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2.
Am J Occup Ther ; 75(1): 7501205070p1-7501205070p10, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33399055

RESUMO

IMPORTANCE: This study lays the groundwork for a self-management program run by occupational therapy practitioners for parents with spinal cord injury or disease (SCI/D). OBJECTIVE: To develop and implement the Parenting Self-Management Program with people with SCI/D and evaluate the potential impact on knowledge, self-efficacy, and participation. DESIGN: A mixed-methods approach was used to develop (Phase 1) and implement and evaluate (Phase 2) a pilot group intervention for parents with SCI/D. SETTING: Community-based occupational therapy settings. PARTICIPANTS: Phase 1 participants were professionals working in the field of disability and SCI/D (n = 11) and experienced parents with SCI/D (n = 9). Phase 2 participants were people with SCI/D who were newly injured or inexperienced in parenting (n = 10). All participants were paid volunteers. INTERVENTION: The 4-wk Parenting Self-Management Program was piloted with 10 parents with SCI/D. Participants attended a weekly program with other parents with SCI/D led by occupational therapists in which they received parenting resources and presentations and set weekly goals. OUTCOMES AND MEASURES: The General Self-Efficacy Scale, a modified version of the Participation Survey/Mobility, and open-ended questions regarding parents' participation in parenting tasks were administered during Phase 2. RESULTS: Significant increases (p < .05) in perceived knowledge were found for the topics of emergency preparedness, home modifications, adapted equipment, fatigue management, pain management, and community resources among Phase 2 participants. CONCLUSIONS AND RELEVANCE: A self-management approach combined with pertinent resources for parents with SCI/D yielded positive outcomes. WHAT THIS ARTICLE ADDS: This research demonstrates that a self-management structure for a specific population (people with SCI/D) in combination with a targeted occupation (parenting) and delivered through group occupational therapy services, improved client outcomes.


Assuntos
Autogestão , Traumatismos da Medula Espinal , Humanos , Poder Familiar , Pais , Projetos Piloto
3.
Emerg Med Clin North Am ; 39(1): 1-28, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218651

RESUMO

Both blunt and penetrating trauma can cause injuries to the peripheral and central nervous systems. Emergency providers must maintain a high index of suspicion, especially in the setting of polytrauma. There are 2 major classifications of peripheral nerve injuries (PNIs). Some PNIs are classically associated with certain traumatic mechanisms. Most closed PNIs are managed conservatively, whereas sharp nerve transections require specialist consultation for urgent repair. Spinal cord injuries almost universally require computed tomography imaging; some require emergent magnetic resonance imaging. Providers should work to minimize secondary injury. Surgical specialists are needed for closed reduction, surgical decompression, or stabilization.


Assuntos
Sistema Nervoso Periférico/lesões , Traumatismos da Medula Espinal/terapia , Adulto , Humanos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia
4.
Int J Nanomedicine ; 15: 10113-10125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33363370

RESUMO

Background: The excess production of reactive oxygen species (ROS) after traumatic spinal cord injury (TSCI) has been identified as a leading cause of secondary injury, which can significantly exacerbate acute damage in the injured spinal cord. Thus, scavenging of ROS has emerged as an effective route to ameliorate secondary spinal cord injury. Purpose: Selenium-doped carbon quantum dots (Se-CQDs) with the ability to scavenge reactive oxygen species were prepared and used for efficiently ameliorating secondary injury in TSCI. Methods: Water-soluble Se-CQDs were easily synthesized via hydrothermal treatment of l-selenocystine. The chemical structure, size, and morphology of the Se-CQDs were characterized in detail. The biocompatibility and protective effects of the Se-CQDs against H2O2-induced oxidative damage were investigated in vitro. Moreover, the behavioral test, bladder function, histological observation, Western blot were used to investigate the neuroprotective effect of Se-CQDs in a rat model of contusion TSCI. Results: The obtained Se-CQDs exhibited good biocompatibility and remarkable protective effect against H2O2-induced oxidative damage in astrocytes and PC12 cells. Moreover, Se-CQDs displayed marked anti-inflammatory and anti-apoptotic activities, which thereby reduced the formation of glial scars and increased the survival of neurons with unscathed myelin sheaths in vivo. As a result, Se-CQDs were capable of largely improving locomotor function of rats with TSCI. Conclusion: This study suggests that Se-CQDs can be used as a promising therapeutic platform for ameliorating secondary injury in TSCI.


Assuntos
Carbono/química , Pontos Quânticos/química , Espécies Reativas de Oxigênio/metabolismo , Selênio/farmacologia , Traumatismos da Medula Espinal/patologia , Animais , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Antioxidantes/farmacologia , Apoptose/efeitos dos fármacos , Astrócitos/efeitos dos fármacos , Astrócitos/patologia , Modelos Animais de Doenças , Feminino , Camundongos , Atividade Motora/efeitos dos fármacos , Neuroglia/efeitos dos fármacos , Neuroglia/patologia , Neuroproteção/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Fármacos Neuroprotetores/uso terapêutico , Células PC12 , Pontos Quânticos/ultraestrutura , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica/efeitos dos fármacos , Medula Espinal/efeitos dos fármacos , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/fisiopatologia
5.
Zhongguo Gu Shang ; 33(12): 1128-33, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369320

RESUMO

OBJECTIVE: To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury. METHODS: From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T11 in 4 cases, T12 in 5 cases, L1 in 5 cases, L2 in 2 cases. All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach. The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra, Cobb angle of the adjacent segment of the injured vertebra, and ratio of spinal canal encroachment. The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale (VAS). RESULTS: All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (P<0.01). Cobb angle of adjacent segment of injured vertebrae was (28.19±10.89)°before operation, (5.31±5.14)° 3 days after operation, and (6.81±4.59)°at the latest follow-up. The ratio of spinal canal encroachment was (67.68±12.45)% before operation, (7.69±4.46)% at 3 days after operation, and (4.75±1.63)% at the latest follow-up. At 3 days and the latest follow-up, the rate recovered to a certain extent (P<0.05). At the latest follow up, spinal nerve function was improved in 12 patients, no improvement in 4 patients and no deterioration in nerve function. VSA score was improved from preoperative 7.8±0.9 to final follow-up 1.8±0.7. CONCLUSION: For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.


Assuntos
Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Adulto , Parafusos Ósseos , Descompressão , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canal Vertebral , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
Nat Commun ; 11(1): 6425, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33349630

RESUMO

Overcoming the restricted axonal regenerative ability that limits functional repair following a central nervous system injury remains a challenge. Here we report a regenerative paradigm that we call enriched conditioning, which combines environmental enrichment (EE) followed by a conditioning sciatic nerve axotomy that precedes a spinal cord injury (SCI). Enriched conditioning significantly increases the regenerative ability of dorsal root ganglia (DRG) sensory neurons compared to EE or a conditioning injury alone, propelling axon growth well beyond the spinal injury site. Mechanistically, we established that enriched conditioning relies on the unique neuronal intrinsic signaling axis PKC-STAT3-NADPH oxidase 2 (NOX2), enhancing redox signaling as shown by redox proteomics in DRG. Finally, NOX2 conditional deletion or overexpression respectively blocked or phenocopied enriched conditioning-dependent axon regeneration after SCI leading to improved functional recovery. These studies provide a paradigm that drives the regenerative ability of sensory neurons offering a potential redox-dependent regenerative model for mechanistic and therapeutic discoveries.


Assuntos
Regeneração Nervosa , Células Receptoras Sensoriais/metabolismo , Células Receptoras Sensoriais/patologia , Transdução de Sinais , Traumatismos da Medula Espinal/fisiopatologia , Animais , Axônios/patologia , Axotomia , Gânglios Espinais/patologia , Camundongos Endogâmicos C57BL , NADPH Oxidase 2/metabolismo , Crescimento Neuronal , Plasticidade Neuronal , Oxirredução , Fosforilação , Regiões Promotoras Genéticas/genética , Proteína Quinase C/metabolismo , Subunidades Proteicas/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Fator de Transcrição STAT3/metabolismo , Nervo Isquiático/fisiopatologia , Regulação para Cima
7.
J Vis Exp ; (166)2020 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-33369603

RESUMO

Spinal cord injury is a devastating complication of aortic repair. Despite developments for the prevention and treatment of spinal cord injury, its incidence is still considerably high and therefore, influences patient outcome. Microcirculation plays a key role in tissue perfusion and oxygen supply and is often dissociated from macrohemodynamics. Thus, direct evaluation of spinal cord microcirculation is essential for the development of microcirculation-targeted therapies and the evaluation of existing approaches in regard to spinal cord microcirculation. However, most of the methods do not provide real-time assessment of spinal cord microcirculation. The aim of this study is to describe a standardized protocol for real-time spinal cord microcirculatory evaluation using laser-Doppler needle probes directly inserted in the spinal cord. We used a porcine model of ischemia/reperfusion to induce deterioration of the spinal cord microcirculation. In addition, a fluorescent microsphere injection technique was used. Initially, animals were anesthetized and mechanically ventilated. Thereafter, laser-Doppler needle probe insertion was performed, followed by the placement of cerebrospinal fluid drainage. A median sternotomy was performed for exposure of the descending aorta to perform aortic cross-clamping. Ischemia/reperfusion was induced by supra-celiac aortic cross-clamping for a total of 48 min, followed by reperfusion and hemodynamic stabilization. Laser-Doppler Flux was performed in parallel with macrohemodynamic evaluation. In addition, automated cerebrospinal fluid drainage was used to maintain a stable cerebrospinal pressure. After completion of the protocol, animals were sacrificed, and the spinal cord was harvested for histopathological and microsphere analysis. The protocol reveals the feasibility of spinal cord microperfusion measurements using laser-Doppler probes and shows a marked decrease during ischemia as well as recovery after reperfusion. Results showed comparable behavior to fluorescent microsphere evaluation. In conclusion, this new protocol might provide a useful large animal model for future studies using real-time spinal cord microperfusion assessment in ischemia/reperfusion conditions.


Assuntos
Traumatismo por Reperfusão/patologia , Traumatismos da Medula Espinal/patologia , Isquemia do Cordão Espinal/patologia , Medula Espinal/patologia , Animais , Aorta/cirurgia , Modelos Animais de Doenças , Feminino , Hemodinâmica , Masculino , Microcirculação , Medula Espinal/irrigação sanguínea , Suínos
8.
Texto & contexto enferm ; 29: e20190003, Jan.-Dec. 2020. tab
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1145163

RESUMO

ABSTRACT Objective: to understand the strengths and limits in the daily life of the adherence to rehabilitation of people with spinal cord injury and their families. Method: an interpretive study of a qualitative nature, based on Comprehensive and Everyday Life Sociology, involving 21 participants, 12 individuals with spinal cord injury and 9 family members, in a Specialized Rehabilitation Center in southern Brazil. The sources of evidence were individual and collective interviews, adopting the strategy of workshops for data validation. The Atlas.ti software was used for data collation and organization. Data analysis involved the following stages: preliminary analysis, ordering, key links, coding, and categorization. Results: the following categories and subcategories were found: Strengths in the adherence to rehabilitation - welcoming and walking side by side; rehabilitation: a return to life; coexistence that brings the family together, as well as practicing faith. Limits on the adherence to rehabilitation - (d)efficiency of the health professionals in health care. Conclusion: rehabilitation was evidenced as a possibility of returning to life, which enables coexistence among equals and stimulates self-care and adaptation. The family rescues the desire to live, and faith is a mechanism of hope and optimism. It is noteworthy that the welcoming deficit in Primary Health Care and the scarcity of rehabilitation care services in the hospital determine the onset of avoidable complications, in addition to the lack of guidance and/or referrals, characterizing a gap in the Referral and Counter-Referral System.


RESUMEN Objetivo: comprender los puntos favorables y los límites en el día a día de la adhesión a la rehabilitación de personas con lesión medular y sus familias. Método: estudio interpretativo de carácter cualitativo, fundamentado en la Sociología Comprensiva y de lo Cotidiano y realizado con 21 participantes, 12 de ellos personas con lesión medular y 09 familiares, en un Centro Especializado de Rehabilitación del sur de Brasil. Las fuentes de evidencias fueron entrevistas individuales y colectivas, para las cuales se adoptó la estrategia de talleres para validar los datos. Para el agrupamiento y la organización de los datos se utilizó el software Atlas.ti. El análisis de los datos abarcó las siguientes etapas: análisis preliminar, ordenamiento, vinculaciones clave, codificación y categorización. Resultados: se hicieron evidentes las siguientes categoría y subcategorías: Puntos favorables en la adhesión a la rehabilitación - recibir con brazos abiertos y caminar lado a lado; rehabilitación: un retorno a la vida; la convivencia que acerca a la familia, al igual que como practicar la fe. Límites en la adhesión a la rehabilitación - la (d)eficiencia de los profesionales de la salud en la atención. Conclusión: la rehabilitación se presentó como una posibilidad de retornar a la vida, que hace posible la convivencia entre semejantes, estimula el autocuidado y la adaptación. La familia rescata la voluntad de vivir, y la fe es un mecanismo de esperanza y optimismo. Se destaca que el déficit de recepción en la Atención Primaria de la Salud y la escasez de cuidados de rehabilitación en el ámbito hospitalario determinan la aparición de complicaciones evitables, además de la falta de orientación y/o derivaciones, lo que caracteriza una falla en el Sistema de Derivaciones y Contraderivaciones.


RESUMO Objetivo: compreender as potências e os limites no quotidiano da adesão à reabilitação de pessoas com lesão medular e suas famílias. Método: estudo interpretativo de natureza qualitativa, fundamentado na Sociologia Compreensiva e do Quotidiano, envolvendo 21 participantes, sendo 12 pessoas com lesão medular e 09 familiares, em um Centro Especializado de Reabilitação no sul do Brasil. As fontes de evidências foram entrevistas individuais e coletivas, adotando-se, para estas, a estratégia de oficinas para validação dos dados. Para o agrupamento e organização dos dados, utilizou-se o software Atlas.ti. A análise dos dados envolveu: análise preliminar, ordenação, ligações-chave, codificação e categorização. Resultados: evidenciaram as categorias e subcategorias: Potências na adesão à reabilitação - acolher e caminhar junto; reabilitação: um retorno à vida; a convivência que aproxima a família, bem como praticar a fé. Limites na adesão à reabilitação - (d)eficiência dos profissionais de saúde no cuidado. Conclusão: evidenciou-se a reabilitação como uma possibilidade de retorno à vida, que possibilita a convivência entre iguais, estimula o autocuidado e a adaptação. A família resgata o querer viver, e a fé é um mecanismo de esperança e otimismo. Ressalta-se que o déficit de acolhimento na Atenção Primária à Saúde e a escassez de cuidados de reabilitação no âmbito hospitalar determinam o aparecimento de complicações evitáveis, além da falta da orientação e/ou encaminhamentos, caracterizando uma falha no Sistema de Referência e Contrarreferência.


Assuntos
Humanos , Reabilitação , Traumatismos da Medula Espinal , Atividades Cotidianas , Família , Enfermagem em Reabilitação
9.
Urologiia ; (5): 127-132, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185360

RESUMO

AIM: to evaluate the medico-economic significance of neurogenic lower urinary tract dysfunction (NLUTD) in the Russian Federation, to calculate the economic burden of NLUTD in patients with targeted entities and to prepare suggestions for improving the methods of payment for the provision of medical care to patients with NLUTD in inpatient practice. MATERIALS AND METHODS: an analysis of the literature and an expert assessment of the prevalence of NLUTD in the Russian Federation were performed. Due to the various etiology of NLUTD, the following entities were considered: craniocerebral trauma, acute stroke, multiple sclerosis, spinal cord injury (hereinafter referred to as targeted entities), characterized by the highest rate of NLUTD and high social significance (damage to the working-age population): traumatic brain injury, acute stroke, multiple sclerosis, spinal cord injury. The calculations of the economic burden of NLUTD and its main complications (stage 5 of chronic kidney disease (CKD), urinary tract infection) in the Russian Federation (using mainly the normative method) were carried out, based on national statistics, regulatory legal acts and expert assessments of healthcare specialists. Proposals have been prepared for improving the reimbursement (tariffs of the KSG) for payment of NLUTD in the inpatient practice. RESULTS: according to the study, the number of patients with NLUTD due to the group of targeted entities is estimated at 910 000. The economic burden (excluding indirect and unaccounted costs) of the NLUTD is 33.3 billion rubles per year. The burden associated with secondary complications (stage 5 CKD, urogenital infection) due to ineffective diagnosis and treatment of NLUTD is 51.6 billion rubles. The total costs on the NLUTD is estimated at 84.9 billion rubles. Direct costs, calculated by the normative method based on the analysis of standards of medical care per patient are 36,546 rubles per year. Provision of medical care to patients with NLUTD in accordance with federal guarantees within the framework of the compulsory medical insurance is provided in accordance with the tariffs of KSG st30.005 (profile "urology"). The KSG tariff for 2019 (taking into account the established standards of financial costs for one case of hospitalization in the inpatient department and the established cost-intensity coefficients (CZ) established by the CG is 21,495.07 rubles, which is 58% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. The real estimate of the tariff for the payment of treatment of NLUTD in the constituent entities of the Russian Federation is 35-38% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. The real estimate of the costs for the treatment of NLUTD in regions is 35-38% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. To provide effective specialized urological care in the framework of compulsory medical insurance at the rates of the CSG for neuro-urological care (st30.005), expert calculations of the actual cost of NLUTD therapy were made. The proposed average cost of the CSG and the values of the cost intensity factors: CSG (min) st30.005.1 - 39,936 rubles, CZ - 1.65; CSG (max) st30.005.2 - 68,531 rubles, CZ - 2.75. The weighted average savings while expanding the availability of complex neuro-urological care for patients with NLUTD in accordance with the proposed payment rates is 9.4 billion rubles per year. CONCLUSIONS: Evaluation of the prevalence and burden of NLUTD showed the high medical and economic significance of NLUTD in the Russian Federation. The results of the study indicate a significant discrepancy between the requirements and the real costs within federal guarantees for the organization of medical care for patients with NLUTD. To provide effective specialized urological care in the compulsory medical insurance at the rates of CSG for neuro-urological care, it is necessary to increase funding, through the correction at the federal level of the cost-intensity coefficient from 1.65 to 2.75 for the CSG st30.005, which will ensure the increase in the cost for a case of treatment in inpatient department in form 39 936 to 68 531 rubles. The weighted average savings while expanding the availability of complex neuro-urological care for patients with NLUTD in accordance with the proposed payment rates is 9.4 billion rubles per year.


Assuntos
Traumatismos da Medula Espinal , Doenças Urológicas , Urologia , Humanos , Federação Russa/epidemiologia , Fatores Socioeconômicos , Doenças Urológicas/economia
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1429-1437, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191702

RESUMO

Objective: To study the local vascular remodeling, inflammatory response, and their correlations following acute spinal cord injury (SCI) with different grades, and to assess the histological changes in SCI rats. Methods: One hundred and sixteen adult female Sprague Dawley rats were randomly divided into 4 groups ( n=29). The rats in sham group were received laminectomy only. A standard MASCIS spinal cord compactor was applied with drop height of 12.5, 25.0, or 50.0 mm to establish the mild, moderate, or severe SCI model, respectively. Quantitative rat endothelial cell antigen 1 (RECA1) and CD68 positive areas and the correlations were studied by double immunofluorescent (DIF) staining at 12 hours, 24 hours, 3 days, 7 days, and 28 days following SCI. Moreover, qualitative neurofilament-H (NF-H) and glial fibrillary acidic protein (GFAP) positive glial cells were studied by DIF staining at 28 days. ELISA was used to detect the levels of tumor necrosis factor α (TNF-α), interleukin 1ß (IL-1ß), and IL-6 in spinal cord homogenates at 12 hours, 24 hours, and 3 days, and the correlations between TNF-α, IL-1ß, or IL-6 levels and microvascular density (RECA1) were accordingly studied. Moreover, the neural tissue integrity and neuron damage were assessed by HE staining at 12 hours, 24 hours, 3 days, 7 days, and 28 days, and Nissl's staining at 28 days following SCI, respectively. Results: DIF staining revealed that the ratio of RECA1 positive area was the highest in moderate group, higher in mild and severe groups, and the lowest in sham group with significant differences between groups ( P<0.05). The ratio of CD68 positive area was the highest in severe group, higher in moderate and mild groups, and the lowest in sham group with significant differences between groups ( P<0.05), except the comparisons between mild and moderate groups at 24 hours and 28 days after SCI ( P>0.05). There was no significant correlation between the RECA1 and CD68 expressions in sham group at different time points ( P>0.05). At 12 and 24 hours after SCI, the RECA1 and CD68 expressions in mild and moderate groups showed significant positive correlations ( P<0.05), while no significant correlation was found in severe group ( P>0.05). No significant correlations between the RECA1 and CD68 expressions was shown in all SCI groups at 3 days and in severe group at 7 days ( P>0.05), while the negative correlations were shown in mild and moderate groups at 7 days, and in all SCI groups at 28 days ( P<0.05). In mild, moderate, and severe groups, the axons became disrupted, shorter and thicker rods-like, or even merged blocks with increased injury, while the astrocytes decreased in number, unorganized and condensed in appearance. ELISA studies showed that TNF-α, IL-1ß, and IL-6 levels in sham group were significantly lower than those in other 3 groups at different time points ( P>0.05). The differences in TNF-α, IL-1ß, and IL-6 levels between SCI groups at different time points were sinificant ( P<0.05), except IL-1ß levels between the mild and moderate groups at 12 hours ( P>0.05). Three inflammatory factors were all significantly correlated with the microvascular density grades ( P<0.05). Histological analysis indicated that the damage to spinal cord tissue structure correlated with the extent of SCI. In severe group, local hemorrhage, edema, and infiltration of inflammatory cells were found the most drastic, the grey/white matter boundary was disappeared concurrently with the formation of cavity and shortage of normal neurons. Conclusion: In the acute stage following mild or moderate SCI, progressively aggravated injury result in higher microvessel density and increased inflammation. However, at the SCI region, the relation between microvessel density and inflammation inverse with time in the different grades of SCI. Accordingly, the destruction of neural structures positively relate to the grades of SCI and severity of inflammation.


Assuntos
Traumatismos da Medula Espinal , Remodelação Vascular , Animais , Feminino , Ratos , Ratos Sprague-Dawley , Medula Espinal , Fator de Necrose Tumoral alfa
11.
Methodist Debakey Cardiovasc J ; 16(3): 250-251, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133364

RESUMO

The column in this issue is supplied by Juan Jose Olivero, MD, who was a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program before his retirement in 2019. Dr. Olivero obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas. He currently serves on the journal's editorial board and is editor of the "Points to Remember" section.


Assuntos
Pneumonia Aspirativa/terapia , Atelectasia Pulmonar/terapia , Quadriplegia/terapia , Traumatismos da Medula Espinal/terapia , Humanos , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/fisiopatologia , Prognóstico , Atelectasia Pulmonar/diagnóstico , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/fisiopatologia , Quadriplegia/diagnóstico , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia
12.
Nursing (Säo Paulo) ; 23(270): 4836-4860, nov.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145461

RESUMO

Objetivo: objetiva-se analisar as publicações sobre o cuidado de Enfermagem no cotidiano da reabilitação de pessoas com lesão medular e suas famílias. Método:trata-se de uma revisão integrativa da literatura, nas bases de dados PubMed, LILACS e SciELO, utilizando os descritores: Enfermagem, Lesão Medular e Reabilitação, sendo critérios de inclusão: artigos completos de pesquisa, de relato de caso ou de experiências, com adultos, disponíveis nos idiomas inglês, português e espanhol, no período de 2003 a 2013. Resultados:foram selecionados 60 artigos, que resultaram em três categorias de análise: O viver e conviver com um trauma raquimedular; O cuidado de Enfermagem à pessoa com lesão medular em processo de reabilitação; Qualidade de vida da pessoa com lesão medular e sua família. Conclusão:conclui-se que para cuidar de pessoas com lesão medular e de suas famílias é preciso buscar formação profissional qualificada parapromoverpossibilidades de cuidados que melhorem o viver e o conviver dessas pessoas.(AU)


Objective: the objective is to analyze publications on nursing care in the daily rehabilitation of people with spinal cord injury and their families. Method: this is an integrative literature review, in the PubMed, LILACS and SciELO databases, using the descriptors: Nursing, Spinal Cord Injury and Rehabilitation, with inclusion criteria: complete research articles, case reports or experiences , with adults, available in English, Portuguese and Spanish, from 2003 to 2013. Results: 60 articles were selected, which resulted in three categories of analysis: Living with a spinal cord trauma; Nursing care for the person with spinal cord injury in the rehabilitation process; Quality of life of the person with spinal cord injury and his family. Conclusion: it is concluded that in order to care for people with spinal cord injury and their families, it is necessary to seek qualified professional training to promote possibilities of care that improve the living and living of these people.(AU)


Objetivo: el objetivo es analizar publicaciones sobre cuidados de enfermería en la rehabilitación diaria de personas con lesión medular y sus familias. Método: se trata de una revisión integradora de la literatura, en las bases de datos PubMed, LILACS y SciELO, utilizando los descriptores: Enfermería, Lesión de la Médula Espinal y Rehabilitación, con criterios de inclusión: artículos completos de investigación, relatos de casos o experiencias. , con adultos, disponible en inglés, portugués y español, de 2003 a 2013. Resultados: Se seleccionaron 60 artículos, que dieron como resultado tres categorías de análisis: Viviendo con un trauma medular; Atención de enfermería a la persona con lesión medular en el proceso de rehabilitación; Calidad de vida de la persona con lesión medular y su familia. Conclusión: se concluye que para atender a las personas con lesión medular y sus familias es necesario buscar una formación profesional calificada que promueva posibilidades de atención que mejoren el vivir y vivir de estas personas.(AU)


Assuntos
Humanos , Reabilitação , Traumatismos da Medula Espinal , Enfermagem em Reabilitação , Cuidados de Enfermagem/métodos , Atividades Cotidianas
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2151-2154, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018432

RESUMO

Cervical spinal cord injury (cSCI) can cause paralysis and impair hand function. Existing assessments in clinical settings do not reflect an individual's performance in their daily environment. Videos from wearable cameras (egocentric video) provide a novel avenue to analyze hand function in non-clinical settings. Due to the large amounts of video data generated by this approach, automated analysis methods are necessary. We propose to employ an unsupervised learning process to produce a summary of the grasping strategies used in an egocentric video. To this end, an approach was developed consisting of hand detection, pose estimation, and clustering algorithms. The performance of the method was examined with external evaluation indicators and internal evaluation indicators for an uninjured and injured participant, respectively. The results demonstrated that a Gaussian mixture model obtained the highest accuracy in terms of the maximum match, 0.63, and the Rand index, 0.26, for the uninjured participant, and a silhouette score of 0.13 for the injured participant.


Assuntos
Mãos , Traumatismos da Medula Espinal , Análise por Conglomerados , Força da Mão , Humanos , Paralisia
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2159-2162, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018434

RESUMO

Cervical spinal cord injury (cSCI) causes the paralysis of upper and lower limbs and trunk, significantly reducing quality of life and community participation of the affected individuals. The functional use of the upper limbs is the top recovery priority of people with cSCI and wearable vision-based systems have recently been proposed to extract objective outcome measures that reflect hand function in a natural context. However, previous studies were conducted in a controlled environment and may not be indicative of the actual hand use of people with cSCI living in the community. Thus, we propose a deep learning algorithm for automatically detecting hand-object interactions in egocentric videos recorded by participants with cSCI during their daily activities at home. The proposed approach is able to detect hand-object interactions with good accuracy (F1-score up to 0.82), demonstrating the feasibility of this system in uncontrolled situations (e.g., unscripted activities and variable illumination). This result paves the way for the development of an automated tool for measuring hand function in people with cSCI living in the community.


Assuntos
Medula Cervical , Traumatismos da Medula Espinal , Dispositivos Eletrônicos Vestíveis , Mãos , Humanos , Qualidade de Vida
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3142-3145, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018671

RESUMO

Today's standard clinical practice to assess the walking ability of patients with neurological disorders during rehabilitation is based on simple gait tests such as the six-minute walking test (6MWT). Since the outcome of these tests is the average walking speed only, the aim of this work was to show that the application of movement sensors during a standardized walking test for the population of spinal cord injured (SCI) patients provides additional information on gait quality not directly described by the average speed. Hence, gait features that are related to quantitative and qualitative aspects of gait were extracted from the ankle sensor recordings of 29 SCI subjects and 19 healthy controls performing the 6MWT. The subjects were clustered into groups based on these gait features, and six gait features were selected to demonstrate the key differences between the clusters. The correlation of these features to the outcome of the 6MWT is discussed with their implications on gait quality.


Assuntos
Traumatismos da Medula Espinal , Dispositivos Eletrônicos Vestíveis , Marcha , Humanos , Traumatismos da Medula Espinal/diagnóstico , Caminhada
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3293-3296, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018708

RESUMO

It is still a challenge to delay the onset of fatigue on muscle contraction induced by Functional Electrical Stimulation (FES). We explored the use of two stimulation methods with the same total area, single electrode stimulation (SES), and spatially distributed electrical stimulation (SDSS) during isometric knee extension with spinal cord injured (SCI) volunteers. We applied stimulation on the left and right quadriceps of two SCI participants with both methods and recorded isometric force and evoked electromyography (eEMG). We calculated the force-time integral (FTI) and eEMG-time integral (eTI) for each stimulation series and used a linear regression as a measure of decay ratio. Moreover, we also estimated the contribution from each channel from eEMG.


Assuntos
Terapia por Estimulação Elétrica , Traumatismos da Medula Espinal , Eletrodos , Humanos , Contração Muscular , Fadiga Muscular , Traumatismos da Medula Espinal/terapia
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3525-3528, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018764

RESUMO

Intraspinal microstimulation is an effective method to rebuild motor function after spinal cord injury. However, in the implementation, available map of stimulation sites is lacking for reference. The location of electrode implantation can only be determined through multiple stimulation, causing secondary damage to the spinal cord. Therefore, in this paper, SD rats were chosen as the research subject, and the intraspinal microstimulation was used to perform three-dimensional scanning electrical stimulation on the lumbar spinal cord that controls the hindlimb motion. The site coordinates and corresponding threshold current that can induce motion of hip, knee and ankle joints were recorded. In order to reduce the individual variances and improve the universality and applicability of the map, the results of 6 groups were normalized, and three-dimensional map of spinal motor function were drawn in the same coordinate system. The overlap of the distribution area of the same motion in each group was defined as the core region. The threshold current of all sites were analyzed statistically to obtain the most appropriate range of current intensity required to induce hindlimb motion. Using appropriate current for intraspinal microstimulation in the core region can selectively induce desired hindlimb motion, greatly improving the accuracy and reliability of electrode implantation.


Assuntos
Região Lombossacral , Traumatismos da Medula Espinal , Animais , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/terapia
18.
Wiad Lek ; 73(9 cz. 1): 1882-1887, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33099535

RESUMO

Morbidity and mortality associated with aortic aneurysm remains high. Aneurysms involving the thoracic and lumbar part of the aorta (TAAA) are particularly burdened with mortality. They are also one of the biggest challenges that vascular surgeons can face. Despite several dozen years of progress in surgical techniques, as well as the constant development of accompanying methods of spinal protection, ischemic spinal cord injury with subsequent paresis or pareresis is still one of the most serious complications of both open and closed surgical treatment of aortic aneurysms. Ischemic complications of the spinal cord occur immediately after the procedure, when the patient wakes up with a neurological deficit (according to some authors within the first day after the procedure) or in a deferred manner. In the case of open surgery, immediate damage is more common, in the case of endovascular surgery - deferred. Factors such as low blood pressure, arrhythmias, cardiovascular failure, sepsis and anemia due to anemia contribute to an increased risk of deferred complications. The rehabilitation of a patient with limb paralysis as a consequence of vascular spinal injury is laborious and requires a comprehensive approach. Proper treatment and prompt intervention in the form of rehabilitation is a great therapeutic challenge. The aim of the paper was to present the importance of the ischemic injuries of spinal cord following aortic stent graft implantation through a case report.


Assuntos
Aneurisma da Aorta Torácica , Traumatismos da Medula Espinal , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Humanos , Isquemia , Traumatismos da Medula Espinal/complicações , Stents/efeitos adversos
19.
Nat Commun ; 11(1): 5209, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33060602

RESUMO

Chronic high-thoracic and cervical spinal cord injury (SCI) results in a complex phenotype of cardiovascular consequences, including impaired left ventricular (LV) contractility. Here, we aim to determine whether such dysfunction manifests immediately post-injury, and if so, whether correcting impaired contractility can improve spinal cord oxygenation (SCO2), blood flow (SCBF) and metabolism. Using a porcine model of T2 SCI, we assess LV end-systolic elastance (contractility) via invasive pressure-volume catheterization, monitor intraparenchymal SCO2 and SCBF with fiberoptic oxygen sensors and laser-Doppler flowmetry, respectively, and quantify spinal cord metabolites with microdialysis. We demonstrate that high-thoracic SCI acutely impairs cardiac contractility and substantially reduces SCO2 and SCBF within the first hours post-injury. Utilizing the same model, we next show that augmenting LV contractility with the ß-agonist dobutamine increases SCO2 and SCBF more effectively than vasopressor therapy, whilst also mitigating increased anaerobic metabolism and hemorrhage in the injured cord. Finally, in pigs with T2 SCI survived for 12 weeks post-injury, we confirm that acute hemodynamic management with dobutamine appears to preserve cardiac function and improve hemodynamic outcomes in the chronic setting. Our data support that cardio-centric hemodynamic management represents an advantageous alternative to the current clinical standard of vasopressor therapy for acute traumatic SCI.


Assuntos
Coração/fisiopatologia , Hemodinâmica/fisiologia , Hemorragia/fisiopatologia , Fenômenos Fisiológicos Respiratórios , Traumatismos da Medula Espinal/fisiopatologia , Medula Espinal/fisiopatologia , Animais , Modelos Animais de Doenças , Dobutamina/farmacologia , Feminino , Fluxometria por Laser-Doppler , Chaperonas Moleculares/metabolismo , Norepinefrina/farmacologia , Fluxo Sanguíneo Regional/fisiologia , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/patologia , Suínos , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/fisiopatologia
20.
Science ; 370(6512)2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33004487

RESUMO

Injuries to the central nervous system (CNS) are inefficiently repaired. Resident neural stem cells manifest a limited contribution to cell replacement. We have uncovered a latent potential in neural stem cells to replace large numbers of lost oligodendrocytes in the injured mouse spinal cord. Integrating multimodal single-cell analysis, we found that neural stem cells are in a permissive chromatin state that enables the unfolding of a normally latent gene expression program for oligodendrogenesis after injury. Ectopic expression of the transcription factor OLIG2 unveiled abundant stem cell-derived oligodendrogenesis, which followed the natural progression of oligodendrocyte differentiation, contributed to axon remyelination, and stimulated functional recovery of axon conduction. Recruitment of resident stem cells may thus serve as an alternative to cell transplantation after CNS injury.


Assuntos
Células-Tronco Neurais/fisiologia , Neurogênese/fisiologia , Oligodendroglia/fisiologia , Regeneração da Medula Espinal/fisiologia , Animais , Astrócitos/fisiologia , Axônios/fisiologia , Linhagem da Célula , Epêndima/citologia , Epêndima/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Neurogênese/genética , Fator de Transcrição 2 de Oligodendrócitos/metabolismo , Oligodendroglia/citologia , Recuperação de Função Fisiológica/genética , Recuperação de Função Fisiológica/fisiologia , Remielinização/genética , Remielinização/fisiologia , Análise de Célula Única , Traumatismos da Medula Espinal/fisiopatologia , Regeneração da Medula Espinal/genética
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