Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Enhanced inhibition of neuronal ferroptosis and regulation of microglial polarization with multifunctional traditional Chinese medicine active ingredients-based selenium nanoparticles for treating spinal cord injury

Spinal cord injury (SCI) is a devastating condition that results in the loss of sensory and motor functions. The complex pathogenesis of SCI contributes to the limited availability of effective therapies. Two major factors exacerbating secondary injury in SCI are neuronal ferroptosis and microglial inflammatory polarization. Tanshinone IIA (TSIIA) has demonstrated a significant anti-ferroptosis effect by inhibiting lipid peroxidation, while tetramethylpyrazine (TMP) exhibits remarkable anti-inflammatory properties by promoting the shift of microglial polarization from the M1 to the M2 phenotype. However, most drugs currently under development primarily target a single aspect of this multifaceted condition, which is insufficient for comprehensive treatment. Selenium nanoparticles have emerged as a promising therapeutic strategy due to their ability to encapsulate various agents, effectively targeting diverse pathophysiological mechanisms while offering favorable water solubility and low toxicity. In this study, we developed a novel nanocarrier functionalized with astragalus polysaccharide (APS) and loaded with TSIIA and TMP. Results from both in vitro and in vivo studies indicate that TSIIA/TMP/APS@Se NPs possess anti-ferroptosis properties and can regulate microglial polarization, potentially enhancing functional recovery following SCI. In summary, this study presents a promising alternative strategy for treating SCI, highlighting its significant potential for future clinical applications.

Association between biological aging and cardiovascular health: Combined evidence based on cross-sectional and prospective study

PURPOSE

To examine the relationship between biological aging metrics and cardiovascular health, as well as the mediating effect of sleep duration.

METHOD

We applied the recommended sampling weights to adjust for the complex survey design of NHANES. Using NHANES data, we first employed restricted cubic spline (RCS) and logistic regression models to explore the cross-sectional associations between biological aging metrics, defined by the Klemera-Doubal method biological age (KDM-BA), phenotypic age (PA), homeostatic dysregulation (HD), and allostatic load (AL), and the prevalence of cardiovascular diseases (CVD) and its subtypes. We then used Cox regression, Kaplan-Meier curves, and RCS models to assess the prospective associations between biological aging metrics and all-cause as well as CVD mortality. Further, ROC and DCA models were used to assess the predicting ability of 4 biological aging metrics to cardiovascular health.

RESULT

This study included 7,704 participants. We found that biological aging metrics were strongly linked to the prevalence of CVD and its subtypes, as well as to all-cause and CVD mortality. Sleep duration appeared to moderate these associations. Among the four biological aging metrics, PA was the most effective predictor of CVD prevalence and its subtypes, though none of the metrics accurately predicted mortality.

CONCLUSION

Biological aging metrics were significantly associated with cardiovascular health, while sleep duration may attenuate this relationship. Clinically, PA can be a potential predictor of cardiovascular health.

Pharmacological intervention for chronic phase of spinal cord injury

Spinal cord injury is an intractable traumatic injury. The most common hurdles faced during spinal cord injury are failure of axonal regrowth and reconnection to target sites. These also tend to be the most challenging issues in spinal cord injury. As spinal cord injury progresses to the chronic phase, lost motor and sensory functions are not recovered. Several reasons may be attributed to the failure of recovery from chronic spinal cord injury. These include factors that inhibit axonal growth such as activated astrocytes, chondroitin sulfate proteoglycan, myelin-associated proteins, inflammatory microglia, and fibroblasts that accumulate at lesion sites. Skeletal muscle atrophy due to denervation is another chronic and detrimental spinal cord injury-specific condition. Although several intervention strategies based on multiple outlooks have been attempted for treating spinal cord injury, few approaches have been successful. To treat chronic spinal cord injury, neural cells or tissue substitutes may need to be supplied in the cavity area to enable possible axonal growth. Additionally, stimulating axonal growth activity by extrinsic factors is extremely important and essential for maintaining the remaining host neurons and transplanted neurons. This review focuses on pharmacotherapeutic approaches using small compounds and proteins to enable axonal growth in chronic spinal cord injury. This review presents some of these candidates that have shown promising outcomes in basic research ( in vivo animal studies) and clinical trials: AA-NgR(310)ecto-Fc (AXER-204), fasudil, phosphatase and tensin homolog protein antagonist peptide 4, chondroitinase ABC, intracellular sigma peptide, (-)-epigallocatechin gallate, matrine, acteoside, pyrvate kinase M2, diosgenin, granulocyte-colony stimulating factor, and fampridine-sustained release. Although the current situation suggests that drug-based therapies to recover function in chronic spinal cord injury are limited, potential candidates have been identified through basic research, and these candidates may be subjects of clinical studies in the future. Moreover, cocktail therapy comprising drugs with varied underlying mechanisms may be effective in treating the refractory status of chronic spinal cord injury.

Graphene oxide scaffolds promote functional improvements mediated by scaffold-invading axons in thoracic transected rats

Millions of patients and their caretakers live and deal with the devastating consequences of spinal cord injury (SCI) worldwide. Despite outstanding advances in the field to both understand and tackle these pathologies, a cure for SCI patients, with their peculiar characteristics, is still a mirage. One of the most promising therapeutic strategies to date for these patients involves the use of epidural electrical stimulation. In this context, electrically active materials such as graphene and its derivates become particularly interesting. Indeed, solid evidence of their capacity to closely interact with neural cells and networks is growing. Encouraged by previous findings in our laboratory on the exploration of 3D porous reduced graphene oxide (rGO) scaffolds in chronic cervical hemisected rats (C6), herein we report their neuro-reparative properties when chronically implanted in complete transected rats (T9-T10), in which no preserved contralateral neural networks can assist in any observed recovery. Electrophysiological recordings from brainstem regions show antidromic activation of a small population of neurons in response to electrical stimulation caudal to the injury. These neurons are located in the Gigantocellular nucleus of reticular formation and vestibular nuclei, both regions directly related to motor functions. Together with histological features at the lesion site, such as more abundant and larger blood vessels and more abundant, longer and more homogeneously distributed axons, our results corroborate that rGO scaffolds create a permissive environment that allows the invasion of functional axonic processes from neurons located in brainstem nuclei with motor function in a rat model of complete thoracic transection. Additionally, behavioral tests evidence that these scaffolds play an important role in whole-body mechanical stabilization (postural control) proved by the absence of scoliosis, a higher trunk stability and a larger cervico-thoraco-lumbar movement range in rGO-implanted rats.

Advances in the Treatment of Spinal Cord Injury with Nanozymes

Spinal cord injury (SCI) with increasing incidence can lead to severe disability. The pathological process involves complex mechanisms such as oxidative stress, inflammation, and neuron apoptosis. Current treatment strategies focusing on the relief of oxidative stress and inflammation have achieved good effects, while many problems and challenges remain such as the side effect and short half-life of the therapeutic agents. Nanozymes exhibiting good biocatalytic activities can sustainably scavenge free radicals, inhibit neuroinflammation, and protect the neurons. With high stability in physiological conditions and cost-effectiveness, the nanozymes provide a new strategy for SCI treatment. In this Review, we outline the advances of nanozymes and their enzyme-mimicking activities and highlight the progress in the intervention of SCI-adopting nanozymes. We also propose future directions and clinical translation for the nanozyme strategy against SCI.

Metabolic Reprogramming in Spinal Cord Injury and Analysis of Potential Therapeutic Targets

Spinal cord injury (SCI) is a critical neurological disorder that frequently leads to permanent disability, profoundly affecting the quality of life of individuals with SCI. In this research, we examined the varied expression of genes associated with metabolic reprogramming-related genes in SCI. By employing the Gene Expression Omnibus datasets GSE5296 and GSE47681, 1001 differentially expressed genes (DEGs) were identified through the limma R package. Among these, 871 and 130 genes were upregulated and downregulated, respectively. A subset of 10 metabolic reprogramming-related differentially expressed genes (MRRDEGs) was recognized as key players in metabolic reprogramming. Analyses of enrichment performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes indicated that the identified MRRDEGs predominantly participated in processes related to pyruvate metabolism and carbohydrate degradation. Nine hub genes were discerned using a protein-protein interaction network. Subsequently, an SCI mouse model was established using the LISA SCI modeling device, and preliminary validation was conducted through quantitative real-time PCR experiments at various time points after SCI, specifically on days 1, 3, and 7, suggesting their central role in SCI. Receiver operating characteristic curve analysis indicated that these MRRDEGs could be used to diagnose SCI. The CIBERSORT algorithm analysis of immune infiltration identified an inverse relationship between M0 and M2 macrophages. Furthermore, a positive relationship was observed between Ucp2 and M0 macrophages, underscoring their essential function in the immune response following SCI. These results highlight MRRDEGs' importance in SCI and propose their potential roles as targets for therapeutic interventions.

Neuroprotective effect and possible mechanism of edaravone in rat models of spinal cord injury: a systematic review and network meta-analysis

Objective

The present review was developed to critically evaluate the neuroprotective effects of edaravone for experimental rat models of spinal cord injury (SCI) and generalize the possible mechanisms.

Methods

Systematic searches were carried out on databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library from their inception to March 2024. Controlled studies that assessed the neurological roles of edaravone on rats following SCI were selected. The Basso, Beattie, and Bresnahan (BBB) locomotor rating scale, residual white matter area, and malondialdehyde (MDA) level of the SCI rats were systematically searched by two reviewers.

Results

Ten eligible publications were included. Meta-analyses showed increased BBB scores in edaravone-treated rats compared with control ones. The effect size gradually increased from day 7 (seven studies, n = 246, weighted mean difference (WMD) = 1.96, 95% confidence interval (CI) = 1.23 to 2.68, P < 0.00001) to day 28 (seven studies, n = 222, WMD = 4.41, 95% CI = 3.19 to 5.63, P < 0.00001) after injury and then maintained stably in the following time. Meanwhile, edaravone treatment was associated with an amendment in the spared area of white matter and a lowering in the MDA expression in the lesion area. The subgroup analyses revealed that rats treated with edaravone exhibited superior locomotor recovery in compression injury models than contusion ones. In network analyses, the surface under the cumulative ranking curve gradually increased up to a dose of 5-6 mg/(kg·d) of edaravone, after which it plateaued. Mechanism analysis suggested edaravone can ameliorate oxidative stress, mitigate neuroinflammation, and counteract neuron apoptosis and ferroptosis via multiple signaling pathways to exert its neuroprotective effects.

Conclusion

Collectively, with a protective effect and a systematic action mechanism, edaravone warrants further investigation in SCI research and treatment. Nonetheless, in light of the limitations in the included studies, the findings in this review should be interpreted with caution.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42022374914.

An engineering-reinforced extracellular vesicle-integrated hydrogel with an ROS-responsive release pattern mitigates spinal cord injury

The local delivery of mesenchymal stem cell-derived extracellular vesicles (EVs) via hydrogel has emerged as an effective approach for spinal cord injury (SCI) treatment. However, achieving on-demand release of EVs from hydrogel to address dynamically changing pathology remains challenging. Here, we used a series of engineering methods to further enhance EVs' efficacy and optimize their release pattern from hydrogel. Specifically, the pro-angiogenic, neurotrophic, and anti-inflammatory effects of EVs were reinforced through three-dimensional culture and dexamethasone (Dxm) encapsulation. Then, the prepared Dxm-loaded 3EVs (3EVs-Dxm) were membrane modified with ortho-dihydroxy groups (-2OH) and formed an EV-integrated hydrogel (3EVs-Dxm-Gel) via the cross-link with phenylboronic acid-modified hyaluronic acid and tannic acid. The phenylboronic acid ester in 3EVs-Dxm-Gel enabled effective immobilization and reactive oxygen species-responsive release of EVs. Topical injection of 3EVs-Dxm-Gel in SCI rats notably mitigated injury severity and promoted functional recovery, which may offer opportunities for EV-based therapeutics in central nervous system injury.

Effects of virtual reality with different modalities on upper limb recovery: a systematic review and network meta-analysis on optimizing stroke rehabilitation

Background

As a major cause of disability worldwide, stroke affects about 80% of survivors with upper limb (UL) motor dysfunction, significantly impairing their quality of life. Virtual reality (VR) has been recognized as an innovative rehabilitation tool; however, the effectiveness of VR systems with different immersion modalities is still uncertain. This systematic review and network meta-analysis (NMA) aims to evaluate the comparative effectiveness of intervention measures, including non-immersive gaming consoles, immersive VR (IVR), non-immersive VR (NIVR), and conventional therapy (CT) on upper limb motor function in stroke rehabilitation.

Materials and methods

A systematic search of PubMed, Embase, Cochrane Library, and Scopus identified randomized controlled trials (RCTs) published up to 12 June 2024. UL motor recovery was assessed using the Fugl-Meyer Upper Extremity (FMUE) scale. The NMA was performed using the Bayesian approach with the BUGSnet package in R software to calculate the relative effectiveness of each intervention.

Results

34 RCTs involving 1,704 participants were included. Among non-immersive gaming systems, Microsoft Kinect demonstrated the greatest effective in enhancing UL motor function, followed by Nintendo Wii, then NIVR and IVR head-mounted devices. CT showed the least effective. Specifically, Microsoft Kinect significantly improved FMUE scores (mean difference [MD] = 7.27, 95% confidence interval [CI]: 0.59 to 13.77, p < 0.05), followed by Nintendo Wii (MD = 4.53, 95% CI: 0.87 to 8.14, p < 0.05), and NIVR (MD = 3.57, 95% CI: 1.18 to 6.01, p < 0.05). In contrast, IVR head-mounted devices showed no statistically significant differences in outcomes, with MD of 4.16 (95% CI: -0.02 to 8.38).

Conclusion

Non-immersive gaming console of Microsoft Kinect is the most effective intervention for improving UL motor function in stroke survivors. In contrast, IVR head-mounted devices did not offer significant advantages over CT. These findings suggest that non-immersive gaming consoles of Microsoft Kinect could be a more cost-effective and accessible alternative for stroke rehabilitation.

Exploring the role of parthanatos in CNS injury: Molecular insights and therapeutic approaches

BACKGROUND

Central nervous system (CNS) injury causes severe organ damage due to both damage resulting from the injury and subsequent cell death. However, there are currently no effective treatments for countering the irreversible loss of cell function. Parthanatos is a poly (ADP-ribose) polymerase 1 (PARP-1)-dependent form of programmed cell death that is partly responsible for neural cell death. Consequently, the mechanism by which parthanatos promotes CNS injury has attracted significant scientific interest.

AIM OF REVIEW

Our review aims to summarize the potential role of parthanatos in CNS injury and its molecular and pathophysiological mechanisms. Understanding the role of parthanatos and related molecules in CNS injury is crucial for developing effective treatment strategies and identifying important directions for future in-depth research.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Parthanatos (from Thanatos, the personification of death according to Greek mythology) is a type of programmed cell death that is initiated by the overactivation of PARP-1. This process triggers a cascade of reactions, including the accumulation of poly(ADP-ribose) (PAR), the nuclear translocation of apoptosis-inducing factor (AIF) after its release from mitochondria, and subsequent massive DNA fragmentation caused by migration inhibitory factor (MIF) forming a complex with AIF. Secondary molecular mechanisms, such as excitotoxicity and oxidative stress-induced overactivation of PARP-1, significantly exacerbate neuronal damage following initial mechanical injury to the CNS. Furthermore, parthanatos is not only associated with neuronal damage but also interacts with various other types of cell death. This review focuses on the latest research concerning the parthanatos cell death pathway, particularly considering its regulatory mechanisms and functions in CNS damage. We highlight the associations between parthanatos and different cell types involved in CNS damage and discuss potential therapeutic agents targeting the parthanatos pathway.

Global Burden of Vertebral Fractures and Spinal Cord Injuries Due to Falls From 1990 to 2021: A Population-Based Study

Study DesignMeta-analysis-based calculation.ObjectivesFalls are the primary cause of vertebral fractures and spinal cord injuries (SCI). We aimed to analyze the burden and trends of vertebral fractures and SCI due to falls.MethodsWe extracted data on the incidence, prevalence, and years lived with disability (YLDs) of vertebral fractures and SCI due to falls in 21 regions and 204 countries. Estimated annual percentage changes and the Joinpoint regression analysis was used to assess time trends. And we used the Bayesian Age-Period-Cohort model to project the burden for the next 15 years. Then, We developed smoothed curve models and used Spearman's correlation coefficient to analyze the relationship between the Socio-Demographic Index (SDI) and the burden. Finally, frontier analysis was applied to evaluate the effective differences.ResultsIn 2021, there were 4.73 million new cases of vertebral fractures and 3.67 million prevalent cases, and SCI accounted for .3 million new cases and 6.94 million prevalent cases. Although age-standardized rates (ASRs) showed a declining trend, absolute case numbers increased by more than 50% since 1990. Middle-aged males and elderly females are more vulnerable. A positive correlation was found between SDI and ASRs (P < .001), with higher burdens in high SDI regions. Burdens continue to rise in low and middle SDI regions due to limited healthcare resources and development-related risks.ConclusionsThe global burden of vertebral fractures and SCI continues to grow. Prevention of falls and musculoskeletal degeneration is critical. Urgent action is needed to improve healthcare infrastructure and preventive measures.

Teriparatide mitigates oxidative stress following spinal cord injury and enhances neurological recovery via the Nrf2/HO-1 signaling pathway

Introduction

Spinal Cord Injury (SCI) represents a devastating form of central nervous system trauma, where oxidative stress plays a critical role in the ensuing pathology. Targeting oxidative stress presents a viable therapeutic avenue. Teriparatide, a synthetic analog of parathyroid hormone, is conventionally utilized for osteoporosis and bone defect management. Emerging evidence suggests teriparatide's potential in modulating oxidative stress in ischemic stroke, yet its efficacy in SCI remains underexplored.

Methods

We investigated the neuroprotective effects of teriparatide in a rat spinal cord injury (SCI) model. Teriparatide was administered to animals post-injury, and functional recovery was assessed using the open field test and Basso-Beattie-Bresnahan (BBB) locomotor rating scale. Molecular analyses included evaluation of Nrf2 pathway activation and antioxidant protein expression via immunofluorescence, Western blot, and ELISA. Additionally, glutathione peroxidase (GSH-PX) activity and malondialdehyde (MDA) levels were measured using commercial assay kits.

Results

We obtained two significant results: Firstly, teriparatide treatment significantly enhanced motor function recovery post-SCI. Secondly, teriparatide upregulated Nrf2 expression, which subsequently increased the production of the antioxidant proteins HO-1 and SOD2, reduced MDA levels in spinal tissues, and boosted GSH-PX activity.

Conclusion

Our findings demonstrate that teriparatide activates the Nrf2/HO-1 antioxidant pathway, effectively mitigating oxidative damage in SCI. This repositioning of an FDA-approved osteoporosis drug presents a clinically translatable strategy for neuroprotection.

Bladder Emptying Strategies, Active Follow-up Adherence and Barriers in Post-Discharge Spinal Cord Injury individuals: A Multiple Center Cross-Sectional Study

Background

Adherence plays a crucial role in the long-term management of chronic conditions, including neurogenic lower urinary tract dysfunction (NLUTD) in individuals with spinal cord injury (SCI). Poor adherence can lead to complications, reduced quality of life, and increased healthcare costs.

Purpose

This study aimed to evaluate the post-discharge bladder-emptying practices and adherence to follow-up in SCI individuals with NLUTD, identifying key factors influencing adherence to improve long-term care strategies.

Methods

A cross-sectional survey was conducted in Southwest China from May 1 to September 30, 2023. Online questionnaires were employed to collect data on sociodemographic characteristics, bladder emptying methods, active follow-up adherence and related barriers.

Results

Out of 412 fully completed questionnaires, as for bladder-emptying method, 70.15% of respondents opted for clean intermittent catheterization (CIC) as their primary or preferred mode. CIC usage was more prevalent among participants with thoracic and lumbar SCI, while those with cervical SCI demonstrated a higher reliance on indwelling catheterization (IDC) and cystostomy. A significant 63.55% did not engage in regular hospital follow-ups participants with thoracic SCI had the lowest adherence rate (49.79%), followed by lumbar (72.62%) and cervical (77.59%) groups. Preferences for medical consultation were highest for rehabilitation physicians at 65.68%, with neurourologists following at 33.83%. Key barriers to follow-up adherence were identified as the more severity of SCI, lack of disease knowledge, increasing age, and reliance on adult children for care. In contrast, positive predictors of follow-up adherence were ample financial support and previous medical consultation experiences.

Conclusion

This study revealed insufficient follow-up adherence among SCI individuals with NLUTD, with CIC emerging as the preferred method for bladder emptying strategy. Age and injury level significantly influenced adherence. To improve long-term management of NLUTD, future initiatives should focus on enhancing health education accessibility, optimizing healthcare services, and providing comprehensive financial support to high-risk groups.

Global trends and hotspots of neuromodulation in spinal cord injury: a study based on bibliometric analysis

OBJECTIVE

Spinal cord injury (SCI) is a debilitating condition that can result in permanent disability. Neuromodulation is a promising technology that has gained popularity as a treatment for SCI. This study aims to analyze the published literature to investigate the global trends and hotspots in research on neuromodulation in the context of SCI.

METHODS

All relevant publications on the topic of neuromodulation in SCI from January 1, 2005, to September 17, 2024, were acquired from the Web of Science Core Collection database. Bibliometric analysis was performed to evaluate the publication distribution by country, institution, author, and journal, as well as keyword, using CiteSpace, VOSviewer, and Scimago Graphica software.

RESULTS

Overall, 3,211 publications were eligible for inclusion in the analysis. The publication number in 2005 and 2024 were 77 and 222, respectively. A steady increasing trend in the publication number over the past two decades was observed. The Unites States published 1544 articles with 52,521 citations, ranking first regarding publication number and total citations. Case Western Reserve University was the most productive institution that published 181 papers. All of the highly productive institutions were located in the United States, Canada, and Australia. The University of California Los Angeles harvested 6626 total citations and 81.8 average citations, ranking first among the productive institutions. Gorgey AS published 60 articles and ranked first regarding total publication number. Edgerton VR harvested 4333 citations and ranked first among the authors for total citations. The analysis of high-yielding journals suggested that Journal of Spinal Cord Medicine was the most productive journal with 133 publications. Spinal Cord yielded 4200 citations and ranked first among the journals for total citations. The keyword analysis identified "functional electrical stimulation" and "spinal cord stimulation" as research hotspots.

CONCLUSION

This study delineates the current knowledge landscape and research trends on the topic of neuromodulation in SCI. The findings highlight the growing interest in this field and underscore the significance of neuromodulation in SCI research.

Clonally expanded, targetable, natural killer-like NKG7 T cells seed the aged spinal cord to disrupt myeloid-dependent wound healing

Spinal cord injury (SCI) increasingly affects aged individuals, where functional impairment and mortality are highest. However, the aging-dependent mechanisms underpinning tissue damage remain elusive. Here, we find that natural killer-like T (NKLT) cells seed the intact aged human and murine spinal cord and multiply further after injury. NKLT cells accumulate in the spinal cord via C-X-C motif chemokine receptor 6 and ligand 16 signaling to clonally expand by engaging with major histocompatibility complex (MHC)-I-expressing myeloid cells. NKLT cells expressing natural killer cell granule protein 7 (Nkg7) disrupt myeloid-cell-dependent wound healing in the aged injured cord. Nkg7 deletion in mice curbs NKLT cell degranulation to normalize the myeloid cell phenotype, thus promoting tissue repair and axonal integrity. Monoclonal antibodies neutralizing CD8+ T cells after SCI enhance neurological recovery by promoting wound healing. Our results unveil a reversible role for NKG7+CD8+ NKLT cells in exacerbating tissue damage, suggesting a clinically relevant treatment for SCI.

A multi-analyte blood test for acute spinal cord injury

BACKGROUNDRapid diagnosis to facilitate urgent intervention is critical for treatment of acute spinal cord injury (SCI). We hypothesized that a multi-analyte blood biomarker would support point-of-care SCI diagnosis, correlate with injury severity, and predict long-term neurologic outcomes.METHODSDroplet digital PCR (ddPCR) assays were designed to amplify differentially hypomethylated genomic loci in spinal cord tissue. An optimized ddPCR assay was applied to cell-free DNA (cfDNA) from plasma samples collected from prospectively enrolled acute SCI patients. Targeted proteomic profiling was also performed. Spinal cord-derived cfDNA and plasma proteins were tested for their association with SCI and ability to predict conversion in American Spinal Injury Association (ASIA) score at 6 months.RESULTSA bespoke ddPCR assay detected spinal cord-derived cfDNA in plasma of 50 patients with acute SCI (AUC: 0.89, 95% CI 0.83-0.95, P < 0.0001). Levels of cfDNA were highest in patients with the most severe injury, i.e., ASIA A, compared with those with ASIA B (P = 0.04), ASIA C (P = 0.009), and ASIA D injuries (P < 0.001). Dimensionality reduction identified 4 candidate proteins (FABP3, REST, IL-6, NF-H) that were integrated with spinal cord-derived cfDNA to derive the Spinal Cord Injury Index (SCII), which has high sensitivity and specificity for SCI diagnosis (AUC: 0.91, 95% CI 0.82-0.99, P < 0.0001), correlates with injury severity (P < 0.0001), and predicts 6-month neurologic improvement (AUC: 0.77, 95% CI 0.61-0.93, P = 0.006).CONCLUSIONThe detection of spinal cord-derived cfDNA and plasma protein alterations as part of a multi-analyte blood test can inform SCI diagnosis and prognosis.FUNDINGNorth American Spine Society Young Investigator Award; Morton Cure Paralysis Fund.

Mapping Theme Trends and Recognizing Hot Spots in Acute Spinal Cord Injury: A Bibliometric Analysis

BACKGROUND

Acute spinal cord injury causes severe motor and sensory dysfunction, significantly burdening individuals and society. This study uses bibliometric analysis to identify research trends and key areas, providing insights for future advancements in treatment.

METHODS

Scientific publications on acute spinal cord injury were collected from PubMed and the Web of Science Core Collection between 2000 and 2022. Data were analyzed using Bibliometric, CiteSpace, and Bibliographic Item Co-occurrence Matrix Builder, with gCLUTO applied for co-word bicluster analysis based on MeSH term matrices.

RESULTS

Two thousand five hundred thirteen publications on acute spinal cord injury were published, with the number of articles increasing annually from 38 to 268. Spinal cord has emerged as the leading journal in this field, and the United States maintains its dominant position in global research impact. The University of Toronto ranks first among research institutions, with significant contributions from researchers such as Fehlings and Kwon. Research on acute spinal cord injury primarily focuses on 7 key areas: metabolism, pharmacology, surgical timing, rehabilitation, pathology, clinical predictors, and diagnostic imaging.

CONCLUSIONS

Our study reveals substantial growth in acute spinal cord injury research over the past 2 decades, emphasizing leading countries, researchers, institutions, and journals. Animal models remain pivotal in drug development for basic medicine and neuroscience. Consensus has been reached among experts regarding the timing of surgical intervention, while artificial intelligence and multidisciplinary approaches are emerging as promising avenues for comprehensive treatment. Additionally, ongoing research into spinal cord injury pathophysiology provides essential guidance for pharmacological and surgical treatments.

The potential role of RhoA/ROCK-inhibition on locomotor recovery after spinal cord injury: a systematic review of in-vivo studies

STUDY DESIGN

Systematic Review.

OBJECTIVES

To thoroughly assess the existing literature regarding the impact of anti-RhoA/ROCK agents or procedures on functional recovery in animal models of SCI.

SETTING

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences.

METHODS

A comprehensive search was conducted in Ovid MEDLINE, Embase, Scopus, and Web of Science Core Collection utilizing a combination of keywords. All in-vivo animal studies of acute or chronic SCI that evaluated the pharmacological effects of Rho/ROCK inhibitors in English literature were included in this study.

RESULTS

Totally, 2320 articles were identified, of which, 60 papers were included for further analysis. A total of 47 (78%) studies were conducted merely on rats, 9 (15%) on mice, 3 (5%) used both, and the remaining used other animals. Y-27632, Fasudil, C3 Transferase and its derivatives (C3-05/PEP-C3/CT04/C3bot154-182/C3bot26mer(156-181)), Ibuprofen, Electroacupuncture (EA), SiRhoA, miR-133b, miR-135-5p, miR-381, miR-30b, Statins, 17β-estradiol, β-elemene, Lentivirus-mediated PGC-1a, Repulsive guidance molecule (RGMa), Local profound hypothermia, Jisuikang (JSK), Hyperbaric oxygen (HBO), Lv-shRhoA (Notch-1 inhibitor), Anti-Ryk antibody, LINGO-antagonist, BA-210, p21Cip1/WAF1, ORL-1 antagonist, Epigallocatechin-3-gallate (EGCG), Tamsulosin, AAV.ULK1.DN, and Indomethacin were the 28 reported agents/procedures with anti-RhoA/ROCK effects. The pooled SMD for BBB scores was 0.41 (p = 0.048) in the first week, 0.85 (p < 0.001) in the second week, 1.22 (p = 0.010) in the third week, and 1.53 (p = 0.001) in the fourth week.

CONCLUSION

Of the 28 identified anti-RhoA/ROCK agents, all but two (C3bot and its derivatives and EGCG) demonstrated promising results. The results of the meta-analysis cautiously indicate a significant increase in BBB scores over time after SCI.

From single to combinatorial therapies in spinal cord injuries for structural and functional restoration

Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychosocial implications for affected people, their families, and their communities; the financial costs can be challenging for their families and health institutions. Treatments aimed at restoring the spinal cord after spinal cord injury, which have been tested in animal models or clinical trials, generally seek to counteract one or more of the secondary mechanisms of injury to limit the extent of the initial damage. Most published works on structural/functional restoration in acute and chronic spinal cord injury stages use a single type of treatment: a drug or trophic factor, transplant of a cell type, and implantation of a biomaterial. Despite the significant benefits reported in animal models, when translating these successful therapeutic strategies to humans, the result in clinical trials has been considered of little relevance because the improvement, when present, is usually insufficient. Until now, most studies designed to promote neuroprotection or regeneration at different stages after spinal cord injury have used single treatments. Considering the occurrence of various secondary mechanisms of injury in the acute and sub-acute phases of spinal cord injury, it is reasonable to speculate that more than one therapeutic agent could be required to promote structural and functional restoration of the damaged spinal cord. Treatments that combine several therapeutic agents, targeting different mechanisms of injury, which, when used as a single therapy, have shown some benefits, allow us to assume that they will have synergistic beneficial effects. Thus, this narrative review article aims to summarize current trends in the use of strategies that combine therapeutic agents administered simultaneously or sequentially, seeking structural and functional restoration of the injured spinal cord.

ISRIB facilitates post-spinal cord injury recovery through attenuation of neuronal apoptosis and modulation of neuroinflammation

Background

Neuronal apoptosis and inflammation are two critical factors that impede functional recovery post spinal cord injury (SCI). Previous studies have demonstrated the inhibitory effects of integrated stress response inhibitor (ISRIB) on neuroinflammation in brain injury. However, whether ISRIB can regulate neuron death and neuroinflammation in the context of SCI remains elusive.

Methods

We employed an oxygen-glucose deprivation/reperfusion (OGD/R) model to simulate spinal cord ischemia-reperfusion injury and utilized lipopolysaccharide (LPS) to activate microglia. We assessed cell viability and death to demonstrate the neuroprotective effect of ISRIB against neuron death, while evaluating cytokine levels and the expression of Arg1 and iNOS to elucidate the regulatory role of ISRIB in neuroinflammation. Bulk RNA-seq analysis was employed to investigate the global transcriptional changes in neurons and microglia induced by ISRIB treatment. Additionally, we validated the promoting effects of ISRIB on motor and sensory recovery in a mouse model of SCI.

Results

We observed that ISRIB exerted a suppressive effect on neuron death and neuroinflammation. RNA-seq data revealed that the ISRIB exhibited regulation of neuron apoptosis through the P53 signaling pathway, as well as modulation of neuroinflammation by the JAK2/STAT3 signaling pathway. Western blotting and immunofluorescence analyses demonstrated that ISRIB reduced P53 expression in neuronal nuclei and inhibited the phosphorylation of JAK2 and STAT3 in microglia. In addition, we validated the capacity of ISRIB to promote locomotor function recovery in a mouse model of SCI.

Conclusion

Our study confirmed the ability of ISRIB to regulate neuron apoptosis and neuroinflammation in SCI via the P53 signaling pathway and the JAK2/STAT3 signaling pathway, respectively. Treatment with ISRIB in mice with SCI promoted the recovery of neural function. This research provides new evidence and options for therapeutic strategies of SCI.

The translational potential of this article

Our study provides experimental evidence to support the application of ISRIB in the repair of spinal cord injury.

Hotspots and Trends in Spinal Cord Stimulation Research for Spinal Cord Injury: A Bibliometric Analysis with Emphasis on Motor Recovery (2014-2024)

BACKGROUND

Spinal cord stimulation (SCS) has emerged as a key therapeutic strategy for enhancing motor recovery in spinal cord injury (SCI). This study employs bibliometric analysis to explore research trends and hotspots in SCS for motor recovery, highlighting advances and emerging directions over the past decade.

METHODS

This cross-sectional bibliometric study retrieved publications on SCS for motor recovery from the Web of Science Core Collection database (2014-2024). Key information, including annual publication trends, contributing countries, institutions, authors, journals, keywords, and highly cited references, was analyzed using CiteSpace and VOSviewer.

RESULTS

A total of 1033 publications were analyzed, demonstrating exponential growth in SCS research since 2014. The United States and Switzerland were identified as leading contributors, with prominent institutions such as the Swiss Federal Institute of Technology and the University of California System driving advancements. Key authors included Grégoire Courtine and Susan J. Harkema. Research themes have evolved through four phases: foundational studies on spinal cord mechanisms, exploration of neural circuits, application of electrical stimulation for motor recovery, and advancements in noninvasive therapies such as transcutaneous SCS. Highly cited journals, including Nature and Lancet, have published transformative studies, underscoring the field's clinical and academic significance.

CONCLUSIONS

This bibliometric analysis provides a comprehensive overview of SCS research for motor recovery post-SCI over the past decade. Interdisciplinary collaboration and technological innovation have positioned SCS as a cornerstone of SCI rehabilitation. Future efforts should focus on optimizing approaches, leveraging advanced imaging and artificial intelligence technologies, and broadening rehabilitation goals to improve outcomes for SCI patients.

Punicalagin inhibits neuron ferroptosis and secondary neuroinflammation to promote spinal cord injury recovery

Spinal cord injury (SCI) represents a severe type of central nervous system damage, with no effective treatment currently available, partly due to neuronal ferroptosis and subsequent neuroinflammation. Punicalagin, an anti-inflammatory compound extracted from pomegranate peel, has exhibited therapeutic potential for inflammatory diseases. In this study, we present evidence that punicalagin facilitates the recovery of neurological function following SCI by mitigating neuronal ferroptosis. Mechanistically, this effect involves the upregulation of nuclear factor E2-related factor 2 (Nrf2) and the activation of the Nrf2- Solute Carrier Family 7 Member 11 (SLC7A11)- Glutathione Peroxidase 4 (GPX4) signaling pathway. Furthermore, punicalagin aids in the resolution of secondary neuroinflammation by modulating the M1/M2 polarization of microglia, thereby promoting SCI recovery. Collectively, these findings suggest that punicalagin enhances functional recovery after SCI by inhibiting neuronal ferroptosis and reducing microglial M1 polarization. Consequently, punicalagin may represent a promising therapeutic agent for the treatment of spinal cord injury.

Effect of high-intensity exercise training on functional recovery after spinal cord injury

Spinal cord injury (SCI) is a severe disorder of the central nervous system characterized by high prevalence and significant disability, imposing a substantial burden on patients and their families. In recent years, exercise training has gained prominence in the treatment of SCI due to its advantages, including low cost, high safety, ease of implementation, and significant efficacy. However, a consensus regarding the effects of various exercise training modalities and intensities on functional recovery in individuals with SCI remains elusive, and the efficacy and risks associated with high-intensity exercise training (HIET) are subjects of ongoing debate. Some studies have indicated that HIET offers superior therapeutic benefits, such as enhanced cardiovascular stress reflex sensitivity and increased release of neurotrophic factors, compared to moderate- or low-intensity exercise training. Nonetheless, HIET may entail risks, including secondary injuries, heightened inflammatory responses, and falls. This study reviews the positive and negative effects of HIET on various body systems in individuals with SCI, focusing on mechanisms such as neuroplasticity and immune regulation, to provide a theoretical basis and evidence for its prospective clinical application. Additionally, the limitations of existing studies are analyzed to inform recommendations and guidance for future research.

The Effect of a Low-Glycemic Index Diet on Postprandial Hypotension in Individuals With Chronic Spinal Cord Injury: Results From a Pilot Study

Background

One in two individuals with spinal cord injury (SCI) experiences postprandial hypotension (PPH), a decline (>20 mm Hg) in systolic blood pressure (SBP) within 2 hours after eating. Consuming meals with a low glycemic index (GI) could prevent or lessen PPH.

Objectives

To determine the effect of a low-GI diet on PPH and postprandial glucose and insulin in individuals with chronic SCI (>1 year postinjury).

Methods

Eleven participants (6 males, 5 females; age 43 ± 11 years) with chronic SCI (C4-C7, 7; T4-T12, 4) took part in a randomized crossover study (low GI vs. high GI). On each occasion, BP, glucose, and insulin were measured in the fasted state and for 2 hours after consuming a breakfast meal (60% carbohydrate, 28% fat, 12% protein) in laboratory-controlled conditions. Participants wore an ambulatory BP monitor and continuous glucose monitor for 3 days at home, and consumed study meals that were macronutrient-matched across conditions.

Results

The maximum decrease in systolic blood pressure (SBP) following the laboratory-controlled breakfast meals tended to be lower in the low-GI (14 ± 12 mm Hg) compared to the high-GI (24 ± 25 mm Hg) diet (d = 0.52, P = .056). Serum glucose (P < .01) and insulin (P = .026) concentrations were lower at 30 minutes in the low-GI diet. In the home setting, peak glucose concentrations were lower after lunch (P = .011) and dinner (P < .01) in the low-GI diet.

Conclusion

A low-GI meal may be an effective solution to reduce the magnitude of PPH and peak glucose concentrations in individuals with chronic SCI.

Focusing on Formyl Peptide Receptors after Traumatic Spinal Cord Injury: from Immune Response to Neurogenesis

The intricate pathophysiological cascades following spinal cord injury (SCI), encompassing cellular demise, axonal degeneration, and the formation of glial scars, pose formidable barriers to neural regeneration and restoration. Notably, neuroinflammation and glial scars emerge as pivotal barrier to post-SCI repair. Formyl peptide receptors (FPRs) emerge as critical regulators of immune responses, exerting significant influence over inflammatory modulation and nerve regeneration subsequent to SCI. Beyond their classical expression in myeloid cells, FPRs demonstrate a pronounced presence within the central nervous system (CNS) with roles in the progression of neurodegenerative disorders and neurological malignancies. Post-SCI, the equilibrium of the inflammatory microenvironment is recalibrated through the strategic modulation of FPRs, including facilitating a balance in microglial polarization, stimulating neural stem cells (NSCs) migration, and promoting neural axon elongation. These observations enlighten the potential of FPRs as innovative targets for neuronal regenerations bolstering SCI repair. This review endeavors to delineate the distribution and function of FPRs in the aftermath of SCI, with a special attention to their roles in inflammatory regulation, NSCs mobilization, and synaptic growth. By elucidating these mechanisms, we aspire to contribute novel insights and strategies for SCI therapy.

The changing burden of gout in adults aged 70 and above based on the global burden of disease 2019

Introduction

Gout is a significant global health issue, particularly among adults aged 70 and above. Understanding its epidemiological evolution and associated factors is crucial for guiding interventions and improving management.

Methods

This study analyzed data from the Global Burden of Disease study to assess the prevalence and trends of gout among adults aged 70 and above from 1990 to 2019. We evaluated temporal trends and regional disparities by calculating the estimated annual percentage change (EAPCs).

Results

Globally, the number of older adults individuals affected by gout increased from 5,316,210 cases in 1990 to 15,666,063 cases in 2019. It is noteworthy that the global burden of gout among the older adults continued to rise from 1990 to 2019, with an EAPC of 1.17 (95% CI: 1.02 to 1.32). In 2019, the prevalence rates among individuals aged 70-74, 75-79, 80-84, and 85 and above were 3,121.31 per 100,000, 3,437.17 per 100,000, 3,592.38 per 100,000, and 3,726.91 per 100,000, respectively. The regions with the highest prevalence rates of gout in 2019 were Australasia, High-income North America, and Southern Latin America, with rates of 8,500.73, 8,351.33, and 4,666.87 per 100,000, respectively. At the national level, some developed countries such as New Zealand, the United States of America, and Australia had the highest prevalence rates, reaching 8,893.74, 8,508.06, and 8,427.94 per 100,000, respectively. It is noteworthy that regions with higher levels of Socio-Demographic Index tended to have relatively higher burden of gout among the older adults, and the prevalence rates varied across different regions and age groups.

Conclusion

The study underscores the persistent burden of gout among the older adults, emphasizing the need for targeted interventions to address this issue and improve public health outcomes in this demographic.

A biomimetic injectable chitosan/alginate hydrogel biocopmosites encapsulating selenium- folic acid nanoparticles for regeneration of spinal cord injury: An in vitro study

Spinal cord injury (SCI) poses significant challenges to regenerative medicine due to its limited self-repair capabilities. In this study, we engineered a biomimetic injectable hydrogel using modified chitosan and alginate biopolymers encapsulating selenium-folic acid nanoparticles (Se-FA NPs) to facilitate SCI regeneration. The hydrogel exhibited a unique porous structure attributed to the incorporation of nanofiber fragments, enhancing its biocompatibility and bioactivity. Through a series of in vitro evaluations, including cell viability assays, proliferation studies, gene expression analysis, we assessed the hydrogel's cytocompatibility and its potential for supporting neural cell growth. Our results demonstrate the promising efficacy of the hydrogel in providing a conducive microenvironment for neural tissue regeneration. Moreover, the sustained release of Se-FA NPs from the hydrogel system offers neuroprotective, antioxidative, and anti-inflammatory benefits crucial for SCI therapy. Overall, our biomimetic hydrogel biocomposites hold great potential as a therapeutic strategy for promoting spinal cord regeneration, highlighting their significance in advancing the field of regenerative medicine.

Methods of diagnosis and rehabilitation of dysphagia in patients with spinal cord injury: a systematic review

INTRODUCTION

Latest epidemiological metrics put a global prevalence of 20.6 million people suffering from spinal cord injury (SCI), leading to a burden of functional disability, deterioration in quality of life and reduced life expectancy. A thorough statement of diagnostic methods and treatment protocols for swallowing disorders after SCI stands as a major priority to streamline patient care and cost-sharing. Here we have provided a systematic overview of the evidence on diagnostic and rehabilitation protocols of dysphagia in the SCI population.

EVIDENCE ACQUISITION

The literature was searched in six electronic databases up to April 30th, 2024. Screening the 521 retrieved articles for inclusion criteria resulted in the selection of 43 studies that reported assessment tools and rehabilitation protocols for dysphagia in patients with SCI. Two researchers extracted the data in parallel, and inter-rater reliability (IRR) was used to estimate inter-coder agreement and then κ statistic to measure accuracy and precision. Based on PRISMA concepts and quality assessment steps, a k coefficient of at least 0.9 was obtained in all data extraction steps. All reports were assessed for risk of bias using the NIH Quality Assessment Toolkit. The study protocol was registered on PROSPERO (CRD42023449137).

EVIDENCE SYNTHESIS

Dysphagia assessment methods were collected and grouped into four different macro categories (clinical assessment, rating scale, self-reported questionnaire, and instrumental assessment). It was found that the Bedside Swallow Evaluation (BSE) for the clinical assessment category (50%), the Bazaz score (32.5%) for the rating scale category, the Eating Assessment Tool-10 (EAT-10) (44.4%) for the self-reported questionnaire category, and the Videofluoroscopic Study of Swallowing (VFSS) (48.9%) for the instrumental assessment category were the most representative tools. The rehabilitation protocols described included either an early oral feeding exclusion or a consistency-modified oral intake, postural adaptations, oxygen therapy with a high-flow nasal cannula combined with indirect/direct therapy, specific exercises, and neuromuscular electrical stimulation.

CONCLUSIONS

Methods of diagnosis and rehabilitation protocols for dysphagia in SCI patients appear inconsistent. Further rigorous studies are needed to achieve better clinical handling in SCI settings while lowering the load of patient morbidity and related healthcare costs.

Schwann cell transplantation for remyelination, regeneration, tissue sparing, and functional recovery in spinal cord injury: A systematic review and meta-analysis of animal studies

INTRODUCTION

Spinal cord injury (SCI) is a significant global health challenge that results in profound physical and neurological impairments. Despite progress in medical care, the treatment options for SCI are still restricted and often focus on symptom management rather than promoting neural repair and functional recovery. This study focused on clarifying the impact of Schwann cell (SC) transplantation on the molecular, cellular, and functional basis of recovery in animal models of SCI.

MATERIAL AND METHODS

Relevant studies were identified by conducting searches across multiple databases, which included PubMed, Web of Science, Scopus, and ProQuest. The data were analyzed via comprehensive meta-analysis software. We assessed the risk of bias via the SYRCLE method.

RESULTS

The analysis included 59 studies, 48 of which provided quantitative data. The results revealed significant improvements in various outcome variables, including protein zero structures (SMD = 1.66, 95 %CI: 0.96-2.36; p < 0.001; I2 = 49.8 %), peripherally myelinated axons (SMD = 1.81, 95 %CI: 0.99-2.63; p < 0.001; I2 = 39.3 %), biotinylated dextran amine-labeled CST only rostral (SMD = 1.31, 95 % CI: 0.50-2.12, p < 0.01, I2 = 49.7 %), fast blue-labeled reticular formation (SMD = 0.96, 95 %CI: 0.43-1.49, p < 0.001, I2 = 0.0 %), 5-hydroxytryptamine caudally (SMD = 0.83, 95 %CI: 0.36-1.29, p < 0.001, I2 = 17.2 %) and epicenter (SMD = 0.85, 95 %CI: 0.17-1.53, p < 0.05, I2 = 62.7 %), tyrosine hydroxylase caudally (SMD = 1.86, 95 %CI: 1.14-2.59, p < 0.001, I2 = 0.0 %) and epicenter (SMD = 1.82, 95 %CI: 1.18-2.47, p < 0.001, I2 = 0.0 %), cavity volume (SMD = -2.07, 95 %CI: -2.90 - -1.24, p < 0.001, I2 = 67.2 %), and Basso, Beattie, and Bresnahan (SMD = 1.26, 95 %CI: 0.93-1.58; p < 0.001; I2 = 79.4 %).

CONCLUSIONS

This study demonstrates the promising potential of SC transplantation as a therapeutic approach for SCI, clarifying its impact on various biological processes critical for recovery.

Evaluation of prehospital care for neurotrauma in Iran

STUDY DESIGN

Narrative review.

BACKGROUND

Neurotrauma has a considerable impact on healthcare, the economy, and human resources worldwide. In Iran, young males are especially vulnerable, with road traffic accidents (RTAs) being the major cause. Evaluating prehospital care systems is critical for detecting shortcomings and implementing improvements. This study seeks to evaluate the prehospital neurotrauma care procedure in Iran, highlighting its strengths and flaws.

METHOD

We searched PubMed and Scopus databases for literature on the present condition of prehospital neurotrauma care in Iran. Consultations with an expert panel yielded additional material not previously available in the literature, particularly on Iran's emergency medical system.

RESULTS

Our findings indicate that the emergency dispatch system in Iran is relatively well-managed, regardless of the lack of a single emergency contact number. However, major obstacles still exist, particularly in terms of human resources, training, and equipment availability. Emergency medical technicians (EMTs) have intermediate to poor levels of knowledge and skills in dealing with neurotrauma, which might be considerably improved by ongoing training programs. Furthermore, Iranian hospitals lack specific trauma center designations and levels, resulting in overcrowded emergency rooms and delayed care delivery. National neurotrauma guidelines have been adopted in recent years, although their compliance is not consistently monitored.

CONCLUSION

Compared to developed healthcare systems, Iran's prehospital treatment system for individuals with neurotrauma has considerable limitations. Improving EMT education, recruiting more trained professionals, and simultaneous improvement of current medical facilities should be addressed as the first steps toward better care.

Global, regional, and national burden of esophageal cancer using the 2019 global burden of disease study

Esophageal cancer, with its aggressive nature and high mortality, poses diverse epidemiological challenges worldwide. Over the past three decades, esophageal cancer has exhibited a substantial global burden, marked by a significant increase in absolute numbers, contrasting with a decline in age-standardized metrics. Prevalence nearly doubled, reaching 0.961 million in 2019, while the age-standardized rate (ASR) decreased to 11.6 per 100,000 cases. New incidence cases surged by 67.07%, yet the age-standardized incidence rate reduced to 6.5 per 100,000 cases. Deaths increased to 0.498 million, with a decline in age-standardized mortality to 6.1 per 100,000 cases. Disability-Adjusted Life Years (DALYs) rose to 11.67 million, but the ASR decreased to 139.8 per 100,000 cases. Gender-specific analysis revealed consistently higher rates in males, with increasing gaps over time. Correlations with SDI indicated a negative association, and frontier analysis underscored the impact of socio-economic progress on disease control. Projections suggest a continued rise in prevalence, incidence, deaths, and DALYs, with gender-specific variations. The research underscores the importance of continued efforts in public health and medical research to adapt to and manage the changing landscape of esophageal cancer globally.

Analysis of the spatiotemporal dynamics of vascular injury and regeneration following experimental Spinal Cord Injury

Introduction

The loss of vasculature in Spinal Cord Injury (SCI) contributes to secondary injury, expanding the injury to unharmed spinal cord (SC) regions. Understanding these mechanisms is crucial for developing therapeutic interventions.

Research question

Comprehensive analysis of the temporospatial dynamics of vascular injury and regeneration following SCI.

Materials and methods

Adult C57BL/6J mice were subjected to clip-compression SCI (Th 6/7, 5g, 60s, n = 20) or sham injury (laminectomy, n = 4), and sacrificed at 1, 3, 7, 14, and 28 days (d) post-injury following intracardial fluorescein isothiocyanate (FITC)-Lectin perfusion. Histological analysis (CD31, FITC-Lectin, Ki-67, IgG, TER-119) assessed vascular changes, permeability, and proliferation within the injury epicenter (region 0 (R0), ± 0,5 mm) and two adjacent SC regions (R1: ± 1 mm, R2: ± 2.5 mm).

Results

Perfusion loss (FITC-Lectin+/CD31+), was most severe in R0 and R1 at d3 (p < 0.01). Significant vascular loss in R2 started at d3 (p = 0.043). Perfusion was restored at d28 in R0 and R1, and at d7 in R2. Vessel density (CD31+) returned to baseline quicker (R0: d3, R1 and R2: d14). Vascular proliferation (CD31+/Ki-67+) manifested across all regions at d3 (p < 0.01), and most notably in R2 (p < 0.01). Vascular permeability for IgG remained disrupted until d3 in R0 and R1 and until d14 in R2.

Discussion and conclusion

Vascular injury is most severe initially and spreads to the surrounding SC regions. Gradual vascular regeneration occurs early and up to a considerable distance from the injury epicenter, highlighting the potential of early therapeutic interventions targeted at vascular repair and regeneration.

Functional Independence and Elbow Strength in Tetraplegia: Analysis of Tendon Transfers

BackgroundOver half of spinal cord injuries result in tetraplegia, profoundly impairing daily activities (ADLs).ObjectiveTo evaluate biceps-to-triceps (B-T) and deltoids-to-triceps (D-T) tendon transfers, comparing their impacts on elbow extension strength and ADL independence.MethodsRetrospective review of tendon transfers performed between 2003 and 2023 at a neurorehabilitation center. Post-surgery muscle strength was assessed using the Medical Research Council (MRC) scale and ADL independence with the motor Functional Independence Measure (mFIM). We used ANOVA to identify post-surgery associations between MRC achieved scores and performance in ADLs.ResultsA total of 34 individuals (42 arms) underwent B-T or D-T surgeries, predominantly at C5 level (66.7%) with 69.0% classified as AIS A. Post-surgery, 81% of B-T and 76.2% of D-T achieved antigravity elbow extension (MRC 3-4), with mean MRC scores of 3.2 for both groups. The B-T group, older at surgery (39.9 vs. 27.8 years) and with shorter time since injury to surgery (2.3 vs. 5.0 years), showed significant post-surgery improvements in Self-care, Transfers, Locomotion, and total mFIM. In contrast, significant associations between MRC scores and mFIM outcomes in D-T transfers involved Self-care, Sphincter control, Transfers, and total mFIM.ConclusionsMRC scores and ADLs were positively impacted by rehabilitation tendon transfers.

TRIM32 promotes neuronal ferroptosis by enhancing K63-linked ubiquitination and subsequent p62-selective autophagic degradation of GPX4

Ferroptosis, characterized by iron-dependent phospholipid peroxidation, is recognized as one of the cell death pathways activated following spinal cord injury (SCI). However, the precise regulatory mechanisms governing this process remain poorly understood. Here, this study identified TRIM32, an E3 ubiquitin ligase, as a key enhancer of neuronal ferroptosis. TRIM32 promoted neuronal ferroptosis by accelerating the degradation of GPX4, which is an essential inhibitor of ferroptosis. Conditional deletion of Trim32 in neurons markedly inhibited neuronal ferroptosis and promoted neuronal survival, eventually improving mouse locomotor functional recovery after SCI. However, overexpression of Trim32 showed aggravated neuronal loss and poor behavioral function, which could be attenuated by ferroptosis inhibitor Liproxstatin-1. Mechanistically, TRIM32 interacted with GPX4, promoted K63-linked ubiquitination modification of GPX4 at K107, thus enhanced p62-dependent autophagic degradation of GPX4. Moreover, ROS-ATM-Chk2 signaling pathway phosphorylates TRIM32 at S55, further contributing to GPX4 ubiquitination and degradation and subsequent neuronal ferroptosis after SCI, suggesting a positive feedback loop between ROS and TRIM32. Clinically, lipid peroxidation was significantly promoted in patients with SCI. These findings reveal that TRIM32 functions as a neuronal ferroptosis enhancer which is detrimental to neuronal survival and locomotor functional recovery in mice after SCI by promoting K63-linked ubiquitination and subsequent p62-dependent autophagic degradation of GPX4, suggesting a promising therapeutic target for SCI.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Spinal Cord Injury: Current Status and Perspective

Spinal cord injury (SCI) can lead to devastating dysfunctions and complications, significantly impacting patients' quality of life and aggravating the burden of disease. Since the main pathological mechanism of SCI is the disruption of neuronal circuits, the primary therapeutic strategy for SCI involves reconstructing and activating circuits to restore neural signal transmission. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique, can modulate the function or state of the nervous system by pulsed magnetic fields. Here, we discuss the basic principles and potential mechanisms of rTMS for treating SCI, including promoting the reconstruction of damaged circuits in the spinal cord, activating reorganization of the cerebral cortex and circuits, modulating the balance of inputs to motoneurons, improving the microenvironment and intrinsic regeneration ability in SCI. Based on these mechanisms, we provide an overview of the therapeutic effects of rTMS in SCI patients with motor dysfunction, spasticity and neuropathic pain. We also discuss the challenges and prospectives of rTMS, especially the potential of combination therapy of rTMS and neural progenitor cell transplantation, and the synergistic effects on promoting regeneration, relay formation and functional connectivity. This review is expected to offer a relatively comprehensive understanding and new perspectives of rTMS for SCI treatment.

The trunk segmental motion complexity and balance performance in challenging seated perturbation among individuals with spinal cord injury

BACKGROUND

Motion complexity is necessary for adapting to external changes, but little is known about trunk motion complexity during seated perturbation in individuals with spinal cord injury (SCI). We aimed to investigate changes following SCI in trunk segmental motion complexity across different perturbation directions and how they affect postural control ability in individuals with SCI.

METHODS

A total of 17 individuals with SCI and 18 healthy controls participated in challenging sagittal-seated perturbations with hand protection. Upper arm activation was measured using surface electromyography for trial consistency. Motion complexity parameters, quantified across three degrees of freedom, was assessed using relative angular acceleration from six trunk segments obtained through motion capturing system. Motion performance parameters were assessed using center of pressure (CoP) measurements from a force plate, including settling time, maximum CoP displacement (MD) variability, and steady-state error. Statistical analyses examined group and direction differences, while complexity-performance relationships were evaluated using multiple response least partial squares regression.

RESULTS

Compared to healthy controls, individuals with SCI showed significantly lower motion complexity in the lumbar and upper thoracic segments (approximately10% - 20%), with identical settling time and higher MD variability. Backward perturbations, as opposed to forward perturbations, resulted in reduced complexity in the aforementioned segments and increased steady-state error. Lower lumbar rotation complexity negatively correlated with MD variability (β = -0.240) and steady-state error (β = -0.485) in individuals with SCI, while showing a minor positive correlation with settling time (β = 0.152) during backward perturbation.

CONCLUSION

Simplified motion control in individuals with SCI may arise from uncoordinated lumbar and overactive thoracic neuromuscular control, compromising stability despite maintaining speed. Increasing lumbar motion complexity could enhance postural stability and accuracy during backward perturbation, representing a potential target for developing seated balance rehabilitation strategies and promoting more adaptive trunk control.

Revisiting the unobtrusive role of exogenous stem cells beyond neural circuits replacement in spinal cord injury repair

Rationale: Stem cell transplantation is a promising strategy to establish neural relays in situ for spinal cord injury (SCI) repair. Recent research has reported short-term survival of exogenous cells, irrespective of immunosuppressive drugs (ISD), results in similar function recovery, though the mechanisms remain unclear. This study aims to validate this short-term repair effect and the potential mechanisms in large animals. Methods: In this study, human spinal cord neural progenitor cells (hscNPCs) and human umbilical cord mesenchymal stem cells (hUMSCs) were transplanted into two different SCI model without ISD, respectively; Immunofluorescence was utilized to visualize neuronal regeneration and angiogenesis in the lesion site. Motor evoked potentials (MEPs) were detected to assess the integrity of motor pathways. And RNA sequencing was used to observe transcriptomic changes at the edge of the lesion. Results: The findings revealed hscNPCs failed to survive long-term, but the dogs exhibited better motor function recovery. Moreover, hscNPCs remodeled the injury microenvironment shortly after transplantation by reducing inflammation and enhancing angiogenesis, leading to increased endogenous neuronal regeneration. Similarly, hUMSCs neither survive long-term nor directly reconstruct neural circuits. However, basal functional recovery and endogenous neuronal regeneration were also detected in monkeys with hUMSCs. Conclusions: Exogenous short-term transplantation of stem cells in large animal SCI models does not restore basal function by directly replacing neural circuits throughout the lesion site. Rather, it does so by remodeling the lesion microenvironment in the early stages of transplantation to promote endogenous neural regeneration.

Global, regional, and national burden of spinal cord injury from 1990 to 2021 and projections for 2050: A systematic analysis for the Global Burden of Disease 2021 study

OBJECTIVES

Spinal cord injury (SCI) leads to significant functional impairments and mortality, yet outdated epidemiological data hinder effective public health policies. This study utilizes the latest data from the Global Burden of Disease Study 2021 (GBD 2021) to analyze SCI trends and inform prevention strategies.

METHODS

Using GBD 2021 data, we examined age-standardized incidence, prevalence, and years lived with disability (YLDs) of SCI, along with trends, driving factors, age-sex-time patterns, and projections up to 2050.

RESULTS

In 2021, the burden of SCI, including incidence, prevalence, and YLDs, increased with age. However, both prevalence and YLDs exhibited a slight decline after peaking at age 70, with similar trends observed in both males and females. From 1990-2021, the global burden of SCI showed a gradual decline across all populations, including males and females, and it is projected to decrease further by 2050. Nevertheless, significant disparities in disease burden exist between different countries and regions; high-SDI areas experienced a gradual decline after reaching a peak, while low-SDI areas saw a gradual increase from low levels. The primary drivers of this change include population growth and aging, although epidemiological shifts have somewhat alleviated the burden of SCI. The research also indicates that males and older adults, particularly those aged 70 and above, bear the most severe burden of SCI, with falls, road injuries, and interpersonal violence being the leading causes of this condition.

CONCLUSIONS

While the global burden of SCI is decreasing, the complex distribution across demographics and regions necessitates targeted prevention and treatment strategies to further reduce the burden and improve patient outcomes.

Public Awareness Levels Regarding Cervical Spine Injury and the Suitable First Aid Response Among Adults in Makkah, Saudi Arabia

Purpose

Cervical spine injuries (CSIs) are a growing concern, leading to severe and permanent disabilities. Educating the public about these injuries and appropriate emergency responses is crucial to prevent irreversible damage, minimize disability, and save lives, especially with the rising number of trauma victims worldwide. Herein, we assessed the awareness of CSIs, trauma identification, and first-aid procedures among adults in Makkah, Saudi Arabia.

Sample and Methods

This descriptive cross-sectional study included 591 participants aged 18 or older from Makkah, Saudi Arabia, selected using an online questionnaire and conducted between January and March 2024. We evaluated participants' knowledge and awareness levels about CSIs, analyzing variables such as personal data and first aid training using descriptive statistics, cross-tabulation, and Pearson chi-square tests.

Results

In total, 318 (53.8%) participants demonstrated good awareness of CSIs. Most (76.5%) identified road traffic accidents as a significant risk factor for CSIs. Additionally, 476 (80.5%) participants recognized that CSIs can involve spinal cord damage. Motor disability was acknowledged by 434 (73.9%) participants as a complication linked to CSIs, while 296 (50.1%) and 224 (37.9%) participants recognized sensory disability and respiratory problems as potential associated complications, respectively.

Conclusion

Our findings show that 53.8% of participants had an acceptable awareness level of CSIs, with road traffic accidents identified as the primary cause of spinal injuries. It is crucial to prioritize regular and organized public education and enforce strict road safety measures, particularly among the young, to mitigate the extensive physical, social, emotional, and economic consequences of this issue.

Dynamic changes in pyroptosis following spinal cord injury and the identification of crucial molecular signatures through machine learning and single-cell sequencing

The pathological cascade of spinal cord injury (SCI) is highly intricate. The onset of neuroinflammation can exacerbate the extent of damage. Pyroptosis is a form of inflammation-linked programmed cell death (PCD), the inhibition of pyroptosis can partially mitigate neuroinflammation. It is imperative to delineate the principal cell types susceptible to pyroptosis and concomitantly identify key genes associated with this process. We initially defined the pyroptosis-related genes (PRGs) and analyzed their expression at different time points post SCI. The results demonstrate a substantial upregulation of differentially expressed genes (DEGs) related to pyroptosis on the 7 days post-injury (dpi), these DEGs in the 7 dpi are closely related to the inflammatory response. Subsequently, immune infiltration analysis revealed a predominant presence of inflammatory microglia. Through correlation analysis, we postulated that pyroptosis primarily manifested within the inflammatory microglia. Employing machine learning algorithms, we identified four pyroptosis-related molecular signatures, which were experimentally validated using BV2 cells and spinal cord tissue samples. The robustness of the identified molecular signatures was further confirmed through single-cell sequencing data analysis. Overall, our study elucidates the temporal dynamics of pyroptosis and identifies key molecular signatures following SCI. These findings can provide novel evidence for therapeutic interventions in SCI.

Neurostimulation on lumbosacral nerves as a new treatment for spinal cord injury impairments and its impact on cortical activity: a narrative review

Spinal cord injury (SCI) can cause significant motor, sensory, and autonomic dysfunction by disrupting neural connections. As a result, it is a global health challenge that requires innovative interventions to improve outcomes. This review assesses the wide-ranging impacts of SCI and focuses on the laparoscopic implantation of neuroprosthesis (LION) as an emerging and promising rehabilitation technique. The LION technique involves the surgical implantation of electrodes on lumbosacral nerves to stimulate paralyzed muscles. Recent findings have demonstrated significant improvements in mobility, sexual function, and bladder/bowel control in chronic SCI patients following LION therapy. This manuscript revisits the potential physiological mechanisms underlying these results, including neuroplasticity and modulation of autonomic activity. Additionally, we discuss potential future applications and amendments of LION therapy. This study emphasizes the potential of neuromodulation as a complementary approach to traditional rehabilitation, that can provide a beacon of hope for improving functionality and quality of life for individuals with SCI.

Lentiviral Injection of Inter-α-Trypsin Inhibitor Heavy Chain 4 Promotes Female Spinal Cord Injury Mice Recuperation by Diminishing Peripheral and Central Inflammation

Inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4) acts as a mediator of inflammation and extracellular matrix stabilization. The current study intended to delve into the impact of ITIH4 on locomotor performance, nerve injury, neuroinflammation, systemic inflammation, and the downstream pathway in spinal cord injury (SCI) mice. Overexpression lentivirus of ITIH4 (LV-ITIH4) and negative control lentivirus (LV-NC) were intravenously injected into adult C57BL/6 mice on 7 days before SCI surgery. All mice were euthanized on day 28 after SCI surgery, and their blood samples and spinal cord tissues were collected. Decreased relative gene expression and protein levels of ITIH4 were observed in SCI mice. LV-ITIH4 improved the locomotor performance compared to LV-NC in SCI mice. In spinal cord of SCI mice, LV-ITIH4 reduced apoptosis and increased survival of neurons compared to LV-NC. By comparison with LV-NC, LV-ITIH4 also reduced relative gene expressions of interleukin (IL)-6 and tumor necrosis factor-α in spinal cord of SCI mice. Moreover, LV-ITIH4 reduced microglia M1 polarization compared with LV-NC in spinal cord of SCI mice. In the serum, LV-ITIH4 decreased the protein levels of IL-6 and IL-1β compared to LV-NC in SCI mice. LV-ITIH4 also inhibited the nuclear factor kappa-B (NF-κB) pathway compared to LV-NC in spinal cord of SCI mice. ITIH4 enhances locomotor performance in SCI mice, and it inhibits nerve injury, neuroinflammation, systemic inflammation, and the NF-κB pathway in SCI mice.

Basilar invagination and atlantoaxial dislocation as a complication of severe dystrophic cervical kyphosis correction in neurofibromatosis type 1: Report of a rare case and review of literature

INTRODUCTION AND IMPORTANCE

Neurofibromatosis type 1 (NF1) affects the musculoskeletal system as well as the cervical spine. It is associated with severe, progressive cervical kyphosis. Surgical intervention is the treatment of choice to avoid neurological impairment and malalignment.

CASE PRESENTATION

We herein report an 11-year-old NF-1 patient with severe cervical kyphosis and intact neurological status. We applied five days of cervical traction followed by surgery utilizing the combined cervical approach (posterior release, anterior corpectomy and reconstruction, and posterior cervicothoracic instrumentation). In one-year follow-up, atlantoaxial dislocation (AAD) and basilar invagination (BI) were detected in neuroimagings. The complication was corrected by adding C1 to the previous construct via unilateral C1 lateral mass screw, contralateral C1 sublaminar hook, unilateral C3 and contralateral C4 sublaminar hook insertion, fixed with contoured rods medial to previous rods. This led to the correction of the AAD and the BI and the patients remained neurologically intact.

CLINICAL DISCUSSION

Severe cervical kyphosis in the setting of NF-1 is progressive and carries a considerable risk of neurologic compromise. Surgical intervention is thus necessary.

CONCLUSION

The combined approach with complete spinal column reconstruction is the surgical approach of choice. However, complete curve correction to near-normal lordosis carries the risk of proximal junctional failure (PJF).

Mirtazapine Improves Locomotor Activity and Attenuates Neuropathic Pain Following Spinal Cord Injury in Rats via Neuroinflammation Modulation

Neuroinflammation-related locomotor deficits and neuropathic pain are expected outcomes of spinal cord injury (SCI). The atypical antidepressant mirtazapine has exhibited potential neuroprotective and anti-inflammatory effects. This research aims to investigate the impacts of mirtazapine on post-SCI neuropathic pain and locomotor recovery, with a particular focus on neuroinflammation. The study utilized 30 male Wistar rats divided into five groups: Sham, SCI with vehicle treatment, and SCI administered with mirtazapine (3, 10, and 30 mg/kg/day, ip, for one week). Locomotor activity was assessed using the Basso, Beattie, and Bresnahan (BBB) scale. Mechanical, thermal, and cold allodynia were assessed using von-Frey filaments, tail flick latency, and the acetone test, respectively. ELISA was utilized to measure cytokines, while Western blotting was used to determine TRPV1 channel, 5-HT2A receptor, NLRP3, and iNOS expression. Histopathological analyses were also examined, including hematoxylin and eosin (H&E) and Luxol fast blue (LFB) staining. Mirtazapine (10 and 30 mg/kg/day) significantly improved locomotor recovery according to BBB score. It attenuated mechanical, thermal, and cold allodynia post-SCI. Moreover, it decreased pro-inflammatory cytokines TNF-α, IL-1β, IL-6, and IL-18, while increasing anti-inflammatory cytokine IL-4 and IL-10. Furthermore, it downregulated iNOS, NLRP3, and TRPV1 expression and upregulated the 5-HT2A receptor. H&E and LFB staining further revealed attenuated tissue damage and decreased demyelination. Our findings suggest that mirtazapine can alleviate neuropathic pain and reinforce locomotor recovery post-SCI by modulating neuroinflammatory responses, NLRP3, iNOS, TRPV1 channel, and 5-HT2A receptor expression.

Metal Ruthenium Complexes Treat Spinal Cord Injury By Alleviating Oxidative Stress Through Interaction With Antioxidant 1 Copper Chaperone Protein

Oxidative stress is a major factor affecting spinal cord injury (SCI) prognosis. A ruthenium metal complex can aid in treating SCI by scavenging reactive oxygen species via a protein-regulated mechanism to alleviate oxidative stress. This study aimed to introduce a pioneering strategy for SCI treatment by designing two novel half-sandwich ruthenium (II) complexes containing diverse N^N-chelating ligands. The general formula is [(η6-Arene)Ru(N^N)Cl]PF6, where arene is either 2-phenylethanol-1-ol (bz-EA) or 3-phenylpropanol-1-ol (bz-PA), and the N^N-chelating ligands are fluorine-based imino-pyridyl ligands. This study shows that these ruthenium metal complexes protect neurons by scavenging reactive oxygen species. Notably, η6-Arene substitution from bz-PA to bz-EA significantly enhances reactive oxygen species scavenging ability and neuroprotective effect. Additionally, molecular dynamics simulations indicate that the ruthenium metal complex increases Antioxidant 1 Copper Chaperone protein expression, reduces oxidative stress, and protects neurons during SCI treatment. Furthermore, ruthenium metal complex protected spinal cord neurons and stimulated their regeneration, which improves electrical signals and motor functions in mice with SCI. Thus, this treatment strategy using ruthenium metal complexes can be a new therapeutic approach for the efficient treatment of SCI.

Stabbing injury of the spinal cord: A case report and systematic literature review

BACKGROUND

Spinal cord injury caused by stab wounds (SCISW) represents one of the rarest causes of traumatic spinal cord injury. Because of their rarity, management of such cases may be challenging due to the lack of specific guidelines.

METHODS

The systematic review was performed on 30th June 2024 according to the PRISMA 2020 guidelines. A literature search was conducted across four databases: PubMed, Scopus, Web of Science, and The Polish Medical Bibliography. Additionally, a unique case was presented as an illustrative clinical presentation.

RESULTS

A total of 89 eligible articles, including 78 case reports (89 patients) and 11 case series (882 patients), were found. The current report describes a case of a 41-year-old man with one neck stab wound and a stab wound of the chest. Clinical examination demonstrated complete paraplegia and a lack of sensation below the level of T1. Magnetic resonance imaging (MRI) showed a complete transection of the spinal cord at the T1-T2 level. Due to the lack of foreign bodies at the injury site, the patient was managed conservatively.

CONCLUSION

Direct stabbing injuries rarely lead to complete transection of the spinal cord as in our case. Computed tomography (CT) scans or plain radiographs are necessary to exclude retained foreign bodies. MRI as a further imaging tool can confirm the SCI and may be useful as a predictor of outcomes. Regarding optimal management, conservative treatment should be preferred over surgical intervention in the absence of a foreign body at the injury site.

Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: a systematic analysis for the GBD 2021

BACKGROUND

Cancer is the second most common cause of death globally. Therefore, it is imperative to investigate cancer incidence, mortality rates, and disability-adjusted life years (DALYs) to enhance preventive measures and healthcare resource allocation. This study aimed to assess cancer burden and associated risk factors in 204 countries and territories between 1980 and 2021.

METHODS

We selected data on cancer incidence and mortality rates and associated risk factors from the global burden of disease (GBD) study tool for 204 countries and territories from 1990 to 2021 and 1980 to 2021. We estimated the age-standardized incidence (ASIR) and age-standardized deaths (ASDR) of 34 cancer types categorized as level 3 causes based on the GBD hierarchy.

RESULTS

In 2021, cancer accounted for 14.57% (95% uncertainty interval: 13.65-15.28) of total deaths and 8.8% (7.99-9.67) of total DALYs in both sexes globally. ASIR and ASDR were 790.33 (694.43-893.01) and 116.49 (107.28-124.69), respectively. Additionally, females exhibited higher ASIR than males (923.44 versus 673.09), while males exhibited higher ASDR than females (145.69 versus 93.60). This indicates that policymakers should focus on the importance of gender equality in healthcare. Non-melanoma skin cancer exhibited the highest ASIR (74.10) in both sexes, while digestive cancers accounted for 39.29% of all cancer-related deaths, and Asia exhibited the heaviest cancer burden. In females, breast cancer exhibited the highest ASIR (46.40) and ASDR (14.55). In males, tracheal, bronchial, and lung cancer exhibited the highest ASIR (37.85) and ASDR (34.32), highlighting the urgent need for targeted tobacco control measures. Different cancers in various countries exhibit unique characteristics. Therefore, policymakers should formulate specific prevention and control strategies that reflect the cancer in their country. Tobacco was the primary level 2 risk factor for cancer DALYs in males. It accounted for 29.32% (25.32-33.14) of all cancer DALYs. Dietary risks, alcohol consumption, and air pollution accounted for 5.89% (2.01-10.73), 5.48% (4.83-6.11), and 4.30% (2.77-5.95) of male cancer DALYs, respectively. Therefore, policymakers should prioritize smoking regulation and other carcinogenic risks.

CONCLUSION

Cancer is a significant public health concern globally. Understanding the common etiologies of different cancers is essential for developing effective control strategies and targeted interventions.

The acute phase management of traumatic spinal cord injury (tSCI) with polytrauma: A narrative review

Introduction

Traumatic spinal cord injury (tSCI) is frequently observed in polytrauma patients.

Research question

What is the optimal strategy to manage tSCI in the setting of polytrauma?

Material and methods

This narrative review focuses on: 1) extraspinal damage control surgery and resuscitation, 2) the perioperative protection of the injured spine during emergency surgery, 3) imaging and timing of spinal surgery in polytrauma, 4) early interventions for skin, bowel and bladder, and 5) the multidisciplinary approach to tSCI polytrauma patients.

Results

Damage control resuscitation (DCR) and damage control surgery (DCS), aim to prevent/correct post-traumatic physiological derangements to minimize bleeding until definitive hemostasis is achieved. Spinal protection during emergency surgery is of paramount importance to reduce secondary insults to the injured spine. Imaging, especially magnetic resonance imaging (MRI), is useful for decision-making regarding surgical management of the injured spine. Early decompressive surgery (within 24 h from trauma) is associated with better neurological outcomes. Early consultation with a physical medicine and rehabilitation physician is beneficial to optimize recovery. A close collaboration between different medical specialties involved in the early management of tSCI patients with polytrauma is advisable to improve outcome.

Discussion and conclusion

This narrative review aims to collate basic knowledge regarding acute phase management of tSCI patients in the context of polytrauma. More evidence and data form well-powered studies are necessary in this setting.

Electrical stimulation and conductive materials: electrophysiology-based treatment for spinal cord injury

Spinal cord injury is a serious disease of the central nervous system. The electrophysiological properties of the spinal cord that are essential to maintaining neurotransmission can be impaired after the injury. Therefore, electrophysiological evaluation is becoming an important indicator of the injury extent or the therapeutic outcomes by reflecting the potential propagation of neural pathways. On the other hand, the repair of damaged nerves is one of the main goals of spinal cord injury treatment. Growing research interest has been concentrated on developing effective therapeutic solutions to restore the normal electrophysiological function of the injured spinal cord by using conductive materials and/or exerting the merits of electrical stimulation. Accordingly, this review introduces the current common electrophysiological evaluation in spinal cord injury. Then the cutting-edge therapeutic strategies aiming at electrophysiological improvement in spinal cord injury are summarized. Finally, the challenges and future prospects of neural restoration after spinal cord injury are presented.