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<p><b>OBJECTIVE</b>To conduct a clinical trial of ketogenic diet (KD) in patients with acute spinal cord injury (SCI) and evaluate its safety and feasibility by measuring blood ketone bodies and blood glucose levels.</p><p><b>METHOD</b>Ten patients with acute SCI were recruited in the trial during the period from May, 2012 to October, 2013. The patients received a standard KD after fasting for 48 h. The levels of blood ketone, blood glucose and uric ketone were tested daily, and routine blood examination, electrolytes, liver and kidney function, body mass index (BMI), sensory and motor function, and adverse reactions were monitored weekly to assess the safety and feasibility of KD.</p><p><b>RESULTS</b>KD treatment lasted for a mean of 12.9 days (4 to 29 days) in these patients. In all the patients, blood ketone level increased during the fasting and maintained a level above 2.0 mmol/L after taking KD, while the uric ketone level ranged from +++ to ++++. The blood glucose level was in the normal range during KD. Except for blood chloride level and BMI, routine blood test results, electrolytes, liver and kidney function showed no significant changes after KD. No significant changes were observed in the sensation of light touch and pinprick. The average motor ASIA score increased from 33.3 to 35.1 after KD. Gastrointestinal dysfunction (diarrhea, nausea, poor appetite, gastric pain, and abdominal distension) was recorded in 5 patients, hypoglycemia occurred in one patient early after KD, and one patient experienced urticaria during KD. All the adverse reactions were relieved after symptomatic treatments.</p><p><b>CONCLUSION</b>This preliminary clinical trial demonstrated that KD could increase ketone bodies level and maintain a normal blood glucose level, suggesting its safety and feasibility in patients with acute SCI.</p>
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Diet, Ketogenic , Methods , Feasibility Studies , Spinal Cord Injuries , Diet Therapy , Treatment OutcomeABSTRACT
Objective To investigate the causes and prevention strategies of postoperative spinal cord injury after anterior approach surgery for cervical spondylotic myelopathy. Methods The clinical data of 749 patients with cervical spondylotic myelopathy treated with anterior approach surgery from 2001 to 2009 were retrospectively studied.There were five patients with spinal cord dysfunction instantly or early after operation,including three males and two females at average age of 52 years (range,48-62 years).Two patients were combined with ossification of the posterior longitudinal ligament.The Japanese Orthopaedic Association (JOA) score was average 12.4(9-16)preoperatively.The surgeries included anterior cervical diskectomy(or corpectomy)and interbody fusion(iliac bone graft or cage or titanium mesh)and locking plates fixation.The blood loss was 50-200 ml.The symptoms included instant spinal cord injury in two patients,loss of the motor and feeling of both legs at 6 h after surgery in one,paralysis of one side limbs at 24 h after surgery in one and numbness of limbs at 5 days after surgery in one.Four patients were treated by large dose of methylprednisolone.Five patients underwent anterior exploration surgery,of which one patient received posterior cervical one-door expansive laminoplasty. Results The patients were followed up for average 16 months(12-24 months).The JOA score of four patients was recovered at three months and WaS better than preoperation after surgery.The function of spinal cord of one patient showed no improvement at one year after surgery.The causes for spinal cord injury included inappropriate surgical manipulation in decompression and haemostasis in two patients,insufficient decompression in one,epidural hematoma in one and absorbable hemostatic gauze in one. Conclusions The major causes of postoperative spinal cord injury in anterior approach surgery for cervical spondylofic myelopathy are the delayed postoperative injury.The spinal cord can recover to normal and has satisfactory prognosis if discovered promptly.We must avoid the spinal cord injury by surgical Manipulation that may result in permanent neurological deficits.
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Objective To study the possibility of inducing human umbilical cord blood mesenchymal stem cells(MSCs) to differentiate into neuron-like cells by lithium chloride(LiCl) in vitro.Methods Human umbilical cord blood was collected from mature neonates.All samples were obtained sterilely with 20 U/ml heparin.The cord mononuclear cells were isolated with lymphocyte separation medium(density 1.077 g/ml), then purified by wall sticking screening and expanded with slight sugar DIEM containing 15% FBS.The third passage of the expanded MSCs were pre-inducted with DIEM containing 15% FBS and 20 ng/ml bFGF for 24 hours, then induced with DIEM without serum but 3 mol/L LiCl for 6 days in group A.The MSCs were induced with DIEM containing 3 mol/L Licl for 7 days in group B.The MSCs were normally cultured with DIEM containing 15% FBS in group C.The morphological changes of the cells were observed under phase contrast microscope.The neuron specific markers containing neuron specific enolase(NSE), microtubule associated protein2(MAP2) and glial fibrillary acid protein(GFAP) were evaluated by indirect immunocyto-chemistry staining.Results After inducted for 3 days, morphological changes were observed obviously in group A and B.6 days later, the differentiated cells showed typical neuronal morphology.The expression of NSE and MAP2 were positive for the majority cells in group A and B, and that of group A[(73.6 ± 7.8)%, 75.5 ± 8.5)% respectively]were obviously higher than group B[(31.0 ± 4.3)%,(33.5 ± 5.0)% respectively], few expressed GFAP in both groups.Conclusion The combination of LiCl and growth factor may induce the human umbilical cord blood MSCs into neuron-like cells in vitro.
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BACKGROUND: Basso, beattie and bresnahan (BBB) score and tilt table test are associated with the height of spinal cord injury degree in study of spinal cord models. OBJECTIVE: To establish modified complete spinal cord transected rat models, and to observe effects of BBB score and tilt table test on function following human umbilical cord blood mesenchymal stem cell transplantation. DESIGN, TIME AND SETTING: The observation control experiments were performed at the Key Laboratory of Tissue Construction and Detection of Guangdong Province from April 2007 to July 2008. MATERIALS: Cord blood was collected from healthy puerperants after full-term delivery. Fifty SPF healthy adult female Sprague Dawley rats were randomly divided into group A (sham operation) (n=10), group B (spinal cord transection and phosphate buffered saline, PBS injection) (n=20), group C (spinal cord transection and hMSCs transplantation) (n=20). METHODS: Human umbilical cord blood stem cells were harvested and cultured in vitro. After incising rat dural sac, arachnoid membrane, spinal cord, bilateral wall and ventral dura mater of spinal cord were completely incised in the dural mate of spinal cord to establish complete spinal cord transected rat models. Vertebral plates were only opened in the group A. Rats in the group C were injected with human umbilical cord blood mesenchymal stem cells (6?109 -7?109L-1) at two broken ends of fractured spinal cord. Phosphate buffer saline was injected into rats in the group B. MAIN OUTCOME MEASURES: At 12 weeks after surgery, a behavioral testing was performed every 2 weeks upon each hindlimb for all animals by using the BBB scoring system and tilt table test. RESULTS: No significant difference in hindlimb motor function was detected in the group A. From the second weeks after surgery, motor function of hindlimbs was gradually recovered in the groups B and C. BBB scoring system and tilt table test showed a consistent increasing tendency in a positive correlation. From the fourth week after surgery, significant difference in tilt table test was detected between rats with BBB score
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[Objective]To establish effective and reliable complete spinal cord transection models in rats,and to investigate the effects of micromanipulation used in surgical procedure of transected spinal cord treated with human umbilical cord blood stem cells(UCBSCs) grafts in rats.[Method]Human UCBSCs were obtained from umbilical cord blood of term deliveries.Sixty Sprague-Dawley(SD) female rats were divided randomly into group A(control group),group B(spinal cord transection and PBS injection),group C(spinal cord transection and UCBSCs transplantation) and group D(spinal cord transection and UCBSCs transplantation by using micromanipulation).All groups were operated,and 1 ?l UCBSCs(6?109/L ~7?109/L) were injected into the both ends of the completely transected spinal cord at the groups C and D by two different surgical procedures respectively.From 1 week to 8 week post-operation,a behavioral testing was performed weekly upon each hindlimb for all animals according to the BBB scoring system.At the 8th week,all animals were sacrificed and the spinal cords were taken out for morphological observation.[Result]No changes were observed at group A pre-and post-operation.After 2 weeks post-operation,the hindlimb motor function of groups C and D began to recover.After 3 weeks post-operation,the group D showed more improvement than group C,and the difference between groups D and C were significant in the BBB scores(P
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Objective To investigate the early clinical efficacy of percutaneous kyphoplasty using the Sky Bone Expander system in the treatment of osteoporotic compression fractures. Methods Twelve cases of osteoporotic vertebral body compression fracture (17 vertebrae) underwent percutaneous kyphoplasty using the Sky Bone Expander system. During the operation the unipedicle technique was applied and the expansion height was 14 mm for bone cement injection. Surgical complications and the restoration of vertebral height and kyphosis angle were observed. The pain of thoracic and lumbar region on the back was evaluated with the visual analogue scale (VAS). Results The operative time for each vertebra was 52.4?28.7 min (range, 23～90 min), with a volume of 5.4?1.0 ml (range, 3.5～7 ml) of cement injected. A follow-up was made for 3～6 months (mean, 4.5 months). The VAS scores were 7.6?1.8 points preoperatively, 2.8?1.1 points at day 1, 2.6?1.2 points at day 3, and 2.2?1.0 points at last follow-up. Preoperatively, the anterior vertebral height was 13.8?5.3 mm (compression by 49.1%?19.1%) and the midline vertebral height was 9.9?4.6 mm (compression by 39.8%?18.4%), while postoperative anterior and midline vertebral height were 16.6?4.8 mm (compression by 59.1%?17.2%) and 15.2?4.0 mm (compression by 60.6%?16.9%), respectively. The kyphotic angle was decreased from 22.3??8.5? preoperatively to 12.5??6.4? postoperatively. Intervertebral disc leakage of bone cement was observed in 1 case with no symptoms. There were no other surgical complications. Conclusions Kyphoplasty using the Sky Bone Expander system is an effective and safe treatment for osteoprotic vertebral compression fractures. The long-term outcomes are subject to further observations.