Page 83 of 287 FirstFirst ... 33737475767778798081828384858687888990919293133183 ... LastLast
Results 821 to 830 of 2863

Thread: ChinaSCINet Update

  1. #821
    Senior Member lynnifer's Avatar
    Join Date
    Aug 2002
    Location
    Windsor ON Canada
    Posts
    19,320
    Quote Originally Posted by Wise Young View Post
    ...this was the first time that I have seen this procedure being applied to chronic patients. Yes, they develop callouses on their feet and forearms/elbow. We had a scare last February when two patients complained of pain in their legs and x-rays showed presence of what seem to be fractures. However, upon review of earlier x-rays, the fractures seem to have been there before. In any case, none of the 20 subjects with chronic spinal cord injury have suffered any major fractures even though all of them have the typical osteoporosis that all chronic spinal cord injured patients have...
    How do the muscles respond? I've been told and read that it's fibrous tissue that would not respond? Have there been before/after tests to see how the muscles are reacting?
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  2. #822
    callouses? oh no! i better just keep my butt in this chair and get pressure sores instead.


  3. #823
    Everybody,

    People can ask questions and don't have to donate money to ask questions. What people don't have the right to do here on CareCure is to question somebody's honesty, integrity, motivation, intelligence, or work ethics when asking questions. That just leads to anger, erodes friendships, and causes miscommunication.

    Wise.
    ----------------------

    Paolo,

    Please be patient. I have been writing an answer to your question and it is taking more time than I had thought. I should have posted that I will be answering part of your question. By the way, please do not expect me to present detailed data about our study and you simply will have to wait until we have it accepted for publication before I present such data.

    Wise.

    Magnetic resonance diffusion tensor imaging (MR-DTI)

    Magnetic resonance diffusion tensor imaging (MR-DTI) is a method of analyzing magnetic resonance data so that it shows water diffusion. As you know, standard magnetic resonance detects water (H2O). Water is the most abundant molecule in biological tissues and excitation of H2O by pulses of electromagnetic energy in a strong magnetic field will perturb the molecule so that it emits energy back in a specific frequency. Movement of water produces changes of magnetic resonance in sequential snapshots of the tissue. Normally, in non-oriented tissues, water diffuses in all directions. However, in oriented tissues, the diffusion will be more restricted in some directions than others. This property is called anisotrophy.

    White matter is the most oriented tissues in the central nervous system, containing bundles of fibers running longitudinally for long distances. Also called diffusion MRI (dMRI), MR-DTI has been used for mapping diffusion in brain tissues since the early 1980's. During the last 25 years, it has been applied to many neurological conditions and has served as the basis of the Human Brain Connectome project, which is building maps of anatomical and functional connections of the human brain. Many studies have now been published on MR-DTI of spinal white matter. For example, a search "diffusion tensor imaging" and "spinal cord" on Google Scholar yielded over 150 published articles on the subject.

    Software is now available for a user to select an area of interest (i.e. white matter above the injury site or below the injury site) and the program will find contiguous tissues that show the same directional diffusion characteristics. In other words, the software will show bundles of oriented fibers that are contiguous with each other. By doing so, we can see the white matter above the injury site and below the injury site. If any white matter tracts were to regrow across the injury site, we should be able to see them cross the injury site. So, we used MR-DTI in our trial to identify the injection sites (at the white matter wave fronts rostral and caudal to the injury site) and to detect white matter growth across in the injury site. The degree and volume anisotrophy can be quantified to assess white matter change.

    Mulcahey, et al. [1] at Shriner’s hospital recently examined the DTI images of children with spinal cord injury. They found good-to-strong reliability on repeated scans and moderate-to-good concurrent validity with clinical (ASIA) classifications of the injury. They concluded that DTI is a better predictor of clinical findings (i.e. AIS A, B, C, D, E) than conventional MRI. Freund, et al. [2] imaged nine adult volunteers with cervical spinal cord injury and found significant differences of corticospinal tract of SCI subjects compared to controls, including ability to predict paralysis of different parts of the body. Bosma & Stroman [3] reviewed studies using DTI to visualize spinal cords in patients with amyotrophic lateral sclerosis, myelitis, and spinal cord tumors. Smith, et al. [4] at Kennedy Krieger in Baltimore reported that DTI images can reliably discriminate sensory and motor tracts. Ellington, et al. [5] compared four subjects with spinal cord injury with 4 normal subjects. They found a general decrease in both longitudinal and transverse diffusivity in the former.

    Many investigators have used DTI to investigate animal models of spinal cord injury. Tu, et al. [6] at Washington University in St. Louis used DTI to quantify spared white matter in mice after contusion injuries. Sundberg, et al. [7] used DTI to assess rats at various times up to 56 days after contusion injuries. White matter in regions up to a centimeter from the injury site showed significant changes that were not seen on conventional MRI. Histological evidence confirmed significant decrease in myelin and oligodendrocyte presence in these areas of the spinal cord, suggesting that DTI images are sensitive reflection of not only the volume but also the quality of white matter. Kim, et al. [8, 9] at Washington University showed that DTI can predict long-term locomotor recovery in mice after graded contusion injuries. Herrara, et al. [10] pointed out that while DTI can detect demyelination, axonal damage and longitudinal diffusivity (lambda) did not always correlate. Ellingson, et al. [11] found that both transverse and longitudinal diffusivity (tADC and lADC), as well as mean diffusivity (MD) and fractional anisotrophy (FA), changed over time in rodents after injury.

    Nobody has looked at human spinal cords before and after cell transplants, or changes in white matter associated with transplants. Therefore, we planned such a study in Hong Kong. It was a very difficult study because the presence of metallic implants around the injury site distorted the images and introduced artifacts. Most patients have such metallic implants. Also, we had to work out many issues, including the parameters that would be used for imaging the white matter. We hypothesized that subjects with “complete” ASIA A spinal cord injuries would not have any white matter crossing the injury site, that injections of small amounts of cells (i.e. 4 and 8 ┬Áliters) would not change the white matter in the spinal cord, and that restoration of function would be associated with appearance of white matter bundles crossing the injury site. So, we did a study of MR-DTI images of 8 subjects with chronic SCI before and at 6 weeks, 6 months, 12 months (and 18 months) after transplantation umbilical cord blood mononuclear cells (four injections of 4 or 8 ┬Áliters) in the spinal cord above and below and injury site. These are compared with 8 normal control subjects.

    This will be the subject of the study that we will soon submit for publication.

    References Cited

    1. Mulcahey MJ, Samdani A, Gaughan J, Barakat N, Faro S, Betz RR, et al. Diffusion tensor imaging in pediatric spinal cord injury: preliminary examination of reliability and clinical correlation. Spine (Phila Pa 1976). 2012;37(13):E797-803.
    2. Freund P, Wheeler-Kingshott CA, Nagy Z, Gorgoraptis N, Weiskopf N, Friston K, et al. Axonal integrity predicts cortical reorganisation following cervical injury. J Neurol Neurosurg Psychiatry. 2012;83(6):629-37. PMCID: 3348614.
    3. Bosma R, Stroman PW. Diffusion tensor imaging in the human spinal cord: development, limitations, and clinical applications. Crit Rev Biomed Eng. 2012;40(1):1-20.
    4. Smith SA, Jones CK, Gifford A, Belegu V, Chodkowski B, Farrell JA, et al. Reproducibility of tract-specific magnetization transfer and diffusion tensor imaging in the cervical spinal cord at 3 tesla. NMR Biomed. 2010;23(2):207-17. PMCID: 2830283.
    5. Ellingson BM, Ulmer JL, Schmit BD. Morphology and morphometry of human chronic spinal cord injury using diffusion tensor imaging and fuzzy logic. Ann Biomed Eng. 2008;36(2):224-36.
    6. Tu TW, Kim JH, Wang J, Song SK. Full tensor diffusion imaging is not required to assess the white-matter integrity in mouse contusion spinal cord injury. J Neurotrauma. 2010;27(1):253-62. PMCID: 2824236.
    7. Sundberg LM, Herrera JJ, Narayana PA. In vivo longitudinal MRI and behavioral studies in experimental spinal cord injury. J Neurotrauma. 2010;27(10):1753-67. PMCID: 2992395.
    8. Kim JH, Loy DN, Wang Q, Budde MD, Schmidt RE, Trinkaus K, et al. Diffusion tensor imaging at 3 hours after traumatic spinal cord injury predicts long-term locomotor recovery. J Neurotrauma. 2010;27(3):587-98. PMCID: 2867549.
    9. Kim JH, Tu TW, Bayly PV, Song SK. Impact speed does not determine severity of spinal cord injury in mice with fixed impact displacement. J Neurotrauma. 2009;26(8):1395-404. PMCID: 2850293.
    10. Herrera JJ, Chacko T, Narayana PA. Histological correlation of diffusion tensor imaging metrics in experimental spinal cord injury. J Neurosci Res. 2008;86(2):443-7.
    11. Ellingson BM, Kurpad SN, Schmit BD. Ex vivo diffusion tensor imaging and quantitative tractography of the rat spinal cord during long-term recovery from moderate spinal contusion. J Magn Reson Imaging. 2008;28(5):1068-79.



    Quote Originally Posted by paolocipolla View Post
    Wise, I am not sure you have seen the following consideration and quetion I have posted before:

    Around minute 43 of your talk you show a Diffusion Tensor Image of the first patient that was transplanted in HK and then you say that in many patients you are "seeing axons growing accross the gap"
    I would suggest that if you claim that you should also show a DTI image that support what you are saying, otherwise you are asking people to have blind faith in your words.
    Me and many other CC members are very anxious to see these DTIs and I hope all goes well getting the data published with the DTIs included.

    Then I have a question:

    to my knoledge DTI can't show axons, but just a "mathematical riconstruction" of the image of the spinal cord were myelin is present i.e. tissue with white matter,
    Is that correct?

    Paolo

    P.S. to all the CC members: I have donated money and I have convinced friends to donate money to support Wise's work, so I believe I have the right to ask questions.
    Last edited by Wise Young; 06-14-2012 at 10:54 AM.

  4. #824
    Quote Originally Posted by lynnifer View Post
    How do the muscles respond? I've been told and read that it's fibrous tissue that would not respond? Have there been before/after tests to see how the muscles are reacting?
    Lynnifer,

    I have seen many people go through the walking program in Kunming. Their muscles seem to be okay. Most people with cervical and thoracic spinal cord injury are spastic and it seems to help them with their standing.

    Do you have a lumbosacral injury and have atrophy in your legs? Severely atrophied muscles may become fibrotic, i.e. muscle fibers are replaced by fibrous (scar) tissues. If you can stretch your muscles, they are not fibrotic.

    Even if they are, there will be ways to get around the problem. We may have to inject myoblasts into the muscles to rebuild them when we re-innervate them. This will have to be done for lumbosacral injuries.

    Walking is also not the be-all and end-all of spinal cord regeneration. Long tract regeneration, if it is indeed occurring, should improve bowel, bladder, and other function as well.

    We had to choose primary outcome measures in the first trials. I expect that there will other trials that will be looking for bladder and bowel, and even sexual function, if the treatment is regenerating the spinal cord.

    I am hoping that our next generation of trials will focus on lumbosacral spinal cord injury. As I have explained, we will probably need to do neuronal replacement as well as regeneration.

    Wise.
    Last edited by Wise Young; 06-14-2012 at 10:14 AM.

  5. #825
    Senior Member khmorgan's Avatar
    Join Date
    Jan 2008
    Location
    South Florida
    Posts
    366
    What Dr. Young actually said at the June Open House was:

    "We also now have Diffusion Tensior Imaging of these patients, and the Hong Kong study suggests that many of the axons are actually growing across the injury site."

    He never said that the DTIs actually showed the axons. You can say he meant it, but he didn't say it.

    What really bugs me is that people ask for hints at how the trials are going and then jump on gaps in the hints. Furthermore, I hate to see Dr. Young wasting his time defending his unpublished work. Maybe he should do what Dr. Davies did, just say "Wait until it's published."

    Sorry, I'll resume lurking.
    Last edited by khmorgan; 06-14-2012 at 11:30 AM.

  6. #826
    Senior Member
    Join Date
    Jun 2011
    Location
    North Carolina
    Posts
    847
    This may have been answered before but I could not find it. If your therapy shows to restore some function but does not restore all function, would you recomend waiting a year or so and come back and get more injections and another course of lithium or is it a one time thing? This goes for any therapy I would guess. Thanks

  7. #827
    Quote Originally Posted by #LHB# View Post
    This may have been answered before but I could not find it. If your therapy shows to restore some function but does not restore all function, would you recomend waiting a year or so and come back and get more injections and another course of lithium or is it a one time thing? This goes for any therapy I would guess. Thanks
    Let us cross that bridge when we get there. Much depends on the results of the phase 3 trial. All that I can say is that we are committed to designing clinical trials for people who have already participated in our previous trials. We are also listening to the community and view ourselves as partners with those who are part of our trials. Wise.

  8. #828
    Senior Member
    Join Date
    Jun 2011
    Location
    North Carolina
    Posts
    847
    Thanks Dr Wise

  9. #829
    wise your roadmap for therapies is quite comprehensive. the muse cells and cethrin seems to bring much excitement to you and other resarchers. I belive that thos eof us to come. acutes, and many of the youger ones on the forum will benefit from your work. the current trials , if suceesful, will bring some relief for those of us that have been languishing in chairs, but hope for something. You've metnioned some researchers that I had not heard of but will goggle to see what they have to say. All I can say, is that I've stubbornly exercised day in day out for years and am ready for a chance. I know many others are also in that mold. don't forget about us.

    anthony

  10. #830
    Quote Originally Posted by keeping on View Post
    wise your roadmap for therapies is quite comprehensive. the muse cells and cethrin seems to bring much excitement to you and other resarchers. I belive that thos eof us to come. acutes, and many of the youger ones on the forum will benefit from your work. the current trials , if suceesful, will bring some relief for those of us that have been languishing in chairs, but hope for something. You've metnioned some researchers that I had not heard of but will goggle to see what they have to say. All I can say, is that I've stubbornly exercised day in day out for years and am ready for a chance. I know many others are also in that mold. don't forget about us.

    anthony
    anthony, thanks. Wise.

Similar Threads

  1. ChinaSCINET Update
    By Schmeky in forum Cure
    Replies: 11
    Last Post: 06-16-2008, 06:25 PM
  2. ChinaSCINET on Schedule?
    By Schmeky in forum Cure
    Replies: 11
    Last Post: 01-27-2008, 05:53 AM
  3. Dr. Young and ChinaSciNet
    By Imight in forum Cure
    Replies: 17
    Last Post: 01-14-2008, 12:51 AM
  4. ChinaSCINET Schedule
    By Schmeky in forum Cure
    Replies: 4
    Last Post: 07-11-2007, 04:30 AM
  5. ChinaSCINET, On Schedule?
    By Schmeky in forum Cure
    Replies: 56
    Last Post: 01-30-2007, 03:46 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •