We would like to thank the Canadian Institutes of Health Research (CIHR) who have provided funding for this research. Further, we would like to acknowledge Dr. Tim Taha and Dr. Scott Thomas from the University of Toronto for their assistance with the development of our protocol for the collection of resting state heart rate variability data.

Le protocole décrit comprend pré-blessure / tests de base et post-blessure évaluation de suivi et est réalisée à l&#39;aide de trois stations. Ce test peut être réalisé individuellement ou en groupes de quatre sujets dans chaque station à la fois. Sujets passent par chaque station dans l&#39;ordre indiqué ci-dessous. Le tableau 1 illustre le schéma d&#39;administration de tests du protocole. Le comité d&#39;éthique de cette recherche a été obtenue du comité d&#39;éthique de la recherche Bloorview Hollande à l&#39;Hôpital de réadaptation Hollande Bloorview Kids. Tous les participants et leurs tuteurs légaux signer au consentement éclairé préalable à l&#39;achèvement du protocole et de la collecte des données connexes. Avant la lésion d&#39;essais / de base 1 Station 1: Obtenir des informations démographiques d&#39;avant la lésion, post-commotion cérébrale Symptôme rapport et l&#39;état de repos variabilité du rythme cardiaque (VRC) de données <ol><li> Avant de soumettre (s) arrivant pour les tests, assurez-vous tout l&#39;équipement est fonctionment bien et prêt pour les essais et que les chambres d&#39;évaluation sont exempt de distractions inutiles. </li><li> Après avoir examiné le consentement des parents et sous réserve, mesurer et enregistrer la taille et le poids du sujet. Mettre en place la fréquence cardiaque sangles et montres moniteur sur chaque sujet correctement. </li><li> Administrer la forme de l&#39;information démographique et de recueillir rapport des symptômes post-commotion cérébrale utilisant la version enfant de la post-commotion cérébrale Symptom Inventory (PCSI-C), tandis que chaque sujet est assis pendant 5 min. </li><li> Demandez à chaque sujet était en position couchée sur le sol sur une natte aseptisé propre. Allumez les moniteurs de fréquence cardiaque de repos pour enregistrer la variabilité du rythme cardiaque (VRC) des données d&#39;état (avec la fonction de l&#39;intervalle RR réglé sur [On]). Demandez à chaque objet reste couché en position couchée calme, sans parler pendant 10 minutes lors de l&#39;enregistrement RH. </li><li> Après 10 min, cliquez sur le bouton de tour sur la montre pour indiquer la fin de décubitus dorsal repos collecte de données de VRC de l&#39;Etat. Demandez au sujet de revenir à une position assise, cliquez sur les bu au tourtton sur la montre de nouveau pour indiquer début de la collecte de données reposant VRC état d&#39;assise. </li><li> Demandez à chaque objet rester en position assise pendant 5 minutes sans parler. Après 5 min, arrêter la fonction d&#39;enregistrement de la montre pour terminer la session et reposant collecte de données de VRC de l&#39;Etat. Demandez au sujet de décoller la bande de fréquence cardiaque et montres. </li></ol> 2 Station 2: Obtenir des données sur le rendement cognitif <ol><li> Demandez à chaque objet à un sit cabine individuelle avec un ordinateur portable personnel mis en place avec une souris. Assurez environnement test est libre de toute distraction. </li><li> Administrer l&#39;évaluation immédiate post-commotion cérébrale et des tests cognitifs (IMPACT), un outil d&#39;évaluation neuropsychologique rapide et informatisé (environ 25 min à compléter). </li></ol> 3 Station 3: Obtention statique Solde Grip Force et l&#39;Agilité / motricité données <ol><li> Administrer l&#39;évaluation de l&#39;équilibre statique à l&#39;aide du test clinique modifiée sensorielle Integratile solde de (m-CTSIB) sur le système de balance portable. Tout en se tenant sur le plateau de force du système de l&#39;équilibre, l&#39;objet terminé quatre conditions imposées qui incluent debout, les yeux ouverts pendant 20 secondes; debout, les yeux fermés pendant 20 secondes; debout, les yeux ouverts sur coussin de mousse indexée pendant 20 secondes; et debout avec les yeux fermés sur coussin de mousse indexée pendant 20 sec. </li><li> L&#39;aide d&#39;un dynamomètre, mesurer et la force de préhension dossier de la main en kg pour les deux mains droite et gauche. Enregistrez la main dominante pour chaque sujet, tout en remplissant 3 essais consécutifs pour chaque main de départ avec la main dominante. Sur les 3 essais prises, la poignée de main maximale sur chaque main sera également enregistré. Pour chaque essai, le sujet est dit de presser la poignée aussi fort qu&#39;ils le peuvent pendant 3 sec en gardant une position neutre du membre supérieur (debout, droite bras parallèle à côté du corps, paume vers le corps et neutre du poignet). </li><li> Dans un couloir ou une salle de sport au moins 2,5 m de large et 15 m de long administrer l&#39;agilité / moteurl&#39;évaluation des compétences en utilisant l&#39;évaluation ABI-Challenge (ABI-CA) - Module de commotion cérébrale. Poser du ruban adhésif sur le sol dans un points pour chaque 1 m marquage ligne droite. Dans l&#39;ordre suivant administrer ces 6 tests en suivant les directives et les critères de notation fournis dans le module de commotion cérébrale. <ol><li> Pantins (Timed): <ol><li> Stand avec vos bras à vos côtés et sauter dans une position &quot;X&quot; avec les bras et les jambes, puis retourner instantanément en position de départ. Comptez le nombre peut être fait en 15 secondes. </li></ol></li><li> Pylône / cône parcours d&#39;obstacles terme (Timed): <ol><li> Exécutez dans et hors des pylônes à la fin (10 m) et aussi vite que vous le pouvez, mais à une vitesse que vous vous sentez en sécurité. Ne touchez pas les pylônes. Exécutez directement à travers la ligne d&#39;arrivée. (pylônes situés à 3, 5, 7, 10 m) </li></ol></li><li> Arrière tandem marche (Timed): <ol><li> Sur la piste bordée, marcher à reculons dans une configuration en tandem pour 5 m. Modèle Tandem est en contact avec leur talon de leurs Opposorteil ite sur chaque étape. </li></ol></li><li> Course-navette modifiée (Timed): <ol><li> Exécutez le long de la piste de 10 m, ramasser un sac de fèves à la fin du cours, et courir en arrière pour placer le pouf dans un panier au point de départ. Ils doivent toucher la ligne de départ avec leur pied chaque fois qu&#39;ils reviennent au panier. Répétez cette opération trois fois jusqu&#39;à ce que tous les poufs sont dans le panier au point de départ. </li></ol></li><li> Tenants et aboutissants (Timed): <ol><li> Stand avec les deux pieds à l&#39;intérieur de deux lignes parallèles (dans le chemin) qui sont 40 cm de distance. Se déplacer d&#39;un pied à l&#39;extérieur de la ligne correspondante, suivie par la jambe opposée déplacer à l&#39;extérieur de l&#39;autre ligne. Le premier pied est ensuite renvoyé à l&#39;intérieur, suivi par le deuxième pied. Cycles doivent être consécutives et doivent être effectuées dans un mode rythmique (de temps égal entre chaque étape), et seront répétées 10x pas aller de l&#39;avant ou vers l&#39;arrière. </li></ol></li><li> Saut en longueur: Aller de l&#39;avant à partir debout avec les deux pieds que far que vous le pouvez et maintenez l&#39;atterrissage pendant 3 sec. Mesurer et enregistrer la distance de la face la plus éloignée de la patte arrière. Trois essais sont donnés pour atteindre la plus grande distance </li></ol></li></ol> 4. post-blessure / tests de suivi <ol><li> L&#39;obtention de données post-commotion cérébrale tandis sujet éprouve des symptômes post-commotion cérébrale <ol><li> Le même jour, un sujet souffre d&#39;une blessure, le personnel de recherche est contacté par sujet en utilisant téléphone ou par e-mail. Le personnel de recherche enregistre des détails cliniques et fonctionnelles concernant le préjudice. </li><li> Immédiatement après une commotion cérébrale (après blessure 24-48 h), de recueillir: reposant données état de VRC (répéter les étapes 1.3, 1.5 à 1.10); données post-commotion cérébrale symptômes (répétez l&#39;étape 1.4); et les données de la balance (la répétition de l&#39;étape 3.1). Si les symptômes sont aggravés au cours des essais, arrêter la collecte de données et permettre à l&#39;objet de repos. </li><li> Continuer à recueillir des données au repos état de VRC (répétez les étapes 1.3, 1.5 à 1.10), les données de symptômes post-commotion cérébrale (répétez l&#39;étape 1.4), etLes données de balance (répétition de l&#39;étape 3.1) hebdomadaire jusqu&#39;à symptômes post-commotion cérébrale ont résolu. Si les symptômes sont aggravés au cours des essais, arrêter la collecte de données et permettre à l&#39;objet de repos. </li><li> Le personnel de recherche suivi avec l&#39;objet hebdomadaire par téléphone pour déterminer si des symptômes post-commotion cérébrale résoudre (en utilisant PCSI-C). </li></ol></li></ol> 5. Obtenir des données post-commotion cérébrale alors qu&#39;il est soumis est n&#39;éprouvaient plus de symptômes post-commotion cérébrale <ol><li> 1 semaine après que les symptômes post-commotion cérébrale ont résolu, collecter: reposant données état de VRC (répéter les étapes 1.3, 1.5 à 1.10); données post-commotion cérébrale symptômes (répétez l&#39;étape 1.4); les données de performance cognitive (répétez les étapes 2.1 à 2.2); Les données de balance (répétition de l&#39;étape 3.1); données de poignée (répétition de l&#39;étape 3.2); et, les données de compétences agilité / moteur (répétez l&#39;étape 3.3). Si les symptômes sont aggravés au cours des essais, arrêter la collecte de données et permettre à l&#39;objet de repos. </li><li> À un mois après que les symptômes post-commotion cérébrale ont résolu, répétez l&#39;étape 5.1. 3 mois après après-concussion symptômes aient disparu, répétez l&#39;étape 5.1. A 6 mois après post-commotions symptômes aient disparu, répétez l&#39;étape 5.1. </li></ol>

<ol>
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The authors have nothing to disclose.

Ce protocole présente une approche multi-modale à la mesure de la récupération dans les jeunes athlètes suite à une commotion cérébrale. Une caractéristique essentielle de ce protocole est la comparaison des données post-commotion cérébrale dans un large éventail de domaines de performance (cognition, l&#39;équilibre, la force, l&#39;agilité, l&#39;état de repos de la variabilité de la fréquence cardiaque, etc) avant le traumatisme / base. Ces données servent de moyen pour indiquer la récup?...

Commotion peut être définie comme «un processus physiopathologique complexe touchant le cerveau induite par les forces biomécaniques traumatiques» 1, et peut entraîner des symptômes comportementaux / short et somatiques à long terme, cognitifs et / ou affectifs 2. Fonctionnellement, une commotion cérébrale et des symptômes liés peuvent avoir un impact significatif sur la participation de l&#39;un dans les activités quotidiennes et activités 3. Il a été estimé que, dans les Etats-Unis, entre 1,6 et 3,8 millions de commotion cérébrale se produit chaque année à la suite de la participation au sport 4. Spécifique pour les enfants et les jeunes impliqués dans le sport, une commotion cérébrale est l&#39;une des blessures les plus fréquemment rapportés 5-7. Malgré le choc de l&#39;impact peut avoir sur les activités quotidiennes et la prévalence de la commotion cérébrale chez les enfants et les jeunes, il subsiste un manque de données scientifiques déclaré la façon dont le cerveau de la jeunesse répond à des commotions cérébrales dans une variété de domaines de performance. Baseline tintéres-, ou l&#39;utilisation de pré-blessure résultats des tests de référence pour la comparaison avec post-blessure résultats des tests d&#39;informer la récupération, est une pratique de la popularité croissante au sein de la communauté sportive de la jeunesse et a été suggéré internationalement 8 à être &quot;utile d&#39;ajouter utiles l&#39;information »(p.3) au cours de la gestion des commotions cérébrales. Afin de représenter au mieux la nature variée des symptômes post-commotion cérébrale (somatiques, cognitifs et émotionnels / comportementaux), il est important que l&#39;évaluation de la récupération post-commotion cérébrale comprennent une variété de mesures des résultats. En outre, la gestion des commotions cérébrales actuel repose en grande partie sur le rapport subjective des symptômes post-commotion cérébrale. La validité de ce rapport subjectif peut être influencée par divers facteurs 9 et peut conduire à la fois à la sous-déclaration des symptômes 10,11 et un indice moins précis et fiable de récupération. En conséquence, il existe un besoin important d&#39;explorer des approches pour mesurer la récupération post-commotion cérébrale dans performandomaines de la CE qui sont à la fois objective et sensible. Il a été démontré que la cognition, l&#39;équilibre, la force et l&#39;agilité peut être altérée chez les jeunes suite d&#39;une commotion et une lésion cérébrale 12-17. Les mesures figurant dans le présent protocole d&#39;essai ont été choisis pour donner un aperçu de la récupération dans ces domaines suite d&#39;une commotion et d&#39;intégrer l&#39;utilisation d&#39;outils de tests cliniques validées qui sont couramment utilisés dans les milieux cliniques axées sur la gestion des commotions cérébrales. En outre, dans une perspective plus exploratoire, reposant VRC de l&#39;Etat peut être considéré comme une mesure précise de l&#39;équilibre sympathovagal 18,19. Dans une population en bonne santé, l&#39;équilibre sympathovagal est défini comme le système parasympathique est dominant au repos, tandis que le système sympathique est sous contrôle inhibiteur tonique. On suppose que les post-commotion cérébrale, due à un stress physiologique, un déséquilibre entre les deux systèmes existera et état de repos peut se déplacer à l&#39;hyperactivité de l&#39;système sympathique et hypoactivité du système parasympathique 20. L&#39;objectif du protocole de cette étude est de procéder à une évaluation multi-modal de la performance avant et après la commotion parmi les athlètes de jeunes (10-18 ans) afin d&#39;obtenir une compréhension plus globale, objective et exacte de la reprise suite d&#39;une commotion. Cette étude vise à fournir un aperçu de l&#39;élaboration et la prestation de protocoles de gestion des commotions cérébrales et de réadaptation spécifiques pour les enfants et les jeunes.

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		<tr>
			<td>Name of Reagent/ Equipment</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments/Description</td>
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		<tr>
			<td>Scale</td>
			<td>Weight Watchers: Conair&#160;</td>
			<td>WW30WB</td>
			<td></td>
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		<tr>
			<td>Measuring Tape</td>
			<td>Hi-Viz Lufkin</td>
			<td>HVC716CME</td>
			<td></td>
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			<td>Heart Rate Monitor (Chest Strap and Watch)</td>
			<td>Polar</td>
			<td>RS800CX GPS</td>
			<td></td>
		</tr>
		<tr>
			<td>Exercise/Yoga Mat</td>
			<td>Pur Athletics</td>
			<td>WTE10126</td>
			<td></td>
		</tr>
		<tr>
			<td>Sportline Stopwatch (Model 228)</td>
			<td>EB Sport Group</td>
			<td>#2787</td>
			<td></td>
		</tr>
		<tr>
			<td>Laptop - MacBook Pro</td>
			<td>Apple</td>
			<td>A1278</td>
			<td></td>
		</tr>
		<tr>
			<td>Computerized Cognitive Assessment- Immediate Post-Concussion Assessment and Cognitive Task</td>
			<td>ImPACT Application&#39;s Inc.&#160;</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Hand Grip Dynamometer</td>
			<td>Sammons Preston- Smedley-Type</td>
			<td>5032P</td>
			<td></td>
		</tr>
		<tr>
			<td>BioSway</td>
			<td>Biodex Medical Supplies Inc.&#160;</td>
			<td>950-510</td>
			<td></td>
		</tr>
		<tr>
			<td>Painter&#39;s Mate Green Tape</td>
			<td>ShurTech Brands LLC</td>
			<td>#49462</td>
			<td></td>
		</tr>
		<tr>
			<td>Pylons/Cones (12&#34;)</td>
			<td>Canadian Tire</td>
			<td>84-295-4</td>
			<td></td>
		</tr>
		<tr>
			<td>Basket</td>
			<td>Canadian Tire</td>
			<td>42-9919-2</td>
			<td></td>
		</tr>
		<tr>
			<td>Bean Bags</td>
			<td>Eastpoint/Go Gater</td>
			<td>1-1-16392</td>
			<td></td>
		</tr>
	</tbody>
</table>

a multi-modal approach to assessing recovery in youth athletes following concussion

Commotion est l&#39;une des blessures les plus fréquemment rapportés chez les enfants et les jeunes impliqués dans la participation au sport. Après une commotion cérébrale, les jeunes peuvent éprouver toute une gamme de symptômes neuro-comportementaux à court et à long terme (somatique, cognitif et émotionnel / comportemental) qui peuvent avoir un impact significatif sur sa participation à des activités et des activités d&#39;intérêt quotidiens (par exemple, l&#39;école, le sport, le travail, famille vie sociale /, etc). Malgré cela, il subsiste un manque dans la recherche axée sur le plan clinique visant spécifiquement à explorer commotion dans la population des jeunes au sport, et plus particulièrement, des approches multi-modales à la mesure de la récupération. Cet article donne un aperçu d&#39;une approche nouvelle et multi-modale à la mesure de la récupération entre les jeunes athlètes suite d&#39;une commotion. L&#39;approche présentée implique l&#39;utilisation de deux pré-blessure / tests de base et post-traumatique / tests de suivi pour évaluer la performance à travers une grande variété de domaines (post-concussymptômes de Sion, de la cognition, de l&#39;équilibre, la force, l&#39;agilité / la motricité et l&#39;état de repos variabilité du rythme cardiaque). Le but de cette recherche est d&#39;acquérir une compréhension plus objective et précise de la reprise suite d&#39;une commotion chez les athlètes de jeunes (âgés de 10-18 ans). Les résultats de cette recherche peuvent contribuer à éclairer l&#39;élaboration et l&#39;utilisation des approches améliorées de commotions cérébrales et de réadaptation spécifique à la communauté sportive des jeunes.

Le protocole présenté est une enquête en cours. Tableau 1 illustre le schéma d&#39;administration de tests du protocole. Les résultats représentatifs sont présentés pour démontrer la faisabilité de la collecte des données de base / d&#39;avant l&#39;accident et post-commotion cérébrale à travers une variété de domaines de performance connus pour être touchés par une commotion cérébrale chez les jeunes. Un seul cas d&#39;un jeune homme ayant subi une commotion qui a terminé toutes le...

Watch this Scientific Journal Video about A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion at JoVE.com

A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

Une approche multi-modale de la reprise Évaluer chez les athlètes de la jeunesse suite d&#39;une commotion

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can ...

a-multi-modal-approach-to-assessing-recovery-youth-athletes-following

Research

JoVE Journal

Medicine

13.3K vues.  Holland Bloorview Kids Rehabilitation Hospital. This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

Vidéo: A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth involved in organized sports such as competitive hockey are nearly six times more likely to suffer a severe concussion compared to children involved in other leisure physical activities2. While the most common cognitive sequelae of mTBI appear similar for children and adults, the recovery profile and breadth of consequences in children remains largely unknown2, as does the influence of pre-injury characteristics (e.g. gender) and injury details (e.g. magnitude and direction of impact) on long-term outcomes. Competitive sports, such as hockey, allow the rare opportunity to utilize a pre-post design to obtain pre-injury data before concussion occurs on youth characteristics and functioning and to relate this to outcome following injury. Our primary goals are to refine pediatric concussion diagnosis and management based on research evidence that is specific to children and youth. To do this we use new, multi-modal and integrative approaches that will:
 1.Evaluate the immediate effects of head trauma in youth 
2.Monitor the resolution of post-concussion symptoms (PCS) and cognitive performance during recovery 
3.Utilize new methods to verify brain injury and recovery
To achieve our goals, we have implemented the Head Impact Telemetry (HIT) System. (Simbex; Lebanon, NH, USA). This system equips commercially available Easton S9 hockey helmets (Easton-Bell Sports; Van Nuys, CA, USA) with single-axis accelerometers designed to measure real-time head accelerations during contact sport participation 3 - 5. By using telemetric technology, the magnitude of acceleration and location of all head impacts during sport participation can be objectively detected and recorded. We also use functional magnetic resonance imaging (fMRI) to localize and assess changes in neural activity specifically in the medial temporal and frontal lobes during the performance of cognitive tasks, since those are the cerebral regions most sensitive to concussive head injury 6. Finally, we are acquiring structural imaging data sensitive to damage in brain white matter.

This article provides an overview of a multi-modal approach to mild traumatic brain injury diagnosis and recovery in youth. This approach combines neuropsychological testing with functional magnetic resonance imaging and the Head Impact Telemetry System to monitor the relationship between head impacts and brain activity during cognitive testing.

Une enquête sur les effets en matière de sport commotions dans la jeunesse utilisant l&#39;imagerie par résonance magnétique et le système de télémétrie choc de la tête

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth ...

Recherche

Médecine

Assessing Teratogenic Changes in a Zebrafish Model of Fetal Alcohol Exposure

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, including mental retardation due to disordered and damaged brain development. Fetal alcohol spectrum disorder (FASD) is a term used to cover a continuum of birth defects that occur due to maternal alcohol consumption, and occurs in approximately 4% of children born in the United States. With 50% of child-bearing age women reporting consumption of alcohol, and half of all pregnancies being unplanned, unintentional exposure is a continuing issue2. In order to best understand the damage produced by ethanol, plus produce a model with which to test potential interventions, we developed a model of developmental ethanol exposure using the zebrafish embryo. Zebrafish are ideal for this kind of teratogen study3-8. Each pair lays hundreds of eggs, which can then be collected without harming the adult fish. The zebrafish embryo is transparent and can be readily imaged with any number of stains. Analysis of these embryos after exposure to ethanol at different doses and times of duration and application shows that the gross developmental defects produced by ethanol are consistent with the human birth defect. Described here are the basic techniques used to study and manipulate the zebrafish FAS model.

In order to understand the molecular mechanisms of the ethanol-induced developmental damage, we have developed a zebrafish model of ethanol exposure and are exploring the physical, cellular, and genetic alterations that occur after ethanol exposure1. We then seek to find potential interventions and rapidly test them in this animal model.

Évaluer les changements tératogènes dans un modèle de poisson zèbre de l&#39;exposition d&#39;alcoolisation fœtale

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, ...

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell proliferation in the bone marrow cavity as well as for interaction of tumor and bone cells resulting in local bone destruction. Our aim was to develop a model of experimental bone metastasis that allows in vivo assessment of angiogenesis in skeletal lesions using non-invasive imaging techniques.
For this purpose, we injected 105 MDA-MB-231 human breast cancer cells into the superficial epigastric artery, which precludes the growth of metastases in body areas other than the respective hind leg1. Following 25-30 days after tumor cell inoculation, site-specific bone metastases develop, restricted to the distal femur, proximal tibia and proximal fibula1. Morphological and functional aspects of angiogenesis can be investigated longitudinally in bone metastases using magnetic resonance imaging (MRI), volumetric computed tomography (VCT) and ultrasound (US).
MRI displays morphologic information on the soft tissue part of bone metastases that is initially confined to the bone marrow cavity and subsequently exceeds cortical bone while progressing. Using dynamic contrast-enhanced MRI (DCE-MRI) functional data including regional blood volume, perfusion and vessel permeability can be obtained and quantified2-4. Bone destruction is captured in high resolution using morphological VCT imaging. Complementary to MRI findings, osteolytic lesions can be located adjacent to sites of intramedullary tumor growth. After contrast agent application, VCT angiography reveals the macrovessel architecture in bone metastases in high resolution, and DCE-VCT enables insight in the microcirculation of these lesions5,6. US is applicable to assess morphological and functional features from skeletal lesions due to local osteolysis of cortical bone. Using B-mode and Doppler techniques, structure and perfusion of the soft tissue metastases can be evaluated, respectively. DCE-US allows for real-time imaging of vascularization in bone metastases after injection of microbubbles7.
In conclusion, in a model of site-specific breast cancer bone metastases multi-modal imaging techniques including MRI, VCT and US offer complementary information on morphology and functional parameters of angiogenesis in these skeletal lesions.

In the pathogenesis of bone metastasis, angiogenesis is a crucial process and therefore represents a target for imaging and therapy. Here, we present a rat model of site-specific breast cancer bone metastasis and describe strategies to non-invasively image angiogenesis in vivo using magnetic resonance imaging, volumetric computed tomography and ultrasound.

Multi-modale d&#39;imagerie de l&#39;angiogenèse dans un modèle de rat nu des métastases osseuses du cancer du sein par imagerie par résonance magnétique, la tomodensitométrie et volumétrique ultrasons

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell ...

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Concussion as defined by the 2013 Concussion Consensus Statement &#8220;may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an &#8216;impulsive&#8217; force transmitted to the head.&#8221; Concussions leave the individual with both short- and long-term effects. The short-term effects of sport related concussions may include changes in playing ability, confusion, memory disturbance, the loss of consciousness, slowing of reaction time, loss of coordination, headaches, dizziness, vomiting, changes in sleep patterns and mood changes. These symptoms typically resolve in a matter of days. However, while some individuals recover from a single concussion rather quickly, many experience lingering effects that can last for weeks or months. The factors related to concussion susceptibility and the subsequent recovery times are not well known or understood at this time. Several factors have been suggested and they include the individual&#8217;s concussion history, the severity of the initial injury, history of migraines, history of learning disabilities, history of psychiatric comorbidities, and possibly, genetic factors. Many studies have individually investigated certain factors both the short-term and long-term effects of concussions, recovery time course, susceptibility and recovery. What has not been clearly established is an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes, and recovery. The purpose of this manuscript is to show one such multifaceted approached which examines concussions using computerized neurocognitive testing, event related potentials, somatosensory perceptual responses, balance assessment, gait assessment and genetic testing.

There is great variability in an individual&#8217;s risk for concussion and their corresponding recovery. A multifaceted approach to concussion evaluation is warranted; including baseline testing of athletes before participation in sport and timely evaluation post injury. The goal of this protocol is to provide an appropriate multifaceted approach to examine concussions.

Une approche neuroscientifique à l&#39;examen de commotions cérébrales dans étudiants-athlètes

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 ...

Non-invasive Assessments of Subjective and Objective Recovery Characteristics Following an Exhaustive Jump Protocol

Fast recovery after strenuous exercise is important in sports and is often studied via cryotherapy applications. Cryotherapy has a significant vasoconstrictive effect, which seems to be the leading factor in its effectiveness. The resulting enhanced recovery can be measured by using both objective and subjective parameters. Two commonly measured subjective characteristics of recovery are delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE). Two important objective recovery characteristics are countermovement jump (CMJ) performance and peak power output (PPO). Here, we provide a detailed protocol to induce muscular exhaustion of the frontal thighs with a self-paced, 3 x 30 countermovement jump protocol (30-s rest between each set). This randomized controlled trial protocol explains how to perform local cryotherapy cuff application (+ 8 &#176;C for 20 min) and thermoneutral cuff application (+ 32 &#176;C for 20 min) on both thighs as two possible post-exercise recovery modalities. Finally, we provide a non-invasive protocol to measure the effects of these two recovery modalities on subjective (i.e., DOMS of both frontal thighs and RPE) and objective recovery (i.e., CMJ and PPO) characteristics 24, 48, and 72 h post-application. The advantage of this method is that it provides a tool for researchers or coaches to induce muscular exhaustion, without using any expensive devices; to implement local cooling strategies; and to measure both subjective and objective recovery, without using invasive methods. Limitations of this protocol are that the 30 s rest period between sets is very short, and the cardiovascular demand is very high. Future studies may find the assessment of maximum voluntary contractions to be a more sensitive assessment of muscular exhaustion compared to CMJs.

This protocol describes the procedure for non-invasive recovery assessments during a 72 h recovery period. This protocol induces muscular exhaustion of the frontal thighs using countermovement jumps and uses either local cold-cuff or thermoneutral-cuff application as a recovery modality.

Évaluations non invasives des caractéristiques subjectives et objectives de récupération suite à un protocole de saut exhaustif

Fast recovery after strenuous exercise is important in sports and is often studied via cryotherapy applications. Cryotherapy has a significant ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Un essai clinique évaluant l'innocuité, l'efficacité et la livraison de sacs à trois chambres à base d'huile d'olive pour la nutrition parentérale

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To date, return-to-activity decision-making has been anchored in the monitoring of self-reported concussion symptoms and neurocognitive testing. However, multi-modal assessments that corroborate objective physiological measures with traditional subjective symptom reporting are needed and can be valuable. Heart rate variability (HRV) is a non-invasive physiological indicator of the autonomic nervous system, capturing the reciprocal interplay between the sympathetic and parasympathetic nervous systems. There is a dearth of literature exploring the effect of concussion on HRV in youth athletes, and developmental differences preclude the application of adult findings to a pediatric population. Further, the current state of HRV methodology has primarily included short-term (5-15 min) recordings, by using resting state or short-term physical exertion testing to elucidate changes following concussion. The novelty in utilizing a 24 h&#160;recording methodology is that it has the potential to capture natural variation in autonomic function, directly related to the activities a youth athlete performs on a regular basis. Within a prospective, longitudinal research setting, this novel approach to quantifying autonomic function can provide important information regarding the recovery trajectory, alongside traditional self-report symptom measures. Our objectives regarding a 24 h recording methodology were to (1) evaluate the physiological effects of a concussion in youth athletes, and (2) describe the trajectory of physiological change, while considering the resolution of self-reported post-concussion symptoms. To achieve these objectives, non-invasive sensor technology was implemented. The raw beat-to-beat time intervals captured can be transformed to derive time domain and frequency domain measures, which reflect an individual&#39;s ability to adapt and be flexible to their ever-changing environment. By using non-invasive heart rate technology, autonomic function can be quantified outside of a traditional controlled research setting.

We demonstrate a 24 h heart rate recording methodology to evaluate the influence of concussion across the recovery trajectory in youth athletes, within an ecologically valid context.

Fonction autonome suite à une commotion cérébrale chez les jeunes athlètes : une Exploration de la variabilité de fréquence cardiaque à l’aide de la méthode d’enregistrement de 24 heures

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To ...

A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids direct contact with the measured area, it is suitable for monitoring blood flow changes during wound healing in human patients. Vestibuloplasty is periodontal surgery to the oral vestibule, aiming to restore vestibular depth with simultaneous enlargement of the keratinized gingiva. In this special clinical case, a split thickness flap was elevated at the first upper premolar and a xenogenic collagen matrix was adapted to the resulting recipient bed. LSCI was used to monitor the re- and neovascularization of the graft and the surrounding mucosa for one year. A protocol is introduced for the correct adjustment of microcirculation measurement in the oral mucosa, highlighting difficulties and possible failures.
The clinical case study presented demonstrated that &#8212; following the appropriate protocol &#8212; LSCI is a suitable and reliable method for following up microcirculation in a healing wound in the human oral mucosa and gives useful information on graft integration.

This study introduces a protocol for measuring microcirculation in human oral mucosa by laser speckle contrast imaging. The monitoring of wound healing after vestibuloplasty combined with a xenogenic collagen graft is presented on a clinical case.

Une nouvelle approche pour la surveillance de néovascularisation de la greffe dans la gencive humaine

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids ...

Multi-Modal Home Sleep Monitoring in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.

Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.

Accueil multimodale sommeil suivi in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project is to 1) describe the development and implementation of the Concussion Carepath, 2) demonstrate the process of integrating technology in the form of a mobile application to enable the carepath and guide clinical decision-making, and 3) present data on the utility of the C3 app in facilitating decision-making throughout the injury recovery process. A multi-disciplinary team of experts in concussion care was formed to develop an evidence-informed algorithm, outlining best practices for the clinical management of concussion along three phases of recovery &#8211; acute, subacute, and post-concussive. A custom mobile application, the Cleveland Clinic Concussion (C3) app was developed and validated to provide a platform for the systematic collection of objective, biomechanical outcomes and to provide guidance in clinical decision-making in the field and clinical environments. The Cleveland Clinic Concussion app included an electronic incident report, assessment modules to measure important aspects of cognitive and motor function, and a return to play module to systematically document the six phases of post-injury rehabilitation. The assessment modules served as qualifiers within the carepath algorithm, driving referral for specialty services as indicated. Overall, the carepath coupled with the C3 app functioned in unison to facilitate communication among the interdisciplinary team, prevent stagnant care, and drive patients to the right provider at the right time for efficient and effective clinical management.

A multidisciplinary carepath to standardize disparate concussion care was developed and implemented at the Cleveland Clinic. The Cleveland Clinic Concussion (C3) mobile application was used to enable the carepath through biomechanical outcomes characterizing cognitive and motor function. Patient outcomes improved while cost of care was reduced following implementation.

Développement et mise en œuvre d’une technologie pluridisciplinaire renforcée voie de soins aux jeunes et aux adultes souffrant de commotion cérébrale

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project ...