Effect of Concussion on Reaction Time and Neurocognitive Factors: Implications for Subsequent Lower Extremity Injury

BackgroundRecent evidence has demonstrated that athletes are at greater risk for a lower extremity injury following a return-to-sport (RTS) after sport-related concussion (SRC). The reason for this is not completely clear, but it has been hypothesized that persistent deficits in neurocognitive factors may be a contributing factor.Hypothesis/PurposeThis study assessed simple reaction time, processing speed, attention, and concentration in a group of athletes, post-concussion upon clearance for RTS for potential deficits that may result in slower reaction time, processing speed, attention, and concentration. The researchers hypothesized that the concussion group would demonstrate worse scores on both assessments compared to a sex-, age-, and sport-matched cohort.Study DesignCase-controlled studyMethodsTwelve participants who had suffered a SRC and eight healthy individuals who were matched to the concussed group by age, sex, and sport were evaluated. Those with a concussion had been cleared for RTS by a licensed healthcare provider. Each participant underwent neurocognitive tests that included a simple reaction time test (SRT) and the King-Devick Test (K-D). Independent t-tests were performed to compare the groups with significance set a priori at p<0.05.ResultsThere was a significant difference (p =0.024) between groups for SRT with the concussed group demonstrating a better SRT than the control group. There were no significant differences (p =0.939) between the groups for the K-D.ConclusionWith no significant differences between groups in the K-D assessment and, surprisingly, the concussed group having a better SRT compared to the healthy group, our hypothesis was not supported.Clinical RelevanceThese specific measures, compounded with extensive post-concussion time lapse until RTS clearance, may have limited capacity in revealing potential persistent deficits in relevant neurocognitive characteristics.Level of EvidenceLevel of Evidence 3     

Post-Traumatic Epilepsy: Cellular Mechanisms and Implications for Treatment

Summary: Epilepsy complicates severe head trauma. Development of persistent seizures appears to correlate with the extent of trauma. Although early reports suggested that prophylactic administration of antiepileptic drugs would prevent epileptogenesis, controlled studies have failed to corroborate this assumption. Head trauma initiates a sequence of responses that includes altered blood flow and vasoregulation, disruption of the blood-brain barrier, increases in intracranial pressure, focal or diffuse ischemia, hemorrhage, inflammation, necrosis, and disruption of fiber tracts. The presence of an intracranial hematoma has a robust association with the development of post-traumatic epilepsy. Extravasation of blood is followed by hemolysis and deposition of heme-containing compounds into the neuropil, initiating a sequence of univalent redox reactions and generating various free radical species, including superoxides, hydroxyl radicals, peroxides, and perferryl ions. Free radicals initiate peroxidation reactions by hydrogen abstraction from methylene groups adjacent to double bonds of fatty acids and lipids within cellular membranes. Intrinsic enzymatic mechanisms for control of free radical reactions include activation of catalase, peroxidase, and superoxide dismutase. Steroids, proteins, and tocopherol also terminate per-oxidative reactions. Tocopherol and selenium are effective in preventing tissue injury initiated by ferrous chloride and heme compounds. Treatment strategies for prevention or prophylaxis of post-traumatic epilepsy must await absolute knowledge of mechanisms. Antioxidants and chelators may be useful, given the speculation that peroxidative reactions may be an important component of brain injury responses. However, potential treatment strategies involving -y-aminobutyric acid (GABA) agonists, NMDA receptor antagonists, and barbiturates need further scientific assessment.     

高压氧对迟发性放射损伤的作用

放射疗法是一种对肿瘤和周围正常组织均有显著作用的物理疗法,在放疗的同时,不可避免地会损伤正常组织导致放射损伤,特别是迟发性放射损伤,这将严重影响患者的生存质量。随着时间的推移迟发性放射损伤会发展得更加严重,甚至致死,因此限制了临床治疗时的放射剂量,目前这一问题并未得到解决。笔者主要就高压氧治疗对迟发性放射损伤的影响作一综述。     

88例颈椎过伸性损伤手术疗效分析

目的 探讨手术与非手术治疗颈椎过伸性损伤(CWI)的疗效.方法 对88例颈椎过伸性损伤患者进行回顾性分析.其中手术组64例(颈椎前路手术减压术44例,后路减压术20例),非手术组24例.颈椎损伤神经功能恢复按Frankle分级和ASIA评分标准进行评估.结果 随访6～24个月,结果显示,两组神经功能均较治疗前有明显改善,手术组比非手术组神经功能恢复好,两组间差异有统计学意义;前路手术较后路手术神经功能恢复好.结论 手术治疗急性颈椎过伸性损伤疗效较好;而前路减压是过伸性颈椎损伤首选的治疗方法.     

口腔修复技术治疗早期牙隐裂的临床效果

目的 分析口腔修复技术治疗早期牙隐裂的临床效果。方法 选取2021年11月-2022年11月于 我院口腔科治疗的102例早期牙隐裂患者为研究对象,采用随机数字表法分为对照组与观察组,每组 51例。对照组予以传统调磨填充治疗,观察组采用口腔修复技术治疗,比较两组修复效果、疼痛程度 （VAS评分）、并发症发生率、复发率、舒适度、满意度。结果 观察组修复治疗总有效率高于对照组 （P＜0.05）;观察组治疗后VAS评分低于对照组（P＜0.05）;观察组并发症发生率、复发率均低于对 照组（P＜0.05）;观察组舒适度、满意度均优于对照组（P＜0.05）。结论 对早期牙隐裂患者进行口腔 修复技术治疗能够达到良好的修复效果,可减轻患者咀嚼过程中的疼痛感,有利于预防并发症发生,减 少复发情况,提高患者舒适度和满意度,值得临床应用。     

Return to Play After Distal Biceps Tendon Repair

Purpose of ReviewDistal biceps tendon ruptures (DBTR) are uncommon injuries in 40- to 50-year-old men but occur at a younger age in the athlete population. The distal biceps tendon is an important supinator of the forearm and flexor of the elbow. A complete injury results in limiting function in the upper extremity. The current review evaluates the different options in management and the current literature on return to play in athletes.Recent FindingsThe distal biceps tendon inserts on the posterior aspect of the radial tuberosity as two independent heads. The long head footprint is more proximal and posterior giving it a better lever arm for supination. The short head footprint is more distal and anterior giving it a better lever arm for flexion. Surgical anatomic repair is highly recommended among the athlete population, to restore proper function of the upper extremity. There is scarce literature on return to play among athletes. The most recent studies on high-performance athletes are on National Football League (NFL) players. These studies showed that 84–94% of NFL players returned to play at least one game after distal biceps repair. Compared to matched control groups, there was no difference in the player’s performance after surgery.SummaryAnatomic repair of DBTR results in excellent outcomes, high return to work, and high rate of return to play among athletes. When compared to matched control groups, NFL players have the performance score and play the same number of games after surgery.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12178-022-09742-x.     

重型颅脑损伤病人的临床评估

对６８例重型脑外伤患者的评分和预后评估进行分析，提出以重型脑外伤病人的血压、脉搏、呼吸、神智（ＧＣＳ）、瞳孔５项指标作为评估指数进行评分（简称重型脑外伤评估指数），总分为２５分，最低分５分。结果表明：评分在７分以下，持续２～４ｈ者，抢救意义不大；８～１３分，抢救４～６ｈ无效者，其死亡、残废率很高；计分在１４分以上者，有抢救意义，尤以１８分以上者，抢救意义明显增大     

牙周炎患者种植义齿修复后口腔自我维护的临床观察

目的：探讨菌斑显示剂在牙周炎患者种植义齿修复后口腔维护中的作用。方法整群选择2013年5月—2015年2月在医院进行义齿修复的62例患者共78颗种植体作为研究对象,随机分为观察组和对照组,每组31例39颗种植体。在修复后的口腔自我维护中,对照组给予一般维护,观察组在此基础上给予菌斑显示剂,比较两组患者的牙周参数和种植体周围黏膜炎发生率。结果种植体完成修复2周后,两组患者PLI、SBI、PD和菌斑指数与对照组相较差异无统计学意义(P>0.05);修复3个月后所有患者观察组PLI、SBI、PD和菌斑指数均优于对照组(P<0.05);种植修复后1年内,观察组种植体周围粘膜炎平均发生率为45.6%,对照组为59.4%,差异有统计学意义(P<0.05)。结论系统的口腔自我维护能够显著降低牙周炎患者种植体周围黏膜炎的发生率,使用菌斑显示剂让患者对菌斑有良好的自我控制效果显著。     

大鼠脊髓损伤后巢蛋白在脊髓组织中的表达

目的探讨大鼠脊髓损伤后巢蛋白(nestin)的表达规律及其意义。方法30只Wister成年大鼠,随机分为正常对照组(A组)、损伤组(B组)。采用Allen打击模型(25g·cm),在T10段造成急性脊髓损伤,于损伤后1d、3d、1周、4周、8周进行取材,对距离损伤中心5mm处脊髓进行nestin免疫组化检测。应用图像分析软件进行nestin阳性区域面积侧算。结果A组脊髓室管膜细胞只可见极少数细胞胞浆内nestin表达,白质中几乎无表达。B组中nestin于损伤后24h表达于室管膜以及软膜,灰质和白质亦有少量表达,1周达到高峰(P<0.05),4周明显下降,8周时很少或几乎无表达。结论脊髓组织的许多部位可能存在具有分化和更新潜能的祖细胞,脊髓损伤后这些细胞被激活,在功能恢复中可能发挥着重要的作用。     

选择性融合术治疗老年人颈椎过伸性损伤

目的探讨选择性融合治疗合并多节段退变的颈椎过伸性损伤的手术疗效。方法对2002~2006年收治的16例颈椎过伸性损伤根据临床表现实施单节段椎间隙减压,植骨融合内固定术,术后予以脱水、抗感染等对症治疗。结果所有患者随访均获得了骨性融合,神经功能障碍按JOA评分由术前14~16(平均15.2±1.3)分改善至术后16~17(平均16.7±0.6)分。结论选择性融合治疗多节段退变的颈椎过伸性损伤是一种简单、安全的手术治疗方法,可以减少患者的创伤,最大程度地保留患者颈椎运动功能。