Cord Swelling Research Articles

Photobiomodulation reduces spinal cord edema by decreasing the expression of AQP4 in the astrocytes of male spinal cord injury rats via the JAK2/STAT3 signaling pathway.

BackgroundSpinal cord swelling commonly occurs following SCI. Previous studies suggest that PBM may reduce inflammation and scar formation after SCI. However, whether PBM can alleviate post-spinal cord injury edema and its underlying mechanisms have not yet been reported. This study aims to investigate the effects of PBM on spinal cord swelling in rats following SCI and explore the underlying mechanisms. MethodsA rat model of SCI was established, and the rats received continuous PBM therapy for two weeks. Tissue hydration, motor function, AQP4 expression, and pathological changes in the spinal cord were evaluated at different time points. In vitro, astrocytes were subjected to PBM and treated with either cucurbitacin I or TGN020 following OGD. ResultsThe results indicate that PBM reduces tissue swelling in rats with SCI, improves motor function recovery, and inhibits the upregulation of AQP4 and GFAP associated with SCI. In vitro, PBM reduces abnormal activation of the JAK2/STAT3 signaling pathway in astrocytes, leading to decreased AQP4 synthesis and astrocyte activation. ConclusionsThese findings suggest that PBM reduces spinal cord swelling in rats after injury. This effect is associated with the inhibition of JAK2/STAT3 signaling pathway activation in astrocytes and the reduction in AQP4 expression.

Predictive value of magnetic resonance imaging indications of spinal cord swelling for cervical spondylotic myelopathy prognosis.

Magnetic resonance imaging (MRI) is the preferred examination approach for patients with suspected cervical spondylotic myelopathy (CSM). To investigate the predictive value of MRI spinal cord swelling on the prognosis of decompression surgery in patients with CSM. A retrospective analysis of 115 patients with CSM who underwent decompression surgery was performed. According to whether cervical MRI showed spinal cord swelling, they were divided into a spinal cord swelling group and non-swelling group. The Modified Japanese Orthopaedic Association (MJOA) score, MJOA improvement rate and abnormal spinal cord enhancement rate in the two groups were compared before and after surgery. Multiple linear regression was used to analyse the influencing factors of the MJOA improvement rate. The time from symptom onset to operation (t= 2.400, p= 0.018) and preoperative MJOA score in the spinal cord swelling group were lower than those in the non-swelling group (t= 3.253, p= 0.002). The body mass index (t= 2.895, p= 0.005), anteroposterior diameter of the spinal canal (t= 4.421, p< 0.001), cross-sectional area (t= 3.136, p= 0.002), postoperative improvement rate (t= 4.277, p< 0.001) and proportion of abnormal enhancement of the spinal cord in the swelling group were higher than those in the non-swelling group (χ2= 3.136, p= 0.002). The preoperative MJOA score in the swelling group was lower than that in the non-swelling group (t= 2.583, p= 0.013). A multivariate linear regression model revealed that age and spinal cord swelling were independent predictors of MJOA score improvement, explaining 33.2% of the total variation. Patients with CSM with spinal cord swelling have less time from symptoms to surgery, and the degree of preoperative neurological deterioration is more obvious. Spinal cord swelling is an independent predictor of surgical prognosis in patients with CSM.

Efficacy of spinal fusion in treatment of splintered fracture of the C6 vertebral body with spinal cord compression in an adolescent (case history)

Fractures and dislocation fractures of C5‑Th1 vertebrae account for about 70 % of all spinal injuries. The article describes a case history of the successful treatment of the fractured C6 vertebra by means of spinal fusion with an autogenous bone. The SCT (spiral computed tomography) and MRI (magnetic resonance imaging), performed for diagnostic purposes, showed a splintered fracture of the C6 vertebra with spinal cord compression and mild spinal cord swelling. The clinical picture indicated acute pain in the cervical spine, quadriplegia, and functional disorder of the pelvic organs caused by the severity and level of the injury. The patient underwent two simultaneous surgeries: during the first operation, a fragment of autologous bone from the left iliac wing was taken, and during the second surgery, spinal fusion of C5‑C7 with autologous bone and fixation with a titanium plate were performed. After the interventions, the follow-up SCT of the C-spine showed no signs of spinal cord compression, and the wedge-shaped deformation of the vertebral canal was remedied. No displacement of the vertebral bodies and changes in the height of the vertebrae and vertebral discs is present. After treatment, the patient will undergo long-term rehabilitation measures. The obtained result proves the efficacy of autobone spinal fusion with anterior low-profile titanium plate fixation with four screws. Due to correct and timely medical care provided to the patient, all of the treatment objectives (minimizing secondary injuries of the spinal cord and ensuring optimal conditions for recovery of neurons and axons in the area of disturbed blood supply, spine stabilization) were accomplished.

Diagnosis of spinal dural arteriovenous fistula: a multimodal MRI assessment strategy

To identify more specific screening indicators at magnetic resonance imaging (MRI) for the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) and to determine an efficient diagnostic strategy. This retrospective study analysed clinical and imaging data of patients diagnosed with SDAVF and alternative myelopathy who underwent conventional MRI examinations. Additionally, three-dimensional (3D) T2-weighted sampling perfection with application-optimised contrasts using different flip-angle evolutions (3D-T2-SPACE) and contrast-enhanced magnetic resonance angiography (CE-MRA) data from patients with SDAVF were compared with digital subtraction angiography (DSA) data. The age of onset, perimedullary flow voids (PFV), distribution of lesions, syringomyelia, degree of spinal oedema, and cauda equina disorder (CED) were factors that showed statistically significance in the identification of SDAVF with alternative myelopathy. After controlling for age, gender, PFV, degree of spinal cord swelling, and syringomyelia, the multivariable ordinal logistic regression model showed that the CED sign (OR = 32.46; 95% confidence interval [CI]: 2.47-427.15; p=0.008) was an independent predictor for SDAVF. The diagnostic model constructed using the PFV and CED signs had better diagnostic performance, with an area under the curve of 0.957 (p<0.001), maximum Youden index of 0.844, sensitivity of 92.9%, and specificity of 91.5%. Both 3D-T2-SPACE (77.8%) and CE-MRA (83.3%) sequences had good localisation values for SDAVF. Combining the two imaging examinations had better diagnostic accuracy than that of DSA. CED and PFV on conventional MRI were specific indicators for the diagnosis of SDAVF. To compensate for the lack of fistula localisation on conventional MRI, 3D-T2-SPACE and CE-MRA can be used. Together they complement each other and have good diagnostic potential.

Development of a novel 12-point grading system for evaluating epidural spinal cord compression and its clinical implications

BACKGROUND CONTEXTThe assessment of epidural spinal cord compression (ESCC) plays a crucial role in clinical decision-making, yet the current grading system lacks reliability and requires improvements. PURPOSEThe study aims to develop a reliable grading system for evaluating ESCC and to investigate its association with the neurological status of patients. STUDY DESIGN/SETTINGA prospective cohort study. PATIENT SAMPLEA total of 330 patients with metastatic spinal disease were included in the study. OUTCOME MEASURESThe main outcome was the neurological status evaluated using the American Spinal Injury Association (ASIA) scale. METHODSWe proposed a novel grading system, called the 12-point ESCC grading system, to evaluate ESCC based on findings from spinal magnetic resonance imaging (MRI). This new grading system consists of 12 grades, ranging from Grade 0 to 3, with higher grades indicating more severe ESCC. The detailed information about the sagittal image of the spine and the severity of spinal cord swelling was considered in this new grading system. The Spearman correlation analysis and logistic regression analysis were employed to investigate the correlation between the previous 6-point grading system and ASIA, as well as between the new 12-point ESCC grading system and ASIA. The prediction effectiveness was evaluated using the area under curve (AUC) analysis. RESULTSPatients with higher grades in the 12-point ESCC grading system exhibited a higher likelihood of experiencing a worse neurological condition. Specifically, patients with grades 2a to 2d and 3a to 3d according to the new 12-point ESCC grading system were significantly associated with more complete paralysis (p<.001) compared with patients with grade 0. The Spearman correlation coefficient was 0.729 between the previous 6-point ESCC grading system and ASIS and 0.750 between the new 12-point ESCC grading system and ASIS. When categorizing ASIS into complete paralysis and other neurological statuses, the 6-point ESCC score yielded an AUC of 0.820, which increased to 0.860 with the new 12-point ESCC grading system. Furthermore, when ASIS was divided into normal and abnormal neurological statuses, the AUC increased from 0.889 to 0.906. Additionally, spinal cord swelling was significantly associated with more complete paralysis (p<.001) and abnormal neurological status (p<.001) based on the new 12-point ESCC grading system. CONCLUSIONSThe new 12-point ESCC grading system provides more detailed information and further improves the prediction effectiveness for evaluating neurological status compared with the previous 6-point ESCC grading system. In the new 12-point ESCC grading system, higher grades or the presence of spinal cord swelling are indicative of a worse neurological condition.

A case series of 37 surgically managed, paraplegic, deep pain negative French bulldogs, with thoracolumbar intervertebral disc extrusion, from two English referral centres.

Thoracolumbar intervertebral disc extrusions (TL-IVDEs) are a common spinal disorder in dogs, especially within chondrodystrophic breeds. Loss of deep pain perception is a well-documented negative prognostic indicator in dogs with TL-IVDE. The objectives of this study were to report the rate of return of deep pain perception and independent ambulation in surgically treated, paraplegic, deep pain perception negative French bulldogs with TL-IVDEs. A retrospective case series of deep pain perception negative dogs with TL-IVDE presenting to two referral centres between 2015 and 2020 was conducted. Medical and MRI records were reviewed, including the following quantitative MRI changes: lesion length, extent of spinal cord swelling and severity of spinal cord compression. Thirty-seven French bulldogs met the inclusion criteria, with 14 of 37 (38%) regaining deep pain perception by the time of discharge (median hospitalisation 10.0 days [interquartile range 7.0-15.5 days]) with two dogs independently ambulatory (6%). Ten of the 37 dogs were euthanased during hospitalisation. Significantly fewer dogs (3/16, 19%) with L4-S3 lesions regained deep pain perception compared to 11 of 21 (52%) of dogs with T3-L3 lesions (p = 0.048). Quantitative MRI changes were not associated with the return of deep pain perception. After discharge, with a median 1-month follow-up period, an additional three dogs regained deep pain perception and five dogs became independently ambulatory (17/37 [46%] and 7/37 [19%], respectively). This study adds support to the contention that the recovery of French bulldogs with TL-IVDE from surgery is poor compared with other breeds; further prospective, breed-controlled studies are indicated.

AN OBSERVATION ON DESARDA TECHNIQUE OF INGUINAL HERNIA REPAIR

Background: Inguinal hernia repair is one of the most commonly performed procedure in surgical practice throughout the world. The non-mesh repair technique of inguinal hernia by Mohan P. Desarda is becoming popular nowadays. Study of the outcomes of the procedure and comparison with other workers is desirable for wider acceptance of the procedure. To study the Objective: outcomes of inguinal hernia repair by Desarda technique. This is an observational study of 32 patients with inguinal hernia repair by Desarda techn Methodology: ique carried out in Dept. of general surgery, Patna Medical College and Hospital, Patna from October 2020 to October 2022. Out of 32 patients included in the study 18 Result: right sided,12 left sided and 2 bilateral inguinal hernia was there. The mean age of study population was 42.72±12.137 years. Mean operating time was found to be 60.81±10.91 minutes. Majority (87.5%) of the patients experienced moderate pain (measured by VAS ) on the rst post-operative day which gradually decreased with the time. Different postoperative complications ; hematoma in 1 patient (3.125%), seroma in 2 patients (6.25%), surgical site infection in 1 patient (3.125%), scrotal swelling in 2 patients (6.125%) and cord swelling in 1 patient (3.125%) were seen. Conclusion: Non mesh Desarda repair of inguinal hernia repair is associated with less operating time, early ambulation, less post operative pain and complication. As it doesn't use mesh so it is cost effective also and should denitely be encouraged.

A diagnostic conundrum in the time of a pandemic: a subtle, isolated myelopathy. (P10-5.028)

<h3>Objective:</h3> NA <h3>Background:</h3> Anti-CV2/collapsin response-mediator protein 5 (CRMP5) antibodies are considered “high-risk” markers, frequently associating with paraneoplastic syndromes (PNS). <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 44-year-old woman was recovering from a mild case of COVID-19 when she presented with a single episode of urinary retention and a subacute paraparesis with prominent sensory disturbances and girdle-like pain. Since a spinal cord MRI did not show any lesions and EMG did not detect any conduction defects, she refused further examinations and underwent empiric antimicrobial and steroid therapy, along with physical treatment. However, almost two months later she was still suffering from dysesthesia, dysuria, dyschezia and gait disturbance. A second MRI revealed multiple, asymmetric, short-segment lesions in the spinal cord, with persistent contrast-enhancement (despite the previous steroid treatment), but no brain involvement. Cerebrospinal fluid (CSF) analysis and infectious workup were unremarkable, detecting only a slight increase in CSF proteins and a mirror pattern. An extensive screening for autoimmune and paraneoplastic diseases disclosed anti-CV2/CRMP5 antibodies in the serum; however, antibody titer and confirmatory tests were not available at that time and there was no corresponding reactivity in her CSF. After 3 months the antibodies were still present, arguing for a PET scan, which was uneventful. In the meanwhile the woman was treated with IV steroids, followed by a slow oral tapering with gradual but significant improvement. Indeed, after 6 months the MRI showed a diffuse reduction of the spinal cord swelling and T2 signal change, with no contrast enhancement; her neurological exam still remains strikingly normal. <h3>Conclusions:</h3> This remarkable response to immunotherapy, along with the atypical clinical phenotype and radiographic findings (when compared to reported anti-CV2/CRMP-5 myelopathies), argues for an alternative diagnosis, contemplating a post-infectious etiology rather than a PNS. The case also underlines how commercial line blots should always be confirmed by alternative and more reliable techniques. <b>Disclosure:</b> Federica Boso has nothing to disclose. Dr. Giometto has nothing to disclose.

An unusual case of a tibial metastasis as the first clinical presentation of a serous papillary carcinoma of the ovarian epithelial type of the testis.

Among testicular neoplasms, ovarian-type epithelial tumors constitute an exceedingly rare group, with only a few cases reported in the literature. We describe the case of an 82-year-old man, presented with complaints of right leg pain and difficulty walking, who was found to have a large right tibial metastasis of unknown primary origin. Whole body CT scan did not reveal any cranial, thoracic or abdominal tumor masses, but it showed abnormal para-aortic lymph nodes and right spermatic cord swelling. An extemporary ultrasound examination found a right testicular mass. The patient underwent radical orchiectomy, and the diagnosis of a serous papillary carcinoma of the ovarian epithelial type of the testis was made. To the best of our knowledge, this is the first case in the literature of isolated bone metastasis from ovarian-type epithelial tumor of testis.

Characterising spinal cerebrospinal fluid flow in the pig with phase-contrast magnetic resonance imaging

BackgroundDetecting changes in pulsatile cerebrospinal fluid (CSF) flow may assist clinical management decisions, but spinal CSF flow is relatively understudied. Traumatic spinal cord injuries (SCI) often cause spinal cord swelling and subarachnoid space (SAS) obstruction, potentially causing pulsatile CSF flow changes. Pigs are emerging as a favoured large animal SCI model; therefore, the aim of this study was to characterise CSF flow along the healthy pig spine.MethodsPhase-contrast magnetic resonance images (PC-MRI), retrospectively cardiac gated, were acquired for fourteen laterally recumbent, anaesthetised and ventilated, female domestic pigs (22–29 kg). Axial images were obtained at C2/C3, T8/T9, T11/T12 and L1/L2. Dorsal and ventral SAS regions of interest (ROI) were manually segmented. CSF flow and velocity were determined throughout a cardiac cycle. Linear mixed-effects models, with post-hoc comparisons, were used to identify differences in peak systolic/diastolic flow, and maximum velocity (cranial/caudal), across spinal levels and dorsal/ventral SAS. Velocity wave speed from C2/C3 to L1/L2 was calculated.ResultsPC-MRI data were obtained for 11/14 animals. Pulsatile CSF flow was observed at all spinal levels. Peak systolic flow was greater at C2/C3 (dorsal: − 0.32 ± 0.14 mL/s, ventral: − 0.15 ± 0.13 mL/s) than T8/T9 dorsally (− 0.04 ± 0.03 mL/s; p < 0.001), but not different ventrally (− 0.08 ± 0.08 mL/s; p = 0.275), and no difference between thoracolumbar levels (p > 0.05). Peak diastolic flow was greater at C2/C3 (0.29 ± 0.08 mL/s) compared to T8/T9 (0.03 ± 0.03 mL/s, p < 0.001) dorsally, but not different ventrally (p = 1.000). Cranial and caudal maximum velocity at C2/C3 were greater than thoracolumbar levels dorsally (p < 0.001), and T8/T9 and L1/L2 ventrally (p = 0.022). Diastolic velocity wave speed was 1.41 ± 0.39 m/s dorsally and 1.22 ± 0.21 m/s ventrally, and systolic velocity wave speed was 1.02 ± 0.25 m/s dorsally and 0.91 ± 0.22 m/s ventrally.ConclusionsIn anaesthetised and ventilated domestic pigs, spinal CSF has lower pulsatile flow and slower velocity wave propagation, compared to humans. This study provides baseline CSF flow at spinal levels relevant for future SCI research in this animal model.

A Case of Paraneoplastic NMOSD With Sarcoma and Unusual Cauda Equina Enhancement

Objective To describe a case of sarcoma associated with NMOSD presenting with myeloradiculitis. Background Neuromyelitis optica is a demyelinating disease of the CNS that predominantly affects the spinal cord and optic nerves. Reports of NMOSD occurring in the setting of cancer suggest that aquaporin-4 autoimmunity may have a paraneoplastic basis. Here, we describe a patient with metastatic sarcoma who tested positive for aquaporin-4 IgG consistent with NMOSD. Design/Methods 66-year-old man with left thigh soft tissue sarcoma with metastasis to the lungs admitted for 2-day history of urinary retention. Neurological exam showed bilateral lower extremity weakness, with decreased patellar reflexes. MRI spine showed cord swelling with enhancement from C6 downwards into the thoracic spine with associated syringohydromyelia and diffuse enhancement of the cauda equina. MRI brain was normal without abnormal enhancement in the optic nerves. CSF analysis demonstrated elevated protein and 0 oligoclonal bands. Was started on methylprednisolone 1 gram daily for 5 days empirically for transverse myelitis. Extensive serum and CSF workup for other causes of myelopathy including rheumatologic, infectious, and nutritional etiologies were unremarkable until NMO IgG antibody came back positive at 1:10000 titer. He had minimal clinical improvement after methylprednisolone course and so was started on plasmapheresis for five days. His weakness improved slightly but continued to have urinary retention. Discharged to a long-term acute care facility on prednisone 60 mg daily with intermittent bladder catheterization and plan for follow-up with Neuroimmunology. Results NA. Conclusions Myeloradiculitis has been reported with anti-MOG disease but is not a typical finding for NMO. We report this case to highlight this unusual finding. In addition, sarcoma is an uncommon cause of paraneoplastic syndromes and to our knowledge, this is the first report of sarcoma being associated with paraneoplastic NMOSD.

Diagnostic yield of magnetic resonance (MRI) imaging and treatment outcomes in patients with spinal cord trauma in, Nigeria: A single centre study

Background: Spinal cord trauma (SCT) is a devastating condition that can lead to significant neurological impairment and reduced quality of life. Magnetic Resonance Imaging (MRI) has been playing an increasingly important role in the management of spinal trauma patients. This study was designed to determine diagnostic yield of magnetic resonance imaging and the relationship between MRI findings and treatment outcomes in patients with trauma to the spinal cord. Materials and Method: A total of 245 patients who meet the inclusion criteria had their records and MRI findings evaluated retrospectively using convenience sampling method. The quantitative parameters that were used included: maximum spinal cord compression (MSCC), maximum canal compromise (MCC) and length of lesion while the qualitative parameters used are; intramedullary haemorrhage, cord oedema, cord swelling, disc herniation and soft tissue injury. Data such as cause of injury, anatomical level of injury, associated injury, and time of presentation, neurological/clinical presentation, and patterns of treatment, duration of hospitalization, ASIA classification and treatment outcome were collected. Results: The majority 53.47% (n = 131) had cervical spine involvement. Greater proportion 61.22 % (n=150) of spinal cord injuries were caused by road traffic accident (RTA). Most of the patients 33.06% (n=81) had only haemorrhage. Majority 51.02% (n = 125) had ASIA A and the least 4.49% (n = 11) had ASIA E classification. Among ASIA A patients, 21.63% (n = 53) had only haemorrhage while 29.39% (n= 72) had both haemorrhage and Oedema. Out of 53 ASIA A patients that had only haemorrhage, 21.57% (n = 11) of the ASIA A patients had incomplete recovery while 78.43% (n = 42) had no recovery. Out of the 72 ASIA A patients that had both haemorrhage and oedema, 18.06% (n = 13) had incomplete recovery while 81.94% (n = 59) had no recovery. Conclusion: The majority of the patients had cervical spine cord injuries and RTA was the most common causes of spinal cord injuries. Most of the patients had ASIA a classes of spinal cord injuries with more of them having only haemorrhage. The patients’ recovery rate was very poor across all the various classes of ASIA and MRI has shown to be good prognostic tools for the evaluation of spinal cord injuries.

HASTE MRI sequence findings correlate with loss of deep pain perception in dogs with thoracolumbar disc extrusion.

Thoracolumbar intervertebral disc extrusion (TL IVDE) is a common reason for the veterinary hospital admission. Various imaging factors including degree and length of compression have been tested for correlation with clinical severity, but no reliable correlation has been found. Half-Fourier acquisition single-shot turbo spin echo (HASTE) magnetic resonance imaging (MRI) sequences highlight the dorsal and ventral cerebrospinal fluid (CSF) columns and have been used to demonstrate spinal cord swelling in dogs with TL IVDE. This has been used as a predictor of progressive ascending-descending myelomalacia but has not been correlated with neurological grade. This study aims to investigate the correlation between the attenuation of CSF HASTE signal and clinical severity in dogs suffering from TL disc extrusions. Dogs less than 15kg who were non-ambulatory due to suspected TL IVDE were prospectively recruited for a study into conservative management. MRI studies were undertaken under sedation including HASTE sequences. The ratio of the length of CSF attenuation to the length of the L2 vertebra was calculated and correlated with clinical severity. Twenty dogs met the inclusion criteria. No statistically significant difference was demonstrated between the mean CSF attenuation and neurological grade (p= 0.17 but there was a significant difference in the mean CSF attenuation in those who retained deep pain perception and those who did not (p= 0.02). Time to loss of ambulation was also found to not be correlated with CSF attenuation (p= 0.95). In conclusion, the length of CSF attenuation of HASTE MRI sequences in dogs less than 15kg suffering from IVDEs may be correlated with a loss of deep pain perception.

Traumatic Cervical Spinal Cord Injury: Correlation of Imaging Findings with Neurological Outcome

Abstracts Background Traumatic spinal cord injury (TSCI) is extremely costly to the global health system. Due to the significant frequency rate of traumatic cervical spinal cord injuries (TCSCI), the possible association between imaging findings and clinical outcome is not yet clear. In this study, we quantified maximum spinal cord compression and maximum cord swelling following TCSCI and determined the relevance of imaging findings to clinical outcome in patients. Materials and Methods This retrospective cohort comprises 20 patients with TCSCIs (C3-C7), classified as complete, incomplete, and no SCI, who were treated at the Poursina Hospital, Iran, from 2018 to 2020, and underwent spinal surgery. Patients with penetrating injuries and multiple trauma were excluded. Imaging findings revealing spinal cord compression, swelling, and canal stenosis, based on the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of patients from hospital admission (up to 48 hours after injury) and improvement of postoperative neurological symptoms (6–12 months) were evaluated. Results Cord compression (p = 0.05) and cord swelling (p = 0.02) were significantly related to predictive neurological outcomes in all cases. Evaluation with AIS at hospital admission and at 6 to 12 months postoperatively showed significant correlation with fracture type (p = 0.05) and the longitudinal length of the intramedullary lesion (IML); p = 0.01, respectively. Conclusion According to the results obtained in this study, it may be concluded that there is a significant association between cervical spinal cord compression and swelling, and clinical outcomes in patients with complete, incomplete, and no SCI.

Integrated strategy of network pharmacology, molecular docking, HPLC-DAD and mice model for exploring active ingredients and pharmacological mechanisms of Penthorum chinense Pursh against alcoholic liver injury

Ethnopharmacological relevancePenthorum chinense Pursh (PCP, Saxifragaceae) is an edible plant and frequently-used Chinese herbal medicine, and is commonly used as Miao medicine in China. It showed well effect on alcoholic liver injury (ALI), but studies on its active ingredients and mechanisms against ALI remain at the starting stage. Aim of the studyThis work aims to explore the active ingredients and pharmacological mechanisms of PCP against ALI. Materials and methodsFirst, network pharmacology was applied to decipher the potential active ingredients and pharmacological mechanisms of PCP against ALI by ingredient identification, ADMET evaluation, target identification, network construction and analysis, protein-protein interaction (PPI) analysis, and gene enrichment analysis. Second, molecular docking was used to explore the interaction between key active ingredient and hub protein of PCP against ALI. Then, the ingredient analysis of PCP aqueous extract and semiquantitative analysis of key active ingredient were carried out on HPLC-DAD. Subsequently, mice with ALI were used to investigate the therapeutic effect or verify the predicted mechanisms of PCP or key active ingredient against ALI by analyzing body weight, liver index, ALT and AST activities in serum and liver tissues, oxidation related indices (SOD activity, GSH level and MDA level) in liver tissues, histopathology of liver tissues (oil red O, hematoxylin-eosin and DAB-TUNEL staining), and changes of related proteins (PI3K, Akt, p-Akt, Bax and Bcl-2) in liver tissues with the aid of Western blot. ResultsNetwork pharmacology showed that the active ingredients and related genes of PCP against ALI comprised 10 ingredients and 52 genes. Based on the result of ingredient analysis of PCP aqueous extract, quercitrin was identified as the key active ingredient of PCP against ALI. PPI analysis indicated that AKT1 was the hub gene of PCP against ALI, and molecular docking suggested that there were good interaction between quercetin and Akt1 protein. Gene enrichment analysis showed that the pivotal molecular mechanism of PCP against ALI might be to inhibit hepatocyte apoptosis via activation of PI3K-Akt signaling pathway. PCP and quercitrin showed anti-ALI effect by offsetting weight loss and increase of liver index, and reversing the imbalance of oxidative stress and histopathological changes of liver tissues (abnormal fatty acid metabolism, hepatic cord swelling and inflammatory cell infiltration) in mice with ALI. PCP caused the decrease of DAB-TUNEL-positive cells, upregulated the anti-apoptotic proteins (PI3K, Akt and p-Akt) levels and the ratio of p-Akt/Akt, and downregulated pro-apoptotic protein (Bax) level and the ratio of Bax/Bcl-2 in liver tissues of mice with ALI, indicating that the mechanism of PCP against ALI involved in inhibiting hepatocyte apoptosis via activation of PI3K-Akt signaling pathway. ConclusionPCP and quercitrin showed well anti-ALI effect. The key active ingredient of PCP against ALI was identified as quercitrin. The underlying pharmacological mechanisms of PCP against ALI may be related to PI3K-Akt signaling pathway-mediated inhibition of hepatocyte apoptosis. This work provided new evidence to support the application of PCP in treatment of ALI, and a research basis for the research and development of functional foods or drugs against ALI from PCP.

Novel Therapeutic Effects in Rat Spinal Cord Injuries: Recovery of the Definitive and Early Spinal Cord Injury by the Administration of Pentadecapeptide BPC 157 Therapy.

Recently, marked therapeutic effects pertaining to the recovery of injured rat spinal cords (1 min compression injury of the sacrocaudal spinal cord (S2-Co1) resulting in tail paralysis) appeared after a single intraperitoneal administration of the stable gastric pentadecapeptide BPC 157 at 10 min post-injury. Besides the demonstrated rapid and sustained recovery (1 year), we showed the particular points of the immediate effect of the BPC 157 therapy that began rapidly after its administration, (i) soon after injury (10 min), or (ii) later (4 days), in the rats with a definitive spinal cord injury. Specifically, in counteracting spinal cord hematoma and swelling, (i) in rats that had undergone acute spinal cord injury, followed by intraperitoneal BPC 157 application at 10 min, we focused on the first 10–30 min post-injury period (assessment of gross, microscopic, and gene expression changes). Taking day 4 post-injury as the definitive injury, (ii) we focused on the immediate effects after the BPC 157 intragastric application over 20 min of the post-therapy period. Comparable long-time recovery was noted in treated rats which had definitive tail paralysis: (iii) the therapy was continuously given per orally in drinking water, beginning at day 4 after injury and lasting one month after injury. BPC 157 rats presented only discrete edema and minimal hemorrhage and increased Nos1, Nos2, and Nos3 values (30 min post-injury, (i)) or only mild hemorrhage, and only discrete vacuolation of tissue (day 4, (ii)). In the day 4–30 post-injury study (iii), BPC 157 rats rapidly presented tail function recovery, and no demyelination process (Luxol fast blue staining).

Magnetic Resonance Imaging in 50 Captive Non-domestic Felids - Technique and Imaging Diagnoses.

Magnetic resonance imaging (MRI) is the recognized gold standard for diagnostic imaging of the central nervous system in human and veterinary patients. Information on the use of this modality and possible imaging abnormalities in captive non-domestic felids is currently limited to individual case reports or small case series. This retrospective study provides information on technique and imaging findings in a cohort of cases undergoing MRI at an academic Veterinary Medical Center. The University of Tennessee College of Veterinary Medicine MRI database was searched for non-domestic felids undergoing MRI of the brain or spine from 2008 to 2021. Medical record data were recorded, and MRI studies were reviewed. Fifty animals met the inclusion criteria. The most common brain diseases were Chiari-like malformation (n = 8) and inflammatory conditions (n = 8). Other abnormalities included pituitary lesions (n = 5), brain atrophy (n = 2), and one each of metabolic and traumatic conditions. Fourteen animals had a normal brain MRI study. The most common spinal abnormality was intervertebral disc disease (n = 7). Other disorders included vertebral dysplasia (n = 2), presumptive ischemic myelopathy (n = 1), subdural ossification causing spinal cord compression (n = 1), and multiple myeloma (n = 1). Spinal cord swelling of undetermined cause was suspected in two animals, and seven patients had a normal MRI study of the spine. MRI is a valuable tool in the diagnostic workup of non-domestic felids with presumptive neurologic disease.

Gadolinium Enhancement in Cervical Spondylosis Patients with Spinal Cord Swelling

Gadolinium Enhancement in Cervical Spondylosis Patients with Spinal Cord Swelling

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Isolated thoracic intramedullary Erdheim-Chester disease presenting with paraplegia: a case report and literature review

BackgroundErdheim-Chester disease (ECD) is a rare, idiopathic, systemic non-Langerhans cell histiocytosis involving long bone and visceral organs. Central nervous system (CNS) involvement is uncommon and most cases develop as a part of systemic disease. We present a rare case of variant ECD as an isolated intramedullary tumor.Case presentationA 75-year-old female patient with a medical history of diabetes and hypertension presented with sudden-onset flaccid paraparesis for 1 day. Neurological examination revealed grade 2–3 weakness in both legs, decreased deep tendon reflex, loss of anal tone, and numbness below T4. Leg weakness deteriorated to G1 before surgery. Preoperative magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed an intramedullary mass lesion at T2-T4 with no systemic lesion, which was heterogeneous enhancement pattern with cord swelling and edema from C7 to T6. Gross total removal was achieved for the white-gray-colored and soft-natured intramedullary mass lesion with an ill-defined boundary. Histological finding revealed benign histiocytic proliferation with foamy histiocytes and uniform nuclei. We concluded it as an isolated intramedullary ECD. The patient showed self-standing and walkable at 18-month with no evidence of recurrence and new lesion on spine MRI and whole-body FDG-PET/CT until sudden occurrence of unknown originated thoracic cord infarction.ConclusionsWe experienced an extremely rare case of isolated intramedullary ECD, which was controlled by surgical resection with no adjuvant therapy. Histological examination is the most important for final diagnosis, and careful serial follow-up after surgical resection is required to identify the recurrence and progression to systemic disease.