Retrospective cohort study. To evaluate surgical consistency and clinical outcomes in intramedullary ependymoma (WHO grade II) cases by using X-bar charts as a tool to assess procedural stability. The single institution in Japan. This study included patients who underwent resection of intramedullary ependymomas between 2001 and 2023. All surgeries were performed by one of five board-certified spine surgeons. Operative time was analyzed for stability using X-bar charts. Neurological outcomes were assessed using the modified McCormick Scale (mMS), and regression analysis was performed to evaluate the relationship between operative time and mMS. The study included 144 patients (82 men, 62 women; average age 50.3 ± 14.6 years). Tumors were located at cervical (67.4%) or thoracic (32.6%) levels, averaging 3.0 ± 1.2 vertebrae. The surgeon who performed 71 cases was defined as the experienced surgeon, and the other surgeons performed 10–24 cases, respectively. The mean operative time was 380.6 ± 140.7 min, and 135 cases achieved gross total resection. The average follow-up duration was 6.9 ± 3.9 years. X-bar charts showed surgical stability once the average number of cases exceeded 17. No significant correlation was found between operative time and mMS for any surgeon. Perioperative complications were minimal. X-bar charts are a valuable tool for objectively evaluating surgical stability. In intramedullary ependymoma surgeries, consistency in operative time was achieved after 17 cases, and longer procedures did not adversely affect neurological outcomes. This method could be extended to monitor procedural reliability in other complex surgical interventions.
{"title":"How many cases of spinal intramedullary ependymoma surgery are required to achieve stability? - Analysis using X-bar charts","authors":"Narihito Nagoshi, Kengo Nagashima, Toshiki Okubo, Masahiro Ozaki, Satoshi Suzuki, Kazuki Takeda, Takahito Iga, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1038/s41393-025-01090-0","DOIUrl":"10.1038/s41393-025-01090-0","url":null,"abstract":"Retrospective cohort study. To evaluate surgical consistency and clinical outcomes in intramedullary ependymoma (WHO grade II) cases by using X-bar charts as a tool to assess procedural stability. The single institution in Japan. This study included patients who underwent resection of intramedullary ependymomas between 2001 and 2023. All surgeries were performed by one of five board-certified spine surgeons. Operative time was analyzed for stability using X-bar charts. Neurological outcomes were assessed using the modified McCormick Scale (mMS), and regression analysis was performed to evaluate the relationship between operative time and mMS. The study included 144 patients (82 men, 62 women; average age 50.3 ± 14.6 years). Tumors were located at cervical (67.4%) or thoracic (32.6%) levels, averaging 3.0 ± 1.2 vertebrae. The surgeon who performed 71 cases was defined as the experienced surgeon, and the other surgeons performed 10–24 cases, respectively. The mean operative time was 380.6 ± 140.7 min, and 135 cases achieved gross total resection. The average follow-up duration was 6.9 ± 3.9 years. X-bar charts showed surgical stability once the average number of cases exceeded 17. No significant correlation was found between operative time and mMS for any surgeon. Perioperative complications were minimal. X-bar charts are a valuable tool for objectively evaluating surgical stability. In intramedullary ependymoma surgeries, consistency in operative time was achieved after 17 cases, and longer procedures did not adversely affect neurological outcomes. This method could be extended to monitor procedural reliability in other complex surgical interventions.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 7","pages":"372-376"},"PeriodicalIF":2.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120867","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 : 2025-05-13DOI: 10.1038/s41393-025-01086-w
Susan M. Stoikov, Chau T. D. Do, Kiley J. Pershouse, Claire E. Panagoda, Donna G. Harre, Delena I. Amsters
Descriptive study of a pilot model of care named QuickStart. To describe the eligibility, rehabilitation pathways, team composition, and service delivery of a novel model of care for people with newly acquired spinal cord injuries (SCI). Queensland Spinal Cord Injuries Service, Metro South Health, Queensland, Australia. In April 2022, QuickStart was established with a multidisciplinary team of health professionals to provide early in-reach specialist SCI expertise to individuals with newly acquired spinal cord injury and their treating clinicians. Between July 2022 and June 2024, QuickStart accepted 508 patients who were admitted to a Queensland or northern New South Wales hospital. Patients who received QuickStart support followed one of two pathways: they completed their primary rehabilitation in the Spinal Injuries Unit (SIU) at Princess Alexandra Hospital or at another facility. QuickStart provides specialised SCI support to patients and their treating team via a range of modalities including face-to-face review, telephone and videoconference. Referral numbers increased by 22% from the first year of operation, along with a 38% increase in the average QuickStart caseload. Patients received, on average, 12 occasions of service and a total service provision time of 452 min. All QuickStart patients received referrals to other specialised SCI community services within the Queensland Spinal Cord Injuries Service. QuickStart is a promising model of care that has improved access to specialised SCI expertise for individuals with newly acquired SCI, particularly those who may not have immediate access to specialised rehabilitation services.
研究设计：对一个名为“快速起步”的护理试点模型进行描述性研究。目的：描述新获得性脊髓损伤（SCI）患者的资格、康复途径、团队组成和服务提供的一种新型护理模式。地点：澳大利亚昆士兰州，Metro South Health，昆士兰脊髓损伤服务中心。方法：2022年4月，QuickStart与多学科卫生专业人员团队成立，为新获得性脊髓损伤患者及其治疗临床医生提供早期可及的专业SCI专业知识。结果：在2022年7月至2024年6月期间，快速启动接受了508名在昆士兰州或新南威尔士州北部医院住院的患者。接受快速入门支持的患者遵循以下两种途径之一：他们在亚历山德拉公主医院的脊柱损伤科（SIU）或其他机构完成了初级康复。QuickStart通过面对面审查、电话和视频会议等多种方式为患者及其治疗团队提供专业的脊髓损伤支持。与第一年相比，转诊人数增加了22%，同时快速入门项目的平均工作量增加了38%。患者平均接受服务12次，总服务时间452 min。所有快速入门患者都被转介到昆士兰州脊髓损伤服务中心的其他专业脊髓损伤社区服务。结论：快速启动是一种很有前途的护理模式，它改善了新获得性脊髓损伤患者获得专业脊髓损伤专业知识的机会，特别是那些可能无法立即获得专业康复服务的患者。
{"title":"Providing a QuickStart for people with newly acquired spinal cord injury: a new model of care offering in-reach advice and support","authors":"Susan M. Stoikov, Chau T. D. Do, Kiley J. Pershouse, Claire E. Panagoda, Donna G. Harre, Delena I. Amsters","doi":"10.1038/s41393-025-01086-w","DOIUrl":"10.1038/s41393-025-01086-w","url":null,"abstract":"Descriptive study of a pilot model of care named QuickStart. To describe the eligibility, rehabilitation pathways, team composition, and service delivery of a novel model of care for people with newly acquired spinal cord injuries (SCI). Queensland Spinal Cord Injuries Service, Metro South Health, Queensland, Australia. In April 2022, QuickStart was established with a multidisciplinary team of health professionals to provide early in-reach specialist SCI expertise to individuals with newly acquired spinal cord injury and their treating clinicians. Between July 2022 and June 2024, QuickStart accepted 508 patients who were admitted to a Queensland or northern New South Wales hospital. Patients who received QuickStart support followed one of two pathways: they completed their primary rehabilitation in the Spinal Injuries Unit (SIU) at Princess Alexandra Hospital or at another facility. QuickStart provides specialised SCI support to patients and their treating team via a range of modalities including face-to-face review, telephone and videoconference. Referral numbers increased by 22% from the first year of operation, along with a 38% increase in the average QuickStart caseload. Patients received, on average, 12 occasions of service and a total service provision time of 452 min. All QuickStart patients received referrals to other specialised SCI community services within the Queensland Spinal Cord Injuries Service. QuickStart is a promising model of care that has improved access to specialised SCI expertise for individuals with newly acquired SCI, particularly those who may not have immediate access to specialised rehabilitation services.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 6","pages":"285-291"},"PeriodicalIF":2.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982727","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 : 2025-05-10DOI: 10.1038/s41393-025-01084-y
Hélène Le Liepvre, Emma D’Anglejan, Haude Chaussard, Damien Marmouset, Killian Allepot, Frédérique Bouchand, Latifa Noussair, François Genêt, Vincent T. Carpentier, Aurélien Dinh
Pressure injuries are common among individuals with spinal cord injury and often complicated by superinfection, leading to sepsis, hospitalizations, and significant healthcare costs. Osteomyelitis associated with pressure injuries poses diagnostic challenges and requires effective medical and surgical management. To investigate current practices, a national survey of French centers managing over 20 cases annually was conducted. Results revealed significant variability in surgical techniques, antibiotic protocols, and people care pathways. Musculocutaneous and perforator flaps were commonly used, but their application differed among centers. No flaps were performed during acute infections due to failure risks. Bedridden periods and hip flexion protocols varied, with prolonged immobility linked to complications such as thromboembolism and malnutrition. Antibiotic durations ranged from 5–180 days, reflecting differing approaches to infection management. Cure rates within one year ranged from 70–90%. These findings underscore the need for standardized, evidence-based protocols to optimize care for this vulnerable population.
{"title":"Management of pressure injuries with associated osteomyelitis in people with spinal cord injury: a national survey of referral centers in France","authors":"Hélène Le Liepvre, Emma D’Anglejan, Haude Chaussard, Damien Marmouset, Killian Allepot, Frédérique Bouchand, Latifa Noussair, François Genêt, Vincent T. Carpentier, Aurélien Dinh","doi":"10.1038/s41393-025-01084-y","DOIUrl":"10.1038/s41393-025-01084-y","url":null,"abstract":"Pressure injuries are common among individuals with spinal cord injury and often complicated by superinfection, leading to sepsis, hospitalizations, and significant healthcare costs. Osteomyelitis associated with pressure injuries poses diagnostic challenges and requires effective medical and surgical management. To investigate current practices, a national survey of French centers managing over 20 cases annually was conducted. Results revealed significant variability in surgical techniques, antibiotic protocols, and people care pathways. Musculocutaneous and perforator flaps were commonly used, but their application differed among centers. No flaps were performed during acute infections due to failure risks. Bedridden periods and hip flexion protocols varied, with prolonged immobility linked to complications such as thromboembolism and malnutrition. Antibiotic durations ranged from 5–180 days, reflecting differing approaches to infection management. Cure rates within one year ranged from 70–90%. These findings underscore the need for standardized, evidence-based protocols to optimize care for this vulnerable population.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 6","pages":"319-322"},"PeriodicalIF":2.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027186","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}
Bioinformatics analysis and experimental validation study. To investigate the role and expression patterns of disulfidptosis-related genes in spinal cord injury (SCI), identify potential pivotal genes, and explore possible therapeutic targets. Shanghai, China. Data acquisition and pre-processing: Screened 27 disulfidptosis-related genes based on literature and downloaded RNA-sequencing data of ASCI patients from GEO database (GSE151371); Identification of differentially expressed genes (DEGs): Used R package “limma” for differential gene expression analysis between ASCI samples and normal controls; Evaluating immune cell infiltration: Employed ssGSEA algorithm and CIBERSORT to determine immune cell abundance; Identification and functional verification of key genes: Intersected disulfidptosis-related genes with DEGs, and used machine learning techniques (Random Forest, Lasso, Support Vector Machine) to identify hub genes. Validated hub genes expression by real-time PCR; Construction of a diagnostic model: Developed a backpropagation neural network clinical prediction model based on hub genes and clinical features, and evaluated its performance using ROC curve. 6. Subcluster analysis: Performed consensus cluster analysis of ASCI samples and hub genes, and used GSVA to elucidate functional differences between subgroups. Identified 7764 DEGs in ASCI, with GO and KEGG enrichment in inflammation and autophagy-related pathways; Found differences in immune cell infiltration between ASCI and control groups, and correlation between immune cells and DRGs; Determined seven hub genes (MYL6, NUBPL, CYFIP1, IQGAP1, FLNB, SLC7A11, CD2AP) through machine learning; Validated the expression of hub genes by qRT-PCR; Constructed a clinical diagnostic model with good predictive accuracy (overall dataset accuracy of 83.3%); Identified two subtypes of ASCI based on hub genes, with different immune infiltration and pathway activity. Disulfidptosis is closely related to spinal cord injury. The identified hub genes and subtypes provide new insights for biomarker and therapeutic target research. The diagnostic model has potential for clinical application, but further studies are needed due to limitations such as small sample size. This study was supported in part by the project of Youth Scientific and Technological Talents of PLA (2020QN06125), Changhong Talent Project in First affiliated hospital of Navy Medical University (Wei Xianzhao) and Basic Medical Research Project in First affiliated hospital of Navy Medical University (2023PY17). I want to reiterate that there is no prior publication of figures or tables and no conflict of interest in the submission of this manuscript.
研究设计：生物信息学分析和实验验证研究。目的：探讨脊髓损伤相关基因在脊髓损伤（SCI）中的作用和表达模式，寻找潜在的关键基因，探索可能的治疗靶点。背景：中国上海。方法：数据采集及预处理：根据文献筛选27个二硫塌陷相关基因，并从GEO数据库（GSE151371）下载ASCI患者rna测序数据；差异表达基因（deg）鉴定：使用R包“limma”进行ASCI样本与正常对照差异基因表达分析；免疫细胞浸润评估：采用ssGSEA算法和CIBERSORT确定免疫细胞丰度；关键基因的鉴定与功能验证：将二硫裂病相关基因与deg交叉，利用机器学习技术（Random Forest, Lasso, Support Vector machine）鉴定枢纽基因。实时荧光定量PCR验证枢纽基因表达；诊断模型构建：建立基于枢纽基因和临床特征的反向传播神经网络临床预测模型，并采用ROC曲线对其性能进行评价。6. 亚类分析：对ASCI样本和枢纽基因进行一致聚类分析，利用GSVA分析亚群间功能差异。结果：在ASCI中鉴定出7764个deg，在炎症和自噬相关通路中富集GO和KEGG；发现ASCI组免疫细胞浸润与对照组存在差异，免疫细胞与DRGs存在相关性；通过机器学习确定了7个枢纽基因（MYL6、NUBPL、CYFIP1、IQGAP1、FLNB、SLC7A11、CD2AP）；通过qRT-PCR验证hub基因的表达；构建了预测准确率较高的临床诊断模型（总体数据集准确率为83.3%）；根据中枢基因鉴定出两种ASCI亚型，具有不同的免疫浸润和途径活性。结论：双上睑下垂与脊髓损伤密切相关。中心基因和亚型的鉴定为生物标志物和治疗靶点的研究提供了新的思路。该诊断模型具有临床应用潜力，但由于样本量小等局限性，尚需进一步研究。项目资助：中国人民解放军青年科技人才项目（2020QN06125）、海军医科大学第一附属医院长虹人才项目（魏贤昭）、海军医科大学第一附属医院基础医学研究项目（2023PY17）为本研究的部分资助项目。我想重申，在提交这篇稿件时，没有事先发表任何数据或表格，也没有利益冲突。图形摘要分为两部分。上半部分依次显示脊髓损伤后人体内二翘下垂的发生及免疫微环境的变化。下半部分为通过检测二硫塌陷相关基因的变化，结合患者临床资料构建脊髓损伤诊断模型。
{"title":"Identification of disulfidptosis-related genes and subgroups in spinal cord injury","authors":"Ye Tao, Shanhe Wang, Xiongfei Li, Letian Jin, Chen Liu, Kun Jiao, Xiaoyu Li, Yajun Cheng, Kehan Xu, Xiaoyi Zhou, Xianzhao Wei","doi":"10.1038/s41393-025-01081-1","DOIUrl":"10.1038/s41393-025-01081-1","url":null,"abstract":"Bioinformatics analysis and experimental validation study. To investigate the role and expression patterns of disulfidptosis-related genes in spinal cord injury (SCI), identify potential pivotal genes, and explore possible therapeutic targets. Shanghai, China. Data acquisition and pre-processing: Screened 27 disulfidptosis-related genes based on literature and downloaded RNA-sequencing data of ASCI patients from GEO database (GSE151371); Identification of differentially expressed genes (DEGs): Used R package “limma” for differential gene expression analysis between ASCI samples and normal controls; Evaluating immune cell infiltration: Employed ssGSEA algorithm and CIBERSORT to determine immune cell abundance; Identification and functional verification of key genes: Intersected disulfidptosis-related genes with DEGs, and used machine learning techniques (Random Forest, Lasso, Support Vector Machine) to identify hub genes. Validated hub genes expression by real-time PCR; Construction of a diagnostic model: Developed a backpropagation neural network clinical prediction model based on hub genes and clinical features, and evaluated its performance using ROC curve. 6. Subcluster analysis: Performed consensus cluster analysis of ASCI samples and hub genes, and used GSVA to elucidate functional differences between subgroups. Identified 7764 DEGs in ASCI, with GO and KEGG enrichment in inflammation and autophagy-related pathways; Found differences in immune cell infiltration between ASCI and control groups, and correlation between immune cells and DRGs; Determined seven hub genes (MYL6, NUBPL, CYFIP1, IQGAP1, FLNB, SLC7A11, CD2AP) through machine learning; Validated the expression of hub genes by qRT-PCR; Constructed a clinical diagnostic model with good predictive accuracy (overall dataset accuracy of 83.3%); Identified two subtypes of ASCI based on hub genes, with different immune infiltration and pathway activity. Disulfidptosis is closely related to spinal cord injury. The identified hub genes and subtypes provide new insights for biomarker and therapeutic target research. The diagnostic model has potential for clinical application, but further studies are needed due to limitations such as small sample size. This study was supported in part by the project of Youth Scientific and Technological Talents of PLA (2020QN06125), Changhong Talent Project in First affiliated hospital of Navy Medical University (Wei Xianzhao) and Basic Medical Research Project in First affiliated hospital of Navy Medical University (2023PY17). I want to reiterate that there is no prior publication of figures or tables and no conflict of interest in the submission of this manuscript.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 6","pages":"306-318"},"PeriodicalIF":2.2,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017862","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}
Survey. This study aimed to investigate the rate of return to work among individuals with spinal cord injuries in Japan and identify factors associated with their return. Returning to work is difficult for people with spinal cord injuries, although it contributes to their personal quality of life and society. Previous studies have examined various factors inhibiting return to work, but none have examined social participation. Questionnaires were sent to individuals of working age with spinal cord injuries. Their employment status, marital status, neurological status, activities of daily living, enjoyment of sports and/or hobbies post-injury, and whether they lived with family were examined using the visual analog scale for pain. Among the 134 respondents, 61 (46%) were employed at the time of the survey. Multivariate logistic regression analysis revealed that mild paralysis and enjoyment of sports and/or hobbies were significant factors associated with return to work. Among those employed, 27% secured jobs through private job introductions, highlighting the role of social connections in facilitating employment. Besides mild paralysis, social participation in sports and/or hobbies was significantly associated with a return to work. As social connections can provide opportunities to obtain jobs, providing spaces for interaction through sports and hobbies, can create a conducive environment for returning to work.
{"title":"Factors affecting return to work after spinal cord injury in Japan: a cross-sectional study","authors":"Tetsuo Hayashi, Hiromitsu Kobayashi, Momo Irie, Hiroaki Sakai, Mayumi Takegawa, Ryota Takanami, Muneaki Masuda, Kensuke Kubota, Mari Sato, Osamu Kawano, Takeshi Maeda","doi":"10.1038/s41393-025-01083-z","DOIUrl":"10.1038/s41393-025-01083-z","url":null,"abstract":"Survey. This study aimed to investigate the rate of return to work among individuals with spinal cord injuries in Japan and identify factors associated with their return. Returning to work is difficult for people with spinal cord injuries, although it contributes to their personal quality of life and society. Previous studies have examined various factors inhibiting return to work, but none have examined social participation. Questionnaires were sent to individuals of working age with spinal cord injuries. Their employment status, marital status, neurological status, activities of daily living, enjoyment of sports and/or hobbies post-injury, and whether they lived with family were examined using the visual analog scale for pain. Among the 134 respondents, 61 (46%) were employed at the time of the survey. Multivariate logistic regression analysis revealed that mild paralysis and enjoyment of sports and/or hobbies were significant factors associated with return to work. Among those employed, 27% secured jobs through private job introductions, highlighting the role of social connections in facilitating employment. Besides mild paralysis, social participation in sports and/or hobbies was significantly associated with a return to work. As social connections can provide opportunities to obtain jobs, providing spaces for interaction through sports and hobbies, can create a conducive environment for returning to work.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 6","pages":"279-284"},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035527","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 : 2025-04-30DOI: 10.1038/s41393-025-01079-9
Hye Jin Nam, Haesun Lee, Ju Young Yoon
Cross-sectional survey. This study aims to identify and prioritize the gaps between the required and current levels of support services for individuals with SCI in South Korea. Community. The cross-sectional analysis involved 532 participants who are members of the Korea Spinal Cord Injury Association. These participants were recruited through the 2021 Survey on Needs of People with SCI, conducted via face-to-face interviews by trained investigators. The survey assesses the demand and current levels of 11 key support services. The Borich needs assessment and the locus for focus model were employed to identify the priorities of these services. Results indicated significant disparities between the required and current levels across all services. Among the 532 participants, 70.1% were male and the average age was 49.6 years. The highest priority services were identified as “support for caregiver costs,” “livelihood security,” “health management,” and “home modification”. Secondary priorities included “training for daily living activities” and “vocational rehabilitation.” The study emphasizes the importance of aligning service provision with the specific needs of the SCI population to enhance their quality of life and promote successful reintegration into the community. The findings underscore the urgent need for comprehensive support systems to address the economic and functional challenges of individuals with SCI. Policymakers and service providers are encouraged to focus on these identified priorities to better meet the needs of individuals with SCI, to ensure their sustained independence and improved well-being.
{"title":"Priorities for support service needs among individuals with spinal cord injury","authors":"Hye Jin Nam, Haesun Lee, Ju Young Yoon","doi":"10.1038/s41393-025-01079-9","DOIUrl":"10.1038/s41393-025-01079-9","url":null,"abstract":"Cross-sectional survey. This study aims to identify and prioritize the gaps between the required and current levels of support services for individuals with SCI in South Korea. Community. The cross-sectional analysis involved 532 participants who are members of the Korea Spinal Cord Injury Association. These participants were recruited through the 2021 Survey on Needs of People with SCI, conducted via face-to-face interviews by trained investigators. The survey assesses the demand and current levels of 11 key support services. The Borich needs assessment and the locus for focus model were employed to identify the priorities of these services. Results indicated significant disparities between the required and current levels across all services. Among the 532 participants, 70.1% were male and the average age was 49.6 years. The highest priority services were identified as “support for caregiver costs,” “livelihood security,” “health management,” and “home modification”. Secondary priorities included “training for daily living activities” and “vocational rehabilitation.” The study emphasizes the importance of aligning service provision with the specific needs of the SCI population to enhance their quality of life and promote successful reintegration into the community. The findings underscore the urgent need for comprehensive support systems to address the economic and functional challenges of individuals with SCI. Policymakers and service providers are encouraged to focus on these identified priorities to better meet the needs of individuals with SCI, to ensure their sustained independence and improved well-being.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 6","pages":"298-305"},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987660","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 : 2025-04-29DOI: 10.1038/s41393-025-01078-w
Mengdong He, Emily Hon, Lin Xu, Stephen Hampton, Kimberly Waddell
Retrospective cohort study. To characterize guideline-discordant clean intermittent catheterization (CIC) during hospitalizations of patients with spinal cord injury (SCI), explore predictors of guideline-discordant CIC, and examine its association with urinary tract infection (UTI). Acute care hospitals within a large academic health system. Using electronic health records (9/1/2021-9/30/2023), we identified adults hospitalized with a discharge diagnosis of SCI and ≥1 documented CIC bladder output. The primary outcome was guideline-discordant CIC (bladder output volume >500 mL and/or time between CIC > 6 h). Generalized linear model and Chi-square test were used to evaluate patient factors and UTI risk associated with guideline-discordant CIC. The study included 413 patients with SCI covering 8,016 CIC measurements during 519 hospitalizations. Their mean (SD) age was 55.2 (20.6) years, with 34.7% female and 46.8% Black. 52.8% were covered by Medicare. 79.4% had a thoracolumbar-level SCI. 50.2% of CICs were guideline-discordant. Males and those with managed care insurance had significantly higher odds of guideline-discordant CIC (OR = 1.34, 95% CI, 1.03 to 1.73 and OR = 2.05, 95% CI, 1.18 to 3.54, respectively). Patients with an indwelling catheter for ≥12 days before initiating CIC had significantly lower odds of guideline-discordant CIC (OR = 0.65, 95% CI, 0.49 to 0.84). The UTI incidence was 12.5% in hospitalizations with guideline-discordant CIC compared to 10.4% with guideline-concordant CIC (P = 0.49). Half of CICs did not adhere to guidelines, highlighting the need for quality improvement initiatives. Further research examining the association between UTI and CIC care patterns is warranted.
{"title":"Quantifying guideline-discordant intermittent catheterization in adults hospitalized with spinal cord injury: a retrospective cohort study","authors":"Mengdong He, Emily Hon, Lin Xu, Stephen Hampton, Kimberly Waddell","doi":"10.1038/s41393-025-01078-w","DOIUrl":"10.1038/s41393-025-01078-w","url":null,"abstract":"Retrospective cohort study. To characterize guideline-discordant clean intermittent catheterization (CIC) during hospitalizations of patients with spinal cord injury (SCI), explore predictors of guideline-discordant CIC, and examine its association with urinary tract infection (UTI). Acute care hospitals within a large academic health system. Using electronic health records (9/1/2021-9/30/2023), we identified adults hospitalized with a discharge diagnosis of SCI and ≥1 documented CIC bladder output. The primary outcome was guideline-discordant CIC (bladder output volume >500 mL and/or time between CIC > 6 h). Generalized linear model and Chi-square test were used to evaluate patient factors and UTI risk associated with guideline-discordant CIC. The study included 413 patients with SCI covering 8,016 CIC measurements during 519 hospitalizations. Their mean (SD) age was 55.2 (20.6) years, with 34.7% female and 46.8% Black. 52.8% were covered by Medicare. 79.4% had a thoracolumbar-level SCI. 50.2% of CICs were guideline-discordant. Males and those with managed care insurance had significantly higher odds of guideline-discordant CIC (OR = 1.34, 95% CI, 1.03 to 1.73 and OR = 2.05, 95% CI, 1.18 to 3.54, respectively). Patients with an indwelling catheter for ≥12 days before initiating CIC had significantly lower odds of guideline-discordant CIC (OR = 0.65, 95% CI, 0.49 to 0.84). The UTI incidence was 12.5% in hospitalizations with guideline-discordant CIC compared to 10.4% with guideline-concordant CIC (P = 0.49). Half of CICs did not adhere to guidelines, highlighting the need for quality improvement initiatives. Further research examining the association between UTI and CIC care patterns is warranted.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 5","pages":"270-276"},"PeriodicalIF":2.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044613","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 : 2025-04-25DOI: 10.1038/s41393-025-01080-2
Ankit Mishra, Mohammed Eldolify, Rebecca Shirley, James K-K Chan
Retrospective case series. To describe our five-year experience of surgical excision and flap reconstruction of pressure ulcers in individuals with spinal cord injury (SCI). Tertiary spinal centre in Stoke Mandeville, United Kingdom. All spinal injury patients that underwent surgical reconstruction of pressure ulcers at the Stoke Mandeville Hospital National Spinal Injury Centre between 2018 and 2022 inclusive were included. Ulcers underwent ‘pseudotumour’ excision followed by either immediate or staged flap reconstruction. The primary outcome was complete healing at one year. Secondary outcomes included flap loss, complications, and return to theatre. 52 cases were included across 44 patients. 43 cases (82.7%) underwent immediate debridement and reconstruction. The mean number of procedures was 1.9 (range 1–6). Local flaps were used in 22 (41.5%) cases. There was one (1.9%) free flap (anterolateral thigh), eight (15.4%) pedicled flaps, and 21 (39.6%) flaps based on single perforators. 49 cases completed follow-up; 41 (83.7%) were healed at one year after their initial surgery. Immediate reconstructions were 36.7% more likely to achieve healing at this time point than staged cases (P = .028, Fisher’s exact). There was partial or total flap loss in 15 (28.8%) cases. Thirty-nine complications were seen in 24 (46.2%) cases. Twenty-three cases (44.2%) required returns to theatre. Surgical debridement with flap reconstruction is a safe and reliable treatment approach for pressure ulcers in those with SCI, with a complication rate comparable to existing literature. Immediate flap reconstruction and local flap designs may be associated with a lower risk of complications and higher healing rates.
{"title":"Flap reconstruction of pressure ulcers in patients with spinal cord injury: a retrospective cohort study","authors":"Ankit Mishra, Mohammed Eldolify, Rebecca Shirley, James K-K Chan","doi":"10.1038/s41393-025-01080-2","DOIUrl":"10.1038/s41393-025-01080-2","url":null,"abstract":"Retrospective case series. To describe our five-year experience of surgical excision and flap reconstruction of pressure ulcers in individuals with spinal cord injury (SCI). Tertiary spinal centre in Stoke Mandeville, United Kingdom. All spinal injury patients that underwent surgical reconstruction of pressure ulcers at the Stoke Mandeville Hospital National Spinal Injury Centre between 2018 and 2022 inclusive were included. Ulcers underwent ‘pseudotumour’ excision followed by either immediate or staged flap reconstruction. The primary outcome was complete healing at one year. Secondary outcomes included flap loss, complications, and return to theatre. 52 cases were included across 44 patients. 43 cases (82.7%) underwent immediate debridement and reconstruction. The mean number of procedures was 1.9 (range 1–6). Local flaps were used in 22 (41.5%) cases. There was one (1.9%) free flap (anterolateral thigh), eight (15.4%) pedicled flaps, and 21 (39.6%) flaps based on single perforators. 49 cases completed follow-up; 41 (83.7%) were healed at one year after their initial surgery. Immediate reconstructions were 36.7% more likely to achieve healing at this time point than staged cases (P = .028, Fisher’s exact). There was partial or total flap loss in 15 (28.8%) cases. Thirty-nine complications were seen in 24 (46.2%) cases. Twenty-three cases (44.2%) required returns to theatre. Surgical debridement with flap reconstruction is a safe and reliable treatment approach for pressure ulcers in those with SCI, with a complication rate comparable to existing literature. Immediate flap reconstruction and local flap designs may be associated with a lower risk of complications and higher healing rates.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 6","pages":"292-297"},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039546","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 : 2025-04-14DOI: 10.1038/s41393-025-01077-x
Qingsheng Zhou, Qiongxuan Fang, Chunming Zhang, Wei Liu, Yifeng Sun
An integrated bioinformatics data study. This study, through bioinformatics analysis, aims to map the landscape of astrocytes, explore key signaling pathways, and uncover molecular mechanisms that support SCI recovery facilitated by MSCs and iPSCs. Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. We performed a bioinformatics analysis of single-cell transcriptomes (scRNA-seq), spatial transcriptomics, and bulk RNA-seq data sourced from Gene Expression Omnibus (GEO) datasets. The data processing involved R packages like “Seurat,” “DESeq2,” and “WGCNA.” For pathway enrichment, we used Gene Set Enrichment Analysis (GSEA) and the Enrichr web server. Single-cell and spatial transcriptomic analysis revealed notable changes in the astrocyte landscape after SCI, highlighting a significant disruption in astrocyte populations within the injured region. Findings suggest that BDNF regulation of GABA neurotransmission and GABA receptor signaling in astrocytes plays a key role in promoting neuronal regeneration. Additionally, hUC-MSCs were found to enhance neural repair by activating BDNF-regulated GABA signaling of astrocytes. A promising alternative involves iPS-derived MSCs, which have shown potential to boost neural regeneration through BDNF, GABA, and GABA receptor signaling pathways of astrocytes. In summary, SCI disrupts astrocyte populations, impacting their ability to support neural repair. BDNF-regulated GABA signaling in astrocytes is essential for neuron regeneration. Both hUC-MSCs and iPS-derived MSCs show promise in enhancing neural recovery by activating these pathways, offering potential new therapeutic options for SCI.
研究设计：综合生物信息学数据研究。目的：本研究旨在通过生物信息学分析，绘制星形胶质细胞景观，探索关键信号通路，揭示MSCs和iPSCs促进SCI恢复的分子机制。单位：北京清华长庚医院，清华大学临床医学院。方法：我们对来自Gene Expression Omnibus （GEO）数据集的单细胞转录组（scRNA-seq）、空间转录组和大量RNA-seq数据进行了生物信息学分析。数据处理涉及到像“Seurat”、“DESeq2”和“WGCNA”这样的R包。对于途径富集，我们使用基因集富集分析（GSEA）和富集web服务器。结果：单细胞和空间转录组分析显示，SCI后星形胶质细胞景观发生了显著变化，突出了损伤区域内星形胶质细胞群的显著破坏。研究结果表明，BDNF调节GABA神经传递和GABA受体信号在星形胶质细胞中起着促进神经元再生的关键作用。此外，hUC-MSCs通过激活bdnf调节的星形胶质细胞的GABA信号来增强神经修复。一种有希望的替代方法是ips衍生的MSCs，它已显示出通过星形胶质细胞的BDNF、GABA和GABA受体信号通路促进神经再生的潜力。结论：总之，脊髓损伤破坏星形胶质细胞群，影响其支持神经修复的能力。星形胶质细胞中bdnf调节的GABA信号对于神经元再生至关重要。hUC-MSCs和ips衍生的MSCs都显示出通过激活这些通路来增强神经恢复的希望，为脊髓损伤提供了潜在的新治疗选择。
{"title":"BDNF-GABA signaling in astrocytes: enhancing neural repair after SCI through MSC therapies","authors":"Qingsheng Zhou, Qiongxuan Fang, Chunming Zhang, Wei Liu, Yifeng Sun","doi":"10.1038/s41393-025-01077-x","DOIUrl":"10.1038/s41393-025-01077-x","url":null,"abstract":"An integrated bioinformatics data study. This study, through bioinformatics analysis, aims to map the landscape of astrocytes, explore key signaling pathways, and uncover molecular mechanisms that support SCI recovery facilitated by MSCs and iPSCs. Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. We performed a bioinformatics analysis of single-cell transcriptomes (scRNA-seq), spatial transcriptomics, and bulk RNA-seq data sourced from Gene Expression Omnibus (GEO) datasets. The data processing involved R packages like “Seurat,” “DESeq2,” and “WGCNA.” For pathway enrichment, we used Gene Set Enrichment Analysis (GSEA) and the Enrichr web server. Single-cell and spatial transcriptomic analysis revealed notable changes in the astrocyte landscape after SCI, highlighting a significant disruption in astrocyte populations within the injured region. Findings suggest that BDNF regulation of GABA neurotransmission and GABA receptor signaling in astrocytes plays a key role in promoting neuronal regeneration. Additionally, hUC-MSCs were found to enhance neural repair by activating BDNF-regulated GABA signaling of astrocytes. A promising alternative involves iPS-derived MSCs, which have shown potential to boost neural regeneration through BDNF, GABA, and GABA receptor signaling pathways of astrocytes. In summary, SCI disrupts astrocyte populations, impacting their ability to support neural repair. BDNF-regulated GABA signaling in astrocytes is essential for neuron regeneration. Both hUC-MSCs and iPS-derived MSCs show promise in enhancing neural recovery by activating these pathways, offering potential new therapeutic options for SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 5","pages":"263-269"},"PeriodicalIF":2.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062225","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 : 2025-03-26DOI: 10.1038/s41393-025-01076-y
Kwang-Jin Jung, Yong-Tak Kim, Mi-Ri Jeon, Chan-Woo Lee, Keum-Jin Lee
Cross-sectional survey. To identify the factors determining the employment of individuals with spinal cord injury (SCI) living in South Korea, which shows a lower-than-average employment rate in international comparative studies, and to examine the potential importance for policy. Community of patients with SCI who are members of the Korea Spinal Cord Injury Association (KSCIA). A survey involving 200 members of the KSCIA was conducted. In the analysis, we included 177 individuals aged 15–64 years and were at least 2 years post-injury at the time of the survey. Descriptive statistics were calculated and logistic regression was applied to examine the association between 11 variables and employment outcomes. A higher “education level” and participation in “vocational rehabilitation services” were positively associated with employment for individuals with SCI. By contrast, “receiving welfare benefits” was negatively associated with employment probability. The analysis, which categorized employment predictors into human capital, injury, and environmental models, showed no associations for factors in the Injury Model but indicated positive associations for education in the Human Capital Model and for receiving compensation in the form of welfare benefits and participation in vocational rehabilitation services in the Environment Model. Among the three models, the Environment Model had the greatest explanatory power. This suggests that in Korea, policy interventions targeting modifiable environmental factors hold significant potential to improve employment outcomes for individuals with SCI.
{"title":"Factors impacting employment outcomes for persons with spinal cord injury in South Korea","authors":"Kwang-Jin Jung, Yong-Tak Kim, Mi-Ri Jeon, Chan-Woo Lee, Keum-Jin Lee","doi":"10.1038/s41393-025-01076-y","DOIUrl":"10.1038/s41393-025-01076-y","url":null,"abstract":"Cross-sectional survey. To identify the factors determining the employment of individuals with spinal cord injury (SCI) living in South Korea, which shows a lower-than-average employment rate in international comparative studies, and to examine the potential importance for policy. Community of patients with SCI who are members of the Korea Spinal Cord Injury Association (KSCIA). A survey involving 200 members of the KSCIA was conducted. In the analysis, we included 177 individuals aged 15–64 years and were at least 2 years post-injury at the time of the survey. Descriptive statistics were calculated and logistic regression was applied to examine the association between 11 variables and employment outcomes. A higher “education level” and participation in “vocational rehabilitation services” were positively associated with employment for individuals with SCI. By contrast, “receiving welfare benefits” was negatively associated with employment probability. The analysis, which categorized employment predictors into human capital, injury, and environmental models, showed no associations for factors in the Injury Model but indicated positive associations for education in the Human Capital Model and for receiving compensation in the form of welfare benefits and participation in vocational rehabilitation services in the Environment Model. Among the three models, the Environment Model had the greatest explanatory power. This suggests that in Korea, policy interventions targeting modifiable environmental factors hold significant potential to improve employment outcomes for individuals with SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 5","pages":"257-262"},"PeriodicalIF":2.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721545","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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