Injury volume extracted from MRI predicts neurologic outcome in acute spinal cord injury: A prospective TRACK-SCI pilot study.

Conventional MRI measures of traumatic spinal cord injury severity largely rely on 2-dimensional injury characteristics such as intramedullary lesion length and cord compression. Recent advances in spinal cord (SC) analysis have led to the development of a robust anatomic atlas incorporated into an open-source platform called the Spinal Cord Toolbox (SCT) that allows for quantitative volumetric injury analysis. In the current study, we evaluate the prognostic value of volumetric measures of spinal cord injury on MRI following registration of T2-weighted (T2w) images and segmented lesions from acute SCI patients with a standardized atlas. This IRB-approved prospective cohort study involved the image analysis of 60 blunt cervical SCI patients enrolled in the TRACK-SCI clinical research protocol. Axial T2w MRI data obtained within 24 h of injury were processed using the SCT. Briefly, SC MRIs were automatically segmented using the sct_deepseg_sc tool in the SCT and segmentations were manually corrected by a neuro-radiologist. Lesion volume data were used as predictor variables for correlation with lower extremity motor scores at discharge. Volumetric MRI measures of T2w signal abnormality comprising the SCI lesion accurately predict lower extremity motor scores at time of patient discharge. Similarly, MRI measures of injury volume significantly correlated with motor scores to a greater degree than conventional 2-D metrics of lesion size. The volume of total injury and of injured spinal cord motor regions on T2w MRI is significantly and independently associated with neurologic outcome at discharge after injury.

A revised phylogeny of macropathine cave crickets (Orthoptera: Rhaphidophoridae) uncovers a paraphyletic Australian fauna.

Australian cave crickets are members of the subfamily Macropathinae (Orthoptera: Rhaphidophoridae). The subfamily is thought to have originated prior to the tectonic separation of the supercontinent Gondwana based on distributions of extant lineages and molecular phylogenetic evidence, although the Australian fauna have been underrepresented in previous studies. The current study augments existing multigene data (using 12S, 16S, and 28S rRNA genes) to investigate the placement of the Australian representatives within the Macropathinae and to assess divergence dates of select clades. Results suggest that the endemic Tasmanian genus Parvotettix is the sister lineage to the remaining members of the subfamily, an outcome that presents a paraphyletic Australian fauna in contrast to previous studies. All other Australian taxa represented in this study (Micropathus and Novotettix) emerged as a sister group to the New Zealand and South American macropathine lineages. Estimation of phylogenetic divergence ages among the aforementioned clades were calibrated using two methods, in absence of suitable fossil records: (i) tectonic events depicting the fragmentation of Gondwanan landmasses that invoke vicariant scenarios of present day geographic distributions; and (ii) molecular evolutionary rates. Geological calibrations place the median age of the most recent common ancestor of extant macropathines at ∼125 to ∼165 Ma, whereas analyses derived from molecular substitution rates suggest a considerably younger origin of ∼32 Ma. This phylogenetic study represents the most rigorous taxonomic sampling of the Australian cave cricket fauna to date and stresses the influence of lineage representation on biogeographic inference.

Caretakers' Self-Selected Oral Health Goals: Self-Efficacy, Perceived Compliance, and Effect on Recall Attendance.

PURPOSE: The purpose of this study was to describe caretakers' self-selected pediatric oral health goals, self-reported compliance, perceived self-efficacy, and perceived barriers to goal accomplishment. The effect of self-management plans on recall attendance was also evaluated. METHODS: Fifty caretaker-patient pairs who presented for examinations at a university pediatric dental clinic were assigned to an intervention group. Fifty age-matched subjects were assigned to the comparison group. At baseline both groups completed a demographic survey. The intervention group developed a self-management plan and selected oral health goals. Follow-up surveys were administered to the intervention group two weeks and six months later. RESULTS: The most frequently selected oral-health goals were brush twice daily (21 percent) and toothbrush before bed (17 percent). At the two-week follow-up, 39 percent of contacted caretakers recalled their chosen goals correctly, compared to 26 percent at six months. Approximately half of the participants in both groups attended the six-month follow-up visit. The difference in recall attendance between intervention and comparison group was not significant (P=0.80). CONCLUSIONS: Caretakers most frequently selected goals that were associated with toothbrushing. They initially reported high confidence levels; however, recall and compliance with self-selected oral-health goals decreased significantly over the course of six months.

Collaterals: Implications in cerebral ischemic diseases and therapeutic interventions.

Despite the tremendous progress made in the treatment of cerebrovascular occlusive diseases, many patients suffering from ischemic brain injury still experience dismal outcomes. Although rehabilitation contributes to post-stroke functional recovery, there is no doubt that interventions that promote the restoration of blood supply are proven to minimize ischemic injury and improve recovery. In response to the acutely decreased blood perfusion during arterial occlusion, arteriogenesis, the compensation of blood flow through the collateral circulation during arterial obstructive diseases can act not only in a timely fashion but also much more efficiently compared to angiogenesis, the sprouting of new capillaries, and a mechanism occurring in a delayed fashion while increases the total resistance of the vascular bed of the affected territory. Interestingly, despite the vast differences between the two vascular remodeling mechanisms, some crucial growth factors and cytokines involved in angiogenesis are also required for arteriogenesis. Understanding the mechanisms underlying vascular remodeling after ischemic brain injury is a critical step towards the development of effective therapies for ischemic stroke. The present article will discuss our current views in vascular remodeling acutely after brain ischemia, namely arteriogenesis, and some relevant clinical therapies available on the horizon in augmenting collateral flow that hold promise in treating ischemic brain injury. This article is part of a Special Issue entitled SI: Cell Interactions In Stroke.

Mosquito communities with trap height and urban-rural gradient in Adelaide, South Australia: implications for disease vector surveillance.

Understanding the factors influencing mosquito distribution is important for effective surveillance and control of nuisance and disease vector mosquitoes. The goal of this study was to determine how trap height and distance to the city center influenced the abundance and species of mosquitoes collected in Adelaide, South Australia. Mosquito communities were sampled at two heights (<2 m and ~10 m) along an urban-rural gradient. A total of 5,133 mosquitoes was identified over 176 trap nights. Aedes notoscriptus, Ae. vigilax, and Culex molestus were all more abundant in lower traps while Cx. quinquefasciatus (an ornithophilic species) was found to be more abundant in high traps. Distance to city center correlated strongly with the abundance of Ae. vigilax, Ae. camptorhynchus, Cx. globocoxitus, and Cx. molestus, all of which were most common at the sites farthest from the city and closest to the saltmarsh. Overall, the important disease vectors in South Australia (Ae. vigilax, Ae. camptorhynchus, Ae. notoscriptus, and Cx. annulirostris) were more abundant in low traps farthest from the city and closest to the saltmarsh. The current mosquito surveillance practice of setting traps within two meters of the ground is effective for sampling populations of the important disease vector species in South Australia.

Pathology of spinal ependymomas: an institutional experience over 25 years in 134 patients.

BACKGROUND: Ependymomas constitute approximately 40% of primary intraspinal tumors. Current World Health Organization (WHO) grading may not correlate with observed progression-free survival (PFS). OBJECTIVE: This retrospective study of prospectively collected data examines whether PFS is influenced by the histological grade or by the extent of resection. It also analyzes the usage and effectiveness of postoperative adjuvant radiotherapy. METHODS: We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up magnetic resonance imaging. RESULTS: There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty patients had WHO grade I tumors, 101 had grade II tumors, and 3 had grade III tumors. Kaplan-Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (P < .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P < .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P < .36). CONCLUSION: Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. The extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to its higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.

Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases.

PURPOSE: To provide actuarial outcomes and dosimetric data for spinal/paraspinal metastases, with and without prior radiation, treated with stereotactic body radiotherapy (SBRT). METHODS AND MATERIALS: A total of 39 consecutive patients (60 metastases) were treated with SBRT between April 2003 and August 2006 and retrospectively reviewed. In all, 23 of 60 tumors had no previous radiation (unirradiated) and 37/60 tumors had previous irradiation (reirradiated). Of 37 reirradiated tumors, 31 were treated for "salvage" given image-based tumor progression. Local failure was defined as progression by imaging and/or clinically. RESULTS: At last follow-up, 19 patients were deceased. Median patient survival time measured was 21 months (95% CI = 8-27 months), and the 2-year survival probability was 45%. The median total dose prescribed was 24 Gy in three fractions prescribed to the 67% and 60% isodose for the unirradiated and reirradiated cohorts, respectively. The median tumor follow-up for the unirradiated and reirradiated group was 9 months (range, 1-26) and 7 months (range, 1-48) respectively. Eight of 60 tumors have progressed, and the 1- and 2-year progression-free probability (PFP) was 85% and 69%, respectively. For the salvage group the 1 year PFP was 96%. There was no significant difference in overall survival or PFP between the salvage reirradiated vs. all other tumors treated (p = 0.08 and p = 0.31, respectively). In six of eight failures the minimum distance from the tumor to the thecal sac was or=6 months follow-up and no radiation-induced myelopathy or radiculopathy has occurred. CONCLUSION: Spine SBRT has shown preliminary efficacy and safety in patients with image-based progression of previously irradiated metastases.

Brief functional analysis and treatment of tantrums associated with transitions in preschool children.

A brief functional analysis was used to examine the influence of termination of prechange activities and initiation of postchange activitieson tantrums exhibited by 2 preschool children. For 1 participant, tantrums were maintained by access to certain (pretransition) activities. For a 2nd participant, tantrums were maintained by avoidance of certain task initiations. Although advance notice of an upcoming transition was ineffective, differential reinforcement of other behavior plus extinction reduced tantrums for both participants.

Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults.

BACKGROUND: Release of tethered spinal cord by sectioning of the filum terminale carries a significant risk of injury to the neighboring motor and sensory nerve roots. Intraoperative neurophysiological monitoring techniques can help to minimize these adverse neurologic outcomes. METHODS: We performed a retrospective review of 67 consecutive patients undergoing tethered cord release. We excluded 52 pediatric patients which limited our study to 15 adult patients treated during a four year period, including patients with a thick filum, low lying conus, myelomeningocele, filum tumor, spinal cord malformation, and/or lipoma. Clinical outcomes were determined from postoperative follow-up visits. Two patients were lost to follow up and were excluded from the clinical outcome analysis. Electrical stimulation of the filum terminale and lumbo-sacral nerve roots in conjunction with electromyogram (EMG) recording was performed intraoperatively. RESULTS: The mean electrical threshold for EMG response during stimulation of the filum terminale was 37.1 volts (V), range 15 to 100 V. In comparison, the lowest threshold obtained by direct stimulation of the ventral nerve roots was a mean of 1.46 V, with a range of 0.1 to 7 V. More than 70% of the patients studied demonstrated a filum to motor root threshold ratio of 100:1 or greater. No patient developed new neurologic symptoms or signs postoperatively. Bowel and bladder function improved in 46% of patients, back pain in 39% and motor function in 31%. Eight percent reported decline in bladder control and worsening back pain postoperatively. CONCLUSIONS: The often dramatic difference in the threshold of the filum terminale and adjacent motor nerve roots (100:1) helps to identify, isolate, and safely section the filum terminale. Tethered cord release using intraoperative neurophysiological monitoring is safe and in the majority of cases leads to improvement or at least, stabilization of neurologic function. Monitoring prevented intraoperative nerve root injury that might have resulted in immediate onset of new neurologic deficits caused by the surgical procedure.

Maori men's perceptions and experiences of health seeking for prostate health problems in New Zealand.

To discover Maori men's perceptions and experiences of health seeking for prostate health problems. A qualitative research design was sued with semi-structured interviews being the primary data source. From January 2000 to February 2002 a total of 357 Maori men were recruited into the Wellington Region Community Prostate Study, Wellington School of Medicine and Health Sciences, New Zealand. 20 men were interviewed in total, including 16 who were symptomatic of prostate disease and four who were non-symptomatic. A number of barriers were described for not seeking prostate health care, and the majority of these were related to the health system not dealing appropriately with cultural issues. Additionally, a lack of prostate knowledge, due to unavailability of appropriate information and societal pressure of being male, were implicated. Solutions offered by participants were also largely culturally related, for example, whanau (family), te reo Maori (Maori language), rongoa (traditional Maori medicine) and more Maori health professionals. Results re-affirm the need for attention to be paid to the establishment of culturally safe health care and access to appropriate prostate health information. Findings could have implications beyond prostate disease and New Zealand, to countries with indigenous populations who share similar health experiences to Maori.

Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report.

PURPOSE: The purpose of this study was to assess the efficacy of antimicrobial therapy in the prevention of early childhood caries (ECC). METHODS: The study population consisted of 83 subjects (age: 12 to 19 months (x= 15.6); gender: 40 females and 43 males). Inclusion criteria included: (1) unremarkable medical history; (2) presence of 4 maxillary primary incisors (MPI) with no visible defects; (3) clinically caries free; (4) use of a nursing bottle at naptime and/or bedtime which contained a cariogenic substrate; (5) 2 consecutive ms positive cultures from pooled MPI plaque. The subjects were randomized into 2 groups. The 39 subjects in the experimental group and the 44 subjects in the control group were evaluated every 2 months during the study period. At each evaluation, the subjects had 10% povidone iodine (experimental group) or placebo (control group) applied to their dentition. Treatment failure was defined as the appearance of a white spot lesion(s) on any of the MPI during the study period. RESULTS: Using the Kaplan-Meier procedure, the estimated percents (+/- SES) of participants to experience 12 months of disease-free survival were 91 +/- 5% for those receiving treatment and 54 +/- 9% for those in the control group. Via the log-rank test, the hazard of treatment failure is statistically significantly higher in the placebo group (log-rank statistic 10.28, two-sided P=0.0013). CONCLUSIONS: These observations indicate that topical antimicrobial therapy increases disease-free survival in children at high risk for ECC.