成年大鼠脊髓损伤后反应性星形胶质细胞增生和巢蛋白表达的相关性及意义

目的 探讨脊髓损伤后反应性星形胶质细胞的增生和巢蛋白的表达情况,并观察其细胞类型及相关性.方法 利用动脉瘤夹压迫法建立成年大鼠脊髓损伤动物模型.利用BBB评分标准表、免疫组化、免疫荧光双标法与LeicaQ500IW图像处理系统分析和显示脊髓损伤后不同时期(1、3、5 d,1、2、4、6、8、w)、不同部位脊髓损伤的程度以及巢蛋白与胶质酸性纤维蛋白(GFAP)的表达变化及细胞类型.结果 BBB评分结果显示术后所有实验动物双后肢(HL)评分低至0~1min,随后逐渐上升,1～2周内恢复的幅度较大,以后恢复较缓慢,较正常对照组具统计学意义(P<0.05).甲苯胺蓝染色可见损伤区有核固缩、胞浆溶解、尼氏体模糊且染色较深的神经元.随着动物存活时间延长,损伤范围逐渐扩大,约1周后损伤范同不再扩大.正常对照组脊髓神经元胞体和突起轮廓清晰.免疫荧光双标染色及图像处理系统分析结果显示脊髓伤24h后可诱导损伤及邻近区域巢蛋白和GFAP高度表达,中央管周围室管膜区几乎均为巢蛋白/GFAP-细胞群.室管膜区以外的灰质和白质中几乎全是巢蛋白/GFAP 细胞群,3～7d逐渐达到高峰,之后逐渐减弱,在损伤后2周左右恢复至对照组水平(P<0.05).正常对照组在脊髓中央管室管膜区有少量巢蛋白/GFAP-细胞,在室管膜区以外的灰质和白质中偶可见染色强度较弱的巢蛋白/GFAP 共存细胞.结论 成年大鼠脊髓损伤可诱导巢蛋白和GFAP的表达.巢蛋白的表达和反应性星形胶质细胞增生呈正相关,且表达多相互共存;星形胶质细胞和神经干细胞对脊髓损伤都有反应,并可能参与中枢神经系统损伤修复.     

Epidural spinal tumor and periaortitis as rare complications of Wegener’s granulomatosis

Abstract

This case report describes findings in a 61-year-old woman who manifested scleritis, small pulmonary nodules, otitis media, periaortitis, and progressive epidural spinal tumor, associated with elevated serum myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels. She was clinically diagnosed with Wegener’s granulomatosis, although vasculitis was not diagnosed due to the lack of typical histological findings. We discuss the differential diagnosis in this patient, and the association of MPO-ANCA with periaortitis or epidural spinal tumor.     

Comparison of the Ferno Scoop Stretcher with the Long Backboard for Spinal Immobilization

Objectives. Spinal immobilization is essential in reducing risk of further spinal injuries in trauma patients. The authors compared the traditional long backboard (LBB) with the Ferno Scoop Stretcher (FSS) (Model 65-EXL). They hypothesized no difference in movement during application andimmobilization between the FSS andthe LBB. Methods. Thirty-one adult subjects had electromagnetic sensors secured over the nasion (forehead) andthe C3 andT12 spinous processes andwere placed in a rigid cervical collar, with movement recorded by a goniometer (a motion analysis system). Subjects were tested on both the FSS andthe LBB. The sagittal flexion, lateral flexion, andaxial rotation were recorded during each of four phases: 1) baseline, 2) application (logroll onto the LBB or placement of the FSS around the patient), 3) secured logroll, and4) lifting. Comfort andperceived security also were assessed on a visual analog scale. Results. There was approximately 6–8 degrees greater motion in the sagittal, lateral, andaxial planes during the application of the LBB compared with the FSS (both p < 0.001). No difference was found during a secured logroll maneuver. The FSS induced more sagittal flexion during the lift than the LBB (p < 0.001). The FSS demonstrated superior comfort andperceived security. Conclusion. The FSS caused significantly less movement on application andincreased comfort levels. Decreased movement using the FSS may reduce the risk of further spinal cord injury.     

The neurotoxicity of intrathecal lidocaine is enhanced in postpartum compared to virgin rats

During the perinatal period, the pharmacokinetics and pharmacodynamics of drugs may be altered. Data about the neurotoxicity of intrathecal local anesthetics in the peripartum period are lacking. So we hypothesized that the neurotoxicity of intrathecal lidocaine during perinatal period may be changed. Therefore, we designed the present study to determine whether the neurotoxicity of intrathecal lidocaine in postpartum rats would be different from that in nonpregnant, virgin rats. Postpartum and nonpregnant rats randomly received an intrathecal infusion of lidocaine 50 mg/mL in saline, lidocaine 20 mg/mL in saline, or saline for 1 h at a rate of 1 μL/min. Four days after drug infusion, the rats were assessed for persistent impairment of sensory and motor function (MF) using the tail‐flick (TF) test, paw pressure test, and MF score. Spinal cords and nerve roots were obtained for light and electron microscopic examinations, and the injury scores were compared between groups. The TF latencies and the mean nerve injury scores of the postpartum group were significantly higher than those of nonpregnant group. Lidocaine induced a dose‐dependent impairment in TF latencies and nerve injury scores. There was no significant interaction between postpartum and the drug. Our results suggest that the neurotoxicity of intrathecal lidocaine is enhanced in rats during the early postpartum period compared with nonpregnant, virgin rats.     

The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in orthopaedic applications

Preclinical proof-of-concept, feasibility and efficacy studies in lower animals resulted in the accumulation of data that served as a backbone for clinical trials with the recombinant, osteogenic bone morphogenetic protein-2 (BMP-2). Among the important observations was the dependence of dose and carrier on the outcome for osseous union in relation to the animal model used. Clinical outcome data for spinal applications indicate better overall results compared with traditional controls that utilised autogenous iliac crest bone graft for fusion. Parameters include less blood loss, less operating room time and costs, better fusion outcomes and increased patient satisfaction. At this juncture, the long journey from the identification of BMP-2 in demineralised bone fraction to FDA approval for use in a singular orthopaedic application has been completed. It has been demonstrated to be safe, efficacious and cost-effective, leading to increased patient satisfaction and improved clinical outcome.     

Cell transplantation for spinal cord injury focusing on iPSCs

Introduction: Reports of functional recovery from spinal cord injury (SCI) after the transplantation of neural stem cells (NSCs) derived from fetus/embryonic stem cells (ESCs), has raised great expectations for the successful clinical use of stem cell transplantation therapy. However, the ethical issues involved in destroying human embryos or fertilized oocytes to obtain NSCs have been a major obstacle to developing clinically useful stem cell sources, and the transplantation of stem cells isolated from other human embryonic tissues has not yet been developed for use in clinical applications.

Areas covered: Recently, induced pluripotent stem cells (iPSCs), which can serve as a source of cells for autologous transplantation, have been attracting a great deal of attention as a clinically viable alternative to stem cells obtained directly from tissues. In this review, the authors outline the neural induction of ESC/iPSC, their therapeutic efficacy in SCI and their safety in vivo.

Expert opinion: Although iPSCs offer great promise as the cell source for autologous transplantation for SCI, safety issues including tumorigenicity should be determined prior to the clinical trial.     

三种术式治疗腰椎不稳症的临床疗效观察

目的 探讨3种术式治疗腰椎不稳症的疗效.方法 对86例腰椎不稳症分3组,用3种手术方式治疗,对治疗结果进行回顾性统计分析.结果 86例术后随访8～48个月,平均26个月.根据影像学检查,3组植骨融合率分别为78%、92.5%、95.5%.术后优良率分别为:1年82.5%,84.2%,85.5%;2年79.5%,84%,85.2%;3年75.8%,83.6%,85%.结论 单纯后路植骨远期疗效不如联合椎弓根螺钉内固定加椎间融合;应根据腰椎退变及硬膜囊神经根受压的程度选择合适的融合术式.     

去铁敏对损伤脊髓一氧化氮合酶表达的影响

目的 研究去铁敏(DFO)对急性脊髓损伤大鼠的神经功能保护作用及对3种一氧化氮合酶(NOS)亚型表达的影响.方法 利用Allen's打击模型,致伤力为25gcf(10g×2.5cm),选用SD大鼠36只,随机分为3组(n＝12):空白组(C组);脊髓损伤组(生理盐水组,S组);去铁敏治疗组(DFO组).分别于伤后4小时取材,免疫组化方法检测3种NOS亚型的表达情况,并于伤后5周行BBB评分.结果 DFO组及S组伤后上述指标比较差异有统计学意义(P<0.05或P<0.01).结论 去铁敏通过阻断铁离子引发的脊髓组织脂质过氧化反应而减轻脊髓组织的炎症反应,减少诱导型NOS(iNOS)的表达;并通过减轻脊髓组织细胞内钙超载,降低固有型NOS(cNOS)的活性,减少了脊髓组织的继发损伤程度.     

大鼠中度脊髓损伤后两种后肢行为学评估标准的比较研究

目的对大鼠中度脊髓损伤后两种后肢行为学评估标准进行评价。方法24只雄性Wistar大鼠随机分为假手术组和损伤组。损伤组采用Alleng打击法制作脊髓损伤模型，假手术组仅行椎板切除术。术后1、3、7、14、21天分别采用Tarlov评分和BBB（basso，beattie and bresnahan）评分对两组大鼠后肢运动功能恢复情况进行评估。结果两组大鼠BBB评分值在伤后各时间点差异均非常显著（P〈0．01），Tarlov评分值在伤后各时间点有显著性差异（P〈0．05），但只在1、3、7天时差异才非常显著（P〈0．01）；评分值按百分制换算后，假手术组大鼠两组评分值之间的一致性较好，仅在伤后7天时有显著性差异（P〈0．05），损伤组大鼠两组评分值之间的差异较大，伤后1、3、7天时差异非常显著（P〈0．01）。结论BBB评分的敏感性和区分度优于Tarlov评分，能更准确、客观地反映大鼠中度脊髓损伤后运动功能恢复情况。     

前路内固定矫正结核性脊柱畸形

目的　总结前路病灶清除、椎体间植骨和前路内固定手术治疗结核性脊柱畸形的临床疗效 ,探讨前路内固定植入在脊柱结核外科治疗中的安全性和价值。　方法　 1997年 6月～ 2 0 0 1年5月 ,采用前路病灶清除、椎体间植骨和一期前路内固定手术治疗脊柱结核 18例 ,其中颈椎 1例 ,胸椎10例 ,胸腰段 2例 ,腰椎 5例。平均每例受累椎体 2 8个。脊柱后凸畸形角度 2 7 0°～ 75 5°,平均47 5°± 11 4°。均采用髂骨植骨。　结果　 18例病例均获得随访 ,平均随访时间 2 5个月。所有病例均未出现伤口深部感染或窦道形成 ,植骨均完全融合 ,平均融合时间为 3 6个月。后凸畸形矫正度数为 32 7°± 8 3°,后期矫正度丢失 3 2°± 2 8°。　结论　前路内固定手术在脊柱外科治疗中能有效地达到矫正后凸畸形、重建脊柱稳定性和促进椎体间植骨融合的目的 ,是一种安全和有效的治疗方法。