不同类型脊髓损伤患者和正常成人外周血白细胞糖皮质激素受体的比较及意义

目的 比较正常成人和急性脊髓损伤患者、慢性脊髓压迫症患者外周血白细胞塘皮质激素受体的结合位点数并探讨其意义。方法 采用放射配体结合法测定15例正常成人、20例急性脊髓损伤患者和21例慢性脊髓压迫症患者外周血白细胞上糖皮质激素受体结合位点数。结果 正常成人外周血白细胞精皮质激素受体结合位点数为4462±891.6个/细胞,慢性脊髓压迫症患者为4225±1271个/细胞,急性脊髓损伤患者为2517±857.8个/细胞,经统计学比较正常成人组和慢性脊髓压迫症患者组没有显著性差异,急性脊髓损伤组与其他两者相差均有显著性意义。急性脊髓损伤组中,全瘫患者为2279±921个/细胞,不全瘫患者为2806±718个/细胞,两者无统计学差异。结论 外周血白细胞上的糖皮质激素受体有高亲和力和低亲和力两种结合位点,急性脊髓损伤后外周血白细胞的精皮质激素受体结合位点数的减少主要是高亲和力位点的减少,低亲和力位点维持不变。大剂量的糖皮质激素和白细胞的低亲和力位点结合,抑制白细胞的趋向移动,减少白细胞进入损伤脊髓区,减轻损伤后的急性炎症反直,起到神经保护作用。慢性脊髓压迫症患者予以糖皮质激素治疗无疗效。     

Anesthetic considerations for patients with acute cervical spinal cord injury

Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures.To this end,anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan.Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews,consider cervical spinal cord movement and compression during airway management,and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations.During induction,anesthesiologists should avoid hypotension and depolarizing muscle relaxants.Mean artery pressure should be maintained within 85–90 mmHg(1 mmHg = 0.133 kPa; vasoactive drug selection and fluid management).Normal arterial carbon dioxide pressure and normal blood glucose levels should be maintained.Intraoperative neurophysiological monitoring is a useful option.Anesthesiologists should be attentive to postoperative respiratory insufficiency(carefully considering postoperative extubation),thrombus,and infection.In conclusion,anesthesiologists should carefully plan the treatment of patients with acute cervical spinal cord injuries to protect the nervous system and improve patient outcome.     

神经生长因子对创伤性脊髓损伤大鼠膀胱功能和轴突损伤修复的作用研究

目的 探讨神经生长因子(Nerve growth factor, NGF)对创伤性脊髓损伤(Traumatic spinal cord injury, t-SCI)大鼠膀胱功能和脊髓神经轴突损伤修复的影响及其分子机制。方法 取30只雄性Sprague-Dawley(SD)大鼠,通过改良Allen’s击打法构建创伤性脊髓损伤模型,随机分为假手术组、损伤组和NGF组,每组各10只;采用血脑屏障(Blood-brain barrier, BBB)评分观察术前、术后大鼠的后肢运动功能;BL-420生物仪实验系统检测尿动力学;甲苯胺蓝染色吻合口远端截取的左侧腰6前根,计算有髓轴突数量;采用苏木精-伊红(Hematoxylin eosin, HE)染色大鼠膀胱组织;原位末端标记法(TdT-mediated dUTP nick and labeling, TUNEL)染色大鼠损伤严重的脊髓,观察脊髓神经细胞的凋亡率;蛋白免疫印迹法(Western blot)检测脊髓组织中原癌基因丝氨酸/苏氨酸蛋白激酶(proto-oncogene serine/threonine-protein kinase, R...     

颅脑损伤患者深静脉血栓形成的危险因素分析及预防方法

目的探讨颅脑损伤患者深静脉血栓(DVT)形成的高危因素及预防方法。方法对3 6 2例颅脑损伤患者伤后每间隔1 0 d检查一次下肢血管彩超,发现DVT后给予及时治疗。对发生DVT与未发生DVT的患者进行年龄、疾病、卧床时间、性别等各因素的患病率进行对照分析。结果 3 6 2例患者发现DVT 4 8例,DVT患肢6 3侧,DVT患病率高血压者为1 7.5 0%(2 8/1 6 0),无高血压者9.9 0%(2 0/2 0 2),年龄<6 0岁者1 0.7 1%(3 3/3 0 8),>6 0岁者2 7.7 8%(1 5/5 4),糖尿病者2 5.3 0%(2 1/8 3),无糖尿病者9.6 8%(2 7/2 7 9);瘫痪肢体2 2.9 2%(4 4/1 9 2),未瘫痪肢体3.5 7%(1 9/5 3 2),卧床≤1 0 d时DVT患病率2.2 1%(8/3 6 2),≤2 0 d时7.4 6%(1 7/2 2 8),≤3 0 d时1 2.1 2%(2 4/1 9 8),≤4 0 d时2 4.4 3%(3 2/1 3 1),≤5 0 d时3 9.8 1%(4 3/1 0 8)。结论颅脑损伤患者DVT的发生与年龄、血压、血糖、肢体活动度、卧床时间等密切相关,与性别关系不大。高龄、高血压史、糖尿病史、瘫痪肢体、卧床时间>1 0 d等均是形成DVT的高危因素,而且卧床时间越长,形成DVT的风险越大。     

Population-based epidemiology of postoperative venous thromboembolism in Taiwanese patients receiving hip or knee arthroplasty without pharmacological thromboprophylaxis

Introduction

Population-based evaluation on the incidence of postoperative venous thromboembolism (VTE) has not yet been reported for Asians receiving arthroplasty. In Taiwan, thromboprophylaxis was not commonly applied for patients. The population-based cohort study aimed to investigate the epidemiology, and to determine the risk factors VTE for patients receiving hip or knee replacement without pharmacological thromboprophylaxis in Taiwan.

Materials and Methods

We retrospectively acquired patients’ data from National Health Insurance databases representing more than 99% of about 23 million Taiwanese citizens. The primary outcome was the incidence of composite symptomatic VTE within 28 days after receiving hip or knee replacement surgery.

Results

During 2002 to 2006, there were 114,026 patients undergoing hip (n = 61,460) or knee (n = 52,566) replacement surgery. The occurrence rate of overall postoperative VTE was 0.44%. The incidence of pulmonary embolism was four in 10,000 patients receiving hip replacement or seven in 10,000 individuals undergoing knee replacement. The weekly cumulative incidence of VTE was persistently rising up to 28 days after surgery. Dramatic increase in risk of post-surgical VTE was associated with prior disease history of PE (p < 0.001 for hip replacement, p = 0.01 for knee replacement) or DVT (p = 0.004 for hip replacement, p < 0.001 for knee replacement). Prior claim of congestive heart failure was an independent risk factor associated with patients receiving knee arthroplasty (p = 0.01).

Conclusion

Life-threatening PE occurred and increased cumulatively up to 28 days after hip or knee arthroplasty in Asians. Proper prophylaxis for patients with the exposure of high risks needs to be scrutinized.     

Experimental acute traumatic injury of the adult rat spinal cord by a subdural inflatable balloon: methodology, behavioral analysis, and histopathology.

We describe an experimental model to produce closed traumatic injuries to the spinal cord of adult rats. This model uses an inflatable balloon that is introduced in the dorsal subdural space and moved to a location rostral to the laminectomy site. The spinal cord trauma can be graded by varying either the duration of compression or the volume of saline used to inflate the balloon. The locomotor deficit of animals with various degrees of injury has been assessed at increasing delays after trauma. The parameters generating transient or definitive deficits of varying intensity were defined. Some injured animals underwent nuclear magnetic resonance imaging. Detailed histopathological studies demonstrated that the extent of the spinal lesion was significantly correlated with the physical parameters of compression and with the severity of the behavioral deficit.     

急性脊髓损伤的循证治疗

目的：对1例急性脊髓损伤患者进行循证治疗,总结评价治疗急性脊髓损伤的最佳证据。 方法：系统检索美国国家指南交换中心NGC（2000/2011）、Cochrane 图书馆（2011 年第1 期）、TRIP Database(2000/2011)、PubMed（1966/2011）中治疗急性脊髓损伤的相关研究,依据循证医学倡导的最佳研究证据、医师的临床经验和患者的意愿相结合制定治疗方案。 结果：共纳入34篇研究文献,包括1篇临床指南,22篇系统评价和11篇随机对照试验。目前的证据表明：对于急性脊髓损伤的患者,不推荐使用任何神经保护类药物;推荐早期手术;使用物理方式和注射低分子量肝素来防止静脉血栓的发生;功能性电刺激和针灸对急性脊髓损伤患者的功能恢复有促进作用。实验中未给予患者任何神经保护类药物,于伤后6h进行颈椎手术,术后应用低分子量肝素和物理措施预防血栓形成,每日进行呼肌功能锻炼,同时给予功能性电刺激和针灸治疗。经过3个月的随访,证实此方案适合该患者。 结论：应用循证医学的方法为急性脊髓损伤的患者制定个性化治疗方案,能显著提高治疗效果和预后。     

Early methylprednisolone impact treatment for sensory and motor function recovery in patients with acute spinal cord injury★ A self-control study

BACKGROUND： For the treatment of spinal cord injury, any pathological changes of the injured tissue should be primarily corrected or reversed. Any remaining fibrous function and neurons with intact structure should be retained, and the toxic substances caused by ischemia-hypoxia following spinal cord injury, should be eliminated to create a favorable environment that would promote neural functional recovery. OBJECTIVE： This study was designed to investigate the effects of the impact of early methylprednisolone-treatment on the sensory and motor function recovery in patients with acute spinal cord injury. DESIGN： A self-control observation. SETTING： Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China. PARTICIPANTS： Forty-three patients with acute spinal cord injury were admitted to the Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, between October 2005 and September 2007. These patients were recruited for the present study. The patients comprised 33 males and 10 females, and all met with the inclusive criteria namely, the time between suffering from acute spinal cord injury and receiving treatment was less than or equal to eight hours. METHODS： According to the protocol determined by the State Second Conference of Acute Spinal Cord Injury of USA, all patients received the drop-wise administration of a 30-mg/kg dose of methylprednisolone （H200040339, 500 mg/bottle, Pharmacia N.V/S.A, Belgium） for 15 minutes within 8 hours post injury. After a 45-minute interval, methylprednisolone was administered at 5.4 mg/kg/h for 23 hours. MAIN OUTCOME MEASURES： Prior to and post treatment, acupuncture sense and light touch scoring were performed at 28 dermatomic area key points, including occipital tuberosity and supraclavicular fossa. At the same time, motor scoring of key muscles among 10 pairs of sarcomeres was also performed. RESULTS： All 43 patients participated in the final analysis. There was no s     

Methylprednisolone and tetrandrine in combination with direct current electrical field for treating acute spinal cord injury

BACKGROUND: The direct current electrical field can effectively promote the regeneration of the spinal cord; moreover, methylprednisolone (MP) can relieve secondary edema after spinal cord injury. Tetrandrine (Tet) is an effective component of hanfangji and can protect the effect of spinal cord and axis-cylinder. Whether direct current electrical field combining with MP or Tet has synergic or strengthening effect on treating complete spinal cord injury or not should be studied further. OBJECTIVE:To study the effect of direct current electrical field assisted by MP and Tet on treating spinal cord injury. DESIGN: Randomized controlled animal study. SETTING: People's Hospital of Hainan Province. MATERIALS: A total of 45 healthy hybrid dogs, of both genders, weighing 10–12 kg, aged 1.5–2 years, were provided by Animal Center of Hainan Province. Somatosensory evoked potential meter (DANTEC Company), IBAS-2.0 imaging analysis meter (Germany), and self-made electronic stimulator. METHODS: The experiment was carried out in Hainan People's Hospital from May 2001 to June 2004. All experimental dogs were randomly divided into 4 groups: control group (n =9), electrostimulating group (n =12), MP + electrostimulating group (n =12) and Tet + electrostimulating group (n =12). ① After anesthesia, Allen WD method was used to induce complete spinal cord injury. The metal bar, which was 10 cm in height fell freely and vertically hit the spinal cord to provide a complete spinal cord injury. Dogs in control group and electrostimulating group were implanted electrical stimulators 6 hours after spinal cord injury (no electricity in control group); dogs in MP + electrostimulating group were injected 30 mg/kg MP for 15 minutes at 2 hours after spinal cord injury and electrical stimulators implanted at 6 hours after injury; dogs in Tet + electrostimulating group were intravenously injected with 7.5 mg/kg Tet at 2 hours after spinal cord injury and electrical stimulators implanted at 6 hours after injury; and then, 7.5 mg/kg Tet injected at days 2 and 3 after injury. ② Specimens were taken from control group from three dogs of every month; from the injured segments of spinal cords at 1 month, 2 months and 3 months; and from electrostimulating group, MP + electrostimulating group and Tet + electrostimulating group of 4 dogs for histological examinations. ③ Detection of neurological function: Neurological function was evaluated with the functional 10 grading system. The scores ranged from 0 to 10 (0: complete paraplegia; 10: normality). ④ Detection of cortical somatosensory evoked potential (CSEP): According to the scheme formulated by the International Electroencephalographical Association, the patterns of the fundamental waves were P1–N1–P1 waves. The latency of the P1 wave and the amplitude of P1–N1 waves were mainly observed individually at 1, 2 and 3 months after the injury. ⑤ Histological detection: All spinal cord specimens of the injuried segment were harvested at 1, 2 and 3 months after injury. They were stained with hematoxylin and Nissl staining methods, and then were observed under an optical microscope, and the neurons were counted. The sectional areas of the neurons and the density of the Nissl bodies were measured by a system image pattern analysis (IBAS-2.0, Germany). MAIN OUTCOME MEASURES: The neurological function, cortical somatosensory evoked potential, neuronal amount, sectional area of neurons and Nissl body density at 1 to 3 months after injury. RESULTS: All 45 experimental dogs were involved in the final analysis. ① Detection of neurological function: One month later, the dogs in MP + electrostimulating group could walk, but the dogs in electrostimulating group and Tet + electrostimulating group could stand. Two months after injury, the dogs in MP + electrostimulating group almost recovered to normal, but the dogs in electrostimulating group could walk and those in Tet + electrostimulating group could run. Those in control group had no parent recovery. ② Detection of P1 latency and P1–N1 amplitude: Changes of P1 latency in control group were long and P1–N1 amplitude was very low at 1 month later. Compared to electrostimulating group, MP + electrostimulating group and Tet + electrostimulating group, there were significant differences (P < 0.05). P1 latency was manifestly shortened and amplitude were raised in electrostimulating group, MP + electrostimulating group and Tet + electrostimulating group. Those in MP + electrostimulating group and Tet + electrostimulating group were superior to those in electrostimulating group and there were significant differences (P < 0.05). ③ Sectional areas of neurons and Nissl body density: At 1–3 months after injury, sectional areas of neurons were larger in electrostimulating group [(170.14±7.45), (209.60±14.80), (312.47±12.63) μm2], MP + electrostimulating group [(282.18±15.25), (418.18±16.27), (515.25±15.10) μm2] and Tet + electrostimulating group [(231.81±7.38), (322.67±8.45), (386.82±10.42) μm2] than control group[(98.12±4.93), (113.50±6.74), (122.59±8.03) μm2, P < 0.05]; especially, sectional area was the largest in MP + electrostimulating group. At 1–3 months after injury, Nissl body density was more in electrostimulating group (170.14±7.45, 209.60±14.80, 312.47±12.63), MP + electrostimulating group (282.18±15.25, 418.18±16.27, 515.25±15.10) and Tet + electrostimulating group (231.81±7.38, 322.67±8.45, 386.82±10.42) than control group (98.12±4.93, 113.50±6.74, 122.59±8.03, P < 0.05); especially, Nissl body density was the most in MP + electrostimulating group. CONCLUSION: The direct current electrical field can effectively promote spinal cord regeneration. The combination of direct current electrical field with large dose MP or Tet has synergistic effects for treating spinal cord injury. The curative effects of direct current electrical field with large dose MP are much better than those with Tet.     

Modulation of autophagy for neuroprotection and functional recovery in traumatic spinal cord injury

Spinal cord injury(SCI) is a serious central nervous system trauma that leads to loss of motor and sensory functions in the SCI patients. One of the cell death mechanisms is autophagy, which is ‘self-eating' of the damaged and misfolded proteins and nucleic acids, damaged mitochondria, and other impaired organelles for recycling of cellular building blocks. Autophagy is different from all other cell death mechanisms in one important aspect that it gives the cells an opportunity to survive or demise depending on the circumstances. Autophagy is a therapeutic target for alleviation of pathogenesis in traumatic SCI. However, functions of autophagy in traumatic SCI remain controversial. Spatial and temporal patterns of activation of autophagy after traumatic SCI have been reported to be contradictory. Formation of autophagosomes following therapeutic activation or inhibition of autophagy flux is ambiguous in traumatic SCI studies. Both beneficial and harmful outcomes due to enhancement autophagy have been reported in traumatic SCI studies in preclinical models. Only further studies will make it clear whether therapeutic activation or inhibition of autophagy is beneficial in overall outcomes in preclinical models of traumatic SCI. Therapeutic enhancement of autophagy flux may digest the damaged components of the central nervous system cells for recycling and thereby facilitating functional recovery. Many studies demonstrated activation of autophagy flux and inhibition of apoptosis for neuroprotective effects in traumatic SCI. Therapeutic induction of autophagy in traumatic SCI promotes axonal regeneration, supporting another beneficial role of autophagy in traumatic SCI. In contrast, some other studies demonstrated that disruption of autophagy flux in traumatic SCI strongly correlated with neuronal death at remote location and impaired functional recovery. This article describes our current understanding of roles of autophagy in acute and chronic traumatic SCI, crosstalk between autophagy and apoptosis, therapeutic activation or inhibition of autophagy for promoting functional recovery, and future of autophagy in traumatic SCI.     

Anorectal functions in patients with spinal cord injury

We wished to establish anorectal functions in patients with spinal cord lesions, related to the level of lesion and its completeness. We also wished to determine the value of neurophysiological tests for completeness of transsections in comparison with manometry and visceral sensory testing. In 32 patients (31.5 +/- 14.1 years, 25 males) with spinal trauma, completeness of transsection was assessed clinically. In 16 of these patients (30 +/- 15.6 years, nine males), a neurological work-up included recording of somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) from the pudendal nerve within the first week after trauma. Also, anal sphincter EMG and pudendal nerve terminal motor latency (PNTML) were assessed. All patients also underwent conventional anorectal manometry and visceral sensory testing. Of all 32 patients, 15 were judged as 'complete' based on their clinical signs. Of those 16 tested neurologically, seven were labelled 'complete' since no MEP or SEP were detectable; one had pudendal SEP and MEP present, while SEP were present but delayed (47.0 +/- 8.8 msec) in the remaining patients. In four of these patients, also MEP were recorded (27.9 +/- 5.2 msec) and normal. PNTML was present in 12/16 patients independent of the completeness of lesion, and was rated normal in nine and delayed in three patients. EMG was normal in five, and pathological in 11 cases. In 5/15 cases of those judged as 'complete' (in 3/7 evaluated neurologically), visceral sensory testing revealed a minimal threshold for rectal perception of distension of 44 mL (range: 10-130), which sometimes was also perceived as urge to defecate. In a further case, manometry showed major voluntary action of the anal sphincter. These patients had lesions at all levels of the spinal column, ranging from cervical (C4,C6,C7) via thoratical (2 x T7,T8,T12) to lumbar segments. Anorectal function testing, and specifically visceral sensory testing may be superior to neurological assessment of 'completeness' of spinal cord lesions. It may be that visceral afferent pathways others than spinothalamic tract are involved in rectal perception that are less accessible to conventional neurophysiological diagnostic work-up.     

Gastric and small intestinal dysfunction in spinal cord injury patients

Fynne L, Worsøe J, Gregersen T, Schlageter V, Laurberg S, Krogh K. Gastric and small intestinal dysfunction in spinal cord injury patients.
Acta Neurol Scand: 2012: 125: 123–128.
© 2011 John Wiley & Sons A/S. Background – Many patients with spinal cord injury (SCI) suffer from constipation, abdominal pain, nausea, or bloating, and colonic transit times are prolonged in most. Gastric and small intestinal dysfunction could contribute to symptoms but remain to be described in detail. Also, it is obscure whether the level of SCI affects gastric and small intestinal function. Aim – To study orocecal transit time and gastric emptying (GE) in patients with SCI. Methods – Nineteen patients with SCI (7 ♀, median age 54 years) and 15 healthy volunteers (9 ♀, median age 32 years) were included. All were referred because of neurogenic bowel problems. Eleven patients had low SCI (located at conus medullaris or cauda equina) affecting only the parasympathetic nerves to the left colon and eight had high SCI (above Th6) affecting parasympathetic and sympathetic innervation. Subjects ingested a small magnetic pill that subsequently was tracked by the Motility Tracking System – MTS‐1 (Motilis, Lausanne, Switzerland). Results – Orocecal transit time was longer than normal both in individuals with high lesions (P < 0.01) and in individuals with low lesions (P < 0.01). Individuals with high lesions had slower GE than those with conal/cauda equina lesions (P < 0.05). Basic contractile frequencies of the stomach and small intestine were unaffected by SCI. Conclusion – Surprisingly, upper gastrointestinal transit is prolonged in subjects with SCI suffering from bowel problems, not only in subjects with cervical or high thoracic lesions but also in subjects with conal/cauda equina lesions. We speculate that this is secondary to colonic dysfunction and constipation.     

脊髓损伤大鼠损伤早期电位变化与损伤程度的关系

To investigate characteristics of injury potentials after different degrees of spinal cord injury in rats,the present study established models of spinal cord contusion with severe,moderate,and mild degrees of injury.Injury potential was measured in vivo using a direct current voltage amplification system.Results revealed that in the first 4 hours after acute spinal cord injury,initial amplitude of injury potential was greatest after severe injury,followed by moderate and mild injuries.Amplitude of injury potential decreased gradually with injury time,and the recession curve was logarithmic.Under the same degree of injuries,amplitude of rostral injury potential was generally less than caudal injury potential.Results suggested that injury potential reflected injury severity,because large initial amplitude of injury potential during the early injury stage implied severe injury.     

脊髓损伤的移植治疗进展

脊髓损伤的治疗是神经科学领域的难点热点问题之一。本以神经干细胞移植为重点综述了脊髓损伤的多种移植治疗方案及其治疗效果。并对比不同治疗方案的优缺点阐述了应用于临床治疗的可能性。     

Current therapeutic strategies for inflammation following traumatic spinal cord injury

Damage from spinal cord injury occurs in two phases-the trauma of the initial mechanical insult and a secondary injury to nervous tissue spared by the primary insult.Apart from damage sustained as a result of direct trauma to the spinal cord,the post-traumatic inflammatory response contributes significantly to functional motor deficits exacerbated by the secondary injury.Attenuating the detrimental aspects of the inflammatory response is a promising strategy to potentially ameliorate the secondary injury,and promote significant functional recovery.This review details how the inflammatory component of secondary injury to the spinal cord can be treated currently and in the foreseeable future.     

丹酚酸B促进大鼠急性脊髓损伤修复及量效关系探讨

目的 研究腹腔注射丹酚酸B(Sal B)对大鼠急性脊髓损伤(SCI)模型的神经保护作用和促功能恢复作用,探讨Sal B在急性SCI治疗的应用价值,并探讨其量效关系. 方法参照Allen法制作SD大鼠T9脊髓节段急性损伤模型,腹腔注射Sal B或PBS液,按照注射液的不同分为4组:Sal B高剂量组(20 mg/kg组),Sal B中剂量组(10 mg/kg组),Sal B低剂量组(2 mg/kg组)和对照组(注射PBS液),每组12只.用比色法检测髓过氧化物酶活性;用免疫组织化学染色法检测损伤脊髓节段MMP-1、c-Fos抗体表达情况,用干湿重法评价的水肿程度,并采用后肢功能评分(BBB)评分评价10 d内大鼠的运动功能恢复情况. 结果损伤后4 h Sal B治疗组髓过氧化物酶活性下降,损伤后1 dHE染色切片显示SalB组治疗后局部组织损伤减轻,炎性细胞浸润数量减少,损伤后1d免疫组化染色结果显示,Sal B治疗组比对照组MMP-1表达减少,c-Fos表达下调;Sal B治疗组水肿程度轻于对照组,从SCI后第7天起,SalB组高剂量组(20 mg/kg组)和对照组之间的BBB评分有显著性差异(P<0.05).各指标改善情况与Sal B剂量呈正相关性. 结论 Sal B可减轻大鼠SCI后的组织损伤,下调损伤相关因子MMP-1和c-Fos的表达,降低损伤局部髓过氧化物酶活性,减轻组织水肿,并能促进损伤大鼠的功能恢复.     

Early methylprednisolone impact treatment for sensory and motor function recovery in patients with acute spinal cord injury A self-control study

BACKGROUND: For the treatment of spinal cord injury, any pathological changes of the injured tissue should be primarily corrected or reversed. Any remaining fibrous function and neurons with intact structure should be retained, and the toxic substances caused by ischemia-hypoxia following spinal cord injury, should be eliminated to create a favorable environment that would promote neural functional recovery. OBJECTIVE: This study was designed to investigate the effects of the impact of early methylprednisolone-treatment on the sensory and motor function recovery in patients with acute spinal cord injury. DESIGN: A self-control observation. SETTING: Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China. PARTICIPANTS: Forty-three patients with acute spinal cord injury were admitted to the Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, between October 2005 and September 2007. These patients were recruited for the present study. The patients comprised 33 males and 10 females, and all met with the inclusive criteria namely, the time between suffering from acute spinal cord injury and receiving treatment was less than or equal to eight hours. METHODS: According to the protocol determined by the State Second Conference of Acute Spinal Cord Injury of USA, all patients received the drop-wise administration of a 30-mg/kg dose of methylprednisolone (H200040339,500mg/bottle, Pharmacia N.V/S.A, Belgium) for 15 minutes within 8 hours post injury. After a 45-minute interval, methylprednisolone was administered at 5.4mg/kg/h for 23 hours. MAIN OUTCOME MEASURES: Prior to and post treatment, acupuncture sense and light touch scoring were performed at 28 dermatomic area key points, including occipital tuberosity and supraclavicular fossa. At the same time, motor scoring of key muscles among 10 pairs of sarcomeres was also performed.RESULTS: All 43 patients participated in the final analysis. There was no significant difference of sensory and motor scores in patients with complete acute spinal cord injury between prior to and post methylprednisolone impact treatment (P>0.05). The motor score was significantly decreased in patients with incomplete acute spinal cord injury post methylprednisolone impact treatment (P<0.01).CONCLUSION: Early methylprednisolone impact may improve the motor function of patients with incomplete acute spinal cord injury. However, it has no influences on patients with complete acute spinal cord injury.     

Expression of inflammatory cytokines following acute spinal cord injury in a rodent model

Many therapies that have been developed for acute spinal cord injury (SCI) either influence or are influenced by posttraumatic inflammation. Many such therapies have reportedly produced promising neurologic benefits in animal models of SCI, but demonstrating convincing efficacy in human clinical trials has remained elusive. This discrepancy may be related in part to differences in the inflammatory response to SCI between human patients and the widely studied rodent models. Our objectives were, therefore, to establish the time course of inflammatory cytokine release in the spinal cord of rats after a thoracic contusion, to determine whether the cytokine release was injury dependent, and to correlate these findings with those that we have recently reported for the cerebrospinal fluid (CSF) of human SCI patients. After rodent SCI, GRO (the rat equivalent of IL-8), IL-6, IL-1α, IL-1β, IL-13, MCP-1, MIP1α, RANTES, and TNFα were elevated within the spinal cord, whereas IL-12p70 was decreased. In human SCI, IL-6, IL-8, and MCP-1 were also elevated within the cerebrospinal fluid but at later times than those observed in the rodent spinal cord. IL-6, IL-8, and MCP-1 were released in an injury-dependent manner in both the rodent model of SCI and the human condition. In this regard, similar patterns of expression were observed for a number of inflammatory cytokines after SCI in rodent spinal cords and in human CSF. Such proteins may therefore have potential utility as biomarkers and surrogate outcome measures for evaluating biological response to therapeutic interventions.