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1.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083190

RESUMO

Hypercalcaemia due to immobilisation is an uncommon diagnosis and requires extensive evaluation to rule out common causes of hypercalcaemia such as primary hyperparathyroidism and malignancy.We report an unusual case of profound hypercalcaemia due to immobilisation in a young man due to acute spinal cord ischaemia, leading to paraplegia. Other causes of hypercalcaemia were ruled out and elevated bone turnover markers supported our hypothesis. Conventional treatment with intravenous fluids, bisphosphonates and diuretics was insufficient. Subcutaneous calcitonin lowered the plasma calcium acutely and was continued for 8 weeks. Subsequent normocalcaemia was sustained for 2 years.


Assuntos
Conservadores da Densidade Óssea , Hipercalcemia , Traumatismos da Medula Espinal , Conservadores da Densidade Óssea/uso terapêutico , Calcitonina , Cálcio , Difosfonatos/uso terapêutico , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Masculino , Traumatismos da Medula Espinal/complicações
2.
Int J Mol Sci ; 22(9)2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-34063051

RESUMO

Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.


Assuntos
Toxinas Botulínicas/envenenamento , Toxinas Botulínicas/uso terapêutico , Espasticidade Muscular/complicações , Espasticidade Muscular/tratamento farmacológico , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico , Animais , Humanos , Dose Máxima Tolerável , Neurotoxinas/envenenamento
3.
Medicine (Baltimore) ; 100(24): e26424, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128907

RESUMO

BACKGROUND: Spinal cord injury (SCI) is one of the most disabling and destructive neurological diseases. Neurogenic bladder dysfunction (NBD) is one of the serious complications after SCI, 80% of patients after SCI will have neurogenic bladder symptoms. NBD after SCI may lead to urinary retention, urinary incontinence, and urinary tract infection. In severe cases, it can lead to renal failure or even death. NBD after SCI not only seriously affects the patient's quality of life but also physical and mental health. NBD after SCI is a social and medical problem. In recent years, more and more clinical studies prove that heat-sensitive can improve the clinical symptoms of NBD after SCI. Therefore, this article conducts a systematic evaluation and meta-analysis on the efficacy and safety of heat-sensitive moxibustion in treating NBD after SCI. METHODS: Search 8 electronic databases including PubMed, Embase, Web of Science, The Cochrane Library, Clinical Trials, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and China Biomedical Literature Database. We will search above electronic databases from the inception to May 2021, without any language restriction. Clinical randomized controlled trials containing heat-sensitive moxibustion for NBD after SCI and eligible interventions(s) and outcome(s) were included, with no limitation of language and publication status. Two researchers will independently conduct literature search, screening, information extraction, quality assessment, and data analysis. Review Manager 5.3 software will be used for statistical analysis. RESULTS: The findings will be submitted to a peer-reviewed publication. CONCLUSION: This systematic review and meta-analysis will provide a standard clinical decision-making guideline for heat-sensitive moxibustion treatment of NBD after SCI. INPLASY REGISTRATION NUMBER: INPLASY202150071.


Assuntos
Metanálise como Assunto , Moxibustão/métodos , Traumatismos da Medula Espinal/complicações , Revisões Sistemáticas como Assunto , Bexiga Urinaria Neurogênica/terapia , Protocolos Clínicos , Temperatura Alta , Humanos , Moxibustão/efeitos adversos , Bexiga Urinaria Neurogênica/etiologia
4.
J Int Med Res ; 49(6): 3000605211022294, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34154433

RESUMO

OBJECTIVE: Spasticity is a frequent complication after spinal cord injury (SCI), but the existing therapies provide only limited relief and are associated with adverse reactions. Therefore, we aimed to develop a novel strategy to ameliorate the spasticity induced by SCI. METHODS: This nonrandomized controlled study used a repeated measurement design. The study involved four monkeys, two of which served as controls and only underwent spinal cord hemisection surgery at the T8 spine level. The other two monkeys underwent transplantation of sural nerve segments into the injured sites and long-term infusion of acidic fibroblast growth factor (aFGF). All monkeys received postoperative exercise training and therapy. RESULTS: The combined therapy substantially reduced the spasticity in leg muscle tone, patella tendon reflex, and fanning of toes. Although all monkeys showed spontaneous recovery of function over time, the recovery in the controls reached a plateau and started to decline after 11 weeks. CONCLUSIONS: The combination of peripheral nerve grafting and aFGF infusion may serve as a complementary approach to reduce the signs of spasticity in patients with SCI.


Assuntos
Fator 1 de Crescimento de Fibroblastos , Traumatismos da Medula Espinal , Animais , Haplorrinos , Humanos , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Regeneração Nervosa , Nervos Periféricos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico
5.
J Vet Diagn Invest ; 33(4): 788-791, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34041971

RESUMO

The most prevalent causes of death in racehorses are musculoskeletal injuries, causing ~83% of deaths within the racing industry in California and elsewhere. The vast majority of these injuries have preexisting lesions that predispose to fatal injury. A 4-y-old Thoroughbred colt suffered an acute suspensory apparatus failure, including biaxial proximal sesamoid bone fractures of the right front fetlock, causing loss of support of the fetlock joint and consequent fall with fractures of the cervical and sacral spine. Cervical fracture caused spinal cord damage that resulted in sudden death. A preexisting lesion in the medial proximal sesamoid bone likely predisposed to complete fracture of this bone and fetlock breakdown. Interestingly, a comparable osteopenic lesion was present in the intact medial proximal sesamoid bone of the left forelimb, which is consistent with bilateral repetitive overuse injury in racehorses. The morphologic features of the cervical and sacral spine fractures were compatible with acute injury; no evidence of preexisting lesions was seen. Most likely, these acute vertebral fractures occurred as a result of the horse falling. This case emphasizes the importance of performing a detailed autopsy in horses that suffer an appendicular musculoskeletal injury, particularly in fatal cases when the horse dies following a leg injury.


Assuntos
Morte Súbita/veterinária , Cavalos/lesões , Ossos Sesamoides/lesões , Traumatismos da Medula Espinal/veterinária , Fraturas da Coluna Vertebral/veterinária , Animais , Morte Súbita/etiologia , Fraturas Ósseas/veterinária , Masculino , Ossos Sesamoides/patologia , Traumatismos da Medula Espinal/complicações , Fraturas da Coluna Vertebral/complicações
6.
J Neuroeng Rehabil ; 18(1): 86, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030720

RESUMO

BACKGROUND: Exoskeleton-assisted walking (EAW) is expected to improve the gait of spinal cord injury (SCI) individuals. However, few studies reported the changes of pulmonary function (PF) parameters after EAW trainings. Hence, we aimed to explore the effect of EAW on PF parameters, 6-min walk test (6MWT) and lower extremity motor score (LEMS) in individuals with SCI and to compare those with conventional trainings. METHODS: In this prospective, single-center, single-blinded randomized controlled pilot study, 18 SCI participants were randomized into the EAW group (n = 9) and conventional group (n = 9) and received 16 sessions of 50-60 min training (4 days/week, 4 weeks). Pulmonary function parameters consisting of the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow (FEF), peak expiratory flow, and maximal voluntary ventilation, 6MWT with assisted devices and LEMS were reported pre- and post-training. RESULTS: Values of FVC (p = 0.041), predicted FVC% (p = 0.012) and FEV1 (p = 0.013) were significantly greater in EAW group (FVC: 3.8 ± 1.1 L; FVC% pred = 94.1 ± 24.5%; FEV1: 3.5 ± 1.0 L) compared with conventional group (FVC: 2.8 ± 0.8 L; FVC% pred = 65.4 ± 17.6%; FEV1: 2.4 ± 0.6 L) after training. Participants in EAW group completed 6MWT with median 17.3 m while wearing the exoskeleton. There was no difference in LEMS and no adverse event. CONCLUSIONS: The current results suggest that EAW has potential benefits to facilitate PF parameters among individuals with lower thoracic neurological level of SCI compared with conventional trainings. Additionally, robotic exoskeleton helped walking. TRIAL REGISTRATION: Registered on 22 May 2020 at Chinese Clinical Trial Registry (ChiCTR2000033166). http://www.chictr.org.cn/edit.aspx?pid=53920&htm=4 .


Assuntos
Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Resistência Física/fisiologia , Fenômenos Fisiológicos Respiratórios , Traumatismos da Medula Espinal/reabilitação , Adulto , Terapia por Exercício/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Testes de Função Respiratória , Robótica , Método Simples-Cego , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Caminhada
8.
Mil Med Res ; 8(1): 29, 2021 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-33910625

RESUMO

BACKGROUND: Traumatic spinal cord injury (SCI) is also a combat-related injury that is increasing in modern warfare. The aim of this work is to inform medical experts regarding the different course of bladder cancer in able-bodied patients compared with SCI patients based on the latest medical scientific knowledge, and to present decision-making aids for the assessment of bladder cancer as a late sequela of traumatic SCI. METHODS: A study conducted between January 1998 and December 2019 in the BG Trauma Hospital Hamburg formed the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 40 out of 7396 treated outpatient and inpatient SCI patients. General patient information, latency period, age at initial diagnosis, type of bladder management and survival of SCI patients with bladder cancer were collected and analysed. T category, grading and tumour entity in these patients were compared with those in the general population. Relevant bladder cancer risk factors in SCI patients were analysed. Furthermore, relevant published literature was taken into consideration. RESULTS: Initial diagnosis of urinary bladder cancer in SCI patients occurs at a mean age of 56.4 years (SD ± 10.7 years), i.e., approximately 20 years earlier as compared with the general population. These bladder cancers are significantly more frequently muscle invasive (i.e., T category ≥ T2) and present a higher grade at initial diagnosis. Furthermore, SCI patients show a significantly higher proportion of the more aggressive squamous cell carcinoma than that of the general population in areas not endemic for the tropical disease schistosomiasis. Consequently, the survival time is extremely unfavourable. A very important finding, for practical reasons is that, in the Hamburg study as well as in the literature, urinary bladder cancer is more frequently observed after 10 years or more of SCI. Based on these findings, a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSIONS: The results showed that urinary bladder cancer in SCI patients differs considerably from that in able-bodied patients. The presented algorithm is an important aid in everyday clinical practice for assessing the correlation between SCI and bladder cancer.


Assuntos
Traumatismos da Medula Espinal/complicações , Neoplasias da Bexiga Urinária/etiologia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Traumatismos da Medula Espinal/epidemiologia , Fatores de Tempo , Neoplasias da Bexiga Urinária/epidemiologia , Ferimentos e Lesões/complicações
9.
Am J Phys Med Rehabil ; 100(5): 432-434, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1169720

RESUMO

ABSTRACT: Spinal cord injuries lead to impairment of the central regulation of respiratory muscle activity. This impairs the cough response, which can increase the risk of complications if infected with coronavirus disease 2019. This case describes a 32-yr-old man with an acute traumatic motor incomplete spinal cord injury, C4 American Spinal cord Injury Association Impairment Scale D D, in an inpatient rehabilitation facility who presented with only a fever. Initial infectious workup was negative, and he continued to have elevated temperatures with no other symptoms. He was then tested for coronavirus disease 2019 and found to be positive. This is the first documented case that identifies this potentially lethal disease in an acute motor incomplete spinal cord injury in an inpatient rehabilitation setting. We further discuss how physiatrists need to be aware of milder presentation of coronavirus disease 2019 in patients with spinal cord injuries. Inability to recognize this disease can lead to delayed diagnosis and asymptomatic spread in an inpatient rehabilitation setting.


Assuntos
COVID-19/complicações , COVID-19/diagnóstico , Controle de Infecções/organização & administração , Traumatismos da Medula Espinal/reabilitação , Adulto , COVID-19/terapia , Vértebras Cervicais , Hospitalização , Humanos , Masculino , Traumatismos da Medula Espinal/complicações
10.
Acta Neurochir Suppl ; 131: 367-372, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33839876

RESUMO

INTRODUCTION: Degenerative cervical myelopathy (DCM) leads to functional impairment by compression of the spinal cord and nerve roots. In DCM, the dynamics of cerebrospinal fluid pressure (CSFP) and intraspinal pressure (ISP), as well as spinal cord perfusion pressure (SCPP) remain not investigated yet. Recent technical advances have enabled investigation of these parameters in acute spinal cord injury (SCI). We aim to investigate the properties of CSFP/ISP and spinal cord hemodynamics during and after decompressive surgery in DCM. MATERIALS AND METHODS: Four patients with DCM were enrolled; during surgery and 24 h postoperative, ISP at level was measured in one patient, and CSFP was measured in two patients. In one patient, CSFP was recorded at bedside before surgery. RESULTS: All measurements were conducted without adverse events and were well tolerated. With CSFP analysis, post-decompression Queckenstedt's test was responsive in two patients (i.e., jugular vein compression resulted in an elevation of CSFP pressure). In the patient whose CSFP was tested at bedside, Queckenstedt's test was not responsive before decompression. Individual optimum SCPPs were calculated to be between 70 and 75 mmHg. CONCLUSION: ISP and CSFP can reflect spinal compression and sufficient decompression. A better understanding and systematic monitoring possibly lead to improved hemodynamic management and may allow early recognition of postoperative complications such as swelling and bleeding.


Assuntos
Pressão do Líquido Cefalorraquidiano , Constrição Patológica , Estudos de Viabilidade , Humanos , Traumatismos da Medula Espinal/complicações
11.
NeuroRehabilitation ; 48(3): 353-363, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814472

RESUMO

BACKGROUND: A number of physiological and atmospheric variables are believed to increase spasticity in persons with spinal cord injury (SCI) based on self-reported measures, however, there is limited objective evidence about the influence of these variables on spasticity. OBJECTIVE: We investigated the relationship between physiological/ atmospheric variables and level of spasticity in individuals with SCI. METHODS: In 53 participants with motor-incomplete SCI, we assessed the influence of age, time since injury, sex, injury severity, neurological level of injury, ability to walk, antispasmodic medication use, temperature, humidity, and barometric pressure on quadriceps spasticity. Spasticity was assessed using the pendulum test first swing excursion (FSE). To categorize participants based on spasticity severity, we performed cluster analysis. We used multivariate stepwise regression to determine variables associated with spasticity severity level. RESULTS: Three spasticity groups were identified based on spasticity severity level: low, moderate, and high. The regression analysis revealed that only walking ability and temperature were significantly related to spasticity severity. CONCLUSIONS: These outcomes validate the self-reported perception of people with SCI that low temperatures worsen spasticity. The findings refine prior evidence that people with motor-incomplete SCI have higher levels of spasticity, showing that those with sufficient motor function to walk have the highest levels of spasticity.


Assuntos
Espasticidade Muscular/epidemiologia , Traumatismos da Medula Espinal/complicações , Tempo (Meteorologia) , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Quadríceps/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Caminhada
12.
BMJ Case Rep ; 14(4)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827865

RESUMO

A 49-year-old consultant medical oncologist, with a medical history of complete T5 spinal cord injury (March 1992) and long-term paralysis from the chest down, presented with shingles affecting the T7 dermatome. He also had a dull frontal headache, a feeling of agitation and increased blood pressure of 135/90 on a home blood pressure machine (higher than his usual blood pressure of 90/70). Having been taught about autonomic dysreflexia at the time of his initial spinal cord injury, he self-diagnosed autonomic dysreflexia caused by the noxious stimulus of shingles below his level of spinal cord injury. He self-administered a nifedipine 5 mg sublingual capsule to decrease his blood pressure before urgently seeing his general practitioner. Treatment of the shingles with acyclovir and analgesia successfully managed the problem and avoided hospital admission. This case highlights key aspects in treating autonomic dysreflexia and the value of doctor-patient partnership in doing so.


Assuntos
Disreflexia Autonômica , Doenças do Sistema Nervoso Autônomo , Exantema , Traumatismos da Medula Espinal , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/tratamento farmacológico , Disreflexia Autonômica/etiologia , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medula Espinal , Traumatismos da Medula Espinal/complicações
13.
BMJ Case Rep ; 14(4)2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832933

RESUMO

Pregnancy in patients with spinal cord injury presents unique challenges to their care teams. While spinal cord injury alters the function of several organ systems, one of the most important consequences is autonomic dysreflexia. Anaesthesia providers must be familiar with the pathophysiology and management of gravid patients with spinal cord injury to manage their deliveries successfully. A multidisciplinary team is essential; close collaboration between the obstetrical and anaesthesiology teams is crucial. The authors will present a case of a successful caesarean delivery in a woman with a T5 injury as well as a recent epidural abscess using general endotracheal anaesthesia.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Complicações na Gravidez , Traumatismos da Medula Espinal , Cesárea , Contraindicações , Feminino , Humanos , Unidades de Terapia Intensiva , Gravidez , Complicações na Gravidez/terapia , Segundo Trimestre da Gravidez , Traumatismos da Medula Espinal/complicações
14.
Work ; 68(4): 1009-1018, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33867367

RESUMO

BACKGROUND: Psychological morbidity is commonly experienced by people with a spinal cord injury (SCI), but whether it is associated with occupational role transitions in is unknown. OBJECTIVE: To analyze whether anxiety or depression symptoms are independently associated to increased likelihoods of role transitions in adults with SCI. METHODS: Cross-sectional study; multivariate analysis using a heteroscedastic Dirichlet regression. PARTICIPANTS: Thirty persons with traumatic SCI. MEASURES: Role Checklist (e.g. role transitions: dependent variables) and Beck's Depression Inventory and State-Trait Anxiety Inventory (independent variables), adjusted for socio-demographic, functional, and injury-level confounders. RESULTS: Greater depression symptoms independently increased the likelihood of occupational role transitions, either for roles loss [adjusted Odds Ratio (AOR): 1.04; 95% confidence interval (CI):1.009-1.080] or roles gain [AOR: 1.07; 95% CI:1.02-1.13], as opposed to continued occupational roles. Higher anxiety as a trait, in turn, independently reduced the likelihood of occupational roles gain [AOR: 0.93; 95% CI: 0.869-0.992]. The "worker" role was the one lost more frequently (83%). CONCLUSION: Psychological morbidity is associated to occupational role transitions, as opposed to continued roles. Further research (e.g. with larger samples, longitudinal design, using structural equation modelling) should elucidate on the intricate relationships between mental health status and occupational role transitions in people experiencing SCI.


Assuntos
Depressão , Traumatismos da Medula Espinal , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Brasil/epidemiologia , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Humanos , Análise Multivariada , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia
15.
Biomed Res Int ; 2021: 6687963, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928162

RESUMO

Objectives: To investigate the roles of miR-221 in spinal cord injury (SCI) as well as the underlying mechanism. Methods: A mouse model of SCI was generated and used to examine dynamic changes in grip strength of the mouse upper and lower limbs. The expression of miR-221 and tumor necrosis factor-α (TNF-α) was detected by RT-qPCR and Western blot. Levels of inflammation and oxidative stress in microglia cells of the injured mice overexpressing miR-221 were then measured by ELISA. Bioinformatics analysis and dual-luciferase reporter assay were conducted to identify the miR-221 target. Results: We successfully constructed SCI mouse model. The results of qRT-PCR showed that miR-221 was gradually upregulated in the spinal cord tissue of mice in the SCI group with the prolonged injury time. At the same time, the mRNA and protein of TNF-α gradually decreased. We further confirmed through cell experiments that the inflammatory factors TNF-α and IL-6, as well as iNOS and eROS, were upregulated in spinal cord microglia cells of SCI mice, and upregulation of miR-122 can inhibit their expression. Finally, the luciferase reporter experiment confirmed that miR-122 targeted TNF-α. Conclusions: We present evidence that miR-221 promotes functional recovery of the injured spinal cord through targeting TNF-α, while alleviating inflammatory response and oxidative stress.


Assuntos
Inflamação/genética , MicroRNAs/metabolismo , Traumatismos da Medula Espinal/genética , Fator de Necrose Tumoral alfa/metabolismo , Animais , Sequência de Bases , Modelos Animais de Doenças , Regulação para Baixo/genética , Inflamação/complicações , Inflamação/patologia , Masculino , Camundongos Endogâmicos C57BL , MicroRNAs/genética , Traumatismos da Medula Espinal/complicações
16.
Int J Mol Sci ; 22(6)2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33802713

RESUMO

Spinal cord injury (SCI) affects approximately 300,000 people in the United States. Most individuals who sustain severe SCI also develop subsequent osteoporosis. However, beyond immobilization-related lack of long bone loading, multiple mechanisms of SCI-related bone density loss are incompletely understood. Recent findings suggest neuronal impairment and disability may lead to an upregulation of receptor activator of nuclear factor-κB ligand (RANKL), which promotes bone resorption. Disruption of Wnt signaling and dysregulation of RANKL may also contribute to the pathogenesis of SCI-related osteoporosis. Estrogenic effects may protect bones from resorption by decreasing the upregulation of RANKL. This review will discuss the current proposed physiological and cellular mechanisms explaining osteoporosis associated with SCI. In addition, we will discuss emerging pharmacological and physiological treatment strategies, including the promising effects of estrogen on cellular protection.


Assuntos
Osteoporose/etiologia , Osteoporose/fisiopatologia , Traumatismos da Medula Espinal/complicações , Animais , Remodelação Óssea/fisiologia , Estrogênios/uso terapêutico , Exercício Físico , Humanos , Osteoporose/tratamento farmacológico , Transdução de Sinais
17.
Top Spinal Cord Inj Rehabil ; 27(1): 1-10, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814879

RESUMO

Individuals with a spinal cord injury (SCI) have a unique physiology characterized by sarcopenia, neurogenic osteoporosis, neurogenic anabolic deficiency, sympathetic dysfunction, and blunted satiety associated with their SCI, all of which alter energy balance and subsequently body composition. The distinct properties of "neurogenic obesity" place this population at great risk for metabolic dysfunction, including systemic inflammation, hyperglycemia, dyslipidemia, and hypertension. The purpose of this article is to demonstrate the relationship between neurogenic obesity and the metabolic syndrome after SCI, highlighting the mechanisms associated with adipose tissue pathology and those respective comorbidities. Additionally, representative studies of persons with SCI will be provided to elucidate the severity of the problem and to prompt greater vigilance among SCI specialists as well as primary care providers in order to better manage the epidemic from a public health perspective.


Assuntos
Síndrome Metabólica/etiologia , Obesidade/complicações , Obesidade/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Humanos
18.
Top Spinal Cord Inj Rehabil ; 27(1): 11-22, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814880

RESUMO

Background: Obesity is at epidemic proportions in the population with spinal cord injury (SCI), and adipose tissue (AT) is the mediator of the metabolic syndrome. Obesity, however, has been poorly appreciated in SCI because of the lack of sensitivity that body mass index (BMI) conveys for obesity risk in SCI without measuring AT. Objectives: The specific objectives were to compare measures of body composition assessment for body fat with the criterion standard 4-compartment (4C) model in persons with SCI, to develop a regression equation that can be utilized in the clinical setting to estimate fat mass (FM), and to determine cardiometabolic risk using surrogates of obesity in a current model of metabolic syndrome. Methods: Seventy-two individuals with chronic (>1 year) motor complete (AIS A and B) C5-L2 SCI were recruited over 3 years. Subjects underwent assessment with 4C using hydrostatic (underwater) weighing (UWW), dual-energy x-ray absorptiometry (DXA), and total body water (TBW) assessment to determine percent body fat (%BF); fasting glucose and lipid profiles, and resting blood pressure were also obtained. BMI, DXA, bioelectrical impedance analyses (BIA), BodPod, circumferences, diameters, lengths, and nine-site skinfold (SF) were assessed and validated against 4C. A multiple linear regression model was used to fit %BF (dependent variable) using anthropometric and demographic data that had the greatest correlations with variables, followed by a combined forward/backward stepwise regression with Akaike information criterion (AIC) to identify the variables most predictive of the 4C %BF. To allow for a more practical model for use in the clinical setting, we further reduced the AIC model with minimal loss of predictability. Surrogate markers of obesity were employed with metabolic biomarkers of metabolic syndrome to determine prevalence in persons with SCI. Results: Subject characteristics included age 44.4 ± 11.3 years, time since injury (TSI) 14.4 ± 11.0 years, BMI 27.3 ± 5.9 kg/m2; 59 were men and 13 were women. Sitting waist circumference (WCSit ) was 95.5 ± 13.1 cm, supine waist circumference (WCSup) was 93.4 ± 12.7 cm, and abdominal skinfold (ABDSF) was 53.1 ± 19.6 mm. Findings showed 4C %BF 42.4 ± 8.6%, UWW %BF 37.3 ± 9.7%, DXA %BF 39.1 ± 9.4%, BodPod %BF 33.7 ± 11.4%, nine-site SF %BF 37.8 ± 9.3%, and BIA %BF 27.6 ± 8.6%. A regression equation using age, sex, weight, and ABDSF provided R2 correlation of 0.57 with 4C %BF (p < .0001). Metabolic syndrome was identified in 59.4% of the sample. Conclusion: Body composition techniques to determine body fat are labor intensive and expensive for persons with SCI, and the regression equation developed against the criterion standard 4C model may allow clinicians to quickly estimate %BF and more accurately demonstrate obesity-induced cardiometabolic syndrome in this population.


Assuntos
Tecido Adiposo/metabolismo , Antropometria/métodos , Fatores de Risco Cardiometabólico , Obesidade/metabolismo , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Composição Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Top Spinal Cord Inj Rehabil ; 27(1): 23-35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814881

RESUMO

Over two-thirds of persons with spinal cord injury (SCI) experience neurogenic obesity-induced cardiometabolic syndrome (CMS) and other chronic comorbidities. Obesity is likely to impede social and recreational activities, impact quality of life, and impose additional socioeconomic burdens on persons with SCI. Advances in imaging technology facilitate the mapping of adiposity and its association with the cardiometabolic profile after SCI. Central adiposity or central obesity is characterized by increased waist (WC) and abdominal circumferences (AC) as well as visceral adipose tissue (VAT). A number of studies, while relying on expensive imaging techniques, have reported direct associations of both central obesity and VAT in imposing significant health risks after SCI. The mechanistic role of central obesity on cardiometabolic heath in persons with SCI has yet to be identified, despite the knowledge that it has been designated as an independent risk factor for cardiometabolic dysfunction and premature mortality in other clinical populations. In persons with SCI, the distribution of adipose tissue has been suggested to be a function of sex, level of injury, and age. To date, there is no SCI-specific WC or AC cutoff value to provide anthropometric prediction of VAT and diagnostic capability of persons at risk for central obesity, CMS, and cardiovascular disease after SCI. The purpose of the current review is to summarize the factors contributing to visceral adiposity in persons with SCI and to develop an SCI-specific anthropometric prediction equation for this population. Furthermore, a proposed WC cutoff will be discussed as a surrogate index for central obesity, CMS, and cardiovascular disorders after SCI.


Assuntos
Antropometria/métodos , Fatores de Risco Cardiometabólico , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/metabolismo , Obesidade/diagnóstico por imagem , Obesidade/metabolismo , Traumatismos da Medula Espinal/complicações , Fatores Etários , Humanos , Valor Preditivo dos Testes , Fatores Sexuais
20.
Top Spinal Cord Inj Rehabil ; 27(1): 36-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814882

RESUMO

The population with SCI is at a significant risk for both insulin resistance and type 2 diabetes mellitus (T2DM) secondary to neurogenic obesity. The prevalence of insulin resistance and T2DM in persons with SCI suggests that disorders of carbohydrate metabolism are at epidemic proportions within the population. However, the true frequency of such disorders may be underestimated because biomarkers of insulin resistance and T2DM used from the population without SCI remain nonspecific and may in fact fail to identify true cases that would benefit from intervention. Furthermore, diet and exercise have been used to help mitigate neurogenic obesity, but results on disorders of carbohydrate metabolism remain inconsistent, likely because of the various ways carbohydrate metabolism is assessed. The objective of this article is to review current literature on the prevalence and likely mechanisms driving insulin resistance and T2DM in persons with SCI. This article also explores the various assessments and diagnostic criteria used for insulin resistance and T2DM and briefly discusses the effects of exercise and/or diet to mitigate disorders of carbohydrate metabolism brought on by neurogenic obesity.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Resistência à Insulina , Obesidade/complicações , Traumatismos da Medula Espinal/complicações , Diabetes Mellitus Tipo 2/terapia , Carboidratos da Dieta/metabolismo , Terapia por Exercício , Humanos , Obesidade/terapia , Traumatismos da Medula Espinal/terapia
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