ObjectiveTo summarize the research progress of autologous vein nerve conduit for the repair of peripheral nerve defect. MethodsThe recent domestic and foreign literature concerning autologous vein nerve conduit for repair of peripheral nerve defect was analyzed and summarized. ResultsA large number of basic researches and clinical applications show that the effect of autologous venous nerve conduit is close to that of autologous nerve transplantation in repairing short nerve defect, especially the compound nerve conduit has a variety of autologous nerve tissue, cells, and growth factors, etc. ConclusionAutologous vein nerve conduit for repair of non-nerve defect can be a good supplement of autologous nerve graft, improvement of autologous venous catheter to repair peripheral nerve defect is the research direction in the future.
Objective To review the possible mechanisms of the mammal ian target of rapamycin (mTOR) in theneuronal restoration process after nervous system injury. Methods The related l iterature on mTOR in the restoration ofnervous system injury was extensively reviewed and comprehensively analyzed. Results mTOR can integrate signals fromextracellular stress and then plays a critical role in the regulation of various cell biological processes, thus contributes to therestoration of nervous system injury. Conclusion Regulating the activity of mTOR signaling pathway in different aspects cancontribute to the restoration of nervous system injury via different mechanisms, especially in the stress-induced brain injury.mTOR may be a potential target for neuronal restoration mechanism after nervous system injury.
Objective To analyze the therapy and effectiveness of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury. Methods Between October 2005 and October 2012, 16 cases of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury were treated. There were 14 males and 2 females with an average age of 42 years (range, 22-58 years). Fracture was caused by traffic accident in 8 cases, by mechanical crush in 5 cases, and by falling in 3 cases. According to the anatomical features of the ulnar styloid and imaging findings, ulnar styloid fractures were classified as type I (ulnar styloid tip fracture) in 1 case and type II (ulnar styloid base fracture) in 15 cases. The skin sensation of ulnar wrist was S0 in 5 cases, S1 in 1 case, S2 in 7 cases, and S3 in 3 cases according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist. The time from injury to operation was 6-72 hours (mean, 18 hours). Fracture was treated by operative fixation, and nerve was repaired by epineurium neurolysis in 13 cases of nerve contusion and by sural nerve graft in 3 cases of complete nerve rupture. Results All incisions healed by first intention. Sixteen patients were followed up for an average time of 14 months (range, 6-24 months). The X-ray films showed that all of them achieved bone union at 4-10 weeks after operation (mean, 6 weeks). No patient had complications such as ulnar wrist chronic pain and an inability to rotate. According to Green-O’Brien wrist scoring system, the results were excellent in 13 cases and good in 3 cases; according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist, the results were excellent in all cases, including 11 cases of S4 and 5 cases of S3+. Two-point discrimination of the ulnar wrist was 5-9 mm (mean, 6.6 mm). Conclusion For patients with ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury, internal fixation and nerve repair should be performed. It can prevent ulnar wrist pain and promote sensory recovery.
OBJECTIVE In order to investigate the opportunity of repair and prognosis of recurrent laryngeal nerve injuries after thyroidectomy. METHODS Twelve cases with recurrent laryngeal nerve injuries after thyroidectomy were immediately and delayed operated on nerve repair and reinnervation. In immediate operation, 5 cases were repaired by direct recurrent laryngeal nerve suture, and 1 case was treated by transposition of the phrenic nerve to the recurrent laryngeal nerve and sutured the adductor branch to the branch of ansa cervicalis. In delayed operation, 3 cases were treated by anastomosis the main trunk of ansa cervicalis to the adductor branch of recurrent laryngeal nerve, and 3 cases were operated on neuromuscular pedicle to reinnervate posterior cricoarytenoid muscle. RESULTS Followed up 6 months, the effect was excellent in 1 case who was immediately operated by selective reinnervation of the abductor and adductor muscles of the larynx, better in 9 cases, and poor in 2 cases who were delayed operated over 12 months. CONCLUSION It can be concluded that the earlier reinnervation is performed, the better prognosis is.
Objective To construct adenovirus expressing NGF (Ad-NGF) and to investigate its promotive effect on the reparation and regeneration of sciatic nerve injury in rats. Methods NGF gene sequence was cloned into shuttle plasmid pCA13 of adenovirus type 5. After packed in HEK-293 cells, the recombinant adenoviruses-Ad-NGF underwent sequence identification. Thirty-two male SD rats weighing 180-200 g were randomly divided into 4 groups (n=8 rats per group). Sciatic nerve injury model was establ ished by disconnecting and direct suturing the right sciatic nerve in the rat. Theright gastrocnemius muscle of group A and C received Ad-NGF injection and adenovirus vector without NGF gene sequence injection, respectively, and 1 × 108 PFU/per time was given every other day for three times. Group B and D received NGF injection (200 U/d) and normal sal ine (100 ?L/d), respectively, for 3 weeks. The effect of various treatments on injured sciatic nerve was evaluated by performing sciatic nerve function index and nerve electrophysiology detections 31 days after operation. Meanwhile, the sciatic nerve in the anastomosis and at the site 1 cm distal to the anastomosis were obtained, and underwent RTPCR and Western blot analysis for detecting NGF mRNA and protein expression level in the injured sciatic nerve in the rats. Histology, immunohistochemistry, and transmission electron microscope observations were conducted. Results Ad-NGF carrying NGF gene sequence was constructed successfully and confirmed by sequence analysis. The sciatic nerve function index, nerve conduction velocity, evoked potential ampl itude, and latent period of group A was better than those of other groups (P lt; 0.05), and there were no significant differences among group B, C, and D (P gt; 0.05). RT-PCR and Western blot detection: the expression levels of NGF mRNA and protein in group A were greater than those of group B, C, and D (P lt; 0.05), and no significant differences were noted among group B, C, and D (P gt; 0.05). Histology and immunohistochemistry observation showed that the regeneration of the sciatic nerve in group A was obvious superior to that of other groups. Transmission electron microscopy observation suggested there was significant difference between group A and groups B, C, and D in terms of axonal diameter of sciatic nerve cross-section, myel in sheath thickness and nerve fiber number (P lt; 0.05), and there were no significant differences among group B, C, and D (P gt; 0.05). Conclusion Ad-NGF can effectively promote the repair of sciatic nerveinjury in rats, and is a new method for obtaining large amounts of NGF in the area of injured peripheral nerve.
Objective To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) embedded in fibrin glue around chemical extracted acellular nerve allograft (CEANA) on the peripheral nerve regeneration. Methods Twenty-oneadult male C57 mice (weighing 25-30 g) and 15 adult male Balb/c mice (weighing 25-30 g) were selected. The sciatic nerves were harvested from the Balb/c mice to prepare CEANA. The BMSCs were isolated from 3 C57 mice and were cultured; BMSCs embedded in fibrin glue were cultured for 3, 7, 14, and 21 days. Then the supernatant was obtained and co-cultured with PC12 cells for 2 days to observe the PC12 cell growth in vitro. The other 18 C57 mice were used to establ ish the left sciatic nerve defect models of 10 mm and divided into 3 groups: autogenous nerve graft with fibrin glue (group A, n=6), CEANA graft with BMSCs (5 × 106) embedded in fibrin glue (group B, n=6), and CEANA graft with fibrin glue (group C, n=6). The right sciatic nerves were exposed as the controls. At 2, 4, 6, and 8 weeks, the mouse static sciatic index (SSI) was measured. The histomorphometric assessment of triceps surae muscles and nerve grafts were evaluated by Masson staining, toluidine blue staining, and transmission electron microscope (TEM) observationat 8 weeks after operation. Results BMSCs were uniform distribution in fibrin glue, which were spherical in shape, and the cells began to grow apophysis at 3 days. PC12 cells differentiated into neuron-l ike cells after addition supernatant co-cultured after 2 days. Incisions healed well in each group. At 2, 4, 6, and 8 weeks, the SSI increased gradually in 3 groups. SSI in group A was higher than that in groups B and C at 4, 6, and 8 weeks after operation (P lt; 0.05). SSI in group B was sl ightly higher than that in group C, but had no significant difference (P gt; 0.05). At 8 weeks, the wet weight recovery rate of triceps surae muscles and fibers number of myel inated nerve were better in group B than in group C, but worse in group B than in group A, showing significant differences (P lt; 0.05). The triceps surae muscle fibers area and myel in sheath thickness had significant differences between group B and group C (P lt; 0.01), but there was no significant difference between group A and group B (P gt; 0.05). Conclusion BMSCs embedded in fibrin glue around CEANA can improve functional recovery of peripheral nerve injury.
Objective To obtain highly purified and large amount of Schwann cells (SCs) by improved primary culture method, to investigate the biocompatibility of small intestinal submucosa (SIS) and SCs, and to make SIS load nerve growth factor (NGF) through co-culture with SCs. Methods Sciatic nerves were isolated from 2-3 days old Sprague Dawley rats and digested with collagenase II and trypsin. SCs were purified by differential adhesion method for 20 minutes and treated with G418 for 48 hours. Then the fibroblasts were further removed by reducing fetal bovine serum to 2.5% in H-DMEM. MTT assay was used to test the proliferation of SCs and the growth curve of SCs was drawn. The purity of SCs was calculated by immunofluorescence staining for S-100. SIS and SCs at passage 3 were co-cultured in vitro. And then the adhesion, proliferation, and differentiation of SCs were investigated by optical microscope and scanning electron microscope (SEM). The NGF content by SCs was also evaluated at 1, 2, 3, 4, 5, and 7 days by ELISA. SCs were removed from SIS by repeated freeze thawing after 3, 5, 7, 10, 13, and 15 days of co-culture. The NGF content in modified SIS was tested by ELISA. Results The purity of SCs was more than 98%. MTT assay showed that the SCs entered the logarithmic growth phase on the 3rd day, and reached the plateau phase on the 7th day. SCs well adhered to the surface of SIS by HE staining and SEM; SCs were fusiform in shape with obvious prominence and the protein granules secreted on cellular surface were also observed. Furthermore, ELISA measurement revealed that, co-culture with SIS, SCs secreted NGF prosperously without significant difference when compared with the control group (P gt; 0.05). The NGF content increased with increasing time. The concentration of NGF released from SIS which were cultured with SCs for 10 days was (414.29 ± 20.87) pg/cm2, while in simple SIS was (4.92 ± 2.06) pg/cm2, showing significant difference (P lt; 0.05). Conclusion A large number of highly purified SCs can be obtained by digestion with collagenase II and trypsin in combination with 20-minute differential adhesion and selection by G418. SIS possesses good biocompatibility with SCs, providing the basis for further study in vivo to fabricate the artificial nerve conduit.
Objective To investigate the effectiveness of heterodigital antegrade digital artery island flap innervated by proper digital nerve and the dorsal branch of proper digital nerve for repairing digital volar complex soft tissue defects. Methods Between May 2014 and January 2018, 27 patients with digital volar complex soft tissue defects were treated. There were 17 males and 10 females with an average age of 37 years (range, 18-60 years). The causes included electric saw injury in 8 cases, twisted injury in 12 cases, and heavy pound injury in 7 case. There were 9 thumbs, 5 index fingers, 6 middle fingers, 3 ring fingers, and 4 little fingers. The interval between injury and admission ranged from 1 to 4 hours (mean, 2.5 hours). The defect size ranged from 2.2 cm×1.4 cm to 3.8 cm×2.3 cm. The mean length of unilateral proper digital nerve defect was 2.9 cm (range, 2-4 cm). All defects were repaired with heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve. The proper digital nerve and the dorsal branch of the proper digital nerve in the flap were anastomosed with the proper digital nerve stumps in the wound. The flap size ranged from 2.4 cm×1.6 cm to 4.1 cm×2.6 cm. A segment of dorsal branch of the proper digital nerve was intercalated into the defect of the proper digital nerve in donor site. And the defect of donor site was repaired with the full-thickness skin graft. Results All flaps and skin grafts survived, and the wounds healed by first intention. All patients were followed up 12-24 months (mean, 17 months). The appearance, color, and texture of the flaps were similar to the surrounding tissue. There was no pain and double sensibility in any flap. At last follow-up, the static two-point discrimination of the flaps ranged from 4 to 8 mm (mean, 5.3 mm). And the two-point discrimination of digital pulps of recipient and donor fingers ranged from 4 to 10 mm with the average of 6.2 mm and 6.0 mm, respectively. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 18 cases and good in 9 cases. No scar contracture was observed in donor site. Conclusion The heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve provides a safe and simple technique with minimal donor site cost and satisfactory effectiveness, which could be an ideal option for repairing digital volar defect, especially for the defect complicated with digital nerve defect.
ObjectiveThe aim of this study was to evaluate the repair effect of spontaneous reinnervation in rats underwent recurrent laryngeal nerve (RLN) transection. MethodsThirty male Wistar rats (340-360 g) were divided into experiment group (n=15) and blank control group (n=15), and then 15 rats of these 2 groups were divided into 3 time point groups equally:4 weeks group, 8 weeks group, and 12 weeks group. Fifteen rats of experiment group underwent right RLN transection with excision of a 5 mm segment, and other 15 rats of blank control group exposed RLN only, without transection. Grade of vocalization, maximum angle of arytenoid cartilage, axon number of distal part of RLN, and expression of the brain-derived neurotrophic factor (BDNF) in right thyroarytenoid muscle were evaluated at different time points, including 4, 8, and 12 weeks after operation. ResultsGrade of vocalization, maximum angle of arytenoid cartilage, axon numbers of distal part of RLN, and the expression of BDNF in the right thyroarytenoid muscle of experiment group were all lower than those corresponding index of blank control group (P < 0.05), and these indexes of experiment group were restored gradually with time, but failed to reach normal level during the observed time. ConclusionsEven though spontaneous reinnervation is presented after RLN injury, but the effect is unsatisfactory.
Objective To elucidate the new concept and theory of neurorestoratology. Methods With the review of the development course and important research works in the field of neurorestoratology during the 20th century, especially recent 30 years, the regularity summary, science and technology philosophy induction, and theory distillation were carried out in this article. Results The new discipl ine system was brought forward as follows: ① Definition: neurorestoratology was asub-discipl ine of neuroscience which studies neural regeneration, neural structural repair of replacement, eruroplasticity and neuromodulation. The core purpose was to promote neural functional recovery of all neural degenerative diseases and damages. ② One central task and two basic points: to recover neurological function was the central research task all the time and the two basic points were the precl inical (basic) neurorestoration and the cl inical neurorestoration. ③ Four rationale of the discipl ine: l imited renovation, relearning, insufficient reserve, and l ifelong reinforcement. ④ Five major factors of neurorestoratology (5N’s dogma): neuroregeneration, neurorepair, neuroplasticity, neuromodulation, neurorehabil itation. “Neuroprotection” appeared to be included in the broad definition. ⑤ Four-step rule of neurorestoratology: structural neurorestoration, signal neurorestoration, rehabil itative neurorestoration, and functional neurorestoration. ⑥ Emphasize that translational medicine from lab to bed in neurorestoration. Conclusion The discipl ine of neurorestoratology has the vast development prospectand will be sure to increase the rapid progress of the basic and cl inical restorative neuroscience.