Free Nerve Research Articles

Microstructural characteristics of lymphatic vessels in skin tissues of acupoints "Taichong" and "Yongquan" in the rat

To provide a new method for investigating the histological characteristics of acupoints by obser-ving the microstructure of the lymphatic vessels in the skin tissue of "Taichong" (LR3) and "Yongquan" (KI1) regions. Six male SD rats were used in the present study. The skin tissue of LR3 and KI1 from the hind foot were taken following transcardial perfusion with 4% paraformaldehyde. The skin tissues were cut into sagittal sections with a freezing microtome and stained by fluorescent immunohistochemistry with lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1), calcitonin gene-related peptide (CGRP), and phalloidin for displaying the lymphatic vessels, nerve fibers, and blood vessels, separately. The samples were viewed and recorded using fluorescent microscope and laser scanning confocal microscope. In the skin tissue of LR3 and KI1 regions, the lymphatic vessels, nerve fibers, and blood vessels were labeled with LYVE-1, CGRP and phalloidin, respectively. The lymphatic capillaries were found to start from the enlarged blind end and distribute in the dermis and subcutaneous tissues with various forms, crisscrossing. Abundant blood capillaries at various thickness distributed around the lymphatic capillaries in a parallel or crossed pattern, intermingled with free nerve fibers. The lymphatic capillaries, blood capillaries and nerve fibers extensively distribute in the skin tissues of LR3 and KI1 regions in rats, suggesting an involvement of the immunomodulation in the effects of acupuncture in pathological conditions, despite being not limited to the acupoint regions in the distribution of lymphatic capillaries.

71. Intraoperative blink reflex monitoring during microvascular decompression for trigeminal neuralgia

Microvascular decompression surgery (MVD) is an established technique for refractory trigeminal neuralgia. In order to reduce the risk of 5°, 7° and 8° cranial nerve lesions, intraoperative monitoring is recommended. To evaluate intraoperative BR modification during MVD surgery. Considering the reflex arc, BR could be useful to monitor sensory part of trigeminal nerve, facial nerve and brainstem function during MVD. We evaluated BR intraoperative modifications in all patients who underwent MVD surgery for trigeminal neuralgia from 2013 to 2016. All the patients underwent surgery with monitoring of BAEPs, EMG free run, BR and direct nerves stimulation. BR was recorded in 14/18 patients. In 12/14 R1 amplitude was stable; these patients didn’t report postoperative facial or trigeminal nerve lesions. In 2/14 we observed intraoperative decrease of R1 amplitude. In one patient, we recorded B and C train at EMG free run; after the operation, he experienced a transient facial palsy. In the other patient, we didn’t record spontaneous pathological EMG activity in facial muscles and we recorded stable amplitude responses after direct nerves stimulation. After the operation, he reported hemifacial hypoesthesia. BR can be an integrative monitoring technique during MVD surgery.

Attachment Rate of the Inferior Alveolar Nerve to Buccal Plate During Bilateral Sagittal Split Osteotomy Influences Self-Reported Sensory Impairment

This study was aimed to investigate a modified buccal osteotomy technique and whether the integrity of the lingual part of the lower border influences the attachment of the neurovascular bundle to the proximal segment of the mandible during a sagittal split osteotomy without increasing the number of bad splits. The presence of self-reported sensibility disturbance in the lower lip at the last follow-up visit was assessed. This study included 220 and 133 patients with bilateral sagittal split osteotomy undergoing the classical and the new modified buccal osteotomy techniques, respectively. In the new technique, the lower border is divided into a lingual fragment that remains incorporated in the tooth-bearing fragment and a buccal fragment that comes with the proximal fragment (buccal plate). In the classical technique, the inferior alveolar nerve was attached to the proximal segment of the mandible in more than one third of operation sites (36.36% on the right and 40.91% on the left) compared with less than one fourth of the operation sites using the new technique (9.73% on the right and 23.01% on the left). The overall figure of self-reported changed sensibility was 09.40% (12/128) in the new technique compared to 15.12% in the classical technique. We present a suitable improvement to the classical buccal osteotomy technique that allows less manipulation and injury of the inferior alveolar nerve with consequent reduction in self-reported postoperative changes in lower lip sensation

Neural reactivity detected by immunofluorescence in a patient with a localized blistering disease

Introduction: Multiple clinical etiologies exist for rapidly appearing skin blisters are multiple. Case report: A 69-year-old male from a rural area of Georgia, USA, was evaluated for the presence of suddenly appearing, localized erythema and edema on his leg with a skin blister. At presentation, the patient was taking multiple medications for other medical issues. Methods: Skin biopsies for hematoxylin and eosin (H&E) examination, as well as for direct immunofluorescence, indirect immunofluorescence and immunohistochemistry studies were performed. Results: H&E staining demonstrated a subepidermal blistering process. Within the dermis, a mild, superficial, perivascular and perineural infiltrate of lymphocytes, histiocytes and eosinophils was seen. Direct and indirect immunofluorescence revealed focal dermal perineural and free epidermal nerve fiber staining utilizing antibodies to human Complement/C1q, C3, C4, kappa and lambda light chains. Immunohistochemistry studies revealed IgG, IgE, C3, fibrinogen, albumin and kappa deposition inside and around the blister. Conclusions: Our case has some clinical and epidemiological features that resemble localized bullous pemphigoid, however, the most interesting findings were the neural reactivity without concomitant diabetes or peripheral neuropathy. Notably, a concomitant leak of ricin was simultaneously detected in same geographic area as the patient. We suggest that ricin environmental toxicity may have contributed to the observed neural reactivity.

“Double cervical rib with uncommon presentation”

Double or Bilateral cervical ribs. Pseudo arthrosis of cervical rib with first rib causing neurovascular complication is a rare congenital anomaly. We report a case of young man who presented with intermittent claudication in the right hand and involvement of peripheral nerves. He had bilateral cervical ribs. Left side cervical rib was small. Right side cervical rib had pseudo arthrosis with first rib. There was total occlusion of subclavian artery beyond first part. Abnormal sensation in the inner aspect of hand and fingers. He was managed with subclavian to axillary artery bypass with 6 mm Goretex graft and excision of cervical rib on right side and division of all sclaenus muscles i.e. scelnus anterior, medium minimus with fibrous bands to free subclavian artery and nerves.

Propriozeption im vorderen Kreuzband des menschlichen Kniegelenkes - morphologische Grundlagen

In 21 human anterior cruciate ligaments removed with their synovial sheaths during autopsy and operation, nerves and nerve endings were demonstrated by light microscopy, scanning electron microscopy and transmission electron microscopy. Ultrastructural examination allowed a classification of nerve endings into three types: Ruffinian corpuscles, Pacinian corpuscles and free (afferent and efferent) nerve endings. The nerve endings corresponded to those characteristic of articular capsules. The anterior cruciate ligament shows evidence of a proprioceptive function besides its stabilizing function, which is based on its collagenous structure. Together, they probably represent the most important factor in the dynamic stabilization of the knee joint. At present it is only possible to speculate on the potential clinical significance of these findings, for example in development of rehabilitation programs and prevention strategies offering protection against anterior cruciate tears. This also applies to the question of whether to preserve the ligament during surgery for ruptures and knee-joint prostheses.

Vitiligo-Related Neuropeptides In Nerve Fibers Of The Skin

Skin distribution of substance P (SP)-, somatostatin (SOM)-, calcitonin gene-related peptide (CGRP)- and neuropeptide Y (NPY)-like immunoreactivity (LI) in vitiligo patients was studied by an indirect immunofluorescence technique. Immunocytochemical characteristics of the epidermis, dermal-epidermal junction, papillary and reticular dermis and skin appendages were analyzed in lesional and marginal vitiligo areas, as well as in healthy skin. In healthy pigmented skin, SP-, SOM-, CGRP-, and NPY-LI nerve fibers were observed with specific distributional patterns. In uninvolved vitiligo skin, thin SP-containing fibers were evident in dermal papillae, extending into the epidermis, and SP-LI fibers were seen around blood vessels and sweat glands. SOM-LI varicose nerve fibers were associated with Meissner corpuscles in the dermal papillae, while CGRP-LI was demonstrated in the free subepidermal nerve terminals and in sensory nerve fibers around blood vessels, hair follicles and sweat glands. Autonomic NPY-nerve fibers innervated the eccrine sweat glands and blood vessels. The distribution of these neuropeptides in both marginal and lesional areas of vitiliginous skin was the same as in the skin of healthy control subjects, except for an increased immunoreactivity against NPY and, to a lesser extent, against CGRP in the skin depigmentation lesions. The elevated NPY levels in skin affected by vitiligo suggest that this peptide may serve as a neurochemical marker in the pathogenesis of the disease, thus supporting the neuronal theory of vitiligo.

Nerve endings in the epithelium and submucosa of human epiglottis.

An electron-microscopic study of the sensory innervation of human epiglottis was undertaken. The nerve supply of this structure was abundant; numerous free unmyelinated nerve endings of 2.5-3 microns were observed in the stratified epithelium of the epiglottis associated with clear cells containing mitochondria, rough endoplasmic reticulum, microtubules and dense-cored granules. The nerve and cell complex resembled a corpuscular structure, probably of a quimiosensitive character. In the submucosa, unmyelinated nerves were observed which may come from deeper myelinated trunks, and some of them entered the epithelium. Encapsulated corpuscles were also found in the submucosa. Four elements could be distinguished: nerve endings, lamellar cells, interlamellar substance, and capsule. Our observations at an ultrastructural level complete previous observations by means of light microscopy indicating that the epiglottis is a zone with an important innervation in the epithelium as well as in the submucosa. This sensory innervation probably bears a relation to reflexes, such as cough and deglution, to protect the airways.

Peptide-containing nerves in the human pregnant uterine cervix: an immunohistochemical study exploring the effect of RU 486 (mifepristone)

The presence of several neuropeptides (neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), substance P (SP), galanin (GAL), enkephalin (ENK), somatostatin (SOM) was established in the early pregnant human cervix using indirect immunofluorescence immunohistochemistry. Several peptides (VIP, NPY, CGRP, GAL) were present both in free nerves among smooth muscle cells and around blood vessels. Others (SP, SOM) were only seen as single varicosities among smooth muscle cells. Randomized treatment of patients with RU 486 (mifepristone) prior to surgical sampling revealed no clearcut differences in peptide immunoreactivities. After RU 486 treatment, however, there was a tendency towards a decrease of NPY- and VIP-immunoreactivity, and an increase of CGRP-immunoreactivity.

Pruritus

Pruritus is an unpleasant sensation that provokes an urge to scratch. Many stimuli (notably histamine) are able to induce pruritus. The neural conduction of the itch sensation from the free unmyelinated nerve endings to the central nervous system mainly occurs on unmyelinated C fibres and the anterolateral spinothalamic tract. Pruritus is a common symptom in many skin or systemic diseases, but very little is known about the mechanism of the condition. Treatment evaluation is difficult; many methods do not evaluate the pruritus, but only the scratching, which is a consequence of pruritus. A number of asymptomatic treatments are only partially effective and we know little about their mechanism of action. Antihistamines remain the treatment of first choice for pruritus without known cause, but generally give incomplete relief. Whenever possible it is best to treat the underlying disease.

The vascularized saphenous nerve as cross-face nerve graft

The vascular anatomy of the saphenous nerve was studied by cadaver preparation, Indian ink and micropaque injection. A constant vascularized nerve graft with a good pedicle and suitable length for a cross-face anastomosis was found. The vascularized saphenous nerve was used for the first time as a cross-face graft in 8 patients with facial palsy. The Tinel-sign was followed-up and a biopsy of the nerve graft at the time of the muscle transplantation was carried out to compare the morphological results of the vascularized nerve graft with two free sural nerve grafts which were used in two patients at the same time. The functional results are demonstrated.

Endoneural and epineural blood flow evaluation with free vascularized and conventional nerve grafts in the canine

Endoneural and epineural blood flow evaluation with free vascularized and conventional nerve grafts in the canine

Free muscle transplantation and intercostal nerve crossing as a reconstructive procedure for elbow flexion in brachial plexus injuries. (Japanese)Jpn. J. Plast. Reconstr. Surg. 27

Free muscle transplantation and intercostal nerve crossing as a reconstructive procedure for elbow flexion in brachial plexus injuries. (Japanese)Jpn. J. Plast. Reconstr. Surg. 27

Re-animation of the Paralyzed Face

This 367-page work is divided into four parts: (1) Mechanism of Facial Expression and Pathophysiology of Degeneration; (2) Etiology of Disruption of the Facial Neuromuscular Motor Unit; (3) Contemporary Concepts in Free Nerve and Muscle Grafting; (4) Re-animation of the Paralyzed Face. The contributors include otolaryngologists, plastic surgeons, a neurologist, a neurosurgeon, a neuropathologist, and a physical medicine specialist. The organization is such that the reader is taken through anatomy and pathophysiology of the various types of facial paralysis, and then an excellent section on the basic science of nerve and muscle grafting leads into the practical section that deals with reanimation procedures. This third section, itself, is well worth the purchase price of the book. The reanimation procedures are subdivided into the following categories: immediate treatment (this includes a neurologist's chapter on medical treatment for Bell's palsy and an otolaryngologist's concepts with regard to surgical treatment for this disease);

Innervation of Scar Tissue in the Skin of the Rat

In this study the reinnervation of scar tissue was investigated histochemically to demonstrate catecholamine fluorescence and nonspecific cholinesterase activity. The scarring was produced by healing and contraction of a defect in the dorsal skin of the rat. The first regenerating nerves showing nonspecific cholinesterase activity were observed in the scar four weeks postoperatively. Throughout the investigation period, that is up to twenty weeks after the operation, only free regenerated nerves were found in the scar; no encapsulated nerve endings were observed. No fluorescent adrenergic nerves were found in the dense collagenous part of the scar tissue. Regenerated fluorescent nerves were, however, observed in the loose regenerated connective tissue under the scar. Most of these nerves followed the course of blood vessels. In the present work a vigorous contraction of the scar tissue was noted and a poor innervation of the scar tissue with free nerves was observed. The role of these regenerated nerve endings in sensory discrimination, and the importance of different transmitters acting in the sensory system are discussed.

Adrenergic terminal structures in the mesentery of mammals.

This work is devoted to the study of adrenergic terminal structures in the mesentery of mammals (cat, dog). The investigation was performed with the Falck-Hillarp method of catecholamine fluorescence microscopy on total stretch mesentery preparations. The investigation showed that richly developed perivascular plexus constitute the basis of the adrenergic innervation system of the mesentery. In numerous points of these plexuses, single adrenergic fibers or polyaxonal structures are observed to issue into nonvascular areas of the mesentery where after repeated dichotomic division they pass into the preterminal and terminal parts. Being constructed on the principle of extended or restrained arborizations, these innervating structures have a morphological similarity with free sensory nerve endings. In this connection, the question of the possible existence of the sensory (afferent) links in the catecholamine-containing vegetative nerve plexuses is discussed.

Adrenergic terminal structures in the mammalian mesentery

The work is devoted to the study of adrenergic terminal structures in the mesentery of mammals by fluorescent microscopy of catecholamines. The system of adrenergic innervation of the mesentery proved to be based on well-developed perivascular plexuses. In many points of these plexuses individual adrenergic fibers penetrated the avascular mesenteric areas, where they formed preterminal and terminal portions as a result of repeated dichotomic divisions. These innervating structures built by the principle of widespread or restricted arborizations displayed morphological similarity to free sensory nerve endings. In this connection a possibility of distinction of the sensory (afferent) links in the catecholamine-containing vegetative nerve plexuses is discussed.