bFGF对大鼠脊髓损伤后神经细胞凋亡的影响

目的 :探讨大鼠脊髓损伤后应用碱性成纤维细胞生长因子 (basicfibroblastgrowthfactor ,bFGF)对脊髓损伤区细胞凋亡的影响。方法 :利用Allen氏WD(weightdrop ,WD)技术 ,以 10 g× 2 .5cm致伤力造成SD大白鼠T8脊髓损伤模型 ,并于损伤平面以下蛛网膜下腔置细塑料导管。bFGF治疗组 (A组 )分别于术后即刻 1、2、4、8、12、2 4及 48h经导管注入bFGF溶液 2 0 μl(含bFGF10 0 u) ,以后每周经导管注入 2 0 μlbFGF ;对照组 (B组 )则在同时间注入等量生理盐水。损伤后 1、3、7、14、2 8d对脊髓损伤区进行细胞凋亡的检测 (TUNEL) ,采用计算机图像分析技术进行定量分析。结果 :A、B两组中均发现凋亡细胞 ,B组细胞凋亡率大于A组。结论 :bFGF能抑制脊髓损伤后脊髓损伤区的细胞凋亡。     

Quality of Life in and After Spinal Cord Injury Rehabilitation: A Longitudinal Multicenter Study

Purpose:

To investigate the changes in quality of life (QOL) in persons with spinal cord injury (SCI) and their close persons during the first 2 years post injury.

Method:

Longitudinal multiple sample multiple wave panel design. Data included 292 patients recruited from Austrian British German Irish and Swiss specialist SCI rehabilitation centers and 55 of their close persons. Questionnaire booklets were administered at 6 weeks 12 weeks 1 year and 2 years after injury to both samples.

Results:

Study 1 investigated the WHOQOL-BREF domains in individuals with SCI and found differences mostly in the physical domain indicating that QOL increases for persons with SCI from onset. An effect of the culture was observed in the psychological and environmental domains with higher QOL scores in the German-speaking sample. Study 2 compared individuals with SCI to their close persons and found differences in the physical environmental and social domains over time. The scores on the psychological dimension did not significantly differ between the persons with SCI and their close persons over time.

Conclusion:

QOL measured by the WHOQOL-BREF shows that QOL changes during rehabilitation and after discharge. Apart from the physical dimension the persons with SCI and their close persons seem to experience a similar change in QOL. Further longitudinal research is suggested to clarify the mutual adjustment process of people with SCI and their close persons and to explore cultural differences in QOL between English-and German-speaking countries.Key words: close persons, quality of life, rehabilitation, spinal cord injuryAspinal cord injury (SCI) is a highly disruptive event in the life of an individual and requires a considerable coping process. Shortly after the injury, all attention is put into stabilizing the patient and from that moment the individual has to cope with challenges at physical, social, environmental, and psychological levels.The institutionalized context of the rehabilitation provides a largely standardized supportive setting that helps the person with SCI to become acquainted with the recently acquired disability. The health care professionals in collaboration with the patients and their close persons, that is, relatives or significant others, work together to prepare the transition back to everyday life.One expectation of rehabilitation is that the person with SCI will regain a satisfactory level of well-being and fulfill his or her aims in life. Many factors may facilitate the retrieval of a good quality of life (QOL). Some aspects of SCI are permanent or only susceptible to small changes (eg, the paralysis and other irrevocable neurological problems related to the injury), but many others (eg, psychological and social aspects) can be more or less actively influenced by the person with SCI.A number of recent studies regarding QOL in SCI emphasize that QOL is not strongly affected by physical variables.^1–4 Age ^3–7 and gender^1,2–4,7 are also weakly related to the QOL of the persons with SCI. Physical health aspects that can explain differences in QOL are pain^1,6,8–11 or secondary conditions such as pressure sores and dysreflexia. ^4,6,11Psychological resources are strong predictors of life satisfaction and well-being. Psychological resources are personal traits and characteristics that might influence the way a person perceives and manages challenges. Positive affect,^3,11 high self-efficacy,^1,6,9,11 optimism,⁶ hope,^3,11 and sense of coherence^11,12 have proven to be positively associated with better QOL. More dynamic psychological processes such as appraisals or coping strategies used by the persons with SCI have also significantly contributed to predicting QOL over time. ¹³Studies reporting on how the environment affects perceived QOL in persons with SCI are less frequent, despite a probable relation between mobility impairments and the advantages that a well-designed, obstacle-free, secure, and friendly environment might convey to persons with SCI. ^14–16A supportive familial environment⁶ and friends¹⁷ are important. Close persons of individuals with SCI have to adjust to the new situation, such as accepting a partner with altered needs with different degrees of daily care. Close persons of persons with SCI reported that becoming a caregiver is difficult and often dramatically life changing.¹⁸ Weitzenkamp¹⁹ reports high levels of depression in spousal caregivers, with sometimes higher rates of depression than partners with SCI. He also compared caregivers of persons with SCI with non-caregiving spouses, and found that caregivers showed higher levels of depression and emotional and physical stress.Familial caregivers hold a central position in the life of persons with SCI. Their health and QOL affects the health and well-being of the persons with SCI; life with SCI involves a systemic adjustment process. Ploypetch⁵ indicated that the participants’ perceived QOL was affected more if the caregiver was a member of the participants’ family rather than a health professional. Lucke ²⁰ showed that the level of QOL in persons with SCI and their caregiving spouses may vary significantly over time, with a drop at 3 months post injury and an increase in QOL in the following 6 months. As a consequence, QOL has to be seen as dynamic, reflecting the adjustment to changes occurring over time in individuals and their environment. Some longitudinal studies of persons with SCI and their QOL have been conducted,^21–23 but longitudinal studies involving the close persons of individuals with SCI remain scarce in the literature. ²⁰The present report shows the changes in QOL during the first 2 years post injury in individuals with SCI and their close persons from 5 European countries. The first aim is to describe the physical, social, environmental, and psychological QOL in persons with SCI in relation to injury and sociodemographic variables.

Hypothesis 1: It is expected that QOL in persons with SCI is quite high, especially after 2 years.

Second, the experienced QOL of the individuals with SCI and their close persons are compared at 6 weeks, 12 weeks, 1 year, and 2 years post injury.

Hypothesis 2: We expected that the scores of the physical QOL domain would be lower in the persons with SCI compared to the noninjured close persons. No significant differences were expected between the scores of the psychological domain.

     

Early versus Delayed Surgery for Acute Traumatic Cervical/Thoracic Spinal Cord Injury in Beijing,China: The Results of a Prospective,Multicenter Nonrandomized Controlled Trial

ObjectivesTo compare the effects of early surgery (within 24 h) and delayed surgery on the outcomes of patients with acute cervical/thoracic spinal cord injury (SCI) in Beijing, China.MethodsWe conducted a clinical trial involving patients who were aged 16–85 years, had acute SCI from 1 June 2016 to 1 June 2019 in Beijing. The enrolled patients were divided into two groups according to the timing of surgical decompression. The primary outcome was the ordinal change in the American Spinal Injury Association Impairment Scale (AIS) grade. The secondary outcomes included the surgical time, volume of surgical bleeding, rate of admission to the intensive care unit (ICU), length of stay in the ICU, duration of mechanical ventilation, length of hospital stay, and postoperative complications. And the time consumption of different phases before operation was recorded for the patients transported to hospital by ambulance.ResultsA total of 148 patients were included in the study, including 55 in the early surgery group and 93 in the delayed surgery group. At 52 weeks post‐surgery, 27.3% of the patients in the early surgery group showed AIS improvement by at least two grades, compared to 8.7% of the patients in the delayed surgery group (P = 0.102). According to the logistic regression analysis, the odds of at least a two‐grade AIS improvement was six times higher among the patients who underwent early surgery than among those who underwent delayed surgery (OR = 6.66, 95%CI 1.14–38.84). The delay surgery group consumed significantly more time in the phases of transfer and inspection or examination than the early surgery group, and the Chinese regional trauma treatment system was widely used in the early surgery group.ConclusionDecompression within 24 h after SCI can improve patients'' recovery of neurological function without increasing the incidence of postoperative complications and surgical risks. The Chinese regional trauma treatment system can improve the diagnosis and treatment efficiency of patients with acute SCI and speed up the operation timing.     

Spinal Cord Injury Community Survey: A National,Comprehensive Study to Portray the Lives of Canadians with Spinal Cord Injury

Background:

To better understand service-related needs and the current situation of persons with spinal cord injury (SCI) living in the community, a more comprehensive approach for studying their interrelationships (needs vs community living outcomes) is greatly needed.

Objective:

To describe the development, design, and findings of a Canadian survey portraying the life situation of people with SCI.

Method:

The SCI Community Survey covers demographics, health, SCI-specific needs, community participation, employment, quality of life, health care utilization, and overall health rating. A total of 1,549 persons with SCI completed the survey (Web or phone) between May 2011 and August 2012.

Results:

Some major expressed needs for services to support community living are met to a great extent for a substantial proportion of people with SCI. Complications remain highly prevalent for some health issues, including pain, sexual dysfunction, and musculoskeletal disorders. The extent of community participation based on values and preferences varies tremendously among daily activities and social roles. Some dimensions of quality of life are rated positively (eg, family life) while others are greatly disrupted (eg, sex life and physical health). Most of these findings vary significantly between people with traumatic and nontraumatic lesions.

Conclusion:

This survey is the first in Canada and among the first worldwide to draw a comprehensive picture of major aspects of the lives of people with SCI including service needs. The results will help to determine the links between various aspects of community living and guide service providers and policy makers in focusing on major issues to enhance quality of life after SCI.Key words: community living, SCI-related needs, secondary health conditions, social participation, spinal cord injury, quality of lifeThere is a strong focus in acute care and rehabilitation on developing functional independence through education, teaching, health care, and services for people who sustain spinal cord injury (SCI). Nonetheless, after discharge from hospital or an SCI unit, rehabilitation is not complete and the challenging journey toward a full and productive life begins. Community living presents various physical, social, and attitudinal barriers that many people with SCI have difficulty overcoming, even though the UN Convention on the Rights of Persons with Disabilities¹ enshrines the right to full and effective community participation, to live independently, to be included in the community, and to participate in political, public, and cultural life, recreation, and sports.Various environmental and contextual dimensions influence community living and require attention. Among these, access to services in the community is critical to ensure that people with SCI achieve optimal quality of life. The World Report on Disability² identified a series of community services that could influence effective participation, including home care and support, primary health care, transportation, social and family support, education and job training, and technologies to enhance mobility, communication, and home adaptation. While the report suggests critical community services, it is unclear to what extent such services correspond to met and unmet needs expressed by people with SCI, given the complex relationship between service use and unmet needs.³Kennedy et al⁴ used a broad definition of need (circumstance requiring a course of action, want, or requirement) and included the prevention and treatment of health complications, increase in social participation, and quality of life with other needs that are more aligned with a focus on community (eg, wheelchair needs, relationships, emotional well-being, and accommodation). They found that employment and recreational activities were the needs that were least likely to be met.The identification of service needs therefore remains a major issue, and only a few studies have investigated the expressed needs of persons with SCI and barriers to needs being met. Cox et al⁵ suggested areas with the greatest needs, such as physical changes in the environment, transportation, and work issues. They also identified the greatest perceived barriers to needs being met, with limited local specialist knowledge and inadequate funding being most important. In Canada, 2 national surveys examined self-reported needs as well as service availability for individuals with SCI living in the community,^6,7 suggesting that needs for financial support, attendant care, equipment and accessibility, active living, and specialized equipment are largely unmet.These previous surveys provided insight into needs that should be met for community integration or participation, but the needs identified were a combination of services (eg, recreational programs) and influencing factors (eg, accessible infrastructure). These surveys were not able to clarify the relationships between services and outcomes or to determine which factors facilitated or hindered access to services.There is a general consensus that, following SCI, quality of life remains the ultimate goal of rehabilitation, but this is influenced by issues such as the occurrence of secondary health conditions (SHCs) and the extent of social participation.⁸ For example, some dimensions of participation are carried out in a satisfactory manner without difficulty but significant restrictions are observed in family roles (primarily activities related to housework, home maintenance, and role fulfillment at home), work, and education.^9–11 To ensure that quality of life remains relatively constant across the lifespan, factors that influence it, including service needs, must be identified on a personal basis.To better understand the service needs of persons with SCI living in the community and their short- and long-term life situation after discharge from hospital or rehabilitation, a comprehensive study examining the relationships between needs and influencing factors and their impact on important outcomes is needed. Such a survey should include data on major life dimensions identified in the literature and by community advocates, namely quality of life and community participation, as well as other influencing variables, such as the occurrence of SHCs.¹²The aim of this article is to describe the development, design, and initial findings of a Canadian survey portraying the life situation of people with SCI living in the community. Specifically, the survey aimed to (a) identify the proportion of people with SCI requiring services for community living and the extent of met and unmet needs, (b) determine the barriers or facilitators to service utilization, and (c) describe the outcome in the lives of people with SCI (occurrence of SHCs, degree of participation in major life areas including productive activities, quality of life) and their interrelationships with service needs (met and unmet).     

手术减压时间对损伤脊髓轴索病理和损伤区面积的影响

目的 探讨大鼠脊髓损伤后手术减压时间对大鼠脊髓轴索病理和损伤区面积的影响。方法 将动物分为两组：大鼠脊髓挫伤2h手术减压组（A组）,大鼠脊髓挫伤8h手术减压组（B组）。手术后1、3、7、14、28d进行轴索病理变化的观察并测量脊髓损伤面积,采用计算机图像分析技术,进行定量分析。计算Tarlv评分并检测感觉诱发电位（SEP）和运动诱发电位（MEP）。结果 图象分析发现：脊髓损伤后B组轴索丢失明显多于A组。脊髓损伤面积B组亦明显大于A组;大鼠后肢功能Tarlv评分和电生理检查也有类似的变化趋势。结论 大鼠脊髓损伤后早期手术减压对损伤的大鼠脊髓轴索有保护作用,能减少脊髓损伤面积,并促进大鼠后肢功能恢复。     

Prevention and Treatment of Bone Loss after a Spinal Cord Injury: A Systematic Review

Preserving and maintaining bone mass after a spinal cord injury (SCI) is crucial to decrease the risk of fragility or low trauma fractures- significant health events that occur as a result of minimal trauma such as falling during transfers or from a standing height or less. There is an increased risk for low trauma fractures after a SCI especially in the lower extremity. Therefore, purpose of this systematic review was to appraise the literature to provide clinical guidance for the optimization of bone health after SCI. The key research questions focused on prevention of acute bone loss and effective treatment of established low bone mass with long-standing SCI (≥ 1year). We report moderate evidence for the treatment of bone loss using pharmacology; however, non-pharmacological evidence for preventing and treating bone loss is limited.     

Neurological prognosis after traumatic quadriplegia. Three-year experience of California Regional Spinal Cord Injury Care System.

Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year following-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete functions at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cork injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury.     

体外转基因成肌细胞移植对大鼠损伤脊髓细胞凋亡的影响

目的：探讨大鼠脊髓损伤后胚胎脊髓和腺病毒介导的脑源性神经生长因子（AxCA-BDNF)体外转基因成肌细胞移植对大鼠脊髓细胞凋亡的影响。方法：将动物分为：大鼠脊髓半切洞损伤明胶海绵填充组（A组）,大鼠脊髓半切洞损伤应用胚胎脊髓移植组（B组）,脊髓半切洞损伤损伤AxCA-BDNF基因转染的成肌细胞移植组（C组）大鼠脊髓半切洞损伤后应用胚胎脊髓和AxCA-BDNF基因转染的成肌细胞移植组（D组）。手术后1、3、7、14、28d应用行为学和电生理检查观察大鼠功能恢复情况,对脊髓损伤区进行细胞凋亡的检测（TUNEL）以及Bcl-2蛋白表达的测定（免疫组化法）。采用计算机图像分析技术,进行定量分析。结果：A、B、C、D四组中均发现凋亡细胞及Bcl-2蛋白阳性表达细胞,图像分析发现,各组凋亡细胞核为A＞B＞C＞D;Bcl-2免疫反应阳性细胞表达顺序为D＞C＞B＞A,Bcl-2免疫反应阳性细胞的表达与大鼠后肢功能恢复有同样的变化趋势。结论：大鼠胚胎脊髓和体外转基因成肌细胞移植能抑制脊髓损伤后的细胞凋亡。     

Highlighting discrepancies in walking prediction accuracy for patients with traumatic spinal cord injury: an evaluation of validated prediction models using a Canadian Multicenter Spinal Cord Injury Registry

BACKGROUND CONTEXT

Models for predicting recovery in traumatic spinal cord injury (tSCI) patients have been developed to optimize care. Several models predicting tSCI recovery have been previously validated, yet recent findings question their accuracy, particularly in patients whose prognoses are the least predictable.

脊髓半切伤后胶质纤维酸性蛋白的表达及意义

目的：研究脊髓半切伤(hSCI)后脊髓远端组织星形胶质细胞中胶质纤维酸性蛋白(GFAP)表达的意义，并探讨反应性胶质化在脊髓半切伤中的作用。方法：SD大鼠25只，随机分为5组(n＝5)正常对照组、伤后1、4、7、14d组，用免疫组化及图像分析方法观察星形胶质细胞中GFAP的表达；用大鼠综合性为评分(CBS)方法对各组评分。结果：hSCI后远端星形胶质细胞GFAP表达比对照组明显增高(P＜0．01);l-14d呈进行性增高，损伤各组CBS1—14d呈降低趋势，两指标有显著相关性(r＝—0．05，P＜0．01)。结论：hSCI后星形胶质细胞通过其反应形胶质化对脊髓再生和修复其重要作用。     

脊髓损伤后凋亡调控基因Bcl-2、Bax的表达及意义

目的 :观察探讨大白鼠脊髓损伤后细胞凋亡及调控基因Bcl -2、Bax的表达及意义。方法 :2 8只SD大鼠随机分为 7组 ,Allen′s法致伤脊髓 ,于术后 4、 8、 2 4、 48、 72、 168h采集脊髓标本 ,1组作为对照组 ,分别行HE染色、TUNEL染色和免疫组化技术检测Bcl -2、Bax的表达。结果 :TUNEL染色显示有神经元和胶质细胞凋亡。Bcl-2在术后 4h开始出现阳性表达 ,2 4h达高峰。Bax术后 4h出现阳性表达 ,8h时达高峰。结论 :脊髓损伤后存在神经元和胶质细胞的凋亡 ,Bcl-2、Bax基因对调控细胞凋亡可能具有重要作用。     

干细胞与脊髓损伤的治疗

脊髓损伤的治疗一直是世界性的难题,促进脊髓损伤后神经组织的修复,传统的手术和相应的辅助治疗并未取得突破性进展。组织工程学的发展,为神经组织的修复提供了良好的可能。被移植到患者脊髓损伤区域的干细胞,通过替换受损细胞、减少胶质瘢痕的形成、促进残存神经元细胞轴突再生及突触形成等,可促进脊髓形态及功能恢复。我们就目前应用干细胞治疗脊髓损伤的研究现状进行概述,并对其临床应用前景进行展望。     

bFGF对大鼠脊髓损伤后c-fos mRNA表达的影响

目的：探讨碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF)对大鼠脊髓损伤后c-fosmRNA表达的影响。方法：采用Allen's法造成大鼠Ts脊髓损伤模型,用原位杂交方法检测神经元c-fosmRNA的表达。结果：脊髓损伤后神经元c-fosmRNA表达较正常末损伤神经元显著增加,表达高峰出现在损伤后1h,bFGF能显著抑制损伤后神经元c-fosmRNA的异常表达。结论：应用外源性bFGF抑制了脊髓损伤后的c-fos基因表达,保护了神经元并抑制了继发性损害的发生,是bFGF保护脊髓损伤可能的作用机理。     

手术减压时间对兔颈脊髓急性损伤并压迫模型的疗效影响

目的制造颈脊髓损伤动物模型,观察颈脊髓损伤后减压时间对脊髓损伤后神经功能恢复的影响。方法选择新西兰大白兔65只,随机分对照组与实验组,实验组进一步分为6个亚组(A、B、C、D、E、F组)。C3椎体前路钻孔开窗,用改良Allen’s法40.0gcm力撞击脊髓,然后从骨窗处置入小螺钉造成脊髓压迫。并在术后18h、24h、2d、3d、5d、7d减压(去除小螺钉)。在术后28d内对改良Tarlov评分,体感诱发电位,细胞凋亡及病理等监测指标进行观察。结果运动学评分和体感诱发电位显示A、B组的神经恢复情况优于其他组,C、D组优于E、F组。而E、F、G组之间无明显差别。组织学显示脊髓受压时间越长,脊髓结构损害越严重。结论本实验显示脊髓损伤后确实存在一个减压的时间窗,该窗口为损伤后3d内,而术后18h内减压可以获得最佳的神经功能恢复。