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DiPiro ND, Murday D, Krause JS. Differences in personal characteristics and health outcomes between ambulatory and non-ambulatory adults with traumatic spinal cord injury. J Spinal Cord Med 2023:1-9. [PMID: 37819626 DOI: 10.1080/10790268.2023.2234726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To identify differences in personal characteristics, health outcomes, and hospital utilization as a function of ambulatory status among adults with chronic SCI. DESIGN Prospective cohort study linked to state administrative billing data. SETTING Population-based SCI Registry from the Southeastern United States. PARTICIPANTS 1,051 adults (>18 years old) with chronic (>1-year), traumatic SCI. OUTCOME MEASURES The self-report assessment (SRA) included demographic, injury and disability characteristics, health status, psychological and behavioral factors, and participation and quality of life (QOL) variables. We linked cases to administrative billing data to assess hospital utilization, including Emergency Department (ED) visits and inpatient (IP) admissions (through the ED and direct IP) in non-federal state hospitals within the year following the SRA. RESULTS There were 706 ambulatory and 345 non-ambulatory participants. We found significant differences across all sets of factors and significant differences in hospital utilization metrics. Ambulatory adults had fewer ED visits (36% vs 44%), IP admissions through the ED (11% vs 25%) and IP only admissions (9% vs 19%) and spent fewer days in the hospital for both admissions through the ED (0.9 vs 4.6 days) and IP only admissions (0.7 vs 3.1 days). They also reported having fewer past year ED visits (44% vs 62%) and IP admissions (34% vs 52%). CONCLUSIONS We identified differences in personal characteristics, ED visits and IP admissions between ambulatory and non-ambulatory adults with SCI, providing a better understanding of the characteristics of those with SCI. The findings suggest the need for separate analyses based on ambulatory status when assessing long-term health outcomes including hospital utilization.
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Affiliation(s)
- Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Murday
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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Ejtehadi M, Amrein S, Hoogland IE, Riener R, Paez-Granados D. Learning Activities of Daily Living from Unobtrusive Multimodal Wearables: Towards Monitoring Outpatient Rehabilitation. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941240 DOI: 10.1109/icorr58425.2023.10304743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Monitoring activities of daily living (ADLs) for wheelchair users, particularly spinal cord injury individuals is important for understanding the rehabilitation progress, customizing treatment plans, and observing the onset of secondary health conditions. This work proposes an innovative sensory system for measuring and classifying ADLs relevant to secondary health conditions. We systematically evaluated multiple wearable sensors such as pressure distribution mats on the wheelchair seat, accelerometer data from the ear and wrists, and IMU data from the wheelchair wheels to achieve the best unobtrusive combination of sensors that successfully distinguished ADLs. Our work resulted in an XGBoost classifier with a 20-second window size and extracted features in statistical, time, frequency, and wavelet domains, with an average class-wise F1 score of 82% (with only 3 out of 12 classes being mislabeled). Our study results demonstrate that the newly investigated modality of the bottom pressure mat emerges as the most relevant information source for recognizing ADLs, while heart and respiratory rates did not provide added value for the selected set of ADLs. The proposed sensory system and methodology proved high quality in most classes and easily extendable for long-term monitoring in outpatient rehabilitation, with the need for an extended database of activities.
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He X, Guo X, Deng B, Kang J, Liu W, Zhang G, Wang Y, Yang Y, Kang X. HSPA1A ameliorated spinal cord injury in rats by inhibiting apoptosis to exert neuroprotective effects. Exp Neurol 2023; 361:114301. [PMID: 36538982 DOI: 10.1016/j.expneurol.2022.114301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Traumatic spinal cord injury (TSCI) is a serious nervous system insult, and apoptosis in secondary injury is an important barrier to recovery from TSCI. Heat shock protein family A member 1A (HSPA1A) is a protective protein whose expression is elevated after stress. However, whether HSPA1A can inhibit apoptosis after spinal cord injury, and the potential mechanism of this inhibition, remain unclear. In this study, we established in vivo and in vitro models of TSCI and induced HSPA1A overexpression and silencing. HSPA1A upregulation promoted the recovery of neurological function and pathological morphology at the injury site, enhanced neurological cell survival, and inhibited apoptosis in rats following TSCI. In the in vitro model, HSPA1A overexpression inhibited H2O2-induced apoptosis, indicating that HSPA1A suppressed the expression of Bax, caspase-9, and cleaved-caspase-3, promoted the expression of Bcl-2. Furthermore, inhibition of HSPA1A expression can aggravate H2O2-induced apoptosis. We also found that HSPA1A overexpression activated the Wnt/β-catenin signaling pathway, and that inhibition of this pathway attenuated the inhibitory effect of HSPA1A overexpression on apoptosis. Together, these results indicate that HSPA1A has neuroprotective effects against TSCI that may be exerted through activation of the Wnt/β-catenin signaling pathway to inhibit apoptosis.
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Affiliation(s)
- Xuegang He
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China
| | - Xudong Guo
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China
| | - Bo Deng
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Jihe Kang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China
| | - Wenzhao Liu
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China
| | - Guangzhi Zhang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China
| | - Yonggang Wang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China
| | - Yong Yang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China
| | - Xuewen Kang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China; The Second Clinical Medical College, Lanzhou University, Lanzhou, China; The International Cooperation Base of Gansu Province for the Pain Research in Spinal Disorders, Lanzhou, China.
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Unplanned hospital admissions due to secondary health conditions after spinal cord injury: a population-based description of determinants of length of stay. Spinal Cord 2023; 61:290-295. [PMID: 36782017 DOI: 10.1038/s41393-023-00880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
STUDY DESIGN Population-based prospective study. OBJECTIVES To provide a population-based description of length of stay (LOS) and person-related risk factors following unplanned hospital admission due to a secondary health condition (SHC) in persons with spinal cord injury (SCI). SETTING Specialized SCI hospital and rehabilitation center in Switzerland. METHODS Descriptive analysis of LOS using routine clinical data of persons with SCI, who were acutely hospitalized between 01.01.2017-30.06.2018. Multivariable regression analysis was used to derive marginal predictions of LOS by acute SHCs and person characteristics. RESULTS The study included 183 persons, 83% were male, and the median age was 57 years (interquartile range, IQR, 49-67 years). SCI cause was traumatic in 160 (88.4%) cases, 92 (50.3%) were persons with tetraplegia, 147 (80.3%) were classified as motor complete lesions (American Spinal Injury Association Impairment Scale (AIS) A or B) and median time since injury (TSI) was 24 (IQR 13-34) years. Median LOS was 19 (IQR 9-39) days, varying from 74 (IQR 39-92) days for pressure ulcers, 13 (IQR 8-24) days for urinary tract infections (UTI), to 27 (IQR 18-47) days for fractures. LOS was prolonged in persons with multiple co-morbidities or those developing complications during hospitalization. Sex, SCI etiology and lesion level were not associated with LOS. CONCLUSIONS This population-based description identified substantial variation in LOS between acute SHCs and clinical complications as the main, potentially modifiable, person-related risk factors for extended hospital stay.
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