Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain

PURPOSE: The purpose of this study was to compare the postoperative rates of ganglion recurrence between arthroscopic and open techniques of dorsal ganglion (DG) excision. METHODS: A total of 72 patients had either arthroscopic or open excision of a primary, simple DG by 1 of 2 senior hand surgeons. Three prospective postoperative assessments were performed. The first examination was performed at 5 to 7 days, the second at 4 to 8 weeks, and the third assessment was performed at a minimum of 1 year after surgery. Percentages of ganglion recurrence at the second and third assessments were recorded. RESULTS: Forty-one patients had arthroscopic excision, and 31 patients had open excision. Baseline patient age, gender, and surgical side were similar between the 2 groups. Recurrence of the DG at the second postoperative assessment was 1 of 41 patients in the arthroscopic group and none in the open excision group, and, after a minimum of 12 months after excision, recurrence was 3 of 28 in the arthroscopic group and 2 of 23 in the open group. CONCLUSIONS: This study compares the rates of ganglion recurrence between arthroscopic and open DG excision. Our results demonstrate that at 12 months follow-up, the rates of recurrence with arthroscopic DG excision are comparable with and not superior to those of open excision. Our results suggest that additional long-term comparative studies are needed to accurately differentiate the efficacy of open and arthroscopic techniques.     

The incidence of dorsal radiocarpal ligament tears in patients having diagnostic wrist arthroscopy for wrist pain

PURPOSE: The goal of this study was to examine the incidence of dorsal radiocarpal ligament (DRCL) tears in patients having diagnostic arthroscopy for chronic wrist pain. METHODS: A chart review was performed of 64 patients who had diagnostic wrist arthroscopy for chronic wrist pain that was refractory to conservative measures. For each case, interosseous ligament instability/tears were graded according to the Geissler classification. Tears of the triangular fibrocartilage complex and the presence or absence of a DRCL tear were noted. RESULTS: There were 35 of 64 wrists (in 64 patients) with DRCL tears. The average duration of wrist pain prior to treatment was 20 months. Only 10 patients could recall a specific injury. Five patients had an isolated DRCL tear. A scapholunate interosseous ligament injury was identified in 13 patients, of whom 7 had a concomitant DRCL tear. A lunotriquetral interosseous ligament injury was present in 7 patients, of whom 2 had a concomitant DRCL tear. Two patients had a capitohamate ligament tear: 1 of these patients had a DRCL tear. There were 7 patients with a solitary triangular fibrocartilage complex tear: 6 of 7 were in association with a DRCL tear. One patient had a chronic ulnar styloid nonunion and a DRCL tear. Two or more lesions were present in 23 patients; DRCL tears were present in 12. CONCLUSIONS: DRCL tears are commonly seen with injuries to the primary wrist stabilizers. Recognition of this condition and further research into treatment methods are needed. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.     

Involvement of the cerebellar dorsal vermis in vergence eye movements in monkeys

Frontal-eyed primates use both smooth pursuit in frontoparallel planes (frontal pursuit) and pursuit-in-depth (vergence pursuit) to track objects moving slowly in 3-dimensional (3D) space. To understand how 3D-pursuit signals represented in frontal eye fields are processed further by downstream pathways, monkeys were trained to pursue a spot moving in 3D virtual space. We characterized pursuit signals in Purkinje (P) cells in the cerebellar dorsal vermis and their discharge during vergence pursuit. In 41% of pursuit P-cells, 3D-pursuit signals were observed. However, the majority of vermal-pursuit P-cells (59%) discharged either for vergence pursuit (43%) or for frontal pursuit (16%). Moreover, the majority (74%) of vergence-related P-cells carried convergence signals, displaying both vergence eye position and velocity sensitivity during sinusoidal and step vergence eye movements. Preferred frontal-pursuit directions of vergence + frontal-pursuit P-cells were distributed in all directions. Most pursuit P-cells (73%) discharged before the onset of vergence eye movements; the median lead time was 16 ms. Muscimol infusion into the sites where convergence P-cells were recorded resulted in a reduction of peak convergence eye velocity, of initial convergence eye acceleration, and of frontal-pursuit eye velocity. These results suggest involvement of the dorsal vermis in conversion of 3D-pursuit signals and in convergence eye movements.     

阴茎背神经切断术治疗早泄

目的评价阴茎背神经切断术治疗早泄的效果。方法自1997~2006年门诊早泄患者19例行阴茎背神经切断术治疗早泄。局麻下于阴茎背侧距冠状沟0.5~1cm处做2~3cm横切口,切开深筋膜,暴露左右两侧之阴茎背神经,并切除部分神经分支。记录患者手术前后阴道内射精潜伏时间和夫妻双方性交满意度。结果19例患者术前平均阴道内射精潜伏时间和性交满意度分别为(1.01±0.58)min(0.10~1.90min)和(14.89±6.08)%(5%~25%),术后平均射精潜伏期和性交满意度分别为(4.14±2.99)min(0.40~9.10min)和(57.47±28.28)%(10%~87%),手术前后相比P<0.01。19例中15例有效,有效率为78.95%,4例无效,2例出现术后轻度局部疼痛,1周后缓解。结论阴茎背神经切断术是一种治疗早泄的有效方法,适用于治疗年轻且不合并ED的患者。     

系统腰腹肌功能锻炼对经皮椎间孔镜靶向穿刺定位治疗 LDH 术后功能恢复的临床研究

目的：评价功能锻炼在腰椎间盘突出症（lumbar disc herniation,LDH）术后的时效性及对腰椎功能恢复的影响。方法：将纳入标准的 100 例患者随机分为治疗组和对照组各 50 例,治疗组在经皮椎间孔镜靶向穿刺定位治疗后给予系统腰腹肌功能锻炼,对照组给予直腿抬高练习和背伸肌适度锻炼,随访 1 年;分别于术前及术后１ d、3 月、6 月及 1 年采用VAS、ODI 评分和术后 1 年的腰背部不适例数、腰椎稳定性进行对比。结果：两组术后不同时间点腰痛、腿痛 VAS 评分、ODI 评分术均低于术前（P<0.05）,两组术前、术后 1 d 腰痛、腿痛 VAS 评分、ODI 评分比较,差异均无统计学意义（P>0.05）;治疗组腰痛 VAS 评分术后 3 月 [(1.31±0.42) 分 vs (2.01±1.03) 分 ]、术后 6 月 [(0.67±0.32) 分 vs (1.58±0.74) 分 ]、术后 1 年 [(0.41±0.17) 分 vs (1.37±0.64) 分 ] 均低于对照组（P<0.05）;治疗组腿痛 VAS 评分术后 3 月 [(1.31±0.42) 分 vs (2.01±1.03) 分 ]、术后 6 月 [(0.67±0.32) 分 vs (1.58±0.74) 分 ]、术后 1 年 [(0.41±0.17) 分 vs (1.37±0.64) 分 ] 均低于对照组（P<0.05）;治疗组 ODI 评分术后 3 月 [(10.14±1.07) 分 vs (12.33±1.28) 分]、6 月 [(8.21±0.14) 分 vs (10.34±0.75)分 ]、1 年 [(7.92±0.05) 分 vs (9.28±0.42) 分 ] 均低于对照组（P<0.05）。术后 1 年,两组腰椎曲度、前凸指数、骶骨倾斜角方面与术前比较差异均有统计学意义（P<0.05）;治疗组术后 1 年前凸指数 [(2.52±0.27) cm vs (2.32±0.58) cm]、骶骨倾斜角 [(31.08±4.81)° vs (28.19±3.05)° ] 均高于对照组（P<0.05）。两组术后 1 年腰腿部不适阳性率比较,P<0.05。结论：经皮椎间孔镜靶向穿刺定位治疗 LDH 术后给予系统腰腹肌功能锻炼,可明显缓解疼痛不适,维持腰椎的稳定性,降低复发率,且症状随系统功能锻炼次数的增加改善越明显。     

接合两侧指背神经的指动脉终末背侧皮支皮瓣修复指端缺损

目的探讨接合两侧指背神经的指动脉终末背侧皮支皮瓣修复指端缺损的方法和临床疗效。方法2008年8月-2011年8月．采用接合两侧指背神经的指动脉终末背侧皮支皮瓣修复2～5指指端缺损6例,其中食指2例,中指1例。环指2例,小指1例,皮瓣切取面积最大22mm×20mm,最小10mm×9mm。结果6例6指皮瓣全部成活．术后经6～24个月随访,平均13个月,皮瓣外观及手指功能恢复满意,感觉恢复S3,皮瓣两点辨别觉6～9mm,平均7．6mm,供区无并发症。结论接合两侧指背神经的指动脉终末背侧皮支皮瓣具有血供可靠．不破坏重要血管,且有可供接合的神经,操作简便等优点,是修复手指指端缺损较为理想的方法。     

Effects of movement imitation training in Parkinson's disease: A virtual reality pilot study

BackgroundHypometria is a clinical motor sign in Parkinson's disease. Its origin likely emerges from basal ganglia dysfunction, leading to an impaired control of inhibitory intracortical motor circuits. Some neurorehabilitation approaches include movement imitation training; besides the effects of motor practice, there might be a benefit due to observation and imitation of un-altered movement patterns. In this sense, virtual reality facilitates the process by customizing motor-patterns to be observed and imitated.ObjectiveTo evaluate the effect of a motor-imitation therapy focused on hypometria in Parkinson's disease using virtual reality.MethodsWe carried out a randomized controlled pilot-study. Sixteen patients were randomly assigned in experimental and control groups. Groups underwent 4-weeks of training based on finger-tapping with the dominant hand, in which imitation was the differential factor (only the experimental group imitated). We evaluated self-paced movement features and cortico-spinal excitability (recruitment curves and silent periods in both hemispheres) before, immediately after, and two weeks after the training period.ResultsMovement amplitude increased significantly after the therapy in the experimental group for the trained and un-trained hands. Motor thresholds and silent periods evaluated with transcranial magnetic stimulation were differently modified by training in the two groups; although the changes in the input–output recruitment were similar.ConclusionsThis pilot study suggests that movement imitation therapy enhances the effect of motor practice in patients with Parkinson's disease; imitation-training might be helpful for reducing hypometria in these patients. These results must be clarified in future larger trials.     

Targeting Corticotropin‐Releasing Factor Projections from the Oval Nucleus of the Bed Nucleus of the Stria Terminalis Using Cell‐Type Specific Neuronal Tracing Studies in Mouse and Rat Brain

The bed nucleus of the stria terminalis (BNST) is known to play a critical role in mediating the behavioural and autonomic responses to stressors. The oval nucleus of the BNST (BNSTov) contains cell bodies that synthesise the stress hormone corticotropin‐releasing factor (CRF). Although afferent fibres originating from the BNSTov have been shown to innervate several key structures of the neuroendocrine and central autonomic system, the question remains as to whether some of these fibres are CRF‐positive. To directly address this question, we injected a ‘floxed’ anterograde tracer (rAAV5/EF1a‐DIO‐mCherry) into the BNSTov of CRFp3.0Cre^GFP transgenic mice, which express a green fluorescent protein (GFP) under the control of the CRF promoter. Serial sections were then analysed for the presence of double‐labelled fibres in potential projection sites. To determine whether CRF neurons in the rat BNSTov send comparable projections, we infused rat BNSTov with an adeno‐associated viral vector (AAV) in which the human synapsin promoter drives enhanced GFP expression. We then used CRF immunoreactivity to examine double‐labelled fluorescent fibres and axon terminals in projection sites from brain sections of the AAV‐infused rats. We have observed several terminal fields in the mouse and rat brain with double‐labelled fibres in the Dorsal raphe nucleus (DRD), the paraventricular nucleus of the hypothalamus and, to a lesser extent, in the ventral tegmental area. We found double‐labelled terminal boutons in the nucleus accumbens shell, prelimbic cortex and posterior basolateral nucleus of the amygdala. The most intense double‐labelling was found in midbrain, including substantia nigra pars compacta, red nucleus, periaqueductal grey and pontine nuclei, as well as DRD. The results of the present study indicate that CRF neurons are the output neurons of the BNSTov and they send projections not only to the centres of neuroendocrine and autonomic regulation, but also regions modulating reward and motivation, vigilance and motor function, as well as affective behaviour.     

Mapping the electrophysiological and morphological properties of CA1 pyramidal neurons along the longitudinal hippocampal axis

Differences in behavioral roles, anatomical connectivity, and gene expression patterns in the dorsal, intermediate, and ventral regions of the hippocampus are well characterized. Relatively fewer studies have, however, focused on comparing the physiological properties of neurons located at different dorsoventral extents of the hippocampus. Recently, we reported that dorsal CA1 neurons are less excitable than ventral neurons. There is little or no information for how neurons in the intermediate hippocampus compare to those from the dorsal and ventral ends. Also, it is not known whether the transition of properties along the dorsoventral axis is gradual or segmented. In this study, we developed a statistical model to predict the dorsoventral position of transverse hippocampal slices. Using current clamp recordings combined with this model, we found that CA1 neurons in dorsal, intermediate, and ventral hippocampus have distinct electrophysiological and morphological properties and that the transition in most (but not all) of these properties from the ventral to dorsal end is gradual. Using linear and segmented regression analyses, we found that input resistance and resting membrane potential changed linearly along the V–D axis. Interestingly, the transition in resonance frequency, rebound slope, dendritic branching in stratum radiatum, and action potential properties was segmented along the V–D axis. Together, the findings from this study highlight the heterogeneity in CA1 neuronal properties along the entire longitudinal axis of hippocampus. © 2015 Wiley Periodicals, Inc.     

l‐DOPA‐induced dyskinesia in Parkinson's disease: Are neuroinflammation and astrocytes key elements?

Inflammation in Parkinson's disease (PD) is a new concept that has gained ground due to the potential of mitigating dopaminergic neuron death by decreasing inflammation. The solution to this question is likely to be complex. We propose here that the significance of inflammation in PD may go beyond the nigral cell death. The pathological process that underlies PD requires years to reach its full extent. A growing body of evidence has been accumulated on the presence of multiple inflammatory signs in the brain of PD patients even in very late stages of the disease. Because neuron‐microglia‐astrocyte interactions play a major role in the plasticity of neuronal response to l ‐DOPA in post‐synaptic neurons, we focused this review on our recent results of l ‐DOPA‐induced dyskinesia in rodents correlating it to significant findings regarding glial cells and neuroinflammation. We showed that in the rat model of PD/l ‐DOPA‐induced dyskinesia there was an increased expression of inflammatory markers, such as the enzymes COX2 in neurons and iNOS in glial cells, in the dopamine‐denervated striatum. The gliosis commonly seem in PD was associated with modifications in astrocytes and microglia that occur after chronic treatment with l ‐DOPA. Either as a cause, consequence, or promoter of progression of neuronal degeneration, inflammation plays a role in PD. The key aims of current PD research ought to be to elucidate (a) the time sequence in which the inflammatory factors act in PD patient brain and (b) the mechanisms by which neuroinflammatory response contributes to the collateral effects of l ‐DOPA treatment.