Recurrent ulnar nerve entrapment at the elbow: Correlation of surgical findings and 3-Tesla magnetic resonance neurography

The authors describe the correlation between 3-Tesla magnetic resonance neurography (MRN) and surgical findings in two patients who underwent multiple previous failed ulnar nerve surgeries. MRN correctly localized the site of the abnormality. Prospectively observed MRN findings of perineural fibrosis, ulnar nerve re-entrapment abnormalities, medial antebrachial cutaneous neuroma and additional median nerve entrapment were confirmed surgically.     

脊髓背侧损伤大鼠排尿上行传导通路的改变

目的采用生物素葡聚糖胺(BDA)示踪技术观察大鼠脊髓背侧损伤后排尿上行传导通路的改变。方法采用清洁级雌性SD大鼠30只,随机分为实验对照组和脊髓背侧损伤17 g/2 cm、17 g/5 cm及17 g/10cm,3个小组,使用该院自行设计的实验装置在T12~L1水平制备背侧脊髓损伤动物模型,对照组大鼠仅暴露脊髓,但不损伤脊髓。术后第1天,所有大鼠开腹,BDA注射于膀胱壁。BDA注射2周后取出脊髓组织,行BDA染色并观察其变化。结果神经示踪后BDA免疫组化阳性的神经元呈棕褐色深染。BDA阳性的神经元细胞主要分布在脊髓灰质。通过观察脊髓组织内BDA的变化情况,发现脊髓损伤后损伤部位以上脊髓组织内BDA阳性的神经元细胞数目较对照组减少;随着脊髓损伤程度的加重,神经元细胞染色程度减弱。并且在脊髓损伤组中,损伤部位以上出现一侧深染者,向上走行过程中观察到另一侧相应位置也出现明显BDA染色阳性的区域。结论 BDA示踪技术在神经传导的研究中有较好的应用价值。神经示踪结果提示外伤性脊髓损伤后膀胱尿道与排尿中枢间神经通路的传导发生了减弱,并且膀胱尿道与排尿中枢间神经通路在传导过程中存在神经支配向对侧交叉传导的情况。     

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

ABSTRACT

The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0–9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Gait analysis and clinical assessment of spasticity were performed before and after each phase. Analysis of variance (ANOVA) for repeated measurements was used to test for changes in gait measures across the four measurement sessions. Friedman's was used to test for changes in muscle tone (Modified Ashworth Scale) across the four measurement sessions. Stride length (p <.001), gait speed (p <.001), stride time (p <.001), stance phase time (p <.001), double support time (p <.003), muscle tone (p <.02), and peak dorsiflexion angle during midstance (p <.004) improved significantly following the intervention phase. The results of this study demonstrate that the gait pattern of children with cerebral palsy classified as level II or III on the Gross Motor Functional Classification System (GMFCS) improved by a prolonged standing program. However, these improvements were not maintained at 3 weeks. Further research is necessary with larger sample sizes to replicate these findings and determine specific “dosing” for standing programs to create long-lasting functional effects on gait.     

Perceptual Embodiment of Prosthetic Limbs by Transcutaneous Electrical Nerve Stimulation

Objectives: In able‐bodied participants, it is possible to induce a sense of perceptual embodiment in an artificial hand using a visual‐tactile illusion. In amputee patients, electrical stimulation of sensory afferents using transcutaneous electrical nerve stimulation (TENS) has been shown to generate somatic sensations in an amputee's phantom limb(s). However, the effects of TENS on the perceptual embodiment of an artificial limb are not known. Our objective was to investigate the effects of TENS on the perceptual embodiment of an artificial limb in fully intact able‐bodied participants. Materials and Methods: We used a modified version of the rubber hand illusion presented to 30 able‐bodied participants (16 women, 14 men) to convey TENS paresthesia to an artificial hand. TENS electrodes were located over superficial radial nerve on the lateral aspect of the right forearm (1 cm proximal to the wrist), which was hidden from view. TENS intensity was increased to a strong non‐painful TENS sensation (electrical paresthesia) was felt beneath the electrodes and projecting into the fingers of the hand. The electrical characteristics of TENS were asymmetric biphasic electrical pulsed waves, continuous pulse pattern, 120 Hz pulse frequency (rate), and 80 µs pulse duration (width). Results: Participants reported significantly higher intensities of the rubber hand illusion during the two TENS conditions (mean = 5.8, standard deviation = 1.9) compared with the two non‐TENS conditions (mean = 4.9, standard deviation = 1.7), p < 0.0005. Conclusions: Our findings provide initial evidence that TENS paresthesia can be projected into an artificial limb, and this can enhance the sense of perceptual embodiment of an artificial hand. Further exploratory studies involving an amputee population are warranted.     

Salidroside protects PC12 cells from MPP-induced apoptosis via activation of the PI3K/Akt pathway

Oxidative stress plays an important role in the pathogenesis of Parkinson’s disease (PD). Salidroside (SAL), a phenylpropanoid glycoside isolated from Rhodiola rosea L., can exert potent antioxidant properties. In this study, we investigated the protective effects, and the possible mechanism of action, of SAL against 1-methyl-4-phenylpyridinium (MPP⁺)-induced cell damage in rat adrenal pheochromocytoma PC12 cells. Pretreatment of PC12 cells with SAL significantly reduced the ability of MPP⁺ to induce apoptosis in a dose and time-dependent manner. SAL significantly and dose-dependently inhibited MPP⁺-induced chromatin condensation and MPP⁺-induced release of lactate dehydrogenase by PC12 cells. SAL enhanced Akt phosphorylation in PC12 cells, and the protective effects of SAL against MPP⁺-induced apoptosis were abolished by LY294002, a specific inhibitor of phosphatidylinositol 3-kinase (PI3K) phosphorylation. These findings suggest that SAL prevents MPP⁺-induced apoptosis in PC12 cells, at least in part through activation of the PI3K/Akt pathway.     

Therapeutic targets for overactive bladder other than smooth muscle

Introduction: For a long time, our concepts of regulation of urinary bladder function in health and disease as well as of the target structures of therapeutics have focused on detrusor smooth muscle cells. However, other structures including urothelium, afferent nerves and bladder blood vessels may also be important in pathophysiology and its treatment.

Areas covered: Based on a selective review of literature, we discuss the role of urothelium, afferent nerve fibers and bladder blood vessels in bladder pathophysiology and as targets for treatment.

Expert opinion: There is solid evidence now that multiple anatomical structures within the urinary bladder contribute to the regulation of its function and hence may be targets for established and emerging drugs. However, most previous studies have looked at the various target structures in isolation. In contrast, we propose that they should be seen as a network sensing and responding to alterations in the cellular environment or to xenobiotics. Studies are emerging in which the interaction of two of these structures is explored. Major advances in our understanding of bladder function are expected to result from studies integrating multiple such structures but these may be technically challenging and difficult to perform and interpret.     

阴茎背神经离断术联合α1受体阻断药治疗早泄的疗效

目的探讨阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄的疗效。方法对89例早泄患者随机分为3组:单纯药物治疗组、单纯阴茎背神经离断组、联合治疗组,每组给予相应治疗,观察阴道内射精潜伏期的变化。结果联合治疗组阴道内射精潜伏期(160.4±57.7 s)较单纯药物α1受体阻断药治疗组(64.3±23.2 s)和单纯阴茎背神经离断组(106.5±41.4 s)明显延长(P<0.01)。结论阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄效果明显。     

NGF is involved in oral ovalbumin‐induced altered colonic contractility in rats: evidence from the blockade of TrkA receptors with K252a

Background Nerve growth factor (NGF)‐mucosal mast cell (MMC) interaction has been implicated in the remodeling of enteric circuitries and associated functional changes. We investigated the involvement of NGF and its receptor TrkA in the altered colonic contractile activity observed in the model of oral ovalbumin (OVA)‐induced MMC hyperactivity in rats. We also studied the role of colonic MMCs as a source of NGF. Methods Rats received oral OVA, alone or with the TrkA antagonist K252a. Colonic co‐expression of NGF/TrkA and rat mast cell protease II (RMCPII) (double immunofluorescence), RMCPII content (ELISA) and expression of NGF, Brain‐derived neurotrophic factor (BDNF) and TrkA/B (QT‐PCR) were assessed. Colonic contractile activity was determined in vivo and in vitro. Key Results TrkA, but not NGF, was localized in colonic MMCs (RMCPII‐positive). Oral ovalbumin exposure increased colonic RMCPII levels but did not change the percentage of TrkA‐positive MMCs. Neither OVA nor K252a, alone or combined, altered NGF, BDNF or TrkA/B expression. Spontaneous colonic activity in vivo and in vitro was altered by OVA, an effect prevented by K252a. Electrical stimulation‐induced contractile responses in vivo and carbachol responses in vitro were increased by OVA in a K252a‐independent manner. In OVA‐treated animals, inhibition of NO synthesis with l ‐NNA significantly enhanced spontaneous colonic activity in vitro, a response completely prevented by K252a. Conclusions & Inferences These results suggest that NGF‐TrkA‐dependent pathways are implicated in colonic contractile alterations observed during OVA exposure in rats. NGF‐TrkA system might represent a potential target for treatment of gastrointestinal disorders characterized by colonic motor alterations.     

Pupil-sparing third nerve palsies and hemiataxia: Claude’s and reverse Claude’s syndrome

We report two patients with midbrain infarction with pupil-sparing third nerve palsies and hemiataxia: one with contralateral ataxia (Claude’s syndrome) and one with ipsilateral ataxia (which we refer to as reverse Claude’s syndrome). We highlight the importance of a thorough neurologic evaluation with partial oculomotor palsies and describe, to our knowledge, the fourth account in the literature of a pupil-sparing third nerve palsy with ipsilateral cerebellar ataxia.