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Neurosurgical Forum: Letters to the Editor To The Editor J. Paul Muizelaar , M.D., Ph.D. , James W. Kupiec , M.D. , Lottie A. Rapp , Ph.D. Wayne State University, Detroit, Michigan 942 942 We have completed the analysis of serum antibody samples that were collected during the course of the controlled trial of polyethylene glycol—conjugated superoxide dismutase (Dismutec (pegorgotein, formerly known as PEG-SOD)) in severe head injury, the clinical results of which were

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Tyler S. Cole, Kaith K. Almefty, Jakub Godzik, Amy H. Muma, Randall J. Hlubek, Eduardo Martinez-del-Campo, Nicholas Theodore, U. Kumar Kakarla and Jay D. Turner

neurological disease were excluded. All aspects of this study protocol were approved by the local institutional review board prior to patient enrollment. Informed consent for study enrollment was obtained from all patients. Study participation had no bearing on surgical decision-making. Functional Hand Testing All patients were tested by a licensed occupational therapist who performed 3 tests to assess hand function. These tests included palmar dynamometry to measure grip strength, the hydraulic pinch gauge test to measure pinch strength, and the 9-hole peg test (9-HPT) to

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Leendert H. Oterdoom, D. L. Marinus Oterdoom, Johannes C. F. Ket, J. Marc C. van Dijk and Pieter Scholten

P ercutaneous endoscopic gastrostomy (PEG) is a safe and frequently performed procedure in patients who are incapable of sufficient oral intake. If more than 6 weeks of nasogastric tube feeding is expected, placement of a PEG tube can be considered. 13 Neurological disease with concomitant difficulty in or unsafe swallowing is a common indication. Some neurological diseases are accompanied by hydrocephalus, requiring drainage of cerebrospinal fluid (CSF). Ventriculoperitoneal shunting is a widely used method. 17 Some gastrointestinal guidelines consider

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Matthew R. McCann, Kevin W. Hatton, Olga A. Vsevolozhskaya and Justin F. Fraser

exacerbates neurological injury and leads to longer hospitalizations and worse outcomes. 11 , 15 To address this issue, patients are given enteral feeding, often by nasogastric tube. Prolonged feeding by nasogastric tube is associated with various complications including nasal lesions, chronic sinusitis, gastroesophageal reflux, and aspiration pneumonia. 10 Percutaneous endoscopic gastrostomy (PEG) is an alternative method available to provide feeding in critically ill patients, which may avert the aforementioned complications. A meta-analysis demonstrated that PEG

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Kiyoshi Ito, Tetsuyoshi Horiuchi, Kiyomitsu Oyanagi, Tetsuo Nomiyama and Kazuhiro Hongo

fistulas and to achieve intraoperative hemostasis. 5 Recently, polyethylene glycol (PEG) hydrogel sealant has been introduced to the field of neurosurgery to achieve a watertight dural closure. 2 , 3 , 14–16 This hydrogel sealant system can also be used to seal dural defects. Polyethylene glycol hydrogel sealant is a chemical synthetic sealant formed by mixing PEG ester solution and trilysine amine solution. When mixed together, these precursors cross-link to form the hydrogel sealant. After application, the hydrogel gradually breaks down into water-soluble molecules

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G. Rees Cosgrove, Johnny B. Delashaw, J. Andre Grotenhuis, John M. Tew, Harry van Loveren, Robert F. Spetzler, Troy Payner, Gail Rosseau, Mark E. Shaffrey, L. Nelson Hopkins, Richard Byrne and Alex Norbash

sutures (possibly using duraplasty to cover significant dural gaps), adhesives, hemostatic agents, and other preparations not specifically approved by the US FDA for dural sealing. In contrast, the PEG hydrogel sealant used in this study was specifically developed to provide a watertight closure as an adjunct to standard methods of dural repair. The PEG hydrogel sealant system involves spraying a synthetic, bio-compatible, tissue-adherent PEG hydrogel onto sutured dural incisions to prevent CSF leakage. We present results from an FDA investigational device exemption

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Xin Zhou, C. Rory Goodwin, Pablo F. Recinos, Jesse X. Yang and George I. Jallo

, fibrin glue, or polyethylene glycol (PEG) sealants. Fibrin glue is a biological adhesive comprising fibrinogen, thrombin, other clotting factors, and calcium that forms fibrin monomers, which help plug microscopic holes by hardening around tissues. 3 PEG is a synthetic dural sealant developed as an alternative to human-derived fibrin glue. Prior studies have suggested that combining standard suture repair with PEG sealants may reduce incisional CSF leak rates and in turn lower postoperative complications. 9 , 12 , 13 One such PEG dural sealant, DuraSeal (Covidien

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Lauren Conova, Jennifer Vernengo, Ying Jin, B. Timothy Himes, Birgit Neuhuber, Itzhak Fischer, Anthony Lowman, Jennifer Vernengo, Ying Jin, B. Timothy Himes, Birgit Neuhuber, Itzhak Fischer and Anthony Lowman

effect on cell growth. The long-term goal of this work is to develop a device that combines these cellular, mechanical, and biochemical strategies into one multifunctional platform. Specifically, this study investigates a hydrogel based on PNIPAAm lightly cross-linked with PEG or MC. Aqueous solutions of PNIPAAm have an LCST around 32°C, allowing them to be injected as a viscous liquid at room temperature and solidify in situ without the use of toxic monomers or cross-linkers. 51 In our prior work, it was found that copolymerization of NIPAAm with hydrophilic

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Lauren Conova Grous, Jennifer Vernengo, Ying Jin, B. Timothy Himes, Jed S. Shumsky, Itzhak Fischer and Anthony Lowman

example, neurotrophin-3 (NT-3) or BDNF delivery to the spinal cord promotes axon growth and plasticity. 5 , 10 , 26 , 27 , 30 , 34 , 37 Of particular interest, BDNF delivery to the spinal cord promotes regeneration of RST axons. 18 , 19 Additionally, our prior in vitro work using a synthetic scaffold based on PNIPAAm- g -PEG indicated that codissolved BDNF is released in bioactive form from PNIPAAm- g -PEG with a minimal burst, followed by a linear release for 4 weeks. 6 Our recent in vivo research using PNIPAAm- g -PEG showed that the hydrogel is biocompatible, can

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J. Paul Muizelaar, Anthony Marmarou, Harold F. Young, Sung C. Choi, Aizik Wolf, Roberta L. Schneider and Hermes A. Kontos

sufficient in the very same patients. 2, 3, 33 Thus, in those patients a cerebral ischemia-reperfusion injury is thought to have taken place. In experimental ischemia-reperfusion injury, SOD has been shown to have beneficial effects, 9, 16, 17, 26, 28, 41 thus making it attractive to evaluate in human traumatic brain injury. Superoxide dismutase has a very short biological half-life (t½ = 6 minutes), which limits its clinical utility. Conjugation with polyethylene glycol (PEG) extends the half-life of SOD to approximately 5 days and may limit its immunogenicity