National Center on Medical Consequences of Spinal Cord Injury

 产品说明： 在美国大约有250，000人患有创伤性脊髓损伤（SCI），另外至少有400，000人患有非创伤性病因的脊髓损伤。由于泌尿系统和肺部并发症的有效治疗，SCI患者的寿命在过去几十年中有所增加。然而，SCI患者年龄越来越大，医疗管理成本越来越高。因此，我们越来越迫切地需要继续了解SCI的医学后果，并寻求安全有效的治疗方案，以尽量减少或预防这些不良疾病。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其寿命，这是VA RR & D服务的最佳传统目标。拟议的脊髓损伤医学后果卓越中心（CoE MCSCI）将继续为医学、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等几个专业领域的研究人员提供支持。欧盟委员会的医生/科学家-研究者将对各种医学并发症启动介入治疗，或努力更好地描述病理生理状况。将采用的治疗或研究方法包括以下药理学和非药理学干预：伊班膦酸减少不完全运动性SCI患者的骨丢失;肠促胰岛素[胰高血糖素样肽]（利拉鲁肽）]改善碳水化合物/脂质代谢和软组织身体组成;一种通过离子电渗法经皮给予新斯的明和格隆溴铵以改善常规肠道护理的新方法;一种改善肠道运动和排空的口服振动胶囊;外骨骼辅助行走（EAW）以改善通过SCI-QOL肠道管理调查、不透射线标记物和高分辨率测压法测量的结肠运动;自主心血管损伤程度的鉴定和分类;升高血压和预防认知损伤的抗水肿剂[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）];一种新的膳食，其具有增强的膳食诱导产热的能力，以降低冷暴露时体温过低的风险;成对的中枢刺激，以加强现有的手部神经通路;和基于家庭的便携式睡眠监测相比，目击多导睡眠图用于识别睡眠呼吸障碍。与一般人群相比，SCI患者的心血管发病率发生在生命早期，并且更普遍。冠状动脉疾病的传统危险因素可能无法准确预测大血管疾病的存在。因此，新出现的风险因素的测量，以及传统的风险因素，以及冠状动脉钙的量化将继续在我们的欧洲委员会的建议，使卫生专业人员能够更好地识别和治疗血管疾病的人。SCI患者的EAW已被证明是一种改变游戏规则的机械干预措施，可改善移动性，并改善几种健康相关疾病，包括肠功能障碍，建议在欧洲委员会中进行评估。一种新的分子信号通路涉及从头出现的连接蛋白半通道，可能是SCI后肌肉炎症和萎缩以及可能的其他神经系统疾病的基础;这些半通道的抑制剂可能被证明是有效的治疗剂，以减少制动后肌肉萎缩。未来的创新疗法有望被纳入与内分泌代谢、呼吸、胃肠道、自主神经和肌肉骨骼功能障碍相关的常规护理中。

 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.