Spinal cord最新文献

Study design: Prospective cohort study.

Objectives: To describe barriers to admission to and discharge from an inpatient rehabilitation unit for patients with newly acquired spinal cord injury or disease (SCI/D) and to identify modifiable factors whereby patient flow can be optimized.

Setting: Netherlands.

Methods: In-patients with newly acquired SCI/D referred to a rehabilitation centre in the Netherlands between December 2018 and December 2019 were included. Demographic, clinical characteristics and information about waiting days and causes of delay were recorded. Descriptive analysis was used.

Results: In total, 105 patients were included; 33 patients (31%) were female, mean age was 59 years, 60% had a non-traumatic SCI/D, 42% of the SCI/D were tetraplegia and 62% were AIS D at referral. No significant differences in demographic or clinical characteristics were found between patients with and without a barrier to admission. Most common admission barriers were bed availability and capacity of nursing and other health staff. The most frequent discharge barriers were delay in care approval, lack of availability of nursing home places and waiting for home modifications.

Conclusion: Most frequent admission barriers were availability of beds and staffing capacity; most discharge barriers were problems with home modifications, waiting for care approval or a nursing home place. Recommendations for reducing these barriers are recognizing a potential problem at an early stage, timely communication with patient and/or family about options for discharge, while simultaneously initiating a home modification plan and exploring temporary accommodation options.

Study design: Narrative review OBJECTIVES: Sir Ludwig Guttmann realised spinal cord injury (SCI) rehabilitation should incorporate more than a biomedical approach if SCI patients were to adjust to their injury and achieve productive social re-integration. He introduced components into rehabilitation he believed would assist his patients build physical strength as well as psychological resilience that would help them re-engage with their communities. We pay tribute to Sir Ludwig by presenting research that has focussed on psychosocial factors that contribute to adjustment dynamics after SCI.

Setting: Not applicable.

Methods: Five factors with a psychosocial source will be examined, featured in my research, namely psychological distress, cognitive impairment, pain catastrophizing, sleep disorder and fatigue. A multifactorial model of adjustment will be examined.

Results: Evidence shows these factors can be significant barriers to adjustment and reciprocally related to self-efficacy and life decisions. A theoretical rehabilitation framework/model is presented called the SCI Adjustment Model (SCIAM), that explains the process of adjustment dynamics. It describes how multifactorial factors contribute to adjustment in a non-linear process over time.

Conclusions: Key clinical messages include: (i) adjustment dynamics will be enhanced if viewed through the lens of a multifactorial model that clarifies how multiple psychosocial factors can combine and act as barriers or facilitators to adjustment; (ii) judiciously using this information, assess and then strategize to reduce the influence of barriers or strengthen facilitators during SCI rehabilitation and beyond, and (iii) integrate psychosocial guidelines and a person-centred approach into SCI rehabilitation to achieve treatment goals.

Study design: Registry-based cohort study.

Objectives: To evaluate the impact of the introduction of a new bladder management model of care at the Victorian Spinal Cord Service (VSCS) on the incidence of subsequent emergency department presentations and readmissions to hospital for urinary tract infection (UTI) in the first 2 years after injury.

Setting: VSCS, Austin Health, Melbourne, Australia.

Methods: A new model of care that prioritized intermittent self-catheterization was implemented at the VSCS on 1 August 2017. Data from the Victorian State Trauma Registry and Austin Health medical record were used to compare the rate of readmissions, emergency department (ED) presentations and hospitalisations for UTI in the first two years post-injury before and after practice was changed.

Results: A total of 333 cases were included; 149 cases pre-model of care change and 184 cases after. 143 males and 41 females with a mean (SD) age of 48.9 (19.7) were admitted to the VSCS following the change in model of care. The rate of any subsequent hospitalisation for UTI (ED presentation or admission) was lower following the introduction of the new bladder management model of care (Incidence rate ratio 0.30, 95% CI 0.12-0.73).

Conclusions: Our data demonstrates the real-world impact of a change in bladder management after new SCI. These data strengthen the consensus recommendation in current practice guidelines.

Study design: Retrospective review.

Objectives: While most individuals with spinal cord injury (SCI) are expected to have 1-2 urinary tract infections (UTIs) per year, there is a subset with higher incidence. We evaluate our practice to characterize common causes of recurrent UTIs, hypothesizing that more frequent infections typically have addressable risk factors.

Setting: Tertiary urology clinic, San Jose, CA.

Methods: We reviewed patients with SCI referred to a tertiary urology clinic for evaluation and management of "recurrent UTIs" during the years 2015-2020. Following workup, the suspected cause of recurrent UTIs and number of post-specialty evaluation UTIs (patient reported) were noted.

Results: Forty persons with SCI with a mean of 4.8 UTI treatments in the prior year comprised our cohort with most performing CIC (80%). After workup, 37/40 (92.5%) had a likely cause for their reported recurrent UTIs. In 16/40 (40%), careful questioning determined that the patient was not having UTIs based on guideline definitions. In those with confirmed recurrent UTIs, a bladder diary (62.5%) or urodynamic study (64%) was more likely to identify a cause compared to imaging (2.6%) or cystoscopy (8%). With a minimum 1-year follow-up, 90% of our population had a 50% or more reduction in UTI incidence, mostly using non-antibiotic strategies.

Conclusion: In a referral SCI population with a chief complaint of "recurrent UTIs", over a third were not having UTIs. In addition to detailed history, a bladder diary +/- urodynamics are most useful in finding the cause and improving UTI.

Study design: Systematic scoping review.

Objectives: Extended reality (XR) is becoming a recognisable tool for assisting in spinal cord injury (SCI) rehabilitation. While the success of XR mediated interventions is often evaluated based on improvements in physical and functional performance, the present systematic scoping review aimed to identify and synthesize evidence on reported psychological outcomes of XR interventions in SCI rehabilitation. In doing so, we aimed to contribute towards an adaptation of XR that is meaningful for individuals living with SCI.

Methods: Seven bibliometric databases were systematically searched. Included studies needed to be peer-reviewed, test structured and targeted XR interventions in an adult (≥ 16 years) SCI population, and assess any psychological construct. Individual double-screening against a pre-defined eligibility criteria was performed. Data from the included studies were extracted, tabulated, and analysed.

Results: A total of 964 unique studies were initially identified. 13 studies were included in the analysis. The psychological outcomes most frequently quantified were depression, self-esteem, and anxiety. Among other things, qualitative evidence suggests VR-based interventions provided enjoyment, relaxation, and a source of positive distraction.

Conclusion: Immersive XR interventions in SCI rehabilitation have been positively evaluated, both qualitatively and quantitatively, based on the psychological outcomes of participants. While further research is needed, we find immersive XR to be an emerging treatment option with promise for maintaining and improving psychological health during SCI rehabilitation.

Study design: Experimental Animal Study.

Objective: To continue validating an antibody which targets an epitope of neurofilament light chain (NF-L) only available during neurodegeneration and to utilize the antibody to describe the pattern of axonal degeneration 10 days post-unilateral C4 contusion in the rat.

Setting: University of Florida laboratory in Gainesville, USA.

Methods: Sprague Dawley rats received either a unilateral 150kdyne C4 contusion (n = 4 females, n = 5 males) or a laminectomy control surgery (n = 2 females, n = 3 males). Ten days following SCI or laminectomy, spinal cords and brainstems were processed for immunohistochemistry. Serial spinal cord and brainstem cross-sections were stained with the degeneration-specific NF-L antibody (MCA-6H63) and dual labeled with either an antibody against the C-terminus portion of NF-L (NF-L-Ct), to label healthy axons, or an antibody against amyloid precursor protein (APP), considered the current "gold standard" for identifying axonal injury. The pattern of ongoing axonal degeneration was assessed.

Results: Spinal cord and brainstem cross-sections from injured rats had punctate MCA-6H63 positive fibers with a pathological appearance, loss of anti-NF-L-Ct colabeling, and frequent colocalization with APP. Immunopositive fibers were abundant rostral and caudal to the lesion in white matter tracts that would be disrupted by the unilateral C4 contusion. This pattern of staining was not observed in control tissue.

Conclusions: The MCA-6H63 antibody labels degenerating axons following SCI and offers a tool to quantify axonal degeneration.

Study design: Narrative review.

Background: Neurotrauma has a considerable impact on healthcare, the economy, and human resources worldwide. In Iran, young males are especially vulnerable, with road traffic accidents (RTAs) being the major cause. Evaluating prehospital care systems is critical for detecting shortcomings and implementing improvements. This study seeks to evaluate the prehospital neurotrauma care procedure in Iran, highlighting its strengths and flaws.

Method: We searched PubMed and Scopus databases for literature on the present condition of prehospital neurotrauma care in Iran. Consultations with an expert panel yielded additional material not previously available in the literature, particularly on Iran's emergency medical system.

Results: Our findings indicate that the emergency dispatch system in Iran is relatively well-managed, regardless of the lack of a single emergency contact number. However, major obstacles still exist, particularly in terms of human resources, training, and equipment availability. Emergency medical technicians (EMTs) have intermediate to poor levels of knowledge and skills in dealing with neurotrauma, which might be considerably improved by ongoing training programs. Furthermore, Iranian hospitals lack specific trauma center designations and levels, resulting in overcrowded emergency rooms and delayed care delivery. National neurotrauma guidelines have been adopted in recent years, although their compliance is not consistently monitored.

Conclusion: Compared to developed healthcare systems, Iran's prehospital treatment system for individuals with neurotrauma has considerable limitations. Improving EMT education, recruiting more trained professionals, and simultaneous improvement of current medical facilities should be addressed as the first steps toward better care.

Study design: Retrospective study.

Objectives: To check the hypothesis that irisin could mediate systemic metabolic effects of testosterone in men with chronic spinal cord injury (SCI).

Setting: Spinal Unit of the San Raffaele Institute in Sulmona.

Methods: Fifteen men with chronic SCI admitted to a rehabilitation program were involved. They underwent clinical and biochemical evaluations. Irisin levels were measured with a high-sensitivity ELISA kit. Free testosterone levels were calculated (cFT) from total testosterone, sex hormone binding globulin, and albumin concentrations using the Vermeulen formula.

Results: Androgen deficiency (total testosterone <3 ng/ml and cFT <64 pg/ml) was found in 53% of participants and was associated with significantly lower irisin levels, higher body mass index (BMI), and higher triglycerides. Participants were engaged in significantly poorer leisure time physical activity (LTPA). Circulating irisin correlated with cFT (r = 0.55; p = 0.03) and both were negatively correlated with triglycerides levels, homeostatic model assessment of insulin resistance (HOMA-IR) and systemic inflammation, as assessed by erythrocyte sedimentation rate (ESR). Correlations with irisin did not reach statistical significance for either BMI (r = -0.40; p = 0.13) or LTPA (r = 0.46; p = 0.08). In bivariate linear regression models, lower irisin levels were significantly associated with higher triglycerides (β = -0.46; 95% CI: -0.75 to -0.16), HOMA-IR (β = -0.32; 95% CI: -0.63 to -0.004) and ESR (β = -0.89; 95% CI: -1.69 to -0.10) independently of cFT. Conversely, the negative associations of cFT with the same variables were lost after adjustment for irisin levels.

Conclusions: Spinal cord-injured men with androgen deficiency exhibit lower levels of irisin, which could mediate the systemic effects of testosterone.

Study design: Retrospective cohort study.

Objectives: Due to the rarity of intradural spinal tumors (ISTs) in individuals under 20, comprehensive studies are lacking. This study aims to compare the clinical data of intramedullary and extramedullary IST cases in patients under 20 years of age with those of adult cases and to identify functional predictors that affect surgical outcomes.

Setting: The single institution in Japan.

Methods: This retrospective study included 1367 patients diagnosed with extramedullary or intramedullary ISTs who underwent surgery at our institution from 2001 to 2021. Patients were divided into two groups: under 20 years old (Under-20) and 20 years and older. Collected data included demographics, magnetic resonance imaging (MRI) results, and surgical and clinical information. Neurological status was evaluated using the modified McCormick Scale (mMS).

Results: Among 1367 cases, 55 patients (4.0%) were under 20 years old. The most frequent tumors in the Under-20 group were astrocytoma (18.2%), followed by myxopapillary ependymoma (16.4%). Seven patients in the Under-20 group died during follow-up. Among the surviving patients, unstable gait post-surgery was associated with malignant tumors and worse preoperative mMS scores.

Conclusions: This study highlights significant differences in IST epidemiology and pathology between minors and adults, emphasizing the need for early MRI to prevent paralysis progression and improve outcomes. Understanding these differences is crucial for effective diagnosis and treatment during the first two decades of life.