Functional and morphological assessment of a standardized crush injury of the rat median nerve.

The availability of effective experimental models for investigating nerve regeneration and designing new strategies for promoting this unique repair process is important. The aim of this study was to standardize a rat median nerve crush injury model using a non-serrated clamp exerting a compression force of 17.02 MPa for a duration of 30s. Results showed that functional recovery, evaluated by grasping test, was already detectable at day-12 and progressively increased until day-28 after which animal performance plateaued until the end of testing (day-42), reaching a range of 75-80% of pre-operative values. Morphological analysis on the median nerve segments, distal to the crush lesion, which were withdrawn at the end of the experiment showed that regenerated nerve fibers are significantly more numerous and densely packed; they are also smaller and have a thinner myelin sheath compared to controls. Together, these results provide a baseline characterization of the crush median nerve injury experimental model for its employment in the investigation of nerve regeneration research, especially when a reproducible regeneration process is required, such as for the study of biological mechanisms of peripheral nerve fiber regeneration or development of new therapeutic agents for promoting posttraumatic nerve repair.

Lack of topographic specificity in nerve fiber regeneration of rat forelimb mixed nerves.

Multiple nerve repair by means of a Y-shaped nerve guide represents a good model for studying the specificity of peripheral nerve fiber regeneration. Here we have used it for investigating the specificity of axonal regeneration in mixed nerves of the rat forelimb model. The left median and ulnar nerves, in adult female rats, were transected and repaired with a 14-mm Y-shaped conduit. The proximal end of the Y-shaped conduit was sutured to the proximal stump of either the median nerve or the ulnar nerve. Ten months after surgery, rats were tested for functional recovery of each median and ulnar nerve. Quantitative morphology of regenerated myelinated nerve fibers was then carried out by the two-dimensional disector technique. Results showed that partial recovery of both median and ulnar nerve motor function was regained in all experimental groups. Performance in the grasping test was significantly lower when the ulnar nerve was used as the proximal stump. Ulnar test assessment showed no significant difference between the two Y-shaped repair groups. The number of regenerated nerve fibers was significantly higher in the median nerve irrespectively of the donor nerve, maintaining the same proportion of myelinated fibers between the two nerves (about 60% median and 40% ulnar). On the other hand, nerve fiber size and myelin thickness were significantly larger in both distal nerves when the median nerve was used as the proximal donor nerve stump. G-ratio and myelin thickness/axon diameter ratio returned to normal values in all experimental groups. These results demonstrate that combined Y-shaped-tubulization repair of median and ulnar nerves permits the functional recovery of both nerves, independently from the proximal donor nerve employed, and that tissue, and not topographic, specificity guides nerve fiber regeneration in major forelimb mixed nerves of rats.

Low-power laser biostimulation enhances nerve repair after end-to-side neurorrhaphy: a double-blind randomized study in the rat median nerve model.

Previous studies have shown that low-power laser biostimulation (lasertherapy) promotes posttraumatic nerve regeneration. The objective of the present study was to investigate the effects of postoperative lasertherapy on nerve regeneration after end-to-side neurorrhaphy, an innovative technique for peripheral nerve repair. After complete transection, the left median nerve was repaired by end-to-side neurorrhaphy on the ulnar "donor" nerve. The animals were then divided into four groups: one placebo group, and three laser-treated groups that received lasertherapy three times a week for 3 weeks starting from postoperative day 1. Three different types of laser emission were used: continuous (808 nm), pulsed (905 nm), and a combination of the two. Functional testing was carried out every 2 weeks after surgery by means of the grasping test. At the time of withdrawal 16 weeks postoperatively, muscle mass recovery was assessed by weighing the muscles innervated by the median nerve. Finally, the repaired nerves were withdrawn, embedded in resin and analyzed by light and electron microscopy. Results showed that laser biostimulation induces: (1) a statistically significant faster recovery of the lesioned function; (2) a statistically significant faster recovery of muscle mass; (3) a statistically significant faster myelination of the regenerated nerve fibers. From comparison of the three different types of laser emissions, it turned out that the best functional outcome was obtained by means of pulsed-continuous-combined laser biostimulation. Taken together, the results of the present study confirm previous experimental data on the effectiveness of lasertherapy for the promotion of peripheral nerve regeneration and suggest that early postoperative lasertherapy should be considered as a very promising physiotherapeutic tool for rehabilitation after end-to-side neurorrhaphy.

HuC/D confocal imaging points to olfactory migratory cells as the first cell population that expresses a post-mitotic neuronal phenotype in the chick embryo.

In the present study, the expression of the HuC/D RNA-binding proteins, a marker of neurons that have left the mitotic cycle, in cells migrating from the olfactory neuroepithelium toward the telencephalon in the chick embryo was investigated by means of immunofluorescence and confocal laser microscopy. Results showed that this migratory cell population is early and massively labeled by the a-HuC/D antibody starting from the first olfactory pit stage. At this developmental stage, olfactory migratory cells appeared to be the only neuronal population that expressed the HuC/D antigens in the whole embryo. In following developmental stages, the great majority of migratory cells, the number of which increased progressively, continued to be heavily immunopositive for the a-HuC/D antibody while immunopositivity to this antibody begins to be detected in other regions of the nervous system. HuC/D immunopositivity persisted until stage 30 HH (about 6.5 days), the later developmental stage investigated in this study, when colocalization with GnRH was detected. Negativity to the anti-proliferating cell nuclear antigen (anti-PCNA) immunostaining, a marker of S-phase, showed that migratory olfactory cells have left the mitotic cycle. Altogether, these results suggest that we have identified the first population of post-mitotic neurons in the developing nervous system of the chick embryo.

The use of brainstorming for teaching human anatomy.

Interactive teaching techniques have been used mainly in clinical teaching, with little attention given to their use in basic science teaching. With the aim of partially filling this gap, this study outlines an interactive approach to teaching anatomy based on the use of "brainstorming." The results of the students' critique of the teaching techniques are also included. Seventy-five students from the first-year nursing curriculum were tested by a structured questionnaire after three brainstorming sessions. The overall response to these sessions was very positive, indicating that students perceived this interactive technique as both interesting and useful. Furthermore, this approach may provide a useful strategy when learning the clinical courses of the upcoming academic years.

Evidence of very early neuronal migration from the olfactory placode of the chick embryo.

Cell migration from the olfactory neuroepithelium is a very peculiar phenomenon in the development of the nervous system. In this paper, we provide evidence that, in the chick embryo, migration of cells from the olfactory neuroepithelium begins earlier than previously reported, namely at the same time as the first olfactory placode differentiation, that occurs several hours before the superficial ectodermal invagination that gives rise to the olfactory pit. Moreover, we provide evidence that very early migrating cells express the HuC/D RNA-binding protein antigen, a specific neuronal marker. These observations refocus our knowledge on the very first developmental stages of olfactory neuroepithelium.

Methodological issues in size estimation of myelinated nerve fibers in peripheral nerves.

Size estimation of myelinated nerve fibers in peripheral nerves is a very common task in neuromorphology and different dedicated morpho-quantitative procedures have been devised and used to date. Unfortunately, many reports on experimental nerve studies lack comprehensive information on the procedures that have been designed and applied for myelinated fiber size estimation. This paper addresses the issue in the light of the recent advances in quantitative morphology that have recognized the concept of unbiased estimates as the key methodological issue to be addressed in morpho-quantitative studies. The potential foundations of bias at various study levels are analysed together with indications on how to cope with them. In addition, the issue of the precision of size estimates is addressed and the various geometrical parameters that can be selected for myelinated nerve fiber size assessment are outlined. Taken together, information provided in this paper is expected to help investigators conduct an appropriate preliminary study design phase, the key step for setting up the most adequate morpho-quantitative procedure for any given research goal.

Confocal imaging of Schwann-cell migration along muscle-vein combined grafts used to bridge nerve defects in the rat.

Schwann cells guide axonal regrowth during peripheral nerve repair. In a case of a nerve lesion with substance loss, a graft conduit is necessary to enable axons to reach the distal nerve stump. If a non-nervous autograft is used, the question arises as to the presence and origin of Schwann cells along the grafted tube. We addressed this issue using a tubulization technique based on the use of an autologous vein filled with fresh skeletal muscle for the repair of sciatic nerve defects in the rat. We showed that both ends of the graft were early and progressively colonized by a number of glial fibrillar acid protein-immunopositive and S-100 immunonegative cells, an immunocytochemical pattern typical of immature Schwann cells. These cells, which were located in the interstice between grafted skeletal muscle fibers, are mainly organized into long chains oriented along the main axis of the graft and progressively colonize all the graft. Schwann cells coming from the distal nerve end are suitable for being responsible for guiding regeneration of nerve fibers along the graft toward the correct periphery (tissue specificity).

Unscheduled DNA synthesis in rat adult myenteric neurons: an immunohistochemical study.

Unscheduled DNA synthesis refers to DNA synthesis not followed by cell division. Previous studies have suggested that this phenomenon may occur in neurons from peripheral myenteric ganglia in conditions of functional hyperstimulation. In order to verify these observations, we have carried on an immunohistochemical study on myenteric neurons from the hypertrophic intestinal loops upstream from a partial obstruction (an experimental condition that induces a relevant increase of the neuronal workload) after labelling with two different markers: the proliferating cell nuclear antigen (PCNA), that is specifically expressed in cell nuclei during the S-phase, and the protein gene product 9.5 (PGP 9.5), a specific marker of nerve cells. While no myenteric neuron immunopositive for the anti-PCNA antibody was found in the control intestine, in the hypertrophic myenteric ganglia some neurons were positive for PCNA. These results provide an unequivocal evidence on the existence of unscheduled DNA synthesis in myenteric neurons from the hypertrophic intestine.

Adult stem cells and neurogenesis: historical roots and state of the art.

Over the last few years, an impressive number of papers have addressed the stem cell issue. However, as often occurs when a scientific subject undergoes a period of fast growth, some confusion is generated. To help reduce the existing uncertainty, this paper focuses on the concept of adult stem cells in relation to the classification of cell populations on the basis their proliferative behavior. Particular attention is dedicated to adult neural stem cells, an issue that has recently seen the most amazing advances. Finally, the concept of adult stem cells is differentiated from that of developmental stem cells in relation to the employment of stem cells for transplantation therapies.

A stereological study of long-term regeneration of rat severed sciatic nerve repaired by means of muscle-vein-combined grafts.

This study is a stereological analysis, by the 2-D dissector method, on the long-term regeneration of myelinated nerve fibers of the rat sciatic nerve repaired by muscle-vein-combined graft, a surgical technique that has been shown to be a valid tool for the repair of peripheral nerve defects with substance loss. Quantitative analysis showed that the total number and mean density of regenerated myelinated nerve fibers was significantly higher than in control nerves. The contrary was true for fiber mean size. The morpho-quantitative parameters of regenerated fibers from nerves repaired by the muscle-vein-combined graft were similar to those observed in rats where nerve defects were repaired by direct nerve suture thus confirming the validity of this surgical technique.

Morphological analysis of peripheral nerve regenerated by means of vein grafts filled with fresh skeletal muscle.

Clinical data have shown that a vein segment filled with fresh skeletal muscle can be considered a good autologous grafting conduit for the repair of peripheral nerve lesions. In this study, the long-term morphological organization of rat sciatic nerve fibers regenerated along a muscle-vein-combined graft conduit is further analysed by light and electron microscopy. Regenerated nerve fibers were organized into fascicles of various sizes that were clearly delimited by perineurial-like shells made by long and thin cytoplasmic processes of perineurial-like bipolar cells and by densely packed collagen fibrils. Grafted skeletal muscle fibers were still detectable among nerve fiber fascicles. However, in spite of the persistence of skeletal muscle along the graft, regenerated nerve fibers showed a good morphological pattern of regeneration, providing further evidence that the muscle-vein-combined grafting technique represents an effective surgical alternative to the classical fresh nerve autograft for the repair of peripheral nerve defects.

Tissue specificity in rat peripheral nerve regeneration through combined skeletal muscle and vein conduit grafts.

Diffusible factors from the distal stumps of transected peripheral nerves exert a neurotropic effect on regenerating nerves in vivo (specificity). This morphological study was designed to investigate the existence of tissue specificity in peripheral nerve fiber regeneration through a graft of vein filled with fresh skeletal muscle. This tubulization technique demonstrated experimental and clinical results similar to those obtained with traditional autologous nerve grafts. Specifically, we used Y-shaped grafts to assess the orientation pattern of regenerating axons in the distal stump tissue. Animal models were divided into four experimental groups. The proximal part of the Y-shaped conduit was sutured to a severed tibial nerve in all experiments. The two distal stumps were sutured to different targets: group A to two intact nerves (tibial and peroneal), group B to an intact nerve and an unvascularized tendon, group C to an intact nerve and a vascularized tendon, and group D to a nerve graft and an unvascularized tendon. Morphological evaluation by light and electron microscopy was conducted in the distal forks of the Y-shaped tube. Data showed that almost all regenerating nerve fibers spontaneously oriented towards the nerve tissue (attached or not to the peripheral innervation field), showing a good morphological pattern of regeneration in both the early and late phases of regeneration. When the distal choice was represented by a tendon (vascularized or not), very few nerve fibers were detected in the corresponding distal fork of the Y-shaped graft. These results show that, using the muscle-vein-combined grafting technique, regenerating axons are able to correctly grow and orientate within the basement membranes of the graft guided by the neurotropic lure of the distal nerve stump.

Nerve repair by means of vein filled with muscle grafts. II. Morphological analysis of regeneration.

The morphological features of regeneration in long-distance (3 cm) muscle-vein-combined grafts were experimentally investigated in the rat sciatic nerve by means of light and electron microscopy. In the early phases of regeneration (14 days after surgery), many regenerating nerve fibers were detected along the muscle-vein-combined graft. Six months after surgery, quantitative morphometrical analysis of myelinated nerve fibers showed that both the total number and density of myelinated nerve fibers were significantly greater in regenerated nerves than in control nerves. The contrary appeared true for the mean fiber size, with fiber size significantly smaller in regenerated nerves. Ultrastructural observations allowed the description of some peculiar aspects of the relationship between muscle fibers, nerve fibers, and Schwann cells in both early and late phases of regeneration.

Morphological and morphometrical changes in dorsal root ganglion neurons innervating the regenerated lizard tail.

The variations occurring in neurons from dorsal root ganglia that provide innervation to the regenerated tail of the lizard (vicarious ganglia) are analysed. Vicarious ganglion neurons, when compared to control ganglion neurons (i.e. ganglia from the same animal that were not involved in the reinnervation process), show a size increase of the soma (cell hypertrophy) which applies to all cell types and subtypes. No statistically significant differences in the relative percentage of neurofilament-poor (type D) and neurofilament-rich (type L) neurons were found between vicarious dorsal root ganglia compared to controls in all animals. On the contrary, within L neuron sub-types, a statistically significant increase in sub-type L2 (very rich in neurofilaments), and the appearance of sub-type L3 neuron which is not detectable in controls, were demonstrated in vicarious dorsal root ganglia. In spite of these variations in size and percentage distribution, no structural and ultrastructural differences of the various cell types and sub-types are detectable, except for the appearance of the sub-type L3 neurons. However, this neuron sub-type might not be considered specific of hypertrophy since the same morphological features have been observed, in normal conditions, in lizard dorsal root ganglia from cervical and lumbar spinal levels that provide innervation to limb plexuses.

Types and sub-types of neurons in dorsal root ganglia of the lizard Podarcis sicula: a light and electron microscope study.

A morphological analysis of types and sub-types of neurons from dorsal root ganglia at different spinal levels was carried out by combined light and electron microscopy in Podarcis sicula. Two neuron types were recognized: small dark cells (type D) and large light cells (type L). Type L cells were further sub-divided into three sub-types (L1, L2, L3) on the basis of entity and distribution of neurofilaments. Percentage distribution of neuron types did not vary in relation to the spinal level. On the contrary, differences were found in the percentage of the three type L neuron sub-types; a higher percentage of cells very rich in neurofilaments (L2, L3) was found in dorsal root ganglia from the cervical and the lumbar spinal levels. Results are discussed in relation to the spinal-level-related extent of innervation territory of dorsal root ganglia.

Morphometrical analysis of types and sub-types of neurons in dorsal root ganglia of the lizard Podarcis sicula.

In the present study, we conducted a morphometrical analysis of the different types and sub-types of lizard DRG neurons at various spinal levels. This analysis demonstrated significant differences in size distribution among the various neuron types and sub-types, as well as a significant shift to greater values in neurons from the dorsal root ganglia at the cervical and the lumbar spinal levels. The results are critically evaluated in relation to methodological issues, and the implications of these findings are discussed.

Smooth muscle cell hypertrophy and hyperplasia in the partially obstructed gut of the rat: a quantitative evaluation.

Partial surgical stenosis of the gut induces smooth muscle cell hypertrophy and hyperplasia in the loops upstream from the obstruction in a few days. In the present study we report a quantitative evaluation of these phenomena in the circular smooth muscle layer of the small intestine of the rat 7 days after a subtotal stenosis. In the loops upstream from the obstruction, lumen diameter and muscle wall thickness were found to be increased in comparison with downstream tracts. Morphometrical analysis showed that cross-sectional profile areas of smooth muscle cells, within the circular layer of upstream loops, significantly increased in size. Moreover, smooth muscle underwent a marked cell hyperplasia; in fact, estimates of the number of smooth muscle cell nuclear profiles turned out to be from 2.0 to 3.8 times greater in upstream loops than in downstream loops. The relation between the degree of lumen dilatation and the degree of the increase of the circular muscle layer thickness and of hypertrophic and hyperplastic response is discussed.

Nucleo-plasmic index variability in dorsal root ganglion neurons of the lizard (Podarcis sicula) during neuronal hypertrophy.

The nucleo-plasmic index was investigated in lizard dorsal root ganglion neurons from different spinal levels (cervical, thoracic, lumbar and caudal) in normal conditions, as well as in caudal dorsal root ganglion (DRG) neurons innervating the regenerated lizard tail (caudal hypertrophic ganglia). Results showed no statistically significant difference in the distribution of nucleo-plasmic index values in DRGs from different spinal levels providing sensory innervation to peripheral territories of different size. On the contrary, in the caudal hypertrophic ganglia, a significant shift towards lower values of the nucleo-plasmic index was observed. This observation suggests that this 'old', and merely morphological, parameter could be regarded as a good and simple marker for the study of neuronal hypertrophy considered as a dynamic response of neurons to variations of the innervation territory.