Reabilitação da bexiga neurogênica: métodos de manejo, complicações urológicas, estilo de vida e satisfação pessoal em pessoas com lesão medular / Neurogenic bladder rehabilitation: management methods, urological complications, lifestyle and personal satisfaction in people with spinal cord injury

Os danos neurológicos após a lesao medular (LM) são responsáveis por alterações nas funções de armazenamento de urina e da micção, as quais representam a causa mais frequente de reinternações hospitalares e prejuízo da qualidade de vida (QV). No Brasil estudos sobre essa temática ainda são incipientes. Diante disso, o objetivo deste estudo foi analisar os métodos de manejo da bexiga neurogênica e sua relação com as complicações urológicas de incontinência urinária (IU) e infecção de trato urinário (ITU), estilo de vida e satisfação pessoal em brasileiros com LM. Tratou-se de um estudo quantitativo, exploratório, analítico e de corte transversal, com 290 adultos, cadastrados em um banco de dados do Núcleo de Pesquisa e Atenção em Reabilitação Neuropsicomotora (NeuroRehab) para participação voluntária em pesquisas em LM. Os dados foram coletados com o instrumento validado, índice de tratamento do intestino e da bexiga (BBTI), por meio de entrevista telefônica. A maioria eram homens (70,0%), jovens, com média de idade de 41,02 anos (DP=10,43), beneficiários da previdência social (58,6%), com renda familiar entre 1 e três salários mínimos, com LM no nível torácico (62,8%), predominante traumática (77,6%), e causada por acidentes de trânsito (44,1%). A principal forma de esvaziamento da bexiga foi o cateterismo intermitente limpo (CIL) (74,1%). A satisfação com a rotina de manejo vesical (p = 0,0261), flexibilidade com a rotina (p = 0,007), e menor impacto na qualidade de vida (p ≤ 0,001) estavam relacionados ao esvaziamento vesical por micção normal, assim como uma melhor adaptação para trabalho fora de casa (p < 0,001), a realização de atividades do dia a dia (p ≤0,001) e uma menor interferência na vida social(p = 0,001). Entre os que realizavam o CIL, o método exigiu uma adaptação na rotina (p = 0,014), maior impossibilidade para trabalhar fora de casa (p = 0,004) e ser visto como um problema (p=0,014). Por outro lado, quando é realizado pelo próprio indivíduo (autocateterismo) essas associações não ocorreram (p=0,064). Mais da metade dos participantes relataram episódios de IU (55,6%) e de ITU (58,6%). O manejo com o uso do estímulo do reflexo da bexiga foi associado à IU (p=0,046).A IU alterou negativamente a satisfação com a rotina (p≤0,001), a eficácia do manejo vesical (p≤0,001), a QV (p=0,008), os relacionamentos pessoais (p=0,001), sociais(p=0,002), e as atividades laborais(p≤0,001). Houve associação entre o CIL com maiores episódios de ITU (p=0,001), enquanto a micção normal (p≤0,001) e compressão da bexiga (p=0,029) com menores episódios de ITU. A ITU apresentou impacto negativo em todas as variáveis que avaliaram a satisfação e o estilo de vida, como QV (p=0,040), satisfação com sua rotina (p=0,008), atividades laborais (p=0,012), sair de casa (p=0,030) e relacionamento social (p=0,005). Os dados apresentados neste estudo mostram os desafios das pessoas com LM no manejo vesical e podem indicar a demanda do contínuo desenvolvimento do tratamento da bexiga neurogênica. Nessa direção, são necessários mais estudos que busquem alternativas que considerem tanto a preservação do trato urinário quanto as questões pessoais do manejo vesical após a LM

Neurological damage caused to spinal cord injury (SCI) is responsible for changes in the functions of urine storage and urination, which represent the most frequent cause of hospital readmissions and impaired quality of life (QOL).In Brazil, studies on life satisfaction and urinary complications related to forms of bladder emptying are still incipient. Therefore, interest in studying issues related to the method of bladder management, its relationship with urinary complications of urinary incontinence (UI) and Urinary Tract Infection (UTI) and with satisfaction and lifestyle. This was a quantitative, exploratory, analytical and cross-sectional study, with 290 adults, registered in a database of the Center for Research and Care in Neuropsychomotor Rehabilitation (NeuroRehab) for voluntary participation in research in SCI. The sociodemographic data, SCI and bladder characterization from the Bowel and Bladder Treatment Index (BBTI) were collected through telephone interviews. Most participants were male(70,0%), young, with an average age of 41.02 years (SD=10,43), social security beneficiaries(58,6%), with low family income (between one and three minimum wages), with predominantly traumatic SCI (77,6%) at the thoracic level (62,8%) and of main cause traffic accidents (44,1%). Most participants used clean intermittent catheterization (CIC) as the main way to empty the bladder (74,1%). Satisfaction with the bladder management routine (p = 0,0261), flexibility with the routine (p = 0,007) and less impact on quality of life (p < 0,001) were related to bladder emptying by normal urination, as well as better adaptation to working outside the home (p < 0,001), performing daily activities (p < 0,001) and a less interference in social life (p = 0,001). Participants who performed the CIC evaluated that the method requires an adaptation in the routine, brings greater impossibility to work outside the home (p = 0,014) and is seen as a problem (p =0,014). On the other hand, when it is performed by the individual, these associations did not occur (p=0,064). More than half of the participants reported episodes of UI (55,6%) and UTI (58,6%). Management using bladder reflex stimulation was associated with UI IU (p=0,046). Incontinence negatively changed satisfaction with routine (p<0,001), effectiveness of bladder management (p<0,001), QOL(p=0,008), personal (p=0,001), and social relationships (p=0,002) and work activities (p<0,001). Regarding UTI, there was an association between CIC with more episodes of UTI (p=0,001) and normal urination (p<0,001) and bladder compression(p=0,029) with fewer episodes, with UTI having a negative impact on all variables that assessed satisfaction and lifestyle. The data presented in this study show the challenges faced by people with SCI in bladder management and may indicate the demand for the continued development of the treatment of neurogenic bladder. In this sense, further studies are needed that seek alternatives that consider both the preservation of the urinary tract and personal issues in bladder management after SCI.

Acesso e acessibilidade ao rastreamento de câncer em mulheres brasileiras com lesão medular / Acceso y accesibilidad al rastreo de cáncer en mujeres brasileñas con lesión medular / Access and accessibility to cancer screening for Brazilian women with spinal cord injury

Resumo Objetivo identificar e analisar a acessibilidade e o acesso de mulheres brasileiras com lesão medular para a realização de exames preventivos do câncer de mama e colo de útero. Método estudo quantitativo e transversal desenvolvido em plataforma virtual. Realizadas análises estatísticas descritivas e de associação entre as variáveis qualitativas por meio do teste exato de Fisher. Quando identificada a associação (p<0,05), foi realizada a regressão logística. Resultados participaram 120 mulheres brasileiras com lesão medular com idades entre 25 e 67 anos; 85,83% foram ao ginecologista após a lesão medular, 79,17% realizaram a citologia e 52,50%, a mamografia. Observou-se que as mulheres que utilizavam a saúde suplementar apresentaram maior probabilidade de terem ido ao ginecologista do que as usuárias do serviço público. Aquelas com companheiro e as de maior idade apresentaram maior probabilidade de terem realizado o exame de citologia. Para a mamografia, aquelas de maior idade e que utilizavam a saúde suplementar apresentaram maiores chances de terem realizado o exame de mamografia após a lesão medular. Conclusão mulheres com lesão medular buscam a realização de exames de rastreamento. Entretanto, encontram dificuldades relacionadas à estrutura física, aos equipamentos, transporte, profissionais da saúde, assim como dificuldades sociodemográficas e quanto ao serviço de saúde utilizado.

Resumen Objetivo este estudio tuvo como objetivo identificar y analizar la accesibilidad y el acceso de mujeres brasileñas con lesión medular para la realización de exámenes preventivos de cáncer de mama y de cuello uterino. Método se desarrolló un estudio cuantitativo y transversal, realizado en un entorno virtual. Los análisis estadísticos descriptivos y la asociación entre variables cualitativas se realizaron mediante la prueba exacta de Fisher, cuando se identificó una asociación se realizó una regresión logística. Resultados participaron 120 mujeres brasileñas con lesión medular, la edad de las participantes varió de 25 a 67 años. Con relación al rastreo, el 85,83% de las mujeres acudió al ginecólogo tras la LM, el 79,17% se sometió a citología y el 52,50% a mamografía. Se observó que las mujeres que utilizaban un seguro médico privado tenían más probabilidades de haber visto a un ginecólogo que las usuarias del servicio público. Las que tenían pareja y mayores tenían más probabilidades de someterse a citología oncótica. Para la mamografía, las que eran mayores y que usaban un seguro médico privado tenían más probabilidades de someterse al examen después de la LM. Conclusión las mujeres con LM buscan pruebas de detección. Sin embargo, enfrentan dificultades relacionadas con la estructura física, equipamientos, transporte, profesionales de la salud, así como dificultades sociodemográficas relacionadas con el tipo de servicio de salud utilizado.

Abstract Objective to identify and analyze the accessibility and accessibility of Brazilian women with spinal cord injury to preventive examinations for breast and cervical cancer. Method quantitative and cross-sectional study developed in a virtual platform. Descriptive statistical analysis was performed, as well as association analysis between qualitative variables using Fisher's exact test. When identified the association (p<0.05), logistic regression was performed. Results a total of 120 Brazilian women with spinal cord injury, aged between 25 and 67 years participated in the study; 85.83% visited a gynecologist after the spinal cord injury, 79.17% underwent cytology and 52.50% underwent mammography. It was observed that women who used the supplementary health plan were more likely to have visited a gynecologist than those who used the public service. Those who had a partner and were older were more likely to have undergone the cytology exam. For mammography, those who were older and who used supplementary health care were more likely to have had mammography exams after the spinal cord injury. Conclusion women with spinal cord injury seek screening tests. However, they encounter difficulties related to the physical structure, equipment, transportation, health professionals, as well as socio-demographic difficulties and difficulties regarding the health service used.

Intramedullary injury combined with osteoporosis therapeutics regulates targeted local osteogenesis.

Bone marrow ablation prompts transient bone formation in nearly the entire medullary cavity before marrow regeneration occurs. Here, we establish a procedure to direct bone formation in a desired particular site within the medullary cavity for support of biomedical devices. Local intramedullary injury was performed in the tibiae of rats and parathyroid hormone (PTH), alendronate, or saline was administered. Newly generated bone in the medulla was assessed by micro-CT and histology. To evaluate the function of newly generated bone, animals received intramedullary injury in tibiae followed by daily PTH. At day-14, implants were placed in the endocortical bone and the bone response to the implants was assessed. The fate of newly generated bone was compared with and without implants. We found that neither intramedullary injury nor medication alone resulted in bone formation. However, when combined, substantial bone was generated locally inside the diaphyseal medulla. Newly formed bone disappeared without implant placement but was retained with implants. Bone was especially retained around and between the implants. This study found that local bone marrow disruption followed by PTH or alendronate generated substantial cancellous bone locally in the diaphyseal medulla. This approach offers promise as a tissue engineering tool in medicine and dentistry.

Produção científica dos cuidados de enfermagem ao paciente com traumatismo da medula espinhal: uma análise bibliométrica / Scientific production of patient nursing care spinal cord injury: a bibliometric analysis / Producción científica del cuidado de enfermería del paciente lesión de la médula espinal: un análisis bibliométrico

Objetivo: Descrever a distribuição da produção científica dos cuidados de enfermagem ao paciente com traumatismo da medula espinhal e verificar quais as temáticas mais abordadas. Método: Análise bibliométrica através da Lei de Bradford, Lei de Zipf e estatística textual realizada com publicações em português, inglês e espanhol, no período de 1978 a 2018. Resultados: Amostra composta por 33 artigos distribuídos em 13 periódicos, sendo a maioria originais e de abordagem quantitativa. O Brasil publicou o maior número de artigos, apresentando a terceira colocação dos periódicos no núcleo de Bradford. Foi identificado um valor médio do multiplicador de Bradford (XmB) = 2,1. Os termos com maior semântica foram: lesão medular, paciente, enfermagem, enfermeiro e cuidado. Conclusão: Os indicadores bibliométricos demonstraram uma produção científica com pouca produtividade, porém com tendência a crescimento nas últimas décadas. Novos estudos acerca da temática são necessários para aprimorar o cuidado ofertado ao paciente com lesão medular

Objective: To describe the distribution of scientific production of nursing care to patients with spinal cord trauma and to verify which themes are most addressed. Method: Bibliometric analysis through the Bradford Law, Zipf Law and textual statistics made with publications in Portuguese, English and Spanish, from 1978 to 2018. Results: Sample composed of 33 articles distributed in 13 journals, most of them original and of quantitative approach. Brazil has published the largest number of articles, presenting the third position of the journals in the Bradford nucleus. An average Bradford multiplier value (XmB) = 2.1 was identified. The terms with the highest semantics were: spinal cord injury, patient, nursing, nurse and care. Conclusion: The bibliometric indicators showed a scientific production with low productivity, but with a tendency to growth in the last decades. Further studies on the subject are needed to improve the care offered to patients with spinal cord injury

Objetivo: Describir la distribución de la producción científica de cuidados de enfermería a pacientes con trauma de la médula espinal y verificar qué temas se abordan más. Método: Análisis bibliométrico a través de la Ley Bradford, la Ley Zipf y estadísticas textuales realizadas con publicaciones en portugués, inglés y español, de 1978 a 2018. Resultados: Muestra compuesta por 33 artículos distribuidos en 13 revistas, la mayoría originales y de enfoque cuantitativo. Brasil ha publicado la mayor cantidad de artículos, presentando la tercera posición de las revistas en el núcleo de Bradford. Se identificó un valor multiplicador promedio de Bradford (XmB) = 2.1. Los términos con la semántica más alta fueron: lesión de la médula espinal, paciente, enfermería, enfermera y atención. Conclusión: Los indicadores bibliométricos mostraron una producción científica con baja productividad, pero con tendencia al crecimiento en las últimas décadas. Se necesitan más estudios sobre el tema para mejorar la atención ofrecida a los pacientes con lesión de la médula espinal

Single-Dose Administration of Recombinant Human Thrombopoietin Mitigates Total Body Irradiation-Induced Hematopoietic System Injury in Mice and Nonhuman Primates.

PURPOSE: Recombinant human thrombopoietin (rhTPO) has been evaluated as a therapeutic intervention for radiation-induced myelosuppression. However, the immunogenicity induced by a repeated-dosing strategy raises concerns about the therapeutic use of rhTPO. In this study, single-dose administration of rhTPO was evaluated for efficacy in the hematopoietic response and survival effect on mice and nonhuman primates exposed to total body irradiation (TBI). METHODS AND MATERIALS: Survival of lethally (9.0 Gy) irradiated C57BL/6J male mice was observed for 30 days after irradiation. Hematologic evaluations were performed on C57BL/6J male mice given a sublethal dose of radiation (6.5 Gy). Furthermore, in sublethally irradiated mice, we performed bone marrow (BM) histologic evaluation and evaluated BM-derived clonogenic activity. Next, the proportion and number of hematopoietic stem cells (HSCs) were analyzed. Competitive repopulation experiments were conducted to assess the multilineage engraftment of irradiated HSCs after BM transplantation. Flow cytometry was used to evaluate DNA damage, cell apoptosis, and cell cycle stage in HSCs after irradiation. Finally, we evaluated the efficacy of a single dose of rhTPO administered after 7 Gy TBI in male and female rhesus monkeys. RESULTS: A single administration of rhTPO 2 hours after irradiation significantly mitigated TBI-induced death in mice. rhTPO promoted multilineage hematopoietic recovery, increasing peripheral blood cell counts, BM cellularity, and BM colony-forming ability. rhTPO administration led to an accelerated recovery of BM HSC frequency and multilineage engraftment after transplantation. rhTPO treatment reduced radiation-induced DNA damage and apoptosis and promoted HSC proliferation after TBI. Notably, a single administration of rhTPO significantly promoted multilineage hematopoietic recovery and improved survival in nonhuman primates after TBI. CONCLUSIONS: These findings indicate that early intervention with a single administration of rhTPO may represent a promising and effective radiomitigative strategy for victims of radiation disasters.

Diagnostic accuracy of dual-energy CT for detection of bone marrow lesions in the subacutely injured knee with MRI as reference method.

BACKGROUND: Dual-energy computer tomography (DECT) can detect post-traumatic bone marrow lesions. Prospective studies of the knee with large numbers of participants and intra-observer agreement assessment are limited. PURPOSE: To investigate the diagnostic accuracy of DECT in detecting bone marrow lesions as well as estimating the bone marrow lesion volume in patients with suspected anterior cruciate ligament trauma with magnetic resonance imaging (MRI) as reference standard. MATERIAL AND METHODS: Forty-eight consecutive patients with suspected anterior cruciate ligament injury were imaged bilaterally with DECT within a mean of 25 days (range 4-55 days) following injury and MRI within seven days of DECT. Two readers analyzed DECT virtual non-calcium-blinded images. Consensus MRI was reference standard. Intra- and inter-observer agreement were determined using weighted kappa statistics. Sensitivity, specificity, and negative and positive predictive values were calculated. Bone marrow lesion volumes were measured; for comparison, intra-class correlation coefficient was used. RESULTS: The 48 patients (26 men, 22 women; mean age 23 years, age range 15-37 years) were imaged bilaterally yielding 52 knees with bone marrow lesions, of which 44 were in the femur and 41 were in the tibia. Intra- and inter-observer agreement to detect bone marrow lesions was moderate and fair to moderate (κ 0.54-0.66, 95% confidence interval [CI] 0.39-0.80 and 0.37-0.41, 95% CI 0.20-0.57) and overall sensitivity and specificity were 70.1% and 69.1%, respectively. Positive and negative predictive values were 72.9% and 66.1%, respectively. Bone marrow lesion volumes showed excellent intra- and inter-observer agreement (0.83-0.91, 95% CI 0.74-0.94 and 0.76-0.78, 95% CI 0.57-0.87). CONCLUSION: The diagnostic performance of DECT to detect bone marrow lesions in the subacutely injured knee was moderate with intra- and inter-observer agreement ranging from moderate to substantial and fair to moderate. Bone marrow lesion volume correlation was excellent.

Longitudinal Effects of Acute Anterior Cruciate Ligament Tears on Peri-Articular Bone in Human Knees Within the First Year of Injury.

Anterior cruciate ligament (ACL) tears are common sports-related knee injuries that increase the risk of developing post-traumatic osteoarthritis. ACL tears are rarely an isolated injury but are often associated with traumatic bone marrow lesions (BMLs). While early loss of bone mass following the ACL injury has been previously described, to date, microarchitectural information has not been reported due to the limited resolution of clinical imaging systems. In this study, we provide the first evidence of detailed bone mass and microarchitectural changes in the first 10 months following an acute ACL tear, and localized to traumatic BMLs. Fifteen participants with an acute unilateral ACL tear were assessed at four-time points using dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography, and traumatic BMLs were identified with magnetic resonance imaging. Loss of bone mass was localized to the injured knee (-4.6% to -15.8%, depending on bone and depth) and was accelerated immediately following the injury before suggesting a recovery phase. This loss of bone was accelerated even greater in traumatic BMLs (-18.2% to -20.6%, depending on bone). Bone loss was accompanied by microstructural degeneration of trabecular bone. For example, in the lateral femur of the injured knee, the subchondral bone plate decreased in thickness (-9.0%). This study confirmed loss of bone mass in the months following ACL tears and described the underlying bone microstructural changes. The presented bone changes were accelerated in regions of traumatic BMLs. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2325-2336, 2019.

Síndrome hemofagocítico / The hemophagocytic syndrome

Antecedentes. El síndrome hemofagocítico (SH) es un síndrome de activación inmune patológica, infrecuente, subdiag-nosticada, su importancia radica en su gravedad, pues son cuadros muy agresivos que evolucionan en poco tiempo de forma fulmi-nante, con un fallo multiorgánico letal, antes de establecer un diagnóstico. Se encuentran en todos los grupos de edad, pero en gen-eral es más frecuente en los niños. Esta revisión se realizó con el propósito de conocer más a profundidad esta patología, identificar el padecimiento oportunamente y así mismo administrar el tratamiento temprano y adecuado para mejorar la supervivencia del paciente. Métodos: La búsqueda exhaustiva de artículos con menos de 10 años de publicación en las bases de datos PubMed, Scielo, Elsevier, Scribd, Medigraphic. Desarrollo y Conclusiones: Aunque el SH es de difícil identificación por los síntomas tan inespecíficos, si se diagnostica y trata en el momento oportuno, dada su elevada morbimortalidad se lograra salvar muchas vidas...(AU)

Skull bone marrow injury caused by MR-guided focused ultrasound for cerebral functional procedures.

OBJECTIVE: One patient for whom an MR-guided focused ultrasound (MRgFUS) pallidotomy was attempted was discovered to have multiple new skull lesions with the appearance of infarcts on the MRI scan 3 months after his attempted treatment. The authors conducted a retrospective review of the first 30 patients treated with MRgFUS to determine the incidence of skull lesions in patients undergoing these procedures and to consider possible causes. METHODS: A retrospective review of the MRI scans of the first 30 patients, 1 attempted pallidotomy and 29 ventral intermediate nucleus thalamotomies, was conducted. The correlation of the mean skull density ratio (SDR) and the maximum energy applied in the production or attempted production of a brain lesion was examined. RESULTS: Of 30 patients treated with MRgFUS for movement disorders, 7 were found to have new skull lesions that were not present prior to treatment and not visible on the posttreatment day 1 MRI scan. Discomfort was reported at the time of treatment by some patients with and without skull lesions. All patients with skull lesions were completely asymptomatic. There was no correlation between the mean SDR and the presence or absence of skull lesions, but the maximum energy applied with the Exablate system was significantly greater in patients with skull lesions than in those without. CONCLUSIONS: It is known that local skull density, thickness, and SDR vary from location to location. Sufficient energy transfer resulting in local heating sufficient to produce a bone lesion may occur in regions of low SDR. A correlation of lesion location and local skull properties should be made in future studies.

Percutaneous Spinal Ablation in a Sheep Model: Protective Capacity of an Intact Cortex, Correlation of Ablation Parameters with Ablation Zone Size, and Correlation of Postablation MRI and Pathologic Findings.

BACKGROUND AND PURPOSE: Despite the growing use of percutaneous ablation therapy for the treatment of metastatic spine disease, several issues have yet to be fully addressed. Our aims were to determine whether the vertebral body cortex protects against ablation-induced spinal cord injury; correlate radiofrequency, cryo-, and microwave ablation parameters with resulting spinal ablation zone dimensions and describe normal spinal marrow postablation changes on MR imaging. MATERIALS AND METHODS: Ten thoracolumbar vertebrae in 3 sheep were treated with radiofrequency ablation, cryoablation, or microwave ablation under fluoroscopic guidance. Technique parameters were chosen to produce ablation zones that exceeded the volume of the vertebral bodies in sheep 1 and were confined to the vertebrae in sheep 2 and 3. Expected ablation zone dimensions were based on data provided by the device manufacturers. Postablation MR imaging was performed at 48 hours (sheep 1) or 7 days (sheep 2 and 3). RESULTS: In sheep 1, cryoablation and microwave ablations extended into the spinal canal and caused histologically confirmed neurologic injury, but radiofrequency ablation did not. The mean difference between the lengths of the radiofrequency ablation zone dimensions measured on gross pathology compared with those expected was 9.6 ± 4.1 mm. The gross pathologic cryo- and microwave ablation zone dimensions were within 1 mm of those expected. All modalities produced a nonenhancing ablation zone with a rim of enhancement, corresponding histologically to marrow necrosis and hemorrhagic congestion. CONCLUSIONS: An intact cortex appears to protect against radiofrequency ablation-induced spinal cord injury, but not against non-impedance-based modalities. Ablation dimensions produced by microwave and cryoablation are similar to those expected, while radiofrequency ablation dimensions are smaller. Ablation of normal marrow produces a rim of enhancement at the margin of the ablation zone on MR imaging.

A method to establish a mouse model of bone marrow microenvironment injury.

A normal bone marrow microenvironment plays a very important role in the normal functioning of hematopoietic stem cells. Once disturbed, this microenvironment can become favorable for the occurrence of blood disorders, cancers, and other diseases. Therefore, further studies on the bone marrow microenvironment should be performed to reveal regulatory and stem cell fate determination mechanisms and promote the development of bone marrow transplantation, tissue repair and regenerative medicine, and other fields. A small animal model for further research is also urgently needed. In this study, an electric shock device was designed to elicit a femur bone marrow microenvironment injury in mice. A wire was inserted into the distal femur but not into the proximal femur, and the bone marrow microenvironment was evidently damaged by application of 100 ± 10 V for 1.5 ± 0.5 min ; mortality, however, was low in the mice. Gross observation, hematoxylin and eosin staining, immunohistochemistry, bright-field microscopy, and micro-CT scanning were also conducted. A large number of new blood capillaries and sinusoids appeared in the injured distal femur after 2 weeks. The capillaries in the injured femur disappeared after 4 weeks, and mature blood vessels were scattered throughout the injured area. Red blood cells disappeared, and the cellular structure and trabecular bone were better than those observed 2 weeks previously. Thus, we developed a simply operated, accurate, reliable, and easily controlled small animal model as a good technical platform to examine angiogenesis and segmentation damage in the bone marrow microenvironment.

Imaging Radiation-Induced Gastrointestinal, Bone Marrow Injury and Recovery Kinetics Using 18F-FDG PET.

Positron emission tomography using 18F-Fluro-deoxy-glucose (18F-FDG) is a useful tool to detect regions of inflammation in patients. We utilized this imaging technique to investigate the kinetics of gastrointestinal recovery after radiation exposure and the role of bone marrow in the recovery process. Male Sprague-Dawley rats were either sham irradiated, irradiated with their upper half body shielded (UHBS) at a dose of 7.5 Gy, or whole body irradiated (WBI) with 4 or 7.5 Gy. Animals were imaged using 18F-FDG PET/CT at 5, 10 and 35 days post-radiation exposure. The gastrointestinal tract and bone marrow were analyzed for 18F-FDG uptake. Tissue was collected at all-time points for histological analysis. Following 7.5 Gy irradiation, there was a significant increase in inflammation in the gastrointestinal tract as indicated by the significantly higher 18F-FDG uptake compared to sham. UHBS animals had a significantly higher activity compared to 7.5 Gy WBI at 5 days post-exposure. Animals that received 4 Gy WBI did not show any significant increase in uptake compared to sham. Analysis of the bone marrow showed a significant decrease of uptake in the 7.5 Gy animals 5 days post-irradiation, albeit not observed in the 4 Gy group. Interestingly, as the metabolic activity of the gastrointestinal tract returned to sham levels in UHBS animals it was accompanied by an increase in metabolic activity in the bone marrow. At 35 days post-exposure both gastrointestinal tract and bone marrow 18F-FDG uptake returned to sham levels. 18F-FDG imaging is a tool that can be used to study the inflammatory response of the gastrointestinal tract and changes in bone marrow metabolism caused by radiation exposure. The recovery of the gastrointestinal tract coincides with an increase in bone marrow metabolism in partially shielded animals. These findings further demonstrate the relationship between the gastrointestinal syndrome and bone marrow recovery, and that this interaction can be studied using non-invasive imaging modalities.

Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries.

OBJECTIVES: To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature. METHOD: Retrospective study including 220 patients with traumatic knee injuries. Knee MRIs were evaluated for trauma mechanism, soft tissue injury, and the location of bone marrow abnormalities. The locations of the abnormalities were correlated with trauma mechanisms and soft tissue injuries using the chi-square test with Bonferroni correction. RESULTS: One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur. CONCLUSIONS: Our study provides evidence of associations between traumatic bone marrow abnormality patterns and different trauma mechanisms in acute knee injury, and reveals some overlap, especially of the two most common trauma mechanisms (valgus and pivot shift), in a large patient cohort. KEY POINTS: • Specific bone marrow oedema patterns after knee trauma were confirmed. • New associations between bone marrow oedema patterns and knee trauma were shown. • Bone marrow oedema patterns help in identifying associated soft tissue injuries.

The role of subchondral bone damage in post-traumatic osteoarthritis.

Osteoarthritis (OA), the most common musculoskeletal disease in the United States, is characterized by cartilage breakdown, pain, and restricted movement. Post-traumatic OA (PTOA) occurs subsequent to traumatic joint injury, such as anterior cruciate ligament (ACL) rupture, and makes up 12% of the overall disease burden, with healthcare costs of approximately $3 billion/year. The current paradigm for PTOA is based on the observation that joint injury affects multiple tissues, all of which may contribute to subsequent joint failure. Subchondral bone plays a significant role in PTOA, as shown by magnetic resonance imaging evidence that subchondral bone marrow lesions (BMLs) are present in 80% of ACL rupture cases immediately after joint injury. The presence of BMLs indicates an acute consequence of injury, specifically in subchondral bone, which could be targeted with preventative therapy. BMLs may be a direct representation of physical damage to bone tissue. Interestingly, microdamage is known to induce osteoclast-mediated remodeling in bone. Furthermore, the contiguous link between subchondral bone and articular cartilage may allow transport of small molecules, resulting from these remodeling processes, to cross the osteochondral junction and contribute to PTOA development. Targeting subchondral bone by inhibiting subchondral remodeling, particularly in the early phase postinjury, may be a potential approach for preventing PTOA.

Diretrizes de atenção à pessoa com lesão medular / Care guidelines for the person with spinal cord injury / Directrices para la atención a la persona con lesión medular

Chamamos de lesão medular toda injúria às estruturas contidasno canal medular (medula, cone medular e cauda equina), podendolevar a alterações motoras, sensitivas, autonômicas e psicoafetivas.Estas alterações se manifestarão principalmente como paralisiaou paresia dos membros, alteração de tônus muscular, alteração dosreflexos superficiais e profundos, alteração ou perda das diferentessensibilidades (tátil, dolorosa, de pressão, vibratória e proprioceptiva),perda de controle esfincteriano, disfunção sexual e alteraçõesautonômicas como vasoplegia, alteração de sudorese, controle detemperatura corporal entre outras.O cuidado ao paciente com Lesão Medular inclui um conjuntode ações que se inicia no primeiro atendimento e continua até asua reintegração social. Por isso, toda a equipe de atendimento deveestar envolvida desde a fase aguda em ações que permitam, no futuro,a inclusão social e econômica do paciente com sequela de lesãoraquimedular. Este processo deve ser desenvolvido pelo atendimentosimultâneo e integrado de diversos profissionais de saúde...

[Effects and mechanism of iron overload on hematopoiesis in mice with bone marrow injury].

OBJECTIVE: To explore effects of iron overload on hematopoiesis in mice with bone marrow injury and its possible mechanism (s). METHODS: C57BL/6 mice were divided into control, iron, irradiation, irradiation+iron groups. The iron-overloaded model of bone marrow injury was set up after mice were exposed to the dose of 4 Gy total body irradiation and (or) were injected iron dextran intraperitoneally. Iron overload was confirmed by observing iron deposits in mice and bone marrow labile iron pool. Additionally, the number of peripheral blood and bone marrow mononuclear cells and the frequency of erythroid cells and myeloid cells were counted and hematopoietic function was assessed. RESULTS: (1)Iron overload occurred by bone marrow biopsy and flow cytometry analysis. (2)Compared with control group, the number of platelets [(801.9±81.2)×109/L vs (926.0±28.2)×109/L] and BMMNC and the frequency of erythroid cells and myeloid cells decreased. Moreover, hematopoietic colony forming units and single-cell cloning counts decreased significantly in irradiation group (P<0.05). (3)Compared with irradiation group, the number of platelets [(619.0±60.9)×109/L vs (801.9±81.2)×109/L] and the frequency of erythroid cells and myeloid cells decreased; moreover, hematopoietic colony forming units and single-cell cloning counts decreased significantly in irradiation+iron group (P<0.05). (4)Compared with irradiation group, ROS level increased by 1.94 fold in BMMNC, 1.93 fold in erythroid cells and 2.70 fold in myeloid cells, respectively (P<0.05). CONCLUSION: The dose of 4 Gy total body irradiation caused bone marrow damage and iron overload based on this injury model, which could damage bone marrow hematopoietic function aggravatingly. And further study found that iron overload was closely related to increased ROS level in BMMNC. The findings would be helpful to further study the injury mechanism of iron overload on the hematopoiesis of bone marrow.

Aspectos preventivos e reabilitacionais das complicações decorrentes da lesão medular: revisão de literatura / The preventive aspects and rehabilitation of the complications arising out of spinal cord injury: a review

A lesão medular pode ser classificada em paraplegia ou tetraplegia, e, quando um tratamento preventivo não é efetuado, pode ocorrer várias complicações, tais como: úlceras por pressão, ossificação heterotópica, osteoporose e hipotensão postural. Sendo que estas complicações podem muitas vezes ser prevenidas, ou se uma vez instaladas, podem ser tratadas. O objetivo deste trabalho foi fazer uma revisão bibliográfica sobre as complicações encontradas nos pacientes com lesão medular e verificar os benefícios que podem ser obtidos com a prevenção e a reabilitação. Foi realizado um levantamento bibliográfico no período de janeiro a abril de 2013, com publicações entre 2002 e 2013, nos idiomas inglês, espanhol e português. Foram encontrados 38 estudos relacionados às complicações e seus tratamentos, nas bases de dados Pubmed, Lilacs e Scielo. Quando abordadas precocemente, melhoram a funcionalidade e o prognóstico do indivíduo, porém quando já instaladas podem ser tratadas para reversão do quadro ou simplesmente retardar a progressão.

The spinal cord injury is a common cause of paraplegia and tetraplegia and there are some complications when preventive treatment is not well done, just like pressure ulcers, heterotopic ossification, osteoporosis and postural hypotension. The purpose of this study is to work in a bibliographic review about the complications that must be found in spinal cord injury individuals and verify the benefits with prevention and rehabilitation programs. It was found 38 studies about complications and treatment, from the period of January and April of 2013, between 2002 and 2013, from Pubmed, Lilacs and Scielo. When adressed correctly, improve functionality and the prognosis of the individual, but when they are installed must be treated to reverse or stop progression.

Aplicação de células-tronco mesenquimais no tratamento de lesões raquimedulares naturalmente adquiridas em cães e em gatos domésticos / Application of mesenchymal stem cells in the treatment of naturally acquired spinal cord injuries in dogs and domestic cats

Mecanismos de lesão e suas consequencias decorrentes de injúria da medula espinhal (IME) envolvem morte neuronal tanto por necrose quanto por apoptose. Sabendo-se que a regeneração do sistema nervoso central é limitada após danos tissulares, é crucial o desenvolvimento de novas abordagens que otimizem o retorno funcional após IME. As opções de tratamento tardio em cães e em gatos não estão disponíveis e os aspectos de segurança e terapeutico do transplante autólogo de células-tronco mesenquimais derivadas de medula óssea (BMMC) não foram ainda descritas anteriormente. O objetivo desta pesquisa é isolar e caracterizar as BMMC em cães e em gatos; selecionar cães e gatos com IME crônica; elaborar uma abordagem terapeutica à IME utilizando BMMC...

Lesion mechanisms and its evolution following spinal cord injury (SCI) involves neuronal death by both necrosis and apoptosis. Since regeneration of the central nervous system is limited after injuries, it is crucial to develop novel approaches that optimize functional recovery aft er SCI. Stem cell-based therapy has been investigated in a number of degenerative and traumatic diseases, including SCI. Late spinal cord injury treatment options in dogs and cats are not available. Neither the safety aspects and therapeutic effects of autologous bone marrow mesenchymal stem cell (BMMC)...

Isolamento e caracterização de células-tronco obtidas de corações de camundongos adultos / Isolation and characterization of stem cells from hearts of adult mice

O uso de células-tronco representa uma alternativa para o tratamento das doenças que acometem o coração, devido à capacidade que essas células indiferenciadas têm de preservar sua própria população e de se diferenciar em células dos diversos tecidos, incluindo o cardíaco. Nesse trabalho comparamos as características de células-tronco isoladas a partir do tecido cardíaco e da medula óssea de camundongos transgênicos para a proteína fluorescente verde (GFP). As células-tronco cardíacas e da medula óssea apresentaram característica morfológica fibroblastóide e imunofenotípica de células-tronco mesenquimais, com alta expressão dos marcadores CD44, CD90, CD73, Sca-1 e baixa expressão dos marcadores de células hematopoiéticas. A análise citogenética revelou um cariótipo poliplóide a partir da terceira passagem das células-tronco isoladas do coração e da medula-óssea. A capacidade de diferenciação em vários tipos celulares, tais como adipócitos, osteócitos e condrócitos, também foi avaliada nas células-tronco de ambas as fontes. Tanto as células-tronco isoladas do coração como da medula óssea foram capazes de se diferenciar nessas três linhagens. Quando estimuladas com 5’azacitidina para testar o potencial cardiomiogênico das células isoladas do coração e da medula óssea, apenas as células-tronco cardíacas passaram a expressar alguns marcadores de cardiomiócitos, tais como troponina T cardíaca e GATA-4...

Stem cells are undifferentiated cells with the ability of self-renewal and differentiation into different cell types, with the potential to treat heart diseases. In the present study we compared the characteristics of stem cells isolated from the heart to bone marrow stem cells, both obtained from EGFP transgeneic mice. Cardiac and bone marrow stem cells presented fibroblastic morphology and an immunophenotype compatible with mesenchymal stem cells – high expression of CD44, CD90, CD73, Sca-1 and low expression of of hematopoietic lineage markers. Cytogenetic analysis demonstrated polyploid karyotypes after the third passage of the stem cells isolated from heart and bone marrow. Both bone marrow and heart stem cells were able to differentiate into adipocytes, osteocytes and chondrocytes. In order to test the potential of differentiation into cardiomyocytes, cells were stimulated with 5’azacytidine and only cardiac stem cells expressed heart-specific markers: cardiac T troponin and GATA-4...