Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.169
Filtrar
2.
Med Clin North Am ; 104(2): 263-278, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035568

RESUMO

Individuals with spinal cord injuries or disorders (SCI/D), whether of traumatic or nontraumatic cause, require multidisciplinary management by their care team to achieve optimal health outcomes. SCI/D is relatively rare in the general population and primary care providers (PCPs) may not have extensive experience managing people with these disorders. Spinal cord injuries, impair the body's autonomic and biomechanical performance by interrupting the communications to and from major bodily systems. This article provides a framework to help PCPs understand how these changes impact their patient's physiologic function and subsequent risks for health complications with guidance for initial treatment approaches.


Assuntos
Administração dos Cuidados ao Paciente/métodos , Traumatismos da Medula Espinal , Doença Crônica , Humanos , Equipe de Assistência ao Paciente/organização & administração , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia
3.
J Photochem Photobiol B ; 203: 111741, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31901721

RESUMO

Spinal cord injury (SCI) is a distressing injury and an irretrievable dramatic event that can debilitate victims for lifespan. Recovery and treatment of SCI is critical challenges for medicine, to overcome the hurdles stem cells and hydrogel scaffolds implantation is a boon for SCI recovery. In this regard, we reported the synthesis of Gold nanoparticles (Au NPs) loaded Agarose/Poly (N-isopropylacrylamide) (PNIPAM) as promising materials for SCI treatment. Herein, Au NPs was synthesized by well-established citrate reduction method and the prepared materials were characterised by UV-visible spectroscopy (UV-vis), Transmission electron microscopy (TEM), Fourier- transform infrared spectroscopy (FT-IR), Scanning electron microscopy (SEM), and EDAX analysis. The microscopic images showed an elliptical or ovoid porous structure nature of hydrogel, and successful and homogenous loading of photo plasmonic nanoparticles into the hydrogel structure. The in vitro cell viability and inflammation analyses data exhibited that prepared hydrogels have no toxic to the cells and displayed high anti-regenerative ability with bone marrow Mesenchymal stem cells (MSCs) and macrophages cells. The in vivo analysis study demonstrated that the treated materials with encapsulated MSCs have greater nerve tissue regeneration efficacy which was confirmed by the results of BBB scores. The hind limb locomotion of treated model animals was totally vanished after post-operational surgery. It's established that implanted nano-hydrogel materials combined with MSCs have quicker recovery of motor function after post-operative surgery, when compared to the other implanted animal groups.


Assuntos
Materiais Biocompatíveis/química , Hidrogéis/química , Transplante de Células-Tronco Mesenquimais , Nanopartículas Metálicas/química , Traumatismos da Medula Espinal/terapia , Bexiga Urinária/fisiopatologia , Resinas Acrílicas/química , Animais , Células da Medula Óssea/citologia , Ouro/química , Membro Posterior/fisiologia , Locomoção , Células-Tronco Mesenquimais/química , Células-Tronco Mesenquimais/citologia , Tecido Nervoso/fisiologia , Regeneração , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/patologia , Tecidos Suporte/química
4.
Zhongguo Zhen Jiu ; 40(1): 3-7, 2020 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-31930890

RESUMO

OBJECTIVE: To compare the clinical effect on intestinal dysfunction of spinal cord injury (SCI) between the comprehensive therapy of tongdu tiaoshen moxibustion (moxibustion for opening the governor vessel and regulating the spirit) and rehabilitation training and the simple treatment with rehabilitation training. METHODS: A total of 60 patients with intestinal dysfunction of SCI were randomized into a comprehensive therapy group and a rehabilitation group, 30 cases in each one (3 cases were dropped out in each group). On the base of the routine western medicine treatment and rehabilitation training, the bowel training and rectal function training were provided, once a day in the rehabilitation group. In the comprehensive therapy group, on the base of the treatment as the rehabilitation group, the tongdu tiaoshen moxibustion was exerted at Yaoyangguan (GV 3), Mingmen (GV 4), Zhiyang (GV 9), Dazhui (GV 14) and Baihui (GV 20), etc, once a day, 30 min each time. In both groups, the treatment for 4 weeks was as one course and 3 courses of treatment were required. Separately, before treatment, after 4, 8 and 12 weeks of treatment, the scores of neurogenic bowel dysfunction (NBD) and World Health Organization quality of life scale (WHOQOL-BREF) were observed and the clinical effect was evaluated after 12 weeks of treatment. RESULTS: After treatment, the total effective rate was 88.9% (24/27) in the comprehensive therapy group, which was higher than 74.1% (20/27) in the rehabilitation group (P<0.05). After 4, 8 and 12 weeks of treatment, NBD scores were all reduced obviously as compared with those before treatment in the two groups (all P<0.01). After 8 and 12 weeks of treatment, NBD scores in the comprehensive therapy group were lower than the rehabilitation group (both P<0.05). After 4, 8 and 12 weeks of treatment, the scores of all of the domains (psychology, physiology, social relations and environment) in WHOQOL-BREF were higher than those before treatment in the two groups (all P<0.01). After 4 weeks of treatment, the scores in the psychology and physiology domains in the comprehensive therapy group were higher than the rehabilitation group (all P<0.05). After 8 and 12 weeks of treatment, the scores of all of the domains in the comprehensive therapy group were higher than the rehabilitation group (all P<0.05). CONCLUSION: The comprehensive treatment of tongdu tiaoshen moxibustion and rehabilitation training achieves the better effect on intestinal dysfunction of SCI than the simple rehabilitation training and greatly improves the quality of life in SCI patients.


Assuntos
Moxibustão , Traumatismos da Medula Espinal , Pontos de Acupuntura , Humanos , Qualidade de Vida , Traumatismos da Medula Espinal/terapia
5.
World Neurosurg ; 133: e391-e396, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526882

RESUMO

OBJECTIVE: We sought to report the safety of implementation of a novel standard of care protocol using spinal cord perfusion pressure (SCPP) maintenance for managing traumatic spinal cord injury (SCI) in lieu of mean arterial pressure goals at a U.S. Level I trauma center. METHODS: Starting in December 2017, blunt SCI patients presenting <24 hours after injury with admission American Spinal Injury Association Impairment Scale (AIS) A-C (or AIS D at neurosurgeon discretion) received lumbar subarachnoid drain (LSAD) placement for SCPP monitoring in the intensive care unit and were included in the TRACK-SCI (Transforming Research and Clinical Knowledge in Spinal Cord Injury) data registry. This SCPP protocol comprises standard care at our institution. SCPPs were monitored for 5 days (goal ≥65 mm Hg) achieved through intravenous fluids and vasopressor support. AISs were assessed at admission and day 7. RESULTS: Fifteen patients enrolled to date were aged 60.5 ± 17 years. Injury levels were 93.3% (cervical) and 6.7% (thoracic). Admission AIS was 20.0%/20.0%/26.7%/33.3% for A/B/C/D. All patients maintained mean SCPP ≥65 mm Hg during monitoring. Fourteen of 15 cases required surgical decompression and stabilization with time to surgery 8.8 ± 7.1 hours (71.4% <12 hours). At day 7, 33.3% overall and 50% of initial AIS A-C had an improved AIS. Length of stay was 14.7 ± 8.3 days. None had LSAD-related complications. There were 7 respiratory complications. One patient expired after transfer to comfort care. CONCLUSIONS: In our initial experience of 15 patients with acute SCI, standardized SCPP goal-directed care based on LSAD monitoring for 5 days was feasible. There were no SCPP-related complications. This is the first report of SCPP implementation as clinical standard of care in acute SCI.


Assuntos
Pressão do Líquido Cefalorraquidiano , Traumatismos da Medula Espinal/terapia , Padrão de Cuidado , Idoso , Vértebras Cervicais/cirurgia , Protocolos Clínicos , Terapia Combinada , Descompressão Cirúrgica , Drenagem , Hidratação , Humanos , Infusões Intravenosas , Isquemia/prevenção & controle , Laminectomia , Pessoa de Meia-Idade , Medula Espinal/irrigação sanguínea , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Centros de Traumatologia , Resultado do Tratamento , Vasoconstritores/uso terapêutico
6.
Braz J Med Biol Res ; 52(12): e8735, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826179

RESUMO

Exosomes, a kind of extracellular vesicle, are promising therapeutic agents for spinal cord injury (SCI). This article aimed to investigate effects of exosomes secreted from miRNA-29b-modified bone marrow mesenchymal stem cells (BMSCs) on SCI. Exosomes were extracted from BMSCs transfected with miRNA-29b or negative control (miR NC). SCI rats were injected intravenously with exosomes (control exosomes, miRNA-29b exosomes) and BMSCs (miR NC, miRNA-29b) through the tail vein. The expression of miRNA-29b in spinal cord tissues of SCI rats was detected by qRT-PCR. The hind limb motor function was evaluated by Basso Beattie Bresnahan (BBB) score. The histopathological damage and neuronal regeneration in spinal cord tissues was observed by HE staining and immunohistochemistry, respectively. The injection of miRNA-29b exosomes and miRNA-29b BMSCs both significantly increased the expression of miRNA-29b in spinal cord tissues of SCI rats (P<0.05). Compared with SCI rats, rats in the miRNA-29b exosomes and the miRNA-29b groups exhibited improved SCI, including increased BBB score, NF200 and GAP-43 positive neurons, as well as decreased contractile nerve cell numbers and GFAP positive neurons (all P<0.05). The relieving degree of SCI was significantly higher in the miRNA-29b exosomes group than in the miRNA-29b BMSCs group (P<0.05). Exosomes secreted from miRNA-29b-modified BMSCs were effective in the repair of SCI in rats.


Assuntos
Exossomos/metabolismo , Transplante de Células-Tronco Mesenquimais , MicroRNAs/metabolismo , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/terapia , Transfecção , Animais , Modelos Animais de Doenças , Feminino , Imuno-Histoquímica , Masculino , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase Reversa
7.
Adv Exp Med Biol ; 1190: 265-279, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31760650

RESUMO

Given recent progress in our understanding of oligodendrocyte biology, significant attention has been directed toward cell therapy for myelin repair and remyelination. This trend has been reinforced by findings about the importance of white matter lesions in a variety of central nervous system (CNS) diseases, including demyelinating diseases as well as brain or spinal cord trauma and degenerative disorders such as Alzheimer's disease. Remyelination strategies include the implementation of myelin forming cells and the surrounding conditions and pathological disease context. Successful remyelination requires proper number of cells at the required location and subsequent maturation. Those processes involve variety of molecules, related to oligodendrocyte development or inflammation in the lesion. Understanding and manipulation of the functions of those molecules may improve the outcome of the cell therapies toward remyelination. Furthermore, the development of monitoring method for myelination is also anticipated to evaluate the effects of therapeutic interventions.


Assuntos
Doenças Desmielinizantes/terapia , Bainha de Mielina/fisiologia , Oligodendroglia/fisiologia , Remielinização , Traumatismos da Medula Espinal/terapia , Humanos , Bainha de Mielina/patologia , Oligodendroglia/patologia
8.
Wilderness Environ Med ; 30(4S): S87-S99, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31780084

RESUMO

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards.


Assuntos
Padrões de Prática Médica , Traumatismos da Medula Espinal/terapia , Traumatismos da Coluna Vertebral/terapia , Medicina Selvagem/normas , Humanos , Imobilização/efeitos adversos , Imobilização/métodos , Sociedades Médicas , Traumatismos da Medula Espinal/prevenção & controle , Traumatismos da Coluna Vertebral/prevenção & controle , Medicina Selvagem/métodos
9.
S Afr Med J ; 109(8b): 17-23, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31662144

RESUMO

BACKGROUND: The publicity around stem cell therapy has given many persons who have sustained a devastating injury such as spinal cord injury (SCI) the hope of achieving partial or full recovery from their injuries. Several phase I and II clinical trials are being conducted owing to positive results obtained in animal models. While safety during the trials has been demonstrated, clinical efficacy in the outcome of ethically approved trials is still lacking. Many persons affected by SCI are, however, desperate for a cure and are lured into undergoing stem cell therapy by marketing campaigns and information readily available on the internet. These people travel far and wide to undergo stem cell therapy, which has led to the term 'stem cell tourism'. Objectives. To compare the data from participants' self-report questionnaires before and after their stem cell therapy to determine if there were differences in their functional and neurological status, and to record details of the procedures. Method. Persons who sustained a SCI and who received apparent stem cell therapy in South Africa (SA) or elsewhere were recruited to participate in the present study. Volunteers who gave written informed consent were asked to complete a biographical questionnaire and validated self-report questionnaire (Spinal Cord Independence Measure version III (SCIM III)) before and after their stem cell therapy to determine if there were differences in their functional and neurological status. The results of the self-report questionnaires were compared with the published expected functional outcome of people with lesions at a similar level of SCI to the participants. The secondary aims of the study were to document details of the procedures and their locations, the sources of 'stem cells' and the cost. Results. There was no indication that the participants' functional outcomes, as measured by the self-reported SCIM III, were better than the expected level of functional ability in patients with similar injury levels. Likewise, the neurological motor recovery scored on the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) motor scores showed no improvement post stem cell therapy. Conclusion. This study highlights the need to curb the practice of offering unethical and non-evidence-based stem cell therapy for SCI. Ethical research and treatment is encouraged as well as an effective legal framework and education of health professionals, patients and their family members and caregivers, which will avoid unrealistic expectations, bogus therapies and the potential adverse effects of non-evidence-based 'stem cell therapies' offered by clinics via the internet.


Assuntos
Turismo Médico , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/terapia , Transplante de Células-Tronco/métodos , Viagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , África do Sul , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
10.
J Bone Joint Surg Am ; 101(19): 1750-1760, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577680

RESUMO

BACKGROUND: Treatment outcomes and risk factors for neurological deficits in pediatric patients with an os odontoideum are unclear. METHODS: We reviewed the data for 102 children with os odontoideum who were managed at 11 centers between 2000 and 2016 and had a minimum duration of follow-up of 2 years. Thirty-one children had nonoperative treatment, and 71 underwent instrumented posterior cervical spinal arthrodesis for the treatment of C1-C2 instability. Nonoperative treatment consisted of observation (n = 29) or immobilization with a cervical collar (n = 1) or halo body jacket (n = 1). Surgical treatment consisted of atlantoaxial (n = 50) or occipitocervical (n = 21) arthrodesis. One patient also underwent transoral odontoidectomy. RESULTS: Thirty children (29%) presented with neurological deficits, 28 of whom had radiographic atlantoaxial instability (atlantoaxial distance >5 mm) or limited space (≤13 mm) available for the spinal cord (risk ratio, 7.8 [95% confidence interval, 2.0 to 31] compared with children with no radiographic risk factors). The 27 children without neurological deficits or atlantoaxial instability at presentation underwent nonoperative treatment and remained asymptomatic. Of the initial nonoperative cohort, one child developed atlantoaxial instability, and another had a persistent neurological deficit; both children underwent spinal arthrodesis during the study period. One child with cervical instability declined surgery and remained asymptomatic. Spinal fusion occurred in 68 patients in the surgical group by the end of the study period (mean, 3.7 years; range, 2.0 to 11.8 years). Surgical complications occurred in 21 children, including nonunion in 12, new neurological deficits in 4, cerebrospinal fluid leak in 2, symptomatic instrumentation requiring removal 2, and vertebral artery injury in 1. Nine children underwent revision surgery. In the surgical group, Japanese Orthopaedic Association neurological function scores improved significantly from preoperatively to the latest follow-up for the upper extremities (p = 0.026) and lower extremities (p = 0.007). CONCLUSIONS: The risk of developing a neurological deficit was strongly associated with atlantoaxial instability and limited space available for the spinal cord in children with os odontoideum. Nonoperative treatment was safe for asymptomatic patients without atlantoaxial instability. Spinal arthrodesis resolved the neurological deficits of children with symptomatic os odontoideum. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Articulação Atlantoaxial/cirurgia , Vértebra Cervical Áxis/anormalidades , Instabilidade Articular/cirurgia , Doenças do Sistema Nervoso/etiologia , Fusão Vertebral/métodos , Adolescente , Articulação Atlantoaxial/lesões , Vértebra Cervical Áxis/cirurgia , Braquetes , Criança , Pré-Escolar , Humanos , Imobilização/métodos , Lactente , Cervicalgia/etiologia , Cervicalgia/terapia , Doenças do Sistema Nervoso/terapia , Fatores de Risco , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/terapia , Resultado do Tratamento , Conduta Expectante
11.
Biochimie ; 167: 171-178, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31605737

RESUMO

The therapeutic effect of stem cell transplantation in traumatic spinal cord injury (SCI) has been extensively studied these days, and evidence has shown that stem cell-derived exosomes and exosome-shuttled miRNA (e.g. miR-21) contribute to the protective effects of stem cell transplantation against SCI. It has been reported that obesity, a prevalent metabolic disorder, reshapes stem cells and their extracellular vesicles. However, the effects of exosomes derived from obese rat stem cells on SCI and its underlying mechanism remain unknown. Here, we examined the effects of exosomes derived from obese rat mesenchymal stem cells (MSCs) on SCI, and tested the role of miR-21 in their effects. We found that exosomes derived from obese rat MSCs showed decreased miR-21 levels and did not exert protective effects against SCI. Overexpression of miR-21 in obese rat MSCs restored the protective effects of exosomes purified from obese rat MSCs against SCI. In addition, obese rat MSCs showed insulin resistance, and MSC insulin resistance decreased miR-21 levels in its secreted exosomes. These results suggested that miR-21 deficiency in obese rat MSCs contributes to the impaired protective effects of obese rat MSCs-derived exosomes against SCI, and further reinforced the notion that miR-21 is a potential molecule for treatment of SCI.


Assuntos
Exossomos/fisiologia , Células-Tronco Mesenquimais/metabolismo , MicroRNAs/fisiologia , Obesidade/metabolismo , Traumatismos da Medula Espinal/terapia , Animais , Células Cultivadas , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Ratos , Ratos Sprague-Dawley
12.
Int Rev Neurobiol ; 147: 199-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607355

RESUMO

Body-weight-supported locomotor training is an activity-based therapy used frequently to train individuals with spinal cord injury (SCI) for restoring walking ability. Locomotor training after SCI is developed on the basic scientific findings of activity-dependent neuroplasticity. Based on the research from animal SCI models, there exists a spinal neural networks for locomotion which can be reactivated by intense repetitive locomotor training. Notably, the effectiveness of locomotor training depends largely on the severity of injury and time after injury. Locomotor training, using body-weight-supported walking overground or on a treadmill, with assistance manually or robotically, with a variety of training intensity and training programs, has been shown to elicit improvements in locomotor function for incomplete SCI individuals. For chronic and motor complete SCI, other interventions with proven effectiveness such as epidural stimulation might be applied in addition to locomotor training to improve the chance of locomotor recovery. In this chapter, we review the factors that influence the functional outcomes of locomotor training. We also summarize the circuitry, cellular and molecular levels of mechanisms underlying the positive role of locomotor training in inducing neuroplasticity and functional recovery following SCI.


Assuntos
Locomoção/fisiologia , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Medula Espinal/fisiologia , Animais , Humanos
13.
Zhongguo Zhen Jiu ; 39(9): 953-6, 2019 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-31544383

RESUMO

OBJECTIVE: To compare the clinical effect of the herbal cake-separated moxibustion with new-type moxibustion device combined with bladder function exercise and simple bladder function exercise on improving urinary retention after spinal cord injury. METHODS: Sixty-eight patients were randomly divided into a control group and an observation group, 34 cases in each group. The bladder function exercise was given in the control group. On the basis of the treatment in the control group, herbal cake-separated moxibustion with new-type moxibustion decice was applied at Shenque (CV 8), Guanyuan (CV 4), Qihai (CV 6), Zhongji (CV 3) for 30 min, once a day in the observation group. The two groups were treated for 4 weeks as a course, 2 courses of treatment were needed. Bladder maximum volume, bladder residual urine volume and urinary tract infection before and after treatment were compared, and the clinical efficacy was evaluated in the two groups. RESULTS: The total effective rate in the observation group was 88.2% (30/34), which was better than 64.7% (22/34) in the control group (P<0.05). The increase of bladder maximum volume and decrease of bladder residual urine volume in the observation group were significantly better than those in the control group (P<0.01). At the 4th, 6th and 8th weeks for treatment, the improvement of urinary tract infection in the observation group was better than that in the control group (P<0.05). CONCLUSION: At the same time of bladder function training, herbal cake-separated moxibustion with new-type moxibustion device could improve urinary retention after spinal cord injury.


Assuntos
Moxibustão , Traumatismos da Medula Espinal , Retenção Urinária , Humanos , Traumatismos da Medula Espinal/terapia , Resultado do Tratamento , Bexiga Urinária , Retenção Urinária/terapia
14.
Mol Med Rep ; 20(5): 4285-4292, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31545436

RESUMO

The aim of the present study was to investigate whether nuclear factor erythroid 2p45­related factor 2 (Nrf2) overexpression by gene transfer may protect neurons/glial cells and the association between neurons/glial cells and axons in spinal cord injury (SCI). In the present study, Nrf2 recombinant adenovirus (Ad) vectors were constructed. The protein levels of Nrf2 in the nucleus and of the Nrf2­regulated gene products heme oxygenase­1 (HO­1) and NAD (P)H­quinone oxidoreductase­1 (NQO1), were detected using western blot analysis in PC12 cells following 48 h of transfection. Furthermore, the expression of Nrf2 was localized using an immunofluorescence experiment, and the expression of Nrf2, HO­1 and NQO1 were detected using an immunohistochemical experiment in the grey matter of spinal cord in rats. Post­injury motor behavior was assessed via the Basso, Beattie and Bresnahan (BBB) locomotor scale method. In PC12 cells, subsequent to Ad­Nrf2 transfection, nuclear Nrf2, HO­1 and NQO1 levels were significantly increased compared with the control (P<0.01). There was statistically significant changes in the PC12­Ad­Nrf2 group [Nrf2 (1.146±0.095), HO­1 (1.816±0.095) and NQO1 (1.421±0.138)] compared with the PC12­control group [Nrf2 (0.717±0.055), HO­1 (1.264±0.081) and NQO1 (0.921±0.088)] and PC12­Ad­green fluorescent protein group [Nrf2 (0.714±0.111), HO­1 (1.238±0.053) and NQO1 (0.987±0.045); P<0.01]. The BBB scores of the rats indicated that they had improved functional recovery following the local injection of Ad­Nrf2. On the third day following the operation, BBB scores in the adenovirus groups (0.167±0.408) were significantly decreased compared with the SCI group (1±0.894; P<0.05). In the injured section of the spinal cord in the rats, the number of positive cells expressing Nrf2, HO­1 and NQO1 were raised compared with the control and SCI groups, indicating that the adenovirus vector­mediated gene transfer of Nrf2 promotes functional recovery following spinal cord contusion in rats.


Assuntos
Adenoviridae/genética , Expressão Gênica , Vetores Genéticos/genética , Fator 2 Relacionado a NF-E2/genética , Traumatismos da Medula Espinal/genética , Traumatismos da Medula Espinal/reabilitação , Animais , Modelos Animais de Doenças , Feminino , Técnicas de Transferência de Genes , Genes Reporter , Terapia Genética , Vetores Genéticos/administração & dosagem , Imuno-Histoquímica , Masculino , Atividade Motora , Fator 2 Relacionado a NF-E2/metabolismo , Neuroglia/metabolismo , Neurônios/metabolismo , Ratos , Traumatismos da Medula Espinal/terapia , Transdução Genética
15.
Medicina (Kaunas) ; 55(10)2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31546613

RESUMO

Background and objectives: Functional electrical stimulation (FES) has shown good results in improving static and dynamic sitting balance in persons with spinal cord injuries. There is limited information about how regular surface FES combined with therapeutic exercise (TE) affect dynamic sitting balance and muscle tone. The objective of this study was to evaluate the effectiveness of a six-week physical therapy program consisting of FES and TE on muscle tone and sitting balance in persons with spinal cord injury (SCI). It was also important to explore the relationship between muscle tone and dynamic sitting balance. The third objective was to assess the change of characteristics over a six month period, when no intervention was carried out. Material and methods: Five men with SCI were alternately allocated to two study groups: SCI_FES+TE and SCI_TE. Eight healthy control group participants were recruited to collect reference data. SCI participants' intervention lasted for six weeks in their homes. SCI_FES+TE conducted exercises with FES applied on erector spinae (ES) and rectus abdominis (RA) muscles. SCI_TE conducted exercises only. Muscle oscillation frequency (MOF; characterizing muscle tone) and limits of stability (LOS; characterizing sitting balance) were measured. A crossover study design was used. The time between the initial intervention and the crossover was seven months (ClinicalTrials registration ID NCT03517787). Results: MOF in SCI_FES+TE increased by 6.0% for ES and 6.1% for RA muscles. LOS of flexion increased 30.1% in SCI_FES+TE. Increase in lateral directions was similar for both study groups. Moderate to high negative correlation was found between MOF and LOS. After seven months, MOF of ES decreased 0.8%, MOF or RA decreased 1.4%, LOS of flexion decreased 31.9%, and LOS of lateral flexion to the left decreased 46.4%. Conclusions: The six-week therapy program combining FES and TE increased trunk muscle tone and dynamic sitting balance in flexion more than TE alone. Higher antagonist muscle tone negatively affects dynamic sitting balance and center of pressure (COP) trajectory distance in various directions. After seven months, a slight decline in trunk muscles tone values and an extensive decrease in sitting balance values were noticed.


Assuntos
Terapia por Estimulação Elétrica , Terapia por Exercício , Tono Muscular/fisiologia , Equilíbrio Postural/fisiologia , Postura Sentada , Traumatismos da Medula Espinal/terapia , Adulto , Estudos de Casos e Controles , Terapia Combinada , Estudos Cross-Over , Humanos , Masculino , Valores de Referência , Traumatismos da Medula Espinal/fisiopatologia
16.
Int J Mol Sci ; 20(18)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31547264

RESUMO

The transplantation of Wharton's jelly derived mesenchymal stromal cells (WJ-MSCs) possesses therapeutic potential for the treatment of a spinal cord injury (SCI). Generally, the main effect of MSCs is mediated by their paracrine potential. Therefore, application of WJ-MSC derived conditioned media (CM) is an acknowledged approach for how to bypass the limited survival of transplanted cells. In this study, we compared the effect of human WJ-MSCs and their CM in the treatment of SCI in rats. WJ-MSCs and their CM were intrathecally transplanted in the three consecutive weeks following the induction of a balloon compression lesion. Behavioral analyses were carried out up to 9 weeks after the SCI and revealed significant improvement after the treatment with WJ-MSCs and CM, compared to the saline control. Both WJ-MSCs and CM treatment resulted in a higher amount of spared gray and white matter and enhanced expression of genes related to axonal growth. However, only the CM treatment further improved axonal sprouting and reduced the number of reactive astrocytes in the lesion area. On the other hand, WJ-MSCs enhanced the expression of inflammatory and chemotactic markers in plasma, which indicates a systemic immunological response to xenogeneic cell transplantation. Our results confirmed that WJ-MSC derived CM offer an alternative to direct stem cell transplantation for the treatment of SCI.


Assuntos
Meios de Cultivo Condicionados/farmacologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Traumatismos da Medula Espinal/terapia , Geleia de Wharton/citologia , Animais , Células Cultivadas , Citocinas/sangue , Humanos , Masculino , Transplante de Células-Tronco Mesenquimais/métodos , Ratos , Ratos Wistar , Traumatismos da Medula Espinal/sangue , Traumatismos da Medula Espinal/fisiopatologia
17.
World Neurosurg ; 132: e246-e258, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493613

RESUMO

OBJECTIVE: To provide an analysis of Web of Science (WoS) indexed literature related to stem cells therapy in spinal cord injury published between 1999 and 2018. METHODS: Data were obtained from the WoS Core Collection on March 30, 2019. Qualitative and quantitative analysis was conducted based on WoS. Co-citation analysis, collaboration analysis, and co-words analysis of keywords was conducted by using CiteSpace. RESULTS: A total of 4188 references were obtained. The number of publications continually increased over the investigated period. Articles were the most frequently document type. Cell Transplantation (127) was the most productive journal. Experimental Neurology (2180) was the most frequently co-cited journal. H. Okano was the most productive and influential author, with 98 publications and 4860 cited counts. The most productive country and institution were the United States and University of Toronto, respectively. Researchers and institutions from Canada, the United States, Japan, and China were the core research forces. There was a broad and close cooperation worldwide. The Lu et al.'s (2012) article (co-citation counts, 177) was the most representative and symbolic reference. Transplantation, functional recovery, marrow-derived mesenchymal stem cell treatment, and progenitor cells were the hot spots. Inflammation, glial scar, nerve regeneration, neurite outgrowth, and bone marrow stromal cell were research frontiers. CONCLUSIONS: Research on stem cells for spinal cord injury is a well-developed and promising research field. There is broad global scientific research cooperation. More cooperation among top authors, institutions, and countries is needed. Our results may be helpful for researchers in identifying further potential perspectives on collaborators, research frontiers, and hot topics.


Assuntos
Bibliometria , Traumatismos da Medula Espinal/terapia , Transplante de Células-Tronco/métodos , Humanos , Fator de Impacto de Revistas
18.
Int J Mol Sci ; 20(15)2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31390782

RESUMO

Regeneration of injuries occurring in the central nervous system, particularly spinal cord injuries (SCIs), is extremely difficult. The complex pathological events following a SCI often restrict regeneration of nervous tissue at the injury site and frequently lead to irreversible loss of motor and sensory function. Neural stem/progenitor cells (NSCs/NPCs) possess neuroregenerative and neuroprotective features, and transplantation of such cells into the site of damaged tissue is a promising stem cell-based therapy for SCI. However, NSC/NPCs have mostly been induced from embryonic stem cells or fetal tissue, leading to ethical concerns. The pioneering work of Yamanaka and colleagues gave rise to the technology to induce pluripotent stem cells (iPSCs) from somatic cells, overcoming these ethical issues. The advent of iPSCs technology has meant significant progress in the therapy of neurodegenerative disease and nerve tissue damage. A number of published studies have described the successful differentiation of NSCs/NPCs from iPSCs and their subsequent engraftment into SCI animal models, followed by functional recovery of injury. The aim of this present review is to summarize various iPSC- NPCs differentiation methods, SCI modelling, and the current status of possible iPSC- NPCs- based therapy of SCI.


Assuntos
Diferenciação Celular , Células-Tronco Pluripotentes Induzidas/metabolismo , Regeneração Nervosa , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/terapia , Transplante de Células-Tronco , Animais , Humanos , Células-Tronco Pluripotentes Induzidas/citologia , Células-Tronco Neurais/citologia , Células-Tronco Neurais/metabolismo , Traumatismos da Medula Espinal/etiologia , Tecidos Suporte
19.
Exp Neurol ; 321: 113032, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31398353

RESUMO

Many studies, using pre-clinical models of SCI, have demonstrated the efficacy of chondroitinase ABC as a treatment for spinal cord injury and this has been confirmed in laboratories worldwide and in several animal models. The aim of this review is report the current state of research in the field and to compare the relative efficacies of these new interventions to improve outcomes in both acute and chronic models of SCI. We also report new methods of chondroitinase delivery and the outcomes of two clinical trials using the enzyme to treat spinal cord injury in dogs and disc herniation in human patients. Recent studies have assessed the outcomes of combining chondroitinase with other strategies known to promote recovery following spinal cord injury and new approaches. Evidence is emerging that one of the most powerful combinations is that of chondroitinase with cell transplants. The particular benefits of each of the different cell types used for these transplant experiments are discussed. Combining chondroitinase with rehabilitation also improves outcomes. Gene therapy is an efficient method of enzyme delivery to the injured spinal cord and circumvents the issue of the enzyme's thermo-instability. Other methods of delivery, such as via nanoparticles or synthetic scaffolds, have shown promise; however, the outcomes from these experiments suggest that these methods of delivery require further optimization to achieve similar levels of efficacy to that obtained by a gene therapy approach. Pre-clinical models have also shown chondroitinase is efficacious in the treatment of other conditions, such as peripheral nerve injury, stroke, coronary reperfusion, Parkinson's disease and certain types of cancer. The wide range of conditions where the benefits of chondroitinase treatment have been demonstrated reflects the complex roles that chondroitin sulphate proteoglycans (its substrate) play in health and disease and warrants the enzyme's further development as a therapy.


Assuntos
Condroitina ABC Liase/uso terapêutico , Animais , Humanos , Traumatismos da Medula Espinal/terapia
20.
IEEE Int Conf Rehabil Robot ; 2019: 132-138, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374619

RESUMO

Active assistive devices have been designed to augment the hand grasping capabilities of individuals with spinal cord injuries (SCI). An intuitive bio-signal of wrist extension has been utilized in the device control, which imitates the passive grasping effect of tenodesis. However, controlling these devices in this manner limits the wrist joint motion while grasping. This paper presents a novel hybrid control interface and corresponding algorithms (i.e., a hybrid control method) of the Semi-soft Assistive Glove (SAG) developed for individuals with C6/C7-SCI. The secondary control interface is implemented to enable/disable the grasp trigger signal generated by the primary interface detecting the wrist extension. A simulation study reveals that the hybrid control method can facilitate grasping situations faced in daily activities. Empirical results with three healthy subjects suggest that the proposed method can assist the user to reach and grasp objects with the SAG naturally.


Assuntos
Luvas Protetoras , Equipamentos de Autoajuda , Traumatismos da Medula Espinal/terapia , Humanos , Postura , Reprodutibilidade dos Testes , Extremidade Superior/fisiopatologia , Interface Usuário-Computador , Punho/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA