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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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Cao Y, DiPiro ND, Krause JS. Longitudinal changes in employment, health, participation, and quality-of-life and the relationships with long-term survival after spinal cord injury. Spinal Cord 2023; 61:430-435. [PMID: 36854965 PMCID: PMC10767623 DOI: 10.1038/s41393-023-00882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVE To identify five-year longitudinal changes in employment, health, participation, and quality-of-life outcomes (QOL) among participants with chronic spinal cord injury (SCI) and to compare the amount of change in these outcomes between those surviving and those not surviving until follow-up. METHODS Participants were 1157 individuals from the SCI Longitudinal Aging Study, who have completed at least two self-report assessments separated by five-year intervals. The main outcome measures were 13 indicators related to employment, health, participation, and QOL/psychosocial indicators. Survival status measured at follow-up. RESULTS Those who survived to follow up had a history indicating a greater likelihood of employment, better health, participation, and QOL/psychosocial indicators. Among survivors, longitudinal declines were limited to the percent employed and participation indicators, whereas those deceased by follow-up had significant undesirable changes in employment, participation, health, and QOL/psychosocial indicators. More specifically, compared to the survivors, those deceased by follow-up experienced a greater increase in hospitalizations, decreases in nights away from home, and declines in global satisfaction over the five-year interval. CONCLUSIONS Longitudinal declines in employment and some aspects of participation are common among long-term survivors and may be part of the natural course of outcomes after SCI. However, more dramatic increases in hospitalizations, fewer nights away from home, and declining satisfaction may be red flags for declining longevity.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Cao Y, DiPiro N, Krause JS. Life Satisfaction Trend and Mortality After Traumatic Spinal Cord Injury: A Cohort Study. Top Spinal Cord Inj Rehabil 2023; 29:33-41. [PMID: 36819925 PMCID: PMC9936900 DOI: 10.46292/sci22-00090] [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] [Indexed: 02/17/2023]
Abstract
Background Individuals with traumatic spinal cord injuries (SCIs) have lower subjective well-being and diminished longevity, yet there is a lack of research on how life satisfaction and changes in life satisfaction relate to longevity. Objectives To identify the relationships between survival status and life satisfaction and its changing trend over a 10-year period. Methods Data were taken from the SCI Longitudinal Aging Study. A cohort study of 676 adult participants with SCI completed three assessments separated by 5-year intervals. We applied the survival analyses by using person-year logistic regression models. Results There were 135 participants (20%) who were deceased by the end of 2019. After controlling for demographic and injury factors, life satisfaction was significantly related to survival. In the final model, having an upward trend of life satisfaction was significantly associated with lower odds of mortality, whereas a downward trend in life satisfaction was not significant. Conclusion Our findings demonstrate the importance of current life satisfaction and having a trend toward improving satisfaction to survival. The findings indicated the importance of psychosocial adaptation to life quality and longevity after SCI.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Nicole DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
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Pasipanodya E, Khong CM, Dirlikov B, Prutton M, Held M, Shem K. Telepsychology for Individuals With Spinal Cord Injury: Protocol for a Randomized Control Study of Video-Based Cognitive Behavioral Therapy. Top Spinal Cord Inj Rehabil 2022; 28:56-67. [PMID: 36457360 PMCID: PMC9678220 DOI: 10.46292/sci22-00010] [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] [Indexed: 11/17/2022]
Abstract
Background A substantial proportion of individuals with spinal cord injury (SCI) experience depression, which has been negatively associated with recovery and community participation after injury. Despite significant barriers to seeking and receiving in-person mental health care, little research has focused on the efficacy of telepsychology among individuals with SCI. Objectives To describe the design and implementation of an ongoing single-center, randomized controlled, video-based cognitive behavioral therapy (CBT) intervention among individuals with SCI. Methods Participants within 1 year of SCI will be randomized 1:1 to intervention or usual care in a 24-week study. Intervention participants will engage in 10 sessions of CBT over 12 weeks with a licensed clinical psychologist, using iPads via Apple FaceTime. Primary outcomes are depressive symptomatology, anxiety, and life satisfaction (as measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Satisfaction with Life Scale, respectively) measured at three time points (baseline, 12 weeks, and 24 weeks). These and other measures are also assessed during monthly telephone surveys conducted between primary timepoints. Results Recruitment is ongoing. Forty-six participants have been enrolled thus far. Conclusion Telepsychology is a convenient, flexible, and effective alternative to traditional in-person services. We anticipate that intervention participants will experience improvements in depressive and anxiety symptoms and will have greater life satisfaction. Telepsychology interventions among individuals with SCI are tasked to maintain participant privacy, provide assistive technology and/or engage caregivers to minimize mobility limitations, and manage risk remotely. Challenges encountered include recruitment during the COVID-19 pandemic. Early intervention on symptoms of psychological morbidity using telepsychology may facilitate greater adaptation following SCI.
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Affiliation(s)
- Elizabeth Pasipanodya
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Cria-May Khong
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Michael Prutton
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Mark Held
- Department of Psychiatry, Santa Clara Valley Medical Center, San Jose, California
| | - Kazuko Shem
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California
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Cao Y, DiPiro ND, Jarnecke M, Krause JS. Social participation as a mediator of the relationships of socioeconomic factors and longevity after traumatic spinal cord injury. Spinal Cord 2022; 60:799-804. [PMID: 35379958 PMCID: PMC9444867 DOI: 10.1038/s41393-022-00794-x] [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: 11/01/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVE Previous research has indicated that socioeconomic factors affect longevity after traumatic spinal cord injury (SCI). Our purpose was to evaluate whether social participation mediates the relationship between socioeconomic factors and survival status after SCI. SETTING Medical university in the southeastern United States. METHODS Participants (N = 1540) met the following inclusion criteria: traumatic SCI of at least 1-year duration, minimum of 18 years of age, and having residual impairment from SCI. The main outcome measures were a) survival status as of December 31, 2019, identified by the National Death Index (NDI) search, b) socioeconomic status (SES), measured by education, employment status, and family income, and c) participation, measured by marital/relationship status, hours out of bed per day, days leaving home per week, and nights away home during the past year. RESULTS Thirty nine percent of participants (n = 602) were decreased by the end of 2019. Socioeconomic factors were associated with longevity controlling for demographic, injury characteristics, and health status. However, the association of SES with longevity was mediated by three social participation mobility indicators (hours out of bed, days out of house, and nights away from home), such that SES was no longer significantly related to longevity after inclusion of the participation variables. CONCLUSIONS Although socioeconomic factors are related to longevity, their relationship appears to be mediated by social participation mobility indicators. Intervention studies are needed to address the modifiable factors that may promote longevity, including promoting an active lifestyle.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Nicole D. DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Melinda Jarnecke
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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Radomski MV, Anheluk M, Carroll GL, Grabe K, Halsten JW, Kath K, Kreiger RA, Lunos ME, Rabusch S, Swenson KK, Zola J. Preliminary Efficacy of an Occupation-Oriented Purpose in Life Intervention After Breast Cancer. Can J Occup Ther 2022; 89:115-126. [PMID: 35040344 DOI: 10.1177/00084174211073264] [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] [Indexed: 11/15/2022]
Abstract
Background. Purpose in life is important to health and well-being; purpose disruption often goes unidentified after breast cancer. Purpose. To evaluate the efficacy of a purpose renewal intervention and utility of a screening question for identifying people with purpose-related distress. Method. In this prospective pretest-posttest study, participants with breast cancer received an 8-session purpose renewal group intervention (n = 35). Participants completed standardized measures of meaning and purpose at pretest, posttest, and two-month follow-up and a forced-choice Purpose Status Question (PSQ) at pretest. Findings. Participants made statistically significant pretest-to-posttest and pretest-to-follow-up improvements. The PSQ demonstrated construct validity: 40% of participants lacked purpose direction at pretest and this subgroup made significantly greater improvements than participants who reported purpose direction at pretest. Implications. The PSQ warrants further study as a screener to identify people with purpose-related distress. Many breast cancer survivors may benefit from a purpose in life intervention; a subgroup may benefit more.
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Eroğlu S, Solak S, Dündar Ü. The association of Type D personality with functional outcomes, quality of life and neuropathic pain in persons with spinal cord injury. Spinal Cord 2022; 60:567-573. [PMID: 35124701 DOI: 10.1038/s41393-022-00760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES This study aimed to investigate the association of Type D personality (TDP) with functional outcomes, health-related quality of life (HRQoL) and neuropathic pain in persons with spinal cord injury (SCI), using dichotomous and continuous analysis methods. SETTING Tertiary rehabilitation center. METHODS This study included 105 persons with SCI. Independence level was determined using the Functional Independence Measure (FIM)-motor subscale. The Short Form-36 questionnaire (SF-36) was used to assess HRQoL. TDP (combined existence of negative affectivity and social inhibition) was assessed using Type D Scale-14 (DS-14). Presence of chronic pain was questioned and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale was used to distinguish neuropathic pain from others. RESULTS In dichotomous method, the FIM-motor score was significantly lower in persons with TDP (41 persons, 39%) (p = 0.025). Persons with TDP had significantly lower scores in vitality, emotional role and mental health. There was no significant difference between the groups, regarding neuropathic pain and LANSS scores (p > 0.05 for all). Negative affectivity and total DS-14 scores had negative correlation with mental health and vitality. In continuous interaction method, TDP predicted mainly the mental health components of SF-36 (particularly, vitality and mental health). Negative affectivity was the driving factor. TDP was not associated with FIM-motor, VAS pain or LANSS scores. CONCLUSIONS Mental component of HRQoL is associated with Type D in persons with SCI in both analyses. Assessment of potential differences related with TDP may be beneficial to develop and apply person-specific goals in SCI rehabilitation.
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Affiliation(s)
- Selma Eroğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | - Samed Solak
- Department of Physical Medicine and Rehabilitation, Kahta State Hospital, Adıyaman, Turkey
| | - Ümit Dündar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Is Self-Efficacy Related to the Quality of Life in Elite Athletes after Spinal Cord Injury? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010866. [PMID: 34682606 PMCID: PMC8535663 DOI: 10.3390/ijerph182010866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022]
Abstract
Background: A spinal cord injury (SCI) is a traumatic event that affects every aspect of life: physical, mental, economic, and social. The main aim of this study was to investigate self-efficacy, quality of life, and their correlations among outstanding athletes who have suffered spinal cord injuries, and to determine whether these individuals have specific psychological characteristics that contribute to a better quality of life. Methods: The study involved nine athletes with at least national-level achievements in sports prior to an SCI. Participation in the study consisted of an interview via an online communicator, followed by an online questionnaire consisting of a personal questionnaire and two scales: The World Health Organization Quality of Life Scale (WHOQoL-BREF), and the General Self-Efficacy Scale (GSES). Results: Spearman’s correlation showed a correlation between general self-efficacy, perception of quality of life, and satisfaction with own physical health, as well as psychological resources and environmental support. Conclusions: Involvement in an environment that was important to the injured person before the accident, in either a passive (in the absence of functional capacity) or active form, promotes a greater sense of self-efficacy and good QoL, regardless of the time that has passed since the accident, and despite high levels of pain or secondary health issues. To fill the gap in professional long-term healthcare services for athletes after SCIs, intervention programs should be considered that support self-efficacy, which is an important factor that can be subject to improvement.
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Purpose in Life of Elite Athletes after Spinal Cord Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115563. [PMID: 34070973 PMCID: PMC8197014 DOI: 10.3390/ijerph18115563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022]
Abstract
Background: Searching for the meaning of human existence is man’s fundamental orientation. People are free to find meaning in their lives, and while they are not always free to choose the conditions of life, they are free to choose their attitude toward the conditions in which they find themselves. When people experience an unchangeable situation, the most important thing is the attitude they take toward it. This study aimed to identify the sense of meaning in life among elite athletes after a spinal cord injury (SCI) and to analyze the different aspects contributing to this domain. Methods: The study involved five athletes with at least national-level achievements in sports prior to a SCI. The study consisted of an interview using a communicator and filling out two online questionnaires—a personal questionnaire and the Purpose in Life Scale. Results: Analyzing the quantitative results, four participants achieved results indicating a high sense of meaning in life, while one participant achieved a significantly lower result. Conclusions: What affects one’s purpose in life is not so much the objective physical limitation but how much physicality one perceives to have lost as a result of the injury. Elite athletes stay involved in the sporting environment, which prevents the loss of purpose and maintains a sense of meaning at a high level. Both telling the story of your own illness and listening to the stories of others help the process of self-healing.
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An evaluation of the representativeness of a national spinal cord injury registry: a population-based cohort study. Spinal Cord 2021; 59:1072-1078. [PMID: 33828247 DOI: 10.1038/s41393-021-00622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Population-based cohort study for the western part of Quebec. OBJECTIVES To determine the impact of declining to participate in a national spinal cord injury (SCI) registry on patient outcomes and continuum of care. SETTING Level-1 trauma center specialized in SCI care in Montreal, Canada. METHODS This cohort study compared the outcomes of 444 patients who were enrolled in the Rick Hansen SCI registry and 140 patients who refused. Logistic regression analyses were performed to assess the association between voluntary participation and the outcomes, while adjusting for confounding factors. The main outcomes were: attendance to follow-up 6- to 12-month post injury, 1-year mortality, and the occurrence of pressure injury during acute care. RESULTS Declining to be enrolled in the registry was a significant predictor of lower attendance to specialized follow-up (adjusted odds ratio [OR] 0.04, 95% confidence interval [CI] 0.02-0.08). It was also associated with a higher 1-year mortality rate (OR 12.50, CI 4.50-33.30) and higher occurrence of pressure injury (OR 2.56, CI 1.56-4.17). CONCLUSIONS This study sheds invaluable insight on individuals that researchers and clinicians are usually blind to in SCI cohort studies. This study suggests that decline to participate in a registry during the care hospitalization may be associated with worsened health, poorer outcomes, and reduced follow-up to specialized care. Declining the enrollment to voluntary registry could represent a potential prognostic factor for future research.
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