The future of bone marrow stromal cell transplantation for the treatment of spinal cord injury

Bone marrow stromal cell （BMSC） transplantation therapy is a promising approach for treating spinal cord injury （SCI）, based on a number of experimental and clinical reports （Wright et al., 2011）. BMSCs are a source of neuroregenerative somatic stem cells that are without the potential for tumorigenicity. Although clinical studies of autologous BMSC transplantation have been reported in Asia （fiang et al., 2013; Yoon et al., 2007）, in Japan, it is currently an uncommon procedure and highly controversial as well. This perspective paper provides an overview of the clinical effectiveness of BMSC trans- 191antation and a proposal to enhance its use as a viable therapy.

Vein transplantation using human umbilical cord blood stem cells in the treatment of stroke sequela

BACKGROUND: Transplanted mononuclear cell (MNC) of umbilical blood can survive in central nervous system (CNS) of host through blood brain barrier, differentiate into nerve cells, migrate to damaged site and integrate morphological structure and function with nerve cells of host so as to improve deficiencies of sensatory function, motor function and cognitive function and influence on stroke sequela. OBJECTIVE: To observe the vein transplantation of human umbilical cord blood stem cells (HUCBSC) for improving neurological function, limb function and activity of daily living of patients with stroke and evaluate the reliability. DESIGN: Self-controlled study. SETTING: Department of Neurosurgery, the Second People's Hospital of Zhengzhou City; Red-crossed Blood Center of Henan Province; Department of Neurosurgery, the Fist Affiliated Hospital of Zhengzhou University. PARTICIPANTS: A total of 10 patients with stroke sequela were selected from Department of Cerebral Surgery, the Second People's Hospital of Zhengzhou City from April to December 2005. There were 9 males and 1 female aged from 35 to 75 years with the mean age of 56 years. All of them were diagnosed with CT and MRI examination and coincidence with diagnostic criteria of stroke established by the Fourth National Academic Meeting for Cerebrovascular Disease. All patients provided informed consent. METHODS: 80-140 mL umbilical blood of term birth of newborn was selected hermetically and maintained in sterile plastic bag. And then, the blood was centrifugated at the speed of 1 500 r/min for 30 minutes at 22 ℃ in order to separate MNC, i.e., HUCBSC. In addition, after final diagnosis during hospitalization, stroke patients were perfused with HUCBSC through superficial vein of back of the hand. Each patient was averagely perfused with 6 portions of HUCBSC (cellular numbers ≥ 1×108/portion) and the interval between each portion was 1-7 days with the mean interval of 4 days. MAIN OUTCOME MEASURES: ① Neurological function of stroke patients was evaluated with neurological function deficiency (NFD) before treatment and at 3 months after treatment. The scale includes consciousness, level fix function, facial paralysis, language, muscle force of upper limbs, muscle force of lower limb and step function. The total scores ranged from 0 to 45; meanwhile, the lower the scores were, the better the neurological function was. ② Motor function of injured limbs was evaluated with Fugl-Meyer Assessment (FMA), including motor function of upper limbs, motor function of lower limbs, balance ability, sensory function and motion of joint. The total scores ranged from 0 to 226; meanwhile, the higher the scores were, the better the motor function of limbs was. ③ Activities of daily living (ADL) was evaluated with Barthel Index (BI), including having meals, taking a bath, dressing oneself, putting on clothes, walking in balance and stair activity. The total scores ranged from 0 to 100; meanwhile, the higher the scores were, the stronger the ADL was. RESULTS: A total of 10 patients were involved in the final analysis. After treatment, NFD of stroke patients was (10.9±5.09) points, which was lower than that before treatment [(25.4±6.09) points, t =8.213, P < 0.01]. In addition, after treatment, FMA and BI of stroke patients were (80.9±25.00) points and (81.1±15.93) points, respectively, which were higher than those before treatment [(31.9±21.85) points, (36.2±19.41) points, t =13.024, 13.670, P < 0.01]. Immuno-suppressive drugs were not used during the whole therapeutic procedure; moreover, immunological rejection and allergic reaction were not observed during the same period. CONCLUSION: Transplanting HUCBSC through superficial vein of back of the hand is regarded as a simple and safe method for the treatment of stroke sequela.

The current role of radiofrequency ablation in the treatment of hepatocellular carcinoma

Local ablative therapy is used in treating liver tumors by either injection of cytotoxic agents（chemicals,radioactive isotopes,hyperthermic agents or chemotherapeutic agents）or application of an energy source to achieve thermal ablation,cryoablation or conformal external beam radiation（Table 1）.

Nose-to-brain drug delivery approach：a key to easily accessing the brain for the treatment of Alzheimer＇s disease

Alzheimer＇s disease（AD）：AD,a neurodegenerative disorder and a significant cause of dementia throughout the world mostly affects the older adults but sometimes also seen in young age（early state AD）（Agrawal et al.,2017）.

Full-thickness scleral incisions technique for the treatment of a cyclodialysis cleft following ab interno trabeculotomy

Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visualization technique that was performed on a patient after a microincisional glaucoma surgery (MIGS) complication.

Recent advances in the treatment of post-stroke aphasia

Aphasia is an impairment of language use following brain damage. There is no consensual definition of aphasia beyond this general description （Code and Petheram, 2011）. In a more restricted defini- tion, however, aphasia is an impairment of linguistic processing at the phonological, morphological, lexical semantic or syntactic level which is usually caused by lesions of the left cerebral hemisphere. This impairment can affect language reception and expression depending on the various aphasic syndromes （McNeil and Pratt, 2001）. Aphasia results in restrictions in those activities of daily living which rely on communication.

Evaluation of the Protégé^(TM) stent in the treatment of carotid artery stenosis with adjunctive use of a filter Embolic Protection Device (PROCAR)-one-month follow-up data on 77 patients

Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.

The Treatment of Children's Diarrhea with Massage and Acupunture in 58 cases

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Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.

Future directions for using estrogen receptor agonists in the treatment of acute and chronic spinal cord injury

All synthetic and natural estrogen receptor agonists, in- cluding the most potent physiological molecule estrogen or estradiol （E2）, work typically via activation of nuclear estrogen receptor alpha （ERα） and estrogen receptor beta （ERβ）. Both ERα and ERβ modulate the expression of a variety of genes in the cells. Neurons and glial cells express ERa and ERβ. Many studies so far from our and other laboratories have firmly established the mode of actions that ERα and ERβ agonists are very promising anti-inflammatory and neuroprotective agents in the treatment of neurodegenera- rive diseases and injuries including spinal cord injury （SCI） （Chakrabarti et al., 2014a）.

The seeming paradox of adenosine receptors as targets for the treatment of Alzheimer's disease: agonists or antagonists?

Alzheimer＇s disease （AD） is the most common neurodegenerative disorder, and its incidence is relatively high among elderly people, affecting about 1-2% of the population between 60-65 years old and rising dramatically （about 30%） in people aged 80 years or older （Selkoe, 2002）. Nowadays, considering the increasing mean lifespan of populations in developed countries, the disease is becoming more and more a health concern, and the search for an effective cure has turned into＂a real need＂.

CLINICAL APPLICATION OF CHINESE HERBS REMEDIES AS IMMUNOMODULATORS IN THE TREATMENT OF CANCER

IMMUNITY AND TUMOR Immune system has closely relation to the growth and development of tumor. One of its immune functions is to constantly recognize and kill malignant cells which develop from normal cells. The occurance of tumor indicates to some extent the failure of this "immune serveillance" function. Many studies have shown that the tumor cells of body have some tumor interrelative antigen that dose not exist in normal tissues. Tests in vitro

Editor's Choice--Umbilical cord mesenchymal stem cell transplantation for the treatment of peripheral nerve injury

Schwann cells are the predominant seed cells for cell transplantation in the treatment of peripheral nerve injury. However, the source of Schwann cells is limited and amplification remains difficult. Studies have shown that mesenchymal stem cells, an alternative cell type, can be used for transplantation treatment of peripheral nerve defects. Umbilical cord mesenchymal stem cells are pluripotent stem cells derived from newborn umbilical cord tissues.

TEGAFUR PLUS MMC OR ACNU IN THE TREATMENT OF ADVANCED GASTRIC CANCER-A PILOT STUDY

Twenty four cases of advanced gastric cancer were divided into two groups according to the general condition of the patients (PS 0-2 and 3-4), further subdivided into localized abdominal form, liver metastatic form, ascitic form and distant metastatic form. These patients were allocated randomly into Regimen A or B. Regimen A: Tegafur 600 mg daily and Mitomycin C (MMC) 5 mg/m2/1-2 weeks. Regimen B: Tegafur 600 mg daily and ACNU (Nimustine, water-soluble Nitrosourea) 60 mg/week for 2 weeks. After a course of ACNU, it was with drawn for 4 weeks and then resumed again. The response rate of Regimen A was 3/11 (27%), that of Regimen B was 3/13 (23%).

Editor's Choice——Application of genetic engineering for the treatment of neurodegenerative diseases

Gene therapy has been shown to be an effective method for protecting neural functions in the substantia nigra,

Nonprecsion (Standard) Psychosocial Interventions for the Treatment of Mental Disorders

Advances in precision treatment promise to greatly improve the extent to which therapies for mental disorders are better matched to patient characteristics.At the same,we need to ensure that more readily disseminable and available nonprecison treatments are further developed as well.These treatments refer to standardized interven-tions that do not have to be individualized and are more readily available.Impetus for this call stems from the treatment gap,namely,the huge difference in the proportion of individuals who are in need of mental health services and who actually receive any form of treatment.The prevalence rates for mental disorders worldwide are high and in low-,middle-,and high-income countries and the vast majority of individuals in need of services receive none.To address the need,we need interventions that can reach large numbers of individuals and espe-cially target those individuals least likely to receive services.Standardized treatments that can be widely applied may be in a better position at present to reach people in need who otherwise receive no care.

Chinese herbal monomers in the treatment of cerebral ischemia/reperfusion injury

This study examines the neuroprotective effects and mechanisms of action of total saponins from Rubus parvifolius L. （TSRP） on focal cerebral ischemia and reperfusion injury in rats. Focal cerebral ischemia and reperfusion injury was performed in rats using the suture method. The results indicate that intragastric injection of TSRP, at 5, 10 and 20 mg/kg, could decrease neurological impairment, reduce cerebral infarct volume, diminish pathological changes, and significantly inhibit the apoptosis of neurons surrounding the ischemic area. In addition, TSRP upregulated the expression of the anti-apoptotic factor Bcl-2, at the protein and mRNA levels, and it downregulated the expression of the pro-apoptotic factor Bax, at the protein and mlRNA levels. These findings indicate that TSRP protects against cerebral ischemia/reperfusion injury, and that it may do so by regulating the expression of Bcl-2 and Bax.

Correlation between current intensity and effective duration in the treatment of botulinus toxin for cerebral palsy by myoelectricity locating

BACKGROUND： Researches prove that the treatment of cerebral palsy by botulinus toxin （BTX-A） can improve effect and prolong effective duration. Current intensity is the important factor during injection. OBJECTIVE： To observe the changes of motor function and muscular intensity of children with spastic cerebral palsy after injecting BTX-A and analyze correlation between current intensity and effective duration. DESIGN： Cases control trial before and after nerves block SETTING： Capital University of Medical Sciences, China Rehabilitation Research Center PARTICIPANTS： From June 2002 to November 2004, 14 children with spastic cerebral palsy were treated by BTX-A block. All children were hospitalized in the Children Rehabilitation Department of China Rehabilitation Research Center. The children included 9 male and 5 female, and ranged from 4 to 13 years old, and average age was （6±2） years. Muscular tension ranged from grade 1 to grade 3. The diagnosis and the tape of cerebral palsy based on standard of the Fist Nationwide Cerebral Palsy Symposium, and all children were diagnosed with electroencephalogram （EEG）, CT and MRI, and permitted by their guardians. METHODS： （1） Locating and calculation： To locate block points by G6805-2A electro-therapeutic apparatus （Shanghai Huayi Electronic Instrument Plant） at the least stimulating current （continuous wave; impulse frequency; 2.667-83.333 Hz; current intensity： 0-6 mA; voltage： 6 V） to touch off muscles contraction. The current intensity of each point was recorded, and the average current intensity of each patient was calculated at the same time. （2） Dose of BTX-A： Basing upon the spastic degree and weight of patients, the dose was made certain： dose （IU）=（scores of Modified Ashworth Scale ＋2.5） xweight （kg）. The number of the block points was in all 4. The dose of injection ranged from 50 IU to 160 IU with the average of （73.6＋25.8） IU. The BTX-A was made by Lanzhou Institute of Biological Products, and each bottle contains 100 IU BTX-A. Muscular tension was evaluated by Modified Ashworth Scale. The scale ranged from grade 0 to grade 4, and the scores were from 0 to 4. The higher the scores were, the higher the muscular tension was. （3） Effect： Changes of muscular tension were evaluated by modified Ashworth Scale before and after block. Motor function was evaluated by Physician Rating Scale （PRS） before and after treatment. It contained Gait pattern, Hindfoot （ankle） position （stance-floor contact）, Hindfoot position （foot strike）, Knee position （degree of recurvation）, Crouch and Speed of gait. The scores ranged from 0 to 14. The higher the points were, the better the motor function was. （4） Effective duration： The duration was definited by the recovering of the Modified Ashworth Scale. （5） Statistic analysis： Firstly, the current intensity and the effect duration were analyzed by One-Sample Kolmogorov-Smirnov Test, the current intensity： Z= 0.456, P= 0.985, the effective duration： Z= 0.557, P= 0.915. Both data were normal distribution. Secondly, both data were analyzed by Linear Regression. The efficiency of the BTX-A block was analyzed by paired-samples t test. MAIN OUTCOME MEASURES： （1） Changes of motor function of muscular tension; （2） correlation between current intensity and effective duration. RESULTS： Fourteen children with spastic cerebral palsy were all involved in the final analysis. （1） Therapeutic effect： The average score of Ashworth scale after block was lower than that before block [（1.02±0.34） points vs. （2.12±0.48） points, t= 3.644, P〈 0.01]. The average score of RPS after block was higherthan that before block [（9.75±2.78） points vs. （6.16±0.58） points, t =13.222, P〈 0.01]. （2） Relation between the current intensity and the effective duration： The current intensity was （0.1857±0.0506） mA, and the effective duration was （26.36±4.48） weeks. The current intensity was negative correlation with effective duration （r = -0.775, P = 0.01 ）. CONCLUSION： （1） BTX-A occlusion can decrease muscular tension and improve motor function of lower limbs of children with spastic cerebral palsy. （2） The lower the current intensity is, the longer the effective duration is.