Which Protocol for Milrinone to Treat Cerebral Vasospasm Associated With Subarachnoid Hemorrhage?

Background: Milrinone has emerged as an option to treat delayed cerebral ischemia after subarachnoid hemorrhage. However, substantial variation exists in the administration of this drug. We retrospectively assessed the effectiveness of 2 protocols in patients with angiographically proven cerebral vasospasm. Methods: During 2 successive periods, milrinone was administered using either a combination of intra-arterial milrinone infusion followed by intravenous administration until day 14 after initial bleeding (IA+IV protocol), or a continuous intravenous milrinone infusion for at least 7 days (IV protocol). The primary endpoint was the reversion rate of vasospastic arterial segments following the first IA infusion of milrinone (IA+IV protocol) compared with the reversion rate during the first week of IV infusion (IV protocol). Results: There were 24 and 77 consecutive patients in IA+IV and IV protocols, respectively. The reversion rate was comparable between the 2 protocols: 71% (95% confidence interval [CI], 59%-83%) in the IA+IV protocol versus 64% (95% CI, 58%-71%) in the IV protocol (P=0.36). Rescue procedures for persistence or recurrence of vasospasm, that is, mechanical angioplasty and/or IA milrinone infusion, were similar between the 2 protocols. Patients with a good neurological outcome at 1 year, that is, modified Rankin Scale scores 0-2, were comparable between the 2 protocols. Side effects of milrinone were uncommon and equally distributed within the 2 protocols. Conclusions: These findings indicate that a continuous IV infusion of milrinone was as efficient as combined IA+IV infusion and suggest that this modality could be considered as a first easy-to-use option to treat patients with CVS. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Jean-François Payen, MD, PhD, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, F-38000, Grenoble, France (e-mail: jfpayen@univ-grenoble-alpes.fr). Received April 11, 2018 Accepted June 7, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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JNA Journal Club

No abstract available

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The Effect of Fluid Loading and Hypertonic Saline Solution on Cortical Cerebral Microcirculation and Glycocalyx Integrity

Background: Fluid loading and hyperosmolar solutions can modify the cortical brain microcirculation and the endothelial glycocalyx (EG). This study compared the short-term effects of liberal fluid loading with a restrictive fluid intake followed by osmotherapy with hypertonic saline (HTS) on cerebral cortical microcirculation and EG integrity in a rabbit craniotomy model. Methods: The experimental rabbits were allocated randomly to receive either

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Impact of CPAP on Forehead Near-infrared Spectroscopy Measurements in Patients With Acute Respiratory Failure: Truth or Illusion

Background: Critically ill patients with acute respiratory failure admitted to an intensive care unit are at high risk for cerebral hypoxia. We investigated the impact of continuous positive airway pressure (CPAP) therapy on regional cerebral tissue oxygenation (rSO2). Materials and Methods: In total, 40 extubated surgical intensive care unit patients requiring classic oxygen therapy (COT) for acute respiratory failure were examined. Near-infrared spectroscopy (INVOS 5100C, Covidien) was used for 30 minutes to detect bilateral rSO2 during COT via facemask (6 L/min) and CPAP therapy (40% fraction of inspired oxygen, 8 cm H2O CPAP) using a randomized crossover study design. Patients served as their own control. Continuous hemodynamic routine monitoring and blood gas analysis were performed. The effect of CPAP therapy on rSO2 and influence of assessed covariables were investigated using a mixed linear model. Results: Median rSO2 increased from 57.9% (95% confidence interval [CI], 54.2-61.5) during COT to 62.8% (95% CI, 59.2-66.5) during CPAP therapy (P

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JNA Journal Club

No abstract available

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Minimum Clinically Important Difference of the Health-Related Quality of Life Scales in Adult Spinal Deformity Calculated by Latent Class Analysis: Is It Appropriate to Use the Same Values for Surgical and Non-Surgical Patients?

Health-related quality of life (HRQOL) parameters has been shown to be reliable and valid in patients with adult spinal deformity (ASD). Minimum clinically important difference (MCID) has become increasingly important to clinicians in evaluating patients with a threshold of improvement that is clinically relevant.

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Robotic-Assisted Pedicle Screw Placement Fails to Reduce Overall Postoperative Complications in Fusion Surgery

Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear.

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Alterations in 90-Day Morbidity, Mortality and Readmission Rates Following Spine Surgery in Medicare Accountable Care Organizations (2009-2014)

The impact of Accountable Care Organizations (ACOs) on healthcare quality and outcomes, including morbidity, mortality and readmissions, has not been substantially investigated, especially following spine surgery.

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SYSTEMATIC SCREENING FOR PRIMARY SCLEROSING CHOLANGITIS WITH MAGNETIC RESONANCE CHOLANGIOGRAPHY IN INFLAMMATORY BOWEL DISEASE

Primary sclerosing cholangitis (PSC) is a major concern in inflammatory bowel disease (IBD).

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Proximal Iliotibial Band Enthesopathy in a Runner: A Case Report

Overuse injuries of the hip are frequent among runners and often present a diagnostic dilemma requiring imaging modalities beyond radiographs, delayed diagnosis, and prolonged time away from sport and activity. We report a case of a 38 year-old female recreational runner with progressive lateral hip pain and MRI findings of edema along the gluteal aponeurotic fascia and origin of the tensor fascia lata muscle consistent with the diagnosis of enthesopathy of the proximal iliotibial band.

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Interdisciplinary Pain Management Improves Pain and Function in Pediatric Patients with Chronic Pain Associated with Joint Hypermobility Syndrome

The relationship between chronic musculoskeletal pain and joint hypermobility in a small percentage of the pediatric population is well described. However, literature discussing the treatment of chronic pain associated with joint hypermobility in pediatrics is limited. The present study examines the impact of interdisciplinary treatment on chronic pain in pediatrics with joint hypermobility syndrome (JHS).

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Frequency and Characteristics of Recommendations from Interdisciplinary Outpatient Cancer Rehabilitation Monthly Team Meetings

Ambulatory cancer rehabilitation programs vary widely in the types of services offered, and there is a lack of consistency with respect to the coordination of rehabilitation with oncologic treatment plans. There are no guidelines for outpatient interdisciplinary rehabilitation team meetings, and the types and characteristics of recommendations that a physiatrist can provide during these meetings have not been reported.

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Bone Marrow Derived and Adipose Derived Mesenchymal Stem Cell Therapy in Primary Knee Osteoarthritis: A Narrative Review

Regenerative medicine in the context of musculoskeletal injury is a broad term that offers potential therapeutic solutions to restore or repair damaged tissue. The current focus in recent literature and clinical practice has been on cell based therapy. In particular, much attention has been centered on autologous bone marrow concentrate (BMAC) and adipose derived (AD) mesenchymal stem cells (MSCs) for cartilage and tendon disorders. This article provides an overview of MSC derived therapy and offers a comprehensive review of Adipose and Bone Marrow derived MSC therapy in primary knee osteoarthritis OA.

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P25. Time specific neuronal activation and its association with cognitive control over emotions

Successful cognitive control over emotions (CCE) can impede a biased attention towards negative valenced information ('Negativity Bias', NB) which can be observed in various psychiatric disorders. On a neurophysiological level CCE and the NB can be investigated with event related potentials (ERPs). The goal of the current study is to investigate the NB and CCE with ERPs on feedback as its emotional valence is largely based on the interpretation by the participant.

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SYSTEMATIC SCREENING FOR PRIMARY SCLEROSING CHOLANGITIS WITH MAGNETIC RESONANCE CHOLANGIOGRAPHY IN INFLAMMATORY BOWEL DISEASE

Primary sclerosing cholangitis (PSC) is a major concern in inflammatory bowel disease (IBD).

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