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“Objective: The effect of an atherothrombotic aorta on the short-and long-term outcomes of total aortic arch replacement,

including postoperative neurologic deficits, remains unknown. We evaluated this relationship and also elucidated the synergistic effect of multiple other risk factors, in addition to an atherothrombotic aorta, on the neurologic outcome.

Methods: A group of 179 consecutive patients undergoing total aortic arch replacement were studied. An atherothrombotic aorta was present in 34 patients (19%), more than moderate leukoaraiosis in 71 (39.7%), and significant extracranial carotid artery stenosis in 27 (15.1%). In-hospital deaths occurred in 2 patients, 1 (2.9%) of 34 patients with and 1 (0.7%) of 145 patients without an atherothrombotic aorta (P=.26). Permanent neurologic deficits occurred selleck in 4 (2.2%) and transient see more neurologic deficits in 17 (9.5%) patients. Multivariate analysis demonstrated that the risk factors for transient neurologic deficits were an atherothrombotic aorta (odds ratio, 4.4), extracranial carotid artery stenosis (odds ratio, 5.5), moderate/severe leukoaraiosis (odds ratio, 3.6), and cardiopulmonary bypass time (odds ratio, 1.02). To calculate the probability of transient neurologic

deficits, the following equation was derived: probability of transient neurologic deficits = 1+exp [7.276-1.489 (atherothrombotic aorta)-1.285 (leukoaraiosis)-1.701 (extracranial carotid artery stenosis)-0.017 (cardiopulmonary bypass time)](-1). An exponential increase occurred in the probability of transient neurologic deficits with presence of an atherothrombotic aorta and other risk factors in relation to the cardiopulmonary bypass time. Survival at

3 years after surgery was significantly reduced in patients with vs without an atherothrombotic aorta (75.0% +/- 8.8% vs 89.2% +/- 3.1%, P=.01).

Conclusions: Patients with an atherothrombotic aorta and associated preoperative comorbidities might be predisposed to adverse short-and long-term outcomes, including transient neurologic deficits. (J Thorac Cardiovasc Surg 2013;145:984-91)”
“The effects of repetitive transcranial magnetic stimulation (rTMS) on cortical selleck chemicals excitability are usually inferred from indirect indexes, such as EMG responses. It has now become possible to directly evaluate rTMS impact by means of concurrent EEG recording. The aim of this study was to examine the modulation induced by high frequency rTMS (20 Hz) over left primary motor cortex on the ongoing oscillatory activity. Thirteen subjects underwent two sham and a real rTMS session while acquiring EEG. Event-related desynchronization/synchronization was calculated for the a and beta bands. rTMS induced a dose-dependent increase in synchronization in both bands over central and parietal sites. The strongest effect found for the a band outlasted the end of the stimulation.