Cord Damage Research Articles

Improvement of Functional State of Patients after Spinal Cord Injury During Epidural Electrical Stimulation: Prospective Study

the lack of convincing evidence of a therapeutic effect.
 AIM. To evaluate the effect of complex rehabilitation using EPS and activation of the proprioceptive apparatus on the indicators of the functional state of patients with long-term consequences of spinal cord injury with partial spinal cord injury.
 MATERIALS AND METHODS. A prospective study was conducted with the participation of 29 patients with long-term consequences of spinal cord injury with partial spinal cord injury. The catamnesis of the disease was 3.7 ± 0.5 years. Comprehensive rehabilitation included epidural electrical stimulation by implantable electrode and activation of the proprioceptive apparatus. The neurological (ASIA scale) and functional (CSIM III scale) status of the patient was analyzed. Motor function was evaluated using 10-meter Walk test; M-responses of limb muscles — using electromyography, temperature and pain sensitivity — using esthesiometry.
 RESULTS. An increase in muscle strength and M-response of the muscles of the extremities, normalization of the motor deficit index, reduction of the walking test time, increase in movement speed and the patient’s independence index were revealed. There is an improvement in temperature and pain sensitivity at the level of damage and in the dermatomes located distally. The effect decreases in dermatomes far from the level of the electrode installation; but with increase in the number of courses the effect increases.
 DISCUSSION. The results obtained indicate that this rehabilitation complex, including UES, has a positive effect on the functioning of both the motor and sensitive spheres.
 CONCLUSION. Application of EES and activation of the proprioceptive apparatus improves the functional condition of sensorimotor sphere in the long-term consequences of spinal cord injury with partial spinal cord damage. Repeated rehabilitation courses have cumulative effect.

Research on Parkinson's disease recognition algorithm based on sample enhancement

Parkinson's disease patients have early vocal cord damage, and their voiceprint characteristics differ significantly from those of healthy individuals, which can be used to identify Parkinson's disease. However, the samples of the voiceprint dataset of Parkinson's disease patients are insufficient, so this paper proposes a double self-attention deep convolutional generative adversarial network model for sample enhancement to generate high-resolution spectrograms, based on which deep learning is used to recognize Parkinson's disease. This model improves the texture clarity of samples by increasing network depth and combining gradient penalty and spectral normalization techniques, and a family of pure convolutional neural networks (ConvNeXt) classification network based on Transfer learning is constructed to extract voiceprint features and classify them, which improves the accuracy of Parkinson's disease recognition. The validation experiments of the effectiveness of this paper's algorithm are carried out on the Parkinson's disease speech dataset. Compared with the pre-sample enhancement, the clarity of the samples generated by the proposed model in this paper as well as the Fréchet inception distance (FID) are improved, and the network model in this paper is able to achieve an accuracy of 98.8%. The results of this paper show that the Parkinson's disease recognition algorithm based on double self-attention deep convolutional generative adversarial network sample enhancement can accurately distinguish between healthy individuals and Parkinson's disease patients, which helps to solve the problem of insufficient samples for early recognition of voiceprint data in Parkinson's disease. In summary, the method effectively improves the classification accuracy of small-sample Parkinson's disease speech dataset and provides an effective solution idea for early Parkinson's disease speech diagnosis.

Our experience with the surgical management of lower cervical spine fractures: fifty case series.

Trauma to the lower cervical spine is a serious lesion due to its neurological consequences which jeopardize the vital and functional prognosis. They constitute a public health problem due to their frequency and seriousness requiring rapid and adequate treatment. The aim of our study is to (1) describe the epidemiological, clinical, and radiological characteristics of lower cervical spine trauma patients; (2) support the therapeutic management of these patients and show our experience in surgery for lower cervical spine trauma; and (3) analyze the anatomical and functional results and discuss them with literature data. This is a retrospective descriptive study of 50 patients with lower cervical spine trauma treated surgically over a period of five years from January 1, 2016, to December 2020. The average age of our patients was 34.5 years, with a sex ratio of 1.7. The etiologies are dominated by accidents on public roads (58%). They show neurological disorders such as spinal cord damage in 30% of cases and root damage in 20% of cases. The radiological assessment revealed eight tear drops, ten comminuted fractures, 12 severe sprains, 12 biarticular dislocations, six uniarticular dislocations, and two herniated discs. Treatment was surgical in all patients with an anterolateral approach and anterior arthrodesis. The evolution was favourable in 21 patients and stationary in 29 patients. Our study concluded that dislocations and fracture dislocations were the predominant type of injury in cases of AVP. Tetraplegia was mainly observed with uni- and biarticular dislocations. The variation in consolidation time was not correlated with trauma-to-surgery time. Better neurological recovery was observed with mild initial neurological damage than with initially severe damage. The appearance of an adjacent syndrome is less frequent with monosegmental arthrodesis than with multisegmental arthrodesis. Cage arthrodesis was an alternative to iliac harvesting with similar results.

FUNDC1-induced mitophagy protects spinal cord neurons against ischemic injury

Local ischemia and hypoxia are the most important pathological processes in the early phase of secondary spinal cord injury (SCI), in which mitochondria are the main target of ischemic injury. Mitochondrial autophagy, also known as mitophagy, acts as a selective autophagy that specifically identifies and degrades damaged mitochondria, thereby reducing mitochondria-dependent apoptosis. Accumulating evidence shows that the mitophagy receptor, FUN14 domain-containing 1 (FUNDC1), plays an important role in ischemic injury, but the role of FUNDC1 in SCI has not been reported. In this study, we aimed to investigate whether FUNDC1 can enhance mitophagy and inhibit neuronal apoptosis in the early stage of SCI. In a rat SCI model, we found that FUNDC1 overexpression enhanced neuronal autophagy and decreased neuronal apoptosis in the early stage of injury, thereby reducing spinal cord damage. In vitro studies showed that the neuroprotective effects of FUNDC1 were achieved by inhibiting mitochondria-dependent apoptosis and improving mitochondrial function. In addition, FUNDC1 enhanced mitophagy. The protective effects of FUNDC1 against apoptosis and mitochondrial dysfunction were reversed by 3-methyladenine (3-MA), an autophagy inhibitor. Taken together, our results confirm that FUNDC1 can protect against neuronal loss after SCI by inducing mitophagy, inhibiting mitochondria-dependent apoptosis, and improving mitochondrial function.

Clinical profile of paediatric spinal cord damage in a developing country’s rural-area tertiary hospital neurosurgery

BackgroundSpinal cord damage (SCD) is rare in children, hence the paucity of literature on the subject, particularly in developing countries. This study aims to define the clinical epidemiology of paediatric SCD in a Nigerian tertiary health facility.MethodsA retrospective review of a 42-month long prospectively collected clinical data on paediatric SCD in a rural neurosurgery unit.ResultsThere were 37 children (20 males) accounting for about 12% of the paediatric neurosurgical patients we managed during the study period. The mean age was 6.9 years (peak = 0–4 years, 43.2%). Traumatic spinal cord injury (SCI) was the cause of SCD in 54.1% (20/37) of the cases, spinal bifida in 37.8%, spinal cord tumour in 5.4%, and spinal tuberculosis in 2.7%. The mean age of patients with traumatic SCI was 11.5 years, while the median age for spinal bifida was 3 days. Traumatic SCI was caused by road traffic accident in 70% (14/20), and falls in 25%. The cervical spinal cord was the location of the spinal cord damage in 51.4% of all the cases in this study, lumbosacral in 24.3%, and sacral in 10.8%. Traumatic SCI was predominantly located in the cervical region in (90%, 18/20) while spinal bifida was most commonly lumbosacral (64.3%, 9/14).ConclusionSpinal cord damage accounted for more than a tenth (12.1%) of our paediatric neurosurgical workload in this rural neurosurgery, and are mostly due to traumatic SCI and spinal bifida.

Plasma GDNF levels in spinal dysraphism and its relation with neurological impairment in children: A point of care study

GDNF plays a crucial role in the stimulation of recovery, neuroplasticity and synaptic reorganization after spinal cord injury providing neuroprotection and neuroregeneration. Plasma GDNF levels are upregulated in cases of spina bifida owing to the intrauterine damage of the exposed spinal cord. Our aim was to compare the plasma GDNF levels in patients of spina bifida with non-spina bifida cases and assess the correlation with neurological impairment at one year of follow up. Single centre prospective analysis of cases of spina bifida from 2020 to 2022at presentation and after one year of follow up post-surgery. Cases with hernia and hydrocele without any other disorders were recruited into the control group. Plasma GDNF levels were assessed with immunoassay kits and compared with neurological involvement. 85 cases were included in the study. GDNF levels were elevated in cases compared to controls (mean 6.62 vs 1.76) with significant p value (<0.01). Same was observed for open and closed defects (mean 7.63 vs 4.86: p<0.01). At follow up of 52 cases post-surgery cases with neurogenic bladder with abnormal urodynamic studies, sphincter involvement and motor impairment had significantly elevated baseline levels of GDNF compared with those who did not have this neurological impairment (p<0.01). The neurotrophic factor up-regulation can reflect an endogenous attempt at neuroprotection against the biochemical and molecular cascades triggered by the spinal cord damage. This upregulation can be represented as important biochemical markers of severe spinal cord damage and can be associated with severity of spine injury in MMC patients. Our results are in keeping with these findings, that, there were increased levels of plasma GDNF levels in cases of spinal dysraphism compared to control population. Also, the type of lesion reflecting the severity whether a closed or an open dysraphism, showed significant difference in levels between them suggesting, yet again, more damage in open defect as expected. The levels were higher with involvement of bladder, sphincter and lower limb power. There is significant elevation of plasma GDNF levels in cases of spina bifida and this elevation is proportional to the degree of spinal damage and hence the neurological impairment. GDNF levels are a good predictor for assessing the severity of the lesion and thus the outcome in these cases. Additional prospective and long-term studies with a larger cohort are needed for a better understanding of neurotrophin pattern modulation in MMC.

Impact of spasticity on quality of life of Lebanese individuals with spinal cord injury: Validity and reliability of the Arabic modified patient-reported impact of spasticity measure

Context Spasticity is one of the most complicated problems after spinal cord injury (SCI). Different assessment tools are used to assess spasticity and its impact on individuals with SCI. The modified Patient-Reported Impact of Spasticity Measure (mPRISM) is a recommended tool to measure spasticity in spinal cord damage. Objective To translate and cross-culturally adapt mPRISM to Arabic and examine its validity and reliability in a sample of Lebanese adults with SCI. Design A cross-sectional study. Participants 107 individuals with SCI. Outcome measures mPRISM. Intervention mPRISM was translated into Arabic, and pilot testing of the pre-final version was conducted. Exploratory factor analysis, Poisson regression, and Cronbach’s alpha were performed to evaluate the construct and convergent validity and reliability of the Arabic version of mPRISM (AR-mPRISM). Results mPRISM was successfully translated and cross-culturally adapted to Arabic. Results of an exploratory factor analysis conducted on the scale showed a coherent 5-domain structure that explained 69.631% of the total variance. Convergent validity was demonstrated by a significant association with sociodemographic and injury correlates. The five extracted subscales demonstrated high internal consistency with a Cronbach’s alpha > 0.8. Conclusion Results support the construct and convergent validity and reliability of AR-mPRISM for assessing spasticity impact on the quality of life of Arabic Speaking SCI population.

A Rare Mechanical Cause of Extubation Failure After Short-Term Intubation and Outgoing with the Stridor Clinic: Obstructive Fibrinous Tracheal Pseudomembrane : A CASE REPORT

Stridor after extubation is generally a clinical symptom that may indicate laryngeal edema or vocal cord injury due to intubation, and hoarseness may accompany this.The presence of stridor may cause reintubation due to upper airway obstruction, a risk factor for patient mortality and morbidity.Laryngeal edema and vocal cord damage are mostly seen as the cause of stridor.In this case, OFTP (Obstructive fibrinous tracheal pseudomembrane) and stridor in the lower line of the vocal cords, which are rarely seen during short-term intubation, are presented.

FGF21 prevents neuronal cell ferroptosis after spinal cord injury by activating the FGFR1/β-Klotho pathway

Spinal cord injury (SCI) is a kind of traumatic nervous system disease caused by neuronal death, causing symptoms like sensory, motor, and autonomic nerve dysfunction. The recovery of neurological function has always been a intractable problem that has greatly distressed individuals and society. Although the involvement of iron-dependent lipid peroxidation leading to nerve cell ferroptosis in SCI progression has been reported, the underlying mechanisms remain unaddressed. Thus, this study aimed to investigate the potential of recombinant human FGF21 (rhFGF21) in inhibiting ferroptosis of nerve cells and improving limb function after SCI, along with its underlying mechanisms. In vivo animal model showed that FGFR1, p-FGFR1, and β-Klotho protein gradually increased over time after injury, reaching a peak on the third day. Moreover, rhFGF21 treatment significantly reduced ACSL4, increased GPX4 expression, reduced iron deposition, and inhibited ferroptosis. Meanwhile, rhFGF21 decreased cell apoptosis following acute spinal cord damage. In contrast, FGFR1 inhibitor PD173074 partially reversed the rhFGF21-induced therapeutic effects. Overall, this work revealed that rhFGF21 activates the FGFR1/β-Klotho pathway to decrease ferroptosis of nerve cells, suggesting that FGF21 could be a new therapeutic target for SCI neurological rehabilitation.

Regulation of "Right Ankle Dorsiflexion" Motor Imagery on Brain Function of Spinal Cord Injury: A FOCA-Based Prospective Study.

Motor dysfunction is the main functional disability after spinal cord injury (SCI), seriously affecting the life and work of patients. In addition to spinal cord damage, the brain undergoes structural and functional plastic changes. This study explored brain function remodeling in patients with SCI and the effect of right ankle dorsiflexion motor imagery task on brain function. This prospective study enrolled 11 patients with SCI and dyskinesia of the right lower limb and 12 healthy subjects at the General Hospital of Western Theater Command PLA (January 2015 to December 2016). They underwent functional magnetic resonance imaging (fMRI) in the resting state and the "right ankle dorsiflexion" motor imagery task state. Four-dimensional (spatiotemporal) concordance (FOCA) of local neuronal activity was used for fMRI image analysis. The differences between SCI patients and healthy subjects were compared using the two-sample t-test. In the resting state, compared with healthy subjects, patients with SCI showed decreased FOCA in the left putamen, right caudate nucleus, and right superior occipital gyrus and increased FOCA in the left precentral gyrus. In the right ankle dorsiflexion motor imagery task state, FOCAs in the right inferior temporal gyrus and left inferior parietal lobule were decreased in patients with SCI. After SCI, a series of changes in the structure and function of the brain occur. Research on brain plasticity after SCI might help explore the central mechanisms underlying functional recovery after treatments, providing more therapeutic strategies for SCI.

Increased excitability and reduced GABAergic levels in somatosensory cortex under chronic spinal cord injury

The complete or partial damage of ascending somatosensory pathways produced by a spinal cord injury triggers changes in the somatosensory cortex consisting in a functional expansion of activity from intact cortical regions towards deafferented ones, a process known as cortical reorganization. However, it is still unclear whether cortical reorganization depends on the severity of the spinal cord damage or if a spinal cord injury always leads to a similar cortical reorganization process in the somatosensory cortex. To answer these open questions in the field, we obtained longitudinal somatosensory evoked responses from bilateral hindlimb and forelimb cortex from animals with chronic full-transection or contusive spinal cord injury at thoracic level (T9-T10) to induce sensory deprivation of hindlimb cortex while preserving intact the forelimb cortex. Electrophysiological recordings from the four locations were obtained before lesion and weekly for up to 4 weeks. Our results show that cortical reorganization depends on the type of spinal cord injury, which tends to be more bilateral in full transection while is more unilateral in the model of contusive spinal cord injury. Moreover, in full transection of spinal cord, the deafferented and intact cortex exhibited similar increments of somatosensory evoked responses in both models of spinal cord injury - a feature observed in about 80% of subjects. The other 20% were unaffected by the injury indicating that cortical reorganization does not undergo in all subjects. In addition, we demonstrated an increased probability of triggered up-states in animals with spinal cord injury. This data indicates increased cortical excitability that could be proposed as a new feature of cortical reorganization. Finally, decreased levels of GABA marker GAD67 across cortical layers were only found in those animals with increased somatosensory evoked responses, but not in the unaffected population. In conclusion, cortical reorganization depends on the types of spinal cord injuries, and suggest that the phenomenon is strongly determined by cortical circuits. Moreover, changes in GABAergic transmission at the deprived cortex may be considered one of the mechanisms underlying the process of cortical reorganization and increased excitability.

MI brain-computer interfaces: A concise overview

BCI stands for brain–computer interface, and this is the hottest topic among the research community to convert brain impulses into preset instructions that can be used to interact with each other or operate external equipment. A variety of BCI systems have been created during the last decades to give an alternate communications platform for people with extreme neurological illnesses including “amyotrophic lateral sclerosis, spinal cord damage, and brainstem stroke”. BCI literature reviews have also been produced to give BCI researchers well-organized information on important BCI research topics as well as valuable suggestions for the effective design of BCI systems. However, no one has lately looked into general trends in a range of EEG-based BCI study features. The inability of an EEG to measure neural activity down beyond the top layers of the brain is one of its limitations. Additionally, they have low signal-to-noise ratios and are useless for pinpointing the precise location of medications and neurotransmitters in the brain. In this paper, a literature review is conducted with 60 research appears collected from different international journals, published during different years (2013–2022). To be more valuable, this survey provides information about different aspects like signal acquisition techniques, EEG-based BCI paradigms, and channel selection techniques applied in the collected papers. A brief review of various techniques for feature extraction and classification is also included. In addition, the performance of each of the works in terms of accuracy, sensitivity, and kappa coefficient as well is manifest.

Therapy of spinal cord injury by zinc pyrogallol modified nanozyme via anti-inflammatory strategies

ROS-mediated treatment is a potential strategy that can reduce the risk of spinal cord injury (SCI)-related obvious adverse effects, but at the cost of therapeutic efficacy. Considering the significant reactive oxygen species (ROS) scavenging ability and biocompatibility of natural enzyme such as superoxide dismutase (SOD) and catalase (CAT), zinc pyrogallol nanozyme (PA-Zn) was developed to treat the injured spinal cord, in which zinc as metal center was coupled to pyrogallol through the Zn-O-C bridge to form a zinc four-coordination structure that can mimic enzyme-like behaviors of SOD and CAT for SCI treatment. In vitro tests demonstrated that PA-Zn could efficiently inhibit the expression of ROS and M1-related markers (IL-1β), and upregulate the expression of M2-related markers (Arg-1). Furthermore, PA-Zn could significantly promote ventral horn neurons survival and locomotor functional recovery in vivo, while inhibit injured spinal cord damage, and decrease the infiltration of macrophages in the lesion. PA-Zn had a better therapeutic effect on SCI animals at extremely low dosage (0.1 mg kg−1) and shorter time (2 weeks). The working dosage of PA-Zn was even 100-fold lower than some previous reported nanomedicines for SCI treatment. The PA-Zn with muti-enzymatic activities and biocompatibility showed reliable and efficient treatment efficiency for not only SCI but also other ROS-mediated diseases.

Gonadotropin-releasing hormone and growth hormone act as anti-inflammatory factors improving sensory recovery in female rats with thoracic spinal cord injury.

The potential for novel applications of classical hormones, such as gonadotropin-releasing hormone (GnRH) and growth hormone (GH), to counteract neural harm is based on their demonstrated neurotrophic effects in both in vitro and in vivo experimental models and a growing number of clinical trials. This study aimed to investigate the effects of chronic administration of GnRH and/or GH on the expression of several proinflammatory and glial activity markers in damaged neural tissues, as well as on sensory recovery, in animals submitted to thoracic spinal cord injury (SCI). Additionally, the effect of a combined GnRH + GH treatment was examined in comparison with single hormone administration. Spinal cord damage was induced by compression using catheter insufflation at thoracic vertebrae 10 (T10), resulting in significant motor and sensory deficits in the hindlimbs. Following SCI, treatments (GnRH, 60 μg/kg/12 h, IM; GH, 150 μg/kg/24 h, SC; the combination of both; or vehicle) were administered during either 3 or 5 weeks, beginning 24 h after injury onset and ending 24 h before sample collection. Our results indicate that a chronic treatment with GH and/or GnRH significantly reduced the expression of proinflammatory (IL6, IL1B, and iNOS) and glial activity (Iba1, CD86, CD206, vimentin, and GFAP) markers in the spinal cord tissue and improved sensory recovery in the lesioned animals. Furthermore, we found that the caudal section of the spinal cord was particularly responsive to GnRH or GH treatment, as well as to their combination. These findings provide evidence of an anti-inflammatory and glial-modulatory effect of GnRH and GH in an experimental model of SCI and suggest that these hormones can modulate the response of microglia, astrocytes, and infiltrated immune cells in the spinal cord tissue following injury.

USP7 regulates HMOX-1 via deubiquitination to suppress ferroptosis and ameliorate spinal cord injury in rats

Heme oxygenase 1 (HMOX-1) is overexpressed in spinal cord injury (SCI) and relevant to ferroptosis. Ubiquitin-specific-processing protease 7 (USP7) has unveiled its role in regulating HMOX-1 stabilization while its function in SCI remains unknown. This study is to explore the potential molecular mechanism of the USP7-HMOX-1 axis in ferroptosis in a SCI rat model. SCI was assessed with Basso, Beattie, Bresnahan locomotion evaluation, hematoxylin-eosin histological staining, and immunofluorescence detection of NeuN. Ferroptosis was assessed by detections of the iron content, malondialdehyde and glutathione levels, mitochondrial damage, and glutathione peroxidase 4, 4-hydroxynonenal, USP7, and HMOX-1 expression in spinal cord. Co-immunoprecipitation was used to detect the binding of USP7 to HMOX-1. The ubiquitination level of HMOX-1 was measured after USP7 overexpression. USP7 expression was downregulated and HMOX-1 expression was upregulated in SCI rat models. HMOX-1 or USP7 overexpression promoted motor function recovery, ameliorated spinal cord damage, increased NeuN expression, and blocked the occurrence of ferroptosis in SCI rat models. In SCI rats, USP7 directly bound to HMOX-1 and its overexpression promoted HMOX-1 expression via deubiquitination. To sum up, USP7 overexpression facilitated the expression of HMOX-1 through deubiquitination, thereby reducing ferroptosis and alleviating SCI.

Functional Outcome in C2/C3 Fracture Dislocation Managed with Combined Surgical Decompression and Posterior Stabilization

Spinal cord injury is one of the main reasons for permanent paralysis and immobility till now. Spine injury is usually fatal because it involves more than one component, such as discoligamentous misconfiguration, vascular and spinal cord damage. Spine dislocation fracture at the level of C2-3 is rare and usually affects one or two vertebras. Good functional outcome in spine injury is uncommon in which death almost always happens suddenly or is caused by secondary trauma. Emergency room with a cervical spine injury. The patient was pushed by his friends from the side during playtime, causing the neck to hit the corner of a table. The dislocation fracture at the level of C2-3 and spinal cord compression directly caused tetraplegia. The condition was handled with a decompression procedure, spine fusion at the level of C1-4, and posterior stabilization with pedicle screws. A day after the operation, minimal movements were seen in both arms and legs, with motoric strength of 2/2/2/2. The score improved to 4/4/4/4 after two weeks of meds and physiotherapy. The patient started to write again in week 3. The dislocation fracture in this patient caused spinal cord compression. A retropulsion fracture fragment can be displaced to the spinal canal and potentially cause further spinal cord damage. Displacement towards the anterior horn leads to motoric dysfunction. Dislocation fracture at the level of C2-3 hinders neurotransmitter impulse, causing total paralysis on all extremities with intact sensory function. The patient had temporary external stabilization around the neck area while waiting for the procedure. The management concept in cases like this includes affected spinal cord decompression and internal fixation using pedicle screws to ensure fracture stabilization.

Usefulness of the H-Reflex for Intraoperative Monitoring of Thoracoabdominal Aneurysms.

Intraoperative neurophysiologic monitoring in thoracoabdominal aneurysms (TAAA) is essential to avoid intraoperative spinal cord injury). Motor and somatosensory evoked potentials may be considered intraoperative tools for detecting spinal cord injury. H-reflex is a well-known neurophysiologic technique to evaluate L5-S1 root. Current evidence supports the observation that H-reflex changes may occur with spinal cord damage as high as the cervical level. This study aimed to evaluate the usefulness of the H-reflex in these surgeries. The use of intraoperative H-reflex in TAAA monitoring was evaluated in 12 patients undergoing open or endovascular repair of TAAA for a period of four years (2016-2020) using somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) and bilateral H-reflex. Six neurophysiologic alarms were recorded in five of the 12 patients. Summarizing the neurophysiologic changes of our series, we considered a peripheral change when we detected a unilateral loss of SSEPs, TcMEPs, and H-reflex. Instead, we assumed a central change when we detected a unilateral or bilateral loss of TcMEPs and H-reflex with normal SSEPs, which we considered a sign of spinal cord ischemia. Interestingly H-reflex always changed significantly in combination with TcMEPs in the same fashion. According to our series, H-reflex can detect intraoperative changes with the same sensitivity as TcMEPs in TAAA surgeries. With the support of other techniques, it can be useful to localize the origin of the lesion (peripheral or central spinal cord), to help in surgical decision-making to avoid postoperative neurologic damage. Based on our results, we recommend the systematic use of H-reflex in TAAA surgeries.

Decubitus Ulcers in Patients with Spinal Cord Injury in Different Hospitals of Lahore

BACKGROUND: Spinal cord damage is a debilitating nervous disorder that has a significant economic, social, and psychological burden on those who are affected as well as the healthcare system. The spinal cord can be damaged due to either trauma to the cord or spinal cord dysfunctions. Pressure injuries are the leading secondary complication in patients with spinal cord injuries. OBJECTIVE: The purpose of this research was to document the prevalence of decubitus ulcers in spinal cord injury patients. METHOD: It was a cross-sectional study that included a sample of 114 patients either male or female with traumatic spinal cord injury or non-traumatic spinal cord injury with age ranging from less than 12 years to greater than 89 years from various hospitals in Lahore. The sampling technique used was non-probability convenient sampling. Written consent was taken from all patients before the collection of data. Pressure ulcer assessment was done using the European pressure ulcer prevalence study questionnaire. Data were analyzed using the IBM SPSS STATISTICS-25.0 version. Categorical variables were presented as frequencies and percentages, with the use of bar charts or pie charts. RESULTS: Out of 114 patients 68 patients were male (59.6%) and 46 were female (40.4%). This study concluded that 58.9% of patients had decubitus ulcers whether severe or at stage one of PU as a secondary complication of spinal cord injury. From the total sample of 114 patients 49.9% of participants had the most severe decubitus ulcers mostly on the sacrum which can lead to infection and requires surgical interventions such as debridement. Stage 1 decubitus ulcers were seen on the elbow and back. CONCLUSION: More than half of the patients included in this study had one or more pressure ulcers that can be damaging to their health and quality of life. In developed and developing countries pressure ulcers are widespread but are preventable.&#x0D; Key Words:&#x0D; Spinal cord injury, pressure ulcer, sacrum&#x0D;

Protective Effect of Hydrogen-Rich Saline on Spinal Cord Damage in Rats.

The anti-inflammatory and anti-apoptotic effects of molecular hydrogen, delivered as hydrogen-rich saline (HRS), on spinal cord injury was investigated. Four-month-old male Sprague Dawley rats (n = 24) were classified into four groups: (1) control-laminectomy only at T7-T10; (2) spinal injury-dura left intact, Tator and Rivlin clip compression model applied to the spinal cord for 1 min, no treatment given; (3) HRS group-applied intraperitoneally (i.p.) for seven days; and (4) spinal injury-HRS administered i.p. for seven days after laminectomy at T7-T10 level, leaving the dura intact and applying the Tator and Rivlin clip compression model to the spinal cord for 1 min. Levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured in blood taken at day seven from all groups, and hematoxylin-eosin (H & E) and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) were used to stain the tissue samples. IL-6 and TNF-α levels were significantly lower in the group treated with HRS following the spinal cord injury compared to the group whose spinal cord was damaged. A decrease in apoptosis was also observed. The anti-inflammatory and anti-apoptotic effect of IL-6 may be a clinically useful adjuvant therapy after spinal cord injury.

Mature B-cell lymphoma with acute myelitis as the first presentation: a case report and literature review

BackgroundLymphomas are malignant tumors of the immune system that arise in lymphoid organs and can impact the central nervous system. However, lymphomas with acute myelitis as the first manifestation are exceedingly rare, and most of them are symptoms of spinal cord damage due to the lack of specificity in their clinical manifestations. The rate of early misdiagnosis is exceedingly high, and the prognosis is dire. Here, we report a case of mature B-cell lymphoma with acute myelitis as the first presentation and review the related literature.Case presentationIn this study, We report a case of a 70-year-old male patient with bilateral lower extremity weakness, bowel and bladder dysfunction, and recurrent fever. A paraureteral mass was seen beneath the right kidney on imaging, and the final pathological biopsy revealed: CD20 ( +), mature B-cell tumor, The patient refused to undergo additional tests to ascertain the type of lymphoma and subsequent therapy and asked to be discharged. In mid-November 2020, the patient died.ConclusionsThis case report shows that patients with lymphoma can present with acute myelitis as the first symptom, especially if they have recurrent fever, that conventional treatment for myelitis is ineffective, and that tumors are considered after other causes of myelitis have been ruled out. Furthermore, a focused search for tumor-related evidence, as well as early identification and therapy, may help patients live longer lives.