Kinetic parameters during land and water walking performed by individuals with Down Syndrome

BACKGROUND

Down Syndrome (DS) is a genetic condition presenting delay in acquisition of main motor milestones, such as walking. Although studies have been investigating the biomechanical parameters during land walking performed by individual with DS, the literature is scarce regarding kinetic parameters analysis in this population, specially during water walking.

RESEARCH QUESTION

This study sought to assess the vertical ground reaction force (Fz) of walking performed in water and on land at different speeds by individuals with DS.

METHODS

Fourteen adults with DS (age: 27.9 ± 7.9 years; body mass: 58.4 ± 12.9 kg; height: 1.4 ± 0.1 m, body mass index: 29.2 ± 5.4 kg.m^-2) completed two sessions of data collection, one on land and another in aquatic environment. The protocol consisted of walking performed at three self-selected speeds (slow, comfortable and fast) in randomized order. The Fz was assessed with a waterproof force plate in each condition. Two-way repeated-measures ANOVA (environment and speed), with Bonferroni's post hoc tests, were used for analysis. A significance level was set as α = 0.05.

RESULTS

Significant differences were observed between environments (p < 0.001), with reduced first peak of Fz (68-73%), second peak of Fz (66-70%), loading rate (75-78%) and impulse (40-41%) in the water walking for all speeds analyzed. In the aquatic environment, no significant difference was observed for the first and second Fz peaks with the increasing speed of walking. Moreover, the loading rate significantly increased (p = 0.019) as the impulse significantly reduced (p < 0.001) in the higher speeds.

SIGNIFICANCE

Individuals with DS present reduced Fz outcomes during water walking in comparison to land. Therefore, water walking may be performed by individuals with DS with safe vertical loads on lower limbs regardless the self-selected speed for rehabilitation, correction of gait and training purposes.

[Diagnosis and clinical aspects of gastrointestinal cytomegalovirus diseases in patients with human immunodeficiency virus 1 infection]

Eleven Human Immunodeficiency Virus 1 (HIV1)-infected patients (10 male, 1 female; age 23-51 years (median 36); 10 male homosexuals, 1 IV drug abuser; WR3 1 patient, WR5 5, WR6 5) with intestinal Cytomegalovirus (CMV)-manifestations were compared with a group of 78 HIV1-infected patients in respect to their clinical, immunological and virus-serological data and the results of the histological and microbiological examination of endoscopically obtained biopsies. No differences were observed on age, sex, risk of infection, stage and immunological status. Bloody diarrhea was most important in discriminating CMV-colitis and non-CMV-related intestinal manifestations. Dysphagia and other symptoms occurring in patients with CMV-esophagitis were not able to predict CMV-esophagitis specifically. 6 of 11 patients with serological findings consistent with an active CMV-infection had no detectable CMV-manifestations; 6 of 11 patients with intestinal CMV-manifestations did not show serological findings suggestive of active CMV-infection. Ulcerative alternations of intestinal mucosa represent the most powerful indicator of intestinal CMV-disease in endoscopical examination. Only in two patients, ulcerative alterations were seen without diagnosis of CMV-disease being established. CMV was isolated in one of 11 patients, in two patients CMV was isolated from biopsies of unchanged mucosa. Simultaneous infection by HSV and CMV was detected in three patients, in one patient in the same localisation. Histology revealed inclusion bodies in 8 of 11 patients with intestinal CMV-disease, in no case inclusion bodies were seen without CMV-disease.

DNA-grading of malignant lymphomas. I. Prognostic significance, reproducibility and comparison with other classifications

The prognostic significance of the DNA Malignancy Grade (DNA-MG) was tested for 83 malignant non Hodgkin lymphoma patients in comparison with three different subjective morphological classification systems (New Working Formulation for Clinical Usage, Rappaport and Kiel Classification). Monolayer smears prepared from paraffin embedded tissue and imprint smears from fresh cut lymph-nodes were investigated. Feulgen staining was performed automatically. The scalar DNA-MG was determined by rapid interactive DNA-cytometry, using an automatic microscope and a TV-image analysis system. A strong influence of the DNA-MG on length of survival was found. Compared with morphological classification systems, the DNA-MG was of greater prognostic validity as revealed by different statistical tests. Significant differences of survival probabilities between some groups with differences of 0.5 DNA-MG only were found. The interobserver reproducibility of this new prognostic index was found to be 95% within a range of +/-0.4 DNA-MG.

Skin involvement of malignant B-cell lymphomas

In 1186 patients with systemic malignant B-cell lymphomas, the skin was involved in 6.17% of low-grade malignant, 9.7% of medium-grade malignant, and 7.4% of high-grade malignant lymphomas. Skin involvement is associated with an impaired prognosis in malignant B-cell lymphomas, with the exception of medium-grade malignant lymphomas.

Concepts of lymphoma classification

Three major classification schemes for malignant non-Hodgkin's lymphomas are widely applied today: Rappaport's classification, the Kiel classification, and the New Working Formulation for Clinical Usage. All three classifications define prognostically relevant lymphoma entities yet can only partly be translated one into the other. This is because morphologically defined lymphomas still include certain inhomogeneic entities, which again applies to all three classifications. It is therefore strongly suggested that supplemented morphologic methods of lymphoma classification be by immunologic and cytochemical investigations to improve on the scientific definition of malignant lymphomas and also to obtain the most solid basis for therapeutic planning.

Histopathological correlation of the Kiel with the original Rappaport classification of malignant non-hodgkin lymphomas

Using the Kiel and the Rappaport classifications, a comparative histopathological analysis of 486 cases with non-Hodgkin lymphomas from a prospective study of the Kiel Lymphoma Study Group, still in progress, was performed. The greater part of Rappaport's classical lymphoma entities was found to be inhomogeneous and to include tumors of considerable prognostic heterogeneity, as shown by differences in actuarial survival. Some of the Kiel lymphoma entities have been identified in several lymphoma types of the Rappaport classification, indicating that "translation" of one scheme into the other is difficult or impossible. In addition, centrocytic lymphoma of the Kiel classification may not be homogeneous. On the whole, the Kiel classification appears to be superior to the original Rappaport classification in categorizing the various prognostically diverse types of non-Hodgkin lymphomas.

[T-lymphocytes in the peripheral blood. Study on 113 patients with malignant melanoma]

In the present study, we determined the absolute and the percental numbers of T-lymphocytes in 113 patients with malignant melanomas, of whom 50 had metastases and 63 did not. The findings were compared to those in a control group of 22 persons. The patients with melanomas were divided up into clinical stages: stage I (primary tumour), II (metastases in the local lymph nodes), and stage III (systemic metastases). There was a statistically significant reduction of T-lymphocytes in all patients with melanomas, but there were no significant differences between the three stages. Therapy with DTIC did not lead to any major reduction in T-lymphocytes, possibly because of subsequent treatment with BCG. We found no clear correlation between the reduction of T-lymphocytes and an unfavourable prognosis.

[The distribution of B-lymphocytes in lymphoepithelial tissues as well as in tumors of the neck-, nose-, and throat region derived from lymphoreticular and lymphoepithelial tissues (author's transl)]

B-Lymphocytes carrying IgG-, IgM,- and IgA-surface receptors were estimated by fluorescence microscopy in the palatine tonsil of 50 patients aged 3 to 18 years as well as in 44 patients with various types of malignant lymphoms and lymphoepithelial carcinomas. Hyperplastic tonsillartissue contains large numbers of B-cells with a marked variability in concentration (4-30% IgG-cells, medium 12,9%;6-36 IgM-cells, medium 23.4%;3-38% IgA cells, medium 20.8%). There appears to exist an age-dependent increase in IgM-cells and an increase in IgG-and IgA-cells in patients with numerous recurrent infections of the upper respiratory tract. Malignant lymphomas can be grouped into three main categories: Such with a predominance of one B-cell line (above 75-80% of one immunological cell type); these include primarily malignant lymphomas of the well differentiated lymphocytic type (IgM and IgA receptors). Secondly, such with a significant decrease in B-cells (below 10%) which include primarily malignant lymphomas of the poorly differentiated lymphocytic type. Thirdly, such with an increased B-cell content but with more than one cell line participating in cell proliferation. The latter ones comprise certain cases of Hodkin's lymphomas. Lymphoepithial carcinomas are charactersized by a significant decrease in total B-cell content, except for IgE- and IgD-cells which were not investigated. The results show that the immunologic classification of malignant lymphomas correlates only to a certain degree with the morphologic classification; i.e. the same morphologic type of tumor may possess different immunologic characteristics. Since the immunologic characteristics may reflect a certain functional potential of these tumors as well as probably a certain kind of immunologic incompetence prior to tumor development, it is suggested, that future morphologic investigations of malignant lymphomas and lymphoepithelial carcinomas are combined with immunologic classifications.

Graft-versus-host disease. Morphologic variation and differential diagnosis in 8 cases of HL-A matched bone marrow transplantation

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