MR Imaging of the Cervical Spine in Nonaccidental Trauma: A Tertiary Institution Experience.

BACKGROUND AND PURPOSE: Cervical MR imaging has demonstrated a utility for detecting soft tissue injury in nonaccidental trauma. The purpose of this study was to identify the incidence and types of cervical spine injury on MR imaging in nonaccidental trauma and to correlate cervical spine injury with parenchymal injury on brain MR imaging and findings on head CT. MATERIALS AND METHODS: A retrospective review of children diagnosed with nonaccidental trauma in a tertiary referral pediatric hospital over 8 years was performed. Inclusion criteria were children younger than 5 years of age, a confirmed diagnosis of nonaccidental trauma, and cervical spine MR imaging within 1 week of presentation. Brain and cervical spine MR imaging, head CT, cervical radiographs, and skeletal surveys were reviewed. RESULTS: There were 89 patients included in this study (48 males; mean age, 9.1 months [range, 1-59 months]). Cervical spine injury on MR imaging was found in 61 patients (69%). Ligamentous injury was seen in 60 patients (67%), with interspinous ligaments being most commonly involved. Abnormal capsular fluid (atlanto-occipital and atlantoaxial) was present in 28 patients (32%). Cervical spine injury on MR imaging was significantly associated with parenchymal restricted diffusion on brain MR imaging and parenchymal injury on head CT (P = .0004 and P = .0104, respectively). Children with restricted diffusion on brain MR imaging were 6.22 (point estimate) times more likely to have cervical spine injury on MR imaging. CONCLUSIONS: There is a high incidence of cervical spine injury in pediatric nonaccidental trauma. Positive findings may affect management and suggest a traumatic etiology.

Diet and exercise interventions following coronary artery bypass graft surgery: a review and call to action.

Coronary artery bypass graft (CABG) surgery has been used for the treatment of coronary artery disease (CAD) for approximately 50 years, and has been performed on millions of people globally. However, little is known about the impact of diet and exercise on long-term outcomes of patients who have undergone CABG surgery. Although clinical practice guidelines on the management of this patient population have been available for approximately 2 decades, evidence regarding secondary prevention behavioral interventions, lifestyle modifications and self-management to slow the progressive decline of CAD, reduce cardiac hospitalizations, and prevent reoperation remains virtually absent from the literature. Diet and exercise are modifiable factors that affect secondary CAD risk. This article reviews the relevant current literature on long-term diet and exercise outcomes in patients who underwent CABG. The limited available literature shows the positive impacts of exercise on psychosocial well-being and physical fitness. Current evidence indicates diet and exercise interventions are effective in the short-term, but effects fade over time. Potential age and sex differences were found across the reviewed studies; however, further research is needed with more rigorous designs to replicate and confirm findings, and to define optimal management regimens and cost-effective prevention strategies.

Antibody validation by Western blotting.

Validation of antibodies is an integral part of translational research, particularly for biomarker discovery. Validation is essential to show the specificity of the reagent (antibody) and to confirm the identity of the protein biomarker, prior to implementing the biomarker in clinical studies.Antibody validation is the procedure in which a single antibody is thoroughly assayed for sensitivity and specificity. Although a plethora of commercial antibodies exist, antibody specificity must be thoroughly demonstrated using a complex biological sample, rather than a recombinant protein, prior to use in clinical translational research. In the simplest iteration, antibody specificity is determined by the presence of a single band in a complex biological sample, at the expected molecular weight, on a western blot.Numerous western blotting procedures are available, spanning the spectrum of single blots to multiplex blots, with images and quantitation generated by manual or automated systems. The basic principles of western blotting are (a) separation of protein mixtures by gel electrophoresis, (b) transfer of the proteins to a blot, (c) probing the blot for a protein or proteins of interest, and (d) subsequent detection of the protein by chemiluminescent, fluorescent, or colorimetric methods. This chapter focuses on the chemiluminescent detection of proteins using a manual western blotting system and a vacuum-enhanced detection system (SNAP i.d.™, Millipore).

Concentration and Preservation of Very Low Abundance Biomarkers in Urine, such as Human Growth Hormone (hGH), by Cibacron Blue F3G-A Loaded Hydrogel Particles.

Urine is a potential source of diagnostic biomarkers for detection of diseases, and is a very attractive means of non-invasive biospecimen collection. Nonetheless, proteomic measurement in urine is very challenging because diagnostic biomarkers exist in very low concentration (usually below the sensitivity of common immunoassays) and may be subject to rapid degradation. Hydrogel nanoparticles functionalized with Cibacron Blue F3G-A (CB) have been applied to address these challenges for urine biomarker measurement. We chose one of the most difficult low abundance, but medically relevant, hormones in the urine: human growth hormone (hGH). The normal range of hGH in serum is 1 to 10 ng/mL but the urine concentration is suspected to be a thousand times less, well below the detection limit (50 pg/mL) of sensitive clinical hGH immunoassays. We demonstrate that CB particles can capture, preserve and concentrate hGH in urine at physiological salt and urea concentrations, so that hGH can be measured in the linear range of a clinical immunometric assay. Recombinant and cadaveric hGH were captured from synthetic and human urine, concentrated and measured with an Immulite chemiluminescent immunoassay. Values of hGH less than 0.05 ng/mL (the Immulite detection limit) were concentrated to 2 ng/mL, with a urine volume of 1 mL. Dose response studies using 10 mL of urine demonstrated that the concentration of hGH in the particle eluate was linearly dependent on the concentration of hGH in the starting solution, and that all hGH was removed from solution. Thus if the starting urine volume is 100 mL, the detection limit will be 0.1 pg/mL. Urine from a healthy donor whose serum hGH concentration was 1.34 ng/mL was studied in order detect endogenous hGH. Starting from a volume of 33 mL, the particle eluate had an hGH concentration of 58 pg/mL, giving an estimated initial concentration of hGH in urine of 0.175 pg/mL. The nanotechnology described here appears to have the desired precision, accuracy and sensitivity to support large scale clinical studies of urine hGH levels.

Nursing outcomes classification: a preliminary report of field testing.

Clinically useful and measurable patient outcomes that are sensitive to nursing interventions are needed to determine the effectiveness of nursing care. Nursing Outcomes Classification (NOC) researchers are evaluating the reliability, validity, and usefulness of the first 190 published outcomes in 10 sites representing the continuum of care. Preliminary analysis of inter-rater reliability and construct or criterion validity of 15 outcomes are described. Results indicate NOC outcomes can be used to accurately document the effectiveness of nursing interventions.

Intermanual and alternate-form equivalence on the trail making tests.

Intermanual discrepancies in performance and alternate-form equivalence on the Trail Making Test were examined among 40 left- and 40 right-hand-preferred normal adults (N = 80). The findings indicate that administration of the Trail Making Tests to the nonpreferred hand does not result in a clinically meaningful difference in score. Neither hand preference nor task complexity (numeric or numeric/lexical) significantly affected the magnitude of the intermanual discrepancy. Mixed-model analyses of variance revealed an interaction (p < .001) indicating that the alternate form for the numeric/lexical Trial Making Test (Trail Making Test, Part D; TMT-D) is slightly more difficult than is the original form Trail Making Test, Part B (TMT-B). Therefore, individuals exposed first to TMT-D performed relatively better in the second trial, whereas individuals exposed first to TMT-B first produced equivalent scores when presented the more difficult form (TMT-D) on the second trial. Thus, although TMT-D is not an equivalent form to TMT-B, it may serve as an excellent alternate form at retest.

Verbal learning subtypes in traumatic brain injury: a replication.

Traumatic brain injury (TBI) has been associated with memory impairments, but the severity and qualitative aspects of such impairment do not appear homogeneous across patients. This study sought to replicate an earlier investigation that found distinct verbal learning subtypes in TBI using the California Verbal Learning Test (CVLT). CVLT data from 88 acute rehabilitation inpatients with mild, moderate, and severe traumatic brain injuries were analyzed with multiple cluster analytic techniques. Cluster analyses yielded five learning subtypes, three of which appeared similar to the subtypes previously identified as Active, Disorganized, and Passive subtypes, and two that appeared similar to the Deficient subgroup. Traumatic brain injury appears to be characterized by heterogeneous, but fairly reliable, verbal learning subtypes that can be detected early postinjury.

Information processing time adds useful information to traditional recall measures.

Clinical work and research activity using memory tests typically use measures of recall. While these measures are useful, they may restrict the nature of memory assessments. A memory test was developed to record encoding and recall times. Analyses were then conducted to determine whether these encoding and recall times related to recall performance. Results indicated that encoding time and recall time related significantly to recall performance. Data also revealed that while the strength of the relationship between encoding time and recall errors generally remained constant, the relationship between recall time and recall errors decreased as task demands increased.

Making science accessible to deaf students. The need for science literacy and conceptual teaching.

Upon examination of current literature, there is a noticeable disparity between suggested science teaching practice and what actually happens in the classroom. This disparity may be more pronounced in science classrooms of deaf students for several reasons discussed in this paper. Science education professionals recommend conceptual teaching, but rote, procedural teaching is often the reality. This is a call to arms for teachers of the deaf to teach science conceptually in an effort to afford deaf students more opportunities to grasp meaning and not function merely at the recall level.

The effects of traumatic brain injuries on information processing.

Many individuals experience memory impairment subsequent to traumatic brain injuries (TBI). These memory deficits may result from general impairment of information processing rather than damage to memory critical neurological systems. The investigators examined learning time and recall errors for easy and hard word pairs in a distraction and no-distraction condition to examine learning patterns. Although results indicated that individuals with and without TBI generally showed the same learning and retrieval patterns, individuals with TBI did so in an accentuated manner. This suggests that attentional deficits associated with TBI are not responsible for subsequent memory deficits.

A shortened intermediate version of the Halstead Category Test.

An effort was made to determine whether the intermediate (ages 9-14) version of the Halstead Category Test (HCT) could be shortened to increase clinical utility without altering it's basic psychometric properties. The Long Intermediate Halstead Category Test was administered to four clinical groups. Statistics were conducted to verify that these groups did not relate differentially to the Category Test or other neuropsychological measures. Twelve shortened Category Tests were then extracted. The psychometric properties of these extracted shortened versions were compared to the long version and the three best were selected for further tests. These three shortened versions were then cross validated. Results indicated that the psychometric properties were similar across the shortened versions. The shortest version was there for chosen which best retained the characteristics of the original test.

Confirmatory factor analysis of the Wechsler Memory Scale-Revised in a sample of head-injured patients.

As part of a standard evaluation of neuropsychological sequelae, the Wechsler Memory Scale-Revised (WMS-R) was administered to 107 patients with a history of traumatic brain injury. Confirmatory factor analyses were conducted on the 12 subtests of the WMS-R to examine the fit of various hypothesized factor patterns, including patterns identified in previous exploratory factor analytic studies. Because part of the correlation between immediate and delayed recall trials of the same material is attributable to a common measurement procedure, this correlation due to measurement commonality was partialled out of the conceptual factor structure. The results suggested the presence of 3 distinct but highly correlated factors: attention/concentration, immediate memory, and delayed recall. Models that posited separate verbal and nonverbal memory processes failed to improve fit over more parsimonious models. Comparisons with previous factor analytic studies and implications for clinical assessment are discussed.

Peak flow meters: are they monitoring tools or training devices?

Previous studies have been inconclusive as to whether peak flow meter use teaches asthma patients to better perceive their own pulmonary functioning. This investigation utilized a delayed baseline design to determine if pulmonary awareness could be improved among a sample of 24 adult patients who compared daily peak expiratory flow rates (PEFR) with asthma symptom ratings. Results indicated that among this sample of adult patients: (i) perception of pulmonary functioning was poor, (ii) adherence to peak flow meter use was poor, and (iii) among patients who use peak flow meters daily, self-perception of pulmonary functioning did not improve significantly. Summary tables and descriptive statistics for pulmonary functioning are provided, and treatment implications are discussed.

Spinal cord injury and concomitant traumatic brain injury. Results of a longitudinal investigation.

One-hundred fifty persons with traumatic onset spinal cord injury (SCI) were administered a comprehensive neuropsychologic test battery an average of 7 weeks after SCI, and 67 were retested using the same battery an average of 38 weeks after initial testing. It was hypothesized that if traumatic brain injury were a significant sequela of SCI, retesting would reveal evidence of cognitive recovery over time and would further enable a clearer separation of preinjury cognitive capacity from the effects of injury. Significant improvement in test performance occurred across time to the degree and in a pattern similar to that noted in persons who have sustained mild to moderate traumatic brain injury. Hypothesized relationships between level and extent of SCI, etiology of injury and presence/absence of loss of consciousness and neuropsychologic test scores were not observed. Implications for the rehabilitation process are discussed.