Prediction of thigh skeletal muscle mass using dual energy x-ray absorptiometry compared to magnetic resonance imaging after spinal cord injury

Objectives: A rapid decline in lean mass (LM), fat-free mass (FFM) and increased intramuscular fat (IMF) predispose persons with spinal cord injury (SCI) to chronic medical conditions including dyslipidemia, insulin resistance, type 2 diabetes mellitus and cardiovascular disease. (1) To determine the relationship between dual energy x ray absorptiometry (DXA) and gold standard magnetic resonance imaging (MRI) LM values; (2) to develop predictive equations based on this relationship for assessing thigh LM in persons with chronic SCI.

Study Design: Cross-sectional predicational design.

Settings: Clinical research medical center.

Participants: Thirty-two men with chronic (>1 y post-injury) motor complete SCI.

Methods: Participants completed total body DXA scans to determine thigh LM and were compared to measurements acquired from trans-axial MRI.

Outcome measures: MRI was used to measure whole muscle mass (MM_MRI-WM), absolute muscle mass (MM_MRI-ABS) after excluding IMF, and knee extensor muscle mass (MM_MRI-KE). DXA was used to measure thigh LM (LM_DXA) and (FFM_DXA). To predict MM_MRI-KE, LM_DXA was multiplied by 0.52 and yielded LM_DXA-KE.

Results: LM_DXA predicted MM_MRI-WM [r²_?=?0.90, standard error of the estimate (SEE)?=?0.23?kg, P?<?0.0001] and MM_MRI-ABS (r²?=?0.82, SEE?=?0.28?kg, P?<?0.0001). LM_DXA-KE predicted MM_MRI-KE (r²?=?0.78, SEE?=?0.16?kg, P?<?0.0001).

Conclusion: DXA measurements revealed an acceptable agreement with the gold standard MRI and may be a viable alternative for assessing thigh skeletal muscle mass after SCI.     

Relationships between T-scores at the hip and bone mineral density at the distal femur and proximal tibia in persons with spinal cord injury

Objective: To identify T-score values at the total hip (TH) and femoral neck (FN) that correspond to the cutoff value of <0.60?g/cm² for heightened risk of fracture at the distal femur (DF) and proximal tibia (PT).

Design: Retrospective analysis of data in a research center’s database.

Setting: Community-based individuals with spinal cord injury (SCI).

Participants: 105 unique individuals with SCI.

Outcome Measurements: DXA derived areal BMD (aBMD) and T-score of the DF, PT, TH, and FN.

Results: The aBMD at the DF and PT regions were predictors of T-scores at the TH (R ²?=?0.63, P?<?0.001 and R ²?=?0.65, P?<?0.001) and FN (R ²?=?0.55, P?<?0.001 and R ²?=?0.58, P?<?0.001). Using the DF and PT aBMD of 0.60?g/cm² as a value below which fractures were more likely to occur, the predicted T-score was ?3.1 and ?3.5 at the TH and ?2.6 and ?2.9 at the FN, respectively. However, when the predicted and observed T-score values disagree outside the 95% limit of agreement, the predicted T-score values are lower than the measured T-score values, overestimating the measured values between ?2.0 and ?4.0 SD.

Conclusion: The DF and PT cutoff value for aBMD of 0.60?g/cm² was a moderate predictor of T-score values at the TH and FN, with considerable inaccuracies outside the clinically acceptable limits of agreement. As such, the direct measurement of knee aBMD in persons with SCI should be performed, whenever possible, prior to prescribing weight bearing upright activities, such as robotic exoskeletal-assisted walking.     

Short-term effects of respiratory muscle training combined with the abdominal drawing-in maneuver on the decreased pulmonary function of individuals with chronic spinal cord injury: A pilot randomized controlled trial

Objective: To investigate the effects of respiratory muscle training (RMT) combined with the abdominal drawing-in maneuver (ADIM) on the pulmonary function in patients with chronic spinal cord injury (SCI).

Methods: Thirty-seven subjects with SCI (level of injury: C4–T6, time since injury: 4–5 years) were randomly allocated to three groups; the integrated training group (ITG), the RMT group (RMTG), and the control group (CG). The ITG performed RMT using an incentive respiratory spirometer (IRS) and the ADIM using a stabilizer. The RMTG received only RMT using an IRS. Subjects in the CG received alternative and routine physical therapy or usual care. The interventions were conducted over an eight-week period. Pulmonary function was evaluated using spirometry to measure the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁).

Results: The differences between the pre- and post-test values for FVC (0.47?±?0.05 versus 0.15?±?0.06 versus –0.03?±?0.01) and FEV₁ (0.74?±?0.07 versus 0.27?±?0.17 versus 0.02?±?0.67)were significant among the groups. Post-test, in the ITG, the FVC and FEV₁ values showed significant differences from those in the RMTG and CG (F?=?11.48 and 11.49, P?=?0.002 and 0.001). Furthermore, following the 8­week intervention, the change ratio values of the FVC and FEV₁ of the ITG were increased further by an average of 9.75% and 7.91%, respectively, compared with those of the RMTG.

Conclusion: These findings suggest positive evidence that RMT with additional ADIM training can improve pulmonary function in SCI pulmonary rehabilitation.     

Restoration of cough via spinal cord stimulation improves pulmonary function in tetraplegics

Background: Spinal cord injury (SCI) results in significant loss in pulmonary function secondary to respiratory muscle paralysis. Retention of secretions and atelectasis and, recurrent respiratory tract infections may also impact pulmonary function.

Objective: To determine whether usage of lower thoracic spinal cord stimulation (SCS) to restore cough may improve spontaneous pulmonary function in individuals with chronic SCI.

Design/Methods: 10 tetraplegics utilized SCS system on a regular daily basis. Spontaneous inspiratory capacity (IC), maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured at baseline prior to usage of the device and repeated every 4–5 weeks over a 20-week period. Maximum airway pressure generation (P) during SCS (40?V, 50?Hz, 0.2?ms) at total lung capacity (TLC) with subject maximal expiratory effort, at the same timepoints were determined, as well.

Results: Following daily use of SCS, mean IC improved from 1636?±?229 to 1932?±?239?ml (127?±?8% of baseline values) after 20 weeks (P?<?0.05). Mean MIP increased from 40?±?7, to 50?±?8?cmH₂O (127?±?6% of baseline values) after 20 weeks, respectively (P?<?0.05). MEP also improved from 27?±?3.7 to 33?±?5 (127?±?14% of baseline values) (NS). During SCS, P increased from baseline in all participants from mean 87?±?8?cmH₂O to 117?±?14 cmH₂O at weeks 20, during TLC with subject maximal expiratory effort, respectively (P?<?0.05). Each subject stated that they experienced much greater ease in raising secretions with use of SCS.

Conclusion: Our findings indicate that use of SCS not only improves expiratory muscle function to restore cough but also results in improvement inspiratory function, as well.     

Aquatic,deep water peak VO2 testing for individuals with spinal cord injury

Objective: To determine the reliability of peak VO₂ testing for individuals with spinal cord injury (SCI) in deep water and on land; and to examine the relationship between these two testing conditions.

Design: Reliability study.

Setting: Comprehensive rehabilitation center in Baltimore, MD, USA.

Participants: 17 participants (13 men, 4 women) with motor complete and incomplete SCI. Participants were randomized into either aquatic or arm cycle ergometer first measurements.

Intervention: Pilot study to assess peak VO₂.

Outcome measures: Peak VO₂ measured with metabolic cart in supported deep water with the addition of Aquatrainer® connection, and on land with arm cycle ergometer. Two trials were conducted for each condition with 48?h separating each test.

Results: Peak oxygen consumption reliability was statistically significant for both conditions, aquatic (r?=?0.93, P?<?0.001) and arm cycle ergometry (r?=?0.96, P?<?0.001). Additionally, aquatic and arm cycle peak VO₂ correlation existed (r?=?0.72, P?<?0.001). For these 17 participants, lower extremity motor score influenced supported, deep water peak VO₂, B?=?0.57, P?<?0.02, whereas age, sex, and weight did not impact deep water or ergometer values.

Conclusion: Determining peak VO₂ for individuals with SCI is highly reproducible for arm cycle ergometry and in deep water assessment. Additionally, aquatic, deep water peak VO₂ testing is valid when compared to arm cycle ergometry. Although the peak VO₂ relationship between deep water and arm cycle ergometry is high, variance in the two conditions does exist. Therefore, it is important to assess peak VO₂ via the same exercise modality utilized in the treatment intervention.     

Surgical management of patients following traumatic spinal cord injury: Identifying barriers to early surgery in a specialized spinal cord injury center

Context/Objective: Early surgery in individuals with traumatic spinal cord injury (T-SCI) can improve neurological recovery and reduce complications, costs and hospitalization. Patient-related and healthcare-related factors could influence surgical delay. This study aimed at determining factors contributing to surgical delay in individuals with T-SCI.

Design: Prospective cohort study.

Setting: Single Level I trauma center in Québec, Canada.

Participants: One hundred and forty-four patients who sustained a T-SCI.

Interventions: None.

Outcome measures: Socio-demographic and clinical administrative data were collected during the pre-operative period. The cohort was stratified in early surgery, or ES (<24 hours post-trauma) and late surgery, or LS (≥ 24 hours post-trauma) groups. A multivariate logistic regression analysis using patient- and healthcare-related factors was carried out to identify the main predictors of LS.

Results: 93 patients had ES (15.6?±?4.7 hours post-trauma), which is 31 hours earlier than the 51 patients in the LS group (46.9?±?30.9 hours; P??3). The transfer delay from trauma site to the SCI center was 8 hours shorter (5.0?±?3.0 hours vs 13.6?±?17.0; P??3) for the ES group, and the surgical plan was completed 17 hours faster (6.0?±?4.0 hours vs 23.3?±?23.6 hours; P??3) than for the LS group. The occurrence of LS was predicted by modifiable factors, such as the transfer delay to the SCI center, the delay before surgical plan completion, and the waiting time for the operating room.

Conclusions: A dedicated team for surgical treatment of individuals with T-SCI, involving direct transfer to the SCI center, faster surgery planning and access to the operating room in hospitals dealing with emergencies from all subspecialties could improve surgical delay and increase the rate of patients undergoing ES.     

Biomarkers for recurrent pressure injury risk in persons with spinal cord injury

Objective: To investigate potential linkages between pressure injury (PrI) recurrence following spinal cord injury (SCI) and muscle-based and circulatory biomarkers, specifically fatty metabolites and inflammatory cytokines.

Design: Observational study.

Setting: Tertiary Care Center.

Participants: 30 individuals with complete or incomplete SCI. Study participants either had never developed a PrI (Group I) or had a history of recurrent PrI (Group II).

Interventions: Not applicable.

Outcome Measures: Gluteal muscle histology, immunohistochemistry, muscle-based and circulatory fatty metabolites and inflammatory cytokines.

Results: Gluteal intramuscular adipose tissue (IMAT) was greater than 15% in most Group II (83%) individuals. Muscle tissue histology confirmed intramuscular structural differences. Fatty acid binding protein 4 (FABP4) and fatty acid binding protein 3 (FABP3) were reliably detected in muscle and blood and significantly correlated with IMAT (P?<?0.001). FABP4 was significantly higher in Group II muscle and blood (P?<?0.05). FABP3 was significantly higher in Group I muscle (P?<?0.05). Circulatory FABP3 levels were lower for Group I. Inflammatory biomarkers were more reliably detected in blood. Colony-Stimulating Factor-1 was slightly higher in Group II muscle. Circulatory interleukin-13 was significantly higher (P?<?0.01) in Group I. Vascular endothelial growth factor (VEGF-A) was significantly increased (P?<?0.05) in Group I muscle and blood.

Conclusion: Identifying individuals with SCI at highest risk for recurrent PrI may impact patient management. IMAT content evaluation illustrates that muscle quality is a key biomarker. Low circulatory inflammatory biomarker expression potentially limits clinical significance for between group differences. Circulatory levels of FABP4 hold great potential as a recurrent PrI risk biomarker.     

Very low doses of direct intravenous iron in each session as maintenance therapy in hemodialysis patients

Background: Intravenous (IV) iron supplementation is widely used in hemodialysis (HD) patients to treat their periodic losses. However, the ideal dose and frequency is unknown. The goal of the study is to see if a 20?mg dose of iron IV at the end of each session of HD as iron maintenance is better than the iron prior therapy. We analyze the erythropoiesis activity (EA) and functional iron (FI) after four weeks of treatment.

Methods: In 36 patients, we measure reticulocyte count and content of hemoglobin reticulocyte (CHr) as EA and FI markers, respectively, before and after the treatment. Before the study, 23 patients received another different therapy with IV iron as maintenance therapy.

Results: Reticulocyte count: 49.7?±?23.8?×?10³ before and 47.2?±?17.2?×?10³ after the treatment (p=?0.51). The CHr: 34.8?±?3.7?pg and 34.4?±?3.5?pg, respectively, (p=?0.35), showing an excellent correlation with the other FI markers (serum iron r?=?0.6; p?=?0.001; saturation transferrin r?=?0.49; p?=?0.004); that is not shown with the serum ferritin (r?=?0.23; p?=?0.192) or the hepcidin levels (r?=?0.22; p?=?0.251). There was not a correlation between the C-Reactive Protein, reticulocyte count, and CHr. The 13 patients who did not receive the iron prior to the study showed high FI levels, but not an increased of the serum ferritin or the serum hepcidin levels.

Conclusions: The administration of a small quantity of iron at the end of every HD session keeps the EA and the FI levels and allows reducing the iron overload administered and/or decreasing the iron stores markers in some patients.     

Poster Presentations

Objective: To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI).

Design: Community Survey (2011–2013) as part of the Swiss Spinal Cord Injury Cohort Study.

Setting: Community.

Participants: Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10–100?m).

Interventions: Not applicable.

Outcome Measures: Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains “changing basic body position,” “transferring oneself” and “moving around.” Binary outcomes (“independence” vs. “no independence”) were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions).

Results: Regression analyses (N?=?949; 27% women; median age 51, interquartile range 41–61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for “changing basic body position” (age 16–30 (reference), 31–45 (0.99; 0.53–1.83), 46–60 (0.64; 0.33–1.21), 61–75 (0.45; 0.22–0.92), 76+ (0.18; 0.07–0.44); P?Conclusions: Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.     

Postural stability during standing and its association with physical and cognitive functions in non-dialysis chronic kidney disease patients

Purpose

Chronic kidney disease (CKD) is characterised by poor physical function. A possible factor may be aberrant changes to balance and postural stability (i.e. ability to maintain centre of pressure (COP)). Previous research has exclusively focused on patients undergoing renal replacement therapy (RRT). The current study investigated postural stability in a group of CKD patients not requiring RRT.

Methods

30 CKD patients (aged 57.0?±?17.8 years, 47% female, mean eGFR 42.9?±?27.2 ml/kg/1.73 m²) underwent a series of physical function assessments including the sit-to-stand-5 and -60, incremental shuttle walk test, gait speed, and short physical performance battery. Postural stability (defined as total COP ellipse (mm²) displacement) was measured using the Fysiometer board. Control reference data were provided by the manufacture. Cognitive function was assessed using the ‘Montreal Cognitive Assessment-Basic’ (MOCA-B)’.

Results

CKD patients had poorer postural stability during quiet standing than reference values across all age categories (≤?39 years, 24.9?±?11.3 vs. 10.4?±?1.8 mm²; 40–59 years, 34.3?±?19.0 vs. 17.7?±?6.2 mm²;?≥?60 years, 39.7?±?21.2 vs. 16.8?±?2.9 mm², all comparisons P?<?0.001). Reductions in postural stability were associated with both physical and cognitive functioning. In females only, postural stability worsened with declining renal function (r?=???0.790, P?<?0.01).

Conclusions

To our knowledge, this is the first and largest experimental report concerning measurement of postural stability of CKD patients not requiring RRT. Our findings suggest that postural stability is associated with worse physical and cognitive functioning in this patient group.

     

Effect of acute intermittent hypoxia on motor function in individuals with chronic spinal cord injury following ibuprofen pretreatment: A pilot study

Introduction: Acute intermittent hypoxia (AIH) enhances lower extremity motor function in humans with chronic incomplete spinal cord injury (SCI). AIH-induced spinal plasticity is inhibited by systemic inflammation in animal models. Since SCI is frequently associated with systemic inflammation in humans, we tested the hypothesis that pretreatment with the anti-inflammatory agent ibuprofen enhances the effects of AIH.

Methods: A randomized, double-blinded, placebo-controlled crossover design was used. Nine adults (mean age 51.1?±?13.1 years) with chronic motor-incomplete SCI (7.7?±?6.3 years post-injury) received a single dose of ibuprofen (800?mg) or placebo, 90 minutes prior to AIH. For AIH, 9% O₂ for 90 seconds was interspersed with 21% O₂ for 60 seconds. Maximal voluntary ankle plantar flexion isometric torque was assessed prior to, and at 0, 30, and 60 minutes post-AIH. Surface electromyography (EMG) of plantar flexor muscles was also recorded.

Results: Torque increased significantly after AIH at 30 (P?=?0.007; by ～20%) and 60 (P?2?=?0.17, P?2?=?0.17, P?Conclusions: AIH systematically increased lower extremity torque in individuals with chronic incomplete SCI, but there was no significant effect of ibuprofen pretreatment. Our study re-confirms the ability of AIH to enhance leg strength in persons with chronic incomplete SCI.     

Circulating irisin levels reflect visceral adiposity in non-diabetic patients undergoing hemodialysis

Background: Recent evidence suggests that increased visceral adiposity is a strong independent risk factor for cardiovascular death and all-cause mortality in hemodialysis (HD) patients. Irisin, which is a novel myokine, can play critical roles in diabetes and adiposity. The purpose of our study was to investigate whether serum irisin levels are associated with body mass index, waist circumference (WC), and total fat mass in non-diabetic patients undergoing maintenance HD.

Methods: This cross-sectional study included 108 non-diabetic HD patients and 40 age- and sex-matched apparently healthy subjects. Serum irisin concentrations were determined using an enzyme-linked immunosorbent assay. Body fat composition (TBF-410 Tanita Body Composition Analyzer) was measured and calculated.

Results: Serum irisin levels did not differ between HD patients and the healthy controls (523.50?±?229.32 vs. 511.28?±?259.74, p?=?0.782). Serum irisin levels were associated with age (r?=?0.314; p?=0.006), HOMA-IR (r?=?0.472; p?=?0.003), WC (r?=?0.862; p?r?=?0.614; p?β?=?1.240, p?β?=?0.792, p?=?0.015) were the variables that were significantly associated with irisin concentrations (R^2?=^?0.684, p?Conclusions: These results suggest that serum irisin levels are related to visceral adiposity in non-diabetic HD patients.     

Biochemical Markers and Obstructive Sleep Apnea Risk in Individuals After Long-Term Bariatric Surgery

Background

Individuals who have undergone long-term bariatric surgery may be at increased obstructive sleep apnea (OSA) risk. The purpose of this study was to estimate the frequency of OSA risk and its associations, via biochemical markers, in patients who have undergone long-term bariatric surgery.

Methods

This cross-sectional study evaluated patients after 5 years or more post Roux-en-Y gastric bypass. Biochemical markers, anthropometrics, and OSA risk, via the STOP-Bang score screening tool, were evaluated. Independent Student t, Pearson’s chi-squared, or correlation tests were applied, according to total OSA risk score groups or its isolated components.

Results

Among the 77 patients evaluated (88.3% female; body mass index?=?32.7?±?5.8 kg/ m²; postoperative time?=?9.9?±?3.1 years), 36 were at risk for OSA. OSA risk score was positively correlated to high-sensitivity C-reactive protein levels (r²?=?0.270; p?=?0.025), triglycerides (r²?=?0.338, p?=?0.004), total cholesterol (r²?=?0,262; p?=?0,028), and HbA1c (r²?=?0.332; p?=?0.005). Compared to each counterpart, basal insulin and triglycerides were higher among those who self-reported witnessed apnea (12.8?±?6.5 vs 8.1?±?3.8, p?=?0.013; 136.4?±?41.1 vs 88.5?±?34.8, p?=?0.001, respectively), while levels of total cholesterol and LDL-C were higher in participants who reported tiredness (183.9?±?27.0 vs 164.8?±?33.4, p?=?0.005; 105.9?±?24.4 vs 92.0?±?26.6, p?=?0.018). Participants with snoring also had higher levels of triglycerides (107?±?41.1 vs 83.7?±?33.9, p?=?0.010).

Conclusions

OSA risk was highly prevalent among patients who had undergone long-term bariatric surgery, as noted via increased STOP-Bang scores, as were isolated components related to inflammatory markers and lipid and glycemic profile.

Graphical Abstract

     

Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal pelvic calculi (diameter >2 cm): a meta-analysis

Objective: To systematically assess the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal pelvic calculi >2?cm.

Methods: We searched PubMed, Embase, Cochrane Library, and Google Scholar about LP and PCNL for the treatment of renal stones. The retrieval time ended in September 2015. Two reviewers independently assessed the quality of all included studies. The available data in the studies were analyzed using the RevMan 5.2 software.

Results: Four randomized controlled trials (RCTs) and nine Non-Randomized Concurrent Controlled Trials (NRCCTs) were included, involving a total of 766 patients. This meta-analysis showed that LP has a statistically higher stone-free rate than PCNL [I^2?=?0, OR?=?0.26 (95% CI 0.10–0.64), p?=?0.003], lower drop in hemoglobin level [I^2?=^?0, difference in mean drop?=??0.83 (95% CI ?1.05 to ?0.61), p?I^2?=^?0, OR?=?0.36 (95% CI 0.14–0.89), p?=?0.03], and PCNL is associated with a lower length of hospital stay [I^2?=^?74%, difference in mean of hospital stay?=?0.72 (95% CI 0.04–1.40), p?=?0.04].

Conclusion: LP is an alternative for the treatment of large solitary renal stone. LP may have a higher stone-free rate, lesser blood loss, lower postoperation fever rate, while PCNL may have a lower length of hospital stay. However, further well designed and large volume randomized controlled trials are needed to confirm these findings.     

Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands

Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs).

Design: TSI-stratified cross-sectional study. Strata were 10–19, 20–29 and 30+ years.

Setting: Community.

Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18–35 years; TSI?≥?10 years; current age 28–65 years; wheelchair dependency.

Interventions: Not applicable.

Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician.

Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β?=?–0.7; P?<?.001) and waist circumference (β?=?–0.1; P?=?.042) were independent determinants (explained variance 55%).

Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence.     

Physiological and perceptual effects of precooling in wheelchair basketball athletes

Objective: To investigate the physiological and perceptual effects of three precooling strategies during pre-exercise rest in athletes with a spinal cord injury (SCI).

Design: Randomized, counterbalanced. Participants were precooled, then rested for 60 minutes (22.7?±?0.2°C, 64.2?±?2.6%RH).

Setting: National Wheelchair Basketball Training Centre, Australia.

Participants: Sixteen wheelchair basketball athletes with a SCI.

Interventions: Participants were precooled through; 1) 10 minutes of 15.8°C cold water immersion (CWI), 2) ingestion of 6.8?g/kg^?1 of slushie (S) from sports drink; 3) ingestion of 6.8?g/kg^?1 of slushie with application of iced towels to the legs, torso and back/arms (ST); or 4) ingestion of 6.8?g/kg^?1 of room temperature (22.3°C) sports drink (CON).

Outcome measures: Core temperature (T_gi), skin temperature (T_sk), heart rate (HR), and thermal and gastrointestinal comfort.

Results: Following CWI, a significant reduction in T_gi was observed compared to CON, with a greatest reduction of 1.58°C occurring 40 minutes post-cooling (95% CI [1.07, 2.10]). A significant reduction in T_gi following ST compared to CON was also observed at 20 minutes (0.56°C; [0.03, 1.09]) and 30 minutes (0.56°C; [0.04, 1.09]) post-cooling. Additionally, a significant interaction between impairment level and time was observed for T_gi and HR, demonstrating athletes with a higher level of impairment experienced a greater reduction in HR and significant decrease in rate of decline in T_gi, compared to lesser impaired athletes.

Conclusion: CWI and ST can effectively lower body temperature in athletes with a SCI, and may assist in tolerating warm conditions.     

Higher dietary intake of vitamin D may influence total cholesterol and carbohydrate profile independent of body composition in men with Chronic Spinal Cord Injury

Study Design: A case-control design.

Objectives: To determine the effects of dietary vitamin D intake on insulin sensitivity (Si), glucose effectiveness (Sg), and lipid profile in individuals with spinal cord injury (SCI).

Methods: 20 male, paraplegic (T3-L1) with chronic (> one year) motor complete SCI (AIS A or B) were recruited. Three-day dietary records were analyzed for dietary vitamin D (calciferol), and participants were assigned to one of two groups, a high vitamin D intake group and a low vitamin D intake group based on the mid-point of vitamin D frequency distribution. Individuals in both groups were matched based on age, weight, time since injury and level of injury. Sg, Si and lipid profiles were measured of the two groups.

Results: The high vitamin D group had an average intake of 5.33?±?4.14 mcg compared to low vitamin D group, 0.74?±?0.24 mcg. None of the 20 participants met the recommended guidelines for daily vitamin D intake. The higher vitamin D group had a significantly lower (P?=?0.035) total cholesterol (148.00?±?14.12 mg/dl) than the lower vitamin D group (171.80?±?36.22 mg/dl). Vitamin D adjusted to total dietary intake was positively correlated to improvement in Si and Sg (P<0.05).

Conclusion: The findings suggest that persons with SCI consume much less than the recommended guidelines for daily vitamin D intake. However, a higher dietary intake of vitamin D may influence total cholesterol and carbohydrate profile as demonstrated by a significant decrease in total cholesterol and improvement in glucose homeostasis independent of body composition changes after SCI.     

Association of musculoskeletal pain,fear-avoidance factors,and quality of life in active manual wheelchair users with SCI: A pilot study

Objective: Limited evidence examines the association of psychological factors, such as fear of movement and pain catastrophizing, with musculoskeletal pain patterns in active manual wheelchair users with spinal cord injury (SCI). This study investigated the relationship among musculoskeletal pain, fear avoidance factors, quality of life (QoL), activity and duration of injury in individuals with SCI.

Design: Cross-sectional correlational.

Setting: Community setting.

Participants: Twenty-six individuals with SCI (age?=?42?±?14 years, duration manual wheelchair use?=?17?±?13 years, work/school/volunteer hours/week?=?31?±?14; recreation/sports hours/week 10?±?12).

Outcome Measures: Demographics and self-report measures including the Musculoskeletal Pain Survey (MPS), Wheelchair Users Shoulder Pain Index (WUSPI), Tampa Scale of Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), Fear of Pain (FPQ), Subjective Quality of Life Questionnaire (SQoL), and the Social Interaction Inventory (SII). Spearman’s rho (ρ) assessed correlation among measures.

Results: Strong association existed between age and duration of injury (ρ?=?0.66, P?<?0.001). SQoL offered a strong, direct correlation with age (ρ?=?0.63, P?=?0.01), duration of injury (ρ?=?0.70, P?=?0.001), and strong, inverse relationship with MPStotal (ρ?=??0.66, P?=?0.003) and MPS shoulder subscore (ρ?=??0.64, P?=?0.004). WUSPI demonstrated strong, inverse association with self-reported work hours (ρ?=??0.52, P?=?0.02) and a strong, direct relationship to PCS (ρ?=?0.79, P?=?<0001). PCS demonstrated a strong, inverse relationship to work/school/volunteer hours (ρ?=?0.71, P?<?0.001) and strong association to TSK-11_total (ρ?=?0.61, P?=?0.001). A moderate, inverse relationship was identified for recreational/sports hours and FPQ (ρ?=?0.48, P?=?0.03).

Conclusion: This cyclical relationship of musculoskeletal pain, reduced activity, and maladaptive psychological factors allude to interdependence of factors, supporting the multidisciplinary approach to care.     

Sacral examination in spinal cord injury: Is it really needed?

Objective: To determine if a self-report measure of S4-5 motor and sensory function in patients with chronic SCI accurately predicts sacral examination results.

Design: Prospective, single-blinded self-report survey compared with sacral exam.

Setting: Outpatient SCI clinic.

Participants: 116 patients aged 18+ with chronic SCI > 6 months who have undergone sacral exam.

Interventions: The survey included demographic/clinical and sacral function information such as light tough (LT), pinprick sensation (PP), deep anal pressure (DAP) and voluntary anal contraction (VAC). Survey results and sacral exam were compared and stratified by the patient’s American Spinal Cord Injury Association Impairment Scale (AIS) category.

Outcome Measures: Sacral self-report survey, AIS examination.

Results: Mean age was 41.3?±?14.4 years with majority male (69%) and Caucasian (71.6%). Overall, Positive Predictive Value (PPV) ranged between 48% (VAC) to 73% (DAP) and Negative Predictive Value (NPV) between 92% (VAC) to 100% (LT). AIS-A had NPV of 100% across all categories, and AIS-D had PPV of 100% across all categories.

Conclusion: Patient report of sacral sparing can predict negative sensation in patients with AIS-A and predict positive sensation in persons with AIS-D. Overall, the self-report of sacral sparing of motor and sensory function is not predictive enough to rely on for accurate classification.     

Increased serum renalase in hemodialysis patients: is it related to left ventricular hypertrophy?

Introduction: Left ventricular hypertrophy (LVH) is one of the most common cardiac abnormalities in patients with end stage renal disease (ESRD). Hypertension, diabetes, increased body mass index, gender, age, anemia, and hyperparathyroidism have been described as risk factors for LVH in patients on dialysis. However, there may be other risk factors which have not been described yet. Recent studies show that renalase is associated with cardiovascular events. The aim of this study was to reveal the relation between renalase, LVH in patients under hemodialysis (HD) treatment.

Methods: The study included 50?HD patients and 35 healthy controls. Serum renalase levels and left ventricle mass index (LVMI) were measured in all participants and the relation between these variables was examined.

Findings: LVMI was positively correlated with dialysis vintage and C-reactive protein (CRP) (r?=?0.387, p?=?0.005 and r?=?0.597, p?r?=??0.324, p?=?0.022 and r?=??0.499, p?r?=?0.263, p?=?0.065). Serum renalase levels were significantly higher in HD patients (212?±?127?ng/mL) compared to controls (116?±?67?ng/mL) (p?r?=?0.677, p?r?=?0.625, p?Discussion: In our study, LVMI was correlated with dialysis vintage, residual diuresis, CRP, and hemoglobin. LVMI tends to correlate with renalase and this correlation may be significant in studies with more patient numbers. The main parameters affecting renalase levels are dialysis vintage and serum creatinine.