Introduction: Systemic hypothermia remains a promising neuroprotective strategy. There has been recent interest in its use in patients with spinal cord injury (SCI). In this article, we describe our extended single center experience using intravascular hypothermia for the treatment of cervical SCI. Methods: Thirty-five acute cervical SCI patients received modest (33 1C) intravascular hypothermia for 48 h. Neurological outcome was assessed by the International Standards for Neurological Classification of Spinal Cord Injury scale (ISNCSCI) developed by the American Spinal Injury Association. Local and systemic complications were recorded. Results: All patients were complete ISNCSCI A on admission, but four converted to ISNCSCI B in o24 h post injury. Hypothermia was delivered in 5.76 ( ± 0.45) hours from injury if we exclude four cases with delayed admission (418 h). Fifteen of total 35 patients (43%) improved at least one ISNCSCI grade at latest follow up 10.07 ( ± 1.03) months. Even excluding those patients who converted from ISNCSCI A within 24 h, 35.5% (11 out of 31) improved at least one ISNCSCI grade. Both retrospective (n ¼ 14) and prospective (n ¼ 21) groups revealed similar number of respiratory complications. The overall risk of any thromboembolic complication was 14.2%. Conclusion:The results are promising in terms of safety and improvement in neurological outcome. To date, the study represents the largest study cohort of cervical SCI patients treated by modest hypothermia. A multi-center, randomized study is needed to determine if systemic hypothermia should be a part of SCI patients' treatment for whom few options exist. Spinal Cord (2013) 51, 395-400; doi:10.1038/sc.2012.161; published online 18 December 2012Keywords: acute cervical SCI; cooling catheter; systemic hypothermia INTRODUCTION Hypothermia continues to show promise in a variety of acute central nervous system injuries. Various factors need to be considered with systemic cooling of the spinal cord injury (SCI) patient, including methods of cooling, window from injury to initiation, duration and depth of hypothermia, and rate of re-warming. Two main methods of spinal cord cooling exist. Local cooling (epidural vs intradural) has a rich history with both experimental and clinical evidence supporting its use. 1 Systemic cooling may be applied either via a transcutaneous or intravascular route. Modern cooling blankets can be applied and have the advantage of being less invasive but also the disadvantage of being less precise with regards to temperature control. 2 While profound levels of hypothermia (T o32 1C) can be difficult to administer and are subject to increased complication rates, mild (modest) levels of hypothermia (T 32-34 1C) have been shown to provide significant protection against traumatic and ischemic neuronal cell death. 2,3 When administered after experimental acute SCI, there is a reduction in the volume of histopathological damage and a concomitant improvement in BBB walking index. 4,5 A recent study revealed beneficial effec...

Pediatric patients who have mild alterations in consciousness in the field have a significant incidence of intracranial injury. The great majority of these patients will not require operative intervention, but the implications of missing these hemorrhages can be severe for this subgroup of head-injured patients. Because clinical criteria and cranial x-rays are poor predictors of intracranial hemorrhage, it is recommended that all children with a GCS score of 13 or 14 routinely undergo screening via non-contrast-enhanced computed tomography.

Background: Staphylococcus aureus surgical-site infections (SSIs) are a major cause of poor health outcomes, including mortality, across surgical specialties. Despite current advances as a result of preventive interventions, the disease burden of S. aureus SSI remains high, and increasing antibiotic resistance continues to be a concern. Prophylactic S. aureus vaccines may represent an opportunity to prevent SSI.Methods: A review of SSI pathophysiology was undertaken in the context of evaluating new approaches to developing a prophylactic vaccine to prevent S. aureus SSI.Results: A prophylactic vaccine ideally would provide protective immunity at the time of the surgical incision to prevent initiation and progression of infection. Although the pathogenicity of S. aureus is attributed to many virulence factors, previous attempts to develop S. aureus vaccines targeted only a single virulence mechanism. The field has now moved towards multiple-antigen vaccine strategies, and promising results have been observed in early-phase clinical studies that supported the recent initiation of an efficacy trial to prevent SSI. Conclusion:There is an unmet medical need for novel S. aureus SSI prevention measures. Advances in understanding of S. aureus SSI pathophysiology could lead to the development of effective and safe prophylactic multiple-antigen vaccines to prevent S. aureus SSI.