Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)

BACKGROUND:There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (<24 hours after injury) versus late (≥ 24 hours after injury) decompressive surgery after traumatic cervical SCI. METHODS:We performed a multicenter, international, prospective cohort study (Surgical Timing In Acute Spinal Cord Injury Study: STASCIS) in adults aged 16-80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change in ASIA Impairment Scale (AIS) grade at 6 months follow-up. Secondary outcomes included assessments of complications rates and mortality. FINDINGS:A total of 313 patients with acute cervical SCI were enrolled. Of these, 182 underwent early surgery, at a mean of 14.2(± 5.4) hours, with the remaining 131 having late surgery, at a mean of 48.3(± 29.3) hours. Of the 222 patients with follow-up available at 6 months post injury, 19.8% of patients undergoing early surgery showed a ≥ 2 grade improvement in AIS compared to 8.8% in the late decompression group (OR = 2.57, 95% CI:1.11,5.97). In the multivariate analysis, adjusted for preoperative neurological status and steroid administration, the odds of at least a 2 grade AIS improvement were 2.8 times higher amongst those who underwent early surgery as compared to those who underwent late surgery (OR = 2.83, 95% CI:1.10,7.28). During the 30 day post injury period, there was 1 mortality in both of the surgical groups. Complications occurred in 24.2% of early surgery patients and 30.5% of late surgery patients (p = 0.21). CONCLUSION:Decompression prior to 24 hours after SCI can be performed safely and is associated with improved neurologic outcome, defined as at least a 2 grade AIS improvement at 6 months follow-up

Cyclooxygenase-2 inhibition delays the attainment of peak woven bone formation following four-point bending in the rat

Fracture healing is retarded in the presence of cyclooxygenase-2 (COX-2) inhibitors, demonstrating an important role of COX-2 in trauma-induced woven bone adaptation. The aim of this experiment was to determine the influence of COX-2 inhibition on the remodeling and consolidation of non-traumatic woven bone produced by mechanical loading. A periosteal woven bone callus was initiated in the right tibia of female Wistar rats following a single bout of four-point-bending, applied as a haversine wave for 300 cycles at a frequency of 2Hz and a magnitude of 65N. Daily injections of Vehicle (VEH: polyethyleneglycol) or the COX-2 inhibitor, DFU (2.0 mg.kg-1 and 0.02mg.kg-1 i.p.), commenced 7 days postloading, and tibiae were examined 2, 3, 4 and 5 weeks postloading. Tibiae were dissected, embedded in polymethylmethacrylate and sectioned for histomorphometric analysis of periosteal woven bone. No significant difference in peak woven bone area was observed between DFU-treated and VEH rats. But treatment with DFU resulted in a temporal defect in woven bone formation, where the achievement of peak woven bone area was delayed by one week. Woven bone remodeling was observed in DFU-treated rats at 21 days post-loading, demonstrating that remodeling of the periosteal callus is not prevented in the presence of a COX-2 inhibitor in the rat. We conclude that COX-2 inhibition does not significantly disrupt the mechanism of woven bone remodeling, but alters its timing

Tree topology used for the analysis of the natural selection in which the five laurasiatherian species included in all the orthologous groups are depicted.

<p>This tree is based on published literature <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0065491#pone.0065491-Nery1" target="_blank">[57]</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0065491#pone.0065491-Hallstrom1" target="_blank">[59]</a>.</p

Enrichment analysis of positively selected genes in the dolphin and cow lineages.

<p>Enrichment analysis of positively selected genes in the dolphin and cow lineages.</p

Distribution of the number of species included in each orthologous group.

<p>Distribution of the number of species included in each orthologous group.</p

GO distribution within the functional categories overrepresented in the dolphin lineage.

<p>GO distribution within the functional categories overrepresented in the dolphin lineage.</p