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At least 73 records · Page 4Linked to original sources

Denatured muscle grafts for nerve repair in an experimental model of nerve damage in leprosy. 2. Recovery of peripheral peptide-containing nerves assessed by quantitative immunohistochemical study.

A marked depletion of neuropeptide-immunoreactive nerves, a consequence of the nerve damage which is commonly found in leprosy, has been reported in peripheral tissues of leprosy patients and of a leprosy animal model. The aim of this study was to investigate peripheral reinnervation following a denatured autologous muscle graft in an animal model of leprosy nerve damage. Possible reinnervation of the foot-pad skin was studied by immunohistochemistry using antisera to the neuronal marker protein gene product 9.5 (PGP), the neuropeptides calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP), and the C-flanking peptide of neuropeptide Y (CPON). The extent of the reinnervation process was assessed by image analysis quantification at different time points. At 8 weeks after muscle grafting, there were small numbers of immunoreactive nerves (p < 0.05). At 12, 16, and 20 weeks postoperatively there was a gradual increase in all immunostaining. At 20 weeks, no significant difference was found for PGP-, CGRP-, and SP-immunoreactive nerves in the epidermal and subepidermal layers compared to control (contralateral) tissue. In experimental tissue the recovery of immunoreactive nerves around sweat glands took longer (up to 12 weeks) than in other skin compartments, but after that time the recovery was rapid and at 20 weeks no difference was measured for VIP-immunoreactive nerves in comparison with controls. Around blood vessels, the recovery of CGRP- and CPON-immunoreactive fibers was slow, and at 20 weeks a difference with control samples (p < 0.01) was noted. In the same area, there was no significant difference for PGP immunoreactivity between controls and tissues at 20 weeks. In contrast, the immunoreactive nerve bundles in the dermis showed a faster recovery than nerves in other skin areas, with amounts similar to controls at 20 weeks. The significant recovery of immunoreactive nerves, in particular of those containing sensory neuropeptide, is consistent with the described functional recovery.

Animals↗

Re-innervation of facial nerve territory using a composite hypoglossal nerve--muscle autograft--facial nerve bridge. An experimental model in sheep.

The hypoglossal nerve has been used both entirely and in part to repair the facial nerve. Using the partial technique it may be difficult to obtain sufficient length and a free interposed graft is then required to extend the hypoglossal element. In six sheep the facial nerve was excised between its emergence from the stylomastoid foramen and its bifurcation in the parotid gland. The hypoglossal nerve was exposed and split longitudinally producing a limb which was reflected towards the distal stump of the facial nerve. This left a gap of 4-5 cm which was bridged with a freeze-thawed coaxially aligned skeletal muscle autograft. The sheep were examined at 8 months. Laser doppler blood-flow studies showed the blood-flow distal to the graft to be about 25% of that at an equivalent site on the normal side. Peak nerve conduction velocities were also reduced on the repaired side but stimulation of the proximal hypoglossal nerve was nevertheless capable of causing adequate contraction of both facial and tongue muscles. Histological comparison of the repaired facial nerves with equivalent sites on the normal side showed a reduction in mean axon and fibre diameters with normal myelin sheath thickness for the regenerated axon sizes. All of these features are to be expected in a regenerated nerve and are consistent with a good level of recovery of function.

Animals↗

[Study of conductivity of the motor fibers of the ulnar nerve with respect to intensity, localization and diagnosis of peripheral nerve disease. I. General and morphologic observations on the affected area of the ulnar nerve with emphasis on the elbow region and causes of the disease].

The introductory part deals with a great community impact of ulnar nerve damage and its high incidence. From peripheral nerves, this ulnar is the most frequently exposed to injuries and impresses. The impressory damage occurs mainly in elbow region. Anatomic peculiarities of ulnar nerve are scrutinized concerning with more connective tissue presence on its cutting section comparably to the other upper limb nerves. Frequent innervative deviations are referred to especially in ulnar and median nerve regions in the course of ulnar nerve branching. Also three types of anastomoses are listed between the both nerves which are important as to the clinical pattern in damages and for electrophysiologic diagnosing. From the clinical tests, those of rare use are emphasized (test of crossed fingers, palmaris brevis sign, Mumenthaler's sign, ulnar test). The last part deals in detail with anatomic, functional and clinical problems of ulnar nerve in elbow area. Its biomechanic relations in the cubital tunnel are elucidated as well as etiopathogenetic factors of neural damage in this area (traction and compressive theories and hypermobility of the nerve etc.). The most frequent causes of ulnar injuries are reviewed. The present work is of introductory value for those dealing mainly with electrophysiologic problems of both sensitive and motoric neural injuries varying in the intensity, location and diagnosis.

Humans↗

Peripheral nerve regeneration with sustained release of poly(phosphoester) microencapsulated nerve growth factor within nerve guide conduits.

Prolonged delivery of neurotrophic proteins to the target tissue is valuable in the treatment of various disorders of the nervous system. We have tested in this study whether sustained release of nerve growth factor (NGF) within nerve guide conduits (NGCs), a device used to repair injured nerves, would augment peripheral nerve regeneration. NGF-containing polymeric microspheres fabricated from a biodegradable poly(phosphoester) (PPE) polymer were loaded into silicone or PPE conduits to provide for prolonged, site-specific delivery of NGF. The conduits were used to bridge a 10 mm gap in a rat sciatic nerve model. Three months after implantation, morphological analysis revealed higher values of fiber diameter, fiber population and fiber density and lower G-ratio at the distal end of regenerated nerve cables collected from NGF microsphere-loaded silicone conduits, as compared with those from control conduits loaded with either saline alone, BSA microspheres, or NGF protein without microencapsulation. Beneficial effects on fiber diameter, G-ratio and fiber density were also observed in the permeable PPE NGCs. Thus, the results confirm a long-term promoting effect of exogenous NGF on morphological regeneration of peripheral nerves. The tissue-engineering approach reported in this study of incorporation of a microsphere protein release system into NGCs holds potential for improved functional recovery in patients whose injured nerves are reconstructed by entubulation.

Absorbable Implants↗

Fiber types of the lingual branch of the trigeminal nerve, chorda tympani, lingual-tonsillar and pharyngeal branches of the glossopharyngeal nerve, and superior laryngeal nerve and their relation to the cardiovascular responses in rats.

The effect of repetitive electrical stimulation at 50 Hz for 20 s of the lingual branch of the trigeminal nerve (LN), chorda tympani (CT), lingual-tonsillar (LT-IXth) and pharyngeal (PH-IXth) branches of the glossopharyngeal nerve, and superior laryngeal nerve (SLN) on the changes in arterial blood pressure (BP) and heart rate (HR) were investigated in anesthetized and paralyzed rats. The compound action potentials in these nerves were simultaneously recorded to know the relationships between the fiber types and the cardiovascular responses. In all nerves except the CT, repetitive electrical stimulation of the nerve elicited a tachycardia and an increase in BP. These cardiovascular responses were mainly related to the component-2 in the compound action potentials in respective nerves. The conduction velocities of the component-2 in the five nerves examined in the present experiment were between 9.5 and 17.0 m/s (mean, n = 4-7). Other components which have faster (component-1) or slower conduction velocities (component-3 and -4) than the component-2 were not likely to elicit the cardiovascular responses. These results suggest that nociceptive and taste fibers of A-delta fibers innervating the oral cavity and pharyngolaryngeal region largely contribute to the cardiovascular responses.

Animals↗

Peripheral nerve injuries. Nerve sutures and nerve grafting.

In the repair of transected peripheral nerves it is attempted to achieve an optimal coaptation of the fascicular tissue. A certain amount of fibroblast activity is essential for nerve regeneration but the fibroblast activity should not be overwhelming. At present fibroblast activity can be reduced only -by resection of the epineural tissue in nerve segments, in which it represents a high percentage of the cross-section (polyfascicular nerve structure with group arrangement), -by reducing the surgical trauma to a minimum, -by reducing the application of foreign material to a minimum, -by avoiding tension at the suture site, -by performing a proper resection, and -by adjusting the type of coaptation to the structure prevailing in the two nerve stumps. In clean cuts without major complications primary nerve repair is recommended. The patients have to be followed and, if within six months no signs of recovery occur, re-exploration is indicated. Complicated cases with nerve defects should be treated by early secondary repair. If during secondary repair an end-to-end coaptation can not be achieved easily, the application of nerve grafts is the treatment of choice.

Axons↗

Cavernous nerve reconstruction during radical prostatectomy by sural nerve grafting: surgical technique in nerve harvesting and grafting.

The authors performed cavernous nerve reconstruction by nerve grafting in 22 patients (unilateral-16, bilateral-6) between August 2001 and June 2004. Harvesting of the sural nerve was unexpectedly more difficult than nerve grafting in the extremities or the head and neck, because a knee and lumbar bending position was impossible due to the pelvic surgical field. Suture of the grafted nerve on the distal side required great effort, because there was only sufficient space for one hand at the maximum in a deep region of the pelvic cavity, and the nerve ends easily become invisible by inflow of even a small amount of urine or blood. The mean time of the nerve harvesting and grafting was 1 hr 50 min for unilateral grafting and 2 hr 40 min for bilateral grafting. Recovery of erectile function was observed in about half the patients who had undergone surgery nearly 1 year before. Since harvesting of the sural nerve and nerve grafting were more difficult than expected, modification and improvement of many surgical elements, such as improvement of surgical devices and application of endoscopic techniques, are necessary.

Aged↗

Nerve fibers of the eighth nerve and their distribution to the sensory nerves of the inner ear in the bullfrog.

The number of both myelinated and unmyelinated nerve fibers has been determined for the eighth nerve and each of its sensory branches in the bullfrog. No significant differences were found in the size distribution of the myelinated nerve fibers among the three ampullary nerves or between the saccular and lagenar nerves. Comparison of these two functional groups also showed no significant differences in the myelinated nerve fiber size distribution between the angular acceleration and otolithic receptors, collectively the equilibrium receptors. The wide variability, that was found not only among the animals but also between the right and left sides, most likely resulted in the absence of differences. Highly significant differences were noted when the myelinated nerve fiber diameter distributions to the acoustic organs were compared to those of the equilibrium organs. The most notable difference was the absence of any myelinated nerve fibers whose diameters were greater than 8 micrometer.

Animals↗

Order-disorder phenomena in myelinated nerve sheaths: V. Effects of temperature on rat sciatic and optic nerves, and structural differences between the two types of nerve.

We describe in this work X-ray scattering and electron microscope studies of rat sciatic and optic nerves as a function of temperature. The scattering experiments were analyzed as described in the previous papers of this series: a variety of parameters were determined, some of which characterize the lattice disorder, others the structure of the motif. The main results are the following. All the parameters determined by the X-ray scattering study vary with temperature and the temperature-dependence is specific for the type of nerve (sciatic or optic). Most of the disorder-related parameters display a minimum or a maximum in the vicinity of physiological temperature (38 degrees C in rat); this observation, strongly supported by the electron microscope study, shows that the degree of organization of myelin is highest near physiological temperature. The structure of the motif, as revealed by the electron density profile, is fairly different in the two types of nerves (in contrast with the assumption made by previous workers); the structure also varies with temperature and the temperature-induced alterations are nerve-type specific. In the two types of nerve the thickness of the lipid bilayer varies with temperature as expected for a lipid-containing system with hydrocarbon chains in the disordered conformation. In sciatic nerve the thickness of the (thinner) cytoplasmic polar layer, which is also the layer most affected by lattice disorder in this type of nerve, decreases dramatically with increasing temperature. In optic nerve, in which lattice disorder predominantly affects the extracellular layer, the thickness of both the cytoplasmic and the extracellular layer is barely affected by temperature.

Algorithms↗

Comparison of nerve regeneration in vascularized and conventional grafts: nerve electrophysiology, norepinephrine, prostacyclin, malondialdehyde, and the blood-nerve barrier.

We compared the efficacy of vascularized (VASC) and conventional (CONV) sciatic nerve grafts in restoring nerve blood flow (NBF), conduction, the blood-nerve barrier, norepinephrine (NE), and 6-keto prostaglandin F1 alpha (6-KPGF; the stable prostacyclin metabolite) in the sciatic nerve of the rat. We also measured malondialdehyde (MDA) content. NBF was much greater in VASC grafts, but the increase was confined to non-nutritive flow. There was a statistically non-significant increase in nerve action potential amplitude in the grafted segments of VASC nerves at 1 and 2 months post graft. The [14C]sucrose permeability surface area (PA) product was increased in both CONV and VASC at 1 and 3 months and was not different to each other. NE and 6-KPGF, the major vasoconstrictor and dilator of nerve microvessels were better restored in VASC than CONV reaching statistically significance for 6-KPGF (P less than 0.001). MDA used as an index of oxygen free radical generation was not significantly different in the 3 groups. The better restoration of 6-KPGF and perhaps NE suggest that VASC grafts may be more effective in restoring vasoreactivity of peripheral nerve following graft.

Action Potentials↗

Paradoxical clinical consequences of peripheral nerve injury: conduction of nerve impulses does not occur across the site of injury immediately following nerve division and repair.

The occasional apparent clinical phenomenon of the immediate although transient return of peripheral nerve function after nerve division and primary repair has been previously reported. Electrophysiological findings from the sciatic nerve of the rabbit have been previously presented in support of the concept of the transmission of nerve impulses across a freshly divided and repaired peripheral nerve for a short period until the onset of Wallerian degeneration. This paper presents experimental evidence to show that these findings were misinterpreted and that a compound action potential cannot be transmitted across a surgically repaired division in a peripheral nerve. Observations from previous experimental research in neurophysiology are discussed which confirm these conclusions. The claim that failure to diagnose a peripheral nerve injury at presentation can be explained in some circumstances by "jump transmission" is not based on sound evidence and the concept of "jump transmission" cannot be accepted as a defence for clinicians who fail to diagnose a peripheral nerve injury.

Action Potentials↗

Functional nerve recovery after bridging a 15 mm gap in rat sciatic nerve with a biodegradable nerve guide.

Recovery of nerve function was evaluated after bridging a 15 mm sciatic nerve gap in 51 rats with a biodegradable poly(DL-lactide-epsilon-caprolactone) nerve guide. Recovery of function was investigated by analysing the footprints, by analysing video recordings of gait, by electrically eliciting the withdrawal reflex, by nerve conduction velocity and by electromyography (EMG). Sensory nerve function recovered as measured by electrostimulation. Motor nerve function partly recovered but electromyograms remained abnormal throughout the study. We conclude that functional reinnervation by regenerating axons occurs after bridging a 15 mm nerve gap with a biodegradable poly(DL-lactide-epsilon-caprolactone) nerve guide, but the walking patterns remain abnormal. Video analysis is a useful tool to record and analyse the walking patterns of rats. Further studies are necessary to investigate the possibility of obtaining selective reinnervation of specific muscles.

Animals↗

Contribution of the sciatic and saphenous nerve to the ventrobasal thalamic neuronal responses to pinch in rats with a chronic sciatic nerve constriction: a study using anesthetic blocks and nerve section.

To extend the study on the respective contribution of the sciatic and saphenous nerve in abnormal nociceptive responses observed in rats with a loose constriction of one sciatic nerve, neuronal responses to pinch applied to the territory of the injured nerve, recorded in the ventrobasal complex of the thalamus have been studied. Eleven neurones recorded in 11 rats with a nerve constriction since 15-19 days and clear abnormal pain-related behaviour to mechanical stimulus, were tested before and during an anesthetic block of the saphenous and/or of the sciatic nerve, and/or after the saphenous nerve section. Only the sciatic nerve block depressed significantly the pinch responses.

Anesthetics↗

Effect of nerve growth factor on changes of myelin basic protein and functional repair of peripheral nerve following sciatic nerve injury in rats.

OBJECTIVE: To investigate the therapeutic effect of nerve growth factor (NGF) on changes of myelin basic protein (MBP) and functional repair of sensory and motor nerve following sciatic nerve injury. METHODS: The sciatic nerves of rats were injured by sectioning with shaver,and divided into 3 groups: NGF group (Group A), group of normal saline solution (Group B), untreated group (Group C). The time point of observation was at the 4th week after operation. Sensory evoked potential (SEP) and motor evoked potential (MEP) were detected by Model WD-4000 nerve potential working diagnosis system. Immunohistochemical analysis was used for identification of MBP. RESULTS: The latency of SEP in the Group A at the 4th week after operation was shorter than that in the Group B (P<0.05). The MEP was elicited in 76% of the Group A and was higher than that in the Group B. Results of immunohistochemistry showed that there were less MBP-positive cells in the Group A than in the Group B in one and four weeks respectively. CONCLUSIONS: NGF can improve the conductive function of injured peripheral nerve and facilitate regeneration of nerve.

Animals↗

Peripheral nerve-stimulated macrophages simulate a peripheral nerve-like regenerative response in rat transected optic nerve.

We have previously demonstrated that the failure of the mammalian central nervous system (CNS) to regenerate following axonal injury is related to its immunosuppressive nature, which restricts the ability of both recruited blood-borne monocytes and CNS-resident microglia to support a process of repair. In this study we show that transected optic nerve transplanted with macrophages stimulated by spontaneously regenerating nerve tissue, e.g., segments of peripheral nerve (sciatic nerve), exhibit axonal regrowth at least as far as the optic chiasma. Axonal regrowth was confirmed by double retrograde labeling of the injured optic axons, visualized in their cell bodies. Transplanted macrophages exposed to segments of CNS (optic) nerve were significantly less effective in inducing regrowth. Immunocytochemical analysis showed that the induced regrowth was correlated with a wide distribution of macrophages within the transplanted-transected nerves. It was also correlated with an enhanced clearance of myelin, known to be inhibitory for regrowth and poorly eliminated after injury in the CNS. These results suggest that healing of the injured mammalian CNS, like healing of any other injured tissue, requires the partnership of the immune system, which is normally restricted, but that the restriction can be circumvented by transplantation of peripheral nerve-stimulated macrophages.

Animals↗

The use of the rat facial nerve model to assess the effect of differing nerve anastomotic agents on the facial nerve.

There are relatively few papers which prove that one nerve anastomotic agent for the facial nerve is superior to any other. Previous experiments on the division and anastomosis of the facial nerve have failed to consider the indeterminate variables involved, i.e. operator variability, controls and the reaction of the materials on normal nerve tissue. In this experiment, a variety of anastomotic agents were tested to see if the anastomotic agents themselves affected the extra-temporal facial nerve function. The absorbable suture, non-absorbable suture, glue and tube wrap used had no effect on normal nerve tissue or on the anastomosis of the sectioned facial nerve of the rat compared with simple laying together of the divided ends of the divided nerve.

Anastomosis, Surgical↗

Effects of insulin-like growth factor-1 in motor nerve regeneration after nerve transection and repair vs. nerve crushing injury in the rat.

Despite highest standards in nerve repair, functional recovery following nerve transection still remains unsatisfactory. Non-specific re-innervation of target organs are regarded as one reason for a poor functional outcome. Insulin-like growth factor-1 (IGF-1) has demonstrated promoting effects on sciatic nerve regeneration after crushing injury. Similarly, IGF-1 has shown a direct inductive effect on motoneuron growth associated protein-43 (GAP-43) which is believed to play a role in axon guidance during development. Based on this fact we have examined the trophic effects of recombinant human IGF-1 on peripheral motor nerve regeneration following transection and epineural repair in rats median nerve. RhIGF-1 (0.5 mg/kg/rat) was administered subcutaneously to the neck of the repaired side for 14 days postoperation. Accuracy of re-innervation of the flexor carpi radialis muscle motoneuron pool was studied by sequential retrograde double labelling technique. Motor recovery was tested with the grasping test. No significant differences between experimental and control animals in accuracy of re-innervation and in recovery of muscle power could be demonstrated. Non-specific re-innervation of the flexor carpi radialis muscle was found in 23.2% in the experimental group and in 24.2% in the control group. These results demonstrate that systemically applied rhIGF-1 failed to improve functional motor recovery after nerve transection and repair in the rat as it was demonstrated after nerve crushing injury in several studies. Furthermore, systemically applied IGF-1 did not improve accuracy of re-innervation after axotomy and repair in adult rats.

Animals↗

The nerve gap dilemma: a comparison of nerves repaired end to end under tension with nerve grafts in a primate model.

The objective of this study was to compare, in a clinically relevant primate model, axon regeneration after epineurial repair under tension (15 mm gap) with interfascicular nerve grafts with the use of either standard microsuture techniques or a new interfascicular nerve graft technique termed fascicular tubulization that uses a hypoantigenic collagen membrane formed into a tube to approximate nerve ends. Electrophysiologic analysis demonstrated that the percentage of proximal axons that conducted across the repair site was greater in those nerves repaired under tension with epineurially placed sutures than in either of the tensionless repairs involving interfascicular graft techniques. The mean diameters of the regenerated axons repaired under tension with epineurial sutures were greater than those of the nerves repaired with interfascicular grafts, although the difference was not statistically significant. Interfascicular nerve grafting with tubulization using the current collagen tube resulted in regeneration equal to the sutured interfascicular nerve grafts. For modest defects (perhaps up to 3 to 4 cm in the adult), it seems advantageous to accept the modest tension associated with an epineurial repair rather than to use an autograft (or artificial graft) to achieve a tension-free repair.

Anastomosis, Surgical↗