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Multi-center, retrospective cohort study.To determine the epidemiology, identify predictors of early mortality, and develop predictive models for traumatic spinal cord injury (SCI).Despite improved initial care and management strategies, traumatic SCI remains a devastating event. Knowledge of the epidemiological state and predictive factors for mortality is important for developing strategies and counseling; however, they have not been adequately investigated, and predictive modeling regarding outcomes remains an underused modality for patients with traumatic SCI.Using a nationwide trauma registry-the Japan Trauma Data Bank-we identified adult (≥18 yrs) patients with SCI between 2004 and 2015. The endpoint was in-hospital mortality. Characteristics of each patient were described. Multivariate logistic regression analyses were performed to identify factors significantly associated with in-hospital mortality and develop a predictive model.In total, 236,698 patients were registered in the database. Of the 215,835 adult patients, 8069 (3.7%) had SCI. The majority had SCI at the cervical level with falls at ground level being the primary etiology. Over the study period, median age, the proportion of cervical SCI, and the etiology of falls at ground level increased. The mortality rate was 5.6%. The following eight factors, age, sex, Glasgow Coma Scale on arrival (GCS), hypotension on arrival, bradycardia on arrival, severe head injury, Injury Severity Score (ISS), and neurological severity of SCI, were independently associated with mortality. A predictive model consisting of these variables predicted mortality with area under the receiver operating characteristic curve of 0.88 (95% confidence interval [CI], 0.86-0.90).Over the 12-year period, patient characteristics, etiology, and post-SCI outcomes significantly changed. We identified eight prognostic factors of early mortality. A predictive model including these factors showed excellent performance and may improve treatment strategies, healthcare resource allocation, and counseling.3.

We developed a simple in vitro antithrombogenic testing method using a mock circulation system as used in the hemolysis tests to evaluate the antithrombogenicity of centrifugal blood pumps. This method was not designed to substitute for animal experiments but was intended to be a screening test method for selecting pumps robust enough to operate properly during animal experiments. In this study, we were able to maintain an almost constant activated clotting time for test blood for 10 hours by using both trisodium citrate and calcium chloride. We carried out the in vitro antithrombogenic testing of monopivot type centrifugal blood pumps (models DD3 and DD6) and hydrodynamic bearing pumps (models HH2 and HH7), which were developed at Advanced Industrial Science and Technology. Thrombus formation was not observed in the DD3 or DD6 pumps but occurred in the HH2 and HH7 pumps. The HH2 pump generated thrombi during a 1.5-hour ex vivo test, and the test was terminated. We expect this in vitro testing method to be useful for undertaking evaluations before animal experiments.

The functional roles of endothelin ET A and ET B receptors in the development of monocrotaline (MCT)-induced pulmonary hypertension were investigated using MCT-treated rats in the absence or presence of a daily administration of A-192621, a selective ET B receptor antagonist, ABT-627, a selective ET A receptor antagonist, or a combination of both drugs. Four weeks after the injection of saline or MCT (60 mg/kg, s.c.), cardiac hypertrophy, right ventricular systolic pressure and morphologic changes of pulmonary arteries were evaluated. Compared with the control animals, MCT produced marked pulmonary hypertension associated with increases in right ventricular pressure and hypertrophy, and pulmonary arterial medial thickening. These MCT-induced alterations were markedly suppressed by daily treatment with ABT-627 for 4 weeks (10 mg/kg/d, twice daily), whereas treatment with A-192621 significantly aggravated the above MCT-induced pathologic changes. The blockade of both receptor subtypes by a combination of A-192621 and ABT-627 also significantly improved the MCT-induced pathologic changes, to the same extent as with ABT-627 administration. Thus, an exaggerated response to MCT during ET B receptor blockade also seems to be mediated by ET A receptor activation, thereby suggesting that ET A receptor-mediated action is exclusively contributive to the pathogenesis of MCT-induced pulmonary hypertension, although we cannot rule out a protective role of ET B receptor-mediated action.

We are developing microcapsule suspensions to evaluate the absolute hemolytic properties of centrifugal blood pumps. Four types of microcapsule suspensions, with maximum diameters of 100 microm or 10 microm, and membranes of polyurethane or melamine resin, were exposed to fluid dynamic shear up to 15,000 s(-1) with a rotating shear stressor developed in our laboratory. As a result, destruction was observed of only the 100 microm microcapsules. The microcapsules with polyurethane membranes broke at a high shear velocity range over 11,250 s(-1), a tendency similar to that observed using bovine blood. The microcapsules with melamine resin ruptured at approximately 7,500 s(-1). These observations could lead to determination of absolute hemolysis from shear stress occurring in centrifugal blood pumps.

Background and Purpose —The efficacy of superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis in adult moyamoya disease was evaluated by clinicopathophysiological studies. Methods —Fifteen patients with cerebral ischemic attacks (ischemia group) and 15 patients with intracranial hemorrhages (hemorrhage group) were investigated. Clinicoangiographic features and regional cerebral blood flow (rCBF) of the MCA territory were preoperatively and postoperatively investigated, and cortical arterial pressure (CAP) and anastomotic blood flow (AF) were intraoperatively measured. Results —In the ischemia group, the preoperative rCBF of 38.4 mL/100 g per minute was significantly increased to 42.1 mL/100 g per minute with a diminution of angiographic moyamoya vessels in 67% of patients after surgery. The mean CAP and AF were 25.6 mm Hg and 34.7 mL/min, respectively. Proximal and distal cerebral vascular resistance (PCVR=[Mean Systemic Arterial Blood Pressure−Mean CAP]/rCBF and DCVR=[Mean CAP/rCBF]) were 1.78 and 0.68, respectively. One patient died perioperatively as a result of intracerebral hemorrhage. During follow-up (mean, 67 months), 12 of 14 patients recovered without neurological deficits, 1 was moderately disabled because of the initial insult, and another patient experienced an intracerebral hemorrhage but recovered fully. In the hemorrhage group, the preoperative rCBF of 38.0 mL/100 g per minute was significantly increased to 42.7 mL/100 g per minute with a diminution of moyamoya vessels in 60% after surgery. The mean CAP and AF were 29.1 mm Hg and 24.1 mL/min, respectively. PCVR and DCVR were 1.72 and 0.77, respectively. One patient became hemiparetic because of perioperative intracerebral hemorrhage. During follow-up (mean, 94 months), 3 patients had fatal intracranial hemorrhages, 10 had good recoveries, and 2 had moderate disabilities. Conclusions —This study revealed a high PCVR and a very low DCVR in both the ischemia and hemorrhage groups of patients. STA-MCA anastomosis partially normalized cerebral circulation and decreased moyamoya vessels but did not completely prevent rebleeding.

WE DESCRIBE NEWLY developed tumor-holding clips, which have been applied in more than 50 patients with large or deep-seated tumors. We devised various kinds of standard tumor clips by modifying Sugita aneurysm clips. Our new tumor clips permit gentle, steady, and easy retraction of the tumor in any direction without disturbance of the operative field. With the use of these clips, a surgeon can operate with both hands. From our experience of removing more than 50 tumors, we confirm that our tumor clips are useful for the removal of large or deep-seated tumors. (Neurosurgery 37 :152-154, 1995)