Provocative stimulation of growth hormone: a monozygotic twin study discordant for spinal cord injury

BACKGROUND/OBJECTIVE: A blunted growth hormone (GH) response to provocative testing and/or low levels of plasma insulin-like growth factor-I (IGF-I) have been reported in persons with spinal cord injury (SCI). A reduction in activity of the GH-IGF-I axis may have deleterious effects on body composition and function. Provocative testing for GH stimulation was performed to determine the response in monozygotic twins that were discordant for SCI. METHODS: GH stimulation testing was performed by the administration of intravenous arginine. RESULTS: Nine SCI twins with paraplegia, a mean age of 39 +/- 9 years, and duration of injury of 14 +/- 9 years were studied. The twins with SCI had a significantly lower body mass index than non-SCI twins (22.5 +/- 4.0 vs 25.1 +/- 4.2 kg/m2; P < 0.05); percent fat mass was greater in the twins with SCI (30 +/- 11% vs 22 +/- 10%; P < 0.05). Baseline serum GH was correlated with percent fat only in the SCI twins. The response to GH provocative stimulation was less in the twins with SCI: peak GH response was 5.8 +/- 6.6 vs 13.0 +/- 7.3 ng/mL (P < 0.05), and sum GH response was 15.7 +/- 15.6 vs 30.2 +/- 17.3 ng/mL (P = 0.06). Although baseline serum GH was correlated with stimulated response in the SCI twins, this relationship was not found in the non-SCI twins. Adiposity was positively related to the provocative serum GH response in twins with SCI rather than negatively related, as noted in the non-SCI twins. CONCLUSIONS: This study confirms and extends prior work that reported a reduction in stimulated GH release in persons with SCI, which was related to baseline values.     

Pulse Wave Velocity for Assessment of Arterial Stiffness Among People With Spinal Cord Injury: A Pilot Study

Background/Objective: The most significant complication and leading cause of death for people with spinal cord injury (SCI) is coronary artery disease (CAD). It has been confirmed that aortic pulse wave velocity (PVW) is an emerging CAD predictor among able-bodied individuals. No prior study has described PWV values among people with SCI. The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PVW, and leg (the femoral to posterior tibial artery) PVW in people with SCI (SCI group) to able-bodied controls (non-SCI group).

Methods: Participants included 12 men with SCI and 9 non-SCI controls matched for age, sex, height, and weight. Participants with a history of CAD or current metabolic syndrome were excluded. Aortic, arm, and leg PVW was measured using the echo Doppler method.

Results: Aortic PVW (mean ± SD) in the SCI group (1,274 ± 369 cm/s) was significantly higher (P < 0.05) than in the non-SCI group (948 ± 110 cm/s). There were no significant between-group differences in mean arm PVW (SCI: 1,152 ± 193 cm/s, non-SCI: 1,237 ± 193 cm/s) or mean leg PVW (SCI: 1,096 ± 1 73 cm/s, non-SCI: 994 ±178 cm/s) values.

Conclusions: Aortic PVW was higher among the SCI group compared with the non-SCI group. The higher mean aortic PVW values among the SCI group compared with the non-SCI group indicated a higher risk of CAD among people with SCI in the absence of metabolic syndrome.     

Altered resting hemodynamics in lower-extremity arteries of individuals with spinal cord injury

Abstract

Objective

To investigate lower-extremity arterial hemodynamics in individuals with spinal cord injury (SCI). We hypothesized that oscillatory shear index would be altered and resting mean shear would be higher in the lower-extremity arteries of SCI.

Research

Cross-sectional study of men and women with SCIs compared to able-bodied controls.

Subjects

Subjects included 105 ages 18–72 years with American Spinal Injury Association (ASIA) Impairment Scale grades A, B, or C and injury duration at least 5 years. Subjects were matched for age and cardiovascular disease risk factors with 156 able-bodied controls.

Methods

Diameter and blood velocity were determined with subject at rest via ultrasound in superficial femoral, popliteal, brachial, and carotid arteries. Mean shear, antegrade shear, retrograde shear, and oscillatory shear index were calculated.

Results

Oscillatory shear index was lower in SCI compared to controls for superficial femoral (0.16 ± 0.10 vs. 0.26 ± 0.06, P < 0.01) and popliteal arteries (0.20 ± 0.11 vs. 0.26 ± 0.05, P < 0.01). Mean shear rate was higher in SCI compared to controls for superficial femoral (43.54 ± 28.0 vs. 20.48 ± 13.1/second, P < 0.01) and popliteal arteries (30.43 ± 28.1 vs. 11.68 ± 9.5/second, P < 0.01).

Conclusions

The altered resting hemodynamics in SCI are consistent with an atheroprotective hemodynamic environment.     

Bladder Stones Following Sci In The Sprague-Dawley Rat

Abstract

Objective: To develop a spinal cord injury (SCI) animal model for the study of bladder stones and compare this model with a non-SCI animal model.

Methods: Small pieces of catheters were implanted into the bladders of Sprague-Dawley rats as a nidus for bladder stone formation. Three weeks later, the rats underwent an SCI surgery (SCI transection or sham SCI). Control rats had SCI surgery, but no catheters were implanted into their bladders.

Main Outcome Measures: Bladder stone number, weight, and composition were determined in two groups of SCI and sham SCI animals: Group A (recent spinal shock: 2 weeks post-SCI/sham SCI surgery) and Group B(out of spinal shock: 3 weeks to 3 months post-SCI/sham SCI surgery). AX2 test was used to compare the incidence of bladder stones in SCI vs sham SCI animals. AStudent t test was used to compare the weight of bladder stones in the 2 groups.

Results: Group A(recent spinal shock): Of the 20 SCI rats, 8 (40%) had stones. None of the sham SCI rats with implanted catheters (n = 5) had stones (0%). Group B(out of spinal shock): All 6 of the SCI rats with implanted catheters had stones (100%). Of the 10 sham SCI animals with implanted catheters, 3 (30%) had stones. Stones were more common in the SCI rats than in the sham SCI rats (X²., = 4.9, P < 0.05). The mean weight of the bladder stones in SCI rats (42.2 ± 16.3 mg) was greater than that in sham SCI rats (5.4 ± 1.5 mg) (P < 0.01). Group C (controls: SCI surgery, but no catheter implanted): At 3 weeks post-SCI, control rats had no stones (n = 7); control rats at 3 months post-SCI also had no stones (n = 9). Stone composition in the 3 sham SCI animals was calcium apatite (90%) and calcium oxylate (10%). In the 14 SCI rats, 10 had struvite stones (1 00%), 1 had struvite (70%) and carbonate apatite (30%) stones, 1 had brushite (100)% stones, and 2 had carbonate apatite (>90%) stones.

Conclusion: Bladder stones occurred earlier and more frequently and attained a larger size in SCI rats with catheters compared with sham SCI rats with catheters. There were no stones in SCI rats without catheter implants, even at 3-month follow-up. The bladder stone composition in SCI rats was similar to that in humans with SCI. The Sprague-Dawley rat model appears to be an excellent animal model for the study of bladder stones following SCI.

J Spinal Cord Med. 2003;26:65-68     

Low-Frequency Fatigue in Individuals With Spinal Cord Injury

Abstract

Background/Objective: This study examined magnitude and recovery of low-frequency fatigue (LFF) in the quadriceps after electrically stimulated contractions in spinal cord-injured (SCI) and able-bodied subjects.

Subjects: Nine SCI (ASIA A-C, levels C5-T9, injured 13.6 ± 12.2 years) and 9 sedentary able-bodied subjects completed this study.

Methods: Fatigue was evoked in 1 thigh, and the nonfatigued leg served as a control. The fatigue test for able-bodied subjects lasted 15 minutes. For SCI, stimulation was adjusted so that the relative drop in force was matched to the able-bodied group. Force was assessed at 20 (P20) and 100 Hz (PI 00), and the ratio of P20/P100 was used to evaluate LFF in thighs immediately after, at 10, 20, and 60 minutes, and at 2, 4, 6, and 24 hours after a fatigue test.

Results: The magnitude of LFF (up to 1 hour after fatigue) was not different between able-bodied and patients with SCI. However, recovery of LFF over 24 hours was greater in able-bodied compared with patients with SCI in both the experimental (P < 0.001) and control legs (P < 0.001). The able-bodied group showed a gradual recovery of LFF over time in the experimental leg, whereas the SCI group did not.

Conclusions: These results show that individuals with SCI are more susceptible to LFF than able-bodied subjects. In SCI, simply assessing LFF produced considerable LFF and accounted for a substantial portion of the response. We propose that muscle injury is causing the dramatic LFF in SCI, and future studies are needed to test whether “fatigue” in SCI is actually confounded by the effects of muscle injury.     

Evaluation of the Effects of Compression Stockings Using Venous Plethysmography in Persons With Spinal Cord Injury

Abstract

Background/Objective: To examine the effect of graduated compression stockings (GCS) on the properties of the venous vascular system, as characterized by venous capacitance (VC) and venous outflow (VO), in the lower extremities of individuals with spinal cord injury (SCI), according to injury level.

Methods: Nine male subjects with SCI (5 with low paraplegia [LP], 4 with high paraplegia [HP]) performed 2 plethysmography tests: with and without graduated compression knee-length stockings (pressure of 21 mm/Hg). The VC, VO, and cardiovascular parameters (heart rate and blood pressure) were evaluated with and without GCS.

Results: The VC and VO were lower in patients with HP than in those with LP. For all subjects, VC was significantly lower (-14%) with GCS than without (1.77 ± 1.18 vs 1.53 ± 1.09 vol%, P < 0.01). On the contrary, VO did not differ significantly when wearing or not wearing GCS.

Conclusions: This study demonstrated that 21-mm/Hg knee-length GCS are sufficient to prevent venous distension in individuals with SCI, even those with longstanding paraplegia, by significantly decreasing venous capacitance. This intervention may help to prevent deep vein thrombosis.     

Continuous Loss of Bone During Chronic Immobilization: A Monozygotic Twin Study

Acute immobilization is associated with rapid loss of bone. Prevailing opinion, based on population cross-sectional data, assumes that bone mass stabilizes thereafter. In order to address whole-body and regional skeletal mass in long-term immobilization, monozygotic twins were studied, one of each twin pair having chronic spinal cord injury (SCI) of a duration ranging from 3 to 26 years. The research design consisted of the co-twin control method using 8 pairs of identical male twins (mean ± SD age, 40 ± 10 years; range 25–58 years), one of each set with SCI. The twins were compared by paired t-tests for total and regional bone mineral content (BMC) and bone mineral density (BMD) measured by dual-energy X-ray absorptiometry. Linear regression analyses were performed to determine the associations of age or duration of injury with the differences between twin pairs for total and regional skeletal bone values. In the SCI twins, total-body BMC was significantly reduced (22%± 9%, p<0.001), with the predominant sites of reduction for BMC and BMD being the legs (42%± 14% 35%± 10%, p<0.0001), and pelvis (50%± 10% and 29%± 9%, p<0.0001). Duration of SCI, not age, was found to be linearly related to the degree of leg bone loss in SCI twins (BMC: r ²= 0.60, p<0.05; BMD: r ²= 0.70, p<0.01). Our findings suggest that pelvic and leg bone mass continues to decline throughout the chronic phase of immobilization in the individual with SCI, and this bone loss appears to be independent of age. Received: 28 September 1998 / Accepted: 28 December 1998     

Physical exercise improves arterial stiffness after spinal cord injury

Abstract

Objective/background

Aortic pulse wave velocity (PWV), the gold-standard assessment of central arterial stiffness, has prognostic value for cardiovascular disease risk in able-bodied individuals. The aim of this study was to compare aortic PWV in athletes and non-athletes with spinal cord injury (SCI).

Design

Cross-sectional comparison.

Methods

Aortic PWV was assessed in 20 individuals with motor-complete, chronic SCI (C2–T5; 18 ± 8 years post-injury) using applanation tonometry at the carotid and femoral arterial sites. Ten elite hand-cyclists were matched for sex to 10 non-athletes; age and time since injury were comparable between the groups. Heart rate and discrete brachial blood pressure measurements were collected throughout testing.

Outcome measures

Aortic PWV, blood pressure, heart rate.

Results

Aortic PWV was significantly lower in athletes vs. non-athletes (6.9 ± 1.0 vs. 8.7 ± 2.5 m/second, P = 0.044). There were no significant between-group differences in resting supine mean arterial blood pressure (91 ± 19 vs. 81 ± 10 mmHg) and heart rate (60 ± 10 vs. 58 ± 6 b.p.m.).

Conclusion

Athletes with SCI exhibited improved central arterial stiffness compared to non-athletes, which is in agreement with the previous able-bodied literature. This finding implies that chronic exercise training may improve arterial health and potentially lower cardiovascular disease risk in the SCI population.     

Spinal cord injury causes more damage to bone mass, bone structure, biomechanical properties and bone metabolism than sciatic neurectomy in young rats

Introduction Although both spinal cord injury (SCI) and sciatic neurectomy (NX) can cause osteopaenia in young rats, the effects of these two injuries on cortical and cancellous bone may differ. The objective of this study was to compare the effects of SCI and NX on bone weight, bone material property, bone mass, bone geometry, trabecular microarchitecture, mechanical strength and bone turnover in young rats.Materials and methods Thirty six-week-old male Sprague-Dawley rats were randomised into three groups (10 per group): SCI, bilateral sciatic NX and untreated control (CON). All rats were killed on day 21. Bone mineral density (BMD) was studied using dual-energy X-ray absorptiometry (DXA). At death, the right proximal tibial metaphysis and the fourth lumbar vertebra were examined for bone structural geometric analysis by micro-computed tomography (CT) and then processed for histomorphometry to assess bone cell activity. Serum N-terminal telopeptide of type I collagen (NTX) and osteocalcin (OC) levels were analysed by enzyme-linked immunosorbent assay (ELISA). Biomechanical strength properties of the femur and humerus were measured by three-point bending, and the third lumbar vertebra and the proximal end of tibia were tested by compression.Results BMD in the sublesional areas of SCI rats was significantly lower than that of NX rats (proximal tibia, 0.176±0.018 g/cm² vs. 0.224±0.015 g/cm², P<0.001). Bone volume (BV/TV), trabecular number (Tb.N) and thickness (Tb.Th) in the tibial second spongiosa of SCI rats were significantly less than those in NX rats (BV/TV: 7.15±1.18% vs. 12.32±1.83%, P<0.001; Tb.N: 1.23±0.22 vs. 2.38±0.45, P<0.001; Tb.Th: 33.73±5.15 μm vs. 42.80±7.44 μm, P<0.01) and trabecular separation (Tb.Sp: 1,053.37±164.24 μm vs. 748.32±129.36 μm, P<0.01) was significantly greater than in NX rats. Furthermore, poorer trabecular connectivity was found in SCI rats than in NX rats (number of nodes, N.Nd/TV: 1.04±0.09 vs. 3.29±0.53; number of terminus, N.Tm/TV: 28.53±3.17 vs. 21.64±2.31, P<0.01). The bone formation rate of the tibial second spongiosa in SCI rats was significantly higher than in NX rats (2.06±0.13 vs. 1.53±0.09, P<0.001) and, also, the eroded surface in SCI rats was significantly higher than in NX rats (13.42±1.24 vs. 10.36±1.07, P<0.001). In addition, biomechanical tests showed that SCI rats had poorer biomechanical properties of the femur, proximal tibia and fourth lumbar vertebra than in NX rats. There were significantly higher levels of OC in SCI rats compared with NX rats (30.19±1.17 vs. 21.15±1.76, P<0.001). Also, serum NTX levels were significantly higher than in NX rats (51.60±2.61 vs. 33.85±1.93, P<0.001).Conclusion SCI caused more damage to bone mass, bone structure, biomechanical properties and bone metabolism than NX in young rats. This suggests that different mechanisms may underlie osteopaenia following SCI and NX.     

Lean tissue mass and energy expenditure are retained in hypogonadal men with spinal cord injury after discontinuation of testosterone replacement therapy

Abstract

Objective

To determine whether favorable changes to lean tissue mass (LTM), resting energy expenditure (REE), and testosterone (T) that occurred with 12 months of physiological testosterone replacement therapy (TRT) were retained 6 months after discontinuing treatment.

Design

Prospective, open-label, controlled drug intervention trial.

Setting

Metropolitan area hospitals.

Subjects

Eugonadal (n = 11) and hypogonadal (n = 13) men with chronic spinal cord injury (SCI).

Interventions

Hypogonadal subjects received a 5 or 10 mg transdermal T patch daily for 12 months, with adjustment of the dose to normalize the serum T concentration; TRT was discontinued after 12 months (TRT-12M) and subjects were followed for an additional 6 months and re-evaluated (Post-TRT). Total body dual energy X-ray absorptiometry and blood draws were performed at baseline (BL) prior to TRT, TRT-12M, and Post-TRT. Eugonadal subjects did not receive treatment and were evaluated at comparable time points.

Results

There were no significant differences between groups prior to TRT at BL for any of the study endpoints. In the hypogonadal group, a significant increase in LTM was observed from BL to TRT-12M (50.2 ± 7.4 vs. 52.9 ± 6.8 kg, P < 0.01), which persisted Post-TRT compared to BL (52.2 ± 7.8 kg, P < 0.05). The increase in REE from BL to TRT-12M (1283 ± 246 vs. 1410 ± 250 kcal/day) was also retained at Post-TRT (1393 ± 220 kcal/day). These sustained improvements in LTM and REE after termination of anabolic hormonal therapy may be associated with persistent beneficial effects on health and physical function of hypogonadal men with chronic 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.     

Resting energy expenditure in male athletes with a spinal cord injury

Objective: To investigate whether there are differences in the resting energy expenditure (REE) and body composition of athletes with a spinal cord injury (SCI) compared to active able-bodied controls.

Design: In this cross sectional study, male athletes with a SCI were compared to active able-bodied controls matched for age, stretch stature and body mass. In addition, the accuracy of standard REE prediction equations in estimating REE was assessed.

Participants: Seven male wheelchair athletes with a SCI and six matched active able-bodied controls volunteered to participate.

Outcome measures: REE was measured using indirect calorimetry and estimated using population-specific prediction equations. Body composition (lean tissue mass, fat mass and bone mineral content) was measured by dual energy X-ray absorptiometry (DXA).

Results: While absolute and adjusted REE in the athletes with SCI was lower than controls, this difference was not significant (P?=?0.259). When adjusted for lean tissue mass (LTM), REE was significantly higher (P?=?0.038) in the athletes with SCI compared to the controls (146 ± 29kJ/kg LTM vs. 125 ± 8kJ/kg LTM). LTM was significantly lower in the athletes with SCI (44.35 ± 6.98?kg) compared to the able-bodied controls (56.02 ± 4.93?kg; P < 0.01). The differences between predicted and measured REE in the athletes with SCI were not statistically significant (except for the Owen equation), however there was no significant correlation between the measures.

Conclusion: This suggests that existing prediction equations used to estimate energy requirements may require modification for athletes with SCI.     

Reduced loading due to spinal-cord injury at birth results in “slender” bones: a case study

Introduction The present case study compared bone density, bone geometry and muscle cross-sectional area (CSA) in a male who sustained spinal-cord injury (SCI) at birth (from here called SCI-B) with two matched controls without SCI, and also with four individuals with SCI of similar level and injury completeness but sustained at age 15 or greater. Methods All subjects with SCI were at least 3 years post-injury and had experienced motor incomplete lesions at the cervical level. Computed tomography was used to measure volumetric bone density, indices of bone strength [CSA and maximum, minimum and polar area moments of inertia (I _max, I _min, I _pol)] and muscle CSA at the tibia (66% of tibia length, measured proximally from the distal end). Results Lower leg muscle CSA of SCI-B was 63±6% of values in non-SCI controls, and 72±12% of values in other males with SCI. In SCI-B, bone CSA was roughly half (52±4%) that of non-SCI controls and 73±16% of bone CSA values in other males with SCI. The magnitudes of the area moment of inertia variables (I _max, I _min, and I _pol) in SCI-B were ~25% of control values. Further, the moment of inertia variables in SCI-B were 27–54% of values obtained in other males with SCI, indicating that experiencing SCI in the early stages of life has a remarkable impact on bone shape. Interestingly, tibia bone density did not appear to be affected; the average difference in bone density between SCI-B and non-SCI controls was −1.2±0.7%. The bone densities of other males with SCI were 4–19% lower than in SCI-B. Conclusions Muscle atrophy and bone loss are commonly reported consequences of SCI. This case reveals that important changes in bone geometry occur after SCI, and that mechanical loading during growth plays a vital role in the development of bone size and shape.     

Depression and Spinal Cord Injury: A Monozygotic Twin Study

Abstract

Although, in earlier work, depression in individuals with spinal cord injury (SCI) was attributed to difficulties adjusting to SCI, more recent articles have emphasized the importance of constitutional and environmental factors not specific to SCI, as well as established theoretical models of depression. To further explore this question, 11 pairs of monozygotic twins, where one of each pair was spinal cord injured, were studied. Measures included the Beck ? Depression Inventory, the depression scale of the SCL-90R, and the Rosenberg Self-Esteem Scale. Using pairwise t tests, the authors did not find any significant differences between SCI and non-SCI co-twins. These findings are consistent with the idea that the occurrence of SCI does not inevitably lead to increased depression.     

Body Composition,Basal Metabolic Rate and Leptin in Long-Term Weight Regain After Roux-en-Y Gastric Bypass Are Similar to Pre-surgical Obesity

Purpose

The purpose of this study is to evaluate the relationship between body composition, basal metabolic rate (BMR), and serum concentrations of leptin with long-term weight regain after Roux-en-Y gastric bypass (RYGB) and compare it with obesity before surgery.

Materials and Methods

Prospective longitudinal analytical study. Three groups were formed: individuals 60 months post RYGB, with weight regain (G1) and without it (G2), and individuals with obesity who had not undergone bariatric surgery (G3). Body fat (BF), body fat mass (BFM), visceral fat (VF), fat-free mass (FFM), skeletal muscle mass (SMM), and BMR were assessed by octapolar and multi-frequency electrical bioimpedance. Fasting serum concentrations of leptin were measured.

Results

Seventy-two individuals were included, 24 in each group. Higher means of BF, BFM, VF, and leptin levels were observed in G1, when compared to G2 (BF: 47.5 ± 5.6 vs. 32.0 ± 8.0, p < 0.05; FBM: 47.8 ± 11.6 vs. 23.9 ± 7.0, p < 0.05; VF: 156.8 ± 30.2 vs. 96.1 ± 23.8, p < 0.05; leptin: 45,251.2 pg/mL ± 20,071.8 vs. 11,525.7 pg/mL ± 9177.5, p < 0.000). G1 and G2 did not differ in FFM, SMM, and BMR. G1 and G3 were similar according to BF, FFM, BMR, and leptin levels. Body composition, but not leptin, was correlated with %weight regain in G1 (FBM: r = 0.666, p < 0.000; BF: r = 0.428, p = 0.037; VF: r = 0.544, p = 0.006).

Conclusion

Long-term weight regain after RYGB is similar to pre-surgical obesity in body composition, BMR, and leptin concentrations, indicating relapse of metabolic and hormonal impairments associated with excessive body fat.

Graphical abstract

     

In-Vivo Whole Bladder Response to Anticholinergic and Musculotropic Agents in Spinal Cord Injured Rats

Abstract

The purpose of this study was to compare the effect on urodynamic parameters of anticholinergic and musculotropic agents in sham injured and spinal cord injured (SC I) rats. A standard rat SCI model induced by impact trauma was employed. Cystometrograms were performed under urethane anesthesia four weeks after SCI. Bladder capacity and voiding pressure were determined at the point of micturition monitored urodynamically and visually. The effect of oxybutynin chloride (0.01 - 0.1 mg/kg), propantheline bromide (0.05 - 0.5 mg/kg) and flavoxate hydrochloride (0.1 - 1.0 mg/kg) were assessed independently in sham injured and SCI rats (n = 1 0 in each group). Bladder capacities were 0.6± 0.2 and 7.1± 1.6 ml in sham and SCI rats (p <0.01 ), respectively. Maximal filling pressure was 17.5±5 mmHg in sham and 25±5 mmHg in SCI rats (p <0.05). Bladder capacity increased with all three medications. Administration of oxybutynin, propantheline and flavoxate in sham rats resulted in bladder capacities of 0.88±0.3, 0.71±0.3 and 0.8± 0.2 ml, respectively (p <0.01 ). In SCI rats, these drugs resulted in bladder capacities of 9.8± 1.1, 7.9± 1.3 and 8.8±2.0 ml , respectively (p <0.01 ). No significant change in maximum filling pressure occurred. We conclude that anticholinergic and musculotropic agents caused a similar increase in bladder capacity in both sham and SCI rats. Oxybutynin enhanced bladder capacity more than propantheline or flavoxate. (J Spinal Cord Med 1997; 20:31-35)     

Five-Year Longitudinal Bone Evaluations In Individuals With Chronic Complete Spinal Cord Injury

Background/Objectives:Knowledge of spinal cord injury (SCI) bone changes has been derived primarilythrough cross-sectional studies, many of which are controvertible. Longitudinal studies are sparse, and longtermlongitudinal chronic studies are unavailable. The objective of this study was to provide a clearerperception of chronic longitudinal bone variations in people with complete SCI.

Methods:Bone status of 31 individuals with chronic, complete SCI was assessed twice using dual-energy xrayabsorptiometry at an average interval of 5.06 ± 0.9 years. Because the sample of women was small (4),the primary analyses of change and comparisons of those with paraplegia vs tetraplegia were confined to themale participants.

Results: Spine Z-scores showed a significant increase (P < 0.0001 ). The average Z-scores, initial and followup,were within the normal range. Hip Z-scores also showed a significant increase (P < 0.0001 ), and hipbone mineral density (BMD) increased in 48% of the participants. Knee BMD and lower extremity total bonemineral showed significant decreases (P < 0.003 and P < 0.02, respectively), but increases were seen in 33% and 26% at the respective sites. Individuals with tetraplegia had significantly lower values across all regions(P < 0.0001 ), and changes were significantly different compared with paraplegia (P < 0.0001 ). Bone valuesand changes in men vs women, despite the small sample of women, showed highly significant differences(P < 0.003?0.002).

Conclusion:Chronic effects of complete SCI do not exclusively result in continued loss of BMD or a staticstate of lowered BMD; gain in BMD may occur. The nature and magnitude of the effects of complete SCI on BMD vary by site, with sex and level of injury, which has implications for treatment and its assessment.     

Atorvastatin can delay arterial stiffness progression in hemodialysis patients

Purpose

Arterial stiffness is one of the vascular pathologies in hemodialysis (HD) patients with increased cardiovascular mortality and morbidity. Few approaches have been tested to reduce arterial stiffness in patients with chronic kidney disease (CKD). We aimed to assess effects of atorvastatin on arterial stiffness in hemodialysis patients.

Methods

This research is a double-blinded, placebo-controlled, randomized clinical trial which included 50 patients maintained on regular HD. Patients were allocated to receive 10 mg atorvastatin or placebo for 24 weeks. Aortic pulse wave velocity (PWV) as an index of large artery stiffness and augmentation index (AIx) as an index of wave reflections were assessed at baseline and after 6 months in both groups.

Results

In atorvastatin group at study end, there was no significant difference from baseline findings in aortic PWV (7.86?±?2.5 vs 7.88?±?2.6 m/sec; p?=?0.136), AIx (26.04?±?8.5 vs 26.0?±?8.6%; p?=?0.714) and central pulse pressure (PP) (p?=?1.0). On the other hand, in placebo group after 24 weeks, aortic PWV (7.80?±?2.16 vs 7.63?±?2.1 m/sec; p?<?0.001), AIx (25.88?±?9.4 vs 25.04?±?9.4%; p?<?0.001) increased significantly from baseline measurements but central pulse pressure (PP) (p?=?0.870) did not. Also, the change (Δ) in aortic PWV and AIx was significantly higher than the change in the atorvastatin group with p value of?<?0.001 and?<?0.001, respectively.

Conclusions

Arterial stiffness parameters remained stable in atorvastatin group but increased significantly in placebo-treated patients suggesting a potential role for atorvastatin to delay arterial stiffness progression in HD patients. Larger randomized clinical trials are needed to confirm these findings.

Clinical Trials registration

ClinicalTrials.gov NCT04472637.

     

Impact of the hip joint mobility on whole-body sagittal alignment: prospective analysis in case with hip arthroplasty

Purpose

To clarify the impact of restriction of hip extension on radiographic whole-body sagittal alignment with using postoperative changes of radiographical parameters for hip osteoarthritis.

Methods

We prospectively enrolled 68 patients with hip osteoarthritis scheduled for arthroplasty. Variables included manual examination of hip range of motion (H-ROM) and radiographic whole-body sagittal alignment parameters including sagittal vertical axis (SVA), center of acoustic meatus and femoral head offset (CAM-HA), thoracic kyphosis (TK), lumbar lordosis, sacral slope (SS), and knee flexion angle (KF). We divided patients with preoperative hip extension angle < 0 into the extension restriction (ER) + group and ≥ 0 into the ER− group. Differences in H-ROM, radiographic parameters between groups and postoperative changes were comparatively analyzed.

Results

Fifty-seven patients (The ER + group included 28 patients and the ER− group included 29 patients.) were available for the analysis. Pre-/postoperative H-ROM were 99.7 ± 24.9/118.1 ± 16.0 degrees (p < .01). Greater increases in SVA (5.4 ± 3.4 vs 3.4 ± 2.8 cm, p = .02) and in CAM-HA (3.9 ± 3.9 vs 2.8 ± 3.4 cm, p =  013) were found in the ER + group versus ER− group. Postoperatively, the ER + group showed an increase in TK (pre-/postoperative: 35.2 ± 9.7/37.4 ± 8.8 degrees, p = .04) and decreases in SS (36.5 ± 9.6/33.7 ± 9.9 degrees, p < .01) and KF (9.5 ± 7.0/6.9 ± 6.0 degrees, p = .02). Postoperative changes in radiographic parameters in the ER− group were not significant.

Conclusion

Patients with restriction of hip extension showed global spine imbalance, and significant changes in TK, SS, and KF were observed after arthroplasty. The presence of hip joint disorder and H-ROM restriction must be considered when evaluating spinopelvic alignment and whole-body sagittal alignment.