Neurological Recovery Rate Research Articles

Association between Case Volumes of Extracorporeal Life Support and Clinical Outcome in Out-of-Hospital Cardiac Arrest

Aim Extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) is increasing. There is little evidence identifying the association between hospital ECLS case volumes and outcomes in different populations receiving ECLS or conventional cardiopulmonary resuscitation (CPR). The goal of this investigation was to identify the association between ECLS case volumes and clinical outcomes of OHCA patients. Methods This cross-sectional observational study used the National OHCA Registry for adult OHCA cases in Seoul, Korea between January 2015 and December 2019. If the ECLS volume during the study period was >20, the institution was defined as a high-volume ECLS center. Others were defined as low-volume ECLS centers. Outcomes were good neurologic recovery (cerebral performance category 1 or 2) and survival to discharge. We performed multivariate logistic regression and interaction analyses to assess the association between case volume and clinical outcome. Results Of the 17,248 OHCA cases, 3,731 were transported to high-volume centers. Among the patients who underwent ECLS, those at high-volume centers had a higher neurologic recovery rate than those at low-volume centers (17.0% vs. 12.0%), and the adjusted OR for good neurologic recovery was 2.22 (95% confidence interval (CI): 1.15–4.28) in high-volume centers compared to low-volume centers. For patients who received conventional CPR, high-volume centers also showed higher survival-to-discharge rates (adjusted OR of 1.16, 95%CI: 1.01–1.34). Conclusions High-volume ECLS centers showed better neurological recovery in patients who underwent ECLS. High-volume centers also had better survival-to-discharge rates than low-volume centers for patients not receiving ECLS.

Outcome of Single Stage Anterior and Posterior Surgery for Tuberculous Paraplegia.

Morbidity and mortality from tuberculosis, a significant infectious illness, are expected to rise worldwide. The projected number of new cases rose from 7.5 million in 1990 to 11.9 million in 2005, a 58.6% increase in 2011. The widespread belief that TB is no longer a public health concern is unfounded; on the contrary, the link between HIV/AIDS and antibiotic resistance has further exacerbated the crisis that already existed. Similar to the nations in sub-Saharan Africa, India is now considered a Group IV country, with an annual risk of infection between 1% and 2.5%. 2. Although 60% of TB cases occur in people who are HIV-positive, only 3-5% of cases in HIV-negative individuals are skeletal. The most frequent type of articuloskeletal tuberculosis is spinal tuberculosis. 1. The goal of this study is to evaluate the neurological outcome of anterior debridement, fusion, posterior instrumentation, and early rehabilitation in individuals with spinal cord injuries. 2. The goal of this study is to determine the prevalence of pressure ulcers, hypostatic pneumonia, and urinary tract infections urinary tract infections (UTIs) among these individuals. 3. The goal of this study is to determine the frequency of graft-related problems. 4. See how well these individuals are able to keep their corrected deformities from returning. Patients who had simultaneous anterior (anterior debridement and bone grafting) and posterior (posterior instrumentation and fusion) procedures were followed prospectively. Thirty patients' films were examined. In addition, cord edema was suggested in 13 of the patients based on the presence of strong signal intensities there. Myelomalacia signs were seen in one patient, but he or she went on to make a complete neurological recovery. The average duration of operation was 355 minutes, and this included the time needed to position the patient for the two separate procedures. There was an 89.5% rate of neurological recovery with an average corrected loss of 6.98 degrees (0.20 degrees to 35.90 degrees), and the complication rate was acceptable in the group analyzed.

Abstract Number ‐ 277: Mobile Stroke Unit Direct to Angiosuite Process Metrics and Clinical Outcomes

Introduction Mobile Stroke Units (MSUs) speed treatment with tPA, but did not affect time from alert to puncture time for endovascular therapy (EVT) in the Benefits of Stroke Treatment Using a Mobile Stroke Unit (BEST‐MSU), a prospective multicenter controlled trial comparing MSU with standard EMS management. The lack of improvement in EVT treatment time could be because the CTA to identify large vessel occlusions (LVOs), and alerting of the EVT team, were delayed in most MSU patients until after Emergency Department (ED) arrival. The impact of identifying LVOs by imaging on the MSU enabling a direct (from MSU) to angiosuite (DTAS) protocol has yet to be studied. Methods We conducted a pre‐specified substudy of tPA‐eligible stroke patients with LVOs on computed tomography (CT) and/or CT angiography (CTA) who were enrolled into the MSU arm of the BEST‐MSU study. We compared alert to puncture time and other process metrics, mean utility‐weighted modified Rankin Scale (uw‐mRS) and functional independence (mRS 0–2) at 90 days, and rate of early neurologic recovery (30% improvement in NIHSS score) at 24 hours in patients who were managed by DTAS vs post‐ED arrival diagnosis and alerting. Results A total of 169 MSU patients with LVOs were identified; 22 in the DTAS group and 111 in the non DTAS group. Data were not available for 36 LVO patients. Baseline characteristics including age, sex, ethnicity, prestroke mRS, and initial NIHSS were comparable between the groups. 100.0% of patients in the DTAS group vs 90.1% in the non DTAS received tPA (p = 0.264). EVT was performed on 85.0% of patients in the DTAS group vs 77.1% in the non DTAS group (p = 0.634). DTAS group had a faster alert to puncture time (108.00 min [94.75,124.75.] vs 150.50 min [121.25, 179.00], p< 0.001) and door to puncture time (37.00 min [25.50,62.75 vs 86.50 min [62.50,116.00], p< 0.001). The mean score on the uw‐mRS at 90 days was 0.626 ±0.367 in the DTAS group and 0.660 ±0.382 in the non DTAS group and after adjustment for age, baseline NIHSS, premorbid functional status, prior stroke/TIA and site, no significant difference was observed; (p = 0.54). In an unadjusted analysis, early neurologic recovery (72.7% vs 67.6%, (OR = 0.634, 95% CI [0.46,3.82]) and functional independence (50.0% vs 51.4%, p = 1.000) were comparable between DTAS and non DTAS patients. Patients in the DTAS group were less likely to receive general anesthesia (36.4% vs 71.2%, p = 0.004). Rates of recanalization (77.3% vs73,4%, p = 0.947) and post procedural PH‐2 hemorrhage (4.5% vs 0.9%, p = 0.746) were similar in the DTAS and non DTAS group respectively. Conclusions In tPA‐eligible LVO stroke patients, DTAS management resulted in shorter alert to puncture (42 minutes) and door to puncture times (50 minutes) with similar safety and clinical outcomes compared with non DTAS management. MSU DTAS represents an optimized pathway for LVO patients triaged and treated in the field.

Novel Three-Holed Titanium Plate Fixation during Open Door Laminoplasty for Cervical Spondylotic Myelopathy: Comparison with Conventional Titanium Plate.

For reconstructing the posterior cervical muscular-ligament complex, attachment points and various modified techniques were designed and applied in clinical practice. This study investigated the clinical and radiographic outcomes of open door laminoplasty with modified centerpiece mini-plate fixation and extensor attachment point reconstruction in the treatment of cervical spondylotic myelopathy (CSM). Sixty-nine patients with CSM who underwent C3-C7 open door laminoplasty at our hospital from January 2016 to May 2018 were divided into two groups: 37 and 32 patients underwent laminoplasty with modified and conventional centerpiece titanium plate fixation (MPF and CPF groups), respectively. Changes in cervical spinal angle (CSA), cervical range of motion (ROM), posterior cervical muscle atrophy, neurological function (Japanese Orthopaedic Association [JOA] score), Neck Disability Index (NDI), and axial symptom severity were compared between the two groups. There were no significant differences in operative duration (136.7± 23.9 vs 128.3± 21.5 min, t=1.525, p > 0.05), volume of intraoperative blood loss (275.9± 33.1 vs 268.2± 31.6ml, t=0.984, p > 0.05), lamina open angle (41.2° ± 4.5° vs 39.4° ± 4.1°, t=1.726, p > 0.05), and spinal cord drift distance (2.4± 0.3 vs 2.3± 0.4 mm, t=1.184, p > 0.05) between the two groups. After surgery, JOA score significantly increased (p < 0.05), and neurological recovery rates were similar (62.7% vs 63.4%, t=0.208, p > 0.05). The NDI score was significantly decreased in both the groups (p< 0.05); however, the MPF group recovered to a greater degree than the CPF group (8.3± 1.2 vs 9.8± 1.4) (t=4.793, p< 0.05). There was no significant change in cervical ROM postoperatively compared with preoperatively in either group (p > 0.05). CSA decreased from 21.7° ± 2.8° to 18.3° ± 2.1°, and posterior cervical muscle cross-sectional area decreased from 35.2± 4.9 cm2 to 31.0 ± 4.1 cm2 in the CPF group (p < 0.05), but no significant change was observed in the MPF group (20.6° ± 2.5° to 20.4° ± 2.6°and 35.9± 5.1 to 34.1± 4.6 cm2 , respectively) (p> 0.05). Postoperative axial symptom severity was significantly worse in the CPF group than in the MPF group (Z=-2.357, p < 0.05). As an improvement to the conventional titanium plate, the modified centerpiece titanium plate effectively provides an attachment point for the posterior muscle-ligament complex, reducing posterior cervical muscle atrophy and improving neck function, without inflicting additional surgical trauma.

Aneurysmal subarachnoid haemorrhage in Māori and European New Zealanders – A comparative study

A retrospective analysis of 358 patients admitted to the neurosurgical unit at a tertiary referral centre in Aotearoa New Zealand between 2010 and 2017 was undertaken to describe the relationship of ethnicity to demographic, disease characteristic and outcome data in Māori and European New Zealanders experiencing aneurysmal subarachnoid haemorrhage (aSAH). Māori had a higher incidence (RR 1.38, p = 0.01; 95 % CI 1.08–1.77) and presented at a younger age (mean age difference of 5 years). Higher rates of smoking and hypertension were observed in the Māori population studied. However, these do not fully explain any other differences observed. There was no significant difference in clinical grade at presentation. However, despite experiencing lower rates of posterior circulation aneurysms (adjusted OR 0.33, p = 0.05) and radiological findings predicting highest risk of vasospasm i.e., Modified Rankin Scale 4 (OR 0.54, p = 0.02), Māori had a higher incidence of clinical vasospasm (adjusted OR 1.40, p = 0.048, 95 % CI 1.01–1.98). While there was no observed difference in mortality, Māori may experience lower rates of excellent neurological recovery and survive with greater disability compared to European New Zealanders. Overall, this study is suggestive of inequities between Māori and European New Zealanders and highlights the need for further investigation in this area.

Evaluation of optimal scene time interval for out-of-hospital cardiac arrest using a deep neural network

AimThis study aims to develop a cardiac arrest prediction model using deep learning (CAPD) algorithm and to validate the developed algorithm by evaluating the change in out-of-hospital cardiac arrest patient prognosis according to the increase in scene time interval (STI). MethodsWe conducted a retrospective cohort study using smart advanced life support trial data collected by the National Emergency Center from January 2016 to December 2019. The smart advanced life support data were randomly partitioned into derivation and validation datasets. The performance of the CAPD model using the patient's age, sex, event witness, bystander cardiopulmonary resuscitation (CPR), administration of epinephrine, initial shockable rhythm, prehospital defibrillation, provision of advanced life support, response time interval, and STI as prediction variables for prediction of a patient's prognosis was compared with conventional machine learning methods. After fixing other values of the input data, the changes in prognosis of the patient with respect to the increase in STI was observed. ResultsA total of 16,992 patients were included in this study. The area under the receiver operating characteristic curve values for predicting prehospital return of spontaneous circulation (ROSC) and favorable neurological outcomes were 0.828 (95% confidence interval 0.826–0.830) and 0.907 (0.914–0.910), respectively. Our algorithm significantly outperformed other artificial intelligence algorithms and conventional methods. The neurological recovery rate was predicted to decrease to 1/3 of that at the beginning of cardiopulmonary resuscitation when the STI was 28 min, and the prehospital ROSC was predicted to decrease to 1/2 of its initial level when the STI was 30 min. ConclusionThe CAPD exhibits potential and effectiveness in identifying patients with ROSC and favorable neurological outcomes for prehospital resuscitation.

Role of diffusion tensor imaging in neurological prognostication in spinal tuberculosis – A prospective pilot study

PurposeThe current study aims to explore the correlation between the Diffusion Tensor Imaging (DTI) indices and neurological status of individuals with TB spine with neurological deficit (TBSND). Further, factors affecting the rate of post-operative neurological recovery were also analysed with special emphasis on DTI indices. MethodsThe current study included 51 individuals with TBSND undergoing posterior instrumentation and posterolateral decompression. All individuals underwent DTI scanning at the site of compression and at a normal level proximal to the disease. The relationship of the DTI parameters with the pre-operative motor, sensory and total scores were analysed. All clinical and radiological parameters were further analysed on the basis of their recovery patterns after decompression surgery. ResultsThe FA values at the compressed segment were significantly lower while the ADC values were significantly higher when compared with the non-compressed levels. Pre-operative motor and total neurological scores were found to be significantly positively correlated to FA values and ADC values. Faster neurological recovery after decompression was associated with high FA values and younger age while incomplete neurological recovery was associated with high ADC values. ConclusionsHigher FA indices along with lower age constitute independent predictors for faster neurological recovery following decompression. FA values correlate with the neurological status of individuals with TBSND and its use may be explored as an adjunct to objectively assess the cord damage and for predicting neurological recovery pattern after decompression in such individuals.

Prognostic effect of increased postoperative MRI T2WI high signal intensity in degenerative cervical myelopathy

BACKGROUND CONTEXTHigh cord signals (HCS) are common in patients undergoing surgery for degenerative cervical myelopathy (DCM). Few studies have investigated the prognostic effects of postoperative HCS changes. PURPOSETo investigate whether different changes in the postoperative magnetic resonance imaging (MRI) T2-weighted images (T2WIs) signal intensity ratio (SIR) is related to patient outcomes, predictors of unsatisfactory recovery, and the factors associated with changes in postoperative SIR. STUDY DESIGNA retrospective chart review at a single institution. PATIENT SAMPLEThe study population included all consecutive patients who showed HCS in preoperative MRI T2WIs and underwent double-door laminoplasty for DCM from December 2017 to December 2020. OUTCOME MEASURESPatient self-reported measures included the Japanese Orthopedic Association (JOA) score, 36-Item Short Form Survey (SF-36) physical component score, and SF-36 mental component score. Imaging measures included SIR, length of HCS, and canal narrowing ratio (CNR). METHODSWe reviewed patient records and analyzed the statistical associations of MRI T2WI measures with the JOA score, SF-36 physical, and mental component scores. RESULTSFifty-three patients were categorized into three groups based on the postoperative HCS changes, identified from MRI T2WI before and after surgery: reduced (Group A, N=26); unchanged (Group B, N=12); and increased (Group C, N=15). The neurological recovery rates 12 months after surgery were 67.72%±17.45% in Group A, 51.53%±16.00% in Group B, and 13.35%±21.35% in Group C (p<.001). Significant differences across the three groups were found in symptom duration, postoperative SIR and length of HCS, pre- and postoperative CNR, recovery rate, JOA, SF-36 scores, with patients in Group C having the worst outcomes. Longer DCM symptom duration, greater preoperative CNR, and increased postoperative HCS were prognostic factors for a recovery rate<50%. Preoperative CNR, with an optimal threshold of 57.303%, was an independent risk factor for increased postoperative HCS. CONCLUSIONSLess than one-third of DCM patients with preoperative HCS exhibited an increase in HCS after double-door laminoplasty and reported worse outcomes at the 12-month follow-up when compared to patients with decreased or unchanged postoperative HCS.

Direct to angiosuite strategy versus standard workflow triage for endovascular therapy: systematic review and meta-analysis

BackgroundReducing stroke workflow times when performing endovascular thrombectomy is associated with improvement in clinical outcomes. We compared outcomes among large vessel occlusion (LVO) stroke patients following the direct to angiosuite...

Influence of fixed titanium plate position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy

BackgroundDuring open-door laminoplasty, the position of the bone gutter is not fixed, and when the gutter migrates inward, the outer end of the titanium plate must be fixed on the lamina edge. It is unclear whether this will affect the clinical efficacy. This study aimed to observe the influence of the titanium plate fixation position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy (CSM).MethodsA total of 98 patients with CSM who underwent open-door laminoplasty from August 2016 to October 2019 were included in this retrospective study. Fifty-five patients had the titanium plate fixed on the lateral mass (lateral mass group), and 43 patients had the titanium plate fixed on the lamina edge (lamina group). The opening angle, opening width, occurrence of hinge fracture, spinal cord drift distance, cervical curvature index (CCI), neurological function recovery (JOA score), neck function (NDI), C5 palsy and severity of axial symptoms were observed and compared between the two groups.ResultsThe opening angle in the lamina group was significantly larger than that in the lateral mass group, while the opening width and the spinal cord drift distance were significantly smaller than those in the lateral mass group (P < 0.05). The occurrence of hinge fracture in the lamina group was significantly higher than that in the lateral group (25.6% and 9.1%, respectively) (P < 0.05). The CCI was maintained well in both groups (P > 0.05), and there was no significant difference between the groups (P > 0.05). After surgery, the JOA score significantly increased in both groups (P < 0.05), and the neurological recovery rates were similar between the two groups (62.6% vs. 64.5%). The NDI score significantly decreased in both groups (P < 0.05), but the lateral mass group recovered to a greater degree than the lamina group (P < 0.05). The occurrence of C5 palsy was 2.3% in the lamina group and 14.5% in the lateral mass group, and there was a significant difference between the groups (P < 0.05). Postoperative axial symptom severity was significantly worse in the lamina group than in the lateral mass group (P < 0.05).ConclusionsIn open-door laminoplasty, it is feasible to fix the titanium plate on the lateral mass or to the lamina due to the same neurological function recovery. However, fixing it to the lamina will increase the opening angle and decrease the opening width, making the hinge prone to fracture and increasing the severity of postoperative axial symptoms.

Extracorporeal membrane oxygenation in children: An update of a single tertiary center 11-Year experience from Croatia.

Extracorporeal membrane oxygenation (ECMO) is an important treatment option for organ support in respiratory insufficiency, cardiac failure, or as an advanced tool for cardiopulmonary resuscitation. Reports on pediatric ECMO use in our region are lacking. This study is a retrospective review of all pediatric cases that underwent a veno-arterial (VA) or veno-venous (VV) ECMO protocol between November 2009 and August 2020 at the Department of Pediatrics, University Hospital Center Zagreb, Croatia. Fifty-two ECMO runs identified over the period; data were complete for 45 cases, of which 23 (51%) were female, and median age was 8 months. Thirty-eight (84%) patients were treated using the VA-and 7 (16%) using VV-ECMO. The overall survival rate was 51%. Circulatory failure was the most common indication for ECMO (N = 38, 84%), and in 17 patients ECMO was started after cardiopulmonary resuscitation (E-CPR). Among survivors, 74% had no or minor neurological sequelae. Variables associated with poor outcome were renal failure with renal replacement therapy (p < .001) and intracranial injury (p < .001). Overall survival rate in our cohort is comparable to the data published in the literature. The use of hemodialysis was shown to be associated with higher mortality. High rates of full neurological recovery among survivors are a strong case for further ECMO program development in our institution.

Effects of Traumatic Brain Injury on the Gut Microbiota Composition and Serum Amino Acid Profile in Rats.

Traumatic brain injury (TBI) heavily impacts the body: it damages the brain tissue and the peripheral nervous system and shifts homeostasis in many types of tissue. An acute brain injury compromises the “brain–gut-microbiome axis”, a well-balanced network formed by the brain, gastrointestinal tract, and gut microbiome, which has a complex effect: damage to the brain alters the composition of the microbiome; the altered microbiome affects TBI severity, neuroplasticity, and metabolic pathways through various bacterial metabolites. We modeled TBI in rats. Using a bioinformatics approach, we sought to identify correlations between the gut microbiome composition, TBI severity, the rate of neurological function recovery, and blood metabolome. We found that the TBI caused changes in the abundance of 26 bacterial genera. The most dramatic change was observed in the abundance of Agathobacter species. The TBI also altered concentrations of several metabolites, specifically citrulline and tryptophan. We found no significant correlations between TBI severity and the pre-existing gut microbiota composition or blood metabolites. However, we discovered some differences between the two groups of subjects that showed high and low rates of neurological function recovery, respectively. The present study highlights the role of the brain–gut-microbiome axis in TBI.

Abstract 24: Mobile Stroke Units Associated With Favorable Clinical Outcome In Large Vessel Occlusion Stroke Patients: BEST-MSU Substudy

Introduction: Mobile Stroke Units (MSUs) improve clinical outcome in patients treated with tPA compared to standard management by Emergency Medical Services (EMS), but the impact of MSUs on outcomes in patients with large vessel occlusions (LVOs) having endovascular thrombectomy (EVT) has yet to be determined. Methods: A pre-specified substudy of tPA-eligible stroke patients with LVOs on CT and/or CTA who were enrolled in the Benefits of Stroke Treatment Using a Mobile Stroke Unit (BEST-MSU), a prospective multicenter controlled trial comparing MSU with standard EMS management, was conducted. The primary outcome was the score on the 90-day utility-weighted modified Rankin Scale (uw-mRS). Secondary outcomes were rate of early neurologic recovery (30% improvement in NIHSS score) at 24 hours and functional independence (mRS 0-1) at 90 days. Results: A total of 295 patients were included, 169 in the MSU group and 126 in the EMS group. Baseline characteristics were comparable between the groups, with the exception of baseline NIHSS (MSU median 19.0 [IQR 13.0, 23.0] vs EMS 16.0 [11.0, 20.0], p=0.003). 92% MSU vs 87% EMS LVO patients received tPA, and 78% vs 85% went on to have EVT. MSU LVO patients had faster tPA bolus from symptom onset (65.0 min [50.5, 92.0] vs 96.0 [79.3, 130.0], p&lt;0.001), however the two groups had similar onset to groin puncture (169.0 min [133.8, 212.3] vs 162.0 [135.3, 207.0], p=0.77). The mean (±SD) score on the uw-mRS at 90 days was 0.64±0.39 in the MSU group and 0.50±0.40 in the EMS group (mean difference 0.16, 95% CI [0.07, 0.25] after adjustment for age, baseline NIHSS, premorbid functional status, prior stroke/TIA and site; p&lt;0.001). Early neurologic recovery (68% vs 52%; adjusted OR 1.89 95% CI [1.14,3.17]) and functional independence (Figure 1, 42% vs 29%; 2.48 [1.38,4.55]) also favored the MSU group. Conclusions: In tPA-eligible LVO stroke patients, MSU management was associated with better clinical outcomes compared with standard EMS management.

Контрольована нормотермія в пацієнтів у критичному стані з травматичним ушкодженням головного мозку

Актуальність. Гіпертермія викликає церебральне пошкодження в результаті реалізації трьох механізмів: клітинних, місцевих і системних ефектів. Метою даного дослідження були вивчення ефективності контро­льованої нормотермії в комплексі інтенсивної терапії пацієнтів із черепно-мозковою травмою, ускладненою розвитком гіпертермії центрального генезу, рефрактерної до фармакологічної терапії, оцінка її впливу на швидкість неврологічного відновлення і рівень летальності. Матеріали та методи. Обстежено 60 пацієнтів (середній вік — 41,05 ± 12,90 року) із діагнозом «тяжка черепно-мозкова травма». Пацієнти були розподілені на 4 групи: I (n = 15) — пацієнти з температурою тіла 38,3–39,5 °С, у яких проводилась контрольована нормотермія гіпотермом Blanketrol II (CSZ, США) для досягнення цільового значення температури тіла 37 °С; II група (n = 15) — пацієнти з температурою тіла ≥ 39,5 °С, яким здійснювали індукцію охолодження інфузією розчину Рінгера лактат (4 °С) у дозі 20–23 мл/кг із подальшим підтриманням контрольованої нормотермії гіпотермом Blanketrol II для досягнення цільового значення температури тіла 37 °С; III група (n = 15) — пацієнти з гіпертермією (38,3–39,5 °С), у яких проводилась стандартна інтенсивна терапія; IV група (n = 15) — пацієнти з гіпертермією ≥ 39,5 °С, яким здійснювали стандартну інтенсивну терапію. У всіх пацієнтів оцінювалися динаміка неврологічного статусу за шкалою коми Глазго, тривалість проведення механічної вентиляції легенів. Результати перенесеної черепно-мозкової травми визначалися за шкалою СРС (Сerebral Performance Categories) на 28-му добу дослідження. Результати. У I і III групах пацієнтів не було виявлено вірогідних відмінностей за рівнем вихідної гіпертермії — 38,98 ± 0,28 та 38,94 ± 0,27 °С відповідно. Відзначалася тенденція до глибшого неврологічного дефіциту початково в I групі порівняно з III групою пацієнтів — 6,26 ± 0,77 і 6,60 ± 0,71 бала за шкалою коми Глазго відповідно. Навпаки, у II групі пацієнтів початково було виявлено вірогідно більш глибокий неврологічний дефіцит (5,33 ± 0,47 бала, p &lt; 0,05) порівняно з пацієнтами IV групи (5,66 ± 0,47 бала). При аналізі тривалості механічної вентиляції легень не було виявлено вірогідних відмінностей між I (10,86 ± 9,49 доби) і III (10,26 ± 4,13 доби) групами. Була визначена тенденція більш тривалого проведення респіраторної підтримки в IV групі (25,53 ± 8,09 доби) порівняно з пацієнтами II групи (18,86 ± 8,39 доби). Рівень летальності становив у I групі 20 %, у III — 13,3 %, у II — 33,3 %, у IV — 46,7 %, однак ці відмінності також були невірогідними. При аналізі неврологічного статусу на 28-му добу з використанням шкали СРС була відзначена тенденція до поліпшення результатів у хворих I групи (2,20 ± 1,27 бала) порівняно з пацієнтами III групи (2,86 ± 1,08 бала). Було виявлено вірогідне поліпшення неврологічних результатів у хворих II групи (2,6 ± 1,4 бала, p &lt; 0,05) порівняно з пацієнтами IV групи (3,66 ± 1,49 бала). Не були визначені клінічно значущі побічні ефекти запропонованих варіантів контрольованої нормотермії. Виснов­ки. Запропонований спосіб здійснення контрольованої нормотермії створює більш сприятливі умови для більш повного відновлення порушених неврологічних функцій після тяжкої черепно-мозкової травми.

Comparative outcome analysis of lateral mass fixation and trans-facet fixation with posterior decompression in the management of cervical spondylotic myelopathy: An institutional experience.

Aims and ObjectivesPosterior subaxial cervical fusion with lateral mass screw and rod instrumentation is a well-established fixation technique. Subaxial transarticular facet fixation is a lesser known fusion technique that has been shown to be biomechanically equivalent to lateral mass screws. The aim of this study was to evaluate the outcome of cervical decompressive laminectomy with lateral mass fixation compared with decompressive laminectomy with trans-facet fixation.Materials and Methods:The study was conducted with 20 patients operated for cervical decompressive laminectomy with lateral mass fixation compared with 20 patients operated with trans-facet fixation. The modified Japanese orthopedic association score (mJOA) scale, Nurick's functional grading and neurological recovery rate (NRR) was used as the functional outcome measurement. The clinical follow-up period was 6 months.Results:In Group I, the mean preoperative and postoperative mJOA scores in Group I and II were 8.2 ± 2.1 and 12.7 ± 2.8 and 9.3 ± 1.9 and 13.5 ± 1.88, respectively, were statistically significant (P < 0.05). Postoperative NRR at the end of the follow-up period was satisfactory (excellent and good) 55% in Group I and 60% in Group II. Fusion was documented in all 40 patients. No patients experienced neural or vascular injury as a result of screw position.Conclusions:Both trans-facet and lateral mass fixation techniques are simple, safe, and effective procedures in achieving relief and improvement in patients with multilevel cervical spondylotic myelopathy. Trans-facetal fixation can provide a reasonable alternative to lateral mass fixation.

Can the rate of mortality and neurological recovery be predicted from the time of onset of symptoms and MRI grade in patients with cerebral fat embolism? : a study of 34 patients.

The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated. The study included 34 patients who were diagnosed with CFES following trauma between 2012 and 2018. The clinical diagnosis was confirmed and the severity graded by MRI. We investigated the rate of mortality, the time and extent of neurological recovery, the time between the injury and the onset of symptoms, the clinical severity of the condition, and the MRI grade. All patients were male with a mean age of 29.7 years (18 to 70). The mean follow-up was 4.15 years (2 to 8), with neurological recovery being assessed by the Glasgow Outcome Scale and the Mini-Mental State Examination. In all, seven who had early-onset CFES (< 24 hours), and a severe Takahashi grade on MRI, died. There was a significant association between the time of onset of neurological signs and mortality (p = 0.035). Mortality was also significantly associated with a severe Takahashi grade (p < 0.001). Among the 27 surviving patients, 26 (96.3%) recovered completely. One (3.7%) had a cognitive deficit. The mean time to recovery was 4.7 weeks (2 to 13), with late recovery aftereight eight weeks being recorded in three patients. There was a significantly increased rate of mortality in patients with CFES who had an early onset of symptoms and a severe grade on MRI. Complete neurological recovery can be expected in most patients with CFES who survive. Cite this article: Bone Joint J2022;104-B(1):142-149.

Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards

Purpose: This study investigated differences in the clinical outcomes of cardiopulmonary resuscitation (CPR) of patients hospitalized in general wards according to the operation of a rapid response team.Methods: This retrospective study included 122 patients over the age of 19 who were admitted to general ward of a hospital located in Suwon, between July 1, 2015 and December 31, 2019, and received CPR during the operating hours of the rapid response team. The collected data were analyzed by descriptive statistics, the x2 test, Fisher's exact test, and one-way analysis of variance using SPSS for Windows version 25.0.Results: The proportion of nurses who were the initial responders to cardiac arrest was 79.1% during the extended-operation period. 41.2% during the pre-operation period, and 42.2% during the limited-operation period (p&lt;.001). The rate of good neurological recovery at discharge post-CPR was 25.0% in patients who received CPR during the pre-operation period, 36.4% during the limited-operation period, and 87.5% during the extended-operation period (p=.042).Conclusion: This study identified clinical outcomes in patients who received CPR according to the operation status of the rapid response team. These results are expected to help in the further implementation of rapid response teams.

Relationship of Change in Cervical Curvature after Laminectomy with Lateral Mass Screw Fixation to Spinal Cord Shift and Clinical Efficacy

Although laminectomy with lateral mass screw fixation (LCSF) is an effective surgical treatment for cervical spondylotic myelopathy (CSM), loss of cervical curvature may result. This study aimed to investigate the effect of cervical curvature on spinal cord drift distance and clinical efficacy. We retrospectively analyzed 78 consecutive CSM patients with normal cervical curvature who underwent LCSF. Cervical curvature was measured according to Borden's method 6 months after surgery. Study patients were divided into two groups: group A, reduced cervical curvature (cervical lordosis depth 0-7mm; n = 42); and group B, normal cervical curvature (cervical lordosis depth 7-17mm; n = 36). Spinal cord drift distance, laminectomy width, neurologic functional recovery, axial symptom (AS) severity, and incidence of C5 palsy were measured and compared. Cervical lordosis depth was 5.1 ± 1.2 mm in group A and 12.3 ± 2.4 mm in group B (p < 0.05). Laminectomy width was 21.5 ± 2.6 mm in group A and 21.9 ± 2.8 mm in group B (p > 0.05). Spinal cord drift distance was significantly shorter in group A (1.9 ± 0.4 vs. 2.6 ± 0.7 mm; p < 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased after surgery in both groups (p < 0.05). Neurologic recovery rate did not differ between the two groups (61.5 vs. 62.7%; p > 0.05). AS severity was significantly higher in group A (p < 0.05). C5 palsy occurred in three group A patients (7.1%) and four group B patients (11.1%), but the difference was not significant (p > 0.05). After LCSF, 53.8% of the patients developed loss of cervical curvature. A smaller cervical curvature resulted in a shorter spinal cord drift distance. Loss of cervical curvature was related to AS severity but not improvement of neurologic function or incidence of C5 palsy.

CBF oscillations induced by trigeminal nerve stimulation protect the pericontusional penumbra in traumatic brain injury complicated by hemorrhagic shock

Traumatic peri-contusional penumbra represents crucial targets for therapeutic interventions after traumatic brain injury (TBI). Current resuscitative approaches may not adequately alleviate impaired cerebral microcirculation and, hence, compromise oxygen delivery to peri-contusional areas. Low-frequency oscillations in cerebral blood flow (CBF) may improve cerebral oxygenation in the setting of oxygen deprivation. However, no method has been reported to induce controllable oscillations in CBF and it hasn’t been applied as a therapeutic strategy. Electrical stimulation of the trigeminal nerve (TNS) plays a pivotal role in modulating cerebrovascular tone and cerebral perfusion. We hypothesized that TNS can modulate CBF at the targeted frequency band via the trigemino-cerebrovascular network, and TNS-induced CBF oscillations would improve cerebral oxygenation in peri-contusional areas. In a rat model of TBI complicated by hemorrhagic shock, TNS-induced CBF oscillations conferred significant preservation of peri-contusional tissues leading to reduced lesion volume, attenuated hypoxic injury and neuroinflammation, increased eNOS expression, improved neurological recovery and better 10-day survival rate, despite not significantly increasing CBF as compared with those in immediate and delayed resuscitation animals. Our findings indicate that low-frequency CBF oscillations enhance cerebral oxygenation in peri-contusional areas, and play a more significant protective role than improvements in non-oscillatory cerebral perfusion or volume expansion alone.

Impact of focal apex angle on postoperative decompression status of the spinal cord and neurological recovery after cervical laminoplasty.

Although anterior compression factors and cervical alignment affect neural decompression, cervical laminoplasty may be used to achieve indirect posterior decompression. The focal apex (FA) angle of the anterior compression factor of the spine represents the degree of anterior prominence toward the spinal cord. The authors investigated the mechanism underlying the influence of FA angle and cervical alignment on spinal cord alignment (SCA) after laminoplasty, including how high-intensity signal cord change (HISCC) on preoperative T2-weighted MRI (T2-MRI) may affect neurological improvement. We performed a retrospective study of patients who underwent laminoplasty for CSM or OPLL at two hospitals (Kanto Rosai Hospital, Kawasaki City, and Yokohama Minami Kyousai Hospital, Yokohama City, Japan) between April 2004 and March 2015. In total, 109 patients (mean age 67.3 years) with cervical compression myelopathy were included. FA angle was defined as the preoperative angle between the lines from the top of the prominence to the upper and lower adjacent vertebrae. Preoperative cervical alignment was measured between the C2 and C7 vertebrae (C2-7 angle). MRI was used to classify SCA as lordosis (type-L SCA), straight (type-S), local kyphosis (type-LK), or kyphosis (type-K). Preoperative HISCC was investigated by using T2-MRI. Neurological status was evaluated by using the Japanese Orthopaedic Association score. The mean preoperative FA and C2-7 angles were 32.1° and 12.4°, respectively. Preoperative SCA was type-L or type-S in 53 patients. The neurological recovery rate (NRR) was significantly higher for patients with preoperative type-L and type-S SCA (51.4% for those with type-L and 45.0% for those with type-S) than for patients with other types (35.3% for those with type-LK and 31.7% for those with type-K). Among patients with preoperative type-L or type-S SCA, 87.3% maintained SCA; however, 5/12 (41.7%) patients with a preoperative average C2-7 angle < 12.4° and an average FA angle > 32.1° had postoperative type-LK or type-K SCA. SCA changed to type-L or type-S in 13.0% of patients with preoperative type-LK or type-K SCA. Moreover, in these patients, FA angle was significantly smaller and NRR was significantly higher than in other patients in whom postoperative SCA remained type-LK or type-K. Preoperative T2-MRI showed 73 patients with HISCC (43 with type-L and type-S, and 30 with type-LK and type-K SCA) and 36 without HISCC (20 with type-L and type-S, and 16 with type-LK and type-K SCA); the NRRs of these patients were 42.6% and 41.2%, respectively. No significant differences in SCA or NRR were observed between patients with and without HISCC. NRR depends on preoperative SCA type; however, it is possible to change the type of SCA after laminoplasty. Preoperative FA and C2-7 angles influence change in SCA; therefore, they are important parameters for successful decompression with cervical laminoplasty.