Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic ...Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.展开更多
Low back pain(LBP)is the world's leading cause of disability and is increasing in prevalence more rapidly than any other pain condition.Intervertebral disc(IVD)degeneration and facet joint osteoarthritis(FJOA)are ...Low back pain(LBP)is the world's leading cause of disability and is increasing in prevalence more rapidly than any other pain condition.Intervertebral disc(IVD)degeneration and facet joint osteoarthritis(FJOA)are two common causes of LBP,and both occur more frequently in elderly women than in other populations.Moreover,osteoarthritis(OA)and OA pain,regardless of the joint,are experienced by up to twice as many women as men,and this difference is amplified during menopause.Changes in estrogen may be an important contributor to these pain states.Receptors for estrogen have been found within IVD tissue and nearby joints,highlighting the potential roles of estrogen within and surrounding the IVDs and joints.In addition,estrogen supplementation has been shown to be effective at ameliorating IVD degeneration and OA progression,indicating its potential use as a therapeutic agent for people with LBP and OA pain.This review comprehensively examines the relationship between estrogen and these pain conditions by summarizing recent preclinical and clinical findings.The potential molecular mechanisms by which estrogen may relieve LBP associated with IVD degeneration and FJOA and OA pain are discussed.展开更多
Skeletal interoception regulates bone homeostasis through the prostaglandin E2(PGE2)concentration in bone.Vertebral endplates undergo ossification and become highly porous during intervertebral disc degeneration and a...Skeletal interoception regulates bone homeostasis through the prostaglandin E2(PGE2)concentration in bone.Vertebral endplates undergo ossification and become highly porous during intervertebral disc degeneration and aging.We found that the PGE2 concentration was elevated in porous endplates to generate spinal pain.Importantly,treatment with a high-dose cyclooxygenase 2 inhibitor(celecoxib,80 mg·kg−1 per day)decreased the prostaglandin E2 concentration and attenuated spinal pain in mice with lumbar spine instability.However,this treatment impaired bone formation in porous endplates,and spinal pain recurred after discontinuing the treatment.Interestingly,low-dose celecoxib(20 mg·kg−1 per day,which is equivalent to one-quarter of the clinical maximum dosage)induced a latent inhibition of spinal pain at 3 weeks post-treatment,which persisted even after discontinuing treatment.Furthermore,when the prostaglandin E2 concentration was maintained at the physiological level with low-dose celecoxib,endplate porosity was reduced significantly,which was associated with decreased sensory nerve innervation and spinal pain.These findings suggest that low-dose celecoxib may help to maintain skeletal interoception and decrease vertebral endplate porosity,thereby reducing sensory innervation and spinal pain in mice.展开更多
基金supported by the National Key Research and Development Project,No.2019YFA0112100(to SF).
文摘Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
基金supported by the Natural Science Foundation of China (No.81871800 and 82072496)granted to W.D.the Natural Science Foundation of Hebei Province (No.H2020206203)granted to S.Y.+1 种基金a National Health and Medical Research Council (NHMRC)Australia Ideas Grant (No.2011398) granted to D.H.supported by the Assistant Secretary of Defense for Health Affairs endorsed by the US Department of Defense through the FY19 Chronic Pain Management Research Program (D.M.K:award no.W81XWH2010909)。
文摘Low back pain(LBP)is the world's leading cause of disability and is increasing in prevalence more rapidly than any other pain condition.Intervertebral disc(IVD)degeneration and facet joint osteoarthritis(FJOA)are two common causes of LBP,and both occur more frequently in elderly women than in other populations.Moreover,osteoarthritis(OA)and OA pain,regardless of the joint,are experienced by up to twice as many women as men,and this difference is amplified during menopause.Changes in estrogen may be an important contributor to these pain states.Receptors for estrogen have been found within IVD tissue and nearby joints,highlighting the potential roles of estrogen within and surrounding the IVDs and joints.In addition,estrogen supplementation has been shown to be effective at ameliorating IVD degeneration and OA progression,indicating its potential use as a therapeutic agent for people with LBP and OA pain.This review comprehensively examines the relationship between estrogen and these pain conditions by summarizing recent preclinical and clinical findings.The potential molecular mechanisms by which estrogen may relieve LBP associated with IVD degeneration and FJOA and OA pain are discussed.
基金supported by National Institute on Aging of the National Institutes of Health under Award Number R01 AG068997 and P01 AG066603(to X.C.).
文摘Skeletal interoception regulates bone homeostasis through the prostaglandin E2(PGE2)concentration in bone.Vertebral endplates undergo ossification and become highly porous during intervertebral disc degeneration and aging.We found that the PGE2 concentration was elevated in porous endplates to generate spinal pain.Importantly,treatment with a high-dose cyclooxygenase 2 inhibitor(celecoxib,80 mg·kg−1 per day)decreased the prostaglandin E2 concentration and attenuated spinal pain in mice with lumbar spine instability.However,this treatment impaired bone formation in porous endplates,and spinal pain recurred after discontinuing the treatment.Interestingly,low-dose celecoxib(20 mg·kg−1 per day,which is equivalent to one-quarter of the clinical maximum dosage)induced a latent inhibition of spinal pain at 3 weeks post-treatment,which persisted even after discontinuing treatment.Furthermore,when the prostaglandin E2 concentration was maintained at the physiological level with low-dose celecoxib,endplate porosity was reduced significantly,which was associated with decreased sensory nerve innervation and spinal pain.These findings suggest that low-dose celecoxib may help to maintain skeletal interoception and decrease vertebral endplate porosity,thereby reducing sensory innervation and spinal pain in mice.
