Case series of two patients with Fibrocartilaginous Embolism mimicking Transverse Myelitis of the Spinal Cord

Fibrocartilaginous Embolism (FCE) refers to the extrusion of some of the fibro-cartilaginous nucleus pulposus material from within the inter-vertebral disc to eventually embolize into one of the spinal cord vessels with resultant spinal cord infarction. According to a 2016 review, AbdelRazek et al. (2106) [1] there are 41 pathologically confirmed and 26 clinically suspected cases in the literature till the end of 2015. We add two more clinically diagnosed cases.     

血管源性脑水肿大鼠血管周围间隙扩张的病理学观察

目的观察血管源性脑水肿大鼠脑组织中血管周围间隙(VRS)扩张情况,并探讨其机制。方法选择造模成功的20只SD雄性大鼠,分为模型组和对照组,每组各10只。模型组大鼠腹腔注射盐酸去氧肾上腺素6.0mg/kg,8 h注射1次,共注射3次。对照组大鼠腹腔注射等量生理盐水。所有大鼠在48 h后,取脑行冷冻切片,HE染色。在光学显微镜下观察VRS扩张情况,并行VRS计数。结果模型组大鼠注射药物后出现小便失禁,呼吸急促,竖毛肌收缩,眼球突出,肢体抽搐等。光学显微镜下显示,对照组大鼠未出现明显扩张的VRS;模型组大鼠出现明显扩张的VRS。与对照组比较,模型组大鼠扩张的VRS数目明显增多,差异有统计学意义(P<0.01)。结论血管源性脑水肿可能是VRS扩张的机制之一。     

胆红素对新生儿脐血单核细胞髓样分化蛋白-2、肿瘤坏死因子受体相关因子6mRNA表达的影响

目的观察脐血单核细胞(CBMC)经不同水平胆红素孵育后髓样分化蛋白2(MD-2)、TNF受体相关因子6(TRAF6)mRNA表达的变化。方法采集10例健康足月新生儿的脐血,经纤维蛋白结合法分离得CBMC,将其加入含不同水平胆红素(0μmol.L-1、17.1μmol.L-1、42.8μmol.L-1、102.6μmol.L-1、153.9μmol.L-1、220.6μmol.L-1和307.8μmol.L-1)的牛血清清蛋白溶液中孵育1 h,再加入脂多糖(LPS)刺激30 min。收集CBMC,采用反转录-PCR方法测定其MD-2、TRAF6 mRNA的表达水平。结果 1.LPS单独作用对CMBC MD-2 mRNA和TRAF6 mRNA表达水平无明显影响,低水平胆红素(17.1μmol.L-1、42.8μmol.L-1)单独作用对CBMC MD-2 mRNA和TRAF6 mRNA表达水平无明显影响。2.先经不同水平胆红素孵育,再接受LPS刺激,胆红素有抑制细胞MD-2 mRNA表达的趋势,随着胆红素水平的升高,抑制趋势越明显;先经不同水平胆红素孵育,再接受LPS刺激,低水平胆红素促进细胞TRAF6 mRNA的表达,当胆红素≥102.6μmol.L-1时,抑制TRAF6 mRNA表达,胆红素水平越高,抑制作用越明显。在相同胆红素水平作用下,随着MD-2 mRNA表达水平的降低,TRAF6 mRNA表达水平随之降低。结论低水平胆红素对CBMC MD-2 mRNA的表达无明显影响,对TRAF6 mRNA的表达有促进作用。高水平胆红素对二者的表达均有抑制作用,随着胆红素水平升高,抑制作用越来越明显。高胆红素血症患儿免疫功能低下可能与高浓度胆红素对免疫细胞的抑制作用有关。     

How does wearable robotic exoskeleton affect overground walking performance measured with the 10-m and six-minute walk tests after a basic locomotor training in healthy individuals?

It is still unknown to what extent overground walking with a WRE is equivalent to natural overground walking without a WRE. Hence, the interpretability of the 10-m (10MWT) and six-minute (6MWT) walk tests during overground walking with a WRE against reference values collected during natural overground walking without a WRE is challenging. This study aimed to 1) compare walking performance across three different overground walking conditions: natural walking without a WRE, walking with a WRE providing minimal assistance (active walking), and walking with a WRE proving complete assistance (passive walking) and 2) assess the association and the agreement between the 10MWT and the 6MWT during passive and active walking with a WRE. Seventeen healthy individuals who underwent basic locomotor training with a WRE performed the 10MWT (preferred and maximal speeds) and the 6MWT under the three conditions. For the 10MWT, the speed progressively and significantly decreased from natural walking without a WRE (preferred: 1.40 ± 0.18 m/s; maximal: 2.16 ± 0.19 m/s), to active walking with a WRE (preferred: 0.48 ± 0.10 m/s; maximal: 0.61 ± 0.14 m/s), and to passive walking with a WRE (preferred: 0.38 ± 0.09 m/s; maximal: 0.42 ± 0.10 m/s). For the 6MWT, total distances decreased from walking without a WRE (609 ± 53.9 m), to active walking with a WRE (196.6 ± 42.6 m), and to passive walking with a WRE (144.3 ± 33.3 m). The 10MWT and 6MWT provide distinct information and can’t be used interchangeably to document speed only during active walking with the WRE. Speed and distance drastically decrease during active and, even more so, passive walking with the WRE in comparison to walking without a WRE. Selection of walking tests should depend on the level of assistance provided by the WRE.     

Analgesic effects of intrathecal tramadol in patients undergoing caesarean section: a randomised,double-blind study

BackgroundIntrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery. The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section.MethodsEighty full-term parturients scheduled for elective caesarean section were randomly divided into two groups. In the fentanyl group, patients received intrathecal 0.5% bupivacaine 10 mg with fentanyl 10 μg; in the tramadol group, patients were given the same dose of bupivacaine with tramadol 10 mg. Sensory and motor block characteristics, duration of postoperative analgesia, maternal side effects, and neonatal outcome were compared.ResultsOne patient in the tramadol group and two patients in the fentanyl group were excluded from data analysis. Median [interquartile range] duration of postoperative analgesia in the tramadol and the fentanyl groups was 300 [240–360] min and 260 [233–300] min respectively (P = 0.02). The incidence of shivering was lower in patients who received tramadol (5%) than those who had fentanyl (32%) (P = 0.003). Apgar scores, umbilical cord acid–base measurement and neurologic and adaptive capacity scores were comparable between the two groups.ConclusionCompared to intrathecal fentanyl 10 μg, tramadol 10 mg, as an adjunct to bupivacaine for subarachnoid block for caesarean section, showed a longer duration of analgesia with a reduced incidence of shivering.     

The influence of social support on the rehabilitation of women with spinal cord injury: experiences recounted by occupational therapists

Abstract

Objective: Women with a spinal cord injury (SCI) often require support from others to perform their everyday activities. The aim was to describe OTs' experiences of how social support from the network influences or could influence the rehabilitation of women with SCIs. Methods: Four occupational therapists, specialized in rehabilitation of persons with SCIs, narrated 11 separate stories relating to women with an SCI. Five themes were identified: “Assisting the women to identify new ways to perform activities”, “Giving support to the women by re-establishing relationships on their behalf”, “Enabling the women to find solutions to problems that have an impact on everyday activities”, “Enabling the women to learn what it is like to live with an SCI from first-hand accounts”, and “Assisting the women to set goals in anticipation of life outside the clinic”. Results and conclusions: The results indicate that professionals within rehabilitation need to be aware of and actively create and strengthen natural social networks during the complex and demanding rehabilitation process. Furthermore, they ought to use their capacity as professionals to ensure that support is provided and to reduce negative interactions within the injured person's network, given that social support, social integration, and negative interactions have the potential to influence health and well-being.     

羟基红花黄色素A在急性脊髓损伤中对细胞凋亡的影响

目的：观察羟基红花黄色素A(HSYA) 在急性脊髓损伤（ASCI）中的治疗作用及潜在机制。方法：SD 大鼠随机分为空白对照组、损伤对照组和HSYA治疗组，采用ALLEN’S打击法建立急性脊髓损伤模型，各组分别于术后1、7、14d观察其行为学评分，14d通过免疫组化的方法观察脊髓损伤部位神经细胞凋亡(caspase-3p20、Bcl-2与Bax)。结果：（1）行为学观察评分：HSYA治疗组与损伤对照组下肢功能均有恢复(P＜0.05），且HSYA治疗组恢复更明显(P＜0.05）；（2）免疫组化检测：caspsase-3阳性细胞数HSYA治疗组表达较损伤对照组少(P＜0.05）；Bcl-2阳性细胞HSYA治疗组的表达较损伤对照组多(P＜0.05）；Bax阳性的细胞HSYA治疗组的表达较损伤对照组少(P＜0.05）。结论：HSYA在急性脊髓损伤中具有抑制神经细胞凋亡，减少了脊髓损伤部位的继发性损伤，从而促进功能的恢复的作用，因此HSYA有可能成为治疗脊髓损伤的药物之一。