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INTRODUCTION: This study aimed to compare the status of disability between chronic renal failure patients who underwent hemodialysis (HD) and patients with paraplegia due to spinal cord injuries. METHODS: Thirty chronic renal failure patients (12 women and 18 men) who have been receiving regular HD treatment (HD group) and 30 paraplegic patients (Paraplegic group) (22 women and 8 men) defined by Spinal Cord Injury Association were recruited to the study. All sociodemographical characteristics and brief personal information about the dialysis and paraplegic patients were recorded. The disability status was analyzed by Craig Handicap Assessment and Reporting Technique Short Form (CHART-SF). RESULTS: The mean ages of patients were 39.40+-6.81 in HD and 36.17+-8.92 years in the spinal cord injury group (p>0.05). According to CHART subgroup analysis, the physical independence level was 89.20+-21.43 and 77.87+-33.25 (p>0.05); cognitive evaluation was 91.97+-18.15 and 77.63+-33.25 (p0.05); roles and activities status were 24.58+-35.10 and 38.75+-40.22 (p>0.05); social integration was 70.37+-16.30 and 64.37+-22,64 (p>0.05); in HD and paraplegic group, respectively. DISCUSSION AND CONCLUSION: Although there is no physically handicapped state in HD patients, the severity of disability level is considered to be as high as in paraplegic patients.

Background: Pain after spinal cord injury (SCI) is debilitating and has been reported to be difficult to treat, despite pharmacological interventions. Pain medication misuse (PMM) and associated individual factors among people with spinal cord injury (PWSCI) are scarce. Aim: To determine PMM and the associated factors in PWSCI. Setting: Homes of community-dwelling manual wheelchair users with SCI in South Africa. Methods: Community-dwelling PWSCI (n = 122) were consecutively sampled and the Pain Medication Questionnaire (PMQ) was used to determine PMM. Descriptive statistics, Fisher’s exact test, independent t-tests, and simple linear regression tests were performed using SPSS v27. Testing was conducted at the 0.05 level of significance. Results: Eighty-five per cent of the participants reported the presence of pain and 48.1% of them used pain medication. Forty-four percent of people who used pain medication scored ≥ 30, indicative of serious aberrant drug-taking behaviours. Opioids were mainly used for neuropathic pain and in combination with other types of medications such as anticonvulsants and non-steroidal anti-inflammatories (44.0%). Pain severity and the type of pain medication were found to be predictors of PMM (p 0.01 respectively). Conclusion: Pain relief after SCI remains difficult to achieve, with an evident high risk of PMM, which may lead to long-lasting side effects, dependency, or overdose. Contribution: This study has shown the need for the assessment of the potential risk of dependency before prescribing pain medication, particularly opioids to PWSCI.

Objectives: This study explored publicly funded health system and patient expenditure in the post-acute phase following discharge from inpatient acquired brain injury (ABI) or spinal cord injury (SCI) rehabilitation. The secondary aim was to explore sociodemographic and injury characteristics associated with high costs. Methods: This was a prospective cohort study. 153 patients (ABI: n = 85; SCI: n = 68) who consented to the use of their Medicare data were recruited between March 2017 and March 2018, at the point of discharge from ABI or SCI specialist rehabilitation units. The main outcome measure involved linkage of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data for the 12 months following discharge from rehabilitation. Bayesian penalised regression was used to determine characteristics associated with high costs. Results: The median number of MBS items used in the 12 months after discharge was 33 (IQR: 21–52). General practitioners and allied health services were accessed by 100% and 41% of the cohort, respectively. The median MBS system cost (in Australian dollars) was $2006 (IQR: $162–$3090). Almost half (46%) of the participants had no MBS patient expenditure. The median PBS system cost was $541 (IQR: $62–$1574). For people with ABI, having a traumatic injury or one comorbidity was associated with lower PBS system costs by on average $119 and $134, respectively. We also found that hospitalisation in ABI was associated with higher PBS system costs, by on average $669. Conclusion: There was evidence of high and variable MBS and PBS costs, raising concerns about financial hardship. Future research should focus on identifying any unmet service and prescription needs in the post-acute rehabilitation phase for these populations. What is known about the topic? Acquired brain injury and spinal cord injury incur high long-term health costs, yet little is known about Medicare service use and costs in the early post-acute phase. What does this paper add? This study provides insight into service use and the burden of injury on Medicare Benefits Schedule and Pharmaceutical Benefits Scheme systems in the 12 months after hospital discharge. High and variable system and patient expenditure are most notable. What are the implications? Highly variable patient costs raise concerns about the access and affordability of sufficient healthcare services in the post-acute rehabilitation period. [ABSTRACT FROM AUTHOR]

Study Design: The effect of amlodipine (AM) on spinal cord injury (SCI) and autophagy was researched by establishing ventral spinal cord cells (VSC4.1) oxygen and glucose deprivation model and SCI mice model.Objective: To determine the neuroprotective effects of AM by upregulating autophagy during SCI repair.Summary Of Background Data: AM, an antihypertensive medication, has been shown in several studies to inhibit neuronal apoptosis and exert neuroprotective effects in various central nervous system diseases. However, its effects on SCI are unexplored. Autophagy could inhibit cell apoptosis, which has been shown to promote SCI repair. However, the role of AM in autophagy remains unclear.Methods: We examined the relationship between AM, apoptosis, and autophagy in ventral spinal cord cells and the injured spinal cords of C57BL/6 female mice respectively, following histological, behavioral, microscopic, immunofluorescence, and western blotting analyses.Results: We found that AM could inhibit motor neuronal apoptosis in vitro. Furthermore, AM promoted locomotor recovery by upregulating autophagy and alleviating apoptosis, neuronal loss, and spinal cord damage after SCI.Conclusion: AM inhibited motoneuronal apoptosis by upregulating autophagy to improve SCI recovery. [ABSTRACT FROM AUTHOR]

Introduction: Pressure ulcers are costly and devastating complications of spinal cord injury. A variety of treatment options are available for the management of pressure ulcers. Despite the fact that regular repositioning with a 30-degree and a 90-degree tilt is the most commonly applied interventions for the management of PU in clinical settings, however, their effectiveness is questionable because high-quality evidence is lacking to support or negate these treatment options. The objective of the current research study was to find out the effectiveness of two-hourly repositioning with a 30-degree tilt and four-hourly repositioning with a 90-degree tilt in the pressure ulcer healing of paraplegic spinal cord injured patients. Material & Methods: A pre-test and post-test control group research study was carried out at Paraplegic Centre, Peshawar from January to June 2019. A total of 42 paraplegic complete spinal cord injury patients with grade-II and -III pressure ulcers participated in the study. Participants in group A received two-hourly repositioning with a 30-degree tilt while participants in group B received four-hourly repositioning with a 90-degree tilt. Both groups were followed for three months. Pressure Ulcer Scale for Healing was used for data collection before and after the intervention. Results: The mean age of the subjects was 33.6 ± 11.6 years. Pre-treatment Pressure Ulcer Scale for Healing score of group A was 12.9 ± 1.94 and of group B was 12.33 ± 1.65 (p-value=0.311) while post-treatment Pressure Ulcer Scale for Healing score of group A was 1.04 ± 3.30 and of the group B was 7.23 ± 4.21 (p

Aim and Background: Spinal cord injury (SCI) is damage to some point of spinal cord or spinal neurons of end of spinal channel that frequently causes permanent changes in body’s strength, sensation, and other performances below the damaged point. When someone suffers from SCI may feel that all aspects of his/her life including mental, emotional, and social is affected. Thus, the current research aimed to examine the effectiveness of the acceptance and commitment therapy (ACT) enriched with compassion on improvement of resilience and self-efficacy of patients with SCI in Isfahan province. Methods and Materials: The research design was semi experimental with pre- and post-test and control group and random assignment. The research population includes all patients with SCI of Isfahan among whom 30 were recruited using inclusion and exclusion criteria and randomly assigned to either treatment or control group equally. The subjects filled out Connor & Davidson's (2003) Resilience Scale and Maddux, Mercandandt, Prentice-Dan, Jacobs, & Rogers’ (1982) General Self-Efficacy Test for both pre-test and post-test. Then, the treatment group received 8, 90-min weekly sessions of ACT enriched with compassion while the control group received no treatment. The data were analyzed using analysis of covariance and via statistical package for social sciences version 25. Findings: The results of the analysis showed that the training statistically, significantly improved the patients' resiliency and self-efficacy (p

Introduction: Correct airway management of polytraumatized patients is crucial because of the necessity of securing the airway and providing adequate ventilation without worsening a probable spinal cord injury. Objective: Determine the effect of manual inline stabilization (MILS) on Cormack-Lehane classification and if there is any correlation with body mass index (BMI). Material and methods: In a descriptive study at the Centro Hospitalario del Estado Mayor Presidencial in Mexico City, we included 56 patients with ASA physical status I to IV. The anesthesiologist performed direct laryngoscopy while MILS was performed and observed the CL grade. Immediately after, the patient was repositioned into the sniffing position, direct laryngoscopy was performed, and the CL grade was observed again. Results: The CL grades observed were significantly different between MILS vs. Sniffing position. CL grades were mainly high when positioned in MILS (75% classified as grades III and IV) and diminished significantly when changed to the sniffing position. Conclusion: Improvement of CL grade was observed when changing from MILS to sniffing position. [ABSTRACT FROM AUTHOR]

Accumulating evidence supports that spinal cord injury (SCI) produces robust inflammatory plasticity. We previously showed that the pro-inflammatory cytokine tumor necrosis factor (TNF)α is increased in the spinal cord after SCI. SCI also induces a systemic inflammatory response that can impact peripheral organ functions. The kidney plays an important role in maintaining cardiovascular health. However, SCI-induced inflammatory response in the kidney and the subsequent effect on renal function have not been well characterized. This study investigated the impact of high and low thoracic (T) SCI on C-fos, TNFα, interleukin (IL)-1β, and IL-6 expression in the kidney at acute and sub-chronic timepoints. Adult C57BL/6 mice received a moderate contusion SCI or sham procedures at T4 or T10. Uninjured mice served as naïve controls. mRNA levels of the proinflammatory cytokines IL-1β, IL-6, TNFα, and C-fos, and TNFα and C-fos protein expression were assessed in the kidney and spinal cord 1 day and 14 days post-injury. The mRNA levels of all targets were robustly increased in the kidney and spinal cord, 1 day after both injuries. Whereas IL-6 and TNFα remained elevated in the spinal cord at 14 days after SCI, C-fos, IL-6, and TNFα levels were sustained in the kidney only after T10 SCI. TNFα protein was significantly upregulated in the kidney 1 day after both T4 and T10 SCI. Overall, these results clearly demonstrate that SCI induces robust systemic inflammation that extends to the kidney. Hence, the presence of renal inflammation can substantially impact renal pathophysiology and function after SCI. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of nosocomial urinary tract infections in patients admitted for spinal cord injury rehabilitation, identify the organisms responsible, and determine their susceptibility to systemic antimicrobials. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Sep 2022 to Apr 2023. Methodology: Samples for urine culture and sensitivity were taken from 47 individuals; 25 of these were excluded due to the growth of mixed organisms. Both male and female patients were included with Spinal Cord injury and admitted to the Inpatient Department for rehabilitation. Spinal cord injuries were classified as acute (<6 months) and chronic (>six months), depending upon the time elapsed since the injury. Symptoms of urinary tract infections were documented. Results: The sample showed a male preponderance, with 18(81.80%) males and 4(18.20%) females. Twelve individuals (54.5%) had symptoms of urinary tract infection. The urine sample yielded microbial growth in 19(86.40%) samples, confirming the diagnosis of UTI. Out of the participants, 9(40.90%) had acute SCI, while 13(59.10%) had chronic SCI. The mean duration since the SCI was 8.04±5.84 months. Conclusion: In patients with urinary tract infections associated with spinal cord injury, Klebsiella and Escherichia coli were found to be the major causative organisms. Meropenem, Fosfomycin, and Gentamicin were found to be the most effective initial choice of antibiotics, exhibiting increased sensitivity against the alleged microorganisms. [ABSTRACT FROM AUTHOR]

INTRODUCTION[|]Increased intracellular calcium concentration plays an important role in the secondary mechanism of spinal cord injury. In the presenting experimental study, we aimed to evaluate the healing effect of barnidipine, which has a high affinity for L-type calcium channels, on acute spinal cord injury and to compare its effects with those of methylprednisolone.[¤]METHODS[|]A total of 32 Spraque Dawley albino adult female rats were divided into 4 groups; group 1: sham-operated (n=8), group 2: only ischemia (n=6), group 3: barnidipine-treated (n=8), and group 4: methylprednisolone-treated (n=6). An ischemia-reperfusion model was created by clipping the abdominal aorta in the rats. Motor examination was performed 1 hour after the surgical procedure and before sacrification. Immediately following the second motor examination, rats were sacrificed and tissue samples were taken for histopathological examination and for testing of tissue malondialdehyde (MDA) levels.[¤]RESULTS[|]A significant correlation of motor examination was found between the sham-operated and barnidipine-treated groups and the sham-operated and only ischemia groups at the 1st and 24th hour (p0.008). Light microscopic examination of the sham-operated group revealed findings consistent with normal spinal cord structure. In group 2, 3, and 4, light microscopic examination revealed polymorphonuclear leukocyte infiltration and a small amount of axonal swelling. There was no significant correlation between the ischemia and barnidipine-treated groups and the barnidipine and methylprednisolone groups in terms of MDA levels (p>0.008).[¤]DISCUSSION AND CONCLUSION[|]A single dose of barnidipine (10 mg/kg) and methylprednisolone are not effective and not sufficient to prevent spinal ischemia-reperfusion injury in rats.[¤]

Objective: To describe the living situation of family caregivers of persons with spinal cord injury. Design: Cross-sectional questionnaire. Subjects: Primary family caregivers of persons with chronic spinal cord injury in Switzerland. Methods: Cross-sectional study of family caregivers of persons with spinal cord injury. For comparison, the study population was matched to family care-givers of persons dealing with long-term health conditions in the general population, using a propensity-score based algorithm. Results: A total of 717 family caregivers participat-ed in the survey (35% response rate). Participants were mostly female (72%), mean age 57 years, and had spent approximately 13 years caring for their relative. A mean of 21 h/week was spent providing care and assistance. The vast majority of family care-givers reported coping well with their situation. However, support from public services was deemed inadequate. Compared with family caregivers in the general population, family caregivers of persons with spinal cord injury performed more caring tasks and reported a slightly lower quality of life. Conclusion: Family caregivers of persons with spinal cord injury are self-reliant to cope with their situation, but report discontent with public support ser-vices. The healthcare system could provide alternative support measures, such as direct financial compensation.

The aim was investigate the time-course of cardiac autonomic response in men with incomplete cervical spinal cord injury (SCI) practitioners or not of physical exercise. Twenty men were separated into three groups: control group without SCI (CON; 28.3 ± 4.5 yrs; 178.4 ± 6.5 cm; 82.1 ± 6.8 kg; n=8), regularly engaged in strength training and low aerobic training; exercise group with cervical SCI (EG, 32.3 ± 4.5 yrs, 175.1 ± 5.3 cm, 73.6 ± 9.6 Kg; n=8) that practiced wheelchair rugby and sedentary group with cervical SCI (SG, 30.8 ± 5.3 yrs, 173.4 ± 10.1 cm, 69.7 ± 7.1 Kg; n=4) who did not practice physical exercise. Heart rate variability variables were calculated from ECG, in rest. CON showed high values compared to EG and SG of: standard deviation of R-R intervals (SDNN), proportion of adjacent R-R intervals differing by more than 50 ms, number of interval differences of successive NN intervals greater than 50 ms, root mean square of successive differences and the high-frequency spectral power. SDNN was significantly lower in EG compared to CON. changes in cardiac autonomic function could be noted in subjects with cervical SCI regularly engaged in an exercise program.

Objectives: This study aims to examine the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on gait parameters and lower extremity motor recovery in a more specific sample of individuals with chronic and traumatic incomplete spinal cord injury (iSCI)., Patients and Methods: This double-blind, sham-controlled, randomized study included a total of 28 individuals (20 males, 8 females; mean age: 35.7±12.1 years; range, 18 to 45 years) with chronic (>1 year) traumatic iSCI. The participants were randomly allocated to either sham rTMS group (n=14) or real rTMS group (n=14). We compared the groups based on the lower extremity motor scores (LEMS), the temporal-spatial gait measurements using three-dimensional gait analysis, the Walking Index for SCI-II (WISCI-II), and 10-m walking test at baseline, three weeks (post-treatment) and five weeks (follow-up) after the treatment., Results: The real rTMS group revealed a significant improvement in walking speed, LEMS score, and 10-m walking test after the treatment compared to baseline (p=0.001, p=0.002, and p=0.023, respectively). Changes in the LEMS score were significantly increased in the real rTMS group compared to the sham group at both three and five weeks (p=0.001 and p=0.001, respectively). No significant difference was observed in the other variables between the groups (p>0.05)., Conclusion: Our study findings support the therapeutic effectiveness of rTMS on motor recovery in chronic iSCI. The rTMS can be used as an adjuvant therapy to conventional physiotherapy in the rehabilitation of patients with iSCI., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2023, Turkish Society of Physical Medicine and Rehabilitation.)

BACKGROUND This study determined whether the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire, a measure of self-reported frequency and severity of symptoms during hypo- and hypertensive episodes, correlates with blood pressure (BP) instability. In addition, test–retest reliability of the ADFSCI questionnaire was assessed. METHODS Thirty individuals with spinal cord injury (SCI) (aged 42±12 years; level of lesion = C3–L1; American Spinal Injury Association Impairment Scale = A–C; lesion duration = 1 month to 30 years after injury) participated in this study. Twenty-four-hour ambulatory BP monitoring (ABPM) was used to assess BP instability. ABPM recorded systolic BP (SBP), diastolic BP (DBP), and heart rate at 15-minute intervals during the daytime and 1-hour intervals during the nighttime. Test–retest reliability was performed by completion of the ADFSCI questionnaire on 2 occasions (i.e., 9±4 days in between). RESULTS Individuals with SCI who self-reported autonomic dysreflexia (AD) episodes showed significantly higher SBP coefficient of variation (CV) (14%) and more AD events (n = 11) than individuals who reported never having AD symptoms (CV = 9%; AD events = 1). Both the number of AD events over the 24-hour period and the BP variability (SBP CV) were significantly related to the patients’ self-reported total AD score (rho = 0.522, P = 0.005; rho = 0.584, P = 0.001, respectively) and daily AD frequency (rho = 0.553, P = 0.003; rho = 0.586, P = 0.001, respectively). Conversely, no significant correlations existed between the number of hypotensive events over the 24-hour period and self-reported frequency and severity in the ADFSCI questionnaire. CONCLUSIONS This study provides evidence that ABPM offers a strong clinical basis for documenting and understanding BP instability, such as AD, and related symptoms in individuals with SCI. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) involves a series of pathological events. Abnormal sodium influx has been implicated as one of the key events in the pathophysiology of the SCI. Pharmacological blockade of sodium channels can reduce secondary injury and increase recovery from trauma. The aim of the present study was to show the neuroprotective effect of phenytoin, a sodium channel blocker, after experimental SCI.Control and laminectomy-only groups were not injured. 50?g-cm weight drop injury was produced in the trauma group. In the treatment groups, methylprednisolone (30?mg/kg) and phenytoin (1?mg/kg, 10?mg/kg, or 30?mg/kg) were given intraperitoneally immediately after injury. Malondialdehyde (MDA) levels in the spinal cord samples were examined for lipid peroxidation. Spinal cord ultrastructure was evaluated and grading system was used for quantitative evaluation.Trauma increased tissue MDA levels. Treatment with methylprednisolone and phenytoin decreased MDA levels compared to trauma in all doses. Significant ultrastructural neuroprotection was observed with 30?mg/kg of phenytoin treatment according to general neural score. This ultrastructural neuroprotection of phenytoin was not different from methylprednisolone. Phenytoin appears to protect spinal cord against injury by decreasing lipid peroxidation and lessening neuronal damage associated with SCI in rats. [ABSTRACT FROM AUTHOR]

Background.The secondary injury process following spinal cord trauma has been shown to involve different mechanisms such as excessive release of excitatory amino-acids, and induction of free radical induced lipid peroxidation. In this experimental study, the time-level relationship of the nitric oxide and the neuroprotective effects of aminoguanidine were investigated in a rat spinal cord trauma model.Methods.The experiments were performed on 63 Wistar albino rats divided into three groups; sham-operated control (Group 1), trauma created control (Group 2) and aminoguanidine group (Group 3). In groups 2 and 3, spinal cord trauma was produced at thoracic level by using weight the drop technique (at a severity of 50?gr-cm). After the trauma, the rats in Group 3, received an intraperitoneal injection of 100?mg/kg aminoquanidine twice a day for 3 days. The effects of the injury and the efficacy of aminoguanidine were determined based on biochemical parameters (lipid peroxidation and nitric oxide levels in tissue), and on light microscopy findings in cord tissue collected at different times post-injury. Biochemical parameters were performed one hour, three and five days after injury. Functional recovery was assessed at 3, and 5 days after cord trauma with the inclined-plane technique and Tarlov’s motor grading scale.Findings.Although there was no statistically significant difference at the 1st hour, the values of the tissue nitric oxide in trauma created controls were 42% higher on the 3rd day and 40% higher on the 5th day when compared with those in sham controls. The levels of the tissue lipid peroxidation in trauma created controls were 88% higher at the 1st hour and 52.8% higher on the 5th day when compared with shame controls, but there was no meaningful difference on the 3rd day. In the trauma created control group, the mean motor function scores decreased to 1.16?±?0.40 and to 1?±?0 on the 3rd and 5th day, respectively. In this group the mean values of the inclined plane were 39.16?±?2.04 on the 3rd day and 37.91?±?1.02 on the 5th day. No statistically significant difference was observed in both tissue lipid peroxidation and nitric oxide levels for all time points between the aminoguanidine group and the sham-operated controls (p>0.01). The motor function scores were observed as 2.16?±?0.40 on the 3rd day and as 3?±?0 on the 5th day in aminoguanidine group. These values were significantly higher than the trauma created controls (p<0.01). Aminoguanidin treatment also improved the inclined plane performance of the rats; In this group, the mean values of the inclined plane scores were 44.58?±?2.92 and 52.91?±?1.88 on the 3rd and 5th days, respectively. These values were significantly higher than the trauma created controls (p<0.01).Interpretation.This study shows that the nitric oxide level does not increase in the spinal cord tissue during the first hour after the spinal cord trauma. It increases significantly in the spinal cord tissue not only three days but also five days following the trauma. Aminoguanidine treatment, which is started just after the trauma, can prevent both the nitric oxide production and lipid peroxidation in spinal cord tissue and it can improve the functional status of the animals. In this respect, aminoguanidine may have a potential role in the treatment of acute spinal cord injury. [ABSTRACT FROM AUTHOR]

Neutralizing the myelin-associated growth inhibitor Nogo-A in adult spinal cord-injured rats can promote regeneration of injured and compensatory sprouting of uninjured axons. Nogo-A is present in humans, making its neutralization a possible novel treatment option for paraplegic patients. In this study we examined the effects of an extensively used anti-Nogo-A antibody (mAb IN-1) on the regenerative capabilities of lesioned corticospinal tract (CST) axons in a primate, the Marmoset monkey. Unilateral thoracic lesions of the CST were performed in six adult Marmosets, followed by the application of mAb IN-1 into the cerebrospinal fluid circulation by a graft of hybridoma cells. A unilateral injection of biotin dextran amine into the motor cortex was performed to analyse sprouting and regeneration of the lesioned axons. In the control antibody-treated animal CST fibers stopped rostral to the lesion site and often showed retraction bulbs. In contrast, in four out of five mAb IN-1-treated animals fine labeled neurites had grown into, through and around the lesion site. Thus, this study provides first anatomical evidence that in primates, the neutralization of the myelin-associated inhibitor Nogo-A results in increased regenerative sprouting and growth of lesioned spinal cord axons. [ABSTRACT FROM AUTHOR]

Subarachnoid-pleural fistula is a rare occurrence in humans as a result of trauma or spinal surgery. Such fistulas commonly remain undiagnosed until sufficient cerebrospinal fluid accumulates in the pleural space to cause respiratory distress. We describe a subarachnoid-pleural fistula in a dog that occurred subsequent to blunt trauma sustained during a fall, with concurrent acute, traumatic intervertebral disc rupture. The extruded disc material penetrated the dura mater, allowing communication between the subarachnoid space and the extrapleural thoracic cavity. Radiographic, myelographic, and computed tomographic (CT) findings are reviewed. Abnormalities noted during myelography included an intradural-extramedullary lesion at T11–T12, with epidural leakage of contrast medium from the region of T12 extending cranially. In images from myelography and CT there was extravasation of contrast medium extending from the subarachnoid and epidural space into the extrapleural thoracic cavity. [ABSTRACT FROM AUTHOR]

The recent discovery of the Nogo family of myelin inhibitors and the Nogo-66 receptor opens up a very promising avenue for the development of therapeutic agents for treating spinal cord injury. Nogo-A, the largest member of the Nogo family, is a multidomain protein containing at least two regions responsible for inhibiting central nervous system (CNS) regeneration. So far, no structural information is available for Nogo-A or any of its structural domains. We have subcloned and expressed two Nogo-A fragments, namely the 182 residue Nogo-A(567–748) and the 66 residue Nogo-66 in Escherichia coli. CD and NMR characterization indicated that Nogo-A(567–748) was only partially structured while Nogo-66 was highly insoluble. Nogo-40, a truncated form of Nogo-66, has been previously shown to be a Nogo-66 receptor antagonist that is able to enhance CNS neuronal regeneration. Detailed NMR examinations revealed that a Nogo-40 peptide had intrinsic helix-forming propensity, even in an aqueous environment. The NMR structure of Nogo-40 was therefore determined in the presence of the helix-stabilizing solvent trifluoroethanol. The solution structure of Nogo-40 revealed two well-defined helices linked by an unstructured loop, representing the first structure of Nogo-66 receptor binding ligands. Our results provide the first structural insights into Nogo-A functional domains and may have implications in further designs of peptide mimetics that would enhance CNS neuronal regeneration. [ABSTRACT FROM AUTHOR]

Six spinal cord injured (SCI) patients were trained to step on a treadmill with body-weight support for 1.5–3 months. At the end of training, foot motion recovered the shape and the step-by-step reproducibility that characterize normal gait. They were then asked to step backward on the treadmill belt that moved in the opposite direction relative to standard forward training. In contrast to healthy subjects, who can immediately reverse the direction of walking by time-reversing the kinematic waveforms, patients were unable to step backward. Similarly patients were unable to perform another untrained locomotor task, namely stepping in place on the idle treadmill. Two patients who were trained to step backward for 2–3 weeks were able to develop control of foot motion appropriate for this task. The results show that locomotor improvement does not transfer to untrained tasks, thus supporting the idea of task-dependent plasticity in human locomotor networks. [ABSTRACT FROM AUTHOR]

Functional electrical stimulation (FES) enables restoration of movement in individuals with spinal cord injury. FES-based devices use electric current pulses to stimulate and excite the intact peripheral nerves. They produce muscle contractions, generate joint torques, and thus, joint movements. Since the underlying neuromuscular-skeletal system is highly nonlinear and time-varying, feedback control is necessary for accurate control of the generated movement. However, classical feedback/closed-loop control algorithms have so far failed to provide satisfactory performance and were not able to guarantee stability of the closed-loop system. Because of this, only open-loop controlled FES devices are in clinical use in spite of their limitations. The purpose of the reported research was to design a novel closed-loop FES controller that achieves good tracking performance and guarantees closed-loop stability. Such a controller was designed based on a mathematical neuromuscular-skeletal model and is founded on a sliding mode control theory. The controller was used to control shank movement and was tested in computer simulations as well as in actual experiments on healthy and spinal cord injured subjects. It demonstrated good robustness, stability, and tracking performance properties. [ABSTRACT FROM AUTHOR]

Spinal cord transection (SCT) inhibits gastrointestinal motility in rats. We evaluated the effect of preinjury large bowel emptying on this phenomenon. Male Wistar rats (N = 52) were fasted for 24 or 48 hr with water ad libituin and pretreated with lactose (0.8 g) or saline. Next, laminectomy followed or not by complete SCT between T4 and T5 vertebrae was performed. Phenol red recovery in the stomach and proximal, medial, and distal small intestine was determined 1 day later. In animals submitted to 24 hr fasting + saline, SCT increased gastric recovery by 42.8% and decreased medial small intestine recovery by 56.2%, while 48 hr fasting + saline or 24 hr fasting + lactose prevented the inhibition of gastric emptying (GE) in SCT animals. The 48 hr fasting + lactose prevented the inhibition of both GE and gastrointestinal transit. SCT-induced inhibition of upper gastrointestinal motility may involve enhancement of inhibitory reflexes, which can be prevented by large bowel emptying. [ABSTRACT FROM AUTHOR]

Summary. Background: Effects of medroxyprogesterone acetate, enoxaparin and pentoxyfylline on lipid peroxidation, antioxidant defence system, paraoxonase activities, and homocysteine levels in an experimental model of spinal cord injury were investigated. Method: Sixty-three male albino Wistar rats were anaesthetized by 400 mg/kg chloral hydrate and divided into 5 groups. G1 (n 7) = control group provided the baseline levels. G2–G5 underwent T3–6 total laminectomies and spinal cord injuries by clip compression at T4–5 levels. Medications were applied to G3–G5 right after the injury. Hence, G2 constituted laminectomy + injury (lam+I); G3 = lam + I + medroxyprogesterone acetate (MPA), G4 = lam + I + enoxaparin (E), and G5 = lam+I+pentoxyfylline (P) groups. Animals were decapitated either at the 1st or 4th hour after injury. Tissue and blood malonyldialdehyde (MDA) and plasma homocysteine and erythrocyte superoxide dismutase (SOD) levels, and erythrocyte glutathione peroxidase (GSH-Px) and plasma paraoxonase (PON1) activities were assayed. SPSS 9.0 program was used for statistical analysis and graphics. Intergroup comparisons were made by Bonferroni corrected Mann Whitney U test (P<0.025), and intragroups comparisons by Wilcoxon Rank test (P<0.03). Findings: In intergroup comparison, G1–G2, G1–G3, G1–G5, G2–G3, G2–G4, and G4–5 groups differed from each other for all parameters (P<0.025, MWU) except for G4–G5 4th hour MDA levels. G1–G4 was similar for all 1st hour parameters (P>0.025, MWU), but different for 4th hour (P<0.025, MWU) except for GSH-Px and SOD levels. For G2–G5, all parameters for 1st and 4th hour were similar except for 4th PON1, Hcy and SOD levels. For G3–G4, all 1st hour parameters were different from each other (P<0.025, MWU); whereas all 4th hour parameters were similar except for SOD level. For G3–G5, all parameters at 1st and 4th hour were similar except for 4th hour GSH-Px, PON1, and Hcy. In intragroup comparison, all parameters differed from each other at all times (P<0.03, WRT) except for 1st hour G4 MDA, Hcy and SOD levels compared to basal levels. Interpretation: In injury groups, plasma Hcy levels decreased and PON1 activities increased as erythrocyte SOD level and GSH-Px activities decreased in parallel to increases of tissue and blood MDA levels. These changes were relatively suppressed by MPA, enoxaparin and pentoxyfylline administrations at varying degrees. Enoxaparin was the most powerful agent, particularly at 1st hour. MPA was also effective, particularly at 4th hour. Pentoxyfylline despite having slight effect at 4th hour, was not effective according to both control and injury groups. Enoxaparin and MPA can be used in the treatment of spinal cord injuries. PON1 and Hcy are helpful in monitoring the antioxidant defence system as well as SOD and GSH-Px, both in injury and medically treated groups. [ABSTRACT FROM AUTHOR]

Background: White matter damage and neuronal cell death are incurred by spinal cord injury (SCI). FBXW7α, an important mediator of cell division and growth was investigated to explore its role in repairing the traumatic spinal cord in rats. Underlying mechanisms such as oxidative stress and inflammasomes signaling were also studied., Methods: Spinal cord injury in rats was established by longitudinal surgical incision from the lower to mid-thoracic vertebrae on the backside, followed by 20-g weight placed on the exposed Th12 surface for 30 min. AAV-delivered FBXW7α and -sh-FBXW7α were intrathecally injected into the rat spinal cord. Indices of oxidation, neurotrophic factors, and pyroptosis were measured by Western blot, Elisa, and RT-PCR., Results: We found the overexpression of FBXW7α in spinal cord rescue neuronal death triggered by the injury. Specifically, the nutritional condition, oxidative stress, and pyroptosis were improved. A synchronization of BNDF and GDNF expression patterns in various groups indicated the secretion of neurotrophic factors affect the outcome of SCI. The SOD1, CAT, and GSH-px were suppressed after trauma but all restored in response to FBXW7α overexpression. Inflammasomes-activated pyroptosis was incurred after the injury, and relevant biomarkers such as GSDMD, caspase-1, caspase- 11, IL-1β, and IL-18 were down-regulated after the introduction of FBXW7α into the injured cord. Additionally, up-regulating FBXW7α also repaired the mitochondria dysfunction., Conclusion: Our data indicate FBXW7α probably serves as an important molecular target for the therapy of spinal cord injury., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background & Objective: NSCs therapy is considered one of the most potential methods for spinal cord injury (SCI)., Methods: We build the SCI model rats to investigate the therapeutic effect of fire needle acupuncture in improving the locomotor function of SCI rats and its possible mechanism. BBB scale was used for the motor ability of rats. The expression of Nestin, NSE, Gal-C, and GFAP was detected by immunohistochemistry. Wnt, GSK3β, β-catenin, ERK1/2, CyclinD1, and ngn1 were detected by western blot and PCR. The BBB score of both model group (1.20±0.94, 3.12±0.67, 5.34±1.57, 7.12±1.49) and fire needle group (1.70±0.58, 4.50±1.63, 7.53±2.41, 9.24±0.63) gradually increased after SCI. Furthermore, at d10 and d14, the fire needle group showed a significantly high score compared with that in model group at the same time (P<0.05). Fire needle increased Nestin, NSE, and Gal-C expression inhibited GFAP expression after SCI. Also, fire needle could up-regulate Wnt3a, GSK3β, β-catenin, and ngn1, and down-regulate ERK1/2, cyclinD1 gene and protein expression., Conclusion: In conclusion, fire needle could improve lower limb locomotor function of SCI rats. Also, fire needles could promote endogenous NSCs proliferation differentiating into neurons, and the mechanism might be mediated by promoting the activation of Wnt/β-catenin and inhibiting the overexpression of ERK., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Mesenchymal Stem Cells (MSCs) are promising candidates for nerve tissue engineering. Brain Derived Neurotrophic Factor (BDNF) secreted by MSCs can function to increase neural differentiation and relieve inflammation response. Gene transfection technology is an efficient strategy to increase the secretion levels of cytokines and enhance cellular functions. However, transfection and in vivo gene expression of environmentally sensitive stem cells have been one of the most challenging subjects due to the requirement in both safety and transfection efficiency. In this study, gene transfection technology was applied to prepare BDNF gene recombinant MSCs based on our previously reported liposomal vector ScreenFect® A. To improve cellular survival and gene expression after in situ implantation of MSCs, an adhesive peptide modified hydrogel scaffold was constructed using hyaluronic acid. The scaffold was optimized and modified with an adhesive peptide PPFLMLLKGSTR. The transfected MSCs exhibited improved cellular survival and sustained gene expression in the three-Dimentional (3D) scaffold in vitro. Compared to untransfected MSCs, gene recombinant MSCs effectively improved spinal tissue integrity, inhibited glial scar formation and alleviated inflammatory response. These effects were found discounted when cells were implanted without the scaffold., Conclusion: The study developed a promising implantation system for therapy of severe spinal cord injury and provided the first understanding of Screenfect® A about its functions on stem cell therapy for nerve tissue repair as well as three-dimentional gene expression., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Iatrogenic spinal cord injury (SCI) is the most devastating complication of spine surgery, which usually results in permanent and serious disabilities of patients. Improvement of the visualization and discrimination of the spinal cord is critical for accuracy and safety during surgery; however, to date, there is no suitable technology to fulfill this clinical need. Here, we first show an efficient and rapid fluorescence imaging of the spinal cord in rabbit by epidural administration of a nerve-highlighting fluorophore, i.e. ( E, E )-1,4-bis( p -aminostryl)-2-methoxy benzene (BMB). The BMB is firstly encapsulated into polymeric micelles to form a BMB-micelle (BMB-m) formulation with well-dispersion in normal saline solution. After epidural administration of BMB-m, BMB is transported by the flow of cerebrospinal fluid (CSF) and binds to the peripheral region of the white matter thus facilitating rapid staining of the spinal cord. Furthermore, this BMB imaging technology also holds great potential for visually monitoring the integrity of the spinal cord in real time and promptly identifying acute SCI during spine surgery., Competing Interests: Competing Interests: The authors have declared that no competing interest exists.

We here propose an updated concept of stem cells (SCs), with an emphasis on neural stem cells (NSCs). The conventional view, which has touched principally on the essential property of lineage multipotency (e.g., the ability of NSCs to differentiate into all neural cells), should be broadened to include the emerging recognition of biofunctional multipotency of SCs to mediate systemic homeostasis, evidenced in NSCs in particular by the secretion of neurotrophic factors. Under this new conceptual context and taking the NSC as a leading example, one may begin to appreciate and seek the "logic" behind the wide range of molecular tactics the NSC appears to serve at successive developmental stages as it integrates into and prepares, modifies, and guides the surrounding CNS micro- and macro-environment towards the formation and self-maintenance of a functioning adult nervous system. We suggest that embracing this view of the "multipotency" of the SCs is pivotal for correctly, efficiently, and optimally exploiting stem cell biology for therapeutic applications, including reconstitution of a dysfunctional CNS.