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Kurban D, Davidson RA, Smith KM, Carlson M, Joseph J, Elliott S, Noonan VK, Fallah N, Krassioukov AV. Construct validity of the international standards to document remaining autonomic function after spinal cord injury (ISAFSCI) (1st edition). Spinal Cord 2023; 61:644-651. [PMID: 37814014 DOI: 10.1038/s41393-023-00932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
STUDY DESIGN Observational study. OBJECTIVES To assess the construct validity of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) (2012 1st Edition). SETTING Two Canadian spinal cord injury (SCI) centers. METHODS Data were collected between 2011-2014. Assessments included the ISAFSCI, standardized measures of autonomic function and a clinical examination. Construct validity of ISAFSCI was assessed by testing a priori hypotheses on expected ISAFSCI responses to standard measures (convergent hypotheses) and clinical variables (clinical hypotheses). RESULTS Forty-nine participants with an average age of 45 ± 12 years were included, of which 42 (85.7%) were males, 37 (77.6%) had a neurological level of injury at or above T6, and 23 (46.9%) were assessed as having motor and sensory complete SCI. For the six General Autonomic Function component hypotheses, two hypotheses (1 clinical, 1 convergent) related to autonomic control of blood pressure and one clinical hypothesis for temperature regulation were statistically significant. In terms of the Lower Urinary Tract, Bowel and Sexual Function component of the ISAFSCI, all the hypotheses (5 convergent, 3 clinical) were statistically significant except for the hypotheses on female sexual items (2 convergent, 2 clinical), likely due to small sample size. CONCLUSION The construct validity of ISAFSCI (2012 1st Edition) for the General Autonomic Function component was considered to be weak while it was much stronger for the Lower Urinary Tract, Bowel and Sexual Function component based on a priori hypotheses. These results can inform future psychometric studies of the ISAFSCI (2021 2nd Edition).
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Affiliation(s)
| | - Ross A Davidson
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Karen M Smith
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada
| | - Marie Carlson
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | | | - Stacy Elliott
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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El Sammak S, Michalopoulos GD, Arya N, Bhandarkar AR, Moinuddin FM, Jarrah R, Yolcu YU, Shoushtari A, Bydon M. Prediction Model for Neurogenic Bladder Recovery One Year After Traumatic Spinal Cord Injury. World Neurosurg 2023; 179:e222-e231. [PMID: 37611802 DOI: 10.1016/j.wneu.2023.08.054] [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: 05/21/2023] [Revised: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Neurogenic bladder is a common complication after spinal cord injury (SCI) that carries substantial burdens on the inflicted individual. The objective of this study is to build a prediction model for neurogenic bladder recovery 1 year after traumatic SCI. METHODS We queried the National Spinal Cord Injury Model Systems database for patients with traumatic SCI who had neurogenic bladder at the time of injury. The primary outcome of interest was the complete recovery of bladder function at 1 year. Multiple imputations were performed to generate replacement values for missing data, and the final imputed data were used for our analysis. A multivariable odds logistic regression model was developed for complete bladder recovery at 1 year. RESULTS We identified a total of 2515 patients with abnormal bladder function at baseline who had an annual follow-up. A total of 417 patients (16.6%) recovered bladder function in 1 year. Predictors of complete bladder recovery included the following baseline parameters: sacral sensation, American Spinal Injury Association (ASIA) impairment score, bowel function at baseline, voluntary sphincter contraction, anal sensation, S1 motor scores, and the number of days in the rehabilitation facility. The model performed with a discriminative capacity of 90.5%. CONCLUSIONS We developed a prediction model for the probability of complete bladder recovery 1 year after SCI. The model performed with a high discriminative capacity. This prediction model demonstrates potential utility in the counseling, research allocation, and management of individuals with SCI.
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Affiliation(s)
- Sally El Sammak
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Namrata Arya
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Phoenix, Arizona, USA
| | - Archis R Bhandarkar
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - F M Moinuddin
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Jarrah
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz U Yolcu
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Shoushtari
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Ju C, Ma Y, Zuo X, Wang X, Song Z, Zhang Z, Zhu Z, Li X, Liang Z, Ding T, Hu X, Wang Z. Photobiomodulation promotes spinal cord injury repair by inhibiting macrophage polarization through lncRNA TUG1-miR-1192/TLR3 axis. Cell Mol Biol Lett 2023; 28:5. [PMID: 36658478 PMCID: PMC9854040 DOI: 10.1186/s11658-023-00417-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Secondary spinal cord injury (SCI) often causes the aggravation of inflammatory reaction and nerve injury, which affects the recovery of motor function. Bone-marrow-derived macrophages (BMDMs) were recruited to the injured area after SCI, and the M1 polarization is the key process for inducing inflammatory response and neuronal apoptosis. We previously showed that photobiomodulation (PBM) can inhibit the polarization of M1 phenotype of BMDMs and reduce inflammation, but the underlying mechanisms are unclear. The purpose of this study is to explore the potential target and mechanism of PBM in treating SCI. METHODS Transcriptome sequencing and bioinformatics analysis showed that long noncoding RNA taurine upregulated gene 1 (lncRNA TUG1) was a potential target of PBM. The expression and specific mechanism of lncRNA TUG1 were detected by qPCR, immunofluorescence, flow cytometry, western blotting, fluorescence in situ hybridization, and luciferase assay. The Basso mouse scale (BMS) and gait analysis were used to evaluate the recovery of motor function in mice. RESULTS Results showed that lncRNA TUG1 may be a potential target of PBM, regulating the polarization of BMDMs, inflammatory response, and the axial growth of DRG. Mechanistically, TUG1 competed with TLR3 for binding to miR-1192 and attenuated the inhibitory effect of miR-1192 on TLR3. This effect protected TLR3 from degradation, enabling the high expression of TLR3, which promoted the activation of downstream NF-κB signal and the release of inflammatory cytokines. In vivo, PBM treatment could reduce the expression of TUG1, TLR3, and inflammatory cytokines and promoted nerve survival and motor function recovery in SCI mice. CONCLUSIONS Our study clarified that the lncRNA TUG1/miR-1192/TLR3 axis is an important pathway for PBM to inhibit M1 macrophage polarization and inflammation, which provides theoretical support for its clinical application in patients with SCI.
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Affiliation(s)
- Cheng Ju
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Yangguang Ma
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Xiaoshuang Zuo
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Xuankang Wang
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Zhiwen Song
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Zhihao Zhang
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Zhijie Zhu
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Xin Li
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Zhuowen Liang
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Tan Ding
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Xueyu Hu
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
| | - Zhe Wang
- grid.233520.50000 0004 1761 4404Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle West Road No. 127, Xi’an, 710032 Shaanxi China
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What should be clarified when learning the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) among medical students. Spinal Cord Ser Cases 2021; 7:68. [PMID: 34333517 DOI: 10.1038/s41394-021-00431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/08/2022] Open
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Wyndaele JJ, Wyndaele MIAJ, Sakakibara R. Testing sensation of gently squeezing the testes has diagnostic value in spinal cord injury men. Spinal Cord Ser Cases 2021; 7:67. [PMID: 34330888 PMCID: PMC8324907 DOI: 10.1038/s41394-021-00430-5] [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: 04/10/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Determine the diagnostic value of testing the sensation of squeezing the testes. SETTING Research group run by the University of Antwerp. METHODS During the clinical examination, it was evaluated if male spinal cord injury (SCI) patients felt gentle squeezing of the testes. The outcome was related to the type of SCI, to the sensations of the light touch of the dermatomes of the perineum, of bladder filling, of overactive detrusor (DOA) contractions during urodynamics, and of electrosensation elicited in different parts of the lower urinary tract. The neurological pathways elicited by these tests were compared. RESULTS Seventy-four patients were included, mean age 46 ± 17 years, a number of weeks post SCI 318 ± 586. Sensation in the testes was present in 72.2%. In patients with AIS A, the sensation was found positive in 41%, while all with AIS B-D felt the sensation. Testes sensation was strongly correlated with the sensation of touch of the perineum and with the filling sensation during cystometry, proving a dorsal column pathway. The sensation of DOA contractions and electrosensation in the bladder, bladder neck/proximal, and distal urethra were not significantly related to the outcome of the testicular examination, showing that anterior and lateral spinothalamic pathways were not involved CONCLUSIONS: Our data show that sensation from gently squeezing the testes informs about the dorsal column from spinal cord level T10-L2 upwards. The test can help refine the neurologic diagnosis after SCI. We advocate to include this easy-to-do test in the neuro-urologic clinical examination.
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Affiliation(s)
| | | | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Tokyo, Japan
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