Effects of decompression joint Governor Ves(4)

Previous studies have found that the death of the spinal cord neurons after SCI occurs mainlyviaapoptosis (Springer et al., 1999; Zhang et al., 2012). Permanent or long-term loss of neural function caused by SCI is associated with spinal cord edema, degeneration, necrosis, and apoptosis of neurons and oligodendrocytes. SCI-induced apoptotic cell death of neurons and oligodendrocytes has been shown to cause progressive degeneration of the spinal cord, leading to permanent functional de fi cits (Moon et al., 2012). The key link in cell apoptosis is the cleavage of related cysteine protease proteins (Park et al., 2012). Among them, caspase-9 is an initiator of the caspase apoptotic protease. When caspase-9 is activated, it can activate the downstream protease cascade,including caspase-3, which can act on the poly (ADP-ribose)polymerase and lead to apoptosis, finally causing cell death(Eldadah et al., 2000). Therefore, caspase-9 is an important mediator of cell apoptosis. Inactivating caspase-9 can inhibit apoptosis and promote the recovery of nerve function. In the present study, for the groups compressed for 12 and 48 hours,there were similar changes; in other words, there was greater inactivation of caspase-9 in the EA group than in the MP and SCI groups. This result proves that EA can more strongly promote the recovery of neural function and may lead to a better long-term outcome than observed in the MP and SCI groups.

Our results showed that the platelet-activating factor contents of the 12-hour EA group were lower than in the 12-hour SCI group, and the caspase-9 expression of the 12-hour EA group was lower than in the 12-hour SCI group. Thus, why were there no signi fi cant differences in BBB scores at 14 days between the 12-hour EA and the 12-hour SCI groups? The authors believe that the reasons are as follows. First, we can conclude that the EA group had a faster recovery than the 12-hour SCI group, which was the effect of EA, but the short duration of compression and the strong ability of the rats to recover may have been the primary reasons for this. Second,spinal cord decompression may have some bene fi cial effects that have not yet been identi fi ed. For example, over time, the levels of substance P, a potential anti-in fl ammatory modulator used to treat injury-induced in fl ammatory central nervous system disorders (Jiang et al., 2012), constantly change after decompression in SCI patients (Da et al., 2017), which may in fl uence recovery. Third, acute SCI is an extremely complex physiological process, so we cannot exclude factors that we have not studied yet that may in fl uence recovery.

Our study focused on acute upper cervical SCI. Given the high mortality and instability of the previous upper cervical SCI animal models, therapeutic and mechanistic studies of acute upper cervical SCI have been limited, and our model solved the problem of high mortality and instability and enriched this academic fi eld. Early and late decompression leads to different outcomes following acute upper cervical SCI. We chose two time points to intervene with Governor Vessel EA, which made the study systematic and , the syndrome differentiation and treatment theory of traditional Chinese medicine was re fl ected.

The limitation of this study was primarily the small sample size, which may have increased error bias and in fl uenced the results. Besides, the mechanism of secondary injury includes not only changes in the microenvironment of the spinal cord and apoptosis, but also the axonal regeneration barrier (Tran, et al., 2018). Our follow-up studies will assess different factors associated with acute upper cervical SCI.

In summary, EA was effective for SCI, and delayed decompression combined with EA was a more effective treatment than decompression alone. Early decompression combined with EA promoted the recovery of motor function more effectively than decompression alone. However, whether it has a favorable fi nal effect requires additional study.

Author contributions:YLW and YNQ performed the experiments and wrote the manuscript. WW and PY designed and supervised the study. FY and XST analyzed the data and provided technical support. MST planed the overall and provided critical revision of the manuscript for intellectual content. All authors approved the fi nal version of the paper.

Con fl icts of interest:The authors have no con fl icts of interest to declare.

Financial support:This study was supported by a grant from the Capital Characteristic Clinical Application Research Project of Beijing Municipal Science and Technology Plan of China, No. Z1611. The funding body played no role in the study design, in the collection, analysis and interpretation of data, in the writing of the paper, and in the decision to submit the paper for publication.

Institutional review board statement:All experiments were approved by the Institutional Animal Care and Use Committee of China-Japan Friendship Hospital of China (No. ). The experimental procedure followed the United States National Institutes of Health Guide for the Care and Use of Laboratory Animals (NIH Publication No. 85-23, revised 1985).

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