Perinatal spinal cord injury requiring long-term home mechanical ventilation: a report of four cases

Although perinatal spinal cord injury has been discussed in detail in the literature with respect to aetiology and diagnosis, few studies address long-term outcome, and none address the outcome of long-term home mechanical ventilation in this population. The four patients reported here with perinatal spinal cord injury have used home mechanical ventilation for time periods ranging from 6 to 17 years, with varying results. Their courses with respect to respiratory, neuromuscular, neuropsychological, and nutritional issues are described with reference to the current literature. It is believed that, with the advent of organized home mechanical ventilation programmes and increased acceptance of this technology by the lay public and medical community, the prognosis of the child with perinatal spinal cord injury requiring assisted ventilation is much improved, and may be more positive than the literature currently suggests.     

电针刺激脊髓损伤患者穴位的脊髓磁共振功能成像激活区特征****☆

背景：研究发现脊髓功能激活区域和电生理等理论对应区域相一致,多数学者认为使用功能磁共振技术检测脊髓神经功能是可行的。 目的：检测电针刺激脊髓损伤患者的脊髓磁共振功能成像激活区特征,验证使用脊髓磁共振功能成像技术来客观评价针灸治疗脊髓损伤疗效的可行性。 方法：使用电针同时刺激3例脊髓损伤患者和5名健康志愿者的右手合谷穴和曲池穴,采用组块设计方法,使用SPM2软件得到患者和健康志愿者脊髓内真实的激活区,分析激活区在矢状位和横断位上的分布特征,并与健康志愿者的激活分布对比,找出患者的激活分布差异。 结果与结论：5名健康志愿者在脊柱C2、C5段均重复出现激活信号,在C6段4名出现激活;3例脊髓损伤患者在脊柱C2,C6段均出现均重复出现激活,其中1例患者与健康志愿者激活分布特征基本一致。可以观察到针灸刺激脊髓损伤患者的脊髓功能激活,因此可以根据功能激活区的分布及强度,在一定程度上客观评价针灸治疗脊髓损伤的疗效。 关键词：磁共振功能成像;脊髓损伤;针灸;穴位;SEEP;数字化图像与影像     

大鼠脊髓完全性损伤模型的建立

背景：建立有效的完全性脊髓损伤动物模型是深入研究脊髓损伤的前提,只有建立标准的、可重复性高的实验动物模型才能择优选出治疗脊髓损伤的可行方案。 目的：实验拟建立一种稳定的大鼠完全性脊髓损伤动物模型。 设计、时间及地点：对照观察动物实验,于2007-11/2008-10在石河子大学药学院动物试验中心完成。 材料：30只健康Wistar大鼠随机分成假手术组6只、实验组24只。 方法：显露实验组大鼠T8~T12棘突及椎板,切除T9~10棘突及椎板,暴露相应脊髓段作为损伤区,采用大鼠脑定位仪自主设计改良Allen模型打击装置,予15 g×20 cm=2.94×10-2N 重力打击大鼠T10节段脊髓,动物模型保证硬脊膜完整。假手术组仅同法暴露相应脊髓段,但不做打击。 主要观察指标：造模后2,4,8周以斜板试验及BBB评分观察大鼠双后肢运动功能,以苏木精-伊红染色观察大鼠脊髓组织的变化。 结果：假手术组大鼠苏醒后能站立行走,斜板试验角度均大于70°,BBB评分21分,脊髓结构正常。实验组大鼠造模后双下肢全瘫,2只大鼠表现为痉挛性瘫痪,5只大鼠表现出不同程度的自残现象。造模后2,4,8周斜板试验角度均小于30°,BBB评分均少于10分,随时间延长,部分大鼠可见后肢刺激性反射,但无主动性功能活动,局部脊髓结构破坏严重。 结论：以2.94×10-2N 重力打击大鼠脊髓可保证硬脊膜的完整,并获得稳定的完全性脊髓损伤动物模型。     

COMPLICATIONS FROM INTRATHECAL STEROID THERAPY IN PATIENTS WITH MULTIPLE SCLEROSIS

Methylprednisolone acetate was administered intrathecally 83 times to 23 patients who had 46 separate exacerbations of multiple sclerosis. Four patients improved, 7 worsened, and 12 were unchanged during treatment and follow-up. Serious side effects occurred in 3 patients; adhesive arachnoiditis in 2, and aseptic meningitis in one. Three other patients had severe exacerbations within 24 hours of treatment, followed by slow improvement, or no improvement. When the clinical response of this patient group was evaluated and compared with other series, it was found that improvement occurred with chance frequency. Exacerbations continued to occur with natural frequency. These findings suggest that there is no rationale for this mode of therapy, as there are dangers from these intrathecal injections, and the treatment does not alter the course of the disease.     

The evidence for prolonged muscle stretching in ankle joint management in upper motor neuron lesions: considerations for rehabilitation – a systematic review

Background: As clinicians, muscles stretching approaches are one of the most commonly used interventions in rehabilitation. However, there is a need for an in-depth evaluation of research on prolonged stretching in terms of the features of the stretching approaches, such as duration and frequency, as well as the compatible measures of a successful stretching approach.

Objective: This review is an effort to synthesize findings from studies on “prolonged” stretching approaches in patients with UMNs including stroke, spinal cord injuries, and traumatic brain injuries. We investigated the compatible features of successful stretching regimens in terms of reducing spasticity, improving the Active Range of Motion (AROM), Passive Range of Motion (PROM), and gait training of spastic patient with upper motor neuron lesions.

Methods: Studies evaluating the effectiveness of “prolonged” stretching on spastic ankle planterflexor muscles and its complications were critically reviewed, and the level of evidence was analyzed.

Results: There is a sufficient level of evidence to support the use of stretching as and effective techniques in rehabilitation. However, more research is yet to be done to objectively examine the ideal parameters of a successful stretching approach using functional assessments, such as walking, speed, walking capacity, and balance.

Conclusion: The review adds stronger understanding with regard to stretching considerations in rehabilitation following UMNs. The ideal approach, as well as the functional implications on motor performance are yet to be further studied.     

Estrogen and progesterone as neuroprotective agents in the treatment of acute brain injuries

Estrogen and progesterone are often thought of as steroid hormones that strongly influence reproductive and maternal behaviours. However, the steroids are now showing considerable promise as neuroprotective and neuroregenerative agents in stroke and traumatic brain injuries. Collectively, these two hormones have been reported to reduce the consequences of the injury cascade by enhancing anti-oxidant mechanisms, reducing excitotoxicity: altering glutamate receptor activity, reducing immune inflammation, providing neurotrophic support, stimulating axonal remyelinization and enhancing synaptogenesis and dendritic arborization. Estrogen has often been tried as a prophylactic treatment in females for ischemic brain injury, while progesterone has, thus far, been given as a post-injury treatment for both male and female subjects with acute, ischemic and traumatic injuries of the brain and spinal cord. This review compares and evaluates estrogen and progesterone as neuroactive agents in the acute treatment of brain damage caused by stroke and trauma.     

Chronische Rückenmarksschädigung nach Starkstrom-Unfall

Summary Neuropathological changes in the spinal cord are described which have been observed 8 years after an electric injury with currents of 15000 V. Severe demyelination extended throughout all spinal segments concentrating on the posterior and lateral tracts. Besides a slight pallor of the pyramidal tracts in the medulla oblongata no damage to other parts of the CNS could be detected. In contrast to the degree of demyelination in the spinal cord, loss of axons and nerve cells was slight and for the latter limited to lumbar segments.The main clinical symptom in this patient was spastic paresis of all limbs increasing up to a time of 2 years after the injury. This clinical picture has been described in 14 cases collected by Panse and occurred only after accidents with currents of more than 1000 V. The clinical diagnosis of a distinct type of electric injury distinguishable from other syndroms after electric accidents and from the true heredodegenerative diseases of the spinal cord is supported by this first morphological report.

     

家兔脑桥被盖背外侧部向骶髓的直接投射

为研究家兔脑桥排尿反射通路的构成,本实验采用顺、逆行追踪技术结合免疫组化方法对家兔脑桥被盖背外侧部与骶髓的纤维联系进行了研究。将麦芽凝集素辣根过氧化物酶（ＷＧＡ－ＨＲＰ）或荧光素四甲基罗达明葡聚糖胺（ＴＭＲ）注射到骶髓后,在脑桥被盖背外侧部发现一团ＷＧＡ－ＨＲＰ或ＴＭＲ标记的神经元。为确定这些逆标细胞是否属于蓝斑核内的神经元,将ＴＭＲ注射例的脑桥切片用抗酪氨酸羟化酶（ＴＨ）抗体孵育并进行免疫荧光组化染色。结果显示,ＴＨ阳性细胞环绕于ＴＭＲ标记神经元周围,但未见ＴＭＲ／ＴＨ双标细胞。将ＷＧＡ－ＨＲＰ注射于脑桥被盖背外侧部后,在骶髓节段的骶髓副交感核、中间带灰质和后连合核等处发现有大量顺行标记的纤维和终末。结合在其他种属动物上的研究资料,推测位于家兔脑桥被盖背外侧部的这团神经元可能相当于在大鼠和猫相应部位发现的与脑桥排尿反射密切相关的Ｂａｒｒｉｎｇｔｏｎ核     

CORTISOL DECREASES AND SEROTONIN AND DOPAMINE INCREASE FOLLOWING MASSAGE THERAPY

In this article the positive effects of massage therapy on biochemistry are reviewed including decreased levels of cortisol and increased levels of serotonin and dopamine. The research reviewed includes studies on depression (including sex abuse and eating disorder studies), pain syndrome studies, research on auto-immune conditions (including asthma and chronic fatigue), immune studies (including HIV and breast cancer), and studies on the reduction of stress on the job, the stress of aging, and pregnancy stress. In studies in which cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies in which the activating neurotransmitters (serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin and an average increase of 31% was noted for dopamine. These studies combined suggest the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences.     

Zur differentialdiagnose granulomatöser myelitiden

Zusammenfassung Es werden 3 Fälle mit subakutem und chronischem lymphocytär-entzündlichem spinalem Querschnittssyndrom referiert. 2 der Fälle weisen auf Grund der neuropathologischen Befunde auf Neurobrucellose bzw. M. Boeck des Rückenmarks hin, der dritte konnte bereits klinisch als spinaler Boeck identifiziert werden. Unter Hinweis auf ähnliche bisher veröffentlichte Beobachtungen wird zur Symptomatologie und Differentialidagnose dieser Krankheitsbilder Stellung genommen.

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Differential diagnosis of granulomatous myelitides

Summary 3 cases of subacute (chronic) inflammatory alteration of the spinal cord with paraplegia were observed. In 2 of them the neuropathological findings point to a neurobrucellosis or sarcoidosis of the spinal cord. The clinical data of the third case were consistent with spinal sarcoidosis. The symptoms and the differential diagnosis of the spinal manifestations of these diseases are discussed on the basis of similar observations reported in the literature.

     

Experience with transcranial magnetic stimulation in evaluation of spinal cord injury

Abstract

Nine subjects (seven male, two female) underwent transcranial magnetic stimulation (TMS) toward the evaluation of spinal cord injury (SCI). The evaluation of SCI with TMS tended to support clinical findings. Those subjects with clinically complete injuries demonstrated no evoked muscle response below the level or injury. Those subjects with clinically incomplete injuries showed trends toward prolonged evoked muscle latencies on the weaker side. Facilitation tended to enhance distal muscle responses. With incomplete spinal injurYI the facilitation maneuver allowed the recording of weak muscle responses as well as those otherwise not present at rest. Maximum anal sphincter contraction also hf;lped facilitate muscle responses and tended to impart less noise in the recordings. Facilitation failed, however to produce a response in those subjects with clinically complete injuries. No subject experienced adverse effects during the study. TMS promises to be an effective tool for the evaluation of SCI. [Neural Res 1997; 19: 497-500]     

L—NAME加重强啡肽致脊髓损伤作用

大鼠脊髓蛛网膜下腔注射（ｉ．ｔ．）强啡肽Ａ１－１７（ＤｙｎｏｒｐｈｉｎＡ１－１７，Ｄｙｎ）１．２５～２０ｎｍｏｌ可引起剂量依赖性后肢和尾部瘫痪。其中１．２５和２．５ｎｍｏｌ运动功能无影响，在１０ｎｍｏｌ为致一过性瘫痪剂量，脊髓无明显病理变化，２０ｎｍｏｌ为致持久性瘫痪剂量，脊髓发生进行性中央性坏死，一氧化氮合成酶抑制Ｎ＾６０－硝基－左旋精氨酸甲酯（Ｌ－ＮＡＭＥ）ｉ．ｔ．１～５μｍｏｌ时对正常大鼠     

PRIMARY BIOMARKERS IN CEREBRAL SPINAL FLUID OBTAINED FROM PATIENTS WITH INFLUENZA-ASSOCIATED ENCEPHALOPATHY ANALYZED BY METABOLOMICS

In order to search for the specific biomarkers of patients with influenza-associated encephalopathy this article analyzed all metabolites in cerebrospinal fluid (CSF) by using metabolome analysis. In all metabolites, the peaks of two molecular weights, 246.0092 and 204.0611, were significantly higher than those in other diseases including influenza without convulsion (p < .05). The peak of a molecular weight 228.0247 in all of the patients except one was less than that in other patients. These results indicate that the new metabolites detected in CSF would be primary markers for the diagnosis of influenza-associated encephalopathy.     

携带神经干细胞肌基膜管组织工程支架中神经干细胞的存活分化

摘要 背景：多项研究已证实神经干细胞能促进脊髓损伤大鼠神经功能的恢复,肌基膜管具有良好的细胞、组织相容性和降解性,那么能否将二者结合起来构建一个新的神经组织工程支架？ 目的：以神经干细胞为种子细胞,以肌基膜管为支架,观察携带神经干细胞的肌基膜管组织工程支架中神经干细胞的存活与分化情况。 方法：体外分离培养大鼠神经干细胞,并进行鉴定。用化学萃取方法制作去细胞骨骼肌基膜管支架,将神经干细胞移植入肌基膜管支架培养7 d后,用免疫组织化学方法检测神经干细胞的存活及分化情况,扫描电镜观察其超微结构。 结果与结论：神经干细胞分离培养第5天,Nestin免疫荧光染色可见大量神经球。加血清诱导神经干细胞分化至7 d,进行抗NF、抗GFAP免疫荧光染色,镜下可见NF、GFAP阳性细胞,证明培养的神经干细胞具有多项分化潜能。苏木精-伊红染色法显示肌基膜管中肌细胞成分已消失,肌基膜管支架内主要是大致平行的管道。携带神经干细胞的肌基膜管组织工程支架免疫荧光染色证明,神经干细胞在支架内仍具有干细胞特性,并可分化为神经元和神经胶质细胞。扫描电镜显示神经干细胞可以稳固地贴附在肌基膜管内,提示制备的神经组织工程支架具有良好的生物相容性,可以进行体内移植治疗脊髓损伤等神经系统疾病。 关键词：肌基膜管;组织工程支架;神经干细胞;移植;脊髓损伤 doi:10.3969/j.issn.1673-8225.2010.47.003     

A NEW EXTRA-VERTEBRAL TREATMENT MODEL FOR INCOMPLETE SPINAL CORD INJURIES

The present study is an investigation of the results of the studies on the effects of acupuncture application therapy on obesity. It has been reported that acupuncture application in obesity treatment is effective in procuring weight loss. It can affect appetite, intestinal motility, and metabolism, as well as emotional factors such as stress. Increases in neural activity in the ventromedial nuclei of the hypothalamus, in tone in the smooth muscle of the stomach and in levels of enkephalin, beta endorphin, and serotonin in plasma and brain tissue have also been observed with the application of acupuncture. It has been observed that acupuncture application to obese people increases excitability of the satiety center in the ventromedial nuclei of the hypothalamus. Acupuncture stimulates the auricular branch of the vagal nerve and raises serotonin levels. Both of these activities have been shown to increase tone in the smooth muscle of the stomach, thus suppressing appetite. Among other things, serotonin enhances intestinal motility. It also controls stress and depression via endorphin and dopamine production. In addition to these effects, it is thought that the increase in plasma levels of beta endorphin after acupuncture application can contribute to the body weight loss in obese people by mobilizing the body energy depots through lipolithic effect.     

Spinale sarkoidose

Summary Report on a case of spinal sarcoidosis in a thirty-year-old man. The disease began with a slight thoracic cord compression syndrome. The clinical examination revealed a lymph-node sarcoidosis of the chest. The patient recovered after 6 months treatment with corticosteroids and later with chloroquine.

     

Pathomorphology of experimental head injury due to rotational acceleration

Summary We have shown that pure non-deforming rotational acceleration to the head is capable of producing lesions not only in the brain but through the entire length of the spinal cord, extending to the cauda equina.In clinical circumstances in which humans are subjected to severe rotational acceleration of the head, the spinal cord, as well as the brain should be examined pathologically.Supported in part by Contract DA-49-193-MD-2610 with the U.S.Army Medical Research and Development Command, Washington, D.C., NB 07377-01, with USPHS-Dept. of Health, Education and Welfare and Mary K. Petersen Foundation.