Pharmacological interventions targeting the microcirculation following traumatic spinal cord injury

Traumatic spinal cord injury is a devastating disorder chara cterized by sensory,motor,and autonomic dysfunction that seve rely compromises an individual's ability to perform activities of daily living.These adve rse outcomes are closely related to the complex mechanism of spinal cord injury,the limited regenerative capacity of central neurons,and the inhibitory environment fo rmed by traumatic injury.Disruption to the microcirculation is an important pathophysiological mechanism of spinal cord injury.A number of therapeutic agents have been shown to improve the injury environment,mitigate secondary damage,and/or promote regeneration and repair.Among them,the spinal cord microcirculation has become an important target for the treatment of spinal cord injury.Drug inte rventions targeting the microcirculation can improve the microenvironment and promote recovery following spinal cord injury.These drugs target the structure and function of the spinal cord microcirculation and are essential for maintaining the normal function of spinal neuro ns,axons,and glial cells.This review discusses the pathophysiological role of spinal cord microcirculation in spinal cord injury,including its structure and histopathological changes.Further,it summarizes the progress of drug therapies targeting the spinal cord mic rocirc ulation after spinal cord injury.

Oscillating field stimulation promotes axon regeneration and locomotor recovery after spinal cord injury

Oscillating field stimulation(OFS)is a potential method for treating spinal cord injury.Although it has been used in spinal cord injury(SCI)therapy in basic and clinical studies,its underlying mechanism and the correlation between its duration and nerve injury repair remain poorly understood.In this study,we established rat models of spinal cord contusion at T10 and then administered 12 weeks of OFS.The results revealed that effectively promotes the recovery of motor function required continuous OFS for more than 6 weeks.The underlying mechanism may be related to the effects of OFS on promoting axon regeneration,inhibiting astrocyte proliferation,and improving the linear arrangement of astrocytes.This study was approved by the Animal Experiments and Experimental Animal Welfare Committee of Capital Medical University(supplemental approval No.AEEI-2021-204)on July 26,2021.

Catgut Implantation at Baliao and Xingfu One Acupuncture Point to Treat Dysdefecation in Patients with Incomplete Spinal Cord Injury: Three Cases Report

Objective: To probe into the effect of catgut implantation at Baliao and Xingfu One Acupuncture Point on dysdefecation in patients with incomplete spinal cord injury (SCI). Methods: Three SCI patients voluntarily accepted catgut embedding at Baliao and Xingfu One Acupuncture point. Before and after treatment, they were filled out the self-rating scale of defecation, including the data of defecation frequency, total defecation time, defecation effort, fecal texture, fecal characteristics and fecal incontinence, etc. Results: Compared with the baseline data, constipation was improved and fecal incontinence was disappeared. Conclusions: Catgut implantation at Baliao and Xingfu One Acupuncture Point is effectual for patients with neurogenic dysporia secondary to incomplete SCI.

Olfactory ensheathing cell transplantation improves sympathetic skin responses in chronic spinal cord injury

Forty-three patients with chronic spinal cord injury for over 6 months were transplanted with bryonic olfactory ensheathing cells, 2-4 × 106, into multiple sites in the injured area under the sur-gical microscope. The sympathetic skin response in patients was measured with an electromyo-graphy/evoked potential instrument 1 day before transplantation and 3-8 weeks after trans-tion. Spinal nerve function of patients was assessed using the American Spinal Injury Association impairment scale. The sympathetic skin response was elicited in 32 cases before olfactory en-sheathing celltransplantation, while it was observed in 34 cases after transplantation. tantly, sympathetic skin response latency decreased significantly and amplitude increased cantly after transplantation. Transplantation of olfactory ensheathing cells also improved American Spinal Injury Association scores for movement, pain and light touch. Our findings indicate that factory ensheathing celltransplantation improves motor, sensory and autonomic nerve functions in patients with chronic spinal cord injury.

Prognosis of traumatic spinal cord injury in children:Follow-up of 86 patients

Purpose:The long-term situation of children with spinal cord injury(SCI)was investigated,and suggestions for helping them better return to the society were provided.Methods:SCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed.Information including motor function,complications,characteristic changes,self-care abilities,school attendance and social participation were collected by telephone interview and electronic questionnaire.All the answers were statistically analyzed.Results:A total of 86 cases were enrolled,77 girls and 9 boys,with a median injury age of 6 years and 2 months.The follow-up time was 3-130 months.The main cause of trauma in these children was sport injury(66.3%),the thoracic spinal cord was involved the most(91.9%),and complete SCIs accounted for the majority(76.7%).In terms of complications,children with complete SCIs were more likely to have urinary incontinence,constipation and characteristic changes(p<0.05);whereas the incomplete SCIs often have spasticity(p<0.05).As to the daily living abilities,children with incomplete lumbar SCIs were more capable to accomplish personal hygiene,transfer,and bathing independently than those with complete injuries,or cervical/thoracic SCIs,respectively(p<0.05).Moreover,children older than 9 years care more able to dress and transfer independently than the youngers(p<0.05).Wheelchair users accounted for 84.9%and more than half of them were able to propel wheelchair independently,and those who move passively in wheelchairs were mostly introverted kids(p<0.05).Almost all(93.8%)children with incomplete injuries were able to walk independently.Most(79.1%)children continued to attending school,and 41.9%participated in interest classes.Unfortunately,67.4%of the children spent less time playing with their peers than before the injury.Conclusion:SCIs impair physical structures and function of children,affect their independence in daily living,and restrict school attendance and social interaction.Comprehensive rehabilitation after injury is a systematic work.Medical staff and caregivers should not only pay attention to neurological function,but also help them improve self-care abilities.It is also important to balance rehabilitation training and school work and social participation.

Application of Out-of-Hospital Extended Nursing in Brace Treatment of Patients with Idiopathic Scoliosis

Objective:To investigate the effect of out-of-hospital extended nursing on the compliance behaviors and therapeutic effect of brace treatment of patients with idiopathic scoliosis.Methods:54 patients with idiopathic scoliosis between February 2015 and December 2017 were randomly divided into control group and observation group.Patients in the control group received pelvic suspension traction,gymnastic exercises,and brace wear at discharge,on the basis of which patients in the observation group were added with extended care outside the hospital.The compliance behaviors and the changes of scoliosis angle(Cobb angle)of patients in the 2 groups were evaluated.Results:Compared with the control group,patients in the observation group had better compliance behaviors in completion status of functional exercise(χ2=5.594,P=0.018),brace wear(χ2=6.171,P=0.013),subsequent visit on time(χ2=9.247,P=0.002).Cobb angle was improved significantly in both groups at the last follow-up compared with that on admission,and the improvement was more significantly in the observation group(P<0.001).Conclusion:Through the implementation of out-of-hospital extended nursing,the compliance behaviors and clinical effect of brace treatment for idiopathic scoliosis patients are obviously improved,and this active nursing model is worth popularizing in clinic.

Entrapment of middle cluneal nerves as an unknown cause of low back pain

Entrapment of middle cluneal nerves induces low back pain and leg symptoms. The middle cluneal nerves can become spontaneously entrapped where this nerve pass under the long posterior sacroiliac ligament. A case of severe low back pain, which was completely treated by release of the middle cluneal nerve, was presented. Entrapment of middle cluneal nerves is possibly underdiagnosed cause of low-back and/or leg symptoms. Spinal surgeons should be aware of this clinical entity and avoid unnecessary spinal surgeries and sacroiliac fusion. This paper is to draw attention by pain clinicians in this unrecognized etiology.