The impact of body mass index on traumatic spinal cord injury characteristics.

Novel Neurotrophin-3 peptidomimetic synthetic neurotrophin promotes neurological recovery after spinal cord injury.

Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales represent a growing cause of ventilator- associated pneumonia (VAP) in critically ill patients. Although carbapenems remain the standard treatment, carbapenem-sparing strategies are increasingly needed to limit the emergence of carbapenem resistance. Cefepime/enmetazobactam (FEP/META) is a novel β-lactam/β-lactamase inhibitor combination with demonstrated activity against ESBL-producing organisms and favorable intrapulmonary pharmacokinetic properties. We present one of the first reported European cases of VAP due to CTX-M-producing Escherichia coli successfully treated with cefepime/enmetazobactam in a 72-year-old patient admitted to the intensive care unit for traumatic spinal cord injury. The isolate was resistant to third-generation cephalosporins and cefepime but remained susceptible to carbapenems and FEP/META (minimum inhibitory concentration [MIC] 0.06mg/L). Targeted treatment with FEP/META (2.5g every 8h intravenously) was administered for 7days. Rapid clinical and microbiological improvement was observed, with resolution of fever, decline in inflammatory biomarkers, and improvement in oxygenation parameters. No relapse or adverse events occurred. This case supports the potential role of FEP/META as a carbapenem-sparing option for ESBL-related VAP and highlights the importance of pharmacokinetic/pharmacodynamic considerations in optimizing antimicrobial stewardship strategies.

Health Literacy During Inpatient Rehabilitation and Its Association with One-Year Health and Functional Outcomes in Individuals with Traumatic Spinal Cord Injury.

ABSTRACT Context/Objective The optimal timing of surgical decompression for traumatic spinal cord injury (TSCI) remains uncertain. This study evaluated the association between ultra-early decompression and neurological outcomes, focusing on early post-injury time windows. Design Retrospective cohort study. Setting Single tertiary trauma center. Participants Eighty-two adult patients with TSCI who underwent surgical decompression between January 2022 and August 2024 were included. Patients with central cord syndrome, penetrating injury, incomplete imaging, follow-up <3 months, or unreliable neurological assessment were excluded. Interventions Surgical decompression at varying time thresholds (≤8, ≤10, ≤12, and ≤24 h after injury). Outcome Measures Neurological improvement, defined as an increase of at least one AIS grade at ≥3 months. Results In AIS A patients, decompression within 8 h was associated with a higher rate of neurological improvement (87.5% vs 29.4%; OR 16.80, 95% CI 1.62–174.52). Multivariable analysis showed a substantial but non-significant effect for ≤8 h (aOR 4.99, 95% CI 0.83–29.95). A strong adjusted association was observed at ≤10 h (aOR 4.92, 95% CI 1.15–20.97). Shock was associated with lower odds of improvement. The most consistent associations were observed within the 8–12 h window. Conclusion Earlier decompression may be associated with improved neurological outcomes after TSCI. The findings suggest that the therapeutic window for neurological recovery may lie within the first 8–12 h, although causal inference cannot be established.

Companionship as a mediator of the relationship between marital status and psychosocial outcomes: Findings in individuals with spinal cord injury.

Erectile dysfunction (ED) is prevalent after traumatic cervical spinal cord injury (CSCI), yet predictive tools for postoperative recovery remain underdeveloped. This study aimed to develop a clinical prediction model for erectile function recovery in male patients undergoing posterior cervical surgery for incomplete traumatic CSCI (iCSCI). In this retrospective cohort study, 207 male patients (aged 18-60 years) with iCSCI (ASIA grades B-D) who underwent posterior cervical decompression between 2018 and 2023 were included. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) at protocol-defined 3-month and 2-year postoperative follow-up visits. Improvement was defined as an increase of ≥ 1 severity category. Candidate predictors were screened via univariate analysis (P ≤ 0.20) and correlation assessment, followed by forward stepwise logistic regression. Model performance was evaluated using area under the receiver operating characteristic (ROC) curve (AUC) and internally validated via bootstrapping. Median total follow-up was 41.00 months. Overall, 72.5% of patients showed erectile function improvement. The final prediction model included four independent predictors: preoperative ASIA grade (OR for grade D vs. B: 30.519, P < 0.001), injury level (C0-C3 vs. C4-C7; OR: 5.749, P = 0.012), injury to surgery interval (OR per day: 0.858, P = 0.018), and spinal cord compression ratio (OR per 1%: 0.937, P = 0.002). The model demonstrated robust discrimination (AUC: 0.881) and good calibration (Hosmer-Lemeshow P = 0.194). Bootstrap internal validation yielded an optimism-corrected AUC of 0.850. A nomogram was constructed to facilitate individualized risk estimation. In male iCSCI patients, erectile function demonstrates significant potential for recovery following posterior cervical surgery. The validated four-factor model-presented as a clinical nomogram-enables personalized preoperative risk stratification to guide counseling and rehabilitation planning. External validation is required before widespread clinical implementation.

Evaluating and addressing the mental and behavioral health issues of patients with spinal cord injury (SCI) during the rehabilitation process is essential. This systematic review and meta-analysis investigated the prevalence of mental disorders post-traumatic SCI and evaluated psychosocial interventions, leveraging a Knowledge Graph of Spinal Cord Injury (SCIKG) to overcome limitations of traditional literature searches. The SCIKG integrated structured ontologies (SNOMED CT, UMLS, MeSH) to enable hierarchical semantic reasoning across mental disorder subconcepts. SPARQL queries identified literature from PubMed, Embase, PsycINFO, Web of Science, and Cochrane Central up to July 2025, supplemented by citation tracing. Two researchers independently screened studies against predefined criteria. Prevalence was pooled using DerSimonian-Laird random-effects models (RevMan 5.4; Stata metaprop) to account for heterogeneity (I4 > 50%). SCIKG quality was assessed across Coverage, Accuracy, Freshness, and Consistency dimensions RESULTS: From 16,861 screened records, pooled prevalence estimates of anxiety, depression, post-traumatic stress disorder (PTSD), cognitive impairments, suicide ideation, drug abuse, and sleep dysregulation post-SCI were 23% (95% confidence interval (CI), 21%-26%), 24% (95% CI, 22%-26%), 25% (95% CI, 21%-29%), 55% (95% CI, 27%-82%), 18% (95% CI, 12%-24%), 36% (95% CI, 30%-42%), and 41% (95% CI, 8%-73%), respectively. Subgroup analyses revealed significant variations: Western cohorts reported 30% higher anxiety than Asian populations; self-report tools overestimated depression by 40% versus clinical interviews; violence-related SCI increased PTSD risk by 75%. Psychosocial interventions mainly focused on specific subgroups in SCI patients with increased levels of pain, psychological distress, or pressure ulcers. Studies indicated inconsistent enhancements in participants' psychosocial adaptation, cognitive appraisal, and mental health. However, no significant effect was observed on their coping abilities. Mental disorders are prevalent and heterogeneously distributed post-SCI, influenced by cultural, methodological, and injury-phase factors. Knowledge graphs enhance evidence synthesis precision, revealing critical gaps in assessment standardization. Routine screening with validated, culturally adapted tools is warranted. Future research must prioritize phase-stratified designs, SCI-specific diagnostic thresholds, and large-scale trials of tailored psychosocial interventions. Not applicable.

Traumatic spinal cord injury (SCI) can cause severe central nervous system damage. Efferocytosis, an intrinsic regulatory mechanism through which microglia eliminate apoptotic cells, is suppressed because of the local ischaemic and hypoxic microenvironment after spinal cord injury (SCI). In addition, hypoxia and reoxygenation (H/R) trigger mitochondrial respiratory chain electron leakage, leading to the massive generation of mitochondrial reactive oxygen species (mtROS), impairing the energy supply and causing oxidative stress damage in neurons, which induces neuronal apoptosis. Synergistic therapies targeting efferocytosis and neuronal apoptosis are important for recovery after SCI. In this study, by loading celastrol in a layered double hydroxide, a multifunctional nanoparticle, Cel-LDH, was developed to facilitate SCI recovery by concurrently normalizing efferocytosis homeostasis and inhibiting neuronal apoptosis. Cel-LDH composite nanoparticles strongly scavenged ROS and preserved mitochondrial homeostasis, thus regulating apoptosis-related proteins, including Bax and Bcl-2, and effectively inhibiting the apoptotic process of neurons. Furthermore, Cel-LDH nanoparticles promoted autophagy, inhibited the cyclic GMP-AMP (cGAMP) synthase (cGAS)-stimulator of interferon genes (Sting) pathway to modulate the anti-inflammatory phenotypic transformation of microglia, and subsequently restored the efferocytosis homeostasis of microglia, thus suppressing inflammatory cascades and creating favourable microenvironments for the repair of SCI. This approach not only remodels the dysfunctional efferocytosis capacity but also inhibits neuronal apoptosis, providing a new therapeutic strategy for SCI.

BackgroundTraumatic spinal cord injury (SCI) often results in irreversible motor, sensory, and autonomic dysfunction, with limited effective treatment options currently available. Human umbilical cord-derived mesenchymal stem cells (UC-MSCs) represent a promising therapeutic approach due to their immunomodulatory, neuroprotective, and regenerative properties. However, the lack of comprehensive efficacy data using GMP-grade cells, uncertainty regarding optimal dosing, and incomplete understanding of their mechanisms have hindered clinical translation.MethodsA T10-level SCI model was established in 50 Sprague‒Dawley rats using Allen’s weight-drop method. The animals were randomly divided into five groups: Sham, Model, Solvent, Low-dose (1 × 10⁷ cells/kg), and High-dose (3 × 10⁷ cells/kg). GMP-grade human UC-MSCs were administered intravenously on post-injury days 3 and 7. A comprehensive evaluation was performed using BBB scoring for locomotor function, MRI for lesion volume assessment, histopathological examination (H&E and Nissl staining), ELISA for serum cytokine quantification, immunofluorescence for GFAP and GAP-43 expression, single-cell RNA sequencing (scRNA-seq) of peripheral blood mononuclear cells (PBMCs), in vivo UC-MSCs tracking, and sRNA sequencing of human UC-MSC-derived exosomes.ResultsThe high-dose UC-MSC treatment demonstrated significant therapeutic effects, including: improved hindlimb motor function (BBB scores from days 7 to 21), reduced spinal cord lesion volume, attenuated pathological damage (decreased cavity formation, preserved neuronal morphology, increased neuron density), and suppressed acute inflammation (reduced TNF-α and IL-6 levels). Additionally, high-dose treatment decreased astrocyte activation (reduced GFAP expression), enhanced neuronal plasticity (increased GAP-43), modulated immune cell populations (increased naïve CD4⁺/CD8⁺ T cells, decreased memory B cells), and downregulated SCI-activated genes (including Kras and Nfkb1). In vivo tracking revealed initial pulmonary accumulation of UC-MSCs followed by clearance within 3 days. sRNA sequencing of human UC-MSC-derived exosomes identified several human-derived miRNAs (hsa-miR-21-5p, hsa-let-7a-5p, hsa-miR-10b-5p, hsa-miR-451a, and hsa-miR-10a-5p) potentially involved in the repair process.ConclusionsGMP-grade human UC-MSCs exert therapeutic effects in SCI through multiple mechanisms, including anti-inflammatory actions, inhibition of glial scarring, neuroprotection, and immune modulation. The high-dose regimen (3 × 10⁷ cells/kg) demonstrated superior efficacy across functional, structural, and molecular endpoints. This study provides critical preclinical evidence supporting the clinical application of UC-MSCs for SCI treatment and elucidates their underlying therapeutic mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12967-026-08373-x.

Traumatic spinal cord injuries are frequent CNS injuries that occur due to circumstances such as falls or accidents. Traumatic spinal cord injuries are more common in the older age group and in men, with high incidence and prevalence explained by the absence of an efficient pharmacological or neurosurgical treatment. Traumatic SCI can be classified as primary or secondary injuries that can eventually lead to death or physical dependence. Resveratrol is a stilbene polyphenol plant extract that has shown promising remedial effect on a wide spectrum of injuries and diseases including cardiovascular diseases, cancers, neurodegenerative diseases and CNS injuries. Many studies tried to pinpoint if there is any neuroprotective effect targeted against the damage caused by traumatic spinal cord injury. Therefore, the aim of this systematic review is to systemically assess and analyze these findings to take a stand from the hypothesis. This systematic review adheres to PRISMA guidelines (2020), when the process started by a comprehensive search strategy from 2015 to 2025 tailored for four databases. Primary and secondary screening were done to finally retrieve eight articles out of the initially discovered 456 studies. Data extraction, analysis and quality assessment were then done to synthesize the appropriate results and findings. The consistent results showed that resveratrol significantly modulates traumatic SCI and offers neuroprotection leading to improvement in motor function recovery as a result of preserving more motor neurons, upregulating autophagy but downregulating apoptosis, neuroinflammation, oxidative stress and ferroptosis through specific biochemical molecular pathways. Therefore, resveratrol shows promise for treating traumatic spinal cord injury which encourages the conduction of more robust preclinical studies and early phase clinical trials.

The Value of Recovery After Spinal Cord Injury: Long-Term Healthcare Costs in Relation to Home Time in a Population-Based Cohort.

Cohort study. To identify pre-COVID differences between those reporting COVID-related difficulty and those who did not during the pandemic, and examine their longitudinal changes in outcomes after the pandemic. Self-reported data were collected by a medical university in the United States. There were 297 participants with traumatic SCI identified from a state population-based registry, who completed the assessment within the three months prior to the COVID-19 pandemic restrictions. Among them, 172 were successfully followed three times. Not applicable. Four domains of outcome measures: (1) self-reported health outcomes, (2) healthcare utilization, (3) social participation, and (4) psychological well-being. Those who reported COVID-related difficulties during the pandemic were those with poorer outcomes prior to the pandemic. We observed the curvilinear effects for those with difficulties during the pandemic, especially on the perspective of life satisfaction indicators, declining first after the pandemic and then improving at the time of the third follow-up post pandemic. For those who had not reported COVID-related difficulties, an indicator of general health showed an overall declining trend, while one mental health indicator and one health utilization indicator were noted curvilinear trend. The absence of measurable pandemic effects underscore the resilience demonstrated by people with SCI. The findings underscore the importance of (1) measuring individual differences in resilience to unforeseen circumstances, (2) focusing resources on those with a history of poor outcomes, and (3) methodologically, measuring outcomes over time.

Traumatic Spinal Cord Injury Outcomes Among Understudied Racial and Ethnic Populations in Hawai’i (P2-3.009)

Systematic Review OBJECTIVES: The objective of this study was to investigate female participation in spinal cord injury (SCI) motor rehabilitation randomized controlled trials (RCTs) which included the overall proportion of female participants and how this proportion changed with time post-injury (TPI), study quality and the intervention investigated. Systematic searches were conducted in MEDLINE, Embase, PsycInfo and CINAHL databases inclusive to December 31, 2024. Study eligibility included RCTs or RCT crossovers published in English and investigated an intervention for motor rehabilitation on adult participants with traumatic and/or non-traumatic SCI. Data from the RCTs was extracted and summarized using online Excel, with statistical analyses conducted in RStudio. Overall, 252 RCTs met the inclusion criteria and were included in the dataset. Of these, 237 RCTs reported the sex of participants. The overall proportion of female participants was 22.4%, with no significant changes between 2000 and 2024. No significant differences were found between the proportion of female participants and TPI. High quality studies had significantly higher female participation compared to low quality studies (p = 0.008). Significantly higher female participation was found in RCTs investigating technology-based interventions (p < 0.001), with no significant differences found in pharmacological or non-technology-based interventions. The underrepresentation of female participants in studies of SCI motor rehabilitation limits the generalizability of research results and potentially hinders the availability of rehabilitation strategies for female individuals. Understanding what challenges may be preventing higher enrollment and implementing recruitment strategies may aid in increasing the number of female participants in SCI rehabilitation RCTs.

Traumatic spinal cord injury (SCI) shows pronounced biological sex differences in incidence and short-term outcomes, yet mechanistic studies and therapeutic development are not consistently sex-informed. Here we summarize evidence that sex hormones, sex-chromosome effects and immune-glial interactions shape key components of the secondary injury cascade, including blood-spinal cord barrier (BSCB) disruption, neuroinflammation, oxidative stress, cell death and remyelination. Estrogens and progesterone generally support barrier stabilization, temper leukocyte infiltration, bias microglia/macrophages toward reparative programs, and promote neurotrophin signaling and myelin repair. In males, post-injury androgen deficiency together with stronger early innate immune activation may exacerbate oxidative damage, demyelination and scar formation, potentially limiting plasticity. Clinical evidence remains limited and confounded, but available data support the need for adequately powered, sex-stratified trials, particularly for time-sensitive hormonal and immunomodulatory interventions. Incorporating sex as a biological variable in experimental design and translation may improve target selection, dosing and therapeutic windows for SCI.

Trichostatin A-primed spinal cord organoids alleviate oxidative stress and improve recovery after spinal cord injury involving the NRF2/HO-1 signaling pathway.

Study DesignSystematic review.ObjectivesMaintenance of mean arterial pressure (MAP) at 85-90 mmHg after traumatic spinal cord injury (SCI) is widely recommended, but supporting evidence is limited. We performed a systematic review and meta-analysis to evaluate whether MAP augmentation improves outcomes after SCI.MethodsPubMed, Embase, and CENTRAL were searched through January 2026. Random-effects meta-analyses were performed. Prespecified cohort-level analyses compared standard (≥65 mmHg) with augmented MAP targets (≥85 mmHg). Weighted linear meta-regression explored dose-response relationships between achieved MAP and primary outcomes.ResultsThirty-three studies comprising 3535 patients were included. Neurological improvement occurred in 31.4% and 37.6% of patients subjected to standard and augmented MAP, respectively (P = 0.25; I2 = 84.6). Mortality occurred in 38.8% and 10.3% of patients, respectively (P = 0.08; I2 = 83.9), though this was observed with markedly asymmetric denominators (103 vs 1162) and substantial inter-study heterogeneity, and is unlikely to reflect a true treatment effect. Respiratory complications were significantly lower in patients subjected to standard MAP (P = 0.04; I2 = 82.2%). Meta-regression did not identify a linear association between achieved MAP and either primary outcome. Certainty of evidence was low.ConclusionsAcross heterogeneous, predominantly observational cohorts, pooled analyses showed no statistically significant differences in neurological improvement or mortality between standard and augmented MAP targets after acute traumatic SCI. A higher incidence of respiratory complications in patients subjected to augmented MAP represented the only statistically significant signal. These findings support avoidance of hypotension but do not establish clear benefit of universal MAP escalation.

To share real-world experiences and insights regarding complications associated with intrathecal baclofen (ITB) therapy from a major Chinese tertiary center, providing practical guidance for regions where ITB use is still emerging. A single-center, single-surgeon retrospective analysis was conducted on all patients who received ITB pump implantation at Ruijin Hospital (Shanghai, China) between 1st Jan 2011, and 31st Oct 2025. Data on demographics, medical history, and ITB-associated complications were extracted. Clinical effectiveness was assessed using a 5-level Likert scale of goal achievement. Data from 68 individuals (44 males), representing 214.3 pump-years of therapy, were included. The most common supra-spinal pathology was cerebral palsy (10/68, 14.7%), and the predominant spinal pathology was traumatic spinal cord injury (23/68, 33.8%). 87.2% of individuals reported to have goals considered achieved or partially achieved. A total of 24 complications were documented in 19 individuals. The overall complication incidence was 0.11 events per pump-year and 0.30 per implantation. Catheter-related issues were the most frequent (8/24, 33.3%), followed by drug-related (7/24, 29.2%) and procedure-related (6/24, 25.0%) complications. Human error-related issues accounted for 25.0% (6/24) of all documented complications. Notably, refinement of surgical nuances was found to successfully mitigate wound tension and skin erosion. In addition, a multimodal neuromodulation strategy integrating sacral neuromodulation was successfully piloted in a representative case of ITB dose-limiting urinary retention. This study presentsone of the largest reported ITB cohort in China. Our experiences underscore that long-term success in ITB therapy extends beyond surgical precision to encompass systemic clinical governance, including rigorous safety protocols and the management of refractory side effects through multimodal neuromodulation approaches. These insights, including the novel use of multimodal neuromodulation to manage dose-limiting adverse effects of ITB, may help optimize ITB practice, particularly in regions where its use is still emerging.

Traumatic spinal cord injury (SCI) initiates a neuroinflammatory response dominated by tissue-resident microglia. Thiolutin (THL) can weaken several inflammatory diseases by blocking the NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome activation. At present, whether THL improves functional recovery after SCI is unclear. Crosstalk between neurons and microglia was simulated by a co-culture system in which microglia were activated by LPS + ATP and treated with THL. Contused SCI mouse models were constructed for studying the efficacy of THL and related mechanisms. Motor function of mice was assessed by BMS scoring, incline plane test, and footprint analysis. Pathological alterations following SCI were determined by hematoxylin-eosin, luxol fast blue, and Nissl staining. Neuronal apoptosis in vitro was assessed by flow cytometry and Tunel staining. The NLRP3 inflammasome activation, inflammatory response, and microglia polarization were assessed by western blot, ELISA, and immunofluorescence. THL treatment repressed microglia pyroptosis-induced neuronal apoptosis and inflammatory response in a co-culture system in vitro. Also, treatment with THL repressed microglial activation and M1-type polarization, along with the NLRP3 inflammasome activation. Furthermore, THL treatment improves motor function of mice with SCI, accompanied by reduced cavity area of the spinal cord, inflammatory response, M1-type microglia polarization, and enhanced remyelination and neuronal regeneration. However, THL treatment did not work in SCI-experienced Nlrp3-/- mice. THL improves motor function following SCI by repressing neuroinflammation and neuronal apoptosis via suppressing NLRP3 inflammasome-mediated microglial polarization and pyroptosis.