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Hypoxic ischemic (HI) brain injury that occurs during neonatal period has been correlated with severe neuronal damage, behavioral deficits and infant mortality. Previous evidence indicates that N-acetylcysteine (NAC), a compound with antioxidant action, exerts a potential neuroprotective effect in various neurological disorders including injury induced by brain ischemia. The aim of the present study was to investigate the role of NAC as a potential therapeutic agent in a rat model of neonatal HI brain injury and explore its long-term behavioral effects. To this end, NAC (50 mg/kg/dose, i.p.) was administered prior to and instantly after HI, in order to evaluate hippocampal and cerebral cortex damage as well as long-term functional outcome. Immunohistochemistry was used to detect inducible nitric oxide synthase (iNOS) expression. The results revealed that NAC significantly alleviated sensorimotor deficits and this effect was maintained up to adulthood. These improvements in functional outcome were associated with a significant decrease in the severity of brain damage. Moreover, NAC decreased the short-term expression of iNOS, a finding implying that iNOS activity may be suppressed and that through this action NAC may exert its therapeutic action against neonatal HI brain injury.

Patients on antithrombotics experiencing mild traumatic brain injury (mTBI) may benefit from a routine repeat CT scan to detect delayed intracranial hemorrhage (dICH). The primary outcome was the incidence of dICH on routine repeat CT scans of mTBI patients on antithrombotics within an intra-hospital observation period of up to 48 hours. The secondary outcomes were potential risk factors, readmissions, neurosurgical interventions, and mortality. A systematic review and a meta-analysis of single proportions were performed according to the PRISMA and PRESS guidelines. The risk of bias was assessed using Newcastle-Ottawa Scale. Eighteen studies with 4613 patients were included. The pooled incidence of dICH was 2% [95% CI 1-2%] with similar rates between different antithrombotic regimens, even in combination. Of the 67 patients with dICH reported (1.45%), eleven required surgery (0.24%), while six died (0.13%). Loss of consciousness was a risk factor of dICH (risk ratio 3.04 [95%CI 0.96; 9.58]). A total of 48 patients were reported for readmission without associated death or surgical intervention. The contribution of this routine repeat CT scan should be questioned due to the low incidence, the limited clinical significance, and the unsubstantiated clinical benefit of early or systematic detection of dICH.

Background and Purpose— Acute stroke treatment is challenging, and stroke remains a major cause of death and disability. The purpose of this meta-analysis is to investigate the effects of postacute stroke intravenous administration of the neuroprotectant magnesium sulfate (MgSO 4 ) on global outcome, functional outcome, and mortality 90 days poststroke (ischemic and nonischemic). Methods— We searched in Pubmed, Science Direct, CENTRAL, and ClinicalTrials.gov, up to November 11, 2017, and we conducted a systematic review and meta-analysis of randomized controlled trials. We synthesized results by using random-effects model, weighted mean differences, standardized mean differences, and odds ratios. Results— Seven randomized controlled trials (4347 patients) met our criteria. Compared with placebo, treatment did not improve functional outcome defined as Barthel Index >60 (odds ratio =1.05; 95% CI, 0.92–1.19) and >95 (odds ratio =0.95; 95% CI, 0.76–1.20), 90 days poststroke. It also did not improve global outcome measured with modified Rankin Scale (standardized mean difference =−0.01; 95% CI, −0.12 to 0.10), 90 days poststroke. In an additional subgroup meta-analysis that exclusively included ischemic stroke patients, intravenous MgSO 4 resulted in lower modified Rankin Scale score (improved global outcome; weighted mean difference =−0.96; 95% CI, −1.34 to −0.58; I 2 =0%], 90 days poststroke. Finally, mortality stayed unaltered (odds ratio =1.10; 95% CI, 0.94–1.29). Conclusions— The findings of our meta-analysis showed that intravenous MgSO 4 generally did not improve global/functional outcomes and mortality at 90 days after stroke (combined ischemic stroke and nonischemic stroke). The finding of favorable neurological outcome, selectively in ischemic stroke patients, should be viewed with extreme caution given the limited number of patients included in this subgroup meta-analysis.

Background: Endotracheal suctioning of respiratory secretions is one of the most common causes of pain and discomfort in Intensive Care Unit environment. The electrical properties of the skin, also known as electrodermal activity (EDA), are considered as an indirect measure of autonomous nervous system. Aim: This study explores EDA changes during endotracheal suction in sedated adult critical care patients; and compares these changes to other monitoring parameters. Materials and methods: Skin conductance variability, selected hemodynamic and respiratory parameters, bispectral index (BIS) and ambient noise level, were monitored during 4 hour routine daytime intensive care nursing and treatment in an adult Intensive Care Unit. 4h-measurements were divided into 2 groups, based upon the sedation level (group A: Ramsay sedation scale 2-4 and group B: 5-6 respectively) of the patients. Selected recordings before and after endotracheal suction (stress events) were performed. Seven stress events from Group A and 17 from Group B were included for further analysis. Patients’ demographics, laboratory exams and severity scores were recorded. Pain status evaluation before every event was also performed via 2 independent observers. Results: In both groups the rate of EDA changes was greater than in other monitoring parameters. Yet, in group A only selected parameters were significantly changed after the start of the procedure, while in group B, every parameter showed significant change (p Conclusion: EDA measurements are more sensitive to stress stimuli, than cardiovascular, respiratory or even BIS monitoring. Deeper sedation seems to affect more the intensity of EDA changes during suction.

Introduction: Although cervical arthroplasties have been widely used with some success over the last decade, long terms results are missing, particularly for the latest designed implants such as semi constrained prostheses. Material and methods: 89 patients were enrolled in an observational study evaluating long term safety and potential complications related to the use of the cervical prosthesis Baguera® C. All patients had been treated at one or two levels between June 2009 and June 2011. At the 5 years FU visit, the patients were evaluated clinically and neurologically, and with self-assessment questionnaires (NDI, SF12). Radiological examination was performed by lateral X-rays in neutral, flexion and extension positions. Results: There were no reoperations at the arthroplasty level, no fracture of system components, no loss of fixation, and no migration nor subsidence. 17 patients had signs of adjacent level(s) degeneration. The performance related to Baguera®C usage, was evaluated at 5+ Y. PO by three parameters: Range of Motion (ROM), NDI and SF-12 scores. ROM at the treated level was 8.6° ± 5.0°. 87.7% of the treated levels showed preserved motion. NDI score was 19.5% ± 14.1%. 92% of the subjects reported NDI scores over 50%, and 74.2% of the subjects reported NDI scores under 30% and 45% of the subjects reported NDI scores under 10%. The QOL Index and Patient Satisfaction (SF-12 scores) reached 48.5 ± 8.6 for the PCS physical score and 48.0 ± 10.5 for the MCS Mental score. Both SF-12 components, physical and mental, were close to a normal health status (50%). Conclusion: Cervical disc replacement with the Baguera®C prosthesis shows excellent safety, clinical results and long-term motion preservation. There was no index or adjacent level reoperation after 5 years. Radiological progression of adjacent level degeneration was seen in a significant minority of cases, but without clinical expression.

Massive rotator cuff tear repair is frequently complicated by unsatisfactory clinical results due to possible tendon retraction, muscle atrophy, and fatty degeneration. The objective of this study was the development of a chronic massive tear in a rat model and the evaluation of the muscle force in vivo and of the histologic changes in a 3- dimensional manner.To simulate massive rotator cuff tears, both the supraspinatus (SS) and the infraspinatus (IS) tendons were surgically detached from the right humerus of 15 male adult Sprague-Dawley rats. Twelve weeks postoperatively, all animals underwent isometric tension recordings of both the SS and IS muscles. Histologic analysis and image deconvolution processing were performed to estimate the presence and the distribution of atrophy in 3 dimensions.An overall 30% and 35% reduction in muscle force of the SS and IS muscles, respectively, was observed compared with the left uninjured shoulder (P .005). Histologic analysis revealed that the degeneration and the fatty infiltration were more evident near the tendon and at the dorsal side in both muscle groups.These results show that functional impairment of SS and IS muscles after chronic massive tendon tears could be attributed to the decrease in muscle force production during their repair on the greater tuberosity and, second, to the comparatively greater degeneration of their dorsal part.

Introduction: Quantitative descriptions of fiber type organization in hind limb muscles are incomplete or rare. Methods: Fiber morphometrics for both rat tibialis anterior (TA) muscles were measured in 3 dimensions. Results: Slow oxidative fiber area and perimeter varied in all zones. Fast oxidative glycolytic fibers (FOG) were predominant in the mediolateral and posterior zones, and fast glycolytic fibers (FG) predominated in the anterior zone. The mean area of FOG and succinate dehydrogenase intermediate fibers was lowest in the anterior zone. Mean area of FG was highest in the proximal and distal parts of the muscle. The area and perimeter of fast fibers differed significantly between the right and left limbs in the medial zone. In the middle and lateral zones, they differed at the proximal and distal parts. Conclusions: This detailed analysis in a high resolution, 3-dimensional map provides an essential tool for understanding the structure and function of TA muscles. Muscle Nerve 48: 951–957, 2013

Introduction: In many cases, cervical arthroplasty can avoid adjacent segment degeneration, by preserving the mobility of the operated level. In this paper, we present and analyze the radiological results of a cohort of patients who underwent cervical disc arthroplasty, with the Baguera®C cervical disc prosthesis. Material and methods: 99 patients and a total of 123 prostheses were included in a retrospective analysis of radiographic images, based on a registry type data collection, with a two-year follow-up (FU). The radiological data was independently assessed for the range of motion, disc angle, disc height at the operated level and at the adjacent level, and for heterotopic ossifications (HO). Results: At the operated level, the range of motion (ROM) decreased from 10.2° preoperatively to 8.7° (nonsignificant) after two years in the one level total disc replacement (TDR) group, from 9.8° to 9.1° (non-significant) in the two levels TDR group. The motion of the upper FSU changed from 10.6° preoperatively to 13.5° after two years in the one level TDR group, from 11.6° to 10.9° in the two levels group. The disc height at the level of the operated FSU changed from 4 mm preoperatively to 7.1 mm after six weeks and 6.5 mm after two years for the one level TDR. The disc height at the level above the highest operated FSU changed from 4.24 mm preoperatively to 4 mm after six weeks and 4.2 mm after two years for the one level TDR, from 4.5 mm to 5.4 mm (6W) and 5.3 mm (2Y) for the two levels TDR. No heterotopic ossification was observed in 46% of the patients. HO was observed, respectively 20.1% grade I, 14.5% grade II, 13.7% grade III and 5.6% grade IV. HO restricting mobility (grades III and IV) were seen in 19.3%. The prostheses were mobile in 80.6% after two years. Conclusion: Cervical arthroplasty using the Baguera®C prosthesis, demonstrated cervical mobility preservation in 80.6% of the patients, an HO rate of 54%, mostly grade I and II, no signs of subsidence and no signs of degeneration or kyphosis of the adjacent disc. This motion preserving surgical treatment, either used alone or in combination with segmental fusion, shows encouraging results in term of adjacent level disease protection and appears, therefore, as safe and effective.

The purpose of this study was to elucidate the effect of deafferentation on spinal motoneurons. We studied the effects of spinal cord transection and/or dorsal rhizotomy upon the contractile properties of EDL and soleus muscle, as well as on the number of motoneurons corresponding to these muscles. Neonatal Wistar rats were randomly divided into four groups in which spinal midthoracic section (T8-T10), unilateral dorsal lumbar rhizotomy (L3-S2) or both procedures were performed on the second postnatal day (PND2). Another group served as unoperated control. At 2 months of age, the animals were evaluated for the contractile properties of a fast (EDL) and a slow (soleus) muscle. Isometric tension recordings were elicited by way of sciatic nerve branches stimulation. In addition, the incremental method was applied for the determination of the number of motor units supplying the two muscles, which was also verified by using the horseradish peroxidase (HRP) method of reverse labeling of motoneurons. Muscle alterations were confirmed by the usual biochemical staining. Our results, in agreement with the data from other researchers, show that significant muscle atrophy takes place after all experimental procedures. Additionally, spinal cord section alters the development of the dynamic properties of soleus muscle, which attains a fast profile. Following transection, the number of motor units remained unaltered, while rhizotomy affected only the soleus by reducing its motor units. The combined procedure affected both muscles, indicating that adequate synaptic input is essential for motoneuron survival.

It has been shown in the rat, that during the first five postnatal days, motoneurons are particularly vulnerable to excitotoxic cell death and glutamate receptors play a significant role in this time-dependent process. Various categories of glutamate blockers (MK-801, Mg, PNQX, DAP-5) have various actions on the respective receptors. Furthermore, the different response between mature and immature motoneurons following injury is attributed to the quantity of glutamate receptors on the cell membrane. The effect of these substances on the recovery of fast and slow muscles after sciatic nerve crush, at critical developmental stages, shows a variable but impressive reversal of the devastating effects on rat muscle properties, which is different between fast and slow muscles. In addition, blocking of NMDA receptors by various substances rescues motoneurons and increases the number of motor units surviving into adulthood. In this way, glutamate receptor blockers may represent a promising therapeutic approach to retain nerve and muscle function during neurodegenerative events.

Quantitative descriptions of fiber type organization in hind limb muscles are incomplete or rare.Fiber morphometrics for both rat tibialis anterior (TA) muscles were measured in 3 dimensions.Slow oxidative fiber area and perimeter varied in all zones. Fast oxidative glycolytic fibers (FOG) were predominant in the mediolateral and posterior zones, and fast glycolytic fibers (FG) predominated in the anterior zone. The mean area of FOG and succinate dehydrogenase intermediate fibers was lowest in the anterior zone. Mean area of FG was highest in the proximal and distal parts of the muscle. The area and perimeter of fast fibers differed significantly between the right and left limbs in the medial zone. In the middle and lateral zones, they differed at the proximal and distal parts.This detailed analysis in a high resolution, 3-dimensional map provides an essential tool for understanding the structure and function of TA muscles.

The importance of tumor volume as a prognostic factor in high-grade gliomas is highly controversial and there are numerous methods estimating this parameter. In this study, a computer-based application was used in order to assess tumor volume from hard copies and a survival analysis was conducted in order to evaluate the prognostic significance of preoperative volumetric data in patients harboring glioblastomas. 50 patients suffering from glioblastoma were analyzed retrospectively. Tumor volume was determined by the various geometric models as well as by an own specialized software (Volumio). Age, performance status, type of excision, and tumor location were also included in the multivariate analysis. The spheroid and rectangular models overestimated tumor volume, while the ellipsoid model offered the best approximation. Volume failed to attain any statistical significance in prognosis, while age and performance status confirmed their importance in progression-free and overall survival of patients. Geometric models provide a rough approximation of tumor volume and should not be used, as accurate determination of size is of paramount importance in order to draw safe conclusions in oncology. Although the significance of volumetry was not disclosed, further studies are definitely required.

An isolated spinal demyelinating lesion is very rare and almost always associated with multiple sclerosis. There are only a few reports of biopsy or resection of MS-associated lesions. Sometimes the radiological and the histopathological findings can lead to a false diagnosis of a tumour. A 15-year-old girl presented with a progressive spastic tetraparesis and various associated clinical symptoms. Magnetic resonance imaging (MRI) suggested a possible intramedullary tumour extending from C4 to C7 and the need for surgical intervention. There was no previous neurological or other history and the brain MRI was normal. The performing surgeons based their procedures on oncological criteria. The extracted lesion was finally diagnosed as a demyelinating plaque. The postoperative course was uneventful without deterioration of the neurological status and the young patient improved completely after 4-months of rehabilitation. After an 8-year follow-up, the patient remains in remission and free of neurological defects. Apart from the radiological findings, the CSF exam as well as the evoked potentials does not suggest a diagnosis of MS. A demyelinating plaque in the cervical spinal cord can occasionally imitate a cervical intramedullary tumour leading to an operation. Such lesions underscore the sensitivity of present-day lesion detection procedures. An addition of a MS work up could be beneficial in some cases of intramedullary tumours without a typical history, although in the case presented this type of workup was negative.

P55. The Influence of Preoperative Disc and Prosthesis Heights Ratio on Postoperative Range of Motion and Sagittal Balance Two Years after Cervical Arthroplasty Patrick Fransen, Vincent Pointillart, MD, PhD, Nils Hansen-Algenstaedt, MD, Athanasios Chatzisotiriou, MD, PhD, David C. Noriega, MD; Centre Hospitalier Universitaire Pellegrin, Bordeaux Cedex, France; Orthocentrum Hamburg, Hamburg, Germany; Thessaloniki, Greece; Valladolid, Spain

Objective and Importance: Disorders of thermoregulation are occasionally noticed after operations in the region of the third ventricle. Various factors are usually implicated, but the actual contribution of each of them is rather vague. Apart from the presumed derangement in the functional connections of the hypothalamic region, mechanical reasons of compression should be thoroughly considered. Clinical Presentation: An 8.5-year-old patient was subjected to a radical excision of a craniopharyngioma compressing the third ventricle. Three months after the operation, he presented with a febrile syndrome of unknown origin. All usual investigations proved negative. Intervention: A chronic subdural hygroma was evacuated, an encapsulated CSF cyst of the suprachiasmatic cistern was drained and the lamina terminalis incised resulting in a moderate control of pyrexia. The administration of chlorpromazine contributed to the final resolution of hyperthermia. Conclusion: Postoperative hyperthermia may result following resection of tumors of the hypothalamic floor. It should not be blindly attributed to hypothalamic dysfunction as surgical causes could be implicated as well. Chlorpromazine could be a useful adjunct to the correction of the disorder.

Background In this study several tumor-related volumes were assessed by means of a computer-based application and a survival analysis was conducted to evaluate the prognostic significance of pre- and postoperative volumetric data in patients harboring glioblastomas. In addition, MGMT (O6-methylguanine methyltransferase) related parameters were compared with those of volumetry in order to observe possible relevance of this molecule in tumor development. Methods We prospectively analyzed 65 patients suffering from glioblastoma (GBM) who underwent radiotherapy with concomitant adjuvant temozolomide. For the purpose of volumetry T1 and T2-weighted magnetic resonance (MR) sequences were used, acquired both pre- and postoperatively (pre-radiochemotherapy). The volumes measured on preoperative MR images were necrosis, enhancing tumor and edema (including the tumor) and on postoperative ones, net-enhancing tumor. Age, sex, performance status (PS) and type of operation were also included in the multivariate analysis. MGMT was assessed for promoter methylation with Multiplex Ligation-dependent Probe Amplification (MLPA), for RNA expression with real time PCR, and for protein expression with immunohistochemistry in a total of 44 cases with available histologic material. Results In the multivariate analysis a negative impact was shown for pre-radiochemotherapy net-enhancing tumor on the overall survival (OS) (p = 0.023) and for preoperative necrosis on progression-free survival (PFS) (p = 0.030). Furthermore, the multivariate analysis confirmed the importance of PS in PFS and OS of patients. MGMT promoter methylation was observed in 13/23 (43.5%) evaluable tumors; complete methylation was observed in 3/13 methylated tumors only. High rate of MGMT protein positivity (> 20% positive neoplastic nuclei) was inversely associated with pre-operative tumor necrosis (p = 0.021). Conclusions Our findings implicate that volumetric parameters may have a significant role in the prognosis of GBM patients. Furthermore, volumetry could help not only to improve the prediction of outcome but also the outcome itself by identifying patients at high risk of treatment failure and, thus, seek alternative treatment for these patients. In this small series, MGMT protein was associated with less aggressive tumor characteristics.