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Simona Capossela,1 Vikas Mathew,1 Manuela Boos,2 Alessandro Bertolo,1 Olga Krupkova,2– 4 Jivko V Stoyanov1,5 1SCI Biobanking and Translational Medicine, Swiss Paraplegic Research, Nottwil, Switzerland; 2Institute for Biomechanics, D-HEST, ETH Zurich, Zurich, Switzerland; 3Department of Spinal Surgery, University Hospital Basel, Basel, Switzerland; 4Department of Biomedicine, University of Basel & University Hospital Basel, Basel, Switzerland; 5Center for Applied Biotechnology and Molecular Medicine (CABMM), Zurich, SwitzerlandCorrespondence: Jivko V StoyanovSwiss Paraplegic Research, Nottwil CH-6207, SwitzerlandTel +41 41-939-6635Fax +41 41-939-6640Email jivko.stoyanov@paraplegie.chPurpose: The production of nano-erythrosomes (NEs) by extrusion, which is considered the “gold standard”, has several disadvantages such as difficult equipment assembly, long procedure time, variable pressure, and problems with sterility. An alternative approach, using ultrasound probe, has been shown to overheat the sample and have suboptimal results compared to the extrusion method. In our study, we propose, develop, and test a new method for the fabrication of NEs based on shear force and then compare it to the “gold standard” extrusion approach.Methods: The new method consists of mechanical shear force disruption of the hemoglobin-depleted erythrocyte ghost membranes, with the aid of a rotor stator based tissue homogenizer. Using the same batches of erythrocyte ghost membranes, we compared NEs produced by shear force to NEs produced by the well-established extrusion approach. NEs were characterized for yield, size, encapsulation efficiency, morphology, and stability by flow cytometry (FC), transmission electron microscopy (TEM), and zeta potential analysis.Results: The shear force based process was easier to set up, significantly faster, had better sterility control, and decreased variability between batches. The shear force method generated NEs with the desired size distribution (particles diameter ∼ 125 nm), which were morphologically and functionally equivalent to the NEs produced by extrusion. NEs produced by shear force were stable in terms of counts, size, and fluorescence intensity for 3 weeks at +4°C. Moreover, they showed colloidal stability and minimal influence to centrifugal stress, turbulence shock, and hemolytic potential.Conclusion: The newly proposed shear force method allows faster, easier, and highly reproducible NEs production when compared to the conventional extrusion approach. The new setup allows simultaneous production of sterile batches of NEs, which have homogenous size distribution, good stability, and improved shelf life storage. The ability of the shear force method to process also high concentration samples indicates a future potential development of large-scale NEs production and industrial application, which has been a challenge for the extrusion method.Keywords: erythrocytes, nanotechnology, nanoerythrosomes, extrusion, shear force, new method

Simona Capossela,1 David Pavlicek,1 Alessandro Bertolo,1 Gunther Landmann,2 Jivko V Stoyanov1 1Swiss Paraplegic Research, Nottwil, Switzerland; 2Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland Introduction: Chronic back pain is one of the most important socioeconomic problems that affects the global population. Elevated levels of inflammatory mediators, such as cytokines, have been correlated with pain, but their role in chronic back pain remains unclear. The effectiveness of anti-inflammatory drugs seems to be limited for chronic back pain. The authors wanted to investigate the levels of inflammatory mediators in long-term medically treated patients with persistent chronic back pain. Methods: Cytokine plasma levels of patients with chronic back pain (n=23), compared to pain-free healthy controls (n=30), were investigated by immunoassay. Patients with chronic back pain were exposed to long-term conservative medical therapy with physiotherapy and anti-inflammatories, also combined with antidepressants and/or muscle-relaxants. Results: The patients with chronic back pain expressed lower levels of the chemokines MCP1, CCL5, and CXCL6 compared to pain-free healthy controls. Significantly lower concentrations of the anti-inflammatory cytokines, interleukin (IL)-4 and granulocyte-colony stimulating factor were also found. Interestingly, levels of proinflammatory cytokines (IL-2, IL-6, IL-1β, tumor necrosis factor alpha), IL-10, granulocyte-macrophage colony-stimulating factor, and stromal cell-derived factor 1 alpha showed no significant differences between both groups. Conclusion: This decrease of inflammatory mediators in medically treated patients with chronic back pain is of unclear origin and might be either a long-term side effect of medical therapy or related to chronic pain. Further longitudinal research is necessary to elucidate the underlying cause of these findings. Keywords: chronic pain, back pain, inflammation, cytokine, chemokine

The alternative medicine is an addition of official medicine. We offer our new outpatient card for Chinese medical centers. Alternative outpatient card consists of several parts: title and disease historical part, a table for pulse diagnosis, a scheme for language diagnosis, a scheme for aurikulodiagnostika, a scheme for diagnosis of the steps. The outpatient card allows: deposition of a large number of medical procedures on one page, using easy to adopt the human body which are applied on medical prescriptions; possible therapeutic application of 2 recipes of a different color on a separate circuit or the same color on two separate circuits, possibility to cause a minimum of 10 alternating healing recipes on each card. [ABSTRACT FROM AUTHOR]

Introduction : We conducted a twenty-year bibliometric analysis of scientific literature, focusing on the trends of The International Classification of Functioning, Disability and Health (ICF) use in health research., Methods : We retrieved 3'467 documents published between 2002 and 2022, sourced from the Web of Science Core Collection database. We used the Bibliometrix and VoSviewer tools for descriptive analyses and data visualization., Results : Our findings indicate a significant increase in ICF application since 2011, with an average annual growth rate of 13.19%. Prominent contributions were observed globally, with notable outputs from the U.S., Canada, Germany, the Netherlands, and Switzerland. The Ludwig Maximilian University Munich, Swiss Paraplegic Research, and McMaster University authored a quarter of the documents (24.6%). Collaboration networks of countries and institutions revealed robust partnerships, particularly between Germany and Switzerland. "Rehabilitation" was the most frequently occurring keyword, although a thematic shift towards epidemiology, aging, and health-related quality of life was observed post-2020. While rehabilitation remained the primary thematic focus, literature post-2020 highlighted epidemiology as a growing area of interest., Conclusions : A steady increase in ICF-based research mirrors the rising interest in a biopsychosocial and person-centered approach to healthcare. However, the literature is primarily produced by high-resource countries, with underrepresentation from low and middle-resource countries, suggesting an area of future research to address this discrepancy.

Study Design: Cross-sectional analysis from the Inception Cohort of the Swiss Spinal Cord Injury Study (SwiSCI)., Objectives: To describe five lifestyle components in newly injured individuals with spinal cord injury (SCI), explore co-occurrence of these components, and identify associated personal and clinical factors., Settings: Initial rehabilitation stay following traumatic and non-traumatic SCI., Methods: Lifestyle components including overweight/obesity, low diet score, physical inactivity, smoking, and alcohol consumption were used independently and to calculate a composite lifestyle score. Analyses were conducted using descriptive statistics, co-occurrence analysis, and multivariate logistic regression., Results: We included 251 individuals, of whom 77.7% were male, 73.7% suffered from traumatic SCI, and 59.8% had paraplegia. The median age was 51 years (IQR 36-64). Approximately twelve weeks after the injury, more than two-thirds of the study population met the criteria for overweight/obesity, and consumed insufficient amounts of fruits and vegetables, and excessive amounts of meat. Alcohol was consumed by 85.3% of individuals, and 26.8% were current smokers. Almost all study participants met the physical activity guidelines (90 min of moderate to strenuous activity physical activity per week). One-quarter of study participants experienced the co-occurrence of overweight/obesity, low diet score and alcohol consumption. Female sex, younger age and higher education were associated with healthier lifestyle components., Conclusion: Despite methodological limitations, this study underscores the complexities of healthy lifestyle adherence among individuals newly injured with SCI. It highlights the necessity of improving and implementing screening strategies throughout the continuum of SCI care as early as possible following the trauma., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval: The SwiSCI study is compliant with the Swiss Human Research Act (810.30 Federal Act of September 30, 2011, on Research involving Human Beings) and Federal Regulations on Data Protection. Participation in the SwiSCI study is voluntary, and the patients’ informed consent is obtained prior to participation. The relevant ethics committees of the participating centers (Ethics Committee northwest/central Switzerland (EKNZ), Ethics Committee Vaud (CEVD), Ethics Committee Zurich (KEKZH)) have approved the study protocol and all associated assessments. The data used for the present study were anonymized, with no possibility to identify participants. All study participants signed informed consent., (© 2024. The Author(s).)

Objective: To evaluate the effect of lifestyle and behavioral interventions on anthropometric indices and body composition in individuals with spinal cord injury (SCI)., Data Sources: MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched from inception to January 22, 2024., Study Selection: Randomized controlled trials (RCTs), non-RCTs, and pre-post studies on the effectiveness of lifestyle and/or behavioral interventions in improving body composition (including body mass index, waist circumference, fat mass, and lean mass) were eligible., Data Extraction: Study design characteristics, number of participants, intervention/control characteristics, and outcomes were extracted., Data Synthesis: Sixty-one interventional studies were included in the systematic review, among which 5 RCTs contributed to meta-analysis. Exercise, alone or combined with functional electrical stimulation (FES), supplements, or educational sessions, was the most studied intervention across the identified studies, accounting for 75% of studies. Exercise regimen compared with the usual activities yielded a decrease in BMI (mean difference [MD], -0.38 kg/m 2 ; 95% CI, -0.57 to -0.19; I 2 : 0%; P q :.45]) and waist circumference (MD, -2.93 cm; 95% CI, -3.98 to -1.88; I 2 : 0%; P q : 0.59). No significant differences were observed when comparing changes in total body fat percentage nor lean body mass between the 2 groups. Exercise with FES and testosterone, exercise and personalized diet, high-protein diet, and α-lipoic acid supplementation were mapped as other potentially beneficial interventions, whereas studies targeting behavioral changes were inconclusive., Conclusions: Exercise-based interventions alone or combined with FES or standardized/personalized dietary regimens show promise as effective strategies for improving anthropometric indices and body composition among individuals with SCI, emphasizing the potential benefit of the weight management program. The present findings may not be applicable to individuals with high SCI lesions. Further research to evaluate the effectiveness of a more complex lifestyle and/or behavioral interventions in individuals with SCI is warranted., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of the study is to examine the changes in the burden of secondary health conditions and their risk factors among newly injured individuals with spinal cord injury after discharge from inpatient rehabilitation to community living., Design: This is a prospective cohort study., Results: Among 280 included persons, the majority were men with traumatic spinal cord injury and paraplegia. The most common secondary health conditions at discharge from rehabilitation and in the community setting were pain (60.8% vs. 75.9%), urinary tract infections (27.8% vs. 47.6%), and pressure sores (9.9% vs. 27.5%). There was also a significant increase in reported heart disease (9.3% vs. 14.8%) and diabetes (0% vs. 4.2%). The odds of experiencing pain, pressure sores, depression and urinary tract infections increased after discharge from rehabilitation, whereas the odds of respiratory problems decreased significantly during the observation period. Factors such as sex, injury severity, activity limitations, and duration of follow-up were identified as potential risk factors influencing secondary health condition occurrence., Conclusions: Our study emphasizes a significant rise in secondary health conditions after the transition to community living. Future research should prioritize development of targeted intervention programs tailored to address the unique needs of affected individuals at this pivotal stage in the continuum of spinal cord injury care., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The transition from paediatric to adult medical care is a critical period for adolescents with spina bifida, often marked by deteriorating health and functional status., Objectives: To describe the health status and functioning of individuals with spina bifida at the time of transition from paediatric to adult care and to identify risk profiles for potentially modifiable secondary health conditions (urinary tract infections, pressure injuries, respiratory problems and obesity)., Methods: Descriptive study of data (derived from medical records) from all adolescents and young adults with spina bifida aged 15-25 years who were referred to a single specialised spinal cord injury centre as part of the transition programme during the period from 1 September 2015 to 31 May 2022. Descriptive statistics were used to describe the study population and to analyse the frequency and co-occurrence of congenital and acquired secondary health conditions. The equality of proportions test was used to test the prevalence of secondary health conditions based on important personal and clinical characteristics., Results: We included 43 adolescents with spina bifida with a mean age of 18.4 years (SD 2.5); in 63% of them the neurological level was lumbar, and around 50% of them were wheelchair-dependent. The median Spinal Cord Injury Measure (SCIM) III score was 72 (IQR 61-89). The mean number of secondary health conditions at time of transition was 8.8. The most prevalent secondary health conditions were lower urinary tract dysfunction, bowel dysfunction, sexual dysfunction and contractures. Respiratory problems were more prevalent in females and in individuals with lower SCIM III scores, whereas no differences were observed in the prevalence of other modifiable secondary health conditions. Clustering of secondary health conditions was mainly seen for urinary tract infection + pressure injury and for urinary tract infection + pressure injury + obesity., Conclusion: The prevalence of secondary health conditions among individuals with spina bifida at time of transition is alarmingly high and functional profiles underscore the need for supporting adolescents and young adults with daily medical issues. The study highlights the critical role of transition programmes and interdisciplinary follow-up care in preventing health problems and improving functioning and independence in everyday life.

Study Design: Longitudinal study., Objective: To explore whether individuals with traumatic spinal cord injury (TSCI) and non-traumatic SCI (NTSCI) experience different trajectories in changes of cardiometabolic disease (CMD) factors during initial rehabilitation stay., Setting: Multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study., Methods: Individuals without history of cardiovascular diseases were included. CMD factors and Framingham risk score (FRS) were compared between TSCI and NTSCI. Linear mixed models' analysis was employed to explore the trajectory in CMD factors changes over rehabilitation period and a multivariate linear regression analysis was used at discharge from inpatient rehabilitation to explore factors associated with CMD risk profile in TSCI and NTSCI. We performed age and sex-stratified analyses., Results: We analyzed 530 individuals with SCI (64% with TSCI and 36% NTSCI). The median age was 53 years (IQR:39-64) with 67.9% (n = 363) of the study cohort being male. The median rehabilitation duration was 4.4 months (IQR 2.4-6.4). At admission to rehabilitation, FRS (9.61 vs. 5.89) and prevalence of hypertension (33.16% vs. 13.62%), diabetes (13.68% vs. 4.06%), and obesity (79.05% vs. 66.67%) were higher in NTSCI as compared to TSCI, No difference was observed in cardiometabolic syndrome between the groups (around 40% in both groups). Overall, we observed longitudinal increases in total cholesterol, HDL-C and HDL/total cholesterol ratio, and a decrease in fasting glucose over the rehabilitation period. No differences in longitudinal changes in cardiovascular risk factors were observed between TSCI and NTSCI., Conclusions: There was no deterioration in cardiometabolic risk factors over rehabilitation period, at discharge from initial rehabilitation stay. Both TSCI and NTSCI experienced high burden of cardiometabolic syndrome components with NTSCI experiencing more disadvantageous risk profile. The effectiveness of therapeutic and lifestyle/behavioral strategies to decrease burden of cardiometabolic disease and its components in early phase should be explored in future studies., (© 2024. The Author(s).)

Disorders related to gut health are a significant cause of morbidity among athletes in wheelchair. This pilot feasibility trial aims to investigate whether probiotics compared to prebiotics can improve inflammatory status and gut microbiome composition in elite athletes in wheelchair. We conducted a 12-week, randomized, cross-over controlled trial involving 14 elite Swiss athletes in wheelchair. Participants were given a multispecies-multistrain probiotic or prebiotic (oat bran) daily for 4 weeks (Clinical trials.gov NCT04659408 09/12/2020). This was followed by a 4-week washout and then crossed over. Thirty inflammatory markers were assessed using bead-based multiplex immunoassays (LegendPlex) from serum samples. The gut microbiome was characterized via 16S rRNA sequencing of stool DNA samples. Statistical analyses were conducted using linear mixed-effect models (LMM). At baseline, most athletes (10/14) exhibited low levels of inflammation which associated with higher gut microbiome alpha diversity indices compared to those with high inflammation levels. The use of probiotic had higher decrease in 25 (83%) inflammatory markers measured compared to prebiotic use. Probiotic has the potential in lowering inflammation status and improving the gut microbiome diversity. The future trial should focus on having sufficient sample sizes, population with higher inflammation status, longer intervention exposure and use of differential abundance analysis., (© 2024. The Author(s).)

Objectives: To describe the concept, establishment and the operationalization of the biobank of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), the available biosamples, and demographic and clinical characteristics of study participants., Setting: The SwiSCI biobank is a platform for research within SwiSCI. It collects and processes serum, plasma, PBMCs, RNA, DNA, and urine from three rehabilitation centers. Samples are collected at admission to first rehabilitation and at discharge. Additionly, the biobank provides services to projects nested in SwiSCI or otherclinical trials among Spinal Cord Injury population., Methods: Descriptive statistics were used for an overview of available biosamples, study participant characteristics, and comparison of the participating centers., Results: Between the SwiSCI biobank establishment on June 27th, 2016, and October 19th, 2023, the SwiSCI Study has obtained informed consent from 524 individuals. Of these, 315 (60.1%) have agreed to donate biospecimens to the biobank. The average age of the contributors was 54 years (range: 38-65), with the majority being male (80%). Most participants suffered from traumatic injuries (66%) and were classified as paraplegic (64%). Approximately 80% presented with motor and sensory-incomplete SCI. The median Spinal Cord Independence Measure (SCIM) score was 31 (Interquartile Range: 19-58). The proportion of individuals providing paired biosamples at two distinct time points ranged from 63% (for RNA) to 65% (for urine and urine sediment)., Conclusions: The SwiSCI biobank is a unique platform designed to serve as a basis for collaborative SCI research, including multi-omics approaches. The longitudinal collection of biospecimens and cryopreservation of multiple aliquots for each participant are fundamental for scrutinizing the temporal associations, ensuring research reproducibility, and achieving an adequate sample size for future investigations., (© 2024. The Author(s).)

Background: Accurate identification of bacterial communities is crucial for research applications, diagnostics, and clinical interventions. Although 16S ribosomal RNA (rRNA) gene sequencing is a widely employed technique for bacterial taxonomic classification, it often results in misclassified or unclassified bacterial taxa. This study sought to refine the full-length 16S rRNA gene sequencing protocol using the MinION sequencer, focusing on the V1-V9 regions. Our methodological enquiry examined several factors, including the number of PCR amplification cycles, choice of primers and Taq polymerase, and specific sequence databases and workflows employed. We used a microbial standard comprising eight bacterial strains (five gram-positive and three gram-negative) in known proportions as a validation control., Results: Based on the MinION protocol, we employed the microbial standard as the DNA template for the 16S rRNA gene amplicon sequencing procedure. Our analysis showed that an elevated number of PCR amplification cycles introduced PCR bias, and the selection of Taq polymerase and primer sets significantly affected the subsequent analysis. Bacterial identification at genus level demonstrated Pearson correlation coefficients ranging from 0.73 to 0.79 when assessed using BugSeq, Kraken-Silva and EPI2ME-16S workflows. Notably, the EPI2ME-16S workflow exhibited the highest Pearson correlation with the microbial standard, minimised misclassification, and increased alignment accuracy. At the species taxonomic level, the BugSeq workflow was superior, with a Pearson correlation coefficient of 0.92., Conclusions: These findings emphasise the importance of careful selection of PCR settings and a well-structured analytical framework for 16S rRNA full-length gene sequencing. The results showed a robust correlation between the predicted and observed bacterial abundances at both the genus and species taxonomic levels, making these findings applicable across diverse research contexts and with clinical utility for reliable pathogen identification., (© 2024. The Author(s).)

Objectives: To illustrate and explore associations between the gut microbiome and spinal cord injury (SCI) characteristics, physical training, dietary intake, body composition, and blood biomarkers of elite Swiss athletes., Design and Setting: Baseline data analysis of athletes with SCI who participated in a pilot trial (NCT04659408) in the Swiss Paraplegic Center, Nottwil, Switzerland., Participants: Elite athletes, five males, and six females, with SCI who competed internationally., Outcome Measures: We conducted a differential abundance analysis and measured the alpha and beta diversity of the gut microbiome., Results: The athletes' median age was 34.5 years. Six had traumatic SCI and five had a spina bifida. The athletes competed in para-cycling (5), wheelchair athletics (3), and wheelchair tennis (3). A higher duration of training per week was positively associated with Akkermansia and Akkermansiaceae but negatively associated with Prevotellaceae . Muribaculaceae was negatively associated with the average number of trainings per week. Waist circumference is negatively associated with Butyricimonas . Significant differences in the alpha diversity were found with sex, gastrointestinal quality of life index (GIQLI) scores, total caloric intake, total fat intake, total carbohydrate intake, and high-sensitivity C-reactive protein (hs-CRP). Beta diversity differences were found with impairment of the sympathetic nervous system of the gut at the genus level and HbA1c at the family level., Conclusions: This study provides insight into the gut microbiome of athletes with SCI. Our results were similar to those found in athletes without SCI. Further replication is needed to confirm the relationships of organisms observed in the gut of athletes with SCI.

Objectives: The aims of the study are to determine the cardiovascular risk burden rehabilitation discharge and to explore the association between recovery during rehabilitation and cardiovascular disease risk profile., Methods: We included adults without cardiovascular disease admitted for rehabilitation. We evaluated rehabilitation outcomes on admission and discharge. Cardiovascular disease risk profile was assessed by Framingham risk score, high-density lipoprotein, and fasting glucose level., Results: We analyzed data from 706 participants (69.6% men) with a median age of 53.5 yrs. The median time since injury was 14 days, and the admission length was 5.2 months. Majority had paraplegia (53.3%) and motor incomplete injury (53.7%). One third of the cohort had high cardiovascular risk profile before discharge. At discharge, poorer anthropometric measures were associated with higher Framingham risk score and lower high-density lipoprotein levels. Individuals with higher forced vital capacity (>2.72 l) and peak expiratory flow (>3.4 l/min) had 0.16 mmol/l and 0.14 mmol/l higher high-density lipoprotein compared with those with lower respiratory function, respectively. Individuals with higher mobility score (>12.5) and functional independence score (>74) had 0.21 and 0.18 mmol/l higher high-density lipoprotein compared with those with lower scores., Conclusions: There is high cardiometabolic syndrome burden and cardiovascular disease risk profile upon rehabilitation discharge. Higher respiratory function, mobility, and overall independence were associated with better cardiovascular disease risk profile, although with study design limitations and short follow-up. Future studies should explore whether rehabilitation outcomes could be used to prioritize screening., To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME., Cme Objectives: Upon reading this journal article, the reader is expected to: (1) Determine the burden of cardiometabolic disease in the early phase of spinal cord injury (SCI); (2) Differentiate the proposed SCI cutoff for high-risk obesity from the able-bodied population; and (3) Increase physicians' acuity for detecting cardiometabolic disease in their practice., Level: Advanced., Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)