Effectiveness of respiratory proprioceptive neuromuscular facilitation technique on pulmonary function in spinal cord injury patients: a randomized controlled trial

Background: Spinal cord injury (SCI) often leads to respiratory complications due to impaired neuromuscular control. Proprioceptive neuromuscular facilitation (PNF) techniques have shown promise in improving respiratory function in various populations, but their effectiveness in SCI patients remains underexplored. This study aimed to investigate the effectiveness of respiratory PNF techniques on pulmonary function in individuals with SCI. Methods: A randomized controlled trial was conducted involving SCI patients with respiratory impairment. A total of 43 participants were included in this study. The study duration was 4 years with an intervention period of 4 weeks and the outcome measures were pulmonary functions and chest expansion using inch tape. Results: There was a significant improvement in pulmonary functions in the control group and a highly significant improvement in pulmonary functions in the experimental group after 4 weeks of interventions and chest expansion was significantly improved in the experimental group. Conclusions: The respiratory PNF techniques demonstrated a clinically meaningful enhancement in pulmonary function and chest mobility among SCI patients. Respiratory PNF techniques represent a valuable adjunct therapy for improving pulmonary function and chest mobility in individuals with SCI.

Primary spinal glioblastoma multiforme: a case report

Spinal cord glioblastoma multiforme (GBM) is an uncommon disease within spinal tumours. According to our review of literature, less than 200 patients have been reported so far. Here we highlight the case of a 35 year female who complained of mild and intermittent lower back pain that radiates to bilateral thighs and was associated with tingling and numbness over both feet. The patient was evaluated and operated elsewhere with L1-L2 laminectomy and micro-surgical excision and it was reported as a case of myxopapillary ependymoma. However, immunohistochemical (IHC) stains were positive for GBM grade IV. A residual tumour was seen in postoperative magnetic resonance imaging (MRI) at our institute. Subsequently, the patient was subjected to adjuvant radiotherapy (RT) and regular Temozolomide chemotherapy following near-total resection of the mass. Aggressive management of this condition with timely chemo radiation is needed to enhance survival and assure a decent quality of life.

Unexpected clinical and functional recovery in patients with chronic traumatic chronic spinal cord injury: a case series

Motor recovery in traumatic spinal cord injury (tSCI) is reported to reach its plateau by 1 year and maximum recovery period is reported to be 2 years. Acute rehabilitation is very well documented in literature with patients reporting for functional rehabilitation immediately after shock period is over. However, the scenario being a bit different in rural areas with comparatively less awareness about role of physiotherapy, patients with tSCI reports at later stages. Reported here is a series of chronic tSCI cases who showed remarkable clinical and functional recovery in short time. Aim of this study is to report recovery in patients with chronic tSCI and to compare the patient outcomes with expected outcomes. Conventional physiotherapy was given 5 days a week with minimum 45 mins treatment. Baseline assessment at admission and at discharge was recoded. Improvement was recorded with spinal cord independence at different time points. Nine patients below 40 years of age, average duration of injury 6.2 years were treated for average of 8 months. NLI did not change in 3 patients whereas in 6 patients NLI moved 2 segments down. Mean change in SCIM score was 10 between admission and discharge. Functional status was compared with expected parameters and was found to be improved by 70%, suggesting had they come at early stage, expected recovery could have been achieved. Clinical and functional recovery in patients with tSCI may occur even after 2 years post injury.

COVID-19 associated transverse myelitis: case report / Mielitis transversa asociada a COVID-19: reporte de un caso

Abstract Background: Transverse myelitis (TM) is a demyelinating inflammatory disease that presents with motor, sensory, and autonomic dysfunction, which may be acute or subacute. COVID-19-associated TM has been described in a scarce number of patients. Clinical case: A 15-year-old previously healthy male patient with respiratory disease before his neurological deterioration presented to the emergency room after developing a complete medullary syndrome located at the cervical-dorsal level, with ascending and symmetric paraparesis that rapidly progressed to paraplegia, with sensory dysfunction from the T3 level, sphincter dysfunction and sudden ventilatory deterioration that required mechanical ventilation. Magnetic resonance imaging was compatible with acute TM. Inflammatory and non-inflammatory etiologies were discarded. In addition, a positive severe acute respiratory syndrome coronavirus 2 test was obtained. Treatment included steroid pulses and plasmapheresis, with an insidious evolution. Conclusion: COVID-19 is an infrequent cause of TM and should be suspected when other etiologies have been ruled out.

Resumen Introducción: La mielitis transversa (MT) es una enfermedad inflamatoria desmielinizante que se presenta con disfunción motora, sensitiva y autonómica, de forma aguda o subaguda. La MT asociada al COVID-19 se ha escrito en un escaso número de pacientes. Caso clínico: Se presenta el caso de un masculino de 15 años previamente sano, quien cursaba con un cuadro respiratorio y que desarrollo un deterioro neurológico súbito que involucro un síndrome medular completo localizado en el nivel cérvico dorsal, con paraparesia simétrica que progreso a la paraplejia, con disfunción sensitiva desde el nivel medular de T3, disfunción de esfínteres y deterioro ventilatorio que requirió manejo avanzado de la vía aérea. Su resonancia magnética fue compatible con mielitis transversa aguda. Se descartaron causas inflamatorias y no inflamatorias de la patología. Además, se obtuvo un resultado positivo de SARS-COV-2. Se inició tratamiento con pulsos de metilprednisolona y plasmaféresis, con una evolución insidiosa. Conclusión: El COVID-19 es una causa infrecuente de MT y debe sospecharse cuando otras causas han sido descartadas.

Influences of Glabridin Treatment on Motor Function Recovery after Spinal Cord Injury / Influencia del Tratamiento con Glabridina en la Recuperación de la Función Motora después de una Lesión de la Médula Espinal

SUMMARY: Spinal cord injury (SCI) usually arises from compression due to traffic accidents and falls, resulting in varying degrees of movement, sensory loss, and possible paralysis. Glabridin (Gla) is a natural compound derived from licorice. It significantly affects drug development and medicine because of its anti-inflammatory, anti-oxidative, anti-tumoral, antibacterial, bone protective, cardiovascular protective, neuroprotective, liver protective, anti-obesity, and anti-diabetic properties. Various methods were employed to administer Gla to SCI mice in order to investigate its impact on the recovery of motor function. The mice were allocated into four cohorts using a randomization procedure. In the sham cohort, solely the lamina of vertebral arch was surgically exposed without causing any harm to the spinal cord tissue. Conversely, the injury cohort was subjected to spinal cord tissue damage and received no treatment thereafter. The mice in the remaining two cohorts received a dosage of 40 mg/kg Gla every two days via either intraperitoneal or intrathecal injection for a duration of 42 d following spinal cord injury. We conducted behavioral tests utilizing the Basso Mouse Scale score and gait analysis techniques. Magnetic resonance imaging and hematoxylin and eosin were employed to evaluate scar tissue formation. Systemic inflammation in mice was evaluated by employing an enzyme-linked immunosorbent assay. Gla promoted motor function recovery in mice following SCI and improved the pathological environment in the damaged area. These alterations were more evident in mice subjected to the intrathecal injection method. Intraperitoneal injections appear to be more beneficial for controlling systemic inflammatory responses. Although more intensive studies are required, Gla exhibits promising clinical potential as a cost-effective dietary phytochemical.

La lesión de la médula espinal (LME) generalmente surge de la compresión producto de caídas y accidentes de tránsito, lo que resulta en alteraciones del movimiento, pérdida sensorial y posible parálisis. La Glabridina (Gla) es un compuesto natural derivado del regaliz, constituyéndose en un aporte significativo para el desarrollo de fármacos y la medicina debido a sus propiedades antiinflamatorias, antioxidantes, antitumorales, antibacterianas, osteoprotectoras, cardioprotectoras, neuroprotectoras, hepatoprotectoras, antidiabéticas y contra la obesidad. En el presente trabajo se emplearon varios métodos para administrar Gla a ratones con lesión medular con el fin de investigar su impacto en la recuperación de la función motora. Los ratones fueron distribuidos en cuatro grupos mediante un procedimiento de aleatorización. En el grupo simulado, únicamente se expuso quirúrgicamente la lámina del arco vertebral sin causar ningún daño al tejido de la médula espinal. Por el contrario, el grupo lesionado fue sometido a daño del tejido de la médula espinal, sin recibir tratamiento posterior. Los ratones de los dos grupos restantes recibieron una dosis de 40 mg/kg de Gla cada dos días mediante inyección intraperitoneal o intratecal durante 42 días después de la lesión de la médula espinal. Fueron realizadas pruebas de comportamiento utilizando la puntuación de la escala Basso Mouse y técnicas de análisis de la marcha. Se emplearon imágenes por resonancia magnética y se aplicaron tinciones histológicas (Hematoxilina & Eosina) en muestras para evaluar la formación de tejido cicatricial. La inflamación sistémica en ratones se evaluó mediante el empleo de un ensayo inmunoabsorbente ligado a enzimas. Gla promovió la recuperación de la función motora en ratones después de una lesión medular y mejoró el entorno patológico en el área dañada. Estas alteraciones fueron más evidentes en ratones sometidos al método de inyección intratecal. Las inyecciones intraperitoneales parecen ser más beneficiosas para controlar las respuestas inflamatorias sistémicas. Aunque se requieren estudios más intensivos, Gla exhibe un potencial clínico prometedor como fitoquímico dietético rentable.

Comparative Efficacy of Baclofen and Diazepam in Treating Spasticity Following Acquired Spinal Cord Injuries: A Randomized Controlled Trial

Introduction: Spasticity is a pervasive and debilitating condition. Anti-spastic medications like Baclofen and Diazepam are most commonly used for spasticity management. Objectives: The study aimed to evaluate and compare the efficacy of Baclofen with that of Diazepam in the management of spasticity following acquired spinal cord injuries. Methods: In this randomised open-label study involving 60 patients, 30 patients received 5 mg of oral Baclofen thrice daily and 30 patients received 5 mg of oral Diazepam thrice daily for the management of spasticity. The extent of spasticity was measured by Modified Ashworth Scale (MAS). The efficacy of these drugs was measured with the mean improvement in the above parameters on days 7, 14, 28, 56 and 90 from the start of pharmacotherapy. Results: Baseline muscle spasticity scores were comparable. At the endpoint, mean improvement in tone of right and le? hip flexors (1.43 vs. 0.87), hip adductors (1.30 vs. 0.87), knee flexors (0.80 vs. 0.37), ankle plantar flexors (0.80 vs. 0.37) and ankle dorsiflexors (1.23 vs. 0.93) were significantly higher in Baclofen group (p<0.05), while the tone of right and le? hip abductors, hip and knee extensors showed no significant difference among the groups. Conclusion: Baclofen was found to be superior to Diazepam in terms of efficacy, especially for flexor spasticity of lower limbs in acquired spinal cord injuries.

Silent Beats : Spontaneous Recovery of Transient Ventricular Asystole following High Spinal Cord Injury

Background : High Spinal Cord Injuries can give rise to various complications, including cardiovascular disturbances. One rare but critical manifestation following such injuries is transient ventricular asystole, characterized by a temporary absence of ventricular contractions. This case report presents a unique instance of transient ventricular asystole following a High Spinal Cord Injury (HSCI), highlighting its rarity and the remarkable spontaneous recovery observed without invasive cardiac intervention. The importance of vigilant monitoring and comprehensive assessment in Spinal Cord Injury (SCI) patients is emphasized without delaying definitive neurosurgical management. Case Presentation : A 29-year-old female experienced a HSCI due to a road traffic accident. Cardiopulmonary resuscitation was performed upon arrival at the Emergency Department. Subsequent evaluations revealed hypotonia in all limbs and the patient was admitted to the Intensive Care Unit. Her Initial Electrocardiogram (ECG) showed ventricular asystole, but later ECGs displayed sinus rhythm with intermittent sinus tachycardia. Imaging confirmed cervical spine dislocation and kyphoscoliotic deformity. Remarkably, the patient抯 cardiac function rapidly recovered, eliminating the need for invasive cardiac treatment. Discussion : Cardiac asystole is a rare complication after cervical spine trauma with High Spinal Cord Injuries. In this case, transient ventricular asystole likely resulted from a cervical vertebral fracture and manipulation during stabilization. The patient抯 spontaneous recovery without cardiac intervention highlights the importance of avoiding unnecessary cardiac workups that may delay definitive neurosurgical management. Conclusions : Spinal Cord Injury impacts the autonomic nervous system, leading to cardiovascular changes like bradyarrhythmia. This case emphasizes the significance of meticulous monitoring and prompt neurosurgical intervention in HSCI cases while minimizing undue focus on invasive cardiac interventions.

Validation of nursing educational technology for neurogenic bowel rehabilitation in people with spinal cord injury / Validación de tecnología educativa de enfermería para la rehabilitación del intestino neurogénico en personas con lesión medular / Validação de tecnologia educativa de enfermagem para a reabilitação do intestino neurogênico em pessoas com lesão medular

Introduction: Considered an unpredictable and recurring problem, Neurogenic Bowel does not resolve over time and progressively worsens, translating into a physical and psychological challenge, significantly reducing Quality of Life. Objective: To construct and validate the face and content of an educational technology for use by nurses in the rehabilitation of Neurogenic Bowel in people with Spinal Cord Injury. Materials and methods: A methodological, quantitative study developed in two stages: the construction of an educational technology on the Canvas platform based on a literature review based on Wanda Horta's Theory of Human Needs and its validation by expert judges. The validation process included nurses with ability in neurogenic bowel in teaching, research or care. The criterion for validation was agreement of over 80%, analyzed using the Content Validation Index and binomial test with confidence intervals of 95.00% (p<0.05). Results: The integrative literature review proved necessary for the construction of the proposed educational technology and covered characteristics of the Neurogenic Bowel, bowel emptying techniques, guidelines and the systematization of nursing care. The protocol was validated by ten expert judges who had graduated in nursing for more than 10 years (100.00%), with an average age of 41.8 years, female (60.00%) and an average training period of 18.6 years. An overall Content Validation Index of 0.96 (p≤0.001) was obtained for the items assessed (objective, content, relevance, functionality, efficiency and appearance/diagramming). Discussion: The implementation of an intestinal rehabilitation program aims, above all, to achieve frequent, regular and consistent stools in people with spinal cord injury and nurses, as multipliers of knowledge, can be facilitators in the teaching-learning process for carers, people with this condition and other members of the healthcare team. Conclusion: It can be concluded that the educational technology has been validated and could help the teaching-learning process for nurses in the clinical practice of caring for people with Neurogenic Bowel Disease.

Introducción: Considerado un problema impredecible y recurrente, el Intestino Neurogénico no se resuelve por sí solo con el tiempo y se vuelve progresivamente más pronunciado, traduciéndose en un desafío físico y psicológico, reduciendo significativamente la Calidad de Vida. Objetivo: Construir y validar el rostro y el contenido de una tecnología educativa para uso del enfermero en la rehabilitación del Intestino Neurogénico en personas con Lesión Médular. Materiales y Métodos: Estudio metodológico, cuantitativo, desarrollado en dos etapas: construcción de una tecnología educativa en la plataforma Canvas a partir de una revisión de literatura basada en la Teoría de las Necesidades Humanas de Wanda Horta y validación por jueces expertos. Para la validación se incluyeron enfermeros con experiencia en Intestino Neurogénico en la docencia, investigación o asistencia. El criterio de validación fue la concordancia mayor al 80%, analizado mediante el Índice de Validación de Contenido y prueba binomial con intervalos de confianza al 95,00% (p<0,05). Resultados: La revisión integradora de la literatura resultó necesaria para la construcción de la tecnología educativa propuesta e incluyó características del Intestino Neurogénico, técnicas de vaciamiento intestinal, guías y la sistematización de los cuidados de enfermería. Diez jueces expertos graduados en enfermería hacen más de 10 años (100,00%), con edad promedio de 41,8 años, predominantemente del sexo femenino (60,00%) y tiempo promedio de formación de 18,6 años, validaron el protocolo. Se obtuvo un Índice de Validación de Contenido general de 0,96 (p≤0,001) en los ítems evaluados (objetivo, contenido, relevancia, funcionalidad, eficiencia y apariencia/diseño). Discusión: La implementación de un programa de rehabilitación intestinal tiene como objetivo, sobre todo, obtener deposiciones frecuentes, regulares y consistentes en personas con Lesión Médular y el enfermero como multiplicador de conocimientos puede ser un facilitador en el proceso de enseñanza-aprendizaje de los cuidadores, de las personas. con esta afección y para otros miembros del equipo de atención médica. Conclusión: Se concluye que la tecnología educativa está validada y puede facilitar el proceso de enseñanza-aprendizaje del enfermero en la práctica clínica del cuidado de personas con Intestino Neurogénico.

Introdução: Considerado um problema imprevisível e recorrente, o Intestino Neurogênico não se resolve com o tempo e se acentua progressivamente, traduzindo-se em um desafio de caráter físico e psicológico, diminuindo significativamente a Qualidade de Vida. Objetivo: Construir e validar face e conteúdo de uma tecnologia educativa para uso de enfermeiros na reabilitação do Intestino Neurogênico em pessoas com Lesão Medular. Materiais e métodos: Estudo metodológico, quantitativo, desenvolvido em duas etapas: construção de uma tecnologia educativa na plataforma Canvas a partir da revisão da literatura fundamentado na Teoria das Necessidades Humanas de Wanda Horta e validação dele por juízes experts. Para a validação foram incluídos enfermeiros com expertise em Intestino Neurogênico na docência, pesquisa ou assistência. O critério para validação foi concordância superior a 80%, analisada por meio do Índice de Validação de Conteúdo e teste binomial com intervalos de confiança em 95,00% (p<0,05). Resultados: A revisão integrativa da literatura mostrou-se necessária para a construção da tecnologia educativa proposta e contemplou características do Intestino Neurogênico, técnicas de esvaziamento intestinal, orientações e a sistematização da assistência de enfermagem. Validaram o protocolo dez juízes experts graduados em enfermagem há mais de 10 anos (100,00%), com idade média de 41,8 anos, predominantemente do sexo feminino (60,00%) e tempo médio de formação de 18,6 anos. Obteve-se Índice de Validação de Conteúdo geral de 0,96 (p≤0,001) nos itens avaliados (objetivo, conteúdo, relevância, funcionalidade, eficiência e aparência/diagramação). Discussão: A implementação de um programa de reabilitação intestinal objetiva, sobretudo, a obtenção fezes frequentes, regulares e consistentes em pessoas com Lesão Medular e o enfermeiro enquanto multiplicador de conhecimento pode ser um facilitador no processo de ensino aprendizagem para os cuidadores, para as pessoas com esta condição e para outros membros da equipe de saúde. Conclusão: Conclui-se que a tecnologia educativa está validada e poderá facilitar o processo de ensino-aprendizagem do enfermeiro na prática clínica de cuidado com pessoas com Intestino Neurogênico.

Habilidades nas transferências para desempenho das atividades cotidianas de pessoas com lesão da medula espinal / Skills in transfers to perform the daily activities of people with spinal cord injury / Habilidades en transferencias para realizar las actividades diarias de personas con lesión médula espinal

Objetivo: refletir sobre a importância do trabalho das equipes de reabilitação, orientando e habilitando os cadeirantes para o desempenho seguro das transferências diárias, fundamentais na realização das atividades cotidianas e inclusão social. Métodos: trata-se de estudo teórico-reflexivo fundamentado na teoria do déficit de autocuidado, com a utilização integrada dos diagnósticos de enfermagem, da classificação internacional das práticas de enfermagem e do instrumento de avaliação das transferências, adequados às necessidades de pessoas com lesão medular, atendidas nos ambientes institucionais de cuidados, visando o preparo para o desempenho das atividades cotidianas. Resultados: cabe aos enfermeiros assumir liderança nas equipes de reabilitação física, norteando suas intervenções no treinamento dessas pessoas e seus cuidadores para o desempenho e ajuda segura nas transferências para cuidar de si. Conclusão: considerando a lesão medular entre os maiores problemas da saúde coletiva que afeta a humanidade contemporânea, tanto pelos comprometimentos na qualidade de vida das pessoas, quanto no aumento das despesas hospitalares e reabilitação requeridos, a adoção de estratégias de cuidados preventivos de complicações musculoesqueléticas é sempre bem-vinda. Essas pessoas, quando não orientadas, executam movimentos repetitivos para se deslocar em transferências de uma superfície para outra, correndo elevados riscos de contrair lesões nas articulações, pele e mucosas. (AU)

Objective: to reflect on the importance of the work of rehabilitation teams, guiding and enabling wheelchair users to safely perform daily transfers, essential for carrying out daily activities and social inclusion. Methods: this is a theoretical-reflective study based on the theory of self-care deficit, with the integrated use of nursing diagnoses, the international classification of nursing practices and the transfer assessment instrument, adapted to the needs of people with spinal cord injury, attended in institutional care environments, aiming to prepare for the performance of daily activities. Results: it is up to nurses to assume leadership in physical rehabilitation teams, guiding their interventions in the training of these people and their caregivers for performance and safe help in transfers to take care of themselves. Conclusion: considering spinal cord injury among the biggest collective health problems that affect contemporary humanity, both because of the compromises in people's quality of life, as well as the increase in hospital and rehabilitation expenses required, the adoption of preventive care strategies for musculoskeletal complications is always welcome. These people, when not guided, perform repetitive movements to move in transfers from one surface to another, running high risks of contracting injuries to the joints, skin and mucous membranes. (AU)

Objetivo: reflexionar sobre la importancia del trabajo de los equipos de rehabilitación, orientando y capacitando a los usuarios de silla de ruedas para realizar con seguridad las tranferencias cotidianas, indispensables para el desarrollo de las actividades cotidianas y la inclusión social. Métodos: se trata de un estudio teórico-reflexivo basado en la teoría del déficit de autocuidado, con el uso integrado de los diagnósticos de enfermería, la clasificación internacional de prácticas de enfermería y el instrumento de evaluación de la transferencia, adaptado a las necesidades de las personas con lesión medular. asistidos en ambientes de atención institucional, con el objetivo de preparar para el desempeño de las actividades diárias. Resultados: corresponde a los enfermeros asumir el liderazgo en los equipos de rehabilitación física, orientando sus intervenciones en la formación de esas personas y sus cuidadores para el desempeño y ayuda segura en las transferencias para cuidarse. Conclusion: considerando la lesión medular entre los mayores problemas de salud colectiva que afectan a la humanidad contemporánea, tanto por los compromisos en la calidad de vida de las personas, como por el aumento de los gastos hospitalarios y de rehabilitación requeridos, la adopción de estrategias de atención preventiva de las complicaciones musculoesqueléticas siempre es bienvenido Estas personas, cuando no están guiadas, realizan movimientos repetitivos para moverse en transferencias de una superficie a otra, corriendo un alto riesgo de contraer lesiones en las articulaciones, piel y mucosas. (AU)

Epidemiological Profile of Adult Patients with Surgically Treated Intracranial Neoplasms

Aims: The American Cancer Society,s estimates for brain and spinal cord tumors in the United States for 2023, include both adults and children,25,400 malignant tumors will be diagnosed. The objective of this study was to analyze the epidemiological profile, risk factors for complications and death in the in-hospital postoperative period, in addition to describing the histological type of intracranial tumors most frequently operated on in a private Brazilian institution. Study Design: Retrospective cohort study. Place and Duration of Study: Biocor Instituto/Rede D’Or, from 2018 to 2021 Methodology: Data were collected from the medical records of patients who underwent surgery for intracranial tumors. The variables analyzed in this study were demographic characteristics (age, sex, and comorbidities), histological types of primary and secondary neoplasms, anatomical location of the lesions, neurological deficits at admission and post-surgical treatment (at discharge), whether the surgery was urgent or elective, whether it was a reoperation, and whether there were deaths or complications during hospitalization. Results: Of 242 patients, 11 patients were excluded, and 231 patients were included in the analysis. The most common histological type was meningioma, accounting for 28% of cases. The histological type most associated with the risk of death was hemangioblastoma; however, it was also the histological type that presented the lowest incidence of cases. 39 patients (17%) had some complication in the in-hospital postoperative period, and 14 patients (6%) died. Conclusions: Meningiomas constituted the majority of cases, accounting for 28% of the sample. The rate of complications and mortality was higher when compared to data from the international literature because this series analyzed brain metastases together with the excision of primary tumors. Concerning in-hospital deaths, hemangioblastoma emerged as the histological type most associated with the risk of death. It is noteworthy, however, that hemangioblastoma also exhibited the lowest incidence among the various histological types.

Impact of COVID-19 on socio-behavioural, health and oral health-related aspects on spinal cord injury patients: a cross-sectional study

Background: Spinal cord injury (SCI) is a damaging, life-altering injury, which is estimated to have an annual global incidence of 40 to 80 cases per million population and is two to five times more possible to die prematurely. This study aims to evaluate the impact of COVID-19 on socio-behavioural, health, and oral health-related aspects of spinal cord injury patients. Methods: This cross-sectional study was conducted among 50 spinal cord injury patients in the rehabilitation center in Chennai, Tamil Nadu, which was conducted between May and June 2022. Results: The comparison of mean distribution scores based on DMFT showed that complete injury patients had a lower DMFT score of 6.40 when compared to incomplete injury (8.41). The periodontal status assessment revealed that SCI with complete injury had a lower mean number of teeth with gingival bleeding and periodontal pocket (3.81 and 2.31 respectively) when compared to incomplete injury (7.12 and 4.49). Moreover, the impact of COVID-19 on the socio-behavior and health status was found to be higher in complete injury than that in incomplete injury patients. Conclusions: Therefore, this pandemic highlights the need to advocate the development of a nationwide SCI registry or surveillance system is fundamental to an understanding of the epidemiology and, hence, the prevention of this emerging health burden.

Delayed Paraparesis: An Unusual Complication Following Coarctation of Aorta Repair

Paraparesis following cardiac surgery is a manifestation of spinal cord injury (SCI). It can occur in any aortic surgery from the aneurysm to the coarctation of the aorta (CoA) where the cross?clamp of the aorta is applied. Though the incidence of paraplegia is low, its occurrence affects the morbidity and mortality of the patient. There are only sporadic case reports on the development of paraplegia following recurrent and technically challenging repair of CoA. However, the spontaneous development of paraplegia has also been reported in cases of unoperated CoA. The present report describes the case of delayed SCI in which paraparesis developed 5 days post a coarctation repair. The risk factors and strategies to protect the spinal cord during aortic surgeries are emphasized.

Effect and mechanism of transplantation bone marrow stromal stem cells transfected NRG1 gene on repair of hemi-transected spinal cord injury in rats / 解放军医学杂志

Objective To investigate the effect and mechanism of transplantation of neuregulin1(NRG1)gene-modified bone marrow mesenchymal stem cells(BMSCs)on the repair of hemi-transected spinal cord injury(SCI)in rats.Methods Isolated and cultured rat BMSCs,followed by transfection with the NRG1 gene.The levels of NRG1 in BMSCs lysate and culture supernatant was deected by ELISA method,and the proliferation activity of the BMSCs was detected by cell counting method.Forty-three healthy 8-week-old SD rats were randomly divided into control group(n=10),SCI model group(n=10),BMSCs group(n=10),and NRG1-BMSCs group(n=13).After establishing the spinal cord hemisection model,animals received in-situ transplantation of BMSCs or NRG1-BMSCs.On the 1,7,14,21,and 28 days after transplantation,the hind limb motor function was evaluated using BBB score and inclined plate test;on the 7th day after transplantation,the migration and distribution of transplanted cells was monitored using a fluorescence microscope;on the 28th day after transplantation,the pathological changes of rat spinal cord tissues was examined using HE staining and Nissl staining;cell apoptosis using TUNEL staining,and levels of endoplasmic reticulum stress-related proteins[X-box binding protein 1(XBP1),C/EBP homologous protein(CHOP),activating transcription factor 4(ATF4),ATF6,glucose-regulated protein 78(GRP78)]and apoptosis-related proteins[B-cell lymphoma-2(Bcl-2)and Bcl-2-associated protein X(Bax)]in rat spinal cord tissues using Western blotting.Results BMSCs were successfully isolated,cultured,and transfected with the NRG1 gene.ELISA method results showed that the NRG1 contents in the NRG1-BMSCs lysate and culture supernatant were significantly higher than that of BMSCs in a time-dependent manner(P<0.05).The proliferation activity of NRG1-BMSCs was significantly higher than that of BMSCs(P<0.05).On the 21 and 28 days after transplantation,the BBB score and the slope angle of the inclined plate in NRG1-BMSCs group were higher than those in SCI model group or BMSCs group(P<0.05).However,it did not reverse to the level in control group(P<0.05).On the 28th day after transplantation,compared with the SCI model group and BMSCs group,neuronal pyknosis reduced,the Nissl body density increased,the expression levels of XBP1,CHOP,ATF4,ATF6,GRP78,and Bax,and the rate of TUNEL-positive cells significantly reduced in NRG1-BMSCs group(P<0.05),and the expression level of Bcl-2 significantly increased(P<0.05).Conclusion Transplantation of NRG1 gene-modified BMSCs can alleviate SCI and improve the recovery of motor function in rats.The mechanism may be related to promoting the proliferation activity of BMSCs,inhibiting cell apoptosis,and mitigating endoplasmic reticulum stress.

Long-term efficacy and complications of implantable diaphragm pacer in children with high cervical spinal cord injury: case report and literature review / 中华实用儿科临床杂志

The long-term efficacy and complications of implantable diaphragm pacer (IDP) in a child with cervical spinal cord injury (CSCI) in the Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center in September 2022 were retrospective analyzed.A male child had quadriplegia without an obvious cause at the age of 12 years, and he was then lived completely with the assistance of mechanical ventilation.At the age of 14 years, he could wean off the ventilator in unilateral diaphragmatic pacing mode.However, mechanical ventilation was re-given for months after 5 years due to pneumonia, and then the IDP was re-given with the self-felt decreased pacing effect.After hospitalization, the patient was examined with mild diaphragmatic atrophy, secondary flat chest, and mild scoliosis.After optimization of the transdiaphragmatic pacing threshold and rehabilitation, his respiratory function improved.IDP can be used in CSCI for long time, while flat chest and scoliosis that limited the expansion of the lungs should be considered.At the meantime, the increased abdominal spasm affected the abdominal compliance, leading to the decrease in the efficiency of the diaphragm.

Mechanism of Shikonin on spinal cord injury in rats based on TNFR/RIPK1 pathway / 中国骨伤

OBJECTIVE@#To explore the effect of shikonin on the recovery of nerve function after acute spinal cord injury(SCI) in rats.@*METHODS@#96 male Sprague-Dawley(SD)rats were divided into 4 groups randomly:sham operation group (Group A), sham operation+shikonin group (Group B), SCI+ DMSO(Group C), SCI+shikonin group (Group D).The acute SCI model of rats was made by clamp method in groups C and D . After subdural catheterization, no drug was given in group A. rats in groups B and D were injected with 100 mg·kg-1 of shikonin through catheter 30 min after modeling, and rats in group C were given with the same amount of DMSO, once a day until the time point of collection tissue. Basso-Beattie-Bresnahan(BBB) scores were performed on 8 rats in each group at 6, 12, and 3 d after moneling, and oblique plate tests were performed on 1, 3, 7 and 14 d after modeling, and then spinal cord tissues were collected. Eight rats were intraperitoneally injected with propidine iodide(PI) 1 h before sacrificed to detection PI positive cells at 24 h in each group. Eight rats were sacrificed in each group at 24 h after modeling, the spinal cord injury was observed by HE staining.The Nissl staining was used to observe survivor number of nerve cells. Western-blot technique was used to detect the expression levels of Bcl-2 protein and apoptosis related protein RIPK1.@*RESULTS@#After modeling, BBB scores were normal in group A and B, but in group C and D were significantly higher than those in group A and B. And the scores in group D were higher than those in group C in each time point (P<0.05). At 12 h after modeling, the PI red stained cells in group D were significantly reduced compared with that in group C, and the disintegration of neurons was alleviated(P<0.05). HE and Nissl staining showed nerve cells with normal morphology in group A and B at 24h after operation. The degree of SCI and the number of neuronal survival in group D were better than those in group C, the difference was statistically significant at 24h (P<0.05). The expression of Bcl-2 and RIPK1 proteins was very low in group A and B;The expression of RIPK1 was significantly increased in Group C and decreased in Group D, with a statistically significant difference (P<0.05);The expression of Bcl-2 protein in group D was significantly higher than that in group C (P<0.05).@*CONCLUSION@#Shikonin can alleviate the pathological changes after acute SCI in rats, improve the behavioral score, and promote the recovery of spinal nerve function. The specific mechanism may be related to the inhibition of TNFR/RIPK1 signaling pathway mediated necrotic apoptosis.

Study on the neuroprotective effect of curculigoside on rats with spinal cord injury / 中国药房

OBJECTIVE To investigate the neuroprotective effect of curculigoside （CUR） on rats with spinal cord injury （SCI） based on phosphatase and tensin homologue deleted on chromosome ten gene-induced putative kinase 1 （PINK1）/E3 ubiquitin ligase Parkin signaling pathway. METHODS Taking male SD rats as subjects， 15 rats were randomly selected as sham operation group； the rest rats were chosen to establish SCI model by spinal cord impact method， and then were divided into model group， CUR low-dose group （36 mg/kg CUR， gavage）， CUR high-dose group （72 mg/kg CUR， gavage） and CUR high-dose+3- methyladenine （3-MA） group （72 mg/kg CUR， gavage+20 mg/kg autophagy inhibitor 3-MA， intraperitoneal injection）， with 15 rats in each group. Rats in each group were given corresponding liquid/normal saline， once a day， for 28 consecutive days. Basso- Beattie-Bresnahan （BBB） score and Rivlin inclined plate experiment were performed on the 14th and 28th day after administration； the pathological changes of spinal cord tissue in rats were observed in each group； the apoptosis of spinal cord tissue， the levels of oxidative stress factors [malondialdehyde （MDA）， superoxide dismutase （SOD）， glutathione （GSH）]， and the protein expressions of brain-derived neurotrophic factor （BDNF）， glial fibrillary acidic protein （GFAP）， PINK1， Parkin， p62 and microtubule- associated protein light chain 3 （LC3） were all determined. RESULTS Compared with the sham operation group， obvious edema and bleeding in the spinal cord tissue of rats were observed in the model group， accompanied by a large number of inflammatory cell infiltration； BBB score and inclined plate angle， SOD and GSH levels， the protein expressions of BDNF， PINK1 and Parkin， and LC3Ⅱ/Ⅰ ratio were significantly reduced； the apoptosis rate， MDA level， the protein expressions of GFAP and p62 in spinal cord tissue were significantly increased （P＜0.05）. Compared with the model group， the edema， bleeding and infiltration of inflammatory cells in the spinal cord tissue of rats were reduced in the administration groups， and the above quantitative indicators had been significantly improved （P＜0.05）； 3-MA could significantly reverse the improvement effects of the above indexes by CUR （P＜0.05）. CONCLUSIONS CUR can promote the recovery of neurological and motor functions in SCI rats， improve the pathological injury of the spinal cord and inhibit apoptosis， which may be related to mitochondrial autophagy mediated by activating the PINK1/Parkin signaling pathway.

High-intensity interval training in people with spinal cord injury: a systematic review / Entrenamiento por intervalos de alta intensidad en personas con lesiones medulares: una revisión sistemática / Treinamento intervalado de alta intensidade em pessoas com lesão da medula espinhal: revisão sistemática

ABSTRACT Objective: Analyze the effects of high-intensity interval training (HIIT) on cardiometabolic parameters, and cardiorespiratory fitness to compile the most used HIIT training types in adults with spinal cord injury (SCI). Methods: This is a systematic review of searches performed in the electronic databases PubMed / Medline, Science Direct, and Google Scholar. Studies included I) needed to apply HIIT training II) adults with SCI to analyze III) cardiometabolic aspects and cardiorespiratory fitness. Two independent reviewers selected the articles for inclusion, extracted their data, and assessed their methodological quality. Results: 654 studies were found. Thus, 12 studies, 11 pre- and post-intervention, and one control group (CG) with 106 participants were analyzed. Pre- and post-HIITT intervention results revealed significant improvement in cardiorespiratory fitness and cardiometabolic aspects (VO2peak, LDH, HDL, insulin resistance). In addition, GC results revealed significant improvement in cardiorespiratory fitness observed in the intervention group (HIIT) compared to the moderate-low intensity (GC) group. Seven studies used the arm ergometer as the primary exercise modality. Two studies described functional electrical stimulation (FES) performed with the arm ergometer plus electrical stimulation in the lower limbs. None reported heart rate dynamics during the study period. Conclusion: High-intensity interval training improves physical fitness and cardiometabolic health in adults with SCI. Evidence level II; Systematic Review of level II studies.

RESUMEN Objetivo: Analizar los efectos del entrenamiento interválico de alta intensidad (HIIT) sobre los parámetros cardiometabólicos, fitness cardiorrespiratorio y recopilar los tipos de HIIT más utilizados en el entrenamiento en adultos con lesión medular (LME). Métodos: Se trata de una revisión sistemática, para lo cual se realizaron búsquedas en bases de datos electrónicas PubMed/Medline, Science Direct y Google Scholar. Se incluyeron estudios que I) necesitaban aplicar entrenamiento HIIT en II) adultos con SCI y analizar III) aspectos cardiometabólicos y aptitud cardiorrespiratoria. Dos revisores independientes seleccionaron los artículos para su inclusión, extrajeron sus datos y evaluaron su calidad metodológica. Resultados: De los 654 estudios encontrados, se analizaron 12 estudios, 11 pre y post intervención y 1 grupo control (GC) con un total de 106 participantes. Los resultados previos y posteriores a la intervención HIIT revelaron una mejora significativa en la aptitud cardiorrespiratoria y los aspectos cardiometabólicos (VO2pico, LDH, HDL, resistencia a la insulina). Los resultados de GC revelaron una mejora significativa en la aptitud cardiorrespiratoria observada del grupo de intervención (HIIT) en comparación con el grupo de intensidad moderada-baja (GC). Siete estudios utilizaron el ergómetro de brazo como la modalidad principal de ejercicio. Dos estudios describieron la estimulación eléctrica funcional (EEF) realizada con el ergómetro de brazo más la estimulación eléctrica en los miembros inferiores. Ninguno informó la dinámica de la frecuencia cardíaca durante el período de estudio. Conclusiones: El entrenamiento intervalos de alta intensidad mejora la condición física y la salud cardiometabólica en adultos con LME. Evidencia de nivel II; Revisión sistemática de estudios de nivel II.

RESUMO Objetivo: Analisar os efeitos do treinamento intervalado de alta intensidade (HIIT) nos parâmetros cardiometabólicos, aptidão cardiorrespiratória e compilar os tipos de HIIT mais utilizados no treinamento em adultos com lesão da medula espinhal (LME). Métodos: Trata-se de revisão sistemática, para a qual foram realizadas pesquisas nas bases de dados eletrônicas PubMed / Medline, Science Direct e Google Scholar. Foram incluídos estudos em que I) o treinamento HIIT era aplicado em II) adultos com LME e analisaram III) os aspectos cardiometabólicos e aptidão cardiorrespiratória. Dois revisores independentes selecionaram os artigos para a inclusão, extraindo seus dados e avaliarando a sua qualidade metodológica. Resultados: 654 estudos foram encontrados. Desses, 12 estudos, 11 pré e pós intervenção e 1 grupo controle (GC) com um total de 106 participantes foram analisados. Resultados pré e pós intervenção de HIIT revelaram significante melhora na aptidão cardiorrespiratória e aspectos cardiometabólicos (VO2pico, LDH, HDL, resistência à insulina). Resultados do GC revelaram uma significativa melhoria na aptidão cardiorrespiratória observada no grupo de intervenção (HIIT) em relação ao grupo de intensidade moderada-baixa (GC). Sete estudos usaram o ergômetro de braço como modalidade de exercício primária. Dois estudos descreveram a estimulação elétrica funcional (EEF) realizada com o ergômetro de braço adicionando estimulação elétrica nos membros inferiores. Nenhum relatou a dinâmica da frequência cardíaca durante o período do estudo. Conclusão: O treinamento intervalado de alta intensidade melhora a aptidão física e a saúde cardiometabólica em adultos com LME. Nível de evidência II; Revisão sistemática de Estudos de Nível II.

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.

Hydrogen-rich saline treated neuropathic pain in rats by increasing autophagy / 天津医药

Objective To evaluate the role of autophagy in the treatment of neuropathic pain(NP)with hydrogen-rich saline.Methods Forty adult male Sprague-Dawley rats with successful intubation were randomly divided into 5 groups(n= 8)using a random number table:the sham operation group(group S),the neuropathic pain group(group C),the hydrogen-rich saline group(group H),the autophagy inhibitor group(group M)and the hydrogen-rich saline + autophagy inhibitor group(group HM).There were 8 rats in each group.The NP model was established by chronic constriction of the sciatic nerve(CCI)in rats.The autophagy inhibitor 3-methyladenine(3-MA)was intraperitoneally injected with 30μg/kg in the group M and the group HM.The hydrogen-rich saline(0.6 mmol/L)was intraperitoneally injected with 10 mL/kg in the group H and the group HM.The other groups were intraperitoneally injected with the same amount of normal saline twice a day for 7 consecutive days.Paw withdrawal threshold to mechanical stimulation(MWT)and paw withdrawal latency to thermal stimulation(TWL)were measured at 1 day before and 1,3,5,7 and 14 days after modeling(T0-T5).After the last measurement of pain threshold,the L4-L6 segment of spinal cord was removed for determination of the expression of autophagy-related proteins microtubule-associated protein light chain 3(LC3)Ⅱ,Beclin-1 and p62 proteins by Western blot assay.The expression levels of superoxide dismutase(SOD)and malondialdehyde(MDA)in spinal cord tissue were detected.Results Compared with the group S,MWT and TWL were decreased in the group C at T2-5,the expression levels of LC3 Ⅱ,Beclin-1 and p62 were increased,SOD activity was decreased,and MDA content was increased at T5(P＜0.05).Compared with the group C,MWT and TWL were increased in the group H at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were increased,p62 protein expression levels were decreased,SOD activity was increased,and MDA content was decreased at T5(P＜0.05).MWT and TWL were decreased in the group M at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were decreased,p62 protein expression levels were increased,SOD activity was decreased,and MDA content was increased at T5(P＜0.05).Compared with the group M,MWT and TWL were increased in the group HM at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were increased,p62 protein expression levels were decreased,SOD activity was increased,and MDA content was decreased at T5(P＜0.05).Conclusion Hydrogen-rich saline can alleviate neuropathic pain and inhibit oxidative stress in spinal cord in rats,and the mechanism may be related to the increase of autophagy.

Effect of Yiqi Huoxue Tongluo Decoction on miR-126a-5p and VEGF signaling pathway in cervical spondylotic myelopathy model rats / 天津医药

Objective To investigate the effect of Yiqi Huoxue Tongluo Decoction on microRNA-126a-5p(miR-126a-5p)and vascular endothelial growth factor(VEGF)signaling pathway in cervical spondylotic myelopathy model rats.Methods Thirty healthy male SD rats were divided into the sham operation group,the model group and the traditional Chinese medicine(TCM)group by random number table method.Cervical spondylotic myelopathy models were prepared in the model group and the TCM group.The TCM group was given intragastric administration of Yiqi Huoxue Tongluo Decoction,while the sham operation group and the model group were given intragastric administration of normal saline for 12 weeks.After intervention,the threshold of mechanical stimulation and retraction time of thermal stimulation in each group were measured by behavior tests.Rats were sacrificed to collect intervertebral disc tissue for hematoxylin-eosin(HE)staining and observe the number of vascular buds in intervertebral disc.Rat intervertebral disc annulus fibrosus cells were subjected to terminal dexynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)staining.The miR-126a-5p and VEGF mRNA of rat intervertebral disc tissue were detected by real-time fluorescence quantitative polymerase chain reaction(RT-PCR).The expression of VEGF protein of rat intervertebral disc tissue was detected by Western blot assay.Results Compared with the sham operation group,the number of vascular buds in intervertebral disc was decreased in the model group and the TCM group.The cell destruction of intervertebral disc annulus was obvious in rats,and apoptosis was high and cell density decreased.Mechanical stimulation threshold decreased,and mechanical stimulation threshold decreased.The level of miR-126a-5p was decreased,and the expression levels of VEGF mRNA and protein were increased.Compared with the model group,the number of vascular buds in intervertebral disc was increased in the TCM group.The destruction of intervertebral disc annulus cells was alleviated in rats.The apoptosis of annulus fibrosus cells in intervertebral disc decreased and cell density increased.The threshold of mechanical stimulation increased,and the retraction time of thermal stimulation was prolonged.The level of miR-126a-5p increased,and the expression levels of VEGF mRNA and protein decreased(P＜0.05).Conclusion The mechanism of Yiqi Huoxue Tongluo Decoction in the treatment of cervical spondylotic myelopathy may be related to the up-regulation of miR-126a-5p expression and the down-regulation of VEGF expression.