Wednesday, May 30, 2007

MRI Predicts Spinal Cord Injury Recovery

MRI imaging is giving neurosurgeons good insight into whether patients with serious spinal cord injuries can recover, a new study shows.

Within 48 hours of the injury, these images should be able to provide a reasonable prediction of a patient's fate, Canadian researchers reported n the June issue of the journal Radiology.

Currently, MRIs are commonly but inconsistently performed on spinal cord injury patients, noted study co-author Dr. Michael G. Fehlings, professor of neurosurgery at the University of Toronto. In light of the study results, they should become the "standard of care, unless pressing medical circumstances preclude the test from being done," he said.

The U.S. National Spinal Cord Injury Association estimates that between 250,000 to 400,000 Americans now have spinal cord injuries or other spinal cord problems. Motor vehicle accidents are responsible for about 44 percent of spinal cord injuries in the United States.

In the new study, Fehlings and colleagues examined 100 patients -- 79 men and 21 women -- with severe spinal cord injuries, mostly as a result of motor vehicle accidents. The patients underwent MRI scans that "allow doctors to see the site of spinal cord injury and to appreciate whether the spine is fractured and whether there is pressure on the spinal cord," Fehlings said.

His team found that three factors -- severity of spinal cord compression, bleeding and spinal cord swelling -- were directly connected to poor outcomes. Essentially, the factors indicate "a more severe injury with less opportunity for recovery," Fehlings said.

But the prognosis was good for patients without these symptoms, even if they were severely injured.

In addition to predicting the likelihood of recovery, MRI images can help doctors determine whether patients should undergo spinal cord decompression surgery, Fehlings said.

There is, of course, a potential downside to a bleak prediction: It could leave patients with little hope for the future. But Fehlings said that's not necessarily so.

"Communication with patients is an art. It is important for physicians to communicate a sense of hope even in the setting of a severe spinal cord injury," he said.

From another perspective, one doctor said it's important for patients "to understand the bleakness of the future" if there are signs of those factors discussed in the study.

"Better to know than to be given false hope," reasoned Dr. Robert Quencer, a radiologist at the University of Miami/Jackson Memorial Medical Center.

By Randy Dotinga

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Saturday, March 10, 2007

Scientists plan China, HK, Taiwan Stem Cell Trial

Scientists are preparing for a large clinical trial in 2008 which aims to use stem cells to help 400 patients with spinal cord injuries in Hong Kong, mainland China and Taiwan grow new cells and nerve fibers.

Stem cells from umbilical cord blood will be injected into the spinal cords of the participants, who will also be given lithium to help stimulate cell regeneration, said Wise Young, a leading neuroscientist and spinal cord injury researcher.

"What we'd like to do is study a broad range of patients, not just (those with) complete (spinal cord injuries)," said Young, professor at Rutgers' department of cellbiology and neuroscience. Rutgers is the state university in New Jersey in the U.S.

Researchers are now giving lithium to 20 patients in Hong Kong in the phase 1 safety and feasibility trial. Lithium is a chemical element that is believed to boost cell regeneration.
In preparation for the large 2008 trial, which will involve 400 patients in 14 mainland Chinese cities, Hong Kong and Taipei, doctors in all three places recently agreed on the method to deliver stem cells into spinal cords, said Young, who is also a visiting professor at the University of Hong Kong.

Stem cells extracted from matching umbilical cord blood taken from public blood banks will be injected into the spinal cords of the subjects, who will also be given lithium.

The procedure should hopefully help subjects grow new nerve fibers and "bridges" -- structures that allow the new fibers to reconnect with other parts of the spinal cord.

"Our main outcome measure will be neurological motor and sensory scores," Young said in an interview with selected media. "We want to see whether the patients recover sensation. It has three measures: touch, pain which is assessed by pin-prick, and the third is strength of 10 standardized muscles."

The trial, the biggest in the field in Asia, comes as China is devoting significant resources into stem cell research.

Its attitude and achievements have drawn U.S.-based scientists like Young to conduct research there due to opposition to embryonic stem cell research in the United States.

Opponents of embryonic stem cell research, including President George W. Bush, say it is unethical to experiment on human embryos, even those never destined to become a baby.
Stem cells are the body's master cells, found throughout the tissue and blood. Whether from the adult or from embryos, they may be used to find treatments and cures for serious diseases such as cancer and diabetes.

Embryonic stem cells are considered potentially the most powerful but are also the most controversial, and federal law greatly restricts the use of taxpayer money to pay for experiments using them.

"Scientists in the U.S. are so upset at the stopping of (embryonic) stem cell research, but this would be a great opportunity for Asia, great opportunity for China ... because there are so many researchers working in this field," Young said, adding that Hong Kong had a special position in all of this.

"Hong Kong is in a special position for science because it has credibility. Many people don't trust what is going on inside China," he said, noting also that Hong Kong badly needed government support and funding.

Private donors are funding the US$26 million spinal cord clinical trial.

By Tan Ee Lyn HONG KONG, Reuters

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