Rotator cuff surgery in persons with spinal cord injury: relevance of a multidisciplinary approach.

BACKGROUND: This article is a prospective review of patients with spinal cord injury who underwent multidisciplinary consultation from January 2005 to September 2013 for pain in one or both shoulders. METHODS: We performed clinical, functional, and lesion evaluations of 38 patients with paraplegia and quadriplegia presenting with rotator cuff pathologies. RESULTS: Surgery was indicated and performed on 38 shoulders in 28 patients. The lesion assessment during surgery showed injuries that were more severe than one would have thought based on imaging data. The mean pain intensity rating in the operative and nonoperative groups was 0 and 1.6, respectively, at rest and 2 and 4.9, respectively, during paroxysmal peaks. On average, for patients who had surgery, the Functional Independence Measure score decreased by 2.3. The mean satisfaction index in operated patients was 8.5 of 10. CONCLUSIONS: When the surgical indication was based on a multidisciplinary decision, no negative results were reported that could have challenged the validity of this decision. Pain relief was the primary benefit reported after surgery. The functional status was modified because of the technical aids needed to prevent shoulder overuse. There are several arguments in favor of rotator cuff surgery for wheelchair-bound patients with spinal cord injury. Because of their functional impairments, wheelchair-bound patients will continue to overburden their shoulders after rotator cuff surgery. A multidisciplinary approach emerges as the solution to inform and educate patients to limit the risk of recurrence.

Osteoporosis in persons with spinal cord injury: the need for a targeted therapeutic education.

OBJECTIVES: To identify circumstances surrounding the onset of fracture and common risk factors in persons with spinal cord injury (SCI) and to suggest an alternative or complement to the pharmacologic approach by evaluating the need for a prospective study based on the impact of a targeted therapeutic education on risk management of fractures in this population. DESIGN: Retrospective study. SETTING: Hospital and Rehabilitation Center Setting. PARTICIPANTS: Women (n=7) and men (n=25; N=32; with ≥1 fracture after the initial SCI that occurred at home or in a hospital setting; mean ± SD age, 53±12y at the time of clinical review) with bone mineral density (BMD) measurements. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, main circumstances of onset, and complications of fractures, as well as transversal bone mineral density evaluation. RESULTS: Nine patients had more than 1 fracture and 23 patients had only 1 fracture (total, 43 fractures; mean age at onset of fracture, 49±12y; median time since injury, 13.9y; mean delay in diagnosis, 6.5±15d). Fractures occurred mostly in the lower limbs. The circumstances of onset of these fractures were different and very stereotyped. In 3 cases, no trauma was reported. The most frequent mechanisms identified were forced maneuvers by the patient or a third party and falls. In 10 cases, the fracture occurred during a wheelchair transfer with forced maneuver or a fall from the wheelchair. Twenty-five patients were confined to bed after the fracture (mean duration of bed confinement, 18±28d; range, 0-120d). Postfracture follow-up showed that for 43 cases of fractures, 19 had at least 1 orthopedic complication, 15 had local complications, and 23 had general complications. Patients (23 of 32) benefited from dual-energy X-ray absorptiometry to assess BMD a few months or years after the fracture (mean femoral neck BMD, 0.574±0.197g/cm²; mean femoral neck T score, -3.8±1.5). CONCLUSION: With this retrospective analysis of common risk factors and circumstances of onset of secondary fractures, there is a clear future for a prospective study to evaluate the impact of targeted therapeutic education on risk factors for secondary fractures in patients with SCI.

Metastatic paraplegia and functional outcomes: perspectives and limitations for rehabilitation care. Part 2.

OBJECTIVE: To identify functional outcomes that could justify the need for a rehabilitation care program for patients with metastatic epidural spinal cord compression (MESCC) and paraplegia. DATA SOURCES: Publications from 1950 to January 2010 selected from 3 databases. STUDY SELECTION: Original articles dealing with outcome data for functional status, pain, and bladder dysfunction. DATA EXTRACTION: Standardized reading grid. DATA SYNTHESIS: The data are dominated by retrospective studies for even functional-related data, and studies from rehabilitation teams are rare. They report a functional evolution similar to a population with traumatic spinal cord injury for the first 3 months. Patients who were ambulatory before treatment retained their ability to walk, and patients who were nonambulatory before treatment could regain gait abilities. Data also showed a positive impact on pain and bladder and/or bowel dysfunction. CONCLUSIONS: By restricting physical medicine and rehabilitation therapeutic care to a short time (1-2mo), the progression margin is possible in the short term and implies a voluntary and active therapeutic care approach for patients with paraplegia after MESCC on the basis of a codified and standardized program with clinical indicators, as well as patients' comfort indicators.

Nuclear localization of the duck hepatitis B virus capsid protein: detection and functional implications of distinct subnuclear bodies in a compartment associated with RNA synthesis and maturation.

We have reinvestigated the subcellular distribution of the duck hepatitis B virus (DHBV) core protein in infected duck hepatocytes and in transfected cells. By using indirect immunofluorescence, the protein was found to be localized not only in the cytoplasm, as described previously, but also within the cell nucleus, being concentrated in distinct, brightly staining nuclear core bodies (NCBs). In colocalization studies using confocal microscopy, the NCBs were found exclusively in the periphery of nuclear subdomains characterized as splicing factor compartments and distal to other subnuclear domains. Also relevant for their functional significance is that the NCBs formed during the establishment of virus infection, i.e., at very low overall concentrations of newly synthesized core protein, and persisted throughout all stages of infection. Moreover, a subset of NCBs colocalized with foci of pregenomic DHBV RNA present at concentrations detectable by fluorescence in situ hybridization. Taken together, these findings indicate that a minor fraction of the DHBV core protein molecules escapes the major cytoplasmic assembly pathway to accumulate in specific subnuclear domains, and they furthermore suggest that these NCBs serve a role in the synthesis and/or maturation of the DHBV RNA pregenome.

Intact microtubules support adenovirus and herpes simplex virus infections.

Capsids and the enclosed DNA of adenoviruses, including the species C viruses adenovirus type 2 (Ad2) and Ad5, and herpesviruses, such as herpes simplex virus type 1 (HSV-1), are targeted to the nuclei of epithelial, endothelial, fibroblastic, and neuronal cells. Cytoplasmic transport of fluorophore-tagged Ad2 and immunologically detected HSV-1 capsids required intact microtubules and the microtubule-dependent minus-end-directed motor complex dynein-dynactin. A recent study with epithelial cells suggested that Ad5 was transported to the nucleus and expressed its genes independently of a microtubule network. To clarify the mechanisms by which Ad2 and, as an independent control, HSV-1 were targeted to the nucleus, we treated epithelial cells with nocodazole (NOC) to depolymerize microtubules and measured viral gene expression at different times and multiplicities of infections. Our results indicate that in NOC-treated cells, viral transgene expression was significantly reduced at up to 48 h postinfection (p.i.). A quantitative analysis of subcellular capsid localization indicated that NOC blocked the nuclear targeting of Ad2 and also HSV-1 by more than 90% at up to 7 h p.i. About 10% of the incoming Texas Red-coupled Ad2 (Ad2-TR) was enriched at the nucleus in microtubule-depleted cells at 5 h p.i. This result is consistent with earlier observations that Ad2-TR capsids move randomly in NOC-treated cells at less than 0.1 micro m/s and over distances of less than 5 micro m, characteristic of Brownian motion. We conclude that fluorophore-tagged Ad2 and HSV-1 particles are infectious and that microtubules play a prominent role in efficient nuclear targeting during entry and gene expression of species C Ads and HSV-1.

Protein kinase and NO-stimulated ADP-ribosyltransferase activities associated with glyceraldehyde-3-phosphate dehydrogenase isolated from human liver.

Background/aims: GAPD has been exhaustively investigated as a key cytosolic enzyme in glycolysis. In recent years GAPD has also been implicated in many cellular activities unrelated to glycolysis. However, although various functions have been ascribed to GAPD from rabbit muscle, human blood and rat tissues, no information is available on human liver GAPD. We have recently demonstrated that, as a cellular kinase, GAPD might interfere in the life-cycle of hepatitis B virus. We therefore investigated the enzymatic activities and subcellular localization of GAPD in normal human liver. Methods: GAPD and hepatocyte membranes were isolated from human liver homogenates to study the subcellular localization and enzymatic activities of GADP (kinase and ADP-ribosyltransferase). Results: (i) GAPD was recovered from the plasma-membrane-enriched fraction, in internal membranes, and in the cytosol; (ii) GAPD could be phosphorylated, a phenomenon inhibited by both GAP and NADH; and (iii) GAPD exhibits ADP-ribosyltransferase activity, which is stimulated by nitric oxide in a concentration-dependent manner. Conclusions: Human liver GAPD may play significant biological roles in addition to glycolysis, especially in signal transduction and in intracellular processes possibly involved in HBV infection.