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Mueller G, Berlowitz DJ, Raab AM, Postma K, Gobets D, Huber B, Hund-Georgiadis M, Jordan X, Schubert M, Wildburger R, Brinkhof MWG. Incidence and Risk Factors of Pneumonia in Individuals With Acute Spinal Cord Injury: A Multi-national, Multi-center, Prospective Cohort Study. Arch Phys Med Rehabil 2024; 105:884-891. [PMID: 38032554 DOI: 10.1016/j.apmr.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. DESIGN Multi-centric, longitudinal cohort study. SETTING 10 specialized SCI rehabilitation units in Europe and Australia. PARTICIPANTS Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24-hour mechanical ventilation; 503 participated in the study (N=503). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan-Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. RESULTS Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH2O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). CONCLUSION Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia.
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Affiliation(s)
- Gabi Mueller
- Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - David J Berlowitz
- Institute for Breathing and Sleep and the University of Melbourne, Austin Health, Melbourne, Australia
| | - Anja M Raab
- School of Health Professions of Bern University of Applied Sciences, Switzerland
| | - Karin Postma
- Rijndam Rehabilitation, Rotterdam, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Gobets
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | | | | | | | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Berger MJ, Dengler J, Westman A, Curt A, Schubert M, Abel R, Weidner N, Röhrich F, Fox IK. Nerve Transfer After Cervical Spinal Cord Injury: Who Has a "Time Sensitive" Injury Based on Electrodiagnostic Findings? Arch Phys Med Rehabil 2024; 105:682-689. [PMID: 37979641 DOI: 10.1016/j.apmr.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To use the ulnar compound muscle action potential (CMAP) to abductor digiti minimi (ADM) to identify the proportion of individuals with cervical spinal cord injury (SCI) who have lower motor neuron (LMN) abnormalities involving the C8-T1 spinal nerve roots, within 3-6 months, and thus may influence the response to nerve transfer surgery. DESIGN Retrospective analysis of prospectively collected data. Data were analyzed from European Multicenter Study About SCI database. SETTING Multi-center, academic hospitals. PARTICIPANTS We included 79 subjects (age=41.4±17.7, range:16-75; 59 men; N=79), who were classified as cervical level injuries 2 weeks after injury and who had manual muscle strength examinations that would warrant consideration for nerve transfer (C5≥4, C8<3). INTERVENTIONS None. MAIN OUTCOME MEASURES The ulnar nerve CMAP amplitude to ADM was used as a proxy measure for C8-T1 spinal segment health. CMAP amplitude was stratified into very abnormal (<1.0 mV), sub-normal (1.0-5.9 mV), and normal (>6.0 mV). Analysis took place at 3 (n=148 limbs) and 6 months (n=145 limbs). RESULTS At 3- and 6-month post-injury, 33.1% and 28.3% of limbs had very abnormal CMAP amplitudes, respectively, while in 54.1% and 51.7%, CMAPs were sub-normal. Median change in amplitude from 3 to 6 months was 0.0 mV for very abnormal and 1.0 mV for subnormal groups. A 3-month ulnar CMAP <1 mV had a positive predictive value of 0.73 (95% CI 0.69-0.76) and 0.78 (95% CI 0.75-0.80) for C8 and T1 muscle strength of 0 vs 1 or 2. CONCLUSION A high proportion of individuals have ulnar CMAPs below the lower limit of normal 3- and 6-month post cervical SCI and may also have intercurrent LMN injury. Failure to identify individuals with LMN denervation could result in a lost opportunity to improve hand function through timely nerve transfer surgeries.
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Affiliation(s)
- Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jana Dengler
- Division of Plastic Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario; Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | - Amanda Westman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Röhrich
- BG Klinikum Bergmannstrost, Zentrum für Rückenmarkverletzte und Klinik für Orthopädie, Halle, Germany
| | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Dimitriou D, Meisterhans M, Geissmann M, Borpas P, Hoch A, Rosner J, Schubert M, Aguirre J, Eichenberger U, Zingg PO. The effect of experimentally induced gluteal muscle weakness on joint kinematics, reaction forces, and dynamic balance performance during deep bilateral squats. J Orthop Res 2024; 42:164-171. [PMID: 37309814 DOI: 10.1002/jor.25644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
Squatting is a common daily activity and fundamental exercise in resistance training and closed kinetic chain programs. The aim of this study was to investigate the effects of an experimentally induced weakness of the gluteal muscles on joint kinematics, reactions forces (JRFs), and dynamic balance performance during deep bilateral squats in healthy young adults. Ten healthy adults received sequential blocks of (1) branch of the superior gluteal nerve to the tensor fasciae latae (SGNtfl) muscle, (2) superior gluteal nerve (SGN), and (3) inferior gluteal nerve (IGN) on the dominant right leg. At the control condition and following each block, the participants were instructed to perform deep bilateral squats standing on two force plates. Hip, knee, ankle, and pelvis kinematics did not differ significantly following iatrogenic weakness of gluteal muscles. The most important finding was the significant differences in JRFs following SGN and IGN block, with the affected hip, patellofemoral, and ankle joint demonstrating lower JRFs, whereas the contralateral joints demonstrated significantly higher JRFs, especially the patellofemoral joint which demonstrated an average maximum difference of 1.43 x body weight compared with the control condition. When performing a deep bilateral leg squat under SGN and IGN block, the subjects demonstrated an increased center of pressure (CoP) range and standard deviation (SD) in mediolateral compared with the control condition. These results imply that squat performance changes significantly following weakness of gluteal muscles and should be considered when assessing and training athletes or patients with these injuries.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Michel Meisterhans
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Marina Geissmann
- Swiss Center for Movement Analysis, Balgrist Campus AG, Zurich, Switzerland
| | - Paul Borpas
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - José Aguirre
- Balgrist University Hospital, Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Urs Eichenberger
- Balgrist University Hospital, Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
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Wagner A, Brach M, Scheel-Sailer A, Friedli M, Hund-Georgiadis M, Jordan X, Schubert M, Gemperli A. Use of professional home care in persons with spinal cord injury in Switzerland: a cross-sectional study. BMC Health Serv Res 2023; 23:1393. [PMID: 38087349 PMCID: PMC10714621 DOI: 10.1186/s12913-023-10429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Persons with spinal cord injury (SCI) living in the community often require care. The boundaries between professional home care and informal care are blurred, and it is unclear who the typical user of home care is. The objective of this study was to describe the characteristics of persons with SCI using professional home care in Switzerland, determine the frequency of home care visits, and investigate the association of sociodemographic factors, SCI-specific characteristics, secondary health conditions, and functional independence with the use of home care. METHODS We used cross-sectional data from the 2017 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Out of 3,959 eligible individuals 1294 completed the questionnaire and were included in the analysis (response rate 33%). Using descriptive statistics, differences between home care users and non-users as well as the frequency of home care visits were investigated. The association between sociodemographic factors, SCI-specific characteristics, secondary health conditions, functional independence and the use of home care was analyzed using multivariable logistic regression. Multiple imputation was used to account for missing data. RESULTS Of 1,294 participants, 280 (22%) used professional home care. The median weekly professional home care duration was 6 h (Q1 = 2, Q3 = 12). More home care was used in persons with lower functional independence (Odds ratio (OR) 0.30 per 10 unit decrease in the Spinal Cord Independence Measure, 95%-Confidence interval (CI) 0.24-0.37), fewer secondary health conditions (OR 0.96 per unit Spinal Cord Injury Secondary Conditions Scale, 95%-CI 0.94-0.99), tetraplegia (OR 2.77, 95%-CI 1.92-4.00), women (OR 2.42, 95%-CI 1.70-3.43), higher age (OR 1.22 per 10 years increase, 95%-CI 1.06-1.39), living alone (OR 2.48, 95%-CI 1.53-4.03), and those receiving support from an informal caregiver (OR 1.88, 95%-CI 1.27-2.77). CONCLUSIONS This is the first study to examine the use of professional home care from the perspective of persons with SCI in Switzerland. Lower functional independence strongly predicts increased home care use. The findings showed that professional home care complements informal care and is more likely to be used by individuals with SCI who live alone, have tetraplegia, and are female.
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Affiliation(s)
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | | | | | | | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland.
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Pfender N, Rosner J, Zipser CM, Friedl S, Schubert M, Sutter R, Klarhoefer M, Spirig JM, Betz M, Freund P, Farshad M, Curt A, Hupp M. Increased cranio-caudal spinal cord oscillations are the cardinal pathophysiological change in degenerative cervical myelopathy. Front Neurol 2023; 14:1217526. [PMID: 38020663 PMCID: PMC10663304 DOI: 10.3389/fneur.2023.1217526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is the most common cause of non-traumatic incomplete spinal cord injury, but its pathophysiology is poorly understood. As spinal cord compression observed in standard MRI often fails to explain a patient's status, new diagnostic techniques to assess DCM are one of the research priorities. Minor cardiac-related cranio-caudal oscillations of the cervical spinal cord are observed by phase-contrast MRI (PC-MRI) in healthy controls (HCs), while they become pathologically increased in patients suffering from degenerative cervical myelopathy. Whether transversal oscillations (i.e., anterior-posterior and right-left) also change in DCM patients is not known. Methods We assessed spinal cord motion simultaneously in all three spatial directions (i.e., cranio-caudal, anterior-posterior, and right-left) using sagittal PC-MRI and compared physiological oscillations in 18 HCs to pathological changes in 72 DCM patients with spinal canal stenosis. The parameter of interest was the amplitude of the velocity signal (i.e., maximum positive to maximum negative peak) during the cardiac cycle. Results Most patients suffered from mild DCM (mJOA score 16 (14-18) points), and the majority (68.1%) presented with multisegmental stenosis. The spinal canal was considerably constricted in DCM patients in all segments compared to HCs. Under physiological conditions in HCs, the cervical spinal cord oscillates in the cranio-caudal and anterior-posterior directions, while right-left motion was marginal [e.g., segment C5 amplitudes: cranio-caudal: 0.40 (0.27-0.48) cm/s; anterior-posterior: 0.18 (0.16-0.29) cm/s; right-left: 0.10 (0.08-0.13) cm/s]. Compared to HCs, DCM patients presented with considerably increased cranio-caudal oscillations due to the cardinal pathophysiologic change in non-stenotic [e.g., segment C5 amplitudes: 0.79 (0.49-1.32) cm/s] and stenotic segments [.g., segment C5 amplitudes: 0.99 (0.69-1.42) cm/s]). In contrast, right-left [e.g., segment C5 amplitudes: non-stenotic segment: 0.20 (0.13-0.32) cm/s; stenotic segment: 0.11 (0.09-0.18) cm/s] and anterior-posterior oscillations [e.g., segment C5 amplitudes: non-stenotic segment: 0.26 (0.15-0.45) cm/s; stenotic segment: 0.11 (0.09-0.18) cm/s] remained on low magnitudes comparable to HCs. Conclusion Increased cranio-caudal oscillations of the cervical cord are the cardinal pathophysiologic change and can be quantified using PC-MRI in DCM patients. This study addresses spinal cord oscillations as a relevant biomarker reflecting dynamic mechanical cord stress in DCM patients, potentially contributing to a loss of function.
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Affiliation(s)
- Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Carl M. Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Reto Sutter
- Radiology, Balgrist University Hospital, Zurich, Switzerland
| | | | - José M. Spirig
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Michael Betz
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Markus Hupp
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
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Stalder SA, van der Lely S, Anderson CE, Birkhäuser V, Curt A, Gross O, Leitner L, Mehnert U, Schubert M, Tornic J, Kessler TM, Liechti MD. Development of a Sham Protocol to Investigate Transcutaneous Tibial Nerve Stimulation in Randomised, Sham-Controlled, Double-Blind Clinical Trials. Biomedicines 2023; 11:1931. [PMID: 37509569 PMCID: PMC10377596 DOI: 10.3390/biomedicines11071931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Transcutaneous tibial nerve stimulation (TTNS) is a promising treatment for neurogenic lower urinary tract symptoms. However, the evidence is limited due to a general lack of randomised controlled trials (RCTs) and, also, inconsistency in the sham and blinding conditions. In the context of much-needed RCTs, we aimed to develop a suitable sham-control protocol for a clinical setting to maintain blinding but avoid meaningful stimulation of the tibial nerve. Three potential electrode positions (lateral malleolus/5th metatarsal/plantar calcaneus) and two electrode sizes (diameter: 2.5 cm/3.2 cm) were tested to determine which combination provided the optimal sham configuration for a TTNS approach, based on a visible motor response. Sixteen healthy volunteers underwent sensory and motor assessments for each sham configuration. Eight out of them came back for an extra TTNS visit. Sensory thresholds were present for all sham configurations, with linear regression models revealing a significant effect regarding electrode position (highest at plantar calcaneus) but not size. In addition, motor thresholds varied with the position-lowest for the 5th metatarsal. Only using this position and 3.2 cm electrodes attained a 100% response rate. Compared to TTNS, sensory and motor thresholds were generally higher for the sham configurations; meanwhile, perceived pain was only higher at the lateral malleolus. In conclusion, using the 5th metatarsal position and 3.2 cm electrodes proved to be the most suitable sham configuration. Implemented as a four-electrode setup with standardized procedures, this appears to be a suitable RCT protocol for maintaining blinding and controlling for nonspecific TTNS effects in a clinical setting.
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Affiliation(s)
- Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, 8092 Zürich, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Collene E Anderson
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Jure Tornic
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
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Zipser-Mohammadzada F, Scheffers MF, Conway BA, Halliday DM, Zipser CM, Curt A, Schubert M. Intramuscular coherence enables robust assessment of modulated supra-spinal input in human gait: an inter-dependence study of visual task and walking speed. Exp Brain Res 2023; 241:1675-1689. [PMID: 37199775 DOI: 10.1007/s00221-023-06635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
Intramuscular high-frequency coherence is increased during visually guided treadmill walking as a consequence of increased supra-spinal input. The influence of walking speed on intramuscular coherence and its inter-trial reproducibility need to be established before adoption as a functional gait assessment tool in clinical settings. Here, fifteen healthy controls performed a normal and a target walking task on a treadmill at various speeds (0.3 m/s, 0.5 m/s, 0.9 m/s, and preferred) during two sessions. Intramuscular coherence was calculated between two surface EMG recordings sites of the Tibialis anterior muscle during the swing phase of walking. The results were averaged across low-frequency (5-14 Hz) and high-frequency (15-55 Hz) bands. The effect of speed, task, and time on mean coherence was assessed using three-way repeated measures ANOVA. Reliability and agreement were calculated with the intra-class correlation coefficient and Bland-Altman method, respectively. Intramuscular coherence during target walking was significantly higher than during normal walking across all walking speeds in the high-frequency band as obtained by the three-way repeated measures ANOVA. Interaction effects between task and speed were found for the low- and high-frequency bands, suggesting that task-dependent differences increase at higher walking speeds. Reliability of intramuscular coherence was moderate to excellent for most normal and target walking tasks in all frequency bands. This study confirms previous reports of increased intramuscular coherence during target walking, while providing first evidence for reproducibility and robustness of this measure as a requirement to investigate supra-spinal input.Trial registration Registry number/ClinicalTrials.gov Identifier: NCT03343132, date of registration 2017/11/17.
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Affiliation(s)
| | - Marjelle Fredie Scheffers
- Department of Neurophysiology, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Bernard A Conway
- Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
| | - David M Halliday
- School of Physics, Engineering and Technology, University of York, York, YO10 5DD, UK
- York Biomedical Research Institute, University of York, York, UK
| | - Carl Moritz Zipser
- Department of Neurophysiology, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Department of Neurophysiology, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Department of Neurophysiology, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
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Kheram N, Boraschi A, Pfender N, Spiegelberg A, Kurtcuoglu V, Curt A, Schubert M, Zipser CM. Queckenstedt's test repurposed for the quantitative assessment of the cerebrospinal fluid pulsatility curve. Acta Neurochir (Wien) 2023; 165:1533-1543. [PMID: 37079108 DOI: 10.1007/s00701-023-05583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Before the era of spinal imaging, presence of a spinal canal block was tested through gross changes in cerebrospinal fluid pressure (CSFP) provoked by manual compression of the jugular veins (referred to as Queckenstedt's test; QT). Beyond these provoked gross changes, cardiac-driven CSFP peak-to-valley amplitudes (CSFPp) can be recorded during CSFP registration. This is the first study to assess whether the QT can be repurposed to derive descriptors of the CSF pulsatility curve, focusing on feasibility and repeatability. METHOD Lumbar puncture was performed in lateral recumbent position in fourteen elderly patients (59.7±9.3 years, 6F) (NCT02170155) without stenosis of the spinal canal. CSFP was recorded during resting state and QT. A surrogate for the relative pulse pressure coefficient was computed from repeated QTs (i.e., RPPC-Q). RESULTS Resting state mean CSFP was 12.3 mmHg (IQR 3.2) and CSFPp was 1.0 mmHg (0.5). Mean CSFP rise during QT was 12.5 mmHg (7.3). CSFPp showed an average 3-fold increase at peak QT compared to the resting state. Median RPPC-Q was 0.18 (0.04). There was no systematic error in the computed metrics between the first and second QT. CONCLUSION This technical note describes a method to reliably derive, beyond gross CSFP increments, metrics related to cardiac-driven amplitudes during QT (i.e., RPPC-Q). A study comparing these metrics as obtained by established procedures (i.e., infusion testing) and by QT is warranted.
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Affiliation(s)
- Najmeh Kheram
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Nikolai Pfender
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Spiegelberg
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Carl Moritz Zipser
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland.
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Kheram N, Boraschi A, Pfender N, Friedl S, Rasenack M, Fritz B, Kurtcuoglu V, Schubert M, Curt A, Zipser CM. Cerebrospinal Fluid Pressure Dynamics as a Bedside Test in Traumatic Spinal Cord Injury to Assess Surgical Spinal Cord Decompression: Safety, Feasibility, and Proof-of-Concept. Neurorehabil Neural Repair 2023; 37:171-182. [PMID: 36919616 PMCID: PMC10152574 DOI: 10.1177/15459683231159662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Sufficient and timely spinal cord decompression is a critical surgical objective for neurological recovery in spinal cord injury (SCI). Residual cord compression may be associated with disturbed cerebrospinal fluid pressure (CSFP) dynamics. OBJECTIVES This study aims to assess whether intrathecal CSFP dynamics in SCI following surgical decompression are feasible and safe, and to explore the diagnostic utility. METHODS Prospective cohort study. Bedside lumbar CSFP dynamics and cervical MRI were obtained following surgical decompression in N = 9 with mostly cervical acute-subacute SCI and N = 2 patients with non-traumatic SCI. CSFP measurements included mean CSFP, cardiac-driven CSFP peak-to-valley amplitudes (CSFPp), Valsalva maneuver, and Queckenstedt's test (firm pressure on jugular veins, QT). From QT, proxies for cerebrospinal fluid pulsatility curve were calculated (ie, relative pulse pressure coefficient; RPPC-Q). CSFP metrics were compared to spine-healthy patients. computer tomography (CT)-myelography was done in 3/8 simultaneous to CSFP measurements. RESULTS Mean age was 45 ± 9 years (range 17-67; 3F), SCI was complete (AIS A, N = 5) or incomplete (AIS B-D, N = 6). No adverse events related to CSFP assessments. CSFP rise during QT was induced in all patients [range 9.6-26.6 mmHg]. However, CSFPp was reduced in 3/11 (0.1-0.3 mmHg), and in 3/11 RPPC-Q was abnormal (0.01-0.05). Valsalva response was reduced in 8/11 (2.6-23.4 mmHg). CSFP dynamics corresponded to CT-myelography. CONCLUSIONS Comprehensive bedside lumbar CSFP dynamics in SCI following decompression are safe, feasible, and can reveal distinct patterns of residual spinal cord compression. Longitudinal studies are required to define critical thresholds of impaired CSFP dynamics that may impact neurological recovery and requiring surgical revisions.
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Affiliation(s)
- Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Maria Rasenack
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | | | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Carl M Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
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10
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Guekos A, Grata AC, Hubli M, Schubert M, Schweinhardt P. Are changes in nociceptive withdrawal reflex magnitude a viable central sensitization proxy? Implications of a replication attempt. Clin Neurophysiol 2023; 145:139-150. [PMID: 36272950 DOI: 10.1016/j.clinph.2022.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The nociceptive withdrawal reflex (NWR) has been proposed to read-out central sensitization (CS). Replicating a published study, it was assessed if the NWR magnitude reflects sensitization by painful heat. Additionally, NWR response rates were compared for two stimulation, the sural nerve at the lateral malleolus (SU) and the medial plantar nerve on the foot sole (MP), and three recording sites, biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA) muscles. METHODS 16 subjects underwent one experiment with six blocks of eight transcutaneous electrical stimulations to elicit the NWR while surface electromyography was collected. Tonic heat was concurrently applied in the same dermatome. Temperatures rose from 32 °C in the first to 46 °C in the last block following the previously published protocol. RESULTS Tonic heat did not influence NWR magnitude. The highest NWR response rate was obtained for MP-TA combination (79%). Regarding elicitation in all three muscles, SU stimulation outperformed MP (59% vs 57%). CONCLUSIONS The replication failed. NWR magnitude as a CS proxy in healthy subjects needs continued investigation. With respect to response rates, MP-TA proved efficient, whereas SU stimulation seemed preferable for multiple muscle recordings. SIGNIFICANCE Unclear methodological descriptions in the original study affected CS and NWR replication. The NWR magnitude changes induced by CS may closely depend on the different stimulation methods used.
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Affiliation(s)
- A Guekos
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Decision Neuroscience Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - A C Grata
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago IL, United States
| | - M Hubli
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Schubert
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - P Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
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11
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Schubert M, Stober J, Herrmann A, Grigore E, Kasparek W, Lechte C, Monaco F, Petzold B, Plaum B, Poli E, Ruset C, Vorbrugg S, Wagner D. Experiments with reduced single pass absorption at ASDEX Upgrade – instrumentation and applications. EPJ Web Conf 2023. [DOI: 10.1051/epjconf/202327702008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Reflecting gratings have been installed in the vacuum vessel of ASDEX Upgrade for all beamlines of the electron cyclotron resonance heating system. Potentially unabsorbed millimetre wave power after the first pass through the plasma is redirected towards the plasma centre. This increases the efficiency of heating schemes with reduced single pass absorption like O-2 or X-3. In order to monitor beam position and power, thermocouples were installed into the gratings. A numerical model was developed to evaluate the beam intensity during short pulses from the thermocouple measurement in a non-stationary environment. An experiment was carried out, where only the X-3 resonance is present in the plasma, and the millimetre wave beam shine-through was measured successfully as a function of the central plasma electron temperature. This allows to deduce the X-3 absorption experimentally. Scanning the launching angles, it seems possible to measure the 2D beam cross section after the first pass through the plasma.
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12
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Stober J, Schubert M, Schneider M, Denk SS, Fischer R, Poli E, Stieglitz D, Willensdorfer M, Loarte A, Ricci D. Quantification of X3 absorption for ITER L-mode parameters in ASDEX Upgrade. EPJ Web Conf 2023. [DOI: 10.1051/epjconf/202327702007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
For an early H-mode access in hydrogen, ITER considers operating at 1/3 of the full field using 170 GHz X-Mode for heating at the 3rd harmonic. The optical thickness for such a heating scheme depends on Te2. It is rather low in the ohmic phase (with Te about 1-2 keV), but reaches high single pass absorption for the strongly EC heated plasma with Te exceeding 10 keV. Launching ECRH into an ohmic plasma may trigger a boot-strap process on Te if the additional power absorption due to increasing Te exceeds the additional power losses due to increased transport (which often tends to increase with input power). In this contribution we present measurements of the X3 absorption for the parameter range relevant for ITER, i.e. ne 2 1019 m−3, Te 2 keV in order to back up theoretical estimates used for the modeling so far. In ASDEX Upgrade (AUG) such low densities cannot be reached in H-mode such that dominant heating with NBI is not an option. For moderate Te, it is also not an option to use X3 heating as main heating, due to the excessive stray radiation threatening in-vessel components. This dilemma is solved with the 2-frequency EC system of AUG. The main central heating is done with the lower frequency of 105 GHz at the 2nd harmonic and full single pass absorption. Up to 3.5 MW of ECRH are used at that frequency to vary Te. Two other gyrotrons are used at 140 GHz to probe the X3 interaction close to the plasma center with a sequence of short blips. The expected values of single pass absorption are calculated with TORBEAM and vary from 7% to 70%. Below 40% single pass absorption the non-absorbed power triggers an arc in the tile gaps of the inner heat shield which screens the thermo-couples from the incoming beam such that they cannot be used. Between 40% and 80% single pass absorption, the predictions and measurements agree within the uncertainty of the measurement, unless we have clear evidence for non-linear interactions, which are not described by TORBEAM and which are not expected in ITER, but are due to some specific experimental choices for an isolated subset of our results.
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13
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Schubert M, Pelz A, Trautmann G, Block K, Furlan S, Gutsmann M, Kohler S, Volpe P, Blottner D, Meisel A, Salanova M. Opposite Regulation of Homer Signal at the NMJ Postsynaptic Micro Domain between Slow- and Fast-Twitch Muscles in an Experimentally Induced Autoimmune Myasthenia Gravis (EAMG) Mouse Model. Int J Mol Sci 2022; 23:ijms232315052. [PMID: 36499379 PMCID: PMC9738765 DOI: 10.3390/ijms232315052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Accelerated postsynaptic remodelling and disturbance of neuromuscular transmission are common features of autoimmune neurodegenerative diseases. Homer protein isoform expression, crosslinking activity and neuromuscular subcellular localisation are studied in mouse hind limb muscles of an experimentally induced autoimmune model of Myasthenia Gravis (EAMG) and correlated to motor end plate integrity. Soleus (SOL), extensor digitorum longus (EDL) and gastrocnemius (GAS) skeletal muscles are investigated. nAChR membrane clusters were studied to monitor neuromuscular junction (NMJ) integrity. Fibre-type cross-sectional area (CSA) analysis is carried out in order to determine the extent of muscle atrophy. Our findings clearly showed that crosslinking activity of Homer long forms (Homer 1b/c and Homer2a/b) are decreased in slow-twitch and increased in fast-twitch muscle of EAMG whereas the short form of Homer that disrupts Homer crosslinking (Homer1a) is upregulated in slow-twitch muscle only. Densitometry analysis showed a 125% increase in Homer protein expression in EDL, and a 45% decrease in SOL of EAMG mice. In contrast, nAChR fluorescence pixel intensity decreased in endplates of EAMG mice, more distinct in type-I dominant SOL muscle. Morphometric CSA of EAMG vs. control (CTR) revealed a significant reduction in EDL but not in GAS and SOL. Taken together, these results indicate that postsynaptic Homer signalling is impaired in slow-twitch SOL muscle from EAMG mice and provide compelling evidence suggesting a functional coupling between Homer and nAChR, underscoring the key role of Homer in skeletal muscle neurophysiology.
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Affiliation(s)
- Martin Schubert
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10115 Berlin, Germany
| | - Andreas Pelz
- Department of Experimental Neurology, Charité—Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Gabor Trautmann
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10115 Berlin, Germany
| | - Katharina Block
- Center of Space Medicine Berlin, Neuromuscular Signaling and System, 10115 Berlin, Germany
| | - Sandra Furlan
- C.N.R. Institute of Neuroscience, 35131 Padova, Italy
| | - Martina Gutsmann
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10115 Berlin, Germany
| | - Siegfried Kohler
- Department of Experimental Neurology, Charité—Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Pompeo Volpe
- Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy
| | - Dieter Blottner
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10115 Berlin, Germany
- Center of Space Medicine Berlin, Neuromuscular Signaling and System, 10115 Berlin, Germany
| | - Andreas Meisel
- Department of Experimental Neurology, Charité—Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Michele Salanova
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10115 Berlin, Germany
- Center of Space Medicine Berlin, Neuromuscular Signaling and System, 10115 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450528-354
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14
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Seidler A, Freiberg A, Drössler S, Hussenoeder FS, Conrad I, Riedel-Heller S, Starke KR, Schubert M. Elevated risk of depression and anxiety disorder by „high strain“ occupations: a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Poor working conditions might lead to mental illness.
Methods
We performed a systematic review with meta-analyses as an update of a review published in 2013. We registered the study protocol with PROSPERO (registration number: CRD42020170032) and searched for epidemiological studies in MEDLINE, PsycINFO, and Embase. Two reviewers carried out independently all review steps including title-abstract screening, full-text screening, risk-of-bias assessment and data extraction. Discordances were solved by consensus. We determined the certainty of evidence using the GRADE-approach.
Results
Ten cohort studies with acceptable study quality examined the relationship between high job strain and the incidence of depression. In the “classic” demand-control-model, ‘high strain’ (combination of high demands and low control) is compared with ‘low strain’ (combination of low demands and high job control). For high strain, the risk of depression was elevated by 73%, the pooled effect estimate for the risk of depression was 1.73 (95% CI 1.32-2.27. In a dichotomous analysis (without dividing job strain into the four dimensions mentioned above), there was a doubled risk of depression with high job strain (pooled effect estimate=1.99, 95% CI 1.68-2.35). We found comparable risk estimates for men and women. The GRADE assessment revealed a high certainty of evidence of the association between job strain and depression. We also found a considerably increased risk of anxiety disorder among individuals prone to high job strain.
Conclusions
This systematic review finds a clear association between high job strain (high demands in combination with low control) and depression as well as anxiety disorders.
Acknowledgment: This study was financially supported by SUVA (Schweizerische Unfallversicherungsanstalt).
Key messages
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Affiliation(s)
- A Seidler
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - A Freiberg
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - S Drössler
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - FS Hussenoeder
- University of Leipzig, Institute of Social Medicine, Occupational Occupational Medicine and Public Health , Leipzig, Germany
| | - I Conrad
- University of Leipzig, Institute of Social Medicine, Occupational Occupational Medicine and Public Health , Leipzig, Germany
| | - S Riedel-Heller
- University of Leipzig, Institute of Social Medicine, Occupational Occupational Medicine and Public Health , Leipzig, Germany
| | - K Romero Starke
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - M Schubert
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
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15
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Pavese C, Scivoletto G, Puci MV, Abel R, Curt A, Maier D, Rupp R, Schubert M, Weidner N, Montomoli C, Kessler TM. Prediction of bowel management independence after ischemic spinal cord injury. Eur J Phys Rehabil Med 2022; 58:709-714. [PMID: 35666490 PMCID: PMC10019474 DOI: 10.23736/s1973-9087.22.07366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ischemic spinal cord injury (SCI) belongs to the heterogeneous group of non-traumatic SCI, while the course of sensorimotor and functional recovery is comparable to traumatic SCI. Recently, we derived from data of patients with traumatic SCI a valid model to predict an independent and reliable bowel management one year after SCI. AIM To evaluate the performance of this model to predict an independent and reliable bowel management one year following ischemic SCI. DESIGN Prognostic study - observational study. SETTING European Multicenter Study about Spinal Cord Injury (EMSCI) ClinicalTrials.gov: NCT01571531. POPULATION One hundred and forty-two patients with ischemic SCI of various level and severity of injury. METHODS The prediction model relied on a single predictor collected within 40 days from injury, the International Standards for Neurological Classification of Spinal Cord Injury total motor score. Bowel outcome one year after SCI derived from the dichotomization of the Spinal Cord Independence Measure (SCIM) item 7 scores. We defined a positive outcome as independent bowel management with regular movements and appropriate timing with no or rare accidents (score of 10 in SCIM version II and score of 8 or 10 in version III). RESULTS The model showed a fair discrimination with an area under the receiver operating characteristic (ROC) curve of 0.780 (95% confidence interval=0.702-0.860). In addition, the model displayed an acceptable accuracy and calibration. CONCLUSIONS The study extends the validity of our rule to patients with ischemic SCI, thus providing the first model to predict an independent and reliable bowel management in this population. CLINICAL REHABILITATION IMPACT The model may be employed in clinical practice to counsel patients, to define the rehabilitation aims and to estimate the need of assistance after discharge, as well as in the research field for the optimization of patients' allocation in the design of future clinical trials.
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Affiliation(s)
- Chiara Pavese
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit, Pavia Institute, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mariangela V Puci
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Rainer Abel
- Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany
| | - Armin Curt
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schubert
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland -
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16
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Liao S, Omage SO, Börmel L, Kluge S, Schubert M, Wallert M, Lorkowski S. Vitamin E and Metabolic Health: Relevance of Interactions with Other Micronutrients. Antioxidants (Basel) 2022; 11:antiox11091785. [PMID: 36139859 PMCID: PMC9495493 DOI: 10.3390/antiox11091785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
A hundred years have passed since vitamin E was identified as an essential micronutrient for mammals. Since then, many biological functions of vitamin E have been unraveled in both cell and animal models, including antioxidant and anti-inflammatory properties, as well as regulatory activities on cell signaling and gene expression. However, the bioavailability and physiological functions of vitamin E have been considerably shown to depend on lifestyle, genetic factors, and individual health conditions. Another important facet that has been considered less so far is the endogenous interaction with other nutrients. Accumulating evidence indicates that the interaction between vitamin E and other nutrients, especially those that are enriched by supplementation in humans, may explain at least some of the discrepancies observed in clinical trials. Meanwhile, increasing evidence suggests that the different forms of vitamin E metabolites and derivates also exhibit physiological activities, which are more potent and mediated via different pathways compared to the respective vitamin E precursors. In this review, possible molecular mechanisms between vitamin E and other nutritional factors are discussed and their potential impact on physiological and pathophysiological processes is evaluated using published co-supplementation studies.
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Affiliation(s)
- Sijia Liao
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, 07743 Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, 07743 Jena, Germany
| | - Sylvia Oghogho Omage
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, 07743 Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, 07743 Jena, Germany
| | - Lisa Börmel
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, 07743 Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, 07743 Jena, Germany
| | - Stefan Kluge
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, 07743 Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, 07743 Jena, Germany
| | - Martin Schubert
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, 07743 Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, 07743 Jena, Germany
| | - Maria Wallert
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, 07743 Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, 07743 Jena, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, 07743 Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, 07743 Jena, Germany
- Correspondence:
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17
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Schubert M, Kilzer L, Dubielzig T, Schilling M, Ospelkaus C, Hampel B. Active impedance matching of a cryogenic radio frequency resonator for ion traps. Rev Sci Instrum 2022; 93:093201. [PMID: 36182479 DOI: 10.1063/5.0097583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
A combination of direct current (DC) fields and high amplitude radio frequency (RF) fields is necessary to trap ions in a Paul trap. Such high electric RF fields are usually reached with the help of a resonator in close proximity to the ion trap. Ion trap based quantum computers profit from good vacuum conditions and low heating rates that cryogenic environments provide. However, an impedance matching network between the resonator and its RF source is necessary, as an unmatched resonator would require higher input power due to power reflection. The reflected power would not contribute to the RF trapping potential, and the losses in the cable induce additional heat into the system. The electrical properties of the matching network components change during cooling, and a cryogenic setup usually prohibits physical access to integrated components while the experiment is running. This circumstance leads to either several cooling cycles to improve the matching at cryogenic temperatures or the operation of poorly matched resonators. In this work, we demonstrate an RF resonator that is actively matched to the wave impedance of coaxial cables and the signal source. The active part of the matching circuit consists of a varactor diode array. Its capacitance depends on the DC voltage applied from outside the cryostat. We present measurements of the power reflection, the Q-factor, and higher harmonic signals resulting from the nonlinearity of the varactor diodes. The RF resonator is tested in a cryostat at room temperature and cryogenic temperatures, down to 4.3 K. A superior impedance matching for different ion traps can be achieved with this type of resonator.
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Affiliation(s)
- M Schubert
- Institut für Elektrische Messtechnik und Grundlagen der Elektrotechnik, TU Braunschweig, Hans-Sommer Strasse 66, 38106 Braunschweig, Germany
| | - L Kilzer
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - T Dubielzig
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - M Schilling
- Institut für Elektrische Messtechnik und Grundlagen der Elektrotechnik, TU Braunschweig, Hans-Sommer Strasse 66, 38106 Braunschweig, Germany
| | - C Ospelkaus
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - B Hampel
- Institut für Elektrische Messtechnik und Grundlagen der Elektrotechnik, TU Braunschweig, Hans-Sommer Strasse 66, 38106 Braunschweig, Germany
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18
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Kheram N, Pfender N, Boraschi A, Farshad M, Kurtcuoglu V, Curt A, Schubert M, Zipser CM. Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions. Front Neurol 2022; 13:951018. [PMID: 36016547 PMCID: PMC9397118 DOI: 10.3389/fneur.2022.951018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Abstract
Spinal canal narrowing with consecutive spinal cord compression is considered a key mechanism in degenerative cervical myelopathy (DCM). DCM is a common spine condition associated with progressive neurological disability, and timely decompressive surgery is recommended. However, the clinical and radiological diagnostic workup is often ambiguous, challenging confident proactive treatment recommendations. Cerebrospinal fluid pressure dynamics (CSFP) are altered by spinal canal narrowing. Therefore, we aim to explore the potential value of bedside CSFP assessments for qualitative and quantitative assessment of spinal canal narrowing in DCM. In this prospective case series, seven patients with DCM underwent bedside lumbar puncture with measurement of CSFP dynamics and routine CSF analysis (NCT02170155). The patients were enrolled when standard diagnostic algorithms did not permit a clear treatment decision. Measurements include baseline CSFP, cardiac-driven CSFP peak-to-trough amplitude (CSFPp), and the Queckenstedt's test (firm pressure on jugular veins) in neutral and reclined head position. From the Queckenstedt's test, proxies for craniospinal elastance (i.e., relative pulse pressure coefficient; RPPC-Q) were calculated analogously to infusion testing. CSFP metrics were deemed suspicious of canal narrowing when numbers were lower than the minimum value from a previously tested elderly spine-healthy cohort (N = 14). Mean age was 56 ± 13 years (range, 38–75; 2F); symptom severity was mostly mild to moderate (mean mJOA, 13.5 ± 2.6; range, 9–17). All the patients showed some extent of cervical stenosis in the MRI of unclear significance (5/7 following decompressive cervical spine surgery with an adjacent level or residual stenosis). Baseline CSFP was normal except for one patient (range, 4.7–17.4 mmHg). Normal values were found for CSFPp (0.4–1.3 mmHg) and the Queckenstedt's test in normal head positioning (9.-25.3 mmHg). During reclination, the Queckenstedt's test significantly decreased in one, and CSFPp in another case (>50% compared to normal position). RPPC-Q (0.07–0.19) aligned with lower values from spine-healthy (0.10–0.44). Routine CSF examinations showed mild total protein elevation (mean, 522 ± 108 mg/ml) without further evidence for the disturbed blood brain barrier. Intrathecal CSFP measurements allow discerning disturbed from normal CSFP dynamics in this population. Prospective longitudinal studies should further evaluate the diagnostic utility of CSFP assessments in DCM.
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Affiliation(s)
- Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Andrea Boraschi
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Carl M. Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
- *Correspondence: Carl M. Zipser
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19
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Zipser-Mohammadzada F, Conway BA, Halliday DM, Zipser CM, Easthope CA, Curt A, Schubert M. Intramuscular coherence during challenging walking in incomplete spinal cord injury: Reduced high-frequency coherence reflects impaired supra-spinal control. Front Hum Neurosci 2022; 16:927704. [PMID: 35992941 PMCID: PMC9387543 DOI: 10.3389/fnhum.2022.927704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
Individuals regaining reliable day-to-day walking function after incomplete spinal cord injury (iSCI) report persisting unsteadiness when confronted with walking challenges. However, quantifiable measures of walking capacity lack the sensitivity to reveal underlying impairments of supra-spinal locomotor control. This study investigates the relationship between intramuscular coherence and corticospinal dynamic balance control during a visually guided Target walking treadmill task. In thirteen individuals with iSCI and 24 controls, intramuscular coherence and cumulant densities were estimated from pairs of Tibialis anterior surface EMG recordings during normal treadmill walking and a Target walking task. The approximate center of mass was calculated from pelvis markers. Spearman rank correlations were performed to evaluate the relationship between intramuscular coherence, clinical parameters, and center of mass parameters. In controls, we found that the Target walking task results in increased high-frequency (21–44 Hz) intramuscular coherence, which negatively related to changes in the center of mass movement, whereas this modulation was largely reduced in individuals with iSCI. The impaired modulation of high-frequency intramuscular coherence during the Target walking task correlated with neurophysiological and functional readouts, such as motor-evoked potential amplitude and outdoor mobility score, as well as center of mass trajectory length. The Target walking effect, the difference between Target and Normal walking intramuscular coherence, was significantly higher in controls than in individuals with iSCI [F(1.0,35.0) = 13.042, p < 0.001]. Intramuscular coherence obtained during challenging walking in individuals with iSCI may provide information on corticospinal gait control. The relationships between biomechanics, clinical scores, and neurophysiology suggest that intramuscular coherence assessed during challenging tasks may be meaningful for understanding impaired supra-spinal control in individuals with iSCI.
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Affiliation(s)
- Freschta Zipser-Mohammadzada
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- *Correspondence: Freschta Zipser-Mohammadzada,
| | - Bernard A. Conway
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - David M. Halliday
- Department of Electronic Engineering, University of York, York, United Kingdom
- York Biomedical Research Institute, University of York, York, United Kingdom
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Chris A. Easthope
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- Cereneo Foundation, Center for Interdisciplinary Research, Vitznau, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
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20
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Schubert M, Romero Starke K, Kaboth P, Hegewald J, Reusche M, Gerlach J, Friedemann D, Zülke A, Riedel-Heller SG, Zeeb H, Seidler A. BELÄSTIGUNG UND SCHLAFGESTÖRTHEIT DURCH
VERKEHRSLÄRM: EIN VERGLEICH MIT DEN
WHO-EXPOSITIONS-WIRKUNGSFUNKTIONEN. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Schubert
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - K Romero Starke
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - P Kaboth
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - J Hegewald
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
- Bundesanstalt für Arbeitsschutz und Arbeitsmedizin,
Prävention arbeitsbedingter Erkrankungen, Berlin,
Deutschland
| | - M Reusche
- Universität Leipzig, Medizinische Fakultät, Institut
für Medizininformatik, Biometrie und Epidemiologie, Leipzig,
Deutschland
| | - J Gerlach
- Technische Universität Dresden, Institut für
Verkehrsplanung und Straßenverkehr, Professur für
Verkehrsökologie, Dresden, Deutschland
| | | | - A Zülke
- Universität Leipzig, Medizinische Fakultät, Institut
für Arbeits-, Sozial- und Umweltmedizin, Leipzig,
Deutschland
| | - SG Riedel-Heller
- Universität Leipzig, Medizinische Fakultät, Institut
für Arbeits-, Sozial- und Umweltmedizin, Leipzig,
Deutschland
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und
Epidemiologie – BIPS GmbH, Abteilung Prävention und Evaluation,
Bremen, Deutschland
| | - A Seidler
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
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21
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Seidler A, Freiberg A, Drössler S, Hussenoeder FS, Conrad I, Riedel-Heller SG, Romero Starke K, Schubert M. Erhöhtes Risiko für Depressionen und
Angststörungen bei hohen psychosozialen beruflichen Belastungen
(„High Strain“): ein systematischer Review mit
Metaanalysen. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Seidler
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - A Freiberg
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - S Drössler
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - FS Hussenoeder
- Universität Leipzig, Medizinische Fakultät, Institut
für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig,
Deutschland
| | - I Conrad
- Universität Leipzig, Medizinische Fakultät, Institut
für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig,
Deutschland
| | - SG Riedel-Heller
- Universität Leipzig, Medizinische Fakultät, Institut
für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig,
Deutschland
| | - K Romero Starke
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - M Schubert
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
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22
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Schubert M, Krenz H, Sansone A, Kliesch S, Gromoll J. O-248 Cluster Analysis of men with idiopathic and unexplained male infertility identifies FSHB Genotype as relevant diagnostic parameter. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
In a cohort of idiopathic and unexplained infertile men we aimed to identify subgroups with similar characteristics, and therewith underlying etiologic factors, by clustering approach.
Summary answer
We identified two distinct patient clusters. Across all diverse phenotypes of infertility, the strongest segregation markers were FSHB c.-211G>T, FSH, and bi-testicular volume.
What is known already
In about 30-75% of infertile men no major causative factors can be identified; leading to the diagnose of unexplained (normozoospermia) or idiopathic (abnormal semen parameters) male infertility. This cohort of men remains very heterogenous, albeit the detailed andrological characterization that is currently applied in infertility workup.
New analysis tools such as machine learning and cluster analysis can provide a more in-depth approach. Such explorative analyses have the potential to uncover hitherto hidden patterns in data that might be difficult to spot for andrologists but become visible by these tools.
Study design, size, duration
A Cluster analysis was retrospectively performed in a clinically well characterized cohort of 2742 men with unexplained or idiopathic male infertility. These men had visited our Centre within a 10-year period (2008-2018) for infertility workup. Due to the well curated database (Androbase®) we were able to include up to 37 andrologic parameters in the unbiased cluster analysis.
Participants/materials, setting, methods
After applying strict selection criteria 2742, of initially 7627, infertile men remained for cluster analysis (exclusion: obstructive -, genetic -, other causative factors, female factor; inclusion: azoo- to normozoospermia, FSH ≥ 1IU/l, Testosterone ≥ 8nmol/l). For subsequent analyses the following parameters were included: somatic/semen/hormone parameters, testicular sonography and testis volume, genotyping of the FSHB c.-211G>T (rs10835638) single nucleotide polymorphism. For cluster analysis, partitioning around medoids method was employed based on Gower distance between patients.
Main results and the role of chance
The applied cluster approach for the study population yielded two separate clusters (average silhouette width ∼0.12). These clusters showed significantly different distributions in bi-testicular volume, FSH and FSHB genotype. Cluster 1 contained all men homozygous for G (wildtype) in FSHB c.-211G>T (100%), while Cluster 2 contained most patients carrying a T allele (>96.6%). Even in subgroup analysis (Total sperm count (TSC) <1Mill and TSC 1³Mill) two clusters each were formed too. Again, the strongest segregation markers between the respective clusters were FSHB c.-211G>T, bitesticular volume, and FSH, supporting the notion of a contributing genetic factor.
Surprisingly, sperm parameters like TSC, motility and morphology played a minor role in cluster formation; as well as testicular maldescent, varicocele, smoking, and microlithiasis testes.
The genetic parameter of FSHB c.-211G>T in combination with the established parameters FSH and testicular volume should attract more attention in future clinical workups of infertile men with unknown etiologic factors.
Limitations, reasons for caution
Categorical and numeric features contribute diversely to the calculation of patient dissimilarity. Potentially, categorical features can have a higher impact because patients are rated as completely different if they fall in different categories; for numeric features, the dissimilarity depends on the range of values.
Wider implications of the findings
The FSHB SNP was identified as an informative segregation marker; we therefore suggest introducing diagnostic genotyping into clinical routine in men with so far idiopathic or unexplained male infertility. This may reduce the high number of infertile men with so far unknown origin by nearly one-third.
Trial registration number
DFG Clinical Research Unit 326 Male Germ Cells
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Affiliation(s)
- M Schubert
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology- University Münster , Münster, Germany
| | - H Krenz
- Institute of Medical Informatics, University of Münster , Münster, Germany
| | - A Sansone
- Department of Systems Medicine, Chair of Endocrinology and Medical Sexology- University of Rome Tor Vergata , Rome, Italy
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology- University Münster , Münster, Germany
| | - J Gromoll
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology CeRA- University of Münster , Münster, Germany
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23
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Bourguignon L, Tong B, Geisler F, Schubert M, Röhrich F, Saur M, Weidner N, Rupp R, Kalke YBB, Abel R, Maier D, Grassner L, Chhabra HS, Liebscher T, Cragg JJ, Kramer J, Curt A, Jutzeler CR. International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials. BMC Med 2022; 20:225. [PMID: 35705947 PMCID: PMC9202190 DOI: 10.1186/s12916-022-02395-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The epidemiological international landscape of traumatic spinal cord injury (SCI) has evolved over the last decades along with given inherent differences in acute care and rehabilitation across countries and jurisdictions. However, to what extent these differences may influence neurological and functional recovery as well as the integrity of international trials is unclear. The latter also relates to historical clinical data that are exploited to inform clinical trial design and as potential comparative data. METHODS Epidemiological and clinical data of individuals with traumatic and ischemic SCI enrolled in the European Multi-Center Study about Spinal Cord Injury (EMSCI) were analyzed. Mixed-effect models were employed to account for the longitudinal nature of the data, efficiently handle missing data, and adjust for covariates. The primary outcomes comprised demographics/injury characteristics and standard scores to quantify neurological (i.e., motor and sensory scores examined according to the International Standards for the Neurological Classification of Spinal Cord Injury) and functional recovery (walking function). We externally validated our findings leveraging data from a completed North American landmark clinical trial. RESULTS A total of 4601 patients with acute SCI were included. Over the course of 20 years, the ratio of male to female patients remained stable at 3:1, while the distribution of age at injury significantly shifted from unimodal (2001/02) to bimodal distribution (2019). The proportional distribution of injury severities and levels remained stable with the largest percentages of motor complete injuries. Both, the rate and pattern of neurological and functional recovery, remained unchanged throughout the surveillance period despite the increasing age at injury. The findings related to recovery profiles were confirmed by an external validation cohort (n=791). Lastly, we built an open-access and online surveillance platform ("Neurosurveillance") to interactively exploit the study results and beyond. CONCLUSIONS Despite some epidemiological changes and considerable advances in clinical management and rehabilitation, the neurological and functional recovery following SCI has remained stable over the last two decades. Our study, including a newly created open-access and online surveillance tool, constitutes an unparalleled resource to inform clinical practice and implementation of forthcoming clinical trials targeting neural repair and plasticity in acute spinal cord injury.
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Affiliation(s)
- Lucie Bourguignon
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Martin Schubert
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Frank Röhrich
- Berufsgenossenschaftliche Klinik Bergmanstrost of Halle, Halle, Germany
| | - Marion Saur
- Orthopädische Klinik, Hessisch Lichtenau, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Rainer Abel
- Spinal Cord Injury Center, Bayreuth, Germany
| | - Doris Maier
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - Lukas Grassner
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Harvinder S Chhabra
- Spine Service, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, India
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | | | - John Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Catherine R Jutzeler
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland. .,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland. .,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland.
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24
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Raguindin PF, Stoyanov J, Eriks-Hoogland I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from Swiss Spinal Cord Injury cohort (SwiSCI). PM R 2022. [PMID: 35648677 DOI: 10.1002/pmrj.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early screening is important in individuals with spinal cord injury (SCI) as they were deemed high-risk for cardiometabolic diseases. Few studies explored changes in cardiometabolic risk profile in the early phase of the injury. Thus, it remains unclear how early the cardiometabolic status deteriorates after injury. OBJECTIVE We determined the longitudinal changes in the cardiometabolic risk profile and examined the association between injury characteristics and cardiometabolic status in subacute SCI. SETTING Multicenter Swiss Spinal Cord Injury Cohort. PARTICIPANTS Adults with traumatic SCI without history of cardiovascular disease or type 2 diabetes. MAIN OUTCOME MEASURES Blood pressure (BP), lipid profile, fasting glucose, waist circumference (WC), weight, body mass index (BMI) and Framingham risk score (FRS) were compared across time and according to the injury characteristics. RESULTS We analyzed the data of 258 individuals with traumatic SCI (110 tetraplegia and 148 paraplegia, 122 motor complete and 136 incomplete). The median age was 50 years (IQR 32-60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2-7.1). At admission to rehabilitation, fully-adjusted linear regression models showed higher baseline weight (β 0.06, 95% CI 0.005, 0.11), systolic BP (β 0.05, 95% CI 0.008, 0.09), diastolic BP (β 0.05 95% CI 0.004, 0.10), and triglycerides (β 0.27 95% CI 0.13, 0.42) in paraplegia than tetraplegia. Systolic BP, diastolic BP, HDL-C were higher in incomplete than complete injury. In our main analysis, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation. Individuals with paraplegia had a higher increase in BMI than tetraplegia, while no differences in other cardiometabolic risk factors were detected when comparing motor incomplete and complete injury. Trajectories of each participant showed that the majority of individuals with SCI decreased FRS score at follow-up compared to baseline and no significant changes in prevalence of cardiometabolic syndrome were observed. At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had cardiometabolic syndrome. CONCLUSION We observed a modest improvement in lipid profile and FRS during the first inpatient rehabilitation hospitalization. Injury characteristics, such as level and completeness, were not associated with changes in cardiometabolic risk factors in the subacute phase of the injury. Despite this, a significant proportion of study participants remained at risk of cardiometabolic disease at discharge, suggesting that early cardiometabolic preventive strategies may be initiated as early as during the first inpatient rehabilitation hospitalization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Xavier Jordan
- Clinique Romande de Réadaptation, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Martin Schubert
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse 340, Zurich, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
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25
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Mohammadzada F, Zipser CM, Easthope CA, Halliday DM, Conway BA, Curt A, Schubert M. Mind your step: Target walking task reveals gait disturbance in individuals with incomplete spinal cord injury. J Neuroeng Rehabil 2022; 19:36. [PMID: 35337335 PMCID: PMC8957135 DOI: 10.1186/s12984-022-01013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Walking over obstacles requires precise foot placement while maintaining balance control of the center of mass (CoM) and the flexibility to adapt the gait patterns. Most individuals with incomplete spinal cord injury (iSCI) are capable of overground walking on level ground; however, gait stability and adaptation may be compromised. CoM control was investigated during a challenging target walking (TW) task in individuals with iSCI compared to healthy controls. The hypothesis was that individuals with iSCI, when challenged with TW, show a lack of gait pattern adaptability which is reflected by an impaired adaptation of CoM movement compared to healthy controls. Methods A single-center controlled diagnostic clinical trial with thirteen participants with iSCI (0.3–24 years post injury; one subacute and twelve chronic) and twelve healthy controls was conducted where foot and pelvis kinematics were acquired during two conditions: normal treadmill walking (NW) and visually guided target walking (TW) with handrail support, during which participants stepped onto projected virtual targets synchronized with the moving treadmill surface. Approximated CoM was calculated from pelvis markers and used to calculate CoM trajectory length and mean CoM Euclidean distance TW-NW (primary outcome). Nonparametric statistics, including spearman rank correlations, were performed to evaluate the relationship between clinical parameter, outdoor mobility score, performance, and CoM parameters (secondary outcome). Results Healthy controls adapted to TW by decreasing anterior–posterior and vertical CoM trajectory length (p < 0.001), whereas participants with iSCI reduced CoM trajectory length only in the vertical direction (p = 0.002). Mean CoM Euclidean distance TW-NW correlated with participants’ neurological level of injury (R = 0.76, p = 0.002) and CoM trajectory length (during TW) correlated with outdoor mobility score (R = − 0.64, p = 0.026). Conclusions This study demonstrated that reduction of CoM movement is a common strategy to cope with TW challenge in controls, but it is impaired in individuals with iSCI. In the iSCI group, the ability to cope with gait challenges worsened the more rostral the level of injury. Thus, the TW task could be used as a gait challenge paradigm in ambulatory iSCI individuals. Trial registration Registry number/ ClinicalTrials.gov Identifier: NCT03343132, date of registration 2017/11/17. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01013-7.
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Affiliation(s)
- Freschta Mohammadzada
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Chris A Easthope
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.,Cereneo Foundation, Center for Interdisciplinary Research, 6354, Vitznau, Switzerland
| | - David M Halliday
- Department of Electronic Engineering, University of York, York, YO10 5DD, UK.,York Biomedical Research Institute, University of York, York, UK
| | - Bernard A Conway
- Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
| | - Armin Curt
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Pfender N, Rosner J, Zipser CM, Friedl S, Vallotton K, Sutter R, Klarhoefer M, Schubert M, Betz M, Spirig JM, Seif M, Hubli M, Freund P, Farshad M, Curt A, Hupp M. Comparison of axial and sagittal spinal cord motion measurements in degenerative cervical myelopathy. J Neuroimaging 2022; 32:1121-1133. [PMID: 35962464 PMCID: PMC9805009 DOI: 10.1111/jon.13035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE The timing of decision-making for a surgical intervention in patients with mild degenerative cervical myelopathy (DCM) is challenging. Spinal cord motion phase contrast MRI (PC-MRI) measurements can reveal the extent of dynamic mechanical strain on the spinal cord to potentially identify high-risk patients. This study aims to determine the comparability of axial and sagittal PC-MRI measurements of spinal cord motion with the prospect of improving the clinical workup. METHODS Sixty-four DCM patients underwent a PC-MRI scan assessing spinal cord motion. The agreement of axial and sagittal measurements was determined by means of intraclass correlation coefficients (ICCs) and Bland-Altman analyses. RESULTS The comparability of axial and sagittal PC-MRI measurements was good to excellent at all cervical levels (ICCs motion amplitude: .810-.940; p < .001). Significant differences between axial and sagittal amplitude values could be found at segments C3 and C4, while its magnitude was low (C3: 0.07 ± 0.19 cm/second; C4: -0.12 ± 0.30 cm/second). Bland-Altman analysis showed a good agreement between axial and sagittal PC-MRI scans (coefficients of repeatability: minimum -0.23 cm/second at C2; maximum -0.58 cm/second at C4). Subgroup analysis regarding anatomic conditions (stenotic vs. nonstenotic segments) and different velocity encoding (2 vs. 3 cm/second) showed comparable results. CONCLUSIONS This study demonstrates good comparability between axial and sagittal spinal cord motion measurements in DCM patients. To this end, axial and sagittal PC-MRI are both accurate and sensitive in detecting pathologic cord motion. Therefore, such measures could identify high-risk patients and improve clinical decision-making (ie, timing of decompression).
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Affiliation(s)
- Nikolai Pfender
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Jan Rosner
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland,Department of NeurologyBern University HospitalInselspitalUniversity of BernBernSwitzerland
| | - Carl Moritz Zipser
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Susanne Friedl
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Kevin Vallotton
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Reto Sutter
- RadiologyBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | | | - Martin Schubert
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Michael Betz
- University Spine Centre ZurichBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - José Miguel Spirig
- University Spine Centre ZurichBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Maryam Seif
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland,Department of NeurophysicsMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Michèle Hubli
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Patrick Freund
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Mazda Farshad
- University Spine Centre ZurichBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Armin Curt
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland,University Spine Centre ZurichBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Markus Hupp
- Spinal Cord Injury CenterBalgrist University HospitalUniversity of ZurichZurichSwitzerland
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Schubert M, Kluge S, Brunner E, Pace S, Birringer M, Werz O, Lorkowski S. The α-tocopherol-derived long-chain metabolite α-13'-COOH mediates endotoxin tolerance and modulates the inflammatory response via MAPK and NFκB pathways. Free Radic Biol Med 2022; 178:83-96. [PMID: 34848369 DOI: 10.1016/j.freeradbiomed.2021.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022]
Abstract
SCOPE The long-chain metabolites of (LCM) vitamin E are proposed as the active regulatory metabolites of vitamin E providing, with their anti-inflammatory properties, an explanatory approach for the inconsistent effects of vitamin E on inflammatory-driven diseases. We examined the modulation of cytokine expression and release from macrophages, a fundamental process in many diseases, to gain insights into the anti-inflammatory mechanisms of the α-tocopherol-derived LCM α-13'-COOH. METHODS AND RESULTS Suppressed gene expression of C-C motif chemokine ligand 2 (Ccl2), tumor necrosis factor (Tnf), and interleukin (Il) 6 in response to lipopolysaccharides by 24 h pre-treatment with α-13'-COOH in RAW264.7 macrophages was revealed using quantitative reverse transcription PCR. Further, reduced secretion of IL1β and CCL2 was found in this setup using flow cytometry. In contrast, 1 h pre-treatment suppressed only CCL2. Consequent gene expression analysis within 24 h of α-13'-COOH treatment revealed the induction of mitogen-activated protein kinases (MAPK) and nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) negative feedback regulators including the 'master regulators' dual-specificity phosphatase 1 (Dusp1/Mkp1) and tumor necrosis factor induced protein 3 (Tnfaip3/A20). Approaches with immunoblots and chemical antagonists suggest a feedback induction via activation of extracellular-signal regulated kinase (ERK), p38 MAPK and NFκB pathways. CONCLUSIONS CCL2 is suppressed in murine macrophages by α-13'-COOH and the indirect suppression of MAPK and NFκB pathways is likely a relevant process contributing to anti-inflammatory actions of α-13'-COOH. These results improve the understanding of the effects of α-13'-COOH and provide a basis for new research strategies in the context of inflammatory diseases.
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Affiliation(s)
- Martin Schubert
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
| | - Stefan Kluge
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
| | - Elena Brunner
- Institute of Pharmacy, Friedrich Schiller University Jena, Germany
| | - Simona Pace
- Institute of Pharmacy, Friedrich Schiller University Jena, Germany
| | - Marc Birringer
- Department of Nutrition, Food and Consumer Sciences, University of Applied Sciences Fulda, Germany; Regionales Innovationszentrum Gesundheit und Lebensqualität (RIGL), Fulda, Germany
| | - Oliver Werz
- Institute of Pharmacy, Friedrich Schiller University Jena, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany.
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Lütolf R, Júlio SU, Schubert M, Hubli M. Intra-epidermal evoked potentials: A promising tool for spinal disorders? Neurophysiol Clin 2021; 52:44-57. [PMID: 34953638 DOI: 10.1016/j.neucli.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To test the robustness and signal-to-noise ratio of pain-related evoked potentials following intra-epidermal electrical stimulation (IES) compared to contact heat stimulation in healthy controls, and to explore the feasibility and potential added value of IES in the diagnosis of spinal disorders. METHODS Pain-related evoked potentials induced by IES (custom-made, non-invasive, concentric triple pin electrode with steel pins protruding 1 mm from the anode, triangularly separated by 7-10 mm respectively) and contact heat stimulation were compared in 30 healthy subjects. Stimuli were applied to four different body sites. Two IES intensities, i.e., high (individually adapted to contact heat painfulness) and low (1.5 times pain threshold), were used. Additionally, a 40-year-old patient with unilateral dissociated sensory loss due to a multi-segmental syringohydromyelia was assessed comparing IES and contact heat stimulation. RESULTS Both IES and contact heat stimulation led to robust pain-related evoked potentials recorded in all healthy subjects. Low intensity IES evoked potentials (14.1-38.0 µV) had similar amplitudes as contact heat evoked potentials (11.8-32.3 µV), while pain ratings on the numeric rating scale were lower for IES (0.8-2.5, compared to 1.5-3.9 for contact heat stimulation). High intensity IES led to evoked potentials with higher signal-to-noise ratio than low intensity IES and contact heat stimulation. The patient case showed impaired pain-related evoked potentials in segments with hypoalgesia for both IES modes. IES evoked potentials were preserved, with delayed latencies, while contact heat evoked potentials were abolished. CONCLUSION IES evoked robust pain-related cortical potentials, while being less painful in healthy controls. The improved signal-to-noise ratio supports the use of IES for objective segmental testing of nociceptive processing. This was highlighted in a spinal syndrome case, where IES as well as contact heat stimulation reliably detected impaired segmental nociception.
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Affiliation(s)
- Robin Lütolf
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Sara U Júlio
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Zipser C, Pfender N, Kheram N, Boraschi A, Aguirre J, Ulrich N, Spirig J, Ansorge A, Betz M, Wanivenhaus F, Hupp M, Kurtcuoglu V, Farshad M, Curt A, Schubert M. Intraoperative monitoring of CSF pressure in patients with degenerative cervical myelopathy (COMP-CORD Study): a prospective cohort study. J Neurotrauma 2021; 39:300-310. [PMID: 34806912 DOI: 10.1089/neu.2021.0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is hallmarked by spinal canal narrowing and related cord compression and myelopathy. CSF pressure dynamics are likely disturbed due to spinal canal stenosis. The study aims to investigate the diagnostic value of continuous intraoperative CSF pressure monitoring during surgical decompression. Prospective single center study (NCT02170155) with enrolment of DCM patients that underwent surgical decompression between December 2019 and May 2021. Data from N=17 patients were analyzed, symptom severity graded with the modified Japanese Orthopedic Score (mJOA). CSF pulsations were continuously monitored with a lumbar intrathecal catheter during surgical decompression. Mean patient age was 62±9 years (range 38-73; 8F), symptoms were mild-moderate in most patients (mean mJOA 14±2, range 10-18). Measurements were well tolerated without safety concerns. In 15/16 (94%) CSF pulsations increased at the time of surgical decompression. In one case, responsiveness could not be evaluated for technical reasons. Unexpected CSF pulsation decrease was related to adverse events (i.e., CSF leakage). Median CSF pulsation amplitudes increased from pre-decompression (0.52 mmHg [IQR 0.71]) to post-decompression (0.72 mmHg [IQR 0.96]) (P=0.001). Mean baseline CSF pressure increased with lower magnitude than pulsations, from 9.5±3.5 to 10.3±3.8 mmHg (P=0.003). Systematic relations of CSF pulsations were confined to surgical decompression, independent of arterial blood pressure (P=0.927) or heart rate (P=0.102). Intraoperative CSF pulsation monitoring was sensitive, timely, and specifically related to surgical decompression while in addition adverse events could be discerned. Further investigation of the clinical value of intraoperative guidance for decompression in complex DCM surgery is promising.
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Affiliation(s)
- Carl Zipser
- Balgrist University Hospital, 31031, Center for Paraplegia, Forchstrasse 340, Zürich, Zurich, Switzerland, 8008;
| | - Nikolai Pfender
- University of Zurich , Spinal Cord Injury Center Balgrist , Zurich , Switzerland;
| | - Najmeh Kheram
- Balgrist University Hospital, 31031, Center for Paraplegia, Zurich, Switzerland;
| | - Andrea Boraschi
- University of Zurich , Department of Physiology, Zurich , Switzerland;
| | - Jose Aguirre
- Balgrist University Hospital, 31031, Anesthesiology, Zurich, Switzerland;
| | - Nils Ulrich
- Balgrist University Hospital, 31031, Spine Surgery, Zurich, Switzerland;
| | - Jose Spirig
- Balgrist University Hospital, 31031, Spine Surgery, Zurich, Switzerland;
| | - Alexandre Ansorge
- Balgrist University Hospital, 31031, Spine Surgery, Zurich, Switzerland;
| | - Michael Betz
- University of Zurich , Spine Surgery, Zurich , Switzerland;
| | | | - Markus Hupp
- Uniklinik Balgrist, 31031, Forchstr. 340, Zurich, Switzerland, 8008;
| | - Vartan Kurtcuoglu
- University of Zurich , Department of Physiology, Zurich , Switzerland;
| | - Mazda Farshad
- University of Zurich , Spine Surgery, Zurich , Switzerland;
| | - Armin Curt
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland, 8008;
| | - Martin Schubert
- Spinal cord Injury Center, University Hospital Balgrist, Forchstrasse 340, Zurich, Zurich, Switzerland, 8008;
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Buzzell A, Chamberlain JD, Schubert M, Mueller G, Berlowitz DJ, Brinkhof MWG. Perceived sleep problems after spinal cord injury: Results from a community-based survey in Switzerland. J Spinal Cord Med 2021; 44:910-919. [PMID: 31977291 PMCID: PMC8725774 DOI: 10.1080/10790268.2019.1710938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: To investigate the burden of sleep problems within the Spinal Cord injured (SCI) community with respect to the general population (GP) in Switzerland. The study further explored potential predictors for receiving treatment for sleep problems after SCI.Design: Cross-sectional study.Setting: SCI community in Switzerland.Participants: Individuals diagnosed with an SCI, aged 16 years or older that permanently reside in Switzerland (N = 1549).Interventions: Not applicable.Outcome measures: Perceived sleep problems within the SCI community and GP. For those with sleep problems and SCI, an indicator for having received treatment was measured.Results: 58.8% of survey participants indicated having a sleep problem; 69.4% of those with a sleep problem did not indicate receiving treatment. Amongst people living with an SCI, individuals between the ages of 46-60 years (adjusted Odds Ratio, OR = 3.07; 95% CI 1.54-6.16), participants reporting severe financial hardship (OR = 2.90; 95% CI) 1.69-4.96, and those that indicated having pain (OR = 5.62; 95% CI 3.52-8.98) were more likely to have a chronic sleep problem. In comparison to the Swiss GP, the prevalence of having a sleep problem was 18% higher among persons with SCI, with the largest discrepancy for males with paraplegia between the ages of 46-60 years (Prevalence ratio, PR = 1.28; 95% CI, 1.21-1.36).Conclusion: Individuals with SCI experience more sleep problems compared to the Swiss GP. Findings from this study suggest that clinical screening for sleep issues targeting high risk groups is needed to reduce the large prevalence of non-treatment in individuals with SCI.
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Affiliation(s)
- Anne Buzzell
- Swiss Paraplegic Research, Nottwil, Switzerland,University of Lucerne, Department of Health Sciences and Medicine, Lucerne, Switzerland
| | - Jonviea D. Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland,University of Lucerne, Department of Health Sciences and Medicine, Lucerne, Switzerland,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR1219, Bordeaux, France,France Inserm, CIC1401-EC, Bordeaux, France
| | | | | | - David J. Berlowitz
- The University of Melbourne and the Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Martin W. G. Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland,University of Lucerne, Department of Health Sciences and Medicine, Lucerne, Switzerland,Correspondence to: Martin W. G. Brinkhof, Swiss Paraplegic Research, Guido A. Zäch Strasse 4, CH-6207Nottwil, Switzerland; Ph: +41 41 939 65 92.
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Raguindin PF, Stoyanov J, Eriks I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Changes in cardiometabolic risk factors during inpatient rehabilitation of traumatic spinal cord injury from a multicenter Swiss Spinal Cord Injury Cohort (SwiSCI). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiometabolic health has a growing relevance in spinal cord injury (SCI) considering the increasing survival and aging population. We explored longitudinal changes in cardiometabolic risk profile and examined whether injury characteristics could be a non-modifiable risk factor for individuals with SCI in subacute phase of the injury.
Methods
We used the data from a multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study and included adults with traumatic SCI (TSCI) without cardiometabolic diseases and diabetes at baseline. We included individuals with available data on admission and prior to discharge from first SCI rehabilitation. Blood pressure, lipid profile, fasting glucose, waist circumference (WC), weight, and body mass index (BMI) were compared according to the injury level (tetraplegia-TP vs paraplegia-PP) and completeness (motor complete-COM vs incomplete-INC). We used multivariable linear regression for cross-sectional analysis and linear mixed models for longitudinal analysis, adjusting for age, sex, lifestyle factors, medication-use, and injury characteristics. We performed age- (above and below median age) and sex-stratified analyses. Sensitivity analyses were also performed by removing systemic steroid-use (proxy for acute injury), adjusting for opioid-use (medication side-effect) and adjusting further for BMI and WC.
Results
We analyzed 258 individuals with TSCI (110 TP and 148 PP, 122 COM and 136 INC). Median age was 50 years (IQR 32–60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2–7.1). On admission, the fully-adjusted models showed higher baseline weight, systolic BP, diastolic BP and triglycerides in PP than TP. Systolic BP, diastolic BP, HDL, HDL/LDL were higher in INC than COM. In the overall population, we observed increases in cholesterol, HDL, and HDL/LDL ratio over rehabilitation period. Individuals with PP had a higher increase in BMI as compared to TT, while no differences were detected when comparing INC and COM injury (Table 1–3). Results from sensitivity analyses were generally in line with the overall findings; however, at baseline, there was some indication that lipid profile may be different in COM and INC injury. In sex-stratified longitudinal analysis, triglycerides were higher in females PP than TP, and diastolic BP was higher in females with INC than COM. For age-stratified longitudinal analysis, elderly with PP have higher triglycerides than younger adults.
Conclusion
We reported changes in BMI and lipid profile during the inpatient rehabilitation of individuals with traumatic SCI and without history of cardiovascular diseases and diabetes. Injury characteristics may not be an independent risk factor for subacute phase, but maybe important in specific subgroups, like in women and in the elderly (>50 years old).
Funding Acknowledgement
Type of funding sources: None. MethodsResults
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Affiliation(s)
- P F Raguindin
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - J Stoyanov
- Swiss Paraplegic Research, Notwill, Switzerland
| | - I Eriks
- Swiss Paraplegic Center, Nottwil, Switzerland
| | - G Stucki
- Swiss Paraplegic Research, Notwill, Switzerland
| | - X Jordan
- Clinique Romande de Réadaptation, Sion, Switzerland
| | - M Schubert
- University Hospital Balgrist, Zurich, Switzerland
| | - O H Franco
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - T Muka
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - M Glisic
- Swiss Paraplegic Research, Notwill, Switzerland
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Schubert M, Weise SM, Knöller K. Atmospheric washout of 35S during single rain events - Implications for 35S sampling schemes. J Environ Radioact 2021; 237:106669. [PMID: 34118616 DOI: 10.1016/j.jenvrad.2021.106669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 06/12/2023]
Abstract
Cosmogenic radiosulfur (35S; half-life: 87.4 days) is transferred with the rain to the groundwater (as 35SO42-) and can be used as residence time tracer for the detection of sub-yearly groundwater residence times. Due to the distinct but non-regular annual 35S pattern in precipitation, related data evaluation requires consideration of a35S input function that is based on representative rain samples. While minor rain events can easily be sampled quantitatively and hence representatively, a long-lasting rain event may get documented by a sample that represents only a certain sequence of the event, thus potentially resulting in a35S activity concentration that might not be representative. With the aim to examine the magnitude of temporal variations of the 35S activity concentration in rain during long-lasting rain events, we present and discuss two related exemplary 35S time series. Furthermore, we evaluate the applicability of the parameters total sulfate and electrical conductivity (EC), both detected in rainwater as easily attainable 35S proxies. The results of the study show (i) that the 35S activity concentration may vary substantially during long-lasting rain events due to atmospheric migration processes and aerosol washout and (ii) that neither sulfate nor EC are suitable as 35S proxies due to the different origin of 35S on the one hand and sulfate/EC on the other. Hence, for the determination of a35S activity concentration that is representative for a long-lasting rain event 35S analyses of an adequate number of sub-samples cannot be avoided.
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Affiliation(s)
- M Schubert
- UFZ Helmholtz Centre for Environmental Research, Permoserstr. 15, 04318, Leipzig, Germany.
| | - S M Weise
- UFZ Helmholtz Centre for Environmental Research, Theodor-Lieser-Str. 4, 06120, Halle, Germany
| | - K Knöller
- UFZ Helmholtz Centre for Environmental Research, Theodor-Lieser-Str. 4, 06120, Halle, Germany
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Stieglitz LH, Hofer AS, Bolliger M, Oertel MF, Filli L, Willi R, Cathomen A, Meyer C, Schubert M, Hubli M, Kessler TM, Baumann CR, Imbach L, Krüsi I, Prusse A, Schwab ME, Regli L, Curt A. Deep brain stimulation for locomotion in incomplete human spinal cord injury (DBS-SCI): protocol of a prospective one-armed multi-centre study. BMJ Open 2021; 11:e047670. [PMID: 34593490 PMCID: PMC8487195 DOI: 10.1136/bmjopen-2020-047670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/09/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a devastating condition with immediate impact on the individual's health and quality of life. Major functional recovery reaches a plateau 3-4 months after injury despite intensive rehabilitative training. To enhance training efficacy and improve long-term outcomes, the combination of rehabilitation with electrical modulation of the spinal cord and brain has recently aroused scientific interest with encouraging results. The mesencephalic locomotor region (MLR), an evolutionarily conserved brainstem locomotor command and control centre, is considered a promising target for deep brain stimulation (DBS) in patients with SCI. Experiments showed that MLR-DBS can induce locomotion in rats with spinal white matter destructions of >85%. METHODS AND ANALYSIS In this prospective one-armed multi-centre study, we investigate the safety, feasibility, and therapeutic efficacy of MLR-DBS to enable and enhance locomotor training in severely affected, subchronic and chronic American Spinal Injury Association Impairment Scale C patients in order to improve functional recovery. Patients undergo an intensive training programme with MLR-DBS while being regularly followed up until 6 months post-implantation. The acquired data of each timepoint are compared with baseline while the primary endpoint is performance in the 6-minute walking test. The clinical trial protocol was written in accordance with the Standard Protocol Items: Recommendations for Interventional Trials checklist. ETHICS AND DISSEMINATION This first in-man study investigates the therapeutic potential of MLR-DBS in SCI patients. One patient has already been implanted with electrodes and underwent MLR stimulation during locomotion. Based on the preliminary results which promise safety and feasibility, recruitment of further patients is currently ongoing. Ethical approval has been obtained from the Ethical Committee of the Canton of Zurich (case number BASEC 2016-01104) and Swissmedic (10000316). Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT03053791.
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Affiliation(s)
| | - Anna-Sophie Hofer
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Markus F Oertel
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Linard Filli
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Romina Willi
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Adrian Cathomen
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Christian Meyer
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, Zurich, Switzerland
| | | | - Lukas Imbach
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Iris Krüsi
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Andrea Prusse
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin E Schwab
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
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Rimkus GG, Schubert M, Morgan D, Jungjohann S. Rapid direct analysis of retinyl palmitate (vitamin A) in fortified vegetable oils by HPLC-FLD. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2021; 39:24-34. [PMID: 34587464 DOI: 10.1080/19440049.2021.1977854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Large-scale food fortification of vegetable oils with vitamin A has been implemented successfully for decades in numerous African and Asian countries, contributing demonstrably to reductions in vitamin A deficiency. For these programmes, reliable and validated analytical data are essential to demonstrate compliance with legal standards and fortification levels. Commonly, many analytical laboratories use a saponification method for the quantitative analysis of retinyl palmitate (the mostly used form of vitamin A for fortification) in fortified oils, which implies a multiple-step procedure with long analysis times and the potential risk of analyte loss. The aim of the present study was to develop and validate a direct High-performance Liquid Chromatography (HPLC) method that reduces these sample preparation steps, leading to the cost- and time-efficient quantification of retinyl palmitate in fortified oils. Oil samples are dissolved into the HPLC solvents, then injected directly into a common C18 column, and subsequently detected by a fluorescence detector. The limit of quantification (1.0 mg retinyl palmitate kg-1) and the working range of 1.0-100 mg retinyl palmitate kg-1 with a linearity of R2 = 0.9989 are appropriate to analyse fortified oil samples. The method also showed adequate precision (RSD between 1.1% and 3.1%) and recoveries (86-103%) at two different concentration levels. The accuracy of the direct HPLC method was additionally proven by the comparison of spiked samples with two external laboratories that used the saponification method. The robustness of the method was confirmed by the analysis of various spiked edible oils. The HPLC column is not deteriorated by the lipid matrix and shows excellent stability and long lifetime. Also, 9-cis-retinyl palmitate formed mainly by light exposure could be detected by this method. The direct HPLC method is a well-suited alternative to the saponification method for the rapid and reliable routine analysis of fortified oil samples.
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Affiliation(s)
- Gerhard G Rimkus
- Department of HPLC and Element Analysis, Intertek Food Services GmbH, Bremen, Germany
| | - Martin Schubert
- Department of HPLC and Element Analysis, Intertek Food Services GmbH, Bremen, Germany
| | - David Morgan
- Department of Large Scale Food Fortification, The Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Svenja Jungjohann
- Department of Large Scale Food Fortification, The Global Alliance for Improved Nutrition, Geneva, Switzerland
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Yang Y, Venkataramani V, Schubert M, Beretta C, Botz M, Fankhauser L, Wick W, Kuner T, Winkler F. P13.01 Neuronal activity drives distinct invasion modes of glioma cells. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Gliomas are incurable brain tumors characterized by their infiltrative growth which makes them a whole-brain disease. Previously we described membrane protrusions called tumor microtubes (TMs), and glutamatergic synapses between neurons and glioma cells, as mechanisms contributing to glioma cell invasion and tumor progression. However, the interrelation of the two, and the exact mechanisms of glioma cell dynamics over time was unknown. Therefore, we investigate neuronal synaptic input on TM-associated glioma cell motility.
MATERIAL AND METHODS
Here we established a novel workflow for analyzing single glioma cell dynamics over several hours with in-vivo two-photon microscopy. First, a membranous fluorescent marking of patient-derived glioma cells was established to reliably track membrane changes. Secondly, augmented microscopy based on deep- and machine-learning algorithms was used to track glioma cells. Neuronal activity was manipulated with different doses of isoflurane anesthesia, and used to study its effects on glioma cell dynamics.
RESULTS
This novel method revealed that motility of glioma cells can be described by the displacement of whole glioma cell somata (somatokinesis) and TM dynamics. TM motility in turn could be sub-categorized into protrusion, retraction and branching. Next, we describe three different invasion modes, all with similarities to different cell types involved in CNS development. Lastly, the effects of neuronal activity on glioma cell invasion were investigated. With the application of high anesthesia and subsequently reduced neuronal activity, TM turnover, branching events and as a result glioma cell invasion were inhibited, but in a heterogeneous manner.
CONCLUSION
The novel workflow allowed to comprehensively characterize glioma cell invasion over several hours. Its application demonstrates novel, hitherto unknown cellular mechanisms of glioma cell invasion, and provides a link between TM biology and neuron-glioma communication. Finally, neuronal input drives distinct subtypes of glioma cell motility patterns.All in all, this work presents an important first step in understanding mechanisms that lead to the whole- brain colonization of glioma cells making these brain tumors incurable. A further characterization of the exact molecular mechanisms that drive neuronal activity-dependent glioma cell motility is warranted.
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Affiliation(s)
- Y Yang
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Venkataramani
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - M Schubert
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - C Beretta
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
- CellNetworks Math-Clinic, Heidelberg University, Heidelberg, Germany
| | - M Botz
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - L Fankhauser
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - W Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kuner
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - F Winkler
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Schubert M, Pérez Lanuza L, Wöste M, Dugas M, Rassam Y, Heilmann-Heimbach S, Tüttelmann F, Kliesch S, Gromoll J. O-089 A Genome Wide Association Study in men with unexplained infertility identifies nine SNPs at the FSHB locus to be associated with Follicle Stimulating Hormone level. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Which single nucleotide polymorphisms (SNPs) are associated with Follicle stimulating hormone (FSH) levels in men with unexplained infertility and can affect FSH action and spermatogenesis?
Summary answer
We identified a genomic region at chromosome 11p.14.1, including nine SNPs, that are significantly associated with FSH levels in men with unexplained infertility.
What is known already
FSH action is essential for the initiation and maintenance of human spermatogenesis. One well-studied SNP, FSHB c.-211G>T (rs10835638), is associated with FSHB mRNA transcription and directly affects FSH serum levels, testicular volume and spermatogenesis. Carriers of a T-allele in this promoter are diagnosed with functional secondary hypogonadism with isolated FSH deficiency.
Other genetic variants, for example at the FSHR have been shown to slightly modulate FSH action, however the clinical impact in these variants seems to
be low. The so far identified FSH-associated SNPs revealed an impact of up to 2.3 % on FSH serum level variance.
Study design, size, duration
A Genome wide association study (GWAS) was performed on a clinically well characterized cohort of 742 men with unexplained infertility (discovery study). Of the nine identified SNPs, validation was performed for rs11031005 and the already described rs10835638 in an independent cohort of 1123 men with unexplained infertility (validation study).
Participants/materials, setting, methods
Patients were retrospectively selected from our CeRA database Androbase® applying strict selection criteria; DNA was isolated from stored EDTA-blood samples. Informative genetic variants were identified using Illumina PsychArray v1.3. Illumina®GenomeStudio v2.0, PLINK v1.90 and R 3.6.3 were used to perform quantitative association analysis based on normalized FSH values. The validation study was performed using TaqMan PCR for SNP detection and R 3.6.3 for quantitative association to analyze the impact of each SNP on FSH level.
Main results and the role of chance
Imputation of the GWAS data revealed 94 SNPs with suggestive significance (p < 8.56e-06) and nine SNPs (including rs10835638) with genome-wide significance (p < 4.28e-07). The nine SNPs are all located at the FSHB locus on Chromosome 11p.14.1 and are in high linkage disequilibrium (LD). The validation study of 1123 patients with unexplained infertility for the SNPs rs11003005 and rs10835638 revealed a significant association with FSH (p = 4.71e-06 and p = 5.55e-07) and FSH/LH ratio (p = 2.08e-12 and p = 6.4e-12).The nine significant SNPs accounted for 3.60 –4.65 % variance in FSH serum level each in the entire discovery cohort. In an oligozoospermic subgroup (n = 249) this effect was increased to 4.89 – 6.95 %.
This the first GWAS in men with unexplained infertility. This study shows that not one single SNP, but rather a genomic region has an impact on FSH serum level in men with unexplained male infertility. This effect is even more pronounced in the more severe phenotype of oligozoospermic men.
Limitations, reasons for caution
The study is restricted to men with unexplained infertility, which might cause a selection bias. Validation and functional evaluation of the eight newly identified SNPs in independent cohorts would emphasize the results more. The sample size of 742 limits detection of loci with smaller effect on FSH levels.
Wider implications of the findings
The determination of one of the nine SNPs can improve diagnostic precision in identifying men with secondary functional hypogonadism with isolated FSH deficiency. An oligozoospermic subgroup of these men would putatively benefit from FSH treatment and has to be proven in randomized controlled trials.
Trial registration number
German Research Foundation CRU326
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Affiliation(s)
- M Schubert
- Centre of Reproductive Medicine and Andrology CeRA- University Münster, Department of Clinical and Surgical Andrology, Münster, Germany
| | - L Pérez Lanuza
- University Childreńs Hospital Münster, Department of Pediatric Hematology and Oncology, Münster, Germany
| | - M Wöste
- University of Münster, Institute of Medical Informatics, Münster, Germany
| | - M Dugas
- University of Münster, Institute of Medical Informatics, Münster, Germany
| | - Y Rassam
- Centre of Reproductive Medicine and Andrology CeRA- University Münster, Department of Clinical and Surgical Andrology, Münster, Germany
| | - S Heilmann-Heimbach
- University of Bonn- School of Medicine & University Hospital Bonn, Institute of Human Genetics, Bonn, Germany
| | - F Tüttelmann
- University of Münster, Institute of Reproductive Genetics, Münster, Germany
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology CeRA- University Münster, Department of Clinical and Surgical Andrology, Münster, Germany
| | - J Gromoll
- Centre of Reproductive Medicine and Andrology CeRA- University of Münster, Institute of Reproductive and Regenerative Biology, Münster, Germany
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Pavese C, Scivoletto G, Puci MV, Schubert M, Curt A, Finazzi Agrò E, Montomoli C, Kessler TM. External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury. Neurorehabil Neural Repair 2021; 35:659-662. [PMID: 34114519 DOI: 10.1177/15459683211023191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The prediction of functional outcomes after spinal cord injury (SCI) is essential to plan the rehabilitation phase and the social reintegration. Recently, 2 models to predict independent and reliable bowel management 1 year after traumatic SCI have been derived and validated in 2 cohorts of patients included in the European Multicenter Study about Spinal Cord Injury (EMSCI). Objective. We aimed to validate 2 prediction models for bowel outcome after traumatic SCI in a patient sample external to EMSCI. Methods. The simplified model (based on a single predictor, the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] total motor score) and the full model (based on 2 predictors, the ISNCSCI total motor score and item 3a of the Spinal Cord Independence Measure) were applied to the retrospectively collected data of 111 patients with traumatic SCI. Results. The simplified and the full models showed excellent discrimination with an area under the receiver operating characteristic curve of .939 (95% confidence interval (CI) .87-1.00) and .922 (95% CI 0.85-.99), respectively. Both models displayed similar results for sensitivity and negative predictive values; however, the simplified model showed higher values for specificity, positive predictive values, and accuracy. The calibration analysis showed a partial overlap between predicted probabilities and observed proportion, with better and acceptable calibration for the simplified model. Conclusions. Using an independent sample, our study demonstrates the validity of a simple model to predict independent and reliable bowel management 1 year after traumatic SCI.
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Affiliation(s)
- Chiara Pavese
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Neurorehabilitation Unit, IRCCS ICS Maugeri Spa-SB, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariangela V Puci
- Unit of Bio Statistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Armin Curt
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Department of Urology, Policlinico Tor Vergata, Rome, Italy
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Switzerland
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Schubert M, Pérez Lanuza L, Wöste M, Dugas M, Rassam Y, Heilmann-Heimbach S, Tüttelmann F, Kliesch S, Gromoll J. Identifying a genomic region at Chromosome 11p.14.1 that is associated to FSH serum level in men with unexplained male infertility. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gross O, Leitner L, Rasenack M, Schubert M, Kessler TM. Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder? Spinal Cord 2021; 59:1026-1033. [PMID: 33963273 PMCID: PMC8397615 DOI: 10.1038/s41393-021-00635-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
Study design Cross-sectional study. Objectives To evaluate if specific definitions of detrusor sphincter dyssynergia (DSD) might distinguish between individuals with spinal cord injury (SCI) and those with no underlying neurological disorder (NO ND). Setting Single tertiary university SCI center. Methods A series of 153 individuals, 81 with traumatic SCI and 72 with NO ND, were prospectively evaluated and included in this study. All individuals underwent a clinical neuro-urological examination, a neurophysiological work-up and a video-urodynamic investigation and were diagnosed with DSD as defined by the International Continence Society (ICS). We determined the DSD grades/types according to the classifications by Yalla (grade 1–3), Blaivas (type 1–3) and Weld (type 1–2). Distribution of the DSD grades/types were compared between SCI and NO ND individuals. Associations between the various DSD grades/types and clinical parameters, such as risk factors for upper urinary tract damage (all individuals) or lower extremity motor scores, SCI injury levels and severity scores (only SCI group), were assessed. Results The distribution of all DSD types were similar between groups (p > 0.05). None of the DSD classifications allowed risk assessment for upper urinary tract damage. A significant association between DSD type and other clinical parameters could not be found (p > 0.05). Conclusions None of the investigated DSD definitions can distinguish between patients with SCI and with NO ND. The more complex DSD classifications by Yalla, Blaivas or Weld cannot compete with the ICS binary yes-no definition which is pragmatic and straightforward for managing patients in daily clinical practice. Sponsorship None.
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Affiliation(s)
- Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Maria Rasenack
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
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Fekete C, Gurtner B, Kunz S, Gemperli A, Gmünder HP, Hund-Georgiadis M, Jordan X, Schubert M, Stoyanov J, Stucki G. Inception cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI): Design, participant characteristics, response rates and non-response. J Rehabil Med 2021; 53:jrm00159. [PMID: 33569608 PMCID: PMC8814861 DOI: 10.2340/16501977-2795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To provide a methodological reference paper for the inception cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), by detailing its methodological features and reporting on participant characteristics, response rates and non-response bias. Design Prospective cohort study starting in 2013 in all 4 specialized rehabilitation centres in Switzerland. Subjects Included are 655 newly diagnosed first rehabilitation patients aged ≥16 years with traumatic or non-traumatic spinal cord injury (TSCI, NTSCI). Methods Descriptive statistics were used to depict participant characteristics and to compare characteristics of responders and non-responders. Logistic regressions were conducted to estimate non-response bias. RESULTS The sample consisted of 69% males, with mean age 53.5 years, 57.9% TSCI, 60.7% paraplegia and 78.8% incomplete SCI. Males and younger persons more often sustained TSCI and more severe SCI, resulting in longer duration of rehabilitation. Complete lesions were more prevalent in TSCI compared to NTSCI. The response rate was 47.5% and study participation was less likely in females, older persons, persons with lower functional independence and those with NTSCI. Conclusion SwiSCI inception cohort data enable the estimation of epidemiological figures of SCI in Switzerland, and prognostic and trajectory modelling of outcomes after SCI to guide policy, service provision and clinical practice.
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Affiliation(s)
- Christine Fekete
- SwiSCI, Swiss Paraplegic Research, Nottwil, Switzerland. E-mail:
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Hupp M, Pfender N, Vallotton K, Rosner J, Friedl S, Zipser CM, Sutter R, Klarhöfer M, Spirig JM, Betz M, Schubert M, Freund P, Farshad M, Curt A. The Restless Spinal Cord in Degenerative Cervical Myelopathy. AJNR Am J Neuroradiol 2021; 42:597-609. [PMID: 33541903 DOI: 10.3174/ajnr.a6958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The spinal cord is subject to a periodic, cardiac-related movement, which is increased at the level of a cervical stenosis. Increased oscillations may exert mechanical stress on spinal cord tissue causing intramedullary damage. Motion analysis thus holds promise as a biomarker related to disease progression in degenerative cervical myelopathy. Our aim was characterization of the cervical spinal cord motion in patients with degenerative cervical myelopathy. MATERIALS AND METHODS Phase-contrast MR imaging data were analyzed in 55 patients (37 men; mean age, 56.2 [SD,12.0] years; 36 multisegmental stenoses) and 18 controls (9 men, P = .368; mean age, 62.2 [SD, 6.5] years; P = .024). Parameters of interest included the displacement and motion pattern. Motion data were pooled on the segmental level for comparison between groups. RESULTS In patients, mean craniocaudal oscillations were increased manifold at any level of a cervical stenosis (eg, C5 displacement: controls [n = 18], 0.54 [SD, 0.16] mm; patients [n = 29], monosegmental stenosis [n = 10], 1.86 [SD, 0.92] mm; P < .001) and even in segments remote from the level of the stenosis (eg, C2 displacement: controls [n = 18], 0.36 [SD, 0.09] mm; patients [n = 52]; stenosis: C3, n = 21; C4, n = 11; C5, n = 18; C6, n = 2; 0.85 [SD, 0.46] mm; P < .001). Motion at C2 differed with the distance to the next stenotic segment and the number of stenotic segments. The motion pattern in most patients showed continuous spinal cord motion throughout the cardiac cycle. CONCLUSIONS Patients with degenerative cervical myelopathy show altered spinal cord motion with increased and ongoing oscillations at and also beyond the focal level of stenosis. Phase-contrast MR imaging has promise as a biomarker to reveal mechanical stress to the cord and may be applicable to predict disease progression and the impact of surgical interventions.
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Affiliation(s)
- M Hupp
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - N Pfender
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - K Vallotton
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - J Rosner
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.).,Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - S Friedl
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - C M Zipser
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | | | - M Klarhöfer
- Siemens Healthcare AG (M.K.), Zurich, Switzerland
| | - J M Spirig
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Betz
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Schubert
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - P Freund
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - M Farshad
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - A Curt
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.).,University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Hecker A, Aguirre J, Eichenberger U, Rosner J, Schubert M, Sutter R, Wieser K, Bouaicha S. Deltoid muscle contribution to shoulder flexion and abduction strength: an experimental approach. J Shoulder Elbow Surg 2021; 30:e60-e68. [PMID: 32540315 DOI: 10.1016/j.jse.2020.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rotator cuff (RC) and the deltoid muscle are 2 synergistic units that enable the functionally demanding movements of the shoulder. A number of biomechanical studies assume similar force contribution of the force couple (RC and deltoid) over the whole range of motion, whereas others propose position-dependent force distribution. There is a lack of in vivo data regarding the deltoid's contribution to shoulder flexion and abduction strength. This study aimed to create reliable in vivo data quantifying the deltoid's contribution to shoulder flexion and abduction strength throughout the range of motion. METHODS Active range of motion and isometric muscle strength of shoulder abduction and flexion in 0°, 30°, 60°, 90°, and 120° of abduction/flexion as well as internal and external rotation in 0° and 90° of abduction were obtained in 12 healthy volunteers on the dominant arm before and after an ultrasound-guided isolated axillary nerve block. Needle electromyography was performed before and after the block to confirm deltoid paralysis. Radiographs of the shoulder and an ultrasonographic examination were used to exclude relevant shoulder pathologies. RESULTS Active range of motion showed a minimal to moderate reduction to 94% and 88% of the preintervention value for abduction and flexion. Internal and external rotation amplitude was not impaired. The abduction strength was significantly reduced to 76% at 0° (P = .002) and to 25% at 120° (P < .001) of abduction. The flexion strength was significantly reduced to 64% at 30° (P < .001) and to 30% at 120° (P < .001) of flexion. The strength reduction was linear, depending on the flexion/abduction angle. The maximal external rotation strength showed a significant decrease to 53% in 90° (P < .001) of abduction, whereas in adduction no strength loss was observed (P = .09). The internal rotation strength remained unaffected in 0° and 90° of abduction (P = .28; P = .13). CONCLUSION The deltoid shows a linear contribution to maximal shoulder strength depending on the abduction or flexion angle, ranging from 24% in 0° to 75% in 120° of abduction and from 11% in 0° to 70% in 120° of flexion, respectively. The overall contribution to abduction strength is higher than to flexion strength. The combination of deltoid muscle and teres minor contributes about 50% to external rotation strength in 90° of abduction. The internal rotation strength is not influenced by a deltoid paralysis. This study highlights the position-dependent contribution of the shoulder muscles to strength development and thereby provides an empirical approach to better understand human shoulder kinematics.
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Affiliation(s)
- Andreas Hecker
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Department of Orthopedics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - José Aguirre
- Department of Anesthesiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Urs Eichenberger
- Department of Anesthesiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Department of Neurology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Samy Bouaicha
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Kluge S, Schubert M, Börmel L, Lorkowski S. The vitamin E long-chain metabolite α-13'-COOH affects macrophage foam cell formation via modulation of the lipoprotein lipase system. Biochim Biophys Acta Mol Cell Biol Lipids 2021; 1866:158875. [PMID: 33421592 DOI: 10.1016/j.bbalip.2021.158875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022]
Abstract
The α-tocopherol-derived long-chain metabolite (α-LCM) α-13'-carboxychromanol (α-13'-COOH) is formed via enzymatic degradation of α-tocopherol (α-TOH) in the liver. In the last decade, α-13'-COOH has emerged as a new regulatory metabolite revealing more potent or even different effects compared with its vitamin precursor α-TOH. The detection of α-13'-COOH in human serum has further strengthened the concept of its physiological relevance as a potential regulatory molecule. Here, we present a new facet on the interaction of α-13'-COOH with macrophage foam cell formation. We found that α-13'-COOH (5 μM) increases angiopoietin-like 4 (ANGPTL4) mRNA expression in human THP-1 macrophages in a time- and dose-dependent manner, while α-TOH (100 μM) showed no effects. Interestingly, the mRNA level of lipoprotein lipase (LPL) was not influenced by α-13'-COOH, but α-TOH treatment led to a reduction of LPL mRNA expression. Both compounds also revealed different effects on protein level: while α-13'-COOH reduced the secreted amount of LPL protein via induction of ANGPTL4 cleavage, i.e. activation, the secreted amount of LPL in the α-TOH-treated samples was diminished due to the inhibition of mRNA expression. In line with this, both compounds reduced the catalytic activity of LPL. However, α-13'-COOH but not α-TOH attenuated VLDL-induced lipid accumulation by 35%. In conclusion, only α-13'-COOH revealed possible antiatherogenic effects due to the reduction of VLDL-induced foam cell formation in THP-1 macrophages. Our results provide further evidence for the role of α-13'-COOH as a functional metabolite of its vitamin E precursor.
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Affiliation(s)
- Stefan Kluge
- Institute of Nutritional Sciences, Friedrich Schiller University, Jena, Germany
| | - Martin Schubert
- Institute of Nutritional Sciences, Friedrich Schiller University, Jena, Germany
| | - Lisa Börmel
- Institute of Nutritional Sciences, Friedrich Schiller University, Jena, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University, Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany.
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Buzzell A, Camargos KC, Chamberlain JD, Eriks-Hoogland I, Hug K, Jordan X, Schubert M, Brinkhof MWG. Self-reports of treatment for secondary health conditions: results from a longitudinal community survey in spinal cord injury. Spinal Cord 2020; 59:389-397. [PMID: 33293608 DOI: 10.1038/s41393-020-00596-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal community survey. OBJECTIVES To describe the treatment for secondary health conditions as reported by individuals living with spinal cord injury (SCI) and to identify potential predictors of treatment. SETTING Community (people with SCI living in Switzerland). METHODS Data on the frequency, severity, and treatment of 14 common health conditions (HCs) in the past three months were collected in two surveys by the Swiss Spinal Cord Injury (SwiSCI) cohort study, in 2012 and 2017. Variation in treatment was analyzed using descriptive statistics, by survey period and severity of HC. Conditional multilevel random-effects logistic regression was used to describe differences in self-reported treatment with respect to sociodemographic and socioeconomic factors in addition to SCI characteristics and severity and number of HCs. RESULTS Severe or chronic autonomic dysreflexia and sleep problems showed in the self-report as the HCs with the lowest occurrence/frequency of treatment. Across all HCs, higher age, shorter time since injury, the total number of HCs, and level of severity were associated with a higher propensity for reporting treatment. Individuals with severe financial difficulties additionally had 1.40 greater odds of receiving treatment (95% CI 1.09-1.80). CONCLUSIONS This study identified systematic differences in the report of HCs and their treatment within the Swiss SCI community. This study thus provides a basis to guide future research on identifying targets of intervention for long-term clinical management of SCI.
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Affiliation(s)
- Anne Buzzell
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Kamilla Coutinho Camargos
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Jonviea D Chamberlain
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inserm, CIC1401-EC, F-33000, Bordeaux, France
| | | | | | | | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Anderson CE, Birkhäuser V, Stalder SA, Bachmann LM, Curt A, Jordan X, Leitner L, Liechti MD, Mehnert U, Möhr S, Pannek J, Schubert M, van der Lely S, Kessler TM, Brinkhof MWG. Optimizing clinical trial design using prospective cohort study data: a case study in neuro-urology. Spinal Cord 2020; 59:1003-1012. [PMID: 33235299 PMCID: PMC7611589 DOI: 10.1038/s41393-020-00588-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
Study Design Simulations using data from a prospective cohort study. Objectives To illustrate how prospective cohort data can be employed in randomized controlled trial (RCT) planning to assess feasibility and operational challenges, using TASCI (Transcutaneous tibial nerve stimulation in patients with Acute Spinal Cord Injury to prevent neurogenic detrusor overactivity: a nationwide randomized, sham-controlled, double-blind clinical trial) as a case study. Setting Spinal cord injury rehabilitation centers in Switzerland. Methods TASCI is nested in the multicenter Swiss Spinal Cord Injury Cohort Study (SwiSCI), which prospectively includes patients with acute spinal cord injury. In simulations, data from 640 patients, collected by SwiSCI, were used to investigate different scenarios of patient eligibility and study consent, as well as the performance of the randomization list. Descriptive analysis was used to describe the population of interest and the simulation results; multivariable logistic regression analysis was performed to identify predictors of discharge within the TASCI intervention time period. Results The recruitment target of 114 patients is obtainable within the originally envisioned three-year time period under the most favorable recruitment scenario examined. The distribution of the primary prognostic factor produced imbalance in the randomization lists and informed further discussion of the cut-off values used in stratification. Influxes of patients resulted in overlapping intervention periods for multiple participants, which guided resource allocation. Early discharge was related to the primary prognostic factor and study center, but is only anticipated in about 8% of participants. Conclusions Prospective cohort data are a very valuable resource for planning RCTs.
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Affiliation(s)
- Collene E Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Armin Curt
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sandra Möhr
- Neuro-Urology, REHAB Basel, Basel, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Raab AM, Brinkhof MWG, Berlowitz DJ, Postma K, Gobets D, Hirschfeld S, Hopman MTE, Huber B, Hund-Georgiadis M, Jordan X, Schubert M, Wildburger R, Mueller G. Respiratory function and respiratory complications in spinal cord injury: protocol for a prospective, multicentre cohort study in high-income countries. BMJ Open 2020; 10:e038204. [PMID: 33154049 PMCID: PMC7646333 DOI: 10.1136/bmjopen-2020-038204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Pneumonia is one of the leading complications and causes of death after a spinal cord injury (SCI). After a cervical or thoracic lesion, impairment of the respiratory muscles decreases respiratory function, which increases the risk of respiratory complications. Pneumonia substantially reduces patient's quality of life, may prolong inpatient rehabilitation time, increase healthcare costs or at worse, lead to early death. Respiratory function and coughing can be improved through various interventions after SCI, but the available evidence as to which aspect of respiratory care should be optimised is inconclusive. Furthermore, ability of respiratory function parameters to predict pneumonia risk is insufficiently established. This paper details the protocol for a large-scale, multicentre research project that aims to evaluate the ability of parameters of respiratory function to predict and understand variation in inpatient risk of pneumonia in SCI. METHODS AND ANALYSIS RESCOM, a prospective cohort study, began recruitment in October 2016 across 10 SCI rehabilitation centres from Australia, Austria, Germany, the Netherlands and Switzerland. Inpatients with acute SCI, with complete or incomplete cervical or thoracic lesions, 18 years or older and not/no more dependent on 24-hour mechanical ventilation within the first 3 months after injury are eligible for inclusion. The target sample size is 500 participants. The primary outcome is an occurrence of pneumonia; secondary outcomes include pneumonia-related mortality and quality of life. We will use the longitudinal data for prognostic models on inpatient pneumonia risk factors. ETHICS AND DISSEMINATION The study has been reviewed and approved by all local ethics committees of all participating centres. Study results will be disseminated to the scientific community through peer-reviewed journals and conference presentations, to the SCI community, other stakeholders and via social media, newsletters and engagement activities. TRIAL REGISTRATION DETAILS ClinicalTrials.gov NCT02891096.
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Affiliation(s)
- Anja M Raab
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Martin W G Brinkhof
- Life Course Epidemiology Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - David J Berlowitz
- Department of Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Postma
- Department of Rehabilitation Medicine, Rijndam Rehabilitation and Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Gobets
- Department of Rehabilitation Medicine, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Sven Hirschfeld
- Department of Spinal Cord Medicine, BG Trauma Hospital, Hamburg, Germany
| | - Maria T E Hopman
- Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Burkhart Huber
- Trauma Surgery, AUVA Rehabilitation Center Häring, Bad Häring, Austria
| | | | - Xavier Jordan
- Spinal Cord Unit, Clinique romande de réadaptation, Sion, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Renate Wildburger
- Allgemeine Unfallversicherungsanstalt, AUVA Rehabilitation Clinic Tobelbad, Tobelbad, Austria
| | - Gabi Mueller
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
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Fischer T, Stern C, Freund P, Schubert M, Sutter R. Wallerian degeneration in cervical spinal cord tracts is commonly seen in routine T2-weighted MRI after traumatic spinal cord injury and is associated with impairment in a retrospective study. Eur Radiol 2020; 31:2923-2932. [PMID: 33125565 PMCID: PMC8043949 DOI: 10.1007/s00330-020-07388-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/09/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
Objectives Wallerian degeneration (WD) is a well-known process after nerve injury. In this study, occurrence of remote intramedullary signal changes, consistent with WD, and its correlation with clinical and neurophysiological impairment were assessed after traumatic spinal cord injury (tSCI). Methods In 35 patients with tSCI, WD was evaluated by two radiologists on T2-weighted images of serial routine MRI examinations of the cervical spine. Dorsal column (DC), lateral corticospinal tract (CS), and lateral spinothalamic tract (ST) were the analyzed anatomical regions. Impairment scoring according to the American Spinal Injury Association Impairment Scale (AIS, A–D) as well as a scoring system (0–4 points) for motor evoked potential (MEP) and sensory evoked potential (SEP) was included. Mann-Whitney U test was used to test for differences. Results WD in the DC occurred in 71.4% (n = 25), in the CS in 57.1% (n = 20), and in 37.1% (n = 13) in the ST. With WD present, AIS grades were worse for all tracts. DC: median AIS B vs D, p < 0.001; CS: B vs D, p = 0.016; and ST: B vs D, p = 0.015. More pathological MEP scores correlated with WD in the DC (median score 0 vs 3, p < 0.001) and in the CS (0 vs 2, p = 0.032). SEP scores were lower with WD in the DC only (1 vs 2, p = 0.031). Conclusions WD can be detected on T2-weighted scans in the majority of cervical spinal cord injury patients and should be considered as a direct effect of the trauma. When observed, it is associated with higher degree of impairment. Key Points • Wallerian degeneration is commonly seen in routine MRI after traumatic spinal cord injury. • Wallerian degeneration is visible in the anatomical regions of the dorsal column, the lateral corticospinal tract, and the lateral spinothalamic tract. • Presence of Wallerian degeneration is associated with higher degree of impairment.
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Affiliation(s)
- Tim Fischer
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph Stern
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
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Zipser CM, Pfender N, Spirig JM, Betz M, Aguirre J, Hupp M, Farshad M, Curt A, Schubert M. Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study. BMJ Open 2020; 10:e037332. [PMID: 32958488 PMCID: PMC7507854 DOI: 10.1136/bmjopen-2020-037332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Degenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression. METHODS AND ANALYSIS Twenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt's) CSFP-findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging. ETHICS AND DISSEMINATION The study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02170155).
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Affiliation(s)
- Carl Moritz Zipser
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Nikolai Pfender
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Jose Miguel Spirig
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Michael Betz
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Jose Aguirre
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Markus Hupp
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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Liechti MD, van der Lely S, Stalder SA, Anderson CE, Birkhäuser V, Bachmann LM, Brinkhof MWG, Curt A, Jordan X, Leitner L, Mehnert U, Möhr S, Pannek J, Schubert M, Kessler TM. Update from TASCI, a Nationwide, Randomized, Sham-controlled, Double-blind Clinical Trial on Transcutaneous Tibial Nerve Stimulation in Patients with Acute Spinal Cord Injury to Prevent Neurogenic Detrusor Overactivity. Eur Urol Focus 2020; 6:877-879. [PMID: 31601539 DOI: 10.1016/j.euf.2019.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
Transcutaneous tibial nerve stimulation has the potential to revolutionize the management of lower urinary tract dysfunction in patients with acute spinal cord injury. TASCI is a nationwide randomized, sham-controlled, double-blind clinical trial for which the preparatory phase has been successfully completed.
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Affiliation(s)
- Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Martin W G Brinkhof
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland
| | - Armin Curt
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sandra Möhr
- Neuro-Urology, REHAB Basel, Basel, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
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Birkhäuser V, Liechti MD, Anderson CE, Bachmann LM, Baumann S, Baumberger M, Birder LA, Botter SM, Büeler S, Cruz CD, David G, Freund P, Friedl S, Gross O, Hund-Georgiadis M, Husmann K, Jordan X, Koschorke M, Leitner L, Luca E, Mehnert U, Möhr S, Mohammadzada F, Monastyrskaya K, Pfender N, Pohl D, Sadri H, Sartori AM, Schubert M, Sprengel K, Stalder SA, Stoyanov J, Stress C, Tatu A, Tawadros C, van der Lely S, Wöllner J, Zubler V, Curt A, Pannek J, Brinkhof MWG, Kessler TM. TASCI-transcutaneous tibial nerve stimulation in patients with acute spinal cord injury to prevent neurogenic detrusor overactivity: protocol for a nationwide, randomised, sham-controlled, double-blind clinical trial. BMJ Open 2020; 10:e039164. [PMID: 32792454 PMCID: PMC7430472 DOI: 10.1136/bmjopen-2020-039164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Neurogenic lower urinary tract dysfunction (NLUTD), including neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia, is one of the most frequent and devastating sequelae of spinal cord injury (SCI), as it can lead to urinary incontinence and secondary damage such as renal failure. Transcutaneous tibial nerve stimulation (TTNS) is a promising, non-invasive neuromodulatory intervention that may prevent the emergence of the C-fibre evoked bladder reflexes that are thought to cause NDO. This paper presents the protocol for TTNS in acute SCI (TASCI), which will evaluate the efficacy of TTNS in preventing NDO. Furthermore, TASCI will provide insight into the mechanisms underlying TTNS, and the course of NLUTD development after SCI. METHODS AND ANALYSIS TASCI is a nationwide, randomised, sham-controlled, double-blind clinical trial, conducted at all four SCI centres in Switzerland. The longitudinal design includes a baseline assessment period 5-39 days after acute SCI and follow-up assessments occurring 3, 6 and 12 months after SCI. A planned 114 participants will be randomised into verum or sham TTNS groups (1:1 ratio), stratified on study centre and lower extremity motor score. TTNS is performed for 30 min/day, 5 days/week, for 6-9 weeks starting within 40 days after SCI. The primary outcome is the occurrence of NDO jeopardising the upper urinary tract at 1 year after SCI, assessed by urodynamic investigation. Secondary outcome measures assess bladder and bowel function and symptoms, sexual function, neurological structure and function, functional independence, quality of life, as well as changes in biomarkers in the urine, blood, stool and bladder tissue. Safety of TTNS is the tertiary outcome. ETHICS AND DISSEMINATION TASCI is approved by the Swiss Ethics Committee for Northwest/Central Switzerland, the Swiss Ethics Committee Vaud and the Swiss Ethics Committee Zürich (#2019-00074). Findings will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03965299.
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Affiliation(s)
- Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sarah Baumann
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Michael Baumberger
- Spinal Cord and Rehabilitation Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Lori A Birder
- Neuro-Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sander M Botter
- Swiss Center for Musculoskeletal Biobanking, Balgrist Campus AG, Zürich, Switzerland
| | - Silvan Büeler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Célia D Cruz
- Instituto de Investigação e Inovação em Saúde, Translational Neuro-urology Group, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Departemento de Biomedicina, Unidade de Biologia Experimental, Universidade do Porto, Porto, Portugal
| | - Gergely David
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Knut Husmann
- Swiss Center for Musculoskeletal Biobanking, Balgrist Campus AG, Zürich, Switzerland
| | - Xavier Jordan
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Eugenia Luca
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sandra Möhr
- Clinic of Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
| | - Freschta Mohammadzada
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Daniel Pohl
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Institute for Regenerative Medicine, University of Zürich, Zürich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zürich, Zürich, Switzerland
| | - Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Cornelia Stress
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Aurora Tatu
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Cécile Tawadros
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jens Wöllner
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Veronika Zubler
- Department of Radiology, Balgrist University Hospital, Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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