Autologous bone marrow mononuclear cells to treat severe traumatic brain injury in children.

Autologous bone marrow mononuclear cells (BMMNCs) infused after severe traumatic brain injury have shown promise for treating the injury. We evaluated their impact in children, particularly their hypothesized ability to preserve the blood-brain barrier and diminish neuroinflammation, leading to structural CNS preservation with improved outcomes. We performed a randomized, double-blind, placebo-sham-controlled Bayesian dose-escalation clinical trial at two children's hospitals in Houston, TX and Phoenix, AZ, USA (NCT01851083). Patients 5-17 years of age with severe traumatic brain injury (Glasgow Coma Scale score ≤ 8) were randomized to BMMNC or placebo (3:2). Bone marrow harvest, cell isolation and infusion were completed by 48 h post-injury. A Bayesian continuous reassessment method was used with cohorts of size 3 in the BMMNC group to choose the safest between two doses. Primary end points were quantitative brain volumes using MRI and microstructural integrity of the corpus callosum (diffusivity and oedema measurements) at 6 months and 12 months. Long-term functional outcomes and ventilator days, intracranial pressure monitoring days, intensive care unit days and therapeutic intensity measures were compared between groups. Forty-seven patients were randomized, with 37 completing 1-year follow-up (23 BMMNC, 14 placebo). BMMNC treatment was associated with an almost 3-day (23%) reduction in ventilator days, 1-day (16%) reduction in intracranial pressure monitoring days and 3-day (14%) reduction in intensive care unit (ICU) days. White matter volume at 1 year in the BMMNC group was significantly preserved compared to placebo [decrease of 19 891 versus 40 491, respectively; mean difference of -20 600, 95% confidence interval (CI): -35 868 to -5332; P = 0.01], and the number of corpus callosum streamlines was reduced more in placebo than BMMNC, supporting evidence of preserved corpus callosum connectivity in the treated groups (-431 streamlines placebo versus -37 streamlines BMMNC; mean difference of -394, 95% CI: -803 to 15; P = 0.055), but this did not reach statistical significance due to high variability. We conclude that autologous BMMNC infusion in children within 48 h after severe traumatic brain injury is safe and feasible. Our data show that BMMNC infusion led to: (i) shorter intensive care duration and decreased ICU intensity; (ii) white matter structural preservation; and (iii) enhanced corpus callosum connectivity and improved microstructural metrics.

Parental perceptions of risk and protective factors associated with the adaptation of siblings of children with cystic fibrosis.

When a child is diagnosed with a chronic, life-threatening illness, there is a significant impact on the healthy siblings. Few studies have addressed the adaptation of well siblings in diagnoses other than cancer. The purpose of this descriptive correlational study was to examine the relationships between the risk and protective factors that affect the psychological adaptation of healthy siblings of a child with cystic fibrosis. Findings from this study suggest family environment, especially parental stress and perceived social support, may affect the adaptation of the well sibling. Adolescent well siblings were more at risk for environmental influences than their younger counterparts.

A multiscale region-based motion detection and background subtraction algorithm.

This paper presents a region-based method for background subtraction. It relies on color histograms, texture information, and successive division of candidate rectangular image regions to model the background and detect motion. Our proposed algorithm uses this principle and combines it with Gaussian mixture background modeling to produce a new method which outperforms the classic Gaussian mixture background subtraction method. Our method has the advantages of filtering noise during image differentiation and providing a selectable level of detail for the contour of the moving shapes. The algorithm is tested on various video sequences and is shown to outperform state-of-the-art background subtraction methods.

Vertebral body reconstruction for thoracolumbar spinal metastasis--a review of techniques.

The spine is the most common site of skeletal metastases with its involvement occurring in up to 40% of patients. Metastatic spinal involvement can cause a number of sequelae like pain, instability and neurologic compression. About 10% of patients with involvement of the vertebral column will subsequently develop neurologic compression.The metastatic spinal lesions mostly affect the vertebral body and pedicle (85%). Management of spinal metastases remains controversial. Recent reports attest to the beneficial role of surgery. The role of decompressive laminectomy without stabilization, has been questioned. The Involvement of Vertebral Body and anterior compression had led to an increasing attention to anterior decompressive procedures, reconstruction and Stabilization. We Review here the Techniques described in literature for anterior reconstruction after vertebral corpectomy.