Sexual function and infertility following spinal cord injury

Changes in sexual function and fertility frequently occur following spinal cord injury (SCI). This article presents an overview of human sexual response and the changes that occur in that response following SCI. This article addresses the issues of childbearing for women with SCI, erectile function for men with SCI, and the issues of fertility and parenting for men and women with SCI.     

Clinical management of chronic pain in spinal cord injury.

Spinal cord injury (SCI) can cause paralysis; sensory impairment; autonomic nervous system dysfunction; and bowel, bladder, and sexual dysfunction. These impairments may lead to immobility, physical dependence, and alterations in lifestyle and self-esteem. The addition of chronic, intractable pain to these impairments can be truly devastating. Chronic pain superimposed on spinal cord injury can virtually drain the individual of strength, motivation, and will. For the spinal cord injury survivor who already faces functional loss, severe pain can further restrict even the diversional activities that are available. Thus, it may become impossible for the individual to escape his or her pain even temporarily. The various medical, physical, and surgical treatments considered to be efficacious in treating this pain are reviewed. However, although chronic pain in SCI may be managed by these therapies, a permanent cure may not result.     

Assessment of sexual functions after spinal cord injury in Indian patients

This study assessed the interacting physical, psychological and social aspects of sexuality among 86 males and 14 females with spinal cord injury (SCI). Data collection involved the use of a 42-item study-specific questionnaire designed to determine different aspects of sexuality. Subjects were rated, after interview, on a scale according to an integrated index of sexual function (IISF). It was observed that patients scoring higher on this index were sexually more active and showed positive sexual adjustments. A higher incidence of complications of SCI, partner dissatisfaction, less partner co-operation, lower self-esteem and social taboos were factors responsible for less sexual activity in our patients. The present study suggests that there is a strong need for improved treatment of the medical complications of SCI, sexual counselling, literature, information and peer support in this country. We are of the opinion that the IISF can be utilized in rehabilitation settings to examine the interplay of the various complex factors in sexual rehabilitation post-SCI.     

Sexual function in females with severe cervical spinal cord injuries: a controlled study with the Female Sexual Function Index

The objective of this study was to identify the sexual adjustment of females with severe cervical spinal cord injuries (SCI) using the Female Sexual Function Index (FSFI). The 19-item questionnaire of the FSFI concerns sexual function and satisfaction in sex life. This study, conducted by the Orthopaedic and Psychiatry Departments of Patras University, used a sample of a series of 39 consecutive female patients with severe traumatic SCI. We compared these female patients with an age-economic-educational level- and marital status-matched control group of the general population. Sexual activity was lower among females with SCI, but the desire, the emotional quality of sex life and overall sexual satisfaction did not differ from the controls. These results demonstrate that sexual life in females with SCI remains almost unaffected.     

早期应用阿仑膦酸钠对脊髓损伤大鼠骨密度及生物力学特性的影响

目的探讨早期应用阿仑膦酸钠(ALN)对脊髓损伤(SCI)大鼠股骨骨密度及生物力学特性的影响。方法将36只3月龄雌性SD大鼠随机分为假手术组(sham组)、SCI组、SCI ALN组，假手术组仅行T10椎板切除，其余组行T10椎板切除、脊髓横断术。SCI ALN组于术后1周开始腹腔注射ALN，每周3次。术后8周取股骨，进行骨密度及生物力学检测。结果脊髓横断术后8周大鼠股骨骨密度及生物力学参数与Sham组相比发生了显著性改变；与SCI组相比，SCI ALN组股骨骨密度值显著升高(P＜0．01)；弹性载荷值、最大载荷值显著升高(P＜0．01)，最大应力值升高(P＜0．05)。结论脊髓横断术后8周的大鼠可用于SCI后骨质疏松的研究；早期应用ALN可减少SCI大鼠股骨的骨量丢失，改善SCI大鼠股骨的生物力学特性。     

大鼠脊髓损伤后NG2胶质细胞的活化增殖研究

目的观察大鼠损伤脊髓中NG2胶质细胞的活化。方法 60只雄性Wistar大鼠随机分为两组(n=15):手术组用改良Allen`s打击法制作脊髓损伤模型;假手术组只切除椎板,不损伤脊髓。在术后3 d、7 d、30 d,用免疫组化方法检测NG2细胞活化。结果相比较假手术组,手术组脊髓损伤后NG2细胞活化明显,细胞增殖活化在术后3 d升高,7 d达高峰,持续至30 d(P<0.05)。结论大鼠脊髓损伤后NG2大量活化增殖,参与了胶质瘢痕形成,对脊髓损伤后脊髓功能的恢复产生一定影响。     

腺病毒介导HIF-1α基因对大鼠脊髓损伤后NGb表达的影响

目的探讨HIF-1α在脊髓损伤后对NGb表达的调控作用,为脊髓损伤的基因治疗提供新思路及实验依据。方法采用电控大鼠脊髓损伤打击装置致大鼠脊髓损伤模型。采用脊髓内注射法将滴度为4(1010 PFU/ml(Plaque-Forming U-nit,PFU),含HIF-1α基因(Ad-HIF-1α)或不含HIF-1α基因(Ad-Blank)的腺病毒载体稀释液2μL注入脊髓。免疫组织化学法检测大鼠脊髓HIF-1α、NGb的表达。分析在转HIF-1α基因前后两种蛋白质表达水平的变化。结果Normal、Sham组大鼠脊髓NGb呈中等表达,SCI、Ad-Blank大鼠脊髓内NGb呈高表达,在第3天达到最高值。Ad-HIF-1α组光密度值均较SCI及Ad-Blank组各时间点的光密度值高(P<0.05),在损伤后的第7 d达到最高值。结论转HIF-1α基因促进脊髓损伤后NGb的表达上调,并提示NGb基因是低氧反应基因(Hypoxia Respose gene,HRG)??HIF-1α的调控基因。     

Spinal cord injury pain.

Awareness that SCI pain is common emerged during the past decade. However, there are a number of unresolved issues. There is a need for variety of experimental models to reflect diversity of SCI pains. Current classification is not as user-friendly as it should be. More attention should be given to a condition of the spinal cord below and above the SCI lesion. A consensus for what is an optimal SCI functional assessment for patients with sensory complaints and pain should be developed. Further extensive SCI pain research is needed prior to spinal cord regeneration trials in order to be able to cope with a potential for newly developed pains that may appear during incomplete spinal cord regenerative attempts.     

PPAR-β激动剂治疗大鼠脊髓损伤的观察

目的：探讨过氧化物酶增殖物激活受体-β（peroxisome proliferater activated receptors-beta,PPAR-β）对脊髓损伤（spinal cord injury,SCI）大鼠脊髓组织及运动功能的影响。方法45只SD大鼠随机分为假手术组（Sham组）、脊髓损伤组（SCI组）和PPAR-β受体激动剂GWO742治疗组（GWO742组）。Sham组大鼠仅做椎板切除术不损伤脊髓组织,GWO742组和SCI组大鼠分别采用改良Allens打击法制作SCI模型,并于术后1h开始分别通过腹腔注射同等剂量0.3mg/（kg＆#183;d）的PPAR-β受体激动剂GWO742和生理盐水。各组大鼠分别于术后1、3、7、14、21d随机抽取大鼠行BBB评分;术后24h随机抽取大鼠10只,处死取脊髓组织行HE染色观察脊髓组织病理变化,TUNEL法染色检测细胞凋亡。结果 BBB评分结果显示,术后3、7、14、21d,GWO742组大鼠较SCI组大鼠BBB评分高,且差异均有统计学意义（P〈0.05）;HE染色结果显示SCI组大鼠脊髓组织充血、水肿、损伤中心区出现液化坏死并伴有炎性细胞浸润,GWO742组大鼠脊髓出血、坏死范围及炎性细胞浸润明显轻于SCI组;TUNEL染色显示伤后24h,SCI组和GWO742组损伤脊髓组织均可发现TUNEL阳性细胞,而GWO742组TUNEL阳性细胞数明显少于SCI组（P〈0.05）。结论 PPAR-β受体激活后能够减轻SCI大鼠脊髓组织充血、水肿等病理学改变,抑制神经元凋亡,促进大鼠后肢运动功能恢复。     

Human umbilical cord blood-derived CD34+ cells may attenuate spinal cord injury by stimulating vascular endothelial and neurotrophic factors

Human umbilical cord blood-derived CD34(+) cells were used to elucidate the mechanisms underlying the beneficial effects exerted by cord blood cells in spinal cord injury (SCI). Rats were divided into four groups: (1) sham operation (laminectomy only); (2) laminectomy + SCI + CD34(-) cells (5 x 10(5) human cord blood lymphocytes and monocytes that contained <0.2% CD34(+) cells); (3) laminectomy + SCI + CD34(+) cells (5 x 10(5) human cord blood lymphocytes and monocytes that contained approximately 95% CD34(+) cells); and (4) laminectomy + SCI + saline (0.3 mL). Spinal cord injury was induced by compressing the spinal cord for 1 min with an aneurysm clip calibrated to a closing pressure of 55 g. CD34 cells or saline was administered immediately after SCI via the tail vein. Behavioral tests of motor function measured by maximal angle an animal could hold to the inclined plane were conducted at days 1 to 7 after SCI. The triphenyltetrazolium chloride staining and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay were also conducted after SCI to evaluate spinal cord infarction and apoptosis, respectively. To elucidate whether glial cell line-derived neurotrophic factor (GDNF) or vascular endothelial growth factor (VEGF) can be secreted in spinal cord-injured area by the i.v. transplanted CD34(+) cells, analysis of spinal cord homogenate supernatants by specific enzyme-linked immunosorbent assay for GDNF or immunofluorescence for VEGF was conducted. It was found that systemic administration of CD34(+), but not CD34(-), cells significantly attenuated the SCI-induced hind limb dysfunction and spinal cord infarction and apoptosis. Both GDNF and VEGF could be detected in the injured spinal cord after transplantation of CD34(+), but not CD34(-), cells. The results indicate that CD34(+) cell therapy may be beneficial in reversing the SCI-induced spinal cord infarction and apoptosis and hindlimb dysfunction by stimulating the production of both VEGF and GDNF in a spinal cord compression model.     

Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele

PURPOSE: To study satisfaction with sexual life and self-assessed sufficiency of sexual counselling in persons with traumatic spinal cord injury (SCI) and meningomyelocele (MMC). METHOD: A postal questionnaire on aspects of health and functioning was answered by 190 persons with traumatic SCI who had been treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, G?teborg, Sweden and 41 persons with MMC who were admitted to the Young Adult Teams in G?teborg, Bor?s and Sk?vde, Sweden. RESULTS: On a numerical scale from 0 (dissatisfied) to 10 (satisfied) the median of satisfaction with sexual life was 3 for the men and 4 for the women among the persons with traumatic SCI. In the MMC group the median of satisfaction with sexual life was 5 for the men and 8 for the women. Sexual dissatisfaction increased with increasing age in both groups. Inconvenience caused by urinary and faecal incontinence, as well as neuropathic pain increased sexual dissatisfaction in the men with traumatic SCI. A total of 69% of the men with traumatic SCI and 56-59% of the participants in other subgroups reported that the sexual counselling they had received was sufficient. CONCLUSIONS: The results corroborate findings from earlier studies that satisfaction with sexual life is rather low among persons with SCI. Especially ageing men with traumatic SCI who have sustained injury at an older age are a challenge for rehabilitation. The high satisfaction with sexual life in the women in comparison with the men with MMC is a finding not reported earlier. Our results suggest that adequate treatment of incontinence and pain might improve even sexual satisfaction. Sexual counselling should be given to all individuals with SCI and to their partners. Sexual counselling for young adults with MMC is an important part of the rehabilitation process.     

实验用脊髓腹侧损伤撞击器的设计及应用

背景：目前脊髓损伤的基础研究主要依赖于动物损伤模型,每种脊髓损伤模型都有其适应范围及不足之处。目的：设计并制造实验用大鼠脊髓腹侧损伤撞击器,并在大鼠脊髓损伤实验中验证仪器的使用效果。方法：设计脊髓腹侧损伤撞击器的图纸,并按图纸组装成成品;应用该仪器制作SD大鼠脊髓腹侧损伤模型。随机分为3组,中度损伤组用23V电压的打击力量,重度损伤组用25V电压打击力量,对照组在安装撞击钩后,不实施打击。结果与结论：重度损伤组BBB评分明显低于中度损伤组（P〈0.001）。BBB评分与脊髓残留组织呈线性相关（P〈0.001）,23V电压力量30%的脊髓变形率可以制作中度脊髓损伤模型,25V电压力量61%的脊髓变形率可以制作重度脊髓损伤模型。证实实验设计的脊髓腹侧损伤仪器能够制作大鼠脊髓腹侧中、重度损伤模型,损伤力量大小方便可控,脊髓形变可测。     

3. Rehabilitation outcomes

This self-directed learning module highlights rehabilitation outcomes in spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the multiple concerns for functional recovery after SCI, chiefly, the potential for ambulation, upper-extremity recovery, options for functional neuromuscular stimulation (FNS), sexual activity, and optimal outcome after a metastatic lesion. Motor incomplete patients have a better prognosis for ambulation than persons with sensory incomplete injury. Positive predictors for ambulation, including pinprick and lower-extremity motor scores greater than 20, are discussed. Meaningful recovery can occur in the upper extremities for at least 1 year. FNS options have been developed to promote functional control of the upper extremities for persons with tetraplegia, phrenic pacing, and bladder continence. A critical component of an individual's expression of self is his/her sexuality; sexual function after SCI is described in detail, including options for treatment of erectile dysfunction and various birth control methods for women. Expectations for an appropriate rehabilitation stay for a person with metastatic SCI differ for an individual with traumatic SCI. Differences may include changing routine pathways and timelines to focus on patient-centered quality of life for transition to home.Overall Article Objective:To identify potential outcomes in ambulation, upper-extremity function, FNS, and sexual function after SCI and after metastatic cancer.     

督脉电针对大鼠脊髓损伤后神经功能恢复的影响

目的探讨督脉电针治疗对大鼠脊髓损伤后神经功能恢复的影响。方法利用多中心急性脊髓损伤打击器建立大鼠T11脊髓损伤模型,建模成功后随机分为对照组(A组)和督脉电针组(B组)。脊髓损伤后1周,B组接受督脉电针治疗。两组大鼠于脊髓损伤后1、2、4、8周行BBB后肢运动功能评分,脊髓损伤后2、4、8周行体感诱发电位(SEP)检测,脊髓组织行HE染色与神经丝蛋白(NF200)免疫组化染色。结果 SCI后1周,两组大鼠BBB后肢运动功能评分无显著性差异(P>0.05);SCI后2、4、8周,B组BBB后肢运动功能评分较A组明显升高(P<0.01),SEP潜伏期明显缩短、波幅明显增高(P<0.01)。HE染色显示损伤区瘢痕组织及空洞形成,B组脊髓空洞比A组小;脊髓组织NF200阳性表达B组各时间点较A组明显增强(P<0.01)。结论督脉电针治疗可有效促进SCI大鼠神经功能恢复。     

Exogenous administration of glial cell line-derived neurotrophic factor improves recovery after spinal cord injury

The aim of present study was to examine whether systemically delivered glial cell-derived neurotrophic factor (GDNF) was beneficial in reversing the spinal cord injury (SCI) in a spinal cord compression model. Rats were divided into three major groups: (1) sham operation (laminectomy only); (2) laminectomy+SCI+normal saline (1ml/kg, i.v.); (3) laminectomy+SCI+GDNF (50ng/kg, i.v.). Spinal cord injury was induced by compressing the spinal cord for 1min with an aneurysm clip calibrated to a closing pressure of 55g. GDNF or saline was administered immediately after SCI via the tail vein. Behavioral tests of motor function measured by maximal angle an animal could hold to the inclined plane were conducted at days 1-7 after SCI. The triphenyltetrazolium chloride staining and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay were also conducted after SCI to evaluate spinal cord infarction and apoptosis, respectively. Both GDNF and vascular endothelial growth factor (VEGF) in the injured spinal cord were assayed by immunofluorescence. It was found that systemically delivered GDNF, but not vehicle solution, significantly attenuated the SCI-induced hind limb dysfunction and spinal cord infarction and apoptosis. Both GDNF and VEGF could be detected in the injury spinal cord after GDNF, but not vehicle solution, therapy. The results indicate that GDNF treatment may be beneficial in reversing hind limb dysfunction by reducing spinal cord infarction and apoptosis in a spinal cord compression model.     

Basic concepts of activity-based interventions for improved recovery of motor function after spinal cord injury

Roy RR, Harkema SJ, Edgerton VR. Basic concepts of activity-based interventions for improved recovery of motor function after spinal cord injury. Spinal cord injury (SCI) is a devastating condition that affects a large number of individuals. Historically, the recovery process after an SCI has been slow and with limited success. Recently, a number of advances have been made in the strategies used for rehabilitation, resulting in marked improved recovery, even after a complete SCI. Several rehabilitative interventions, that is, assisted motor training, spinal cord epidural stimulation, and/or administration of pharmacologic agents, alone or in combination, have produced remarkable recovery in motor function in both humans and animals. The success with each of these interventions appears to be related to the fact that the spinal cord is smart, in that it can use ensembles of sensory information to generate appropriate motor responses without input from supraspinal centers, a property commonly referred to as central pattern generation. This ability of the spinal cord reflects a level of automaticity, that is, the ability of the neural circuitry of the spinal cord to interpret complex sensory information and to make appropriate decisions to generate successful postural and locomotor tasks. Herein, we provide a brief review of some of the neurophysiologic rationale for the success of these interventions.     

Morphine Resistance in Spinal Cord Injury-Related Neuropathic Pain in Rats is Associated With Alterations in Dopamine and Dopamine-Related Metabolomics

Opioids are not universally effective for treating neuropathic pain following spinal cord injury (SCI), a finding that we previously demonstrated in a rat model of SCI. The aim of this study was to determine analgesic response of morphine-responsive and nonresponsive SCI rats to adjunct treatment with dopamine modulators and to establish if the animal groups expressed distinct metabolomic profiles. Thermal thresholds were tested in female Long Evans rats (N = 45) prior to contusion SCI, after SCI and following injection of morphine, morphine combined with dopamine modulators, or dopamine modulators alone. Spinal cord and striatum samples were processed for metabolomics and targeted mass spectrometry. Morphine provided analgesia in 1 of 3 of SCI animals. All animals showed improved analgesia with morphine + pramipexole (D3 receptor agonist). Only morphine nonresponsive animals showed improved analgesia with the addition of SCH 39166 (D1 receptor antagonist). Metabolomic analysis identified 3 distinct clusters related to the tyrosine pathway that corresponded to uninjured, SCI morphine-responsive and SCI morphine-nonresponsive groups. Mass spectrometry showed matching differences in dopamine levels in striatum and spinal cord between these groups. The data suggest an overall benefit of the D3 receptor system in improving analgesia, and an association between morphine responsiveness and metabolomic changes in the tyrosine/dopamine pathways in striatum and spinal cord.PerspectiveSpinal cord injury (SCI) leads to opioid-resistant neuropathic pain that is associated with changes in dopamine metabolomics in the spinal cord and striatum of rats. We present evidence that adjuvant targeting of the dopamine system may be a novel pain treatment approach to overcome opioid desensitization and tolerance after SCI.     

急性大鼠脊髓损伤Allen's法模型的改良及电生理评价

目的建立一种更实用、标准、可靠的急性大鼠脊髓撞击损伤模型,为脊髓损伤(spinal cord injury,SCI)的进一步研究奠定基础。方法将36只成年雌性Wistar大鼠随机分成三组,每组12只。脊髓损伤(SCI)组:用自制改良的Allen’s撞击器,以60gcm致伤力损伤大鼠T10胸椎对应脊髓。假手术组:只打开椎板,暴露脊髓,不造成SCI。正常对照组:正常大鼠,不做任何处理。各组定期行为学观察(BBB评分),术后30天进行组织学观察和神经电生理检测。结果 HE染色:假手术组与正常对照组基本一致的。SCI组可见灰、白质组织结构不完整,损伤区可见大片坏死灶、细胞肿胀。BBB评分:假手术组术后1周功能恢复接近正常。SCI组术后第2周开始恢复,到第3周基本停止,最终BBB评分未超过6分,两组比较有明显差异。神经电生理(SEP,MEP)检测:SCI组可以明显看到SEP与MEP的峰-峰值急剧降低,且潜伏期明显延长,差异显著(P0.01)。结论改良后的急性大鼠脊髓损伤模型制作法操作简便、重复性好,是较为理想的方法。     

纳米粒子基因复合体应用于脊髓损伤治疗的实验研究

目的:观察壳聚糖纳米粒子胶质细胞源性神经营养因子基因复合体(CS-nano/pcD-NA3.1/GDNF)对脊髓损伤(SCI)的治疗作用.方法:Wistar大鼠170只,随机分为5组:A组(椎板切除+SCI-CS-nano/pcDNA3.1/GDNF,n=40),B组(椎板切除+SCI+GDNF基因治疗,n=40),C...     

人脐血单个核细胞和脐带间充质干细胞移植用于大鼠脊髓损伤的实验研究

目的:探讨人脐血单个核细胞和脐带间充质干细胞(MSCs)移植对脊髓损伤功能恢复的影响,寻找一种更适合治疗脊髓损伤的细胞源。方法:采集新鲜人脐带血和脐带,分离培养单个核细胞和MSCs。将脊髓损伤模型随机分成3组:单个核细胞移植组、MSCs移植组和低糖必需培养基(L-DMEM)培养组。采用免疫组化和免疫荧光检测细胞移植后1—4周细胞在脊髓内的存活情况和迁移情况,使用BBB行为学评分评估大鼠脊髓功能恢复情况。结果:L-DMEM培养液组在术后各时间点观察评分无明显差异,而细胞移植组脊髓功能处于逐渐恢复过程,与L-DMEM培养液比较,差异有显著性意义。单个核细胞移植组对损伤脊髓功能的修复作用较MSCs移植组显著,且差异有显著性意义。结论:与MSCs相比较,人脐血单个核细胞更适合作为治疗脊髓损伤的细胞源。