Botulinum neurotoxin type A responders among children with spastic cerebral palsy: Pattern-specific effects.

AIM: To identify short-term effects of botulinum neurotoxin type A (BoNT) injections on gait and clinical impairments, in children with spastic cerebral palsy (CP), based on baseline gait pattern-specific subgroups. METHOD: Short-term effects of BoNT injections in the medial hamstrings and gastrocnemius were defined in a retrospective convenience sample of 117 children with CP (median age: 6 years 4 months; GMFCS I/II/III: 70/31/16; unilateral/bilateral: 56/61) who had received gait analyses before and 2 months post-BoNT. First, baseline gait patterns were classified. Statistical and meaningful changes were calculated between pre- and post-BoNT lower limb sagittal plane kinematic waveforms, the gait profile score, and non-dimensional spatiotemporal parameters for the entire sample and for pattern-specific subgroups. These gait waveforms per CP subgroup at pre- and post-BoNT were also compared to typically developing gait and composite scores for spasticity, weakness, and selectivity were compared between the two conditions. RESULTS: Kinematic improvements post-BoNT were identified at the ankle and knee for the entire sample, and for subgroups with apparent equinus and jump gait. Limbs with baseline patterns of dropfoot and to a lesser extent true equinus showed clear improvements only at the ankle. In apparent equinus, jump gait, and dropfoot, spasticity improved post-BoNT, without leading to increased weakness or diminished selectivity. Compared to typical gait, knee and hip motion improved in the crouch gait subgroup post-BoNT. CONCLUSION: This comprehensive analysis highlighted the importance of investigating BoNT effects on gait and clinical impairments according to baseline gait patterns. These findings may help identify good treatment responders.

Mathematical modeling for Delta and Omicron variant of SARS-CoV-2 transmission dynamics in Greece.

A compartmental, epidemiological, mathematical model was developed in order to analyze the transmission dynamics of Delta and Omicron variant, of SARS-CoV-2, in Greece. The model was parameterized twice during the 4th and 5th wave of the pandemic. The 4th wave refers to the period during which the Delta variant was dominant (approximately July to December of 2021) and the 5th wave to the period during which the Omicron variant was dominant (approximately January to May of 2022), in accordance with the official data from the National Public Health Organization (NPHO). Fitting methods were applied to evaluate important parameters in connection with the transmission of the variants, as well as the social behavior of population during these periods of interest. Mathematical models revealed higher numbers of contagiousness and cases of asymptomatic disease during the Omicron variant period, but a decreased rate of hospitalization compared to the Delta period. Also, parameters related to the behavior of the population in Greece were also assessed. More specifically, the use of protective masks and the abidance of social distancing measures. Simulations revealed that over 5,000 deaths could have been avoided, if mask usage and social distancing were 20% more efficient, during the short period of the Delta and Omicron outbreak. Furthermore, the spread of the variants was assessed using viral load data. The data were recorded from PCR tests at 417 Army Equity Fund Hospital (NIMTS), in Athens and the Ct values from 746 patients with COVID-19 were processed, to explain transmission phenomena and disease severity in patients. The period when the Delta variant prevailed in the country, the average Ct value was calculated as 25.19 (range: 12.32-39.29), whereas during the period when the Omicron variant prevailed, the average Ct value was calculated as 28 (range: 14.41-39.36). In conclusion, our experimental study showed that the higher viral load, which is related to the Delta variant, may interpret the severity of the disease. However, no correlation was confirmed regarding contagiousness phenomena. The results of the model, Ct analysis and official data from NPHO are consistent.

Researching Nursing Students' Attitudes toward Mental Health Practice: Cultural Adaptation and Validation of the Greek Version of the Acceptability of Locking the Door Questionnaire in Acute Psychiatric Care.

The present article describes the cultural adaptation and validation of the Greek version of the Acceptability of Locking the Door Questionnaire and aims to determine students' preference regarding mental health nursing as a possible career choice. The linguistic adaptation of the original instrument was performed according to the most recent guidelines and it was then administered to 274 third-year nursing students. Results support the validity and reliability of the instrument, which can be used to assess effectively the attitudes of the intended population. Sixty per cent of students considered mental health nursing as a possible career choice. Research on students' attitudes appeared to be a strategy of creating the space for lively discussions among them and capturing their interest in mental health education and practice. Theoretical preparation and clinical placements of mental health nursing students should incorporate strategies to improve their perceptions of working in mental health settings.

Single-event multilevel surgery, but not botulinum toxin injections normalize joint loading in cerebral palsy patients.

BACKGROUND: Many patients with cerebral palsy present a pathologic gait pattern, which presumably induces aberrant musculoskeletal loading that interferes with natural bone growth, causing bone deformations on the long term. Botulinum toxin interventions and single-event multilevel surgeries are used to restore the gait pattern, assuming that a normal gait pattern restores musculoskeletal loading and thus prevents further bone deformation. However, it is unknown if these interventions are able to restore musculoskeletal loading. Hence, we investigated the impact of botulinum toxin injections and single-event multilevel surgery on musculoskeletal loading. METHODS: Gait data collected in 93 children with bilateral cerebral palsy, which included pre- and post multi-level botulinum toxin (49 children) and single-event multilevel surgery (44 children) assessments, and 15 typically developing children were retrospectively processed using a musculoskeletal modelling workflow to calculate joint angles, moments, muscle and joint contact force magnitudes and orientations. Differences from the typically developing waveform were expressed by a root-mean square difference were compared using paired t-tests for each intervention separately (alpha <0.05). FINDINGS: Botulinum toxin induced significant changes in the joint angles, but did not improve the muscle and joint contact forces. Single-event multilevel surgery induced significant kinematic and kinetic changes, which were associated with improved muscle and joint contact forces. INTERPRETATION: The present results indicate that botulinum toxin injections were not able to restore normal gait kinematics nor musculoskeletal loading, whereas single-event multilevel surgery did successfully restore both. Therefore, single-event multilevel surgery might be protective against the re-occurrence of bone deformation on the longer term.

Machine learning in knee osteoarthritis: A review.

Objective: The purpose of present review paper is to introduce the reader to key directions of Machine Learning techniques on the diagnosis and predictions of knee osteoarthritis. Design: This survey was based on research articles published between 2006 and 2019. The articles were divided into four categories, namely (i) predictions/regression, (ii) classification, (iii) optimum post-treatment planning techniques and (iv) segmentation. The grouping was based on the application domain of each study. Results: The survey findings are reported outlining the main characteristics of the proposed learning algorithms, the application domains, the data sources investigated and the quality of the results. Conclusions: Knee osteoarthritis is a big data problem in terms of data complexity, heterogeneity and size as it has been commonly considered in the literature. Machine Learning has attracted significant interest from the scientific community to cope with the aforementioned challenges and thus lead to new automated pre- or post-treatment solutions that utilize data from the greatest possible variety of sources.

Laparoscopic posterior appendix Mitrofanoff using the modified Shanfield anastomosis.

Laparoscopic transperitoneal technique for appendicovesicostomy was performed in a 5-year-old boy with a non-neurogenic neuropathic bladder using a transumbilical 5-mm port, two 3-mm working ports and a modified Shanfield anastomosis. Posterior extramucosal detrusorotomy and submucosal dissection was performed. The proximal appendix was spatulated and advanced into the bladder through a mucosal window using a U-stitch and fixed. The detrusor was then approximated creating an antirefluxing extramucosal tunnel. VQ plasty was fashioned for stoma formation. The procedure and postoperative period were uneventful. Clean intermittent catheterisation (CIC) was established subsequently and continued for the last 6 months. Our experience shows that appendix Mitrofanoff can be performed with minimal number and size of ports, resulting in a good cosmetic outcome. A simplified anastomosis makes it less cumbersome, and catheterisation is reliable as there is no mucosa-mucosa junction to negotiate.

IL-6 is associated to IGF-1Ec upregulation and Ec peptide secretion, from prostate tumors.

BACKGROUND: Ec peptide (PEc), resulting from the proteolytic cleavage of the IGF-1Ec isoform, is involved in prostate cancer progression and metastasis, whereas in muscle tissue, it is associated with the mobilization of satellite cells prior to repair. Our aim is to determine the physiological conditions associated to the IGF-1Ec upregulation and PEc secretion in prostate tumors, as well as, the effect of tumor PEc on tumor repair. METHODS: IGF-1 (mature and isoforms) expression was examined by qRT-PCR, both in prostate cancer cells co-incubated with cells of the immune response (IR) and in tumors. PEc secretion was determined by Multiple Reaction Monitoring. The effect of PEc, on mesenchymal stem cell (MSC) mobilization and repair, was examined using migration and invasion assays, FISH and immunohistochemistry (IHC). The JAK/STAT signaling pathway leading to the IGF1-Ec expression was examined by western blot analysis. Determination of the expression and localization of IL-6 and IGF-1Ec in prostate tumors was examined by qRT-PCR and by IHC. RESULTS: We documented that IL-6 secreted by IR cells activates the JAK2 and STAT3 pathway through IL-6 receptor in cancer cells, leading to the IGF-1Ec upregulation and PEc secretion, as well as to the IL-6 expression and secretion. The resulting PEc, apart from its oncogenic role, also mobilizes MSCs towards the tumor, thus promoting tumor repair. CONCLUSIONS: IL-6 leads to the PEc secretion from prostate cancer cells. Apart from its oncogenic role, PEc is also involved in the mobilization of MSCs resulting in tumor repair.

Validity of the Greek Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) among Greek adolescents.

The aim of this study is to examine the validity of the Greek version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) in a sample of adolescent pupils. EDE-Q is a self- report instrument that assesses attitudes and behaviors related to Eating Disorders (EDs). A two-stage identification protocol has been applied to the 16 schools that agreed to participate in the present study. Initially, 2058 adolescents, in class under the supervision of one research assistant and one teacher, completed a Questionnaire on socio-demographic data, the Greek EDE-Q-6.0 and the Greek Eating Attitudes Test (EAT-26) while their weight and height were measured. Six-hundred and twenty six participants, who had scores on EAT-26≥20 and/or were underweight or overweight, were considered as "possible-cases" while the remaining 1432 pupils of the sample were thought as "non-possible cases". At the second stage, parents of 66 of the participants identified as possible-cases as well as parents of 72 participants from 358 controls randomly selected from the sample of "non-possible cases" agreed that their children would be examined by means of Best Estimate Diagnostic Procedure. Participants meeting DSM-IV-TR Eating Disorders criteria were identified. Receiver Operating Characteristics (ROC) analysis was applied to reveal EDE-Q's criterion validity. The kappa statistic test was used as measure of agreement between categorical variables at EDE-Q and at interview (the presence of objective binge eating episode, of self-induced vomiting, the use of laxatives and of excessive exercise). The Discriminant and Convergent validity were assessed using the non-parametric Mann-Whitney U test and by means of the Spearman's correlation coefficient, respectively. Nineteen cases of EDs were identified [one case of Anorexia Nervosa (AN), 13 cases of Eating Disorder Not Otherwise Specified (EDNOS), 5 cases of Binge Eating Disorder (BED)]. At the cut off point of 2.6125 on the EDE-Q's global scale the instrument screens with a sensitivity (Se) of 89.5% and a specificity (Sp) of 73.1%, a Positive Predictive Value (PPV) of 34.7% and a Negative Predictive Value (NPV) of 97.8% The same analyses for both sexes revealed a cut-off point of 2.612 for females and of 3.125 for males on the global EDE-Q-6.0 score (Se=84.62%, Sp=73.33% for females and Se=83.33%, Sp= 84.09% for males), yielding a PPV and a NPV of 35.5% and of 96.5% for females and 41.7% and 97.4% for males, respectively. A very low agreement level, between EDE-Q and interview, was observed regarding the presence of objective bulimic episodes (OBEs) [k=0.191 (SE=0.057)] and the unhealthy weight control behaviors [k=0.295 (SE=0.073)]. Positive correlations were found between EAT-26 and EDE-Q-6.0 for both global scale and subscales (rho=0.50-0.57). The results suggest that EDE-Q-6.0, when using its global score, appears to be a proper screening tool for assessing the core psychopathology of eating disorders in community samples in two-stage screening studies since it distinguishes very well the cases from the non-cases. However, the assessment of the presence and frequency of pathological behaviours which characterize EDs appears to be problematic since adolescents, especially the younger ones, misunderstood terms like large amount of food and loss of control or misinterpret the motivation for excessive exercise. Therefore, marked discrepancies were observed between pathological behaviors self-reported at questionnaire and those detected at interview. We may assume that giving participants more information regarding the definition of these concepts may increase the accuracy with which the participants report these behaviors.

A patient with partial trisomy 21 and 7q deletion expresses mild Down syndrome phenotype.

BACKGROUND: Down syndrome (DS) is the most common aneuploidy in live-born individuals and it is well recognized with various phenotypic expressions. Although an extra chromosome 21 is the genetic cause for DS, specific phenotypic features may result from the duplication of smaller regions of the chromosome and more studies need to define genotypic and phenotypic correlations. CASE REPORT: We report on a 26 year old male with partial trisomy 21 presenting mild clinical symptoms relative to DS including borderline intellectual disability. In particular, the face and the presence of hypotonia and keratoconus were suggestive for the DS although the condition remained unnoticed until his adult age array comparative genomic hybridization (aCGH) revealed a 10.1 Mb duplication in 21q22.13q22.3 and a small deletion of 2.2 Mb on chromosomal band 7q36 arising from a paternal translocation t(7;21). The 21q duplication encompasses the gene DYRK1. CONCLUSION: Our data support the evidence of specific regions on distal 21q whose duplication results in phenotypes recalling the typical DS face. Although the duplication region contains DYRK1, which has previously been implicated in the causation of DS, our patient has a borderline IQ confirming that their duplication is not sufficient to cause the full DS phenotype.

Dexamethasone plus octreotide regimen increases anticancer effects of docetaxel on TRAMP-C1 prostate cancer model.

AIM: The aim of this study was to evaluate whether the neoadjuvant use of the dexamethasone (DEX) plus octreotide (OCT) regimen can improve the direct anticancer effects of docetaxel (DOC) in the TRAMP-C1 prostate cancer model. MATERIALS AND METHODS: TRAMP-C1 cells were first characterized for the expression of SSTR1-5 and then were inoculated onto the femur of C57Bl mice. Investigation protocols employed TRAMP-C1 cell proliferation and invasion assays, analysis of radiographic images of the bone lesions and overall survival of the diseased animals. RESULTS: The triple combination treatment scheme showed significant anticancer effects, in both proliferation and invasion assays, compared to any single agent treatment scheme. DOC treatment following the neoadjuvant administration of DEX plus OCT regimen improved significantly the anticancer effects both on the grading of the bone lesions and on the overall survival of the diseased animals. CONCLUSION: Our data suggest that the neoadjuvant administration of DEX plus OCT regimen can improve the anticancer effects of DOC on the TRAMP-C1 model.

[Acute unilateral loss of vision in a 38-year-old male patient]. / Akute einseitige Visusminderung bei einem 38-jährigen Patienten.

Although Valsalva retinopathy is a rare condition, it should be considered in the differential diagnosis of an acute macular hemorrhage in an otherwise healthy young patient. In most cases the patient presents with sudden, painless visual deterioration and a central scotoma. It is essential to immediately acquire a medical history because patients have typically undertaken strenuous physical activity in the recent past.

[Reliability of the Greek version of the eating disorder examination questionnaire (EDE-Q) in a sample of adolescent students].

The increasing prevalence of Eating Disorders over the last decades generates a growing interest of researchers and health care providers for their early detection through suitable questionnaires. The aim of the present study is to examine the reliability of the Greek version of EDE-Q 6.0 among secondary school adolescents. EDE-Q is a widely used self-report questionnaire that assesses the specific psychopathology of eating disorders. Its 6.0th version consists of 28 items. It yields two types of data: (a) four subscale scores (Restraint, Eating Concern, Shape Concern and Weight Concern) as well as a global score which is the average of the four subscale scores and (b) frequency data on key eating and compensatory behaviors (e.g. binge eating episodes, self-induced vomiting, excessive exercise). The sample comprises 257 secondary school students (133 girls and 124 boys) residents of north Evros-Greece, aged 16.1±1.4 years. The students completed the EDE-Q twice within a median interval of 34 days. In addition, their demographic data were collected and their weight and height were measured. The reliability of the EDE-Q was assessed by means of: (a) its internal consistency which was tested by Cronbach's alpha coefficient for each of the EDE-Q subscales as well as for the global score at both data collection times and (b) its test-retest reliability which was estimated by calculating: (1) intraclass correlation coefficients (ICCs) and Pearson's correlation coefficients (PCCs) for continuous variables (subscales and global score) and (2) Kendal's tau b coefficients for categorical variables (frequency of behavioral features). Cronbach's alphas indicating internal consistency of EDE-Q ranged from 0.71 to 0.91. ICCs and PCCs indicating the test-retest reliability of each subscale and the global score of the questionnaire ranged from 0.55 to 0.70 and from 0.58 to 0.73 respectively. Kendal tau b coefficients indicating the test-retest reliability of items assessing behavioral features ranged from 0.22 to 0.57. All the above correlations that concern the test-retest reliability of the EDE-Q were statistically significant at the 0.001 level. The Greek version of EDE-Q 6.0, standardized in a sample of secondary school students, presents adequate test-retest reliability and internal consistency as well.

Expression of IGF-1 isoforms after exercise-induced muscle damage in humans: characterization of the MGF E peptide actions in vitro.

Different insulin-like growth factor-1 (IGF-1) isoforms, namely IGF-1Ea, IGF-1Eb and IGF-1Ec (MGF), have been proposed to have various functions in muscle repair and growth. To gain insight into the potentially differential actions of IGF-1 isoforms in the regulation of muscle regeneration, we assessed the time course of their expressions at both mRNA and protein levels after exercise-induced muscle damage in humans. In addition, we characterized mature IGF-1 and synthetic MGF E peptide signalling in C2C12 myoblast-like cells in vitro. Ten healthy male volunteers were subjected to exercise-induced muscle damage and biopsy samples were taken from the exercised muscles before and 6 h, 2, 5 and 16 days post exercise. Muscle damage was documented by specific functional and biochemical responses post exercise. PCR-based analyses of muscle biopsy samples revealed a rapid and transient up-regulation of MGF mRNA expression which was followed by a prolonged increase of IGF-1Ea and IGF-1Eb mRNA expression (p<0.05). Patterns similar to those for mRNA expression were detected for MGF and IGF-1Ea expression at the protein level. The action of synthetic MGF E peptide differed from that of mature IGF-1 since its proliferative effect on C2C12 myoblast-like cells was not blocked by an anti-IGF-1 receptor neutralizing antibody and it did not phosphorylate Akt. Therefore, we conclude that the differential expression profile of IGF-1 isoforms in vivo and the possible IGF-1R - independent MGF E peptide signalling in skeletal muscle-like cells in vitro support the notion that tissue-specific mRNA expression of MGF isoform produces mature IGF-1 and MGF E peptides which possibly act as distinct mitogens in skeletal muscle regeneration.

[Fulminant process of an orbital Mucoracea infection]. / Fulminanter Verlauf einer orbitalen Mucoracea-Infektion.

Rhinoorbitocerebral mucormycosis is a rare invasive fungal infection that is fatal when untreated. We describe an immunosuppressed patient with chronic lymphatic leukaemia who developed a severe rhinoorbitocerebral mucormycosis after allogeneic bone marrow transplantation. Due to the potentially fulminant course and fatal outcome, radical excision of the necrotic area in combination with antifungal therapy is necessary in the presence of suspicious clinical signs of mucormycosis despite a lack of histopathologic confirmation.

Keratinocyte growth factor is effective in the prevention of intestinal mucositis in patients with hematological malignancies treated with high-dose chemotherapy and autologous hematopoietic SCT: a video-capsule endoscopy study.

Oral and/or intestinal mucositis is a severe complication of hematopoietic SCT. Keratinocyte growth factor (KGF) has proven activity in the prevention of oral mucositis. We examined the efficacy of KGF in the prevention of intestinal mucositis. From January 2006 until December 2007, 35 consecutive patients underwent autologous SCT (auto-SCT) in our institution. A total of 15 consecutive patients who underwent auto-SCT from March 2007 to December 2007 received KGF for the prevention of mucositis and were included in the study group A, whereas 20 consecutive patients treated from January 2006 to March 2007, were included in the historical control group B. Oral and intestinal mucositis were significantly less severe in group A (P=0.002 and P<0.001, respectively). These results were confirmed with the use of video-capsule endoscopy. Patients in group A had a significantly lower incidence of neutropenic fever (P=0.026). Severe intestinal mucositis was significantly associated with a higher incidence of documented infections too (P=0.019). KGF is effective in the prevention of intestinal mucositis in patients undergoing auto-SCT. Patients with severe intestinal mucositis run a higher risk to develop infections.

The pupillary light reflex pathway: cytoarchitectonic probabilistic maps in hemianopic patients.

OBJECTIVE: The anatomy of the human pupillary light reflex (PLR) pathway is a matter of debate. The aim of this study was twofold: namely, to investigate the association of a relative afferent pupillary defect (RAPD) in acquired suprageniculate lesions with the location and extent of the cerebral lesions. Further, we suggest a new strategy of lesion analysis by combining established techniques with the stereotaxic probabilistic cytoarchitectonic atlas developed by the Jülich group. METHODS: Twenty-three patients with homonymous visual field defects participated in this study. The RAPD was quantified clinically by two independent examiners with graded neutral density filters (swinging flashlight test). Using MRI in each individual, cerebral regions commonly affected in patients with a RAPD but spared in patients without a RAPD were determined and subsequently assessed by using cytoarchitectonic probabilistic maps. RESULTS: A RAPD was present in 10/23 patients. Comparison of patients showing a RAPD vs those not showing a RAPD revealed that a region including the course of the optic radiation at its early beginning in the temporal white matter is commonly associated with a RAPD. CONCLUSIONS: It was demonstrated that the pupillary light reflex (PLR) depends on the input of suprageniculate neurons, thus supporting the involvement of a cortical pathway also. The site of integration of cortical signals in relation to the PLR into the pupillomotor pathway may be located suprageniculately in the vicinity of the lateral geniculate nucleus. Moreover, the suggested combination of established lesion analysis techniques with the probabilistic cytoarchitectonic atlas turned out to be a very helpful amelioration of stroke data analyses.