Journal of neurotrauma
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Journal of neurotrauma · Sep 2017
ReviewThe Impact of Mean Arterial Pressure on Functional Outcome Post-Acute Spinal Cord Injury: A Scoping Systematic Review of Animal Models.
The aim of this work was to perform a scoping systematic review on the animal literature surrounding mean arterial blood pressure (MAP) and functional outcomes post-acute spinal cord injury (ASCI). We performed a systematic review of the literature by searching: MEDLINE, BIOSIS, EMBASE, Global Health, SCOPUS, and Cochrane Library from inception to January 2015. We also performed a hand search of various published meeting proceedings. ⋯ Two studies displayed worse functional outcomes secondary to episodes of hypotension. Four studies failed to demonstrate a relationship between MAP and functional outcome within the animal models. This review concludes that, within the animal literature, there is insufficient evidence to draw a conclusion about the effect of MAP on neurological outcome in animal models of ASCI.
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Journal of neurotrauma · Sep 2017
Multi-domain assessment of autonomic function in spinal cord injury using a modified autonomic reflex screen.
The aim of this study was to characterize autonomic lesions in participants with spinal cord injury (SCI; n = 10) using an autonomic reflex screen, incorporating sudomotor, cardiovagal, and sympathetic adrenergic tests, as well as hemodynamic responses to head-up tilt (HUT). Hemodynamic responses were compared to healthy controls (n = 20) and previously published normative cutoffs in order better identify autonomic impairments. Sympathetic skin responses (SSRs), heart rate response to deep breathing (HRDB), and heart rate and beat-to-beat blood pressure responses to Valsalva maneuver (VM) and HUT were measured. ⋯ Measures of cardiovagal function, including HRDB (SCI = 7.7 ± 3.8 beats/min vs. controls = 17.6 ± 8.1 beats/min) and Valsalva ratio (SCI = 1.53 ± 0.29 vs. controls = 1.85 ± 0.37), were significantly reduced in SCI participants, compared to controls (p < 0.05). These findings suggest that an autonomic reflex screen, which includes standardized testing protocol and normative data for comparison, is useful for determining the autonomic domains affected by the neurological injury in SCI. We also demonstrated significant cardiovagal impairment in SCI participants compared to controls, which warrants further investigation to determine whether cardiovagal dysfunction is associated with the negative cardiovascular outcomes, which are known to occur in SCI.
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Journal of neurotrauma · Sep 2017
N-Palmitoylethanolamine-oxazoline (PEA-OXA) as a new therapeutic strategy to control neuroinflammation: neuroprotective effects in experimental models of spinal cord and brain injury.
Modulation of N-acylethanolamine-hydrolyzing acid amidase (NAAA) represents a potential alternative strategy in the treatment of neuroinflammation. Recent studies showed that pharmacological modulation of NAAA could be achieved with the oxazoline of palmitoylethanolamide (PEA; PEA-OXA). The aim of this study was to evaluate the neuroprotective effects of PEA-OXA in the secondary neuroinflammatory events induced by spinal and brain trauma in mice. ⋯ In addition, the expression of neurotrophic factors, such as glial cell line-derived neurotrophic factor, brain-derived neurotrophic factor, and neurotrophin-3 were increased by PEA-OXA treatment. Moreover, PEA-OXA also significantly decreased glial fibrillary acidic protein hyperexpression, the nuclear translocation of nuclear factor (NF)-κB, phosphorylation of Ser536 on the NF-κB subunit p65, and degradation of IκB-α, as well as diminished the expression of pro-inflammatory mediators such as cyclooxygenase-2 (COX-2), inducible nitric oxide synthase, tumor necrosis factor (TNF)-α and interleukin (IL)-1β. The modulation of intracellular NAAA by PEA-OXA treatment could thus represent a novel therapy to control neuroinflammatory conditions associated with SCI and TBI.
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Journal of neurotrauma · Sep 2017
Early blockade of matrix metalloproteinases in spinal cord injured dogs results in a long-term increase in bladder compliance.
Spinal cord injury (SCI) is often accompanied by reduced bladder compliance, which contributes to adverse conditions including urinary tract infections and vesicoureteral reflux. Reduced compliance is, in part, attributed to extensive remodeling of the bladder wall, including the extracellular matrix (ECM). Here, we tested the hypothesis that blockade of matrix metalloproteinases (MMPs), known for their ability to remodel the ECM, improves bladder compliance in dogs with SCI. ⋯ There were transient, but significantly (p = 0.023) greater, adverse events (31 of 42; 74%) in the GM6001-treated group relative to vehicle controls (22 of 46; 48%). Whereas there were no differences in TSCIS between treatment groups at day 42 (p = 0.9679), bladder compliance was significantly higher in dogs treated with GM6001+DMSO compared to controls (p = 0.0272). Further studies are needed to determine whether this inhibition results from a direct interaction with the bladder wall or indirectly through neural-based mechanisms.
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Journal of neurotrauma · Sep 2017
Long-term paired associative stimulation enhances motor output of the tetraplegic hand.
A large proportion of spinal cord injuries (SCI) are incomplete. Even in clinically complete injuries, silent non-functional connections can be present. Therapeutic approaches that can strengthen transmission in weak neural connections to improve motor performance are needed. ⋯ The improvement was significantly higher in PAS-treated than in PNS-treated hands (176 ± 29%, p = 0.046, n = 5 patients). Long-term PAS might be an effective tool for improving motor performance in incomplete chronic SCI patients. Further studies on PAS in larger patient cohorts, with longer stimulation duration and at earlier stages after the injury, are warranted.