The Effectiveness of a Family-Centered Childhood Obesity Intervention at the YMCA: A Pilot Study.

OBJECTIVE: Community-based, family-centered obesity prevention/treatment initiatives have been shown to be effective in reducing body mass index (BMI) and improving healthy habits in children if implemented with high intensity and sufficient duration. Let's Go! 5-2-1-0 Program (5-2-1-0) was incorporated into family-centered, monthly physical activity classes and cooking classes over six months delivered by Young Men's Christian Association (YMCA) staff. We hypothesized that implementation of this intervention would improve 5-2-1-0 knowledge attainment, increase healthy behavior (based on 5- 2-1-0 curriculum), and improve BMI and waist circumference measurements in children. METHODS: Children attending YMCA summer camps in Rochester, MN, during 2016 were recruited via study packets mailed to their families. Height, weight, and waist circumference measurements as well as the results of the Modified Healthy Habits Survey and the 5-2-1-0 Knowledge Acquisition Survey were recorded for each participating child at baseline and 6-month follow-up. The intervention group received monthly healthy habit reminder emails, and was invited to monthly evening cooking and physical activity classes for 7 sessions over a 6-month period. RESULTS: Fifteen families in the intervention group attended classes. Of those, 13 families regularly participated in (attended at least 5 out of 7) both the monthly physical activity and cooking classes. The children in the intervention group had a significant improvement in the number of Knowledge Acquisition Survey questions answered correctly (p<0.001), while there was no improvement in the control group. As compared to children in the control group, there was no significant change in BMI or waist circumference or healthy habits in the intervention group. CONCLUSION: Our study findings indicate that our intervention resulted in improved knowledge about healthy habits, but did not significantly impact healthy habits or BMI. Potential reasons for this were the small sample size and the attenuated length and/or intensity of the intervention.

Myelin protein zero mutation His39Pro: hereditary motor and sensory neuropathy with variable onset, hearing loss, restless legs and multiple sclerosis.

BACKGROUND: Mutations of myelin protein zero (MPZ) may cause inherited neuropathy with variable expression. OBJECTIVE: To report phenotypic variability in a large American kindred with MPZ mutation His39Pro. PATIENTS: Genetic testing was performed on 77 family members and 200 controls. Clinical and electrophysiological field study assessments were available for review in 47 family members. RESULTS: His39Pro was found in all 10 individuals prospectively identified with neuropathy. 200 normal controls were without mutation. Symptoms of neuropathy began in adulthood and were slowly progressive except for one acute-onset painful sensory neuropathy. Associated features included premature hearing loss (n = 7), nocturnal restless leg symptoms (n = 8) and multiple sclerosis in one. CONCLUSIONS: MPZ mutation His39Pro may be associated with acute-onset neuropathy, early-onset hearing loss and restless legs. The relationship with multiple sclerosis in the proband remains uncertain.

Enhancement of R3230AC rat mammary tumor growth and cellular differentiation by dibutyryl cyclic adenosine monophosphate.

Daily sc injections of 8 mg N6, O2'-dibutyryl 3',5'-cyclic AMP (DBcAMP) beginning 1 day after tumor implantation significantly increased the growth rate of R32230AC rat mammary adenocarcinomas, which nearly doubled in in situ volume by day 40 compared to similarly implanted tumors in saline-injected controls. Weights of excised tumors, intact, drained, and dried all increased approximately 80%, which suggested that the increase in tumor size was not due to accumulation of secreted fluid or tissue water. Injections of 17beta-estradiol valerate (0.1 mg/wk) from day 1 or of DBcAMP from day 22 resulted in insignificant changes in growth--28% and 35% increases in tumor volume and a 5% decrease and an 18% increase, respectively, in drained wet weight. Electron microscopic examination revealed that estrogen and DBcAMP caused differentiation of the tumor cells into two different states: Estrogen-treated tumors resembled lactating mammary glands; they contained large lipid droplets, organized rough endoplasmic reticulum, and vesicles containing electron dense granules resembling protein. DBcAMP-treated tumor cells were marked by a proliferation of the Golgi complex and numerous vesicles containing fine granular material.

In situ long-term monitoring system for radioactive contaminants.

A long-term in situ subsurface instrument for monitoring radioactive contaminant plumes, as an alternative to soil analysis, is described. A portable, laser-based reader optically stimulates luminescence from sensors, each containing an Al2O3:C dosemeter. The sensors, designed for placement at various subsurface locations around a waste site, are allowed to accumulate dose for a predetermined time that is based on the instrument's minimum detectable dose (MDD). The reader is then attached to the sensor by fibre optic cable to read the accumulated dose; an increase above natural background levels indicating the presence of leaked radioactivity. Based on an MDD of 5 microGy, it is shown that the sensor can measure soil concentrations of 1.85 Bq cm(-3) after an exposure time of 50 h for 137Cs and 67 h for 90Sr/90Y. Discrimination between beta and gamma radiation is possible using an end cap placed over one of the two paired sensors, allowing simultaneous measurement of 137Cs and 90Sr/90Y in a mixed field. The monitor system represents a substantial improvement over quarterly soil sampling because of a greatly increased measurement frequency and the ability to perform measurements reproducibly.

Hereditary motor and sensory neuropathy type 2C is genetically distinct from types 2B and 2D.

BACKGROUND: Linkage analysis studies have identified 3 genetically different varieties of hereditary motor and sensory neuropathy type 2 (HMSN 2, also called Charcot-Marie-Tooth disease type 2, or CMT 2): HMSN 2A (linked to 1p35-p36), 2B (to 3q13-q22), and 2D (to 7p14). Hereditary motor and sensory neuropathy type 2C is characterized by diaphragmatic and vocal cord paresis; its disease locus has not been mapped. OBJECTIVE: To determine whether the HMSN 2C phenotype, previously shown not to be linked to the HMSN 2A locus, is linked to the HMSN 2B or HMSN 2D loci. DESIGN: Linkage analysis. SETTING AND PATIENTS: Thirty-three subjects, including 12 affected individuals and 11 individuals at risk, in a large family with HMSN 2C. RESULTS: Evidence was found against linkage of HMSN 2C phenotype to either the HMSN 2B or the 2D loci. CONCLUSIONS: HMSN 2C is genetically distinct from HMSN 2A, 2B, and 2D. We think that at least 4 genetically distinct varieties of autosomal dominant HMSN 2 exist.

Calcification in brainstem gliomas.

Calcification in brainstem gliomas is an unusual histologic and and radiologic finding. To date, radiologic evidence of calcification in these tumors has not been reported. The two patients described here had evidence of calcification on either computerized tomography (CT) or plain skull films. Increasing availability of CT scans may provide a more accurate estimate of the incidence of calcification in these tumors.

Scheuermann's dorsal kyphosis and spinal cord compression: case report.

Although Scheuermann's disease (juvenile dorsal kyphosis) is a common problem of late childhood and adolescence, its potential for neurological complications is not widely appreciated. In rare instances, spinal cord compression appears to be produced by the kyphotic protrusion alone, and we present an example of this unusual problem. Although the results of surgical treatment in this situation cannot be substantiated, anterior spondylotomy and decompression followed by posterior fixation appear to offer the best mechanical relief. Spinal cord compression can also be produced by extradural cysts, with which Scheuermann's disease is frequently associated. Scheuermann's disease also is reported to occur in combination with thoracic disc protrusion, but the coincidence here may be random. Pertinent literature is reviewed.

Triad of hypopituitarism, granulomatous hypophysitis, and ruptured Rathke's cleft cyst.

A 19-year-old girl with pituitary insufficiency and a large sella turcica was found to have granulomatous hypophysitis in association with a Rathke's cleft cyst. We think that the inflammatory process represents a foreign body reaction to leakage of cyst contents, with destruction of pituitary tissue.

Simultaneous subdural effusion and hydrocephalus in infancy.

Hydrocephalus and subdural hematoma or effusion of infancy rarely present simultaneously, where both are active contributors to acutely increased intracranial pressure. In three cases, clinical findings characteristic of both were present. Decompression of one can facilitate expansion of the other. Rapid progression of unsuspected hydrocephalus could be responsible for some of the poor results reported after treatment of subdural effusion alone. This possibility should be considered whenever progress is unsatisfactory during treatment of subdural effusion.

Radiology in survivors of traumatic atlanto-occipital dislocation.

Traumatic atlanto-occipital dislocation is fatal, but survivals are reported. Six cases of survival after atlanto-occipital dislocation are presented. Lateral cervical spine radiographs demonstrated retropharyngeal swelling in all patients, and Powers' ratio was abnormal in five of six patients. Reformatted computed tomography (CT) images or three-dimensional CT were useful in confirming the diagnosis. Initial treatment consisted of immobilization with halo or collar, and, in one patient, Crutchfield tongs. Reduction of the dislocation was associated with decreasing Powers' ratio in five long-term survivors. Residual neurologic deficits, however, were seen in these patients. Atlanto-occipital dislocation should be suspected in trauma patients with findings of brain stem injury--especially agonal respirations, irregular heart rate, lower cranial nerve abnormality, and asymmetrical motor deficits.

Local-advancement soft-tissue coverage in a child with ipsilateral grade IIIB open tibial and ankle fractures.

This case describes the successful treatment of a child with a vascular injury and two ipsilateral grade IIIB open lower leg fractures using two local-advancement soft-tissue techniques. Multiple relaxing skin incisions were used for closure of the wound associated with the patient's midshaft tibial fracture, whereas a randomly patterned rotational fasciocutaneous flap was used for coverage of the wound associated with the patient's medial malleolar fracture. These straightforward local-advancement soft-tissue coverage techniques allowed for treatment of a child with vascular injuries, ensuring the viability of the foot, while preventing distant donor site morbidity and functional sacrifice. Additionally, no special microsurgical or specialty training is necessary to achieve a similar result.

Spontaneous healing of a massive tibial cortical defect.

This case report describes the spontaneous healing of a 20-cm massive tibial cortical defect. The defect was created during debridement of necrotic bone and soft tissue in a low-velocity gunshot wound of the tibia that became infected in a skeletally mature patient. The patient was treated in an external fixator and had a soleus flap to provide soft-tissue coverage. He had refused any surgical reconstructive options. Despite the absence of surgical reconstruction, his tibia healed, and he returned to full activity without any orthotic device 9 months after the original injury.

Immobilization of the mallet finger. Effects on the extensor tendon.

Since the mallet finger that is treated with isolated splinting of the distal interphalangeal (DIP) joint can be moved freely proximal to the DIP joint, we sought to determine whether such motion might cause a tendon gap that could explain the extensor lag that often follows treatment. Experiments were performed on 32 cadaveric fingers with open mallet finger lesions, immobilizing either the DIP joint alone or both the DIP and PIP joints, while repeatedly flexing and extending the more proximal finger and wrist joints. For each experiment, the gap in the extensor tendon was measured. Joint motion proximal to the DIP joint and retraction of the intrinsics did not cause a tendon gap in a finger with a mallet lesion, supporting the convention that only the DIP joint needs to be immobilized.

Comparative histology of the annular and cruciform pulleys.

Twenty annular and 12 cruciform pulleys were dissected from four unembalmed fresh cadaveric fingers and stained with haematoxylin and eosin, Verhoeff-van Gieson stain for elastin, alcian blue stain for hyaluronic acid, and a separate stain for S-100 to identify chondroid cells. Three distinct layers were identified in both annular and cruciform pulleys: an outer layer of fibrofatty tissue with vascular channels outermost, an inner layer of hyaluronic acid-secreting cells, and a collagen-rich layer in between. Chondroid metaplasia was noted in the inner layer of both types of pulleys. Minimal differences were noted in regard to the elastin fibre content of the pulleys, with slightly more elastin in the annular pulleys, but no other differences were noted.

Advances in immunotherapy of sepsis.

Septic shock, with its associated high morbidity and mortality, has long been a challenge to the critical care nurse. A promising new development in the treatment of this condition is the use of monoclonal antibodies to inactivate two prime mediators that induce the cascade of events that culminate in septic shock and multiple organ failure: bacterial endotoxin and tumor necrosis factor (TNF). The effectiveness of this immunotherapy depends on its timely administration, which necessitates the early identification of sepsis.

Optically stimulated luminescence (OSL) of tooth enamel and its potential use in post-radiation exposure triage.

Optically stimulated luminescence (OSL) properties of dental enamel are discussed with a view to the development of an in vivo dose assessment technique for medical triage following a radiological/nuclear accident or terrorist event. In the OSL technique, past radiation exposure is assessed by stimulating the sample with light of one wavelength and monitoring the luminescence at another wavelength, under the assumption that the luminescence originates from the recombination of radiation-induced charges trapped at metastable defects in the enamel and that the intensity of the luminescence signal is in proportion to the absorbed radiation dose. Several primary findings emerged from this research: (a) sensitivities varied considerably between different teeth and also between fragments of the same tooth, (b) OSL signals were found to decay rapidly during the first 12 h after irradiation and more slowly afterward, (c) the fading rate of the luminescence signal varied between fragments, and (d) blue light stimulation yields greater sensitivity than infra-red stimulation, while the OSL signal obtained with a high-intensity pulsed green-light laser was found not to be correlated with the radiation dose. Significant challenges remain to developing a practical in vivo technique, including the development of calibration procedures and lowering minimum detectable doses.

SPTLC1 and RAB7 mutation analysis in dominantly inherited and idiopathic sensory neuropathies.

BACKGROUND: The variable clinical features of hereditary sensory and autonomic neuropathy (HSAN I) suggest heterogeneity. Some cases of idiopathic sensory neuropathy could be caused by missense mutations of SPTLC1 and RAB7 and not be recognised as familial. OBJECTIVE: To screen persons with dominantly inherited HSAN I and others with idiopathic sensory neuropathies for known mutations of SPTLC1 and RAB7. PATIENTS: DNA was examined from well characterised individuals of 25 kindreds with adult onset HSAN I for mutations of SPTLC1 and RAB7; 92 patients with idiopathic sensory neuropathy were also screened for known mutations of these genes. RESULTS: Of the 25 kindreds, only one had a mutation (SPTLC1 399T-->G). This kindred, and 10 without identified mutations, had prominent mutilating foot injuries with peroneal weakness. Of the remainder, 12 had foot insensitivity with injuries but no weakness, one had restless legs and burning feet, and one had dementia with hearing loss. No mutation of RAB7 was found in any of these. No known mutations of SPTLC1 or RAB7 were found in cases of idiopathic sensory neuropathy. CONCLUSIONS: Adult onset HSAN I is clinically and genetically heterogeneous and further work is required to identify additional genetic causes. Known SPTLC1or RAB7 mutations were not found in idiopathic sensory neuropathy.