The Effect of Different Acupuncture Therapies on Neurological Recovery in Spinal Cord Injury: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Many acupuncture therapies were used to treat spinal cord injury (SCI) and its complications. The difference in efficacy among these therapies has not been assessed. To compare the efficacy of different acupuncture therapies for SCI, we searched databases (PubMed, Embase, Cochrane Library, CNKI, and WanFang) for relevant RCTs in both English and Chinese before June 2019 that reported the association between acupuncture therapies and SCI. The RCTs were categorized according to the location of the acupoints used in them. The neural function was assessed by American Spinal Injury Association (ASIA) motor score, and daily living ability was accessed by Modified Barthel Index (MBI) after SCI. In total, 22 trials involving 1644 participants were included. The pairwise meta-analysis and random effects model network meta-analysis were conducted. The results indicated that exercise combined with electro-acupuncture (EA) is superior to exercise without acupuncture in improving the ASIA motor score. EA was associated with a significantly higher improvement in the MBI score than exercise alone, except for EA of head + limbs and limbs. Additionally, EA on the head + back and back + front (chest and abdomen) rank the top in both increasing the ASIA motor score and the MBI score. Acupuncture can significantly increase motor function and daily living ability of individuals who suffer from SCI, especially acupuncture of the back + front or the head + back. The evidence supports acupuncture of the back + front or the head + back as an effective treatment for SCI.

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A Functional Outcome Prediction Model of Acute Traumatic Spinal Cord Injury Based on Extreme Gradient Boost

10.21203/rs.3.rs-905273/v2 ◽

2021 ◽

Author(s):

Sizheng Zhan ◽

Boxuan Huang ◽

Wenyong Xie ◽

Feng Xue ◽

Dianying Zhang ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Prediction Model ◽

Functional Outcome ◽

Nonlinear Regression ◽

Spinal Injury ◽

Surgical Decompression ◽

Cord Injury ◽

The Difference ◽

Outcome Index

Abstract Purpose: We aimed to construct a nonlinear regression model through Extreme Gradient Boost (XGBoost) to predict functional outcome 1 year after surgical decompression for patients with acute spinal cord injury (SCI).Methods: We prospectively enrolled 249 patients with acute SCI from 5 primary orthopedic centers from June 1, 2016, to June 1, 2020. We identified a total of 6 predictors with three aspects: 1) clinical characteristics, including age, American Spinal Injury Association (ASIA) Impairment Scale (AIS) at admission, level of injury and baseline ASIA motor score (AMS); 2) MR imaging, mainly including Brain and Spinal Injury Center (BASIC) score; 3) surgical timing, specifically comparing whether surgical decompression was received within 24 hours or not. We assessed the SCIM score at 1 year after the operation as the functional outcome index. XGBoost was used to build a nonlinear regression prediction model through the method of boosting integrated learning.Results: We successfully constructed a nonlinear regression prediction model through XGBoost and verified the credibility. The average absolute value of the difference between the predicted value and the actual value is 3.72 (t=1.29, P=0.203), ranging from 0 to 8.44. AMS and age ranked first and second in predicting the functional outcome.Conclusion: We verified the feasibility of using XGBoost to construct a nonlinear regression prediction model for the functional outcome of patients with acute SCI, and we found that age and AMS play the most important role in predicting the functional outcome.Trial registration: ClinicalTrials.gov identifier: NCT03103516.

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Cranberry for Bacteriuria in Individuals with Spinal Cord Injury: A Systematic Review and Meta-Analysis

Oxidative Medicine and Cellular Longevity ◽

10.1155/2020/9869851 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Anna Raguzzini ◽

Elisabetta Toti ◽

Tommaso Sciarra ◽

Anna Lucia Fedullo ◽

Ilaria Peluso

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Urinary Tract ◽

Meta Analysis ◽

Asymptomatic Bacteriuria ◽

Model Analysis ◽

Lower Urinary Tract Dysfunction ◽

Cochrane Library ◽

Effect Model ◽

Cord Injury

Background. Urinary tract infection (UTI) is common in individuals with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD) and in veterans with SCI who use antibiotics improperly for asymptomatic bacteriuria. Cranberry (CB) has been suggested for UTI prevention. Methods. We performed a systematic search up to May 2020 in the following databases: AccessMedicine, BioMed Central, CINAHL, Cochrane Library, ProQuest, and PubMed. Quality assessment was performed using a specifically designed quality score. Risk ratio was calculated with both random effect model analysis (DerSimonian-Laird method) and quality effect model analysis (Doi Thalib method). Results. Six studies on bacteriuria and SCI were reviewed. From the four studies available for meta-analysis, two of which with individuals taking both CB and control, 477 data from 415 participants were analysed (241 CB and 236 control). No significant differences were detected with meta-analysis. However, bias, limitations, and incompleteness were observed in the reviewed studies. Conclusion. Although further studies are needed, we suggest an accurate monitoring of diet and fluid intake, the evaluation of risk for potential food or nutraceutical interactions with drugs, and the inclusion of inflammatory markers among the outcomes in addition to UTI.

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The Comparative Effects of Mesenchymal Stem Cell Transplantation Therapy for Spinal Cord Injury in Humans and Animal Models: A Systematic Review and Meta-Analysis

Biology ◽

10.3390/biology10030230 ◽

2021 ◽

Vol 10 (3) ◽

pp. 230

Author(s):

Louis D. V. Johnson ◽

Mark R. Pickard ◽

William E. B. Johnson

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Stem Cell ◽

Animal Models ◽

Mesenchymal Stem Cell ◽

Meta Analysis ◽

Sensory Function ◽

Cochrane Library ◽

Cord Injury

Animal models have been used in preclinical research to examine potential new treatments for spinal cord injury (SCI), including mesenchymal stem cell (MSC) transplantation. MSC transplants have been studied in early human trials. Whether the animal models represent the human studies is unclear. This systematic review and meta-analysis has examined the effects of MSC transplants in human and animal studies. Following searches of PubMed, Clinical Trials and the Cochrane Library, published papers were screened, and data were extracted and analysed. MSC transplantation was associated with significantly improved motor and sensory function in humans, and significantly increased locomotor function in animals. However, there are discrepancies between the studies of human participants and animal models, including timing of MSC transplant post-injury and source of MSCs. Additionally, difficulty in the comparison of functional outcome measures across species limits the predictive nature of the animal research. These findings have been summarised, and recommendations for further research are discussed to better enable the translation of animal models to MSC-based human clinical therapy.

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A meta-analysis of exosome in the treatment of spinal cord injury

Open Medicine ◽

10.1515/med-2021-0304 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1043-1060

Author(s):

Hanxiao Yi ◽

Yang Wang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Sequential Analysis ◽

Meta Analysis ◽

Cochrane Library ◽

Trial Sequential Analysis ◽

Therapeutic Effects ◽

Locomotor Function ◽

Cord Injury

Abstract Context There are no recommended therapeutic agents for acute spinal cord injury (SCI) due to the pathophysiological complexity of the injury. Objective The objective of this study is to investigate the efficacy of various exosomes and potential factors impacting the efficacy of exosomes. Methods We searched the PubMed, EMBASE, Web of Science, Medline, Scopus, and Cochrane Library databases to systematically collect articles comparing the locomotor function of SCI rodents undergoing exosome treatment and untreated SCI rodents. No language was preferred. Results Pooled analysis revealed that the locomotor function recovery of SCI rodents receiving exosomes was greatly improved (583 rats, 3.12, 95% CI: 2.56–3.67, p < 0.01; 116 mice, 2.46, 95% CI: 1.20–3.72, p < 0.01) compared to those of control rodents. The trial sequential analysis demonstrated the findings of the meta-analysis with the cumulative Z-curve crossing the upper monitoring boundary for the benefit and reaching the adjusted required information size. However, the origin of the exosome, SCI model, and administration method determined the therapeutic effect to some extent. Conclusions Despite the proven therapeutic effects of exosomes on SCI rodents, the results should be interpreted cautiously considering the diversity in vivo and in vitro in relation to future trials.

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Blood Serum Cytokines in Patients with Subacute Spinal Cord Injury: A Pilot Study to Search for Biomarkers of Injury Severity

Brain Sciences ◽

10.3390/brainsci11030322 ◽

2021 ◽

Vol 11 (3) ◽

pp. 322

Author(s):

Sergei Ogurcov ◽

Iliya Shulman ◽

Ekaterina Garanina ◽

Davran Sabirov ◽

Irina Baichurina ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pilot Study ◽

Injury Severity ◽

Spinal Injury ◽

Neuron Specific Enolase ◽

Enzyme Linked Immunosorbent Assay ◽

Cord Injury ◽

The Difference ◽

Endothelial Growth Factor

Background. Despite considerable interest in the search for a spinal cord injury (SCI) therapy, there is a critical need to develop a panel of diagnostic biomarkers to determine injury severity. In this regard, there is a requirement for continuing research into the fundamental processes of neuroinflammatory and autoimmune reactions in SCI, identifying changes in the expression of cytokines. Methods. In this pilot study, an extended multiplex analysis of the cytokine profiles in the serum of patients at 2 weeks post-SCI (n = 28) was carried out, together with an additional assessment of neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF) levels by enzyme-linked immunosorbent assay. A total of 16 uninjured subjects were enrolled as controls. Results. The data obtained showed a large elevation of IFNγ (>52 fold), CCL27 (>13 fold), and CCL26 (>8 fold) 2 weeks after SCI. The levels of cytokines CXCL5, CCL11, CXCL11, IL10, TNFα, and MIF were different between patients with baseline American Spinal Injury Association Impairment Scale (AIS) grades of A or B, whilst IL2 (>2 fold) and MIP-3a (>6 fold) were significantly expressed in the cervical and thoracic regions. There was a trend towards increasing levels of NSE. However, the difference in NSE was lost when the patient set was segregated based on AIS group. Conclusions. Our pilot research demonstrates that serum concentrations of cytokines can be used as an affordable and rapid detection tool to accurately stratify SCI severity in patients.

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Transplantation of mesenchymal stem cells for spinal cord injury: a systematic review and network meta-analysis

Journal of Translational Medicine ◽

10.1186/s12967-021-02843-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Wei-can Chen ◽

Wei-feng Liu ◽

Yu-yan Bai ◽

Ying-ying Zhou ◽

Yan Zhang ◽

...

Keyword(s):

Spinal Cord ◽

Stem Cells ◽

Spinal Cord Injury ◽

Mesenchymal Stem Cells ◽

Adverse Reactions ◽

Spinal Injury ◽

Meta Analysis ◽

Intrathecal Injection ◽

Sensory Score ◽

Cord Injury

AbstractSpinal cord injury (SCI) is a severe traumatic disease of the central nervous system, with a global prevalence of 236–4187 per million people. This meta-analysis aimed to evaluate the safety and efficacy of mesenchymal stem cells (MSCs) in treating patients with SCI as well as the optimal source and transplantation method of MSCs. PubMed, OVID, Cochrane, Web of Science, and China Biomedical Database were searched up until April 01, 2021. The study was conducted for five endpoints: American Spinal Injury Association (ASIA) motor and sensory score, ASIA grade improvement, Barthel Index (BI), and adverse reactions. Standard meta-analysis and network meta-analysis were performed using Stata 14.0. Eighteen studies with a total of 949 patients, were included in the meta-analysis. Standard meta-analysis showed that MSCs significantly improved ASIA motor score (P < 0.001), sensory score (P < 0.001), ASIA grade (P < 0.001), and BI (P < 0.001) compared to rehabilitation. In addition, in the network meta-analysis, autologous MSCs significantly improved the ASIA motor [MD = 8.01, 95% CI (4.27, 11.76)], sensory score [MD = 17.98, 95% CI (10.04, 25.91)], and BI [MD = 7.69, 95% CI (2.10, 13.29)] compared to rehabilitation. Similarly, compared to rehabilitation, intrathecal injection (IT) of MSCs significantly improved the ASIA motor [MD = 7.97, 95% CI (4.40, 11.53)] and sensory score [MD = 19.60, 95% CI (9.74, 29.46)]. Compared to rehabilitation, however, only the IL of MSCs was associated with more adverse reactions [OR = 17.82, 95% CI (2.48, 128.22)]. According to the results of SUCRA, both autologous MSCs and IT transplantation approaches most improved the neurological function in SCI patients. Cell transplantation using MSCs is effective in patients with SCI and IT of autologous MSCs may be more beneficial.

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A Functional Outcome Prediction Model of Acute Traumatic Spinal Cord Injury Based on Extreme Gradient Boost

10.21203/rs.3.rs-905273/v1 ◽

2021 ◽

Author(s):

Sizheng Zhan ◽

Boxuan Huang ◽

Wenyong Xie ◽

Feng Xue ◽

Dianying Zhang ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Prediction Model ◽

Functional Outcome ◽

Nonlinear Regression ◽

Spinal Injury ◽

Surgical Decompression ◽

Cord Injury ◽

The Difference ◽

Outcome Index

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The Efficacy and Safety of Mesenchymal Stem Cell Transplantation for Spinal Cord Injury Patients: A Meta-Analysis and Systematic Review

Cell Transplantation ◽

10.1177/0963689718808471 ◽

2018 ◽

Vol 28 (1) ◽

pp. 36-46 ◽

Cited By ~ 25

Author(s):

Panfeng Xu ◽

Xianliang Yang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Adverse Effects ◽

Cell Transplantation ◽

Meta Analysis ◽

Urine Volume ◽

Efficacy And Safety ◽

Motor Score ◽

Residual Urine Volume ◽

Cord Injury

Spinal cord injury (SCI) is a devastating disease, with a high rate of disability. In this meta-analysis, we aimed to comprehensively assess the efficacy and safety of mesenchymal stem cells (MSCs) in treating clinical SCI patients. We systematically searched the PUBMED, EMBASE, Chinese Biomedical (CBM), Web of Science and Cochrane databases using the strategy of combination of free-text words and MeSH terms. The indicators of the American Spinal Injury Association (ASIA) impairment scale (AIS)-grading improvement rate and adverse effects were displayed with an overall relative risk (RR). For the continuous variables of the ASIA motor score, light-touch score, pinprick score, activities of daily living (ADL) score, and residual urine volume, we used odds ratio (OR) to analyze the data. Eleven studies comprising 499 patients meeting all inclusion and exclusion criteria were included. No serious heterogeneity or publication bias was observed across each study. The results showed that significant improvements of total AIS grade (RR: 3.70; P < 0.001), AIS grade A (RR: 3.57; P < 0.001), ASIA sensory score (OR: 8.63; P < 0.001) and reduction of residual urine volume (OR: −36.37; P = 0.03) were observed in experimental group compared with control group. However, no significant differences of motor score (OR: 1.37, P = 0.19) and ADL score (OR: 2.61, P = 0.27) were observed between experimental and control groups. In addition, there were no serious and permanent adverse effects after cell transplantation. Cell transplantation with MSCs is effective and safe in improving the sensory and bladder functions of SCI patients.

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Application of olfactory ensheathing cells in clinical treatment of spinal cord injury: meta-analysis and prospect

Journal of Neurorestoratology ◽

10.26599/jnr.2019.9040008 ◽

2019 ◽

Vol 7 (2) ◽

pp. 70-81

Author(s):

Huijing Chen ◽

Qijia Tan ◽

Caijun Xie ◽

Cong Li ◽

Yun Chen ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Meta Analysis ◽

Treatment Options ◽

Primary Source ◽

Olfactory Ensheathing Cells ◽

Cochrane Library ◽

Invasive Treatment ◽

Cord Injury ◽

Ensheathing Cells

Background:A number of clinical trials of olfactory ensheathing cells (OECs) for the treatment of chronic spinal cord injury (SCI) have been carried out all over the world. However, their safety and efficacy have not been basically evaluated. Moreover, there are no uniform standards laid out for the use of optimal source, transplantation method and the dosage of OECs.Objective:This study evaluated the source, dose, and route of transplantation of OECs for the treatment of chronic SCI.Methods:PubMed, Cochrane Library, EMBASE, CNKI, and Wanfang Data were searched for the clinical studies of OECs in the treatment of chronic SCI on July 2018.Results:A total of 30 articles on OECs transplantation for chronic SCI were selected for comprehensive evaluation of OECs sources, doses, and transplantation methods. The efficacy of OECs in the treatment of chronic SCI was evaluated using Review Manager 5.3.Conclusion:Fetal OECs are the primary source of cells for the treatment of chronic SCI in OECs, with standardized cell-culture and quality-control processes. Fetal OECs can significantly improve the neurological function of patients with chronic SCI. It is an ideal cell therapy for neurorestoration. However to explore more precise and minimally invasive treatment options are required in the future.

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