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.

Il protocollo descritto comprende pre-infortunio / test di base e post-infortunio valutazione di follow-up e si completa con tre stazioni. Questo test può essere completato individualmente o in gruppi di quattro soggetti ad ogni stazione alla volta. Soggetti procedere attraverso ogni stazione nell&#39;ordine indicato di seguito. La tabella 1 illustra lo schema di somministrazione di test del protocollo. Approvazione etica per questa ricerca è stato ottenuto dalla Holland Bloorview ricerca Comitato Etico presso l&#39;Holland Bloorview Bambini Rehabilitation Hospital. Tutti i partecipanti ed i loro tutori legali forniscono firmati consenso informato prima di completare il protocollo e la raccolta dei dati relativi. Pre-infortunio / test di base 1 Stazione 1: Ottenere pre-infortunio Informazioni demografiche, post-commozione cerebrale Sintomo Relazione e Riposo Stato Variabilità della frequenza cardiaca (HRV) Dati <ol><li> Prima di sottoporre (s) in arrivo per il test, assicurarsi tutte le apparecchiature è la funzioneing correttamente e pronto per i test e che le camere di valutazione sono liberi da distrazioni inutili. </li><li> Dopo aver esaminato il consenso dei genitori e soggetto, misurare e registrare l&#39;altezza e il peso del soggetto. Impostare le cinghie del monitor di frequenza cardiaca e orologi su ogni argomento in modo corretto. </li><li> Amministrare il form informazioni demografiche e raccogliere post-commozione cerebrale rapporto sintomo utilizzando la versione Bambino del post-commozione cerebrale Symptom Inventory (PCSI-C), mentre ciascun soggetto è seduto per 5 min. </li><li> Avere ogni soggetto giaceva supino a terra su una stuoia igienizzato pulito. Accendere il monitor della frequenza cardiaca per registrare i dati di stato variabilità della frequenza cardiaca (HRV) a riposo (con funzione di intervallo RR impostata su [On]). Avere ogni soggetto rimane sdraiato in posizione supina in silenzio senza parlare per 10 minuti durante la registrazione HR. </li><li> Dopo 10 minuti, fare clic sul pulsante giro sull&#39;orologio per indicare la fine del supino riposo raccolta dati HRV stato. Chiedere al soggetto di ritornare ad una posizione seduta, fare clic sui bu girotton in guardia ancora una volta per indicare inizio di riposare stato seduto raccolta dati HRV. </li><li> Avere ogni soggetto rimanere in posizione seduta per 5 minuti senza parlare. Dopo 5 minuti, interrompere la funzione di registrazione orologio per terminare la sessione e di riposo raccolta dati HRV stato. Chiedere al soggetto di togliere la fascia di frequenza cardiaca e orologi. </li></ol> 2 Stazione 2: Ottenere Cognitive Performance Data <ol><li> Avere ogni sit soggetto ad una cabina singola con un computer portatile personale istituito con il mouse. Assicurarsi che il test ambiente è privo di distrazioni. </li><li> Amministrare il post-commozione cerebrale valutazione immediata e Cognitive Test (Impact), uno strumento di valutazione neuropsicologica rapida e informatizzata (circa 25 minuti per completare). </li></ol> 3 Stazione 3: Ottenere equilibrio statico, Grip Forza e Agilità / Motor Skills dati <ol><li> Somministrare la valutazione dell&#39;equilibrio statico utilizzando il test clinico modificata di Sensory Integratisu di Balance (m-CTSIB) sul sistema bilancia portatile. Mentre in piedi sulla forceplate sistema di equilibrio, il soggetto compie quattro condizioni ordinate che includono in piedi con gli occhi aperti per 20 secondi; piedi con gli occhi chiusi per 20 secondi; in piedi con gli occhi aperti sul tappetino in gomma indicizzato per 20 sec; e in piedi con gli occhi chiusi sul tappetino in gomma indicizzato per 20 sec. </li><li> Utilizzando un dinamometro, misurare e registrare la mano forza di presa in kg per entrambe le mani destra e sinistra. Registrare la mano dominante per ogni soggetto, mentre ancora completato 3 prove consecutive per ogni mano iniziale con la mano dominante. Dei 3 studi presi, il massimo grip mano su ogni mano sarà registrata. Per ogni prova il soggetto viene detto di spremere la presa così difficile come si può per 3 sec mantenere una posizione neutra arto superiore (in piedi, dritto braccio parallelo accanto al corpo, palmo rivolto verso il corpo e il polso neutro). </li><li> In un corridoio o in palestra almeno 2,5 m di larghezza e 15 m di lunghezza amministrano l&#39;agilità / motorevalutazione delle competenze utilizzando la Valutazione ABI-Challenge (ABI-CA) - Modulo Commozione cerebrale. Posare il nastro sul terreno in un punti per ogni 1 m di marcatura linea retta. Nel seguente ordine amministrare questi 6 test seguendo le linee guida e criteri di valutazione previsti nel modulo commozione cerebrale. <ol><li> Jumping-jacks (a tempo): <ol><li> In piedi con le braccia lungo i fianchi e saltare in una posizione &quot;X&quot; con le braccia e le gambe, e poi tornare immediatamente nella posizione di partenza. Contare il numero può essere fatto in 15 sec. </li></ol></li><li> Run Pilone / cono percorso ad ostacoli (temporizzata): <ol><li> Eseguire dentro e fuori dei piloni fino alla fine (10 m) e ritorno il più velocemente possibile, ma a una velocità che si sente al sicuro. Non toccare i piloni. Eseguire direttamente attraverso la linea del traguardo. (Piloni situato a 3, 5, 7, 10 m) </li></ol></li><li> Backwards passi tandem (temporizzata): <ol><li> In pista alberato, camminare all&#39;indietro in un modello tandem per 5 m. Tandem modello è a contatto con il loro tallone di loro oppospunta ite ad ogni passo. </li></ol></li><li> Corsa navetta Modified (temporizzata): <ol><li> Correte lungo la pista 10 m, prendere un sacchetto di fagioli alla fine del corso, e correre di nuovo per posizionare il sacchetto di fagioli in un cestino al punto di partenza. Essi devono toccare la linea di partenza con il piede ogni volta che ritornano a canestro. Ripetere questa operazione per tre volte fino a quando tutte le beanbags sono nel cestello al punto di partenza. </li></ol></li><li> Ins e out (a tempo): <ol><li> Stand con entrambi i piedi all&#39;interno di due linee parallele (nel percorso) che sono di 40 cm. Spostare un piede di fuori della linea corrispondente seguita dalla gamba opposta muove al di fuori della linea. Il primo piede viene quindi restituito al suo interno, seguito dal secondo piede. Cicli devono essere consecutivi e devono essere eseguite in modo ritmico (tempo uguale tra un passo), e sarà ripetuto 10 volte, non si muove avanti o indietro. </li></ol></li><li> Salto in lungo: Salto in avanti da in piedi con entrambi i piedi come far possibile e tenere premuto lo sbarco per 3 secondi. Misurare e registrare la distanza dalla parte anteriore del piede posteriore più lontana. Tre studi sono date per raggiungere la distanza maggiore </li></ol></li></ol> 4. post-infortunio / test di follow-up <ol><li> Ottenere dati post-commozione cerebrale mentre è soggetto sta vivendo sintomi post-commozione cerebrale <ol><li> Lo stesso giorno un soggetto subisce un infortunio, personale di ricerca viene contattato per argomento utilizzando il telefono o e-mail. Personale di ricerca registra i dettagli clinici e funzionali riguardanti il ​​pregiudizio. </li><li> Subito dopo la commozione cerebrale (24-48 ore dopo infortunio), raccogliere: Riposo dati HRV stato (ripetere i passi 1,3, 1,5-1,10); dati post-commozione cerebrale sintomi (ripetere il punto 1.4); e dati di bilancio (ripetere il punto 3.1). Se i sintomi sono aggravate durante la prova, arrestare la raccolta dei dati e consentire soggetti a riposo. </li><li> Continuare a raccogliere dati HRV stato di riposo (ripetere i passi 1,3, 1,5-1,10), dati di sintomi post-commozione cerebrale (ripetere il punto 1.4), edati di bilancio (ripetere il punto 3.1) settimanale fino a sintomi post-commozione cerebrale hanno risolto. Se i sintomi sono aggravate durante la prova, arrestare la raccolta dei dati e consentire soggetti a riposo. </li><li> Personale di ricerca prosegue con soggetto settimanale per telefono per determinare quando i sintomi post-commozione cerebrale risolvono (utilizzando PCSI-C). </li></ol></li></ol> 5. Ottenere dati post-commozione cerebrale Mentre soggetto non è più di sintomi post-commozione cerebrale <ol><li> Al 1 settimana dopo sintomi post-commozione cerebrale si sono risolti, raccogliere: Riposo dati HRV stato (ripetere i passi 1,3, 1,5-1,10); dati post-commozione cerebrale sintomi (ripetere il punto 1.4); dati di performance cognitiva (ripetere i punti 2.1-2.2); dati di bilancio (ripetere il punto 3.1); dati di presa della mano (ripetere il punto 3.2); e, dati abilità agilità / motore (ripetere il punto 3.3). Se i sintomi sono aggravate durante la prova, arrestare la raccolta dei dati e consentire soggetti a riposo. </li><li> Ad 1 mese dopo sintomi post-commozione cerebrale aver risolto, ripetere il punto 5.1. A 3 mesi dopo il POST-concussion sintomi si sono risolti, ripetere il punto 5.1. A 6 mesi dopo il post-traumi sintomi si sono risolti, ripetere il punto 5.1. </li></ol>

<ol>
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The authors have nothing to disclose.

Questo protocollo presenta un approccio multi-modale per misurare il recupero negli atleti giovani a seguito di una commozione cerebrale. Una caratteristica fondamentale di questo protocollo è il confronto dei dati di post-commozione cerebrale attraverso una vasta gamma di domini di performance (la cognizione, l&#39;equilibrio, la forza, l&#39;agilità, riposo stato variabilità della frequenza cardiaca, ecc) per pre-infortunio / basale. Questi dati servono come mezzo per indicare il recupero tra i singoli atl...

Commozione cerebrale può essere definito come &quot;un processo fisiopatologico complesso che colpisce il cervello indotta da traumatici forze biomeccaniche&quot; 1, e può portare a sintomi comportamentali / short e somatiche-lungo termine, cognitivi e / o emotivi 2. Funzionalmente, commozione cerebrale e sintomi correlati possono avere un impatto significativo sulla propria partecipazione alle attività quotidiane e inseguimenti 3. E &#39;stato stimato che negli Stati Uniti, tra 1,6 e 3,8 milioni di commozione cerebrale si verificano ogni anno a causa della partecipazione sportiva 4. Specifico per bambini e giovani coinvolti nello sport, commozione cerebrale è una delle lesioni più comunemente riportati 5-7. Nonostante la commozione cerebrale impatto può avere sulle attività quotidiane e la prevalenza di commozione cerebrale tra i bambini ei giovani, resta la mancanza di dati scientifici che riportano come il cervello dei giovani risponde a Commozione cerebrale attraverso una varietà di domini di performance. Baseline tressante, o l&#39;uso di punteggi di test pre-infortunio come punto di riferimento per il confronto con i punteggi di test post-infortunio di informare il recupero, è una pratica di crescente popolarità all&#39;interno della comunità sport giovanile ed è stato proposto a livello internazionale 8 di essere &quot;utile per aggiungere utili informazioni &quot;(p.3) durante la gestione di commozione cerebrale. Al fine di rappresentare al meglio la varietà di sintomi post-commozione cerebrale (somatici, cognitivi ed emotivi / comportamentali), è importante che la valutazione del recupero post-commozione cerebrale includono una varietà di misure di outcome. Inoltre, la gestione commozione cerebrale corrente si basa molto sulla relazione personale di sintomi post-commozione cerebrale. La validità di questa relazione soggettiva può essere influenzata da una varietà di fattori 9 e può portare a entrambi sotto-segnalazione di sintomi 10,11 e un indice meno preciso e affidabile di recupero. Di conseguenza, vi è la necessità significativa di esplorare approcci per misurare il recupero post-commozione cerebrale attraverso performandomini ce che sono sia oggettiva e sensibile. E &#39;stato dimostrato che la cognizione, l&#39;equilibrio, la forza e l&#39;agilità può essere alterata in gioventù dopo commozione cerebrale e lesioni 12-17. Le misure contenute in questo protocollo di test sono stati scelti per fornire una conoscenza di recupero di tutti questi domini seguente commozione cerebrale e di integrare l&#39;uso di strumenti di test clinici validati che vengono comunemente utilizzati nei diversi contesti clinici focalizzati sulla gestione commozione cerebrale. Inoltre, da un punto di vista più esplorativo, riposo HRV stato può essere visto come una misura accurata di equilibrio simpatovagale 18,19. In una popolazione sana, equilibrio simpatovagale è definito come il sistema parasimpatico essendo dominante a riposo, mentre il sistema simpatico è sotto controllo inibitorio tonico. Si ipotizza che il post-commozione cerebrale, a causa di stress fisiologico, uno squilibrio tra i due sistemi esisterà e stato di riposo può passare alla iperattività delsistema simpatico e ipoattività del sistema parasimpatico 20. L&#39;obiettivo del protocollo di questo studio è quello di condurre una valutazione multi-modale di prestazioni pre e post-commozione cerebrale tra gli atleti giovani (età 10-18 anni) al fine di ottenere una comprensione più olistica, oggettiva e accurata di recupero dopo commozione cerebrale. Questo studio mira a fornire una conoscenza lo sviluppo e la fornitura di protocolli di gestione commozione cerebrale e riabilitazione specifici per bambini e giovani.

<table border="0" cellpadding="0" cellspacing="0" width="584">
	<tbody>
		<tr>
			<td>Name of Reagent/ Equipment</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments/Description</td>
		</tr>
		<tr>
			<td>Scale</td>
			<td>Weight Watchers: Conair&#160;</td>
			<td>WW30WB</td>
			<td></td>
		</tr>
		<tr>
			<td>Measuring Tape</td>
			<td>Hi-Viz Lufkin</td>
			<td>HVC716CME</td>
			<td></td>
		</tr>
		<tr>
			<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>
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a multi-modal approach to assessing recovery in youth athletes following concussion

Commozione cerebrale è una delle lesioni più comunemente riportati tra i bambini ei giovani coinvolti nella partecipazione sportiva. A seguito di una commozione cerebrale, i giovani possono sperimentare una serie di sintomi neurocomportamentali breve e lungo termine (somatico, cognitivo ed emotivo / comportamentale) che possono avere un impatto significativo sulla propria partecipazione alle attività quotidiane e inseguimenti di interesse (ad esempio, la scuola, lo sport, il lavoro, familiare / vita sociale, ecc). Nonostante questo, rimane una scarsità nella ricerca clinica guidata destinato specificamente ad esplorare commozione cerebrale nella popolazione sportiva giovanile, e più specificamente, approcci multi-modali per la misurazione di recupero. Questo articolo fornisce una panoramica di un romanzo e un approccio multi-modale per la misurazione di recupero tra gli atleti giovanili seguente commozione cerebrale. L&#39;approccio presentato prevede l&#39;utilizzo di / test sia pre-infortunio / test di base e post-infortunio di follow-up per valutare le prestazioni in una vasta gamma di domini (post-concussintomi sione, la cognizione, l&#39;equilibrio, la forza, l&#39;agilità e abilità motorie / stato di riposo variabilità della frequenza cardiaca). L&#39;obiettivo di questa ricerca è quello di ottenere una comprensione più oggettiva e accurata di recupero in seguito commozione cerebrale negli atleti giovani (età 10-18 anni). I risultati di questa ricerca possono contribuire a informare lo sviluppo e l&#39;uso di approcci migliori per concussione gestione e la riabilitazione specifica per la comunità sport giovanile.

Il protocollo presentato è un&#39;indagine in corso. Tabella 1 illustra lo schema di somministrazione di test del protocollo. I risultati rappresentativi sono presentati per dimostrare la fattibilità della raccolta di dati di base / pre-infortunio e post-commozione cerebrale attraverso una varietà di domini di performance noti per essere colpito da commozione cerebrale in gioventù. Un singolo caso di un giovane commozione cerebrale che ha completato tutte le fasi del protocollo è presentato per dim...

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.

Un approccio multi-modale per Valutare recupero negli atleti giovanili seguito Commozione cerebrale

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 Views.  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.

Video: 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.

Un&#39;indagine degli effetti dello sport legati Commozione cerebrale in gioventù Utilizzando la risonanza magnetica funzionale e l&#39;impatto del sistema di telemetria Testa

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 ...

Ricerca

Medicina

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.

Valutare i cambiamenti teratogeni in un modello di Zebrafish di esposizione alcolica fetale

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-modal Imaging di angiogenesi in un modello di ratto Nudo di metastasi ossee cancro al seno utilizzando la risonanza magnetica, tomografia computerizzata volumetrica e Ultrasuoni

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.

Un approccio neuroscientifica all&#39;esame di traumi in studenti-atleti

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.

Valutazione non invasiva delle caratteristiche di recupero soggettivo e obiettivo A seguito di un protocollo di salto esaurito

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.

Uno studio clinico che valuta la sicurezza, l'efficacia e la consegna di sacchetti a tre camere a base di olio d'oliva per la nutrizione parenterale

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.

La funzione autonoma dopo trauma cranico in giovani atleti: un'esplorazione della variabilità della frequenza cardiaca utilizzando la metodologia di registrazione 24 ore

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.

Un nuovo approccio al monitoraggio dell'innesto neovascolarizzazione nella gengiva umana

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.

Sonno di multi-modale Home monitoraggio in adulti più anziani

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.

Sviluppo e implementazione di una tecnologia multi-disciplina migliorate percorso di cura per giovani e adulti con trauma cranico

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