Flexed-knee gait in children with cerebral palsy

Aims

The purpose of this study was to evaluate the long-term outcome of adolescents with cerebral palsy who have undergone single-event multilevel surgery for a flexed-knee gait, followed into young adulthood using 3D motion analysis.

Patients and Methods

A total of 59 young adults with spastic cerebral palsy, with a mean age of 26 years (sd 3), were enrolled into the study in which their gait was compared with an evaluation that had taken place a mean of 12 years (sd 2) previously. At their visits during adolescence, the children walked with excessive flexion of the knee at initial contact and surgical or therapeutic interventions were not controlled between visits.

Results

Based on the change in flexed-knee gait over approximately ten years, improvements were seen in increased Gait Deviation Index (p < 0.001) and decreased flexion of the knee at initial contact (p < 0.001). Greater popliteal angle (p < 0.001), reduced Gross Motor Function Measure section D (p = 0.006), and reduced speed of gait (p = 0.007) suggested a mild decline in function. Quality-of-life measures showed that these patients fell within normal limits compared with typical young adults in areas other than physical function.

Conclusion

While some small significant changes were noted, little clinically significant change was seen in function and gait, with gross motor function maintained between adolescence and young adulthood. Cite this article: Bone Joint J 2018;100-B:549–56.

Anti-tumour activity of platinum compounds in advanced prostate cancer-a systematic literature review

BACKGROUND

For men with advanced castration-resistant prostate cancer (CRPC), several treatment options are available, including androgen receptor (AR) pathway inhibitors (abiraterone acetate, enzalutamide), taxanes (docetaxel, cabazitaxel) and the radionuclide (radium-223). However, cross-resistance is a clinically relevant problem. Platinum compounds have been tested in a number of clinical trials in molecularly unselected prostate cancer patients. Advances in CRPC molecular profiling have shown that a significant proportion of patients harbour DNA repair defects, which may serve as predictive markers for sensitivity to platinum agents.

OBJECTIVE

To systematically identify and analyse clinical trials that have evaluated platinum agents in advanced prostate cancer patients.

METHODS

PubMed was searched to identify published clinical trials of platinum agents in advanced prostate cancer. The PRIMSA statement was followed for the systematic review process. Identified trials are analysed for study design, statistical plan, assessments of anti-tumour activity and the potential value of predictive biomarkers.

RESULTS

A total of 163 references were identified by the literature search and 72 publications that met the selection criteria were included in this review; of these 33 used carboplatin, 27 cisplatin, 6 satraplatin, 4 oxaliplatin and 2 other platinum compounds. Overall, anti-tumour activity varies in the range of 10%-40% for objective response and 20%-70% for PSA decline ≥50%. Response seemed highest for the combinations of carboplatin with taxanes or oxaliplatin with gemcitabine. The interpretation of the clinical data is limited by differences in response criteria used and patient populations studied.

CONCLUSION

Platinum compounds have moderate anti-tumour activity in molecularly unselected patients with advanced prostate cancer. Translational evidence of DNA repair deficiency should be leveraged in future studies to select prostate cancer patients most likely to benefit from platinum-based therapy.

A randomized phase II study of the telomerase inhibitor imetelstat as maintenance therapy for advanced non-small-cell lung cancer

BACKGROUND

Continuation or 'switch' maintenance therapy is commonly used in patients with advancd non-small-cell lung cancer (NSCLC). Here, we evaluated the efficacy of the telomerase inhibitor, imetelstat, as switch maintenance therapy in patients with advanced NSCLC.

PATIENTS AND METHODS

The primary end point of this open-label, randomized phase II study was progression-free survival (PFS). Patients with non-progressive, advanced NSCLC after platinum-based doublet (first-line) chemotherapy (with or without bevacizumab), any histology, with Eastern Cooperative Oncology Group performance status 0-1 were eligible. Randomization was 2 : 1 in favor of imetelstat, administered at 9.4 mg/kg on days 1 and 8 of a 21-day cycle, or observation. Telomere length (TL) biomarker exploratory analysis was carried out in tumor tissue by quantitative PCR (qPCR) and telomerase fluorescence in situ hybridization.

RESULTS

Of 116 patients enrolled, 114 were evaluable. Grade 3/4 neutropenia and thrombocytopenia were more frequent with imetelstat. Median PFS was 2.8 and 2.6 months for imetelstat-treated versus control [hazard ratio (HR) = 0.844; 95% CI 0.54-1.31; P = 0.446]. Median survival time favored imetelstat (14.3 versus 11.5 months), although not significantly (HR = 0.68; 95% CI 0.41-1.12; P = 0.129). Exploratory analysis demonstrated a trend toward longer median PFS (HR = 0.43; 95% CI 0.14-1.3; P = 0.124) and overall survival (OS; HR = 0.41; 95% CI 0.11-1.46; P = 0.155) in imetelstat-treated patients with short TL, but no improvement in median PFS and OS in patients with long TL (HR = 0.86; 95% CI 0.39-1.88; and HR = 0.51; 95% CI 0.2-1.28; P = 0.145).

CONCLUSIONS

Maintenance imetelstat failed to improve PFS in advanced NSCLC patients responding to first-line therapy. There was a trend toward a improvement in median PFS and OS in patients with short TL. Short TL as a predictive biomarker will require further investigation for the clinical development of imetelstat.

New non-invasive approaches for the diagnosis of cardiomyopathy: magnetic resonance imaging

Cardiac magnetic resonance imaging (CMR) permits a detailed look at the myocardium in patients with recent onset heart failure. Late-enhancement CMR provides information that is similar to that obtained by the naked eye of a pathologist. Myocardial scarring is endocardial in myocardial infarction, but it is epicardial in myocarditis and intramyocardial in hypertrophic cardiomyopathy. Thus, the distinction between these entities is possible by depicting scar via late-enhancement CMR and observing myocardial function by cine magnetic resonance imaging. Moreover, non-invasive follow-up--and hence observation of the healing or remodelling process--can be achieved using CMR. New CMR pulse sequences also permit depiction of myocardial oedema, which may occur early in patients with myocarditis and may be the only sign of the disease in the absence of necrosis. It is anticipated that cardiac MRI will become a standard diagnostic technique in patients with new onset of heart failure, left-ventricular hypertrophy or clinical symptoms suggestive of myocarditis.

Lack of evidence for local immune activity in oral hairy leukoplakia and oral wart lesions

BACKGROUND

Oral warts, caused by human papillomavirus (HPV), and oral hairy leukoplakia (OHL) caused by Epstein-Barr virus (EBV), are common oral manifestations in HIV-infected persons. Although both conditions occur most often with reduced blood CD4+ T-cell numbers, oral warts and OHL rarely occur simultaneously, suggesting that dysfunctions in other secondary local immune parameters are also involved. The present study evaluated tissue-associated proinflammatory and T-helper cytokine and chemokine mRNA expression and the presence of T cells in each lesion.

METHODS

Biopsies were taken from lesion-positive and adjacent lesion-negative sites of HIV+ persons with oral warts or OHL and lesion-negative sites from HIV+ persons who were oral HPV or EBV DNA-positive (matched controls). Cytokine/chemokine mRNA expression was quantified by real-time polymerase chain reaction. CD3, CD4, and CD8 cells were identified by immunohistochemistry.

RESULTS

No differences were detected in tissue-associated cytokine/chemokine mRNA expression in warts or OHL when compared to lesion-negative sites. Immunohistochemical analysis of T cells showed CD8+ cells exclusively, but few cells were present in either lesion. No differences were detected between lesion-positive and -negative control sites of each pathologic condition.

CONCLUSION

Little evidence was found for local immune reactivity to either oral warts and OHL, suggesting that CD4+ T cells are a primary host defense against both oral warts and OHL, but with nonimmune factors potentially responsible for the divergent prevalence of each.

Use of traditional drugs in a hospital of Chinese medicine in Germany

The frequency of use of traditional Chinese drugs was investigated in relation to Western and Chinese diagnostic classifications in a hospital for traditional Chinese medicine in Germany. All 1597 in-patients treated in the hospital between February 1992 and August 1993 entered a prospective observational study. About two thirds of the patients suffered from chronic pain syndromes, the most frequent single diagnosis being migraine (n=244). All patients were treated with at least one of four Chinese therapies (traditional Chinese drugs, acupuncture, Tuina-massage, Qi-gong). 95.1% of all patients received traditional Chinese drug treatment, prescribed in complex prescriptions including 3 to 12 single drugs from a total of 305. Drug patterns prescribed to patients with the same Western diagnosis tended to be similar, but could differ strongly for single drugs in subgroups with distinct Chinese diagnoses. Studies evaluating traditional Chinese treatment strategies in patients classified according to Western nosology should take into account possible diagnostic differences according to Chinese nosology. The development of a reliable coding system for Chinese diagnostic classifications is a precondition for further cross-cultural studies.

Use of traditional drugs in a hospital of Chinese medicine in Germany

The frequency of use of traditional Chinese drugs was investigated in relation to Western and Chinese diagnostic classifications in a hospital for traditional Chinese medicine in Germany. All 1597 in-patients treated in the hospital between February 1992 and August 1993 entered a prospective observational study. About two thirds of the patients suffered from chronic pain syndromes, the most frequent single diagnosis being migraine (n=244). All patients were treated with at least one of four Chinese therapies (traditional Chinese drugs, acupuncture, Tuina-massage, Qi-gong). 95.1% of all patients received traditional Chinese drug treatment, prescribed in complex prescriptions including 3 to 12 single drugs from a total of 305. Drug patterns prescribed to patients with the same Western diagnosis tended to be similar, but could differ strongly for single drugs in subgroups with distinct Chinese diagnoses. Studies evaluating traditional Chinese treatment strategies in patients classified according to Western nosology should take into account possible diagnostic differences according to Chinese nosology. The development of a reliable coding system for Chinese diagnostic classifications is a precondition for further cross-cultural studies.

Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial

OBJECTIVES

To investigate whether acupuncture is superior to placebo and equivalent to sumatriptan for the early treatment of an acute migraine attack.

DESIGN

Randomized, partly double-blind (sumatriptan versus placebo) trial.

SETTING

Two hospitals in Germany (one specialized in traditional Chinese medicine and one in the treatment of headache).

SUBJECTS

A total of 179 migraineurs experiencing the first symptoms of a developing migraine attack.

INTERVENTIONS

Traditional Chinese acupuncture, sumatriptan (6 mg subcutaneously) or placebo injection.

MAIN OUTCOME MEASURE

Number of patients in whom a full migraine attack (defined as severe migraine headache) within 48 h was prevented. In patients who developed a migraine attack in spite of early treatment, acupuncture and sumatriptan were applied a second time, whilst patients initially randomized to placebo received sumatriptan.

RESULTS

A full migraine attack was prevented in 21 of 60 (35%) patients receiving acupuncture, 21 of 58 (36%) patients receiving sumatriptan and 11 of 61 (18%) patients receiving placebo (relative risk of having a full attack 0.79 (95% CI, 0.64-0.99) for acupuncture versus placebo, and 0.78 (95% CI, 0.62-0.98) for sumatriptan versus placebo). Response to the second intervention in patients who developed a full attack was better with sumatriptan (17/31 patients who received sumatriptan twice and 37/46 patients who had had placebo first) than with acupuncture (4/31). The number of patients reporting side-effects was 14 in the acupuncture group, 23 in the sumatriptan group and 10 in the placebo group.

CONCLUSIONS

In this trial acupuncture and sumatriptan were more effective than a placebo injection in the early treatment of an acute migraine attack. When an attack could not be prevented, sumatriptan was more effective than acupuncture at relieving headache.

Th1/Th2 cytokine profiles in saliva of HIV-positive smokers with oropharyngeal candidiasis

Oropharyngeal candidiasis (OPC) is a common opportunistic infection among HIV-positive individuals and often correlates with a CD4 cell number < 200 cells/microl. This study further examined the association of smoking and OPC in HIV-positive persons. A strong association between smoking and OPC was seen in HIV-positive individuals with > or =200 CD4 cells/microl. In HIV-positive persons with > or =200 CD4 cells/microl, OPC+ smokers had lower gamma-interferon (IFN-gamma) concentrations and a trend toward higher interleukin (IL)-4 concentrations in whole saliva compared to OPC- persons with > or =200 CD4 cells/microl, a cytokine profile consistent with that observed in HIV+OPC+ persons with < 200 CD4 cells/microl. These results suggest that premature OPC in HIV-positive smokers is associated with altered oral host defence mechanisms that cannot be overcome by levels of systemic CD4 cells that are otherwise sufficient to protect against OPC.

Candida-specific systemic cell-mediated immune reactivities in human immunodeficiency virus-positive persons with mucosal candidiasis

Oropharyngeal candidiasis (OPC), as opposed to vulvovaginal candidiasis (VVC), is a common opportunistic infection in human immunodeficiency virus (HIV)-positive persons that correlates with reduced CD4 T cell counts. Although cell-mediated immunity (CMI) by CD4 Th1-type cells is considered to be the predominant host defense against mucosal candidiasis, the immune factors associated with susceptibility to OPC in HIV-positive persons are not well understood. This study investigated Candida-specific systemic CMI in HIV-positive persons with OPC and/or VVC. Reductions in delayed skin test reactivity to Candida antigen were observed in HIV-positive persons with CD4 cell counts <200 cells/microL, irrespective of the presence of mucosal infection. Likewise, despite the correlate of OPC with reduced CD4 cell counts in HIV-positive persons, differences in Candida-specific peripheral blood mononuclear cell proliferation and Th1/Th2 cytokine production between HIV-positive and HIV-negative persons were not consistent in a manner to suggest that deficiencies in Candida-specific systemic CMI account solely for the susceptibility to OPC.

Photocatalytic oxidation of gaseous chlorinated organics over titanium dioxide

The photocatalytic oxidation of high levels of volatile chlorinated organic compounds in gas phase has been studied using a specially designed photoreactor. The influence of light intensity, initial water vapour concentration, temperature, inlet contaminant concentration and flow rate on destruction efficiency has been investigated. The performance of the titanium catalyst was strongly affected by the presence of water in the air stream. Experiments have been most successfully conducted at room temperature, low initial contaminant concentrations, low flow rates and high light intensities. Several by-products have been detected performing photocatalytic degradation of trichloroethylene (TCE) and tetrachloroethylene (PCE). No catalyst deactivation was observed.

Monitoring of liver enzymes in patients treated with traditional Chinese drugs

BACKGROUND

Use of traditional Chinese drug treatment is widespread. While cases of hepatotoxic effects have been reported, little is known about the frequency of such effects.

OBJECTIVES

To investigate the frequency, magnitude and course of liver enzyme elevations in patients treated with traditional Chinese drugs.

DESIGN

Retrospective study.

SETTING

Hospital for traditional Chinese medicine in Germany.

PATIENTS

All 1507 patients admitted for inpatient treatment between February 1994 and July 1995.

MAIN OUTCOME MEASURE

Number of patients who presented at discharge with a more than 2-fold elevation of alanine amino transferase (ALT) levels (over maximum normal values or elevated admission values).

RESULTS

A more than 2-fold elevation of ALT values was observed in 14 patients (0.9%). In 13 cases a causal relationship with Chinese drug therapy seemed possible and, for one patient, likely. However, all patients were also on non-Chinese drug treatment. Follow-up values of ALT within 8 weeks after discharge were normal in 11 patients (six of them had continued to take traditional Chinese drugs) and close to normal in the remaining three. In five patients there were indications for previous liver damage.

CONCLUSIONS

In the population and setting studied, clinically relevant liver enzyme elevations occurred in about 1/100 patients treated with traditional Chinese drugs.

The Nursing Research Initiative for Scotland

The Nursing Research Initiative for Scotland (NRIS) was established at the end of 1994, one of seven research units core funded by the Chief Scientist Office (CSO) of the Scottish Office. It is a national unit, so although its central base is in Glasgow, it works with nurses, other direct care staff and academics throughout Scotland.

Heterogeneous photocatalytic oxidation of organics for air purification by near UV irradiated titanium dioxide

The photocatalytic degradation of high concentrations of various organic pollutants (acetone, 2-propanol and toluene) in dry and humid air streams was carried out using a specially designed photoreactor based on the UV-TiO2 principle. The influence of several parameters which control the destruction efficiency (flow rate, initial contaminant and water vapour concentration, temperature and light intensity) has been studied. The conversion was maximal at room temperature, low flow rates and low initial contaminant concentrations. The presence of water in the inlet stream strongly affected the performance of the catalyst. The primary oxidation product of 2-propanol was acetone.

Systematic clinical auditing in complementary medicine: rationale, concept, and a pilot study

A scientific evaluation of complementary medical practices commonly used in healthcare is urgently required. Although randomized clinical trials are the primary tool for such an evaluation, for a number of conceptual and pragmatic reasons, they should not be the only tool. The authors propose systematic clinical auditing as a concept to (1) provide information on the "epidemiology" of complementary medical practices, (2) make the processes used in the daily practice of these complementary methods clearly intelligible, and (3) give a preliminary estimation of outcomes. Systematic clinical auditing uses mainly observational studies of large samples of patients. A pilot study was conducted to investigate the feasibility of using a systematic clinical audit in a hospital for traditional Chinese medicine in Germany. All 1597 patients admitted between February 1, 1992, and August 31, 1993, were included in the study. Patients' characteristics, diagnoses, and preventive and therapeutic interventions were recorded, and patients were asked to rate the intensity of their main complaints (on scale of 1 to 10) at admission; at discharge; and at 2, 6, and 12 months after admission. About two thirds of all patients had chronic pain complaints; the most common diagnosis was migraine (n = 244). Nearly all patients received acupuncture and Chinese herbal therapy; 61% received tuina massages, and 16% received qigong. The mean intensity of main complaints was 7.0 (2.0, SD) at admission, 4.6 (2.4) at discharge, and 5.5 (2.7) 12 months after admission. In the authors' opinion, systematic clinical auditing is a valuable tool for collecting basic information on structural characteristics, processes, and outcomes in complementary medicine and for determining representative and relevant questions for future randomized clinical trials.

Insulin stimulates fatty acid acylation of adipocyte proteins

Isolated rat adipocytes were incubated with [3H]palmitate in the presence or absence of insulin. Insulin caused marked (20-fold), rapid (T1/2 approximately 15 min), and concentration-dependent labeling of an 80 kilodalton protein. The insulin concentration producing half-maximal labeling was 0.4 ng/ml. The label was removed from the protein by treatment with hydroxylamine indicating the fatty acid was linked to the protein via an oxyester bond. Label removed from the protein co-eluted with palmitate standard by high-performance liquid chromatography. In summary, adipocyte proteins are subject to acylation by exogenous long-chain fatty acids and this process is stimulated by insulin.

Immunologically cross-reactive and redox-competent cytochrome b6/f-complexes in the chlorophyll-free plasma membrane of cyanobacteria

Plasma and thylakoid membranes were separated and purified from cell-free extracts of the cyanobacteria Anacystis nidulans, Synechocystis 6714, Anabaena variabilis and Nostoc sp. strain Mac. Immunoblots of the membrane proteins using antisera raised against subunits I-IV of the chloroplast b6/f-complex gave evidence for the presence of a homologous complex in both plasma and thylakoid membranes from the four species of cyanobacteria investigated. Both plasma and thylakoid membranes catalyzed the electron transfer from (exogenous) plastoquinol-9 and NADH to horse heart ferricytochrome c. However, while with plasma membranes these reactions were severely inhibited by low concentrations of antimycin A and rotenone, respectively, the inhibitors were without major effect on thylakoid membranes. The results will be discussed in terms of a possible similarity (analogy and/or homology?) of cyanobacterial plasma membranes to the inner mitochondrial membrane.

The dilemma of less than 500 grams birth: epidemiologic considerations

The reporting practice of perinatal data of less than 500 gm is widely inconsistent. This is due mainly to the differences in reporting requirements and ambiguity in the definition of live births, stillbirths and abortions. To evaluate the magnitude a birthweight of less than 500 gm has on a regional perinatal network's vital statistics, we studied race and weight specific data from a cohort of 48,096 births over a 2-year period. One hundred and ten (0.23%) births weighed less than 500 gm, 60 of them were live births occurring at a mean gestation of 22.3 +/- 3 weeks, all of whom died. Blacks had the highest rates for other adverse perinatal outcome measures as well as significantly higher incidence of birthweights less than 500 gm (0.3%), compared to whites and Hispanics, 0.17 and 0.21%, respectively (P less than 0.001). Although they constituted a small fraction of the total births in all ethnic groups, infants weighing less than 500 gm accounted for a significant proportion, 18 and 21%, of the perinatal and neonatal mortality rates (PMR and NMR). These proportions were much higher in the black subgroup. We conclude that major discrepancies in reporting of vital data concerning these infants could affect the vital rates significantly. The effect is not uniform, since the subsets with a high incidence of infants weighing less than 500 gm will have far more variations. This must be considered when comparative epidemiologic studies of perinatal outcome are carried out.

[Results of radiation therapy in cervix carcinoma with reference to side effects]

The analysis of 770 patients after irradiation of cervix-carcinoma from 1968 to 1976 with Cobalt 60, radium or operation or only irradiation therapy shows five-year survival rates of 78% for stage I, 61% for stage II, and 23% for stage III. Bowel reaction was seen in 27%, 4% developed stenoses, 1.3% a recto-vaginal fistula. A complication of the bladder was seen in 18%, 2.7% had an ureteral stricture and 0.8% a bladder-fistula.