Degang Yang

Background: Arthritis is a major cause of pain, functional limitation, and disability among middle-aged and older adults. Although allostatic load (AL) and depressive symptoms have each been linked to adverse health outcomes, prospective evidence on their independent and joint associations with incident arthritis remains limited, particularly in Chinese populations. Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 8882 participants aged 45 years and older without arthritis at baseline in 2011 were included and followed through 2020. AL was calculated from 11 equally weighted baseline biomarkers (body mass index, systolic and diastolic blood pressure, blood urea nitrogen, total cholesterol, high- and low-density lipoprotein cholesterol, C-reactive protein, glycated hemoglobin, cystatin C, and fasting glucose) using prespecified risk thresholds and categorized as low (0–1), medium (2–3), or high (4–11) burden. Depressive symptoms were measured at baseline using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), with a cutoff score of 10. New-onset (incident) arthritis was defined as a newly reported physician diagnosis of “arthritis or rheumatism” during follow-up. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. Multiplicative and additive interactions between AL and depressive symptoms were also examined. Results: During follow-up, both higher AL and depressive symptoms were independently associated with an increased risk of new-onset arthritis. In the fully adjusted model, compared with the low-AL group, the HRs for incident arthritis were 1.10 (95% CI: 1.02–1.20) for the medium-AL group and 1.21 (95% CI: 1.04–1.35) for the high-AL group. Participants with depressive symptoms had a significantly higher risk of incident arthritis than those without depressive symptoms (HR = 1.53, 95% CI: 1.41–1.65). No significant multiplicative interaction was observed between AL and depressive symptoms (p for interaction = 0.192). Additive interaction analysis suggested limited evidence of excess joint risk in participants with high AL and depressive symptoms, with an attributable proportion of 0.19 (95% CI: 0.02–0.37). Conclusions: Higher allostatic load and depressive symptoms were independently associated with an elevated risk of new-onset arthritis among middle-aged and older adults. Although no significant multiplicative interaction was identified, their co-occurrence may confer additional risk on an additive scale. These findings highlight the potential relevance of considering both cumulative physiological stress and psychological distress in arthritis risk assessment.

Study design Cross-sectional explorative observational study. Setting The China Rehabilitation Research Center is one of the centers for spinal cord injury in China, and this study investigates the Chinese part of spinal cord injury. Objective To observe the changes of fecal short-chain fatty acids (SCFA) in patients with traumatic spinal cord injury (TSCI) compared with normal controls. Methods Thirty-eight patients with TSCI who were hospitalized in Beijing Boai Hospital of China Rehabilitation Research Center from April, 2017 to October, 2018 were recruited. Basic data such as age, gender, neurological level, etiology, and defecation method were recorded, and neurogenic bowel dysfunction score (NBD) was assessed. Twenty-one healthy subjects from the staffs of Beijing Bo’ai Hospital were recruited as the control group. Fresh stool samples were collected and gas chromatography–mass spectrometry (GC-MS) was used to determine the contents of caproic acid, isovaleric acid, isobutyric acid, valeric acid, butyric acid, propionic acid and acetic acid in feces of TSCI patients and controls. The Mann-Whitney U test was used to compare SCFA levels between the two groups. Results Compared with healthy controls, the levels of isovaleric acid and isobutyric acid in the feces of TSCI patients increased, while the levels of butyric acid and acetic acid decreased, and the differences were statistically significant (P < 0.05). Conclusion The fecal content of propionic acid and butyric acid decreased while that of isobutyric acid and isoamyl acid increased in patients with chronic TSCI.

Spinal cord injury leads to loss of innervation of skeletal muscle, decreased motor function, and significantly reduced load on skeletal muscle, resulting in atrophy. Factors such as braking, hormone level fluctuation, inflammation, and oxidative stress damage accelerate skeletal muscle atrophy. The atrophy process can result in skeletal muscle cell apoptosis, protein degradation, fat deposition, and other pathophysiological changes. Skeletal muscle atrophy not only hinders the recovery of motor function but is also closely related to many systemic dysfunctions, affecting the prognosis of patients with spinal cord injury. Extensive research on the mechanism of skeletal muscle atrophy and intervention at the molecular level has shown that inflammation and oxidative stress injury are the main mechanisms of skeletal muscle atrophy after spinal cord injury and that multiple pathways are involved. These may become targets of future clinical intervention. However, most of the experimental studies are still at the basic research stage and still have some limitations in clinical application, and most of the clinical treatments are focused on rehabilitation training, so how to develop more efficient interventions in clinical treatment still needs to be further explored. Therefore, this review focuses mainly on the mechanisms of skeletal muscle atrophy after spinal cord injury and summarizes the cytokines and signaling pathways associated with skeletal muscle atrophy in recent studies, hoping to provide new therapeutic ideas for future clinical work.

Background: Spinal cord injury (SCI) patients display disruption of gut microbiome and gut dysbiosis exacerbate neurological impairment in SCI models. Cumulative data support an important role of gut microbiome in SCI. Here, we investigated the hypothesis that fecal microbiota transplantation (FMT) may exert a neuroprotective effect on SCI mice. Results: We found that FMT facilitated functional recovery, promoted neural axonal regeneration, improved animal weight gain and metabolic profiling, and enhanced intestinal barrier integrity and GI motility. High-throughput sequencing revealed that levels of phylum Firmicutes, genus Blautia, Anaerostipes and Lactobacillus were reduced in fecal samples of SCI mice, and FMT remarkably reshaped gut microbiome. Also, FMT-treated SCI mice showed increased amount of fecal short-chain fatty acids (SCFAs), which correlated with alteration of intestinal permeability and locomotor recovery. Furthermore, FMT down-regulated IL-1β/NF-κB signaling in spinal cord and NF-κB signaling in gut. Conclusion: Our study demonstrates that reprogramming of gut microbiota by FMT improves locomotor and GI functions in SCI mice, possibly through the anti-inflammatory functions of SCFAs.

Neurogenic bowel dysfunction (NBD) and gut dysbiosis frequently occur in patients with traumatic cervical spinal cord injury (TCSCI). We evaluated neurogenic bowel management and changes in the gut microbiota in patients with TCSCI as well as associations between these changes and serum biomarkers. Fresh fecal and clinical data were collected from 20 male patients with TCSCI and 23 healthy males. Microbial diversity and composition were analyzed by sequencing the V3-V4 region of the 16S rRNA gene. Moderate NBD was observed in patients with TCSCI. The diversity of the gut microbiota was lower in patients with TCSCI than in healthy adults. Furthermore, patients with TCSCI showed altered levels of serum biomarkers related to lipid metabolism, indicating unfavorable lipid profiles. Interestingly, Firmicutes had a positive effect and Verrucomicrobia had a negative effect on lipid metabolism (P < 0.05). At the genus level, Bacteroides and Blautia were significantly more abundant in patients than in healthy subjects and could be associated with lipid metabolism (P < 0.05). Faecalibacterium, Megamonas. and Prevotella, which were correlated with lipid metabolism markers, may be suitable targets for the treatment of TCSCI. Lactobacillus was positively correlated with glucose levels. The dysbiosis of several key gut bacteria was associated with serum biomarkers of lipid metabolism in patients with TCSCI. The observed interdependency of the microbiota and lipid metabolism provides a basis for understanding the mechanisms underlying lipid disorders after cervical SCI.

Neurogenic bowel dysfunction (NBD) is a major physical and psychological problem in patients with spinal cord injury (SCI), and gut dysbiosis is commonly occurs in SCI. Here, we document neurogenic bowel management of male patients with chronic traumatic complete SCI in our centre and perform comparative analysis of the gut microbiota between our patients and healthy males. A total of 43 male patients with chronic traumatic complete SCI (20 with quadriplegia and 23 with paraplegia) and 23 healthy male adults were enrolled. Clinical data and fresh stool specimens were collected from all participants. Face-to-face interviews were conducted to survey the neurogenic bowel management of 43 patients with SCI. Gut microbiomes were analysed by sequencing of the V3–V4 region of the 16S rRNA gene. NBD was common in adult male patients with chronic traumatic complete SCI. Patients with quadriplegia exhibited a longer time to defecate than did those with paraplegia and had higher NBD scores and heavier neurogenic bowel symptoms. The diversity of the gut microbiota in the SCI group was reduced, and the structural composition was different from that of the healthy adult male group. The abundance of Veillonellaceae and Prevotellaceae increased, while Bacteroidaceae and Bacteroides decreased in the SCI group. The abundance of Bacteroidaceae and Bacteroides in the quadriplegia group and Acidaminococcaceae, Blautia, Porphyromonadaceae, and Lachnoclostridium in the paraplegia group were significantly higher than those in the healthy male group. Serum biomarkers (GLU, HDL, CR, and CRP), NBD defecation time and COURSE had significant correlations with microbial community structure. Microbial community structure was significantly associated with serum biomarkers (GLU, HDL, CR, and CRP), NBD defecation time, and COURSE. This study presents a comprehensive landscape of the gut microbiota in adult male patients with chronic traumatic complete SCI and documents their neurogenic bowel management. Gut microbiota dysbiosis in SCI patients was correlated with serum biomarkers and NBD symptoms.

This study examined the diversity and structure of gut microbiota in healthy adults and chronic traumatic complete spinal cord injury (SCI) patients, documented neurogenic bowel management of SCI patients. The V3-V4 region of 16S rRNA gene from DNA of 91 fecal samples of 48 healthy and 43 diseased subjects was amplified and sequenced. There was difference in gut microbiota between healthy adult males and females. Neurogenic bowel dysfunction (NBD) was common in patients with chronic traumatic complete SCI, patients with quadriplegia have longer time to defecate than paraplegic patients, with higher NBD scores and heavier neurogenic bowel symptoms. Gut microbiota dysbiosis existed in SCI patients. The abundance of Veillonellaceae and Prevotellaceae increased while Bacteroidaceae and Bacteroides decreased in SCI group. The abundance of Bacteroidaceae, Bacteroides in quadriplegia group and Acidaminococcaceae, Blautia in paraplegia group were significant high than the health male group. Serum biomarkers GLU, HDL, CR and NBD symptoms defecation time, COURSE had significant correlation with microbial community structure. This study presents a comprehensive landscape of gut microbiota in adult male patients with chronic traumatic complete SCI and documents their neurogenic bowel management. The gut microbiota dysbiosis of SCI patients was correlation with serum biomarkers and NBD symptoms. IMPORTANCE: Neurogenic bowel dysfunction is a major physical and psychological problem in patients with spinal cord injury, which can seriously affect the quality life of them. Gut dysbiosis are highly likely to occur in spinal cord injury patients There are few studies on intestinal microecology after spinal cord injury, and the clinical studies are fewer. It is importance to document their neurogenic bowel management and present a landscape of gut microbiota in them. We found the gut microbiota dysbiosis of spinal cord injury patients was correlation with serum biomarkers and neurogenic bowel dysfunction symptoms. These results may have implications in the next study about metagenomics and precision treatment of neurogenic bowel dysfunction in spinal cord injury patients.

To investigate the clinical outcomes of semicircular decompression in treating old thoracolumbar fractures and intractable neuropathic pain. From September 2009 to September 2013, 21 patients with old thoracolumbar fracture and intractable neuropathic pain were treated with semicircular decompression. Among initial surgery, posterior pedicle screw fixation was used in these patients, with or without laminectomy. All patients were male, range in age from 20 to 28 years old with an average of (25.00±2.38) years. Vertebral body residual bone block resulted in intra-spinal placeholder more than 50%. All patients were complete spinal cord injury (ASIA grade) or cauda equina injury. VAS scores was from 6 to 10 points with the mean of 7.14±0.91. In these patients, MRI, CT, X-rays were performed; denomination and dosage of analgesics were recorded; nerve function and pain status were respectively evaluated by ASIA grade and VAS score before and after operation. All patients were followed up from 8 to 32 months with an average of (17.29±6.02) months. All bone fragments of spinal canal were removed and spinal cord decompressions were achieved. At final follow-up, VAS scores were from 0 to 8 points with an average of (2.43±2.46) points, and were obviously reduced than peroperative data (P<0.05). Eleven cases of them stopped analgesic intake and 7 cases reduced using. Three patients' symptoms and VAS scores were not improved. Old thoracolumbar fractures and intractable neuropathic pain need receive imaging examination as soon as possible and consider semicircular decompression therapy if bone fragments were in vertebral canal and spinal canal stenosis existed. This therapy can effectively relieve pain and profit nerve functional recovery.