Evaluation of hyperbaric oxygen therapy for spinal cord injury in rats with different treatment course using diffusion tensor imaging

The Value of DTI Parameters in Predicting Postoperative Spinal Cord Function Fluctuations in Patients with High Cervical Disc Tumors

Objective

To explore the characteristics of magnetic resonance diffusion tensor imaging (DTI) parameters in patients with high cervical spinal myeloma and the evaluation of postoperative spinal cord function.

Methods

In recent years, 42 patients with high cervical spine myeloma were selected as the observation group, and 42 healthy volunteers were selected as the control group during the same period. The apparent dispersion coefficient (ADC), the fractional anisotropy (FA), the number of fiber bundles (FT), and the fiber bundle ratio (FTR) were compared between the two groups. The correlation between the ADC, FA, FT, FTR, and the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) score in the observation group were analyzed. Spinal cord function was evaluated using the Japanese Orthopaedic Association Score (JOA). Logistic regression model was used to analyze the factors affecting the recovery of spinal cord function after surgery. The receiver operating characteristic curve (ROC) was used to analyze the value of ADC, FA, FT, FTR1, and FTR2 in predicting the recovery of spinal cord function.

Results

The ADCs of the lesion layer and lower layer of the observation group were higher than the middle and lower layers of the control group, the FA and FT were lower than the middle and lower layers of the control group, and FTR1 and FTR2 were lower than those of the control group (P < 0.05). The ADC of the lesion layer in the observation group was negatively correlated with ISNCSCI score, and the FA, FT, FTR1, FTR2, and ISNCSCI scores were positively correlated (P < 0.05). Three months after the operation, JOA was used to evaluate the spinal cord function, which was excellent in 23 cases and poor in 19 cases. Logistic regression model analysis showed that after the ISNCSCI score was controlled, the increase in ADC and the decrease in FA, FT, FTR1, and FTR2 of the lesion layer were independent risk factors for poor postoperative body function recovery (P < 0.05). ROC analysis showed that the combination of ADC, FA, FT, FTR1, and FTR2 of the lesion layer predicted the AUC of spinal cord functional recovery was 0.941, which was better than the single prediction (P < 0.05).

Conclusion

The abnormal DTI parameter values of patients with high cervical spinal myeloma can better reflect the lack of spinal cord function, and they can effectively predict the recovery of the patient's body function after surgery, providing a reference for clinical diagnosis and treatment.

A review on the neuroprotective effects of hyperbaric oxygen therapy

Hyperbaric oxygen therapy, intermittent breathing of 100% oxygen at a pressure upper than sea level, has been shown to be some of the neuroprotective effects and used therapeutically in a wide range of neurological disorders. This review summarizes current knowledge about the neuroprotective effects of hyperbaric oxygen therapy with their molecular mechanisms in different models of neurological disorders.

Hyperbaric oxygen therapy for spinal cord injury: A protocol for systematic review and meta-analysis

BACKGROUND

Hyperbaric oxygen (HBO) therapy can prevent further spinal cord injury (SCI) caused by spinal cord ischemia-reperfusion injury to the maximum extent, which has been reported increasingly in recent years. However its security and effectiveness still lack of high-quality medical evidence. In this study, we will perform a systematic review of previously published randomized controlled trials (RCTs) to evaluate the efficacy and safety of HBO therapy for SCI.

METHODS

All potential RCTs on HBO therapy for SCI will be searched from the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wanfang database and Chinese Biomedical Literature Database. We will search all electronic databases from their initiation to the September 30, 2020 in spite of language and publication date. Two contributors will independently select studies from all searched literatures, extract data from included trials, and evaluate study quality for all eligible RCTs using Cochrane risk of bias tool, respectively. Any confusion will be resolved by consulting contributor and a consensus will be reached. We will utilize RevMan 5.3 software to pool the data and to conduct the data analysis.

RESULTS

The quality of the assessments will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Data will be disseminated through publications in peer-reviewed journals.

CONCLUSION

This study will provide evidence to evaluate the efficacy and safety of HBO therapy for SCI at evidence-based medicine level.

TRIAL REGISTRATION NUMBER

INPLASY 2020100084.

Collagen scaffold combined with human umbilical cord-mesenchymal stem cells transplantation for acute complete spinal cord injury

Currently, there is no effective strategy to promote functional recovery after a spinal cord injury. Collagen scaffolds can not only provide support and guidance for axonal regeneration, but can also serve as a bridge for nerve regeneration at the injury site. They can additionally be used as carriers to retain mesenchymal stem cells at the injury site to enhance their effectiveness. Hence, we hypothesized that transplanting human umbilical cord-mesenchymal stem cells on collagen scaffolds would enhance healing following acute complete spinal cord injury. Here, we test this hypothesis through animal studies and a phase I clinical trial. (1) Animal experiments: Models of completely transected spinal cord injury were established in rats and canines by microsurgery. Mesenchymal stem cells derived from neonatal umbilical cord tissue were adsorbed onto collagen scaffolds and surgically implanted at the injury site in rats and canines; the animals were observed after 1 week–6 months. The transplantation resulted in increased motor scores, enhanced amplitude and shortened latency of the motor evoked potential, and reduced injury area as measured by magnetic resonance imaging. (2) Phase I clinical trial: Forty patients with acute complete cervical injuries were enrolled at the Characteristic Medical Center of Chinese People’s Armed Police Force and divided into two groups. The treatment group (n = 20) received collagen scaffolds loaded with mesenchymal stem cells derived from neonatal umbilical cord tissues; the control group (n = 20) did not receive the stem-cell loaded collagen implant. All patients were followed for 12 months. In the treatment group, the American Spinal Injury Association scores and activities of daily life scores were increased, bowel and urinary functions were recovered, and residual urine volume was reduced compared with the pre-treatment baseline. Furthermore, magnetic resonance imaging showed that new nerve fiber connections were formed, and diffusion tensor imaging showed that electrophysiological activity was recovered after the treatment. No serious complication was observed during follow-up. In contrast, the neurological functions of the patients in the control group were not improved over the follow-up period. The above data preliminarily demonstrate that the transplantation of human umbilical cord-mesenchymal stem cells on a collagen scaffold can promote the recovery of neurological function after acute spinal cord injury. In the future, these results need to be confirmed in a multicenter, randomized controlled clinical trial with a larger sample size. The clinical trial was approved by the Ethics Committee of the Characteristic Medical Center of Chinese People’s Armed Police Force on February 3, 2016 (approval No. PJHEC-2016-A8). All animal experiments were approved by the Ethics Committee of the Characteristic Medical Center of Chinese People’s Armed Police Force on May 20, 2015 (approval No. PJHEC-2015-D5).