Predictive value of proton magnetic resonance spectroscopy in pediatric closed head injury.

We studied 26 infants (1-18 months old) and 27 children (18 months or older) with acute nonaccidental (n = 21) or other forms (n = 32) of traumatic brain injury using clinical rating scales, a 15-point MRI scoring system, and occipital gray matter short-echo proton MRS. We compared the differences between the acutely determined variables (metabolite ratios and the presence of lactate) and 6- to 12-month outcomes. The metabolite ratios were abnormal (lower NAA/Cre or NAA/Cho; higher Cho/Cre) in patients with a poor outcome. Lactate was evident in 91% of infants and 80% of children with poor outcomes; none of the patients with a good outcome had lactate. At best, the clinical variables alone predicted the outcome in 77% of infants and 86% of children, and lactate alone predicted the outcome in 96% of infants and 96% of children. No further improvement in outcome prediction was observed when the lactate variable was combined with MRI ratios or clinical variables. The findings of spectral sampling in areas of brain not directly injured reflected the effects of global metabolic changes. Proton MRS provides objective data early after traumatic brain injury that can improve the ability to predict long-term neurologic outcome.

Glucocorticoid cytosol binding in exercise-induced sparing of muscle atrophy.

Female rats were initially divided into a sedentary or an exercise group that was trained by treadmill running to a final work rate of 31 m/min, 100 min/day, for 13-18 wk. During the last 12 days of training each of these groups were further subdivided into groups that received daily subcutaneous injections of cortisol acetate (CA) (100 mg/kg body wt) or the vehicle (1% carboxymethyl cellulose). Exercise prevented approximately 40% of the gastrocnemius muscle weight loss due to CA treatment. Training did not influence glucocorticoid cytosol-receptor binding concentrations, using [3H]triamcinolone acetonide (TA) as the labeled glucocorticoid in any of the skeletal muscle types investigated. TA-receptor binding capacities were depleted by the multiple injections but were higher in the red fiber types of the CA-treated trained than those in the CA-treated sedentary animals. In a second series of experiments in which receptor depletion and repletion rates were studied using a single injection of cortisol, TA binding capacities 2 h after the cortisol injection were higher in slow-twitch red soleus muscles of trained as compared with sedentary rats (36.4 +/- 2.0 vs. 26.8 +/- 2.5 fmol/mg protein). Similar patterns of TA binding were also observed at 2 h between trained and sedentary animals in the fast-twitch red muscle types, whereas no training related differences were observed in white muscle types. Total and free serum cortisol concentrations also returned to base-line values faster in the trained animals following the single injection protocol.(ABSTRACT TRUNCATED AT 250 WORDS)