Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Pharmacological intervention for chronic phase of spinal cord injury

Spinal cord injury is an intractable traumatic injury. The most common hurdles faced during spinal cord injury are failure of axonal regrowth and reconnection to target sites. These also tend to be the most challenging issues in spinal cord injury. As spinal cord injury progresses to the chronic phase, lost motor and sensory functions are not recovered. Several reasons may be attributed to the failure of recovery from chronic spinal cord injury. These include factors that inhibit axonal growth such as activated astrocytes, chondroitin sulfate proteoglycan, myelin-associated proteins, inflammatory microglia, and fibroblasts that accumulate at lesion sites. Skeletal muscle atrophy due to denervation is another chronic and detrimental spinal cord injury-specific condition. Although several intervention strategies based on multiple outlooks have been attempted for treating spinal cord injury, few approaches have been successful. To treat chronic spinal cord injury, neural cells or tissue substitutes may need to be supplied in the cavity area to enable possible axonal growth. Additionally, stimulating axonal growth activity by extrinsic factors is extremely important and essential for maintaining the remaining host neurons and transplanted neurons. This review focuses on pharmacotherapeutic approaches using small compounds and proteins to enable axonal growth in chronic spinal cord injury. This review presents some of these candidates that have shown promising outcomes in basic research ( in vivo animal studies) and clinical trials: AA-NgR(310)ecto-Fc (AXER-204), fasudil, phosphatase and tensin homolog protein antagonist peptide 4, chondroitinase ABC, intracellular sigma peptide, (-)-epigallocatechin gallate, matrine, acteoside, pyrvate kinase M2, diosgenin, granulocyte-colony stimulating factor, and fampridine-sustained release. Although the current situation suggests that drug-based therapies to recover function in chronic spinal cord injury are limited, potential candidates have been identified through basic research, and these candidates may be subjects of clinical studies in the future. Moreover, cocktail therapy comprising drugs with varied underlying mechanisms may be effective in treating the refractory status of chronic spinal cord injury.

Graphene oxide scaffolds promote functional improvements mediated by scaffold-invading axons in thoracic transected rats

Millions of patients and their caretakers live and deal with the devastating consequences of spinal cord injury (SCI) worldwide. Despite outstanding advances in the field to both understand and tackle these pathologies, a cure for SCI patients, with their peculiar characteristics, is still a mirage. One of the most promising therapeutic strategies to date for these patients involves the use of epidural electrical stimulation. In this context, electrically active materials such as graphene and its derivates become particularly interesting. Indeed, solid evidence of their capacity to closely interact with neural cells and networks is growing. Encouraged by previous findings in our laboratory on the exploration of 3D porous reduced graphene oxide (rGO) scaffolds in chronic cervical hemisected rats (C6), herein we report their neuro-reparative properties when chronically implanted in complete transected rats (T9-T10), in which no preserved contralateral neural networks can assist in any observed recovery. Electrophysiological recordings from brainstem regions show antidromic activation of a small population of neurons in response to electrical stimulation caudal to the injury. These neurons are located in the Gigantocellular nucleus of reticular formation and vestibular nuclei, both regions directly related to motor functions. Together with histological features at the lesion site, such as more abundant and larger blood vessels and more abundant, longer and more homogeneously distributed axons, our results corroborate that rGO scaffolds create a permissive environment that allows the invasion of functional axonic processes from neurons located in brainstem nuclei with motor function in a rat model of complete thoracic transection. Additionally, behavioral tests evidence that these scaffolds play an important role in whole-body mechanical stabilization (postural control) proved by the absence of scoliosis, a higher trunk stability and a larger cervico-thoraco-lumbar movement range in rGO-implanted rats.

From single to combinatorial therapies in spinal cord injuries for structural and functional restoration

Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychosocial implications for affected people, their families, and their communities; the financial costs can be challenging for their families and health institutions. Treatments aimed at restoring the spinal cord after spinal cord injury, which have been tested in animal models or clinical trials, generally seek to counteract one or more of the secondary mechanisms of injury to limit the extent of the initial damage. Most published works on structural/functional restoration in acute and chronic spinal cord injury stages use a single type of treatment: a drug or trophic factor, transplant of a cell type, and implantation of a biomaterial. Despite the significant benefits reported in animal models, when translating these successful therapeutic strategies to humans, the result in clinical trials has been considered of little relevance because the improvement, when present, is usually insufficient. Until now, most studies designed to promote neuroprotection or regeneration at different stages after spinal cord injury have used single treatments. Considering the occurrence of various secondary mechanisms of injury in the acute and sub-acute phases of spinal cord injury, it is reasonable to speculate that more than one therapeutic agent could be required to promote structural and functional restoration of the damaged spinal cord. Treatments that combine several therapeutic agents, targeting different mechanisms of injury, which, when used as a single therapy, have shown some benefits, allow us to assume that they will have synergistic beneficial effects. Thus, this narrative review article aims to summarize current trends in the use of strategies that combine therapeutic agents administered simultaneously or sequentially, seeking structural and functional restoration of the injured spinal cord.

Focusing on Formyl Peptide Receptors after Traumatic Spinal Cord Injury: from Immune Response to Neurogenesis

The intricate pathophysiological cascades following spinal cord injury (SCI), encompassing cellular demise, axonal degeneration, and the formation of glial scars, pose formidable barriers to neural regeneration and restoration. Notably, neuroinflammation and glial scars emerge as pivotal barrier to post-SCI repair. Formyl peptide receptors (FPRs) emerge as critical regulators of immune responses, exerting significant influence over inflammatory modulation and nerve regeneration subsequent to SCI. Beyond their classical expression in myeloid cells, FPRs demonstrate a pronounced presence within the central nervous system (CNS) with roles in the progression of neurodegenerative disorders and neurological malignancies. Post-SCI, the equilibrium of the inflammatory microenvironment is recalibrated through the strategic modulation of FPRs, including facilitating a balance in microglial polarization, stimulating neural stem cells (NSCs) migration, and promoting neural axon elongation. These observations enlighten the potential of FPRs as innovative targets for neuronal regenerations bolstering SCI repair. This review endeavors to delineate the distribution and function of FPRs in the aftermath of SCI, with a special attention to their roles in inflammatory regulation, NSCs mobilization, and synaptic growth. By elucidating these mechanisms, we aspire to contribute novel insights and strategies for SCI therapy.

Mapping Theme Trends and Recognizing Hot Spots in Acute Spinal Cord Injury: A Bibliometric Analysis

BACKGROUND

Acute spinal cord injury causes severe motor and sensory dysfunction, significantly burdening individuals and society. This study uses bibliometric analysis to identify research trends and key areas, providing insights for future advancements in treatment.

METHODS

Scientific publications on acute spinal cord injury were collected from PubMed and the Web of Science Core Collection between 2000 and 2022. Data were analyzed using Bibliometric, CiteSpace, and Bibliographic Item Co-occurrence Matrix Builder, with gCLUTO applied for co-word bicluster analysis based on MeSH term matrices.

RESULTS

Two thousand five hundred thirteen publications on acute spinal cord injury were published, with the number of articles increasing annually from 38 to 268. Spinal cord has emerged as the leading journal in this field, and the United States maintains its dominant position in global research impact. The University of Toronto ranks first among research institutions, with significant contributions from researchers such as Fehlings and Kwon. Research on acute spinal cord injury primarily focuses on 7 key areas: metabolism, pharmacology, surgical timing, rehabilitation, pathology, clinical predictors, and diagnostic imaging.

CONCLUSIONS

Our study reveals substantial growth in acute spinal cord injury research over the past 2 decades, emphasizing leading countries, researchers, institutions, and journals. Animal models remain pivotal in drug development for basic medicine and neuroscience. Consensus has been reached among experts regarding the timing of surgical intervention, while artificial intelligence and multidisciplinary approaches are emerging as promising avenues for comprehensive treatment. Additionally, ongoing research into spinal cord injury pathophysiology provides essential guidance for pharmacological and surgical treatments.

A biomimetic injectable chitosan/alginate hydrogel biocopmosites encapsulating selenium- folic acid nanoparticles for regeneration of spinal cord injury: An in vitro study

Spinal cord injury (SCI) poses significant challenges to regenerative medicine due to its limited self-repair capabilities. In this study, we engineered a biomimetic injectable hydrogel using modified chitosan and alginate biopolymers encapsulating selenium-folic acid nanoparticles (Se-FA NPs) to facilitate SCI regeneration. The hydrogel exhibited a unique porous structure attributed to the incorporation of nanofiber fragments, enhancing its biocompatibility and bioactivity. Through a series of in vitro evaluations, including cell viability assays, proliferation studies, gene expression analysis, we assessed the hydrogel's cytocompatibility and its potential for supporting neural cell growth. Our results demonstrate the promising efficacy of the hydrogel in providing a conducive microenvironment for neural tissue regeneration. Moreover, the sustained release of Se-FA NPs from the hydrogel system offers neuroprotective, antioxidative, and anti-inflammatory benefits crucial for SCI therapy. Overall, our biomimetic hydrogel biocomposites hold great potential as a therapeutic strategy for promoting spinal cord regeneration, highlighting their significance in advancing the field of regenerative medicine.

Schwann cell transplantation for remyelination, regeneration, tissue sparing, and functional recovery in spinal cord injury: A systematic review and meta-analysis of animal studies

INTRODUCTION

Spinal cord injury (SCI) is a significant global health challenge that results in profound physical and neurological impairments. Despite progress in medical care, the treatment options for SCI are still restricted and often focus on symptom management rather than promoting neural repair and functional recovery. This study focused on clarifying the impact of Schwann cell (SC) transplantation on the molecular, cellular, and functional basis of recovery in animal models of SCI.

MATERIAL AND METHODS

Relevant studies were identified by conducting searches across multiple databases, which included PubMed, Web of Science, Scopus, and ProQuest. The data were analyzed via comprehensive meta-analysis software. We assessed the risk of bias via the SYRCLE method.

RESULTS

The analysis included 59 studies, 48 of which provided quantitative data. The results revealed significant improvements in various outcome variables, including protein zero structures (SMD = 1.66, 95 %CI: 0.96-2.36; p < 0.001; I2 = 49.8 %), peripherally myelinated axons (SMD = 1.81, 95 %CI: 0.99-2.63; p < 0.001; I2 = 39.3 %), biotinylated dextran amine-labeled CST only rostral (SMD = 1.31, 95 % CI: 0.50-2.12, p < 0.01, I2 = 49.7 %), fast blue-labeled reticular formation (SMD = 0.96, 95 %CI: 0.43-1.49, p < 0.001, I2 = 0.0 %), 5-hydroxytryptamine caudally (SMD = 0.83, 95 %CI: 0.36-1.29, p < 0.001, I2 = 17.2 %) and epicenter (SMD = 0.85, 95 %CI: 0.17-1.53, p < 0.05, I2 = 62.7 %), tyrosine hydroxylase caudally (SMD = 1.86, 95 %CI: 1.14-2.59, p < 0.001, I2 = 0.0 %) and epicenter (SMD = 1.82, 95 %CI: 1.18-2.47, p < 0.001, I2 = 0.0 %), cavity volume (SMD = -2.07, 95 %CI: -2.90 - -1.24, p < 0.001, I2 = 67.2 %), and Basso, Beattie, and Bresnahan (SMD = 1.26, 95 %CI: 0.93-1.58; p < 0.001; I2 = 79.4 %).

CONCLUSIONS

This study demonstrates the promising potential of SC transplantation as a therapeutic approach for SCI, clarifying its impact on various biological processes critical for recovery.

Global, regional, and national burden of esophageal cancer using the 2019 global burden of disease study

Esophageal cancer, with its aggressive nature and high mortality, poses diverse epidemiological challenges worldwide. Over the past three decades, esophageal cancer has exhibited a substantial global burden, marked by a significant increase in absolute numbers, contrasting with a decline in age-standardized metrics. Prevalence nearly doubled, reaching 0.961 million in 2019, while the age-standardized rate (ASR) decreased to 11.6 per 100,000 cases. New incidence cases surged by 67.07%, yet the age-standardized incidence rate reduced to 6.5 per 100,000 cases. Deaths increased to 0.498 million, with a decline in age-standardized mortality to 6.1 per 100,000 cases. Disability-Adjusted Life Years (DALYs) rose to 11.67 million, but the ASR decreased to 139.8 per 100,000 cases. Gender-specific analysis revealed consistently higher rates in males, with increasing gaps over time. Correlations with SDI indicated a negative association, and frontier analysis underscored the impact of socio-economic progress on disease control. Projections suggest a continued rise in prevalence, incidence, deaths, and DALYs, with gender-specific variations. The research underscores the importance of continued efforts in public health and medical research to adapt to and manage the changing landscape of esophageal cancer globally.

TRIM32 promotes neuronal ferroptosis by enhancing K63-linked ubiquitination and subsequent p62-selective autophagic degradation of GPX4

Ferroptosis, characterized by iron-dependent phospholipid peroxidation, is recognized as one of the cell death pathways activated following spinal cord injury (SCI). However, the precise regulatory mechanisms governing this process remain poorly understood. Here, this study identified TRIM32, an E3 ubiquitin ligase, as a key enhancer of neuronal ferroptosis. TRIM32 promoted neuronal ferroptosis by accelerating the degradation of GPX4, which is an essential inhibitor of ferroptosis. Conditional deletion of Trim32 in neurons markedly inhibited neuronal ferroptosis and promoted neuronal survival, eventually improving mouse locomotor functional recovery after SCI. However, overexpression of Trim32 showed aggravated neuronal loss and poor behavioral function, which could be attenuated by ferroptosis inhibitor Liproxstatin-1. Mechanistically, TRIM32 interacted with GPX4, promoted K63-linked ubiquitination modification of GPX4 at K107, thus enhanced p62-dependent autophagic degradation of GPX4. Moreover, ROS-ATM-Chk2 signaling pathway phosphorylates TRIM32 at S55, further contributing to GPX4 ubiquitination and degradation and subsequent neuronal ferroptosis after SCI, suggesting a positive feedback loop between ROS and TRIM32. Clinically, lipid peroxidation was significantly promoted in patients with SCI. These findings reveal that TRIM32 functions as a neuronal ferroptosis enhancer which is detrimental to neuronal survival and locomotor functional recovery in mice after SCI by promoting K63-linked ubiquitination and subsequent p62-dependent autophagic degradation of GPX4, suggesting a promising therapeutic target for SCI.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Spinal Cord Injury: Current Status and Perspective

Spinal cord injury (SCI) can lead to devastating dysfunctions and complications, significantly impacting patients' quality of life and aggravating the burden of disease. Since the main pathological mechanism of SCI is the disruption of neuronal circuits, the primary therapeutic strategy for SCI involves reconstructing and activating circuits to restore neural signal transmission. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique, can modulate the function or state of the nervous system by pulsed magnetic fields. Here, we discuss the basic principles and potential mechanisms of rTMS for treating SCI, including promoting the reconstruction of damaged circuits in the spinal cord, activating reorganization of the cerebral cortex and circuits, modulating the balance of inputs to motoneurons, improving the microenvironment and intrinsic regeneration ability in SCI. Based on these mechanisms, we provide an overview of the therapeutic effects of rTMS in SCI patients with motor dysfunction, spasticity and neuropathic pain. We also discuss the challenges and prospectives of rTMS, especially the potential of combination therapy of rTMS and neural progenitor cell transplantation, and the synergistic effects on promoting regeneration, relay formation and functional connectivity. This review is expected to offer a relatively comprehensive understanding and new perspectives of rTMS for SCI treatment.

Punicalagin inhibits neuron ferroptosis and secondary neuroinflammation to promote spinal cord injury recovery

Spinal cord injury (SCI) represents a severe type of central nervous system damage, with no effective treatment currently available, partly due to neuronal ferroptosis and subsequent neuroinflammation. Punicalagin, an anti-inflammatory compound extracted from pomegranate peel, has exhibited therapeutic potential for inflammatory diseases. In this study, we present evidence that punicalagin facilitates the recovery of neurological function following SCI by mitigating neuronal ferroptosis. Mechanistically, this effect involves the upregulation of nuclear factor E2-related factor 2 (Nrf2) and the activation of the Nrf2- Solute Carrier Family 7 Member 11 (SLC7A11)- Glutathione Peroxidase 4 (GPX4) signaling pathway. Furthermore, punicalagin aids in the resolution of secondary neuroinflammation by modulating the M1/M2 polarization of microglia, thereby promoting SCI recovery. Collectively, these findings suggest that punicalagin enhances functional recovery after SCI by inhibiting neuronal ferroptosis and reducing microglial M1 polarization. Consequently, punicalagin may represent a promising therapeutic agent for the treatment of spinal cord injury.

Clonally expanded, targetable, natural killer-like NKG7 T cells seed the aged spinal cord to disrupt myeloid-dependent wound healing

Spinal cord injury (SCI) increasingly affects aged individuals, where functional impairment and mortality are highest. However, the aging-dependent mechanisms underpinning tissue damage remain elusive. Here, we find that natural killer-like T (NKLT) cells seed the intact aged human and murine spinal cord and multiply further after injury. NKLT cells accumulate in the spinal cord via C-X-C motif chemokine receptor 6 and ligand 16 signaling to clonally expand by engaging with major histocompatibility complex (MHC)-I-expressing myeloid cells. NKLT cells expressing natural killer cell granule protein 7 (Nkg7) disrupt myeloid-cell-dependent wound healing in the aged injured cord. Nkg7 deletion in mice curbs NKLT cell degranulation to normalize the myeloid cell phenotype, thus promoting tissue repair and axonal integrity. Monoclonal antibodies neutralizing CD8+ T cells after SCI enhance neurological recovery by promoting wound healing. Our results unveil a reversible role for NKG7+CD8+ NKLT cells in exacerbating tissue damage, suggesting a clinically relevant treatment for SCI.

The trunk segmental motion complexity and balance performance in challenging seated perturbation among individuals with spinal cord injury

BACKGROUND

Motion complexity is necessary for adapting to external changes, but little is known about trunk motion complexity during seated perturbation in individuals with spinal cord injury (SCI). We aimed to investigate changes following SCI in trunk segmental motion complexity across different perturbation directions and how they affect postural control ability in individuals with SCI.

METHODS

A total of 17 individuals with SCI and 18 healthy controls participated in challenging sagittal-seated perturbations with hand protection. Upper arm activation was measured using surface electromyography for trial consistency. Motion complexity parameters, quantified across three degrees of freedom, was assessed using relative angular acceleration from six trunk segments obtained through motion capturing system. Motion performance parameters were assessed using center of pressure (CoP) measurements from a force plate, including settling time, maximum CoP displacement (MD) variability, and steady-state error. Statistical analyses examined group and direction differences, while complexity-performance relationships were evaluated using multiple response least partial squares regression.

RESULTS

Compared to healthy controls, individuals with SCI showed significantly lower motion complexity in the lumbar and upper thoracic segments (approximately10% - 20%), with identical settling time and higher MD variability. Backward perturbations, as opposed to forward perturbations, resulted in reduced complexity in the aforementioned segments and increased steady-state error. Lower lumbar rotation complexity negatively correlated with MD variability (β = -0.240) and steady-state error (β = -0.485) in individuals with SCI, while showing a minor positive correlation with settling time (β = 0.152) during backward perturbation.

CONCLUSION

Simplified motion control in individuals with SCI may arise from uncoordinated lumbar and overactive thoracic neuromuscular control, compromising stability despite maintaining speed. Increasing lumbar motion complexity could enhance postural stability and accuracy during backward perturbation, representing a potential target for developing seated balance rehabilitation strategies and promoting more adaptive trunk control.

Revisiting the unobtrusive role of exogenous stem cells beyond neural circuits replacement in spinal cord injury repair

Rationale: Stem cell transplantation is a promising strategy to establish neural relays in situ for spinal cord injury (SCI) repair. Recent research has reported short-term survival of exogenous cells, irrespective of immunosuppressive drugs (ISD), results in similar function recovery, though the mechanisms remain unclear. This study aims to validate this short-term repair effect and the potential mechanisms in large animals. Methods: In this study, human spinal cord neural progenitor cells (hscNPCs) and human umbilical cord mesenchymal stem cells (hUMSCs) were transplanted into two different SCI model without ISD, respectively; Immunofluorescence was utilized to visualize neuronal regeneration and angiogenesis in the lesion site. Motor evoked potentials (MEPs) were detected to assess the integrity of motor pathways. And RNA sequencing was used to observe transcriptomic changes at the edge of the lesion. Results: The findings revealed hscNPCs failed to survive long-term, but the dogs exhibited better motor function recovery. Moreover, hscNPCs remodeled the injury microenvironment shortly after transplantation by reducing inflammation and enhancing angiogenesis, leading to increased endogenous neuronal regeneration. Similarly, hUMSCs neither survive long-term nor directly reconstruct neural circuits. However, basal functional recovery and endogenous neuronal regeneration were also detected in monkeys with hUMSCs. Conclusions: Exogenous short-term transplantation of stem cells in large animal SCI models does not restore basal function by directly replacing neural circuits throughout the lesion site. Rather, it does so by remodeling the lesion microenvironment in the early stages of transplantation to promote endogenous neural regeneration.

Global, regional, and national burden of spinal cord injury from 1990 to 2021 and projections for 2050: A systematic analysis for the Global Burden of Disease 2021 study

OBJECTIVES

Spinal cord injury (SCI) leads to significant functional impairments and mortality, yet outdated epidemiological data hinder effective public health policies. This study utilizes the latest data from the Global Burden of Disease Study 2021 (GBD 2021) to analyze SCI trends and inform prevention strategies.

METHODS

Using GBD 2021 data, we examined age-standardized incidence, prevalence, and years lived with disability (YLDs) of SCI, along with trends, driving factors, age-sex-time patterns, and projections up to 2050.

RESULTS

In 2021, the burden of SCI, including incidence, prevalence, and YLDs, increased with age. However, both prevalence and YLDs exhibited a slight decline after peaking at age 70, with similar trends observed in both males and females. From 1990-2021, the global burden of SCI showed a gradual decline across all populations, including males and females, and it is projected to decrease further by 2050. Nevertheless, significant disparities in disease burden exist between different countries and regions; high-SDI areas experienced a gradual decline after reaching a peak, while low-SDI areas saw a gradual increase from low levels. The primary drivers of this change include population growth and aging, although epidemiological shifts have somewhat alleviated the burden of SCI. The research also indicates that males and older adults, particularly those aged 70 and above, bear the most severe burden of SCI, with falls, road injuries, and interpersonal violence being the leading causes of this condition.

CONCLUSIONS

While the global burden of SCI is decreasing, the complex distribution across demographics and regions necessitates targeted prevention and treatment strategies to further reduce the burden and improve patient outcomes.

Evaluation of prehospital care for neurotrauma in Iran

STUDY DESIGN

Narrative review.

BACKGROUND

Neurotrauma has a considerable impact on healthcare, the economy, and human resources worldwide. In Iran, young males are especially vulnerable, with road traffic accidents (RTAs) being the major cause. Evaluating prehospital care systems is critical for detecting shortcomings and implementing improvements. This study seeks to evaluate the prehospital neurotrauma care procedure in Iran, highlighting its strengths and flaws.

METHOD

We searched PubMed and Scopus databases for literature on the present condition of prehospital neurotrauma care in Iran. Consultations with an expert panel yielded additional material not previously available in the literature, particularly on Iran's emergency medical system.

RESULTS

Our findings indicate that the emergency dispatch system in Iran is relatively well-managed, regardless of the lack of a single emergency contact number. However, major obstacles still exist, particularly in terms of human resources, training, and equipment availability. Emergency medical technicians (EMTs) have intermediate to poor levels of knowledge and skills in dealing with neurotrauma, which might be considerably improved by ongoing training programs. Furthermore, Iranian hospitals lack specific trauma center designations and levels, resulting in overcrowded emergency rooms and delayed care delivery. National neurotrauma guidelines have been adopted in recent years, although their compliance is not consistently monitored.

CONCLUSION

Compared to developed healthcare systems, Iran's prehospital treatment system for individuals with neurotrauma has considerable limitations. Improving EMT education, recruiting more trained professionals, and simultaneous improvement of current medical facilities should be addressed as the first steps toward better care.

Public Awareness Levels Regarding Cervical Spine Injury and the Suitable First Aid Response Among Adults in Makkah, Saudi Arabia

Purpose

Cervical spine injuries (CSIs) are a growing concern, leading to severe and permanent disabilities. Educating the public about these injuries and appropriate emergency responses is crucial to prevent irreversible damage, minimize disability, and save lives, especially with the rising number of trauma victims worldwide. Herein, we assessed the awareness of CSIs, trauma identification, and first-aid procedures among adults in Makkah, Saudi Arabia.

Sample and Methods

This descriptive cross-sectional study included 591 participants aged 18 or older from Makkah, Saudi Arabia, selected using an online questionnaire and conducted between January and March 2024. We evaluated participants' knowledge and awareness levels about CSIs, analyzing variables such as personal data and first aid training using descriptive statistics, cross-tabulation, and Pearson chi-square tests.

Results

In total, 318 (53.8%) participants demonstrated good awareness of CSIs. Most (76.5%) identified road traffic accidents as a significant risk factor for CSIs. Additionally, 476 (80.5%) participants recognized that CSIs can involve spinal cord damage. Motor disability was acknowledged by 434 (73.9%) participants as a complication linked to CSIs, while 296 (50.1%) and 224 (37.9%) participants recognized sensory disability and respiratory problems as potential associated complications, respectively.

Conclusion

Our findings show that 53.8% of participants had an acceptable awareness level of CSIs, with road traffic accidents identified as the primary cause of spinal injuries. It is crucial to prioritize regular and organized public education and enforce strict road safety measures, particularly among the young, to mitigate the extensive physical, social, emotional, and economic consequences of this issue.

Dynamic changes in pyroptosis following spinal cord injury and the identification of crucial molecular signatures through machine learning and single-cell sequencing

The pathological cascade of spinal cord injury (SCI) is highly intricate. The onset of neuroinflammation can exacerbate the extent of damage. Pyroptosis is a form of inflammation-linked programmed cell death (PCD), the inhibition of pyroptosis can partially mitigate neuroinflammation. It is imperative to delineate the principal cell types susceptible to pyroptosis and concomitantly identify key genes associated with this process. We initially defined the pyroptosis-related genes (PRGs) and analyzed their expression at different time points post SCI. The results demonstrate a substantial upregulation of differentially expressed genes (DEGs) related to pyroptosis on the 7 days post-injury (dpi), these DEGs in the 7 dpi are closely related to the inflammatory response. Subsequently, immune infiltration analysis revealed a predominant presence of inflammatory microglia. Through correlation analysis, we postulated that pyroptosis primarily manifested within the inflammatory microglia. Employing machine learning algorithms, we identified four pyroptosis-related molecular signatures, which were experimentally validated using BV2 cells and spinal cord tissue samples. The robustness of the identified molecular signatures was further confirmed through single-cell sequencing data analysis. Overall, our study elucidates the temporal dynamics of pyroptosis and identifies key molecular signatures following SCI. These findings can provide novel evidence for therapeutic interventions in SCI.

Neurostimulation on lumbosacral nerves as a new treatment for spinal cord injury impairments and its impact on cortical activity: a narrative review

Spinal cord injury (SCI) can cause significant motor, sensory, and autonomic dysfunction by disrupting neural connections. As a result, it is a global health challenge that requires innovative interventions to improve outcomes. This review assesses the wide-ranging impacts of SCI and focuses on the laparoscopic implantation of neuroprosthesis (LION) as an emerging and promising rehabilitation technique. The LION technique involves the surgical implantation of electrodes on lumbosacral nerves to stimulate paralyzed muscles. Recent findings have demonstrated significant improvements in mobility, sexual function, and bladder/bowel control in chronic SCI patients following LION therapy. This manuscript revisits the potential physiological mechanisms underlying these results, including neuroplasticity and modulation of autonomic activity. Additionally, we discuss potential future applications and amendments of LION therapy. This study emphasizes the potential of neuromodulation as a complementary approach to traditional rehabilitation, that can provide a beacon of hope for improving functionality and quality of life for individuals with SCI.

Lentiviral Injection of Inter-α-Trypsin Inhibitor Heavy Chain 4 Promotes Female Spinal Cord Injury Mice Recuperation by Diminishing Peripheral and Central Inflammation

Inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4) acts as a mediator of inflammation and extracellular matrix stabilization. The current study intended to delve into the impact of ITIH4 on locomotor performance, nerve injury, neuroinflammation, systemic inflammation, and the downstream pathway in spinal cord injury (SCI) mice. Overexpression lentivirus of ITIH4 (LV-ITIH4) and negative control lentivirus (LV-NC) were intravenously injected into adult C57BL/6 mice on 7 days before SCI surgery. All mice were euthanized on day 28 after SCI surgery, and their blood samples and spinal cord tissues were collected. Decreased relative gene expression and protein levels of ITIH4 were observed in SCI mice. LV-ITIH4 improved the locomotor performance compared to LV-NC in SCI mice. In spinal cord of SCI mice, LV-ITIH4 reduced apoptosis and increased survival of neurons compared to LV-NC. By comparison with LV-NC, LV-ITIH4 also reduced relative gene expressions of interleukin (IL)-6 and tumor necrosis factor-α in spinal cord of SCI mice. Moreover, LV-ITIH4 reduced microglia M1 polarization compared with LV-NC in spinal cord of SCI mice. In the serum, LV-ITIH4 decreased the protein levels of IL-6 and IL-1β compared to LV-NC in SCI mice. LV-ITIH4 also inhibited the nuclear factor kappa-B (NF-κB) pathway compared to LV-NC in spinal cord of SCI mice. ITIH4 enhances locomotor performance in SCI mice, and it inhibits nerve injury, neuroinflammation, systemic inflammation, and the NF-κB pathway in SCI mice.

Basilar invagination and atlantoaxial dislocation as a complication of severe dystrophic cervical kyphosis correction in neurofibromatosis type 1: Report of a rare case and review of literature

INTRODUCTION AND IMPORTANCE

Neurofibromatosis type 1 (NF1) affects the musculoskeletal system as well as the cervical spine. It is associated with severe, progressive cervical kyphosis. Surgical intervention is the treatment of choice to avoid neurological impairment and malalignment.

CASE PRESENTATION

We herein report an 11-year-old NF-1 patient with severe cervical kyphosis and intact neurological status. We applied five days of cervical traction followed by surgery utilizing the combined cervical approach (posterior release, anterior corpectomy and reconstruction, and posterior cervicothoracic instrumentation). In one-year follow-up, atlantoaxial dislocation (AAD) and basilar invagination (BI) were detected in neuroimagings. The complication was corrected by adding C1 to the previous construct via unilateral C1 lateral mass screw, contralateral C1 sublaminar hook, unilateral C3 and contralateral C4 sublaminar hook insertion, fixed with contoured rods medial to previous rods. This led to the correction of the AAD and the BI and the patients remained neurologically intact.

CLINICAL DISCUSSION

Severe cervical kyphosis in the setting of NF-1 is progressive and carries a considerable risk of neurologic compromise. Surgical intervention is thus necessary.

CONCLUSION

The combined approach with complete spinal column reconstruction is the surgical approach of choice. However, complete curve correction to near-normal lordosis carries the risk of proximal junctional failure (PJF).

Mirtazapine Improves Locomotor Activity and Attenuates Neuropathic Pain Following Spinal Cord Injury in Rats via Neuroinflammation Modulation

Neuroinflammation-related locomotor deficits and neuropathic pain are expected outcomes of spinal cord injury (SCI). The atypical antidepressant mirtazapine has exhibited potential neuroprotective and anti-inflammatory effects. This research aims to investigate the impacts of mirtazapine on post-SCI neuropathic pain and locomotor recovery, with a particular focus on neuroinflammation. The study utilized 30 male Wistar rats divided into five groups: Sham, SCI with vehicle treatment, and SCI administered with mirtazapine (3, 10, and 30 mg/kg/day, ip, for one week). Locomotor activity was assessed using the Basso, Beattie, and Bresnahan (BBB) scale. Mechanical, thermal, and cold allodynia were assessed using von-Frey filaments, tail flick latency, and the acetone test, respectively. ELISA was utilized to measure cytokines, while Western blotting was used to determine TRPV1 channel, 5-HT2A receptor, NLRP3, and iNOS expression. Histopathological analyses were also examined, including hematoxylin and eosin (H&E) and Luxol fast blue (LFB) staining. Mirtazapine (10 and 30 mg/kg/day) significantly improved locomotor recovery according to BBB score. It attenuated mechanical, thermal, and cold allodynia post-SCI. Moreover, it decreased pro-inflammatory cytokines TNF-α, IL-1β, IL-6, and IL-18, while increasing anti-inflammatory cytokine IL-4 and IL-10. Furthermore, it downregulated iNOS, NLRP3, and TRPV1 expression and upregulated the 5-HT2A receptor. H&E and LFB staining further revealed attenuated tissue damage and decreased demyelination. Our findings suggest that mirtazapine can alleviate neuropathic pain and reinforce locomotor recovery post-SCI by modulating neuroinflammatory responses, NLRP3, iNOS, TRPV1 channel, and 5-HT2A receptor expression.

Metal Ruthenium Complexes Treat Spinal Cord Injury By Alleviating Oxidative Stress Through Interaction With Antioxidant 1 Copper Chaperone Protein

Oxidative stress is a major factor affecting spinal cord injury (SCI) prognosis. A ruthenium metal complex can aid in treating SCI by scavenging reactive oxygen species via a protein-regulated mechanism to alleviate oxidative stress. This study aimed to introduce a pioneering strategy for SCI treatment by designing two novel half-sandwich ruthenium (II) complexes containing diverse N^N-chelating ligands. The general formula is [(η6-Arene)Ru(N^N)Cl]PF6, where arene is either 2-phenylethanol-1-ol (bz-EA) or 3-phenylpropanol-1-ol (bz-PA), and the N^N-chelating ligands are fluorine-based imino-pyridyl ligands. This study shows that these ruthenium metal complexes protect neurons by scavenging reactive oxygen species. Notably, η6-Arene substitution from bz-PA to bz-EA significantly enhances reactive oxygen species scavenging ability and neuroprotective effect. Additionally, molecular dynamics simulations indicate that the ruthenium metal complex increases Antioxidant 1 Copper Chaperone protein expression, reduces oxidative stress, and protects neurons during SCI treatment. Furthermore, ruthenium metal complex protected spinal cord neurons and stimulated their regeneration, which improves electrical signals and motor functions in mice with SCI. Thus, this treatment strategy using ruthenium metal complexes can be a new therapeutic approach for the efficient treatment of SCI.

Stabbing injury of the spinal cord: A case report and systematic literature review

BACKGROUND

Spinal cord injury caused by stab wounds (SCISW) represents one of the rarest causes of traumatic spinal cord injury. Because of their rarity, management of such cases may be challenging due to the lack of specific guidelines.

METHODS

The systematic review was performed on 30th June 2024 according to the PRISMA 2020 guidelines. A literature search was conducted across four databases: PubMed, Scopus, Web of Science, and The Polish Medical Bibliography. Additionally, a unique case was presented as an illustrative clinical presentation.

RESULTS

A total of 89 eligible articles, including 78 case reports (89 patients) and 11 case series (882 patients), were found. The current report describes a case of a 41-year-old man with one neck stab wound and a stab wound of the chest. Clinical examination demonstrated complete paraplegia and a lack of sensation below the level of T1. Magnetic resonance imaging (MRI) showed a complete transection of the spinal cord at the T1-T2 level. Due to the lack of foreign bodies at the injury site, the patient was managed conservatively.

CONCLUSION

Direct stabbing injuries rarely lead to complete transection of the spinal cord as in our case. Computed tomography (CT) scans or plain radiographs are necessary to exclude retained foreign bodies. MRI as a further imaging tool can confirm the SCI and may be useful as a predictor of outcomes. Regarding optimal management, conservative treatment should be preferred over surgical intervention in the absence of a foreign body at the injury site.

Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: a systematic analysis for the GBD 2021

BACKGROUND

Cancer is the second most common cause of death globally. Therefore, it is imperative to investigate cancer incidence, mortality rates, and disability-adjusted life years (DALYs) to enhance preventive measures and healthcare resource allocation. This study aimed to assess cancer burden and associated risk factors in 204 countries and territories between 1980 and 2021.

METHODS

We selected data on cancer incidence and mortality rates and associated risk factors from the global burden of disease (GBD) study tool for 204 countries and territories from 1990 to 2021 and 1980 to 2021. We estimated the age-standardized incidence (ASIR) and age-standardized deaths (ASDR) of 34 cancer types categorized as level 3 causes based on the GBD hierarchy.

RESULTS

In 2021, cancer accounted for 14.57% (95% uncertainty interval: 13.65-15.28) of total deaths and 8.8% (7.99-9.67) of total DALYs in both sexes globally. ASIR and ASDR were 790.33 (694.43-893.01) and 116.49 (107.28-124.69), respectively. Additionally, females exhibited higher ASIR than males (923.44 versus 673.09), while males exhibited higher ASDR than females (145.69 versus 93.60). This indicates that policymakers should focus on the importance of gender equality in healthcare. Non-melanoma skin cancer exhibited the highest ASIR (74.10) in both sexes, while digestive cancers accounted for 39.29% of all cancer-related deaths, and Asia exhibited the heaviest cancer burden. In females, breast cancer exhibited the highest ASIR (46.40) and ASDR (14.55). In males, tracheal, bronchial, and lung cancer exhibited the highest ASIR (37.85) and ASDR (34.32), highlighting the urgent need for targeted tobacco control measures. Different cancers in various countries exhibit unique characteristics. Therefore, policymakers should formulate specific prevention and control strategies that reflect the cancer in their country. Tobacco was the primary level 2 risk factor for cancer DALYs in males. It accounted for 29.32% (25.32-33.14) of all cancer DALYs. Dietary risks, alcohol consumption, and air pollution accounted for 5.89% (2.01-10.73), 5.48% (4.83-6.11), and 4.30% (2.77-5.95) of male cancer DALYs, respectively. Therefore, policymakers should prioritize smoking regulation and other carcinogenic risks.

CONCLUSION

Cancer is a significant public health concern globally. Understanding the common etiologies of different cancers is essential for developing effective control strategies and targeted interventions.

The acute phase management of traumatic spinal cord injury (tSCI) with polytrauma: A narrative review

Introduction

Traumatic spinal cord injury (tSCI) is frequently observed in polytrauma patients.

Research question

What is the optimal strategy to manage tSCI in the setting of polytrauma?

Material and methods

This narrative review focuses on: 1) extraspinal damage control surgery and resuscitation, 2) the perioperative protection of the injured spine during emergency surgery, 3) imaging and timing of spinal surgery in polytrauma, 4) early interventions for skin, bowel and bladder, and 5) the multidisciplinary approach to tSCI polytrauma patients.

Results

Damage control resuscitation (DCR) and damage control surgery (DCS), aim to prevent/correct post-traumatic physiological derangements to minimize bleeding until definitive hemostasis is achieved. Spinal protection during emergency surgery is of paramount importance to reduce secondary insults to the injured spine. Imaging, especially magnetic resonance imaging (MRI), is useful for decision-making regarding surgical management of the injured spine. Early decompressive surgery (within 24 h from trauma) is associated with better neurological outcomes. Early consultation with a physical medicine and rehabilitation physician is beneficial to optimize recovery. A close collaboration between different medical specialties involved in the early management of tSCI patients with polytrauma is advisable to improve outcome.

Discussion and conclusion

This narrative review aims to collate basic knowledge regarding acute phase management of tSCI patients in the context of polytrauma. More evidence and data form well-powered studies are necessary in this setting.

Electrical stimulation and conductive materials: electrophysiology-based treatment for spinal cord injury

Spinal cord injury is a serious disease of the central nervous system. The electrophysiological properties of the spinal cord that are essential to maintaining neurotransmission can be impaired after the injury. Therefore, electrophysiological evaluation is becoming an important indicator of the injury extent or the therapeutic outcomes by reflecting the potential propagation of neural pathways. On the other hand, the repair of damaged nerves is one of the main goals of spinal cord injury treatment. Growing research interest has been concentrated on developing effective therapeutic solutions to restore the normal electrophysiological function of the injured spinal cord by using conductive materials and/or exerting the merits of electrical stimulation. Accordingly, this review introduces the current common electrophysiological evaluation in spinal cord injury. Then the cutting-edge therapeutic strategies aiming at electrophysiological improvement in spinal cord injury are summarized. Finally, the challenges and future prospects of neural restoration after spinal cord injury are presented.

Enabling Technologies in the Management of Cervical Spine Trauma

STUDY DESIGN

Narrative review.

OBJECTIVE

The objective of this study is to explore and evaluate the role of novel technologies in enhancing the diagnosis, surgical precision, and rehabilitation of cervical spine trauma, and to discuss their potential impact on clinical outcomes.

SUMMARY OF BACKGROUND DATA

Traumatic cervical spine injuries are challenging to manage due to their complex anatomy, the potential for long-term disability, and severe neurological deficits. Traditional management approaches are being supplemented by emerging technologies that promise to improve patient care and outcomes.

METHODS

A literature review was conducted to identify and analyze advancements in imaging, navigation, robotics, and wearable technologies in the context of cervical spine trauma. The review focuses on the potential of these technologies to improve early detection, surgical accuracy, and postoperative recovery.

RESULTS

Technological innovations, including advanced imaging techniques, machine learning for diagnostics, augmented reality, and robotic-assisted surgery, are transforming the management of cervical spine trauma. These tools contribute to more efficient, accurate, and personalized treatment approaches, potentially improving clinical outcomes and reducing patient care burdens.

CONCLUSIONS

Although these technologies hold great promise, challenges such as implementation costs and the need for specialized training must be addressed. With continued research and interdisciplinary collaboration, these advancements can significantly enhance the management of cervical spine trauma, improving patient recovery and quality of life.

LEVEL OF EVIDENCE

Level V.

Global, regional, and national burden of bladder cancer, 1990-2019: an age-period-cohort analysis based on the Global Burden of Disease 2019 study

OBJECTIVES

Bladder cancer is a common malignancy worldwide, with substantial morbidity and mortality. This study aimed to assess the global, regional, and national burden of bladder cancer from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study and to analyze the trends using an age-period-cohort (APC) model.

STUDY DESIGN

In this cross-sectional study, secondary analyses were conducted to assess the burden of bladder cancer using data from GBD 2019.

METHODS

Bladder cancer prevalence, incidence, mortality, disability-adjusted life years (DALYs), and their age-standardized rates (ASRs) were obtained from the GBD 2019 study. The estimated annual percentage changes (EAPCs) were calculated to quantify the trends in ASRs. An APC analysis was performed to distinguish the effects of age, period, and cohort on the observed temporal trends.

RESULTS

The global prevalence of bladder cancer increased substantially from 1990 to 2019, reaching 2,869,046.4 cases (95% UI: 2,614,200.3-3,114,474.4) in 2019. The age-standardized prevalence rate rose from 20.9 per 100,000 population in 1990 to 37.1 per 100,000 population in 2019, with an EAPC of 1.97 (95% CI: 1.93-2.01). The global burden of bladder cancer, as measured by DALYs, increased from 48.0 per 100,000 population in 1990 to 56.8 per 100,000 population in 2019, with an EAPC of 0.47 (95% CI: 0.4-0.53), demonstrating the growing impact of this disease on population health.

CONCLUSIONS

This study demonstrates a significant increase in prevalence, incidence, mortality, and DALYs, with substantial variations across sociodemographic index (SDI) quintiles and GBD regions. The findings emphasize the need for concerted efforts at the global, regional, and national levels to reduce the burden of bladder cancer through primary prevention, early detection, and improved access to treatment services.

Spinal cord injury and risk of overall and type specific cardiovascular diseases: A meta-analysis

BACKGROUND

Cardiovascular disease (CVD) is a growing concern among people with spinal cord injury (SCI). This meta-analysis aims to explore the risk of overall CVD and specific types of cardiovascular events among SCI patients.

METHODS

This meta-analysis is registered on PROSPERO (CRD CRD42024537888). The data sources comprised PubMed, Embase, the Cochrane Library, and reference lists of the included studies. The literature collection span is from database establishment until April 17, 2024. This meta-analysis encompassed observational studies investigating the association between SCI and the risk of overall types of CVD or specific CVD types. Risk of bias was evaluated utilizing the Newcastle-Ottawa Quality Assessment Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) Scale. Odds ratios (ORs) with 95% confidence intervals (CIs) were aggregated using a random-effects model.

RESULTS

Our initial search generated 5357 relevant records form these international databases. This meta-analysis encompassed 9 observational studies involving 2,282,691 individuals, comprising 193,045 patients with SCI and 2,209,646 controls. We observed a 1.56-fold [OR = 1.56, 95% CI (1.43, 1.70), I2 = 91.3%, P < 0.001] rise in the risk of overall types of CVD among SCI patients, with a 1.82-fold increase in males and a 1.76-fold increase in females. SCI patients without comorbidities exhibited a 2.10-fold elevated risk of overall CVD types, while those with comorbidities had a 1.48-fold increased risk. Concerning specific CVD types, SCI patients showed a 1.58-fold [OR = 1.57, 95% CI (1.22, 2.03), I2 = 92.4%] higher risk of myocardial infarction, a 1.52-fold [OR = 1.52, 95% CI (1.07, 2.16), I2 = 88.7%] increase in atrial fibrillation, a 1.64-fold [OR = 1.64, 95% CI (1.22, 2.20), I2 = 95.5%] elevation in heart failure risk, and 2.38-fold [OR = 2.38, 95% CI (1.29, 4.40), I2 = 92.5%] increments in stroke risk. But there was no statistically significant difference in the risk of hypertension [OR = 1.54, 95% CI (0.98, 2.42), I2 = 96.6%].

CONCLUSIONS

The risk of overall CVD in SCI patients surpassed that of the non-SCI control group, with elevated risks of specific cardiovascular events like myocardial infarction, atrial fibrillation, heart failure, and stroke. Clinicians should prioritize awareness of CVD risks in SCI patients.

Meaning of Work Participation After Spinal Cord Injury in Bangladesh: A Qualitative Study in a Low- and Middle-Income Country Context

PURPOSE

This study aimed to explore the meaning of work participation for people with spinal cord injury (SCI) in Bangladesh.

METHODS

Narrative inquiry methodological framework was used to explore the meaning of work participation after SCI. Face-to-face interviews with twenty adults with SCI, who were either living in the community or in-patients at a rehabilitation center. The Worker Role Interview questionnaire was used as an interview guide. Participants were descriptively analyzed in two groups, rehabilitation participants and community participants. Their transcripts were analyzed using individual narrative analysis to understand the meaning of their experience at an individual level and then the findings from the individual narrative analyses were summarized using thematic analysis to identify themes that collectively represented the meaning of work after SCI in Bangladesh.

RESULT

Five themes were identified from the interviews: "work life before injury"; "current life in relation to work"; "framing future prospects of work participation"; "motives for working"; and "enablers of work participation."

CONCLUSION

The meaning of work is subjective and is influenced by the participants' pre-existing experiences and other factors related to their work life, such as work preferences, habits, and daily routines. Therefore, creating opportunities to better understand the meaning of work for each individual and incorporating these factors into rehabilitation are keys to sustainable rehabilitation outcomes.

Feasibility and safety of two weeks of blood flow restriction exercise in individuals with spinal cord injury

CONTEXT

Reduced muscle strength and function are common after spinal cord injury (SCI). While low-load blood flow restriction exercise (BFRE) enhances muscle strength in healthy and clinical populations, its safety and feasibility in individuals with SCI remain underexplored.

OBJECTIVES

To investigate the feasibility and safety of low-load BFRE in individuals with incomplete SCI.

STUDY DESIGN

Case series.

SETTING

SCI rehabilitation center.

PARTICIPANTS

Six participants with motor incomplete SCI were enrolled in the study.

INTERVENTION

A two-week BFRE intervention for the lower limbs was conducted twice weekly at 40% total arterial occlusion pressure, using 30-40% of 1-repetition maximum loads.

OUTCOME MEASURES

Feasibility measures, specifically recruitment and eligibility rates and intervention acceptability, were collected. Blood pressure (BP) responses and specific coagulation markers for deep vein thrombosis (DVT) were assessed as safety measures.

RESULTS

Recruitment and eligibility rates were 2.8% and 6.6% for individuals admitted for first-time rehabilitation (subacute SCI) and 8.3% and 13.9% for 4-week readmission rehabilitation stays (chronic SCI), respectively. Intervention acceptability was high, characterized by 95.8% training adherence and low-to-moderate self-reported pain levels. BP responses and changes in C-reactive protein, Fibrinogen, and D-dimer during the intervention remained within clinically acceptable levels.

CONCLUSION

BFRE was feasible in an SCI rehabilitation setting despite a low recruitment rate. BFRE imposed no heightened risk of DVT or severe BP fluctuations in the present case series. Additionally, no severe adverse events occurred, and only mild complaints were reported. More extensive safety considerations warrant larger-scale exploration.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03690700.

AMPA receptors play an important role in the biological consequences of spinal cord injury: Implications for AMPA receptor modulators for therapeutic benefit

Spinal cord injury (SCI) afflicts millions of individuals globally. There are few therapies available to patients. Ascending and descending excitatory glutamatergic neural circuits in the central nervous system are disrupted by SCI, making α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) a potential therapeutic drug target. Emerging research in preclinical models highlights the involvement of AMPARs in vital processes following SCI including breathing, pain, inflammation, bladder control, and motor function. However, there are no clinical trial data reported in this patient population to date. No work on the role of AMPA receptors in sexual dysfunction after SCI has been disclosed. Compounds with selective antagonist and potentiating effects on AMPA receptors have benefit in animal models of SCI, with antagonists generally showing protective effects early after injury and potentiators (ampakines) producing improved breathing and bladder function. The role of AMPARs in pathophysiology and recovery after SCI depends upon the time post injury, and the timing of AMPAR augmentation or antagonism. The roles of inflammation, synaptic plasticity, sensitization, neurotrophic factors, and neuroprotection are considered in this context. The data summarized and discussed in this paper document proof of principle and strongly encourage additional studies on AMPARs as novel gateways to therapeutic benefit for patients suffering from SCI. The availability of both AMPAR antagonists such as perampanel and AMPAR allosteric modulators (i.e., ampakines) such as CX1739, that have been safely administered to humans, provides an expedited means of clinical inquiry for possible therapeutic advances.

A novel approach to the epidemiology of people living with spinal cord injuries in France based on an original algorithm from public health insurance data

INTRODUCTION

French Public Health Insurance gathers health, demographic and economic data based on codes from the 10th version of the international classification of diseases (ICD-10), specific nomenclature for each health-care (medical or surgical) procedures, medical expenses and justifications for full coverage of medical care. We aimed to build an algorithm that could identify the French population of people living with spinal cord injury (SCI) relying on public health insurance metadata.

MATERIAL AND METHODS

The SNDS (in French, Système National des Données de Santé) was searched for the time-period 2012-2019, looking for: full-coverage motives, ICD-10 codes, and health-therapeutic procedures specific of our population of interest. We built a step-by-step algorithm that identified i)including codes, ii)excluding codes, iii)codes needing confirmation. A group of 3 physicians recognized as experts in this field contributed with data scientists to the selection of pertinent codes and their association. Including codes were ALD-20 (full-coverage 'paraplegia', in French, Affection de Longue Durée), G114 (spastic paraplegia), Q05.x (spina bifida), spinal cord trauma (S14.x; S24.x), vascular myelopathy (G951), degenerative myelopathies (M47.x). Autoimmune, other disabling neurological diseases with a specific ICD code, and oncologic patients were excluded. Neurological symptoms (G82.x) needed confirmation. We identified 6 categories of SCI regarding their etiology, based on ICD-10 code combinations (congenital, genetic, tumoral, traumatic, acquired and symptomatic) Finally antibiotics consumption and hospitalizations of persons identified as SCI were compared to a control sample from overall population (with a 1:5 ratio).

RESULTS

Among almost 245 000 persons with putative SCI, we identified 133 849 living individuals with SCI aged>16 (55.8% men, age 57 yo [44;70]) by 2019. Confirmed traumatic SCI were 21 459 (67% were men, age 53 yo [39;67]), acquired non-traumatic were the most frequent (n=62 561, 46.7%). SCI consumed 1.5 to 3-times more antibiotics and were 4-fold more hospitalized than controls. Also, when hospitalized, they remained twice longer in rehabilitation facilities and 3-times longer in acute care.

CONCLUSION

Using multiple code entries, our algorithm allowed an exhaustive identification of the French adult SCI population, with an updated epidemiology. This innovative method opens the field for large-scale studies regarding medical history of persons living with SCI by the prism of medical expenses and habits.

A national cross-sectional survey on community spinal cord injury individuals profiles, health-related quality of life and support services in China: implications for healthcare and rehabilitation

BACKGROUND

Spinal cord injury (SCI) results in severe, permanent functional changes and has become a global health priority due to its high incidence, cost, and disability rate. Current national epidemiological data on SCI in China are limited and outdated. This study aimed to provide a comprehensive, national cross-sectional investigation of SCI epidemiology in China.

METHODS

This cross-sectional study included 3055 SCI participants aged 8 to 78 years, conducted from May to September 2023. Data collected encompassed demographic characteristics, employment status, etiology, years lived with disability (YLD), family structure, caregiving status, income, health insurance, paralysis type, and health-related quality of life (HRQoL). Descriptive statistics analyses were used to assess demographic and injury characteristics. Group differences were assessed using t-tests, one-way ANOVA and Chi-square tests. Significant factors were examined using multivariate regression analysis.

RESULTS

The majority (88.9%) of respondents were aged 15 to 59 years, with a male-to-female ratio of 2.36:1. Car accidents caused 45.4% of tetraplegia cases, falls caused 35.9% of paraplegia cases, and myelitis was the leading cause of non-traumatic SCI. Among paraplegia participants, 65.5% had complete SCI, while 53.1% of tetraplegia participants had incomplete SCI. Functional improvement was reported by 9.58% of participants. Half (50.3%) of the respondents were unemployed, and 75% had incomes below the national average. HRQoL was significantly lower in the SCI population compared to controls, mainly influenced by injury site, income, age and etiology (p < 0.05).

CONCLUSIONS

SCI participants in China exhibit low HRQoL and reemployment rates. Accessible community and vocational rehabilitation programs, alongside robust public medical services, are essential for enhancing reemployment and HRQoL among SCI participants, reducing the overall disease burden.

Comprehensive evaluation of Chinese herbal compound prescriptions for postoperative spinal cord injury: A network meta-analysis of randomized controlled trials

Background

Spinal cord injury (SCI) is a catastrophic condition associated with spinal nerve damage, which can lead to complete or partial loss of sensory and motor functions. Chinese herbal compound prescriptions (CHCP) have shown varying degrees of therapeutic effects on spinal cord injuries. However, there is a significant lack of clinical evidence-based research to substantiate these effects.

Purpose

This study aims to thoroughly assess the viability of CHCPs in postoperative SCI through network meta-analysis.

Methods

Computer searches were conducted across multiple databases, including PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM, from their inception until May 2024. The meta-analysis adhered to the PRISMA guidelines and was registered in the PROSPERO database (CRD42023462686). A network meta-analysis was performed using the BUGSnet software package via R. Study design: A network meta-analysis of randomized clinical trials (RCTs).

Results

A total of 26 RCTs involving 1848 patients were ultimately included. The network meta-analysis revealed the effectiveness in improving ASIA motor score as follows: "HQGZD" > "Other Decoctions" > "BYHWD" > "TDHXD" > "THCQD" > "Surgery". For ASIA sensory score, the effectiveness ranking was: "HQGZD" > "Other Decoctions" > "BYHWD" > "TDHXD" > "THCQD" > "Surgery". Additionally, the experimental group had a higher ADL score compared to the control group, with a statistically difference [SMD = 1.08, 95 % CI = (0.88, 1.27), p < 0.05]. The experimental group had fewer adverse events compared to the control group, with a statistically difference [RR = 0.41, 95 % CI (0.22, 0.78), p < 0.05].

Conclusion

The findings suggest that CHCP can mprove postoperative ASIA motor and sensory scores, enhance ADL scores, and reduce adverse events following SCI surgery. Specifically, combining surgery with Huangqi Guizhi Wuwu Decoction or Buyang Huanwu Decoction may provide superior therapeutic effects in SCI treatment. Integrating CHCP into postoperative care for SCI patients may offer potential benefits.

Pharmacological management of secondary chronic spinal cord injury: a systematic review

INTRODUCTION

Spinal cord injury (SCI) may bring lifelong consequences for affected patients and a high financial burden to the health care system.

SOURCE OF DATA

Published peer-reviewed scientific articles identified from EMBASE, Google Scholar, PubMed and Scopus.

AREAS OF AGREEMENT

Surgery and blood pressure management are the main targets in acute SCI to avoid secondary damage.

AREAS OF CONTROVERSY

The management of secondary chronic SCI is challenging, with unpredictable outcomes.

GROWING POINTS

Given the lack of consensus on pharmacological therapy for acute and secondary chronic SCI, the present study analyses the currently available drugs and treatment options to manage secondary chronic SCI.

AREAS TIMELY FOR DEVELOPING RESEARCH

Different approaches exist for the pharmacological management of secondary chronic SCI. One of the most investigated drugs, 4-aminopyridine, improves central motor conduction and shows improvement in neurological signs. Positive results in different areas have been observed in patients receiving the anti-spastic drugs tizanidine and baclofen or Granulocyte colony-stimulating factor. Growth hormone showed only minimal or no significant effects, and the therapy of secondary chronic SCI with riluzole has been poorly researched to date.

Exosomes as promising bioactive materials in the treatment of spinal cord injury

Patients with spinal cord injury (SCI) have permanent devastating motor and sensory disabilities. Secondary SCI is known for its complex progression and presents with sophisticated aberrant inflammation, vascular changes, and secondary cellular dysfunction, which aggravate the primary damage. Since their initial discovery, the potent neuroprotective effects and powerful delivery abilities of exosomes (Exos) have been reported in different research fields, including SCI. In this study, we summarize therapeutic advances related to the application of Exos in preclinical animal studies. Subsequently, we discuss the mechanisms of action of Exos derived from diverse cell types, including neurogenesis, angiogenesis, blood-spinal cord barrier preservation, anti-apoptosis, and anti-inflammatory potential. We also evaluate the relationship between the Exo delivery cargo and signaling pathways. Finally, we discuss the challenges and advantages of using Exos to offer innovative insights regarding the development of efficient clinical strategies for SCI.

Acupuncture for the treatment of anxiety and depression in patients with spinal cord injury: A study protocol for systematic review and meta analysis

BACKGROUND

Spinal cord injury patients frequently suffer from anxiety and depression, which can seriously affect their quality of life and recovery. Acupuncture, as a traditional Chinese therapy, has been used to treat anxiety and depression for more than 2000 years. The aim is to evaluate the clinical efficacy of acupuncture in the treatment of anxiety and depression in spinal cord injury patients.

METHODS

The literature on acupuncture treating anxiety and depression in patients with spinal cord injury in PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Data, and Wanfang data were searched through computers from the establishment of the database to May 2024. In the study, the Cochrane tool for assessing the risk of bias was used and the meta-analyses were carried out using the software package Review Manager 5.4.

RESULTS

Ten trials were included in this systematic review, with 361 cases in the experimental group and 355 cases in the control group. Meta-analysis showed that compared with conventional treatment, acupuncture combined with conventional treatment was beneficial in improving the total clinical efficacy (odds ratio = 3.55 [95% confidence interval {CI}: 1.34-9.37], P < .001). We found acupuncture-assisted therapy could be beneficial in improving the Modified Barthel Index (MD = 10.48 [95% CI: 4.78-16.19], P < .001) and reducing anxiety or depression scores (such as the Self-Rating Anxiety Scale [MD = -6.08 {95% CI: -6.85 to -5.30}, P < .001]; reducing the Self-Rating Depression Scale [MD = -6.01 {95% CI: -6.95 to -5.07}, P < .001]). In addition, the study showed that the application of acupuncture treatment could improve 5-hydroxytryptamine compared to control group (MD = 44.99 [95% CI: 40.04-49.95], P < .001) and reduce TNF-α compared to control group (MD = -7.78 [95% CI: -8.73 to -6.83], P < .001).

CONCLUSION

Acupuncture could be used as a complementary therapy to reduce anxiety and depression in spinal cord injury patients. Further original and high-quality research is needed to verify the conclusions of this study.

An eight-year follow-up study of Home Invasive Mechanical Ventilation in Finland

BACKGROUND

Studies on long-term invasive mechanical ventilation (IMV) via tracheostomy in chronic respiratory insufficiency are limited. The aim of this study was to clarify the use of HIMV (home invasive mechanical ventilation) within the Finnish population and to analyze the characteristics and survival rate of HIMV patients from 2015 to 2022.

METHODS

Data on HIMV patients was collected annually from all Finnish Hospital District patient registries between January 1, 2015, and December 31, 2022. Data included basic demographic data of the patients, underlying diagnosis, time from diagnosis to HIMV initiation, treatment duration, and mortality.

RESULTS

This study included 179 patients. In 2015, there were 107 HIMV patients, and as of December 31, 2022, there were 95 patients. During the eight-year follow-up period, 84 patients (46.9%) died and there were 67 new patients between 2015 and2022. The prevalence of HIMV treatment in Finland was 2.4/100,000 on January 1,2015, and 1.8/ 100 000 on December 31, 2022. The average number of years living with HIMV for deceased patients at death was 10.1 ± 10.5 years largely depending on the underlying diagnosis. Of all the HIMV treatments, 32% were elective.

CONCLUSIONS

HIMV is a rare treatment in Finland, and based on our 8-year follow-up, prevalence of HIMV is diminishing. Given the high demands, and significant costs associated with HIMV, it is essential to prepare for long treatment, when planning HIMV. It is also advisable to prolong non-invasive ventilation (NIV) treatments for as long as possible.

The epidemiology of spinal fractures: A nationwide data-based study in Iran

Background

Blunt trauma is a physical injury to a part of the body, mainly caused by road accidents, direct blows, attacks, sports injuries, and falls in elderly people. Spinal fractures are observed only in a small percentage of injured patients. Accordingly, the present study was conducted on collected data between 2018 and 2022 to determine the frequency of spinal fractures in blunt trauma in Iran while also considering the mechanism of injury as a secondary outcome of interest.

Methods

In this retrospective study, blunt trauma patients with spinal fractures, regardless of age were included by the census sampling method. Data were obtained from the National Trauma Registry of Iran. Means and standard deviations were used for continuous variables, and the chi-square test was used to assess the relationship between the variables.

Results

Among 25,986 cases of all-cause trauma patients, 1,167 cases (4.5%) of blunt trauma and spinal fracture were included in the study. Gender, the severity of injury, and the cause of trauma showed a significant difference among different age groups (p < 0.05). Significant differences were found in the injury mechanisms across various spine regions (p < 0.05). The majority of patients (68.2%) had lumbar spinal fractures. Road traffic collisions were the most common cause of spinal cord injuries, accounting for 58.3% of cases, followed by falls (36.1%). The injury severity score was higher in younger patients (under 18 years old), with a mean of 4.4 ± 3.5, and in patients with cervical injuries. The majority of injuries occurred in the lumbar area (68.2%), followed by the thoracic area. Furthermore, notable variations existed in Emergency Room (ER) stay duration, overall hospitalization, Intensive Care Unit (ICU) stay duration, and injury severity levels, all influenced by the spinal regions (p < 0.05). Distinctively, ICU stay durations and ER stay duration showed significant differences, particularly in relation to injuries in the lumbar and thoracic regions (p < 0.05).

Conclusion

According to the results of the present study, trauma is more severe, and cervical injuries are more common in young people, which is a critical finding that underscores the need for targeted interventions to mitigate the severity of trauma in this age group. Additionally, the majority of cervical injuries occurred in young people, which is a particularly concerning finding given the potential for long-term disability and impact on quality of life. Our findings suggest that strategies to reduce cervical injuries, such as speed control, seat belt use, and phone-free driving, are crucial interventions for mitigating the severity of trauma and promoting patient outcomes in young people.

Perception of community reintegration among individuals with spinal cord injury in northwest Nigeria: a qualitative description

PURPOSE

To explore the meaning of community reintegration and strategies for promoting community reintegration based on the lived experiences of individuals with spinal cord injury in northwest Nigeria.

MATERIAL AND METHODS

Using a qualitative description, we purposively recruited people with spinal cord injury residing in Kano, Nigeria. Eight focus groups were conducted to gather relevant information about the meaning and strategies for community reintegration, based on the lived experiences of the participants.

RESULTS

A total of 64 people aged 18-60 years completed the study. Most of the participants had lived with spinal cord injury for more than five years. The individuals perceived community reintegration as a multi-dimensional concept reflected by five major themes namely: living life as usual, gainful engagement, a basket of opportunities, courage and support, and acceptance of destiny. Furthermore, the participants considered education and awareness about spinal cord injury, supportive and enabling environment, equal opportunities, care and moral support, and accessible health and rehabilitation services as critical for promoting community reintegration.

CONCLUSION

Community reintegration is a multidimensional process, and its promotion in northwest Nigeria requires a multisectoral approach.

MCT1-mediated endothelial cell lactate shuttle as a target for promoting axon regeneration after spinal cord injury

Rationale: Spinal cord injury (SCI)-induced vascular damage causes ischemia and hypoxia at the injury site, which, in turn, leads to profound metabolic disruptions. The effects of these metabolic alterations on neural tissue remodeling and functional recovery have yet to be elucidated. The current study aimed to investigate the consequences of the SCI-induced hypoxic environment at the epicenter of the injury. Methods: This study employed metabolomics to assess changes in energy metabolism after SCI. The use of a lactate sensor identified lactate shuttle between endothelial cells (ECs) and neurons. Reanalysis of single-cell RNA sequencing data demonstrated reduced MCT1 expression in ECs after SCI. Additionally, an adeno-associated virus (AAV) overexpressing MCT1 was utilized to elucidate its role in endothelial-neuronal interactions, tissue repair, and functional recovery. Results: The findings revealed markedly decreased monocarboxylate transporter 1 (MCT1) expression that facilitates lactate delivery to neurons to support their energy metabolism in ECs post-SCI. This decreased expression of MCT1 disrupts lactate transport to neurons, resulting in a metabolic imbalance that impedes axonal regeneration. Strikingly, our results suggested that administering adeno-associated virus specifically to ECs to restore MCT1 expression enhances axonal regeneration and improves functional recovery in SCI mice. These findings indicate a novel link between lactate shuttling from endothelial cells to neurons following SCI and subsequent neural functional recovery. Conclusion: In summary, the current study highlights a novel metabolic pathway for therapeutic interventions in the treatment of SCI. Additionally, our findings indicate the potential benefits of targeting lactate transport mechanisms in recovery from SCI.

Worldwide burden of liver cancer across childhood and adolescence, 2000-2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

Liver cancer is a significant contributor to the global disease burden, of which hepatoblastomas are the most common liver tumors in children, with 90% of cases occurring within the first 5 years of life. It is important for pediatricians and subspecialists in pediatric gastroenterology and hepatology to have knowledge of the epidemiology and incidence trends of pediatric hepatic cancer, despite its rarity. In the present study, we first provide estimates of the incidence and mortality burden of hepatoblastoma and liver cancer from 2000 to 2021 in the childhood and adolescence.

Methods

Liver cancer burden and its attributable risk factors were estimated using data from the Global Burden of Disease Study (GBD) 2021. Percentage change was estimated to show the trend of liver cancer estimates from 2000 to 2021. The age-standardized rate (ASR) and estimated annual percentage change (EAPC) were utilized for measuring hepatoblastomas incidence and deaths rate trends. In accordance with the GBD framework, 95% uncertainty intervals (UIs) for all estimates by averaging the data from 1000 draws, with the lower and upper bounds of the 95% UIs.

Findings

Globally, from 2000 to 2021 in the age 5-19 years group, the incidence cases and deaths cases due to liver cancer decreased from 2449.2 (95% UI: 2235.9-2689.8) to 1692.9 (95% UI: 1482.0-1992.5) and 2248.5 (95% UI: 2053.7-2474.9) to 1516.6 (95% UI: 1322.1-1797.9), respectively. Meanwhile, from 2000 to 2021 in the age 20-24 years group, the incidence cases and deaths cases due to liver cancer decreased from 1453.5 (95% UI: 1327.8-1609.4) to 1285.1 (95% UI: 1159.2-1447.2) and 1432.3 (95% UI: 1307.6-1585.7) to 1195.5 (95% UI: 1066.1-1355.2), respectively. In addition, the prevalence of liver cancer decreased from 41.9% (95% UI: 18.7%-64.7%) to 26.4% (95% UI: 14.2%-39.1%) in the age 5-19 years group, and 46.6% (95% UI: 42.8%-51.5%) to 36.5% (95% UI: 33.1%-40.9%) in the age 20-24 years. From 2000 to 2021, in the age group of 5-19 years, the proportion of liver cancer incidence due to hepatitis B has decreased from 42.2% to 37.9%, while the proportion due to hepatitis C has increased from 1.1% to 1.6%. Additionally, there has been an increase in the proportion of NASH-induced liver cancer incidence from 5.2% to 9.4%, and alcohol use induced liver cancer incidence has also increased from 0.5% to 0.7% over the same period. Globally, from 2000 to 2021, the incidence cases and deaths cases due to hepatoblastoma decreased from 6131.8 (95% UI: 5234.8-6961.9) to 4045.6 (95% UI: 3250-4995.8) and 4059.2 (95% UI: 3494.5-4621.2) to 2416 (95% UI: 1940.2-3022.5), respectively. There was some variation in age-related sex-specific patterns, the highest number of hepatoblastoma incidence cases occurred in children between 2 and 4 years old and females in the age range of 12 months to 9 years had a higher number of new cases. Importantly, the incidence of hepatoblastoma was started to increase sharply after the age of 1 month.

Interpretation

The results of the present study are significant for liver health policy and practice in childhood and adolescence. Differentiated intervention and outreach strategies based on age and gender would be necessary to reduce the impact of liver cancer. Early screening and interventions for hepatoblastoma is important especially in the population of under 9 years old.

Funding

This study was supported by the National Key R&D Program of China (grant numbers 2023YFC2307000), National Natural Science Foundation of China [grant numbers 82170571 and 81974068], China Postdoctoral Science Foundation (grant numbers 2023M741283).

Ergogenic effects of spinal cord stimulation on exercise performance following spinal cord injury

Cervical or upper-thoracic spinal cord injury (SCI, ≥T6) often leads to low resting blood pressure (BP) and impaired cardiovascular responses to acute exercise due to disrupted supraspinal sympathetic drive. Epidural spinal cord stimulation (invasive, ESCS) and transcutaneous spinal cord stimulation (non-invasive, TSCS) have previously been used to target dormant sympathetic circuits and modulate cardiovascular responses. This case series compared the effects of cardiovascular-optimised ESCS and TSCS versus sham ESCS and TSCS on modulating cardiovascular responses and improving submaximal upper-body exercise performance in individuals with SCI. Seven males with a chronic, motor-complete SCI between C6 and T4 underwent a mapping session to identify cardiovascular responses to spinal cord stimulation. Subsequently, four participants (two ESCS and two TSCS) completed submaximal exercise testing. Stimulation parameters (waveform, frequency, intensity, epidural electrode array configuration, and transcutaneous electrode locations in the lumbosacral region) were optimised to elevate cardiovascular responses (CV-SCS). A sham condition (SHAM-SCS) served as a comparison. Participants performed arm-crank exercise to exhaustion at a fixed workload corresponding to above ventilatory threshold, on separate days, with CV-SCS or SHAM-SCS. At rest, CV-SCS increased BP and predicted left ventricular cardiac contractility and total peripheral resistance. During exercise, CV-SCS increased time to exhaustion and peak oxygen pulse (a surrogate for stroke volume), relative to SHAM-SCS. Ratings of perceived exertion also tended to be lower with CV-SCS than SHAM-SCS. Comparable improvements in time to exhaustion with ESCS and TSCS suggest that both approaches could be promising ergogenic aids to support exercise performance or rehabilitation, along with reducing fatigue during activities of daily living in individuals with SCI.

Challenges in traumatic spinal cord injury care in developing countries - a scoping review

Objective

To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care.

Methods

We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care.

Results

We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and 61 on post-hospital care. Challenges related to post-hospital problems including the personal, financial, and social consequences of patients' disabilities and the deficiencies in empowering people with TSCI were foremost studied. Lack of trained human resources, insufficient public education and delays in care delivery were barriers in the acute and chronic management of TSCI. A well-defined pre-hospital network and standard guidelines for the management of acute neurotrauma are needed. Critical challenges in injury prevention include deficiencies in infrastructure and supportive legislation.

Conclusion

Studies focusing on injury prevention and pre-hospital care in TSCI management in developing countries warrant further investigation. It is imperative to develop systematic and evidence-based initiatives that are specifically tailored to the unique circumstances of each country to address these challenges effectively. By understanding the primary obstacles, policymakers and healthcare providers can establish goals for improving education, planning, legislation, and resource allocation.

Beat-to-Beat Blood Pressure Variability Within 24 Hours of Ischemic Stroke Onset: A Potential Predictor of Functional Prognosis

BACKGROUND

Beat-to-beat blood pressure variability (BPV) is based on each heartbeat and represents a dynamic equilibrium process modulated by artery and cardiac involvement of pressure-receptive reflexes. To date, there remains a lack of prospective studies illustrating the clinical value of beat-to-beat BPV within 24 hours of acute ischemic stroke onset.

METHODS AND RESULTS

This study prospectively monitored beat-to-beat blood pressure and heart rate in patients with acute ischemic stroke within 24 hours of onset using a noninvasive plethysmograph and calculated beat-to-beat BPV, heart rate variability, and the cross-correlation baroreflex sensitivity. A modified Rankin Scale score of ≥2 at 90 days was defined as an unfavorable prognosis. Multivariate logistic regression was performed, and the nomogram model was developed by adding the beat-to-beat BPV to the traditional model for predicting prognosis. Beat-to-beat BPV increased significantly in the unfavorable outcome group (P<0.05) compared with that in the favorable outcome group, whereas no difference was observed in beat-to-beat heart rate variability and cross-correlation baroreflex sensitivity between both groups (P>0.05). Furthermore, beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with unfavorable outcome at 90 days (P<0.005). The addition of beat-to-beat BPV to the traditional model for predicting prognosis enhanced the area under the receiver operating characteristic curve from 0.816 to 0.830.

CONCLUSIONS

Increased beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with a poor prognosis at 90 days and may be a potential predictor for discriminating unfavorable prognosis.