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Gu X, Yi S, Deng A, Liu H, Xu L, Gu J, Gu X. Combined use of chitosan-PGLA nerve grafts and bone marrow mononuclear cells to repair a 50-mm-long median nerve defect combined with an 80-mm-long ulnar nerve defect in the human upper arm. Curr Stem Cell Res Ther 2022; 17:389-397. [PMID: 35379140 DOI: 10.2174/1574888x17666220404195534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Severe peripheral nerve injury, especially the long-distance peripheral nerve defect caused severe functional disability to patients. And there is always a lack of effective and less side effects of repair methods for clinics. A case study was performed to observe the regenerative outcomes of the surgical repair of long-distance peripheral nerve defects in the upper arm with chitosan-poly(glycolide-co-lactide) (PGLA) nerve grafts combined with bone marrow mononuclear cells (BMMCs). METHODS The right upper arm of a 29-year-old woman was injured, leaving a 50-mm-long median nerve defect, an 80-mm-long ulnar nerve defect, and muscle and blood vessel disruptions. The nerve defects were repaired by implanting BMMC-containing chitosan-PGA nerve grafts on the 40th day after injury. A series of functional assessments were carried out from 2 weeks to 66 months after surgical repair. Sensory function was assessed by the pinprick test, two-point discrimination test and Semmes-Weinstein monofilament test. Motor function was evaluated by the range of motion of the wrist joint and muscle power. Autonomic function was monitored by laser-Doppler perfusion imaging (LDPI). Tissue morphology was observed through ultrasonic investigations. RESULTS No adverse events, such as infection, allergy, or rejection, caused by the treatment were detected during the follow-up period. Sensory and pinprick nociception in the affected thumb, index, and middle fingers were restored gradually from the 6th month after surgery. The monofilament tactile sensation was 0.4 g in the terminal finger pulp of the thumb and index finger, 2.0 g in the middle finger, and greater than 300 g in the ring finger and little finger at the 66th month. Motor function recovery was detected at the 5th month after surgery, when the muscle strength of the affected forearm flexors began to recover. At the 66th month after surgery, the patient's forearm flexor strength was grade 4, with 80° of palmar flexion, 85° of dorsal extension, 8° of radial deviation, 40° of ulnar deviation, 40° of anterior rotation, and 85° of posterior rotation of the affected wrist. The patient could perform holding, picking up, and some other daily activities with the affected hand. The patient's sweating function of the affected hand was close to the level of the healthy hand. LDPI showed that the skin blood flow perfusion was significantly increased, with perfusion similar to on the normal side in some areas. Neuromusculoskeletal ultrasonography showed the presence of nerve structures. CONCLUSIONS These results suggest that chitosan-PGLA nerve grafts combined with BMMCs could effectively repair long-distance nerve defects and achieve good clinical results.
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Affiliation(s)
- Xiaokun Gu
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair, Department of Hand Surgery, Affifiliated Hospital of Nantong University, 20# Xisi Road, Nantong, Jiangsu 226001, P.R. China
| | - Sheng Yi
- Key Laboratory of Neuroregeneration, Ministry of Education and Jiangsu Province, Coinnovation Center of Neuroregeneration, Nantong University, 19# Qixiu Road, Nantong, Jiangsu 226001, P.R. China
| | - Aidong Deng
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair, Department of Hand Surgery, Affifiliated Hospital of Nantong University, 20# Xisi Road, Nantong, Jiangsu 226001, P.R. China
| | - Hong Liu
- Department of hematology, Affifiliated Hospital of Nantong University, 20# Xisi Road, Nantong, Jiangsu 226001, P.R. China
| | - Lai Xu
- Key Laboratory of Neuroregeneration, Ministry of Education and Jiangsu Province, Coinnovation Center of Neuroregeneration, Nantong University, 19# Qixiu Road, Nantong, Jiangsu 226001, P.R. China
| | - Jianhui Gu
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair, Department of Hand Surgery, Affifiliated Hospital of Nantong University, 20# Xisi Road, Nantong, Jiangsu 226001, P.R. China
| | - Xiaosong Gu
- Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair, Department of Hand Surgery, Affifiliated Hospital of Nantong University, 20# Xisi Road, Nantong, Jiangsu 226001, P.R. China
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Goeteyn J, Pesser N, van Sambeek MRHM, Thompson RW, van Nuenen BFL, Teijink JAW. Duplex Ultrasound Studies Are Neither Necessary or Sufficient for the Diagnosis of Neurogenic Thoracic Outlet Syndrome. Ann Vasc Surg 2021; 81:232-239. [PMID: 34775011 DOI: 10.1016/j.avsg.2021.09.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Duplex ultrasound (DU) is used in the diagnosis of neurogenic thoracic outlet syndrome (NTOS) to measure compression of the subclavian artery (SCA) which is thought to strengthen the NTOS diagnosis. However, the value of DU in NTOS remains unclear. METHODS A retrospective review of a prospectively acquired database from the TOS center of the Catharina Hospital Eindhoven was performed of patients referred between January 2017 and December 2019. Only "proven NTOS" patients, defined as a successful response to thoracic outlet decompression (TOD) surgery based on patient-reported outcomes (NRS pain scale, CBSQ and DASH score) were included to exclude wrongfully diagnosed NTOS patient. The presence of vascular symptoms (defined as discoloration, edema or temperature changes of the hand or fingers), results of provocative maneuvers, and outcome of DU was used for analysis. To assess the link between vascular symptoms and compression on DU, a chi-squared test was performed. Further, we looked for a correlation between vascular symptoms, compression on DU and clinical outcome using a repeated measures analysis of variance (ANOVA). RESULTS Vascular symptoms were seen in 49 of 133 patients (36.8%). In total, 51 of 133 patients (38.3%) had at least 50% variation in SCA peak systolic velocity (PSV) during DU at the level of SCA stenosis. SCA occlusion was seen in 11 patients (8.3%) during provocative maneuvers. The presence of clinical "arterial symptoms" was not significantly correlated with vascular laboratory findings, neither for alterations in PSV during DU (P = 0.245) nor for positional SCA occlusion (P = 0.540). No statistically significant correlations between the degree of SCA stenosis and postoperative outcomes, as measured with the DASH, CBSQ, or NRS scale for pain were found (P = 0.787). CONCLUSIONS The role of DU in the work-up of NTOS in patients with vascular complaints is questionable. Changes in flow velocities are seen in NTOS patients and do not correlate with "vascular symptoms" or clinical outcome.
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Affiliation(s)
- Jens Goeteyn
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Niels Pesser
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Technology, University of Technology Eindhoven, Eindhoven, The Netherlands
| | - Robert W Thompson
- Department of Surgery, Center for Thoracic Outlet Syndrome, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Lakatos S, Jancsó G, Horváth Á, Dobos I, Sántha P. Longitudinal Study of Functional Reinnervation of the Denervated Skin by Collateral Sprouting of Peptidergic Nociceptive Nerves Utilizing Laser Doppler Imaging. Front Physiol 2020; 11:439. [PMID: 32528300 PMCID: PMC7253695 DOI: 10.3389/fphys.2020.00439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Restitution of cutaneous sensory function is accomplished by neural regenerative processes of distinct mechanisms following peripheral nerve lesions. Although methods available for the study of functional cutaneous nerve regeneration are specific and accurate, they are unsuitable for the longitudinal follow-up of the temporal and spatial aspects of the reinnervation process. Therefore, the aim of this study was to develop a new, non-invasive approach for the longitudinal examination of cutaneous nerve regeneration utilizing the determination of changes in the sensory neurogenic vasodilatatory response, a salient feature of calcitonin gene-related peptide-containing nociceptive afferent nerves, with scanning laser Doppler flowmetry. Scanning laser Doppler imaging was applied to measure the intensity and spatial extent of sensory neurogenic vasodilatation elicited by the application of mustard oil onto the dorsal skin of the rat hindpaw. Mustard oil induced reproducible and uniform increases in skin perfusion reaching maximum values at 2-4 min after application whereafter the blood flow gradually returned to control level after about 8-10 min. Transection and ligation of the saphenous nerve largely eliminated the vasodilatatory response in the medial aspect of the dorsal skin of the hindpaw. In the 2 nd to 4 th weeks after injury, the mustard oil-induced vasodilatatory reaction gradually recovered. Since regeneration of the saphenous nerve was prevented, the recovery of the vasodilatatory response may be accounted for by the collateral sprouting of neighboring intact sciatic afferent nerve fibers. This was supported by the elimination of the vasodilatatory response in both the saphenous and sciatic innervation territories following local treatment of the sciatic nerve with capsaicin to defunctionalize nociceptive afferent fibers. The present findings demonstrate that this novel technique utilizing scanning laser Doppler flowmetry to quantitatively measure cutaneous sensory neurogenic vasodilatation, a vascular response mediated by peptidergic nociceptive nerves, is a reliable non-invasive approach for the longitudinal study of nerve regeneration in the skin.
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Affiliation(s)
- Szandra Lakatos
- Department of Physiology, University of Szeged, Szeged, Hungary
| | - Gábor Jancsó
- Department of Physiology, University of Szeged, Szeged, Hungary
| | - Ágnes Horváth
- 1st Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Ildikó Dobos
- Department of Physiology, University of Szeged, Szeged, Hungary
| | - Péter Sántha
- Department of Physiology, University of Szeged, Szeged, Hungary
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Zhang T, Niu J, Wang Y, Yan J, Hu W, Mi D. The role of C-afferents in mediating neurogenic vasodilatation in plantar skin after acute sciatic nerve injury in rats. BMC Neurosci 2020; 21:15. [PMID: 32299361 PMCID: PMC7161243 DOI: 10.1186/s12868-020-00564-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background Vasomotor regulation of dermal blood vessels, which are critical in the function of the skin in thermoregulatory control, involves both neural and non-neural mechanisms. Whereas the role of sympathetic nerves in regulating vasomotor activities is comprehensively studied and well recognized, that of sensory nerves is underappreciated. Studies in rodents have shown that severance of the sciatic nerve leads to vasodilatation in the foot, but whether sympathetic or sensory nerve fibers or both are responsible for the neurogenic vasodilatation remains unknown. Results In adult Sprague–Dawley rats, vasodilatation after transection of the sciatic nerve gradually diminished to normal within 3–4 days. The neurotmesis-induced neurogenic vasodilatation was not detectable when the sciatic nerve was chronically deafferentated by selective resection of the dorsal root ganglia (DRGs) that supply the nerve. Specific activation of C-afferents by intra-neural injection of capsaicin resulted in neurogenic vasodilatation to a magnitude comparable to that by neurotmesis, and transection of the sciatic nerve pre-injected with capsaicin did not induce further vasodilatation. Conclusions Our results collectively indicate that vasodilatation after traumatic nerve injury in rats is predominantly mediated by C-fiber afferents.
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Affiliation(s)
- Tao Zhang
- Department of Radiology, The Third People's Hospital of Nantong City and The Third Nantong Hospital Affiliated to Nantong University, Nantong, 226001, Jiangsu, China
| | - Jiahui Niu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, 226001, Jiangsu, China
| | - Yaxian Wang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, 226001, Jiangsu, China
| | - Junying Yan
- School of Medicine, Nantong University, Nantong, 226001, Jiangsu, China
| | - Wen Hu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, 226001, Jiangsu, China.,Department of Neurochemistry, Inge Grundke-Iqbal Research Floor, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, 10314, USA
| | - Daguo Mi
- Department of Orthopedics, Nantong City Hospital of Traditional Chinese Medicine, Nantong, 226001, Jiangsu, China.
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Wang XS, Chen X, Gu TW, Wang YX, Mi DG, Hu W. Axonotmesis-evoked plantar vasodilatation as a novel assessment of C-fiber afferent function after sciatic nerve injury in rats. Neural Regen Res 2019; 14:2164-2172. [PMID: 31397356 PMCID: PMC6788242 DOI: 10.4103/1673-5374.262595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Quantitative assessment of the recovery of nerve function, especially sensory and autonomic nerve function, remains a challenge in the field of nerve regeneration research. We previously found that neural control of vasomotor activity could be potentially harnessed to evaluate nerve function. In the present study, five different models of left sciatic nerve injury in rats were established: nerve crush injury, nerve transection/suturing, nerve defect/autografting, nerve defect/conduit repair, and nerve defect/non-regeneration. Laser Doppler perfusion imaging was used to analyze blood perfusion of the hind feet. The toe pinch test and walking track analysis were used to assess sensory and motor functions of the rat hind limb, respectively. Transmission electron microscopy was used to observe the density of unmyelinated axons in the injured sciatic nerve. Our results showed that axonotmesis-evoked vasodilatation in the foot 6 months after nerve injury/repair recovered to normal levels in the nerve crush injury group and partially in the other three repair groups; whereas the nerve defect/non-regeneration group exhibited no recovery in vasodilatation. Furthermore, the recovery index of axonotmesis-evoked vasodilatation was positively correlated with toe pinch reflex scores and the density of unmyelinated nerve fibers in the regenerated nerve. As C-fiber afferents are predominantly responsible for dilatation of the superficial vasculature in the glabrous skin in rats, the present findings indicate that axonotmesis-evoked vasodilatation can be used as a novel way to assess C-afferent function recovery after peripheral nerve injury. This study was approved by the Ethics Committee for Laboratory Animals of Nantong University of China (approval No. 20130410-006) on April 10, 2013.
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Affiliation(s)
- Xue-Song Wang
- Department of Orthopedics, The Affiliated Hospital of Jiangnan University (The Third People's Hospital of Wuxi City), Wuxi, Jiangsu Province, China
| | - Xue Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Tian-Wen Gu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu Province, China
| | - Ya-Xian Wang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu Province, China
| | - Da-Guo Mi
- Department of Orthopedics, Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu Province, China
| | - Wen Hu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu Province, China
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Liu D, Mi D, Zhang T, Zhang Y, Yan J, Wang Y, Tan X, Yuan Y, Yang Y, Gu X, Hu W. Tubulation repair mitigates misdirection of regenerating motor axons across a sciatic nerve gap in rats. Sci Rep 2018; 8:3443. [PMID: 29467542 PMCID: PMC5821835 DOI: 10.1038/s41598-018-21652-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/06/2018] [Indexed: 01/22/2023] Open
Abstract
The repair of peripheral nerve laceration injury to obtain optimal function recovery remains a big challenge in the clinic. Misdirection of regenerating axons to inappropriate target, as a result of forced mismatch of endoneurial sheaths in the case of end-to-end nerve anastomosis or nerve autografting, represents one major drawback that limits nerve function recovery. Here we tested whether tubulation repair of a nerve defect could be beneficial in terms of nerve regeneration accuracy and nerve function. We employed sequential retrograde neuronal tracing to assess the accuracy of motor axon regeneration into the tibial nerve after sciatic nerve laceration and entubulation in adult Sprague-Dawley rats. In a separate cohort of rats with the same sciatic nerve injury/repair protocols, we evaluated nerve function recovery behaviorally and electrophysiologically. The results showed that tubulation repair of the lacerated sciatic nerve using a 3-6-mm-long bioabsorbable guidance conduit significantly reduced the misdirection of motor axons into the tibial nerve as compared to nerve autografting. In addition, tubulation repair ameliorated chronic flexion contracture. This study suggests that tubulation repair of a nerve laceration injury by utilizing a bioresorbable nerve guidance conduit represents a potential substitute for end-to-end epineurial suturing and nerve autografting.
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Affiliation(s)
- Dan Liu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.,The Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Daguo Mi
- Department of Orthopedics, Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, 226001, China
| | - Tuanjie Zhang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Yanping Zhang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.,Department of Burns and Plastic Surgery and Cosmetology, Longyan First Hospital, Longyan, Fujian, 364000, China
| | - Junying Yan
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, China
| | - Yaxian Wang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Xuefeng Tan
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, China
| | - Ying Yuan
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.,The Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Yumin Yang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Xiaosong Gu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Wen Hu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.
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