Dissecação anatômica como estratégia para o estudo do sistema neural em fetos humanos / Anatomic dissection as a strategy for the study of the neural system in fetuses / Disección anatómica como estrategia para el estudio del sistema neural en fetos

Esse trabalho busca relatar o processo de confecção de peças anatômicas para o ensino da anatomia humana a partir de material cadavérico fetal. Os discentes do curso de medicina da Universidade Federal do Paraná (UFPR) ­ Campus Toledo participaram do programa de voluntariado acadêmico e deram atenção especial aos aspectos técnicos do processo de dissecação, bem como a experiência subjetiva desse procedimento como ferramenta de aprendizado ativo. O procedimento foi realizado na sala de preparação de cadáver da UFPR ­ Campus Toledo, utilizando instrumental de dissecação e cadáveres humanos fetais com 20, 17 e 14 semanas de idade gestacional, direcionado de modo a expor as partes constituintes do sistema neural. Foram confeccionadas peças de cérebro, cerebelo, tronco encefálico, medula espinal, nervos espinais e suas estruturas associadas. Os voluntários envolvidos foram capazes de produzir material de estudo de qualidade através da dissecação e fortalecer seu conhecimento em anatomia humana e aptidão manual. Também foi dada atenção à importância e às limitações do processo de dissecação como estratégia de aprendizado em cursos da área de saúde. pôde ser observado que a dissecação pode fazer parte de uma formação completa e bem estruturada dos discentes, que por sua vez irão integrar a sociedade e a academia. Além disso, a exposição da topografia neural fetal pode servir de referencial para posteriores estudos que venham a utilizar essas informações.

This work aims to report the confection process of anatomic pieces for teaching human anatomy from fetal cadaveric material. The students of the medicine course of Universidade Federal do Paraná (UFPR) ­ Campus Toledo, took part in the academic volunteer program and paid special attention to the technical aspects of the dissection process, as well as the subjective experience of this procedure as an active learning tool. The procedure was performed at the cadaver preparation room of the UFPR ­ Campus Toledo, using dissection tools and human fetal corpses of 20, 17 and 14 weeks of gestational ages, directed so as to expose the constituent parts of the neural system. Pieces of the brain, cerebellum, brainstem, spinal cord, spinal nerves, and its associated structures were made. The involved voluntaries were able to produce quality study material through dissection, and strengthen their knowledge in human anatomy and manual skill. Attention was also given to the importance and limitations of the dissection process as a learning strategy in health courses. it was observed that dissection can be part of a complete and well-structured training of students, who in turn will integrate society and academia. In addition, the exposure of fetal neural topography can serve as a reference for further studies that use this information

Este trabajo tiene como objetivo relatar el proceso de confección de piezas anatómicas para la enseñanza de la anatomía humana a partir de material cadavérico fetal. Los alumnos del curso de medicina de la Universidade Federal do Paraná (UFPR) - Campus Toledo, participaron del programa de voluntariado académico y prestaron especial atención a los aspectos técnicos del proceso de disección, así como a la vivencia subjetiva de este procedimiento como herramienta de aprendizaje activo. El procedimiento fue realizado en la sala de preparación de cadáveres de la UFPR - Campus Toledo, utilizando herramientas de disección y cadáveres de fetos humanos de 20, 17 y 14 semanas de edad gestacional, dirigidos de forma a exponer las partes constitutivas del sistema neural. Se realizaron piezas del cerebro, cerebelo, tronco encefálico, médula espinal, nervios espinales y sus estructuras asociadas. Los voluntarios participantes pudieron elaborar material de estudio de calidad mediante la disección y reforzar sus conocimientos de anatomía humana y habilidad manual. También se prestó atención a la importancia y las limitaciones del proceso de disección como estrategia de aprendizaje en los cursos de salud. Se observó que la disección puede formar parte de una formación completa y bien estructurada de los estudiantes, que a su vez integrarán la sociedad y el mundo académico. Además, la exposición de la topografía neural fetal puede servir de referencia para estudios posteriores que utilicen esta información.

Hirayama Disease: Case Report / Doença de Hirayama: Relato de caso

Abstract A 26-year-old previously healthy patient who, at the age of 18 years, began progressive loss of distal strength, rest tremor, and muscle atrophy in the left upper limb. Upon examination, the patient presented moderate distal atrophy, degree 4 in muscular strength, and minipolymioclonus. Electromyoneurography revealed (EMNG) chronic preganglionic bilateral involvement of bilateral C7/C8/T1, worse on the left, with signs of active C8/T1 denervation. A cervical spine magnetic resonance imaging (MRI) scan showed spondylodiscal degenerative changes with central protrusions in C4-C5, C6-C7, and right central in C5-C6, which touched the dural sac. The anteroposterior diameter of the medulla in neutral position, in the C5-C6 plane, was of 5.1 mm. There was a reduction of the spinal cord caliber to 4.0 mm after the dynamic maneuver of forced flexion of the spine, as well as signal increase in the anterior horns. The clinical findings and those of the complementary tests were compatible with Hirayama disease (HD), a rare benign motor neuron disease that affects cervical spinal segments and is most prevalent in men, with onset in the early 20s. Unilateral and slowly progressive weakness is typical, but self-limited. Sensory disturbances, and autonomic and upper motor neuron signals are rare. Management is usually conservative, with the use of a soft cervical collar. Although rare, HD should be considered in young patients with focal asymmetric atrophy in the upper limbs. The early diagnosis of HD depends on the degree of suspicion, as well as on the cooperation and communication among the various specialties involved in the investigation.

Resumo Paciente de 26 anos, previamente hígido, que, aos 18 anos, iniciou perda progressiva de força distal, tremor de repouso, e atrofia muscular no membro superior esquerdo. Ao exame, apresentou atrofia moderada, distal, força muscular de grau 4, e minipolimioclonus. A eletroneuromiografia (ENMG) revelou comprometimento pré-ganglionar crônico de C7/C8/T1 bilateral pior à esquerda, com sinais de desnervação ativa em C8/T1. A ressonância magnética (RM) de coluna cervical mostrou alterações degenerativas espondilodiscais com protrusões centrais em C4-C5, C6-C7, e central direita em C5-C6, que tocavam o saco dural. O diâmetro anteroposterior da medula na posição neutra, no plano de C5-C6, era de 5,1 mm. Houve redução do calibre da medula para 4,0 mm após a manobra dinâmica de flexão forçada da coluna, e aumento de sinal nos cornos anteriores. Os achados clínicos e os dos exames complementares eram compatíveis com doença de Hirayama (DH), uma doença benigna rara dos neurônios motores, que afeta os segmentos espinhais cervicais e é mais prevalente em homens e de início próximo aos 20 anos. É típica a fraqueza unilateral e lentamente progressiva, porém autolimitada. Perturbações sensoriais, sinais autonômicos e do neurônio motor superior são raras. O manejo geralmente é conservador, com uso de colar cervical macio. Apesar de rara, a DH deve ser considerada em pacientes jovens que apresentam atrofias assimétricas focais de membros superiores. O diagnóstico precoce de DH depende do grau de suspeição, e da cooperação e comunicação entre as diversas especialidades envolvidas na investigação.

Idiopathic Hypertrophic Spinal Pachymeningitis: A Case Report / Paquimeningite hipertrófica idiopática espinhal: Relato de caso

Abstract Idiopathic hypertrophic pachymeningitis is rare cause of neurological symptoms with myelopathy due to spinal cord compression. We report a case of pachymeningitis, which was manifested primarily by tetraparesis after low-energy trauma and recurrence the myelopathy symptoms after 5 years of surgery. The patient, a 19-year-old woman, was subjected to extensive investigation without evidence of any underlying disease. A meningeal biopsy was performed and showed an unspecific inflammatory process with extensive fibrosis of the dura mater. These findings, associated with the exclusion of other causes, suggest idiopathic hypertrophic pachymeningitis.

Resumo A paquimeningite hipertrófica idiopática é uma causa rara de sintomas neurológicos apresentando mielopatia por compressão da medula espinhal. Relatamos um caso de paquimeningite com manifestação primária de tetraparesia após trauma de baixa energia e recorrência dos sintomas de mielopatia 5 anos após a cirurgia. A paciente, uma mulher de 19 anos, foi submetida a extensa investigação sem evidências de qualquer doença de base. Uma biópsia da meninge revelou processo inflamatório inespecífico com extensa fibrose da dura máter, também visualizado no período perioperatório. Esses achados, associados à exclusão de outras causas, sugerem o diagnóstico de paquimeningite hipertrófica idiopática.

Solitary Dorsal Intramedullary Schwanomma ­ A Rare Lesion

Intramedullary schwanommas are rare, and most cases are reported in cervical region. Less than 20 dorsal intramedullary schwanommas have been reported till date in literature. This is due to their cell of origin, the Schwann cell, which is not normally found within the parenchyma of the brain and spinal cord; therefore it is not surprising that these lesions are rare. We report a rare solitary dorsal intramedullary schwanomma in a young adult patient who presented with paraplegia.

Antinociceptive effect of N-(9,13b-dihydro-1H-dibenzo[c, f]imidazo[1,5-a]azepin-3-yl)-2-hydroxybenzamide on different pain models in mice

Abstract N-(9,13b-dihydro-1H-dibenzo[c,f]imidazo[1,5-a]azepin-3-yl)-2-hydroxybenzamide (DDIAHB) is a new drug developed through molecular modelling and rational drug design by the molecular association of epinastine and salicylic acid. The present study was designed to assess the possible antinociceptive effects of DDIAHB on different pain models in male ICR mice. DDIAHB exerted the reductions of writhing numbers and pain behavior observed during the second phase in the formalin test in a dose-dependent manner. Moreover, DDIAHB increased the latency in the hot-plate test in a dose-dependent manner. Furthermore, intragastric administration DDIAHB caused reversals of decreased pain threshold observed in both streptozotocin-induced diabetic neuropathy and vincristine-induced peripheral neuropathy models. Additionally, intragastric pretreatment with DDIAHB also caused reversal of decreased pain threshold observed in monosodium urate-induced pain model. We also characterized the possible signaling molecular mechanism of the antinociceptive effect-induced by DDIAHB in the formalin model. DDIAHB caused reductions of spinal iNOS, p-STAT3, p-ERK and p-P38 levels induced by formalin injection. Our results suggest that DDIAHB shows an antinociceptive property in various pain models. Moreover, the antinociceptive effect of DDIAHB appear to be mediated by the reductions of the expression of iNOS, p-STAT3, p-ERK and p-P38 levels in the spinal cord in the formalin-induced pain model.

Muscle pain induced by static contraction is modulated by transient receptor potential vanilloid 1 and ankyrin 1 receptors

Abstract Molecular mechanisms involved in the development of muscle pain induced by static contraction are not completely elucidated. This study aimed to evaluate the involvement of the transient receptor potential vanilloid 1 (TRPV1) and the transient receptor potential ankyrin 1 (TRPA1) receptors expressed in peripheral and central terminals of primary afferents projected to gastrocnemius muscle and spinal cord in muscle pain induced by static contraction. An electrical stimulator provided the contraction of rat gastrocnemius muscle and mechanical muscle hyperalgesia was quantified through the pressure analgesimeter Randall-Selitto. AMG9810 and HC030031 were used. When administered in ipsilateral, but not contralateral gastrocnemius muscle, drugs prevented mechanical muscle hyperalgesia induced by static contraction. Similar results were obtained by intrathecal administrations. We propose that, in an inflammatory muscle pain, peripheral and central TRPV1 and TRPA1 work together to sensitize nociceptive afferent fibers, and that TRPV1 and TRPA1 receptors are potential target to control inflammatory muscle pain.

Comparación de secuencias volumétricas con técnicas convencionales en resonancia magnética de columna lumbar / Comparison of volumetric and conventional sequences for the evaluation in magnetic resonance of the lumbar spine

Objetivo: Comparar el protocolo que incluye la secuencia tridimensional SPACE-3D con el protocolo convencional en el estudio imagenológico por resonancia magnética (RM) del paciente con dolor lumbar. Metodología: Se realizó un estudio prospectivo de pruebas diagnósticas, en el que se tomaron imágenes por RM de la columna lumbar de 40 pacientes utilizando un protocolo convencional y otro protocolo que incluyera una secuencia volumétrica (SPACE-3D) en conjunto con secuencia axial con información T1 y sagital STIR, en un resonador de 1,5T. Las imágenes fueron interpretadas por dos radiólogos de manera independiente, empleando tanto el protocolo convencional como el protocolo que incluía la secuencia volumétrica, con un mes de diferencia. Se compararon ambos protocolos calculando la sensibilidad y la especificidad con el intervalo de confianza (IC 95 %), se consideró significación estadística un valor de p≤ 0,05 utilizando la prueba de Chi-cuadrado. Se evaluaron para ambas técnicas variables como presencia o no de artefactos, protrusión/extrusión discal, estrechez del canal neural central, receso lateral o foramen de emergencia radicular, radiculopatía. Se calculó la concordancia inter e intraobservador utilizando el índice Kappa con un IC 95 %. Resultados: Se encontró que el protocolo que incluye la secuencia SPACE-3D presenta rendimiento diagnóstico similar (no inferior) frente al protocolo con las secuencias convencionales para las variables evaluadas; igualmente, se detectaron los hallazgos anormales, lo cual permitió un estudio completo y un diagnóstico en menor tiempo. Conclusiones: El rendimiento diagnóstico del protocolo que incluye la secuencia volumétrica SPACE-3D es similar (no inferior) al protocolo con las secuencias convencionales utilizadas en RM de columna lumbar y acorta el tiempo total del estudio

Objective: To compare the protocol that includes the three-dimensional SPACE-3D sequence with the conventional protocol in the magnetic resonance imaging (MRI) study of patients with low back pain. Methods: A prospective study of diagnostic tests was carried out, in which MR images of the lumbar spine were taken from 40 patients using a conventional protocol and another protocol that included a volumetric sequence (SPACE-3D) in conjunction with axial T1 and sagittal STIR sequences, in a 1.5T resonator. The images were interpreted by two radiologists independently, both the conventional protocol and the protocol that included the volumetric sequence, one month apart. Both protocols were compared, calculating the sensitivity and specificity with the confidence interval (CI 95%), a value of p ≤0.05 using the Chi-square test was considered statistically significant. Variables such as the presence or absence of artifacts, disc protrusion/extrusion, narrowing of the central neural canal, lateral recess or root emergence foramen, and presence of radiculopathy, among others, were evaluated for both techniques. Inter- and intra-observer agreement was calculated using the Kappa index with a 95% CI. Results: it was found that the protocol that included the SPACE-3D sequence presents similar diagnostic performance (not inferior) when compared to the protocol with the conventional sequences for the variables evaluated, similarly, abnormal findings were detected, which allowed a complete study and diagnosis in less time. Conclusions: The diagnostic performance of the protocol that includes the SPACE-3D volumetric sequence is similar (not inferior) to the protocol with conventional sequences used in MRI of the lumbar spine and shortens the total study time.

Elaboração e validação de instrumento baseado no Core Set resumido da classificação internacional da funcionalidade para indivíduos com lesão medular aguda / Development and validation of an instrument based on the summarized Core Set of the international classification of functioning for individuals with acute spinal cord injury

A Lesão de Medula Espinhal (LME) é um trauma com efeitos devastadores na vida dos indivíduos. Estima-se que mais de 130.000 pessoas sejam afetadas por LME, a cada ano, em todo o mundo. Aproximadamente, 45% de todas as lesões são completas, deixando apenas uma pequena chance de recuperação funcional. As complicações ocasionadas pela LME influenciam a qualidade de vida dos indivíduos, aumentam as demandas de cuidados e os encargos sociais e econômicos de saúde. Este é um estudo metodológico, que teve o objetivo de construir e validar instrumento baseado no Core Set resumido da CIF, para indivíduos com lesão medular aguda traumática. Essa pesquisa foi aprovada pelo Comitê de Ética e desenvolvida nas seguintes etapas: 1 - Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: "Elaboração e Validação de Instrumento baseado no Core Set resumido da Classificação Internacional da Funcionalidade para indivíduos com Lesão Medular Aguda"; 2- Validação do instrumento e coleta de dados pelos juízes; 3- Aplicação do pré-teste. O instrumento para validação de face e conteúdo composto por 15 categorias que integraram os componentes da CIF: funções do corpo (6), estrutura do copo (2), atividades e participação (2), fatores ambientais e fatores pessoais (5). A validade de conteúdo do instrumento foi feita por um comitê de vinte e dois juízes. Dos 22 juízes, 18 (81,8%) eram do sexo feminino e 4 (18,2%) do sexo masculino. A maioria era constituída por jovens, com média entre 40±10 anos, sendo que 3 participantes (13,6%) tinham idade entre 20 e 29 anos, 8 (36,4%) de 30 e 39 anos, 7 (31,8%) entre 40 e 49 anos, 3 (13,6%) 50 e 59 anos e 1 (4,5%) 60 e 69 anos. Cerca de 95,5 % relataram participar, nos últimos 2 anos, de eventos científicos na área temática da pesquisa, 13 (59,1%) realizavam estudos sobre a CIF e 14 (63,6%) a utilizavam na sua prática clínica. Todas as categorias obtiveram uma concordância de IVC >0,80, sendo assim, o instrumento, pode ser considerado validado. Na maioria das categorias, os juízes fizeram sugestões que visavam às modificações de termos, para serem substituídos ou reformulados, e os qualificadores repontuados, de acordo com os percentuais da CIF. Após consenso entre os pesquisadores foram realizadas as alterações sugeridas e elaborada a versão final do instrumento, com aplicação do pré-teste. O instrumento validado poderá contribuir para prática clínica dos profissionais da saúde, no processo de avaliação da funcionalidade dos indivíduos com lesão medular aguda

Spinal Cord Injury (SCI) is a trauma with devastating effects on the lives of individuals. It is estimated that more than 130,000 people are affected by SCI each year worldwide. Approximately 45% of all injuries are complete, leaving only a small chance of functional recovery. The complications caused by SCI influence the quality of life of individuals, increase the demands for care, and increase the social and economic burden of health care. This is a methodological study, which aimed to construct and validate an instrument based on the summarized ICF Core Set for individuals with traumatic acute spinal cord injury. This research was approved by the Ethics Committee and developed in the following stages: 1 - Development of the instrument from the summarized ICF core set for acute spinal cord injury: "Development and validation of an instrument based on the summarized core set of the International Classification of Functioning for individuals with acute spinal cord injury"; 2 - Validation of the instrument and data collection by the judges; 3 - Application of the pre-test. The instrument for face and content validation consisted of 15 categories that integrated the ICF components: body functions (6), body structure (2), activities and participation (2), environmental factors and personal factors (5). The content validity of the instrument was done by a committee of twenty-two judges. Of the 22 judges, 18 (81.8%) were female and 4 (18.2%) were male. The majority were young, averaging 40±10 years, with 3 participants (13.6%) aged 20-29 years, 8 (36.4%) 30-39 years, 7 (31.8%) 40-49 years, 3 (13.6%) 50-59 years, and 1 (4.5%) 60-69 years. About 95.5% reported participating, in the last 2 years, of scientific events in the thematic area of the research, 13 (59.1%) carried out studies about the ICF and 14 (63.6%) used it in their clinical practice. All categories obtained a CVI agreement >0.80, thus, the instrument can be considered validated. In most of the categories, the judges made suggestions that aimed at the modification of terms, to be replaced or reformulated, and the qualifiers were re-assessed, according to the ICF percentages. After consensus was reached among the researchers, the suggested changes were made and the final version of the instrument was prepared, with the application of the pre-test. The validated instrument may contribute to the clinical practice of health professionals in the process of evaluating the functionality of individuals with acute spinal cord injury

Expresión de proteínas inducibles por frío en la médula espinal de rata sometida a hipotermia sistémica / Expression of cold-inducible proteins in rat spinal cord subjected to systemic hypothermia

Introducción: La lesión traumática de la médula espinal es la principal causa de discapacidad motora en el mundo, y representa una prioridad para la Organización Mundial de la Salud. Se estudió, a nivel estructural y bioquímico, el efecto de la hipotermia sobre la expresión de la CIRBP (proteína activada por frío) en el asta anterior de la médula de ratas Sprague-Dawley albinas macho de 60 días, planteándola como terapéutica posible. Materiales y Métodos:Se dividió a 24 ratas en dos grupos: normotermia a 24 °C (n = 6) e hipotermia a 8 °C (n = 18), durante 180 min, sacrificadas a las 12, 24 y 48 h después del tratamiento. Se utilizó Western blot e inmunohistoquímica para la CIRBP. Resultados:Se observó un aumento progresivo de la expresión de la CIRBP de 12 a 48 h en las motoneuronas del asta anterior. Los valores fueron estadísticamente significativos entre los grupos de 24 h y 48 h comparados con los de los controles. Conclusiones: Este modelo experimental resultó eficaz, accesible y económico para generar hipotermia sistémica y abre un abanico de estrategias terapéuticas. El aumento en la expresión de las proteínas inducibles por frío en la médula espinal de ratas permite, por primera vez, estudiar el beneficio que aporta la hipotermia a nivel molecular, lo que resulta de suma importancia para estudios de terapéuticas en las lesiones medulares. Nivel de Evidencia: I

Introduction: Traumatic spinal cord injury is the main cause of motor disability in developed and underdeveloped countries, being a priority interest to the WHO. The effect of hypothermia on the expression of CIRBP (cold-activated protein) in the anterior grey column of 60-day-old male albino Sprague-Dawley rats was studied at the structural and biochemical levels and proposed as a possible therapeutic approach. Materials and Methods: 24 rats were randomly divided into two groups; normothermia (n = 6), at 24° C, and hypothermia, (n = 18) at 8° C for 180 minutes and euthanized at 12, 24, and 48 h post-treatment. Western blot and immunohistochemistry for CIRBP were used. Results: A progressive increase in the expression of CIRBP was observed from 12 to 48 hours, with statistically significant values after 24 and 48 hours compared to controls. Conclusion: This experimental model demonstrated efficacy, accessibility, and economy to generate systemic hypothermia, which provides a novel range of therapeutic strategies. The increase in the expression of cold-inducible proteins in the rats' spinal cords allows us to study the benefit of hypothermia at the molecular level for the first time, being of utmost importance for therapeutic studies in spinal cord injuries. Level of Evidence: I

Modelo de hipotermia experimental en murinos para estudios de lesión medular / Experimental hypothermia murine model for spinal cord injury studies

Introducción: Los ensayos de hipotermia sistémica en murinos son costosos, debido a la complejidad de los sistemas. El objetivo de este estudio fue evaluar si el modelo de hipotermia sistémica exógena utilizado en nuestro laboratorio para la hipotermia ocular es útil para reducir significativamente la temperatura de la médula espinal en ratas adultas. Materiales y métodos: Se utilizaron 36 ratas Sprague-Dawley albinas macho de 60 días, distribuidas en dos grupos: grupo normotermia a 24 °C (n = 18) y grupo hipotermia (n = 18) en cámara fría a 8 °C durante 180 minutos. Resultados: La temperatura rectal promedio fue de 37,71 ± 0,572 °C en el grupo normotermia y 34,03 ± 0,250 °C en el grupo hipotermia (p <0,0001). La temperatura medular promedio fue de 38,8 ± 0,468 °C en el grupo normotermia y de 36,4 ± 0,290 °C en el grupo hipotermia (p <0,0001). Conclusiones: El uso de hipotermia sistémica en ratas de laboratorio parece ser un método prometedor para evaluar los mecanismos fisiológicos y patológicos que se desencadenan en la médula espinal. La exposición al frío en cámara genera hipotermia medular significativa en ratas adultas. Los resultados sugieren que podría ser un modelo adecuado de hipotermia medular de bajo costo. Nivel de Evidencia: III

Given the complexity of hypothermal trial systems in murines, they are expensive. Our objective was to evaluate if the exogenous hypothermal model used in our laboratory for ocular hypothermia was useful for a significant reduction in medullar spine temperature in adult murines. Materials and methods: 36 60-day-old adult male Sprague-Dawley rats were used. They were separated into two groups: a normal temperature group at 24 °C (n=18) and a hypothermia group in a cold chamber at 8 °C for 180 minutes (n=18). Results: The mean rectal temperature was 37.71 °C ± 0.572 in the normothermia group and 34.03°C ± 0.250 in the hypothermia group (p <0.0001). The mean medullar temperature was 38.8 ± 0.468 °C in the normothermia group and 36.4 ± 0.290 °C in the hypothermia group (p <0.0001). Conclusion: Using systematic hypothermia in lab rats seems to be promising to evaluate physiologic and pathological mechanisms triggered in the medullar spine. Exposure to cold in the external chamber produces significant medullar hypothermia in adult rats. Results suggest this might be an adequate and inexpensive medullar hypothermal model. Level of Evidence: III

Cornuside ameliorated experimental autoimmune encephalomyelitis by limiting the recruitment of CD4+ T lymphocytes in the spinal cord

We conducted this study to determine whether cornuside could improve the neurological deficit symptoms of experimental autoimmune encephalomyelitis (EAE) rats, as well as determine the potential involvement of CD4+ T lymphocytes, vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-α (TNF-α). Altogether, 32 Lewis rats were randomly divided into control, EAE, EAE/prednisolone, and EAE/cornuside, wherein their neurological function was assessed every day. CD4+ T lymphocyte recruitment into the spinal cord (SC) was evaluated using immunohistochemistry. The VCAM-1, ICAM-1 and TNF-α mRNA expressions in the SC were determined by real-time quantitative PCR, and the VCAM-1 and ICAM-1 proteins were determined by western blotting. Compared to the control group, the EAE group rats with neurological deficits had enhanced CD4+ T lymphocyte infiltration and higher expression levels of VCAM-1, ICAM-1, and TNF-α in the SC. Meanwhile, compared with the EAE group, the EAE/cornuside and EAE/prednisolone groups had lower neurological scores, less CD4+ T lymphocyte infiltrations, and lower expression levels of VCAM-1, ICAM-1, and TNF-α in the SC. Thus, cornuside ameliorated EAE, which could be owed to the inhibition of CD4+ T lymphocyte recruitment and VCAM-1, ICAM-1, and TNF-α expressions in the SC

Recovery of motor function in rats with complete spinal cord injury following implantation of collagen/silk fibroin scaffold combined with human umbilical cord-mesenchymal stem cells

SUMMARY OBJECTIVE: This study aimed to assess the effect of the collagen/silk fibroin scaffolds seeded with human umbilical cord-mesenchymal stem cells on functional recovery after acute complete spinal cord injury. METHODS: The fibroin and collagen were mixed (mass ratio, 3:7), and the composite scaffolds were produced. Forty rats were randomly divided into the Sham group (without spinal cord injury), spinal cord injury group (spinal cord transection without any implantation), collagen/silk fibroin scaffolds group (spinal cord transection with implantation of the collagen/silk fibroin scaffolds), and collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group (spinal cord transection with the implantation of the collagen/silk fibroin scaffolds co-cultured with human umbilical cord-mesenchymal stem cells). Motor evoked potential, Basso-Beattie-Bresnahan scale, modified Bielschowsky's silver staining, and immunofluorescence staining were performed. RESULTS: The BBB scores in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group were significantly higher than those in the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.05 or p<0.01). The amplitude and latency were markedly improved in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group compared with the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.05 or p<0.01). Meanwhile, compared to the spinal cord injury and collagen/silk fibroin scaffolds groups, more neurofilament positive nerve fiber ensheathed by myelin basic protein positive structure at the injury site were observed in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group (p<0.01, p<0.05). The results of Bielschowsky's silver staining indicated more nerve fibers was observed at the lesion site in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group compared with the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.01, p< 0.05). CONCLUSION: The results demonstrated that the transplantation of human umbilical cord-mesenchymal stem cells on a collagen/silk fibroin scaffolds could promote nerve regeneration, and recovery of neurological function after acute spinal cord injury.

Dorsal Root Entry Zone Lesioning: Systematic Review

Introduction Dorsal root entry zone (DREZ) leasioning (DREZ-otomy) is considered an effective treatment for chronic pain due to spinal cord injuries, brachial and lumbosacral plexus injuries, postherpetic neuralgia, spasticity, and other conditions. The objective of the technique is to cause a selective destruction of the afferent pain fibers located in the dorsal region of the spinal cord. Objective To identify and review the effectiveness and the main aspects related to DREZ-otomy, as well as the etiologies that can be treated with it. Methods The PubMed, MEDLINE and LILACS databases were used as bases for this systematic review, having the impact factor as the selection criteria. The 23 selected publications, totalizing 1,099 patients, were organized in a table for systematic analysis. Results Satisfactory pain control was observed in 70.1% of the cases, with the best results being found in patients with brachial/lumbosacral plexus injury (70.8%) and the worst, in patients with trigeminal pain (40% to 67%). Discussion Most of the published articles observed excellent results in the control of chronic pain, especially in cases of plexus injuries. Complications are rare, and can be minimized with the use of new technologies for intraoperative monitoring and imaging. Conclusion DREZ-otomy can be considered a great alternative for the treatment of chronic pain, especially in patients who do not tolerate the side effects of the medications used in the clinical management or have refractory pain.

Reporte de caso: Quiste neuroentérico intradural/extramedular en paciente joven / Case report: Intradural/extramedullary neurenteric cyst in a young patient

Introducción: Los quistes neuroentéricos son lesiones congénitas, benignas, solitarias e infrecuentes del eje espinal, compuestas de tejido endodérmico heterotópico, productos del cierre incompleto del tubo neural. Se presentan, principalmente, en hombres durante la primera y segunda década de vida. Se localizan mayoritariamente en el espacio intradural/extramedular, ventralmente a la médula espinal, a nivel cervical bajo o torácico superior. La sintomatología neurológica depende de la localización del quiste. El diagnóstico presuntivo se realiza con una resonancia magnética, y el definitivo con un estudio histopatológico, llevado a cabo posterior a la exéresis completa o parcial de la muestra, con abordaje posterior, en la mayoría de los casos. Caso: Se describe el caso de una paciente de 35 años, quien tiene antecedente de haber presentado a los 14 años un quiste neuroentérico intradural/extramedular, a nivel cervial bajo. Había debutado con cervicalgia irradiada a miembros superiores e inferiores, radiculopatía, pérdida de la fuerza muscular, e hiperreflexia. Se realizó en ese momento una resonancia magnética, evidenciando una lesión ocupante de espacio en C5 y C6, la cual fue intervenida quirúrgicamente a través de una laminectomía en C5-C6 con abordaje posterior. Se realizó exéresis completa de la misma. El estudio anatomopatológico reportó quiste neuroentérico intradural/extramedular, sin atipias celulares. La evolución posoperatoria de la paciente resultó satisfactoria. Conclusión: Se describe este caso clínico, resaltando su importancia, al tratarse de lesiones sumamente infrecuentes en la literatura médica, con sintomatología poco específica, pudiendo confundirse con otras patologías, y recidivar, incluso después de haberse extraído completamente

Introduction: Neuroenteric cysts are congenital, benign, solitary, and infrequent lesions of the spinal axis, composed of heterotopic endodermic tissue, resulting from an incomplete closure of the neural tube. They mainly occur in men, during the first or second decade of life. Most of these cysts are located in the intradural/extramedullary compartment, ventrally to the spinal cord, especially at the lower cervical or upper thoracic spine. The neurological symptomatology varies depending on the location of the cyst. The presumptive diagnosis is made with magnetic resonance imaging, and the definitive diagnosis is made with a histopathological assessment, which is done after a complete or partial resection of the mass, generally with a posterior approach. Case presentation: We describe the case of a 35-year-old female patient, with the medical history of presenting an intradural/extramedullary neuroenteric cyst, located at the lower cervical level, at the age of 14. She presented cervical pain irradiated to upper and lower limbs, radicular pain, loss of muscular strength, and hyperreflexia. A magnetic resonance imaging was indicated, showing a space-occupying lesion at the C5 and C6 levels, which was surgically intervened through a posterior cervical (C5-C6) laminectomy. A complete resection of this mass was performed. The histopathological assessment reported an intradural/extramedullary neuroenteric cyst, with no cellular atypia. The patient's postoperative progress and development were satisfactory. Conclusion: The objective is to describe this case, highlighting its importance, since these lesions are extremely infrequent in the medical literature, with a non-specific symptomatology, which is why they can be confused with other pathologies, and recur, even after their complete resection.

Manejo quirúrgico de ependimomas en médula cervical: A propósito de un caso clínico / Surgical management of ependymomas in the cervical spine: Apropos of a clinical case

Introducción: los ependimomas son tumores cerebrales que surgen de células ependimarias, células de soporte en el cerebro y la médula espinal. Representan entre el 2 y el 3% de todos los tumores cerebrales primarios. Son el cuarto tumor cerebral más común en los niños, donde el 90% de los mismos se localizan en la fosa posterior. En adultos, el 60% de estos tumores se encuentran en la médula espinal pudiendo presentarse a cualquier nivel de ésta; el caso a continuación reporta un ependimoma cervical. Objetivo: reportar un caso de ependimoma medular de ubicación poco frecuente, con resección total, sin recidiva porterior a 2 años de seguimiento.Descripción del caso: se reporta el caso de un paciente adulto, 44 años, masculino, con un síndrome medular cervical completo, progresivo, provocado por un ependimoma cervical. Intervención: se realizó laminectomía de dos espacios [C7 a T1], apertura dural, mielotomía posterior logrando exéresis total de la lesión con durorrafia a sello de agua y posterior cierre por planos sin complicaciones, con seguimiento de 2 años de sobrevida. Conclusiones: la resección total macroscópica de este tipo de tumores es muy importante para poder evitar residiva. El ependimoma cervical puede recidivar, sobre todo cuando existen residuales de la lesión. El manejo oportuno depende de gran manera de que los pacientes acudan tempranamente a valoración especializada; la resección guiada con monitorización neurofisiológica transoperatoria provee mayor oportunidad a los pacientes a no presentar secuelas permanentes y permite asimismo, mejores resultados de la rehabilitación neurológica postoperatoria

Introduction: ependymomas are brain tumors that arise from ependymal cells, supporting cells in the brain and spinal cord. They represent between 2 and 3% of all primary brain tumors. They are the fourth most common brain tumor in children, where 90% of them are located in the posterior fossa. In adults, 60% of these tumors are found in the spinal cord and can occur at any level of the spinal cord; the case below reports a cervical ependymoma. Objective: to report a case of medullary ependymoma of rare location, with total resection, without recurrence after 2 years of follow-up. Case description: a 44-year-old male adult patient with a progressive, complete cervical spinal cord syndrome, caused by a cervical ependymoma, is reported.Intervention: two-space laminectomy [C7 to T1], dural opening and posterior myelotomy were performed, achieving total excision of the lesion with water-seal durorrhaphy and subsequent closure by planes without complications, with a 2-year survival follow-up. Conclusions: macroscopic total resection of this type of tumor is very important to avoid residual. Cervical ependymoma can recur, especially when there is residual lesion. Timely management depends to a great extent on the patients attending early for a specialized evaluation; guided resection with intraoperative neurophysiological monitoring provides a greater opportunity for patients to not present permanent sequelae and also allows better results of postoperative neurological rehabilitation.

Poliomielitis, una historia de inicio triste y final feliz / Poliomyelitis, a story with a sad beginning and a happy ending

Se desarrollan los principales elementos históricos en el estudio y la lucha contra la poliomielitis, su aislamiento por Karl Landsteiner en 1909, la primera vacuna con virus muerto (Jonas Salk, 1955), la segunda vacuna con virus vivo atenuado (Albert Sabin, 1961) y la reducción paulatina de la polio en todo el mundo, hasta llegar a menos de 200 casos al año (virus salvaje)(AU)

The main historical events in the study and fight against polio are shown, its isolation by Karl Landsteiner in 1909, the development of the first vaccine with dead virus (Jonas Salk, 1955), the second vaccine with live attenuated virus (Albert Sabin, 1961) and the gradual reduction of polio worldwide, reaching less than 200 cases a year (wild virus)(AU)

The effect of mild hypothermia plus rutin on the treatment of spinal cord injury and inflammatory factors by repressing TGF-β/smad pathway

ABSTRACT Purpose To probe the mechanism of mild hypothermia combined with rutin in the treatment of spinal cord injury (SCI). Methods Thirty rats were randomized into the following groups: control, sham, model, mild hypothermia (MH), and mild hypothermia plus rutin (MH+Rutin). We used modified Allen's method to injure the spinal cord (T10) in rats, and then treated it with MH or/and rutin immediately. BBB scores were performed on all rats. We used HE staining for observing the injured spinal cord tissue; ELISA for assaying TNF-α, IL-1β, IL-8, Myeloperoxidase (MPO), and Malondialdehyde (MDA) contents; Dihydroethidium (DHE) for measuring the reactive oxygen species (ROS) content; flow cytometry for detecting apoptosis; and both RT-qPCR and Western blot for determining the expression levels of TGF-β/Smad pathway related proteins (TGF-β, Smad2, and Smad3). Results In comparison with model group, the BBB score of MH increased to a certain extent and MH+Rutin group increased more than MH group (p < 0.05). After treatment with MH and MH+Rutin, the inflammatory infiltration diminished. MH and MH+Rutin tellingly dwindled TNF-β, MDA and ROS contents (p < 0.01), and minified spinal cord cell apoptosis. MH and MH+Rutin could patently diminished TGF-β1, Smad2, and Smad3 expression (p < 0.01). Conclusions MH+Rutin can suppress the activation of TGF-β/Smad pathway, hence repressing the cellular inflammatory response after SCI.

Standardization of an experimental model of intradural injection after spinal cord injury in rats

OBJECTIVES: The intrathecal route has not yet been thoroughly standardized and evaluated in an experimental model of spinal cord injury (SCI) in Wistar rats. The objective of this study was to standardize and evaluate the effect of intradural injection in this animal model. METHOD: The animals were divided into 6 groups: 1) laminectomy and intradural catheter; 2) laminectomy, intradural catheter and infusion; 3) only SCI; 4) SCI and intradural catheter; 5) SCI, intradural catheter and infusion; and 6) control (laminectomy only). Motor evaluations were performed using the Basso, Beattie and Bresnahan (BBB) scale and the horizontal ladder test; motor evoked potentials were measured for functional evaluation, and histological evaluation was performed as well. All experimental data underwent statistical analysis. RESULTS: Regarding motor evoked potentials, the groups with experimental SCI had worse results than those without, but neither dural puncture nor the injection of intrathecal solution aggravated the effects of isolated SCI. Regarding histology, adverse tissue effects were observed in animals with SCI. On average, the BBB scores had the same statistical behaviour as the horizontal ladder results, and at every evaluated timepoint, the groups without SCI presented scored significantly better than those with SCI (p<0.05). The difference in performance on motor tests between rats with and without experimental SCI persisted from the first to the last test. CONCLUSIONS: The present work standardizes the model of intradural injection in experimental SCI in rats. Intrathecal puncture and injection did not independently cause significant functional or histological changes.

Absceso epidural posterolateral y compresión radicular: una rara complicación del absceso retrofaríngeo / Posterolateral epidural abscess and root compression: a rare complication of retropharyngeal abscess

Introducción: el absceso epidural posterolateral y la compresión radicular es una rara complicación del absceso retrofaríngeo (ARF). Se realizó el reporte de un caso con esta complicación extremadamente rara. Método: reporte de caso y revisión de la literatura (estudios radiológicos, historia y hallazgos clínicos). Se firmó consentimiento del paciente para la publicación. Resultados: paciente de 33 años remitido a nivel terciario de atención con un cuadro clínico de cervicalgia, odinofagia y fiebre. La tomografía axial computarizada (TAC) y la resonancia magnética nuclear (RMN) mostraron una colección retrofaríngea con compromiso epidural en el espacio medular cervical; en el examen físico se encontró odinofagia, cervicalgia, fiebre y pérdida de la fuerza muscular en el miembro superior derecho. El paciente fue llevado a manejo quirúrgico por otorrinolaringología y ortopedia para el drenaje de la colección; además, se le administró antibioticoterapia con cefepime y clindamicina por 21 días con buenos resultados; se consideró que el origen del absceso era idiopático. Conclusiones: el absceso epidural y la compresión radicular secundarias a un ARF es una rara y potencialmente mortal complicación de esta patología, con secuelas importantes en el paciente que la padece, que requiere un manejo médico-quirúrgico. En nuestro caso el manejo fue interdisciplinario, ya que integró otorrinolaringología, ortopedia, infectología y fisioterapia, lo que resultó en una evolución satisfactoria del paciente.

Introduction: posterolateral epidural abscess and radicular compression is a rare complication of retropharyngeal abscess (RFA), a case report with this extremely rare complication was made. Method: case report and review of the literature (radiological studies, clinical history, clinical findings) patient's consent was signed for the publication. Results: a 33-year-old patient referred at the tertiary care level with a clinical picture of cervicalgia, odynophagia and fever; CT and MRI showed retropharyngeal collection with epidural involvement in the cord cervical space, physical examination, odynophagia, cervicalgia, fever and loss of muscle strength in the right upper limb. Led to surgical management by ENT and orthopedics column for drainage of the collection; antibiotic therapy with cefepime, clindamycin for 21 days with good results; It was considered of idiopathic origin. Conclusions: epidural abscess and root compression secondary to an RFA is a rare and potentially fatal complication of this pathology with important sequelae in the patient, which requires medical-surgical management, in our case the management was integrated interdisciplinary otolaryngology, orthopedics, infectology, physiotherapy , with satisfactory evolution in the patient.