Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimization of the macroscopic holes silk^(+) tNGC approach containing macroscopic holes might result in improved grafting technology suitable for future clinical use.

Surgicopathological classification of hepatic space-occupying lesions:A single-center experience with literature review

Accompanying rapid developments in hepatic surgery,the number of surgeries and identifications of histological types of primary hepatic space-occupying lesions (PHSOLs) have increased dramatically.This has led to many changes in the surgicopathological spectrum of PHSOLs,and has contributed to a theoretical basis for modern hepatic surgery and oncological pathology.Between 1982 and 2009 at the Eastern Hepatobiliary Surgery Hospital (EHBH) in Shanghai,31 901 patients underwent surgery and were diagnosed as having a PHSOL.In this paper,we present an analysis of the PHSOL cases at the EHBH for this time period,along with results from a systematic literature review.We describe a surgicopathological spectrum comprising more than 100 types of PHSOLs that can be stratified into three types:tumor-like,benign,and malignant.We also stratified the PHSOLs into six subtypes derived from hepatocytes;cholangiocytes;vascular,lymphoid and hemopoietic tissues;muscular,fibrous and adipose tissues;neural and neuroendocrine tissues;and miscellaneous tissues.The present study provides a new classification system that can be used as a current reference for clinicians and pathologists to make correct diagnoses and differential diagnoses among various PHSOLs.

Role of the nucleus tractus solitarii in the protection of pre-moxibustion on gastric mucosal lesions

Previous studies have shown that somatic sensation by acupuncture and visceral nociceptive stimulation can converge in the nucleus tractus solitarii where neurons integrate signals impact- ing on the function of organs. To explore the role of the nucleus tractus solitarii in the protective mechanism of pre-moxibustion on gastric mucosa, nucleus tractus solitarii were damaged in rats and pre-moxibustion treatment at the Zusanli （ST36） point followed. The gastric mucosa was then damaged by the anhydrous ethanol lavage method. Morphological observations, enzyme linked immunosorbent assays, and western immunoblot analyses showed that gastric mucosa surface lesion and the infiltration of inflammatory cells were significantly ameliorated after pre-moxibustion treatment. Furthermore, the gastric mucosal damage index and somatostatin level were reduced, and epidermal growth factor content in the gastric mucosa and heat-shock protein-70 expression were increased. These results were reversed by damage to the nucleus tractus solitarii. These findings suggest that moxibustion pretreatment at the Zusanli point is protective against acute gastric mucosa injury, and nucleus tractus solitarii damage inhibits these responses. Therefore, the nucleus tractus solitarii may be an important area for regulating the signal transduction of the protective effect of pre-moxibustion on gastric mucosa.

Florid reactive periostitis ossificans of the humerus: Case report and differential diagnosis of periosteal lesions of long bones

A case of florid reactive periostitis ossificans(RPO) arising in a long bone is presented. This is a rare bone proliferation with a pronounced periosteal reaction. Less than 100 cases have been described in the literature with far fewer outside the bones of the hand, feet, fingers, and toes. Although the etiology is unknown, a relationship to preceding trauma is suggested. The imaging and histologic features show an overlap with other bone lesions including bizarre parosteal osteochondromatous proliferation, subungual exostosis, and malignant surface tumors of bone and cartilage which include, periosteal and parosteal osteosarcoma. It is important to recognize the clinical presentation and diagnostic features of RPO as a benign entity so that it is not mistaken for a more aggressive neoplasm. We present a case of a right distal humeral lesion that on histopathological review revealed florid RPO. This diagnosis was not suspected on imaging studies, but was made on open biopsy of the mass. The patient remains disease free, years postoperatively. In addition to presenting this unique case report, we review the pertinent literature, and offer a differential diagnosis and treatment strategy for its management.

Rhesus monkey neural stem cell transplantation promotes neural regeneration in rats with hippocampal lesions

Rhesus monkey neural stem cells are capable of differentiating into neurons and glial cells. Therefore, neural stem cell transplantation can be used to promote functional recovery of the nervous system. Rhesus monkey neural stem cells （1 ×10^5 cells/μL） were injected into bilateral hippocampi of rats with hippocampal lesions. Confocal laser scanning microscopy demonstrated that green fluorescent protein-la- beled transplanted cells survived and grew well. Transplanted cells were detected at the lesion site, but also in the nerve fiber-rich region of the cerebral cortex and corpus callosum. Some transplanted cells differentiated into neurons and glial cells clustering along the ventricular wall, and integrated into the recipient brain. Behavioral tests revealed that spatial learning and memory ability improved, indicating that rhesus monkey neural stem cells noticeably improve spatial learning and memory abilities in rats with hippocampal lesions.

Role of Ultrasonography in Evaluation of Peripheral Nerves

Ultrasonography is first line, cost-effective modality in imaging of peripheral nerves. High frequency probes allow high resolution imaging of peripheral nerves located at relatively superficial location. USG can diagnose and localize various pathologies that involve the peripheral nerves such as traumatic, inflammatory, infective, neoplastic, and traumatic neuropathies. USG exceptionally has an important role to play in evaluation of patients with suspected nerve injury, as MRI may not differentiate neural contusion from nerve disruption. Neurapraxic injury is seen as swollen nerve with hypoechoic appearance.

Unusual cause of lesions in the descending duodenum and liver:A case report and review of literature

The descending duodenum is rarely involved in Schistosoma japonicum(S. japonicum) infection. Here, we report a case of acute Schistosoma infection, which presented with abdominal pain, abdominal distension and irregular fever. Tumor-like lesions were observed in the descending duodenum. Simultaneously, heterogeneity in hepatic perfusion was demonstrated by dynamic computed tomography scanning. Biopsy of the descending duodenum showed the deposition of Schistosoma eggs. Following administration of the antihelminthic drug praziquantel, the patient showed rapid clinical improvement. In conclusion, we report a patient with acute S. japonicum infection presenting as tumor-like lesions in the descending duodenum and heterogeneity of blood perfusion in liver parenchyma.

Impulse magnetic stimulation facilitates synaptic regeneration in rats following sciatic nerve injury

The current studies describing magnetic stimulation for treatment of nervous system diseases mainly focus on transcranial magnetic stimulation and rarely focus on spinal cord magnetic stimulation. Spinal cord magnetic stimulation has been confirmed to promote neural plasticity after injuries of spinal cord, brain and peripheral nerve. To evaluate the effects of impulse magnetic stimulation of the spinal cord on peripheral nerve regneration, we compressed a 3 mm segment located in the middle third of the hip using a sterilized artery forceps to induce ischemia. Then, all animals underwent impulse magnetic stimulation of the lumbar portion of spinal crod and spinal nerve roots daily for 1 month. Electron microscopy results showed that in and below the injuryed segment, the inflammation and demyelination of neural tissue were alleviated, apoptotic cells were reduced, and injured Schwann cells and myelin fibers were repaired. These findings suggest that high-frequency impulse magnetic stimulation of spinal cord and corresponding spinal nerve roots promotes synaptic regeneration following sciatic nerve injury.

Ultrasonographic reference values for assessing normal radial nerve ultrasonography in the normal population

High-resolution ultrasound has been used recently to characterize median and ulnar nerves, but is seldom used to characterize radial nerves. The radial nerve is more frequently involved in en- trapment syndromes than the ulnar and median nerves. However, the reference standard for normal radial nerves has not been established. Thus, this study measured the cross-sectional areas of radial nerves of 200 healthy male or female volunteers, aged 18 to 75, using high-resolution ultrasound. The results showed that mean cross-sectional areas of radial nerves at 4 cm upon the lateral epicondyle of the humerus and mid-humerus （midpoint between the elbow crease and axilla） were 5.14± 1.24 and 5.08 ± 1.23 mm2, respectively. The age and the dominant side did not affect the results, but the above-mentioned cross-sectional areas were larger in males （5.31± 1.25 and 5.19 ±1.23 mm2） than in females （4.93 ± 1.21 and 4.93 ± 1.23 mm2, respectively）. In addition, the cross-sectional areas of radial nerves were positively correlated with height and weight （r = 0.38, 0.36, respectively, both P 〈 0.05）. These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evalua- tion of peripheral neuropathies.

MK-801 attenuates lesion expansion following acute brain injury in rats: a meta-analysis

OBJECTIVE: To evaluate the efficacy and safety of MK-801 and its effect on lesion volume in rat models of acute brain injury.DATA SOURCES: Key terms were "stroke","brain diseases","brain injuries","brain hemorrhage, traumatic","acute brain injury","dizocilpine maleate","dizocilpine","MK-801","MK801","rat","rats","rattus" and "murine". PubMed, Cochrane library, EMBASE, the China National Knowledge Infrastructure, WanFang database, the VIP Journal Integration Platform(VJIP) and SinoMed databases were searched from their inception dates to March 2018.DATA SELECTION: Studies were selected if they reported the effects of MK-801 in experimental acute brain injury. Two investigators independently conducted literature screening, data extraction, and methodological quality assessments.OUTCOME MEASURES: The primary outcomes included lesion volume and brain edema. The secondary outcomes included behavioral assessments with the Bederson neurological grading system and the water maze test 24 hours after brain injury.RESULTS: A total of 52 studies with 2530 samples were included in the systematic review. Seventeen of these studies had a high methodological quality. Overall, the lesion volume(34 studies, n = 966, MD =-58.31, 95% CI:-66.55 to-50.07;P < 0.00001) and degree of cerebral edema(5 studies, n = 75, MD =-1.21, 95% CI:-1.50 to-0.91;P < 0.00001) were significantly decreased in the MK-801 group compared with the control group. MK-801 improved spatial cognition assessed with the water maze test(2 studies, n = 60, MD =-10.88, 95% CI:-20.75 to-1.00;P = 0.03) and neurological function 24 hours after brain injury(11 studies, n = 335, MD =-1.04, 95% CI:-1.47 to-0.60;P < 0.00001). Subgroup analysis suggested an association of reduction in lesion volume with various injury models(34 studies, n = 966, MD =-58.31, 95% CI:-66.55 to-50.07;P = 0.004). Further network analysis showed that 0–1 mg/kg MK-801 may be the optimal dose for treatment in the middle cerebral artery occlusion animal model.CONCLUSION: MK-801 effectively reduces brain lesion volume and the degree of cerebral edema in rat models of experimental acute brain injury, providing a good neuroprotective effect. Additionally, MK-801 has a good safety profile, and its mechanism of action is well known. Thus, MK-801 may be suitable for future clinical trials and applications.

Neuronal injury in the motor cortex after chronic stroke and lower limb motor impairment: a voxelbased lesion symptom mapping study

Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro- nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deficits expected after damage to the cortical motor system due to stroke. These findings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.

Severer nodular lesion in white matter than in gray matter in simian immunodeficiency virus-infected monkey, but not closely correlated with viral infection

Immune cell accumulation and white matter anomaly are common features of HIV(human immunodeficiency virus)-infected patients in combination antiretroviral therapy(cART) era.Neuroimaging tests on cART treated patients displayed prominent diffuse white matter lesions.Notably,immune cell nodular lesion(NL) was a conspicuous type of pathological change in HIV/SIV(simian immunodeficiency virus) infected brain before cART.Therefore,we used SIV infected brain to investigate the distribution of those NLs in gray and white matters.We found a significant higher number of NLs in white matter than that in gray matter.However,virus infection correlated with macrophage NLs but not with microglia NLs,especially in white matter.In addition,NLs interrupted white matter integrity more severely,since even tiny nodules could disconnect nerve fibers in white matter tracts.In the gray matter with dense myelinated axons,NLs obviously encroached those fibers;in the area of few myelinated axons,small nodules well co-localized with extracellular matrix between neurons.

维生素B_(12)缺乏引起的快速进展性痴呆、不自主运动1例

报告1例41岁男性,以快速进行性加重的记忆力减退2个月,发作性四肢抖动2周为主要表现。查体示言语不利,记忆力、注意力、理解力、定向力均下降。血清维生素B_(12)水平下降,血清抗胃壁细胞抗体、抗内因子抗体阳性,血液分析提示大细胞性贫血,神经心理量表提示多个认知域功能损害,电生理检查提示周围神经损害,脑脊液及影像学检查未见异常。诊断为维生素B_(12)缺乏性痴呆,维生素B_(12)缺乏相关的不自主运动,恶性贫血。给予补充B族维生素及叶酸,认知功能损害明显改善,肢体抖动症状消失。报告本病例旨在提高临床医生对于维生素B_(12)缺乏导致痴呆、不自主运动的认识,以早期诊断及治疗。

急性脑梗死患者病灶体积及预后的MRI评价

目的探究脑梗死患者MRI表现与病灶体积、神经损害及预后的相关性。方法纳入辽宁省老年病医院2019年1月~2022年9月收治的脑梗死患者297例,分析其MRI表现,依据MRI检查计算病灶体积,采取Pearson相关分析病灶体积与神经损害(NIHSS评分)的相关性,绘制受试者工作特征(ROC)曲线分析病灶体积对预后的预测价值。结果45例MRI检查时处于超急性期,常规MRI扫描并未见异常表现,扩散加权成像(DWI)呈高信号,表观扩散系数(ADC)低信号,磁共振灌注成像(PWI)表现为低灌注;另252例急性期患者常规MRI扫描可见T_(1)WI低信号,T_(2)WI高信号,液体衰减反转恢复序列(FLAIR)、DWI均呈高信号表达,ADC则呈低信号。脑梗死患者病灶体积与NIHSS评分呈显著正相关(r=0.595,P<0.01),且病灶体积预测脑梗死患者预后不良的曲线下面积为0.821(95%CI:0.760~0.882),以8.467 mm3为临界值,敏感度及特异度分别为79.10%、85.30%。结论脑梗死患者MRI表现可因病程呈差异化,且MRI测得病灶体积与神经功能损伤密切相关,对预后有一定预测价值。

高频超声对四肢神经肿瘤样病变的诊断价值

目的探讨高频超声对四肢神经肿瘤样病变的诊断价值。方法选择经手术及病理诊断的四肢神经肿瘤样占位患者30例,其中男性14例,女性16例;年龄6~81岁,平均年龄50.3岁;肿块直径0.4~11.2 cm,平均直径3.4 cm。患者均行高频超声检查,观察肿块的位置、形态、大小、边界、内部回声及血流情况,并与术中肿块定位及术后病理结果进行对照,对肿块超声特征进行分析。结果30例神经肿块中良性肿块27例,恶性肿块3例;其中神经鞘瘤19例,其余11例。超声定位诊断符合率73.3%(22/30),定性诊断符合率53.3%(16/30);其中创伤性神经瘤诊断符合率100.0%(2/2),神经鞘瘤诊断符合率73.7%(14/19),良性肿块中1例误诊为恶性肿块,术后病理诊断为结节性筋膜炎。超声表现为76.7%(23/30)肿块呈“鼠尾征”;83.3%(25/30)肿块为低回声;8例肿块有靶征,均为神经鞘瘤;76.7%(23/30)肿块形态规则,7例形态不规则,其中1例结节性筋膜炎呈多发“筋膜尾征”;53.3%(16/30)神经肿块内见1~2级血流。2例肿块出现相连神经干肿胀,1例淋巴瘤,1例神经鞘瘤。结论四肢神经肿瘤样病变中以神经鞘瘤最多见。超声对诊断四肢神经肿瘤样病变具有较高的准确度。

补阳还五汤加减治疗气虚血瘀型糖尿病足效果分析

目的分析补阳还五汤加减治疗气虚血瘀型糖尿病足的临床效果。方法选取2020年11月至2022年11月项城市中医院收治的82例气虚血瘀型糖尿病足患者作为研究对象,按照是否应用补阳还五汤加减将其分为观察组(41例)与对照组(41例),观察组患者在腰交感神经毁损术治疗基础上联合应用补阳还五汤加减,对照组患者单纯行腰交感神经毁损术治疗,对比观察两组患者中医证候积分、血液流变学状态、疼痛情况、下肢供血情况与生活质量。结果治疗6周后,观察组患者肢体症状、局部皮肤、精神神志、舌脉积分均明显低于对照组(t=4.111、5.122、4.339、4.913,P均<0.001),全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数以及疼痛评分亦均明显低于对照组(t=2.999、3.309、5.588、7.532、4.613,P=0.004、P=0.001、P<0.001、P<0.001、P<0.001),踝肱指数(ABI)、2型糖尿病患者生活质量评定量表(DMQLS)评分均明显高于对照组(t=2.316、5.248,P=0.023、P<0.001)。结论与单纯应用腰交感神经毁损术治疗相比,在腰交感神经毁损术基础上联合应用补阳还五汤加减治疗糖尿病足,更能显著改善患者血液流变学状态及下肢供血情况,减轻疼痛等症状,提高其生活质量。

血管源性脑白质病变的视网膜成像研究进展

血管源性脑白质病变(White Matter Lesions, WMLs)在老年人群中发病率高,往往引起血管性认知障碍和痴呆。视网膜血管在胚胎学起源和解剖结构上类似于脑小血管,而视网膜神经纤维层又是大脑的延伸白质。近年来越来越多的研究证实WMLs可引起视网膜改变,本综述总结了现有的研究结果,概述了WMLs患者视网膜成像临床研究现状,以期指导临床对WMLs的筛查和预防。

“神经生长液”合剂促进神经损伤修复实验观察

在确定含有促神经生长有效成份的单味草药的基础上，按照中医药理论组合成一种新型方剂─“神经生长液”口服液合剂。经损伤坐骨神经的ＳＤ大鼠服用后的实验结果表明，“神经生长液”口服液合剂，具有促进损伤神经恢复功能的作用。

膝关节置换术中腓总神经损伤的原因与预防

[目的]了解膝关节置换术(TKA)中腓总神经损伤的原因及预防要点。[方法]回顾总结本院1996年1月～2007年6月2000例初次TKA术后腓总神经麻痹患者的致伤原因。6例新鲜完整正常人体下肢标本模拟行TKA术,观察术中容易损伤腓总神经的操作步骤。[结果]9(0.45%)例患者术中腓总神经出现不明原因损伤。标本模拟手术过程证实,术中可能导致腓总神经损伤的高危操作依次为:①松解股骨后外侧关节囊、腓肠肌外侧头时,助手自后向前环抱提拉股骨远端将腓总神经压迫贴近股骨,后外侧骨面大大增加腓总神经挫伤几率,且术后多为其深、浅支同时出现症状。②外侧Hoffman板钩放置位置偏于外侧副韧带后侧或深度过大,钩尖部在运动中容易划伤腓总神经,术后多为深支或浅支的不全损伤。③安装假体试模后,为纠正残余屈曲角度,强力完全伸直或过仰,容易导致腓总神经牵拉伤。[结论]术中松解后外侧关节囊、腓肠肌外侧头时,应该避免助手自后向前环抱股骨远端向上提拉。注意Hoffman板钩位置、插入方向及其深度。避免强力过伸膝关节。

老年性痴呆病因病机从肾论

近年来随着老龄化社会的发展趋势,老年性痴呆已成为严重威胁老年人身心健康的疾病。文章从"肾"而论其病因病机,肾藏五脏六腑之精,主骨生髓,上通于脑,肾虚则脑髓不足,神机失用。与现代医学研究相结合,肾精亏虚导致神经内分泌紊乱,形成渐进性病理改变。因此,肾的兴衰对老年性痴呆具有重要影响。