Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review

(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations.

Immune activation is essential for the antitumor activity of EZH2 inhibition in urothelial carcinoma

The long-term survival of patients with advanced urothelial carcinoma (UCa) is limited because of innate resistance to treatment. We identified elevated expression of the histone methyltransferase EZH2 as a hallmark of aggressive UCa and hypothesized that EZH2 inhibition, via a small-molecule catalytic inhibitor, might have antitumor effects in UCa. Here, in a carcinogen-induced mouse bladder cancer model, a reduction in tumor progression and an increase in immune infiltration upon EZH2 inhibition were observed. Treatment of mice with EZH2i causes an increase in MHC class II expression in the urothelium and can activate infiltrating T cells. Unexpectedly, we found that the lack of an intact adaptive immune system completely abolishes the antitumor effects induced by EZH2 catalytic inhibition. These findings show that immune evasion is the only important determinant for the efficacy of EZH2 catalytic inhibition treatment in a UCa model.

P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

Introduction

Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients.

Methods

A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review.

Results

Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%).

Discussion

Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

The interaction of Src and RACK1 is enhanced by activation of protein kinase C and tyrosine phosphorylation of RACK1

RACK1 is an intracellular receptor for the serine/ threonine protein kinase C. Previously, we demonstrated that RACK1 also interacts with the Src protein-tyrosine kinase. RACK1, via its association with these protein kinases, may play a key role in signal transduction. To further characterize the Src-RACK1 interaction and to analyze mechanisms by which cross-talk occurs between the two RACK1-linked signaling kinases, we identified sites on Src and RACK1 that mediate their binding, and factors that regulate their interaction. We found that the interaction of Src and RACK1 is mediated, in part, by the SH2 domain of Src and by phosphotyrosines in the sixth WD repeat of RACK1, and is enhanced by serum or platelet-derived growth factor stimulation, protein kinase C activation, and tyrosine phosphorylation of RACK1. To the best of our knowledge, this is the first report of tyrosine phosphorylation of a member of the WD repeat family of proteins. We think that tyrosine phosphorylation of these proteins is an important mechanism of signal transduction in cells.

Effects of topical tumoricidal agents on port-site recurrence of colon cancer: an experimental study in rats

BACKGROUND

Reports of metastatic spread of colon and rectal cancer to port sites after laparoscopic resection of potentially curable lesions has raised doubt regarding the efficacy and safety of laparoscopic technology in cancer surgery. Experimental study in animals has led us to believe that the mode of spread of these metastases is via the direct route. We hypothesized, therefore, that we could decrease the rate of trocar-site recurrences by treating the individual port sites with a topical tumoricidal agent.

MATERIALS AND METHODS

Male BD-IX rats weighing 240 to 360 g were injected with syngeneic colon cancer to simulate free intraperitoneal cancer spread to trocar sites. All rats were subjected to a sham laparoscopic operation after 2 x 10(5) viable cancer cells had been injected into their peritoneal cavities. Five-millimeter trocars were inserted into each rat after abdominal insufflation to 10 mm Hg. Pneumoperitoneum was maintained for 10 minutes before the trocars were removed simultaneously. Trocar sites were then subjected to one of three treatments, with each animal receiving a maximum of two different treatments. Sites were treated with 70% ethanol (N = 42), povidine/ iodine (N = 40), or no topical treatment (N = 46). Three weeks later, the animals were euthanized and autopsied. Subcutaneous tumors at trocar sites or tumors with >50% volume within the wound were considered implants.

RESULTS

Control sites revealed a metastasis rate of 41% (19/46). The tumor implant rate was 36% (15/42) at alcohol-treated sites and 20% (8/40) at sites treated with povidone-iodine (P < 0.05).

CONCLUSION

Topical administration of povidone-iodine to trocar wounds after laparoscopic surgery can significantly reduce the incidence of port-site metastasis in a syngeneic animal model of colon cancer.

Abdominal insufflation does not cause hematogenous spread of colon cancer

BACKGROUND AND PURPOSE

Previous investigators have suggested that port-site recurrences are possibly a result of abdominal insufflation, forcing viable cancer cells into the circulation to metastasize and thrive in areas of trauma. Using a syngeneic animal cancer model, we tested the hypothesis that pneumoperitoneum increases the incidence of wound metastasis by a blood-borne mechanism.

METHODS

Male BD IX rats (N = 150) were injected intraperitoneally with 2 x 10(5) viable syngeneic 1,2-dimethylhydralazine-induced colon cancer cells (DHD-K12). Animals were divided into three groups: A (abdominal insufflation with 3-cm incision on the back into muscle remote from the peritoneum); B (3-cm back incision alone); and C (control group with 3-cm midline abdominal incision). Three weeks after surgery, the animals were euthanized and autopsied.

RESULTS

In the two groups with back wounds, the incidence of cancer growth at the incision was zero, as demonstrated grossly and by histologic sample (A: 0/47, B: 0/43). In contrast, the autopsied control group had a 42% incidence of metastasis to the wound (25/59). There seemed to be no difference in the distribution of intra-abdominal disease between those rats that underwent insufflation and those that did not.

CONCLUSION

It is unlikely that pneumoperitoneum promotes hematogenous wound implantation of free intraperitoneal cancer cells.

The deltaA gene of zebrafish mediates lateral inhibition of hair cells in the inner ear and is regulated by pax2.1

Recent studies of inner ear development suggest that hair cells and support cells arise within a common equivalence group by cell-cell interactions mediated by Delta and Notch proteins. We have extended these studies by analyzing the effects of a mutant allele of the zebrafish deltaA gene, deltaA(dx2), which encodes a dominant-negative protein. deltaA(dx2/dx2)homozygous mutants develop with a 5- to 6-fold excess of hair cells and a severe deficiency of support cells. In addition, deltaA(dx2/dx2) mutants show an increased number of cells expressing pax2.1 in regions where hair cells are normally produced. Immunohistological analysis of wild-type and deltaA(dx2/dx2) mutant embryos confirmed that pax2.1 is expressed during the initial stages of hair cell differentiation and is later maintained at high levels in mature hair cells. In contrast, pax2.1 is not expressed in support cells. To address the function of pax2.1, we analyzed hair cell differentiation in no isthmus mutant embryos, which are deficient for pax2.1 function. no isthmus mutant embryos develop with approximately twice the normal number of hair cells. This neurogenic defect correlates with reduced levels of expression of deltaA and deltaD in the hair cells in no isthmus mutants. Analysis of deltaA(dx2/dx2); no isthmus double mutants showed that no isthmus suppresses the deltaA(dx2) phenotype, probably by reducing levels of the dominant-negative mutant protein. This interpretation was supported by analysis of T(msxB)(b220), a deletion that removes the deltaA locus. Reducing the dose of deltaA(dx2) by generating deltaA(dx2)/T(msxB)(b220)trans-heterozygotes weakens the neurogenic effects of deltaA(dx2), whereas T(msxB)(b220) enhances the neurogenic defects of no isthmus. mind bomb, another strong neurogenic mutation that may disrupt reception of Delta signals, causes a 10-fold increase in hair cell production and is epistatic to both no isthmus and deltaA(dx2). These data indicate that deltaA expressed by hair cells normally prevents adjacent cells from adopting the same cell fate, and that pax2.1 is required for normal levels of Delta-mediated lateral inhibition.

Abdominal incision tumor implantation following pneumoperitoneum laparoscopic procedure vs. standard open incision in a syngeneic rat model

INTRODUCTION

A recent hamster model study suggests that the abdominal wall wound implantation rate increases following laparoscopic colon cancer surgery compared with the traditional open technique. However, results of that study were confounded by several factors, including a midline incision in the laparoscopy group, an unclear definition of wound implantation, significant age variations in study subjects, and cell line use with low viability. The aim of this study was to compare the abdominal incision implantation rates following a pneumoperitoneum-laparoscopic-type procedure with a standard open incision using a syngeneic host/colon cancer rat model.

METHODS

Viable DHD/K12 rat colon carcinoma cells (2 x 10(5) cells/rat) were injected intraperitoneally via 18G angiocath into anesthetized, immunocompetent BD-IX rats (syngeneic host rats). Rats were then randomly divided into open incision and laparoscopy groups. At three weeks post-operatively, tumor growth at the injection, incision, and port sites was measured.

RESULTS

Following standard midline incision, 50 percent of rats (26/50 rats) developed wound implantations, whereas only 25 percent of rats (14/57 rats) developed at least one trocar site wound implantation after laparoscopy with pneumoperitoneum. Fourteen percent of trocar sites (16/114 port sites) developed wound implantations. No tumor growth was noted on the peritoneal surfaces other than in the incisional sites.

CONCLUSION

Laparoscopic-type procedure with pneumoperitoneum did not increase wound implantation in a syngeneic host/colon carcinoma rat model compared with the standard open incision technique.

Effect of sucrose acetate isobutyrate (SAIB) ingestion on the hepatobiliary function of normal human male and female volunteers

A study of the effects of sucrose acetate isobutyrate (SAIB) ingestion was conducted in 13 male and 14 female healthy human volunteers. SAIB, in a gum arabic/water emulsion diluted with orange juice, was ingested once daily, at a dose of 20 mg SAIB/kg body weight in a total volume of 1.16 ml/kg body weight, for a period of 2 wk following a 1-week control period. During the control period, the subjects consumed the same preparation without SAIB. The study was performed in a single-blind manner, each subject serving as his or her own control. Haematology and clinical chemistry tests were conducted on blood samples taken on day -6 and day 0 of the control period and at 7 and 15 days during the SAIB dosing period. In addition to routine haematology and clinical chemistry, specific tests of hepatobiliary function included serum alkaline phosphatase, aspartate and alanine aminotransferases, lactic dehydrogenase, gamma-glutamyltransferase, total and direct bilirubin, bile acids and proteins. None of these parameters were affected by ingestion of SAIB. It was concluded that ingestion of 20 mg SAIB/kg body weight daily for 14 days does not affect the hepatobiliary function of human volunteers.

Luteinizing hormone activates chloride currents in hen ovarian granulosa cells

Luteinizing hormone (LH) induces progesterone production in hen ovarian granulosa cells, and this induction is inhibited when chloride ions are removed from the culture medium. This suggests that chloride channels may be involved in the signal transduction pathway responsible for the LH-induced progesterone production. In this report, we examined effects of LH on plasma membrane ion currents in single granulosa cells isolated from the largest preovulatory follicle (Fl) of the hen (Gallus domesticus). Using the perforated patch whole cell voltage clamp technique, we found that addition of LH rapidly activated a chloride current in these cells. This chloride current was present at all voltages tested (-90 to +50 mV), showed outward rectification and showed no obvious time or voltage dependence. Its magnitude was 3.5-fold that of the total resting membrane current measured before LH treatment. LH is known to elevate cyclic AMP in these cells. We found that addition of the cAMP analog Sp-cAMPS mimicked LH in inducing chloride currents in these cells. We conclude that LH can activate a chloride conductance in granulosa cells, and that this action may be mediated by cAMP.

Bovine serum albumin enhances calcium currents in chicken granulosa cells

The effect of bovine serum albumin (BSA) on Ca2+ currents in chicken granulosa cells was examined using both the nystatin-perforated and the conventional whole cell patch clamp techniques. Under voltage-clamp conditions, depolarizing voltage steps evoked inward Ca2+ currents with both methods. The time- and voltage-dependence of Ca2+ currents measured with the perforated patch technique was similar to those obtained with conventional whole cell recording. Commercially prepared BSA and essentially fatty acid free BSA both rapidly enhanced the amplitude of Ca2+ currents. However, the fatty acid free BSA was more potent, and its potency was greatly reduced by incubation with saturating concentrations of oleic acid. These data show that BSA, a common constituent of incubation media, can influence ion channels in the plasma membrane of granulosa cells.

Electrical fields in the vicinity of epithelial wounds in the isolated bovine eye

A lateral potential drop along the outer surface of the cornea could be measured at the edge of wounds made in the corneal epithelium of the isolated bovine eye when the cornea was covered by simulated tear film of modified Hanks' solution. These lateral fields (LFs) had an average magnitude of 42 +/- 1.4 mV mm-1 in the first 0.25 mm from the wound edge. The polarity of these surface LFs is more positive at the wound than in regions away from the wound. Very little if any lateral field could be measured at the edge of wounds along the inner surface of the corneal epithelium. The surface LFs depend on the cornea's transepithelial potential (TEP), which in this isolated bovine eye preparation we determined (with conventional microelectrode techniques) to have an average value of 24.7 +/- 2.2 mV, stroma-side positive. We found that this TEP drives a current from wounds in the epithelium with an average current density of 55 +/- 12 microA cm-2. We also have found that the average transcorneal potential (TCP) was 3.2 +/- 0.5 mV greater than the average TEP, confirming that the major contribution to the TCP comes from the corneal epithelium.

Analysis of the role of hormones and growth factors in growth control and tissue differentiation using transplanted mammalian embryos and fetal structures

Results obtained from our analyses of the role of hormones and growth factors in rat embryonic and fetal development are reviewed. Whole 10-day embryos or structures from 14-16-day fetuses (paws, intestines, reproductive tracts) were transplanted under the kidney capsule of syngeneic host rats of different age, sex, physiological state or level of nutrition. In intact hosts, fetal transplants grew almost as much as they would have if left in situ in the fetuses, and tissue differentiation in them was essentially normal. By contrast, growth of embryo transplants was severely depressed relative to their growth in utero, but tissue differentiation was only slightly retarded. Fetal paws grew equally well in female hosts widely diverging in age and growth rate. Thus, in such hosts growth of the fetal paw was highly independent of the growth rate of the hosts. In hosts in which growth was arrested or reduced by diabetes, hypophysectomy or food restriction, growth of paw transplants was impaired, but not as severely as that of the hosts themselves. Fetal skeletal structures were relatively independent of thyroid hormones (TH) for growth; TH dependence developed progressively postnatally. In pregnant hosts, fetal paw transplants grew as well during the first half of gestation as they did in virgin females. By contrast, during the second half of pregnancy and during both halves of the lactational period, growth of the transplants was significantly reduced. Host skeletal growth was also inhibited during late pregnancy and throughout lactation. The impaired growth during the second half of gestation was associated with a large reduction in serum IGF-I concentration and a resistance to the growth-promoting actions of GH. In the lactating hosts, serum IGF-I concentration returned almost to prepregnancy levels and the resistance to GH persisted, but at a reduced level. The direct effects of hormones, growth factors, and antibodies to them on growth and tissue differentiation in the transplants were assessed using infusion methods. Substances were infused into the renal artery of transplant-bearing kidneys via catheters attached to osmotic minipumps. The direct effects of insulin, GH, IGFs, basic FGF and EGF on transplant growth and tissue differentiation were evaluated. Insulin directly stimulated growth of transplants in diabetic hosts but GH did not have a direct effect in hypophysectomized rats. The growth-restorative effects of GH observed in hypophysectomized hosts were apparently mediated indirectly via IGF-I. Infused rat IGF-II (MSA) was more effective at stimulating growth of embryo transplants than was recombinant human IGF-I.(ABSTRACT TRUNCATED AT 400 WORDS)

Growth-promoting properties of the internal milieu of pregnant and lactating rats

The growth-promoting properties of the internal milieu of pregnant and lactating rats were investigated using transplanted whole rat embryos or fetal paws. When placed under the kidney capsule of intact nonpregnant hosts and incubated for 12 days, such transplants grow rapidly, and tissues differentiate normally. Thus they provide an accurate means of assessing the growth-promoting properties of the internal environment of host animals in different physiological states. Transplant growth during days 0-11 of pregnancy was similar to that observed in age-matched virgin control hosts during an equivalent 12-day period. However, growth of transplants was decreased by 40% in hosts during days 10-22 of pregnancy and by approximately 30% in hosts during days 1-13 or days 11-23 of lactation. Increase in tail length, which was used as an index of maternal skeletal growth, was reduced by 50% during the second half of pregnancy and the early and late periods of lactation compared with age-matched virgin females. No such inhibition was recorded during the first half of pregnancy. Compared with virgins, serum insulin-like growth factor I (IGF-I) levels were reduced by approximately 20% on days 6 and 10 of pregnancy, and by 63-66% during the second half of gestation. Serum IGF-I levels rose during lactation to reach prepregnancy levels by day 12, but a second decline occurred by day 18 postpartum.(ABSTRACT TRUNCATED AT 250 WORDS)

[Neonatal necrotizing enterocolitis: surgical treatment]

Since December 1984 to July 1987, 18 patients with NEC were studied. Vásquez-Estévez's protocol, was applied in order to define the surgical indication, taking in to account ten different clinical and laboratory parameters, each one scored 0 to 3 points. Only patients with score 15 or more should be operated and this was the case in 30% of our NEC. In all surgically treated patients intestinal necrosis was a constant finding, two of them had also bowel perforations. No patients died in the conservative management group (score under 15). Lethality among operated subjects was 16%.

Use of a population-based tumor registry to estimate cancer incidence among a cohort of chemical workers

There have been many studies conducted of mortality in occupational cohorts, but few of cancer incidence. Two major facilities of the Western Division of Dow Chemical USA are located fortuitously within an area covered by the population-based California Tumor Registry, which allowed linkage of records to identify incident cancers among 1,403 male workers. Using adjusted county rates for comparison, 49 new cancers were observed in the cohort from 1969 through 1983, whereas 63.0 were expected (standardized incidence ratio = 78, 95% confidence limits = 53 to 103). Nonsignificant excesses were noted for several cancer groups among some categories of workers; however, there was no predominant tumor type within the groups. The successful completion of this collaborative project suggests that using population-based tumor registries for surveillance of occupational cohorts is feasible.

Evaluation of fluorescent antinuclear antibody assays, Crithidia luciliae substrate, and single-stranded DNA-binding capacity in diagnosis of four rheumatic diseases

Sera from groups of patient with systemic lupus erythematosus, mixed connective tissue disease, rheumatoid arthritis, and progressive systemic sclerosis and normal controls were compared, using different antinuclear antibody assays. Hep-II cells, used as a substrate for the detection of antinuclear antibodies, appeared to be more sensitive than rat liver substrate. In addition, the fluorescent patterns were easier to identify on Hep-II cells. All systemic lupus erythematosus sera with antibodies reactive with kinetoplasts of Crithidia luciliae had binding greater than 43% for single-stranded DNA. Based on the high sensitivity of the Hep-II substrate and the relative specificity of high (greater than 43%) binding for single stranded DNA by sera from patients with systemic lupus erythematosus, it appears that these two tests are most useful in differential diagnosis and for the detection of systemic lupus erythematosus.