Extracorporeal shock wave for plantar flexor spasticity in spinal cord injury: A case report and review of literature.

BACKGROUND: Approximately 65%-78% of patients with a spinal cord injury (SCI) develop any symptom of spasticity. The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy (rESWT) on plantar flexor spasticity in a patient with incomplete SCI. CASE SUMMARY: An 18-year-old man with an incomplete SCI completed five sessions of rESWT. The primary outcomes were the changes in ankle-passive range of motion (A-PROM) and passive resistive force to ankle dorsiflexion. The outcomes were assessed at baseline (T0), immediately after treatment (T1) and 1 wk after the end of treatment (T2). The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0. The passive resistive force to ankle dorsiflexion at low velocity decreased by 33% at T1 and 55% at T2 in the gastrocnemius muscle and by 41% at T1 and 39% at T2 in the soleus muscle compared with T0. At high velocity, it also decreased by 44% at T1 and 30% at T2 in the gastrocnemius muscle compared with T0. However, in the soleus muscle, the change was minor, with a decrease of 12% at T1 and increased by 39% at T2 compared with T0. CONCLUSION: In this patient, the findings showed that rESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term. Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.

Sperm DNA damage in men with spinal cord injury: the relative incidence of single- and double-strand DNA breaks.

BACKGROUND: Men with spinal cord injury (SCI) show a high proportion of sperm DNA damage in their ejaculate but the underlying pathology remains elusive. OBJECTIVE: To investigate the relative incidence of single (SSBs) and double-strand DNA breaks (DSBs) and DNase activity in men with SCI. MATERIALS AND METHODS: This study included ejaculates of 20 men with SCI and 27 normozoospermic (sperm donors). A TwoTails comet assay (TTComet) allowed visualization of three categories of sperm DNA damage corresponding to SSBs, DSBs and those with a combination of SSBs and DSBs, facilitating accurate calculation of the total proportion of SSBs and DSBs. A subset of 15 individuals (sperm donors and SCI patients) was used to test for DNase activity in the seminal plasma. RESULTS: While the proportion of DSBs in men with SCI (median-57.5%) was higher (P = 0.000) than normozoospermic samples (median-4.6%), the proportion of SSBs was higher (P = 0.022) in the normozoospermic ejaculates (median-6.0%) compared to men with SCI (median-2.5%). The relative proportion of the total DSBs with respect to the total SSBs was 3.3× in men with SCI but 0.9× in normozoospermic samples. We further confirmed the high DNase activity in the seminal plasma of men with SCI. DISCUSSION: The TTComet assay provided new insights to the pathology of sperm DNA in men with SCI and may have diagnostic value in developing sperm selection methodologies to reduce DSBs prior to ART. CONCLUSION: Men with SCI are characterized by a high proportion of sperm with DSBs and high levels of DNase activity in the seminal plasma compared to normozoospermic men.

Systemic Immune Profile Predicts the Development of Infections in Patients with Spinal Cord Injuries.

Patients with spinal cord injury (SCI) frequently develop infections that may affect quality of life, be life-threatening, and impair their neurological recovery in the acute and subacute injury phases. Therefore, identifying patients with SCI at risk for developing infections in this stage is of utmost importance. We determined the systemic levels of immune cell populations, cytokines, chemokines, and growth factors in 81 patients with traumatic SCI at 4 weeks after injury and compared them with those of 26 age-matched healthy control subjects. Patients who developed infections between 4 and 16 weeks after injury exhibited higher numbers of neutrophils and eosinophils, as well as lower numbers of lymphocytes and eotaxin-1 (CCL11) levels. Accordingly, lasso logistic regression showed that incomplete lesions (American Spinal Injury Association Impairment Scale [AIS] C and D grades), the levels of eotaxin-1, and the number of lymphocytes, basophils, and monocytes are predictive of lower odds for infections. On the other hand, the number of neutrophils and eosinophils as well as, in a lesser extent, the levels of IP-10 (CXCL10), MCP-1 (CCL2), BDNF [brain-derived neurotrophic factor], and vascular endothelial growth factor [VEGF]-A, are predictors of increased susceptibility for developing infections. Overall, our results point to systemic immune disbalance after SCI as predictors of infection in a period when infections may greatly interfere with neurological and functional recovery and suggest new pathways and players to further explore novel therapeutic strategies.

A New Score Based on the International Standards for Neurological Classification of Spinal Cord Injury for Integrative Evaluation of Changes in Sensorimotor Functions.

Sensorimotor function of patients with spinal cord injury (SCI) is commonly assessed according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). From the ISNCSCI segmental motor and sensory assessments, upper and lower extremity motor scores (UEMS and LEMS), sum scores of pinprick (PP) and light touch (LT) sensation, the neurological level of injury (NLI) and the classification of lesion severity according to the American Spinal Injury Association Impairment Scale (AIS) grade are derived. Changes of these parameters over time are used widely to evaluate neurological recovery. Evaluating recovery based on a single ISNCSCI scoring or classification variable, however, may misestimate overall recovery. Here, we propose an Integrated Neurological Change Score (INCS) based on the combination of normalized changes between two time points of UEMS, LEMS, and total PP and LT scores. To assess the agreement of INCS with clinical judgment of meaningfulness of neurological changes, changes of ISNCSCI variables between two time points of 88 patients from an independent cohort were rated by 20 clinical experts according to a five-categories Likert Scale. As for individual ISNCSCI variables, neurological change measured by INCS is associated with severity (AIS grade), age, and time since injury, but INCS better reflects clinical judgment about meaningfulness of neurological changes than individual ISNCSCI variables. In addition, INCS is related to changes in functional independence measured by the Spinal Cord Independence Measure (SCIM) in patients with tetraplegia. The INCS may be a useful measure of overall neurological change in clinical studies.

Free circulating DNA and DNase activity in the ejaculates of men with spinal cord injury.

STUDY DESIGN: Retrospective descriptive study. OBJECTIVES: To study the presence of cell-free DNA (cfDNA) and DNase activity in males with spinal cord injury (SCI) with elevated sperm DNA fragmentation. SETTING: Hospital in Toledo, Spain; University-based Genetics laboratory in Madrid, Spain. METHODS: Semen was collected from 15 males with spinal cord injury and elevated sperm DNA fragmentation (SDF). The presence and concentration of cfDNA was assessed using standard gel electrophoresis and microfluidic electrophoresis. DNase activity was evaluated in seminal plasma and under the presence of EDTA and EGTA to control the response of enzyme activity. cfDNA fragments were mapped on the sperm genome using FISH. All results were compared to 15 normozoospermic fertile donors. RESULTS: Standard gel electrophoresis revealed a cfDNA band of ~150 bp in all samples from males with SCI; this band was ocasionally accompanied by another band of ~90 bp. These bands were not observed in normozoospermic donors. Microfluidid electrophoresis only identified the equivalent band of 150 bp. No correlation was observed between the intensity of the two bands and the level of SDF in males with SCI. Although DNase activity was present in the seminal plasma of both normozoospermic donors and men with SCI it did not digest cfDNA. cfDNA fragments were found to be hybridized all over the sperm genome. CONCLUSIONS: SCI patients with elevated sperm DNA fragmentation showed a 150 bp DNA band of cfDNA in the seminal plasma, which appeared resistant to DNase activity.

Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury.

STUDY DESIGN: Cohort study of patients with spinal cord injury (SCI). OBJECTIVES: To describe the clinical and analytical features of a coronavirus disease 2019 (Covid-19) infected cohort with SCI to enable accurate diagnosis and to outline prevention measures. SETTING: This study was conducted at the National Hospital for Paraplegics (Toledo, Spain). METHODS: A cohort analysis of seven patients with SCI infected by Covid-19 was performed. Diagnosis was confirmed with reverse transcriptase polymerase chain reaction (RT-PCR) of nasal exudate or sputum samples. Clinical, analytical, and radiographic findings were registered. RESULTS: RT-PCR detected COVID-19 infection in all patients, affecting males and people with a cervical level of injury more often (five out of seven). The average delay for diagnostic confirmation was 4 days (interquartile range, 1-10). Fever was the most frequent symptom (six out of seven). The second most common symptom was asthenia (four out of seven), followed by dyspnea, cough, and expectoration (three out of seven for each symptom). The Modified Early Warning System score for Covid-19 severity rating was classified as severe in five out of seven cases. All but one patient showed radiological alterations evident in chest X-rays at the time of diagnosis. All patients recovered gradually. CONCLUSION: Our patients with SCI and Covid-19 infection exhibited fewer symptoms than the general population. Furthermore, they presented similar or greater clinical severity. The clinical evolution was not as pronounced as had been expected. This study recommends close supervision of the SCI population to detect early compatible signs and symptoms of Covid-19 infection.

The incidence and etiology of sperm DNA fragmentation in the ejaculates of males with spinal cord injuries.

STUDY DESIGN: Retrospective descriptive study. OBJECTIVES: To determine the incidence and probable etiology of sperm DNA fragmentation (SDF) in a sample of males with spinal cord injury (SCI). SETTING: Hospital in Toledo, Spain; University-based Genetics laboratory in Madrid, Spain. METHODS: Semen collected by vibro-stimulation from 27 males with various levels of spinal cord injury. Classical semen parameters, SDF, leukocytospermia and pro-oxidant capacity were assessed and compared with a cohort of normozoospermic fertile donors (n = 10). RESULTS: Males with SCI presented with lower semen quality compared with normozoospermic donors with respect to progressive motility (p = 0.0002), SDF (p < 0.00005), pro-oxidant capacity (p = 0.0191) and leukocytospermia (p < 0.00005). Although there was no significant correlation between semen quality and time since the lesion occurred, the period of abstinence appeared to be positively correlated with SDF (r = 0.486; p = 0.041). When the semen parameters of males with SCI were categorized based on those with cervical and thoracic lesions, sperm concentration was higher for those with cervical damage (p = 0.0257). Males with complete lesions (AIS A) had ejaculates that were lower in progressive motility (p = 0.0040) than those with incomplete injuries (AIS B-D). CONCLUSIONS: Ejaculates of males with SCI have excessively elevated SDF when compared with normozoospermic donors, which is likely to be associated with coincident high levels of leucocytospermia and pro-oxidant capacity. We propose that these phenomena are caused by the accumulation and degeneration of spermatozoa in the cauda epididymidis.

A dataset for the analysis of antibody response to glycan alpha-Gal in individuals with immune-mediated disorders.

Humans evolved by losing the capacity to synthesize the glycan Galα1-3Galß1-(3)4GlcNAc-R (α-Gal), which resulted in the development of a protective response mediated by anti-α-Gal IgM/IgG/IgA antibodies against pathogens containing this modification on membrane proteins. As an evolutionary trade-off, humans can develop the alpha-Gal syndrome (AGS), a recently diagnosed disease mediated by anti-α-Gal IgE antibodies and associated with allergic reactions to mammalian meat consumption and tick bites. However, the anti-α-Gal antibody response may be associated with other immune-mediated disorders such as those occurring in patients with COVID-19 and Guillain-Barré syndrome (GBS). Here, we provide a dataset (209 entries) on the IgE/IgM/IgG/IgA anti-α-Gal antibody response in healthy individuals and patients diagnosed with AGS, tick-borne allergies, GBS and COVID-19. The data allows correlative analyses of the anti-α-Gal antibody response with factors such as patient and clinical characteristics, record of tick bites, blood group, age and sex. These analyses could provide insights into the role of anti-α-Gal antibody response in disease symptomatology and possible protective mechanisms.

Development of chronic pain in males with traumatic spinal cord injury: role of circulating levels of the chemokines CCL2 and CXCL10 in subacute stage.

STUDY DESIGN: Longitudinal study. OBJECTIVES: To assess the impact of spinal cord injury (SCI) on circulating levels of chemokines (CCL2 and CXCL10) and its relation with pain development. SETTING: National Hospital for SCI patients. METHODS: We longitudinally studied changes in the circulating levels of CCL2 and CXCL10 in 27 male patients with complete SCI who were evaluated in the early subacute phase and indeed 3 and 6 months after injury measuring at each time-point serum levels of CCL2 and CXCL10. Patients were telephonically interviewed about pain 1 year after SCI. RESULTS: In the early subacute phase, patients with pain showed higher CXCL10 and similar CCL2 levels as opposed to those without pain. Moreover, CCL2 concentrations were positively associated with pain intensity. The results obtained by analysing the temporal profile of the chemokines suggested that CXCL10 was inclined to decrease over time, while CCL2 increased over time. CONCLUSION: The results of this preliminary study, the first performed in humans with traumatic SCI, suggest a link between changes in the circulating chemokine profile and pain development in subacute SCI stage as well as with severity in a more chronic stage. Large series studies will evaluate whether the circulating chemokine status can be useful as a biomarker for assessing the patients' risk for pain development.

[Sexual life quality of spinal cord-injured men receiving pharmacological treatment for erectile dysfunction and their partners]. / Calidad de la vida sexual de varones heterosexuales con lesión medular en tratamiento farmacológico para la disfunción eréctil y de sus compañeras.

OBJECTIVE: To assess the quality of sexual life reported by spinal cord-injured men treated with oral drugs for erectile dysfunction (ED) and their female partners. MATERIAL AND METHOD: Men with spinal cord injuries (SCI) complaining of ED and their female partners were evaluated using the Sexual Life Quality Questionnaire (SLQQ), a fully validated instrument in Spain. Two studies were conducted. A transversal study (1) on patients who were already on treatment with phosphodiesterase type 5 inhibitors (PDE5Is) and their partners, with 73 couples providing valid data. An additional prospective study (2) assessed SCI patients naive to PDE5Is in which both the patients and their spouses answered the SLQQ before treatment and after 3 months taking PDE5Is regularly, with 12 couples completing the study. RESULTS: The SLQQ scores of SC injured men on PDE5Is (study 1) were under the remembered pre-lesion level, with lower scores reported by those with complete lesions (P<.2 vs incomplete). Their partners' SLQQ scores were apparently similar to pre-injury times. The SLQQ scores of the patients and their partners were well correlated (r = 0.57, P<.0001), and they both reported high treatment satisfaction. Study 2: Untreated SCI patients reported very low SLQQ scores that were improved by PDE5Is treatment (P<.004), albeit without reaching the pre-injury level. A similar trend was found in their partners. Again both patients and partners reported high treatment satisfaction scores (P <.001). CONCLUSION: The sexual life quality levels of SC injured men on PDE5Is and their able-bodied spouses are well correlated. Both partners report high treatment satisfaction scores.

Calidad de la vida sexual de varones heterosexuales con lesión medular en tratamiento farmacológico para la disfunción eréctil y de sus compañeras / Sexual life quality of spinal cord-injured men receiving pharmacological treatment for erectile dysfunction and their partners

Objetivo: Evaluar la calidad de vida sexual de los varones con lesión medular (LM) con tratamiento farmacológico para la disfunción eréctil (DE) y de sus compañeras. Material y método: Se evaluó a varones de 18 a 65 años con LM y pareja estable que estuviesen en tratamiento de su DE mediante fármacos inhibidores de la fosfodiesterasa tipo 5 (iFDE5) o solicitasen iniciarlo. Se realizaron 2 estudios: un estudio transversal, sobre pacientes ya en tratamiento para la DE y sus compañeras, para el que 78 parejas proporcionaron datos válidos. Se complementó con un estudio prospectivo, sobre pacientes que iniciaban tratamiento para la DE y sus compañeras, comparando sus repuestas antes y a los 3 meses de iniciar el tratamiento; completaron este estudio 12 de las parejas invitadas. Los pacientes y sus parejas respondieron separadamente al Cuestionario de Calidad de Vida Sexual (SLQQ), validado en España. Resultados: Estudio transversal: las puntuaciones de la Escala de Calidad de Vida Sexual (parte I del cuestionario SLQQ) de los lesionados medulares en tratamiento fue inferior a la recordada con anterioridad a la lesión; por el contrario, para sus compañeras era similar a la prelesional. Las puntuaciones de ambos miembros de la pareja mostraron una robusta correlación (r = 0,57, p < 0,0001). Las puntuaciones de los pacientes con lesiones completas fueron inferiores a las lesiones incompletas (p < 0,02). Respecto a la satisfacción con el tratamiento (parte II del cuestionario SLQQ), las puntuaciones de los pacientes y sus compañeras estaban próximas al valor máximo de la escala y la prueba de Wilcoxon con respecto al valor de referencia fue muy significativa en ambos (p < 0,0001). Estudio prospectivo: los lesionados medulares mostraron bajas puntuaciones antes del tratamiento, que aumentaron significativamente a los 3 meses del tratamiento (p < 0,004). Las puntuaciones de satisfacción con el tratamiento fueron altas en ambos miembros de la pareja (p < 0,001). Conclusión: Los niveles de calidad de vida sexual informados por los pacientes con LM tratados con iFDE5 y sus compañeras sanas se muestran correlacionados. Ambos miembros de la pareja informaron de buena satisfacción con el tratamiento

Objective: To assess the quality of sexual life reported by spinal cord-injured men treated with oral drugs for erectile dysfunction (ED) and their female partners. Material and method: Men with spinal cord injuries (SCI) complaining of ED and their female partners were evaluated using the Sexual Life Quality Questionnaire (SLQQ), a fully validated instrument in Spain. Two studies were conducted. A transversal study (1) on patients who were already on treatment with phosphodiesterase type 5 inhibitors (PDE5Is) and their partners, with 73 couples providing valid data. An additional prospective study (2) assessed SCI patients naive to PDE5Is in which both the patients and their spouses answered the SLQQ before treatment and after 3 months taking PDE5Is regularly, with 12 couples completing the study. Results: The SLQQ scores of SC injured men on PDE5Is (study 1) were under the remembered pre-lesion level, with lower scores reported by those with complete lesions (P<.2 vs incomplete). Their partners' SLQQ scores were apparently similar to pre-injury times. The SLQQ scores of the patients and their partners were well correlated (r = 0.57, P<.0001), and they both reported high treatment satisfaction. Study 2: Untreated SCI patients reported very low SLQQ scores that were improved by PDE5Is treatment (P<.004), albeit without reaching the pre-injury level. A similar trend was found in their partners. Again both patients and partners reported high treatment satisfaction scores (P <.001). Conclusion: The sexual life quality levels of SC injured men on PDE5Is and their able-bodied spouses are well correlated. Both partners report high treatment satisfaction scores