Distal neurotization of the anterior interosseous nerve to recover hand grasping / Neurotização distal do nervo interósseo anterior para recuperação da preensão da mão

ABSTRACT Lower trunk lesions are uncommon, representing about 3 to 5% of brachial plexus lesions in adults. One of the functions lost by patients who suffer this type of injury is the flexion of the fingers, with important harming of palmar grip. This series of cases proposes the transfer of a branch of the radial nerve to the anterior interosseous nerve (AIN), presenting a new alternative for the treatment of these lesions with highly satisfactory results. Objective: To demonstrate our strategy, technique, and results in the reinnervation of the AIN in lesions isolated from the lower trunk of the brachial plexus in four cases of high lesion of the median nerve. Method: Prospective cohort study in which four patients underwent neurotizations. The treatment was directed to the recovery of the fingers' flexors of the hand and the grip. Results: All patients presented reinnervation of the flexor pollicis longus (FPL) and deep flexors of the 2nd, 3rd, and 4th fingers. The deep flexor of the 5th finger also showed reinnervation but with reduced strength (M3/4) comparing to the others (M4+). Conclusion: Despite the limited number of cases in this and other studies, the results are uniformly good, allowing to consider this treatment predictable. Level of Evidence IV, Case Series.

RESUMO As lesões do tronco inferior são incomuns, representando cerca de 3 a 5% das lesões do plexo braquial em adultos. Uma das funções perdidas pelos pacientes que sofrem esse tipo de lesão é a flexão dos dedos, com comprometimento importante da preensão palmar. Esta série de casos propõe a transferência de um ramo do nervo radial para o nervo interósseo anterior (NIA), apresentando uma nova alternativa para o tratamento dessas lesões com resultados altamente satisfatórios. Objetivo: Demonstrar nossa estratégia, técnica e resultados na reinervação do NIA em lesões isoladas do tronco inferior do plexo braquial em quatro casos de lesão alta do nervo mediano. Método: Estudo de coorte prospectivo no qual quatro pacientes foram submetidos a neurotizações. O tratamento foi direcionado para a recuperação dos flexores dos dedos da mão e da preensão. Resultados: Todos os pacientes apresentaram reinervação do flexor pollicis longus (FPL) e dos flexores profundos do 2º, 3º e 4º dedo. O flexor profundo do 5º dedo também apresentou reinervação, porém com força reduzida (M3/4) em relação aos demais (M4+). Conclusão: Apesar do número de casos limitados neste e em outros estudos, os resultados se mostram uniformemente bons, o que permite considerar esse tratamento previsível. Nível de Evidência IV, Série de Casos.

Microanatomy of the nerve to iliacus muscle and its clinical significance / Microanatomía del nervio del músculo ilíaco y su importancia clínica

The iliacus muscle, arising from iliac fossa is innervated chiefly by nerves to iliacus and femoral nerve. The tendon of iliacus muscle in the caudal part fuses with the tendon of psoas major muscle to form iliopsoas tendon As the iliacus/iliopsoas is responsible for flexing of the thigh and the forward tilting of the pelvis, body posture, Olympic lifts, daily activities like walking and running, so impairment of above functions, due to spinal cord injury or injury to nerves to iliacus, remained a grey area to explore manifestation of nerve lesions at fascicular level. Therefore an experimental study was designed to map the complex fascicular pathways suffering from splits, fusions and multiplexing coupled with measurement of distances of closely sampled histological slides. Tracking, correlation and interpretation of fascicles, in these slides of a cropped femoral nerve in iliacus region from a 70 year old female cadaver were analyzed. The study resulted in three schematic models of fascicular pathways in 3 nerves to iliacus and 2 tabular models of 2 remaining nerves to iliacus revealing complete picture of fascicles interrupted by dynamic transformational processes. These results would facilitate MRI neurographic interpretation at fascicular level and neurosurgical treatment through identification. The fascicular identification and setup would also discover anatomical complications and location of injury. Besides the huge data volume evolved off this experiment, the study would not only open up grey area for neuroanatomical research but also would revolutionize the neurosurgical repair and grafting of nerves to iliacus at fascicular level.

El músculo ilíaco, que se inserta en la fosa ilíaca, está inervado principalmente por los nervios ilíaco y femoral. El tendón del músculo ilíaco en la parte caudal se fusiona con el tendón del músculo psoas mayor para formar el tendón del músculo iliopsoas. Los músculos ilíaco e iliopsoas son responsables de la flexión del muslo y la inclinación hacia delante de la pelvis, la postura del cuerpo, los levantamientos olímpicos, las actividades diarias como caminar y correr, por lo que el deterioro de las funciones anteriores, debido a lesiones de la médula espinal o de los nervios ilíacos, constituyen una dificultad para explorar la manifestación de lesiones nerviosas a nivel fascicular. Por lo tanto, se diseñó un estudio experimental para mapear las complejas vías fasciculares que presentan divisiones, fusiones y multiplexación, junto con medición en muestras histológicas. Se analizó el seguimiento, correlación y la interpretación de los fascículos en muestras de secciones del nervio femoral en la región ilíaca de un cadáver femenino de 70 años. Se obtuvieron tres modelos esquemáticos de vías fasciculares en 3 ramos del nervio ilíaco y dos modelos tabulares de los 2 ramos nerviosos restantes del nervio ilíaco, que muestran una imagen completa de los fascículos interrumpidos por procesos de transformación dinámica. Estos resultados facilitarían la interpretación neurográfica de la resonancia nuclear magnética a nivel fascicular y el tratamiento neuroquirúrgico a través de su identificación. La identificación y configuración del fascículo también permitirían descubrir complicaciones anatómicas y la localización de la lesión. Además del enorme volumen de datos que se desprendió de este estudio, éste no solo contribuiría a la investigación neuroanatómica, sino también puede aportar a la reparación neuroquirúrgica y al injerto de nervios al músculo ilíaco a nivel fascicular.

Correlation of the electric excitability treated with electroacupuncture at different acupoints and the prognosis of Bell's palsy / 中国针灸

OBJECTIVE@#To explore the correlation of the electric excitability treated with electroacupuncture (EA) at different acupoints and the prognosis of Bell's palsy, using the Logistic regression analysis.@*METHODS@#A total of 93 patients of Bell's palsy were collected in the retrospective analysis. Acupuncture was applied to Cuanzu (BL 2), Yangbai (GB 14), Yingxiang (LI 20), Dicang (ST 4), Xiaguan (ST 7) and Qianzheng (Extra point) on the affected side. The electric stimulation was added at the three pairs of points, named Cuanzu (BL 2) and Yangbai (GB 14) (A group), Yingxiang (LI 20) and Dicang (ST 4) (B group) and Qianzheng (Extra point) and Xiaguan (ST 7) (C group), continue wave, 1 Hz at current frequency, for 30 min in one treatment. EA was given once every two days. The endpoint outcome evaluation was conducted when the facial nerve function was recovered completely after treatment or in 16 weeks after onset. On the 8th day of onset, the prognosis-related indexes were collected, such as the electric excitability grade in the A, B and C groups, gender, age, the facial nerve lesion segment and type 2 diabetes mellitus (T2DM). The Logistic regression analysis was conducted on these indexes and the prognosis.@*RESULTS@#The single factor Logistic regression analysis showed that the gender, age and the electric excitability of the C group were negatively correlated with the prognosis statistically (>0.05). T2DM, the facial nerve lesion segment and the electric excitability of the A and B groups were positively correlated with the prognosis statistically (<0.05). The multivariate Logistic regression analysis indicated that the electric excitability in the A and B groups was the independent predictor of Bell's palsy prognosis (<0.05). values were 8.410 (1.176-60.113) and 12.589 (1.355-116.922) respectively.@*CONCLUSION@#The electric excitability of EA at the pairs of Cuanzu (BL 2) and Yangbai (GB 14), and of Yingxiang (LI 20) and Dicang (ST 4) is one of the indexes for the prognosis evaluation of Bell's palsy. It contributes to the early identification of the severity of facial nerve lesion, the regulation of the therapeutic regimen and the improvement of the clinical effects.

Neurodegenerative disorder after optic nerve crush in transgenic fluorescence mice / 眼科新进展

Objective To observe optic nerve axons degenerative disorder and microglial responses by establishing unilateral optic nerve crush model.Methods YFP mouse group with axonal markers and GFP mouse group with microglia markers were divided into surgery and control group,the optic nerve were dissected at 4 hours,1 day,3 days,5 days,10 days after optic nerve crush,and the neuronal degenerative disorder and microglial responses were observed by confocal laser scanning microscope.Rrsults Compared with control group,the optic nerve axons in YFP mouse group were fractured in injury region at postoperative 4 hours;The partial axon became beadlike change at postoperative 1 day;Most of the axons turned into the process of beadlike change at postoperative 3 days;The axons became to debris from beadlike at postoperative 5 days;The axons changed into many debris at postoperative 10 days.Compared with control group,the formation of glial scar and resting microglia in GFP mouse group began to emerge at postoperative 4 hours;The microglia gradually activated and began to cover the injury region at postoperative 1 day;The activated miacroglia basically covered the injury region at postoperative 3 days;The number of microglia roughly remained stable,although the axons continued to deteriorate at postoperative 5 days and 10 days.Conclusion The optic nerve occur irreversible degenerative disorder after being injured,meanwhile with the microglial increase and activation.This phenomenon suggests that microglia is closely associated with optic nerve degeneration.

Multimodal analgesia for intractable lower limb ischemic pain / 中国生化药物杂志

Objective To observe the curative effect of lumbar sympathetic nerve injury combined with systemic and local medication in intractable lower limb ischemic pain.Methods21 patients with intractable lower limb ischemic pain accepted lumbar sympathectomy,at the same time foot topical Votalinemulgel used and Combined with anticonvulsants and opioids according to circumstances,the visual analogue scale of resting pain(visual analogue scale,VAS),the Local skin temperaturebefore and after treatment were observed and evaluated.ResultsAfter Lumbar sympathetic nerve block and topical Votalinemulgel,21 patients had pain relief.After treatment, 2 patients had poor effect,the remaining 19 patients had pain relief to VAS<3, 4 patients did not need systemic analgesic drugs,the rest of the patients need systemic analgesic drugs.ConclusionIt is necessary to adopt multimodal comprehensive treatment for intractable lower limb ischemic pain.

Numbness after Transradial Cardiac Catheterization: the Results from a Nerve Conduction Study of the Superficial Radial Nerve

BACKGROUND AND OBJECTIVES: Numbness on the hand occurs infrequently after a transradial cardiac catheterization (TRC). The symptom resembles that of neuropathy. We, therefore, investigated the prevalence, the predicting factors and the presence of neurological abnormalities of numbness, using a nerve conduction study (NCS). SUBJECTS AND METHODS: From April to December 2013, all patients who underwent a TRC were prospectively enrolled. From among these, the patients who experienced numbness on the ipsilateral hand were instructed to describe their symptoms using a visual analogue scale; subsequently, NCSs were performed on these patients. RESULTS: Of the total 479 patients in the study sample, numbness occurred in nine (1.8%) following the procedure. The NCS was performed for eight out of the nine patients, four (50%) of which had an abnormal NCS result at the superficial radial nerve. A larger sheath and history of myocardial infarction (p=0.14 and 0.08 respectively) tended towards the occurrence of numbness; however, only the use of size 7 French sheaths was an independent predictor for the occurrence of numbness (odds ratio: 5.50, 95% confidence interval: 1.06-28.58, p=0.042). The symptoms disappeared for all patients but one, within four months. CONCLUSION: A transient injury of the superficial radial nerve could be one reason for numbness after a TRC. A large sheath size was an independent predictor of numbness; therefore, large sized sheaths should be used with caution when performing a TRC.

A communicating branch between the dorsal and superficial ramus of the ulnar nerve (Kaplan's anastomosis): clinical and surgery discussion / Ramo comunicante entre los ramos dorsal y superficial del nervio ulnar (anastomosis de Kaplan): discusión clínica y quirúrgica

The Kaplan´s anastomosis represents the communication between the dorsal and superficial branch of the ulnar nerve distal to ulnar canal. In the present study, a case about this nerve communication, found in a male adult cadaver, is reported. Information about brachial plexus distal anastomosis is fundamental for interpretation of clinical and electrophysiological findings, in order to establish the precise diagnosis of neurological lesions at this level. Its relations with flexor carpi ulnaris muscle's tendon and with pisiform bone exposes it to iatrogenic lesions during surgery.

La anastomosis de Kaplan representa la comunicación entre la rama dorsal y superficial del nervio ulnar distal al canal ulnar. En el presente estudio se informa de un caso de esta comunicación nerviosa, encontrado en un cadáver adulto de sexo masculino. Información sobre el plexo braquial y sus anastomosis distales son fundamentales para la interpretación de los hallazgos clínicos y electrofisiológicos, a fin de establecer el diagnóstico preciso de las lesiones neurológicas a este nivel. Sus relaciones con el tendón del músculo flexor ulnar del carpo, como con el hueso pisiforme, pueden facilitar la ocurrencia de lesiones iatrogénicas durante la cirugía.

Effects of sciatic nerve transection on glucose uptake in the presence and absence of lactate in the frog dorsal root ganglia and spinal cord

Frogs have been used as an alternative model to study pain mechanisms because the simplicity of their nervous tissue and the phylogenetic aspect of this question. One of these models is the sciatic nerve transection (SNT), which mimics the clinical symptoms of phantom limb, a condition that arises in humans after amputation or transverse spinal lesions. In mammals, the SNT increases glucose metabolism in the central nervous system, and the lactate generated appears to serve as an energy source for nerve cells. An answerable question is whether there is elevated glucose uptake in the dorsal root ganglia (DRG) after peripheral axotomy. As glucose is the major energy substrate for frog nervous tissue, and these animals accumulate lactic acid under some conditions, bullfrogs Lithobates catesbeianus were used to demonstrate the effect of SNT on DRG and spinal cord 1-[14C] 2-deoxy-D-glucose (14C-2-DG) uptake in the presence and absence of lactate. We also investigated the effect of this condition on the formation of 14CO2 from 14C-glucose and 14C-L-lactate, and plasmatic glucose and lactate levels. The 3-O-[14C] methyl-D-glucose (14C-3-OMG) uptake was used to demonstrate the steady-state tissue/medium glucose distribution ratio under these conditions. Three days after SNT, 14C-2-DG uptake increased, but 14C-3-OMG uptake remained steady. The increase in 14C-2-DG uptake was lower when lactate was added to the incubation medium. No change was found in glucose and lactate oxidation after SNT, but lactate and glucose levels in the blood were reduced. Thus, our results showed that SNT increased the glucose metabolism in the frog DRG and spinal cord. The effect of lactate on this uptake suggests that glucose is used in glycolytic pathways after SNT.

As rãs são usadas como modelos experimentais alternativos no estudo da nocicepção, tanto pela simplicidade do seu tecido nervoso como por permitirem uma abordagem filogenética sobre o tema. Um desses modelos é a secção do nervo isquiático (SNI), o qual simula os sintomas clínicos do membro fantasma, uma condição que ocorre nos humanos após amputação ou secção completa da medula espinal. Em mamíferos, a SNI aumenta o metabolismo da glicose no sistema nervoso central, e o lactato é uma fonte energética para as células nervosas. Porém é desconhecido se essa é a situação em gânglio da raiz dorsal (GRD). Como a glicose é o principal substrato energético para o tecido nervoso de rãs, e a concentração plasmática de lactato está aumentada nesses animais em distintas situações, a rã-touro Lithobates catesbeianus foi usada para demonstrar os efeitos da SNI sobre a captação de 1-[14C] 2-deoxi-D-glicose (14C-2-DG), na presença e ausência de lactato, em GRD e medula espinal. Foram demonstrados ainda os efeitos dessa condição experimental sobre a formação de 14CO2 a partir de 14C-glicose e 14C-L-lactato, e a concentração plasmática de glicose e lactato. A captação de 3-O-[14C] metil-D-glicose (14C-3-OMG) foi usada para demonstrar a relação tecido/meio estável da glicose nessas condições. A captação de 14C-2-DG aumentou três dias após a SNI, sem qualquer alteração na captação de 14C-3-OMG. O aumento foi reduzido quando o lactato foi acrescentado ao meio de incubação. A taxa de oxidação da glicose e do lactato não modificou após SNI, mas houve redução na concentração plasmática de glicose e lactato. Assim, a SNI aumenta o metabolismo da glicose no GRD e medula espinal de rãs. Os efeitos do lactato sobre essa captação sugerem o uso da glicose na via glicolítica após a SNI.

Effects of sciatic nerve transection on glucose uptake in the presence and absence of lactate in the frog dorsal root ganglia and spinal cord / Efeito da secção do nervo isquiático sobre a captação de glicose na presença e ausência de lactato em gânglio da raiz dorsal e medula espinhal de rãs

Frogs have been used as an alternative model to study pain mechanisms because the simplicity of their nervous tissue and the phylogenetic aspect of this question. One of these models is the sciatic nerve transection (SNT), which mimics the clinical symptoms of “phantom limb”, a condition that arises in humans after amputation or transverse spinal lesions. In mammals, the SNT increases glucose metabolism in the central nervous system, and the lactate generated appears to serve as an energy source for nerve cells. An answerable question is whether there is elevated glucose uptake in the dorsal root ganglia (DRG) after peripheral axotomy. As glucose is the major energy substrate for frog nervous tissue, and these animals accumulate lactic acid under some conditions, bullfrogs Lithobates catesbeianus were used to demonstrate the effect of SNT on DRG and spinal cord 1-[14C] 2-deoxy-D-glucose (14C-2-DG) uptake in the presence and absence of lactate. We also investigated the effect of this condition on the formation of 14CO2 from 14C-glucose and 14C-L-lactate, and plasmatic glucose and lactate levels. The 3-O-[14C] methyl-D-glucose (14C-3-OMG) uptake was used to demonstrate the steady-state tissue/medium glucose distribution ratio under these conditions. Three days after SNT, 14C-2-DG uptake increased, but 14C-3-OMG uptake remained steady. The increase in 14C-2-DG uptake was lower when lactate was added to the incubation medium. No change was found in glucose and lactate oxidation after SNT, but lactate and glucose levels in the blood were reduced. Thus, our results showed that SNT increased the glucose metabolism in the frog DRG and spinal cord. The effect of lactate on this uptake suggests that glucose is used in glycolytic pathways after SNT.

As rãs são usadas como modelos experimentais alternativos no estudo da nocicepção, tanto pela simplicidade do seu tecido nervoso como por permitirem uma abordagem filogenética sobre o tema. Um desses modelos é a secção do nervo isquiático (SNI), o qual simula os sintomas clínicos do “membro fantasma”, uma condição que ocorre nos humanos após amputação ou secção completa da medula espinal. Em mamíferos, a SNI aumenta o metabolismo da glicose no sistema nervoso central, e o lactato é uma fonte energética para as células nervosas. Porém é desconhecido se essa é a situação em gânglio da raiz dorsal (GRD). Como a glicose é o principal substrato energético para o tecido nervoso de rãs, e a concentração plasmática de lactato está aumentada nesses animais em distintas situações, a rã-touro Lithobates catesbeianus foi usada para demonstrar os efeitos da SNI sobre a captação de 1-[14C] 2-deoxi-D-glicose (14C-2-DG), na presença e ausência de lactato, em GRD e medula espinal. Foram demonstrados ainda os efeitos dessa condição experimental sobre a formação de 14CO2 a partir de 14C-glicose e 14C-L-lactato, e a concentração plasmática de glicose e lactato. A captação de 3-O-[14C] metil-D-glicose (14C-3-OMG) foi usada para demonstrar a relação tecido/meio estável da glicose nessas condições. A captação de 14C-2-DG aumentou três dias após a SNI, sem qualquer alteração na captação de 14C-3-OMG. O aumento foi reduzido quando o lactato foi acrescentado ao meio de incubação. A taxa de oxidação da glicose e do lactato não modificou após SNI, mas houve redução na concentração plasmática de glicose e lactato. Assim, a SNI aumenta o metabolismo da glicose no GRD e medula espinal de rãs. Os efeitos do lactato sobre essa captação sugerem o uso da glicose na via glicolítica após a SNI.

Brachial Plexopathies.

Lesions of the brachial plexus are most commonly caused by traumatic injuries. Other causes include infiltration by tumors, intrinsic or extrinsic compressions, damage from radiation therapy, or neuralgic amyotrophy (Parsonage-Turner syndrome). Less frequent causes of brachial plexus lesions include metabolic disease (e.g. diabetes), viral infections, immunological reactions to vaccination or infections, drugs, malignancies, paraneoplastic conditions, or hereditary disease (SEPT9 mutations, HNPP). The diagnosis of brachial plexus lesion is based upon history, clinical examination, and instrumental investigations, particularly, nerve conduction studies, electromyography, evoked potentials, magnetic stimulation, and the MRI. Treatment depends on the cause of the plexus lesion and includes prophylactic measures, physiotherapy, drugs, or surgery. Rarely applied measures include therapeutic magnetic stimulation or pulsed radiofrequency treatment. Outcome of plexus lesions depends on the underlying cause and the effectiveness of the treatment and ranges from favorable to deleterious. The outcome can be improved if diagnosis is made early and treatment is immediately applied after diagnosis.

An improved experimental model for peripheral neuropathy in rats

A modification of the Bennett and Xie chronic constriction injury model of peripheral painful neuropathy was developed in rats. Under tribromoethanol anesthesia, a single ligature with 100% cotton glace thread was placed around the right sciatic nerve proximal to its trifurcation. The change in the hind paw reflex threshold after mechanical stimulation observed with this modified model was compared to the change in threshold observed in rats subjected to the Bennett and Xie or the Kim and Chung spinal ligation models. The mechanical threshold was measured with an automated electronic von Frey apparatus 0, 2, 7, and 14 days after surgery, and this threshold was compared to that measured in sham rats. All injury models produced significant hyperalgesia in the operated hind limb. The modified model produced mean ± SD thresholds in g (19.98 ± 3.08, 14.98 ± 1.86, and 13.80 ± 1.00 at 2, 7, and 14 days after surgery, respectively) similar to those obtained with the spinal ligation model (20.03 ± 1.99, 13.46 ± 2.55, and 12.46 ± 2.38 at 2, 7, and 14 days after surgery, respectively), but less variable when compared to the Bennett and Xie model (21.20 ± 8.06, 18.61 ± 7.69, and 18.76 ± 6.46 at 2, 7, and 14 days after surgery, respectively). The modified method required less surgical skill than the spinal nerve ligation model.

Sciatic Nerve Injury Caused by a Stretching Exercise in a Trained Dancer

Sciatic nerve injury after stretching exercise is uncommon. We report a case of an 18-year-old female trained dancer who developed sciatic neuropathy primarily involving the tibial division after routine stretching exercise. The patient presented with dysesthesia and weakness of the right foot during dorsiflexion and plantarflexion. The mechanism of sciatic nerve injury could be thought as hyperstretching alone, not caused by both hyperstretching and compression. Electrodiagnostic tests and magnetic resonance imaging revealed evidence of the right sciatic neuropathy from the gluteal fold to the distal tibial area, and partial tear of the left hamstring origin and fluid collection between the left hamstring and ischium without left sciatic nerve injury. Recovery of motor weakness was obtained by continuous rehabilitation therapy and some evidence of axonal regeneration was obtained by follow-up electrodiagnostic testing performed at 3, 5, and 12 months after injury.

Fracturas del clivus / Clivus fractures

Las fracturas de base de cráneo se encuentran entre el 3.5 y el 24 por ciento de los pacientes con trauma craneoencefálico. Las fracturas del clivus, se consideran fracturas de la base craneana posterior y se clasifican en longitudinales, transversas y oblicuas. El diagnóstico de estas fracturas ha aumentado con el uso del TAC de cráneo. Anteriormente su diagnostico se realizaba con mayor frecuencia en autopsias. Las fracturas del clivus con gran frecuencia se asocian a lesión de estructuras neurológicas y vasculares vecinas, tienen un mal pronóstico neurológico aunque se han descrito casos asintomático de fracturas clivales. En este artículo se reportara nuestra experiencia con esta patología traumática y se hará una revisión de la literatura.

Skull base fractures are found in 3.5 to 24 percent of all traumatic brain injury. Clivus fracture is considered a posterior skull base fracture and is classified into longitudinal, transversal and oblique. The finding of these fractures had incremented with the use of CT scans. Previously the diagnosis of clival fractures was made mostly at autopsy studies. Clival fractures are associated with injuries to nervous and vascular structures in its vicinity. These fractures have a bad neurological prognosis although there are cases of asymptomatic patients with clival fractures in the scientific literature. In this article we will repot our experience with this traumatic pathology and we will review the literature.

Differential astroglial responses in the spinal cord of rats submitted to a sciatic nerve double crush treated with local injection of cultured Schwann cell suspension or lesioned spinal cord extract: implications on cell therapy for nerve repair

PURPOSE: Reactive astrocytes are implicated in several mechanisms after central or peripheral nervous system lesion, including neuroprotection, neuronal sprouting, neurotransmission and neuropathic pain. Schwann cells (SC), a peripheral glia, also react after nerve lesion favoring wound/repair, fiber outgrowth and neuronal regeneration. We investigated herein whether cell therapy for repair of lesioned sciatic nerve may change the pattern of astroglial activation in the spinal cord ventral or dorsal horn of the rat. METHODS: Injections of a cultured SC suspension or a lesioned spinal cord homogenized extract were made in a reservoir promoted by a contiguous double crush of the rat sciatic nerve. Local injection of phosphate buffered saline (PBS) served as control. One week later, rats were euthanized and spinal cord astrocytes were labeled by immunohistochemistry and quantified by means of quantitative image analysis. RESULTS: In the ipsilateral ventral horn, slight astroglial activations were seen after PBS or SC injections, however, a substantial activation was achieved after cord extract injection in the sciatic nerve reservoir. Moreover, SC suspension and cord extract injections were able to promote astroglial reaction in the spinal cord dorsal horn bilaterally. Conclusion: Spinal cord astrocytes react according to repair processes of axotomized nerve, which may influence the functional outcome. The event should be considered during the neurosurgery strategies.

OBJETIVO: Astrócitos reativos participam de vários mecanismos após lesões do sistema nervoso central e periférico, os quais incluem neuroproteção, brotamento neuronal, neurotransmissão e dor neuropática. As células de Schwann (CS), um tipo de glia periférica, também reagem com a lesão do nervo, podendo interferir com o reparo e cicatrização, crescimento de fibras e regeneração neuronais. Investigamos aqui a possibilidade da terapia celular para o reparo do nervo ciático poder alterar o padrão da ativação astrocitária nos cornos anterior e posterior da medula espinal do rato. MÉTODOS: Suspensão de CS cultivadas ou extrato homogeneizado de medula espinal lesada de rato foram inoculados num reservatório feito a partir de dois esmagamentos aplicados no nervo ciático do rato distantes 0,5mm entre si. Injeção local de salina tamponada serviu como controle. Os ratos foram mortos uma semana após e os astrócitos da medula espinal marcados por método imunohistoquímico e quantificados por análise de imagem. RESULTADOS: No corno anterior da medula, ipsilateral à lesão, ativação astrocitária leve foi vista após as injeções de tampão ou CS, entretanto, ativação celular intensa foi observada nesta região com a inoculação neural do extrato homogeneizado de tecido medular lesado. Adicionalmente, as inoculações de CS e de extrato homogeneizado de tecido medular promoveram forte reação astrocitária no corno dorsal da medula espinal, bilateralmente. CONCLUSÕES: Os astrócitos da medula espinal reagem em função do processo de reparo do nervo lesado, o que pode influenciar o resultado funcional esperado, algo que deve ser considerado durante o planejamento da estratégia neurocirúrgica.

Protective effects of ?-crystallin on injured optic nerve fiber of LongEvens rats by CTB conjugates anterograde labeling / 第三军医大学学报

Objective To investigate in vivo the protective effects of intraocular injection of ?-crystallin after optic nerve injury.Methods Sixteen rats were divided into normal control group,and 2-week,4-week,6-week groups after optic nerve lesion.?-crystallin and bovine serum albumin(BSA) was respectively injected into the right and left corpus vitreums after the optic nerve crush injury.CTB conjugates were injected into the vitreous of all the rats at 48 h before observing optic nerve with confocal microscope(488 nm).Results It could be seen the normal stripe of the nerve fiber in the injuried optic nerve stained with CTB conjugates and some dots and lumps of fluorescence could be seen in the optic nerve.The fluorescence intensity of the ?-crystallin group was notably higher than the BSA group.Conclusion CTB conjugates anterograde labeling is a reliable and convenient method to observe the optical nerve fiber after optic nerve lesion.?-crystallin administered intraocularly at the lesion time can protect the optic nerve fiber.

Clinical Analysis of Sensory Strabismus with Fundus Abnormalities in Children and the Effectiveness of Occlusion Therapy

Fifty-nine children (75 eyes) with organic amblyopia were investigated to know the distribution and incidence of the optic nerve or retinal lesion, the type of sensory strabismus, and the effect of occlusion therapy in organicamblyopia. Optic nerve lesion was found more frequently than retinal lesion as causes of organic amblyopia. Among these optic nerve lesions, optic nerve hypoplasia and tilted disc were most frequently found, and in the retinal lesion, ROP (retinopathy of prematurity: macular dragging), foveal dysplasia, and myopic degeneration were frequent.Thirty-nine of 59 children with organic amblyopia (66%)showed strabismus and 74.4% of them had horizontal deviation; 17 eyes had esotropia, and 12 eyes exotropia. No vertical eyeball deviation was found. Myopic anisometropia was accompanied in 19 cases. Better visual outcome was obtained after occlusion therapy in cases with tilted disc and ROP according to the degree of these lesions. However, there was no improvement in other cases. Authors suggest that fundus examination should be included in the routine ophthalmologic examination in chlidren with strabismus.

Multiple Cranial Nerve Injury by Single Cervical Stab Wound: A case report

The cranial nerve lesions can occur from a stroke, traumatic brain injury or direct cervical injury, and can produce various functional problems of the craniofacial structures. Usually the cranial nerve injury can be diagnosed by a simple clinical manifestation, and physical or neurological examination. Electrophysiologic study and imaging study such as MRI are frequently used as the sequential follow up studies for the objective evaluation of neurologic regeneration process. We report a case of multiple cranial nerve injuries, of the fifth, seventh, tenth, eleventh and twelfth cranial nerves from a single deep cervical stab wound of 4 cm in length from 0.5 cm anterior of the tragus to 1 cm posterior to the mandibular angle. Electrophysiologic study including an electromyography of tongue and vocal cord, blink reflex and facial nerve conduction study were used for the diagnosis and follow up.

Facial Nerve Conduction Study in Cured Leprosy Patients

Leprosy is an infectious disease caused by Mycobacterium leprae and characterized by dermal and peripheral nerve lesions. The facial nerve is also frequently involved in leprosy. There are a few electrophysiologic studies on the facial nerve involvement in leprosy patients, but there is no electrophysiologic study on the facial nerve involvement in cured leprosy patitents. So we performed facial nerve conduction study and Blink reflex study in 19 cured leprosy patients who have been managed with Dapsone for a long time. Facial motor latencies were prolonged in 11 patients(57.9%).: 10 of 15 patients in lepromatous type; 1 of 4 patients in tuberculoid type. Prolonged latencies were shown in temporal branch, zygomatic branch, buccal branch, and mandibular branch in 9(47.4%), 6(31.6%), 5(26.3%), and 3(15.8%), respectively. Blink reflex study suggests combined facial nerve and trigeminal nerve lesion in 2 patients.

THE EXPRESSIVE VARIETY OF NGF GENE IN INJURED SCIATIC NERVES OF RAT / 解剖学报

Objective To evaluate the expressive variety of NGF gene in injured sciatic nerves of rat. Methods For hemi-quanti- tative analysis, RT-PCR method was used in the detection of the levels of NGF mRNA in the distal stumps at 1 day and 1, 2, 4 weeks following transection of sciatic nerve. Results The 1evel of NGF mRNA was low in the normal sciatic nerve. But it was increased in the distal stump after sciatic nerve transection. The biphasic increase in NGF mRNA was characterized by a first very rapid and transient increase peaking at ist day after lesion, than a second prolonged and slow elevation starting around ist weed after lesion. Conclusion The process in NGF gene expression after sciatic nerve lesion was biphasicly increased.