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Stenberg, Lena, Derya Burcu Hazer Rosberg, Sho Kohyama, Seigo Suganuma, and Lars B. Dahlin. "Injury-Induced HSP27 Expression in Peripheral Nervous Tissue Is Not Associated with Any Alteration in Axonal Outgrowth after Immediate or Delayed Nerve Repair." International Journal of Molecular Sciences 22, no. 16 (August 11, 2021): 8624. http://dx.doi.org/10.3390/ijms22168624.
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We investigated injury-induced heat shock protein 27 (HSP27) expression and its association to axonal outgrowth after injury and different nerve repair models in healthy Wistar and diabetic Goto-Kakizaki rats. By immunohistochemistry, expression of HSP27 in sciatic nerves and DRG and axonal outgrowth (neurofilaments) in sciatic nerves were analyzed after no, immediate, and delayed (7-day delay) nerve repairs (7- or 14-day follow-up). An increased HSP27 expression in nerves and in DRG at the uninjured side was associated with diabetes. HSP27 expression in nerves and in DRG increased substantially after the nerve injuries, being higher at the site where axons and Schwann cells interacted. Regression analysis indicated a positive influence of immediate nerve repair compared to an unrepaired injury, but a shortly delayed nerve repair had no impact on axonal outgrowth. Diabetes was associated with a decreased axonal outgrowth. The increased expression of HSP27 in sciatic nerve and DRG did not influence axonal outgrowth. Injured sciatic nerves should appropriately be repaired in healthy and diabetic rats, but a short delay does not influence axonal outgrowth. HSP27 expression in sciatic nerve or DRG, despite an increase after nerve injury with or without a repair, is not associated with any alteration in axonal outgrowth.
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Holland, G. R. "Experimental Trigeminal Nerve Injury." Critical Reviews in Oral Biology & Medicine 7, no. 3 (July 1996): 237–58. http://dx.doi.org/10.1177/10454411960070030301.
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The successful reinnervation of peripheral targets after injury varies with the axonal population of the nerve that is injured and the extent of the dislocation of its central component from the peripheral endoneurial tube. Larger-diameter axons such as those supplying mechanoreceptors recover more readily than narrower axons such as those supplying taste. A complex, bi-directional interaction between lingual epithelium and sprouting nerve results in the redifferentiation of taste buds after denervation. Dentin and the dental pulp provide a strong attraction to sprouting nerves and will become reinnervated from collateral sources if recovery of the original innervation is blocked. The most effective repair technique for transected lingual nerves is one which brings the cut ends together rather than one that provides a temporary bridge. Injuries can result in cell death in the trigeminal ganglion but only if the injury is severe and recovery is prevented. Lesser damage results in chromatolysis and the increased expression of neuropeptides. All nerve injuries bring about changes in the trigeminal nucleus. These occur as changes in receptive field and the incidence of spontaneously active neurons, effects which are consistent with the unmasking of existing afferents. These functional changes are short-lived and reversible. Morphologically, nerve injury results in terminal degeneration in the nuclei and an increased expression of the c-Fos gene and some neuropeptides. Only a chronic constriction injury induces behavioral changes. The adult trigeminal system retains considerable plasticity that permits it to respond successfully to nerve injury. Much remains to be learned about this response, particularly of the trophic factors that control peripheral recovery and the central response to more severe injuries.
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Tode, Jan, Irina Kirillova-Woytke, Vanessa H. Rausch, Ralf Baron, and Wilfrid Jänig. "Mechano- and thermosensitivity of injured muscle afferents 20 to 80 days after nerve injury." Journal of Neurophysiology 119, no. 5 (May 1, 2018): 1889–901. http://dx.doi.org/10.1152/jn.00894.2017.
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Chronic injury of limb nerves leading to neuropathic pain affects deep somatic nerves. Here the functional properties of injured afferent fibers in the lateral gastrocnemius-soleus nerve were investigated 20 and 80 days after suturing the central stump of this muscle nerve to the distal stump of the sural nerve in anesthetized rats. Neurophysiological recordings were made from afferent axons identified in either the sciatic nerve (87 A-, 63 C-fibers) or the dorsal root L4/L5 (52 A-, 26 C-fibers) by electrical stimulation of the injured nerve. About 70% of the functionally identified A-fibers had regenerated into skin by 80 days after nerve suture; the remaining A-fibers could be activated only from the injured nerve. In contrast, 93% of the functionally identified C-fibers could only be activated from the injured sural nerve after 80 days. Nearly half of the injured A- (45%) and C-fibers (44%) exhibited ongoing and/or mechanically or thermally evoked activity. Because ~50% of the A- and C-fibers are somatomotor or sympathetic postganglionic axons, respectively, probably all injured muscle afferent A- and C-fibers developed ectopic activity. Ongoing activity was present in 17% of the A- and 46% of the C-fibers. Mechanosensitivity was present in most injured A- (99%) and C-fibers (85%), whereas thermosensitivity was more common in C-fibers (cold 46%, heat 47%) than in A-fibers (cold 18%, heat 12%). Practically all thermosensitive A-fibers and C-fibers were also mechanosensitive. Thus, unlike cutaneous axons, almost all A- and C-fibers afferents in injured muscle nerves demonstrate ectopic activity, even chronically after nerve injury. NEW & NOTEWORTHY After chronic injury of a muscle nerve, allowing the nerve fibers to regenerate to the target tissue, 1) most afferent A-fibers are mechanosensitive and regenerate to the target tissue; 2) ectopic ongoing activity, cold sensitivity, and heat sensitivity significantly decrease with time after injury in A-afferents; 3) most afferent C-fibers do not regenerate to the target tissue; and 4) injured C-afferents maintain the patterns of ectopic discharge properties they already show soon after nerve injury.
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Ahmadian, Amir, Naomi Abel, and Juan S. Uribe. "Functional recovery of severe obturator and femoral nerve injuries after lateral retroperitoneal transpsoas surgery." Journal of Neurosurgery: Spine 18, no. 4 (April 2013): 409–14. http://dx.doi.org/10.3171/2013.1.spine12958.
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The minimally invasive lateral retroperitoneal transpsoas approach is a popular fusion technique. However, potential complications include injury to the lumbar plexus nerves, bowel, and vasculature, the most common of which are injuries to the lumbar plexus. The femoral nerve is particularly vulnerable because of its size and location; injury to the femoral nerve has significant clinical implications because of its extensive sensory and motor innervation of the lower extremities. The authors present an interesting case of a 49-year-old male patient in whom femoral and obturator nerve functional recovery unexpectedly occurred 364 days after the nerves had been injured during lateral retroperitoneal transpsoas surgery. Chronological video and electrodiagnostic findings demonstrate evidence of recovery. Classification and mechanisms of nerve injury and nerve regeneration are discussed.
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Zochodne, D. W. "Epineurial Peptides: A Role in Neuropathic Pain?" Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 20, no. 1 (February 1993): 69–72. http://dx.doi.org/10.1017/s0317167100047466.
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ABSTRACT:Neuropathic pain is not well understood. Although central dorsal horn remodelling is likely important in maintaining chronic neuropathic pain, afferent activity from injured nerves or ganglia may initiate these changes. It is suggested, in this review that the peripheral nerve trunk is capable of sustaining a “flare” response as observed in injured skin and other tissues. The injury response may be associated with local vasodilatation, plasma extravasation and the generation of painful local afferent activity sustained by locally originating peptidergic fibers (nervi nervorum). These fibers contain substance P, calcitonin gene-related peptide and other peptides that have been linked to nociceptive transmission. Manipulation of the local injury response of the nerve trunk by pharmacologic means may provide one strategy in the treatment of neuropathic pain.
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RAYAN, G. M., S. I. SAID, S. L. CAHILL, and J. DUKE. "Vasoactive Intestinal Peptide and Nerve Regeneration." Journal of Hand Surgery 16, no. 5 (October 1991): 515–18. http://dx.doi.org/10.1016/0266-7681(91)90106-x.
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The role of vasoactive intestinal peptide (V.I.P.) in nerve regeneration was investigated by assessing the changes in immunoreactive V.I.P. levels in rat sciatic nerves following injury and repair. 60 rats were divided into three surgical groups and one control group: In group I (primary repair), sciatic nerves were divided and immediately repaired; in group II (secondary repair), sciatic nerves were divided and repaired two weeks later; in group III (no repair), sciatic nerves were divided and not repaired; and in group IV (controls), sciatic nerves were exposed but not divided. Animals were sacrificed at three days and at weekly intervals. Their sciatic nerves were extracted and assayed for V.I.P. concentrations by a specific radioimmunoassay. The mean V.I.P. concentration varied between 22 and 46 pg./mg. protein in the control nerves and between 60 and 529 pg./mg. protein in all other groups. In the three surgical groups the levels were significantly higher in proximal than in distal stumps. Following nerve injury, there was an increase in V.I.P. concentration in the injured and repaired areas. This increase was greater in injured non-repaired areas and was highest in the first 48 hours, but continued during regeneration. The accumulation of V.I.P. in divided nerves occurred in response to nerve injury.
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Cha, Myeoung Hoon, Taick Sang Nam, Yongho Kwak, Hyejung Lee, and Bae Hwan Lee. "Changes in Cytokine Expression after Electroacupuncture in Neuropathic Rats." Evidence-Based Complementary and Alternative Medicine 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/792765.
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The production of proinflammatory cytokines including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α(TNF-α) plays a key role in chronic pain such as neuropathic pain. We investigated changes in cytokine expression in injured peripheral nerves and dorsal root ganglia (DRG) following electroacupuncture (EA) treatment. Neuropathic pain was induced by peripheral nerve injury to the left hind limb of Sprague-Dawley rats under pentobarbital anesthesia. Two weeks later, the nerve-injured rats were treated by EA for 10 minutes. The expression levels of IL-1β, IL-6, and TNF-αin peripheral nerves and DRG of neuropathic rats were significantly increased in nerve-injured rats. However, after EA, the cytokine expression levels were noticeably decreased in peripheral nerves and DRG. These results suggest that EA stimulation can reduce the levels of proinflamtory cytokines elevated after nerve injury.
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Seckel, Brooke R. "Facial Danger Zones: Avoiding Nerve Injury in Facial Plastic Surgery." Canadian Journal of Plastic Surgery 2, no. 2 (June 1994): 59–66. http://dx.doi.org/10.1177/229255039400200207.
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BR Seckel. Facial danger zones: Avoiding nerve injury in facial plastic surgery. Can J Plast Surg 1994;2(2):59-66. with today's new emphasis on more aggressive and deeper facial dissection during rhytidectomy, the peripheral nerve branches of cranial nerves V and VII in the face are more often exposed closer to the plane of dissection and more likely to be injured in the course of composite, extended sub-submuscular aponeurotic system (sub-SMAS), and subperiosteal rhytidectomy. It is important to have a keen and thorough understanding of the location of these nerves to avoid injury. I divide the face into seven facial danger zones based on known anatomic locations of the branches of the peripheral nerves of the face and the location in which they are most easily injured in the course of facial dissection. A description of the nerve and consequence of injury, the anatomic location of the zone, and the technique for safe surgical dissection for each facial danger zone is presented.
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Teodori, Rosana Macher, Joice Betini, Larissa Salgado de Oliveira, Luciane Lobato Sobral, Sibele Yoko Mattozo Takeda, and Maria Imaculada de Lima Montebelo. "Swimming Exercise in the Acute or Late Phase after Sciatic Nerve Crush Accelerates Nerve Regeneration." Neural Plasticity 2011 (2011): 1–8. http://dx.doi.org/10.1155/2011/783901.
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There is no consensus about the best time to start exercise after peripheral nerve injury. We evaluated the morphological and functional characteristics of the sciatic nerves of rats that began to swim immediately after crush nerve injury (CS1), those that began to swim 14 days after injury (CS14), injured rats not submitted to swimming (C), and uninjured rats submitted to swimming (S). After 30 days the number of axons in CS1 and CS14 was lower than in C (P<0.01). The diameter of axons and nerve fibers was larger in CS1 (P<0.01) and CS14 (P<0.05) than in C, and myelin sheath thickness was lower in all crushed groups (P<0.05). There was no functional difference between CS1 and CS14 (P>0.05). Swimming exercise applied during the acute or late phase of nerve injury accelerated nerve regeneration and synaptic elimination after axonotmesis, suggesting that exercise may be initiated immediately after injury.
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Boyer, Richard B., Nathaniel D. Kelm, D. Colton Riley, Kevin W. Sexton, Alonda C. Pollins, R. Bruce Shack, Richard D. Dortch, Lillian B. Nanney, Mark D. Does, and Wesley P. Thayer. "4.7-T diffusion tensor imaging of acute traumatic peripheral nerve injury." Neurosurgical Focus 39, no. 3 (September 2015): E9. http://dx.doi.org/10.3171/2015.6.focus1590.
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Diagnosis and management of peripheral nerve injury is complicated by the inability to assess microstructural features of injured nerve fibers via clinical examination and electrophysiology. Diffusion tensor imaging (DTI) has been shown to accurately detect nerve injury and regeneration in crush models of peripheral nerve injury, but no prior studies have been conducted on nerve transection, a surgical emergency that can lead to permanent weakness or paralysis. Acute sciatic nerve injuries were performed microsurgically to produce multiple grades of nerve transection in rats that were harvested 1 hour after surgery. High-resolution diffusion tensor images from ex vivo sciatic nerves were obtained using diffusion-weighted spin-echo acquisitions at 4.7 T. Fractional anisotropy was significantly reduced at the injury sites of transected rats compared with sham rats. Additionally, minor eigenvalues and radial diffusivity were profoundly elevated at all injury sites and were negatively correlated to the degree of injury. Diffusion tensor tractography showed discontinuities at all injury sites and significantly reduced continuous tract counts. These findings demonstrate that high-resolution DTI is a promising tool for acute diagnosis and grading of traumatic peripheral nerve injuries.
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Ratliff, John K., and Edward H. Oldfield. "Convection-enhanced delivery in intact and lesioned peripheral nerve." Journal of Neurosurgery 95, no. 6 (December 2001): 1001–11. http://dx.doi.org/10.3171/jns.2001.95.6.1001.
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Object. Although the use of multiple agents is efficacious in animal models of peripheral nerve injury, translation to clinical applications remains wanting. Previous agents used in trials in humans either engendered severe side effects or were ineffective. Because the blood—central nervous system barrier exists in nerves as it does in the brain, limited drug delivery poses a problem for translation of basic science advances into clinical applications. Convection-enhanced delivery (CED) is a promising adjunct to current therapies for peripheral nerve injury. In the present study the authors assessed the capacity of convection to ferry macromolecules across sites of nerve injury in rat and primate models, examined the functional effects of convection on the intact nerve, and investigated the possibility of delivering a macromolecule to the spinal cord via retrograde convection from a peripherally introduced catheter. Methods. The authors developed a rodent model of convective delivery to lesioned sciatic nerves (injury due to crush or laceration in 76 nerves) and compared the results to a smaller series of five primates with similar injuries. In the intact nerve, convective delivery of vehicle generated only a transient neurapraxic deficit. Early after injury (postinjury Days 1, 3, 7, and 10), infusion failed to cross the site of injury in crushed or lacerated nerves. Fourteen days after crush injury, CED of radioactively-labeled albumin resulted in perfusion through the site of injury to distal growing neurites. In primates, successful convection through the site of crush injury occurred by postinjury Day 28. In contrast, in laceration models there was complete occlusion of the extracellular space to convective distribution at the site of laceration and repair, and convective distribution in the extracellular space crossed the site of injury only after there was histological evidence of completion of nerve regeneration. Finally, in two primates, retrograde infusion into the spinal cord through a peripheral nerve was achieved. Conclusions. Convection provides a safe and effective means to deliver macromolecules to regenerating neurites in crush-injured peripheral nerves. Convection block in lacerated and suture-repaired nerves indicates a significant intraneural obstruction of the extracellular space, a disruption that suggests an anatomical obstruction to extracellular and, possibly, intraaxonal flow, which may impair nerve regeneration. Through peripheral retrograde infusion, convection can be used for delivery to spinal cord gray matter. Convection-enhanced delivery provides a promising approach to distribute therapeutic agents to targeted sites for treatment of disorders of the nerve and spinal cord.
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Dhanaraju, S., and N. Kannan. "Surgical outcome of prognostic factors for final outcome of hand function following primary median nerve repair." International Surgery Journal 5, no. 11 (October 26, 2018): 3672. http://dx.doi.org/10.18203/2349-2902.isj20184642.
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Background: A major problem in surgery of median nerve injuries is the unpredictable final outcome, so identifying the prognostic factors for final outcome is needed in primary median nerve repair following injury. Assessing the functional recovery of hand function following median nerve repair.Methods: Total no. of patients with median nerve injury repaired in our institution was 70. All the patients assessed preoperatively by clinical examination, surgery performed immediately or within 12 hours of injury, performed under axillary block and tourniquet control, Multiple surgeons involved (about 6 surgeons). All are primarily repaired nerves, repair by 70 prolene epineural sutures, postoperative immobilization of 3 weeks.Results: Median nerve injury associated with other flexors involved patients show good functional recovery, the functional recovery deteriorate once involvement of finger flexors, particularly if all the tendons were injured. The arterial injury and repair don’t seem to influence the outcome of the hand function, but both artery involvement usually associated with all tendon injury, it shows poor outcome.Conclusions: The more distal the injury the outcome will be quicker as compared to middle 1/3 and proximal 1/3 injuries. Pure median nerve injuries sensory recovery in S4 grade about 5%, S3+ recovery of sensation is about 36%. Pure median nerve injury patients M4 motor recovery about 54%.Only median nerve injury the final outcome is good but combined median and ulnar nerve injury and associated tendon injury the outcome is poor.
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Kim, Bo Ra, Dong-Ho Ha, Jong Kuk Kim, and Young Hee Kim. "Comparison of MR findings of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model." PLOS ONE 15, no. 11 (November 19, 2020): e0240911. http://dx.doi.org/10.1371/journal.pone.0240911.
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Purpose The treatment strategy is different for acute traumatic peripheral nerve injury and acute compressive neuropathy. This study aimed to compare magnetic resonance imaging (MRI) features of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model. Materials and methods Twenty female Sprague-Dawley rats were divided into two groups. In the crush injury group (n = 10), the unilateral sciatic nerve was crushed using forceps to represent acute traumatic peripheral nerve injury. In the compression injury group (n = 10), the unilateral sciatic nerve was ligated using silk to represent acute compressive neuropathy. The MRI of eight rats from each group were acquired on postoperative days 3 and 10. Fat-suppressed T2-weighted images were acquired. Changes in the injured nerve were divided into three grades. A Fisher’s exact test was used to compare the changes in the nerves of the two groups. Histological staining and a western blot analysis were performed on one rat in each group on day 3. Neurofilament, myelin basic protein (MBP), and p75NTR staining were performed. Expression of neurofilament, MBP, p75NTR, and c-jun was evaluated by western blot analysis. Results MR neurography revealed substantial nerve changes in the compression injury group compared with the crush injury group at two-time points (p = 0.001 on day 3, p = 0.026 on day 10). The histopathological analysis indicated the destruction of the axon and myelin, mainly at the injury site and the distal portion of the injury in the crush injury group. It was prominent in the proximal portion, the injury site, and the distal portion of the injury in the compression injury group. The degree of axonal and myelin destruction was more pronounced in the compression injury group than in the crush injury group. Conclusion MR neurography showed prominent and long-segmental changes associated with the injured nerve in acute compressive neuropathy compared with acute traumatic peripheral nerve injury.
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Littler, B. "Nerve injury." British Dental Journal 181, no. 1 (July 1996): 8. http://dx.doi.org/10.1038/sj.bdj.4809134.
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Torsney, Carole. "Nerve injury." NeuroReport 11, no. 17 (November 2000): A11. http://dx.doi.org/10.1097/00001756-200011270-00004.
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Biggs, Michael. "Nerve injury." Journal of Clinical Neuroscience 3, no. 2 (April 1996): 180. http://dx.doi.org/10.1016/s0967-5868(96)90017-x.
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Fisher, T. R. "Nerve injury." Injury 21, no. 5 (September 1990): 302–4. http://dx.doi.org/10.1016/0020-1383(90)90046-w.
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Kay, S. "Nerve injury." Current Orthopaedics 7, no. 4 (October 1993): 211–12. http://dx.doi.org/10.1016/0268-0890(93)90257-r.
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Abram, Stephen E., Johnny Yi, Andreas Fuchs, and Quinn H. Hogan. "Permeability of Injured and Intact Peripheral Nerves and Dorsal Root Ganglia." Anesthesiology 105, no. 1 (July 1, 2006): 146–53. http://dx.doi.org/10.1097/00000542-200607000-00024.
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Background Nerve injury that produces behavioral changes of allodynia and hyperalgesia in animals is associated with electrophysiologic changes in dorsal root ganglion (DRG) cells. The introduction of drugs into the DRG or the peripheral nerve that alter calcium, sodium, or potassium channel activity may be of therapeutic benefit after nerve injury. For this reason, the authors sought to determine whether drugs that do not ordinarily cross the blood-nerve barrier will enter the DRG after intravenous or regional injection and to determine whether nerve injury alters drug access to DRGs or peripheral nerves. Methods Both intact and spinal nerve-ligated rats were injected with sodium fluorescein by intravenous, intrathecal, peri-DRG, perisciatic, and epidural routes. DRG, sciatic nerve, and spinal cord tissues were harvested and frozen, and histologic sections were analyzed quantitatively for tissue fluorescence. Results In both intact and nerve-injured animals, fluorescein accumulated in DRGs after intravenous, peri-DRG, and epidural injection. There was accumulation in the proximal portion of the ganglion after intrathecal injection. Minimal amounts of fluorescein were found in the sciatic nerve in intact animals after intravenous or perineural injection, but substantial amounts were found in some nerve fascicles in nerve-injured animals after both intravenous and perineural injection. There was almost no fluorescein found in the spinal cord except after intrathecal administration. Conclusions In both intact and nerve-injured animals, fluorescein accumulates freely in the DRG after intravenous, epidural, or paravertebral injection. The sciatic nerve is relatively impermeable to fluorescein, but access by either systemic or regional injection is enhanced after nerve injury.
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Deng, Kangli, Dan Li Lin, Brett Hanzlicek, Brian Balog, Marc S. Penn, Matthew J. Kiedrowski, Zhiquan Hu, Zhangqun Ye, Hui Zhu, and Margot S. Damaser. "Mesenchymal stem cells and their secretome partially restore nerve and urethral function in a dual muscle and nerve injury stress urinary incontinence model." American Journal of Physiology-Renal Physiology 308, no. 2 (January 15, 2015): F92—F100. http://dx.doi.org/10.1152/ajprenal.00510.2014.
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Childbirth injures muscles and nerves responsible for urinary continence. Mesenchymal stem cells (MSCs) or their secretome given systemically could provide therapeutic benefit for this complex multisite injury. We investigated whether MSCs or their secretome, as collected from cell culture, facilitate recovery from simulated childbirth injury. Age-matched female Sprague-Dawley rats received pudendal nerve crush and vaginal distension (PNC+VD) and a single intravenous (iv) injection of 2 million MSCs or saline. Controls received sham injury and iv saline. Additional rats received PNC+VD and a single intraperitoneal (ip) injection of concentrated media conditioned by MSCs (CCM) or concentrated control media (CM). Controls received a sham injury and ip CM. Urethral and nerve function were assessed with leak point pressure (LPP) and pudendal nerve sensory branch potential (PNSBP) recordings 3 wk after injury. Urethral and pudendal nerve anatomy were assessed qualitatively by blinded investigators. Quantitative data were analyzed using one-way ANOVA and Holm-Sidak post hoc tests with P < 0.05 indicating significant differences. Both LPP and PNSBP were significantly decreased 3 wk after PNC+VD with saline or CM compared with sham-injured rats, but not with MSC or CCM. Elastic fiber density in the urethra increased and changed in orientation after PNC+VD, with a greater increase in elastic fibers with MSC or CCM. Pudendal nerve fascicles were less dense and irregularly shaped after PNC+VD and had reduced pathology with MSC or CCM. MSC and CCM provide similar protective effects after PNC+VD, suggesting that MSCs act via their secretions in this dual muscle and nerve injury.
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Smith, Keith G. "Repair of nerves injured during dental and oral surgery procedures." Faculty Dental Journal 2, no. 4 (October 2011): 158–63. http://dx.doi.org/10.1308/204268511x13154691746978.
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There is still some disagreement and confusion about the optimal management of patients who have suffered a nerve injury during a dental or oral surgery procedure. The majority of the nerve injuries are temporary and normal sensation will usually return without any surgical intervention but there are some patients for whom exploration and repair of their injured nerves may be beneficial. The difficulty lies with the assessment of the nerve injury and the decision making as to whether it is likely to be a temporary injury that will fully recover without any intervention or if early surgical intervention should be recommended.
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Agthong, Sithiporn, Marisa Rodtayoy, and Atitaya Roumwong. "Expression of autophagic and ubiquitin–proteasome proteins in the peripheral nervous system after nerve injury." Asian Biomedicine 13, no. 5 (June 4, 2020): 173–78. http://dx.doi.org/10.1515/abm-2019-0057.
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AbstractBackgroundAutophagy and ubiquitin–proteasome (UPS) are two main degradation systems for intracellular proteins. They are essential for homeostasis of neurons during normal and pathological conditions, but their changes after nerve injury remain unclear.ObjectiveTo examine the protein expression of autophagy and UPS in the dorsal root ganglia (DRG), including intact and injured sciatic nerves after crush injury in rats.MethodsLeft sciatic nerve crush was done in all Wistar rats and the specimens were removed at 1, 3, 7, and 14 days after injury. Expression of the autophagic (Beclin-1 and p62) and UPS proteins [muscle ring finger-1 (MuRF1) and ubiquitinated proteins] was measured using Western blot analysis.ResultsExpression of p62 was significantly increased in the injured versus intact sciatic nerves on day 1 and day 7 (P < 0.05 and P < 0.01, respectively). There was a trend toward higher expression of Beclin-1 on the crushed nerve. In the DRG, expression of p62 and Beclin-1 was not significantly different between the two sides. Expression of MuRF1 and ubiquitinated proteins was not significantly different between the left and right DRG. The low quantity of MuRF1 and high variations in the ubiquitinated protein levels in the nerve prevented further analysis.ConclusionsThese results indicated the induction of autophagy with accumulation of autophagosomes in the nerve, but not DRG, after nerve injury. Future studies on the effects of the autophagic changes and the precise activity of UPS in nerve trauma are crucial.
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Kochi, Takahiro, Yoki Nakamura, Simeng Ma, Kazue Hisaoka-Nakashima, Dengli Wang, Keyue Liu, Hidenori Wake, Masahiro Nishibori, Masahiro Irifune, and Norimitsu Morioka. "Pretreatment with High Mobility Group Box-1 Monoclonal Antibody Prevents the Onset of Trigeminal Neuropathy in Mice with a Distal Infraorbital Nerve Chronic Constriction Injury." Molecules 26, no. 7 (April 2, 2021): 2035. http://dx.doi.org/10.3390/molecules26072035.
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Persistent pain following orofacial surgery is not uncommon. High mobility group box 1 (HMGB1), an alarmin, is released by peripheral immune cells following nerve injury and could be related to pain associated with trigeminal nerve injury. Distal infraorbital nerve chronic constriction injury (dIoN-CCI) evokes pain-related behaviors including increased facial grooming and hyper-responsiveness to acetone (cutaneous cooling) after dIoN-CCI surgery in mice. In addition, dIoN-CCI mice developed conditioned place preference to mirogabalin, suggesting increased neuropathic pain-related aversion. Treatment of the infraorbital nerve with neutralizing antibody HMGB1 (anti-HMGB1 nAb) before dIoN-CCI prevented both facial grooming and hyper-responsiveness to cooling. Pretreatment with anti-HMGB1 nAb also blocked immune cell activation associated with trigeminal nerve injury including the accumulation of macrophage around the injured IoN and increased microglia activation in the ipsilateral spinal trigeminal nucleus caudalis. The current findings demonstrated that blocking of HMGB1 prior to nerve injury prevents the onset of pain-related behaviors, possibly through blocking the activation of immune cells associated with the nerve injury, both within the CNS and on peripheral nerves. The current findings further suggest that blocking HMGB1 before tissue injury could be a novel strategy to prevent the induction of chronic pain following orofacial surgeries.
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Steinfeldt, T., J. Graf, J. Schneider, W. Nimphius, E. Weihe, A. Borgeat, H. Wulf, and T. Wiesmann. "Histological Consequences of Needle-Nerve Contact following Nerve Stimulation in a Pig Model." Anesthesiology Research and Practice 2011 (2011): 1–9. http://dx.doi.org/10.1155/2011/591851.
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Background. Nerve stimulation can facilitate correct needle placement in peripheral regional anesthesia. The aim of this study was to determine whether the high threshold current is associated with reduced nerve injury due to fewer needle-nerve contacts compared with low current.Methods. In anaesthetized pigs, thirty-two nerves of the brachial plexus underwent needle placement at low (0.2 mA) or high current (1.0 mA). The occurrence of needle-nerve contact was recorded. After 48 hours, the nerves were analyzed for occurrence of histological changes. Nerve injury was scored ranging from 0 (no injury) to 4 (severe injury).Results. The frequency of needle-nerve contact was 94% at low compared to 6% at high current. The score was significantly higher at low (median [interquartile range] 2.0 [1.0-2.0]) compared to high current (0.0 [0.0-1.0]P=.001).Conclusions. Inflammatory responses were directly related to needle-nerve contacts. Hence, posttraumatic inflammation may be diminished using higher current for nerve localization.
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Huang, Dong-Xu, Jiang-Nan Li, Ge-Yi Zhang, Wen-Gang Wang, Lei Xia, Xu Gong, and Nan Zhou. "Biomaterials for Repairing Gaps After Peripheral Nerve Injury." Science of Advanced Materials 13, no. 4 (April 1, 2021): 530–36. http://dx.doi.org/10.1166/sam.2021.3963.
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Peripheral nerves have complex and precise structures that differ from other types of tissues and intrinsic regeneration abilities after injury. Spontaneous recovery is possible for neuropraxia and axonotmesis, while surgical treatment is required for neurotmesis. It remains a challenge to repair nerve gaps, a series of severe neurotmesis. It seems that 3 cm is the upper limit distance for primate peripheral nerves to regenerate spontaneously. Nerve autografts are the gold standard treatment for bridging nerve gaps. In the present review, current biomaterials for repairing gaps after peripheral nerve injury are briefly summarized. Moreover, the microstructure of the peripheral nerve, classifications of peripheral nerve injury, and the Wallerian degeneration are reviewed in the biological view and clinical practice. The failure of nerve regeneration in nerve conduits bridging longer than 3 cm gaps may be contributing to the insufficient vascularization of nerve conduit materials. Future researchers could focus on advanced biomaterials that promoting the angiogenesis of nerve conduits.
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Walsh, Sarah, and Rajiv Midha. "USE OF STEM CELLS TO AUGMENT NERVE INJURY REPAIR." Neurosurgery 65, suppl_4 (October 1, 2009): A80—A86. http://dx.doi.org/10.1227/01.neu.0000335651.93926.2f.
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Abstract OBJECTIVE The purpose of this review is to summarize the basic science literature related to chronic nerve injuries, and to then use this as the background to provide emerging insights into the promising role of cellular therapy for nerve injury repair. METHODS The literature pertinent to the experimental and clinical aspects of chronic nerve injury was reviewed, as was emerging literature and our own recent experience in using cellular therapy to repair injured nerves. RESULTS Peripheral nerves have the potential to regenerate axons and reinnervate end organs. Yet, outcome after peripheral nerve injury, even after nerve repair, remains relatively poor. The single most important quantitative contributor to poor motor recovery is chronic denervation of the distal nerve. Chronic denervation is common because of the often extensive injury zone that prevents any axonal outgrowth or (even if outgrowth occurs) the relatively slow rate of regeneration. As a consequence, the distal nerve remains chronically devoid of regrowing axons. In turn, prolonged denervation of Schwann cells (SCs) seems to be the critical factor that makes them unreceptive for axonal regeneration. Regenerative success was demonstrated when denervated SCs were replaced with healthy SCs cultured from a secondary nerve. This cell-replacement strategy is, however, limited in the clinical setting by the inability to obtain sufficient numbers of cells and the requirement for sacrifice of additional nerve tissue. We, along with several other groups, have therefore begun investigating stem cell therapies to improve the regenerative environment. CONCLUSION There are several avenues of stem cell-based approaches to peripheral nerve repair. One of these, skin-derived precursor cells, are easily accessible, autologous adult stem cells that can survive and myelinate in the peripheral nerve environment and become SC-like in their apparent differentiation.
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Jawad, Saad Ramadhan. "Recurrent Laryngeal Nerve Injury With Versus Without Nerve Identification In Different Thyroidectomy Procedures." AL-Kindy College Medical Journal 14, no. 1 (October 10, 2018): 29–32. http://dx.doi.org/10.47723/kcmj.v14i1.13.
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Background: The world health organization estimates that worldwide 2 billion people still have iodine deficiency Objectives: Is to make comparison between the effect of identification of recurrent laryngeal nerve (RLN) and non-identification of the nerve on incidence of recurrent laryngeal nerve injury (RLNI) in different thyroidectomy procedures.
Type of the study: cross –sectional study.
Methods: 132 patients with goiters underwent thyroidectomy .Identification of RLN visually by exposure were done for agroup of them and non-identification of the nerves for the other group. The outcomes of RLNI in the two groupsanalyzed statistically for the effect of Identification of RLN on decreasing the incidence of the nerveinjury .The benefits of identification of RLN evaluated in each procedure ofthyroidectomy which were total thyroidectomy (TT), near totalthyroidectomy (NTT), and subtotal thyroidectomy (STT).Patients were followed up monthly for 6 months by indirect laryngoscopy for mobility of the vocal cords.
Results: 132 patients underwent thyroidectomy,258 RLNswere at risk, 124 nerves were identified and134 nerves were not identified,1 RLN was injured in identified group, and 8 RLN were injured in non-identified group. The pvalue was (0.0393) which was significant. TT were performed for 56 patients (42.4%) and total hemi thyroidectomy(THT) for 6patients(4.5%), there were 118 RLNs at risk, 64RLNs were identified and 54 RLNs were not identified.1RLN was injured in identified group, and 7RLNs were injured in non-identifiedgroup, the pvalue was(0.023)which was significant.NTT procedure were performed for 38 patients(28.8%) , 76 RLNs were at risk. 30 RLNswere identified and none of themwas injured, 46 RLNswere not identified, 1 RLN was injured the p value was(1)which was not significant.STT were performed for 32patients(24.4%),64 RLNs were at risk. 30 RLNs were identified and 34 RLNs not identified,there was no nerve injury in both groups .
Conclusions: identification of RLN decrease incidence of RLNI in TT, while there was no significant increase of RLNI in NTT and STT when the nerve was not identified
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Margiana, Ria, Kamila Alawiyah, Khoirul Ima, Rizni Fitriana, Arif Rahmat Widodo, and Theresa Devi Wibowo. "Improvement of Walking Analysis using the Sciatic Function Index for Sciatic Nerve Function in Injured Rat Model Treated with Low-Intensity Aerobics." Open Access Macedonian Journal of Medical Sciences 9, A (November 27, 2021): 1162–68. http://dx.doi.org/10.3889/oamjms.2021.7289.
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BACKGROUND: Sciatica is a disease of the peripheral nerves. Sciatica indicates that there is damage to the peripheral nerves in the sciatic nerves. Factors that can affect this disease include gender, posture, parity, age, genetic factors, and occupation. Some of the pathophysiological conditions of sciatica include the pathology of the intervertebral disc, dorsal root, and sciatic nerve itself. The results of standard therapy with surgery have not been effective and very expensive. Therefore, research on therapy in sciatica cases still needs to be done and evaluated. Physical exercise treatment (aerobic] is necessary for this therapy in sciatica cases due to promote the function of peripheral nerves. AIM: This study aimed to determine the effect of aerobic exercise treatment on peripheral nerve injury and its relationship to walking function during injury-induced peripheral nerve regeneration. METHODS: This study was an experimental study with a post-test. he study sample consisted of Male Sprague-Dawley rats with an age of about 2-3 months divided into three groups. Control group was conducted by surgery without clamping/injuring the peripheral nerves. The treatment for second group (P1) was clamping/injury of peripheral nerve and given the treatment of physical exercise with aerobics. The treatment for third group (P2) was clamping/injury of peripheral nerve and not given the treatment of physical exercise with aerobics. The intensity of giving physical exercise treatment with aerobic that is carried out is for 42 days. Nerve functional evaluation was carried out using the sciatic function index (SFI) method. Histological staining for sciatic was used hematoxylin-Eosin (HE) staining and immunohistochemistry with Growth Associated Protein 43 (GAP43) [Bioss, bs-0154R] and S100 antibody [ab52642]. This research was approved by Animal Ethics Committee of University of Indonesia protocol (No.19-07-0852). RESULTS: There was a significant change between the 7th and 14th days (p<0.001; paired t-test) in the P1 treatment. Improvement in nerve function was found on the 14th day after being given aerobic treatment. This is indicated by the data average change in SFI scores on days 7 and 4 was from -144 to 34. This data is also supported by footprint changes for injured hindfoot data. CONCLUSION: Low intensity aerobics treatment improve the walking function and nerve function in sciatic nerve injury on day 14. This is due to the effect of physical exercise on the injured sciatic nerve.
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Dorafshar, Amir H., A. Lee Dellon, EricLee Wan, Sashank Reddy, and Victor W. Wong. "Injured Anterior Superior Alveolar Nerve Endoscopically Resected within Maxillary Sinus." Craniomaxillofacial Trauma & Reconstruction 10, no. 3 (September 2017): 208–11. http://dx.doi.org/10.1055/s-0036-1592088.
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Posttraumatic facial pain is due to an injured nerve, most often a branch of the trigeminal nerve. While surgical approaches to injuries of the supraorbital, supratrochlear, infraorbital, and inferior alveolar nerves have been reported, an injury to the anterior superior alveolar nerve (ASAN) has not been reported. An algorithm is proposed for the diagnosis of injury to the ASAN versus the infraorbital nerve itself. A case is reported in which pain relief was achieved by dividing the ASAN within the maxillary sinus, leaving the proximal end exposed within the sinus at the level of the orbital floor.
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Suter, Marc R., Michael Papaloïzos, Charles B. Berde, Clifford J. Woolf, Nicolas Gilliard, Donat R. Spahn, and Isabelle Decosterd. "Development of Neuropathic Pain in the Rat Spared Nerve Injury Model Is Not Prevented by a Peripheral Nerve Block." Anesthesiology 99, no. 6 (December 1, 2003): 1402–8. http://dx.doi.org/10.1097/00000542-200312000-00025.
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Background The mechanisms responsible for initiation of persistent neuropathic pain after peripheral nerve injury are unclear. One hypothesis is that injury discharge and early ectopic discharges in injured nerves produce activity-dependent irreversible changes in the central nervous system. The aim of this study was to determine whether blockade of peripheral discharge by blocking nerve conduction before and 1 week after nerve injury could prevent the development and persistence of neuropathic pain-like behavior in the spared nerve injury model. Methods Bupivacaine-loaded biodegradable microspheres embedded in fibrin glue were placed in a silicone tube around the sciatic nerve to produce a conduction block. After sensory-motor testing of block efficacy, a spared nerve injury procedure was performed. Development of neuropathic pain behavior was assessed for 4 weeks by withdrawal responses to stimulation (i.e., von Frey filaments, acetone, pinprick, radiant heat) in bupivacaine microspheres-treated animals (n = 12) and in controls (n = 11). Results Bupivacaine microspheres treatment produced conduction blockade with a complete lack of sensory responsiveness in the sural territory for 6 to 10 days. Once the block wore off, the degree of hypersensitivity to stimuli was similar in both groups. Conclusions Peripheral long-term nerve blockade has no detectable effect on the development of allodynia or hyperalgesia in the spared nerve injury model. It is unlikely that injury discharge at the time of nerve damage or the early onset of ectopic discharges arising from the injury site contributes significantly to the persistence of stimulus-evoked neuropathic pain in this model.
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Chi, Han-Hsiung, Jye-Chang Lee, Chih-Cheng Chen, Shih-Kuo Chen, and Chen-Tung Yen. "An Index Combining Lost and Remaining Nerve Fibers Correlates with Pain Hypersensitivity in Mice." Cells 9, no. 11 (November 4, 2020): 2414. http://dx.doi.org/10.3390/cells9112414.
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Multiple peripheral nerves are known to degenerate after nerve compression injury but the correlation between the extent of nerve alteration and pain severity remains unclear. Here, we used intravital two-photon fluorescence microscopy to longitudinally observe changes in cutaneous fibers in the hind paw of Nav1.8-Cre-tdTomato mice after chronic constriction injury (CCI). Results showed that the CCI led to variable loss of the skin nerve plexus and intraepidermal nerve fibers. The timing of Nav1.8 nerve fiber loss correlated with the development of mechanical hypersensitivity. We compared a scoring approach that assessed whole-paw nerve degeneration with an index that quantified changes in the nerve plexus and terminals in multiple small regions of interest (ROI) from intravital images of the third and fifth toe tips. We found that the number of surviving nerve fibers was not linearly correlated with mechanical hypersensitivity. On the contrary, at 14 days after CCI, the moderately injured mice showed greater mechanical hypersensitivity than the mildly or severely injured mice. This indicates that both surviving and injured nerves are required for evoked neuropathic pain. In addition, these two methods may have the estimative effect as diagnostic and prognostic biomarkers for the assessment of neuropathic pain.
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Pathak, L. "Peri-operative peripheral nerve injury." Health Renaissance 11, no. 3 (January 17, 2014): 260–66. http://dx.doi.org/10.3126/hren.v11i3.9643.
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Peripheral nerve injury in peri-operative period is the topic of interest especially for the anesthesiologists because the concentration of rest of the operation theatre team lies on the positioning of the patient required for the surgical exposure rather than towards the stretching or compression of the nerves. Etiology of peri-operative peripheral nerve injury (PPNI) is complex and multifactorial. Prevention of injury and its consequences to some extent can be done with the alertness of the concerned surgical team and the anesthesiologist. DOI: http://dx.doi.org/10.3126/hren.v11i3.9643 Health Renaissance 2013;11(3):260-266
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Devale, Maksud Mubarak, Gaurav Jatin Kadakia, Vicky Ghewarchand Jain, and Rohit Prakash Munot. "Direct electrical injury to brachial plexus." Indian Journal of Plastic Surgery 50, no. 02 (May 2017): 217–19. http://dx.doi.org/10.4103/ijps.ijps_177_16.
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ABSTRACTElectrical current can cause neurological damage directly or by conversion to thermal energy. However, electrical injury causing isolated brachial plexus injury without cutaneous burns is extremely rare. We present a case of a 17-year-old boy who sustained accidental electrical injury to left upper extremity with no associated entry or exit wounds. Complete motor and sensory loss in upper limb were noted immediately after injury. Subsequently, the patient showed partial recovery in muscles around the shoulder and in ulnar nerve distribution at 6 months. However, there was no improvement in muscles supplied by musculocutaneous, median and radial nerves. On exploration at 6 months after trauma, injury to the infraclavicular plexus was identified. Reconstruction of musculocutaneous, median and radial nerves by means of sural nerve cable grafts was performed. The patient has shown excellent recovery in musculocutaneous nerve function with acceptable recovery of radial nerve function at 1-year post-injury.
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Jack, Megan M., and Douglas E. Wright. "204 Voluntary Exercise Modulates Macrophage Polarization Following Sciatic Nerve Injury and Improves Functional Recovery in Mice." Neurosurgery 64, CN_suppl_1 (August 24, 2017): 255. http://dx.doi.org/10.1093/neuros/nyx417.204.
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Abstract INTRODUCTION Peripheral nerve injury is associated with trauma and is often amenable to surgery. Functional recovery remains a challenging clinical problem that often leads to significant morbidity. Therapies that augment surgical repair may be beneficial in functional outcomes. Macrophages are responsible for the breakdown of debris following injury as well as promotion of regenerative signals. Macrophage polarization is the process by which macrophages take on phenotypically distinct functions based on the local environment and signaling cues. Exercise has been shown to drive macrophage polarization from a pro-inflammatory M1 phenotype towards an anti-inflammatory M2 phenotype in numerous tissues, but remains uninvestigated in the peripheral nervous system. METHODS The purpose of our study was to identify how exercise affects macrophage polarization, motor and sensory function, and neuroregeneration following sciatic nerve crush. Male and female C57BL/6 mice underwent sciatic nerve crush injury and were then given access to running wheels (exercised) or not given access to running wheels (sedentary) for 4 weeks. Analysis included behavioral assessments, anatomical studies, and in vitro studies. RESULTS >Exercised mice ran an average of 2.9 km per night. Injured exercised mice were protected from the development of thermal hyperalgesia. Exercised mice had fewer paw slips on beam walk testing compared to sedentary mice. No differences were measured in mechanical sensitivity or motor coordination and balance. Motor nerve conduction velocities from injured exercised animals were significantly higher than injured sedentary animals suggesting improved nerve recovery with exercise. Injured sciatic nerves from exercised mice demonstrated increased M2 macrophages compared to sciatic nerves from injured sedentary mice. The behavioral changes and altered macrophage polarization correlated with increased epidermal nerve fiber density, improved myelination, and increased in vitro neurite outgrowth from injured exercised animals. CONCLUSION Exercise alters macrophage polarization towards an anti-inflammatory phenotype which improves repair and recovery of the injured peripheral nerve.
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D'Amelio, Louis F., David J. Musser, and Michael Rhodes. "Bilateral femoral nerve neuropathy following blunt trauma." Journal of Neurosurgery 73, no. 4 (October 1990): 630–32. http://dx.doi.org/10.3171/jns.1990.73.4.0630.
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✓ A unique case of bilateral compressive injury of the femoral nerves is reported in a 19-year-old man. Traumatic femoral nerve neuropathy following operative injury, penetrating injury, anticoagulant therapy with hemorrhage, and stretch injury has been described previously, and the literature concerning this unusual clinical problem is reviewed. Bilateral traumatic femoral nerve neuropathy resulting from compressive injury has not been previously reported.
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FULLARTON, A. C., D. V. LENIHAN, L. M. MYLES, and M. A. GLASBY. "Assessment of the Method and Timing of Repair of a Brachial Plexus Traction Injury in an Animal Model for Obstetric Brachial Plexus Palsy." Journal of Hand Surgery 27, no. 1 (February 2002): 13–19. http://dx.doi.org/10.1054/jhsb.2001.0657.
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A Sunderland type IV traction injury to the C6 root of adult sheep or newborn lamb brachial plexus was used as a model for obstetric traction injury to the C5 root in humans. In one experimental cohort the injury was created and repaired using interfascicular nerve autografts or coaxially aligned freeze-thawed skeletal muscle autografts in a group of adult sheep and in a group of newborn lambs. In a second cohort a similar injury was created and repaired either immediately or after a delay of 30 days, using either interfascicular nerve autografts or coaxially aligned freeze-thawed skeletal muscle autografts in four groups of six newborn lambs. In all cases both functional and morphometric indices of nerve regeneration were poorer in the injured and repaired nerves than in normal nerves. In lambs the method of repair made no difference and no significant differences were found for any of the indices of nerve function or morphology. In sheep the use of muscle grafts was associated with a poorer outcome than the use of nerve autografts. Where a delay of 30 days had elapsed between injury and repair, the results using nerve autografts were not significantly different. Where freeze-thawed muscle autografts had been used, the maturation of the regenerated nerve fibres after delay was significantly poorer than after immediate repair. The electrophysiological variables CVmax and jitter, which may be applied clinically, were found to be good discriminators of recovery in all of the animals and in respect of all procedures.
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McALLISTER, R. M. R., S. E. A. GILBERT, J. S. CALDER, and P. J. SMITH. "The Epidemiology and Management of Upper Limb Peripheral Nerve Injuries in Modern Practice." Journal of Hand Surgery 21, no. 1 (February 1996): 4–13. http://dx.doi.org/10.1016/s0266-7681(96)80004-0.
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This paper reports an epidemiological and clinical study of 813 patients with 1,111 peripheral nerve injuries who were treated for upper limb trauma, which included nerve injury, at two plastic surgery units in south-east England, predominantly between the years 1982 and 1991. The frequency distributions of the levels of nerve injury, and the causes of nerve injury in the sample, are presented, together with the surgical management and timing of nerve repair in these patients. 1,018 clinically suspected nerve injuries in 730 patients (91.6% of nerves, 89.8% of patients) were treated by primary nerve repair, elective delayed nerve repair or primary surgical exploration alone. Divisions of 93 nerves in 83 patients (8.3% of nerves, 10.2% of patients) were treated other than by primary repair or elective delayed repair, due to delayed referral from accident and emergency departments, resulting from missed or uncertain diagnosis at presentation or otherwise unaccounted delay in the initial referral.
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Yu, Tianhao, Yingxi Xu, Xingya Jia, and Qiang Ao. "Intraluminal Guiding Structure of Nerve Conduits for Peripheral Nerve Regeneration." Science of Advanced Materials 12, no. 1 (January 1, 2020): 56–65. http://dx.doi.org/10.1166/sam.2020.3720.
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Peripheral nerve injury that can lead to disability affects millions of people worldwide annually. As the gold standard treatment of peripheral nerve injury, autologous nerve grafts are the most widely used and effective, but the clinical application of the treatment is greatly limited by many disadvantages. Tissue engineering nerve conduits gradually become promising autologous nerve grafts alternatives to promote the regeneration of injured nerves. This review places emphasis on tissue engineering designs of physical and topographic guiding structure inside nerve conduits in order to promote the migration of Schwann cells and directional regrowth of axons towards target organs. Various strategies of intraluminal guiding cues have been described and analyzed, including the incorporation with the tissue with natural basement membrane, collagen, microfilaments, intraluminal multi-channel and grooves in the inner wall. Recently, much progress has been made in the development of tissue engineering nerve conduits, but poor curative effect and deficiencies such as axon dispersion and malposition healing still remain unsolved, many crucial factors need to be considered in further research before clinical practices.
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Deng, Kangli, Brian M. Balog, Dan Li Lin, Brett Hanzlicek, Qi-Xiang Song, Hui Zhu, and Margot S. Damaser. "Daily bilateral pudendal nerve electrical stimulation improves recovery from stress urinary incontinence." Interface Focus 9, no. 4 (June 14, 2019): 20190020. http://dx.doi.org/10.1098/rsfs.2019.0020.
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Stress urinary incontinence (SUI) in women is strongly associated with childbirth which injures the pudendal nerve (PN) and the external urethral sphincter (EUS) during delivery. Electrical stimulation (ES) can increase brain-derived neurotrophic factor (BDNF) expression in injured neurons, activate Schwann cells and promote neuroregeneration after nerve injury. The aim of this study was to determine if more frequent ES would increase recovery from SUI in a rat model. Forty female Sprague–Dawley rats underwent either sham injury or pudendal nerve crush (PNC) and vaginal distention (VD) to establish SUI. Immediately after injury, electrodes were implanted at the pudendal nerve bilaterally. Each injured animal underwent sham ES, twice per week ES (2/week), or daily ES of 1 h duration for two weeks. Urethral and nerve function were assessed with leak point pressure (LPP), EUS electromyography and pudendal nerve sensory branch potential (PNSBP) recordings two weeks after injury. LPP was significantly increased after daily ES compared to 2/week ES. EUS neuromuscular junction innervation was decreased after injury with sham ES, but improved after 2/week or daily ES. This study demonstrates that daily bilateral ES to the pudendal nerve can accelerate recovery from SUI. Daily ES improved urethral function more than 2/week ES.
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Yamamoto, Tatsuo, and Yoshihiko Sakashita. "Differential Effects of Intrathecally Administered Morphine and Its Interaction with Cholecystokinin-B Antagonist on Thermal Hyperalgesia following Two Models of Experimental Mononeuropathy in the Rat." Anesthesiology 90, no. 5 (May 1, 1999): 1382–91. http://dx.doi.org/10.1097/00000542-199905000-00023.
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Background Cholecystokinin-B receptor activation has been reported to reduce morphine analgesia. Neuropathic pain is thought to be relatively refractory to opioids. One possible mechanisms for a reduced effect of morphine on neuropathic pain is the induction of cholecystokinin in the spinal cord by nerve injury. The authors evaluated the role of the spinal cholecystokinin-B receptor on morphine analgesia in two rat neuropathic pain models: chronic constriction injury and partial sciatic nerve injury. Methods A chronic constriction injury is created by placing four loosely tied ligatures around the right sciatic nerve. A partial sciatic nerve injury was created by tight ligation of one third to one half of the right sciatic nerve. All drugs were injected intrathecally 7 and 11 days after the nerve injury. The effect of the drugs was reflected in the degree of paw withdrawal latency to thermal nociceptive stimulation. The paw withdrawal latencies of injured and uninjured paws were measured 5, 15, 30, and 60 min after the drugs were injected. Results In the chronic constriction injury model, intrathecal morphine increased the paw withdrawal latencies of injured and uninjured paws. PD135158, a cholecystokinin-B receptor antagonist, potentiated the analgesic effect of morphine on injured and uninjured paws. In the partial sciatic nerve injury model, the effect of morphine on the injured paw was less potent than that on the uninjured paw, and PD135158 potentiated the morphine analgesia in the uninjured paw and had only a minor effect on the morphine analgesia in the injured paw. Conclusions The effectiveness of morphine for thermal hyperalgesia after nerve injury depends on the type of nerve injury. The role of the cholecystokinin-B receptor in morphine analgesia in thermal hyperalgesia after nerve injury also depends on the type of nerve injury.
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Haroon, Kaisar, Tania Taher, Shafiul Alam, Abdullah Alamgir, Md Arif Reza, and Sk Sader Hossain. "Nerve Anastomosis-our Experience of Thirteen Cases." Bangladesh Journal of Neurosurgery 9, no. 1 (August 30, 2019): 33–38. http://dx.doi.org/10.3329/bjns.v9i1.42922.
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Background: Peripheral nerve injury is a common condition. Though it is not life threatening, it may cause disability to a person. In this study we have analysed our experience of anastomosis of injured nerves. Materials and methods: This is an observational study that was done within a period from January 2014 to December 2018. 13 patients with injury to the nerves were operated upon. There were 11 male and 2 female patients. All patients were followed up in OPD upto one and half years. 5 patients were lost from follow up, of these, two were female. Results: After surgery, touch returned in 5 patients. Of motor function,there was no improvement in 1 patient, grade 1 in 1 patient, grade 2 in 4 patients and grade 3 in 3 patients. Those who came earlier had better outcome, so had those with small injury and distal to the limb. Conclusion: peripheral nerve injury has to be repaired as soon as possible. The sooner it can be done the better will be the outcome.
Bang. J Neurosurgery 2019; 9(1): 33-38
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Sobel, E., EY Huang, and CB Wieting. "Drop foot as a complication of acupuncture injury and intragluteal injection." Journal of the American Podiatric Medical Association 87, no. 2 (February 1, 1997): 52–59. http://dx.doi.org/10.7547/87507315-87-2-52.
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Two cases of peroneal nerve palsy resulting in drop foot are reported. One case involves direct injury to the common peroneal nerve by an acupuncture needle. A second case describes sciatic nerve injury caused by an intragluteal injection. Although acupuncture injury at the spinal cord level and the peripheral nerves of the upper extremity has been documented, peroneal nerve palsy resulting from acupuncture therapy has not been previously reported.
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Park, Hye Ran, Gwang Soo Lee, Il Sup Kim, and Jae-Chil Chang. "Brachial Plexus Injury in Adults." Nerve 3, no. 1 (April 30, 2017): 1–11. http://dx.doi.org/10.21129/nerve.2017.3.1.1.
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Grabb, Paul A., A. Leland Albright, Robert J. Sclabassi, and Ian F. Pollack. "Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children." Neurosurgical Focus 1, no. 2 (August 1996): E3. http://dx.doi.org/10.3171/foc.1996.1.2.4.
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The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculature were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year. Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries. Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.
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Grabb, Paul A., A. Leland Albright, Robert J. Sclabassi, and Ian F. Pollack. "Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children." Journal of Neurosurgery 86, no. 1 (January 1997): 1–4. http://dx.doi.org/10.3171/jns.1997.86.1.0001.
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✓ The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculatures were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year. Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries. Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.
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Ye, Xuan, Yun-Dong Shen, Jun-Tao Feng, and Wen-Dong Xu. "Nerve fascicle transfer using a part of the C-7 nerve for spinal accessory nerve injury." Journal of Neurosurgery: Spine 28, no. 5 (May 2018): 555–61. http://dx.doi.org/10.3171/2017.8.spine17582.
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OBJECTIVESpinal accessory nerve (SAN) injury results in a series of shoulder dysfunctions and continuous pain. However, current treatments are limited by the lack of donor nerves as well as by undesirable nerve regeneration. Here, the authors report a modified nerve transfer technique in which they employ a nerve fascicle from the posterior division (PD) of the ipsilateral C-7 nerve to repair SAN injury. The technique, first performed in cadavers, was then undertaken in 2 patients.METHODSSix fresh cadavers (12 sides of the SAN and ipsilateral C-7) were studied to observe the anatomical relationship between the SAN and C-7 nerve. The length from artificial bifurcation of the middle trunk to the point of the posterior cord formation in the PD (namely, donor nerve fascicle) and the linear distance from the cut end of the donor fascicle to both sites of the jugular foramen and medial border of the trapezius muscle (d-SCM and d-Traps, respectively) were measured. Meanwhile, an optimal route for nerve fascicle transfer (NFT) was designed. The authors then performed successful NFT operations in 2 patients, one with an injury at the proximal SAN and another with an injury at the distal SAN.RESULTSThe mean lengths of the cadaver donor nerve fascicle, d-SCM, and d-Traps were 4.2, 5.2, and 2.5 cm, respectively. In one patient who underwent proximal SAN excision necessitated by a partial thyroidectomy, early signs of reinnervation were seen on electrophysiological testing at 6 months after surgery, and an impaired left trapezius muscle, which was completely atrophic preoperatively, had visible signs of improvement (from grade M0 to grade M3 strength). In the other patient in whom a distal SAN injury was the result of a neck cyst resection, reinnervation and complex repetitive discharges were seen 1 year after surgery. Additionally, the patient’s denervated trapezius muscle was completely resolved (from grade M2 to grade M4 strength), and her shoulder pain had disappeared by the time of final assessment.CONCLUSIONSNFT using a partial C-7 nerve is a feasible and efficacious method to repair an injured SAN, which provides an alternative option for treatment of SAN injury.
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Blondet, Brigitte, Gilles Carpentier, Fouad Lafdil, and Jose Courty. "Pleiotrophin Cellular Localization in Nerve Regeneration after Peripheral Nerve Injury." Journal of Histochemistry & Cytochemistry 53, no. 8 (August 2005): 971–77. http://dx.doi.org/10.1369/jhc.4a6574.2005.
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Pleiotrophin (PTN) is a member of the family of heparin-binding growth factors that displays mitogenic activities and promotes neurite outgrowth in vitro. In vivo, PTN is widely expressed along pathways of developing axons during the late embryonic and early postnatal period. Although the level of PTN gene expression is very low during adulthood, activation of the gene may occur during recovery from injury and seems to play an important role in tissue regeneration processes. In this study, we investigated whether PTN was involved in the regenerative process of injured peripheral nerves. To refer localization of the fluorescent markers to myelinated axons, we developed a specific computer tool for colocalization of fluorescence images with phase contrast images. Immunohistochemical analysis showed PTN in different types of nonneural cells in distal nerve segments, including Schwann cells, macrophages, and endothelial cells, but not in axons. Schwann cells exhibited PTN immunoreactivity as early as 2 days after injury, whereas PTN-positive macrophages were found 1 week later. Strong PTN immunoreactivity was noted in endothelial cells at all time points. These findings support the idea that PTN participates in the adaptive response to peripheral nerve injury. A better understanding of its contribution may suggest new strategies for enhancing peripheral nerve regeneration.
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Miclescu, Adriana, Antje Straatmann, Panagiota Gkatziani, Stephen Butler, Rolf Karlsten, and Torsten Gordh. "Chronic neuropathic pain after traumatic peripheral nerve injuries in the upper extremity: prevalence, demographic and surgical determinants, impact on health and on pain medication." Scandinavian Journal of Pain 20, no. 1 (December 18, 2019): 95–108. http://dx.doi.org/10.1515/sjpain-2019-0111.
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AbstractBackground and aimsAside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated with chronic neuropathic pain after nerve injuries in the upper extremity were assessed.MethodsA standardized data collection template was employed prospectively and retrospectively for all patients with traumatic nerve injuries accepted at the Hand Surgery Department, Uppsala, Sweden between 2010 and 2018. The template included demographic data, pain diagnosis, type of injured nerve, level of injury, date of the lesion and repair, type of procedure, reoperation, time since the procedure, S-LANSS questionnaire (Self report-Leeds Assessment of Neuropathic Symptoms and Signs), RAND-36 (Item short form health survey), QuickDASH (Disability of Shoulder, Arm and Hand) and additional questionnaires concerned medication, pain intensity were sent to 1,051 patients with nerve injuries. Partial proportional odds models were used to investigate the association between persistent pain and potential predictors.ResultsMore than half of the patients undergoing a surgical procedure developed persistent pain. Prevalence of neuropathic pain was 73% of the patients with pain (S-LANSS ≥ 12 or more). Multivariate analysis indicated that injury of a major nerve OR 1.6 (p = 0.013), years from surgery OR 0.91 (p = 0.01), younger age OR 0.7 (p < 0.001), were the main factors for predicting pain after surgery. The type of the nerve injured was the strongest predictor for chronic pain with major nerves associated with more pain (p = 0.019).ConclusionsA high prevalence of chronic pain and neuropathic pain with a negative impact on quality of life and disability were found in patients after traumatic nerve injury. Major nerve injury, younger age and less time from surgery were predictors for chronic pain.
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Bhushan, Suhas N., and Arun H. N. "Management of neck dissection complications in head and neck cancers." International Surgery Journal 6, no. 3 (February 25, 2019): 664. http://dx.doi.org/10.18203/2349-2902.isj20190811.
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Background: Neck dissection is a vital step in eradicating the regional lymph node metastasis. The aim of study is to establish the incidence of post-operative complications in patients undergoing neck dissection and its management.Methods: A cross-sectional retrospective study of 82 patients admitted in the department of general surgery, BMCRI from June 2016 till January 2018 who underwent neck dissections for various head and neck cancers. These patients were studied for post-operative complications and their management.Results: Intra-operative complication being vascular injury (IJV repaired-2 cases), nerve injury and lymphatic injury (thoracic duct identified and serial ligation in 3 cases and right-side lymphatic duct injury in l case). Immediate post-operative complication being hemorrhage among 2 cases, re-opened in 1 case and managed by compression dressing in 1 case. Delayed complications being nerve injury among which marginal mandibular nerve injured in 5 cases, phrenic nerve in 1 case, vagus nerve in 1 case, spinal accessory nerve in 13 cases (palsy in 3 cases and praxia in 10 cases). Another delayed complication being chylorrhoea in 2 cases which was managed conservatively. Wound dehiscence noted among 4 cases, 2 of them were major (1 required redo flap, 1 managed conservatively) and 2 of them were minor complications.Conclusions: In our study, there were no peri-operative deaths. Nerves were most common structures injured. A careful pre-operative assessment, meticulous surgical technique, high quality post-operative care and appropriate rehabilitation help in preventing and managing complications.
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Liu, Yi, Jinlong Zhang, Yuyu Sun, Xiaogang Zhou, Kun Yuan, and Zhiming Cui. "Study on the function of self-polymerizing peptide nanofiber material combined with nerve growth factor-mediated RNA repair for nerve injury treatment in rabbits with the osteofascial compartment syndrome." Materials Express 10, no. 7 (October 1, 2020): 1149–54. http://dx.doi.org/10.1166/mex.2020.1713.
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The present study aimed to establish an animal model of the osteofascial compartment syndrome (OFCS) in hind legs of rabbits, and to repair an early nerve injury using the self-polymerized peptide nanofiber material that was laced with nerve growth factors (NGFs). An animal model of the compartment syndrome was established using the tourniquet method. The intrafascial pressure of rabbit legs at different time points was measured after successful modeling. Western blotting was used to assess the proliferation of nerve cells after injury. After incision and decompression, the repair group was implanted with the self-polymerized peptide nanofiber material in combination with NGFs at the nerve injury sites for repair of the injured nerves. Rabbit hind leg nerve specimens were collected from experimental rabbits (control group), rabbits 5 days after injury (unrepaired group), and rabbits 5 days after injury (repaired group), and hematoxylin-eosin (HE) staining analysis and immunofluorescence experiments were also performed. After loosening the tourniquet, the intra-fascial pressure peaked on the 1st day after injury and then gradually decreased. A western blot showed low expression of the proliferating cell nuclear antigens (PCNAs) in the control group, as it began to increase 4 h after injury, peaked 5 days after injury (P < 0.05), and then gradually decreased. Meanwhile, the tissue morphology of the repair group was better than that of the non-repair group. Fluorescence double labeling results showed that the proliferation of nerve cells in the repair group increased significantly, and S100 and DAPI co-labeling intensities increased significantly. The early application of the self-polymerizing peptide nanofiber material combined with NGF exhibited evident effects on the nerve injury treatment in the osteofascial compartment syndrome.