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Individuals’ access to sport and physical activity has been hampered due to COVID-19 lockdown restrictions. In Australia participation in community sport was cancelled during lockdowns. There is limited research on the impact of sport participation restrictions on the health and wellbeing of adults.AimThe aim of this study was to investigate the perceived health and wellbeing of a sample of predominantly active Australian adults, both during COVID-19 and in comparison with one year earlier (pre COVID-19).MethodsA survey was conducted during the first COVID-19 restrictions and lockdowns in Australia in May–June 2020. It was distributed by national and state sporting organisations and through researchers’ social media accounts. This particular paper focuses on adults aged 18–59 years. The survey collected information on participant demographics, the sport and physical activity patterns pre- COVID-19, and health and wellbeing outcomes during COVID-19 lockdown and compared to one year earlier. The health measures were cross-tabulated against the demographic and sport and physical activity variables, and group profiles compared with chi-square tests. Scales were derived from three wellbeing questions, and group differences were analysed by t-tests and F-tests.ResultsThe survey sample included 1279 men and 868 women aged 18–59 years. Most (67%) resided in metropolitan cities. The great majority (83%) were sport participants. During COVID-19 lockdown men were significantly more likely than women to report worse or much worse general (p = 0.014), physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction (p = 0.016). The inactive adults were significantly more likely to report poorer general health (p = 0.001) and physical health (p = 0.001) compared to active adults. The younger age cohort (18–29 years) were significantly more likely to report poorer general wellbeing (p p ConclusionIt seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted males and younger adults in particular. Sports clubs provide an important setting for individuals’ health and wellbeing which is why clubs require the capacity to deliver sport and individuals may need to regain the motivation to return.

The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) is challenging, because persistent intravascular abnormalities after previous DVT often hinder a diagnosis by compression ultrasonography. Magnetic resonance direct thrombus imaging (MRDTI), a technique without intravenous contrast and with a 10-minute acquisition time, has been shown to accurately distinguish acute recurrent DVT from chronic thrombotic remains. We have evaluated the safety of MRDTI as the sole test for excluding recurrent ipsilateral DVT. The Theia Study was a prospective, international, multicenter, diagnostic management study involving patients with clinically suspected acute recurrent ipsilateral DVT. Treatment of the patients was managed according to the result of the MRDTI, performed within 24 hours of study inclusion. The primary outcome was the 3-month incidence of venous thromboembolism (VTE) after a MRDTI negative for DVT. The secondary outcome was the interobserver agreement on the MRDTI readings. An independent committee adjudicated all end points. Three hundred five patients were included. The baseline prevalence of recurrent DVT was 38%; superficial thrombophlebitis was diagnosed in 4.6%. The primary outcome occurred in 2 of 119 (1.7%; 95% confidence interval [CI], 0.20-5.9) patients with MRDTI negative for DVT and thrombophlebitis, who were not treated with any anticoagulant during follow-up; neither of these recurrences was fatal. The incidence of recurrent VTE in all patients with MRDTI negative for DVT was 1.1% (95% CI, 0.13%-3.8%). The agreement between initial local and post hoc central reading of the MRDTI images was excellent (κ statistic, 0.91). The incidence of VTE recurrence after negative MRDTI was low, and MRDTI proved to be a feasible and reproducible diagnostic test. This trial was registered at www.clinicaltrials.gov as #NCT02262052.

Objective: Ecological models have been applied to investigate multiple domains influencing physical activity behaviour, including individual, social, organisational, community, environmental and policy factors. With regard to the built environment, research to date has been limited to small geographical areas and/or small samples of participants. This study examined the geographical association between provision of sport facilities and participation in sport across an entire Australian state, using objective total enumerations of both, for a group of sports, with adjustment for the effect of socioeconomic status (SES). Methods: De-identified membership registration data were obtained from state sport governing bodies of four popular team sports. Associations between participation rate, facility provision rate and SES were investigated using correlation and regression methods. Results: Participation rate was positively associated with provision of facilities, although this was complicated by SES and region effects. The non-metropolitan region generally had higher participation rates and better provision of facilities than the metropolitan region. Conclusions: Better provision of sports facilities is generally associated with increased sport participation, but SES and region are also contributing factors. Implications for public health: Community-level analysis of the population, sport participation and provision of facilities should be used to inform decisions of investments in sports facilities.

Background: A magnetic resonance imaging Oil RI) scan of the shoulder can have added value in diagnosing symptomatic osteoarthiitis of the acromioclavicular (AC) joint. Specific MRI signs have been recognized but not analyzed extensively before. This study aims to identify predictive MRI signs in patients with symptomatic AC osteoarthritis.Methods: The MRI scans of 70 patients with symptomatic AC osteoarthritis were compared with those of 70 patients with subacromial pain syndrome and no clinical signs of symptomatic AC osteoarthritis. Seven variables were evaluated on the MRI scans of the AC joint joint space narrowing, inferior osteophytes, joint effusion, osteolysis, hone marrow edema, impression on the supraspinatus, and inferior joint distension. Logistic regression analysis of these variables was performed.Results: The presence of inferior osteophytes, bone marrow edema, impression on the supraspinatus, and inferior joint distension was individually associated with symptomatic AC osteoarthritis. Bone marrow edema was observed only in patients with symptomatic AC osteoarthritis. Multivariate analysis showed a significant association between inferior joint distension, as well as impression on the supraspinatus muscle, and symptomatic AC osteoarthritis. The area under the receiver operating characteristic curve in the multivariate logistic model was 0.839 (95% confidence interval, 0.771 to 0.907). Interobserver and intraohserver variability showed good to excellent is values (range, 0.68 to 0.88).Conclusion: We identified predictive MRI signs in patients with symptomatic AC osteoarthritis. These findings, including bone marrow edema, inferior joint distension, and impression on the supraspinatus muscle, showed good discriminative ability. They are practical and easy to use and can assist the physician in diagnosing symptomatic AC osteoarthritis. (C) 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Background: Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tears.Methods: We conducted a randomized controlled trial that included 56 patients with a degenerative full-thickness rotator cuff tear between January 2009 and December 2012; 31 patients were treated conservatively, and rotator cuff repair was performed in 25 patients. Outcome measures, including the Constant-Murley score (CMS), visual analog scale (VAS) pain and VAS disability scores, were assessed preoperatively and after 6 weeks and 3, 6, and 12 months. Magnetic resonance imaging was performed preoperatively and at 12 months postoperatively.Results: At 12 months postoperatively, the mean CMS was 81.9 (standard deviation [SD], 15.6) in the surgery group vs 73.7 (SD, 18.4) in the conservative group (P = .08). VAS pain (P = .04) and VAS disability (P = .02) were significantly lower in the surgery group at the 12-month follow-up. A subgroup analysis showed postoperative CMS results were significantly better in surgically treated patients without a retear compared with conservatively treated patients (88.5 [SD, 6.2] vs 73.7 [SD, 18.4]).Conclusion: In our population of patients with degenerative rotator cuff tears who were randomly treated by surgery or conservative protocol, we did not observe differences in functional outcome as measured with the CMS 1 year after treatment. However, significant differences in pain and disabilities were observed in favor of surgical treatment. The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.

Aim The primary aim of this study is to analyse the long-term results of the third generation of the “Zweymüller” total hip arthroplasty (THA) comprising the SL-Plus Stem and the Bicon-Plus cup. Methods We evaluated 208 patients with a SL/Bicon-Plus primary THA (218 hips). Survival analysis was performed with a follow-up of 13 to 15 years. Complementary clinical and radiological analysis was performed using the “Hip Injury and Osteoarthritis Outcome Score” (HOOS) and x-rays of the hips. Results The probability of survival of the stem and cup with revision for any reason was respectively 0.96/0.97 at 10 years and 0.92/0.94 at 15 years. The probability of survival of the stem and cup with revision for aseptic loosening was respectively 0.99/0.97 at 10 years and 0.95/0.94 at 15 years. Clinical assessment of the patients, reported by the HOOS, were scored with a median for the subdivisions: symptoms 90%, pain 93%, function in daily activity 87%, function in leisure or sport 75%, and quality of life with 75%. Periprosthetic radiolucent lines were observed in half of all hips in Gruen zones 1 and 7. Mean linear wear of the polyethylene was 1.8 mm which corresponds to 0.12 mm/year. 2/3 of the hips show heterotopic ossifications, mostly Brooker type 1 and 2. Conclusions The “third generation” Zweymüller total hip arthroplasty consisting of the SL stem and the Bicon cup has good long term results in terms of survival, clinical and radiological outcome.

BACKGROUND: Supplementation of oligosaccharides in premature infants was shown to influence the immune system. We determined the effect of combined short-chain galacto-oligosaccharides (scGOS), long-chain fructo-oligosaccharides (lcFOS) and pectin-derived acidic oligosaccharides (pAOS) on antibody concentrations after pneumococcal conjugate vaccination in very preterm infants. METHODS: Very preterm infants with gestational age 0.05). After the booster vaccination at 11 months, antibody levels were no longer different between the two preterm groups. CONCLUSION: Enteral supplementation of scGOS/lcFOS/pAOS has a regulatory effect on the response to conjugated polysaccharide pneumococcal vaccine with normalization of the enhanced responses in preterm infants toward levels similar to healthy term infants.

Background Clinical outcomes in patellofemoral joint replacement may be related to femoral component rotation. Assessment of rotational alignment is however difficult as patients with isolated patellofemoral osteoarthritis often have trochlear dysplasia. The use of the medial malleolus as a landmark to guide rotation has been suggested. The purpose of our study was to evaluate this technique with regard to femoral component rotation, and to correlate rotation with clinical outcomes at one-year follow-up. Methods Forty-one knees in 39 patients had patellofemoral joint replacement using the Zimmer Gender-Solutions patellofemoral prosthesis. Intraoperatively, we determined femoral component rotational alignment using an extramedullary rod aimed at the inferior tip of the medial malleolus. Postoperatively, we measured the angle between the femoral component and the anatomical transepicondylar axis using CT. The amount of rotation was correlated with clinical outcomes at one-year follow-up. Results Forty knees in 38 patients were available for one-year follow-up. Mean femoral component rotation relative to the anatomical transepicondylar axis was 1.4° external rotation (range, − 3.8 to 5.7°). We found no statistically significant correlation between femoral component rotation and change from baseline KOOS subscales at one-year follow-up. Conclusions Our findings show that when using the medial malleolus as a landmark to guide rotation, the femoral component of the patellofemoral prosthesis was oriented in external rotation relative to the anatomical transepicondylar axis in 80% of knees. Our study did not show a relation between the amount of external rotation and clinical outcomes. Level of evidence Level III.

Despite the health benefits of sport, the proportion of people participating in sport decreases with age. This qualitative study explored the benefits and barriers regarding older adult community sport participation, from the perspective of national sporting organizations, in addition to older adult sport club and nonsport club members, across eight focus group interviews (n = 49). Seven benefits were discussed, primarily social and physical health and intergenerational opportunities. Ten barriers were also discussed, including physical health, time constraints, and lack of appropriate playing opportunities. Ensuring access to activities that can benefit social health is of great importance to older adults. As sport can provide participation opportunities across generations, it can be an ideal physical activity option for this age group. However, a major barrier is that sport policy often prioritizes the participation for younger age groups. Policymakers should include a focus on older adults, to derive social health benefits. ispartof: JOURNAL OF AGING AND PHYSICAL ACTIVITY vol:26 issue:3 pages:363-371 ispartof: location:United States status: published

Infections are common in preterm infants and cause differences in cytokine levels. Aim of this study was to measure cytokine levels in preterm infants during the first year of life and to determine the effect of feeding a specific non-digestible carbohydrate mixture (scGOS/lcFOS/pAOS). Furthermore, other perinatal factors in relation to these cytokine levels were analysed. In a randomized controlled trial, preterm infants (GA

A transglutaminase cross-linked caseinate was designed for use in dairy products to increase the viscosity of food matrices. The difference in structure of cross-linked caseinate might have implications for the risk of developing cow's milk allergy. The sensitizing capacity and the allergenicity (the potency to induce an allergic effector response) of cross-linked sodium caseinate was investigated using a mouse model for cow's milk allergy. Mice were orally sensitized with cross-linked caseinate or caseinate using cholera toxin as adjuvant. Anaphylactic shock reactions, change in body temperature, acute allergic skin response, caseinate-, cross-linked caseinate-IgE and mMCP-1 concentrations were determined after challenge with cross-linked caseinate or caseinate. Sensitization with cross-linked caseinate did not result in anaphylactic shock symptoms, drop in body temperature or release of serum mMCP-1. A tendency toward decreased casein-specific IgE levels was observed. The allergenicity did not differ between both products. These results indicate that in already caseinate-sensitized mice, cross-linked caseinate did not provoke more pronounced allergenic reactions compared to sodium caseinate. On top of that, reduced sensitization to cross-linked caseinate was observed. Cross-linked caseinate might therefore be an interesting new dietary concept for humans at risk for food allergy although more mechanistic studies and clinical trials are needed for validation.

Newborn infants, especially preterm infants, have an immature immune system, which is not capable to actively protect against vaccine-preventable infections. Therefore, the newborn is dependent on transplacental transport of Immunoglobulin G (IgG), an active, FcRn receptor mediated process. Fetal IgG rises from approximately 10% of the maternal concentration at 17-22 weeks of gestation to 50% at 28-32 weeks of gestation. If transplacental acquired IgG is lower in preterm than in term infants, preterm infants are especially at risk for these vaccine-preventable diseases. The aim of this study was to review the transplacental transfer of IgG against vaccine-preventable diseases (measles, rubella, varicella-zoster, mumps. Haemophilus influenza type B, diphtheria, tetanus, pertussis and polio) to (pre)term infants and to identify factors that influence the transplacental transfer of these antigens. After selection, 18 studies on transplacental transport to preterm infants were included. In general, these studies showed for all antibodies that preterm infants have lower antibody concentrations compared with term infants. Maternal and infants antibody concentrations showed a strong correlation in 7 of the included studies. Infant antibody concentration was not associated with parity, maternal age, height or weight. Infants of vaccinated mothers had lower anti-measles antibody titers than infants of natural immunized mothers. IgG titers of preterm infants decrease earlier in life below protective antibody titers than term infants. Combined with their immature immune system, this puts preterm infants at increased risk for vaccine-preventable diseases. (C) 2010 Elsevier Ireland Ltd. All rights reserved

Summary. Background: Accurate diagnosis of acute recurrent deep vein thrombosis (DVT) is relevant to avoid improper diagnosis and unnecessary life-long anticoagulant treatment. Compression ultrasound has high accuracy for a first episode of DVT, but is often unreliable in suspected recurrent disease. Magnetic resonance direct thrombus imaging (MR DTI) has been shown to accurately detect acute DVT. The purpose of this prospective study was to determine the MR signal change during 6 months follow-up in patients with acute DVT. Patients/methods: This study was a prospective study of 43 consecutive patients with a first episode of acute DVT demonstrated by compression ultrasound. All patients underwent MR DTI. Follow-up was performed with MR-DTI and compression ultrasound at 3 and 6 months respectively. All data were coded, stored and assessed by two blinded observers. Results: MR direct thrombus imaging identified acute DVT in 41 of 43 patients (sensitivity 95%). There was no abnormal MR-signal in controls, or in the contralateral extremity of patients with DVT (specificity 100%). In none of the 39 patients available at 6 months follow-up was the abnormal MR-signal at the initial acute DVT observed, whereas in 12 of these patients (30.8%) compression ultrasound was still abnormal. Conclusion: Magnetic resonance direct thrombus imaging normalizes over a period of 6 months in all patients with diagnosed DVT, while compression ultrasound remains abnormal in a third of these patients. MR-DTI may potentially allow for accurate detection in patients with acute suspected recurrent DVT, and this should be studied prospectively.

Background: Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as reflected by decreased intestinal permeability. The aim of our study was to investigate whether glutamine-enriched enteral nutrition in VLBW infants enhances the normal decrease in intestinal permeability, as measured by the sugar absorption test (SAT). Methods: In a double-blind, randomized, placebo-controlled trial, VLBW infants (gestational age

Accurate diagnostic assessment of suspected ipsilateral recurrent deep vein thrombosis (DVT) is a major clinical challenge because differentiating between acute recurrent thrombosis and residual thrombosis is difficult with compression ultrasonography (CUS). We evaluated noninvasive magnetic resonance direct thrombus imaging (MRDTI) in a prospective study of 39 patients with symptomatic recurrent ipsilateral DVT (incompressibility of a different proximal venous segment than at the prior DVT) and 42 asymptomatic patients with at least 6-month-old chronic residual thrombi and normal D-dimer levels. All patients were subjected to MRDTI. MRDTI images were judged by 2 independent radiologists blinded for the presence of acute DVT and a third in case of disagreement. The sensitivity, specificity, and interobserver reliability of MRDTI were determined. MRDTI demonstrated acute recurrent ipsilateral DVT in 37 of 39 patients and was normal in all 42 patients without symptomatic recurrent disease for a sensitivity of 95% (95% CI, 83% to 99%) and a specificity of 100% (95% CI, 92% to 100%). Interobserver agreement was excellent (κ = 0.98). MRDTI images were adequate for interpretation in 95% of the cases. MRDTI is a sensitive and reproducible method for distinguishing acute ipsilateral recurrent DVT from 6-month-old chronic residual thrombi in the leg veins.

SUMMARY Persistent infection with Pseudomonas aeruginosa and inflammatory mechanisms play an important role in cystic fibrosis (CF) lung disease. ANCA against BPI, a potent host defence protein with anti-bacterial and anti-endotoxin properties, have been described in CF. We have assessed the relationship of anti-BPI antibodies to pulmonary disease severity in 148 CF subjects. IgA and IgG anti-BPI antibodies were found in 55.4% and 70.3% of CF patients, respectively, and higher levels were strongly associated with colonization with P. aeruginosa (P = 0.001 and 0.039 for IgA and IgG antibodies, respectively). IgA and IgG anti-BPI antibodies were independently associated with more severe lung disease as assessed by chest radiograph score (P = 0.023) and a significantly lower forced expiratory volume in 1 s (FEV1)% (P = 0.01). The pathophysiological relevance of the autoantibodies was investigated further by determining their epitope specificity and their effect on bacterial phagocytosis in vitro. Both isotypes of anti-BPI antibodies were specific for the C-terminus of BPI shown recently to be important for BPI-mediated opsonization, and in vitro affinity-purified anti-BPI antibodies significantly reduced BPI-induced phagocytosis of Escherichia coli compared with controls. These data indicate that anti-BPI autoantibodies are associated with colonization with P. aeruginosa and worse lung disease in CF. The inhibition of bacterial phagocytosis suggests that these autoantibodies may contribute to the persistence of P. aeruginosa in the CF lung and so play a role in perpetuating CF lung damage.

A 11-year-old female gymnast presented with long-standing bilateral wrist pain. Radiographs showed physeal widening and irregularity of the left distal radial and ulnar metaphyses, and irregularity of the right distal radial and ulnar metaphyses without physeal widening. 'Gymnast wrist' was diagnosed and cessation of strenuous activities was advised.

We studied the outcome of pneumococcal meningitis in 83 children who were admitted to a referral hospital and whose meningitis was diagnosed between 1970 and 1994. The median age of the children was 8 months. The most frequently isolated capsular serotypes and/or serogroups of Streptococcus pneumoniae were 6, 14, 18, 19, and 23. Twenty-nine children (35%) were referred by other hospitals. A mortality rate of 17% (primary referrals, 7%; secondary referrals, 35%) was observed. At discharge, 25 survivors (36%) had sequelae: hearing loss (> or = 30 dB) in 19% and neurological sequelae in 25%. During admission, the presence of coma, respiratory distress, shock, a cerebrospinal fluid (CSF) protein level of > or = 2.5 g/L, a peripheral white blood cell count of < 5 x 10(9)/L, and a serum sodium level of < 135 mmol/L were associated with mortality. Sequelae were associated with the presence of coma and a CSF glucose level of < 0.6 mmol/L. We conclude that the mortality rate of pneumococcal meningitis is lower among children than among adults. Children often die of neurological sequelae, while adults frequently die of cardiorespiratory failure due to underlying diseases. For children, coma, respiratory distress, and shock during admission were the clinical findings with the strongest predictive value for sequelae or death.

Flow cytometric DNA ploidy measurements were performed on formalin fixed paraffin embedded tumour specimens from patients with a T1 glottic laryngeal carcinoma in order to evaluate the role of DNA content in relation to local control. From 1980 to 1987, a consecutive series of 90 patients with a T1 glottic laryngeal carcinoma were treated by radiotherapy with curative intent. Biopsies from 44 of these patients were readily available for DNA flow cytometry. In this group aneuploidy was associated with a significantly higher risk (P = 0.018) of local recurrence within 2 years after completion of radiotherapy (38% vs. 9% in the diploid group).

Preterm infants have an impaired gut barrier function. We aimed to determine the effects of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides (short-chain galacto-oligosaccharides (SCGOS)/long-chain fructo-oligosaccharides (LCFOS)) and acidic oligosaccharides (AOS) on intestinal permeability of preterm infants as measured by the sugar absorption test in the first week of life. Furthermore, we determined host- and treatment-related factors associated with intestinal permeability. In a randomised controlled trial, preterm infants with a gestational age SCGOS/LCFOS/AOS or placebo (maltodextrin) between days 3 and 30 of life. Intestinal permeability, reflected by the urinary lactulose/mannitol (L/M) ratio after oral ingestion of lactulose and mannitol, was assessed at three time points: before the start of the study (t = 0), at day 4 (t = 1) and at day 7 (t = 2) of life. Data were analysed by generalised estimating equations. In total, 113 infants were included. Baseline patient and nutritional characteristics were not different between the SCGOS/LCFOS/AOS (n 55) and the placebo groups (n 58). SCGOS/LCFOS/AOS had no effect on the L/M ratio between t = 0 and t = 2. In both the groups, the L/M ratio decreased from t = 0 to t = 2 (P P = 0·002). Exclusive breast milk feeding and mixed breast milk/formula feeding during the first week of life decreased the L/M ratio (P P

Background: Maternal antibodies, transported through the placenta during pregnancy, contribute to the protection of infants from infectious diseases during the first months of life. The aim of this study was to measure the concentration of antibodies against several vaccine-preventable diseases in paired maternal and cord blood serum samples in preterm and term infants and to assess placental transfer ratios and infant antibody concentrations against vaccine-preventable diseases. Methods: Antibody concentrations specific against pertussis proteins (pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae), diphtheria and tetanus toxins, and antibody concentrations specific against polysaccharides from Haemophilus influenzae type b and Neisseria meningitidis serogroup C were measured in cord blood samples from preterm (

In contrast with clinical studies in term infants or older children, it is very difficult to investigate possible immunoregulatory effects of a novel infant formula composition in preterm infants. This is mainly because of the multicausal origin of infections in this high-risk population that is usually admitted to the neonatal intensive care unit. Possible effects of nutrition composition on onset and incidence of nosocomial infections in these very small infants have to be compared with infections that may have originated in utero. The development of the gastrointestinal tract may be inhibited after severe intrauterine growth retardation, leading to functional impairment of the gut shortly after birth. This may be related to the onset of necrotizing enterocolitis of the newborn. However, this disease in very small preterm infants is possibly also related to the initiation of oral feeding and/or the amount of feeding. Specific infection risks of neonatal intensive care as a result of invasive techniques such as artificial ventilation or total parenteral nutrition using indwelling umbilical and/or Silastic lines and so-called "all-in-one" mixtures may influence the incidence of infections. Widespread use of intravenous antibiotics in the neonatal intensive care unit may create an even larger infection risk. Investigation of possible immunomodulatory effects of factors such as prebiotics and probiotics added to the nutrition of preterm infants should always be considered along with other nutritional factors known to influence the immature immune system.

BackgroundPrevention of serious infections in preterm infants is a challenge, since prematurity and low birth weight often requires many interventions and high utility of devices. Furthermore, the possibility to administer enteral nutrition is limited due to immaturity of the gastrointestinal tract in the presence of a developing immune system. In combination with delayed intestinal bacterial colonisation compared with term infants, this may increase the risk for serious infections. Acidic and neutral oligosaccharides play an important role in the development of the immune system, intestinal bacterial colonisation and functional integrity of the gut. This trial aims to determine the effect of enteral supplementation of acidic and neutral oligosaccharides on infectious morbidity (primary outcome), immune response to immunizations, feeding tolerance and short-term and long-term outcome in preterm infants. In addition, an attempt is made to elucidate the role of acidic and neutral oligosaccharides in postnatal modulation of the immune response and postnatal adaptation of the gut.Methods/DesignIn a double-blind placebo controlled randomised trial, 120 preterm infants (gestational age DiscussionEspecially preterm infants, who are at increased risk for serious infections, may benefit from supplementation of prebiotics. Most studies with prebiotics only focus on the colonisation of the intestinal microflora. However, the pathways how prebiotics may influence the immune system are not yet fully understood. Studying the immune modulatory effects is complex because of the multicausal risk of infections in preterm infants. The combination of neutral oligosaccharides with acidic oligosaccharides may have an increased beneficial effect on the immune system. Increased insight in the effects of prebiotics on the developing immune system may help to decrease the (infectious) morbidity and mortality in preterm infants.Trial registrationCurrent Controlled Trials ISRCTN16211826.

Lambers Heerspink FO, van Raay JJ, Koorevaar RC, van Eerden PJ, Westerbeek RE, van’t Riet E, van den Akker-Scheek I, Diercks RL. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. J Shoulder Elbow Surg. 2015 Aug;24(8):1274-81. ### Question: In patients with degenerative rotator cuff tears, how does surgical repair compare with conservative treatment with respect to functional outcomes? ### Design: Randomized (unclear allocation concealment), unblinded, controlled trial with 12 months of follow-up. ### Setting: A university hospital and 2 regional hospitals in the Netherlands. ### Patients: 56 patients (mean age, 61 years; 63% men) with degenerative, nontraumatic full-thickness rotator cuff tears were enrolled. Exclusion criteria included trauma associated with the onset of complaints, previous shoulder surgery, frozen shoulder, osteoarthritis of the glenohumeral or acromioclavicular joint, diabetes, cognitive disorders, and neurologic diseases affecting the upper extremities. 45 patients (80%) were included in the analysis. ### Intervention: Patients were allocated to surgery (n = 25) or conservative treatment (n = …

Background & aims: In a previous study, we have found that glutamine supplementation decreased the infection rate in very low birth weight (VLBW) infants. In this study, we investigated whether this beneficial effect originated from increased number of bifidobacteria and lactobacilli in the intestinal microflora of these infants. Methods: In a randomized controlled trial, VLBW infants (gestational age 0.05). In both groups, colonization with bifidobacteria was delayed, whereas potentially pathogenic bacteria such as E. coli, appeared rapidly after birth. Antibiotic treatment decreased the prevalence of all faecal bacteria (p

To retrospectively review the clinical presentation and serological testing of children diagnosed with coeliac disease at Starship Children's Hospital (Auckland, New Zealand) over a 4-year period between January 1999 and December 2002.A review of Starship Hospital medical records of all children diagnosed with coeliac disease by small bowel biopsy between January 1999 and December 2002 was conducted. Patients had anti-gliadin, endomysial, and tissue transglutaminase antibodies performed prior to small bowel biopsy.There were 48 patients, median age of 6.9 years (range 1.6 to 15.7 years). Comparing symptomatic age groups older and younger than 5 years, the former age group presented significantly more often with abdominal pain (p=0.005) and the latter age group presented significantly more often with failure to thrive (p=0.02). Screening at-risk groups yielded nine children (19%) with asymptomatic disease. Thirty-three of 36 (92%) patients tested positive for the anti-endomysial IgA antibody, and 26 of 27 (96%) patients tested positive with the anti-tissue transglutaminase IgA antibody. Three patients (aged 3, 4, and 6 years of age) were negative for anti-endomysial antibodies (including one also negative for anti-tissue transglutaminase antibody), but all three were positive for anti-gliadin antibody.Our study found that children with coeliac disease are being diagnosed at an older age. Older children also presented with more abdominal pain while younger children presented with more failure to thrive. At-risk groups for coeliac disease may be asymptomatic and form a significant group of patients diagnosed with coeliac disease. Anti-endomysial and tissue transglutaminase antibodies are reliable tests for coeliac disease. However, in younger patients or if there is a high clinical index of suspicion of coeliac disease, small bowel biopsy should be performed even if the anti-endomysial and tissue transglutaminase antibody tests are negative.

Background: Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion because nutrition is limited in the first weeks of life. Objective: The objective was to determine the effect of glutamine-enriched enteral nutrition on feeding tolerance, infectious morbidity, and short-term outcome in VLBW infants. Design: In a double-blind randomized controlled trial, VLBW infants (gestational age = 1 serious infection compared with 38 of 50 (76%) in the control group (odds ratio: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Other variables of feeding tolerance and short-term outcome were not significantly different between groups. Conclusions: Glutamine-enriched enteral nutrition did not improve feeding tolerance or short-term outcome in VLBW infants. However, infectious morbidity was significantly lowered in infants who received glutamine-enriched enteral nutrition

Previous research has suggested that some children have a preference for sour tastes. The origin of this preference remains unclear. We investigated whether preference for sour tastes is related to a difference in rated sour intensity due to physiological properties of saliva, or to an overall preference for intense and new stimuli. Eighty-nine children 7-12 years old carried out a rank-order procedure for preference and category scale for perceived intensity for four gelatins (i.e. 0.0 M, 0.02 M, 0.08 M, 0.25 M added citric acid) and four yellow cards that differed in brightness. In addition, we measured their willingness to try a novel candy and their flow and buffering capacity of their saliva. Fifty-eight percent of the children tested preferred one of the two most sour gelatins. These children had a higher preference for the brightest color (P < 0.05) and were more likely to try the candy with the unknown flavor (P < 0.001) than children who did not prefer the most sour gelatins. Preference for sour taste was not related with differences in rated sour intensity, however those who preferred sour taste had a higher salivary flow (P < 0.05). These findings show that a substantial proportion of young children have a preference for extreme sour taste. This appears to be related to the willingness to try unknown foods and preference for intense visual stimuli. Further research is needed to investigate how these findings can be implemented in the promotion of sour-tasting food such as fruit.

BACKGROUND: Maternal antibodies, transported over the placenta during pregnancy, contribute to the protection of infants from infectious diseases during the first months of life. In term infants, this protection does not last until the first recommended measles-mumps-rubella vaccination at 14 months in the Netherlands, while these viruses still circulate. The aim of the study was to investigate the antibody concentration against measles, mumps, rubella and varicella (MMRV) in mothers and preterm infants or healthy term infants at birth. METHODS: Antibody concentrations specific for MMRV were measured in cord blood samples from preterm (gestational age

A clinical study of patients on the North West Regional Genetic Register with neurofibromatosis type 1 (NF1) identified 523 affected cases from 304 families. In those for whom relevant information was available, 86.7% (383 of 442) had more than six café au lait patches, 83.8% (310 of 370) had axillary freckling, 42.3% (151 of 357) had inguinal freckling, and 63% (157 of 249) had Lisch nodules. Cutaneous neurofibromas were present in 59.4% (217 of 365) and 45.5% (150 of 330) were noted to have subcutaneous tumours. Plexiform neurofibromas were present in 15.3% (80 of 523). A positive family history of NF1 was found in 71.2% (327 of 459) and 28.8% (132 of 459) of affected patients were considered to be the result of a new mutation. Learning difficulties of varying severity occurred in 62% (186 of 300). CNS tumours associated with NF1 were reported in 9.4% (49) of patients, optic gliomas occurring in 25 of these, 4.8% of patients. Some degree of scoliosis was reported for 11.7% (61), 1.9% (10) had pseudoarthrosis, 4.3% (23) had epilepsy, and 2.1% (11) had spinal neurofibromas. Actuarial analyses were carried out for both optic glioma and malignant nerve sheath tumours and the data are presented. Keywords: neurofibromatosis type 1; optic glioma; malignancy; Lisch nodules

To assess the effect on clinical outcome of managing paediatric and adult patients with cystic fibrosis at specialised cystic fibrosis centres.Cross sectional study.Two adult cystic fibrosis centres in the United Kingdom.Patients from an adult cystic fibrosis centre in Manchester were subdivided into those who had received continuous care from paediatric and adult cystic fibrosis centres (group A), and those who had received paediatric care in a centre not specialising in cystic fibrosis followed by adult care in a cystic fibrosis centre (group B). Group C were referrals to the new adult cystic fibrosis centre in Cambridge who had received neither paediatric nor adult centre care for their cystic fibrosis.Body mass index (weight (kg)/height (m2)), lung function (forced expiratory volume in one second (FEV1 percentage of predicted)), the Northern chest x ray film score, and age at colonisation with Pseudomonas aeruginosa.A prominent stepwise increase in body mass index was associated with increasing amounts of care at a cystic fibrosis centre; 18.3, 20.2, and 21.3 for groups C, B, and A respectively (P0.001). Improved nutritional status was correlated with a higher FEV1 and better (lower) chest x ray film scores; r=0. 52 and -0.45 respectively (P0.001 for both).These findings provide the first direct evidence that management of cystic fibrosis in paediatric and adult cystic fibrosis centres results in a better clinical outcome, and strongly supports the provision of these specialist services.

Cystic fibrosis (CF) is characterized by progressive and ultimately fatal pulmonary disease although there are notable variations in clinical features. This heterogeneity is thought to lie outside the cystic fibrosis transmembrane regulator (CFTR) gene locus and may stem from deficiencies in the antiproteinase screen that protects the lung from proteolytic attack. One hundred and fifty seven patients were recruited from two UK CF centres. The serum concentrations of alpha1-antitrypsin, alpha1-antichymotrypsin and C-reactive protein (CRP) were determined and patients were screened for the common S and Z deficiency alleles of alpha1-antitrypsin and the G-->A mutation in the 3' noncoding region of the alpha1-antitrypsin gene (Taq-I G-->A allele). Alpha1-antitrypsin deficiency phenotypes were detected in 20 (16 MS, 1 S and 3 MZ) out of 147 unrelated tested CF patients and were, surprisingly, associated with significantly better lung function (adjusted mean forced expiratory volume in one second (FEV1) 62.5% of predicted for deficient group and 51.1% pred for normal alleles; p=0.043). The Taq-I G-->A allele was found in 21 out of 150 unrelated patients and had no significant effect on CF lung disease or on levels of alpha1-antitrypsin during the inflammatory response. We show here that, contrary to current thinking, common mutations of alpha1-antitrypsin that are associated with mild to moderate deficiency of the protein predict a subgroup of cystic fibrosis patients with less severe pulmonary disease. Moreover, the Taq-I G-->A allele has no effect on serum levels of alpha1-antitrypsin in the inflammatory response, which suggests that the previously reported association of the Taq-I G-->A allele with chronic obstructive pulmonary disease is not mediated by its effect on the serum level of alpha1-antitrypsin.

Calves were delivered by Caesarean section in 128 cases during the early months of 1984. All animals were allocated alternately to a trial group and a group of controls. When the peritoneum and transverse muscle had been sutured, the wounds of the animals in the trial group were irrigated and washed with 300 ml. of Betadine (10 per cent of PVP-iodine in water). This was followed by closure of the wound. The animals of the group of controls were not treated. The procedure was performed in ninety-four primiparae (73 per cent) and thirty-four multiparae (27 per cent). The indication for Caesarean section consisted in fetal oversize in 119 cases (93 per cent). Eight calves (6 per cent) were stillborn or died immediately post partum. The proportion of animals in which the placentae were retained, was 9 per cent. Two animals died from peritonitis and intra-abdominal haemorrhage respectively. Irrigation of the wound did not have any effect on the number of wound infections (Table 3). Wound infection occurred in nineteen animals (15 per cent). The operations were performed by six veterinary surgeons (Table 4). The trial group and group of controls treated by each veterinarian did not differ essentially as regards wound healing.

202 Owners of dogs showing problem behaviour were interviewed during the period from January 1, 1981 to May 31, 1981. The major problem was found to consist in aggressiveness in these dogs, particularly aggressiveness to human individuals (Table 3). An analysis was made to examine whether problem behaviour was specific to breed group or sex. There were not any good grounds for this assumption. Analysis of the ratio between flight and aggressive behaviour (Figure 3) revealed that the male dogs of mastiffs, sheepdogs and bastards showed more aggressiveness than did the bitches of these breeds. The findings in these studies showed that problem behaviour was due to the fact that the dog occupied the wrong place in the hierarchy of the family. This in turn was due to ignorance of the owner. Treatment in the form of basic training in obedience accompanied by enlightenment of the owners on canine behaviour was found to be successful in well over 80 per cent of the cases.

An exceptional case of obscure bleeding in the upper digestive tract caused by an arteriovenous haemangioma of the epiglottis is presented. The clinical details and surgical findings are described.