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Zhou H, Lou Y, Chen L, Kang Y, Liu L, Cai Z, Anderson DB, Wang W, Zhang C, Wang J, Ning G, Gao Y, He B, Ding W, Wang Y, Mei W, Song Y, Zhou Y, Xia M, Wang H, Zhao J, Yin G, Zhang T, Jing F, Zhu R, Meng B, Duan L, Zhang Z, Wu D, Cai Z, Huang L, Yin Z, Li K, Lu S, Feng S. Epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China: a hospital-based retrospective study. Neural Regen Res 2024; 19:1126-1133. [PMID: 37862218 PMCID: PMC10749597 DOI: 10.4103/1673-5374.382257] [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: 12/20/2022] [Revised: 03/21/2023] [Accepted: 06/26/2023] [Indexed: 10/22/2023] Open
Abstract
Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death. China has the largest population of patients with traumatic spinal cord injury. Previous studies of traumatic spinal cord injury in China have mostly been regional in scope; national-level studies have been rare. To the best of our knowledge, no national-level study of treatment status and economic burden has been performed. This retrospective study aimed to examine the epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China at the national level. We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China. Patient epidemiological and clinical features, treatment status, and total and daily costs were recorded. Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program. The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall (annual percentage change, -0.5% and 2.1%, respectively). A total of 10,053 (74.7%) patients underwent surgery. Only 2.8% of patients who underwent surgery did so within 24 hours of injury. A total of 2005 (14.9%) patients were treated with high-dose (≥ 500 mg) methylprednisolone sodium succinate/methylprednisolone (MPSS/MP); 615 (4.6%) received it within 8 hours. The total cost for acute traumatic spinal cord injury decreased over the study period (-4.7%), while daily cost did not significantly change (1.0% increase). Our findings indicate that public health initiatives should aim at improving hospitals' ability to complete early surgery within 24 hours, which is associated with improved sensorimotor recovery, increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
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Affiliation(s)
- Hengxing Zhou
- Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
- Department of Orthopedics, Shandong University Center for Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Yongfu Lou
- Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
- Department of Orthopedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Lingxiao Chen
- Department of Orthopedics, Shandong University Center for Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
- Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Yi Kang
- Department of Orthopedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Lu Liu
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Zhiwei Cai
- Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - David B. Anderson
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, NSW, Australia
- Sydney Spine Institute, Burwood, Sydney, NSW, Australia
| | - Wei Wang
- Department of Orthopedics, Shandong University Center for Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Chi Zhang
- Department of Orthopedics, Shandong University Center for Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Jinghua Wang
- Laboratory of Epidemiology, Tianjin Neurological Institute, Department of Neurology, Tianjin Medical University General Hospital & Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Guangzhi Ning
- Department of Orthopedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Yanzheng Gao
- Department of Orthopedics, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, China
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yisheng Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wei Mei
- Department of Spine Surgery, Zhengzhou Orthopedics Hospital, Zhengzhou, Henan Province, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Maosheng Xia
- Department of Orthopedics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Huan Wang
- Department of Spinal Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoyong Yin
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Tao Zhang
- Department of Spinal Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Feng Jing
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, China
| | - Rusen Zhu
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Bin Meng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Li Duan
- Department of Orthopedics, Shenzhen Intelligent Orthopedics and Biomedical Innovation Platform, Guangdong Artificial Intelligence Biomedical Innovation Platform, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong Province, China
| | - Zhongmin Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Desheng Wu
- Department of Spine Surgery, Shanghai East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zhanhai Yin
- Department of Orthopedics, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Kainan Li
- Department of Orthopedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, China
| | - Shibao Lu
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China; National Geriatric Diseases Research Center, Beijing, China
| | - Shiqing Feng
- Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
- Department of Orthopedics, Shandong University Center for Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
- Department of Orthopedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
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Noh SH, Lee E, Kim KT, Kim SH, Cho PG. Traumatic spinal cord injury in South Korea for 13 years (2008-2020). Sci Rep 2024; 14:8290. [PMID: 38594283 PMCID: PMC11004143 DOI: 10.1038/s41598-024-57965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/23/2024] [Indexed: 04/11/2024] Open
Abstract
Traumatic spinal cord injury (TSCI) has significant physical, psychological, and socioeconomic impacts. However, the epidemiological characteristics and treatment patterns of TSCI in South Korea remain unclear. This study aimed to investigate TSCI incidence and treatment behaviors in South Korea from 2008 to 2020. We included data from 30,979 newly diagnosed TSCI patients obtained from the Health Insurance Review and Assessment Service (HIRA). Treatment trends, location of surgery, surgical method, comorbidities, factors affecting hospital stay, and risk factors affecting readmission were analyzed. Patients were divided into the surgery group [n = 7719; (25%)] and the non-surgery group [n = 23,260; (75%)]. Surgical cases involved cervical (64%), thoracic (17%), and lumbar/sacral (19%) lesions. Anterior fusion (38%), posterior fusion (54%), and corpectomy (8%) were the surgical methods. Surgical treatments increased annually. Factors influencing hospital stay included male sex, older age, and higher Charlson comorbidity index (CCI). Female sex and higher CCI scores were associated with readmission. In conclusion, a quarter of all TSCI patients underwent surgery, with an upward trend. Risk factors for longer hospital stays were thoracic spine injury, older age, higher CCI, and male sex. Risk factors for readmission included age range of 40-59 years, lumbar/sacral spine injuries, CCI score of 2, and female sex.
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Affiliation(s)
- Sung Hyun Noh
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, 164, Republic of Korea
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eunyoung Lee
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea
| | - Sang Hyun Kim
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, 164, Republic of Korea
| | - Pyung Goo Cho
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, 164, Republic of Korea.
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Gao Y, Wang K, Wu S, Wu J, Zhang J, Li J, Lei S, Duan X, Men K. Injectable and Photocurable Gene Scaffold Facilitates Efficient Repair of Spinal Cord Injury. ACS APPLIED MATERIALS & INTERFACES 2024; 16:4375-4394. [PMID: 38185858 DOI: 10.1021/acsami.3c14902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
RNA interference-based gene therapy has led to a strategy for spinal cord injury (SCI) therapy. However, there have been high requirements regarding the optimal gene delivery vector for siRNA-based SCI gene therapy. Here, we developed an injectable and photocurable lipid nanoparticle GelMA (PLNG) hydrogel scaffold for controlled dual siRNA delivery at the SCI wound site. The prepared PLNG scaffold could efficiently protect and retain the bioactivity of the siRNA nanocomplex. It facilitated sustainable siRNA release along with degradation in 7 days. After loading dual siRNA targeting phosphatase and tensin homologue (PTEN) and macrophage migration inhibitory factor (MIF) simultaneously, the locally administered siRNAs/PLNG scaffold efficiently improved the Basso mouse scale (BMS) score and recovered ankle joint movement and plantar stepping after treatment with only three doses. We further proved that the siRNAs/PLNG scaffold successfully regulated the activities of neurons, microglia, and macrophages, thus promoting neuron axon regeneration and remyelination. The protein array results suggested that the siRNAs/PLNG scaffold could increase the expression of growth factors and decrease the expression of inflammatory factors to regulate neuroinflammation in SCI and create a neural repair environment. Our results suggested that the PLNG scaffold siRNA delivery system is a potential candidate for siRNA-based SCI therapy.
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Affiliation(s)
- Yan Gao
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kaiyu Wang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shan Wu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jieping Wu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin Zhang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingmei Li
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Sibei Lei
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xingmei Duan
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Ke Men
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
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Choi Y, Leigh JH. Epidemiology of Traumatic and Non-Traumatic Spinal Cord Injury in Korea: A Narrative Review. Korean J Neurotrauma 2023; 19:434-445. [PMID: 38222829 PMCID: PMC10782106 DOI: 10.13004/kjnt.2023.19.e54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 01/16/2024] Open
Abstract
This review describes the incidence rates and trends of traumatic spinal cord injuries (TSCI) and non-traumatic spinal cord injuries (NTSCI) in South Korea. The incidence of NTSCI has increased more rapidly than that of TSCI in recent years. In 2007, TSCI was more common, but by 2020, NTSCI had surpassed TSCI, particularly in older individuals. While men have a higher incidence of both TSCI and NTSCI, the incidence difference by sex is greater in TSCI. The incidence rates of both TSCI and NTSCI are higher in older individuals, particularly those in their 70s and 80s. For TSCI, falls and traffic accidents are the most common causes, with falls being more prevalent in older adults. Cervical SCIs are the most common TSCI, especially in high-income countries like South Korea. Patients with NTSCI predominantly display paraplegia, which is usually associated with non-traumatic causes such as degenerative disorders and tumors. Higher rates of tetraplegia and paraplegia are observed with TSCI and NTSCI, respectively. The neurological levels of injury also differ between TSCI and NTSCI. Overall, SCIs are a growing concern in South Korea and there is a need for targeted interventions for their management and prevention, especially in older age groups.
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Affiliation(s)
- Yoonjeong Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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5
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Zhu B, Gu G, Ren J, Song X, Li J, Wang C, Zhang W, Huo Y, Wang H, Jin L, Feng S, Wei Z. Schwann Cell-Derived Exosomes and Methylprednisolone Composite Patch for Spinal Cord Injury Repair. ACS NANO 2023; 17:22928-22943. [PMID: 37948097 DOI: 10.1021/acsnano.3c08046] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Spinal cord injury (SCI) can cause permanent loss of sensory and motor function, and there is no effective clinical treatment, to date. Due to the complex pathological process involved after injury, synergistic treatments are very urgently needed in clinical practice. We designed a nanofiber scaffold hyaluronic acid hydrogel patch to release both exosomes and methylprednisolone to the injured spinal cord in a non-invasive manner. This composite patch showed good biocompatibility in the stabilization of exosome morphology and toxicity to nerve cells. Meanwhile, the composite patch increased the proportion of M2-type macrophages and reduced neuronal apoptosis in an in vitro study. In vivo, the functional and electrophysiological performance of rats with SCI was significantly improved when the composite patch covered the surface of the hematoma. The composite patch inhibited the inflammatory response through macrophage polarization from M1 type to M2 type and increased the survival of neurons by inhibition neuronal of apoptosis after SCI. The therapeutic effects of this composite patch can be attributed to TLR4/NF-κB, MAPK, and Akt/mTOR pathways. Thus, the composite patch provides a medicine-exosomes dual-release system and may provide a non-invasive method for clinical treatment for individuals with SCI.
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Affiliation(s)
- Bin Zhu
- National Spinal Cord Injury International Cooperation Base, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
| | - Guangjin Gu
- Department of Orthopedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopedics, Advanced Medical Research Institute, Shandong University, Jinan, Shandong 250033, China
| | - Jie Ren
- National Spinal Cord Injury International Cooperation Base, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
| | - Xiaomeng Song
- National Spinal Cord Injury International Cooperation Base, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
| | - Junjin Li
- National Spinal Cord Injury International Cooperation Base, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
| | - Chunyan Wang
- Department of Rehabilitation Medicine, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
| | - Wencan Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopedics, Advanced Medical Research Institute, Shandong University, Jinan, Shandong 250033, China
| | - Yanqing Huo
- Department of Orthopaedics, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Haifeng Wang
- Department of Orthopaedics, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Lin Jin
- International Joint Research Laboratory for Biomedical Nanomaterials of Henan, Zhoukou Normal University, Zhoukou, Henan 466001, China
| | - Shiqing Feng
- National Spinal Cord Injury International Cooperation Base, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Department of Orthopaedics, Qilu Hospital of Shandong University, The Second Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, Jinan, Shandong 250033, China
| | - Zhijian Wei
- National Spinal Cord Injury International Cooperation Base, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Department of Orthopaedics, Qilu Hospital of Shandong University, The Second Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, Jinan, Shandong 250033, China
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Sun Z, Wang Y, Pang X, Wang X, Zeng H. Mechanisms of polydatin against spinal cord ischemia-reperfusion injury based on network pharmacology, molecular docking and molecular dynamics simulation. Bioorg Chem 2023; 140:106840. [PMID: 37683540 DOI: 10.1016/j.bioorg.2023.106840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Polydatin has shown considerable pharmacological activities in ischemia-reperfusion injuries of various organs. However, its effects and mechanisms in spinal cord ischemia-reperfusion injury have not been fully established. In this study, the mechanisms of polydatin against spinal cord ischemia-reperfusion injury were investigated via network pharmacology, molecular docking and molecular dynamics simulation. METHODS Spinal cord ischemia-reperfusion injury-related targets were obtained from the GeneCards database, while polydatin-related action targets were obtained from the CTD and SwissTarget databases. A protein-protein interaction network of potential targets was constructed using the String platform. After selecting the potential key targets, GO functional enrichment and KEGG pathway enrichment analyses were performed via the Metascape database, and a network map of "drug-target-pathway-disease" constructed. The relationships between polydatin and various key targets were assessed via molecular docking. Molecular dynamics simulation was conducted for optimal core protein-compound complexes obtained by molecular docking. RESULTS Topological analysis of the PPI network revealed 14 core targets. GO functional enrichment analysis revealed that 435 biological processes, 12 cell components and 29 molecular functions were enriched while KEGG pathway enrichment analysis revealed 91 enriched signaling pathways. Molecular docking showed that polydatin had the highest binding affinity for MAPK3, suggesting that MAPK3 is a key target of polydatin against spinal cord ischemia-reperfusion injury. Molecular dynamics simulations revealed good binding abilities between polydatin and MAPK3. CONCLUSIONS Polydatin exerts its effects on spinal cord ischemia-reperfusion injury through multiple targets and pathways. MAPK3 may be a key target of polydatin in spinal cord ischemia-reperfusion injury.
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Affiliation(s)
- Zhicheng Sun
- Department of Spinal Surgery, Xiangya Hospital of Central South University, Changsha, PR China.
| | - Yuanqing Wang
- School of Life Science and Technology, Central South University of Forestry and Technology, Changsha, PR China.
| | - Xiaoyang Pang
- Department of Spinal Surgery, Xiangya Hospital of Central South University, Changsha, PR China.
| | - Xiyang Wang
- Department of Spinal Surgery, Xiangya Hospital of Central South University, Changsha, PR China.
| | - Hao Zeng
- Department of Spine and Osteopathy Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China; Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, PR China.
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Kim Y, Jeong M, Park MW, Shin HI, Lee BC, Kim DH. Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:S56-S64. [PMID: 37726959 DOI: 10.12701/jyms.2023.00689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. METHODS We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. RESULTS The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. CONCLUSION Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.
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Affiliation(s)
- Yoonhee Kim
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minjae Jeong
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung Woo Park
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Iee Shin
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Chan Lee
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Gao J, Khang MK, Liao Z, Webb K, Detloff MR, Lee JS. Rolipram-loaded PgP nanoparticle reduces secondary injury and enhances motor function recovery in a rat moderate contusion SCI model. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2023; 53:102702. [PMID: 37574117 DOI: 10.1016/j.nano.2023.102702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
Spinal cord injury (SCI) results in immediate axonal damage and cell death, as well as a prolonged secondary injury consist of a cascade of pathophysiological processes. One important aspect of secondary injury is activation of phosphodiesterase 4 (PDE4) that leads to reduce cAMP levels in the injured spinal cord. We have developed an amphiphilic copolymer, poly (lactide-co-glycolide)-graft-polyethylenimine (PgP) that can deliver Rolipram, the PDE4 inhibitor. The objective of this work was to investigate the effect of rolipram loaded PgP (Rm-PgP) on secondary injury and motor functional recovery in a rat moderate contusion SCI model. We observed that Rm-PgP can increase cAMP level at the lesion site, and reduce secondary injury such as the inflammatory response by macrophages/microglia, astrogliosis by activated astrocytes and apoptosis as well as improve neuronal survival at 4 weeks post-injury (WPI). We also observed that Rm-PgP can improve motor functional recovery after SCI over 4 WPI.
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Affiliation(s)
- Jun Gao
- Drug Design Delivery and Development (4D) Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Min Kyung Khang
- Drug Design Delivery and Development (4D) Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Zhen Liao
- Drug Design Delivery and Development (4D) Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, USA.
| | - Ken Webb
- MicroEnvironmental Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, USA.
| | - Megan Ryan Detloff
- Department of Neurobiology & Anatomy, Marion Murray Spinal Cord Research Center, College of Medicine, Drexel University, Philadelphia, PA 19129, USA.
| | - Jeoung Soo Lee
- Drug Design Delivery and Development (4D) Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, USA.
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Baltin M, Smirnova V, Khamatnurova R, Sabirova D, Samigullin B, Sachenkov O, Baltina T. Functional State of the Motor Centers of the Lumbar Spine after Contusion (Th8-Th9) with Application of Methylprednisolone-Copolymer at the Site of Injury. Biomedicines 2023; 11:2026. [PMID: 37509665 PMCID: PMC10377350 DOI: 10.3390/biomedicines11072026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Spinal cord injuries must be treated as soon as possible. Studies of NASCIS protocols have questioned the use of methylprednisolone therapy. This study aimed to evaluate the effect of local delivery of methylprednisolone succinate in combination with a tri-block copolymer in rats with spinal cord injury. The experiments were conducted in accordance with the bioethical guidelines. We evaluated the state of the motor centers below the level of injury by assessing the amplitude of evoked motor responses in the hind limb muscles of rats during epidural stimulation. Kinematic analysis was performed to examine the stepping cycle in each rat. Trajectories of foot movements were plotted to determine the range of limb motion, maximum foot lift height, and lateral deviation of the foot in rats on the 21st day after spinal cord injury. We have shown that the local application of methylprednisolone succinate in combination with block copolymer leads to recovery of center excitability by 21 days after injury. In rats, they recovered weight-supported locomotion, directional control of walking, and balance. The proposed assessment method provides valuable information on gait disturbances following injury and can be utilized to evaluate the quality of therapeutic interventions.
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Affiliation(s)
- Maxim Baltin
- Research Laboratory "Mechanobiology", Institute of Fundamental Medicine and Biology, Kazan Federal University, 420015 Kazan, Russia
- Research Institute of Sports Reserve Training Technologies, Volga State University of Physical Culture, Sports and Tourism, Universiade Village, 35, 420010 Kazan, Russia
| | - Victoriya Smirnova
- N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, 420008 Kazan, Russia
| | - Regina Khamatnurova
- Interdisciplinary Neuroscience Faculty, Goethe-Universität Frankfurt am Main, 60323 Frankfurt am Main, Germany
| | - Diana Sabirova
- N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, 420008 Kazan, Russia
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, 76 K. Marx St., 420015 Kazan, Russia
| | - Bulat Samigullin
- Research Laboratory "Mechanobiology", Institute of Fundamental Medicine and Biology, Kazan Federal University, 420015 Kazan, Russia
- NeuroStart Medical Center, 420049 Kazan, Russia
| | - Oskar Sachenkov
- N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, 420008 Kazan, Russia
- Department Machines Science and Engineering Graphics, Tupolev Kazan National Research Technical University, 420111 Kazan, Russia
| | - Tatyana Baltina
- Research Laboratory "Mechanobiology", Institute of Fundamental Medicine and Biology, Kazan Federal University, 420015 Kazan, Russia
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, 76 K. Marx St., 420015 Kazan, Russia
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Bae SW, Shin HI, Bang MS, Lee MY. Epidemiology of Work-Related Traumatic Spinal Cord Injury: An Analysis of Workers' Compensation Claims in Korea, 2011-2019. J Occup Environ Med 2023; 65:e453-e457. [PMID: 37026737 PMCID: PMC10332647 DOI: 10.1097/jom.0000000000002852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE We aimed to identify the incidence and burden of work-related traumatic spinal cord injury (wrTSCI) in Korea in the 10-year period from 2010 to 2019. METHODS We used nationwide workers' compensation insurance data. The study population comprised industrially injured workers with TSCI diagnosis codes. The annual incidence of wrTSCI (number per million workers) was calculated. RESULTS The mean annual incidence of wrTSCI was 22.8/1,000,000 (95% confidence interval, 20.5 to 25.0), and the mean total cost per claim was 231.40 million KRW. The incidence of TSCI in the cervical region was the highest (13.1/1,000,000; 95% confidence interval, 11.4 to 14.9), and most cases were in the construction industry (47.3%). CONCLUSION These findings can help identify specific at-risk groups and facilitate the development of prevention strategies.
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Lin J, Chen P, Tan Z, Sun Y, Tam WK, Ao D, Shen W, Leung VYL, Cheung KMC, To MKT. Application of silver nanoparticles for improving motor recovery after spinal cord injury via reduction of pro-inflammatory M1 macrophages. Heliyon 2023; 9:e15689. [PMID: 37234658 PMCID: PMC10205515 DOI: 10.1016/j.heliyon.2023.e15689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Silver nanoparticles (AgNPs) possess anti-inflammatory activities and have been widely deployed for promoting tissue repair. Here we explored the efficacy of AgNPs on functional recovery after spinal cord injury (SCI). Our data indicated that, in a SCI rat model, local AgNPs delivery could significantly recover locomotor function and exert neuroprotection through reducing of pro-inflammatory M1 survival. Furthermore, in comparison with Raw 264.7-derived M0 and M2, a higher level of AgNPs uptake and more pronounced cytotoxicity were detected in M1. RNA-seq analysis revealed the apoptotic genes in M1 were upregulated by AgNPs, whereas in M0 and M2, pro-apoptotic genes were downregulated and PI3k-Akt pathway signaling pathway was upregulated. Moreover, AgNPs treatment preferentially reduced cell viability of human monocyte-derived M1 comparing to M2, supporting its effect on M1 in human. Overall, our findings reveal AgNPs could suppress M1 activity and imply its therapeutic potential in promoting post-SCI motor recovery.
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Affiliation(s)
- Jie Lin
- Department of Orthopaedics & Traumatology, The University of Hong Kong Shenzhen Hospital, School of Clinical Medicine, The University of Hong Kong, Shenzhen, Guangdong, 518053, China
- Department of Orthopaedics & Traumatology, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Peikai Chen
- Department of Orthopaedics & Traumatology, The University of Hong Kong Shenzhen Hospital, School of Clinical Medicine, The University of Hong Kong, Shenzhen, Guangdong, 518053, China
| | - Zhijia Tan
- Department of Orthopaedics & Traumatology, The University of Hong Kong Shenzhen Hospital, School of Clinical Medicine, The University of Hong Kong, Shenzhen, Guangdong, 518053, China
| | - Yi Sun
- Department of Sports Medicine, Peking University-Shenzhen Hospital, Shenzhen, Guangdong, 518034, China
| | - Wai Kit Tam
- Department of Orthopaedics & Traumatology, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Di Ao
- Department of Orthopaedics & Traumatology, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Wei Shen
- Department of Orthopaedics & Traumatology, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Victor Yu-Leong Leung
- Department of Orthopaedics & Traumatology, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong Shenzhen Hospital, School of Clinical Medicine, The University of Hong Kong, Shenzhen, Guangdong, 518053, China
- Department of Orthopaedics & Traumatology, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Michael Kai Tsun To
- Department of Orthopaedics & Traumatology, The University of Hong Kong Shenzhen Hospital, School of Clinical Medicine, The University of Hong Kong, Shenzhen, Guangdong, 518053, China
- Department of Orthopaedics & Traumatology, School of Clinical Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
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12
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Incidence of traumatic spinal cord injury worldwide: A systematic review, data integration, and update. World Neurosurg X 2023; 18:100171. [PMID: 36910686 PMCID: PMC9996445 DOI: 10.1016/j.wnsx.2023.100171] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives This review was designed to update our earlier systematic review which evaluated both published and unpublished evidence on the incidence of traumatic spinal cord injury (TSCI) worldwide. Methods We used various search methods including strategic searching, reference checking, searching for grey literature, contacting registries, authors, and organizations requesting unpublished data, browsing related websites, and hand searching key journals. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. Records published between April 2013 and May 2020 were added to the original systematic review. Results Overall, 58 resources including 45 papers, 10 SCI registry reports, 1 book, and 2 theses were retrieved. We found TSCI incidence data for eight new countries, which overall shapes our knowledge of TSCI incidence for 49 countries. The incidence of TSCI ranges from 3.3 to 195.4 cases per million (cpm) based on subnational studies and from 5.1 to 150.48 cpm based on national studies. Most of the studies were low quality, lacked consistent case selection due to unclear definition of TSCI and unclear ascertainment methods. Conclusions There is an increasing number of publications in the literature focusing on the epidemiologic data of TSCI. The absence of a standard form of reporting TSCI hinders the comparability of data across different data sources. Use of various definitions for TSCI may lead to heterogeneity in reports. Use of sensitivity analyses based on reasonable classification criteria can aid in offering a uniform set of case identification and ascertainment criteria for TSCI.
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Key Words
- AMR, American region
- ASCIR, Australian Spinal Cord Injury Register
- CPM, Cases Per Million
- CoCoPop, Condition, Context, and Population
- EMR, Eastern Mediterranean region
- EUR, European Region
- Epidemiology
- ICD, International Codes of Disease
- ISCoS, International Spinal Cord Society
- InSCI, The International Spinal Cord Injury
- Incidence
- JBI, Joanna Briggs Institute
- PHM, Prehospital mortality
- PICO, Population, Intervention, Comparator, and Outcome
- SEAR, South East Asia Region
- Spinal cord injury
- SwiSCI, Swiss Spinal Cord Injury
- TSCI, Traumatic Spinal Cord Injury
- TSI, Traumatic spinal injuries
- WPR, Western Pacific Region
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Choi Y, Kim YE, Leigh JH, Lee YS, Kim HK, Yi YG, Lee J, Lee MY, Lee G, Shin HI, Bang MS. Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea. J Korean Med Sci 2023; 38:e26. [PMID: 36808542 PMCID: PMC9941017 DOI: 10.3346/jkms.2023.38.e26] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasi-national databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). METHODS We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane-Armitage trend test was performed according to the injured body region. RESULTS In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = - 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. CONCLUSIONS The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.
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Affiliation(s)
- Yoonjeong Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Young-Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
| | - Ye Seol Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Han-Kyoul Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - You Gyoung Yi
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Jinyoung Lee
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Min-Yong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Rehabilitation Medicine, Korea Workers' Compensation and Welfare Incheon Hospital, Incheon, Korea
| | - Gangpyo Lee
- Department of Rehabilitation Medicine, Korea Workers' Compensation and Welfare Incheon Hospital, Incheon, Korea
- Rehabilitation Medicine Research Center, Korea Workers' Compensation and Welfare Service Incheon Hospital, Incheon, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
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14
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Kim HK, Leigh JH, Choi Y, Lee JH, Bang MS. Spinal Cord Injury Fact Sheet in Korea. Ann Rehabil Med 2023; 47:4-10. [PMID: 36880194 PMCID: PMC10020047 DOI: 10.5535/arm.23020] [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: 02/11/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Spinal cord injury (SCI) has been recognized as a medically complex and life-disrupting condition. As the aging of the population accelerates, the trend of SCI has changed. This review aimed to provide comprehensive statistics and recent epidemiological changes in SCI and rehabilitation in Korea. All three insurance databases (National Health Insurance Service [NHIS], automobile insurance [AUI], and industrial accident compensation insurance [IACI]) were considered. These nationwide databases provide data on the current trends in term of incidence, etiology, and rehabilitation of SCI. Traumatic spinal cord injury (TSCI) was more frequent among the elderly in the NHIS compared to working age individuals in the AUI and IACI. In all three trauma-related insurance databases, male with TSCI outnumbered female. TSCI incidence per year was approximately 17 times higher among males than females, on average, in IACI. In all three insurances, the cervical level of TSCI was the most frequent. Although the ratio of SCI patients receiving rehabilitation treatment at primary and secondary hospitals increased for nine years, the increase in training on activities of daily living (ADL training) was found to be relatively small. This review provides a broader and comprehensive understanding of the incidence, etiology, and rehabilitation treatment of SCI in Korea.
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Affiliation(s)
- Han-Kyoul Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Yoonjeong Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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15
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Lisheng H, Dong Z, Xuedong B, Jinglei S, Shaokui N, Tianjun G, Feng G, Qing H. Successful treatment of thoracic myelopathy caused by spontaneous spinal epidural hematoma (SSEH) combined with calcification of the ligamentum flavum (CLF) by posterior percutaneous endoscopic surgery (PPES): A case report. Front Surg 2023; 9:1077343. [PMID: 36713675 PMCID: PMC9874224 DOI: 10.3389/fsurg.2022.1077343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Study Design A retrospective case report. Objective To report a case who developed deteriorated paraplegia by spontaneous spinal epidural hematoma (SSEH) based on calcification of the ligamentum flavum (CLF) at the T10-11 level, achieved full neurological recovery following posterior percutaneous endoscopic surgery (PPES). Summary of Background Data CLF rarely occurs at the thoracic spine, and the symptom usually progress slowly. SSEH is another rare spinal lesion that might progress rapidly and cause emergent severe spinal cord compression syndrome. Coexistence of SSEH and CLF at the same thoracic level was rarely reported in English literature. Methods A 65-year-old man presented to our hospital with the complaint of sensorimotor loss on the lower limbs and dysfunction of bladder for 1 day after a progressive weakness and numbness of the lower limbs for 3 months. MR examination found a dorsal protruding mass at the T10-11 level, while computed tomography (CT) found the protruding mass contained scattered calcified deposits. The patient was diagnosed with thoracic CLF. Decompression via PPES was carried out to realize bilateral decompression through a unilateral approach. Results During the operation, the protruding mass was found to be composed of SSEH and CLF together. After the operation, the patient's neurological function recovered quickly. One week later, the patient could walk by himself. After 3 months, complete neurological function had recovered. Conclusion SSEH could develop based on CLF at thoracic level and cause serious neurological dysfunction. PPES might be an advisable method to remove CLF and evacuate SSEH with good clinical results.
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Affiliation(s)
- Hou Lisheng
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China,Correspondence: Hou Lisheng Bai Xuedong
| | - Zhang Dong
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Bai Xuedong
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China,Correspondence: Hou Lisheng Bai Xuedong
| | - Shi Jinglei
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Nan Shaokui
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Gao Tianjun
- Senior Department of Traditional Chinese Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Ge Feng
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - He Qing
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
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16
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Lee BJ, Jeong JH. Early Decompression in Acute Spinal Cord Injury : Review and Update. J Korean Neurosurg Soc 2023; 66:6-11. [PMID: 36274255 PMCID: PMC9837486 DOI: 10.3340/jkns.2022.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) has a significant negative effect on the quality of life due to permanent neurologic damage and economic burden by continuous treatment and rehabilitation. However, determining the correct approach to ensure optimal clinical outcomes can be challenging and remains highly controversial. In particular, with the introduction of the concept of early decompression in brain pathology, the discussion of the timing of decompression in SCI has emerged. In addition to that, the concept of "time is spine" has been added recently, and the mortality and complications caused by SCI have been reduced by providing timely and professional treatment to patients. However, there are many difficulties in establishing international clinical guidelines for the timing of early decompression in SCI because policies for each country and medical institution differ according to the circumstances of medical infrastructure and economic conditions in the surgical treatment of SCI. Therefore, we aim to provide a current review of timing of early decompression in patient with SCI.
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Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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17
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Kostoff RN, Briggs MB, Kanduc D, Dewanjee S, Kandimalla R, Shoenfeld Y, Porter AL, Tsatsakis A. Modifiable contributing factors to COVID-19: A comprehensive review. Food Chem Toxicol 2023; 171:113511. [PMID: 36450305 PMCID: PMC9701571 DOI: 10.1016/j.fct.2022.113511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
The devastating complications of coronavirus disease 2019 (COVID-19) result from an individual's dysfunctional immune response following the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Multiple toxic stressors and behaviors contribute to underlying immune system dysfunction. SARS-CoV-2 exploits the dysfunctional immune system to trigger a chain of events ultimately leading to COVID-19. The current study identifies eighty immune system dysfunction-enabling toxic stressors and behaviors (hereafter called modifiable contributing factors (CFs)) that also link directly to COVID-19. Each CF is assigned to one of the five categories in the CF taxonomy shown in Section 3.3.: Lifestyle (e.g., diet, substance abuse); Iatrogenic (e.g., drugs, surgery); Biotoxins (e.g., micro-organisms, mycotoxins); Occupational/Environmental (e.g., heavy metals, pesticides); Psychosocial/Socioeconomic (e.g., chronic stress, lower education). The current study shows how each modifiable factor contributes to decreased immune system capability, increased inflammation and coagulation, and increased neural damage and neurodegeneration. It is unclear how real progress can be made in combatting COVID-19 and other similar diseases caused by viral variants without addressing and eliminating these modifiable CFs.
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Affiliation(s)
- Ronald Neil Kostoff
- Independent Consultant, Gainesville, VA, 20155, USA,Corresponding author. Independent Consultant, 13500 Tallyrand Way, Gainesville, VA, 20155, USA
| | | | - Darja Kanduc
- Dept. of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, Via Orabona 4, Bari, 70125, Italy
| | - Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad, 500007, Telangana, India
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, 5265601, Israel
| | - Alan L. Porter
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece
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18
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Xie DM, Sun C, Tu Q, Li S, Zhang Y, Mei X, Li Y. Modified black phosphorus quantum dots promotes spinal cord injury repair by targeting the AKT signaling pathway. J Tissue Eng 2023; 14:20417314231180033. [PMID: 37333896 PMCID: PMC10272649 DOI: 10.1177/20417314231180033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Spinal cord injury (SCI) is a serious refractory disease of the central nervous system (CNS), which mostly caused by high-energy trauma. Existing interventions such as hormone shock and surgery are insufficient options, which relate to the secondary inflammation and neuronal dysfunction. Hydrogel with neuron-protective behaviors attracts tremendous attention, and black phosphorus quantum dots (BPQDs) encapsulating with Epigallocatechin-3-gallate (EGCG) hydrogels (E@BP) is designed for inflammatory modulation and SCI treatment in this study. E@BP displays good stability, biocompatibility and safety profiles. E@BP incubation alleviates lipopolysaccharide (LPS)-induced inflammation of primary neurons and enhances neuronal regeneration in vitro. Furthermore, E@BP reconstructs structural versus functional integrity of spinal cord tracts, which promotes recovery of motor neuron function in SCI rats after transplantation. Importantly, E@BP restarts the cell cycle and induces nerve regeneration. Moreover, E@BP diminishes local inflammation of SCI tissues, characterized by reducing accumulation of astrocyte, microglia, macrophages, and oligodendrocytes. Indeed, a common underlying mechanism of E@BP regulating neural regenerative and inflammatory responses is to promote the phosphorylation of key proteins related to AKT signaling pathway. Together, E@BP probably repairs SCI by reducing inflammation and promoting neuronal regeneration via the AKT signaling pathway.
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Affiliation(s)
- Dong-Mei Xie
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chuanwei Sun
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Qingqiang Tu
- Zhongshan Medical College, Sun Yat-sen University, Guangzhou, China
| | - Suyi Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xifan Mei
- Department of Orthopedics, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, China
| | - Yuanlong Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Lee S, Nam H, Joo KM, Lee SH. Advances in Neural Stem Cell Therapy for Spinal Cord Injury: Safety, Efficacy, and Future Perspectives. Neurospine 2022; 19:946-960. [PMID: 36351442 PMCID: PMC9816608 DOI: 10.14245/ns.2244658.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating central nervous system injury that leads to severe disabilities in motor and sensory functions, causing significant deterioration in patients' quality of life. Owing to the complexity of SCI pathophysiology, there has been no effective treatment for reversing neural tissue damage and recovering neurological functions. Several novel therapies targeting different stages of pathophysiological mechanisms of SCI have been developed. Among these, treatments using stem cells have great potential for the regeneration of damaged neural tissues. In this review, we have summarized recent preclinical and clinical studies focusing on neural stem cells (NSCs). NSCs are multipotent cells with specific differentiation capabilities for neural lineage. Several preclinical studies have demonstrated the regenerative effects of transplanted NSCs in SCI animal models through both paracrine effects and direct neuronal differentiation, restoring synaptic connectivity and neural networks. Based on the positive results of several preclinical studies, phase I and II clinical trials using NSCs have been performed. Despite several hurdles and issues that need to be addressed in the clinical use of NSCs in patients with SCI, gradual progress in the technical development and therapeutic efficacy of NSCs treatments has enhanced the prospects for cell-based treatments in SCI.
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Affiliation(s)
- Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea,Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon, Korea,Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Kyeung-Min Joo
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea,Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon, Korea,Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea,Corresponding Author Kyeung-Min Joo Department of Anatomy and Cell Biology, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon 16419, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea,Co-corresponding Author Sun-Ho Lee Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Zhang Y, Li AA, Xiao SN, Zhong NS, Tong WL, Wang SJ, Liu JM, Liu ZL. A Bibliometric Analysis of Publications on Spinal Cord Injury Treatment With Glucocorticoids Using VOSviewer. Front Public Health 2022; 10:907372. [PMID: 36003626 PMCID: PMC9393342 DOI: 10.3389/fpubh.2022.907372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/20/2022] [Indexed: 01/03/2023] Open
Abstract
Background Spinal cord injury (SCI) has devastating physical and social consequences for patients. Systemic administration of methylprednisolone (MP) at a higher dosage though can reduce neurological deficits following acute SCI. Still, this treatment regimen is controversial, owing to the apparent dose-related side effects and relatively minor improvement in neurological function. Therefore, this study aimed at the bibliometric analysis of published literature related to SCI treatment, which may lead to future research trends. Methods The literature published relating to SCI and using glucocorticoids for its treatment between 1982 and 2022 was collected and scanned in the Web of Science collection database using the keywords glucocorticoid, dexamethasone, MP, corticosteroids, and SCI, followed by using VOSviewer for bibliometric analysis of these articles. Results A total of 1,848 published articles and 7,448 authors on SCI and glucocorticoid usage were identified. The SCI total link strength accounts for 1,341, and MP for 762 has a strong link to neuroprotection and inflammation. The mean citation count for the top 20 most-cited articles was 682 (range: 358–1,828), where most of these were descriptive studies having focused on clinical features. The Journal of Neurotrauma was the highest-ranked journal with 6,010 citations. A total of 69 articles were published by Michael G Fehlings from the University of Toronto with 6,092 citations. The University of Toronto has published 90-related manuscripts with 7,632 citations. In contrast, 800 articles were published in the United States, with 39,633 citations and total link strength of 5,714. The second-ranked country was China, with 241 published articles and 3,403 citations. Conclusions The research published on applying MP in treating SCI has increased with time. Although the United States has made a significant global contribution to this important field of research, it requires rigorous clinical trials designed to verify the therapeutic role of MP in SCI and its appropriate dosage to find solutions for neurological recovery.
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Affiliation(s)
- Yu Zhang
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - An-An Li
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Shi-Ning Xiao
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Nan-Shan Zhong
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Wei-Lai Tong
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Shi-Jiang Wang
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Jia-Ming Liu
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Zhi-Li Liu
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- *Correspondence: Zhi-Li Liu
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Lee BJ, Jeong JH. Review: Steroid Use in Patients With Acute Spinal Cord Injury and Guideline Update. Korean J Neurotrauma 2022; 18:22-30. [PMID: 35557630 PMCID: PMC9064751 DOI: 10.13004/kjnt.2022.18.e21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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22
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Kim S. Meta-analysis of the Effectiveness of Steroid Pulse Therapy in Treating Patients with Spinal Cord Injury. Open Nurs J 2021. [DOI: 10.2174/1874434602115010186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
High-dose steroid injection therapy is effective in reducing anti-inflammation and edema and is often used to treat patients with acute spinal cord injury. To evaluate the effectiveness of steroid pulse therapy and identify the factors that affect its effectiveness in patients with acute traumatic spinal cord injury.
Methods:
A comprehensive literature search of the databases Pubmed, Medline, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL was performed on July 31, 2019, with no language and time limits. For analysis, studies conducted within the last 10 years were included to reflect on the recent trend.
Results:
A total of 3 randomized controlled trials and 5 observational studies with 2418 patients were included in this meta-analysis. High-dose steroid injection therapy was found to have a high effect on patients with acute spinal cord injury. The following factors had a strong influence on the effectiveness of high-dose steroid treatment in patients with acute spinal cord injuries: injury, onset ASIA, onset neurological assessment scales, time to start treatment after injury, age, BMI, and gender.
Conclusion:
It is necessary to accurately assess the scope of spinal injury in the early stages and actively provide nursing interventions to identify and mediate factors affecting the treatment effect.
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Torabi S, Anjamrooz SH, Zeraatpisheh Z, Aligholi H, Azari H. Ibrutinib reduces neutrophil infiltration, preserves neural tissue and enhances locomotor recovery in mouse contusion model of spinal cord injury. Anat Cell Biol 2021; 54:350-360. [PMID: 34031271 PMCID: PMC8493027 DOI: 10.5115/acb.20.299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022] Open
Abstract
Following acute spinal cord injury (SCI), excessive recruitment of neutrophils can result in inflammation, neural tissue loss and exacerbation of neurological outcomes. Ibrutinib is a bruton's tyrosine kinase inhibitor in innate immune cells such as the neutrophils that diminishes their activation and influx to the site of injury. The present study evaluated the efficacy of ibrutinib administration in the acute phase of SCI on neural tissue preservation and locomotor recovery. Ibrutinib was delivered intravenously at 3.125 mg/kg either immediately, 12 hours after, or both immediately and 12 hours after SCI induction in adult male C57BL/6 mice. Neutrophil influx into the lesion area was evaluated 24 hours following SCI using light microscopy and immunohistochemistry methods. Animals' body weight changes were recorded, and their functional motor recovery was assessed based on the Basso mouse scale during 28 days after treatment. Finally, spinal cord lesion volume was estimated by an unbiased stereological method. While animals' weight in the control group started to increase one week after injury, it stayed unchanged in treatment groups. However, the double injection of ibrutinib led to a significantly lower body weight compared to the control group at 4 weeks post-injury. Mean neutrophil counts per visual field and the lesion volume were significantly decreased in all ibrutinib-treated groups. In addition, ibrutinib significantly improved locomotor functional recovery in all treated groups, especially in immediate and double-injection groups. Neural tissue protection and locomotor functional recovery suggest ibrutinib treatment as a potent immunotherapeutic intervention for traumatic SCI that warrants clinical testing.
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Affiliation(s)
- Somayyeh Torabi
- Department of Anatomical Sciences, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hadi Anjamrooz
- Department of Anatomical Sciences, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zeraatpisheh
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Aligholi
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Azari
- Department of Neurosurgery, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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Gao J, Khang M, Liao Z, Detloff M, Lee JS. Therapeutic targets and nanomaterial-based therapies for mitigation of secondary injury after spinal cord injury. Nanomedicine (Lond) 2021; 16:2013-2028. [PMID: 34402308 PMCID: PMC8411395 DOI: 10.2217/nnm-2021-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/29/2021] [Indexed: 12/31/2022] Open
Abstract
Spinal cord injury (SCI) and the resulting neurological trauma commonly result in complete or incomplete neurological dysfunction and there are few effective treatments for primary SCI. However, the following secondary SCI, including the changes of microvasculature, inflammatory response and oxidative stress around the injury site, may provide promising therapeutic targets. The advances of nanomaterials hold promise for delivering therapeutics to alleviate secondary SCI and promote functional recovery. In this review, we highlight recent achievements of nanomaterial-based therapy, specifically targeting blood-spinal cord barrier disruption, mitigation of the inflammatory response and lightening of oxidative stress after spinal cord injury.
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Affiliation(s)
- Jun Gao
- Department of Bioengineering, Drug Design, Development & Delivery (4D) Laboratory, Clemson University, Clemson, SC 29634, USA
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Minkyung Khang
- Department of Bioengineering, Drug Design, Development & Delivery (4D) Laboratory, Clemson University, Clemson, SC 29634, USA
| | - Zhen Liao
- Department of Bioengineering, Drug Design, Development & Delivery (4D) Laboratory, Clemson University, Clemson, SC 29634, USA
| | - Megan Detloff
- Department of Neurobiology & Anatomy, Drexel University, Philadelphia, PA 19129, USA
| | - Jeoung Soo Lee
- Department of Bioengineering, Drug Design, Development & Delivery (4D) Laboratory, Clemson University, Clemson, SC 29634, USA
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Lee BS, Kim O, Ham D. Epidemiological changes in traumatic spinal cord injuries for the last 30 years (1990-2019) in South Korea. Spinal Cord 2021; 60:612-617. [PMID: 34465888 DOI: 10.1038/s41393-021-00694-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/01/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective descriptive study. OBJECTIVES To identify the characteristics of and epidemiological trends in traumatic spinal cord injuries (TSCIs) in Korea from 1990 to 2019. SETTING National Rehabilitation Center affiliated with the Ministry of Health and Welfare in Korea. METHODS The medical records of 3395 individuals with TSCIs were retrospectively reviewed. Three groups were formed based on onset period (1990-1999, 2000-2009, and 2010-2019) and six groups based on age (≤15, 16-30, 31-45, 46-60, 61-75, and ≥76 years). Pearson's chi-square and analysis of variance tests were used for statistical analysis. RESULTS From 1990 to 2019, the mean age (standard deviation, [SD]) at the time of injury increased from 32.4 (SD = 12.4) years in the 1990s to 47.1 (SD = 16.2) years in the 2010s (F = 222.317 p = <0.001). Land transport and falls were the most common causes of TSCIs. The number of injuries from land transport gradually decreased, while that from falls increased (24.9% in 1990s to 46.3% in 2010s [χ2 = 134.415 p < 0.001]). In the >60 years group, falls were the most common cause of injury, which resulted in 42.9% TSCIs in the 1990s to 59.1% in the 2010s (χ2 = 10.398, p > 0.05). Tetraplegia (n = 769, 58.6%) was more common than paraplegia; incomplete tetraplegia (entire population: =564, 43%; >60 years group: n = 186, 43%) was the highest in the 2010s. CONCLUSIONS Falls have been the most common cause of TSCIs after 2010s. Implementing national education and campaigns for preventing falls is important to reduce/prevent TSCIs caused by falls in the aged population.
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Affiliation(s)
- Bum-Suk Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, South Korea
| | - Onyoo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, South Korea.
| | - Daehoon Ham
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, South Korea
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Epidemiologic changes in nontraumatic spinal cord injury for the last 30 years (1990-2019) in South Korea. Spinal Cord 2021; 60:268-273. [PMID: 34453110 DOI: 10.1038/s41393-021-00695-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective descriptive study. OBJECTIVES To summarize epidemiologic data on nontraumatic spinal cord injury (NTSCI) for the last 30 years and compare these findings to data from individuals with traumatic spinal cord injury (TSCI). SETTING National Rehabilitation Center affiliated with the Ministry of Health and Welfare in Korea. METHODS The medical records of 948 individuals with NTSCIs were retrospectively reviewed. Three groups were created based on onset period (1990-1999, 2000-2009, 2010-2019) and six groups based on age (≤15, 16-30, 31-45, 46-60, 61-75, and ≥76 years). Pearson's chi-square and analysis of variance tests were used for statistical analysis. RESULTS The male-to-female ratio was 1.30:1 for NTSCI individuals and 3.47:1 for TSCI individuals. The mean age (standard deviation [SD]) at the time of injury increased from 38.7 (SD = 18.1) years in the 1990s to 55.5 (SD = 16.6) years in the 2010s (F = 44.597, p ≤ 0.001). Vertebral column degenerative disorder was the primary cause of injury in 28.9% of the cases, and the most common neurologic level was T12-L2. Paraplegia occurred in 74.6% of cases, and tetraplegia in 25.4% of cases. The proportion of NTSCI individuals increased from 11.2% to 29.3% during the observation period. CONCLUSIONS The proportion of NTSCI among total spinal cord injuries has increased in Korea over the last 30 years (1990-2019). Compared to individuals with TSCI, those with NTSCI had a higher age at onset, with different male-to-female ratios. Our study is the most comprehensive investigation of NTSCI in Korea, and our findings can inform research directions and medical guidelines.
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Kim HS, Park JH, Lee HS, Lee JY, Jung JW, Park SB, Hyun DJ, Park S, Yoon J, Lim H, Choi YY, Kim MJ. Effects of Wearable Powered Exoskeletal Training on Functional Mobility, Physiological Health and Quality of Life in Non-ambulatory Spinal Cord Injury Patients. J Korean Med Sci 2021; 36:e80. [PMID: 33783145 PMCID: PMC8007419 DOI: 10.3346/jkms.2021.36.e80] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a serious clinical condition that impacts a patient's physical, psychological, and socio-economic status. The aim of this pilot study was to evaluate the effects of training with a newly developed powered wearable exoskeleton (Hyundai Medical Exoskeleton [H-MEX]) on functional mobility, physiological health, and quality of life in non-ambulatory SCI patients. METHODS Participants received 60 minutes of walking training with a powered exoskeleton 3 times per week for 10 weeks (total 30 sessions). The 6-minute walking test (6MWT) and timed-up-and-go test (TUGT) were performed to assess ambulatory function. The physiological outcomes of interest after exoskeleton-assisted walking training were spasticity, pulmonary function, bone mineral density, colon transit time, and serum inflammatory markers. Effects of walking training on subjective outcomes were estimated by the Korean version of the Falls Efficacy Scale-International and the 36-Item Short-Form Health Survey version 2. RESULTS Ten participants finished 30 sessions of training and could ambulate independently. No severe adverse events were reported during the study. After training, the mean distance walked in the 6MWT (49.13 m) was significantly enhanced compared with baseline (20.65 m). The results of the TUGT also indicated a statistically significant improvement in the times required to stand up, walk 3 m and sit down. Although not statistically significant, clinically meaningful changes in some secondary physiological outcomes and/or quality of life were reported in some participants. CONCLUSION In conclusion, this study demonstrated that the newly developed wearable exoskeleton, H-MEX is safe and feasible for non-ambulatory SCI patients, and may have potential to improve quality of life of patients by assisting bipedal ambulation. These results suggest that the H-MEX can be considered a beneficial device for chronic non-ambulatory SCI patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04055610.
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Affiliation(s)
- Hyeon Seong Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Ho Seok Lee
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Young Lee
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Won Jung
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Si Bog Park
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Jin Hyun
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - Sangin Park
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - JuYoung Yoon
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - Hyunseop Lim
- Robotics Lab., R&D Division of Hyundai Motor Company, Uiwang, Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Updated Review: The Steroid Controversy for Management of Spinal Cord Injury. World Neurosurg 2021; 150:1-8. [PMID: 33684579 DOI: 10.1016/j.wneu.2021.02.116] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute spinal cord injury (ASCI) is a devastating event that can have a profound impact on the lives of patients and their families. While no definitive medical treatment exists, the role of methylprednisolone (MP) in the management of ASCI and other spinal cord pathologies has been investigated in depth; however, its use remains contentious. While MP initially showed promise in the efficacy of ASCI treatment, more recent studies have questioned its use citing numerous systemic adverse effects. Pharmacologic treatments in this area are poorly understood due to the scarcity of knowledge surrounding the pathophysiology and heterogeneity of patients presenting with these conditions. Despite these shortcomings and due to the lack of alternative treatment options, MP is still widely used by physicians. METHODS We review prior and current literature on the use of MP treatment for ASCI patients with a discussion of novel drug delivery systems that have demonstrated the potential to improve MP's bioavailability at the site of injury while minimizing systemic side effects. In addition, current views on the role of MP and dexamethasone in metastatic spinal cord compression and postoperative infection are reviewed. RESULTS While some data support benefits in the use of steroids on spinal cord pathology, extensive research suggests at best limited effects and an unresolvable risk/benefit problem. CONCLUSIONS At present, evidence regarding use of dexamethasone for MSCC is contentious, especially regarding dose regiments. Ultimately, further investigation into the use of steroids is required to determine its utility in treating patients with spinal cord pathology.
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Shin H. Etiology and epidemiology of spinal cord injury in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.10.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute spinal cord injury (SCI) is a catastrophic traumatic event that affects the physical and psychological well-being of individuals and results in considerable socio-economic losses. SCI is an incurable condition; therefore, prevention is critical. Thorough understanding of the epidemiology of SCI is essential to implement optimal preventive measures and effectively plan clinical services. The incidence of SCI was 54 and 40.2 cases per million population in the United States and Japan, respectively; however, national statistical data regarding SCI are unavailable in Korea. Considering that the incidence in Korea is similar to that observed in the United States or Japan, it is estimated that 2,000 to 2,500 new cases of SCI are observed in Korea annually. The male:female ratio is 3:1 to 5:1 in most countries and 3:1 in Korea. More than 50% of patients with SCI are aged <30 years at the time of the injury. However, the incidence of SCI is rapidly increasing in elderly individuals and in women. The most common causes of SCI in descending order of frequency include traffic accidents, falls, sports injuries, and violence. Incomplete injury is increasingly being observed in recent times in contrast to a higher incidence of complete injury reported previously. It is important to establish an accurate comprehensive statistical database in Korea, similar to The National Spinal Cord Injury Statistical Center, USA.
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Leigh JH, Kim HK, Bang MS. Incidence of acute spinal cord injury in South Korea does not reflect a sizable number of traumatic spinal cord injuries. Spinal Cord 2020; 58:939-940. [PMID: 32355313 DOI: 10.1038/s41393-020-0475-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Rehabilitation Medicine, Workers' Compensation and Welfare Incheon Hospital, Incheon, Republic of Korea
| | - Han-Kyoul Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea.
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Choi SH, Jeong SY, Kang CN. A more accurate incidence of acute spinal cord injury in South Korea can be estimated by the national health insurance system. Spinal Cord 2020; 58:941-942. [PMID: 32355312 DOI: 10.1038/s41393-020-0476-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sung Hoon Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Soo-Young Jeong
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Chang-Nam Kang
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea.
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Comparing Activity and Participation between Acquired Brain Injury and Spinal-Cord Injury in Community-Dwelling People with Severe Disability Using WHODAS 2.0. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093031. [PMID: 32349383 PMCID: PMC7246687 DOI: 10.3390/ijerph17093031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/14/2022]
Abstract
Central-nervous-system (CNS) injuries constitute a significant cause of morbidity (often resulting in long-term disability) and mortality. This cross-sectional study compared the activity and participation of community-dwelling people with severe disability from acquired brain injuries (ABI) (n = 322) and spinal-cord injuries (SCI) (n = 183) to identify risk factors related to disability. Data were collected through a questionnaire survey of community-dwelling people with severe disability attending 65 healthcare centers. The survey included the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and sociodemographic factors. We categorized a registered grade of disability of 1 or 2 as severe disability. WHODAS 2.0 domain and summary scores were compared between the ABI and SCI groups, and risk factors associated with disability were identified through regression analysis. ABI participants had significantly higher disability in cognition and relationships, whereas patients with SCI had higher disability in mobility (p < 0.05). Onset duration was negatively correlated with cognition, relationships, participation, and summary scores in ABI participants (p < 0.05). Neither group’s socioeconomic factors were associated with WHODA 2.0 scores. Understanding the different patterns of disability between SCI and ABI in community-dwelling people with severe disability helps establish future plans for the management of health resources.
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