A systematic review of the rehabilitation of moderate to severe acquired brain injuries

Objective: To conduct a systematic review of the rehabilitation literature of moderate to severe acquired brain injuries (ABI) from traumatic and non-traumatic causes.

Methods: A review of the literature was conducted for studies looking at interventions in ABI rehabilitation. The methodological quality of each study was determined using the Downs and Black scale for randomized controlled trials (RCTs) and non-RCTs as well as the Physiotherapy Evidence Database (PEDro) scale for RCTs only.

Results: Almost 14 000 references were screened from which 1312 abstracts were selected. A total of 303 articles were chosen for careful review of which 275 were found to be interventional studies but only 76 of these interventional studies were RCTs. From this, 5 levels of evidence were determined with 177 conclusions drawn; however of the 177 conclusions only 7 were supported by two or more RCTs and 41 were supported by one RCT.

Conclusion: Only 28% of the interventional studies were RCTs. Over half of the 275 interventional studies were single group interventions, pointing to the need for studies of improved methodological quality into ABI rehabilitation.     

The C-terminus of MinE from Neisseria gonorrhoeae acts as a topological specificity factor by modulating MinD activity in bacterial cell division

MinE regulates the proper placement of the cytokinetic FtsZ ring at midcell by inducing the pole-to-pole movement of MinCD complexes. While the N-terminus of MinE has been implicated in MinD binding, a clear functional role of the C-terminus has not been elucidated. We previously determined that MinE from Neisseria gonorrhoeae (Ng) was functional in Escherichia coli (Ec). Thus, using E. coli as a model organism, gonococcal MinE (MinE(Ng)) function was examined by generating amino acid substitutions of highly conserved MinE(Ng) residues and by testing the ability of the mutant proteins to interact with gonococcal MinD (MinD(Ng)), to induce a minicell phenotype upon overexpression, to initiate MinD(Ng) oscillation, and to stimulate MinD(Ng) ATPase activity. N-terminal MinE(Ng) mutants were unable to bind to MinD(Ng); thus, they did not induce a minicell phenotype, promote MinD(Ng) oscillation or stimulate MinD(Ng) ATPase activity. While C-terminal MinE(Ng) mutants exhibited reduced abilities to bind to MinD(Ng), we show that differences in MinD(Ng) binding to the C-terminus of MinE(Ng) alter the ability of MinE(Ng) to properly stimulate MinD(Ng) activity. We present four major findings from our studies of MinE(Ng): both the N- and C-termini of MinE(Ng) interact with MinD(Ng); interaction between MinD(Ng) and MinE(Ng) is required for the recruitment of MinD(Ng) to the coiled array; oscillation of MinD(Ng) does not require ATPase stimulation; and, the extent of MinD(Ng) ATPase stimulation depends on the binding strength between MinD(Ng) and the C-terminus of MinE(Ng.).     

Atrioesophageal fistula after catheter pulmonary venous ablation for atrial fibrillation: imaging features

Atrioesophageal fistula is a rare but highly morbid complication of catheter-mediated pulmonary vein ablation for the treatment of atrial fibrillation. Among patients who do not exsanguinate from upper gastrointestinal tract bleeding, presentation includes sepsis and embolic cerebrovascular disease. We present a case of atrioesophageal fistula after pulmonary venous ablation as a treatment for atrial fibrillation, focusing on the imaging features of this diagnosis.     

Enhanced marrow [18F]fluorodeoxyglucose uptake related to myeloid hyperplasia in Hodgkin's lymphoma can simulate lymphoma involvement in marrow

[18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) is increasingly used for the clinical staging of lymphomas and for assessment of response to therapy. We report the case of a woman with classic Hodgkin's lymphoma who had marked FDG uptake by tumor and bone marrow suggestive of diffuse marrow involvement by lymphoma. However, iliac crest bone marrow examination showed marked myeloid hyperplasia without evidence of lymphoma involvement. We discuss the implications for interpretation of FDG-PET imaging of bone marrow in lymphomas.     

Flow-cytometric analysis of peripheral blood neutrophils: a simple, objective, independent and potentially clinically useful assay to facilitate the diagnosis of myelodysplastic syndromes

The diagnosis of myelodysplastic syndromes (MDS) is based upon cytopenias, morphologic dysplasia, and cytogenetic abnormalities. Because morphologic dyspoiesis may be subtle, and many cases have normal cytogenetics, additional objective diagnostic tools are needed. We previously developed a novel peripheral blood neutrophil flow-cytometric (FCM) scoring system to identify patients with MDS. Here, in an analysis of 25 patients, we demonstrate that FCM abnormalities are independent of currently measured parameters in MDS, including cytopenias, marrow blast percent, and IPSS score. Importantly, FCM abnormalities were seen in 9/16 MDS patients with normal cytogenetics, suggesting that this simple, non-invasive assay could play a central role in the diagnosis of MDS.     

Scanning beyond anatomic limits of the thorax in chest CT: findings, radiation dose, and automatic tube current modulation

OBJECTIVE: Our objective was to determine additional radiation dose associated with scanning beyond the anatomic limits of the thorax in chest CT protocol and to assess the effect of z-axis modulation on the additional radiation dose associated with the scanning protocol. MATERIALS AND METHODS: "Extra" images for routine chest CT were defined as those above lung apices (supraapical) and those caudal to the lowermost portion of lung parenchyma (infrapulmonary), including images obtained beyond the adrenal glands (infraadrenal). One hundred and forty-eight consecutive chest CT examinations (70 men, 78 women; age range, 15-90 years) performed September 13-25, 2003, were reviewed to determine the number of supraapical, infrapulmonary, and infraadrenal extra images. All examinations were performed using z-axis modulation (n = 70) or fixed tube current (n = 78). The CT dose index volume and dose-length product (DLP) values for the extra images were calculated. Two radiologists reviewed these extra images for pathologic findings. Student's t test was used to perform the statistical analysis. RESULTS: One hundred forty-four (97%) examinations had supraapical extra images and 145 (98%) had infrapulmonary extra images. A total of 31 additional findings were observed in extra images. Most clinically important findings were identified in patients with a history of malignancy. With z-axis modulation, the mean DLP for supraapical and infrapulmonary extra images was 39.98 mGy x cm and 132.59 mGy x cm, respectively. With fixed tube current, the mean DLP for supraapical and infrapulmonary extra images was 30.31 mGy x cm and 95.91 mGy x cm, respectively. CONCLUSION: A substantial number of extra images are acquired during chest CT that do not add clinically important information in patients with nonmalignant indications. The use of z-axis modulation increased radiation dose for the extra images.