脊髓损伤病理生理PPT课件

1、.,1,Yang xuan,PathophysiologyofSCI,.,2,CONTENTS,Epidemiology of SCI,PathophysiologyofSCI,EmergingRegeneration&RepairStrategies,SCI,.,3,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 wo

2、rk-related injuries (30%) violent crime (11%), sports-related injuries (9%),REGIONS : cervical spine,Epidemiology of SCI,.,4,VS,PrimaryInjuryPhase,SecondaryInjuryMechanisms,PathophysiologyofSCI,Click here to add title,axon,blood vessels,cell membrane,edema,electrolyte shifts,free radical production,

3、inflammation,cell death delayed apoptotic,.,5,compression-contusion type 1、shearing 2、laceration 3、acute stretching 4、sudden acceleration deceleration,in,PrimaryInjuryPhase,.,6,1,2,3,4,1：Immediate Phase (02 Hours),Acute Phase（2-48hours),Subacute Phase (2 Days to 2 Weeks),Intermediate Phase (2 Weeks

4、to 6 Months),SecondaryInjuryMechanisms,5、chronic phase(6 months),.,7,swelling and hemorrhage,Immediate Phase 0-2hours,spinal cord ischemia,cell membrane& vascular & microvasculature,glutamate TNF and IL-,.,8,action potential blockade,Vascularµvasculature disruption,activation of calpains, mitoc

5、hondrial dysfunction, free radical production .,Early Acute Phase (248 Hours),lipid peroxidation,glutamate rise,Ca+2 ions,.,9,free radical reaction,lipid peroxidation,axonal disruption death neurons& glia,membrane damage,cell lysis, the dysfunction of organelles, calcium dyshomeostasis,free radicals

6、 absorb an electron from a lipid molecule,ROS and RNS,.,10,Ionic Dysregulation,necrotic apoptotic cell death,mitochondrial damage, aberrant enzyme activation, changes in gene expression and apoptosis,excessive intracellular level of Ca+2 ions,.,11,Excitotoxicity,extracellular glutamate rise,excessiv

7、e activation of glutamate receptors,influx of Na+ and Ca+,injury,Neurons and oligodendrocytes,demyelination of axons and loss of neurons,.,12,Inflammatory Mediators Cellular Immune Response,activation of resident microglia.,astrocytes, microglia, T cells, neutrophils, invading monocytes.,infiltratio

8、n 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,

9、 lesion size, worsened functional recovery,.,13,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.,.,14,Subacute Phase (2 Days to 2 Weeks),astrocytes cytotoxic edem

10、a and necrotic cell death,hypertrophic aproliferative,astrocytic intermediate filament glial fibrillary acidic proteinGFAP,astrocytic scar,physical chemical barrier,ionic homeostasis the integrity of the BBB, resolution of the edema limiting the infiltration of immune cells,REACTIVE ASTROCYTOSIS,ben

11、efit,.,15,Intermediate Phase (2 Weeks to 6 Months),maturation of the astrocytic scar regenerative axonal sprouting,reticulospinal fibers 3-8months,corticospinal tract axons 3weeks-3months,insufficient functional recovery,.,16,Chronic Phase ( 6 Months),feature: 1 maturation/stabilization of the lesio

12、n including continued scar formation 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 removed 3 lesion, may not remain static, and syrinx formation in

13、 as many as 30% of patients with SCI can cause delayed neurological dysfunction (ascending paralysis, brainstem symptoms) and neuropathic pain,.,17,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，或者通过复