面神经修复中再生室内髓鞘碱性蛋白的作用初探

目的探讨外源性髓鞘碱性蛋白（myelinbasicprotein,MBP）在家兔面神经再生室修复中的作用。方法将33只家兔横断的面神经干近、远端缝于硅胶管壁上,形成约12μL大小的神经再生室。一侧为实验组,将MBP注入再生室内;对侧为对照组不注任何物质。分别在术后4、6、8周处死动物,切取标本,在光镜下行组织形态学观察。结果形态学分析表明术后4周2组再生室内再生面神经的有髓轴突直径、髓鞘厚度及长入再生室远端有髓轴突数差异无显著性(P>0.05),随着时间的延长(术后6、8周),MBP组较对照组再生面神经显得更为成熟,6周时再生轴突成熟程度差异更明显。结论MBP有促进家兔面神经再生修复的作用,但在活体内增强受损轴突生长的机理以及MBP促进FN轴突再生的作用时间尚不清楚。     

几丁质再生室修复面神经缺损的实验研究

寻求适合临床应用的可吸收性面神经修复材料。方法：用几丁质管作为人工再生室修复兔面神经颊支８ｍｍ缺损,观察神经再生及其功能恢复情况。结论可吸收性几丁质再生室能有效地引导面神经再生并恢复其功能,有一定的临床应用价值。     

骨髓间质细胞植入变性骨骼肌修复面神经缺损实验研究

目的利用骨髓间质细胞植入微波变性骨骼肌桥接大鼠面神经缺损,研究骨髓间质细胞在面神经修复中的作用。方法骨髓间质细胞培养;大鼠面神经10mm缺损模型制备、手术修复及细胞移植;对大鼠移植段再生神经电生理测试并进行轴突计数。结果术后二周,细胞植入组轴突再生明显;术后八周,细胞移植组再生轴突计数、神经传导速度及动作电位振幅均高于单纯变性骨骼肌组。结论骨髓间质细胞植入可以促进面神经损伤的修复。然而,骨髓间质细胞移植的确切效果还需要进一步研究。     

骨髓间质细胞植入微波变性骨骼肌与自体神经桥接大鼠面神经缺损的比较研究

目的　探讨骨髓间质细胞（mesenchymal stem cells,MSCs）植入微波变性骨骼肌替代自体神经桥接修复大鼠面神经缺损的可行性。方法　培养异体骨髓间质细胞,大鼠面神经缺损模型制备及手术修复,动物电生理测试及再生神经轴突计数,统计学分析。结果　术后2周时细胞植入组中段可见再生轴突形成,而自体神经组再生轴突形成不明显;术后第4、8周自体神经组多项指标优于细胞植入组,8周时两组轴突计数之间有统计学意义;细胞植入组修复效果优于单纯骨骼肌组,但两组之间没有统计学意义。结论  骨髓间质细胞植入微波变性骨骼肌可以用于周围神经修复,但其修复效果尚未达到自体神经移植的修复效果。     

面神经修复及再生的组织工程学研究进展

包括面神经在内的神经缺损重建修复是周围神经外科的一大难题。材料工程学的发展极大地促进了周围神经损伤修复的研究，以许旺细胞为中心的神经再生微环境、组织工程神经桥接材料及组织工程神经评价系统是面神经组织工程的主要研究热点。现就以上领域的研究进展作一综述。     

睫状神经营养因子对面神经损伤的修复作用

目的探讨局部应用睫状神经营养因子对面神经损伤的修复作用。方法将成年新西兰兔面神经上颊支切除5mm,在断端间置入硅胶再生室,实验组室内注入睫状神经营养因子,对照组用生理盐水。术后4周和8周进行电生理学、组织病理学观察和形态学定量分析。结果术后4周,两组电刺激面神经很少能引发面肌兴奋,有髓轴索计数,轴索直径和面积t检验,两组差异有显著性意义(P<0.05)。术后8周面神经复合肌动作电位,实验组运动神经传导速度明显短于对照组,有髓轴索计数,轴索直径和面积实验组大于对照组(P<0.05)。结论局部应用睫状神经营养因子可促进面神经损伤的修复。     

兔化学去细胞神经桥接大鼠面神经缺损

目的 探索化学去细胞神经异种移植桥接面神经缺损的可能性.方法 用TritonX-100和脱氧胆酸钠制备兔化学去细胞神经,桥接大鼠面神经6 mm缺损.术后5个月行神经电生理、面神经运动神经元逆行示踪、再生神经形态学等检测.以大鼠自体神经移植和兔新鲜神经移植为对照.结果 化学去细胞异种神经未被宿主排斥和吸收,正常侧/实验侧潜伏期比值为0.663±0.142,实验侧/正常侧波幅比值为0.334±0.032,实验侧/正常侧标记面神经运动神经元比值为0.293±0.023,神经移植段及移植远段有大量再生神经纤维且超微结构正常.与大鼠自体神经移植比较差异无统计学意义(P＞0.05),而新鲜神经异种移植被宿主排斥和吸收.结论 化学去细胞神经异种移植可能是修复面神经缺损的一种很有前途的方法.     

颞骨内面神经缺损几丁质室修复的实验研究

目的探讨几丁质室修复颞骨内面神经缺损的可行性。方法采用生物材料几丁质室桥接兔骨内面神经缺损24只(侧),硅胶室作为对照组24只(侧),术后1、3和5个月对再生神经分别进行大体观察、电生理测试、组织学检查以及数字形态学分析。结果①术后3个月,近端神经纤维已通过几丁质室进入远端神经,术后5个月,新生神经更显成熟;②神经诱发电位显示再生神经传导功能恢复良好,实验组和对照组之间差异无显著性;③再生神经均以有髓神经纤维为主,轴突发育良好,超微结构显示髓鞘板层明暗相间、结构清晰,轴浆细胞器丰富;④术后5个月,几丁质组再生神经纤维面积恢复率、轴突面积恢复率及轴突数目恢复率均达71％以上,与硅胶组比较差异均无显著性。结论几丁质室修复颞骨内面神经缺损可取得良好的再生效果。     

面神经

20031198面神经再生液的采集及其蛋白质组学分析和生物活性检测/杨慧…//临床耳鼻咽喉科杂志一2003,17(l)一37一39 目的:检测面神经再生液的蛋白质成分及对运动神经元的生物营养活性。方法:建立面神经再生室的动物模型,采集面神经再生液,用双向凝胶电泳技术对再生液进行蛋白组学的研究,并应用运动神经元培养的方法检验其生物活性。结果:再生液中检测到(850士78)个蛋白质斑点,实验组培养神经元的胞体面积、突起长度及光密度值总体上大于对照组。结论:再生液中蛋白含量丰富,种类繁多,面神经再生液对运动神经元确有活性作用。图2表1参6(林琳)20…     

微波变性自体骨骼肌和异体神经修复面神经缺损的实验研究

目的 利用不同的桥接移植供体修复大鼠面神经缺损增强其再生。方法 用微波变性异体腓神经和微波变性自体骨骼肌作为桥接材料修复一侧面神经下颌支缺损。植入桥接材料１０周后观测大鼠面神经再生情况,采用霍乱毒素Ｂ亚单位偶联的辣根过氧化物酶（ｈｏｒｓｅｒａｄｉｓｈ ｐｅｒｏｘｉｄａｓｅ ｃｏｎｊｕｇａｔｅｄ ｃｈｏｌｅｒａ ｔｏｘｉｎ Ｂ ｓｕｂｕｎｉｔ,ＣＢ－ＨＲＰ）逆行示踪法、神经肌电图、Ｆｌａｍｍｉｎｇ染色及ＨＥ染色观察神经轴突和髓鞘生长发育以及神经肌肉机能恢复情况。经典的自体神经移植作为对照。结果 微波变性异体腓神经组和微波变性自体骨骼肌组轴突再生率和数量较高,与自体神经组比较差异有显著性。自体腓神经移植组髓鞘发育较好。结论 作为修复面神经缺损的桥接供体微波变性异体腓神经和自体骨骼肌制备简便,来源充分,神经再通效果好     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.