Comparing outcomes of early,late, and non-surgical management of intraspinal abscess

Intraspinal abscesses (ISAs) are rare lesions that are often neurologically devastating. Current treatment paradigms vary widely including early surgical decompression, drainage, and systemic antibiotics, delayed surgery, and sole medical management. The National Inpatient Sample (NIS) database was queried for cases of ISA from 2003 to 2012. Early and late surgery were defined as occurring before or after 48 h of admission. Outcome measures included mortality, incidence of major complications, length of stay (LOS), and inpatient costs. A total of 10,150 patients were included (6281 early surgery, 3167 delayed surgery, 702 medical management). Paralysis, the main comorbidity, was most associated with early surgery (p < 0.0001). In multivariate analysis, the rates of postoperative infection and paraplegia were highest with early surgery (p < 0.0001), but the incidence of sepsis was higher with delayed surgery (p < 0.0001). Early surgery was least associated with in-hospital mortality (p = 0.0212), sepsis (p < 0.001), and had the shortest LOS (p < 0.001). Charges were highest with delayed surgery, and least with medical management (p < 0.001). Medical management was associated with lower rates of complications (p < 0.001). This is the largest study of patients with ISAs ever performed. Our results suggest that patients with ISAs undergoing surgical management have better outcomes and lower costs when operated on within 48 h of admission, emphasizing the importance of accurate and early diagnosis of ISA.     

In-hospital outcomes of aneurysmal subarachnoid hemorrhage associated with cocaine use in the USA

Cocaine use is associated with higher mortality in small retrospective studies of brain-injured patients. We aimed to explore in-hospital outcomes in a large population based study of aneurysmal subarachnoid hemorrhage (aSAH) with cocaine use. aSAH patients were identified from the 2007–2010 USA Nationwide Inpatient Sample using International Classification of Disease, Ninth Revision codes. Demographics, comorbidities and surgical procedures were compared between cocaine users and non-users. The primary outcomes were in-hospital mortality and home discharge/self-care. Secondary outcomes were vasospasm treated with angioplasty, hydrocephalus, gastrostomy and tracheostomy. There were 103,876 patients with aSAH. The cocaine group were younger (45.8 ± 9.8 versus 58.4 ± 15.8, p < 0.001), predominantly male (53.3% versus 38.5%, p < 0.001) and had a higher proportion of black patients (36.9% versus 11.5%, p < 0.001). The incidence of seizures was higher among cocaine users (16.2% versus 11.1%, p < 0.001). Endovascular coiling of intracranial aneurysms (24% versus 18.5%, p < 0.001) was more frequent in cocaine users. The univariate analysis showed higher rates of in-hospital mortality and vasospasm treated with angioplasty, but lower home discharge in the cocaine group. In the multivariate analysis, the cocaine cohort had higher in-hospital mortality (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.27–1.61, p < 0.001) and lower home discharge rates (OR 0.79, 95% CI 0.69–0.87, p < 0.001) after adjusting for confounders. Rates of vasospasm treated with angioplasty however were similar between the two groups. Cocaine use was found to be independently associated with poor outcomes, particularly higher mortality and lower home discharge rates. Cocaine use however, was not associated with vasospasm that required treatment with angioplasty. Prospective confirmation is warranted.     

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery

IntroductionOlder patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery.AimTo determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors.MethodsWe prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery.ResultsPatients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p < 0.01), history of smoking (p < 0.01), arterial hypertension (p = 0.022), diabetes mellitus (p = 0.024), heart failure (p = 0.036) and preoperative cognitive dysfunction (p < 0.01), and surgery-associated aspects such as EuroSCORE (p < 0.01) and operation time (p < 0.01) were identified as related risk factors.ConclusionsOlder patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.     

Trauma-induced spinal cord injury in cervical spondylotic myelopathy with or without lower cervical instability

Dynamic factors are important contributors to neurologic deficits in cervical spondylotic myelopathy (CSM) patients. Between 2005 and 2009, we retrospectively investigated 72 patients with CSM with or without lower cervical instability for their neurologic status after low-energy trauma and surgery. Patients were divided into two groups: the instability group and the stability group. The neurologic status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system. The incidence of neurologic deterioration after trauma was higher in patients with lower cervical instability than in those without (p < 0.05). Patients in the instability group had a lower preoperative JOA score (p < 0.05) and experienced less post-surgery improvement in neurologic function than those in the stability group (p < 0.01). Even a minor trauma to the neck can lead to irreversible spinal cord injury for patients with CSM with cervical instability. Eliminating local instability through surgical and non-surgical methods is necessary for such patients before decompression and fusion surgery.     

Belgian Schizophrenia Outcome Survey – Results of a 2-year naturalistic study in patients stabilised on monotherapy with olanzapine,risperidone or haloperidol

ObjectivesThis Schizophrenia Outcome Survey compared medical costs, psychopathology and adverse events in outpatients for 2 years following hospitalisation for an acute schizophrenic episode.MethodsAdults stabilised with haloperidol, olanzapine or risperidone entered this observational study ≤1 month after discharge and were assessed at baseline, 3, 6, 12, 18 and 24 months using Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Global Assessment of Functioning and adverse events reporting.ResultsAmong 323 patients (haloperidol 32, olanzapine 149, risperidone 142), baseline characteristics were similar in the olanzapine and risperidone groups, except for more first episodes in the risperidone group (p = 0.01). Haloperidol patients were more often single and institutionalised, less educated, had more residual schizophrenia, were longer hospitalised in the previous year, took more corrective and psychotropic drugs and had more extrapyramidal symptoms (EPS) and gynaecomastia (all significantly). Sixty-eight percent of patients completed a 2-year follow-up. In all groups, CGI and GAF improved during the first 3 months (both p < 0.0001) while BPRS deteriorated in the first year (all within group changes p < 0.05, between group changes NS) before it stabilised. There were no significant differences in hospitalisations and no change in social profile. At the last visit, 66% of haloperidol (p < 0.01), 35% of olanzapine (NS) and 39% (NS) of risperidone patients had ≥1 EPS; 69% (p < 0.013), 40 and 44%, respectively, had ≥1 sexual problem (NS). Mean weight gain was 0.4 (NS), 2.6 (p < 0.05) and 2.6 kg (p < 0.05), respectively.ConclusionsIn this naturalistic study, treatment allocation might have introduced a bias in the interpretation of efficiency results, but olanzapine and risperidone caused less EPS than haloperidol during 2 years of outpatient follow-up.     

Trends in the presentation,surgical treatment,and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010

ObjectiveThis is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications.Materials and methodsRetrospective review of the Nationwide Inpatient Sample 2001–2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9 years] vs. adolescent [10–18 year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality.Results6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p < 0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p < 0.001), cardiac (OR 0.27, p < 0.001), respiratory (OR 0.26, p < 0.001), digestive system (OR 0.32, p < 0.001), puncture nerve/vessel (OR 0.56, p = 0.009), wound (OR 0.25, p < 0.001), infection (OR 0.29, p < 0.001), posthemorrhagic anemia (OR 0.04, p = 0.002), ARDS (OR 0.13, p < 0.001), and venous thrombotic (OR 0.53, p = 0.043) complications. Detethering increased nervous system (OR 1.34, p = 0.049) and urinary (OR 2.60, p < 0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p < 0.001), LOS (5.77 vs. 4.13 days, p < 0.001), and charges ($54,592.28 vs. $33,043.83, p < 0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p < 0.001) than pediatric.ConclusionsWith fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.     

Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder

Mindfulness-based cognitive therapy (MBCT) has been studied to treat patients with depressive or anxiety disorders. The aim of this study was to examine whether MBCT is effective as an adjunct to pharmacotherapy in the treatment of patients with panic disorder. Twenty-three patients with panic disorder were included in a MBCT program for a period of 8 weeks. The Hamilton Anxiety Rating Scale (HAM-A), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), and Panic Disorder Severity Scale (PDSS) were used to assess the patients during the MBCT program. Both HAM-A and PDSS scores were significantly decreased at the 2nd, 4th and 8th weeks compared to baseline in the patients with panic disorder (HAM-A, p < 0.01; PDSS, p < 0.01). Also, BAI, APPQ and ASI-R were improved significantly after MBCT program (BAI, p < 0.01; APPQ, p < 0.01; ASI-R, p < 0.01). In addition, all subscale scores of ASI-R decreased significantly. MBCT could be effective as an adjunct to pharmacotherapy in patients with panic disorder. However, randomized controlled trials are needed.     

Executive dysfunction in vascular cognitive impairment in the consortium to investigate vascular impairment of cognition study

Background and purposeThe importance of executive dysfunction is increasingly recognized in the dementia syndrome. Although executive dysfunction has been associated with subcortical ischemic lesions, it may not be unique to VCI or to its clinical subtypes.MethodsSecondary analysis of the CIVIC study, a multi-centre memory clinic cohort study. An executive dysfunction index variable was created using 30 items from the clinical evaluation.ResultsOf 1347 patients, 151 had a baseline diagnosis of no cognitive impairment (NCI), 463 had AD, 324 had VCI, 97 had vascular cognitive impairment not dementia (VCI-ND) and 253 had non-vascular CIND. Those with VCI and AD had higher mean executive dysfunction index values than those with NCI (F = 160.2, p < 0.01). Within the VCI subtypes, people with VaD and mixed dementia had the highest mean executive dysfunction index values (F = 92.5, p < 0.01). Higher executive dysfunction index values were significantly correlated with lower MMSE scores (R = 0.70, p < 0.01), higher Functional Rating Scale scores (R = 0.77, p < 0.01) and higher Geriatric Depression Score values (R = 0.11, p < 0.01). Compared to those who had a lower burden of executive dysfunction, patients with more executive dysfunction (index values > = 0.2) were more likely to be institutionalized (HR = 5.2, p < 0.01) or to die (HR = 2.4, p < 0.01) during the next 30 months.ConclusionsExecutive dysfunction is common in both AD and VCI. It is associated with poor performance on other measures of cognition and function. The presence of executive dysfunction is associated with worse near-term outcomes.     

A new zero-profile,stand-alone Fidji cervical cage for the treatment of the single and multilevel cervical degenerative disc disease

To investigate the clinical and radiological results of the new zero-profile, stand-alone Fidji cervical cage to treat single- and multiple-level cervical DDD, and evaluate the safety and efficiency. Between October 2011 and July 2014, 72 consecutive patients (41 males and 31 females; mean age 50.9 years [range, 33–68 years]) with cervical DDD who underwent surgery and were followed for more than 2 years were enrolled in this study (mean 31.1 months, range 24–47 months). The study compared clinical outcomes, radiologic parameters and complication rates. The SF-36, VAS, NDI, and JOA scores of all patients were improved significantly after surgery at any time point. (all p < 0.05). The C2–C7 Cobb angle and the disc height index (DHI) of all patients were improved significantly after surgery at any time point (all p < 0.05). From 3 months after surgery to final follow-up the DHI showed a significant reduction comparing 1 week after surgery (all p < 0.05). The fusion rates were 91.7% (66/72) and the radiologic mean fusion time was 9.9 months. Radiological evidence of adjacent segment degeneration (ASD) was observed in 4/41 patients (9.8%). Postoperative complications included epidural hematoma, hoarseness, dysphagia, axial neck pain, and subsidence. The zero-profile, stand-alone Fidji cervical cage for ACDF can be considered an effective, reliable and safe alternative procedure in the treatment of cervical DDD.     

Evaluation of patients with multiple sclerosis using a combination of morphometrical features and clinical scores

Our aim was to measure cerebellum volume (CV), sclerotic plaque numbers (PN), and plaque surface area (SA) in the parietal lobe, and to investigate the relationship between CV and PN or SA in the parietal lobe, and the clinical status of patients with multiple sclerosis (MS). MRIs were performed in 14 patients with relapsing-remitting MS (RRMS), 13 patients with secondary progressive MS (SPMS), and 26 healthy control participants. The Cavalieri method was used to measure CV and SA. The cerebellum volume was significantly reduced in MS patients compared to controls (p < 0.01). In all patients, CV was negatively correlated with the duration of the disease, relapse number, and Expanded Disability Status Scale (EDSS) scores (p < 0.01). CV was related to mean PN in both the right and left parietal lobes (p < 0.01) and mean SA (p < 0.05) in RRMS patients; CV was also correlated with mean PN (p < 0.01) and mean SA (p < 0.05) in SPMS patients. The progression index (Pi) values were 2.03 ± 0.4 in RRMS patients and 0.83 ± 0.2 in SPMS patients (p = 0.023, t = 2.612) (where Pi = EDSS/time from onset in years). We propose that atrophy begins both in the supratentorial and infratentorial areas simultaneously in the RR stage, and that the Cavalieri method can be used to predict SPMS among patients with RRMS.     

Polyneuropathy induced by HIV disease and antiretroviral therapy

ObjectiveTo investigate the underlying mechanisms of polyneuropathy induced by HIV infection or antiretroviral drugs.MethodsWe tested 100 HIV patients (59 with AIDS). Ninety-three patients received antiretroviral drugs. Forty-four were treated with neurotoxic compounds (ddI, ddC, d4T). Nerve conduction velocities and the sympathetic skin response (SSR) in palms and soles were measured in all patients. In skin biopsies (ankle and thigh), the intraepidermal nerve fiber density (IENFD) and the number of epidermal fibers without contact to the basal membrane (fragments) were quantified using PGP9.5 staining.ResultsSeverity of the disease (CD4 + count) correlated to conduction velocities of peroneal (p < 0.01, Spearmans rank correlation), sural (p < 0.01) and median nerves (p < 0.05/p < 0.001, sensory/motor). In contrast, the duration of neurotoxic treatment did not impair conduction velocities (p > 0.3) but correlated to reduced IENFD in the ankle (r = ?0.24, p < 0.05). Despite their reduced IENFD, patients with long neurotoxic treatment had a high number of fragments irrespective of their CD4 + count.ConclusionsNeurotoxic treatment appears to primarily impair thin fiber conduction, whereas HIV neuropathy is linked to large fiber impairment and reduction of fragments of nerve fibers.SignificanceThese findings emphasize the differential pattern of polyneuropathy in HIV patients caused by the infection or induced by antiretroviral treatment.     

Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65 years old): A study of 453 consecutive elderly spine surgery patients

In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65 years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47 days vs. 5.70 days, p = 0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p = 0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p = 0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates.     

When should we test for voltage-gated potassium channel complex antibodies? A retrospective case control study

Patients with voltage-gated potassium channel (VGKC)-complex antibodies are increasingly recognized as having central, peripheral or combined phenotypes. With increasing awareness, more patients are tested and the clinical spectrum is expanding. Consequently, clinicians may be uncertain as to which patients should or should not be tested. Previous studies have identified common clinical features, but none has looked at the usefulness of these in predicting seropositive disease. We conducted a case-control study of patients tested for VGKC-complex antibodies over 10 years at a regional tertiary neurology centre determining which clinical/biochemical features were associated with antibody-positive disease. We found a marked increase in the numbers tested, although the percentage positive remained low. Antibody titre was highest in central disease (p < 0.001). Time from presentation to testing was shorter in those with VGKC-disease (p = 0.01). Seizures were present in 11 (69%) of those with VGKC-disease versus three (18%) without (odds ratio [OR] 10.3, 95% confidence interval [CI]: 2.0–52.7, p = 0.005). There was an inverse correlation between the antibody titre and serum sodium. A multivariate model selected seizures and hyponatraemia as predictive of VGKC disease (sensitivity 75% and specificity 82%); faciobrachial dystonic movements were specific but insensitive. Interestingly serum alkaline phosphatase was higher in those with VGKC-disease (p = 0.016) and highest in those with peripheral disease (p = 0.015). An ALP > 70 u/L was strongly associated with antibody positivity (OR 4.11 95% CI: 1.43–11.8, p = 0.007) with a sensitivity of 74.2%. The presence of seizures, faciobrachial movements, and hyponatraemia should raise suspicion of VGKC-disease; alkaline phosphatase may represent a novel biomarker, particularly in those with peripheral disease.     

Childhood onset of migraine,gender, parental social class,and trait neuroticism as predictors of the prevalence of migraine in adulthood

This study investigated the effects of socio-demographic and psychological factors in childhood and adulthood on the prevalence of migraine in adulthood using data from The National Child Development Studies (NCDS), a birth cohort in the UK. The analytical sample comprises 5799 participants with complete data. Logistic regression analysis showed that higher professional parental social class (OR = 2.0: 1.05, 3.86, p < 0.05), female sex (OR = 2.24: 1.68–2.99, p < 0.001), migraine in childhood diagnosed by physicians (OR = 1.76: 1.23–2.50, p < 0.01), and higher trait neuroticism (OR = 1.17:1.26-1.06, p < 0.01): < 0 were all significantly associated with the prevalence of migraine in adulthood. Both socio-demographic and personality factors were significantly associated with the prevalence of migraine in adulthood.     

Restless legs syndrome in end-stage renal disease: Clinical characteristics and associated comorbidities

BackgroundDespite being frequently described in patients with end-stage renal disease (ESRD), clinical characteristics and comorbidities in association with restless legs syndrome (RLS) are still to be confirmed.ObjectivesThe aim of this study was to investigate clinical factors associated with RLS in ESRD patients in hemodialysis.MethodsThis is a cross-sectional study of 400 patients on hemodialysis, evaluating RLS, clinical features and other sleep abnormalities.ResultsOut of 400, 86 patients presented RLS (21.5%; mean age 48.8 ± 13.8 y), being more frequent in females (p < 0.005). Forty-eight individuals (12% mean age 50.7 ± 13.1 y) had moderate/severe RLS, 14 reported symptoms prior to hemodialysis, 13 described family history of RLS, and eight described symptoms as disturbing during dialysis. RLS cases showed lower hemoglobin (p < 0.005), poorer quality of sleep (Pittsburgh Sleep Quality Index >5, p = 0.002), higher scores on the Beck Depression Inventory Scale (p < 0.005), greater scores on the Charlson Comorbidity Index (p = 0.01) and the Epworth Sleepiness Scale (p = 0.001) and higher risk of obstructive sleep apnea (OSA; Berlin questionnaire, p = 0.01). Hypertension was more frequent in cases with moderate/severe RLS (p = 0.01) and remained after controlling for the risk of OSA (p = 0.02).ConclusionIn ESRD patients in hemodialysis, RLS is present in 21.5%; 16% report symptoms prior to hemodialysis and a family history of RLS. Symptoms are disturbing during hemodialysis in 9% of cases. RLS is associated with lower hemoglobin, worse sleep quality, excessive daytime sleepiness, depressive symptoms and higher risk of OSA. Hypertension is associated with moderate/severe RLS.     

The Burden of Narcolepsy Disease (BOND) study: health-care utilization and cost findings

ObjectivesThe aim of this study was to characterize health-care utilization, costs, and productivity in a large population of patients diagnosed with narcolepsy in the United States.MethodsThis retrospective, observational study using data from the Truven Health Analytics MarketScan® Research Databases assessed 5 years of claims data (2006–2010) to compare health-care utilization patterns, productivity, and associated costs among narcolepsy patients (identified by International Classification of Diseases, Ninth Revision (ICD9) narcolepsy diagnosis codes) versus matched controls. A total of 9312 narcolepsy patients (>18 years of age, continuously insured between 2006 and 2010) and 46,559 matched controls were identified.ResultsCompared with controls, narcolepsy subjects had approximately twofold higher annual rates of inpatient admissions (0.15 vs. 0.08), emergency department (ED) visits w/o admission (0.34 vs. 0.17), hospital outpatient (OP) visits (2.8 vs. 1.4), other OP services (7.0 vs. 3.2), and physician visits (11.1 vs. 5.6; all p < 0.0001). The rate of total annual drug transactions was doubled in narcolepsy versus controls (26.4 vs. 13.3; p < 0.0001), including a 337% and 72% higher usage rate of narcolepsy drugs and non-narcolepsy drugs, respectively (both p < 0.0001). Mean yearly costs were significantly higher in narcolepsy compared with controls for medical services ($8346 vs. $4147; p < 0.0001) and drugs ($3356 vs. $1114; p < 0.0001).ConclusionsNarcolepsy was found to be associated with substantial personal and economic burdens, as indicated by significantly higher rates of health-care utilization and medical costs in this large US group of narcolepsy patients.     

Effects of ebselen versus nimodipine on cerebral vasospasm subsequent to experimental subarachnoid hemorrhage in rats

We investigated the effect of ebselen relative to nimodipine in an animal model of subarachnoid hemorrhage. Thirty Wistar albino rats were divided into 5 groups: G1, no intervention; G2, sham surgery without subarachnoid hemorrhage (SAH); G3, SAH only; G4, SAH plus nimodipine treatment; G5, SAH plus ebselen treatment. For G2 animals, physiological saline (0.9% NaCl) was injected into the cisterna magna. For G3, G4 and G5 animals, SAH was induced by injecting autologous non-heparinized blood into the cisterna magna. One hour after injection, G4 animals received nimodipine at 6-hour intervals and G5 animals received ebselen twice a day for 48 hours. After treatment, brain tissue and blood samples were taken for biochemical and histopathological examination. Mean malonyldialdehyde concentration was significantly higher in G3 than in G1 (p < 0.0001), G2 (p = 0.01), G4 (p = 0.002) and G5 (p = 0.014), and significantly higher in G5 than in G1 (p = 0.013). Mean superoxide dismutase activity was significantly lower in G4 than in both G1 (p = 0.025) and G2 (p = 0.02). Mean wall thickness was significantly greater in G3 than in G1 (p < 0.0001), G2 (p = 0.01), G4 (p < 0.0001) and G5 (p < 0.0001). Mean wall thickness was also significantly greater in both G1 and G2 than in G4 (p < 0.0014 and p < 0.0001) and G5 (p < 0.0001 and p < 0.0001). Mean luminal diameter of the basilar artery was significantly smaller in G3 than in G2 (p = 0.02), G4 (p < 0.018) and G5 (p < 0.001). Our results confirm that ebselen may have neuroprotective effects by acting to prevent vasospasm.     

Assessment of physical fitness and exercise tolerance in children with developmental coordination disorder

Children with developmental coordination disorder (DCD) have been shown to be less physically fit when compared to their typically developing peers. The purpose of the present study was to examine the relationships among body composition, physical fitness and exercise tolerance in children with and without DCD. Thirty-seven children between the ages of 7 and 9 years participated in this study. Participants were classified according to results obtained on the Movement Assessment Battery for Children (MABC) and were divided in 2 groups: 19 children with DCD and 18 children without DCD. All children performed the following physical fitness tests: The five-jump test (5JT), the triple-hop distance (THD) and the modified agility test (MAT). Walking distance was assessed using the 6-min walking test (6MWT). Children with DCD showed higher scores than children without DCD in all MABC subscale scores, as well as in the total score (p < 0.001). Participants with DCD were found to perform significantly worse on the MAT (p < 0.001), the THD (p < 0.001) and 5JT (p < 0.05). Moreover, children with DCD had poorer performance on the 6MWT than children without DCD (p < 0.01). Our results found significant correlations among body mass index (BMI), THD (r = 0.553, p < 0.05), 5JT (r = 0.480, p < 0.05) and 6MWT (r = 0.544, p < 0.05) only in DCD group. A significant correlation between MAT and 5JT (r = −0.493, p < 0.05) was found. Similarly, THD and 5JT (r = 0.611, p < 0.01) was found to be correlated in children with DCD. We also found relationships among 6MWT and MAT (r = −0.522, p < 0.05) and the 6MWT and 5JT (r = 0.472, p < 0.05) in DCD group. In addition, we found gender specific patterns in the relationship between exercise tolerance, explosive strength, power, DCD, and BMI. In conclusion, the present study revealed that BMI was indicative of poorer explosive strength, power and exercise tolerance in children with DCD compared to children without DCD probably due to a limited coordination on motor control.     

Outcomes and patterns of care in adult skull base chordomas from the Surveillance,Epidemiology, and End Results (SEER) database

This study aims to demonstrate survival rates and treatment patterns among patients with chordomas of the skull base using a large population database. Patients with cranial chordomas between 1973 and 2009 were identified from the USA Surveillance, Epidemiology, and End Results (SEER) public use database. Kaplan–Meier analysis was used to examine the effect of surgery and radiation on overall survival. We identified 394 patients with histologically-confirmed cranial chordomas. Median survival was 151 months. Most patients (89.09%) underwent surgery. Less than half (44.92%) received radiation after diagnosis. Patients who underwent surgical resection survived significantly longer than those who did not undergo resection, regardless of other treatments (151 versus 81 months, p < 0.001). Ten year survival was lower among patients receiving radiation (44.8% versus 61.4%, p = 0.66). Surgery predicted better overall survival by univariate analysis (hazard ratio [HR] 0.603, p = 0.0293); younger age at diagnosis (HR 1.028, p < 0.001), and later year of diagnosis (HR 0.971, p = 0.0027) were prognostic of improved survival in a multivariate model. In subgroup analysis of patients with documented tumor size, smaller tumor size (HR 1.021, p = 0.0067), younger age (HR 1.031, p = 0.001), and treatment within a higher volume registry (HR 0.490, p = 0.0129) predicted improved survival. Surgical intervention offers survival benefit for cranial chordomas. Findings of decreased survival in patients receiving radiation may be associated with selection. Studies examining surgical extent of resection data and radiation details are needed to determine the impact of radiotherapy.