Systemic immunosuppression is a devastating result of spinal cord injury (SCI), leaving many patients susceptible to infections such as pneumonia. SCI-associated pneumonia (SCI-AP) is a clinically-relevant outcome modifier associated with increased mortality and disability. While it is known that lungs become damaged after SCI, it is yet to be established how an acquired pneumonia further impacts the lungs after SCI. Using a controlled mouse model of induced spinal cord injury-associated pneumonia (SCI-AP), we quantified structural and immunological changes by comparing T9 contusive SCI with laminectomy controls, with or without pneumonia. This approach allowed us to distinguish alterations attributable to pneumonia from those resulting directly from spinal cord injury. Matching clinical onset in patients, SCI-AP was induced at 3 days post-injury. Hematoxylin & Eosin stains were performed on paraffin-embedded lung tissue at acute and chronic timepoints post-injury to assess the time course of histological changes post-infection. Structural changes in bronchial wall thickness and apoptosis within the nuclei of the epithelial walls of lung bronchioles were assessed in the lower right lung. Consistent with pneumonia onset, neutrophils were detected in the lungs. SCI-AP mice had significantly more F4/80+ macrophages in their lung tissue compared to SCI mice. Bronchial walls become thinner and contain higher cell numbers undergoing programmed cell death after SCI-AP induction. These histological changes have functional impacts on whole body metabolism, as monitored with a comprehensive monitoring system. This work demonstrates features of acute and chronic SCI-AP and its subsequent structural changes in the lung in a mouse model, and provides mechanisms that may contribute to persistent pulmonary dysfunction and increased susceptibility to respiratory complications after SCI. Further investigations are needed to see if these changes are present clinically.

Pericytes are contractile cells of the microcirculation that participate in wound healing after spinal cord injury (SCI). Thus far, the extent to which pericytes cause or contribute to axon growth and regeneration failure after SCI remains controversial. Here, we found that SCI leads to profound changes in vasculature architecture and pericyte coverage. We demonstrated that pericytes constrain sensory axons on their surface, causing detrimental structural and functional changes in adult dorsal root ganglion neurons that contribute to axon regeneration failure after SCI. Perhaps more excitingly, we discovered that in vivo programming of adult pericytes via local administration of platelet-derived growth factor BB (PDGF-BB) effectively promotes axon regeneration and recovery of hindlimb function by contributing to the formation of cellular bridges that span the lesion. Ultrastructural analysis showed that PDGF-BB induced fibronectin fibril alignment and extension, effectively converting adult pericytes into a permissive substrate for axon growth. In addition, PDGF-BB localized delivery positively affects the physical and chemical nature of the lesion environment, thereby creating more favorable conditions for SCI repair. Thus, therapeutic manipulation rather than wholesale ablation of pericytes can be exploited to prime axon regeneration and SCI repair.

You have accessJournal of UrologyCME1 Apr 2023MP52-06 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SPINAL CORD INJURY ARE INDEPENDENTLY ASSOCIATED WITH CHOICE OF BLADDER MANAGEMENT METHOD Megan Stout, Juan Peng, Yu-Ying Chen, Huacong Wen, Jan Schwab, and Nima Baradaran Megan StoutMegan Stout More articles by this author , Juan PengJuan Peng More articles by this author , Yu-Ying ChenYu-Ying Chen More articles by this author , Huacong WenHuacong Wen More articles by this author , Jan SchwabJan Schwab More articles by this author , and Nima BaradaranNima Baradaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical factors are known to impact choice of bladder management method (BMM) in patients with spinal cord injury (SCI) such as injury level, impairment severity, manual dexterity, as well as patient preference. The primary objective of this study was to evaluate the effect of sociodemographic characteristics of patients in this context. METHODS: From the Spinal Cord Injury Model System adult patients (>18 at time of injury) were screened. Exclusion criteria included death within one year of injury and lack of BMM data. Outcomes of interest included age, gender, race, education, marital status, household income, employment status, health insurance type, injury level, injury etiology, ventilatory status, neurological impairment category (quadriplegic vs paraplegic), composite poverty scale, and American Spine Injury Association (ASIA) impairment scale. Logistic regression models and multivariate analysis was used to determine associations between sociodemographic factors and use of indwelling catheters as primary choice of BMM. RESULTS: A total of 12,708 patients were screened and 9,097 were included. Majority of patients were male (79.4%), white (71.2%), had an average annual income of <$25,000 (33.3%) and public insurance (68.5%). Most were tetraplegic (47.3%) with ASIA score of “A” (complete impairment, 57.5%).The BMM breakdown was those that used indwelling catheters (34.4%) versus those with “other” methods (intermittent catheterization, external catheters, or urinary diversion; 65.6%). On multivariate analysis, after adjusting for disease characteristics, men were significantly more likely to be impacted by sociodemographic factors. In men, white race, non-Hispanic ethnicity, having public insurance, lower income, higher impairment severity, older age at injury and longer injury duration was associated with higher use of indwelling catheters (Figure 1). In females, only age at injury and neurologic impairment were significant. CONCLUSIONS: Sociodemographic variables are significantly associated with the choice of BMM in men with SCI. The reason for the discrepancy between genders is unknown. Further analysis utilizing this database to discern BMM choice between groups could guide future patient counseling and optimization of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e704 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Megan Stout More articles by this author Juan Peng More articles by this author Yu-Ying Chen More articles by this author Huacong Wen More articles by this author Jan Schwab More articles by this author Nima Baradaran More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To evaluate the impact of bladder management method, specifically chronic indwelling catheter (IndC), on survival in patients with spinal cord injury (SCI) in Spinal Cord Injury Model System database. METHODS:Spinal Cord Injury Model System is a multicenter longitudinal database since 1970 with >40,000 patients with SCI. Adult patients (>18 at the time of injury) were screened. Patients who died within 1 year of injury and had 2 or more changes in method of bladder management, or reported normal volitional void were excluded. Outcome of interest was death from nonpulmonary, nonwound related sepsis (NPNWS). Left truncation cox regression method using age as the time-scale was used to calculate hazard ratios. RESULTS:A total of 13,616 patients were included. Comparison was performed between "IndC" group (n = 4872; 36.1%) vs "Other" (n = 8744; 63.9%). After adjusting for age and change in bladder management method, "IndC" is associated with elevated NPNWS mortality (2.10; 95% confidence interval 1.72-2.56, P < .001). Multivariable analysis, adjusting for age at injury, gender, race, education, insurance status, etiology of SCI, injury level, neurologic impairment level, and change in bladder management method, showed IndC was associated with significantly higher risk of death from NPNWS compared to other methods of bladder management. CONCLUSION:In a large cohort of SCI patients, bladder management with IndC is predictive of significantly propagated NPNWS related mortality compared to other methods of bladder management. While identifying IndC is an independent mortality risk factor, a better understanding of the underlying mechanisms could inform strategies to improve neurourological care and survival after SCI.

To investigate the humoral immune response following SARS-CoV-2 vaccination in patients with multiple sclerosis (pwMS) and to determine the effect of disease modifying therapies (DMT) on the vaccination response.

Supplemental Digital Content is Available in the Text. Objective: To evaluate the effect of providing quasi-contextualized speech therapy, defined as metacognitive, compensatory, or strategy training applied to cognitive and language impairments to facilitate the performance of future real-life activities, on functional outcomes up to 1 year following traumatic brain injury (TBI). Setting: Acute inpatient rehabilitation. Participants: Patients enrolled during the TBI-Practice-Based Evidence (TBI-PBE) study (n = 1760), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, received speech therapy in acute inpatient rehabilitation at one of 9 US sites, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation. Design: Propensity score methods applied to a database consisting of multisite, prospective, longitudinal observational data. Main Measures: Participation Assessment with Recombined Tools-Objective-17, FIM Motor and Cognitive scores, Satisfaction With Life Scale, and Patient Health Questionnaire-9. Results: When at least 5% of therapy time employed quasi-contextualized treatment, participants reported better community participation during the year following discharge. Quasi-contextualized treatment was also associated with better motor and cognitive function at discharge and during the year after discharge. The benefit, however, may be dependent upon a balance of rehabilitation time that relied on contextualized treatment. Conclusions: The use of quasi-contextualized treatment may improve outcomes. Care should be taken, however, to not provide quasi-contextualized treatment at the expense of contextualized treatment.

Introduction: Uncertainty regarding reperfusion of mildly-symptomatic (minor) large vessel occlusion (LVO)-strokes exists. Recently, benefits from reperfusion were suggested. However, there is still no strong data to support this. Furthermore, a proportion of those patients don't improve even after non-hemorrhagic reperfusion. Our study evaluated whether or not non-perfusion factors account for such persistent deconditioning. Methods: Patients with identified minor LVO-strokes (NIHSS <= 8) from our stroke alert registry between January-2016 and May-2018 were included. Variables/predictors of outcome were tested using univariate/multivariate logistic and linear regression analyses. Three month-modified ranking scale (mRS) was used to differentiate between favorable (mRS = 0-2) and unfavorable outcomes (mRS = 3-6). Results: Eighty-one patients were included. Significant differences between the two outcome groups regarding admission-NIHSS and discharge-NIHSS existed (OR = 0.47, 0.49 / p = 0.0005, <0.0001 respectively).The two groups had matching perfusion measures. In the poor outcome group, discharge-NIHSS was unchanged from the admission-NIHSS while in the good outcome group, discharge-NIHSS significantly improved. Conclusion: Admission and discharge NIHSS are independent predictors of outcome in patients with minor-LVO strokes. Unchanged discharge-NIHSS predicts worse outcomes while improved discharge-NIHSS predicts good outcomes. Unchanged NIHSS in the poor outcome group was independent of the perfusion parameters. In literature, complement activation and pro-inflammatory responses to ischemia might account for the progression of stroke symptoms in major-strokes. Our study concludes similar phenomena might be present in minor-strokes. Therefore, discharge-NIHSS may be useful as a clinical marker for future therapies.