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Yang Z, Chen X, Liu R, Wang C, Zhao Y, Shi Z, Li M. Gene sequence analysis and screening of feature genes in spinal cord injury. Mol Med Rep 2015; 11:3615-20. [PMID: 25607546 DOI: 10.3892/mmr.2015.3220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 12/19/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to screen for feature genes associated with spinal cord injury (SCI), in order to identify the underlying pathogenic mechanisms. Differentially expressed genes were screened for using pre‑processing data. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis was performed to analyze and identify the genes involved in pathways associated with SCI. Subsequently, Gene Ontology enrichment analysis and Uniprot tissue analysis were used to screen out genes specifically expressed in spinal cord tissue. In addition, a protein‑protein interaction network was used to demonstrate possible associations among SCI‑associated feature genes. Finally, a link was identified between feature genes and SCI by analyzing protein domains in coding areas of the three feature genes. The cytochrome c oxidase subunit Va, adenosine triphosphate (ATP) synthase, H+ transporting, mitochondrial F1 complex, α subunit 1 and cardiac muscle and mitochondrial β‑F1‑ATPase may be downregulated in SCI, resulting in destruction of the mitochondrial electron transport chain and membrane‑bound enzyme complexes/ion transporters, thus, affecting the normal function of nerves. The three screened feature genes have the potential to become candidate target molecules to monitor, diagnose and treat SCI and may be beneficial for the early diagnosis and therapeutic control of the condition.
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Affiliation(s)
- Zongde Yang
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Xin Chen
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Ren Liu
- Department of Anesthesia, Fuzhou General Hospital of Nanjing Military Command Affiliated to Fujian Medical University, Fuzhou, Fujian 350025, P.R. China
| | - Chuanfeng Wang
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Yinchuan Zhao
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Zhicai Shi
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Ming Li
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
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Abstract
The spectrum of spinal surgery in adult life is considerable. Anaesthesia for major spinal surgery, such as spinal stabilization following trauma or neoplastic disease, or for correction of scoliosis, presents a number of challenges. The type of patients who would have been declined surgery 20 yr ago for medical reasons, are now being offered extensive procedures. They commonly have preoperative co-morbid conditions such as serious cardiovascular and respiratory impairment. Airway management may be difficult. Surgery imposes further stresses of significant blood loss, prolonged anaesthesia, and problematical postoperative pain management. The perioperative management of these patients is discussed. The advent of techniques to monitor spinal cord function has reduced postoperative neurological morbidity in these patients. The anaesthetist has an important role in facilitating these methods of monitoring.
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Affiliation(s)
- D A Raw
- University Department Anaesthesia, The Duncan Building, Daulby Street, Liverpool, L69 3GA, UK.
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Abstract
Increasing numbers of patients with spinal cord injury present for surgery or obstetric care. Spinal cord injury causes unique pathophysiological changes. The most important peri-operative dangers are autonomic dysreflexia, bradycardia, hypotension, respiratory inadequacy and muscle spasms. Autonomic dysreflexia is suggested by headache, sweating, bradycardia and severe hypertension and may be precipitated by surgery, especially bladder distension. Patients with low, complete lesions, undergoing surgery below the level of injury, may safely do so without anaesthesia provided there is no history of autonomic dysreflexia or troublesome spasms. An anaesthetist should be present to monitor the patient in this situation. General anaesthesia of sufficient depth is effective at controlling spasms and autonomic dysreflexia but hypotension and respiratory dysfunction are risks. There is a growing consensus that spinal anaesthesia is safe, effective and technically simple to perform in this group of patients. We present a survey of 515 consecutive anaesthetics in cord-injured patients and a review of the current literature on anaesthesia for patients with chronic spinal cord lesions.
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Affiliation(s)
- P R Hambly
- Nuffield Department of Anaesthetics, John Radcliffe, Headington, Oxford, UK
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Colachis SC. Autonomic hyperreflexia with spinal cord injury. THE JOURNAL OF THE AMERICAN PARAPLEGIA SOCIETY 1992; 15:171-86. [PMID: 1500943 DOI: 10.1080/01952307.1992.11735871] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autonomic hyperreflexia occurs in up to 85 percent of individuals with spinal cord injuries above the major splanchnic sympathetic outflow. In such cases, paroxysmal reflex sympathetic activity develops in response to noxious stimuli below the level of the neurologic lesion. The clinical features of autonomic hyperreflexia are due largely to reflex sympathetic adrenergic and cholinergic discharges with dysfunctional supraspinal regulatory control. Cephalgia, diaphoresis, flushing, tachycardia or bradycardia, and paroxysmal hypertension are most commonly observed. Although a variety of stimuli can provoke autonomic responses of variable magnitudes, bladder and bowel distention continue to account for most episodes. Removal of the offending stimulus is important to restoring the autonomic nervous system to its baseline activity. Current understanding of the pathophysiology, clinical features, and medical management of this fascinating but potentially serious complication of spinal cord injury are reviewed.
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Affiliation(s)
- S C Colachis
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus 43210
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Affiliation(s)
- C S Trop
- Department of Urology, University of Southern California, Los Angeles
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Hauswald M, Sklar DP, Tandberg D, Garcia JF. Cervical spine movement during airway management: cinefluoroscopic appraisal in human cadavers. Am J Emerg Med 1991; 9:535-8. [PMID: 1930391 DOI: 10.1016/0735-6757(91)90106-t] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to determine which airway maneuvers cause the least cervical spine movement. A controlled laboratory investigation was performed in a radiologic suite, using eight human traumatic arrest victims who were studied within 40 minutes of death. All subjects were ventilated by mask and intubated orally, over a lighted oral stylet and flexible laryngoscope, and nasally. Cinefluoroscopic measurement of maximum cervical displacement during each procedure was made with the subjects supine and secured by hard collar, backboard, and tape. The mean maximum cervical spine displacement was found to be 2.93 mm for mask ventilation, 1.51 mm for oral intubation, 1.65 mm for guided oral intubation, and 1.20 mm for nasal intubation. Ventilation by mask caused more cervical spine displacement than the other procedures studied (ANOVA: F = 9.298; P = .00004). It was concluded that mask ventilation moves the cervical spine more than any commonly used method of endotracheal intubation. Physicians should choose the intubation technique with which they have the greatest experience and skill.
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Affiliation(s)
- M Hauswald
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque 87131
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Abstract
Anaesthetists are responsible for the management of the airway in patients with unstable cervical spines. Unfortunately, the anaesthetic literature does not contain a recent, critical analysis of the current medical literature to aid anaesthetists attending such patients. This review is intended to serve such a purpose. Using the Index Medicus as a guide, 30 years of medical literature were reviewed, with emphasis on the last ten years. Key words employed for this review are cited in the manuscript. Relevant papers were selected from anaesthetic, orthopaedic, rheumatologic, emergency medicine and trauma journals and reviewed. Relevant findings included the high prevalence of cervical spinal instability in such disorders such as Trisomy 21 and rheumatoid arthritis and the relatively low incidence after trauma. There are deficiencies in the minimalist approaches to assessing the cervical spine, such as a simple cross table lateral radiograph after trauma, as they are neither sensitive nor specific. Finally, recognizing the potential for instability and intubating with care, while avoiding spinal movement, appears to be more important than any particular mode of intubation in preserving neurological function.
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Affiliation(s)
- E T Crosby
- Department of Anaesthesia, Women's College Hospital, Toronto, Ontario
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Affiliation(s)
- P Rosen
- Emergency Medical Services, Denver General Hospital, Colorado 80204-4507
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Abstract
Trauma is the leading cause of death for persons aged 1 to 38 years. Successful management is facilitated by prehospital endotracheal intubation, transport to regional trauma centers, rapid resuscitation by an on-site team of trained physicians, timely operative intervention, and provision of care by well-prepared anesthesiologists familiar with the potential complications typical of traumatized patients. No particular anesthetic agent or technique is ideal. Causes for intraoperative hypotension include hypovolemia, hemopneumothorax, pericardial tamponade, an intracranial mass, acidosis, and hypothermia. The anesthesiologist should play an active role in all phases of trauma management, including provision of postoperative intensive care and pain relief.
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Affiliation(s)
- B J Nicholls
- Department of Anesthesiology, University of Washington, Harborview Medical Center, Seattle 98104
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Eason JR, Swaine CN, Jones PI, Gronow MJ, Beaumont A. Unstable cervical fracture. Anaesthetic management for an urgent caesarean section. Anaesthesia 1987; 42:745-9. [PMID: 3631474 DOI: 10.1111/j.1365-2044.1987.tb05320.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The anaesthetic management of a 26-year-old woman who sustained an unstable fracture of C2 when 40 weeks pregnant, is described.
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Raeder JC, Gisvold SE. Perioperative autonomic hyperreflexia in high spinal cord lesions: a case report. Acta Anaesthesiol Scand 1986; 30:672-3. [PMID: 3811812 DOI: 10.1111/j.1399-6576.1986.tb02499.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We report the case of a 20-year-old man with serious perioperative attacks of autonomic hyperreflexia starting during urological surgery 14 months after a complete C6-C7 spinal cord injury. The intraoperative attacks were controlled by deepening the level of anaesthesia, while the postoperative attacks were treated with emepronium bromide. A brief discussion of the pathophysiology and treatment is given.
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O’Donohue WJ, Giovannoni, RM, Goldberg AI, Keens TG, Make BJ, Plummer AL, Prentice WS. Long-term Mechanical Ventilation. Chest 1986. [DOI: 10.1378/chest.90.1_supplement.1s] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kay MM, Kranz JM. External transcutaneous pacemaker for profound bradycardia associated with spinal cord trauma. SURGICAL NEUROLOGY 1984; 22:344-6. [PMID: 6474337 DOI: 10.1016/0090-3019(84)90137-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The successful use of external transthoracic pacing is described in a case of spinal cord trauma with profound bradycardia. This modality achieved blood pressures equal to transvenous pacing. In patients in whom venous access is difficult or represents a risk of infection, transthoracic pacing may offer a worthwhile alternative.
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Layman PR. Sweating during anaesthesia. Anaesthesia 1984; 39:846. [PMID: 6476333 DOI: 10.1111/j.1365-2044.1984.tb06564.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Layman P. Sweating during anasthesia. Anaesthesia 1983. [DOI: 10.1111/j.1365-2044.1983.tb06564.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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