Pub Date : 2024-03-07DOI: 10.1038/s41393-024-00971-0
Cuili Kuang, Yunfei Zha
Case-control study. Investigating the association between neurodegeneration within rostral spinal cord and brain gray matter volume (GMV) and assessing the relationship between remote neurodegenerative changes and clinical outcomes at the early phase of Cervical Spondylotic Myelopathy (CSM). University/hospital. Using Spinal Cord Toolbox, spinal cord morphometrics (cross-sectional area [CSA], gray matter area [GMA], white matter area [WMA]) of 40 patients with CSM and 28 healthy controls (HCs) were computed and compared using two-sample t test. Brain GMV of the two groups was analyzed using voxel-based morphometry approach. Pearson’s correlation between spinal cord morphometrics and altered brain GMV and Spearman’s relationship between remote neurodegenerations and clinical outcomes were conducted in CSM group. Compared to HCs, CSA and WMA at C2/3 and GMV in right postcentral gyrus (PoCG.R) and left supplementary motor area (SMA.L) were significantly decreased in patients with CSM. CSA and WMA at C2/3 were associated with GMV in SMA.L and MCG.R in patients with CSM. CSA at C2/3 and GMV in PoCG.R were related to modified Japanese Orthopedic Association score in patients with CSM. The associations between CSA and WMA at C2/3 and GMV in SMA.L and MCG.R suggest a concordant change pattern and adaptive mechanisms for neuronal plasticity underlying remote neurodegeneration in early CSM. The atrophy of CSA at C2/3 and GMV loss in PoCG.R can serve as potential neuroimaging biomarkers of early structural changes within spinal cord and brain preceding marked clinical disabilities in patients with CSM.
{"title":"Neurodegeneration within the rostral spinal cord is associated with brain gray matter volume atrophy in the early stage of cervical spondylotic myelopathy","authors":"Cuili Kuang, Yunfei Zha","doi":"10.1038/s41393-024-00971-0","DOIUrl":"10.1038/s41393-024-00971-0","url":null,"abstract":"Case-control study. Investigating the association between neurodegeneration within rostral spinal cord and brain gray matter volume (GMV) and assessing the relationship between remote neurodegenerative changes and clinical outcomes at the early phase of Cervical Spondylotic Myelopathy (CSM). University/hospital. Using Spinal Cord Toolbox, spinal cord morphometrics (cross-sectional area [CSA], gray matter area [GMA], white matter area [WMA]) of 40 patients with CSM and 28 healthy controls (HCs) were computed and compared using two-sample t test. Brain GMV of the two groups was analyzed using voxel-based morphometry approach. Pearson’s correlation between spinal cord morphometrics and altered brain GMV and Spearman’s relationship between remote neurodegenerations and clinical outcomes were conducted in CSM group. Compared to HCs, CSA and WMA at C2/3 and GMV in right postcentral gyrus (PoCG.R) and left supplementary motor area (SMA.L) were significantly decreased in patients with CSM. CSA and WMA at C2/3 were associated with GMV in SMA.L and MCG.R in patients with CSM. CSA at C2/3 and GMV in PoCG.R were related to modified Japanese Orthopedic Association score in patients with CSM. The associations between CSA and WMA at C2/3 and GMV in SMA.L and MCG.R suggest a concordant change pattern and adaptive mechanisms for neuronal plasticity underlying remote neurodegeneration in early CSM. The atrophy of CSA at C2/3 and GMV loss in PoCG.R can serve as potential neuroimaging biomarkers of early structural changes within spinal cord and brain preceding marked clinical disabilities in patients with CSM.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"214-220"},"PeriodicalIF":2.2,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A Systematic Review To determine the therapeutic efficacy of in vivo reprogramming of astrocytes into neuronal-like cells in animal models of spinal cord injury (SCI). PRISMA 2020 guidelines were utilized, and search engines Medline, Web of Science, Scopus, and Embase until June 2023 were used. Studies that examined the effects of converting astrocytes into neuron-like cells with any vector in all animal models were included, while conversion from other cells except for spinal astrocytes, chemical mechanisms to provide SCI models, brain injury population, and conversion without in-vivo experience were excluded. The risk of bias was calculated independently. 5302 manuscripts were initially identified and after eligibility assessment, 43 studies were included for full-text analysis. After final analysis, 13 manuscripts were included. All were graded as high-quality assessments. The transduction factors Sox2, Oct4, Klf4, fibroblast growth factor 4 (Fgf4) antibody, neurogenic differentiation 1 (Neurod1), zinc finger protein 521 (Zfp521), ginsenoside Rg1, and small molecules (LDN193189, CHIR99021, and DAPT) could effectively reprogramme astrocytes into neuron-like cells. The process was enhanced by p21-p53, or Notch signaling knockout, valproic acid, or chondroitin sulfate proteoglycan inhibitors. The type of mature neurons was both excitatory and inhibitory. Astrocyte reprogramming to neuronal-like cells in an animal model after SCI appears promising. The molecular and functional improvements after astrocyte reprogramming were demonstrated in vivo, and further investigation is required in this field.
{"title":"Reprogramming of astrocytes to neuronal-like cells in spinal cord injury: a systematic review","authors":"Seyed Danial Alizadeh, Mohammad-Rasoul Jalalifar, Zahra Ghodsi, Mohsen Sadeghi-Naini, Hamid Malekzadeh, Golnoosh Rahimi, Kurosh Mojtabavi, Sina Shool, Zahra Eskandari, Rasoul Masoomi, Sahar Kiani, James Harrop, Vafa Rahimi-Movaghar","doi":"10.1038/s41393-024-00969-8","DOIUrl":"10.1038/s41393-024-00969-8","url":null,"abstract":"A Systematic Review To determine the therapeutic efficacy of in vivo reprogramming of astrocytes into neuronal-like cells in animal models of spinal cord injury (SCI). PRISMA 2020 guidelines were utilized, and search engines Medline, Web of Science, Scopus, and Embase until June 2023 were used. Studies that examined the effects of converting astrocytes into neuron-like cells with any vector in all animal models were included, while conversion from other cells except for spinal astrocytes, chemical mechanisms to provide SCI models, brain injury population, and conversion without in-vivo experience were excluded. The risk of bias was calculated independently. 5302 manuscripts were initially identified and after eligibility assessment, 43 studies were included for full-text analysis. After final analysis, 13 manuscripts were included. All were graded as high-quality assessments. The transduction factors Sox2, Oct4, Klf4, fibroblast growth factor 4 (Fgf4) antibody, neurogenic differentiation 1 (Neurod1), zinc finger protein 521 (Zfp521), ginsenoside Rg1, and small molecules (LDN193189, CHIR99021, and DAPT) could effectively reprogramme astrocytes into neuron-like cells. The process was enhanced by p21-p53, or Notch signaling knockout, valproic acid, or chondroitin sulfate proteoglycan inhibitors. The type of mature neurons was both excitatory and inhibitory. Astrocyte reprogramming to neuronal-like cells in an animal model after SCI appears promising. The molecular and functional improvements after astrocyte reprogramming were demonstrated in vivo, and further investigation is required in this field.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"133-142"},"PeriodicalIF":2.2,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retrospective cohort study. To find out if comprehensive rehabilitation itself can improve daily performance in persons with DCM. The spinal department of a rehabilitation hospital. Data from 116 DCM inpatients who underwent comprehensive rehabilitation after spinal surgery were retrospectively analyzed. The definitions of the calculated outcome variables made possible analyses that distinguished the effect of rehabilitation from that of spinal surgery. Paired t-tests were used to compare admission with discharge outcomes and functional gains. Spearman’s correlations were used to assess relationships between performance gain during rehabilitation and between time from surgery to rehabilitation. The Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) increased during rehabilitation from 57 (24) to 78 (19) (p < 0.001). The Spinal Cord Independence Measure 3rd version (SCIM III) gain attributed to neurological improvement (dSCIM-IIIn) was 6.3 (9.2), and that attributed to rehabilitation (dSCIM-IIIr) 16 (18.5) (p < 0.001). dSCIM-IIIr showed a rather weak negative correlation with time from spinal surgery to rehabilitation (r = −0.42, p < 0.001). The study showed, for the first time, that comprehensive rehabilitation can achieve considerable functional improvement for persons with DCM of any degree, beyond that of spinal surgery. Combined with previously published evidence, this indicates that comprehensive rehabilitation can be considered for persons with DCM of any functional degree, before surgery.
{"title":"The role of comprehensive rehabilitation in the care of degenerative cervical myelopathy","authors":"Amiram Catz, Yaron Watts, Hagay Amir, Lilach Front, Ilana Gelernter, Dianne Michaeli, Vadim Bluvshtein, Elena Aidinoff","doi":"10.1038/s41393-024-00965-y","DOIUrl":"10.1038/s41393-024-00965-y","url":null,"abstract":"Retrospective cohort study. To find out if comprehensive rehabilitation itself can improve daily performance in persons with DCM. The spinal department of a rehabilitation hospital. Data from 116 DCM inpatients who underwent comprehensive rehabilitation after spinal surgery were retrospectively analyzed. The definitions of the calculated outcome variables made possible analyses that distinguished the effect of rehabilitation from that of spinal surgery. Paired t-tests were used to compare admission with discharge outcomes and functional gains. Spearman’s correlations were used to assess relationships between performance gain during rehabilitation and between time from surgery to rehabilitation. The Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) increased during rehabilitation from 57 (24) to 78 (19) (p < 0.001). The Spinal Cord Independence Measure 3rd version (SCIM III) gain attributed to neurological improvement (dSCIM-IIIn) was 6.3 (9.2), and that attributed to rehabilitation (dSCIM-IIIr) 16 (18.5) (p < 0.001). dSCIM-IIIr showed a rather weak negative correlation with time from spinal surgery to rehabilitation (r = −0.42, p < 0.001). The study showed, for the first time, that comprehensive rehabilitation can achieve considerable functional improvement for persons with DCM of any degree, beyond that of spinal surgery. Combined with previously published evidence, this indicates that comprehensive rehabilitation can be considered for persons with DCM of any functional degree, before surgery.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"200-206"},"PeriodicalIF":2.2,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00965-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.1038/s41393-024-00966-x
Bo Wang, Pengfei Zheng, Yapeng Zhang, Wangmi Liu, Lei Liu, Yuntao Wang
Retrospective cohort study. Hospital-acquired infections (HAIs) pose a significant risk for pediatric patients with spinal cord injuries (SCIs), potentially leading to extended hospital stays and increased morbidity. This study aims to identify patients at higher risk for HAIs. Hospitals from multiple areas in China. This retrospective study included 220 pediatric SCI patients from Jan 2005 to Dec 2023, divided into a training set (n = 154) and a validation set (n = 66). We conducted a multivariate logistic regression analysis to identify risk factors associated with HAIs and constructed a predictive nomogram. The model’s performance was assessed using receiver operating characteristic (ROC) curves, area under the ROC curve (AUC) and calibration plots, while decision curve analysis was utilized to determine clinical utility. The nomogram incorporated age, time from injury to the hospital, history of urinary and pulmonary infections, urobilinogen positivity, damaged segments, and admission American Spinal Injury Association (ASIA) scores. The model demonstrated excellent discrimination in the training set (AUC = 0.957) and good discrimination in the validation set (AUC = 0.919). Calibration plots indicated an acceptable fit between predicted probabilities and observed outcomes. Decision curve analysis confirmed the model’s net benefit over clinical decision thresholds in both sets. We developed and validated a predictive nomogram for HAIs in pediatric SCI patients that shows promise for clinical application. The model can assist healthcare providers in identifying patients at higher risk for HAIs, potentially facilitating early interventions and improved patient care strategies.
{"title":"A nomogram for predicting the hospital-acquired infections in children with spinal cord injuries: a retrospective, multicenter, observational study","authors":"Bo Wang, Pengfei Zheng, Yapeng Zhang, Wangmi Liu, Lei Liu, Yuntao Wang","doi":"10.1038/s41393-024-00966-x","DOIUrl":"10.1038/s41393-024-00966-x","url":null,"abstract":"Retrospective cohort study. Hospital-acquired infections (HAIs) pose a significant risk for pediatric patients with spinal cord injuries (SCIs), potentially leading to extended hospital stays and increased morbidity. This study aims to identify patients at higher risk for HAIs. Hospitals from multiple areas in China. This retrospective study included 220 pediatric SCI patients from Jan 2005 to Dec 2023, divided into a training set (n = 154) and a validation set (n = 66). We conducted a multivariate logistic regression analysis to identify risk factors associated with HAIs and constructed a predictive nomogram. The model’s performance was assessed using receiver operating characteristic (ROC) curves, area under the ROC curve (AUC) and calibration plots, while decision curve analysis was utilized to determine clinical utility. The nomogram incorporated age, time from injury to the hospital, history of urinary and pulmonary infections, urobilinogen positivity, damaged segments, and admission American Spinal Injury Association (ASIA) scores. The model demonstrated excellent discrimination in the training set (AUC = 0.957) and good discrimination in the validation set (AUC = 0.919). Calibration plots indicated an acceptable fit between predicted probabilities and observed outcomes. Decision curve analysis confirmed the model’s net benefit over clinical decision thresholds in both sets. We developed and validated a predictive nomogram for HAIs in pediatric SCI patients that shows promise for clinical application. The model can assist healthcare providers in identifying patients at higher risk for HAIs, potentially facilitating early interventions and improved patient care strategies.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"183-191"},"PeriodicalIF":2.2,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-23DOI: 10.1038/s41393-024-00964-z
Christel M. C. van Leeuwen, Erika Papazoglou, Janske H. W. van Eersel, Janneke M. Stolwijk-Swüste, Marcel W. M. Post
Retrospective analysis of medical records. To assess personality traits in persons with spinal cord injury (SCI) and compare these with the general population group. Moreover, to explore associations between personality traits and depressive and anxiety symptoms among persons with SCI in first inpatient rehabilitation. Specialized rehabilitation center in The Netherlands. Data were used from a routine psychological screening, administered in the first weeks of admission (N = 67). Measures included the Hospital Anxiety and Depression Scale and the Dutch Personality Questionnaire, which includes subscales measuring neuroticism, social inadequacy, rigidity, hostility, egoism, dominance, and self-esteem. Correlational and regression analyses were conducted. Mean age of the participants was 58 (SD 17) years. The majority (63%) were male, and had a low lesion (57%). The participants scored significantly higher on dominance and lower on social inadequacy, hostility, and egoism in comparison with the general population. In the bivariate regression analyses, high neuroticism (β = 0.42 and β = 0.53) and low self-esteem (β = -0.25 and β = -0.29) were significantly associated with increased depressive and anxiety symptoms. In the hierarchical regression analyses, only high neuroticism was significantly associated with increased depressive (β = 0.42, p < 0.05) and anxiety (β = 0.55, p < 0.001) symptoms. Personality traits are not the same between the SCI population and the general population. Assessment of personality traits early in inpatient rehabilitation can help to identify individuals at risk of mood problems and, thereby, facilitate interventions. Future research with a larger, representative SCI sample, is required to confirm these findings.
{"title":"Associations between personality traits and depressive and anxiety symptoms among persons with spinal cord injury in first inpatient rehabilitation","authors":"Christel M. C. van Leeuwen, Erika Papazoglou, Janske H. W. van Eersel, Janneke M. Stolwijk-Swüste, Marcel W. M. Post","doi":"10.1038/s41393-024-00964-z","DOIUrl":"10.1038/s41393-024-00964-z","url":null,"abstract":"Retrospective analysis of medical records. To assess personality traits in persons with spinal cord injury (SCI) and compare these with the general population group. Moreover, to explore associations between personality traits and depressive and anxiety symptoms among persons with SCI in first inpatient rehabilitation. Specialized rehabilitation center in The Netherlands. Data were used from a routine psychological screening, administered in the first weeks of admission (N = 67). Measures included the Hospital Anxiety and Depression Scale and the Dutch Personality Questionnaire, which includes subscales measuring neuroticism, social inadequacy, rigidity, hostility, egoism, dominance, and self-esteem. Correlational and regression analyses were conducted. Mean age of the participants was 58 (SD 17) years. The majority (63%) were male, and had a low lesion (57%). The participants scored significantly higher on dominance and lower on social inadequacy, hostility, and egoism in comparison with the general population. In the bivariate regression analyses, high neuroticism (β = 0.42 and β = 0.53) and low self-esteem (β = -0.25 and β = -0.29) were significantly associated with increased depressive and anxiety symptoms. In the hierarchical regression analyses, only high neuroticism was significantly associated with increased depressive (β = 0.42, p < 0.05) and anxiety (β = 0.55, p < 0.001) symptoms. Personality traits are not the same between the SCI population and the general population. Assessment of personality traits early in inpatient rehabilitation can help to identify individuals at risk of mood problems and, thereby, facilitate interventions. Future research with a larger, representative SCI sample, is required to confirm these findings.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"178-182"},"PeriodicalIF":2.2,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute experimental study. Cold-induced vasodilation is a local mechanism of protection against frostbite in non-injured persons. We assessed whether an increase in skin blood flow (SkBF) during local cooling (LC) was observed in individuals with spinal cord injuries (SCIs) and if the response patterns differed between region levels or sites. Laboratory of Wakayama Medical University and the affiliated clinics, Japan. A local cooler device (diameter 4 cm) was placed on the chest (sensate) and right thigh (non-sensate) in persons with cervical (SCIC; n = 9) and thoracolumbar SCIs (SCITL; n = 9). After the surface temperature under the device was controlled at 33 °C for 10 min (baseline), LC (−0.045 °C/s) was applied and the skin temperature was maintained at 15 and 8 °C for 15 min of each stage. SkBF (laser Doppler flowmetry) was monitored using a 1-mm needle-type probe inserted into its center. The percent change in SkBF (%ΔSkBF) on the chest remained unchanged until the end of 15 °C stage; thereafter, it increased to a level at least 70% greater than the baseline during the 8 °C stage in both groups. The %ΔSkBF on the thigh in both SCIC and SCITL notably increased from 8 and 6 min respectively, during the 8°C stage, compared to 1 min before the stage; however, it did not exceed the baseline level. An increase in SkBF during LC was observed both in the sensate and non-sensate areas in SCIs, although the magnitude was larger in the sensate area.
{"title":"Observations of cold-induced vasodilation in persons with spinal cord injuries","authors":"Yasuhisa Fujita, Yoshi-ichiro Kamijo, Tokio Kinoshita, Takamasa Hashizaki, Kouta Murai, Tatsuya Yoshikawa, Yasunori Umemoto, Chikako Kaminaka, Manabu Shibasaki, Fumihiro Tajima, Yukihide Nishimura","doi":"10.1038/s41393-024-00960-3","DOIUrl":"10.1038/s41393-024-00960-3","url":null,"abstract":"Acute experimental study. Cold-induced vasodilation is a local mechanism of protection against frostbite in non-injured persons. We assessed whether an increase in skin blood flow (SkBF) during local cooling (LC) was observed in individuals with spinal cord injuries (SCIs) and if the response patterns differed between region levels or sites. Laboratory of Wakayama Medical University and the affiliated clinics, Japan. A local cooler device (diameter 4 cm) was placed on the chest (sensate) and right thigh (non-sensate) in persons with cervical (SCIC; n = 9) and thoracolumbar SCIs (SCITL; n = 9). After the surface temperature under the device was controlled at 33 °C for 10 min (baseline), LC (−0.045 °C/s) was applied and the skin temperature was maintained at 15 and 8 °C for 15 min of each stage. SkBF (laser Doppler flowmetry) was monitored using a 1-mm needle-type probe inserted into its center. The percent change in SkBF (%ΔSkBF) on the chest remained unchanged until the end of 15 °C stage; thereafter, it increased to a level at least 70% greater than the baseline during the 8 °C stage in both groups. The %ΔSkBF on the thigh in both SCIC and SCITL notably increased from 8 and 6 min respectively, during the 8°C stage, compared to 1 min before the stage; however, it did not exceed the baseline level. An increase in SkBF during LC was observed both in the sensate and non-sensate areas in SCIs, although the magnitude was larger in the sensate area.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"170-177"},"PeriodicalIF":2.2,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00960-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.1038/s41393-024-00957-y
Arrani Senthinathan, Mina Tadrous, Swaleh Hussain, B. Catharine Craven, Susan B. Jaglal, Rahim Moineddin, John Shepherd, Lauren Cadel, Vanessa K. Noonan, Sandra McKay, Karen Tu, Sara J. T. Guilcher
{"title":"Correction: Examining the impact of COVID-19 on health care utilization among persons with chronic spinal cord injury/dysfunction: a population study","authors":"Arrani Senthinathan, Mina Tadrous, Swaleh Hussain, B. Catharine Craven, Susan B. Jaglal, Rahim Moineddin, John Shepherd, Lauren Cadel, Vanessa K. Noonan, Sandra McKay, Karen Tu, Sara J. T. Guilcher","doi":"10.1038/s41393-024-00957-y","DOIUrl":"10.1038/s41393-024-00957-y","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"197-198"},"PeriodicalIF":2.2,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00957-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.1038/s41393-024-00961-2
Sven Hoekstra, Michelle Trbovich, Wouter Koek, Michael Mader, Marzieh Salehi
Retrospective longitudinal cohort study of veterans with SCI. Spinal cord injury (SCI) is associated with an increased risk of developing diabetes mellitus (DM), likely due to body composition alterations and autonomic nervous system dysfunction. These factors are more pronounced in persons with tetraplegia (TP) versus paraplegia (PP). However, the effect of level of injury (LOI) on DM incidence is largely unknown. Therefore, the objective is to examine the effect of LOI on DM incidence in persons with SCI. South Texas Veterans Health Care System. We obtained electronic record data on age, sex, race/ethnicity, LOI and HbA1c concentration from January 1st 2001 through December 31st 2021. Cox proportional hazard regression analyses were used to assess the association between LOI, DM and all-cause mortality. Among 728 non-diabetic veterans with SCI (350 TP/ 378 PP, 52 ± 15 years, 690 male/38 female) 243 developed DM, of which 116 with TP and 127 with PP. Despite chronological variations between TP and PP, DM risk over the entire follow-up did not differ between the groups (hazard ratio (HR): 1.06, 95% CI: 0.82–1.38). Mortality was higher in TP versus PP (HR: 1.40, 95% CI: 1.09–1.78). However, developing DM did not increase the risk of death, regardless of LOI (HR: 1.07, 95% CI: 0.83–1.37). Despite chronological variations between both groups, the level of injury had minimal effect on long-term DM development in this cohort of veterans with SCI. Sponsorship NIH (DK105379; MS), RR&D SPiRE (I21RX003724-01A1; MT and SH).
{"title":"The effect of level of injury on diabetes incidence and mortality after spinal cord injury – a longitudinal cohort study","authors":"Sven Hoekstra, Michelle Trbovich, Wouter Koek, Michael Mader, Marzieh Salehi","doi":"10.1038/s41393-024-00961-2","DOIUrl":"10.1038/s41393-024-00961-2","url":null,"abstract":"Retrospective longitudinal cohort study of veterans with SCI. Spinal cord injury (SCI) is associated with an increased risk of developing diabetes mellitus (DM), likely due to body composition alterations and autonomic nervous system dysfunction. These factors are more pronounced in persons with tetraplegia (TP) versus paraplegia (PP). However, the effect of level of injury (LOI) on DM incidence is largely unknown. Therefore, the objective is to examine the effect of LOI on DM incidence in persons with SCI. South Texas Veterans Health Care System. We obtained electronic record data on age, sex, race/ethnicity, LOI and HbA1c concentration from January 1st 2001 through December 31st 2021. Cox proportional hazard regression analyses were used to assess the association between LOI, DM and all-cause mortality. Among 728 non-diabetic veterans with SCI (350 TP/ 378 PP, 52 ± 15 years, 690 male/38 female) 243 developed DM, of which 116 with TP and 127 with PP. Despite chronological variations between TP and PP, DM risk over the entire follow-up did not differ between the groups (hazard ratio (HR): 1.06, 95% CI: 0.82–1.38). Mortality was higher in TP versus PP (HR: 1.40, 95% CI: 1.09–1.78). However, developing DM did not increase the risk of death, regardless of LOI (HR: 1.07, 95% CI: 0.83–1.37). Despite chronological variations between both groups, the level of injury had minimal effect on long-term DM development in this cohort of veterans with SCI. Sponsorship NIH (DK105379; MS), RR&D SPiRE (I21RX003724-01A1; MT and SH).","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"164-169"},"PeriodicalIF":2.2,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1038/s41393-024-00962-1
Kim D. Anderson, Anne M. Bryden, Brian Gran, Susan W. Hinze, Mary Ann Richmond
Longitudinal, qualitative cohort study. To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced. Academic and Veterans hospitals in Midwest USA. In-depth, semi-structured interviews were conducted in two cohorts of PWS and SP during the initial inpatient rehabilitation stay, at 6 mpi, and at 12 mpi. Recordings were transcribed; four authors independently undertook line-by-line coding. The team discussed codes to reach consensus and synthesize into broader themes within the International Classification of Function, Disability, and Health and Transformative frameworks. Data are reported on 23 PWS and 21 SP. PWS and SP are similar in defining recovery as gaining motor function and achieving independence. However, SP more frequently define recovery in terms of maintaining positivity and emotional recovery. At 12 mpi both groups shift to define recovery according to progress. Social roles, being active, and employment are persistent themes of how PWS and SP define successful CR. However, SP also frequently define successful CR as reestablishing identity and emotional adjustment. Veterans with SCI less frequently defined successful CR as employment. This study is the first to reveal how PWS and SP define recovery and reintegration during the first 12 mpi. Given decreasing lengths of stay, this information can be used to tailor rehabilitation strategies during the critical first year of injury to optimize recovery.
{"title":"Definitions of recovery and reintegration across the first year: A qualitative study of perspectives of persons with spinal cord injury and caregivers","authors":"Kim D. Anderson, Anne M. Bryden, Brian Gran, Susan W. Hinze, Mary Ann Richmond","doi":"10.1038/s41393-024-00962-1","DOIUrl":"10.1038/s41393-024-00962-1","url":null,"abstract":"Longitudinal, qualitative cohort study. To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced. Academic and Veterans hospitals in Midwest USA. In-depth, semi-structured interviews were conducted in two cohorts of PWS and SP during the initial inpatient rehabilitation stay, at 6 mpi, and at 12 mpi. Recordings were transcribed; four authors independently undertook line-by-line coding. The team discussed codes to reach consensus and synthesize into broader themes within the International Classification of Function, Disability, and Health and Transformative frameworks. Data are reported on 23 PWS and 21 SP. PWS and SP are similar in defining recovery as gaining motor function and achieving independence. However, SP more frequently define recovery in terms of maintaining positivity and emotional recovery. At 12 mpi both groups shift to define recovery according to progress. Social roles, being active, and employment are persistent themes of how PWS and SP define successful CR. However, SP also frequently define successful CR as reestablishing identity and emotional adjustment. Veterans with SCI less frequently defined successful CR as employment. This study is the first to reveal how PWS and SP define recovery and reintegration during the first 12 mpi. Given decreasing lengths of stay, this information can be used to tailor rehabilitation strategies during the critical first year of injury to optimize recovery.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"156-163"},"PeriodicalIF":2.2,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00962-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retrospective cohort study. To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C). Multi-institutions in Japan. We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis. Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness). Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL. No funding was received for this study.
{"title":"Neurological recovery rate and predictive factors of incomplete AIS grade C spinal cord injury in the older aged population","authors":"Koji Tamai, Hidetomi Terai, Hiroaki Nakamura, Noriaki Yokogawa, Takeshi Sasagawa, Hiroaki Nakashima, Naoki Segi, Sadayuki Ito, Toru Funayama, Fumihiko Eto, Akihiro Yamaji, Kota Watanabe, Junichi Yamane, Kazuki Takeda, Takeo Furuya, Atsushi Yunde, Hideaki Nakajima, Tomohiro Yamada, Tomohiko Hasegawa, Yoshinori Terashima, Ryosuke Hirota, Hidenori Suzuki, Yasuaki Imajo, Shota Ikegami, Masashi Uehara, Hitoshi Tonomura, Munehiro Sakata, Ko Hashimoto, Yoshito Onoda, Kenichi Kawaguchi, Yohei Haruta, Nobuyuki Suzuki, Kenji Kato, Hiroshi Uei, Hirokatsu Sawada, Kazuo Nakanishi, Kosuke Misaki, Akiyoshi Kuroda, Gen Inoue, Kenichiro Kakutani, Yuji Kakiuchi, Katsuhito Kiyasu, Hiroyuki Tominaga, Hiroto Tokumoto, Yoichi Iizuka, Eiji Takasawa, Koji Akeda, Norihiko Takegami, Haruki Funao, Yasushi Oshima, Takashi Kaito, Daisuke Sakai, Toshitaka Yoshii, Tetsuro Ohba, Bungo Otsuki, Shoji Seki, Masashi Miyazaki, Masayuki Ishihara, Seiji Okada, Shiro Imagama, Satoshi Kato","doi":"10.1038/s41393-024-00963-0","DOIUrl":"10.1038/s41393-024-00963-0","url":null,"abstract":"Retrospective cohort study. To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C). Multi-institutions in Japan. We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis. Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness). Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL. No funding was received for this study.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"149-155"},"PeriodicalIF":2.2,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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