经皮电刺激促进周围神经功能恢复的组织学研究

目的观察并探讨经皮电刺激对大鼠周围神经再生的组织学影响和促进神经损伤后功能恢复的机制。方法用组织学方法观察经皮电刺激对损伤周围神经髓鞘结构和数目的影响,并与对照组进行比较。结果经皮电刺激组可见大量新生髓鞘,髓鞘数目为[(715．29±84．30)个,(?)±s,下同],较对照组(403．67±70．56)个明显增多,两者差异有统计学意义(P＜0．01)。结论经皮电刺激可能具有通过促进Schwann细胞增殖和髓鞘形成,改善受损周围神经再生修复的作用。     

模拟膈神经脉冲电刺激促进周围神经再生的研究

目的　研究膈神经生物电脉冲 (BIPN)对周围神经再生的促进作用。方法　新西兰家兔 18只平均分为 3组 ,切断双侧坐骨神经后端端缝合予以电刺激。A组以BIPN刺激与无刺激对照 ;B组以BIPN刺激与方波脉冲刺激对照 ;C组以方波脉冲刺激与无刺激对照。刺激 4周后行足底溃疡直径、神经电生理、胫前肌肌湿重、组织学和电镜超微结构检测。结果　A、B组BIPN侧足底溃疡直径分别为 (16.3 3± 17.17)mm和 (2 2 .3 3± 7.5 0 )mm ,均优于对照侧 (P <0 .0 1,P <0 .0 5 ) ;复合肌肉诱发电位 (CMAP)潜伏期分别为 (1.98± 0 .2 0 )ms和 (1.92± 0 .16)ms ,均优于对照侧 (P <0 .0 5 ) ;A组CMAP波幅为 (0 .18± 0 .0 7)mV ,优于对照侧 (P <0 .0 5 ) ;远端有髓纤维通过率分别为 (62 .44± 6.68) %和 (5 4.48± 5 .0 5 ) % ,均优于对照侧 (P <0 .0 1) ;胫前肌肌湿重分别为(1.67± 0 .2 4)g和 (1.71± 0 .2 5 )g ,均优于对照侧 (P <0 .0 1) ;超微结构观察示BIPN侧再生髓鞘成熟度优于方波脉冲侧 ,更优于无刺激侧。结论　膈神经电脉冲能较明显地促进周围神经再生。     

经皮电刺激促进周围神经再生的实验研究

为了观察经皮电刺激能否促进周围神经再生，选用３６只大鼠坐骨神经，切断后的神经断端吻合与钳夹损伤后的神经干瘢痕模型，通过参数为２～５Ｈｚ，０．４ｍｓ，２４～４８Ｖ的经皮电刺激，分别于术后１～６周，进行电生理组织形态学观察。结果显示：电刺激组的神经传导速度、肌肉最大诱发电位波幅、神经纤维生长速度、吻合口轴突通过率、肌纤维截面积及肌重均优于同期对照侧。表明经皮电刺激能促进周围神经再生。     

人羊膜上皮细胞对大鼠坐骨神经再生影响的实验研究

目的 通过实验研究了解人羊膜上皮细胞(human amniotic epithelial cells,HAECs)对大鼠坐骨神经再生的促进作用.方法 取60只SD大鼠随机分为两组,羊膜细胞组和对照组,各组再分为2周和4周组,每组15只.制作大鼠周围神经损伤再生室模型,HAECs组局部应用培养的HAECs,对照组局部使用等量的生理盐水.术后分别于2周、4周检测神经传导功能和HE染色观察神经纤维形态学变化.结果 术后2周两组的神经电生理及组织学检测比较差异无统计学意义;4周HAECs组的大鼠坐骨神经传导功能明显恢复,HE染色显示术后坐骨神经手术部位出现大量炎性肉芽组织,呈现纤维性修复,吻合口以远HAECs组神经纤维形态结构较对照组完整,神经纤维与髓鞘直径均较对照组大.结论 HAECs移植可加速大鼠坐骨神经损伤后神经传导功能恢复,有助于有髓神经纤维损伤后的轴突与髓鞘的再生修复.     

人羊膜上皮细胞对大鼠坐骨神经再生影响的实验研究

目的 通过实验研究了解人羊膜上皮细胞(human amniotic epithelial cells,HAECs)对大鼠坐骨神经再生的促进作用.方法 取60只SD大鼠随机分为两组,羊膜细胞组和对照组,各组再分为2周和4周组,每组15只.制作大鼠周围神经损伤再生室模型,HAECs组局部应用培养的HAECs,对照组局部使用等量的生理盐水.术后分别于2周、4周检测神经传导功能和HE染色观察神经纤维形态学变化.结果 术后2周两组的神经电生理及组织学检测比较差异无统计学意义;4周HAECs组的大鼠坐骨神经传导功能明显恢复,HE染色显示术后坐骨神经手术部位出现大量炎性肉芽组织,呈现纤维性修复,吻合口以远HAECs组神经纤维形态结构较对照组完整,神经纤维与髓鞘直径均较对照组大.结论 HAECs移植可加速大鼠坐骨神经损伤后神经传导功能恢复,有助于有髓神经纤维损伤后的轴突与髓鞘的再生修复.     

术中短期低频电刺激对陈旧性周围神经缺损再生能力的影响

目的探讨术中短期低频电刺激(short-term low-frequency electrical stimulation,SLES)对陈旧性周围神经缺损再生能力的影响。方法成年雌性SD大鼠30只,体质量160~180 g,制备大鼠坐骨神经13 mm长陈旧性缺损模型,随机分为实验组和对照组,每组15只。实验组切取对侧正常坐骨神经桥接缺损并施以SLES,对照组同法修复神经缺损但不予以电刺激。修复术后1、2、7 d取大鼠脊髓腰膨大段(L_(4、5))以及相应背根神经节,行抗生长相关蛋白43(growth-associated proteins 43,GAP-43)及抗脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)双重免疫荧光染色观察。修复术后3个月行荧光金逆行示踪实验。取再生神经组织中段作横、纵冰冻切片,分别行Meyer神经三色染色和抗鼠神经丝蛋白(neurofilament,NF)及可溶性蛋白100(soluble protein100,S-100)双重免疫荧光染色观察,并取术侧远端神经行透射电镜观察,测量有髓神经纤维、轴突直径及髓鞘厚度,计算有髓神经纤维密度及G比值。取术侧腓肠肌计算相对湿重比,并行Karnovsky-Root运动终板胆碱酯酶组织学染色观察。结果实验组修复术后1、2 d,术侧对应运动神经元和感觉神经元GAP-43和BDNF表达上调快于对照组。荧光金逆行示踪实验示,实验组术侧脊髓前角及相应背根神经节中标记的神经元多于对照组。实验组再生神经Meyer神经三色染色和双重免疫荧光染色均显示再生神经组织发育优于对照组。透射电镜观察示再生神经纤维成簇分布,实验组轴突直径、髓鞘厚度、有髓神经纤维密度及G比值均高于对照组,但差异无统计学意义(P0.05)。实验组术侧腓肠肌相对湿重比高于对照组,差异有统计学意义(t=4.633,P=0.000)。腓肠肌Karnovsky-Root运动终板胆碱酯酶组织学染色示,实验组运动终板的形态和数量略优于对照组。结论术中SLES能在一定程度上提高大鼠短期(1个月)长距离陈旧性周围神经缺损的再生能力。     

模拟膈神经生物电刺激促进周围神经再生的实验研究

目的　研究膈神经生物电脉冲 (bioelectricalimpulseofphrenicnerve ,BIPN)在周围神经再生过程中的作用。方法　取家兔 18只 ,共 3 6根坐骨神经 ,平均分为 3组。A组为模拟膈神经生物电脉冲(BIPN)组。B组为连续方波脉冲刺激组。C组为不作任何刺激对照组。术后 4周 ,取材检测。神经标本比较神经纤维计数、截面积及远端有髓纤维通过率。取胫前肌标本检测肌纤维截面积。结果　A、B、C 3组的神经缝合口远端有髓神经纤维计数分别为 12 3 6.9 2 0 2、10 82 .5 2 14 .6和 840 .6 174.4根。A、B 2组比较 ,差异有统计学意义 (t值 3 .3 2 3、P值 <0 .0 1)。A、B、C 3组的神经纤维通过率分别为 5 8.5 7.0 1、5 3 .2 10 .4和 3 5 .2 7.3 %。A、B 2组比较 ,差异有统计学意义 (t值 2 .2 2 1、P值 <0 .0 5 )。A、B、C 3组的神经纤维截面积分别为 12 7.4 7.2、119.1 5 .2和 118.8 5 .5 μm2 。A、B 2组比较 ,差异有统计学意义 (t值 4.3 98、P值 <0 .0 1)。A、B、C 3组的肌纤维截面积分别为 70 4.8 10 8.5、62 3 .3 189.1和 5 80 .5 10 8.3μm2 。A、B 2组比较 ,差异有统计学意义 (t值 2 .3 0 8、P值 <0 .0 5 )。结论　模拟膈神经电脉冲能有效促进周围神经损伤后的神经纤维再生。     

神经生长因子和雪旺氏细胞分泌的神经营养活性物质促进周围神经再生的实验研究

在桥接大鼠坐骨神经２０ｍｍ缺损的肌移植体中，于术中、术后１０天、２０天分３次分别注Ａ２．５Ｓ神经生长因子（ＮＧＦ）纯品和雪旺氏细胞分泌的神经营养活性物质（５Ｃ－Ｄ－ＮＴＳ）。术后５个月经组织形态学、神经电生理和肌肉收缩功能测定等，发现两者均能促进周围神经再生，其中注入ＳＣ－Ｄ－ＮＴＳ组能增加再生有髓神经纤维的数目、直径和髓鞘厚度，提高腓肠肌Ｍ波幅值，增强比目鱼肌收缩力；而注入ＮＧＦ组仅增加再生有髓神经纤维数口。     

大鼠周围神经移植修复马尾神经损伤的早期形态学观察

目的：探讨坐骨神经移植修复马尾神经损伤的可行性,观察马尾神经再生情况。方法：将30只雌性Wistar大鼠分为三组,实验组：将20只大鼠马尾在L2水平行半侧切除,将对侧坐骨神经移植到马尾切除侧,近端接马民行断端,移植的坐骨神经远端与马尾切除侧坐骨神经吻合,分别于术后4、6、8周在光镜及电镜下观察马尾再生情况。实验对照组：5只大鼠,仅切除部分马尾。正常对照组：5只大鼠,不做处理。结果：实验对照组坐骨神经的轴突及髓鞘均崩解,无再生轴突形成。实验组术后4周HE及固蓝染色偶见髓鞘及轴突形成,雪旺细胞数目少,有世噬细胞吞噬现象;术后6周较4周再生髓鞘及神经轴突数目增多,雪旺细胞大量增生,巨噬细胞吞噬现象减少;术后8周高倍镜下可见再生的典型形式,即胶质基质中的退变纤维中有大量簇状细小的有髓神经纤维,电镜下可见含较多细的有髓和无髓神经纤维,内含较多线粒体等管状结构,雪旺细胞核大而明显,胞浆丰富,粗面内质网及高尔基体、线粒体增加明显。结论：周围神经移植修复马尾神经是可能的,马尾神经损伤后有再生的可能性。     

异体神经段皮下包埋对坐骨神经再生影响的研究

目的　探讨异体周围神经段皮下包埋对坐骨神经再生的影响。　方法　 Wistar大鼠 30只 ,雄性。 6只为供体 (C组 ) ,余随机分为两组。实验组 (A组 ) 12只 ,于右大腿后侧皮下行异体坐骨神经 (15 mm)包埋 ,2周后取出 ,修整为 10 mm的片段移植于左侧新鲜的坐骨神经缺损处 (10 m m)。对照组 (B组 ) 12只 ,于右腿相应部位皮肤切口直接缝合 ,左侧新鲜坐骨神经 (10 mm)原位吻合。术后 2、4、8和 14周行组织学观察 ,14周作电生理测定和电镜观察。　结果　术后 2周 ,A组炎性反应稍重于 B组 ;至 4周时两组的炎性反应程度相似 ,近端少许胶原纤维增生 ;8周时两组的炎性反应基本停止 ,胶原纤维增生稍明显 ;14周时两组神经外膜构成完整 ,束膜、内膜结构无明显差异。再生大量的有髓神经纤维及少量的无髓神经纤维。髓鞘结构完整。再生轴突数目、面积差异无统计学意义 ,束膜厚度、分布及范围相似。运动神经传导速度、峰值及潜伏期差异无统计学意义 (P>0 .0 5 )。　结论　皮下包埋的异体周围神经段虽有一定的炎性反应 ,但仍具有与自体神经移植相似的神经再生引导作用。     

Clinical elements for the neuromuscular stimulation and functional electrical stimulation protocols in the practice of neurorehabilitation

The physicians and their multidisciplinary teams involved in the clinical practice of neurological rehabilitation have more and more opportunities to apply neuromuscular stimulation (NMS) and functional electrical stimulation (FES) of peripheral nerves as a part of their daily practice. In this article, we outline clinical protocols of NMS and FES in the following clinical conditions of upper motor neuron dysfunction: to prevent consequences of disuse of the neuromuscular system of the upper motor neuron, to facilitate recovery processes of impaired upper motor neuron functions due to acute and/or subacute neurological conditions, to maintain or enhance the trophic state of the muscle, to modify altered control of muscle tone, to modify altered patterns of automatic and volitional functional movements, to enhance functional movement of the single joint muscle group within intact functional multijoint movement, and to modify altered neurocontrol of posture, locomotion, and skillful movements. We emphasize the importance of understanding the motor control alteration while developing clinical protocols and defining the goals. It is very important to be aware that similar clinical findings and due to the same cause can have different features of residual motor control, and therefore potentials for recovery or modification can be very different.     

Mild electrical stimulation with heat stimulation increase heat shock protein 70 in articular chondrocyte

The objective of this study is to investigate the effects of mild electrical stimulation (MES) and heat stress (HS) on heat shock protein 70 (HSP70), that protects chondrocytes and enhances cartilage matrix metabolism, in chondrocyte and articular cartilage. Rabbit articular chondrocytes were treated with MES and/or HS. The safeness was assessed by LDH assay and morphology. HSP70 protein, ubiquitinated proteins and HSP70 mRNA were examined by Western blotting and real‐time PCR. Rat knee joints were treated with MES and/or HS. HSP70 protein, ubiquitinated proteins, HSP70 mRNA and proteoglycan core protein (PG) mRNA in articular cartilage were investigated. In vitro, HS increased HSP70 mRNA and HSP70 protein. MES augmented ubiquitinated protein and HSP70 protein, but not HSP70 mRNA. MES + HS raised HSP70 mRNA and ubiquitinated protein, and significantly increased HSP70 protein. In vivo, HS and MES + HS treatment augmented HSP70 mRNA. HS modestly augmented HSP70 protein. MES + HS significantly increased HSP70 protein and ubiquitinated proteins. PG mRNA was markedly raised by MES + HS. This study demonstrated that MES, in combination with HS, increases HSP70 protein in chondrocytes and articular cartilage, and promotes cartilage matrix metabolism in articular cartilage. MES in combination with HS can be a novel physical therapy for osteoarthritis by inducing HSP70 in articular cartilage. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 894–900, 2013     

孕激素阻断LH峰用于促排卵的方案应用进展

随着卵泡发育基础内分泌理论的深入研究,以及胚胎玻璃化冷冻和冻融胚胎移植(FET)技术的不断完善,近年来控制性卵巢刺激(COS)方案呈现许多新进展,越来越趋向于简单化、多样化、个体化。孕激素阻断LH峰用于促排卵的方案简称孕激素阻断方案,是利用内源或外源性孕激素阻断LH峰,结合促排卵药物进行卵巢刺激的一种促排卵策略,包括黄体期促排卵(LPS)、卵泡期联合黄体期双重刺激(duostim),卵泡期高孕酮状态下促排卵(PPOS),以及其它孕激素方式下的促排卵方案。本文对孕激素阻断方案发展历史,作用机制,临床应用及适用人群等方面进行综述。     

无创迷走神经刺激的临床应用进展

迷走神经活性的调节影响大脑和身体之间的信息传递过程及生理状态。无创迷走神经刺激（nVNS）通过刺激耳迷走神经或颈部迷走神经对多个器官和系统产生保护作用,远程调节机体功能。近年来nVNS在预防及治疗神经系统疾病、自身免疫相关性疾病及心血管系统疾病中取得重大进展。本文对nVNS及相关技术的应用研究进展进行综述,为进一步探索nVNS在围术期的应用提供参考。     

Electrical stimulation: Nonunions

The current paper attempts to provide an overview on the currently available fundamental, preclinical, and clinical evidence on the biologic rationale and therapeutic efficacy of electrical stimulation devices applied in patients with long-bone nonunions. Electrical stimulation (ES) involves the generation of an electrical or electromagnetic current through the ununited fracture. Such currents, which are present in physiologically healing bone, provide stimuli that favor a healing response to bone cells. These stimuli include the enhancement of transmembrane and intracellular calcium-mediated signal transduction and an increased synthesis of paracrine and autocrine growth factors by osteoblasts. Favorable healing union rates, ranging from 43% to 90%, as found by several clinical case series, have prompted the orthopedic community to, at least partially, adopt ES for the treatment of long bone nonunions. Nonetheless, randomized controlled trials have not provided definitive evidence of ES causing nonunions to heal more often than sham devices. This impediment is probably formed by small sample sizes, lack of consistency regarding the definition of union and nonunion, and variability in ES current used.     

Electrical stimulation for gastroparesis

Background Gastroparesis is a disabling, and sometimes fatal, disease that often does not respond to medical treatment. This single-surgeon prospective study examines the safety and 6-month efficacy of electrical stimulation for the treatment of gastroparesis. Methods Sixteen patients with medically refractory gastroparesis underwent laparoscopic implantation of an electrical stimulator device (Enterra Therapy, Medtronic, Minneapolis, MN, USA) consisting of a subcutaneous stimulator and two gastric wall leads. Gastric emptying scans (GES) confirmed the diagnosis of gastroparesis. Patients were evaluated preoperatively using a self-administered GI symptomatology questionnaire and RAND 36 Health Survey. Once patients were >6-months from implantation, a repeat GES was obtained and patients completed a postoperative GI symptomatology questionnaire and RAND 36 Health Survey. Ten of 16 patients in this case series were >6-months from implantation. One was lost to follow-up. An F-test was used to establish equality of standard deviations between the 16 patients evaluated preoperatively and the subset of 10 patients evaluated postoperatively. A Student’s t-test was used to evaluate the significance of differences in pre- and postoperative results. Results Average operating time was 117 min with no intraoperative complications. The majority of patients were discharged on postoperative day 1. There were two complications in the postoperative period. Patients experienced a significant decrease in nausea and vomiting as measured by the GI symptomatology questionnaire. Half of all patients no longer required gastric prokinetic medications and there was a subjective reduction of pyrosis, early satiety, and epigastric pain. A significant increase in quality of life as measured by the RAND 36 Health Survey was seen, and six of eight patients no longer demonstrated gastroparesis on GES. Conclusion Laparoscopic implantation of an electrical stimulation device is a safe and effective treatment by subjective and objective standards for the management of medically refractory gastroparesis.     

Deep brain stimulation devices: a brief technical history and review

Deep brain stimulation (DBS)—a broadly accepted therapeutic modality with tens of thousands of patients currently implanted—is the application of implantable electrical stimulation devices to treat neurological disorders. Approved indications include involuntary movement disorders; investigational applications include epilepsy, selected psychiatric disorders, and other conditions. DBS differs fundamentally from functional electrical stimulation and sensory prosthetics in that DBS therapies do not substitute for or replace injured tissues, organs, or body functions. DBS—targeted to particular brain nuclei or pathways that are specific for the disorder under treatment—influences brain function and behavioral output in ways that can relieve symptoms and improve the overall functioning of the patient. We will briefly review the history and present status of DBS from a technical and device-oriented perspective, with an eye toward future advances.