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The last proton bound calcium isotope ^{35}Ca has been studied for the first time, using the ^{37}Ca(p,t)^{35}Ca two neutron transfer reaction. The radioactive ^{37}Ca nuclei, produced by the LISE spectrometer at GANIL, interacted with the protons of the liquid hydrogen target CRYPTA, to produce tritons t that were detected in the MUST2 detector array, in coincidence with the heavy residues Ca or Ar. The atomic mass of ^{35}Ca and the energy of its first 3/2^{+} state are reported. A large N=16 gap of 4.61(11) MeV is deduced from the mass measurement, which together with other measured properties, makes ^{36}Ca a doubly magic nucleus. The N=16 shell gaps in ^{36}Ca and ^{24}O are of similar amplitude, at both edges of the valley of stability. This feature is discussed in terms of nuclear forces involved, within state-of-the-art shell model calculations. Even though the global agreement with data is quite convincing, the calculations underestimate the size of the N=16 gap in ^{36}Ca by 840 keV.
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The excited states of unstable ^{20}O were investigated via γ-ray spectroscopy following the ^{19}O(d,p)^{20}O reaction at 8 AMeV. By exploiting the Doppler shift attenuation method, the lifetimes of the 2_{2}^{+} and 3_{1}^{+} states were firmly established. From the γ-ray branching and E2/M1 mixing ratios for transitions deexciting the 2_{2}^{+} and 3_{1}^{+} states, the B(E2) and B(M1) were determined. Various chiral effective field theory Hamiltonians, describing the nuclear properties beyond ground states, along with a standard USDB interaction, were compared with the experimentally obtained data. Such a comparison for a large set of γ-ray transition probabilities with the valence space in medium similarity renormalization group ab initio calculations was performed for the first time in a nucleus far from stability. It was shown that the ab initio approaches using chiral effective field theory forces are challenged by detailed high-precision spectroscopic properties of nuclei. The reduced transition probabilities were found to be a very constraining test of the performance of the ab initio models.
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Meat fermentation ensures its preservation, improved safety and quality. This prominently used traditional process has survived for ages, creating physical, biochemical, and microbial changes, and to significantly affect the functionality, organoleptic property, and nutrition of the fermented products. In some process, the growth of various pathogenic and spoilage microorganisms is inhibited. The production of fermented meat relies on naturally occurring enzymes (in the muscle or the intestinal tract) as well as microbial metabolic activities. In this review, fermented meat types and their health benefits were firstly introduced. This was followed by a description of fermentation conditions vis-à-vis starters, bacterial, yeast and mold cultures, and their role in meat. The review focuses on how microorganisms affect texture change, flavor formation, and biogenic amines (BA) accumulation in fermented meat. In addition, the production conditions and the major biochemical changes in fermented meat products were also introduced to present the best factors influencing the quality of fermented meat. Microorganisms and microbial enzymes in fermented meats were discussed as they could affect organoleptic characteristics of fermented meats. Moreover, safety concerns and prospects for further research of fermented meat were also discussed with emphasis on novel probiotic and starter cultures development; bioinformatics, omics technologies and data modeling to maximize the benefit from fermentation process in meat production.
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Microbiología de Alimentos , Productos de la Carne , Fermentación , Bacterias , Productos de la Carne/análisis , Aminas Biogénicas/análisisRESUMEN
Detailed spectroscopy of the neutron-deficient nucleus ^{36}Ca was obtained up to 9 MeV using the ^{37}Ca(p,d)^{36}Ca and the ^{38}Ca(p,t)^{36}Ca transfer reactions. The radioactive nuclei, produced by the LISE spectrometer at GANIL, interacted with the protons of the liquid hydrogen target CRYPTA, to produce light ejectiles (the deuteron d or triton t) that were detected in the MUST2 detector array, in coincidence with the heavy residues identified by a zero-degree detection system. Our main findings are (i) a similar shift in energy for the 1_{1}^{+} and 2_{1}^{+} states by about -250 keV, as compared with the mirror nucleus ^{36}S; (ii) the discovery of an intruder 0_{2}^{+} state at 2.83(13) MeV, which appears below the first 2^{+} state, in contradiction with the situation in ^{36}S; and (iii) a tentative 0_{3}^{+} state at 4.83(17) MeV, proposed to exhibit a bubble structure with two neutron vacancies in the 2s_{1/2} orbit. The inversion between the 0_{2}^{+} and 2_{1}^{+} states is due to the large mirror energy difference (MED) of -516(130) keV for the former. This feature is reproduced by shell model calculations, using the sd-pf valence space, predicting an almost pure intruder nature for the 0_{2}^{+} state, with two protons (neutrons) being excited across the Z=20 magic closure in ^{36}Ca (^{36}S). This mirror system has the largest MEDs ever observed, if one excludes the few cases induced by the effect of the continuum.
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BACKGROUND: The housing stock of rural sub-Saharan Africa is changing rapidly. With millions of new homes required over the coming decades, there is an opportunity to protect residents by screening homes from malaria mosquitoes. This study, undertaken in the Upper River Region of The Gambia, explores local perceptions of what a good house should provide for its inhabitants and responses to living in a house that has been modified as part of a randomized control trial designed to assess whether improved housing provided additional protection against clinical malaria in children (the RooPfs trial). METHODS: This descriptive, exploratory study was undertaken over 22 months using mixed-methods (informal conversations, observations, focus group discussions, photovoice, and a questionnaire survey) in a parallel convergent design. Analysis was conducted across the data sets using a framework approach. Following coding, the textual data were charted by a priori and emerging themes. These themes were compared with the quantitative survey results. The nature and range of views about housing and the RooPfs study modifications and the relationships among them were identified and described. RESULTS: The data were derived from a total of 35 sets of observations and informal conversations in 10 villages, 12 discussions with the photovoice photographers, 26 focus group discussions (across 13 villages) and 391 completed questionnaires. The study participants described a 'good house' as one with a corrugate-metal roof, cement walls (preferably cement block, but mud block covered with cement plaster was also an acceptable and cheaper substitute) and well-fitting doors. These features align with local perceptions of a modern house that provides social status and protection from physical harms. The RooPfs modifications were largely appreciated, although poor workmanship caused concerns that houses had become insecure. However, the long-term trusting relationship with the implementing institution and the actions taken to rectify problems provided reassurance and enhanced acceptability. CONCLUSION: In developing housing to address population needs in Africa, attention should be paid to local perceptions of what is required to make a house secure for its inhabitants, as well as providing a healthy environment.
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Anopheles , Malaria , Niño , Animales , Humanos , Anopheles/fisiología , Control de Mosquitos/métodos , Malaria/prevención & control , Malaria/epidemiología , Vivienda , África del Sur del SaharaRESUMEN
Energies and spectroscopic factors of the first 7/2-, 3/2-, 1/2-, and 5/2- states in the (35)Si21 nucleus were determined by means of the (d, p) transfer reaction in inverse kinematics at GANIL using the MUST2 and EXOGAM detectors. By comparing the spectroscopic information on the Si35 and S37 isotones, a reduction of the p3/2-p1/2 spin-orbit splitting by about 25% is proposed, while the f7/2-f5/2 spin-orbit splitting seems to remain constant. These features, derived after having unfolded nuclear correlations using shell model calculations, have been attributed to the properties of the two-body spin-orbit interaction, the amplitude of which is derived for the first time in an atomic nucleus. The present results, remarkably well reproduced by using several realistic nucleon-nucleon forces, provide a unique touchstone for the modeling of the spin-orbit interaction in atomic nuclei.
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Single nucleon pickup reactions were performed with a 18.1 MeV/nucleon (14)O beam on a deuterium target. Within the coupled reaction channel framework, the measured cross sections were compared to theoretical predictions and analyzed using both phenomenological and microscopic overlap functions. The missing strength due to correlations does not show significant dependence on the nucleon separation energy asymmetry over a wide range of 37 MeV, in contrast with nucleon removal data analyzed within the sudden-eikonal formalism.
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INTRODUCTION: Helicobacter pylori (H. pylori) eradication treatment includes a proton pump inhibitor and two antibiotics: amoxicillin and clarithromycin. The goal of that treatment is to eradicate the infection in at least 90% of the patients. Failure to eradicate the infection can have multiple causes, among which is the presence of point mutations in the antimicrobial target genes. OBJECTIVE: To characterize the mutations present in the pbp1a gene and their possible association with resistance to amoxicillin in vitro. METHODOLOGY: Susceptibility to amoxicillin was evaluated in 147 isolates of H. pylori from the Colombian municipality of Túquerres. PCR amplification and sequencing of the glycosyltransferase domain of the pbp1a gene were carried out on Túquerres isolates, and the association between mutations and resistance was evaluated. RESULTS: A total of 5.4% (8/147) Túquerres isolates were resistant to amoxicillin in vitro. PCR amplification of the glycosyltransferase domain of the pbp1A gene was performed on 87.5% of the amoxicillin-resistant isolates in vitro, and in the DNA sequencing analysis, a total of 2 changes of amino acids from 3 DNA mutations that encoded the PBP1A-1 protein were observed. CONCLUSION: The present study is the first report on pbp1a gene mutations in H. pylori isolates coming from a population in Túquerres. Mutations that have not been reported in previous studies were found.
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Infecciones por Helicobacter , Helicobacter pylori , Humanos , Amoxicilina/farmacología , Mutación Puntual , Helicobacter pylori/genética , Glicosiltransferasas/genética , Infecciones por Helicobacter/tratamiento farmacológico , Pruebas de Sensibilidad MicrobianaRESUMEN
Excited states in (38,40,42) Si nuclei have been studied via in-beam γ-ray spectroscopy with multinucleon removal reactions. Intense radioactive beams of ^{40}S and (44)S provided at the new facility of the RIKEN Radioactive Isotope Beam Factory enabled γ-γ coincidence measurements. A prominent γ line observed with an energy of 742(8) keV in (42) Si confirms the 2(+) state reported in an earlier study. Among the γ lines observed in coincidence with the 2^{+} â 0+ transition, the most probable candidate for the transition from the yrast 4(+) state was identified, leading to a 4(1)+) energy of 2173(14) keV. The energy ratio of 2.93(5) between the 2(1)+ and 4(1)(+) states indicates well-developed deformation in (42) Si at N = 28 and Z = 14. Also for 38,40)Si energy ratios with values of 2.09(5) and 2.56(5) were obtained. Together with the ratio for (42)Si, the results show a rapid deformation development of Si isotopes from N = 24 to N = 28.
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AIM: Seborrheic dermatitis is a chronic inflammatory disease aggravated by Malassezia species. Toll-like receptors (TLR) are part of innate immune system that can be activated by yeasts. Previous studies showed that an association of Umbelliferae extract with a lipid (TLR2-Regul™) decreases the IL-8 expression in human skin in contact with M. furfur. The aim of this study was to assess the activity of a topical formulated with TLR2-Regul™ in the prevention of seborrheic dermatitis (SD) relapses. METHODS: Immune-competent SD adult patients were treated for SD (topical imidazoles or steroids). Cleared patients were randomized and received a topical containing TLR2-Regul™ (A) or its vehicle (B). Erythema, scales and pruritus were assessed during two months. RESULTS: The study included 115 patients, mean age 43.4, sex ratio m/f 1.5. At week 4 the relapse rate was 26% (N.=15) in group A and 43% (N.=25) in group B. At W8 the relapse rate was 21% (N.=12) in group A and 40% (N.=23) (P=0.0309). CONCLUSION: In this series of 115 adults with seborrheic dermatitis, patients treated with a topical containing TLR-Regul™ showed a significantly less relapse rate compared with the excipient group (P<0.05). TLR modulation could represent a new therapeutic approach in the prevention of seborrheic dermatitis relapses.
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Apiaceae , Dermatitis Seborreica/tratamiento farmacológico , Fármacos Dermatológicos/uso terapéutico , Fitoterapia , Extractos Vegetales/uso terapéutico , Receptor Toll-Like 2/efectos de los fármacos , Administración Cutánea , Adulto , Anciano , Anciano de 80 o más Años , Dermatitis Seborreica/microbiología , Fármacos Dermatológicos/administración & dosificación , Método Doble Ciego , Eritema/tratamiento farmacológico , Femenino , Humanos , Interleucina-8/efectos de los fármacos , Interleucina-8/metabolismo , Malassezia/efectos de los fármacos , Masculino , Persona de Mediana Edad , Pomadas , Fitoterapia/métodos , Extractos Vegetales/administración & dosificación , Prurito/tratamiento farmacológico , Prevención Secundaria , Resultado del TratamientoRESUMEN
BACKGROUND: Current data for the use of dimethyl fumarate (DMF) in Japanese patients with relapsing-remitting multiple sclerosis (RRMS) is limited. OBJECTIVES: To assess the efficacy of DMF in Japanese patients with RRMS. METHODS: The phase 3, multinational APEX study (ClinicalTrials.gov identifier: NCT01838668) consisted of two parts: a 24-week double-blind part where subjects were randomized to receive DMF 240 mg or placebo twice daily in East Asian and Eastern European countries, and an open-label extension part where all subjects received DMF. The primary endpoint was the total number of new gadolinium-enhancing lesions in Weeks 12-24. In this interim analysis, we report efficacy data in the Japanese subgroup (DMF n = 56; placebo n = 58) over 72 weeks, including an extension phase. RESULTS: DMF reduced the total number of new gadolinium-enhancing lesions in Weeks 12-24 by 85% versus placebo (p < 0.0001). At Week 24, the annualized relapse rate was also reduced by 48% with DMF, versus placebo. DMF reduced the probability of relapse from Week 8 and was sustained. The number of gadolinium-enhancing lesions was maintained through 72 weeks. CONCLUSIONS: DMF demonstrated sustained efficacy in this Japanese subgroup. The results were consistent with those observed in studies of DMF enrolling primarily Caucasian patients.
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Starting with the duty of Governments to provide adequate resources for the establishment and development of health services, this paper draws on experiences in four developed countries to illustrate the problems and their outcomes. The examples chosen demonstrate the contrast in philosophies and approach to resource allocation for health care.
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Asignación de Recursos para la Atención de Salud/organización & administración , Servicios de Salud/provisión & distribución , Presupuestos , Países Desarrollados , Financiación Gubernamental , Asignación de Recursos para la Atención de Salud/economía , HumanosRESUMEN
The author reviews the legal theory and practice of the requirements for informed consent. He uses a discussion of relevant cases and judgements from courts in the UK, USA, Australia and Malaysia to illustrate apparently conflicting attitudes exemplified by these cases. From this he aims to form some consensus in their application to everyday practice.
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Consentimiento Informado/legislación & jurisprudencia , Australia , Humanos , Malasia , Reino Unido , Estados UnidosRESUMEN
Loco-regional recurrence in 50% of oral squamous cell carcinoma (OSCC) patients poses major challenge for oncologists. Lack of biomarkers that can predict disease aggressiveness and recurrence risk makes the scenario more dismal. On the basis of our earlier global proteomic analyses we identified five differentially expressed proteins in OSCC. This study aimed to develop protein biomarkers-based prognostic risk prediction model for OSCC. Sub-cellular expression of five proteins, S100A7, heterogeneous nuclear ribonucleoproteinK (hnRNPK), prothymosin α (PTMA), 14-3-3ζ and 14-3-3σ was analyzed by immunohistochemistry in test set (282 Indian OSCCs and 209 normal tissues), correlated with clinic-pathological parameters and clinical outcome over 12 years to develop a risk model for prediction of recurrence-free survival. This risk classifier was externally validated in 135 Canadian OSCC and 96 normal tissues. Biomarker signature score based on PTMA, S100A7 and hnRNPK was associated with recurrence free survival of OSCC patients (hazard ratio=1.11; 95% confidence interval 1.08, 1.13, P<0.001, optimism-corrected c-statistic=0.69) independent of clinical parameters. Biomarker signature score stratified OSCC patients into high- and low-risk groups with significant difference for disease recurrence. The high-risk group had median survival 14 months, and 3-year survival rate of 30%, whereas low-risk group survival probability did not reach 50%, and had 3-year survival rate of 71%. As a powerful predictor of 3-year recurrence-free survival in OSCC patients, the newly developed biomarkers panel risk classifier will facilitate patient counseling for personalized treatment.
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The effects of tricyclic antidepressants drugs (TCA) amitriptyline, imipramine and nortriptyline, on purified Electrophorus electricus (L.) acetylcholinesterase (AChE; acetylcholine hydrolase, EC 3.1.1.7) were studied using kinetic methods and specific fluorescent probe propidium. The antidepressants inhibited AChE activity by a non-competitive mechanism. Inhibition constants range from 200 to 400 microM. Dimethylated amitriptyline and imipramine were more potent inhibitors than the monomethylated nortriptyline. Fluorescence measurements using bis-quaternary ligand propidium were used to monitor ligand-binding properties of these cationic antidepressants to the AChE peripheral anionic site (PAS). This ligand exhibited an eight-fold fluorescence enhancement upon binding to the peripheral anionic site of AChE from E. electricus (L.) with K(D)=7 x 10(-7)M. It was observed that TCA drugs displaced propidium from the enzyme. On the basis of the displacement experiments antidepressant dissociation constants were determined. Similar values for the inhibition constants suggest that these drugs have similar affinity to the peripheral anionic site. The results also indicate that the catalytic active center of AChE does not participate in the interaction of enzyme with tricyclic antidepressants. These studies suggest that the binding site for tricyclic antidepressants is located at the peripheral anionic site of E. electricus (L.) acetylcholinesterase.
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Acetilcolinesterasa/metabolismo , Antidepresivos Tricíclicos/farmacología , Inhibidores de la Colinesterasa/metabolismo , Electrophorus/metabolismo , Amitriptilina/farmacología , Animales , Colorantes/metabolismo , Imipramina/farmacología , Estructura Molecular , Nortriptilina/farmacología , Propidio/metabolismo , Unión Proteica , Espectrometría de FluorescenciaRESUMEN
The present investigation deals with the purification and the partial characterization of the soluble creatine kinase (CK) isoenzyme, isolated from the electric organ electrocyte of Electrophorus electricus (L.). Purification was performed by precipitation of the enzyme in the crude extract with ammonium sulfate (80%). The precipitate obtained was analyzed on an ion exchange column of diethylaminoethyl cellulose-52 (DEAE) followed by gel filtration on Superose 12 in a Fast Protein Liquid Chromatography (FPLC) system. Electrophoretic mobility of the active peak confirmed previous results identifying the hybrid isoenzyme MB in the electrocyte cytoplasm. Electrocyte CK is a dimeric enzyme with two identical subunits of approximately 40 kDa as estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The sequence analysis of the N-terminal peptide (14 amino acids) of the 40 kDa subunit showed homology with other CK enzymes from electric fish (Torpedo) and human muscle type CK.
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Creatina Quinasa/aislamiento & purificación , Órgano Eléctrico/química , Animales , Creatina Quinasa/química , Electroforesis en Gel de Poliacrilamida , Electrophorus , Isoenzimas/química , Isoenzimas/aislamiento & purificación , Análisis de Secuencia de ProteínaRESUMEN
The conventional surgical treatment of isolated critical stenosis of the left main coronary artery restores a less physiologic perfusion of the myocardium, leads to occlusion of the left coronary ostium, and consumes an appreciable length of bypass material. Starting in June 1985, 23 surgical angioplasties have been performed in 22 patients. The left main stem was approached posteriorly in the first 11 patients, and an anterior approach was preferred in the last 12 because of better exposure. The onlay patch consisted of saphenous vein in the first 14 patients; pericardium was preferred in the last nine. The five failures occurred early. Four of these occurred in patients older than 60 years in whom calcifications of the left main stem had been seen on the preoperative angiogram. Eighteen procedures (78.3%) succeeded, but one patient (5.5%) died later of a massive air embolism. The 17 survivors are free of symptoms (maximal stress test combined with thallium scintigraphy) after a mean follow-up of 24.3 months. Angiographic restudy at an average of 8 months was obtained in 14 patients (82.3%) and revealed an excellent result in 13. In five patients, a late angiographic restudy (22 to 37 months) still revealed perfect patency of the left main stem. Provided that well-defined contraindications (calcifications, involvement of the distal bifurcation, older age) are respected, surgical angioplasty deserves a place in the array of surgical strategies.
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Enfermedades de las Arterias Carótidas/cirugía , Adulto , Anciano , Arterias Carótidas/diagnóstico por imagen , Constricción Patológica/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , RadiografíaRESUMEN
BACKGROUND: We evaluate the efficiency of multilevel somatosensory evoked potential (SEP) monitoring for intraoperative re-establishment of blood flow to the spinal cord in 63 patients undergoing descending aorta repair. METHODS: The presence of critical vessels in a cross-clamped aortic segment was ascertained by a 15 minute SEP observation period while the segment between the clamps was vented to drain out the collateral flow. RESULTS: SEPs influenced the surgical strategy in 17 cases (27%): use of the Biomedicus in 1 traumatic rupture; critical vessel reimplantation or distal clamp replacement in 13 cases of segmental spinal ischemia; and hastening the procedure or proximal clamp replacement in 3 cases of left carotid ischemia. There were no cases of unexplained multilevel SEP abnormalities. Immediate paraplegia was observed in 2 cases (1 pre-existing; 1 forecast by a 199-minute period of SEP absence due to segmental ischemia); 2 patients presented delayed paraplegias despite unchanged intraoperative SEPs, and 1 case presented a transient paraplegia due to lower motoneuronal involvement. CONCLUSIONS: SEPs efficiently identified critical vessels to be reimplanted in order to avoid immediate paraplegia. However, systematic additional vessel reimplantation, if technically feasible, and prolongation of SEP monitoring during the postoperative period with careful blood pressure control are needed to prevent delayed paraplegia.
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Aneurisma de la Aorta Torácica/cirugía , Potenciales Evocados Somatosensoriales , Isquemia/prevención & control , Monitoreo Intraoperatorio , Complicaciones Posoperatorias/prevención & control , Médula Espinal/irrigación sanguínea , Adulto , Constricción , Humanos , Persona de Mediana Edad , Paraplejía/prevención & control , Flujo Sanguíneo Regional , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
BACKGROUND: We performed a prospective randomized trial to compare intermittent antegrade warm blood cardioplegia with intermittent antegrade and retrograde cold crystalloid cardioplegia. METHODS: Two hundred consecutive patients scheduled for isolated coronary bypass surgical procedures were randomized into two groups: Group 1 (n = 92) received cold crystalloid cardioplegia with moderate systemic hypothermia, group 2 (n = 108) received intermittent antegrade warm blood cardioplegia with systemic normothermia. Preoperative, intraoperative, and postoperative data were prospectively collected. RESULTS: For the same median number of distal anastomoses, cardiopulmonary bypass duration and total ischemic arrest duration (57.3 +/- 20.5 versus 75 +/- 22.1 minutes, p < 0.001) were shorter in group 2 than in group 1. Apart from a higher right atrial pressure in the cold cardioplegia group, no hemodynamic difference was observed. Aspartate aminotransferase, creatine kinase-MB fraction, and cardiac troponin I levels were significantly lower in group 2 than in group 1. Outcome variables were not significantly different. CONCLUSIONS: Intermittent antegrade warm blood cardioplegia results in less myocardial cell damage than cold crystalloid cardioplegia, as assessed by the release of cardiac-specific markers. This beneficial effect has only marginal clinical consequences. Normothermic bypass has no deleterious effect on end-organ function.
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Puente de Arteria Coronaria/métodos , Paro Cardíaco Inducido/métodos , Anciano , Sangre , Temperatura Corporal , Soluciones Cardiopléjicas , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Tasa de SupervivenciaRESUMEN
OBJECTIVES: Intraoperative median nerve SEP monitoring uses the disappearance of cortical and brain stem activities as the criterion to determine that brain cooling is sufficient in deep hypothermic circulatory arrest (CA) surgery. This study presents the results of a retrospective SEP analysis of intraoperative events that engendered neurological complications. METHODS: Median nerve SEP monitoring was performed on 58 consecutive patients who underwent surgery under deep hypothermic CA. The monitoring was retrospectively analyzed and compared with intraoperative events, and postoperative symptoms. RESULTS: Intraoperative SEP abnormalities were observed in 9 out of the 16 patients who presented neurological complications. Among the 7 others, the abnormalities either were present preoperatively (n = 2), occurred postoperatively (n = 3) or only involved the lower limbs (n = 2). Although the mere inspection of the intraoperative SEPs was insufficient to determine the origin of the alterations, their comparison with intraoperative events facilitated the identification of hemodynamic factors in 7 cases and embolism in two cases. There were no patients in whom CA per se caused neurological complications. CONCLUSIONS: Intraoperative SEP monitoring helps identify intraoperative events responsible for neurological complications and prevent these in subsequent procedures. However, the neurological complications of deep hypothermic CA can also be due to pre- or postoperative factors that escape the domain of intraoperative monitoring.