The influence of level of spinal cord injury on adipose tissue and its relationship to inflammatory adipokines and cardiometabolic profiles

Objective: Level of injury (LOI) and the role of adipose tissue and its proinflammatory adipokines in cardiometabolic dysfunction following spinal cord injury (SCI) remains poorly understood. We aim to examine the influence of LOI on adipose tissue and its relationship to proinflammatory adipokines and cardiometabolic profiles following SCI.

Design: Cross sectional and correlational study.

Setting: Clinical hospital and academic setting.

Participants: Forty-seven individuals with chronic motor complete SCI (age 43.8±11.5 y, BMI: 27.3±5.3) were classified as having tetraplegia (TSCI; n=12) or paraplegia (PSCI; n=35).

Intervention: Non applicable.

Outcome Measures: Visceral (VAT) and subcutaneous (SAT) adipose tissue volumes were measured using magnetic resonance imaging. Proinflammatory adipokines (tumor neurosis factor-α, interleukin-6 (IL-6), plasminogen activatable inhibitor-1, thrombin-activatable fibrinolysis inhibitor, and high-sensitivity c-reactive protein) and cardiovascular, carbohydrate, and lipid profiles were assessed according to standard techniques.

Results: VAT volume was greater in TSCI versus PSCI (p=0.042); however, after covarying for age this significance was lost (p>0.05). IL-6 was significantly elevated in TSCI (p<0.05), while other markers of inflammation generally were elevated, but did not reach statistical significance (p>0.05). Systolic blood pressure and total cholesterol were significantly lower in TSCI (p<0.05), while fasting glucose was significantly lower in PSCI (p<0.05). A number of proinflammatory adipokines and cardiometabolic markers significantly correlated with adipose tissue depots by LOI (p<0.05).

Conclusion: The results show that LOI does not influence the distribution of adipose tissue, but does influence proinflammatory adipokines and cardiometabolic profiles following SCI. Further research is needed to evaluate impact of lean body mass on these findings.     

Influence of motor complete spinal cord injury on visceral and subcutaneous adipose tissue measured by multi-axial magnetic resonance imaging

Objective

Abdominal obesity conveys substantial health risks, in association with high levels of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and an increased proportion of VAT to SAT. The purposes were to determine the influence of spinal cord injury (SCI) on the associations between single axial cross-sectional area (CSA) slices and the average CSA or volumes of VAT and SAT across multi-axial slices of magnetic resonance imaging (MRI); and the relationships relative to the whole body composition and anthropometrics.

Methods

Thirteen healthy male participants with traumatic motor complete SCI underwent fast spin-echo MRI to measure VAT and SAT across multi-axial slices, followed by dual-energy X-ray absorptiometry to measure whole body fat-free mass (FFM) and fat mass (FM). Waist circumference (WC) was also measured in the seated position.

Results

The trunk CSAs of VAT and SAT were 99 ± 51 and 164 ± 69 cm², respectively, and the ratio of VAT to SAT was 0.68 ± 0.33. The CSAs of VAT and SAT at a single slice strongly predicted the average CSA and modestly predicted the volumes across multi-axial slices. VAT and SAT represented 5.7 ± 1.8% and 9.7 ± 3.2% of the total body FM, respectively. Percent body FFM was negatively related to VAT and SAT volumes, but not to a single axial CSA.

Conclusion

A single slice CSA can modestly predict the volume of multi-axial slices in individuals with SCI, yet it is not related to any of the body composition variables. Increased percent FFM is associated with a reduction in VAT and SAT volumes measured across multi-axial slices. The ratio of VAT to SAT is greater than 0.4, suggesting that individuals with SCI are at high risk of developing metabolic sequelae.     

Neurogenic obesity and systemic inflammation following spinal cord injury: A review

Content: Spinal Cord Injury (SCI) results in physiological changes that markedly reduces whole-body metabolism, resulting in neurogenic obesity via adipose tissue accumulation. Adipose tissue has been implicated in the release of proinflammatory adipokines that lead to chronic, systemic inflammation, and evidence suggests these adipokines contribute to the pathogeneses of metabolic diseases that often accompany obesity. In this review, we propose the concept of neurogenic obesity through paralysis-induced adiposity as the primary source of systemic inflammation and metabolic dysfunction reported in chronic SCI. We also briefly discuss how exercise in SCI can attenuate the negative consequences of obesity-induced inflammation and its comorbidities.

Methods: A MEDLINE, PubMed, Google Scholar, and ClinicalKey search was performed using the following search terms: obesity, adiposity, adipose tissue, proinflammatory adipokines, proinflammatory cytokines, metabolic dysfunction, exercise, physical activity, and spinal cord injury. All papers identified were full-text, English language papers. The reference list of identified papers was also searched for additional papers.

Results: Research suggests that obesity in SCI results in a state of chronic, systemic inflammation primarily through proinflammatory adipokines secreted from excess adipose tissue. The reduction of adipose tissue through the use of diet and exercise demonstrates promise to combat neurogenic obesity, inflammation, and cardiometabolic dysfunction in SCI.

Conclusion: Proinflammatory adipokines may serve as biomarkers for the development of obesity-related complication in SCI. Mechanistic and interventional studies on neurogenic obesity-induced inflammation in chronic SCI are warranted.     

Prevalence of metabolic syndrome in veterans with spinal cord injury

Context/Objective: Recent literature would suggest the prevalence of metabolic syndrome in persons with spinal cord injury (SCI) is higher than that of the general population, although no large cohorts have yet been reported. Part of the controversy relates to the differing definitions provided for metabolic syndrome and the characterization of obesity in persons with SCI.

Design/Participants: The current retrospective investigation represents a cross-sectional cohort of 473 veterans with SCI from a single center in the mid-Atlantic region of the United States for whom modified International Diabetes Federation (IDF) criterion variables for the metabolic syndrome were available in the computerized personal record system (CPRS).

Outcome Measures: These variables included a surrogate marker of obesity appropriate to SCI (Body Mass Index (BMI) ≥ 22?kg/m²), as well as indicators of diabetes, dyslipidemia and hypertension.

Results: Over 57% of the veterans assessed were determined to have metabolic syndrome by modified IDF criteria, including 76.7% with BMI ≥ 22?kg/m², 55.1% with or under treatment for hypertension, 49.7% with or previously diagnosed with diabetes mellitus, and 69.7% with or under treatment for high density lipoprotein (HDL) cholesterol under 40?mg/dl.

Conclusion: Metabolic syndrome and its constituent components appear to be more prevalent in veterans with SCI than in the general population, suggesting a greater need for identification and treatment interventions in this specialty population.     

同种胚胎脊髓移植物对成年大鼠损伤脊髓组织形态与功能的修复作用

探讨大鼠胚胎脊髓组织移植物对成年大鼠损伤脊髓组织形态与功能的修复作用。在半切洞损伤的成年大鼠脊髓内，植入大鼠胚胎脊髓组织，术后行联合行为记分、诱发电位及组织学检查。结果：移植物能在宿主脊髓损伤部位存活，并能生长、分化、修复宿主脊髓的组织损伤，诱导宿生神经纤维联系的重建，改善宿主损伤脊髓的神经传导，促进功能恢复。以上结果提示：胚胎脊髓移植物对成年大鼠损伤脊髓组织形态与功能均具有修复作用。     

完全横断性脊髓损伤后跨神经元变性的实验研究

目的：探讨大鼠完全性脊髓损伤后损伤平面以下下运动神经元轴突参与组成的周围神经的变化及其变化规律，为临床治疗、康复及预后的判断提供相关的理论基础。方法：48只成年雄性Wistar大鼠随机分为假手术组和脊髓损伤组，各组24只，每组均对应分为7d、1个月、2个月、3个月4个时间点，每组每个时间点6只大鼠。完全性脊髓损伤组大鼠制作T10水平完全性脊髓横断模型。在预定取材时间点处死相应动物，自腓总神经入肌点处向近端切取10mm该神经，分别行天青美-蓝染色光镜观察及超微结构观察。结果：各时间点假手术组腓总神经光镜下观察，神经纤维排列均匀；轴突外形正常、染色均匀。超微结构观察，髓鞘外形正常，板层清晰；轴索位置正常，轴索内微丝微管正常。完全性脊髓损伤组光镜观察发现腓总神经髓鞘和轴索出现明显退变，且退变随时间推移逐渐加重，同时出现轴突发芽现象。超微结构观察可见轴索内线粒体肿胀．轴浆内微丝、微管溶解，髓鞘板层结构破坏，雪旺氏细胞增生及空泡变性现象。退变的同时．腓总神经出现大量的新生神经纤维即轴突发芽现象。结论：完全性横断性脊髓损伤后周围神经存在退变现象．且退变程度随时间的延长逐渐加重，说明大鼠完全横断性脊髓损伤可以导致损伤水平以下周围神经发生跨神经元变性。     

TRH对大鼠脊髓损伤后SCBF和SEP的影响

脊髓损伤（ＳＣＩ）后内源性阿片肽释放，并参与脊髓的继发损伤机制。ＴＲＨ可阻断阿片肽的自主神经效应，而不影响痛觉。本实验探讨大剂量ＴＲＨ（２ｍｇ／ｋｇ／ｈ）治疗对大鼠脊髓打击伤（Ａｌｌｅｎｓ法１０ｇｘ５ｃｍ）后脊髓血流量（ＳＣＢＦ）和脊髓诱发电位（ＳＥＰ）的影响。脊髓损伤后１ｈ，ＳＣＢＦ开始显著下降，持续至伤后２４ｈ，ＳＥＰ峰潜时呈进行性延长趋势；伤后即刻静脉注射ＴＲＨ（２ｍｇ／ｋｇ／ｈ，共５次），可使伤后即刻和２４ｈ的ＳＣＢＦ显著升高，并使伤后ＳＣＢＦ下降时间延迟３ｈ，同时ＳＥＰ峰潜时有不同程度改善。结果表明，ＴＲＨ对受伤脊髓早期有一定的防治作用，并具有一定的后发效应；同时也可促进脊髓的神经传导功能。本文亦对ＴＲＨ治疗ＳＣＩ的病理生物学机制进行了讨论。     

Classification of obesity,cardiometabolic risk,and metabolic syndrome in adults with spinal cord injury

Objective: To describe and compare (1) classification of obesity using clinical proxies of body composition that are easily accessible in the outpatient clinic setting, (2) cardiometabolic risk using existing screening tools and staging systems, and (3) the presence of metabolic syndrome (MetS) using four commonly-used definitions in adults with spinal cord injury (SCI).

Design: Retrospective chart review

Setting: Outpatient Veterans Affairs (VA) SCI Annual Evaluation Clinic

Participants: Patients who attended an annual evaluation appointment with demographic, anthropometric, and biochemical data documented in their medical records as part of routine medical care.

Outcome measures: Obesity classification (body mass index, waist circumference, ideal body weight percentage), cardiometabolic risk scores (Framingham Risk Score, Cardiometabolic Disease Staging System, Edmonton Obesity Staging System), and MetS classification (using four commonly-used definitions) were described and compared.

Results: Of the 155 veterans included in this analysis, 93% were considered “at risk” by at least one of the measurements studied. However, there was considerable variation between the different screening tools. The κ-agreement between various definitions of MetS ranged from fair to moderate.

Conclusion: Screening tools that were developed for the non-SCI population produced variable assessments of risk when applied to veterans with SCI. Due to the fair to moderate inter-rater agreement between MetS definitions, it is unknown which definition is superior to identify MetS in the SCI population. An SCI-specific screening tool is needed to accurately classify obesity, cardiometabolic risk, and MetS in order to provide timely education and intervention.     

Management of obesity after spinal cord injury: a systematic review

Context: Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it’s metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished.

Objectives: To identify and compare effective means of obesity management among SCI individuals.

Methods: This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies.

Results: Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight.

Conclusions: The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.     

芬苯达唑对大鼠脊髓损伤后免疫反应和运动功能恢复的影响

目的：观察芬苯达唑对脊髓损伤大鼠的CD45R阳性B细胞、IgG免疫反应以及运动功能恢复的影响。方法将75只成年雌性SD大鼠随机分为假手术组、模型对照组和芬苯达唑组,每组25例。假手术组、模型对照组术前4周给予常规啮齿动物饲料喂食（含18%蛋白质的饲料）,芬苯达唑组术前4周给予加入芬苯达唑的常规啮齿动物饲料喂食。用Allen法构建脊髓损伤模型,分别于术后第1、7、14、21、28天行Basso?Beatti?Bresnahan（BBB）运动功能评估,利用免疫组化检测损伤部位脊髓组织中IgG的表达水平,利用免疫荧光检测脊髓损伤部位CD45R阳性B细胞的信号水平。结果脊髓损伤后,模型对照组和芬苯达唑组的BBB评分均显著低于假手术组（均P＜0.05）,随着时间的延长,两组的BBB运动评分均逐渐有所恢复,但仍低于假手术组;脊髓损伤后第1天,模型对照组与芬苯达唑组的BBB运动评分分别为（3.10±0.29）分、（3.23±0.48）分,差异尚无统计学意义;而在脊髓损伤后的第7、14、21、28天,芬苯达唑组的BBB评分均高于模型对照组,差异均有统计学意义（均P＜0.05）。免疫组化检查证实损伤部位脊髓标本的IgG水平显著升高,第7天开始,芬苯达唑组各个时间点的IgG免疫反应水平均低于模型对照组,差异均有统计学意义（均P＜0.05）。免疫荧光检查证实脊髓损伤后损伤部位脊髓节段CD45R阳性B细胞信号水平显著升高,第7天开始,芬苯达唑组各个时间点脊髓损伤部位的CD45R阳性B细胞的信号水平均低于模型对照组,差异均有统计学意义（均P＜0.05）。结论芬苯达唑预处理可降低脊髓组织中IgG的表达水平及脊髓损伤部位的CD45R阳性B细胞的信号水平,促进脊髓损伤后的神经功能恢复。     

应用改进封闭脊髓窗技术活体观察脊髓损伤后脊髓微循环变化

目的:探讨应用改进的封闭脊髓窗技术活体观察大鼠脊髓损伤后脊髓微循环变化的可行性及效果.方法:改进传统的脊髓窗,设计带有打击探头的脊髓窗.45只SD大鼠随机分为对照组(n=20)和实验组(n=25).实验组大鼠脊髓窗安装完成后进行窗内打击脊髓,然后即时观察并记录打击后2h内打击点周围微动脉直径的变化.对照组大鼠在脊髓窗安装完成后不进行打击,只对脊髓微动脉直径进行连续2h观察并记录.术后两组大鼠进行BBB运动功能评分,处死动物取脊髓标本切片,HE染色,观察脊髓组织改变情况.结果:实验组大鼠打击点周围2～6mm的微动脉直径在打击后10min、30min、1h、2h各时间点均较打击前明显减小,术后2d及7d时BBB功能评分明显低于术前,病理切片可见脊髓打击区神经组织变性液化.对照组大鼠在观测开始及结束时脊髓微动脉直径无明显变化,术后BBB评分与术前BBB评分均为21分,病理切片未见脊髓损伤表现.结论:改进的封闭脊髓窗技术可以有效地实现窗内打击脊髓,并可以安全地对脊髓表面微血管进行活体观测.脊髓表面打击点周围2～6mm的微动脉在脊髓损伤后10min即发生痉挛.     

Body mass index changes over 3 years and effect of obesity on community mobility for persons with chronic spinal cord injury

Objective: To identify the prevalence of obesity in persons with chronic spinal cord injury (SCI), determine change in body mass index (BMI) over time, and identify impact of obesity on community mobility.

Design: Prospective three year longitudinal study.

Setting: Outpatient clinic of rehabilitation center.

Participants: Convenience sample of 222 persons with paraplegia between 2–20 years post SCI.

Outcome Measures: BMI at baseline and three years; community mobility (daily wheelchair propulsion distance and velocity, average number of daily transfers and depression raises).

Results: Participants were 34.1 (27.3, 40.3) years of age and median duration of SCI was 8.7 (3.2, 15.1) years. The SCI adjusted BMI classification identified 44% of participants as obese. BMI increased over time with 13% moving into a higher weight category. Median change in BMI was 0.46 (?0.92, 1.50) kg/m^{2 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief. 2012;(82):1–8. [Google Scholar]} (z?=??2.684, P?=?0.007), and increased at a rate of 0.15?kg/m²/yr. Average BMI was negatively correlated with daily wheelchair propulsion distance (r?=??0.179, P?=?0.009), however there was no significant relationship with velocity, number of daily transfers or depression raises.

Conclusion: The majority of participants with chronic SCI were overweight (23%) or obese (44%) and BMI increased by 0.46?kg/m² over three years. Those with higher BMIs pushed their wheelchairs shorter distances, but other mobility measures were not impacted by body weight. Continued mobility activities with increasing body weight can increase risk for shoulder injury. Identifying persons who are obese allows for directed and timely health and mobility intervention.     

Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury

Purpose

In the acute phase of spinal cord injury (SCI), ischemia and parenchymal hemorrhage are believed to worsen the primary lesions induced by mechanical trauma. To minimize ischemia, keeping the mean arterial blood pressure above 85 mmHg for at least 1 week is recommended, and norepinephrine is frequently administered to achieve this goal. However, no experimental study has assessed the effect of norepinephrine on spinal cord blood flow (SCBF) and parenchymal hemorrhage size. We have assessed the effect of norepinephrine on SCBF and parenchymal hemorrhage size within the first hour after experimental SCI.

Methods

A total of 38 animals were included in four groups according to whether SCI was induced and norepinephrine injected. SCI was induced at level Th10 by dropping a 10-g weight from a height of 10 cm. Each experiment lasted 60 min. Norepinephrine was started 15 min after the trauma. SCBF was measured in the ischemic penumbra zone surrounding the trauma epicenter using contrast-enhanced ultrasonography. Hemorrhage size was measured repeatedly on parasagittal B-mode ultrasonography slices.

Results

SCI was associated with significant decreases in SCBF (P = 0.0002). Norepinephrine infusion did not significantly modify SCBF. Parenchymal hemorrhage size was significantly greater in the animals given norepinephrine (P = 0.0002).

Conclusion

In the rat, after a severe SCI at the Th10 level, injection of norepinephrine 15 min after SCI does not modify SCBF and increases the size of the parenchymal hemorrhage.     

Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands

Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs).

Design: TSI-stratified cross-sectional study. Strata were 10–19, 20–29 and 30+ years.

Setting: Community.

Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18–35 years; TSI?≥?10 years; current age 28–65 years; wheelchair dependency.

Interventions: Not applicable.

Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician.

Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β?=?–0.7; P?<?.001) and waist circumference (β?=?–0.1; P?=?.042) were independent determinants (explained variance 55%).

Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence.     

外伤性无骨折脱位型颈髓损伤的误诊及对疗效的影响

目的 探讨外伤性无骨折脱位型颈脊髓损伤的误诊原因及其对疗效的影响. 方法 回顾1998年10月至2005年10月52例无骨折脱位型颈脊髓损伤患者病例资料,分析18例被漏诊或误诊患者其被漏诊或误诊的原因,并分别于入院时及治疗后随访时对脊髓损伤程度按ASIA标准分级进行评定与比较. 结果 所有患者获得6～67个月(平均29个月),患者入院时及治疗后随访时采用ASIA标准分级比较,34例无漏诊或误诊患者平均提高1.06级,18例被漏诊或误诊患者平均提高0.50级,采用等级资料Ridit分析,两组差异有统计学意义(u=2.0739,P=0.0381). 结论 无骨折脱位型颈脊髓损伤易被漏诊或误诊,早期确诊并合理治疗具有较好的疗效.     

Intrathecal transplantation of autologous adipose-derived mesenchymal stem cells for treating spinal cord injury: A human trial

Context: Spinal cord injury (SCI) can cause irreversible damage to neural tissues. However, there is currently no effective treatment for SCI. The therapeutic potential of adipose-derived mesenchymal stem cells (ADMSCs) has been emerged.

Objective: We evaluated the effects and safety of the intrathecal transplantation of autologous ADMSCs in patients with SCI.

Participants/Interventions: Fourteen patients with SCI were enrolled (12 for ASIA A, 1 for B, and 1 for D; duration of impairments 3–28 months). Six patients were injured at cervical, 1 at cervico-thoracic, 6 at thoracic, and 1 at lumbar level. Autologous ADMSCs were isolated from lipoaspirates of patients’ subcutaneous fat tissue and 9?×?10⁷ ADMSCs per patient were administered intrathecally through lumbar tapping. MRI, hematological parameters, electrophysiology studies, and ASIA motor/sensory scores were assessed before and after transplantation.

Results: ASIA motor scores were improved in 5 patients at 8 months follow-up (1–2 grades at some myotomes). Voluntary anal contraction improvement was seen in 2 patients. ASIA sensory score recovery was seen in 10, although degeneration was seen in 1. In somatosensory evoked potential test, one patient showed median nerve improvement. There was no interval change of MRI between baseline and 8 months post-transplantation. Four adverse events were observed in three patients: urinary tract infection, headache, nausea, and vomiting.

Conclusions: Over the 8 months of follow-up, intrathecal transplantation of autologous ADMSCs for SCI was free of serious adverse events, and several patients showed mild improvements in neurological function. Patient selection, dosage, and delivery method of ADMSCs should be investigated further.     

大鼠急性脊髓损伤后肺组织的病理改变及其意义

目的:探讨大鼠急性脊髓损伤后肺组织的病理改变及其意义。方法:84只体重240～250g Wister成年大鼠随机分为对照组和实验组,每组42只,每组又分为造模后6h、12h、24h、3d、1周、2周、4周共7个时间点,每个时间点6只,雌雄不限。实验组采用T10段脊髓的Allen′s打击模型,打击力度为10×2.5g·cm;对照组只暴露T10段脊髓。在不同时间点处死大鼠,取肺组织,称湿、干重量,计算湿干重之比;通过大体解剖和光学显微镜观察肺组织的病理学变化。结果:实验组大鼠急性脊髓损伤后12h出现肺部出血和水肿,伤后3d最为严重,伤后1周开始减轻,伤后4周基本恢复正常;对照组无肺组织出血及水肿。实验组大鼠伤后6h出现散在肺泡毛细血管充血,伤后12h肺泡毛细血管有少量出血,伤后3d出血、水肿达到高峰,伤后1周开始减轻,伤后4周基本恢复正常。伤后6h实验组大鼠肺的湿干重之比与对照组比较无显著性差异(P>0.05);伤后12h、24h、3d、1周、2周湿干重之比明显较对照组高,有显著性差异(P<0.05);伤后4周时无明显差异(P>0.05)。结论:大鼠急性脊髓损伤后早期出现肺组织充血、出血和水肿,这可能是早期呼吸功能衰竭和肺部感染的病理基础。     

The prevention of iatrogenic spinal cord injury utilizing the evoked spinal cord potential

Summary The evoked spinal cord potential elicited by direct stimulation of the cord has been used clinically to monitor cord function in the course of operations on the spine. The technique used allows measurement of a relatively large amplitude of potential, which is fairly stable against anaesthetics and related drugs, by means of a simple recording system and is sensitive enough to indicate cord damage. Continuous monitoring can easily be carried out. We have encountered no complications when using this method on 99 patients.

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Résumé Le potentiel évoqué provoqué par la stimulation directe de la moelle épinière a été utilisé en clinique pour contrôler la fonction de la moelle lors des interventions sur le rachis. Cette technique permet de mesurer une assez grande amplitude de potentiel, qui est relativement stable à l'égard des anesthésiques et d'autres drogues de même type, grâce à un système simple d'enregistrement; il est suffisamment sensible pour détecter des altérations de la moelle. Une surveillance continue peut aisément être effectuée. Aucun incident n'a été rencontré chez 99 malades lors de l'utilisation de cette méthode.

     

完全性脊髓损伤早期患者脑皮层结构变化的磁共振研究

目的:观察完全性脊髓损伤(SCI)患者在损伤早期大脑皮层结构是否存在改变及其与患者感觉运动功能损伤程度的相关性。方法:2013年10月~2013年12月在北京军区总医院骨科住院的13例完全性SCI患者被纳入研究,其中男7例,女6例,年龄26.3±7.9岁(21~40岁)。同时招募健康对照15例,其中男8例,女7例,年龄25.7±5.8岁(20~38岁)。SCI患者损伤时间为64.4±20.3d(28~84d)。13例患者脊髓功能用美国脊髓损伤协会(ASIA)分级标准评定均为A级,其中ASIA运动评分为36.5±25.9(18~55)分,针刺觉评分为43.3±27.3(27~88)分,轻触觉评分为42.5±30.3(25~80)分。所有SCI患者在入院当天接受结构MRI检查。MRI扫描后的结构数据用基于体素形态学分析的方法(VBM)来分析,对比分析13例完全性SCI患者和15例年龄、性别相匹配的健康对照者大脑灰质体积改变的区域。运用Person相关性分析探讨脑皮层结构改变与患者运动感觉功能之间的关系。结果:与健康对照者相比,完全性SCI患者初级运动中枢、初级躯体感觉中枢和辅助运动区存在明显的灰质萎缩(P0.05)。相关性分析显示完全性SCI患者上述区域萎缩程度与患者的ASIA运动评分以及ASIA感觉评分无明显相关性(P0.05)。结论:在损伤早期,完全性SCI患者初级运动中枢、初级躯体感觉中枢和辅助运动区存在明显的灰质萎缩,上述区域萎缩程度与患者的ASIA评分无明显相关性。     

细胞自噬在脊髓损伤中作用的研究进展

近年来,细胞自噬在脊髓损伤中的研究逐渐成为热点,但脊髓损伤后早期自噬激活所起的作用尚有争议。其原因在于细胞自噬在脊髓损伤中的作用具有两面性:一方面自噬能诱导自噬性细胞死亡的发生并参与细胞凋亡的发生,另一方面自噬能促进受损变性蛋白的代谢以及抑制细胞凋亡。然而究其对脊髓损伤后修复的利弊作用,早期自噬激活的程度具有决定作用,脊髓损伤后适当地上调自噬水平可促进受损变性蛋白的代谢并抑制细胞凋亡,而过度激活自噬可能引发自噬性细胞死亡。