OBJECTIVE： The aim of this study was to evaluate the effectiveness and safety of stem cell transplantation for spinal cord injury（SCI）.DATA SOURCES： PubM ed, EMBASE, Cochrane, China National Knowledge Infrastructu...OBJECTIVE： The aim of this study was to evaluate the effectiveness and safety of stem cell transplantation for spinal cord injury（SCI）.DATA SOURCES： PubM ed, EMBASE, Cochrane, China National Knowledge Infrastructure, China Science and Technology Journal, Wanfang, and Sino Med databases were systematically searched by computer to select clinical randomized controlled trials using stem cell transplantation to treat SCI, published between each database initiation and July 2016. DATA SELECTION： Randomized controlled trials comparing stem cell transplantation with rehabilitation treatment for patients with SCI. Inclusion criteria：（1） Patients with SCI diagnosed according to the American Spinal Injury Association（ASIA） International standards for neurological classification of SCI;（2） patients with SCI who received only stem cell transplantation therapy or stem cell transplantation combined with rehabilitation therapy;（3） one or more of the following outcomes reported： outcomes concerning neurological function including sensory function and locomotor function, activities of daily living, urination functions, and severity of SCI or adverse effects. Studies comprising patients with complications, without full-text, and preclinical animal models were excluded. Quality of the included studies was evaluated using the Cochrane risk of bias assessment tool and Rev Man V5.3 software, provided by the Cochrane Collaboration, was used to perform statistical analysis. OUTCOME MEASURES： ASIA motor score, ASIA light touch score, ASIA pinprick score, ASIA impairment scale grading improvement rate, activities of daily living score, residual urine volume, and adverse events.RESULTS： Ten studies comprising 377 patients were included in the analysis and the overall risk of bias was relatively low level. Four studies did not detail how random sequences were generated, two studies did not clearly state the blinding outcome assessment, two studies lacked blinding outcome assessment, one study lacked follow-up information, and four studies carried out selective reporting. Compared with rehabilitation therapy, stem cell transplantation significantly increased the lower limb light touch score（odds ratio（OR） = 3.43, 95% confidence interval（CI）： 0.01 – 6.86, P = 0.05）, lower limb pinprick score（OR = 3.93, 95%CI： 0.74 – 7.12, P = 0.02）, ASI grading rate（relative risk（RR） = 2.95, 95%CI： 1.64 – 5.29, P = 0.0003）, and notably reduced residual urine volume（OR = –8.10, 95%CI： –15.09 to –1.10, P = 0.02）. However, stem cell transplantation did not significantly improve motor score（OR = 1.89, 95%CI： –0.25 to 4.03, P = 0.08） or activities of daily living score（OR = 1.12, 95%CI： –1.17 to 4.04, P = 0.45）. Furthermore, stem cell transplantation caused a high rate of mild adverse effects（RR = 14.49, 95%CI： 5.34 – 34.08, P 〈 0.00001）; however, these were alleviated in a short time. CONCLUSION： Stem cell transplantation was determined to be an efficient and safe treatment for SCI and simultaneously improved sensory and bladder functions. Although associated minor and temporary adverse effects were observed with transplanted stem cells, spinal cord repair and axon remyelination were apparent. More randomized controlled trials with larger sample sizes and longer follow-up times are needed to further validate the effectiveness of stem cell transplantation in the treatment of SCI.展开更多
Degenerative cervical myelopathy is a common cause of spinal cord injury,with longer symptom duration and higher myelopathy severity indicating a worse prognosis.While numerous studies have investigated serological bi...Degenerative cervical myelopathy is a common cause of spinal cord injury,with longer symptom duration and higher myelopathy severity indicating a worse prognosis.While numerous studies have investigated serological biomarkers for acute spinal cord injury,few studies have explored such biomarkers for diagnosing degenerative cervical myelopathy.This study involved 30 patients with degenerative cervical myelopathy(51.3±7.3 years old,12 women and 18 men),seven healthy controls(25.7±1.7 years old,one woman and six men),and nine patients with cervical spondylotic radiculopathy(51.9±8.6 years old,three women and six men).Analysis of blood samples from the three groups showed clear differences in transcriptomic characteristics.Enrichment analysis identified 128 differentially expressed genes that were enriched in patients with neurological disabilities.Using least absolute shrinkage and selection operator analysis,we constructed a five-gene model(TBCD,TPM2,PNKD,EIF4G2,and AP5Z1)to diagnose degenerative cervical myelopathy with an accuracy of 93.5%.One-gene models(TCAP and SDHA)identified mild and severe degenerative cervical myelopathy with accuracies of 83.3%and 76.7%,respectively.Signatures of two immune cell types(memory B cells and memory-activated CD4^(+)T cells)predicted levels of lesions in degenerative cervical myelopathy with 80%accuracy.Our results suggest that peripheral blood RNA biomarkers could be used to predict lesion severity in degenerative cervical myelopathy.展开更多
BACKGROUND Perinatal complications may result in life-long morbidities,among which cerebral palsy(CP)is the most severe motor disability.Once developed,CP is a nonprogressive disease with a prevalence of 1-2 per 1000 ...BACKGROUND Perinatal complications may result in life-long morbidities,among which cerebral palsy(CP)is the most severe motor disability.Once developed,CP is a nonprogressive disease with a prevalence of 1-2 per 1000 live births in developed countries.It demands an extensive and multidisciplinary care.Therefore,it is a challenge for our health system and a burden for patients and their families.Recently,stem cell therapy emerged as a promising treatment option and raised hope in patients and their families.AIM The aim is to evaluate the efficacy and safety of stem cell treatment in children with CP using a systematic review and meta-analysis METHODS We performed a systematic literature search on PubMed and EMBASE to find randomized controlled clinical trials(RCT)investigating the effect of stem cell transplantation in children with CP.After the review,we performed a randomeffects meta-analysis focusing on the change in gross motor function,which was quantified using the gross motor function measure.We calculated the pooled standardized mean differences of the 6-and/or 12-mo-outcome by the method of Cohen.We quantified the heterogeneity using the I-squared measure.RESULTS We identified a total of 8 RCT for a qualitative review.From the initially selected trials,5 met the criteria and were included in the meta-analysis.Patients’population ranged from 0.5 up to 35 years(n=282).We detected a significant improvement in the gross motor function with a pooled standard mean difference of 0.95(95%confidence interval:0.13-1.76)favoring the stem cell group and a high heterogeneity(I2=90.1%).Serious adverse events were rare and equally distributed among both intervention and control groups.CONCLUSION Stem cell therapy for CP compared with symptomatic standard care only,shows a significant positive effect on the gross motor function,although the magnitude of the improvement is limited.Short-term safety is present and further highquality RCTs are needed.展开更多
基金supported by the National Natural Science Foundation of China,No.81273775
文摘OBJECTIVE： The aim of this study was to evaluate the effectiveness and safety of stem cell transplantation for spinal cord injury（SCI）.DATA SOURCES： PubM ed, EMBASE, Cochrane, China National Knowledge Infrastructure, China Science and Technology Journal, Wanfang, and Sino Med databases were systematically searched by computer to select clinical randomized controlled trials using stem cell transplantation to treat SCI, published between each database initiation and July 2016. DATA SELECTION： Randomized controlled trials comparing stem cell transplantation with rehabilitation treatment for patients with SCI. Inclusion criteria：（1） Patients with SCI diagnosed according to the American Spinal Injury Association（ASIA） International standards for neurological classification of SCI;（2） patients with SCI who received only stem cell transplantation therapy or stem cell transplantation combined with rehabilitation therapy;（3） one or more of the following outcomes reported： outcomes concerning neurological function including sensory function and locomotor function, activities of daily living, urination functions, and severity of SCI or adverse effects. Studies comprising patients with complications, without full-text, and preclinical animal models were excluded. Quality of the included studies was evaluated using the Cochrane risk of bias assessment tool and Rev Man V5.3 software, provided by the Cochrane Collaboration, was used to perform statistical analysis. OUTCOME MEASURES： ASIA motor score, ASIA light touch score, ASIA pinprick score, ASIA impairment scale grading improvement rate, activities of daily living score, residual urine volume, and adverse events.RESULTS： Ten studies comprising 377 patients were included in the analysis and the overall risk of bias was relatively low level. Four studies did not detail how random sequences were generated, two studies did not clearly state the blinding outcome assessment, two studies lacked blinding outcome assessment, one study lacked follow-up information, and four studies carried out selective reporting. Compared with rehabilitation therapy, stem cell transplantation significantly increased the lower limb light touch score（odds ratio（OR） = 3.43, 95% confidence interval（CI）： 0.01 – 6.86, P = 0.05）, lower limb pinprick score（OR = 3.93, 95%CI： 0.74 – 7.12, P = 0.02）, ASI grading rate（relative risk（RR） = 2.95, 95%CI： 1.64 – 5.29, P = 0.0003）, and notably reduced residual urine volume（OR = –8.10, 95%CI： –15.09 to –1.10, P = 0.02）. However, stem cell transplantation did not significantly improve motor score（OR = 1.89, 95%CI： –0.25 to 4.03, P = 0.08） or activities of daily living score（OR = 1.12, 95%CI： –1.17 to 4.04, P = 0.45）. Furthermore, stem cell transplantation caused a high rate of mild adverse effects（RR = 14.49, 95%CI： 5.34 – 34.08, P 〈 0.00001）; however, these were alleviated in a short time. CONCLUSION： Stem cell transplantation was determined to be an efficient and safe treatment for SCI and simultaneously improved sensory and bladder functions. Although associated minor and temporary adverse effects were observed with transplanted stem cells, spinal cord repair and axon remyelination were apparent. More randomized controlled trials with larger sample sizes and longer follow-up times are needed to further validate the effectiveness of stem cell transplantation in the treatment of SCI.
基金supported by Hunan Provincial Key Research and Development Program,No.2021SK2002(to BW)the Natural Science Foundation of Hunan Province of China(General Program),No.2021JJ30938(to YL)。
文摘Degenerative cervical myelopathy is a common cause of spinal cord injury,with longer symptom duration and higher myelopathy severity indicating a worse prognosis.While numerous studies have investigated serological biomarkers for acute spinal cord injury,few studies have explored such biomarkers for diagnosing degenerative cervical myelopathy.This study involved 30 patients with degenerative cervical myelopathy(51.3±7.3 years old,12 women and 18 men),seven healthy controls(25.7±1.7 years old,one woman and six men),and nine patients with cervical spondylotic radiculopathy(51.9±8.6 years old,three women and six men).Analysis of blood samples from the three groups showed clear differences in transcriptomic characteristics.Enrichment analysis identified 128 differentially expressed genes that were enriched in patients with neurological disabilities.Using least absolute shrinkage and selection operator analysis,we constructed a five-gene model(TBCD,TPM2,PNKD,EIF4G2,and AP5Z1)to diagnose degenerative cervical myelopathy with an accuracy of 93.5%.One-gene models(TCAP and SDHA)identified mild and severe degenerative cervical myelopathy with accuracies of 83.3%and 76.7%,respectively.Signatures of two immune cell types(memory B cells and memory-activated CD4^(+)T cells)predicted levels of lesions in degenerative cervical myelopathy with 80%accuracy.Our results suggest that peripheral blood RNA biomarkers could be used to predict lesion severity in degenerative cervical myelopathy.
文摘BACKGROUND Perinatal complications may result in life-long morbidities,among which cerebral palsy(CP)is the most severe motor disability.Once developed,CP is a nonprogressive disease with a prevalence of 1-2 per 1000 live births in developed countries.It demands an extensive and multidisciplinary care.Therefore,it is a challenge for our health system and a burden for patients and their families.Recently,stem cell therapy emerged as a promising treatment option and raised hope in patients and their families.AIM The aim is to evaluate the efficacy and safety of stem cell treatment in children with CP using a systematic review and meta-analysis METHODS We performed a systematic literature search on PubMed and EMBASE to find randomized controlled clinical trials(RCT)investigating the effect of stem cell transplantation in children with CP.After the review,we performed a randomeffects meta-analysis focusing on the change in gross motor function,which was quantified using the gross motor function measure.We calculated the pooled standardized mean differences of the 6-and/or 12-mo-outcome by the method of Cohen.We quantified the heterogeneity using the I-squared measure.RESULTS We identified a total of 8 RCT for a qualitative review.From the initially selected trials,5 met the criteria and were included in the meta-analysis.Patients’population ranged from 0.5 up to 35 years(n=282).We detected a significant improvement in the gross motor function with a pooled standard mean difference of 0.95(95%confidence interval:0.13-1.76)favoring the stem cell group and a high heterogeneity(I2=90.1%).Serious adverse events were rare and equally distributed among both intervention and control groups.CONCLUSION Stem cell therapy for CP compared with symptomatic standard care only,shows a significant positive effect on the gross motor function,although the magnitude of the improvement is limited.Short-term safety is present and further highquality RCTs are needed.
