Daily Training efficiency during computerized cognitive rehabilitation training (CCRT): an analysis from a randomized trial in Ugandan children with and without severe malaria.

Children in Uganda are at risk for significant cognitive sequelae from severe malaria. Computerized cognitive rehabilitation training (CCRT) represents a potential method to improve working memory, behavior, and executive functioning, cognitive domains most at risk following severe malaria. The primary aim of this study was to complete a secondary analysis of data from a concluded CCRT randomized control trial in order to compare the training efficiency of a commonly used CCRT program under conditions of titrated (adaptive) or non-titrated (non-adaptive) training and with children with increasing malaria severity to determine how various factors may affect potential CCRT improvement. A total of 201 school-aged children (66.2% boys) who were either healthy (n = 102) or previously diagnosed with severe or cerebral malaria (n = 99) were randomized into two active treatment arms (titrated and non-titrated learning). Each child received 24 one-hour sessions of training over 8 weeks using Captain's Log® CCRT by BrainTrain, which includes a comprehensive set of CCRT tasks. Children generally benefited from CCRT over the 24 training sessions, but titrated CCRT showed a clear advantage over non-titrated. Severity of illness or factors such as BMI, did not moderate CCRT performance indicators. These findings support our hypothesis that titrated CCRT would result in steeper improvement in learning, but do not support our hypothesis that history of recent significant illness would affect learning proficiency. Findings were evident across all CCRT performance scores, even given that children were from generally rural, low-resource settings and were generally unfamiliar with computers.ABBREVIATIONS:Computerized Cognitive Rehabilitation Training (CCRT); Mental Processing Index (MPI); Home Observation for the Measurement of the Environment (HOME); Socioeconomic Status (SES); least square means (LSM).

Thoracolumbar Fusion in Extreme Obesity: Complications and Patient-Reported Outcomes.

BACKGROUND: Extreme obesity (class III) is defined by the Centers for Disease Control as a body mass index (BMI) value ≥40. Recent studies suggest that obese patients have poor outcomes after thoracolumbar spinal fusions. The objective of this study was to analyze 30-day adverse events and patient-reported outcomes (PROs) for this population. PATIENTS AND METHODS: A retrospective chart review of spinal fusion surgeries performed at a single institution from 2006 to 2016 was executed. All patients had a preoperative BMI ≥40. Patient characteristics, including age, sex, BMI, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and others, were collected. Thirty-day adverse events (complications, readmissions, reoperations, and mortality) and PROs (Oswestry Disability Index [ODI] and visual analog scale [VAS]) were recorded. RESULTS: Fifty-six patients were identified, including 30 men (54%). Mean age was 55.7 years (range, 31-74 years). Mean BMI was 44.2 (range, 40.0-54.7). Mean ASA was 2.7 (range, 2-3), and mean CCI was 1.1 (range, 0-6). Mean number of fused levels was 2.3 (range, 1-14). Mean length of stay was 4.4 ± 2.1 days. Mean number of complications was 0.7 ± 1.1, with 30.4% of patients having had at least 1 complication. The 30-day all-cause readmission rate was 5.4%, and 30-day reoperation rate was 3.6%. For 30 patients (54%) with 1-year PROs, mean preoperative ODI was 65.2 ± 11.1, and mean preoperative VAS was 6.6 ± 1.6. Mean ODI change was -19.9 ± 20.1 (P < .001), and mean VAS change was -2.6 ± 2.3 (P < .001). A total of 15 patients (50%) achieved the minimum clinically important difference in ODI (12.8), with a mean follow-up of 18.9 months. CONCLUSIONS: Patients with extreme obesity who undergo thoracolumbar fusion have acceptable 30-day adverse events and potentially can achieve significant improvement in pain and disability.

Proximity of Cytomegalovirus-Specific CD8+ T Cells to Replicative Senescence in Human Immunodeficiency Virus-Infected Individuals.

Antiretroviral therapy (ART) effectively extends the life expectancy of human immunodeficiency virus (HIV)-infected individuals; however, age-related morbidities have emerged as major clinical concerns. In this context, coinfection with cytomegalovirus (CMV) accelerates immune senescence and elevates risk for other age-related morbidities, possibly through increased inflammation. We investigated potential relationships between CMV memory inflation, immune senescence, and inflammation by measuring markers of inflammation and telomere lengths of different lymphocyte subsets in HIV-infected individuals seropositive for anti-CMV antibodies. Our study cohort consists mainly of middle aged men who have sex with men (MSM) and heterosexuals who are stable under long-term ART. Median levels of IL-6, TNF-α, and CRP were significantly higher in those coinfected with CMV. Lymphocyte telomere length in general correlated with age, but for 32/32 subjects tested, there was a consistent hierarchy of telomere lengths with CD8+ T cells' shorter than the general lymphocyte population, CD57+CD8+ T cells' shorter than CD8+ T cells' and CMV-specific CD57+CD8+ T cells' the shortest of all. Telomeres of HIV-specific CD8+ T cells were longer than those of CMV-specific CD8+ T cells in all cases tested and over 10 years, CMV-specific CD8+ T cell telomeres of two HIV-infected individuals eroded faster than those of HIV-specific CD8+ T cells. These data indicate that CMV-specific CD8+ T cells of HIV-infected individuals are the lymphocytes closest to telomere-imposed replicative senescence. Exhaustive proliferation of CMV-specific CD8+ T cells in HIV-infected individuals is a potential source of senescent lymphocytes affecting systemic immune function and inflammation.

Use of Intraoperative Navigation for Reconstruction of the C1 Lateral Mass After Resection of Aneurysmal Bone Cyst.

BACKGROUND: Aneurysmal bone cysts (ABCs) are rare blood-filled cystic lesions that are found in the long bones and spine. Here, we present a case of an ABC found in the lateral mass and lamina of C1. Lesions in this area provide a surgical challenge because of its difficulty to access as well as its need for reconstruction. We describe a novel use of intraoperative navigation (ION) to assist in the placement of a C1 lateral mass titanium cage. CASE DESCRIPTION: An 18-year-old female patient presented with headaches and progressive neck pain. Imaging revealed a large cystic lesion involving the C1 lamina and right lateral mass. The patient underwent ION-assisted aggressive intralesional resection of the ABC and reconstruction of the C1 lateral mass with a static titanium cage, supplemented with posterior fusion from the occiput to C3. At 2-year follow-up, there was no evidence of recurrence and the hardware remained intact. CONCLUSIONS: ION is a useful aid in assessing the extent of tumor resection and performing cage reconstruction of the C1 lateral mass.