Neural Stem Cells Transfected with Leukemia Inhibitory Factor Promote Neuroprotection in a Rat Model of Cerebral Ischemia / 神经科学通报·英文版

Leukemia inhibitory factor (LIF) contributes to the neuroprotection by neural stem cells (NSCs) after ischemic stroke. Our aim was to explore whether LIF-transfected NSCs (LIF-NSCs) can ameliorate brain injury and promote neuroprotection in a rat model of cerebral ischemia. To accomplish this goal, we transfected NSCs with a lentivirus carrying the LIF gene to stably overexpress LIF. The LIF-NSCs reduced caspase 3 activation under conditions of oxygen-glucose deprivation in vitro. Transient cerebral ischemia was induced in rats by 2 h of middle cerebral artery occlusion (MCAo), and LIF-NSCs were intravenously injected at 6 h post-ischemia. LIF-NSC treatment reduced the infarction volume and improved neurological recovery. Moreover, LIF-NSCs improved glial cell regeneration and ameliorated white matter injury in the MCAo rats. The NSCs acted as carriers and increased the expression of LIF in the lesions to protect against cerebral infarction, suggesting that LIF-NSCs could be a potential treatment for cerebral infarction.

The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia

STUDY DESIGN: Retrospective clinical series. PURPOSE: To study the clinical, functional and radiological results of patients with tuberculous spondylitis with and without paraplegia, treated surgically using the "Extended Posterior Circumferential Decompression (EPCD)" technique. OVERVIEW OF LITERATURE: With the increasing possibility of addressing all three columns by a single approach, posterior and posterolateral approaches are gaining acceptance. A single exposure for cases with neurological deficit and kyphotic deformity requiring circumferential decompression, anterior column reconstruction and posterior instrumentation is helpful. METHODS: Forty-one patients with dorsal/dorsolumbar/lumbar tubercular spondylitis who were operated using the EPCD approach between 2006 to 2009 were included. Postoperatively, patients were started on nine-month anti-tuberculous treatment. They were serially followed up to thirty-six months and both clinical measures (including pain, neurological status and ambulatory status) and radiological measures (including kyphotic angle correction, loss of correction and healing status) were used for assessment. RESULTS: Disease-healing with bony fusion (interbody fusion) was seen in 97.5% of cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine and 207.3% in lumbar spine. Corresponding loss of correction was 3.6 degrees in dorsal spine and 1.9 degrees in the lumbar spine. Neurological recovery in Frankel B and C paraplegia was 85.7% and 62.5%, respectively. CONCLUSIONS: The EPCD approach permits all the advantages of a single or dual session anterior and posterior surgery, with significant benefits in terms of decreased operative time, reduced hospital stay and better kyphotic angle correction.

Prediction of Neurological Recovery in Patients with Hypoxic-ischemic Encephalopathy

The incidence of hypoxic-ischemic encephalopathy (HIE) is not well known, however, the common causes of hypoxic-ischemic encephalopathy are sudden cardiac arrest, acute respiratory failure and carbon monoxide poisoning. Due to high metabolic demand, the brain is very susceptible to damage from deprivation of blood supply and oxygen delivery. When patients recover from comatose after HIE, there are various spectrums of neurological outcomes, ranging from vegetative state to good recovery. Various methods including neurologic examination, neurophysiologic and biochemical tools, neuroimaging technique have been proposed for the prognostic evaluation of HIE. This article reviews the pathophysiology of HIE and predictive methods for neurological recovery after HIE.

Papel neuroprotector da hipotermia terapêutica pós paragem cardio-respiratória / The neuroprotective role of therapeutic hypothermia after cardiac arrest

OBJECTIVOS: A hipotermia terapêutica demonstrou ter efeitos neuro e cardioprotectores, com melhoria da sobrevida e redução das sequelas neurológicas em doentes vítimas de paragem cardio-respiratória. O objectivo deste estudo foi avaliar a evolução dos doentes submetidos a hipotermia terapêutica após paragem cardio-respiratória. MÉTODOS: Estudo prospectivo observacional dos doentes submetidos a hipotermia terapêutica após paragem cardio-respiratória numa unidade de cuidados intensivos polivalente durante 10 meses. Aos doentes admitidos até 12 horas após paragem cardio-respiratória foi induzida a hipotermia terapêutica através da administração de fluidos arrefecidos e arrefecimento corporal externo e mantida a temperatura alvo, 33°C, durante 24 horas. RESULTADOS: Foram incluídos 12 doentes, idade (mediana) de 64 anos, 58 por cento do sexo masculino. A paragem cardio-respiratória ocorreu em meio hospitalar em 6 doentes. O índice de Charlson, o Sequential Organ Failure Assessment (SOFA) e o Acute Physiology and Chronic Health Evaluation II, no primeiro dia, foram 2.9 [IIQ 6.8], 11 [IIQ 2.75], e 24.5 [IIQ 15.25], respectivamente. A taxa de mortalidade na unidade de cuidados intensivos polivalente foi de 42 por cento (N=5). Dos 7 sobreviventes, 5 recuperaram o estado neurológico prévio à paragem cardio-respiratória. A hipotermia terapêutica foi iniciada cerca de 120 minutos [IIQ 78.75], após recuperação de circulação espontânea. A maioria dos doentes (75 por cento) necessitou de suporte vasopressor. Foi constatado, nos 3 dias subsequentes à paragem cardio-respiratória e hipotermia terapêutica, uma diminuição do valor mediano de SOFA (11[IIQ 2.75], no dia 0, 10 [IIQ 3], no dia 1 e 7 [IIQ 4.5], no dia 2). CONCLUSÃO: A aplicação de um protocolo de hipotermia terapêutica revelou ser simples e eficaz e permitiu obter em doentes com indicação, boa recuperação neurológica.

OBJECTIVES: Therapeutic hypothermia following cardiorespiratory arrest has been demonstrated to have cardio- and neuroprotective effects, resulting in improved survival and better neurological outcomes. The objective of this study was to assess the outcomes of patients undergoing therapeutic hypothermia following cardiorespiratory arrest. METHODS: A prospective, 10-month observational study of patients admitted to an intensive care unit and undergoing therapeutic hypothermia after cardiorespiratory arrest was undertaken. Therapeutic hypothermia was induced by cold fluid administration and body surface cooling in patients admitted no more than 12 hours after resuscitation from cardiorespiratory arrest. A target temperature of 33ºC was maintained for 24 hours. RESULTS: Overall, 12 patients were included (median age 64 years, 58 percent male). Half of the cardiorespiratory arrests were in-hospital. The median first-day Charlson Index, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II scores were of 2.9, 11 and 24.5, respectively. The intensive care unit mortality rate was 42 percent (N=5). Five of the 7 surviving patients recovered their pre-cardiorespiratory arrest neurological status. Hypothermia was initiated 120 min (median) after recovery of spontaneous circulation. Most patients (75 percent) required vasopressor support. During the first 3 days after cardiorespiratory arrest and therapeutic hypothermia, a progressive SOFA score decrease (median 11 on day 0, 10 on day 1 and 7 on day 2) was observed. DISCUSSION: In this study, therapeutic hypothermia was applied to all post-cardiorespiratory arrest patients and demonstrated good neurological outcome in surviving patients.

Clinical Results of Internal Fixation Using Several Instruments in Unstable Thoracolumbar Bursting Fracture

Fifty six patients with unstable thoracolumbar bursting fractures were treated using variable internal fixation devices such as the Kaneda Anterior Fixation System(Kaneda device), the Z-Plate-ATL(TM) Anterior Fixation System(Z-Plate ATL(TM) device), the Harrington device, Cotrel-Ducousset(CD) or Compact Contrel Dubousset(CCD) device or Steffee Transpedicular System with or without decompression. Such internal fixation devices were grouped into anterior and posterior internal fixation devices and compared with each other in the aspect of the degree of neurological improvement, the changes of the vertebral height and the kyphotic angle, the duration of admission, and postoperative complications. In conclusion, the anterior internal fixation device appears to be of more benefit in the management of patients with unstable thoracolumbar bursting fracture.