The Unique Properties of Placental Mesenchymal Stromal Cells: A Novel Source of Therapy for Congenital and Acquired Spinal Cord Injury.

Spinal cord injury (SCI) is a devasting condition with no reliable treatment. Spina bifida is the most common cause of congenital SCI. Cell-based therapies using mesenchymal stem/stromal cells (MSCS) have been largely utilized in SCI. Several clinical trials for acquired SCI use adult tissue-derived MSC sources, including bone-marrow, adipose, and umbilical cord tissues. The first stem/stromal cell clinical trial for spina bifida is currently underway (NCT04652908). The trial uses early gestational placental-derived mesenchymal stem/stromal cells (PMSCs) during the fetal repair of myelomeningocele. PMSCs have been shown to exhibit unique neuroprotective, angiogenic, and antioxidant properties, all which are promising applications for SCI. This review will summarize the unique properties and current applications of PMSCs and discuss their therapeutic role for acquired SCI.

Developmental and maladaptive plasticity in neonatal SCI.

Babies and young children with early spinal cord injury (SCI) have evidence of an improved level of recovery over an extended time period. Enhanced neuroplasticity is well recognized in neonatal animal models. In the young human, developmental apraxia and learned early habitual movements mask expression of residual or recovered motor function. Techniques providing sensorimotor stimulation with threshold electrical stimulation (TES) and EMG triggered stimulation (ETS) act to increase awareness and useful function. Small cohort size and prolonged developmental maturation argue for the use of single subject research designs in this population.

Trauma raquimedular en la Unidad de Cuidados Intensivos / Raquimedular trauma in the Intensive Care Unit

Se realizó un estudio descriptivo y retrospectivo de los pacientes con diagnóstico de Trauma raqui-medular que ingresaron en la Unidad de Cuidados Intensivos del Hospital Universitario Carlos Manuel de Céspedes de Bayamo, con el objetivo de identificar los aspectos clínicos y epidemiológicos presentes en ellos. El procesamiento estadístico se realizó teniendo en cuenta la estadística descriptiva. Se ingresaron un total de 8 pacientes con este diagnóstico, todos del sexo masculino. Predominaron las edades entre 36 a 45 años, 3 pacientes (37,5 por ciento), media de 44,38 +/-17,4 años. Necesitaron ventilación mecánica 6 pacientes (75,0 por ciento), 3 casos (37,5 por ciento) presentaron bronconeumonía bacteriana. El tratamiento la metilprednisolona se usó en 5 casos (62.5 por ciento), y necesitaron fijación quirúrgica 4 enfermos (50,0 por ciento). Fallecieron 5 pacientes (62,5 por ciento). Concluimos que esta afección fue más frecuente en adultos jóvenes del sexo masculino. El uso de ventilación mecánica fue necesario en la mayoría de los casos, la bronconeumonía fue la complicación que se evidenció aislándose gérmenes propios del medio hospitalario. El esteroide más usado fue la metilprednisolona, y la fijación quirúrgica la necesitaron la mitad de los pacientes. Predominan los casos de estadía hospitalaria prolongada(AU)

It was performed a descriptive and retrospective study of patients with a diagnosis of raquimedular Trauma who were hospitalized in the Intensive Care Unit of the University Hospital Carlos Manuel de Céspedes in Bayamo, with the aim of identifying the clinical and epidemiological aspects presented in them. Statistical processing was carried out taking into account the descriptive statistics. There were hospitalized an amount of 8 male patients with this diagnosis. The ages from 36 to 45 years prevailed, 3 patients (37.5 percent), average of 44,38 +/-17.4 years. 6 patients (75.0 percent) needed mechanical ventilation, 3 cases (37.5 percent) presented bacterial-bronchopneumonia. Methylprednisolone treatment was used in 5 cases (62.5 percent), and the surgical fixation was needed by 4 patients (50.0 percent). 5 patients (62.5 percent) deceased. We concluded that this condition was more frequent in young male adults. The use of mechanical ventilation was required in the majority of cases and bronchopneumonia was the complication that was evidenced, isolating the germs proper from the hospital environment. The most commonly used steroid was methylprednisolone and surgical fixation was needed by half of the patients. The cases of prolonged hospital stay prevailed(EU)

US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases.

Ultrasonography (US) of the spinal cord is performed in newborns with signs of spinal disease (cutaneous lesions of the back, deformities of the spinal column, neurologic disturbances, suspected spinal cord injury due to traumatic birth, and syndromes with associated spinal cord compression). The examination is performed with high-frequency linear- and curved-array transducers in the sagittal and axial planes from the craniocervical junction to the sacrum. Normal variants such as transient dilatation of the central canal and ventriculus terminalis can be demonstrated with US. US allows detection of congenital malformations, such as myelocele or myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, terminal myelocystocele, lateral meningocele, caudal regression syndrome, and hydromyelia or syringomyelia. Acquired intraspinal diseases following birth trauma and transient alterations after lumbar puncture can also be detected with US. US can demonstrate the entire spectrum of intraspinal anatomy and pathologic conditions with high geometric resolution. Therefore, US should be considered the initial imaging modality of choice for investigating the spinal cord in newborns.

[Perinatal spinal cord injuries]. / Traumatismes médullaires périnatals.

BACKGROUND: Injury to the spinal cord is still observed in the neonate. Its prognosis is poor. CASE REPORTS: The first neonate was delivered by cesarean section for breech presentation with hyperextension of the neck. She rapidly developed acute respiratory distress and paraplegia. MRI showed spinal cord hemorrhage involving the cervical and upper thoracic cord with rupture of the cord. The patient died a few weeks later. The second neonate was delivered vaginally in breech presentation without any difficulty. She progressively developed tetraplegia evolving into spasticity. MRI showed stretching of cervical spinal cord. The patient later developed sphincter disturbances, repeated urinary and pulmonary infection and severe scoliosis. CONCLUSIONS: Early prenatal damage to the spinal cord was possible in the first patient. Ultrasonography could help to evaluate the extent of damage. The condition leads to difficult ethical and therapeutic problems.

Abnormal behavioral patterns in the human fetus at term: correlation with lesion sites in the central nervous system after birth.

We describe three fetuses at term that demonstrated abnormal behavioral patterns in utero when observed using real-time ultrasound. The abnormal patterns turned out to have neurologic correlations after birth. In case 1, despite a normal breathing pattern, no movement in any of the four extremities was observed, thus suggesting the existence of a spinal cord lesion at the rostral end, located at C4 or C5. In case 2 a lack of breathing movement was noted repeatedly, together with the abnormal finding that alternation of periods of rapid eye movement (REM) sleep with those of non-rapid eye movement (NREM) sleep was not present. These findings implied a lesion involving the pons and/or medulla oblongata. In case 3 movement of the four extremities, breathing movement, and alternating periods of REM sleep and NREM sleep were found to be within the normal range. The concurrence of regular mouthing and the NREM sleep period was not observed, however, suggesting impairment in the brain function responsible for NREM sleep located from the pons through the thalamocortical connection to the cerebral hemisphere.

Congenital spinal cord haemangioblastoma: another cause of spinal cord section syndrome in the newborn.

A newborn infant with negative perinatal history and characteristic clinical findings of upper cervical spinal cord section is described. Metrizamide myelography performed on the 7th and 22nd days of life was negative. Peroneal somatosensory evoked responses showed a conduction block at the cervical level. Necropsy revealed a haemangioblastoma extending from levels C1 to C5.

Thoracic spinal cord (T3-T4) transection in a breech-presenting, cesarean-section-delivered preterm infant.

Thoracic spinal cord transection below the origin of the brachial plexus is a rare event among breech-presenting infants delivered by cesarean section. A case of a thoracic (T3-T4) spinal cord injury with paravertebral hemorrhage mimicking catastrophic intracranial bleeding is presented to illustrate the value of careful application of traction or any longitudinal stretching forces during fetal head extraction.

Evidence of spinal cord injury in an infant delivered by cesarean section. A case report.

A 3-month-old female infant is reported with upper spinal cord injury at birth. Breech presentation and hyperextension of head were observed 1 week prior to delivery. She was delivered by elective cesarean section. The absence of fetal movements 1 day prior to delivery and the uneventful cesarean section strongly suggest a spinal cord injury in utero secondary to hyperextension of the neck.

Neonatal spinal cord injury.

In this review of the prognosis of patients having neonatal spinal cord injury, findings in 3 patients and 11 case histories from the literature are evaluated as to obstetric complications, clinical and pathologic examinations, and follow-up data from 2 to 12 years, or until death of the child. Eight of the 14 patients died: 4 at less than 3 months of age, 3 between 3 months and 1 year of age, and 1 at 3 1/2 years of age. Six children survived for more than 2 years for follow-up examination. Survival is dependent on the level of the lesion, with cervical lesions being almost incompatible with life. The quality of survival for those with levels of C8-T1 and below depends on the child's multiple medical complications.

Spinal cord injury in a fetus.

In her eighth month of pregnancy a woman was stabbed in the abdomen with a barbecue fork. Upon delivery one week later, the child was noted to have two scars in the thoracic region on the back. The legs were flaccid. Surgical exploration at the age of seven months revealed marked, dense scarring of spinal cord and arachnoid membrane. No similar case was found in the literature.