Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review

Background

Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown.

Purpose

To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke.

Methods

A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool.

Results

Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country.

Conclusion

CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke.

Systematic Review Registration

https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.

Rationale and design of the multicentric, double-blind, double-placebo, randomized trial APrepitant versus HYdroxyzine in association with cytoreductive treatments for patients with myeloproliferative neoplasia suffering from Persistent Aquagenic Pruritus. Trial acronym: APHYPAP

Background

Aquagenic pruritus (AP), an intense sensation of scratching induced after water contact, is the most troublesome aspect of BCR-ABL1-negative myeloproliferative neoplasms (MPNs). Mostly described in polycythemia vera (PV, ~ 40%), it is also present in essential thrombocythemia (ET) and primary myelofibrosis (PMF) (10%). Even if this symptom can decrease or disappear under cytoreductive treatments, 30% of treated MPN patients still persist with a real impact on the quality of life (QoL). Because its pathophysiology is poorly understood, efficient symptomatic treatments of AP are missing. The neuropeptide substance P (SP) plays a crucial role in the induction of pruritus. Several studies showed the efficacy of aprepitant, an antagonist of SP receptor (NK-1R), in the treatment of chronic pruritus but never evaluated in AP. The objectives of APHYPAP are twofold: a clinical aim with the evaluation of the efficacy of two drugs in the treatment of a persistent AP for MPN patients and a biological aim to find clues to elucidate AP pathophysiology.

Methods/design

A multicentric, double-blind, double-placebo, randomized study will include 80 patients with MPN (PV or ET or PMF) treated since at least 6 months for their hemopathy but suffering from a persistent AP (VAS intensity ≥6/10). Patients will be randomized between aprepitant (80 mg daily) + placebo to match to hydroxyzine OR hydroxyzine (25 mg daily) + placebo to match to aprepitant for 14 days. At D0, baseline information will be collected and drugs dispense. Outcome measures will be assessed at D15, D30, D45, and D60. The primary study endpoint will be the reduction of pruritus intensity below (or equal) at 3/10 on VAS at D15. Secondary outcome measures will include the number of patients with a reduction or cessation of AP at D15 or D60; evaluation of QoL and AP characteristics at D0, D15, D30, D45, and D60 with MPN-SAF and AP questionnaires, respectively; modification of plasmatic concentrations of cytokines and neuropeptides at D0, D15, D30, and D60; and modification of epidermal innervation density and pruriceptor expression at D0 and D15.

Discussion

The APHYPAP trial will examine the efficacy of aprepitant vs hydroxyzine (reference treatment for AP) to treat persistent AP in MPN patients. The primary objective is to demonstrate the superiority of aprepitant vs hydroxyzine to treat persistent AP of MPN patients. The treatment received will be considered efficient if the AP intensity will be reduced at 3/10 or below on VAS after 14 days of treatment. The results of this study may provide a new treatment option for this troublesome symptom and also give us more insights in the pathophysiology understanding of AP.

Trial registration

APHYPAP. NCT03808805, first posted: January 18, 2019; last update posted: June 10, 2021. EudraCT 2018-090426-66

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

The crystal growth and properties of novel magnetic double molybdate RbFe5(MoO4)7 with mixed Fe3+/Fe2+ states and 1D negative thermal expansion

Single crystals of new composition RbFe₅(MoO₄)₇ were successfully grown by the flux method, and their crystal structure was determined using the X-ray single-crystal diffraction technique.

Continuous analogue to iterative optimization for PDE-constrained inverse problems

The parameters of many physical processes are unknown and have to be inferred from experimental data. The corresponding parameter estimation problem is often solved using iterative methods such as steepest descent methods combined with trust regions. For a few problem classes also continuous analogues of iterative methods are available. In this work, we expand the application of continuous analogues to function spaces and consider PDE (partial differential equation)-constrained optimization problems. We derive a class of continuous analogues, here coupled ODE (ordinary differential equation)-PDE models, and prove their convergence to the optimum under mild assumptions. We establish sufficient bounds for local stability and convergence for the tuning parameter of this class of continuous analogues, the retraction parameter. To evaluate the continuous analogues, we study the parameter estimation for a model of gradient formation in biological tissues. We observe good convergence properties, indicating that the continuous analogues are an interesting alternative to state-of-the-art iterative optimization methods.

Follow-up Findings in Regional Cerebral Blood Flow (r-CBF)-SPECT in a Case of idiopathic Childhood Hemidystonia

A 9½-year-old girl suffered from intermitting tremor and jitteriness of her left hand and oral muscles every 4 to 6 weeks with long lasting episodes. Clinically myoclonias and dystonic positioning of the left arm, hand and facial muscles were seen. No evidence of trauma, infection or inborn errors of metabolism was found. Successful therapy with carbamazepine was initiated while L-DOPA failed. An ictal 99m-Tc-HMPAO-SPECT showed severe asymmetry with focal hyperperfusion of the contralateral right thalamus and basal ganglia as well as of the bifrontal cortex, whereas no anatomical lesions were found by MRI. In contrast, an interictally performed 99m-Tc-HMPAO SPECT showed hypoperfusion of the right thalamus and normalisation of the frontal perfusion under medical treatment. These 99m-Tc-HMPAO-SPECT findings may provide new insights into the localisation and pathophysiological pathways of idiopathic childhood dystonia.

Einsatz einer Klauenwaschanlage unter Beurteilung der Reinigungswirkung, des Tierverhaltens und der Waschwasserqualität

Gegenstand und Ziel: Informationen über Klauenreinigungssysteme waren bislang kaum verfügbar. Ziel dieser Arbeit war daher, das Klauenhygienesystem der Firma devio AG hinsichtlich Reinigungswirkung, Kuhverkehr und Waschwasserqualität zu testen. Material und Methoden: In zwei Versuchsphasen wurde die Klauenwaschanlage ohne und mit Einsatz eines Biozids in einer zweiphasigen kontrollierten Studie getestet. An den Klauen der Hintergliedmaßen von 55 Kühen (Deutsches Fleckvieh) wurde im 4-wöchigen Turnus der Verschmutzungsgrad untersucht und in vier Grade eingeteilt. Neben der Reinigungswirkung wurde der Kuhverkehr durch Videoaufnahmen aufgezeichnet und ausgewertet. Ferner erfolgte eine Bestimmung der Waschwasserqualität bei Einsatz des Biozids. Ergebnisse: In der zweiten Versuchsphase ergab sich eine signifikant geringere Verschmutzung der Klauen in der Versuchsgruppe, während dies in der ersten Versuchsphase nicht der Fall war. Die Videoauswertungen zeigten nach einer Adaptationszeit von etwa 2 Tagen einen ungestörten Tierverkehr. Die durchschnittliche Aufenthaltsdauer in der Klauenwaschanlage stiegerte sich innerhalb einer Woche nach Inbetriebnahme von durchschnittlich 23 s auf 32 s und die Aufenthaltsdauer vor dem System sank von durchschnittlich 3 min 51 s auf 2 min 20 s. Die Keimzahlen im Waschwasser erhöhten sich mit zunehmender Anzahl an Überquerungen der Anlage von anfänglich 1,2 × 106 auf 7,3 × 107 KbE/ml. Schlussfolgerung: Die untersuchte Klauenwaschanlage ermöglicht durch ihre stabile Bauweise und den ungestörten Kuhverkehr eine problemlose Integration in den Milchviehbetrieb. Durch die Verbesserung der Klauensauberkeit kann die Klauenwaschanlage einen positiven Beitrag zur Klauenhygiene leisten. Der Anstieg der Keimzahlen im Waschwasser ist jedoch im Bezug auf die Übertragung von Keimen von Kuh zu Kuh nicht unbedenklich.

Melt growth and properties of bulk BaSnO3 single crystals

We present the first-time growth of bulk BaSnO₃ single crystals from the melt by direct solidification, their basic electrical and optical properties as well as their structural quality. Our measurement of the melting point (MP) of BaSnO₃ amounts to 1855 °C  ±  25 K. At this temperature an intensive decomposition and non-stoichiometric evaporation takes place as the partial pressure of SnO(g) is about 90 times higher than that of BaO(g). X ray powder diffraction identified only the BaSnO₃ perovskite phase, while narrow rocking curves having a full width at half maximum of 26 arcsec and etch pit densities below 10⁶ cm^-2 confirm a high degree of structural perfection of the single crystals. In this respect they surpass the structural properties of those single crystals that were reported in the literature. The electrical conductivity of nominally undoped crystals depends on the growth conditions and ranges from insulating to medium n-type conductivity. After post-growth annealing in an oxidizing atmosphere undoped crystals are generally insulating. Doping the crystals with lanthanum during growth results in a high n-type conductivity. For a La doping concentration of 0.123 wt.% we measured an electron concentration of 3.3  ×  10¹⁹ cm^-3 and an electron mobility of 219 cm² V^-1 s^-1. Based on optical absorption measurements we determined an energy of 3.17  ±  0.04 eV at 5 K and of 2.99  ±  0.04 eV at 297 K for the indirect band gap of BaSnO₃.

Polyurethane dressing, tetracycline and salicylic acid use for treatment of digital dermatitis in cattle. A comparative study

OBJECTIVE

The use of antibiotics is a proven approach for local and systemic treatment of digital dermatitis (DD). Even if they are administered only locally and at low dosage, their use should be restricted to an absolute minimum. The efficacy of a commercial polyurethane wound dressing in treating acute digital dermatitis was compared with topical treatment using a commercially available tetracycline spray and a salicylic acid paste.

MATERIALS AND METHODS

A total of 105 cows in a dairy farm (with about 160 dairy cows) were included in the study, with 101 cows needing topical treatment for digital dermatitis on one or both hind feet. All animals underwent hoof trimming prior to the treatment. Affected feet (n = 152) were randomly assigned to one of three comparable treatment groups. Topical treatment was administered to all visible digital dermatitis lesions. Animals in the positive control groups were given a topical treatment of tetracycline (53 DD lesions in 49 cows) or salicylic acid (53 DD lesions in 50 cows) formulations, whose therapeutic effects were scientifically verified. Spray was applied once, at a usual dosage and without any bandage. Salicylic acid paste was fixed in place with a bandage for 5 days. In the test group (46 DD lesions in 45 cows), a polyurethane bandage was left in place for 10 days. Whereas, 47 feet (from 38 cows) without lesions or with lesions showing no pain were designated as group 0. Each lesion was evaluated at day 0 during trimming, and on day 10 and 36. The lesions were scored based on severity and size.

RESULTS

All groups showed a statistically significant improvement in the clinical appearance of the lesions at day 10. There were no significant differences in the findings between the second and the third evaluation (day 10 and day 36) either within a group or between the groups.

CONCLUSION

The use of an alternative treatment regimen like a polyurethane wound dressing shows good clinical healing, it is as effective as the conventional methods, and unlike the conventional methods, does not require a latency period.

[Prevention of preterm birth by Shirodkar cerclage--clinical results of a retrospective analysis]

In spite of the continuous progress in prenatal care, 1 out of 10 babies is born too early--tendency rising worldwide. As a consequence of the heterogeneous aetiology of preterm birth, there is still no single and efficient interventional therapy. Cerclage is one option for pregnancies with cervical insufficiency, whereas the clinical benefit is discussed controversially. We analyzed in a retrospective study with 120 patients the effect of a cerclage intervention regarding pregnancy prolongation. Patients with cervical incompetence and Shirodkar cerclage were compared to those undergoing conservative treatment. As expected, gestational age at delivery was significantly lower after emergency cerclage (31 weeks) compared to prophylactic (36 weeks) and therapeutic cerclage (35 weeks). Prolongation differs significantly between the prophylactic (18 weeks), therapeutic (14 weeks) and emergency cerclage (10 weeks) groups. Conservative management achieved 8 weeks prolongation. Of note, particularly emergency cerclage in cases with advanced cervical incompetence resulted in a substantially higher pregnancy prolongation (10 weeks) compared to no intervention (one week). The efficiency of cerclage operations has to be assessed in a differentiated manner based on the clinical situation and indication. The clinical benefit depends strongly on proper patient selection.

Einfluss eines neuartigen Biozids auf die Prävalenz von Dermatitis digitalis bei Milchkühen

Gegenstand und Ziel: Es wurde untersucht, ob der Einsatz des Biozidprodukts T-Hexx Dragonhyde HBC (Fa. Hydromer, Branchburg, NJ, USA) die Prävalenz der Dermatitis digitalis (DD) beeinflusst. Material und Methoden: In einem Milchviehbetrieb (110 melkende Kühe) wurden 48 lahmheitsfreie Tiere randomisiert Versuchs- und Kontrollgruppe zugeteilt. Die mit 70–80% hohe Prävalenz der DD wurde 2 Monate lang vier Mal im Abstand von je 16–21 Tagen erfasst. Ein Punkteschema diente zur Dokumentation des Grades der DD-Läsionen an den Hinterklauen. Die Kühe der Versuchsgruppe wurden zweimal wöchentlich für zwei Melkzeiten nach Vorreinigung der Klauen mit Wasser durch ein Klauenbad mit T-Hexx-Dragonhyde geleitet, bei den Kontrolltieren erfolgte nur eine Klauenreinigung. Die Spritzer der Biozidlösung an Tieren und Umgebung wurden fotografisch dokumentiert und beurteilt. Wasser- und Biozidbad wurden nach Nutzung durch steigende Tierzahlen bakteriologisch untersucht. Ergebnisse: Statistisch signifikante Unterschiede der Prävalenzen der DD zwischen und innerhalb der beiden Gruppen waren nicht festzustellen. Die Punktebewertung der Läsionen differierte zwischen beiden Gruppen nicht. Im Wasserbad nahm mit steigender Zahl der Durchgänge die Zahl der koloniebildenden Einheiten (KBE) pro Milliliter sowie die der Enterobacteriaceae deutlich zu. Im T-Hexx-Dragonhyde-Bad ließen sich zu keinem Zeitpunkt KBE oder Enterobacteriaceae bestimmen. Die auffälligen Spritzer der Lösung waren bis in Höhe des Euters sichtbar. Schlussfolgerung und klinische Relevanz: Ein Einfluss des Biozidprodukts bei 4%- und 2%iger Badkonzentrationen auf die Prävalenz der DD konnte nicht nachgewiesen werden. Die hygienische Wirkung der Lösung war nicht gleichbedeutend mit einer erfolgreichen Keimreduktion an der Klaue. Eine mögliche Prävention der DD durch veterinärhygienische Maßnahmen könnte zukünftig bei geringerer Prävalenz und größerem Stichprobenumfang überprüft werden. Bei Anwendung von Klauenbädern besteht grundsätzlich die Gefahr einer Kontamination der Milch bzw. einer Mastitis durch Spritzer der Lösung.

[Influence of a new biocidal product on the prevalence of digital dermatitis in dairy cows]

OBJECTIVE

It was investigated whether usage of the biocidal product T-Hexx Dragonhyde (Hydromer, Branchburg, NJ, USA) could influence the prevalence of digital dermatitis (DD).

MATERIAL AND METHODS

On a dairy farm (110 milking cows) 48 dairy cows without lameness were selected randomly for a test group or a control (negative) group, respectively. A high prevalence of DD (70-80%) was documented over a period of 2 months, during which four examinations were made, with an interval of 16-21 days between each examination. The respective grade of the DD-lesion on the hind hoofs was documented according to a scoring scheme. After precleaning the claws with water, the test group passed through a hoof bath containing T-Hexx Dragonhyde on 2 days per week at two milking times on each day, whereas the claws of control animals were cleaned using only a water bath. Splashes contaminating the animals and the environment were documented photographically and evaluated. Bacteriological examinations of the water bath and the T-Hexx-bath were performed after increasing numbers of animals had passed through the baths.

RESULTS

Between and within groups no statistically significant differences in the prevalence of DD were found. DD-lesion scoring did not show any difference between the groups. With increasing numbers of animals having passed through the water bath, there was a significant increase in colony-forming units per millilitre and of enterobacteriaceae. In the T-Hexx Dragonhyde footbath, bacterial contamination remained below the detection limit at all times. The coloured splashes of the footbath were visible up to the level of the udder and teats.

CONCLUSION AND CLINICAL RELEVANCE

The prevalence of DD was not influenced by the 2% or 4% concentration of the biocidal product in the footbath. Thus the microbiocidal effect of the solution did not lead to an efficient reduction in bacteria on the hoof. To demonstrate a potential preventive effect on DD, future studies would require herds with lower prevalence and a higher sample size. However, when applying footbaths there is the general risk of milk contamination or causing mastitis.

[Evaluation of a claw hygiene system concerning its cleaning effect, the cow traffic and the quality of the washing water]

OBJECTIVE

Only limited scientific information on the efficiency of claw cleaning systems for dairy cows is currently available. For this reason, this investigation aimed to test the devio AG's claw hygiene system regarding its cleaning effect as well as its impact on the cow traffic and the quality of its washing water.

MATERIAL AND METHODS

During the first of two investigative phases of this controlled study, main water was used to clean the claws, while in the second phase a biozide was additionally applied. Every 4 weeks the hind claws of approximately 55 dairy cows (German Fleckvieh breed) were evaluated and their degree of soiling classified into four categories. In addition to the system's cleaning effect, its effect on cow traffic was investigated using video recordings and the quality of the recycled washing water was tested using bacteriological sampling.

RESULTS

In the second investigation phase, claw cleanliness in the treatment group was significantly higher than in the control group. However, there was no significant difference between the two groups during the first investigation phase. The video analysis showed, that after a short period of adaptation, there was undisturbed cow traffic. Within one week of installing the claw hygiene system, the length of stay in the system increased from a mean of 23 s to 32 s and the time the cows spent waiting in front of the system was reduced from a mean of 3 min 51 s to 2 min 20 s. Water analysis revealed an increasing bacterial count from initially 1.2 × 10⁶ to 7.3 × 10⁷ CFU/ml.

CONCLUSIONS

The undisturbed cow traffic allows the easy integration of the claw cleaning system into a free-stall barn. The improvement of claw cleanliness can make a positive contribution to claw hygiene. However, the increasing bacterial contamination of the washing water gives cause for concern in terms of infections being passed between cows when using this system.

Hepatitis B-associated acute liver failure: immediate treatment with entecavir inhibits hepatitis B virus replication and potentially its sequelae

BACKGROUND

Acute hepatitis B virus (HBV) infection is followed by high viral replication rates leading to hepatocyte death and ultimately, in some cases, to acute liver failure (ALF) necessitating liver transplantation. Thus, the objective of treating HBV-induced ALF is to eliminate or significantly suppress HBV replication.

METHODS/RESULTS

This prospective study (02/2008-02/2009) included 6 patients (1 female and 5 males, median age 35.5 years). HBV DNA and hepatitis B surface antigen (HBsAg) levels were detected, and hepatocyte death was quantified in patients' sera by (a) M65 ELISA and (b) M30 ELISA. All patients received entecavir treatment at 1 mg daily within 1-18 days after admission. Upon treatment, pathologic parameters rapidly decreased and returned to normal values or trace amounts (HBV DNA) within 3 months in all of the cases. A seroconversion to anti-HBsAg was achieved in 5 out of 6 patients; one patient with late onset of treatment did not seroconvert. M65 and the difference of M65-M30 as a marker for cell necrosis dropped significantly within 1 week of treatment.

CONCLUSION

This preliminary series of 6 patients reveals that immediate treatment of HBV-induced ALF with entecavir is well tolerated and beneficially affects the course of the disease.

Outbreak of Clostridium difficile 027 infection in Vienna, Austria 2008-2009

From November 2008 to 15 April 2009, 36 isolates of CD027 identified in Austria, all originating from four hospitals in Vienna. All isolates were positive for toxin A, toxin B and the binary toxin, and showed a characteristic 18 bp deletion in the tcdC gene. Clostridium difficile is an anaerobic spore-forming bacterium. Some strains may cause diarrhoea due to formation of toxins. Symptomatic C. difficile infection (CDI) is primarily linked with hospital admission and antibiotic treatment, although antibiotic exposure is neither necessary nor sufficient for CDI [1,2]. In Belgium, for instance, one third of CDI cases reported in the hospital surveillance system are not hospital-associated [3]. Symptoms range from mild diarrhoea to serious manifestations such as pseudomembranous colitis, toxic megacolon or perforation of the colon. C. difficile challenges hygiene standards as it is forms spores. The risk of infection rises with increasing age, underlying disease and immunodeficiency [4]. In recent years, a particularly virulent strain, ribotype 027 (CD027), has emerged in a number of countries, particularly in connection with hospital outbreaks, but also in community-acquired diarrhoea cases [5]. The risk of serious disease and death associated with CD027 exceeds that of other C. difficile strains. The classical CD027 is characterised - among other things - by an increased production of toxins A and B, production of a binary toxin and resistance to newer fluoroquinolones such as moxifloxacin. The first three Austrian cases of CD027 occurred in 2006 and in March 2008 [6,7]. Since August 2006, the Austrian National Reference Centre for C. difficile has ribotyped approximately 2,700 human C. difficile isolates received from all nine Austrian provinces. In recent months, a drastic increase in CD027 cases has been noted, all originating from four hospitals in Vienna. From November 2008 to 15 April 2009, 36 isolates of CD027 were received at the National Reference Centre. The Figure summarises these C. difficile 027 cases by month of reception of the sample at the reference centre.

Outbreak of Clostridium difficile 027 infection in Vienna, Austria 2008-2009

From November 2008 to 15 April 2009, 36 isolates of CD027 were identified in Austria, all originating from four hospitals in Vienna. All isolates were positive for toxin A, toxin B and the binary toxin, and showed a characteristic 18 bp deletion in the tcdC gene.

Fetal heart rate variability reveals differential dynamics in the intrauterine development of the sympathetic and parasympathetic branches of the autonomic nervous system

The aim of this study was to investigate the hypothesis that fetal beat-to-beat heart rate variability (fHRV) displays the different time scales of sympatho-vagal development prior to and after 32 weeks of gestation (wks GA). Ninety-two magnetocardiograms of singletons with normal courses of pregnancy between 24 + 1 and 41 + 6 wks GA were studied. Heart rate patterns were either quiet/non-accelerative (fHRP I) or active/accelerative (fHRP II) and recording quality sufficient for fHRV. The sample was divided into the GA groups <32 wks GA/>32 wks GA. Linear parameters of fHRV were calculated: mean heart rate (mHR), SDNN and RMSSD of normal-to-normal interbeat intervals, power in the low (0.04-0.15 Hz) and high frequency range (0.15-0.4 Hz) and the ratios SDNN/RMSSD and LF/HF as markers for sympatho-vagal balance. fHRP I is characterized by decreasing SDNN/RMSSD, LF/HF and mHR. The decrease is more pronounced <32 wks GA. Beyond that GA SDNN/RMSSD is predominantly determined by RMSSD during fHRP I and by SDNN during fHRP II. In contrast to fHRP I, during fHRP II, mHR is positively correlated to SDNN/RMSSD instead of SDNN >32 wks GA. LF/HF increases in fHRP II during the first half of the third trimester. Non-accelerative fHRP are indicative of parasympathetic dominance >32 wks GA. In contrast, the sympathetic accentuation during accelerative fHRP is displayed in the interrelations between mHR, SDNN and SDNN/RMSSD. Prior to 32 wks GA, fHRV reveals the increasing activity of the respective branches of the autonomic nervous system differentiating the types of fHRP.

Characterization of Clostridium difficile isolates using capillary gel electrophoresis-based PCR ribotyping

We have developed a Clostridium difficile PCR ribotyping method based on capillary gel electrophoresis and have compared it with conventional PCR ribotyping. A total of 146 C. difficile isolates were studied: five isolates were reference strains (PCR ribotypes 001, 014, 017, 027 and 053); 141 were clinical isolates comprising 39 Austrian PCR ribotypes collected in the period 2006–2007 at 25 Austrian healthcare facilities. Capillary gel electrophoresis yielded up to 11 fragments per isolate and 47 ribotype patterns. All but one of the five PCR ribotypes of reference strains were clearly reflected in the chromatograms of capillary-based typing. Capillary gel electrophoresis divided 24 isolates belonging to PCR ribotype type 014 into seven subgroups, whereas subtyping the same isolates using multiple-locus variable-number tandem-repeat analysis yielded three unrelated subgroups, without obvious correlation to sr subgroups. Using a web-based software program (http://webribo.ages.at), we were able to correctly identify these 014 isolates by simply allocating the seven subgroup patterns to one ribotype, i.e. to PCR ribotype 014. We consider capillary gel electrophoresis-based PCR ribotyping to be a way of overcoming the problems associated with inter-laboratory comparisons of typing results, while at the same time substantially diminishing the hands-on time for PCR ribotyping.