ObjectiveTo describe early functional outcomes of nerve transfer surgery in a relatively large cohort of patients with acute flaccid myelitis (AFM).MethodsA retrospective case analysis was made of patients with AFM treated with nerve transfer surgery between 2007 and 2018. Surgical criteria were persistent motor deficits after 6 months from onset and available donor nerves. Thirty‐two patients with AFM were evaluated; 16 underwent nerve transfer surgeries. Motor function was evaluated by a licensed occupational therapist using the Active Movement Scale preoperatively and during follow‐up examinations. Patients with 6 or more months of follow‐up were included in the analysis. Patients with procedures other than nerve transfers were excluded.ResultsSixteen patients with AFM had nerve transfers, with a male predominance (75%) and median age of 2.5 years (range = 4 months–12 years). Eleven patients had a minimum 6 months of follow‐up. Nerve transfers to restore elbow function had 87% excellent recovery for elbow flexion and 67% for elbow extension. Finger and thumb extension were full against gravity in 1 patient (100%). Shoulder external rotation was excellent in 50% of patients and shoulder abduction in only 20%. Nine of 10 patients (90%) had resolution of shoulder pseudosubluxation following nerve transfer to the suprascapular nerve.InterpretationPatients with AFM with persistent motor deficits 6 to 9 months after onset benefit from nerve transfer surgery. Restoration of elbow function was more reliable than restoration of shoulder function. We recommend early referral of patients with incomplete recovery to a center experienced in nerve transfers for timely evaluation and treatment. ANN NEUROL 2019;86:607–615

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Purpose. This study investigates the antibacterial properties of two different platelet-rich plasma (PRP) platelet concentration preparations (PRPLP and PRPHP) through a time-kill assay. Methods. Two different PRP preparations -a single spin process yielding lower white blood cells and platelet concentration (PRPLP) and one yielding high platelet and white blood cell concentration (PRPHP) -were obtained from 2 individuals. PRPLP, PRPHP, phosphate buffered saline (PBS), whole blood and Cefazolin were added to experimental reaction tubes, each containing a single bacterial inoculum of Staphylococcus aureus (S. aureus), Staphylococcus epidermidis (S. epi), methicillin-resistant Staphylococcus aureus (MRSA) or Propionibacterium acnes (P. acnes). Two dilutions (1:1,000, and 1:10,000) were plated in duplicate tubes, along with positive (blood and PBS) and negative (Cefazolin) controls and assessed at five time points (0, 1, 4, 8 and 24 hours). Results. After centrifugation, platelet count of PRPLP was 386 ± 65.5 x 103/?L and PRPHP was 867 ± 234.4 x 103/?L. Both PRP products showed a significant decrease (p<0.05) in bacterial growth at 8 hours compared to whole blood. Conclusion. The application of PRPLP and PRPHP showed a significant decrease in bacterial growth after 8 hours for S. aureus, S. epi, MRSA and P.acnes compared to the whole blood control group. S.epi, MRSA, and P. acnes also showed a significant decrease in bacterial growth after 24 hours. Despite differences in platelet concentration and WBC concentration, no difference in antibacterial activity was seen between the two preparations.

Osteoporosis-related fractures create a heavy economic and healthcare burden. Although diphosphonate medications have been successful at decreasing the risk of osteoporotic fragility fractures and have become staples in the treatment of osteoporosis, concerns have been raised about the association of diphosphonate therapy with spontaneous nonvertebral fractures. Diphosphonate fractures are characteristically transverse or slightly oblique in nature and occur in the lateral cortex, or tension side, of the subtrochanteric region of the femur where diffuse cortical thickening and fracture can be observed on radiographs. A multidisciplinary approach incorporating both medical and surgical teams should be used in the case of diphosphonate-associated fractures. Future medical and surgical developments that augment fracture fixation and counteract diphosphonate-associated osteoclast apoptosis may play a role in therapy. Although diphosphonate use has decreased the rate of osteoporosis-related fractures, increased awareness and association with atypical subtrochanteric fractures is an important concern for clinicians to keep in mind.