmology, University of Pavia, Pavia, Italy.
| | | | | | | | | |
Collapse
|
6
|
Sigala S, Zoli M, Palazzolo F, Faccoli S, Zanardi A, Mercuri NB, Spano P. Selective disarrangement of the rostral telencephalic cholinergic system in heterozygous reeler mice. Neuroscience 2006; 144:834-44. [PMID: 17112676 DOI: 10.1016/j.neuroscience.2006.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 10/10/2006] [Accepted: 10/11/2006] [Indexed: 10/23/2022]
Abstract
Reelin (RELN) is a key molecule for the regulation of neuronal migration in the developing CNS. The reeler mice, which have spontaneous autosomal recessive mutation in the RELN gene, reveal multiple defects in brain development. Morphological, neurochemical and behavioral alterations have been detected in heterozygous reeler (HR) mice, suggesting that not only the presence, but also the level of RELN influences brain development. Several studies implicate an involvement of RELN in the pathophysiology of neuropsychiatric disorders in which an alteration of the cholinergic cortical pathways is implicated as well. Thus, we decided to investigate whether the basal forebrain (BF) cholinergic system is altered in HR mice by examining cholinergic markers at the level of both cell body and nerve terminals. In septal and rostral, but not caudal, basal forebrain region, HR mice exhibited a significant reduction in the number of choline acetyltransferase (ChAT) immunoreactive (ir) cell bodies compared with control mice. Instead, an increase in ChAT ir neurons was detected in lateral striatum. This suggests that an alteration in ChAT ir cell migration which leads to a redistribution of cholinergic neurons in subcortical forebrain regions occurs in HR mice. The reduction of ChAT ir neurons in the BF was paralleled by an alteration of cortical cholinergic nerve terminals. In particular, the HR mice presented a marked reduction of acetylcholinesterase (AChE) staining accompanied by a small reduction of cortical thickness in the rostral dorsomedial cortex, while the density of AChE staining was not altered in the lateral and ventral cortices. Present results show that the cholinergic basalo-cortical system is markedly, though selectively, impaired in HR mice. Rostral sub-regions of the BF and rostro-medial cortical areas show significant decreases of cholinergic neurons and innervation, respectively.
Collapse
Affiliation(s)
- S Sigala
- Section of Pharmacology, Department of Biomedical Sciences and Biotechnology, University of Brescia Medical School, V.le Europa 11, 25123 Brescia, Italy
| | | | | | | | | | | | | |
Collapse
|
7
|
Agnati LF, Leo G, Zanardi A, Genedani S, Rivera A, Fuxe K, Guidolin D. Volume transmission and wiring transmission from cellular to molecular networks: history and perspectives. Acta Physiol (Oxf) 2006; 187:329-44. [PMID: 16734770 DOI: 10.1111/j.1748-1716.2006.01579.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present paper deals with a fundamental issue in neuroscience: the inter-neuronal communication. The paper gives a brief account of our previous and more recent theoretical contributions to the subject and also reports new recent data that support some aspects of our proposal on two major modes of communication in the central nervous system: the wiring and the volume transmission. There exist two competing theories on inter-neuronal communication: the neuron doctrine and the theory of the diffuse nerve network, supported by Cajal and Golgi, respectively (see their respective Nobel Lectures). The present paper gives a brief account of a view on inter-neuronal communication in the brain, the volume and wiring transmission concept that to a great extent reconcile these two theories. Thus, the theory of volume and wiring transmission are summarized and its recent developments that allow to extend these two modes of communication from the cellular network to the molecular network level is also briefly illustrated. The explanatory value of this broadened view is further enhanced by our recent proposal on the existence of a Global Molecular Network enmeshing the entire central nervous system. It may be interesting to note that also the Global Molecular Network theory is reminiscent of the old reticular theory of Apathy. Finally, the so-called 'tide hypothesis' for diffusion of signals in the brain is briefly discussed and its possible extension to the molecular level is for the first time introduced. Early indirect evidence supporting volume transmission in the brain was the discovery of transmitter-receptor mismatches. Thus, as an experimental part of the present paper a new approach to evaluate transmitter-receptor mismatches is given and evidence for inter-relationships between temperature micro-gradients and mismatches is provided.
Collapse
Affiliation(s)
- L F Agnati
- Department of Biomedical Sciences, Section of Physiology, University of Modena, Modena, Italy.
| | | | | | | | | | | | | |
Collapse
|
8
|
Benedetti M, Marchesi R, Zanardi A, Pastorelli A, Scicchitano D, Castagnoli L, Pandolfi U, Tinozzi S. [Reconversion after Hartmann's procedure. Our experience]. Ann Ital Chir 1998; 69:89-93; discussion 93-4. [PMID: 11995043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
An increasing number of intestinal reconversion after Hartmann have been performed in recent years, especially due to improved surgical techniques and progressively lengthened lifespan. The authors report 33 cases of intestinal recanalization of 100 interventions according to Hartmann from 1984 to 1996 (21 not neoplastic pathologies, 12 neoplasias). The variables considered included: patient age, type of disease requiring intervention according to Hartmann, oncologic characteristic of patients with neoplasia, interval between the two interventions, preoperative examinations performed, morbidity and mortality after reconversion. Furthermore, the fundamental indications for reconversion are described, in particular in patients with neoplasias (CEA, transanal echo, total body Ct, anal manometry). The low frequency of preoperative complications, zero mortality, satisfactory long-term follow-up (only one patient with neoplastic relapse) indicate that colon-rectal reconversion can also be performed in the elderly and patients with neoplasias with favorable prognosis.
Collapse
Affiliation(s)
- M Benedetti
- Istituto di Chirurgia Generale e dei Trapianti d'Organo Patologia Chirurgica II, IRCCS Policlinico S. Matteo, Università degli Studi di Pavia
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Prando R, Melga PL, Accoto S, Buzzo P, Cheli V, De Grandi R, Augeri C, Zanardi A. [Residual beta-cell function in type diabetes]. MINERVA ENDOCRINOL 1988; 13:95-102. [PMID: 3050429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|