面神经损伤后rhEPO对面运动神经元的保护作用

目的：观察重组人促红细胞生成素（recombinant human erythropoietin, rhEPO）对大鼠受损面神经的保护作用及对Caspase-3表达的影响。方法：75只雌性大鼠随机分为rhEPO治疗组(n=25) 、对照组(n=25)、假手术组(n=25)，50只大鼠建立左侧面神经干损伤动物模型,rhEPO组大鼠致伤后即刻及每天腹腔内注射rhEPO(5000U/kg)，连续两周，对照组给予等量生理盐水。分别于第3、7、14、21、28天采用Toluidine blue染色计算面神经元存活率，TUNEL检测细胞凋亡，免疫组化检测Caspase-3的表达。结果：从伤后第7天开始治疗组和对照组左侧面神经元存活率逐渐下降，每个时间点治疗组面神经元存活率明显高于对照组（P＜0.05）；治疗组与对照组在伤后第3天未见Tunel染色阳性细胞，对照组第7天见表达，第14天数量达高峰，治疗组在伤后第7、14、21天面神经元凋亡细胞数显著减少 (P<0．05)；伤后第3天对照组见 Caspase-3表达增加，第14天达高峰，第28天仍见少许表达，治疗组在各时间点Caspase-3表达均明显低于对照组(P<0．05)。结论：rhEPO对受损大鼠面神经元有保护作用；降低Caspase-3的表达、抑制细胞凋亡可能是rhEPO治疗创伤性面瘫的重要机制。     

胰岛素面部注射对大鼠面神经挤压伤的效果

目的探讨胰岛素面部注射对大鼠面神经挤压伤神经纤维的再生及神经损伤后功能恢复的效果。方法雄性Sprague-Dawley 大鼠30 只建立面神经挤压损伤模型,20 只纳入实验,随机分为治疗组和对照组各10 只。治疗组局部给予胰岛素250 ng/kg 注射,对照组局部给予等量生理盐水注射。于损伤后7 d 内每天进行神经功能评分;术后7 d 利用逆行荧光金标记技术观察神经纤维的再生。结果术后5~7 d,治疗组神经损伤评分均低于对照组(P<0.05)。治疗组损伤侧面神经核内逆行荧光金标记的     

Longitudinal Changes in Glucose Metabolism of Denervated Muscle after Complete Peripheral Nerve Injury

Purpose

Electrodiagnostic studies can obtain information 2 or 3 weeks after an acute nerve injury. Previous studies have shown increased glucose metabolism in denervated muscles 1 week after injury using 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) positron emission tomography (PET). Therefore, this study aimed to evaluate the changes in glucose metabolism in denervated muscles using serial monitoring by [¹⁸F]FDG PET scans.

Procedures

Denervation was induced in eight male Sprague-Dawley rats (aged 7 weeks old) weighing 200–250 g. The right legs of the rats were denervated by resecting the sciatic nerve in the thigh after the initial skin incision. Two rats were sacrificed 1 and 10 weeks after denervation. Skeletal muscles (gastrocnemius and tibialis anterior) were excised from both the right and left legs of the rats. Staining with hematoxylin and eosin, glucose transporter (GLUT)-1, GLUT-4, and hexokinase II was undertaken. PET/computed tomography (CT) scans were performed on the six remaining rats a total of five times at 1, 2, 5, 8, and 10 weeks after denervation. Regions of interest were drawn on integrated PET/CT images to measure the degree of [¹⁸F]FDG uptake in the right and left lower leg muscles. Target-to-background ratios (TBRs) were calculated by dividing the FDG uptake of the lower leg muscles by that of the upper leg muscles.

Results

The TBRs of the denervated muscles were higher than those of the control muscles at both 1 (6.84?±?1.98 vs. 1.18?±?0.11, p?=?0.009) and 2 (4.10?±?2.05 vs. 1.86?±?0.73, p?=?0.0374) weeks after denervation. After 5 (2.18?±?0.78 vs. 1.35?±?0.47, p?=?0.1489), 8 (1.76?±?0.18 vs. 1.69?±?0.18, p?=?0.5127), and 10 (1.76?±?0.52 vs. 1.56?±?0.37, p?=?0.5637) weeks, the difference in the TBRs between the denervated and controls became non-significant.

Conclusions

[¹⁸F]FDG PET can visualize increased glucose metabolism in a denervated muscle early as 1 week after injury. Therefore, PET could be adopted as a noninvasive imaging modality for acute nerve injuries. In addition, [¹⁸F]FDG PET may help to understand the role of the nervous system in the control of peripheral tissues.

     

面神经损伤后电刺激对神经营养素-3水平的影响

目的：观察面神经损伤后早期电刺激对再生微环境中神经营养素-3(NT-3)水平的影响。方法：切断兔面神经后建立硅胶再生室模型，实验组给予电刺激，对照组不作处理。用双抗体夹心酶联免疫吸附法测定伤后3、5、7、10及14d时再生室内NT-3的浓度，比较2组浓度的差异和不同时间点的浓度变化。结果：NT-3浓度在伤后10d再生室内达高峰，伤后14d实验组仍维持在高水平，对照组则明显下降。结论：电刺激对面神经损伤后再生微环境里NT-3有维持高水平的作用。这可能是电刺激促进周围神经再生的机理之一。     

CD59蛋白表达在外周神经损伤型神经病理性疼痛中的意义

目的观察CD59蛋白在大鼠3种外周神经损伤模型脊髓背角的表达情况,以探讨其在神经病理性疼痛(neu-ropathic pain,NPP)发病机制中的作用。方法选择80只健康雄性SD大鼠分为假手术组、慢性坐骨神经缩窄性损伤模型(chronic constriction injury of the sciatic nerve,CCI)组、坐骨神经分支选择性损伤模型(spared nerve injury,SNI)组和选择性脊神经结扎模型(spinal nerve ligation,SNL)组等4组,按分组制作模型,分别于术前、术后1、3、7 d用热刺激和机械刺激法测定大鼠的痛阈值变化,评估其可靠性后,于术后7 d处死大鼠,取腰4～腰6段脊髓背角,用Western-blot和流式细胞两种技术测定CD59蛋白含量。结果 CCI组、SNI组、SNL组大鼠于术后1、3、7 d痛阈值降低,与假手术组比较差异有统计学意义(P<0.05),模型制作成功。Western-blot检测显示,3组模型大鼠脊髓背角CD59蛋白表达均不同程度降低,与假手术组比较差异有统计学意义(P<0.05)。流式细胞检测显示假手术组大鼠脊髓背角细胞CD59阳性表达率为93.92%,而CCI组、SNI组和SNL组CD59阳性表达率分别为86.78%、85.68%和85.70%,与假手术组比较差异有统计学意义(P<0.05)。结论 NPP大鼠脊髓背角细胞CD59蛋白表达下降,可能是此处发生补体级联反应的重要原因,CD59蛋白在NPP的形成中发挥一定作用。     

桡神经损伤的康复效果

目的探讨康复治疗对桡神经损伤的治疗作用及预后。方法20例不同原因所致桡神经损伤患者,采用NMR-神经肌肉康复仪治疗,同时进行康复训练。随访12～30个月。结果未手术15例评分16分（优）,恢复正常的时间3.5～18个月。行神经探察及松解术3例,1例16分（优）,2例15分（优）。行神经吻合术1例,术后6个月评分6分（可）。行桡神经移植术1例,术后12个月评分4分（差）。结论运动疗法及神经肌肉电治疗是桡神经损伤后有效的康复方法。     

术中面神经肌电监测对腮腺切除术后 面神经麻痹发生率的影响Meta分析

目的：通过Meta分析,分析术中面神经肌电监测对腮腺切除术后即刻面神经麻痹和持续面神经麻痹发生率的影响。方法：检索1970年至2020年12月发表的与主题相关的文献,对符合纳入标准的临床研究,应用Stata16.0软件进行Meta分析,比较术中进行面神经肌电监测（监测组）和不进行面神经肌电监测（对照组）对术后面神经麻痹发生率的影响。结果：共纳入14篇临床研究。Meta分析结果显示：术中面神经监测组术后即刻面神经麻痹的发病率低于对照组（27.7%vs. 38.2%,P<0.05）;但2组术后持续性面神经麻痹的发生率差异无统计学意义（5.1%vs. 9.8%,P>0.05）。纳入的文献中包括4篇随机对照研究,Meta分析结果显示,监测组和对照组的术后即刻面神经麻痹和持续面神经麻痹的发生率差异均无统计学意义（42.3%vs. 51.7%,5.6%vs. 11.8%,均P>0.05）。结论：术中面神经电生理监测可减少术后即刻面神经麻痹的发生风险,但是对持续性面神经麻痹没有显著影响。但由于纳入的随机对照研究数量较少,后续尚需进一步分析。     

家兔面神经钳压伤后修复过程的初步观察

本文对14只新西兰家兔面神经(FN)颞外段钳压伤后,从睑裂恢复及神经兴奋性试验(NET)及病组织学观察修复情况。钳压伤后即刻行鞘膜切开组,神经兴奋性平均5天后消失,不行鞘膜切开组,兴奋性4天后消失,两者结睑裂恢复及病理学观察,无显著差异。我们认为FN颞外段钳压伤可以不行鞘膜切开,仍可很快恢复。     

Effect of Ultrasound Therapy on Expression of Vascular Endothelial Growth Factor,Vascular Endothelial Growth Factor Receptors,CD31 and Functional Recovery After Facial Nerve Injury

Functional recovery is provided by some neurotrophic factors released from the near vicinity of the injury site. Ultrasound treatment is known to increase neurotrophic factor expression. This study was aimed at determining the effect of ultrasound treatment on the expression of vascular endothelial growth factor (VEGF), its receptors and new vessel formation after facial nerve injury. Sixty-four Wistar rats were divided into four groups: control (group 1), sham (group 2), facial-facial coaptation (group 3), and facial-facial coaptation and ultrasound treatment (group 4). Animals in each group were evaluated on the 14th and 28th days. Immunohistochemical staining and electrophysiological and gene-level evaluations were performed for the expression of VEGF and its receptors. When the results were evaluated, it was determined that VEGF, VEGFR1 (VEGF receptor 1), VEGFR2 (VEGF receptor 2) and CD31 levels were significantly higher in groups 3 and 4 compared with the control and sham groups. The increase in these values was more prominent after 28 d of ultrasound treatment than all groups. Electrophysiological results revealed similar evident functional improvement in group 4 with decreased latency and increased amplitudes compared with group 3. Our findings suggest that ultrasound treatment might promote injured facial nerve regeneration by stimulating release of VEGF and its receptors and may result in functional improvement.     

腓总神经损伤的综合治疗①

目的观察腓总神经损伤综合治疗的疗效。方法 80例腓总神经损伤患者分成治疗组和对照组各40例。治疗组在常规药物治疗同时配合超短波、调制中频电疗法和肌电生物反馈治疗,对照组用常规药物治疗及针灸、康复锻炼。治疗前及治疗2个疗程后用Fugl-Meyer评定法(FMA)评定下肢功能,采用医学研究院神经外伤学会(MCRR)标准评定疗效。结果治疗后,治疗组FMA评分值较对照组增高(P<0.05),治疗组优良率为80.00%,对照组为50.00%(P<0.01)。结论综合方法治疗腓总神经损伤临床疗效显著。     

降钙素基因相关肽在面神经切断后SD大鼠面神经核中的表达变化

目的：研究降钙素基因相关肽（calcitonin gene—related peptide，CGRP）在面神经损伤后再生过程中面神经核中的表达变化。方法：健康SD大鼠36只分别于茎乳孔处行左侧面神经切断术，而右侧于相应部位仅行面神经游离术；随机均分为术后3、7、14、21、28、35d6组。分别于相应时间点取出含面神经核团脑干部分，用免疫组化及图像分析技术，观察大鼠两侧面神经核中CGRP表达的变化。结果：CGRP分布于正常SD大鼠面神经各亚核，损伤侧的面神经核中CGRP表达比对照侧增强（P〈0．05）；图像分析CGRP灰度值两侧比较，差异有统计学意义（P〈0．05）。结论：周围性面神经损伤导致CGRP在面神经核中的表达增加，提示CGRP在面神经再生修复过程中发挥调理作用。