2
|
Feng J, Li T, Lv M, Kim S, Shin JH, Zhao N, Chen Q, Gong Y, Sun Y, Zhao Z, Zhu N, Cao J, Fang W, Chen B, Zheng S, Xu Z, Jin X, Shen Y, Qiu Y, Yin H, Jiang S, Li J, Ying Y, Chen L, Liu Y, Jia J, Zuo C, Xu J, Gu Y, Xu W. Reconstruction of paralyzed arm function in patients with hemiplegia through contralateral seventh cervical nerve cross transfer: a multicenter study and real-world practice guidance. EClinicalMedicine 2022; 43:101258. [PMID: 35028546 PMCID: PMC8741478 DOI: 10.1016/j.eclinm.2021.101258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A previous randomized controlled trial showed contralateral seventh cervical nerve (CC7) cross transfer to be safe and effective in restoring the arm function of spastic arm paralysis patients in a specified population. Guidance on indications, safety and expected long-term improvements of the surgery are needed for clinical practice. METHODS This is a retrospective, multicenter, propensity score-matched cohort study. All patients registered between 2013 and 2019 with unilateral spastic arm paralysis over 1 year who were registered at one of five centers in China and South Korea were included. Patients received CC7 cross transfer or rehabilitation treatment in each center. Primary outcome was the change in the upper-extremity Fugl-Meyer (UEFM) score from baseline to 2-year follow-up; larger increase indicated better functional improvements. FINDINGS The analysis included 425 eligible patients. After propensity score matching, 336 patients who were 1:1 matched into surgery and rehabilitation groups. Compared to previous trial, patient population was expanded on age (< 12 and > 45 years old), duration of disease (< 5 years) and severity of paralysis (severe disabled patients with UEFM < 20 points). In matched patients, the overall increases of UEFM score from preoperative evaluation to 2-year follow-up were 15.14 in the surgery group and 2.35 in the rehabilitation group (difference, 12.79; 95% CI: 12.02-13.56, p < 0.001). This increase was 16.58 at 3-year and 18.42 at 5-year follow-up compared with the surgery group baseline. Subgroup analysis revealed substantial increase on UEFM score in each subgroup of age, duration of disease, severity of paralysis and cause of injury. No severe complication or disabling sequela were reported in the surgery group. INTERPRETATION This study showed that CC7 cross transfer can provide effective, safe and stable functional improvements in long-term follow-up, and provided evidences for expanding the indications of the surgery to a wider population of patients with hemiplegia.
Collapse
Affiliation(s)
- Juntao Feng
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Tie Li
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Sangsoo Kim
- Kim Sang Soo Microclinic, Seoul, South Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
| | - Naiqing Zhao
- Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Qingzhong Chen
- Department of Hand Surgery, Department of Rehabilitation, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China
| | - Yanpei Gong
- Department of Hand Surgery, Department of Rehabilitation, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China
| | - Yucheng Sun
- Department of Hand Surgery, Department of Rehabilitation, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China
| | - Zaixing Zhao
- Department of Handsurgery, Department of Neurology, Ningxia Hui Autonomous Region Wujingzong Hospital, Yinchuan, China
| | - Ning Zhu
- Department of rehabilitation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jihua Cao
- Department of Handsurgery, Department of Neurology, Ningxia Hui Autonomous Region Wujingzong Hospital, Yinchuan, China
| | - Wen Fang
- Department of rehabilitation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Bin Chen
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Song Zheng
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhu Xu
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xin Jin
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yundong Shen
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Yanqun Qiu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Huawei Yin
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Su Jiang
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Jie Li
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Ying Ying
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Liwen Chen
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Ying Liu
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Chuntao Zuo
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianguang Xu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
| | - Yudong Gu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Wendong Xu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Shanghai, China
- State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center of Brain Science, Department of Anatomy and Histology and Embryology, Institutes of Brain Science, Fudan University, Shanghai, China
- Corresponding author at: The National Clinical Research Center for Aging and Medicine, Hand Surgery Department, Jing'an District Central Hospital, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
3
|
Sarveazad A, Janzadeh A, Taheripak G, Dameni S, Yousefifard M, Nasirinezhad F. Co-administration of human adipose-derived stem cells and low-level laser to alleviate neuropathic pain after experimental spinal cord injury. Stem Cell Res Ther 2019; 10:183. [PMID: 31234929 PMCID: PMC6591829 DOI: 10.1186/s13287-019-1269-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
Background Evidence has suggested that human adipose-derived stem cells (hADSCs) and low-level laser has neuroprotective effects on spinal cord injury (SCI). Therefore, the combined effect of the hADSCs and laser on neuregeneration and neuropathic pain after SCI was investigated. Methods Forty-eight adult male Wistar rats with 200–250 g weight were used. Thirty minutes after compression, injury with laser was irritated, and 1 week following SCI, about 1 × 106 cells were transplanted into the spinal cord. Motor function and neuropathic pain were assessed weekly. Molecular and histological studies were done at the end of the fourth week. Results The combined application of hADSCs and laser has significantly improved motor function recovery (p = 0.0001), hyperalgesia (p < 0.05), and allodynia (p < 0.05). GDNF mRNA expression was significantly increased in hADSCs and laser+hADSC-treated animals (p < 0.001). Finally, co-administration of hADSCs and laser has enhanced the number of axons around cavity more than other treatments (p < 0.001). Conclusions The results showed that the combination of laser and ADSCs could significantly improve the motor function and alleviate SCI-induced allodynia and hyperalgesia. Therefore, using a combination of laser and hADSCs in future experimental and translational clinical studies is suggested.
Collapse
Affiliation(s)
- Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Atousa Janzadeh
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Taheripak
- Department of Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Dameni
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farinaz Nasirinezhad
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. .,Department of Physiology, School of Medicine, Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran.
| |
Collapse
|
4
|
Yousefifard M, Rahimi-Movaghar V, Nasirinezhad F, Baikpour M, Safari S, Saadat S, Moghadas Jafari A, Asady H, Razavi Tousi SMT, Hosseini M. Neural stem/progenitor cell transplantation for spinal cord injury treatment; A systematic review and meta-analysis. Neuroscience 2016; 322:377-97. [PMID: 26917272 DOI: 10.1016/j.neuroscience.2016.02.034] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 12/21/2022]
Abstract
Despite the vast improvements of cell therapy in spinal cord injury treatment, no optimum protocol has been developed for application of neural stem/progenitor cells. In this regard, the present meta-analysis showed that the efficacy of the neural stem/progenitor cell (NSPC) transplantation depends mainly on injury model, intervention phase, transplanted cell count, immunosuppressive use, and probably stem cell source. Improved functional recovery post NSPC transplantation was found to be higher in transection and contusion models. Moreover, NSPC transplantation in acute phase of spinal injury was found to have better functional recovery. Higher doses (>3×10(6)cell/kg) were also shown to be optimum for transplantation, but immunosuppressive agent administration negatively affected the motor function recovery. Scaffold use in NSPC transplantation could also effectively raise functional recovery.
Collapse
Affiliation(s)
- M Yousefifard
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - V Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - F Nasirinezhad
- Physiology Research Center, Department of Physiology, Iran University of Medical Sciences, Tehran, Iran
| | - M Baikpour
- Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Safari
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - A Moghadas Jafari
- Department of Emergency Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - H Asady
- Department of Occupational Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S M T Razavi Tousi
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M Hosseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
8
|
Eaton MJ, Berrocal Y, Wolfe SQ, Widerström-Noga E. Review of the history and current status of cell-transplant approaches for the management of neuropathic pain. PAIN RESEARCH AND TREATMENT 2012; 2012:263972. [PMID: 22745903 PMCID: PMC3382629 DOI: 10.1155/2012/263972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 04/09/2012] [Indexed: 11/18/2022]
Abstract
Treatment of sensory neuropathies, whether inherited or caused by trauma, the progress of diabetes, or other disease states, are among the most difficult problems in modern clinical practice. Cell therapy to release antinociceptive agents near the injured spinal cord would be the logical next step in the development of treatment modalities. But few clinical trials, especially for chronic pain, have tested the transplant of cells or a cell line to treat human disease. The history of the research and development of useful cell-transplant-based approaches offers an understanding of the advantages and problems associated with these technologies, but as an adjuvant or replacement for current pharmacological treatments, cell therapy is a likely near future clinical tool for improved health care.
Collapse
Affiliation(s)
- Mary J. Eaton
- Miami VA Health System Center, D806C, 1201 NW 16th Street, Miami, FL 33125, USA
| | - Yerko Berrocal
- Department of Cellular Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Stacey Q. Wolfe
- Department of Neurosurgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA
| | - Eva Widerström-Noga
- Miami VA Health System Center, D806C, 1201 NW 16th Street, Miami, FL 33125, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
| |
Collapse
|