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The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study. 成人脊髓损伤患者准备重复使用导管的时间负担:一项横断面研究。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-01 DOI: 10.1038/s41394-023-00596-0
T Miller, L J Roik, T Kalimullina, S Samejima, C Shackleton, R N Malik, R Sachdeva, A V Krassioukov

Study design: Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine.

Setting: Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS).

Results: Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R2 = 0.745, β = -0.833, p ≤ 0.001).

Conclusions: Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.

研究设计:横断面 研究目的:神经源性下尿路功能障碍在脊髓损伤(SCI)患者中很常见。虽然建议使用一次性清洁间歇性导尿管来促进常规膀胱排空,但导尿管重复使用的情况很普遍。与导尿管重复使用的准备(即清洁)相关的障碍尚不清楚。本研究通过评估 (1) 清洁导尿管所需的时间,以及 (2) 对导尿管清洁工作难度的感知,对患有 SCI 的成人再次使用导尿管的障碍进行了研究:实验室 方法:20 名慢性 SCI 患者(受伤后≥ 1 年;第 1 组 = 10 名四肢瘫痪患者;第 2 组 = 10 名截瘫患者)完成了这项研究。采用标准化清洁程序(即米尔顿法),对每位参与者的导管清洁进行计时。采用 5 点李克特量表对感知难度进行评估。功能障碍用上肢运动评分(UEMS)进行评估:总清洁时间(第 1 组 = 1584.1 ± 179.8 秒;第 2 组 = 1321.0 ± 93.8 秒,p = 0.004)和感知难度[第 1 组 = 2.6 (2, 3);第 2 组 = 2 (1.7, 2.3),p = 0.028]在组间存在显著差异。总清洁时间与 UEMS(ρ = -0.709,p ≤ 0.001)和感知难度(ρ = 0.468,p = 0.037)明显相关。结论:UEMS 是总清洁时间的独立预测因子(R2 = 0.745,β = -0.833,p ≤ 0.001):对于 SCI 水平较高、严重程度较高、上肢运动障碍较明显的患者来说,准备导管以备再次使用既费时又费力,这与总清洁时间有独立关联。持续执行这一例行工作需要投入大量时间,并对整体生活质量产生深远的负面影响。
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引用次数: 0
Para-spinal abscess presenting with abdominal pain-a case report of 'red herring' symptoms. 伴有腹痛的脊柱旁脓肿--"红线 "症状的病例报告。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-31 DOI: 10.1038/s41394-023-00598-y
Mayya Vorona, James Livingstone, Farzan Dholoo

Introduction: Paraspinal abscesses are rare infections affecting the paraspinal muscles and soft tissues. An evolving abscess may pose a threat to the spinal cord via the compressive effect which can manifest as impaired motor or sensory function at the corresponding vertebral level. Paraspinal abscess is often a late diagnosis due to non-specific symptoms at presentation. This results in high morbidity and mortality.

Case presentation: We describe the case of a 59-year-old female with a paraspinal abscess presenting with epigastric pain who was initially worked up for a suspected intra-abdominal pathology, however computerised tomography of the chest, abdomen, and pelvis (CTCAP) revealed no abnormality. Later, rising inflammatory markers, accompanied by worsening cervicalgia, prompted a CT of the head, neck and thorax which revealed a soft tissue abscess compressing the thecal sac at cervical levels 1 to 3 (C1-3). This was successfully managed with radiologically guided drainage and long-term intravenous antibiotics. Our patient made a full recovery and a repeat MRI demonstrated resolution of the abscess.

Conclusion: We demonstrate that spinal abscess can present with a misleading combination of symptoms and highlight the importance of considering rarer differentials in the face of an evolving clinical picture. Our case also demonstrates that once the correct diagnosis is reached, patients can make an excellent recovery from uncomplicated spinal abscesses.

简介脊柱旁脓肿是一种影响脊柱旁肌肉和软组织的罕见感染。不断发展的脓肿可能通过压迫效应对脊髓构成威胁,表现为相应椎体水平的运动或感觉功能受损。由于出现非特异性症状,脊柱旁脓肿通常诊断较晚。这导致了高发病率和高死亡率:我们描述了一例 59 岁女性脊柱旁脓肿患者的病例,她因上腹疼痛而就诊,起初怀疑是腹腔内病变,但胸部、腹部和盆腔计算机断层扫描(CTCAP)未发现异常。后来,炎症标志物升高,并伴有颈痛加重,促使患者进行头颈部和胸部 CT 检查,结果发现颈椎 1-3 级(C1-3)处有软组织脓肿压迫椎囊。通过放射引导引流和长期静脉注射抗生素,脓肿得到了成功控制。患者完全康复,复查磁共振成像显示脓肿已消退:我们的病例表明,脊柱脓肿可表现为一系列令人误解的症状,并强调了在临床症状不断变化的情况下考虑罕见鉴别的重要性。我们的病例还表明,一旦诊断正确,无并发症的脊柱脓肿患者也能很好地康复。
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引用次数: 0
Intermittent colonic exoperistalsis for chronic constipation in spinal cord-injured individuals. A long-term structured patient feedback survey to evaluate home care use. 间歇性结肠外蠕动治疗脊髓损伤患者的慢性便秘。一项评估家庭护理使用的长期结构化患者反馈调查。
IF 1.2 Q4 Medicine Pub Date : 2023-07-29 DOI: 10.1038/s41394-023-00597-z
Jana Bremer, Jörn Bremer, Maike König, Peter Koßmehl, Ines Kurze, Jeannette Obereisenbuchner, Elisabeth Weinschenk, Immaculada Herrero-Fresneda

Study design: Structured patient feedback survey evaluating real-world home care use.

Objectives: To assess the long-term effectiveness, tolerability, and satisfaction with the intermittent colonic exoperistalsis (ICE) treatment device MOWOOT in spinal cord-injured (SCI) individuals with chronic constipation.

Setting: Four specialized German hospitals.

Methods: SCI individuals with chronic constipation were invited to use MOWOOT 10-20 min daily and answer a questionnaire about their bowel situation before treatment (feedback 1, F1) and after ≥10 months of use (feedback 2, F2). Collected variables were device use, bowel function effectiveness, chronic constipation symptoms, concomitant use of laxatives and evacuation aids, and satisfaction with bowel function and management, which were compared between time points. At F2, participants reported efficacy, tolerability/side effects, and ease of use.

Results: Eleven participants used the device for a mean (SD) of 13.27 (4.03) months. From F1 to F2, mean time per evacuation decreased by 24.5 min (p = 0.0076) and the number of failed attempts to evacuate/week, by 1.05 (p = 0.0354) with a tendency toward increased bowel movements and softer stool consistency, and decreased incomplete bowel movements. Participants experienced decreased difficulty/strain (p = 0.0055), abdominal pain (p = 0.0230), bloating (p = 0.0010), abdominal cramps (p = 0.0019), and spasms (p = 0.0198), without significant changes in the use of laxatives and evacuation aids. Satisfaction with bowel function and management improved (p = 0.0095) and more participants reported being very satisfied/satisfied (p = 0.0300). Most reported tolerability, efficacy, and ease of use as very good/good.

Conclusion: Long-term in-home ICE treatment improved bowel function and chronic constipation symptoms in SCI individuals, providing clinical benefits to this population.

Sponsorship (mowoot devices lending): 4 M Medical GmbH, Norderstedt, Germany.

研究设计:结构化的患者反馈调查,评估真实世界的家庭护理使用情况。目的:评价间歇性结肠外肠(ICE)治疗装置MOWOOT对脊髓损伤(SCI)慢性便秘患者的长期疗效、耐受性和满意度。环境:四家德国专科医院。方法:邀请慢性便秘的SCI患者每天使用MOWOOT 10-20分钟,并回答治疗前(反馈1,F1)和使用≥10个月后(反馈2,F2)的肠道情况问卷。收集的变量包括器械使用情况、肠功能有效性、慢性便秘症状、同时使用泻药和排便辅助剂、肠功能和管理满意度,并在不同时间点之间进行比较。在F2时,参与者报告了疗效、耐受性/副作用和易用性。结果:11名参与者使用该设备的平均(SD)为13.27(4.03)个月。从F1到F2,平均每次排便时间减少了24.5分钟(p = 0.0076),排便失败次数减少了1.05 (p = 0.0354),排便增加,大便粘稠度变软,排便不完全减少。参与者经历了困难/紧张(p = 0.0055)、腹痛(p = 0.0230)、腹胀(p = 0.0010)、腹部痉挛(p = 0.0019)和痉挛(p = 0.0198)的降低,在使用泻药和排泄辅助剂方面没有显著变化。对肠道功能和管理的满意度提高(p = 0.0095),更多的参与者报告非常满意/满意(p = 0.0300)。大多数报告的耐受性,疗效和易用性为非常好/好。结论:长期在家ICE治疗可改善脊髓损伤患者的肠功能和慢性便秘症状,为该人群提供临床益处。赞助(mowoot设备出借):4 M Medical GmbH, Norderstedt, Germany。
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引用次数: 0
Spinal Rosai-Dorfman disease-a report of 2 cases and review of literature. 脊髓罗赛-多夫曼病--2 例病例报告和文献综述。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-29 DOI: 10.1038/s41394-023-00600-7
Saumyajit Basu, Rohan Gala, Kushal Gohil

Introduction: Rosai-Dorfman Disease (RDD) is a rare benign histiocytic disease that infrequently affects the spine. We report two cases of spinal RDD and review the relevant literature. This report addresses the various diagnostic dilemmas related to the evaluation of Spinal RDD and its treatment.

Case presentation: Case 1: A 32-year-old male presented with low back pain and left anterior thigh for last 8 months. On examination, there was sensory diminution on inner aspects of the thigh with an absent left knee jerk. CT/MRI scans revealed an extradural lesion at L2/3 with neural compression. PET scan showed several hypermetabolic lesions in ribs, humerus, femur, and vertebrae. He underwent en bloc excision of the extradural mass with L2-3 pedicle screw-rod fixation and was later managed with chemotherapy. Case 2: A 42-year-old male presented with spastic paraparesis with urinary incontinence for the last 4 weeks. On examination, he had a neurological level of T6. MRI scan revealed a lesion in posterior elements of T6-7 compressing the spinal cord. He underwent T6-7 laminectomy with decompression. In both cases, the diagnosis was confirmed by histopathology and further managed by Hemato-oncologist. They both did well at 1-year follow-up with improvement in neurology.

Discussion: Spinal RDD to date remains a large diagnostic dilemma with no pathognomonic clinical or radiological features; mimicking many osteolytic lesions in the spine. The diagnosis is purely histopathological and immunological. The lesion's complete surgical excision is the mainstay of treatment with a better prognosis and decreased chances of recurrences.

简介罗赛-多夫曼病(RDD)是一种罕见的良性组织细胞疾病,很少累及脊柱。我们报告了两例脊柱 RDD 病例,并回顾了相关文献。本报告探讨了与脊柱 RDD 评估和治疗相关的各种诊断难题:病例 1:一名 32 岁男性,因腰痛和左大腿前侧疼痛就诊 8 个月。经检查,大腿内侧感觉减退,左膝抽搐消失。CT/MRI 扫描显示 L2/3 硬膜外病变,神经受压。正电子发射计算机断层扫描显示,肋骨、肱骨、股骨和椎骨有多处高代谢病变。他接受了硬膜外肿块全切术,并用椎弓根螺钉固定 L2-3,随后接受了化疗。病例 2:一名 42 岁的男性患者,因痉挛性截瘫伴尿失禁就诊 4 周。经检查,他的神经水平为 T6。核磁共振扫描显示,T6-7 后部有病变,压迫脊髓。他接受了 T6-7 椎板切除减压术。两个病例均经组织病理学确诊,并由血液肿瘤专家进一步处理。随访1年后,两人的神经功能均有所改善:讨论:迄今为止,脊柱 RDD 仍是一个巨大的诊断难题,它没有任何临床或放射学特征,与脊柱中的许多溶骨性病变相似。诊断完全依靠组织病理学和免疫学。病变完全手术切除是治疗的主要方法,预后较好,复发几率较低。
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引用次数: 0
A curious cervical spine case: multiple, primary CNS leiomyosarcomas presenting with rapid growth in the immunocompromised patient. 一个奇特的颈椎病例:免疫力低下患者中出现的快速生长的多发性原发性中枢神经系统白肌瘤。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-28 DOI: 10.1038/s41394-023-00588-0
Aleka Scoco, Kainaat Javed, Reza Yassari

Introduction: Primary CNS leiomyosarcomas are rare, dural-based intracranial or intravertebral tumors seen in immunocompromised patients and are associated with latent EBV infection. They may mimic a meningioma or schwannoma on imaging but their clinical presentation progresses much more rapidly. Often times, these tumors are hard to distinguish from secondary, metastatic leiomyosarcoma.

Case presentation: A 30-year-old female with congenital HIV presented to clinic with shoulder pain, paresthesias of the right upper extremity and gait instability. She was noted to have a contrast enhancing dural-based spinal canal lesion measuring 1.5 cm at the C1 vertebral level on MRI. Surgery was proposed but patient deferred. She represented to our Emergency Department 1 month later with right-sided hemiparesis and difficulty with ambulation. On repeat MRI, the lesion had grown to 2.6 cm. She was taken to the OR emergently for gross total tumor resection. The histopathology demonstrated a primary CNS leiomyosarcoma. MRI scan of the brain revealed an extra-axial right frontal lobe lesion measuring 1.8 cm which was also treated with subtotal surgical resection followed by proton beam radiotherapy.

Discussion: Primary CNS leiomyosarcomas should be considered in young immunocompromised patients presenting with dural-based spinal cord tumors. Histopathological studies including EBV testing can definitively make the diagnosis. These tumors have an aggressive nature and need to be treated with complete surgical resection to prevent severe neurological deterioration and adjuvant therapy to prevent recurrence.

导言:原发性中枢神经系统良性肉瘤是一种罕见的硬脑膜颅内或椎管内肿瘤,多见于免疫功能低下的患者,与潜伏的EB病毒感染有关。它们在影像学上可能与脑膜瘤或分裂瘤相似,但临床表现进展更快。很多时候,这些肿瘤很难与继发性、转移性骨髓瘤区分开来:一名患有先天性艾滋病的 30 岁女性患者因肩部疼痛、右上肢麻痹和步态不稳前来就诊。核磁共振检查发现,她的C1椎体位置有一个造影剂增强的硬脊膜椎管病变,大小为1.5厘米。医生建议进行手术治疗,但患者拒绝了。一个月后,她因右侧肢体偏瘫和行走困难到我院急诊科就诊。再次进行核磁共振检查时,病灶已增大到 2.6 厘米。她被紧急送往手术室进行肿瘤全切。组织病理学显示,这是一种原发性中枢神经系统良性肉瘤。脑部核磁共振成像扫描显示,右额叶轴外病变达1.8厘米,也进行了次全切手术,随后进行了质子束放疗:讨论:对于出现硬脊膜脊髓肿瘤的免疫功能低下的年轻患者,应考虑原发性中枢神经系统白肌瘤。组织病理学研究包括 EBV 检测可明确诊断。这些肿瘤具有侵袭性,需要进行彻底的手术切除治疗,以防止严重的神经功能衰退,并进行辅助治疗以防止复发。
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引用次数: 0
Clinical profile of COVID-19 infection among persons with spinal cord injury: a case series. 脊髓损伤患者感染 COVID-19 的临床概况:病例系列。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-18 DOI: 10.1038/s41394-023-00592-4
Chinzah Zonunsanga, Vanlal Hruaii, Joseph Chhakchhuak Vanlalsanga, Lalnuntluanga Sailo, Asem Rangita Chanu

Study design: Retrospective case series.

Objective: To report the clinical features and outcomes of spinal cord injury (SCI) patients with COVID-19 and to see if they are any different from COVID-19 in the general population.

Setting: A tertiary care hospital in North-East India.

Methods: Data of already diagnosed traumatic SCI patients with COVID-19 infection reporting to the COVID-19 management team (from June 2021 to November 2021) were collected. The source of data was hospital records (admitted patients) and home visits and teleconsultation logs (home isolation patients).

Results: There were eight traumatic SCI patients (five admitted, three in home isolation) with COVID-19 infection. Four patients had complete injury with American Spinal Injury Association Impairment Scale (AIS) Grade A, two with AIS Grade C, and one each of Grade B and D respectively. Five patients were cervical level injuries, and others were T10 level and below. Six patients were categorized as mild clinical illness and one each as moderate and severe illness. Cough was the most common symptom which was seen in seven patients. Only two patients needed oxygen therapy. All eight traumatic SCI patients recovered eventually from COVID-19 symptoms and regained their pre-COVID-19 functional status, 1 month after being free from COVID-19 symptoms.

Conclusion: The COVID-19 infection did not result in a worsening of functional ability among SCI people after 1-month post-recovery. It also did not affect the SCI patients in doing activities such as rehabilitation exercises at 6 months follow up.

研究设计回顾性病例系列:报告患有COVID-19的脊髓损伤(SCI)患者的临床特征和预后,并观察其与普通人群中的COVID-19是否存在差异:地点:印度东北部的一家三甲医院:收集向COVID-19管理小组报告的已确诊感染COVID-19的外伤性SCI患者的数据(2021年6月至2021年11月)。数据来源为医院记录(入院患者)和家访及远程会诊记录(家庭隔离患者):共有八名创伤性 SCI 患者(五名入院,三名在家隔离)感染了 COVID-19。四名患者为完全损伤,美国脊柱损伤协会损伤量表(AIS)为A级,两名为AIS C级,B级和D级各一名。五名患者为颈椎水平损伤,其他患者为 T10 及以下水平损伤。六名患者被归类为轻度临床疾病,中度和重度疾病各一名。咳嗽是最常见的症状,出现在 7 名患者身上。只有两名患者需要接受氧气治疗。所有 8 名创伤性 SCI 患者最终都从 COVID-19 症状中恢复过来,并在摆脱 COVID-19 症状 1 个月后恢复到 COVID-19 前的功能状态:结论:COVID-19 感染并没有导致 SCI 患者在康复 1 个月后功能恶化。结论:COVID-19 感染并未导致 SCI 患者在康复 1 个月后的功能能力恶化,也未影响 SCI 患者在 6 个月随访期间进行康复锻炼等活动。
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引用次数: 0
United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study. 团结和灵活:脊柱科早期职业康复的合作方法。一项现实主义研究。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-13 DOI: 10.1038/s41394-023-00587-1
Emily Timothy, John Bourke, Jennifer Dunn, Rachelle Martin, Jo Nunnerley

Study design: Qualitative study using realist review.

Objectives: To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation.

Setting: New Zealand Spinal Unit.

Methods: People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods.

Results: We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work.

Conclusions: To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment.

Sponsorship: This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

研究设计:采用现实主义审查方法进行定性研究:对脊髓损伤(SCI)康复过程中,早期干预职业康复(EIVR)如何在住院多学科背景下发挥作用进行概念化:环境:新西兰脊柱科:方法:观察新近获得 SCI 的患者及其康复团队成员在一系列康复治疗、团队会议和治疗互动中的表现。还对参与者进行了访谈,以探讨EIVR如何与多学科团队(MDT)一起发挥作用。采用现实主义方法对访谈和观察结果进行了转录、编码和分析:我们确定了影响多学科小组如何开展 EIVR 的三种主要环境:(1) 团结的方法,(2) 灵活的方法,以及 (3) 犹豫不决的方法。这些环境为 SCI 患者带来了四种与工作相关的结果:提高了工作自我效能感、增强了对工作的希望、保持了工作认同感,以及工作不确定性增加这一不太理想的结果:为了优化 SCI 患者的工作成果,必须考虑如何在更广泛的 MDT 中提供和整合 EIVR。这种认识也可以为在不同环境中建立新的EIVR服务提供参考。研究结果表明,EIVR服务和更广泛的MDT之间的统一性、灵活性和明确性是支持 SCI患者就业的重要基础:本研究由新西兰卫生研究委员会(Health Research Council NZ)与坎特伯雷区卫生局(Canterbury District Health Board)合作资助。
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引用次数: 0
Acute changes in antioxidants and oxidative stress to vigorous arm exercise: an intervention trial in persons with spinal cord injury and healthy controls. 剧烈手臂运动后抗氧化剂和氧化应激的急性变化:脊髓损伤患者和健康对照组的干预试验。
IF 1.2 Q4 Medicine Pub Date : 2023-07-13 DOI: 10.1038/s41394-023-00590-6
Matthijs F Wouda, Hanne Bjørg Slettahjell, Eivind Lundgaard, Nasser E Bastani, Truls Raastad, Rune Blomhoff, Emil Kostovski

Study design: Intervention trial.

Background: Literature remains unclear on possible health benefits and risks assosciated with high intensity exercise for persons with SCI. Elevated oxidative stress levels might influence their ability to exercise at high intensity. We investigated several biomarkers of oxidative stress and antioxidant defense at rest, during and after vigorous exercise among persons with chronic SCI.

Setting: Sunnaas Rehabilitation Hospital, Norway.

Methods: Six participants (five males) with chronic SCI (AIS A, injury level thoracic 2-8, >1 year postinjury) and six matched able-bodied controls performed two maximal arm-cranking tests, with one-three days in between. During the second exercise test, participants performed three bouts with four minutes arm cranking at high intensity (85-95% of peak heart rate (HRpeak)), before they reached maximal effort. Blood and urine biomarkers for oxidative stress and antioxidant levels were collected at six time points at the day of the second exercise test; baseline, at high intensity exercise, at maximal effort, at five, 30 and 60 min post-exercise, and 24 h post exercise.

Results: Participants with SCI had significant lower levels of creatinine (∆16 µmol/L, p = 0.03), α-carotene (∆0.14 nmol/L, p < 0.001) and β-carotene (∆0.51 nmol/L, p = 0.001) at baseline compared to controls. Urine and blood biomarkers of oxidative stress and antioxidant levels showed similar response to vigorous exercise in the SCI and control group.

Conclusions: SCI participants showed similar changes in redox status during high intensity exercise compared to matched able-bodied. SCI participants had lower levels of exogen antioxidants both before, during and after vigorous exercise.

研究设计背景:干预试验:关于高强度运动对 SCI 患者可能带来的健康益处和风险,目前尚无明确的文献资料。氧化应激水平升高可能会影响他们进行高强度运动的能力。我们研究了慢性 SCI 患者在休息时、剧烈运动期间和运动后氧化应激和抗氧化防御的几种生物标志物:地点:挪威桑纳斯康复医院:六名慢性 SCI 患者(五名男性)(AIS A,受伤级别为胸椎 2-8,伤后超过一年)和六名匹配的健全对照组患者进行了两次最大臂力曲柄运动测试,两次测试之间间隔一至三天。在第二次运动测试中,参与者在达到最大努力之前,进行了三次四分钟的高强度臂力曲柄运动(心率峰值的 85-95%)。在第二次运动测试当天的六个时间点收集了血液和尿液中氧化应激和抗氧化剂水平的生物标志物;基线、高强度运动时、最大努力时、运动后5分钟、30分钟和60分钟以及运动后24小时:与匹配的健全人相比,SCI 参与者在高强度运动中显示出相似的氧化还原状态变化。在剧烈运动前、运动中和运动后,SCI 参与者的外源性抗氧化剂水平都较低。
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引用次数: 0
Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report. 自发生物反馈训练改善了一名颈部运动性完全脊髓损伤患者的自律神经反应--病例报告。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-12 DOI: 10.1038/s41394-023-00593-3
Rachel D Torres, Hani Rashed, Prateek Mathur, Camilo Castillo, Thomas Abell, Daniela G L Terson de Paleville

Study design: Single-subject case design OBJECTIVE: To evaluate the Autogenic Feedback Training Exercise (AFTE) on autonomic nervous system responses.

Introduction: AFTE combines specific autogenic exercises with biofeedback of multiple physiological responses. Originally developed by the National Aeronautics and Space Administration (NASA), AFTE is used to improve post-flight orthostatic intolerance and motion sickness in astronauts. Individuals with cervical or upper thoracic spinal cord injury (SCI) often present symptoms of autonomic dysfunction similar to astronauts. We hypothesize that AFTE challenges nervous system baroreflex, gastric and vascular responses often impaired after SCI.

Methods: Using a modified AFTE protocol, we trained a hypotensive female participant with cervical motor complete (C5/6-AIS A) SCI, and a male non-injured control participant (NI) and measured blood pressure (BP), heart rate (HR), gastric electrical activity, and microvascular blood volume before, during and after AFTE. The participants were instructed to complete breathing and imagery exercises to help facilitate relaxation. Subsequently, they were instructed to use stressful imagery and breathing exercises during arousal trials.

Results: Both participants completed 8 sessions of approximately 45 min each. Microvascular blood volume decreased 23% (SCI) and 54% (NI) from the beginning to the end of the stimulation cycles. The participant with SCI became progressively more normotensive and improved levels of gastric electrical activity, while the NI participant's changes in HR, gastric electrical activity, and BP were negligible.

Conclusions: AFTE may offer a novel non-pharmacologic intervention to minimize symptoms of dysautonomia in people with SCI.

研究设计:目标:评估自体反馈训练(AFTE)对自律神经系统反应的影响:自体反馈训练结合了特定的自体运动和多种生理反应的生物反馈。AFTE 最初由美国国家航空航天局(NASA)开发,用于改善宇航员飞行后的直立性不耐受和晕动病。颈椎或上胸椎脊髓损伤(SCI)患者通常会出现与宇航员类似的自主神经功能紊乱症状。我们假设,AFTE 可挑战神经系统的气压反射、胃和血管反应,而这些反应在 SCI 后往往会受损:我们使用修改后的 AFTE 方案,对一名患有颈部运动完全性(C5/6-AIS A)SCI 的低血压女性参与者和一名未受伤的男性对照参与者(NI)进行了训练,并在 AFTE 之前、期间和之后测量了血压(BP)、心率(HR)、胃电活动和微血管血容量。参与者在指导下完成呼吸和想象练习,以帮助放松。随后,他们被要求在唤醒试验中使用压力想象和呼吸练习:结果:两名参与者都完成了 8 次训练,每次约 45 分钟。从刺激周期开始到结束,微血管血容量分别下降了 23%(SCI)和 54%(NI)。SCI 参与者的血压逐渐趋于正常,胃电活动水平也有所提高,而 NI 参与者的心率、胃电活动和血压变化微乎其微:AFTE可能是一种新型的非药物干预方法,可最大程度地减轻SCI患者的自律神经失调症状。
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引用次数: 0
First report of lumbar spinal epidural hematoma after pelvic ring fracture. 首次报告骨盆环骨折后出现腰椎硬膜外血肿。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-11 DOI: 10.1038/s41394-023-00589-z
Moritz Wagner, Tino Riegger, Alexander Brunner, Dietmar Dammerer, Benjamin Ulmar, Hedye Aliabadi

Introduction: Spinal epidural hematoma is a rare condition that most commonly occurs as a complication of spinal surgery. For patients with neurological deficits, surgical decompression can generally provide good outcome.

Case: A 56-year-old, otherwise healthy, patient was admitted to the orthopedic emergency department with a pelvic ring fracture. Over the course of 4 days, a lumbar spinal epidural hematoma developed, with the patient complaining of pain radiating to the S1 dermatome and saddle paresthesia. The hematoma was surgically decompressed, and the patient had a complete recovery.

Discussion: To our knowledge, this is the first report of a spinal epidural hematoma after pelvic ring fracture. The etiology of spinal epidural hematoma is diverse, but it is most frequently observed after spinal surgery. It has rarely been observed after lumbar spinal fractures, nearly exclusively in patients with ankylosing spondylitis.

Conclusion: Pelvic ring fracture might result in spinal epidural hematoma. The presence of neurological deficits after such fractures is an indication for lumbosacral MRI. Surgical decompression will generally resolve the neurological symptoms.

简介脊柱硬膜外血肿是一种罕见病,最常见于脊柱手术并发症。对于有神经功能缺损的患者,手术减压通常可以取得良好的疗效:病例:一名 56 岁、身体健康的患者因骨盆环形骨折被送入骨科急诊室。4 天后,患者出现腰椎硬膜外血肿,主诉疼痛放射至 S1 皮节,并伴有鞍部麻痹。经过手术对血肿进行减压,患者完全康复:据我们所知,这是第一例骨盆环骨折后脊柱硬膜外血肿的报告。脊柱硬膜外血肿的病因多种多样,但最常见于脊柱手术后。腰椎骨折后很少出现这种情况,几乎只出现在强直性脊柱炎患者身上:结论:骨盆环骨折可能导致脊柱硬膜外血肿。结论:骨盆环骨折可能导致脊髓硬膜外血肿,此类骨折后出现神经功能缺损是腰骶部磁共振成像的适应症。手术减压一般可缓解神经症状。
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引用次数: 0
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Spinal Cord Series and Cases
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