脊髓损伤病理生理PPT课件

,Yang xuan,PathophysiologyofSCI,CONTENTS,Epidemiology of SCI,PathophysiologyofSCI,EmergingRegeneration&RepairStrategies,SCI,AGE ： The average age from 28.7 to 37.6 years in the elderly from 4.7 to 10% SEX : male-to-female ratio is 4 to 1,CAUSE : motor vehicle accidents (50%), falls and work-related injuries (30%) violent crime (11%), sports-related injuries (9%),REGIONS : cervical spine,Epidemiology of SCI,VS,PrimaryInjuryPhase,SecondaryInjuryMechanisms,PathophysiologyofSCI,Click here to add title,axon,blood vessels,cell membrane,edema,electrolyte shifts,freeradical production,inflammation,cell death delayed apoptotic,compression-contusion type1、shearing2、laceration3、acute stretching4、sudden acceleration deceleration,in,PrimaryInjuryPhase,1,2,3,4,1：Immediate Phase (02 Hours),Acute Phase（2-48hours),Subacute Phase (2 Days to 2 Weeks),Intermediate Phase (2 Weeks to 6 Months),SecondaryInjuryMechanisms,5、chronic phase(6 months),swelling and hemorrhage,Immediate Phase 0-2hours,spinal cord ischemia,cell membrane& vascular & microvasculature,glutamateTNF and IL-,action potential blockade,Vascularµvasculature disruption,activation of calpains, mitochondrial dysfunction, free radical production .,Early Acute Phase (248 Hours),lipid peroxidation,glutamate rise,Ca+2 ions,free radical reaction,lipid peroxidation,axonal disruption death neurons& glia,membrane damage,cell lysis, the dysfunction of organelles, calcium dyshomeostasis,free radicals absorb an electron from a lipid molecule,ROS and RNS,Ionic Dysregulation,necrotic apoptotic cell death,mitochondrial damage, aberrant enzyme activation, changes in gene expression and apoptosis,excessive intracellular level of Ca+2 ions,Excitotoxicity,extracellular glutamate rise,excessive activationof glutamate receptors,influx of Na+ and Ca+,injury,Neurons and oligodendrocytes,demyelination of axons and loss of neurons,Inflammatory Mediators Cellular Immune Response,activation of resident microglia.,astrocytes, microglia, T cells, neutrophils,invading monocytes.,infiltration of inflammatory cells,TNF, interferons, aILs,traumatic spinal cord,overexpression of TNF- is deleterious in the acute phase, but beneficial in the chronic phase in the response to SCI,inhibition of TNF signaling,improve functional neurological recovery,TNF-deficient mice,increased apoptotic cells, lesion size, worsened functional recovery,Subacute Phase (2 Days to 2 Weeks),1 removing cell debris from the lesion area 2 promoting axon growth to some degree through theremoval of growth-inhibitory components of myelin debris.,Subacute Phase (2 Days to 2 Weeks),astrocytes cytotoxic edema and necrotic cell death,hypertrophic aproliferative,astrocytic intermediate filament glial fibrillary acidic proteinGFAP,astrocytic scar,physical chemical barrier,ionic homeostasisthe integrity of the BBB, resolution of the edema limiting the infiltration of immune cells,REACTIVE ASTROCYTOSIS,benefit,Intermediate Phase (2 Weeks to 6 Months),maturation of the astrocytic scar regenerative axonal sprouting,reticulospinal fibers3-8months,corticospinal tract axons3weeks-3months,insufficient functionalrecovery,Chronic Phase ( 6 Months),feature:1 maturation/stabilization of the lesion including continued scarformation and the development of cysts and/or syrinxes.2 The process of Wallerian degeneration of injured or severed axons is ongoing and it may take years for severed axons and their cell bodies to be fully removed3 lesion, may not remain static, and syrinx formation in as many as 30% of patients with SCI can cause delayed neurological dysfunction (ascending paralysis, brainstem symptoms) and neuropathic pain,国外研究综述,Click here to add title,您的内容打在这里，或者通过复制您的文本后，在此框中选择粘贴，并选择只保留文字。您的内容打在这里，或者通过复制您的文本后，在此框中选择粘贴，并选择只保留文字。您的内容打在这里，或者通过复制您的文本后，在此框中选择粘贴，并选择只保留文字。,您的内容打在这里，或者通过复制您的文本后，在此框中选择粘贴，并选择只保留文字。您的内容打在这里，或者通过复制您的文本后，在此框中选择粘贴，并选择只保留文字。,国外研究综述,您的内容打在这里