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LA LUSSAZIONE DELL'ANCA IN BAMBINI AFFETTI DA PARALISI CEREBRALE INFANTILE BILATERALE NON DEAMBULANTI: ANDAMENTO E FATTORI DETERMINANTI LA LUSSAZIONE DELL'ANCA E LA COXALGIA, RUOLO PREVENTIVO DEL POSTURAL MANAGEMENT
No full textIntroduzione
La paralisi cerebrale infantile (PCI) è la più comune causa di disabilità motoria nell'infanzia (prevalenza 2-2,5/1000). Determina un rischio aumentato di progressiva lussazione dell'anca, la quale può provocare coxalgia. I bambini più gravi, non deambulanti, classificati al livello IV-V del Gross Motor Classification System (GMFCS) sono i più colpiti. La lussazione è misurata con l'Indice di Migrazione (IM). Mancano dati sulla prevalenza di lussazione d'anca e coxalgia nella popolazione italiana affetta da PCI. Il postural management è raccomandato come approccio preventivo, ma le evidenze sono scarse e non vi sono dati in merito a tipologia e tempistica.
Obiettivi
1. Studio retrospettivo monocentrico: identificare prevalenza e fattori determinanti la lussazione d'anca(1.1) e la coxalgia (1.2); il valore di IM oltre il quale non ci si possa aspettare un miglioramento con soli approcci conservativi (1.3).
2. Studio randomizzato controllato multicentrico: verificare se il mantenere una posizione seduta che mantenga la testa femorale centrata in acetabolo sia più efficace del tradizionale postural management, nel prevenire un aumento del IM in bambini affetti da PCI tetraplegici
Metodi
1. Criteri di inclusione: PCI spastica o discinetica, livello IV-V del GMFCS , età 0-18 anni. Variabili considerate: IM, livello del GMFCS, età, sesso, tipo di PCI, epilessia farmacoresistente, utilizzo di stabilizzatori-deambulatori o stabilizzatori con o senza sgravio di peso, precedenti inoculi di tossina botulinica o chirurgia, baclofen per os o intratecale, coxalgia. Sono state eseguite statistiche descrittive e una regressione multipla lineare stepwise per analizzare andamento dell'IM ed i fattori che lo influenzano (1.1); statistiche descrittive ed una regressione logistica multivariata stepwise per studiare prevalenza e fattori determinanti coxalgia (1.2); un'analisi con la curva receiver operating characteristics (ROC) per trovare il "punto di non ritorno" (1.3).
2. Criteri di inclusione: PCI spastica o discinetica, età 1-6 anni, livello IV-V di GMFCS, IM<41%. Dopo randomizzazione ai soggetti viene chiesto di mantenere per almeno 5 ore/giorno, per 2 anni, la posizione seduta sperimentale oppure tradizionale. L'obiettivo principale è evitare un aumento dell'IM, misurato a 12 e 24 mesi. Obiettivi secondari includono una valutazione di compliance, qualità di vita, coxalgia, costo dei sistemi di postura.
Risultati
1. Sono stati reclutati 504 pazienti: 302 livello V di GMFCS, 209 di sesso femminile, 432 PCI spastiche.
1.1 L'andamento della lussazione d'anca nelle forme spastiche all'interno del campione esaminato, conferma l'andamento già descritto. Le forme discinetiche invece presentano valori di IM inferiori ed un andamento più variabile rispetto all'età e al livello GMFCS. Età, gravità di PCI e sottotipo spastico sono i principali fattori favorenti. L'analisi di regressione multipla stepwise ha dimostrato che gli ausili per la verticalità assistita con o senza sgravio di peso, in combinazione con la tossina botulinica, contribuiscono a ridurre l'IM. La chirurgia scheletrica, ed in misura minore la chirurgia parti molli, si confermano efficaci nel ridurre l'IM.
1.2 La prevalenza di coxalgia è 9,7% (6,7% livello V GMFCS). Età, sesso, MP, scoliosi lombare sono significativi fattori determinanti indipendenti.
1..3 Il valore limite è MP≥ 50% (sensibilità 84.5%, specificità 100%, p<0.001, test chi-quadrato).
2. L'emergenza del Covid-19 ha determinato un ritardo.
Conclusioni
Forme spastiche e discinetiche hanno andamenti differenti dell'IM. I sistemi per la verticalità assistita hanno un ruolo protettivo. Una prevalenza di coxalgia inferiore alla letteratura. IM<50% è il limite per approcci conservativi preventivi. Il RCT è in corso.Background
Cerebral palsy (CP) is the most common motor disability in childhood (prevalence 2-2.5/1000). CP children have increased risk to incur in progressive hip displacement, which may induce hip pain. More severe non-ambulatory quadriplegic patients, classified as Gross Motor Function Classification System (GMFCS) IV and V, are the most affected. Hip displacement is measured by means of the migration percentage (MP). Data about prevalence of hip luxation and hip pain in the Italian CP population are missing. Postural management is recommended to prevent hip displacement, though the evidence is limited and indications about type and timing are lacking.
Objectives
1. Retrospective single center study involving non-ambulatory CP children: to investigate prevalence and determinants of hip subluxation (1.1) and of hip pain (1.2); the MP value beyond which no reduction might be expected, unless addressing surgery (1.3).
2. Multicenter randomized-controlled trial (RCT): to verify if keeping a sitting position centering the femoral head into the acetabulum is more effective than usual postural management, in preventing MP progression in quadriplegic CP children.
Methods
1. Retrospective study. Inclusion criteria: spastic or dyskinetic CP, GMFCS level IV or V, age 0-18 years. Considered variables: MP, GMFCS level, age, sex, CP subtype, drug-resistant epilepsy, use of walkers or standing devices with weight relief, previous botulinum, or hip surgery, oral or intrathecal baclofen, hip pain. Descriptive statistics and multiple linear stepwise regression were performed to analyze MP trends and determinants (1.1); multivariate stepwise logistic regression to enquire hip pain prevalence and its determinants (1.2); receiver operating characteristic (ROC) curve analysis to find the “point of no return” (1.3).
2. Prospective multicenter RCT. Inclusion criteria: spastic or dyskinetic CP, age 1-6 years, GMFCS IV-V, MP <41%. Subjects are randomly requested to maintain the experimental or traditional sitting position, at least 5 hours a day, for 2 years. The primary outcome is the MP, at 12 and 24 months. Secondary outcomes include compliance and Health Related Quality of Life (HRQoL), hip pain, device cost.
Results
1. A total of 504 subjects were included: 302 GMFCS V, 209 females, 432 spastic CP
1.1 Hip subluxation in spastic CP of the examined sample confirmed the trends previously described. Dyskinetic subtype showed overall lower MP values and a more variable behavior relative to age and GMFCS level. Age, CP severity and spastic subtype are the main determinants. The stepwise multiple regression analysis demonstrated that walking and standing assistive devices with or without weight-relief, combined with botulinum contributed to reduce the MP progression. Bone surgery and, to a lesser extent, also soft tissue surgery, confirmed to be effective in reducing the MP.
1.2 The overall prevalence of hip pain was 9.7% (6.7% were GMFCS V). Age, sex, MP, and lumbar scoliosis were significant independent determinants of hip pain.
1.3 The optimal cut-off value was identified as MP≥ 50%, with a sensitivity of 84.5% and a specificity of 100% (p-value <0.001, performing the chi-squared test).
2. Covid-19 emergency induced a relevant delay. Only partial and preliminary results are available.
Conclusions
Based on our data a divergent MP trend is observed in dyskinetic compared to spastic subjects. Walking and standing devices with or without weight-relief, combined with botulinum contribute to reduce the MP progression in quadriplegic CP children (1.1). A lower prevalence of hip pain was found, compared to previous studies (1.2). The point of no-return under which conservative approaches may have a preventive role is MP<50% (1.3). The RCT is still ongoing (2)
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
A retrospective cohort study about hip luxation in non-ambulatory cerebral palsy patients: The point of no return
Full text linkPURPOSE: The migration percentage is a widely used criterion for surgery in displaced hips. Literature suggests that no hip can spontaneously improve if the migration percentage exceeds 45%, in a mixed population of cerebral palsy children. The aim of the present article was to identify the point of no return of the migration percentage in a selected sample of non-ambulatory cerebral palsy children, being the most exposed to hip luxation. METHODS: This single-center retrospective cohort study included patients with spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV or V, age 0–18, having at least three pelvic radiographies, excluding radiographies relative to hips having previously undergone surgery. The following information was collected: sex, cerebral palsy subtype, Gross Motor Function Classification System level, presence of drug-resistant epilepsy, migration percentage, age at assessment, use of walking or standing assistive devices, previous botulinum injection, oral or intrathecal baclofen, and hip pain. Data were analyzed at the level of the individual hips. Descriptive statistics were presented. Receiver operating characteristic curve analysis was conducted to investigate which value of the migration percentage could be adopted as the “point of no return”: that is, the cutoff value beyond which no migration percentage reduction, by more than 5%, could be expected. RESULTS: The optimal cutoff value was identified as migration percentage ≥50%, with a sensitivity of 84.5% and a specificity of 100% (p-value <0.001). CONCLUSION: Based on the present study, migration percentage ≥50% is the “point of no return” for Gross Motor Function Classification System IV-V cerebral palsy patients, representing the cutoff value beyond which no spontaneous cerebral palsy reduction may be expected, unless addressing surgery. LEVEL OF EVIDENCE: level II—retrospective study
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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