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Self-reinnervated cat medial gastrocnemius muscles. I. comparisons of the capacity for regenerating nerves to form enlarged motor units after extensive peripheral nerve injuries.

1. The aims of this study are to determine 1) whether regenerating motor axons have the capacity to form enlarged motor units (MUs) in muscles reinnervated by few motoneurons and 2) whether the type of nerve injury, repair, and/or growth environment affects this capacity. 2. MU innervation ratio (IR) was estimated by measuring isometric unit tetanic force in reinnervated cat medial gastrocnemius muscles 3-16 mo after denervation by either 1) crushing its nerve, 2) transecting the nerve and suturing the proximal end to the distal stump (N-N suture), or 3) transecting the nerve and suturing the proximal end directly to the muscle fascia (N-M suture). In addition, the number of regenerating axons was experimentally reduced by cutting one of two contributing ventral roots. 3. Muscles were reinnervated by 2-88% of their normal complement of MUs. Mean unit tetanic force increased as the number of reinnervated MUs decreased in reinnervated muscles after nerve crush or N-N suture, but not after N-M suture, even when few axons made functional connections. When the number of MUs was < 20% of normal, mean unit force was significantly higher in reinnervated muscles after nerve crush compared with muscle reinnervated after N-N suture. 4. The cross-sectional areas (CSAs) of all muscle fiber types were similar to normal in reinnervated muscles after nerve crush, but the CSAs of type IIa and IIb fibers were significantly smaller in muscles reinnervated after complete nerve transections (i.e., N-N or N-M sutures). 5. When MU force was normalized to mean muscle fiber CSA, cut motor axons displayed the same capacity to form enlarged MUs as crushed motor axons. The force of the MUs increased by as much as 5-8 times that of normal, provided the axons grew along the distal nerve stump (N-N suture). 6. Tetanic force increased in the normal order slow < fast-fatigue resistant < fast-fatigue intermediate = fast-fatigable. However, the increase in tetanic force of the slow (S) units was significantly larger than the corresponding increase of the more forceful fast (F) units. The disproportional increase in S and not F unit force, was primarily due to a significant decline in CSA of the type IIa and IIb muscle fibers. 7. The technique of glycogen depletion was used to count MU fibers to estimate the IR of MUs in 5 normal and 11 reinnervated muscles (7 N-N sutures, 4 N-M sutures). Unit tetanic force covaried with IR in both normal and reinnervated muscles. 8. These results show that regenerating axons have the same capacity as intact axons in partially denervated muscles to form enlarged MUs to compensate for a reduced number of functioning MUs. Only when axons regenerate in the absence of the distal nerve sheath is this capacity compromised.

Animals↗

Reconstructive procedures for extremities with peripheral nerve defects.

Surgeons who undertake reconstruction of extremities with peripheral nerve loss should be experienced enough to select the appropriate procedures for the individual patient. To gain adequate strength for a specific function, a new muscle-tendon unit usually is added to the power-train rather than redistribute muscles that have related function. Precise sensibility required precise motion, which is very difficult to achieve following peripheral nerve loss. The anticipated result should be a balanced simplification of motor and sensory function.

Arm Injuries↗

Peripheral nerve injuries and repair in the upper extremity.

Peripheral nerve injuries are commonly seen as a result of domestic, industrial, or military trauma. Sharp objects usually cause these nerve injuries. When assessing these injuries, it is important to evaluate each nerves' motor and sensory function. One must be cognizant of associated injuries such as fractures, vascular damage, and musculotendinous lacerations. The time since the injury, level of injury, and age of the patient are important prognosticators impacting the return of function. Intraoperatively, one must assess the vascularity of the soft tissue bed and the nerve itself, the nerve gap, conduction, and the topography of the fascicles to insure proper orientation. Application of the principles of nerve repair (magnification, minimal tension, meticulous soft tissue handling, experienced surgeon and staff) can enhance the chances for a successful result. Additionally, to maximize functional recovery following peripheral nerve repair, a carefully planned program of postoperative occupational therapy and rehabilitation must be instituted.

Arm Injuries↗

End-to-end versus peripheral nerve graft repair of the oculomotor nerve in rats: A comparative histological and morphometric study.

A comparative study was undertaken to evaluate end-to-end versus peripheral nerve graft repair in cranial nerve reconstruction. In 14 rats, the oculomotor nerve was sharply transected in the cavernous sinus and repaired either by end-to-end coaptation (n = 7) or by interposition of a peripheral nerve graft (n = 7). The results were evaluated 16 weeks after surgery by light and transmission electron microsurgery and by morphometric analysis. The degree of neuroma formation, fibrosis, and axonal disorganisation at the repair site was the same for both groups. Histologically, both end-to-end and graft repair groups revealed various degrees of axonal regeneration with myelinated nerve fibres in the distal nerve segments. In both groups, the number of nerve fibres distal to the repair site was increased compared to proximal to the repair (P < 0.001) but myelinated axon diameter was significantly less than that of control nerves (P < 0.001). No difference existed between the two repair groups in terms of mean myelinated axonal diameter. However, the number and density of myelinated axons was statistically greater in the graft group (P < 0.05). In conclusion, despite the disadvantage of two repair sites, peripheral nerve grafting results in equal or slightly superior axonal regeneration compared to an end-to-end repair in the rodent model of intracranial oculomotor nerve reconstruction. We speculate that this may be due to the structure of the peripheral nerve graft.

Animals↗

Peripheral nerve maturation in premature infants.

The association of peripheral nerve conduction velocity and conceptional age in premature infants is well established. However, the impact of premature birth on the rate of maturation of peripheral nerves is unclear. In this study a group of 119 premature infants and 32 term infants had nerve conduction velocity determinations. The correlation of velocity and conceptional age is significant. There appears to be no effect upon nerve conduction velocity by the occurrence of prenatal or postnatal events. It is unclear whether extrauterine rates of increase of velocity in prematures are comparable to intrauterine rates, but testing of prematures after they have reached their expected date of birth shows them to have identical mean values to term infants tested at term.

Age Factors↗

Somatic unmyelinated fibre degeneration in rabbits with granulomatous hypersensitivity produced by a non-myelin antigen in sensory peripheral nerve.

Rabbits previously sensitised by injection of human sensory peripheral nerve showed degeneration of somatic unmyelinated fibres at skin test sites when challenged by sensory nerve or certain non-myelin fractions prepared from human sensory nerve. Epithelioid cells were found in the endoneurium and may mediate the nerve damage. The degeneration was consistently found and lasted for at least 58 days. Phagocytosing macrophages were absent. Differences in the pattern of nerve damage to that of EAN and EAE are discussed.

Animals↗

Peripheral nerve surgery of the foot and ankle. A review of current principles.

Planning for peripheral nerve surgery requires consideration of a multitude of factors, as well as a surgeon's meticulous skill and experience. With so little room for error, every advantage must be taken to optimize repair. Peripheral nerve surgery of the foot and ankle is an underappreciated area of neurosurgery with comparatively limited published reports and data. The authors reviewed the current trends in the surgical management of peripheral nerve injuries of the foot and ankle in the hope that an understanding of the basic principles involved will allow for future study of the results of such surgery by more surgeons who deal with these problems.

Ankle↗

Peripheral nerve dysfunction in adult patients with cystic fibrosis.

The prevalence of peripheral nerve dysfunction was assessed in 24 randomly selected adult patients with cystic fibrosis. Median, peroneal and sural nerves were studied. In 15 patients (62%), one or more electrical abnormality were detected. In the median nerve, conduction velocity was slowed in 29% of sensory studies and 12.5% of motor studies; compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes were normal. The CAMP was low in 17% of peroneal studies with motor conduction velocity slow in 8%. The sural SNAP was low in 17% and sensory nerve conduction velocity slow in 25%. Using a multiple regression analysis only age at diagnosis was identified as a significant predictor of peripheral nerve dysfunction (multiple R = 0.55; p < 0.01). This study demonstrates that mild peripheral nerve dysfunction is common in patients with cystic fibrosis. With the improving long term survival of these patients we predict that the prevalence and severity of this complication will increase.

Action Potentials↗

A morphological study of Schwann cells and axonal regeneration in chronically transected human peripheral nerves.

Relatively little is known about the effects of chronic transection on human peripheral nerves. In this study intraoperative biopsies were obtained from proximal and distal nerve stumps and intervening neuromas resected before peripheral nerve reconstruction. Biopsies were collected from ten patients following differing types of nerve injury, with delays to repair ranging from 8 to 53 months. Nerves were examined by light and electron microscopy. In general, reinnervation was poor, although even following the most severe injuries, all of the distal stumps contained some regrowing axons, which were always associated with Schwann cells. Denervated Schwann cells, arranged in typical bands of Büngner were consistently present in each distal stump. Our findings confirm that the morphology of chronically denervated human peripheral nerves is essentially similar to that described in experimental models.

Adolescent↗

CD44-independent hepatocyte growth factor/c-Met autocrine loop promotes malignant peripheral nerve sheath tumor cell invasion in vitro.

Malignant peripheral nerve sheath tumors (MPNSTs) are invasive peripheral nerve neoplasms that express both the receptor tyrosine kinase c-Met and its ligand hepatocyte growth factor (HGF). The combined expression of these proteins has been implicated in tumor cell growth and metastasis. However, HGF/c-Met autocrine activity requires the presence of a serine protease, the HGF activator (HGFA), and, in some cells, the CD44 transmembrane glycoprotein. Here, we found that HGFA, HGF, c-Met, and CD44 are coexpressed in MPNSTs but their localization did not correlate with increased cell proliferation. The ST8814 MPNST cell line also expresses all of these proteins, can convert pro-HGF to active HGF, and exhibits constitutive c-Met phosphorylation. Blocking c-Met activity or expression inhibits the invasive behavior of these cells but not their proliferation. Interestingly, although a CD44 splice variant contributes to MPNST cell invasion and interacts with c-Met and HGF in ST8814 cells, it is not required for c-Met activation. These data indicate that an HGF/c-Met autocrine loop can promote MPNST invasion through a CD44-independent mechanism and suggest that c-Met, HGFA, and HGF are potential molecular targets to inhibit MPNST metastasis.

Autocrine Communication↗

[Advances of functional electrical stimulation in treatment of peripheral nerve injuries].

OBJECTIVE: To review the advances of functional electrical stimulation (FES) in treatment of peripheral nerve injuries. METHODS: By index of recent literature, the measures of stimulation, the mechanisms of FES and unsolved problems were evaluated and analyzed. RESULTS: Great advances have been made in the treatment of peripheral nerve injuries. It can not only enhance the regeneration of injured peripheral nerve, but also prevent muscular atrophy. CONCLUSION: FES is an effective treatment for peripheral nerve injuries.

Electric Stimulation↗

The effect of a conditioning lesion on the regeneration rate of peripheral nerve axons containing substance P.

The regeneration rate of peripheral nerve axons containing substance P-like immunoreactivity (SPLI) was measured in rat sciatic nerve by radioimmunoassay of SPLI in nerve segments 2, 4 and 6 days after a test lesion made by briefly crushing the nerve at the hip. The regeneration rate of the fastest growing sensory axons was also measured in the same nerves using the pinch-reflex procedure. Three groups of animals were compared: group S, which received only the single test lesion, had regeneration rates of 3.57 +/- 0.26 (S.E.) mm/day for SPLI-containing axons and 3.53 +/- 0.14 mm/day for the fastest growing sensory axons. Group A/H, which received a conditioning lesion on the tibial nerve at the ankle 7 days prior to the test lesion at the hip, had a regeneration rate for SPLI-containing axons which was not significantly different from group S, of 3.35 +/- 0.17 mm/day. However, the regeneration rate for the sensory axons was significantly increased to 4.60 +/- 0.23 mm/day. Group H/H, which received both conditioning and test lesions at the hip, once again separated by 7 days, showed a significant increase in regeneration rate of SPLI-containing axons to 5.50 +/- 0.33 mm/day and a further increase over group A/H in the regeneration rate of sensory axons to 6.70 +/- 0.25 mm/day. We conclude that the small-diameter, unmyelinated axons containing SPLI in peripheral nerve normally regenerate at the same rate as the fastest growing sensory axons.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Gait analysis in rats with peripheral nerve injury.

Rats are commonly used to study peripheral nerve repair and grafting. The traditional footprint method to assess functional recovery is messy, indirect, and not useful when contractures develop in the animal model. The aim of the present study was to establish an accurate, reproducible, but simple, method to assess dynamic limb function. The basic quantitative aspects of a normal gait were characterized from 59 recorded walks in 23 rats. The video was digitized and analyzed frame by frame on a personal computer. Seven parameters of the gait were assessed: (1) walking speed; (2) stance phase, swing phase and right to left stance/swing ratio; (3) step length and step length ratio; (4) ankle angles at terminal stance and midswing; (5) tail height; (6) midline deviation; and (7) tail deviation. These gait parameters were then applied to groups of animals with sciatic (group S), tibial (group T), and peroneal (group P) nerve injuries. A discriminant analysis was performed to analyze each parameter and to compute a functional score. We found that the video gait analysis was superior to the footprint method and believe it will be very useful in future studies on peripheral nerve injury.

Animals↗

Analysis of chromosomal imbalances in sporadic and NF1-associated peripheral nerve sheath tumors by comparative genomic hybridization.

Peripheral nerve sheath tumors arise either sporadically or in association with neurofibromatosis type 1 (von Recklinghausen's neurofibromatosis, NF1) or type 2. In this study, comprehensive screening for relative chromosome copy number changes was performed on 10 benign and 19 malignant peripheral nerve sheath tumors (MPNSTs) by applying comparative genomic hybridization (CGH). In benign tumors, no chromosomal imbalances were found by CGH, whereas in MPNSTs chromosomal gains and losses were frequently detected. No differences regarding the frequency and distribution of chromosomal imbalances were observed between the 13 sporadic and 6 NF1-associated MPNSTs analyzed. In both, the number of gains was significantly higher than the number of losses, suggesting a predominant role of proto-oncogene activation during MPNST progression. Candidate regions with potentially relevant proto-oncogenes included chromosomal bands 17q24-q25, 7p11-p13, 5p15, 8q22-q24, and 12q21-q24; those with putative tumor suppressor genes were 9p21-p24, 13q14-q22, and 1p. High-level amplifications were restricted to sporadic tumors and affected eight different chromosomal subregions. In three of these MPNSTs, identical subregions on chromosomal arms 5p and 12q were coamplified. This study revealed a number of new characteristic chromosomal imbalances and provides a basis for molecular identification of oncogenes and tumor suppressor genes of pathogenetic relevance in both sporadic and NF1-associated MPNSTs. Genes Chromosomes Cancer 25:362-369, 1999.

Adolescent↗

Short-time predegenerated peripheral nerve grafts promote regrowth of injured hippocampal neurites.

Our previous studies revealed that predegenerated peripheral nerve grafts facilitated neurite outgrowth from the injured hippocampus and that this effect was particularly distinct when 7-, 28-, and 35-days predegenerated nerve grafts were used. It is recently known that a totally transected peripheral nerve exhibits biphasic neurite-promoting activity. The early phase lasts 7 days. The aim of the present study was to find whether short-time predegenerated (1-6 days) peripheral nerve grafts exert any neurotrophic effect and when this influence is maximal. Experiments were carried out on adult male Wistar rats. Sciatic nerves were totally transected and following 1, 2, 3, 4, 5 and 6 days their distal stumps were implanted into the hippocampus. Control animals were treated with non-predegenerated sciatic nerve grafts. In all groups FITC-HRP was injected into the free end of graft six weeks following surgery. Special histochemic technique showed AChE-positive fibres inside the grafts of all examined groups. Fluorescence microscopic examination revealed the labeled cells in all examined groups, however their number was different in each group, depending on the predegeneration stage. They were most numerous at the fourth day of predegeneration.

Acetylcholinesterase↗

Peripheral nerve elongation by laser Doppler flowmetry controlled expansion: morphological aspects.

Peripheral nerve elongation by a tissue expander may offer an alternative to nerve grafting in the management of segmental nerve loss. We investigated the morphological changes in peripheral nerve following slow nerve elongation by laser Doppler flowmetry controlled expansion in a rabbit sciatic nerve model. The animals were randomly assigned to one of four groups, with an expander volume of 0, 5, 10 or 15 cm3, respectively. An elongation of up to 40% was possible with preservation of clinical function. Nerve conduction velocity decreased in relation to elongation. Paranodal widening, followed by remyelination of the node, were early and constant morphological features. Demyelination and remyelination of whole internodes, and axonal degeneration occurred sporadically and did not correlate with elongation, rate of elongation or neurophysiological parameters. The model of laser Doppler flowmetry controlled nerve expansion provides a method for remodelling of myelin sheaths and lengthening of nerve fibers without axonal damage.

Animals↗

Association between metabolic gene polymorphisms and susceptibility to peripheral nerve damage in workers exposed to n-hexane: a preliminary study.

Chronic exposure to n-hexane may result in peripheral neuropathy. 2,5-Hexanedione (2,5-HD) has been identified as a toxic metabolite of n-hexane. The CYP2E1, CYP1A1 and GST genes are involved in the formation of 2,5-hexanedione from n-hexane as well as the elimination of 2,5-HD-formed electrophile, and these genes are highly polymorphic in the general population. A nested case-control study in an industrial cohort was conducted to evaluate the associations between polymorphisms in these metabolic genes and n-hexane-induced peripheral nerve damage. The study subjects included 22 cases, who worked in a printing factory with symptoms of peripheral nerve damage, and 163 controls, who came from the same factory of cases. DNA was extracted from blood samples and genotyping was conducted for CYP2E1 Pst, CYP2E1 Dra, CYP2E1 Ins96, CYP1A1 Msp, GSTT1 null, GSTM1 null and GSTP1 105V. Unconditional logistic regression was applied to estimate the odds ratio and 95% confidence intervals. There were no significant differences between the two groups regarding age, sex, smoking and alcohol status. A significant association between Dra polymorphism and peripheral nerve damage was found. The frequency of CYP2E1 Dra homozygous mutation in the case group (18.2%) was higher than that in the control group (3.7%, p=0.015). Individuals with homozygote genotype (CC) of CYP2E1 Dra had a significantly higher risk of peripheral nerve damage compared with those with DD genotype (adjusted OR=?.58, 95% CI=1.32-23.65) after n-hexane exposure duration, sex, age, smoking and alcohol status were adjusted. No significant association was found that CYP2E1 Pst, CYP2E1 Ins96, CYP1A1 Msp, GSTT1, GSTM1, GSTP gene polymorphisms associated with the susceptibility of peripheral nerve damage. These findings suggested that CYP2E1 gene might increase the susceptibility to n-hexane-induced peripheral damage.

Adult↗

Treatment of recurrent peripheral nerve entrapment problems: role of scar formation and its possible treatment.

Surgical management of peripheral nerve entrapment syndromes is usually successful, but the recurrence of symptoms after initial improvement can and does occur. Extraneural fibrosis is one possible cause of recurrent peripheral nerve problems as a result of nerve compression or tethering. Several approaches to prevent extraneural scarring after surgery have been studied, including wrapping the involved nerve with a graft, the application of various chemical compounds, and radiation. ADCON-T/N, an antiscar bioabsorbable gel device was evaluated in a retrospective clinical review. Sixty-seven percent of patients treated with ADCON-T/N after reoperation of a peripheral nerve experienced prolonged clinical improvement compared with 50% of patients who did not receive ADCON-T/N. These preliminary results suggest that ADCON-T/N may prove to be clinically useful in the surgical treatment of peripheral nerve problems. Additional more rigorous clinical studies are necessary, however.

Animals↗