Clinical Study of Modified Shenqi Pill （肾气丸） Plus Tongdu Tiaoshen Acupuncture （通督调神针刺） for Neurogenic Bladder After Spinal Cord Injury of Kidney-Yang Deficiency Syndrome / 中医杂志

ObjectiveTo observe the clinical efficacy of modified Shenqi Pill （肾气丸） plus Tongdu Tiaoshen Acupuncture （通督调神针刺） in the treatment of neurogenic bladder after spinal cord injury of kidney-yang deficiency syndrome. MethodsForty-six patients were randomly divided into 23 cases each in the control group and the treatment group. Both groups were given conventional treatment， i.e. oral methylcobalamin tablets （0.5 mg each time， 3 times a day） and paraplegic conventional acupuncture （once a day， 6 consecutive days a week）. The control group was given simple bladder function rehabilitation training on the basis of the conventional treatment； and the treatment group was given modified Shenqi Pill orally （1 dose a day， 150 ml each time， taken warmly in morning and evening） and Tongdu Tiaoshen Acupuncture （once a day， 6 consecutive days per week） in addition to what were given to the control group. The treatment course lasted for 4 weeks. The 24 h urination frequency， 24 h urine leakage frequency， 24 h single urine volume， bladder residual urine volume， international lower urinary tract symptom （LUTS） score， traditional Chinese medicine （TCM） syndrome score were compared between the two groups， and clinical effectiveness and TCM syndrome effectiveness were compared between the two groups after treatment. ResultsTwenty patients in each group were finally analyzed in this study. The number of 24 h urination， the number of 24 h urine leakage， bladder residual urine volume， LUTS score， and the TCM syndrome scores decreased after treatment in both groups， and the 24 h single urine volume increased （P＜0.01）； and much more improvement was found of each index in the treatment group than in the control group （P＜0.05 or P＜0.01）. The total clinical effectiveness and TCM syndrome effectiveness in the treatment group was 85.00% （17/20） respectively， which were statistically significantly higher than 45.00% （the total clinical effectiveness， 9/20） and 60.00% （TCM syndrome effectiveness， 12/20） in the control group （P＜0.01）. ConclusionModified Shenqi Pill plus Tongdu Tiaoshen Acupuncture can signi-ficantly improve the clinical symptoms of neurogenic bladder patients after spinal cord injury of kidney-yang deficiency syndrome， having better effectiveness than simple bladder function rehabilitation training， and its mechanism may be related to the improvement of the injured nerve function innervating the bladder.

Vulnerabilidad del adulto mayor con lesión cervical traumática

Fundamento: los adultos mayores sufren caídas que producen complicaciones traumáticas, dentro de estas se encuentra el trauma raquimedular que produce una alta tasa de discapacidad y mortalidad. Objetivo: exponer factores pronósticos que repercuten en el adulto mayor con lesión espinal cervical traumática. Métodos: se realizó un estudio de corte transversal sobre 42 pacientes geriátricos diagnosticados con trauma raquimedular cervical atendidos en Camagüey, desde 2019 hasta el 2022. Se analizaron las variables siguientes: datos demográficos, tipo de accidente, nivel de la lesión, complicaciones médicas, terapia utilizada y como variable dependiente la mortalidad. Resultados: se observó un predominio de los pacientes entre 60 a 74 años. El análisis estadístico sobre las probabilidades de fallecer mostró que ante un evento cervical traumático los pacientes con ventilación mecánica asistida, complicaciones médicas, nivel de severidad de la lesión (ASIA A o B) que sufrieron un accidente de tránsito tuvieron mayor riesgo de morir que los que no se encontraban en estos grupos. El nivel de dependencia social del grupo estuvo entre moderado y severo. Conclusiones: el envejecimiento poblacional requiere del desarrollo de terapias especializadas, donde se tomen en cuenta las características morfofisiológicas de este grupo que permitirá mejor recuperación funcional y una calidad de vida adecuada.

Foundation older adults suffer falls that produce traumatic complications, among which is spinal cord trauma with a high rate of disability and mortality. Objective to set out the prognostic factors that affect the elderly with traumatic cervical spinal injury. Methods: a cross-sectional study was carried out with 42 geriatric patients diagnosed with spinal cord trauma treated in Camagüey, from 2019 to 2022. The research consisted of a stage for the collection of demographic data, the type of accident, the level of injury, medical complications, the therapy used and another where the statistical processing was carried out where the mortality variable was considered as dependent. Results: a predominance of patients between 60 and 74 years of age was observed. The statistical analysis on the probabilities of dying showed that in a traumatic cervical event, patients with assisted mechanical ventilation, medical complications, injury severity level (ASIA A or B) who suffered a traffic accident had a higher risk of dying than those who were not in these groups. The level of social dependence of the group was between moderate and severe. Conclusions: population aging requires the development of specialized therapies, where the morphophysiological characteristics of this group are taken into account, which will allow better functional recovery and an adequate quality of life.

Impacto de los ejercicios físicos en la rehabilitación de pacientes con lesiones medulares cervical incompleta, en Guinea-Bissau

Las personas con lesiones de la médula espinal cervical tienen de dos a cinco veces más probabilidades de morir prematuramente, estas lesiones son una de las causas de muerte más frecuente en la población mundial independientemente de la religión, edad, raza, sexo, nacionalidad o clase social; las tasas de supervivencia más bajas, se encuentran en los países de ingresos bajos y medianos. En Guinea-Bissau, los pacientes desconocen su enfermedad y los beneficios de la actividad física para su tratamiento; por ello, se realizó un estudio con diez pacientes que asisten al área de Neuro-rehabilitación motora, Bissau, donde el objetivo fue: determinar el impacto de los ejercicios físicos en la rehabilitación de los pacientes con lesión medular cervical incompleta. Se utilizaron métodos de orden cualitativo (revisión documental) y cuantitativos (medición) y criterio de expertos que permitieron el estudio del objeto y la evaluación teórica y práctica de los ejercicios físicos, los que fueron validados por 17 expertos, entre los cuales el 95 % evaluaron los indicadores en adecuados y muy adecuados y se aplicó en la práctica a diez pacientes con resultados muy satisfactorios, lo que confirmó la pertinencia del estudio realizado. El 100 % de los participantes alcanzaron un nivel significativo en las actividades de la vida diaria, capacidades físicas y funcionales. Este estudio respondió a necesidades investigativas de la Universidad de Ciencias de la Cultura Física y el Deporte "Manuel Fajardo", de Cuba y al Centro de Neuro-Rehabilitación Físico Motor Sanca, de Guinea-Bissau.

SÍNTESE Pessoas com lesões da medula cervical têm duas a cinco vezes mais probabilidade de morrer prematuramente, essas lesões são uma das causas de morte mais freqüentes na população mundial, independentemente da religião, idade, raça, sexo, nacionalidade ou classe social; as mais baixas taxas de sobrevivência são encontradas em países de baixa e média renda. Na Guiné-Bissau, os pacientes desconhecem sua doença e os benefícios da atividade física para seu tratamento; portanto, foi realizado um estudo com dez pacientes que freqüentavam a área de neuro-reabilitação motora, Bissau, onde o objetivo era: determinar o impacto dos exercícios físicos na reabilitação de pacientes com lesão incompleta da medula cervical. Foram utilizados métodos qualitativos (revisão documental) e quantitativos (medição) e julgamento de especialistas para estudar o objeto e a avaliação teórica e prática dos exercícios físicos, que foram validados por 17 especialistas, 95% dos quais avaliaram os indicadores como adequados e muito adequados, e foram aplicados na prática a dez pacientes com resultados muito satisfatórios, confirmando a relevância do estudo realizado. 100% dos participantes atingiram um nível significativo nas atividades de vida diária, nas habilidades físicas e funcionais. Este estudo respondeu às necessidades de pesquisa da Universidade de Cultura Física e Ciências do Esporte "Manuel Fajardo", Cuba e do Centro de Reabilitação Neuro-Motora Sanca, Guiné-Bissau.

People with cervical spinal cord injuries are two to five times more likely to die prematurely, these injuries are one of the most frequent causes of death in the world population regardless of religion, age, race, sex, nationality or social class; the lowest survival rates are found in low- and middle-income countries. In Guinea-Bissau, patients are unaware of their illness and the benefits of physical activity for their treatment; for this reason, a study was carried out with ten patients who attend the area of Motor Neuro-rehabilitation, Bissau, where the objective was: to determine the impact of physical exercises on the rehabilitation of patients with incomplete cervical spinal cord injury. Qualitative (documentary review) and quantitative (measurement) and expert criteria methods were used, which allowed the study of the object and the theoretical and practical evaluation of the physical exercises, which were validated by 17 experts, among whom 95% they evaluated the indicators as adequate and very adequate and it was applied in practice to ten patients with very satisfactory results, which confirmed the relevance of the study carried out. 100% of the participants reached a significant level in activities of daily living, physical and functional capacities. This study responded to the research needs of the "Manuel Fajardo" University of Physical Culture and Sports Sciences, of Cuba and the Sanca Neuro - Physical Motor Rehabilitation Center, of Guinea-Bissau.

Effect of 12-week sports intervention programme on physical fitness and sports performance in individuals with spinal cord injury

Objectives: Inactivity in individuals with spinal cord injury (SCI) results in low physical fitness, cardiopulmonary endurance and poor quality of life. Sports participation is known to enhance physical fitness. Therefore, the present study evaluated effect of a structured, 12-week MGM Sports Intervention for Sports Intervention Program for SCI (SPISI) on physical fitness and throw-ball performance in individuals with SCI. Materials and Methods: The study was conducted at MGM School of Physiotherapy and Spinal Cord Injury Rehabilitation centre in Navi Mumbai, India. Following ethical approval, 15 individuals with SCI (80% males and 20% females mean age 33.1 ± 7.2 years) were recruited. Upper-extremity explosive power (medicine-ball-throw), agility (t-test), cardiorespiratory endurance (incremental shuttle wheelchair propulsion test) and ball-throwing capacity (maximal-pass test) were evaluated pre- and post-12-week sports intervention programme (SPISI). The protocol involved strength training of upper extremity training at 50% 1 repetition maximum and participation in throw-ball sport. Results: Following training, increase in upper extremity explosive power (11%), cardiopulmonary endurance (5%), agility (8%) and ball-throwing capacity in distance (7%) (P < 0.05) was observed. The large effect size was observed for sports performance (maximal-pass test distance-Cohen’s d 1.261), moderate for cardiorespiratory endurance (incremental wheelchair propulsion test distance Cohen’s d 0.517) and upper extremity explosive power (medicine-ball throw distance 0.593). Increment in all outcome variables was greater than minimal clinically important difference. Conclusion: Sports intervention programme (SPISI) for 12 weeks brought about minimal clinically important difference in upper-extremity explosive power, agility, cardiorespiratory endurance and sport-specific performance and should be included as an integral component of rehabilitation of individuals with SCI.

Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report

Abstract Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.

Updated Understanding of the Glial-Vascular Unit in Central Nervous System Disorders / 神经科学通报·英文版

The concept of the glial-vascular unit (GVU) was raised recently to emphasize the close associations between brain cells and cerebral vessels, and their coordinated reactions to diverse neurological insults from a "glio-centric" view. GVU is a multicellular structure composed of glial cells, perivascular cells, and perivascular space. Each component is closely linked, collectively forming the GVU. The central roles of glial and perivascular cells and their multi-level interconnections in the GVU under normal conditions and in central nervous system (CNS) disorders have not been elucidated in detail. Here, we comprehensively review the intensive interactions between glial cells and perivascular cells in the niche of perivascular space, which take part in the modulation of cerebral blood flow and angiogenesis, formation of the blood-brain barrier, and clearance of neurotoxic wastes. Next, we discuss dysfunctions of the GVU in various neurological diseases, including ischemic stroke, spinal cord injury, Alzheimer's disease, and major depression disorder. In addition, we highlight the possible therapies targeting the GVU, which may have potential clinical applications.

Spatiotemporal Dynamics of the Molecular Expression Pattern and Intercellular Interactions in the Glial Scar Response to Spinal Cord Injury / 神经科学通报·英文版

Nerve regeneration in adult mammalian spinal cord is poor because of the lack of intrinsic regeneration of neurons and extrinsic factors - the glial scar is triggered by injury and inhibits or promotes regeneration. Recent technological advances in spatial transcriptomics (ST) provide a unique opportunity to decipher most genes systematically throughout scar formation, which remains poorly understood. Here, we first constructed the tissue-wide gene expression patterns of mouse spinal cords over the course of scar formation using ST after spinal cord injury from 32 samples. Locally, we profiled gene expression gradients from the leading edge to the core of the scar areas to further understand the scar microenvironment, such as neurotransmitter disorders, activation of the pro-inflammatory response, neurotoxic saturated lipids, angiogenesis, obstructed axon extension, and extracellular structure re-organization. In addition, we described 21 cell transcriptional states during scar formation and delineated the origins, functional diversity, and possible trajectories of subpopulations of fibroblasts, glia, and immune cells. Specifically, we found some regulators in special cell types, such as Thbs1 and Col1a2 in macrophages, CD36 and Postn in fibroblasts, Plxnb2 and Nxpe3 in microglia, Clu in astrocytes, and CD74 in oligodendrocytes. Furthermore, salvianolic acid B, a blood-brain barrier permeation and CD36 inhibitor, was administered after surgery and found to remedy fibrosis. Subsequently, we described the extent of the scar boundary and profiled the bidirectional ligand-receptor interactions at the neighboring cluster boundary, contributing to maintain scar architecture during gliosis and fibrosis, and found that GPR37L1_PSAP, and GPR37_PSAP were the most significant gene-pairs among microglia, fibroblasts, and astrocytes. Last, we quantified the fraction of scar-resident cells and proposed four possible phases of scar formation: macrophage infiltration, proliferation and differentiation of scar-resident cells, scar emergence, and scar stationary. Together, these profiles delineated the spatial heterogeneity of the scar, confirmed the previous concepts about scar architecture, provided some new clues for scar formation, and served as a valuable resource for the treatment of central nervous system injury.

Water tank scale: a reliable method for assessing motor function after spinal cord injury in rats / 南方医科大学学报

OBJECTIVE@#To analyze the reliability of the Water Tank Scale for assessing recovery of motor function after spinal cord injury (SCI) in rats.@*METHODS@#Thirty-six adult female SD rats were randomly divided into SCI and sham-operated groups (n= 18). The recovery of the hind limb motor function was assessed using Water Tank scoring, BBB scoring, and motor-evoked potentials (MEP) at 1, 3, 5, 7, 14 and 21 days after SCI. MEP was used as the gold standard for analyzing and comparing differences between the two scoring methods.@*RESULTS@#The Water Tank scores of the rats were significantly higher than the BBB scores on day 3 (0.22±0.43 vs 0, P < 0.05) and also on days 5, 7 and 14 after SCI (0.67±0.49 vs 0.11±0.32, 4.33±1.19 vs 2.83±1.04, 8.61± 1.20 vs 7.06±1.0, P < 0.01). On day 21 after SCI, the scores of the Water Tank Scale of the rats did not significantly differ from the BBB scores (14.78±1.06 vs 14.50±1.47, P>0.05). Neurophysiological monitoring showed that both the Water Tank score and BBB score were significantly correlated with MEP latency, but the Water Tank score had a greater correlation coefficient with MEP latency (r=-0.90).@*CONCLUSION@#Compared with the BBB scale, Water Tank scoring allows more objective and accurate assessment of functional recovery of the spinal cord in early stages following SCI in rats, and can thus be used as a reliable method for assessing functional recovery of the hind limbs in rat models of acute SCI.

High mobility group box-1 inhibition reduces expression of matrix metalloproteinase-9 in astrocytes in rats after spinal cord injury / 中华创伤骨科杂志

Objective:To investigate the role and underlying mechanisms of inhibiting high mobility group box-1 (HMGB1) in the expression of matrix metalloproteinase-9 (MMP-9) in spinal cord astrocytes (AS) in rats after spinal cord injury (SCI).Methods:After an SCI model was established in Sprague-Dawley (SD) rats using a modified Allen's Weight-Dropping method and ethyl pyruvate (EP) or glycyrrhizin (GL) was used to inhibit the effect of HMGB1, the rats were divided into a sham group, an SCI group, an SCI+EP (50 mg/kg) group, and an SCI+GL (100 mg/kg) group. The expression levels of glial fibrillary acid protein (GFAP) and MMP-9 in spinal cord AS were observed. After the spinal cord AS in SD rats was cultured and incubated by the oxygen-glucose deprivation/reoxygenation (OGD/R) procedure, the expression of MMP-9 protein was detected at 6 h/R 6 h, 12 h, 24 h, and 48 h after OGD. The time point with the highest expression was chosen in the subsequent experiments as an OGD/R group. HMGB1 was inhibited by HMGB1 shRNA or EP to observe the effect of HMGB1 on the expression of MMP-9 protein in AS treated with OGD/R. Then, toll-like receptor 4 (TLR4) inhibitor, TIR-domain-containing adaptor inducing interferon- β (TRIF) inhibitor, and nuclear factor-kappa B (NF- κB) inhibitor were used to investigate the effects of TLR4/TRIF/NF- κB signaling pathway during the regulation of HMGB1 on MMP-9 in vitro. Results:Western blot showed that the expression of MMP-9 protein in the spinal cord was significantly increased in rats at 1 d after SCI, and the expression of MMP-9 protein in the SCI+EP group and the SCI+GL group was significantly lower than that in the SCI group ( P<0.001). Immunofluorescence showed that GFAP and MMP-9 proteins were co-localized in the spinal cord after SCI, and the expression of GFAP and MMP-9 proteins in the SCI+EP and SCI+GL groups was significantly lower than that in the SCI group ( P<0.05). Since the expression of MMP-9 protein in the spinal cord AS cultured in vitro was significantly higher in the OGD 6h/R 12h group than that in the normal group and the OGD 6h/R 6h, 24, and 48 h groups, the OGD 6h/R 12h was taken as the OGD/R group. The MMP-9 protein expression in AS in the OGD/R+HMGB1 shRNA group and the OGD/R+EP group was significantly lower than that in the OGD/R group ( P<0.001). In the cultured AS, moreover, inhibiting TLR4, TRIF, and NF- κB reduced MMP-9 protein expression after OGD 6 h/R 12 h when compared with that in the OGD/R group ( P<0.001). Conclusions:HMGB1 inhibition may result in a reduction in MMP-9 expression both in the spinal cord AS in SCI rats and in AS after OGD/R treatment in vitro. HMGB1 may regulate MMP-9 protein expression in AS after OGD/R treatment via the TLR4/TRIF/NF- κB signal pathway.

A classification and regression tree to guide tracheostomy for patients with traumatic cervical spinal cord injury / 中华创伤骨科杂志

Objective:To construct a classification and regression tree which can be used to guide the tracheostomy for traumatic cervical spinal cord injury (TCSCI) based on the identification of the risk factors for TCSCI.Methods:The 498 patients with TCSCI were retrospectively analyzed who had been treated at Department of Orthopedics, The Second Hospital Affiliated to Army Medical University from January 2009 to December 2018. There were 403 males and 86 females, with an age of (50.2±13.6) years. Of the patients, 69 received tracheostomy and 420 did not. The gender, age, smoking history, injury cause, neurological level of injury (NLI), American Spinal Cord Injury Association (ASIA) grade, injury severity score (ISS), thoracic injuries, prior pulmonary diseases, prior basic diseases, and operative approaches of the patients were statistically analyzed by single factor analysis. After the independent risk factors for tracheostomy were analyzed by binary logistic regression, the classification and regression tree was developed which could be used to guide the tracheostomy.Results:The logistic regression analysis showed age>50 years ( OR=4.744, 95% CI: 1.802 to 12.493, P=0.002), NLI at C 4 and above ( OR=23.662, 95% CI: 8.449 to 66.268, P<0.001), ASIA grade A ( OR=40.007, 95% CI: 12.992 to 123.193, P<0.001), and ISS score>16 ( OR=10.502, 95% CI: 3.909 to 28.211, P<0.001) were the independent risk factors for the tracheotomy. The classification and regression tree revealed that ASIA grade A and NLI at C 4 and above were the first and second decision nodes, which had a strong predictive effect on tracheostomy. 86.84% of the patients with ASIA grade A and NLI at C 4 and above underwent tracheostomy. Conclusion:Our classification and regression tree shows that NLI at C 4 and above and ASIA grade A have a strong guiding effect on tracheotomy for TCSCI.

Adaptive physical activity and its health benefits for patients with spinal cord injury based on ICF: a scoping review / 中国康复理论与实践

ObjectiveTo analyze adaptive physical activity interventions and their health benefits for patients with spinal cord injury (SCI) based on International Classification of Functioning, Disability and Health (ICF). MethodsA combination of subject headings and free words was employed to search for relevant literature on physical activity in patients with SCI in PubMed, Web of Science, EBSCO and CNKI, from January, 2017 to July, 2022. A scoping review was conducted. ResultsEight English articles were included, from Australia, the United States, Estonia, Canada, Netherlands and Brazil. The study involved 150 patients with SCI and included seven randomized controlled trials and one non-randomized controlled trial. These literatures were primarily from journals in the fields of SCI, neurology, neuromuscular medicine and physical activity, with publication dates concentrated between 2017 and 2021. The included studies involved participants with complete or incomplete SCI, presenting with paraplegia, tetraplegia, and various levels of injury severity (grades A to D). The main functional disorders related to ICF included b710 mobility of joint functions, b715 stability of joint functions, b720 mobility of bone functions, b730 muscle power functions, b735 muscle tone functions, b750 motor reflex functions, b760 control of voluntary movement functions and b770 gait pattern functions; the functions involved in activities and participation included d410 changing basic body position, d415 maintaining a body position, d420 transferring oneself, d445 hand and arm use, d450 walking, d455 moving around, d570 looking after one's health, d610 acquiring a place to live, d910 community life, d920 recreation and leisure; the environmental factors involved were e1151 assistive products and technology for personal use in daily living, and e1401 assistive products and technology for culture, recreation and sport. Physical activity intervention sites mainly included home, community, medical or rehabilitation institutions. The physical activity could be classified into prevention, health promotion, treatment and rehabilitation. Patients with SCI had completed acute and subacute rehabilitation in medical and rehabilitation institutions, and returned to their families and communities, and some of them received services in medical and rehabilitation institutions from time to time. The forms of physical activity included strength training combined with routine nursing, short-term resistance training, hydrotherapy and robot treadmill activities, functional electrical stimulation and therapeutic exercise, progressive exercise training based on exoskeleton of power machine, leg bicycle assisted by electrical stimulation combined with manual bicycle, and acute exercise with different intensity. The activity frequency was twelve to 60 minutes a time, two to three times a week, lasting for three to 16 weeks, and the activity intensity was mainly medium to high. The health benefits of physical activity on patients with SCI were mainly reflected in four aspects: physical and mental health, activity and behavior health, environmental factors, quality of life and well-being. In terms of physical and mental health, it helped to improve muscle function (muscle strength, strength perception), walking function (walking speed, walking distance), respiratory and circulatory system functions (peak oxygen uptake, aerobic endurance, cardiopulmonary function, reducing the risk of cardiopulmonary diseases, etc.), immune system related functions, and improving psychosocial function (fatigue degree). In terms of activity and behavioral health, it was helpful to improve activity skills and abilities. In terms of environmental factors, the availability and effectiveness of some auxiliary equipment were confirmed. In terms of quality of life and well-being, it could improve self-living ability and quality of life. ConclusionThis study established a PICO framework for adaptive physical activity and its health effects in patients with SCI based on ICF. Physical activity for patients with SCI can be conducted in various settings, including home, community, or medical and rehabilitation institutions. The physical activities of patients with SCI are characterized by wheelchair-based adaptive physical activities, which are mainly divided into two categories: various aerobic exercises and resistance exercises based on wheelchairs, and physical activities based on auxiliary exercise equipment or intervention methods (such as robot treadmill, power machine exoskeleton, functional electrical stimulation, etc.). The frequency of physical activity in patients with SCI is twelve to 60 minutes a time, two to three times a week, lasting for three to 16 weeks, and the activity intensity is maily medium to high. Therapists and rehabilitation professionals can provide guidance and support through various means, such as online or offline supervision and one-on-one coaching, to promote the health benefits of physical activity for patients with SCI, including improved physical and psychological function, enhanced activity levels, reduced sedentary behavior, and increased self-care abilities and quality of life.

Exercise rehabilitation interventions for people with spinal cord injury and their health benefits: a systematic review of systematic reviews based on ICD-11 and ICF / 中国康复理论与实践

ObjectiveBased on the International Classification of Diseases, Eleventh Revision (ICD-11) and the International Classification of Functioning, Disability and Health (ICF), systematic reviews about the effects of different types of exercise rehabilitation and related interventions on body structure and function, activity and participation, and quality of life in people with spinal cord injury (SCI) were systematically reviewed. MethodsSystematic reviews of exercise rehabilitation and health benefits in patients with spinal cord injury were searched from PubMed, Embase, EBSCO, Web of Science and CNKI, from January, 2015 to January, 2023. ResultsEight English articles were included, from Canada, the United States, South Korea, Australia, Brazil and Netherlands, derived from the fields of physical medicine and rehabilitation, neuromedicine and rehabilitation, and exercise intervention, with the publication date mainly concentrated from 2015 to 2021. A total of 165 randomized controlled trials were involved, with 2 746 participants, aged 18 to 65 years. The diseases were mainly spinal cord injury (complete or incomplete), quadriplegia, paraplegia (thoracic, lumbar and sacral injuries), and motor neuron injury (upper and lower). There were three main types of interventions: passive intervention, using sports assistive devices, such as powered exoskeleton-assisted robots, electric bicycles, etc., and functional electrical stimulation; active interventions, such as stepping exercises; training on flat ground, outdoor walking, and activities of daily living; mixed intervention (active & passive), such as combination of exercise and functional electrical stimulation, combination of exercise and motor assistive devices. The frequency of intervention was ten to 240 minutes a time, two to 18 times a week, with the intensity of low to vigorous, for one to 456 weeks. The intervention sites mainly involved families, community health service centers and sports venues. The health impact mainly involved improving cardiovascular and increasing blood flow velocity in the legs; improving musculoskeletal structure, as well as muscle strength, tolerance and flexibility; relieving spasms and improving reflex excitability of the nervous system; increasing gait speed and walking distance; improving functional independence, such as bowel regularity; improving physical health, such as reducing spasticity and drug use (e.g., baclofen), increasing the immune response to infection, and reducing the risk of disease (vascular dementia and respiratory disease); and improving psychological condition. ConclusionBased on ICD-11 and ICF, this study constructed a research framework for active or passive exercise rehabilitation and related interventions in patients with spinal cord injury. Patients with spinal cord injury can improve their body structure and function, increase their activity and participation, and improve their quality of life and well-being through passive interventions (using motor assistive devices, functional electrical stimulation), active interventions (such as stepping exercises, outdoor walking, etc.), and mixed interventions (combining exercise and functional electrical stimulation, exercise and sports assistive devices).

Proteomic Study on the Effect of Wenshen Tongdu Formula （温肾通督方） on Spleen B Cells in Spinal Cord Injury Model Mice / 中医杂志

ObjectiveTo explore the effects and possible mechanism of Wenshen Tongdu Formula （温肾通督方， WTF） on spinal cord injury. MethodsThirty-six C57BL/6 female mice were randomly divided into sham operation group， model group and WTF group， with 12 mice in each group. The spinal cord injury model was established in the model group and the WTF group using the modified Allen's method， while in the sham operation group the spinal cord was only exposed. Since the 1st day after surgery， 50 g/（kg·d） of WTF solution was given to the WTF group by gavage， while 20 ml/（kg·d） of normal saline was given to the sham operation and model group by gavage， all for 14 days. Before surgery and on the 1st， 7th， and 14th days after surgery， the motor function of the mice was evaluated using the inclined plane test and hind limb motor function score （by BMS）. On the 3rd day after surgery， the nerve electrophy-siology was detected through electromyography and motor evoked potential； the spleen length was measured， and B cells in the spleen were sorted by magnetic beads； the differential expression of proteins were detected through proteomics technology； and the protein expression of mitochondrial outer membrane transport porin 20 （Tom20） and downstream cleaved caspase-3 in spleen B cells were measured using Western blotting. On the 14th day after surgery， MRI was used to observe the recovery of the spinal cord. ResultsCompared to those in the sham operation group at the same time， the BMS scores and subscores and the inclined plane test angle in the model group were reduced on the 1st， 7th and 14th days after surgery； the peak value of electromyogram and motor evoked potential were reduced， and the spleen length was shortened， while the expression of Tom20 and cleaved caspase-3 increased in splenic B cells increased （P＜0.05）. Compared to those in the model group at the same time， the BMS subscores on the 14th day and the angle of the inclined plane test on the 7th and 14th days after surgery increased in the WTF group； the peak value of electromyography and motor evoked potential， as well as the length of spleen increased， and the expression of Tom20 and cleaved caspase-3 decreased （P＜0.05）. The proteomics results showed that there were 100 differential proteins in the WTF group versus the model group， of which 37 were up-regulated and 63 were down-regulated. GO enrichment analysis showed that differential proteins mainly played their roles in oxygen binding， exogenous apoptosis negative feedback， zinc ion response， and oxygen transport. KEGG enrichment analysis showed that differential proteins were mainly concentrated in metabolic pathways， Huntington's disease， oxidative phosphorylation and other pathways. Subcellular localization showed that differential proteins were associated with mitochondria. Magnetic resonance imaging on the 14th day after surgery showed that the spinal cord structure of the mice in the sham operation group was intact， and the segments were clear， with normal spinal cord signal； the low signal area in the spinal cord injury area increased in the model group， and the spinal cord became significantly thinner； the injured segment had obvious depression in the WTF group， but the structure was more complete than that in the model group. ConclusionWTF may promote spinal cord injury repair by regulating immune function， and its mechanism may be related to inhibiting pyroptosis of spleen B cells.

Relationship between impairment and magnetic resonance imaging finding in patients with traumatic cervical spinal cord injury after surgery / 中国康复理论与实践

ObjectiveTo explore the application of Brain and Spinal Injury Center (BASIC) score in evaluation of traumatic cervical spinal cord injury. MethodsFrom January, 2015 to December, 2021, 175 patients with traumatic cervical spinal cord injury in Beijing Bo'ai Hospital were analyzed. Gender, age, cause of injury, injury mechanism and American Spinal Injury Association Impairment Scale (AIS) grade were collected. The sagittal and axial T2 weighted imaging (T2WI) of the patients were evaluated with BASIC score, single/multi-segment injury, and with/without intramedullary hemorrhage. According to the injury mechanism, the patients were divided into two groups: with fracture/fracture dislocation (n = 92) and without fracture and dislocation (n = 83). The baseline demographic indicators and T2WI evaluation indicators were compared between the two groups, and the relationship between AIS grade and BASIC score, intramedullary hemorrhage, single/multi-segment injury were investigated. ResultsThere were significant differences in gender, age and AIS grade, BASIC score, and the rates of inntramedullary hemorrhage and single segment injury of T2WI between two groups (t = -10.276, χ2 > 8.703, P < 0.01); however, no difference was found in the cause of injury (P > 0.05). The AIS grade was significantly correlated with the BASIC score (r = 0.790, P < 0.001). There was significant difference in AIS grade between intramedullary hemorrhage or not, and single/multi-segment injury (χ2 > 5.516, P < 0.05). ConclusionThe BASIC score of T2WI is a predictor of the severity of spinal cord injury after traumatic cervical spinal cord injury, and is different with the injury mechanisms.

Relationship between symmetry of lower limb function and gait symmetry in patients with incomplete spinal cord injury / 中国康复理论与实践

ObjectiveTo observe the characteristics of gait symmetry and its influencing factors in patients with incomplete spinal cord injury (ISCI). MethodsFrom May, 2018 to November, 2021, 34 patients with ISCI in Beijing Bo'ai Hospital were divided into symmetrical injury of lower limb (SI) group and asymmetrical injury of lower limb (ASI) group according to the lower extremities motor score (LEMS). Three dimensional motion acquisition system and plantar pressure acquisition system were used for gait test. The symmetry indexes of step length, stance time and swing time were caculated. ResultsThe symmetry indexes of step length, stance time and swing time were significant lower in SI group than in ASI group (|t| > 2.619, P < 0.01). Stance time and swing time significantly correlated to the difference of bilateral LEMS in ASI group (r > 0.468, P < 0.01). Discriminant analysis showed that gait parameter equations were different for patients with different symmetry of lower limb injuries. ConclusionThe symmetry of lower limb motor function impacts gait symmetry for patients with ISCI, especially the difference value of bilateral total LEMS. Gait parameters can be used to determine the symmetry of lower limb injury in patients with ISCI.

Application of International Standards for Neurological Classification of Spinal Cord Injury in China: a bibliometrics re-analysis / 中国康复理论与实践

ObjectiveTo analyze the application of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in China. MethodsResearches using ISNCSCI in the spinal cord injury were retrieved from CNKI, from January 1st, 2020 to December 31st, 2022. The authors and the keywords of the included literatures were analyzed using VOSviewer and CiteSpace to generate a collaboration network graph of authors and a theme distribution map of keywords. The objects, purposes, causes of spinal cord injury, distribution of researchers' departments, ISNCSCI version used, corresponding publication time and other information of the included studies were manual searched and analyzed. ResultsA total of 285 literatures were finally included, involving 1 279 authors, out of whom 111 published 97.19% of the total number of articles. The main keywords included spinal cord injury, spinal fractures, neurological function, thoracolumbar fractures and spinal tuberculosis, which classified in seven clusters, and the topics of spinal cord injury, efficacy, spinal fractures, quality of life and prognosis were the hotspots in the field. With manual searching, the main topic was spinal cord injury; the main object was traumatic spinal cord injury; the main purpose was to evaluate the surgical efficacy; the research institutions were mostly the comprehensive hospitals or specialized hospitals focusing on orthopedics (spinal surgery); the clinical departments that used ISNCSCI the most were orthopedics (including spinal surgery) and rehabilitation medicine, and nursing teams were paying more attention to ISNCSCI; the most commonly used versions of ISNCSCI were 2011 (7th edition) and 2000 (6th edition), however, for a large number of articles, the versions were not clear or earlier than 2000. ConclusionThe application of ISNCSCI in China should be improved in the standardization.

Effect of transcranial direct current stimulation combined with task-oriented rehabilitation training on forelimb motor dysfunction in rats with spinal cord injury / 中国康复理论与实践

ObjectiveTo observe the effect of transcranial direct current stimulation (tDCS) combined with task-oriented rehabilitation training single pellet reaching and grasping (SPG) on the motor function of forelimb in rats with unilateral contusion of C5 spinal cord. MethodsA total of 60 adult male Sprague-Dawley rats were randomly divided into sham operation group (sham group), spinal cord injury (SCI) group, tDCS group, SPG group, false group and tDCS+SPG group, with ten rats in each group. Only C5 lamina was removed in the sham group, and the C5 spinal cord contusion model was established by IH spinal cord impactor in the other five groups. The rats received tDCS in tDCS group, SPG in SPG group, tDCS without current in false group, tDCS combined with SPG in tDCS+SPG group, and no treatment in the SCI and the sham groups. The rats were evaluated with Rearing and Grooming tests, and motor-evoked potential (MEP). ResultsFour weeks after operation, compared with SCI group, the scores of Rearing and Grooming increased in tDCS group and tDCS+SPG group (P < 0.05), and they were more in the tDCS+SPG group than in tDCS group and SPG group (P < 0.05); the score of Grooming increased in SPG group (P < 0.05); while the amplitude of MEP increased in tDCS group, SPG group and tDCS+SPG group (P < 0.05), and the latency shortened in tDCS group and tDCS+SPG group (P < 0.05); and the amplitude increased more in tDCS+SPG group than in tDCS group and SPG group (P < 0.01). ConclusiontDCS could promote the recovery of motor function in rats with SCI, and the combination therapy of tDCS and task-oriented rehabilitation training is more effective.

Risk factors for urinary tract infection after a spinal cord injury / 中华物理医学与康复杂志

Objective:To explore the risk factors for urinary tract infection (UTI) after a spinal cord injury (SCI).Methods:The medical records of 403 SCI patients were analyzed retrospectively. They were divided into UTI group and no-UTI group according to whether they had a UTI at admission. Gender, age, cause of injury, injury level of the spinal cord, voluntary anal contraction, time from injury to admission, American Spinal Injury Association (ASIA) grade, axillary temperature at admission, complications at admission (diabetes, hypertension, fracture of the pelvis, pressure sores or anemia), white blood cell count and urinary bacteria were compared between the two groups. Binary logistic regression was used to highlight the risk factors for a UTI after an SCI.Results:Of the 354 patients included in the final analysis, 62 (17.51%) had a UTI at admission. The regression showed that UTI after an SCI was closely related to an inability to voluntarily contract the anus, anemia, elevated white blood cell count and a high level of bacteria in the urine.Conclusions:Inability to contract the anus, fever, anemia and an elevated white blood cell count are independent indicators of a UTI after an SCI. A temperature ≥37.3°C is a simple indicator of a concentration of bacteria in the urine ≥1266/μL.

Risk factors for deep vein thrombosis after a spinal cord injury: A retrospective study / 中华物理医学与康复杂志

Objective:To explore the risk factors for lower extremity deep vein thrombosis (DVT) in patients with a spinal cord injury (SCI).Methods:The medical records of 276 hospitalized SCI patients were analyzed retrospectively. They were divided into a DVT group ( n=63) and a no-DVT group ( n=213). Gender, age, blood type, smoking history, surgical history, the time from SCI to admission, cause of SCI, fracture, SCI segments, American Spinal Cord Injury Association grade and complications were compared between the two groups. Binomial logistic regression was used to isolate the risk factors for lower extremity DVT among such patients. Results:Among 84% of the 63 with a lower extremity DVT, it was a calf muscle venous thrombosis. Anemia, hyponatremia and time from SCI to admission (which ranged from 74 to 195 days) were the most serious DVT risk factors.Conclusions:SCI patients are of high risk for DVT, with anemia and hyponatremia being independent risk factors.

Ultrashortwave therapy can inhibit inflammation and promote recovery from spinal cord injury / 中华物理医学与康复杂志

Objective:To observe any effect of ultrashortwave (USW) therapy on inflammatory cytokines and the MAPK pathway of rats with a spinal cord injury.Methods:Seventy-nine Sprague-Dawley rats were randomly divided into a control group ( n=35), an intervention group ( n=35) and a sham group ( n=9). Allen′s method was used to establish a contusion model of SCI in the rats of the control and intervention groups, while the sham group′s spinal tissues were exposed but not stricken. Beginning twenty-four hours after SCI modeling, the intervention group was given 7min of USW therapy daily, five days a week till the day of sacrifice for sampling the target area of spinal cord for tests. Then, motion function was evaluated using Basso, Beattie and Bresnahan (BBB) scoring. One, three and seven days after the SCI modeling, immunofluorescence and western blotting were employed to observe any changes in inflammatory factors and the MAPK pathway in the lesioned area. Results:Fourteen days after the modeling the average BBB score of the intervention group was significantly higher than the control group′s average. Moreover, 7 days after the modeling the average content of the domains containing protein 3 (NLRP3), interleukin-6 (IL-6), IL-6 receptor and tumor necrosis factor-α (TNF-α) in the target area of the spinal cord of sham group showed significantly lower levels than in the other 2 groups. And the levels in the intervention group were significantly lower than in the control group. Seven days after the modeling the number of cells positive for zinc finger protein 36 (TTP) in the lesioned area of the intervention group was significantly greater than among the control group. At the same time the levels of MAPK-activated protein kinase 2 (MK2), phosphorylated-mitogen-activated protein kinase-activated version (p-MK2) and TTP in the control and intervention groups were significantly higher than in the sham group. And there were significant differences between the intervention group and control group in the levels of MK2, p-MK2 and TTP.Conclusion:Ultrashortwave therapy can inhibit inflammation by regulating the MAPK inflammatory pathway, promoting the recovery of motion functions, at least in rats.