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。     

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.     

Healthcare utilization following spinal cord injury: Objective findings from a regional hospital registry

Objective: The purpose was to describe the prevalence and characteristics of healthcare utilization among individuals with spinal cord injury (SCI) from a Level I trauma center.

Design: Retrospective data analysis utilizing a local acute trauma registry for initial hospitalization and merged with the Dallas-Fort Worth Hospital Council registry to obtain subsequent health care utilization in the first post-injury year.

Setting: Dallas, TX, USA.

Participants: Six hundred and sixty four patients were admitted with an acute traumatic SCI from January 2003 through June 2014 to a Level I trauma center. Fifty five patients that expired during initial hospitalization and 18 patients with unspecified SCI (defined by ICD-9 with no etiology or level of injury specified) were not included in the analysis, leaving a final sample of 591.

Outcome Measures: Data included demographic and clinical characteristics, charges, and healthcare utilization.

Results: Mean age was 46.1?years (±18.9?years), the majority of patients were male (74%), and Caucasian (58%). Of the 591 patients, 345 (58%) had additional inpatient or emergency healthcare utilization accounting for 769 additional visits (median of 3 visits per person). Of the 769 encounters, 534 (69%) were inpatient and 235 (31%) were emergency visits not resulting in an admission. The most prevalent ICD-9 codes listed were pressure ulcer, neurogenic bowel, neurogenic bladder, urinary tract infection, fluid electrolyte imbalance, hypertension, and tobacco use.

Conclusion: Individuals with SCI experience high levels of healthcare utilization which are costly and may be preventable. Increasing our understanding of the prevalence and causes for healthcare utilization after acute SCI is important to target preventive strategies.     

儿童无放射学影像异常的脊髓损伤14例临床分析

目的：提高对儿童无放射学影像异常的脊髓损伤（spinal cord injury without radiographic abnormality，SCIWORA）的认识。方法：对1992年1月至2005年8月北京儿童医院住院患者中诊断为“急性脊髓炎”或“脊髓损伤”的187例进行回顾性分析，发现其中14例为SCIWORA。男6例，女8例。年龄1岁3个月～15岁（15岁1例，1岁3个月～7岁13例）。均有明确外伤史。损伤水平在C6～T9，颈髓2例，胸髓12例。脊髓功能ASIA分级：A级9例，C级4例，D级1例。脊柱X线片和CT未见骨折及脱位；MRI检查示脊髓水肿9例,脊髓出血2例，脊髓挫伤3例。采用综合治疗，包括卧床、局部制动，应用激素、脱水剂、神经营养药等。结果：4例患者失访，10例患者随访6个月～5年，平均2年3个月，4例（C级3例，D级1例）患者（均为MRI显示水肿局限者）在伤后6个月运动、感觉及括约肌功能完全恢复（E级）；6例（A级）患者运动、感觉及括约肌障碍未恢复。2例（A级）病初MRI表现为脊髓弥漫水肿者，伤后4～6个月复查MRI脊髓呈萎缩样改变。结论：对怀疑SCIWORA的儿童，应首选MRI检查。脊髓水肿局限者预后好，水肿弥漫或伴有出血、挫伤者预后差。     

脊髓损伤患者骨密度变化

目的 观察脊髓损伤患骨密度的变化。方法 用SPA法和US法对45例健康人,32例卧床2月病人和48例胸腰段脊髓损伤2月患行骨密度测量。结果 脊髓损伤患跟骨密度下降最为明显,卧床组次之。桡骨骨密度卧床组变化不明显,脊髓损伤组仍明显下降。结论 骨质疏松是脊髓损伤中层得的主要并发症之一,且机理复杂,应注意预防。     

Incidence of urinary tract infection following initiation of intermittent catheterization among patients with recent spinal cord injury in Germany and the Netherlands

Objective: To assess incidence of urinary tract infection (UTI) among patients with recent spinal cord injury (SCI) who initiated intermittent catheterization (IC).Design: Retrospective chart review.Setting: Two European SCI rehabilitation centers.Participants: Seventy-three consecutive patients with recent SCI who initiated IC.Outcome measures: Incidence of UTI, using six different definitions, each based on microbiology ± symptomatology ± mention of UTI . Rates were expressed in terms of numbers of UTIs per 100 patient-months (PMs). Attention was focused on first-noted UTI during the three-month follow-up, as assessed with each of the six definitions.Results: Fifty-eight percent of patients (n = 33) met ≥1 definitions for UTI during follow-up (rate: 31.5 UTIs per 100 PMs), ranging from 14% (5.3 per 100 PMs; definition requiring bacteriuria, pyuria, and presence of symptoms) to 45% (22.7 per 100 PMs; definition requiring “mention of UTI”). Ten cases were identified using the definition that required bacteriuria, pyuria, and symptoms, whereas definitions that required bacteriuria and either pyuria or symptoms resulted in the identification of 20–25 cases. Median time to UTI ranged from 42 days (“mention of UTI”) to 81 days (definition requiring bacteriuria and ≥100 leukocytes/mm³).Conclusion: Depending on definition, 14% to 45% of patients with recent SCI experience UTI within three months of initiating IC. Definitions requiring bacteriuria and either pyuria or symptoms consistently identified about twice as many cases as those that required all three conditions. Standardizing definitions may help improve detection, treatment, and prevention of UTI within this vulnerable population.     

脊髓损伤后血流改变

选用成年狗１０只，于胸９－０给以２０ｇ×２５ｃｍ打击量，应用氢清除法于伤后１５ｍｉｎ～４ｂ测定脊髓血流量（ＳＣＢＦ）。结果显示伤后不同时期灰质血流量均较白质血流量（ｗＳＣＢＦ）为高，近侧节较远侧节亦高，伤后２ｈ，ｗＳＣＢＦ稍升高，但４ｈ恢复正常。作者认为，伤后头几个小时为关键时刻，此时如能采用有效措施，对不全瘫还能逆转。本文结果与文献相比有些差异，可能与实验条件不同及观察时间较短有关。     

脊髓损伤后的高凝状态

目的:观察脊髓损伤患者凝血系统的变化。方法:以20例符合条件的脊髓损伤病人为研究对象,分别于伤后2~6h、伤后1、3、5d采集病人股静脉血,测定血浆凝血酶抗凝血酶Ⅲ复合物(TAT)、凝血酶原片段1 2(F1 2)和D-二聚体(D-dimer)浓度;同时测定20名健康献血员TAT、F1 2、D-dimer血浆浓度作为正常对照。结果:正常对照组TAT、F1 2和D-dimer血浆浓度分别为3.1±0.9ng/ml、0.9±0.2nmol/l和42.6±9.3ng/ml。20例脊髓损伤病人伤后2~6hTAT、F1 2、D-dimer血浆浓度即显著增高(P<0.05),分别达45.3±14.2ng/ml、4.1±0.7nmol/l和136.2±14.3ng/ml,伤后1、2d内仍明显高于对照组,伤后3、4d趋于正常。结论:脊髓损伤后可激活凝血系统,造成高凝状态,这种高凝状态于伤后数小时即可发生,且持续存在2~3d。     

Osteoporosis after spinal cord injury.

Dual-photon absorptiometry characterized bone loss in males aged less than 40 years after complete traumatic paraplegic and quadriplegic spinal cord injury. Total bone mass of various regions and bone mineral density (BMD) of the knee were measured in 55 subjects. Three different populations were partitioned into four groups: 10 controls (healthy, age matched); 25 acutely injured (114 days after injury), with 12 reexamined 16 months after injury; and 20 chronic (greater than 5 years after injury). Significant differences (p less than 0.0001) in bone mass mineral between groups at the arms, pelvis, legs, distal femur, and proximal tibia were found, with no differences for the head or trunk. Post hoc analyses indicated no differences between the acutely injured at 16 months and the chronically injured. Paraplegic and quadriplegic subjects were significantly different only at the arms and trunk, but were highly similar at the pelvis and below. In the acutely injured, a slight but statistically insignificant rebound was noted above the pelvis. Regression techniques demonstrated early, rapid, linear (p less than 0.0001) decline of bone below the pelvis. Bone mineral loss occurs throughout the entire skeleton, except the skull. Most bone loss occurs rapidly and below the pelvis. Homeostasis is reached by 16 months at two thirds of original bone mass, near fracture threshold.     

脊髓损伤合并截肢患者的康复效果分析

目的:探讨脊髓损伤合并截肢患者的康复治疗效果。方法:1991年～2011年共收治脊髓损伤合并截肢者6例,ASIA分级A级5例,C级1例;右下肢截肢者3例,左下肢截肢者1例,左上肢截肢者1例,右下肢与右上肢截肢者1例,均进行康复评价并确定康复方案。在患者全身情况和残肢关节活动度获得改善后,对截瘫合并下肢截肢者予穿戴假肢和矫形器行站立和行走训练,合并上肢截肢者予佩戴功能性假肢等康复治疗。经过物理治疗(PT)、作业治疗(OT)训练及佩戴相应的假肢和矫形器,并经过反复训练和强化后观察康复效果。应用脊髓损伤神经学分类国际标准(ASIA标准)评估患者神经功能,使用功能独立性评定(FIM)量表评估患者生活自理能力。结果:本组病例平均住院康复时间为126d(58~236d)。5例截瘫患者ASIA神经功能无明显改善(P>0.05),但FIM运动评分显著提高(入院得分为25.83分,出院平均得分为52.17分)(P<0.05)。另1例颈脊髓损伤患者入院为不完全损伤,经过治疗后感觉评分提高58分,运动评分提高14分,FIM评分中自理活动能力提高9分,转移能力提高14分,运动能力提高5分。结论:脊髓损伤合并截肢患者经过佩戴假肢并予综合康复后,患者丧失的部分功能可得到替代,生活自理能力可得到明显提高。     

Cholecystectomy in patients with previous spinal cord injury

BACKGROUND: The number of people in the United States with spinal cord injury (SCI) is estimated at about 200,000. The prevalence of gallbladder disease in this population is about three times as high as in neurally intact people, but the results of surgical treatment have received little attention. METHODS: A retrospective, population-based study of patients with SCI who later received cholecystectomy for benign gallbladder disease was performed. National computer data sets of all patients receiving medical care in all Department of Veterans Affairs (DVA) medical centers for fiscal years 1994 to 1998 were used. Computer-based data were augmented with chart-based resources. RESULTS: During the period of interest, there were 21,849 patients with ICD-9-CM codes for SCI in the DVA computer system, among whom 367 had codes for cholecystectomy. After retrieval and review of data from individual charts, 118 were deemed evaluable. There were 68 who had successful laparoscopic cholecystectomy and 14 who required conversion to open cholecystectomy after laparoscopic efforts failed (conversion rate 14 of 82=17%). There were 36 who received planned open cholecystectomy. Patients under the age of 60 years were more likely to have a laparoscopic approach (P <0.05). Emergency cholecystectomies were more likely to be performed via the open route (P <0.01). The morbidity rate was 8 of 68 (12%) for successful laparoscopic cholecystectomy, 4 of 14 (29%) for failed laparoscopic surgery completed by conventional open technique, and 11 of 36 (31%) for planned open surgery. The mortality rate in the traditional surgery group was 1 of 36 (3%). There were no deaths in the other groups. CONCLUSIONS: We believe this series is the largest so far reported. The mortality rate of cholecystectomy in SCI patients is comparable to that in neurally intact individuals, but the morbidity rate is high. Contractures, stomas, heterotopic ossification, and other sequelae of SCI do not generally cause technical difficulties with surgery. If complications of cholecystectomy are indeed SCI-related, attention to perioperative SCI care could improve outcomes of cholecystectomy. Future research should continue to explore this important research topic.     

Open-heart operations in patients with a spinal cord injury

BACKGROUND: The objective of our study was to evaluate the outcomes of open-heart surgery in patients with a spinal cord injury. METHODS: A retrospective analysis of all patients (n = 8) with a spinal cord injury who underwent open-heart operations in a single institution from April 1994 to November 2006 was conducted. RESULTS: All patients had a permanent spinal cord injury with levels ranging from T3 to L2 with a mean age of 62 years (range, 47-72). Seven coronary artery bypass operations and 2 aortic valve replacements were performed. The mean cardiac ejection fraction was 44% (range, 20-60). Seventy-five percent of the patients were extubated within 24 hours of the operation. A decubitus ulcer occurred in only 1 patient. The acute hospital stay averaged 14 days (range, 6-36). One patient died from multiorgan failure on postoperative day 13 giving an in-hospital 30-day mortality of 12.5%. The 5-year survival was 75% with a mean follow-up of 67 months (range, .5-129). CONCLUSIONS: Open-heart operations in patients with a spinal cord injury can be performed safely with acceptable early and late outcomes.     

Continuous intrathecal infusion of baclofen in patients with spasticity caused by spinal cord injuries

The aim of this study was to determine the efficacy and safety of intrathecal baclofen therapy delivered by a programmable pump for the chronic treatment of spinal spasticity. Twelve patients with intractable spasticity caused by spinal cord injuries underwent implantation of a programmable continuous infusion pump after significant reduction in spasticity following an intrathecal test bolus of baclofen. No deaths or new permanent neurological deficits occurred following surgery or chronic intrathecal baclofen therapy. The follow-up (12 months) shows a reduction in rigidity in the lower limb of 2.0 points on the Ashworth scale and in the upper limb of 1.2 points. Muscle spasms were reduced from a mean preoperative score of 2.8 to a mean postoperative score of 1.0. In two cases, we observed postoperative catheter dislocation, a complication which could be corrected surgically. This study demonstrates that chronic intrathecal baclofen infusion is a safe and effective form of treatment of intractable spasticity in patients with spinal cord injury. There is considerable reduction in the risk of infection in view of the fact that interrogation and programming of the implanted programmed pumps is noninvasive. Electronic Publication     

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.     

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.     

Fecal microbiota transplantation as potential first-line treatment for patients with Clostridioides difficile infection and prior appendectomy

Clostridioides difficile infection (CDI) is a global health problem. The association of appendectomy on the severity and prognosis of CDI has been reported in many literatures, but there are still contradictions. In a retrospective study entitled “Patients with Closterium diffuse infection and prior appendectomy may be prone to word outcomes” published in World J Gastrointest Surg 2021, the author found that prior appendectomy affects the severity of CDI. Appendectomy may be a risk factor for increasing the severity of CDI. Therefore, it is necessary to seek alternative treatment for patients with prior appendectomy when they are more likely to have severe or fulminant CDI.     

锂剂治疗脊髓损伤机制的研究进展

脊髓损伤是由一系列内外因素所造成的骨科及神经科学领域严重的致残性疾病,是目前医学界的一大难题.锂剂作为治疗双相情感障碍的主要药物已有100多年的历史.研究证实锂剂对脑神经元有保护作用,其对脊髓损伤的治疗作用也渐渐被观察到.锂剂能够通过保护神经元完整、减少损伤后炎症反应、促进神经营养因子的生成和释放、刺激神经发生以及促进自噬、抑制凋亡等机制达到治疗脊髓损伤的目的.通过回顾有关锂剂对神经系统作用的研究,总结分析了锂剂治疗脊髓损伤作用机制的研究进展,以锂剂为基础的综合治疗具有良好的应用前景.     

Hemostatic parameters in patients with spinal cord injury in subacute and chronic phase of the rehabilitation

Objective: The goal of this study was to measure hemostatic markers after SCI.Design: Assesing changes in coagulation and fibrynilitic system in SCI patients in different time post injury to Cross-sectional study.Setting: Rehabilitation Department of the Bydgoszcz University Hospital, Poland from 2011 to 2017.Participants: SCI patient during acute and chronic rehabilitation (N = 88).Outcome Measures: Assesing following parameters: platelet counts and levels of D-dimer, antithrombin III (ATIII), tissue factor (TF), tissue factor pathway inhibitor (TFPI) and the inflammatory marker, C-reactive protein (CRP).Interventions: Eighty-eight SCI patients were divided into three groups based on the time elapsed from injury: group I (three weeks to three months), group II (three to twelve months) and group III (more than twelve months). All patients underwent ultrasonography (US) to detect acute or chronic recanalized deep vein thrombosis (DVT). Platelet counts and levels of D-dimer, ATIII, TF, TFPI and CRP were assessed. TF and TFPI levels were measured in the control group of forty healthy individuals without SCI, the rest of the parameters were compared to laboratory norms.Results: D-dimer levels were significantly higher in group I compared to group II (P = .0002) and group III (P < .001). Group II had higher D-dimer levels than group III (P = .032). TFPI levels were higher in group II compared with group III (P = .0041) and control group (P = .000033). TF was significantly higher in all the SCI groups compared with the control group (P < .001).Conclusions: D-dimer and TF levels were still elevated twelve months after SCI. TF levels were also elevated over 12 months after inury. The results may indicate that sub-acute and even chronic SCI patients have disturbed coagulation and fibrynolitic system.