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1.
Rev. bras. ortop ; 58(2): 331-336, Mar.-Apr. 2023. tab
Article in English | LILACS | ID: biblio-1449803

ABSTRACT

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.


Subject(s)
Humans , Spinal Cord Injuries/surgery , Surveys and Questionnaires , Adrenal Cortex Hormones/therapeutic use
2.
Rev. bras. ortop ; 58(2): 337-341, Mar.-Apr. 2023. tab
Article in English | LILACS | ID: biblio-1449790

ABSTRACT

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.


Subject(s)
Humans , Spinal Cord Injuries/therapy , Surveys and Questionnaires , Adrenal Cortex Hormones/therapeutic use
3.
Enferm. foco (Brasília) ; 14: 1-7, mar. 20, 2023.
Article in Portuguese | LILACS, BDENF | ID: biblio-1442824

ABSTRACT

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)


Subject(s)
Spinal Cord Injuries , Prejudice , Rehabilitation , Activities of Daily Living , Family
4.
Braz. j. anesth ; 73(4): 506-509, 2023. graf
Article in English | LILACS | ID: biblio-1447627

ABSTRACT

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.


Subject(s)
Humans , Spinal Cord Injuries , Analgesia, Epidural , Anesthesia, Epidural , Analgesia, Obstetrical/methods , Catheters , Analgesics , Anesthetics, Local
5.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1451242

ABSTRACT

: 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


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Spinal Cord Injuries/rehabilitation , Patient Satisfaction , Nursing Care , Paraplegia , Quadriplegia , Thoracic Vertebrae , Brazil , Cervical Vertebrae , Lumbar Vertebrae
6.
Rev. Univ. Ind. Santander, Salud ; 54: e330, Dec. 2022. graf
Article in Spanish | LILACS | ID: biblio-1407029

ABSTRACT

Resumen Introducción: El pedaleo pasivo (PP) es considerado una herramienta en la rehabilitación de personas con lesión medular (LM). Objetivo: Revisar la evidencia científica sobre los efectos clínicos producidos por intervenciones que emplean PP en personas con lesión medular torácica crónica. Metodología: Revisión narrativa. Se realizó una búsqueda en las bases de información científica MEDLINE, CINAHL, LILACS, PEDro y Clinicalkey de artículos en inglés y español, con términos como "spinal cord injury", "thoracic injuries", "passive pedaling", "cycling passive" y "protocol", entre otros. Resultados: Se obtuvieron 14 artículos que describen efectos limitados a nivel de los sistemas cardiovascular, neuromuscular y musculoesquelético; se encontró heterogeneidad clínica en los sujetos del estudio, así como diferencias en los parámetros de realización del pedaleo. Conclusiones: Los estudios del PP en personas con LM torácica crónica evalúan en su mayoría el efecto de una única sesión. Los cambios cardiovasculares son estudiados con mayor frecuencia, aunque se requieren más investigaciones.


Abstract Introduction: Passive leg cycling is considered as a tool in rehabilitation of people with spinal cord injury (SCI). Objective: To review the scientific evidence on the clinical effects produced by interventions that use passive leg cycling in people with chronic thoracic spinal cord injury. Methodology: Narrative review. A search was performed by using the MEDLINE, CINAHL, LILACS, PEDro and Clinicalkey databases, for articles in English and Spanish, with terms such as "spinal cord injury", "thoracic injuries", "passive pedaling", "passive cycling" and "protocol", among others. Results: 14 papers were included in our research which described limited effects at the level of the cardiovascular, neuromuscular and musculoskeletal systems. We found clinical heterogeneity in the subjects, as well as differences in the cycling parameters used by authors. Conclusions: Studies of PP in people with chronic thoracic SCI mostly evaluated the effect of a single session. Cardiovascular changes were mostly studied; however, more evidence is needed.


Subject(s)
Humans , Male , Female , Spinal Cord Injuries , Exercise Therapy
7.
Rev. bras. ortop ; 57(4): 584-589, Jul.-Aug. 2022. tab, graf
Article in English | LILACS | ID: biblio-1394872

ABSTRACT

Abstract Objective To describe magnetic resonance imaging (MRI) characteristics of shoulders from patients with spinal cord injury (SCI) and to correlate these findings with age, duration of SCI and neurological level. Method The study sample included patients with thoracic SCI over 18 years of age, who were active wheelchair users and had undergone an MRI of the shoulder from January 2004 to December 2015. Results We studied 41 shoulders (37 patients), including 27 men (65.9%) and 14 women (34.1%). At the time of MRI, the mean age was 41.9 years and the mean duration of SCI was 9.4 years. The analysis of the relationship between the duration of trauma and severity of the rotator cuff lesion (RCL), as well as between age and the severity of the shoulder injury showed a statistically significant difference (p< 0.001), with a positive association in both cases. No statistically significant difference (p= 0.095) was observed between the neurological level of the SCI and RCL. Conclusion In this study, a progressive increase in the severity of the shoulder lesions can be noted with advancing age and a longer duration of SCI. However, level of the SCI does not seem to interfere with RCL. Level of Evidence Level IV, case series.


Resumo Objetivo Descrever as características de ressonância magnética (RM) dos ombros de pacientes com lesão medular (LM) e correlacionar esses achados com idade, duração da LM e nível neurológico. Método A amostra do presente estudo incluiu pacientes maiores de 18 anos com LM torácica, que eram cadeirantes ativos e haviam sido submetidos a uma ressonância magnética do ombro de janeiro de 2004 a dezembro de 2015. Resultados Foram estudados 41 ombros (37 pacientes), incluindo 27 de pacientes do sexo masculino (65,9%) e 14 de pacientes do sexo feminino (34,1%). Na época da ressonância magnética, a média de idade era de 41,9 anos e a duração média da LM era de 9,4 anos. A análise da relação entre a duração do trauma e a gravidade da lesão do manguito rotador (LMR), bem como entre a idade e a gravidade da lesão do ombro mostrou diferença estatisticamente significativa (p< 0,001), com associação positiva em ambos os casos. Não foi observada diferença estatisticamente significativa (p= 0,095) entre o nível neurológico da LM e da LMR. Conclusão Neste estudo, pode-se notar um aumento progressivo da gravidade das lesões do ombro com o avanço da idade e uma maior duração da LM. No entanto, o nível da LM não parece interferir com a LMR. Nível de Evidência Nível IV, série de casos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Spinal Cord Injuries/diagnostic imaging , Wheelchairs , Magnetic Resonance Imaging , Retrospective Studies , Shoulder Injuries/diagnostic imaging
8.
Rev. bras. ortop ; 57(3): 384-391, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1388028

ABSTRACT

Abstract Objective The "Self-report S4-5 sensory and motor function questionnaire (S4-5Q)" is a short questionnaire that aims to assess the function of the sacral segments, S4 and S5, after a spinal cord injury (SCI), with the purpose of replacing the rectal exam test. The aim of the present study was to carry out a cross-cultural adaptation of the S4-5Q to the Brazilian Portuguese language and to investigate the test-retest reliability of this version. Method The translation and cross-cultural adaptation was performed using the methodology of translation and backtranslation. Initially, translations were done by three independent translators. Their synthesis was then submitted to an expert committee for analysis (SCI health professionals); then, the backtranslation to the original language was sent to the original author and, after all the adjustments, the final version was completed. For test-retest reliability, 24 individuals with chronic SCI were recruited (2 evaluations with an interval of 7 to 14 days between them). Statistical analysis was performed using IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) with data pretabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Reliability was tested with Cohen Kappa, and internal consistency with Cronbach α, both adopting p < 0.05 as significant. Results In the reliability analysis, the results of all questions showed almost perfect agreement (Kappa > 0.81) and good internal consistency (Cronbach α: 0.65-0.77) between the questions and final classification. Conclusion The cross-culturally adapted S4-5Q is reliable to be applied to the Brazilian population with chronic SCI to determine their S4-5 sensory and motor function.


Resumo Objetivo O "Self-report S4-5 Sensory and Motor Function Questionnaire (S4-5Q)" é um breve questionário de avaliação da função dos segmentos sacrais S4 e S5 após uma lesão medular (LM), cuja finalidade é substituir o exame de toque retal. O objetivo do presente estudo foi realizar uma adaptação transcultural do questionário S4-5Q para a língua portuguesa do Brasil e investigar a confiabilidade teste-reteste desta versão. Método A tradução e a adaptação transcultural foram realizadas utilizando a metodologia de tradução e retrotradução. Inicialmente, as traduções foram realizadas por três tradutores independentes. Sua síntese foi então submetida a um comitê de especialistas (profissionais de saúde com experiência em LM). Em seguida, a retrotradução para o idioma original foi enviada ao autor original, sendo que a versão final foi concluída após todas as adaptações. Para a confiabilidade teste-reteste, foram recrutados 24 indivíduos com lesão medular espinal (LME) em fase crônica (2 avaliações com intervalo de 7 a 14 dias entre elas). A análise estatística foi realizada no IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) com dados pré- tabulados no programa Microsoft Excel (Microsoft Corporation, Redmond, WA, EUA). A confiabilidade foi testada por meio do coeficiente Kappa de Cohen, e a consistência interna foi medida através do α de Cronbach, ambas adotando p < 0,05 como significante. Resultados Na análise de confiabilidade, os resultados de todas as perguntas apresentaram concordância quase perfeita (Kappa > 0,81) e boa consistência interna (α de Cronbach: 0,65-0,77) entre as perguntas e a classificação final. Conclusão O questionário S4-5Q adaptado culturalmente é confiável, podendo ser aplicado à população brasileira com LME crônica, com o objetivo de avaliar a função sensorial e motora nos segmentos sacrais S4-S5.


Subject(s)
Humans , Sacrococcygeal Region , Spinal Cord Injuries , Cross-Cultural Comparison , Surveys and Questionnaires
9.
Article in Chinese | WPRIM | ID: wpr-927398

ABSTRACT

OBJECTIVE@#To observe the effect of moxibustion at oppositely-located points "Mingmen" (GV 4) and "Shenque" (CV 8) on the motor function of the hind limbs and bladder function in rats with neurogenic bladder after suprasacral spinal cord injury (SCI), so as to explore the effect of this therapy on bladder tissue apoptosis mediated by endoplasmic reticulum stress pathway.@*METHODS@#Twenty-eight female Wistar rats were randomly divided into a sham-operation group (8 rats) and a model establishment group (20 rats). Using the modified Allen's method, the spinal cord of T10 segment was injured to establish a neurogenic bladder model in the model establishment group. Sixteen rats were modeled successfully and then divided into a model group (8 rats) and a moxibustion group (8 rats). In the moxibustion group, 2 h after consciousness regaining from modeling anesthesia, moxibustion was exerted at "Shenque" (CV 8) and "Mingmen" (GV 4), 2 cones at each acupoint in one intervention. The intervention was administered once every two days and 5-time intervention was required totally. After intervention, Basso, Beattie and Bresnahan locomotor rating scale (BBB) score for the motor function of the hind limbs, and the urodynamics indexes (maximum bladder capacity, urine leakage pressure and bladder compliance) were compared among groups. HE staining method was adopted to observe the morphological changes of bladder tissue. With Western blot method and real-time PCR assay, the protein and mRNA expressions of the endoplasmic reticulum stress-related genes (glucose- regulated protein 78 [GRP78], activating transcription factor 4 [ATF4] and cysteinyl aspartate specific proteinase-12 [Caspase-12]) were determined.@*RESULTS@#The transitional epithelial cells were arranged irregularly, the bladder wall was getting thinner, and the cellular vacuolar degeneration and neutrophil infiltration were found in the model group. Whereas, compared with the model group, in the moxibustion group, the arrangement of transitional epithelial cells was clear and continuous in layers, the cellular vacuolar degeneration was mild and the infiltration presented in a small amount of neutrophil granulocytes. Compared with the sham-operation group, in the model group, the BBB score was reduced (P<0.01), the maximum bladder capacity and bladder compliance were increased (P<0.01), and the protein expression levels of GRP78, ATF4 and Caspase-12, as well as mRNA expressions were all increased (P<0.01). In comparison with the model group, in the moxibustion group, BBB score was increased (P<0.01), the maximum bladder capacity and bladder compliance were decreased (P<0.01), and the protein and mRNA expression levels of GRP78, ATF4 and Caspase-12 were all decreased (P<0.01).@*CONCLUSION@#Moxibustion at the "oppositely-located points" improves the urination function, alleviate urine retention in neurogenic bladder rats after spinal cord injury. The underlying mechanism may be related to the down-regulation of the expressions of GRP78, ATF4 and Caspase-12 in the endoplasmic reticulum stress pathway of the bladder tissues, and thus to alleviate the apoptosis of bladder tissue.


Subject(s)
Animals , Female , Rats , Caspase 12/genetics , Electroacupuncture , Endoplasmic Reticulum Stress , Moxibustion , RNA, Messenger , Rats, Sprague-Dawley , Rats, Wistar , Spinal Cord , Spinal Cord Injuries/therapy , Urinary Bladder, Neurogenic/therapy
10.
Article in Chinese | WPRIM | ID: wpr-927376

ABSTRACT

OBJECTIVE@#To observe the effect of moxibustion at "Guanyuan" (CV 4) and "Shenque" (CV 8) on acetylcholine (Ach), adenosine triphosphate (ATP) and muscarinic-type choline receptor (M2) and purine receptor P2X3 in bladder tissue in the rats with neurogenic bladder (NB) of detrusor areflexia after lumbar-sacral spinal cord injury and explore the underlying mechanism of moxibustion for promoting detrusor contraction.@*METHODS@#Sixty SD rats were randomly divided into a model preparation group (n=45) and a sham-operation group (n=15). In the model preparation group, the modified Hassan Shaker spinal cord transection method was used to prepare the model of NB. In the sham-operation group, the spinal cord transection was not exerted except laminectomy and spinal cord exposure. Among the rats with successfully modeled, 30 rats were selected and divided randomly into a model group and a moxibustion group, with 15 rats in each one. On the 15th day after the operation, moxibustion was applied at "Guanyuan" (CV 4) and "Shenque" (CV 8) in the moxibustion group, 10 min at each acupoint, once a day. The consecutive 7-day treatment was as one course and the intervention for 2 courses was required. Urodynamic test was adopted to evaluate bladder function in rats. Using HE staining, the morphological changes in bladder tissue were observed. The content of Ach and ATP in bladder tissue was measured with biochemical method, and the protein and mRNA expression levels of M2 and P2X3 receptors in bladder tissue were detected with Western blot and real-time fluorescence quantification PCR method.@*RESULTS@#Compared with the sham-operation group, the maximum bladder capacity, leakage point pressure and bladder compliance were increased in the rats of the model group (P<0.05). Compared with the model group, the maximum bladder capacity, the leakage point pressure and bladder compliance were decreased in the rats of the moxibustion group (P<0.05). In the model group, the detrusor fibres were arranged irregularly, bladder epithelial tissues were not tightly connected and cell arrangement was disordered, combined with a large number of vacuolar cells. In the moxibustion group, compared with the model group, the detrusor fibres were arranged regularly, bladder epithelial cells were well distributed and vacuolar cells were reduced. Compared with the sham-operation group, the content of Ach and ATP in bladder tissue was decreased (P<0.05), the protein and mRNA expression levels of M2 and P2X3 receptors were reduced (P<0.05) in the model group. In the moxibustion group, the content of Ach and ATP in bladder tissue was increased (P<0.05) and the protein and mRNA expression levels of M2 and P2X3 receptors were increased (P<0.05) as compared with the model group.@*CONCLUSION@#Moxibustion at "Guanyuan" (CV 4) and "Shenque" (CV 8) may effectively improve bladder function in the rats with NB of detrusor areflexia after lumbar-sacral spinal cord injury and its underlying mechanism is related to promoting the release of Ach and up-regulating the expression of M2 receptor, thereby enhancing the release of ATP and increasing the expression of P2X3 receptor. Eventually, detrusor contraction is improved.


Subject(s)
Animals , Rats , Moxibustion/methods , Rats, Sprague-Dawley , Receptors, Purinergic P2X3/metabolism , Spinal Cord Injuries/therapy , Urinary Bladder , Urinary Bladder, Neurogenic/therapy
11.
Rio de Janeiro; s.n; 2022. 284 p. ilus, tab, graf.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1428523

ABSTRACT

A lesão traumática da medula espinhal acontece de forma abrupta na vida de uma pessoa, alterando não só a sensibilidade e a motricidade logo abaixo do nível da lesão, mas também processos fisiológicos, psicológicos, sociais, culturais e espirituais. Dessa forma, faz-se necessário compreender o fenômeno sob a perspectiva de um paradigma integrativo-integrador e organicista, mas também que ofereça subsídio para a tomada de decisão do enfermeiro na promoção deste processo adaptativo. Com este intuito, a pesquisa em tela teve por objetivo geral construir uma teoria de médio alcance do processo adaptativo da pessoa com lesão traumática da medula espinhal baseada no Modelo de Adaptação de Callista Roy e como objetivos específicos: descrever o processo adaptativo da pessoa com lesão medular traumática; deduzir elementos do modelo de adaptação de Callista Roy para conceitualização; elaborar afirmativas teóricas e proposições concernentes ao nível de médio alcance; modelar a teoria de médio alcance do processo adaptativo da pessoa com lesão medular traumática; e propor instrumentos de operacionalização teórica para o processo de enfermagem. Trata-se de uma pesquisa do tipo teórica, de natureza explicativa, orientada pelo raciocínio dedutivo e indutivo. Seguiu o método de construção de teorias em disciplinas aplicadas de Swanson e Chermack e estratégias de teorização utilizando componentes terminológicos para teorias produtoras de situação de Brandão e Santana. O procedimento dedutivo se deu a partir da dedução dos constructos do Modelo de Adaptação de Roy e a indução por meio da pesquisa foi realizada por meio de uma revisão de escopo que seguiu a metodologia da Joanna Briggs Institute. Na fase de conceitualização, procedeu-se a análise dos estudos, a identificação e a organização dos conceitos, por correspondência com os constructos do Modelo de Adaptação de Roy, da taxonomia de interface NANDA International (NANDA-I) e da taxonomia de referência Systematized Nomenclature of Medicine International - Clinical Terms (SNOMED CT), foram definidos os limites da teoria, elaboradas as afirmativas relacionais e a modelagem teórica. Na fase de operacionalização, foram descritas as proposições e elaborados instrumentos orientadores do processo de enfermagem com base na teoria. O processo de adaptação da pessoa à lesão traumática da medula espinhal e as respostas de enfrentamento são os conceitos centrais da teoria. O sentido da vida, as experiências prévias e a postura interna em relação aos desafio modulam as respostas de enfrentamento que se dão no escopo das respostas humanas fisiológicas, de autoconceito, de alterações de papéis e de interdependência, que geram respostas efetivas ou comprometidas. O enfermeiro auxilia a pessoa, por meio da aplicação do processo de enfermagem individualizado, que deve ser orientado pelo contato empático enfermeiro-pessoa, sob a perspectiva da multidimensionalidade, de forma integral e integrada. Oferece tecnologias leve e leve-dura embasadas na teoria de médio alcance por meio de orientações para avaliação inicial, rol de diagnósticos de enfermagem da NANDA-I agrupados por resposta humana, de resultados Nursing Outcomes Classification, de intervenções Nursing Interventions Classification e um guia para avaliação e indicação prescritiva utilizando a SNOMED CT no formato de mapas mentais de cada um dos conceitos. Assim, a tese defendida descreve e explica o processo de adaptação da pessoa com lesão traumática da medula espinhal e oferece tecnologias que possam orientar o enfermeiro na promoção de cuidado de enfermagem, com características prescritivas para o alcance de respostas efetivas, contribuindo originalmente para a enfermagem como disciplina.


Traumatic spinal cord injury happens abruptly in a person's life, altering not only sensitivity and motricity just below the level of injury, but also physiological, psychological, social, cultural, and spiritual processes. Thus, it is necessary to understand the phenomenon from the perspective of an integrative-integrative and organicist paradigm, but also one that offers subsidy for nurses' decision-making in promoting this adaptive process. To this end, the present research had the general objective of building a medium-range theory of the adaptive process of people with traumatic spinal cord injury based on the Adaptation Model of Callista Roy and as specific objectives: to describe the adaptive process of people with spinal cord injuries. Traumatic spinal cord; deduce elements of Callista Roy's adaptation model for conceptualization; develop theoretical statements and propositions concerning the mid-range level; model the middle-range theory of the adaptive process of the person with traumatic spinal cord injury; and propose instruments of theoretical operationalization for the nursing process. This is theoretical research, explanatory in nature, guided by deductive and inductive reasoning. It followed Swanson and Chermack's theory-building method in applied disciplines and Brandão and Santana's theorizing strategies using terminological components for situation-producing theories. The deductive procedure was based on the deduction of the constructs of the Roy Adaptation Model and the induction through the research was conducted through a scoping review that followed the methodology of the Joanna Briggs Institute. In the conceptualization phase, the studies were analyzed, the concepts were identified and organized, by correspondence with the constructs of the Roy Adaptation Model, the NANDA International interface taxonomy (NANDA-I), and the Systematized reference taxonomy Nomenclature of Medicine International - Clinical Terms (SNOMED CT), the limits of the theory were defined, relational statements and theoretical modeling were elaborated. In the operationalization phase, propositions were described, and guiding instruments of the nursing process based on theory were elaborated. The process of adaptation of the person to the traumatic spinal cord injury and the coping responses are the central concepts of the theory. The meaning of life, previous experiences, and internal posture concerning challenges modulate the coping responses that occur within the scope of human physiological responses, self-concept, changes in roles, anperson, through the application of the individualized nursing process, which must be guided by the empathetic nurse-person contact, from the perspective of multidimensionality, in an integral and integrated way. Provides soft and light-hard technologies based on mid-range theory through initial assessment guidelines, NANDA-I nursing diagnoses list grouped by the human response, Nursing Outcomes Classification, Nursing Interventions Classification, and a guide to evaluation and prescriptive indication using SNOMED CT in the form of mental maps of each of the concepts. Thus, the defended thesis describes and explains the adaptation process of the person with traumatic spinal cord injury and offers technologies that can guide nurses in promoting nursing care, with prescriptive characteristics to reach effective responses, originally contributing to nursing as a discipline.


La lesión traumática de la médula espinal ocurre abruptamente en la vida de una persona, alterando no solo la sensibilidad y la motricidad justo por debajo del nivel de la lesión, sino también los procesos fisiológicos, psicológicos, sociales, culturales y espirituales. Por lo tanto, es necesario comprender el fenómeno en la perspectiva de un paradigma integrador-integrador y organicista, pero también que ofrece subsidio para la toma de decisiones de los enfermeros en la promoción de este proceso adaptativo. Para ello, la presente investigación tuvo como objetivo general construir una teoría de alcance medio del proceso adaptativo de las personas con lesión medular traumática basada en el Modelo de Adaptación de Callista Roy y como objetivos específicos: describir el proceso adaptativo de las personas con lesiones de la médula espinal. Médula espinal traumática; deducir elementos del modelo de adaptación de Callista Roy para la conceptualización; desarrollar enunciados teóricos y proposiciones relativas al nivel medio; modelar la teoría de rango medio del proceso adaptativo de la persona con lesión medular traumática; y proponer instrumentos de operacionalización teórica para el proceso de enfermería. Esta es una investigación teórica, de naturaleza explicativa, guiada por razonamientos deductivos e inductivos. Siguió el método de construcción de teorías de Swanson y Chermack en disciplinas aplicadas y las estrategias de teorización de Brandão y Santana utilizando componentes terminológicos para teorías productoras de situaciones. El procedimiento deductivo se basó en la deducción de los constructos del Modelo de Adaptación de Roy y la inducción a través de la investigación se realizó a través de un scoping review que siguió la metodología del Instituto Joanna Briggs. En la fase de conceptualización se analizaron los estudios, se identificaron y organizaron los conceptos, por correspondencia con los constructos del Modelo de Adaptación de Roy, la taxonomía de interfaz de NANDA International (NANDA-I), y la taxonomía de referencia Systematized Nomenclature of Medicine International - Clinical Terms (SNOMED CT), se definieron los límites de la teoría, se elaboraron enunciados relacionales y modelos teóricos. En la fase de operacionalización, fueron descritas proposiciones y elaborados instrumentos orientadores del proceso de enfermería basados en la teoría. El proceso de adaptación de la persona a la lesión medular traumática y las respuestas de afrontamiento son los conceptos centrales de la teoría. El sentidde afrontamiento que se dan en el ámbito de las respuestas fisiológicas humanas, el autoconcepto, los cambios de roles y la interdependencia, que generan respuestas efectivas o comprometidas. El enfermero asiste a la persona, a través de la aplicación del proceso de enfermería individualizado, que debe ser guiado por el contacto empático enfermero-persona, desde la perspectiva de la multidimensionalidad, de forma integral e integrada. Proporciona tecnologías suaves y ligeras basadas en la teoría de rango medio a través de pautas de evaluación inicial, una lista de diagnósticos de enfermería NANDA-I agrupados por la respuesta humana, resultados de Nursing Outcomes Classification, intervenciones de Nursing Interventions Classification y una guía para la evaluación e indicación prescriptiva usando SNOMED CT en forma de mapas mentales de cada uno de los conceptos. Así, la tesis defendida describe y explica el proceso de adaptación de la persona con lesión medular traumática y ofrece tecnologías que pueden orientar a los enfermeros en la promoción del cuidado de enfermería, con características prescriptivas para alcanzar respuestas efectivas, contribuyendo originalmente a la enfermería como disciplina.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Spinal Cord Injuries , Nursing Theory , Anxiety , Rehabilitation , Self Care , Self Concept , Nursing Diagnosis , Adaptation, Psychological , Sexuality , Self Efficacy , Personal Autonomy , Spirituality , Depression , Resilience, Psychological , Standardized Nursing Terminology , Nursing Process
12.
Motriz (Online) ; 28: e10220006821, 2022. tab
Article in English | LILACS | ID: biblio-1375940

ABSTRACT

Abstract Aim: This study aims to characterize the stress, recovery, mood, and motivation together with the training load of athletes with cervical spinal cord injury (CSCI) during a period of resumption of wheelchair rugby (WCR) training. Additionally, it aims to compare the psychological and load training aspects during a competitive preseason and determine the correlations between training load, mood, stress, and recovery. Methods: We evaluated variables such as mood (Brazilian Mood Scale, BRAMS), stress and recovery (Recovery-Stress Questionnaire for Athletes, RESTQ-Sport 76) and training load (Subjective Perception of Effort - SPE) of eight high-performance athletes of wheelchair rugby with CSCIs at three different times (E1 = returning from vacation, E2 = half of the preseason, and E3 = after 2 months of training) for 2 months at a monthly interval. We also evaluated motivation (Sport Motivation Scale) at E1 and E3. Results: Results indicated few changes during the competitive preseason in terms of stress, recovery, and mood. However, the training load decreased toward the end of this period. Furthermore, we found that physical complaints positively correlated with depression when resuming training. In the middle of the competitive preseason period, we also noted positive correlations between conflict/pressure and fatigue and between fatigue and energy loss. At the end of this period, the SPE and arbitrary units correlated positively with conflict/pressure. Conclusion: We found few changes during the competitive preseason in terms of stress, recovery, and mood but not motivation, which did not change during this period. On the other hand, the training load decreased at the end of the competitive preseason. Furthermore, we observed correlations between training load and psychological aspects at different times.


Subject(s)
Humans , Spinal Cord Injuries/physiopathology , Exercise , Psychology, Sports , Para-Athletes , Stress, Physiological , Wit and Humor , Motivation
13.
Rev. Esc. Enferm. USP ; 56(spe): e20210449, 2022. tab, graf
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1387295

ABSTRACT

ABSTRACT Objective: To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). Method: This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. Results: This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). Conclusion: Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.


RESUMEN Objetivo: Evaluar el efecto de la electroestimulación abdominal (EE) sobre la frecuencia de las evacuaciones, la consistencia y la cantidad de heces en personas con estreñimiento debido a una lesión de la médula espinal (LME). Método: Estudio piloto experimental de tipo crossover-aleatorizado en dos grupos de tratamiento: convencional rehabilitación intestinal y convencional asociado a EE con Functional Electrical Stimulation (FES) de 8 y 20 Hz aplicados a los músculos abdominales. Se realizó un seguimiento de ambos grupos durante dos semanas con 30 minutos de sesión diaria de EE. Los participantes estaban hospitalizados en un instituto de rehabilitación de la ciudad de São Paulo. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: Diez personas con LME participaron en el estudio, la mayoría hombres (70%) con una edad media de 39 años (DE = 16,37). La EE asociada al tratamiento convencional demostró ser más eficaz en el aumento de la frecuencia de evacuación (p = 0,029) y la cantidad de heces (p = 0,031). Conclusión: La EE abdominal asociada al tratamiento convencional ayudó a aumentar la frecuencia de evacuación y la cantidad de heces en el contexto de estreñimiento en personas con LME. Este estudio piloto servirá de base para futuros ensayos clínicos con mayor muestreo y evidencia estadística.


RESUMO Objetivo: Avaliar o efeito da eletroestimulação (EE) abdominal sobre a frequência de evacuações, a consistência e a quantidade de fezes em pessoas com constipação decorrente da lesão medular (LM). Método: Estudo piloto experimental do tipo crossover-randomizado em dois grupos de tratamento: convencional de reabilitação intestinal e convencional associado à EE com Functional Electrical Stimulation (FES) de 8 e 20 Hz aplicados na musculatura abdominal. Ambos os grupos em seguimento por duas semanas, com 30 minutos de sessão diária de EE. Os participantes estavam internados em um instituto de reabilitação da cidade de São Paulo. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Participaram do estudo 10 pessoas com LM, a maioria do sexo masculino (70%), com média de idade de 39 anos (DP = 16,37). A EE, associada ao tratamento convencional, mostrou-se mais eficaz no aumento da frequência evacuatória (p = 0,029) e na quantidade de fezes (p = 0,031). Conclusão: A EE abdominal associada ao tratamento convencional auxiliou no aumento da frequência evacuatória e na quantidade de fezes no quadro de constipação em pessoas com LM. Este estudo piloto servirá como base para um futuro ensaio clínico com maior amostragem e comprovação estatística.


Subject(s)
Spinal Cord Injuries , Electric Stimulation , Rehabilitation , Abdominal Muscles , Constipation , Enterostomal Therapy
14.
Article in Spanish | LILACS, BINACIS | ID: biblio-1378016

ABSTRACT

Introducción: La lesión traumática de la médula espinal es la principal causa de discapacidad motora en el mundo, y representa una prioridad para la Organización Mundial de la Salud. Se estudió, a nivel estructural y bioquímico, el efecto de la hipotermia sobre la expresión de la CIRBP (proteína activada por frío) en el asta anterior de la médula de ratas Sprague-Dawley albinas macho de 60 días, planteándola como terapéutica posible. Materiales y Métodos:Se dividió a 24 ratas en dos grupos: normotermia a 24 °C (n = 6) e hipotermia a 8 °C (n = 18), durante 180 min, sacrificadas a las 12, 24 y 48 h después del tratamiento. Se utilizó Western blot e inmunohistoquímica para la CIRBP. Resultados:Se observó un aumento progresivo de la expresión de la CIRBP de 12 a 48 h en las motoneuronas del asta anterior. Los valores fueron estadísticamente significativos entre los grupos de 24 h y 48 h comparados con los de los controles. Conclusiones: Este modelo experimental resultó eficaz, accesible y económico para generar hipotermia sistémica y abre un abanico de estrategias terapéuticas. El aumento en la expresión de las proteínas inducibles por frío en la médula espinal de ratas permite, por primera vez, estudiar el beneficio que aporta la hipotermia a nivel molecular, lo que resulta de suma importancia para estudios de terapéuticas en las lesiones medulares. Nivel de Evidencia: I


Introduction: Traumatic spinal cord injury is the main cause of motor disability in developed and underdeveloped countries, being a priority interest to the WHO. The effect of hypothermia on the expression of CIRBP (cold-activated protein) in the anterior grey column of 60-day-old male albino Sprague-Dawley rats was studied at the structural and biochemical levels and proposed as a possible therapeutic approach. Materials and Methods: 24 rats were randomly divided into two groups; normothermia (n = 6), at 24° C, and hypothermia, (n = 18) at 8° C for 180 minutes and euthanized at 12, 24, and 48 h post-treatment. Western blot and immunohistochemistry for CIRBP were used. Results: A progressive increase in the expression of CIRBP was observed from 12 to 48 hours, with statistically significant values after 24 and 48 hours compared to controls. Conclusion: This experimental model demonstrated efficacy, accessibility, and economy to generate systemic hypothermia, which provides a novel range of therapeutic strategies. The increase in the expression of cold-inducible proteins in the rats' spinal cords allows us to study the benefit of hypothermia at the molecular level for the first time, being of utmost importance for therapeutic studies in spinal cord injuries. Level of Evidence: I


Subject(s)
Animals , Rats , Spinal Cord , Spinal Cord Injuries , Heterogeneous-Nuclear Ribonucleoproteins , Hypothermia
15.
Coluna/Columna ; 21(3): e265129, 2022. tab
Article in English | LILACS | ID: biblio-1404393

ABSTRACT

ABSTRACT Spinal cord injuries can have serious consequences for the individual, such as loss of motor function, sensory impairment, and alteration of physiological systems functions. Treatments for spinal cord injuries involve the use of drugs and surgical approaches. In the surgical field, there is a question about the ideal time after the trauma to perform the surgical procedure. The studies divide the time until surgery after the injury into two categories: "early" and "late". To review the scientific literature on this topic, and to assess the relative effectiveness of early versus late decompressive surgery, we considered early intervention up to 24 hours and late intervention from 24 hours after the injury. For this, we performed a literature review and selected retrospective, prospective observational studies, clinical studies, and reviews with meta-analysis that compared the recovery time of patients with spinal cord injury after surgeries performed within 24 hours (early) and after 24 hours (late). The results showed potential for neurological improvement with early or even ultra-early surgical decompression (up to 12 hours) in patients with traumatic cervical spinal cord injury. On the other hand, reports about the advantage of early decompression when there is a thoracic injury are scarce. In addition to the time to decompression, the concomitant use of some drugs seems to play an important role in patients' recovery. Level of Evidence II; Literature review.


RESUMO: Lesões na medula espinhal podem gerar sérias consequências para o indivíduo, como perda de função motora, prejuízo sensorial e alteração de funções de sistemas fisiológicos. Os tratamentos para lesões na medula espinhal envolvem o uso de fármacos e abordagens cirúrgicas. No âmbito cirúrgico, há o questionamento sobre qual o tempo ideal após o traumatismo para realizar o procedimento cirúrgico. Os trabalhos dividem em duas categorias o tempo até a realização da cirurgia após a lesão: "precoce" e "tardio". Com a finalidade de revisar a literatura científica sobre esse tema, a fim de avaliar a eficácia relativa da cirurgia descompressiva precoce versus tardia, consideramos a intervenção precoce até 24 horas e a tardia a partir de 24 horas da injúria. Para isto realizamos uma revisão da literatura e selecionamos estudos observacionais retrospectivos, prospectivos, estudos clínicos e revisões com meta-análise que comparavam o tempo de recuperação de pacientes com lesão medular após cirurgias realizadas em até 24 horas (precoce) e após 24 horas (tardio). Os resultados demonstraram potencial de melhora neurológica com a descompressão cirúrgica precoce ou até ultraprecoce (até 12 horas) em pacientes com lesão medular traumática cervical. Por outro lado, relatos acerca da vantagem da descompressão precoce quando há uma lesão torácica são escassos. Além do tempo até a descompressão, o uso concomitante de alguns fármacos parece ter um importante papel na recuperação dos pacientes. Nível de evidência II; Revisão de literatura.


RESUMEN: Las lesiones de la médula espinal pueden tener consecuencias graves para el individuo, como pérdida de función motora, deterioro sensorial y alteración de funciones de los sistemas fisiológicos. Los tratamientos para las lesiones de médula espinal involucran uso de medicinas y enfoques quirúrgicos. En el campo quirúrgico, existe la duda sobre el momento exacto después del traumatismo para realizar lo procedimiento quirúrgico. Los estudios dividen el tiempo hasta la cirugía después de la lesión en dos categorías: "temprano" y "tardío". Con el fin de revisar la literatura científica sobre este tema, y con el fin de evaluar la efectividad relativa de la descompresión quirúrgica temprana frente a la tardía, se consideró la intervención temprana hasta las 24 horas y la intervención tardía a partir de las 24 horas después de la lesión. Para ello, efectuamos una revisión bibliográfica y seleccionamos estudios retrospectivos, prospectivos observacionales, estudios clínicos y revisiones con metaanálisis que compararon el tiempo de recuperación de pacientes con lesión medular con cirugías realizadas en 24 horas (temprano) y a las 24 horas (tardía). Los resultados presentaron potencial para la mejora neurológica con descompresión quirúrgica temprana o incluso ultra temprana (hasta 12 horas) en pacientes con lesión traumática de la médula espinal cervical. Por otro lado, son escasos reportes sobre la ventaja de descompresión temprana cuando existe una lesión torácica. Además del tiempo de descompresión, el uso concomitante de algunos fármacos parece jugar un papel importante en la recuperación de los pacientes. Nivel de Evidencia II; Revisión de literatura.


Subject(s)
Spinal Cord Injuries
16.
Article in English | WPRIM | ID: wpr-928993

ABSTRACT

OBJECTIVES@#Electroacupuncture can enhance autophagic flow, promote neuronal regeneration, axonal and myelin remodeling to achieve the protection of spinal cord injury, but its role in neurogenic urine retention is not completely clear. This study aims to investigate whether the mechanism of electroacupuncture in the treatment of neurogenic urine retention is through autophagy mediated by adenosine monophosphate activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) pathway.@*METHODS@#A rat model of neurogenic urine retention after sacral spinal cord injury was established. The rats with successful model were randomly divided into a model group, an electroacupuncture group (electro-acupuncture for Ciliao, Zhongji, and Sanyinjiao by electronic stimulation, once a day, 20 min each time for 7 days), and an electroacupuncture+AMP-activated protein kinase (AMPK) inhibitor group (on the basis of the treatment of electroacupuncture group, 100 μg of AMPK inhibitor compound C was injected intramuscularly around the L2-3 intervertebral space on the 1st and 4th day). The normal group did not receive any treatment. The maximum bladder volume, bladder basal pressure, leak point pressure, and bladder compliance were recorded by multi-channel physiological recorder; the morphology of bladder tissue was observed by HE staining; autophagy was observed under transmission electron microscope; the expressions of LC3II and Beclin1 protein were observed by immunofluorescence staining; the protein levels of AMPK, phosphorylated-AMPK (p-AMPK), mTOR, phosphorylated-mTOR (p-mTOR), microtubule associated protein 1 light chain 3 (LC3) II and Beclin1 in bladder tissue were detected by Western blotting.@*RESULTS@#Compared with the normal group, the maximum bladder capacity, leak point pressure, bladder compliance, p-AMPK, LC3II, Beclin1 protein expressions in the bladder tissue of the model group increased, and the p-mTOR protein expressions were decreased (all P<0.05); compared with the model group, the maximum bladder capacity, bladder compliance, p-mTOR protein expression in the bladder tissue of the electroacupuncture group were decreased, and the p-AMPK, LC3II, and Beclin1 protein expressions were increased (all P<0.05); compared with the electroacupuncture group, the maximum bladder capacity, bladder compliance, p-mTOR protein expression in the bladder tissue of the electroacupuncture+AMPK inhibitor group were increased, the p-AMPK, LC3II, and Beclin1 protein expressions were decreased (all P<0.05). In the model group, the bladder became larger, with unclear and varying degrees of degeneration, severe tissue damage and autophagosome appeared; the bladder of the electroacupuncture group was smaller than that of the model group, and all levels were clearly visible with autophagy bodies; the layers were slightly disordered and damaged in the electroacupuncture + AMPK inhibitor group.@*CONCLUSIONS@#Electroacupuncture can activate autophagy through AMPK/mTOR pathway, thereby reducing neurogenic urine retention caused by spinal cord injury.


Subject(s)
Animals , Rats , AMP-Activated Protein Kinases , Autophagy , Beclin-1 , Electroacupuncture , Mammals , Rats, Sprague-Dawley , Spinal Cord Injuries , TOR Serine-Threonine Kinases
17.
Article in Chinese | WPRIM | ID: wpr-928293

ABSTRACT

Spinal cord injury is a severe central nervous system disease, which will cause a series of complex pathophysiological changes and activate a variety of signaling pathways including Notch signaling. Studies have evidenced that activation of the Notch signaling pathway is not conducive to nerve repair and symptom improvement after spinal cord injury. Its mechanisms include inhibiting neuronal differentiation and axon regeneration, promoting reactive astrocyte proliferation, promoting M1 macrophage polarization and the release of proinflammatory factors, and inhibiting angiogenesis. Therefore, it has become a promising therapeutic strategy to inhibit Notch signal as a target in the treatment of spinal cord injury. In recent years, some researchers have used drugs, cell transplantation or genetic modification to regulate Notch signaling, which can promote the recovery of nerve function after spinal cord injury, thereby providing new treatment strategies for the treatment of spinal cord injury. This article will summarize the mechanism of Notch signaling pathway in spinal cord injury, and at the same time review the research progress in the treatment of spinal cord injury by modulating Notch signaling pathway in recent years, so as to provide new research ideas for further exploring new strategies for spinal cord injury.


Subject(s)
Humans , Axons/metabolism , Cell Transplantation , Nerve Regeneration , Signal Transduction/genetics , Spinal Cord/metabolism , Spinal Cord Injuries/metabolism
18.
Article in Chinese | WPRIM | ID: wpr-928194

ABSTRACT

Electric field stimulation (EFS) can effectively inhibit local Ca 2+ influx and secondary injury after spinal cord injury (SCI). However, after the EFS, the Ca 2+ in the injured spinal cord restarts and subsequent biochemical reactions are stimulated, which affect the long-term effect of EFS. Polyethylene glycol (PEG) is a hydrophilic polymer material that can promote cell membrane fusion and repair damaged cell membranes. This article aims to study the combined effects of EFS and PEG on the treatment of SCI. Sprague-Dawley (SD) rats were subjected to SCI and then divided into control group (no treatment, n = 10), EFS group (EFS for 30 min, n = 10), PEG group (covered with 50% PEG gelatin sponge for 5 min, n = 10) and combination group (combined treatment of EFS and PEG, n = 10). The measurement of motor evoked potential (MEP), the motor behavior score and spinal cord section fast blue staining were performed at different times after SCI. Eight weeks after the operation, the results showed that the latency difference of MEP, the amplitude difference of MEP and the ratio of cavity area of spinal cords in the combination group were significantly lower than those of the control group, EFS group and PEG group. The motor function score and the ratio of residual nerve tissue area in the spinal cords of the combination group were significantly higher than those in the control group, EFS group and PEG group. The results suggest that the combined treatment can reduce the pathological damage and promote the recovery of motor function in rats after SCI, and the therapeutic effects are significantly better than those of EFS and PEG alone.


Subject(s)
Animals , Rats , Electric Stimulation , Polyethylene Glycols/therapeutic use , Rats, Sprague-Dawley , Recovery of Function/physiology , Spinal Cord , Spinal Cord Injuries/therapy
19.
Int. j. morphol ; 39(6): 1749-1757, dic. 2021. ilus
Article in English | LILACS-Express | LILACS | ID: biblio-1385536

ABSTRACT

SUMMARY: Spinal cord regeneration after mechanical injury is one of the most difficult biomedical problems. This article evaluates the effect of poly(N-[2-hydroxypropyl]-methacrylamide) hydrogel (PHPMA-hydrogel) on spinal cord regeneration in young rats after lateral spinal cord hemi-excision (laceration) at the level of segments T12-T13 (TrGel group). The locomotor function score (FS) and the paretic hindlimb spasticity score (SS) were assessed according to Basso-Beattie-Bresnahan (BBB) and Ashworth scales, respectively, and compared to a group of animals with no matrix implanted (Tr group). Regeneration of nerve fibers at the level of injury was evaluated at ~5 months after spinal cord injury (SCI). One week after the SCI induction, the FS on the BBB scale was 0.9±0.5 points in the Tr group and 3.6±1.2 points in the TrGel group. In the Tr group, the FS in 5 months was significantly lower than in 2 weeks after SCI, while no significant changes in FS were detected in the TrGel group over the entire observation period. The final FS was 0.8±0.3 points in the Tr group and 4.5±1.8 points in the TrGel group. No significant changes in SS have been observed in the TrGel group throughout the experiment, while the Tr group showed significant increases in SS at 2nd week, 6th week, 3th month and 5th month. The SS in 5 months was 3.6±0.3 points on the Ashworth scale in the Tr group and 1.8±0.7 points in the TrGel group. Throughout the observation period, significant differences in FS between groups were observed only in 5 weeks after SCI, whereas significant differences in SS were observed in 2, 3 and 6-8 weeks post-injury. Glial fibrous tissue containing newly formed nerve fibers, isolated or grouped in small clusters, that originated from the surrounding spinal cord matter have been found between the implanted hydrogel fragments. In conclusion, PHPMA-hydrogel improves recovery of the hindlimb locomotor function and promotes regenerative growth of nerve fibers. Further research is needed to clarify the mechanism of this PHPMA-hydrogel effect.


RESUMEN: La regeneración de la médula espinal después de una lesión mecánica es uno de los problemas biomédicos más difíciles. Este artículo evalúa el efecto del hidrogel de poli (N- [2-hidroxipropil] -metacrilamida) (PHPMA-hidrogel) sobre la regeneración de la médula espinal en ratas jóvenes después de la hemiescisión lateral de la médula espinal (lesión) a nivel de los segmentos T12 - T13 (Grupo TrGel). La puntuación de la función locomotora (FS) y la puntuación de espasticidad parética de las patas traseras (SS) se evaluaron de acuerdo con las escalas de Basso- Beattie-Bresnahan (BBB) y Ashworth, respectivamente, y se compararon con un grupo de animales sin matriz implantada (grupo Tr). Se evaluó la regeneración de las fibras nerviosas al nivel de la lesión ~ 5 meses después de la lesión de la médula espinal (LME). Una semana después de la inducción de SCI, el FS en la escala BBB fue 0,9 ± 0,5 puntos en el grupo Tr y 3,6 ± 1,2 puntos en el grupo TrGel. En el grupo Tr, el FS en 5 meses fue significativamente menor que en 2 semanas después de SCI, mientras que no se detectaron cambios significativos en FS en el grupo TrGel durante el período de observación. El FS final fue de 0,8 ± 0,3 puntos en el grupo Tr y de 4,5 ± 1,8 puntos en el grupo TrGel. No se han obser- vado cambios significativos en SS en el grupo TrGel durante el experimento, mientras que el grupo Tr mostró aumentos significativos en SS en la 2ª semana, 6ª semana, 3º mes y 5º mes. La SS en 5 meses fue de 3,6 ± 0,3 puntos en la escala de Ashworth en el grupo Tr y de 1,8 ± 0,7 puntos en el grupo TrGel. A lo largo del período de observación, se observaron diferencias significativas en FS entre los grupos solo en 5 semanas después de la LME, mientras que se observaron diferencias significativas en SS en 2, 3 y 6-8 semanas después de la lesión. Entre los fragmentos de hidrogel implantados se observó tejido fibroso glial que contenía fibras nerviosas recién formadas, aisladas o agrupadas en pequeños grupos, que se originaban a partir de la materia de la médula espinal circundante. En conclusión, PHPMA-hydrogel mejora la recuperación de la función locomotora de las patas traseras y promueve el crecimiento regenerativo de las fibras nerviosas. Se requieren más estudios para aclarar el mecanismo del efecto de hidrogel PHPMA.


Subject(s)
Animals , Rats , Polyhydroxyethyl Methacrylate/administration & dosage , Spinal Cord Injuries/therapy , Hydrogel, Polyethylene Glycol Dimethacrylate/administration & dosage , Spinal Cord Injuries/physiopathology , Rats, Wistar , Recovery of Function/drug effects , Disease Models, Animal , Spinal Cord Regeneration/drug effects
20.
Coluna/Columna ; 20(4): 240-244, Oct.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1356183

ABSTRACT

ABSTRACT Objectives: To evaluate and compare the clinical evolution of surgical approaches used in patients with severe cervical myelopathy. Methods: Retrospective observational study in which 19 patients with myelopathy who underwent surgery were evaluated. Neurological assessments using the Frankel scale were conducted both preoperatively and one year following surgery, and the modified Japanese Orthopedic Association (JOA), Nurick, and Visual Analog Scale for pain (VAS) questionnaires were applied 1 year after the surgical procedure. Results: 89% of the participants were male and the average age was 63.9 years. No patient had postoperative neurological worsening, 12 patients (63.16%) had mild pain, and seven (36.84%) had moderate pain. The group with degenerative disease showed neurological improvement after surgery and the exclusively anterior approach was used in 84% of the cases, the exclusively posterior approach in 10% of the cases, and the dual approach in 6% of the cases. Conclusion: Surgical treatment has good results for inhibiting the unfavorable natural evolution of myelopathy within 1 year following surgery and promotes neurological improvement in degenerative cases, making it possible to use the anterior access route in most cases. Level of evidence III; Retrospective Study.


RESUMO Objetivos: Avaliar a evolução clínica em comparação com as vias de acesso cirúrgico em pacientes com mielopatia cervical grave. Métodos: Estudo observacional retrospectivo no qual foram avaliados 19 pacientes com mielopatia submetidos à cirurgia. Foram aplicados o questionário da Japanese Orthopedic Association (JOA) modificado, a Escala de Nurick e a Escala Visual Analógica (EVA) da dor um ano depois do procedimento cirúrgico e realizada avaliação neurológica pré-operatória e após um ano da cirurgia com a Escala de Frankel. Resultados: Os participantes eram 89% do sexo masculino e a média de idade foi de 63,9 anos. Nenhum paciente apresentou piora neurológica pós-operatória, 12 pacientes (63,16%) apresentaram dor leve e sete (36,84%) dor moderada. O grupo com doença degenerativa apresentou melhora neurológica depois da cirurgia e a via de acesso anterior exclusiva foi utilizada em 84% dos casos, 10% tiveram acesso exclusivamente por via posterior e 6% tiveram acesso com dupla via. Conclusões: O tratamento cirúrgico apresenta bons resultados para inibir a evolução natural desfavorável da mielopatia no período de um ano depois da cirurgia e promove melhora neurológica nos casos degenerativos, sendo possível a utilização da via de acesso anterior na maior parte dos casos. Nível de evidencia III; Estudo Retrospectivo.


RESUMEN Objetivos: Evaluar la evolución clínica en comparación con las vías de acceso quirúrgico en pacientes con mielopatía cervical severa. Métodos: Estudio observacional retrospectivo en el que se evaluaron 19 pacientes con mielopatía intervenidos quirúrgicamente. Se aplicó el cuestionario modificado de la Japanese Orthopedic Association (JOA), la escala de Nurick y la Escala Visual Analógica (EVA) del dolor 1 año después de la intervención quirúrgica y se realizó la evaluación neurológica preoperatoria y un año después de la cirugía utilizando la Escala de Frankel. Resultados: El 89% de los participantes eran hombres y la edad promedio era de 63,9 años. Ningún paciente presentó empeoramiento neurológico postoperatorio, 12 pacientes (63,16%) presentaron dolor leve y siete (36,84%) dolor moderado. El grupo con enfermedad degenerativa presentó mejoría neurológica tras la cirugía y en el 84% de los casos se utilizó la vía de acceso anterior exclusiva, el 10% la vía posterior exclusiva y el 6% la vía doble. Conclusión: El tratamiento quirúrgico presenta buenos resultados al inhibir la evolución natural desfavorable de la mielopatía en el período de un año después de la cirugía y promueve la mejoría neurológica en los casos degenerativos, posibilitando el uso de la vía de acceso anterior en la mayoría de los casos. Nivel de evidencia III; Estudio Retrospectivo.


Subject(s)
Humans , Male , Middle Aged , Aged , Spinal Cord Injuries
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