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Fechner P, König F, Kratsch W, Lockl J, Röglinger M. Near-Infrared Spectroscopy for Bladder Monitoring: A Machine Learning Approach. ACM TRANSACTIONS ON MANAGEMENT INFORMATION SYSTEMS 2022. [DOI: 10.1145/3563779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Patients living with neurogenic bladder dysfunction can lose the sensation of their bladder filling. To avoid over-distension of the urinary bladder and prevent long-term damage to the urinary tract, the gold standard treatment is clean intermittent catheterization at predefined time intervals. However, the emptying schedule does not consider actual bladder volume, meaning that catheterization is performed more often than necessary which can lead to complications such as urinary tract infections. Time-consuming catheterization also interferes with patients' daily routines and, in the case of an empty bladder, uses human and material resources unnecessarily. To enable individually tailored and volume-responsive bladder management, we design a model for the continuous monitoring of bladder volume. During our design science research process, we evaluate the model's applicability and usefulness through interviews with affected patients, prototyping, and application to a real-world in vivo dataset. The developed prototype predicts bladder volume based on relevant sensor data (i.e., near-infrared spectroscopy and acceleration) and the time elapsed since the previous micturition. Our comparison of several supervised state-of-the-art machine and deep learning models reveals that a long short-term memory network architecture achieves a mean absolute error of 116.7
ml
that can improve bladder management for patients.
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Affiliation(s)
- Pascal Fechner
- inContAlert GmbH, Research Center Finance & Information Management, University of Bayreuth
| | - Fabian König
- Research Center Finance & Information Management, University of Applied Sciences Augsburg, Branch Business & Information Systems Engineering of the Fraunhofer FIT
| | - Wolfgang Kratsch
- Research Center Finance & Information Management, University of Applied Sciences Augsburg, Branch Business & Information Systems Engineering of the Fraunhofer FIT
| | - Jannik Lockl
- inContAlert GmbH, University of Bayreuth, University College London
| | - Maximilian Röglinger
- Research Center Finance & Information Management, University of Bayreuth, Branch Business & Information Systems Engineering of the Fraunhofer FIT
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Osei-Owusu P, Collyer E, Dahlen SA, Echols Adams RE, Tom VJ. Maladaptation of Renal Hemodynamics Contributes to Kidney Dysfunction Resulting from Thoracic Spinal Cord Injury in Mice. Am J Physiol Renal Physiol 2022; 323:F120-F140. [PMID: 35658716 PMCID: PMC9306783 DOI: 10.1152/ajprenal.00072.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal dysfunction is a hallmark of spinal cord injury (SCI). Several SCI sequalae are implicated, however, the exact pathogenic mechanism of renal dysfunction is unclear. Herein, we found that T3 (T3Tx) or T10 (T10Tx) complete thoracic spinal cord transection induced hypotension, bradycardia, and hypothermia immediately after injury. T3Tx-induced hypotension but not bradycardia or hypothermia slowly recovered to levels in T10Tx SCI and uninjured mice ~16 h after injury as determined by continuous radiotelemetry monitoring. Both types of thoracic SCI led to a marked decrease in albuminuria and proteinuria in all phases of SCI, while the kidney injury marker, NGAL, rapidly increased in the acute phase, remaining elevated in the chronic phase of T3Tx SCI. Renal interstitial and vascular elastin fragmentation after SCI were worsened during chronic T3Tx SCI. In the chronic phase, renal vascular resistance response to a step increase in renal perfusion pressure or a bolus injection of Ang II or NE was almost completely abolished after T3Tx SCI. Bulk RNAseq analysis showed enrichment of genes involved in extracellular matrix (ECM) remodeling and chemokine signaling in the kidney from T3Tx SCI mice. Serum levels of interleukin 6 was elevated in the acute but not chronic phase of T3Tx and T10Tx SCI, while serum amyloid A1 level was elevated in both acute and chronic phases. We conclude that tissue fibrosis and hemodynamic impairment are involved in renal dysfunction resulting from thoracic SCI; these pathological alterations, exacerbated by high thoracic-level injury, is mediated at least partly by renal microvascular ECM remodeling.
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Affiliation(s)
- Patrick Osei-Owusu
- Physiology & Biophysics, Case Western Reserve University, Cleveland, OH, United States
| | - Eileen Collyer
- Neurobiology and Anatomy, Drexel University, Philadelphia, PA, United States
| | - Shelby A Dahlen
- Physiology & Biophysics, Case Western Reserve University, Cleveland, OH, United States
| | - Raisa E Echols Adams
- Physiology & Biophysics, Case Western Reserve University, Cleveland, OH, United States
| | - Veronica J Tom
- Neurobiology and Anatomy, Drexel University, Philadelphia, PA, United States
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Eckerbom P, Hansell P, Cox E, Buchanan C, Weis J, Palm F, Francis S, Liss P. Circadian variation in renal blood flow and kidney function in healthy volunteers monitored with noninvasive magnetic resonance imaging. Am J Physiol Renal Physiol 2020; 319:F966-F978. [PMID: 33073586 DOI: 10.1152/ajprenal.00311.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Circadian regulation of kidney function is involved in maintaining whole body homeostasis, and dysfunctional circadian rhythm can potentially be involved in disease development. Magnetic resonance imaging (MRI) provides reliable and reproducible repetitive estimates of kidney function noninvasively without the risk of adverse events associated with contrast agents and ionizing radiation. The purpose of this study was to estimate circadian variations in kidney function in healthy human subjects with MRI and to relate the findings to urinary excretions of electrolytes and markers of kidney function. Phase-contrast imaging, arterial spin labeling, and blood oxygen level-dependent transverse relaxation rate (R2*) mapping were used to assess total renal blood flow and regional perfusion as well as intrarenal oxygenation in eight female and eight male healthy volunteers every fourth hour during a 24-h period. Parallel with MRI scans, standard urinary and plasma parameters were quantified. Significant circadian variations of total renal blood flow were found over 24 h, with increasing flow from noon to midnight and decreasing flow during the night. In contrast, no circadian variation in intrarenal oxygenation was detected. Urinary excretions of electrolytes, osmotically active particles, creatinine, and urea all displayed circadian variations, peaking during the afternoon and evening hours. In conclusion, total renal blood flow and kidney function, as estimated from excretion of electrolytes and waste products, display profound circadian variations, whereas intrarenal oxygenation displays significantly less circadian variation.
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Affiliation(s)
- Per Eckerbom
- Section of Radiology, Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Peter Hansell
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Buchanan
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Jan Weis
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Fredrik Palm
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Per Liss
- Section of Radiology, Department of Surgical Sciences, University Hospital, Uppsala, Sweden
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Haddad R, Denys P, Arlandis S, Giannantoni A, Del Popolo G, Panicker JN, De Ridder D, Pauwaert K, Van Kerrebroeck PE, Everaert K. Nocturia and Nocturnal Polyuria in Neurological Patients: From Epidemiology to Treatment. A Systematic Review of the Literature. Eur Urol Focus 2020; 6:922-934. [PMID: 32192920 DOI: 10.1016/j.euf.2020.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/12/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population. OBJECTIVE To systematically review the literature about nocturia in neurological patients. EVIDENCE ACQUISITION Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators. EVIDENCE SYNTHESIS A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not. CONCLUSIONS Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients. PATIENT SUMMARY In this report, we looked at the published studies about nocturia-the fact of waking to void during the hours of sleep-in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic.
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Affiliation(s)
- Rebecca Haddad
- Urology Department, Ghent University Hospital, Ghent, Belgium.
| | - Pierre Denys
- Neuro-Urology Unit, PMR Department, Université de Versailles Saint Quentin, APHP, Raymond Poincaré Hospital, Garches, France
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Siena, Italy
| | - Giulio Del Popolo
- Neuro-Urology & Spinal Unit Department, Careggi University Hospital, Firenze, Italy
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Dirk De Ridder
- Urology, University Hospitals KU Leuven, Leuven, Belgium
| | - Kim Pauwaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
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Everaert K, Hervé F, Bower W, Djurhuus JC, Dmochowski R, Fine N, Wein A, Wyndaele M, Weiss J. How can we develop a more clinically useful and robust algorithm for diagnosing and treating nocturia? ICI-RS 2017. Neurourol Urodyn 2019; 37:S46-S59. [PMID: 30133785 DOI: 10.1002/nau.23569] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/26/2018] [Indexed: 12/15/2022]
Abstract
AIMS Nocturia, or waking up at night to void, is a highly prevalent and bothersome symptom. Currently, there is a lack of clear and consistent recommendations regarding evaluation and management of nocturia. The aim of this report is to discuss how to fill the gaps in our knowledge in order to develop a practical patient-oriented diagnostic and therapeutic algorithm for nocturia. METHODS This paper is a report of the presentations and subsequent discussion of a Think Tank session at the annual International Consultation on Incontinence Research Society (ICI-RS) in June 2017 in Bristol. RESULTS AND CONCLUSION Further investigations are needed to better understand the pathophysiology of nocturia, to allow improvement in diagnosis, and to optimize treatment by increasing efficacy and reducing adverse events. Patient-oriented practical guidelines on nocturia are needed to help clinicians from different disciplines diagnose and treat nocturia.
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Affiliation(s)
- Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - François Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Wendy Bower
- Faculty of Medicine, Department of Medicine and Community Care, Melbourne Health, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
| | - Jens C Djurhuus
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennesse
| | - Noam Fine
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York
| | - Alan Wein
- Department of Urology, Perelman School of Medicine-University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michel Wyndaele
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Jeffrey Weiss
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York
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Gumbel JH, Montgomery LR, Yang CB, Hubscher CH. Activity-Based Training Reverses Spinal Cord Injury-Induced Changes in Kidney Receptor Densities and Membrane Proteins. J Neurotrauma 2019; 37:555-563. [PMID: 31456470 DOI: 10.1089/neu.2019.6670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Complications in upper and lower urinary function arise after spinal cord injury (SCI), which creates a significant impact on quality of life for those affected. One upper urinary complication is SCI-induced polyuria, or the overproduction of urine, of which the underlying mechanisms have yet to be elucidated. Activity-based training (ABT) has been utilized in both animal and clinical settings as a rehabilitative therapy to improve many issues that arise after SCI, including more recently urogenital function. The goal of the current study was to identify potential mechanisms contributing to previously identified improvements in polyuria with ABT, using a male rat moderate-severe spinal contusion model. Although ABT had no significant effect on reversing injury-induced alterations of serum arginine vasopressin and urinary atrial natriuretic peptide levels, there was a dramatic effect upon the receptors of these fluid balance hormones (vasopressin receptor 2 and natriuretic peptide A receptor), as well as kidney aquaporin 2 and sodium channels. ABT changes in densities of key receptors and kidney membrane proteins involved in fluid balance after chronic SCI support the likelihood of multiple mechanisms through which exercise can positively influence urinary tract function after SCI. By understanding the mechanisms, amount, and timing regarding how ABT improves different aspects of urinary function, more targeted training strategies can be developed to optimize the functional gains within the SCI population.
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Affiliation(s)
- Jason H Gumbel
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky
| | - Lynnette R Montgomery
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Rehabilitation Center, University of Louisville, Louisville, Kentucky
| | - Cui Bo Yang
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky
| | - Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Rehabilitation Center, University of Louisville, Louisville, Kentucky
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7
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Ahmed WA, Rouse A, Griggs KE, Collett J, Dawes H. Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study. Spinal Cord 2019; 58:165-173. [PMID: 31358907 DOI: 10.1038/s41393-019-0330-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective chart audit. OBJECTIVES The National Early Warning Score (NEWS) is based on seven physiological parameters which can be altered in some individuals with spinal cord injuries (SCI). The aim was to start the development of adapted NEWS suitable for SCI population. The objective was to determine the SBP NEWS specificity based on neurological level of injury (NLI) and completeness of injury. SETTING Tertiary centre in the UK. METHODS Adult patients admitted for the first time to the National Spinal Injuries Centre between 1 January 2015 and 31 December 2016 were included if they were >6 months post injury. Data were extracted retrospectively including the last ten consecutive BP and heart rate readings before discharge. Data were analysed based on different AIS grades, completeness of injury and NLI. RESULTS One hundred and ninety one patients were admitted in 2015 and 2016 and 142 patients were included in the primary analysis. The mean SBP ranged between 92 and 151 mmHg. Patients with the NLI of T6 and above (≥T6) motor complete lesions had a significantly lower SBP than motor incomplete lesions. The specificity of the SBP NEWS was 35.3% in ≥T6 motor complete individuals versus 80.3% in ≥T6 motor incomplete individuals. CONCLUSION The baseline BP is significantly lower in the ≥T6 motor complete SCI individuals (>6 months post injury) resulting in a very low specificity of 35.3% to SBP NEWS, which could lead to mismatch between clinical deterioration and NEWS resulting in lack of timely clinical response.
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Affiliation(s)
- Wail A Ahmed
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. .,Oxford Brookes University, Oxford, UK.
| | - Alex Rouse
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.,Oxford Brookes University, Oxford, UK
| | - Katy E Griggs
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, UK
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Fang X, Goh MY, O'Callaghan C, Berlowitz D. Relationship between autonomic cardiovascular control and obstructive sleep apnoea in persons with spinal cord injury: a retrospective study. Spinal Cord Ser Cases 2018; 4:29. [PMID: 29619250 DOI: 10.1038/s41394-018-0062-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/16/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022] Open
Abstract
Study design Retrospective study. Objective To determine if there is an association between obstructive sleep apnoea (OSA) and blood pressure (BP) pattern or heart rate variability (HRV) in people with spinal cord injury (SCI). Setting A state-based spinal cord service in Victoria, Australia. Methods We identified 42 subjects who had ambulatory BP monitoring (ABPM) within 6 months of a diagnostic sleep study at Austin Hospital between 2009 and 2014. Markers for autonomic function, including circadian BP pattern and HRV were extracted from the ABPM study database. Apnoea/hypopnoea index (AHI), arousals/hour and oxygen desaturation index were extracted from the sleep study database. Subjects with a nocturnal systolic BP dipping more than 10% of daytime value were defined as dippers, between 10 and 0% were non-dippers and those with a higher night than day systolic BP were reverse dippers. Severity of OSA is classified as non-OSA (AHI < 5), mild (AHI 5-15), moderate (AHI 15-30) and severe (AHI > 30). Results Subjects (n = 42) were predominantly male (85.7%), aged 44 ± 15.4 (mean ± SD), with a BMI of 24.4 ± 5.7 (mean ± SD) and mainly tetraplegic (92.9%). There was no difference in AHI, oxygen desaturation index or arousals/hour between dippers, non-dippers and reverse dippers. None of the HRV parameters differed between dippers, non-dippers and reverse dippers. No differences were found in 24 h, night-time, daytime or nocturnal dip in BP between subjects with non-OSA, mild, moderate and severe OSA. Conclusion We found no relationship between BP pattern or HRV and the severity of OSA in persons with SCI.
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Affiliation(s)
- Xizhe Fang
- 1Institute for Breathing and Sleep, Austin Hospital, Heidelberg, VIC Australia.,2University of Melbourne, Melbourne, VIC Australia
| | - Min Yin Goh
- 2University of Melbourne, Melbourne, VIC Australia.,3Department of Clinical Pharmacology, Austin Hospital, Heidelberg, VIC Australia.,The Spinal Research Institute, Melbourne, VIC Australia
| | - Christopher O'Callaghan
- 2University of Melbourne, Melbourne, VIC Australia.,3Department of Clinical Pharmacology, Austin Hospital, Heidelberg, VIC Australia
| | - David Berlowitz
- 1Institute for Breathing and Sleep, Austin Hospital, Heidelberg, VIC Australia
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Goh MY, Millard MS, Wong ECK, Berlowitz DJ, Graco M, Schembri RM, Brown DJ, Frauman AG, O’Callaghan CJ. Comparison of diurnal blood pressure and urine production between people with and without chronic spinal cord injury. Spinal Cord 2018; 56:847-855. [DOI: 10.1038/s41393-018-0081-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 12/20/2022]
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10
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Wecht JM, Bauman WA. Implication of altered autonomic control for orthostatic tolerance in SCI. Auton Neurosci 2018; 209:51-58. [DOI: 10.1016/j.autneu.2017.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/16/2017] [Accepted: 04/25/2017] [Indexed: 12/22/2022]
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11
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Sankari A, Martin JL, Badr MS. Sleep Disordered Breathing and Spinal Cord Injury: Challenges and Opportunities. CURRENT SLEEP MEDICINE REPORTS 2017; 3:272-278. [PMID: 29177130 DOI: 10.1007/s40675-017-0093-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose of review This paper focuses on the sleep disorders in patients with spinal cord injury (SCI/D), particularly mechanism of sleep disordered breathing (SDB) and challenges in diagnosis and management. Based on a review of recent literatures and studies the paper summarizes some main challenges with respect to management of SDB in patients with SCI; and what are the responsible mechanisms of disease? What are the barriers in diagnosing and treating SDB using standard treatment such as positive airway pressure (CPAP)?. Recent findings Previous studies have shown that most SCI/D patients have SDB with heterogeneity in prevalence mainly related to using different definition or methods of diagnosing SDB, while recent studies using new definition of SDB based on recommended criteria from the American Academy of Sleep Medicine (AASM) and also include the data on effect of SCI/D level on prevalence and describe different type of SDB. Furthermore, recent data describes simplified method of diagnosing SDB by using a combination of home sleep apnea testing and transcutaneous CO2 monitoring. Finally, emerging data has been pointing at strong relationship between SDB and cardiovascular disease including nocturnal hypertension in patients with SCI/D. Summary The findings indicate that early testing for SDB and associated cardiovascular disease in patients with SCI is recommended and could be beneficial in reduced the high morbidity and mortality in this group of patients with disability. In addition, studies on treatment of other sleep disorders in SCI/D are not available to inform clinical decision making. Understanding the pathophysiology of sleep disorders in SCI/D is critical for the development of new effective therapies. This review provides evidence for best practices; highlights new discoveries for the diagnosis and management of sleep disorders in SCI/D, and discuss challenges and future directions.
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Affiliation(s)
- Abdulghani Sankari
- John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Jennifer L Martin
- VA Greater Los Angeles Healthcare System, North Hills, CA, USA.,David Geffen School of Medicine at the University of California, Los Angeles
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Medicine, Wayne State University, Detroit, MI, USA
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Montgomery LR, Hubscher CH. Altered vasopressin and natriuretic peptide levels in a rat model of spinal cord injury: implications for the development of polyuria. Am J Physiol Renal Physiol 2017; 314:F58-F66. [PMID: 28877880 DOI: 10.1152/ajprenal.00229.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Urinary dysfunction is a common complaint following spinal cord injury (SCI) and is a leading issue for individuals with SCI that impacts their quality of life. One urinary complication that has received little attention is SCI-induced polyuria, even though individuals with SCI will significantly restrict their fluid intake to decrease urine production, leading to sequelae of medical complications. Understanding the mechanisms instigating the development of polyuria will allow us to target interventions that may alleviate polyuria symptoms, leading to significant improvements in the quality of life and urinary health of individuals with SCI. In a rat SCI contusion model, an increase in the amount of urine excreted over a 24-h period ( P ≤ 0.001) was found at 2 wk postinjury. The urine excreted was more dilute with decreased urinary creatinine and specific gravity ( P ≤ 0.001). Several factors important in fluid balance regulation, vasopressin (AVP), natriuretic peptides, and corticosterone (CORT), also changed significantly postinjury. AVP levels decreased ( P = 0.042), whereas atrial natriuretic peptide (ANP) and CORT increased ( P = 0.005 and P = 0.031, respectively) at 2 wk postinjury. There was also a positive correlation between the increase in ANP and urine volume postinjury ( P = 0.033). The changes in AVP, ANP, and CORT are conducive to producing polyuria, and the timing of these changes coincides with the development of SCI-induced polyuria. This study identifies several therapeutic targets that could be used to ameliorate polyuria symptoms and improve quality of life in individuals with SCI.
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Affiliation(s)
- Lynnette R Montgomery
- Department of Anatomical Sciences and Neurobiology and Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky
| | - Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology and Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky
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