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Thread: Beijing - Brief Report of My China Trip

  1. #21
    Senior Member bilby's Avatar
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    Dr. Young-

    I had a late decompression operation three years after my initial injury. I had two follow-up examinations -one after a week, the other after a year. I assume they wanted to develop statical information on late decompression operations. Barth Green was the doctor who conducted the operation; he was also affiliated with the therapist that gathered the follow-up information. I know it had something to do with the Miami project.

    Anyway, why can't you use the static's that are already accumulated on late decompression operations and contrast them with the oeg results? You can see if the recovery of the patients with oeg's are consistent with the static's on late decompression operations. Of course this wouldn't answer all the questions but it would be a start.

    Some of the patients that underwent the Diacrin procedure regained some movement and sensation; it occurred almost immediately after the operation much like the outcome of the patients with the oeg implants. It happened so fast that regeneration could also be ruled out as the cause. Follow-up visits have been performed but I'm unaware of the results. It would be interesting to know if the recovery continued beyond the initial gains.

  2. #22
    Bilby, thanks so much for contributing your experience. Bohlman has published fairly large series of late decompression cases and has found that many of his patients recovered function if they had compression of the cord, particularly those that were incomplete. He did not see that much recovery after decompressing patients who were "complete" for more than three years but this was before we knew that intensive ambulatory training can reverse learned non-use. I suspect that his results might be better if the patients had received systematic and intensive training and exercise.

    I find it very interesting that some of the patients in the Diacrin study also showed rapid return of some function. I believe that this kind of recovery may involve mechanisms that we don't understand. It may be due to sprouting of surviving axons. We know that sprouting can occur within a day or two and that it can expand sensory dermatomes. It may also be some form of disinhibition phenomenon. In any case, what is really important is to know whether the recovery is sustained and continues. At the hospital, I met several patients who were several months after transplantation. According to the patients and their families, they continued to show recovery. One particularly impressive case was a man who was 18 years after injury. His daughter said that she had never seen her father move his legs in 18 years. These types of anecdotal stories, however, cannot substitute for detailed and systematic examinations of the patients. It is important to know whether these occur in 80%, 40%, 20%, or 5% of the cases...

    It is Dr. Huang's impression that the transplanted patients recover more sensation and motor function after transplantation than those who just got decompression. However, he did recount one case of a man that he had decompressed. The man was incomplete but not functional. In any case, after the decompression without transplantation, the patient recovered independent walking. Dr. Huang said that the man was not that interested in OEG transplants after his recovery. In any case, this kind of dramatic recovery after decompression is not common. All the patients who received transplants had already been decompressed before and they did not recover dramatically. I don't think that the recovery that they are seeing is due to decompression or untethering of the cord or else it would be much more widely reported.

    Wise.

  3. #23
    Originally posted by Wise Young:


    Very recently, however, I have changed my views about regeneration. Since visiting Kawaguchi in Japan last month, I have become convinced that it should be possible to produce massive regeneration of the mammalian spinal cord. I want to start a program to pursue this goal for people with very severe spinal cord injuries.

    Wise.
    ROCK & ROLL BABY!!!!!!!!

    Bring it on Doc. Just tell us where to go and who to kick to get this sucker going!!!

    You made my week.

  4. #24
    Wise
    How can you tell who are the people with very severe injuries as compared to someone with enough fibres in tact to walk but isn't walking? MRI scan can't see the axons can it?

    However, a treatment for people with very few axons remaining would be beneficial to everyone wouldn't it?

    Chris

  5. #25
    Dr. Young, I am still curious what you would consider "massive regeneration" (10%, 20%, 50%, etc.)?

    And this may or may not be an issue, but how difficult is this surgery or rather, can it be taught pretty easily? Are their only a handful of neurosurgeons who could do this or should most be skilled enough for the procedure?

  6. #26
    Senior Member rdf's Avatar
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    Thanks for all the cool news, Wise. Did you notice any commanality of spiritual or religious beliefs of the patients? Do the Chinese emphasize or make use of mental attitude or processes parallel to the physical surgery?

    I'm just musing I suppose, trying to figure why they regained sensory and/or motor improvement in just a few days. We all know that if you believe something will work, there is a greater probability that it will than if you don't believe.

    Wise, is it possible that there are normal axons in our spinal cords that are myelinated, traverse the injury site, and are not cut, bruised, or injured at all, but became dormant (and never re-awakened) because of the harmful cellular environment and resulting trauma that occurs shortly after an sci accident?

    And if so, how would you make these sleeping healthy axons not remain dormant, but wake them up? Could stimulation from fetal oeg cells wake them up, or maybe just the surgery itself? Or is it not possible for us to have healthy axons traversing the injury site at all, if we are complete.

    I think the "fetal" aspect of this is the main difference from the other oeg procedures we've seen with similar positive results, albeit nowhere near as fast. That's the scary part, we all know that any research utilizing "fetal" material doesn't fly well in this part of the world.

    -Bob

  7. #27
    rdf, the patients did not seem any more religious than you or me. They do believe in Dr. Huang and obviously were trying hard to impress the visitors (us). However, I think that they were honest and some seemed surprised that they were getting function back so quickly. Dormant axons crossing the injury site may be present and it is possible that there has been a change in the environment of the cord that increased the excitability of the axons or their connections, or some form of disinhibition. If this is true, it would suggest a new mechanism of recovery that we had never thought about. I agree with you that the fetal source of the cells is a problem, even if there is no political or religious opposition to use of cells from this source. It will be a problem even in China because even there I don't think there will be enough fetuses for everybody with spinal cord injury. That is why it is important to develop a source of olfactory ensheating glia that does not require availability of aborted fetal material.

    Carl R, I mean regeneration that is so complete that one cannot see where the spinal cord has been cut. This is what Kawaguchi has been able to achieve in some rats.

    Chris2, good question. Because we cannot see dormant axons in the spinal cord, we don't have any easy way of telling that they are there. A treatment for severe spinal cord injury may be different from a treatment for incomplete injuries. In a severe spinal cord injury, one may want to cut out the injury site and cleanly reconnect the spinal cord.

    Larwatson, it takes the right people and funding to build a team. That is what I have working on since coming back from Japan.

    Wise.

  8. #28
    Dr. Young, will you be trying to replicate Kawaguchi results in your laboratory soon? How were you able to tell regeneration in rats was that massive and did the rats seem to regain function that was close to normal if the regeneration was that successful?

  9. #29
    Carl R, hopefully soon, histologically, yes. Wise.

  10. #30
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    Dr. Young, the work of Dr. Kawaguchi that showed such amazing regeneration in rats that caused you to alter your thinking...did the rats regain levels of functional recovery not before seen in other studies?

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