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Objective To investigate the effects of quercetin on glial scar formation and axonal regeneration after spinal cord injury (SCI) and its association with the p38 mitogen activated protein kinase (MAPK) signal pathway.Methods 128 female Sprague-Dawley (SD) rats were randomly divided into a control group (SCI + saline),an intervention group (SCI + quercetin + anisomycin),a treatment group (SCI + quercetin) and a sham-operation group (n =32).Basso Beattie Bresnahan (BBB) assessment and footprint analysis of the hind limb were performed on days 1,3,7,14,21 and 28 postoperation in each group.The expression levels of p38MAPK,phosphorylation p38MAPK,glial fibrillary acidic protein (GFAP) and neurofilament protein-200 (NF-200) were detected by Western blot.The numbers of GFAP and NF-200 positive staining cells in the injured spinal cord in each group were detected by immunohistochemistry.Results The BBB scores in the treatment group were significantly higher than in the intervention and control groups at each time point after SCI except on day 3 postoperation (P ＜ 0.05).The expression levels of phosphorylation p38MAPK protein in each SCI group were significantly higher than in the sham-operation group on days 3 and 7 postoperation (P ＜ 0.05).The expression levels of phosphorylation p38MAPK protein in the treatment group were significantly lower than in the control and intervention groups on days 3,7 and 14 postoperation (P ＜ 0.05),but there was no significant difference on day 28 postoperation among all the groups (P ＞ 0.05).The numbers of NF-200 and GFAP positive staining cells were significantly greater than in the sham-operation group at each time point postoperation (P ＜ 0.05);the NF-200 positive staining cells in the treatment group were significantly increased in comparison with the control and intervention groups (P ＜ 0.05);the GFAP positive staining cells in the treatment group were significandy fewer than in the control and intervention groups on days 7,14 and 28 postoperation (P ＜ 0.05).Conclusions Quercetin may have protective effects against acute SCI by decreasing glial scar formation,increasing axonal regeneration and promoting recovery of locomotor and nerve function in rats.The effects may be correlated with inhibition of the p38MAPK signal pathway.
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Objective To investigate the stability of lumbar single?level dynamicly fixed by socket track pedicle screws after decompression. Methods Socket track pedicle screws are made of titanium?alloy, swing like universal screw within the scope of 18° in the sagittal plane and 8° in the horizontal plane. Motion constraints were due to the hole which the screw goes through. Six pig spines (L1-5) were tested by applying a pure moment of 4.018 Nm in 3 directions of loading. The range of motion (ROM) of the following groups underwent different surgical procedures was measured:(1) intact;(2) dynamic fixation 1 (decompres?sion by total laminectomy and instrumentation with socket track pedicle screws); (3) dynamic fixation 2 (decompression by total laminectomy and bilateral facetectomy while instrumentation with socket track pedicle screws);( 4) instability resulted from decom?pression (decompression by total laminectomy plus bilateral facetectomy without any rod);(5) hybrid fixation (decompression by to?tal laminectomy and bilateral facetectomy while instrumentation with 2 socket track pedicle screws connected with 2 unilateral pedicle screws ). Results Compared with the intact specimens (in flexion, extension, lateral bending and rotation, corresponding angular displacements were 1.84°±0.75°, 1.55°±0.34°, 2.2°±1.07°, 2.06°±0.76° respectively), the ROM of segment L3, 4 of each group were significantly restricted except for axial rotation. In flexion, extension and lateral bending, the ROM was reduced to 0.71°±0.39°, 0.46°±0.18°, 0.85°±0.66° in dynamic fixation 1 group;0.79°±0.43°, 0.71°±0.20°, 1.17°±0.48° in dynamic fixation 2 group and 0.63°±0.50°, 0.37°±0.19°, 0.54°±0.60° in hybrid fixation group. The rotation ROM of dynamic fixation 1 group and hy?brid fixation group were decreased to 1.50°±0.64° and 1.22°±0.36°, whereas the ROM of dynamic fixation 2 had a non?significant reduction to 1.85°±0.67°. The extension and rotation ROM of dynamic fixation 2 increased significantly comparing to dynamic fixa?tion 1 group; the extension, lateral bending and axial rotation ROM of hybrid fixation group were reduced comparing to the state of dynamic fixation 2 group. Conclusion The dynamic instrumentation of single?level lumbar spine with socket track pedicle screws could offer stability in all directions. The flexion, extension, lateral bending and rotation ROM of spine with dynamic instru?mentation after total laminectomy and bilateral facetectomy could be reduced.
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Objective To investigate the effects of bone marrow stromal cell (BMSC) transplantation on axonal and glial scarring after spinal cord injury (SCI).Methods Thirty New Zealand white rabbits were randomly assigned to a sham operation group (group A),a saline treatment group (group B) or a BMSC treatment group (group C).Group A served as controls,in which the canal was opened without damage to the spinal cord.In groups C and B SCI models were established with aneurysm clips and the rabbits of groups C and B were then given injections of BMSCs and saline solution respectively via the intra-intercostal artery at 1 week post injury.At 1 day,1 week,2 weeks and 4 weeks post injury,Basso Beattie-Bresnahan (BBB) scores were assessed to evaluate the recovery of locomotor function in the hind limbs.Spinal cord samples were harvested for HE and Nissl staining,and immunohistochemistry and image analysis were used to detect any changes in neurofilament (NF200) and glial fibrillary acidic protein (GFAP) in the injured spinal cords.Results The average BBB scores of group A were significantly higher those that of groups B and C at each time point,and those of group C were significantly better than those of group B at the 2nd and 4th week post injury.At the 4th week post injury,HE staining showed there was no glial scarring or cavities in group A,but that there was glial cellular proliferation,glial scarring and cavity formation at the injury site in groups B and C.In group C all were obviously less than in group B.Nissl staining indicated there were more typical neurons in group A,while there were a larger number of ruptured neurons,more degradation,and irregular remaining neurons in groups B and C.These abnormalities were again significantly more prevalent in group C.Immunohistochemical examination showed significant increases in NF200 positive neurons and GFAP in groups B and C compared with group A.The number of NF200 positive neurons was significantly higher in group C than in group B,but the GFAP positive area was significantly smaller in group C than in group B.Conclusion BMSC transplantation via the intercostal arteries can effectively improve axonal regeneration,attenuate glial cellular proliferation and reduce glial scar formation,promoting functional recovery after SCI,at least in rabbits.
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Objective To evaluate the effect of special rectification of clinical antimicrobial use in a hospital. Methods Medical records of patients receiving inguinal hernia repair before (in 2011)and after (in 2012)the per-formance of special rectification were reviewed,and the rationality of perioperative antimicrobial prophylaxis was compared.Results Prophylactic antimicrobial usage rate in patients receiving inguinal hernia repair decreased from 53.90%(76/114)in 2011 to 5.59%(10/179)in 2012,the difference was significant (χ2 =93.68,P <0.05);aver-age expense of antimicrobial use per patient decreased by 86.95% (from ￥ 624.73 in 2011 to ￥ 81 .52 in 2012);Combination use and single use was 93.42% and 80.00% respectively.Surgical site infection did not occur in both groups.Conclusion Through the special rectification activities of the clinical antimicrobial use,perioperative anti-microbial prophylaxis and expense of antimicrobial agents in patients receiving inguinal hernia repair is effectively re-duced.
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Objective To establish bladder reflex arc with sensory afferent pathway using SD rats,and evaluate its effect in the treatment of atonic bladder after spinal cord injury.Methods Twenty-four male SD rats were used in the study.For each rat,the right side was the experimental side,and the left side was the control side.In the right side,the L5 ventral root (VR) was anastomosed to S2 VR,and the distal end of S2 dorsal root (DR) was anastomosed to the proximal end of L5 peripheral process of dorsal ganglion.In the left side,no treatment was done.In order to evaluate the validity of the bladder reflex arc,general observation,neuro-electrophysiological test and wheat germ agglutinin horseradish peroxidase (WGA-HRP) method were used before and after the spinal cord destruction between L6 and S2 level at 3 months postoperatively.Results Twenty-one rats survived 3 months after the operation,and anastomotic nerves were separated successfully only in seven rats.Compound action potentials (CAPs) of plexus vesica and compound muscle action potentials (CMAPs) of bladder smooth muscle were found by electrical stimulation in distal end of the anastomotic stoma of the right S2 DR.There was no statistically significant difference in action potential before and after paraplegia.No action potential was detected in control sides after paraplegia.The curves of CAPs and CMAPs in the right side were similar to those in the control side,and the mean maximum amplitude reached respectively 71.9％ and 82.4％ of those in the left side before paraplegia.In addition,WGAHRP labeled cells were observed in L5 anterior horn and posterior horn in the experimental side after WGAHRP injection.Conclusion Reconstruction of bladder reflex arc with sensory afferent pathway can promote axonal regeneration of motor and sensory nerves,and then the regenerated axon could contact with cells in anterior and posterior horn of spinal cord through parasympathetic nerves,ultimately the capability of axoplasmic transportation could be reestablished.Therefore,this method can be used for treating atonic bladder.
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Objective To provide the morphological evidence for sensory pathway by the repair of dorsal root (DR) in which received transected and anastomosed with central processes (DR) and peripheral processes (spinal nerve) respectively. Methods 74 SD rats were divided into three groups randomly. Group A: the distal ending of L6 DR was sutured to the proximal ending of the L4 DR in right side. Group B: the postganglionic spinal nerve of L4 was cut at a point 2 mm to intervertebral foramen and its proximal stump was reconnected to the distal ending of L6 DR in right side. Group C: under the same operative manipulation on group B, but no anastomosis was performed to serve as the sham operation group. The left side was kept intact and served as a normal control in all groups. The repairing results of DR axonal regeneration were evaluated at 3 months after operation by retrograde tracing, the density of positive Calcitonin gene-related peptide (CGRP) axon in dorsal root entry zone (DREZ), survival rate of neurons in DR ganglia and posterior horn, light and transmission electron microscope. Results HRP retrograde tracing demonstrated axonal axoplasmic transport of regenerative nerve recovered well in group B. Regenerative fibers were found. There was no difference between group A or B and normal control with regard to the number of myelinated axons and the thickness of myelin. Regenerating axon stop at the DREZ in group A and the density of positive CGRP were lower than those in group B and normal control. Survival rate of neurons in L6 DR ganglia had no difference among all groups. However, in posterior horn, a significant increase in death was seen in group A and sham group. Conclusion The ability of axonal regeneration was effective and with no disservice to neurons in posterior horn following anastomosis of postganglionic spinal nerve and dorsal root, by which axoplasmic transport across the DREZ into the spinal cord.
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Objective To summarize and explore the clinical value of selective partial neurotomy of muscular branch of triceps in the treatment of spastic talipes equines.Methods Forty-two cases were included in our study from Aug.2000 to Des.2007,all these cases accepted the operation of selective partial neurotomy muscular branch of triceps.In this study,29 cases were male,13 cases were female.Muscle force of legs,muscular tension,pathologic reflex,gesture and function of legs after operation were compared with that of before operation.Results The mean fallow-up was 18 months.During the fallow-up of this study,muscular tension degraded,the function of ankle joints and the gesture of extremitas inferior were improved obviously.The effective power was about 90% after 12 months follow-up.Conclusions Selective partial neurotomy of muscular branch of triceps is a effective method for the treatment of spastic talipes equines.The operation procedure is simple and effective,and could be generalized in the primary level hospital.
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Objective To investigate and analyze whether the different types of radial head fracture and internal fixations have influence on the out comeof elbow function after surgery. Methods We reviewed the clinical data of 46 cases of radial head fractures from August 2002 to December 2008, 34 males, and 12 females, aged from 19 to 51years. All these cases underwent open reduction and internal fixation including fixation with Kirschner wire fixation, mini-plate and/or screw fixation and radial head resection. Results Forty-six cases were followed up in this study for a period of 8 months to 4 years (mean 2 yeats and 4 months).According to Mayo assessment of elbow function, the results of 35 cases were excellent or good (35/46 cases, 76.1%). Better function recovery was got in those who were preferred mini-screw internal fixation or combined with mini-plate. The same results were also found in those with Mason type Ⅱ fracture and in those underwent surgery within 2 weeks. Conclusions Good results can be got through surgical treatment as the indication of open reduction is clear, especially in cases with radial head fracture of Mason type Ⅱ and Ⅲ.The type of radial head fracture, the method of internal fixation and the timing of surgery all affect the outcome.
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BACKGROUND: Several studies have demonstrated that bone marrow mcscnchymal stem cells (MSCs) can differentiate into osteoblasts after induction of bone morphogenetic protein (BMP).OBJECTIVE: This study was designed to compare the osteogenetic effects between MSCs, bBMP, and fibrin gel alone and their composite.DESIGN: A controlled observation experiment.SETTING: Second People's Hospital of Guangdong Province and Second Hospital Affiliated to Sun Yat-sen University.MATERIALS: This study was performed at the Second Hospital Affiliated to Sun Yat-sen University between January 2004 and June 2006. Healthy New Zealand rabbits were provided by the Laboratory Animal Center, Sun Yat-sen University.METHODS: Bone marrow was taken from the lilac bone. By density gradient centrifugation, autologous MSCs were in vitro cultured and amplified. A composite was made of fibrin gel and bovine bone morphogenetic protein (bBMP). After adding MSCs, another composite was made. Twelve rabbits underwent lumbar L3/4, LA/5, and LS/6 discectomy and interbody fusion via an anterior retroperitoneal approach. Three fusion sites in each animal were randomly assigned into three of four treatments: composite of MSCs and hBMP and fibrin gel (group A), composite of MSCs and fibrin gel (group B), composite of bBMP and fibrin gel (group C) and fibrin gel alone (group D). The interbodies were observed radiologically and histologically 3 months after surgery.MAIN OUTCOME MEASURES: Bone formation in the spinal interveRebral space of rabbits.RESULTS: Twelve weeks after surgery, bone formation was appasenfly greater in the Group A than in the other groups.Histological findings revealed continuous bone formation. The groups B and C showed equivalent radiological and histological changes. Bone formation was intermittent. Group D had fibrous union, but no bone formation. No residual fibrin gel was found in all groups, but a small amount of residual nucleus gelatinosus with a little cartilaginous tissue was visible in the intervertebral disc.X-ray examination results did not reveal vertebral posterior hyperplasia or spinal stenosis. There was significant difference in range of lumbar motion between the group B and the groups C and D (P ＜ 0.05). No pronounced difference in vertebral posterior height loss existed among the groups.CONCLUSION: The composite of MSCs, fibrin gel and bBMP can promote bone regeneration and achieve osseous spinal fusion.
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[Objective]To discuss the indication and attentive affairs among single and combined surgical treatments for spastic cerebral palsy by analyzing the therapeutic efficacy of different operations,such as lengthening tendon,osteotomy and neurectomy,etc.[Method]Six hundred and forty-two patients(aged 10 months to 37 years)were treated with combined operations of different operations,including traditional operations on soft tissue release,osteotomy,selective posterior rhizotomy,selective rhizotomy and converse anastomosis,neurectomy,etc.The follow-up period ranged from 6 months to 4 years(mean 18 months).[Result]The traditional soft tissue release and lengthening was still the major surgical treatment to cerebral palsy.It resulted on rectifying fixed contracure and deformity,although could not decrease muscular tension.The decisive processes lied on neurectomy.Though the selective posterior rhizotomy and selective peripheral neurectomy reduced muscular strength partially in the early stage,the muscular tension was also reduced,therefore the range of motion of joints was enlarged and the functions of extremities were strengthened.[Conclusion]Classifying the types of cerebral palsy carefully,mastering the indications of all sorts of surgical treatment strictly,realizing the latent complications of different operations,combining different processes of surgical treatment can enhance therapeutic efficacy,reduce recurrence of convulsion and malformed,as well as avoiding serious complications during therapy.In addition,postoperative exercise is also the basic treatment to spastic cerebral palsy.
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BACKGROUND: Since there are only cell axons of neurons in peripheral cells, the study on neural stem cells (NSCs) is almost focused on neuronal cells, for which, the study on repair of peripheral nerve may be based on some experiences in NSCs.OBJECTIVE: To observe the repair of peripheral nerve after graft of autologus bone marrow derived NSCs in the injured area. To observe whether the grafted NSCs were survived and migrated in spinal cord as differentiated neurons in the injured area of peripheral nerve or not.DESIGN: Observed controlled experiment was designed.SETTING: Institute of Neurological Medicine of Zhujiang Hospital affiliated to Southern Medical UniversityMATERIALS: Eight New Zealand big white rabbits were employed, of clean grade, mass weighted varied from 1.5 to 2.5 kg and of either sex.METHODS: The experiment was performed in Institute of Neurological Medicine of Zhujiang Hospital affiliated to Southern Medical University collected from New Zealand big white rabbits for culture and differentiation was prepared. Sciatic neural injured area of one side was randomized as graft side. Physiological saline, collagen matrix and cellular embedding solution were infused up to 0.01 mL (containing stem cells 1×1010L-1). Another side was taken as the control, in which, collagen matrix suspension 0.01 mL was infused. Peffusion and fixation were followed 3 months after graft and auto-graft was performed in the injured peripheral nerve. The materials were collected for observation from graft area, spinal cord area, injured area on the opposite side and normal neural area.MAIN OUTCOME MEASURES: Morphology of nerve fibers and neuronal cells in NSC graft area, spinal cord area and non-graft area on opposite injury side.RESULTS: The density and continuity of nerve fibers grown in graft area were higher remarkably than non-graft area on opposite side and more Schwann cells were seen under optic microscope. With amplified ×400 visual field, Ranvier's node of spinal nerve fiber was visible. In addition,mucous matrix and few fibroblasts were seen also in the space of nerve fibers. The survived neuronal cells were no visible in graft area, spinal cord area and non-graft area of sciatic injury on the opposite side.CONCLUSION: Graft of autologus bone-marrow derived neural stem cells in defect area of peripheral area benefits repair of nerve fibers. But the neural stem cells cannot survive as neurons in graft area of peripheral nerve, spinal cord area and the defect control on the opposite side.