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Medusahead is an introduced, winter-annual grass covering millions of hectares of the semiarid West. It forms exclusive stands and has a dense thatch cover that resists the establishment of desirable species. Prescribed fire can remove medusahead litter and improve plant establishment. Medusahead control is fundamental to establishing desirable species that will, in turn, resist further invasion. Imazapic is an effective herbicide for control of medusahead, but more information is needed on its effects on desirable species. Our objectives were to test how imazapic application rate and timing affected medusahead, seeded desirable species, and other nontarget vegetation on burned and unburned rangeland in southeast Oregon. We burned existing medusahead infestations at two different sites in June 2003. Following the burn, imazapic was applied at rates of 0, 35, 70, 105, 140, 175, and 210 g ai/ha between July and October of 2003 in a randomized strip-plot design. In November 2003, monocultures of seven desirable species were drill-seeded across the imazapic treated areas. Data on cover and density of medusahead and seeded species were collected in 2004 and 2005. Cover data of nontarget species were collected in the summer of 2005. Medusahead cover was highest in control plots and lowest in plots that received the highest herbicide application rates. Medusahead cover was lower in burned plots. The effect of imazapic on nontarget vegetation was less clear. Seeded species established in the study plots, but their response to herbicide rate showed few consistent patterns; some of the seeded species showed little response to herbicide, whereas others appeared to establish best at different herbicide rates, depending on site and whether the plots were burned or unburned. Site and burn treatment also affected how imazapic rate or application month influenced cover of perennial or annual grasses or forbs.

OBJECTIVE: To evaluate the response of bone to 2 anabolic stimuli, teriparatide and mechanical loading, in subjects with spinal cord injury. DESIGN: A pilot study, 1 group, pretest-posttest. SETTING: A rehabilitation hospital. PARTICIPANTS: A convenience sample of 12 nonambulatory chronic spinal cord injury subjects. METHODS: The subjects were administered open-label teriparatide 20 μg/d while undergoing robotic-assisted stepping 3 times a week for 6 months, followed by 6 months of teriparatide alone. MAIN OUTCOME MEASUREMENTS: Bone status was evaluated at 3, 6, and 12 months by using dual-energy x-ray absorptiometry to calculate bone mineral density (BMD) at the spine and hip, magnetic resonance imaging to assess bone microarchitecture of the distal tibia, and serum bone markers. RESULTS: Mean (SD) baseline BMD measurements at the spine and the left and right total hip were 1.05 ± 0.162 g/cm(2), 0.638 ± 0.090 g/cm(2) and 0.626 ± 0.088 g/cm(2), respectively. After 6 months of treatment, BMD changed 2.19% ± 3.61%, 0.02% ± 2.21%, and 0.74% ± 2.80% at the spine, and left and right total hip, respectively. These changes were not statistically significant (P > .05 for all). Magnetic resonance imaging supported an anabolic effect after 3 months of treatment with significant (P < .05) changes in trabecular thickness, 4.4% ± 4.06%; surface-to-curve ratio, 23.6% ± 22.3%; and erosion index, -17.04% ± 12.9%. Although the trend remained after 6 months, statistical significance was not retained. At 6 months, bone markers indicated an increase in mean levels of bone-specific alkaline phosphatase, 53.8% ± 62.9%; C-terminal telopeptides of type I collagen, 137.6% ± 194.6%; and intact amino-terminal propeptide of type I procollagen, 61.4% ± 99.3%. CONCLUSION: In this limited pilot study, teriparatide and mechanical loading resulted in a numerical but not statistically significant increase in lumbar spine BMD and no significant BMD changes at the hip. Magnetic resonance imaging at the distal tibia suggested an anabolic effect, but the high sensitivity offered by this technique was challenged by the limited ability to obtain analyzable data from all the subjects. Further studies that involve longer treatment periods and greater mechanical loading are warranted.

OBJECTIVE: To determine what if any changes occur to the lumbar disks in the spine after prolonged sitting with and without intermittent breaks during a 4-hour period. DESIGN: A prospective observational study. SETTING: An academic outpatient clinic. METHODS: The measurement of lumbar disk changes was performed with 12 subjects after an analysis of a mid sagittal lumbar magnetic resonance image, which measured lumbar disk height and disk diameter. Scanning and analysis were done over a 2-day period: day 1 at the start of the work day and 4 hours later after continuous sitting; at the start of work day 2 and after four hours after a change in position and stretching protocol every 15 minutes. RESULTS: For this study, we first evaluated each level of the lumbar spine for any changes after prolonged sitting for 4 hours over the 2 days. Multiple comparisons bias was eliminated by a Bonferroni correction to limit the overall experiment-wise error rate to .05. The comparison was conducted by using a paired t-test when the normality condition was satisfied and by using a Wilcoxon signed rank test when normality was not satisfied. To test for normality, a Shapiro-Wilk test was used. We found that, for disk height, L4-5 was significantly decreased at the end of the sitting for day 1 but not for day 2. There were no significant height changes for the other lumbar disks. In addition, for disk diameter, there were no significant differences present for any of the disks. CONCLUSIONS: Analysis of the data shows that the greatest change in disk height is at the L4-5 level after prolonged sitting without intermittent breaks. The other levels did not show a significant change in their height. The findings also showed that the L4-5 height changes were not significant with brief positional changes every 15 minutes. Fewer changes in disk height may correlate with an improvement in low back pain and disability.

A new animal model characterized by hereditary athymia and asplenia was used as a recipient of chronic myelogenous leukemic (CML) cells with the Philadelphia (Ph1+) chromosome. Transplanted CML cells form solid vascularized tumors containing cells similar to those seen in the patient in a long-term culture. Cells taken from the tumors were nearly triploid, retained all human chromosome markers, and had the same antigenic determinants(s) as cells in culture.

Animal models have proved valuable to investigate the pathogenesis of dry eye disease, identify therapeutic targets and the efficacy of candidate therapeutics for dry eye. Pharmacological inhibition of the lacrimal functional unit and exposure of the mouse eye to desiccating stress was found to activate innate immune pathways, promote dendritic cell maturation and initiate an adaptive T cell response to ocular surface antigens. Disease relevant mediators and pathways have been identified through use of genetically altered mice, specific inhibitors and adoptive transfer of desiccating stress primed CD4+ T cells to naïve recipients. Findings from mouse models have elucidated the mechanism of action of cyclosporine A and the rationale for developing lifitegrast, the two currently approved therapeutics in the US.

In Brief Study Design. Retrospective medical record review and literature review. Objective. To identify cases where a cerebrospinal fluid (CSF) leak occurred during an anterior cervical discectomy and fusion (ACDF) and to create a management algorithm based on the findings. Summary of Background Data. ACDF is a commonly performed spinal operation. It is effective with very low complication rates. One rare complication of ACDF is a CSF leak. There is limited information on the management of CSF leaks after ACDF and management is on a surgeon-by-surgeon basis. Methods. We reviewed 3 surgeons' case logs and identified cases where a CSF leak was encountered during ACDF and reviewed the patients' medical records, operative reports and imaging to determine how these leaks were managed. We also performed a PubMed search for articles about the presentation and management of CSF leaks after ACDF. Results. Thirteen CSF leaks were identified in 1223 ACDFs, corresponding to a CSF leak rate of 1%. Of these, 9 were successfully treated with intraoperative repair. Postoperative lumbar drainage was used in the remaining 4 patients and was successful in 1 patient. Three patients underwent neck re-exploration and attempted delayed repair. Three patients, including one who was found to have hydrocephalus, ultimately required continuous CSF diversion via shunting. We identified 7 case reports of CSF leak in ADCF in the literature and 1 article that reviewed the prevalence and management of this complication. Conclusion. CSF leak after ACDF is an uncommon complication that can usually be repaired. We provide a stepwise management strategy for CSF leaks in ACDF. Level of Evidence: 5 Anterior cervical discectomy and fusion (ACDF) is commonly performed without complication. One complication of ACDF is a cerebrospinal fluid (CSF) leak. We identified 13 patients with this complication. A literature search identified reports of CSF leaks in ACDF. On the basis of these, we provide a management strategy of CSF leaks in ACDF.

OBJECTIVE: To describe changes in and predictors of comfortable gait speed (GS-C) after using a foot-drop stimulator (FDS; Bioness L300; Bioness Inc, Valencia, CA) for 42 weeks in persons who had sustained a stroke. DESIGN: Secondary analysis of prospective assessments. SETTING: Multicenter clinical trial. PARTICIPANTS: A total of 99 subjects who had sustained a stroke ≥ 3 months earlier and who had GS-C ≤ 0.8 m/s and drop foot with a mean age of 60.7 years and a poststroke time of 4.8 years. METHODS: GS-C was assessed at baseline and at 30 weeks with and without use of an FDS (therapeutic effect) and at 6, 12, 30, 36, and 42 weeks with use of an FDS (total effect). After subjects participated in 8 physical therapy sessions, an FDS was used for ambulation over the course of 42 weeks. MAIN OUTCOME MEASUREMENTS: Changes in mean GS-C over time, FDS "responder" status defined as either ≥ 0.1 m/s gain in GS-C (the minimal clinically important difference [MCID]) or advancing by one Perry Ambulation Category (PAC), and the incidence and nature of adverse events (AEs). RESULTS: A total of 74 (75%) and 69 (70%) of 99 subjects completed assessments at 30 weeks and 42 weeks, respectively. Baseline GS-C was 0.42 m/s without use of an FDS and 0.49 m/s with use of an FDS. GS-C improved to 0.54 m/s at 30 weeks without use of an FDS (effect size = 0.75) and 0.54, 0.55, 0.58, 0.60, and 0.61 m/s at 6, 12, 30, 36, and 42 weeks with use of an FDS, respectively (effect size 0.84 at 42 weeks). Half of the subjects achieved a maximum GS-C by 12 weeks. Approximately 18% were PAC responders and 29% were MCID responders for 30-week therapeutic effect, and 55% were PAC responders and 67% were MCID responders for 42-week total effect. After logistic regression, the following factors emerged as the strongest predictors of FDS responders: younger age, faster baseline GS-C and Timed Up and Go, and balance. At 42 weeks, 60% reported a device-related AE; 92% were mild and 96% were anticipated. CONCLUSIONS: When an FDS was used, GS-C improved progressively over 42 weeks, with ≥ 50% of patients achieving a clinically meaningful 42-week total effect and 50% achieving a maximum GS-C by 12 weeks. Younger patients with greater mobility levels may benefit most from use of an FDS. AEs were frequent, mild, and reversible.

STUDY DESIGN: Retrospective review of prospective database. OBJECTIVE: To investigate the incidence of cervical dural tears (DTs), risk factors for occurrence and failure of treatment, and the effect on clinical outcomes. SUMMARY OF BACKGROUND DATA: Only 1 study has specifically investigated the impact of cervical DTs. METHODS: Cervical spine surgical procedures performed by the senior author (K.D.R.) at Washington University from 1995-2012 were evaluated. Demographic data, surgical history, operative data, and complications were recorded prospectively, and retrospectively reviewed. Intraoperative treatment of DTs was noted. Treatment failure was defined by reoperation or delayed lumbar drain placement. Patients who sustained a dural tear (DT group) were compared with those who did not sustain a dural tear (No-DT group) to identify risk factors. Comparison between successful and failed treatments was used to identify risk factors for treatment failure. RESULTS: A total of 3848 cervical surgical procedures were performed, with 38 occurrences (1.0%) of DT. Risk factors for DT were: older age (P < 0.01), rheumatoid arthritis (relative risk [RR] = 3.1, 95% confidence interval [CI] = 1.0-9.8), ossification of the posterior longitudinal ligament (RR = 19.2, 95% CI = 10.4-35.6), cervical deformity (RR = 3.3, 95% CI = 1.6-6.6), longer operative time (P = 0.01), greater number of surgical levels (P < 0.01), worse preoperative neurological status (P < 0.01), and performance of a corpectomy (RR = 2.1, 95% CI = 1.1-4.0) or revision laminectomy (RR = 20.0, 95% CI = 8.4-47.4). Initial treatments failed in 12 cases (32%) and hospital readmission was required for 5 patients (13%). Older age and ossification of the posterior longitudinal ligament were found to be risk factors for failure of the DT treatment. With an average follow-up of 18 months, there were no clinical sequelae from the DTs. CONCLUSION: In the largest series of cervical DTs reported, the incidence of DTs was found to be 1% and several risk factors were identified. Initial treatment failures occurred more often than previously reported. No significant clinical impact was found after successful DT treatment. LEVEL OF EVIDENCE: 4.

OBJECTIVE: To determine the relationship between severity of injury and self-reports and parent reports of daytime somnolence in adolescents after traumatic brain injury (TBI), and to determine the relationship between daytime somnolence and self-report and parent report of executive functioning in daily life. DESIGN: Cross-sectional study conducted within the first 6 months (mean ± standard deviation 14.97 ± 7.51 weeks) after injury. Partial correlation controlling for injury severity was used to examine the associations of TBI severity with daytime somnolence and the association of daytime somnolence with executive functioning. SETTING: Outpatient visits at 3 children's hospitals and 2 general hospitals with pediatric trauma commitment. PARTICIPANTS: A total of 102 adolescents, 12-18 years old, who sustained moderate-to-severe TBI (n = 60) or complicated mild TBI (n = 42). MAIN OUTCOME MEASUREMENTS: Parent-report Sleepiness Scale, Epworth Sleepiness Scale (youth report), Behavior Rating Inventory of Executive Function (BRIEF) (self-report and maternal report). RESULTS: Adolescents who sustained moderate-to-severe TBI had increased daytime somnolence compared with those with complicated mild injuries in the parent report but not in the youth report. Based on the parent report, 51% of adolescents with moderate-to-severe TBI showed significant daytime somnolence compared with 22% of those with complicated mild TBI. The parent report of daytime somnolence was associated with executive dysfunction on both the BRIEF self-report and parent report; however, the youth report of daytime somnolence was associated only with the BRIEF self-report. CONCLUSIONS: The parent report of daytime somnolence correlated with TBI severity and predicted executive functioning difficulties of the teens in everyday circumstances. Although a correlation between daytime somnolence and executive dysfunction were also apparent on self-report, this did not differ based on injury severity. Teens tended to report fewer difficulties with executive function, which suggests that the teens have decreased awareness of their impairments.

OBJECTIVE: To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. DESIGN: Retrospective cohort study. SETTING: A total of 1257 inpatient rehabilitation facilities in the United States. PATIENTS: Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. METHODS: Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. MAIN OUTCOME MEASUREMENTS: Discharge setting (community versus institutional). RESULTS: Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. CONCLUSIONS: Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture.

OBJECTIVE: To determine predictive factors for TRansferring Inpatient rehabilitation facility (IRF) cancer Patients Back to Acute Care (TRIPBAC). DESIGN: A retrospective chart review of patients with cancer admitted to an IRF from 2009 to 2010 because of a functional impairment that developed as a direct consequence of their cancer or its treatment. SETTING: IRF of a community-based, academic, tertiary care facility. METHODS: The characterization of patients with cancer in the IRF was primarily based on analysis of the IRF Patient Assessment Instrument and other internal IRF data logs. MAIN OUTCOME MEASUREMENT: Frequency and reasons for TRIPBAC. RESULTS: The TRIPBAC rate in our IRF was 17.4%. The most common reasons for TRIPBAC were postneurosurgical complications (31%). Factors associated with TRIPBAC were a motor Functional Independence Measure score of 35 points or lower on admission (odds ratio 4.01, 95% confidence interval 1.79-8.98; P = .001) and the presence of a feeding tube or a modified diet (odds ratio 3.18, 95% confidence interval 1.44-7.04; P = .004). CONCLUSIONS: Motor Functional Independence Measure score on admission is the best predictor for TRIPBAC in patients with cancer admitted to our IRF, followed by the presence of a feeding tube or a modified diet.

Millions of dollars are expended, in the USA and elsewhere, to provide paraprofessionals or ‘teaching assistants’ for regular early childhood classrooms. However, little consistent information exists related to best practice in the use of paraprofessionals in these early childhood settings. This article describes a study employing the use of 159 teacher and 161 paraprofessional surveys and classroom observations in 23 randomly selected kindergarten and four-year-old classrooms. Paraprofessionals delivered large amounts of group instruction and frequently managed student behavior. Furthermore, it was found that a lack of understanding of specific duties and expectations related to the roles of paraprofessionals was characteristic of both teachers and the paraprofessionals themselves.

STUDY DESIGN: A posterolateral rabbit spinal fusion model was used to evaluate the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) and teriparatide (PTH [1-34]) used individually and in combination on spinal fusion outcomes. OBJECTIVE: To test the efficacy of parathyroid hormone on improving spinal fusion outcomes when used with BMP-2. SUMMARY OF BACKGROUND DATA: Of the more than 250,000 spinal fusion surgical procedures performed each year, 5% to 35% of these will result in pseudarthrosis. Growing controversy on the efficacy and cost of rhBMP-2 for improving spinal fusion outcomes has presented a challenge for clinicians. Research into PTH as an adjunct therapy to rhBMP-2 for spinal fusion has not yet been investigated. METHODS: Forty-eight male New Zealand white rabbits underwent bilateral posterolateral intertransverse process arthrodesis surgery at the L5-L6 level. Animals were divided into 6 groups. Two groups were treated with autograft alone or autograft and PTH (1-34), whereas the other 4 groups were treated with low-dose rhBMP-2 alone, high-dose rhBMP-2 alone, or either dose combined with PTH (1-34). All animals were euthanized 6 weeks after surgery. The L4-L7 spinal segment was removed and assessed using manual palpation, computed tomography (CT), and biomechanical testing. RESULTS: CT assessments revealed fusion in 50% of autograft controls, 75% of autograft PTH (1-34) animals, 87.5% in the 2 groups treated with low-dose rhBMP-2, and 100% in the 2 groups treated with high-dose rhBMP-2. CT volumetric analysis demonstrated that all groups treated with biologics had fusion masses that were on average significantly larger than those observed in the control group (P < 0.0001). Biomechanical data demonstrated no statistical difference between controls, PTH (1-34), and low-dose rhBMP-2 in any testing orientation. PTH (1-34) did not increase bending stiffness when used adjunctively with either low-dose or high-dose rhBMP-2. CONCLUSION: Although intermittent teriparatide administration results in increased fusion mass volume, it does not improve biomechnical stiffness over use of autograft alone. When delivered concurrently with high- and low-dose rhBMP-2, teriparatide provided no statistically significant improvement in biomechanical stiffness. LEVEL OF EVIDENCE: N/A.

Abstract Aim Intraoperative peripheral nerve injury can have permanent neurological consequences. Its incidence is not known and varies according to the location and the surgical specialty. This study was a prospective analysis of intraoperative peripheral nerve injury as a complication of abdominal colorectal surgery. Method All patients who underwent major colorectal abdominal surgery in our Colorectal Unit between 1996 and 2009 were analyzed. Data on nerve injury were prospectively collected. Results There were 2304 patients, of whom eight (0.3%) experienced intraoperative peripheral nerve injury. This occurred in 5/2211 (0.2%) open procedures and in 3/93 (3%) laparoscopic procedures. There was no association between intraoperative peripheral nerve injury and age, gender, body mass index, surgeon, operation time, American Society of Anesthesiology (ASA) score and urgent surgery. The use of Allen‐type stirrups and a vacuum bag (in laparoscopic surgery) seemed to be protective for nerve injury in the lower and upper limbs respectively. Conclusion Adequate positioning and the use of pressure‐free positioning devices may prevent intraoperative peripheral nerve injury, particularly during laparoscopy.

OBJECTIVES: To determine whether a knee brace incorporating inflatable air bladders can alter the net peak external knee adduction moment in persons with medial compartment knee osteoarthritis. DESIGN: Prospective cohort study. SETTING: Motion analysis laboratory. PARTICIPANTS: Subjects (n = 18) diagnosed with knee osteoarthritis as defined by the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. METHODS: Instrumented gait analysis was performed while subjects walked with and without the knee brace. When subjects wore the knee brace, the air bladders were either uninflated or inflated to 7 psi. The net external knee adduction moment was obtained by subtracting the abduction moment produced by the knee brace (estimated using a finite element analysis model) from the external knee adduction moment (estimated using a camera-based motion analysis system). MAIN OUTCOME MEASUREMENTS: The net external knee adduction moment was compared across all testing conditions. RESULTS: A 7.6% decrease in net peak external knee adduction moment was observed when subjects wore the knee brace uninflated compared with when they did not wear the brace. Inflation of the bladders to 7 psi led to a 26.0% decrease in net peak external knee adduction moment. CONCLUSIONS: The results of the study suggest that the effects of an unloading knee brace may be enhanced by incorporating inflatable air bladders into the design of the brace, thus leading to an improved correction of the excessive peak external knee adduction moment observed in patients with medial compartment knee osteoarthritis.

Abstract Cahal Tok (Place of Flint) is a limestone rise with some structural evidence, associated with the previously designated LDF Chert Site, close to the ceremonial center of El Pilar. Excavations uncovered evidence that during the Late Classic period, specialized flintknappers produced bifaces, primarily chert axes, at the Cahol Tok locus, first on a cleared limestone shelf then on a prepared cobble platform. Small flakes remained in situ whereas much of the larger debris was deposited to the east off the edge of the platform and into the LDF debitage dump. The identification of a specialized manufacturing locale near the ceremonial precinct of a major center is unusual in Maya archaeology. Central control of an important industry may be implied, although knapping could equally well be organized more independently. We expect that small industrial areas are actually present at most large sites, but may often be difficult to recognize.

OBJECTIVE: By using data from Department of Veterans Affairs (VA) national databases, this article presents and internally validates a 1-year all-cause mortality prediction index after hospitalization for acute stroke. DESIGN: An observational cohort. SETTING: VA medical centers. PARTICIPANTS: Veterans with a diagnosis of a new stroke who were discharged between October 1, 2006, and September 30, 2008. MAIN OUTCOME MEASURE: Death due to any cause that occurred between the index hospital discharge date and the 1-year anniversary of that date. RESULTS: Within 1-year after discharge, 1542 (12.3%) of the total 12,565 patients had died. Seventeen risk factors known at the point of hospital discharge remained in the predictive model of 1-year postdischarge mortality after backward selection, including advanced age, admission from extended care, type of stroke, 8 comorbid conditions, 4 types of procedures that occurred during the index hospitalization, hospital length of stay (longer than 3 weeks), and discharge location. We assigned a score to each variable in the final model and a risk score was determined for each patient by adding up the points for all risk factors present. According to these risk scores, the patients were divided into approximate quartiles that yielded low, moderate, high, and highest mortality likelihood strata. The risk of 1-year mortality ranged from 2.24% in the lowest quartile to 29.50% in the highest quartile in the derivation cohort and from 2.11%-30.77% in the validation cohort. Model discrimination demonstrated an area under the receiver operating characteristic curve of 0.785 in the derivation cohort and 0.787 in the validation cohort. The Hosmer-Lemeshow goodness of fit indicated that the model fit was adequate (P = .69). CONCLUSION: When using readily available data, a simple index that stratifies stroke patients at hospital discharge according to low, moderate, high, and highest likelihood of all-cause 1-year mortality is feasible and can inform the postdischarge planning process, depending on level of risk.

O Complexo Metamorfico Bonfim um dos vdrios fragmentos de idade arqueana que constituem a crosta sialica da poro meridional do Craton do Sao

BACKGROUND: Macrophage infiltration to the injury site during the acute response to traumatic spinal cord injury (SCI) is not uniform. Macrophage phenotype has been characterized as either proinflammatory (M1) or anti-inflammatory (M2). Results of animal studies suggest that M1 or M2 dominance at the site of injury relates to spontaneous recovery after SCI. OBJECTIVE: To investigate whether the phenotype of circulating macrophage precursors-monocytes (MO) is altered in the acute phase of SCI and corresponds to circulating inflammatory cytokines. STUDY DESIGN: A prospective observational cohort study. SETTING: A single academic medical center in Pennsylvania. PATIENTS: A cohort of 27 subjects with complete or incomplete traumatic SCI enrolled within 7 days after SCI injury. METHODS: The MO phenotype was defined within the first week after SCI by using flow cytometry and was compared with that of historic uninjured controls. Concentrations of 25 cytokines and/or chemokines were assessed by using Luminex in serial blood samples up to 2 weeks after SCI. An analysis of variance was used to determine the correlations between the phenotypes and the cytokine profiles. RESULTS: Patient subsets were identified with either M1- or M2-dominant circulating MOs distinct from the uninjured controls. The M1 dominant was associated with higher circulating levels of proinflammatory mediators interleukin (IL)12p70 and interferon gamma-induced protein 10 kDa (IP-10/CXCL10), and lower levels of anti-inflammatory cytokines IL-10, IL-15, and IL-7, whereas the M2 dominant exhibited the opposite cytokine profiles with significantly higher IL-10 and IL-7. CONCLUSION: In the acute phase after SCI, at comparable injury severity, subgroups of patients exhibit distinct M1 or M2 MOs dominance and the phenotype is correlated with M1- or M2-specific cytokine and/or chemokine profiles. Although further studies are needed to determine how these observed phenotypic differences relate to functional recovery, our findings (1) provide the first evidence, to our knowledge, that indicates the possible individual differences in the immune responses to the comparable traumatic SCI, with potential implications for management of acute SCI and rehabilitation; and (2) may represent easily accessible biomarkers with prognostic utility.

Physical activity (PA) rates in young Latina girls are low. This study examined acceptability and feasibility of implementing a mother-daughter intervention targeting individual and family-level correlates of PA. Eleven mother-daughter dyads participated in an 8-week intervention promoting PA in preadolescents. Preliminary data suggest increases in self-report PA, reductions in television watching, and improvements in parenting and mother-daughter communication. Focus group data suggest that participants benefited from receiving the intervention in a group format. Findings suggest that mother-daughter interventions promoting PA in young Latinas are feasible. Physical activity may improve family communication and mother-daughter relations.