脊髓损伤预后评估方法的研究进展

脊髓损伤（spinal cord injury,SCI）可导致严重的感觉和运动功能障碍,使患者丧失自理能力和劳动能力,且由于目前SCI患者神经功能预后普遍较差,从而造成较大的社会及经济负担。如果可以对SCI患者的神经功能预后情况进行准确地评估,进一步对不同患者开展多元化诊疗,那么将大幅度提升我们对SCI的诊疗效率与SCI患者后期的生活质量,因此一个可靠的评估方法极为重要。近年来,针对此方面的研究越来越多,研究者们相继提出了多种评估方法,笔者对国内外文献进行整理,并通过临床与生物标志物两个方面对SCI患者神经功能预后的评估方法进行综述。     

脊髓损伤中的自噬及相关研究进展

<正>脊髓损伤(spinal cord injury,SCI)是一种严重的神经系统创伤,会导致损伤节段以下肢体功能障碍,不仅给患者本人带来身体和心理的严重伤害,还会给社会带来巨大的经济负担。SCI的常见病因有高处坠落伤、交通事故、重物砸伤、运动损伤等。进入20世纪后半叶,随着我国经济水平的快速发展,SCI的发生率呈现逐年升高趋势,上     

诱导多功能干细胞在脊髓损伤修复中的作用

脊髓损伤(spinal cord injury,SCI)是一种以损伤平面以下感觉、运动功能完全丧失和大小便失禁为主要临床表现的中枢神经系统的严重创伤.目前SCI的年发病率为一百万分之十五到四十.发达国家SCI患者的长期生存率较高,因此有大量患者因SCI导致慢性残疾~([1]).SCI使大量脊髓神经元凋亡,导致脊髓修复能力和促进修复因素(如神经营养因素)缺乏,神经元坏死后形成的胶质瘢痕和空洞阻碍轴突生长,这些不可逆的病理过程是导致SCI治疗困难的主要原因~([2]).目前尚无治愈SCI的方法,对急性期患者的处理也仅限于应用大剂量皮质类固醇减轻炎症,提高手术效果,减少远期伤害.对亚急性和慢性患者的处理主要是对症疗法(镇痛、减少机会性感染等)和物理疗法~([3]).现有的治疗方法虽有一定疗效,但却很难阻止病变进展,更无法从根本上逆转神经系统退行性变的趋势.     

硫酸软骨素蛋白多糖在脊髓损伤病理机制中的作用

脊髓损伤（spinal cord injury,SCI）是由各种因素导致的脊髓损伤平面以下的感觉、运动及其他系统功能紊乱的中枢神经系统疾病。SCI不仅给患者带来严重的身心伤害,还会对家庭和社会造成巨大的经济负担。静息状态的星形胶质细胞被激活后转化为反应性星形胶质细胞（reactive astrocytes,RAS）是脊髓受损后所导致的一系列临床表现的病理基础。其主要作用是保护正常组织和神经元、减少损伤区域的水肿及炎性反应、促进损伤处血管再生。在脊髓损伤的早期,RAS可以通过减轻并修复损伤、保护血脑屏障、为神经元提供适宜的生存环境等方式对中枢神经系统起到保护作用。随着损伤的进展,神经元会出现脱髓鞘和突触连接的中断,加上氧化应激的产生,会导致细胞的凋亡、成纤维细胞的侵袭和炎症反应的持续发展,促使RAS不断分泌并上调损伤处硫酸软骨素蛋白多糖（chondroitin sulphate proteoglycans,CSPGs）的表达,最终在损伤区域的周围形成神经胶质瘢痕,以隔离损伤部位,阻止病变的进一步发展。所以在后期的损伤修复过程中,胶质瘢痕的形成不仅阻碍了轴突的延长,还严重影响了轴突的再生。因此,星形胶质细胞的活化和CSPGs的表达在SCI和修复过程中是一把双刃剑：损伤早期RAS可以防止炎症的扩大,避免更多细胞的损伤和坏死;后期会导致轴突再生的失败。所以在损伤后期消除RAS分泌的CSPGs所引发的胶质瘢痕,是SCI修复过程中的重要环节。笔者对CSPGs在SCI中的作用做一综述,为SCI的临床治疗提供参考。     

脊髓损伤性勃起功能障碍的诊治进展

脊髓损伤(spinal cord injury SCI)能导致勃起功能障碍(erectile dysfunction ED)普遍得到共识.据统计,脊髓损伤患者82%为男性,大部分在30岁左右 ,正处于性活跃期. ED的发生严重的影响患者和配偶的生活质量,因此,SCI性ED是亟待研究的课题.本文对男性勃起的神经支配、SCI性ED的发生机制、诊断、治疗作一综述,并对病因治疗作服进一步展望.     

脊髓损伤性勃起功能障碍的诊治进展

脊髓损伤（spinal cord injury SCI）能导致勃起功能障碍（erectile dysfunction ED）普遍得到共识。据统计，脊髓损伤患者82％为男性，大部分在30岁左右，正处于性活跃期。ED的发生严重的影响患者和配偶的生活质量，因此，SCI性ED是亟待研究的课题。本文对男性勃起的神经支配、SCI性ED的发生机制、诊断、治疗作了综合慨述，并对病因治疗作了进一步展望。     

miRNA在急性脊髓损伤病理生理调节机制中的作用研究进展

急性脊髓损伤（spinal cord injury,SCI）是中枢神经系统的严重损伤,是一种严重威胁人类生命健康的疾患。早期、全面的医疗干预和康复治疗对减轻脊髓损伤程度和提高患者的生活质量有着极其重要的影响。急性SCI存在两种机制：机械压迫导致的初次损伤和其后多种生物机制导致的二次损伤[1],受伤当时的暴力性质决定初次损伤的程度,随后启动包括自由基损伤、细胞凋亡、炎症反应等二次损伤,其具体分子机制、如何减轻并逆转二次损伤一直是近年来的研究热点[2]。     

少突胶质前体细胞移植治疗脊髓损伤

脊髓损伤(spinal cord injuries,SCI)是常见的中枢神经系统损伤,可以造成感觉、运动等神经功能严重丧失。迄今为止,临床上尚无有效方法治疗脊髓损伤。以往研究表明,脊髓损伤后继发性病理生理变化不仅导致神经元丢失及轴突断裂,同时也影响着星形胶质细胞和少突胶质细胞(oligoden     

长链非编码RNA在脊髓损伤中病理生理作用的研究进展

正脊髓损伤(spinal cord injury,SCI)是一种严重的神经系统疾病,其特点为损伤部位神经元功能的永久丧失及胶质瘢痕形成,导致相应支配区域的感觉和运动功能障碍。SCI可能会引起一系列严重后果,例如感觉障碍和肢体瘫痪;另外,由于失去了神经的营养作用,骨质疏松和肌肉萎缩也是其常见的并发症~([1])。SCI不仅给患者及家庭带来沉重的生理和心理负担,而且给社会造成巨大的经济损失,故而其预防、治疗和康复已成为医学领域的重要问题。SCI的发病机制复杂,涉及原发性和继发性损伤两个阶     

应用于脊髓损伤后缺损区域的桥接体

脊髓损伤(SCI)是一种严重的致残疾病,在我国发病率逐渐增多.其中,发生缺损的离断SCI占了相当大的比例.脊髓损伤的修复已经成为21世纪急需解决的医学难题之一.鉴于SCI后将导致损伤平面以下传导束支配的大范围运动感觉功能缺失,从而严重威胁患者的生命及生活质量.因此,当前脊髓修复的重点难点在于如何恢复已经中断了的传导束的传导功能[1].     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.