Therapeutic effect of RA223 in the management of breast cancer bone metastases.

Radium 223 dichloride (Ra223) is the only targeted alpha therapy able to extend survival in patients with bone metastases from prostate cancer. Mechanism of action and data currently available focused mainly on osteoblastic metastases from prostate cancer. Phase 1 and 2 trials documented a clinical efficacy also in breast cancer patients with predominately bone disease, highlighting a reduction in alkaline phosphatase and other bone biomarkers. In our institution, a patient with breast cancer affected by osteolytic metastases was treated with off-label use of Ra223. Our patient had a good treatment compliance and up to now she has not been revealed the presence of SSE or hematological complications. Our preliminary experience shows that Ra223 may play a critical role to bone metastates in patients with breast cancer.

Mirror neuron system activation in children with developmental coordination disorder: A replication functional MRI study.

BACKGROUND: It has been hypothesised that abnormal functioning of the mirror neuron system (MNS) may lead to deficits in imitation and the internal representation of movement, potentially contributing to the motor impairments associated with developmental coordination disorder (DCD). AIMS: Using fMRI, this study examined brain activation patterns in children with and without DCD on a finger adduction/abduction task during four MNS activation states: observation; motor imagery; execution; and imitation. METHODS AND PROCEDURES: Nineteen boys (8.25-12.75 years) participated, including 10 children with DCD (≤16th percentile on MABC-2; no ADHD/ASD), and nine typically developing controls (≥25th percentile on MABC-2). OUTCOMES AND RESULTS: Even though children with DCD displayed deficits behaviourally on imitation (Sensory Integration & Praxis Test Subtests) and motor imagery assessments prior to scanning, no differences in MNS activation were seen between the DCD and control groups at a neurological level, with both groups activating mirror regions effectively across conditions. Small clusters of decreased activation during imitation were identified in non-mirror regions in the DCD group, including the thalamus, caudate, and posterior cingulate - regions involved in motor planning and attentional processes. CONCLUSIONS AND IMPLICATIONS: The results of this study do not provide support for the MNS dysfunction theory as a possible causal mechanism for DCD. Further research to explore attentional and motor planning processes and how they may interact at a network level may enhance our understanding of this complex disorder.

The relationship between motor proficiency and mental health outcomes in young adults: A test of the Environmental Stress Hypothesis.

Growing evidence has highlighted the importance of motor proficiency in relation to psychosocial outcomes including self-perceived competence in various domains, perceived social support, and emotional areas such as anxiety and depression. The Environmental Stress Hypothesis-elaborated (Cairney, Rigoli, & Piek, 2013) is a proposed theoretical framework for understanding these relationships and recent studies have begun examining parts of this model using child and adolescent populations. However, the extent to which the relationships between these areas exist, persist or change during early adulthood is currently unclear. The current study aimed to investigate the Environmental Stress Hypothesis in a sample of 95 young adults aged 18-30years and examined the mediating role of physical self-worth and perceived social support in the relationship between motor proficiency and internalising symptoms. The McCarron Assessment of Neuromuscular Development (McCarron, 1997) was used to assess motor proficiency, the Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) provided a measure of internalising symptoms, and the Physical Self Perceptions Profile (Fox & Corbin, 1989) and the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988) were used to investigate the possible mediating role of physical self-worth and perceived social support respectively. Potential confounding variables such as age, gender and BMI were also considered in the analysis. Structural Equation Modelling revealed that perceived social support mediated the relationship between motor proficiency and internalising symptoms, whereas, the mediating role of physical self-worth was non-significant. The current results provide support for part of the model pathways as described in the Environmental Stress Hypothesis and suggest an important relationship between motor proficiency and psychosocial outcomes in young adults. Specifically, the results support previous literature regarding the significant role of perceived social support for mental well-being and suggest that an intervention that considers social support may also indirectly influence mental health outcomes in young adults who experience movement difficulties.

Assessing motor proficiency in young adults: The Bruininks Oseretsky Test-2 Short Form and the McCarron Assessment of Neuromuscular Development.

Currently, only two motor tests have norms extending into young adulthood - the McCarron Assessment of Neuromuscular Development (MAND, McCarron 1997) and the Bruininks Oseretsky Test of Motor Proficiency-2 (BOT-2, Bruininks & Bruininks, 2005). Research into the motor difficulties in early adulthood and health outcomes has been impeded because there is no agreed gold standard motor test for this group. The purposes of this study were to compare the discrimination accuracy, classification agreement, and predictive values, and gender distribution and prevalence of each test in identifying motor impairment (MI) in relation to DSM-V diagnostic criteria for DCD. Ninety-one young, healthy adults (M=21.4years, SD=3.3) were recruited. Those classified as MI by each test scored at one standard deviation or more below the overall mean standard score. Small, statistically significant correlations were found between the MAND and BOT-2 SF tests for score rank (r=0.370, p=0.01) and standard score values (r=0.404; p=0.01). The overall decision agreement for non-MI cases was relatively high at 85% but very low for MI cases (4.4%). Unexpectedly, gender was balanced in MI cases. BOT-2 SF identified twice as many MI cases than MAND (13.2% vs 6.6%), yet overall comparative test specificity was high (89%). Predictive values for MAND, compared against BOT-2 SF as the standard, indicated broad independence between these tests and overall, the decision statistics indicated that the two tests identified different adult cohorts with MI. Objective classification of adult motor proficiency using a gold standard assessment tool including complex and ecologically valid tasks is still elusive.

Investigation of treadmill and overground running: implications for the measurement of oxygen cost in children with developmental coordination disorder.

Differences in the kinematics and kinetics of overground running have been reported between boys with and without developmental coordination disorder (DCD). This study compared the kinematics of overground and treadmill running in children with and without DCD to determine whether any differences in technique are maintained, as this may influence the outcome of laboratory treadmill studies of running economy in this population. Nine boys with DCD (10.3 ± 1.1 year) and 10 typically developing (TD) controls (9.7 ± 1 year) ran on a treadmill and overground at a matched velocity (8.8 ± 0.9 km/h). Kinematic data of the trunk and lower limb were obtained for both conditions using a 12-camera Vicon MX system. Both groups displayed an increase in stance time (p < 0.001), shorter stride length (p < 0.001), higher cadence (p < 0.001) and reduced ankle plantar flexion immediately after toe-off (p < 0.05) when running on the treadmill compared with overground. The DCD group had longer stance time (p < 0.009) and decreased knee flexion at mid-swing (p = 0.04) while running overground compared to their peers, but these differences were maintained when running on the treadmill. Treadmill running improved ankle joint symmetry in the DCD group compared with running overground (p = 0.019). Overall, these findings suggest that there are limited differences in joint kinematics and lower limb symmetry between overground and treadmill running in this population. Accordingly, laboratory studies of treadmill running in children with DCD are likely representative of the energy demands of running.

A comparison of the oxygen cost and physiological responses to running in children with and without Developmental Coordination Disorder.

The aim of this study was to compare the oxygen cost of running in boys with and without Developmental Coordination Disorder (DCD). Fourteen boys with DCD (9.1 ± 1.4 yr) and 16 typically developing (TD) controls (9.4 ± 1.3 yr) were tested on two separate occasions at least a week apart. On the first visit, motor proficiency, body composition and maximal aerobic capacity were established. On the second visit, oxygen consumption was determined via indirect calorimetry while participants ran at three submaximal speeds (7.2 km/h, 8.0 km/h and 8.8 km/h) on a motorised treadmill for 4 min each. Additional physiological responses such as blood lactate, respiratory exchange ratio (RER), heart rate, salivary alpha amylase and pain threshold were monitored at baseline and after each submaximal effort. Although there were no differences in the oxygen cost of running at all three speeds, the boys with DCD had higher blood lactate concentration (7.2 km/h, p=0.05; 8.0 km/h p=0.019), heart rate (p ≤ 0.001), RER (8.0 km/h, p=0.019; 8.8 km/h, p=0.001), salivary alpha amylase (8.0 km/h, p=0.023; 8.8 km/h, p=0.020) and a lower pain threshold (p<0.01). The higher overall metabolic cost of running in boys with DCD as indicated by the higher RER, heart rate and blood lactate concentrations, together with the higher levels of sympathoadrenal medullary activity and sensitivity to pain, may be deterring factors for participation in physical activity in this population.

A comparison of running kinematics and kinetics in children with and without developmental coordination disorder.

The aim of this study was to compare running gait in children with and without developmental coordination disorder (DCD). Fourteen boys with DCD (9.5 ± 1 yr) and 14 typically developing (TD) controls (9.6 ± 1 yr) ran at a velocity of 2.44 ± 0.25 m/s along a 15m track, with kinematic and kinetic data of the trunk and lower limb obtained for three cycles of each limb using a 12-camera Vicon MX system and AMTI force plate. Although features of the kinematic and kinetic trajectories were similar between groups, the DCD group displayed decreased peak knee extension compared with the TD group prior to initial foot contact (p = 0.016). Furthermore, the DCD group displayed increased variability in sagittal plane kinematics at the hip and ankle during toe off compared with the TD group. Kinetic analysis revealed that children with DCD displayed significantly reduced knee extensor moments during the stance phase of the running cycle (p = 0.033). Consequently, peak knee power absorption and ankle power generation was significantly lower in the DCD group (p = 0.041; p = 0.017). Furthermore, there was a trend for children with DCD to have shorter strides (p = 0.052, ES = 0.499) and a longer stance period than the TD controls (p=0.06, ES = 0.729). These differences may have implications for the economy of running and subsequently the planning of targeted intervention programs to improve running gait in children with DCD.

[Computerized management of a medical department, disease-related group management, clinical research and evaluations]. / Gestion de services, tarification à l'activité, recherche clinique et évaluation des pratiques professionnelles: un même outil informatique.

The current French hospital reform is based on the disease-related group (DRG) approach and the constitution of bigger units pooling several departments of different specialties. This reform needed an efficient assessment of various medical activities. We report our experience of a medical table of our hospital activities used for 27 months. This medical table was made with a basic software integrating 24 parameters. The original concept was the translation of the specific final diagnosis for DRG defined by the site of infection. To create this medical table, we first simplified the conclusions of the patient's chart using a consensual and systematic plan. The number of patients per DRG and their evolution were therefore specifically determined. The medical table helped us in the daily management of our department, to identify the area of recruitment, the potential for heterogeneous care, allowing the implementation of protocols and their applications. Moreover, the table quantified morbidity and mortality, indicating our need for cooperation with other departments. All this data used medical-lexical terms, allowing other than economic analyses, even if this table identifies hospitalization-related costs, namely duration of hospital-stay, nosocomial infections and iatrogenic events. Finally, our table supports medical research and evaluation of practice. Our future goals are to introduce this table in several infectious-diseases units, and create specific tables for the main RDG, including economic parameters.

The effect of cigarette taxes on cigarette consumption, 1955 through 1994.

OBJECTIVES: This study examines the effectiveness of state and federal taxes in reducing the consumption of cigarettes, estimates the impact of government health warnings, and shows how warnings and taxes interact. METHODS: By means of a pooled time-series analysis from 1955 through 1994 with the 50 states as units of analysis, the impact of excise taxes on cigarette consumption for several different models and econometric techniques is assessed. RESULTS: From 1955 through 1994, increases in state taxes were effective in reducing cigarette use. Federal tax increases, however, appear to have been more effective. This difference is partly the result of the "bootlegging" of cigarettes across state lines and the size of the increases in the federal tax. Cigarette consumption also declined when health warning labels were added. CONCLUSIONS: Increases of taxes on cigarettes are associated with declines in the consumption of tobacco. Because of inflation, increased health concerns, and the declining percentage of smokers, however, large reductions in consumption require large tax increases.