Síndrome de Brown-Séquard como forma de presentación de mielitis transversa idiopática / Brown-Séquard syndrome as a presentation of idiopathic transverse myelitis

El síndrome de Brown-Séquard es el conjunto de signos y síntomas causado por hemisección medular de diversos orígenes. Puede generarse por múltiples causas; las traumáticas son las más frecuentes. Las causas menos frecuentes son patología inflamatoria, isquémica, tumoral o infecciosa. Se presenta un niño de 12 años, con instauración aguda y progresiva de un síndrome de hemisección medular derecho, con parálisis hipo/arrefléctica homolateral y afectación de sensibilidad termoalgésica contralateral. En la resonancia magnética de médula espinal, se observó compromiso inflamatorio en hemimédula derecha a nivel de segunda y tercera vértebras torácicas. Con diagnóstico de mielitis transversa idiopática, inició tratamiento con corticoide intravenoso a altas dosis con evolución clínica favorable y restitución de las funciones neurológicas.

Brown-Séquard syndrome refers to a set of signs and symptoms caused by hemisection of the spinal cord from various sources. It may have multiple causes; traumatic injuries are the most frequent ones. The less common causes include inflammation, ischemia, tumors, or infections. This report is about a 12-year-old boy with an acute and progressive course of right hemisection of the spinal cord, with ipsilateral hypo/areflexic paralysis and contralateral loss of thermalgesic sensation. The MRI of the spinal cord showed inflammation in the right side of the spinal cord at the level of the second and third thoracic vertebrae. The patient was diagnosed with idiopathic transverse myelitis and was started on intravenous high-dose corticosteroids; he showed a favorable clinical course and recovered neurological functions.

Treatment of Acute Spinal Cord Injuries: A Survey Among Iberolatinoamerican Spine Surgeons - Part 1: Use of High-Dose Corticosteroids / Tratamento das lesões agudas da medula espinal: Uma pesquisa entre cirurgiões de coluna iberoamericanos - Parte 1: Uso de corticosteroides em altas doses

Abstract Objective The aim of the present study was to evaluate the current practice of using of methylprednisolone sodium succinate (MPSS) in acute spinal cord Injuries (ASCIs) among spine surgeons from Iberolatinoamerican countries. Methods A descriptive cross-sectional study design as a survey was conducted. A questionnaire composed of 2 sections, one on demographic data regarding the surgeons and MPSS administration, was sent by email to members of the Sociedad Ibero Latinoamericana de Columna (SILACO, in the Spanish acronym) and associated societies. Results A total of 182 surgeons participated in the study: 65.4% (119) orthopedic surgeons and 24.6% (63) neurosurgeons. Sixty-nine (37.9%) used MPSS in the initial management of ASCIs. There were no significant differences between countries (p = 0.451), specialty (p = 0.352), or surgeon seniority (p = 0.652) for the use of corticosteroids in the initial management of ASCIs. Forty-five (65.2%) respondents reported using an initial high-dose bolus (30 mg/Kg) followed by a perfusion (5.4 mg/ kg/h). Forty-six (66.7%) surgeons who used MPSS only prescribed it if the patients presented within 8 hours of the ASCI. Most of the surgeons (50.7% [35]) administered high-dose corticosteroids because of the conviction that it has clinal benefits and improves neurological recovery. Conclusion Results from the present survey show that MPSS use in ASCI is not widespread within spine surgeons and that the controversy regarding its use remains unresolved. This is probably due to the low level of evidence of the available data, to variations over the years, to inconsistencies in acute care protocols, and to health service pathways.

Resumo Objetivo O objetivo do presente estudo foi avaliar a prática atual de uso do succinato sódico de metilprednisolona (MPSS, na sigla em inglês) nas lesões agudas da medula espinal (LAMEs) entre cirurgiões de coluna de países ibero-americanos. Métodos Um estudo transversal descritivo foi realizado. O questionário continha duas seções, uma sobre os dados demográficos dos cirurgiões e acerca da administração de MPSS, e foi enviado por correio eletrônico aos membros da Sociedad Ibero Latinoamericana de Columna (SILACO, na sigla em espanhol) e sociedades associadas. Resultados No total, 182 cirurgiões participaram do estudo: 65,4% (119) eram cirurgiões ortopédicos e 24,6% (63), neurocirurgiões. Sessenta e nove (37,9%) usaram MPSS no tratamento inicial da LAME. Não houve diferenças significativas entre países (p = 0,451), especialidades (p = 0,352) ou senioridade do cirurgião (p =0,652) em relação ao uso de corticosteroides no tratamento inicial da LAME. Destes, 45 (65,2%) relataram a administração de um bolus de alta dose (30 mg/kg) seguido por perfusão (5,4 mg/kg/h). Quarenta e seis (66,7%) dos cirurgiões que usam MPSS apenas o prescrevem a pacientes tratados nas primeiras 8 horas após a LAME. A maioria dos cirurgiões (50,7% [35]) administrou corticosteroides em alta dose devido à convicção de seus benefícios clínicos e melhora da recuperação neurológica. Conclusão Os resultados do presente questionário mostram que o uso de MPSS na LAME não está disseminado entre os cirurgiões de coluna e que a controvérsia sobre sua administração ainda não foi resolvida. É provável que isto se deva ao baixo nível de evidência dos dados existentes, a variações ao longo dos anos, a inconsistências nos protocolos terapêuticos agudo e a diferentes sistemas de saúde.

Treatment of Acute Spinal Cord Injuries: A Survey Among Iberolatinoamerican Spine Surgeons - Part 2 Timing to Surgery / Tratamento de lesões agudas da medula espinal: Uma pesquisa entre cirurgiões de coluna iberoamericanos - Parte 2: Momento da cirurgia

Abstract Objective The objective of the present study was to evaluate the current practice in terms of timing to surgery in acute spinal cord injury (ASCI) patients among spinal surgeons from Iberolatinoamerican countries. Methods A descriptive cross-sectional study design as a questionnaire was sent by an email for all members of the Sociedad Ibero Latinoamericana de Columna (SILACO, in the Spanish acronym) and associated societies. Results A total of 162 surgeons answered questions related to the timing for surgery. Sixty-eight (42.0%) considered that ASCI with complete neurology injury should be treated within 12 hours, 54(33.3%) performed early decompression within 24 hours, and 40 (24,7%) until the first 48 hours. Regarding ASCI with incomplete neurological injury, 115 (71.0%) would operate in the first 12 hours. There was a significant difference in the proportion of surgeons that would operate ASCI within ≤ 24 hours, regarding the type of injury (complete injury:122 versus incomplete injury:155; p<0.01). In the case of patients with central cord syndrome without radiological evidence of instability, 152 surgeons (93.8%) would perform surgical decompression: 1 (0.6%) in the first 12 hours, 63 (38.9%) in 24 hours, 4 (2.5%) in 48 hours, 66 (40.7%) in the initial hospital stay, and 18 (11.1%) after neurologic stabilization. Conclusion All inquired surgeons favour early decompression, with the majority performing surgery in the first 24 hours. Decompression is performed earlier in cases of incomplete than in complete injuries. In cases of central cord syndrome without radiological evidence of instability, there is a tendency towards early surgical decompression, but the timing is still extremely variable. Future studies are needed to identify the ideal timing for decompression of this subset of ASCI patients.

Resumo Objetivo O objetivo do presente estudo foi avaliar a prática atual em termos de momento de realização da cirurgia em pacientes com lesão medularaguda (LMA) entre cirurgiões de coluna de países ibero-americanos. Métodos Estudo transversal descritivo com base em um questionário enviado por correio eletrônico para todos os membros da Sociedad Ibero Latinoamericana de Columna (SILACO, na sigla em espanhol) e sociedades associadas. Resultados Um total de 162 cirurgiões responderam a perguntas relacionadas ao momento da cirurgia. Sessenta e oito (42,0%) consideraram que a LMA com lesão neurológica completa deve ser tratada em até 12 horas, 54 (33,3%) realizariam a descompressão precoce em até 24 horas e 40 (24,7%) fariam este procedimento nas primeiras 48 horas. Em relação à LMA com lesão neurológica incompleta, 115 (71,0%) operariam nas primeiras 12 horas. Houve diferença significativa na proporção de cirurgiões que fariam o tratamento cirúrgico da LMA em ≤ 24 horas quanto ao tipo de lesão (lesão completa [122] versus lesão incompleta [155]; p<0.01). Em pacientes com síndrome medular central sem evidência radiológica de instabilidade, 152 cirurgiões (93,8%) realizariam a descompressão cirúrgica: 1 (0,6%) nas primeiras 12 horas, 63 (38,9%) em 24 horas, 4 (2,5%) em 48 horas, 66 (40,7%) no internamento inicial e 18 (11,1%) após a estabilização neurológica. Conclusão Todos os cirurgiões participantes favoreceram a descompressão precoce; a grande maioria realizaria a cirurgia nas primeiras 24 horas. A descompressão é feita antes em casos de lesões incompletas do que em lesões completas. Nos casos de síndrome medular central sem evidência radiológica de instabilidade, há uma tendência à descompressão cirúrgica precoce, mas o momento de intervenção ainda é extremamente variável. Estudos futuros são necessários para identificar o momento ideal para descompressão neste subconjunto de pacientes com LMA.

Autopreconceito e preconceito social no quotidiano de pessoas com lesão medular e suas famílias / Self-reception and social prejudice in the daily life of people with spinal cord injury and their families / Autoconvención y prejuicio social en la vida cotidiana de las personas con lesiones medulares y sus familias

Objetivo: Compreender a vivência do autopreconceito e do preconceito social no cotidiano de pessoas com lesão medular e de suas famílias. Métodos: Estudo interpretativo, qualitativo, desenvolvido com 21 participantes (12 pessoas com lesão medular e 9 familiares), de um Centro Especializado de Reabilitação no sul do Brasil, cujas fontes de evidências foram entrevistas individual e duas oficinas que corroboram para validação dos dados. Para o agrupamento e organização dos dados, utilizou-se o software Atlas.ti e a análise dos dados envolveu: análise preliminar, ordenação, ligações-chaves, codificação e categorização, guiada pelo olhar da Sociologia Compreensiva e do Quotidiano. Resultados: Evidencia o autopreconceito: marcas no corpo e na alma, cadeira de rodas e a percepção negativa da doença, do declínio à reconstrução da autoimagem; preconceito nas mais diversas dimensões: familiar e social. Conclusão: O autopreconceito influencia negativamente a autoimagem, criando um mecanismo de defesa e de negação da condição de vivenciar a lesão medular. A família é determinante na transformação do quotidiano e da maneira como a pessoa convive e percebe a sua condição. Precisa-se de uma sensibilização para o olhar sobre pré-conceitos estabelecidos que implicam sobre a segregação de pessoas em sociedade. (AU)

Objective: To understand the experience of self-concept and social prejudice in the daily lives of people with spinal cord injury and their families. Methods: Interpretative, qualitative study, developed with 21 participants (12 people with spinal cord injury and 9 family members), of a Specialized Rehabilitation Center in southern Brazil, whose sources of evidence were individual interviews and two workshops that corroborate for data validation. For the grouping and organization of the data, the Atlas.ti software was used and the analysis of the data involved: preliminary analysis, ordering, key links, coding and categorization, guided by the gaze of Comprehensive Sociology and Everyday Life. Results: Evidence of self-concept: marks on the body and soul, wheelchair and the negative perception of the disease, from the decline to the reconstruction of self-image; prejudice in the dimensions: family and social. Conclusion: Self-prejudice negatively influences self-image, creating a mechanism of defense and denial of condition experiencing spinal cord injury. The family is decisive in everyday transformation the way that a person lives and perceives his condition. We need a sensibilization to look established preconceptions that imply about the segregation of people in society. (AU)

Objetivo: Comprender la vivencia del autopreconceito y del prejuicio social en el cotidiano de personas con lesión de la médula espinal y de sus familias. Métodos: Estudio interpretativo cualitativo, desarrollado con 21 participantes (12 personas con lesión medular y 9 familiares), de un Centro Especializado de Rehabilitación en el sur de Brasil, cuyas fuentes de evidencia fueron entrevistas individuales y dos talleres que corroboraron la validación de datos. Para la agrupación y organización de los datos, se utilizó el software Atlas.ti y el análisis de los datos implicó: análisis preliminar, ordenación, enlaces claves, codificación y categorización, guiada por la mirada de la Sociología Comprensiva y del Cotidiano. Resultados: evidencia del autopreconceito: marcas en el cuerpo y en el alma, silla de ruedas y la percepción negativa de la enfermedad, del declive a la reconstrucción de la autoimagen; prejuicio en las dimensiones: familiar y social. Conclusion: el auto prejuicio influencia negativamente la autoimagen, creando un mecanismo de defensa y de negación de la condición experimentando una lesión en la médula espinal. La familia es determinante en la transformación de la vida cotidiana y en que la persona que vive y se da cuenta de su condición. Se necesita una conciencia para mirar los preconceptos establecidos que implican sobre la segregación de las personas en la sociedad. (AU)

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.

Epidemiology of vertebral fractures evaluated at iot-fmusp from 2019 to 2022 / Epidemiologia das fraturas vertebrais avaliadas no iot-fmusp de 2019 a 2022 / Epidemiología de fracturas vertebrales evaluadas en iot-fmusp del2019 al 2022

ABSTRACT: Objective: To determine the epidemic profile of patients with spinal fractures referred for evaluation by Spine Group of IOT-HCFMUSP between 2019 and 2022. To enable the effect of the Covid-19 Pandemic on these epidemic profiles. Methods: We retrospectively analyzed the medical records of patients with spinal fractures referred by the São Paulo Center for the Regulation of Health Offers and Services (CROSS) to the Spine Group of IOT-HCFMUSP between 2019 and 2022. The epidemiological profile between the pre-pandemic Covid-19 period and the period of the Covid-19 pandemic until December 2022 in the city of São Paulo was compared. Results: The medical records of 427 patients were analyzed between March 2019 and December 2022. During the period, males accounted for 71.9% of cases, and the mean age was 46.7 years. Falls from heights were the most frequent trauma mechanism (63.7%), followed by motorcycle accidents (14.3%). The absence of neurological deficit occurred in 76.8% of the cases, and the most injured region was the lumbar region (39.3%). There were changes in the epidemiological profile during the Covid-19 pandemic compared to the pre-pandemic. Conclusions: A predominance of middle-aged males was observed, in addition to the trauma mechanism of falling from a height, as well as the absence of a neurological deficit in the initial evaluation. The lumbar and cervical regions were the most frequent sites of injury. The pandemic period interfered with the epidemiological profile presented and in the time interval between the injury and the evaluation at the IOT-HCFMUSP. Level of Evidence IV; Case Series.

RESUMO: Objetivos: Determinar o perfil epidemiológico dos pacientes com fraturas na coluna vertebral encaminhados para avaliação pelo Grupo de Coluna do IOT-HCFMUSP entre 2019 e 2022. Avaliar o efeito da Pandemia de Covid-19 sobre esse perfil epidemiológico. Métodos: Foram analisados retrospectivamente os prontuários dos pacientes com fratura na coluna encaminhados pela Central de Regulação de Ofertas e Serviços de Saúde (CROSS) de São Paulo ao Grupo de Coluna do IOT-HCFMUSP entre os anos de 2019 e 2022. Foi comparado o perfil epidemiológico entre o período pré-pandemia Covid-19 e o período de pandemia Covid-19 até dezembro de 2022 na cidade de São Paulo. Resultados: Analisou-se o prontuário médico de 427 pacientes entre março de 2019 e dezembro de 2022. No período o sexo masculino correspondeu a 71,9% dos casos, a média da idade foi de 46,7 anos. Queda de altura foi o mecanismo de trauma mais frequente (63,7%), seguido de acidentes de motocicleta (14,3%). A ausência de déficit neurológico ocorreu em 76,8% dos casos, bem como a região mais lesada foi a lombar (39,3%). Houveram mudanças no perfil epidemiológico durante a pandemia de Covid 19 em relação à pré-pandemia. Conclusões: Observado predomínio do sexo masculino de meia idade, além do mecanismo de trauma de queda de altura, bem como ausência de déficit neurológico a avaliação inicial. A região lombar e cervical foram os locais mais frequentes de lesão. O período pandêmico interferiu no perfil epidemiológico apresentado e nos intervalos de tempo entre a lesão e a avaliação no IOT-HCFMUSP. Nível de Evidência IV; Série de Casos.

RESUMEN: Objetivos: Determinar la epidemiología de los pacientes con fracturas vertebrales evaluadas por el Grupo de Columna IOT-HCFMUSP entre 2019 y 2022. Evaluar el efecto de la Pandemia Covid-19 sobre esta epidemiología. Métodos: Análisis retrospectivo de historias clínicas de pacientes con fracturas de columna remitidos por el Central de Regulação de Ofertas e Serviços de Saúde (CROSS) de São Paulo al Grupo de Columna IOT-HCFMUSP entre 2019 y 2022. Se comparó el perfil epidemiológico entre el periodo de la pre-pandemia de Covid-19 y el período de pandemia de Covid-19 hasta diciembre de 2022. Resultados: Serie de casos de 427 pacientes entre marzo de 2019 y diciembre de 2022. En el período, el sexo masculino representó el 71,9% de los casos, la edad promedio fue de 46,7 años. La caída de altura fue el mecanismo traumático más común (63,7%), seguido de los accidentes de motocicleta (14,3%). La ausencia de déficit neurológico se presentó en el 76,8% de los casos, siendo la región lumbar (39,3%) la región más lesionada. Hubo cambios en el perfil epidemiológico durante la pandemia de Covid-19 con relación a la prepandemia. Conclusiones: Hubo predominio del sexo masculino, caídas de altura como mecanismo traumático y ausencia de déficit neurológico en la evaluación inicial. La región lumbar y cervical fueron los sitios de lesión más frecuentes. El período pandémico interfirió con el perfil epidemiológico presentado y los intervalos de tiempo entre la lesión y la evaluación en el IOT-HCFMUSP.

Aspects épidémiologiques, diagnostiques et thérapeutiques des traumatismes vertébro-médullaires au Centre Hospitalier Universitaire d'Owendo, Gabon / Spinal cord injury at the Owendo teaching hospital, Gabon. Epidemiology, diagnosis and management

Spinal cord injury constitutes a multidisciplinary therapeutic emergency. It occurs usually in a context of polytrauma. The aim of this study was to describe the management of spinal cord injury admitted to the emergency department of a "trauma center". Methods: This is a prospective observational study carried out at the University Hospital of Owendo, Gabon. Patients admitted to the emergency department of any age for spinal cord injury and having performed a radiological examination were included. Socio-demographic parameters, circumstances and times of onset of trauma, mode of transport, state of consciousness, sensory and motor deficit, American Spinal Injury Association (ASIA) Score, hemodynamic and respiratory status were assessed. Results: During the study period, 850 patients were registered at the emergency department. Among them 112 were admitted for spinal cord injury (3.17%). The average age of the patients was 36 ± 3 years. The male gender accounted for 77% of cases. It concerned in 36% of cases the unemployed. The road accident was incriminated in 61%. Pedestrians were involved in 81% of cases. The clinical evaluation on admission found a sensorimotor deficit in 45 patients (40.17%), there were 11 tetraplegias (10%) and 3 paraplegias (3%). The majority of patients (77.7%) were classified as Fränkel stage A. The lesions were dominated by dislocations of the cervical spine (30.4%). Specialized care was essentially orthopedic in 60.7%. No patient was operated. Conclusion: Spinal cord injuries are "time-dependent" medical and surgical emergencies. A codified organization of pre-hospital care and an efficient "trauma center" are essential factors for the management of this type of traumatic pathology

Profil clinique, thérapeutique et devenir des traumatismes vertèbro-médullaires aux Cliniques Universitaires de Kinshasa en République Démocratique du Congo / Clinical, therapeutic and outcome of vertebro medullary traumas at Kinshasa University Hospital, in the Democratic Republic of Congo

Les traumatismes vertébromédullaires (TVM) en Afrique subsaharienne sont très peu documentés. L'objectif de ce travail était de décrire les aspects cliniques, thérapeutiques et évolutifs de TVM. Méthodes. C'était une série analytique des cas de TVM soignés aux Cliniques Universitaires de Kinshasa (CUK) entre 2016 et 2022. Les variables d'intérêt englobaient les données cliniques, thérapeutiques, le score ASIA à l'admission et à la sortie, et le devenir. Nous avons recouru au test de Chi carré de Pearson pour comparer les proportions. Résultats. Sur les 123 patients opérés pour lésions vertébro-médullaires, 62 cas étaient traumatiques (50,4 %). Le sexe masculin était prépondérant (75,8 %). Leur âge moyen était de 36,0 ± 13,0 ans. Les accidents de la voie publique (74,2 %) en étaient la principale cause. A l'admission, il y avait 58,1% des paraplégiques et 21 % des tétraplégiques. Vingt-sept patients (43,5 %) ont été admis 1 à 2 mois après le traumatisme. Les patients classés ASIA A représentait 62,9 % des cas. Vingt traumatismes (32,3 %) ont siégé sur le rachis cervical inférieur et 25 (40,3%), à la charnière thoraco-lombaire. Au niveau cervical, 10 cas étaient classés Argenson B (16,1 %) et en thoraco-lombaire, il y avait 17 fractures Magerl A (27,4 %) et 22 Magerl B (35,5 %) avec 63,6 % d'antélisthésis. La laminectomie (59,8 %) et la corporectomie (25,8 %) avec fixation rachidienne étaient les procédures les plus pratiquées. Les suites opératoires étaient simples dans 68,4 %. Il y a eu 9 cas d'infection du site opératoire (14,5 %), 2 cas de fistules de LCS (3,2 %), 3 cas d'escarres (4,8 %) de décubitus et 5 décès (8,1%). Le score ASIA à la sortie était significativement amélioré par rapport à celui de départ dans 33,9 % de cas (p <0,001). Conclusion. Les traumatismes vertébro-médullaires consécutifs aux accidents de trafic routier demeurent des lésions assez fréquentes nécessitant un traitement chirurgical. Les jeunes de sexe masculin sont les plus touchés. Le déficit neurologique est souvent complet. La laminectomie ou la corporectomie suivies de la fixation rachidienne sont couramment réalisées avec une récupération neurologique satisfaisante dans un tiers de cas.

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.

Fatores que implicam na sexualidade dos pacientes com lesão medular / Factors that imply on the sexuality of patients with spindle injury

A Lesão Medular acomete as funções sexuais devido à interrupção dos estímulos neurais, determinando as disfunções sexuais que dependem do nível, tipo da lesão, fatores físicos, psíquicos e sociais. Surge, assim, o processo de reabilitação sexual no sentido de promover a reinserção desses indivíduos. Objetivo: Identificar as alterações fisiológicas, fatores psicológicos e sociais intrínsecos, dentro do contexto da sexualidade em indivíduos com Lesão Medular. Métodos: Trata-se de um estudo exploratório, descritivo, de abordagem quantitativa, nos quais foram incluídos 50 participantes com Lesão Medular em um Centro de Reabilitação. O instrumento de coleta utilizado foi o Questionário de Sexualidade Humana na Lesão Medular, abordando aspectos da sexualidade nos períodos antes e após a lesão. Resultados: A sexualidade foi afetada negativamente, sendo que a vida sexual ativa, após a lesão, teve em média de frequência 2,02 (±1,80), vontade 7,15 (±2,66) e satisfação sexual 4,80 (±3,08), mostrando que esta reduziu significativamente. Quanto às respostas sexuais, a ejaculação é a mais afetada: média 0,61 (±2,08), seguida da ereção 3,02 (±3,20), orgasmo masculino 2,95 (±3,49) e orgasmo feminino 0,22 (±0,67). Além disso, foi possível constatar uma lacuna existente na abordagem da temática pelos profissionais de saúde, onde apenas 21(42%) dos indivíduos receberam algum tipo de aconselhamento sexual após a lesão. Conclusão: Tornaram-se claros os impactos negativos das alterações enfrentadas após a Lesão Medular quanto aos ajustes físicos, psicológicos e sociais ressaltando a necessidade de capacitação dos profissionais para que estejam aptos a realizarem a reabilitação sexual desses indivíduos

Spinal cord injury affects sexual functions due to interruption of neural stimuli, determining sexual dysfunctions that will depend on the level, type of injury, physical, psychological and social factors. Thus arises the process of sexual rehabilitation, in the sense of promoting the reintegration of these individuals. Objective: Identify the physiological alterations, intrinsic psychological and social factors, within the context of sexuality in individuals with Spinal Cord Injury. Methods: This is an exploratory, descriptive study with a quantitative approach, in which 50 participants with Spinal Cord Injury in a Rehabilitation Center were included. The collection instrument used was the Questionnaire of Human Sexuality in Spinal Cord Injury, addressing aspects of sexuality in the periods before and after the injury. Results: Sexuality was negatively affected, in which active sex life after the injury had an average frequency of 2.02 (±1.80), desire 7.15 (±2.66) and sexual satisfaction 4.80 (±3 .08), showing that it reduced significantly. As for sexual responses, ejaculation is the most affected, mean 0.61 (±2.08), followed by erection 3.02 (±3.20), male orgasm 2.95 (±3.49) and female orgasm 0.22 (±0.67). In addition, it was possible to verify an existing gap in the approach of the theme by health professionals, where only 21 (42%) of the individuals received some type of sexual counseling after the injury. Conclusion: It became clear the negative impacts of the alterations faced after the Spinal Cord Injury regarding the physical, psychological and social adjustments, emphasizing the need for professional training so that they are able to carry out the sexual rehabilitation of these individuals

Experiência de pacientes com lesão medular em reabilitação: um estudo misto acerca dos cuidados de enfermagem / Experience of patients with spindle injury in rehabilitation: a mixed study about nursing care

: A obtenção da satisfação do paciente é uma das ferramentas de investigação de indicadores de qualidade, sendo fonte de informação relevantes para o desenvolvimento de melhorias na qualidade da assistência. Objetivo: O estudo teve por intuito compreender a visão e a satisfação de pacientes com lesão medular internados em um centro de referência em reabilitação, quanto aos cuidados de enfermagem, de forma a evidenciar o papel do profissional enfermeiro na adesão durante o processo de reabilitação e readaptação. Metodologia: Trata-se de uma pesquisa de campo de caráter misto com abordagem exploratória observacional, realizada em um centro de reabilitação, com 22 participantes, sendo que 21 destes corresponderam à pesquisa qualitativa. Para a coleta de dados, foram aplicados o Instrumento de Satisfação do Paciente (ISP) e um questionário com 4 questões norteadoras. Resultados: A satisfação dos participantes em relação aos cuidados de enfermagem foi positiva nos três domínios, sendo o domínio educacional o mais bem avaliado (4,39), seguido da área técnica profissional (4,06) e por último confiança (4,04). Os resultados qualitativos foram divididos em duas categorias "Relação enfermeiro-paciente" e "A percepção do cuidado". Conclusão:Tornou-se claro o papel do enfermeiro na adesão à reabilitação, sendo possível constatar a relação da satisfação com os aspectos de humanização em saúde

Obtaining patient satisfaction is one of the research tools for quality indicators, being a source of relevant information for the development of improvements in the quality of care. Objective: The study aimed to understand the vision and satisfaction of patients with spinal cord injury hospitalized in a Rehabilitation Reference Center, regarding nursing care, in order to highlight the role of nurses in adherence during the rehabilitation and readaptation process. Methodology: This is a mixed field research with an exploratory observational approach, carried out in a Rehabilitation Center, with 22 participants, 21 of which corresponded to qualitative research. For data collection, the Patient Satisfaction Instrument (PSI) and a questionnaire with 4 guiding questions were applied. Results: The classification of participants in relation to nursing care was positive in the three domains, with the educational domain being the best evaluated (4.39), followed by the technical-professional area (4.06) and finally trust (4.04). Qualitative results were divided into two categories "Nurse-patient relationship" and "Perception of care". Conclusion: In addition, the role of nurses in adherence to rehabilitation became clear, and it was possible to verify the relationship between satisfaction and aspects of humanization in health

Acetylcorynoline inhibits microglia activation by regulating EGFR/MAPK signaling to promote functional recovery of injured mouse spinal cord / 南方医科大学学报

OBJECTIVE@#To investigate the effect of acetylcorynoline (Ace) for promoting functional recovery of injured spinal cord in rats and explore the underlying mechanism.@*METHODS@#Rat models of spinal cord injury (SCI) were treated with intraperitoneal injection of different concentrations of Ace, with the sham-operated rats as the control group. After the treatment, the changes in motor function of the rats and the area of spinal cord injury were assessed with BBB score and HE staining, and the changes in pro-inflammatory cytokine levels and microglial activation were determined using PCR, ELISA and immunofluorescence staining. In a lipopolysaccharide (LPS)-treated BV2 cell model, the effects of different concentrations of Ace or DMSO on microglial activation and inflammatory cytokine production were observed. Network pharmacology analysis was performed to predict the target protein and signaling mechanism that mediated the inhibitory effect of Ace on microglia activation, and AutoDock software was used for molecular docking between Ace and the target protein. A signaling pathway blocker (Osimertinib) was used to verify the signaling mechanism in rat models of SCI and LPS-treated BV2 cell model.@*RESULTS@#In rat models of SCI, Ace treatment significantly increased the BBB score, reduced the area of spinal cord injury, and lowered the number of activated microglia cells and the levels of pro-inflammatory cytokines (P < 0.05). The cell experiments showed that Ace treatment significantly lower the level of cell activation and the production of inflammatory cytokines in LPS-treated BV2 cells (P < 0.05). Network pharmacology analysis suggested that EGFR was the main target of Ace, and they bound to each other via hydrogen bonds as shown by molecular docking. Western blotting confirmed that Ace inhibited the activation of the EGFR/MAPK signaling pathway in injured mouse spinal cord tissue and in LPS-treated BV2 cells, and its inhibitory effect was comparable to that of Osimertinib.@*CONCLUSION@#In rat models of SCI, treatment with Ace can inhibit microglia-mediated inflammatory response by regulating the EGFR/MAPK pathway, thus promoting tissue repair and motor function recovery.

Guidelines for management of pediatric acute hyperextension spinal cord injury / 中华创伤杂志(英文版)

Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.

Prognosis of traumatic spinal cord injury in children: Follow-up of 86 patients / 中华创伤杂志(英文版)

PURPOSE@#The long-term situation of children with spinal cord injury (SCI) was investigated, and suggestions for helping them better return to the society were provided.@*METHODS@#SCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed. Information including motor function, complications, characteristic changes, self-care abilities, school attendance and social participation were collected by telephone interview and electronic questionnaire. All the answers were statistically analyzed.@*RESULTS@#A total of 86 cases were enrolled, 77 girls and 9 boys, with a median injury age of 6 years and 2 months. The follow-up time was 3-130 months. The main cause of trauma in these children was sport injury (66.3%), the thoracic spinal cord was involved the most (91.9%), and complete SCIs accounted for the majority (76.7%). In terms of complications, children with complete SCIs were more likely to have urinary incontinence, constipation and characteristic changes (p < 0.05); whereas the incomplete SCIs often have spasticity (p < 0.05). As to the daily living abilities, children with incomplete lumbar SCIs were more capable to accomplish personal hygiene, transfer, and bathing independently than those with complete injuries, or cervical/thoracic SCIs, respectively (p < 0.05). Moreover, children older than 9 years care more able to dress and transfer independently than the youngers (p < 0.05). Wheelchair users accounted for 84.9% and more than half of them were able to propel wheelchair independently, and those who move passively in wheelchairs were mostly introverted kids (p < 0.05). Almost all (93.8%) children with incomplete injuries were able to walk independently. Most (79.1%) children continued to attending school, and 41.9% participated in interest classes. Unfortunately, 67.4% of the children spent less time playing with their peers than before the injury.@*CONCLUSION@#SCIs impair physical structures and function of children, affect their independence in daily living, and restrict school attendance and social interaction. Comprehensive rehabilitation after injury is a systematic work. Medical staff and caregivers should not only pay attention to neurological function, but also help them improve self-care abilities. It is also important to balance rehabilitation training and school work and social participation.

Clinical characteristics and treatment of spinal cord injury in children and adolescents / 中华创伤杂志(英文版)

Pediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden on patients, their families and the society. There are differences in Chinese and foreign literature reports on the incidence, injury mechanism and prognosis of SCI in children and adolescents. In addition to traumatic injuries such as car accidents and falls, the proportion of sports injuries is increasing. The most common sports injury is the backbend during dance practice. Compared with adults, children and adolescents are considered to have a greater potential for neurological improvement. The pathogenesis and treatment of pediatric SCI remains unclear. The mainstream view is that the mechanism of nerve damage in pediatric SCI include flexion, hyperextension, longitudinal distraction and ischemia. We also discuss the advantages and disadvantages of drugs such as methylprednisolone in the treatment of pediatric SCI and the indications and timing of surgery. In addition, the complications of pediatric SCI are also worthy of attention. New imaging techniques such as diffusion tensor imaging and diffusion tensor tractography may be used for diagnosis and assessment of prognosis. This article reviews the epidemiology, pathogenesis, imaging, clinical characteristics, treatment and complications of SCI in children and adolescents. Although current treatment cannot completely restore neurological function, patient quality of life can be enhanced. Continued developments and advances in the research of SCI may eventually provide a cure for children and adolescents with this kind of injury.

Unraveling quad fever: Severe hyperthermia after traumatic cervical spinal cord injury / 中华创伤杂志(英文版)

PURPOSE@#There are many infectious and inflammatory causes for elevated core-body temperatures, though they rarely pass 40 ℃ (104 ℉). The term "quad fever" is used for extreme hyperpyrexia in the setting of acute cervical spinal cord injuries (SCIs). The traditional methods of treating hyperpyrexia are often ineffective and reported morbidity and mortality rates approach 100%. This study aims to identify the incidence of elevated temperatures in SCIs at our institution and assess the effectiveness of using a non-invasive dry water temperature management system as a treatment modality with mortality.@*METHODS@#A retrospective analysis of acute SCI patients requiring surgical intensive care unit admission who experienced fevers ≥ 40 ℃ (104 ℉) were compared to patients with maximum temperatures < 40 ℃. Patients ≥18 years old who sustained an acute traumatic SCI were included in this study. Patients who expired in the emergency department; had a SCI without radiologic abnormality; had neuropraxia; were admitted to any location other than the surgical intensive care unit; or had positive blood cultures were excluded. SAS 9.4 was used to conduct statistical analysis.@*RESULTS@#Over the 9-year study period, 35 patients were admitted to the surgical intensive care unit with a verified SCI. Seven patients experienced maximum temperatures of ≥ 40 ℃. Six of those patients were treated with the dry water temperature management system with an overall mortality of 57.1% in this subgroup. The mortality rate for the 28 patients who experienced a maximum temperature of ≤ 40 ℃ was 21.4% (p = 0.16).@*CONCLUSION@#The diagnosis of quad fever should be considered in patients with cervical SCI in the presence of hyperthermia. In this study, there was no significant difference in mortality between quad fever patients treated with a dry water temperature management system versus SCI patients without quad fever. The early use of a dry water temperature management system appears to decrease the mortality rate of quad fever.

Short-chain fatty acids ameliorate spinal cord injury recovery by regulating the balance of regulatory T cells and effector IL-17+ γδ T cells / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Spinal cord injury (SCI) causes motor, sensory, and autonomic dysfunctions. The gut microbiome has an important role in SCI, while short-chain fatty acids (SCFAs) are one of the main bioactive mediators of microbiota. In the present study, we explored the effects of oral administration of exogenous SCFAs on the recovery of locomotor function and tissue repair in SCI. Allen's method was utilized to establish an SCI model in Sprague-Dawley (SD) rats. The animals received water containing a mixture of 150 mmol/L SCFAs after SCI. After 21 d of treatment, the Basso, Beattie, and Bresnahan (BBB) score increased, the regularity index improved, and the base of support (BOS) value declined. Spinal cord tissue inflammatory infiltration was alleviated, the spinal cord necrosis cavity was reduced, and the numbers of motor neurons and Nissl bodies were elevated. Enzyme-linked immunosorbent assay (ELISA), real-time quantitative polymerase chain reaction (qPCR), and immunohistochemistry assay revealed that the expression of interleukin (IL)‍-10 increased and that of IL-17 decreased in the spinal cord. SCFAs promoted gut homeostasis, induced intestinal T cells to shift toward an anti-inflammatory phenotype, and promoted regulatory T (Treg) cells to secrete IL-10, affecting Treg cells and IL-17+ γδ T cells in the spinal cord. Furthermore, we observed that Treg cells migrated from the gut to the spinal cord region after SCI. The above findings confirm that SCFAs can regulate Treg cells in the gut and affect the balance of Treg and IL-17+ γδ T cells in the spinal cord, which inhibits the inflammatory response and promotes the motor function in SCI rats. Our findings suggest that there is a relationship among gut, spinal cord, and immune cells, and the "gut-spinal cord-immune" axis may be one of the mechanisms regulating neural repair after SCI.

Effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury / 浙江大学学报·医学版

OBJECTIVES@#To investigate the effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury.@*METHODS@#A total of 80 patients with incomplete spinal cord injury caused by thoracolumbar fracture admitted in Ningbo Yinzhou No.2 Hospital from April 2020 to December 2021 were randomly divided into control group and study group, with 40 cases in each group. In addition to routine training, the control group received torso training on stable surface and the study group received torso training on unstable surface. The gait, lower limb muscle strength, balance function, lower limb function, mobility and nerve function of the two groups were compared.@*RESULTS@#After treatment, the stride length, stride frequency and comfortable walking speed improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05). The muscle strength of quadriceps femoris, gluteus maximus, hamstring, anterior tibialis and gastrocnemius were improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05); the total trajectories of static eye opening and static eye closing gravity center movement in the two groups were significantly shorter (all P<0.05), and the improvements in the study group were more significant (all P<0.05). The dynamic stability limit range and the American Spinal Injury Association (ASIA) lower extremity motor score, Berg balance scale, modified Barthel index scale in the two groups were significantly higher (all P<0.05), and these scores in study group were significantly higher than those in the control group (all P<0.05). Both groups showed a significant improvement in ASIA grade (all P<0.05), and the improvement in the study group was significantly better (P<0.05).@*CONCLUSIONS@#Torso training on unstable surface can effectively improve the gait and lower limb muscle strength of patients with incomplete spinal cord injury and improve the lower limb motor function.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data / 中华创伤杂志(英文版)

PURPOSE@#To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs).@*METHODS@#Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI).@*RESULTS@#Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance.@*CONCLUSIONS@#These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.