Can diffusion tensor imaging predict motor power affection after moderate traumatic brain injury?

Objective

To determine whether commissural and projection fibers fractional anisotropy (FA) abnormalities can help in the prediction of long-term outcome of motor power affection after moderately severe traumatic brain injury (TBI).

Methods

MRI protocol included diffusion tensor imaging (DTI) and was performed for 32 patients with moderate TBI and 32 matched control subjects. Regions of interests were applied in the FA maps in the corpus callosum, internal capsules posterior limb, and cerebral peduncles. Results were compared in patients with motor power affection and patients without motor power affection to the control group.

Results

All patients had FA values lower than the control group with significance differences in the corpus callosum. Patient group with weakness had FA values lower than the control groups with significance differences in the posterior limb of the left internal capsules (p = 0.001) and left cerebral peduncles (p < 0.001). Significant differences were found when comparing the posterior limb of the left internal capsule (p = 0.002) and left cerebral peduncle (p = 0.022) to the right side in the weakness group.

Conclusion

FA values measured in the acute stage provided information about associated and projectional fibers disruptions, which have a prognostic value about motor power affection.     

醒脑开窍针法配合康复训练治疗颅脑外伤肢体运动障碍的临床观察

目的:观察醒脑开窍针法配合康复训练治疗中重度颅脑外伤后肢体运动障碍的疗效。方法:60例中重度颅脑外伤后肢体运动障碍的患者,随机分为两组,每组30例,对照组给予西医常规治疗配合康复训练,治疗组在对照组基础上加用醒脑开窍针法。运用Fugl—Meyer运动功能评分法、Barthel ADL指数评定方法进行疗效评定。结果:治疗后两组病例的运动功能及日常生活能力均较治疗前有改善,但治疗组疗效优于对照组(P<0.05)。结论:初步说明本法治疗中重度颅脑外伤后肢体运动障碍有良好疗效,且该法简便易行、容易推广,同时也为扩大醒脑开窍针法的运用范围提供了参考。     

Diffuse and spatially variable white matter disruptions are associated with blast-related mild traumatic brain injury

Mild traumatic brain injury (mTBI) due to explosive blast is common among military service members and often associated with long term psychological and cognitive disruptions. Little is known about the neurological effects of blast-related mTBI and whether they differ from those of civilian, non-blast mTBI. Given that brain damage from blasts may be diffuse and heterogeneous, we tested the hypothesis that blast mTBI is associated with subtle white matter disruptions in the brain that are spatially inconsistent across individuals. We used diffusion tensor imaging to examine white matter integrity, as quantified by fractional anisotropy (FA), in a group of American military service members with (n = 25) or without (n = 33) blast-related mTBI who had been deployed as part of Operation Iraqi Freedom or Operation Enduring Freedom. History of civilian non-blast mTBI was equally common across groups, which enabled testing of both blast and non-blast mTBI effects on measures sensitive to (1) concentrated, spatially consistent (average FA within a region of interest [ROI]), (2) concentrated, spatially variable (number of ROIs with low average FA), and (3) diffuse (number of voxels with low FA) disruptions of white matter integrity. Blast mTBI was associated with a diffuse, global pattern of lower white matter integrity, and this pattern was not affected by previous civilian mTBI. Neither type of mTBI had an effect on the measures sensitive to more concentrated and spatially consistent white matter disruptions. Additionally, individuals with more than one blast mTBI tended to have a larger number of low FA voxels than individuals with a single blast injury. These results indicate that blast mTBI is associated with disrupted integrity of several white matter tracts, and that these disruptions are diluted by averaging across the large number of voxels within an ROI. The reported pattern of effects supports the conclusion that the neurological effects of blast mTBI are diffuse, widespread, and spatially variable.     

脑外伤功能障碍的早期康复和护理

地震后脑外伤是自然灾害危及生命、导致残疾的主要原因。在脑外伤患者生命体征稳定后,应尽早介入康复,详细评价外伤后所造成的各种功能障碍,采取积极有效的康复治疗和护理。本文针对脑外伤后常见的功能障碍情况,大体介绍了目前常用的康复和护理措施。     

仿真人体体模在全身照射中剂量评估及监测的研究

利用仿真人体体模和热释光测量设备,在X射线全身照射治疗条件下,测量了人体各重要组织和器官的吸收剂量,获得了人体内剂量分布信息,对全身放射治疗中人体各组织和器官的实际受照剂量进行评估和监测。     

Effects of CranioSacral therapy upon symptoms of post-acute concussion and Post-Concussion Syndrome: A pilot study

ObjectiveThe purpose of this study was to investigate the utilization of CranioSacral Therapy (CST) in patients with Post-Concussion Syndrome (PCS) and capture patient-reported perceptions of clinical outcomes of lived treatment experiences.DesignTwo-part, longitudinal study conducted through a chart review of target group, followed by a Patient-reported Treatment Outcome Survey (PTOS).ParticipantsA convenience sample of 212 patients with a historical incidence of head trauma not requiring hospitalization was obtained through medical records department dating back ten years. Inclusion criteria for further chart review (n = 67) was determined by identifying patients with a confirmed concussion directly correlated with presenting symptoms and for which CST was specifically sought as a treatment option. Demographics and patient-determined treatment duration data were analyzed by comparison groups extensively suggested in existing literature: Recovery time since injury as either Post-acute concussion (<6 months) or Post-Concussion Syndrome (PCS) (≥6 months); Athletes (A) or Non-athletes (NA); and traditional gender. Final PTOS group criteria was determined by eliminating confounding issues reporting (n = 47): (A, n = 24 and NA, n = 23).ResultsQuantitative data was analyzed via Numerical Analysis, and qualitative data was analyzed via Inductive Content Analysis. Symptoms reported in all charts as well as in the PTOS were consistent with identified PCS subtypes. Utilization of CST revealed that most patients determined the treatment effect upon concussion symptoms within 1–3 sessions. Nearly twice as many sessions were attended in the PCS than post-acute groups. Referral sources, studied for a perspective on local concussion after-care discharge planning, ranged from professional to personal recommendation or self-discovery. A majority of patients met goals of reducing post-acute or PCS as reasons cited by self-determined change-in-status or discharge from service. Patients were asked to indicate on the PTOS which pre- and post-treatment symptoms were helped or not helped by this particular intervention.ConclusionsPatient-reported changes of PCS symptoms is critical when evaluating treatment options. CST is an experiential treatment that addresses subjective levels of dysfunction, thus it is the patient deciding the value of an intervention. A sizable portion of patients in all groups reported a positive effect upon their symptoms by CST. Patients indicated personal meaning to CST through their utilization of multiple sessions. A high percentage indicated the likelihood of referring others with PCS for CST. Of the 212 patient charts first studied, the 145 not meeting inclusion criteria suggest some chronic conditions may present as long-term effects of older head injuries. CST is a low-risk, conservative treatment option for PCS sub-types worthy of further clinical study.     

Marrow transplantation for leukemia following fractionated total body irradiation. A comparative trial of methotrexate and cyclosporine

Fifty-six patients, 30-47 yr of age, with leukemia in relapse received allogeneic marrow transplants from HLA-identical siblings. All patients were treated with cyclophosphamide (120 mg/kg) and 7 daily fractions of 2.25 Gy of total body irradiation (TBI) for seven consecutive days. Nine patients (16%) are currently alive and free of disease 324-845 days from transplantation. The actuarial relapse and survival rates at 2 yr were 56% and 9.5% respectively. These data were not remarkably different from those in previous studies using 10 Gy of TBI administered as a single dose. Thirty patients were randomized to receive methotrexate (MTX) and 26 to receive cyclosporine (CSP) as postgrafting prophylaxis for acute graft-versus-host disease (GVHD). The probability of developing significant acute GVHD by day 100 post-transplant was 71% for patients in the MTX group and 45% for patients in the CSP group (p less than 0.05). The probability of relapse was 37% for patients in the MTX group and 70% for patients in the CSP group (p less than 0.05). Transplant-related deaths were more frequent in the MTX group and leukemic deaths were more frequent in the CSP group although this may have been related to an uneven distribution of high-risk patients. Long-term disease-free survival was comparable. Patients in the MTX group had more severe mucositis, more alveolar pneumonias and possibly more deaths due to complications of acute and chronic GVHD. Patients in the CSP group had a higher incidence of hypertension, neurological complications and renal dysfunction.