Does Muscle Atrophy and Fatty Infiltration Plateau or Persist in Chronic Spinal Cord Injury?

Atrophy and fatty infiltration of lower extremity muscle after spinal cord injury (SCI) predisposes individuals to metabolic syndrome and related diabetes and cardiovascular disease. The objective of this study was to prospectively measure changes in muscle atrophy and fat content of distal lower extremity muscles and explore related factors in a cohort of adults with chronic SCI and diverse impairments. Muscle cross-sectional area and density were calculated from peripheral quantitative computed tomography scans of the 66% site of the calf from 70 participants with chronic SCI (50 male, mean age 49 years, C2-T12, American Spinal Injury Association Impairment Scale A-D) at study enrollment and annually for 2 years. Mixed-model repeated measures analysis of variance (rANOVA) examined longitudinal changes in muscle area and density, and regression analyses explored factors related to muscle changes using 16 potential correlates selected a priori. A high degree of individual variation in muscle area and density change was observed over 2 years (range: 8.5 to???22.6?cm²; 6.4 to??8.6?mg/cm³). Repeated measures analysis of variance revealed significant reductions in muscle area (estimated mean difference [95% confidence intervals] ?1.76 [?3.29?to ?0.23]) cm², p?=?0.025) and density (?1.04 [?1.94 to??0.14] mg/cm³, p?<?0.024); however, changes in area were not significant with outliers removed. Regression analyses explained a small proportion of the variability in muscle density change; however, none of the preselected variables were significantly related to changes in muscle density after post hoc sensitivity analyses. Lower extremity muscle size and fat content may not reach a “steady-state” after chronic SCI. Progressive atrophy and fatty infiltration of lower extremity muscle may have adverse implications for metabolic syndrome and cardiovascular disease risk and related mortality after chronic SCI.     

Measuring Marrow Density and Area Using Peripheral Quantitative Computed Tomography at the Tibia: Precision in Young and Older Adults and Individuals With Spinal Cord Injury

The objective of this study was to compare the test-retest precision error for peripheral quantitative computed tomography (pQCT)-derived marrow density and marrow area segmentation at the tibia using 3 software packages. A secondary analysis of pQCT data in young adults (n?=?18, mean?±?standard deviation 25.4?±?3.2?yr), older adults (n?=?47, 71.8?±?8.2?yr), and individuals with spinal cord injury (C1–T12 American Spinal Injury Association Impairment Scale, classes A–C; n?=?19, 43.5?±?8.6?yr) was conducted. Repeat scans of the tibial shaft (66%) were performed using pQCT (Stratec XCT2000). Test-retest precision errors (root mean square standard deviation and root mean square coefficient of variation [RMSCV%]) for marrow density (mg/cm³) and marrow area (mm²) were reported for the watershed-guided manual segmentation method (SliceOmatic version 4.3 [Sliceo-WS]) and the 2 threshold-based edge detection methods (Stratec version 6.0 [Stratec-TB] and BoneJ version 1.3.14 [BoneJ-TB]). Bland-Altman plots and 95% limits of agreement were computed to evaluate test-retest discrepancies within and between methods of analysis and subgroups. RMSCV% for marrow density segmentation was >5% for all methods across subgroups (Stratec-TB: 12.2%–28.5%, BoneJ-TB: 14.5%–25.2%, and Sliceo-WS: 10.9%–23.0%). RMSCV% for marrow area segmentation was within 5% for all methods across subgroups (Stratec-TB: 1.9%–4.4%, BoneJ-TB: 2.6%–5.1%, and Sliceo-WS: 2.4%–4.5%), except using BoneJ-TB in older adults. Intermethod discrepancies in marrow density appeared to be present across the range of marrow density values and did not differ by subgroup. Intermethod discrepancies varied to a greater extent for marrow area and were found to be more frequently at mid- to higher-range values for those with spinal cord injury. Precision error for pQCT-derived marrow density segmentation exceeded 5% for all methods of analysis across a range of bone mineral densities and fat infiltration, whereas precision error for marrow area segmentation ranged from 2% to 5%. Further investigation is necessary to determine alternative acquisition and analysis methods for pQCT-derived marrow segmentation.     

The Patient Health Questionnaire depression screener in spinal cord injury

Context: Although depression is not inevitable following spinal cord injury/dysfunction (SCI/D), it can have a negative impact on rehabilitation. Evidence-based assessment of depression utilizing self-report instruments, such as the Patient Health Questionnaire-9 (PHQ-9), is considered good clinical practice. Although the PHQ-9 has been studied in individuals with SCI/D, little is known about the clinical utility of the Patient Health Questionnaire-2 (PHQ-2). Traditional cutoff scores for the PHQ-2 were examined to explore their operating characteristics as related to PHQ-9 results.

Methods: Archival data were collected for 116 Veterans with SCI/D who completed the PHQ-2 and PHQ-9 as one component of their routine, comprehensive SCI annual evaluation at a Veterans Affairs Medical Center. Logistic regressions were performed to determine the impact of different cutoff scores for the PHQ-2 on the likelihood that participants would endorse clinically significant levels of depressive symptoms on the PHQ-9 (≥10).

Results: Using a cutoff score of 3 or greater correctly classified 94.8% of the cases, outperforming the other cutoff scores. A cutoff score of 3 or greater had a sensitivity of 83.3% and specificity of 97.8%, and yielded a positive predictive value of 90.9% and a negative predictive value of 95.7%.

Conclusion: The PHQ-2 shows promise as a clinically useful screener in the community-residing SCI/D population. Findings regarding the presence of suicidal ideation emphasize the importance of routine screening for depressive symptomatology in the SCI/D population. Future research should investigate the role of the PHQ-2 in clinical decision-making and treatment monitoring.     

Different methods of modelling intraoperative hypotension and their association with postoperative complications in patients undergoing non-cardiac surgery

Background

Associations between intraoperative hypotension (IOH) and postoperative complications have been reported. We examined whether using different methods to model IOH affected the association with postoperative myocardial injury (POMI) and acute kidney injury (AKI).

Effects of Traditional Chinese Medicine,Dilong Injection,on Random Skin Flap Survival in Rats

Background: Dilong injection as a medicinal preparation extracted from earthworm in traditional Chinese medicine, is used to activate blood circulation and remove blood stasis. In this research, we aim to investigate its potential effect on random skin flap survival in rat models. Materials and methods: McFarlane flaps were established in 60 male Sprague–Dawley rats randomly divided into two groups: the control group and the Dilong injection group. Diong injection group was injected with the Diong injection (4 mL/kg) once a day for seven days, and the control group was given an equal volume of saline solution. After seven days, flaps were obtained and stained with Hematoxylin and Eosin. Histological examination was done to determine changes in histology such as thickness of granulation tissue, tissue edema, neutrophil infiltration, and the microvascular density (MVD). In addition, immunohistochemical detection was carried out to show vascular endothelial growth factor (VEGF) expression level. Results: Compared with the control group, the Dilong group exhibited more fibroblastic proliferation, thinner neutrophil infiltration with less edema through histological examination. The MVD and the VEGF expression of flaps were significantly higher. The mean superoxide dismutase activity was evidently higher in the Dilong group than in the control group, while the mean MDA level was lower. Conclusions: According to the comparison made between the two groups for histological and immunohistochemical evaluation, the Dilong injection group has potential effects on the survival of random skin flaps in rat models.     

Cold intolerance after nerve injury

Cold intolerance after nerve injury can be severe and has been associated with high levels of pain and disability. This article provides an overview of the assessment and nonoperative management of cold-induced symptoms after peripheral nerve injury. A comprehensive evaluation should include both objective measures such as skin temperatures and subjective tools to assess the patient's perspective and impact of the symptoms. Management of the patient with cold intolerance remains challenging and should include adaptive strategies, warming interventions, and desensitization conditioning programs to minimize cold-induced pain and hyperresponses.     

Femoral Nerve Palsy Following Total Hip Arthroplasty: Incidence and Course of Recovery

Background

Femoral nerve palsy (FNP) is a relatively uncommon complication following total hip arthroplasty (THA). There is little recent literature regarding the incidence of FNP and the natural course of recovery.

Nephrotoxicity After the Treatment of Periprosthetic Joint Infection With Antibiotic-Loaded Cement Spacers

Background

Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded cement spacer (ACS). The risk for acute kidney injury (AKI) related to use of antibiotic spacers has not been well defined. We aimed to identify the incidence of and risk factors for AKI after placement of an ACS.

Invasive fungal infection in immunocompetent trauma patients – A case series

Zygomycosis is the third leading cause of invasive fungal infection after candidiasis and aspergillosis. Although zygomycosis mostly affects immunocompromised individuals trauma may potentiate infection in immunocompetent individuals. The mortality rate of Zygomycosis is around 50% due to angioinvasion. Here we report a series of 5 cases of angio invasive fungal infection in immunocompetent individuals who sustained trauma in urban areas, out of which only one patient survived following high above knee amputation.     

大鼠脊髓全横断诱导芳香族氨基酸脱酸酶细胞产生5-羟色胺的机制研究

目的:探讨大鼠脊髓损伤(spinal cord injury,SCI)前后芳香族氨基酸脱酸酶(Aromatic L-amino acid decarboxylase,AADC)细胞的分布以及SCI后不同时间段AADC细胞表达5-羟色胺(5-HT)的特点。方法:60只成年雄性Wistar大鼠随机分为正常对照组(12只)、脊髓损伤2d组(24只,其中假手术/Sham组12只)及脊髓损伤60d组(24只,其中假手术/Sham组12只)。使用负压吸引器将大鼠T10-T11脊髓完全离断1~3mm,建立脊髓胸段T10-T11全横断模型。使用BBB评分评价SCI大鼠不同时间点后肢运动功能。各组大鼠在相应时间点灌注取材,并且在灌注前30min腹腔注射外源性5-羟色胺酸(5-HTP)(100mg/kg),免疫荧光法检测脊髓腰段(L段)和骶尾段(S+C段)中AADC和5-HT表达水平。结果:SCI大鼠在术后1~2、3、7、14、28、60d时BBB评分别为0、1.00±0.58、3.30±0.95、6.30±0.10、7.50±0.36、7.87±0.08分。AADC细胞主要在脊髓的背角、中间带、中央管周围等部位表达。正常对照组、脊髓损伤2d组和脊髓损伤60d组AADC表达数量在脊髓L段为:46.75±5.50、49.50±4.87、48.50±6.38个,在脊髓S+C段为1026.50±66.59、1066.75±80.56、1046.25±67.79个,三组结果相比无显著性差异(P0.05)。正常对照组大鼠脊髓L段和S+C段中AADC细胞中未见5-HT的表达,但在SCI2d组和SCI 60d组均观察到AADC细胞表达5-HT,L段两组表达率分别为(44.43±6.03)%和(96.20±1.53)%,S+C段分别为(44.45±5.71)%和(95.14±3.02)%,两组间差异有显著性(P0.05)。结论:AADC细胞在脊髓胸段T10~T11全横断损伤前后脊髓中表达数量和部位相似。SCI后,损伤平面以下脊髓中的AADC细胞功能增加,可利用外源性5-HTP生成5-HT。