Brain Reorganization following Intervention in Children with Congenital Hemiplegia: A Systematic Review

Noninvasive rehabilitation strategies for children with unilateral cerebral palsy are routinely used to improve hand motor function, activity, and participation. Nevertheless, the studies exploring their effects on brain structure and function are very scarce. Recently, structural neuroplasticity was demonstrated in adult poststroke patients, in response to neurorehabilitation. Our purpose is to review current evidence on the effects of noninvasive intervention strategies on brain structure or function, in children with unilateral cerebral palsy. The main literature databases were searched up to October 2013. We included studies where the effects of upper limb training were evaluated at neurofunctional and/or neurostructural levels. Only seven studies met our selection criteria; selected studies were case series, six using the intervention of the constraint-induced movement therapy (CIMT) and one used virtual reality therapy (VR). CIMT and VR seem to produce measurable neuroplastic changes in sensorimotor cortex associated with enhancement of motor skills in the affected limb. However, the level of evidence is limited, due to methodological weaknesses and small sample sizes of available studies. Well-designed and larger experimental studies, in particular RCTs, are needed to strengthen the generalizability of the findings and to better understand the mechanism of intervention-related brain plasticity in children with brain injury.

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A Machine Learning Approach to Reveal the NeuroPhenotypes of Autisms

International Journal of Neural Systems ◽

10.1142/s0129065718500582 ◽

2019 ◽

Vol 29 (07) ◽

pp. 1850058 ◽

Cited By ~ 8

Author(s):

Juan M. Górriz ◽

Javier Ramírez ◽

F. Segovia ◽

Francisco J. Martínez ◽

Meng-Chuan Lai ◽

...

Keyword(s):

Machine Learning ◽

Brain Structure ◽

Feature Space ◽

Classification Problem ◽

Small Sample ◽

Biological Sex ◽

Machine Learning Approach ◽

Learning Machine ◽

Small Sample Sizes ◽

Low Dimensional

Although much research has been undertaken, the spatial patterns, developmental course, and sexual dimorphism of brain structure associated with autism remains enigmatic. One of the difficulties in investigating differences between the sexes in autism is the small sample sizes of available imaging datasets with mixed sex. Thus, the majority of the investigations have involved male samples, with females somewhat overlooked. This paper deploys machine learning on partial least squares feature extraction to reveal differences in regional brain structure between individuals with autism and typically developing participants. A four-class classification problem (sex and condition) is specified, with theoretical restrictions based on the evaluation of a novel upper bound in the resubstitution estimate. These conditions were imposed on the classifier complexity and feature space dimension to assure generalizable results from the training set to test samples. Accuracies above [Formula: see text] on gray and white matter tissues estimated from voxel-based morphometry (VBM) features are obtained in a sample of equal-sized high-functioning male and female adults with and without autism ([Formula: see text], [Formula: see text]/group). The proposed learning machine revealed how autism is modulated by biological sex using a low-dimensional feature space extracted from VBM. In addition, a spatial overlap analysis on reference maps partially corroborated predictions of the “extreme male brain” theory of autism, in sexual dimorphic areas.

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The impact of the 30 most cited articles on hip arthroscopy: what is the subject matter?

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz067 ◽

2020 ◽

Vol 7 (1) ◽

pp. 14-21

Author(s):

Alexander von Glinski ◽

Emre Yilmaz ◽

Ryan Goodmanson ◽

Clifford Pierre ◽

Sven Frieler ◽

...

Keyword(s):

Surgical Treatment ◽

Hip Arthroscopy ◽

Randomized Clinical Trials ◽

Technical Note ◽

Small Sample ◽

Level Of Evidence ◽

Thomson Reuters ◽

Treatment Indications ◽

Small Sample Sizes ◽

The Impact

Abstract The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on recent surgical treatment. Due to advancements in hip arthroscopy, there is a widening spectrum of diagnostic and treatment indications. The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on contemporary surgical treatment. The Thomson Reuters Web of Science was used to identify the 30 most cited studies on hip arthroscopy between 1900 and 2018. These 30 articles generated 6152 citations with an average of 205.07 citations per item. Number of citations ranged from 146 to 461. Twenty-five out of the 30 papers were clinical cohort studies with a level of evidence between III and IV, encompassing 4348 patients. Four studies were reviewed (one including a technical note) and one a case report. We were able to identify the 30 most cited articles in the field of hip arthroscopy. Most articles were reported in high-impact journals, but reported small sample sizes in a retrospective setting. Prospective multi-arm cohort trials or randomized clinical trials represent opportunities for future studies.

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A Review of Feeding Interventions for Infants with Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-148.1 ◽

2004 ◽

Vol 41 (3) ◽

pp. 268-278 ◽

Cited By ~ 44

Author(s):

Julie Reid

Keyword(s):

Cleft Palate ◽

Nutrition Education ◽

Small Sample ◽

Data Driven ◽

Quality Of Data ◽

Level Of Evidence ◽

Feeding Methods ◽

Level I ◽

Small Sample Sizes ◽

Feeding Interventions

Objective A literature review was conducted to identify feeding interventions recommended for infants with cleft conditions. Selected articles were critically appraised using an evidence-based practice framework to determine the strength of the evidence underpinning each intervention. Design Electronic databases were searched for reports of cleft palate feeding interventions. The selected articles were coded as being data driven or not; those containing data were then critically appraised using a recognized evidence hierarchy. Finally, each report was ascribed a level of evidence (from I to IV), depending on the quality of data presented. Results Fifty-five articles published between 1955 and 2002 were reviewed. There are currently no completed systematic reviews relevant to this body of literature (level I evidence). Two well-designed randomized controlled trials (level II evidence) were found. These were considered to provide the strongest evidence for feeding intervention techniques. These articles described a combination of interventions, including early feeding and nutrition education, as well as assisted feeding methods for infants with isolated cleft conditions. Three examples of level III.3 evidence were also found. Fifty (91%) of 55 articles reviewed were non–data-driven reports of expert opinion (level IV). Conclusions A paucity of evidence rated as either moderate or strong prevailed, underscoring the need for ongoing scientific evaluation of feeding interventions used with infants who have cleft palate. A number of factors, including the heterogeneity of samples studied, lack of replication of trials, and small sample sizes, affected the type and strength of evidence underpinning specific feeding interventions.

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ERECTOR SPINAE AND SCOLIOSIS IN A POPULATION WITH CEREBRAL PALSY: A PRELIMINARY STUDY

Coluna/Columna ◽

10.1590/s1808-185120181701155345 ◽

2018 ◽

Vol 17 (1) ◽

pp. 14-18

Author(s):

OSAMA J. ALÍ-MORELL ◽

FÉLIX ZURITA-ORTEGA ◽

BERENICE FERNÁNDEZ-ESTÉVEZ ◽

BEATRIZ PADILLA-OBISPO ◽

ROBERTO MARTÍNEZ-PORCEL

Keyword(s):

Cerebral Palsy ◽

Case Series ◽

Muscular Activity ◽

Population Level ◽

Vestibular Stimulation ◽

Cross Sectional Study ◽

Erector Spinae ◽

Level Of Evidence ◽

Cross Sectional ◽

Cobb Method

ABSTRACT Objective: To verify the relation of muscular response to the vestibular stimulation of the erector spinae, specifically longissimus thoracis and iliocostalis lumborum, with the origin of scoliosis in a population of individuals with level V cerebral palsy of the Gross Motor Function Classification System (GMFCS). Methods: Cross-sectional study of 12 individuals aged between four and 14 years. The muscular activity of the longissimus thoracis and iliocostalis lumborum was recorded by electromyography in the presence of anteroposterior and lateral imbalances, comparing it with that obtained in sitting position without imbalances. Scoliosis was assessed by radiological study following Cobb method. Results: Statistically significant differences were found between correct responses of both muscles to anteroposterior imbalances and absence of right thoracolumbar scoliosis (p=0.005; p=0.028), left thoracic scoliosis (p=0.005; p=0.046) and right lumbar scoliosis (p=0.005; p=0.046). Conclusions: The symmetry of muscular responses to anteroposterior imbalances, both of longissimus thoracis and iliocostalis lumborum, seems to be one of the factors that prevent the development of spine deviations in this population. Level of evidence: IV. Type of Study: Case series

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Efficacy of Dietary Supplements in Inflammatory Bowel Disease and Related Autoimmune Diseases

Nutrients ◽

10.3390/nu12072156 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2156 ◽

Cited By ~ 2

Author(s):

Priyanka Jadhav ◽

Yan Jiang ◽

Karolin Jarr ◽

Cosima Layton ◽

Judith F. Ashouri ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Immune Response ◽

Psoriatic Arthritis ◽

Bowel Disease ◽

Inflammatory Diseases ◽

Small Sample ◽

Therapeutic Options ◽

Current Evidence ◽

Inflammatory Bowel ◽

Small Sample Sizes

The microbiome is an important contributor to a variety of fundamental aspects of human health, including host metabolism, infection, and the immune response. Gut dysbiosis has been identified as a contributor to the errant immune response in a variety of immune-mediated inflammatory diseases (IMIDs), such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriatic disease (psoriasis and psoriatic arthritis). Given this, probiotics and prebiotics have been investigated as therapeutic options in these disease states. In our review, we highlight the current evidence on prebiotics and probiotics as well as other supplements (such as fish oils, vitamin D, and curcumin) as therapies for IBD. Recommendations, however, regarding the specific use of such supplements in IBD have been lacking, particularly from professional societies, often due to study limitations related to small sample sizes and design heterogeneity. Hence, we additionally examine the literature on the use of prebiotics, probiotics, and other supplements in related IMIDs, namely RA and psoriasis/psoriatic arthritis, as these diseases share many approved therapeutic options with IBD. Based on these combined findings, we offer additional evidence that may help guide clinicians in their treatment of patients with IBD (and other IMIDs) and provide recommendations on potential next steps in therapeutic research in this area.

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Genetic Mutations in Young Nonsmoking Patients With Oral Cavity Cancer: A Systematic Review

OTO Open ◽

10.1177/2473974x20970181 ◽

2020 ◽

Vol 4 (4) ◽

pp. 2473974X2097018

Author(s):

Rohini R. Bahethi ◽

Katelyn O. Stepan ◽

Rachel Pinotti ◽

Ryan Li ◽

Nishant Agrawal ◽

...

Keyword(s):

Risk Factors ◽

Oral Cavity ◽

Similar Rate ◽

Genetic Alterations ◽

Small Sample ◽

Genetic Mutations ◽

Case Control Studies ◽

Level Of Evidence ◽

Tp53 Mutations ◽

Small Sample Sizes

Objective This investigation aims to review the known genetic mutations associated with oral cavity squamous cell carcinoma (OCSCC) in young adults with limited environmental risk factors (YLERs). Data Sources A comprehensive search strategy was designed to identify studies in MEDLINE (Ovid), Embase (Ovid), and Scopus from database inception to May 2017 that included adults ≤50 years of age with OCSCC and minimal tobacco use history (≤10 pack-years) who had their tumors genetically sequenced or mutational profiles analyzed. Review Methods Identified articles were screened by 2 reviewers. Quality of evidence was graded by the MINORS criteria for case-control studies; other studies were graded by assigning a level of evidence for gene mutation literature. Results Thirteen studies met our inclusion criteria, and 130 patients met our criteria for age and tobacco history. TP53 was the most commonly evaluated gene (10 of 13 studies) and the most frequently observed mutation. One study reported that nonsmokers had significantly fewer TP53 mutations, while 9 studies found no difference in the prevalence of TP53 mutations. No other mutations were found specific to this cohort. Conclusions TP53 mutations may occur at a similar rate in YLERs with OCSCC as compared with older patients or those with risk factors. However, few studies have aimed to characterize the genetic landscape of oral cavity tumors in this population, often with small sample sizes. Future studies are needed to explore unidentified genetic alterations leading to tumor susceptibility or alternative mechanisms of carcinogenesis.

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Ozone exposure and health effects: a protocol for an umbrella review and effect-specific systematic maps

BMJ Open ◽

10.1136/bmjopen-2019-034854 ◽

2020 ◽

Vol 10 (8) ◽

pp. e034854

Author(s):

Tianyu Zhao ◽

Iana Markevych ◽

Christian Janßen ◽

Dennis Nowak ◽

Nadine Steckling-Muschack ◽

...

Keyword(s):

Health Effects ◽

Systematic Reviews ◽

Health Effect ◽

Experimental Studies ◽

Ozone Exposure ◽

Current Evidence ◽

Umbrella Review ◽

Level Of Evidence ◽

Ambient Ozone ◽

Specific Health

IntroductionAmbient ozone exposure may be adverse to health. Since the reported associations between ozone and health effects are heterogeneous and the underlying pathways are indistinct, the overall relationship remains unclear. Only a few overall syntheses of the evidence regarding ozone and health effects are available to date.Methods and analysisWe plan to summarise the current evidence on ozone-related health effects systematically. First, to identify the possible associations between ambient ozone exposure and health outcomes, we will conduct an umbrella review. PubMed, Web of Science and grey literature will be searched for systematic reviews on exposure to ambient ozone and any possible health endpoints published before 31 May 2019. Data selection and extraction will be carried out by one reviewer, and a second reviewer will check the agreement of a sample of the studies. The methodological quality of the eligible systematic reviews and level of evidence regarding ozone and every specific health effect will be evaluated. Second, for each of the identified effects with a high level of evidence, comprehensive information retrievals will be conducted, considering both epidemiological and experimental studies. The study selection and data mapping will be carried out by one reviewer and checked by the second reviewer. We will summarise the information of the filtered epidemiological and experimental studies to conduct several systematic maps presenting the currently available evidence for the specific health effect. Because the association between ozone exposure and chronic obstructive pulmonary disease (COPD) is relatively well investigated, we will at least conduct one systematic map of ozone and COPD.Ethics and disseminationNo ethical approval is required for this study. The completed umbrella review and systematic maps will be considered for publication and presentation. We will additionally upload the relevant data to publicly accessible online databases.PROSPERO registration numberCRD42019123064.

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Equinus Correction During Multilevel Surgery in Adults With Cerebral Palsy

Foot & Ankle International ◽

10.1177/1071100718765161 ◽

2018 ◽

Vol 39 (7) ◽

pp. 812-820 ◽

Cited By ~ 3

Author(s):

Cornelia Putz ◽

Eva Maria Mertens ◽

Sebastian I. Wolf ◽

Andreas Geisbüsch ◽

Mirjam Niklasch ◽

...

Keyword(s):

Cerebral Palsy ◽

Clinical Examination ◽

Case Series ◽

Muscle Length ◽

Ankle Dorsiflexion ◽

Spastic Cerebral Palsy ◽

Level Of Evidence ◽

Multilevel Surgery ◽

Tendon Lengthening

Background: Equinus foot deformity constitutes a common gait disorder in ambulatory adults with bilateral spastic cerebral palsy (BSCP). The outcome after intramuscular aponeurotic lengthening in the context of single-event multilevel surgery (SEMLS) in adulthood has not been investigated. Methods: We followed a group of 31 ambulatory adults with BSCP and equinus who underwent SEMLS including gastrocnemius-soleus intramuscular aponeurotic recession or Achilles tendon lengthening. All patients were analyzed preoperatively and at least 1 year (mean follow-up period: 1.6 years) postoperatively by clinical examination and 3-dimensional instrumented gait analysis including the Gait Profile Score (GPS). Results: Clinical examination showed no significant improvement of ankle dorsiflexion ( P = .5) and an unchanged plantarflexion ( P = .7) with knee extended but a significant postoperative reduction of spasticity in the calf muscle ( P = .0001) as measured by clinical examination following the modified Ashworth scale. Significant improvement of mean ankle dorsiflexion in stance and swing ( P = .0001) was found. The GPS decreased and improved significantly (15.9 ± 4.6 to 11.4 ± 3.1; P = .0001). Persistence of equinus and calcaneal gait indicating under- and overcorrection at follow-up was found in 1 patient (3%), respectively. Conclusion: Intramuscular gastrocnemius-soleus aponeurotic recession is part of multilevel surgery corrected equinus deformity in adults. The increase in muscle length led to significant improvement of kinetic and kinematic parameters during walking without a loss of muscle strength and push-off capacity. The risk of overcorrection after equinus correction in adults with BSCP was found to be relatively low. Level of Evidence: Level IV, retrospective case series.

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Systematic Review on the Efficacy of Cytoreductive Surgery Combined With Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis From Colorectal Carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.1142 ◽

2006 ◽

Vol 24 (24) ◽

pp. 4011-4019 ◽

Cited By ~ 243

Author(s):

Tristan D. Yan ◽

Deborah Black ◽

Renaldo Savady ◽

Paul H. Sugarbaker

Keyword(s):

Systematic Review ◽

Colorectal Carcinoma ◽

Peritoneal Carcinomatosis ◽

Median Survival ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Case Series ◽

Current Evidence ◽

Morbidity Rate ◽

Level Of Evidence

Purpose The efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for patients with peritoneal carcinomatosis from colorectal carcinoma remains to be established. Methods A systematic review of relevant studies before March 2006 was performed. Two reviewers independently appraised each study using a predetermined protocol. The quality of studies was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results of all included studies. Results Two randomized controlled trials, one comparative study, one multi-institutional registry study, and 10 most recent case-series studies were evaluated. The level of evidence was low in 13 of the 14 eligible studies. The median survival varied from 13 to 29 months, and 5-year survival rates ranged from 11% to 19%. Patients who received complete cytoreduction benefited most, with median survival varying from 28 to 60 months and 5-year survival ranging from 22% to 49%. The overall morbidity rate varied from 23% to 44%, and the mortality rate ranged from 0% to 12%. Conclusion The current evidence suggests that cytoreductive surgery combined with perioperative intraperitoneal chemotherapy is associated with an improved survival, as compared with systemic chemotherapy for peritoneal carcinomatosis from colorectal carcinoma.

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Management of Severe Equinovalgus in Patients With Cerebral Palsy by Naviculectomy in Combination With Midfoot Arthrodesis

Foot & Ankle International ◽

10.1177/1071100717709577 ◽

2017 ◽

Vol 38 (9) ◽

pp. 1011-1019 ◽

Cited By ~ 2

Author(s):

Chakravarthy U. Dussa ◽

Leonhard Döderlein ◽

Raimund Forst ◽

H. Böhm ◽

Albert Fujak

Keyword(s):

Cerebral Palsy ◽

Case Series ◽

Success Rates ◽

Retrospective Case ◽

Level Of Evidence ◽

Revision Operation ◽

3 Dimensional ◽

Joint Deformity ◽

The Mean

Background: Equinovalgus deformity is the second most common deformity in cerebral palsy and may be flexible or rigid. Several operative methods from joint sparing to arthrodesis have been described with varying success rates. The aim of this study was to investigate the effectiveness of naviculectomy in combination with midfoot arthrodesis (talo-cuneiform and calcaneocuboid arthrodesis) in the correction of a rigid equinovalgus foot deformity in cerebral palsy. Methods: Forty-eight rigid equinovalgus feet were operated upon in 30 patients from 2008 to 2013. Of these, 44 feet in 26 patients with cerebral palsy (Gross Motor Function Classification System III, IV, or V) with follow-up of more than 2 years were included in the study. The mean age at surgery was 18.1 years. The outcomes were measured objectively using radiographic angles and subjectively using 5 questions to be answered by the caregiver. The feet were then graded into excellent, good, fair, and poor. The mean follow-up was 5.0 ± 1.7 years. Results: Excellent to good results were obtained in 81% of the feet. Both objective and subjective outcomes improved significantly postoperatively ( P < .001). Three feet in 2 patients were graded as poor and underwent a revision operation for pain and recurrence. Conclusions: Naviculectomy in combination with midfoot arthrodesis enabled a good 3-dimensional correction of the forefoot. However, the procedure did not necessarily correct the fixed subtalar joint deformity. Several additional bony and soft-tissue procedures were necessary to achieve a complete correction in these difficult feet. Level of Evidence: Level IV, retrospective case series.

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