Influence of electroacupuncture on the expression of AMPA receptor subunit GluR1 in the spinal injured area of the rats with acute spinal cord injury / 中国针灸

OBJECTIVE@#To explore the influence of electroacupuncture (EA) on the expression of AMPA receptor subunit GluR1 in the rats with acute spinal cord injury (SCI) and explore the potential effect mechanism of EA in treatment of acute SCI.@*METHODS@#A total of 80 SD rats were randomly divided into five groups, i.e. a sham-operation group, a model group, an AMPA antagonist (DNQX) group, an EA group and a DNQX+EA group, 16 rats in each group. The modified Allen's impacting method was adopted to prepare the rat model of acute SCI at T@*RESULTS@#Compared to the sham-operation group in 6 h, 24 h and 48 h after modeling, the BBB scores were all significantly decreased in the model group (@*CONCLUSION@#The intervention with EA at "Dazhui" and "Mingmen" promotes the repair of the injured nerve in the spinal anterior horn probably through inhibiting GluR1 expression in the spinal injured area in the rats with acute SCI.

Study on the Effects of Ligustrazine on Gene Expression of Acute Spinal Cord Injury Model Rats Based on Transcriptome Sequencing / 中国药房

OBJECTIVE：To investigate the effects of ligustrazine on ge ne expression of acute spinal cord injury （SCI）model rats. METHODS ：Male SD rats were randomly divided into sham operation group （group A ，6 rats），model group （group B ，6 rats at each time point ，12 rats in total ）and ligustrazine intervention group （group C ，6 rats at each time point ，12 rats in total ）. Acute SCI model was established by modified Allen ’s method in group B and C. After modeling ，group C was given ligustrazine 100 mg/kg intraperitoneally ，while group A and B were given constant volume of normal saline intraperitoneally ，once a day ，for consecutive 7 d or 14 d（i.e. group B 7d and B 14d，group C 7d and C 14d）. BBB scoring was conducted in each group before modeling ， 7 and 14 days after modeling. HE and Nissl staining observation were also carried out for spinal cord specimen. The differentially expressed genes （DEGs）between group A and group B ，group B and group C were analyzed by transcriptome sequencing. The enrichment of Gene Ontology （GO）and KEGG signaling pathway was analyzed by GO database and KEGG database. RESULTS ： Compared with group A ，BBB scores of group B were decreased significantly 7 d and 14 d after modeling （P＜0.05），and the number of nerve cells and Nissl body in spinal cord tissue were decreased. Compared with group B ，BBB scores of group C were increased significantly at above time points （P＜0.05），and the number of nerve cells and Nissl body in spinal cord tissue were increased. The numbers of DEGs of group A and group B 7 d， group A and group B 14d，group B 7d and group C 7d，group B 14d FAA380076） and group C 14 d were 886，1 404，70，66，respectively. The genes with opposite expression trend included Ncmap，Prx， Gabrq， Gabrg2， etc. The enrichment cell component ， molecular function ，biological process of DEGs were different 630179114@qq.com in each group ，mainly involving lyocytosis ，lysosome，plasmamembrane，homotype protein binding ，immune response ，ion channel activity ，immune response （group A and B ）；basolateral plasma membrane ，exodeoxyribonuclease activity ，response to INF-γ （group B 7 d and C 7 d）；extracellular domain ，receptor regulatory activity ，phenolic compound metabolism process （group B 14 d and C 14 d）. DEGs enriched in cytokine-cytokine receptor interaction（group A and B ）；CAMs，complement and coagulation cascades and Hedgehog signaling pathway （group B 7d and C 7d）； retrograde endocannabinoid signaling ，neuroactive ligand-receptor interaction ，PPAR signaling pathway ，GABA ergic synapse （group B 14 d and C 14 d），etc. CONCLUSIONS ：Protective effect of ligustrazine on acute SCI model rats may be associated with inflammatory response ，immune response/regulation ，neuron ion channel ，cytokine-cytokine receptor interaction ，neuroactive ligand-receptor interaction and regulation of GABA ergic synapse activity .

Influence of electroacupuncture of "Dazhui" (EX-B2) and "Mingmen" (GV4) on NR2B expression in anterior horns of spinal cord in rats with acute spinal cord injury / 针刺研究

OBJECTIVE: To observe the influence of eletroacupuncture (EA) at "Dazhui" (EX-B2) and "Mingmen" (GV4) on expression of NR2B subunit of N-methyl-D-aspartate receptor (NMDA) in the injured anterior horn (AH) area of rats with acute spinal cord injury (SCI), so as to explore its mechanisms underlying improvement of neural repair. METHODS: A total of 96 male Sprague-Dawley (SD) rats were randomly and equally divided into four groups: sham operation (sham), model, medication (Methyl-prednisone, MP) and EA (n＝24 in each group). The acute SCI model was established by using a MASCIS spinal cord impactor. EA (2 Hz, 0.5 mA) was applied to EX-B2 and GV4 for 30 min, once at 0.5 h, 12 and 24 h after SCI. Rats of the medication group were treated by tail intravenous injection of MP 30 mg/kg within 15 min (impact therapy) and 5.4 mg•kg－1•h－1 (maintaining treatment) 45 min thereafter for 23 h. The Basso, Beattie and Bresnahan (BBB) rating scale (0 to 21 points) was used to assess changes of locomotor function 6, 24 and 48 h after SCI. Histopathological changes of the injured spinal cord AH region were observed after sectioning and hematoxylin-eosin (H.E.) staining, and the expression levels of NR2B mRNA and protein of AH were measured by quantitative real-time PCR, Western blot and immunofluorescence, respectively. RESULTS: After SCI, the BBB scores at 6, 24 and 48 h were significantly decreased in the model group compared with those of the sham group (P0.05). After modeling, the histopathological changes (blurred border of the grey-white matter, cellular karyopyknosis, deepening of the cytoplasmic red stain, and rupture, dissolution and disordered arrangement of myelinated nerve fibers) in the injury area of the spinal cord in the model group were apparent, the number of NR2B positive neurons and the relative expression levels of NR2B mRNA and protein were significantly increased in the model group relevant to the sham group (P0.05). CONCLUSION: EA at EX-B2 and GV4 may inhibit the expression of NR2B mRNA and protein in acute SCI rats, which may contribute to its action in promoting nerve repair of the injured ventricolumna area of the thoracic spinal cord.

Effects of electroacupuncture at "Changqiang" (GV 1) on expression of nerve growth factor and brain derived neurotrophic factor in rats after acute spinal cord injury / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of electroacupuncture (EA) at"Changqiang"(GV 1) on expression of nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) in rats after acute spinal cord injury (ASCI), and to explore the mechanism of EA at"Changqiang"(GV 1) on ASCI.</p><p><b>METHODS</b>Twenty-four adult female SD rats were randomly divided into an EA group, a model group and a sham operation group, 8 rats in each one. The rats in the sham operation group were treated with laminectomy to expose the spinal cord without any strike. The rats in the model group and EA group were treated with modified Allen's method to establish ASCI model. After model was established, the rats in the EA group were treated with EA at"Changqiang"(GV 1), once a day for continuous 7 days. The rats in the sham operation group and model group were treated with immobilization, once a day, without any other interventions. The basso beattie bresnahan (BBB) was evaluated 1, 3, 5, 7 days after operation. 7 days after operation, the rats were sacrificed with perfusion and the spinal cord was embedded with paraffin. The morphological changes of spinal cord and neuron were observed by Nissl's staining method; the expressions of NGF and BDNF were detected by immune fluorescence method.</p><p><b>RESULTS</b>3 days, 5 days and 7 days after operation, the BBB scores in the EA group were higher than those in the model group (<0.05, <0.01). The Nissl's staining indicated the gray matter of spinal cord was butterfly-shaped with complete structure and clear boundaries between the gray and white matter; the tabby-shaped Nissl bodies were observed in cytoplasm. There were incomplete gray nucleus, big and saturate local stasis plaque. Compared with the model group, the smallerarea of blood stasis, less severity of neuron edema, better morphology of neuron and no vacuole change were observed in the EA group. The immune fluorescence results indicated the expressions of NGF and BDNF in the model group and EA group were higher than those in the sham operation group (all <0.01); the expressions of NGF and BDNF in the EA group were higher than those in the model group (both <0.01).</p><p><b>CONCLUSION</b>EA at"Changqiang"(GV 1) could improve the expression of NGF and BDNF and increase the score of BBB in rats with ASCI, which is beneficial to the repair of ASCI.</p>

Effect of surgical intervention time on the recovery of nerve function in acute spinal cord injury: a Meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of different operation time for acute spinal cord injury(SCI) based on systematic review.</p><p><b>METHODS</b>PubMed database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to February 2017 for relevant randomized clinical trials on the treatment of acute spinal cord injury with different intervention times.</p><p><b>RESULTS</b>Four randomized clinical trials of total 156 cases were included. Early surgical intervention for the patients with incomplete spinal cord injury can improve the ASIA motor function score [MD=3.29, 95%CI(-7.90, 14.49), =0.56] and overall Frankel score[=7.65, 95%CI(2.69, 21.74), =0.000 1]. There was no significant difference in the improvement of the overall Frankel score[=4.88, 95%CI(0.74, 32.09), =0.10] for the patients with complete spinal cord injury between the early surgery and delayed surgery group. There was no significant difference in hospitalization time[MD=-3.4, 95%CI(-8.12, 1.32), =0.16], death rate [=1.07, 95%CI(0.21, 5.56), =0.93]and incidence of decubitus[=1.07, 95%CI(0.17, 6.69), =0.94] between the early surgery and delayed surgery group.</p><p><b>CONCLUSIONS</b>Early surgical intervention can promote the nerve function recovery after spinal cord injury, whithout further incidence of complications, but random control trails with higher quality are still required for this conclusion.</p>

Effects of Danshen Chuanxiongqin Injection Combined with Hyperbaric Oxygen on the Prevention of Early Complications of Acute Spinal Cord Injury / 中国药房

OBJECTIVE:To investigate the effects of Danshen chuanxiongqin injection combined with hyperbaric oxygen on the prevention of early complications in patients with acute spinal cord injury (ASCI).METHODS:A total of 89 ASCI patients were divided into control group (n=44) and combination group (n =45) according to random number table.Control group received routine symptomatic treatment combined with hyperbaric oxygen therapy.Combination group was additionally given Danshen chuanxiongqin intravenous injection 10 mL added into 250 mL 0.9％ Sodium chloride injection intravenously,bid,on the basis of control group.Both group was treated for 2 weeks.The changes of spinal cord function recovery index (Botsford score,FIM score),coagulation indexes [prothrombin time (PT),activated partial thromboplastin time (APTT)],hemodynamic indexes (high-shear blood viscosity,plasma viscosity,erythrocyte aggregation indexes) and inflammatory indexes [D-dimer (D-D),C reactive protein (CRP)] were compared between 2 groups before and after treatment.After 1 month of follow-up,the incidence of early complications as deep venous thrombosis and pulmonary embolism were compared between 2 groups.RESULTS:Two cases lost in control group and three cases lost in combination group;42 cases were included in each group.Before treatment,there was no statistical significance between these indexes between 2 groups (P＞0.05).After 2 weeks of treatment,Botsford score,FIM score,PT and APTT of 2 groups were enhanced significantly compared to before treatment;high-shear blood viscosity,plasma viscosity,erythrocyte aggregation indexes,D-D,CRP level were decreased significantly compared to before treatment;each index of combination group was significantly better than those of control group,with statistical significance (P＜0.05 or P＜0.01).The incidence of early complications in combination group was 16.7％,which was significantly lower than 35.7％ in control group,with statistical significance (P＜0.05).CONCLUSIONS:The application of Danshen chuanxiongqin injection combined with hyperbaric oxygen in the clinical treatment of ASCI can effectively reduce the risk of deep venous thrombosis,pulmonary embolism and other early complications.It has positive effects on alleviating inflammatory reactions,promoting blood microcirculation and improving prognosis of patients.

Electroacupuncture Improves Limb Locomotor Function Possibly by Suppressing Rho-ROCK Ⅱ Pathway Related Factors in Anterior Horns of Spinal Cord in Rats with Acute Spinal Cord Injury / 针刺研究

OBJECTIVE: To observe the effect of electroacupuncture (EA) of "Jiaji" (EX-B 2) on limb locomotor function and expression of Ras homolog gene family member A (RhoA), Rho-associated kinase Ⅱ (ROCK Ⅱ) and myosin light chain (MLC) proteins in the anterior horn of spinal cord in acute spinal cord injury (ASCI) rats, so as to explore its mechanisms under-lying improvement of SCI-induced limb locomotor dysfunction. METHODS: Forty-eight female Wistar rats were randomly divided into sham operation (sham), ASCI model (model), EA EX-B 2 (EA) and ROCK inhibitor (Fasudil) groups which were further divided into 14 d and 28 d subgroups (n=6 in each). The ASCI model was made by using weight drop striking method. Three hours after modeling, EA (100 Hz, 0.4, 0.6 mA) was applied to EX-B 2 (T 9, T 11) for 30 min, once daily for 14 d and 28 d, respectively. The ROCK inhibitor (hydrochloride Fasudil, 10 mg/kg) was administrated by intraperitoneal injection immediately after modeling, once a day, continuously for 14 d or 28 d. The expression of RhoA, ROCK Ⅱ and MLC proteins in the spinal cord anterior horn tissue (T 10) was detected by immunohistochemistry. The rats' hindlimb locomotor function was assessed according to Basso, Beattie and Bresnahan (BBB) locomotor rating scale (21-points). RESULTS: After ASCI, the BBB scores were significantly lower in the model group than in the sham group on day 14 and 28 (P<0.05), and obviously higher in the EA and inhibitor groups than in the model group (P<0.05), suggesting an improvement of the hindlimb locomotor function after EA intervention or suppression of ROCK. Immunohistochemical results indicated that the numbers of RhoA, ROCK Ⅱ and MLC immune-reaction positive cells in the anterior horn of spinal cord were significantly more in the model group than in the sham group (P<0.05), and remarkably decreased in both EA and inhibitor groups on day 14 and 28 relevant to the model group (P<0.05). The therapeutic effects of EA were markedly weaker than those of inhibitor Fasudil in up-regulating BBB score and down-regulating the number of RhoA, ROCK Ⅱ and MLC positive cells (P<0.05). CONCLUSION: EA of EX-B 2 can improve the hindlimb locomotor function in ASCI rats, which may be associated with its effect in down-regulating the expression of RhoA, ROCK Ⅱ and MLC proteins (i.e., inhibiting the RhoA/ROCK signaling pathway) in the anterior horn of spinal cord.

Corticosteroids Treatment in Spinal Cord and Neuromuscular Disorders

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of the vertebrates, as well as the synthetic analogs of these hormones that are synthesized in the laboratories. Two main classes of corticosteroids, glucocorticoids, and mineralocorticoids, are involved in a wide range of physiologic processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. Corticosteroids have been used for almost 60 years in medicine and their roles in patients have always been discussed by researchers and clinicians dedicated in the related field. Currently, they are still used in the treatment of patients with neurological disorders. Usually, corticosteroids are used in the treatment of various inflammatory diseases and conditions. In this review, we present five key indications, i.e., neuromyelitis optica, acute spinal cord injury, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, polymyositis/dermatomyositis for the systemic use of corticosteroids in neurology based on a mix of quality of evidence, prevalence, and impact on disease management.

Discuss the function of docosahexaenoic acid in the early inflammatory response after acute spinal cord injury / 临床外科杂志

Objective To explore the effect of docosahexaenoic acid(DHA)on the neuro-logical outcome as well as the expression of interleukin-1β,interleukin-6 and interleukin-10 after acute spinal cord injury(SCI).Methods One hundred and eight Sprague-Dawley rats were randomly divided into a spinal cord injury group(group A),a DHA treatment group(group B)and a sham operation group(group C),each with 36 rats.SCI models were established in the rats of groups A and B using a version of Allen's weight drop method(T10 level).Group C had removal of the lamina only.Ten minutes later,group A was injected with 5% ethanol in saline(the MT solvent)and group B with 500 mg/kg of DHA preparation.Basso beattie bresnahan locomotor rating scale(BBB)was used to detect locomotors function at 10,24,48 and 72 hours after operation.Rats were sacrificed at 72 h after operation,IL-1β,IL-6 and IL-10 levels in serum were detected in 6 rats of each group.Results BBB locomotor rating scale indicated that hindlimb motor function in Groups B was higher than that in Group A at 10,24,48 and 72 hours after operation.There was a significant difference in locomotor rating score between DHA injection group and control group(P<0.05).The specimens of group A showed inflammatory reaction and ulceration at 72 h:Group C showed the highest levels of IL-10 in serum ,while Group A showed the lowest level.The differences were statistically significant.Group A had the highest levels of IL-1β and IL-6 while group C had the lowest.The difference between group B and groups A and C was significant.Conclusion DHA could play protective role by balancing the reconstruction of the anti-inflammatory response and inflammation in rats with acute spinal cord injury.

Effect and safety of methylprednisolone pulse therapy on spinal nerve function in patients with acute spinal cord injury / 中国生化药物杂志

Objective To investigate the effect of methylprednisolone pulse therapy on spinal nerve functions in patients with acute spinal cord injury (ASCI) and evaluate its safety. Methods 200 patients with ASCI treated in our hospital from January 2010 to December 2016 were selected and were randomly divided into two groups,with 100 cases each group. The patients in control group were treated with routine basic treatment while patients in the study group were treated with methylprednisolone pulse therapy. On the basis of the American spinal cord injury Society scoring criteria (ASIA), the neurological functional recovery scores were performed were scored before and 6 weeks after treatment between the two groups and the adverse reactions were recorded. Results The scores of sensory and motor function of the patients in the two groups were higher than those before the treatment and there was statistical difference (P<0.05), and the scores in the study group was significantly higher than those in the control group, and the difference between the two grouPs was statistically significant (P<0.05). The incidence of adverse reactions in the study group (25.00％) was significantly higher than that in the control group (10.00％), and the difference was statistically significant (P<0.05). The incidence of lung infection and gastrointestinal reaction in the study group were significantly higher than those in the control group and there were statistical difference (P<0.05). Conclusion Methylprednisolone pulse therapy has significant effect on the recovery of neurological function in patients with ASCI, but the incidence of adverse reactions is high, so it is necessary to strengthen the monitoring and intervention in clinic.

Effects of Acetyl-l-carnitine on Autophagy, Apoptosis, and Locomotor Function after Acute Spinal Cord Injury in Rats / 中国康复理论与实践

Objective To observe the effects of acetyl-l-carnitine (ALC) on autophagy, apoptosis and motor function after acute spinal cord injury (ASCI) in rats. Methods Thirty-six adult female Sprague-Dawley rats were randomly divided into sham operation group (Sham group, n=12), simple spinal cord injury group (SCI group, n=12), ALC treatment group (ALC group, n=12). Spinal cord injury model at the level of T10 segment was established using Allen's method. They were assessed with Basso-Beattle-Bresnahan (BBB) scale three days after injury. Then the rats were sacrificed, and the expression of microtubule associated protein 1 light chain 3 (LC3)-II in spinal cord was detect-ed with Western blotting and immunofluorescent labeling, and the number of apoptotic cells were assessed with TUNEL staining. Results The expression of LC3-II and the number of apoptotic cells increased in SCI group compared with those in Sham group (P<0.01), while the BBB score decreased (P<0.001). The expression of LC3-II increased and the number of apoptotic cells decreased in ALC group compared with those in SCI group (P<0.001), while the BBB score increased (P<0.01). Conclusion ALC may promote autophagy, and inhibit apopto-sis to improve the locomotor function after ASCI.

Protective effects of Zhenbao pill on acute spinal cord injury / 国际中医中药杂志

Objective To explore the protective effect of Zhenbao pill on acute spinal cord injury of rat and its possible mechanisms.Methods 64 Wistar rats were randomly divided into a injury group and a drug group, with 32 rats in each group, A T10 acute incomplete spinal cord injury model was produced by using modified Allen technique in the two groups,Zhenbao pill mixed suspension of 0.6 g/kg was given by gavage method daily in the drug group 30 min after moding, the same amount of saline was given in the injury group. Behavior detection were conducted in the first day, third day, and the seventh day after modeling to each 8 rats of the two groups. Spinal cord specimens was got centered about the damage points after rats were executed. histopathological changes were observed under HE staining, the MDA content were determined by thiobarbituric acid spectrophotometer and the apoptotic cells were marked by TUNEL method.Results After 1, 3, 7 d, compared with the injury group, the MDA level in the rat spinal cord tissue in the drug group (15.12 ± 1.27 nmol/mgvs.19.71 ± 1.29 nmol/mg, 20.42 ± 1.33 nmol/mgvs.24.65 ±1.36 nmol/mg, 10.46±1.49 nmol/mg vs.15.46 ± 1.44 nmol/mg) decreased(P<0.05); the apoptosis rate of drug groups (19.61% ± 1.49%vs.26.61% ±1.52%, 21.49% ± 1.37% vs.32.37% ± 1.24%, 13.04% ±  1.30%vs.18.35% ± 1.27%)decreased (P<0.05); the BBB score of drug groups (6.52 ± 1.27vs. 2.63 ± 1.27), (12.68 ± 1.32 vs.6.17 ± 1.34), (15.47 ± 1.27 vs.11.57 ± 1.29) was higher than the injury group (P<0.05). Conclusion Zhenbao pill can significantly improve the histopathological examination,reduce the MDA content in the injured spinal cord specimen of the rat and the rate of neuronal apoptosis, which may promote recovery of neurologic function in the rat suffered from ASCI.

Protective effects of hydrogen sulfide on acute spinal cord injury in rats / 天津医药

Objective To investigate the effects of hydrogen sulfide on autophagy and the apoptosis after acute spinal cord injury in rats. Methods Thirty-six adult male SD rats (250-300 g) were randomly divided into three groups (n=12 for each group):sham operation group (Sham group), spinal cord injury group (Model group) and hydrogen sulfide pre-treatment group (H2S group). Allen’s method was used to establish the rat model of spinal cord injury. Rats of sham operation group re?ceived only laminectomy. Rats of H2S group received sodium hydrosulphide injection intraperitoneally (50μmol/kg) 1h after spinal cord injury, and Model group was given the same amount of saline solution. Rats in the three groups were sacrificed 24 h after spinal cord injury, then the spinal cord was removed. The expressions of LC3, p70S6K and Cleaved caspase-3 were detected by Western blot assay. The expression of LC3 was also detected by immunofluorescence. The cell apoptosis was as?sessed by TUNEL stain. Results Compared with Sham group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were increased in Model group, but the expression of p70S6K decreased and cell apoptosis increased in Model group (P<0.01). Compared with Model group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were decreased significant?ly, while the expression of p70S6K increased and cell apoptosis decreased significantly in H2S group (P < 0.01). Conclu?sion Hydrogen sulfide can inhibit autophagy and reduce cell apoptosis after acute spinal cord injury in rats.

Diminution of Secondary Injury after Administration of Pharmacologic Agents in Acute Spinal Cord Injury Rat Model: Comparison of Statins, Erythropoietin and Polyethylene Glycol

STUDY DESIGN: An experimental animal study. OBJECTIVES: To evaluate and compare the neuroprotective effect of statins, erythropoietin and polyethylene glycol (PEG) after spinal cord injury (SCI). SUMMARY OF LITERATURE REVIEW: There are few comparative studies of pharmacological agents for acute SCI. MATERIALS AND METHODS: Forty Sprague Dawley (SD) rats had a spinal cord injury at T9/10 using an Ohio State University (OSU) impactor. The animals were randomized to receive one of the following; simvastatin, erythropoietin, PEG or saline. A behavioral outcome assessment was performed on days 2, 4 and 7, and then every week using the Basso, Bresnahan, and Beattie (BBB) score and subscore. The animals were sacrificed at the end of 6 weeks and histologic assessment was performed to measure the areas of white and gray matter. RESULTS: For the animals treated with simvastatin, erythropoietin, PEG and saline, the mean BBB scores at 6 weeks post-injury were 13.2+/-0.1, 11.7+/-0.4, 13.3+/-0.3, and 11.4+/-0.2, and the BBB subscores were 9.2+/-1.1, 5.0+/-1.3, 9.1+/-1.1, 4.4+/-1.2, respectively. The BBB scores and BBB subscores were significantly higher in simvastain and PEG-treated animals (p<0.05). The areas of white matter at the lesion epicenter were 0.78+/-0.05mm2, 0.46+/-0.04 mm2, 0.68+/-0.15 mm2, and 0.41+/-0.04mm2 in the simvastatin, erythropoietin, PEG and saline groups, respectively. The simvastatin and PEG-treated animals showed increased sparing of the white matter at the injury epicenter and at 0.2mm rostral and 0.4mm caudal(p<0.05). CONCLUSION: Simvastatin and polyethylene glycol administration showed diminished secondary injury after SCI in rats. In addition, they showed almost the same efficacy. However, erythropoietin did not show neuroprotective effect.

The Influence of Cervical Spondylosis to Acute Cervical Spinal Cord Injury

STUDY DESIGN: A retrospective study OBJECTIVES: To examine the influence of cervical spondylosis on an acute cervical spinal cord injury. SUMMARY OF LITERATURE REVIEW: There are no reports on the relationship between cervical spondylosis and acute cervical spinal cord injuries. MATERIALS AND METHODS: Twenty six patients who underwent operative treatment for acute cervical injuries with spinal cord injury were evaluated. The mean age and follow-up period was 58 years and 2.2 years, respectively. The evaluation was performed by examining the causes of the injuries, and the classification of fractures according to the presence of cervical spondylosis. This study compared the degrees of postoperative neurological recovery with motor index score in the groups with and without cervical spondylosis. RESULTS: Cervical cord injuries were more prevalent in the group 60 years and older; 17 cases vs. 9 cases in the group under 60 years. Eleven (65%) and 6 (35%) cases in the group 60 years and older had sustained a high and low energy injury, respectively. In contrast, mostly high energy injuries (8 in 9 cases) were encountered in the group under 60 years of age. A low energy injury could cause a acute cervical cord injury in the group 60 years and older, who also had cervical spondylosis. In those cases, previous cervical spondylosis might be one of the etiologic factors. CONCLUSIONS: The cases with cervical spondylosis in the group 60 years and older tended to show incomplete cord injury and good postoperative neurological recovery when they had sustained cervical cord injuries.

The Neuroprotective Effect of Combination Therapy of Polyethylene Glycol and Magnesium Sulfate in Acute Spinal Cord Injury / 대한정형외과학회잡지

PURPOSE: To evaluate the neuroprotective effect of combination therapy of polyethylene glycol (PEG) and magnesium sulfate (MgSO4) after a spinal cord injury. MATERIALS AND METHODS: Twenty Sprague Dawley male rats (300-350 gm) had a spinal cord injury after T9/10 laminectomy using an Ohio State University (OSU) impactor under intraperitoneal anesthesia. The animals were randomized to receive either PEG (1 g/kg)+MgSO4 (300 mg/kg) or saline (2 ml) via carotid vein after 2 hours of injury and then every 6 hours for 5 times. The behavioral outcome assessments were performed on days 2, 4 and 7, and then every week using the Basso, Bresnahan, and Beattie (BBB) score and subscore. The animals also underwent sensory threshold testing using a von Frey monofilament device and gait analysis with Catwalk program before and 6 weeks after cord injury. The animals were sacrificed at the end of 6 weeks and histologic assessment was performed to measure the areas of white and gray matter. RESULTS: For the animals treated with PEG+MgSO4 and saline, the mean BBB scores at 6 weeks post-injury were 13.3+/-0.3, 11.4+/-0.2 and the BBB subscores were 9.1+/-1.1, 4.4+/-1.2 respectively (p<0.05). No significant differences were found in sensory testing and gait analysis between the two groups. Histologic assessment revealed no significant difference in gray matter sparing but the areas of white matter at the lesion epicenter were 0.68+/-0.2, 0.41+/-0.04 mm2 in the PEG+MgSO4 and saline groups respectively, which indicated significant sparing of white matter in PEG+MgSO4 group (p<0.05). CONCLUSION: The combination therapy of polyethylene glycol and magnesium sulfate improved the motor function and showed significant histological sparing of the spinal cord after an acute spinal cord injury in rats.

Recent Advances in the Pathophysiology and Treatment of Acute Spinal Cord Injury / 대한척추외과학회지

STUDY DESIGN: This is a literature review OBJECTIVES: We wanted to provide updated information for spine clinicians on the pathophysiology, medical treatment and the timing of surgical treatment after acute spinal cord injury. SUMMARY OF LITERATURE REVIEW: There are many studies concerned with understanding the mechanisms of injury and improving the neurologic function after acute spinal cord injury. However, methylprednisolone therapy has been used only recently for the treatment of this malady. MATERIALS AND METHODS: We conducted a literature review, with a particular focus on the development of pathophysiology and the emerging pharmacologic treatment of acute spinal cord injury, and on the effectiveness of performing early decompression. RESULTS: After primary mechanical impact, a complex cascade of secondary injury follows during acute spinal cord injury. Neuroprotection and axonal regeneration are the main strategies to treat spinal cord injury. Beyond methylprednisolone, a number of other pharmacological treatments have been studied for the acute treatment of spinal cord injury. Animal studies support early decompression of the injured cord. Although there is no standard regarding the timing of decompression, there are many advantages of performing early decompression in human. CONCLUSION: Although a number of pharmacological therapies seem to have neuroprotective potential, high-dose methyprednisolone therapy is the only clinically approved treatment for acute spinal cord injury. Urgent decompression for acute spinal cord injury remains a reasonable practice option.

Neuroprotection for Acute Spinal Cord Injury: Comparison of Simvastatin and Atorvastatin / 대한정형외과학회잡지

PURPOSE: To evaluate the neuroprotective effect of statins after a spinal cord injury. MATERIALS AND METHODS: Twenty four Sprague Dawley rats had a spinal cord injury at T9/10 using an Ohio State University (OSU) impactor. The animals were randomized to receive either simvastatin, atorvastatin, or saline with oral gavage everyday for 7 days. A behavioral outcome assessment was performed on days 2, 4 and 7, and then every week using the Basso, Bresnahan, and Beattie (BBB) score and subscore. The animals also underwent sensory threshold testing using a von Frey monofilament device. The animals were sacrificed at the end of 6 weeks and a spinal cord specimen was harvested. Histology and immunohistochemistry were performed to measure the areas of white and gray matter, and the sparing of oligodenrocytes. RESULTS: For the animals treated with simvastatin, atorvastatin and saline, the mean BBB scores at 6 weeks post-injury was 13.2+/-0.1, 11.8+/-0.5, and 11.3+/-0.2 and the BBB subscores were 9.2+/-1.1, 4.8+/-1.8 and 4.4+/-1.4 respectively (p<0.05). The areas of white matter at the lesion epicenter were 0.78+/-0.05, 0.5+/-0.18 and 0.41+/-0.03 mm2 in the simvastatin, atorvastatin and saline groups respectively, and the number of spared oligodendrocytes was significantly higher in the simvastatin treated animals (p<0.05). CONCLUSION: The simvastatin treatment improved the behavior and histological sparing of the spinal cord after an acute spinal cord injury in rats.

Effects of Suifukang in Treatment of Acute Spinal Card Injury of Rat / 中国中医药信息杂志

Objective To observe the influence of Suifukang (SFK) on hemorheological change of rats induced spinal cord injury. Method Through half-transection spinal cord injury, the effects of SFK on hemorheological changes of 50 SD rats were observed. Results After injury, the hemorheological property was changed from lower coagulability to higher coagulability. After administrated with SFK, the hemorheological property was changed from higher coagulability to lower coagulability. Conclusion SFK could effectively reverse the abnormal hemorheological status into normal one.

Cell Death in Acute Spinal Cord Injury

OBJECTIVE: In acute spinal cord injury, biomechanical and pathological changes in the cord may worsen after injury. To explain these phenomena, the concept of the secondary injury has evolved and numerous pathophysiological mechanisms have postulated. These, however, have mainly focused only on the cell necrosis. The aim of present study is to verify whether apoptosis plays a role in the animal model of secondary injury of spinal cord. MATERIALS AND METHODS: Adult male Sprague-Dawley rats were laminectomized and spinal cord injury was induced using NYU spinal impactor at T9 segment. The animals were sacrificed periodically and tissue specimen was obtained at the injury segment, adjacent segments, and remote segments to observe the secondary injury ultimately for the observation of the spatial and temporal distribution and the related cells for the appearance of apoptosis, if present. RESULTS: In the spatial distribution of apoptosis, the apoptotic cells were located at gray matter of spinal cord and the number of apoptotic cells were significantly higher in adjacent segments than in the injured segment. In the temporal distribution of apoptosis, the number of apoptotic cells were maximal at 4 hours after injury and decreased subsequently. No apoptotic cells were found at remote segments which implies that there were no influence of apoptosis on transneuronal degeneration. CONCLUSION: These results suggest that the lesioned area of spinal cord expanded over time in acute spinal cord injury and apoptosis contributed to the spinal cord neuronal and glial cell loss. In conclusion, apoptosis is thought to have an important role in secondary injury of acute spinal cord injury.