Effects of machined/turned, TiO2-blasted and sandblasted/acid-etched titanium oral implant surfaces on nerve conduction: a study on isolated rat sciatic nerves

The purpose of this study was to explore the clinical relevance of the effects of machined/turned, TiO(2)-blasted and sandblasted/acid-etched titanium oral implant surfaces on nerve conduction. Isolated rat sciatic nerves were placed between two suction electrodes in a pyrex bath containing a tyrode solution. Evoked compound action potentials (cAPs) of the nerves were recorded before and after contact with the implants. The mandibular incisors of randomly selected animals were extracted and changes in cAP amplitudes were used as controls. The differences in final cAP values of Astra Tech implants and rat natural teeth were insignificant (P < 0.05), whereas the differences between other groups were significant (P < 0.05). Machined/turned-surface implants did not cause any change in cAPs. A slight decrease in cAPs was observed for TiO(2)-blasted and sandblasted/acid-etched implants, and the natural teeth. The reductions of cAPs in latter groups were not 50% after an application time of 300 min. The cAP changes of nerves contacting TiO(2)-blasted and sandblasted/acid-etched oral implants fall within physiologic limits in vitro. Machined/turned, TiO(2)-blasted, and sandblasted/acid-etched titanium implant surfaces do not lead to irreversible neurotoxic effects.     

Nerve conduction study of the medial and lateral plantar nerves

The medial and lateral plantar nerves may be evaluated through the recordings of the compound sensory nerve action potentials (CSNAP), compound mixed nerve action potentials (CMNAP) and compound muscular action potentials (CMAP). As some of these potentials are not easily and always obtainable in normal individuals, our purpose was to verify the consistency of these potentials for the study of these nerves. Fifty-one normal adult volunteers were examined. The CSNAP, CMNAP and CMAP, related to the medial and lateral plantar nerves were evaluated bilaterally. CSNAP were not obtained in 7.8% and in 17.6% from the medial and lateral plantar nerves respectively. CMNAP from the lateral plantar nerve were not obtained in 15.6%. CMNAP from the medial plantar nerves and CMAPs from the abductor hallucis and abductor digiti quinti were obtained for all nerves tested. Our results, therefore, suggest that these last 3 parameters are the ones more reliable for clinical application.     

Influence of blood lead concentration on the nerve conduction velocity in patients with end-stage renal disease

Diseases of the peripheral nervous system are the most prevalent in patients with end-stage renal disease (ESRD). Although increased blood levels of lead in ESRD have been reported, the role of lead remains to be elucidated. The purpose of this study was to determine the connection of blood lead concentration with peripheral nerve conduction velocity. One hundred ninety-eight healthy subjects (control group) and 68 patients with ESRD undergoing hemodialysis (ESRD group) were enrolled. Nerve conduction was measured within two hours after hemodialysis. Orthodromic sensory nerve action potentials and compound muscle action potentials were recorded on the median, ulnar, and radial nerves. Hemoglobin-corrected blood lead was significantly higher in ESRD patients than in controls (9.1+/-2.8 microgram/dL vs. 5.9+/-2.3 microgram/dL, p<0.001). 32.4% of 68 ESRD patients with diabetes mellitus were significantly related to poorer motor and sensory nerve conduction velocity (p<0.001). However, blood lead was not a significant predictor of the nerve conduction velocity (p>0.05). Our result suggested that even though the blood lead levels were high in ESRD, they were not associated with the decline of peripheral nerve function. Diabetes mellitus is a primary independent risk of neuropathy in ESRD patients.     

Reduced evoked motor and sensory potential amplitudes in obstructive sleep apnea patients

It is unknown to what extent chronic intermittent hypoxaemia in obstructive sleep apnea causes damage to the motor and sensory peripheral nerves. It was hypothesized that patients with obstructive sleep apnea would have bilaterally significantly impaired amplitudes of both motor and sensory peripheral nerve‐evoked potentials of both lower and upper limbs. An observational study was conducted on 43 patients with obstructive sleep apnea confirmed by the whole‐night polysomnography, and 40 controls to assess the relationship between obstructive sleep apnea and peripheral neuropathy. All obstructive sleep apnea subjects underwent standardized electroneurographic testing, with full assessment of amplitudes of evoked compound muscle action potentials, sensory neural action potentials, motor and sensory nerve conduction velocities, and distal motor and sensory latencies of the median, ulnar, peroneal and sural nerves, bilaterally. All nerve measurements were compared with reference values, as well as between the untreated patients with obstructive sleep apnea and control subjects. Averaged compound muscle action potential and sensory nerve action potential amplitudes were significantly reduced in the nerves of both upper and lower limbs in patients with obstructive sleep apnea compared with controls (P < 0.001). These results confirmed that patients with obstructive sleep apnea had significantly lower amplitudes of evoked action potentials of both motor and sensory peripheral nerves. Clinical/subclinical axonal damage exists in patients with obstructive sleep apnea to a greater extent than previously thought.     

The innervation of the vas deferens of the guinea-pig

1. The compound action potential of the hypogastric nerve of the guinea-pig contained two main elevations. The low-threshold fibres had a range of conduction velocities from 1.5 to 10 m/sec. The high threshold fibres conducted action potentials at less than 1 m/sec. The hypogastric nerve contained small myelinated fibres and non-myelinated fibres.2. In the preparation in vitro, junctional potentials and contractions were elicited by stimulation of the rapidly conducting fibres alone. Trains of C fibre volleys were ineffective.3. In the preparation in vivo, conduction from the hypogastric nerve to the vas deferens nerve was unidirectional and abolished by hexamethonium. After the administration of hexamethonium, the contraction produced by stimulation of the vas deferens nerve was unaffected.4. The close arterial injection of acetylcholine (ACh) into the pelvic viscera caused centrifugal activity in the motor fibres of the vas deferens nerve, but no impulses were detected in the hypogastric nerve.5. Ganglion cells are present in the last 2 cm of the hypogastric nerve.6. It is concluded that there is a ganglionic relay between the hypogastric and vas deferens nerves.     

肯尼迪病患者的神经电生理分析

目的:研究肯尼迪病患者的神经电生理特点,提高对此病电生理的认识。方法:对经基因确诊的3例肯尼迪患者的神经电生理进行总结分析。3例患者均行神经传导和肌电图(EMG)检测。神经传导检查包括:正中神经、尺神经、腓总神经、胫神经和腓肠神经。检测项目包括运动神经潜伏期(Lat)、复合肌肉动作电位波幅(CMAP)、运动神经传导速度(MCV);感觉神经潜伏期(lat)、感觉神经动作电位波幅(SNAP)、感觉神经传导速度(SCV)。EMG:检查双侧舌肌、胸锁乳突肌、三角肌、第一骨间肌、胸椎旁肌、股四头肌、胫前肌。检测项目包括静止时的自发电位,轻收缩时运动单位动作电位(MUP)的时限、波幅,重收缩时的募集相。结果:第1例患者运动神经传导正常,感觉神经SNAP波幅低和SCV正常。第2例患者双正中神经运动Lat延长、CMAP下降,NCV减慢,双正中神经感觉未测及SNAP波幅,合并腕管综合征;其余运动神经传导正常,感觉神经SNAP波幅和SCV均低。第3例运动神经传导正常,感觉SNAP波幅低和SCV下降。本组3例患者EMG多块肌肉静息时出现2处以上的纤颤波、正尖波,轻收缩时MUP时限增宽,波幅增高,部分呈巨大电位,重收缩时呈单纯相或单纯混合相。结论:KD患者EMG呈广泛神经源性改变,可累及感觉。     

Reconstruction of rat peripheral nerve gap without sutures using freeze-dried alginate gel

Many materials have been used for artificial tubular prostheses to assist peripheral nerve gap reconstruction. However, the clinical use of these devices has been restricted because a microsurgical procedure requires specialized techniques and expensive equipment, such as operating microscope systems. Therefore the authors developed a new gluing method, without sutures, that uses freeze-dried alginate gel. A 7-mm gap in the sciatic nerve of rats was bridged with freeze-dried alginate gel. Regeneration was evaluated by electrophysiologic testing and histologic study. Eighteen weeks after surgery, functional reinnervation of motor and sensory nerves had occurred, as demonstrated by recovery of compound muscle action potentials (CMAP), compound nerve action potentials (CNAP), and somatosensory-evoked potentials (SEP). Histologically, many regenerated nerve fasciculi, including myelinated and unmyelinated fibers, were observed and the implanted alginate gel had disappeared. In conclusion, a gluing technique using alginate gel is a potential alternative to the conventional nerve autograft technique. Advantages include simple application and rapid repair. Freeze-dried alginate gel is a promising material for artificial nerve guides for peripheral nerves and also could be used for repair of disrupted pathways in central nervous tissue that is amorphous and cannot be sutured.     

Fast and slow muscles of the chick after nerve cross-union

1. The multiply innervated anterior latissimus dorsi (ALD) and the focally innervated posterior latissimus dorsi (PLD) muscles of the chick were investigated 2-18 months after nerve cross-union.2. The fast PLD muscle re-innervated by the slow muscle nerve became supplied with ;en grappe' end-plates and responded to a single nerve volley with local potentials only. Control PLD muscles re-innervated by the original nerve, had ;en plaque' end-plates and responded to a single nerve volley by synchronous action potentials in the same way as normal muscles.3. In the slow ALD muscle re-innervated with the ;mixed' PLD nerve, the type of innervation and of electromyographic response remained practically unchanged, with the exception of transplanted ALD muscles supplied with PLD nerves where, in addition to local responses, propagated action potentials were registered electromyographically in response to single nerve volleys.4. ALD muscles of young chickens re-innervated both with an implanted purely fast muscle nerve and with the regenerated original nerve, had two types of innervation: ;en plaque' end-plates around the nerve implant, and multiple ;en grappe' end-plates in areas supplied with the ALD nerve. Accordingly, propagated action potentials were registered in response to single nerve volleys in regions near the implant, whereas local potentials were recorded in areas with original innervation.5. Contraction velocity was not substantially altered in PLD and ALD muscles after nerve cross-union.6. No changes were observed in the fine structure of muscle fibres in extrajunctional regions.     

Residual aluminum oxide on the surface of titanium implants has no effect on osseointegration

The cleanliness of titanium dental implants surfaces is considered to be an important requirement for achieving osseointegration, and it has been hypothesized that the presence of inorganic contaminants could lead to lack of clinical success. Aluminum ions are suspected to impair bone formation by a possible competitive action to calcium. The objective of the present study was to describe the effects of residual aluminum oxide particles on the implant surface on the integration of titanium dental implants as compared to decontaminated implants in a rabbit experimental model. Threaded screw-shaped machined grade 3 c.p. titanium dental implants, produced with high-precision equipment, were used in this study. The implants were sandblasted with 100-120 microm Al2O3 particles at a 5atm pressure for 1min, then 24 implants (control implants) underwent ASTM F 86-68 decontamination process in an ultrasonic bath. The other 24 implants (test implants) were washed in saline solution for 15min. Both test and control implants were air-dried and sterilized at 120 degrees C for 30min. After sterilization the implants were inserted into the tibiae (two test and two control implants in each rabbit). Twelve New Zealand white mature male rabbits were used in this study. The protocol of the study was approved by the Ethical Committee of our University. No complications or deaths occurred in the postoperative period. All animals were euthanized, with an overdose of intravenous pentobarbital, after 4 weeks. A total of 48 implants were retrieved. The images were analyzed for quantitation of percentage of surface covered by inorganic particles, bone-implant contact, multinucleated cells or osteoclasts in contact with the implant surface and multinucleated cells or osteoclasts found 3mm from the implant surface. The differences in the percentages between the two groups have been evaluated with the analysis of variance. The implant surface covered by inorganic particles on test implants was significantly higher than that of control implants (p=0.0000). No statistically significant differences were found in the bone-implant contact percentages of test and control implants (p=0.377). No statistically significant differences were found in the number of multinucleated cells and osteoclasts in contact with the implant surface (p=0.304), and at a distance of 3mm from the implant surface (p=0.362). In conclusion, our histological results do not provide evidence to support the hypothesis that residual aluminum oxide particles on the implant surface could affect the osseointegration of titanium dental implants.     

Dental implants stimulate expression of Interleukin-8 and its receptor in human blood--an in vitro approach

Interleukin (IL)-8 secreted from osteoblasts and peripheral blood monocytes increases in patients with aseptic hip-implant loss and in patients with mucositis after dental implant insertion. We explored in vitro the possibility of an IL-8-mediated inflammatory response as a consequence of contact between different dental implant surfaces and human blood. Titanium and zirconia implants were incubated in human blood. Nonstimulated blood served as negative, while blood stimulated with bacterial lipopolysaccharides (LPS) served as positive control. After depyrogenization, to examine the possible role of LPS, implants were again submerged in blood. Gene-expression of IL-8 and its receptor was measured by real-time quantitative polymerase chain reaction. In a receptor mediated, but LPS-independent manner, titanium implants led to a more pronounced increase in IL-8 gene expression when compared with zirconia implants. Depyrogenization resulted after 24 h in zirconia implants in decreased IL-8 gene expression. Altered IL-8 expression could indicate aseptic, at least LPS-independent implant loss, which may be an additional feature in the manifestation of peri-implantitis, possibly triggered by microscopically small implant-particles. Hence, opening a new field of investigations to further understand the possible mechanism underlying the manifestation of implant failure.     

Sensory nerve conduction study in forearm segment of superficial radial nerve: standardization of technique

Sensory nerve conduction velocity (SNCV) over the forearm segment of the superficial radial nerve was studied by an antidromic method in 76 nerves of 50 normal volunteers ranging in age from 16 to 70 years. The mean SNCVs were 53.3 +/- 3.6 m/sec (1 SD) and the mean amplitudes of sensory nerve action potentials were 15.2 +/- 9.8 microV (1 SD). This method of obtaining SNCV over the forearm segment of the superficial radial nerve is easily performed and the findings are consistent.     

Olfactory nerves and their excitatory action in the olfactory bulb

Summary Extracellular field potentials were recorded from the rabbit olfactory bulb following stimulation of the surface and the lateral olfactory tract. Experiments were also performed on olfactory nerve rootlets and a conduction velocity of .34 m/sec and an absolute refractory period of 2.7 msec were obtained. Stimulation of the surface of the bulb produced in a nearby surface recording electrode an initial sharp triphasic potential followed by two slow negative waves and a later positive wave. It was concluded that the initial triphasic potential represents the compound action potential of the olfactory nerves. The first slow negative wave is due to the postsynaptic excitation of the dendrites of secondary neurons by the olfactory nerves. The second negative wave is due to the synaptic depolarization of the granule cell processes by the dendrites of secondary neurons. The later positive wave represents the inhibitory postsynaptic potentials generated in the relay neurons by the granule cell processes.     

Mononeuropathy of the suprascapular nerve: study of 3 South American cases

In this work 3 new cases of suprascapular nerve mononeuropathy are described. ENMG diagnosis criteria were: a) normal sensory conduction studies of the ipsolateral ulnar, median and radial nerves; b) bilateral suprascapular nerve latencies with bilateral compound muscle action potential, obtained from the infraspinatus muscle with symmetrical techniques; and c) abnormal neurogenic infraspinatus muscle electromyographic findings, coexisting with normal electromyographical data of the ipsolateral deltoideus and supraspinatus muscles. These 3 cases of suprascapular mononeurpathy were found in 6,080 ENMG exams from our University Hospital. For us this mononeuropathy is rare with a 0.05% occurrence.     

Inhibition of compound action potentials following administration of dental self-etching primer/adhesives

Self-etching dentin adhesive systems, a new generation of dental-bonding agents, were investigated for their ability to block nerve conductance in the rat sciatic nerve model. Clearfil SE Bond, Mac Bond and FL Bond were used as test materials. Isolated rat sciatic nerves obtained from female albino rats were placed between two electrodes in a bath containing Tyrode solution. The bonding agents were brought into contact with the nerves and the evoked compound action potentials were recorded versus time before and after contact with the materials. Statistical analysis was performed using the Friedman and Wilcoxon Signed-Ranks tests (P = 0.01) to compare the mean percentage of inhibition between test materials versus time. All test materials were able to block nerve transmission rapidly (3.3 +/- 0.5, 5.1 +/- 2.3 and 8.0 +/- 1.9 min for SE Bond, Mac Bond and FL Bond, respectively). Significant differences were found between FL Bond and SE and Mac Bond (P < 0.01). These results indicated that the bonded systems tested, intended primarily as dentinal tubule occluders, may also exert some direct desensitizing effect on intratubular or pulpal nerve terminals in extremely deep cavities or pulpal microexposures, contributing to decreased postoperative pain.     

The characteristics of spontaneous and evoked action potentials recorded from the rabbit''s uterine nerves

1. A method is described for recording in vivo the action potentials of afferent and efferent fibres in whole nerves supplying the rabbit's uterus.

2. Examination of these nerves under the light microscope and the electron microscope showed them to be composed almost entirely of non-myelinated fibres.

3. Two types of spontaneous action potential were observed; one travelled at about 4 m/sec and probably came from the myelinated fibres, the other travelled at 0·4-1·4 m/sec and certainly came from non-myelinated fibres.

4. The efferent fibre spikes were shown to be faster and higher than the spikes from uterine afferent fibres, but slower and smaller than spikes from broad ligament afferent fibres.

5. Apart from differences in conduction velocity and height, all spikes were basically similar, lasting about 1·5 msec. The height was related to the square of the velocity. Some more complex spikes were also observed.

6. The compound action potential evoked by stimulation of the uterine nerve had three peaks, conducted at 1·3, 0·8 and 0·6 m/sec, respectively, and thought to correspond to the fast afferent fibres, the efferent fibres and the slow afferent fibres, respectively. There were also some late peaks due to reflexion of the antidromic action potentials from the ganglion cells.

7. Stimulation of the hypogastric nerve also evoked a compound action potential in the uterine nerves. Stimulation of the pelvic nerves had no effect.

8. By means of ganglion blocking agents, the uterine ganglia were shown to lie in the pelvic plexus, peripheral to the hypogastric nerve, but central to the uterine nerves.

9. It is argued that the spontaneous action potentials came from individual fibres rather than Remak bundles, and that the recording technique used detected the activity of all but the smallest fibres.

     

Physiological characteristics of re-innervation of skeletal muscle in the mouse

1. Re-innervation of soleus was studied in the mouse after either crushing the sciatic nerve or re-implanting the nerve to soleus outside the original end-plate region.2. During the early stages of re-innervation subthreshold end-plate potentials (e.p.p.s) were recorded in muscle fibres in response to nerve stimulation. Later the e.p.p.s became large enough to evoke action potentials in muscle fibres.3. The rate of recovery of the release of acetylcholine (ACh) as estimated from the quantal content of e.p.p.s was faster when nerves re-innervated the old end-plate region after nerve crush than after re-implantation so that new neuromuscular junctions were formed.4. During re-innervation soleus fatigued more rapidly than normal during repetitive nerve stimulation. The fatigue was due to failure of neuromuscular transmission associated with an impaired release of ACh.5. During re-innervation soleus was supersensitive to ACh until nerve stimulation was capable of evoking action potentials in muscle fibres.     

Influence of a self-etching primer on compound nerve action potentials

The aim of this study was to evaluate the effect of self-etching primers on nerve conductance. A self-etching primer (One Up Bond F) which combines etching and bonding in one step, and a fifth-generation bonding agent (Prime&Bond NT ) were tested. Isolated rat sciatic nerves were placed between two platinum electrodes in a bath containing Tyrode solution. The bonding agents were brought into contact with the nerves and the evoked compound action potentials (CAP) were recorded before and after contact with the materials. One Up Bond F caused total inhibition of the CAP within an average time of 7 min. All CAPs in this group were blocked irreversibly. As with Prime&Bond NT, the reduction in CAP was 45.9% after an application time of 15 min, after which readings were terminated. Recovery of the CAP in this group were maintained after rinsing with fresh tyrode solution. One Up Bond F elicited faster blocking of nerve conductance under the conditions of this model. In the context of dentin desensitization with bonding agents, the self-etching primer may be more effective, clinically.     

Inhibition of compound action potentials following administration of dental self-etching primer/adhesives

Self-etching dentin adhesive systems, a new generation of dental-bonding agents, were investigated for their ability to block nerve conductance in the rat sciatic nerve model. Clearfil SE Bond, Mac Bond and FL Bond were used as test materials. Isolated rat sciatic nerves obtained from female albino rats were placed between two electrodes in a bath containing Tyrode solution. The bonding agents were brought into contact with the nerves and the evoked compound action potentials were recorded versus time before and after contact with the materials. Statistical analysis was performed using the Friedman and Wilcoxon Signed-Ranks tests (P = 0.01) to compare the mean percentage of inhibition between test materials versus time. All test materials were able to block nerve transmission rapidly (3.3 ± 0.5, 5.1 ± 2.3 and 8.0 ± 1.9 min for SE Bond, Mac Bond andFL Bond, respectively). Significant differences were found between FL Bond and SE and Mac Bond (P < 0.01). These results indicated that the bonded systems tested, intended primarily as dentinal tubule occluders, may also exert some direct desensitizing effect on intratubular or pulpal nerve terminals in extremely deep cavities or pulpal microexposures, contributing to decreased postoperative pain.     

Phase transformation, roughness, and microhardness of artificially aged yttria- and magnesia-stabilized zirconia femoral heads

Yttria-stabilized zirconia ceramic (Y-TZP) has been used in total hip arthroplasty for many years but is susceptible to low-temperature aging. Medical-grade magnesia-stabilized zirconia (Mg-PSZ) is less commonly used; however, it has been shown to resist phase transformation. The purpose of this study was to directly compare the effects of artificial aging on phase transformation, surface roughness, and Vickers microhardness on Y-TZP and Mg-PSZ femoral heads. Y-TZP and Mg-PSZ heads were artificially aged in an autoclave in stages up to a total of 49 h. The surface roughness of Y-TZP significantly increased with each stage of artificial aging. Y-TZP heads aged for 49 h had a significantly higher monoclinic phase concentration and roughness, and a significantly lower microhardness, than nonaged Y-TZP heads. Artificial aging also caused the surface of Y-TZP to exhibit a lumpy "orange peel"-like appearance with a significantly higher mean peak height, suggesting that artificial aging causes individual grains to be pushed out of the surface. In contrast, artificial aging did not significantly affect the properties of Mg-PSZ heads. These findings suggest that Mg-PSZ is a satisfactory material for orthopaedic implant use, while Y-TZP, in the form tested, is not adequately stable for use as a bearing surface.     

Acute hypoglycemia impairs the functioning of the central but not peripheral nervous system

Acute hypoglycemia impairs functions of the central nervous system, but few controlled studies have assessed the impact of hypoglycemia on the function of the peripheral nervous system. Sixteen non-diabetic humans underwent two separate hyperinsulinemic glucose clamp procedures on different study days, in a counter-balanced fashion. On one occasion, euglycemia was maintained (blood glucose, 5.0 mmol l(-1)), and on the other occasion, hypoglycemia (blood glucose, 2.6 mmol l(-1)) was induced. During each condition, subjects performed a combined psychometric, cognitive-experimental and psychophysical test battery, and measures were made (in the dominant median and common peroneal nerves) of the motor nerve conduction velocities and the amplitudes of the motor action potentials. Hypoglycemia caused impaired performance of general cognitive and information processing tasks (P<.05), but nerve conduction velocities and the amplitudes of motor action potentials were unaffected. Conduction velocities of the common peroneal nerve decreased from baseline within each experimental condition, perhaps due to hyperinsulinemia. Overall, these results demonstrate that multiple levels of information processing in the brain may alter while peripheral nerve function remains intact, and imply that peripheral neurons do not have the same obligate requirement for glucose as a metabolic fuel as neurons of the central nervous system.