Deep Nerve Research Articles

Ultrasound Speckle Tracking Method Based on Gradient Optical Flow to Quantify Small Longitudinal Displacement, Shear and Longitudinal Strain in Peripheral Nerves

ObjectiveThis study aimed to develop, validate and test the clinical feasibility of ultrasound (US) speckle tracking method based on gradient optical flow for quantifying small longitudinal displacements, shear and strain in peripheral nerves. MethodsThe speckle tracking method was validated using seven thawed, fresh-frozen isolated cadaveric forearms. Longitudinal motion of the median nerve was captured using a high-frequency 22 MHz linear probe. An air bubble marker was inserted as a reference point for manual measurement comparison. The precision and accuracy of the method were assessed by comparing manual and automatic measurements. Clinical feasibility was tested on eight healthy subjects, measuring the longitudinal displacement of the median nerve during elbow extension and shoulder anteflexion. ResultsThe method demonstrated linearity, high precision and accuracy, particularly with a backtrace of five frames, reducing the displacement underestimation to 4%. In cadaveric models, the highest shear strain was observed at the nerve-tissue interfaces. In healthy subjects, the mean displacement of the median nerve was 3.3 ± 1.0 mm, with good inter-rater reliability (intraclass correlation coefficient = 0.87). ConclusionThe US speckle tracking method based on gradient optical flow effectively quantifies small longitudinal displacements and shear strain in peripheral nerves, with high precision and accuracy. However, the method could not detect longitudinal strain in nerves within the range of tested displacements. Future studies should investigate its applicability to smaller and deeper nerves and its usefulness in different pathological conditions.

Safety and Efficacy of One vs Two Incision Broström Gould with Calcaneal Osteotomy and Peroneal Tendon Debridement Surgery

Surgical intervention, such as the Broström-Gould procedure, is typically indicated for patients with chronic lateral ankle instability. In this study, we are comparing the safety and efficacy of the Broström-Gould procedure with peroneal tendon debridement, a sliding lateralizing calcaneal osteotomy, and adjuvant procedures performed with a single- versus double-incision approach. Our retrospective analysis included patients who underwent the procedure of interest between 2011 and 2020. Patients were divided into 2 groups: undergoing either a 1-incision (n = 53) or a 2-incision approach (n = 47), both with a lateralizing calcaneal osteotomy. A significant difference in skin bridge breakdown was observed between the 2-incision (n = 6 [13%]) and 1-incision groups (n = 0 [0%]). There were no significant differences in infection, deep wound dehiscence, nerve palsy, or neuroma between patients in the 2 groups. Furthermore, no statistically significant differences in mean PROMIS scores existed between the cohorts. The described Broström-Gould procedure shows promise for treating chronic ankle instability. While patients in both single- and double-incision groups had similar rates of postoperative complications, the decreased incidence of skin bridge breakdown in the 1incision group highlights the approach's safety and potential benefits in reducing wound-related complications.

Underlying Microstructure of the Lamina Cribrosa at the Site of Microvasculature Dropout.

To determine the microstructure of the lamina cribrosa (LC) associated with microvasculature dropout (MvD) of the deep optic nerve head (ONH) in primary open-angle glaucoma (POAG) and to identify factors related to the presence of MvD. POAG eyes that exhibited MvD in the LC (MvD-LC) or MvD in the peripapillary choroid (MvD-PC) underwent optical coherence tomography and optical coherence tomography angiography (OCTA) to evaluate the structure and microvasculature of the deep ONH, respectively. The presence of MvD-LC or MvD-PC was determined using en face OCTA images of the deep ONH. The sectoral LC thickness (LCT) and LC curvature index (LCCI) (at MvD-LC site, when applicable), the mean LCT and LCCI of the global ONH, and other clinical characteristics were measured and compared between eyes with and without MvD-LC. The study included 93 eyes with and 51 without MvD-LC. The presence of MvD-LC was associated with lower sectoral LCT (odds ratio [OR] = 0.96, P < 0.001) and mean LCT (OR = 0.97, P = 0.032), larger visual field pattern standard deviation (PSD; OR = 1.20, P = 0.038), and higher pretreatment intraocular pressure (IOP; OR = 1.22, P = 0.012). Fifteen percent of the eyes with MvD-LC (14/93) did not present MvD-PC. Those eyes had younger age (P = 0.043), thicker juxtapapillary choroid (P = 0.018), larger sectoral LCCI (P = 0.040), thicker retinal nerve fiber layer (P = 0.024), smaller PSD (P = 0.008), and higher pretreatment IOP (P = 0.006) than those with both MvD-LC and MvD-PC. MvD-LC was associated with a localized morphologic alteration of the LC, and eyes with MvD-LC tended to have a higher pretreatment IOP. The clinical implications of MvD-LC should differ from those of MvD-PC in eyes with POAG.

Comprehensive Treatment of Knee Osteoarthritis Pain through Cryoneurolysis: A Promising Approach for Deep and Superficial Genicular Nerve Modulation - Case Report

Background Knee osteoarthritis is a prevalent and debilitating condition characterized by joint pain, stiffness, and limited mobility. Conventional non-operative treatment approaches often do not provide adequate relief of the patient’s symptoms. Cryoneurolysis of the superficial genicular nerves is a growing and accepted technique used to treat knee pain, however, there is limited literature demonstrating the effectiveness of treating both the superficial and deep genicular nerves, as well as the use of subsequent repeat treatments. Case Report This case study reports on a 65 year-old male with Kellgren-Lawrence grade 2-3 tricompartmental bilateral knee osteoarthritis who underwent cryoneurolysis of the superficial and deep genicular nerves with the iovera° cryoneurolysis device followed by two subsequent repeat cryoneurolysis treatments. Conclusion The results demonstrated a complete resolution of the patient’s pain and enhanced quality of life following cryoneurolysis. Furthermore, subsequent repeat treatments sustained the pain reduction, offering the patient an extended period of improved mobility and reduced discomfort. This case study demonstrates that cryoneurolysis holds promise as a valuable addition to the armamentarium of interventions available for managing knee pain and improving the quality of life for patients suffering from osteoarthritis when they are unable or decide not to pursue surgical intervention.

Improved Pain and Function With Triamcinolone Acetonide Extended-Release and Cryoneurolysis for Knee Osteoarthritis: Use of a New Real-World Registry

BackgroundKnee osteoarthritis (OA) affects 19% of American adults aged more than 45 years and costs $27+ billion annually. A wide range of nonoperative treatment options are available. This study compared 6 treatments: cryoneurolysis with deep genicular nerve block (Cryo-Deep/Both), cryoneurolysis with superficial nerve block (Cryo-Superficial), intra-articular hyaluronic acid (IA-HA) injections, nonsteroidal anti-inflammatory drug injections (IA-NSAIDs), IA-corticosteroids (IA-CS) injections, or IA-triamcinolone extended release (IA-TA-ER) injections over 4 months for: (1) pain severity and analgesic use; and (2) physical function (from Knee Injury and Osteoarthritis Outcome Score for Joint Replacement). MethodsPatients who had unilateral knee OA and received nonoperative intervention were enrolled in the Innovations in Genicular Outcomes Research registry, a novel, multicenter real-world registry, between September 2021 and February 2024. A total of 480 patients were enrolled. Both pain and functional outcomes were assessed at baseline, weekly, and monthly, which were analyzed by overall trend, magnitude changes pretreatment to post-treatment, and distribution-based minimally clinically important difference (MCID) score. Multivariate linear regressions with adjustments for 7 confounding factors were used to compare follow-up outcomes among 6 treatment groups. ResultsUse of IA-TA-ER injections was associated with the lowest pain, greatest pain reduction, and highest prevalence of patients achieving MCID relative to other treatments (P < .001). Deep/Both-Cryo and IA-CS were associated with a higher prevalence of achieving MCID than IA-HA, IA-NSAIDs, and Cryo-Superficial (P ≤ .001). Use of IA-TA-ER was also associated with the greatest functional score, improvement from baseline, and highest prevalence of patients achieving MCID than other treatments (P ≤ .003). ConclusionsThe IA-TA-ER appears to outperform other treatments in terms of pain relief and functional improvement for up to 4 months following treatment. In addition, outcomes in the novel cryoneurolysis and conventional IA-CS were similar to one another and better than those in IA-HA and IA-NSAIDs.

Epidemiology of pediatric hand lacerations: a retrospective cohort study focusing on age and injury-causing objects

Purpose: This study analyzed the epidemiology of pediatric hand lacerations in children under 6 years old, focusing on age-related characteristics and the household objects that caused these injuries.Methods: We conducted a retrospective study of patients under 6 years old who presented with hand lacerations at our emergency department from January 2016 to December 2023. Data were collected on demographics, injury-related factors (the affected hand and finger, injury location, and injury-causing object), need for surgical intervention, and damage to deep structures. Patients were categorized as infants (0–1 years), toddlers (1–3 years), or preschoolers (3–6 years). We recorded the frequency, surgical intervention rates, and affected deep structures for each injury-causing object.Results: Of 153 children treated for hand lacerations, toddlers were the most frequently injured (47.7%), followed by preschoolers (44.4%) and infants (7.8%). The index and middle fingers were particularly vulnerable in toddlers and preschoolers, while infantile injuries more commonly affected the palm. Among 31 identified objects, knives/blades, particularly cutting knives (13.7%) and broken glass (13.1%), were the leading causes, with injuries occurring primarily at home. Surgical intervention was necessary in 11.1% of cases, with eyebrow razors (33.3%) most often requiring surgery and causing damage to deep structures, including arteries, nerves, and flexor tendons.Conclusion: The study highlights the significant role of developmental behaviors in pediatric hand laceration risk. Many injuries were caused by everyday household objects, including eyebrow razors, that are often underestimated as potential dangers. Preventive measures and guardian education are crucial to reduce the incidence of these injuries.

Nerve Magnified Regeneration by Distal Nerve Transfer in High Ulnar Nerve Injury

The concept of nerve-magnified regeneration, part of which is end-to-side nerve transfer, provides a theoretical basis for the treatment of high ulnar nerve injuries. High injury to the ulnar nerve causes severe consequences, such as loss of sensation, loss of movement and “claw hand” deformity, affecting the fine motor skills of the hand. A method of nerve-magnified regeneration – distal nerve transfer – interosseous anterior (median nerve) to the deep ulnar nerve at the wrist level is presented, used in 20 patients (2 to 66 years of age) with an average follow-up period of 3 years (10 months to 5 years). This is a microsurgical method for rapid re-innervation of the most distal hand muscles in proximal neurotmesis of ulnar nerve.

Maintaining Functionality in Temporal Skin Tumor Surgery: A Focus on Nerve Injury and Excision Margins.

Operating on temporal cutaneous tumors is challenging because of the intricate facial nerve system, particularly the frontal branches, and the possibility of brow dysfunction. Surgery for deep margin clearance is difficult because of the fragile and sensitive soft tissue in the temporal region. To address this research gap, this study assessed clearance margins, types of skin tumors, and nerve injuries in this critical anatomical position. This retrospective study assessed temporal skin cancer surgery, malignancy types, and clearance margins in patients with frontal-branch facial nerve injuries. Forty-five patients with temporal skin carcinoma biopsies were analyzed. The deep and peripheral excision margins of skin malignancies were examined. Medical records were reviewed for clinically injured frontal nerve. Thirty-four patients were men (75%), and basal cell carcinoma was the most prevalent histological malignancy, followed by squamous cell carcinoma. The mean age of the patients was 77.8 years (39-107 years). Two patients experienced damage to the frontal branch nerve. Twenty-six percent of the skin malignancies had inadequate deep margin excision. Removing temporal skin lesions is difficult. We discovered a 26% and 4% probability of inadequate deep margin excision and frontal branch facial nerve injury, respectively. Temporal skin lesions must be removed safely by surgeons to preserve the branches of the facial nerves. Insufficiently removed tumors require multidisciplinary teamwork and patient discussions regarding the advantages and risks to improve results.

Anatomical Bases of the Temporal Muscle Trigger Points.

Temporal muscles of 14 adult cadavers were studied. The muscle bellies were divided into six areas, three superior (1.2 and 3) and three inferior areas (4, 5, and 6) lower, according to a Cartesian plane to analyze and describe the entry points of the branches of the deep temporal nerves into the muscle. The branching distribution was analyzed using Poisson log-linear tests with Bonferroni post hoc tests for comparison between groups (sextants) (p < 0.05). Deep temporal nerve entry points were found in the temporal muscle in all areas. Most of the branches were observed in areas 2 and 5, which coincide with the muscle fibers responsible for mandible elevation and related to the previously described MTPs. Fewer branches were found in areas 1 and 6, where contraction produces mandible retraction. There is an anatomical correlation between the branching pattern of the deep temporal nerve and temporal muscle trigger points. Adequate knowledge of the innervation of the temporal muscle may help elucidate the pathophysiology of myofascial syndromes and provide a rational basis for interventional or conservative approaches and help surgeons avoid iatrogenic lesions to the deep temporal nerve lesion.

Effects of Deep Optic Nerve Head Structures on Bruch's Membrane Opening- Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer

PurposeTo explore the effects of deep optic nerve head (ONH) structures on Bruch's membrane opening (BMO)-minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) in healthy eyes. DesignProspective cross-sectional study MethodsTwo hundred five healthy eyes of 141 subjects (mean ± standard deviation of age and axial length (AXL): 46.9±10.0 years and 24.79±1.15 mm) were enrolled. Best fit multivariable linear mixed models identified factors associated with BMO-MRW and pRNFLT. Explanatory variables included age, sex, AXL, BMO and anterior scleral canal opening (ASCO) area and ovality, magnitude of BMO and ASCO shift, peripapillary choroidal thickness, lamina cribrosa (LC) parameters, prelaminar thickness and peripapillary scleral (PPS) angle. ResultsThinner BMO-MRW was associated with older age, smaller ASCO/BMO offset magnitude, larger BMO area, thinner prelaminar thickness, deeper LC, and thinner pRNFLT (p=0.011, <0.001, 0.004, <0.001, <0.001, <0.001 respectively). Thinner pRNFLT was associated with shorter AXL, smaller ASCO area, a more posteriorly bowed PPS, shallower LC and thinner BMO-MRW. (p=0.030, 0.002, 0.035, 0.012, <0.001 respectively) ConclusionsBMO-MRW and pRNFLT were influenced by several deep ONH structures such as BMO and ASCO position shift, BMO or ASCO area, prelaminar thickness, PPS bowing and LC depth in addition to patient characteristics such as age and AXL. The degree and/or direction of associations varied between deep ONH structures and BMO-MRW or pRNFLT. Despite both BMO-MRW and pRNFLT being surrogate parameters for RGC loss, a complex relationship with ONH deep-layer morphology was indicated.

Subgemmal neurogenous plaque: a series of six cases and a literature overview.

The study aims to describe six subgemmal neurogenous plaque (SNP) cases and compile the previously available data on SNP. Searches on PubMed, Web of Science, Embase, Scopus, and a two-step study selection were performed to compile data from case reports/series of SNP published in English literature. Our six patients (range 29-63years) had SNP in the posterior lateral border of the tongue. Four of them were associated with lymphoepithelial cysts. A total of 15 studies, comprising 116 patients, were included in this overview. There was a slight predilection for female patients (56.0%) in the 5th (22.4%) and the 7th (23.9%) decades. The lateral border of the tongue (66.4%) was the most common anatomical location. The major manifestation was nodule/papule. Histologically, the presence of taste buds (n = 40/ 34.5%), superficial neural plexus (n = 32/ 27.6%), deep nerve fascicles (n = 32/ 27.6%), ganglion cells (n = 41/ 35.3%), and lymphoid tissue (n = 22/ 19.0%) was mainly reported. Surgical removal was the primary approach, with a low recurrence rate. Although largely unknown, SNP is a regular and likely frequent structure located in the tongue. The findings emphasize the importance of describing clinicopathological patterns of SNP as a differential diagnosis of neural lesions that affect the tongue.

Engineering Sensory Ganglion Multicellular System to Model Tissue Nerve Ingrowth.

Discogenic pain is associated with deep nerve ingrowth in annulus fibrosus tissue (AF) of intervertebral disc (IVD). To model AF nerve ingrowth, primary bovine dorsal root ganglion (DRG) micro-scale tissue units are spatially organised around an AF explant by mild hydrodynamic forces within a collagen matrix. This results in a densely packed multicellular system mimicking the native DRG tissue morphology and a controlled AF-neuron distance. Such a multicellular organisation is essential to evolve populational-level cellular functions and in vivo-like morphologies. Pro-inflammatory cytokine-primed AF demonstrates its neurotrophic and neurotropic effects on nociceptor axons. Both effects are dependent on the AF-neuron distance underpinning the role of recapitulating inter-tissue/organ anatomical proximity when investigating their crosstalk. This is the first in vitro model studying AF nerve ingrowth by engineering mature and large animal tissues in a morphologically and physiologically relevant environment. The new approach can be used to biofabricate multi-tissue/organ models for untangling pathophysiological conditions and develop novel therapies.

Treatment of Work Type II Congenital First Branchial Cleft Anomalies: A Summary of 35 Cases.

Objective: This study aims to summarize the data and treatment of 35 children with Work type II congenital first branchial cleft anomalies (CFBCAs) to provide significant insights into the correlation between these anomalies and the facial nerve. Methods: A total of 35 children diagnosed with Work type II CFBCAs who received treatment at the Department of Otolaryngology-Head and Neck Surgery at Shenzhen Children's Hospital from August 2017 to March 2023 were analyzed retrospectively. Pearson chi-square tests and Fisher's exact tests were used to examine the relationship between clinical characteristics and the location of the lesion, which included the superficial and deep surfaces as well as the area between the branches of the facial nerve. Results: All 35 children underwent open incision and complete resection of fistulae. During the surgery, the lesions were found to be in the superficial facial nerve in 12 (34.3%) cases, between branches in 5 (14.3%) cases, and in the deep facial nerve in 18 (51.4%) cases. In those patients, lesions in females, with a lower edge of the lesion located below the angle of the mandible and the presence of a tympanic membranous attachment, are more likely to be located deep to the facial nerve or between its branches. The difference is statistically significant (P = .007, .032, .015). Conclusion: The treatment principle of Work type II CFBCAs consists of achieving a quiescent stage of inflammation, followed by a complete resection of the lesion on the premise of preserving facial nerve function. Certain clinical features of this disease can predict the relationship between the lesion and the facial nerve. The lesions in females, with a lower edge of the lesion located below the angle of the mandible, non-cystic type of Olsen, and the presence of tympanic membranous attachment, tend to be located deep to the facial nerve or between its branches.

Feasibility Study of Numerical Calculation and Machine Learning Hybrid Approach for Renal Denervation Temperature Prediction

Transcatheter renal denervation (RDN) is a novel treatment to reduce blood pressure in patients with resistant hypertension using an energy-based catheter, mostly radio frequency (RF) current, by eliminating renal sympathetic nerve. However, several inconsistent RDN treatments were reported, mainly due to RF current narrow heating area, and the inability to confirm a successful nerve ablation in a deep area. We proposed microwave energy as an alternative for creating a wider ablation area. However, confirming a successful ablation is still a problem. In this paper, we designed a prediction method for deep renal nerve ablation sites using hybrid numerical calculation-driven machine learning (ML) in combination with a microwave catheter. This work is a first-step investigation to check the hybrid ML prediction capability in a real-world situation. A catheter with a single-slot coaxial antenna at 2.45 GHz with a balloon catheter, combined with a thin thermometer probe on the balloon surface, is proposed. Lumen temperature measured by the probe is used as an ML input to predict the temperature rise at the ablation site. Heating experiments using 6 and 8 mm hole phantom with a 41.3 W excited power, and 8 mm with 36.4 W excited power, were done eight times each to check the feasibility and accuracy of the ML algorithm. In addition, the temperature on the ablation site is measured for reference. Prediction by ML algorithm agrees well with the reference, with a maximum difference of 6 °C and 3 °C in 6 and 8 mm (both power), respectively. Overall, the proposed ML algorithm is capable of predicting the ablation site temperature rise with high accuracy.

Total hip replacement among sickle cell patients in alow-income country-Yemen.

Sickle cell patients presented with progressive hip pain and limitation of daily activities, as evidenced by low preoperative hip scores and failed conservative therapy. Management of femoral head avascular necrosis (AVN) using total hip replacement (THR) in sickle cell disease (SCD) is widespread in developed countries, but it is still in its initiation stage in developing countries. The outcome of using cementless THR among SCD patients is still unknown with lack of published studies from regional countries. This study aimed to evaluate the outcome of using cementless primary THR among patients with sickle cell disease with end-stage hip avascular necrosis in Yemen. Thirty cementless primary total hip arthroplasty (THA) were performed for AVN of the femoral head in 27 sickle cell patients, at Al.-Thawra Modern General Hospital-Sana'a, Yemen, from January 2018 to December 2022. The mean age of the patients was 27 ± fiveyears (ranged 18-37years) with a male to female ratio was 3:1. Steinberg staging for hip AVN was stage IV, one patient (3%); stage VI, thirteen patients (45%); and stage V, sixteen patients (51%). THR was on right side 14 (52%), left side 10 (37%), and bilateral 3 (11%). The implant used was ceramic on polyethylene acetabular liner. All patients showed improvement in Harris hip score from preoperative mean hip score was 25 ± 8 points to postoperative mean hip score was 88 ± 6 points at the last follow-up. Mean of the length of stay in hospital was 12.7 ± eightdays (ranged from 4 to 32days); the mean operating time was 107 ± 23min. Three cases had superficial wound infection; four patients had five intraoperative fractures; two cases had pulmonary complications; one case had abdominal crisis. All patients had postoperative leg length discrepancy less than 2cm. None had deep infection, nerve injury, wound hematoma, aseptic loosing, dislocation, DVT, heterotopic ossification, or death. THR in SCD has a good outcome using cementless THA with a low rate of complication in Yemen, a developing country.

Comparison of the efficacy and safety of ultrasound-guided CHIVA and traditional HLS in the treatment of varicose veins of lower extremities - a meta-analysis.

Systematic evaluation of the efficacy and safety of conservative hemodynamic cure for venous insufficiency (CHIVA) compared with high ligation and stripping (HLS) in the treatment of varicose veins of lower extremities. We conducted a systematic literature search and compared the randomized controlled trial and retrospective cohort study of CHIVA and HLS in the treatment of varicose veins of lower extremities in several databases, including China National Knowledge Infrastructure, Wanfang database, cqvip datebase, PubMed, Cochrane library and EMBASE, to identify articles that might meet the criteria. Meta-analysis was performed using Revman 5.3 and Stata 13.0 software. This Meta-analysis included a total of 14 research articles. This meta-analysis shows that CHIVA requires shorter operation time than HLS [mean difference (MD) = -13.57, 95% confidence interval (CI) (-21.05, -6.10), P = .0004]. There is less blood loss with CHIVA surgery [MD = -21.72, 95% CI (-30.35, -13.09), P < .00001]. The number of incisions made by the CHIVA technique is less [MD = -3.67, 95% CI (-4.03, -3.31), P < .00001]. Patients who underwent CHIVA had a shorter hospital stay [MD = -3.40, 95% CI (-4.72, -2.09), P < .00001]. The relapse rate was lower after CHIVA [OR = 0.36, 95% CI (0.18, 0.70), P = .003]. In terms of postoperative complications, CHIVA has a lower total complication rate [MD = 0.26, 95% CI (0.15, 0.46), P < .00001]. The incidence of deep vein thrombosis was lower after CHIVA [MD = 0.23, 95% CI (0.06, 0.92), P = .04]. CHIVA has a lower incidence of sensory disturbance than HLS [OR = 0.39, 95% CI (0.25, 0.60), P < .0001]. CHIVA technique has less nerve injury rate than HLS [OR = 0.11, 95% CI (0.02, 0.62), P = .01]. The incidence of hematoma was lower after CHIVA [OR = 0.48, 95% CI (0.27, 0.87), P = .02]. Among other metrics, the comparison results of the 2 techniques were similar. By comparison, it is found that CHIVA has shorter operation time, less blood loss, and fewer surgical incisions. Patients who underwent CHIVA surgery had shorter hospital stays and lower relapse rates. In terms of complications, the incidence of total complications after CHIVA is lower, and the incidence of postoperative deep vein thrombosis, postoperative sensory, nerve injury, and postoperative hematoma is also lower than that of HLS.

Deep learning-driven MRI trigeminal nerve segmentation with SEVB-net.

Trigeminal neuralgia (TN) poses significant challenges in its diagnosis and treatment due to its extreme pain. Magnetic resonance imaging (MRI) plays a crucial role in diagnosing TN and understanding its pathogenesis. Manual delineation of the trigeminal nerve in volumetric images is time-consuming and subjective. This study introduces a Squeeze and Excitation with BottleNeck V-Net (SEVB-Net), a novel approach for the automatic segmentation of the trigeminal nerve in three-dimensional T2 MRI volumes. We enrolled 88 patients with trigeminal neuralgia and 99 healthy volunteers, dividing them into training and testing groups. The SEVB-Net was designed for end-to-end training, taking three-dimensional T2 images as input and producing a segmentation volume of the same size. We assessed the performance of the basic V-Net, nnUNet, and SEVB-Net models by calculating the Dice similarity coefficient (DSC), sensitivity, precision, and network complexity. Additionally, we used the Mann-Whitney U test to compare the time required for manual segmentation and automatic segmentation with manual modification. In the testing group, the experimental results demonstrated that the proposed method achieved state-of-the-art performance. SEVB-Net combined with the ωDoubleLoss loss function achieved a DSC ranging from 0.6070 to 0.7923. SEVB-Net combined with the ωDoubleLoss method and nnUNet combined with the DoubleLoss method, achieved DSC, sensitivity, and precision values exceeding 0.7. However, SEVB-Net significantly reduced the number of parameters (2.20 M), memory consumption (11.41 MB), and model size (17.02 MB), resulting in improved computation and forward time compared with nnUNet. The difference in average time between manual segmentation and automatic segmentation with manual modification for both radiologists was statistically significant (p < 0.001). The experimental results demonstrate that the proposed method can automatically segment the root and three main branches of the trigeminal nerve in three-dimensional T2 images. SEVB-Net, compared with the basic V-Net model, showed improved segmentation performance and achieved a level similar to nnUNet. The segmentation volumes of both SEVB-Net and nnUNet aligned with expert annotations but SEVB-Net displayed a more lightweight feature.

Deep Optic Nerve Head Morphology in Tilted Disc Syndrome and Its Clinical Implication on Visual Damage.

To study deep optic nerve head (ONH) morphology in tilted disc syndrome (TDS) and identify factors associated with retinal nerve fiber layer (RNFL) defect. In patients with TDS, we evaluated the optic disc shape using the Bruch's membrane opening (BMO)-anterior scleral canal opening (ASCO) offset and measured the border tissue (BT) length, depth, and angle in the direction of the tilt, using radial ONH optical coherence tomography (OCT). We compared the parameters between the TDS groups with and without RNFL defects. Twenty-one eyes had no glaucomatous RNFL defect, and 38 eyes had a glaucomatous RNFL defect. The group with RNFL defects had a higher baseline IOP, larger tilt axis of BMO-ASCO optic disc margin (76.4° ± 14.5° vs. 87.9° ± 15.4°, P = 0.012), larger BMO-lamina cribrosa insertion (LCI) angle (25.6° ± 9.3° vs. 43.6° ± 15.2°, P < 0.001), and more lamina cribrosa (LC) defects (4.3% vs. 30.6%, P = 0.028) than without RNFL defects. The tilt axis and BMO-LCI angle were significant factors after adjusting for baseline IOP and LC defect. The BMO-LCI angle had excellent diagnostic power for glaucomatous RNFL defect in TDS, similar to the visual field mean deviation. OCT-based large deep ONH BT angle and tilt axis were factors associated with the presence of RNFL defects in TDS. The results suggest a mechanism of RNFL defect associated with structural ONH deformation. Further investigations are warranted to understand the role of ONH structures in a general population with and without optic disc tilt.

Restoring Function of the Flexor Tendons of the Hand: State of the Science in Kazakhstan.

We conducted a literature review to highlight the diagnosis and treatment of hand flexor tendon injuries and discuss the current state of the science of hand surgery in the Republic of Kazakhstan. We reviewed the Google Scholar, PubMed, Web of Science, Elsevier, and National Center for Biotechnology Information databases and other printed sources for open access articles in three languages. We accepted relevant scientific articles that reflected the peculiarities of restoring function of the tendon flexors of the hand. We reviewed articles from the present to the previous 20 years and included 31 of these sources in our literature review. The medical examination of a patient who has sustained a flexor tendon injury should be thorough and gradual, supported by ultrasound and X-ray examination. For effective restoration of hand function following a hand injury, it is important for the surgeon to conduct a step-by-step assessment of the damage that has occurred to soft tissues, superficial and deep tendons, bones, nerves, and blood vessels. The main goal of tendon repair is to preserve tendon function. It is also known that early postoperative tendon movement leads to faster healing. The most frequent complications associated with flexor tendon repair include the development of adhesions, wound infection, tendon rupture, impaired hand function, and scar formation. Relative to the state of the science in the Republic of Kazakhstan, we conclude that hand surgery should be performed by highly skilled specialists in the field of microsurgery in a specialized department with microsurgical equipment.

Image analysis comparison of nerve staining with food dye, methylene blue or tissue marker

ObjectiveNovel locoregional techniques use dye studies to confirm successful nerve targeting. The goal was to objectively quantify and compare nerve staining characteristics of dye mixtures commonly reported in the literature using image analysis software. Study designProspective, randomized cadaveric study. MethodsThirty-six brachial plexus nerves from unpreserved pig cadavers were randomized into three groups of 12: FD (1:10 mixture of blue food dye and bupivacaine 0.5%), MB (methylene blue 1%) and TM (0.1:10 mixture of blue tissue marker and lidocaine 2%). Nerves were immersed in dye for 1, 15, 30 or 60 minutes (n = 3 each). Images of nerves before immersion (baseline) and at each time point with epineurium intact (superficial staining) and after longitudinal bisection (deep staining) were processed using image analysis software. Color saturation values were divided into quartiles (dark, medium-dark, medium-light or light). Percentage of stained nerve area in each quartile was calculated and compared using two-way anova. ResultsSuperficially, at minute 1, dark saturation covered 40% of nerve area in FD versus 19% in MB (p = 0.04) and 0% in TM (p < 0.0001). In bisected nerves, dark and medium-dark saturations occurred only in FD; medium-light saturation comprised anywhere from 4% to 22.5% over time in FD versus <1% at any time in MB (p = 1.000; p = 0.343; p = 0.383; p = 0.262). Deep staining was not found in TM at any point. Conclusion and clinical relevanceFood dye rapidly stains superficial and deep nerve layers. Based on these characteristics, investigators can choose the appropriate dye for their study.