Clinical Findings in a Multicenter MRI Study of Mild TBI

Background: Uncertainty continues to surround mild traumatic brain injury (mTBI) diagnosis, symptoms, prognosis, and outcome due in part to a lack of objective biomarkers of injury and recovery. As mTBI gains recognition as a serious public health epidemic, there is need to identify risk factors, diagnostic tools, and imaging biomarkers to help guide diagnosis and management. Methods: One hundred and eleven patients (15-50 years old) were enrolled acutely after mTBI and followed with up to four standardized serial assessments over 3 months. Each encounter included a clinical exam, neuropsychological assessment, and magnetic resonance imaging (MRI). Chi-square and linear mixed models were used to assess changes over time and determine potential biomarkers of mTBI severity and outcome. Results: The symptoms most frequently endorsed after mTBI were headache (91%), not feeling right (89%), fatigue (86%), and feeling slowed down (84%). Of the 104 mTBI patients with a processed MRI scan, 28 (27%) subjects had white matter changes which were deemed unrelated to age, and 26 of these findings were deemed unrelated to acute trauma. Of the neuropsychological assessments tested, 5- and 6-Digit Backward Recall, the modified Balance Error Scoring System (BESS), and Immediate 5-Word Recall significantly improved longitudinally in mTBI subjects and differentiated between mTBI subjects and controls. Female sex was found to increase symptom severity scores (SSS) at every time point. Age \u3e/= 25 years was correlated with increased SSS. Subjects aged \u3e/= 25 also did not improve longitudinally on 5-Digit Backward Recall, Immediate 5-Word Recall, or Single-Leg Stance of the BESS, whereas subjects \u3c 25 years improved significantly. Patients who reported personal history of depression, anxiety, or other psychiatric disorder had higher SSS at each time point. Conclusions: The results of this study show that 5- and 6-Digit Backward Recall, the modified BESS, and Immediate 5-Word Recall should be considered useful in demonstrating cognitive and vestibular improvement during the mTBI recovery process. Clinicians should take female sex, older age, and history of psychiatric disorder into account when managing mTBI patients. Further study is necessary to determine the true prevalence of white matter changes in people with mTBI

Clinical Findings in a Multicenter MRI Study of Mild TBI

Background: Uncertainty continues to surround mild traumatic brain injury (mTBI) diagnosis, symptoms, prognosis, and outcome due in part to a lack of objective biomarkers of injury and recovery. As mTBI gains recognition as a serious public health epidemic, there is need to identify risk factors, diagnostic tools, and imaging biomarkers to help guide diagnosis and management.Methods: One hundred and eleven patients (15–50 years old) were enrolled acutely after mTBI and followed with up to four standardized serial assessments over 3 months. Each encounter included a clinical exam, neuropsychological assessment, and magnetic resonance imaging (MRI). Chi-square and linear mixed models were used to assess changes over time and determine potential biomarkers of mTBI severity and outcome.Results: The symptoms most frequently endorsed after mTBI were headache (91%), not feeling right (89%), fatigue (86%), and feeling slowed down (84%). Of the 104 mTBI patients with a processed MRI scan, 28 (27%) subjects had white matter changes which were deemed unrelated to age, and 26 of these findings were deemed unrelated to acute trauma. Of the neuropsychological assessments tested, 5- and 6-Digit Backward Recall, the modified Balance Error Scoring System (BESS), and Immediate 5-Word Recall significantly improved longitudinally in mTBI subjects and differentiated between mTBI subjects and controls. Female sex was found to increase symptom severity scores (SSS) at every time point. Age ≥ 25 years was correlated with increased SSS. Subjects aged ≥ 25 also did not improve longitudinally on 5-Digit Backward Recall, Immediate 5-Word Recall, or Single-Leg Stance of the BESS, whereas subjects < 25 years improved significantly. Patients who reported personal history of depression, anxiety, or other psychiatric disorder had higher SSS at each time point.Conclusions: The results of this study show that 5- and 6-Digit Backward Recall, the modified BESS, and Immediate 5-Word Recall should be considered useful in demonstrating cognitive and vestibular improvement during the mTBI recovery process. Clinicians should take female sex, older age, and history of psychiatric disorder into account when managing mTBI patients. Further study is necessary to determine the true prevalence of white matter changes in people with mTBI

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Longitudinal Change in Diffusion Kurtosis Imaging Metrics as a Biomarker of Mild Traumatic Brain Injury ABSTRACT

Objective: To determine the utility of diffusion kurtosis imaging (DKI) as an advanced neuroimaging biomarker for Mild Traumatic Brain Injury (mTBI). Background: In the absence of structural abnormalities in mTBI, diffusion tensor imaging (DTI) metrics are often inadequate to determine longitudinal changes in microstructural white matter integrity. DKI extends conventional DTI for greater sensitivity and specificity of microstructural axonal injury. Design/Methods: 111 mTBI patients and 32 controls (15–50 years old) were enrolled acutely after mTBI and followed with up to 4 standardized serial assessments over 3 months. Patients were enrolled at either Encounter 1 (E1), within 72 hours, or Encounter 2 (E2), 5–10 days post-injury, and returned for Encounter 3 (E3) at 15–29 days and Encounter 4 (E4) at 83–97 days. Each encounter included a clinical exam, neuropsychological assessment, as well as diffusion kurtosis imaging. Data were analyzed as mean percentage of diffusion kurtosis orthogonal outlier within each region of interest. Voxels were considered an outlier if orthogonal kurtosis was \u3e99.5% percentile of the healthy control distribution. Results: Within mTBI subjects, mean percentage of orthogonal kurtosis imaging (Korth) outliers was significantly greater at E1–E3 relative to E4 (p\u3c.05). Between-subjects analysis revealed a significant difference in mean percentage of Korth outliers at E2 between mTBI and controls (p\u3c.05). Furthermore, rank-sum test of regions of interest (ROI) sorted by ROIs with the greatest number of outliers at E2, identified a subset of 20 regions that differed acutely between mTBI and controls. Conclusions: Diffusion kurtosis imaging was sensitive to longitudinal changes in white matter integrity. Additionally, mean percentage of Korth outliers in a subset of 20 ROIs may serve as a potential mTBI diagnostic marker

Painful erythematous, infiltrated papulonodules in a middle aged man

Cutaneous leiomyomas (CL) often present as painfultumors in the skin. Herein we report an adultman who presented with multiple, erythematouspapulonodules in both segmental and non-segmentaldistribution

Clinical assessment of nutrition status score and body mass index in newborns: A comparative study

Background: Fetal growth restriction can occur at any gestational period and is affected by maternal, placental and environmental factors. These factors can cause neonatal mortality or morbidity and long term sequalae. Thereby it is important to assess the nutritional status at birth. Clinical assessment of nutrition status score (CAN) assessment based on birth centile became important. Objectives: Aim was to compare CAN score and BMI birth centiles using pre-designated cut offs for assessing fetal nutrition. Materials and Methods: 1000 newborns cross-Sectional descriptive study. Department of Paediatrics, K.S. Hegde Medical Academy, Mangalore. Nov-2015 to June-2017. Inclusion criteria included term neonates with gestational age >37 completed weeks of gestation by dates or ultra-sonogram.  Neonates with major congenital malformation or syndromes were excluded.  Results: Out of 1000 newborns, 259 newborns (25.9%) had BMI below 10th centile out of which 99(9.9%) had BMI less than 3rd centile suggesting severe malnutrition. Malnutrition as per CAN Score was seen in 319(31.9%) infants. When CAN score and BMI was compared, among the 353 babies who had CAN score less than 25 indicating FM, only 129(36.5%) had BMI less than 10th  centile. In 130 of the 259 infants with BMI less than 10th centile, CAN score was normal