Journal of neurotrauma
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Journal of neurotrauma · Feb 2016
Intrathecal acetyl-l-carnitine protects tissue and improves function after a mild contusive spinal cord injury in rats.
Primary and secondary ischemia after spinal cord injury (SCI) contributes to tissue and axon degeneration, which may result from decreased energy substrate availability for cellular and axonal mitochondrial adenosine triphosphate (ATP) production. Therefore, providing spinal tissue with an alternative energy substrate during ischemia may be neuroprotective after SCI. To assess this, rats received a mild contusive SCI (120 kdyn, Infinite Horizons impactor) at thoracic level 9 (T9), which causes loss of ∼ 80% of the ascending sensory dorsal column axonal projections to the gracile nucleus. ⋯ Furthermore, grid walking, a task we have shown to be dependent on dorsal column function, was not improved. Thus, mitochondrial substrate replacement may only be efficacious in areas of lesser or temporary ischemia, such as the ventral spinal cord and injury penumbra in this study. The current data also support our previous evidence that microvessel loss is central to secondary tissue degeneration.
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Journal of neurotrauma · Feb 2016
Review Meta AnalysisMelatonin for Spinal Cord Injury in Animal Models: A Systematic Review and Network Meta-Analysis.
Spinal cord injury (SCI) leads to loss of function below the lesion and affects individuals worldwide. An increasing number of experimental studies support the effectiveness of melatonin (MT) for SCI. Our objectives were to investigate neurological recovery and anti-oxidant effects of MT in animal models of SCI, and to explore the appropriate dose. ⋯ Studies indicated that MT administration significantly improved neurological recuperation and anti-oxidant effects in rat models of SCI. The appropriate dose of MT was 12.5 mg/kg for SCI rat models. The majority of included studies were low quality; however, optimal MT treatment in SCI still requires high quality studies.
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Journal of neurotrauma · Feb 2016
Multicenter Study Observational StudyResponsiveness, Sensitivity and Minimally Detectable Difference of the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, Version 1.0 (GRASSP V1).
As spinal cord injury (SCI) trials begin to involve subjects with acute cervical SCI, establishing the property of an upper limb outcome measure to detect change over time is critical for its usefulness in clinical trials. The objectives of this study were to define responsiveness, sensitivity, and minimally detectable difference (MDD) of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP). An observational, longitudinal study was conducted. ⋯ GRASSP demonstrates good responsiveness and excellent sensitivity that is superior to ISNCSCI and SCIM III. MDD values are useful in the evaluation of interventions in both clinical and research settings. The responsiveness and sensitivity of GRASSP make it a valuable condition-specific measure in tetraplegia, where changes in upper limb neurological and functional outcomes are essential for evaluating the efficacy of interventions.
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Journal of neurotrauma · Feb 2016
Cerebral blood flow responses to autonomic dysreflexia in those with high level spinal cord injury.
Autonomic dysreflexia (AD) is a life-threatening episode of transient hypertension affecting up to 90% of those with high-level spinal cord injury (SCI), and can lead to cerebral hemorrhage. Due to the nature of this medical emergency, cerebral blood flow (CBF) has not been recorded during AD. ⋯ Mean arterial BP increased during AD (66 ± 11 vs. 83 ± 10 mm Hg; p = 0.004), whereas CBF (76 ± 4 vs. 74 ± 4 cm · sec(-1)) and end-tidal partial pressure of carbon dioxide (PETCO2) (35 ± 1 vs. 34 ± 3 mm Hg) were maintained. These preliminary data indicate that the brain may effectively buffer moderate episodes of AD.
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Journal of neurotrauma · Feb 2016
Do patients with complete spinal cord injury benefit from early surgical decompression? Analysis of neurological improvement in a prospective cohort study.
The prognosis for patients with a complete traumatic spinal cord injury (SCI) is generally poor. It is unclear whether some subgroups of patients with a complete traumatic SCI could benefit from early surgical decompression of the spinal cord. The objectives of this study were: (1) to compare the effect of early and late surgical decompression on neurological recovery in complete traumatic SCI and (2) to assess whether the impact of surgical timing is different in patients with cervical or thoracolumbar SCI. ⋯ Overall, 28% (15/53) of complete SCI had improvement in AIS: 34% (13/38) who were operated <24 h and 13% (2/15) who were operated ≥ 24 h (p = 0.182). Sixty-four percent (9/14) of cervical complete SCI operated <24 h had improvement in AIS as opposed to none in the subgroup of six complete cervical SCI operated ≥ 24 h (p = 0.008). Surgical decompression within 24 h in complete SCI may optimize neurological recovery, especially in patients with cervical SCI.