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Upper limb kinematics after cervical spinal cord injury: a review

Upper limb kinematics after cervical spinal cord injury: a review

Although a number of upper limb kinematic studies have been conducted, no review actually addresses the key-features of open-chain upper limb movements after cervical spinal cord injury (SCI). The aim of this literature review is to provide a clear understanding of motor control and kinematic changes during open-chain upper limb reaching, reach-to-grasp, overhead movements, and fast elbow flexion movements after tetraplegia. Using data from MEDLINE between 1966 and December 2014, we examined temporal and spatial kinematic measures and when available electromyographic recordings. We included fifteen control case and three series case studies with a total of 164 SCI participants and 131 healthy control participants. SCI participants efficiently performed a broad range of tasks with their upper limb and movements were planned and executed with strong kinematic invariants like movement endpoint accuracy and minimal cost. Our review revealed that elbow extension without triceps brachii relies on increased scapulothoracic and glenohumeral movements providing a dynamic coupling between shoulder and elbow. Furthermore, contrary to normal grasping patterns where grasping is prepared during the transport phase, reaching and grasping are performed successively after SCI. The prolonged transport phase ensures correct hand placement while the grasping relies on wrist extension eliciting either whole hand or lateral grip. One of the main kinematic characteristics observed after tetraplegia is motor slowing attested by increased movement time. This could be caused by (i) decreased strength, (ii) triceps brachii paralysis which disrupts normal agonist – antagonist co-contractions, (iii) accuracy preservation at movement endpoint, and/or (iv) grasping relying on tenodesis. Another feature is a reduction of maximal superior reaching during overhead movements which could be caused by i) strength deficit in agonist muscles like pectoralis major, ii) strength deficit in proximal synergic muscles responsible for scapulothoracic and glenohumeral joint stability, iii) strength deficit in distal synergic muscles preventing the maintenance of elbow extension by shoulder elbow dynamic coupling, iv) shoulder joint ankyloses, and/or v) shoulder pain. Further studies on open chain movements are needed to identify the contribution of each of these factors in order to tailor upper limb rehabilitation programs for SCI individuals.
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Bimanual reach to grasp movements after cervical spinal cord injury

Bimanual reach to grasp movements after cervical spinal cord injury

Injury to the cervical spinal cord results in bilateral deficits in arm/hand function reducing functional independence and quality of life. To date little research has been undertaken to investigate control strategies of arm/hand movements following cervical spinal cord injury (cSCI). This study aimed to investigate unimanual and bimanual coordination in patients with acute cSCI using 3D kinematic analysis as they performed naturalistic reach to grasp actions with one hand, or with both hands together (symmetrical task), and compare this to the movement patterns of uninjured younger and older adults. Eighteen adults with a cSCI (mean 61.61 years) with lesions at C4-C8, with an American Spinal Injury Association (ASIA) grade B to D and 16 uninjured younger adults (mean 23.68 years) and sixteen unin- jured older adults (mean 70.92 years) were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, and had longer deceleration phases than uninjured participants. These differences were exacerbated during bimanual reach-to- grasp tasks. Maximal grasp aperture was no different between groups, but reached earlier by people with cSCI. Participants with a cSCI were less synchronous than younger and older adults but all groups used the deceleration phase for error correction to end the move- ment in a synchronous fashion. Overall, this study suggests that after cSCI a level of biman- ual coordination is retained. While there seems to be a greater reliance on feedback to produce both the reach to grasp, we observed minimal disruption of the more impaired limb on the less impaired limb. This suggests that bimanual movements should be integrated into therapy.
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The effect of task symmetry on bimanual reach-to-grasp movements after cervical spinal cord injury

The effect of task symmetry on bimanual reach-to-grasp movements after cervical spinal cord injury

Injury to the cervical spinal cord results in deficits in bimanual control, reducing functional independence and quality of life. Despite this, little research has investigated the control strategies which underpin bimanual arm/hand movements following cervical spinal cord injury (cSCI). Using kinematics and surface electromyography this study explored how task symmetry affects bimanual control, in patients with an acute cSCI (< 6 m post injury), as they performed naturalistic bimanual reach- to-grasp actions (to objects at 50% and 70% of their maximal reach distance), and how this differs compared to uninjured age-matched controls. Twelve adults with a cSCI (mean age 69.25 years), with lesions at C3–C8, categorized by the American Spinal Injury Impairment Scale (AIS) at C or D and 12 uninjured age-matched controls (AMC) (mean age 69.29 years) were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, less smooth and had longer deceleration phases than AMC (p < 0.05). Participants with a cSCI were less synchronous than AMC at peak veloc- ity and just prior to object pick up (p < 0.05), but both groups ended the movement in a synchronous fashion. Peak muscle activity occurred just prior to object pick up for both groups. While there seems to be a greater reliance on the deceleration phase of the movement, we observed minimal disruption of the more impaired limb on the less impaired limb and no addi- tional effects of task symmetry on bimanual control. Further research is needed to determine how to take advantage of this retained bimanual control in therapy.
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				Quality of life regarding eating and drinking of  person with cervical spinal cord injury
			
		
		
			
				
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← Return to Article Details Quality of life regarding eating and drinking of person with cervical spinal cord injury Download

The patients with spinal cord injury have several problems regarding eating and drinking. The quality of life is a major concern of spinal cord injured survivors. The physical, emotional and functional status of swallowing is the ultimate representation of the quality of life. Severity of the swallowing affects wellbeing of a person. The symptoms are coughing, dryness of mouth, aspiration, in ability to manage the liquid and different types of solid foods. Difficulty of swallowing also influences the person as handicapped. Spinal cord injury is highly seen in the young aged person as they have work in risk and hazardous work place. Spinal cord injury is a lifelong condition that can be treated and rehabilitated by multi specialty professionals. Speech & language therapist are also in a major role for the rehabilitation swallowing problem and voice disorders. The study explores very important findings of cervical spinal cord injury patient. The findings would be very helpful for the further planning of treatment and rehabilitation. A complete rehabilitation would include all aspect of the patient’s life. The future study could be placed in community level in final stage of rehabilitation. Acknowledgement: The researchers are highly grateful to the Centre for the Rehabilitation of the Paralysed (CRP) authority to give opportunity to conduct the study and also grateful to the participant
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The effects of unimanual and bimanual massed practice on upper limb function in adults with cervical spinal cord injury: a systematic review

The effects of unimanual and bimanual massed practice on upper limb function in adults with cervical spinal cord injury: a systematic review

Anderson, A orcid.org/0000-0002-4048-6880, Alexanders, J, Addington, C et al. (1 more author) (2019) The effects of unimanual and bimanual massed practice on upper limb function in adults with cervical spinal cord injury: a systematic review. Physiotherapy, 105 (2). pp. 200-213. ISSN 0031-9406

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Intraoperative sonography of cervical spinal cord injury: results in 30 patients

Intraoperative sonography of cervical spinal cord injury: results in 30 patients

M Grade Ill lesion at C3-C4 Focus of increased T2-weighted signal at C3-C4 consistent disk level with contusion Two foci of increased T2M Two grade II lesions at C4-C5 and mid-C5 weighte[r]

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Original Article A hemi-contusive cervical spinal cord injury model with displacement control in rats

Original Article A hemi-contusive cervical spinal cord injury model with displacement control in rats

anterior horn and lateral funiculus was obser- ved in the present study using an oblique hemi- contusion cervical SCI model. This hemi-contu- sion model was first developed by Lee and his colleague, who declared his model was aimed to injure the corticospinal and rubrospinal tra- cts of the ipsilateral side so that the deficit of motor function was confined to the ipsilateral forelimb. Compared to the hemi-contusion inju- ry with force control [15], the spare of white matter and gray matter is larger in the present model. Most tissue of anterior funiculus was undamage in the present study, while anterior funiculus and posterior horn were within the lesion area in the previous study [15]. We spe- culated the different contusion injury devices contributed to the discrepancy. A branch of corticospinal tract is located in the dorsal column in rats, and different to human being [26]. Accordingly, we consider that motor func- tional deficit of ipsilateral forelimb is caused by the completely destroying the anterior horn neurons (Figure 7).
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Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury

Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury

Once higher CMAP amplitudes were identified to be associated with better neurological recovery, we de- signed a logistic multivariable model in order to analyze whether early ulnar CMAP amplitudes are an independ- ent predictor of 1-year neurological recovery (SAS®, PROC LOGISTIC). For this purpose, we defined the first 4 weeks after injury as the prediction time frame (visits very acute and acute I). Primarily, we used the very acute values as predictors. Only if the very acute visit values were missing (AIS or CMAP or NLI), we used the acute I values. For the 1-year endpoint we used a last observa- tion carried forward approach (complete-case analysis set). The outcome variable was dichotomized into AIS A-C versus AIS D (with D indicating a “good”/“useful” neurological outcome). The initial AIS grade was en- tered into the model as categorical factor dichotomized into motor complete (A and B) versus motor incomplete (C and D). In the initial statistical analysis plan, ordinal scaling (A = 0, B = 1, C = 2, D = 3) was favored. However, all initial AIS D patients in the EMSCI-HD cohort were still AIS D at the final follow up visit (ceiling effect of the AIS). Hence, a separate category for AIS D would have been uninformative due to a perfect prediction of the final AIS (D versus A-C). The CMAP amplitude was entered into the model as continuous variable. Further- more, NLI and age were entered in the first step of the model. Using a backward variable elimination approach (alpha level of < 0.05 to stay in the model) the following variables were retained in the final model: initial AIS and CMAP amplitude. First, we analyzed the logistic model for the right hand. For hypothesis generation alpha levels of < 0.05 were regarded as statistically sig- nificant. For hypothesis testing, the significant effects were then reanalyzed for the left hand using the same model. Alpha levels of < 0.05 were regarded statistically significant. ROC curves were generated and compared via a bootstrap approach and plotted for each independ- ent variable separately (pROC, R) [18]. Predicted prob- abilities of the full logistic model were used to plot the final model ROC curve. For differences in ROC curve areas under the curve (AUC) an alpha level < 0.05 was regarded statistically significant.
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A suite of automated tools to quantify hand and wrist motor function after cervical spinal cord injury

A suite of automated tools to quantify hand and wrist motor function after cervical spinal cord injury

cSCI participants were tested with the GRASSP and JHFT exams, two established functional arm assessments suited to the injury [5]. Both assessments were adminis- tered by trained medical professionals with certified equipment and according to standard procedures [7, 19]. The total GRASSP score ranges from 0 to 116 points for one arm and is comprised of the sum of four subscores that quantify muscle strength, finger sensation, grip dex- terity and functional task performance. The JHFT score is the total time taken to complete seven common activ- ities of daily living using one arm, allowing up to 2 min per task for a maximum total score of 14 min. The GRASSP and JHFT scores for the right arm were com- pared to the measurements made with the devices. Commercial isometric strength gauges were used in the rehabilitative device test sessions to measure peak grip and pinch force for the right hand. A digital dynamom- eter (Fabrication Enterprises Inc., 1335 N capacity, 4.45 N resolution) was used to measure power grip strength and a digital pinch gauge (Fabrication Enterprises Inc., 222 N capacity, 0.445 N resolution) was used to measure lateral pinch force. Three trials were acquired and aver- aged with each device [20].
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Multivariate Analysis of MRI Biomarkers for Predicting Neurologic Impairment in Cervical Spinal Cord Injury

Multivariate Analysis of MRI Biomarkers for Predicting Neurologic Impairment in Cervical Spinal Cord Injury

This study was HIPAA and institutional review board compliant. We performed a retrospective cohort study of patients with acute blunt cervical SCI evaluated at a Level I trauma center (Zucker- berg San Francisco General Hospital) from 2005 to 2014. Inclu- sion criteria were 1) blunt acute cervical SCI, 2) age ⱖ 18 years, 3) presurgical cervical spine MR imaging performed within 24 hours after injury, and 4) documented American Spinal Injury Associ- ation Impairment Scale (AIS) at both admission and discharge. Exclusion criteria were 1) penetrating SCI, 2) surgical decompres- sion and/or fusion before MR imaging, 3) MR imaging that was too degraded by motion or other artifact such that images were nondiagnostic, and 4) preexisting surgical hardware. Of 212 pa- tients initially identified, 95 patients met all inclusion and exclu- sion criteria and were included in the study. The data collected included sex and age, AIS at admission and discharge (as docu- mented in the chart and performed by appropriately trained physiatrists and neurosurgeons), hours to MR imaging from time of injury, days to discharge, and whether surgical decompression of the cervical spine was performed before discharge. Fifty-two of the 95 patients included in this study were included in a cohort of patients as part of a previously published study. 4 This prior,
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The meaning of self-care in persons with cervical spinal cord injury in Japan: a qualitative study

The meaning of self-care in persons with cervical spinal cord injury in Japan: a qualitative study

Secondary conditions such as pressure sores, bladder in- fection, obesity, and pain are preventable or manageable medical complications in persons with physical disabil- ities [1-4]. However, once these secondary conditions occur, they cause significant interruptions in the lives of persons with spinal cord injury (SCI) [5,6]. There is a re- port in Japan that persons with SCI constituted about 60% of the patients at an outpatient clinic for pressure sores, and that patients did not come to the clinic for nearly a year after the onset of the sores, allowing them to reach a critical stage [7]. The authors cited above hy- pothesized that the reluctance of patients to look at their pressure sores was a potential risk for worsening of the sores, even if family caregivers had actually provided care in managing the sores.
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Optimal treatment for Spinal Cord Injury associated with cervical canal Stenosis (OSCIS): a study protocol for a randomized controlled trial comparing early versus delayed surgery

Optimal treatment for Spinal Cord Injury associated with cervical canal Stenosis (OSCIS): a study protocol for a randomized controlled trial comparing early versus delayed surgery

Acute cervical spinal cord injury (SCI) is one of the most devastating conditions, and can lead to paralysis, sensory impairment and bowel, bladder and sexual dysfunction. In addition, patients frequently suffer from intractable pain caused by neural damage. Individuals with cervical canal stenosis are known to develop cervical SCI even after minor trauma. Cervical canal stenosis may be con- genital, but often results from degenerative conditions, such as spondylosis. The SCI patients with canal stenosis are mostly elderly, and usually present with incomplete SCI without bone injury, such as spinal fracture or dis- location. This subgroup of patients has been steadily in- creasing as the society ages and currently accounts for over 60% of cervical SCIs in Japan [1].
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Morphological analysis for subaxial cervical pedicle screw insertion in developmental and non developmental canal stenosis

Morphological analysis for subaxial cervical pedicle screw insertion in developmental and non developmental canal stenosis

From September 2010 to December 2014, 120 consecutive Chinese patients that underwent cervical spinal multipla- nar CT imaging were enrolled in this study. The enrolled patients had cervical spondylotic myelopathy (CSM), cer- vical spondylotic radiculopathy (CSR), or cervical spinal cord injury without fracture and dislocation (CSIWFD). Subjects with evidence of congenital abnormalities, infec- tion, tumors, or cervical fractures and dislocations were excluded. The present study was conducted in accordance with the declaration of Helsinki and with approval from the Ethics Committee of the Affiliated Hospital of South- west Medical University. All patients provided written in- formed consent prior to their inclusion in this study.
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Acute non-ambulatory tetraparesis with absence of the dens in two large breed dogs: case reports with a radiographic study of relatives

Acute non-ambulatory tetraparesis with absence of the dens in two large breed dogs: case reports with a radiographic study of relatives

Presence or absence of deep pain sensation and find- ings on magnetic resonance (MR) images are significant information in prognostic evaluation of dogs with an acute-onset of tetraplegia/tetraparesis secondary to atlantoaxial subluxation [16,34,35]. Nevertheless, it may be difficult to make a certain prognosis and thereby hard to recommend euthanasia versus surgical treatment and rehabilitation of such dogs. In a study of nonsurgical treatment of atlantoaxial subluxation in 19 dogs, Havig et al. [36] found that a good long-term outcome was as- sociated with an acute duration of clinical signs, but not with degree of spinal cord dysfunction at admission, radiographic appearance of the dens, age, or a history of trauma. In a prospective study including MR images of 100 human patients with a traumatic cervical spinal cord injury, Miyanji et al. [37] found that hemorrhage, swell- ing and maximum compression of the spinal cord were associated with a poor prognosis for neurologic recovery. In a one-year-old toy poodle dog presented for acute- onset tetraplegia and given a guarded prognosis for full neurological recovery, Kent et al. [34] chose conservative treatment with external coaptation for eight days before re-examining the dog and evaluating the prognosis. In the present study, both dogs showed irreversible lesions in the atlantoaxial region of the spinal cord consisting of ne- crosis, loss of neural parenchyma and infiltration of gitter cells. Dog 1 was euthanased three days and eighteen hours after the inciting incident. The spinal cord lesion of this dog was extensive, affecting a large proportion of both white and grey matter, making recovery very unlikely. Al- though the lesions in dog 2 affected a smaller area of the spinal cord, a considerable area of both grey and white matter was affected also in this dog. It is uncertain, but considered unlikely, that dog 2 could have recovered based on the histological findings.
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Motor Injury by Compression of Spinal Cord at Cervical Level During Surgery  

Motor Injury by Compression of Spinal Cord at Cervical Level During Surgery  

The patient was seen in outpatient clinics since 2014. A complete and detailed clinical history was made and any type of clinical pathway was followed regarding the Conservative and Symptomatic treatment. The mandatory complementary tests (EMG, MRI) were performed until a correct diagnosis of the pathology suffered by the patient. The patient was diagnosed with a Cervical disc herniation with compression of the C6 root and paresthesia of the left upper limb (Figure 1).

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Effect of Exercise Program on the Rehabilitation of Patients with Cervical Spondylotic Myelopathy

Effect of Exercise Program on the Rehabilitation of Patients with Cervical Spondylotic Myelopathy

Firstly the results presented here indicate that volun- tary physical activity can prime adult sensory and motor neurons for enhanced axonal regeneration after subse- quent injury [20]. Previous works have showed that exer- cise regulates gene expression in the spinal cord [21-24]. The increased motor and sensory scores after exercise in the current study now demonstrates a direct functional out- come of exercise-dependent change. Activity-dependent increase in BDNF and NT3 is one means by which exer- cise could trigger the increased axonal growth potential in neurons thereby facilitating recovery [25-27].
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Meaning of self-management from the perspective of individuals with traumatic spinal cord injury, their caregivers, and acute care and rehabilitation managers: an opportunity for improved care delivery

Meaning of self-management from the perspective of individuals with traumatic spinal cord injury, their caregivers, and acute care and rehabilitation managers: an opportunity for improved care delivery

Hirsche and colleagues [13] conducted a qualitative study on the experiences of individuals with neurological conditions, including stroke, multiple sclerosis, as well as SCI, who participated in the Stanford Chronic Disease Self-Management Program (CDSMP). Participants with SCI reported the least satisfaction with the CDSMP. In- dividuals with SCI as well as some of the leaders of this self-management group suggested assembling a SCI- focused group (e.g., individuals with SCI needed infor- mation specific to and modules adopted for being in a wheelchair/reduced mobility). They also found that when attendant care is an important component (as is the case in individuals with SCI), a different approach may be needed to teach self-management skills (i.e., be- ing a good director of care, instead of a person who manages care independently) [13]. More recently, Ide- Okochi and colleagues [14] examined the meaning of self-care and what factors influenced the construction of its interpretation among persons with cervical SCI living
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Heritability of cervical spinal cord structure

Heritability of cervical spinal cord structure

Automated and semiautomated approaches have been de- veloped to study spinal cord structure, enabling rater- independent segmentation and quantification of spinal cord metrics. Using these methods, recent studies have reported reductions in the spinal cord cross-sectional area (CSA), left- right width (LRW), and anterior-posterior width (APW) in MS, 1,2 amyotrophic lateral sclerosis, 3 and spinal cord injury (SCI). 4–8 After SCI, changes to the sensorimotor cortex have also been reported, 9,10 indicative of cortical reorganization because of the lack of afferent input from the spinal cord. Of interest, spinal cord atrophy correlates with physical function- ing after SCI. 7,8 This suggests that cord atrophy may be pro- portional to somato-motor cortex atrophy. However, it is unknown if such a relationship exists before injury, i.e., is the spinal cord structure linked to the cortical sensorimotor rep- resentation and with motor abilities in healthy subjects? Human brain anatomy is heritable with a genetic contribution between 66% and 97% for total brain volume, as estimated in twin studies. 11 There are no previous studies on heritability of spinal cord structure. Determining factors that contribute to variations in spinal cord structure in healthy individuals add to our understanding of the CNS and, crucially, to markers of neurodegenerative pathology.
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Width and neurophysiologic properties of tissue bridges predict recovery after cervical injury

Width and neurophysiologic properties of tissue bridges predict recovery after cervical injury

Within the motor system, we found a 3-way relationship between ventral midsagittal tissue bridges, MEPs, and motor recovery of the lower limbs. The MEP assessments quantify noninvasively the cortical and spinal excitability of mono- synaptic (i.e., corticospinal tract [CST] 30 ) and arguably the polysynaptic (i.e., extrapyramidal) pathways. 31 After SCI, increases in MEP amplitudes over time have been shown to predict recovery of lower limb function. 32 Thus, the CST is crucially involved in these recovery processes. However, in animal models of SCI, the contribution of polysynaptic pathways to recovery processes has been suggested. 33,34 For instance, plasticity in the cortico-reticulo-spinal circuit, which is in part ventrally located in the spinal cord, pro- moted recovery of locomotion in a rodent model of SCI. 35 Other potential compensatory mechanisms of motor re- covery include sprouting of the anterior CST 36 and the formation of detour pathways via long-projecting proprio- spinal neurons. 37–40 Our findings support the role of the Figure 2 Relationships between midsagittal tissue bridges and ASIA classification
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Alterations in amino acid levels and metabolite ratio of spinal cord in rat with myocardial ischemia-reperfusion injury by proton magnetic resonance spectroscopy

Alterations in amino acid levels and metabolite ratio of spinal cord in rat with myocardial ischemia-reperfusion injury by proton magnetic resonance spectroscopy

twelve metabolites including N-acetylaspartate (NAA), taurine (Tau), glutamate (Glu), gamma amino acid butyric acid (GABA), creatine (Cr), and myoinositol (MI), etc. Results: Rats with myocardial IR injury had higher concentration of Tau in the upper thoracic spinal cord (P < 0.05), and lower concentration of Gly and Glu in the cervical segment of the spinal cord (P < 0.05), when compared to the Control group. The ratios of glutamate/taurine (Glu/Tau), Glu/ (GABA + Tau) and Glu/Total were significantly different between the IR group and the Control group in the upper thoracic spinal cord (P < 0.05). So were the ratios of Glu/(GABA + Tau) in the cervical segment (P < 0.05), and Glu/ Tau and Glu/(GABA + Tau) in the lower thoracic spinal cord (P < 0.05). Conclusions: These findings suggest that myocardial IR injury may be related to spinal biochemical alterations. It is speculated that these observed changes in the levels of spinal metabolites may be involved in the pathogenesis and regulation of myocardial IR injury.
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