针刺对慢性脊髓损伤大鼠神经递质和营养因子表达的影响

目的 探讨针刺治疗慢性脊髓损伤的机理。方法 建立后路渐进性脊髓压迫大鼠模型,然后手术减压,进行电针治疗,观察联合行为评分(CBS)及胆碱乙酰转移酶(ChAT)、脑源性神经营养因子(BDNF)及其受体TrkB的免疫组化检测结果。结果 初次术后90 d,电针组大鼠CBS评分优于减压组( P <0.05),ChAT免疫组化染色阳性细胞数多于减压组 ( P <0.05),神经元和胶质细胞增强的BDNF和TrkB表达得到恢复。结论 电针治疗可能通过影响 BDNF及其受体的表达,促进 ChAT表达和增强其活性而对大鼠慢性脊髓损伤起治疗作用。     

Preventing recurrence after surgical repair of pressure injuries in patients with spinal cord injury: Effects of a presurgical and postsurgical wheelchair seating intervention by experts

ObjectivePressure injuries in people with spinal cord injury or dysfunction (SCI/D) are known to have a high recurrence rate. As a countermeasure, we perform surgery after adjusting the wheelchair and cushion with the intervention of a seating expert. The effectiveness of seating interventions in postsurgical recurrence prevention was examined.Materials and methodsIn this retrospective analysis, the participants were 19 patients with SCI/D who underwent pressure injury surgical treatment in the gluteal region from 2005 to 2018. The patients with conventional rehabilitation were assigned to Group 1 (n = 8), and those with seating intervention by experts in addition to conventional rehabilitation were assigned to Group 2 (n = 11). The main outcome measure was the presence or absence of recurrence 3 years after the surgery. The recurrence rate was compared between the two groups.ResultsThe recurrence rates were 18% with seating intervention and 75% without; there was a significant difference (p = 0.025). The recurrence odds ratio was 13.5.ConclusionThis study suggests that presurgical seating evaluation and assessment by experts, postsurgical rehabilitation based on presurgical evaluation and assessment, and routine follow-up and seating adjustment according to changes are efficacious for preventing postsurgical pressure injury recurrence in patients with SCI/D.     

脉冲电磁场对带血供周围神经移植修复脊髓损伤的作用

目的：探讨脉冲电磁场对带血供周围神经移植修复脊髓损伤的作用。方法：将４０只雌性Ｗｉｓｔａｒ成年鼠分为Ａ、Ｂ２组,Ａ组为单纯用带血供的正中神经移植修复脊髓损伤,Ｂ组为带血供正中神经移植后给予脉冲电磁场治疗,术后６０ｄ进行大体、组织学（光、电镜）观察、电生理检测及移植神经内再生轴突形态计量分析。结果：在组织学,神经传于单纯带血供周围神经移植的Ａ组。结论：带血供周围神经是修复脊髓损伤较为理想的移植材料,     

大鼠脊髓损伤后肾上腺髓质素水平的变化

目的：检测肾上腺髓质素在大鼠脊髓损伤后,在血浆及脊髓中含量的变化。方法：雄性ＳＤ 大鼠４０ 只分为正常组、对照组、损伤组（３０ ｍｉｎ 、２ｈ 、４ｈ 、８ｈ 、１２ｈ 、２４ｈ 、４８ｈ 和７２ｈ） ,采用放射免疫法检测所有大鼠血浆及脊髓中肾上腺髓质素的变化。结果：测得正常大鼠血浆及脊髓中肾上腺髓质素分别为（２－７２７ ±０－１６３）ｐ ｍｏｌ／Ｌ 和（０－０６５ ±０－０１９）ｆｍｏｌ／ｍ ｇ 湿重,损伤组血浆及脊髓中均在８ｈ 达到高峰,脊髓中变化较大。结论：大鼠脊髓损伤后肾上腺髓质素在血浆及脊髓中的含量有明显变化,提示其可能在继发损伤期中发挥了重要作用。     

The Pathogenesis of Neurotrauma Indicates Targets for Neuroprotective Therapies

The spinal cord injury (SCI) initiates an extraordinarily protracted disease with 3 phases; acute, inflammatory, and resolution that are restricted to the cavity of injury (COI) or arachnoiditis by a unique CNS reaction against the severity of destructive inflammation. While the severity of inflammation involving the white matter is fueled by a potently immunogenic activity of damaged myelin, its sequestration in the COI and its continuity with the cerebrospinal fluid of the subdural space allow anti-inflammatory therapeutics infused subdurally to inhibit phagocytic macrophage infiltration and thus provide neuroprotection. The role of astrogliosis in containing and ultimately in eliminating severe destructive inflammation post-trauma appears obvious but is not yet sufficiently understood to use in therapeutic neuroprotective and neuroregenerative strategies. An apparent anti-inflammatory activity of reactive astrocytes is paralleled by their active role in removing excess edema fluid in blood-brain barrier damaged by inflammation. Recently elucidated pathogenesis of neurotrauma, including SCI, traumatic brain injury (TBI), and stroke, calls for the following principal therapeutic steps in its treatment leading to the recovery of neurologic function: (1) inhibition and elimination of destructive inflammation from the COI with accompanying reduction of vasogenic edema, (2) insertion into the COI of a functional bridge supporting the crossing of regenerating axons, (3) enabling regeneration of axons to their original synaptic targets by temporary safe removal of myelin in targeted areas of white matter, (4) in vivo, systematic monitoring of the consecutive therapeutic steps. The focus of this paper is on therapeutic step 1.     

国外肌电图学在肢体动作领域的主题热点与国际前沿分析北大核心

背景:肌电图在人体肢体动作或肌肉活动测量中应用较多,已经受到医学、运动科学、人机功效学等领域专家学者的广泛认可,但国内外肌电图在人肢体动作应用研究的相关综述略显不足。目的:梳理国外Web of Science核心数据库的相关肌电在人肢体动作应用的研究成果,以期为应用肌电图学进一步优化人体康复、人体工程学等方案设计方面提供建议。方法:在WebofScience核心数据库中,语种选择英语,基于布尔逻辑运算,进行主题词进行检索。检索主题词策略为TS=“electromyography”OR“sEMG”OR“surface EMG”AND“human movement”OR“movement”。利用知识图谱软件CitespaceⅤ对所获得的文献进行去重后,进行学科、国家发文量分析,并利用关键词、高被引、共被引等知识图谱分析相关研究的主题热点与国际前沿趋势。结果与结论:(1)表面肌电测量技术在人肢体动作应用研究主要在神经领域、工程学和体育科学领域发文量较多。美国、中国和加拿大发文量排名前3。(2)肌电在人体肢体运动中应用主要关注肌电控制(myoelectric control);慢性下腰痛(chronic low back pain);皮质脊髓兴奋性(corticospinal excitability);帕金森病(Parkinson’s disease);注意力练习(attentional focus);中风存活患者(stroke survivor);前交叉韧带损伤(anterior cruciate ligament injury);肌肉协同(muscle synergies)等热点主题。(3)国际前沿领域研究分为早期前沿、现代前沿,早期前沿主要从肌电控制、肌电影响因素、肌电算法等领域到现代前沿的人机交互、人机功效学(人体假肢)等研究领域过渡。(4)肌电图学在人体工程学、运动生物力学(肌肉激活程度、激活时间)、评价动作模式、疲劳标准、评价康复性训练效果等领域提供肌电信息参数诊断。肌电在中风或脑卒中患者躯干肌电恢复时间、大小和对称性方面存在显著差异,肌电图学在揭示脑卒中患者单侧肢体抗阻训练对未训练肢体激活反应的机制方面仍然有待进一步研究。