Quantitative assessment of column-specific degeneration in cervical spondylotic myelopathy based on diffusion tensor tractography

Purpose Cervical spondylotic myelopathy (CSM) is a common spinal cord disorder in the elderly. Diffusion tensor imaging (DTI) has been shown to be of great value for evaluating the microstructure of nerve tracts in the spinal cord. Currently, the quantitative assessment of the degeneration on the specific tracts in CSM is still rare. The aim of the present study was to use tractography-based quantification to investigate the column-specific degeneration in CSM. Methods A total of 43 volunteers were recruited with written informed consent, including 20 healthy subjects and 23 CSM patients. Diffusion MRI was taken by 3T MRI scanner. Fiber tractography was performed using TrackVis to reconstruct the white matter tracts of the anterior, lateral and posterior column on the bilateral sides. The DTI metrics acquired from tractography, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD), were compared between healthy subjects and CSM patients. Results Compared to healthy subjects, FA was found significantly lower in the lateral (Healthy 0.64 ± 0.07 vs. CSM 0.53 ± 0.08) and posterior column (Healthy 0.67 ± 0.08 vs. CSM 0.47 ± 0.08) (p < 0.001), while MD, AD and RD were significantly higher in the anterior, lateral and posterior column in CSM (p < 0.05). Conclusion Loss of microstructural integrity was detected in the lateral and posterior column in CSM. Tractography-based quantification was capable of evaluating the subtle pathological insult within white matter on a column-specific basis, which exhibited potential clinical value for in vivo evaluation of the severity of CSM. © 2014 Springer-Verlag Berlin Heidelberg.postprin

Comparing the effectiveness of pattern differentiation treatment and fixed formula treatment for perimenopausal syndrome with Chinese herbal medicine: A study protocol

Objective: To further understand and compare the effectiveness of pattern differentiation treatment and fixed prescription treatment in perimenopausal syndrome. Methods: The study will be conducted in the Hong Kong Federation of Trade Unions Workers’ Medical Clinics, Hong Kong Baptist University Chinese Medicine Clinic cum Training and Research Centre (Hong Kong, China). One hundred Chinese women, aged 45–55 years, will be recruited. The participants will be randomized into 2 groups. The intervention group will be administered medication, based on pattern differentiation, by qualified traditional Chinese medicine (TCM) practitioners. After each evaluation, TCM practitioners will evaluate and revise the prescription, based on the participants' patterns. The control group will be given the standard formula, i.e., the Erxian decoction, which contains 6 herbs. The treatment period and the follow-up period will be 8 weeks each. The primary assessment outcome measure will be the Kupperman Index, and the secondary outcome measure will be the Menopause-specific Quality of Life Questionnaire score. Conclusion: Pattern-differentiated treatment is the basic principle of TCM to understand and treat diseases. The study will show the pattern-differentiated treatment is effectiveness than the fixed prescription