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Şık N, Bulut SK, Şalbaş ÖY, Yılmaz D, Duman M. Evaluation of traumatic spinal injuries: a pediatric perspective. Childs Nerv Syst 2024:10.1007/s00381-024-06447-z. [PMID: 38856745 DOI: 10.1007/s00381-024-06447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/01/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE The aim of the present study is to provide information about pediatric patients with spinal trauma. METHODS A single-center retrospective chart review was carried out. Children who arrived at the pediatric emergency department due to trauma and those with spinal pathology confirmed by radiological assessment were included. Demographics, mechanisms of trauma, clinical findings, radiological investigations, applied treatments, hospital stay and prognosis were recorded. RESULTS A total of 105 patients [59 (56.2%) boys; mean age: 12.9 ± 3.8 years (mean ± SD)] were included. The most common age group was that of 14-18 years (58.1%). The three most common trauma mechanisms were road traffic collisions (RTCs) (60.0%), falls (32.4%), and diving into water (2.9%). A fracture of the spine was detected in 97.1% patients, vertebral dislocation in 10.7%, and spinal cord injury in 16.3%. Of the patients, 36.9% were admitted to the ward and 18.4% to the pediatric intensive care unit; 17.1% were discharged with severe complications and 2.9% cases resulted in death. While 34.3% of the patients had a clinically isolated spine injury, the remaining cases entailed an injury to at least one other body part; the most common associated injuries were to the head (39.8%), abdomen (36.1%), and external areas (28.0%). CONCLUSION Spinal trauma was found to have occurred mostly in adolescent males, and the majority of those cases were due to RTCs. Data on the incidence and demographic factors of pediatric spinal trauma are crucial in furthering preventive measures, allowing for the identification of at-risk populations and treatment modalities.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sena Kalkan Bulut
- Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Özge Yıldırım Şalbaş
- Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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Huang H, Ramon-Cueto A, El Masri W, Moviglia GA, Saberi H, Sharma HS, Otom A, Chen L, Siniscalco D, Sarnowska A. Advances in Neurorestoratology-Current status and future developments. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 171:207-239. [PMID: 37783556 DOI: 10.1016/bs.irn.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Neurorestoratology constitutes a novel discipline aimed at the restoration of damaged neural structures and impaired neurological functions. This area of knowledge integrates and compiles all concepts and strategies dealing with the neurorestoration. Although currently, this discipline has already been well recognized by physicians and scientists throughout the world, this article aimed at broadening its knowledge to the academic circle and the public society. Here we shortly introduced why and how Neurorestoratology was born since the fact that the central nervous system (CNS) can be repaired and the subsequent scientific evidence of the neurorestorative mechanisms behind, such as neurostimulation or neuromodulation, neuroprotection, neuroplasticity, neurogenesis, neuroregeneration or axonal regeneration or sprouting, neuroreplacement, loop reconstruction, remyelination, immunoregulation, angiogenesis or revascularization, and others. The scope of this discipline is the improvement of therapeutic approaches for neurological diseases and the development of neurorestorative strategies through the comprehensive efforts of experts in the different areas and all articulated by the associations of Neurorestoratology and its journals. Strikingly, this article additionally explores the "state of art" of the Neurorestoratology field. This includes the development process of the discipline, the achievements and advances of novel neurorestorative treatments, the most efficient procedures exploring and evaluating outcome after the application of pioneer therapies, all the joining of a multidisciplinary expert associations and the specialized journals being more and more impact. We believe that in a near future, this discipline will evolve fast, leading to a general application of cell-based comprehensive neurorestorative treatments to fulfill functional recovery demands for patients with neurological deficits or dysfunctions.
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Affiliation(s)
- Hongyun Huang
- Beijing Hongtianji Neuroscience Academy, Beijing, P.R. China.
| | - Almudena Ramon-Cueto
- Health Center Colmenar Norte, Plaza de Los Ríos 1, Colmenar Viejo, Madrid, Spain
| | - Wagih El Masri
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Spinal Injuries Keele University, Oswestry, United Kingdom
| | - Gustavo A Moviglia
- Wake Forest Institute for Regenerative Medicine. Winston Salem, NC, United States
| | - Hooshang Saberi
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Ali Otom
- Royal Specialty Center for Spine & M-Skeletal Disorders, Amman, Jordan
| | - Lin Chen
- Department of Neurosurgery, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, P.R. China
| | - Dario Siniscalco
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Sarnowska
- Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
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3
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13-cis-Retinoic Acid Affects Brain Perfusion and Function: In Vivo Study. Mol Imaging 2023. [DOI: 10.1155/2023/7855924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Purpose. Study the effects of 13-cis-retinoic acid (13-RA), a synthetic analogue of a vitamin A used for the treatment of severe acne, on the blood flow in the rat brain using technetium-99m hexamethyl propylene amine oxime (99mTc-HMPAO) imaging. Methods. A total of 30 adult male Wistar rats were divided into the control (C), low-dose (L), and high-dose (H) groups. The L and H rats were exposed subcutaneously to 0.3 and 0.5 mg, respectively, of 13-RA per kg of body weight for seven days. Brain blood flow imaging was performed using a gamma camera. Then, a region of interest (ROI) around the brain (target, T), a whole-body region (WB), and a background region (BG) was selected and delimited. The net 99mTc-HMPAO brain counts were calculated as the net target counts,
in all groups. At the end of the 99mTc-HMPAO brain blood flow imaging, the brain, heart, kidney, lung, and liver were rapidly removed, and their uptake was determined. Brain histopathological analysis was performed using hematoxylin and eosin stains. In addition, the plasma fatty acids were studied using gas chromatography/mass spectrometry. Results. There were highly significant differences between L and H in comparison to C and across the groups. The 99mTc-HMPAO radioactivity in the brain showed increased uptake in a dose-dependent manner. There were also significant changes in the brain tissues and decreased free fatty acids among the groups compared to C. Conclusion. 13-RA increases 99mTcHMPAO brain perfusion, uptake, and function and reduces fatty acids.
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Kozler P, Marešová D, Pokorný J. Effect of methylprednisolone on experimental brain edema in rats - own experience reviewed. Physiol Res 2021; 70:S289-S300. [PMID: 35099248 DOI: 10.33549/physiolres.934818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Brain edema - a frequently fatal pathological state in which brain volume increases resulting in intracranial pressure elevation - can result from almost any insult to the brain, including traumatic brain injury. For many years, the objective of experimental studies was to find a method to prevent the development of brain edema at the onset. From this perspective, the use of methylprednisolone (MP) appears promising. High molecular MP (MW>50 kDa) can be incorporated into the brain - in the conditions of the experimental model - either by osmotic blood-brain barrier disruption (BBBd) or during the induction of cellular edema by water intoxication (WI) - a condition that increases the BBB permeability. The time window for administration of the MP should be at the earliest stages of edema. The neuroprotective effect of MP on the permeability of cytoplasmatic membranes of neuronal populations was proved. MP was administrated in three alternative ways: intraperitoneally during the induction of cytotoxic edema or immediately after finishing cytotoxic edema induction in a dose of 100 mg/kg b.w.; into the internal carotid artery within 2 h after finishing cytotoxic edema induction in a dose of 50 mg/kg b.w.; into internal carotid artery 10 min after edema induction by BBBd in a dose of 50 mg/kg b.w.
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Affiliation(s)
- P Kozler
- Institute of Physiology, First Faculty of Medicine, Charles University, Praha 2, Czech Republic.
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Zhang N, Lin J, Lin VPH, Milbreta U, Chin JS, Chew EGY, Lian MM, Foo JN, Zhang K, Wu W, Chew SY. A 3D Fiber-Hydrogel Based Non-Viral Gene Delivery Platform Reveals that microRNAs Promote Axon Regeneration and Enhance Functional Recovery Following Spinal Cord Injury. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2100805. [PMID: 34050637 PMCID: PMC8336488 DOI: 10.1002/advs.202100805] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 05/05/2023]
Abstract
Current treatment approaches toward spinal cord injuries (SCI) have mainly focused on overcoming the inhibitory microenvironment that surrounds lesion sites. Unfortunately, the mere modulation of the cell/tissue microenvironment is often insufficient to achieve desired functional recovery. Therefore, stimulating the intrinsic growth ability of injured neurons becomes crucial. MicroRNAs (miRs) play significant roles during axon regeneration by regulating local protein synthesis at growth cones. However, one challenge of using miRs to treat SCI is the lack of efficient delivery approaches. Here, a 3D fiber-hydrogel scaffold is introduced which can be directly implanted into a spinal cord transected rat. This 3D scaffold consists of aligned electrospun fibers which provide topographical cues to direct axon regeneration, and collagen matrix which enables a sustained delivery of miRs. Correspondingly, treatment with Axon miRs (i.e., a cocktail of miR-132/miR-222/miR-431) significantly enhances axon regeneration. Moreover, administration of Axon miRs along with anti-inflammatory drug, methylprednisolone, synergistically enhances functional recovery. Additionally, this combined treatment also decreases the expression of pro-inflammatory genes and enhance gene expressions related to extracellular matrix deposition. Finally, increased Axon miRs dosage with methylprednisolone, significantly promotes functional recovery and remyelination. Altogether, scaffold-mediated Axon miR treatment with methylprednisolone is a promising therapeutic approach for SCI.
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Affiliation(s)
- Na Zhang
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Junquan Lin
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Vincent Po Hen Lin
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Ulla Milbreta
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Jiah Shin Chin
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
- Interdisciplinary Graduate SchoolNanyang Technological University61 Nanyang DriveSingapore637335Singapore
| | - Elaine Guo Yan Chew
- Human GeneticsGenome Institute of Singapore60 Biopolis StreetSingapore138672Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
| | - Michelle Mulan Lian
- Human GeneticsGenome Institute of Singapore60 Biopolis StreetSingapore138672Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
| | - Jia Nee Foo
- Human GeneticsGenome Institute of Singapore60 Biopolis StreetSingapore138672Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
| | - Kunyu Zhang
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
| | - Wutian Wu
- Guangdong‐Hongkong‐Macau Institute of CNS RegenerationMinistry of Education CNS Regeneration Collaborative Joint LaboratoryJinan University601 West Huangpu AvenueGuangzhou510632P. R. China
- Re‐Stem Biotechnology Co., Ltd.1463 Wuzhong AveSuzhou330520P. R. China
| | - Sing Yian Chew
- School of Chemical and Biomedical EngineeringNanyang Technological University62 Nanyang DriveSingapore637459Singapore
- Lee Kong Chian School of MedicineNanyang Technological University59 Nanyang DriveSingapore636921Singapore
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Pizzolato C, Gunduz MA, Palipana D, Wu J, Grant G, Hall S, Dennison R, Zafonte RD, Lloyd DG, Teng YD. Non-invasive approaches to functional recovery after spinal cord injury: Therapeutic targets and multimodal device interventions. Exp Neurol 2021; 339:113612. [DOI: 10.1016/j.expneurol.2021.113612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
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Pasqualucci A, Al-Sibaie A, Vaidyan KPT, Paladini A, Nadhari MY, Gori F, Greiss HF, Properzi M, Al Ani OSM, Godwin A, Syedkazmi AH, Elhanf OA, Varrassi G. Epidural Corticosteroids, Lumbar Spinal Drainage, and Selective Hemodynamic Control for the Prevention of Spinal Cord Ischemia in Thoracoabdominal Endovascular Aortic Repair: A New Clinical Protocol. Adv Ther 2020; 37:272-287. [PMID: 31721112 DOI: 10.1007/s12325-019-01146-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In patients undergoing thoracoabdominal aorta repair, spinal cord ischemia (SCI) remains one of the most common and important complications resulting in transient paraparesis through to permanent flaccid paraplegia. In this manuscript, after a brief introduction to spinal cord ischemia complication and its prevention in thoracoabdominal endovascular aortic repair (TEVAR), we propose a new clinical protocol potentially able to prevent such complication. METHODS The proposed protocol suggests the use of high dosages of corticosteroids by epidural route, along with drainage of cerebrospinal fluid and controlled vascular hypertension, to reduce the incidence of SCI in TEVAR. Moreover, we paid particular attention to the control of the hemodynamic parameters to obtain adequate peripheral tissue perfusion (oxygen delivery), including in the spinal cord. RESULTS We applied this new protocol in 50 consecutive patients treated with TEVAR for thoracoabdominal aortic aneurysms (TAAs); 47 patients completed the procedure: 27 patients Crawford type I and 20 Crawford type II. Three patients died during surgery because of untreatable aneurysm rupture. The results show that in all patients there were no cases of SCI, after 5 days from TEVAR. DISCUSSION To the best of our knowledge, there are no clinical studies on the use of epidural corticosteroids in patients undergoing treatment of aortic syndrome (both in "open surgery" and endovascular aortic repair). This initial study on 50 consecutive patients has shown that the clinical protocol used could be of great interest to prevent one of the worse complications of TEVAR. Its limitations are the low number of patients studied till now, and the non-randomized protocol adopted. Further studies would be necessary. CONCLUSION Our experience and the results obtained with this new perioperative protocol with epidural corticosteroid and accurate hemodynamic control have been encouraging and it seems a valid proposal to be explored in future by well-structured prospective, randomized protocols.
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Affiliation(s)
- Alberto Pasqualucci
- Department of Surgical and Biomedical Science, University Hospital of Perugia, 06100, Perugia, Italy
- Rashid Hospital, Trauma and Emergency Center (Dubai Health Authority), Dubai, UAE
| | - Ayman Al-Sibaie
- Rashid Hospital, Trauma and Emergency Center (Dubai Health Authority), Dubai, UAE
| | | | | | | | - Fabio Gori
- Department of Surgical and Biomedical Science, University Hospital of Perugia, 06100, Perugia, Italy
| | - Hany Fawzy Greiss
- Rashid Hospital, Trauma and Emergency Center (Dubai Health Authority), Dubai, UAE
| | - Marina Properzi
- Department of Surgical and Biomedical Science, University Hospital of Perugia, 06100, Perugia, Italy
| | | | - Aruna Godwin
- Rashid Hospital, Trauma and Emergency Center (Dubai Health Authority), Dubai, UAE
| | | | - Osama Ahmed Elhanf
- Rashid Hospital, Trauma and Emergency Center (Dubai Health Authority), Dubai, UAE
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Schofield PW, Doty RL. The influence of head injury on olfactory and gustatory function. HANDBOOK OF CLINICAL NEUROLOGY 2019; 164:409-429. [PMID: 31604560 DOI: 10.1016/b978-0-444-63855-7.00023-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head injury, particularly that resulting in brain injury, is a significant public health concern. For example, annual incidence rates of traumatic brain injury, a common consequence of head injury, range from 54 to 60 million people worldwide, including 2.2-3.6 million people whose trauma is moderate to severe. Trauma to the face and brain, including blast injuries common in modern warfare, can result in alterations in the ability to both smell and taste. In the case of smell, these include total loss of function (anosmia), decreased sensitivity (hyposmia), alterations in odor quality (dysosmia), and hallucination (phantosmia). Although taste dysfunction, i.e., altered perception of such basic taste-bud-mediated sensations as sweet, sour, bitter, salty, and savory (umami), can be similarly influenced by head trauma, the effects are typically more subtle and less studied. The present review provides an up-to-date assessment of what is known about the impact of head injury on quantitative measures of taste and smell function, including the influences of severity, type of injury, location of insults, prognosis, and approaches to therapy.
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Affiliation(s)
- Peter W Schofield
- Neuropsychiatry Service, Hunter New England Local Health District and Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Richard L Doty
- Smell and Taste Center and Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Scholpa NE, Schnellmann RG. Mitochondrial-Based Therapeutics for the Treatment of Spinal Cord Injury: Mitochondrial Biogenesis as a Potential Pharmacological Target. J Pharmacol Exp Ther 2017; 363:303-313. [PMID: 28935700 PMCID: PMC5676296 DOI: 10.1124/jpet.117.244806] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022] Open
Abstract
Spinal cord injury (SCI) is characterized by an initial trauma followed by a progressive cascade of damage referred to as secondary injury. A hallmark of secondary injury is vascular disruption leading to vasoconstriction and decreased oxygen delivery, which directly reduces the ability of mitochondria to maintain homeostasis and leads to loss of ATP-dependent cellular functions, calcium overload, excitotoxicity, and oxidative stress, further exacerbating injury. Restoration of mitochondria dysfunction during the acute phases of secondary injury after SCI represents a potentially effective therapeutic strategy. This review discusses the past and present pharmacological options for the treatment of SCI as well as current research on mitochondria-targeted approaches. Increased antioxidant activity, inhibition of the mitochondrial permeability transition, alternate energy sources, and manipulation of mitochondrial morphology are among the strategies under investigation. Unfortunately, many of these tactics address single aspects of mitochondrial dysfunction, ultimately proving largely ineffective. Therefore, this review also examines the unexplored therapeutic efficacy of pharmacological enhancement of mitochondrial biogenesis, which has the potential to more comprehensively improve mitochondrial function after SCI.
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Affiliation(s)
- Natalie E Scholpa
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, Arizona (N.E.S., R.G.S.); and Southern Arizona VA Health Care System, Tucson, Arizona (R.G.S.)
| | - Rick G Schnellmann
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, Arizona (N.E.S., R.G.S.); and Southern Arizona VA Health Care System, Tucson, Arizona (R.G.S.)
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The regulatory effect of electro-acupuncture on the expression of NMDA receptors in a SCI rat model. Life Sci 2017; 177:8-14. [PMID: 28392262 DOI: 10.1016/j.lfs.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In early spinal cord injury (SCI), glutamate receptors, including N-methyl-d-aspartate (NMDA) receptors (NMDARs), are over-stimulated by excessively released glutamate. The enhanced activity of NMDARs may cause cell death by overloading calcium (Ca2+) into cells based on their high permeability to Ca2+. Studies in SCI animals have shown that treatment with electro-acupuncture (EA) is able to reduce cell death and to improve functional recovery. One possible mechanism of this neuroprotective effect is that EA has regulatory effect on NMDARs. AIMS To test whether EA could protect the spinal cord after SCI by decreasing the expression levels of NR1 and NR2A. MAIN METHODS We conducted EA treatment on a rat SCI model produced with a New York University (NYU) Impactor and measured hindlimb locomotor function by Basso, Beattie and Bresnahan Locomotor Rating Scale (BBB Scale). The expression of NR1 and NR2, the subunits of NMDARs, in the injured spinal cord was measured by Immunofluorescence stainings, western blot and real-time quantitative PCR (RT-qPCR). KEY FINDING Our results showed that two days after the SCI the expression of NR1 and NR2 were dramatically enhanced at both protein and mNRA levels, which were significantly reduced by EA treatment at two specific acupoints, Dazhui (DU14) and Mingmen (DU4). SIGNIFICANCE EA is a potential therapeutic method for treating early SCI in human.
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Kang KB, Jones S, Ahmad A, Moss HE. Optic Neuropathy with Delayed Onset After Trauma: Case Report and Review of the Literature. Neuroophthalmology 2016; 40:188-191. [DOI: 10.1080/01658107.2016.1177091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
This article reviews the indications and evidence for the administration of steroids to patients who have suffered significant trauma. Uncontroversial indications are rare. In spinal cord injury steroids are often given but the practical benefits are questionable. The case for treatment in head injury is unproven. Consideration should be given to treating all those patients who develop acute respiratory distress syndrome (ARDS), although treatment should be deferred to the later (fibroproliferative) stages. The role of steroids in sepsis is complicated and, although steroid administration can have dramatic effects on vasopressor requirements, convincing evidence for mortality reduction is not available.
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Affiliation(s)
- David J Lockey
- The Intensive Care Unit, Frenchay Hospital, Frenchay, Bristol, UK
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Salegio EA, Bresnahan JC, Sparrey CJ, Camisa W, Fischer J, Leasure J, Buckley J, Nout-Lomas YS, Rosenzweig ES, Moseanko R, Strand S, Hawbecker S, Lemoy MJ, Haefeli J, Ma X, Nielson JL, Edgerton VR, Ferguson AR, Tuszynski MH, Beattie MS. A Unilateral Cervical Spinal Cord Contusion Injury Model in Non-Human Primates (Macaca mulatta). J Neurotrauma 2016; 33:439-59. [PMID: 26788611 PMCID: PMC4799702 DOI: 10.1089/neu.2015.3956] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The development of a non-human primate (NHP) model of spinal cord injury (SCI) based on mechanical and computational modeling is described. We scaled up from a rodent model to a larger primate model using a highly controllable, friction-free, electronically-driven actuator to generate unilateral C6-C7 spinal cord injuries. Graded contusion lesions with varying degrees of functional recovery, depending upon pre-set impact parameters, were produced in nine NHPs. Protocols and pre-operative magnetic resonance imaging (MRI) were used to optimize the predictability of outcomes by matching impact protocols to the size of each animal's spinal canal, cord, and cerebrospinal fluid space. Post-operative MRI confirmed lesion placement and provided information on lesion volume and spread for comparison with histological measures. We evaluated the relationships between impact parameters, lesion measures, and behavioral outcomes, and confirmed that these relationships were consistent with our previous studies in the rat. In addition to providing multiple univariate outcome measures, we also developed an integrated outcome metric describing the multivariate cervical SCI syndrome. Impacts at the higher ranges of peak force produced highly lateralized and enduring deficits in multiple measures of forelimb and hand function, while lower energy impacts produced early weakness followed by substantial recovery but enduring deficits in fine digital control (e.g., pincer grasp). This model provides a clinically relevant system in which to evaluate the safety and, potentially, the efficacy of candidate translational therapies.
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Affiliation(s)
- Ernesto A Salegio
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Jacqueline C Bresnahan
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Carolyn J Sparrey
- 2 School of Engineering Science, Simon Fraser University , Surrey, British Columbia, Canada
| | - William Camisa
- 3 Taylor Collaboration, St. Mary's Medical Center , San Francisco, California
| | - Jason Fischer
- 3 Taylor Collaboration, St. Mary's Medical Center , San Francisco, California
| | - Jeremi Leasure
- 3 Taylor Collaboration, St. Mary's Medical Center , San Francisco, California
| | - Jennifer Buckley
- 4 Department of Mechanical Engineering, University of Delaware , Newark, Delaware
| | - Yvette S Nout-Lomas
- 5 College of Veterinary Medicine and Biomedical Sciences, Colorado State University , Fort Collins, Colorado
| | - Ephron S Rosenzweig
- 6 Department of Neurosciences, University of California at San Diego , San Diego, California; Veterans Administration Medical Center, La Jolla, California
| | - Rod Moseanko
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Sarah Strand
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Stephanie Hawbecker
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Marie-Josee Lemoy
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Jenny Haefeli
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Xiaokui Ma
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Jessica L Nielson
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - V R Edgerton
- 8 Departments of Physiological Science and Neurology, University of California at Los Angeles , Los Angeles, California
| | - Adam R Ferguson
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Mark H Tuszynski
- 6 Department of Neurosciences, University of California at San Diego , San Diego, California; Veterans Administration Medical Center, La Jolla, California
| | - Michael S Beattie
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
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Cheung V, Hoshide R, Bansal V, Kasper E, Chen CC. Methylprednisolone in the management of spinal cord injuries: Lessons from randomized, controlled trials. Surg Neurol Int 2015; 6:142. [PMID: 26392918 PMCID: PMC4553662 DOI: 10.4103/2152-7806.163452] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/02/2015] [Indexed: 11/23/2022] Open
Abstract
The efficacy of glucocorticoid for treatment of acute spinal cord injuries remains a controversial topic. Differing medical societies have issued conflicting recommendations in this regard. Here we review the available randomized, controlled trial (RCT) data on this subject and offer a synthesis of these data sets.
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Affiliation(s)
- Vincent Cheung
- Division of Neurosurgery, University of California, San Diego, CA, USA
| | - Reid Hoshide
- Division of Neurosurgery, University of California, San Diego, CA, USA
| | - Vishal Bansal
- Department of Surgery, University of California, San Diego, CA, USA
| | - Ekkehard Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Clark C Chen
- Division of Neurosurgery, University of California, San Diego, CA, USA
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Tang P, Zhang Y, Chen C, Ji X, Ju F, Liu X, Gan WB, He Z, Zhang S, Li W, Zhang L. In vivo two-photon imaging of axonal dieback, blood flow, and calcium influx with methylprednisolone therapy after spinal cord injury. Sci Rep 2015; 5:9691. [PMID: 25989524 PMCID: PMC4437044 DOI: 10.1038/srep09691] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/17/2015] [Indexed: 12/30/2022] Open
Abstract
Severe spinal cord injury (SCI) can cause neurological dysfunction and paralysis. However, the early dynamic changes of neurons and their surrounding environment after SCI are poorly understood. Although methylprednisolone (MP) is currently the standard therapeutic agent for treating SCI, its efficacy remains controversial. The purpose of this project was to investigate the early dynamic changes and MP's efficacy on axonal damage, blood flow, and calcium influx into axons in a mouse SCI model. YFP H-line and Thy1-GCaMP transgenic mice were used in this study. Two-photon microscopy was used for imaging of axonal dieback, blood flow, and calcium influx post-injury. We found that MP treatment attenuated progressive damage of axons, increased blood flow, and reduced calcium influx post-injury. Furthermore, microglia/macrophages accumulated in the lesion site after SCI and expressed the proinflammatory mediators iNOS, MCP-1 and IL-1β. MP treatment markedly inhibited the accumulation of microglia/macrophages and reduced the expression of the proinflammatory mediators. MP treatment also improved the recovery of behavioral function post-injury. These findings suggest that MP exerts a neuroprotective effect on SCI treatment by attenuating progressive damage of axons, increasing blood flow, reducing calcium influx, and inhibiting the accumulation of microglia/macrophages after SCI.
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Affiliation(s)
- Peifu Tang
- Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing, China, 100853
| | - Yiling Zhang
- 1] Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing, China, 100853 [2] Key Laboratory of Chemical Genomics, Shenzhen Graduate School, Peking University, Shenzhen, China, 518055
| | - Chao Chen
- 1] Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing, China, 100853 [2] Key Laboratory of Chemical Genomics, Shenzhen Graduate School, Peking University, Shenzhen, China, 518055
| | - Xinran Ji
- Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing, China, 100853
| | - Furong Ju
- School of Life Sciences, Lanzhou University, Lanzhou, China, 73000
| | - Xingyu Liu
- Beijing YouAn Hospital, Capital Medical University, Beijing, China, 100069
| | - Wen-Biao Gan
- 1] Key Laboratory of Chemical Genomics, Shenzhen Graduate School, Peking University, Shenzhen, China, 518055 [2] Skirball Institute, Department of Neuroscience and Physiology, New York University School of Medicine, New York, USA, 10016
| | - Zhigang He
- F.M. Kirby Program in Neuroscience, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - Shengxiang Zhang
- School of Life Sciences, Lanzhou University, Lanzhou, China, 73000
| | - Wei Li
- Key Laboratory of Chemical Genomics, Shenzhen Graduate School, Peking University, Shenzhen, China, 518055
| | - Lihai Zhang
- Department of Orthopedics, the General Hospital of Chinese People's Liberation Army, Beijing, China, 100853
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Geng CK, Cao HH, Ying X, Zhang HT, Yu HL. The effects of hyperbaric oxygen on macrophage polarization after rat spinal cord injury. Brain Res 2015; 1606:68-76. [PMID: 25724144 DOI: 10.1016/j.brainres.2015.01.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/03/2015] [Accepted: 01/18/2015] [Indexed: 01/02/2023]
Abstract
The immunoreactive responses are a two-edged sword after spinal cord injury (SCI). Macrophages are the predominant inflammatory cells responsible for this response. However, the mechanism underlying the effects of HBOT on the immunomodulation following SCI is unclear now. The present study was performed to examine the effects of hyperbaric oxygen therapy (HBOT) on macrophage polarization after the rat compressive injury of the spinal cord. HBOT was associated with significant increases in IL-4 and IL-13 levels, and reductions in TNF-α and IFN-ɣ levels. This was associated simultaneously with the levels of alternatively activated macrophages (M2 phenotype: arginase-1- or CD206-positive), and decreased levels of classically activated macrophages (M1 phenotype: iNOS- or CD16/32-positive). These changes were associated with functional recovery in the HBOT-transplanted group, which correlated with preserved axons and increased myelin sparing. Our results suggested that HBOT after SCI modified the inflammatory environment by shifting the macrophage phenotype from M1 to M2, which may further promote the axonal extension and functional recovery.
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Affiliation(s)
- Cheng-Kui Geng
- Department of Orthopedics, Yan׳an Hospital of Kunming City, the Affiliated Hospital of Kunming Medical University, Kunming 650032, China; Department of Minimally Invasive Neurosurgery, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming 650032, China
| | - Hong-Hua Cao
- Department of Hematology, Tumor Hospital of Yunnan Province & The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China
| | - Xiong Ying
- Department of Orthopedics, Yan׳an Hospital of Kunming City, the Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Hong-Tian Zhang
- Department of Minimally Invasive Neurosurgery, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming 650032, China; The Affiliated Bayi Brain Hospital, The General Hospital of Beijing PLA, Beijing 100700, China.
| | - Hua-Lin Yu
- Department of Minimally Invasive Neurosurgery, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming 650032, China.
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Effects of methylprednisolone and 4-chloro-3-hydroxyanthranilic acid in experimental spinal cord injury in the guinea pig appear to be mediated by different and potentially complementary mechanisms. Spinal Cord 2014; 52:662-6. [PMID: 25047053 DOI: 10.1038/sc.2014.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/19/2014] [Accepted: 06/06/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Blinded, placebo-controlled, parallel treatment group studies of the effects of methylprednisolone (MP) or 4-chloro-3-hydroxyanthranilate (4-Cl-3-HAA) on behavioral outcome and quinolinic acid tissue levels from experimental thoracic spinal cord injury in adult guinea pigs. OBJECTIVES To compare the effects of treatment with high-dose MP, a corticosteroid, and 4-Cl-3-HAA, a compound that inhibits synthesis of the neurotoxin quinolinic acid (QUIN) by activated macrophages. To explore the effect of different times of treatment using these two approaches to ameliorating secondary tissue damage. SETTING Laboratory animal studies at the University of North Carolina, Chapel Hill, NC, USA. METHODS Standardized spinal cord injuries were produced in anesthetized guinea pigs, using lateral compression of the spinal cord. Behavioral impairment and recovery were measured by placing and toe-spread responses (motor function), cutaneus trunci muscle reflex receptive field areas and somatosensory-evoked potentials (sensory function). Tissue quinolinic acid levels were measured by gas chromatograph/mass spectrometry. RESULTS The current experiments showed a reduction in delayed loss of motor and sensory function in the guinea pig with MP (150 mg kg(-1), intraperitoneally in split doses between 0.5 and 6 h), but no significant reduction in tissue QUIN. Improved sensory function was seen with a single dose of 60 mg kg(-1) MP intraperitoneally at 5 h after injury, but not at 10 h after injury. A single dose of 4-Cl-3-HAA at 5 h in the guinea pig did not produce the sensory and motor improvements seen in previous studies with 12 days of dosing, beginning at 5 h. CONCLUSION These studies, together with earlier findings, indicate that both drugs can attenuate secondary pathologic damage after SCI, but through separate mechanisms. These are most likely an acute reduction by MP of oxidative processes and reduction by 4-Cl-3-HAA of QUIN synthesis.
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Brown A, Nabel A, Oh W, Etlinger JD, Zeman RJ. Perfusion imaging of spinal cord contusion: injury-induced blockade and partial reversal by β2-agonist treatment in rats. J Neurosurg Spine 2013; 20:164-71. [PMID: 24313676 DOI: 10.3171/2013.10.spine13113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Traumatic injury to the spinal cord results in considerable delayed tissue loss. The authors investigated the extent to which ischemia occurs following contusion-induced spinal cord injury and whether ischemia exacerbates tissue damage that leads to the loss of locomotor function. They also determined if ischemia is reversed with β2-adrenoceptor agonist treatment, which has been established to be neuroprotective following contusion injury. METHODS The extent and role of circulation loss in spinal cord injury was determined in an established experimental model of contusion injury. The spinal cord dura mater of Wistar rats was exposed by performing a laminectomy at T-8 to T-11. Laser Doppler perfusion imaging was then used to measure microcirculation in the exposed spinal cord. After imaging, a moderately severe contusion injury was produced using a weight-drop device unto the exposed dura at T-10. Perfusion imaging was again performed, scans were quantitated, and integrated intensities were compared. RESULTS Postinjury imaging revealed an 18%-27% reduction in perfusion in regions rostral and caudal to the injury site, and a 68% reduction was observed at the contusion epicenter. These perfusion losses persisted for at least 48 hours. At 24 hours after injury, some rats were intraperitoneally injected with 2 mg/kg of the β2-adrenoceptor agonist clenbuterol, which has been shown to promote the partial recovery of locomotor function and spare spinal cord tissue when administered within 2 days after contusion injury. Clenbuterol injection caused a gradual increase in perfusion, which was detectable at 30 minutes postinjection and continued over time, resulting in an 127% overall increase in perfusion at the epicenter 24 hours after treatment. CONCLUSIONS These results suggest that the occurrence of chronic perfusion loss after contusion contributes to delayed damage and tissue loss. In contrast, β2-adrenoceptor agonist treatment may exert neuroprotection by restoring perfusion, thereby preventing ischemic neurodegeneration. The ability of laser Doppler imaging to measure the loss of perfusion and its restoration upon treatment suggests that it may have clinical utility in the assessment and treatment of spinal cord injury.
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Affiliation(s)
- Abraham Brown
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla; and
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The effect of methylprednisolone intravenous infusion on the expression of ciliary neurotrophic factor in a rat spinal cord injury model. Spine J 2013; 13:439-42. [PMID: 23267738 DOI: 10.1016/j.spinee.2012.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 06/11/2012] [Accepted: 11/16/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Methylprednisolone (MP) infusion after acute spinal cord injury (SCI) remains controversial despite large randomized studies, including the National Acute Spinal Cord Injury Studies (NASCIS). PURPOSE To determine the effect of NASCIS protocol MP infusion on the expression of ciliary neurotrophic factor (CNTF), a neuroprotective cytokine, in a rat model after SCI. STUDY DESIGN Animal laboratory study. METHODS Thirty rats were randomized into an MP infusion group (intravenous [IV]-MP) versus normal saline (NS) control group (IV-NS) after a standardized SCI. Ciliary neurotrophic factor expression was measured by reverse transcription-polymerase chain reaction at 6, 12, 24, 48, and 72 hours post-SCI. RESULTS Mean CNTF expression was diminished in the MP group at 12 (p=.006) and 24 (p=.008) hours postinjury compared with the control group. Expression of CNTF was not significantly different between the groups at 6, 48, and 72 hours post-SCI. CONCLUSIONS Standardized MP infusion post-SCI reduces CNTF activation in a rat SCI model. Further study is needed to determine if this effect is seen in human SCIs.
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Puentes S, Kurachi M, Shibasaki K, Naruse M, Yoshimoto Y, Mikuni M, Imai H, Ishizaki Y. Brain microvascular endothelial cell transplantation ameliorates ischemic white matter damage. Brain Res 2012; 1469:43-53. [DOI: 10.1016/j.brainres.2012.06.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 06/22/2012] [Accepted: 06/26/2012] [Indexed: 11/25/2022]
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Fetal stress and programming of hypoxic/ischemic-sensitive phenotype in the neonatal brain: mechanisms and possible interventions. Prog Neurobiol 2012; 98:145-65. [PMID: 22627492 DOI: 10.1016/j.pneurobio.2012.05.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 12/12/2022]
Abstract
Growing evidence of epidemiological, clinical and experimental studies has clearly shown a close link between adverse in utero environment and the increased risk of neurological, psychological and psychiatric disorders in later life. Fetal stresses, such as hypoxia, malnutrition, and fetal exposure to nicotine, alcohol, cocaine and glucocorticoids may directly or indirectly act at cellular and molecular levels to alter the brain development and result in programming of heightened brain vulnerability to hypoxic-ischemic encephalopathy and the development of neurological diseases in the postnatal life. The underlying mechanisms are not well understood. However, glucocorticoids may play a crucial role in epigenetic programming of neurological disorders of fetal origins. This review summarizes the recent studies about the effects of fetal stress on the abnormal brain development, focusing on the cellular, molecular and epigenetic mechanisms and highlighting the central effects of glucocorticoids on programming of hypoxic-ischemic-sensitive phenotype in the neonatal brain, which may enhance the understanding of brain pathophysiology resulting from fetal stress and help explore potential targets of timely diagnosis, prevention and intervention in neonatal hypoxic-ischemic encephalopathy and other brain disorders.
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Abstract
We present a retrospective case series of 15 children (aged 8-16 years) with blunt traumatic spinal cord injury who were treated with methylprednisolone as per the National Acute Spinal Cord Injury Study protocol. Of all patients, 12 (80%) were male. Causes were sports injuries (n = 9), motor vehicle crashes (n = 2), and falls (n = 4). Most injuries were nonskeletal (n = 14), and all patients had incomplete injury of the spinal cord. The most common location of tenderness was cervical (n = 7). Of the 15 patients, methylprednisolone was initiated within 3 hours in 13 patients and between 3 and 8 hours in 2 patients. All patients received the medication for 23 hours as per the National Acute Spinal Cord Injury Study protocol. Of the 15 patients, 13 recovered completely by 24 hours and were discharged with a diagnosis of spinal cord concussion. One patient had compression fracture of T5 and T3-T5 spinal contusion but no long-term neurological deficit. One patient was discharged with diagnosis of C1-C3 spinal cord contusion (by magnetic resonance imaging) and had partial recovery at 2 years after injury. All patients with a diagnosis of cord concussion had normal plain films of the spine and computed tomographic and magnetic resonance imaging findings. None of the patients had any associated major traumatic injuries to other organ systems. The high-dose steroid therapy did not result in any serious bacterial infections.
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Bains M, Hall ED. Antioxidant therapies in traumatic brain and spinal cord injury. Biochim Biophys Acta Mol Basis Dis 2011; 1822:675-84. [PMID: 22080976 DOI: 10.1016/j.bbadis.2011.10.017] [Citation(s) in RCA: 304] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/28/2011] [Indexed: 12/15/2022]
Abstract
Free radical formation and oxidative damage have been extensively investigated and validated as important contributors to the pathophysiology of acute central nervous system injury. The generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) is an early event following injury occurring within minutes of mechanical impact. A key component in this event is peroxynitrite-induced lipid peroxidation. As discussed in this review, peroxynitrite formation and lipid peroxidation irreversibly damages neuronal membrane lipids and protein function, which results in subsequent disruptions in ion homeostasis, glutamate-mediated excitotoxicity, mitochondrial respiratory failure and microvascular damage. Antioxidant approaches include the inhibition and/or scavenging of superoxide, peroxynitrite, or carbonyl compounds, the inhibition of lipid peroxidation and the targeting of the endogenous antioxidant defense system. This review covers the preclinical and clinical literature supporting the role of ROS and RNS and their derived oxygen free radicals in the secondary injury response following acute traumatic brain injury (TBI) and spinal cord injury (SCI) and reviews the past and current trends in the development of antioxidant therapeutic strategies. Combinatorial treatment with the suggested mechanistically complementary antioxidants will also be discussed as a promising neuroprotective approach in TBI and SCI therapeutic research. This article is part of a Special Issue entitled: Antioxidants and antioxidant treatment in disease.
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Affiliation(s)
- Mona Bains
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, Kentucky 40506, USA
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Abstract
One of the most investigated molecular mechanisms involved in the secondary pathophysiology of acute spinal cord injury (SCI) is free radical-induced, iron-catalyzed lipid peroxidation (LP) and protein oxidative/nitrative damage to spinal neurons, glia, and microvascular cells. The reactive nitrogen species peroxynitrite and its highly reactive free radicals are key initiators of LP and protein nitration in the injured spinal cord, the biochemistry, and pathophysiology of which are first of all reviewed in this article. This is followed by a presentation of the antioxidant mechanistic approaches and pharmacological compounds that have been shown to have neuroprotective properties in preclinical SCI models. Two of these, which act by inhibition of LP, are high-dose treatment with the glucocorticoid steroid methylprednisolone (MP) and the nonglucocorticoid 21-aminosteroid tirilazad, have been demonstrated in the multicenter NASCIS clinical trials to produce at least a modest improvement in neurological recovery when administered within the first 8 hours after SCI. Although these results have provided considerable validation of oxidative damage as a clinically practical neuroprotective target, there is a need for the discovery of safer and more effective antioxidant compounds for acute SCI.
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Affiliation(s)
- Edward D Hall
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, Kentucky 40506, USA.
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Abstract
STUDY DESIGN This study investigated the outcome of combined therapy with irradiation and methylprednisolone (MP) after a traumatic spinal cord injury (SCI). OBJECTIVE To evaluate the neurologic outcomes as well as the antiapoptotic and anti-inflammatory effects on traumatic SCI in rats after combined therapy. SUMMARY OF BACKGROUND DATA Although irradiation carries the risk of secondary SCI, it has been effective for the regeneration of the axons of nerve cells by reducing gliosis. Thus, to minimize apoptosis and irradiation risks after SCI, this study investigated the effects of steroid injections before irradiation. METHODS Thirty-two rats were used for the experimental procedure. After a traumatic SCI, they were divided into 4 groups of 8 rats each: (1) a control group that only had rats with a SCI (Group 1); (2) a group that received MP at 30 minutes, 6 hours and 24 hours, and then received irradiation 2 days after the SCI (Group 2); (3) a group that received MP at 30 minutes, and irradiation 2 days after the SCI (Group 3); and (4) a group that received irradiation 2 days after the traumatic SCI (Group 4). RESULTS The degree of recovery using the inclined plane climbing test was greatest in Group 2, followed by Group 3, Group 4, and Group 1. The cavitation lesions, Terminal Deoxynucleotidyl Transferase dUTP Nick End Labeling -positive apoptosis, glial fibrillary acidic protein-positive astrocyte count, and CC-1-positive oligodendrocyte count significantly decreased in the irradiated groups (Groups 2, 3, 4) compared to the control group (Group 1). In particular, they decreased considerably more in the group that received MP 3 times (Group 2) compared to the group that received MP only once (Group 3). CONCLUSION These results suggest that the combined therapy was effective and might provide synergistic effects for neurologic recovery after a traumatic SCI.
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Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976) 2010; 35:E295-302. [PMID: 20395775 DOI: 10.1097/brs.0b013e3181c392b9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study was performed. OBJECTIVE To assess a technique, three-column reconstruction through single posterior (TRSP) approach, in treatment of highly unstable thoracolumbar fracture. SUMMARY OF BACKGROUND DATA The goal of surgical intervention for treatment of unstable thoracolumbar fractures is to decompress the neural elements, restore vertebral body height, correct angular deformity, and stabilize the columns of the spine. Operative approaches remain disputed. Common opinions include short-segment posterior fixation, multiple-segment posterior fixation, stand-alone anterior approach fixation, and combined anterior-posterior approach. Each technique has its advantages and disadvantages. METHODS A consecutive series of 37 thoracolumbar fractures with load sharing scores > or =6 were managed with TRSP between May 2004 and September 2006. All patients were observed up for a minimum of 2 years. Demographic data, neurologic status, segmental kyphosis, segmental height, the fracture severity score, Visual Analogue Scale, and treatment-related complications were evaluated. RESULTS The mean operative time was 157 minutes (range, 120-240). The mean blood loss was 1086 mL (range, 700-3100). Averagely Frankel score improved from 3.46 to 4.46; kyphotic angulation improved from 25.75 degrees before surgery to 4.49 degrees at last follow-up, and the loss of segmental height improved from a mean of 35.22% before surgery to 7.01% at the time of the last follow-up. The mean preoperative Visual Analogue Scale score was 7.92, and most patients had no complain of pain at last follow-up. No patient experienced worsening of neurologic deficits and other severe complications at last follow-up. One patient developed titanium mess cage subsidence, but revision was not necessary. CONCLUSION The technique of TRSP approach is safe, effective, and offers some advantages over the classic posterior, anterior, combined anterior-posterior approach for some specific highly unstable thoracolumbar fractures.
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Kanai A, Wang G, Hoshi K, Okamoto H. Effects of Intravenous Prostaglandin E1 on Pain and Body Temperature in Patients with Post-Herpetic Neuralgia. PAIN MEDICINE 2010; 11:609-16. [DOI: 10.1111/j.1526-4637.2010.00825.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Murakami H, Kawahara N, Demura S, Kato S, Yoshioka K, Tomita K. Neurological function after total en bloc spondylectomy for thoracic spinal tumors. J Neurosurg Spine 2010; 12:253-6. [DOI: 10.3171/2009.9.spine09506] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Total en bloc spondylectomy (TES) for thoracic spinal tumors may in theory produce neurological dysfunction as a result of ischemic or mechanical damage to the spinal cord. Potential insults include preoperative embolization at 3 levels, intraoperative ligation of segmental arteries, nerve root ligation, and circumferential dural dissection. The purpose of this study was to assess neurological function after thoracic TES.
Methods
The authors performed a retrospective review of 79 patients with thoracic-level spinal tumors that had been treated with TES between 1989 and 2006. Neurological function was retrospectively analyzed according to the Frankel grading system. Of the 79 cases, 26 involved primary tumors and 53 involved metastatic tumors. The number of excised vertebrae was 1 in 60 cases, 2 in 13, and ≥ 3 in 6. The Frankel grade before surgery was B in 1 case, C in 16, D in 29, and E in 33.
Results
At the follow-up, the Frankel grade was C in 2 cases, D in 24, and E in 53. Of 46 cases with neurological deficits before surgery, neurological improvement of at least 1 Frankel grade was achieved in 25 cases (54.3%). Although the Frankel grade did not change in 21 patients, improvement in neurological symptoms within the same Frankel grade did occur in these patients. There were no cases of neurological deterioration.
Conclusions
There was no neurological deterioration due to preoperative embolization, ligation of segmental arteries, or ligation of thoracic nerve roots. Each of the cases with preoperative neurological deficits showed improvement in neurological symptoms. Data in the current study clinically proved that TES is a safe operation with respect to spinal cord blood flow. In TES, the spinal cord is circumferentially decompressed and the spinal column is shortened. An increase in spinal cord blood flow due to spinal shortening in addition to decompression was considered to have brought about a resolution of neurological symptoms with TES.
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Bilginer B, Onal MB, Narin F, Ustun H, Kilinc K, Akalan N. Antiapoptotic and neuroprotective effects of mycophenolate mofetil after acute spinal cord injury in young rats. Childs Nerv Syst 2009; 25:1555-61. [PMID: 19756653 DOI: 10.1007/s00381-009-0985-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the possible beneficial effects of mycophenolate mofetil in comparison with methylprednisolone in an experimental model of spinal cord injury in young rats. MATERIALS AND METHODS Young female Wistar albino rats weighing 100-120 g were used in this study. The animals were anesthetized, the paravertebral muscles were dissected to expose thoracic spinal nerve 7 (T7)-T11 vertebrae, and the spinal cord was exposed at T8-T10 levels by laminectomy with the assistance of a surgical microscope. Weight-drop trauma model was used to perform spinal cord trauma. The animals were subjected to an impact of 50 g/cm to the dorsal surface of the spinal cord. The animals were divided into six groups, and all the groups include 12 animals. Group 1 laminectomy, group 2 laminectomy+ trauma, group 3 was treated with mycophenolate mofetil, group 4 was treated with methylprednisolone, group 5 was treated with mycophenolate mofetil+methylprednisolone, and group 6 served as a vehicle. Immediately after the trauma, 25 mg/kg mycophenolate mofetil (to group 3 and 5) and 30 mg/kg methylprednisolone (to group 4 and 5) were given in a single dose. Biochemical, behavioral, pathological, and immunohistochemical analysis were done. RESULTS Significant decrease in the number of apoptotic cells were detected in the lesion zone 24 h after the spinal cord injury with the mycophenolate mofetil treatment group. Histologic and functional recovery was also significant. CONCLUSION Our results showed that the administration of mycophenolate mofetil on traumatic spinal cord injury decreases apoptosis and improves neurologic recovery.
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Affiliation(s)
- Burcak Bilginer
- Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey.
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Falavigna A, Teles AR, Velho MC, Kleber FD. Effects of hyperbaric oxygen therapy after spinal cord injury: systematic review. COLUNA/COLUMNA 2009. [DOI: 10.1590/s1808-18512009000300015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: to conduct a systematic review of experimental and clinical studies evaluating the effect of hyperbaric oxygen therapy on the spinal cord injury. METHODS: ninety-three studies were identified in the database Pubmed. Among these, through a set of inclusion/exclusion criteria, 11 articles published between 1963 and 2009 were selected. In the nine experimental studies, different ways to apply the treatment were observed. The measured outcomes were: functional, histological, biochemical and electrophysiological. RESULTS: in most of the studies, the results show recovery of locomotor function, histology and/or biochemical features. Regarding the two studies in clinical samples, the results are controversial. The samples are heterogeneous and the application of hyperbaric oxygen therapy is not the same for all patients in each study. CONCLUSION: considering the results of this review, further studies are necessary to define the role of hyperbaric oxygen therapy in acute spinal cord injury.
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Farooque M, Olsson Y, Holtz A. Effect of the 21-aminosteroid U74006F and methylprednisolone on motor function recovery and oedema after spinal cord compression in rats. Acta Neurol Scand 2009. [DOI: 10.1111/j.1600-0404.1994.tb01630.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kawahara N, Tomita K, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: surgical techniques and related basic background. Orthop Clin North Am 2009; 40:47-63, vi. [PMID: 19064055 DOI: 10.1016/j.ocl.2008.09.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors' group has developed a new surgical technique of spondylectomy (vertebrectomy) called "total en bloc spondylectomy" (TES). This technique is different from spondylectomy in that it involves en bloc removal of the lesion, that is, removal of the whole vertebra, body and lamina, as one compartment. The surgical technique of TES has been remarkably improved based on adequate knowledge and consideration of the surgical anatomy, physiology, and biomechanics of the spine and spinal cord. Review of the developmental process of this operation leads to recognition of the tips, pitfalls, and solutions.
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Affiliation(s)
- Norio Kawahara
- Department of Orthopedic Surgery, Graduate school of Medical Science Kanazawa University, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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Spinal cord injury: plasticity, regeneration and the challenge of translational drug development. Trends Neurosci 2008; 32:41-7. [PMID: 18977039 DOI: 10.1016/j.tins.2008.09.008] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 09/12/2008] [Accepted: 09/15/2008] [Indexed: 12/19/2022]
Abstract
Over the past three decades, multiple mechanisms limiting central nervous system regeneration have been identified. Here, we address plasticity arising from spared systems as a particularly important and often unrecognized mechanism that potentially contributes to functional recovery in studies of 'regeneration' after spinal cord injury. We then discuss complexities involved in translating findings from animal models to human clinical trials in spinal cord injury; current strategies might be too limited in scope to yield detectable benefits in the complex and variable arena of human injury. Our animal models are imperfect, and the very variability that we attempt to control in the course of conducting rigorous research might, ironically, limit our ability to identify the most promising therapies in the human arena. Therapeutic candidates are most likely to have a detectable effect in human trials if they elicit benefits in severe contusion and larger animal models and pass the test of independent replication.
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Urgent surgical decompression compared to methylprednisolone for the treatment of acute spinal cord injury: a randomized prospective study in beagle dogs. Spine (Phila Pa 1976) 2008; 33:2260-8. [PMID: 18827690 DOI: 10.1097/brs.0b013e31818786db] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Experimental dog model of acute spinal cord injury. OBJECTIVE To compare the relative value of methylprednisolone, surgical decompression, or both for the treatment of traumatic spinal cord injury. SUMMARY OF BACKGROUND DATA Acute spinal cord injury results from both primary damage to the spinal cord at the time of the initial injury as well as a deleterious secondary cascade of events, which leads to further damage. Surgical decompression is known to improve clinical outcomes, but the timing of surgical decompression remains controversial. METHODS A nylon tie was used to constrict the spinal cord in 18 adult male beagle dogs. The animals were then prospectively randomized to 3 groups: 1) surgical decompression at 6 hours and intravenous methylprednisolone; 2) surgical decompression at 6 hours and intravenous saline; and 3) intravenous methylprednisolone without surgical decompression. Each animal was evaluated by somatosensory-evoked potentials, daily neurologic assessment, and histologic examination at 2 weeks following injury. RESULTS Immediately following spinal cord constriction, all animals were paraplegic, incontinent, and the somatosensory-evoked potentials were abolished. Surgical decompression 6 hours after injury, with or without methylprednisolone, led to significantly better neurologic function at 2 weeks than methylprednisolone alone. CONCLUSION In the setting of acute and persistent spinal cord compression in beagle dogs, surgical decompression 6 hours after injury, with or without methylprednisolone, is more effective for improving neurologic recovery than methylprednisolone alone.
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Chen YS, Tseng FY, Tan CT, Lin-Shiau SY, Hsu CJ. Effects of methylprednisolone on nitric oxide formation and survival of facial motor neurons after axotomy. Brain Res 2008; 1197:23-31. [PMID: 18221735 DOI: 10.1016/j.brainres.2007.12.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 12/12/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022]
Abstract
The aims of this study were to evaluate the effect of a high dose (160 mg/kg) of methylprednisolone sodium succinate (MPSS) on the formation of endogenous nitric oxide (NO) in the brainstem after facial nerve transection and to explore whether this effect has relevance to the survival of facial motor neurons. Guinea pig facial nerves were transected at the tympanic segment, and half were administered with MPSS, while the other half were given a vehicle of saline solution. Post operation NO formation in the brainstem at different time points was directly measured with a NO/ozone chemiluminescence technique. The surviving motor neurons were counted in histological coronal frozen sections of facial motor nuclei. The present results revealed that facial nerve transection induced a significant increase in NO formation in the brainstem by 1 week in both MPSS and saline treated groups and lasted to the end of the study (4 weeks). Compared to the saline treated group, it appeared that MPSS administration could delay the increase of nitric oxide synthase (NOS) expression and NO formation during the first 1 approximately 2 weeks after facial nerve transection. The survival rate of facial motor neurons was significantly higher in the MPSS treated group than in the saline treated group when examined at 3 or 4 weeks after facial nerve transection. These results indicate that a high dose of MPSS elicited a delayed increase of NO formation and thus may concomitantly enhance the survival time of motor neurons after facial nerve transection.
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Affiliation(s)
- Yuh-Shyang Chen
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
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36
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Kahraman S, Düz B, Kayali H, Korkmaz A, Oter S, Aydin A, Sayal A. Effects of methylprednisolone and hyperbaric oxygen on oxidative status after experimental spinal cord injury: a comparative study in rats. Neurochem Res 2007; 32:1547-51. [PMID: 17486444 DOI: 10.1007/s11064-007-9354-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 04/11/2007] [Indexed: 10/23/2022]
Abstract
The effects of hyperbaric oxygen (HBO) therapy or methylprednisolone on the oxidative status were evaluated in experimental spinal cord injury. Clip compression method was used to produce acute spinal cord injury rats. Hyperbaric oxygen was administered twice daily for a total of eight 90 min-sessions at 2.8 atmospheres. Methylprednisolone was first injected with a bolus of 30 mg/kg followed with an infusion rate of 5.4 mg/kg/h for 24 h. Five days after clip application animals were sacrificed and their traumatized spinal cord segment were excised. Tissue levels of thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were evaluated to reflect oxidant/antioxidant status. Non-treated clip-operated animals reflected significantly higher SOD, GSH-Px and TBARS levels that were found to be significantly higher than the sham-operated. Methylprednisolone was not able to lower these levels. HBO administration diminished all measured parameters significantly; however, their levels appeared already to be high when compared with sham animals. According to these results obtained on the 5th day after induction, HBO, but not methylprednisolone, seems to procure prevention against oxidative spinal cord injury.
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Affiliation(s)
- Serdar Kahraman
- Gülhane Askeri Tip Akademisi, Beyin ve Sinir Cerrahisi Anabilim Dali, 06018 Ankara, Turkey
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Hachmeister JE, Valluru L, Bao F, Liu D. Mn (III) tetrakis (4-benzoic acid) porphyrin administered into the intrathecal space reduces oxidative damage and neuron death after spinal cord injury: a comparison with methylprednisolone. J Neurotrauma 2007; 23:1766-78. [PMID: 17184187 DOI: 10.1089/neu.2006.23.1766] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The metalloporphyrin Mn (III) tetrakis (4-benzoic acid) porphyrin (MnTBAP) is a cell-permeable superoxide dismutase mimetic and a broad-spectrum scavenger of reactive species. Since MnTBAP may not cross the blood-brain barrier, this study evaluated the therapeutic potential of MnTBAP to treat spinal cord injury (SCI; 25 g x cm) by directly administering it into the intrathecal space of the rat spinal cord. The cells in spinal sections removed at 24 h post-SCI were immunohistochemically stained with anti-4-hydroxynonenal (HNE), a marker of membrane lipid peroxidation (MLP); anti-nitrotyrosine (Ntyr), a marker of protein nitration; and anti-neuron-specific enolase (NSE) antibodies. Immunostained neurons were counted for quantitative evaluation. Pre-treatment 30 min before SCI with 1 mg/kg MnTBAP or 4-h post-SCI treatment with 2.5 mg/kg MnTBAP administered into the intrathecal space significantly reduced MLP and protein nitration, and increased the number of surviving neurons compared to vehicle controls. However, post-SCI treatment with a standard regimen of methylprednisolone sodium succinate (MPSS; 30 mg/kg followed by 5.4 mg/kg for maintenance, iv administration), the only drug used for clinical treatment of SCI, not only did not reduce MLP and neuron loss, it increased protein nitration compared with vehicle controls (two-way analysis of variance [ANOVA] followed by the Tukey test). These results demonstrate that pre- and post-intrathecal treatments with the low doses of MnTBAP provide sustained neuroprotection by preventing oxidative stress and that post-treatment with MnTBAP is superior to post-treatment with MPSS in preventing oxidative stress and resulting neuron loss.
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Affiliation(s)
- Jorge E Hachmeister
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas 77555-0881, USA
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Carlson KM, Wagner GC. Voluntary exercise and tail shock have differential effects on amphetamine-induced dopaminergic toxicity in adult BALB/c mice. Behav Pharmacol 2007; 17:475-84. [PMID: 16940768 DOI: 10.1097/00008877-200609000-00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exercise exerts neuroprotective effects and facilitates neural recovery in animal models of Parkinson's disease. In the present studies, effects of exercise on amphetamine-induced dopaminergic toxicity were assessed in mice housed individually either with or without access to run wheels. Mice in run wheel cages ran approximately 20 000 revolutions/day (over 10 km/day). Some mice received amphetamine (18.5 mg/kg x 4 injections) whereas controls received saline. Amphetamine caused a 90% dopamine depletion in mice housed either with or without run wheels. A precipitous drop was seen in run wheel activity following amphetamine, lasting at least 7 days. A significant decrease in food intake, water intake and body weight also occurred. The opportunity to exercise did not facilitate behavioral or neurochemical recovery at 1, 2 or 3 days, or 2 weeks after injections. Therefore, shock stress, a component of some forced exercise studies, was evaluated to determine whether stress without exercise provided neuroprotection against amphetamine. Results indicate that shock stress exerted neuroprotective effects, reducing the amphetamine-induced dopamine depletion. It is concluded that voluntary running does not afford either behavioral or neuroprotection nor facilitate recovery from amphetamine-induced dopaminergic toxicity; rather, elevated glucocorticoid levels following shock stress were associated with a reduction in the dopamine depletion.
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Affiliation(s)
- Kirsten M Carlson
- Department of Psychology, Busch Campus, Rutgers University, New Brunswick, New Jersey 08854, USA
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Kanai A, Osawa S, Suzuki A, Ishimaru R, Hoka S. Effectiveness of Prostaglandin E1 for the Treatment of Patients with Neuropathic Pain Following Herpes Zoster. PAIN MEDICINE 2007; 8:36-40. [PMID: 17244102 DOI: 10.1111/j.1526-4637.2007.00249.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Postherpetic neuralgia (PHN) is one of the most painful neuropathic conditions, the mechanism of which remains unclear. There is no universally accepted treatment. The pain in PHN is often relieved by bathing, heating, or sympathetic blockade, suggesting a circulation-dependent property of the pain. Therefore, we examined the effectiveness of prostaglandin E(1) (PGE(1)), which has an analgesic effect via improvement of peripheral blood circulation, for patients with PHN. DESIGN A total of 27 patients with PHN underwent intravenous administration of 60 microg of PGE(1) dissolved in 100 mL of physiological saline and 5 mL of 8.4% sodium bicarbonate solution at an infusion rate of 0.02 microg/kg/min. Oral administration of PGE(1), limaprost alfadex, was followed at doses of 30 microg/day for 2 weeks. Pain at rest and tactile allodynia before and after the treatment was evaluated with visual analog scale (VAS). RESULTS Intravenous PGE(1) significantly decreased VAS in rest pain and tactile allodynia without severe adverse effects. The analgesic effect of PGE(1) continued during the 2 weeks of oral administration of PGE(1). Oral PGE(1) caused nausea in seven cases, diarrhea in three, and abdominal distention in one subject. All subjects, except for two cases of nausea, continued the treatment until the end of the study, although some required a decrease in the dose to 15 microg/day. During the 2-week oral administration, the VAS did not change remarkably in the three patients whose VAS were not decreased by at least 80% during the initial infusion. CONCLUSIONS The results of the present study indicate that oral PGE(1) following the intravenous administration produces prompt and continuous analgesia in patients with PHN. Moreover, the intravenous treatment using PGE(1) appears useful for predicting the analgesic effect of PGE(1) in the patients.
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Affiliation(s)
- Akifumi Kanai
- Department of Anesthesiology, Kitasato University School of Medicine, Japan.
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Tsutsumi S, Ueta T, Shiba K, Yamamoto S, Takagishi K. Effects of the Second National Acute Spinal Cord Injury Study of high-dose methylprednisolone therapy on acute cervical spinal cord injury-results in spinal injuries center. Spine (Phila Pa 1976) 2006; 31:2992-6; discussion 2997. [PMID: 17172994 DOI: 10.1097/01.brs.0000250273.28483.5c] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVE To evaluate the recovery of motor function and the early complications in patients with acute cervical spinal cord injury after receiving a high dose of methylprednisolone sodium succinate (MPSS) within 8 hours of injury. SUMMARY OF BACKGROUND DATA High-dose MPSS therapy has been demonstrated to improve the neurologic recovery in patients with acute spinal cord injury. However, it remains a controversial treatment. METHODS Seventy patients were included in this study: 37 in the MPSS group who were treated with MPSS within 8 hours of their injury according to the Second National Acute Spinal Cord Injury Study protocol, and 33 in non-MPSS group who were not administered with MPSS. Improvements in the American Spinal Injury Association motor score were compared between the MPSS group and the non-MPSS group. In patients with complete motor loss at admission and follow-up periods, improvements of myotomal levels between the MPSS (n = 15) and non-MPSS groups (n = 21) were compared. Early complications within 6 weeks of high-dose MPSS therapy were compared with those of no MPSS therapy. RESULTS Among the patients with incomplete paralysis at admission, the American Spinal Injury Association motor scores in the MPSS group were improved more significantly than those in the non-MPSS group at 6 weeks and 6 months after injury. Meanwhile, among the patients with complete paralysis at admission, the patients in the MPSS group did not show significantly more change in motor score than those in the non-MPSS group. Improvement in myotomal level had no significant difference between the MPSS and non-MPSS groups. The MPSS group had 10 patients with early complications, while the non-MPSS group had 14. The differences between the 2 groups showed no statistical significance. CONCLUSIONS MPSS should be administered to patients with incomplete cervical spinal cord injury according to the Second National Acute Spinal Cord Injury Study protocol.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
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Ates O, Cayli S, Altinoz E, Gurses I, Yucel N, Kocak A, Yologlu S, Turkoz Y. Effects of resveratrol and methylprednisolone on biochemical, neurobehavioral and histopathological recovery after experimental spinal cord injury. Acta Pharmacol Sin 2006; 27:1317-25. [PMID: 17007738 DOI: 10.1111/j.1745-7254.2006.00416.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIM To investigate the neuroprotective effect of resveratrol in an experimental spinal cord injury (SCI) model in rats. METHODS Male Wistar albino rats weighing 200-250 g were randomized into six groups. Weight-drop trauma was performed for SCI. Group 1 underwent laminectomy alone. Group 2 underwent laminectomy followed by SCI. Groups 3, 4, 5, and 6 underwent laminectomy followed by SCI and received resveratrol (100 mg/kg), methylprednisolone (MP) (30 mg/kg), resveratrol (100 mg/kg) plus MP (30 mg/kg), and ethanol (2%), respectively. The rats were divided into two subgroups for biochemical analysis (killed at 24 h after surgery) and for neurobehavioral and histopathological evaluation (killed at 6 weeks after surgery). Posttraumatic neurological recovery after surgery was recorded weekly. RESULTS Groups 3 and 5 revealed significantly lower malon-dialdehyde, nitric oxide, xanthine oxidase, and higher glutathione levels than group 4 (P<0.05). Neurological recovery rates were significantly better in groups 3 and 5 than group 4 (P<0.05). When spinal trauma size ratios were compared, there was no significant difference between treatment groups. CONCLUSION Resveratrol treatment revealed better biochemical recovery in the acute stage of trauma than MP treatment. Although resveratrol and combined treatment revealed better neurobehavioral recovery than MP treatment; resveratrol, MP, and combined treatment modalities improved histopathological recovery at the same level in the final stage of the experiment. Future studies involving different doses of resveratrol and different doses combinations with MP could promise better results as each drug has a different anti-oxidative mechanism of action.
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Affiliation(s)
- Ozkan Ates
- Department of Neurosurgery, Inonu University, School of Medicine, 44280 Malatya, Turkey.
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Yücel N, Cayli SR, Ateş O, Karadağ N, Firat S, Turköz Y. Evaluation of the neuroprotective effects of citicoline after experimental spinal cord injury: improved behavioral and neuroanatomical recovery. Neurochem Res 2006; 31:767-75. [PMID: 16794862 DOI: 10.1007/s11064-006-9075-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2006] [Indexed: 01/14/2023]
Abstract
Spinal cord injury (SCI) caused by trauma mainly occurs in two mechanisms as primary and secondary injury. Secondary injury following the primary impact includes various pathophysiological and biochemical events. Methylprednisolone is the only pharmacological agent having clinically proven beneficial effects on SCI. Citicoline has been shown to have clinical and experimental beneficial effects on brain ischemia. This study aims to investigate the neuroprotective effect of citicoline in an experimental SCI model in rats. Sixty adult Wistar albino rats were randomized into five groups. SCI was performed by the weight-drop model. Group 1 underwent laminectomy alone. The Group 2 underwent laminectomy followed by SCI and received no medication. Group3, Group 4 and Group 5 underwent laminectomy followed by SCI and received medication. Group 3 and Group 5 received citicoline and Group 4 and Group 5 received methylprednisolone. The rats were divided into two subgroups for biochemical analysis (sacrificed at 24 h after surgery) and neurobehavioral and histopathological evaluation (sacrificed at 6 weeks after surgery). Malondialdehyde levels, nitric oxide levels and trauma size ratios were lower and reduced glutathione levels were higher in Group 3, Group 4 and Group 5 as compared to Group 2. Posttraumatic neurological recovery after surgery was significantly better in Group 3, Group 4 and Group 5 compared to Group 2. In conclusion, this study demonstrates that citicoline is as effective as methylprednisolone. The efficacy of citicoline combined with methylprednisolone is not superior to either citicoline or methylprednisolone alone.
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Affiliation(s)
- Neslihan Yücel
- Department of Emergency Medicine, Inönü University, Faculty of Medicine, Malatya 44069, Turkey.
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Cayli SR, Ates O, Karadag N, Altinoz E, Yucel N, Yologlu S, Kocak A, Cakir CO. Neuroprotective effect of etomidate on functional recovery in experimental spinal cord injury. Int J Dev Neurosci 2006; 24:233-9. [PMID: 16701976 DOI: 10.1016/j.ijdevneu.2006.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 04/05/2006] [Accepted: 04/05/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Primary impact to the spinal cord causes rapid oxidative stress after injury. To protect neural tissue, it is important to prevent secondary pathophysiological mechanisms. Etomidate, a strong antiexcitotoxic agent, stimulates the gamma aminobutyric acid (GABA) receptors. The purpose of this study was to investigate neurobehavioral and histological recovery and to evaluate the biochemical responses to treatment of experimental spinal cord injury (SCI) in rats with etomidate or methylprednisolone (MP) or both etomidate and MP. MATERIAL AND METHODS Seventy-two rats were randomly allocated into six groups: a control group (laminectomy alone), a trauma group (laminectomy+trauma), a methylprednisolone group (30 mg/kg MP), an etomidate group (2 mg/kg), a methylprednisolone and etomidate combined treatment group (30 mg/kg MP and 2 mg/kg etomidate) and a vehicle group. Six rats from each group were killed at the 24th hour after the injury. Malondialdehyde, glutathione, nitric oxide and xanthine oxidase levels were measured. Neurological functions of the remaining rats were recorded weekly. Six weeks after injury, all of those rats were killed for histopathological assessment. RESULTS Etomidate treatment revealed similar neurobehavioral and histopathological recovery to MP treatment 6 weeks after injury. Combined treatment did not provide additional neuroprotection. CONCLUSION Etomidate treatment immediately after spinal cord injury has similar neuroprotection to MP. In spite of different neuroprotection mechanisms, combined treatment with MP and etomidate does not provide extra protection.
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Affiliation(s)
- Suleyman R Cayli
- Inonu University, School of Medicine, Department of Neurosurgery, Turgut Ozal Medical Center, 44069 Malatya, Turkey
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Carlson KM, Wagner GC. Shock stress protects mice against amphetamine-induced dopaminergic toxicity. Brain Res 2006; 1087:186-9. [PMID: 16626635 DOI: 10.1016/j.brainres.2006.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 03/08/2006] [Accepted: 03/09/2006] [Indexed: 11/18/2022]
Abstract
The effect of tail shock (ten, 2.0 mA/0.15 s shocks) on amphetamine-induced dopaminergic toxicity in adult, male BALB/c mice was assessed. Fifteen minutes following a single shock session, mice received amphetamine (50-mg/kg) or saline as follows: Shock/Saline; NoShock/Saline; Shock/Amphetamine; No Shock/Amphetamine. Amphetamine caused a 60% dopamine depletion in the No Shock/Amphetamine group. Tail shock provided neuroprotection against amphetamine-induced dopamine depletion, an effect likely related to the stress response.
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Affiliation(s)
- Kirsten M Carlson
- Department of Psychology, Busch Campus, Rutgers University, New Brunswick, NJ 08854, USA
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Abstract
Giant cell arteritis (GCA) is an immune-mediated vasculitis, affecting medium- to large-sized arteries, in individuals over the age of 50 years. Visual loss is a frequent complication of GCA, and once it occurs it tends to be both permanent and profound. Although major advances have been made in recent years in genetics, molecular biology and the description of the vessel wall morphology, the aetiology and pathogenesis of GCA are still incompletely understood. Over the years there has been much debate over whether polymyalgia rheumatica and GCA are separate or linked entities. Recent investigations support that polymyalgia rheumatica and GCA are two different expressions of the same underlying vasculitic disorder. A single cause or aetiological agent has not as yet been identified. Except for the histopathology of the arterial wall, there are no laboratory findings specific for GCA, and no particular signs or symptoms specific for the diagnosis. GCA typically causes vasculitis of the extracranial branches of the aorta and spares intracranial vessels. Transmural inflammation of the arteries induces luminal occlusion through intimal hyperplasia. Clinical symptoms reflect end-organ ischaemia. Branches of the external and internal carotid arteries are particularly susceptible. Corticosteroids remain the only proven treatment for GCA, the regimen initially involving high doses followed by a slow taper. However, early detection and treatment with high-dose corticosteroids is effective in preventing visual deterioration in most patients.
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Affiliation(s)
- Stuart C Carroll
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Okonkwo DO, Reece TB, Laurent JJ, Hawkins AS, Ellman PI, Linden J, Kron IL, Tribble CG, Stone JR, Kern JA. A comparison of adenosine A2A agonism and methylprednisolone in attenuating neuronal damage and improving functional outcome after experimental traumatic spinal cord injury in rabbits. J Neurosurg Spine 2006; 4:64-70. [PMID: 16506468 DOI: 10.3171/spi.2006.4.1.64] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Steroid agents remain the lone pharmacological treatment in widespread use for acute spinal cord injury (SCI), although their utility remains in dispute in the neurotrauma literature. Adenosine A2A receptor activation with ATL-146e, a selective A2A agonist, has shown potential benefit in treating SCI; however, it has not been compared with the gold standard, methylprednisolone. The authors of this study evaluated ATL-146e and methylprednisolone for their ability to preserve neuronal viability and motor function in experimental SCI.
Methods
New Zealand White rabbits sustained SCI or sham injury via the Allen weight-drop technique. Ten minutes postinjury, animals received ATL-146e (ATL group, 0.06 μg/kg/min intravenously for 3 hours), methylprednisolone (steroid group, 30 mg/kg intravenously), or saline (trauma control group). Hindlimb motor function was recorded every 12 hours using the Tarlov motor grading scale (0, paralysis–5, normal hop). At 48 hours, fixed spinal cord tissue was evaluated for neuronal viability.
Hindlimb motor function in animals treated with ATL-146e was equivalent to that of sham-injured animals and was significantly better than that of trauma control animals at all time points and that of steroid-treated animals at 12 hours (p = 0.05). Motor function in steroid-treated animals was worse than in those given ATL-146e and better than that of trauma control animals at later time points, but was not statistically significant (both p > 0.05). Neuronal viability (measured in neurons/hpf) was significantly higher in both treatment groups compared with the trauma control group (12.1 ± 1.4 neurons/hpf for the ATL and 13.3 ± 1.4 neurons/hpf for the steroid group compared with 7.5 ± 1.5 neurons/hpf for the trauma control group; both p < 0.04). Neuronal viability did not differ among ATL-146e–treated, steroid-treated, and sham-injured groups.
Conclusions
The use of ATL-146e is at least as effective as methylprednisolone in preserving function and is equivalent to methylprednisolone in preserving the structure of spinal cord tissue after blunt SCI. Adenosine A2A receptor activation may be an effective treatment for acute SCI while avoiding the adverse effects of steroid agents.
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Affiliation(s)
- David O Okonkwo
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville 22908-0212, USA.
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Tomita K, Kawahara N, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci 2006; 11:3-12. [PMID: 16437342 PMCID: PMC2780651 DOI: 10.1007/s00776-005-0964-y] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Indexed: 12/01/2022]
Affiliation(s)
- Katsuro Tomita
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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48
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Abstract
It has long been recognized that much of the post-traumatic degeneration of the spinal cord following injury is caused by a multi-factorial secondary injury process that occurs during the first minutes, hours, and days after spinal cord injury (SCI). A key biochemical event in that process is reactive oxygen-induced lipid peroxidation (LP). In 1990 the results of the Second National Acute Spinal Cord Injury Study (NASCIS II) were published, which showed that the administration of a high-dose regimen of the glucocorticoid steroid methylprednisolone (MP), which had been previously shown to inhibit post-traumatic LP in animal models of SCI, could improve neurological recovery in spinal-cord-injured humans. This resulted in the registration of high-dose MP for acute SCI in several countries, although not in the U.S. Nevertheless, this treatment quickly became the standard of care for acute SCI since the drug was already on the U.S. market for many other indications. Subsequently, it was demonstrated that the non-glucocorticoid 21-aminosteroid tirilazad could duplicate the antioxidant neuroprotective efficacy of MP in SCI models, and evidence of human efficacy was obtained in a third NASCIS trial (NASCIS III). In recent years, the use of high-dose MP in acute SCI has become controversial largely on the basis of the risk of serious adverse effects versus what is perceived to be on average a modest neurological benefit. The opiate receptor antagonist naloxone was also tested in NASCIS II based upon the demonstration of its beneficial effects in SCI models. Although it did not a significant overall effect, some evidence of efficacy was seen in incomplete (i.e., paretic) patients. The monosialoganglioside GM1 has also been examined in a recently completed clinical trial in which the patients first received high-dose MP treatment. However, GM1 failed to show any evidence of a significant enhancement in the extent of neurological recovery over the level afforded by MP therapy alone. The present paper reviews the past development of MP, naloxone, tirilazad, and GM1 for acute SCI, the ongoing MP-SCI controversy, identifies the regulatory complications involved in future SCI drug development, and suggests some promising neuroprotective approaches that could either replace or be used in combination with high-dose MP.
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Affiliation(s)
- Edward D Hall
- Spinal Cord and Brain Injury Research Center, University of Kentucky Chandler Medical Center, Lexington, Kentucky 40536, USA.
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49
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Abstract
BACKGROUND The pivotal role of inflammation and edema across the spectrum of central nervous system injury has driven extensive investigation into the therapeutic potential of glucocorticoids. OBJECTIVE To review the experimental and clinical data relating to the efficacy and adverse effects of glucocorticoids in conditions encountered in critical neurologic and neurosurgical illness. DATA SOURCE Search of MEDLINE and Cochrane databases, manual review of article bibliographies. DATA SYNTHESIS AND CONCLUSIONS The efficacy of glucocorticoids is well established in ameliorating edema associated with brain tumors and in improving outcome in subsets of patients with bacterial meningitis. Despite frequently encouraging experimental results, clinical trials of glucocorticoids in ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and traumatic brain injury have not shown a definite therapeutic effect. The evidence supporting glucocorticoid therapy for spinal cord injury is controversial; however methylprednisolone continues to be widely employed in this setting.
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Affiliation(s)
- Joao A Gomes
- Neurosciences Critical Care Division, Department of Anesthesia and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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50
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Kawahara N, Tomita K, Kobayashi T, Abdel-Wanis ME, Murakami H, Akamaru T. Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976) 2005; 30:613-20. [PMID: 15770174 DOI: 10.1097/01.brs.0000155407.87439.a2] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Morphometric changes of the spinal cord and influence on spinal cord-evoked potentials and spinal cord blood flow and postoperative function of hind limbs were studied in various degrees of acute spinal column shortening in dogs. OBJECTIVES To study the morphometric and physiologic effects of acute spinal column shortening on the spinal cord. SUMMARY OF BACKGROUND DATA The technique of acute spinal column shortening is sometimes applied for correction of spinal deformity, total en bloc spondylectomy operation, or other diseases. However, safe limits and physiologic effects of acute spinal column shortening have not yet been described. METHODS Total spondylectomy of T13 was performed in dogs after spinal instrumentation placed 2 levels above and 2 levels below the spondylectomy level. Spinal column was gradually shortened until the lower endplate of T12 contacted the L1 upper endplate (maximum of 20 mm). When any morphologic change of the dural sac or the spinal cord was observed, the length of shortening was measured. Spinal cord-evoked potentials were recorded on the exposed dura mater following epidural stimulation at the C7 level in 8 dogs. Spinal cord blood flow was measured during shortening in 6 dogs. Hindlimb function was evaluated 2 weeks after operation in 10 dogs. RESULTS No morphometric changes occurred in the dural sac and the spinal cord until shortening of 7.2 +/- 1.7 mm (n = 6). From 7.2 +/- 1.7 to 12.5 +/- 1.1 mm shortening, the dural sac was deformed, whereas the spinal cord maintained its shape. Shortening more than 12.5 +/- 1.1 mm buckled the dural sac, and the spinal cord kinked itself and was compressed by the buckled dura in its concave side (n = 6). No changes could be detected in spinal cord-evoked potentials in 5 or 10 mm of shortening. Spinal cord-evoked potential changes were recorded in the 2 of 6 dogs with 15 mm of shortening. At 20 mm of shortening, spinal cord-evoked potential abnormality was observed in 4 of 6 dogs. At shortening of 5, 10, 15, and 20 mm, spinal cord blood flow was 146 +/- 10%, 160 +/- 21%, 102 +/- 17%, and 93 +/- 7% of the control (29.2 +/- 7.9 mL/100 g/min, n = 6), respectively. All 3 dogs with 10 mm ofshortening had normal hindlimb function 2 weeks after operation. One of the 3 dogs with 15 mm of shortening had paraparesis. Three of the 4 dogs with 20 mm of shortening had also paraparesis after operation. CONCLUSIONS Acute spinal column shortening can be characterized into 3 phases. Phase 1, safe range: occurred during shortening within one-third of the vertebral segment and is characterized by no deformity of the dural sac or the spinal cord. Phase 2, warning range: occurred during spinal shortening between one-third and two-thirds of the vertebral segment and is characterized by shrinking and buckling of the dural sac and no deformity of the spinal cord. Phase 3, dangerous range: occurred after shortening in excess of two-thirds of the vertebral segment and is characterized by spinal cord deformity and compression by the buckled dura. Spinal shortening within the safe range increases spinal cord blood flow.
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Affiliation(s)
- Norio Kawahara
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan.
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