A combination therapy of neural and glial restricted precursor cells and chronic quipazine treatment paired with passive cycling promotes quipazine-induced stepping in adult spinalized rats

Abstract

Introduction

In order to develop optimal treatments to promote recovery from complete spinal cord injury (SCI), we examined the combination of: (1) a cellular graft of neural and glial restricted precursor (NRP/GRP) cells, (2) passive exercise, and (3) chronic quipazine treatment on behavioral outcomes and compared them with the individual treatment elements. NRP/GRP cells were transplanted at the time of spinalization.

Methods

Daily passive exercise began 1 week after injury to give sufficient time for the animals to recover. Chronic quipazine administration began 2 weeks after spinalization to allow for sufficient receptor upregulation permitting the expression of its behavioral effects. Behavioral measures consisted of the Basso, Beattie, and Bresnahan (BBB) locomotor score and percent of weight-supported steps and hops on a treadmill.

Results

Rats displayed an increased response to quipazine (BBB ≥ 9) beginning at 8 weeks post-injury in all the animals that received the combination therapy. This increase in BBB score was persistent through the end of the study (12 weeks post-injury).

Conclusion

Unlike the individual treatment groups which never achieved weight support, the combination therapy animals were able to perform uncoordinated weight-supported stepping without a body weight support system while on a moving treadmill (6.5 m per minute) and were capable of supporting their own weight in stance during open field locomotion testing. No regeneration of descending serotonergic projections into and through the lesion cavity was observed. Furthermore, these results are a testament to the capacity of the lumbar spinal cord, when properly stimulated, to sustain functioning locomotor circuitry following complete SCI.     

自主神经反射异常

自主神经反射异常（AD）是一种交感神经反应异常的状态，通常发生于胸6及以上的脊髓损伤患者，由交感神经系统对有害刺激的过度反应而产生。因该症状可产生致命并发症，如癫痫、呼吸暂停、心肌梗死，颅内高压和脑出血，故AD的诊治显得极为重要。本文通过复习文献，主要就AD的发病率、发病机制、诱发因素、临床表现和治疗进行简要叙述。     

脊髓损伤中碱性成纤维细胞生长因子的变化与意义

目的：探索脊髓损伤进的自我保护修复机制，为髓有效治疗寻求可行性方案。方法：采用改良的Allen's法建立SD大鼠T8段脊髓损伤模型，观察术后不同时期T8伤段及其远、近脊髓内的bFGF及GFAP蛋白表达分布与变化情况，同时进行组织学观察及图像处理与分析。结果：脊髓损伤后bFGF阳性表达细胞，在术后T8段及远、近段明显增多，图像分析表明，大鼠SCI后4d、7d、14d及21d时T8区bFGF的平均光密度,分别与对照组比较有显著差异（P＜0．05）；而且术后14d时阳性表达最高；GFAP结果示，大量的反应性星形胶质细胞出现于创伤后脊髓灰质中，相邻切片表明，反应性星形胶质细胞是bFGF的主要阳性细胞。结论：脊髓损伤诱导了内源性bFGF蛋白表达短暂增高，提示，神经营养因子bFGF可能参与SCI后的神经元营养及自我“保护”过程。     

脊髓损伤后炎症性细胞因子表达的变化及甲基强的松龙的影响

目的 观察大鼠脊髓损伤(SCI)后,甲基强的松龙(MP)对炎症性细胞因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α) mRNA表达及运动功能恢复的影响。方法 采用改良 Allen氏法建立大鼠脊髓(T9、T10)中度损伤模型,56只SD大鼠随机分为假手术组(n=4)、SCI组(n=24)、生理盐水组(n=14)和 MP组(n=14),分别于损伤后 1 h、4 h、12 h、24 h、72 h和7 d取材,利用半定量RT PCR方法观察损伤段脊髓组织中上述 3 种细胞因子 mRNA表达的变化规律;于 SCI后30 min经尾静脉给予MP(30 mg/kg),利用半定量RT-PCR方法检测 SCI后 4 h时 MP对各炎症性细胞因子 mRNA表达的影响;利用BBB评分检测MP对大鼠SCI后运动功能恢复的影响。结果 假手术组动物脊髓组织中炎症性细胞因子mRNA仅有微弱表达。SCI后1h,各炎症性细胞因子mRNA表达明显升高,其中 IL-1β,IL-6表达于损伤后 12 h达峰值,TNF-α于损伤后 4 h达峰值,至损伤后72 h仍高于假手术组( P <0.05)。SCI后4 h时,MP组大鼠 IL-1β和TNF-αmRNA的表达明显受到抑制,但MP并未对运动功能的恢复产生有益的影响。结论 MP可明显抑制SCI后的炎症反应。     

1352例急性脊柱脊髓损伤早期救治分析

目的 分析急性脊柱脊髓损伤的伤情、合并伤和并发症，提出早期治疗原则。方法 对1352例急性脊柱脊髓损伤病例进行回顾性分析。结果 脊髓完全性损伤875例、不完全性损伤477例；合并症有肺部感染、泌尿系感染、褥疮等；合并伤有颅脑损伤、四肢骨盆骨折、血气胸等。保守治疗包括大剂量甲基强的松龙冲击疗法、高压氧治疗、脱水剂、神经营养药物等；对存在脊柱不稳、脱位和脊髓压迫者，进行减压内固定手术；合并伤均给予专科处理。结论 应重视急性脊柱脊髓损伤的现场急救，进行及时正确的早期处理；应重视处理合并伤，预防脊髓继发性损伤和并发症；早期康复指导是提高救治水平的关键。     

Nursing models and self-concept in patients with spinal cord injury--a comparison between UK and Taiwan

The purpose of this study is to investigate rehabilitation nurses' care for patients with spinal cord injury (SCI). It also examines how rehabilitation nurses perceive their role in assessing the alteration of self-concept and the interventions they use in helping patients to develop a more positive perception of themselves. A critical review of common models in use was undertaken including Roper, Logan and Tierney's Activities of Living Model, Roy's Adaptation Model and Orem's Self-care Deficit Nursing Theory. A nursing framework has been developed for rehabilitation nursing. Data were collected by questionnaire. The findings indicate that rehabilitation nurses are aware of the alteration in self-concept for patients with SCI. Although nursing interventions include physiological, psychological and social aspects of care, nurses do not feel that current nursing models are useful in SCI nursing and tend to support the specially designed model.