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Axonal demyelination is an important factor causing neurological dysfunction after spinal cord injury. Retaining the integrity of myelin sheath and promoting remyelination play an important role in the functional recovery of spinal cord injury. The bottleneck of the failure of remyelination is the inability of myelin-forming cells (oligodendrocytes and Schwann cells) to differentiate and mature. In recent years related research on spinal cord injury demyelination has found that cell transplantation, neuregulin-1 and hydrogel can effectively enhance remyelination, and identified aquaporin-4 (aquaporin-4, AQP4), metal-loproteinase (Matrix metailoproteinase, MMP) may be a potential therapeutic target to promote myelin recovery after spinal cord injury. This review discusses the research progress of enhancing remyelination after spinal cord injury, providing ideas for the further development of new methods for the treatment of spinal cord injury.
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The correct alignment of the knee joint is considered to be one of the most influential factors in determining the long-term prognosis after total knee arthroplasty(TKA). In order to achieve the correct alignment goal, many different alignment concepts and surgical techniques have been established. For example, mechanical alignment(MA), kinematic alignment(KA) and functional alignment(FA) have their own characteristics. MA focuses on achieving neutral alignment of the limbs, parallel and equal bone gaps during stretching and flexion. KA aims to restore the patient 's natural joint line, make the joint level and angle normal and improve the physiological soft tissue balance, and strive to reproduce the normal knee function;among them, functional alignment(FA) developed with robot-assisted surgery technology is a relatively new alignment concept. It not only considers the alignment of the body, but also aims to achieve flexion and extension balance, while respecting the native soft tissue capsule. It not only restores the plane and slope of the in situ joint line accurately during the operation, but also takes into account the balance of soft tissue, which is a better alignment method. Therefore, it is of great significance to correctly construct the lower limb force line of patients, which is helpful to restore knee joint function, relieve pain symptoms and prolong the service life of prosthesi. However, compared with traditional TKA, the operation time of robot-assisted FA-TKA is prolonged, which means that the probability of postoperative infection will be greater. At present, most studies of FA technology report short-term results, and the long-term efficacy of patients is not clear. Therefore, long-term research results are needed to support the application of this technology. Therefore, the author makes a review on the research status of functional alignment.
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Humanos , Artroplastia do Joelho/métodos , Robótica , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Joelho , Prótese do Joelho , Fenômenos BiomecânicosRESUMO
A spinal cord injury is a serious disease, and there is currently no effective treatment. The inflammatory reactions start within a few hours after damages to spinal cord tissues and peak within a few days and they may continue for several years. Reducing the inflammatory response after the spinal cord injury is one of the important treatment strategies. Butyrate and β-hydroxybutyrate are two closely related substances. They have similar structures and differ in only one hydroxyl group. They have attracted widespread attention because of their good anti-inflammatory properties in many diseases. Recently it has been demonstrated that butyrate and β-hydroxybutyrate can inhibit the activity of the NF-κB / NLRP3 inflamma-some signaling pathway and reduce the expression of pro-inflammatory factors; or by enhancing the level of antioxidant molecules, it can reduce the inflammatory response after spinal cord injury. Therefore, butyrate and β-hydroxybutyrate may be promising treatments after a spinal cord injury. Here we review the structure and production of butyrate and β-hydroxybutyrate, the mechanism of anti-inflammatory effects in a spinal cord injury, and the treatment prospects, in order to provide theoretical references for researchers in this field.
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Treatment and rehabilitation of spinal cord injury has been a major problem in the medical field‚ and little progress has been achieved in the improvement of neuronal function following injury. Secondary damage is the main cause of neurological dysfunction after spinal cord injury‚ and inflammation is the most important pathological process in the secondary injury stage. In the acute phase‚ it is believed that the reduction of secondary damage by inhibiting neuroinflammation can reduce the damage of nerve function and achieve neuroprotection. The inflammasome is a type of protein complex‚ which is assembled and named by the receptor proteins of the NLRs family and the PHYIN family of pattern recognition receptors as the main framework. Common inflammasomes include NLRP1‚ NLRP3‚ NLRC4 (IPAF)‚ and AIM2 etc. When infected or stimulated by injury‚ inflammasomes assemble in the cytoplasm and activate the pro-inflammatory protease caspase-1. Activated caspase-1 promotes the maturation and secretion of pro-inflammatory cytokines IL-1β and IL-18 on the one hand‚ and mediates pyroptosis on the other hand. Pyroptosis is a way of programmed cell death induced under pathological conditions of inflammation and stress. Cell swelling and rupture and the release of cell contents are its main characteristics. Both pro-inflammatory cytokines and intracellular substances released by pyroptosis can be used as pro-inflammatory signals to trigger an inflammatory response. Recently‚ it has been discovered that inflammasomes participate in the activation of the inflammatory cascade after spinal cord injury by inducing the release of pro-inflammatory factors and mediating pyroptosis‚ and then aggravate secondary neuroinflammation. Targeted inhibition of the activation of inflammasomes can reduce the inflammatory response‚ promote the survival of nerve cells‚ and achieve neuroprotective effects. Therefore‚ the inflammasome is expected to become a new target for the treatment of spinal cord injury. This article reviewed the structure of the inflammasome and its role in spinal cord injury‚ activation mechanism and treatment‚ which may provide ideas for the follow-up research.
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Objective:To systematically evaluate the effect of targeting mitochondria on spinal cord injury animal models, and provide experimental evidence. Methods:Literatures about animal experiments of targeting mitochondria treatment for spinal cord injury were searched in PubMed, Web of Science, Web of Knowledge, CNKI and Wanfang database from establishment to February, 2021. Three researchers independently screened the literatures and extracted the data, and they were summarized by qualitative analysis. Results:Eleven animal experimental studies were enrolled, including 548 animals with spinal cord injury. Six studies selected male or female Sprague-Dawley rats, and the rats in eight studies weighed 150~275 g. The animal models of spinal cord injury in all studies focused on T9~T11 contusive spinal cord injury, but there were differences in the use of spinal cord strikers and striking strength. The type, time, frequency, concentration and dosage of intervention drugs were all different. Due to the large heterogeneity of the included studies in animal species, animal models and outcome measures, qualitative analysis was conducted. Conclusion:Targeting mitochondria for spinal cord injury in animals could promote the recovery of motor function, reduce the damaged spinal cord tissue and increase the remaining tissue, enhance the ability of anti-oxidation and anti-apoptosis, and enhance mitochondrial biogenesis. Limited by the number and quality of included studies, the above conclusions need to be verified by more high-quality studies.
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Results and Conclusion A total of 236 authors were included, out of whom 49 authors published more than three papers, and high-yielding authors were mainly represented by Zeng Y S and Chen L. There were 162 countries/institutions involved, out of which 85 published more than three papers. Seventy-five journals were included, out of which Exp Neurol was the one with the most articles. There were 107 key words included, and the hot words were spinal cord injury, MSCs, transplantation, bone marrow, repair, and functional recovery, which formed six cluster groups. The trend was to extract and culture progenitor cells and induce their directional differentiation; mechanism of immune regulation, anti-inflammatory and nerve regeneration in the treatment of spinal cord injury by MSCs, as well as the research of tissue engineering technology, biological materials in this field. Objective:To analyze the research status and hotspots of mesenchymal stem cells (MSCs) for treatment of spinal cord injury in the past five years. Methods:The related literatures from 2014 to 2018 in Science Citation Index-Expanded (SCI-E) of Web of Science (WOS) were included. CiteSpace software was used to analyze the cooperation relationship of authors, countries and research institutions. The keywords were taken as nodes for co-occurrence analysis, cluster analysis, dynamic frontier evolution and burst analysis. The co-citation of journals and literatures were taken as nodes for analysis, meanwhile, the visual maps were drawn and the results were analyzed.
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Objective:To investigate the changes of genus-level gut microbiome in patients with spinal cord injury and its significance in clinical rehabilitation. Methods:Fecal samples were collected from 23 patients with spinal cord injury (patients group) and 21 healthy volunteers (control group). Gut microbiome was detected by 16S rDNA high-throughput sequencing. Bioinformatics methods such as species composition analysis and Random Forest were used to analyze the distribution and difference of genus-level gut microbiome between two groups. Results:Compared with the control group, the increased important marker genera in the patients group were as follows: UBA1819, Ruminiclostridium 9, Ruminococcaceae NK4A214 group, Ruminococcus 2, Ruminococceae UCG-005, Ruminiclostridium 5, Flavonifractor belonging to Ruminococceae; Aglistes, dgA-11 gut group, Rikenaceae RC9 gut group belonging to Rikenellaceae; [Eubacterium] oxidoreducens group belonging to Lachnospiraceae; Intestinibacter belonging to Peptostreptococcaceae; Escherichia-Shigella belonging to Enterobacteriaceae; Tannerellaceae belonging to Parabacteroides (|U| > 1.962, P < 0.05). The decreased marker genera in the patients group was Fusobacterium of Fusobacteriaceae (|U| = -2.284, P < 0.05). Conclusion:There are significant differences of gut microbiome in spinal cord injury patients. The relative abundance of Ruminococcaceae relating to depression, Ruminococcus relating to central nervous system diseases, and enteropathogenic bacteria such as Escherichia-Shigella and Erysipelothrix increase; and the relative abundance of butyrate-producing bacteria and anti-inflammatory bacteria benefitting to the intestine decrease; which may play a role in clinic.
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With the deepening of microbial research in central nervous system diseases, the role of gut microbiota in spinal cord injury has also received extensive attention. At present, it is mainly focused on exploring the changes of gut microbiota after spinal cord injury and the potential effects of aryl hydrocarbon receptor agonists, short-chain fatty acids and lipopolysaccharides produced by bacterial metabolism on secondary inflammation after injury, and it is recognized that gut microbiota or supplemental flora metabolites may be a potential pathway for the treatment of spinal cord injury.
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IκB kinase beta (IKKbeta) is a key kinase in nuclear factor kappa B (NF-kappaB) signaling pathway. After spinal cord injury, IKKbeta is activated, and the signal pathway of NF-kappa B is abnormally activated, which produces a large number of inflammatory factors, which has a negative impact on the recovery of spinal cord injury. This article mainly summarized the structure and function of IKKbeta and its application in inflammatory reaction after spinal cord injury, trying to find a new target for the treatment of spinal cord injury.
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Transcranial direct current stimulation regulates nerve cell transmembrane potential through current, leading to depolarization or hyperpolarization, and changes the excitability of cerebral cortex, thus improving neuropathic pain after spinal cord injury. This article mainly reviewed mechanism, clinical application, safety and limitation of transcranial direct current stimulation to neuropathic pain after spinal cord injury.
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Objective To observe the effect of every-other-day fasting(EODF)on pathology and functional recovery of rats with spinal cord clip-compression injury,and to explore the related mechanism. Methods A total of 36 Sprague-Dawley rats were randomly assigned to groups A(sham operation),B(sham operation and EODF),C(spinal cord injury)and D(spinal cord injury and EODF)with nine rats in each group.The spinal cord injury rat model in T10was established by using medical aneurysm clip in latter two groups.The motor func-tion was assessed by Basso-Beattie-Bresnahan(BBB)score one day before and one day,two,four,six,eight,ten, twelve weeks after operation;and toluidine blue staining was performed for pathological observation at twelve weeks after operation.Another 180 Sprague-Dawley rats were randomly assigned in same way.The level of tu-mor necrosis factor-α(TNF-α)and interleukin-10(IL-10)were detected with ELISA six hours,twelve hours,one day,three days and seven days after operation. Results The BBB score reached lowest on the first day in groups C and D(P<0.05),and gradually increased with time,and were higher in group D than in group C eight weeks,ten weeks and twelve weeks after operation(P<0.05). The pathology in spinal cord was less in group D than in group C.Compared with group A,the level of serum TNF-α increased twelve hours after operation(P<0.05),peaked one day after operation,and returned back seven days after operation;the level of serum IL-10 increased at each time point after operation(P<0.05).Compared with group C,the level of serum TNF-α was lower in group D one day after operation(P<0.05);the level of se-rum IL-10 was not significantly different at each time point after operation(P>0.05). Conclusion Long-term EODF can promote the hind limb motor recovery in rats with spinal cord clip-compression inju-ry,and alleviate pathological damage.EODF might inhibit acute inflammatory reaction at acute stage of spinal cord injury,which may be correlated with its neuroprotective effect.
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BACKGROUND: Dietary intervention may be the most available, safe, economic and efficient approach to treat spinal cord injury. OBJECTIVE: To observe the effects of dietary restriction in the form of every-other-day fasting (EODF) on the pathological changes and functional recovery of rats with clip-compression injury of the spinal cord. METHODS: The models of spinal cord injury were established by a medical aneurysm clip in 36 Sprague-Dawley rats, and model rats were then randomized into four groups: group A with spinal cord injury and EODF, group B with spinal cord injury, group C with sham operation and EODF, and group D with sham operation. Food intake and body mass were observed. Motor functional recovery in rats was assessed by Basso, Beattie, Bresnahan scores at preoperative 1 day and postoperative 1 day, 1, 2, 4, 6, 8, 10, and 12 weeks. At 12 weeks after operation, the morphological changes of the spinal cord were observed through hematoxylin-eosin staining. RESULTS AND CONCLUSION: The Basso, Beattie, Bresnahan score in the group B was decreased to the lowest at postoperative 1 day, and gradually increased with time. At 8-12 weeks after operation, the scores in the group A were significantly superior to those in the group B. At 12 weeks after operation, hematoxylin-eosin staining showed less lesion of the spinal cord in the group A than the group B. These results indicate that EODF can improve the motor functional of rats with spinal cord injury, and exerts effective protection on the injured spinal cord.
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<p><b>OBJECTIVE</b>To explore the comprehensive program of integrated Chinese and western medicine in the treatment of cognitive impairment in earthquake brain injury.</p><p><b>METHODS</b>The multi-central randomized controlled trial was adopted. The qualified subjects were randomized into an acupuncture + rehabilitation group (38 cases) and a rehabilitation group (35 cases). In the acupuncture + rehabilitation group, acupuncture, hyperbaric oxygen (HBO) and cognitive rehabilitation training were combined as the comprehensive program of integrated Chinese and western medicine in the treatment. In the rehabilitation group, HBO and cognitive rehabilitation training were adopted. The efficacy and safety were assessed.</p><p><b>RESULTS</b>(1) After treatment of 2 months, the intelligent state, cognitive function and activity of daily life of patients were improved in the both groups (all P < 0.01). (2) After treatment of 2 months, the score of MMSE and the score of activity of daily life were (24.11 +/- 4.08) and (75.45 +/- 13.95) in the acupuncture + rehabilitation group, which were more significant as compared with (17.05 +/- 43.84), (66.06 +/- 12.75) in the rehabilitation group, respectively (both P < 0.01). In 6-month follow-up visit after treatment, the cognitive function and activity of daily life were improved continuously in the acupuncture + rehabilitation group, which was more significant as compared with the rehabilitation group (P < 0.01, P < 0.05).</p><p><b>CONCLUSION</b>The integrated Chinese and western medicine of acupuncture, HBO and cognitive rehabilitation training is safe and effective in the treatment of cognitive impairment in earthquake brain injury. The therapeutic effect is more advantageous as compared with the simple rehabilitation program of western medicine.</p>
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Atividades Cotidianas , Terapia por Acupuntura , Lesões Encefálicas , Psicologia , Reabilitação , Terapêutica , Cognição , Terremotos , Resultado do TratamentoRESUMO
<p><b>OBJECTIVE</b>To compare the differences in the efficacy on traumatic spinal cord injury(SCI) in the thoracic and lumbar vertebra between the paraplegia-triple-needling method and the conventional acupuncture therapy.</p><p><b>METHODS</b>The perspectively randomized controlled trial was adopted. Forty-eight cases of traumatic SCI in the thoracic and lumbar vertebra were randomized into an observation group and a control group, 24 cases in each one. The conventional rehabilitation training was applied in both groups. In addition, the paraplegia-triple-needling method was used in the observation group. In the treatment, acupuncture was applied to the points of the Governor Vessel and the Back-shu which, located two segments above and below the spinal injury plane separately. Acupuncture with the electric pulsing stimulation was applied to the motor points of the key muscles of the lower extremities. In the control group, the conventional acupuncture was applied to Huantiao (GB 30), Zusanli (ST 36), Xuanzhong (GB 39) and Sanyinjiao (SP 6). In each group, the treatment was given once a day, one month treatment made 1 session. Totally, 3 sessions of treatment were required. Before and after treatment, as well as in 1-month follow-up visit after treatment, the modified Barthel index (MBI) and the function comprehensive assessment (FCA) were adopted to assess the activities of daily life (ADL) and the comprehensive function of the patients. The score of MBI and FCA were taken as the double response variables to imitate the multilevel model. The changing tendency of MBI and FCA along with the time was observed in two groups.</p><p><b>RESULTS</b>In the follow-up visit, MBI and FCA score were all improved as compared with those before treatment in two groups (all P < 0.05). There were no statistically significant differences in MBI and FCA score at any time point between two groups (all P > 0.05). In 4-month observation, there was a rising tendency with time in MBI and FAC scoe in both groups, which was roughly linear. As time went on, the increasing amplitude in the observation group was much bigger. It was explained that there was no difference in the short-term efficacy between two groups. However, the long-term efficacy in the observation group was much better.</p><p><b>CONCLUSION</b>Both the paraplegia-triple-needling method and the conventional acupuncture therapy can improve the ADL and the comprehensive function of the patients with traumatic SCI of the thoracic and lumbar vertebra. Concerning the long-term efficacy, the paraplegia-triple-needling combined with the rehabilitation training achieves better result. This therapeutic program is safe and effective.</p>