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The aim of the present study was to reach international consensus on the minimum set of outcomes to measure and report in adult traumatic brachial plexus injury care and research. This would facilitate comparison of outcomes from different centres and meta-analysis in research. A list of outcomes was developed from a systematic review (n = 54) and patient interviews (n = 12). The outcomes were rated in a three-round online Delphi survey completed by international surgeons, patients and therapists. Two online consensus meetings with patients and clinicians ratified the final core outcome set. A total of 72 people (20 surgeons, 21 patients, 31 therapists) from 19 countries completed all survey rounds. Thirty-eight people from nine countries attended separate patient (n = 13) and clinician consensus (n = 25) meetings. Outcomes were included if recommended by more than 85% of contributors. Pain, voluntary movement and carrying out a daily routine are the core outcome domains that should be assessed and reported when treating and researching adults with a traumatic brachial plexus injury. [ABSTRACT FROM AUTHOR]

Objective To explore the treatment outcome of surgical wound drainage following posterior lumbar interbody fusion (PLIF) surgery and provide theoretical support for clinical treatment. Methods A retrospective analysis was conducted on 23 patients who underwent PLIF surgery due to degenerative diseases of the lumbar spine resulting in neurological or spinal cord injury and subsequently developed wound drainage from September 2018 to April 2021. The patients were divided into the infection group (n = 10) and the non infection group (n = 13) based on their clinical data. Clinical manifestations and treatment processes were summarized and compared between the two groups. Results Com- pared with the non infection group, patients in the infection group had significantly more intraoperative bleeding (P< 0.05), longer time to diagnosis of postoperative infection and wound healing (P < 0.05), lower hemoglobin levels on the third day after surgery (P < 0.05), and higher white blood cell count, absolute neutrophil count, erythrocyte sedimentation rate, and C-reactive protein levels (P < 0.05) . All patients were discharged after recovery, and no recurrence was observed during a follow up period of more than one year. Conclusion Early and accurate identification and intervention for surgical wound drainage after PLIF surgery can achieve favorable clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This scoping review explores the risk and management of traumatic injuries to the inferior alveolar and lingual nerves during mandibular dental procedures. Emphasizing the significance of diagnostic tools, the review amalgamates existing knowledge to offer a comprehensive overview. Materials and methods: A literature search across PubMed, Embase, and Cochrane Library informed the analysis. Results: Traumatic injuries often lead to hypo-/anesthesia and neuropathic pain, impacting individuals psychologically and socially. Diagnosis involves thorough anamnesis, clinical-neurological evaluations, and radiographic imaging. Severity varies, allowing for conservative or surgical interventions. Immediate action is recommended for reversible causes, while surgical therapies like decompression, readaptation, or reconstruction yield favorable outcomes. Conservative management, utilizing topical anesthesia, capsaicin, and systemic medications (tricyclic antidepressants, antipsychotics, and serotonin-norepinephrine-reuptake-inhibitors), proves effective for neuropathic pain. Conclusions: Traumatic nerve injuries, though common in dental surgery, often go unrecorded. Despite lacking a definitive diagnostic gold standard, a meticulous examination of the injury and subsequent impairments is crucial. Clinical relevance: Tailoring treatment to each case's characteristics is essential, recognizing the absence of a universal solution. This approach aims to optimize outcomes, restore functionality, and improve the quality of life for affected individuals. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of "tongdu tiaoshen" acupuncture combined with transcranial direct current stimulation (tDCS) on nerve injury markers and event-related potential P300 in patients with post-stroke cognitive impairment (PSCI). Methods: 100 PSCI patients who were admitted to Beijing Rehabilitation Hospital Affiliated to Capital Medical University from September 2020 to December 2022 were selected. Patients were divided into control group (n=50, conventional treatment combine with tDCS) and observation group (n=50, on the basis of control group, combine with "tongdu tiaoshen" acupuncture) according to the random number table method. The efficacy, mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), activities of daily living (ADL), event-related potential P300 and serum nerve injury markers were compared in two groups. Results: Compared with control group, the total clinical effective rate in observation group was higher(P<0.05). Compared with control group 4 weeks after treatment, the scores of MoCA, MMSE and ADL in observation group were higher and the latency was lower. The amplitude was higher, and the levels of neuron-specific enolase (NSE) and S100β protein were lower (P<0.05). Conclusions: The combination of "tongdu tiaoshen" acupuncture and tDCS in the treatment of PSCI patients, which can effectively improve the cognitive function of patients and improve the ability of daily living activities, which may be relate to the improvement of neurological function. [ABSTRACT FROM AUTHOR]

The objective of this review is to evaluate the diagnostic methods to determine the sensory alteration after placing dental implants as well as the respective treatment options. The search was carried out using two databases (PubMed, Scopus) with specific indexing terms: “Mandibular nerve, inferior alveolar nerve, trigeminal nerve, dental implants, hyperalgesia, paresthesia, nerve injury, altered sensation, sensory disturbance, dysesthesia, anesthesia”. Additionally, a manual search was carried out in indexed journals to find articles related to injuries in the inferior alveolar nerve after placing the implant. It was restricted to English papers published during the last ten years, from January 2012 to October 2022. Two reviewers selected the titles and analyzed the abstracts according to the inclusion and exclusion criteria. Some descriptions of preoperative imaging techniques and diagnostic methods to determine sensorial alteration and treatment after nerve injury when placing dental implants were selected and categorized. The search identified twelve articles related to the topics, five were excluded due to incompatibility with the inclusion criteria established. Then, two additional articles were included and identified through inverse search. Finally, nine studies were selected for this review. The studies presented diagnostic methods used to determine inferior alveolar nerve alterations, and we evaluated the treatments received to solve the alterations after placing dental implants. Over the years, various diagnostic methods have been developed to determine sensory alterations after the placement of dental implants. Removing the dental implant is recommended up to 36 hours after the mandibular nerve injury. Microsurgery could lead to proper neurosensorial recovery. [ABSTRACT FROM AUTHOR]

Nerve guidance conduits for peripheral nerve injuries can be improved using bioactive materials such as magnesium (Mg) and its alloys, which could provide both structural and trophic support. Therefore, we investigated whether exposure to Mg and Mg-1.6wt%Li thin films (Mg/Mg-1.6Li) would alter acute Schwann cell responses to injury. Using the RT4-D6P2T Schwannoma cell line (SCs), we tested extracts from freeze-killed cells (FKC) and nerves (FKN) as in vitro injury stimulants. Both FKC and FKN induced SC release of the macrophage chemoattractant protein 1 (MCP-1), a marker of the repair SC phenotype after injury. Next, FKC-stimulated cells exposed to Mg/Mg-1.6Li reduced MCP-1 release by 30%, suggesting that these materials could have anti-inflammatory effects. Exposing FKC-treated cells to Mg/Mg-1.6Li reduced the gene expression of the nerve growth factor (NGF), glial cell line-derived neurotrophic factor (GDNF), and myelin protein zero (MPZ), but not the p75 neurotrophin receptor. In the absence of FKC, Mg/Mg-1.6Li treatment increased the expression of NGF, p75, and MPZ, which can be beneficial to nerve regeneration. Thus, the presence of Mg can differentially alter SCs, depending on the microenvironment. These results demonstrate the applicability of this in vitro nerve injury model, and that Mg has wide-ranging effects on the repair SC phenotype. [ABSTRACT FROM AUTHOR]

We evaluated the management of supracondylar paediatric fractures at our institution over a 10-year period in this retrospective cohort study. In total, 762 children with a supracondylar fracture were treated. The mean age of injury was 5.2 years. The incidence of documented nerve and/or vascular injury was 8.3%. A total of 26 patients had early plastic surgeon involvement; of these, 25 had an open exploration. Eight patients required vein grafting for brachial artery reconstruction for intimal tears. There was one nerve rupture requiring repair and 12 children underwent neurolysis. There were 17 late referrals to the plastic surgery service, of which three were explored (two neurolysis, one neuroma resection and sural nerve grafting). In all cases of nerve injury, the deficit took 7.9 months to recover, indicating a more significant injury than neurapraxia. Early exploration of supracondylar fractures allows direct visualization of the extent of neurovascular injury and immediate intervention. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Many techniques are used for digital nerve repair, most commonly coaptation by sutures. Nerve repairs must be strong while offering an environment for nerve regeneration. Sutures can damage the nerve and thereby limit growth and regeneration. Sutures can rip and cause sudden catastrophic failure. Fibrin glue and conduit-wraps allow a good environment for growth, but neither provides much strength. A benefit to conduit repair would arise if the repair maintained integrity after the peak load so that the path for regrowth stayed in place. The goal for this study was to determine whether conduit with glue provides continued strength after a maximum load is reached. Methods: Digital cadaveric nerves were harvested and repaired with 2 epineurial sutures, conduit, and fibrin glue in all combinations. Tests to failure were performed, gap displacement between nerve ends recorded, and the postpeak load energy to dissociation of the nerve and conduit was calculated. Results: Conduit with glue and 2 sutures at the end had the greatest energy and displacement after the peak load but was not significantly different than conduit with glue and 1 suture. Conduit with glue alone obtained statistically the same displacement as conduit with glue and 2 sutures. Conduit, with or without glue, and 2 sutures was statistically the same as suture only repair for peak load. Conclusion: Conduit/wrap maintains a load capacity and a path for nerve regeneration after the peak. Suture at the ends of conduit, not at the coaptation site, reduces damage at the point of injury. [ABSTRACT FROM AUTHOR]

Background: While numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed. Objective: This study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery. Design: A prospective randomized double-blinded trial. Setting: The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022. Participants: Patients aged 18 – 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery. Interventions: Patients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group). Main outcome measures: Primary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events. Results: Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 – 5.72, P

Abstract Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

Femoral nerve injury is a rare but devastating complication of direct anterior approach total hip arthroplasty that occurs in about 1% of the cases and could potentially lead to debilitating loss of knee extension. In this case report, we present a case of femoral nerve injury following direct anterior approach hip arthroplasty with an inability to extend the affected knee, gait instability, and multiple falls. For this patient, an innovative functional adductor magnus muscle transfer was performed to restore knee extension. At 6 months after surgery, the patient’s knee extension was partly restored, and ambulation was significantly improved.

This article was conducted to evaluate the role of therankeron and methylprednisolone on the healing and regeneration process of the damaged sciatic nerve by crushing in dogs. Eighteen adult dogs were used. The animals were divided into three equal groups. The sciatic nerve of the left hind limb in all experimental animals was damaged by crushing forceps for two minutes. In group one, the damaged nerve was left without any medical therapy, while in groups two and three, methylprednisolone and therankeron were used to treat the crushed sciatic nerve, respectively. The Clinical signs and histopathological changes depended on the 30th and 60th postoperative days to evaluate the degree of nerve repair. In group one, all animals did not use their affected limb with loss of sensation completely, while early and pronounced enhancement in the hind limb function was shown, especially in group three than in group two. In group one, the histopathological changes were characterized by the presence of areas of nerve fiber necrosis and disconnection of it, inflammatory cell infiltration with blood vessel congestion, and edema formation between the nerve fibers in both following periods. The same changes were shown in groups two and three, in addition to the presence of nerve fibers' regeneration, especially in group three, superior to group two. In conclusion, the results of this article revealed positive clinical and histopathological effects of both theranekron and methylprednisolone on the healing and regeneration of the crushed sciatic nerve, with priority for therankeron in dogs.

Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication. Level of evidence V.

Introduction: Complications after major surgery are a significant cause of morbidity and mortality, and they have been shown to harm long-term quality of life. Lymph node status is the chief prognostic indicator. In the head and neck, complications from oncosurgeries can also delay adjuvant treatment, which is known to adversely affect survival. Neck dissection is a standard procedure for head and neck cancer following resections of the primary tumour. The invasive nature of neck dissection predisposes patients to a variety of intraoperative and postoperative complications. Aim: To analyse the complications in patients with head and neck malignancies following neck dissections. Materials and Methods: This was a single-centre cohort study conducted at the Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. All patients diagnosed with head and neck malignancies who underwent neck dissections from July 2022 to December 2022 were included in the study. Complications such as bleeding, haematoma, infection, seroma, wound dehiscence, flap necrosis, fistula, chyle leak, shoulder dysfunction, and nerve and vascular injuries following various neck dissections were observed until discharge. The data was entered in Microsoft excel and results were expressed in terms of frequency and percentage. Results: A total of 67 patients were analysed in this study. Among them, 42 (62.7%) were males and 25 (37.3%) were females, with a mean age of 48 years and an age range of 25-84 years. Three patients underwent bilateral neck dissection, and a total of 70 neck sides were studied. Among the patients who received prior radiotherapy (20, 29.8%), 6 (30.0%) experienced complications, and there were no deaths. Conclusion: Head and neck surgery carries the potential for many complications due to the presence of major vessels and nerves. Carefully performed surgery is the cornerstone of success. Thorough preoperative assessment, proper surgical technique, and postoperative care are essential in preventing and managing complications. A step-by-step approach to studying details and conducting a complete check-up of the patient after the procedure ensures optimal results with minimal late side-effects and complications.

The potassium–chloride cotransporter KCC2 is the main extruder of Cl- in neurons. It plays a fundamental role in the activity of the inhibitory neurotransmitters (GABA and glycine) since low levels of KCC2 promote intracellular Cl- accumulation, leading to the depolarizing activity of GABA and glycine. The downregulation of this cotransporter occurs in neurological disorders characterized by hyperexcitability, such as epilepsy, neuropathic pain, and spasticity. KCC2 is also downregulated after axotomy. If muscle reinnervation is allowed, the KCC2 levels recover in motoneurons. Therefore, we argued that target-derived neurotrophic factors might be involved in the regulation of KCC2 expression. For this purpose, we performed the axotomy of extraocular motoneurons via the monocular enucleation of adult rats, and a pellet containing either VEGF or BDNF was chronically implanted in the orbit. Double confocal immunofluorescence of choline acetyl-transferase (ChAT) and KCC2 was carried out in the brainstem sections. Axotomy led to a KCC2 decrease in the neuropil and somata of extraocular motoneurons, peaking at 15 days post-lesion, with the exception of the abducens motoneuron somata. VEGF administration prevented the axotomy-induced KCC2 downregulation. By contrast, BDNF either maintained or reduced the KCC2 levels following axotomy, suggesting that BDNF is involved in the axotomy-induced KCC2 downregulation in extraocular motoneurons. The finding that VEGF prevents KCC2 decrease opens up new possibilities for the treatment of neurological disorders coursing with neuronal hyperactivity due to KCC2 downregulation.

Black Phosphorus (BP) is a new semiconductor material with excellent biocompatibility, degradability, and optical and electrophysical properties. A growing number of studies show that BP has high potential applications in the biomedical field. This article aims to systematically review the research progress of BP composite medical materials in the field of tissue engineering, mining BP in bone regeneration, skin repair, nerve repair, inflammation, treatment methods, and the application mechanism. Furthermore, the paper discusses the shortcomings and future recommendations related to the development of BP. These shortcomings include stability, photothermal conversion capacity, preparation process, and other related issues. However, despite these challenges, the utilization of BP-based medical materials holds immense promise in revolutionizing the field of tissue repair. [ABSTRACT FROM AUTHOR]

Ephrins are protein ligands that act through the tyrosine kinase receptor family, Eph receptors. The role of ephrin/Eph in the critical processes involved in the development of the nervous system, including axon guidance and cell migration, has been well documented. Moreover, studies have shown an upregulation of ephrin B1/EphB1 and ephrin B2/EphB2 in neuropathic pain of different etiology. The activation of the ephrin B/EphB system in the dorsal root ganglion and dorsal horn of the spinal cord may be essential in initiating and maintaining neuropathic pain. Accordingly, it can be proposed that the pharmacological inhibitors of EphB receptors may be potentially employed to manage the manifestations of pain. One of the primary mechanisms involved in ephrin B/EphB‐mediated synaptic plasticity includes phosphorylation and activation of NMDA receptors, which may be secondary to activation of different kinases, including MAP kinases (MAPK), protein kinase C (PKC), and Src family kinases (SFK). The other molecular mechanisms may include activation of inflammatory cytokines in the spinal cord, caspase‐3, calpain‐1, phosphoinositide 3‐kinase (PI3K), protein kinase A (PKA), and cAMP Response Element‐Binding Protein (CREB). The present review discusses the role and molecular mechanisms involved in ephrin B/EphB‐mediated neuropathic pain of different etiology. [ABSTRACT FROM AUTHOR]

Background: The elaboration of biocompatible nerve guide conduits (NGCs) has been studied in recent years as a treatment for total nerve rupture lesions (axonotmesis). Different natural polymers have been used in these studies, including cellulose associated with soy protein. The purpose of this report was to describe manufacturing NGCs suitable for nerve regeneration using the method of dip coating and evaporation of solvent with cellulose acetate (CA) functionalized with soy protein acid hydrolysate (SPAH). Methods: The manufacturing method and bacterial control precautions for the CA/SPAH NGCs were described. The structure of the NGCs was analyzed under a scanning electron microscope (SEM); porosity was analyzed with a degassing method using a porosimeter. Schwann cell (SCL 4.1/F7) biocompatibility of cell-seeded nerve guide conduits was evaluated with the MTT assay. Results: The method employed allowed an easy elaboration and customization of NGCs, free of bacteria, with pores in the internal surface, and the uniform wall thickness allowed manipulation, which showed flexibility; additionally, the sample was suturable. The NGCs showed initial biocompatibility with Schwann cells, revealing cells adhered to the NGC structure after 5 days. Conclusions: The fabricated CA/SPAH NGCs showed adequate features to be used for peripheral nerve regeneration studies. Future reports are necessary to discuss the ideal concentration of CA and SPAH and the mechanical and physicochemical properties of this biomaterial. [ABSTRACT FROM AUTHOR]

Peripheral neuropathies are associated with various detrimental complications, leading to life-debilitating disorders, including neuropathic pain. Hence, the current study aimed to incorporate naringin, a potential natural component, into chitosan nanoparticles (NPs) to ameliorate the complications resulting from chronic constriction injury (CCI) induced painful neuropathy. The prepared NPs had a particle size of 220 nm and PDI = 0.37, with relatively spherical morphology and zeta potential of +41.5 mV. The relevant analyses indicated the loading and high encapsulation efficiency of naringin into the NPs as well as a prolonged release of naringin. The anti-neuropathic evaluations of chronic constriction injury (CCI)-induced rats treated with naringin-loaded NPs (10 mg/kg) remarkably ameliorated hyperalgesia and cold allodynia. In addition, the treatment with naringin-loaded NPs led to improvements in sensory and locomotor impairment, as evidenced by changes in behavioral parameters such as reduced paw licking, increased rearings, and enhanced crossings. The NPs treatment significantly attenuated the elevated levels of nitrite and restored the reduced glutathione level in the serum of CCI-induced rats. Moreover, histopathological analysis exhibited regeneration of the sciatic nerve injury through reducing myelin degeneration, axonal swelling, and nerve fiber derangement. Therefore, these findings suggest that the naringin-loaded chitosan NPs has promising pharmacological activities for the treatment of neuropathic pain sufferers. [ABSTRACT FROM AUTHOR]

Considerable evidence suggests that oxytocin, as a regulatory nonapeptide, participates in modulatory mechanisms of nociception. Nonetheless, the role of this hypothalamic hormone and its receptor in the sensory pathway has yet to be fully explored. The present study performed immunohistochemistry, enzyme-linked immunosorbent assay, and RT-qPCR analysis to assess changes in the expression of the neuronal oxytocin receptor in female rats following tight ligation of the sciatic nerve after 1, 3, and 7 days of survival. Oxytocin receptor immunoreactivity was present in both dorsal root ganglia and lumbar spinal cord segments, but not accumulated at the site of the ligation of the peripheral nerve branch. We found a time-dependent change in the expression of oxytocin receptor mRNA in L5 dorsal root ganglion neurons, as well as an increase in the level of the receptor protein in the lumbar segment of the spinal cord. A peak in the expression was observed on day 3, which downturned slightly by day 7 after the nerve ligation. These results show that OTR expression is up-regulated in response to peripheral nerve lesions. We assume that the importance of OTR is to modify spinal presynaptic inputs of the sensory neurons upon injury-induced activation, thus to be targets of the descending oxytocinergic neurons from supraspinal levels. The findings of this study support the concept that oxytocin plays a role in somatosensory transmission. [ABSTRACT FROM AUTHOR]

The hypothesis of this study was that trigeminal nerve stimulation (TNS) or peripheral nerve stimulation (PNS) could improve functional outcomes of peripheral nerve injury in a rat forelimb model when compared to control rats not receiving electrical stimulation (ES). While PNS is known to improve outcomes after nerve surgery, the role of TNS has not been explored. Lewis rats were trained to perform a reach and grasp task before receiving a 2 mm gap repair of the ulnar and median nerves and randomized into four treatment groups: (1) sham injury, (2) nerve injury with sham ES, (3) nerve injury with PNS, and (4) nerve injury with TNS. Functional motor (median pull force and percent success in motor task) and sensory metrics (forelimb paw withdrawal thresholds) were collected both pre-injury and throughout rehabilitation. Nerves stained using Gomori's trichrome were assessed quantitatively and qualitatively. The sham ES group did not recover their pre-injury baseline functional outcomes. In contrast, the TNS and PNS groups fully recovered following injury, with no difference in functional outcomes between the pre-injury baseline and the final week of rehabilitation (P > 0.05, all). Histomorphology results demonstrated no quantitative difference, but qualitative differences in architecture were evident. Electrical stimulation of the trigeminal nerve or the injured nerve improved the functional outcomes of nerve regeneration in rodents. Histomorphology results of nerves from the TNS group support the proposed central mechanisms. This is an important step in translating this therapy as an adjunct, non-invasive treatment for high, mixed nerve injuries in humans. [ABSTRACT FROM AUTHOR]

Background: Lipomas are a rare cause of posterior interosseous nerve (PIN) compression. A systematic review of predictors for motor recovery has not been performed. This study sought to evaluate whether patient or lipoma characteristics are associated with motor recovery and could be used to determine when immediate tendon transfers at the time of excision should be performed. Methods: Articles describing patients with forearm lipomas resulting in PIN compression with motor weakness were included. Patient age, gender, symptom duration, laterality and largest dimension of lipoma, surgical intervention, and motor recovery were identified. Article quality was assessed via the Methodological Index for Non-Randomized Studies criteria. Results: Thirty articles reporting on 34 patients were identified. Average age was 58.2 years. Average largest lipoma dimension was 5.7 cm. All patients underwent lipoma removal, and 2 had concomitant tendon transfers. In all, 73.5% of patients had complete motor recovery at an average of 9.7 months. Patient age and largest dimension of lipoma, and duration of symptoms were not significant predictors of motor recovery. Symptom duration was a significant predictor of motor recovery in binary regression, particularly if < 18 months. Conclusions: The majority of patients with PIN weakness secondary to lipoma are likely to have complete motor recovery after excision alone. Concomitant tendon transfers should be considered for patients symptomatic for greater than 18 months. Further, adequately powered, studies are required to stratify risk factors and evaluate other modalities to identify the minority of patients who would benefit from immediate tendon transfer. [ABSTRACT FROM AUTHOR]

Wallerian degeneration following nerve injury not only suppresses CD4+ T-cell responses but also promotes pro-inflammatory immunological responses through TNF-α and IL-1β. Recent research suggests that thymoquinone might enhance nerve recovery by exerting anti-inflammatory effects on both the innate and adaptive immune systems. This study aims to evaluate the effect of thymoquinone on neuroinflammation in a sciatic nerve crush injury, as represented by TNF-α, IL-1β, and the CD4+:CD8+ ratio. In this study, 126 crush injury Wistar rats were divided into three main groups: placebo, thymoquinone 100 mg/kg, and thymoquinone 250 mg/kg administered daily. Rats were euthanized at six distinct time points: 12, 18, and 24 hours, as well as on day-5, day-6, and day-7. TNF-α and IL-1β levels were assessed using the Enzyme-Linked Immunosorbent Assay (ELISA). The CD4+:CD8+ ratio in peripheral blood was determined via flow cytometry. No significant TNF-α differences was found between treatment and placebo groups. However, on day 6, IL-1β was significantly lower in the TQ 250mg/kg group than in the placebo (p=0.008). A similar but non-significant trend existed on days 6 and 7. On day 5, both TQ groups showed a higher, statistically significant CD4+:CD8+ ratio compared to placebo (p=0.007), a trend that continued to day 7 but not statistically significant. Daily TQ administration did not consistently reduce TNF-α and IL-1ß levels. However, both doses elevated the CD4+:CD8+ ratio during the early stages of Wallerian degeneration, suggesting a potential benefit of TQ on nerve regeneration. [ABSTRACT FROM AUTHOR]

To investigate the relationship between serum CXC chemokine ligand 1 (CXCL1), CXC chemokine ligand 10 (CXCL10) and nerve injury index and prognosis after minimally invasive puncture and drainage in patients with hypertensive basal ganglia hemorrhage (HBGH). 162 patients with HBGH who were underwent minimally invasive puncture and drainage in the East ward of Liaocheng People's Hospital from February 2020 to April 2023 were selected as study group, and 110 healthy volunteers who were underwent physical examination in our hospital during the same period were selected as control group. The levels of serum CXCL1, CXCL10 and nerve injury indexes [neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP) and S100茁 protein] were detected and compared between two groups. The correlation between serum CXCL1, CXCL10 and nerve injury indexes were analyzed by Pearson test. All patients were followed up for 3 months, and the prognosis of the patients was evaluated according to the modified Rankin scale (mRS), patients were divided into good prognosis group and poor prognosis group. The prognostic factors of patients with HBGH after minimally invasive puncture and drainage was analyzed by multivariate Logistic regression model. The levels of serum CXCL1 and CXCL10 in study group were higher than those in control group (P<0.05). The levels of serum NSE, GFAP and S100茁 protein in study group were higher than those in control group(P<0.05). Pearson test analysis showed that, serum CXCL1 and CX-CL10 were positively correlated with NSE, GFAP and S100β protein (P<0.05). Univariate analysis showed that, poor prognosis was associated with age, triglyceride (TG), low-density lipoprotein (LDL), prothrombin time (PT), C-reactive protein (CRP), hematoma breaking into the ventricle, hematoma volume, hematoma clearance rate within 24 hours after operation, number of urokinase flushing, recurrence of postoperative intracranial hemorrhage, CXCL1 and CXCL10 (P<0.05). Multivariate Logistic regression analysis showed that, older age, higher LDL, larger hematoma volume, lower hematoma clearance rate within 24 hours after operation, more times of urokinase flushing, higher CXCL1 and higher CXCL10 were risk factors for poor prognosis of HBGH patients after minimally invasive puncture and drainage (P<0.05). Elevate serum CXCL1 and CXCL10 levels in patients with HBGH may lead to nerve injury and poor prognosis. Age, LDL, hematoma volume, hematoma clearance rate within 24 hours after operation, number of urokinase flushes, CXCL1 and CXCL10 are risk factors for poor prognosis in patients with HBGH, which deserves attention. [ABSTRACT FROM AUTHOR]

Neuropathic pain arises from damage or disorders affecting the somatosensory system. In rats, L5 nerve injury induces thermal and mechanical hypersensitivity/hyperalgesia. Recently, we demonstrated that applying resiniferatoxin (RTX) directly on uninjured L3 and L4 nerves alleviated thermal and mechanical hypersensitivity resulting from L5 nerve injury. Herein, using immunohistochemistry, Western blot, and qRT-PCR techniques, we reveal that perineural application of RTX (0.002%) on the L4 nerve substantially downregulated the expression of its receptor (Trpv1) and three different voltage-gated ion channels (Nav1.9, Kv4.3, and Cav2.2). These channels are found primarily in small-sized neurons and show significant colocalization with Trpv1 in the dorsal root ganglion (DRG). However, RTX treatment did not affect the expression of Kv1.1, Piezo2 (found in largesized neurons without colocalization with Trpv1), and Kir4.1 (localized in satellite cells) in the ipsilateral DRGs. Furthermore, RTX application on L3 and L4 nerves reduced the activation of c-fos in the spinal neurons induced by heat stimulation. Subsequently, we investigated whether applying RTX to the L3 and L4 nerves 3 weeks before the L5 nerve injury could prevent the onset of neuropathic pain. Both 0.002 and 0.004% concentrations of RTX produced significant analgesic effects, while complete prevention of thermal and mechanical hypersensitivity required a concentration of 0.008%. Importantly, this preventive effect on neuropathic manifestations was not associated with nerve degeneration, as microscopic examination revealed no morphological changes. Overall, this study underscores the mechanisms and the significance of perineural RTX treatment applied to adjacent uninjured nerves in entirely preventing nerve injury-induced neuropathic pain in humans and animals. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to report our 5 years surgical experience and the rate of neurovascular injury following gunshot fractures of the distal humerus in a in level-1 Trauma Centre in South Africa. Methods: A retrospective case series of 25 consecutive adult gunshot injuries to the distal humerus. Demographic and injury data were extracted from clinical case notes and electronic operative records. Imaging archives were used to classify fractures according to the AO/OTA classification. Results: Twenty-five male patients, with mean age of 32-years-old, sustained gunshot injuries to the distal humerus. Eleven patients had multiple gunshots. Forty-four percent of patients underwent Computed Tomography Angiography (CTA), 20% had confirmed brachial artery injury. Limbs with vascular injury were salvaged with arterial repair and external fixation. Fractures were extra-articular in 20 cases (80%). Nineteen fractures were classified as highly comminuted. Nerve injuries occurred in 52% and were all managed expectantly. Only 32% of patients attended follow-up beyond 3 months. Conclusions: These are rare challenging injuries with high rates of neurovascular damage. This demographic of patients is poorly compliant with follow up highlighting the need for high-quality early care. Brachial artery injury should be excluded with CTA and can be managed with arterial repair and external fixation. All fractures in this series were surgically managed with conventional anatomical plate and screw fixation techniques. For nerve injury, we advocate expectant management. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

• Inflammation can either support or hinder axonal regeneration after nerve injury. • Macrophages play a key role in the inflammatory response to injury. • Modulation of inflammation is a potential therapeutic target for nerve injury. Neurons are the cells of the nervous system and are responsible for every thought, movement and perception. Immune cells are the cells of the immune system, constantly protecting from foreign pathogens. Understanding the interaction between the two systems is especially important in disease states such as autoimmune or neurodegenerative disease. Unfortunately, this interaction is typically detrimental to the host. However, recent efforts have focused on how neurons and immune cells interact, either directly or indirectly, following traumatic injury to the nervous system. The outcome of this interaction can be beneficial – leading to successful neural repair, or detrimental – leading to functional deficits, depending on where the injury occurs. This review will discuss our understanding of neuron-immune cell interactions after traumatic injury to both the peripheral and central nervous system. [ABSTRACT FROM AUTHOR]

Purpose: Our study aimed to illustrate the positional relationship of the two branches of the saphenous nerve: the infrapatellar branch of the saphenous nerve (IPBSN) and medial crural cutaneous nerve (MCCN), as well as the anatomical landmarks using high-resolution ultrasound (HRUS) to help prevent iatrogenic nerve injury. Methods: We used HRUS to explore the positional relationships among the anatomical landmarks, IPBSN, and MCCN in 40 knees of 20 participants. The distances from these branches to key reference points were recorded. Using the ultrasound caliper mode, we measured the depth from the skin surface to the nerves at four distinct points. Results: The average distances between IPBSN and medial border of patella (MBP) and IPBSN and medial border of patellar ligament (MBPL) were 47 ± 7 mm and 42 ± 9 mm, respectively. MCCN showed mean distances of 94 ± 9 mm and 96 ± 9 mm to MBP and MBPL, respectively. The mean distance from the upper edge of pes anserine to IPBSN at the patellar apex (PA) level was 24 ± 10 mm and to MCCN was 34 ± 9 mm. Conclusion: We used high-resolution ultrasound to evaluate IPBSN and MCCN and their positions relative to anatomical landmarks. The study results offer valuable insights into the course of these nerves, which can help establish a safety zone to prevent accidental nerve injuries during knee surgeries and injections. [ABSTRACT FROM AUTHOR]

Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication. [ABSTRACT FROM AUTHOR]

Introduction: Complications after major surgery are a significant cause of morbidity and mortality, and they have been shown to harm long-term quality of life. Lymph node status is the chief prognostic indicator. In the head and neck, complications from oncosurgeries can also delay adjuvant treatment, which is known to adversely affect survival. Neck dissection is a standard procedure for head and neck cancer following resections of the primary tumour. The invasive nature of neck dissection predisposes patients to a variety of intraoperative and postoperative complications. Aim: To analyse the complications in patients with head and neck malignancies following neck dissections. Materials and Methods: This was a single-centre cohort study conducted at the Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. All patients diagnosed with head and neck malignancies who underwent neck dissections from July 2022 to December 2022 were included in the study. Complications such as bleeding, haematoma, infection, seroma, wound dehiscence, flap necrosis, fistula, chyle leak, shoulder dysfunction, and nerve and vascular injuries following various neck dissections were observed until discharge. The data was entered in Microsoft excel and results were expressed in terms of frequency and percentage. Results: A total of 67 patients were analysed in this study. Among them, 42 (62.7%) were males and 25 (37.3%) were females, with a mean age of 48 years and an age range of 25-84 years. Three patients underwent bilateral neck dissection, and a total of 70 neck sides were studied. Among the patients who received prior radiotherapy (20, 29.8%), 6 (30.0%) experienced complications, and there were no deaths. Conclusion: Head and neck surgery carries the potential for many complications due to the presence of major vessels and nerves. Carefully performed surgery is the cornerstone of success. Thorough preoperative assessment, proper surgical technique, and postoperative care are essential in preventing and managing complications. A step-by-step approach to studying details and conducting a complete check-up of the patient after the procedure ensures optimal results with minimal late side-effects and complications. [ABSTRACT FROM AUTHOR]

Distal humerus fractures are often severe, joint-involving injuries that frequently present with concomitant neurovascular injuries and soft tissue damage. Most fractures require surgical treatment to allow for an early range of motion follow-up. The surgery aims to achieve an anatomic, stable reconstruction as a prerequisite for restoring function and weight-bearing of the elbow joint. Open reduction and internal fixation is usually performed for most fracture types, with anatomically bicolumnar locking plates that can be positioned in a 90° or 180° configuration most commonly performed for joint-involving fractures. A detailed fracture analysis with planning of patient positioning, approaches and the choice of implants should precede the surgical treatment. Total elbow replacement may be considered in comminuted osteoporotic fractures where the articular surface cannot be reconstructed. Clinical outcomes of surgically treated distal humerus fractures depend primarily on the fracture type and the anatomical reduction, as well as the presence of concomitant nerve injury. The most common postoperative complications include partial elbow joint stiffness, heterotopic ossification, posttraumatic osteoarthritis, and damage to the ulnar nerve. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have shown that Gandouling (GDL) may alleviate the nerve damage caused by Wilson's disease (WD) by inhibiting the autophagy of nerve cell mitochondria. However, its mechanisms are still unclear. Revealing the therapeutic mechanism of GDL is beneficial for its clinical application and provides theoretical support for the development of new formulations for treating WD. Method: This time we found that the oxidative stress level in the body of the copper‐overloaded WD rates increased, neurons in the hippocampus were damaged, and autophagy occurred. GDL reversed these situations and significantly improved the learning, memory, and spatial cognitive abilities of the high‐copper‐loaded WD rates. After GDL intervention, the expression of phosphatidylinositol‐3 kinase (PI3K), phosphorylated serine–threonine protein kinase (AKT), and phosphorylated forkhead box protein O1 (FoxO1) significantly increased, whereas FoxO1 in the nucleus decreased and phosphorylated FoxO1 in the cytoplasm also significantly raised. In addition, the expression of Sirt1 significantly declined, and Ac‐FoxO1 in the nucleus also significantly increased. Results: These data indicated that GDL may promote the phosphorylation of FoxO1 and promote its nucleation by activating the PI3K/AKT/FoxO1 signaling pathway and inhibit Ac‐FoxO1 hydrolysis in the nucleus through the Sirt1/FoxO1 signaling pathway to suppress the transcriptional activity of FoxO1. Conclusion: Furthermore, it inhibited the expression of autophagy genes Atg12 and Gabarapl1. In summary, our work provides new insights into the potential mechanisms of GDL repairing WD neuronal damage through autophagy pathways. [ABSTRACT FROM AUTHOR]

Regional anaesthetic techniques are fundamental in the anaesthetic care of orthopaedic patients. They may be used as the primary anaesthetic technique or to provide postoperative pain relief. Compared to general anaesthesia alone, regional techniques can provide superior perioperative analgesia, fewer systemic drug adverse effects such as nausea, vomiting and confusion, and earlier mobilization which can reduce nosocomial complications and facilitate expedited hospital discharge. Disadvantages include block failure, nerve injury, unrecognized injury to the anaesthetized limb, prolonged motor blockade and local anaesthetic toxicity. Preoperative assessment should identify contraindications, document pre-existing neurological deficits, and clarify surgical and perioperative aims. Informed consent should be obtained after a clear explanation of the procedure, its risks, and potential complications. Serious and long-term neurological complications are rare and may be reduced by an awake regional technique, sonographic guidance, regular aspiration and by ensuring low-pressure injections. Postoperative follow-up is essential and suspicious neurological findings should be detected, investigated, and managed in an early and timely manner. [ABSTRACT FROM AUTHOR]

This experiment was conducted to study the effects of Cyfluthrin (Cy) exposure on neurobehaviour, hippocampal tissue and synaptic plasticity in Wistar rats. First, it was found that high-dose Cy exposure could cause nerve injury, resulting in symptoms such as deficits in learning and memory ability, spatial exploration and autonomic motor function. Moreover, it was found that medium- and high-dose Cy exposure could cause an abnormal release of the neurotransmitter Glu. Second, brain tissue pathology showed that the middle and high doses of Cy caused tissue deformation, reduced the number of hippocampal puramidal cells, caused a disorder of these cells, decreased the number of Nissl bodies, and caused pyknosis of the hippocampal cell nuclear membrane and serious damage to organelles, indicating that exposure to these doses of Cy may cause hippocampal tissue damage in rats. Third, as the exposure dose increased, morphological changes in hippocampal synapses, including blurred synaptic spaces, a decreased number of synaptic vesicles and a decreased number of synapses, became more obvious. Moreover, the expression levels of the key synaptic proteins PSD-95 and SYP also decreased in a dose-dependent manner, indicating obvious synaptic damage. Finally, the study found that medium and high doses of Cy could upregulate the expression of A2AR in the hippocampus and that the expression levels of inflammatory factors and apoptosis-related proteins increased in a dose-dependent manner. Moreover, the expression of A2AR mRNA was correlated with neurobehavioural indicators and the levels of inflammatory factors, synaptic plasticity-related factors and apoptosis-related factors, suggesting that Cy may cause nerve damage in rats and that this effect is closely related to A2AR. [ABSTRACT FROM AUTHOR]

Peripheral neurons are heterogeneous and functionally diverse, but all share the capability to switch to a pro-regenerative state after nerve injury. Despite the assumption that the injury response is similar among neuronal subtypes, functional recovery may differ. Understanding the distinct intrinsic regenerative properties between neurons may help to improve the quality of regeneration, prioritizing the growth of axon subpopulations to their targets. Here, we present a comparative analysis of regeneration across four key peripheral neuron populations: motoneurons, proprioceptors, cutaneous mechanoreceptors, and nociceptors. Using Cre/Ai9 mice that allow fluorescent labeling of neuronal subtypes, we found that nociceptors showed the greater regeneration after a sciatic crush, followed by motoneurons, mechanoreceptors, and, finally, proprioceptors. By breeding these Cre mice with Ribotag mice, we isolated specific translatomes and defined the regenerative response of these neuronal subtypes after axotomy. Only 20% of the regulated genes were common, revealing a diverse response to injury among neurons, which was also supported by the differential influence of neurotrophins among neuron subtypes. Among differentially regulated genes, we proposed MED12 as a specific regulator of the regeneration of proprioceptors. Altogether, we demonstrate that the intrinsic regenerative capacity differs between peripheral neuron subtypes, opening the door to selectively modulate these responses.

Radiation therapy is a common treatment modality for patients with malignant tumors of the head and neck, chest and axilla. However, radiotherapy inevitably causes damage to normal tissues at the irradiated site, among which damage to the brachial plexus nerve(BP) is a serious adverse effect in patients receiving radiation therapy in the scapular or axillary regions, with clinical manifestations including abnormal sensation, neuropathic pain, and dyskinesia, etc. These adverse effects seriously reduce the living quality of patients and pose obstacles to their prognosis. Therefore, it is important to elucidate the mechanism of radiation induced brachial plexus injury (RIBP) which remains unclear. Current studies have shown that the pathways of radiation-induced BP injury can be divided into two categories: direct injury and indirect injury, and the indirect injury is closely related to the inflammatory response, microvascular damage, cytokine production and other factors causing radiation-induced fibrosis. In this review, we summarize the underlying mechanisms of RIBP occurrence and possible effective methods to prevent and treat RIBP.

DYT-TOR1A dystonia is the most common monogenic dystonia characterized by involuntary muscle contractions and lack of therapeutic options. Despite some insights into its etiology, the disease's pathophysiology remains unclear. The reduced penetrance of about 30% suggests that extragenetic factors are needed to develop a dystonic phenotype. In order to systematically investigate this hypothesis, we induced a sciatic nerve crush injury in a genetically predisposed DYT-TOR1A mouse model (DYT1KI) to evoke a dystonic phenotype. Subsequently, we employed a multi-omic approach to uncover novel pathophysiological pathways that might be responsible for this condition. Using an unbiased deep-learning-based characterization of the dystonic phenotype showed that nerve-injured DYT1KI animals exhibited significantly more dystonia-like movements (DLM) compared to naive DYT1KI animals. This finding was noticeable as early as two weeks following the surgical procedure. Furthermore, nerve-injured DYT1KI mice displayed significantly more DLM than nerve-injured wildtype (wt) animals starting at 6 weeks post injury. In the cerebellum of nerve-injured wt mice, multi-omic analysis pointed towards regulation in translation related processes. These observations were not made in the cerebellum of nerve-injured DYT1KI mice; instead, they were localized to the cortex and striatum. Our findings indicate a failed translational compensatory mechanisms in the cerebellum of phenotypic DYT1KI mice that exhibit DLM, while translation dysregulations in the cortex and striatum likely promotes the dystonic phenotype.

Nerve guidance conduits, or NGCs, used as structures in tissue engineering, play an important role in reconstruction and the growth of axons after nerve injuries. To produce an appropriate scaffold for nerve growth and transfer the suitable amount of growth factors, these channels should be designed and built with topological, mechanical, and biological properties and functional mass transfer requirements. This study deals with a computational design approach of a nerve guidance conduit which, after validating the geometry, simulates the blood flow utilizing the Carreau-Yasuda model and optimizes physical properties. The physical properties are hydraulic pressure, porosity, diffusivity and water absorption. The optimization process consists of three distinct steps: initially, a single objective function is implemented using a genetic algorithm (GA) to determine the optimal hydraulic pressure for the nerve guidance conduit, resulting in a final value of 0.039 Pa. Subsequently, the GA is employed again to optimize porosity, leading to a final value of 0.6473. Finally, a multi-objective function is utilized to consider porosity, diffusivity, and water absorption, simultaneously.

Objective: Acupuncture, a widely employed traditional therapeutic modality known for its efficacy in pain alleviation and diverse condition management, may inadvertently result in mechanical nerve injury due to its invasive nature. This research aimed to ascertain the incidence of nerve injuries post-acupuncture, identify associated risk factors, and map the distribution of nerve injury sites. Methods: A case-control study nested in the National Health Insurance Research Database (NHIRD) 2000–2018 two million cohort was conducted. Patients previously diagnosed with nerve injury, surgery, or degeneration before acupuncture were excluded. Cases were defined as patients receiving acupuncture and seeking medical attention for nerve injury (ICD9-CM code 950–957) within 14 days post-procedure, while control groups comprised patients undergoing acupuncture without subsequent adverse events. Invasive treatments prior to adverse events and adverse events occurring more than 14 days post-acupuncture were excluded. To ensure case-control comparability, factors such as age, gender, socioeconomic status, and medical facility environment were controlled using propensity score matching. Results: The study encompassed 14,507,847 acupuncture treatments administered to 886,753 patients, with 8361 instances of post-acupuncture nerve injury identified, representing an incidence rate of approximately 5.76 per 10,000 procedures. Age emerged as a significant risk factor, with the adjusted odds ratios escalating with age. Several comorbidities including diabetes, hypothyroidism, liver cirrhosis, chronic kidney disease, herpes zoster, hepatitis virus, rheumatoid arthritis, systemic lupus erythematosus, dementia, and cerebrovascular accidents were associated with an elevated risk of nerve injury post-acupuncture. Conclusion: This study underscores the importance of meticulous patient profiling and cautious therapeutic approach in acupuncture, considering the evident influence of various demographic, systemic, and treatment-related factors on the incidence of nerve injuries.

Abstract Objective To observe the three-dimensional positional relationship between impacted mandibular third molars (IMTMs) and mandibular canal close contacts using cone beam computed tomography (CBCT). Methods A total of 101 patients with IMTMs were selected who met the diagnostic criteria for 142 teeth (no bone wall imaging area between IMTMs and the mandibular canal, a high-density bone cortical imaging area only, or a ≦1 mm bone imaging area). The parameters of the rotating CBCT anode were set as follows: 110 kV, 40–50 mA; the focal point and exposure field were set as 0.3 mmh and a high-resolution zoom, respectively; the exposure time and image layer thickness were set as 5.4 s and 0.25 mm. Three-dimensional reconstruction was performed, and the position of the mandibular canal through the IMTM area was observed continuously from the coronal, horizontal and sagittal planes. Results We found that the mandibular canal was interrupted below the third molar (TM) in 85 cases, accounting for 59.86% of all cases. The mandibular canal was located below the buccal and lingual curvatures in 33 and 19 cases, respectively, accounting for 23.23% and 19%. In addition, a small number of mandibular canals were also located on the buccal side of the mandibular molars (2.82%). We also found one case of direct insertion of the mandibular third molar (MTM) into the mandibular canal. In addition, the mandibular canal passed through the IMTM region with 125 close contacts at the roots (88.03%); 14 mandibular canals were in contact with all teeth and 3 were in contact with the crown. Conclusion The use of CBCT can provide a dynamic and comprehensive understanding of the three-dimensional positional relationship of the mandibular alveolar nerve canal passing through the IMTM area, providing a high clinical reference value when extracting IMTMs and reducing the risk of injury to the inferior alveolar nerve.

目的 探讨桥接治疗对前循环大血管闭塞急性脑梗死患者血清神经损伤相关生化标志物的影响以及临床疗效，为急性脑梗死治疗方式的选择提供参考依据。 方法 回顾性分析2018年10月—2020年6月前循环大血管闭塞的急性脑梗死患者的病历资料，根据是否采取桥接治疗分为对照组（静脉溶栓组）和观察组（桥接治疗组）。统计两组在治疗后24 h、14 d的治疗有效（NIHSS评分下降≥4分或NIHSS评分0分）率，治疗后30 d、90 d及180 d的良好预后 （mRS评分≤2分）率及日常生活能力自理（Barthel指数＞60分）率，住院期间脑出血发生率，治疗前以及治疗后3 d、7 d及14 d神经元特异性烯醇化酶（neuron-specific enolase，NSE）、S100钙结合蛋白B（S100 calcium-binding protein B，S100B）及胶质纤维酸性蛋白（glial fibrillary acidic protein，GFAP）水平。采用基于混合效应的logistic回归模型、线性混合效应模型进行预后指标的统计分析。 结果 多因素分析结果显示：观察组的治疗有效率是对照组的3.35倍（OR 3.35，95%CI 1.10～10.13，P=0.041）；观察组的良好预后率是对照组的4.12倍（OR 4.12，95%CI 1.14～14.82，P=0.035）；观察组的日常生活能力自理率与对照组相当（OR 1.47，95%CI 0.28～7.68，P=0.648）；观察组与对照组脑出血发生率差异无统计学意义（7.4% vs. 8.7%，P=1.000）；观察组NSE、S100B、GFAP水平低于对照组，差异具有统计学意义（P60) rate of normal living ability between two groups at 30 d, 90 d and 180 d after treatment, the incidence of intracerebral hemorrhage during hospitalization, and the related biochemical markers of serum nerve injury [neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B) and glial fibrillary acidic protein (GFAP)] before and at 3 d, 7 d and 14 d after treatment were also analyzed. Logistic regression model based on mixed effects and linear mixed effects model were used for statistical analysis of prognostic indicators. Results Multivariate analysis showed that the treatment effective rate of the observation group was 3.35 times higher than that of the control group (OR 3.35, 95%CI 1.10-10.13, P=0.041). The good prognosis rate of the observation group may be 4.12 times higher than that of the control group (OR 4.12, 95%CI 1.14-14.82, P=0.035). The self-care rate of normal living ability in the observation group was similar to that in the control group (OR 1.47, 95%CI 0.28-7.68, P=0.648). There was no significant difference in the incidence of intracerebral hemorrhage between the observation group and the control group (7.4% vs. 8.7%, P=1.000). The levels of NSE, S100B and GFAP in the observation group were lower than those in the control group, and the differences were statistically significant (P

Abstract Background Myelin that surrounds axons breaks in trauma and disease; e.g., peripheral nerve and spinal cord injuries (PNI and SCI) and multiple sclerosis (MS). Resulting myelin debris hinders repair if not effectively scavenged by Schwann cells and macrophages in PNI and by microglia in SCI and MS. We showed previously that myelin debris evades phagocytosis as CD47 on myelin ligates SIRPα (signal regulatory protein-α) on macrophages and microglia, triggering SIRPα to inhibit phagocytosis in phagocytes. Using PNI as a model, we tested the in vivo significance of SIRPα-dependent phagocytosis inhibition in SIRPα null mice, showing that SIRPα deletion leads to accelerated myelin debris clearance, axon regeneration and recovery of function from PNI. Herein, we tested how deletion of CD47, a SIRPα ligand and a cell surface receptor on Schwann cells and phagocytes, affects recovery from PNI. Methods Using CD47 null (CD47−/−) and wild type mice, we studied myelin disruption/dismantling and debris clearance, axon regeneration and recovery of function from PNI. Results As expected from CD47 on myelin acting as a SIRPα ligand that normally triggers SIRPα-dependent phagocytosis inhibition in phagocytes, myelin debris clearance, axon regeneration and function recovery were all faster in CD47−/− mice than in wild type mice. Unexpectedly compared with wild type mice, myelin debris clearance started sooner and CD47-deleted Schwann cells displayed enhanced disruption/dismantling and scavenging of myelin in CD47−/− mice. Furthermore, CD47-deleted macrophages from CD47−/− mice phagocytosed more myelin debris than CD47-expressing phagocytes from wild type mice. Conclusions This study reveals two novel normally occurring CD47-dependent mechanisms that impede myelin debris clearance. First, CD47 expressed on Schwann cells inhibits myelin disruption/dismantling and debris scavenging in Schwann cells. Second, CD47 expressed on macrophages inhibits myelin debris phagocytosis in phagocytes. The two add to a third mechanism that we previously documented whereby CD47 on myelin ligates SIRPα on macrophages and microglia, triggering SIRPα-dependent phagocytosis inhibition in phagocytes. Thus, CD47 plays multiple inhibitory roles that combined impede myelin debris clearance, leading to delayed recovery from PNI. Similar inhibitory roles in microglia may hinder recovery from other pathologies in which repair depends on efficient phagocytosis (e.g., SCI and MS).

High nerve damage at the shoulder or elbow is associated with a long regeneration period for effectors-muscles located within the hand, leading to their irreversible atrophy and permanent dysfunction. Advanced microsurgical reconstructive techniques, such as end-to-side (ETS) sutures, reverse end-to-side (RETS) reconstruction (so-called supercharge/babysitting procedure), or nerve transfers within the hand, shorten the interval and thus the recovery time or provide continuous stimulation of the effector before the regeneration of the native axons of the nerve. The paper aims to present the authors’ results after treatment of a high injury of the ulnar and median nerves with additional RETS performed based on the results of three clinical cases. Two patients No 1 and 2 had a high ulnar nerve injury at the elbow level due to a distal humerus fracture. Nerve neurolysis was performed at the level of the primary lesion, followed by a reverse end-to-side transfer of the anterior interosseous nerve to the deep motor branch of the ulnar nerve. The patient No 3 with damage to the median nerve due to a fracture of the shaft of the radius. Neurolysis of the preserved part of the nerve, resection of the neuroma, and direct suture of the damaged part of the nerve were performed, as well as a simultaneous RETS transfer of the anterior interosseous nerve to the thenar motor branch of the median nerve. All presented patients had significant signs of improvement, with full to partial motor recovery of the nerves supported by supercharge/babysitting RETS technique. It is valuable, especially in borderline cases when the decision is between neurolysis/repair alone or nerve transfer is difficult to take and not clearly defined.

Background: The chorda tympani is frequently harmed during middle ear surgery. Surgery-related chorda tympani injury is rarely associated with impaired taste perception in patients. The use of microscopes marked the beginning of modern tympanoplasty techniques, and the endoscopic tympanoplasty approach is now described in terms of minimally invasive surgery.Aim of the Study: The aim of the current study is to compare chorda tympani nerve [CTN] injuries occurring because of tympanoplasty performed using microscopic and endoscopic methods.Patients and Methods: This prospective study was carried out on 50 patients from Al-Azhar University hospitals who suffered from chronic suppurative otitis media [safe type]. Patients were randomized equally using opaque sealed envelopes into two groups. Group A: 25 patients underwent transcanal endoscopic tympanoplasty with elevation of the tympamomeatal flap. Group B: 25 patients underwent microscopic tympanoplasty by postauricular incision.Results: Chorda tympani nerve was with no injury in 24 [96%] cases in group A and 14 [56%] cases in group B, while 1 [4%] case in group A and 8 [32%] cases in group B had stretched chorda tympani nerve and 3 [12%] cases in group B had transected chorda tympani nerve. The Chorda tympani nerve was significantly less injury, less stretched in group A than group B, and more transected in group B than group A [P value=0.012].Conclusion: In patients undergoing tympanoplasty, Endoscopic ear surgery provides superior visualization, reduces the necessity for extensive manipulation of the chorda tympani, and subsequently lowers the occurrence of CTN injury compared to microscopic ear surgery.

Objective To summarize the nursing experience of osteopathic robot-assisted vascularized fibular transplantation in the treatment of patients with avascular necrosis of femoral head (ANFH). Methods From September 2016 to November 2020, there were 17 ANFH patients (21 hips) in Beijing Jishuitan Hospital undergoing vascularized fibular graft assisted by orthopedic robots. After operation, the patients were given vasodilator, anticoagulant, anti-infective and related nursing care, as well as functional rehabilitation guidance. Results The operation was successful in 21 hips. All patients had no complications such as donor nerve injury and postoperative lower limb venous thrombosis. There was no weight-bearing activity within 3 months postoperatively and partial weight-bearing on crutches between 3 and 6 months. Among 10 patients (12 hips) followed for an average of 15 months, the hip function recovered well in 9 patients, and one bilateral ANFH patient, in whom the right side recovered smoothly, but the left hip joint was painful and restricted. No intra-articular infection and fibular head protrusion were found by arthroscopic exploration in this patient, and the symptoms were relieved after treatment of acetabular osteophyte. Conclusion For the treatment of ANFH with robot-assisted vascularized transplantation, nursing should focus on whether there is nerve injury in the donor area and on postoperative survival of the transplanted fibula. Postoperative functional exercise is an important part of the recovery for limb function.

Keito Koh, Onishi Tatsuki, Sonoko Sakuraba, Sho Yamazaki, Hajime Yako, Takeshi Omae Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JapanCorrespondence: Keito Koh, Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2211, Japan, Tel +81 55 948 3111 ex 7111, Fax +81-55-947-2565, Email mad.mud@star.ocn.ne.jpPurpose: Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches”. In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after non-axillary approaches.Patients and Methods: This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and non-axillary approaches. The etiology, symptoms, and outcomes of patients were investigated.Results: Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2– 20.1) of PONS, four (4.0:1000; 95% CI, 3.8– 4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, 18.1– 23.8) to the axillary and one (2.8:1000; 95% CI, 2.6– 3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005).Conclusion: The incidence of neuropathies after US-guided axillary block under general anesthesia was significantly higher than that after non-axillary approaches.Keywords: ultrasound, brachial plexus block, axillary block, neuropathy, nerve injury

BackgroundPeripheral nerve damage can have debilitating consequences. Rabbit sciatic nerve transection models allow the effective evaluation of surgical repair strategies for large nerve gaps. Despite advantages in size, ease of handling, and functional utility, rabbits can suffer from a number of side effects that affect animal welfare and the quality of scientific inquiry. Such side-effects, which include pressure ulcers and traumatic damage to the foot, are primarily a consequence of insensitivity of the distal hindlimb following sciatic nerve injury. In this study, we present a number of methodologies for identifying, treating, and preventing unintended adverse effects in rabbit sciatic nerve injury models.ResultsFirst, we categorize pressure ulcers according to their severity and describe the deployment of a padded bandaging technique to enable ulcer healing. We also introduce a proactive bandaging approach to reduce the likelihood of pressure ulcer formation. Second, we define phenotypes that distinguish between foot injuries resulting from self-mutilation (autotomy) from those caused by incidental traumatic injury secondary to sensori-motor damage. Finally, we detail an effective strategy to reduce the usage of Elizabethan collars; through a gradual weaning protocol, their usefulness in preventing autotomy is retained, while their propensity to impede rabbit grooming and cause abrasion-injury to the neck region is minimized.ConclusionsWe suggest that application of these methods offer a practical and systematic approach to avoid adverse side effects associated with rabbit sciatic nerve damage, enabling improved animal welfare and scientific outcomes in a powerful nerve injury model.