Onset Of Spinal Cord Injury Research Articles

Employment after Spinal Cord Injury in Norway: A Cross-Sectional Survey

Two research questions are addressed: 1) What predicts employment among persons with spinal cord injury (SCI) in Norway? 2) How do the employed compare with the non-employed in their job motivation, labour discrimination, quality of life, everyday coping, health and pain suffering? We use a cross-sectional survey from 2012. With a 51% response rate, 320 Norwegians aged 21–66 years with SCI participated. After injury, 69.5% were employed, and 44.5% remained employed at the time of the interview. There was no gender difference in employment. Among men and women, age at onset of SCI, ability to continue working in the same organisation and education was associated with employment. For men paraplegia and vocational rehabilitation were also significant. Occupational class was non-significant among both men and women. Job motivation and work ability could have affected past employment, and both the employed and non-employed supported the statement that employers discriminate against wheelchair users.

Progress of the Dutch Spinal Cord Injury Database: Completeness of Database and Profile of Patients Admitted for Inpatient Rehabilitation in 2015.

Background: In the Dutch International Spinal Cord Injury (SCI) Data Sets project, we translated all International SCI Data Sets available in 2012 and created a Dutch SCI Database (NDD). Objective: To describe the number of included patients and completeness of the NDD, and to use the NDD to provide a profile of people with traumatic SCI (T-SCI) and non-traumatic SCI (NT-SCI) in the Netherlands. Methods: The NDD includes patients admitted for their first inpatient rehabilitation after onset of SCI to 1 of the 8 rehabilitation centers with a specialty in SCI rehabilitation in the Netherlands. Data of patients admitted in 2015 were analyzed. Results: Data for 424 patients were available at admission; for 310 of these patients (73.1%), discharge data were available. No significant differences were found between patients with and without data at discharge. Data were nearly complete (>90%) for lower urinary tract, bowel, pain, and skin. Data on sexual function has the lowest completion rate. Complete neurological and functional data were available for 41.7% and 38%, respectively. Most patients were male (63.4%), had NT-SCI (65.5%), and had incomplete SCI (58.4% D). Patients with T-SCI differed from patients with NT-SCI on most characteristics, and they stayed considerably longer in the rehabilitation center (112 days vs 65 days, p < .001). Place of discharge was not different between both groups. Conclusion: With the NDD, we collect important data on the majority of Dutch SCI patients, although much work needs to be done to improve the completeness of the data collection.

Self-Management and Self-Efficacy in Patients With Acute Spinal Cord Injuries: Protocol for a Longitudinal Cohort Study.

BackgroundPeople with recently acquired spinal cord injury (SCI) experience changes in physical, social and psychological aspects of their lives. In the last decades, attention has grown for aspects of self-management and self-efficacy in SCI research. However, we still do not know what the self-management and self-efficacy outcomes of first rehabilitation are and whether utilizing these skills may prevent secondary health conditions (SHCs) and increase participation and psychological adjustment early after SCI.ObjectiveTo describe the course and determinants of self-management and self-efficacy during and after first SCI rehabilitation; and to determine theory-based associations between self-management and self-efficacy with SHCs, participation and psychological adjustment.MethodsMulticenter prospective longitudinal cohort study. All people with a newly acquired SCI admitted to one of the 8 specialized SCI rehabilitation centers in the Netherlands will be considered for inclusion in this study. Main assessments will take place during the first and last week of admission and 3, 6 and 12 months after discharge. The target sample is 250 participants. The primary outcomes are self-management (knowledge and execution of self-care) and self-efficacy (confidence in the ability to manage the consequences of SCI and of self-care). Secondary outcome measures are SHCs, participation and psychological adjustment to SCI.ResultsThe first results with the complete set of data are expected in June 2019.ConclusionsThis protocol describes the SELF-SCI cohort study investigating self-management and self-efficacy of initial inpatient SCI rehabilitation. Second, associations will be investigated with SHCs, participation and psychological adjustment early after onset of SCI, until 1 year after discharge. The results will be used to test theories about motivation to perform health-promoting behaviors and adjustment to SCI.

Vocational interests by gender and race 10 years after spinal cord injury.

To examine and compare vocational interests as a function of gender and race among 247 participants with spinal cord injury (SCI) approximately 10 years after SCI onset utilizing the 2004 edition of the Strong Interest Inventory (SII). For this cross-sectional analysis nested within a prospective cohort study, data were collected via mail and analyzed at a medical university in the Southeastern United States. Among the 563 adults with traumatic SCI initially enrolled during inpatient rehabilitation at a specialty hospital, 247 met current study eligibility criteria and completed the SII approximately 10 years postinjury. The SII is a 291-item measure of vocational interests. Male participants scored highest on the Realistic theme and females scored highest on the Social theme. White participants scored highest on the Realistic theme, whereas Black participants scored highest on the Conventional theme. Differences in vocational interests by gender were seen on two of the six General Occupational Themes (GOT; Realistic and Social) and 12 of the 30 Basic Interest Scales (BIS). Race differences were observed on the Enterprising and Conventional GOT and 11 of 30 BIS. For both female and Black participants, interests are more physically compatible with employment post-SCI than male and White participants. Yet, employment rates in White males with SCI are greater than those of female and Black individuals with SCI. These data suggest further research on factors influencing gender and racial disparities in employment among those with SCI is indicated. (PsycINFO Database Record

Determinants of health knowledge and health perceptions from the perspective of health-related education of patients with spinal cord injury: a systematic review.

Appropriate health knowledge (HK) and health perceptions (HP) of patients with spinal cord injury (SCI) are linked to health-related behaviors, compliance, the involvement of caregivers and efficacy of prophylaxis, and management of secondary conditions. The significance of factors determining the efficacy of educational interventions in patients with SCI is underestimated. This systematic literature review aims at identification of determinants of HK and HP among patients with SCI. We identified 16 papers with quantitative HK and HP measurements conclusive in the identification of HK and HP determinants in individuals with SCI. Better HK and HP correlated with health condition-related variables (traumatic SCI, history of secondary conditions, except depression), body functions and structures (tetraplegia, incomplete deficit), activities (independence in daily living activities, ability of locomotion on a wheelchair, inability to walk), social and vocational participation, environmental factors (access to a computer with Internet connection, living in a big city, being married, healthcare recently received), and personal factors (younger age among adults, living with SCI for a longer time, younger age at SCI onset, higher educational level, internal locus of control). Limitations encountered included high nonresponse rates among the patients enrolled, and use of heterogeneous and nonvalidated tools. The results of these studies do not cover the entire scope of possible interactions and exclusively apply univariate correlations. The paucity and methodological limitations of studies conclusive in the identification of HK and HP determinants in SCI patients and the development of new approaches to information and education warrant more high-quality research on the basis of multivariate analyses.

Changes in alcohol use after the onset of spinal cord injury

Objective: Identify the prevalence of alcohol consumption and binge drinking at time of spinal cord injury (SCI) onset, compare these rates to data from the general population, and identify changes in alcohol use at an average of 17 months post-injury.Design: Cross sectional, mailed self-report assessment.Setting: A specialty hospital in the southeastern United States.Participants: Five hundred sixty-six inpatients completed the baseline measure. After eliminating those under age 18, there were 524 participants at baseline. 410 were approached for follow-up, with 201 of those responding.Interventions: N/A.Outcome Measures: Self-reported assessments were completed during inpatient rehabilitation and at follow-up approximately 17 months later. The two primary outcomes were the number of days consuming 5 or more drinks (binge drinking) and the number of days consuming any alcoholic beverages within the 30 days prior to the assessment. Comparison data were taken from the Behavioral Risk Factor Surveillance System.Results: At SCI onset, the prevalence of alcohol use, particularly binge drinking, was substantially higher than the general population (SCI = 44.9%; general population = 13%). Drinking rates decreased by 17 months post-injury.Conclusion: Alcohol use and binge drinking are elevated over the general population at the time of injury. Drinking patterns reflect a decrease following injury but remain slightly elevated, signifying a need for interventions to minimize long-term health consequences.

Patients' views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury-A qualitative interview-based study.

IntroductionInvolving patients in decision making is a legal requirement in many countries, associated with better rehabilitation outcomes, but not easily accomplished during initial inpatient rehabilitation after severe trauma. Providing medical treatment according to the principles of shared decision making is challenging as a point in case for persons with spinal cord injury (SCI).ObjectivesThe aim of this study was to retrospectively explore the patients’ views on their participation in decision making during their first inpatient rehabilitation after onset of SCI, in order to optimize treatment concepts.MethodsA total of 22 participants with SCI were interviewed in‐depth using a semi‐structured interview scheme between 6 months and 35 years post‐onset. Interviews were transcribed verbatim and analysed with the Mayring method for qualitative content analysis.ResultsParticipants experienced a substantially reduced ability to participate in decision making during the early phase after SCI. They perceived physical, psychological and environmental factors to have impacted upon this ability. Patients mentioned regaining their ability to make decisions was an important goal during their first rehabilitation. Receiving adequate information in an understandable and personalized way was a prerequisite to achieve this goal. Other important factors included medical and psychological condition, personal engagement, time and dialogue with peers.ConclusionDuring the initial rehabilitation of patients with SCI, professionals need to deal with the discrepancy between the obligation to respect a patient's autonomy and their diminished ability for decision making.

Functioning and Physical Activity after Spinal Cord Injury.

Background: Spinal cord injury (SCI) causes medical disorders and loss of functions, independence and physical activity in daily and social life. Primary inpatient rehabilitation after SCI onset is more focused on improving the physical state, physical capacity or developing functional independence and mobility skills. In long-term periods the functioning and socialization processes of people with SCI are improving each year naturally engaging and participating in various areas of everyday life. Objectives: The functioning and physical activity of people with SCI in different period of life: during inpatient SCI rehabilitation, after discharge in the long-term context (1–24 years after SCI on set). Material and Methods: A total of 194 people with SCI were participated in the research during 2007–2015. The study was carried out during inpatient rehabilitation in the Centre of Rehabilitation, Physical and Sports Medicine and during independent life skills and recreation camps in the Landscape Therapy and Recreation Centre (Palanga). Functional problems were assessed by the Comprehensive ICF Core Set for SCI. Socio-demographic characteristics, physical activity in everyday life in different periods after SCI onset were collected by a brief form of the Life Situation Questionnaire-revised. Results: SCI more often experienced young men, up to 34 years of age unmarried and having special or higher education. Prevailed traumatic, in thoracic level and AIS A type SCI. People with SCI actively participated in labour market: during 1–5 years after SCI employed participants increased from 17.8% to 30.2% and in subsequence periods increased significantly to 35.8% (p<0.05). In different period prevailed jobs at home, works to order and shortterm jobs. The comprehensive inpatient rehabilitation statistically significant improved activities and participation skills, especially in solving problems, mobility and self-care, but physical activity in everyday life more increased in 1–5 years period: participants more spent time in a wheelchair, actively participated in sports and household chores, more often went outside of the house and went out to manage social matters or to entertain. Conclusion: During inpatient rehabilitation precisely solved problems, favourable social conditions, promoted physically active lifestyle, assurance of social support and state policy could ensures successful functioning and better physical activity in everyday life and community in long-term context of people with SCI.

Functioning and Physical Activity after Spinal Cord Injury.

Background: Spinal cord injury (SCI) causes medical disorders and loss of functions, independence and physical activity in daily and social life. Primary inpatient rehabilitation after SCI onset is more focused on improving the physical state, physical capacity or developing functional independence and mobility skills. In long-term periods the functioning and socialization processes of people with SCI are improving each year naturally engaging and participating in various areas of everyday life. Objectives: The functioning and physical activity of people with SCI in different period of life: during inpatient SCI rehabilitation, after discharge in the long-term context (1–24 years after SCI on set). Material and Methods: A total of 194 people with SCI were participated in the research during 2007–2015. The study was carried out during inpatient rehabilitation in the Centre of Rehabilitation, Physical and Sports Medicine and during independent life skills and recreation camps in the Landscape Therapy and Recreation Centre (Palanga). Functional problems were assessed by the Comprehensive ICF Core Set for SCI. Socio-demographic characteristics, physical activity in everyday life in different periods after SCI onset were collected by a brief form of the Life Situation Questionnaire-revised. Results: SCI more often experienced young men, up to 34 years of age unmarried and having special or higher education. Prevailed traumatic, in thoracic level and AIS A type SCI. People with SCI actively participated in labour market: during 1–5 years after SCI employed participants increased from 17.8% to 30.2% and in subsequence periods increased significantly to 35.8% (p<0.05). In different period prevailed jobs at home, works to order and shortterm jobs. The comprehensive inpatient rehabilitation statistically significant improved activities and participation skills, especially in solving problems, mobility and self-care, but physical activity in everyday life more increased in 1–5 years period: participants more spent time in a wheelchair, actively participated in sports and household chores, more often went outside of the house and went out to manage social matters or to entertain. Conclusion: During inpatient rehabilitation precisely solved problems, favourable social conditions, promoted physically active lifestyle, assurance of social support and state policy could ensures successful functioning and better physical activity in everyday life and community in long-term context of people with SCI.

Factors associated with the onset and progression of neurotrauma: A systematic review of systematic reviews and meta-analyses

Neurotrauma, including traumatic brain injury (TBI) and spinal cord injury (SCI), is a preventable condition that imposes an important burden on the Canadian society. In this study, the current evidence on risk factors for the onset and progression of neurotrauma is systematically reviewed and synthesized. Searches of the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Medline and Medline in Process (via OVID), EMBASE and PsycINFO from inception to February 2013 were conducted to identify relevant systematic reviews and meta-analyses published in English or French. Two referees screened and assessed the quality of the studies using the AMSTAR tool. Thirty-two studies examined at least one risk factor for the onset of neurotrauma. Thirteen studies passed the quality assessment and the majority evaluated the impact of protective equipment in sports. Helmets effectively reduce TBI from bicycling, skiing, snowboarding, ice hockey and motorcycling. There was no evidence of a protective effect of helmets for SCI. No studies contributed evidence on risk factors for the onset of SCI. Of two studies examining risk factors for the progression of neurotrauma, only injury severity was found to be associated with poorer post-injury outcomes. Substantial evidence supports the use of helmets for the prevention of TBI in sports and motorcycling and face shields in ice hockey. Addressing bicycle helmet legislation across Canada may be an effective option for reducing TBI caused by bicycle accidents. Limited evidence on relevant risk factors for spinal cord injuries and neurotrauma progression was available.

Surgical Management of the Elderly With Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis.

Aging of the population has modified the epidemiology of traumatic spinal cord injury (SCI) as evidenced by the establishment of a bimodal distribution of injuries with increased frequency of fall-related injuries among the elderly. To assess the economic impact of older age (65 years of age and older), using a cost-utility analysis, in the context of acute surgical management and rehabilitation of traumatic cervical SCI, given the paucity of economic studies involving elderly individuals with SCI. The cost-utility analysis was performed from the perspective of a public health care insurer. A time horizon of 6 months from SCI onset was used. Costs were estimated in 2014 US dollars. Utilities were generated from the Surgical Timing in Acute Spinal Cord Injury study. The baseline analysis indicated that surgical and rehabilitative management of acute cervical SCI in the elderly (n = 17) is costlier, but similarly effective, than that in younger adults (n = 47). When considering acute spinal surgical management and rehabilitation of younger adults with SCI as the baseline, the incremental cost-effectiveness ratio analysis revealed an additional cost of $5 655 557 per quality-adjusted life-year gained when managing elderly patients with traumatic cervical SCI. The probabilistic analysis confirmed that spinal surgery in the elderly is costlier, but similarly effective, in younger adults after SCI, even though there is no definitive dominance. This economic analysis indicates that surgical management and rehabilitation of acute traumatic cervical SCI in the elderly are costlier but similarly effective compared with younger adults with similar impairment. AIS, ASIA (American Spinal Injury Association) Impairment Scale.

Assessment of the Neuroprotective Effects of Lavandula angustifolia Extract on the Contusive Model of Spinal Cord Injury in Wistar Rats.

Introduction: Spinal cord injury (SCI) involves a primary trauma and secondary cellular processes that can lead to severe damage to the nervous system, resulting in long-term spinal deficits. At the cellular level, SCI causes astrogliosis, of which glial fibrillary acidic protein (GFAP) is a major index.Objective: The aim of this study was to investigate the neuroprotective effects of Lavandula angustifolia (Lav) on the repair of spinal cord injuries in Wistar rats.Materials and Methods: Forty-five female rats were randomly divided into six groups of seven rats each: the intact, sham, control (SCI), Lav 100, Lav 200, and Lav 400 groups. Every week after SCI onset, all animals were evaluated for behavior outcomes by the Basso, Beattie, and Bresnahan (BBB) score. H&E staining was performed to examine the lesions post-injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP) testing was performed to detect the recovery of neural conduction.Results: BBB scores were significantly increased and delayed responses on sensory tests were significantly decreased in the Lav 200 and Lav 400 groups compared to the control group. The greatest decrease of GFAP was evident in the Lav 200 and Lav 400 groups. EMG results showed significant improvement in the hindlimbs in the Lav 200 and Lav 400 groups compared to the control group. Cavity areas significantly decreased and the number of ventral motor neurons significantly increased in the Lav 200 and Lav 400 groups.Conclusion: Lav at doses of 200 and 400 mg/kg can promote structural and functional recovery after SCI. The neuroprotective effects of L. angustifolia can lead to improvement in the contusive model of SCI in Wistar rats.

Lavandula angustifolia Extract Improves the Result of Human Umbilical Mesenchymal Wharton's Jelly Stem Cell Transplantation after Contusive Spinal Cord Injury in Wistar Rats.

Introduction. The primary trauma of spinal cord injury (SCI) results in severe damage to nervous functions. At the cellular level, SCI causes astrogliosis. Human umbilical mesenchymal stem cells (HUMSCs), isolated from Wharton's jelly of the umbilical cord, can be easily obtained. Previously, we showed that the neuroprotective effects of Lavandula angustifolia can lead to improvement in a contusive SCI model in rats. Objective. The aim of this study was to investigate the effect of L. angustifolia (Lav) on HUMSC transplantation after acute SCI. Materials and Methods. Sixty adult female rats were randomly divided into eight groups. Every week after SCI onset, all animals were evaluated for behavior outcomes. H&E staining was performed to examine the lesions after injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP) testing was performed to detect the recovery of neural conduction. Results. Behavioral tests showed that the HUMSC group improved in comparison with the SCI group, but HUMSC + Lav 400 was very effective, resulting in a significant increase in locomotion activity. Sensory tests and histomorphological and immunohistochemistry analyses verified the potentiation effects of Lav extract on HUMSC treatment. Conclusion. Transplantation of HUMSCs is beneficial for SCI in rats, and Lav extract can potentiate the functional and cellular recovery with HUMSC treatment in rats after SCI.

Cost-Effectiveness Analysis of Long-Term Intermittent Self-Catheterization with Hydrophilic-Coated and Uncoated Catheters in Patients with Spinal Cord Injury in Japan.

To evaluate the cost effectiveness of disposable, hydrophilic-coated catheters in Japan. A Markov decision model previously applied in a European study was used to evaluate the cost effectiveness of intermittent self-catheterization (ISC) with hydrophilic-coated catheters in Japanese spinal cord injury (SCI) patients suffering from chronic urinary retention from a lifetime perspective. To adjust the model to a Japanese setting, relevant Japanese data regarding the baseline risk of urinary tract infection (UTI), the average age at onset of SCI, costs, and general mortality were extracted from published literature, national statistics, or the opinions of Japanese experts. The direct medical costs, quality-adjusted life years (QALYs) and life years gained (LYG) were calculated from the payers' perspective. An annual discount rate of 2% was applied to both the costs and the effects. The incremental cost of hydrophilic-coated catheters was 1 279 886 yen (US$ 10 578 at an exchange rate of US$ 1 = 121 yen) per SCI patient, but they yielded an additional 0.334 QALYs and 0.781 LYG compared with uncoated catheters. The incremental cost-effectiveness ratio (ICER) of hydrophilic-coated catheters vs. uncoated catheters was 3 826 351 yen/QALY (US$ 31 623/QALY) gained and 1 639 562 yen/LYG (US$ 13 550/LYG). The ICER of 3.8 million yen (US$ 31 405) falls well within the Japanese societal willingness to pay per QALY gained; therefore, hydrophilic-coated catheters can be considered highly cost-effective in Japan compared with uncoated catheters. However, because of the lack of relevant studies, a number of key parameters could not be based on Japanese data, and further research among people with SCI in Japan is recommended.

Extradural implantation of sacral anterior root stimulator in spinal cord injury patients.

To evaluate the efficacy and complications of extradural sacral anterior root stimulation (SARS) implantation in patients with neurogenic detrusor overactivity (NDO) resulting from spinal cord injury (SCI). A retrospective study was conducted between 2009 and 2013, on consecutive patients with NDO associated with SCI that underwent SARS implantation. We evaluated those factors related to clinical symptoms such as urinary infection rate, erections, and episodes of autonomic dysreflexia. Data from cystometric bladder capacity (CBC) and post-void residual (PVR) volume were also analyzed. Of the 104 patients included in the study, 95 (91%) patients were men with a mean (standard deviation) (SD) age of 38 (10) years. Mean (SD) time between the onset of SCI and the SARS was 78.2 (59.0) months. At baseline, 95 (91%) patients had urinary infections as compared with 16 (15%) after treatment, P < 0.001. The percentage of patients that had urinary incontinence was significantly higher at baseline than that observed after SARS, 100% versus 14%, respectively, P < 0.001. Similar results were obtained regarding dysreflexia, P < 0.001. After SARS, the mean (SD) bladder capacity was 362 (108) ml and 98 (94%) patients had a bladder capacity greater than 400 ml. As regard to the adverse effects, six patients (6%) required a suburethral mesh implant and two (2%) patients had an infection, 4 and 5 months after SARS, respectively. Extradural implantation of SARS seems to be an effective and safe procedure in patients with spinal cord injury and neurogenic detrusor overactivity. Neurourol. Urodynam. 35:970-974, 2016. © 2015 Wiley Periodicals, Inc.

Improvement in Spinal Cord Injury-Induced Bladder Fibrosis Using Mesenchymal Stem Cell Transplantation Into the Bladder Wall.

Experiments on spinal cord injury (SCI) have largely focused on the transplantation of stem cells into injured spinal cords for motor recovery while neglecting to investigate bladder dysfunction. The present study was performed to investigate the effect of B10 human mesenchymal stem cells (hMSCs) directly transplanted into the bladder wall of SCI rats and to determine whether they are capable of inhibiting collagen deposition and improving cystometric parameters in SCI rats. Forty 6-week-old female Sprague-Dawley rats were divided into four groups (group 1: control, group 2: sham operated, group 3: SCI, group 4: SCI rats that received B10 cells). B10 cells were labeled with fluorescent magnetic nanoparticles (MNPs). Four weeks after the onset of SCI, MNP-labeled B10 cells were injected to the bladder wall. Serial magnetic resonance (MR) images were taken immediately after MNP-B10 injection and at 4 weeks posttransplantation. Voiding function was assessed at 4 weeks posttransplantation, and the bladder was harvested. Improvements in bladder fibrosis and bladder function were monitored by molecular MR imaging. Transplantation of B10 cells into the SCI rats markedly reduced their weights and collagen deposition. MR images showed a clear hypointense signal induced by the MNP-labeled B10 cells at 4 weeks posttransplantation. Transplanted B10 cells were found to differentiate into smooth muscle cells. The intercontraction interval decreased, and the maximal voiding pressure increased after SCI but recovered after B10 cell transplantation. Survival of B10 cells was found at 4 weeks posttransplantation using anti-human mitochondria antibody staining and MR imaging. The transplanted B10 cells inhibited bladder fibrosis and ameliorated bladder dysfunction in the rat SCI model. MSC-based cell transplantation may be a novel therapeutic strategy for bladder dysfunction in patients with SCI.

Preinjury cigarette smoking among those with traumatic spinal cord injury.

Identify the prevalence of cigarette smoking at the time of spinal cord injury (SCI) onset, compare the rate of cigarette smoking to that of the general population in the same geographic area, and identify the relationship of cigarette smoking with demographic, injury, behavioral, and psychological characteristics. Self-report assessments were completed during inpatient rehabilitation for new SCI. The prevalence of smokers at the time of their SCI onset was 37.9%, substantially higher than the rate for those in the general population from the same geographic region (22.8%). Those who were smokers at SCI onset, on average, were older, had less education, were more likely to have consumed alcohol in the month prior to SCI onset, and had higher personality scores indicative of Impulsive/Sensation Seeking and Neuroticism/Anxiety. At the time of SCI, cigarette smoking is elevated over the general population and is related to behavioral and psychological factors that may be important to consider with smoking cessation interventions.

Changes in cigarette smoking after traumatic spinal cord injury.

The objective of this study is to identify changes in the prevalence of cigarette smoking approximately 1 year after discharge from inpatient rehabilitation for spinal cord injury (SCI). Self-report assessments were completed by 129 participants with SCI during initial inpatient rehabilitation and at an average follow-up of 489 days postinjury. The prevalence of cigarette smoking declined from 36.4% at the time of SCI onset to 18.8%, and was not significantly different from the general population at follow-up. Whereas the prevalence of cigarette smoking is elevated at SCI onset, there are significant decreases in the smoking rate over the first 16 months after onset, indicating significant behavioral change.

Efecto de la lesión medular motora completa reciente en el recambio óseo y en la evolución de la masa ósea: resultados preliminares

Summary Background and aim: Spinal cord injury (SCI) has been associated with a marked increase in bone loss and a higher incidence of skeletal fractures, however the pathogenesis and clinical management of this condition remains unclear. The aim of this study was to analyze the bone mineral density (BMD) evolution in patients with complete SCI and its relationship with parameters of bone metabolism and bone turnover markers. Methods: Patients with a recent complete motor SCI (ASIA A)(<6 months) were prospectively included. Bone metabolism parameters (calcium, phosphate, PTH and 25-OHD), bone turnover markers (bone formation: procollagen type 1 aminoterminal propeptide -P1NP-, bone alkaline phosphatase -bone AP-, osteocalcin -OC-; bone resorption: C-telopeptides of type I collagen -CTx-) and BMD were assessed in all patients at baseline and at 6 months. The results were compared with a control group. Results: 23 men with complete SCI (ASIA A) and a mean age of 38±15 years were included at 102±33 days of SCI onset. 52% had paraplegia. 12 patients were assessed at 6 months of follow-up. Patients with SCI showed a significant increase in bone turnover markers, especially P1NP and CTx, compared to controls (P1NP: 191±90 vs 51±19 ng/ml, p<0.001; CTx: 1.37±0.49 vs 0.51±0.23 ng/ml, p<0.001). At 6 months, bone turnover markers decreased (P1NP: -34%, p=0.005 and CTx: -26%, p=0.002) and BMD had a mean decrease of 12% at total femur (p=0.002) compared to baseline, with osteoporosis development in 50% of patients. Bone markers (bone AP, P1NP and OC) were negatively correlated with total femur BMD values. Conclusions: Patients with complete SCI show a marked increase in bone turnover and bone loss, especially at the proximal femur, with the development of osteoporosis being observed in 50% of these patients at 6 months of follow-up. These findings indicate the need to implement preventive measures within the therapeutic approach in these patients.

Evidence for proangiogenic cellular and humoral systemic response in patients with acute onset of spinal cord injury

Context/objectiveTraumatic spinal cord injury (SCI) leads to disruption of local vasculature inducing secondary damage of neural tissue. Circulating endothelial progenitor cells (EPCs) play an important role in post-injury regeneration of vasculature, whereas endothelial cells (ECs) reflect endothelial damage.MethodsTwenty patients with SCI were assessed during the first 24 hours, at day 3, and day 7 post-injury and compared to 25 healthy subjects. We herein investigated EPC and EC counts by flow cytometry as well as the levels of soluble factors (SDF-1, HGF, VEGF, Ang2, EGF, endoglin, PLGF, FGF-2, ET-1, BDNF, IGF-1) regulating their migration and proangiogenic function. To better characterize peripheral blood (PB) cells, global gene expression profiles of PB-derived cells were determined using genome-wide RNA microarray technology.ResultsWe found significantly higher EPC (CD34+/CD133+/VEGFR2+) as well as EC (VEGFR2+) count in PB of patients with SCI within 7 days post-injury and the increased HGF, ET-1, Ang2, EGF, and PLGF plasma levels. Global gene expression analysis revealed considerably lower expression of genes associated with both innate and adaptive immune response in PB cells in patients.ConclusionCollectively, our findings demonstrate that SCI triggers bone marrow-derived EPC mobilization accompanied by increased circulating EC numbers. Significant changes in both chemoattractive and proangiogenic cytokines plasma levels occurring rapidly after SCI suggest their role in SCI-related regenerative responses to injury. Broadened knowledge concerning the mechanisms governing of human organism response to the SCI might be helpful in developing effective therapeutic strategies.