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PubMed1991

Prognostic factors for overall survival in patients with advanced ovarian carcinoma.

Twenty-one pretreatment variables were investigated for prognostic influence on survival in 301 previously untreated patients with ovarian carcinoma, stage IIB-IV. Patients were randomized to sequential combination chemotherapy: cyclophosphamide, doxorubicin, 5-fluorouracil, followed by cisplatin and hexamethylmelamine, or to the 3-drug combination alternating with the 2-drug combination every other month. Median overall survivals were 25 and 22 months, respectively, P greater than 0.4. Based on the results from a Cox multivariate stepwise analysis a subset of independent significant prognostic factors was found to include: residual tumor size, performance status, alkaline phosphatase, number of metastases, histological differentiation grade and type. A prognostic index was calculated for each patient and three prognostic categories of patients were determined. The 3-yr survival rates for patients with low-, intermediate-, and high-risk scores were 62, 31, and 7%, respectively. Multivariate analysis thus contributes further information about the disease, and a knowledge of the distribution of such factors across different trials is important when comparing treatment outcome.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

The substitution of proline 35 by alanine in Rhodobacter capsulatus cytochrome c2 affects the overall protein stability but not the alkaline transition.

It was shown by Koshy et al. [1990, Proc. Natl Acad. Sci USA, 87, 8697-8701; 1994, Biochem. J., 299, 347-350] that the substitution of proline 30 by alanine (P30A) of Drosophila melanogaster and rat cytochromes c exhibited decreased stabilities in both the heme iron-methionine sulfur (Fe-S) bond and overall protein conformation. Now we have found that the stability properties of the equivalent mutant of Rhodobacter capsulatus cytochrome c2 (P35A) are somewhat different. Based on optical and NMR spectroscopies, the Rb.capsulatus P35A alkaline transition (pKalk) was found to be unchanged with respect to the wild type, suggesting that the mutation in Rb.capsulatus cytochrome c2 has little effect on the stability of the Fe-S bond. However, Rb.capsulatus conformational stability was found to be decreased by 1.6 kcal/mol in the oxidized state. The difference in the stability properties of the equivalent proline to alanine substitutions in various species underscores the importance of studying mutations in more than one species before drawing generalizations about the role of conserved residues in protein structure and function.

Cytochrome c Group↗
PubMed1994

Overall long-term impact of total hip and knee joint replacement surgery on patients with osteoarthritis and rheumatoid arthritis.

All patients with OA or RA entering an orthopaedic waiting list for total hip or knee replacement surgery over a period of 2.5 yr were prospectively assessed for overall pain (Visual Analogue Scale) and disability (Health Assessment Questionnaire) prior to and following their operation at annual intervals for up to 5 yr. A total of 293 patients had 335 operations (OA, hip 164; OA, knee 76; RA, hip 41; RA, knee 54). A few patients (14) showed a deterioration in pain and function 1 yr after surgery, but the remainder showed improvements which took 1 yr or more to reach maximum and were maintained for at least 3 yr. Although greater for OA hip patients, improvements occurred and were maintained in all groups, in spite of the polyarticular nature of RA.

Aged↗
PubMed1998

The usefulness of carcinoembryonic antigen testing in the overall management of patients with non-small-cell lung cancer.

Carcinoembryonic antigen (CEA) testing is a valuable adjunct in the overall management of patients who have non-small-cell lung cancer, especially when selecting surgical candidates for curative lung resection and in cases where the diagnosis is in doubt. Carcinoembryonic antigen levels above 50 strongly suggest advanced-stage cancer and should discourage lung resections in otherwise suitable cases. Carcinoembryonic antigen testing can enhance problem solving in difficult cases and help prevent needless invasive interventions.

Aged↗
PubMed2000

Serum level of soluble tumor necrosis factor receptor II (sTNF-R75) is apparently an index of overall monocyte-related infectious and inflammatory activity.

BACKGROUND: The serum level of soluble tumor necrosis factor receptor II (sTNF-R75) has been recently found to correlate with the activity and/or severity of several different infectious and inflammatory diseases. These results have led us to presume that the serum sTNF-R75 level reflects the active immune activity of all causes and may correlate well with nonspecific infectious and inflammatory markers such as peripheral leukocyte counts and serum C-reactive protein level. METHODS: In total, 110 apparently healthy adults, 55 men and 55 women, were enrolled in the study. Serum levels of sTNF-R75, C-reactive protein, globulin, alkaline phosphatase, lactate dehydrogenase, creatinine, urea nitrogen, and counts of neutrophils, lymphocytes, monocytes, eosinophils, and basophils were checked. The relationships between the serum sTNF-R75 level and other parameters were analyzed using the SAS statistical program. RESULTS: By various statistical methods, the serum sTNF-R75 level showed consistently significant positive links with peripheral monocyte count, serum C-reactive protein level, and two parameters of renal clearance function (serum urea nitrogen and creatinine levels). Serum levels of alkaline phosphatase and lactate dehydrogenase had significant positive links with the serum sTNF-R75 level by multivariate regression analysis. There was no significant link between the serum sTNF-R75 level and counts of neutrophils, lymphocytes, eosinophils, or basophils. CONCLUSIONS: Our results, together with those of recent reports showing positive correlations between the serum sTNF-R75 level and activities/severities of different infectious and inflammatory diseases, and also that TNF-alpha is principally produced by monocytes and macrophages, suggest that the serum sTNF-R75 level is very probably an index of overall monocyte-related infectious and inflammatory activities.

Adult↗
PubMed1995

Infants tolerate spinal anesthesia with minimal overall autonomic changes: analysis of heart rate variability in former premature infants undergoing hernia repair.

Unlike adults, neonates tolerate high thoracic spinal anesthesia with minimal changes in heart rate (HR) and arterial blood pressure. To examine the potential autonomic regulatory mechanisms which may account for these findings, the relation between short-term heart rate variability (HRV) and respiratory activity was analyzed in a group of eight ASA grade II former premature infants undergoing high thoracic spinal anesthesia for inguinal hernia repairs. Quantitative measures of sympathetic (As) and parasympathetic (Ap) modulation of HR were derived. HR, arterial blood pressure, and a calibrated respiratory signal were recorded during 4.4-min stable epochs in eight subjects 1) preoperatively, 2) postincision after high thoracic spinal anesthesia, and 3) during an active sleep state in the postoperative period. Power spectral analysis of HRV and respiratory power yielded measures of low-frequency power (LFP: 0.02-0.15 Hz) and high-frequency power (HFP: 0.15-0.8 Hz). Transfer function analysis between respiratory activity and HR were used to quantify As and Ap. All subjects had successful high thoracic spinal anesthesia with highest levels ranging from C7-T4. Mean HR, blood pressure, and respiratory power did not change significantly with high thoracic spinal anesthesia. LFP and HFP both decreased significantly, whereas the LFP/HFP ratio remained stable. Group mean As and Ap both decreased, but the changes were not significant. Despite overall cardiovascular stability, HRV decreased with high thoracic spinal anesthesia, but the balance between LFP and HFP remained stable, suggesting that the reflex response to high thoracic spinal anesthesia was predominantly diminished parasympathetic modulation of cardiac function. The expected decrease in HR and blood pressure from the sympatholysis which results from high thoracic spinal anesthesia were apparently offset by withdrawal of cardiac vagal activity.

Anesthesia, Spinal↗
PubMed1989

Effect of excitatory amino acid receptor blocker MK-801 on overall, neurologic, and morphologic outcome after prolonged cardiac arrest in dogs.

Excitatory amino acids accumulating in the brain during ischemia may cause selective neuronal damage postischemia. This hypothesis was tested in a series of studies using MK-801, an N-methyl-D-aspartate (NMDA) receptor blocker, in a reproducible outcome model of prolonged cardiac arrest in dogs. After normothermic ventricular fibrillation cardiac arrest, the dogs were resuscitated with closed-chest femoral veno-arterial cardiopulmonary bypass. At 4 h they were separated from bypass, ventilation was controlled for 20 h, and intensive care was continued to 96 h. In Study I, ventricular fibrilation cardiac arrest (no-flow) was 17 min; starting immediately with reperfusion, MK-801 1200 mg/kg (n = 5) or an equal volume of placebo (n = 5) was infused over 12 h in blinded, randomized fashion. In Study II, the duration of the no-flow period was reduced to 15 min, and MK-801 2400 mg.kg-1 (n = 4) or placebo (n = 4) was infused. In Study III, no-flow lasted for 15 min, and MK-801 2400 mg/kg was started 30 min before ventricular fibrillation (n = 4); comparison was with Study II controls. In all three studies, MK-801 plasma concentrations peaked at greater than 50 ng/ml and were 15-30 ng/ml over 12 h. All 22 dogs of experiments within protocol survived with severe brain damage. MK-801 delayed return of pupillary reactivity, EEG activity, consciousness, and respiration, necessitating longer periods of controlled ventilation. Neurologic deficit scores, overall performance categories, and brain and heart morphologic damage scores at 96 h did not differ between placebo and MK-801 pretreatment or post-treatment groups. These negative outcome results after prolonged cardiac arrest do not negate the hyperexcitability hypothesis of selective vulnerability, but suggest the existance of additional mechanisms of secondary brain damage.

Animals↗
PubMed1996

Overall mortality of cellular telephone customers.

Unlike mobile cellular telephones, in which the antenna is not part of the handset, a portable cellular telephone exposes the user's head to radio frequency energy transmitted from the antenna. This exposure has prompted concerns about potential biological effects, including brain cancer. As a first step in a record-based mortality surveillance of cellular telephone customers, we report on overall mortality of a cohort of more than 250,000 portable and mobile telephone customers during 1994. We found age-specific rates to be similar for users of the two types of telephones. For customers with accounts at least 3 years old, the ratio of mortality rates in 1994 for portable telephone users, compared with mobile telephone users, was 0.86 (90% confidence interval = 0.47-1.53).

Adult↗
PubMed2000

Diet and overall survival in a cohort of very elderly people.

We conducted a 5-year cohort study among 162 self-sufficient residents in a public home for the elderly in Rome, Italy, to evaluate the association between the consumption of specific food groups and nutrients and overall 5-year survival. We used a validated, semiquantitative food-frequency questionnaire to assess diet at baseline. Individuals consuming citrus fruit at least twice a week had an adjusted risk of dying that was half that of individuals who consumed citrus fruit less than once a week [relative risk (RR) = 0.52; 95% confidence interval (CI) = 0.28-0.95] (with adjustment for gender, age, education, body mass index, smoking status, cognitive function, and chronic diseases). The adjusted RRs of mortality were 0.38 (95% CI = 0.14-1.01) for consumption of milk and yogurt at least three times a week vs less than once a week; 0.21 (95% CI = 0.08-0.35) for moderate consumption of espresso coffee (1-2 cups weekly) vs less than once a week; and 0.35 (95% CI = 0.17-0.69) for > 2 cups a week of espresso coffee vs less than once a week. High levels of intake of ascorbic acid, riboflavin, and linoleic acid were associated with 50-60% decreases in mortality risk. High consumption of meat was associated with a higher risk of mortality (RR = 9.72; 95% CI = 2.68-35.1) among subjects with chronic diseases. Our findings indicate that frequent consumption of citrus fruit, milk, and yogurt; low consumption of meat; and high intake of vitamin C, riboflavin, and linoleic acid are associated with longevity.

Aged↗
PubMed2002

The assay of overall haemostasis potential used to monitor the low molecular mass (weight) heparin, dalteparin, treatment in pregnant women with previous thromboembolism.

The present study aimed to assess whether the determination of overall haemostasis potential (OHP) in plasma is powerful enough to monitor the prophylactic effect of low molecular mass heparin (dalteparin, Fragmin) in patients with increased risk of thromboembolitic events. In five pregnant women who had a history of deep venous thrombosis, OHPs were kinetically investigated in gestation weeks 32-35 twice during 24 h (before injection and after 1, 2, 4, 6, 8, 10, 12, 14, 16 and 24 h). Levels of anti-activated factor X (anti-FXa), reflecting dalteparin activity, as well as prothrombin fragments 1 + 2 (F1 + 2) and soluble fibrin, were also measured. In converse relation to changes of anti-FXa, OHPs decreased reaching the lowest level between 2 and 8 h after the injection, and then rose again, returning to the levels around those before the administration. There were no significant variations in concentrations of F1 + 2 and soluble fibrin during the observation course. These findings indicate that the OHP assay can monitor the alteration of haemostatic balance under the dalteparin influence while anti-FXa only shows the activity of the drug present in plasma. Additionally, analyses of thrombin generation markers are not useful to screen immediate changes in the haemostatic system after dalteparin injection.

Adult↗
PubMed1993

Medical students' clinical self-assessments: comparisons with external measures of performance and the students' self-assessments of overall performance and effort.

PURPOSE: To find predictors of students' initial self-assessments of their clinical performances, the predictive value of their self-assessments, and factors that relate to their final self-assessments. METHOD: Of the 142 third-year students at the University of Michigan Hospital in 1988-89, 137 (96%) completed a self-assessment questionnaire on the first day of their internal medicine clerkship and a slightly expanded questionnaire on the last day. The questionnaires asked the students to use Likert-type scales to rate their abilities regarding clinical skills, use of knowledge in the clinical setting, and discharge of patient care responsibilities. Also collected were data on the students' performances as measured externally: college grade-point averages; standardized examinations taken before, during, and after the clerkship; and ratings given the students by the faculty and residents with whom they worked in the clerkship. Pearson product-moment correlations were then calculated between the students' self-assessment ratings and their scores on the external measures of performance. RESULTS: Weak to absent correlations were found between prior-performance measures and initial self-assessments. The lower-performing students, as measured by college grade-point averages and Medical College Admission Test scores, tended to rate their performances higher than did their peers at initial self-assessment. IN contrast, the higher-performing students rated themselves lower than would be warranted given their prior performances. There were significant increases in the initial self-assessments as the year progressed and the students entered the clerkship after having had more experience. The correlations between the students' final self-assessments and the ratings by faculty and residents were generally weak. The strongest (.267, p < or = .001) concerned the students' medical knowledge. In addition, there was a moderate correlation (.413, p < or = .001) between the students' self-assessments of how hard they had worked and their self-assessments of overall performance. CONCLUSION: The findings in this study were similar to those of previous studies in that they showed relatively poor agreement between external measures of students' performances and students' self-assessments of their performances.

Clinical Clerkship↗
PubMedDate not supplied

The time to onset and overall analgesic efficacy of rofecoxib 50 mg: a meta-analysis of 13 randomized clinical trials.

OBJECTIVE: To determine the time to onset of analgesia of rofecoxib based on a patient-level meta-analysis of randomized, placebo-controlled, postoperative oral surgery pain studies. METHODS: A search on MEDLINE and of Merck data on file was conducted to identify studies that met the inclusion criteria. Meta-analysis inclusion criteria required that patients were treated with a single oral dose of rofecoxib 50 mg when they experienced moderate or severe pain after surgical extraction of > or = 2 third molars; study design involved patient randomization, double-blinding, and matching placebo, and onset data from individual patients were available. The meta-analysis of time to onset also required that studies used the two-stopwatch method. Eleven studies fulfilled the onset criteria and included patients who received a single dose of rofecoxib 50 mg (N = 1220) or placebo (N = 483). These studies were analyzed to determine time to onset of analgesia, time to perceptible pain relief, percentage of patients achieving onset of analgesia, and duration of analgesia. Six of the 11 studies included a nonselective nonsteroidal anti-inflammatory drug (N = 303) and were included in the onset meta-analysis for comparison. The meta-analysis of overall efficacy also required that data on total pain relief scores over 8 hours were available. Over-all effectiveness of analgesia was based on analysis of 13 studies involving 1330 rofecoxib patients and 570 placebo patients on the endpoints of total pain relief scores over 8 hours and patient global assessment of response to therapy at 24 hours. Eight of the 13 studies with a nonselective nonsteroidal anti-inflammatory drug comparator (N = 391) were included for the efficacy meta-analysis. RESULTS: Patient demographics and baseline characteristics were similar across treatment groups in each study. Median time to onset of analgesia for rofecoxib was 34 minutes (95% CI, 31-38 minutes), significantly faster than placebo, which did not achieve onset within the 4 hours the assessment was conducted (P < 0.001). Duration of analgesia for rofecoxib 50 mg was > 24 hours. Rofecoxib achieved a greater mean total pain relief score over 8 hours than placebo (17.4 versus 4.4; P < 0.001) and a greater patient response rate on patient global assessment of response to therapy at 24 hours than placebo (73% versus 16%; P < 0.001). Outcomes were similar between the rofecoxib group and the nonselective nonsteroidal anti-inflammatory drug group. CONCLUSION: In this meta-analysis of over 1200 rofecoxib-treated patients, a single dose of rofecoxib 50 mg demonstrated a rapid onset of analgesia in approximately half an hour combined with sustained effectiveness, supporting its use as a treatment of acute pain.

Adolescent↗
PubMed2000

Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments.

OBJECTIVE: Given the current focus on outcomes, there is a crucial need for easily utilized measures that can effectively quantify morbidity or disability after a child's critical illness or injury. The purpose of this study is to significantly extend the research on two such promising measures: the Pediatric Overall Performance Category (POPC) and the Pediatric Cerebral Performance Category (PCPC). DESIGN: Cross-sectional analysis of a sample of pediatric intensive care unit (PICU) discharges and a prospective follow-up of this cohort of children. SETTING: Arkansas Children's Hospital. PATIENTS: Two hundred children (ranging in age from birth to 21 yrs) discharged from a PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were collected at PICU discharge, hospital discharge, and 1- and 6-month follow-up assessments after hospital discharge. Measures utilized included the POPC (at PICU discharge), PCPC (at PICU discharge), Stanford-Binet Intelligence Scale, fourth edition (at hospital discharge), Bayley Scales of Infant Development, second edition (at hospital discharge), and the Vineland Adaptive Behavior Scales (at 1 and 6 months after discharge). Stanford-Binet Intelligence Quotients and Bayley Mental Developmental Index scores were significantly different across PCPC categories (p < .0001). Bayley Psychomotor Developmental Index scores and Vineland Adaptive Behavior Scales scores varied significantly across POPC categories (p < .0001). The test for linear trend was also significant for each of the comparisons. CONCLUSIONS: The results of this study offer additional support for the use of the PCPC and POPC. These brief and easily completed measures can provide useful information regarding probable outcomes for pediatric intensive care patients when more extensive psychometric testing is not feasible or desirable.

Adolescent↗
PubMed1985

Ranking: a reproducible semiobjective means of evaluating overall resident performance.

Eleven staff radiologists evaluated resident performance by independent subjective ranking regardless of residency year. A pooled ranking correlated with a ranking obtained from the total raw score of the American College of Radiology (ACR) Inservice Examination (P less than .005). The staff pooled ranking had a Spearman rank correlation, r = .70, with resident overall performance upon the ACR Inservice Examination. The pooled ranking had a Spearman rank correlation, r = .90, with a subsequent pooled ranking obtained six months later (P less than .0001). This method of ranking accurately predicts ACR Inservice Examination performance and appears to evaluate the objectivity of the staff radiologists involved.

Clinical Competence↗
PubMed1992

Regional hemodynamic effects and clearance of endothelin-1 in humans: renal and peripheral tissues may contribute to the overall disposal of the peptide.

We investigated the regional balance of endothelin-1 across the renal and leg vascular bed as well as the hemodynamic effects of exogenously administered endothelin-1 in six healthy men. Net regional endothelin-1 balance was calculated from the respective arteriovenous differences in plasma concentrations and the corresponding plasma flow, the latter being determined by para-aminohippurate or indocyanine-green dye using appropriate catheter techniques. During constant intravenous (i.v.) infusion of endothelin-1 (0.4 pmol/kg/min), a slight increase in diastolic blood pressure (p less than 0.05) and a decrease in heart rate (p less than 0.01) were observed. In contrast, no significant changes in leg hemodynamics were noted. Renal plasma flow decreased by approximately 30%, and renal vascular resistance increased by 50% as compared with the control (placebo) period (p less than 0.01). Renin plasma concentrations did not change substantially during endothelin-1 infusion. During the control (placebo) period, arterial endothelin-1 plasma concentrations averaged 2.1 +/- 1.0 pM. An equilibrated peptide balance across the leg and a slight renal uptake of endothelin-1 was observed. After endothelin-1 infusion, arterial plasma concentrations of the peptide increased to 4.9 +/- 1.3 pM (p less than 0.01), and a net overall renal and limb uptake of endothelin-1 accounted for approximately 9 and 6% of the infused endothelin-1 amount, respectively. Results showed that at systemic endothelin-1 plasma concentrations, comparable to those which occur in a variety of pathologic conditions such as hypertension or cardiogenic shock, besides pulmonary clearance, renal and limb uptake of the peptide may also contribute to the short half-life (t1/2) of endothelin-1 in humans.

Adult↗
PubMed1996

The effect of overall treatment time of radiation therapy on local control of T1-stage squamous cell carcinoma of the glottis.

From 1975 to 1990, 72 patients with T1 glottic cancer, excluding a verrucous type of carcinoma, were treated with radiation therapy (RT). All treatments were given with a standard fractionation of 2 Gy per day. The total dose to the tumor ranged from 60 to 70 Gy. Six patients received a split-course RT. The overall local control rate was 87% at 5 years. Forty-one patients who completed RT in 45 days or less had a 5-year local control rate of 95%. Sixteen patients who completed a treatment course in 46 to 49 days had a local control rate of 81%. Fifteen patients with a treatment course of more than 50 days had a local control rate of 73%. There was a statistically significant difference in local control rates among the three groups (P<.05). The split-course RT group had a 5-year local control rate of 50%; that rate was statistically significantly inferior to that of the continuous course group (P<.001). Multivariate analysis also showed that an interruption of the treatment course was an important parameter in relation to the local control. The prolongation of standard RT schedules adversely affected local control of T1 glottic carcinoma and, therefore, should be avoided whenever possible.

Carcinoma, Squamous Cell↗
PubMed1996

Quality improvement among primary care practitioners: an overall appraisal of results of the Ambulatory Care Medical Audit Demonstration Project.

OBJECTIVES: The authors appraised the overall conclusions of a randomized, controlled trial of quality assurance in 16 primary care group practices, addressing the relevance of findings to health maintenance organizations in the 1990s. METHODS: The framework was the analogy of opening the "black box" of quality assurance interventions to examine circumstances in which interventions worked. RESULTS: External pressures for quality improvement were weak during the study and knowledge of continuous quality improvement principles lacking. Correspondingly, within study practices, pre-existing mechanisms lacked the rigorous data-driven approach and system focus of the quality assurance cycles conducted. Additional barriers to demonstrating an effect of quality assurance included pre-existing good performance, high variability in performance measurements, and lack of time within the study for radical re-design of systems. Improvement in performance for one guideline was impeded by change of practice recommendations during the study. Nevertheless, clinically and statistically significant improvements in quality were obtained in five of the seven remaining guidelines, with effects peaking after feedback of performance results. A sixth guideline showed improvement in practices in which the physician leader influenced colleagues to improve. The seventh guideline showed improvement that did not reach statistical significance, in part because of lack of statistical power. CONCLUSIONS: This study demonstrated the effectiveness of cycles of quality measurement and improvement. The findings provide guidance for health-care practitioners and managers of the 1990s, for whom quality measurement and improvement has become a priority.

Ambulatory Care↗
PubMed2001

Coadministration of methylprednisolone with hypertonic saline solution improves overall neurological function and survival rates in a chronic model of spinal cord injury.

OBJECTIVE: We previously demonstrated that administration of 7.5% hypertonic saline (HS) significantly improved spinal cord blood flow and neurological outcomes after spinal cord injury. The aim of this study was to determine whether hypertonicity would enhance the effects of methylprednisolone (MP), further improving neurological function. METHODS: Rat spinal cords were compressed for 10 minutes with 50 g of weight, and neurological function was assessed for 28 days, using the Basso-Beattie-Bresnahan locomotor rating scale. The control group received an intravenous injection of isotonic saline (IS) (5 ml/kg). Group 1 received an intravenous injection of 7.5% HS (5 ml/kg). Group 2 received an intravenous injection of MP (30 mg/kg) and IS (5 ml/kg). Group 3 received an intravenous injection of MP (30 mg/kg) administered with 7.5% HS (5 ml/kg). RESULTS: At 24 hours after spinal cord injury, the combination of MP plus HS provided significant (P < 0.01) neurological improvements, compared with all other treatment groups. At 10 days after injury, the animals that had received MP plus HS exhibited significantly (P < 0.01) higher Basso-Beattie-Bresnahan scores, compared with the MP plus IS and control groups. The median survival time was significantly (P < 0.01) increased for the MP plus HS group (28 d), compared with the MP plus IS group (16 d). Because of the dramatic decrease in survival rates at 28 days after injury, there was a significant (P < 0.01) difference in neurological function only between the MP plus HS group and the control group. CONCLUSION: The results indicate that the administration of HS may enhance the delivery of MP and prevent immunosuppression, leading to improvements in overall neurological function and survival rates after spinal cord injury.

Animals↗