胚胎脊髓细胞悬液在大鼠损伤脊髓中的突触发育过程

目的　观察分析胚胎脊髓细胞悬液在损伤脊髓移植区中的突触发育过程。　方法　对 4 2只 Wistar成年大鼠以改良 Allen法 (10 g× 5 cm)打击脊髓 ,3天后将孕 14天 (E14 ) 5只胚胎脊髓细胞悬液 (FSCS) 2 0 μl植入损伤空腔 ,移植后 2、4、6、8、10和 12周 ,以组织学、免疫组织化学观察移植物成活、分化及其与宿主之间关系。　结果　移植区成神经细胞最先展示了胞质突起 ,随之出现了低电子密度的突触前后膜 ,突触前、后膜电子密度逐渐增高形成良好的致密突起。突触小泡数量和种类逐渐增多 ,突触小泡有圆形清亮小泡、椭圆形小泡、颗粒状小泡和扁平小泡 - f型。突触的连接方式由单个的胞体 -树突突触 ,出现多个的胞体 -树突和树突 -树突突触。同时 ,移植成神经细胞、成少突胶质细胞及成星形细胞的细胞器日渐完善 ,细胞功能活跃。血脑屏障也随之出现。移植区可见神经微丝 (NF)、组织胺 (5 - HT)、降钙素基因相关肽 (CGRP)、胶原纤维酸性蛋白 (GFAP)阳性纤维。　结论　胚胎脊髓细胞悬液在成年大鼠损伤脊髓内可发育为成熟的突触 ,显示了 FSCS与宿主脊髓重建突触方式的信息交换的潜在可行性。     

脊髓损伤两种修复方法的比较研究

目的：比较脊髓损伤后两种修复方法的效果。方法：损伤成鼠胸髓左后术,移植孕１４ｄ３胚胎脊髓（Ｆ组）,胚胎脊髓加自体带蒂正中神经（Ｖ＋Ｆ组）及不移植（对照组）,观察胚胎脊髓的生长、分化情况及对宿主的修复能力。结果：Ｖ＋Ｆ组胚胎脊髓体积增长速度、神经纤维数量和神经元密度显著高于Ｆ组（Ｐ〈０．０１）,细胞分化较好,突触较成熟,界面区无明显的胶质增生。Ｖ＋Ｆ组ＳＥＰ的Ｐ１、Ｎ１波潜伏期显著缩短（Ｐ〈０．０１     

实验性大鼠胚胎脊髓移植对损伤脊髓影响的观察

目的 建立了一个胚胎脊髓（ｆｅｔａｌ ｓｐｉｎａｌ ｃｏｒｄ）组织的低温保存方法笔一个损伤移植模式。方法 通过病理学、组织化学和免疫组织化学的研究,选用胎龄１４天的Ｗｉｓｔａｒ大鼠,分离胚胎脊髓,逐步降温,最后置于液氮中保存。１５天后取出,快速复温,并植入损伤大鼠脊椎内。全部动物于伤后８周处死。结果 经过低温保存的移植物能够在异体脊髓内存活并与宿主组织融合,其在损伤移植区的胶质细胞增生少于对照组。     

自体激活雪旺细胞联合胚胎脊髓细胞悬液修复脊髓损伤中的突触发育过程

 目的观察分析胚胎脊髓细胞悬液(fetal spinal cord cell suspension, FSCS)联合自体激活 雪旺细胞(autologus activated Schwann cells, AASCs)在损伤脊髓移植区中的突触发育过程。方法 42只 Wistar成年大鼠结扎单侧隐神经, 1周后取出结扎远端神经组织, 分离、培养、纯化 AASCs。以改良 Allen 法(10g x 5 cm)打击脊髓, 3天后将孕 14天(E₁₄) FSCS 20μl联合 AASCs植入损伤空腔, 移植后 2、4、6、 8、10和 12周, 以光学显微镜、电镜、免疫组织化学观察移植物成活、分化及其与宿主之间关系。结果 移植区 AASCs生长分化良好, 胶质瘢痕少。成神经细胞最先展示了胞质突起, 随之出现低电子密度的突 触前、后膜, 突触前、后膜电子密度逐渐增高形成良好的致密突起。突触小泡数量和种类逐渐增多, 突触 小泡有圆形清亮小泡、椭圆形小泡、颗粒状小泡和扁平小泡-f型。突触的连接方式由单个的胞体-树突 突触, 出现多个的胞体-树突和树突-树突突触。同时, 移植成神经细胞、成少突胶质细胞、成星形细胞的 细胞器日渐完善, 细胞功能活跃。血脑屏障也随之出现。移植区可见神经微丝、组织胺、降钙素基因相关 肽、胶原纤维酸性蛋白阳性纤维。结论 (1) AASCs辅助下 FSCS在成年大鼠损伤脊髓内可发育为成熟 的突触; (2) FSCS与宿主脊髓重建突触方式的信息交换具有潜在可行性。     

大鼠胚胎脊髓移植物对成体损伤脊髓运用能修复的影响

为了探讨胚胎脊髓移植物对成体损伤脊髓运动功能修复的效应，取妊娠１４天胚胎大鼠脊髓组织，移植到成年大鼠脊髓半切洞损伤模型，术后进行联合行为记分（ＣＢＳ）和运动诱发电位（ＭＥＰ）检查。结果发现，移植组ＣＢＳ与对照组比较相差显著（Ｐ〈０．０５），移植术后４周以内两者相差非常显著（Ｐ〈０．０１）。移植组ＭＥＰ早期反应（Ｐ１，Ｎ１）的峰潜代恢复优于对照组（Ｐ〈０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤     

自体和异体神经组织联合移植修复脊髓损伤的实验研究

目的：探讨神经组织联合移植对成鼠急性脊髓损伤的修复能力。方法：成年雌性Ｗｉｓｔａｒ鼠３６只随机分为３组,损伤Ｔ１－３脊髓左后柱,移植孕１４ｄ胚胎脊髓（ＦＳＣ组１５只）或带血管正中神经加胚胎脊髓（Ｖ＋Ｆ组１５只）,另６只做对照组。术后８周行体感诱发电位、光、电镜和免疫组化检查。结果：Ｖ＋Ｆ组胚胎组织体积增长速度、神经纤维和神经元数目显著高于ＦＳＣ组（Ｐ〈０．０１）,细胞大多分化较好,有少数类似运动神     

大鼠胚胎脊髓移植物对成体损伤脊髓运动功能修复的影响

为了探讨胚胎脊髓移植物对成体损伤脊髓运动功能修复的效应，取妊娠１４天胚胎大鼠脊髓组织，移植到成年大鼠脊髓半切洞损伤模型，术后进行联合行为记分（ＣＢＳ）和运动诱发电位（ＭＥＰ）检查。结果发现，移植组ＣＢＳ与对照组比较相差显著（Ｐ＜０．０５），移植术后４周以内两者相差非常显著（Ｐ＜０．０１）。移植组ＭＥＰ早期反应（Ｐ１，Ｎ１）的峰潜伏时恢复优于对照组（Ｐ＜０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤脊髓的功能修复具有促进作用。这可能与胚胎脊髓组织能分泌多种神经营养因子、神经生长因子、神经递质，或激素的调节作用有关。     

胎鼠脊髓对成鼠急性脊髓损伤的修复作用——光镜CB—HRP示踪与还原银染色

把Ｅ１４胎鼠脊髓植入成鼠损伤脊髓后，分别在术后７、 １５、 ３０、 ４５、 ６０、 １２０天，用 ＣＢ－ＨＲＰ和还原银染色显示了宿主脊髓和移植物内的神经元及神经纤维。结果表明，虽然术后７天就可见宿主神经纤维再生进入移植物，但两种方法均不能显示移植的胚胎神经元及其突起。自术后３０天起，移植物内神经元可被标志，但神经元的体积小，突起数目也短而少。随着神经元体积的逐渐增大和突起数目的不断增多延长，可见宿主神经元向移植物内投射突起，并和后者神经元相互联系。作者认为，胚胎脊髓虽可在术后早期机械修补成鼠脊髓损伤，但并不能与宿主脊髓组织发生广泛的有机纤维联系，这和胚胎脊髓移植后，神经元的缓慢分化发育有关。     

细胞移植治疗脊髓损伤

细胞移植治疗脊髓损伤（spinal cord injury，SCI）是近来SCI治疗的研究热点，主要是通过细胞移植来促进变性神经元的再生和抑制胶质瘢痕形成，达到修复受损的神经通路和突触连接。细胞移植根据移植物的不同可以大体分为神经细胞和非神经细胞移植，移植物包括周围神经源性神经元、嗅鞘细胞、活化巨噬细胞、骨髓基质细胞、少突胶质细胞前体细胞、胚胎干细胞以及转基因细胞等。这些实验方法已经陆续开始应用于临床，给曾经被认为完全不可治愈的脊髓损伤带来了希望。     

胚胎脊髓组织移植联合应用神经生长因子对损伤脊髓再生修复的形态学影响

选择胎龄为１４～１５天的大鼠胚胎脊髓植入成年大鼠半横断的脊髓损伤腔，同时局部应用神经生长因子。术后２～８个月，用组织学、免疫细胞化学、辣根过氧化酶示踪及超微结构的检查方法证实，移植组织在宿主脊髓内的存活率为９０％，并且分化成熟，具有正常的神经组织结构特征，大多数移植物充满损伤腔，与宿主脊髓形成良好的融合，移植组织与宿主组织出现新的纤维联系，使脊髓损伤的两端恢复了解剖的连续性。     

脊髓损伤大鼠脊髓组织的病理形态学观察

目的：研究脊髓损伤（SCI）用高压氧（HBO）处理后脊髓的病理学变化。方法：用SD大鼠复制SCI模型，0．1MPa和0．25MPaHBO处理后，取损伤脊髓作HE染色。结果：正常对照组脊髓结构完整，细胞形态正常，分布均匀，胞膜，胞核正常，组织间隙正常，单纯损伤组示组织出血，疏松水肿，细胞空泡变性，神经纤维溶解，消失；处理后，0．25MPaHBO组及0．25MPaHBO＋激素（L，M）组脊髓恢复最明显，组织水肿，细胞空泡变性减轻，细胞形态恢复，结构排列完整，结论：HBO治疗可明显阻止或减轻脊髓损伤的病理变化，有利于脊髓功能的恢复。     

Spinal Cord Compression

OPINION STATEMENT: Malignant epidural spinal cord compression (MESCC) remains a common neuro-oncologic emergency with high associated morbidity. Despite widespread availability of MRI, the diagnosis frequently goes unmade until myelopathy supervenes, which is unfortunate because the strongest predictor of neurologic outcome with treatment is the neurologic status when treatment is initiated. Once the diagnosis of MESCC is suspected, patients with neurologic deficits should be started on high-dose corticosteroids (eg, dexamethasone, 10-100?mg intravenously, followed by 16 to 100?mg/d in divided doses). Definitive therapy of MESCC almost always includes radiation therapy and in some cases surgical intervention; factors considered include the patient's performance status and extent of visceral and skeletal disease, spinal stability, the tumor's underlying radiosensitivity, and the degree of spinal cord compression. Patients with spinal instability or radioresistant tumors are likely to have a much better neurologic outcome with tumor resection and spinal stabilization prior to radiation; the same may also pertain to patients with moderately radiosensitive tumors who have good life expectancy in terms of their systemic tumor. Conventional radiation has historically been beneficial after surgery and in patients who are not surgical candidates. Recent studies suggest a role for stereotactic body radiation therapy in patients with spinal metastasis from radioresistant tumors and in patients who have received prior standard radiotherapy, so long as the spinal cord has been decompressed.     

Spinal Myoclonus After Spinal Cord Injury

Abstract

Background/Objective: In the course of examining spinal motor function in many hundreds of people with traumatic spinal cord injury, we encountered 6 individuals who developed involuntary and rhythmic contractions in muscles of their legs. Although there are many reports of unusual muscle activation patterns associated with different forms of myoclonus, we believe that certain aspects of the patterns seen with these 6 subjects have not been previously reported. These patterns share many features with those associated with a spinal central pattern generator for walking.

Methods: Subjects in this case series had a history of chronic injury to the cervical spinal cord, resulting in either complete (ASIA A; n = 4) or incomplete (ASIA D; n = 2) quadriplegia. We used multi-channel electromyography recordings of trunk and leg muscles of each subject to document muscle activation patterns associated with different postures and as influenced by a variety of sensory stimuli.

Results: Involuntary contractions spanned multiple leg muscles bilaterally, sometimes including weak abdominal contractions. Contractions were smooth and graded and were highly reproducible in rate for a given subject (contraction rates were 0.3-0.5 Hz). These movements did not resemble the brief rapid contractions (ie, "jerks") ascribed to some forms of spinal myoclonus. For all subjects, the onset of involuntary muscle contraction was dependent upon hip angle; contractions did not occur unless the hips (and knees) were extended (ie, subjects were supine). In the 4 ASIA A subjects, contractions occurred simultaneously in all muscles (agonists and antagonists) bilaterally. In sharp contrast, contractions in the 2 ASIA D subjects were reciprocal between agonists and antagonists within a limb and alternated between limbs, such that movements in these 2 subjects looked just like repetitive stepping. Finally, each of the 6 subjects had a distinct pathology of their spinal cord, nerve roots, distal trunk, or thigh; in 4 of these subjects, treatment of the pathology eliminated the involuntary movements.

Conclusion: The timing, distribution, and reliance upon hip angle suggest that these movement patterns reflect some elements of a central pattern generator for stepping. Emergence of these movements in persons with chronic spinal cord injury is extremely rare and appears to depend upon a combination of the more rostrally placed injury and a pathologic process leading to a further enhancement of excitability in the caudal spinal cord.     

应用中医传感针观察伤段脊髓氧分压的变化

目的：探讨应用中医传感针观察脊髓损伤（SCI）后伤段脊髓氧分压的变化及其与病理变化、神经功能损害的关系。方法：改变Allen法致伤大鼠脊髓，于伤前和伤后1／2、1、3、6、24、72、168h，用中医传感针技术测量脊髓氧分压，应用光、电镜观察脊髓病理变化，应用斜板试验评价大鼠运动功能。结果：SCI后伤段脊髓氧分压明显下降（P＜0．01），与病理变化及神经功能损害的发生发展一致。结论：中医传感针可应用于测量SCI后脊髓氧分压；脊髓氧分压是脊髓损伤研究中的重要观察指标。