Severity of Spinal Cord Injury Influences Diffusion Tensor Imaging of the Brain

Background: The purpose of this study was to determine whether DTI changes in the brain induced by a thoracic spinal cord injury are sensitive to varying severity of spinal contusion in rats. Methods: A control, mild, moderate, or severe contusion injury was administered over the eighth thoracic vertebral level in 32 Sprague-Dawley rats. At 11 weeks postinjury, ex vivo DTI of the brain was performed on a 9.4T Bruker scanner using a pulsed gradient spin-echo sequence. Results: Mean water diffusion in the internal capsule regions of the brain and pyramid locations of the brainstem were correlated with motor function (r2 = 0.55). Additionally, there were significant differences between injury severity groups for mean diffusivity and fractional anisotropy at regions associated with the corticospinal tract (P = 0.05). Conclusion: These results indicate that DTI is sensitive to changes in brain tissue as a consequence of thoracic SCI

Clinical Correlates of High Cervical Fractional Anisotropy in Acute Cervical Spinal Cord Injury

Objective: Fractional anisotropy (FA) of the high cervical cord (C1-C2), rostral to the injury site, correlates with upper limb function in patients with chronic cervical spinal cord injury (SCI). In acute cervical SCI, this relationship has not been investigated. The objective of this study was to identify functional correlates of FA of the high cervical cord in a series of patients with acute cervical SCI. Methods: Traumatic cervical SCI patients who underwent presurgical cervical spine diffusion tensor imaging at our institution were reviewed for this study. FA of the whole cord as well as the lateralcorticospinal tracts (CSTs) was calculated on axial images from C1-C2. Upper limb motor (C5-T1) and sensory (C2-T1) function scores were extracted from the admission American Spinal Injury Association (ASIA) examinations. Correlation analysis for FA with ASIA examinations was performed using a Pearson correlation. Results: Twelve subjects (9 men, 3 women; mean age 54.7 ± 4.0 years) underwent cervical spine diffusion tensor imaging at a mean duration of 3.6 ± 0.9 days postinjury. No patient had cord compression or intramedullary T2-weighted hyperintensities within the C1-C2 segments. FA correlated with upper limb motor score (whole cord: r = 0.59, P = .04; CST: 0.67, P = .01) and the ASIA grade (whole cord: r = 0.61, P = .03; CST: r = 0.71, P = .009). No correlation was found between FA and sensory scores. Conclusions: FA of the whole cervical cord as well as the CST, rostral to the injury site, is associated with preserved upper limb motor function as well as superior ASIA grades after acute cervical SCI. FA of the high cervical cord is a potential biomarker of neural injury after acute cervical SCI

Diffusion Tensor Imaging Correlates with Short-Term Myelopathy Outcome in Patients with Cervical Spondylotic Myelopathy

Objective To determine if spinal cord diffusion tensor imaging indexes correlate with short-term clinical outcome in patients undergoing elective cervical spine surgery for cervical spondylotic myelopathy (CSM). Methods A prospective consecutive cohort study was performed in patients undergoing elective cervical spine surgery for CSM. After obtaining informed consent, patients with CSM underwent preoperative T2-weighted magnetic resonance imaging and diffusion tensor imaging of the cervical spine. Fractional anisotropy (FA) values at the level of maximum cord compression and at the noncompressed C1-2 level were calculated on axial images. We recorded the modified Japanese Orthopaedic Association (mJOA) scale, Neck Disability Index, and Short Form-36 physical functioning subscale scores for all patients preoperatively and 3 months postoperatively. Statistical analysis was performed to identify correlations between FA and clinical outcome scores. Results The study included 27 patients (mean age 54.5 years ± 1.9, 12 men). The mean postoperative changes in mJOA scale, Neck Disability Index, and Short Form-36 physical functioning subscale scores were 0.9 ± 0.3, −6.0 ± 1.9, and 3.4 ± 1.9. The mean FA at the level of maximum compression was significantly lower than the mean FA at the C1-2 level (0.5 vs. 0.55, P = 0.01). FA was significantly correlated with change in mJOA scale score (Pearson r = −0.42, P = 0.02). FA was significantly correlated with the preoperative mJOA scale score (Pearson r = 0.65, P \u3c 0.001). Conclusions Preoperative FA at the level of maximum cord compression significantly correlates with the 3-month change in mJOA scale score among patients with CSM. FA was also significantly associated with preoperative mJOA scale score and is a potential biomarker for spinal cord dysfunction in CSM

Diffusion Tensor Imaging in a Large Longitudinal Series of Patients With Cervical Spondylotic Myelopathy Correlated With Long-Term Functional Outcome

BACKGROUND Fractional anisotropy (FA) of the high cervical cord correlates with upper limb function in acute cervical cord injury. We investigated the correlation between preoperative FA at the level of maximal compression and functional recovery in a group of patients after decompressive surgery for cervical spondylotic myelopathy (CSM). OBJECTIVE To determine the usefulness of FA as a biomarker for severity of CSM and as a prognostic biomarker for improvement after surgery. METHODS Patients received diffusion tensor imaging (DTI) scans preoperatively. FA values of the whole cord cross-section at the level of maximal compression and upper cervical cord (C1-2) were calculated. Functional status was measured using the modified Japanese Orthopedic Association (mJOA) scale preoperatively and at follow-up up to 2 yr. Regression analysis between FA and mJOA was performed. DTI at C4-7 was obtained in controls. RESULTS Forty-four CSM patients enrolled prior to decompression were compared with 24 controls. FA at the level of maximal compression correlated positively with preoperative mJOA score. Preoperative FA correlated inversely with recovery throughout the postoperative period. This was statistically significant at 12 mo postoperation and nearly so at 6 and 24 mo. Patients with preoperative FA0.55. CONCLUSION In the largest longitudinal study of this kind, FA promises a valid biomarker for severity of CSM and postoperative improvement. FA is an objective measure of function and could provide a basis for prognosis. FA is particularly useful if preoperative values are less than 0.55

Alterations in Cortical Sensorimotor Connectivity following Complete Cervical Spinal Cord Injury: A Prospective Resting-State fMRI Study

Functional magnetic resonance imaging (fMRI) studies have demonstrated alterations during task-induced brain activation in spinal cord injury (SCI) patients. The interruption to structural integrity of the spinal cord and the resultant disrupted flow of bidirectional communication between the brain and the spinal cord might contribute to the observed dynamic reorganization (neural plasticity). However, the effect of SCI on brain resting-state connectivity patterns remains unclear. We undertook a prospective resting-state fMRI (rs-fMRI) study to explore changes to cortical activation patterns following SCI. With institutional review board approval, rs-fMRI data was obtained in eleven patients with complete cervical SCI (\u3e2 years post injury) and nine age-matched controls. The data was processed using the Analysis of Functional Neuroimages software. Region of interest (ROI) based analysis was performed to study changes in the sensorimotor network using pre- and post-central gyri as seed regions. Two-sampled t-test was carried out to check for significant differences between the two groups. SCI patients showed decreased functional connectivity in motor and sensory cortical regions when compared to controls. The decrease was noted in ipsilateral, contralateral, and interhemispheric regions for left and right precentral ROIs. Additionally, the left postcentral ROI demonstrated increased connectivity with the thalamus bilaterally in SCI patients. Our results suggest that cortical activation patterns in the sensorimotor network undergo dynamic reorganization following SCI. The presence of these changes in chronic spinal cord injury patients is suggestive of the inherent neural plasticity within the central nervous system

Diffusion Tensor Imaging of the Spinal Cord: Insights From Animal and Human Studies

Diffusion tensor imaging (DTI) provides a measure of the directional diffusion of water molecules in tissues. The measurement of DTI indexes within the spinal cord provides a quantitative assessment of neural damage in various spinal cord pathologies. DTI studies in animal models of spinal cord injury indicate that DTI is a reliable imaging technique with important histological and functional correlates. These studies demonstrate that DTI is a noninvasive marker of microstructural change within the spinal cord. In human studies, spinal cord DTI shows definite changes in subjects with acute and chronic spinal cord injury, as well as cervical spondylotic myelopathy. Interestingly, changes in DTI indexes are visualized in regions of the cord, which appear normal on conventional magnetic resonance imaging and are remote from the site of cord compression. Spinal cord DTI provides data that can help us understand underlying microstructural changes within the cord and assist in prognostication and planning of therapies. In this article, we review the use of DTI to investigate spinal cord pathology in animals and humans and describe advances in this technique that establish DTI as a promising biomarker for spinal cord disorders

Monetary impact of Taenia solium cysticercosis in four countries

The societal monetary burden of cysticercosis in the Eastern Cape Province, South Africa, Honduras, India and the United States of America were estimated. Data on the frequency of infection and on associated morbidity in both human and pig populations and their costs were collected. Decision trees were used to assess the frequency of medical care and loss of value of pigs with their monetary impact

Diffusion Tensor Imaging and Tractography in Brown-Sequard Syndrome

This report illustrates the utility of DTI and DTT in delineating regions of cord injury in two patients with traumatic Brown-Sequard syndrome. Our results indicate that DTI provides clinically relevant information that supplements conventional MR imaging for patients with acute SCI

Improving automatic source code summarization via deep reinforcement learning

© 2018 Association for Computing Machinery. Code summarization provides a high level natural language description of the function performed by code, as it can benefit the software maintenance, code categorization and retrieval. To the best of our knowledge, most state-of-the-art approaches follow an encoder-decoder framework which encodes the code into a hidden space and then decode it into natural language space, suffering from two major drawbacks: a) Their encoders only consider the sequential content of code, ignoring the tree structure which is also critical for the task of code summarization; b) Their decoders are typically trained to predict the next word by maximizing the likelihood of next ground-truth word with previous ground-truth word given. However, it is expected to generate the entire sequence from scratch at test time. This discrepancy can cause an exposure bias issue, making the learnt decoder suboptimal. In this paper, we incorporate an abstract syntax tree structure as well as sequential content of code snippets into a deep reinforcement learning framework (i.e., actor-critic network). The actor network provides the confidence of predicting the next word according to current state. On the other hand, the critic network evaluates the reward value of all possible extensions of the current state and can provide global guidance for explorations. We employ an advantage reward composed of BLEU metric to train both networks. Comprehensive experiments on a real-world dataset show the effectiveness of our proposed model when compared with some state-of-the-art methods