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Severe Impairment (severe + impairment)
Terms modified by Severe Impairment Selected AbstractsHandling and environmental enrichment do not rescue learning and memory impairments in ,CamKIIT286A mutant miceGENES, BRAIN AND BEHAVIOR, Issue 3 2003A. C. Need Environmental enrichment and postnatal handling have been shown to improve learning and memory in the Morris water maze, and to rescue impairments caused by genetic modification, age or genetic background. Mice with a targeted point mutation that prevents autophosphorylation at threonine-286 of the ,-isoform of the Ca2+/calmodulin-dependent kinase II have impaired hippocampus-dependent and -independent strategy learning and memory in the water maze. We have investigated whether these impairments can be rescued with a combination of postnatal handling and environmental enrichment in a hybrid genetic background. Severe impairments were seen in acquisition and probe trials in both enriched and nonenriched mutants, indicating that enrichment did not rescue the learning and memory impairments. However, enrichment did rescue a specific performance deficit; enhanced floating behaviour, in the mutants. In summary, we have shown the lack of autophosphorylation of the ,-isoform of the Ca2+/calmodulin-dependent kinase II prevents enrichment-induced rescues of strategy learning and memory impairments. Furthermore, we have established that there are enrichment mechanisms that are independent of this autophosphorylation. [source] Neurodevelopmental impairment: Predictors of its impact on the families of extremely low birth weight infants at 18 months,INFANT MENTAL HEALTH JOURNAL, Issue 6 2008Bonnie E. Stephens Effects on a family of a child with chronic illness have been described. The Impact on Family Scale (IOF) was developed to measure these effects. The impact of extremely low birth weight (ELBW) infants with neurodevelopmental impairment on families is unknown. This study determined IOF scores for families of ELBW infants with increasing degree of impairment at 18 months and identified factors that increase vulnerability to impact. A total of 3,849 ELBW infant survivors born at the 16 centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1993 and February 2001 were assessed at 18 to 22 months. Infants were divided into four groups by degree of impairment. IOF scores were analyzed by impairment group. Multivariate analyses assessed effects of impairment, social/demographic factors, unmet service needs, and resource utilization on the IOF. A total of 1,624 (42.2%) infants had moderate/severe impairment. Increasing severity of impairment was associated with higher IOF scores. Severity of impairment contributed 6% of variance to the IOF scores. Twenty-one percent of variance was contributed by additional medical needs, low socioeconomic status (SES), and lack of social support. Although increasing severity of impairment impacts families of ELBW infants, significantly more impact is contributed by additional medical needs, low SES, and lack of social support. [source] Novel functions of ribosomal protein S6 in growth and differentiation of Dictyostelium cellsDEVELOPMENT GROWTH & DIFFERENTIATION, Issue 6 2009Kazutaka Ishii We have previously shown that in Dictyostelium cells a 32 kDa protein is rapidly and completely dephosphorylated in response to starvation that is essential for the initiation of differentiation (Akiyama & Maeda 1992). In the present work, this phosphoprotein was identified as a homologue (Dd-RPS6) of ribosomal protein S6 (RPS6) that is an essential member for protein synthesis. As expected, Dd-RPS6 seems to be absolutely required for cell survival, because we failed to obtain antisense-RNA mediated cells as well as Dd-rps6 -null cells by homologous recombination in spite of many trials. In many kinds of cell lines, RPS6 is known to be located in the nucleus and cytosol, but Dd-RPS6 is predominantly located in the cell cortex with cytoskeletons, and in the contractile ring of just-dividing cells. In this connection, the overexpression of Dd-RPS6 greatly impairs cytokinesis during axenic shake-cultures in growth medium, resulting in the formation of multinucleate cells. Much severe impairment of cytokinesis was observed when Dd-RPS6-overexpressing cells (Dd-RPS6OE cells) were incubated on a living Escherichia coli lawn. The initiation of differentiation triggered by starvation was also delayed in Dd-RPS6OE cells. In addition, Dd-RPS6OE cells exhibit defective differentiation into prespore cells and spores during late development. Thus, it is likely that the proper expression of Dd-RPS6 may be of importance for the normal progression of late differentiation as well as for the initiation of differentiation. [source] Health status of children with moderate to severe cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2001Gregory S Liptak MD MPH The aim of the study was to evaluate the health of children with cerebral palsy (CP) using a global assessment of quality of life, condition-specific measures, and assessments of health care use. A multicenter population-based cross-sectional survey of 235 children, aged 2 to 18 years, with moderate to severe impairment, was carried out using Gross Motor Function Classification System (GMFCS) levels III (n= 56), IV (n=55), and V (n=122). This study group scored significantly below the mean on the Child Health Questionnaire (CHQ) for Pain, General Health, Physical Functioning, and Impact on Parents. These children used more medications than children without CP from a national sample. Fifty-nine children used feeding tubes. Children in GMFCS level V who used a feeding tube had the lowest estimate of mental age, required the most health care resources, used the most medications, had the most respiratory problems, and had the lowest Global Health scores. Children with the most severe motor disability who have feeding tubes are an especially frail group who require numerous health-related resources and treatments. Also, there is a relationship among measures of health status such as the CHQ, functional abilities, use of resources, and mental age, but each appears to measure different aspects of health and well-being and should be used in combination to reflect children's overall health status. [source] Balancing needs and means: the dilemma of the ,-cell in the modern worldDIABETES OBESITY & METABOLISM, Issue 2009G. Leibowitz The insulin resistance of type 2 diabetes mellitus (T2DM), although important for its pathophysiology, is not sufficient to establish the disease unless major deficiency of ,-cell function coexists. This is demonstrated by the fact that near-physiological administration of insulin (CSII) achieved excellent blood glucose control with doses similar to those used in insulin-deficient type 1 diabetics. The normal ,-cell adapts well to the demands of insulin resistance. Also in hyperglycaemic states some degree of adaptation does exist and helps limit the severity of disease. We demonstrate here that the mammalian target of rapamycin (mTOR) system might play an important role in this adaptation, because blocking mTORC1 (complex 1) by rapamycin in the nutritional diabetes model Psammomys obesus caused severe impairment of ,-cell function, increased ,-cell apoptosis and progression of diabetes. On the other hand, under exposure to high glucose and FFA (gluco-lipotoxicity), blocking mTORC1 in vitro reduced endoplasmic reticulum (ER) stress and ,-cell death. Thus, according to the conditions of stress, mTOR may have beneficial or deleterious effects on the ,-cell. ,-Cell function in man can be reduced without T2DM/impaired glucose tolerance (IGT). Prospective studies have shown subjects with reduced insulin response to present, several decades later, an increased incidence of IGT/T2DM. From these and other studies we conclude that T2DM develops on the grounds of ,-cells whose adaptation capacity to increased nutrient intake and/or insulin resistance is in the lower end of the normal variation. Inborn and acquired factors that limit ,-cell function are diabetogenic only in a nutritional/metabolic environment that requires high functional capabilities from the ,-cell. [source] The Reliability of Echocardiographic Left Ventricular Wall Motion Index to Identify High-Risk Patients for Multicenter StudiesECHOCARDIOGRAPHY, Issue 1 2006Gunnar H. Gislason M.D. Objective: To study whether the use of echocardiographic left ventricular (LV) wall motion index (WMI) is a dependable parameter for identifying patients with LV dysfunction to be enrolled in multicenter trials. Methods: Videotaped echocardiographic examinations from 200 randomly selected patients that were screened for inclusion into the DIAMOND-CHF and DIAMOND-MI trials were reevaluated by an external expert echocardiographer. WMI was calculated using the 16-segment LV model. Results: The external echocardiographer systematically found lower values of WMI than the core laboratory. The average difference in WMI was 0.18 (SD: 0.33) in the DIAMOND-CHF trial and 0.09 (SD: 0.33) in the DIAMOND-MI trial. The difference in WMI exceeded 0.33 in 34% of the patients in both trials. The cutoff value for inclusion into the DIAMOND trials was WMI , 1.2. There was an agreement on WMI dichotomized to below or above 1.2 in 82% of the patients in both trials ( , coefficient 0.66 for the DIAMOND-CHF and 0.55 for the DIAMOND-MI). Conclusions: Despite substantial interlaboratory variation in WMI in individual patients and a systematic lower WMI score by the external echocardiographer there was an acceptable overall agreement for identifying patients with severe impairment of LV function. This not only underscores the value of LV-WMI as a useful tool for selecting high-risk patients to be included in multicenter studies but also serves to warn against the use of rigid cutoff values for WMI in the treatment of individual patients. [source] Implant-Supported Obturator Overdenture for Extensive Maxillary Resection Patient: A Clinical ReportJOURNAL OF PROSTHODONTICS, Issue 3 2010Cláudio Rodrigues Leles DDS Abstract This clinical report presents an implant-retained obturator overdenture solution for a Prosthodontic Diagnostic Index Class IV maxillectomy patient with a large oronasal communication and severe facial asymmetry, loss of upper lip and midfacial support, severe impairment of mastication, deglutition, phonetics, and speech intelligibility. Due to insufficient bone support to provide satisfactory zygomaticus implant anchorage, conventional implants were placed in the body of the left zygomatic arch and in the right maxillary tuberosity. Using a modified impression technique, a cobalt-chromium alloy framework with three overdenture attachments was constructed to retain a complete maxillary obturator. Patient-reported functional and quality of life measure outcomes were dramatically improved after treatment and at the two-year follow-up. [source] A classification of the fibrin network structures formed from the hereditary dysfibrinogensJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2006T. SUGO Summary.,Objective: The main objective was to study the relationships of the molecular defects in 38 dysfibrinogens with their fibrin networks. Methods and results: Scanning electron microscopic analyses revealed that all the fibrins formed under the same conditions had networks composed of either normal thickness fibers or thin fibers, accompanied by a variety of alterations in the network structure and characteristics. We classified these fibrin networks into five classes, designated normal, less-ordered, porous A, porous B and lace-like networks. The dysfibrinogens with defects in fibrinopeptide A release or the E:D binding sites formed normal or less-ordered networks, while those with defects in the D:D association formed porous A networks composed of many tapered terminating fibers, despite having fibers of normal width, and containing many pores or spaces. The porous B and lace-like networks were composed of highly branched thin fibers because of defects in the lateral association among protofibrils, and the major difference between them was the porosity of the porous B networks. All the porous B networks were easily damaged by mechanical stress, whereas the lace-like networks retained high resistance to such stress, indicating that the network strength was not dependent on the fiber width, but on the porosity that led to fragility of the network. Conclusion: Impairment of the D:D association is the major disturbing factor that leads to the formation of porous fibrin networks. The porosity may be introduced by severe impairment of the D:D association, as well as the lateral association, as has often been observed by extra glycosylation or defects in Ca2+ binding. [source] Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradientLIVER INTERNATIONAL, Issue 2 2010Simonetta Genovesi Abstract Background: Autonomic dysfunction has been reported as one of the complications of cirrhosis. Aims: The aim of this study was to test autonomic dysfunction in cirrhotic patients by analysing the baroreflex sensitivity and the baroreceptor effectiveness index (BEI), in order to determine its correlation with the severity and the aetiology of liver disease. Moreover, we explored the relationship between baroreceptor function and mortality in our cohort of patients. Methods: Clinical and laboratory evaluation, hepatic venous pressure gradient (HVPG) and haemodynamic setting and baroreceptor function were assessed in 45 cirrhotic patients (median age 55, range 38,72 years) divided in groups according to the severity of their disease (26 patients Child A, 13 patients Child B and six patients Child C). Results: Baroreceptor sensitivity and BEI were impaired in more advanced cirrhotic patients compared with subjects with milder disease (P<0.001). HVPG was significantly, independently and inversely correlated with baroreceptor sensitivity (P=0.003). More severe impairment of baroreceptor function was associated with a higher mortality (P=0.04) and subjects with alcohol-related cirrhosis presented worse baroreceptor function (P=0.032) and poorer survival (P=0.003) compared with subjects with post-viral liver disease. Conclusions: These data support the hypothesis that liver disease severity and particularly portal hypertension have an important role in the derangement of baroreceptor function. The aetiology of cirrhosis seems to be related to baroreceptor impairment as well. Mortality rate is higher in subjects with a more damaged autonomic system, strengthening the idea of a worse prognosis in cirrhotic patients with autonomic neuropathy. [source] Cyclopia (synophthalmia) in Smith,Lemli,Opitz syndrome: First reported case and consideration of mechanism,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2010David D. Weaver Abstract Here we present a 24-week fetus with Smith,Lemli,Opitz syndrome (SLOS), alobar holoprosencephaly (HPE) and cyclopia (synophthalmia). Following birth, we suspected SLOS in this fetus due to the additional findings of ambiguous genitalia and bilateral 2,3 toe syndactyly. The diagnosis of SLOS was confirmed by finding an elevated amniotic fluid 7-dehydrocholesterol level (9,890,ng/ml; normal range,=,3,9,ng/ml), and molecularly by detecting two different mutations in the DHCR7 gene, the gene causing SLOS. The first mutation was an IVS8-1G>T change and the second was a deletion of exons 3 and 4; this latter mutation has not been reported previously. The mother carries the deletion, while the father carries the splice-site mutation. Also of note, the father has an abnormally low total plasma cholesterol level (104,109,mg/dl). This is the most severe case of HPE described in any patient with SLOS. We postulate that the HPE in this case resulted from severe impairment of Sonic Hedgehog signaling secondary to abnormal cholesterol metabolism; however, the unique combination of mutations in the fetus functionally appears to be no different from other homozygous null mutations reported in DHCR7. Therefore, there must be other yet to be identified factors that contributed to the severity of HPE in SLOS. © 2010 Wiley-Liss, Inc. [source] Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation?RESPIROLOGY, Issue 2 2009A randomized controlled study ABSTRACT Background and objective: In COPD, hospital admissions and readmissions account for the majority of health-care costs. The aim of this prospective randomized controlled study was to determine if early pulmonary rehabilitation, commenced as an inpatient and continued after discharge, reduced acute health-care utilization. Methods: Consecutive COPD patients (n = 397), admitted with an exacerbation, were screened: 228 satisfied the eligibility criteria, of whom 97 consented to randomization to rehabilitation or usual care. Both intention-to-treat and per-protocol analyses are reported with adherence being defined a priori as participation in at least 75% of rehabilitation sessions. Results: The participants were elderly with severe impairment of pulmonary function, poor health-related quality of life and high COPD-related morbidity. The rehabilitation group demonstrated a 23% (95% CI: 11,36%) risk of readmission at 3 months, with attendees having a 16% (95% CI: 0,32%) risk compared with 32% (95% CI: 19,45%) for usual care. These differences were not significant. There were a total of 79 COPD-related readmission days (1.7 per patient, 95% CI: 0.6,2.7, P = 0.19) in the rehabilitation group, compared with 25 (1.3 per patient, 95% CI: 0,3.1, P = 0.17) for the attendees and 209 (4.2 per patient, 95% CI: 1.7,6.7) for usual care. The BMI, airflow obstruction, dyspnoea and exercise capacity index showed a non-significant trend to greater improvement among attendees compared with those receiving usual care (5.5 (2.3) and 5.6 (2.7) at baseline, improving to 3.7 (1.9) and 4.5 (2.5), respectively, at 3 months). No adverse effects were identified. Conclusions: Early inpatient,outpatient rehabilitation for COPD patients admitted with an exacerbation was feasible and safe, and was associated with a non-significant trend towards reduced acute health-care utilization. [source] Paradoxical Vocal Fold Motion: A Sensory-Motor Laryngeal Disorder,THE LARYNGOSCOPE, Issue 2 2008Sabrina Cukier-Blaj SLP Abstract Objectives: The purpose of this study is to determine the laryngeal sensitivity (LS) thresholds and the ratings of laryngopharyngeal reflux symptoms in patients with paradoxical vocal fold motion (PVFM). Methods: This is a chart review following Institutional Review Board approval of 75 patients from January 2006 to June 2007. The patients were diagnosed with PVFM following case history, transnasal flexible laryngoscopy and spirometric testing. The data analyzed consisted of the reflux symptom index (RSI) and laryngopharyngeal sensitivity (LS). Laryngeal sensitivity and RSI were graded according to mild, moderate, or severe. Results: There were 12 (16%) patients with normal RSI scores, 37 patients (49.3%) with moderate RSI (RSI 11,22), and 26 patients (34.7%) with severe RSI (RSI >22). The right LS was normal in 11 patients (14.7%), moderately impaired in 16 patients (21.3%), and severely impaired in 48 (64%) patients. The left LS showed normal sensation in 11 patients (14.7%), moderately impaired LS in 13 patients (17.3%), and severe impairment in 51 patients (68%). Only one patient had both normal sensation and normal RSI, and 70.4% of patients had abnormal RSI and sensation thresholds. Conclusions: Patients diagnosed with PVFM had a high prevalence of symptoms related to LPR and markedly reduced LS. These findings suggest that PVFM may be triggered by reduced peripheral sensation or laryngeal inflammation. [source] Assignment of the locus for arachnomelia syndrome to bovine chromosome 23 in Simmental cattleANIMAL GENETICS, Issue 6 2009J. Buitkamp Summary Arachnomelia syndrome is a lethal inherited malformation mainly of the limbs, vertebral column and skull in cattle, which poses a severe impairment to farmers and breeders. Recently, a number of cases of arachnomelia syndrome have occurred in the Simmental breed and some sires with excellent breeding values had been shown to be carriers of the disease. We herein report the genetic mapping of the mutation underlying arachnomelia in cattle. The disease was mapped using a two-stage genome scan. A first round autosomal genome-wide screening using a limited number of cases identified three chromosomal regions with lod-scores > 1. The position of the arachnomelia syndrome locus was identified to be on BTA 23 by genotyping an additional, independent set of animals with markers that provided positive lod-scores in the course of the initial genome-wide screen. Using a denser set of regional microsatellites, the locus could be mapped to a region about 9 cM in length. The most significant linkage signal with arachnomelia syndrome was obtained with marker NRKM-17 (lod-score > 20) using a recessive model. Interestingly, different genes seem to be responsible for the disease in Brown Swiss and Simmental breeds, as arachnomelia syndrome was mapped to a different location in Brown Swiss. The results provide sufficient information for the development of a genetic test system and also allow the identification of positional candidate genes. [source] Functional impairment after latissimus dorsi flapANZ JOURNAL OF SURGERY, Issue 1-2 2009Cherry E. Koh Abstract Background:, Available published reports suggest that loss of latissimus dorsi muscle following latissimus myocutaneous flap does not lead to functional impairment. However, significant functional impairment has been observed in clinical practice, prompting this study to evaluate the functional deficit in patients who had undergone reconstruction using latissimus dorsi muscle. Methods:, A retrospective review was undertaken between 1998 and 2003. Patients were identified from the audit of the plastic surgery unit at St Vincent's Hospital and recruited by direct telephone contact. They were assessed using the Disability of Arm, Shoulder and Hand questionnaire. Results:, There were 25 participants. Eighteen completed their questionnaires. Six of 18 patients reported scores of 30 or more, which corresponded to a global moderate functional deficit. These patients were severely limited in their ability to carry out housework. Major postoperative complications were associated with high Disability of Arm, Shoulder and Hand scores (P = 0.028). Three of five patients involved with sports reported impaired performance in sports. The subgroup of four patients who underwent bilateral latissimus dorsi flaps also experienced significant morbidity with all four reporting moderate to severe impairment in their ability to return to gardening and/or sports. Conclusion:, Patients undergoing this procedure should be fully informed of potential sequelae. Athletic patients and patients undergoing bilateral latissimus dorsi flaps should also be warned of possible reduced performance in sports. Alternatively, perforator cutaneous flaps, which preserve the latissimus muscle, should be chosen when feasible. [source] Prioritization of cataract surgery: Visual analogue scale versus scoring systemANZ JOURNAL OF SURGERY, Issue 7 2005Victoria W. Y. Wong Background: The purpose of the present paper was to evaluate the variability of using a visual analogue scale (VAS) and to assess the feasibility of a priority-setting scoring system for prioritizing elective cataract surgery. Methods: Consecutive cases listed for cataract surgery were prospectively recruited. Ophthalmologists listed patients to undergo early or normal surgery and were asked to rate the urgency of surgery using a VAS. Patients were then reassessed and a cataract surgery prioritization (CSP) score was calculated based on the New Zealand priority criteria for cataract surgery. Correlation coefficients between VAS and CSP scores were calculated to determine the variability among ophthalmologists in using the VAS in prioritizing surgery. Further analyses were performed to assess the potential impact of implementing the CSP system. Results: A total of 326 patients were recruited. There was a positive correlation between VAS and CSP scores (Spearman ,= 0.407, P < 0.001). A high degree of variation among ophthalmologists in the use of VAS was found. Patients with poor binocular vision were not listed as early, whereas patients with poor vision in the eye listed for cataract surgery but good vision in the fellow eye were more likely to be prioritized to have early operation. These findings suggest that patients with severe impairment in binocular visual function were not adequately accounted for during cataract surgery listing. Conclusions: The use of a VAS for prioritizing cataract surgery may be suboptimal due to high subjectivity. Adoption of an objective criteria-validated priority-setting scoring system may allow better stratification of patients to ensure better service provision. [source] Impaired platelet aggregation in melanoma patients treated with interferon-,-2b adjuvant therapyCANCER, Issue 3 2002Haim Gutman M.D. Abstract BACKGROUND High-dose interferon (INF)- ,-2b is the only Food and Drug Administration-approved adjuvant treatment for patients with melanoma who are at high risk of recurrence. Although circumstantial evidence points to a potentially harmful effect of INF-,-2b on platelet function, to the authors' knowledge this has never been studied in humans. METHODS The study group was comprised of patients who had undergone surgery for melanoma and were free of disease but at a high risk of recurrence. All patients were candidates for adjuvant INF treatment (high-dose) and were undergoing routine evaluation to which platelet aggregation was added. Aggregation was triggered in standard fashion with adenosine diphosphate, epinephrine, collagen, thrombin, arachidonic acid, and ristocetin. Blood samples were drawn immediately before treatment, during the intravenous loading phase, during the subcutaneous maintenance phase, and 3,6 weeks after cessation of treatment. Patients receiving low-dose, long-standing INF-,-2b treatment also were tested. All results at each phase were compared with those of normal controls. RESULTS In those patients receiving high-dose INF-,-2b, ristocetin-induced aggregation did not appear to be affected. However, the response to , 1 of the other agonists was impaired in 5 of 6 samples during loading, 14 of 15 samples during the maintenance phase, and 8 of 13 samples after treatment, compared with only 1 of 8 samples before treatment (P = 0.025, P = 0.002, and P = 0.067, respectively). During treatment with low-dose INF, platelet function was affected to a lesser extent. CONCLUSIONS INF treatment in melanoma patients appears to be associated with severe impairment of platelet aggregation, which appears to be dose-dependent and cumulative,dose-dependent. This is not detectable by the standard coagulation profile. This effect has significant implications in the event of accidental injury or elective surgery. The antiaggregation activity may be the mechanism by which INF delays, reduces, or prevents the formation of melanoma metastases. Cancer 2002;94:780,5. © 2002 American Cancer Society. DOI 10.1002/cncr.10261 [source] Neuropsychological profile of children with subcortical band heterotopiaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2009MEGAN SPENCER-SMITH BPSYCSC PHD Aim, Subcortical band heterotopia (SBH) or ,double cortex' is a malformation of cortical development resulting from impaired neuronal migration. So far, research has focused on the neurological, neuroimaging, and genetic correlates of SBH. More recently, clinical reports and small sample studies have documented neuropsychological dysfunction in patients with this malformation. This study aimed to characterize further the phenotype of patients with SBH by describing the neuropsychological profiles of children. Method, Seven children (six females) aged 4 to 15 years were assessed for cognitive functioning (intellectual ability, processing speed, attention, working memory) and academic achievement (reading, spelling, arithmetic). Parents completed questionnaires examining their child's social skills and problem behaviours. Magnetic resonance images (MRI) conducted for routine clinical follow-up were coded by a paediatric neurologist. Genetic and seizure history were obtained from medical records. Results, There was variation in the neurological, neuroimaging, and genetic presentation of children in the sample. Impairments were observed in all areas of neuropsychological functioning examined. Intellectual ability was generally within the ,extremely low' range (full-scale IQ 44,74; performance IQ 45,72; verbal IQ 57,80). Generalized impairments in cognitive skills were typical, with severe impairments (scores greater than 2SD below the test mean) reported in processing speed, working memory, and arithmetic. Impairments in academic, social, and behavioural functioning were less generalized. No clear relationship between neuroimaging and neuropsychological impairments was found. Interpretation, Children with SBH demonstrate cognitive, academic, social, and behavioural problems, with the greatest difficulties in processing speed and complex cognitive skills. [source] Therapeutic effects of complex rearing or bFGF after perinatal frontal lesionsDEVELOPMENTAL PSYCHOBIOLOGY, Issue 2 2008Wendy Comeau Abstract We investigated the effects of an enriched environment and/or basic fibroblast growth factor (bFGF) on recovery from neonatal frontal injury in rats. Rats received medial frontal lesions, or sham surgery, on postnatal day (P) 2/3. In the first set of experiments (Experiments 1 and 2), rats were housed in enriched environments that consisted of a large enclosure with multiple objects (or standard housing) for 90 days beginning at weaning (P22) or in adulthood (P110). In Experiment 3, the rats either received 7 days of subcutaneous bFGF beginning on the day after surgery or bFGF plus enriched housing beginning at weaning. After the 90-day housing period, the animals were tested on a spatial navigation task and a skilled reaching task. Early lesions of the medial frontal cortex caused severe impairments in spatial learning but this deficit was markedly reduced with enriched housing, bFGF, or a combination of both, with the latter being most effective. The housing effects varied with age, however: the earlier the experience began, the better the outcome. Enriched housing increased dendritic length in cortical pyramidal neurons, an effect that was greater in the lesion than the control animals, and enriched housing reversed the lesion-induced decrease in spine density. Enriched environment increased the thickness of the cortical mantle in both lesion and controls whereas bFGF had no effect. Experience thus can affect functional and anatomical outcome after early brain injury but the effects vary with age at experience and may be facilitated by treatment with bFGF. © 2008 Wiley Periodicals, Inc. Dev Psychobiol 50: 134,146, 2008. [source] Reconstructing impairment of secretory ameloblast function in porcine teeth by analysis of morphological alterations in dental enamelJOURNAL OF ANATOMY, Issue 1 2006Carsten Witzel Abstract We studied the relationship between the macroscopic appearance of hypoplastic defects in the dental enamel of wild boar and domestic pigs, and microstructural enamel changes, at both the light and the scanning electron microscopic levels. Deviations from normal enamel microstructure were used to reconstruct the functional and related morphological changes of the secretory ameloblasts caused by the action of stress factors during amelogenesis. The deduced reaction pattern of the secretory ameloblasts can be grouped in a sequence of increasingly severe impairments of cell function. The reactions ranged from a slight enhancement of the periodicity of enamel matrix secretion, over a temporary reduction in the amount of secreted enamel matrix, with reduction of the distal portion of the Tomes' process, to either a temporary or a definite cessation of matrix formation. The results demonstrate that analysis of structural changes in dental enamel allows a detailed reconstruction of the reaction of secretory ameloblasts to stress events, enabling an assessment of duration and intensity of these events. Analysing the deviations from normal enamel microstructure provides a deeper insight into the cellular changes underlying the formation of hypoplastic enamel defects than can be achieved by mere inspection of tooth surface characteristics alone. [source] Differential diagnosis of food-induced symptomsPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 1 2008Birgit Ahrens The symptoms of patients presenting with non-allergic food-related reactions may partly mimic allergic responses. Therefore, correct delineation of food allergies is often difficult and various differential diagnoses have to be considered. We describe three cases of differential diagnoses to food-induced symptoms: A 14-month-old with lactose intolerance, an 8-month-old with severe diet-induced malnutrition and subsequent development of kwashiorkor and a 12-yr-old with chronic urticaria due to colouring agents. These cases represent common symptom constellations involving food-induced reactions. A proper and correct diagnosis of food-related symptoms is particularly important for children , not only in order to find the appropriate diet but also to avoid unnecessary exclusion diets, which may lead to severe impairments in growth and development. [source] Practitioner Review: Non-pharmacological treatments for ADHD: A lifespan approachTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 2 2010Susan Young Background:, Attention-deficit/hyperactivity disorder (ADHD) is a chronic and pervasive developmental disorder that is not restricted to the childhood years. Methods:, This paper reviews non-pharmacological interventions that are available at present for preschoolers, school-age children, adolescents and adults. Results:, The most appropriate intervention for preschoolers is parent training. For school-age children with moderate impairments there is some evidence to suggest that group parent training programmes and classroom behavioural interventions may suffice as a first-line treatment. For school-age children with severe impairments, interventions are more appropriate when combined with stimulant medication (i.e., integrated treatment packages are likely to be more successful than ,standalone' treatments). Multimodal interventions seem to be best suited for middle school/adolescent children, which most likely reflects that these interventions usually integrate home and school treatment strategies and often include an element of social skills training. Stimulant medication is generally the first line of treatment for adults but CBT has also been found to be effective at addressing the complex needs of this population. Conclusion:, Current research has largely ignored that ADHD is a developmental disorder that spans the preschool to adult years. Most studies focus on young school-age children and outside of this age group there is a dearth of controlled trials that provide conclusive evidence. As children mature the mode and agent of intervention will shift to reflect the developmental needs and circumstances of the individual. [source] SELECTING POTENTIAL CHILDREN AND UNCONDITIONAL PARENTAL LOVEBIOETHICS, Issue 5 2008JOHN DAVIS ABSTRACT For now, the best way to select a child's genes is to select a potential child who has those genes, using genetic testing and either selective abortion, sperm and egg donors, or selecting embryos for implantation. Some people even wish to select against genes that are only mildly undesirable, or to select for superior genes. I call this selection drift, the standard for acceptable children is creeping upwards. The President's Council on Bioethics and others have raised the parental love objection: Just as we should love existing children unconditionally, so we should unconditionally accept whatever child we get in the natural course of things. If we set conditions on which child we get, we are setting conditions on our love for whatever child we get. Although this objection was prompted by selection drift, it also seems to cover selecting against genes for severe impairments. I argue that selection drift is not inconsistent with the ideal of unconditional parental love and, moreover, that the latter actually implies that we should practise selection drift , in other words, we should try to select potential children with the best genetic endowments. My endowment argument for the second claim works from an analogy between arranging an endowment prior to conception to fund a future child's education, and arranging a genetic endowment by selecting a potential child who already has it, where in both cases the child would not have existed without the endowment. I conclude with some programmatic remarks about the nonidentity problem. [source] | ||||||||||||||||