Journal of neurotrauma
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Journal of neurotrauma · Feb 2014
ReviewSpinal cord injury: How can we improve the classification and quantification of its severity and prognosis?
The preservation of functional neural tissue after spinal cord injury (SCI) is the basis for spontaneous neurological recovery. Some injured patients in the acute phase have more potential for recovery than others. This fact is problematic for the construction of clinical trials because enrollment of subjects with variable recovery potential makes it difficult to detect effects, requires large sample sizes, and risks Type II errors. ⋯ New imaging techniques to assess tract injury and demyelination and methods to quantify tissue injury, inflammatory markers, and neuroglial biochemical changes may improve the evaluation of injury severity, and the correlation with neurological outcome, and measure the effects of treatment more robustly than is currently possible. The ability to test such a multimodality approach will require a high degree of collaboration between clinical and research centers and government research support. When the most informative of these assessments is determined, it may be possible to identify patients with substantial recovery potential, improve selection criteria and conduct more efficient clinical trials.
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Journal of neurotrauma · Feb 2014
Waist circumference is the best index for obesity in individuals with spinal cord injury.
Obesity is an important identifier of cardiovascular disease (CVD) risk, but is challenging to determine accurately in individuals with spinal cord injury (SCI). Body mass index (BMI) is used worldwide as a simple indicator of obesity, but is difficult to measure in individuals with SCI. Furthermore, standard BMI cutoffs underestimate obesity in this population. ⋯ The optimal cutoff for identifying adverse CVD risk in individuals with SCI was identified as WC ≥94 cm, with 100% sensitivity and 79% specificity. We propose that WC is a simple, more sensitive alternative to BMI in this population that is easy to use in multiple settings. The cutoff provides a simple tool to predict adverse CVD risk profiles that can be used to guide risk management, as well as as a practical aid for individuals with SCI to maintain a healthy body composition.
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Journal of neurotrauma · Feb 2014
Observational StudyMedical and surgical management after spinal cord injury: Vasopressor usage, early surgery and complications.
The optimal mean arterial blood pressure for maintenance of spinal cord perfusion is not known. Our aim was to describe vasopressor usage and examine their effects in patients with spinal cord injury (SCI). We undertook a retrospective cohort study of 131 patients with SCI who received any kind of vasopressors to maintain blood pressure in the neurocritical care unit of a Level 1 trauma center (2005-2011). ⋯ Incomplete SCI (OR, 2.64; p=0.019) and surgery <24 h after SCI (OR, 4.25; p=0.025) were independently associated with improved outcome. In summary, vasopressors are associated with increased complications in SCI patients. Further prospective studies are required in order to determine the potential benefits and risks of blood pressure management in patients with SCI.
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Journal of neurotrauma · Feb 2014
The Burden of Acute Traumatic Spinal Cord Injury among Adults in the United States: an Update.
The current incidence estimate of 40 traumatic spinal cord injuries (TSCI) per million population/year in the United States (U. S.) is based on data from the 1990s. We sought to update the incidence and epidemiology of TSCI in U. ⋯ The incidence of TSCI is higher than previously reported with a progressive increase among older adults who also experience worse outcomes compared with younger adults. ED-related TSCI charges are also increasing. These updated national estimates support the development of customized prevention strategies based on age-specific risk factors.
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Journal of neurotrauma · Feb 2014
The cancer drug tamoxifen - a potential therapeutic treatment for spinal cord injury.
Tamoxifen (TMX) is a selective estrogen receptor modulator that can mimic the neuroprotective effects of estrogen but lacks its systemic adverse effects. We found that TMX (1 mg/day) significantly improved the motor recovery of partially paralyzed hind limbs of male adult rats with thoracic spinal cord injury (SCI), thus indicating a translational potential for this cancer medication given its clinical safety and applicability and the lack of currently available treatments for SCI. ⋯ AQP4 increases in TMX-treated SCI rats were associated with smaller fluid-filled cavities with borders consisting of densely packed AQP4-expressing astrocytes that closely resemble the organization of normal glia limitans externa (in contrast to large cavities in control SCI rats that lacked glia limitans-like borders and contained reactive glial cells). Based on our findings, we propose that TMX is a promising candidate for the therapeutic treatment of SCI and a possible intervention for other neuropathological conditions associated with demyelination and AQP4 dysfunction.