Search

Background: This research aimed to identify evidence-based protocols for the safe management of bladder infections and the prevention of UTIs in athletes who have spinal cord injuries (SCI), as they are constantly at high risk of developing UTIs again. Study design: Scoping review Methodology: Four databases were searched (PubMed, Scopus, Web of Science, and Science Direct) for pertinent literature. The non-randomized controlled studies (non-RCT) and randomized controlled trials (RCT) that described the application of any particular measure to properly manage bladder and avoid urinary tract infections (UTIs) in people with spinal cord injuries (SCIs) were chosen. Results: Forty-nine articles were screened for the effectiveness of weekly oral cyclic antibiotics, bacterial interference, coated catheter types, and patient education in preventing UTIs in SCI were shown in 20 RCT and 29 non-RCT researches. Concerns were raised about cranberry supplements and low-dose antibiotic prophylaxis, which is unreliable and leads to the emergence of germs that are resistant to many drugs. Conclusion: According to the scoping review, WOCA is the most effective antibiotic regimen. The proven methods for treating UTIs in SCI patients include coated catheters, bacterial interference, bladder irrigation, and patient education. Moreover, there is a great deal of variation in the research about the efficacy of cranberries. The best option for safe bladder management and preventing UTIs in SCIs is to use suprapubic and coated intermittent catheters (ICs). When a urine bag is full, it should be changed out for a fresh one, and patients should be told to employ spontaneous voiding if that's not an option. [ABSTRACT FROM AUTHOR]

Objectives: Immune regulation is a pivotal factor in the pathogenesis and repair of spinal cord injury (SCI). This study aims to explore potential immune center genes associated with spinal cord injury. Methods: The public data set GSE151371 was obtained from the GEO database. The R software package "limma" was used to identify differentially expressed genes (DEGs) in SCI. GO, KEGG and GSEA pathway analyses were performed using the DEGs. The key module genes related to spinal cord injury were selected through WGCNA analysis. Overlapping genes were extracted from WGCNA, DEGs, and immune-related genes. LASSO analysis was employed to identify central genes associated with SCI immunity. Pearson correlation analysis assessed the correlation between hub genes and immune cells in SCI. In addition, we further investigated the hub genes' expression, diagnostic potential, function, and targeted drugs. Results: We have identified three immunity-related hub genes (ABHD5, EDNRB, EDN3). Immune infiltration analysis showed that the hub gene was significantly associated with resting NK cells, M2 macrophages, and monocytes in the immune microenvironment of SCI. ROC analysis demonstrated that these hub genes have favorable diagnostic performance for SCI. Functional analysis revealed that ABHD5 is primarily associated with lipid metabolism pathways, while EDN3 and EDNRB are mainly involved in endothelin, downstream GPCR signaling, and ERK signaling transduction. In addition, we identified six potential targeted drugs based on our findings. Conclusions: ABHD5, EDNRB, and EDN3 are involved in processes such as SCI progression or repair through immunomodulation and deserve further study. [ABSTRACT FROM AUTHOR]

Background: Sonic Hedgehog (Shh), extensively researched for its role in early neurogenesis and brain development, has recently been recognized for its neuroprotective potential following neuronal injuries. This study examines the immediate impact of early administered Shh on the local inflammatory response post-acute spinal cord injury in rats. Methods: Thirty-four female Wistar rats underwent either sham surgery (laminectomy; n = 10) or clip compression/contusion spinal cord injury (SCI) at the T9 level. This was followed by implantation of an osmotic pump and a subdural catheter for continuous intrathecal delivery of Shh (n = 12) or placebo (NaCl; n = 12). Locomotor function was assessed at 3- and 7-days post-injury (dpi) using the Basso, Beattie, and Bresnahan (BBB) score and the Gridwalk test. Animals were euthanized after 3 or 7 days for immunohistochemical analysis of the local inflammatory reaction and immune cell migration. Results: Shh-treated rats demonstrated significant hindlimb movement and coordination improvements at 7 days post-injury, compared to controls. This enhancement was accompanied by a significant reduction in both immune cell presence and blood plasma products within spinal cord lesions, suggesting Shh's dual role in modulating immune cell migration and maintaining the integrity of the blood-spinal cord barrier. Separately, these Shh-treated rats also showed an increase in M(IL-4) polarization of macrophages, further underlining the potential therapeutic impact of Shh in post-injury recovery. Notably, these effects were not evident at three days post-injury. Conclusion: Shh application at 7 days post-injury showed immunomodulatory effects, possibly via enhanced blood-spinal cord barrier integrity, reduced immune cell migration, and increased anti-inflammatory immune cell differentiation. These mechanisms collectively contribute to enhanced locomotor recovery. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact of developmental endothelial locus-1 (Del-1) on sarcoplasmic reticulum Ca2+ ATPase 2 (SERCA2) and its potential effects on spinal cord injury (SCI). A total of 48 mice were randomly assigned to the sham group, SCI group, and SCI + CE group. Each group was further divided into two subgroups. The Del treatment subgroup received tail-vein injections of Del-1 (1 μg/d) for a consecutive week, while the other group was injected with an equivalent volume of normal saline. After 1 week of experimentation, the mice were euthanized, and the spinal cord was extracted for further analysis. Initially, the impact of Del-1 on SERCA2 in the spinal cord was assessed using western blotting analysis. Subsequently, the effects of Del-1 on stress, inflammation, and apoptosis in the endoplasmic reticulum (ER) of SCI mice were analyzed through Western blotting analysis and fluorescent TUNEL. Finally, the study utilized Western blotting analysis and fluorescent TUNEL analysis to examine the consequences of Del-1 blocking SERCA2 on ER stress, inflammation, and apoptosis in mice. The results revealed that Del-1 treatment significantly increased the expression of SERCA2 in the spinal cord (P < 0.01) and mitigated SCI-induced ER stress, inflammation, and neuronal apoptosis (P < 0.01). Blocking SERCA2 expression in the spinal cord of SCI mice promoted ER stress, inflammatory response, and neuronal cell apoptosis (P < 0.01). However, Del-1 treatment did not alleviate the effects of blocking SERCA2 on ER stress, inflammatory response, and neuronal cell apoptosis (P > 0.05). In conclusion, this study proposed that Del-1 could reduce ER stress, inflammatory response, and nerve cell apoptosis in spinal cord injury by enhancing the expression of SERCA2. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar transcutaneous spinal cord stimulation (tSCS) non-invasively evokes posterior root-muscle reflexes (PRMR) with the aim of neuromodulating sensorimotor function following spinal cord injury. Research is still in its infancy regarding the effect of body position on the nature of these spinally evoked responses. Therefore, the aim of this study was to investigate the influence of body position on the nature of PRMR responses during tSCS. Methods: A total of 11 (6M, 5F) participants completed a full PRMR recruitment curve from 10 ma up to 120 ma (10 ma increments) at the T11/12 intervertebral space using a singular 3.2 cm diameter cathode. At each intensity, three paired pulses (50 ms inter-pulse interval), followed by three singular pulses with a six-second delay were applied in each body position (supine, supine 90-90, sitting and standing) in a randomised order. The PRMR responses in lower limb muscles were recorded using wireless electromyographic sensors placed on the Soleus, Tibialis Anterior, Rectus Femoris and Bicep Femoris long head. A two-way (body position × muscle) repeated measures analysis of variance was used to investigate the effect of body position on PRMR-evoked responses. Results: There was a significant main effect of body position on PRMR resting motor threshold (RMT) (p < 0.001), first response peak-to-peak amplitude (p = 0.003) and percentage post-activation depression (%PAD) (p = 0.012). Sitting had significantly higher RMT and significantly lower first response peak-to-peak amplitudes compared to all other positions, but significant differences in %PAD were only detectible between supine and standing. Conclusions: Body position influences the nature of PRMR-evoked responses during tSCS. [ABSTRACT FROM AUTHOR]

Introduction Spinal cord injury (SCI) may bring lifelong consequences for affected patients and a high financial burden to the health care system. Source of data Published peer-reviewed scientific articles identified from EMBASE, Google Scholar, PubMed and Scopus. Areas of agreement Surgery and blood pressure management are the main targets in acute SCI to avoid secondary damage. Areas of controversy The management of secondary chronic SCI is challenging, with unpredictable outcomes. Growing points Given the lack of consensus on pharmacological therapy for acute and secondary chronic SCI, the present study analyses the currently available drugs and treatment options to manage secondary chronic SCI. Areas timely for developing research Different approaches exist for the pharmacological management of secondary chronic SCI. One of the most investigated drugs, 4-aminopyridine, improves central motor conduction and shows improvement in neurological signs. Positive results in different areas have been observed in patients receiving the anti-spastic drugs tizanidine and baclofen or Granulocyte colony-stimulating factor. Growth hormone showed only minimal or no significant effects, and the therapy of secondary chronic SCI with riluzole has been poorly researched to date. [ABSTRACT FROM AUTHOR]

Exoskeleton can assist individuals with spinal cord injuries (SCI) with simple movements and transform their lives by enhancing strength and mobility. Nonetheless, the current utilization outside of rehabilitation contexts is limited. To promote the widespread adoption of exoskeletons, it is crucial to consider the acceptance of these devices for both rehabilitation and functional purposes. This systematic review aims to identify the barriers or facilitators of the use of lower limbs exoskeletons, thereby providing strategies to improve interventions and increase the adoption of these devices. A comprehensive search was conducted in EMBASE, Web of Science, Scopus, Cochrane, and PubMed. Studies reporting barriers and facilitators of exoskeleton use were included. The studies' quality was assessed using the Mixed Methods Appraisal Tool and undertook a thematic content analysis for papers examining the barriers and facilitators. Fifteen articles met the inclusion criteria. These revealed various factors that impact the utilization of exoskeletons. Factors like age, engagement in an active lifestyle, and motivation were identified as facilitators, while fear of falling and unfulfilled expectations were recognized as barriers. Physical aspects such as fatigue, neuropathic discomfort, and specific health conditions were found to be barriers. This systematic review provides a comprehensive overview of the barriers and facilitators to the use of exoskeleton technology. There are therefore still challenges to be faced, efforts must be made to improve its design, functionality, and accessibility. By addressing these barriers, exoskeletons can significantly improve the quality of life of people with SCI. Optimize the use of this technology to adapt as much as possible to individual needs. Offer an in-depth understanding of the challenges that can arise when adopting exoskeletons. Highlight the critical issues with the device, that prevent me from using it outside of clinical contexts. Offer useful information to therapists to select the most suitable patients for the use of the exoskeleton and to customize rehabilitation programs more effectively. [ABSTRACT FROM AUTHOR]

Abstract Background This research aimed to identify evidence-based protocols for the safe management of bladder infections and the prevention of UTIs in athletes who have spinal cord injuries (SCI), as they are constantly at high risk of developing UTIs again. Study design Scoping review Methodology Four databases were searched (PubMed, Scopus, Web of Science, and Science Direct) for pertinent literature. The non-randomized controlled studies (non-RCT) and randomized controlled trials (RCT) that described the application of any particular measure to properly manage bladder and avoid urinary tract infections (UTIs) in people with spinal cord injuries (SCIs) were chosen. Results Forty-nine articles were screened for the effectiveness of weekly oral cyclic antibiotics, bacterial interference, coated catheter types, and patient education in preventing UTIs in SCI were shown in 20 RCT and 29 non-RCT researches. Concerns were raised about cranberry supplements and low-dose antibiotic prophylaxis, which is unreliable and leads to the emergence of germs that are resistant to many drugs. Conclusion According to the scoping review, WOCA is the most effective antibiotic regimen. The proven methods for treating UTIs in SCI patients include coated catheters, bacterial interference, bladder irrigation, and patient education. Moreover, there is a great deal of variation in the research about the efficacy of cranberries. The best option for safe bladder management and preventing UTIs in SCIs is to use suprapubic and coated intermittent catheters (ICs). When a urine bag is full, it should be changed out for a fresh one, and patients should be told to employ spontaneous voiding if that's not an option.

Abstract Objectives Immune regulation is a pivotal factor in the pathogenesis and repair of spinal cord injury (SCI). This study aims to explore potential immune center genes associated with spinal cord injury. Methods The public data set GSE151371 was obtained from the GEO database. The R software package "limma" was used to identify differentially expressed genes (DEGs) in SCI. GO, KEGG and GSEA pathway analyses were performed using the DEGs. The key module genes related to spinal cord injury were selected through WGCNA analysis. Overlapping genes were extracted from WGCNA, DEGs, and immune-related genes. LASSO analysis was employed to identify central genes associated with SCI immunity. Pearson correlation analysis assessed the correlation between hub genes and immune cells in SCI. In addition, we further investigated the hub genes' expression, diagnostic potential, function, and targeted drugs. Results We have identified three immunity-related hub genes (ABHD5, EDNRB, EDN3). Immune infiltration analysis showed that the hub gene was significantly associated with resting NK cells, M2 macrophages, and monocytes in the immune microenvironment of SCI. ROC analysis demonstrated that these hub genes have favorable diagnostic performance for SCI. Functional analysis revealed that ABHD5 is primarily associated with lipid metabolism pathways, while EDN3 and EDNRB are mainly involved in endothelin, downstream GPCR signaling, and ERK signaling transduction. In addition, we identified six potential targeted drugs based on our findings. Conclusions ABHD5, EDNRB, and EDN3 are involved in processes such as SCI progression or repair through immunomodulation and deserve further study.

Abstract Background Sonic Hedgehog (Shh), extensively researched for its role in early neurogenesis and brain development, has recently been recognized for its neuroprotective potential following neuronal injuries. This study examines the immediate impact of early administered Shh on the local inflammatory response post-acute spinal cord injury in rats. Methods Thirty-four female Wistar rats underwent either sham surgery (laminectomy; n = 10) or clip compression/contusion spinal cord injury (SCI) at the T9 level. This was followed by implantation of an osmotic pump and a subdural catheter for continuous intrathecal delivery of Shh (n = 12) or placebo (NaCl; n = 12). Locomotor function was assessed at 3- and 7-days post-injury (dpi) using the Basso, Beattie, and Bresnahan (BBB) score and the Gridwalk test. Animals were euthanized after 3 or 7 days for immunohistochemical analysis of the local inflammatory reaction and immune cell migration. Results Shh-treated rats demonstrated significant hindlimb movement and coordination improvements at 7 days post-injury, compared to controls. This enhancement was accompanied by a significant reduction in both immune cell presence and blood plasma products within spinal cord lesions, suggesting Shh’s dual role in modulating immune cell migration and maintaining the integrity of the blood-spinal cord barrier. Separately, these Shh-treated rats also showed an increase in M(IL-4) polarization of macrophages, further underlining the potential therapeutic impact of Shh in post-injury recovery. Notably, these effects were not evident at three days post-injury. Conclusion Shh application at 7 days post-injury showed immunomodulatory effects, possibly via enhanced blood-spinal cord barrier integrity, reduced immune cell migration, and increased anti-inflammatory immune cell differentiation. These mechanisms collectively contribute to enhanced locomotor recovery.

Background: Functional electrical stimulation (FES) cycling has been reported to enhance muscle strength and improve muscle fatigue resistance after spinal cord injury (SCI). Despite its proposed benefits, the quantification of muscle fatigue during FES cycling remains poorly documented. This study sought to quantify the relationship between the vibrational performance of electrically‐evoked muscles measured through mechanomyography (MMG) and its oxidative metabolism through near‐infrared spectroscopy (NIRS) characteristics during FES cycling in fatiguing paralyzed muscles in individuals with SCI. Methods: Six individuals with SCI participated in the study. They performed 30 min of FES cycling with MMG and NIRS sensors on their quadriceps throughout the cycling, and the signals were analyzed. Results: A moderate negative correlation was found between MMG root mean square (RMS) and oxyhaemoglobin (O2Hb) [r = −0.38, p = 0.003], and between MMG RMS and total hemoglobin (tHb) saturation [r = −0.31, p = 0.017]. Statistically significant differences in MMG RMS, O2Hb, and tHb saturation occurred during pre‐ and post‐fatigue of FES cycling (p < 0.05). Conclusions: MMG RMS was negatively associated with O2Hb and muscle oxygen derived from NIRS. MMG and NIRS sensors showed good inter‐correlations, suggesting a promising use of MMG for characterizing metabolic fatigue at the muscle oxygenation level during FES cycling in individuals with SCI. [ABSTRACT FROM AUTHOR]

Abstract Background Heart rate variability (HRV) may provide objective information about cardiogenic autonomic balance in individuals with spinal cord injury (SCI). The aim of this study was to characterize the diurnal variation of HRV in individuals with SCI at lesion level T6 and above and lesion level below T6. Methods This was a retrospective analysis of a prior cross-sectional study. Individuals with chronic SCI underwent 24 h recording of the time between consecutive R waves (RR interval) to derive parameters of HRV as follows: standard deviation of all normal-to-normal R–R intervals (SDNN) and square root of the mean of the squared differences between successive R–R intervals (RMSSD) (time domain); and high frequency power (HF), low-frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Changes in the magnitude of HRV outcomes over the 24 h period were investigated using a novel multi-component cosinor model constrained to the form of a three-harmonic Fourier series. Results Participants were grouped as lesion level T6 and above (n = 22) or below T6 (n = 36). Most of them were male (n = 40, 69%) and the median age (interquartile range) was 50.5 (28) years. Both groups exhibited similar diurnal patterns in most HRV metrics. The lowest values occurred in the late afternoon (4–6 pm) and gradually increased, peaking around midnight to early morning (1–6 am). Exceptions included RMSSD, which peaked before midnight, and ULF, which showed a double peak pattern that peaked from 11 am to 1 pm and 4–6 am in participants with lesion level at T6 and above. The HRV values in participants with lesion level T6 and above were generally lower than participants with lesion level below T6, except for peak values of RMSSD, HF and LF. Conclusion This study demonstrated substantial diurnal variation of HRV in participants with SCI in both groups of participants. In clinical and research settings, diurnal variations in HRV must be taken into consideration.

AbstractBackground: Knowledge is still lacking regarding the preferred method for evaluation of learning in the Rey Auditory Verbal Learning Test (RAVLT). Validity of different methods was examined by the effect size in differentiating diagnostic stages in memory clinic patients versus healthy adults and the strength of association between RAVLT performance and brain atrophy. Method: The study included individuals with dementia (n = 247), Mild Cognitive Impairment (MCI, n = 709), Subjective Cognitive Impairment (SCI, n = 175) and cognitively unimpaired adults serving as healthy controls (HC, n = 102). All patients went through a comprehensive clinical examination and neuropsychological assessment of cognition including episodic memory gauged with RAVLT and brain imaging of medial temporal atrophy, cortical atrophy, and white matter hyperintensity. Results: The standard method for evaluation of learning in RAVLT (summed score over five trials) together with the late learning method (mean of trials 4 and 5) were the two most powerful methods according to group differentiation (discriminant validity). Both methods also showed considerable association with medial temporal atrophy (construct validity). The initial RAVLT performance represented by results on trial 1 and the constant in regression analysis with the power function provided information regarding attention that was important for the separation of SCI and HC. Conclusions: The most favorable clinical utility was indicated by discriminant and construct validity by total learning (standard method) including both attention- and learning-related parts and late learning of RAVLT performance, while theoretical understanding of mental processes involved in RAVLT performance was provided by the distinction between initial versus the subsequent learning performance. [ABSTRACT FROM AUTHOR]

Background: The discovery of new prognostic biomarkers following spinal cord injury (SCI) is a rapidly growing field that could help uncover the underlying pathological mechanisms of SCI and aid in the development of new therapies. To date, this search has largely focused on the initial days after the lesion. However, during the subacute stage of SCI (weeks to months after the injury), there remains potential for sensorimotor recovery, and numerous secondary events develop in various organs. Additionally, the confounding effects of early interventions after the injury are less likely to interfere with the results. Methods: In this study, we conducted an untargeted proteomics analysis to identify biomarkers of recovery in blood serum samples during the subacute phase of SCI patients, comparing those with strong recovery to those with no recovery between 30 and 120 days. We analyzed the fraction of serum that is depleted of the most abundant proteins to unmask proteins that would otherwise go undetected. Linear models were used to identify peptides and proteins related to neurological recovery and we validated changes in some of these proteins using Enzyme-linked Immunosorbent Assay (ELISA). Results: Our findings reveal that differences in subacute recovery after SCI (from 30 to 120 days) are associated with an enrichment in proteins involved in inflammation, coagulation, and lipid metabolism. Technical validation using commercial ELISAs further confirms that high levels of SERPINE1 and ARHGAP35 are associated with strong neurological recovery, while high levels of CD300a and DEFA1 are associated with a lack of recovery. Conclusions: Our study identifies new candidates for biomarkers of neurological recovery and for novel therapeutic targets after SCI. [ABSTRACT FROM AUTHOR]

Background: Heart rate variability (HRV) may provide objective information about cardiogenic autonomic balance in individuals with spinal cord injury (SCI). The aim of this study was to characterize the diurnal variation of HRV in individuals with SCI at lesion level T6 and above and lesion level below T6. Methods: This was a retrospective analysis of a prior cross-sectional study. Individuals with chronic SCI underwent 24 h recording of the time between consecutive R waves (RR interval) to derive parameters of HRV as follows: standard deviation of all normal-to-normal R–R intervals (SDNN) and square root of the mean of the squared differences between successive R–R intervals (RMSSD) (time domain); and high frequency power (HF), low-frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Changes in the magnitude of HRV outcomes over the 24 h period were investigated using a novel multi-component cosinor model constrained to the form of a three-harmonic Fourier series. Results: Participants were grouped as lesion level T6 and above (n = 22) or below T6 (n = 36). Most of them were male (n = 40, 69%) and the median age (interquartile range) was 50.5 (28) years. Both groups exhibited similar diurnal patterns in most HRV metrics. The lowest values occurred in the late afternoon (4–6 pm) and gradually increased, peaking around midnight to early morning (1–6 am). Exceptions included RMSSD, which peaked before midnight, and ULF, which showed a double peak pattern that peaked from 11 am to 1 pm and 4–6 am in participants with lesion level at T6 and above. The HRV values in participants with lesion level T6 and above were generally lower than participants with lesion level below T6, except for peak values of RMSSD, HF and LF. Conclusion: This study demonstrated substantial diurnal variation of HRV in participants with SCI in both groups of participants. In clinical and research settings, diurnal variations in HRV must be taken into consideration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Urinary dysfunction is linked to spinal cord injury (SCI). The quality of life (QoL) declines in both neurogenic bladder impairment and non-disordered patients. OBJECTIVE: To ascertain the effectiveness of pulsed magnetic therapy on urinary impairment and QoL in individuals with traumatic incomplete SCI. METHODS: This study included forty male paraplegic subjects with neurogenic detrusor overactivity (NDO) for more than one year following incomplete SCI between T6-T12. Their ages ranged from 20 to 35 and they engaged in therapy for three months. The subjects were divided into two groups of equal size. Individuals in Group I were managed via pulsed magnetic therapy once per week plus pelvic floor training three times a week. Individuals in Group II were managed with only three times a week for pelvic floor training. All patients were examined for bladder cystometric investigations, pelvic-floor electromyography (EMG), and SF-Qualiveen questionnaire. RESULTS: There was a noteworthy increment in individuals in Group I in volume of bladder at first desire to void and maximum cystometric capacity, detrusor pressure at Qmax, and maximum flow rate. There was a momentous increment in Group I in measures of evaluation of EMG biofeedback. There was a notable rise in Group I in SF-Qualiveen questionnaire. CONCLUSION: Magnetic stimulation should be favored as beneficial adjunct to traditional therapy in the management of bladder impairment and enhancing QoL in individuals with SCI. [ABSTRACT FROM AUTHOR]

Introduction: Spinal cord injury (SCI) affects many aspects of life, physically, emotionally and socially. Engaging in online videogames holds the potential to facilitate increased social interactions for individuals with SCI. The aim of this study is to increase our understanding of the experiences people with SCI have with using online videogames as an arena for social participation. Methods: A focus group interview was conducted with seven participants with SCI, aged 15-35, all experienced in using online videogames as a method of socializing. The data was analyzed using thematic analysis. Results: The participants highlighted that playing online videogames way of maintaining social connections and expanding their social network. However, they faced challenges due to limited knowledge and negative attitudes from others regarding use of videogames as a social arena. Three main themes were developed from the findings: "Disabling social barriers", "Attitudes towards gaming" and "Gaming--connecting people". Conclusion: Healthcare professionals should consider videogames as a leisure activity and facilitate their use, recognizing their potential for social interaction and well-being. Prioritizing activities that promote social interaction is crucial for good health. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a debilitating condition with an estimated 18,000 new cases annually in the United States. The field has accepted and adopted standardized databases such as the Open Data Commons for Spinal Cord Injury (ODC-SCI) to aid in broader analyses, but these currently lack high-throughput data despite the availability of nearly 6000 samples from over 90 studies available in the Sequence Read Archive. This limits the potential for large datasets to enhance our understanding of SCI-related mechanisms at the molecular and cellular level. Therefore, we have developed a protocol for processing RNA-Seq samples from high-throughput sequencing experiments related to SCI resulting in both raw and normalized data that can be efficiently mined for comparisons across studies, as well as homologous discovery across species. We have processed 1196 publicly available RNA-Seq samples from 50 bulk RNA-Seq studies across nine different species, resulting in an SQLite database that can be used by the SCI research community for further discovery. We provide both the database as well as a web-based front-end that can be used to query the database for genes of interest, differential gene expression, genes with high variance, and gene set enrichments. [ABSTRACT FROM AUTHOR]

Sensor-based decision tools provide a quick assessment of nutritional and physiological health status of crop, thereby enhancing the crop productivity. Therefore, a 2-year field study was undertaken with precision nutrient and irrigation management under system of crop intensification (SCI) to understand the applicability of sensor-based decision tools in improving the physiological performance, water productivity, and seed yield of soybean crop. The experiment consisted of three irrigation regimes [I1: standard flood irrigation at 50% depletion of available soil moisture (DASM) (FI), I2: sprinkler irrigation at 80% ETC (crop evapo-transpiration) (Spr 80% ETC), and I3: sprinkler irrigation at 60% ETC (Spr 60% ETC)] assigned in main plots, with five precision nutrient management (PNM) practices{PNM1-[SCI protocol], PNM2-[RDF, recommended dose of fertilizer: basal dose incorporated (50% N, full dose of P and K)], PNM3- [RDF: basal dose point placement (BDP) (50% N, full dose of P and K)], PNM4-[75% RDF: BDP (50% N, full dose of P and K)] and PNM5-[50% RDF: BDP (50% N, full P and K)]} assigned in sub-plots using a split-plot design with three replications. The remaining 50% N was top-dressed through SPAD assistance for all the PNM practices. Results showed that the adoption of Spr 80% ETC resulted in an increment of 25.6%, 17.6%, 35.4%, and 17.5% in net-photosynthetic rate (Pn), transpiration rate (Tr), stomatal conductance (Gs), and intercellular CO2 concentration (Ci), respectively, over FI. Among PNM plots, adoption of PNM3 resulted in a significant (p=0.05) improvement in photosynthetic characters like Pn (15.69 µ mol CO2 m-2 s-1), Tr (7.03 m mol H2Om-2 s-1), Gs (0.175 µmol CO2 mol-1 year-1), and Ci (271.7 mol H2O m2 s-1). Enhancement in SPAD (27% and 30%) and normalized difference vegetation index (NDVI) (42% and 52%) values were observed with nitrogen (N) top dressing through SPAD-guided nutrient management, helped enhance crop growth indices, coupled with better dry matter partitioning and interception of sunlight. Canopy temperature depression (CTD) in soybean reduced by 3.09-4.66°C due to adoption of sprinkler irrigation. Likewise, Spr 60% ETc recorded highest irrigation water productivity (1.08 kg ha-1 m-3). However, economic water productivity (27.5 INR ha-1 m-3) and water-use efficiency (7.6 kg ha-1 mm-1 day-1) of soybean got enhanced under Spr 80% ETc over conventional cultivation. Multiple correlation and PCA showed a positive correlation between physiological, growth, and yield parameters of soybean. Concurrently, the adoption of Spr 80% ETC with PNM3 recorded significantly higher grain yield (2.63 t ha-1) and biological yield (8.37 t ha-1) over other combinations. Thus, the performance of SCI protocols under sprinkler irrigation was found to be superior over conventional practices. Hence, integrating SCI with sensor-based precision nutrient and irrigation management could be a viable option for enhancing the crop productivity and enhance the resource-use efficiency in soybean under similar agroecological regions. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a serious neurological injury that causes severe trauma to motor and sensory functions. Although long considered incurable, recent research has brought new hope for functional recovery from SCI. After SCI, astrocytes are activated into many polarization states. Here we discuss the two most important classical phenotypes: the ‘A1’ neurotoxic phenotype and the ‘A2’ neuroprotective phenotype, with A1 astrocytes being neurotoxic and impeding neurorecovery, and A2 astrocytes being neuroprotective. This paper discusses the changes in astrocyte responsiveness after SCI and the pros and cons of their polarization in SCI. It also elucidates the feasibility of astrocyte polarization as a therapeutic target for neuroprotection. In the future, multiple intervention strategies targeting astrocyte polarization are expected to gain wider clinical application, ultimately improving motor-sensory function and quality of life in SCI patients.

Test case prioritization (TCP) is a regression technique that sequences test cases by assigning priority based on specific criteria defined by software testers. Various parameters, such as code coverage, statement coverage, and method coverage, are utilized in Test Case Prioritization (TCP), wherein metaheuristic techniques are widely employed to determine the optimal order of test cases based on these specified parameters. However, simply applying these techniques does not ensure the satisfaction of all the needs of software testers. This paper introduces an empirical study that employs the multi-objective test case prioritization (MOTCP) technique to prioritize the test cases based on target points defined by software testers. The study calculates a Software Complexity Index (SCI) at the code level, identifying fault-prone areas. Furthermore, a Test-case Complexity Index (TCI) is also used for prioritization. The proposed technique incorporates various target points defined by the software tester to calculate SCI and TCI, which serve as our main objectives for TCP. A detailed analysis is also performed to examine the impact of these target points on the generated optimal order of test cases. Finally, the proposed model is compared with other state-of-the-art techniques across various evaluation parameters. [ABSTRACT FROM AUTHOR]

Akt/mTOR/p70S6K signaling pathway promotes motor function recovery after spinal cord injury (SCI) in both neurons and astrocytes. But the role and mechanism of this pathway in oligodendrocytes during nerve repair following SCI has not been researched. This study aimed to investigate the effect and mechanism of this signaling pathway in oligodendrocytes on nerve myelin regeneration and motor function recovery in rats with SCI. After inhibiting or activating this signaling pathway, Western blotting and double immunofluorescence labeling were used to determine the levels of the signaling molecules in this pathway and myelin formation-related proteins in the plane of the thoracic segment of the injured spinal cord. The level of motor function recovery was evaluated and the oligodendrocytes involved in nerve myelin regeneration were studied. Primary oligodendrocytes were isolated and cultured in vitro, then MBP, PLP, and MOG were measured with reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Akt/mTOR/p70S6K signaling pathway was activated after SCI compared with the sham-operated rats, prominently elevated levels of the pathway components were observed in the SC79-treated group. The activation of the signaling pathway significantly increased the expression levels of myelin formation-related proteins, including MBP, PLP, and MOG, and improved the Basso, Beattie, and Bresnahan (BBB) scores in the injured spinal cord. Conversely, rapamycin suppressed the expression of these signaling molecules and reduced the levels of myelin formation-related proteins. Akt/mTOR/p70S6K signaling pathway activation can contribute to nerve myelin regeneration and has the potential to improve the regenerative environment and motor function, as well as the potential to promote repair of SCI. [ABSTRACT FROM AUTHOR]

Background: Controversy exists whether blood pressure augmentation therapy benefits patients suffering from spinal cord injury (SCI). This retrospective comparative study was designed to assess the impact of two different mean arterial pressure (MAP) targets (85–90 mmHg vs. 65–85 mmHg) on neurological recovery after traumatic cervical SCI. Methods: Fifty‐one adult patients with traumatic cervical SCI were retrospectively divided into two groups according to their intensive care unit (ICU) MAP targets: 85–90 mmHg (higher MAP group, n = 32) and 65–85 mmHg (lower MAP group, n = 19). Invasive MAP measurements were stored as 2‐min median values for 3–7 days. The severity of SCI (AIS grade and neurological level) was evaluated upon ICU stay and during rehabilitation. Neurological recovery was correlated with individual mean MAP values and with the proportion of MAP values ≥85 mmHg upon the first 3 days (3d‐MAP%≥85). Results: The initial AIS grades were A 29.4%, B 17.6%, C 31.4%, and D 21.6%. AIS grade improved in 24 patients (47.1%). During ICU care, 82.0% and 36.8% of the measured MAP values reached ≥85 mmHg in the higher and the lower MAP groups, respectively (p <.001). The medians of individual mean MAP values were different between the groups (90.2 mmHg vs. 81.4 mmHg, p <.001). Similarly, 3d‐MAP%≥85 was higher in the higher MAP group (85.6% vs. 50.0%, p <.001). However, neurological recovery was not different between the groups, nor did it correlate with individual mean MAP values or 3d‐MAP%≥85. Conclusion: The currently recommended MAP target of 85–90 mmHg was not associated with improved outcomes compared to a lower target in patients with traumatic cervical SCI in this cohort. [ABSTRACT FROM AUTHOR]

Spinal Cord Injury (SCI) is a devastating neurological event. To assess the degree of spinal cord damage and classify the injury, it is recommended to use the 2019 version of the AIS standard. The severity of trauma was evaluated using the Trauma Severity Score, and various classification systems have been proposed for injuries at different parts and segments of the spine. Understanding the regulated signaling pathways and immune processes following SCI can lead to a better understanding of SCI-induced biomarkers and their underlying mechanisms. In this study, two gene expression datasets (GSE464 and GSE45006) from the Gene Expression Omnibus database were utilized. Differential gene expression and co-expression network analysis were performed, revealing 370 shared genes in the 3-day group and 111 shared genes in the 14-day group after SCI. The study used functional enrichment analysis methods such as Gene Set Enrichment Analysis, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes. The ssGSEA method was used to assess the levels and composition of immune infiltration in both the sham (control) and SCI groups. The single-cell transcriptomics dataset GSE182803 was analyzed to identify genes associated with immune marker cells. Four key genes (Ptgs2, Fn1, Ccl2, and Icam1) were identified in the 3-day group, while only one gene (Cyp51) was identified in the 14-day group after SCI. The findings offer significant insights into the immune-related genes and signaling pathways involved in secondary SCI at different time points and hold potential for the development of intervention strategies for acute and chronic post-SCI. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) can result in lifelong disability. Currently, the literature suggests that biomarkers are helpful in prognosticating SCI, but there is no specific biomarker to date. This is the first study that predicted the prognosis dynamically using biomarkers. Aim: To elucidate the role of biomarkers in prognosticating acute traumatic SCI. Methods: Blood samples were obtained from 35 patients of acute traumatic SCI at presentation, immediate post-op, and at 6 weeks. At 6 months follow-up, patients were divided into two groups, i.e, improved and non-improved based on the improvement in the ASIA grade compared to presentation. A non-parametric test was used for comparing mean NSE, MMP-2, S100-B, and NF serum levels at presentation, immediate post-op, and 6 weeks post-op follow-up between the two groups. Results: There was a significant difference (p = 0.03) in the NF values at presentation between the two groups. The difference of NSE values at 6 weeks was also significant (p = 0.016) between the two groups. S-100B levels were also significantly different between both groups at presentation (p=0.016), and at the immediate post-op stage (p=0.007). MMP-2 levels neither displayed any specific trend nor any significant difference between the two groups. Conclusion: Higher NF values at presentation, and higher S-100B levels at presentation and immediate post-operative period correlated with poor outcome. Also, increased NSE values after surgery are indicative of no improvement. These levels can be used at various stages to predict the prognosis. However, further studies are required on this topic extensively to know the exact cut-off values of these markers to predict the prognosis accurately. Clinical trials registry number: REF/2020/01/030616 [ABSTRACT FROM AUTHOR]

The treatment of spinal cord injury (SCI) is often ineffective. Additionally, SCI-induced inflammation leads to secondary injury. Current anti-inflammatory hydrophilic drugs fail to reach the nerve injury site due to the blood–brain barrier. Here, we synthesized MSR405, a new lipophilic unsaturated fatty acid derivative of Radix Isatidis and investigated its therapeutic effect in SCI model rats. Furthermore, we systematically investigated its structure, toxicity, anti-inflammatory effect, and the underlying mechanism. MSR405 was injected into the abdominal cavity of the Sprague Dawley SCI model rats, and the effect on their behavioral scores and pathology was estimated to assess the status of neurological inflammation. Our data show that MSR405 treatment significantly improved the motor function of SCI rats, and markedly suppressed the associated neuroinflammation. Moreover, MSR405 could attenuate LPS-induced inflammatory response in BV2 cells (Mouse microglia cells) in vitro. Mechanistically, MSR405 inhibits proinflammatory cytokines, supporting the anti-inflammatory response. Additionally, MSR405 can significantly block the TLR4/NF-κB signaling pathway and nitric oxide production. In summary, MSR405 reduces inflammation in SCI rats through the TLR4/NF-κB signal cascade and can inhibit neuroinflammation after spinal cord injury. [ABSTRACT FROM AUTHOR]

Systemic chronic inflammation (SCI) due to intrinsic immune over-activation is an important factor in the development of many noninfectious chronic diseases, such as neurodegenerative diseases and diabetes mellitus. Among these immune responses, macrophages are extensively involved in the regulation of inflammatory responses by virtue of their polarization plasticity; thus, dysregulation of macrophage polarization direction is one of the potential causes of the generation and maintenance of SCI. High-temperature demand protein A2 (HtrA2/Omi) is an important regulator of mitochondrial quality control, not only participating in the degradation of mis-accumulated proteins in the mitochondrial unfolded protein response (UPRmt) to maintain normal mitochondrial function through its enzymatic activity, but also participating in the regulation of mitochondrial dynamics-related protein interactions to maintain mitochondrial morphology. Recent studies have also reported the involvement of HtrA2/Omi as a novel inflammatory mediator in the regulation of the inflammatory response. HtrA2/Omi regulates the inflammatory response in BMDM by controlling TRAF2 stabilization in a collagen-induced arthritis mouse model; the lack of HtrA2 ameliorates pro-inflammatory cytokine expression in macrophages. In this review, we summarize the mechanisms by which HtrA2/Omi proteins are involved in macrophage polarization remodeling by influencing macrophage energy metabolism reprogramming through the regulation of inflammatory signaling pathways and mitochondrial quality control, elucidating the roles played by HtrA2/Omi proteins in inflammatory responses. In conclusion, interfering with HtrA2/Omi may become an important entry point for regulating macrophage polarization, providing new research space for developing HtrA2/Omi-based therapies for SCI. [ABSTRACT FROM AUTHOR]

The escalating incidence of Spinal Cord Injury (SCI), with approximately 0.9 million cases globally, underscores its growing public health concern. Traumatic SCI, often prevalent in developing nations due to factors like motor vehicle accidents and falls, leads to secondary damage involving inflammation, neuronal death, and ionic dysregulation. Despite the absence of an effective treatment for SCI, Stem Cell Therapy (SCT) emerges as a promising avenue, harnessing stem cells' unique capabilities for regeneration and replacement. The review explores various stem cell types, such as Neural Stem/Progenitor Cells (NS/PCs), Embryonic Stem Cells (ESCs), Induced Pluripotent Stem Cells (iPSCs), and Mesenchymal Stem Cells (MSCs), detailing their potential in preclinical and clinical contexts. Specifically, NSCs exhibit therapeutic promise by modulating astrocyte contribution, enhancing differentiation, and promoting growth factors. ESCs, despite their pluripotency, face ethical concerns and potential teratocarcinoma formation. IPSCs, reprogrammed from somatic cells, showcase potential in treating SCI without ethical issues. MSCs, with diverse sources like bone marrow, umbilical cord, and adipose tissue, offer versatility in differentiation and therapeutic benefits. Clinical trials with MSCs, especially BM-MSCs, UC-MSCs, and AD-MSCs, demonstrate improvements in motor and sensory functions, highlighting their regenerative potential. Despite promising results, challenges such as potential tumorigenesis and high costs persist, warranting further exploration and clinical translation of these stem cell therapies for SCI.

Objective: Wheelchair basketball (WCB) demands high-intensity training due to its intermittent nature. However, acute oxygen uptake (V˙O2) in handcycling is restricted. Combining handcycling with low-frequency electromyostimulation (LF-EMS) may enhance V˙O2 in elite WBC athletes. Design: Randomized crossover trail. Subjects: Twelve German national team WCB players (age: 25.6 [5.6] years, height: 1.75 [0.16] m, mass: 74.0 [21.7] kg, classification: 2.92 [1.26]). Method: Participants underwent 2×5 min of handcycling (60 rpm, ¾ bodyweight resistance in watts) (HANDCYCLE) and 2×5 min of handcycling with concurrent LF-EMS (EMS_HANDCYCLE). LF-EMS (4Hz, 350µs, continuous stimulation) targeted gluteal, quadriceps, and calf muscles, adjusted to individual pain thresholds (buttocks: 69.5 [22.3] mA, thighs: 66.8 [20.0] mA, calves: 68.9 [31.5] mA). Results: Significant mode-dependent differences between HANDCYCLE and EMS_HANDCYCLE were found in V˙O2 (17.60 [3.57] vs 19.23 [4.37] ml min-1 kg-1, p = 0.001) and oxygen pulse (16.69 [4.51] vs 18.41 [5.17] ml, p = 0.002). ΔLactate was significantly lower in HANDCYCLE (0.04 [0.28] vs 0.31 [0.26] mmol l-1). Although perceived effort did not differ (p = 0.293), discomfort was rated lower in HANDCYCLE (1.44 [1.28] vs 3.94 [2.14], p = 0.002). Conclusion: LF-EMS applied to the lower extremities increases oxygen demand during submaximal handcycling. Thus, longitudinal application of LF-EMS should be investigated as a potential training stimulus to improve aerobic capacity in wheelchair athletes.

IntroductionSpinal cord injury (SCI) affects many aspects of life, physically, emotionally and socially. Engaging in online videogames holds the potential to facilitate increased social interactions for individuals with SCI. The aim of this study is to increase our understanding of the experiences people with SCI have with using online videogames as an arena for social participation.MethodsA focus group interview was conducted with seven participants with SCI, aged 15–35, all experienced in using online videogames as a method of socializing. The data was analyzed using thematic analysis.ResultsThe participants highlighted that playing online videogames way of maintaining social connections and expanding their social network. However, they faced challenges due to limited knowledge and negative attitudes from others regarding use of videogames as a social arena. Three main themes were developed from the findings: “Disabling social barriers”, “Attitudes towards gaming” and “Gaming—connecting people”.ConclusionHealthcare professionals should consider videogames as a leisure activity and facilitate their use, recognizing their potential for social interaction and well-being. Prioritizing activities that promote social interaction is crucial for good health.

The loss of bilateral hand function is a debilitating challenge for millions of individuals that suffered a motor-complete spinal cord injury (SCI). We have recently demonstrated in eight tetraplegic individuals the presence of highly functional spared spinal motor neurons in the extrinsic muscles of the hand that are still capable of generating proportional flexion and extension signals. In this work, we hypothesized that an artificial intelligence (AI) system could automatically learn the spared electromyographic (EMG) patterns that encode the attempted movements of the paralyzed digits. We constrained the AI to continuously output the attempted movements in the form of a digital hand so that this signal could be used to control any assistive system (e.g. exoskeletons, electrical stimulation). We trained a convolutional neural network using data from 13 uninjured (control) participants and 8 tetraplegic participants (7 motor-complete, 1 incomplete) to study the latent space learned by the AI. Our model can automatically differentiate between eight different hand movements, including individual finger flexions, grasps, and pinches, achieving a mean accuracy of 98.3% within the SCI group. Analysis of the latent space of the model revealed that proportionally controllable movements exhibited an elliptical path, while movements lacking proportional control followed a chaotic trajectory. We found that proportional control of a movement can only be correctly estimated if the latent space embedding of the movement follows an elliptical path (correlation =0.73; p

Purpose: To examine clinical outcomes and employment status in Veterans with and without a dual diagnosis of traumatic brain injury (TBI) and spinal cord injury (SCI). Methods: This cross-sectional study examined a national sample of Veterans enrolled in the VA Million Veteran Program who completed the Comprehensive TBI Evaluation (CTBIE) as part of the Veterans Health Administration's TBI Screening and Evaluation Program. Veterans (N = 12,985) were classified into the following TBI/SCI groups using CTBIE data: those with a dual diagnosis of TBI and SCI (TBI+/SCI+); those with a history of TBI but no SCI (TBI+/SCI−); and those with no history of TBI or SCI (TBI−/SCI−; i.e., the control group). CTBIE-derived outcomes included neurobehavioral symptoms, comorbid psychiatric symptoms, pain and pain interference, and employment status. Results: Chi-square analyses showed significant associations between TBI/SCI group and all clinical outcomes evaluated (all p's <.001; V = 0.07–0.11). In general, the TBI+/SCI+ and TBI +/SCI− groups endorsed comparable levels of neurobehavioral symptoms, psychiatric symptoms, and pain, but significantly greater rates of symptoms and pain relative to the TBI−/SCI− group. Effect sizes for all pairwise comparisons were small (φ = 0.01–0.11). Finally, there was no significant association between TBI/SCI group and employment status (p =.170; V = 0.02), with all three groups showing relatively comparable rates of unemployment. Conclusions: Regardless of SCI status, Veterans with TBI history endorsed poorer clinical outcomes than Veterans without TBI and SCI. However, rates of unemployment were similarly high across all three groups. Findings suggest that any Veteran completing the CTBIE may be at risk for poor clinical and employment outcomes. [ABSTRACT FROM AUTHOR]

Sensor-based decision tools provide a quick assessment of nutritional and physiological health status of crop, thereby enhancing the crop productivity. Therefore, a 2-year field study was undertaken with precision nutrient and irrigation management under system of crop intensification (SCI) to understand the applicability of sensor-based decision tools in improving the physiological performance, water productivity, and seed yield of soybean crop. The experiment consisted of three irrigation regimes [I1: standard flood irrigation at 50% depletion of available soil moisture (DASM) (FI), I2: sprinkler irrigation at 80% ETC (crop evapo-transpiration) (Spr 80% ETC), and I3: sprinkler irrigation at 60% ETC (Spr 60% ETC)] assigned in main plots, with five precision nutrient management (PNM) practices{PNM1-[SCI protocol], PNM2-[RDF, recommended dose of fertilizer: basal dose incorporated (50% N, full dose of P and K)], PNM3- [RDF: basal dose point placement (BDP) (50% N, full dose of P and K)], PNM4-[75% RDF: BDP (50% N, full dose of P and K)] and PNM5-[50% RDF: BDP (50% N, full P and K)]} assigned in sub-plots using a split-plot design with three replications. The remaining 50% N was top-dressed through SPAD assistance for all the PNM practices. Results showed that the adoption of Spr 80% ETC resulted in an increment of 25.6%, 17.6%, 35.4%, and 17.5% in net-photosynthetic rate (Pn), transpiration rate (Tr), stomatal conductance (Gs), and intercellular CO2 concentration (Ci), respectively, over FI. Among PNM plots, adoption of PNM3 resulted in a significant (p=0.05) improvement in photosynthetic characters like Pn (15.69 µ mol CO2 m-2 s-1), Tr (7.03 m mol H2Om-2 s-1), Gs (0.175 µmol CO2 mol-1 year-1), and Ci (271.7 mol H2O m² s-1). Enhancement in SPAD (27% and 30%) and normalized difference vegetation index (NDVI) (42% and 52%) values were observed with nitrogen (N) top dressing through SPAD-guided nutrient management, helped enhance crop growth indices, coupled with better dry matter partitioning and interception of sunlight. Canopy temperature depression (CTD) in soybean reduced by 3.09-4.66°C due to adoption of sprinkler irrigation. Likewise, Spr 60% ETc recorded highest irrigation water productivity (1.08 kg ha-1 m-3). However, economic water productivity (27.5 INR ha-1 m-3) and water-use efficiency (7.6 kg ha-1 mm-1 day-1) of soybean got enhanced under Spr 80% ETc over conventional cultivation. Multiple correlation and PCA showed a positive correlation between physiological, growth, and yield parameters of soybean. Concurrently, the adoption of Spr 80% ETC with PNM3 recorded significantly higher grain yield (2.63 t ha-1) and biological yield (8.37 t ha-1) over other combinations. Thus, the performance of SCI protocols under sprinkler irrigation was found to be superior over conventional practices. Hence, integrating SCI with sensor-based precision nutrient and irrigation management could be a viable option for enhancing the crop productivity and enhance the resource-use efficiency in soybean under similar agroecological regions. [ABSTRACT FROM AUTHOR]

Spinal cord injury is a frequent debilitating neurologic condition with increasing prevalence and related morbidity over the last decades. The neutrophil-to-lymphocyte ratio is a promising biomarker for determining different medical conditions' disease course and outcome such as traumatic brain injury (TBI). This study aimed to investigate the predictive value of neutrophil to lymphocyte ratio (NLR) in the outcome of SCI. In a retrospective cross-sectional study from April 2019 to April 2022, all patients 18 to 65 years old, following spinal cord injury who were referred to Imam Khomeini Hospital and met inclusion and exclusion criteria enrolled in the study. A checklist including demographic data, lab, and clinical findings at admission, 24h, 48 h, and discharge were recorded. IBM SPSS Statistics software was used to analyze the data. A P -value of less than 0.05 was considered significant. Six hundred patients met our inclusion criteria and enrolled in the study. The mean age of the patients was 40.93 ± 12.77, with 75% male and 25% female. There was a significant correlation between the N/L ratio at different time points (p.value=0.001), injury type, and ASIA score at admission and discharge (0.001). Furthermore, the NLR had approached significant value alone to predict outcomes in patients enrolled in the study (0.06). A high NLR is unequivocally linked with poor outcomes in patients suffering from acute SCI and should be considered a negative prognostic factor; however, the NLR had approached significant predicting value in patients enrolled in the study. [ABSTRACT FROM AUTHOR]

Background. Lesions of the vertebral artery (VA) may develop spontaneously or as a result of severe traumatic cervico-cephalic injuries. Most frequent VA injuries (VAI) result from blunt trauma to the spine or may be due to penetrating lesions. VAI plays a significant role in the broader context of cervical spine trauma by providing insights into the vascular aspects of spinal cord injury (SCI). Upper cervical spine fractures and accompanying subluxation, as well as transverse process fractures extending into the artery bone foramen, are associated with an elevated risk of VAI. Clinical case. A 63-year-old female patient with flaccid C4 AIS-A quadriplegia (global motor score 3/100), vertebral myelopathy, neurogenic bladder, sacral pressure sore, and blindness was transferred from the spinal neurosurgical department. The patient fell from the same level and suffered a mild brain concussion and, apparently, a minor cervical SCI on October 1, 2022. She was asymptomatic, then quickly became tetraplegic, and then blindness added on in a few days. She was operated on on October 7, 2022, for a C6 vertebral body fracture and a C5-6 dislocation. The surgical protocol consisted of anterior spinal cord decompression, dislocation reduction, and mixed anterior fusion with bone grafts and fixation screws. Following the traumatic event, a bilateral posterior cerebral artery (PCA) stroke subsequently produced blindness and partial optic atrophy in both eyes. Serial clinical and imaging examinations confirmed the diagnosis: a subacute bilateral occipital stroke and a chronic lacunar lesion in the right thalamus associated with a severe spinal cord lesion. Anticoagulation has partially improved the neurological outcomes of stroke in the PCA territory. Ethical considerations. The patient's next of kin has given written consent to the case study and to use the radiological images related to the case for academic purposes. The personal identity data was anonymized. The presentation of this clinical case has the approval of the ethics commission of TEHBA (no. 40205/01.09.2023). Discussion. The clinical example is notable for the concurrent development of two severely devastating neurological syndromes, quadriplegia, and blindness, which occurred after an initially minor cervical trauma and progressed gradually Careful clinical and imaging monitoring through detailed serial imaging procedures must be performed for every person with severe cranio-cervical trauma. The clinical example emphasizes the importance of the interprofessional team's participation in the patient's care.over a few days. VA lesions after cervical trauma are considered rare, and the diagnosis is difficult because the vast majority of individuals do not exhibit cerebral neurological symptoms (due to the collateral compensatory blood supply from the circle of Willis). Most of the patients with bilateral or dominant VA occlusions are symptomatic, with rapid (and possibly fatal) ischemic damage to the encephalon, cerebellum, or brainstem. The detection and tracking of evolutionary tendencies required a series of clinical tests, including fundoscopy, and imaging procedures, including native CT, MRI, and MR angiography scans of the brain and spine. Conclusions. Although VAI is a rare complication, in every polytrauma patient with head and neck trauma, VA damage should be suspected. [ABSTRACT FROM AUTHOR]

CNS (central nervous system) trauma, which is classified as SCI (spinal cord injury) and TBI (traumatic brain injury), is gradually becoming a major cause of accidental death and disability worldwide. Many previous studies have verified that the pathophysiological mechanism underlying cell death and the subsequent neuroinflammation caused by cell death are pivotal factors in the progression of CNS trauma. Simultaneously, EVs (extracellular vesicles), membrane-enclosed particles produced by almost all cell types, have been proven to mediate cell-to-cell communication, and cell death involves complex interactions among molecules. EVs have also been proven to be effective carriers of loaded bioactive components to areas of CNS trauma. Therefore, EVs are promising therapeutic targets to cure CNS trauma. However, the link between EVs and various types of cell death in the context of CNS trauma remains unknown. Therefore, in this review, we summarize the mechanism underlying EV effects, the relationship between EVs and cell death and the pathophysiology underlying EV effects on the CNS trauma based on information in published papers. In addition, we discuss the prospects of applying EVs to the CNS as feasible therapeutic strategies for CNS trauma in the future. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to establish the best prediction model for postoperative nosocomial pulmonary infection through machine learning (ML) and assist physicians to make accurate diagnosis and treatment decisions. Methods: Patients with spinal cord injury (SCI) who admitted to a general hospital between July 2014 and April 2022 were included in this study. The data were segmented according to the ratio of seven to three, 70% were randomly selected to train the model, and the other 30% were used for testing. We used LASSO regression to screen the variables, and the selected variables were used in the construction of six different ML models. Shapley additive explanations and permutation importance were used to explain the output of the ML models. Finally, sensitivity, specificity, accuracy and area under receiver operating characteristic curve (AUC) were used as the evaluation index of the model. Results: A total of 870 patients were enrolled in this study, of whom 98 (11.26%) developed pulmonary infection. Seven variables were used for ML model construction and multivariate logistic regression analysis. Among these variables, age, ASIA scale and tracheotomy were found to be the independent risk factors for postoperative nosocomial pulmonary infection in SCI patients. Meanwhile, the prediction model based on RF algorithm performed best in the training and test sets. (AUC = 0.721, accuracy = 0.664, sensitivity = 0.694, specificity = 0.656). Conclusion: Age, ASIA scale and tracheotomy were the independent risk factors of postoperative nosocomial pulmonary infection in SCI. The prediction model based on RF algorithm had the best performance. [ABSTRACT FROM AUTHOR]

Background: Rising evidence indicates the development of pyroptosis in the initiation and pathogenesis of spinal cord injury (SCI). However, the associated effects of pyroptosis-related genes (PRGs) in SCI are unclear. Methods: We obtained the gene expression profiles of SCI and normal samples in the GEO. Database: The R package limma screened for differentially expressed (DE) PRGs and performed functional enrichment analysis. Mechanical learning and PPI analysis helped filter essential PRGs to diagnose SCI. Peripheral blood was collected for validation from ten SCI patients and eight healthy individuals. The association of essential PRGs with immune infiltration was evaluated, and pyroptosis subtypes were recognized in SCI patients by unsupervised cluster analysis. Besides, a SCI model was built for in vivo validation of essential PRGs. Result: We identified 25 DE-PRGs between SCI and normal controls. Functional enrichment analysis revealed the principal involvement of DE-PRGs in pyroptosis, inflammasome complex, interleukin-1 beta production, etc. Subsequently, three essential PRGs were identified and validated, showing excellent diagnostic efficacy and significant correlation with immune cell infiltration. Additionally, we developed diagnostic nomograms to predict the occurrence of SCI. Two pyroptosis subtypes exhibited distinct biological functions and immune landscapes among SCI patients. Finally, the expression of these essential PRGswas verified in vivo. Conclusion: The current study described the vital effects of pyroptosis-related genes in SCI, providing a novel direction for effective assessment and management of SCI.

Autonomic dysreflexia is a known complication after spinal cord injury. It is defined as a reflexive increase in blood pressure as a result of a painful or irritating stimulus below the level of the lesion. Although commonly caused by stimuli from the bladder, other rare triggers are still being described. Herein, we present a case with autonomic dysreflexia triggered by obstructive sleep apnoea. A 43-year-old smoker suffered a spinal cord injury after a road traffic accident secondary to multiple cervical spine vertebrae fractures. He presented to our rehabilitation centre 6 months post-injury as a case of complete spinal cord injury with C4 neurological level. Autonomic dysfunction in the form of autonomic dysreflexia was occurring on a daily basis. After exclusion of known inciting factors, it was noticed that early morning episodes of autonomic dysreflexia were persistent. He was also reporting daytime fatigue and sleepiness and multiple night-time awakenings. Therefore, work up for sleep apnoea was done. A diagnosis of moderate obstructive sleep apnoea was made. With continuous positive airway pressure treatment, his daily early morning episodes of autonomic dysreflexia settled. This case illustrates the importance of the pattern of blood pressure elevation to pinpoint specific triggers of autonomic dysreflexia.

Sensor-based decision tools provide a quick assessment of nutritional and physiological health status of crop, thereby enhancing the crop productivity. Therefore, a 2-year field study was undertaken with precision nutrient and irrigation management under system of crop intensification (SCI) to understand the applicability of sensor-based decision tools in improving the physiological performance, water productivity, and seed yield of soybean crop. The experiment consisted of three irrigation regimes [I1: standard flood irrigation at 50% depletion of available soil moisture (DASM) (FI), I2: sprinkler irrigation at 80% ETC (crop evapo-transpiration) (Spr 80% ETC), and I3: sprinkler irrigation at 60% ETC (Spr 60% ETC)] assigned in main plots, with five precision nutrient management (PNM) practices{PNM1-[SCI protocol], PNM2-[RDF, recommended dose of fertilizer: basal dose incorporated (50% N, full dose of P and K)], PNM3-[RDF: basal dose point placement (BDP) (50% N, full dose of P and K)], PNM4-[75% RDF: BDP (50% N, full dose of P and K)] and PNM5-[50% RDF: BDP (50% N, full P and K)]} assigned in sub-plots using a split-plot design with three replications. The remaining 50% N was top-dressed through SPAD assistance for all the PNM practices. Results showed that the adoption of Spr 80% ETC resulted in an increment of 25.6%, 17.6%, 35.4%, and 17.5% in net-photosynthetic rate (Pn), transpiration rate (Tr), stomatal conductance (Gs), and intercellular CO2 concentration (Ci), respectively, over FI. Among PNM plots, adoption of PNM3 resulted in a significant (p=0.05) improvement in photosynthetic characters like Pn (15.69 µ mol CO2 m−2 s−1), Tr (7.03 m mol H2O m−2 s−1), Gs (0.175 µmol CO2 mol−1 year−1), and Ci (271.7 mol H2O m2 s−1). Enhancement in SPAD (27% and 30%) and normalized difference vegetation index (NDVI) (42% and 52%) values were observed with nitrogen (N) top dressing through SPAD-guided nutrient management, helped enhance crop growth indices, coupled with better dry matter partitioning and interception of sunlight. Canopy temperature depression (CTD) in soybean reduced by 3.09–4.66°C due to adoption of sprinkler irrigation. Likewise, Spr 60% ETc recorded highest irrigation water productivity (1.08 kg ha−1 m−3). However, economic water productivity (27.5 INR ha−1 m−3) and water-use efficiency (7.6 kg ha−1 mm−1 day−1) of soybean got enhanced under Spr 80% ETc over conventional cultivation. Multiple correlation and PCA showed a positive correlation between physiological, growth, and yield parameters of soybean. Concurrently, the adoption of Spr 80% ETC with PNM3 recorded significantly higher grain yield (2.63 t ha−1) and biological yield (8.37 t ha−1) over other combinations. Thus, the performance of SCI protocols under sprinkler irrigation was found to be superior over conventional practices. Hence, integrating SCI with sensor-based precision nutrient and irrigation management could be a viable option for enhancing the crop productivity and enhance the resource-use efficiency in soybean under similar agro-ecological regions.

Background: No study has examined the psychometric properties of the sleep condition indicator (SCI) for screening poststroke insomnia in the Indonesian population. We aimed to develop the Indonesian version of the sleep condition indicator (ISCI) and to examine its psychometric properties for screening adult patients in late sub-acute and chronic periods after stroke. Methods: This was a cross-sectional study with two stages. In the first stage, the English version of the SCI was translated into the ISCI using standard procedures. The psychometric properties of the ISCI were tested in the second stage. Internal consistency and test–retest reliability of ISCI were used to evaluate reliability. A confirmatory factor analysis (CFA) was performed to test construct validity. To test concurrent and convergent validity, the Indonesian version of the insomnia severity index (ISI-INA), generalized anxiety disorder questionnaire (IGAD-7), and patient health questionnaire (IPHQ-9) were used. A receiver operating characteristic (ROC) analysis was conducted to calculate the optimal cutoff score of the ISCI on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for insomnia. Results: A total of 160 adults with a diagnosis of stroke for more than 3 months were included (median age of 58.5 years, 31% met the DSM-5 criteria for insomnia). The ISCI had a satisfactory Cronbach's alpha of 0.89 and test–retest reliability of 0.78. The CFA revealed that the ISCI exhibited a satisfactory model fit and was associated with the ISI-INA, IGAD-7, and IPHQ-9 (r = −0.81, −0.32, and −0.52, respectively; all P <.001). The ROC test revealed that the optimal cutoff point of ≤23 yielded the highest sensitivity (94%) and specificity (97%). Conclusion: The study results revealed that the 8-item ISCI is a reliable and valid screening tool for detecting insomnia symptoms according to the DSM-5 criteria in the chronic period after stroke. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) can be caused by a variety of factors and its severity can range from a mild concussion to a complete severing of the spinal cord. Treatment depends on the type and severity of injury, the patient's age and overall health. Reduction of dislocated or fractured vertebrae via closed manipulation or surgical procedures, fixation and removal of bony fragments and debris that compromise the spinal canal are indicated for decompression of the spinal cord and stabilization of the spine. However, when there is no obvious traumatic obstruction of spinal canal, the question arises as to whether laminectomy is needed to be performed to improve neurological outcome. Methods: A literature review covering all indexed studies published between 2013 and 2023 was performed using keywords to identify the patient group of interest (spinal cord injury, SCI, spinal cord trauma, cervical, thoracic, lumbar, thoracolumbar),central cord syndrome (CCS) and the interventions (laminectomy, laminoplasty, decompression, duroplasty). Results: This review includes6 observational studies investigating the outcome of posterior spinal decompression in patients suffering from spinal cord injury without traumatic spinal cord stenosis. Most patients already had degenerative stenosis. From a total of 202, 151 patients (74.7%) improved neurologically by at least one grade at ASIA scale, after being treated with either laminectomy, laminoplasty, duroplasty or a combination of these techniques. Conclusion: Early decompression in SCI patients remains a reasonable practice option and can be performed safely, but no specific evidence supports the use of laminectomy alone. There is emerging evidence that intended durotomy followed by extended meningoplasty may improve the neurological outcome in patients suffering from SCI when meta-traumatic edema is apparent. However, the lack of high-quality evidence and results support the need for further research. [ABSTRACT FROM AUTHOR]

Peer support is widely assumed to help individuals with spinal cord injury (SCI) adjust, yet the evidence is mixed. We propose that peer support may be more likely to promote adjustment when informal support is lacking. To test this hypothesis, 135 individuals living with SCI receiving peer support (46.7% female; M age = 42.36, SD = 14.83) completed an online survey assessing aspects of and satisfaction with the peer support and family/friend support that they were receiving as well as measures of adjustment. Although those reporting receiving more peer support were not any better adjusted than those reporting less, individuals who were more satisfied with the peer support they received reported better adjustment. Moreover, the relation of satisfaction with peer support with depressive symptoms was dependent on the level of family/friend support. These findings suggest that peer support is most effective among those lacking support from family and friends. [ABSTRACT FROM AUTHOR]

Background: Traumatic injuries are among the leading causes of death and disability worldwide. Major trauma presentations have seen a demographic shift recently from the young to the elderly, with significant associated neurological deficit. Aims: To review the presentation and outcome of elderly patients presenting with cervical spinal injuries and associated neurological deficit that underwent surgical intervention in order to optimise treatment strategies. Methods: A retrospective review was conducted at a national tertiary referral centre to analyse admission trends from June 2016 to July 2020 for outcomes of elderly patients (≥ 65) presenting with traumatic cervical spine injuries associated with spinal cord injuries (SCI). Demographic, clinical, and radiological characteristics were collected and analysed. Results: Forty-two patients met the inclusion criteria. The most common mechanisms of injury (MOIs) were falls from standing (38.1%) and falls from height (≥ 2 m) (33.3%). Complete SCIs had increased mean LOS (57.6 vs 21.6 days; p = 0.013), postoperative complications (100% vs 60.6%; p = 0.022), life-threatening complications (57.1% vs 9.1%; p = 0.001), and 90-day mortality (37.5% vs 5.9%; p = 0.007) compared to incomplete SCIs. Conclusion: Elderly patients with complete SCIs have poorer outcomes and mortality than those with less extensive SCIs. They require more resources, have greater risk of complications, and have higher mortality than those with incomplete SCIs, with subsequent implications on optimal treatment strategies. More robust studies are needed to derive improved risk stratification tools for geriatric patients with spinal injuries. [ABSTRACT FROM AUTHOR]

Background. Spinal cord injury (SCI) is a neurological disease associated with a high disability rate. Low-dose lipopolysaccharide (LPS) has been reported to activate cross- immune tolerance and alleviate the effects of various traumatic stimuli. The present study aimed to explore the effect of LPS on SCI and the potential molecular mechanism. Methods. Male Sprague-Dawley (SD) rats were used to established an in vivo SCI model and were intraperitoneally injected with lentivirus particles encoding a MALAT1 small interfering RNA (siRNA) on day 10 prior to SCI and with 0.2 mg/kg LPS 72 h prior to SCI. Basso, Beattie, and Bresnahan (BBB) scoring; HE staining; and TUNEL assay were used to assess neurological function and pathophysiological changes. Western blot and immunohistochemistry (IHC) were used to detect cell autophagy and Nrf2 nuclear translocation. PC12 cells were exposed to oxygen-glucose deprivation/reoxygenation (OGD/R) to establish an in vitro SCI model. In vitro SCI model cells were pretreated with LPS and transfected with siMALAT1 or MALAT1 overexpression plasmid aimed at knocking down MALAT1 or overexpressing MALAT1. The cell counting kit-8 (CCK-8) assay was used to measure the toxicity of LPS towards PC12 cells. Flow cytometry and immunofluorescence analysis were performed to investigate cell apoptosis and Nrf2 nuclear translocation. Results. SCI rats preconditioned with low-dose LPS had higher BBB scores, reduced SCI injury, increased MALAT1 expression and activated autophagy and Nrf2 nuclear translocation in the in vivo SCI model. In the in vitro SCI model, low-dose LPS treatment suppressed the apoptotic ratio of PC12 cells, increased MALAT1 expression, activated autophagy, and promoted Nrf2 nuclear translocation. Silencing MALAT1 exacerbated OGD/R injury in vitro and weakened the protective effect of low-dose LPS. Overexpression of MALAT1 inhibits OGD/R-induced apoptosis by inducing autophagy and promoting Nrf2 nuclear translocation. This was also been confirmed in animal experiments, silencing MALAT1 blocked the promotion of Nrf2 by low-dose LPS and the alleviated of SCI apoptosis. Conclusions. Low-dose LPS exhibited a protective role on SCI by activating autophagy and suppressing nerve cell apoptosis via the lncRNA MALAT1/Nrf2 axis. [ABSTRACT FROM AUTHOR]