Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging / Triângulo de segurança lombar: estudo comparativo dos planos coronal e coronal oblíquo em ressonância magnética 3.0-T

Abstract Objective: To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods: A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results: Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion: The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.

Resumo Objetivo: Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua. Materiais e Métodos: Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador. Resultados: A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18-98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio. Conclusão: As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

CYP1B1-derived epoxides modulate the TRPA1 channel in chronic pain

Pain is often debilitating, and current treatments are neither universally efficacious nor without risks. Transient receptor potential (TRP) ion channels offer alternative targets for pain relief, but little is known about the regulation or identities of endogenous TRP ligands that affect inflammation and pain. Here, transcriptomic and targeted lipidomic analysis of damaged tissue from the mouse spinal nerve ligation (SNL)-induced chronic pain model revealed a time-dependent increase in Cyp1b1 mRNA and a concurrent accumulation of 8,9-epoxyeicosatrienoic acid (EET) and 19,20-EpDPA post injury. Production of 8,9-EET and 19,20-EpDPA by human/mouse CYP1B1 was confirmed in vitro, and 8,9-EET and 19,20-EpDPA selectively and dose-dependently sensitized and activated TRPA1 in overexpressing HEK-293 cells and Trpa1-expressing/AITC-responsive cultured mouse peptidergic dorsal root ganglia (DRG) neurons. TRPA1 activation by 8,9-EET and 19,20-EpDPA was attenuated by the antagonist A967079, and mouse TRPA1 was more responsive to 8,9-EET and 19,20-EpDPA than human TRPA1. This latter effect mapped to residues Y933, G939, and S921 of TRPA1. Intra-plantar injection of 19,20-EpDPA induced acute mechanical, but not thermal hypersensitivity in mice, which was also blocked by A967079. Similarly, Cyp1b1-knockout mice displayed a reduced chronic pain phenotype following SNL injury. These data suggest that manipulation of the CYP1B1-oxylipin-TRPA1 axis might have therapeutic benefit.

Nerve root transfer from C4 to C5 in brachial plexus injuries. Anatomical study and description of the surgical technique / Transferência nervosa da raiz de C4 para C5 em lesões do plexo braquial. Estudo anatômico e descrição de técnica cirúrgica

Abstract Objective This is an anatomical study of C4 and C5 roots for nerve transfers in upper brachial plexus injuries, with surgical technique demonstration. Methods Fifteen brachial plexuses from both male and female cadavers were dissected. Morphological features of C4 and C5 roots were recorded and analyzed, followed by a neurotization simulation. Results In all dissections, C4 and C5 roots morphological features allowed their mobilization and neurotization with no need for a nerve graft. The surgical technique spared important regional nerve branches. Conclusion Based on these data, we conclude that C4-C5 nerve transfers are feasible and result in no additional neurological deficit in upper brachial plexus injuries.

Resumo Objetivo Estudo anatômico das raízes usadas na transferência nervosa de C4 para C5 nas lesões altas do plexo braquial, com demonstração da técnica cirúrgica. Métodos Dissecção de 15 plexos braquiais de cadáveres de ambos os sexos, registro e análise das características morfológicas das raízes de C4 e C5 e simulação de neurotização. Resultados As características morfológicas encontradas nas raízes de C4 e C5 em todas as dissecções permitiram a mobilização das mesmas e a realização de uma neurotização sem a necessidade de usar enxerto nervoso. A técnica cirúrgica permitiu preservar ramos nervosos importantes na região abordada. Conclusão Com base nos dados encontrados no presente estudo, podemos concluir que é possível realizar a transferência entre C4 e C5 sem provocar déficit neurológico adicional nas lesões altas de plexo braquial.

Morphometry of spinal nerve composition and thicknesses of lumbar plexus nerves for use in clinical applications / Morfometría de la composición del nervio espinal y espesores de nervios del plexo lumbar para su uso en aplicaciones clínicas

SUMMARY: The aim of this study was to clarify the diverse spinal compositions of the branches of the lumbar plexus in terms of their prevalence rates and thicknesses. Thirty lumbar plexuses extracted from Korean adults were used in this study. The nerve fascicles were separated and traced with the aid of a surgical microscope. The thickness of each spinal nerve component was calculated based on the mean of the largest and smallest diameters using digital calipers under the surgical microscope. The most common patterns of the spinal composition of the branches of the lumbar plexus were as follows: The iliohypogastric nerve (IHN) and the ilioinguinal nerve (IIN) arose from the ventral ramus of the first lumbar nerve (L1), the genitofemoral nerve (GFN) arose from the anterior division of the ventral ramus of the second lumbar nerve (L2), and the lateral femoral cutaneous nerve (LFCN) arose from the posterior division of the ventral ramus of theL2, the femoral nerve (FN) arose from the posterior division of the ventral ramus of L2-the fourth lumbar nerve (L4), with the thickest spinal component derived from the third lumbar nerve (L3), and the obturator nerve (OBN) arose from the anterior division of the ventral ramus of L2-L4, with the thickest spinal component derived from L3. However, when L5 constituted the FN and OBN, the thickest spinal components of the FN and OBN was L4. This morphometric study has measured the thicknesses of diverse spinal components that constitute the branches of the lumbar plexus after separating the nerve fascicles. The thicknesses of the various spinal components of these branches can be compared in order to understand which make the main and minor contributions to the lower limb.

RESUMEN: El objetivo de este estudio fue evaluar las diversas composiciones espinales de los ramos del plexo lumbar en cuanto a sus tasas de prevalencia y grosor. Se utilizaron treinta plexos lumbares extraídos de individuos adultos coreanos. Se separaron y trazaron los fascículos nerviosos por medio de un microscopio quirúrgico. El grosor de cada componente del nervio espinal se calculó con base en la media de los diámetros mayor y menor utilizando calibradores digitales bajo el microscopio. Los patrones más comunes de la composición espinal de los ramos del plexo lumbar fueron los siguientes: el nervio iliohipogástrico (NIH) y el nervio ilioinguinal (NII) surgieron del ramo ventral del primer nervio lumbar (L1). El nervio genitofemoral (NGF) surgió de la división anterior del ramo ventral del segundo nervio lumbar (L2). El nervio cutáneo femoral lateral (NCFM) surgió de la división posterior del ramo ventral L2. El nervio femoral (NF) surgió de la división posterior del ramo ventral de L2. El cuarto nervio lumbar (L4), con el componente espinal más grueso derivado del tercer nervio lumbar (L3) y el nervio obturador (NOB) surgieron de la división anterior del ramo ventral de L2-L4, con el componente espinal más grueso derivado de L3. Sin embargo, cuando L5 constituía el NF y NOB, los componentes espinales más gruesos del NF y NOB eran de L4. Este estudio morfométrico analizó los espesores de diversos componentes espinales que constituyen las ramas del plexo lumbar después de separar los fascículos nerviosos. Es posible comparar los espesores de los diversos componentes espinales de estos ramos para comprender las contribuciones principales y menores al miembro inferior.

Application of ultrasound-guided selective nerve branch blockage in lumbar spinal nerve posterior branch syndrome / 中国骨伤

OBJECTIVE@#To investigate the efficacy and safety of ultrasound-guided selective nerve branch blockage in the treatment of lumbar spinal nerve posterior branch syndrome.@*METHODS@#A total of 40 patients with lumbar spinal nerve posterior branch syndrome treated by Pain Clinic from May 2017 to December 2018 were selected. According to the method used in locating site for nerve blockage, the patients were divided into ultrasound-guided group and anatomical positioning group, with 20 cases in each group. In anatomical positioning group, there were 7 males and 13 females, aged (63.42±7.71) years old, weighted (63.65±10.72) kg, numerical rating scale (NRS) was (6.61±1.52) scores, course of disease was (16.55±4.68) months. Pain sites:4 cases at L@*RESULTS@#There were no statistically significant differences in gender, age, weight, NRS, course of disease and pain segment distribution between two groups (@*CONCLUSION@#Comparedwith anatomicalpositioning, ultrasound-guided selective nerve branch block for the treatment of posterior branch of the lumbar spinal cord syndrome can reduce the number of treatments and maintain a longer therapeutic effect, but it is also necessary to pay attention to the time of each treatment to avoid dizziness and other adverse reactions.

Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study

STUDY DESIGN: A retrospective study. PURPOSE: The first research on the erector spinae plane (ESP) block was published in 2016. To our knowledge, no cohort studies or randomized controlled trials of the ESP block were performed in 2016 and 2017. OVERVIEW OF LITERATURE: This study retrospectively investigated the efficacy of the ESP block in pain management after lumbar spinal surgery. METHODS: Patients who underwent lumbar spinal surgery in 2017 were enrolled in the study. Those who underwent secondary surgery with local anesthesia other than the ESP block were excluded. The primary outcome was the Numerical Rating Scale (NRS) pain score at various time points until the morning of postoperative day 2. The secondary outcomes were the amount of intravenous fentanyl administered during the first 24 hours following the surgery and the number of patients with complaints of complications such as nausea and vomiting until the morning of postoperative day 2. RESULTS: The data of 41 patients undergoing lumbar spinal surgery were retrospectively analyzed. Of these, 23 received only general anesthesia (G group), whereas the other 18 patients received the ESP block in addition to general anesthesia (E group). The NRS pain scores and the amount of fentanyl administered were lower in the G group than in the E group at all measured time points (all data were less than p<0.05). There was no significant difference in the incidence of complications between the two groups (p=0.11). CONCLUSIONS: The ESP block provides effective postoperative analgesic effect for 24 hours in patients undergoing lumbar spinal surgery.

Ansa cervicalis: a comprehensive review of its anatomy, variations, pathology, and surgical applications / 대한해부학회지

The ansa cervicalis is a neural loop in the neck formed by connecting the superior root from the cervical spinal nerves (C1–2) and the inferior root descending from C2–C3. It has various anatomical variations and can be an important acknowledgment in specific operations of the neck region. This is a review the anatomy, variations, pathology and clinical applications of the ansa cervicalis.

The effect of needle tip position on the analgesic efficacy of pulsed radiofrequency treatment in patients with chronic lumbar radicular pain: a retrospective observational study

BACKGROUND: Pulsed radiofrequency (PRF) is a treatment modality that alleviates radicular pain by intermittently applying high-frequency currents adjacent to the dorsal root ganglion. There has been no comparative study on analgesic effect according to the position of the needle tip in PRF treatment. The objective of this study is to evaluate the clinical outcomes of PRF according to the needle tip position. METHODS: Patients were classified into 2 groups (group IP [group inside of pedicle] and group OP [group outside of pedicle]) based on needle tip position in the anteroposterior view of fluoroscopy. In the anteroposterior view, the needle tip was advanced medially further than the lateral aspect of the corresponding pedicle in group IP; however, in group OP, the needle tip was not advanced. The treatment outcomes and pain scores were evaluated at 4, 8, and 12 weeks after applying PRF. RESULTS: At 4, 8, and 12 weeks, there were no significant differences between the successful response rate and numerical rating scale score ratio. CONCLUSIONS: The analgesic efficacy of PRF treatment did not differ with the needle tip position.

Spinal Nerve Position and Morphometric Analysis with Silicon Molds in the Cadaveric Lumbar Intervertebral Foramen / 체질인류학회지

The intervertebral foramen is formed by two adjacent vertebrae and an intervertebral disc. Previous studies examining the foramen have been performed using various methods. The author obtained characteristics of the intervertebral foramen based on silicon mold. The author used 18 cadavers and dissected the lumbar intervertebral foramen. First, positional levels of the spinal nerve in the intervertebral foramen were measured. Second, after being removed all tissues covering the intervertebral, bony foramen was filled with melted silicon to mold the cross section. Subsequently, the solidified silicon mold was removed and stamped on a paper. The paper was scanned and analyzed area, perimeter, height and width of the intervertebral foramen on a computer. Area (average, 9.43 mm²) and perimeter (average, 48.02 mm) did not show any statistical significant pattern for any lumbar vertebral levels. However, the height and width significantly differed at the fifth lumbar vertebra, which had the shortest height (the fifth, 13.00 mm; average, 15.78 mm) and longest width (the fifth, 8.61 mm; average, 7.87 mm), although there were similar patterns in case of area and perimeter of the first to fourth lumbar vertebra. Height had a decrease tendency while width had an increase tendency both from the second to fifth lumbar vertebra. Spinal nerves went through near the intervertebral disc level from the first to fourth lumbar vertebra, although they passed below the disc at the fifth level. This study provides a different view of methodology for the 3-dimensional aspect for the intervertebral foramen. Results of this study may indicate that height and width of the intervertebral foramen changed along all lumbar vertebral levels; nevertheless, area and perimeter of the intervertebral foramen remained constant.

The abnormalities demonstrated by spine MRI indicate the possibility of etiology for refractory lower urinary tract symptoms in female patients / 中华泌尿外科杂志

Objective To approach the spine MRI features and its possibility of etiology for refractory lower urinary tract symptoms(LUTS) in female patients.Methods We conducted prospectively a cross sectional description study of female patients with refractory LUTS during January 16 through March 27 in 2017 based on a urologist's outpatient work.The including criteria were adult female patients with refractory LUTS which defined as having LUTS more than three months and having poor response to behavior therapy and medication treatment.The excluding criteria were patients having evidence of infection,tumor,stone in urinary tract,any central nerve system diseases,or any other diseases may potentially producing LUTS.Data collected included patients demographic information,main complains,present disease features,disease history,physical examination,urine routine,urodynamic study and spine MRI.The characteristics of clinical manifestation,urodynamic study and spine MRI were analyzed.Results During the time span of study,totally 70 cases had been diagnosed as having refractory LUTS and had qualified data of clinical recordings,urodynamic study and spine MRI.Among these 70 cases,63 (90.9％) had storage phase symptoms,11 (15.7％) had voiding phase symptoms,8 (11.4％) had postmicturition symptoms,12 (17.1％) also had disorders in defecating,45 (64.3％) had pain in lower abdomen or pelvic region.69 cases (98.6％) had urodynamic disorders,33 (47.1％) had oversensitivity of bladder,12 (17.1％) had smaller bladder volume,16(22.9％) had detrusor overactivity,15 (21.4％) had bladder outlet obstruction,39(55.7％) had detrusor underactivity.69 cases(98.6％)had spine MRI abnormalities,54(77.1％) had sacral nerve lesions,49 (70.0％) had cervical lesions,48 (68.6％) had lumbar lesions,4 had thorathic lesions.Conclusions The present study revealed extraordinary high prevalence of abnormality in urodynamic parameters and spine MRI in female patients with refractory LUTS,which implies possibility that the refractory LUTS are caused by lesions in spinal nerve system.

Production and application of assessment card for spinal nerve motor function / 中华护理杂志

Objective To explore the effects of application of self-made assessment card for spinal nerve motor function in clinical nursing.Methods An assessment card for spinal nerve motor function was designed and produced according to "spinal cord injury grading standards" by American Spinal Injury Association(ASIA).A total of 40 nurses working in orthopedic ward of our hospital were selected as study subjects,and divided into the experimental group and the control group with 20 nurses in each group.Theoretical and practical training regarding spinal nerve motor function was provided to nurses in both groups.Then totally 398 patieuts with spine or spinal cord diseases hospitalized in our orthopedic ward were recruited from June to September 2016 as subjects for assessment.The experimental group used self-made assessment card for spinal nerve motor function as guidance;the control group performed routine assessment for spinal nerve motor function.Results There were no significant differences between the experimental group and the control group in scores of theoretical and practical examinations (P＞0.05);compared with the control group,the error of assessment in the experimental group was reduced by 9.5％,missed assessment rate decreased by 16.2％;and the time for assessnent in the experimental group was significantly shorter than that in the control group(P＜0.05).Conclusion The assessment card for spinal nerve motor function can reduce the error of assessment,save the time for assessment,enhance the capacity of specialist nurses and improve work efficiency.

Regulatory Effects of Ionotropic and GroupⅠ Metabotropic Glutamate Receptors on Temperature Hypersensitivity in Rats / 中国医科大学学报

Objective To study the effects of ionic and group Ⅰ metabotropic glutamate receptors on rats' thermal hypersensitivity by intraplantar administration of drugs. Methods After intraplantar administration of glutamate receptor agonists,L-glutamic acid (Glu), N-methyl-D-aspartic-acid (NMDA),and (RS)-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid hydrobromide (AMPA);a Group Ⅰ mGluR agonist, (S) 3,5-dihydroxyphenylglycine [(S)-DHPG];a noncompetitive NMDA receptor antagonist, (+)-MK801 maleate (MK-801);a competitive AMPA/kainate receptor antagonist,6-cyano-7-nitroquinoxaline-2,3-dione (CNQX);and a selective GroupⅠ mGluR antagonist,7-hydroxyiminocyclo propan[b]chromen-1a- carboxylic acid ethyl ester (cpccoEt) into the left hind paws of rats whose L5-6 nerves were sham-operated or ligated,we examined the response of the rats to thermal stimuli provided by radiant heat. Results In sham-operated rats,glutamate,NMDA,AMPA,and (S)-DHPG reduced paw withdrawal latency (PWL) but did not have any effect on SNL rats. However,in SNL rats,MK-801,CNQX,and cpccoEt increased PWL but exerted no effect on sham-operated rats. Conclusion These results suggest that changes in sensitivity of peripheral ionic and group Ⅰ metabotropic glutamate receptors can lead to changes in peripheral nerve plasticity;the generation and maintenance of neuropathic pain caused by nerve injury is based on this plasticity.

Role of NDRG2 in the dorsal horn of the spinal cord in rats with spinal nerve ligation of neuropathic pain / 临床麻醉学杂志

Objective To investigate the effect of NDRG2 on neuropathic pain model rats with spinal cord ligation(SNL)in the dorsal horn of the spinal cordby using intrathecal NDRG2 adenovirus (AD-Ndrg2-RNAi).Methods Forty-two male SD rats weighing 180-230 g were randomly divided into sham operation group (n=6)and SNL group (n=3 6).SNL group underwent lumbar spinal dor-sal ligation.The sham operation group only exposed the spinal nerve without ligation.The mechanical withdraw threshold (MWT)and thermal withdrawlantency (TWL)were measured at 1 d before op-eration and at 1,3,7,10,14 and 21 d after operation.After the behavioral testing,the rats in SNL group were sacrificed and the lumber segment of the spinal cord was removed to test theprotein and mRNA level of NDRG2.Another forty-eight male SD rats were randomly divided into 4 groups after intrathecal catheterization (n=12):group sham operation with saline (group CS);group sham oper-ation with adenovirus (group CA);group SNL with saline (group SS);group SNL with adenovirus(group SA).The rats in groups CS and SS were treated with intrathecal injection of normal saline 10 μl on the third day after operation,while groups CA and SA received the single injection titer of 2× 109PFU/ml of AD-Ndrg2-RNAi on the same day.The rat plantar MWT and TWL were measured at 1 d before SNL and at 1,3,7 and 10 d after SNL.The rats were sacrificed after the lastbehavioral test.Lumbar enlargement of the spinal cord was removed to test the level of NDRG2 and GFAP pro-tein.The expression of NDRG2 mRNA was detected by real-time fluorescence quantitative PCR. Results Compared with sham group,the MWT and TWL was significantly decreased and reduced in SNL group 1,3,7,10,14,21 d and 3,7,10,14,21 d after surgery respectively(P<0.01).Com-pared with 1 d before surgery,protein content and mRNA expression of NDRG2 in the spinal dorsal horn of the SNL group were significantly decreased 1 d after surgery,and they were significantly in-creased on the 7,10,14,and 21 d after operation(P<0.01).Compared with group CS,the MWT and TWL were significantly decreased and reduced in group SS and group SA 1,3,7 and 10 d after surgery(P<0.05).MWT and TWL on 7 and 10 d were increased significantly in group SA (P<0.05)compared with group SS.Compared with group CS,protein content and mRNA expression of NDRG2 in the spinal dorsal horn of group CA were significantly decreased,and increased significantly in group SS 10 d after surgery(P<0.05).Compared with group SS,protein content and mRNA ex-pression of NDRG2 in the spinal dorsal horn of group SA were significantly decreased.Compared with group CS,the protein content of GFAP in spinal dorsal horn of group CA,group SS and group SA were increased significantly 10 d after surgery (P<0.05).Conclusion Intrathecal injection of AD-Ndrg2-RNAi significantly inhibits neuropathic pain caused by spinal cord ligation in rats,suggesting that NDRG2 in astrocytes is involved in the development and progression of neuropathic pain.

Role of N-methyl-D-aspartic acid receptor 2B in neuropathic pain induced by spinal nerve ligation in rats / 医学研究生学报

Objective Spinal cord injury-induced neuropathic pain(NP)does not respond well to any existing therapies clinically.This study aimed to explore the molecular metabolisms neuropathic pain by observing the expressions of the N -methyl-D-as-partic acid receptor 2B(NR2B),tumor necrosis factor-alpha(TNF-α)and brain-derived neurotrophic factor(BDNF)in different sta-ges of the condition in SD rats. Methods Thirty-six adult SD rats were randomly divided into a control,a sham operation and an NP model group.The NP model was established by spinal nerve ligation. At 5 and 14 days after modeling,the hindlimb motor function and paw withdrawal threshold(PWT)of the rats were evaluated by the open-field test and the expressions of NR 2B,TNF-αand BDNF in the dor-sal root ganglia of the L4-6 spinal cord were determined by Western blot. Results At 5 days after modeling,the open-field test showed a significantly shorter total distance of movement in the sham operation group than in the control([14 927.93 ±560.87]vs [18 225.15±371.76]mm,P<0.05)and even shorter in the NP model group([3 224.92±89.64]vs[18 225.15±371.76]mm, P<0.01).The time of activity was markedly decreased in the NP model group as compared with that in the control([203.48±19.94]vs [745.95±13.48]s,P<0.01),but with no statistically significant difference between the sham operation and control groups([727.93± 16.29]vs[745.95±13.48]s,P>0.05).At 14 days after modeling,both the total distance of movement and time of activity were re-markably shorter in the NP model than in the sham operation and control groups([3 395.53±96.12]vs[17 382.26±482.31]and [17 975.40±416.56]mm,P<0.01;[195.53±96.12]vs[739.31±18.36]and[775.20±16.84]s, P<0.01).The PWT showed no statistically significant difference among the three groups of rats before modeling(P>0.05)but markedly decreased in the NP model as compared with the sham operation and control groups(P<0.01),with no significant difference between the latter two(P>0.05).The expressions of NR2B,TNF-αand BDNF were remarkably up-regulated in the NP model group in comparison with the sham operation and control groups at 5 days after modeling(P>0.05)and even more significantly at 14 days(P<0.01). Conclusion NR2B and BDNF may be involved in the development and progression of neuropathic pain in rats.

Origins of plexus brachial in Iguana iguana iguana / Origens do plexo braquial da Iguana iguana iguana

This paper aims to describe the origin of the brachial plexus of 12 iguanas, male and female, which were donated already dead by the Wild Animal Screening Center and Independent Company of Highway and Environmental Police of the Araguaína, Tocantins State, to Veterinary Anatomy Laboratory of Federal University of Tocantins, Araguaína campus These animals were fixed by intramuscular injections of aqueous 10% formalin. It was made a parallel incision to dorsal midline from the skull to the caudal ribs. It was pulled all the epiaxial muscles eight ribs, the periosteum, exposing and individualizing the ventral rami of spinal nerves that make up the brachial plexus. The ventral rami of spinal nerves C6, C7, C8, T1 and T2 form the brachial plexus in 12 iguanas. In 41.6% of cases, the branches involved were C6, C7, C8 and T1; in 33.4%, the branches C6, C7, C8, T1 and T2; 16.6% the branches C7, C8, T1 and T2 and in 8.4%, the branches C7, C8 and T1. The branches ventral C7, C8 and T1 formed three trunks and C6 and T2, when present, consisted of nervous fillet. There was variation in number of vertebrae in Iguana iguana iguana which caused oscillations in anastomoses, that constitute the nerves of brachial plexus. The axillary, subscapular, cutaneous, pectoral, coracobrachialis, radial, median, ulnar, thoracodorsal nerves are the main nerves that constitute the brachial plexus in iguanas.

Esse trabalho tem como objetivo descrever a origem do plexo braquial de 12 iguanas, machos e fêmeas, doados mortos pelo Centro de Triagem de Animais Silvestres e Companhia Independente de Polícia Rodoviária e Ambiental ­ Araguaína ­ Tocantins, ao Laboratório de Anatomia da Universidade Federal do Tocantins, campus de Araguaína. Fixou-se os animais com injeções intramusculares de solução aquosa de formalina a 10%. Realizou-se uma incisão paralela a linha mediana dorsal desde o crânio até a região caudal das costelas. Retirou toda a musculatura epiaxial, oito costelas, o periósteo, expondo e individualizando os ramos ventrais dos nervos espinhais que compõem o plexo braquial. Os ramos ventrais dos nervos espinhais C6, C7, C8, T1 e T2 formam o plexo braquial nas 12 iguanas. Em 41,6% dos casos, os ramos envolvidos foram C6, C7, C8 e T1; em 33,4%, os ramos C6, C7, C8, T1 e T2; em 16,6 % os ramos C7, C8, T1 e T2 e em 8,4%, os ramos C7, C8 e T1. Dos ramos ventrais C7, C8 e T1 formavam três troncos e C6 e T2, quando presentes, consistiam de filetes nervosos. Houve variação no número de vértebras na Iguana iguana iguana, que provocaram oscilações nas anastomoses que constituem os nervos do plexo braquial nas iguanas. Os nervos axillar, subscapular, cutâneo, peitoral, coracobraquial, radial, mediano, ulnar e toracodorsal são os principais nervos que constituem o plexo braquial nas iguanas.

Neuropathic Pain Relieving in Rats by the Inhibition of Monomer of Lamiophlomis Rotata on AKT-mTOR Signaling Pathway in Spinal Dorsal Horn / 中国药师

Objective:To observe the effect of intrathecal administration of 8-O-acetyl-SM(8-OaS) on chronic neuropathic pain in rats by inhibiting the expression of protein kinase B(AKT)-mammalian target of rapamycin(mTOR) signaling pathway in spinal dorsal horn after spinal nerve ligation.Methods:The rat model of neuropathic pain was established by lumbar 5 spinal nerve ligation(SNL), and Von Frey filament was used to investigate the mechanical allodynia. Immunofluorescent histochemistry was adopted to investigate the distribution of pAKT and pmTOR in spinal dorsal horn. The protein levels of pAKT and pmTOR in spinal dorsal horn after drug ad-ministration were quantitatively determined by Western blot. Results: Compared with that in the sham group, the paw withdrawal threshold (PWT) significantly decreased(P<0.01),and the intrathecal administration of 8-OaS attenuated mechanical allodynia ob-viously during the first day and the seventh day after the operation(P<0.05). Meanwhile,double immunofluorescent staining showed the co-expression of pAKT and astrocytes marker glial fibrillary acidic protein(GFAP),and positive labeling of pmTOR was expressed in spinal astrocytes and neurons. The results of Western blot revealed that the protein levels of pAKT and pmTOR in spinal dorsal horn were significantly reduced after the treatment of 8-OaS. Conclusion:Intrathecal administration of 8-OaS attenuates the PWT of SNL-in-duced chronic neuropathic pain. The underlying mechanism of the potential anti-allodynia effect of 8-OaS may be related to the suppres-sion of spinal astrocytes via decreasing the phosphorylation of AKT-mTOR signaling pathway resulting in attenuating the development of neuropathic pain.

Observation on therapeutic effect of nerve root pulsed radiofrequency in elderly acute herpes zoster / 重庆医学

Objective To evaluate the effect of nerve root pulsed radiofrequency combined with neurotropin(NTP) by epidural injection for treating neuralgia in elderly patients with herpeszoster. Methods Sixty patients aged 60-85 years old with herpes zoster neuralgia were selected and divided into the observation group and control group. The control group was given the epidural injection of NTP,while the observation group was given the therapy of nerve root pulsed radiofrequency combined with NTP. Then the curative effects were observed in the two groups. The visual analogue scale (VSA) and Pittsburgh sleep quality index (PSQI) were used to evaluate the status of sleep improvement and the occurrence rate of post herpetic neuralgia (PHN) was also calculated. Results The VAS and PSQI scores at each time points of 1,3,6 months in the both groups were significantly superior to those before treatment (P<0.05). Compared with the control group,the VAS score at each time point after treatment in the observation group was significantly superior to that in the control group(P<0.05) ;The PHN occurrence rate after 6 months of treatment in the observation group was significantly lower than that in the control group (P<0.05). Conclusion Nerve root pulsed radiofrequency combined with NTP by epidural injection is a good method for treating neuralgia in elderly patients with herpes zoster.

Bilateral Mirror Image Cervical Neurofibroma in an Adult with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. Only few cases of Non-Familial Spinal Neurofibromatosis-1 (Non-FSNF1) have been described in literature with tumors involving the spinal roots at every level being even rarer. We reported an interesting case of bilateral symmetrical cervical neurofibroma with multiple spinal neurofibromas appearing as mirror image on CT, associated with non familial NF-1 as a rare presentation in a 25-year-old adult male.

Effect and safety of methylprednisolone pulse therapy on spinal nerve function in patients with acute spinal cord injury / 中国生化药物杂志

Objective To investigate the effect of methylprednisolone pulse therapy on spinal nerve functions in patients with acute spinal cord injury (ASCI) and evaluate its safety. Methods 200 patients with ASCI treated in our hospital from January 2010 to December 2016 were selected and were randomly divided into two groups,with 100 cases each group. The patients in control group were treated with routine basic treatment while patients in the study group were treated with methylprednisolone pulse therapy. On the basis of the American spinal cord injury Society scoring criteria (ASIA), the neurological functional recovery scores were performed were scored before and 6 weeks after treatment between the two groups and the adverse reactions were recorded. Results The scores of sensory and motor function of the patients in the two groups were higher than those before the treatment and there was statistical difference (P<0.05), and the scores in the study group was significantly higher than those in the control group, and the difference between the two grouPs was statistically significant (P<0.05). The incidence of adverse reactions in the study group (25.00％) was significantly higher than that in the control group (10.00％), and the difference was statistically significant (P<0.05). The incidence of lung infection and gastrointestinal reaction in the study group were significantly higher than those in the control group and there were statistical difference (P<0.05). Conclusion Methylprednisolone pulse therapy has significant effect on the recovery of neurological function in patients with ASCI, but the incidence of adverse reactions is high, so it is necessary to strengthen the monitoring and intervention in clinic.

Clinical therapeutic effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain / 实用医学杂志

Objective To investigate the clinical value and effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain. Methods From August 2008 to October 2013 ,96 patients diagnosed as lumbar zygapophysial joint pain were included in the research. 36 patients were treated by spinal nerve medial branch ablation through transforaminal endoscopic ,while 60 patients received conservative treatment. The visual analogue scale (VAS) and Japanese Orthopedics Association(JOA) scores before treatment,1,3,6 and 12 months after treatment were recorded and analyzed. The MacNab scores were recorded and analyzed 12 months after treatment. Results The VAS and JOA scores of surgical treatment group showed significant improvement compared with that before operation (P < 0.05),and there were no significant difference at each time point after surgery. The VAS and JOA scores of conservative treatment group in showed significant improved at 1 months after treatment compared with that before treatment(P<0.05),but there were no significant difference at each time after treatment compared with pretreatment. The VAS and JOA scores of surgical treatment group showed significant improvement compared with conservative treatment group at each time after treatment(P<0.05). The MacNab scores of surgical treatment group(94.44%)was significantly higher than that of conservative treatment group(33.33%). Conclusion The spinal nerve branches ablation under transforaminal endoscopic is an effective and safe minimally invasive spine surgery technique with important clinical value in the treatment of lumbar zygapophysial joint pain.