Early Surgery for Traumatic Spinal Cord Injury: Where Are We Now?

Study Design: Narrative review. Objective: There is a strong biological rationale to perform early decompression after traumatic spinal cord injury (SCI). With an enlarging clinical evidence base, most spine surgeons internationally now favor early decompression for the majority of SCI patients; however, a number of pertinent questions remain surrounding this therapy. Methods: A narrative review evaluating the status of early surgery for SCI. In particular, we addressed the following questions: (1) Which patients stand to benefit most from early surgery? 2) What is the most appropriate time threshold defining early surgery? Results: Although heterogeneity exists, the evidence generally seems to support early surgery. While the best evidence exists for cervical SCI, there is insufficient data to support a differential effect for early surgery depending on neurological level or injury severity. When comparing thresholds to define early versus late surgery-including a later threshold (48-72 hours), an earlier threshold (24 hours), and an ultra-early threshold (8-12 hours)-the 2 earlier time points seem to be associated with the greatest potential for improved outcomes. However, existing prehospital and hospital logistics pose barriers to early surgery in a significant proportion of patients. An overview of recommendations from the recent AOSpine guidelines is provided. Conclusion: In spite of increasing acceptance of early surgery post SCI, further research is needed to (1) identify subgroups of patients who stand to derive particular benefit-in particular to develop more evidence-based approaches for central cord syndrome and (2) investigate the efficacy and feasibility of ultra-early surgery targeting more aggressive timelines

UBVRI photopolarimetry of the long period eclipsing AM Herculis binary V1309

We report simultaneous UBVRI photo-polarimetric observations of the long period (7.98 h) AM Her binary V1309 Ori. The length and shape of the eclipse ingress and egress varies from night to night. We suggest this is due to the variation in the brightness of the accretion stream. By comparing the phases of circular polarization zero-crossovers with previous observations, we confirm that V1309 Ori is well synchronized, and find an upper limit of 0.002 percent for the difference between the spin and orbital periods. We model the polarimetry data using a model consisting of two cyclotron emission regions at almost diametrically opposite locations, and centered at colatitude 35 (deg) and 145 (deg) on the surface of the white dwarf. We also present archive X-ray observations which show that the negatively polarised accretion region is X-ray bright.Comment: 11 pages, 12 figures (2 colour), Fig1 and Fig 4 are in lower resolution than in original paper, accepted for publication in Monthly Notices of the Royal Astronomical Societ

Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review

Study Design: Systematic review. Objectives: The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to initiate and/or discontinue anticoagulant, mechanical, and/or prophylactic inferior vena cava filter following acute SCI? (3) What is the cost-effectiveness of these treatment options? Methods: A systematic literature search was conducted to identify studies published through February 28, 2015. We sought randomized controlled trials evaluating efficacy and safety of antithrombotic strategies. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine studies satisfied inclusion criteria. We found a trend toward lower risk of DVT in patients treated with enoxaparin. There were no significant differences in rates of DVT, PE, bleeding, and mortality between patients treated with different types of low-molecular-weight heparin or between low-molecular-weight heparin and unfractionated heparin. Combined anticoagulant and mechanical prophylaxis initiated within 72 hours of SCI resulted in lower risk of DVT than treatment commenced after 72 hours of injury. Conclusion: Prophylactic treatments can be used to lower the risk of venous thromboembolic events in patients with acute SCI, without significant increase in risk of bleeding and mortality and should be initiated within 72 hours. © 2017, © The Author(s) 2017

Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty: a review of the literature

The available evidence suggests that the treatment of painful vertebral compression fractures (VCFs) secondary to osteoporosis or multiple myeloma, by cement augmentation with balloon kyphoplasty (BK), is both safe and effective. However, there is uncertainty in the literature concerning the potential of the procedure to influence the risk for adjacent segment fracture. The aim of this article is to review the available peer-reviewed literature, regarding adjacent vertebral body fractures after kyphoplasty augmentation

Perspectives On The Sources And Eventual Outcome Of The 2008 Economic And Financial Crisis: A Panel Discussion

In October 2008 the Southern Utah University School of Business held a panel discussion on the current economic crisis. This discussion was part of the School’s Business Convocation series and was open to the public. The panel was designed with two components in mind. First, a pair of academics with expertise in financial institutions and business cycles offered historical and theoretical perspectives on the crisis. Second, a pair of professionals – a local banking official and a fund manager – offered perspectives on the current financial situation and practical experience based on the policy responses to past crises. As moderator, Joe Baker asked each panelist to make a short presentation on a question of general interest that was related to their area of expertise; this was followed by an open question and answer session. The participating panelists and opening questions follow. 1. Stephen Evans, Professor of Finance: Dr. Evans teaches courses on financial institutions and was asked to provide background of how the crisis occurred and what the proposed government bailout plan is expected to accomplish. 2. David Tufte, Associate Professor of Economics: Dr. Tufte is a macroeconomist and was asked to discuss the macroeconomic implications of the crisis in such areas as inflation, interest rates, economic growth and unemployment. 3. Mr. Robb Kerry, Chief Credit Officer of ADB Bank: Mr. Kerry has an extensive background in banking as a bank regulator and banker. Mr. Kerry was asked to discuss the implications of the crisis on banking credit and lending. Mr. Steve Harrop, Finance Professional in Residence: Mr. Harrop was a mutual fund manager for several decades before joining the School of Business faculty where he teaches investments and manages (pro bono) an investment fund. Mr. Harrop will discuss the implications of the crisis on the stock and bond markets

The Quiescent Spectrum of the AM CVn star CP Eri

We used the 6.5m MMT to obtain a spectrum of the AM CVn star CP Eri in quiescence. The spectrum is dominated by He I emission lines, which are clearly double peaked with a peak-to-peak separation of ~1900 km/s. The spectrum is similar to that of the longer period AM CVn systems GP Com and CE 315, linking the short and the long period AM CVn systems. In contrast with GP Com and CE 315, the spectrum of CP Eri does not show a central 'spike' in the line profiles, but it does show lines of SiII in emission. The presence of these lines indicates that the material being transferred is of higher metallicity than in GP Com and CE 315, which, combined with the low proper motion of the system, probably excludes a halo origin of the progenitor of CP Eri. We constrain the primary mass to M_1>0.27 M_sun and the orbital inclination to 33 degr < i < 80 degr. The presence of the He I lines in emission opens up the possibility for phase resolved spectroscopic studies which allows a determination of the system parameters and a detailed study of helium accretion disks under highly varying circumstances.Comment: 12 pages, 2 figures, accepted for publication in ApJ Letter

Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis.

Study Design: Systematic literature review. Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. Results: Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Conclusion: Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status

Political brand identity: an examination of the complexities of Conservative brand and internal market engagement during the 2010 UK General Election campaign

This paper seeks to build an understanding of the importance of internal communications when building a strong political brand. Using Kapferer’s brand prism as a conceptual framework, the paper explores UK Conservative Party members’ attitudes towards the development of the Conservative brand as personified by David Cameron. There are clear implications for political strategists as the findings suggest that it is crucial to engage the internal market in the co-creation of the marketing communications strategy for as brand evangelists they interpret the brand promise at the local level

Case Report: Hemorrhage into an Occult Spinal Ependymoma after Epidural Anesthesia

Epidural anesthesia is a procedure which is well tolerated and has a low incidence of adverse events. In performing caesarean sections, regional anesthesia (spinal or epidural) is the preferred modality for anesthetic delivery. Although rare with continuous epidural anesthesia, epidural hematomas have been reported to occur with an incidence between 1:150,000 and 1:190,00010. An underlying bleeding diathesis has been implicated as a causative factor. We present the sixth reported case of hemorrhage into an occult intradural neoplasm after spinal or epidural anesthesia. Similar lesions have not been reported in the recent spine literature