Protective effect and mechanism of acellular nerve allografts combined with electroacupuncture on spinal ganglia in rats with sciatic nerve injury / 解剖学报

Objective To investigate the protective effect and mechanism of acellular nerve allografts(ANA)combined with electroacupuncture on spinal ganglia in rats with sciatic nerve injury(SNI).Methods Totally 50 male adult SD rats were randomly selected for this experiment.Ten rats were prepared for the ANA.Forty male SD rats were randomly divided into normal group,model group,ANA group and combinational group,with 10 rats in each group.The SNI model was established by cutting off the nerves 10 mm at the 5 mm on the inferior border of piriformis after separating the right sciatic nerves.The rats in the ANA group were bridged with ANA to the two broken ends of injured nerves.The rats in the combinational group were treated with electroacupuncture 2 days after ANA bridging,Huantiao(GB30)and Yanglingquan(GB34)were performed as the acupuncture points,each electroacupuncture lasted 15 minutes and 7 days as a course of treatment,4 courses in all.Sciatic nerve conduction velocity was measured by electrophysiology to evaluate the regeneration of damaged axons.Morphology of spinal ganglia was observed by Nissl staining.The expression of nerve growth factor(NGF)and brain-derived neurotrophic factor(BDNF)were detected by Western blotting and immunofluorescent staining.Results Compared with the normal group,the sciatic nerve conduction velocity in model group decreased significantly(P<0.01),Nissl bodies in neurons of spinal ganglia were swollen and dissolved,with incomplete structure and the number decreased dramatically(P<0.01),while the level of NGF and BDNF also decreased significantly(P<0.01).Compared with the model group,the sciatic nerve conduction velocity in ANA and combinational groups strongly increased(P<0.01),the damage of Nissl bodies in neurons of spinal ganglia reduced and the number obviously increased(P<0.01),the level of NGF and BDNF increased considerably(P<0.01).Compared with the ANA group,the sciatic nerve conduction velocity in combinational group increased significantly(P<0.01),the morphology of Nissl bodies in neurons of spinal ganglia were more regular and the number increased(P<0.01),moreover,the level of NGF also increased significantly(P<0.01).Conclusion ANA combined with electroacupuncture can enhance the sciatic nerve conduction velocity,improve the morphology of neurons in spinal ganglia and play a protective effect on spinal ganglia.The mechanism can be related to the higher expression of NGF and BDNF proteins,especially the expression of NGF protein.

Combination of 1％ platelet-rich plasma and bone marrow mesenchymal stem cells improves the recovery of peripheral nerve injury / 中国组织工程研究

BACKGROUND:Platelet-rich plasma has been shown to enhance the viability and the pro-angiogenesis capacity of mesenchymal stem cells.Extracellular vesicles are one of the key mediators for mesenchymal stem cells to exert their effects,but currently,it is unclear whether platelet-rich plasma affects the functions of extracellular vesicles. OBJECTIVE:To investigate the effects of platelet-rich plasma on the function of extracellular vesicles from bone marrow mesenchymal stem cells,verify whether platelet-rich plasma can be used as an adjuvant to enhance the healing effects of bone marrow mesenchymal stem cells on repairing the peripheral nerve injury. METHODS:For in vitro study,bone marrow mesenchymal stem cells were cultured under normal conditions and with 1%platelet-rich plasma.The ultracentrifugation was used to extract the extracellular vesicles produced by bone marrow mesenchymal stem cells cultured under normal conditions(EVs-nor)or the condition supplemented with 1%platelet-rich plasma(EVs-prp).Extracellular vesicles were used to incubate with Schwann cells.The EdU assay,western blot assay,qPCR and light microscopy photography were performed to examine the effects of EVs-nor and EVs-prp on Schwann cell reprogramming,which was characterized by cell proliferation,c-Jun expression,reprogramming-associated gene expression and cell morphology.For in vivo study,the model of sciatic nerve injury in rats was established.Bone marrow mesenchymal stem cells were grafted with or without 1%platelet-rich plasma into the injured rat sciatic nerve using a chitin nerve conduit.Eight weeks after the surgery,the recovery was assessed by histological and functional indexes,including regenerated nerve fiber density,gastrocnemius wet weight ratio and sciatic function index. RESULTS AND CONCLUSION:(1)Compared with EVs-nor,EVs-prp was stronger in promoting Schwann cell proliferation.The gene expressions of c-Jun and GDNF were significantly upregulated in EVs-prp treated Schwann cells.The morphology of Schwann cells was significantly longer in EVs-prp group than that in EVs-nor group,indicating that EVs-prp had a stronger ability to stimulate Schwann cell reprogramming than EVs-nor.(2)Sciatic nerve injury animal experiment results revealed that grafting mesenchymal stem cells along with platelet-rich plasma into the injured sciatic nerve showed the best recovery compared with grafting mesenchymal stem cells or platelet-rich plasma alone,demonstrated by the significantly improved density of nerve fibers,gastrocnemius wet weight ratio,and sciatic function index.(3)These results suggested that platelet-rich plasma improved the function of bone marrow mesenchymal stem cell-derived extracellular vesicles and could be served as a practical and feasible preparation to synergize with bone marrow mesenchymal stem cells to improve peripheral nerve repair.

Effect of adductor canal block and single sciatic nerve block combined with analgesic drugs on pain after total knee arthroplasty / 中国组织工程研究

BACKGROUND:Total knee arthroplasty is an effective treatment for late-stage osteoarthritis,but postoperative pain and joint function recovery are the main challenges.Nerve block and mixed drug injection are two common pain relief methods,but the effect of their combined use is still unclear. OBJECTIVE:To investigate the effects of ultrasound-guided continuous adductor canal block+single sciatic nerve block+"cocktail"mixed drug analgesia on postoperative pain relief and joint function recovery in total knee arthroplasty. METHODS:120 patients with osteoarthritis admitted to Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine from January to May 2022 were randomly divided into two groups(n=60).The observation group received ultrasound-guided continuous adductor canal block+single sciatic nerve block+"cocktail"mixed drug analgesia.The control group received ultrasound-guided continuous adductor canal block+single sciatic nerve block.The differences in visual analog scale score,hospital for special surgery score,pain mediators,expression levels of inflammatory factors,the occurrence of adverse reactions,and postoperative barehanded muscle strength test were compared between the two groups. RESULTS AND CONCLUSION:(1)The visual analog scale scores at rest and exercise were lower in the observation group than those in the control group at 6,8,12,24,48,and 72 hours postoperatively(P<0.05).(2)Hospital for special surgery scores at 1 and 3 months postoperatively were significantly higher in the observation group than those in the control group(P<0.05).(3)In terms of pain mediators and inflammatory factors,the expression levels were significantly lower in the observation group than those in the control group(P<0.05).(4)There was no statistically significant difference in terms of adverse effects and postoperative barehanded muscle strength examination between the two groups(P>0.05).(5)In total knee arthroplasty,ultrasound-guided continuous adductor canal block and single sciatic nerve block,together with a"cocktail"mixed drug analgesia injected into the joint cavity,can provide excellent analgesia,facilitate the recovery of joint function,and relieve postoperative pain and inflammation with a high degree of safety.

Effects of Wheat Grain Moxibustion on the Expression of TLR4/MyD88/NF-κB Signaling Pathway in Spinal Cord Tissue of Rats with Sciatic Nerve Injury / 中国中医药信息杂志

Objective To observe the effects of wheat grain moxibustion for"Huantiao"on sciatic nerve function,pathological morphology of sciatic nerve stem and expressions of TLR4/MyD88/NF-κB signaling pathway expression in spinal cord tissue of rats with sciatic nerve injury(SNI);To explore the possible mechanism of wheat grain moxibustion for the treatment of SNI.Methods Totally 24 SD male rats were randomly divided into blank group,sham-operation group,model group and wheat grain moxibustion group,with 6 rats in each group.The model group and the wheat grain moxibustion group used a rat model with sciatic nerve clamping injury.From the 7th day after modeling,the rats were treated with moxibustion on the affected side of"Huantiao"for 6 strokes each time,once a day,for consecutive 10 days.The sciatic nerve function index(SFI)of rats on the 7th day after modeling and after intervention were observed,mechanical withdraw threshold(MWT)in rats were measured using a fiber optic pain gauge,ELISA was used to detect NO and iNOS content in spinal cord tissue,HE staining was used to observe the morphology of sciatic nerve stem,the expression of TLR4,NF-κBp65,p-NF-κBp65,MyD88,IκBα and p-IκBα in spinal cord tissue were detected by Western blot.Results Compared with the sham-operation group,the SFI and MWT of the rats in the model group significantly decreased(P<0.01),the arrangement of nerve fibers in sciatic nerve stem was disordered,with a significant increase in the number of Schwann cells and a large number of vacuolar degeneration,the content of NO,iNOS and the expression of TLR4,p-NF-κBp65,MyD88,p-IκBα protein in spinal cord tissue significantly increased(P<0.01).Compared with the model group,the SFI and MWT of the rats in the wheat grain moxibustion group increased significantly(P<0.01),the damage of sciatic nerve stem was reduced,with orderly cell arrangement,a decrease in the number of Schwann cells,and a decrease in axonal demyelination and cellular vacuolar degeneration,the content of NO,iNOS and the expression of TLR4,p-NF-κBp65,MyD88,p-IκBα in spinal cord tissue significantly decreased(P<0.05).Conclusion Wheat grain moxibustion for"Huantiao"can down-regulate TLR4,p-NF-κBp65,MyD88 and p-IκBα protein expressions in spinal cord tissue of SNI rats,reduce the secretion of NO and iNOS,thereby relieve pain and damaged nerve tissue inflammation response.

Effect of Xin-Gui Gel Plaster on Peripheral Neuropathy in Diabetic Rats / 中药新药与临床药理

Objective To observe the effects of Xin-Gui Gel Plaster(Cinnamomi Cortex,Asari Radix et Rhizoma,Euodiae Fructus,Chuanxiong Rhizoma,Borneolum Syntheticum)on peripheral neuropathy in diabetic rats.Methods A single intraperitoneal injection of 1%streptozotonic(STZ,35 mg·kg-1)was used to replicate a type 2 diabetes mellitus(T2DM)rat model followed by the induction of diabetic peripheral neuropathy(DPN)in combination with a long-term(8 consecutive weeks)high-fat and high-sugar diet.SD rats were randomly divided into normal group,model group,Mecobalamin group and Xin-Gui Gel Plaster group,with 6 rats in each group.The rats in the Xin-Gui Gel Plaster group were given Xin-Gui Gel Plaster at acupoints once a day for 8 weeks;the rats in the Mecobalamin group were given Mecobalamin solution by gavage(0.045 mg·kg-1),and the rats in the normal group and the model group were given physiological saline by gavage.Body mass and fasting blood glucose(FBG)were measured at weeks 2,4,6 and 8;the latency of thermal withdrawal latency(TWL)was measured at weeks 4 and 8;nerve conduction velocities,including motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV),were measured at week 8;and serum total cholesterol(TC),triglyceride(TG),fasting blood glucose(FBG)were measured using a fully automated biochemical analyzer.Fasting insulin(FINS)levels were detected by ELISA,and the index of insulin resistance(HOMA-IR)was calculated;and pathological changes in the sciatic nerve tissues of rats were observed by HE staining.Results Compared with the normal group,rats in the model group had significantly lower body mass and FINS levels(P＜0.01),significantly higher levels of FBG,TC,TG and HOMA-IR(P＜0.05,P＜0.01);TWL,MNCV and SNCV were significantly decreased(P＜0.01),and sciatic nerve fibres were disorganized and loosely aligned,with demyelination,axon atrophy and vacuole-like phenomenon.Compared with the model group,there was no significant change in body mass and levels of FBG,TC and TG in the Xin-Gui Gel Plaster group(P＞0.05),FINS level was significantly increased(P＜0.05),and HOMA-IR levels was significantly decreased(P＜0.05);TWL,MNCV and SNCV in the Mecobalamin group and Xin-Gui Gel Plaster group were significantly increased(P＜0.05,P＜0.01),sciatic nerve lesions were improved to different degrees,nerve fibre arrangement was more regular,myelin deficiency and axonal atrophy were significantly improved.Conclusion Xin-Gui Gel Plaster can improve insulin resistance,relieve thermal stimulation sensitivity,improve sciatic nerve conduction velocity to a certain extent in DPN rats,and have a protective effect on peripheral nerves in diabetic rats,but the hypoglycemic and hypolipidemic effects are not obvious.

Butein ameliorates sciatic nerve injury by activating SIRT1 and mediating the FOXO1/NF-κB signaling pathway / 中国医科大学学报

Objective This study aimed to explore the effect and possible mechanism of SIRT1 activation induced by butein on sciatic nerve injury in rats.Methods A total of 30 rats were randomly divided into a sham operation group,a sciatic nerve injury group,and a butein group,with 10 rats in each group.BBB motor scores and sciatic nerve function index were detected on the modeling surgery day,the 7th day after surgery,and the 14th day after surgery.The pathological changes of the sciatic nerve in each group were observed by HE staining.The apoptosis of sciatic nerve cells in each group was detected by TdT-mediated dUTP nick end labeling(TUNEL).The expres-sion of BDNF,MBP,GAP-43,SIRT1,FOXO1,Keap1,and NF-κB in the sciatic nerve was detected by Western blotting.Results Butein improved the pathological injury of the sciatic nerve,reduced the apoptosis of sciatic nerve cells,increased BDNF,MBP,GAP-43,and SIRT1 expression,and decreased FOXO1,Keap1,and NF-κB expression in the sciatic nerve.Conclusion Butein can inhibit FOXO1/NF-κB signaling pathway activation by up-regulating SIRT1 expression in rats with sciatic nerve injury and then improve the sciatic nerve pathological injury in rats.

Excision of a Solitary Fibrous Tumor in the Sciatic Notch with Sciatic Nerve Compression - A Rare Clinical Case / Excisão de tumor fibroso solitário na chanfradura ciática com compressão do nervo ciático - Um raro caso clínico

Abstract We present the clinical case of a 41-year-old woman with no relevant personal history. The patient complained of diffuse self-limiting abdominal pain, and we incidentally detected an extra-abdominal, extraperitoneal tumor mass at the level of the right sciatic notch. The abdominal complaints were gone during the initial follow-up, but the patient developed sciatica radiating to the right foot and electric shock-like pain. A computed tomography (CT)-guided biopsy revealed a low-grade mesenchymal neoplasm of the soft tissues with characteristics consistent with a solitary extrapleural fibrous tumor. The pelvis team of the orthopedics department received the patient for surgical excision of the lesion. The procedure occurred with no complications, and we excised the totality of the lesion with tumor-free margins. An anatomopathological examination was compatible with the biopsy assessment. The excision of the lesion resulted in complete resolution of the sciatic nerve compression-related symptoms.

Resumo É apresentado um caso clínico de uma paciente de 41 anos, sem antecedentes pessoais de relevo, que foi estudada por dor abdominal difusa autolimitada, tendo sido detectada incidentalmente uma massa tumoral extrabdominal, extraperitoneal ao nível da chanfradura ciática direita. Durante o estudo do caso, a doente resolveu as queixas abdominais, mas desenvolveu quadro de ciatalgia, irradiada para o pé direito e dor tipo choque elétrico. Biópsia guiada por TAC revelou tratar-se de uma neoplasia mesenquimatosa dos tecidos moles, de baixo grau, com características que a enquadram em um tumor fibroso solitário extrapleural. A paciente foi referenciada para a equipe de bacia do serviço de ortopedia para excisão cirúrgica da lesão, tendo sido operada sem intercorrências - excisão total da lesão, com margens livres, foi obtida e o exame anatomopatológico foi compatível com o realizado na biópsia. Após excisão da lesão, ocorreu resolução completa dos sintomas relacionados com compressão do nervo ciático.

The Role and Mechanism of Aspirin Combined with Rehabilitation Training in the Repair of Sciatic Nerve Injury and the Changes in the Schwannocytus (Schwann Cells) in Rats / Rol y Mecanismo de la Aspirina Combinados con Entrenamiento de Rehabilitación en la Reparación de la Lesión del Nervio Ciático y los Cambios en los Schwannocitos (Células de Schwann) en Ratas

SUMMARY: This study investigated the role and mechanism of aspirin combined with rehabilitation training in the nerve injury repair and Schwann cell changes in rats with sciatic nerve injury. Totally, 120 male healthy SD rats were randomly divided into sham, model, aspirin, and aspirin + rehabilitation groups, with 30 rats in each group. The sciatic nerve function index (SFI), photothermal pain tolerance threshold and inclined plane test results at 4, 6, and 8 weeks after operation were compared. The distance of sensory nerve regeneration and the expression of S100B protein in Schwann cells were analyzed. Compared with the sham group, the SFI of the model, aspirin, and aspirin+rehabilitation groups were significantly lower at 4, 6, and 8 weeks after operation. However, the aspirin and aspirin+rehabilitation groups had significantly higher SFI than the model group. The SFI at 6 and 8 weeks after operation was higher in the aspirin+rehabilitation group than that in the aspirin group (P<0.05). The photothermal pain tolerance threshold of the sham, aspirin, and aspirin+rehabilitation groups were significantly higher than those of the model group at 4, 6, and 8 weeks after operation (P<0.05). The inclination angles of the model, aspirin, and aspirin+rehabilitation groups were significantly lower than those of the sham group at 4, 6, and 8 weeks after operation, and the inclination angle of the aspirin+rehabilitation group was significantly higher than that of the model and aspirin groups (P<0.05). The sensory nerve regeneration distance in aspirin and aspirin+rehabilitation groups was higher than that in the sham and model groups (P<0.05). The expression of S100B protein in the aspirin and aspirin+rehabilitation groups was higher than that in the model group (P<0.05). Aspirin combined with rehabilitation training can promote the functional recovery of sciatic nerve injury, and the mechanism may be related to the increase of the expression of S100B protein in Schwann cells.

En este estudio se investigó el papel y el mecanismo que desempeña la aspirina combinada, con el entrenamiento de rehabilitación en la reparación de lesiones nerviosas y los cambios en los schwannocitos en ratas con lesiones en el nervio ciático. En total, 120 ratas SD macho sanas se dividieron aleatoriamente en cuatro grupos de 30 ratas en cada uno: simulación, modelo, aspirina y aspirina + rehabilitación. Se compararon el índice de función del nervio ciático (SFI), el umbral de tolerancia al dolor fototérmico y los resultados de la prueba del plano inclinado a las 4, 6 y 8 semanas después de la operación. Se analizó la distancia de regeneración del nervio sensorial y la expresión de la proteína S100B en los schwannocitos. En comparación con el grupo simulado, el SFI de los grupos modelo, aspirina y aspirina+rehabilitación fue significativamente menor a las 4, 6 y 8 semanas después de la operación. Sin embargo, los grupos de aspirina y aspirina + rehabilitación tuvieron un SFI significativamente más alto que el grupo modelo. El SFI a las 6 y 8 semanas después de la operación fue mayor en el grupo de aspirina + rehabilitación que en el grupo de aspirina (P<0,05). El umbral de tolerancia al dolor fototérmico de los grupos simulado, aspirina y aspirina+rehabilitación fue significativamente mayor que el del grupo modelo a las 4, 6 y 8 semanas después de la operación (P<0,05). Los ángulos de inclinación de los grupos modelo, aspirina y aspirina+rehabilitación fueron significativamente menores que los del grupo simulado a las 4, 6 y 8 semanas después de la operación, y el ángulo de inclinación del grupo aspirina+rehabilitación fue significativamente mayor que el de los grupos modelo y aspirina (P<0.05). La distancia de regeneración del nervio sensorial en los grupos de aspirina y aspirina+rehabilitación fue mayor que en los grupos simulado y modelo (P<0,05). La expresión de la proteína S100B en los grupos de aspirina y aspirina+rehabilitación fue mayor que en el grupo modelo (P<0,05). La aspirina combinada con el entrenamiento de rehabilitación puede promover la recuperación funcional de la lesión del nervio ciático, y el mecanismo puede estar relacionado con el aumento de la expresión de la proteína S100B en los schwannocitos.

Investigation of the Neuro-Regenerative Effects of Bioresonance and Magnetotherapy in Sciatic Nerve Damage-Induced Rats / Investigación de los Efectos Neurorregenerativos de Biorresonancia y Magnetoterapia en Ratas Inducidas por Daño del Nervio Ciático

SUMMARY: Peripheral nerve damage is a significant clinical problem that can lead to severe complications in patients. Regarding the regeneration of peripheral nerves, it is crucial to use experimental animals' nerves and use different evaluation methods. Epineural or perineural suturing is the gold standard in treating sciatic nerve injury, but nerve repair is often unsuccessful. This study aimed to investigate the neuroregenerative effects of magnetotherapy and bioresonance in experimental animals with sciatic nerve damage. In this study, 24 female Wistar rats were divided into 7 groups (n=6) as follows: Group 1 (Control), Group 2 (Axonotmesis control), Group 3 (Anastomosis control), Group 4 (Axonotmesis + magnetotherapy), Group 5 (Anastomosis + magnetotherapy), Group 6 (Axonotmesis + bioresonance), Group 7 (Anastomosis + bioresonance). Magnetotherapy and bioresonance treatments were applied for 12 weeks. Behavioural tests and EMG tests were performed at the end of the 12th week. Then the rats were sacrificed, and a histopathological evaluation was made. The statistical significance level was taken as 5 % in the calculations, and the SPSS (IBM SPSS for Windows, ver.21) statistical package program was used for the calculations. Statistically significant results were obtained in animal behaviour tests, EMG, and pathology groups treated with magnetotherapy. There was no statistically significant difference in the groups treated with bioresonance treatment compared to the control groups. Muscle activity and nerve repair occurred in experimental animals with acute peripheral nerve damage due to 12 weeks of magnetotherapy, and further studies should support these results.

El daño a los nervios periféricos es un problema clínico importante que puede conducir a complicaciones graves en los pacientes. En cuanto a la regeneración de los nervios periféricos, es crucial utilizar los nervios de los animales de experimentación y diferentes métodos de evaluación. La sutura epineural o perineural es el gold estándar en el tratamiento de lesiones del nervio ciático, pero la reparación del nervio a menudo no tiene éxito. Este estudio tuvo como objetivo investigar los efectos neuroregenerativos de la magnetoterapia y la biorresonancia en animales de experimentación con daño del nervio ciático. En el estudio, 24 ratas hembras Wistar se dividieron en 7 grupos (n=6) de la siguiente manera: Grupo 1 (Control), Grupo 2 (Control de axonotmesis), Grupo 3 (Control de anastomosis), Grupo 4 (Axonotmesis + magnetoterapia), Grupo 5 (Anastomosis + magnetoterapia), Grupo 6 (Axonotmesis + biorresonancia), Grupo 7 (Anastomosis + biorresonancia). Se aplicaron durante 12 semanas tratamientos de magnetoterapia y biorresonancia. Las pruebas de comportamiento y las pruebas de EMG se realizaron al final de la semana 12. Luego se sacrificaron las ratas y se realizó una evaluación histopatológica. El nivel de significación estadística se tomó como 5 % en los cálculos, y se utilizó el programa de paquete estadístico SPSS (IBM SPSS para Windows, ver.21). Se obtuvieron resultados estadísticamente significativos en pruebas de comportamiento animal, EMG y grupos de patología tratados con magnetoterapia. No hubo diferencia estadísticamente significativa en los grupos con tratamiento de biorresonancia en comparación con los grupos controles. La actividad muscular y la reparación nerviosa, se produjeron en animales de experimentación con daño nervioso periférico agudo, debido a 12 semanas de magnetoterapia.Estudios adicionales deberían respaldar estos resultados.

A study of high division of sciatic nerve in human cadavers and its clinical significance

Background: Sciatic nerve is a mixed nerve which provide sensory and motor supply for skin and muscles of the lower limb by tibial and common peroneal nerve. Anatomical variations of sciatic nerve at high division have been reported by various authors. The path of the sciatic nerve is important while administration of intramuscular injection to prevent nerve injury and nerve blockage failure during anesthesia. This knowledge of high division helps in different surgical approach for sciatic nerve injury or hip dislocation. Aims and Objectives: The aim of the study was to describe incidences of high division variation of Sciatic nerve and different types in cadavers during routine dissection schedule. Materials and Methods: The study was conducted during routine dissection schedule in anatomy department for first MBBS students to observe sciatic nerve course in 30 gluteal regions from 15 adult cadavers fixed by formalin. Location of sciatic nerve in relation to piriformis muscle and its division whether in single nerve sheath or separate sheath and types was recorded. Results: In 12 cadavers (80%), sciatic nerve course found normal which leaves pelvis at inferior border of piriformis muscle and bifurcate in terminal branches tibial nerve and common peroneal nerve as it approaches at the apex of popliteal fossa. In 3 cadavers (20%), two male and one female, we found high division of sciatic nerve where terminal branches, tibial nerve, and common peroneal nerve leave the pelvis below piriformis separately in different sheaths. Conclusion: Knowledge of variations-related high division of sciatic nerve would help surgeons during different interventions related to sciatic nerve and for preventing further complications.

Comparison of the Nerve Regeneration Capacity and Characteristics between Sciatic Nerve Crush and Transection Injury Models in Rats / 生物医学与环境科学（英文）

OBJECTIVE@#To provide useful information for selecting the most appropriate peripheral nerve injury model for different research purposes in nerve injury and repair studies, and to compare nerve regeneration capacity and characteristics between them.@*METHODS@#Sixty adult SD rats were randomly divided into two groups and underwent crush injury alone (group A, n = 30) or transection injury followed by surgical repair (group B, n = 30) of the right hind paw. Each group was subjected to the CatWalk test, gastrocnemius muscle evaluation, pain threshold measurement, electrophysiological examination, retrograde neuronal labeling, and quantification of nerve regeneration before and 7, 14, 21, and 28 days after injury.@*RESULTS@#Gait analysis showed that the recovery speed in group A was significantly faster than that in group B at 14 days. At 21 days, the compound muscle action potential of the gastrocnemius muscle in group A was significantly higher than that in group B, and the number of labeled motor neurons in group B was lower than that in group A. The number of new myelin sheaths and the g-ratio were higher in group A than in group B. There was a 7-day time difference in the regeneration rate between the two injury groups.@*CONCLUSION@#The regeneration of nerve fibers was rapid after crush nerve injury, whereas the transection injury was relatively slow, which provides some ideas for the selection of clinical research models.

Effects of electroacupuncture at "Jiaji" (EX-B 2) combined with neurodynamic mobilization on gastrocnemius muscle atrophy and expression of NF-κB and MuRF1 in rabbits after sciatic nerve injury / 中国针灸

OBJECTIVES@#To observe the effects of electroacupuncture (EA) at "Jiaji" (EX-B 2) combined with neurodynamic mobilization (NM) on the cross-sectional area of the gastrocnemius muscle fibers after sciatic nerve injury in rabbits, and the expression of nuclear factor κB (NF-κB) and muscle-specific ring-finger protein 1 (MuRF1).@*METHODS@#A total of 180 common-grade New Zealand rabbits (half male and half female) were randomly divided into five groups, i.e. a normal control group, a model control group, a NM group, an EA group and a combined intervention group, 36 rabbits in each group. Except in the normal control group, clipping method was used to prepare the model of sciatic nerve injury in the rest groups. On the 3rd day of successful modeling, NM was delivered in the NM group. In the EA group, EA was exerted at bilateral "Jiaji" (EX-B 2) of L4 to L6, stimulated with disperse-dense wave and the frequency of 2 Hz/100 Hz. In the combined intervention group, after EA delivered at bilateral "Jiaji" (EX-B 2) of L4 to L6 , NM was operated. The intervention in each group was delivered once daily, for 6 days a week, and lasted 1, 2 or 4 weeks according to the collection time of sample tissue. After 1, 2 and 4 weeks of intervention, in each group, the toe tension reflex score and the modified Tarlov test score were observed; the morphology of the gastrocnemius muscle was observed by HE staining and the cross-sectional area of muscular fiber was measured; using Western blot method, the expression of NF-κB and MuRF1 of the gastrocnemius muscle was detected.@*RESULTS@#After 1, 2 and 4 weeks of intervention, the toe tension reflex scores and the modified Tarlov scores in the model control group were lower than those of the normal control group (P<0.05), and these two scores in the NM group, the EA group and the combined intervention group were all higher than those of the model control group (P<0.05); the scores in the combined intervention group were higher than those in the EA group and the NM group (P<0.05). The gastrocnemius fibers were well arranged and the myocyte morphology was normal in the normal control group. In the model control group, the gastrocnemius fibers were disarranged, the myocytes were irregular in morphology and the inflammatory cells were infiltrated in the local. In the NM group, the EA group and the combined intervention group, the muscle fibers were regularly arranged when compared with the model control group. After 1, 2 and 4 weeks of intervention, the cross-sectional areas of the gastrocnemius muscle fibers in the model control group were smaller than those of the normal control group (P<0.05). The cross-sectional areas in the NM group, the EA group and the combined intervention group were larger than those of the model control group (P<0.05), and the cross-sectional areas in the combined intervention group were larger than those in the NM group and the EA group (P<0.05). After intervention for 1, 2 and 4 weeks, the protein expressions of NF-κB and MuRF1 in the gastrocnemius muscle were higher in the model control group in comparison of those in the normal control group (P<0.05). In the NM group, the EA group and the combined intervention group, the expressions of NF-κB after intervention for 1, 2 and 4 weeks and the expressions of MuRF1 after 2 and 4 weeks of intervention were lower when compared with those in the model control group (P<0.05). In the combined intervention group, the protein expressions of NF-κB after intervention for 1, 2 and 4 weeks and the expressions of MuRF1 after 2 and 4 weeks of intervention were decreased when compared with those in the NM group and the EA group (P<0.05).@*CONCLUSIONS@#Electroacupuncture at "Jiaji" (EX-B 2) combined with NM may increase the muscle strength and sciatic function and alleviate gastrocnemius muscle atrophy in the rabbits with sciatic nerve injury. The underlying mechanism is related to the inhibition of NF-κB and MuRF1 expression.

Effect of ursolic acid extracted from Hippophae Rhamnoides L.on repair of sciatic nerve injury in rats / 实用医学杂志

Objective To investigate the repairing effect of ursolic acid extracted from Hippophae rhamnoi-des L.on sciatic nerve injury in rats.Methods After preparing a sciatic nerve damage model,thirty 2-month old Wistar rats were randomly divided into ursolic acid and control groups,with 15 rats in each group.Ursolic acid group was given Ursolic acid 150 mg/(kg·d)by gavage,while the control group was given the same dose of normal saline for 6 weeks.After 6 weeks,H&E staining was used to observe the pathological changes of rat sciatic nerves,and SFI and MNCV were calculated;The expression of NGF in sciatic nerve was detected by immunohistochemistry,and the expression of GAP-43 in L4-L6 spinal cord was detected by Western blotting.Results After 6 weeks,compared to the control group,the number of regenerated nerve fibers in the ursolic acid group increased,the arrangement was slightly regular,the capillary structure was abundant,and the proliferation of fibroblasts decreased;SFI and MNCV%were significantly increased(P<0.05),NGF protein positive expression was significantly increased(P<0.05),and the difference was statistically significant(P<0.05).GAP-43 protein expression in sciatic nerve tissue was significantly increased(P<0.05).Conclusions The intervention of ursolic acid extracted from Hippophae rhamnoides L.can improve the function of rats after sciatic nerve injury,promote the increase of regenerated nerve fibers and the repair of myelin sheath in rats with sciatic nerve injury,which may be related to increased NGF and GAP-43 protein expression in rats.

An enriched environment can promote nerve regeneration in a mouse model of sciatic nerve compression / 中华物理医学与康复杂志

Objective:To document any effect of environmental enrichment on nerve regeneration in a mouse model of sciatic nerve compression and explore its mechanism.Methods:A crushed sciatic nerve model was successfully established in 22 C57BL/6 mice, and they were then randomly divided into an intervention group and a control group. The mice of the intervention group were raised in a cage with an enriched environment, while those of the control group were kept in a standard cage. Two weeks later, both groups′ gait was analyzed and the compound muscle action potential (CMAP) of the sciatic nerve was measured. The proportion of myelinated sciatic nerve fibers was examined using toluidine blue staining, and the expression of myelin basic protein (MBP), growth associated protein-43 (GAP43) and p75 neurotrophin receptor (p75 NTR) was measured using immunofluorescence intensity. Results:①The latency of the CMAP [(1.05±0.04)ms] was significantly shortened in the intervention group compared with the control group and the amplitude was significantly higher. ②Gait analysis showed a significant increase in the average contact intensity, stride length and stride rate of the intervention group compared with the control group. However, the step axis angle of the intervention group was significantly smaller than in the control group on average. ③The stained nerve fibers in the intervention group were orderly and dense, and the average number of myelinated fibers was significantly greater than in the control group. ④Quantitative analysis of the immunofluorescence showed that the levels of MBP, GAP43 and p75 NTR in the sciatic nerves of the intervention group were, on average, significantly higher than in the control group. Conclusion:An enriched environmental can promote the regeneration and functional recovery of crushed sciatic nerves by promoting the proliferation and myelination of Schwann cells.

Sciatic nerve derived exosomes in promotion of axon regeneration and functional recovery following peripheral nerve injury in rat / 中华显微外科杂志

Objective:To explore the effect of sciatic nerve derived exosomes(SN-EXO) on axon regeneration and functional recovery after peripheral nerve injury(PNI).Methods:From March 2021 to October 2022, the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University studied the effect of SN-EXO on the proliferation of Schwann cells(SCs) through EdU cell proliferation experiment. Twenty-one healthy male SD rats were randomly divided into 3 groups of sham operation, peripheral nerve injury(PNI) and SN-EXO treatment, with 7 rats in each group. The right sciatic nerves of rat models in sham group were exposed without injury. In the rat in PNI group and SN-EXO treatment group, PBS and SN-EXO were injected under the epineurium of right sciatic nerves following sciatic nerve crush. Sciatic nerve function index(SFI) was performed at 28 days after operation, and then sacrificed. Right sciatic nerves were removed for further exploration of nerve regeneration. The histopathological changes and axon arrangement of sciatic nerves were evaluated by HE staining. Regeneration efficiency of neurofilaments and SCs were obserred by NF200 and S100β double staining of sciatic nerve. The data obtained were statistically analyzed, and P<0.05 was statistically significant. Results:It was found that SN-EXO can significantly enhance the proliferation ability of SCs, with statistically significant difference( P<0.05). SFI in SN-EXO treatment group and PNI group were(-27.65±4.36) and(-57.33±7.49), respectively, and the difference was statistically significant( P<0.05). Axons in SN-EXO treatment group were arranged more closely and orderly than those in the PNI group at 28 days after operation, and there were less injury induced axon disintegration and vacuolation. Immunofluorescence assay indicated that NF200 and S100β fluorescence intensity in SN-EXO treatment group was significantly higher than that in the PNI group, and the difference was statistically significant( P<0.05). Conclusion:SN-EXO could enhance the proliferation of SCs to promote axon regeneration following peripheral nerve injury.

Effects of sciatic nerve electrical stimulation on motor function and expression of BDNF⁃TrkB in rats with spinal cord inj ury / 安徽医科大学学报

Objectives @#To investigate the effect of sciatic nerve electrical stimulation ( SNES) on motor function recovery in rats with incomplete spinal cord injury (SCI) and its possible mechanism.@*Methods @#The incomplete SCI model was constructed by modified Allen ′s method. Forty⁃five Sprague⁃Dawley (SD) rats were randomly divided into three groups : Sham , SCI , and SNES. Electrical stimulation parameters were 1 ms pulse width and 100 Hz , with 20 mins each time , once a day for 21 days. The motor function was assessed by Basso⁃Beattie⁃Bresnahan (BBB) locomotor function scale , and the action potential conduction was detected by electrophysiology. Hematoxy⁃lin⁃eosin (HE) staining was used to observe the pathological changes in the spinal cord and the average cross⁃sectional area (CSA) of biceps femoris muscle fibers. The number of brain⁃derived neurotrophic factor (BDNF) and tropomyosin⁃related kinase B (TrkB) positive cells , relative mRNA and protein expression were analyzed by immunohistochemistry , reverse transcription polymerase chain reaction (RT PCR) and Western blot separately.@*Results@#On 21 d , the BBB score and average amplitude of action potential of SNES group were higher than those of SCI group , and the difference was statistically significant (P < 0. 05) . Compared with SCI group , the pathological injury of spinal cord tissue in SNES group was significantly improved , and the average CSA of biceps femoris muscles had a statistical difference (P < 0. 05) . The number of BDNF and TrkB positive cells in SNES group was higher than that in SCI group , and there were statistical differences (P < 0. 05) . The relative mRNA and protein expressions of BDNF and TrkB in SNES group were higher than those in SCI group , with statistical differences ( P <0. 05) . The relative mRNA and protein expressions of BDNF and TrkB in SNES group were higher than those in SCI group , with statistical differences ( P <0. 05) . @*Conclusion @#These results show that SNES contributes to alleviating spinal cord tissue injury , promoting the recovery of motor function and delaying the atrophy of muscles below the injury level. The possible mechanism is related to the increased expression of BDNF⁃TrkB proteins.

Protocol of a Nerve Neurotmesis Sciatic Repair using Polyvinyl Alcohol Biofilm in Wistar Rats / Protocolo de reparação de uma neurotmese do nervo ciático utilizando o biofilme de álcool polivinílico em ratos Wistar

Background Animal models are commonly used to assess the efficacy of new materials to be employed in the surgical repair of a nerve injury. However, there is no published surgical repair protocol for sciatic nerve neurotmesis in rats. Objective To produce and evaluate a protocol for the tubing technique using a polyvinyl alcohol biofilm after sciatic nerve neurotmesis. Methods Eighteen rats were randomized into 3 groups (n » 6 per group): control group - CG, neurotmesis group - NG, and neurotmesis biofilm group - NBG. The NG and NBGanimals were submitted to neurotmesis of the sciatic nerve at 60 days of life, followed by suture of the nerve stumps; in the NBG, the animals had the suture involved by polyvinyl alcohol biofilm. A descriptive evaluation of the surgical technique was performed after the experimental period. The Shapiro-Wilk normality test was used for body weight, and analysis of variance (ANOVA) with Bonferroni posthoc (p < 0.05) was applied. Results All groups showed good repair of the skin and muscle sutures; however, 33.30% of the CG presented disruption of skin points. Furthermore, 16.70% of the stumps were not structurally aligned and 33.30% had neuromas in the NG, while in the NBG, all stumps were aligned and none of them had neuroma. Conclusions The present study was able to produce a protocol with high reproducibility in view of the mechanical stability, targeting of the nerve stumps, muscle healing, the low frequency of skin breakage and the low complexity level of the technique, and it can be used in future studies that aim to evaluate other biomaterials for nerve repair in rats.

Introdução Modelos animais são comumente utilizados para avaliar a eficácia de novos materiais a ser empregados no reparo cirúrgico de lesões nervosas. No entanto, não há protocolo de reparo cirúrgico publicado para neurotmese do nervo ciático em ratos. Objetivo Produzir e avaliar um protocolo para a técnica de tubulização usando um biofilme de álcool polivinílico após uma neurotmese do nervo ciático. Métodos Dezoito ratos foram randomizados em três grupos (n » 6 por grupo): grupo controle - GC, grupo neurotmese - GN e grupo neurotmese biofilme - GNB. Os animais do GN e do GNB foram submetidos à neurotmese do nervo ciático aos 60 dias de vida, seguida de sutura dos cotos do nervo; no GNB, os animais tiveram a sutura envolvida por biofilme de álcool polivinílico. Após o período experimental, foi realizada avaliação descritiva da técnica cirúrgica. Para o peso corporal, foi utilizado o teste de normalidade Shapiro-Wilk e aplicada a análise de variância (ANOVA) com posthoc de Bonferroni (p < 0,05). Resultados Todos os grupos apresentaram bom reparo de suturas de pele e musculares; porém, 33,30% do GC apresentou rompimento dos pontos da pele. Além disso, 16,70% dos cotos não estavam estruturalmente alinhados e 33,30% apresentavam neuromas no GN, enquanto todos os cotos estavam alinhados e nenhum apresentava neuroma no GNB. Conclusões O presente estudo foi capaz de produzir um protocolo com alta reprodutibilidade tendo em vista a estabilidade mecânica, direcionamento dos cotos nervosos, cicatrização muscular, a baixa frequência de rompimento da pele e o baixo nível de complexidade da técnica, podendo ser utilizado em estudos futuros que avaliem outros biomateriais para reparo de nervo em ratos.

A Cadaveric Based Morphometric Analysis of the Sciatic Nerve with Clinical Implications

Background: The sciatic nerve is one of the very vital nerves of the body, which has importance not only in the field of Anatomy but also in various clinical fields such as Orthopaedics, Anaesthesia, Plastic & Reconstructive Surgery, and Neurosurgery. This study was the first attempt to analyze the different dimensions of the anatomically normal sciatic nerves at different levels, involving Malaysian cadavers.Material & Methods:The study was conducted on 78 adult, both cadaveric and disarticulated lower limb specimens belonging to both genders. The morphometric analysis was done in 64 specimens having anatomically normal sciatic nerves. The dimensions were measured by a digital Vernier caliper, a measuring tape, and thread.Results:The average width, thickness and circumference of the nerve at the lower border of piriformis muscle (PM) were 15.86 mm ± 1.47 (right) & 16.56 mm ± 1.08 (left); 4.22 mm ± 0.29 (right) & 4.10 mm ± 0.20 (left) and 27.70 mm ± 2.02 (right) & 27.72 mm ± 2.39 (left), respectively. Similarly, at the level between ischial tuberosity (IT) and greater trochanter (GT), the mean width was 11.59 mm ± 1.43 (right) & 11.50 mm ± 1.53 (left); thickness was 3.48 mm ± 0.18 (right) & 3.35 mm ± 0.17 (left) and circumference was 27.08 mm ± 2.79 (right) & 27.22 mm ± 2.87 (left). At bifurcation, the mean width was 8.66 mm ± 0.65 (right) & 8.90 mm ± 0.81 (left); thickness was 2.41 mm ± 0.12 (right) & 2.31 mm ± 0.15 (left) and circumference was 19.75 mm ± 1.44 (right) & 19.99 mm ± 1.45 (left). The average distance between IT and GT was 50.37 mm ± 4.47 (right) & 47.73 mm ± 4.24 (left); between lateral border of IT and medial border of sciatic nerve was 15.43 mm ± 1.45 (right) & 14.66 mm ± 1.37 (left); and between medial border of GT and lateral border of the nerve was 27.13 mm ± 1.38 (right) & 25.07 mm ± 1.73 (left). The average length of the nerve was 328.20 ± 26.26 (right) & 332.31 ± 21.89 (left); and that of the thigh was 412.19 ± 24.50 (right) & 407.24 ± 25.82 (left).Conclusion: This knowledge will not only aid future researchers but also will assist surgeons, orthopaedicians, anaesthetists, reconstructive surgeons, and neurosurgeons by preventing iatrogenic nerve injuries.

Fotobiomodulação com LED induz melhora na funcionalidade da marcha em ratos após lesão nervosa periférica / Photobiomodulation with LED increased the gait functionality in rats submitted to peripheral nerve injury

Introdução: As lesões nervosas periféricas (LNP) podem resultar em distúrbios motores e sensoriais alterando a funcionalidade do membro afetado, porém pouco se conhece a respeito dos efeitos da fotobiomodulação (FBM) com diodo emissor de luz (LED). Objetivo: Analisar os efeitos do LED sobre a funcionalidade da marcha de ratos Wistar pós LNP. Metodologia: Ratos Wistar foram submetidos a LNP por esmagamento de ciático e analisados nos seguintes grupos experimentais: (1) Controle; (2) LNP; (3) LNP+ LED (780 nm, potência média 40 mW, exposição radiante, energia por ponto, 3,2 J sobre o nervo ciático (LEDn); (4) LNP+ LED em nervo e região do músculo envolvido (LEDnm) e (5) LNP+ LED apenas em região do músculo (LEDm). Após 7, 14, 21 e 28 dias foram realizadas as análises de marcha utilizando o Índice Funcional Ciático (IFC). Resultado: Após 7 dias, os grupos tratados com LED apresentaram uma melhora da marcha em relação ao grupo Lesão, sendo essa melhora mais pronunciada no grupo LEDn. Após 14 dias, os grupos LEDn e LEDnm apresentaram valores semelhantes ao grupo controle e após 21 e 28 dias o IFC não apresentou diferenças entre os grupos experimentais. Conclusão: O LED aumentou a funcionalidade da marcha avaliada pelo IFC após 1 e 2 semanas pós LNP, especialmente quando foi usado na região nervosa associada ou não à região muscular.

Introduction: Peripheral nerve injuries (PNI) can result in motor and sensory disturbances altering the functionality of the affected limb, however not much is known about the effects of photobiomodulation (PBM) with light emitting diode (LED). Objective: We aimed to analyze the effects of LED on the gait function of Wistar rats after PNI. Methodology: Wistar rats were submitted to PNI by sciatic crush and analyzed in the following experimental groups: (1) Control; (2) PNI; (3) PNI+ LED (780 nm, mean power 40 mW, radiant exposure, energy per spot, 3.2 J on the sciatic nerve) (LEDn); (4) LNP+ LED on nerve and involved muscle region (LEDnm) and (5) LNP+ LED only on muscle region (LEDm). After 7-, 14-, 21- and 28-days gait analyses were performed using the Sciatic Functional Index (SFI). Results: After 7 days, the groups treated with LED showed an improvement in gait compared to the PNI group, with this improvement being more pronounced in the LEDn group. After 14 days, the LEDn and LEDnm groups showed similar values to the control group and after 21 and 28 days the SFI did not show differences between the experimental groups. Conclusion: LED increased the gait functionality evaluated by SFI after 1 and 2 weeks post-PNI, especially when it was used in the nerve region associated or not with the muscle region.

Regional anesthesia for compartment syndrome as a complication of ECMO. Case report / Anestesia regional para síndrome compartimental como complicación de ECMO. Reporte de caso

Abstract We present the case of a patient intervened for mechanical mitral replacement, tricuspid annuloplasty, and correction of a total anomalous pulmonary venous return, which required Extracorporeal Membrane Oxygenation (ECMO) in the immediate postoperative period because of refractory cardiogenic shock. After withdrawal of the arterial cannula, the patient developed compartment syndrome of the right lower limb, requiring urgent intervention. Also, the patient went into respiratory failure, requiring support with high flow oxygen cannula. Given the patient's condition, general anesthesia was discarded. An ultrasound-guided popliteal block and sedation with dexmedetomidine and ketamine was performed instead, maintaining the high flow nasal cannula. Regional anesthesia along with dexmedetomidine and ketamine could be an alternative for a surgical procedure in patients with high risk of cardiovascular and respiratory complications.

Resumen Presentamos el caso de una paciente femenina sometida a remplazo de válvula mitral mecánica, anuloplastia y corrección de retorno venoso pulmonar anómalo total, quien requirió oxigenación con membrana extracorpórea (ECMO) en el postoperatorio inmediato debido a shock cardiogénico refractario. Una vez retirada la cánula arterial, la paciente desarrolló síndrome compartimental de la extremidad inferior derecha, requiriendo intervención urgente. Adicionalmente, presentó insuficiencia respiratoria que requirió soporte de oxígeno por cánula de alto flujo. En vista de la condición de la paciente se descartó la anestesia general, optando a cambio por un bloqueo poplíteo guiado por ultrasonido más sedación con dexmedetomidina y ketamina, manteniendo la cánula nasal de alto flujo. La anestesia regional junto con dexmedetomidina y ketamina puede ser una alternativa para procedimientos quirúrgicos en pacientes de alto riesgo cardiovascular y complicaciones respiratorias.