1
|
Yoo HJ, Koo B, Yong CW, Lee KS. Prediction of gait recovery using machine learning algorithms in patients with spinal cord injury. Medicine (Baltimore) 2024; 103:e38286. [PMID: 38847729 PMCID: PMC11155515 DOI: 10.1097/md.0000000000038286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024] Open
Abstract
With advances in artificial intelligence, machine learning (ML) has been widely applied to predict functional outcomes in clinical medicine. However, there has been no attempt to predict walking ability after spinal cord injury (SCI) based on ML. In this situation, the main purpose of this study was to predict gait recovery after SCI at discharge from an acute rehabilitation facility using various ML algorithms. In addition, we explored important variables that were related to the prognosis. Finally, we attempted to suggest an ML-based decision support system (DSS) for predicting gait recovery after SCI. Data were collected retrospectively from patients with SCI admitted to an acute rehabilitation facility between June 2008 to December 2021. Linear regression analysis and ML algorithms (random forest [RF], decision tree [DT], and support vector machine) were used to predict the functional ambulation category at the time of discharge (FAC_DC) in patients with traumatic or non-traumatic SCI (n = 353). The independent variables were age, sex, duration of acute care and rehabilitation, comorbidities, neurological information entered into the International Standards for Neurological Classification of SCI worksheet, and somatosensory-evoked potentials at the time of admission to the acute rehabilitation facility. In addition, the importance of variables and DT-based DSS for FAC_DC was analyzed. As a result, RF and DT accurately predicted the FAC_DC measured by the root mean squared error. The root mean squared error of RF and the DT were 1.09 and 1.24 for all participants, 1.20 and 1.06 for those with trauma, and 1.12 and 1.03 for those with non-trauma, respectively. In the analysis of important variables, the initial FAC was found to be the most influential factor in all groups. In addition, we could provide a simple DSS based on strong predictors such as the initial FAC, American Spinal Injury Association Impairment Scale grades, and neurological level of injury. In conclusion, we provide that ML can accurately predict gait recovery after SCI for the first time. By focusing on important variables and DSS, we can guide early prognosis and establish personalized rehabilitation strategies in acute rehabilitation hospitals.
Collapse
Affiliation(s)
- Hyun-Joon Yoo
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bummo Koo
- School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea
| | - Chan-woo Yong
- School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea
| | - Kwang-Sig Lee
- AI Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
2
|
Zainudin MF, Abu Hassan SA, Khin NY. Facilitation of neurological recovery in a complete spinal cord injury with NeuroAiD: case report. Spinal Cord Ser Cases 2024; 10:16. [PMID: 38570486 PMCID: PMC10991547 DOI: 10.1038/s41394-024-00632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION NeuroAiD (MLC601 & MLC901)'s neuroprotective capabilities include limiting exaggerated calcium influx, decreasing excitotoxicity, reducing oxidative stress, and preventing glutamate-induced cell death. It has also been shown to facilitate synaptogenesis, neurogenesis, and neuroplasticity. However, its clinical efficacy has primarily been studied in the context of brain injuries, particularly stroke. NeuroAiD's potential application in SCI remains largely untapped. CASE PRESENTATION A 34-year-old male presented with C4 complete tetraplegia. Following surgical decompression and initial inpatient rehabilitation, he started consuming MLC901 two capsules three times daily at month 4 post injury for 6 months. He regained considerable neurological recovery following the supplementation. Apart from the improvement in the neurological level of injury, the patient exhibited motor recovery beyond the initial zone of partial preservation up to 24 months post injury. DISCUSSION Our findings align with a recent animal study demonstrating MLC901's potential to downregulate Vascular Endothelial Growth Factor (VEGF), a molecule known to increase vascular permeability and exacerbate tissue edema and infarction. In another animal study involving stroke-affected mice, MLC901 demonstrates the ability to promote neurological recovery by regulating the expression of proteins mediating angiogenesis, such as hypoxic inducible factor 1α, erythropoietin, angiopoietins 1 and 2, as well as VEGF. The anecdotal findings from this case report offer preliminary insights into NeuroAiD's potential in facilitating recovery during post-acute and chronic phases of severe SCI, necessitating further exploration.
Collapse
Affiliation(s)
- Muhamad Faizal Zainudin
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, 47000, Sungai Buloh, Selangor, Malaysia.
- Department of Rehabilitation Medicine, Queen Elizabeth Hospital, 88200, Kota Kinabalu, Sabah, Malaysia.
| | - Salmah Anim Abu Hassan
- Department of Orthopaedics, Traumatology & Rehabilitation, Kulliyyah of Medicine, International Islamic University, 25200, Kuantan, Pahang, Malaysia
| | - Nyein Yin Khin
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| |
Collapse
|
3
|
Wang B, Xu L, Zheng P, Zhang Y, Liu W, Wang Y, Zhang Z. Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08208-7. [PMID: 38509262 DOI: 10.1007/s00586-024-08208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
AIMS This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI). METHODS Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally. RESULTS In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0 months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets. CONCLUSION The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.
Collapse
Affiliation(s)
- Bo Wang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Liukun Xu
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Zheng
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yapeng Zhang
- Anhui Province Children's Hospital, Hefei City, 230051, Anhui Province, China
| | - Wangmi Liu
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, 310009, Zhejiang Province, China
| | - Yuntao Wang
- Zhongda Hospital, Southeast University, Nanjing City, 210000, Jiangsu Province, China
| | - Zhiqun Zhang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
4
|
Wiles MD, Benson I, Edwards L, Miller R, Tait F, Wynn-Hebden A. Management of acute cervical spinal cord injury in the non-specialist intensive care unit: a narrative review of current evidence. Anaesthesia 2024; 79:193-202. [PMID: 38088443 DOI: 10.1111/anae.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/11/2024]
Abstract
Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well-established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non-specialist units. This review aimed to provide clinicians who work in non-specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation.
Collapse
Affiliation(s)
- M D Wiles
- Academic Department of Anaesthesia and Peri-operative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - I Benson
- National Spinal Injuries Centre, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville, UK
| | - L Edwards
- University of Nottingham, Nottingham, UK
| | - R Miller
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - F Tait
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - A Wynn-Hebden
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
5
|
Wang X, Ye L, Zhang K, Gao L, Xiao J, Zhang Y. Small Extracellular Vesicles Released from miR-211-5p-Overexpressed Bone Marrow Mesenchymal Stem Cells Ameliorate Spinal Cord Injuries in Rats. eNeuro 2024; 11:ENEURO.0361-23.2023. [PMID: 38351058 PMCID: PMC10866331 DOI: 10.1523/eneuro.0361-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
Spinal cord injury (SCI) has become one of the common and serious diseases affecting patients' motor functions. The small extracellular vesicles secreted by bone marrow mesenchymal stem cells (BMSCs) have shown a promising prospect for the treatment of neurological diseases. BMSCs were collected from rat bones. Osteogenic and adipogenic differentiation of BMSCs was further determined. Small extracellular vesicles were obtained by high-speed centrifugation. Dual-luciferase reporter assay was performed to demonstrate the targeting of miR-211-5p to the cyclooxygenase 2 (COX2) mRNA. qRT-PCR and Western blot assay were used for the detection of the mRNA and protein expression. ELISA was performed to estimate the levels of proinflammatory factors in spinal cord tissues. Our results showed that miR-211-5p targeted COX2 mRNA and regulated the protein expression of COX2 in BMSCs. Extracellular vesicles released from miR-211-5p-overexpressed BMSCs ameliorated SCI-induced motor dysfunction and motor evoked potential impairments. Extracellular vesicles released from miR-211-5p-overexpressed BMSCs ameliorated SCI-induced COX2 expression and related inflammatory responses. In conclusion, small extracellular vesicles released from miR-211-5p-overexpressed BMSCs ameliorate spinal cord injuries in rats.
Collapse
Affiliation(s)
- Xianxiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Lei Ye
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Ke Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Lu Gao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Jin Xiao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Yiquan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| |
Collapse
|
6
|
Wasiak K, Frasuńska J, Tarnacka B. Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study. Diagnostics (Basel) 2024; 14:129. [PMID: 38248006 PMCID: PMC10814489 DOI: 10.3390/diagnostics14020129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Regaining greater independence in performing daily activities constitutes a priority for people with tetraplegia following spinal cord injury (SCI). The highest expectations are connected with the improvement of hand function. Therefore, it is so important for the clinician to identify reliable and commonly applicable prognostic factors for functional improvement. The aim of this study was to conduct an analysis to assess the impact of initial functional factors on the clinical improvement in patients during early neurological rehabilitation (ENR). This study assessed 38 patients with complete SCI aged 17-78 who underwent ENR in 2012-2022. The analysis included the motor score from the AIS (MS), the Barthel Index (BI) and the SCIM scale values at the beginning of the ENR program and after its completion. During ENR, patients achieved a statistically significant improvement in MS, BI and SCIM. The initial MS and the level of neurological injury constituted the predictors of functional improvement during ENR. Significant statistical relationships were observed primarily in the correlations between the initial MS and BI, and the increase in the analyzed functional scales of SCI patients. Higher initial MS may increase the chances of a greater and faster functional improvement during ENR.
Collapse
Affiliation(s)
- Krzysztof Wasiak
- Department of Rehabilitation, Mazovian Rehabilitation Center STOCER, 05-520 Konstancin-Jeziorna, Poland;
| | - Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland;
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland;
- Department of Rehabilitation, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| |
Collapse
|
7
|
Acosta-Santillán PL, Toro-Sashida MF, Rosas-Mendoza AV, Fuentes-Orozco C, Jasso-García K, García de León-Flores P, Mellado-Téllez MP, Ibarra-Camargo SA, Chejfec-Ciociano JM, Barbosa-Camacho FJ, Flores-Prado JA, Cervantes-Guevara G, Cervantes-Pérez E, Cevantes-Cardona GA, Alvarez-Villaseñor AS, González-Ojeda A. Quality of sexual life in Mexican men after spinal cord injury. J Rehabil Med 2023; 55:jrm11641. [PMID: 38124428 PMCID: PMC10802783 DOI: 10.2340/jrm.v55.11641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To evaluate the quality of sexual life in men with spinal cord injury. DESIGN Cross-sectional analytical study. PATIENTS Males with a history of spinal cord injury who attended an outpatient rehabilitation service. METHODS An analytical study examined adult male patients with complete spinal cord injury in rehabilitation. A modified Sexual Life Quality Questionnaire (SLQQ) examined quality of sexual life, with scores below 50 suggesting significant sexual dysfunction and dissatisfaction. The assessment evaluated age, occupation, marital status, comorbidities, and treatment methods. RESULTS A total of 80 patients were included; 33 (41%) had a thoracic spinal cord injury, and 47 (59%) had a lumbar spinal cord injury. Thirty-seven patients (46%) were dissatisfied with the quality of their sexual life; 29 patients (88%) with thoracic spinal cord injury and 8 patients (17%) with lumbar spinal cord injury were dissatisfied with the quality of their sexual life (p = 0.001). Patients with higher education level experienced less sexual dissatisfaction (p = 0.03). CONCLUSION Human sexuality involves numerous interconnected elements that impact on general health. Sexual pleasure, self-esteem, and personal relationships are crucial for patients with spinal cord injury to identify rehabilitation needs. These results indicate the importance of supporting sexual well-being in recovery. Further studies of sexual enjoyment and quality of life for patients with spinal cord injury are needed, using larger and more diverse populations.
Collapse
Affiliation(s)
- Paulina Lucia Acosta-Santillán
- Department of Physical Rehabilitation, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Maria Fernanda Toro-Sashida
- Department of Physical Rehabilitation, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Alejandra Viridiana Rosas-Mendoza
- Department of Physical Rehabilitation, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Kelvin Jasso-García
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Paulina García de León-Flores
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Mel Paul Mellado-Téllez
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Silvia Alejandra Ibarra-Camargo
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Jonathan Matías Chejfec-Ciociano
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Francisco José Barbosa-Camacho
- Department of Psychiatry, Civil Hospital of Guadalajara Fray Antonio Alcalde, University Center of Health Sciences, University of Guadalajara, Guadalajara, Jalisco, México
| | - Juan Armando Flores-Prado
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Gabino Cervantes-Guevara
- Department of Wellbeing and Sustainable Development, Centro Universitario del Norte, University of Guadalajara, Guadalajara, Jalisco, México
| | - Enrique Cervantes-Pérez
- Department of Internal Medicine, Civil Hospital of Guadalajara Fray Antonio Alcalde, University Center of Health Sciences, University of Guadalajara, Guadalajara, Jalisco. México
| | - Guillermo Alonso Cevantes-Cardona
- Department of Philosophical, Methodological and Instrumental Disciplines, University Center of Health Sciences, University of Guadalajara, Guadalajara, Jalisco, México
| | | | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Specialties Hospital of the National Medical Center of the West, Mexican Institute of Social Security, Guadalajara, Jalisco, México.
| |
Collapse
|
8
|
Naseri Alavi SA, Kobets AJ, Rezakhah A, Habibi MA, Rezvani K, Emami Sigaroudi F. Can Neutrophil to Lymphocyte Ratio Predict Early Outcome in Patients with Spinal Cord Injury? World Neurosurg 2023; 180:e243-e249. [PMID: 37741330 DOI: 10.1016/j.wneu.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Spinal cord injury is a frequent debilitating neurologic condition with increasing prevalence and related morbidity over the last decades. The neutrophil-to-lymphocyte ratio is a promising biomarker for determining different medical conditions' disease course and outcome such as traumatic brain injury (TBI). This study aimed to investigate the predictive value of neutrophil to lymphocyte ratio (NLR) in the outcome of SCI. METHOD In a retrospective cross-sectional study from April 2019 to April 2022, all patients 18 to 65 years old, following spinal cord injury who were referred to Imam Khomeini Hospital and met inclusion and exclusion criteria enrolled in the study. A checklist including demographic data, lab, and clinical findings at admission, 24h, 48 h, and discharge were recorded. IBM SPSS Statistics software was used to analyze the data. A P-value of less than 0.05 was considered significant. RESULTS Six hundred patients met our inclusion criteria and enrolled in the study. The mean age of the patients was 40.93 ± 12.77, with 75% male and 25% female. There was a significant correlation between the N/L ratio at different time points (p.value=0.001), injury type, and ASIA score at admission and discharge (0.001). Furthermore, the NLR had approached significant value alone to predict outcomes in patients enrolled in the study (0.06). CONCLUSIONS A high NLR is unequivocally linked with poor outcomes in patients suffering from acute SCI and should be considered a negative prognostic factor; however, the NLR had approached significant predicting value in patients enrolled in the study.
Collapse
Affiliation(s)
| | - Andrew J Kobets
- Department of Neurological Surgery, Montefiore Medical, Bronx, New York, USA
| | - Amir Rezakhah
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Amin Habibi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| | - Khashayar Rezvani
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran
| | | |
Collapse
|
9
|
Zhou W, Liu Y, Wang Z, Mao Z, Li M. Serum glucose/potassium ratio as a clinical risk factor for predicting the severity and prognosis of acute traumatic spinal cord injury. BMC Musculoskelet Disord 2023; 24:870. [PMID: 37946195 PMCID: PMC10633987 DOI: 10.1186/s12891-023-07013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Acute traumatic Spinal cord injury (TSCI) is a devastating event that causes severe sensory and motor impairments as well as autonomic dysfunction in patients, yet relevant clinical biomarkers have not been established. This study aimed to determine the significance of the serum glucose/potassium ratio (GPR) in evaluating TSCI severity and predicting prognosis. METHODS An analysis of 520 clinical records of acute TSCI patients from January 2012 to June 2022 was conducted. The relationships between serum GPR and The American Spinal Injury Association Impairment Scale (AIS) grade 6-month post-trauma prognosis and the admission AIS grade were analyzed. To evaluate the discriminatory ability, a receiver operating characteristic curve (ROC) analysis was used. All methods were performed in accordance with the relevant guidelines and regulations. RESULTS Based on the initial assessment of AIS grade, 256 (49.2%) patients were categorized into the severe TSCI group (AIS A-B), and there was a significant correlation between the severe TSCI group and serum GPR (p < 0.001). Serum GPR was reduced in an AIS grade-dependent manner (R = - 0.540, p < 0.001). Of the 520 patients, 262 (50.4%) patients were classified as having a poor prognosis according to the AIS grade at discharge. Serum GPR was also reduced in an AIS grade at discharge-dependent manner (R = - 0.599, p < 0.001), and was significantly higher in the poor prognosis group compared to the good prognosis group (p < 0.001). Poor prognosis was significantly associated with sex (p = 0.009), severity of TSCI (p < 0.001), location of TSCI (p < 0.001), surgical decompression (p < 0.018), body temperature (p < 0.001), heart rate (p < 0.001), systolic arterial pressure (SAP) (p < 0.001), diastolic arterial pressure (DAP) (p < 0.001), serum GPR (p < 0.001), serum glucose (p < 0.001), serum potassium (p < 0.001), and white blood cell count (p = 0.003). Multivariate logistic regression analysis showed a significant correlation between poor prognosis and serum GPR (p = 0.023). The ROC analysis showed the area under the curve of serum GPR to be a poor predictor of prognosis in TSCI patients at 0.842 (95% confidence interval, 0.808-0.875). CONCLUSION There was a significant relationship between serum GPR and admission injury severity and the 6-month prognosis of acute TSCI patients. Serum GPR serves as a readily available clinical risk factor for predicting the severity and 6-month prognosis of acute traumatic spinal cord injury, which holds potential clinical significance for patients with TSCI.
Collapse
Affiliation(s)
- Wu Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, China
| | - Yihao Liu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, China
| | - Zhihua Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, China
| | - Zelu Mao
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, China
| | - Meihua Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, China.
| |
Collapse
|
10
|
Ding Y, Jiang X, Li L, Dai Q, Tao L, Liu J, Li Z, Wang J, Liao C, Gao X. Effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injury. Medicine (Baltimore) 2023; 102:e35102. [PMID: 37747020 PMCID: PMC10519484 DOI: 10.1097/md.0000000000035102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/17/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
This study evaluated the effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injuries (SCIs). A total of 214 patients with SCIs treated in our hospital from October 2019 to October 2021 were included in the retrospective analysis and divided into a general care group (n = 107) and a comprehensive care group (n = 107), based on the care that they received. Patients in the general care group received general functional nursing, whereas those in the comprehensive care group received a comprehensive functional nursing intervention. The Rivermead Mobility Index (RMI), Barthel Index (BI), and Berg Balance Score (BBS) were used to evaluate patient neurobehavioral ability before and after nursing. Changes in cardiopulmonary function indexes, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), vital capacity (VC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and maximal voluntary ventilation (MVV) were measured before and after nursing. The number of micturition, maximum micturition volume, bladder volume, residual urine volume, and lower urinary tract symptom (LUTS) score were recorded, and the improvement in bladder function were measured before and after nursing. The Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores were used to evaluate patients' emotional state. After nursing, the RMI, BI, BBS score, FEV1, FEV1/FVC, MVV, maximum micturition volume, bladder volume, and SF-36 scores of the comprehensive care group were significantly higher than those of the general care group, and the LVEDD, LVESD, micturition time, residual urine volume, and LUTS, HAMA, and BDI scores of the comprehensive care group were significantly lower than those of the general care group. In patients with SCIs, comprehensive functional nursing can promote the recovery of neurocognition, bladder function, and cardiorespiratory function, and improve their quality of life. Comprehensive functional nursing is worthy of clinical application.
Collapse
Affiliation(s)
- Yang Ding
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xixuan Jiang
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lunlan Li
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qing Dai
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lei Tao
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhen Li
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing Wang
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chenxia Liao
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xin Gao
- Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
11
|
Zhang Q, Zhang S, Chen H, Chen G, Cui C, Zhang J, Wang W, Zhang Q, Guo S. Targeting of MALT1 May Improve Functional Recovery and Attenuate Microglia M1 Polarization-Mediated Neuroinflammation During Spinal Cord Injury. Mol Neurobiol 2023; 60:2632-2643. [PMID: 36692707 DOI: 10.1007/s12035-023-03208-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) is involved in neural injury, neuroinflammation, microglia activation, and polarization, while its function in spinal cord injury (SCI) remains unclear. Thus, this study aimed to evaluate the role of MALT1 modification on SCI recovery and its underlying mechanism. SCI surgery or sham surgery was performed in Sprague-Dawley rats. Then, MALT1 knockdown or negative control lentivirus was injected into SCI rats. Subsequently, MALT1 expression, locomotor capability, neural injury, markers for microglia activation and polarization, inflammatory cytokine expressions, and nuclear factor (NF)-κB pathway were detected. SCI rats exhibited higher MALT1 expression, microglia activation and M1 polarization, neuroinflammation, and NF-κB pathway activation, while worse locomotor capacity compared to sham rats (all P < 0.05). In SCI rats, MALT1 knockdown alleviated Basso, Beattie, and Bresnahan score from 10 to 28 days and attenuated HE staining reflected neural injury (all P < 0.05). Besides, MALT1 knockdown declined the number of IBA1+ cells, IBA1+ iNOS+ cells, and IBA1+ CD86+ cells, while enhanced the number of IBA1+ Arg1+ cells and IBA1+ CD206+ cells in SCI rats (all P < 0.05). Meanwhile, MALT1 knockdown declined the expressions of IL-1β, IL-6, and TNF-α in SCI (all P < 0.05), but did not affect IL-10 expression (P > 0.05). Furthermore, MALT1 knockdown suppressed NF-κB pathway activation validated by immunofluorescence staining and western blot assays (all P < 0.05). MALT1 knockdown improves functional recovery, attenuates microglia activation, M1 polarization, and neuroinflammation via inhibiting NF-κB pathway in SCI.
Collapse
Affiliation(s)
- Qingping Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Xi'an Yanta West Road, Xi'an, 710061, Shaanxi, China.
- Department of Neurosurgery, The 6th Affiliated Hospital of Shenzhen University Medical School (Shenzhen Nanshan People's Hospital), No. 89 Taoyuan Road, Nanshan District, Shenzhen, 518052, Guangdong, China.
| | - Shitao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Xi'an Yanta West Road, Xi'an, 710061, Shaanxi, China
- Department of Neurosurgery, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, 710018, Shaanxi, China
| | - Hongquan Chen
- Department of Neurosurgery, Southern University of Science and Technology Hospital, Shenzhen, 518055, Guangdong, China
| | - Gang Chen
- Department of Spine, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Chunhong Cui
- Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Department of Biology and Academy for Advanced Interdisciplinary Studies, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China
| | - Junxin Zhang
- Department of Neurosurgery, Southern University of Science and Technology Hospital, Shenzhen, 518055, Guangdong, China
| | - Weiming Wang
- Department of Neurosurgery, Southern University of Science and Technology Hospital, Shenzhen, 518055, Guangdong, China
| | - Qinghua Zhang
- Department of Neurosurgery, The 6th Affiliated Hospital of Shenzhen University Medical School (Shenzhen Nanshan People's Hospital), No. 89 Taoyuan Road, Nanshan District, Shenzhen, 518052, Guangdong, China
| | - Shiwen Guo
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Xi'an Yanta West Road, Xi'an, 710061, Shaanxi, China.
| |
Collapse
|
12
|
Diagnostic and Predictive Value of Novel Inflammatory Markers of the Severity of Acute Traumatic Spinal Cord Injury: A Retrospective Study. World Neurosurg 2023; 171:e349-e354. [PMID: 36509325 DOI: 10.1016/j.wneu.2022.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In order to assess the relationships between the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio, and systemic immune inflammatory index (SII) and the American Spinal Injury Association Impairment Scale (AIS) grade in patients with acute traumatic spinal cord injury (TSCI). METHODS We retrospectively investigated 526 patients with acute traumatic spinal cord injury admitted to the First Affiliated Hospital of Nanchang University between January 2012 and December 2021, and for whom routine blood tests were performed within 8 hours of injury. To assess the degree of impairment in TSCI patients using the American Spinal Cord Injury Association Impairment Scale. The patients were divided into 2 groups according to AIS grade as follows: patients with an AIS grade of A-B (severe and critical TSCI, respectively) were distinguished from those with an AIS grade of C-E (minimal, mild, and moderate TSCI, respectively). The association between unfavorable outcomes and each indicator was examined separately through univariate logistic regression analysis. Correlations between variables and AIS grades were analyzed by Spearman's correlation test. The discriminative ability of predictive models was evaluated using the area under the curve. RESULTS The NLR, PLR, and SII were elevated in patients with spinal cord injury and exceeded the reference values in 95% of cases. The AIS grades were inversely correlated with the NLR, PLR, and SII. In the receiver operating characteristic curve analysis performed to confirm the utility of the NLR, PLR, and SII for predicting the AIS grade, the area under the curve values were 0.710 (95% confidence interval [CI], 0.666-0.755), 0.603 (95% CI, 0.554-0.651) and 0.638 (95% CI, 0.591-0.685), respectively. The optimal cut-off value for the NLR was 0.361 (sensitivity = 0.79, specificity = 0.57). CONCLUSIONS The analysis of changes in NLR, PLR, and SII as indicators of the novel systemic inflammatory can be an important complement to traditional methods for the assessment of severity and prognosis and the possible selection of patients for close monitoring. And, NLR showed higher diagnostic performance than PLR and SII.
Collapse
|
13
|
Li JL, Fu GQ, Wang YY, Bian MM, Xu YM, Zhang L, Chen YQ, Zhang N, Ding SQ, Wang R, Fang R, Tang J, Hu JG, Lü HZ. The polarization of microglia and infiltrated macrophages in the injured mice spinal cords: a dynamic analysis. PeerJ 2023; 11:e14929. [PMID: 36846458 PMCID: PMC9951800 DOI: 10.7717/peerj.14929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
Background Following spinal cord injury (SCI), a large number of peripheral monocytes infiltrate into the lesion area and differentiate into macrophages (Mø). These monocyte-derived Mø are very difficult to distinguish from the local activated microglia (MG). Therefore, the term Mø/MG are often used to define the infiltrated Mø and/or activated MG. It has been recognized that pro-inflammatory M1-type Mø/MG play "bad" roles in the SCI pathology. Our recent research showed that local M1 cells are mainly CD45-/lowCD68+CD11b+ in the subacute stage of SCI. Thus, we speculated that the M1 cells in injured spinal cords mainly derived from MG rather than infiltrating Mø. So far, their dynamics following SCI are not yet entirely clear. Methods Female C57BL/6 mice were used to establish SCI model, using an Infinite Horizon impactor with a 1.3 mm diameter rod and a 50 Kdynes force. Sham-operated (sham) mice only underwent laminectomy without contusion. Flow cytometry and immunohistofluorescence were combined to analyze the dynamic changes of polarized Mø and MG in the acute (1 day), subacute (3, 7 and 14 days) and chronic (21 and 28 days) phases of SCI. Results The total Mø/MG gradually increased and peaked at 7 days post-injury (dpi), and maintained at high levels 14, 21 and 28 dpi. Most of the Mø/MG were activated, and the Mø increased significantly at 1 and 3 dpi. However, with the pathological process, activated MG increased nearly to 90% at 7, 14, 21 and 28 dpi. Both M1 and M2 Mø were increased significantly at 1 and 3 dpi. However, they decreased to very low levels from 7 to 28 dpi. On the contrary, the M2-type MG decreased significantly following SCI and maintained at a low level during the pathological process.
Collapse
Affiliation(s)
- Jing-Lu Li
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Gui-Qiang Fu
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yang-Yang Wang
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Ming-Ming Bian
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yao-Mei Xu
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Lin Zhang
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yu-Qing Chen
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Nan Zhang
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Shu-Qin Ding
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Rui Wang
- Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Rui Fang
- Department of Clinical Medical, Bengbu Medical College, Bengbu, China
| | - Jie Tang
- Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Jian-Guo Hu
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - He-Zuo Lü
- Clinical Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Anhui Key Laboratory of Tissue Transplantation, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| |
Collapse
|
14
|
Spinal Cord Injury AIS Predictions Using Machine Learning. eNeuro 2023; 10:ENEURO.0149-22.2022. [PMID: 36543536 PMCID: PMC9831144 DOI: 10.1523/eneuro.0149-22.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 10/21/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
The study used machine learning to predict The American Spinal Injury Association Impairment Scale (AIS) scores for newly injured spinal cord injury patients at hospital discharge time from hospital admission data. Additionally, machine learning was used to analyze the best model for feature importance to validate the criticality of the AIS score and highlight relevant demographic details. The data used for training machine learning models was from the National Spinal Cord Injury Statistical Center (NSCISC) database of U.S. spinal cord injury patient details. Eighteen real features were used from 417 provided features, which mapped to 53 machine learning features after processing. Eight models were tuned on the dataset to predict AIS scores, and Shapely analysis was performed to extract the most important of the 53 features. Patients within the NSCISC database who sustained injuries were between 1972 and 2016 after data cleaning (n = 20,790). Outcomes were test set multiclass accuracy and aggregated Shapely score magnitudes. Ridge Classifier was the best performer with 73.6% test set accuracy. AIS scores and neurologic category at the time of admission were the best predictors of recovery. Demographically, features were less important, but age, sex, marital status, and race stood out. AIS scores on admission are highly predictive of patient outcomes when combined with patient demographic data. Promising results in terms of predicting recovery were seen, and Shapely analysis allowed for the machine learning model to be probed as a whole, giving insight into overall feature trends.
Collapse
|
15
|
Vinit S, Michel-Flutot P, Mansart A, Fayssoil A. Effects of C2 hemisection on respiratory and cardiovascular functions in rats. Neural Regen Res 2023; 18:428-433. [PMID: 35900441 PMCID: PMC9396504 DOI: 10.4103/1673-5374.346469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
High cervical spinal cord injuries induce permanent neuromotor and autonomic deficits. These injuries impact both central respiratory and cardiovascular functions through modulation of the sympathetic nervous system. So far, cardiovascular studies have focused on models of complete contusion or transection at the lower cervical and thoracic levels and diaphragm activity evaluations using invasive methods. The present study aimed to evaluate the impact of C2 hemisection on different parameters representing vital functions (i.e., respiratory function, cardiovascular, and renal filtration parameters) at the moment of injury and 7 days post-injury in rats. No ventilatory parameters evaluated by plethysmography were impacted during quiet breathing after 7 days post-injury, whereas permanent diaphragm hemiplegia was observed by ultrasound and confirmed by diaphragmatic electromyography in anesthetized rats. Interestingly, the mean arterial pressure was reduced immediately after C2 hemisection, with complete compensation at 7 days post-injury. Renal filtration was unaffected at 7 days post-injury; however, remnant systolic dysfunction characterized by a reduced left ventricular ejection fraction persisted at 7 days post-injury. Taken together, these results demonstrated that following C2 hemisection, diaphragm activity and systolic function are impacted up to 7 days post-injury, whereas the respiratory and cardiovascular systems display vast adaptation to maintain ventilatory parameters and blood pressure homeostasis, with the latter likely sustained by the remaining descending sympathetic inputs spared by the initial injury. A better broad characterization of the physiopathology of high cervical spinal cord injuries covering a longer time period post-injury could be beneficial for understanding evaluations of putative therapeutics to further increase cardiorespiratory recovery.
Collapse
|
16
|
Szymoniuk M, Litak J, Sakwa L, Dryla A, Zezuliński W, Czyżewski W, Kamieniak P, Blicharski T. Molecular Mechanisms and Clinical Application of Multipotent Stem Cells for Spinal Cord Injury. Cells 2022; 12:120. [PMID: 36611914 PMCID: PMC9818156 DOI: 10.3390/cells12010120] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Spinal Cord Injury (SCI) is a common neurological disorder with devastating psychical and psychosocial sequelae. The majority of patients after SCI suffer from permanent disability caused by motor dysfunction, impaired sensation, neuropathic pain, spasticity as well as urinary complications, and a small number of patients experience a complete recovery. Current standard treatment modalities of the SCI aim to prevent secondary injury and provide limited recovery of lost neurological functions. Stem Cell Therapy (SCT) represents an emerging treatment approach using the differentiation, paracrine, and self-renewal capabilities of stem cells to regenerate the injured spinal cord. To date, multipotent stem cells including mesenchymal stem cells (MSCs), neural stem cells (NSCs), and hematopoietic stem cells (HSCs) represent the most investigated types of stem cells for the treatment of SCI in preclinical and clinical studies. The microenvironment of SCI has a significant impact on the survival, proliferation, and differentiation of transplanted stem cells. Therefore, a deep understanding of the pathophysiology of SCI and molecular mechanisms through which stem cells act may help improve the treatment efficacy of SCT and find new therapeutic approaches such as stem-cell-derived exosomes, gene-modified stem cells, scaffolds, and nanomaterials. In this literature review, the pathogenesis of SCI and molecular mechanisms of action of multipotent stem cells including MSCs, NSCs, and HSCs are comprehensively described. Moreover, the clinical efficacy of multipotent stem cells in SCI treatment, an optimal protocol of stem cell administration, and recent therapeutic approaches based on or combined with SCT are also discussed.
Collapse
Affiliation(s)
- Michał Szymoniuk
- Student Scientific Association at the Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Jakub Litak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
- Department of Clinical Immunology, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland
| | - Leon Sakwa
- Student Scientific Society, Kazimierz Pulaski University of Technologies and Humanities in Radom, Chrobrego 27, 26-600 Radom, Poland
| | - Aleksandra Dryla
- Student Scientific Association at the Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Wojciech Zezuliński
- Student Scientific Association at the Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Wojciech Czyżewski
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4, 20-093 Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Blicharski
- Department of Rehabilitation and Orthopaedics, Medical University in Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| |
Collapse
|
17
|
Liu C, Liu Y, Ma B, Zhou M, Zhao X, Fu X, Kan S, Hu W, Zhu R. Mitochondrial regulatory mechanisms in spinal cord injury: A narrative review. Medicine (Baltimore) 2022; 101:e31930. [PMID: 36401438 PMCID: PMC9678589 DOI: 10.1097/md.0000000000031930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Spinal cord injury is a severe central nervous system injury that results in the permanent loss of motor, sensory, and autonomic functions below the level of injury with limited recovery. The pathological process of spinal cord injury includes primary and secondary injuries, characterized by a progressive cascade. Secondary injury impairs the ability of the mitochondria to maintain homeostasis and leads to calcium overload, excitotoxicity, and oxidative stress, further exacerbating the injury. The defective mitochondrial function observed in these pathologies accelerates neuronal cell death and inhibits regeneration. Treatment of spinal cord injury by preserving mitochondrial biological function is a promising, although still underexplored, therapeutic strategy. This review aimed to explore mitochondrial-based therapeutic advances after spinal cord injury. Specifically, it briefly describes the characteristics of spinal cord injury. It then broadly discusses the drugs used to protect the mitochondria (e.g., cyclosporine A, acetyl-L-carnitine, and alpha-tocopherol), phenomena associated with mitochondrial damage processes (e.g., mitophagy, ferroptosis, and cuproptosis), mitochondrial transplantation for nerve cell regeneration, and innovative mitochondrial combined protection therapy.
Collapse
Affiliation(s)
- Chengjiang Liu
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Yidong Liu
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Boyuan Ma
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Mengmeng Zhou
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Xinyan Zhao
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Xuanhao Fu
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Shunli Kan
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Wei Hu
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
| | - Rusen Zhu
- Department of Spine Surgery, Tianjin Union Medical Center Tianjin, Tianjin, China
- *Correspondence: Rusen Zhu, Department of Spine Surgery, Tianjin Union Medical Center190jieyuan Road, Honggiao District, Tianjin 300121, China (e-mail: )
| |
Collapse
|
18
|
Intraoperative Sensory Signals Predict Prognosis for Patients with Traumatic Cervical Spinal Cord Injury. World Neurosurg 2022; 168:e393-e398. [DOI: 10.1016/j.wneu.2022.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
|
19
|
Lampart P, Schäppi L, Langewitz WA, Rubinelli S, Sigrist-Nix D, Scheel-Sailer A. Health care professionals’ experiences with goal setting during initial rehabilitation after newly acquired spinal cord injury/ disorder – a qualitative focus group study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:982321. [PMID: 36189066 PMCID: PMC9397958 DOI: 10.3389/fresc.2022.982321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022]
Abstract
IntroductionGoal setting (GS) is an important aspect of initial spinal cord injury/ disorder (SCI/D) rehabilitation. However, because expected outcomes are individual and often difficult to determine, GS is not straightforward. The aim of this study was to explore the health care professionals' (HCP's) experiences with and perspectives on the goal-setting process (GSP) during initial SCI/D rehabilitation.MethodFive semi-structured focus groups (FG) (22 purposively sampled HCP, mostly in leadership positions, six different professions). The FG were transcribed verbatim. We analyzed the transcripts for qualitative content analysis following Braun and Clarke (2013).ResultsHCP described GS-influencing aspects at the macro, meso and micro levels. At the macro level, participants spoke about restrictions imposed by health insurers or difficulties in planning the post-inpatient setting. Regarding the meso level, HCP spoke of institutional structures and culture that facilitated the GSP. At the micro level, knowledge of the diagnosis, expected outcomes, and individual patient characteristics were mentioned as important to the rehabilitation process. It was important for HCP to be patient and empathetic, to endure negative emotions, to accept that patients need time to adjust to their new situation, and to ensure that they do not lose hope. Open communication and interprofessional collaboration helped overcome barriers in the GSP.DiscussionThis paper shows the complex relationship between external (e.g., health insurers), emotional, and communication aspects. It calls for a comprehensive approach to optimizing the GSP, so that patients' experiences can be fully considered as a basis to identify the most appropriate care pathway.
Collapse
Affiliation(s)
- Patricia Lampart
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Livia Schäppi
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
20
|
Bertoglio D, Halloin N, Lombaerde SD, Jankovski A, Verhaeghe J, Nicaise C, Staelens S. SV2A PET Imaging Is a Noninvasive Marker for the Detection of Spinal Damage in Experimental Models of Spinal Cord Injury. J Nucl Med 2022; 63:1245-1251. [PMID: 35027368 PMCID: PMC9364338 DOI: 10.2967/jnumed.121.263222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a neurologic condition characterized by long-term motor and sensory neurologic deficits as a consequence of an external physical impact damaging the spinal cord. Anatomic MRI is considered the gold-standard diagnostic tool to obtain structural information for the prognosis of acute SCI; however, it lacks functional objective information to assess SCI progression and recovery. In this study, we explored the use of synaptic vesicle glycoprotein 2A (SV2A) PET imaging to detect spinal cord lesions noninvasively after SCI. Methods: Mice (n = 7) and rats (n = 8) subjected to unilateral moderate cervical (C5) contusion were euthanized 1 wk after SCI for histologic and autoradiographic (3H-labeled (4R)-1-[(3-methylpyridin-4-yl)methyl]-4-(3,4,5-trifluorophenyl)pyrrolidin-2-one [UCB-J]) investigation of SV2A levels. Longitudinal 11C-UCB-J PET/CT imaging was performed in sham (n = 7) and SCI rats (n = 8) 1 wk and 6 wk after SCI. Animals also underwent an 18F-FDG PET scan during the latter time point. Postmortem tissue SV2A analysis to corroborate in vivo PET findings was performed 6 wk after SCI. Results: A significant SV2A loss (ranging from -70.3% to -87.3%; P < 0.0001) was measured at the epicenter of the impact in vitro in both mouse and rat contusion SCI models. Longitudinal 11C-UCB-J PET imaging detected SV2A loss in SCI rats (-49.0% ± 8.1% at 1 wk and -52.0% ± 12.9% at 6 wk after SCI), with no change observed in sham rats. In contrast, 18F-FDG PET imaging measured only subtle hypometabolism (-17.6% ± 14.7%). Finally, postmortem 3H-UCB-J autoradiography correlated with the in vivo SV2A PET findings (r = 0.92, P < 0.0001). Conclusion:11C-UCB-J PET/CT imaging is a noninvasive marker for SV2A loss after SCI. Collectively, these findings indicate that SV2A PET may provide an objective measure of SCI and thus represent a valuable tool to evaluate novel therapeutics. Clinical assessment of SCI with SV2A PET imaging is highly recommended.
Collapse
Affiliation(s)
- Daniele Bertoglio
- Molecular Imaging Center Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Stef De Lombaerde
- Molecular Imaging Center Antwerp, University of Antwerp, Antwerp, Belgium;,Department of Nuclear Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Aleksandar Jankovski
- Institute of NeuroScience, NEUR Division, Université Catholique de Louvain, Louvain, Belgium; and,Department of Neurosurgery, CHU UCL Namur, Yvoir, Belgium
| | - Jeroen Verhaeghe
- Molecular Imaging Center Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Steven Staelens
- Molecular Imaging Center Antwerp, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
21
|
Gao X, Gong Y, Zhang B, Hao D, He B, Yan L. Factors for Predicting Instant Neurological Recovery of Patients with Motor Complete Traumatic Spinal Cord Injury. J Clin Med 2022; 11:jcm11144086. [PMID: 35887845 PMCID: PMC9319428 DOI: 10.3390/jcm11144086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
The objective of this study was to analyze the factors affecting the instant recovery of neurological function in patients with motor complete traumatic spinal cord injury (TSCI) treated in hospital. Methods: A retrospective analysis of 1053 patients with TSCI classified according to the American Spinal Cord Injury Association (ASIA) as grades A and B at 59 tertiary hospitals from 1 January 2018 to 31 December 2018 was performed. All patients were classified into motor complete injury (ASIA A or B) and motor incomplete injury (ASIA C or D) groups, according to the ASIA upon discharge. The injury level, fracture segment, fracture type, ASIA score at admission and discharge, treatment protocol, and complications were recorded. Univariate and multivariate analyses were performed to evaluate the relationship between various factors and the recovery of neurological function. Results: The results of multiple logistic regression analysis revealed that the ASIA score on admission (p < 0.001, odds ratio (OR) = 5.722, 95% confidence interval (CI): 4.147−7.895), fracture or dislocation (p = 0.001, OR = 0.523, 95% CI: 0.357−0.767), treatment protocol (p < 0.001; OR = 2.664, 95% CI: 1.689−4.203), and inpatient rehabilitation (p < 0.001, OR = 2.089, 95% CI: 1.501−2.909) were independently associated with the recovery of neurological function. Conclusion: The recovery of neurological function is dependent on the ASIA score on admission, fracture or dislocation, treatment protocol, and inpatient rehabilitation.
Collapse
Affiliation(s)
- Xiangcheng Gao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Medical College, Yan’an University, Yan’an 716000, China
| | - Yining Gong
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Bo Zhang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Medical College, Yan’an University, Yan’an 716000, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Correspondence:
| |
Collapse
|
22
|
Shen X, Lou X, Shao W, Li Z, Wu Y, Lu S. Gait regulation of hindlimb based on central pattern generator in rats with a spinal cord injury. Proc Inst Mech Eng H 2022; 236:979-987. [DOI: 10.1177/09544119221095341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A spinal stimulator that can regulate hindlimb movements using monopolar stimulation has not been developed yet. Nevertheless, in a previous study, we found a specific central pattern generator site on the right side of the rat spinal cord. By stimulating these sites with certain pulse signals, the alternating movement of the hindlimb can be obtained using fewer electrodes. Therefore, in this research, considering the specific central pattern generator site as the target, functional electrical stimulation was performed on rats with spinal cord injury using monopolar stimulation. Angle sensors were used to track and capture the knee joint angle data of the right hindlimb; thus, the mapping relationship between the voltage amplitude and the knee angle parameters was established. Based on this relationship, the rats’ hindlimb were controlled. Compared with the traditional spinal stimulator, the proposed approach increases the gait feedback, requires fewer electrodes, and simplifies the timing of stimulation. The rats with spinal cord injury were subjected to stimulation training for half an hour every day for 28 consecutive days. The Basso, Beattie and Bresnahan score showed that 76% of the health level could be achieved on the 28th day. Finally, somatosensory evoked potential analysis showed that the measurement results were close to the standard value on the 28th day. This study lays a foundation for future rehabilitation research on the hindlimb.
Collapse
Affiliation(s)
- Xiaoyan Shen
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
- Nantong Research Institute for Advanced Communication Technologies, Jiangsu, P.R. China
| | - Xiongjie Lou
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Wei Shao
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Zhiling Li
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Yan Wu
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Song Lu
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| |
Collapse
|
23
|
Surface EMG in Subacute and Chronic Care after Traumatic Spinal Cord Injuries. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Traumatic spinal cord injury (SCI) is a devastating condition commonly originating from motor vehicle accidents or falls. Trauma care after SCI is challenging; after decompression surgery and spine stabilization, the first step is to assess the location and severity of the traumatic lesion. For this, clinical outcome measures are used to quantify the residual sensation and volitional control of muscles below the level of injury. These clinical assessments are important for decision-making, including the prediction of the recovery potential of individuals after the SCI. In clinical care, this quantification is usually performed using sensation and motor scores, a semi-quantitative measurement, alongside the binary classification of the sacral sparing (yes/no). Objective: In this perspective article, I review the use of surface EMG (sEMG) as a quantitative outcome measurement in subacute and chronic trauma care after SCI. Methods: Here, I revisit the main findings of two comprehensive scoping reviews recently published by our team on this topic. I offer a perspective on the combined findings of these scoping reviews, which integrate the changes in sEMG with SCI and the use of sEMG in neurorehabilitation after SCI. Results: sEMG provides a complimentary assessment to quantify the residual control of muscles with great sensitivity and detail compared to the traditional clinical assessments. Our scoping reviews unveiled the ability of the sEMG assessment to detect discomplete lesions (muscles with absent motor scores but present sEMG). Moreover, sEMG is able to measure the spontaneous activity of motor units at rest, and during passive maneuvers, the evoked responses with sensory or motor stimulation, and the integrity of the spinal cord and descending tracts with motor evoked potentials. This greatly complements the diagnostics of the SCI in the subacute phase of trauma care and deepens our understanding of neurorehabilitation strategies during the chronic phase of the traumatic injury. Conclusions: sEMG offers important insights into the neurophysiological factors underlying sensorimotor impairment and recovery after SCIs. Although several qualitative or semi-quantitative outcome measures determine the level of injury and the natural recovery after SCIs, using quantitative measures such as sEMG is promising. Nonetheless, there are still several barriers limiting the use of sEMG in the clinical environment and a need to advance high-density sEMG technology.
Collapse
|
24
|
Jiang T, He Y. Recent Advances in the Role of Nuclear Factor Erythroid-2-Related Factor 2 in Spinal Cord Injury: Regulatory Mechanisms and Therapeutic Options. Front Aging Neurosci 2022; 14:851257. [PMID: 35754957 PMCID: PMC9226435 DOI: 10.3389/fnagi.2022.851257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/09/2022] [Indexed: 01/09/2023] Open
Abstract
Nuclear factor erythroid-2-related factor 2 (Nrf2) is a pleiotropic transcription factor, and it has been documented that it can induce defense mechanisms both oxidative stress and inflammatory injury. At present, more and more evidences show that the Nrf2 signaling pathway is a key pharmacological target for the treatment of spinal cord injury (SCI), and activating the Nrf2 signaling pathway can effectively treat the inflammatory injury and oxidative stress after SCI. This article firstly introduces the biological studies of the Nrf2 pathway. Meanwhile, it is more powerful to explain that activating the Nrf2 signaling pathway can effectively treat SCI by deeply exploring the relationship between Nrf2 and oxidative stress, inflammatory injury, and SCI. In addition, several potential drugs for the treatment of SCI by promoting Nrf2 activation and Nrf2-dependent gene expression are reviewed. And some other treatment strategies of SCI by modulating the Nrf2 pathway are also summarized. It will provide new ideas and directions for the treatment of SCI.
Collapse
Affiliation(s)
- Tianqi Jiang
- Graduate School of Inner Mongolia Medical University, Hohhot, China,Spine Surgery, Inner Mongolia People’s Hospital, Hohhot, China
| | - Yongxiong He
- Spine Surgery, Inner Mongolia People’s Hospital, Hohhot, China,*Correspondence: Yongxiong He,
| |
Collapse
|
25
|
Mainard N, Tsiakaka O, Li S, Denoulet J, Messaoudene K, Vialle R, Feruglio S. Intraoperative Optical Monitoring of Spinal Cord Hemodynamics Using Multiwavelength Imaging System. SENSORS (BASEL, SWITZERLAND) 2022; 22:3840. [PMID: 35632249 PMCID: PMC9146887 DOI: 10.3390/s22103840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/10/2022]
Abstract
The spinal cord is a major structure of the central nervous system allowing, among other things, the transmission of afferent sensory and efferent motor information. During spinal surgery, such as scoliosis correction, this structure can be damaged, resulting in major neurological damage to the patient. To date, there is no direct way to monitor the oxygenation of the spinal cord intraoperatively to reflect its vitality. This is essential information that would allow surgeons to adapt their procedure in case of ischemic suffering of the spinal cord. We report the development of a specific device to monitor the functional status of biological tissues with high resolution. The device, operating with multiple wavelengths, uses Near-InfraRed Spectroscopy (NIRS) in combination with other additional sensors, including ElectroNeuroGraphy (ENG). In this paper, we focused primarily on aspects of the PhotoPlethysmoGram (PPG), emanating from four different light sources to show in real time and record biological signals from the spinal cord in transmission and reflection modes. This multispectral system was successfully tested in in vivo experiments on the spinal cord of a pig for specific medical applications.
Collapse
Affiliation(s)
- Nicolas Mainard
- Department of Pediatric Surgery, Jeanne-de-Flandre Hospital, CHU Lille, Avenue Eugène-Avinée, 59000 Lille, France
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Olivier Tsiakaka
- CERVO, Biomedical Microsystems Laboratory, Université Laval, Quebec, QC G1V 0A6, Canada;
| | - Songlin Li
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Julien Denoulet
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Karim Messaoudene
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Raphael Vialle
- Clinical Research Group “RIC” Robotics and Surgical Innovations, GRC-33 Sorbonne University, 26 Avenue du Dr. Arnold Netter, 75012 Paris, France;
| | - Sylvain Feruglio
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| |
Collapse
|
26
|
Miclau TA, Torres-Espín A, Morshed S, Morioka K, Huie JR, El Naga A, Chou A, Pascual L, Duong Fernandez X, Kuo YH, Weinstein P, Dhall S, Bresnahan JC, Beattie MS, DiGiorgio AM, Ferguson AR. Appendicular fracture and polytrauma correlate with outcome of spinal cord injury (SCI): A TRACK-SCI study. J Neurotrauma 2022; 39:1030-1038. [PMID: 35255740 PMCID: PMC9536347 DOI: 10.1089/neu.2021.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injuries (SCIs) frequently occur in combination with other major organ injuries, such as traumatic brain injury (TBI) and injuries to the chest, abdomen, and musculoskeletal system (e.g., extremity, pelvic, and spine fractures). However, the effects of appendicular fractures on SCI recovery are poorly understood. We investigated whether the presence of SCI-concurrent appendicular fractures is predictive of a less robust SCI recovery. Patients enrolled in the Transforming Research And Clinical Knowledge in SCI (TRACK-SCI) prospective cohort study were identified and included in this secondary analysis study. Inclusion criteria resulted in 147 patients consisting of 120 isolated SCIs and 27 with concomitant appendicular fracture. The primary outcome was ASIA Impairment Scale (AIS) neurological grades at hospital discharge. Secondary outcomes included hospital length of stay, ICU length of stay, and AIS grade improvement during hospitalization. Multivariable binomial logistic regression analyses assessed whether SCI-concomitant appendicular fractures associate with SCI function and secondary outcomes. These analyses were adjusted for age, gender, injury severity, and non-fracture polytrauma. Appendicular fractures were associated with more severe AIS grades at hospital discharge, though covariate adjustments diminished statistical significance of this effect. Notably, non-fracture injuries to the chest and abdomen were influential covariates. Secondary analyses suggested that appendicular fractures also increased hospital length of stay. Our study indicated that SCI-associated polytrauma is important for predicting SCI functional outcomes. Further statistical evaluation is required to disentangle the effects of appendicular fractures, non-fracture solid organ injury, and SCI physiology to improve health outcomes amongst SCI patients.
Collapse
Affiliation(s)
- Theodore Andrew Miclau
- UCSF School of Medicine, 533 Parnassus Ave, San Francisco, California, United States, 94143;
| | - Abel Torres-Espín
- Universitat Autonoma de Barcelona, Cell Biology, Physiology and Immunology, and Institute of Neuroscience, Campus UAB, Campus UAB, Bellaterra, Barcelona, Spain, 082193;
| | - Saam Morshed
- University of California San Francisco, 8785, Orthopaedic Surgery, San Francisco, California, United States;
| | - Kazuhito Morioka
- University of California San Francisco, 8785, Orthopaedic Surgery, 2550 23rd Street, Bldg. 9, 3rd Floor, Room 346, San Francisco, California, United States, 941110.,University of California San Francisco, 8785, Neurological SUrgery, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, California, United States, 94143;
| | - J Russell Huie
- University of California San Francisco, Brain and Spinal Injury Center, Dept. of Neurological Surgery, 1001 Potrero Ave, San Francisco, California, United States, 94110.,United States;
| | - Ashraf El Naga
- University of California San Francisco, 8785, Orthopaedic Surgery, San Francisco, California, United States;
| | - Austin Chou
- University of California, San Francisco, 1001 Potrero Ave, Building 1, San Francisco, California, United States, 94110;
| | - Lisa Pascual
- University of California San Francisco, 8785, Orthopedic Surgery, 2550 23rd Street, Bldg. 9, 2nd Floor, San Francisco, California, United States, 94110;
| | - Xuan Duong Fernandez
- University of California San Francisco, 8785, Neurological Surgery, San Francisco, California, United States;
| | - Yu-Hung Kuo
- UCSF Fresno, 589388, Department of Neurological Surgery, Fresno, California, United States;
| | - Philip Weinstein
- University of California San Francisco, 8785, Neurological Surgery, San Francisco, California, United States;
| | - Sanjay Dhall
- University of California San Francisco, Neurological Surgery, San Francisco, California, United States;
| | - Jacqueline C Bresnahan
- UCSF, Neurological Surgery, 1001 Potrero Ave, San Francisco, California, United States, 94110;
| | - Michael S Beattie
- UCSF, BASIC, 1001 Potrero Ave, San Francisco, California, United States, 94110;
| | - Anthony Michael DiGiorgio
- University of California San Francisco, 8785, Neurological Surgery, 505 Parnassus Ave, San Francisco, San Francisco, California, United States, 94143;
| | - Adam R Ferguson
- UCSF, Brain and Spinal Injury Center, Dept Neurosurgery, 1001 Potrero Ave, 1001 Potrero Ave, San Francisco, California, United States, 94110;
| |
Collapse
|
27
|
Deng H, Luy DD, Abou-Al-Shaar H, Yue JK, Zinn PO, Puccio AM, Okonkwo DO. Critical care for concomitant severe traumatic brain injury and acute spinal cord injury in the polytrauma patient: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21521. [PMID: 36130580 PMCID: PMC9379735 DOI: 10.3171/case21521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
The occurrence of traumatic brain injury with spinal cord injury (SCI) in polytrauma patients is associated with significant morbidity. Clinicians face challenges from a decision-making and rehabilitative perspective. Management is complex and understudied. Treatment should be systematic beginning at the scene, focusing on airway resuscitation and hemodynamic stabilization, immobilization, and timely transport. Early operative interventions should be provided, followed by minimizing secondary pathophysiology. The authors present a case to delineate decision-making in the treatment of combined cranial and spinal trauma.
OBSERVATIONS
A 19-year-old man presented as a level I trauma patient after falling 30 feet as the result of scaffolding collapse. The patient was unresponsive and was intubated; he had an initial Glasgow Coma Scale score of 4. Computed tomography revealed multicompartmental bleeding and herniation, for which supra- and infratentorial decompressive craniectomies were performed. The patient also suffered from thoracic SCI that resulted in complete paraplegia. Multimodality monitoring was used. After stabilization and lengthy rehabilitation, the patient obtained significant functional improvement.
LESSONS
The approach to initial management of concomitant head and spine trauma is to establish intracranial stability followed by intraspinal stability. Patients can make considerable recovery, particularly younger patients, who are more likely to benefit from early aggressive interventions and medical treatment.
Collapse
Affiliation(s)
| | | | | | - John K. Yue
- Brain Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | | | - Ava M. Puccio
- Department of Neurological Surgery and
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - David O. Okonkwo
- Department of Neurological Surgery and
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| |
Collapse
|
28
|
Garnier-Villarreal M, Pinto D, Mummidisetty CK, Jayaraman A, Tefertiller C, Charlifue S, Taylor HB, Chang SH, McCombs N, Furbish CL, Field-Fote EC, Heinemann AW. Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy. Arch Phys Med Rehabil 2021; 103:665-675. [PMID: 34648804 DOI: 10.1016/j.apmr.2021.07.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.
Collapse
Affiliation(s)
| | - Daniel Pinto
- College of Health Sciences, Marquette University, Milwaukee, Wisconsin.
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Candy Tefertiller
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | - Susan Charlifue
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | | | - Shuo-Hsiu Chang
- UT Health Science Center at Houston, Houston, Texas; Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas
| | - Nicholas McCombs
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - Edelle C Field-Fote
- Shepherd Center, Atlanta, Georgia; Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Allen W Heinemann
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
29
|
Liu X, Zhang Y, Wang Y, Qian T. Inflammatory Response to Spinal Cord Injury and Its Treatment. World Neurosurg 2021; 155:19-31. [PMID: 34375779 DOI: 10.1016/j.wneu.2021.07.148] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 01/14/2023]
Abstract
Spinal cord injury (SCI), as one of the intractable diseases in clinical medicine, affects thousands of human beings, and the pathologic changes after injury have been a hot spot for exploration in clinical medicine. With the development of new treatments, the survival of patients has shown an increasing trend; however, the inflammatory response after injury has not yet been effectively controlled. SCI is divided into primary injury and secondary injury according to the time of injury and pathophysiologic changes. Primary injury occurs immediately and the damage to the injury site is irreversible; however, secondary injury occurs after primary injury and involves pathologic changes at the cellular and molecular levels, which are reversible. Thus, the inflammatory response from secondary injuries has become the main direction of research. In recent years, a complex pathophysiologic mechanism has gradually been unveiled, which has been followed by an upgrade of treatment methods. This article describes the mechanisms of the inflammatory response after SCI and the mainstream treatment modalities. Also, neuroprotective agents and nerve regeneration agent agents are commonly used in the treatment of SCI; the therapeutic mechanism and classification of these agents are reviewed.
Collapse
Affiliation(s)
- Xiangyu Liu
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Yiwen Zhang
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Yitong Wang
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Taibao Qian
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China.
| |
Collapse
|
30
|
Perrouin-Verbe B, Lefevre C, Kieny P, Gross R, Reiss B, Le Fort M. Spinal cord injury: A multisystem physiological impairment/dysfunction. Rev Neurol (Paris) 2021; 177:594-605. [PMID: 33931244 DOI: 10.1016/j.neurol.2021.02.385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
Spinal cord injury (SCI) is a complex disease that affects not only sensory and motor pathways below the neurological level of injury (NLI) but also all the organs and systems situated below this NLI. This multisystem impairment implies comprehensive management in dedicated SCI specialized centers, by interdisciplinary and multidisciplinary teams, able to treat not only the neurological impairment, but also all the systems and organs affected. After a brief history of the Spinal Cord Medicine, the author describes how to determine the level and severity of a SCI based on the International Standards for Neurological Classification of Spinal Cord Injury and the prognosis factors of recovery. This article provides also a review of the numerous SCI-related impairments (except for urinary, sexual problems and pain treated separately in this issue), their principles of management and related complications.
Collapse
Affiliation(s)
- B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France.
| | - C Lefevre
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - P Kieny
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - R Gross
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - B Reiss
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| | - M Le Fort
- Department of Neurological Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, 85, rue st Jacques, 44093 Nantes cedex 01, France
| |
Collapse
|
31
|
Rigot SK, Boninger ML, Ding D, McKernan G, Field-Fote EC, Hoffman J, Hibbs R, Worobey LA. Toward Improving the Prediction of Functional Ambulation After Spinal Cord Injury Though the Inclusion of Limb Accelerations During Sleep and Personal Factors. Arch Phys Med Rehabil 2021; 103:676-687.e6. [PMID: 33839107 DOI: 10.1016/j.apmr.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/21/2021] [Accepted: 02/07/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine if functional measures of ambulation can be accurately classified using clinical measures; demographics; personal, psychosocial, and environmental factors; and limb accelerations (LAs) obtained during sleep among individuals with chronic, motor incomplete spinal cord injury (SCI) in an effort to guide future, longitudinal predictions models. DESIGN Cross-sectional, 1-5 days of data collection. SETTING Community-based data collection. PARTICIPANTS Adults with chronic (>1 year), motor incomplete SCI (N=27). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Ambulatory ability based on the 10-m walk test (10MWT) or 6-minute walk test (6MWT) categorized as nonambulatory, household ambulator (0.01-0.44 m/s, 1-204 m), or community ambulator (>0.44 m/s, >204 m). A random forest model classified ambulatory ability using input features including clinical measures of strength, sensation, and spasticity; demographics; personal, psychosocial, and environmental factors including pain, environmental factors, health, social support, self-efficacy, resilience, and sleep quality; and LAs measured during sleep. Machine learning methods were used explicitly to avoid overfitting and minimize the possibility of biased results. RESULTS The combination of LA, clinical, and demographic features resulted in the highest classification accuracies for both functional ambulation outcomes (10MWT=70.4%, 6MWT=81.5%). Adding LAs, personal, psychosocial, and environmental factors, or both increased the accuracy of classification compared with the clinical/demographic features alone. Clinical measures of strength and sensation (especially knee flexion strength), LA measures of movement smoothness, and presence of pain and comorbidities were among the most important features selected for the models. CONCLUSIONS The addition of LA and personal, psychosocial, and environmental features increased functional ambulation classification accuracy in a population with incomplete SCI for whom improved prognosis for mobility outcomes is needed. These findings provide support for future longitudinal studies that use LA; personal, psychosocial, and environmental factors; and advanced analyses to improve clinical prediction rules for functional mobility outcomes.
Collapse
Affiliation(s)
- Stephanie K Rigot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Dan Ding
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Gina McKernan
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Edelle C Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, GA; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Jeanne Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Rachel Hibbs
- Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Lynn A Worobey
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
| |
Collapse
|