Thesis (M.S.)--University of Michigan, 1984.

Thesis (Ph.D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 97 pages. Includes Vita. Includes bibliographical references.

O estudo observacional e transversal teve por objetivos caracterizar indivíduos adultos que sofreram lesão de medula espinhal (LME) entre janeiro de 2003 a julho 2006, em hospitais credenciados pelo SUS no município de Ribeirão Preto (RP), avaliar a sua independência funcional utilizando a escala medida de independência funcional (MIF), considerando o nível de lesão, identificar a prevalência de úlcera de pressão (UP) e problemas de funcionamento intestinal, assim como as condições de cuidado domiciliar e o acesso e utilização de serviços de saúde. Após a aprovação do Comitê de Ética em Pesquisa, o estudo foi desenvolvido em duas fases. Na primeira foi feito levantamento de prontuários em 2 hospitais e, na segunda, entrevistas com sujeitos e cuidadores nos domicílios, utilizando instrumentos préviamente testados. Os resultados evidenciaram que 28 indivíduos residentes em RP sofreram LME no período e que 19 (67,9%) tiveram UP. Desses, 6 foram a óbito antes da segunda fase do estudo. Dentre os 22 sobreviventes, 91% eram do sexo masculino e 14 (63,6%) tinham entre 20 a 39 anos. Acidente de trânsito foi a etiologia principal (50%) da LME, seguida de queda (27,3%). Onze (50%) tiveram lesão cervical, dez (45,5%) lesão torácica e um lesão lombar. Quinze (68,2%) não tinham ocupação remunerada após a LME e 12 (54,5%) tinham a esposa como cuidador principal. Indivíduos com lesão cervical apresentaram escores menores na MIF total e motora, entretanto, a MIF cognitiva atingiu o valor máximo independente do nível da lesão. Dos 22 sujeitos, nenhum apresentou grau de dependência completa, 11 (50%) apresentavam dependência mínima, 6 (27,3%) dependência máxima e 5 (22,7%) independência moderada ou completa. Os 7 sujeitos com UP tinham maior dependência funcional. Quinze (68,2%) tinham constipação intestinal. O tempo total de cuidado variou de 4 a 15 horas diárias, com média de 9,63, (d.p. 3,4) para sujeitos com lesão cervical; 7,8 (d.p. 2,8) para lesão torácica e 4 para lombar. Houve aumento dos escores da MIF com o aumento do tempo pós-lesão, independente da participação em programa de reabilitação. O trauma causou maior impacto no domínio motor com diminuição da independência funcional nas diferentes atividades para os sujeitos com lesão cervical, entretanto, esses apresentaram escores mais elevados na função controle intestinal do que os indivíduos com lesão torácica. Os resultados apontam aspectos essenciais para a proposição de programa de reabilitação para essa população no contexto estudado. / The purposes of this cross-sectional observational study are: to characterize adult individuals that suffered Spinal Cord Injury (SCI) between January 2003 and July 2006 in hospitals of the Single Health System (SHS) in the city of Ribeirão Preto, and evaluate their functional independence using the Functional Independence Measurement (FIM) scale taking injury level into consideration; and to identify the prevalence of individuals with pressure ulcers (PU) and bowel function problems, as well as home care conditions and the accessibility and use of health care services. After being approved by the Research Ethics Committee, the study was performed in two phases: in the first, patient records from two hospitals were surveyed; in the second, patients and home-care providers were interviewed using previously tested instruments. Results showed that 28 individuals suffered SCI in the referred period, of which 19 (67.9%) developed PU. Six patients died before the second phase of the study. Among the 22 survivors, 91% were men and 14 (63.6%) were between 20 and 39 years old. The main SCI etiology was traffic accidents (50%), followed by falls (27.3%). Eleven (50%) individuals had cervical injury, ten (45.5%) thoracic injury, and one lombar injury. Fifteen (68.2%) were unemployed after SCI and 12 (54.5%) had their wife as their main care provider. Individuals with cervical injury presented lower total and motor FIM scores. However, cognitive FIM scores were the highest, regardless of the injury level. None of the 22 patients presented a degree of complete dependency; 11 (50.0%) presented minimum dependency, six (27.3%) maximum dependency, and five (22.7%) moderate or complete independency. The seven participants with PU were more functionally dependent. Fifteen (68.2%) had constipation. Total care time ranged from 4 to 15 daily hours, with an average of 9.63 (SD 3.4) for individuals with cervical injury; 7.8 (SD 2.8) for thoracic injury; and 4 for lombar injury. FIM scores increased with post-injury time, regardless of participating in rehabilitation. The trauma caused more impact in the motor domain, with reduced functional independence in various activities for individuals with cervical injuries. However, the latter presented higher scores in bowel control function compared to individuals with thoracic injury. Results highlight the essential aspects of their experiences to propose a rehabilitation program for this population in the studied context.

A mortalidade em pessoas com lesão medular é três vezes maior que na população em geral. As doenças cardiovasculares são umas das mais relevantes na lista de doenças que as acometem, ocorrendo cada vez mais precocemente. Dentre os fatores de risco para doenças cardiovasculares a inatividade física é um importante fator modificável para esta população. O grupo de tetraplégicos é o que demonstra maior comprometimento físico. Devido ao menor recrutamento muscular voluntário, as possibilidades terapêuticas para o condicionamento cardiorrespiratório são limitadas. Entre as alternativas terapêuticas está o cicloergometro com estimulação elétrica funcional computadorizada - CFES. Este estudo teve como objetivo comparar os efeitos do condicionamento dos músculos estimulados por corrente elétrica em pacientes tetraplégicos na frequência de treinamento de uma (1) vez por semana e de três (3) vezes por semana, durante seis meses de treinamento. Quatorze indivíduos adultos, homens, tetraplégicos, divididos aleatoriamente em dois grupos, realizaram CFES com as diferentes frequências de treinamento. Foi avaliada a variável trabalho desenvolvida durante cada sessão. A análise estatística foi realizada através de inferência bayesiana. As observações realizadas no presente estudo indicam que o desempenho musculoesquelético do grupo de treinamento de três vezes por semana pode ser melhor que o de uma vez por semana. A variabilidade de desempenho encontrada em estudos longitudinais sugere protocolos de intervenção mais abrangentes. / Mortality in people with spinal cord injury is three times higher than in the overall population. Cardiovascular diseases are the most prevalent one affecting these individuals, occurring increasingly at an earlier age. With the risk factors for cardiovascular diseases, physical inactivity is an important and modifiable aspect for this population. The quadriplegic group is the one showing the larger physical impairment. Due to the lower volunteer muscle recruitment, therapeutic possibilities for cardiorespiratory conditioning are limited. Among the therapeutic alternatives is the computadorized functional electric stimulation - CFES. This study aimed to compare the effects of ergometric training over the conditioning of the muscles of quadriplegic patients, stimulated by electric current, once and three times a week, for six months of training. Fourteen quadriplegic male adults were divided randomly into two groups, performing the training in the different treatment frequencies. Mechanical work varialble was assessed throughout each treatment session. The statistical analysis was performed by Bayesian Inference. The study\'s observations indicate that the musculoskeletal performance of those in the three times a week treatment may be better than of those in the lower frequency group. The variability of the performance found with longitudinal studies suggests broader intervention protocols.

Introdução: A lesão da medula espinhal é uma entidade clínica grave e extremamente incapacitante. Muitos esforços estão sendo realizados para melhorar a resposta neurológica ao trauma da medula espinhal. Dentre eles, destacamos o uso de agentes farmacológicos, a descompressão e estabilização cirúrgica precoces e a hipotermia. A hipotermia pode ser induzida de forma sistêmica ou local. Várias complicações, como arritmias cardíacas, coagulopatias e infecções, foram associadas ao uso sistêmico da hipotermia. Porém, sua aplicação local demanda a necessidade de intervenção cirúrgica de emergência e manejo pós-operatório complicado. Objetivo: Avaliar o efeito neuroprotetor da hipotermia epidural em ratos. Material e método: Foram arrolados 30 ratos Wistar pesando entre 320-360 g e divididos aleatoriamente em dois grupos: o grupo da hipotermia epidural e o grupo controle, com 15 ratos cada. Uma contusão medular produzida por queda padronizada de peso de 10 g, a 25 mm de altura, usando o New York University (NYU) Impactor, foi realizada após a laminectomia em T9-10 em todos os ratos. Os ratos do grupo da hipotermia foram submetidos ao resfriamento a 9-10 °C por um período de 20 minutos, logo após a contusão medular. Os grupos foram analisados durante seis semanas quanto à função motora utilizando-se a escala BBB e o teste do plano inclinado. Ao final da sexta semana, foi realizado ainda o exame de potencial evocado motor dos ratos, cujos resultados foram comparados entre os dois grupos. Resultados: A avaliação da função motora através da aplicação da pontuação da escala BBB ao longo das seis semanas não evidenciou diferenças estatisticamente significantes entre os dois grupos. Não encontramos diferenças estatísticas na avaliação motora através da pontuação do teste do plano inclinado ao longo das seis semanas do estudo. Os valores de latência e amplitude do potencial evocado motor não mostraram diferenças estatísticas significantes entre os grupos ao final da última semana do estudo. Conclusão: A hipotermia não apresentou efeito neuroprotetor quando aplicada no sítio da lesão, logo após a contusão medular, no espaço epidural de ratos Wistar / Introduction: Spinal cord injury (SCI) is a critical and extremely disabling clinical condition. Considerable effort has been made to improve the neurological response to the spinal cord lesion. We must highlight pharmacological agents, early surgical decompression and stabilization and hypothermia. Therapeutic hypothermia can be achieved systemically or locally. Many complications have been associated to the systemic hypothermia, such as cardiac arrhythmias, coagulopathies and infection. However, local application demands surgical intervention and difficult post operative care. Objetive: To evaluate the neuroprotective effect of epidural hypothermia in rats. Methods: Wistar rats (n = 30; weighting 320-360 g) were randomized in two groups: the hypothermia and the control group, with 15 rats in each. A spinal cord lesion was produced by the standardized drop of a 10 g-weight from a height of 2,5 cm, using the New York University Impactor, after the laminectomy at the T9-10 level. Rats of the hypothermia group underwent epidural hypothermia for 20 minutes immediately after spinal cord injury. Motor function was assessed during six weeks using the BBB motor scores and inclined plane test. At the end of the last week, neurologic status was monitored by the motor evoked potential exam and the results were compared between the two groups. Results: Analysis of the BBB scores during the six-weeks period did not show any statistically significant difference between the two groups. We did not find any significant difference between the groups in the scores of the inclined plane test during the six-weeks period. Latency and amplitude values of the motor evoked potential exam did not show any statistically significant difference between the two groups at the end of the study. Conclusion: Hypothermia did not produce any neuroprotective effect when applied immediately after spinal cord contusion, at the injury level and in epidural space of Wistar rats

A lesão traumática da medula espinhal (LTME) é um grande problema de saúde ocasionado principalmente por acidentes automobilísticos, quedas, mergulho e a violência, como ferimentos por arma de fogo (FAF). Pacientes com LTME tem um elevado risco para desenvolver úlcera de pressão (UP) devido à perda da mobilidade e motricidade abaixo do nível medular acometido. É importante a realização de estudos de ocorrência da UP para que medidas de intervenção possam ser implementadas. Assim, este estudo foi realizado de forma retrospectiva em um hospital universitário do interior do estado de São Paulo. Após a aprovação do comitê de regulamentação e normas éticas da instituição, os prontuários foram revisados e 47 desses atenderam aos critérios de inclusão: ter diagnóstico de LTME, ter idade igual ou superior a 18 anos na época do trauma; ter informações referentes a primeira hospitalização após o trauma. A maior parte dos pacientes eram do sexo masculino (97,5%), brancos (68,1%), com idade entre 21 e 30 anos (36,2%). A causa mais freqüente da LTME foi FAF (44,7%) seguido por colisão/capotamento de veículo (23,4%). Quanto ao nível neurológico da lesão, houve predomínio no nível torácico (44,7%) seguido pelo nível cervical. O tempo médio de hospitalização foi de 21,47 dias (DP= 28,50). Em relação à procedência do paciente, 46,8% eram de Ribeirão Preto. Houve ocorrência de UP em 20 (42,5%) dos pacientes, com a média de 2,3 UP por paciente. Os locais de maior freqüência foram na região sacral (36,95%) e calcâneos (17,4%). Apenas 25% dos prontuários tinham o registro da dimensão da UP, 80% apresentavam o registro do aspecto e em 52,1% não havia o registro do estágio de classificação. Houve uma maior freqüência de uso de medidas preventivas nos pacientes com UP. Durante o período de internação, 44,7% dos pacientes tiveram outras complicações clínicas, como pneumonia (25,5%). Dos pacientes com alta hospitalar, 34% tiveram outras internações nos primeiros 6 meses após a LTME, sendo o principal motivo a infecção do sítio cirúrgico, seguido da UP e infecção do trato urinário. Com este estudo, verificamos que há a necessidade de melhorar o registro referente aos dados do paciente para que intervenções possam ser propostas. Programas de educação permanente podem contribuir para modificar esta situação. Outros estudos de investigação sobre o tema são necessários. / Traumatic spinal cord injuries (TSCI) are a significant health issue which is mainly caused by automobil accidents, falls, diving, and violence, such as wounds by gun shot (GS). Patients with TSCI have an increased risk of developing pressure ulcers (PU) due to the loss of movement and motricity under the affected spinal level. Studies concerning PU occurrence are important so intervention measures can be implemented. Thus, this study was performed, in a retrospective way, at a university hospital of Upstate São Paulo. After the approval by the institution’s committee of regulamentation and ethical norms, patient records were reviewed and, from the total, 47 met the inclusion criteria: have a TSCI diagnosis, patient aged over 18 years at the time of injury; have information concerning the first hospitalization after the injury. Most patients were male (97.5%), white (68.1%), aged within 21 and 30 years (36.2%). The most common cause for TSCI was GS (44.7%) followed by vehicle crash/overturn (23.4%). Concerning the neurologic level of the lesion, there was a predominance of the toracic level (44.7%) followed by cervical level. The average time of hospitalization was,in days, 21.47 (SD= 28.50). In terms of patient’s residence, 46.8% were from Ribeirão Preto. Twenty patients (42.5%) presented PU, with an average of 2.3 PU per patient. The most frequent regions were the sacral (36.95%) and heels (17.4%). Only 25% of the patient record stated the PU’s dimensions, 80% stated the aspect, and 52.1% did not state the classification stage. There was a higher frequency of prevention measures with patients with PU. During the period of hospitalization, 44.7% of the patients presented other clinical issues, such as pneumonia (25.5%). From the patients discharged, 34% were hospitalized again within the first 6 months after the TSCI, and the main reason was surgical site infection, followed by PU, and infection of the urinary tract. With this study, it was verified that there is a need for improving the records of patient data so interventions could be proposed. Permanent education programs could contribute to modifying this situation. Other investigations about the subject are necessary.

This thesis assessed the suitability of unilateral, electrolytic lesions as a model of spinal cord damage and repair in the adult rat. This type of lesion resulted acutely in localized damage in the upper motor neuron at the L2-L3 level of the spinal cord. Minimal acute damage to ascending sensory pathways was indicated by preserved somatosensory evoked potentials elicited by stimulation of the tibial nerve. Immediately after lesion generation one of several substrates was injected into the lesion cavity. These substrates were saline buffer, liquid collagen solution, foetal spinal cord cells from 14 day old rat embryos, and a mixture of collagen and E 14 foetal spinal cord cells. The 4 groups were compared for functional recovery over 3 months using the inclined plane test and a Tarlov movement scale. After sacrifice, the tibialis anterior muscles were dissected and weighed to assess atrophy due to lower motor neuron injury. After removing and embedding the spinal cords in paraffin, transverse and longitudinal sections were taken for cytoarchitectural investigation. Cresyl violet was used to indicate Nissl substance, Luxol fast blue stained for myelin and anti - glial fibrillary acidic protein (GFAP) antibody revealed the expression of GFAP in the cord sections. Chronic electrolytic lesions were characterized by the highly variable degree of cavitation, demyelination and macrophage infiltration that was present. There was no significant performance deficit on the inclined plane test in any of the lesioned groups when compared to unoperated animals. The tibialis muscles from all groups were of normal weight, indicating that the lower motor neurons were not significantly damaged by the lesions used. There was, however, a marked decrease in the number of GFAP reactive astrocytes in the lesioned animals when compared to unlesioned controls (P < 0.01, Wilcoxon test). Moreover, this reduction of GFAP - like immunoreactivity was not prevented by implants of foetal neurons, collagen or foetal neurons suspended in collagen. Possible explanations for the reduced GFAP - like immunoreactivity seen in all electrolytically lesioned cords are discussed. / Medicine, Faculty of / Cellular and Physiological Sciences, Department of / Graduate

Orientador: Alberto Cliquet Júnior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T14:27:31Z (GMT). No. of bitstreams: 1 Maria_RenataManzano_M.pdf: 4254573 bytes, checksum: 97e60ced203868705d6cd26bf4a3e1a6 (MD5) Previous issue date: 2014 / Resumo: Neste projeto é apresentada uma proposta de um sistema completo para coletar, processar e analisar sinais resultantes do teste pendular, com a finalidade de avaliar a espasticidade na prática clínica. Comumente apresentado por lesados medulares, a espasticidade pode ser quantificada pela análise dos sinais de ângulo da articulação do joelho e de vibração do quadríceps durante o balanço, monitorados por um eletrogoniômetro e um acelerômetro triaxial, respectivamente. O acompanhamento de cinco pacientes, durante o programa de reabilitação, permitiu estabelecer uma relação entre os indicadores calculados, evidenciando uma relação positiva entre índice de relaxamento - R2n, razão de amplitude - R1, valor quadrático médio ¿ RMS e envoltórias do sinal para casos de espasticidade severa. Comprova-se assim a maior aplicabilidade do acelerômetro nestes casos, e a possibilidade de utilização do acelerômetro no teste pendular para quantificação da espasticidade como forma complementar / Abstract: In this project is presented a proposal of a complete system to acquire, process and analyze pendulum test signals, aiming to assess spasticity in clinical practice. Often presented by spinal cord injured people, spasticity can be quantified by signals of knee joint angle and quadriceps vibration during the swing, monitored by an electrogoniometer and a triaxial accelerometer, respectively. Five patients following, through the rehabilitation program, made possible to establish a relation between relaxation index - R2n, amplitude ratio - R1, root mean square (RMS) and wrapped signals to severe spasticity. Thus, it is confirmed that, in these cases, accelerometer is more efficient and its feasibility is ratified as a possibility in pendulum test to quantify spasticity / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

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研究目的：脊髓損傷是中樞神經系統的嚴重創傷，致殘率高。脊髓損傷後的再生修復一直是當前醫學的難題。迄今為止，脊髓損傷依然缺乏一種有效地治療方法。既往研究證明，胰島素樣生長因子-1對鼠和兔脊髓損傷有保護作用，為了進一步把這些發現應用到臨床方面，我們採用與人類生理更相近的豬只作為實驗動物，構建與臨床相似的脊髓損傷動物模型，并以此為基礎，系統性研究胰島素樣生長因子-1的脊髓保護作用，評估該治療的功效。 / 研究方法：以運動誘發電位為指導，通過直接壓迫和牽拉造成脊髓損傷。18頭猪只隨機分為3組：胰島素樣生長因子-1治療組、生長激素治療組及生理鹽水對照組。脊髓損傷后1小時、24小時及48小時經鞘內注射給藥。于術後第1天、第3天及第21天收集腦脊液檢測胰島素樣生長因子-1和生長激素濃度。連續21天使用修正的 Tarlov 評分標準對動物的運動功能進行評估。第21天處死動物並取材，檢測脊髓中NeuN, GFAP, caspase-3 的活性，并通過TUNEL染色觀察細胞凋亡情況，比較各組之間有無差別。 / 研究結果：通過這種方法建立的脊髓損傷動物模型穩定可靠，各組之間無明顯差異。鞘內給藥24小時及48小時后，腦脊液中胰島素樣生長因子-1和生長激素濃度明顯升高，術後21天檢測，其濃度恢復至基礎值。胰島素樣生長因子-1治療組的運動功能的恢復優於其它各組。與生理鹽水對照組比較，胰島素樣生長因子-1治療組可以明顯提高脊髓損傷后神經元的存活數量，抑制星形膠質細胞增生，減少細胞凋亡。而生長激素治療組僅抑制星形膠質細胞增生，其它方面與生理鹽水對照組無明顯差別。 / 結論：胰島素樣生長因子-1通過提高神經元存活數量，抑制星形膠質細胞增生，以及減少細胞凋亡促進脊髓損傷的恢復。 / Objective: Spinal cord injury is a devastating condition that leads to long-term disabilities. Currently, there is no effective treatment that minimizes spinal cord damage or enhances neurological recovery. Recent studies in rats or rabbits suggested that neurologic recovery after spinal cord injury could be improved with the administration of neurotropic hormones, such as insulin-like growth factor-1 (IGF-1). In order to apply such bench-side discovery to clinical practice, we conducted a study in a higher animal model, akin to human physiology, to evaluate the effectiveness of intrathecal injections of IGF-1to improve neurological recovery in a porcine model of acute traumatic spinal cord injury. / Methods: Traumatic spinal cord injury model was produced by controlled compression and distraction of the exposed T12 segment of the spinal cord. Eighteen pigs were randomly assigned to receive intrathecal injections of either IGF-1, growth hormone or saline at 1, 24 and 48 hours after spinal cord injury. Locomotor function was assessed daily using the validated modified Tarlov’s scale for 21 days. Spinal cord segments were then harvested and the survival of neurons, reactive astrogliosis and apoptosis were determined using neuronal-specific nuclear protein (NeuN), glial fibrillary acidic protein (GFAP), cleaved caspase-3 and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assays. / Results: Intrathecal injections of IGF-1 and growth hormone significantly increase the concentrations of the neurotropic hormones in the cerebrospinal fluid after injury (p < 0.01). These concentrations returned to baseline by 21 days after drug delivery. Motor deficits on the first day after injury were comparable between animals in the treatment and control groups. By the end of the third week, neurologic recovery was better in animals receiving IGF-1 treatment (p < 0.05). Immunohistological and western blot studies of the injured segments of spinal cord showed that treatment with both IGF-1 and growth hormone prevented reactive astrogliosis (p < 0.05) while only IGF-1 improved the survival of mature neurons (p < 0.05). IGF-1 also inhibited apoptosis after spinal cord injury (p < 0.05). / Conclusions: In our clinically relevant model of traumatic spinal cord injury in pigs, intrathecal injection of IGF-1 demonstrated beneficial effects on neurological and histological recovery. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wang, Qinzhou. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 105-122). / Abstract also in Chinese. / Declaration of origination --- p.I / Abstract --- p.II / Acknowledgements --- p.VI / Table of Contents --- p.VIII / List of Tables --- p.XII / List of Figures --- p.XIII / Abbreviations --- p.XVIII / Chapter Part 1 --- Spinal Cord Injury: A Review --- p.1 / Chapter Chapter 1-1 --- Acute Spinal Cord Injury: Epidemiology, Socioeconomic Impact --- p.2 / Chapter 1.1.1 --- Epidemiology of Spinal Cord Injury --- p.2 / Chapter 1.1.2 --- Socioeconomic Impact of Acute Spinal Cord Injury --- p.5 / Chapter Chapter 1-2 --- Mechanisms of Spinal Cord Injury --- p.6 / Chapter Chapter 1-3 --- Putative Treatments for Spinal Cord Injury --- p.8 / Chapter 1.3.1 --- Methylprednisolone --- p.8 / Chapter 1.3.2 --- Stem Cell Therapy --- p.11 / Chapter 1.3.3 --- Riluzole --- p.11 / Chapter 1.3.4 --- Other Pharmacological Therapies for Spinal Cord Injury --- p.12 / Chapter Chapter 1-4 --- Insulin-like Growth Factor-1 for the Treatment of Spinal Cord Injury --- p.13 / Chapter Chapter 1-5 --- Summary --- p.17 / Chapter Part 2 --- Insulin-like Growth Factor-1 and Growth Hormone for Spinal Cord Injury --- p.18 / Chapter Chapter 2-1 --- Hypothesis and Objectives --- p.19 / Chapter Chapter 2-2 --- Establishment of Animal Models for Acute Spinal Cord Injury --- p.22 / Chapter 2.2.1 --- Introduction --- p.22 / Chapter 2.2.2 --- Experimental Animals --- p.22 / Chapter 2.2.3 --- Anesthesia --- p.23 / Chapter 2.2.4 --- Transcranial Electrical Motor Evoked Potential --- p.26 / Chapter 2.2.5 --- Surgery --- p.28 / Chapter 2.2.6 --- Statistics --- p.34 / Chapter 2.2.7 --- Results --- p.34 / Chapter 2.2.8 --- Discussion --- p.38 / Chapter Chapter 2-3 --- Optimal Stimulation Protocols for Transcranial Electrical Motor Evoked Potential. --- p.42 / Chapter 2.3.1 --- Introduction --- p.42 / Chapter 2.3.2 --- Methods --- p.42 / Chapter 2.3.2.1 --- Experimental Animals and Anesthesia --- p.42 / Chapter 2.3.2.2 --- Transcranial Electrical Motor Evoked Potential Recording --- p.44 / Chapter 2.3.2.3 --- Stimulation Protocol --- p.44 / Chapter 2.3.3 --- Analyses --- p.44 / Chapter 2.3.4 --- Results --- p.45 / Chapter 2.3.5 --- Discussion --- p.52 / Chapter Chapter 2-4 --- Evaluation of the Efficacy of Insulin-like Growth Factor-1 and Growth Hormone in a Porcine Model --- p.54 / Chapter 2.4.1 --- Introduction --- p.54 / Chapter 2.4.2 --- Materials and Methods --- p.54 / Chapter 2.4.2.1 --- Study Design --- p.54 / Chapter 2.4.2.2 --- Intrathecal Injection and Collection of Cerebrospinal Fluid --- p.58 / Chapter 2.4.2.3 --- Measurements --- p.58 / Chapter 2.4.2.3.1 --- Clinical Evaluation --- p.58 / Chapter 2.4.2.3.2 --- Biochemical Assessments --- p.58 / Chapter 2.4.2.3.3 --- Spinal Cord Section, Histological and Immunochemical Staining --- p.63 / Chapter 2.4.2.3.4 --- Western Blot --- p.69 / Chapter 2.4.3 --- Statistical Analysis and Sample Size Calculation --- p.72 / Chapter 2.4.3.1 --- General Analysis --- p.72 / Chapter 2.4.3.2 --- Sample Size --- p.72 / Chapter 2.4.4 --- Results --- p.73 / Chapter 2.4.4.1 --- Changes of TceMEP --- p.73 / Chapter 2.4.4.2 --- Motor Deficit after Spinal Cord Injury at Baseline --- p.75 / Chapter 2.4.4.3 --- Insulin-like Growth Factor-1 and Growth Hormone in Cerebrospinal Fluid --- p.77 / Chapter 2.4.4.4 --- Clinical Assessment --- p.80 / Chapter 2.4.4.5 --- Demyelination, Neuron Survival and Astrocyte Reaction --- p.85 / Chapter 2.4.4.6 --- Apoptosis --- p.89 / Chapter 2.4.5 --- Discussion --- p.93 / Chapter 2.4.5.1 --- Principal Findings --- p.93 / Chapter 2.4.5.2 --- Insulin-like Growth Factor-1 and Neuroprotection after Spinal Cord Injury --- p.93 / Chapter 2.4.5.3 --- Growth Hormone and Neuroprotection after Spinal Cord Injury --- p.95 / Chapter 2.4.5.4 --- Strengths and Limitations of Our Study --- p.96 / Chapter 2.4.5.5 --- Summary --- p.97 / Chapter Part 3 --- Summary and Future Directions --- p.99 / Chapter Chapter 3-1 --- Summary --- p.100 / Chapter Chapter 3-2 --- Future Directions --- p.103 / Chapter Part 4 --- References and appendixes --- p.104 / References --- p.105 / Appendixes --- p.123