三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

目的 探讨原发性三叉神经痛(TN)合并根区蛛网膜粘连与HSV-1感染的关系.方法 对TN患者于显微血管减压术中见其三叉神经根区合并蛛网膜粘连者59例,取其蛛网膜作为实验组;未合并根区明显蛛网膜粘连的TN患者24例,取其蛛网膜作为病例对照组;采用PCR和Western Blot方法分别检测其HSV-1特异性DNA片段、特异性抗原,并以20例外伤患者蛛网膜做正常对照.结果 三组资料中DNA片段阳性率分别为:69%、58%和25%;实验组和病例对照组的DNA片段阳性率均高于正常对照组,且差异有统计学意义(P＜0.05),但实验组和病例对照组相比差异无统计学意义(P＞0.05);病毒特异性抗原阳性率分别为:51%、25%和15%,实验组病毒抗原阳性率高于病例对照组,也高于正常对照组,差异有统计学意义(P＜0.05),而病例对照组和正常对照组相比差异无统计学意义(P＞0.05).结论 HSV-1病毒增殖性感染可能促使TN患者三叉神经根区蛛网膜的粘连,蛛网膜组织可能是HSV-1潜伏感染的另一基地;HSV-1病毒感染可能是TN又一致病因素.

Abstract：

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

Differences in individual susceptibility affect the development of trigeminal neuralgia

Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve,and is characterized by a sudden,usually unilateral,recurrent lancinating pain arising from one or more divisions of the nerve.The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course.In this paper,we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention.The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility,nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.     

Reduction in nerve root compression by the nucleus pulposus after Feng's Spinal Manipulation

Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng’s Spinal Manipulation, hot fomentation, and bed rest (treatment group). The remaining 46 patients were treated with hot fomentation and bed rest only (control group). After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng’s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.     

Evaluation of degree of nerve root injury by dermatomal somatosensory evoked potential following lumbar spinal stenosis*☆

BACKGROUND： Computed Tomography （CT） and Magnetic Resonance Imaging （MRI） can display the site of lumbar spinal stenosis and predict nervous compression at the morphological level; however, pure morphological changes cannot reflect functional alterations in a compressed nerve root. Dermatomal somatosensory evoked potential （DSEP） provides a means to assess the functional state of a nerve root. OBJECTIVE： To evaluate the clinical significance of DSEP, assessing the degree of nerve root injury following lumbar spinal stenosis. DESIGN, TIME AND SETTING： A case-control study was performed in the Department of Orthopaedic Surgery, Hainan People＇s Hospital, China, between September 2004 and December 2007. PARTICIPANTS： Forty-seven patients diagnosed with lumbar spinal stenosis by CT or MRI were selected as the case group; fifty healthy subjects were collected as the control group. METHODS： A KEYPOINT myoelectric evoked potential apparatus （DANTEC Company, Denmark） was used to measure DSEP, and stimulative spots were determined in accordance with the skin key sensory spot standards established by The American Spinal Injury Association： L4 in the medial malleolus, L5 in the third metatarsophalangeal joint of the dorsum of foot and S1 in the lateral heel. The needle electrode used as the recording electrode was located at the Cz point of the cranium, and the reference electrode at the Fz point. MAIN OUTCOME MEASURES： Latency of the P40 peak of DSEP, P1-N1 amplitude, P40 waveform and differentiation and disappearance of various waves. RESULTS： The sensitivity and diagnostic concurrence with surgery of nerve root injury following lumbar spinal stenosis evaluated by DSEP was 95.7 %. P40 latencies at L4, L5 and S1 in the case group were significantly longer than in the control group （P 〈 0.05）, and the P1-N1 amplitude in the case group was significantly lower than the control group （P 〈 0.05-0.01）. Nerve root injury was categorized according to DSEP latency as follows： severe da     

Acupuncture at the “Huatuojiaji” point affects nerve root regional interleukin-1 level in a rat model of lumbar nerve root compression

BACKGROUND：It has been shown that interleukin-1 （IL-1） may cause inflammatory reactions, which stimulate the nerve root of patients with lumbar intervertebral disc protrusion and leads to pain. Whether the clinical curative effects of acupuncture in the treatment of lumbar and leg pain are linked to an inhibition of local IL-1 secretion is unknown. OBJECTIVE： To assess the influence of acupuncture on IL-1, this study was designed to verify the effects of acupuncture at the ＂Huatuojiaji （Extra）＂ point on the nerve root in a rat model of lumbar nerve root compression, compared with administration of meloxicam, a non-steroidal anti-inflammatory drug. DESIGN, TIME AND SETTING： Randomized, controlled, molecular biology experiment, performed at the Experimental Center, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between September 2005 and April 2006. MATERIALS： Forty healthy adult Sprague Dawley rats of either gender were included in this study. The rats were randomly and evenly divided into the following four groups： normal control, model, acupuncture and meloxicam groups. Lumbar nerve root compression was induced in rats in the model, acupuncture, and meloxicam groups by inserting a specially made silicon rubber slice at the juncture of the L5 nerve root and the dural sac. The acupuncture needle （pattern number N3030, 30#, 1.5 inch） was purchased from Suzhou Medical Appliance Factory, China. IL-1 enzyme linked immunosorbent assay （ELISA） kit was purchased from Santa Cruz Biotechnology, Inc., USA. METHODS： The acupuncture group was acupunctured at the ＂Huatuojiaji＂ point, which is lateral to the compressed L5-6 nerve root, with an acupuncture depth of 0.5 cm. There were two treatment courses, each of involved seven 20-minute acupuncture sessions, one session a day. The meloxicam group was administered intragastrically 3.75 mg/kg meloxicam （5 mg meloxicam /10 mL physiological saline）. Rats in the normal control group and model group received an intragast     

脊神经根离断对周围皮肤神经再生和创面愈合的影响

Burn wounds were produced on two sides on the backs of Wistar rats,in addition to denervation on one side.The skin neural regeneration at the injury site and burn wound healing were evaluated following spinal nerve root incision.No nerve regeneration was observed in the burn wound region post-denervation,and the degree of epithelization was significantly less than the control group.With increasing time,expression of type I collagen,which plays a supporting role,and collagen III,which exhibits elastic properties,were significantly increased in the two groups,but the expression was less in the denervation group compared with the control group,and the wound healing was faster in the control group.The ratio of type I collagen to type III collagen was significantly lower in the den-ervation group compared with the control group.The ratio gradually decreased with prolonged time in the denervation group,but remained unchanged in the control group.However,the elasticity of the tissues in the denervation group was better than the control group.During burn wound healing,innervations can promote wound healing,but denervation can improve the quality of wound re-modeling.     

Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?

The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4th and 5th fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve.     

Sympathetic skin response in patients with myasthenia gravis★ A comparative analysis

BACKGROUND: The examination of sympathetic skin response is an important index for assessing the autonomic nerve function, and patients with myasthenia gravis are always accompanied by dysautonomia. Therefore, it will be important to know whether sympathetic skin response can be used as the index for the clinical evaluation of myasthenia gravis. OBJECTIVE: To investigate the diagnostic value of sympathetic skin response in the damage of autonomic nerve function of patients with myasthenia gravis. DESIGN: A case-controlled comparative observation. SETTING: Department of Neurology and Room of Nerve Electromyogram, the Affiliated Hospital of North Sichuan Medical College. PARTICIPANTS: Thirty outpatients or inpatients with myasthenia gravis were selected from the Department of Neurology, the Affiliated Hospital of North Sichuan Medical College from May 2006 to May 2007, including 9 males and 21 females, aged 8–72 years with a mean age of (28±5) years old. They were all accorded with the diagnostic standards of myasthenia gravis, accompanied by different severity of autonomic nerve symptoms, including poor skin nutrition, sweating of hands and feet, pyknocardia, persistent hypotension, abdominal pain, constipation, etc. They all had not taken any drug affecting the autonomic nerve function before the examination. Informed consents were obtained from all the patients. Meanwhile, 30 healthy physical examinees were enrolled as the normal control group, including 10 males and 20 females, aged 10–75 years with a mean age of (31±5) years old. Approval was obtained from the hospital ethic committee. METHODS: After admission, the patients were examined with sympathetic skin response using DANTEC keypoint 2.0 electromyography evoked potential apparatus (Danmark). The changes of the latency and wave amplitude of sympathetic skin response were observed. The subjects in the normal control group were examined with the same methods at physical examination. Abnormality was judged by the disappearance of wave form, latency longer than that in the normal control group by Mean±2.5SD, or wave amplitude lower than the average value in the normal control group by 50%. MAIN OUTCOME MEASURES: The results of the latency and wave amplitude of sympathetic skin response were compared between the patients with myasthenia gravis and normal controls. RESULTS: All the 30 patients with myasthenia gravis and 30 healthy physical examinees were involved in the final analysis of results. There were no significant differences between the left and right upper and lower limbs in both the myasthenia gravis group and normal control group (P > 0.05). In the myasthenia gravis group, the abnormal rate of sympathetic skin response was 37% (11/30), the latency was prolonged and the wave amplitude was decreased as compared with those in the normal control group, and there were significant differences (P < 0.01). CONCLUSION: Sympathetic skin response can be used as an electrophysiological index for judging the damages of autonomic nerve function in patients with myasthenia gravis.     

Calcitonin gene-related peptide in anterior and posterior horns of spinal cord after brachial plexus injury

BACKGROUND: The changes of calcitonin gene-related peptide (CGRP) expression are closely associated with peripheral nerve injury, whereas it should be further investigated whether the damage of central nerve can lead to the changes of CGRP expression, and whether it is associated with the neural regeneration and repair. OBJECTIVE: To observe the changing law of CGRP expression in the anterior and posterior horns of spinal cord following brachial plexus injury. DESIGN: A randomized controlled trial. SETTINGS: Department of Anatomy, Yunyang Medical College; Department of Anatomy, Basic Medical College, Sun Yat-sen University. MATERIALS: Sixty-five adult male SD rats of clean degree, weighing 180–220 g, provided by the experimental animal center of the Basic Medical College, Sun Yat-sen University, were randomly divided into control group (n =5) and experimental group (n =60), and the latter was subdivided into three damage groups: avulsion of anterior root group (n =20), disjunction of posterior root group (n =20) and transection of spinal cord group (n =20). Diaminobenzidine (DAB) chromogen, rabbit anti-CGRP polyclonal antibody were the products of Sigma Company; Leica image analytical apparatus was produced by QUIN Company (Germany); Histotome by Sigma Company. METHODS: The experiments were carried out in the Department of Anatomy, Basic Medical College, Sun Yat-sen University from September 2004 to March 2005. Three kinds of models of brachial plexus injury were established: In the avulsion of anterior root group, right C7 anterior root was avulsed, and the distal nerve residual root was transected. In the disjunction of posterior root group, right C7 anterior root was avulsed and right C5–T1 posterior horns were cut to block the sensory afferent pathway. In the transection of spinal cord group, right C7 anterior root was avulsed and C5–6 segments of right spinal cord were semi-transected to block the cortical descending pathway. In the control group, C5–T1 vertebral plates were prayed open, and then the skin was sutured. The C7 segments of spinal cord were removed on the 1st, 3rd, 7th and 14th days postoperatively respectively, and the CGRP expressions in the anterior and posterior horns of spinal cord were determined and analyzed using immunohistochemical method and image analysis. MAIN OUTCOME MEASURES: ① Number of CGRP immuno-positive motor neurons in the anterior horn of spinal cord; ② Total area of CGRP immuno-positive fibers in the posterior horn of spinal cord. RESULTS: All the 65 rats were involved in the analysis of results. ① Number of CGRP immuno-positive motor neurons in the anterior horn of spinal cord: CGRP immuno-positive motor neurons could be observed in the anterior horns of C7 spinal cord in the control group and damage groups, the neurons had big cell body with stained cytoplasm, appeared as brown granules, and mainly distributed in the ventral lateral anterior horn of spinal cord. On the 1st day postoperatively, the number of CGRP positive neurons was obviously higher in the in the avulsion of anterior root group than in the control group (P < 0.01), whereas obviously lower in the disjunction of posterior root group than in the control group (P < 0.01), and there was no obvious difference between the transection of spinal cord group and the control group (P > 0.05). On the 7th day, the numbers of CGRP positive neurons in the damage groups were obviously higher than that in the control group (P < 0.01), also obviously different from those on the 1st day in the same group respectively (P < 0.01). On the 14th day, the number of CGRP positive neurons in the disjunction of posterior root group was decreased, but there was no obvious difference as compared with that in the control group, whereas those in the avulsion of anterior root group and transection of spinal cord group were still obviously higher than that in the control group (P < 0.01). The number of CGRP positive neurons was the most in the avulsion of anterior root group, followed by the transection of spinal cord group, and the least in the disjunction of posterior root group, and there were significant differences among them (P < 0.01). ② Total area of CGRP immuno-positive fibers in the posterior horn of spinal cord: Dense CGRP immuno-positive nerve fibers distributed in the layers Ⅰ and Ⅱ of the C7 posterior horn of spinal cord in the control group. On the 1st day postoperatively, the total areas of CGRP positive fibers in the avulsion of anterior root group and transection of spinal cord group were obviously larger than that in the control group (P < 0.01), whereas there was no obvious difference between the disjunction of posterior root group and control group. On the 7th day, the CGRP expression in the posterior horn of spinal cord decreased to the lowest level in the disjunction of posterior root group, whereas there were no obvious differences in the avulsion of anterior root group and transection of spinal cord group as compared with that in the control group (P > 0.05). On the 14th day, the area continued to decrease in the avulsion of anterior root group and transection of spinal cord group, and it was obviously lower in the transection of spinal cord group than in the control group (P < 0.01), and it was slightly increased in the disjunction of posterior root group as compared with that on 7th day, but still obviously lower than that in the control group (P < 0.01). CONCLUSION: The expression and role of CGRP are in discrepancy in the anterior and posterior horns of spinal cord after brachial plexus injury. The CGRP in anterior horn of spinal cord are derived from the cell body of motor neurons, and may be involved in the repairing mechanism of nerve injury regeneration; Whereas those in the posterior horn are mainly derived from posterior root ganglion, and may be associated with the conduction of noxious stimulations.