CP Subjects Research Articles

Uncovering early predictors of cerebral palsy through the application of machine learning: a case–control study

ObjectiveCerebral palsy (CP) is a group of neurological disorders with profound implications for children’s development. The identification of perinatal risk factors for CP may lead to improved preventive and therapeutic...

On wh and subject positions, the EPP, and contextuality of syntax

Abstract By examining local subject A’-movement, the paper argues for a split IP and a contextual approach to the EPP where its locus is not a fixed, unique position, but varies depending on the syntactic context. The landing site of subject wh-movement ( who left) is argued to be lower than non-subject wh-movement ( who did he leave) but higher than regular subjects ( Amy left). Quirky subjects are argued to be lower than agreeing subjects, with a generalization proposed regarding their availability. The overall account is extended to many cases, including V-2 in Germanic, subject-restricted relativizations, only-subjects, Defaka focus-movement, Hong Kong Sign Language wh-movement, imperative and CP subjects, locative inversion, Singlish non-agreeing subjects, Japanese and Chinese subjects. Regarding the EPP, the paper argues for a contextual approach where, on a par with a contextual approach to phases, there is an EPP domain, with the highest projection in the EPP domain being the locus of the EPP (on a par with the highest projection in a phasal domain being a phase). This conception of the EPP is put into a broader perspective regarding a more general move toward contextuality in syntax.

IRF6 rs2235371 as a risk factor for non-syndromic cleft palate only among the Deutero-Malay race in Indonesia and its effect on the IRF6 mRNA expression level.

During the early embryological development of the face, complex orofacial failure results in a non-syndromic cleft lip and palate (NS CLP). The interferon regulatory factor 6 gene (IRF6) rs2235371 is a non-synonymous polymorphism that is one of the strong candidate genes associated with NS CLP. The purpose of this study was to determine IRF6 rs2235371 as a risk factor for NS CLP and its phenotypes, including complete unilateral cleft lip and palate (CUCLP), bilateral cleft lip and palate (BCLP), cleft lip only (CL), and cleft palate only (CP), as well as to examine the effect of the polymorphism on the IRF6 mRNA expression levels among the Deutero-Malay race in Indonesia. This study used a case-control design and enrolled 264 samples, including 158 NS CLP cases (42 NS CUCLP, 34 NS BCLP, 33 NS CL, and 49 NS CP) and 106 control subjects. DNA was extracted from venous blood, and then subjected to polymerase chain reaction (PCR) and sequencing. The odds ratio (OR) was used to determine the risk factor for NS CLP and its phenotypes. The Livak, KruskalWallis and Mann-Whitney U tests were used to determine mRNA expression levels in the oral epithelium, followed by real-time quantitative PCR (RT-qPCR). Among all of the NS CLP cases, in the NS CP phenotype, OR for the A mutant allele and the GA genotype was 2,492 (p = 0.017) and 2,114 (p = 0.048), respectively. The IRF6 mRNA expression level of the GA genotype was higher in the NS CP subjects as compared to the GG genotype (p = 0.031). The IRF6 rs2235371 polymorphism is associated with the NS CP phenotype in DeuteroMalay patients from Indonesia and it affects the IRF6 mRNA expression level.

Default is different: relations and representations in agreement processing

ABSTRACT Theories of agreement processing typically focus on the mechanisms by which comprehenders relate the morphological features of the agreement-controlling NP and those of the verb. However, agreement is fundamentally a syntactic relation. In this paper, I examine the processing of default agreement with clausal subjects (“[cp That the doctors studied hard] was reassuring”) vs. the processing of agreement with near-synonymous NPs (“[np The fact that the doctors studied hard] was reassuring”). In the NP subject case, there is a syntactic agreement dependency between the head noun fact and the verb was but not in the the CP case. I show that the agreement processing profile for CP subjects differs from those of NP subjects. This suggests that agreement configurations with similar morphology and semantics may be processed using different strategies when embedded in different syntactic structures.

Planned use of long acting reversible postpartum contraception in low-risk women in CenteringPregnancy® group versus individual physician prenatal care

Introduction: Education on effective contraceptive methods is necessary during the prenatal period to help women achieve optimal birth spacing. This study identified rates of long-acting reversible contraception (LARC) uptake in women who attended CenteringPregnancy® (CP) group prenatal care versus individual physician care (IP). Methods: Charts for low-risk women who participated in group CP or IP prenatal care between March 2012 and May 2016 were reviewed. Charts of IP subjects were randomly selected in each year to achieve a CP:IP ratio of at least 1:3. The primary outcome was rate of LARC use at discharge and within 8 weeks postpartum. Pearson chi-squared test and Wilcoxon rank-sum tests were performed, and a p-value <0.05 was considered significant. Results: 129 women participated in CP care and 412 in IP care. CP women were more likely nulliparous (91, or 70.5% vs 212, or 51.5%, p=0.0001) and more likely to attend at least 15 prenatal visits (54, or 41.9% vs 62, or 15.1%, p<0.0001). LARC use rates at discharge and at the postpartum visit were similar (36, or 27.9% vs 89, or 21.6%, p=0.142; 39, or 32.2% vs 110, or 29.4%, p=0.557). Rates of women using effective contraception (LARC and other hormonal options, including oral contraceptives and Depo Provera) at discharge and at the postpartum visit were similar (59, or 45.7% vs 206, or 50.0%, p=0.177; 72, or 59.5% vs 229, or 61.2%, p=0.157). IUD use was greater than subdermal implant use in both groups (31, or 24.0% vs 5, or 3.9%; 72, or 17.5% vs 17, or 4.1%; p=0.081). Rates of routine postpartum visit attendance at 6-8 weeks postpartum were similar and high in both groups (121, or 93.8% vs 374, or 90.8%; adjusted p-value=0.164). Conclusion: Although CP subjects had more prenatal visits and spent more time with providers, there was no difference on uptake of LARC or effective contraception at discharge or at the postpartum visit when compared to IP subjects.

Type 2 diabetes mellitus and pancreatic cancer risk. An independent etiological relation?

Multiple pathogenic genetic variants are associated with pancreatitis in patients of European (EA) and Asian ancestries, but studies on patients of African ancestry (AA) are lacking. We evaluated the prevalence of known genetic variations in African-American subjects in the US.We studied prospectively enrolled controls (n = 238) and patients with chronic (CP) (n = 232) or recurrent acute pancreatitis (RAP) (n = 45) in the NAPS2 studies from 2000-2014 of self-identified AA. Demographic and phenotypic information was obtained from structured questionnaires. Ancestry and admixture were evaluated by principal component analysis (PCA). Genotyping was performed for pathogenic genetic variants in PRSS1, SPINK1, CFTR and CTRC. Prevalence of disease-associated variants in NAPS2 subjects of AA and EA was compared.When compared with CP subjects of EA (n = 862), prevalence of established pathogenic genetic variants was infrequent in AA patients with CP, overall (29 vs. 8.19%, OR 4.60, 95% CI 2.74–7.74, p < 0.001), and after stratification by alcohol etiology (p < 0.001). On PCA, AA cases were more heterogeneous but distinct from EA subjects; no difference was observed between AA subjects with and without CP-associated variants. Of 19 A A patients with CP who had pathogenic genetic variants, 2 had variants in PRSS1 (R122H, R122C), 4 in SPINK1 (all N34S heterozygotes), 12 in CFTR (2 CFTRsev, 9 CFTRBD, 1 compound heterozygote with CFTRsev and CFTRBD), and 1 in CTRC (R254W).Pathogenic genetic variants reported in EA patients are significantly less common in AA patients. Further studies are needed to determine the complex risk factors for AA subjects with pancreatitis.

Intensity of symptoms and outcomes of acute pancreatitis, a preliminary analysis of the PROMISE study

Multiple pathogenic genetic variants are associated with pancreatitis in patients of European (EA) and Asian ancestries, but studies on patients of African ancestry (AA) are lacking. We evaluated the prevalence of known genetic variations in African-American subjects in the US.We studied prospectively enrolled controls (n = 238) and patients with chronic (CP) (n = 232) or recurrent acute pancreatitis (RAP) (n = 45) in the NAPS2 studies from 2000-2014 of self-identified AA. Demographic and phenotypic information was obtained from structured questionnaires. Ancestry and admixture were evaluated by principal component analysis (PCA). Genotyping was performed for pathogenic genetic variants in PRSS1, SPINK1, CFTR and CTRC. Prevalence of disease-associated variants in NAPS2 subjects of AA and EA was compared.When compared with CP subjects of EA (n = 862), prevalence of established pathogenic genetic variants was infrequent in AA patients with CP, overall (29 vs. 8.19%, OR 4.60, 95% CI 2.74–7.74, p < 0.001), and after stratification by alcohol etiology (p < 0.001). On PCA, AA cases were more heterogeneous but distinct from EA subjects; no difference was observed between AA subjects with and without CP-associated variants. Of 19 A A patients with CP who had pathogenic genetic variants, 2 had variants in PRSS1 (R122H, R122C), 4 in SPINK1 (all N34S heterozygotes), 12 in CFTR (2 CFTRsev, 9 CFTRBD, 1 compound heterozygote with CFTRsev and CFTRBD), and 1 in CTRC (R254W).Pathogenic genetic variants reported in EA patients are significantly less common in AA patients. Further studies are needed to determine the complex risk factors for AA subjects with pancreatitis.

Known genetic susceptibility factors for chronic pancreatitis in patients of European ancestry are rare in patients of African ancestry

BackgroundMultiple pathogenic genetic variants are associated with pancreatitis in patients of European (EA) and Asian ancestries, but studies on patients of African ancestry (AA) are lacking. We evaluated the prevalence of known genetic variations in African-American subjects in the US. MethodsWe studied prospectively enrolled controls (n = 238) and patients with chronic (CP) (n = 232) or recurrent acute pancreatitis (RAP) (n = 45) in the NAPS2 studies from 2000-2014 of self-identified AA. Demographic and phenotypic information was obtained from structured questionnaires. Ancestry and admixture were evaluated by principal component analysis (PCA). Genotyping was performed for pathogenic genetic variants in PRSS1, SPINK1, CFTR and CTRC. Prevalence of disease-associated variants in NAPS2 subjects of AA and EA was compared. ResultsWhen compared with CP subjects of EA (n = 862), prevalence of established pathogenic genetic variants was infrequent in AA patients with CP, overall (29 vs. 8.19%, OR 4.60, 95% CI 2.74–7.74, p < 0.001), and after stratification by alcohol etiology (p < 0.001). On PCA, AA cases were more heterogeneous but distinct from EA subjects; no difference was observed between AA subjects with and without CP-associated variants. Of 19 A A patients with CP who had pathogenic genetic variants, 2 had variants in PRSS1 (R122H, R122C), 4 in SPINK1 (all N34S heterozygotes), 12 in CFTR (2 CFTRsev, 9 CFTRBD, 1 compound heterozygote with CFTRsev and CFTRBD), and 1 in CTRC (R254W). ConclusionPathogenic genetic variants reported in EA patients are significantly less common in AA patients. Further studies are needed to determine the complex risk factors for AA subjects with pancreatitis.

Comparative evaluation of efficacy of subgingivally delivered 1.2% Atorvastatin and 1.2% Simvastatin in the treatment of intrabony defects in chronic periodontitis: a randomized controlled trial.

Background. Statins are the recently evolved agents that aid in periodontal regeneration and ultimately in attaining periodontal health. Atorvastatin (ATV) and Simvastatin (SMV) are specific competitive inhibitors of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. The current study was conducted to compare the effectiveness of 1.2% ATV and 1.2% SMV, in addition to scaling and root planing (SRP), in the treatment of intrabony defects in subjects with chronic periodontitis.Methods. Ninety-six individuals were categorized into three treatment groups: SRP plus 1.2% ATV, SRP plus 1.2% SMV and SRP plus placebo. Clinical parameters of full-mouth plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and relative attachment level (RAL) were recorded at baseline before SRP and at 3, 6 and 9 months. Bone fill was assessed using percentage radiographic defect depth reduction at baseline, 6 months and 9 months.Results. Both ATV and SMV showed significant PD reduction and RAL gain than placebo. ATV group showed greater mean PD reduction and mean RAL gain as compared to SMV group at 3, 6 and 9 months. Furthermore, ATV group sites exhibited a significantly greater percentage of radiographic defect depth reduction (33.23 ± 3.11%; 34.84 ± 3.07%) as compared to SMV (30.39 ± 3.36%; 32.15 ± 3.37%) at 6 and 9 months.Conclusion. ATV resulted in greater improvements in clinical parameters with higher percentage of radiographic defect depth reduction as compared to SMV in the treatment of intrabony defects in CP subjects.

Clinically relevant copy number variations detected in cerebral palsy.

Cerebral palsy (CP) represents a group of non-progressive clinically heterogeneous disorders that are characterized by motor impairment and early age of onset, frequently accompanied by co-morbidities. The cause of CP has historically been attributed to environmental stressors resulting in brain damage. While genetic risk factors are also implicated, guidelines for diagnostic assessment of CP do not recommend for routine genetic testing. Given numerous reports of aetiologic copy number variations (CNVs) in other neurodevelopmental disorders, we used microarrays to genotype a population-based prospective cohort of children with CP and their parents. Here we identify de novo CNVs in 8/115 (7.0%) CP patients (∼1% rate in controls). In four children, large chromosomal abnormalities deemed likely pathogenic were found, and they were significantly more likely to have severe neuromotor impairments than those CP subjects without such alterations. Overall, the CNV data would have impacted our diagnosis or classification of CP in 11/115 (9.6%) families.

Foot progression angle change in spastic diaplegia cp subjects following semls

s / Gait & Posture 39S (2014) S1–S141 S35 Fig. 1. X-ray showing the resected fibula. Fig. 2. X-ray showing the reconstructed mandibula. area as well as for large defects of long bones following trauma or tumor-related resection [2,3]. Several studies have evaluated the functional outcome and donor site complications following resection of the fibula e. a. [4,5]. Only one study performed a full three-dimensional gait analysis: one and three months postoperative [6]. The purpose of this study was to investigate possible gait disturbances after resection of the fibula using preoperative and one year postoperative gait analysis. Patients/materials and methods: In this study data of nine patients (mean age: 43.4 (14.8) years, four men, five women) were analysed. The fibula was used as donor site for the reconstruction of the face in seven patients and for the reconstruction of the humerus in two patients. Patients underwent a standardized clinical exam and three-dimensional gait analysis preand after 10.5 (5.3)months postoperatively. Kinematic, kinetic and time-distance parameters were calculated for the involved and non-involved leg. Statistical analyses were performed with non-parametric tests (Figs. 1 and 2). Results: The analysis of the kinematic parameters showed a significant increase in hip extension (∼6◦) and a decrease in hip flexion (∼6◦) in both legs during gait (p<0.038). For the involved leg a small decrease (∼3◦) in maximal plantarflexion was found (p=0.021), which led to a decrease in the maximal plantarflexion moment and power (p=0.051). No differences were found in the kinematics of the knee, kinetics of hip and knee or the time-space parameters (stride length, stride time and speed). Discussion and conclusions: The changes in the hip kinematics are likely the result of an offset in pelvic tilt induced by marker placement at the pelvis which is transferred as an offset onto the hip motion. Further, the results found in this study correspond to the work of Lee et al. [6], who found small differences one month postoperatively and a reduced peak plantarflexion in swing three monthspostoperatively. Thedifferenceswhichwere foundare clinically not relevant and the reduced plantarflexion can likely be Chart 1. Foot progression angle in spastic diaplegia CP subjects before surgical correction (blue) and at follow up (green), with normal values (orange) with 95% confidence intervals. normalized by therapy and training. This is also shown by a longterm follow-up studywhich showednodifferences in anklemotion and moments after 33 months [7]. In conclusion, resection of the fibula for reconstruction surgery does not influence gait one year after operation.

Applicability of using inertial sensor during gait analysis for hemiplegia patients: Case series

Patients/materials andmethods:Weperformed a case-control study.Weanalysed 14 childrenwith CP, aged 6–15 years,whowere followed in our tertiary outpatient child neurorehabilitation unit and 15 controls. There were no significant differences in age (CP 11.4±3.6 years, controls 10.6±2.6 years) or gender between cases and controls. In the CP group 9 children were graded GMFCS I, 5 weregradedGMFCS II, 12 childrenhadunilateral and2hadbilateral CP. Two U-shaped and two 8-shaped trial walks per subject were performed during which the accuracy and precision of the footworn devicewasmeasured using an opticalmotion capture system (Vicon, Oxford Metrics) as the reference system. All subjects then performed a continuous 200-meter walk test at their self-selected pace wearing the foot-worn inertial sensors (Physilog III, LMAMEPFL, Switzerland). Limb-related spatio-temporal parameterswere compared between paretic and control limbs while bilateral gait characteristics were compared between CP and control subjects, using nonparametric analyses. Results: Mean accuracy±precision for both groups was 3.4±4.6 cm for stride length, 4.3±4.2 cm/s for stride velocity and 0.5±2.9◦ for initial contact foot pitch angle. For temporal parameters paretic limbs showed longer stance (61.9±2.5% vs 60±0.9%, P=0.006) and shorter swing (38.1±2.5% vs 39.9±0.9%, P=0.006) phases,with an increase in double support in childrenwith CP (24.8±4.7% vs 20.3±1.7%, P=0.001). For spatial parameters stride length (1.07±0.18m vs 1.32±0.14, P<0.001), speed (1.13±0.23m/s vs 1.39±0.11m/s, P<0.001) and peak angular velocity during swing (385±74◦/s vs 450±41◦/s, P<0.001) were decreased in paretic limbs, with significant differences in foot pitch at both heel strike and toe-off (P<0.001). Both maximal heel clearance (22.7±3.1 cm vs 25.6±3.5 cm, P=0.004) and maximal toe clearance (7.6±2.9 cm vs 13.4±1.6 cm, P<0.001) were lower in paretic limbs. Discussion and conclusions: Foot-worn inertial sensors allowed us to analyze gait kinematics outside a laboratory environment with a good accuracy and precision. The case control comparison yielded results that were congruent with what is known of gait variations in children with cerebral palsy who walk independently. Participants found the system lightweight and easy to wear and use. While not substituting for complete 3D gait analysis, portable sensors provide precise information about gait in conditions that are closer to the child’s habitual environment and motor behaviour, and could therefore prove to be a useful complement.

The role of Toll‐like receptor 2 and 4 in gingival tissues of chronic periodontitis subjects with type 2 diabetes

Diabetes is one important risk factor of chronic periodontitis. However, the roles of toll-like receptor (TLR) 2 and TLR4, which are implicated in the inflammatory process in both chronic periodontitis and diabetes, have not been studied. This study aimed to determine whether TLR2 and TLR4 might be involved in the relationship between chronic periodontitis and diabetes by examining TLR2 and TLR4 expression in gingival tissues from subjects with chronic periodontitis without diabetes (CP) and with diabetes (CP+DM) and from periodontally healthy subjects without diabetes (PH) and with diabetes (PH+DM). Gingival tissues were collected from 23 CP subjects, 21 CP+DM subjects, 22 PH subjects and 20 PH+DM subjects. The expression of TLR2 and TLR4 in gingival tissues was determined using an immunohistochemical method. In gingival epithelium, staining patterns and intensity levels of TLR2 and TLR4 expression were studied. In connective tissues, the percentages of TLR2- and TLR4-positive cells were calculated. The intensity levels and the percentages of positive cells were statistically analyzed. Chronic periodontitis or diabetes showed no significant effect on TLR2 expression in the oral epithelium. However, diabetes increased the expression of TLR2 in sulcular epithelium and changed the pattern of TLR2 expression in gingival epithelium. Chronic periodontitis decreased the expression of TLR4 in gingival epithelium. In connective tissue under sulcular epithelium, CP+DM subjects showed statistically significant higher percentages of TLR2- and TLR4-positive cells compared with PH and PH+DM subjects. Our results suggest that hyperglycemia and chronic periodontitis had effects on TLR2 and TLR4 expression in gingival tissue. The differences in TLR2 and TLR4 expression could contribute to a greater inflammatory response, leading to periodontal disease initiation and progression.

Analysis of myelomonocytic populations during HIV infection (P6185)

Abstract We hypothesized that alterations in the monocytic and myeloid-derived suppressor cells (MDSCs) subsets contributed to impaired T cell function in HIV infection. CD14++CD16- classical, CD14+CD16+ intermediate, CD14lowCD16+ non classical monocytes and HLA-DR-CD14+CD33+CD11b+ MDSCs surface markers (PDL-1, CD40, HLA-ABC, HLA-DR, CD86, CCR2) and intracellular molecules (IL-12, TNF-α) were analyzed by FACS. Studies were performed on freshly isolated PBMC of healthy controls (HD) and compared to HIV-infected subjects: ART Treated (ARTC), untreated progressors (CP) and elite controllers (EC). CP subjects had significantly higher MDSCs frequency than HD, ARTC and EC. CP also express higher level of all monocyte subsets than HD and ARTC. Classical monocytes of HIV+ individuals express less HLA Class I and II molecules than HD, with a trend observed for CD86. A marked decrease in IL-12 secretion in CP upon stimulation with recombinant IFN-γ and/or LPS was also present. Also, CCR2 looks like a good marker to evaluate the importance of non classical monocytes and MDSC populations as well. Our data show that compared to HD, myelomonocytic subsets in HIV+ individuals present phenotypic and functional differences that are not fully corrected by spontaneous or therapy-induced control of viral replication. Perturbations of these subsets can contribute to ongoing immune dysfunction in treated and untreated HIV-infected subjects and may represent a target for therapeutic interventions.

Reduced short term adaptation to robot generated dynamic environment in children affected by Cerebral Palsy

BackgroundIt is known that healthy adults can quickly adapt to a novel dynamic environment, generated by a robotic manipulandum as a structured disturbing force field. We suggest that it may be of clinical interest to evaluate to which extent this kind of motor learning capability is impaired in children affected by cerebal palsy.MethodsWe adapted the protocol already used with adults, which employs a velocity dependant viscous field, and compared the performance of a group of subjects affected by Cerebral Palsy (CP group, 7 subjects) with a Control group of unimpaired age-matched children. The protocol included a familiarization phase (FA), during which no force was applied, a force field adaptation phase (CF), and a wash-out phase (WO) in which the field was removed. During the CF phase the field was shut down in a number of randomly selected "catch" trials, which were used in order to evaluate the "learning index" for each single subject and the two groups. Lateral deviation, speed and acceleration peaks and average speed were evaluated for each trajectory; a directional analysis was performed in order to inspect the role of the limb's inertial anisotropy in the different experimental phases.ResultsDuring the FA phase the movements of the CP subjects were more curved, displaying greater and variable directional error; over the course of the CF phase both groups showed a decreasing trend in the lateral error and an after-effect at the beginning of the wash-out, but the CP group had a non significant adaptation rate and a lower learning index, suggesting that CP subjects have reduced ability to learn to compensate external force. Moreover, a directional analysis of trajectories confirms that the control group is able to better predict the force field by tuning the kinematic features of the movements along different directions in order to account for the inertial anisotropy of arm.ConclusionsSpatial abnormalities in children affected by cerebral palsy may be related not only to disturbance in motor control signals generating weakness and spasticity, but also to an inefficient control strategy which is not based on a robust knowledge of the dynamical features of their upper limb. This lack of information could be related to the congenital nature of the brain damage and may contribute to a better delineation of therapeutic intervention.

Salivary levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of matrix metalloproteinase (TIMP)-1: A pilot study about the relationship with periodontal status and MMP-9−1562C/T gene promoter polymorphism

ObjectiveChronic periodontitis (CP) has been linked with an imbalance in the MMP-9/TIMP-1 ratio. A reasonable biologic explanation for this link is that the MMP-9 transcriptional activity can be modulated by MMP-9−1562C/T gene promoter polymorphism contributing to periodontal breakdown. This study aimed to assess the relationship between salivary MMP-9/TIMP-1 balance, MMP-9−1562C/T genotype and periodontal clinical status. DesignSixty-nine CP subjects and 54 healthy controls (HC) were selected. Periodontal status was assessed by criteria based on probing depth, clinical attachment level, extent, and severity of periodontal breakdown. Salivary levels of MMP-9 and TIMP-1 were analysed using ELISA and MMP-9−1562C/T genotype using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The association between salivary levels of MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio with CP was assessed individually and adjusted for confounding using a binary logistic regression model. ResultsSignificantly higher levels of both markers and their ratios were detected in the CP group in comparison to healthy controls. Synchronously, weak-to-moderate positive significant correlations between salivary biomarkers and clinical parameters were observed. After binary logistic regression analysis, salivary levels of MMP-9>20ngmL−1, TIMP-1>64ngmL−1 as well as MMP-9/TIMP-1 ratio >1 were independently associated with CP. Nevertheless, the MMP-9−1562C/T gene promoter polymorphism was not associated with the different degrees of chronic periodontitis and did not have influence on the salivary levels of biomarkers. ConclusionThe findings when considered within the limitations of this study may indicate that although a dominant expression of MMP-9 over TIMP-1 in saliva might reflect the periodontal clinical status, the functional polymorphisms in the promoter of the MMP-9−1562C/T gene from the Colombian population are not linked neither with significant salivary MMP-9 variations in these individuals nor periodontal clinical status.

Apolipoprotein E and functional motor severity in cerebral palsy

Cerebral palsy is attributed to non-progressive disturbances in the developing fetal or infant brain. The APOE ε4 allele has been associated with poor outcome after brain injury in adults but may be protective among very young children. We conducted this study to explore the hypothesis that the APOE ε4 is associated with lowered severity of cerebral palsy. 158 individuals with CP and their parents were genotyped for APOE. Mean age was 9.1 years; 54% were males. 61% were preterm at birth; 34% less than 30 weeks gestation. 30% of the CP subjects had at least one ε4 allele. There was a trend towards significance for subjects with at least one ε4 allele assigned to the low severity group (p = 0.11). The greater number of ε4 alleles, the more likely an individual was in the low severity CP group (p = 0.12). Individuals with brain injury in the perinatal period were almost 5 times more likely to be in the low severity group (p < 0.01). Family analysis via the TDT supported a protective effect of APOE ε4. Further study is needed to confirm that, in contrast to adults, the APOE ε4 allele appears to confer protection and/or facilitate recovery after brain injury in the fetus or newborn, particularly when that injury occurs around term.

P069 Differences of lower extremity isometric resistance in ambulatory diplegic and quadriplegic CP subjects

mastered by the patient. And a more difficult modified standing posture is perhaps of greater training effect than a standard standing. The standing exercise applied in this case is not a posture designed according to the biomechanical technology, but a fundamental exercising posture from Taijiquan and other Qigong training, which are Chinese Traditional Physical Therapy. The symmetrical Standing Exercise with Lumbar Vertebrae Flection can improve walking speed of stroke patient.

Dependence and perceived difficulty in activities of daily living in adults with cerebral palsy and spina bifida

Purpose : The purpose of this study was to identify differences between two groups of subjects: one with cerebral palsy, the other with spina bifida in their dependence and their perceived difficulty in performing daily activities according to the Functional Independence Measure (FIM) and the Instrumental Activity Measure (IAM), and to compare these findings with the reported use of assistance. Method : Community-living persons, 53 with cerebral palsy and 20 with spina bifida, aged 20 to 39 years, participated in semistructured interviews in their homes, where rating was performed using items from FIM and IAM. Results : Differences were found for the reported use of assistance and the dependence rated according to FIM and IAM. Significant differences for dependence were found between the CP and SB subjects concerning Eating, Bladder and Bowel items and for perceived difficulty concerning toileting, bladder and bowel. There was close overall agreement between dependence and perceived difficulty, except for the item walk/wheelchair. Conclusions : Subjects in both groups needed help in basic and instrumental ADL. The ability of spina bifida subjects was more influenced in toileting, bladder, bowel than the cerebral palsy subjects and tended also to be so in mobility instrumental tasks. FIM and IAM do not cover all aspects of significance in community-living adults. Further items have to be developed, covering personal care and occupational as well as leisure domains.

Glucoregulation during and after Intense Exercise: Effects ofβ -Adrenergic Blockade in Subjects with Type 1 Diabetes Mellitus1

In intense exercise (>80% maximum oxygen uptake) a huge, up to 8-fold increase in glucose production (Ra) is tightly correlated to marked increases in plasma norepinephrine (NE) and epinephrine. Both Ra and glucose uptake (Rd) are enhanced, not reduced, during beta-adrenergic blockade in normal subjects. Beta-blockade also caused a greater fall in immunoreactive insulin (IRI) during exercise, which could, in turn, have increased Ra directly or via an increased glucagon/insulin ratio. To control for adrenergic effects on endogenous insulin secretion, we tested type 1 diabetic subjects (DM) made euglycemic by overnight i.v. insulin that was kept constant in rate during and after exercise. Their responses to postabsorptive cycle ergometer exercise at 85-87% maximum oxygen uptake for approximately 14 min were compared to those of similar male control (CP) subjects. Six DM and seven CP subjects received i.v. 150 microg/kg propranolol over 20 min, then 80 microg/kg x min from -30 min, during exercise and for 60 min during recovery. Plasma glucose increased from similar resting values to peaks of 6.8 mmol/L in DM and 6.5 mmol/L in CP, then returned to resting values in CP within 20 min, but in DM, remained higher than in CP from 8-60 min (P = 0.049). Ra rose rapidly until exhaustion, to 13.3 mg/kg x min in CP and 11.6 in DM (P = NS). Ra declined rapidly in recovery, although somewhat more slowly in DM (P = 0.013 from 2-15 min). The Rd increased to 10.6 in CP and 9.2 mg/kg x min in DM (P = NS), then declined similarly in early recovery, but remained higher in CP from 50-100 min (P = 0.05). The rises in plasma glucose during exercise in both groups were thus due to the increments in Rd less than those in Ra. The higher recovery glucose in DM was due to the slower decline in Ra and the lower Rd in later recovery. IRI was higher in DM than in CP before exercise (P = 0.011), and whereas it decreased in CP (P < 0.05), it increased approximately 2-fold in DM, thus being higher throughout exercise (P = 0.003). The glucagon/insulin ratio was unchanged in DM, but increased in CP during exercise (P = 0.002). NE showed a rapid, marked increment during exercise to peak values of 23.7 nmol/L in CP and 25.7 nmol/L in DM (P = NS), and epinephrine showed parallel responses. Both correlated significantly with the Ra responses. In summary, the Ra responses of both DM and CP during exercise were greater than those of control unblocked subjects (previously reported) despite higher IRI (all exogenous) in DM. This suggests an important contribution of direct alpha-adrenergic stimulation to this Ra effect.