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Goodus MT, Alfredo AN, Carson KE, Dey P, Pukos N, Schwab JM, Popovich PG, Gao J, Mo X, Bruno RS, McTigue DM. Spinal cord injury-induced metabolic impairment and steatohepatitis develops in non-obese rats and is exacerbated by premorbid obesity. Exp Neurol 2024; 379:114847. [PMID: 38852834 DOI: 10.1016/j.expneurol.2024.114847] [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: 02/03/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
Impaired sensorimotor functions are prominent complications of spinal cord injury (SCI). A clinically important but less obvious consequence is development of metabolic syndrome (MetS), including increased adiposity, hyperglycemia/insulin resistance, and hyperlipidemia. MetS predisposes SCI individuals to earlier and more severe diabetes and cardiovascular disease compared to the general population, which trigger life-threatening complications (e.g., stroke, myocardial infarcts). Although each comorbidity is known to be a risk factor for diabetes and other health problems in obese individuals, their relative contribution or perceived importance in propagating systemic pathology after SCI has received less attention. This could be explained by an incomplete understanding of MetS promoted by SCI compared with that from the canonical trigger diet-induced obesity (DIO). Thus, here we compared metabolic-related outcomes after SCI in lean rats to those of uninjured rats with DIO. Surprisingly, SCI-induced MetS features were equal to or greater than those in obese uninjured rats, including insulin resistance, endotoxemia, hyperlipidemia, liver inflammation and steatosis. Considering the endemic nature of obesity, we also evaluated the effect of premorbid obesity in rats receiving SCI; the combination of DIO + SCI exacerbated MetS and liver pathology compared to either alone, suggesting that obese individuals that sustain a SCI are especially vulnerable to metabolic dysfunction. Notably, premorbid obesity also exacerbated intraspinal lesion pathology and worsened locomotor recovery after SCI. Overall, these results highlight that normal metabolic function requires intact spinal circuitry and that SCI is not just a sensory-motor disorder, but also has significant metabolic consequences.
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Affiliation(s)
- Matthew T Goodus
- The Belford Center for Spinal Cord Injury, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Anthony N Alfredo
- Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Neuroscience Graduate Program, The Ohio State University, Columbus, OH 43210, USA
| | - Kaitlin E Carson
- The Belford Center for Spinal Cord Injury, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Priyankar Dey
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | - Nicole Pukos
- The Belford Center for Spinal Cord Injury, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Neuroscience Graduate Program, The Ohio State University, Columbus, OH 43210, USA
| | - Jan M Schwab
- The Belford Center for Spinal Cord Injury, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Department of Neurology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Phillip G Popovich
- The Belford Center for Spinal Cord Injury, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Jie Gao
- Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Xiaokui Mo
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Richard S Bruno
- Human Nutrition Program, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Dana M McTigue
- The Belford Center for Spinal Cord Injury, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; Department of Neuroscience, College of Medicine, The Ohio State University, Columbus, OH 43210, USA.
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Park AJ, Garcia VP, Greiner JJ, Berry AR, Cardenas HL, Wegerson KN, Stauffer B, DeSouza CA. Development of a Hypercoagulable-Hypofibrinolytic State Early After Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:843-849. [PMID: 37977547 DOI: 10.1016/j.apmr.2023.11.001] [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: 06/15/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To determine whether spinal cord injury (SCI) is associated with adverse changes in coagulation and fibrinolytic factors that underlie thrombogenesis and contribute to atherothrombotic events such as myocardial infarctions (MIs) and strokes. DESIGN Cross-sectional study. SETTING Neurorehabilitation hospital and general community. PARTICIPANTS Thirty young and middle-aged (20-58 years) adults (N=30) were studied: 14 non-injured community dwelling adults. (11M/4F) and 16 with subacute tetraplegic motor complete SCI during initial inpatient rehabilitation (13M/3F; time since injury: 11.8±5.3 wk). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Circulating markers of coagulation [von Willebrand factor (vWf) and factors VII, VIII, and X], the fibrinolytic system [tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) antigen and activity], and fibrin formation (D-dimer) were determined by enzyme immunoassay. RESULTS Thirty young and middle-aged (20-58 years) adults were studied: 14 non-injured (11M/4F) and 16 with subacute tetraplegic motor complete SCI (13M/3F; time since injury: range 4-25 wk). Circulating levels of coagulation factors VII, VIII, and X were significantly higher (∼20%-45%; P<.05) in the adults with SCI than non-injured adults, whereas vWf was similar between groups. Fibrinolytic markers were adversely disrupted with SCI with t-PA antigen, PAI-1 antigen and PAI-1 activity were markedly higher (∼50%-800%; P<.05) in adults with SCI compared with non-injured adults. The molar concentration ratio of active t-PA to PAI-1 was significantly higher (∼350%) in adults with SCI. Concordant with coagulation cascade activation and fibrinolytic system inhibition, D-dimer concentrations were markedly ∼70% higher (P<.05) in adults with SCI compared with non-injured adults. CONCLUSIONS Subacute tetraplegic motor complete SCI is associated with a prothrombotic hemostatic profile. Adverse changes in the coagulation cascade and fibrinolytic system appear to occur early after injury and may contribute to the increased atherothrombotic risk in adults living with SCI.
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Affiliation(s)
- Andrew J Park
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Vinicius P Garcia
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - Jared J Greiner
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - Auburn R Berry
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - Hannah L Cardenas
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - Kendra N Wegerson
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - Brian Stauffer
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Division of Cardiology, Denver Health Medical Center, Denver, CO
| | - Christopher A DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO; Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Palazzolo B, Carbone L, James TG, Heizelman R, Sen A, Mahmoudi E, McKee M. Model Clinic to Increase Preventive Screenings Among Patients With Physical Disabilities: Protocol for a Mixed Methods Intervention Pilot Study. JMIR Res Protoc 2023; 12:e50105. [PMID: 37878375 PMCID: PMC10632921 DOI: 10.2196/50105] [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: 06/19/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND People with physical disabilities often experience premature multimorbidity and adverse health events. A tailored primary care approach for this vulnerable population that also accounts for social and functional risk factors could promote healthier aging and more equitable health care. OBJECTIVE This project will evaluate the implementation of a health program designed for people with physical disabilities. The proposed evaluation result is to generate the first best-practice protocol focused specifically on developing primary care to help reduce preventable causes of morbidity and improve functioning among people with physical disabilities. METHODS We will design and implement a pilot health program for people with physical disabilities at a primary care clinic within Michigan Medicine. The health program for people with physical disabilities will be an integrated intervention involving a tailored best practice alert designed to prompt family medicine providers to screen and monitor for common, preventable health conditions. The program will also collect social and functional status information to determine the patient's need for further care coordination and support. Adult participants from this clinic with identified physical disabilities will be targeted for potential enrollment. To create a quasi-experimental setting, a separate departmental clinic will serve as a control site for comparison purposes. A quantitative analysis to estimate the treatment effect of implementing this health program will be conducted using a difference-in-differences approach. Outcomes of interest will include the use of preventative services (eg, hemoglobin A1c for diabetes screening), social work assistance, and emergency and hospital services. These data will be extracted from electronic health records. Time-invariant covariates, particularly sociodemographic covariates, will be included in the models. A qualitative analysis of patient and health care provider interviews will also be completed to assess the effect of the health program. Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scores will be assessed to both screen for depression and anxiety as well as explore program impacts related to addressing health and functioning needs related to physical disabilities in a primary care setting. These will be summarized through descriptive analyses. RESULTS This study was funded in September 2018, data collection started in September 2021, and data collection is expected to be concluded in September 2023. CONCLUSIONS This study is a mixed methods evaluation of the effectiveness of an integrated health program designed for people with physical disabilities, based on a quasi-experimental comparison between an intervention and a control clinic site. The intervention will be considered successful if it leads to improvements in greater use of screening and monitoring for preventable health conditions, increased social worker referrals to assist with health and functioning needs, and improvements in emergency and hospital-based services. The findings will help inform best practices for people with physical disabilities in a primary care setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50105.
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Affiliation(s)
- Beatrice Palazzolo
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Loretta Carbone
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tyler G James
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Robert Heizelman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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Dorton MC, Kramer JK, de Groot S, Post MWM, Claydon VE. Relationships between cardiovascular disease risk, neuropathic pain, mental health, and autonomic function in chronic spinal cord injury. Spinal Cord 2023; 61:548-555. [PMID: 37749189 DOI: 10.1038/s41393-023-00933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
STUDY DESIGN Multicentre, cross-sectional study. OBJECTIVES To determine if clinical measures of poor mental health (MH-) and neuropathic pain (NP) are related to increased CVD risk in individuals with chronic spinal cord injury (SCI), and further elucidate the relationships between CVD risk, autonomic function, NP, and MH-. SETTING Eight SCI rehabilitation centres in the Netherlands. METHODS Individuals (n = 257) with a traumatic, chronic (≥10 yrs) SCI, with age at injury between 18-35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. CVD risk was calculated using Framingham risk score. NP was inferred using The Douleur Neuropathique 4 clinical examination, and MH- was assessed using the five-item Mental Health Inventory questionnaire. Cardiovascular autonomic function was determined from peak heart rate during maximal exercise (HRpeak). RESULTS There was a high prevalence of both NP (39%) and MH- (45%) following SCI. MH- was significantly correlated with an adverse CVD risk profile (r = 0.174; p = 0.01), increased the odds of adverse 30-year CVD risk by 2.2 (CI 0.92-2.81, p = 0.02), and is an important variable in determining CVD risk (importance=0.74, p = 0.05). Females (p = 0.05) and those with a higher HRpeak (p = 0.046) tended to be more likely to have NP. CONCLUSIONS Clinical measures of MH-, but not NP, are important factors for increased CVD risk following SCI. NP tended to be more prevalent in those with more preserved cardiovascular autonomic function. The interrelationships between secondary consequences of SCI are complex and need further exploration.
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Affiliation(s)
- Matthew C Dorton
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - John K Kramer
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel W M Post
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and de Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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5
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Park AJ, Fandl HK, Garcia VP, Coombs GB, DeSouza NM, Greiner JJ, Barak OF, Mijacika T, Dujic Z, Ainslie PN, DeSouza CA. Differential Expression of Vascular-Related MicroRNA in Circulating Endothelial Microvesicles in Adults With Spinal Cord Injury: A Pilot Study. Top Spinal Cord Inj Rehabil 2023; 29:34-42. [PMID: 37235195 PMCID: PMC10208256 DOI: 10.46292/sci22-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Spinal cord injury (SCI) is associated with an increased risk and prevalence of cardiopulmonary and cerebrovascular disease-related morbidity and mortality. The factors that initiate, promote, and accelerate vascular diseases and events in SCI are poorly understood. Clinical interest in circulating endothelial cell-derived microvesicles (EMVs) and their microRNA (miRNA) cargo has intensified due to their involvement in endothelial dysfunction, atherosclerosis, and cerebrovascular events. Objectives The aim of this study was to determine whether a subset of vascular-related miRNAs is differentially expressed in EMVs isolated from adults with SCI. Methods We assessed eight adults with tetraplegia (7 male/1 female; age: 46±4 years; time since injury: 26±5 years) and eight uninjured (6 male/2 female; age: 39±3 years). Circulating EMVs were isolated, enumerated, and collected from plasma by flow cytometry. The expression of vascular-related miRNAs in EMVs was assessed by RT-PCR. Results Circulating EMV levels were significantly higher (~130%) in adults with SCI compared with uninjured adults. The expression profile of miRNAs in EMVs from adults with SCI were significantly different than uninjured adults and were pathologic in nature. Expression of miR-126, miR-132, and miR-Let-7a were lower (~100-150%; p < .05), whereas miR-30a, miR-145, miR-155, and miR-216 were higher (~125-450%; p < .05) in EMVs from adults with SCI. Conclusion This study is the first examination of EMV miRNA cargo in adults with SCI. The cargo signature of vascular-related miRNAs studied reflects a pathogenic EMV phenotype prone to induce inflammation, atherosclerosis, and vascular dysfunction. EMVs and their miRNA cargo represent a novel biomarker of vascular risk and a potential target for intervention to alleviate vascular-related disease after SCI.
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Affiliation(s)
- Andrew J Park
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, Colorado
- University of Colorado, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Hannah K Fandl
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Vinicius P Garcia
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Geoff B Coombs
- University of Western Ontario, School of Kinesiology, London, Ontario, Canada
| | - Noah M DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
- Centre for Heart, Lung and Vascular Health, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Jared J Greiner
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Otto F Barak
- Department of Sports Medicine, University of Novi Sad, Serbia
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Tanja Mijacika
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Christopher A DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
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Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain. Spinal Cord 2022; 60:163-169. [PMID: 35058578 PMCID: PMC8828667 DOI: 10.1038/s41393-021-00731-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/28/2022]
Abstract
Study Design: Longitudinal cohort study of privately-insured beneficiaries with and without traumatic spinal cord injury (SCI). Objectives: Compare the incidence of and adjusted hazards for psychological morbidities among adults with and without traumatic SCI, and examine the effect of chronic centralized and neuropathic pain on outcomes. Setting: Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n=9,081). Adults without SCI were also included (n=1,474,232). Methods: Incidence of common psychological morbidities were compared at 5-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. Results: Adults with SCI had a higher incidence of any psychological morbidity (59.1% vs. 30.9%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any psychological morbidity (HR: 1.67; 95%CI: 1.61, 1.74), and all but one psychological disorder (impulse control disorders), and ranged from HR: 1.31 (1.24, 1.39) for insomnia to HR: 2.10 (1.77, 2.49) for post-traumatic stress disorder. Centralized and neuropathic pain was associated with all psychological disorders, and ranged from HR: 1.31 (1.23, 1.39) for dementia to HR: 3.83 (3.10, 3.68) for anxiety. Conclusions: Adults with SCI have a higher incidence of and risk for common psychological morbidities, as compared to adults without SCI. Efforts are needed to facilitate the development of early interventions to reduce risk of chronic centralized and neuropathic pain and psychological morbidity onset/progression in this higher risk population.
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Raguindin PF, Muka T, Glisic M. Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review. Maturitas 2021; 147:14-18. [PMID: 33832642 DOI: 10.1016/j.maturitas.2021.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 12/27/2022]
Abstract
Cardiometabolic disease (CMD) is among the leading causes of morbidity and mortality in people with a spinal cord injury (SCI). Despite well-acknowledged sex and gender differences in CMD in the general population, they remain insufficiently studied in persons with SCI. To describe the landscape of sex and gender in SCI research, we searched the literature for systematic reviews on cardiometabolic health in this population. Out of 15 systematic reviews identified, only 9 provided meaningful information on sex. Although one-quarter to one-fifth of the SCI population is female, women comprised only one-eighth to a quarter of study participants. A number of clinical studies purposively excluded women, to make the study population more homogenous. For those studies which included both sexes, in general, no sex-specific analyses were performed due to small sample sizes. All these reasons have contributed to the underrepresentation of females in the current body of evidence. Therefore, future studies should adopt a more sex- and gender-sensitive research framework to address cardiometabolic risk in SCI. Novel and advanced epidemiological methods should also be used, considering small sample sizes. Finally, collaborative research (through consortia and multi-center studies) should be encouraged to include more females. More inclusive research will ensure that everyone will benefit from scientific advancements, regardless of sex and gender.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Nottwil, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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8
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Harrington GMB, Cool P, Hulme C, Osman A, Chowdhury JR, Kumar N, Budithi S, Wright K. Routinely Measured Hematological Markers Can Help to Predict American Spinal Injury Association Impairment Scale Scores after Spinal Cord Injury. J Neurotrauma 2021; 38:301-308. [PMID: 32703074 PMCID: PMC7826437 DOI: 10.1089/neu.2020.7144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Neurological outcomes following spinal cord injury (SCI) are currently difficult to predict. While the initial American Spinal Injury Association Impairment Scale (AIS) grade can give an estimate of outcome, the high remaining degree of uncertainty has stoked recent interest in biomarkers for SCI. This study aimed to assess the prognostic value of routinely measured blood biomarkers by developing prognostic models of AIS scores at discharge and 12 months post-injury. Routine blood and clinical data were collected from SCI patients (n = 417), and blood measures that had been assessed in less than 50% of patients were excluded. Outcome neurology was obtained from AIS and Spinal Cord Independence Measure III (SCIM-III) scores at discharge and 12 months post-injury, with motor (AIS) and sensory (AIS, touch and prick) abilities being assessed individually. Linear regression models with and without elastic net penalization were created for all outcome measures. Blood measures associated with liver function, such as alanine transaminase, were found to add value to predictions of SCIM-III at discharge and 12 months post-injury. Further, components of a total blood count, including hemoglobin, were found to add value to predictions of AIS motor and sensory scores at discharge and 12 months post-injury. These findings corroborate the results of our previous preliminary study and thus provide further evidence that routine blood measures can add prognostic value in SCI and that markers of liver function are of particular interest.
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Affiliation(s)
| | - Paul Cool
- Keele University, Staffordshire, United Kingdom
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Charlotte Hulme
- Keele University, Staffordshire, United Kingdom
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Aheed Osman
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Joy Roy Chowdhury
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Naveen Kumar
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Srinivasa Budithi
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Karina Wright
- Keele University, Staffordshire, United Kingdom
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
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9
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Mohamed DA, Mohamed NM, Abdelrahaman S. Histological and Biochemical Changes in Adult Male Rat Liver after Spinal Cord Injury with Evaluation of the Role of Granulocyte-Colony Stimulating Factor. Ultrastruct Pathol 2020; 44:395-411. [PMID: 33280459 DOI: 10.1080/01913123.2020.1844829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Spinal cord injury (SCI) is a devastating disease leading to motor disability. Metabolic dysfunction is another complication of SCI. Thus, we aimed to study the effect of SCI on the histological and biochemical structure of the liver in adult male rats and to delineate the role of post-injury administration of G-CSF. Thirty adult male Sprague-Dawley rats were assigned into three groups: Group I; control (18 rats subdivided equally into three subgroups), and 12 rats underwent SCI and were divided into an SCI group II and G-SCF-treated group III. Twenty-one days post-injury, liver sections were processed for light and electron microscopic examinations and immunohistochemical staining for PCNA and CD68 antibodies. The biochemical assay was carried out for detection of serum levels of ALT, AST, total proteins, albumin, total cholesterol, triglycerides, HDL-c, GSH and MDA. Liver tissue levels of GPx and MDA as well as semiquantitative RT-PCR analysis of hepatic cytokine expression were also conducted. In the SCI group, results showed liver tissue damage in the form of lipid infiltration, blood vessel congestion, vacuolated cells with apoptotic nuclei and increased collagen deposition. Increased CD68-positive macrophages and a decreased number of PCNA-positive cells was detected. Moreover, liver enzymes, total cholesterol and triglycerides were increased while serum albumin, total proteins and HDL-c were decreased in the SCI group. Oxidative stress and increased expression of inflammatory cytokines were detected. Administration of G-CSF induced significant liver improvement with retained liver function by anti-inflammatory, immune-modulatory and antioxidant mechanisms.
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Affiliation(s)
- Dalia A Mohamed
- Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University , Zagazig, Egypt.,Anatomy and Histology Department, College of Medicine, Qassim University , Elmulida, KSA
| | - Noura Mostafa Mohamed
- Department of Medical Biochemistry, Faculty of Medicine, Zagazig University , Zagazig, Egypt.,Department of Science, Faculty of Preparatory Year of Health Sciences, PNU University , Riyadh, KSA
| | - Shaimaa Abdelrahaman
- Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University , Zagazig, Egypt
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10
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Evaluation of cardiovascular disease risk in individuals with chronic spinal cord injury. Spinal Cord 2020; 59:716-729. [PMID: 33070157 DOI: 10.1038/s41393-020-00566-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Multicentre, cross-sectional study. OBJECTIVES To identify which markers of obesity, injury characteristics and autonomic function variables are related to cardiovascular disease (CVD) risk after spinal cord injury (SCI), and establish cut-points for detection and risk management. SETTING Eight SCI rehabilitation centres in the Netherlands. METHODS Individuals (n = 257) with a traumatic, chronic (≥10 years) SCI, with age at injury between 18 and 35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. Three anthropometric measures were tested: body mass index (BMI); waist circumference (WC); and waist-to-height ratio (WHtR). Injury characteristics included: American Spinal Injury Association impairment scale (AIS); duration of injury (DOI); and neurological level of injury (LOI). Cardiovascular autonomic function was assessed from peak heart rate during maximal exercise (HRpeak). Systolic arterial pressure (SAP) and aerobic capacity (VO2peak) were also determined. CVD risk was calculated using the Framingham risk score (FRS). RESULTS All anthropometric variables were associated with FRS, with WC showing the strongest correlation (r = 0.41, p < 0.001) and greatest area under the curve (0.73) for 10-year CVD risk (%). WC, DOI, SAP, HRpeak, LOI, and VO2peak (variable importance: 0.81, 1.0, 0.98, 0.98, 0.66, 0.68, respectively) were important predictive variables for 10-year CVD risk in individuals with SCI. CONCLUSIONS We confirm that WC is a simple, practical measure of CVD risk, and along with DOI and markers of cardiovascular autonomic function, plays a role in the increased CVD risk following SCI.
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Effects of circulating extracellular microvesicles from spinal cord-injured adults on endothelial cell function. Clin Sci (Lond) 2020; 134:777-789. [PMID: 32219341 DOI: 10.1042/cs20200047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/15/2022]
Abstract
People with spinal cord injury (SCI) have three- to four-fold greater risk of cardiovascular disease (CVD) compared with those without SCI. Although circulating extracellular microvesicles are key effectors of vascular health and disease, how their functional phenotype might be altered with SCI is unknown. The aim of the present study was to determine the effects of microvesicles isolated from SCI adults on endothelial cell inflammation and oxidative stress as well as endothelial nitric oxide (NO) synthase (eNOS) activation and tissue-type plasminogen activator (t-PA) expression. Eighteen young and middle-aged adults were studied: 10 uninjured (7M/3F; age: 39 ± 3 years) and 8 cervical level spinal cord injured (SCI; 7M/1F; 46 ± 4 years; cervical injury: C3: n=1; C5: n=4; C6: n=3). Circulating microvesicles were isolated, enumerated and collected from plasma by flow cytometry. Human umbilical vein endothelial cells (HUVECs) were cultured and treated with microvesicles from either the uninjured or SCI adults. Microvesicles from SCI adults did not affect cellular markers or mediators of inflammation and oxidative stress. However, microvesicles from the SCI adults significantly blunted eNOS activation, NO bioavailability and t-PA production. Intercellular expression of phosphorylated eNOS at Ser1177 and Thr495 sites, specifically, were ∼65% lower and ∼85% higher, respectively, in cells treated with microvesicles from SCI compared with uninjured adults. Decreased eNOS activity and NO production as well as impaired t-PA bioavailability renders the vascular endothelium highly susceptible to atherosclerosis and thrombosis. Thus, circulating microvesicles may contribute to the increased risk of vascular disease and thrombotic events associated with SCI.
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12
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McKenzie AI, Reidy PT, Nelson DS, Mulvey JL, Yonemura NM, Petrocelli JJ, Mahmassani ZS, Tippetts TS, Summers SA, Funai K, Drummond MJ. Pharmacological inhibition of TLR4 ameliorates muscle and liver ceramide content after disuse in previously physically active mice. Am J Physiol Regul Integr Comp Physiol 2020; 318:R503-R511. [PMID: 31994900 PMCID: PMC7099462 DOI: 10.1152/ajpregu.00330.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 12/19/2022]
Abstract
Toll-like receptor 4 (TLR4) is a proposed mediator of ceramide accumulation, muscle atrophy, and insulin resistance in skeletal muscle. It is currently unknown whether pharmacological inhibition of TLR4, using the TLR4-specific inhibitor TAK-242 during muscle disuse, is able to prevent changes in intracellular ceramide species and consequently preserve muscle size and insulin sensitivity in physically active mice. To address this question, we subjected running wheel-conditioned C57BL/6 male mice (13 wk old; ∼10/group) to 7 days of hindlimb suspension (HS), 7 days of continued wheel running (WR), or daily injections of TAK-242 during HS (HS + TAK242) for 7 days. We measured hindlimb muscle morphology, intramuscular and liver ceramide content, HOMA-IR, mRNA proxies of ceramide turnover and lipid trafficking, and muscle fatty acid and glycerolipid content. As a result, soleus and liver ceramide abundance was greater (P < 0.05) in HS vs. WR but was reduced with TLR4 inhibition (HS + TAK-242 vs. HS). Muscle mass declined (P < 0.01) with HS (vs. WR), but TLR4 inhibition did not prevent this loss (soleus: P = 0.08; HS vs. HS + TAK-242). HOMA-IR was impaired (P < 0.01) in HS versus WR mice, but only fasting blood glucose was reduced with TLR4 inhibition (HS + TAK-242 vs HS, P < 0.05). Robust decreases in muscle Spt2 and Cd36 mRNA and muscle lipidomic trafficking may partially explain reductions in ceramides with TLR4 inhibition. In conclusion, pharmacological TLR4 inhibition in wheel-conditioned mice prevented ceramide accumulation during the early phase of hindlimb suspension (7 days) but had little effect on muscle size and insulin sensitivity.
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Affiliation(s)
- Alec I McKenzie
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
| | - Paul T Reidy
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
| | - Daniel S Nelson
- University of Utah Department of Nutrition and Integrated Physiology, Salt Lake City, Utah
| | - Jade L Mulvey
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
| | - Nikol M Yonemura
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
| | - Jonathan J Petrocelli
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
| | - Ziad S Mahmassani
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
| | - Trevor S Tippetts
- University of Utah Department of Nutrition and Integrated Physiology, Salt Lake City, Utah
| | - Scott A Summers
- University of Utah Department of Nutrition and Integrated Physiology, Salt Lake City, Utah
| | - Katsuhiko Funai
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
| | - Micah J Drummond
- University of Utah Department of Physical Therapy and Athletic Training, Salt Lake City, Utah
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13
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Goodus MT, McTigue DM. Hepatic dysfunction after spinal cord injury: A vicious cycle of central and peripheral pathology? Exp Neurol 2019; 325:113160. [PMID: 31863731 DOI: 10.1016/j.expneurol.2019.113160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/17/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
The liver is essential for numerous physiological processes, including filtering blood from the intestines, metabolizing fats, proteins, carbohydrates and drugs, and regulating iron storage and release. The liver is also an important immune organ and plays a critical role in response to infection and injury throughout the body. Liver functions are regulated by autonomic parasympathetic innervation from the brainstem and sympathetic innervation from the thoracic spinal cord. Thus, spinal cord injury (SCI) at or above thoracic levels disrupts major regulatory mechanisms for hepatic functions. Work in rodents and humans shows that SCI induces liver pathology, including hepatic inflammation and fat accumulation characteristic of a serious form of non-alcoholic fatty liver disease (NAFLD) called non-alcoholic steatohepatitis (NASH). This hepatic pathology is associated with and likely contributes to indices of metabolic dysfunction often noted in SCI individuals, such as insulin resistance and hyperlipidemia. These occur at greater rates in the SCI population and can negatively impact health and quality of life. In this review, we will: 1) Discuss acute and chronic changes in human and rodent liver pathology and function after SCI; 2) Describe how these hepatic changes affect systemic inflammation, iron regulation and metabolic dysfunction after SCI; 3) Describe how disruption of the hepatic autonomic nervous system may be a key culprit in post-injury chronic liver pathology; and 4) Preview ongoing and future research that aims to elucidate mechanisms driving liver and metabolic dysfunction after SCI.
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Affiliation(s)
- Matthew T Goodus
- The Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
| | - Dana M McTigue
- The Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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14
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Nash MS, Groah SL, Gater DR, Dyson-Hudson TA, Lieberman JA, Myers J, Sabharwal S, Taylor AJ. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury. J Spinal Cord Med 2019; 42:643-677. [PMID: 31180274 PMCID: PMC6758611 DOI: 10.1080/10790268.2018.1511401] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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15
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Murphy SL, Kratz AL, Zynda AJ. Measuring Physical Activity in Spinal Cord Injury Using Wrist-Worn Accelerometers. Am J Occup Ther 2019; 73:7301205090p1-7301205090p10. [PMID: 30839264 PMCID: PMC6402414 DOI: 10.5014/ajot.2019.027748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our objective was to evaluate interunit agreement and construct validity of two activity monitors (Actiwatch Score and PRO-Diary) in people with and without spinal cord injury. METHOD Thirty-eight participants (19 with spinal cord injury; 19 age- and sex-matched controls; mean age = 49 yr) wore both monitors and completed tasks during one visit ranging in physical intensity. To compare activity by group and monitor, we conducted t tests. We assessed interunit agreement using intraclass correlations and Bland-Altman plots. RESULTS Both monitors demonstrated significantly different increasing physical activity levels with higher intensity tasks. Participants with spinal cord injury had similar activity counts within tasks compared with controls except for walking-wheeling. Agreement was high between monitors across tasks (interclass correlation coefficients = .78-.97). CONCLUSION Both monitors demonstrated good construct validity for measuring physical activity across activities and high agreement. Either monitor is appropriate to examine physical activity patterns in people with spinal cord injury.
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Affiliation(s)
- Susan L Murphy
- Susan L. Murphy, ScD, OTR, is Associate Professor, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, and Research Health Science Specialist, Geriatric Research Education and Clinical Center, VA Ann Arbor Health Care System, Ann Arbor, MI;
| | - Anna L Kratz
- Anna L. Kratz, PhD, is Associate Professor, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Aaron J Zynda
- Aaron J. Zynda, BS, CCRP, is Clinical Research Coordinator, Sports Medicine, Texas Scottish Rite Hospital for Children, Dallas
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Harman KA, States G, Wade A, Stepp C, Wainwright G, DeVeau K, King N, Shum-Siu A, Magnuson DSK. Temporal analysis of cardiovascular control and function following incomplete T3 and T10 spinal cord injury in rodents. Physiol Rep 2019; 6:e13634. [PMID: 29595874 PMCID: PMC5875543 DOI: 10.14814/phy2.13634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/05/2018] [Indexed: 11/24/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that results in whole‐body dysfunction, notably cardiovascular (CV) disruption and disease. Injury‐induced destruction of autonomic pathways in conjunction with a progressive decline in physical fitness contribute to the poor CV status of SCI individuals. Despite the wide use of exercise training as a therapeutic option to reduce CV dysfunction, little is known about the acute hemodynamic responses to the exercise itself. We investigated CV responses to an exercise challenge (swimming) following both high and low thoracic contusion to determine if the CV system is able to respond appropriately to the challenge of swimming. Blood pressure (BP) telemetry and echocardiography were used to track the progression of dysfunction in rodents with T3 and T10 SCI (n = 8 each) for 10 weeks postcontusion. At 1 week postinjury, all animals displayed a drastic decline in heart rate (HR) during the exercise challenge, likely a consequence of neurogenic shock. Furthermore, over time, all groups developed a progressive inability to maintain BP within a narrow range during the exercise challenge despite displaying normal hemodynamic parameters at rest. Echocardiography of T10 animals revealed no persistent signs of cardiac dysfunction; T3 animals exhibited a transient decline in systolic function that returned to preinjury levels by 10 weeks postinjury. Novel evidence provided here illustrates that incomplete injuries produce hemodynamic instability that only becomes apparent during an exercise challenge. Further, this dysfunction lasts into the chronic phase of disease progression despite significant recovery of hindlimb locomotion and cardiac function.
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Affiliation(s)
- Kathryn A Harman
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Gregory States
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Abigail Wade
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Chad Stepp
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Grace Wainwright
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Kathryn DeVeau
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Nicholas King
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Alice Shum-Siu
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - David S K Magnuson
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
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Jörgensen S, Hill M, Lexell J. Cardiovascular Risk Factors Among Older Adults With Long-Term Spinal Cord Injury. PM R 2019; 11:8-16. [PMID: 29964213 DOI: 10.1016/j.pmrj.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) now live longer, which increases the risk of cardiovascular disease. Knowledge of cardiovascular risk factors amenable to intervention are therefore needed to support their healthy aging. OBJECTIVE To describe the occurrence of cardiovascular risk factors among older adults with long-term SCI and investigate the association with sociodemographics and injury characteristics. DESIGN Cross-sectional descriptive cohort study. SETTING Home settings. PARTICIPANTS In total, 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years. METHODS Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS), collected through interviews and assessments during home visits and from medical records. MAIN OUTCOME MEASURES Anthropometric measurements, blood pressure, fasting plasma glucose and blood lipids, and data on cardiovascular comorbidity and tobacco use. RESULTS One third had a previous diagnosis of hypertension, and 55% presented with a blood pressure ≥ 140/90 mm Hg at the time of assessment. Sixteen percent had a history of diabetes and in 15% fasting glucose levels were ≥ 7 mmol/L. Dyslipidemia was present in 76%, whereas 16% had prediagnosed dyslipidemia. Mean body mass index (BMI) was 27 kg/m2 and mean waist circumference was 101 cm. When SCI-adjusted BMI cut-off values were used, 93% were considered overweight (BMI ≥22 kg/m2 ), and 60% had a waist circumference associated with cardiometabolic risk. A total of 16% smoked regularly. The median number of cardiovascular risk factors was 3. No significant associations were found between the total number of risk factors and sociodemographics and injury characteristics. CONCLUSIONS The high occurrence of cardiovascular risk factors among older adults with long-term SCI can pose additional consequences to their health. Regular assessments and interventions targeting cardiovascular risk in this population are therefore warranted. Further research is needed to identify modifiable factors associated with their risk profile. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Mattias Hill
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neuroscience, Rehabilitation Medicine,, Uppsala University, Uppsala, Sweden
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18
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Goodus MT, Sauerbeck AD, Popovich PG, Bruno RS, McTigue DM. Dietary Green Tea Extract Prior to Spinal Cord Injury Prevents Hepatic Iron Overload but Does Not Improve Chronic Hepatic and Spinal Cord Pathology in Rats. J Neurotrauma 2018; 35:2872-2882. [PMID: 30084733 DOI: 10.1089/neu.2018.5771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Spinal cord injury (SCI) disrupts autonomic regulation of visceral organs. As a result, a leading cause of mortality in the SCI population is metabolic dysfunction, and an organ central to metabolic control is the liver. Our recent work showed that rodent SCI promotes Kupffer cell (hepatic macrophage) activation, pro-inflammatory cytokine expression, and liver steatosis. These are symptoms of nonalcoholic steatohepatitis (NASH), the hepatic manifestation of metabolic syndrome, and these pre-clinical data replicate aspects of post-SCI human metabolic dysfunction. Because metabolic profile is highly dependent on lifestyle, including diet, it is likely that lifestyle choices prior to injury influence metabolic and hepatic outcomes after SCI. Therefore, in this study we tested if a diet rich in green tea extract (GTE), a known hepatoprotective agent, that began 3 weeks before SCI and was maintained after injury, reduced indices of liver pathology or metabolic dysfunction. GTE treatment significantly reduced post-SCI hepatic iron accumulation and blunted circulating glucose elevation compared with control-diet rats. However, GTE pre-treatment did not prevent Kupffer cell activation, hepatic lipid accumulation, increased serum alanine transaminase, or circulating non-esterified fatty acids, which were all significantly increased 6 weeks post-injury. Spinal cord pathology also was unchanged by GTE. Thus, dietary GTE prior to and after SCI had only a minor hepatoprotective effect. In general, for optimal health of SCI individuals, it will be important for future studies to evaluate how other lifestyle choices made before or after SCI positively or negatively impact systemic and intraspinal outcomes and the overall metabolic health of SCI individuals.
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Affiliation(s)
- Matthew T Goodus
- 1 The Center for Brain and Spinal Cord Repair, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.,2 Department of Neuroscience, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.,3 Belford Center for Spinal Cord Injury, Wexner Medical Center, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Andrew D Sauerbeck
- 1 The Center for Brain and Spinal Cord Repair, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.,2 Department of Neuroscience, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Phillip G Popovich
- 1 The Center for Brain and Spinal Cord Repair, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.,2 Department of Neuroscience, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.,3 Belford Center for Spinal Cord Injury, Wexner Medical Center, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Richard S Bruno
- 4 Human Nutrition Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Dana M McTigue
- 1 The Center for Brain and Spinal Cord Repair, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.,2 Department of Neuroscience, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.,3 Belford Center for Spinal Cord Injury, Wexner Medical Center, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
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Maher JL, McMillan DW, Nash MS. Exercise and Health-Related Risks of Physical Deconditioning After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 23:175-187. [PMID: 29339894 DOI: 10.1310/sci2303-175] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A sedentary lifestyle occurring soon after spinal cord injury (SCI) may be in contrast to a preinjury history of active physical engagement and is thereafter associated with profound physical deconditioning sustained throughout the lifespan. This physical deconditioning contributes in varying degrees to lifelong medical complications, including accelerated cardiovascular disease, insulin resistance, osteopenia, and visceral obesity. Unlike persons without disability for whom exercise is readily available and easily accomplished, exercise options for persons with SCI are more limited. Depending on the level of injury, the metabolic responses to acute exercise may also be less robust than those accompanying exercise in persons without disability, the training benefits more difficult to achieve, and the risks of ill-considered exercise both greater and potentially irreversible. For exercise to ultimately promote benefit and not impose additional impairment, an understanding of exercise opportunities and risks if exercise is undertaken by those with SCI is important. The following monograph will thus address common medical challenges experienced by persons with SCI and typical modes and benefits of voluntary exercise conditioning.
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Affiliation(s)
- Jennifer L Maher
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - David W McMillan
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Department of Kinesiology and Sports Sciences, University of Miami, Coral Gables, Florida
| | - Mark S Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Departments of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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Rapidi CA, Tederko P, Moslavac S, Popa D, Branco CA, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2018; 54:797-807. [PMID: 29952157 DOI: 10.23736/s1973-9087.18.05374-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions. EVIDENCE ACQUISITION A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure. CONCLUSIONS The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.
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Affiliation(s)
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Sasa Moslavac
- Department of Physical and Rehabilitation Medicine, Special Hospital for Medical Rehabilitation, Varaždinske Toplice, Croatia
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania
| | - Catarina A Branco
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga E.P.E, Porto, Portugal
| | - Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University School of Medicine, Madrid, Spain
| | - Nicolas Christodoulou
- Medical School, European University Cyprus, Nicosia, Cyprus.,UEMS PRM Section, Brussels, Belgium
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Nash MS, Groah SL, Gater DR, Dyson-Hudson TA, Lieberman JA, Myers J, Sabharwal S, Taylor AJ. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2018; 24:379-423. [PMID: 30459501 PMCID: PMC6241225 DOI: 10.1310/sci2404-379] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mark S Nash
- Departments of Neurological Surgery and Physical Medicine & Rehabilitation, Applied Physiology Research Laboratory, The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Suzanne L Groah
- Paralysis Rehabilitation and Recovery Program, Spinal Cord Injury Research, MedStar National Rehabilitation Hospital, Washington, DC
- Rehabilitation Medicine, Georgetown University Hospital, Washington, DC
| | - David R Gater
- Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Trevor A Dyson-Hudson
- Spinal Injury Research and Outcomes Assessment Research, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jesse A Lieberman
- Carolinas Rehabilitation and Carolinas Medical Center, Charlotte, North Carolina
| | - Jonathan Myers
- Department of Medicine, Stanford University, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Sunil Sabharwal
- VA Boston Health Care System, Boston, Massachusetts
- VA Spinal Cord Injuries and Disorders System of Care, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Allen J Taylor
- MedStar Georgetown University Hospital, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC
- Uniformed University of the Health Sciences, Bethesda, Maryland
- Georgetown University, Washington, DC
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Medeiros MDSD, Motta J, Mariano S, Menguer L, Silva LAD. Estudo de caso de um programa individualizado de natação em cadeirante portador de poliomielite: análise de parâmetros bioquímicos, qualidade de vida e capacidade física funcional. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2018. [DOI: 10.1016/j.rbce.2018.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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McColl MA, Gupta S, Smith K, McColl A. Promoting Long-Term Health among People with Spinal Cord Injury: What's New? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1520. [PMID: 29211040 PMCID: PMC5750938 DOI: 10.3390/ijerph14121520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022]
Abstract
A key ingredient to successful health promotion is a primary care provider who can offer an informed first response to lifestyle issues, emerging problems and chronic challenges. This article aims to assist family physicians to play their role in promoting the health of people with SCI, by summarizing the latest evidence in the management of spinal cord injury in primary care. This study used a scoping review methodology to survey peer-reviewed journal articles and clinical guidelines published between January 2012 to June 2016. This search strategy identified 153 articles across 20 topics. A prevention framework is used to identify five primary, nine secondary, four tertiary, and two quaternary prevention issues about which family physicians require current information. Major changes in the management of SCI in primary care were noted for 8 of the 20 topics, specifically in the areas of pharmacological management of neuropathic pain and urinary tract infection; screening for bowel and bladder cancer; improvements in wound care; and clarification of dietary fibre recommendations. All of these changes are represented in the 3rd edition of Actionable Nuggets-an innovative tool to assist family physicians to be aware of the best practices in primary care for spinal cord injury.
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Affiliation(s)
- Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Shikha Gupta
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Karen Smith
- Providence Continuing Care Centre, Kingston, ON K7L 4X3, Canada.
| | - Alexander McColl
- Department of Family Medicine, University of New South Wales, Port Macquarie, NSW 2444, Australia.
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Nier LM, Hansen PS. Coronary artery disease presenting with left upper quadrant pain in a patient with chronic cervical tetraplegia. Spinal Cord Ser Cases 2017; 3:17048. [PMID: 28765791 DOI: 10.1038/scsandc.2017.48] [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: 04/27/2017] [Revised: 07/02/2017] [Accepted: 07/04/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION This single-subject case report aims to describe and discuss a case of a patient with established C5 tetraplegia with acute coronary syndrome presenting with left upper quadrant pain and tenderness. CASE PRESENTATION A 65-year-old male with chronic C5 American Spinal Injury Association Impairment Scale (AIS) A tetraplegia presented to the emergency department with severe left upper quadrant pain radiating across the chest to the right upper limb with associated dyspnoea and diaphoresis. Prior to his emergency department admission, he had experienced progressive worsening of left upper quadrant pain and tenderness over several months. He was a non-smoker and swam regularly. He underwent coronary angiography and was found to have significant coronary artery disease. Drug-eluting stents were placed to critical coronary artery lesions followed by an uneventful hospital course with complete symptom resolution and discharge home. DISCUSSION Patients with tetraplegia are known to have higher rates of cardiovascular disease compared to ambulatory patients. Their cardiovascular risk profile may include atypical risk factors, for example, sleep disordered breathing, relative immobility and autonomic dysfunction. A high index of suspicion for cardiac pathology is warranted in those with cervical tetraplegia with persistent 'atypical' symptoms, including within the abdomen (especially when no specific abdominal organ dysfunction is evident). Sleep apnoea and significantly impaired mobility are potential cardiac risk factors in this patient group and should alert the emergency physician to cardiac disease (as in this case) irrespective of their complex past medical history and symptomatology.
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Affiliation(s)
- Lianne Michelle Nier
- Department of Spinal Cord Injury Rehabilitation, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia
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van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, Wolfe DL. Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology 2017; 89:736-745. [PMID: 28733344 DOI: 10.1212/wnl.0000000000004224] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To synthesize and appraise research testing the effects of exercise interventions on fitness, cardiometabolic health, and bone health among adults with spinal cord injury (SCI). METHODS Electronic databases were searched (1980-2016). Included studies employed exercise interventions for a period ≥2 weeks, involved adults with acute or chronic SCI, and measured fitness (cardiorespiratory fitness, power output, or muscle strength), cardiometabolic health (body composition or cardiovascular risk factors), or bone health outcomes. Evidence was synthesized and appraised using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS A total of 211 studies met the inclusion criteria (22 acute, 189 chronic). For chronic SCI, GRADE confidence ratings were moderate to high for evidence showing exercise can improve all of the reviewed outcomes except bone health. For acute SCI, GRADE ratings were very low for all outcomes. For chronic SCI, there was low to moderate confidence in the evidence showing that 2-3 sessions/week of upper body aerobic exercise at a moderate to vigorous intensity for 20-40 minutes, plus upper body strength exercise (3 sets of 10 repetitions at 50%-80% 1-repetition maximum for all large muscle groups), can improve cardiorespiratory fitness, power output, and muscle strength. For chronic SCI, there was low to moderate confidence in the evidence showing that 3-5 sessions per week of upper body aerobic exercise at a moderate to vigorous intensity for 20-44 minutes can improve cardiorespiratory fitness, muscle strength, body composition, and cardiovascular risk. CONCLUSIONS Exercise improves fitness and cardiometabolic health of adults with chronic SCI. The evidence on effective exercise types, frequencies, intensities, and durations should be used to formulate exercise guidelines for adults with SCI.
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Affiliation(s)
- Jan W van der Scheer
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Kathleen A Martin Ginis
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada.
| | - David S Ditor
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Victoria L Goosey-Tolfrey
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Audrey L Hicks
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Christopher R West
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Dalton L Wolfe
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
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Han DS, Hsiao MY, Wang TG, Chen SY, Yang WS. Association of serum myokines and aerobic exercise training in patients with spinal cord injury: an observational study. BMC Neurol 2016; 16:142. [PMID: 27534935 PMCID: PMC4989481 DOI: 10.1186/s12883-016-0661-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/02/2016] [Indexed: 01/20/2023] Open
Abstract
Background Patients with spinal cord injury (SCI) have a higher prevalence of cardiovascular diseases compared to the healthy population. Aerobic exercise training is one of the recommended treatments. However, literature regarding the effect of aerobic training on patients with SCI is scarce. This study evaluated changes in parameters of exercise physiology and serum myokines immediately after exercise and after a training program among patients with SCI. Methods Male patients with SCI and age- and sex-matched healthy individuals were recruited. Cardio-pulmonary exercise testing (CPET) was used to determine oxygen uptake at peak exercise and anaerobic threshold in both groups. The patients with SCI attended aerobic exercise training for 36 sessions within 12–16 weeks. Basic data, hemodynamic and exercise physiology parameters, and serum myokine (myostatin, IGF-1, and follistatin) concentrations were measured pre- and post-exercise in both groups, and were repeated in patients with SCI post-training. Results Eleven patients with SCI underwent CPET and 5 completed the training. The 11 patients and 16 healthy adults had no differences in baseline serum myokine concentrations before CPET. Immediately after the CPET, the reference group had an 18 ± 19 % increase in serum IGF-1, while the patients had no observable myokine changes. After aerobic exercise training, the 5 patients had a 48 ± 18 % increase in serum myostatin compared to the pre-training level, although the body weight and exercise physiology parameters remained unchanged. Conclusions Acute exercise to exhaustion in CPET results in an immediate increase in serum IGF-1 in healthy individuals while aerobic exercise training results in increased serum myostatin in patients with SCI.
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Affiliation(s)
- Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.,Community and Geriatric Medicine Research Center, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ssu-Yuan Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University Hospital, No. 1, Chang-Teh St, Taipei, Taiwan. .,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
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Aidinoff E, Bluvshtein V, Bierman U, Gelernter I, Front L, Catz A. Coronary artery disease and hypertension in a non-selected spinal cord injury patient population. Spinal Cord 2016; 55:321-326. [PMID: 27431657 DOI: 10.1038/sc.2016.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective observational comparative study. OBJECTIVES The objectives of this study were to assess the atherosclerosis diseases and risk factors prevalence after spinal cored injury (SCI). SETTING Loewenstein Rehabilitation Hospital, Israel. METHODS Data of 154 traumatic and non-traumatic SCI patients were retrospectively collected. Coronary artery disease (CAD), myocardial infarction (MI), hypertension (HT) and risk factors for atherosclerotic diseases were examined after SCI for prevalence and effects, and compared with published corresponding data of the general population. RESULTS CAD, MI and HT were found in 11.7, 6.7 and 29.2% of 120 patients, aged 53.4±11.1 years, 83.3% males, who survived until the end of the follow-up. Corresponding values for the general population, adjusted for age, gender and years of education, are 8.5, 6.6 and 24.9% in Israel, and 10.2% for CAD and 40.3% for HT, in US. Body mass index>30 increased the odds of acquiring CAD (P=0.016). Hypercholesterolemia and older age at injury increased the hazard for HT (P=0.044; P=0.019, respectively). A steady partner decreased the risk of CAD (P=0.029). HT was more prevalent at T4-T6 than above T4 (52 vs 23.3%, P=0.02). Patients with SCI below T6 had a higher rate of diabetes mellitus, hypercholesterolemia, and past smoking, and fewer years of education than those with SCI above T7 (P=0.016; P=0.032; P=0.034; P=0.014, respectively). CONCLUSION The prevalence of CAD, HT and some of their risk factors after SCI is generally, but not consistently and not statistically significant, slightly higher than in the corresponding general population. The challenge is to reduce the prevalence of atherosclerotic morbidity after SCI below that in the general population.
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Affiliation(s)
- E Aidinoff
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel.,Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - V Bluvshtein
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel.,Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - U Bierman
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - I Gelernter
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel
| | - L Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - A Catz
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel.,Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Lynch MM, McCormick Z, Liem B, Jacobs G, Hwang P, Hornby TG, Rydberg L, Roth EJ. Energy Cost of Lower Body Dressing, Pop-Over Transfers, and Manual Wheelchair Propulsion in People with Paraplegia Due to Motor-Complete Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2015; 21:140-8. [PMID: 26364283 DOI: 10.1310/sci2102-140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Energy required for able-bodied individuals to perform common activities is well documented, whereas energy associated with daily activities among people with spinal cord injury (SCI) is less understood. OBJECTIVE To determine energy expended during several basic physical tasks specific to individuals with paraplegia due to motor-complete SCI. METHODS Sixteen adults with motor-complete SCI below T2 level and duration of paraplegia greater than 3 months were included. Oxygen consumption (VO2), caloric expenditure, and heart rate were measured at rest and while participants performed lower body dressing (LBD), pop-over transfers (POTs), and manual wheelchair propulsion (MWP) at a self-selected pace. These data were used to calculate energy expenditure in standard metabolic equivalents (METs), as defined by 1 MET = 3.5 mL O2/kg/min, and in SCI METs using the conversion 1 SCI MET = 2.7 mL O2/kg/min. RESULTS VO2 at rest was 3.0 ± 0.9 mL O2/kg/min, which equated to 0.9 ± 0.3 standard METs and 1.1 ± 0.4 SCI METs in energy expenditure. LBD required 3.2 ± 0.7 METs and 4.1 ± 0.9 SCI METs; POTs required 3.4 ± 1.0 METs and 4.5 ± 1.3 SCI METs; and MWP required 2.4 ± 0.6 METs and 3.1 ± 0.7 SCI METs. CONCLUSIONS Resting VO2 for adults with motor-complete paraplegia is 3.0 mL O2/kg/min, which is lower than standard resting VO2 in able-bodied individuals. Progressively more energy is required to perform MWP, LBD, and POTs, respectively. Use of the standard METs formula may underestimate the level of intensity an individual with SCI uses to perform physical activities.
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Affiliation(s)
- Meaghan M Lynch
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Zachary McCormick
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brian Liem
- University of Washington Medical Center, Seattle, Washington
| | - Geneva Jacobs
- Brooks Rehabilitation Hospital, Jacksonville, Florida
| | - Peter Hwang
- Howard A. Rusk Rehabilitation Center, Columbia, Missouri
| | - Thomas George Hornby
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leslie Rydberg
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elliot J Roth
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Cragg JJ, Noonan VK, Noreau L, Borisoff JF, Kramer JK. Neuropathic Pain, Depression, and Cardiovascular Disease: A National Multicenter Study. Neuroepidemiology 2015; 44:130-7. [DOI: 10.1159/000377726] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/05/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Individuals with spinal cord injury (SCI) have a more than twofold increased risk of heart disease and stroke compared with able-bodied individuals. The increased risk appears to be in excess of the risk conferred by several well-established risk factors, including diabetes, hypertension, and sex. This raises the question whether other factors, secondary to SCI, are also contributing to the development of cardiovascular disease (CVD). Two potential factors associated with SCI and CVD are pain and depression. Both are frequently reported among individuals with SCI, develop in the acute stages of injury, and are commonly described as severe. Therefore, the primary aim of this study was to examine the relationship between pain (and types of pain) and depression with CVD among individuals with SCI. Methods: A total of 1,493 individuals (referred sample) with chronic SCI participated in a self-report cross-sectional multicenter Canada-wide survey from 2011-2012 (mean age ± standard deviation: 49.6 ± 13.9 years). Results: After adjustment for age, sex, and injury characteristics, neuropathic pain and depression were significantly and independently associated with CVD (adjusted odds ratio and 95% confidence interval: 2.27 (1.21, 4.60) for neuropathic pain; 4.07 (2.10, 7.87) for depression). In contrast to neuropathic pain, non-neuropathic pain was not significantly associated with CVD (p = 0.13). Conclusion: In conclusion, these data illustrate important interrelationships between secondary complications following SCI, as well as raise the possibility of neuropathic pain (versus nociceptive pain) as a novel and emerging risk factor for CVD.
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Rosety-Rodriguez M, Camacho-Molina A, Rosety I, Fornieles G, Rosety MA, Ordoñez FJ. [Reduction of exercise-mediated endothelial dysfunction markers in sedentary adults with chronic spinal cord injury]. Med Clin (Barc) 2015; 144:59-61. [PMID: 24378148 DOI: 10.1016/j.medcli.2013.10.021] [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: 05/04/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Recent studies have found increased markers of endothelial activation in men with chronic spinal cord injury. This study was conducted to determine the effects of arm-cranking exercise on endothelial dysfunction in male adults with chronic SCI. METHOD A prospective randomized study of 17 sedentary adult males with chronic SCI at or under T5 level. Nine performed a supervised exercise program at a moderate intensity (arm-cranking: 12 weeks, 3 sessions/week). Plasma levels of endothelin-1, soluble intercellular adhesion molecule type 1 (sICAM-1), and soluble vascular adhesion molecule type 1 (sVCAM-1) were assessed by ELISA. Outcome measurements also included physical fitness and total body fat mass percentage. RESULTS We observed both in the randomized and in the before-after studies a significant reduction of the levels of endothelin-1 and sICAM-1. Furthermore, significant improvements of both physical fitness and body composition were also found. CONCLUSION Arm-cranking exercise improved endothelial dysfunction in adult males with chronic SCI. Long-term studies are still required to determine whether the correction of endothelial dysfunction improves the clinical outcomes of adults with chronic SCI.
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Affiliation(s)
| | | | - Ignacio Rosety
- Escuela de Medicina del Deporte, Universidad de Cádiz, Cádiz, España
| | | | - Miguel A Rosety
- Escuela de Medicina del Deporte, Universidad de Cádiz, Cádiz, España
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Sauerbeck AD, Laws JL, Bandaru VVR, Popovich PG, Haughey NJ, McTigue DM. Spinal cord injury causes chronic liver pathology in rats. J Neurotrauma 2014; 32:159-69. [PMID: 25036371 DOI: 10.1089/neu.2014.3497] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Traumatic spinal cord injury (SCI) causes major disruption to peripheral organ innervation and regulation. Relatively little work has investigated these post-SCI systemic changes, however, despite considerable evidence that multiple organ system dysfunction contributes to chronic impairments in health. Because metabolic dysfunction is common after SCI and the liver is a pivotal site for metabolic homeostasis, we sought to determine if liver pathology occurs as a result of SCI in a rat spinal contusion model. Histologic evidence showed excess lipid accumulation in the liver for at least 21 days post-injury after cervical or midthoracic SCI. Lipidomic analysis revealed an acute increase in hepatic ceramides as well as chronically elevated lactosylceramide. Post-SCI hepatic changes also included increased proinflammatory gene expression, including interleukin (IL)-1α, IL-1β, chemokine ligand-2, and tumor necrosis factor-α mRNA. These were coincident with increased CD68+ macrophages in the liver through 21 days post-injury. Serum alanine transaminase, used clinically to detect liver damage, was significantly increased at 21 days post-injury, suggesting that early metabolic and inflammatory damage preceded overt liver pathology. Surprisingly, liver inflammation was even detected after lumbar SCI. Collectively, these results suggest that SCI produces chronic liver injury with symptoms strikingly similar to those of nonalcoholic steatohepatitis (fatty liver disease). These clinically significant hepatic changes after SCI are known to contribute to systemic inflammation, cardiovascular disease, and metabolic syndrome, all of which are more prevalent in persons with SCI. Targeting acute and prolonged hepatic pathology may improve recovery and reduce long-term complications after SCI.
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Affiliation(s)
- Andrew D Sauerbeck
- 1 Department of Neuroscience, The Ohio State University , Columbus, Ohio
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Increased Risk of Deep Vein Thrombosis and Pulmonary Thromboembolism in Patients with Spinal Cord Injury: A Nationwide Cohort Prospective Study. Thromb Res 2014; 133:579-84. [DOI: 10.1016/j.thromres.2014.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/19/2013] [Accepted: 01/07/2014] [Indexed: 11/17/2022]
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Applanation tonometry: a reliable technique to assess aortic pulse wave velocity in spinal cord injury. Spinal Cord 2014; 52:272-5. [DOI: 10.1038/sc.2013.176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/04/2013] [Accepted: 12/17/2013] [Indexed: 11/08/2022]
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Driussi C, Ius A, Bizzarini E, Antonini-Canterin F, d'Andrea A, Bossone E, Vriz O. Structural and functional left ventricular impairment in subjects with chronic spinal cord injury and no overt cardiovascular disease. J Spinal Cord Med 2014; 37:85-92. [PMID: 24456485 PMCID: PMC4066555 DOI: 10.1179/2045772313y.0000000161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXT Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in subjects with long-term spinal cord injury (SCI). More specific recommendations for CVD prevention in this population are needed. METHODS One hundred thirty male subjects (47 subjects with SCI and 83 able-bodied persons (ABPs), mean age 43.89 ± 1.9 and 45.44 ± 12.2 years; P = 0.48) underwent transthoracic echocardiography (TTE). The effects of age, weight, mean arterial pressure (MAP) and level of physical training on cardiac adaptations were evaluated through multiple regression analysis. RESULTS In subjects with SCI, TTE revealed increased wall thickness (P < 0.05), lower E wave, E/A ratio and early diastolic myocardial relaxation velocity on Tissue Doppler Imaging (TDI) (P < 0.05) and higher systolic myocardial contraction velocity on TDI (0.10 ± 0.02 vs. 0.09 ± 0.02 m/seconds, P = 0.002) and peak systolic pressure to end-systolic volume ratio (3.62 ± 1.39 vs. 2.82 ± 0.90, P < 0.001) compared with ABPs. Aortic diameters were larger in subjects with SCI than ABPs. Differences remained statistically significant even after adjustment for age, weight, MAP, and level of physical training. Weight and age were found to be independent variables that substantially affected left ventricular structure and function in subjects with SCI. CONCLUSIONS Subjects with post-traumatic chronic SCI and no overt cardiovascular risk factors, exhibit initial left ventricular remodeling (as assessed by TTE) compared with ABPs. Lifestyle modifications, including regular physical exercise and weight control, should be implemented in all subjects with SCI, even at a very early stage, in order to reduce cardiovascular risk and prevent the development of CVD.
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Affiliation(s)
- Caterina Driussi
- Correspondence to: Caterina Driussi, Department of Emergency and Cardiology, San Antonio Community Hospital, Via Trento-Trieste, 33038 San Daniele del Friuli, Udine, Italy.
| | - Arianna Ius
- Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | | | | | - Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Olga Vriz
- Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
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Serum lipid concentrations among persons with spinal cord injury - a systematic review and meta-analysis of the literature. Atherosclerosis 2013; 232:305-12. [PMID: 24468143 DOI: 10.1016/j.atherosclerosis.2013.11.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 10/24/2013] [Accepted: 11/05/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Lipid optimization comprises a therapeutic cornerstone of primary and secondary cardiovascular disease prevention. This systematic review and meta-analysis sought to clarify patterns of lipid profiles in spinal cord injury (SCI) patients compared to able-bodied individuals as well as among subgroups of SCI patients stratified by sex, activity level, race, and level of injury. METHODS Searches were conducted in PubMed, CINAHL, PsycINFO, and EMBASE. The initial literature search broadly identified peer-reviewed studies that examined cardiovascular risk factors in SCI. A total of 50 studies were ultimately identified that focused on lipid levels in SCI. Demographic data (including subject age, duration of injury, height, weight, and body mass index [BMI]) and lipid values were extracted for able-bodied individuals and subjects with SCI. Statistical analyses included t-testing and analysis of variance (ANOVA). RESULTS Compared with controls, individuals with SCI had significantly lower total cholesterol (TC) (183.4 mg/dL versus 194.9 mg/dL, p = 0.019) and high-density lipoprotein cholesterol (HDL-C) (41.0 mg/dL versus 49.6 mg/dL, p < 0.001) and higher TC/HDL-C ratios (4.5 versus 4.0, p = 0.002), though no significant differences were found for triglyceride (TG) and non-HDL-C values. CONCLUSIONS SCI represents an increasingly common chronic condition, now secondarily characterized by heightened CVD risk potentially in part due to unique lipid profiles characterized primarily by low HDL-C and an increased TC/HDL-C ratio. As other at-risk patient populations have received increased acknowledgment with more stringent lipid panel screening at earlier ages and increased frequency, we would propose that the same be implemented for the SCI population until more-specific CVD risk stratification guidelines are established for this population.
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Cragg JJ, Noonan VK, Dvorak M, Krassioukov A, Mancini GBJ, Borisoff JF. Spinal cord injury and type 2 diabetes: results from a population health survey. Neurology 2013; 81:1864-8. [PMID: 24153440 DOI: 10.1212/01.wnl.0000436074.98534.6e] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the association between spinal cord injury (SCI) and type 2 diabetes in a large representative sample and to determine whether an association exists irrespective of known risk factors for type 2 diabetes. METHODS Data were obtained on 60,678 respondents to the Statistics Canada 2010 Cycle of the cross-sectional Canadian Community Health Survey. Multivariable logistic regression, incorporating adjustment for confounders and probability weights to account for the Canadian Community Health Survey sampling method, was conducted to quantify this association. RESULTS After adjustment for both sex and age, SCI was associated with a significant increased odds of type 2 diabetes (adjusted odds ratio = 1.66, 95% confidence interval 1.16-2.36). These heightened odds persisted after additional adjustment for smoking status, hypertension status, body mass index, daily physical activity, alcohol intake, and daily consumption of fruits and vegetables (fully adjusted odds ratio = 2.45, 95% confidence interval 1.34-4.47). CONCLUSIONS There is a strong association between SCI and type 2 diabetes, which is not explained by known risk factors for type 2 diabetes.
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Affiliation(s)
- Jacquelyn J Cragg
- From the School of Population and Public Health, Faculty of Medicine (J.J.C.), International Collaboration on Repair Discoveries (J.J.C., A.K., J.F.B.), Division of Spine, Department of Orthopaedics (M.D.), Department of Medicine, Division of Physical Medicine and Rehabilitation (A.K.), and Cardiovascular Imaging Research Core Laboratory, Division of Cardiology, Department of Medicine (G.B.J.M.), University of British Columbia, Vancouver; Rick Hansen Institute (V.K.N.), Vancouver; Acute Spine Program (M.D.), Vancouver General Hospital; GF Strong Rehabilitation Centre (A.K.), Vancouver Health Authority, Vancouver; and British Columbia Institute of Technology (J.F.B.), Burnaby, Canada
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Rosety-Rodriguez M, Camacho A, Rosety I, Fornieles G, Rosety MA, Diaz AJ, Bernardi M, Rosety M, Ordonez FJ. Low-grade systemic inflammation and leptin levels were improved by arm cranking exercise in adults with chronic spinal cord injury. Arch Phys Med Rehabil 2013; 95:297-302. [PMID: 24060491 DOI: 10.1016/j.apmr.2013.08.246] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To ascertain the effect of arm cranking exercise on improving plasma levels of inflammatory cytokines and adipokines in untrained adults with chronic spinal cord injury (SCI). DESIGN Longitudinal study. SETTING Community-based supervised intervention. PARTICIPANTS Men (N=17) with complete SCI at or below T5 volunteered for this study. Participants were randomly allocated to the intervention (n=9) or control group (n=8) using a concealed method. INTERVENTION A 12-week arm cranking exercise program of 3 sessions per week consisted of warm-up (10-15min), arm crank (20-30min; increasing 2min and 30s every 3wk) at a moderate work intensity of 50% to 65% of heart rate reserve (starting at 50% and increasing 5% every 3wk), and cool-down (5-10min). MAIN OUTCOME MEASURES Plasma levels of leptin, adiponectin, plasminogen activator inhibitor-1, tumor necrosis factor-alpha, and interleukin-6 were determined. Furthermore, physical fitness (maximum oxygen consumption [V˙O2max]) and body composition (anthropometric index, waist circumference, and body mass index) were also assessed. RESULTS Plasma levels of leptin, tumor necrosis factor-alpha, and interleukin-6 were significantly decreased after the completion of the training program. Similarly, the anthropometric index and waist circumference were diminished too. A moderate correlation was found between leptin and the anthropometric index. Finally, V˙O2max was significantly increased, suggesting an improvement of physical fitness in the intervention group. No changes were found in the control group. CONCLUSIONS Arm cranking exercise improved low-grade systemic inflammation by decreasing plasma levels of inflammatory cytokines. Furthermore, it also reduced plasma leptin levels. Long-term, well-conducted studies are still required to determine whether these changes may improve clinical outcomes of adults with chronic SCI.
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Affiliation(s)
| | - Alejandra Camacho
- Division of Internal Medicine, Juan Ramon Jimenez Hospital, Huelva, Spain
| | - Ignacio Rosety
- Human Anatomy Department, School of Medicine, University of Cadiz, Cadiz, Spain
| | - Gabriel Fornieles
- Medicine Department, School of Medicine, University of Cadiz, Cadiz, Spain
| | - Miguel A Rosety
- School of Sports Medicine, University of Cadiz, Cadiz, Spain
| | - Antonio J Diaz
- Medicine Department, School of Medicine, University of Cadiz, Cadiz, Spain
| | - Marco Bernardi
- School of Speciality in Sports Medicine, Department of Physiology and Pharmacology, "V. Erspamer," "Sapienza," University of Rome, Rome, Italy
| | - Manuel Rosety
- School of Sports Medicine, University of Cadiz, Cadiz, Spain
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Changes of leptin concentration in plasma in patients with spinal cord injury: a meta-analysis. Spinal Cord 2013; 51:728-31. [PMID: 23999108 DOI: 10.1038/sc.2013.82] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/23/2013] [Accepted: 07/08/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to investigate changes of leptin concentration in plasma in patients with spinal cord injury to come to a single concept by using a Meta-analysis. SETTING Systematic Review. METHODS Searching relevant articles was performed in Ovid data base, Medline (PubMed) EMBASE, Google Scholar, Cochrane and Scopus up to February 2013. Five articles were selected using two independent reviewers. Analysis were performed using SPSS version 18 and Comparative Meta-analysis software version 2.0. RESULTS The combined analysis with confidence interval of 95% using comprehensive meta-analysis showed significant higher leptin levels in patients with spinal cord injury in comparison with able bodies (P<0.0001). The effect of spinal lesion level on plasma leptin concentration was also statistically significant (P<0.0001). Body mass index was positively related to plasma leptin concentration in both groups (P<0.0001). CONCLUSION This Meta analysis approves increased level of leptin in spinal cord injured patients which can be due to fat distribution changes and sympathetic dysfunction in these patients. Our results also showed that patients with higher spinal lesion level have higher plasma leptin concentration.
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Kuklina EV, Hagen EM. Link between cardiovascular disease and spinal cord injury: new evidence and update. Neurology 2013; 81:700-1. [PMID: 23884044 DOI: 10.1212/wnl.0b013e3182a1ab26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cragg JJ, Noonan VK, Krassioukov A, Borisoff J. Cardiovascular disease and spinal cord injury: results from a national population health survey. Neurology 2013; 81:723-8. [PMID: 23884034 DOI: 10.1212/wnl.0b013e3182a1aa68] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the association between cardiovascular disease (CVD) and spinal cord injury (SCI) in a large representative sample. METHODS Data were compiled from more than 60,000 individuals from the 2010 cycle of the cross-sectional Canadian Community Health Survey (CCHS). Multivariable logistic regression analysis was conducted to examine this relationship, adjusting for confounders and using probability weighting to account for the CCHS sampling method. RESULTS After adjusting for age and sex, SCI was associated with a significant increased odds of heart disease (adjusted odds ratio [OR] = 2.72, 95% confidence interval [CI] 1.94-3.82) and stroke (adjusted OR = 3.72, 95% CI 2.22-6.23). CONCLUSIONS These remarkably heightened odds highlight the exigent need for targeted interventions and prevention strategies addressing modifiable risk factors for CVD in individuals with SCI.
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Affiliation(s)
- Jacquelyn J Cragg
- School of Population and Public Health, Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver Canada.
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West CR, AlYahya A, Laher I, Krassioukov A. Peripheral vascular function in spinal cord injury: a systematic review. Spinal Cord 2012. [DOI: 10.1038/sc.2012.136] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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