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1.
Zhongguo Zhen Jiu ; 41(3): 307-12, 2021 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-33798315

RESUMO

OBJECTIVE: To explore the influence of electroacupuncture (EA) on the expression of AMPA receptor subunit GluR1 in the rats with acute spinal cord injury (SCI) and explore the potential effect mechanism of EA in treatment of acute SCI. METHODS: A total of 80 SD rats were randomly divided into five groups, i.e. a sham-operation group, a model group, an AMPA antagonist (DNQX) group, an EA group and a DNQX+EA group, 16 rats in each group. The modified Allen's impacting method was adopted to prepare the rat model of acute SCI at T10. In the DNQX group, the intrathecal injection of 10 µL DNQX solution with a concentration of 1 nmol/µL was administered in 0.5 h after modeling success. In the EA group, EA (disperse-dense wave, 2 Hz/100 Hz in frequency, 0.5 mA in output current) was given at "Dazhui" (GV 14) and "Mingmen" (GV 4) in 0.5 h, 12 h and 24 h after modeling success for 30 min and totally 3 times. In the DNQX + EA group, the interventions in the above two groups were managed. The Basso, Beattie and Bresnahan locomotor rating score (BBB) was applied to evaluate the changes of locomotor function in the rats before modeling and in 6 h, 24 h and 48 h after modeling successively. Using the hematoxylin-eosin (HE) staining, the histopathological changes in the spinal anterior horn were observed in the spinal injured area. The immunofluorescence method was adopted to determine the number of GluR1 positive neuron of the spinal anterior horn. The Western blot method was used to determine the protein expression of GluR1 in the injured area. RESULTS: Compared to the sham-operation group in 6 h, 24 h and 48 h after modeling, the BBB scores were all significantly decreased in the model group (P<0.001) at the corresponding points. The BBB score was increased in each of intervention groups, but without statistical difference as compared with the model group (P>0.05). In the model group, it was found that the boundary between gray matter and white matter in the spinal anterior horn was blurred, the interstitial space enlarged, the neuron volume obviously shrunken, the cytoplasm decreased, the red stain deepened and some neuron nuclei fixed and shrunk. In the EA group, the morphology of the spinal anterior horn in the injured area was improved obviously, which was similar in the DNQX group and the DNQX + EA group. Compared with the sham-operation group, the GluR1 protein expression in the spinal injury area was increased (P<0.001) and the number of GluR1 positive neurons elevated (P<0.001) in the spinal anterior horn in the model group. Compared with the model group, in the EA group, the DNQX group and the DNQX + EA group, GluR1 protein expression was decreased (P<0.05, P<0.01) and the number of GluR1 positive neurons in the spinal anterior horn reduced (P<0.001). CONCLUSION: The intervention with EA at "Dazhui" and "Mingmen" promotes the repair of the injured nerve in the spinal anterior horn probably through inhibiting GluR1 expression in the spinal injured area in the rats with acute SCI.


Assuntos
Eletroacupuntura , Traumatismos da Medula Espinal , Animais , Ratos , Ratos Sprague-Dawley , Receptores de AMPA/genética , Medula Espinal , Traumatismos da Medula Espinal/genética , Traumatismos da Medula Espinal/terapia
2.
Microbiome ; 9(1): 59, 2021 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-33678185

RESUMO

BACKGROUND: Spinal cord injury (SCI) patients display disruption of gut microbiome, and gut dysbiosis exacerbate neurological impairment in SCI models. Cumulative data support an important role of gut microbiome in SCI. Here, we investigated the hypothesis that fecal microbiota transplantation (FMT) from healthy uninjured mice into SCI mice may exert a neuroprotective effect. RESULTS: FMT facilitated functional recovery, promoted neuronal axonal regeneration, improved animal weight gain and metabolic profiling, and enhanced intestinal barrier integrity and GI motility in SCI mice. High-throughput sequencing revealed that levels of phylum Firmicutes, family Christensenellaceae, and genus Butyricimonas were reduced in fecal samples of SCI mice, and FMT remarkably reshaped gut microbiome. Also, FMT-treated SCI mice showed increased amount of fecal short-chain fatty acids (SCFAs), which correlated with alteration of intestinal permeability and locomotor recovery. Furthermore, FMT downregulated IL-1ß/NF-κB signaling in spinal cord and NF-κB signaling in gut following SCI. CONCLUSION: Our study demonstrates that reprogramming of gut microbiota by FMT improves locomotor and GI functions in SCI mice, possibly through the anti-inflammatory functions of SCFAs. Video Abstract.


Assuntos
Encéfalo/fisiologia , Transplante de Microbiota Fecal , Microbioma Gastrointestinal/fisiologia , Neuroproteção/fisiologia , Traumatismos da Medula Espinal/terapia , Animais , Ácidos Graxos Voláteis/metabolismo , Fezes/química , Feminino , Interleucina-1beta/metabolismo , Intestinos/microbiologia , Intestinos/fisiologia , Locomoção , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Transdução de Sinais , Traumatismos da Medula Espinal/patologia
3.
Gene ; 781: 145528, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-33631250

RESUMO

BACKGROUND: Spinal cord injury (SCI) leads to severe motor and sensory dysfunctions. Neural stem cells (NSCs) transplantation therapy plays a positive role in functional recovery after SCI, but the effectiveness of this therapy is limited by inadequate differentiation ability of transplanted NSCs. Mammalian achaete-scute homologue-1 (Mash-1) has been reported to improve differentiation of NSCs. Thus, this study modified NSCs with Mash-1 to repair SCI. METHODS: NSCs isolated from rat embryo hippocampus were cultured and identified in vitro and further transfected with the lentiviral vectors (Lv-Mash-1). After establishing a SCI rat model, the rats were transplanted with Mash-1 modified NSCs, the histopathological changes of rat spinal cord were detected by hematoxylin-eosin (HE) staining, and the locomotor activity of rats was evaluated with the Basso, Beattie and Bresnahan (BBB) scale. The NSCs cultured in vitro or extracted from SCI rat spinal cord were identified by immunofluorescence (IF). Mash-1, ß3-Tubulin, and NeuN expressions in those cells were determined by Western blotting and reverse transcription­quantitative polymerase chain reaction (RT­qPCR). RESULTS: NSCs isolated from rat embryo hippocampus were Nestin- and NeuN-positive. NSC transplantation modified by Mash-1 increased BBB score of SCI rats and promoted recovery in lesion site of SCI rats. Mash-1 overexpression also promoted ß3-Tubulin and NeuN expressions in NSCs cultured in vitro or extracted from spinal cord of SCI rats. CONCLUSION: Mash-1 overexpression promoted NSC differentiation into neurons, and further improved locomotor functional recovery of SCI rats.


Assuntos
Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Células-Tronco Neurais/transplante , Neurogênese , Traumatismos da Medula Espinal/terapia , Animais , Antígenos Nucleares/metabolismo , Fatores de Transcrição Hélice-Alça-Hélice Básicos/uso terapêutico , Células Cultivadas , Feminino , Locomoção , Proteínas do Tecido Nervoso/metabolismo , Células-Tronco Neurais/metabolismo , Neurogênese/genética , Neurônios/citologia , Neurônios/metabolismo , Ratos , Ratos Sprague-Dawley , Transfecção , Tubulina (Proteína)/metabolismo
4.
Nat Commun ; 12(1): 781, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536416

RESUMO

After complete spinal cord injuries (SCI), spinal segments below the lesion maintain inter-segmental communication via the intraspinal propriospinal network. However, it is unknown whether selective manipulation of these circuits can restore locomotor function in the absence of brain-derived inputs. By taking advantage of the compromised blood-spinal cord barrier following SCI, we optimized a set of procedures in which AAV9 vectors administered via the tail vein efficiently transduce neurons in lesion-adjacent spinal segments after a thoracic crush injury in adult mice. With this method, we used chemogenetic actuators to alter the excitability of propriospinal neurons in the thoracic cord of the adult mice with a complete thoracic crush injury. We showed that activating these thoracic neurons enables consistent and significant hindlimb stepping improvement, whereas direct manipulations of the neurons in the lumbar spinal cord led to muscle spasms without meaningful locomotion. Strikingly, manipulating either excitatory or inhibitory propriospinal neurons in the thoracic levels leads to distinct behavioural outcomes, with preferential effects on standing or stepping, two key elements of the locomotor function. These results demonstrate a strategy of engaging thoracic propriospinal neurons to improve hindlimb function and provide insights into optimizing neuromodulation-based strategies for treating SCI.


Assuntos
Dependovirus/genética , Membro Posterior/fisiopatologia , Locomoção/fisiologia , Neurônios/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Animais , Antipsicóticos/administração & dosagem , Clozapina/administração & dosagem , Clozapina/análogos & derivados , Vetores Genéticos/genética , Membro Posterior/inervação , Locomoção/efeitos dos fármacos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Medula Espinal/efeitos dos fármacos , Medula Espinal/metabolismo , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia
5.
Zhen Ci Yan Jiu ; 46(1): 45-51, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33559425

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Jiaji" (EX-B2) on the levels of autophagy and endoplasmic reticulum stress in mice with spinal cord injury (SCI), so as to explore its mechanism underlying improvement of SCI. METHODS: A total of 60 female C57BL/6 mice were randomly divided into sham operation, model and EA groups, which were further divided into 7 d and 14 d subgroups (10 mice in each subgroup). The SCI model was established by pressing the exposed spinal cord (L1) with a vascular clamp for 15 s. EA was applied to bilateral EX-B2 3 h after modeling, once a day for 7 and 14 d, respectively. Basso Mouse Scale(BMS) for locomotion was used to evaluate hindlimb motor function on day 7 and 14 after SCI. H.E. staining was used to observe histopathologic changes of the injured spinal cord tissue, and Western blot employed to detect the expression of glucose regulatory protein-78 (GRP78), Caspase-12, microtubule-associated protein light chain 3 II (LC-II) and P62(also known as sqstm1/Sequestome1) proteins. Immunofluorescence staining was used to detect the immunoacti-vities of spinal CCAAT/enhancer-binding protein (C/EBP) homologous protein (CHOP, an endoplasmic reticulum stress-inducible protein) and P62. RESULTS: On the 7th and 14th day after SCI, the BMS scores and expression levels of LC3II protein were significantly down-regulated (P<0.05), and the expression levels of P62, GRP78 and Caspase-12 proteins, the immunoactivities of CHOP and P62 were all significantly up-regulated on both day 7 and 14 in the model group than in the sham operation group (P<0.05).Compared with the model group, the BMS scores and the expression levels of LC3II protein were significantly increased on both day 7 and 14 (P<0.05), while the expression levels of P62, GRP78 and Caspase-12 proteins, and the immunoactivities of CHOP and P62 were obviously decreased on day 7 and 14 in the EA group (P<0.05). Outcomes of H.E. stain showed that the cells with nuclei pyknosis and swelling and the necrotic cells appeared in the model group, which was relatively fewer in the EA group. CONCLUSION: EA of EX-B2 can improve the locomotor function in SCI mice, which may be related to its effects in up-regulating the expression of LC3II (to promote cell autophagy), and down-regulating the expression of P62, GRP78, Caspase-12 and CHOP proteins (to inhibit endoplasmic reticulum stress) in the spinal cord tissue.


Assuntos
Eletroacupuntura , Traumatismos da Medula Espinal , Animais , Autofagia/genética , Estresse do Retículo Endoplasmático/genética , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Medula Espinal , Traumatismos da Medula Espinal/genética , Traumatismos da Medula Espinal/terapia
6.
Nature ; 590(7845): 308-314, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33505019

RESUMO

Spinal cord injury (SCI) induces haemodynamic instability that threatens survival1-3, impairs neurological recovery4,5, increases the risk of cardiovascular disease6,7, and reduces quality of life8,9. Haemodynamic instability in this context is due to the interruption of supraspinal efferent commands to sympathetic circuits located in the spinal cord10, which prevents the natural baroreflex from controlling these circuits to adjust peripheral vascular resistance. Epidural electrical stimulation (EES) of the spinal cord has been shown to compensate for interrupted supraspinal commands to motor circuits below the injury11, and restored walking after paralysis12. Here, we leveraged these concepts to develop EES protocols that restored haemodynamic stability after SCI. We established a preclinical model that enabled us to dissect the topology and dynamics of the sympathetic circuits, and to understand how EES can engage these circuits. We incorporated these spatial and temporal features into stimulation protocols to conceive a clinical-grade biomimetic haemodynamic regulator that operates in a closed loop. This 'neuroprosthetic baroreflex' controlled haemodynamics for extended periods of time in rodents, non-human primates and humans, after both acute and chronic SCI. We will now conduct clinical trials to turn the neuroprosthetic baroreflex into a commonly available therapy for people with SCI.


Assuntos
Barorreflexo , Biomimética , Hemodinâmica , Próteses e Implantes , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Animais , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Vias Neurais , Primatas , Ratos , Ratos Endogâmicos Lew , Sistema Nervoso Simpático/citologia , Sistema Nervoso Simpático/fisiologia
7.
Nat Commun ; 12(1): 391, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452250

RESUMO

Spinal cord injury (SCI) often causes severe and permanent disabilities due to the regenerative failure of severed axons. Here we report significant locomotor recovery of both hindlimbs after a complete spinal cord crush. This is achieved by the unilateral transduction of cortical motoneurons with an AAV expressing hyper-IL-6 (hIL-6), a potent designer cytokine stimulating JAK/STAT3 signaling and axon regeneration. We find collaterals of these AAV-transduced motoneurons projecting to serotonergic neurons in both sides of the raphe nuclei. Hence, the transduction of cortical neurons facilitates the axonal transport and release of hIL-6 at innervated neurons in the brain stem. Therefore, this transneuronal delivery of hIL-6 promotes the regeneration of corticospinal and raphespinal fibers after injury, with the latter being essential for hIL-6-induced functional recovery. Thus, transneuronal delivery enables regenerative stimulation of neurons in the deep brain stem that are otherwise challenging to access, yet highly relevant for functional recovery after SCI.


Assuntos
Terapia Genética/métodos , Interleucina-6/genética , Locomoção/fisiologia , Regeneração Nervosa/fisiologia , Traumatismos da Medula Espinal/terapia , Animais , Axônios/fisiologia , Córtex Cerebral/citologia , Córtex Cerebral/fisiologia , Dependovirus/genética , Modelos Animais de Doenças , Feminino , Vetores Genéticos/administração & dosagem , Vetores Genéticos/genética , Humanos , Janus Quinases/metabolismo , Masculino , Camundongos , Camundongos Knockout , Microinjeções , Neurônios Motores/fisiologia , PTEN Fosfo-Hidrolase/genética , Núcleos da Rafe/citologia , Núcleos da Rafe/fisiologia , Recuperação de Função Fisiológica , Fator de Transcrição STAT3/metabolismo , Neurônios Serotoninérgicos/fisiologia , Índice de Gravidade de Doença , Transdução de Sinais , Medula Espinal/citologia , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Transdução Genética
8.
Nat Commun ; 12(1): 435, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33469022

RESUMO

Epidural electrical stimulation (EES) of lumbosacral sensorimotor circuits improves leg motor control in animals and humans with spinal cord injury (SCI). Upper-limb motor control involves similar circuits, located in the cervical spinal cord, suggesting that EES could also improve arm and hand movements after quadriplegia. However, the ability of cervical EES to selectively modulate specific upper-limb motor nuclei remains unclear. Here, we combined a computational model of the cervical spinal cord with experiments in macaque monkeys to explore the mechanisms of upper-limb motoneuron recruitment with EES and characterize the selectivity of cervical interfaces. We show that lateral electrodes produce a segmental recruitment of arm motoneurons mediated by the direct activation of sensory afferents, and that muscle responses to EES are modulated during movement. Intraoperative recordings suggested similar properties in humans at rest. These modelling and experimental results can be applied for the development of neurotechnologies designed for the improvement of arm and hand control in humans with quadriplegia.


Assuntos
Medula Cervical/fisiopatologia , Neurônios Motores/fisiologia , Quadriplegia/terapia , Recrutamento Neurofisiológico/fisiologia , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal/métodos , Vias Aferentes/fisiopatologia , Animais , Medula Cervical/citologia , Medula Cervical/diagnóstico por imagem , Medula Cervical/lesões , Simulação por Computador , Modelos Animais de Doenças , Eletrodos Implantados , Espaço Epidural , Feminino , Gânglios Espinais/citologia , Gânglios Espinais/diagnóstico por imagem , Gânglios Espinais/fisiopatologia , Humanos , Macaca fascicularis , Imagem por Ressonância Magnética , Masculino , Modelos Neurológicos , Músculo Esquelético/inervação , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Estimulação da Medula Espinal/instrumentação , Extremidade Superior/inervação
9.
BMC Palliat Care ; 20(1): 8, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422058

RESUMO

BACKGROUND: Palliative care improves the quality of lives of patients and families affected by advanced illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country. METHODS: This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants. RESULTS: Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease. CONCLUSIONS: The symptom burden experienced by patients affected by advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.


Assuntos
Infecções por HIV/fisiopatologia , Determinação de Necessidades de Cuidados de Saúde , Neoplasias/fisiopatologia , Cuidados Paliativos , Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Tuberculose Resistente a Múltiplos Medicamentos/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoal Técnico de Saúde , Butão , Cognição , Feminino , Infecções por HIV/psicologia , Infecções por HIV/terapia , Humanos , Hepatopatias Alcoólicas/fisiopatologia , Hepatopatias Alcoólicas/psicologia , Hepatopatias Alcoólicas/terapia , Pneumopatias/fisiopatologia , Pneumopatias/psicologia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/terapia , Enfermeiras e Enfermeiros , Médicos , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/terapia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/terapia , Doente Terminal , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Adulto Jovem
11.
Life Sci ; 267: 118958, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33383054

RESUMO

AIMS: Spinal cord injury (SCI) is a major cause of long-term physical impairment. Currently, treatment for SCI is limited to supportive measures, which can lead to permanent disability, representing a serious social burden. The present study aimed to evaluate the inflammatory microenvironment effects of human umbilical cord mesenchymal stem cells (HUCMSCs)+ Ultrashort Wave (USW) therapy on SCI and reveal possible mechanisms. MAIN METHODS: Low-dose USW was treated one day after SCI, and HUCMSCs suspension was transferred to the lesion using a micro-syringe 7 days after SCI. The functional effects of HUCMSCs and USW, separately and combinedly, were measured, together with the infiltration of CD3+ cells, formation of A1 astrocytes and activation of NUR77/ NF-κB pathway. KEY FINDINGS: Our results showed that HUCMSCs+USW therapy improved motor function of SCI rat, together with decreased infiltration of CD3+ T cells, and decreased induction of microglia and A1 astrocytes. And also USW treatment played a very important role on decreasing the infiltration of CD3+ T cells and IBA-1+ cells. Reduced production of pro-inflammatory cytokines IL-1ß and IL-6 was also observed in rats receiving HUCMSCs+USW therapy, medicated by NUR77/NF-κB pathway. SIGNIFICANCE: These findings indicated that HUCMSCs+USW therapy could attenuate inflammatory microenvironment through NUR77/NF-κB signaling pathway, which might contribute to its better outcome.


Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos , Células-Tronco Mesenquimais/efeitos da radiação , Traumatismos da Medula Espinal/terapia , Animais , Astrócitos/metabolismo , Citocinas/metabolismo , Feminino , Inflamação/patologia , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/fisiologia , Microglia/metabolismo , NF-kappa B/metabolismo , Neuroimunomodulação/fisiologia , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Terapia por Ondas Curtas/métodos , Transdução de Sinais/efeitos dos fármacos , Medula Espinal/metabolismo , Traumatismos da Medula Espinal/metabolismo , Cordão Umbilical
12.
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
13.
J Urol ; 205(1): 213-218, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856985

RESUMO

PURPOSE: Neurogenic lower urinary tract dysfunction is a significant source of morbidity for individuals with spinal cord injury and is managed with a range of treatment options that differ in efficacy, tolerability and cost. The effect of insurance coverage on bladder management, symptoms and quality of life is not known. We hypothesized that private insurance is associated with fewer bladder symptoms and better quality of life. MATERIALS AND METHODS: This is a cross-sectional, retrospective analysis of 1,226 surveys collected as part of the prospective Neurogenic Bladder Research Group SCI Registry. We included patients with complete insurance information, which was classified as private or public insurance. The relationship between insurance and bladder management, bladder symptoms and quality of life was modeled using multinomial logistic regression analysis. Spinal cord injury quality of life was measured by the Neurogenic Bladder Symptom Score. RESULTS: We identified 654 privately insured and 572 publicly insured individuals. The demographics of these groups differed by race, education, prevalence of chronic pain and bladder management. Publicly insured patients were more likely to be treated with indwelling catheters or spontaneous voiding and less likely to take bladder medication compared to those with private insurance. On multivariate analysis insurance type was not associated with differences in bladder symptoms (total Neurogenic Bladder Symptom Score) or in urinary quality of life. CONCLUSIONS: There is an association between insurance coverage and the type of bladder management used following spinal cord injury, as publicly insured patients are more likely to be treated with indwelling catheters. However, insurance status, controlling for bladder management, did not impact bladder symptoms or quality of life.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Adulto , Cateteres de Demora/economia , Cateteres de Demora/estatística & dados numéricos , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Cobertura do Seguro/economia , Seguro Saúde/economia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/economia , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/economia , Traumatismos da Medula Espinal/terapia , Resultado do Tratamento , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/economia , Bexiga Urinaria Neurogênica/etiologia , Cateterismo Urinário/economia , Cateterismo Urinário/estatística & dados numéricos
14.
Fisioterapia (Madr., Ed. impr.) ; 42(6): 319-326, nov.-dic. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-197911

RESUMO

INTRODUCCIÓN: La lesión medular congénita o adquirida produce deficiencias motoras, sensitivas y autonómicas. Por tanto, la recuperación de la función motora es uno de los factores más importantes en el proceso de rehabilitación. En este contexto, las aplicaciones móviles se plantean como herramientas que pueden facilitar el proceso de rehabilitación. OBJETIVO: Conocer el efecto del uso de aplicaciones móviles sobre la función motora en personas con lesión medular. MATERIALES Y MÉTODOS: Se realizó una búsqueda sistemática en la literatura acerca del uso de aplicaciones móviles para personas (en inglés, applications o apps) para personas con lesión medular de cualquier edad y origen, en diferentes bases de datos, cuya elegibilidad se realizó mediante la estrategia CONSORT y la calidad metodológica se evaluó aplicando la escala PEDro. Asimismo, se realizó una búsqueda en los principales mercados de aplicaciones móviles para identificar la utilidad de éstas en la recuperación de la función motora. RESULTADOS: Se incluyeron dos artículos que cumplían con los criterios de inclusión, con un total de participación de 46 personas, 18 asignados al grupo control y 28 que recibieron intervención usando aplicaciones móviles. El grupo de aplicaciones móviles mostró mejorías en la función motora tras la intervención. La búsqueda en los mercados de aplicaciones móviles arrojó 65 apps, de las cuales 27 se centraron específicamente en la función motora de personas con lesión medular y 40 tenían potencial utilidad sobre la misma. CONCLUSIÓN: Debido al número de estudios y a la calidad metodológica de los mismos, no son concluyentes los efectos del uso de aplicaciones móviles sobre la función motora en personas con lesión medular. Aun así, existe una gran cantidad de aplicaciones móviles no validadas en mercados de aplicaciones móviles que fueron específicamente diseñadas o que tienen potencial utilidad para mejorar la función motora de personas con lesión medular


INTRODUCTION: Spinal cord injury of either congenital or acquired origin produces motor, sensory and autonomic deficiencies. Therefore, the recovery of motor function is one of the most important factors in the rehabilitation process; that is why mobile applications are currently considered tools that facilitate the rehabilitation process. AIM: To determine the effects of the use of mobile applications on motor function in people with spinal cord injury. MATERIALS AND METHODS: A systematic literature search was carried out on the use of mobile applications for people with spinal cord injury of any age and origin of injury in different databases, whose eligibility was achieved through the CONSORT strategy and the evaluation of methodological quality using the PEDro scale. We also searched the main mobile applications markets to identify their utility in recovery of motor function. RESULTS: Two articles that met the inclusion criteria were included; with the participation of 46 people, 18 assigned to the control group and 28 received intervention using mobile applications. The latter showed improvement in motor function after the intervention. The search of the application markets showed 65 apps, of which 27 focused specifically on motor function in patients with spinal cord injury and 40 with potential utility. CONCLUSION: Due to the number of studies and their methodological quality, the effects of the use of mobile applications on motor function in people with spinal cord injury are not conclusive. Even so, there are many unverified mobile apps on the apps markets, specifically designed or potentially useful in relation to the motor function of people with spinal cord injury


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Aplicativos Móveis , Traumatismos da Medula Espinal/reabilitação , Locomoção/fisiologia , Atividade Motora/fisiologia , Traumatismos da Medula Espinal/terapia , Telerreabilitação/instrumentação
15.
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
17.
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
18.
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
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4936-4940, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019095

RESUMO

This paper presents the design of a motor-augmented wrist-driven orthosis (MWDO) for improved grasp articulation for people with C6-C7 spinal cord injuries. Based on the traditional passive, wrist-driven orthotic (WDO) mechanism, the MWDO allows for both body-powered and motorized actuation of the grasping output thus enabling more flexible and dexterous operation. Here, the associated control scheme enables active decoupling of wrist and finger articulation, which can be useful during certain phases of manipulation tasks. An additional modification to the traditional WDO is the integration of a magnetic latch at the Distal Interphalangeal (DIP) joint allowing for improved pinching. These abilities are demonstrated with common activities of daily living (ADL).


Assuntos
Traumatismos da Medula Espinal , Punho , Atividades Cotidianas , Força da Mão , Humanos , Aparelhos Ortopédicos , Traumatismos da Medula Espinal/terapia
20.
Nat Commun ; 11(1): 4504, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32908131

RESUMO

The strategies concerning modification of the complex immune pathological inflammatory environment during acute spinal cord injury remain oversimplified and superficial. Inspired by the acidic microenvironment at acute injury sites, a functional pH-responsive immunoregulation-assisted neural regeneration strategy was constructed. With the capability of directly responding to the acidic microenvironment at focal areas followed by triggered release of the IL-4 plasmid-loaded liposomes within a few hours to suppress the release of inflammatory cytokines and promote neural differentiation of mesenchymal stem cells in vitro, the microenvironment-responsive immunoregulatory electrospun fibers were implanted into acute spinal cord injury rats. Together with sustained release of nerve growth factor (NGF) achieved by microsol core-shell structure, the immunological fiber scaffolds were revealed to bring significantly shifted immune cells subtype to down-regulate the acute inflammation response, reduce scar tissue formation, promote angiogenesis as well as neural differentiation at the injury site, and enhance functional recovery in vivo. Overall, this strategy provided a delivery system through microenvironment-responsive immunological regulation effect so as to break through the current dilemma from the contradiction between immune response and nerve regeneration, providing an alternative for the treatment of acute spinal cord injury.


Assuntos
Microambiente Celular/imunologia , Sistemas de Liberação de Medicamentos/instrumentação , Fator de Crescimento Neural/administração & dosagem , Regeneração Nervosa/efeitos dos fármacos , Traumatismos da Medula Espinal/terapia , Tecidos Suporte , Animais , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/imunologia , Preparações de Ação Retardada/administração & dosagem , Modelos Animais de Doenças , Liberação Controlada de Fármacos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Interleucina-4/administração & dosagem , Lipossomos , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/fisiologia , Fator de Crescimento Neural/farmacocinética , Regeneração Nervosa/imunologia , Ratos , Recuperação de Função Fisiológica/imunologia , Medula Espinal/citologia , Medula Espinal/efeitos dos fármacos , Medula Espinal/imunologia , Traumatismos da Medula Espinal/imunologia
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