骨髓间充质干细胞经BDNF基因修饰后移植治疗大鼠半横断脊髓损伤的电生理研究

目的采用电生理的研究方法,观察脑源性神经营养因子(BDNF)基因修饰的骨髓间充质干细胞对脊髓损伤的修复作用。方法随机将大鼠分成3组:空白组10只(只切除椎板,暴露脊髓硬脊膜);SCI组10只;SCI术后细胞移植组10只;从以上三组大鼠随机抽取8只于细胞移植后1 d、7 d、14 d、21 d、30 d、60 d进行SEP(皮层体感诱发电位)、MEP(运动诱发电位)等电生理检测技术,并观察大鼠的运动评分恢复程度。结果细胞移植4d后,大鼠饮食和活动开始增加;后肢变化过程如下:损伤后1~4 d损伤侧后肢迟缓性瘫痪,拖地行走,损伤对侧后肢由损伤初期的运动减弱逐渐恢复,损伤后5~9 d损伤侧后肢痉挛性瘫痪;10~14 d损伤侧下肢恢复少量活动,损伤对侧后肢恢复至较损伤前稍弱的状态;15~21 d损伤侧后肢活动能力较之前有明显改善,至30 d损伤侧后肢活动能力及肌张力恢复程度最明显,30 d以后无更明显改善。免疫组化发现损伤处诱导标记的骨髓间充质干细胞存活,行为学观察发现细胞移植改善了损伤大鼠运动能力。结论骨髓间充质干细胞经BDNF基因修饰后可以促进脊髓损伤大鼠的神经再生及部分传导功能恢复。     

椎间盘脱出大鼠模型的脊髓血流量变化及电针效应

目的 观察大鼠椎间盘脱出模型的脊髓血流量及其电针效应,为兽医临床犬椎间盘病病理和针灸作用机理研究积累资料.方法 通过外科手术将硅胶片填充于大鼠第13胸椎( T13)脊髓腹侧位制作胸腰段椎间盘脱出模型,通过激光散斑血流系统实时监测造模后第一腰椎(L1)脊髓背侧血流量及电针刺激双侧足三里穴和趾间穴对其的影响.结果 以硅胶片填充于大鼠T13的脊髓腹侧位可成功制作出类似犬胸腰段椎间盘脱出的后肢瘫痪模型,且重复性好;模型组大鼠在压迫后,L1段的脊髓背侧血流量呈极显著下降(P＜0.01),电针双侧足三里穴和趾间穴可显著升高血流量(P＜0.05),电针结束后约10 min其血流量逐渐恢复至电针前水平;电针组大鼠电针治疗14 d后,脊髓背侧血流量极显著高于对照组,且运动功能评分显示电针组大鼠的后肢运动功能显著改善.结论 通过外科手术将硅胶片填充于大鼠T13脊髓腹侧位可成功制作胸腰段椎间盘脱出模型;压迫后L1段脊髓血流量显著下降;电针治疗后脊髓血流量极显著升高,且瘫痪大鼠运动机能明显好转,这可能与电针改善脊髓血流量继而减轻脊髓损伤并促进损伤恢复或促进代偿机制有关.     

超早期高压氧对脊髓完全横断损伤大鼠血液生化及后肢运动功能的影响

目的探讨超早期高压氧（HBO）治疗对脊髓完全横断损伤模型血液生化及后肢运动功能的影响。方法 55只SD大鼠随机分为A组（假手术组,15只）、B组（模型组,20只）及C组（高压氧组,20只）,A组仅行椎板切除术,其余2组均行T10椎板水平脊髓完全横向切断术。B、C组均予常规护理,C组于术后3 h置于动物舱内开始高压氧治疗,10 d一疗程,共3疗程。分别于建立模型后第1～6周末,用BBB运动功能评分法评价并比较两组大鼠后肢运动功能恢复程度,术后第6周过量麻醉处死大鼠,以40 g/L多聚甲醛行心室-主动脉灌注,取脊髓损伤区标本,光镜观察损伤脊髓的组织病理学改变。检测血钙（Ca）、血磷（P）、血清碱性磷酸酶（ALP）改变情况。结果 B、C两组大鼠术后第1～6周BBB运动功能评分逐渐增高,C组在3～6周末的BBB运动功能评分均明显高于B组。B组、C组血钙、血磷在术后1、3周高于A组,血清碱性磷酸酶（ALP）术后1、3周低于A组;C组血钙、血磷在术后5、6周低于B组。病理组织切片观察C组较B组组织水肿减轻,炎性细胞浸润减轻。结论超早期高压氧治疗能促进脊髓完全横断损伤大鼠后肢运动功能的部分恢复,降低血钙、血磷含量,对脊髓完全横断损伤大鼠具有保护和治疗作用。     

810nm弱激光照射对大鼠急性脊髓损伤后巨噬细胞极化的作用研究

本研究构建急性大鼠脊髓夹伤模型,并将大鼠随机分为单纯脊髓损伤对照组及脊髓损伤联合弱激光照射组。照射组应用810 nm波长,150 m W照射功率,照射光斑0.3 cm^2的弱激光对脊髓损伤区进行经皮照射,连续照射3天,7天或14天。应用免疫荧光、免疫印迹实验方法,测定脊髓损伤区巨噬细胞及小胶质细胞的极化表达。应用酶联免疫吸附法测定脊髓损伤区白细胞介素4的表达情况。应用坚牢蓝髓鞘染色测定两组损伤脊髓中髓鞘保留的差异。采用BBB评分对两组大鼠后肢运动功能的恢复进行评估。结果表明,810 nm弱激光对脊髓损伤区连续照射3天,7天后,可显著减少M1型巨噬细胞及其标志物诱导型一氧化氮合酶的表达,在7天时间增加M2型巨噬细胞及其标志物精氨酸酶1的表达。弱激光照射组白细胞介素4的表达明显增加。损伤后14天,弱激光照射组脊髓损伤区髓鞘保留面积比值明显提高。损伤后7天及14天时,弱激光照射组大鼠的BBB评分明显升高。该实验结果表明,810 nm弱激光经皮照射,可增加大鼠急性脊髓损伤区M2型巨噬细胞及小胶质细胞的表达,并减少脊髓损伤后的髓鞘脱失,促进脊髓损伤大鼠运动功能的恢复。     

脊髓损伤后神经环路重建的研究进展

成年哺乳类脊髓损伤后的修复与再生是一项复杂且尚未解决的挑战.随着全球经济的增长,脊髓损伤的发生率呈上升趋势.脊髓损伤可能导致永久性的运动功能障碍和感觉丧失,给患者及其家属带来极大的经济压力和心理负担.因此,迫切需要开发有效的治疗脊髓损伤的新策略.近年来,应用外源性或内源性神经元中继的治疗手段为脊髓损伤后环路重建提供了新的思路.将干细胞或生物材料等移植物作用于脊髓损伤区,可改善损伤区局部微环境,诱导神经干细胞定向分化为神经元,促进脊髓环路重建和功能恢复,因此成为较有临床应用前景的方法.本综述主要介绍细胞移植治疗、组织工程策略和基因调控等方法在修复受损脊髓的神经网络中的应用,并讨论了脊髓损伤后新生神经元是否具有潜在的功能整合,重建受损神经环路,并恢复其运动和感觉功能等问题.     

蛇毒神经生长因子促进周围神经再生的诱发电位观察

目的：研究蛇毒神经生长因子（sNGF)对大鼠坐骨神经损伤后诱发电位的影响,评价蛇毒神经生长因子在促进周围神经再生中的作用。方法：建立大鼠坐骨神经钳夹模型,局部滴加药物和术后肌注sNGF,通过脊髓诱发电位（SEP）,运动诱发电位（MEP）评定,观察坐骨神经修复情况。结果：sNGF治疗后可使伤后SEP,MEP提早出现,结论：蛇毒提取的NGF对大鼠坐骨神经损伤修复具有促进作用。     

Neuritin对大鼠急性脊髓损伤后神经中丝作用的研究

目的:探讨Neuritin对大鼠脊髓损伤后神经元突起再生的作用.方法:分为Neuritin组,His组和假手术组.使用改良Allen's打击法打击Neuritin组和His组大鼠T10或T11节段脊髓.Neuritin组和His组经蛛网膜下腔置管局部连续给予Neuritin和His蛋白(6ug/d)一周.假手术组仅咬除椎板不损伤脊髓,经蛛网膜下腔置空管而部损伤脊髓.术后6h、3d、7d、14d、28d、56d分别观察:①运动功能评分(BBB评分)观察大鼠后肢运动功能恢复情况;②HE染色观察脊髓组织形态学变化;③免疫组织化学染色和Western blotting检测损伤段脊髓神经中丝蛋白(NF200)的修复与再生.结果:①BBB评分,Neuritin组和His组在一周内没有明显差别,但Neuritin组和His组的评分均低于假手术组,从术后第14d,实验组评分明显高于对照组(P＜0.05);②HE染色可见损伤段脊髓出血、坏死及炎性细胞浸润;③免疫组化检测,Neuritin组的NF200平均光密度值(IOD/AREA)较His组明显增高(P＜0.05);Western blotting检测的NF200灰度值(GMD)较His组明显增高(P＜0.05),结论:持续外源性Neuritin能促进大鼠脊髓损伤后伤区神经元突起的再生,并能促进大鼠后肢运动功能的康复.     

刺激迷走神经对皮层诱发性下颔运动的抑制作用

迷走传入冲动能影响躯体运动,早年曾有报导。Johnson 和 Luckardt 曾经观察到,刺激迷走神经中枢端能抑制麻醉动物的膝跳反射。其后 Schweitzer 和 Wright 进一步证明,迷走传入冲动不仅抑制脊髓牵张反射,还使动物的各种自发运动立即停止。新近钟慈声发现肺牵张感受器的刺激能抑制免皮层诱发的前肢和后肢肌肉的收缩,这种抑制在切断颈迷走神经后明显减弱或完全消失。     

脊髓损伤的病理改变及修复策略

脊髓损伤造成神经组织坏死,传导通路中断,损伤平面以下运动和感觉功能丧失,导致瘫痪甚至死亡.脊髓损伤的病理变化极其复杂,早期主要为分子基因水平的改变,亚急性期主要为细胞组织水平的变化.这些变化引发继发性损伤,致使组织坏死、神经元死亡、轴突断裂并形成由瘢痕组织包裹的囊性空洞,抑制轴突再生.目前临床上仅能通过手术减压或者使用药物对症干预,无法从根本上改善受损神经的功能.脊髓损伤后功能难以恢复有多方面的原因:炎症反应贯穿脊髓损伤全过程,炎症介质导致损伤区域的神经元及胶质细胞变性坏死,轴突因瓦勒变性而萎缩;神经元再生能力弱,轴突再生乏力,并且瘢痕组织导致轴突无法穿越损伤区域与远端的轴突形成联系.本文就脊髓损伤后的病理改变进行综述并探讨修复策略.     

小鼠脊髓损伤模型的建立及神经干细胞移植后运动功能恢复情况的研究

目的制作小鼠脊髓损伤打击模型,观察神经干细胞(NSCs)移植对脊髓损伤小鼠运动功能恢复及Nestin表达的影响。方法将50只小鼠随机分为空白组(5只)、模型组(15只)、对照组(15只)、治疗组(15只),运用改良Allen's法制备小鼠T10脊髓损伤模型并立即在损伤节段进行NSCs移植,于损伤后1、3、7、14、21d进行BBB评分,并通过免疫荧光法及荧光定量PCR检测Nestin的表达情况。结果所有脊髓打击后小鼠均出现双后肢瘫痪,但随时间延长运动功能可有不同程度恢复,NSCs移植14d后治疗组较模型组及对照组BBB评分显著增高(P0.05),且治疗组Nestin表达量也高于模型组及对照组。结论成功建立了小鼠脊髓损伤打击模型;移植的外源性神经干细胞在脊髓损伤处存活并促进损伤后小鼠运动功能的恢复。     

Rat sciatic nerve crush injury and recovery tracked by plantar test and immunohistochemistry analysis

An experimental crush injury to the sciatic nerve, with a crush force of 49.2 N (pressure p=1.98x10(8) Pa), was inflicted in 30 male rats (Wistar). A control group (sham), with the same number of rats, was also operated upon exactly as the experimental group but without the crush injury. We tested the sensory and motor recovery of the sciatic nerve with Hargreaves method, using an apparatus from Ugo Basile, Italy. Testing was continued for both legs of each rat, injured and uninjured, starting preoperatively (0 day), and then 1, 7, 14, 21, and 28 days postoperatively. The same experiment was run simultaneously with the sham group. The Plantar test showed recovery of the sensory and motor function of the sciatic nerve, though not complete recovery, by 28 days. An immunohistochemical experiment was run in parallel with the plantar test on L3-L6 segments of the spinal cord from where the sciatic nerve extends. We used antibodies for Myelin-associated glycoprotein (MAG), and gangliosides GD1a and GT1b on the aforesaid part of the spinal cord. The immunohistochemical methods showed changes in sensory and motor axons in the spinal cord segment L3-L6 which suggest correspondence with the results of the Plantar test, in terms of recovery of the sensory and motor function after injury of the sciatic nerve. The immunohistochemical results also show ipsilateral and contralateral changes following injury. Results of the plantar test are suggestive that the rat shows compensation for an injury in its contralateral leg.     

Moderately Different NADPH-Diaphorase Positivity in the Selected Peripheral Nerves after Ischemia/ Reperfusion Injury of the Spinal Cord in Rabbit

1. To vicariously investigate the nitric oxide synthase (NOS) production after spinal cord injury, NADPH-d histochemistry was performed on the selected peripheral nerves of adult rabbits 7 days after ischemia. The effect of transient spinal cord ischemia (15 min) on possible degenerative changes in the motor and mixed peripheral nerves of Chinchilla rabbits was evaluated.2. The NADPH-diaphorase histochemistry was used to determine NADPH-diaphorase activity after ischemia/reperfusion injury in radial nerve and mediane nerve isolated from the fore-limb and femoral nerve, saphenous nerve and sciatic nerve separated from the hind-limb of rabbits. The qualitative analysis of the optical density of NADPH-diaphorase in selected peripheral nerves demonstrated different frequency of staining intensity (attained by UTHSCSA Image Tool 2 analysis for each determined nerve).3. On the seventh postsurgery day, the ischemic spinal cord injury resulted in an extensive increase of NADPH-d positivity in isolated nerves. The transient ischemia caused neurological disorders related to the neurological injury—a partial paraplegia. The sciatic, femoral, and saphenous nerves of paraplegic animals presented the noticeable increase of NADPH-d activity. The mean of NADPH-diaphorase intensity staining per unit area ranged from 134.87 (±32.81) pixels to 141.65 (±35.06) pixels (using a 256-unit gray scale where 0 denotes black, 256 denotes white) depending on the determined nerve as the consequence of spinal cord ischemia. The obtained data were compared to the mean values of staining intensity in the same nerves in the limbs of control animals (163.69 (±25.66) pixels/unit area in the femoral nerve, 173.00 (±32.93) pixels/unit area in saphenous nerve, 186.01 (±29.65) pixels/unit area in sciatic nerve). Based on the statistical analysis of the data (two-way unpaired Mann–Whitney test), a significant increase (p≤0.05) of NADPH-d activity in femoral and saphenous nerve, and also in sciatic nerve (p≤0.001) has been found. On the other hand, there was no significant difference between the histochemically stained nerves of fore-limbs after ischemia/reperfusion injury and the same histochemically stained nerves of fore-limbs in control animals.4. The neurodegenerative changes of the hind-limbs, characterized by damage of their motor function exhibiting a partial paraplegia after 15 min spinal cord ischemia and subsequent 7 days of reperfusions resulted in the different sensitivity of peripheral nerves to transient ischemia. Finally, we suppose that activation of NOS indirectly demonstrable through the NADPH-d study may contribute to the explanation of neurodegenerative processes and the production of nitric oxide could be involved in the pathophysiology of spinal cord injury by transient ischemia.     

甲基强的松龙对急性脊髓损伤患者神经生长因子水平变化的影响及其临床疗效

目的:探讨甲基强的松龙对急性脊髓损伤患者神经生长因子水平变化及临床疗效的影响。方法:回顾性研究我院收治的68例急性脊髓损伤患者的临床资料,随机分为实验组和对照组,每组34例。对照组患者给予常规治疗,实验组患者在对照组基础上给予甲基强的松龙治疗。观察并比较治疗前后两组患者神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平变化及神经功能评分和并发症的发生情况。结果:与治疗前相比,两组患者治疗后血清NGF及BDNF水平均升高,且感觉功能评分及运动功能评分均升高,差异具有统计学意义(P0.05);与对照组相比,实验组患者治疗后血清NGF及BDNF水平较高,感觉功能评分及运动功能评分较高,差异具有统计学意义(P0.05);与对照组相比,实验组患者并发症的发生率较低,差异具有统计学意义(P0.05)。结论:甲基强的松龙治疗急性脊髓损伤的临床疗效较好,能够提高患者血清NGF及BDNF水平,改善感觉功能评分及运动功能评分,同时降低并发症的发病率。     

Retrograde tracing and toe spreading after experimental autologous nerve transplantation and crush injury of the sciatic nerve: a descriptive methodological study

ABSTRACT: Evaluation of functional and structural recovery after peripheral nerve injury is crucial to determine the therapeutic effect of a nerve repair strategy. In the present study, we examined the relationship between the structural evaluation of regeneration by means of retrograde tracing and the functional evaluation analysis of toe spreading. Two standardized rat sciatic nerve injury models were used to address this relationship. As such, animals received either a 2 cm sciatic nerve defect (neurotmesis) followed by autologous nerve transplantation (ANT animals) or a crush injury with spontaneous recovery (axonotmesis; CI animals). Functional recovery of toe spreading was observed over an observation period of 84 days. In contrast to CI animals, ANT animals did not reach pre-surgical levels of toe spreading. After the observation period, the lipophilic dye DiI was applied to label sensory and motor neurons in dorsal root ganglia (DRG; sensory neurons) and spinal cord (motor neurons), respectively. No statistical difference in motor or sensory neuron counts could be detected between ANT and CI animals. In the present study we could indicate that there was no direct relationship between functional recovery (toe spreading) measured by SSI and the number of labelled (motor and sensory) neurons evaluated by retrograde tracing. The present findings demonstrate that a multimodal approach with a variety of independent evaluation tools is essential to understand and estimate the therapeutic benefit of a nerve repair strategy.     

Somatosensory evoked potential, neurological examination and magnetic resonance imaging for assessment of cervical spinal cord decompression

The present study was designed to determine the relationship between neurological testing, anatomical imaging, and electrophysiological monitoring for assessing outcome of cervical spinal cord decompression. We prospectively studied 28 consecutive patients (age 39-76 yr) who were subjected to presurgical-(1-3 wk) and postsurgical (3-4 mo) neurological examination and recording of the median nerve somatosensory evoked potential (SEP). In 13 patients, magnetic resonance imaging (MRI) was also performed. Changes in neurological function, SEP and MRI were evaluated and graded as (1) improvement,(2) no change or (3) deterioration. Neurological outcome (NO) was based on changes in motor grade strength, sensory, reflexes and gait. The SEP outcome was based on changes in latency and disappearance of SEP waveform components whereas MRI evaluation was based on changes in spinal cord and canal diameters. Significance of association between NO, SEP and MRI was determined by Pearson's Chi-Square statistic (P<.05). The SEP improved in 71% (20/28) and deteriorated in 28% (8/28) of the subjects. An association between SEP changes and NO was found in 82% (23/28) of the subjects (P = .0038). Decompression increased the spinal canal diameter in 92% (12/13), and the spinal cord diameter in 38% (5/13) of the subjects. An association between NO, or SEP and MRI was not detected. Changes in median nerve SEP latency appear to be predictive of the neurological status of patients subjected to cervical spinal cord decompression. Postoperative increments in SEP latency or disappearance of the SEP waves were indicative of poor outcome after surgical decompression of the cervical spinal cord.     

Weight-Bearing Locomotion in the Developing Opossum,Monodelphis domestica following Spinal Transection: Remodeling of Neuronal Circuits Caudal to Lesion

Complete spinal transection in the mature nervous system is typically followed by minimal axonal repair, extensive motor paralysis and loss of sensory functions caudal to the injury. In contrast, the immature nervous system has greater capacity for repair, a phenomenon sometimes called the infant lesion effect. This study investigates spinal injuries early in development using the marsupial opossum Monodelphis domestica whose young are born very immature, allowing access to developmental stages only accessible in utero in eutherian mammals. Spinal cords of Monodelphis pups were completely transected in the lower thoracic region, T10, on postnatal-day (P)7 or P28 and the animals grew to adulthood. In P7-injured animals regrown supraspinal and propriospinal axons through the injury site were demonstrated using retrograde axonal labelling. These animals recovered near-normal coordinated overground locomotion, but with altered gait characteristics including foot placement phase lags. In P28-injured animals no axonal regrowth through the injury site could be demonstrated yet they were able to perform weight-supporting hindlimb stepping overground and on the treadmill. When placed in an environment of reduced sensory feedback (swimming) P7-injured animals swam using their hindlimbs, suggesting that the axons that grew across the lesion made functional connections; P28-injured animals swam using their forelimbs only, suggesting that their overground hindlimb movements were reflex-dependent and thus likely to be generated locally in the lumbar spinal cord. Modifications to propriospinal circuitry in P7- and P28-injured opossums were demonstrated by changes in the number of fluorescently labelled neurons detected in the lumbar cord following tracer studies and changes in the balance of excitatory, inhibitory and neuromodulatory neurotransmitter receptors’ gene expression shown by qRT-PCR. These results are discussed in the context of studies indicating that although following injury the isolated segment of the spinal cord retains some capability of rhythmic movement the mechanisms involved in weight-bearing locomotion are distinct.     

神经生长因子对兔坐骨神经损伤后脊髓前角运动神经元乙酰胆碱酯酶的影响

钳夹损伤兔右坐骨神经,于损伤处注射蛇毒ＮＧＦ４００Ｂｕ／ｋｇ／日,损伤术后１,３,７天和２,３,４,６,８周动态观察脊髓腰段伤侧第Ⅸ板层外侧群的大型运动神经元的ＡＣｈＥ活性改变。结果表明术后１,３天实验组（指损伤给药组）和对照组（指损伤对照组）ＡＣｈＥ活性均下降（Ｐ＞００５）;术后１,２,３周对照组ＡＣｈＥ活性明显下降,而实验组ＡＣｈＥ活性逐渐趋于恢复（Ｐ＜００１）;术后６周实验组ＡＣｈＥ活性恢复至正常水平（Ｐ＜００１）。本研究显示蛇毒ＮＧＦ对坐骨神经损伤后脊髓前角运动神经元ＡＣｈＥ活性恢复有促进作用,从而对运动神经元可起一定的保护作用和促进恢复的作用     

Spinal Cord Transection in the Larval Zebrafish

Mammals fail in sensory and motor recovery following spinal cord injury due to lack of axonal regrowth below the level of injury as well as an inability to reinitiate spinal neurogenesis. However, some anamniotes including the zebrafish Danio rerio exhibit both sensory and functional recovery even after complete transection of the spinal cord. The adult zebrafish is an established model organism for studying regeneration following spinal cord injury, with sensory and motor recovery by 6 weeks post-injury. To take advantage of in vivo analysis of the regenerative process available in the transparent larval zebrafish as well as genetic tools not accessible in the adult, we use the larval zebrafish to study regeneration after spinal cord transection. Here we demonstrate a method for reproducibly and verifiably transecting the larval spinal cord. After transection, our data shows sensory recovery beginning at 2 days post-injury (dpi), with the C-bend movement detectable by 3 dpi and resumption of free swimming by 5 dpi. Thus we propose the larval zebrafish as a companion tool to the adult zebrafish for the study of recovery after spinal cord injury.     

Cortical reorganization in training.

Plasticity within the human central motor system occurs and has been studied with transcranial magnetic stimulation in patients with amputations, spinal cord injuries, and ischemic nerve block. These studies have identified a pattern of motor system reorganization that results in enlarged muscle representation areas and large motor evoked potentials (MEPs) for muscles immediately proximal to the lesion. Some of these changes are apparent minutes after ischemic nerve block, weeks after spinal cord injury, and as early as six months after amputation.These studies motivated us to study the cortical motor reorganization after finger movement training in normals and after anastomosis of intercostal nerves to the musculocutaneous nerve in young patients with cervical root avulsions due to a traumatic motorcycle injury.