National Center on Medical Consequences of Spinal Cord Injury

国家脊髓损伤医疗后果中心

• 批准号: 9554667
• 负责人: William A Bauman
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9554667
• 关键词: Acids; Address; Adrenergic Receptor; Agonist; Antihypertensive Agents; Appearance; Area; Atrophic; Autonomic nervous system; Blood Pressure; Body Composition; Carbohydrates; Cardiovascular system; Caring; Classification; Connexins; Coronary Arteriosclerosis; Disease; Endocrine; Endocrinology; Epidemiology; Etiology; Functional disorder; Future; Gastroenterology; General Population; Glycopyrrolate; Goals; Hand; Health; Health Professional; Home environment; Immobilization; Impaired cognition; Impairment; Individual; Inflammation; Intervention; Intestines; Investigation; Iontophoresis; Knowledge; Life; Longevity; Lung; Manometry; Measurement; Measures; Mechanics; Medical; Medicine; Metabolic; Midodrine; Mission; Molecular; Molecular Biology; Morbidity - disease rate; Motor; Muscle; Muscular Atrophy; Musculoskeletal; Neostigmine; Neurologic; Neurology; Neuropsychology; Neurorehabilitation; Norepinephrine; Oral; Organ; Paralysed; Pathway interactions; Persons; Pharmacology; Physical Function; Physical Medicine; Physicians; Polysomnography; Population; Quality of life; Regulation; Rehabilitation therapy; Research Personnel; Resolution; Risk; Risk Factors; Scientist; Services; Signal Pathway; Sleep; Sleep Apnea Syndromes; Spinal cord damage; Spinal cord injury; Surveys; Therapeutic; Therapeutic Agents; Thermogenesis; Vascular Diseases; Veterans; Walking; base; bone loss; capsule; cell motility; coronary artery calcium; cost; effective therapy; exoskeleton; gastrointestinal; glucagon-like peptide; improved; inhibitor/antagonist; innovation; insight; lipid metabolism; liraglutide; macrovascular disease; medical complication; medical specialties; natural hypothermia; nervous system disorder; novel; portability; prevent; programs; public health relevance; rehabilitative care; respiratory; routine care; social integration; soft tissue; urologic

 DESCRIPTION: Approximately 250,000 persons in the US have traumatic spinal cord injury (SCI), and at least another 400,000 individuals have spinal cord damage of non-traumatic etiologies. The longevity of those with SCI has increased over the decades because of effective treatments for urological and pulmonary complications. However, the SCI population is growing older and ever more costly to manage medically. Thus, it is increasingly imperative that we continue to understand the medical consequences of SCI and pursue safe and effective treatment options to minimize or prevent these adverse disorders. The mission of the CoE MCSCI is to improve quality of life and to increase longevity in individuals with SCI by identifying and intervening to reduce and/or prevent the secondary medical consequences of SCI, goals which are in the finest tradition of the VA's RR&D Service. The proposed Center of Excellence for the Medical Consequences of Spinal Cord Injury (CoE MCSCI) will continue to provide support for studies by investigators in several specialty areas of Medicine, Rehabilitation Medicine, Neurology, Neuropsychology, Epidemiology, Sleep Medicine, and Molecular Biology. The CoE physician/scientist-investigators will initiate interventional treatments for various medical complications, or strive o better characterize pathophysiological conditions. Therapeutic or investigational approaches that will be pursued include pharmacological and non-pharmacological interventions as follows: ibandronic acid to reduce bone loss in individuals with incomplete motor SCI who are ambulatory; a gut incretin [glucagon- like peptide (liraglutide)] to improve carbohydrate/lipid metabolism and soft tissue body composition; a novel adjunctive approach to improve routine bowel care by administering neostigmine and glycopyrrolate transdermally by iontophoresis; an oral vibrating capsule to improve bowel motility and evacuation; exoskeleton assisted walking (EAW) to improve colonic motility measured by SCI-QOL Bowel Management survey, radiopaque markers, and high resolution manometry; identification and classification of the degree of autonomic cardiovascular impairment; anti-hypotensive agents to raise blood pressure and prevent cognitive impairment [e.g., beta (3)-adrenoceptor agonist (mirabegron); an alpha agonist (midodrine), and a norepinephrine precursor (droxidopa)]; a novel meal with an enhanced ability for meal-induced thermogenesis to reduce risk of hypothermia upon cold exposure; paired central stimulation to strengthen existing neurological pathways to the hands; and home-based portable sleep monitoring compared to witnessed polysomnography for the identification of sleep disordered breathing. Compared to the general population, cardiovascular morbidity in persons with SCI occurs earlier in life and is more prevalent. Conventional risk factors for coronary artery disease may not accurately predict the presence of macrovascular disease. Thus, the measurement of emerging risk factors, as well as conventional risk factors, and the quantification of coronary artery calcium will continue to be studied in our CoE proposal to enable health professionals to better identify and treat persons with vascular disease. EAW in persons with SCI has proven to be a game-changing mechanical intervention for mobility and to improve several health- related conditions, including bowel dysfunction, which is proposed to be assessed in the CoE. A new molecular signaling pathway involving the de novo appearance of connexin hemichannels, may underlie muscle inflammation and atrophy after SCI and possibly other neurological disorders; inhibitors of these hemichannels may be proven to be potent therapeutic agents to reduce muscle atrophy after immobilization. The future holds exciting promise for innovative treatments to be incorporated into routine care associated with endocrine-metabolic, respiratory, gastrointestinal, autonomic, and musculoskeletal dysfunctions.

 描述： 在美国，大约有 250,000 人患有创伤性脊髓损伤 (SCI)，另外至少还有 400,000 人患有非创伤性病因的脊髓损伤。几十年来，由于泌尿科和肺部疾病的有效治疗，SCI 患者的寿命有所延长。然而，脊髓损伤患者的年龄越来越大，治疗费用也越来越高，因此，我们越来越有必要继续了解脊髓损伤的医疗后果并追求安全有效。 CoE MCSCI 的使命是通过识别和干预减少和/或预防 SCI 的继发性医疗后果来改善 SCI 患者的生活质量并延长寿命。秉承 VA RR&D 服务的优良传统，拟议的脊髓损伤医疗后果卓越中心 (CoE MCSCI) 将继续为多个医学专业领域的研究人员的研究提供支持，康复医学、神经病学、神经心理学、流行病学、睡眠医学和分子生物学。 CoE 医生/科学家研究人员将针对各种医疗并发症启动介入治疗，或努力更好地描述病理生理学状况，包括药理学。以及非药物干预措施如下：伊班膦酸可减少不完全运动性 SCI 患者的骨质流失，而肠促胰素 [胰高血糖素 -肽（利拉鲁肽）]改善碳水化合物/脂质代谢和软组织身体成分；通过离子电渗疗法经皮施用新斯的明和格隆溴铵以改善肠道蠕动和外骨骼辅助行走，从而改善常规肠道护理的新辅助方法； (EAW) 改善通过 SCI-QOL 肠道管理调查、不透射线标记和高分辨率测压法测量的结肠运动；自主心血管损害程度的识别和分类；用于升高血压和预防认知障碍的抗高血压药物[例如，β(3)-肾上腺素受体激动剂（米拉贝隆）；α激动剂（米多君）和去甲肾上腺素前体（屈昔多巴） )]；一种增强膳食诱导产热能力的新型膳食，可降低暴露于寒冷时的体温过低的风险，从而增强现有的手部神经通路；与普通人群相比，家庭便携式睡眠监测与可靠的多导睡眠监测相比，SCI 患者的心血管发病发生得更早，并且更普遍，传统的冠状动脉疾病危险因素可能无法准确预测。因此，我们的 CoE 提案将继续研究新出现的危险因素和传统危险因素的测量以及冠状动脉钙的量化，以使卫生专业人员能够更好地识别和治疗患有血管疾病的人。 EAW 中的疾病。 SCI 患者已被证明是一种改变游戏规则的机械干预措施，可改善活动能力并改善多种健康相关状况，包括肠功能障碍，建议在 CoE 中评估涉及连接蛋白从头出现的新分子信号传导途径。半通道，可能是 SCI 后肌肉炎症和萎缩的基础，这些半通道的抑制剂可能被证明是减少固定后肌肉萎缩的有效治疗剂，未来将创新治疗纳入常规治疗具有令人兴奋的前景。与内分泌代谢、呼吸、胃肠道、自主神经和肌肉骨骼功能障碍相关的护理。