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Study design:Retrospective review of a clinical database.Objectives:To examine treatment modalities of incident appendicular fractures in men with chronic SCI and mortality outcomes by treatment modality.Setting:United States Veterans Health Administration Healthcare System.Methods:This was an observational study of 1979 incident fractures that occurred over 6 years among 12 162 male veterans with traumatic SCI of at least 2 years duration from the Veterans Health Administration (VA) Spinal Cord Dysfunction Registry. Treatment modalities were classified as surgical or nonsurgical treatment. Mortality outcomes at 1 year following the incident fracture were determined by treatment modality.Results:A total of 1281 male veterans with 1979 incident fractures met inclusion criteria for the study. These fractures included 345 (17.4%) upper-extremity fractures and 1634 (82.6%) lower-extremity fractures. A minority of patients (9.4%) were treated with surgery. Amputations and disarticulations accounted for 19.7% of all surgeries (1.3% of all fractures), and the majority of these were done more than 6 weeks following the incident fracture. There were no significant differences in mortality among men with fractures treated surgically compared with those treated nonsurgically.Conclusions:Currently, the majority of appendicular fractures in male patients with chronic SCI are managed nonsurgically within the VA health-care system. There is no difference in mortality by type of treatment. [ABSTRACT FROM AUTHOR]

Summary: In this longitudinal case-control study, acute fracture was associated with low serum testosterone, which was transient in 43 % of men. While assessment of gonadal status is part of the assessment of bone fragility, measurement of testosterone in the early period after fracture may overestimate the prevalence of androgen deficiency. Introduction: Measurement of circulating testosterone is recommended in the evaluation of bone fragility in men. Since acute illness can transiently decrease circulating testosterone, we quantified the association of acute fracture and serum testosterone levels. Methods: A case-control study was conducted involving 240 men with a radiologically confirmed minimal trauma fracture presenting to a tertiary referral hospital and 89 age-matched men without a history of minimal trauma fracture serving as controls. Follow-up testosterone levels 6 months after baseline were available for 98 cases and 27 controls. Results were expressed as the median and interquartile (IQR) range. Results: Compared to controls, cases had lower total testosterone [TT, 7.2 (3.5, 10.8) vs 13.6 (10.9, 17.1) nmol/L, p < 0.001]. The 143 cases treated as inpatients had lower testosterone levels than the 97 cases treated as outpatients [TT 4.7 (2.3, 8.1) vs 10.3 (7.5, 12.7) nmol/L, p < 0.001]. Group differences in calculated free testosterone (cFT) were comparable to the group differences in TT. At follow-up, in 98 cases, median TT increased from 6.5 nmol/L (3.2, 8.5) to 9.6 nmol/L (6.9, 12.0) p < 0.0001, and SHBG remained unchanged. Of cases with low testosterone, 43 % with TT <10 nmol/L and/or cFT <230 pmol/L at presentation were reclassified as androgen sufficient at follow-up. TT was unchanged in the controls. Conclusions: Low testosterone levels in men presenting with an acute fracture may, at least in part, be due to an acute, fracture-associated, stress response. To avoid over diagnosis, evaluation for testosterone deficiency should be deferred until recovery from the acute event. [ABSTRACT FROM AUTHOR]

Summary: The Veterans Affairs Spinal Cord Dysfunction Registry from 2002 to 2007 was reviewed to determine whether men with spinal cord injury (SCI) and lower extremity fractures had an increased risk of complications compared to those without fractures. We determined that fractures are associated with significant consequences, particularly during the first month postfracture. Introduction: Despite increasing longevity, patients with SCI have a substantial number of illnesses and comorbid conditions. Lower extremity fractures are frequent events in these patients. However, whether these fractures are associated with any increased risk of complications in SCI is not certain. The purpose of this report was to determine the impact of lower extremity fractures on morbidities in men with SCI. Methods: A population-based, nested, case-control (1,027 cases and 1,027 propensity-matched controls) of men enrolled in the Veterans Affairs Spinal Cord Dysfunction Registry from fiscal years 2002 to 2007 was reviewed to determine whether lower extremity fractures were associated with an increased risk for complications. Results: In propensity score models matched for demographic (age, race) and SCI-related injury factors (level/completeness of SCI), Veterans Affairs-service connection status, and comorbidities, at 1 month following the fracture, there was an increased risk for respiratory infections, pressure ulcers, urinary tract infections, thromboembolic events, depression, and delirium ( p ≤ 0.03 for all). Over 12 months, the only complication more common in fracture cases was pressure ulcers ( p < 0.01), with an absolute difference of less than 2 % when compared to controls. There was no significant increased risk of cardiac arrhythmias at any time examined following fracture (≥0.12). Conclusions: Lower extremity fractures are associated with significant consequences in men with SCI during the first month postfracture, but they do not persist for a long term, except for pressure ulcers. Targeted interventions to prevent complications should be considered following lower extremity fractures in SCI, particularly in the first month following fracture. [ABSTRACT FROM AUTHOR]

Objective:To assess the long-term cognitive, behavioral and academic status of preterm children exposed to clinical chorioamnionitis.Study Design:In total, 985 infants (<37 weeks and 2500 g at birth) were recruited in a multisite interventional research program. Of these, 43 case-infants were identified based on documented diagnosis of maternal clinical chorioamnionitis. Infants with chorioamnionitis were compared with the remainder of the cohort after controlling for maternal and infant variables. All infants underwent cognitive, behavioral and academic achievement assessments at 3, 8 and 18 years. Standardized cognitive and academic achievement scores were cutoff at 2 s.d.'s below the mean, behavioral scores were cutoff at a T-score >70 and examined with χ2 statistics. Mean scores were evaluated using preliminary bivariate analysis and were followed by multiple regression models predicting child outcomes.Result:Overall, children with chorioamnionitis did not have lower scores on any assessment at any age. Children without chorioamnionitis performed significantly lower at 8 years on the Woodcock-Johnson reading subscore and the mean score of the Peabody Picture Vocabulary Test (PPVT). No significant difference persisted to 18-year follow-up. In logistic regression, chorioamnionitis independently predicted higher PPVT scores at 8 years, but not lower performance scores on the Woodcock-Johnson reading subscore.Conclusion:Clinical chorioamnionitis was not associated with adverse neurodevelopmental outcomes in this group of preterm infants <37 weeks and 2500 g. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional survey of veterans with spinal cord injuries and disorders (SCI/D).Objectives:To describe sleep dysfunction (independent of sleep apnea) in persons with traumatic and non-traumatic SCI/D, and to examine characteristics and health outcomes independently associated with sleep dysfunction unrelated to sleep apnea.Setting:Seven Veterans Affairs SCI care facilities in the United States.Methods:Mailed cross-sectional survey with follow-up calls completed by end of 2008. Bivariate analyses to compare measures outcomes in persons with SCI/D who were dysfunctional sleepers vs those who were not. Multivariate logistic regression used to identify variables independently associated with dysfunctional sleep in veterans with SCI/D.Results:Overall, 49% of the sample had sleep dysfunction unrelated to sleep apnea. In this subgroup, bivariate analyses showed that a greater proportion of dysfunctional sleepers than non-dysfunctional sleepers were current smokers, had problems with drinking alcohol, hypertension, asthma, chronic obstructive pulmonary disease (COPD) and problematic weight gain. Variables independently associated with higher odds of dysfunctional sleep included white race, being a current smoker, problems with drinking alcohol, asthma, COPD and problematic weight gain.Conclusion:Consistent with epidemiological evidence for the general population, we found significant associations of sleep dysfunction with weight gain, smoking, alcohol misuse and select chronic conditions (COPD, asthma). Sustained sleep dysfunction may contribute to health deterioration and mortality, highlighting the need to address the high prevalence of sleep dysfunction (independent of sleep apnea) in persons with SCI/D. In particular, efforts aimed at modifying problematic weight gain, alcohol misuse and smoking are warranted in this cohort to improve sleep. [ABSTRACT FROM AUTHOR]

Study design:Retrospective, longitudinal analysis of sensory, motor and functional outcomes from individuals with thoracic (T2-T12) sensorimotor complete spinal cord injury (SCI).Objectives:To characterize neurological changes over the first year after traumatic thoracic sensorimotor complete SCI.Methods:A dataset of 399 thoracic complete SCI subjects from the European Multi-center study about SCI (EMSCI) was examined for neurological level, sensory levels and sensory scores (pin-prick and light touch), lower extremity motor score (LEMS), ASIA Impairment Scale (AIS) grade, and Spinal Cord Independence Measure (SCIM) over the first year after SCI.Results:AIS grade conversions were limited. Sensory scores exhibited minimal mean change, but high variability in both rostral and caudal directions. Pin-prick and light touch sensory levels, as well as neurological level, exhibited minor changes (improvement or deterioration), but most subjects remained within one segment of their initial injury level after 1 year. Recovery of LEMS occurred predominantly in subjects with low thoracic SCI. The sensory zone of partial preservation (ZPP) had no prognostic value for subsequent recovery of sensory levels or LEMS. However, after mid or low thoracic SCI, 3 segments of sensory ZPP correlated with an increased likelihood for AIS grade conversion.Conclusion:The data suggest that a sustained deterioration of three or more thoracic sensory levels or loss of upper extremity motor function are rare events and may be useful for tracking the safety of a therapeutic intervention in early phase acute SCI clinical trials, if a significant proportion of study subjects exhibit such an ascent. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the effectiveness of the commercial progesterone to maintain the pregnancies in noncyclic recipient mares and if it helps to decrease the early embryonic death when used in cyclic pregnant recipient mares. A total of 199 mares were used during February to April of the 2008 breeding season at Burns Ranch. The mares were assigned to groups according to their reproductive status. Noncyclic (n= 42) mares were prepared as embryo transfer recipients using our standard protocol with estradiol cypionate (3 days, 10/6/4 mg, Wickliffe, USA) and long action progesterone (P4LA, 1500 mg, BET Labs, Lexington, KY, USA), and 157 naturally cyclic mares were used from Day 3 to 8 after ovulation as embryo transfer recipients. After embryo transfer, 134 of the 157 cyclic mares got pregnant at 15 days. Some of the pregnant mares (n= 43) were assigned to a progesterone-supplemented group; these mares were administered P4LA (1500 mg) after the first pregnancy diagnosis at around 15 days and repeated 7 days later. The remaining mares were placed in a control group (n= 91), with no treatment, in order to compare the embryonic loss rates for the 3 groups. Recipients were evaluated for the presence of the embryonic vesicle between 13 and 16 days (embryo age), and pregnancies were monitored at 30 and 45 days to determine the early embryonic loss. Statistical analyzes were performed using the chi-square test with 5% defined as significance. Pregnancy rates at 13 to 16 days were not different (P= 0.336) for noncyclic and cyclic recipients (39/42, 90.7% and 134/157, 85.4%, respectively). The embryonic loss was evaluated in the 3 groups as follows: control group; 7 of 91 pregnancies were lost between 15 and 30 days (7.69%) and 2 of 84 were lost between 30 and 45 days (2.38%); the progesterone-supplemented group had lost 4 of the 43 pregnancies between 15 and 30 days (9.30%); and the noncycling progesterone mares had lost 2 of the 39 between 30 and 45 days (5.13%). Rates of embryo loss before 45 days of gestation were not different for the control mares with no progesterone supplementation (9.89%), progesterone-supplemented cyclic mares (9.3%), and noncyclic recipients (5.13%). The noncyclic recipients maintain gestation with the supplemental progesterone with no influence on embryo loss. These results demonstrate no advantage in the use of exogenous progesterone to supplementation for cyclic embryo recipients. Burns Ranch Inc., Menifee, California, USA. [ABSTRACT FROM AUTHOR]