Background: Experimental studies indicated that maternal choline and betaine status have the potential to alter fetal growth, but epidemiological data remain sparse. Objective: We aimed to investigate the association of maternal and cord blood choline and betaine concentrations with birthweight outcomes. Methods: This prospective cohort study involved 988 mother-infant dyads from Hebei and Shandong provinces. Plasma concentrations of choline and betaine in maternal late pregnancy and cord blood were quantified using ultra-performance liquid chromatography-mass spectrometry. Multivariable linear or logistic regression was performed to examine their association with continuous or binary birthweight outcomes. Results: Maternal plasma choline and betaine concentrations in late pregnancy (median [interquartile range]; 12.34 [10.13, 14.78] and 14.99 [12.01, 18.36] μmol/L) were significantly lower than those in cord blood (29.98 [24.74, 35.93] and 31.14 [25.56, 37.28] μmol/L). Each 1 μmol/L increase of late-pregnancy and cord blood betaine concentrations were associated with 9.87 g (95% confidence interval [CI]: -16.08, -3.66 g) and 5.29 g (95% CI: -8.52, -2.06 g) lower birthweight, respectively. Compared with the lowest quintile, the highest quintiles of late-pregnancy and cord blood betaine concentrations were associated with lower risks of large-for-gestational-age (adjusted odds ratios [ORs] = 0.47 [95% CI: 0.24, 0.90] and 0.31 [95% CI: 0.17, 0.56]) and macrosomia (adjusted ORs = 0.12 [95% CI: 0.03, 0.43] and 0.15 [95% CI: 0.05, 0.40]). These associations, particularly for cord blood, persisted and appeared more pronounced in pregnancies with maternal overweight/obesity or gestational diabetes mellitus (GDM), but the interaction effect did not reach statistical significance. No significant associations were observed for choline in any periods. Conclusions: Higher plasma concentrations of betaine in maternal late-pregnancy and cord blood were associated with lower birthweight. These findings emphasize the importance of sufficient betaine status during pregnancy, especially among mothers with obesity or GDM.
Ovarian fibroma with minor sex cord elements is a rare and underrecognized histological variant of ovarian stromal tumors. While the bulk of the tumor resembles a classic fibroma, the presence of small foci of sexcord-like cells can create a diagnostic dilemma, particularly in limited samples. This tumor exhibits hormonal production resulting in endometrial hyperplasia, polyp, or even carcinoma. We report the case of a 56-year-old postmenopausal woman who presented with a history of intermittent postmenopausal bleeding and lower abdominal discomfort with primary infertility. There was a slowly enlarging pelvic mass discovered incidentally on ultrasound imaging. Surgical excision revealed a firm, white encapsulated ovarian tumor. Histologically, the lesion was composed of interlacing bundles of bland spindle cells, characteristic of a fibroma. Notably, scattered discrete clusters and cords of cells resembling Granulosa or Sertoli-type differentiation were observed, occupying less than 10% of the tumor area. These minor sex cord elements exhibited uniform round to oval nuclei and scant cytoplasm, without atypia or mitotic activity. Immunohistochemistry supported the diagnosis, with calretinin and inhibin positivity in the sex cord foci, while the stromal component showed SMA positivity. We report this case because of its rarity and its silent clinical presentation.
Traumatic spinal cord injury (TSCI) without concurrent vertebral fracture is a phenomenon often described in pediatrics. There is limited evidence regarding factors that predispose adults to this rarer injury. To determine different factors that increase the odds of TSCI without vertebral fracture. Retrospective case-control study. Participating sites of the Spinal Cord Injury Model Systems (SCIMS) database. Patients aged 18 or older presenting at a registered SCIMS center following TSCI between 2006 and 2021. None. Logistic regression identified variables associated with TSCI without vertebral fracture (OR > 1). This study included 2,524 patients, of whom 501 did not suffer a vertebral fracture. Patients with incomplete SCI at cervical levels and those of more advanced age were less likely to have a concurrent vertebral fracture. Penetrating injury (OR = 4.13 [95% CI: 2.72, 6.28], P < 0.0001) and medical/surgical complications (OR = 50.30 [95% CI: 27.80, 95.90], P < 0.0001) dramatically increased the odds of suffering SCI without vertebral fracture compared to non-penetrating injuries. Overall results were similar when only blunt injuries were analyzed, except that complete injuries at T1-S5 (OR = 0.41 [95% CI: 0.17, 0.96], P = 0.044) were associated with vertebral fracture. Adults may experience biomechanical stresses similar to those proposed in pediatric populations. The findings of this study can be used to screen patients with suspected spinal cord injury without obvious signs of spinal trauma.
NG101 is a recombinant antibody that neutralizes the nerve growth inhibitor Nogo-A, promoting neural repair and improving upper extremity motor function in spinal cord injury (SCI). This study evaluated spinal cord MRI biomarkers to detect treatment-related structural changes and enhance patient stratification using data from 106 participants with acute cervical SCI in the phase 2b NISCI trial. We assessed lesion volume, tissue bridges, and remote changes in cross-sectional cord area (CSA), and tract-specific myelin-sensitive magnetization transfer saturation (MTsat) over six months. Compared to placebo, NG101-treated participants exhibited faster lesion volume reduction and a slower decline of CSA and MTsat in the corticospinal tracts and dorsal columns. Crucially, multimodal stratification incorporating MRI and electrophysiological measures substantially enhanced the detection of clinical treatment effects. These findings suggest NG101 slows trauma-induced progressive macro- and microstructural degeneration or promotes fiber sprouting. Combining MRI with electrophysiology enables sensitive detection of treatment effects and efficient trial designs. ClinicalTrials.gov identifier: NCT03935321.
Recent research has shown that extracellular vesicles (EVs) have significant potential in treating lung injuries. These vesicles facilitate communication between cells and regulate important biological processes, including cell growth, blood vessel formation, and inflammatory responses. Due to their natural ability to cross biological barriers and low risk of immune rejection, EVs are potential vehicles for targeted drug delivery. Among various biological sources, umbilical cord-derived EVs are highly advantageous because the collection process is non-invasive and provides a high yield of vesicles. Preclinical studies have demonstrated their therapeutic potential in conditions such as bronchopulmonary dysplasia, chronic obstructive pulmonary disease, acute respiratory distress syndrome, and asthma. This review summarizes the current evidence supporting the use of umbilical cord-derived EVs for lung diseases. It also discusses key translational challenges, such as manufacturing scalability and product consistency, alongside advanced engineering strategies for future clinical use.
This study examined whether cognitive fusion statistically mediated the cross-sectional associations of pain interference with depressive and anxiety symptoms among individuals with spinal cord injury (SCI). Cross-sectional mediation models estimated using path analysis were used to test cognitive fusion as a mediator between pain interference and depressive or anxiety symptoms. Online survey completed by adults with SCI in the United States. 156 adults (51.3% female; mean age = 42.1 years) with traumatic (78.2%) or non-traumatic (21.8%) SCI. Pain interference was measured using the spinal cord injury - Quality of Life (SCI-QOL) Pain Interference Short Form. Cognitive fusion was assessed with the Cognitive Fusion Questionnaire-7. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Grief due to SCI, measured using the SCI-QOL Grief and Loss Short form, was retained as a covariate. Pain interference was significantly associated with higher cognitive fusion and greater depressive and anxiety symptoms. After controlling for SCI-related grief, cognitive fusion partially mediated these relationships, accounting for 45.4% of the total effect of pain interference on depressive symptoms and 42.3% of the total effect on anxiety. Cross-sectional path analyses supported an indirect statistical association between pain interference and depressive/anxiety symptoms through cognitive fusion. These findings highlight cognitive fusion as a critical, modifiable psychological mechanism underlying this relationship. Targeting cognitive fusion in interventions such as acceptance and commitment therapy may help mitigate the psychological impact of pain interference and improve mental health.
Oxidative stress plays a central role in the progression of neurodegenerative damage, including spinal cord injury (SCI), where excessive reactive oxygen species (ROS) production leads to neuronal dysfunction and cell death. Although small-molecule antioxidants such as sulforaphane exhibit neuroprotective potential, their clinical efficacy is often limited by instability and poor bioavailability. In this study, we explore a cooperative protein-ligand strategy using human serum immunoglobulin G (HIgG) as a dynamic scaffold for sulforaphane binding and antioxidant modulation. An integrated experimental and computational approach combining multispectroscopy, molecular docking, molecular dynamics (MD) simulations, and in vitro neuronal assays was employed to characterize binding mechanism and antioxidant activity. Spectroscopic analyses confirmed spontaneous and moderately binding of sulforaphane to HIgG, primarily driven by hydrogen bonding and van der Waals interactions within the Fab region. MD simulations and CD data revealed that sulforaphane binding induces subtle but significant local conformational rearrangements in HIgG, enhancing solvent accessibility and flexibility of aromatic and redox-active residues. Functionally, in vitro experiments using spinal cord neurons under H₂O₂-induced oxidative stress demonstrated that the HIgG-sulforaphane complex provides significantly greater cytoprotection and ROS suppression than either component alone. In conclusion, these findings reveal a cooperative antioxidant mechanism in which HIgG-sulforaphane complex contribute to improved neuroprotective activity. This work highlights protein-ligand cooperativity as a promising strategy for designing next-generation antioxidant systems.
The effects of percutaneous spinal cord epidural stimulation (SCES) on motor control have yet to be elucidated in persons with spinal cord injury (SCI). We examined the effects of percutaneous SCES on the central and peripheral nervous systems after SCI. We determined the effect of SCES combined with exoskeletal assisted walking (EAW) and resistance training (RT) on motor performance as assessed by the 10 m-walking test, electromyography outcomes and spasticity measurement. Four chronic (6-24 years post-injury) motor complete (C8-T11 AIS A and B) persons with SCI underwent permanent implantation with percutaneous SCES. Participants were either assigned to 12 months of EAW + SCES or EAW without SCES, 3 × weekly for the first 6 months. This was followed by an additional 6 months of EAW + SCES + RT (n = 3) or EAW + delayed SCES + no RT (n = 1) (both groups: 3-5 × weekly). Measurements were conducted at baseline (BL), post-intervention 1 (P1, 6 months following BL) and post-intervention 2 (P2, ~ 12 months following BL). Central nervous system performance was evaluated by measuring volitional knee isometric torques with SCES ON compared to SCES OFF. H-max/M-max ratio was measured for peripheral nervous system performance. For central adaptations, two participants (0882 and 0884) intentionally (SCES ON + active movement) generated knee extensor isometric torques at either 75% sub-motor threshold (0882; 1.87-6.6 × greater than SCES ON) or 100% motor threshold [0882 (1.6 × greater than SCES ON) and 0884 (3.7-16 × greater than SCES ON)]. A third participant initiated torques in the flexion direction and the fourth participant failed to initiate isometric torque. For peripheral adaptations, individual data indicated improvement in H-reflex and M-waves following P1 (0881 and 0882) and P2 (0881 and 0884). Surface neuromuscular electrical stimulation induced greater (24-42%) isometric knee extensor torques at P2 compared to BL in both groups. Overall, 10-m walking test resulted in 30% longer duration and 29% slower speed with reduced EAW assistance (50-70%) during EAW + SCES ON (duration: 79 s and speed: 0.13 m/s) compared to 100% EAW + SCES OFF (duration: 60.5 s and speed: 0.18 m/s) during P1 measurements. In P2, similar pattern was observed and characterized by longer duration (22%) and slower walking speed (24%). Spasticity decreased (0.5-13%) at different angular velocities following P1 but not after P2. EAW + SCES ON improved intention to generate isometric torques accompanied with improvement in peripheral neuromuscular kinetics. This was mirrored by increasing EMG harmony with training without enhancing EAW 10-m performance. The effects of EAW + SCES on spasticity may warrant additional investigation.
Lipomyelomeningocele (LMM) is the most common form of closed spinal dysraphism and is typically diagnosed in childhood. Although many patients are initially asymptomatic, progressive neurological deterioration may occur over time due to tethered cord syndrome (TCS). Adult presentation of untreated LMM is rare and poorly described in the literature, and optimal management strategies in this population remain controversial. We report the case of a 53-year-old man with a congenital lumbosacral mass and a history of partial superficial lipoma resection in childhood, who presented with progressive sphincter dysfunction, lumbar pain, sexual dysfunction, and neurological decline. His clinical course was marked by long-standing unrecognized neurological impairment, leading to chronic lower extremity ulcerations, recurrent osteomyelitis, and multiple amputations. Magnetic resonance imaging demonstrated a large intra and extradural lumbar lipomyelomeningocele associated with tethered cord syndrome. The patient underwent microsurgical near-total resection of the intradural lipoma, detethering of the neural placode, dorsal neurulation, and expansile duraplasty. Postoperatively, he experienced significant clinical improvement, including recovery of spontaneous urination, reduced need for intermittent catheterization, resolution of neuropathic pain, and improvement in sexual function, without surgical complications. This case highlights the potential for severe and irreversible morbidity associated with delayed diagnosis and inadequate long-standing follow-up of lipomyelomeningocele. Although prophylactic surgery remains controversial, timely recognition, close surveillance, and individualized surgical intervention when symptoms arise may improve neurological and functional outcomes in adult patients. Multidisciplinary, long-term follow-up is essential to reduce morbidity and optimize quality of life in this rare but challenging population.
Epidural spinal cord stimulation (SCS) is a neuromodulatory, reversible procedure for the treatment of selected chronic pain conditions, primarily neuropathic in nature. The updated German S3 guideline provides evidence-based recommendations for the use of SCS and dorsal root ganglion stimulation (DRG-S). Key innovations include recent technical advances and increased integration into multimodal pain management. The guideline aims to enhance the care of patients with chronic pain by offering rational, scientifically substantiated recommendations. A systematic literature review was conducted, including meta-analyses and randomized controlled trials, with relevant case reports also taken into account. Publications were evaluated by topic, including fundamentals, indications, methods, complications, quality management, and psychosocial aspects. Recommendations are based on established evidence classifications. Major updates include strong evidence in favor of SCS for diabetic polyneuropathy. For other neuropathies, smaller studies indicate positive effects. SCS is considered the most effective therapy for chronic, postoperative back and leg pain. Additionally, SCS receives a strong recommendation for peripheral arterial occlusive disease (Fontaine stages IIb and III). For complex regional pain syndrome (CRPS), DRG‑S demonstrates superiority over SCS and is preferentially recommended. The guideline addresses all professional groups involved in the care of pain patients and offers practical guidance for therapeutic decision-making in the management of chronic pain. Die epidurale Rückenmarkstimulation („spinal cord stimulation“ [SCS]) ist ein reversibles Neuromodulationsverfahren zur Behandlung ausgewählter chronischer, in erster Linie neuropathischer Schmerzen. Die aktualisierte deutsche S3-Leitlinie gibt evidenzbasierte Empfehlungen für den Einsatz der SCS und der Spinalganglienstimulation („dorsal root ganglion stimulation“ [DRG-S]). Neu sind technische Fortschritte und die stärkere Einbindung in die multimodale Schmerztherapie. Die Leitlinie dient dazu, die Versorgung von Menschen mit chronischen Schmerzen durch rationale, wissenschaftlich fundierte Empfehlungen zu verbessern. Es erfolgte eine systematische Literaturrecherche mit Auswertung von Metaanalysen und randomisierten, kontrollierten Studien, wobei einzelne relevante Fallberichte ebenfalls berücksichtigt wurden. Thematisch wurden die Publikationen nach Grundlagen, Indikationen, Methoden, Komplikationen, Qualitätsmanagement und psychosozialem Verlauf ausgewertet. Die Empfehlungen beruhen auf etablierten Evidenzklassifikationen. Wesentliche Neuerungen: Für die diabetische Polyneuropathie besteht gute Evidenz zugunsten der SCS. Für andere Neuropathien zeigen kleinere Studien positive Effekte. SCS gilt als effektivste Therapie bei chronischen postoperativen Rücken- und Beinschmerzen. Auch bei der peripheren arteriellen Verschlusskrankheit (Stadium 2b und 3) erhält die SCS eine starke Empfehlung. In der Behandlung des komplexen regionalen Schmerzsyndroms ist die DRG‑S der SCS überlegen und wird bevorzugt empfohlen. Die Leitlinie richtet sich an alle Berufsgruppen, die an der Versorgung von Schmerzpatienten beteiligt sind, und bietet eine praxisnahe Orientierung für Therapieentscheidungen in der chronischen Schmerzbehandlung.
Neuropathic pain (NP) represents one of the most frequent complications following spinal cord injury (SCI) and is associated with dysregulation of non-coding RNAs (ncRNAs). Curcumin possesses anti-inflammatory and neuroprotective properties. This study investigated the dose-dependent effects of curcumin-a compound with anti-inflammatory and neuroprotective properties-on pain-related behaviors and ncRNA expression after SCI. Male Wistar rats (n = 8 per group) were randomly assigned to 5 groups: Control (no surgery, no treatment), Sham (only laminectomy), SCI (clip-compression injury at the T11-T12 vertebral level), Cur100 and Cur200 (Curcumin at 100 and 200 mg/kg given orally 30 min after SCI for 10 consecutive days). Behavioral tests (acetone drop for cold allodynia, tail-flick for thermal hyperalgesia) were conducted over six weeks. Histological (H&E staining for cavity size) and molecular (qPCR for lncRNAs H19, GAS5, CRNDE and miRNAs miR-21-5p, miR-29a-3p) analyses were performed. Data were analyzed with PRISM software. At the endpoint, SCI induced significant cold allodynia, thermal hyperalgesia along with significant upregulation of all target ncRNAs. Curcumin treatment at both doses attenuated NP and modulated ncRNA expression in a parameter-dependent manner-where effects varied based on the specific outcome measured. The higher dose (200 mg/kg) provided greater neuroprotection and more effectively reduced thermal hyperalgesia, while the lower dose (100 mg/kg) was more potent in alleviating cold allodynia and selectively downregulating pro-inflammatory ncRNAs (H19, GAS5, miR-21-5p). These findings highlight the parameter-specificity of curcumin's therapeutic effects, suggesting that optimal dosing should be tailored according to the targeted pain modality and molecular pathway.
Outcomes of allogeneic hematopoietic stem cell transplantation (HSCT) in patients with high-risk acute myeloid leukemia (AML), including those with adverse disease biology or chemotherapy-refractory disease, remain suboptimal. While HLA-matched sibling donor (MSD) is preferred when available, other donor sources such as unrelated donors, haploidentical family donors (HID), and cord blood (CB) are viable alternatives. CB has been associated with potent graft-versus-leukemia (GVL) effects in several studies, and may therefore represent a suitable donor option for high-risk populations. However, data directly comparing outcomes of CB with other donor sources in high-risk AML remain limited. By examining whether the strong GVL effect of CB is effective even in high-risk AML, we aim to inform future donor source selection. We retrospectively analyzed patients with high-risk AML who underwent first allogenic HSCT at our institution between 2008 and 2024. High-risk AML was defined as AML with adverse karyotype risk (according to ELN criteria), AML myelodysplasia-related (AML-MR), post cytotoxic therapy AML, or poor treatment response (primary induction failure or relapsed disease). Patients aged >65 years, with ECOG performance status (PS) 3-4, or favorable cytogenetics were excluded. The primary endpoint was progression-free survival (PFS), overall survival (OS), cumulative incidence of relapse, and non-relapse mortality (NRM). To adjust for baseline differences, both multivariate analyses and propensity score matching were performed. A total of 488 patients were included: 394 (80.7%) received CB and 94 (19.3%) received other donor sources, including 46 MSD, 6 HID, and 42 unrelated bone marrow or peripheral blood donors (25 matched, 17 mismatched). Adverse cytogenetic risk was present in 189 (38.7%), AML-MR in 233 (47.7%), post cytotoxic therapy AML in 45 (9.2%), and poor treatment response in 298 (61.0%). Age was higher in CB recipients (56 vs 48 years in median, p<0.01) and fewer patients were in CR at HSCT (15.0% vs. 35.1%, p<0.01). Earlier transplantation year (<2016) was more common in other donors (62.8% vs. 42.1%, p<0.01). In multivariate analysis, CB was associated with better PFS (HR=0.73, 95% CI: 0.54-0.98, p=0.04) and lower relapse (HR=0.50, 95% CI: 0.33-0.75, p<0.01). In the propensity score matched cohort (94 pairs), CB had a superior 5-year PFS (49.8% [95% CI: 40.2%-61.7%] vs 35.4% [95% CI: 25.6-45.3%], overall p = 0.04), similar 5-year OS (56.2% [95% CI: 46.4-67.9%] vs 44.4% [95% CI: 35.0-56.4%], overall p = 0.16), lower 5-year cumulative incidence of relapse (24.5% [95% CI: 15.9-34.1%] vs 42.8% [95% CI: 32.4-52.8%], overall p < 0.01), and similar cumulative incidence of 5-year NRM (25.7% [95% CI: 17.1-35.2%] vs 21.8% [95% CI: 13.9-30.8%], overall p = 0.75). Among patients with high-risk AML, CB transplantation was associated with significantly lower relapse and superior PFS compared to other donor sources, in both multivariate and propensity score-matched analyses. These findings suggest that CB may offer outcomes comparable to, or potentially better than, other prioritized donor options for this poor-prognosis population, due to robust GVL effects.
Anterior spinal artery syndrome (ASAS) presents with motor paralysis and dissociated sensory loss. Early diagnosis is difficult due to often normal initial MRI findings. Neurophysiological testing may offer critical diagnostic clues in the acute phase before imaging changes appear. A 62-year-old man with vascular risk factors presented with acute-onset flaccid paraplegia and loss of pain and temperature sensation below the hips, with preserved vibration sense - suggestive of ASAS. MRI of the spine at presentation and at 72 h showed no abnormalities. However, nerve conduction studies revealed absent tibial F-waves, indicating anterior horn cell dysfunction, while tibial somatosensory evoked potentials (SSEPs) were preserved, suggesting intact dorsal columns. This "F-EP dissociation" aligned with the clinical picture of ASAS. Supportive therapy was initiated, and a repeat MRI after one week showed confirmed anterior spinal cord infarction. This case highlights the utility of electrophysiological testing in the early diagnosis of MRI-negative ASAS. The combination of absent F-waves and preserved SSEPs serves as surrogate evidence of anterior cord involvement. Timely recognition through clinical and neurophysiological correlation enables early intervention and improved outcomes.
To develop the clinical prediction rule (CPR) of upper urinary tract deterioration (UUTD) outcome at three years, which is the average diagnostic timepoint, in patients with traumatic spinal cord injury (TSCI). Retrospective cohort study. Department of Rehabilitation Medicine, Maharaj Nakorn Chiang Mai Hospital. TSCI patients with onset of injury in January 2008December 2020. After screening the medical records of 714 TSCI patients, clinical and urodynamic parameter data from 176 patients, collected at 3-18 months after SCI, were retrospectively analyzed. CPR was developed to predict UUTD at three years after SCI by conducting logistic regression analysis. The performance of the model was evaluated in terms of both discrimination and calibration using the AuROC and calibration plot, respectively. The incidence of UUTD was 18.8% (33/176) with a mean duration of 3.72 years after the onset of injury. The developed CPR consists of three predictive factors: completeness of SCI (American Spinal Injury Association - ASIA Impairment Scale [AIS] C), presence of detrusor overactivity, and the occurrence of autonomic dysreflexia during a urodynamic study, to predict UUTD at three years after SCI. The developed CPR had acceptable discriminative (AuROC = 0.711 [95%CI:0.603-0.819]) and calibrating performance (nearly approximate observed and predicted risk graphs and Brier Score = 0.1245). Our developed CPR for prognosing UUTD at three years after TSCI was established and demonstrated acceptable performance in both discrimination and calibration. However, a further external validation study is needed before applying this CPR in other clinical contexts.
Metabolic disturbances are well documented in chronic spinal cord injury (SCI), yet data regarding metabolic, inflammatory, and hemodynamic profiles during the subacute rehabilitation period remain limited. This study aimed to determine the prevalence of metabolic syndrome and to examine metabolic, inflammatory, hemodynamic, and functional characteristics of adults with subacute SCI during early inpatient rehabilitation. Retrospective observational study. Inpatient rehabilitation clinic. A total of 87 adults with traumatic or non-traumatic SCI more than six weeks post-injury. Participants underwent a structured inpatient rehabilitation program consisting of multidisciplinary therapy, including physical and occupational therapy. Sociodemographic and injury-related variables, American Spinal Injury Association (ASIA) Impairment Scale (AIS), laboratory parameters (fasting glucose, lipid profile, complete blood count), neutrophil-to-lymphocyte ratio (NLR), blood pressure, and Functional Ambulation Scale (FAS) scores at admission and discharge. Metabolic syndrome was defined using standard biochemical criteria. The mean age was 40.5 ± 19.6 years, and 78.2% of patients were male. Metabolic parameters remained within normal limits across AIS grades and lesion levels. Metabolic syndrome was present in 10.3% of patients. No statistically significant differences in NLR values were observed across AIS groups. Blood pressure remained stable across groups. Functional ambulation improved from a mean FAS score of 0.61 at admission to 1.06 at discharge. Structured inpatient rehabilitation in the subacute phase of SCI appears to support early improvements in ambulation while maintaining metabolic, inflammatory, and hemodynamic stability. Larger longitudinal studies are needed to clarify the long-term significance of these findings.
Attitudes toward health conditions involving physical dysfunction may differ between healthcare professionals (HCPs) and the general public. This study compared affective responses to stroke, femoral neck fracture (FNF), and spinal cord injury (SCI) across both groups within a unified framework. We conducted an online cross-sectional survey of 400 members of the general public (stratified by age and gender) and 400 HCPs representing 18 professions. Affective responses were measured using scales assessing negative affect, interpersonal avoidance, and impressions (physical strength, mental resilience, and mental strength). A 2 × 3 mixed-model ANOVA (group × condition) and correlation analyses were conducted. Negative affect showed a significant group × condition interaction (p < 0.001, ηp2 = 0.030). HCPs scored lower than the general public for stroke and FNF, with no significant difference for SCI. HCPs also reported lower interpersonal avoidance across all conditions. Impression scales showed no interaction; however, HCPs rated higher physical strength and mental strength, while mental resilience showed no group difference. Condition effects were significant, with a consistent hierarchy of SCI > stroke > FNF for both negative affect and interpersonal avoidance. Negative affect and interpersonal avoidance were moderately correlated in both groups. Among HCPs, FNF-related interpersonal avoidance negatively correlated with years of clinical experience. HCPs generally report less negative affect and interpersonal avoidance and hold more positive perceptions of patient capability than the general public. However, both groups share a negativity hierarchy across conditions, suggesting persistent perceptions associated with specific health labels.
Kilohertz-frequency (KHF) waveforms are gaining traction in transcutaneous spinal cord stimulation (tSCS) for motor recovery after paralysis. However, the mechanisms by which these fast-alternating currents depolarize proprioceptive afferent and motor efferent fibres remain unknown. To address this gap, we conducted a study in 28 participants showing, through peripheral nerve stimulation experiments and computational modelling, that KHF waveforms negatively impact the processes required to electrically induce action potentials, thereby increasing response thresholds and biasing recruitment towards motor efferent fibres. While these results translate to tSCS, we also demonstrate that lumbar tSCS still results in the preferential recruitment of proprioceptive afferent fibres, whereas cervical tSCS favours recruitment of motor efferent fibres, regardless of the waveform used. Given the assumed importance of proprioceptive afferent stimulation in motor recovery, our work suggests that the use of KHF waveforms warrants careful consideration in the context of neurorehabilitation applications, particularly for cervical tSCS. We posit that a thorough analysis of the mechanisms mediating responses elicited by novel tSCS approaches is crucial for understanding their potential to restore motor function after paralysis.
Bowel dysfunction is a common and distressing consequence of spinal cord injury (SCI), with profound effects on physical, psychological, and social well-being. Despite its high prevalence, there is limited consolidated evidence regarding patients' lived experiences, which are essential for improving care. To synthesize qualitative research findings on the experiences of individuals with SCI regarding bowel management. A qualitative meta-synthesis was conducted following PRISMA guidelines. Systematic searches were performed in Google Scholar, MEDLINE, CINAHL, PubMed, Web of Science, and Springer Nature Journals between June 3 and June 28, 2024. Studies were appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Data were analyzed through Sandelowski and Barroso's two-stage meta-synthesis method. The review was prospectively registered in PROSPERO (CRD420250578291). Twelve qualitative studies involving 210 participants from seven countries were included. Three overarching themes emerged: (1) Challenges in bowel management, encompassing physical complications, emotional burden, and social restrictions; (2) Perceived shortcomings and expectations, reflecting inadequate professional support and a strong desire for independence; and (3) Managing the difficult process, highlighting self-care adjustments, social support, and consideration of invasive interventions such as colostomy. Bowel management is a central yet challenging aspect of life for individuals with SCI, affecting all domains of quality of life. Findings underscore the need for patient-centered strategies, enhanced professional education, and early discussion of all management options to improve care outcomes.
Biochemical androgen deficiency is a frequent but often under-recognized complication in men with chronic spinal cord injury (SCI). We aimed to identify routinely available clinical predictors of biochemical androgen deficiency and to develop a simple risk stratification tool suitable for rehabilitation settings. Cross-sectional observational study. Single tertiary spinal rehabilitation center in Italy. A total of 136 men with chronic traumatic SCI (duration ≥12 months) not receiving testosterone therapy. Biochemical androgen deficiency, defined as total testosterone <3 ng/mL (<300 ng/dL). Biochemical androgen deficiency was identified in 45 participants (33.1%). In multivariable logistic regression, body mass index (BMI) (OR 1.16 per kg/m², 95% CI 1.01-1.33) and Charlson Comorbidity Index (CCI) (OR 1.39 per point, 95% CI 1.10-1.76) independently predicted biochemical androgen deficiency, whereas age was not significant. A nomogram incorporating BMI and CCI demonstrated clinically meaningful discrimination (AUC 0.77, 95% CI 0.69-0.85) and good agreement between predicted and observed risk. At a predicted probability threshold of 31%, sensitivity was 70% and specificity 76%. Internal bootstrap validation showed minimal optimism. Biochemical androgen deficiency is highly prevalent in men with chronic SCI. A clinically oriented nomogram based on BMI and comorbidity burden may help prioritize biochemical testing and early endocrine evaluation in rehabilitation settings.
This study examined the implementation of heart rate variability biofeedback (HRV-F) as a non-invasive, self-regulatory rehabilitation technique for individuals living with spinal cord injury (SCI). It aimed to understand participants' experiences in receiving and practicing HRV-F activities and identify facilitators and barriers to implementing HRV-F into usual care. A mixed-methods design (interviews, questionnaire surveys) was embedded within a randomized controlled trial (RCT). Facilitators and barriers were identified using the Consolidated Framework for Implementation Research (CFIR v2), and mental health and quality-of-life instruments assessed well-being. Participants valued HRV-F's adaptability, non-pharmacological nature, and the potential to reduce pain and stress. Key facilitators included ease of use, professional support, and motivation to improve health. Barriers included technical issues with equipment, time constraints, and environmental challenges to practicing HRV-F at home. There was no change in mental health or quality of life from baseline to 12 months, although participants reported perceived improvements in relaxation, pain reduction, and confidence. HRV-F was viewed positively by participants and shows promise for SCI rehabilitation. User-centered design, early integration into care, and ongoing support are essential for successful implementation.