Correlation of Pathological Findings with MRI Imaging in Traumatic Spinal Cord Injury in Hyperacute Time Period in Non Human Primate Model

Traumatic Spinal Cord Injury (TSCI) remains a significant cause of human suffering. The World Health Organization estimates that there are between 250,000 to 500,000 new cases every year. Magnetic Resonance Imaging (MRI) has been an important advancement in the diagnosis and management of TSCI. Nevertheless, there is a lack of literature correlating the radiological abnormalities and histopathological findings in the first hour (i.e., hyperacute period) after injury. The aim of this preliminary study is to elucidate the relationship between the MRI abnormalities and histopathological abnormalities in the hyperacute time period. In this study, a non-human primate model (NHP) primate model is used to characterize the histopathological and radiological features. Specifically, an experimental TSCI is created with an epidural catheter. This is followed by MRI imaging. The subject is then humanely euthanized and a post-mortem examination is completed. These results suggest that the noted radiological abnormalities are consistent with a combination of hemorrhage, edema as well as eosinophilic cellular matter in the central canal.

The Magnetic Resonance Image and Pathology of Spinal Cord Cavernous Hemangioma

Objective To investigate the characteristics of magnetic resonance image (MRI) of spinal cord cavernous hemangioma. Methods Six cases of spinal cord cavernous heman-gioma diagnosed by MRI and confirmed by pathology were reviewed. The characteristics of MRI were analyzed and correlated with pathological characteristics of spinal cord cavernous hemangioma. Results In 4 cases, the tumors were located in thoracic segment of the spinal cord and 2 in cervical cord. All lesions were solitary and the spinal cords were normal or a little thicker. The MRI showed that the images of focus were ball-like popcorn or mulberry with mixed signal,with short T2 signal around the focus. Under microscope, the hemangioma was composed of highly expanded blood sinusoids and its wall was thin and consisted of flat epithelial cells. There were some red blood cells in the cavity of the sinusoid and a little fibrous tissue in the diazoma between blood sinusoids. And also some fresh and old hemorrhages could be seen in the specimen. Conclusion MRI has high sensitivity and specificity in the diagnosis of spinal cavernous hemangioma.

A progressive compression model of thoracic spinal cord injury in mice： function assessment and pathological changes in spinal cord

Non-traumatic injury accounts for approximately half of clinical spinal cord injury, including chronic spinal cord compression. However, previous rodent spinal cord compression models are mainly designed for rats, few are available for mice. Our aim is to develop a thoracic progressive compression mice model of spinal cord injury. In this study, adult wild-type C57BL/6 mice were divided into two groups： in the surgery group, a screw was inserted at T9 lamina to compress the spinal cord, and the compression was increased by turning it further into the canal（0.2 mm） post-surgery every 2 weeks up to 8 weeks. In the control group, a hole was drilled into the lamina without inserting a screw. The results showed that Basso Mouse Scale scores were lower and gait worsened. In addition, the degree of hindlimb dysfunction in mice was consistent with the degree of spinal cord compression. The number of motor neurons in the anterior horn of the spinal cord was reduced in all groups of mice, whereas astrocytes and microglia were gradually activated and proliferated. In conclusion, this progressive compression of thoracic spinal cord injury in mice is a preferable model for chronic progressive spinal cord compression injury.

Does diffusion tensor data reflect pathological changes in the spinal cord with chronic injury?

Magnetic resonance diffusion tensor imaging has been shown to quantitatively measure the early pathological changes in chronic cervical spondylotic myelopathy. In this study, a novel spongy poly- urethane material was implanted in the rat C^-s epidural space to establish a rat model of chronic cervical spondylotic myelopathy. Diffusion tensor data were used to predict pathological changes. Results revealed that the fractional anisotropy value gradually decreased at 4, 24, and 72 hours and 1 week after injury in rat spinal cord, showing a time-dependent manner. Average diffusion coeffi- cient increased at 72 hours and 1 week after implantation. Hematoxylin-eosin staining and Luxol-fast-blue staining exhibited that the number of neurons in the anterior horn of the spinal cord gray matter and the nerve fiber density of the white matter gradually reduced with prolonged com- pression time. Neuronal loss was most significant at 1 week after injury. Results verified that the fractional anisotropy value and average diffusion coefficient reflected the degree of pathological change in the site of compression in rat models at various time points after chronic spinal cord compression injury, which potentially has a reference value in the early diagnosis of chronic cervical spondylotic myelopathy.

Changes of blood flow in spinal cord following ischemia and reperfusion and its relation with pathological damages in rabbits

objective: To investigate the changes of spinal cord blood flow (SCBF) after the ischemia and reperfusion injury of the spinal cord and its relation with pathological damages. Methods: Twenty adult Japanese big-ear white rabbits equally randomized into the control group, 30-min-ischemic group, 60-min-is chemic group and 90-min-ischemic group. All the rabbits in the latter 3 groups were inflicted with the is chemia and reperfusion injury of the spinal cord through selective occlusion of the lumbar artery. SCBF was measured with the hydrogen clearance method and the pathological changes of the injured spinal cord were observed with Nissl’s staining. Results: SCBF during ischemia was 0 ml/100 g/min. During reperfusion, it was recovered to different levels. However, it was still decreased as compared with that before ischemia and that in the control group. The pathological changes of the gray matter were the most significant. The severi ty of the pathological changes decreased in the order from 90-min-ischemic group, 6O-min-ischemic group to 30-min ischemic group. Conclusion: Reversible injury occurs in rabbits after ischemia for 30 min, irreversible injury in those after ischemia for 90 min and partially reversible injury in those after ischemia for 60 min.

CORRELATION OF THE MAGNETIC MOTOR EVOKED POTENTIAL TECHNIQUE WITH PATHOLOGICAL CHANGES ASSOCIATED WITH SPINAL CORD INJURY IN ADULT CATS

To determine whether the pathological changes caused by injury to the spinal cord can be correlated with values obtained by the Magnetic Motor Evoked Potential (MEPs) technique, we studied spinal cords from 41 adult cats who were divided into 4 groups. The groups ranged from normal cats whose spinal cords were not compressed, to slightly, moderately and severely injured. MEPs were recorded before compression and in 30 minutes, 6 hours, 1 week, 2 week and 4 week after the compression unit was installed. Pathological changes with increased pressure were seen in blood vessels, nerve cells and fibers, Nissl substance and the central canal. A reversal of pathological changes was observed in slight or moderate injury during the 4 weeks of the experiment. Extensive injury, however, caused irreversible changes in the nerve cells with loss of motor function. The latency of MEPs at 30 minutes and 6 hours in the slightly injured group was 037 and 038 times greater than the baseline and returned to normal levels in 4 weeks. In the moderately injured group, the latency was increased 077 and 081 times and in the severely injured 132 and 136 times over the baseline. Recovery in the second group was partial and not at all in the severely injured. Thus, there appears to be good correlation between observed pathological changes, motor functions and MEPs.

Role of necroptosis in spinal cord injury and its therapeutic implications

Spinal cord injury(SCI),a complex neurological disorder,triggers a series of devastating neuropathological events such as ischemia,oxidative stress,inflammatory events,neuronal apoptosis,and motor dysfunction.However,the classical necrosome,which consists of receptor-interacting protein(RIP)1,RIP3,and mixed-lineage kinase domain-like protein,is believed to control a novel type of programmed cell death called necroptosis,through tumour necrosis factor-alpha/tumour necrosis factor receptor-1 signalling or other stimuli.Several studies reported that necroptosis plays an important role in neural cell damage,release of intracellular pro-inflammatory factors,lysosomal dysfunction and endoplasmic reticulum stress.Recent research indicates that necroptosis is crucial to the pathophysiology of a number of neurological disorders and SCIs.In our review,we summarize the potential role of programmed cell death regulated by necroptosis in SCI based on its molecular and pathophysiological mechanisms.We also summarize the targets of several necroptosis pathways,which provide a more reliable reference for the treatment of SCI.

中线部位和脑室节细胞胶质瘤临床病理分析及文献复习

目的探讨中线部位和脑室节细胞胶质瘤的临床病理及分子遗传学特点。方法收集11例中线部位和脑室节细胞胶质瘤患者的临床特征、免疫表型及分子检测结果,并复习总结相关文献。结果镜下观察节细胞胶质瘤由异常神经元和肿瘤性增生的胶质细胞构成,免疫表型NeuN、MAP2可标记肿瘤中的神经元成分,GFAP和Olig-2标记出了肿瘤性神经胶质细胞成分;分子遗传学常存在BRAFV600E点突变,但也可发现存在其他形式BRAF基因以及MAPK信号通路基因的改变。随访病例多数预后良好。结论发生在中线部位及脑室的节细胞胶质瘤较为罕见,对于发生于不典型部位的这种低级别神经上皮肿瘤,要将其纳入鉴别诊断中,可在形态学基础上,结合免疫组织化学以及分子检测结果进行综合分析。

补体系统参与病理性疼痛的机制研究进展

慢性病理性疼痛是由于躯体感觉系统或者组织损伤而导致的疼痛,在临床上很常见,给患者的身心健康带来很大危害。其治疗方法涵盖了药物治疗、经皮神经电刺激、运动及心理治疗以及介入治疗等方法。然而,这些治疗方法也存在一些缺陷,如疗效欠佳、药物耐受、患者接受度不高等。

Cervical Meningocele about 2 Operated Cases

Cervical meningoceles are the least common forms of spina bifida, representing between 4% to 8% of all spinal dysraphisms. They are not accompanied by neurological deficit in childhood but attached cord syndrome can occur with growth. Surgical treatment, in addition to avoiding rupture and correcting the aesthetic damage, will preserve neurological functions. We report 2 cases that we took care of. They are a 5-month-old infant and a 3-year-old girl. The first presented a 7 cm rounded meningocele pedunculated through the C1 lamina defect. The second presented an 8.6 cm polylobed meningocele pedunculated through the C2 lamina defect. They both underwent surgery with good progress.

椎管内色素性神经鞘瘤临床病理特点分析与文献复习

回顾性分析2013年1月—2023年12月于枣庄市立医院治疗的椎管内色素性神经鞘瘤(melanotic schwannoma,MS)患者的临床病理特点,包括临床病史、磁共振成像(magnetic resonance imaging,MRI)图像、肿瘤组织学特点、免疫组织化学染色结果,并对患者转移和复发情况进行随访,随访结果显示该10例患者均无肿瘤转移及复发的情况。复习相关文献,基于相关文献报道,MS有转移及复发病例存在。本研究结果可能与研究病例有限及随诊时间较短有关。因此,应该重视增加MS患者远期随诊时间,并及时干预及治疗,进而减少患者的转移率及复发率,提高患者的生活质量。本研究旨在提高临床对MS的诊断及治疗的认识。

Methylprednisolone inhibits Nogo-A protein expression after acute spinal cord injury

Oligodendrocyte-produced Nogo-A has been shown to inhibit axonal regeneration. Methylprednisolone plays an effective role in treating spinal cord injury, but the effect of methylprednisolone on Nogo-A in the injured spinal cord remains unknown. The present study established a rat model of acute spinal cord injury by the weight-drop method. Results showed that after injury, the motor behavior ability of rats was reduced and necrotic injury appeared in spinal cord tissues, which was accompanied by increased Nogo-A expression in these tissues. After intravenous injection of high-dose methylprednisolone, although the pathology of spinal cord tissue remained unchanged, Nogo-A expression was reduced, but the level was still higher than normal. These findings implicate that methylprednisolone could inhibit Nogo-A expression, which could be a mechanism by which early high dose methylprednisolone infusion helps preserve spinal cord function after spinal cord injury.

Dynamic changes in intramedullary pressure 72 hours after spinal cord injury

Intramedullary pressure increases after spinal cord injury, and this can be an important factor for secondary spinal cord injury. Until now there have been no studies of the dynamic changes of intramedullary pressure after spinal cord injury. In this study, telemetry systems were used to observe changes in intramedullary pressure in the 72 hours following spinal cord injury to explore its pathological mechanisms. Spinal cord injury was induced using an aneurysm clip at T10 of the spinal cord of 30 Japanese white rabbits, while another 32 animals were only subjected to laminectomy. The feasibility of this measurement was assessed. Intramedullary pressure was monitored in anesthetized and conscious animals. The dynamic changes of intramedullary pressure after spinal cord injury were divided into three stages: stage I(steep rise) 1–7 hours, stage Ⅱ(steady rise) 8–38 hours, and stage Ⅲ(descending) 39–72 hours. Blood-spinal barrier permeability, edema, hemorrhage, and histological results in the 72 hours following spinal cord injury were evaluated according to intramedullary pressure changes. We found that spinal cord hemorrhage was most severe at 1 hour post-spinal cord injury and then gradually decreased; albumin and aquaporin 4 immunoreactivities first increased and then decreased, peaking at 38 hours. These results confirm that severe bleeding in spinal cord tissue is the main cause of the sharp increase in intramedullary pressure in early spinal cord injury. Spinal cord edema and blood-spinal barrier destruction are important factors influencing intramedullary pressure in stages Ⅱ and Ⅲ of spinal cord injury.

CORRECTIVE SURGERY OF CONGENITAL SCOLIOSIS WITH TYPE II SPLIT SPINAL CORD MALFORMATION

Objective To investigate the corrective results of congenital scoliosis with type II split spinal cord malformation.Methods By reviewing the medical records and roentgenograms of congenital scoliosis patients with type II split spinal cord malformation that underwent corrective surgery, septum location and length, curve type, coronal and sagittal Cobb’s angles, apical vertebral rotation and translation, and trunk shift were measured and analyzed.Results A total of 23 congenital scoliosis patients with type II split spinal cord malformation were studied, 6 cases were due to failure of segmentation, 8 cases due to failure of formation, and the remaining 9 cases due to mixed defects.The fibrous septums were located in the thoracic spine in 8 patients, lumbar spine in 4 patients, thoracic and lumbar spine in 10 patients, and from cervical to lumbar spine in 1 patient.The septum extended an average of 4.9 segments.Corrective surgeries included anterior correction with instrumentation in 2 patients, posterior correction with instrumentation in 11 patients, anterior release and posterior correction with instrumentation in 6 patients, anterior and posterior resection of the hemivertebra and posterior correction with instrumentation in 4 patients.The pre- and postoperative coronal Cobb’s angles, apical vertebral translations, apical vertebral rotations, trunk shifts were 61.9° and 32.5°(P<0.001), 48.9 mm and 31.5 mm (P<0.001), 1.2 and 1.1, 12.7 mm and 8.2 mm, respectively.The average correction rate of coronal Cobbs angle was 47.5%.The sagittal balance was also well improved.The fibrous septums were all left in situ. There was no neurological complication.Conclusion For congenital scoliosis with type II split spinal cord malformation, positive correction results with no neurological complication may be obtained without resection of the fibrous septum.

Semaphorin 3A expression in spinal cord injured rats after olfactory ensheathing cell transplantation

Semaphorin 3A expression is thought to increase following spinal cord injury.The impact of olfactory ensheathing cell transplantation remains unclear.The current study demonstrated that spinal cord hemorrhage,edema,degeneration,necrosis,cyst formation,proliferation of glial cells,regeneration of nerve fibers and various pathological reactions occurred following a simple cross-section of spinal cord injury.Transplantation of olfactory ensheathing cells was found to significantly relieve the pathological reactions in the spinal cord described above,decrease the extent of necrosis in damaged neurons and nerve fibers,and downregulate semaphorin 3A expression in the injured zone.The results confirmed that olfactory ensheathing cell transplantation plays a protective role on the injured spinal cord by reducing the expression of semaphorin 3A.

Atypical imaging features of the primary spinal cord glioblastoma:A case report

BACKGROUND Primary spinal cord(PSC)glioblastoma(GB)is an extremely rare but fatal primary tumor of the central nervous system and associated with a poor prognosis.While typical tumor imaging features are generally easy to recognize,glioblastoma multiforme can have a wide range of imaging findings.Atypical GB is often misdiagnosed,which usually delays the optimal time for treatment.In this article,we discuss a clinical case of pathologically confirmed PSC GB under the guise of benign tumor imaging findings,as well as the most recent literature pertaining to PSC GB.CASE SUMMARY A 70-year-old female complained of limb weakness lasting more than 20 d.Irregular masses were observed inside and outside the left foramina of the spinal canal at C7-T1 on medical imaging.Based on the imaging features,radiologists diagnosed the patient with schwannoma.Tumor resection was performed under general anesthesia.The final histopathological findings revealed a final diagnosis of PSC GB,world health organization Grade IV.The patient subsequently underwent a 4-wk course of radiotherapy(60 Gy in 20 fractions)combined with temozolomide chemotherapy.The patient was alive at the time of submission of this manuscript.CONCLUSION Atypical GB presented unusual imaging findings,which led to misdiagnosis.Therefore,a complete recognition of imaging signs may facilitate early accurate diagnosis.

非特异性脊柱感染误诊分析并文献复习

目的探讨非特异性脊柱感染的临床特点、鉴别诊断要点及误诊原因、防范措施。方法回顾性分析2018年2月-2021年3月收治的曾误诊为脊柱结核的非特异性脊柱感染13例的临床资料。结果本组10例受累脊柱棘突及椎旁有较明显压痛,3例受累脊柱棘突及椎旁有轻度压痛;发热9例。病程2~5个月;颈椎2例,胸椎3例,腰椎8例;单一节段受累9例,2~3个节段受累4例。血白细胞和中性粒细胞升高各2例,红细胞沉降率均增快,C反应蛋白升高8例。影像学检查显示病变椎体骨质不同程度破坏,病变椎体椎间隙狭窄或稍窄;4例病变椎体终板缘呈“鸟嘴样”反应性增生;2例病变椎体旁小脓肿形成。本组发病初期皆误诊为脊柱结核,平均误诊时间2.4周,予相应治疗,症状控制不理想。5例行病变椎体穿刺病理检查,8例行手术后病理检查,均确诊为非特异性脊柱感染。本组确诊后均予抗感染治疗,其中5例行病灶清除术;随访3~12个月,病变椎体疼痛较前明显缓解,相应指标皆恢复正常。结论发热、病变椎体进行性疼痛加剧、炎性因子升高、影像学检查示病变椎体骨质破坏等症状不足以诊断非特异性脊柱感染,易与脊柱结核混淆。临床上对此类患者应综合病史、临床表现、实验室指标和影像学表现等进行诊断,必要时行病变椎体穿刺或手术病理检查。

产前超声及MRI在胎儿闭合性脊柱裂诊断中的应用价值

目的探讨产前超声及MRI在胎儿闭合性脊柱裂诊断中的应用价值。方法选取我院经产后临床确诊的闭合性脊柱裂胎儿26例和未合并神经系统畸形的胎儿38例,比较产前超声、MRI单独及联合应用对胎儿闭合性脊柱裂的诊断结果。绘制受试者工作特征(ROC)曲线分析产前超声、MRI单独及联合应用对胎儿闭合性脊柱裂的诊断效能。结果26例闭合性脊柱裂胎儿中,产前超声检出20例,漏诊6例;产前MRI检出17例,漏诊9例;联合应用检出24例,漏诊2例。产前超声联合MRI与产后临床诊断相符者24例,其中7例为MRI漏诊经超声补充诊断,4例为超声漏诊经MRI补充诊断。ROC曲线分析显示,产前超声联合MRI诊断胎儿闭合性脊柱裂的曲线下面积为0.9120,高于其单独应用(0.8964、0.8757),差异均有统计学意义(P=0.023、0.014)。结论产前超声可作为诊断胎儿闭合性脊柱裂的首选检查方式,MRI可作为补充检查方式,二者联合应用可提高对胎儿闭合性脊柱裂的诊断效能。

中医手诊及其在脊髓病变中的应用

手部掌色、纹理、光泽度等变化是身体健康状况及疾病转归的外在体现。通过系统归纳与总结中医手诊源流、内容及理论方法,论述中医手诊在脊髓病变临床诊断中的指导作用。根据中医手诊辨证方法以及分区理论,拇指桡侧和大鱼际赤白肉际处代表人体脊柱区,与颈椎、胸椎、腰椎、骶骨、尾骨、盆腔以及腿部、膝部依次对应;结合此区的岛纹、菱形纹等病理纹可将手诊作为脊髓病变的辅助诊断手段。

转录组测序结合TMT蛋白质组学技术对脊髓损伤小鼠关键基因预测及相关病理机制研究

目的:通过转录组测序(RNA sequencing,RNA-Seq)和TMT蛋白质组学技术,筛选差异表达的基因及蛋白,探讨脊髓损伤后复杂的病理机制。方法:50只雌性C57BL/6小鼠随机分为假手术组、模型组,每组25只。采用钳夹法在腰1处制备小鼠脊髓损伤模型,14 d后进行取材。采用后肢运动功能评分(basso mouse scale,BMS)评估小鼠后肢运动功能变化;HE染色法观察脊髓损伤区病理形态学变化;RNA-Seq技术筛选差异基因;TMT蛋白组学分析筛选差异蛋白;结合2种测序技术筛选变化趋势吻合的mRNA和蛋白并进行生物信息学分析。结果:与假手术组相比,模型组中BMS评分明显降低(P<0.05);HE染色显示脊髓损伤区域结构疏松紊乱,出现空洞,细胞核固缩,炎性浸润严重,神经元坏死;RNA-Seq共筛选出565个差异mRNA,其中545个上调,20个下调,TMT蛋白组学共筛选出339个差异蛋白,其中278个上调,61个下调;2种测序的聚类热图显示2组样本的表达模式差异大;韦恩图分析获得83个趋势上调的mRNA或蛋白;蛋白互作(protein-protein interaction,PPI)网络分析获得11个核心靶点;GO富集分析显示分子功能或生物过程主要在免疫应答、溶酶体途径、细菌反应、液泡裂解等方面;KEGG富集通路主要在结核病变、溶酶体、吞噬小体途径等通路。结论:本研究筛选出的11个mRNA或蛋白可能是调控脊髓损伤病理过程的核心靶点,病理机制可能与免疫应答途径、溶酶体和吞噬小体等通路密切相关。