Improvement Of Nerve Function Research Articles

Decompressive surgery for treating nerve damage in leprosy.

Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain. This is an update of a review first published in 2009 and previously updated in 2010. To assess the effects of decompressive surgery on nerve damage in leprosy. We searched the Cochrane Neuromuscular Disease Group Specialized Register (15 October 2012), CENTRAL (2012, Issue 9 in The Cochrane Library), MEDLINE (January 1966 to October 2012), EMBASE (January 1980 to October 2012), AMED (January 1985 to October 2012), CINAHL Plus (January 1937 to October 2012) and LILACS (from January 1982 to October 2012). We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com) (1 November 2012), conference proceedings and contacted trial authors. Randomised controlled trials (RCTs) and quasi-RCTs of decompressive surgery for nerve damage in leprosy. The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects information from the trials and non-randomised studies. We included two RCTs involving 88 participants. The trials were at high risk of bias. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. After two years' follow-up there was only very low quality evidence of no significant difference in nerve function improvement between participants treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described. Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from RCTs is of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well-designed RCTs are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.

Two randomized controlled clinical trials to study the effectiveness of prednisolone treatment in preventing and restoring clinical nerve function loss in leprosy: the TENLEP study protocols

BackgroundNerve damage in leprosy often causes disabilities and deformities. Prednisolone is used to treat nerve function impairment (NFI). However, optimal dose and duration of prednisolone treatment has not been established yet. Besides treating existing NFI it would be desirable to prevent NFI. Studies show that before NFI is clinically detectable, nerves often show subclinical damage. Within the ‘Treatment of Early Neuropathy in LEProsy’ (TENLEP) study two double blind randomized controlled trials (RCT) will be carried out: a trial to establish whether prednisolone treatment of 32 weeks duration is more effective than 20 weeks in restoring nerve function in leprosy patients with clinical NFI (Clinical trial) and a trial to determine whether prednisolone treatment of early sub-clinical NFI can prevent clinical NFI (Subclinical trial).MethodsTwo RCTs with a follow up of 18 months will be conducted in six centers in Asia. In the Clinical trial leprosy patients with recent (< 6 months) clinical NFI, as determined by Monofilament Test and Voluntary Muscle Test, are included. The primary outcomes are the proportion of patients with restored or improved nerve function. In the Subclinical trial leprosy patients with subclinical neuropathy, as determined by Nerve Conduction Studies (NCS) and/or Warm Detection Threshold (WDT), and without any clinical signs of NFI are randomly allocated to a placebo group or treatment group receiving 20 weeks prednisolone. The primary outcome is the proportion of patients developing clinical NFI. Reliability and normative studies are carried out before the start of the trial.DiscussionThis study is the first RCT testing a prednisolone regimen with a duration longer than 24 weeks. Also it is the first RCT assessing the effect of prednisolone in the prevention of clinical NFI in patients with established subclinical neuropathy. The TENLEP study will add to the current understanding of neuropathy due to leprosy and provide insight in the effectiveness of prednisolone on the prevention and recovery of NFI in leprosy patients. In this paper we present the research protocols for both Clinical and Subclinical trials and discuss the possible findings and implications.Trial registrationNetherlands Trial Register: NTR2300Clinical Trial Registry India: CTRI/2011/09/002022

Fate of Combat Nerve Injury

Assess a cohort of combat-related type III open tibia fractures with peripheral nerve injury to determine the injury mechanism and likelihood for recovery or improvement in nerve function. Retrospective study. Three military medical centers. Out of a study cohort of 213 type III open tibia fractures, 32 fractures (in 32 patients) with a total of 43 peripheral nerve injuries (peroneal or tibial) distal to the popliteal fossa met inclusion criteria and were available for follow-up at an average of 20 months (range, 2-48 months). Clinical assessment of motor and sensory nerve improvement. There was a 22% incidence of peripheral nerve injury in the study cohort. At an average follow-up of 20 months (range, 2-48 months), 89% of injured motor nerves were functional, whereas the injured sensory nerves had function in 93%. Fifty percent and 27% of motor and sensory injuries demonstrated improvement, respectively (P = 0.043). With the numbers available, there was no difference in motor or sensory improvement based on mechanism of injury, fracture severity or location, soft tissue injury, or specific nerve injured. In the subset of patients with an initially impaired sensory examination, full improvement was related to fracture location (P = 0.0164). Type III open tibia fractures sustained in combat are associated with a 22% incidence of peripheral nerve injury, and the majority are due to multiple projectile penetrating injury. Despite the severe nature of these injuries, the vast majority of patients had a functional nerve status by an average of 2-year follow-up. Based on these findings, discussions regarding limb salvage and amputation should not be overly influenced by the patient's peripheral nerve status. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Thymosin β4 promotes the recovery of peripheral neuropathy in type II diabetic mice

Peripheral neuropathy is one of the most common complications of diabetes mellitus. Using a mouse model of diabetic peripheral neuropathy, we tested the hypothesis that thymosin β4 (Tβ4) ameliorates diabetes‐induced neurovascular dysfunction in the sciatic nerve and promotes recovery of neurological function from diabetic peripheral neuropathy. Tβ4 treatment of diabetic mice increased functional vascular density and regional blood flow in the sciatic nerve, and improved nerve function. Tβ4 upregulated angiopoietin-1 (Ang1) expression, but suppressed Ang2 expression in endothelial and Schwann cells in the diabetic sciatic nerve. In vitro, incubation of Human Umbilical Vein Endothelial Cells (HUVECs) with Tβ4 under high glucose condition completely abolished high glucose-downregulated Ang1 expression and high glucose-reduced capillary-like tube formation. Moreover, incubation of HUVECs under high glucose with conditioned medium collected from Human Schwann Cells (HSCs) treated with Tβ4 significantly reversed high glucose-decreased capillary-like tube formation. PI3K/Akt signaling pathway is involved in Tβ4-regulated Ang1 expression on endothelial and Schwann cells. These data indicate that Tβ4 likely acts on endothelial cells and Schwann cells to preserve and/or restore vascular function in the sciatic nerve which facilitates improvement of peripheral nerve function under diabetic neuropathy. Thus, Tβ4 has potential for the treatment of diabetic peripheral neuropathy.

Effect of intravenous transplantation of bone marrow mesenchymal stem cells on neurotransmitters and synapsins in rats with spinal cord injury.

Bone marrow mesenchymal stem cells were isolated, purified and cultured in vitro by Percoll density gradient centrifugation combined with the cell adherence method. Passages 3–5 bone marrow mesenchymal stem cells were transplanted into rats with traumatic spinal cord injury via the caudal vein. Basso-Beattie-Bresnahan scores indicate that neurological function of experimental rats was significantly improved over transplantation time (1–5 weeks). Expressions of choline acetyltransferase, glutamic acid decarboxylase and synapsins in the damaged spinal cord of rats was significantly increased after transplantation, determined by immunofluorescence staining and laser confocal scanning microscopy. Bone marrow mesenchymal stem cells that had migrated into the damaged area of rats in the experimental group began to express choline acetyltransferase, glutamic acid decarboxylase and synapsins, 3 weeks after transplantation. The Basso-Beattie- Bresnahan scores positively correlated with expression of choline acetyltransferase and synapsins. Experimental findings indicate that intravenously transplanted bone marrow mesenchymal stem cells traverse into the damaged spinal cord of rats, promote expression of choline acetyltransferase, glutamic acid decarboxylase and synapsins, and improve nerve function in rats with spinal cord injury.

N.-radialis-Ausfälle im Oberarmbereich

Patients with injury to the radial nerve which can lead to the symptom complex known as wrist drop or carpoptosis, mostly suffer a great deal and often insist on an urgent operation. The timing and technique for treatment depend on various factors and should be discussed individually with each patient and a therapy plan should be determined. In this context the cause of the injury is of absolute importance. Paralysis of the radial nerve due to injury represents the most common traumatic neural lesion in fractures of the long bones. For closed fractures and subsequent limited function of the radial nerve, a waiting procedure is initially recommended because spontaneous regeneration occurs in more than 85% of cases. For open fractures primary exploration with exposure of the nerve is urgently recommended because of the high rate of paralysis of the radial nerve. If spontaneous improvement in nerve function can no longer be expected after a long time interval or reconstruction attempts, surgical transfer of tendons can be performed often with good functional results.

Combination of mouse nerve growth factor and mecobalamin for treatment of incomplete spinal cord injury without high-dose methylprednisolone therapy

Objective To evaluate the clinical efficacy of mouse nerve growth factor (mNGF) plus mecobalamin in the treatment of incomplete spinal cord injury (ISCI) without high-dose methylprednisolone therapy. Methods From October 2007 to September 2010,72 ISCI patients (Frankel grades B,C & D)without previous high-dose methylprednisolone therapy were treated in our department,of whom 56 were retrospectively selected for the present study and divided into 2 groups.In group A 28 patients were treated with combination of mNGF and meeobalamin; 28 patients in group B were treated with mecobalamin only.In this series,American Spinal Injury Association (ASIA) impairment scale and Activity of Daily Living (ADL) evaluation were used to observe and calculate nerve function improvement preoperation and 1 week,8 weeks,12 months postoperation. Results The mean follow-up period was 20 months (from 12 to 48 months).No mortality or incision infection was observed.Fusions of bone graft were observed 10 months postoperation on average.The ASIA and ADL scores at 1 week,8 weeks and 12 months postoperation were significant higher than those preoperation in both groups (P ＜0.05) except the ASIA score 1 week postoperation in group B.The postoperative ASIA and ADL scores in Group A were all significantly higher than those in group B ( P ＜ 0.05).The nerve function improvement at 1 week,8 weeks and 12 months postoperation in group A were 32.1％ (9/28),82.1％ (23/28) and 92.9％ (26/28) respectively,which were better than those in group B [25.0％ (7/28),50.0％ (14/28) and 71.4％ (20/28) ],with a significant difference at 8 weeks and 12 months postoperation ( P ＜ 0.05 ). Conclusion Compared with administration of sole mecobalamin,combination of mNGF and mecobalamin proves to be highly effective in promoting ISCI recovery and improving nerve functiont. Key words: Spinal cord injury; Mouse; Nerve growth factor; Mecobalamin; Nerve function

Morphofunctional characterization of peripheral nerve damage and recovery in sphyngomielinase deficient mice

Mutation of the acid sphingomyelinase (ASM) gene and its reduced enzymatic activity is the main cause of the Type A Niemann-Pick disease. Recent advances demonstrated that ASM is necessary and sufficient to control the formation and release of microvesiscles containing the proinflammatory cytokine interleukin-1β (IL-1β) by glial cells [1]. Since IL-1β modulates the events caused by nerve damage and repair and seems to act as a neuro-modulator between activated glia and neurons [2], the control of its production and secretion might represent a new strategy in nerve regeneration and in the control of neuropathic pain. In this study we used a well-characterized ASM knockout mouse (ASMKO, [3]) to evaluate, through a multimodal approach, the onset and the course of the morphological and functional nerve damage and of neuropathic pain after sciatic nerve crush. Adult (1 and 5 month-old) male ASMKO and age-matched wild-type (WT) mice underwent sciatic nerve crush lesion. Nerve conduction velocity (NCV), walking track analysis followed by ultra-structural and morphometric analysis of sciatic nerves were performed to evaluate the features of nerve damage. Thermal (Plantar test) and mechanical sensitivity (Dynamic Plantar Aesthesiometer apparatus) were used to measure the severity of neuropathic pain. Moreover, the rotarod test completed the analysis as an indicator of motor impairment. One or two months after the nerve crush motor functional recovery was similar in WT and KO mice and the NCV measures performed in the sciatic nerve demonstrated a moderate and progressive improvement of nerve function. The results of the morphological examination confirmed the expected course of nerve recovery, but also demonstrated defective nerve regeneration, particularly evident in older, but already present in younger ASMKO mice. Behavioral tests suggested that the mutated phenotype in ASMKO might have an effect on the onset and development of mechanical and thermal hyperalgesia after nerve crush in both 1 - month and 5 - months - old groups. In conclusion, these data suggest a possible role for ASM-related microvesicles in nerve regeneration and suggest that targeting the IL-1β production and release may represent a new therapeutic strategy for the treatment of nerve damage and neuropathic pain.

MERCURY LEVELS IN URINE AND HAIR, PERIPHERAL NERVE FUNCTION AND SINGLE NUCLEOTIDE POLYMORPHISMS RELATED TO MERCURY METABOLISM

Background and Aims: Mercury (Hg) is a potent neurotoxicant. We investigated the impact of Hg exposure on peripheral nerve function. We also hypothesized that single nucleotide polymorphisms (SNPs) in genes coding glutathione-related proteins, selenoproteins and metallothioneins may modify the relationship of Hg exposure with changes in peripheral nerve function. Methods: Dental professionals (n=515) were recruited in 2009 and 2010. Samples and measurements included: sensory nerve conduction measurements (onset latency, peak latency and amplitude) of the median, ulnar and sural nerves; buccal swabs for DNA; hair; and urine. Results: The subjects included 244 dentists (47.4%), 269 non-dentists (52.2%; mostly dental hygienists and dental assistants), and 2 of unknown occupation (0.4%) All participants completed a questionnaire for demographics and factors related to elemental and methyl-Hg exposure. The mean Hg levels in urine (1.06μg/L) and hair (0.51μg/g) were not significantly different from the US general population (0.95 μg/L and 0.47μg/g, respectively) (NHANES 1999-2000, 2003-2004). In multivariate linear regression models adjusting for demographics, there was a consistent, though mostly not statistically significant, relationship of increased hair Hg levels with improved nerve function for all nerves measurements. A similar relationship was found between increased methylmercury exposure via fish consumption (as measured in daily intake of polyunsaturated fatty acid, eicosapentaenoic acid and docosahexaenoic acid) and improved nerve function. No consistent relationship was observed in covariate-adjusted urine Hg models predicting nerve function. Only 3 out of a total of 504 multivariate models that investigated effect modification of SNPs on the relationship of Hg biomarkers with nerve function had stable and statistically significant interaction terms. Conclusions: Overall, there might be a beneficial effect of fish consumption on peripheral nerve function. There was little evidence of effect modification of the studied SNPs on the relationship of mercury exposure and biomarkers, respectively with peripheral nerve function given the possibility of false positives.

Effects of Chaihujia-Longgumuli decoction on serum levels of brain-derived neurotrophic factor in patients with post-stroke depression

Objective To investigate the effects of Chaihujia-Longgumuli decoction on brain-derived neurotrophic factor (BDNF) levels and neurological function in patients with post-stroke depression (PSD). Methods Patients meet the diagnostic criteria of the PSD were randomly recurited into a control group and a study group.The control group received conventional therapy. On this basis, the study group was treated with Chaihujia-Longgumuli decoction.The levels of serum BDNF,Hamilton Depression Scale(HAMD-24), neurological impairment rating scale (MESSS), stroke rehabilitation assessment of movement table (STREAM) rate situation and clinical efficacy were compared between the two groups. Results After treated for 3 weeks and 6 weeks,the serum BDNF level in the study group was significantly higher(t=2.52、 2.14. P＜0.05) than the control group, while HAMD score was significantly lower than the control group(t=2.07、3.02,P＜0.01). MESSS score in the study group was also significantly lower than control group (t=2.51、4.50, P＜0.01). After 6 weeks treatment both STREAM score(t=2.01, P＜0.05) and the therapeutic effects (x2=7.93,P＜0.05) showed significant difference between the two groups. Conclusion Chaihujia-Longgumuli decoction can increase serum BDNF levels, reduce depression, improve nerve and motor function and boost clinical efficacy. Key words: Post-stroke depression; Brain-derived neurotrophic factor; Chaihujia-Longgumuli decoction

An Unusual Cause of Paralysis of the Peroneal Nerve

We present 3 cases of a 12-year-old boy, an 8-year-old girl, and a 9-year-old boy with progressive paresis of the peroneal nerve. Peroneal intraneural ganglia are a rare cause of paralysis of the lower limb in children; more often these symptoms occur because of exostosis. Ultrasound imaging in both patients showed a cystic mass near the fibular neck. Magnetic resonance imaging examination revealed that the ganglion is communicating with the proximal tibiofibular joint. Surgical exploration in these patients confirmed a cystic formation involving the common peroneal nerve. The ganglion originates from the articular nerve branch to the proximal tibiofibular joint. Total recovery of nerve function was seen 2 years later for the first patient, whereas the other 2 showed immediate postoperative improvement of peroneal nerve function and complete recovery within 6 to 8 weeks. On the other hand, patients with exostosis showed varying outcomes. In children with symptoms suspicious of nerve compression, fast diagnosis and immediate treatment are necessary to ensure the best possible recovery.

Effects of acutely lowering intraocular pressure on the results of multifocal visual evoked potential testing

There have been many reports in the literature on the apparent reversal of optic nerve cupping in patients with glaucoma after lowering intraocular pressure (IOP) on clinical examination, as well as improvement in visual field testing, and increased nerve fibre layer thickness on optical coherence tomography. No studies to date have looked at improvement of multifocal visually evoked potentials (mfVEP) after lowering IOP. This was a prospective study of twenty consecutive patients with elevated IOP seen in the glaucoma department of Wills Eye Institute. Patients who met the inclusion criteria for this study had a complete eye examination including IOP measurement and underwent testing with mfVEP, Heidelberg Retinal Tomograph (HRT) and static achromatic automated perimetry with SITA-Standard 24-2 program Humphrey visual field (HVF) studies at baseline and 2 h post-IOP reduction. A minimum of 30% IOP reduction was required. IOP changes were then compared with various parameters of mfVEP, HRT and HVF using Spearman rank correlation coefficients. The Spearman rank correlation values between change in IOP versus various parameters were calculated: Accumap severity index (ASI), 0.37 (p = 0.14); Accumap superior hemifield, 0.049 (p = 0.85); Accumap inferior hemifield, 0.030 (p = 0.91); HVF mean deviation, 0.081 (p = 0.76); HRT rim area, 0.17 (p = 0.51); HRT cup area, -0.006 (p = 0.98). Weak positive but insignificant correlations were seen for all parameters except cup area. This pilot study failed to confirm statistically significant correlations between IOP reduction and changes in Accumap, HVF and HRT measures, although positive correlations were seen for most measures.

Quality of Life and Objective Measures of Diabetic Neuropathy in a Prospective Placebo-Controlled Trial of Ruboxistaurin and Topiramate

The Norfolk Quality of Life Questionnaire-Diabetic Neuropathy (Norfolk QOL-DN) is a validated comprehensive questionnaire designed to capture the entire spectrum of DN related to large fiber, small fiber, and autonomic neuropathy not captured in existing instruments. We aimed to determine if the Norfolk QOL-DN could be used to capture changes in QOL that correlate with nerve fiber-specific objective measures in a placebo-controlled trial of two agents that affect different nerve fibers. Sixty patients with DN were allocated to treatment on ruboxistaurin (RBX) (n = 18), topiramate (TPX) (n = 18), or placebo (n = 18). QOL-DN was administered and objective measures of nerve function were performed at entry and end of the study period. Total QOL scores improved significantly in the active treatment groups (RBX -9.56 ± 4.13; TPX -12.22 ± 2.76) but not in placebo (-5.56 ± 3.49). There were differences in nerve function improvement between treatments. Neurological symptom scores (NSS) improved with TPX from 5.5 (2.3) to 4.3 (0.65) (p = .007), sensory scores improved with TPX from 15.5 (1.79) to 8.3 (1.19) (p < .001), motor scores did not change, and sensory and motor impairment scores improved with TPX from 18.8 (2.15) to 12.1 (1.71) (p = .003). Total neuropathy scores (TNS) improved with TPX from 24.35 (2.61) to 16.35 (2.02) (p = .001). Neuropathy total symptom score-6 (NTSS-6) changes were significant for both treatments: RBX 4.38 (0.75) to 1.49 (0.38) (p < .001) and TPX 7.57 (1.3) to 4.26 (0.95) (p = .036). Changes in QOL-DN large fiber subscores correlated (Spearman's rank) significantly with changes in NTSS-6 (r = 0.55; p < .0001), NSS (r = 0.31; p < .04), neuropathy impairment score (NIS) (r = 0.35; p < .02), and TNS (r = 0.48; p < .0006). Changes in QOL-DN small fiber subscores correlated significantly with changes in NTSS-6 total scores (r = 0.40; p < .005) and intraepidermal nerve fiber density (IENFD) (r = -0.29; p < .05). Ruboxistaurin produced significant improvement in large fiber measures while TPX produced significant changes in small fiber measures. The Norfolk QOL-DN tool differentiated between these changes captured in the fiber-specific domains. Correlations were found between objective measures of neuropathy and total QOL, but those with nerve fiber domain scores were modest and reinforce the need to quantify QOL as an endpoint in neuropathy independent of other measures.

Short‐term metabolic change is associated with improvement in measures of diabetic neuropathy: a 1‐year placebo cohort analysis

Randomized clinical trials have frequently shown improvement in diabetic sensorimotor polyneuropathy in placebo-treated participants, counter to the prevailing concept that it deteriorates with time. We aimed to determine the variables associated with this paradoxical nerve function improvement. Participants with diabetic sensorimotor polyneuropathy randomized to placebo in a multi-centre, double-blind study were evaluated for the primary outcome of 1-year change in the summed sensory nerve conduction velocity of the bilateral sural and non-dominant median nerves. Association with clinical and biochemical variables measured at 13 time points were examined. The 134 participants had mild to moderate diabetic sensorimotor polyneuropathy of 4.6 years' duration and mean 1-year improvement of 2.0 ± 8.0 m/s. Primary outcome measures were available for 122 participants (91%). In multivariate analyses, the change in HbA(1c) and serum triglycerides from baseline to 2 months demonstrated the strongest association, even independent of baseline and end-of-study levels. According to quintiles of change, we determined thresholds: participants with salutary improvement in HbA(1c) (exceeding a drop of -0.8%) or whose triglycerides did not increase (by 0.32 mmol/l or more) experienced significant improvement (2.9 m/s), while those with salutary levels of both these variables had an exaggerated improvement (5.1 m/s). In comparison, those with non-salutary changes in both variables experienced a loss of -4.9 m/s (ANOVA P=0.0014). In mild to moderate diabetic sensorimotor polyneuropathy, short-term improvements in glycaemic control and serum triglyceride levels have an independent, additive and durable effect on restoration of nerve function.

The surgical treatment of severe adolescent idiopathic cervical kyphosis

To summarize the clinical characteristics of severe adolescent idiopathic cervical kyphosis and the operation method. A retrospective study was performed in 12 adolescent patients with severe cervical kyphosis treated from July 2003 to January 2007. Preoperative the Cobb angle of kyphosis range from 55 degrees to 73 degrees (average 61 degrees ). According to the angles between the posterior vertebral body tangents at every involved level on lateral cervical radiograph in extension, the osteotomy angles and range of lamina and facet were decided. The anterior release and posterior osteotomy were performed firstly. Then skull traction was maintained in order to correct the deformity as long as possible, fusion and internal fixation was completed after 7-10 days. The cervical coronal and sagittal planes X-rays and the MR were hold after operation 3 days, 3 months, 6 months, 1 year and 2 years. At the same time the treatment result, bone fusion and the instrumentation were followed up, and the symptoms were compared between pre-operation and post-operation. The defect appearance of the patients was improved significantly, with the total disappearance of neck pain and improvement of nerve function. Post-operational cervical spine MR showed that the physiological curve of cervical spine was restored, cerebral spinal fluid line was clear in the kyphosis area and no spinal cord compression was found. X-ray imaging of post-operation 3 d showed that Cobb angle ranged from -12.3 degrees to 11.2 degrees with an average of -2.0 degrees . Beside one patient's AISA score was D, other patient's AISA score was E. The severe adolescent idiopathic cervical kyphosis has its own clinical manifestation. It is an ideal treatment to completely assess the deformity, have staging operation and skull traction between two operations.

Unilateral facial nerve paralysis following an infected lower third molar

The authors report the case of a 35-year-old Arab man who presented with unilateral facial nerve palsy in the presence of an infected lower third molar. The paralysis occurred within hours of the development of a left-sided facial swelling. Surgical removal of the tooth and drainage of the abscess produced significant improvement in facial nerve function, and total resolution occurred prior to clinical follow-up 10 days later. The authors discuss the aetiology of this hemifacial paralysis and its significance as a clinical sign of third molar odontogenic infection.

Facial reanimation with end-to-end hypoglossofacial anastomosis: 20 years’ experience

This study aimed to evaluate retrospectively the results of experience with end-to-end anastomosis of cranial nerves VII and XII, performed due to transection of the facial nerve during acoustic neuroma removal. We assessed the facial reanimation results of 33 patients whose facial nerves had been transected during acoustic neuroma excision via a retrosigmoid approach, between 1985 and 2006, and who underwent end-to-end hypoglossofacial anastomosis. We compared the facial nerve functions of patients receiving short term (two to three years) and long term (more than three years) follow up, and we assessed any complications of the anastomosis. A House-Brackmann grade III facial function was achieved in 46.2 and 86.4 per cent of the patients in the short and long term, respectively. House-Brackmann grade IV facial function was achieved in 53.8 and 13.6 per cent of the patients in the short and long term, respectively. There was a statistically significant difference between the facial recovery results, comparing the short and long term follow-up periods (p = 0.03). Disarticulation was the most common complication, seen in 19 (57.6 per cent) patients; numbness of the tongue was the next commonest (10 (30.3 per cent) patients). None of the patients developed dysphagia. Despite such morbidities as disarticulation and tongue numbness, end-to-end hypoglossofacial anastomosis is still an effective procedure for the surgical rehabilitation of static and dynamic facial nerve functions. Significant improvement in facial nerve function can occur more than three years post-operatively.

Effects of Naomaitong combined with mobilization of bone marrow mesenchymal stem cells on neuron apoptosis and expressions of Fas, FasL and caspase-3 proteins in rats with cerebral ischemia

To observe the effects of Naomaitong, a compound traditional Chinese herbal medicine, combined with mobilization of bone marrow mesenchymal stem cells (BMSCs) on neuron apoptosis in rats with cerebral ischemia, and to explore the possible mechanism by detecting the expressions of Fas, FasL and caspase-3 proteins. Two hundred and two SD rats were divided into sham-operated group, untreated group, recombinant granulocyte colony-stimulating factor (rG-CSF) group, Naomaitong group and Naomaitong plus rG-CSF group (combination group). Focal cerebral ischemia was induced by intraluminal middle cerebral artery occlusion using a nylon thread with some modification. Rats in the rG-CSF group and the untreated group were administered with rG-CSF 10 microg/(kg x d) by subcutaneous injection 3 d before and 2 d after the operation respectively, once a day, and rats in the Naomaitong group and the combination group were intragastrically administered Naomaitong before and after the operation until sacrificed. Two, three, seven and fourteen days after operation, count of CD34-positive cells in peripheral blood and CD34 expression in brain tissue were determined. General neural function score (GNFS) was evaluated. Neuron apoptosis, expressions of Fas, FasL and caspase-3 in rat's brain were all measured. Count of CD34-positive cells in peripheral blood and CD34 expression in brain tissue were high in the untreated group, and reached the peak at 3 d and 7 d respectively. CD34 expression in brain tissue was increased in each treated group, especially in the combination group. GNFS was increased at 3 d and 7 d in the untreated group, 7 d and 14 d in the rG-CSF group and the combination group. Expressions of Fas, FasL and caspase-3 were increased 2, 3 and 7 d after operation, while expression of FasL at 2 d in the rG-CSF group, expressions of Fas, FasL and caspase-3 in the combination group were decreased. Expressions of Fas, FasL and caspase-3 at 7 d and 14 d in the combination group were lower than those in the rG-CSF group. Meanwhile, expressions of Fas, FasL and caspase-3 were decreased in each group at 14 d as compared with those at 3 d. There exists interaction between Naomaitong and BMSC mobilization in the effect of improving nerve function and inhibiting neuron apoptosis in rats after cerebral ischemia. It is implied that Naomaitong combined with BMSC mobilization down-regulates the expressions of Fas and FasL in early phase and then inhibits the apoptosis cascade reaction caused by caspase-3, which causes further inhibition of Fas and FasL expression after cerebral ischemia.

Decompressive surgery for treating nerve damage in leprosy. A Cochrane review

Decompressive surgery is used for treating nerve damage in leprosy. We assessed the effectiveness of decompressive surgery for patients with nerve damage due to leprosy. A broad search strategy was performed to find eligible studies, selecting randomised controlled trials (RCTs) comparing decompressive surgery alone or plus corticosteroids with corticosteroids alone, placebo or no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised. We included two randomised controlled trials involving 88 people. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than 6 months duration. After 2 years follow-up there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompression surgery were not adequately described. Evidence from randomised controlled trials does not show a significant added benefit of surgery over steroid treatment alone. Well-designed randomised controlled trials are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.

Prolonged Mechanical Noise Restores Tactile Sense in Diabetic Neuropathic Patients

Acute application of stochastic resonance (SR), defined as a subsensory level of mechanical noise presented directly to sensory neurons, improves the vibration and tactile perception in diabetic patients with mild to moderate neuropathy. This study examined the effect of 1 hour of continuous SR stimulation on sensory nerve function. Twenty diabetic patients were studied. The effect of stimulation was measured at 2 time points, at the beginning and after 60 minutes of continual SR stimulation. This effect was measured using the vibration perception threshold (VPT) at the big toe under 2 conditions: a null (no SR) condition and active SR, defined as mechanical noise below the subject's own threshold of perception. The measurements under null and active conditions were done randomly and the examiner was blinded regarding the type of condition. Immediately after SR application, the VPT with SR in null condition was similar to baseline (32.2 +/- 13.1, P = nonsignificant) but was significantly lower during active SR (27.4 +/- 11.9) compared with both baseline (P = .018) and off position (P = .045). The 60 minutes VPT with active SR (28.7 +/- 11.1) reached significance comparing the baseline when one outlier was removed from the analysis (P = .031). It may be concluded that SR for a continuous 60-minute period can sustain the VPT improvement in diabetic patients with moderate to severe neuropathy. These results permit the conclusion that there is no short-term adaptation to the stimulation signal. Long-term application of this technique, perhaps in the form of a continually vibrating shoe insert, or insole, may result in sustained improvement of nerve function.